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BACKGROUND: Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent-enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. OBJECTIVE: The aim of this systematic review is to synthesize evidence pertaining to conversational agent-enabled intervention design features and their impacts on the engagement of people managing CMD. METHODS: The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent-enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent-enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. RESULTS: This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. CONCLUSIONS: This review will synthesize diverse observations pertaining to conversational agent-enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent-enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent-enabled interventions. TRIAL REGISTRATION: PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52973.

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Introduction According to a 2023 poll by the International Society of Nephrology, 850 million individuals worldwide suffer from chronic kidney disease (CKD) and hemodialysis (HD) is the primary treatment for 69% of the patients with CKD. While HD effectively regulates fluid balance and electrolyte levels, patients often face challenges such as weakness, exhaustion, and cognitive changes, which impact their quality of life. Sleep-related issues, including poor quality, excessive morning sleepiness, insomnia, and restless leg syndrome (RLS), are particularly common among HD patients. These disturbances stem from various factors, including psychological discomfort and biochemical imbalances. Dialysis shifts, despite their importance, remain poorly studied regarding their impact on sleep and biochemical parameters. Our study aims to address these gaps, exploring how different dialysis shifts affect sleep quality and biochemical parameters. Our hypothesis suggests that the particular dialysis shift that hemodialysis patients undergo has an impact on the quality of sleep, with various groups exhibiting varying degrees of sleep disturbance. Simultaneously, we believe that the time of dialysis shifts could influence biochemical parameter variations, which in turn could affect the quality of sleep in hemodialysis patients. Methodology This cross-sectional study focuses on assessing sleep problems and analyzing biochemical variables among hemodialysis (HD) patients in Georgia. A total of 150 participants were selected from morning, afternoon, and evening dialysis shifts, with strict inclusion criteria and exclusion criteria. Assessment procedures involved questionnaires on sleep quality, restless leg syndrome (RLS), daytime sleepiness, and severity of insomnia. Biochemical variables were obtained from the hospital records. Statistical analyses were performed using Graph Pad Prism software (GraphPad, San Diego, USA), including ANOVA and Chi-square tests for association between biochemical variables and dialysis shifts, as well as logistic regression for assessing the influence of biochemical variables on insomnia and poor sleep quality. The significance level was set at 95%. Results Results showed that patients in the afternoon shift undergo longer sessions of hemodialysis compared to other shifts. Notably, a larger proportion of morning shift patients reported poor sleep quality, while a smaller fraction of evening shift patients experienced insomnia. There were no significant associations between dialysis shift and excessive morning sleepiness or restless leg syndrome. Potassium emerged as the sole biochemical variable exhibiting an association with all three dialysis shifts. Biochemical parameters showed no discernible impact on insomnia or poor sleep quality. Conclusion Our findings suggest an association between poor sleep quality and insomnia with dialysis shifts. Hemodialysis does influence potassium levels. However, biochemical variables like sodium, potassium, calcium, phosphorus, vitamin D3, parathyroid gland hormone (PTH), and hemoglobin do not seem to affect poor sleep quality and insomnia. Further research is needed to explore potential sleep issues with nocturnal shifts and to assess if creatinine and chloride have any influence on poor sleep quality. It is important to acknowledge dialysis shift as a contributor to sleep problems, emphasizing the need for targeted interventions to enhance the quality of life for these patients.

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PURPOSE: Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams. METHODS: We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance. RESULTS: 160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of -2.5 and -1 respectively (both p < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference -1, p < 0.001). CONCLUSION: The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.

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BACKGROUND: Standard setting for clinical examinations typically uses the borderline regression method to set the pass mark. An assumption made in using this method is that there are equal intervals between global ratings (GR) (e.g. Fail, Borderline Pass, Clear Pass, Good and Excellent). However, this assumption has never been tested in the medical literature to the best of our knowledge. We examine if the assumption of equal intervals between GR is met, and the potential implications for student outcomes. METHODS: Clinical finals examiners were recruited across two institutions to place the typical 'Borderline Pass', 'Clear Pass' and 'Good' candidate on a continuous slider scale between a typical 'Fail' candidate at point 0 and a typical 'Excellent' candidate at point 1. Results were analysed using one-sample t-testing of each interval to an equal interval size of 0.25. Secondary data analysis was performed on summative assessment scores for 94 clinical stations and 1191 medical student examination outcomes in the final 2 years of study at a single centre. RESULTS: On a scale from 0.00 (Fail) to 1.00 (Excellent), mean examiner GRs for 'Borderline Pass', 'Clear Pass' and 'Good' were 0.33, 0.55 and 0.77 respectively. All of the four intervals between GRs (Fail-Borderline Pass, Borderline Pass-Clear Pass, Clear Pass-Good, Good-Excellent) were statistically significantly different to the expected value of 0.25 (all p-values < 0.0125). An ordinal linear regression using mean examiner GRs was performed for each of the 94 stations, to determine pass marks out of 24. This increased pass marks for all 94 stations compared with the original GR locations (mean increase 0.21), and caused one additional fail by overall exam pass mark (out of 1191 students) and 92 additional station fails (out of 11,346 stations). CONCLUSIONS: Although the current assumption of equal intervals between GRs across the performance spectrum is not met, and an adjusted regression equation causes an increase in station pass marks, the effect on overall exam pass/fail outcomes is modest.

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Transition metal dichalcogenides is an emerging 2D semiconducting material group which has excellent physical properties in the ultimately scaled thickness dimension. Specifically, van der Waals heterostructures hold the great promise in further advancing both the fundamental scientific knowledge and practical technological applications of 2D materials. Although 2D materials have been extensively studied for various sensing applications, temperature sensing still remains relatively unexplored. In this work, we experimentally study the temperature-dependent Raman spectroscopy and electrical conductivity of molybdenum disulfide (MoS2) and its heterostructures with platinum dichalcogenides (PtSe2and PtTe2) to explore their potential to become the next-generation temperature sensor. It is found that the MoS2-PtX2heterostructure shows the great promise as the high-sensitivity temperature sensor.

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Cancer is a leading source of distress and fatality worldwide. Cancer-related aberrant cell proliferation causes excruciating pain and impairment. To cope with pain and manage symptoms and illness, pharmaceutical and non-pharmacological options are available. Self-care behaviors are recognized as a key source in symptom management and improving quality adherence to treatment among the current non-pharmacological strategies. The intervention measures to improve self-care were hardly impacted because of the narrow focus on physical self-care. Bringing in emotional self-care and addressing the individual's emotional health can enhance the effectiveness of interventions on a holistic level. Hence, this study has attempted to explore the factors that influence emotional self-care among individuals with cancer. Following an exploratory research design, the data were collected from 15 participants (4 men and 11 women) using purposive sampling and semi-structured interviews. Through thematic analysis, eight major themes were identified: physiological factors, social factors, family factors, psychological factors, individual factors, socioeconomic factors, cultural factors, and spiritual factors. The findings explained the emotional self-care among patients with cancer and how different identified factors influence their emotional self-care practices.

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INTRODUCTION: Non-communicable diseases, arising out of changing lifestyle habits of people, are the foremost causes of mortality and morbidity worldwide. Most of these diseases occur in low and middle-income countries. Chronic diseases can be managed with the help of health behaviors such as proper diet, physical exercise, adherence to medication, and avoidance of health risk behaviors such as smoking, alcohol consumption, sedentary lifestyle, etc. The social cognitive theory addresses the role of personal and environmental factors in an individual's health behavior. The current study aims to understand the role of social cognitive theory on physical activity and dietary behavior amongst individuals diagnosed with type-2 diabetes. METHODS: A correlational study was conducted among 225 participants with type-2 diabetes, who are under medication. The data was collected using social cognitive questionnaire for physical activity & dietary behavior and Health-Promoting Lifestyle Profile II. Descriptive statistics, Pearson's correlation coefficient and multiple linear regression analysis were used to analyze the data. RESULTS: It was found from the study results that, all the domains of social cognitive theory were significantly correlated with physical activity (p<0.001) and the SCT domains- self-regulation (p<0.001), social support (p<0.001), and outcome expectancy (p<0.05) were significantly correlated with dietary behavior. The results of multiple linear regressions indicated that the domains self- regulation and self- efficacy were the significant predictor for physical activity behavior (R2=.21, p ≤ 0.001) while the domains social support and self-regulation were the significant predictor of dietary behavior (R2=.09, p ≤ 0.001). CONCLUSION: The study results show that there is an influence of social cognitive domains on physical activity and dietary behaviour. Further, this study suggests that social cognitive theory based intervention can be used to promote healthy behaviour.

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The possible use of electrostrictive materials for information processing devices has been widely discussed because it could allow low-power logic operation by overcoming the fundamental limit of subthreshold swing greater than 60 mV/decade in conventional MOSFETs. However, existing proposals for electrostrictive FET applications typically adopt approaches that are entirely theoretical and simulative, thus lacking practical insights into how an electrostrictive material can be best interfaced with a channel material. Here we propose an electrostrictive FET device, involving the epitaxial oxide heterostructure as an ideal material platform for maximum strain transfer. The ON/OFF switching occurs due to a stress-induced concentration change of oxygen vacancies in the memristive oxide channel layer. Based on finite-element simulations, we show that the application of a minimal gate voltage bias can induce stress in the channel layer as high as 108 N/m2 owing to the epitaxial interface between the electrostrictive and memristive oxide layers. Conductive AFM experiments further support the feasibility of the proposed device by demonstrating the stress-induced conductivity modulation of a perovskite oxide thin film, SrTiO3, that is well known to serve as the substrate for epitaxial growth of other functional oxide layers.