Governance in the age of social machines: the web observatory

The World Wide Web has provided unprecedented access to information; as humans and machines increasingly interact with it they provide more and more data. The challenge is how to analyse and interpret this data within the context that it was created, and to present it in a way that both researchers and practitioners can more easily make sense of. The first step is to have access to open and interoperable data sets, which Governments around the world are increasingly subscribing to. But having ‘open’ data is just the beginning and does not necessarily lead to better decision making or policy development. This is because data do not provide the answers – they need to be analysed, interpreted and understood within the context of their creation, and the business imperative of the organisation using them. The major corporate entities, such as Google, Amazon, Microsoft, Apple and Facebook, have the capabilities to do this, but are driven by their own commercial imperatives, and their data are largely siloed and held within ‘walled gardens’ of information. All too often governments and non-profit groups lack these capabilities, and are driven by very different mandates. In addition they have far more complex community relationships, and must abide by regulatory constraints which dictate how they can use the data they hold. As such they struggle to maximise the value of this emerging ‘digital currency’ and are therefore largely beholden to commercial vendors. What has emerged is a public-private data ecosystem that has huge policy implications (including the twin challenges of privacy and security). Many within the public sector lack the skills to address these challenges because they lack the literacy required within the digital context. This project seeks to address some of these problems by bringing together a safe and secure Australian-based data platform (facilitating the sharing of data, analytics and visualisation) with policy analysis and governance expertise in order to create a collaborative working model of a ‘Government Web Observatory’. This neutral space, hosted by an Australian university, can serve as a powerful complement to existing Open Data initiatives in Australia, and enable research and education to combine to support the development of a more digitally literate public service. The project aims to explore where, and in which contexts, people, things, data and the Internet meet and result in evolving observable phenomena which can inform better government policy development and service delivery.&nbsp

Exploring student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity

BACKGROUND: As the prevalence of obesity increases worldwide the field of bariatric medicine has emerged, focussing on the causes, prevention and treatment of obesity. People who are obese regularly face bias from healthcare professionals, which can negativity impact on care delivery and patient outcomes. The introduction of bariatric empathy suits into simulated practice may enable student nurses to appreciate the needs of, and influence their attitudes towards, obese people. OBJECTIVES: The aim of this study was to explore student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity. DESIGN: A mixed methods study incorporating a pre-post design. SETTING: A UK university which provides pre-registration nursing education. PARTICIPANTS: Nursing students in part 1 (n = 39) and part 2 (n = 29) in adult and mental health fields. METHODS: Part 1 and 2 nursing students completed the "Nurses' attitudes towards obesity and obese patients scale" (NATOOPS) questionnaire. Part 2 students also took part in a simulation activity while wearing a bariatric empathy suit and completed the NATOOPS questionnaire again immediately after the simulation activity. Students who wore the empathy suits were invited to a focus group. RESULTS: Part 1 students reported poorer attitudes on the NATOOPS scale than Part 2 students. After wearing the bariatric empathy suits students reported changed attitudes on the NATOOPS in three areas: response to obese patients, characteristics of obese patients and supportive roles in caring for obese patients. Five themes emerged from the focus groups related to physical and psychological impact of the suits; thinking differently; simulation as a learning experience and challenges and recommendations. CONCLUSIONS: Following a structured educational experience student nurses' attitudes were more positive towards obese patients. The characteristics of the educational activity that appeared to influence student nurses' attitudes was related to the "lived experience" of wearing bariatric empathy suits

Defining Terms Used for Animals Working in Support Roles for People with Support Needs

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed

The effect of timing and frequency of push notifications on usage of a smartphone-based stress management intervention: An exploratory trial

Push notifications offer a promising strategy for enhancing engagement with smartphone-based health interventions. Intelligent sensor-driven machine learning models may improve the timeliness of notifications by adapting delivery to a user's current context (e.g. location). This exploratory mixed-methods study examined the potential impact of timing and frequency on notification response and usage of Healthy Mind, a smartphone-based stress management intervention. 77 participants were randomised to use one of three versions of Healthy Mind that provided: intelligent notifications; daily notifications within pre-defined time frames; or occasional notifications within pre-defined time frames. Notification response and Healthy Mind usage were automatically recorded. Telephone interviews explored participants' experiences of using Healthy Mind. Participants in the intelligent and daily conditions viewed (d = .47, .44 respectively) and actioned (d = .50, .43 respectively) more notifications compared to the occasional group. Notification group had no meaningful effects on percentage of notifications viewed or usage of Healthy Mind. No meaningful differences were indicated between the intelligent and non-intelligent groups. Our findings suggest that frequent notifications may encourage greater exposure to intervention content without deterring engagement, but adaptive tailoring of notification timing does not always enhance their use. Hypotheses generated from this study require testing in future work. Trial registration number: ISRCTN67177737 © 2017 Morrison et al

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department

Background: Any infection can potentially develop into sepsis. Many patients present to the Emergency Department (ED) with infection and go on to require antibiotics. However, the timeliness of antibiotics can make a difference to patient survival and reduce the risk of infection developing into sepsis and or septic shock. Methods: Our study was a 4 month prospective descriptive exploratory pilot study. Results: Of all adult (n = 18,807) presentations 3339 (18%) patients had a primary diagnosis related to infection. The study collected data on 104 (3%) patients who were administered antibiotics. One hundred (95%) patients who received antibiotics were admitted to hospital. Triage code did not influence time to antibiotic (p = .352). Eighty-five (81%) patients waited longer than 1 h for their first antibiotic with the shortest administration time 19 min (mean 233 min, SD 247) and the maximum wait for antibiotics was 1481 min. For sepsis or septic shock patients (n = 8) the average time to antibiotics was 411 min (SD = 455 min). Conclusion: The study provides a detailed analysis of ED patients receiving antibiotics. Further research is needed to identify strategies to improve the timely delivery of antibiotics for patients with infections

The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital

Background: Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged. Methods: We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection. Results: The study identified that 16% (n = 7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X2 = 297.83, df = 4, p ≤ .001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n = 3027) of patients with infections were admitted to hospital. Of the patients (n = 1930; 4%) admitted to a critical care area, 6% (n = 122) had a primary diagnosis related to infection. Of the ED deaths (n = 81), 12% (n = 10) had a primary diagnosis related to infection. Conclusion: The study provides a detailed analysis of the prevalence and triage characteristics of patients with infection presenting to one ED. Further research is needed to identify strategies to improve the triage nurse's recognition of severe infection and consistency of urgency code allocation to prevent patient deterioration

Ethical and legal support for innovation on web observatories

In this paper, we consider the ethical and legal context and challenges for the further development of Web Observatories (WOs). First the need for and importance of a transparent and robust legal and ethical framework that can be adopted by WOs is outlined. Then, the legal and ethical challenges faced are explored. Finally, characteristics of best practice and an outline of the proposed solutions, including the development of a new ethical model -- PRO-SENT, are set out

Expanded Exploration of the Auditory Naming Test in Patients with Dementia

BACKGROUND: Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. OBJECTIVE: To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. METHODS: Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). RESULTS: Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p \u3c 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer\u27s disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. CONCLUSION: The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia