Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia:Review and Content Analysis

BackgroundThe COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. ObjectiveThis study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. MethodsWe systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. ResultsOf the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. ConclusionsIn East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination

The benefits, challenges, and best practice for patient and public involvement in evidence synthesis:A systematic review and thematic synthesis

Abstract Introduction Despite the growing evidence on patient and public involvement (PPI) in health research, little emphasis has been placed on understanding its quality and appropriateness to evidence synthesis (ES) and systematic reviews (SR). This study aimed to synthesise qualitative evidence on the benefits, challenges, and best practices for PPI in ES/SR projects from the perspectives of patients/public and researchers. Methods We searched Ovid MEDLINE, Ovid EMBASE, Cochrane Library and CINAHL Plus. We also searched relevant grey literature and conducted hand‐searching to identify qualitative studies which report the benefits and challenges of PPI in individual ES/SR projects. Studies were independently screened by two reviewers for inclusion and appraised using the Joanna Briggs Institute's Qualitative Tool. Included studies were synthesised narratively using thematic synthesis. Results The literature search retrieved 9923 articles, of which eight studies were included in this review. Five themes on benefits emerged: two from patients'/public's perspective—gaining knowledge, and empowerment; and three from researchers' perspective—enhancing relevance, improving quality, and enhancing dissemination of findings. Six themes on challenges were identified: three from patients'/public's perspective—poor communication, time and low self‐esteem; and three from researchers' perspective—balancing inputs and managing relations, time, and resources and training. Concerning recommendations for best practice, four themes emerged: provision of sufficient time and resources, developing a clear recruitment plan, provision of sufficient training and support, and the need to foster positive working relationships. Conclusion Highlighting the benefits and challenges of PPI in ES/SR projects from different stakeholder perspectives is essential to understand the process and contextual factors and facilitate meaningful PPI in ES/SR projects. Future research should focus on the utilisation of existing frameworks (e.g., Authors and Consumers Together Impacting on eVidencE [ACTIVE] framework) by researchers to help describe and/or report the best approaches and methods for involving patients/public in ES/SRs projects. Patient and Public Contribution This review received great contributions from a recognised PPI partner, the Chair of the Cochrane Consumer Network Executive, to inform the final stage of the review (i.e., interpretation, publication and dissemination of findings). The PPI partner has been included as an author of this review

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Background: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes. Objective: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity. Methods: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses. Results: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06–1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90–1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses. Conclusions: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes

Syndecan transmembrane domain specifically regulates downstream signaling events of the transmembrane receptor cytoplasmic domain

Despite the known importance of the transmembrane domain (TMD) of syndecan receptors in cell adhesion and signaling, the molecular basis for syndecan TMD function remains un-known. Using in vivo invertebrate models, we found that mammalian syndecan-2 rescued both the guidance defects in C. elegans hermaphrodite-specific neurons and the impaired development of the midline axons of Drosophila caused by the loss of endogenous syndecan. These compensatory ef-fects, however, were reduced significantly when syndecan-2 dimerization-defective TMD mutants were introduced. To further investigate the role of the TMD, we generated a chimera, 2eTPC, com-prising the TMD of syndecan-2 linked to the cytoplasmic domain of platelet-derived growth factor receptor (PDGFR). This chimera exhibited SDS-resistant dimer formation that was lost in the corre-sponding dimerization-defective syndecan-2 TMD mutant, 2eT(GL)PC. Moreover, 2eTPC specifically enhanced Tyr 579 and Tyr 857 phosphorylation in the PDGFR cytoplasmic domain, while the TMD mutant failed to support such phosphorylation. Finally, 2eTPC, but not 2eT(GL)PC, induced phosphorylation of Src and PI3 kinase (known downstream effectors of Tyr 579 phosphorylation) and promoted Src-mediated migration of NIH3T3 cells. Taken together, these data suggest that the TMD of a syndecan-2 specifically regulates receptor cytoplasmic domain function and subsequent downstream signaling events controlling cell behavior. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.1

Efficacy of oral corticosteroids for preschool wheeze

INTRODUCTION: Acute preschool wheeze is one of the most common respiratory conditions in children aged 1 to 6 years. Due to its high prevalence, it consumes substantial healthcare resources and creates economic burdens. Although oral corticosteroids (OCS) have been widely used to treat acute wheezing episodes in clinical practice, evidence has been contentious regarding the efficacy of OCS for preschool wheeze. This thesis aims to assess the OCS treatment in treating acute preschool wheeze by incorporating perspectives of health professionals (HPs) and patients into an individual participant data (IPD) analysis. METHODS: This PhD project comprises four complementary phases. In Phase One, I conducted a global systematic review and meta-analysis of the literature published between 1994 and 2020 in eight databases. Summary estimates were obtained using a random-effects model, employing the Hartung-Knapp-Sidik-Jonkman (HKSJ) approach. In Phase Two, I invited two groups (1) HPs, including lead authors of OCS preschool wheeze trials, and (2) parents of children who had experience with OCS for acute wheeze in children aged 1-6 years. In the first stage, each group was asked to rank outcome measures based on their priority, and in the second stage, they were invited to a group meeting based on a nominal group technique to identify a consensus primary outcome measure. In Phase Three, a meta-analysis was conducted using IPD from seven trials (no. of children=2172) for children aged 12-71 months (n=1823). The primary outcome was the change in wheeze severity score (WSS), and secondary outcomes were length of hospital stay (LOS), revisit to general practice (GP)/emergency department (ED) or hospital, and further use of asthma medications. I performed a two-stage meta-analysis for overall analyses and adopted a one-stage approach when very few cases were available. Subgroup analyses by risk factors were conducted to examine effect modification and treatment-covariate interaction. In Phase Four, I undertook a Desirability Of Outcome Ranking (DOOR) analysis to assess overall clinical outcomes using data for change in WSS, repeat healthcare service utilisation (i.e. revisit to GP/ED and/or rehospitalisation), and adverse events (AEs). Ordinal DOOR outcomes were constructed by combining these single outcomes. Ranks 1 to 8 were assigned to the ordinal DOOR outcomes of individual patients in order of desirability, in which higher ranks were assigned to those with better DOOR outcomes. I then calculated the probability of those receiving OCS having a better DOOR outcome compared to those receiving a placebo. RESULTS: In Phase One, of 11 studies satisfying the eligibility criteria, ten were included in the meta-analysis, and one study was excluded because the majority of the children were younger than 12 months. According to the meta-analyses, there was no sufficient evidence showing that OCS reduced LOS, risks of revisit to GP/ED or rehospitalisation, or additional need for subsequent steroids or doses of bronchodilator (or short-acting beta-2-agonist, SABA). However, analyses were substantially restricted due to heterogeneous eligibility criteria and different summary estimates between the studies. In the first stage of Phase Two, LOS was the most preferred outcome measure for the HPs (n = 255), whereas the change in WSS was the priority for parents (n = 10). In the second stage, seven HPs and nine parents participated in the consensus group meeting and agreed that change in WSS should be the top priority of the treatment. This result was used as a primary outcome for the IPD meta-analysis. In Phase Three, the IPD meta-analysis showed that compared to the placebo group, the change in WSS at 4 hours in the OCS group showed a mean difference (MD) of -0.31 (95% CI = -0.38 to -0.24, I2 = 0.0%) in the two studies where data were available after adjusting for age (months), allergies and parental allergies. For the change in WSS at 12 hours, the MD in three studies was -0.02 (95% CI = -0.17 to 0.14, I2 = 0.0%). In five studies, OCS treatment was associated with an MD in LOS of -3.18 hours (95% CI = -4.43 to -1.93, I2= 0.0%). For revisit to GP/ED and rehospitalisation, the pooled ORs in seven studies were respectively 1.11 (95% CI =0. 86 to 1.43, I2= 0.0%) and 0.94 (95% CI = 0.38 to 2.32, I2= 20.3%). According to subgroup analyses, OCS had a preferential benefit for children with moderate-to-severe wheeze, especially those with previous wheezing/asthma, history of allergies or parental allergy/asthma. In Phase Four, the DOOR analysis demonstrated the possibility of understanding the global patient experience using a composite of efficacy and safety data of OCS for preschool wheeze. However, the DOOR did not support the benefits of OCS treatment for preschool wheeze when considering the change in WSS, repeat healthcare service utilisation and AEs simultaneously. Although this study successfully constructed the DOOR outcome representing the total patient experience with the OCS course, there remain limitations in applying DOOR because it relies on the availability of data and the outcome definitions. CONCLUSION: This is the first study exploring a consensus outcome measure, performing IPD meta-analyses and applying DOOR methodology to assess the efficacy of OCS for preschool wheeze. It succeeded in incorporating stakeholders' perspectives in evidence synthesis using IPD from seven clinical trials. It provided more reliable evidence of OCS effects and found that OCS is beneficial for short-term outcomes (e.g., reduction in LOS) rather than longer-term outcomes. Thus, this thesis provides important insights into OCS use in the ED setting concerning risk factors. At the same time, it points out what needs to be improved in parent/patient involvement, data recording, and sharing to yield high-quality evidence

Parietal and Medial Temporal Lobe Interactions in Working Memory Goal-Directed Behavior

https://doi.org/10.1016/j.cortex.2022.02.00