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BackgroundPatients with diabetes lack information on which commercially available applications (apps) improve diabetes-related outcomes. We conducted a rapid evidence review to examine features, clinical efficacy, and usability of apps for self-management of type 1 and type 2 diabetes in adults.MethodsOvid/Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews and technology assessments. Reference lists of relevant systematic reviews were examined for primary studies. Additional searches for primary studies were conducted online, through Ovid/Medline, Embase, CINAHL, and ClinicalTrials.gov. Studies were evaluated for eligibility based on predetermined criteria, data were extracted, study quality was assessed using a risk of bias tool, information on app features was collected, and app usability was assessed. Results are summarized qualitatively.ResultsFifteen articles evaluating 11 apps were identified: six apps for type 1 and five apps for type 2 diabetes. Common features of apps included setting reminders and tracking blood glucose and hemoglobin A1c (HbA1c), medication use, physical activity, and weight. Compared with controls, use of eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, most often HbA1c. Patients did not experience improvements in quality of life, blood pressure, or weight, regardless of app used or type of diabetes. Study quality was variable. Of the eight apps available for usability testing, two were scored “acceptable,” three were “marginal,” and three were “not acceptable.”DiscussionLimited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed.RegistrationThis review was funded by the Agency for Healthcare Research and Quality (AHRQ). The protocol is available at: http://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol.

BackgroundIncreases in patient needs can strain hospital resources, which may worsen care quality and outcomes. This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain.MethodsParallel searches were conducted in MEDLINE, CINAHL, the Cochrane Library, and reference lists from 1999-2015. Two reviewers assessed study eligibility. We included English-language studies describing the association between capacity strain (high census, acuity, turnover, or an indirect measure of strain such as delayed admission) and health outcomes or intermediate outcomes for children and adults hospitalized in highly developed countries. We also included studies of health system interventions to improve care during times of capacity strain. Two reviewers extracted data and assessed risk of bias using the Newcastle-Ottawa Score for observational studies and the Cochrane Collaboration Risk of Bias Assessment Tool for experimental studies.ResultsOf 5,702 potentially relevant studies, we included 44 observational and 8 experimental studies. There was marked heterogeneity in the metrics used to define capacity strain, hospital settings, and overall study quality. Mortality increased during times of capacity strain in 18 of 30 studies and in 9 of 12 studies in intensive care unit settings. No experimental studies were randomized, and none demonstrated an improvement in health outcomes after implementing the intervention. The pediatric literature is very limited; only six observational studies included children. There was insufficient study homogeneity to perform meta-analyses.DiscussionIn highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes. Evidence-based solutions to improve outcomes during times of capacity strain are needed.

We revisit the challenges and prospects for ocean circulation models following Griffies et al. (2010). Over the past decade, ocean circulation models evolved through improved understanding, numerics, spatial discretization, grid configurations, parameterizations, data assimilation, environmental monitoring, and process-level observations and modeling. Important large scale applications over the last decade are simulations of the Southern Ocean, the Meridional Overturning Circulation and its variability, and regional sea level change. Submesoscale variability is now routinely resolved in process models and permitted in a few global models, and submesoscale effects are parameterized in most global models. The scales where nonhydrostatic effects become important are beginning to be resolved in regional and process models. Coupling to sea ice, ice shelves, and high-resolution atmospheric models has stimulated new ideas and driven improvements in numerics. Observations have provided insight into turbulence and mixing around the globe and assessed through perturbed physics models. Relatedly, parameterizations of the mixing and overturning processes in boundary layers and the ocean interior have improved. New diagnostics being used for evaluating models alongside present and novel observations are briefly referenced. The overall goal is summarizing new developments in ocean modeling, including: how new and existing observations can be used, what modeling challenges remain, and how simulations can be used to support observations.

The decrease of organic matter content in agricultural soils is a problem of great concern to farmers around the world. Indeed, it lowers soil fertility that directly impairs agricultural crop production and affects a number of other soil properties like water retention capacity, aggregation and structure formation, soil mechanical strength or compactibility. Scarcity in plant available water poses a risk to agriculture, especially in drought-prone areas. However, the increase of organic waste recycling in agriculture may also lead to an increase in soil organic matter contents and to changes in related soil properties. Here, we review 17 long-term field experiments (≥9 years) that investigated the effects of organic amendments on organic carbon and water availability in topsoils. We paid particular attention to the effects of added organic matter on soil bulk density or porosity and consequently on plant available water. Our main findings are that (1) plant available water generally improves after organic waste addition (relative changes from −10 to +30 vol%; p = 0.052), (2) organic matter quality affects changes in organic carbon (p < 0.05), (3) it is more suitable for plant available water quantification to use volumetric rather than gravimetric water contents, (4) the value of the matric potential defining field capacity is an issue, (5) pedotransfer functions developed for American soils adequately predicted most water contents at field capacity and wilting point, and (6) prevailing climate and initial organic carbon content may affect plant available water. This review confirms that organic amendments generally induce beneficial effects on plant available water and other soil properties. It also highlights the influence of organic matter quality on soil organic carbon. Compared with a previous review, this study reinforces reported trends of increasing plant available water with organic waste additions. This may be due to a more restrictive selection of recently published data and the use of volumetric water contents. Our findings are significant for sustainable agriculture regarding the sustainable use of organic wastes and water.

Evidence-based interventions effectively treat sexual dysfunctions. Up to 13.5% of women with gynecological conditions are affected, yet access to therapy is limited. Self-guided digital interventions may offer scalable, accessible first-line support. This randomized controlled mixed methods pilot trial evaluated adherence, acceptance, and safety of the Odeya app and changes in sexual and health outcomes among women with sexual dysfunctions and endometriosis. Following online and flyer-based recruitment, participants completed an online screening and were randomized to either an intervention group (IG) receiving 8 self-guided app modules targeting biopsychosocial aspects of sexuality or to a control group (CG) receiving routine care. Self-administered online questionnaires were completed at baseline (T0), midintervention (T1), postintervention (T2), and 6-month follow-up (T3). Standardized instruments assessed acceptance (Client Satisfaction Questionnaire-Internet [CSQ-I] and German mHealth App Usability Questionnaire [G-MAUQ]), safety (Inventory for the balanced assessment of Negative Effects of Psychotherapy-Online Intervention), sexual health (Female Sexual Distress Scale-Desire/Arousal/Orgasm [FSDS-DAO], Female Sexual Function Index-German version [FSFI-d], and Partnership Questionnaire), and overall health (Patient-Reported Outcome Measurement Information System-29-Item Profile, Beck Depression Inventory-II, and Generalized Anxiety Disorder-7). Adherence indicators included module completion, dropout rates, and symptom tracker use. Group differences were examined descriptively and using Cohen d. Qualitative data were collected through free-list questionnaires from dropouts (n=11) and interviews with completers (IG: n=3; CG: n=2). A total of 60 women (mean age 31.12, SD 6.67 years) with confirmed or suspected endometriosis and sexual distress (FSDS-DAO score >18) were randomized to the IG (n=29) or CG (n=31). IG participants completed on average 61.2% (4.9/8) of modules; the dropout rate was 65.5% (19/29). Emotional strain, time demands, and technical issues were key barriers causing dropout, while persona-based stories facilitated engagement. Participants wished for more professional interaction. IG completers (n=10, 34.5%) showed lower baseline depression and anxiety but higher sexual distress. Satisfaction was high (CSQ-I=26.60; G-MAUQ=5.38). Although some adverse health changes were reported, findings indicate safety. FSDS-DAO scores decreased in both groups, with mean reductions from baseline of -10.39, -12.61, and -14.98 in the IG and -3.68, -14.83, and -6.92 in the CG from T1 to T3, respectively. Moderate to large between-group effects favoring the IG were observed at T1 (d=-0.66) and T3 (d=-0.79). Sexual function (FSFI-d) improved only in the IG (T1-T3: d=0.16-1.00). Qualitative findings highlighted rediscovery of positive sexual experiences, improved communication, and increased openness. Both groups reported improvements in anxiety, depression, and physical functioning, with additional gains in emotion regulation, distress reduction, and body awareness reported in the IG. Women emphasized symptom complexity and a need for more professional guidance. The self-guided intervention was well accepted and showed preliminary improvements among completers. Adherence and sustained engagement seemed shaped by baseline psychosocial health, pointing to a need for tailored adaptations and larger confirmatory trials. German Clinical Trials Register DRKS00034351; https://drks.de/search/en/trial/DRKS00034351.

To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids). Scale development study, involving construct, item and scale development, validation and reliability testing. There has been increasing use of decision support technologies--adjuncts to the discussions clinicians have with patients about difficult decisions. A global interest in developing these interventions exists among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation. Scale development study, involving construct, item and scale development, validation and reliability testing. Twenty-five researcher-members of the International Patient Decision Aid Standards Collaboration worked together to develop the instrument (IPDASi). In the fourth Stage (reliability study), eight raters assessed thirty randomly selected decision support technologies. IPDASi measures quality in 10 dimensions, using 47 items, and provides an overall quality score (scaled from 0 to 100) for each intervention. Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sampled (n = 30), enabling discrimination. The inter-rater intraclass correlation for the overall quality score was 0.80. Correlations of dimension scores with the overall score were all positive (0.31 to 0.68). Cronbach's alpha values for the 8 raters ranged from 0.72 to 0.93. Cronbach's alphas based on the dimension means ranged from 0.50 to 0.81, indicating that the dimensions, although well correlated, measure different aspects of decision support technology quality. A short version (19 items) was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 (CI 0.79 to 0.92). This work demonstrates that IPDASi has the ability to assess the quality of decision support technologies. The existing IPDASi provides an assessment of the quality of a DST's components and will be used as a tool to provide formative advice to DSTs developers and summative assessments for those who want to compare their tools against an existing benchmark.

In uncontrolled before-after studies, CONSORT was shown to improve the reporting of randomised trials. Before-after studies ignore underlying secular trends and may overestimate the impact of interventions. Our aim was to assess the impact of the 2007 STROBE statement publication on the quality of observational study reporting, using both uncontrolled before-after analyses and interrupted time series. For this quasi-experimental study, original articles reporting cohort, case-control, and cross-sectional studies published between 2004 and 2010 in the four dermatological journals having the highest 5-year impact factors (≥ 4) were selected. We compared the proportions of STROBE items (STROBE score) adequately reported in each article during three periods, two pre STROBE period (2004-2005 and 2006-2007) and one post STROBE period (2008-2010). Segmented regression analysis of interrupted time series was also performed. Of the 456 included articles, 187 (41%) reported cohort studies, 166 (36.4%) cross-sectional studies, and 103 (22.6%) case-control studies. The median STROBE score was 57% (range, 18%-98%). Before-after analysis evidenced significant STROBE score increases between the two pre-STROBE periods and between the earliest pre-STROBE period and the post-STROBE period (median score2004-05 48% versus median score2008-10 58%, p<0.001) but not between the immediate pre-STROBE period and the post-STROBE period (median score2006-07 58% versus median score2008-10 58%, p = 0.42). In the pre STROBE period, the six-monthly mean STROBE score increased significantly, by 1.19% per six-month period (absolute increase 95%CI, 0.26% to 2.11%, p = 0.016). By segmented analysis, no significant changes in STROBE score trends occurred (-0.40%; 95%CI, -2.20 to 1.41; p = 0.64) in the post STROBE statement publication. The quality of reports increased over time but was not affected by STROBE. Our findings raise concerns about the relevance of uncontrolled before-after analysis for estimating the impact of guidelines.

The present-day nitrogen isotopic compositions of Earth’s surficial (15N-enriched) and deep reservoirs (15N-depleted) differ significantly. This distribution can neither be explained by modern mantle degassing nor recycling via subduction zones. As the effect of planetary differentiation on the behavior of N isotopes is poorly understood, we experimentally determined N-isotopic fractionations during metal–silicate partitioning (analogous to planetary core formation) over a large range of oxygen fugacities (ΔIW −3.1 < logfO₂ < ΔIW −0.5, where ΔIW is the logarithmic difference between experimental oxygen fugacity [fO₂] conditions and that imposed by the coexistence of iron and wüstite) at 1 GPa and 1,400 °C. We developed an in situ analytical method to measure the N-elemental and -isotopic compositions of experimental run products composed of Fe–C–N metal alloys and basaltic melts. Our results show substantial N-isotopic fractionations between metal alloys and silicate glasses, i.e., from −257 ± 22‰ to −49 ± 1‰ over 3 log units of fO₂. These large fractionations under reduced conditions can be explained by the large difference between N bonding in metal alloys (Fe–N) and in silicate glasses (as molecular N₂ and NH complexes). We show that the δ15N value of the silicate mantle could have increased by ∼20‰ during core formation due to N segregation into the core.

Background Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. Methods We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. Results Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. Conclusions Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.