Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study

Background: Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective: We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods: SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results: Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions: Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

Operation of Power-to-X-Related Processes Based on Advanced Data-Driven Methods: A Comprehensive Review

This study is a systematic analysis of selected research articles about power-to-X (P2X)-related processes. The relevance of this resides in the fact that most of the world&rsquo;s energy is produced using fossil fuels, which has led to a huge amount of greenhouse gas emissions that are the source of global warming. One of the most supported actions against such a phenomenon is to employ renewable energy resources, some of which are intermittent, such as solar and wind. This brings the need for large-scale, longer-period energy storage solutions. In this sense, the P2X process chain could play this role: renewable energy can be converted into storable hydrogen, chemicals, and fuels via electrolysis and subsequent synthesis with CO2. The main contribution of this study is to provide a systematic articulation of advanced data-driven methods and latest technologies such as the Internet of Things (IoT), big data analytics, and machine learning for the efficient operation of P2X-related processes. We summarize our findings into different working architectures and illustrate them with a numerical result that employs a machine learning model using historic data to define operational parameters for a given P2X process

Synergized Toxicity of Promising Plant Extracts and Synthetic Chemicals against Fall Armyworm <i>Spodoptera frugiperda</i> (JE Smith) (Lepidoptera: Noctuidae) in Pakistan

Fall armyworm, Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae), is a destructive pest of a wide array of agricultural and horticultural crops worldwide. This in vitro research assessed the combined effect of methanolic extracts of indigenous flora of Soone Valley (Khushab, Pakistan) and nine commonly used synthetic insecticides against 3rd instar larvae of S. frugiperda using the leaf-dip bioassay method. Toxicity bioassays with twelve plant extracts revealed that the extracts of Withania somnifera (L.) Dunal, Sophora mollis (Royle) Baker and Rhazya stricta Decne. were the most effective, exhibiting minimum LC50 and LT50 values. Bioassays with synthetic insecticides revealed a significantly higher mortality of S. frugiperda larvae by emamectin benzoate (45%), chlorpyrifos (40%) and chlorantraniliprole (38%). Further bioassays with 10 binary combinations of these most effective botanical and synthetic insecticides showed that seven pesticidal combinations exhibited synergistic toxicity, and three combinations comprising emamectin benzoate exhibited an additive effect on the mortality of S. frugiperda larvae. GC–MS analyses of methanolic extracts of W. somnifera, S. mollis and R. stricta revealed 1,2,4-trimethyl-benzene and 3,5-dimethyl-octane, 1-ethyl-2-methyl-benzene, and 1-monolinoleoylglycerol trimethylsilyl ether, decane, and lupeol as major bioconstituents, respectively. Our results demonstrated that combining botanicals with synthetic insecticides can synergize their toxicity against S. frugiperda larvae, suggesting their potential incorporation into future IPM programs against S. frugiperda and other lepidopterous pests

Key Advances in Pervasive Edge Computing for Industrial Internet of Things in 5G and Beyond

This article surveys emerging technologies related to pervasive edge computing (PEC) for industrial internet-of-things (IIoT) enabled by fifth-generation (5G) and beyond communication networks. PEC encompasses all devices that are capable of performing computational tasks locally, including those at the edge of the core network (edge servers co-located with 5G base stations) and in the radio access network (sensors, actuators, etc.). The main advantages of this paradigm are core network offloading (and benefits therefrom) and low latency for delay-sensitive applications (e.g., automatic control). We have reviewed the state-of-the-art in the PEC paradigm and its applications to the IIoT domain, which have been enabled by the recent developments in 5G technology. We have classified and described three important research areas related to PEC—distributed artificial intelligence methods, energy efficiency, and cyber security. We have also identified the main open challenges that must be solved to have a scalable PEC-based IIoT network that operates efficiently under different conditions. By explaining the applications, challenges, and opportunities, our paper reinforces the perspective that the PEC paradigm is an extremely suitable and important deployment model for industrial communication networks, considering the modern trend toward private industrial 5G networks with local operations and flexible management

Containing Future Epidemics With Trustworthy Federated Systems for Ubiquitous Warning and Response

In this paper, we propose a global digital platform to avoid and combat epidemics by providing relevant real-time information to support selective lockdowns. It leverages the pervasiveness of wireless connectivity while being trustworthy and secure. The proposed system is conceptualized to be decentralized yet federated, based on ubiquitous public systems and active citizen participation. Its foundations lie on the principle of informational self-determination. We argue that only in this way it can become a trustworthy and legitimate public good infrastructure for citizens by balancing the asymmetry of the different hierarchical levels within the federated organization while providing highly effective detection and guiding mitigation measures toward graceful lockdown of the society. To exemplify the proposed system, we choose a remote patient monitoring as use case. This use case is evaluated considering different numbers of endorsed peers on a solution that is based on the integration of distributed ledger technologies and NB-IoT (narrowband IoT). An experimental setup is used to evaluate the performance of this integration, in which the end-to-end latency is slightly increased when a new endorsed element is added. However, the system reliability, privacy, and interoperability are guaranteed. In this sense, we expect active participation of empowered citizens to supplement the more usual top-down management of epidemics.Peer reviewe