Background: Spondyloarthritis is divided into axial and peripheral subtypes. The axial subtype is further divided into ankylosing spondylitis (AS) or radiographic axial spondyloarthritis and nonradiographic axial spondyloarthritis (nr-axSpA). Although AS and nr-axSpA share some common features, nr-axSpA lacks X-ray–based sacroiliitis as defined by the modified New York criteria, that is, the presence of either bilateral grade 2 sacroiliitis or unilateral grade 3 sacroiliitis, which is present in AS. Disease activity in either of them is measured via C-reactive protein (CRP) levels or magnetic resonance imaging (MRI) of the pelvis showing sacroiliitis due to the presence of bone marrow edema. A person with active disease can have normal CRP and MRI findings, especially in nr-axSpA. Immune system activation during inflammation has been shown to alter platelet maturation and morphology, as reflected by platelet indices. These platelet indices have been studied in the past in various autoimmune diseases, such as psoriatic arthritis, AS, and rheumatoid arthritis, and have been correlated with disease activity. Particularly, in spondyloarthritis, platelet indices are more central to the pathology of sacroiliitis, and CRP, which is currently used, is a generalized marker of inflammation. Therefore, platelet indices can provide a better understanding of inflammation, particularly in patients with sacroiliitis. Objective: This study aims to investigate whether platelet indices can be better markers of inflammation in patients with nr-axSpA. We will determine whether platelet indices are reliable biomarkers for measuring disease activity in patients with nr-axSpA. Methods: All patients who are classified as having axial spondyloarthritis as per the Assessment of Spondylarthritis International Society criteria will be included in this study. Patients will be divided into 2 case groups: group A (patients without radiographic sacroiliitis [nr-axSpA]) and group B (patients with radiographic sacroiliitis [AS]). Healthy individuals will be enrolled as controls to compare and correlate platelet indices such as platelet count, plateletcrit, mean platelet volume, and platelet distribution width with CRP, erythrocyte sedimentation rate, and MRI findings in patients with AS and nr-axSpA. Results: This is a nonfunded study. The data collection started on February 1, 2025, and we expect to complete the study by December 2027. As of July 2025, 7 individuals had been enrolled in groups A and B, respectively, and 5 individuals had been included in the control group. At the end of the study, we will be able to correlate whether platelet indices are trustworthy biomarkers of active disease in patients with nr-axSpA. Conclusions: If platelet indices prove to be better markers of active disease in patients with nr-AxSpA, then these markers should be included in the routine evaluation of these patients.

This pre-registered study tries to explore whether female loan officers maintain their advantage in credit quality in unsecured lending markets, as observed in secured lending markets. The study addresses three key research questions: (1) Whether female loan officers exhibit higher or lower loan performance compared to their male colleagues in unsecured lending; (2) The underlying factors driving the performance gap between male and female loan officers in this market; and (3) How digital lending models influence the credit quality of loans underwritten by female officers. This research provides empirical evidence on the performance differentials of female loan officers across secured and unsecured lending markets. The findings offer valuable insights for commercial banks seeking to optimize the credit assessment efficiency of loan officers and inform their digital transformation strategies.

Background: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in the United States, with risk factors such as hypertension and elevated low-density lipoprotein (LDL) cholesterol originating in childhood. While statins and blood pressure–lowering medications can mitigate these risks, adherence is often poor, particularly among youth. Innovative solutions, such as monetary incentives via smartphone apps, may enhance adherence, but evidence in youth is lacking. Objective: This study aims to evaluate the efficacy of a smartphone app (Wellth) offering financial incentives to improve adherence to statins and blood pressure–lowering medications among youth aged 12 to 19 years at risk for cardiovascular disease. Methods: We initially designed a randomized controlled trial to compare the efficacy of 2 different incentive structures in youth treated with a statin for familial hypercholesterolemia with inadequate adherence. After facing recruitment challenges, the study protocol was changed to evaluating a single incentive in a pre-post design. The primary outcome was the change in adherence rate over the 60-day incentive period compared to the adherence rate during the 14-day run-in period. The secondary outcome was a change in LDL cholesterol level. Adjustments to the protocol were made in response to recruitment challenges during the COVID-19 pandemic, simplifying the incentive structure and expanding eligibility criteria. Results: The study is currently undergoing recruitment and collection of data from the first participants. The study has faced recruitment challenges exacerbated by the COVID-19 pandemic, necessitating protocol modifications. Detailed analysis of adherence rates and LDL cholesterol changes is ongoing. Conclusions: This study explores the efficacy of monetary incentives delivered through a smartphone app to improve medication adherence in youth at risk for CVD. The findings will be used to build upon the existing literature in an effort to improve medication adherence throughout the life course and ultimately reduce CVD. Trial Registration: ClinicalTrials.gov NCT04458766; https://clinicaltrials.gov/study/NCT04458766

Background: Post–critical illness dysphagia occurs in about 10% to 62% of patients in the intensive care unit (ICU). Studies focusing on risk factors for dysphagia following endotracheal intubation are scarce and provide conflicting results. More research is required to determine the true prevalence of dysphagia, possible mechanisms, and risk factors. Objective: The aims of the study are to determine (1) risk factors associated with post–critical illness dysphagia, (2) the prevalence of post–critical illness dysphagia, (3) outcomes of patients with post–critical illness dysphagia, and (4) the diagnostic accuracy of the water sip test compared to fiber-optic endoscopic evaluation of swallowing (FEES). Methods: We plan to undertake a single-center prospective cohort study of patients with post–critical illness dysphagia admitted to the ICU at Prince Sultan Military Medical City, Saudi Arabia. Our inclusion criteria are as follows: (1) being an adult (age 18 years and older), (2) having undergone invasive mechanical ventilation for >24 hours, (3) having been extubated for >24 hours, (4) being able to participate in a FEES, and (5) being hemodynamically stable. Each day, the research coordinator will screen all patients in the ICU for enrollment in the study. The research coordinator will collect daily data on the use of advanced life support, the need for mechanical ventilation, and outcomes (mortality, duration of mechanical ventilation, ICU length of stay, and hospital length of stay). Enrolled patients will undergo a water sip test in the ICU and FEES performed by a certified speech-language pathologist. Patients will then be followed during a hospital stay truncated for analysis at 30 days as two cohorts: (1) patients that have dysphagia, that is, abnormal FEES results; and (2) patients who have normal FEES results. Logistic regression will identify dysphagia risk factors (eg, age, Acute Physiology and Chronic Health Evaluation II score, and ventilation duration), while sensitivity and specificity tests will be used to compare the results of the water sip test to the FEES. Survival analysis will be used to evaluate 30-day outcomes. Results: The study anticipates enrolling 200 patients over 18 months. Key outcomes include dysphagia prevalence and risk factors. Final results will be analyzed and reported upon completion of the 30-day follow-up for all participants. As of July 13, 2025, a total of 45 patients had been enrolled, with an average recruitment rate of 7.5 patients per month. Conclusions: The study findings will promote early intervention for patients with post–critical illness dysphagia, improve multidisciplinary care, and inform policymakers for better resource allocation. This study lays the groundwork for future research and clinical guidelines tailored to Saudi Arabia’s health care context.

Background: Deep neck abscesses are a disease in the field of otorhinolaryngology-head and neck surgery that causes significant morbidity, death, and expenditures. Treatment length, whether inpatient or outpatient, is also prolonged. Deep neck abscesses are managed with incision and drainage, abscess exploration, systemic broad-spectrum antibiotic treatment, comorbidity control, and postoperative wound care through recovery. Standard dressings for wound treatment have proven time-consuming and expensive. Honey is one type of dressing that has long been used in wound treatment for a number of body areas and disorders. Objective: The purpose of this study is to investigate the use of honey as a potential substitute for standard dressings for deep neck abscesses. Methods: This is a single-blind randomized controlled trial. Randomization will be done through simple random sampling. The population and sample of the study include all patients with deep neck abscesses treated at Dr Sardjito General Hospital, which is equipped with board-certified otorhinolaryngologists. Patients with deep neck abscesses who were given ethical clearance and meet the inclusion criteria were recruited as study participants until the sample size was reached. There are 18 participants in each group. Participants in the intervention group received standard dressings in addition to honey dressings, whereas those in the control group received standard dressings alone. Proinflammatory cytokines and growth factors, wound size, Bates-Jensen Wound Assessment Tools scoring, and quantitative bacterial colony identification will be all evaluated and assessed. The gathered data will be documented and subjected to statistical analysis. Results: This manuscript presents a study protocol for a randomized controlled trial investigating honey as a wound care modality in patients with deep neck space abscesses. Ethical approval and partial funding for the study were obtained in May 2024. Recruitment and data collection commenced in June 2024 and were successfully completed as of June 2025. Conclusions: We hypothesize that honey may serve as a safe, effective, and affordable alternative wound dressing for the management of deep neck abscesses, with potential benefits in both clinical and health care system outcomes. Trial Registration: ClinicalTrials.gov NCT06562257; https://clinicaltrials.gov/study/NCT06562257.

Background: Pediatric to adult health service (AHS) transition is an inevitable but challenging time for many adolescents and young adults (AYAs) with a chronic illness. As the responsibility of illness management begins to shift from parents to the AYA themselves, many AYAs fail to transition in a timely manner which has important health consequences. Mobile apps have the potential to assist AYAs in self-managing their condition during this vulnerable time, but empirical data on app uptake as well as efficacy with respect to transition outcomes and illness control are lacking. Objective: This pragmatic, single arm pilot trial aimed to evaluate AYA usage of a mobile app called ‘TransitionMate’ (TMApp) which was purpose-built to support chronic illness self-management for youth undergoing transition. Secondary aims were to assess AHS attendance and changes in illness control over the first 12 months post-transition. Upon demonstration of TMApp feasibility (≥70% of participants using TMApp at least once a month), a randomized controlled trial was planned to test efficacy of the app in relation to transition and illness control outcomes. Methods: AYAs aged 16-19 years who were transitioning out of two major pediatric hospitals in Sydney, Australia were recruited. Just prior to transition, participants’ demographic and clinical details were collected and TMApp was installed on their mobile devices. Participants were contacted by telephone at six and 12 months for information on self-reported usage, app usefulness and other feedback. Quantitative cohort-level usage data, including the number of times specific app features were accessed, was tracked via mobile analytics. At 12 months, electronic medical records (eMR) from participants’ designated AHS were accessed for data on AHS attendances, measures of illness control and unplanned hospitalizations. Results: 73 AYAs (30 male; median age 18 years) were recruited, with one withdrawing participation in the first month. Participants were primarily from three chronic illness subgroups: diabetes mellitus (n=23); inflammatory bowel disease (n=19); and cystic fibrosis (n=9). 50% of participants reported using TMApp at one month post-transition. Self-reported usage rates subsequently fell to 25% and 11% at six and 12 months, respectively. Mobile analytics data broadly corroborated self-reported usage. Eight participants who continued to use TMApp until 12 months gave a median usefulness rating of 8/10. Over two-thirds (68%) of participants successfully transitioned to their designated AHS by 12 months. Among the successful transitioners who had illness control data available on eMR, over 80% maintained a stable/improved illness status at six and 12 months. Conclusions: Results showed that TMApp was not used regularly enough by AYAs to demonstrate feasibility and justify progression to a randomized controlled trial. Despite low app uptake, over two-thirds of participants successfully transitioned suggesting that TMApp had minimal influence on transition outcomes. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12620000074998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377349&isReview=true.

Background: Care for mild to moderate chronic kidney disease (CKD) entails self-management from patients and clinical support from primary care and nephrology. In response to a gap in resources for this population, My Kidneys My Health was co-developed to support self-management of CKD. Health care providers play a critical role in the implementation of patient resources, yet there is a gap in understanding providers’ perspectives in this role. Objective: This study develops and evaluates strategies to implement My Kidneys My Health into routine primary care and general nephrology clinical care. Methods: Health care providers working in Alberta, Canada who support patients with CKD were invited to participate in our multi-step study, guided by the Quality Implementation Framework. Step 1: we followed qualitative descriptive methodology to identify barriers and enablers to implementation using a directed content analysis and a deductive coding approach. Participants were invited to complete semi-structured interviews from October 2021 to May 2022. Step 2: we identified, prioritized, co-developed, and launched implementation strategies based on Step 1 results using behaviour change theory. Participants were invited to use the materials during the implementation period (May to October 2022). Utilization was tracked through Google Analytics and document distribution tracking. Step 3: we conducted follow-up interviews with participants (October to December 2022) to evaluate implementation based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, following the same qualitative approach as Step 1. Effectiveness was out of scope of this study. Results: 14 health care providers participated in Step 1 qualitative interviews (42.9% from nephrology clinics, 35.7% from primary care). Participants shared an individual-level readiness and interest in sharing My Kidneys My Health with their patients. The key barriers to implementation included awareness, memory, time, motivation, and innovation accessibility. Implementation strategies were co-designed and implemented by Step 1 participants (i.e., educational sessions and materials, reminders, implementation coaching). 9 health care providers participated in Step 3 qualitative interviews. Participants shared their approach to tailoring implementation based on their patients and integrating the resource into their current practices. The resources developed were highly utilized by participants, with positive feedback on their usability and accessibility. Participants expressed motivation to continue sharing My Kidneys My Health; however, awareness and accessibility require further adaptations can improve sustainability of implementation. Our rigorous approach allowed us to address behaviour change and sustainability of implementation of My Kidneys My Health, as well as identifying appropriate and tailored implementation strategies. Conclusions: There is a readiness to implement self-management supports for patients with early-stage CKD. A theory-informed approach and strategic implementation strategies can support sustainability.

Background: Low back pain (LBP) is a leading cause of work absence globally. Digital interventions have the potential to increase access to self-management support for individuals with persistent LBP. Objective: To evaluate the feasibility, usability and acceptability of an online educational programme (MyRelief) designed to support self-management strategies for people with persistent LBP Methods: A prospective uncontrolled feasibility study was conducted across four countries Italy, Portugal, Sweden and the United Kingdom between 2020 and 2021. Adults in employment with non-specific persistent low-back pain (>3months) with access to the internet were eligible to participate. Participants were given access to MyRelief, an eight unit evidence based educational self-management programme. Feasibility of the MyRelief programme was assessed using recruitment rates, a priori success threshold of >70% of the target sample (50 participants), retention <35% drop-out rate. Pre and post intervention measures of functional disability were assessed using the Oswestry Disability Index (ODI), and health related quality of life using the EQ-5D-5L. Additional post intervention measures included the Patient enablement instrument (PEI) the System Usability Scale (SUS). Quantitative data were analysed descriptively, and qualitative feedback was analysed using a reflexive analytical approach. Results: The recruitment feasibility threshold was met (80%), forty participants (21 women,19 men) mean age of 57 years, mean pain duration 11.5 years enrolled in the study. 17 participants (11 male, 6 female) completed both the baseline and 12 week follow-up questionnaires. This represented a retention rate of 42.5% (n=17/40) and a dropout rate of 57.5% , which did not meet a priori criteria of < 35% dropouts. Approximately half of the participants presented with low baseline disability scores (mean ODI 24.0; 95%CI:18-31) with no significant change at follow-up (mean ODI 23.9; 95%CI:16- 31). EQ-5D-5L scores improved from 0.68 (95%CI: 0.608-0.76) to 0.72 (95%CI: 0.66-0.79) indicating a clinically significant change. PEI scores post intervention were high (mean 5.31) indicating good perceived enablement. The mean SUS score was 72.4 (95%CI: 67.5-73.3) indicating an good level of perceived ease-of-use. Over all the quality of outcome measure completion was high (100%). Qualitative feedback indicated areas for improvement relating to challenges around access and navigation within the website. Conclusions: The MyRelief study demonstrated feasibility in terms of recruitment but not retention. However low baseline disability levels are not representative of the wider persistent LBP population. Future studies should broaden recruitment strategies, in particular recruiting from healthcare settings to improve representativeness. Although usability met industry standards, qualitative feedback suggests that navigation and accessibility require further optimisation to better align with end-user preferences for online digital health interventions. Clinical Trial: ClinicalTrial.gov, NCT04673773; https://clinicaltrials.gov/ct2/show/NCT04673773

Low back pain (LBP) is the main cause of activity limitation and work absence across the world, leading to a high social and economic burden for individuals, families, the labour market and society. The overall aim of this multicentre study is to test the usability, acceptability and feasibility of an evidence-based, digital education programme for people living and working with persistent LBP who are in sedentary or physically demanding jobs and need advice on ergonomics, self-management of pain and healthy behavioural strategies.

Introduction Patients with frailty are at risk of adverse outcomes such as mortality, falls, deconditioning and hospital readmissions. With an increasingly ageing population and a greater likelihood of frailty, there is a significant need to ensure that patients are managed in the right place and at the right time. There has been a focus on offering hospital-level care at home as a way to meet this need, incorporating strategies to integrate care and use digital solutions. Digital twin (DT) technology is one advancement, offering a virtual replica of an object/environment, which has the potential to make use of real-time data personalised for an individual patient and/or setting to inform and support patient management decisions. We are yet to realise the full potential of this new way of integrated working and technological advancements. This scoping review aims to ascertain the current evidence for the components of the DT architecture to enable the monitoring and management of patients with frailty living at home. Methods This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guidelines. The following electronic databases will be searched: Medline, Embase, CINAHL, Cochrane CENTRAL, Web of Science and Scopus. Relevant websites will be searched for grey literature or case reports to capture the required information, as well as any documents provided by stakeholders. Primary studies, published in the English language from 2019 to the present day, which report on the monitoring or management of patients with long-term conditions and frailty within their home environment, will be included. Screening will be conducted by at least two independent reviewers against eligibility criteria, and a piloted data extraction form will be used to align with the research questions. Qualitative content analysis will be used. Data will be presented in tabular form, as well as descriptive and illustrative formats, to address the objectives of this review. Ethics and dissemination This scoping review does not require ethical approval. The findings of this review will be disseminated through peer-reviewed journals and conferences and will support the development of a conceptual model of a hospital-at-home DT for the management of patients with frailty.

Background: Increasing demand on healthcare systems requires innovative and transformative solutions to deliver efficient, high-quality care. One promising approach is Digital Twin (DT) technology, which leverages real time data to create dynamic virtual representations of a physical entity (individuals or space) to anticipate future scenarios and support care decisions. While DTs have been explored in various sectors, their application in Hospital at Home (HaH), which delivers acute level care in home environments, remains unexplored. Objective: This review bridges a critical knowledge gap and examines the existing evidence on DT-enabling tools for managing patients with frailty in home settings. This will identify the underpinning architectural components required to inform a HaH-DT system which can support clinical decision-making. Methods: Six electronic databases (Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Web of Science and Scopus) were searched, along with grey literature, to identifying primary studies published in English, between January 2019 and September 2025. Included studies had to report on the monitoring or management of patients with frailty within their own home, and information was charted on a pre-defined data collection form to answer the research objectives. Review articles, protocols, and conference abstracts were excluded. Results: Sixty-nine reports were included, of which 54% (n=37) used quantitative approaches, and 36% (n=25) were pilot or feasibility studies. Reports were analysed for DT-enabling tools and systematically mapped across the proposed five-layered DT architecture: sensing, communication, storage, analytics, and visualisation. Taxonomies of DT layers, their interconnections, and the classifications of the types of data collected (e.g., about the patient, the home environment, the use of medical equipment) are presented. This evidence identifies DT-enabling tools used for a variety of functions and a range of sensing technologies that exist (e.g., passive sensing via wearables, active physiological sensors, ambient sensors to detect motion/environmental changes). The most prevalent modes of communication were wireless and network-based (n=36), with the majority using Bluetooth (n=12). This review highlights better understanding of data management, in particular secure storage, is required within local healthcare systems. The emerging potential of predictive and prescriptive analytics, which can enable clinicians to predict risk, support clinical decision-making, or activate alert-triggered health interventions were mapped. Existing evidence suggests analytics methods are currently largely descriptive with a lack of advanced methods such as prescriptive analytics to enable recommendations of an optimal course of action, and the absence of diagnostic analytics which can highlight why a situation has occurred. Reported DT-enabling tools demonstrate patient-centered benefits, including enhanced motivation, reassurance, and personalised care. However, concerns persist regarding device accuracy, user acceptability, and implications for carers and organisational workflows. Conclusions: This review is among the first to systematically map DT-enabling tools to inform a potential HaH-DT in patients with frailty and organised by a 5-layered conceptual model. Understanding these architectural layers provides the foundations to enable stakeholders advance research and development in areas where there are knowledge gaps and consider how a HaH DT can effectively operate within current healthcare systems. By leveraging technology-enabled care in complex home-based settings, there is great potential to deliver safer, personalised and timely care.

Background: Dental caries is a common chronic disease in children, yet large-scale surveillance is limited by the resource demands of clinical examinations. Digital tools like intraoral scanners may offer a scalable alternative for caries detection, enabling more efficient data collection for research and population-level oral health monitoring. Objective: To assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an intraoral scanner (IOS) in colour and supplemented with fluorescence for caries detection in primary teeth. Methods: Children participating in a clinical trial (n=216, mean age 5.6 years) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS (3Shape TRIOS A/S Denmark). Four trained registered dental practitioners independently assessed each participant’s 3D models in colour, then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again four weeks later. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland–Altman plots were used to visualise agreement. Analyses were performed at the initial (ICDAS>01), moderate (ICDAS>03), and extensive (ICDAS>05) dental caries thresholds. Intraclass Correlation Coefficient (ICC) estimated method agreement and examiner reliability. Results: 8,209 visible primary tooth coronal surfaces were analysed. The likelihood of detecting caries using colour assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio 1.1, 95% confidence interval (CI) 1.0–1.3), moderate (0.9, 0.7-1.1) and extensive (1.0, 0.7–1.3). When colour assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (1.3, 1.1-1.5) and similar at the moderate (0.9, 0.7-1.1) and extensive thresholds (0.9, 0.7-1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Examiner reliability using intraoral scans ranged from good to excellent. Conclusions: On-screen assessment of 3D models in colour shows greatest agreement with visual examination for caries detection at all disease thresholds. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12622001237774

A recommendation of: Emma L. Henderson, Ruth Abrams, Afrodita Marcu, Lou Atkins, Emily K. Farran Investigating the barriers and enablers to data sharing behaviours: A qualitative Registered Report https://osf.io/8yqbs

Background: The loss of a loved one is a common yet stressful event in later life. Internet- and mobile-based interventions have been proposed as an effective treatment approach for individuals with prolonged grief. Objective: The AgE-health study aimed to investigate the efficacy of an eHealth intervention, trauer@ktiv, in reducing prolonged grief symptoms in a sample of older adults. The trauer@ktiv intervention is an unguided, web-based self-management intervention based on cognitive behavioral therapy principles, addressing grief in later life. Methods: The AgE-health study was designed as a randomized controlled trial with an active control group (CG). Recruitment and data assessment took place between October 2020 and September 2022. A sample of 177 older adults (aged ≥60 years) with prolonged grief symptoms was randomly assigned to the intervention group (IG; access to the trauer@ktiv eHealth intervention) or the active CG (access to an information brochure on loss and grief). Participants were interviewed at 2 time points, before and after accessing the intervention, via postal questionnaires (baseline and follow-up 4 months after the intervention). The primary outcome was the reduction in prolonged grief symptoms assessed with the Prolonged Grief-13 scale. Adjusted mixed-effects regression models were used to test for changes in primary and secondary outcomes (eg, depression and self-efficacy) as part of an intention-to-treat (ITT) analysis. The study procedure was described in detail in the study protocol. Results: From baseline to 4 months after the intervention, 7 participants were lost to follow-up. Final analyses included a sample of 170 individuals (IG: n=81, 47.6%; CG: n=89, 52.4%). The study population had an average age of 67.3 (SD 6.4; range 60-95) years and consisted predominantly of female participants (129/170, 75.9%). While there was a pre-post-reduction in persistent grief symptoms, the ITT analysis showed no significant differences between IG and CG at follow-up (Prolonged Grief-13 scale, average marginal effect of 0.56, 95% CI –2.30 to 3.44, P=.70). Similarly, the ITT analysis showed no significant treatment effects for any of the secondary outcomes at follow-up. The trauer@ktiv intervention was rated high on satisfaction and usability. More than half of the IG (49/81, 61%) completed 5 or more of the 8 modules of the eHealth intervention. Conclusions: The tested eHealth intervention, trauer@ktiv, showed no superiority compared to an active CG in reducing prolonged grief symptoms in a sample of older bereaved individuals. Therefore, trauer@ktiv is not suitable as a stand-alone treatment. However, as the ease of use and satisfaction with the application were high, there may be potential for the intervention within a stepped and collaborative treatment approach. Trial Registration: German Clinical Trials Register DRKS00020595; https://drks.de/search/de/trial/DRKS00020595

Background: The global, nearly universal penetration of mobile phones has offered novel opportunities for delivering health services and communicating health-related information to individuals. A low-cost system that facilitates autonomous communication with individuals via mobile phones holds potential for expanding the reach of health messaging and service delivery in settings with human resource and infrastructure limitations. Objective: We sought to design a flexible, low-code system using open-source software that could be adapted to different contexts and technical environments and accommodate a wide range of automation needs. We report on key details of the mobile phone-based appointment reminder and incentive system (mParis), document its use, review implementation challenges and adaptations to address these challenges in the context of a quasi-randomized trial of mobile phone-based reminders and incentives as means of increasing the timeliness of routine childhood vaccinations in Tanzania, and outline other use cases that highlight the versatility of the system. Methods: The mParis instance described in this manuscript, which is hosted in Tanzania, sent automated, individualized vaccination reminders to the mobile phones of mothers of young children. Process workflows, based on the national childhood vaccination schedule of Tanzania, were programmed into mParis. Reminders for vaccinations due at ages 6, 10, and 14 weeks were sent 7 days and 1 day prior to and 14 days after each vaccination due date. A subset of messages included financial incentive offers to mothers for the timely vaccination of their children. We report on implementation outcomes, challenges, and adaptations to address these challenges. Results: Between August and December 2017, 412 pregnant women were enrolled into the trial. After mothers reported the birth of their children, individualized vaccination reminder messages were sent for vaccination due dates between January and July 2018. From March 2018, messages contained financial incentive offers. Of 1,397 messages sent, 1,122 SMS (80.3%) were recorded as delivered, 249 (18.8%) as expired and resent, 23 (1.6%) as failed, and 3 (0.2%) as sent but lacking delivery confirmation. 633 messages (45.3%) contained tiered incentive offers. Of 173 women who received at least one message, 67 (38.7%) were sent reminders only; 106 women (61.3%) were sent at least one incentivized message. Numerous challenges were encountered during the system’s implementation, despite its deliberate design to accommodate basic problems such as intermittent internet access and power failures. Continuous adaptation to increase the resilience of the system, complemented by limited backstops, resulted in a successful deployment. Conclusions: mParis’ open-source nature, auditability, and ability to autonomously execute algorithms in a low-resource setting with frequent infrastructure challenges suggest favorable prospects to automate health communication in a wide range of settings. mParis’ use in multiple other health-related research studies demonstrates its versatility and ability to accommodate challenges that may be encountered in diverse other contexts. Clinical Trial: ClinicalTrials.gov: NCT03252288

This pre-registered study aims to explore the impact of air pollution, an environmental factor, on corporate bond credit spreads. We are going to investigate three questions in this study: (1) whether air pollution exhibits a causal effect on corporate bond risk premiums? (2) what are the underlying mechanisms driving this relationship? (3) how firm-level heterogeneity modulates environmental risk sensitivity? To explore these questions, we collect corporate bonds that have traded in China's exchange markets from 2014 to 2022 to conduct an empirical analysis. These findings underscore the importance of environmental considerations, such as air pollution, in shaping corporate financial risks and investment decisions.

Background: Loneliness is a negative emotional state which is common in later life. The accumulative effects of loneliness have significant impact on physical and mental health of older adults. Automatic methods for detection and prediction are an emerging field to support early identification of loneliness. Objective: We aim to qualitatively explore the thoughts and preferences of people aged 65 and over regarding technologies to detect feelings of loneliness in later life. Methods: We conducted 60 semi-structured interviews with people aged 65 and over between September 2022 and August 2023. Data were analysed using a reflective thematic approach on NVIVO software. Results: Three themes were identified representing what older adults considered important in a system able to detect loneliness. 1) Interest and Control of Data, which was a priority for older adults; 2) Perceived Usefulness to Address Loneliness, which related to the importance of providing recommendations to reduce feelings of loneliness after detection; and 3) Personalisation as a Priority, which included the level of loneliness for which an alert was sent and selection of relevant individuals who would be sent a loneliness alert. Conclusions: Findings from this in-depth qualitative study provide important perspectives from people with lived-experience of loneliness on the context in which a sensor-based loneliness detection system would be most useful and acceptable to older adults. Future research will include such perspectives in the design of innovative technologies enabling the early detection of loneliness and access to timely interventions to tackle loneliness in later life.

Background: Thyroid cancer is one of the most commonly diagnosed malignancies in South Korea, with incidence rates among the highest globally. Young women, in particular, represent a high-risk group, likely due to a combination of biological, occupational, and environmental factors. However, the specific risk factors contributing to thyroid cancer development in this population remain poorly understood. Objective: This study aims to identify the risk factors associated with thyroid cancer among young female nurses using longitudinal survival analysis. Methods: This longitudinal study used data from the Korea Nurses’ Health Study (KNHS), a prospective national cohort of female nurses. Data from the first, fifth, seventh, and ninth surveys were used to construct a person-period data set. Female nurses aged in their 20s at baseline were included. Time-varying explanatory variables included age, marital status, BMI, smoking, alcohol consumption, perceived stress, sleep problems, nursing position, night shift work, working unit, and duration of radiation exposure. The dependent variable was self-reported physician-diagnosed thyroid cancer. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to examine the association between risk factors and thyroid cancer occurrence. Results: A total of 22,759 person-period cases were analyzed, and 105 thyroid cancer events were identified. Kaplan-Meier analysis showed significant associations between thyroid cancer occurrence and age (χ²1=51.6, P&lt;.001), marital status (χ²1=25.1, P&lt;.001), sleep problems (χ²1=20.3, P&lt;.001), night shift work (χ²1=20.1, P&lt;.001), working unit (χ²1=13.0, P&lt;.001), and duration of radiation exposure (χ²1=91.0, P&lt;.001). In the Cox regression model, nurses aged in their 20s had a significantly higher risk of thyroid cancer than those aged in their 30s (hazard ratio [HR] 4.602, 95% CI 1.893-11.188). Those who worked night shifts were also at an increased risk (HR 1.923, 95% CI 1.127-3.280). Compared with no exposure, radiation exposure showed a dose-response relationship: &lt;1 year: HR 3.449, 95% CI 1.474-8.074; ≥1 year: HR 4.178, 95% CI 2.702-6.461. Conclusions: Younger age, night shift work, and duration of radiation exposure were significantly associated with an increased risk of thyroid cancer in young female nurses. These findings highlight the importance of early screening and occupational risk management, including regular radiation monitoring and support for circadian health, in health care settings.

Background: Smart displays and speakers offer voice interaction, which may be more accessible and appealing to older adults with chronic pain and other multimorbid conditions. Previous trials found stronger socioemotional benefits of ElderTree (vs control) among those with high primary care use and multiple chronic conditions. Objective: This study aims to test whether older adults with chronic pain and multiple other chronic conditions use and benefit more from ElderTree, an eHealth intervention targeting pain and quality of life, when delivered on a smart display. Methods: We recruited 269 participants from the University of Wisconsin-Madison health system and community organizations and randomly assigned 1:1:1 to (1) smart display with internet and ElderTree, plus usual care; (2) touchscreen laptop with internet and ElderTree, plus usual care; or (3) usual care alone. Participants were aged ≥60 years, had a chronic pain diagnosis or reported chronic pain, and at least 3 common chronic conditions. Primary outcomes were pain interference and psychosocial quality of life. Data sources were baseline, 4-month, and 8-month surveys and continuous ElderTree usage data. Results: No significant differences were found between the laptop versus smart display groups for pain interference (b=–0.11, 95% CI –1.07 to 0.85; P=.82) or psychosocial quality (b=–0.21, 95% CI –0.96 to 0.55; P=.56), nor between the combined laptop+smart display group versus control group for either outcome (pain interference: b=–0.41, 95% CI –1.23 to 0.41; P=.33; psychosocial quality of life: b=0.04, 95% CI –0.61 to 0.69; P=.90). Mediation was not tested because effects on primary outcomes were nonsignificant. Gender did not moderate the effect of laptop versus smart display groups in pain interference (b=–1.56, 95% CI –3.56 to 0.44; P=.13). Gender did moderate the effect of the combined laptop+smart display group versus control group (b=1.91, 95% CI 0.11 to 3.71; P=.04). Women showed a significant decrease in pain interference (b=–0.69, 95% CI –1.29 to –0.10; P=.02), whereas women in the control group showed no significant change (b=0.25, 95% CI –0.53 to 1.04; P=.53). Men in the combined group showed a nonsignificant decrease (b=–0.67, 95% CI –1.47 to 0.14; P=.10), whereas men in the control group showed a significant decrease (b=–1.61, 95% CI –2.88 to –0.35; P=.01). Participants assigned to the laptop versus smart display used ElderTree more frequently and had more favorable perceptions. Analyses of secondary and exploratory outcomes showed no significant differences between groups. Conclusions: We found no significant differences between the combined ElderTree group and the control group for changes over time in any primary, secondary, or exploratory outcomes. Moderation analyses indicated that only gender moderated study arm effects, and only for the laptop+smart display versus control group on changes over time in the two primary outcomes. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196

Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196

Background: With the ubiquity of smartphones, digital self-report instruments have enormous potential to support the general population in monitoring their mental health. A primary challenge for researchers committed to advancing this work is simply to scope the plethora of widely used candidate instruments. The overarching aim of this study was to address this challenge to support and guide future research in this burgeoning area. Objective: This study aimed to conduct a literature review of self-report instruments used in empirical studies to measure mental health (1) in the general population, (2) delivered in a digital format, and (3) in longitudinal designs. Given the wide range of recognized “mental health” constructs, the review’s search strategies were guided by Keyes’ dual continua model of mental health, recognizing both deficits- and strengths-based constructs. This study’s primary objective was to develop a first-of-its-kind ranking and synthesis of the most frequently used instruments that are potentially suitable for mental health self-monitoring. It was not an objective of this study to evaluate psychometric properties of the identified instruments—we hope the present ranking and synthesis will provide the foundation for future research into optimal digital, prospective self-report of mental health. Methods: Five major electronic databases were searched. Studies that administered digital mental health instruments (in English) repeatedly to community dwellers in the general adult population were eligible. The included studies were grouped by instruments for synthesis using a narrative approach. Results: Preliminary screening of 95,849 records identified 8460 eligible records, among which 1000 records were randomly selected over 4 iterations for full-text screening. A total of 223 records were included. We found that the top 30 most commonly used instruments accounted for 78.4% (308/393) of the total usage across studies. These instruments predominantly measure deficits-based mental health constructs. The Patient Health Questionnaire 9 Items and Generalized Anxiety Disorder 7 Items were by far the most used instruments. The most commonly measured strengths-based constructs were life satisfaction and mental well-being. Conclusions: The findings of this review strongly suggest that scientific investigation of mental health constructs across time on digital platforms still prioritizes deficits-focused instruments originally developed for pen-and-paper administration using classical test theory. These findings are discussed in light of evidence in the literature that deficits-focused instruments demonstrate inferior distributional properties (floor effects) in the general population and theory suggesting that both deficits- and strengths-focused measurements are required to holistically assess mental health. Limitations of the review include the restricted focus on English language instruments and the pragmatic approach to selecting records for full-text screening. It is concluded that, in the smartphone age, it would be timely to develop new digital instruments framed by holistic models of mental health and using contemporary test construction approaches. Trial Registration: PROSPERO CRD42022306547; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022306547

While the pain- and stress-reducing effects of music are well investigated, effects of visual art and the combination of both modalities (music and visual art) are much less explored. We tested the (1) pain- and (2) stress-reducing effects of a multimodal (music + visual art) aesthetic experience—expecting stronger effects than single modal aesthetic experiences (music or visual art)—and, in an exploratory manner, (3) investigated underlying mechanisms of aesthetic experience and (4) individual differences. In a repeated-measures design (music, visual art, multimodal aesthetic experience, control), 42 female participants submitted their self-selected movingly beautiful visual artworks and music pieces to the lab, where pain and stress were induced by a cold pressor test. Pain (global pain perception, pain intensity, pain affect, pain tolerance) and stress responses (subjective reports, autonomic [electrocardiography, electrodermal activity, salivary alpha-amylase] and endocrine activity [salivary cortisol]) were measured. Individual differences of the experience, trait empathy and absorption were investigated. Exposure to multimodal art resulted in longer pain tolerance than single modality of visual art, but no difference was found for music. Other measures of pain intensity, stress intensity, and pain affect did not differ across the conditions. Regarding the mechanisms, exposure to all types of art distracted participants’ attention from pain, prompted mind wandering, and elicited greater enjoyment than the control condition. Physiological measures of electrocardiography and electrodermal activity validated our design: participants were more stressed during the cold pressor test, but no differences were observed across the four conditions. Also, no differences were found regarding cortisol and alpha-amylase. Regarding individual differences, higher trait absorption was associated with longer pain tolerance in the multimodal condition and with lower pain intensity in the music-only condition, compared to the other conditions. In conclusion, exposure to art can influence pain; however, the underlying mechanisms require further research.

This pre-registered report aims to explore the impact of cultural diversity on fintech development through the perspective of dialectal diversity. Specifically, we want to investigate three key questions: (1) Does cultural diversity influence fintech development? (2) If it does, what are the underlying mechanisms? (3) Moreover, does the impact of cultural diversity on fintech development vary across regions or households with heterogeneous characteristics? To explore these questions, we plan to utilize regional dialect data and analytical methods such as instrumental variables and fixed effects to examine fintech adoption at the household level. This report contributes to understanding the informal institutional factors underpinning the development of fintech, and provides new theoretical and practical perspectives for building a more comprehensive and inclusive fintech system.

Background: Effective disease surveillance is essential for understanding epidemiology, detecting outbreaks, and enabling timely public health responses, as demonstrated during the COVID-19 pandemic. In the UK, large-scale studies such as the ONS COVID-19 Infection Survey (CIS) monitored SARS-CoV-2 transmission but required significant resources, making them challenging to sustain in resource-limited settings. In contrast, the Virus Watch study, with a lower cost, relied on self-reported data and symptomatic testing, while SARI Watch leveraged hospital data for cost-effective surveillance. Objective: Our study evaluates Virus Watch’s effectiveness in tracking COVID-19 trends, using ONS CIS and SARI Watch as benchmarks for comparison. Methods: We used the Virus Watch prospective community cohort study to estimate COVID-19 positivity, incidence and hospitalisation rates in England and Wales from June 2020 to February 2023. We compared our findings with modelled positivity and incidence rates from ONS CIS and COVID-19 hospitalisation rates from SARI Watch using 9-week rolling Spearman’s ⍴ correlation to measure synchrony. Results: 58,628 participants were recruited into the Virus Watch study between June 2020 and March 2022, of whom 52,526 (90%) were reported to be living in England and 1,532 (2.6%) in Wales. Virus Watch estimates of COVID-19 positivity and incidence rates in England and Wales were highly correlated with those from ONS CIS. Despite lower absolute values in Virus Watch estimates, both studies showed strong global (overall ⍴s > 0.90) and local (median ⍴s > 0.75) synchrony over time. However, Virus Watch estimates of hospitalisations with COVID-19 were significantly lower and less synchronised with SARI Watch estimates (overall: 0.72, P<.001; median: 0.49, IQR 0.15-0.70). In Wales, Virus Watch estimates exhibited greater variability and lower local synchrony compared to England (overall positivity ⍴: 0.75, P<.001; overall incidence rate ⍴: 0.85, P<.001). Conclusions: Our results highlight the effectiveness of the Virus Watch approach in providing accurate estimates of COVID-19 positivity and incidence rates, even in the absence of national surveillance systems. This low-cost method can be adapted to various settings, particularly low-resource ones, to strengthen public health surveillance and inform timely interventions.

Mentalizing, the ability to attribute mental states to oneself and others, is commonly assessed using a variety of neuropsychological tests. However, whether these tools capture unique aspects of mentalizing or primarily reflect reasoning and language abilities remains unclear. This pre-registered study examines the incremental validity of four widely used mentalizing assessments: the Hinting Task, the Faux-Pas test, the Reading the Mind in the Eyes Test, and Frith–Happé Animations. We aim to determine whether these tests uniquely predict self-reported mentalizing abilities in daily life (using various self-reported indices of mentalizing) beyond general reasoning and language skills. Beyond testing the incremental validity of each test, we will also conduct several exploratory analyses, including head-to-head comparisons between the performance-based tests and multimodal associations between tests and self-report questionnaires. This study will clarify the relevance of mentalizing assessments, offering valuable implications for research and clinical practice.

Literature on person perception suggests the primacy of morality over sociability in interactions. While theories of emotion highlight the importance of adhering to socially acceptable display rules, a contentious debate surrounds whether individuals prioritize moral or sociable communication of emotions. We investigated how people perceive and react to others who falsely communicate empathic versus truthfully communicate unempathic emotions related to others' (mis)fortunes. Through three preregistered studies, we examined participants' perceptions (sociability and morality) and behavioral reactions (in a Dictator Game) by employing various paradigms (vignette and retrospective recall) and situations (e.g., promotion and lottery). Consistently across our studies, we found that participants perceived targets who truthfully communicated unempathic emotions as higher on morality and lower on sociability compared to those who falsely communicated empathic emotions. Moreover, Studies 2 and 3 revealed that participants formed more favorable impressions of, and were more willing to interact with, the target who falsely communicated empathic emotions, as opposed to those who truthfully communicated unempathic emotions. This preference was explained by perceived morality and sociability attributed to the targets. Building on these findings, we propose two follow-up studies aimed at replicating our results and extending them to a laboratory setting – a Gamble Game where participants will directly encounter an actual (mis)fortune, and a Dictator Game with an allegedly real interaction partner. Our expected findings indicate that falsely communicating empathic emotions is favored over truthfully communicating unempathic emotions, suggesting the primacy of sociability over morality in the context of communicating emotions related to others' (mis)fortunes.

It is important to understand how persuasive the most-cited climate change messaging strategies are. In five replication studies, we found limited evidence of persuasive effects of three highly cited strategies (N = 3,216). We then conducted a registered report megastudy (N = 13,544) testing the effects of the 10 most-cited climate change messaging strategies on Americans’ pro-environmental attitudes and behaviour. Six messages significantly affected multiple preregistered attitudes, with effects ranging from 1 to 4 percentage points. Persuasiveness varied little across party lines, inconsistent with theories predicting heterogeneous effects for targeted messages. No message increased pro-environmental donations, suggesting costly behaviours are difficult to influence with messaging alone. Inference of mechanisms driving effects was limited as the most impactful messages influenced multiple mediating variables. Taken together, these results identify several persuasive strategies, while also highlighting the limits of short-form messages for increasing Americans’ support for action to address climate change.

Loneliness and social isolation are associated with several negative health outcomes in older adulthood, including adverse cognitive outcomes and increased mortality risk. Between-study variability in how these constructs are defined and modeled poses a major challenge, potentially contributing to inconsistencies in previous findings. In response, this registered report leveraged a coordinated data analysis framework, applying independent but harmonized operational definitions and statistical models across 11 longitudinal studies of aging (N > 110,000) representing 20 countries. Using Cox regression, logistic regression, and multistate survival models (MSMs), we systematically examined how loneliness and social isolation—both separately and in combination—are associated with cognitive aging outcomes (no cognitive impairment, mild cognitive impairment, severe cognitive impairment) and mortality risk. Preliminary synthesized results based on random-effects meta-analysis show that loneliness and isolation both predict increased risk of dementia and death in Cox and logistic models (all ps < 0.001), with isolation showing a particularly strong link to mortality. In MSMs, however, loneliness (but not isolation) was associated with an increased risk of transitioning from no impairment to mild cognitive impairment. Loneliness and isolation were also associated with an increased risk of transitioning from mild cognitive impairment to death, but this was only true for isolation when loneliness was included in the model. Conversely, isolation appears to be most important for the transition from mild to severe cognitive impairment. Discussion will focus on the evidence for and against the generalizability and variability in associations among social disparities, cognitive outcomes, and mortality risk across individuals, time, and countries.

Different women experience hormonal contraceptives differently, reporting side effects on their sexuality that range from negative to positive. But research on such causal effects of hormonal contraceptives on psychological outcomes struggles both to identify average causal effects and capture the high heterogeneity in women’s treatment responses. In this study, we leveraged longitudinal data to improve our ability to separate the causal effects of hormonal contraceptives from other sources of association, including observed and unobserved confounding, reverse causality, and attrition. In this programmatic registered report (programmatic registered stage 1 protocol: https://osf.io/kj3h2; date of in-principle acceptance: 28/09/2023), we analyzed data from up to 5,041 women (23,130 observations), who participated in PAIRFAM, a German longitudinal panel dataset consisting of 14 waves, using Bayesian multilevel regressions. To deal with confounding and probe the robustness of findings, we implemented two analysis approaches: adjusted regression analysis and inverse probability of treatment weighting approach. We found evidence for positive average treatment effects of hormonal contraceptives on sexual frequency and sexual satisfaction, but no robust evidence for effects on desired sexual frequency. Furthermore, to move beyond average treatment effects, we analyzed heterogeneity in treatment responses. We found relatively high heterogeneity in individual treatment effects on sexual frequency and sexual satisfaction. Interindividual differences were not systematically related to individual treatment effects, and those treatment effects did not predict women’s decisions about which contraceptive method to use in the long run. Our results contribute to understanding the effects of hormonal contraceptives on sexuality in a naturalistic setting, where women adapt their choice of contraceptive method to their own experiences.

The integration of artificial intelligence (AI) in business education marks a significant shift in pedagogical approaches, yet the psychological mechanisms and contextual factors influencing its effectiveness are not yet fully understood. This registered report-stage I study aims to contribute to the field by examining the impact of AI usage on college students' academic self-efficacy and performance in business courses, with a particular focus on the role of teacher support. Drawing on self-efficacy theory, the study proposes a theoretical framework with 4 hypotheses, and employes field and online experiments to test these hypotheses. By addressing the current gaps in research, this study seeks to contribute to the academic literature on the integration of AI in business education, with a focus on self-efficacy and teacher support. The study not only deepens our understanding of the impact of AI in business education but also underscores the critical role of teacher support in shaping student outcomes in the context of AI integration.

Background: Many patients struggle to understand referral letters and discharge summaries; low health literacy is prevalent, and short consultations limit explanations. Large language models (LLMs) can translate clinical jargon into layperson language, but their impact on doctor–patient communication in real care remains untested.

As corporate attention to ESG issues continues to grow, the disagreement in ratings for the same company by different ESG rating agencies have sparked widespread discussion and concern. This report aims to explore how corporate efforts in ESG information disclosure can effectively reduce rating disagreements from the perspective of information asymmetry. Using a 2008–2022 sample of Chinese listed firms, we measure corporate ESG disclosure from annual reports and construct a metric of ESG rating divergence from ratings provided by domestic and international agencies. We examine the underlying mechanisms, including information asymmetry, analyst attention, and media oversight. We also investigate the sources of the change in ESG rating disagreement by examining whether the shift stems from domestic versus international agencies, or from incumbent versus new entrants. Besides, we examine how ESG disagreement affects corporate valuation (proxied by Tobin's Q) and how policy-driven changes in disclosure influence firm value, using a portfolio analysis approach. This report sheds light on the economic consequences of voluntary ESG information disclosure, providing support for the future establishment of unified ESG information disclosure standards.

Mesoporous silica (MS) is widely recognized as a local drug delivery system in bone-related diseases. Although MS enables controlled or sustained release and improved bioavailability of therapeutic agents, its limited native osseointegration capacity remains a critical barrier to effective bone regeneration. Numerous engineering strategies have therefore been proposed to enhance its biological performance. This scoping review protocol aims to collect studies, published from January 2015 onwards, that report evidence on the osseointegration potential (i.e., osteoconductive, osteoinductive, or proangiogenic properties) of MS bone drug delivery systems. Studies indexed in PubMed, Scopus, and Embase will be screened to identify the strategies used to improve MS-mediated bone regeneration, including structural modifications, formulation into composites, and incorporation of bioactive molecules. A structured analytical framework will be applied to explore how specific design approaches relate to biological outcomes across experimental models in vitro, in vivo, or ex vivo. The resulting scoping review will identify trends and knowledge gaps in strategies intended to enhance the osseointegration of MS bone drug delivery systems, supporting their future development and rational optimization for bone repair.

A recommendation of: Sigrid H. Ingvaldsen, Ida Svege, Jan-Ole Hesselberg Evaluation of a Funder-Driven Registered Report Initiative https://osf.io/6ynbq/files/kt2qg

Although the distinction between episodic and semantic memory is supported by numerous neuropsychological studies, neuroimaging data have shown considerable overlap between regions that are activated during semantic and episodic remembering. This might indicate similar or shared mechanisms but might also result from inadequate task designs or poor functional magnetic resonance imaging signal coverage. Here we compared neural activations and representations associated with successful retrieval of episodic and semantic memories, using tasks that are more closely matched. A total of n = 40 participants recalled pairings between logos and brand names, where the pairings corresponded to real-world knowledge (semantic task) or were learned in an initial study phase (episodic task). Neither a priori-defined networks nor clusters generally activated by our task provided evidence for any difference between successful semantic and episodic retrieval, with the Bayes factor for the a priori networks supporting the null hypothesis of no difference. Protocol registration The Stage 1 protocol for this Registered Report was accepted in principle on 15 September 2021. The protocol, as accepted by the journal, can be found at https://osf.io/dm47y/.

Using the 2021 enforcement of China's Data Security Law and Personal Information Protection Law as an external shock, this pre-registered study seeks to explore whether—and through which channels—cross-border data flow restrictions are associated with changes in multinational enterprises' financing constraints. Employing a difference-in-differences framework combined with propensity score matching and entropy-balancing matching, we aim to examine whether the regulatory shock affects multinational enterprises' financing constraints through channels related to operational efficiency and information asymmetry. We further explore how firm characteristics, such as foreign sales intensity and state ownership, may condition these effects, with the former potentially intensifying frictions and the latter possibly providing institutional resilience.

BACKGROUND: Limited empirical evidence exists on the effectiveness of a hybrid approach to heart-healthy lifestyle interventions that integrates mHealth technology with face-to-face counseling. Moreover, its superiority over exclusive mHealth use in promoting heart-healthy behavioral outcomes within a community setting remains unclear. OBJECTIVE: This study aims to evaluate the effectiveness of a hybrid community-based approach to heart-healthy lifestyle intervention incorporating a mobile application and motivational interviewing among community-dwelling adults without a history of cardiovascular disease. METHODS: We conducted a three-arm, parallel-group, randomized controlled trial with assessments at baseline and after 12 weeks. A total of 75 participants, each presenting at least one component of metabolic syndrome and no history of cardiovascular disease, were randomly assigned to one of three groups: hybrid (n=25), mobile (n=25), or control (n=25). Participants were recruited through online platform. The hybrid group underwent a 12-week hybrid intervention combining a mobile application (i.e., "My HeartHELP") and face-to-face motivational interviewing led by a nursing researcher. The mobile group used only the mobile application, while the control group received written material on general heart health. The intervention was facilitated by three trained nursing researchers. The primary outcome was a composite score of 'heart-healthy behaviors', while secondary outcomes included scores for heart-healthy 'information', 'self-efficacy', 'motivation', and cardiovascular parameters. The trial was conducted in two rounds from October 2022 to May 2023. An intention-to-treat analysis was performed. RESULTS: Of the 75 participants, 72 (96%) completed the study. Compared with the control group, both the hybrid and mobile intervention groups demonstrated significantly greater improvements in behavioral outcomes, including composite heart-healthy behavior (F=7.25, P=.001), its theoretical predictors-heart-healthy motivation (F=8.54, P< .001) and self-efficacy for diet (F=4.87, P=.011) and exercise (F=5.48, P=.006)-as well as fasting glucose levels (F=3.90, P=.025) following the 12-week intervention. Particularly, the hybrid group-unlike the mobile group-showed significantly greater improvement in dietary behavior, a subscale of heart-healthy behavior, compared with the control group, and demonstrated significantly greater improvements in Interest/Enjoyment, a core subscale of intrinsic motivation than the mobile and control groups. CONCLUSIONS: The hybrid community-based heart-healthy lifestyle intervention-integrating a mobile application and motivational interviewing-demonstrated overall effectiveness comparable to the mobile application alone, while yielding greater improvements in dietary behavior and core intrinsic motivation. These findings highlight the potential of mHealth applications as practical, standalone tools to promote cardiovascular health, particularly in community settings with limited access to in-person professional support. However, incorporating motivational interviewing may further enhance internalized motivation and complex behavior changes over time. Health professionals can therefore adopt mHealth either independently or in combination with motivational interviewing. Future studies should optimize integration strategies to enhance effectiveness and evaluate the long-term sustainability of such hybrid approaches. CLINICALTRIAL: The trial was registered on the ISRCTN (no.83643383). INTERNATIONAL REGISTERED REPORT: RR2-10.1161/circ.147.suppl_1.P147.

Background: Digital methods that enable early caries identification can streamline data collection in research and optimize dental examinations for young children. Intraoral scanners are devices used for creating 3D models of teeth in dentistry and are being rapidly adopted into clinical workflows. Integrating fluorescence technology into scanner hardware can support early caries detection. However, the performance of caries detection methods using 3D models featuring color and fluorescence in primary teeth is unknown. Objective: This study aims to assess the diagnostic agreement between visual examination (VE), on-screen assessment of 3D models in approximate natural colors with and without fluorescence, and application of an automated caries scoring system to the 3D models with fluorescence for caries detection in primary teeth. Methods: The study sample will be drawn from eligible participants in a randomized controlled trial at the Royal Children’s Hospital, Melbourne, Australia, where a dental assessment was conducted, including VE using the International Caries Detection and Assessment System (ICDAS) and intraoral scan using the TRIOS 4 (3Shape TRIOS A/S). Participant clinical records will be collected, and all records meeting eligibility criteria will be subject to an on-screen assessment of 3D models by 4 dental practitioners. First, all primary tooth surfaces will be examined for caries based on 3D geometry and color, using a merged ICDAS index. Second, the on-screen assessment of 3D models will include fluorescence, where caries will be classified using a merged ICDAS index that has been modified to incorporate fluorescence criteria. After 4 weeks, all examiners will repeat the on-screen assessment for all 3D models. Finally, an automated caries scoring system will be used to classify caries on primary occlusal surfaces. The agreement in the total number of caries detected per person between methods will be assessed using a Bland-Altman analysis and intraclass correlation coefficients. At a tooth surface level, agreement between methods will be estimated using multilevel models to account for the clustering of dental data. Results: Automated caries scoring of 3D models was completed as of October 2023, with the publication of results expected by July 2024. On-screen assessment has commenced, with the expected completion of scoring and data analysis by March 2024. Results will be disseminated by the end of 2024. Conclusions: The study outcomes may inform new practices that use digital models to facilitate dental assessments. Novel approaches that enable remote dental examination without compromising the accuracy of VE have wide applications in the research environment, clinical practice, and the provision of teledentistry. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622001237774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384632

Presented by OSF

A recommendation of: Ellen M. O'Donoghue, Pierre-Yves Oudeyer, Helene Sauzeon, Yana Fandakova, Matthias J. Gruber How curiosity enhances hippocampus-dependent learning across late childhood and early adolescence https://osf.io/c9m8d?view_only=206d69bc700347adbbc7e4d5329405e9

A recommendation of: Yusaku Takamura, Emaad Razzak, Sarah Coustaty, Jianghao Liu, Pierre Pouget, Alfredo Spagna, Paolo Bartolomeo Oculomotor Markers of Visuospatial Mental Imagery in Aphantasia and Visualizers https://osf.io/g4fzv

This pre-registered report aims to explore the interaction between entrepreneurship and poverty alleviation based on a microfinance policy perspective, trying to answer three questions: 1) whether the microfinance policy implementation will improve poor entrepreneurs' access finance? 2) If it does, what is the underlying mechanism? 3) what is the impact of the microfinance policy on local entrepreneurial vitality? To explore such three questions, we utilize microfinance poverty alleviation policy issued in China as an exogenous policy shock to conduct a triple difference-in-difference analysis. This pre-registered report expands the understanding on microfinance poverty alleviation through entrepreneurship, and provides a new perspective for consolidating the poverty alleviation performance of finance and preventing a return to poverty.

A recommendation of: Anastazja Adamczyk, Christine Mohr, Elise Dan-Glauser, Domicele Jonauskaite Registered report protocol for the Perception Census: Linking colour preferences and colour-emotion associations https://osf.io/u8h5n?view_only=d783d8c9d2564c9c916370b66f9756e0

A recommendation of: Matt N. Williams, Mathew D. Marques, Mathew Ling, Stephen R. Hill, John Kerr, Edward J. R. Clarke, Ahnya Martin, Robert M. Ross Do you really believe that? Examining the prevalence and predictors of belief in conspiracy theories when accounting for insincerity https://osf.io/saqdn/files/xeasj?view_only=5598eac28e0a4a619835eb8c9a192e80

This pre-registered report examines how Lunar Superstitions from the traditional Almanac affect investors' behavior in stock markets across the major Asian economies, including Mainland China, Hong Kong SAR, and Taiwan. We are going to investigate four questions in this study: 1) Do the Lunar superstition beliefs affect stock market returns and trading volumes in the stock markets where Chinese investors participate? 2) What are the mechanisms underlying these effects? 3) If so, under what circumstances will these effects be more pronounced? 4) What are the economic consequences of these effects? This research improves the understanding of how heuristics from superstition beliefs shape investors' decision-making when trading risky assets.