BACKGROUND: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers\' workflow.
OBJECTIVE: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication.
METHODS: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians.
RESULTS: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal.
CONCLUSIONS: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care.

Musculoskeletal disorders (MSDs) are prevalent under poor working situations. Where it is not possible to remove the root cause of MSDs, passive exoskeletons could be a solution. In this randomised cross-over field study we investigated the effect of a passive arm-support exoskeleton. Ten participants, recruited from a Dutch gas company, were measured with and without exoskeleton assessing muscle activity, heart rate (HR), arm elevation, and reported about their experiences. Participants spent more time in high arm elevation levels with the exoskeleton than without. Muscle activity was lower in the trapezius (Beta: -1.8 [-3.1; -0.4]) and deltoid (Beta: -1.4 [-2.3; -0.6]) muscles, but not the biceps muscle, during the measurements with exoskeleton than without, suggesting effectiveness of the exoskeleton. HR and discomfort did not statistically significantly differ between the two conditions. Participants would recommend an exoskeleton to their colleagues, but mainly for repetitive work. Their opinions about the usefulness during work varied.
This randomised cross-over field study examined the effect of a passive arm-supporting exoskeleton during field tasks by participants working at a Dutch gas company. It turned out that the exoskeleton had a positive effect on reducing muscle activity. Although most participants would recommend an exoskeleton to their colleagues, some participants reported discomfort while using the exoskeleton and less than half of the participants would use the exoskeleton more often themselves.

The indoor thermal environment has a direct impact on human thermal comfort and health. In order to assess the status of the indoor thermal environment of typical sports buildings in hot summer and cold winter climate zones in China, 14 badminton halls in 10 cities in Hubei Province (including 5 venues in Wuhan) in this climate zone are chosen as research objects for field testing of indoor thermal environment parameters in 4 seasons. All the tested stadiums are naturally ventilated in non-event conditions. The results reveal that the average indoor temperature of badminton halls in summer is excessively high (i.e., 31.89 °C), which is higher than the regulation specified in JGJ31-2003 or GB-T18883-2022 on the reference interval of the indoor air temperature of venues in summer, (i.e., (26-28 °C) or (22-28 °C), respectively). The average indoor temperature of badminton halls in winter is too low (i.e., 12.95 °C), and it is lower than the recommendations of JGJ31-2003 or GB-T18883-2022 on the reference interval of the indoor air temperature of venues in winter (i.e., (16-18 °C) or (16-24 °C), respectively), relative humidity and air velocity are in the thermal comfort interval for all seasons, and the indoor thermal environment factors of badminton courts in spring and autumn meet the comfort requirements. The indoor and outdoor temperatures and the relative humidity of badminton courts are highly correlated. The indoor temperature and relative humidity vary according to changes in those factors outdoors, whereas the air velocity is not affected by outdoor changes. In the hot summer and cold winter climate zones, some discrepancies in the indoor temperature variation patterns of badminton halls at various altitudes are detectable. The results of this study aim to provide a solid basis for the development of indoor thermal-comfort standards for sports stadiums in China.

The Child Pornography Offender Risk Tool (CPORT) is a seven-item actuarial risk assessment tool that is used to estimate the potential for sexual recidivism among men convicted of child sexual exploitation material (CSEM; legally referred to as child pornography) offenses. In the current study, we examined the convergent and divergent validity of the CPORT in a clinical sample of 224 men on federal probation in the United States who were convicted of at least one type of CSEM offense. CPORT scores were significantly, moderately, and positively correlated with scores on another sexual offense risk assessment tool, the Risk Matrix 2000 (RM2000/S), showing broad evidence of convergent validity, and was nonsignificantly associated with scores on a general offense risk assessment tool, the Level of Service/Case Management Inventory (LS/CMI), showing evidence of divergent validity. There was also evidence of specific convergent validity; for example, the CPORT item reflecting prior criminal history was most strongly related to the Criminal History domain of the LS/CMI, and CPORT items reflecting sexual interest in children were significantly and strongly associated with self-reported sexual interest in children from the clinical evaluation. We also examined the impact of including clinical information in the scoring of the CPORT. Including this information reduced the amount of missing scores, but the impact on predictive accuracy is not yet known. Implications for clinical practices are discussed.

The use of voice assistants (e.g., Amazon Alexa, Google Home) is being widely advocated as part of supporting people living with dementia at home. The development of this technology is largely driven by industry, and there is little research to determine how family carers and professionals use voice assistants with people with dementia. This paper presents the findings from further analysis of data from two studies: Study 1-a qualitative study that aimed to explore the views and expectations of family carers and professionals who use voice assistants to support people with a cognitive impairment at home, and Study 2-a qualitative enquiry aiming to identify the views and barriers on using voice assistants by family carers of people with dementia and professionals, together with a pilot case study evaluating a prototype that addresses barriers identified during the enquiry, entitled IntraVox. Based on processing of smart home sensor data, IntraVox uses a personalised human voice to send prompts and reminders to end-users to conduct daily life activities and to activate smart home processes using voice assistants. The results of the qualitative studies indicate that family carers and professionals use voice assistants in their caring role for home automation, skills maintenance and development, prompts and reminders, behaviour and environment monitoring, and for leisure and social interaction support. The findings also show that family carers and professionals have specific challenges that need to be overcome for them to realise the benefits that may be gained through the use of voice assistants within technology enabled care. The pilot case study also provided a useful demonstration that interoperability can be achieved to enable exchanges between IntraVox and voice assistants, with the aim of providing customised and personalised technological solutions that address some of the barriers that people with dementia and their carers face in the use of this technology.

Avian pathogenic Escherichia coli (APEC) cause avian colibacillosis and accurately distinguishing infectious isolates is critical for controlling its transmission. Multilocus sequence typing (MLST) is an accurate and efficient strain identification method for epidemiological surveillance. This research aimed to develop a fast and high-throughput workflow that simultaneously sequences the Achtman typing scheme\'s 7 housekeeping genes of multiple E. coli isolates using the Oxford Nanopore Technologies (ONT) platform for large-scale APEC study. E. coli strains were isolated from poultry farms, the housekeeping genes were amplified, and amplicons were sequenced on an R9.4 MinION flow cell using the Nanopore GridION sequencer (ONT, Oxford, UK) following the initial workflow (ONT-MLST). Moreover, the workflow was revised by introducing large-scale DNA extraction and multiplex PCR into the ONT-MLST workflow and applied to 242 new isolates, 18 isolates from the previous workflow, and 5 ATCC reference strains using Flongle flow cell on the Nanopore MinION Mk1C sequencer (ONT, Oxford, UK). Finally, the sequence type (ST) results of the 308 isolates collected from infected chickens and poultry farm environments were reported and analyzed. Data indicated that E. coli belonging to ST159, ST8578, and ST355 have the potential to infect multiple organs in broiler. In addition, zoonotic STs, ST69, ST10, ST38, and ST131, were detected from poultry farms. With the advantages of the high throughput of ONT, this study provides a rapid workflow for large-scale E. coli typing and identified frequently isolated sequence types related to APEC infection in poultry.

BACKGROUND: It is doubtful that any of the treatments proposed for feline leukaemia virus (FeLV) infection are effective, despite the entity being described 60 years ago.
METHODS: Eighteen pet cats with progressive FeLV infections were recruited in Australia. One or more antiviral drugs were trialled in 16 cats, while two FeLV-infected cats were not handleable and served as untreated controls. Six cats were administered RetroMAD1™ only (0.5 mg/kg orally twice daily), a commercially available recombinant chimeric protein with proposed antiretroviral activity. Three cats were administered the integrase inhibitor raltegravir only (10-15 mg/kg orally twice daily), a drug used as a component of highly effective antiretroviral therapy for human immunodeficiency virus (HIV-1) infection. Three cats were administered RetroMAD1™ and raltegravir concurrently, and four cats were administered raltegravir and the reverse transcriptase inhibitor zidovudine (AZT, 5 mg/kg orally twice daily) concurrently. FeLV RNA and p27 antigen loads were measured at two timepoints (T1-2 months and T3-5 months) during therapy and compared to baseline (pretreatment) levels, to assess the response to therapy using linear modelling. The median survival time (MST) of the cats from commencement of FeLV treatment to death was also determined and compared between treatments.
RESULTS: The MST for the 16 FeLV-positive cats which received antiviral therapy was 634 days, while the MST from FeLV diagnosis to death for the two untreated control cats was 780 days. In cats treated with RetroMAD1™, FeLV viral load decreased from T0 to T1-2 months (median viral load reduced from 1339 × 106 to 705 × 106 copies/mL plasma; P = 0.012), but MST was reduced compared to cats not given RetroMAD1™ (426 days vs 1006 days; P = 0.049). Cats treated with raltegravir and AZT had no significant changes in FeLV viral load over time, but p27 antigen load was decreased from T0 to T3-5 months in cats treated with raltegravir (median p27 antigen level reduced from 50.2% to 42.7%; P = 0.005). All other results were not significantly affected by the treatment provided. Importantly, statistically significant and substantial associations were found between age at FeLV diagnosis and survival time (P = 0.046, R2 = 18.6) and between FeLV viral load at T0 and survival time (P = 0.004, R2 = 44.4). Younger cats, and cats with higher levels of pretreatment FeLV RNA, had reduced survival times. Cats treated with RetroMAD1™ were typically younger (median age 2.0 vs 8.0 years), likely explaining the observed reduction in MST. A significant association was found between FeLV viral load and p27 antigen load at T0 (P = 0.015, R2 = 32.9).
CONCLUSIONS: Results from this small case series do not provide convincing support for the use of RetroMAD1™, raltegravir or AZT, alone or in combination, for the treatment of cats progressively infected with FeLV. The changes observed were biologically insignificant. Age and FeLV viral load at diagnosis are useful prognostic markers, and p27 antigen concentration can be used to predict viral load. Larger field trials should be performed examining antiretroviral therapy in FeLV-positive cats with progressive infections, preferably using three or more drugs from at least two classes, as is standard with human antiretroviral therapy. Future studies would be easier in countries with a higher prevalence of FeLV infections than Australia.

Phytoremediation is a cost-effective and eco-friendly alternative method for arsenic (As) contaminated water treatment. This study conducted a two-year year-round field study (cycle1 and cycle2) in a temperate area (Sendai, Japan) using small As-hyperaccumulator Pteris vittata seedlings to reduce pre-cultivation time and associated costs. The number of seedlings was changed from 256 in the cycle1 period to 165 in the cycle2 period to evaluate the As removal efficiency of P. vittata for As-contaminated water in field conditions with different plant densities. Before the winter season, with continuously increasing fronds, rhizomes, and roots growth, this reduction did not affect the plant\'s As removal efficiency for As-contaminated water to decrease the As concentration from 30 μg/L to the environmental quality standard for As in water, set at 10 μg/L in Japan. During the winter season, we found that cold weather caused P. vittata to wither and release the accumulated As into water without a greenhouse (cycle1). In the meantime, the bioaccumulation factor (BAF) and the translocation factor (TF) values for fronds of P. vittata decreased (BAF for fronds: from 66,089 to 8,460; TF for fronds: from 13.4 to 3.4). On the other hand, with greenhouse protection (cycle2), P. vittata did not severely wither and kept accumulating As. Moreover, BAF and TF values for fronds of P. vittata increased (BAF for fronds: from 24,372 to 36,740; TF for fronds: from 5.2 to 17.2). Maintaining the air temperature inside the greenhouse, particularly around the rhizomes, above 0 °C may be the reason why P. vittata remained alive and functional during the cold winter. These results indicate that a single-layer polyethylene greenhouse was sufficient for the tropical-subtropical As-hyperaccumulator fern P. vittata to survive the cold winter and snow in the temperate area, enabling year-round phytoremediation treatment of As-contaminated water in the open field.

Floating photovoltaics (FPV) are an emerging renewable energy technology. Although they have received extensive attention in recent years, understanding of their environmental impacts is limited. To address this knowledge gap, we measured water temperature and meteorological parameters for six months under FPV arrays and in the control open water site and constructed a numerical model reflecting the water energy balance. Our results showed that FPV arrays caused diurnal variation in water temperature and microclimate. Specifically, we found that FPV had a cooling effect on their host waterbody during the daytime and a heat preservation effect at night, reducing diurnal variation. The diel oscillation of water temperature below FPV panels lagged behind that of open waters by approximately two hours. The microclimate conditions below FPV panels also changed, with wind speed decreasing by 70%, air temperature increasing during the daytime (averaging +2.01°C) and decreasing at night (averaging -1.27°C). Notably, the trend in relative humidity was the opposite (-3.72%, +14.43%). Correlation analysis showed that the degree of water temperature affected by FPV was related to local climate conditions. The numerical model could capture the energy balance characteristics with a correlation coefficient of 0.80 between the simulated and actual data. The shortwave radiation and latent heat flux below FPV panels was significantly reduced, and the longwave radiation emitted by FPV panels became one of the heat sources during the daytime. The combined variations of these factors dominated the water energy balance below FPV panels. The measured data and simulation results serve as a foundation for evaluating the impact of FPV systems on water temperature, energy budget, and aquatic environment, which would also provide a more comprehensive understanding of FPV systems.

Urban wastewater treatment plants (WWTP) represent key point-source discharges of microplastics (MP) into the environment, however, little is known about the microbial carrying capacity of plastics travelling through them. The purpose of this study was to quantify the number of cells that become associated with MP at different locations within a WWTP, and to assess differences in microbiome communities. We conducted a field experiment incubating low density polyethylene (LDPE) MP beads in WWTP influent and effluent, as well as tracking free floating beads during passage in wastewater from a large municipal hospital to an urban WWTP, where they were subsequently recovered. Using two cell counting methods - automated flow cytometric true absolute cell counts and indirect cell quantification via protein content based on a model E. coli cell - we quantified cell attachment to LDPE beads. LDPE associated counts ranged from 350 × 103 cells cm-2 after incubation in wastewater effluent, and 990 × 103 cells cm-2 after incubation in wastewater influent. 16S rRNA gene amplicon sequencing was used to determine the bacterial community structure of the plastic-associated microbiomes. Our results showed that distinct bacterial communities developed on the LDPE MP following exposure to each wastewater type. Influent (untreated) wastewater LDPE-associated microbiomes were dominated by Bacillota whereas the microbes that attached in wastewater effluent (tertiary treated) were dominated by Pseudomonadota. In conclusion, this study provides clear evidence that microplastics migrating through the sewer network and WWTP rapidly accumulate microbiomes with unique microbial community structures varying from sewage influent to effluent. These findings demonstrate the differential microbiological risk from MP associated with routine wastewater discharges to those released from intermittent combined sewer overflows (CSOs) during storm events.