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The combination of building energy management technology and technology of the Fourth Industrial Revolution has a significant potential for reducing energy consumption and, hence, CO2 emissions. However, numerous studies have indicated barriers preventing market growth. These challenges are mainly attributed to characteristics of the ecosystem of the building energy management systems (BEMS) industry. Thisstudy aimed to identify the major challenges hindering the deployment of BEMS in combination with Fourth Industrial Revolution technologies and to derive policies conducive to the achievement of the effective BEMS industry ecosystem. An analytic hierarchy process (AHP) survey was conducted on key players in the ecosystem to achieve this. The main elements of the ecosystem, economic, institutional, technology, and social system that earned weight, followed a decreasing trend in this order. Among the sub-elements, the payback period, upfront cost, electricity pricing scheme, energy consumption/CO2 emission reduction, and government support system ranked first to fifth places, respectively. This result can be used to determine the element in need of priority allocation of resources while establishing an effective BEMS. However, the priority depends on the development stage at which the industry is at, and other elements should not be overlooked.

Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.

Background Access to voting is increasingly recognized as a social determinant of health. Health equity could be improved if healthcare workers (HCWs) routinely assessed the voter registration status of patients during clinical encounters and helped direct them towards appropriate resources. However, little consensus exists on how to achieve these tasks efficiently and effectively in healthcare settings. Intuitive and scalable tools that minimize workflow disruptions are needed. The Healthy Democracy Kit (HDK) is a novel voter registration toolkit for healthcare settings, featuring a wearable badge and posters that display quick response (QR) and text codes directing patients to an online hub for voter registration and mail-in ballot requests. The objective of this study was to assess national uptake and impact of the HDK prior to the 2020 United States (US) elections. Methods Between 19 May and 3 November 2020, HCWs and institutions could order and use HDKs to help direct patients to resources, free of cost. A descriptive analysis was conducted to summarize the characteristics of participating HCWs and institutions as well as the resultant total persons helped prepare to vote. Results During the study period, 13,192 HCWs (including 7,554 physicians, 2,209 medical students, and 983 nurses) from 2,407 affiliated institutions across the US ordered 24,031 individual HDKs. Representatives from 604 institutions (including 269 academic medical centers, 111 medical schools, and 141 Federally Qualified Health Centers) ordered 960 institutional HDKs. Collectively, HCWs and institutions from all 50 US states and the District of Columbia used HDKs to help initiate 27,317 voter registrations and 17,216 mail-in ballot requests. Conclusions A novel voter registration toolkit had widespread organic uptake and enabled HCWs and institutions to successfully conduct point-of-care civic health advocacy during clinical encounters. This methodology holds promise for future implementation of other types of public health initiatives. Further study is needed to assess downstream voting behaviors from healthcare-based voter registration.

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life in the United States and forced Americans to rethink their daily activities, including how they work, attend school, secure food, obtain health care, and maintain social connections. For vulnerable populations that were already facing significant barriers to health, such as people experiencing homelessness, the pandemic has only generated new hardships and exacerbated existing inequities. Compared with the general population, people experiencing homelessness suffer from poorer health and have higher rates of mental illnesses, infectious and noncommunicable diseases, and premature mortality.1,2 Since the start of the pandemic, this highly vulnerable population has also faced increased risks of being exposed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-the virus that causes COVID-19. Nightly, many of these individuals must make the difficult decision between lodging in crowded shelters, where the risk of outbreaks is high, and staying outdoors, where they must weather the elements and risk their safety.3 5 Many people experiencing homelessness also have little or no access to personal protective equipment and testing, and even when testing is available, it may be challenging to conduct contact tracing and quarantine individuals in this population because of their lack of housing and limited access to mobile phones and mailing addresses.6 Furthermore, given their preexisting medical conditions and other factors such as poor nutrition and lack of health insurance, people experiencing homelessness are also more likely to have worse outcomes if they develop COVID-19. The COVID-19 pandemic has also affected the nonprofit organizations that provide people experiencing homelessness with basic needs such as food, clothing, and medical care. Across the United States, communities are engaging in a collective effort to shelter in place and practice social distancing to reduce the person-to-person transmission of SARS-CoV-2. Although these measures are essential to \"flattening the curve\" of active cases of COVID-19, they have dramatically reduced the number of people who are able to volunteer for nonprofit organizations.8 Likewise, the temporary and permanent shuttering of businesses has resulted in sharp declines in the monetary and material donations that sustain these entities.8,9 It is also likely that the high unemployment rate will eventually translate into increased numbers of people experiencing homelessness.

BackgroundPatients have adopted web-based tools to report on the quality of their healthcare experiences. We seek to examine online reviews for US emergency departments (EDs) posted on Yelp, a popular consumer ratings website.MethodsWe conducted a qualitative analysis of unstructured, publicly accessible reviews for hospitals available on http://www.yelp.com. We collected all reviews describing experiences of ED care for a stratified random sample of 100 US hospitals. We analysed the content of the reviews using themes derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) inpatient care survey. We also used modified grounded theory to iteratively code the text of the reviews, identifying additional themes specific to emergency care. The data were double-coded, and discrepancies were evaluated to ensure consensus.ResultsOf the 1736 total reviews, 573 (33%) described patient experiences involving the ED. The reviews contained several themes assessed by the HCAHPS survey, including communication with nurses, communication with doctors, and pain control. The reviews also contained key themes specific to emergency care: waiting and efficiency; decisions to seek care in the ED; and events following discharge, including administrative difficulties.ConclusionsThese exploratory findings suggest that online reviews for EDs contain similar themes to survey-based assessments of inpatient hospital care as well as themes specific to emergency care. Consumer rating websites allow patients to provide rapid and public feedback on their experience of medical care. Web-based platforms may offer a novel strategy for assessing patient-centred quality in emergency care.

Objective Crowdsourcing research allows investigators to engage thousands of people to provide either data or data analysis. However, prior work has not documented the use of crowdsourcing in health and medical research. We sought to systematically review the literature to describe the scope of crowdsourcing in health research and to create a taxonomy to characterize past uses of this methodology for health and medical research. Data sources PubMed, Embase, and CINAHL through March 2013. Study eligibility criteria Primary peer-reviewed literature that used crowdsourcing for health research. Study appraisal and synthesis methods Two authors independently screened studies and abstracted data, including demographics of the crowd engaged and approaches to crowdsourcing. Results Twenty-one health-related studies utilizing crowdsourcing met eligibility criteria. Four distinct types of crowdsourcing tasks were identified: problem solving, data processing, surveillance/monitoring, and surveying. These studies collectively engaged a crowd of >136,395 people, yet few studies reported demographics of the crowd. Only one (5 %) reported age, sex, and race statistics, and seven (33 %) reported at least one of these descriptors. Most reports included data on crowdsourcing logistics such as the length of crowdsourcing (n = 18, 86 %) and time to complete crowdsourcing task (n = 15, 71 %). All articles (n = 21, 100 %) reported employing some method for validating or improving the quality of data reported from the crowd. Limitations Gray literature not searched and only a sample of online survey articles included. Conclusions and implications of key findings Utilizing crowdsourcing can improve the quality, cost, and speed of a research project while engaging large segments of the public and creating novel science. Standardized guidelines are needed on crowdsourcing metrics that should be collected and reported to provide clarity and comparability in methods.

No studies have examined the effect of socioeconomic deprivation on antepartum and intrapartum stillbirths in the poorest women in low income countries. This study used data from a prospective population based surveillance system involving all women of childbearing age and their babies in rural Ghana. The primary objective was to evaluate associations between household wealth and risk of antepartum and intrapartum stillbirth. The secondary objective was to assess whether any differences in risk were mediated by utilisation of health services during pregnancy. Data were analysed using multivariable logistic regression. Random effect models adjusted for clustering of women who delivered more than one infant. There were 80267 babies delivered from 1 July 2003 to 30 September 2008: 77666 live births and 2601 stillbirths. Of the stillbirths 1367 (52.6%) were antepartum, 989 (38.0%) were intrapartum and 245 (9.4%) had no data on the timing of death. 94.8% of the babies born in the study (76129/80267) had complete data on all covariates and outcomes. 36 878 (48.4%) of babies were born to women in the two poorest quintiles and 3697 (4.9%) had no pregnancy care. There was no association between wealth and antepartum stillbirths. There was a marked 'dose response' of increasing risk of intrapartum stillbirth with increasing levels of socioeconomic deprivation (adjOR 1.09 [1.03-1.16] p value 0.002). Women in the poorest two quintiles had greater risk of intrapartum stillbirth (adjOR 1.19 [1.02-1.38] p value 0.023) compared to the richest women. Adjusting for heath service utilisation and other variables did not alter results. Poor women had a high risk of intrapartum stillbirth and this risk was not influenced by health service utilisation. Health system strengthening is required to meet the needs of poor women in our study population.

Previously, the Hepatitis B Foundation (HBF), which aims to find a cure for the disease and improve quality of life for those impacted, reported that the prevalence of hepatitis B infection in a community sample from Greater Philadelphia comprised predominantly of first-generation Americans from the Western Pacific Region was 7.9%. In prior work, we identified lack of knowledge about hepatitis B and available resources, limited English proficiency, concerns about costs, time constraints, discrimination, and stigma as barriers to screening and health care for Asians. 5 Screening can increase when recommended by trusted family members or health professionals and when awareness of hepatitis B increases, 6 and community-based screening programs can leverage linguistic and cultural connections to provide relevant health education, screening, and referral to care. METHODS Program design In line with the Health Belief Model, we designed a screening program to address constructs that affect health behaviors: susceptibility, seriousness, benefits, barriers, cues to action, and self-efficacy. 8 We created an online registration form where individuals could enter their name, birth date, sex, contact information, and preferred language (Figure 1). Table 1 Demographic characteristics, screening results, and referrals to care for remote hepatitis B screening program participants Eligible and completed screening a (N = 26) Demographic characteristics Age, years, mean (SD) 46.6 (12.9) Sex, n (%) Male 11 (42.3) Female 15 (57.7) Ethnicity, n (%) Chinese 12 (46.2) Vietnamese 13 (50.0) Hispanic 1 (3.8) Screening results Hepatitis B surface antigen (HBsAg), n (%) Positive 7 (26.9) Negative 19 (73.1) Hepatitis B core antibody (HBcAb), n (%) Positive 8 (30.8) Negative 18 (69.2) Hepatitis B surface antibody (HBsAb), n (%) <10 IU/ml 2 (7.7) ≥10 IU/ml 24 (92.3) Referral to care type, n (%) Results by mail 26 (100.0) Hepatologist or primary care physician with hepatitis B competency 7 (26.9) Vaccination 2 (7.7) a 30 adults registered but did not complete screening.

(1) Background: In this study, we introduce a manufacturable 32-channel cochlear electrode array. In contrast to conventional cochlear electrode arrays manufactured by manual processes that consist of electrode-wire welding, the placement of each electrode, and silicone molding over wired structures, the proposed cochlear electrode array is manufactured by semi-automated laser micro-structuring and a mass-produced layer-by-layer silicone deposition scheme similar to the semiconductor fabrication process. (2) Methods: The proposed 32-channel electrode array has 32 electrode contacts with a length of 24 mm and 0.75 mm spacing between contacts. The width of the electrode array is 0.45 mm at its apex and 0.8 mm at its base, and it has a three-layered arrangement consisting of a 32-channel electrode layer and two 16-lead wire layers. To assess its feasibility, we conducted an electrochemical evaluation, stiffness measurements, and insertion force measurements. (3) Results: The electrochemical impedance and charge storage capacity are 3.11 ± 0.89 kOhm at 1 kHz and 5.09 mC/cm2, respectively. The V/H ratio, which indicates how large the vertical stiffness is compared to the horizontal stiffness, is 1.26. The insertion force is 17.4 mN at 8 mm from the round window, and the maximum extraction force is 61.4 mN. (4) Conclusions: The results of the preliminary feasibility assessment of the proposed 32-channel cochlear electrode array are presented. After further assessments are performed, a 32-channel cochlear implant system consisting of the proposed 32-channel electrode array, 32-channel neural stimulation and recording IC, titanium-based hermetic package, and sound processor with wireless power and signal transmission coil will be completed.

To investigate the neuronal visual encoding process in the retina, researchers have performed in vitro and ex vivo electrophysiological experiments using animal retinal tissues. The microelectrode array (MEA) has become a key component in retinal experiments because it enables simultaneous neural recording from a population of retinal neurons. However, in most retinal experiments, it is inevitable that the retinal tissue is flattened on the planar MEA, becoming deformed from the original hemispherical shape. During the tissue deforming process, the retina is subjected to mechanical stress, which can induce abnormal physiological conditions. To overcome this problem, in this study, we propose a hemispherical MEA with a curvature that allows retinal tissues to adhere closely to electrodes without tissue deformation. The electrode array is fabricated by stretching a thin, flexible polydimethylsiloxane (PDMS) electrode layer onto a hemispherical substrate. To form micro patterns of electrodes, laser processing is employed instead of conventional thin-film microfabrication processes. The feasibility for neural recording from retinal tissues using this array is shown by conducting ex vivo retinal experiments. We anticipate that the proposed techniques for hemispherical MEAs can be utilized not only for ex vivo retinal studies but also for various flexible electronics.