Therefore, it is a very interesting and important research question to explore the influencing factors of the popularity of COVID-19 videos during the COVID-19 pandemic; (2) Our research collects video data related to the keyword “COVID-19” on video platform, the data are analyzed by content analysis and empirical analysis. We then constructed a theoretical model based on the information adoption model; (3) A total of 251 videos were divided into three categories. The least common category was the data and analysis category (11.2%), followed by the prevention and control status category (13.5%); the knowledge and general science category was the most common (75.3%). From the perspective of video quality, the information sources of most videos are relatively reliable, and the content of medical information is low. The research results showed that short video lengths, longer descriptions, more reliable video sources and lower medical information content were more popular with audiences. Audiences are more likely to be attracted to videos in the prevention and control status category and knowledge and general science category. Videos uploaded by uploaders who have a higher influence are more popular with audiences; (4) Conclusions: During the COVID-19 pandemic, information quality  and source credibility  all significantly influence the popularity level of COVID-19 videos. Our research conclusions can provide management suggestions for the platform, make videos released by uploaders more popular with audiences, and help audiences better understand COVID-19 information and make prevention and control efforts. In December 2019, a new type of coronavirus , and namDuring the pandemic, social media became the main source of information for people to understand it . A UNESCIn a fast-paced environment, short attention and distraction have become the generational characteristics of Gen Z . RothmanWith the spread of the epidemic, the number of infections and deaths continues to increase. Videos about COVID-19 on various video platforms have exploded, and people hope to obtain and share information about COVID-19 through videos. When such explosive information appears in front of an audience, the audience will have more choices, but only a few videos can gain major popularity . Every uSeveral obvious gaps in the current study could be narrowed. First of all, studies on the transmission of text information have used a variety of different platforms as data sources, including Twitter ,25, WeibSecondly, previous studies on the factors affecting the popularity of COVID-19 videos have mainly been conducted from the perspective of certain video features ,30, whilAccording to information adoption model, independent variables including information quality variables ) and source credibility variables (information source reliability (modified DISCERN), influence, and certification type) are established, and a text analysis method is used to study the content category of the videos. The modified DISCERN and MICI variables are quantitatively analyzed through the content analysis method, while information quality and source credibility are included in the regression model.The information adoption model (IAM) combines the technology acceptance model  and the The length of a video refers to the playing time of a video, which is an important index when studying the factors influencing the popularity of a video. The public usually uses fragmented time to watch videos on mobile devices, such that shorter videos are more in line with public consumption habits . Guo (20Hypothesis 1 (H1).During the COVID-19 pandemic, the shorter the video length, the more popular the COVID-19 video is.The length of the video title is the number of characters in the video title. During the COVID-19 pandemic, the public has come into a state of panic, hoping to use video platforms to obtain information in order to alleviate their anxiety, with a strong purpose. video platform has a word limit for video title display; if the title is too long, the integrity of information and perceived usefulness of the video will be affected.The video information may not be adopted and the video can become unpopular with audiences ,43.Hypothesis 2 (H2).During the COVID-19 pandemic, the shorter the video title, the more popular the COVID-19 video is.The description length of a video refers to the length of the description text of the video. The description can help the audience to understand the video content, and is an extension of the video title. Thackeray (2013) has shown that the more descriptive information a video contains, the more views it receives . The lonHypothesis 3 (H3).During the COVID-19 pandemic, the longer the video description, the more popular the COVID-19 video will be.Video content type refers to the type of information contained in the video, which requires qualitative analysis using text analysis. Uncertainty reduction theory states that, when a crisis occurs, people tend to learn more objective details related to the crisis, in order to reduce the associated uncertainty . Due to Hypothesis 4 (H4).During the COVID-19 pandemic, different content types of COVID-19 video have significant differences in the popularity level of audiences.The pragmatic expression of the title is the type of sentence in the video title. After the outbreak of COVID-19, affected by environmental and personal tension, people tend to share and adopt information selectively , where iHypothesis 5 (H5).During the COVID-19 pandemic, different types of pragmatic expression of COVID-19 video titles have significant differences in the popularity level of audiences.Different from other videos, COVID-19 videos are a type of video containing medical information, such that we need to take medical information into consideration. Liu (2019) found, in a study of videos on chronic diseases, that videos with high medical information content are difficult to continuously attract patients, as patients have difficulty in understanding complex medical information, in order to make decisions and self-management; as such, they are not interested in videos with high medical information content . The MedHypothesis 6 (H6).During the COVID-19 pandemic, the lower the medical information and content index (MICI) of the video, the more popular the COVID-19 video is among audiences.The reliability of video information sources refers to the reliability of reference information sources in videos. It is generally believed that professional and official sources are more reliable. The reliability of information sources is an important factor affecting information adoption. In COVID-19 videos, the more reliable the information source is considered to be, the higher the quality, the stronger the audience’s perceived usefulness, and the more popular the video . For theHypothesis 7 (H7).During the COVID-19 pandemic, the more reliable information sources (modified DISCERN) of COVID-19 videos are, the more popular COVID-19 videos will be.In addition to the credibility of the video information, trust in the uploader is an important source of trust in the uploaded video information. Previous studies have shown that audiences must first judge the credibility of the video uploader, before deciding whether to conduct further communication ,60,61. AHypothesis 8 (H8).During the COVID-19 pandemic, the greater the influence of uploaders, the more popular the videos published by them will be.Hypothesis 9 (H9).During the COVID-19 pandemic, uploader’s certification types are different, and the popularity level of COVID-19 videos published by uploader is significantly different.Perceived usefulness refers to the extent to which users believe that a specified system can improve their own work efficiency , which iIn these social behaviors, likes, shares, collects, and coins are all types of positive feedback from the audience, while comments contain both positive and negative feedback. In order to ensure the consistency of the indicators, it is necessary to conduct sentiment analysis on the comments. There was a huge difference in the number of video comments selected in this paper, so the number of positive comments, rather than positive comment rate, was chosen as an indicator.The independent variables of the research model include information quality variables  and source credibility variables . The popularity level was indicated by the dependent variables . The definitions of the variables are provided in According to the hypothesis, we can present the research model of this paper, as shown in The research data of this paper comes from a video platform in China that pays attention to originality. The strong social nature of the platform makes the platform’s audience more active, and audiences are willing to share information on the platform. Platform features and data information features can well meet the requirements of this study.We used “COVID-19” and “COVID-19 pandemic” as search keywords, and selected data from January 2020 to February 2020, obtaining a total of 528 video data. Information of the COVID-19 videos considered in this paper included all the information needed for our research: Video features , uploader features , and popularity level of the video .As the search mechanism can retrieve any video with keywords in the title, tag, description, or uploader name, the search results were not necessarily relevant to COVID-19. Therefore, manual reading was used to clean the data and remove the irrelevant and missing data. A total of 251 videos highly related to COVID-19 were obtained.Sentiment analysis is a text analysis method used to explain the emotional intensity of text . A sentiThe subject of each video was confirmed by clustering the subject of the title and description text of the video. First, we used the jieba library for Chinese word segmentation, then processed the result after word segmentation to make the word segmentation result more accurate. Secondly, the Word2vec model was used to train the word vectors of the text after word segmentation. The clustering algorithm used was Kmeans, which has high efficiency, is simple, and has been widely used. Through the sum of squared errors (SSE) method, the best K value was determined to be 3; that is, the topics were clustered into three categories.The results of topic clustering are shown in For the coding of video content, the modified DISCREN and MICI methods were adopted. Two researchers were invited to watch the videos independently, who checked each of the standards. If they thought the video content met the standard, they answered yes; if not, they answered no. The result of the Cohen Kappa test showed that the coding result Was reliable.DISCREN tool is a 16-item scale developed by Charnock. Singh modified it into a 5-item scale. The answer to each question is yes/no, where “yes” is marked as 1, and “no” is marked as 0, with a total score between 0 and 5 ,58. The MICI is a five-item scale which evaluates from the five perspectives of prevalence, transmission, symptoms, disease diagnosis, and treatment. Each perspective includes five different scoring standards, such that the MICI scores from 0 to 25. The evaluation standards are shown in In this paper, Stata16.0 software is used for empirical analysis.The results of the descriptive statistical analysis of the considered 251 videos are shown in From the perspective of uploader certification types , ordinarIn terms of content types of videos , among tIn order to test whether there was multicollinearity, caused by strong correlations among the independent variables, we conducted a correlation analysis on the independent variables. As can be seen from We estimated the variance inflation factors (VIF) of the respective variables, and the results in In this study, the popularity levels of the dependent variables  were all non-negative integers, and the variance is much larger than the mean; therefore, the negative binomial regression model was adopted for estimation. The results of hypothesis testing are shown in p = 0.079), coins , likes , shares , Collects  and positive comments  were negatively correlated with length, with statistical significance. The IRR values of the six dimensions of the dependent variable indicated that, for every minute the video length increases, views decrease by 0.3%, shares and positive comments decrease by 0.6%, likes and collects decrease by 0.7%, and coins decrease by 0.8%. Thus, H1 was well-supported.H1 states that the longer the length of the COVID-19 video, the less popular it will be. p = 0.003) and Model 4 , it can be found that, for each character increase in the title length, positive comments decrease by 2.6% and shares decreases by 1.8%; however, the p-values of other models were not statistically significant. Therefore, H2 was rejected.From Model 6 , likes , shares , collects  increased, in a statistically significant manner, as the description length increased. However, views and positive comments also showed increasing trends when the description length increased, but the results were not significant. Therefore, H3 was partially supported.Coins , likes , shares  and collects  of knowledge and general science category increase significantly; views, likes , shares , collects  and positive comments  of Prevention and control status category also significantly increased. This demonstrates that different content types of videos are popular at different levels among audiences. Therefore, H4 was supported.As the video content type is a categorical variable, we used the data and analysis category as the control group for negative binomial regression. Compared with data and analysis category videos, views , coins , likes , shares , collects  and positive comments , significantly decreased with the increase of medical information content. H6 is founded.Verification results for H6 showed that the popularity level of COVID-19 videos, as indicated by views , coins , likes , shares , collects  and positive comments  having a positive and significant effect. Taking collects as an example, the collects increased by 67.5% with every increase in the modified DISCERN score. Therefore, H7 was well-supported.The hypothesis 7 verification results show that the modified DISCERN score was, indeed, suitable, with views , coins , likes , shares , collects  and positive comments in relation to uploader influence verified H8.H8 states that the greater the influence an uploader has, the more popular their videos will be.The analysis of Views , coins , likes , shares , collects  and positive comments  were significantly reduced. Therefore, H9 was supported.When the uploader’s certification type was that of an institutional certification, views  and source credibility  variables had significant influences on the popularity level of COVID-19 videos .With respect to information quality, our research results indicate that the shorter the video length and the longer the description length, and the more popular the COVID-19 video. In terms of the MICI values, we found that audiences preferred COVID-19 videos with lower medical information content. In addition, we also conducted text analysis on the video content type, and found three different video types: Data and analysis, knowledge and general science, and prevention and control status. Among them, the data and analysis category is a video content type that was different from that in other past pandemics (such as Ebola), being the product of the era of big data. We found that different content types of videos attracted audiences to different degrees, especially in terms of views, likes, shares, and collects.Considering source credibility, audiences preferred COVID-19 videos with more reliable information sources. The research in this paper found that there were no big differences in the content of videos uploaded by uploaders with different certification types, consistent with past research focused on YouTube. Compared with ordinary users without certification, audiences were not interested in videos uploaded by uploaders certificated by organizations. According to the research results on the influence of uploaders, the greater the influence of an uploader, the more popular their videos are. Previous studies on the features of uploaders, especially their influence, have mainly been conducted in online social communities, and rarely applied to video research focused on public health events. This paper innovatively included the features of uploaders into the model and verified their effects, which is of great significance.Our research has the following contributions:First, we selected a new video as the research data source. Previous studies have mostly chosen YouTube, but their results have shown that the quality of videos on YouTube is generally low and the information sources are unreliable . The resSecond, we innovatively considered the features of uploaders in the model. Uploader features have been extensively studied in the online health community, but rarely from the perspective of public health events. This paper, thus, has made a new attempt in this aspect.Third, in terms of video content types, we proposed three categories of videos on social platforms through text analysis, including data and analysis, knowledge and general science, and prevention and control status. The text analysis in this paper has discovered the new video category of data and analysis, which is a product of the era of big data. The data of confirmed cases, suspected cases, and death cases in various countries and regions have been widely utilized by uploaders, in order to visually display the real-time situation of the epidemic to the audience, through use of the visualization functions of various data analysis software.Our research has important implications for management:In terms of the video platform, the research conclusions of this paper provide a reference for the platform to judge whether the video is likely to be popular with certain audiences. The platform can optimize the recommendation algorithm from the two aspects of information quality and source credibility, and recommend videos that may be popular to audiences, in order to improve the activity in the platform. The platform can standardize the video upload strategy, such as informing uploaders on the video upload page that the video description should be as detailed as possible, in order as to improve the overall quality of the video on the platform.In terms of uploaders, every uploader hopes that their uploaded videos can be welcomed by more audiences. The research conclusions of this paper can help uploaders to make videos more popular, through optimizing video information quality and improving their influence on the platform. This gives uploader more angles to increase the popularity level of their videos, which is of great practical significance.In terms of audiences, we analyzed the types of videos that audiences are attracted to. In the context of the COVID-19 pandemic, audiences hope to obtain more information through the use of video platforms. The research presented in this paper can help audiences to obtain more useful information within their fragmented time, and their anxiety can also be relieved in the process of obtaining information and socializing.There are still many shortcomings in this paper, which need to be resolved in future research. First, in terms of data set selection, only one data set was selected in this paper, which was insufficient, in terms of the ductility of the research conclusions. The main reason for choosing this platform is that the originality of the platform can ensure that the video repetition rate is low, which will not distract the audience’s attention, while its strong social level ensures active social interactions. Other known communities have a hard time comparing to it, on both counts. Second, due to the limitation of content analysis methods, some important variables  were not used in our research model. Wang  has founIn this paper, we explored the factors influencing the popularity of COVID-19 videos, from the two aspects of information quality  and uploader features . The results showed that, on the video platform, shorter video lengths, longer descriptions, more reliable video sources, and lower MICI values made the assessed COVID-19 videos more popular. Audiences are more likely to be attracted to videos in the knowledge and general science and prevention and control status categories, and are more willing to watch these videos, as well as to give their likes, shares, collects, and coins. As expected, when an uploader has higher influence, their videos are more popular with audiences. Our research conclusions can provide management suggestions for the platform, help uploaders make videos more popular with audiences, and help audiences better understand COVID-19 information, such that they can carry out prevention and control well.


Video laryngoscopy has been associated with some orotracheal intubations and enhances the glottic view at time of laryngoscopy and the success rate of the intubation in patients from the emergency department and the intensive care unit. In usual cases, direct laryngoscopy is performed among the patients from the emergency department or the intensive care unit. In this systematic review and meta-analysis, we draw the comparison between the video laryngoscopy and direct laryngoscopy for the emergency orotracheal intubation.  The objective of the study was to identify the clinical efficacy of video laryngoscopy versus laryngoscopy for emergency orotracheal intubation.  MEDLINE, CENTRAL, EMBASE, and Web of Science databases were analyzed from 2003 to 2020. Keywords used for searching the studies were “laryngoscopy,” “video laryngoscopy,” “direct laryngoscopy,” “emergency department,” “intensive care unit,” “orotracheal,” “video laryngoscope,” “glidescope,” “airway scope,” “airway,” “Macintosh laryngoscopy,” “airway management,” “tracheal intubation,” “orotracheal intubation,” and “intubation.” I2 = 78% favoring direct laryngoscopy nonsignificantly with low heterogeneity. Odds ratio for airway trauma or dental damage was 0.67, 95% CI (0.18–2.54), reported higher in video laryngoscopy. Complications with oesophageal laryngoscopy were higher in video laryngoscopy with risk ratio 0.16, 95% CI (0.09–0.29), odds ratio 0.88, 95% CI (0.65–1.18) for sever hypoxemia, risk ratio 1.53, 95% CI (1.02–2.28) for cardiovascular collapse, risk ratio with 95% CI 1.11 (0.59–2.07) for aspiration complications, and odds ratio 1.32, 95% CI  for Inexperienced medical staff handling laryngoscopy.  The first-pass intubation success rates in the intensive care unit were low in video laryngoscopy with 95% CI 1.21 (1.13–1.30) and heterogeneity  No significant efficiency was noticed in using video laryngoscopy when compared with direct laryngoscopy with the available data. The data reported in studies are not enough for efficient clinical analysis of the benefits of using video laryngoscopy over direct laryngoscopy. Thus, information such as length of stay, mortality, sever complications, and length of hospital stay must be reported. The video laryngoscopy (VL) is recommended in the guidelines of airway administration to encourage the tracheal intubation . The hypThe tracheal intubation is an important process for lifesaving carried out in the emergency department or the intensive care unit (ICU) for the patients who are suffering with respiratory disorders or a lower airway protection .In any urgent situation, the airway administration can be challenging because of the heart failure physiology, deficit supply of tools and qualified staffs, disconnected state, parallel performance of the cardiopulmonary resuscitation (CPR) or other related medical course of action, inappropriate approach to the patient's head, and multiple anatomic characteristics of tough airways .It has been investigated that the rate of failure of the urgent tracheal intubations in the emergency department or intensive care unit is remarkably more than that of the tracheal intubations performed in the operating room . The vidA review study from Cochrane identified that the video laryngoscopy is linked with considerably small failure rate and its outcome dimensions expand in the patients with expected tough airway. Video laryngoscopy is a novel tool which consists of a small camera over the tip of the blade for indirect visualization of the glottis.Because of the verified benefits of a fast-learning curve, an enhanced laryngeal visualization, and an expanded rate of success, video laryngoscopy has been extensively utilized for tracheal intubation during the extremity and grave conditions –10.There have been multiple meta-analyses drawing the comparison of video laryngoscopy versus the laryngoscopy for emergency orotracheal intubation in the patients admitted in the emergency department and the intensive care unit and yield varied results , 12. TheArticles that were rejected as per their exclusion criteria: no outcome, insufficient patient data, nonclinical studies, review papers, studies that lacked location and pediatric population, abstracts, and letters or editorials = 117.This systematic review and meta-analysis developed the directions of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) assertion for performing and documenting outcomes. A systematic literature search was conducted referring to MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and Web of Science in the duration of 2003 to 2020.The studies documented in the English language were considered for analysis, and we also considered published review articles as well as editorials as the additional records identifiable for our study.The studies that were published as the prospective randomized control trials which documented the comparisons of video laryngoscopy with direct laryngoscopy among the patients of the emergency department and the intensive care unit. The observational studies comparing the video laryngoscopy and direct laryngoscopy demonstrating the harmful cases of tracheal intubations in the patients of the intensive care unit were also included.The following keywords were used to search the database: “laryngoscopy,” “video laryngoscopy,” “direct laryngoscopy,” “emergency department,” “intensive care unit,” “orotracheal,” “video laryngoscope,” “glidescope,” “airway scope,” “airway,” “Macintosh laryngoscopy,” “airway management,” “tracheal intubation,” “orotracheal intubation,” and “intubation.”The exclusion criteria were as follows: the studies where video laryngoscopy or direct laryngoscopy was utilized as a saving device; the studies that were prehospital studies or simulated studies; the patient data which had information about doubtful laryngeal trauma or an excess of maxillofacial wound with a need of urgent surgical airway; and the studies that had duplicate data.2 = 78% .I2 = 0%; the video laryngoscopy and direct laryngoscopy were examined with respect to the airway trauma or the dental damage during the procedure for 1382 and 737 events of VL and DL, respectively .In I2 = 62%; CI, confidence interval; DL, direct laryngoscopy; and VL, video laryngoscopy.In I2 = 44% .In Z = 0.08 for P = 0.94, on the basis of Macintosh-type laryngoscopy blades in both VL and DL .In I2 = 78% favoring direct laryngoscopy nonsignificantly with low heterogeneity; details of the case are shown in The first-pass intubation success rates in the intensive care unit using video and direct laryngoscopy was analyzed where the success rates of video laryngoscopy were low with 95% CI 1.21 (1.13–1.30) and heterogeneity Airway trauma or dental damage caused due to laryngoscopy procedures were analyzed. Odd ratio for 95% CI were 0.67 (0.18–2.54) with no heterogeneity. Nonsignificant results were obtained with higher incidences of airway trauma or dental damage in video laryngoscopy, thereby favoring direct laryngoscopy. The details of the study are shown in Complications with oesophageal laryngoscopy were higher in video laryngoscopy in comparison to direct laryngoscopy with risk ratio 0.16, 95% CI (0.09–0.29), and low heterogeneity 62%. The number of complicated cases was reported as shown in I2 = 44%. The cases reported are shown in Cases facing severe hypoxemia as a complication of intubation were reported higher in video laryngoscopy when compared with direct laryngoscopy with odds ratio 0.88, 95% CI (0.65–1.18), and very low heterogeneity I2 = 0%; hence, the results are not significant.Cases experiencing cardiovascular collapse as complications of intubation were higher in direct laryngoscopy when compared with video laryngoscopy as shown in I2 = 0%. Data are shown in Complicated cases of procedural complications in aspiration were analyzed where direct laryngoscopy reported higher risk ratio with 95% CI 1.11 (0.59–2.07). Results were not significant with no heterogeneity In this meta-analysis, we have analyzed the efficacy and complications suffered in cases with video laryngoscopy when compared with direct laryngoscopy. The first-pass intubation success rates in the intensive care unit were better in direct laryngoscopy though nonsignificant. The first attempt rates were analyzed, and multiple attempts increase the risk, thus making it complicated. Usually a highly experienced anesthesiologist shows better superiority unless a case of difficult airway is experienced, thereby leading to more success rates .There are plenty other factors which may further elaborate the difference in effectiveness between video or direct laryngoscopy. As patients who are critically ill are subjected to poor oxygen reserved, they are more subjected to hypoxia making the operators opt for direct laryngoscopy or mask oxygenation. Secretions, fluids, and blood in the airway can block the airway from getting clouded, thus impairing visualization in the larynx. Increased term of intubation is a major cause for increasing mortality in patients who are undergoing intubation prior to hospitalization. Mostly direct laryngoscopy is easily assessable to operators in prehospitalization cases.In this systematic review, no significant improvements were noted in video laryngoscopy when compared with direct laryngoscopy. The first-pass intubation success rates in the intensive care unit were better in direct laryngoscopy. Airway trauma or dental damage, oesophageal laryngoscopy, and severe hypoxemia are other complications in intubation reported higher in video laryngoscopy. Thus, intubation outcomes may be worsened by using video laryngoscopy.Hence, more studies need to be performed for determination of benefits of video laryngoscopy for emergency or critical care in patients regardless of any operator's experience. Furthermore, the impacts such as length of stay, mortality, sever complications, and length of hospital stay must be reported for an efficient and clinical analysis of determining the benefits of using video laryngoscopy over direct laryngoscopy.


Short and animated story-based (SAS) videos, which can be rapidly distributed through social media channels, are a novel and promising strategy for promoting health behaviors. In this study, we evaluate the effectiveness of a SAS video intervention to reduce the consumption of added sugars.In December 2020, we randomized 4159 English-speaking participants from the United Kingdom (1:1:1) to a sugar intervention video, a content placebo video about sunscreen use (no sugar message), or a placebo video about earthquakes . We nested six list experiments in each arm and randomized participants (1:1) to a control list or a control list plus an item about consuming added sugars. The primary end-points were mean differences  in behavioral intent and direct restoration of freedom to consume added sugars.P = 0.031), eat fresh fruit daily , and check food labels for sugar content  when compared with the sunscreen (content placebo) video. The sugar video did not arouse intent to restore freedom and consume added sugars when compared with the two placebo videos.Participants (N = 4013) who watched the sugar video had significantly higher behavioral intent to cut their daily intake of added sugar (mean difference (md) = 16.7, 95% confidence interval (CI) = 1.5-31.8, Our SAS intervention video did not arouse reactance and increased short-term behavioral intent among participants to reduce their consumption of added sugars. SAS videos, which draw on best practices from the entertainment-education media, communication theory, and the animation industry, can be an effective strategy for delivering emotionally compelling narratives to promote health behavior change.German Clinical Trials Register: DRKS00022340 Short and animated story-based (SAS) videos are a novel and promising strategy for promoting health behaviors. This strategy draws from entertainment-education media ,2, commu, we show a pathway through which a persuasive health message can arouse the direct restoration of freedom [To be effective, SAS videos will have to overcome the same challenges faced by other traditional methods of health persuasion . These m freedom -17. ThisIn this study, we investigate the effectiveness of a SAS video to reduce the consumption of added sugars . The excTo evaluate the effectiveness of our intervention, we used a randomized controlled trial (RCT) to assign participants to a SAS video about reducing added sugar intake, or a SAS video about sunscreen use (the content placebo), or a SAS video about earthquakes (the placebo). We hypothesize that the exposure to the intervention video will improve behavioral intent to reduce the consumption of added sugars when compared to the content placebo and placebo videos. Intervention effectiveness will be measured by higher behavioral intent scores in the sugar intervention arm. We also hypothesize that the exposure to the intervention video will attenuate the direct restoration of freedom to consume added sugars when compared to the content placebo and placebo videos. No statistically significant difference in the direct restoration scores between the intervention and placebo videos will indicate intervention effectiveness. The findings from this study will provide insights for the understanding of reactance-related processes and their effect on behavioral intent in health promotion.Procedures section.In this web-based RCT, we randomized participants 1:1:1 to a SAS video about added sugars (the intervention arm), a SAS video about sunscreen use (the content placebo arm), and a SAS video about earthquakes (the placebo arm). We nested six list experiments in each trial arm. For each list experiment, we randomized participants 1:1 to a control or treatment group. We motivate our use of the content placebo and placebo arms as well as the list experiment in the www.drks.de) on July 24th, 2020: DRKS00022340.This study was registered at the German Clinical Trials Register , being able to speak English, and having residence in the United Kingdom (UK). Exclusion criteria were not any of the inclusion criteria. We recruited participants on a ‘first come, first served’ basis until the recruitment number (sample size) was reached. Participants were provided with an informed consent form on the Prolific platform, which explained the purpose of the study, the risks and benefits of the research, and a means by which a participant could contact the researcher or the human subjects review board at Heidelberg University. After consenting, Prolific redirected participants to the Gorilla platform, where the study was hosted. Gorilla is a cloud platform that provides versatile tools to undertake web-based, experimental, and behavioral research. We paid participants £1 (US$1.38) for the 10-minute completion time.Participants were asked basic demographic questions about their age, gender, and highest education completed. The Gorilla algorithm then randomly assigned participants to the trial arms. Participants watched one SAS video once from start to finish.The sugar intervention video is animated, completely in English, and 3.42 minutes long. It was developed by our co-author (MA) at the Stanford School of Medicine and designed for a diverse and global audience. The two main characters, a mother and her pre-adolescent daughter, engage in food-related activities, such as grocery shopping and cooking dinner. The sugar video presents educational content on health problems that arise from consuming added sugars in foods, such as yoghurt, chocolate milk, and breakfast cereals. The narrative also includes the story of the father in this family who dies from diabetes-associated complications from the frequent consumption of soda drinks. It concludes with a text message from the World Health Organization (WHO) about the recommended maximum number of teaspoons of sugar per day.content effect of the sugar intervention video as it does not include the content about added sugars. The placebo video about earthquakes [health awareness effect. The total intervention effect is therefore the sum of the content and health awareness effects.The content placebo video is similar in style to the sugar video: it is animated, has a length of 3.42 minutes, and promotes a health message about the use of sunscreen . We use thquakes  is also After random assignment, all participants provided responses to questions about threat to freedom (the antecedent to reactance), anger and negative cognition (the components of reactance), and source appraisal and attitude (the consequences of reactance), as shown in To reduce socially desirable responses to the behavioral intent and direct restoration questions, we nested six list experiments in each arm. motivated …”. To assess direct restoration, we used Lists 2, 4, and 6, which begin the 5/6 items with the words “This week I feel unmotivated …”. To avoid order effects, we made Gorilla present the six list experiments in a random order, with the items in each list presented in random order. We constructed the items to minimize ceiling and floor effects.We assessed two outcomes: the mean difference in 1) behavioral intent to reduce the consumption of added sugars and 2) direct restoration of freedom following exposure to the intervention or placebo message. To assess behavioral intent, we used Lists 1, 3, and 5, which begin the 5/6 items with the words “This week I feel P values for linear combinations of coefficients from the OLS model. For hypothesis testing for the difference in means, we used a t-distribution and set a significance level at 0.05. Using regression models specifically designed for list experiments, we modelled the effect of each reactance component on behavioral intent [We used descriptive statistics to obtain means and standard deviations of gender, age, and education status. For the primary endpoints we calculated the prevalence of behavioral intent to reduce added sugar intake using Lists 1, 3, and 5. We counted the mean number of items that participants selected from the control list  and the mean number of items that the participants selected from the treatment list . For each list experiment, we then estimated the prevalence of behavioral intent, defined as the difference in the mean behavioral intent scores between the treatment and control group . From thl intent . We usedl intent . All staThe full protocol has been published and can be accessed at any time .Data has been collected and stored on the Gorilla platform. The study investigators own and have complete control of the research data, which can be accessed at any time. For statistical analysis, the data was downloaded and is safely stored on a computing system maintained by the Heidelberg University.The participants were completely anonymous to the study investigators as the Prolific platform handled the interaction between the study investigators and participants. Only the participant’s unique, anonymized ID was used to manage the linking between the Prolific and Gorilla platforms. The outcome measures were self-reported and submitted anonymously. The study investigators and those involved in the data analyses were blinded to the group allocation.Because the participants were anonymous to us, we were not able to report any adverse events or harms. It is unlikely there were any adverse events given the format of our 10-minute web-based trial.th and 10th December 2020. After enrollment, 146 (3.5%) participants did not finish the trial either due to technical reasons  or other unknown reasons. In total, 4013 participants (96.4% of the recruited sample) completed the trial and were included in the final analysis . We present the baseline characteristics of the participants by trial arm, including gender, age, and highest education level in . Of the final sample, 60.9% were female, 32.3% were between 25-34 years of age, and 64.1% had some college education or a Bachelor’s degree. We observed no statistically significant differences in baseline characteristics across the three trial arms.We recruited 4159 participants from the UK on the 9The mean scores for the six list experiments by trial arm and list treatment group are shown in Figure S1 in the , we compare behavioral intent  to reduce added sugars  between the sugar, sunscreen, and earthquake videos. Results show that participants who watched the sugar video had significantly higher behavioral intent to cut their daily intake of added sugar , eat fresh fruit daily , and check food labels for sugar content  than those in the content placebo arm. We also observed high behavioral intent to reduce the intake of added sugars between the sugar and earthquake videos but these differences were not statistically different. In In ).For each list experiment, we also assessed the effect of the six reactance components on behavioral intent and direct restoration. More detailed results for the antecedents, components, and consequences of reactance are presented elsewhere . The ploShort and animated (SAS) videos present a promising and effective strategy for promoting healthy behaviors. Such videos can engage large and diverse audiences in evidence-based health education because they use a story format, are emotionally compelling, and can be rapidly distributed through social media channels. Since health education is a cornerstone for changing behaviors, it is crucial to improve the design of SAS videos to increase the long-term impact of such interventions. In this study, we assessed the effectiveness of a SAS video to improve behavioral intent to reduce the consumption of added sugars and to attenuate the direct restoration of freedom to consume added sugars.Our results show that participants who watched the sugar video had significantly higher behavioral intent to reduce added sugars when compared with those who watched the sunscreen (content placebo) video. Specifically, participants who watched the sugar video were more motivated to cut their daily intake of added sugar, eat fresh fruit daily, and check food labels for sugar content. For these three sugar-related behaviors, behavioral intent was approximately 16% higher than the sunscreen video and 12% higher than the earthquake video. Based on these results, we find evidence in favour of our first hypothesis, which states that exposure to the sugar intervention will improve behavioral intent to reduce the consumption of added sugars when compared to the placebo videos.In this study, we also investigated if participants were likely to reject the sugar message. We did this by measuring the participant’s attempt to restore their freedom. The theory of reactance posits that individuals will seek to restore their freedom after it has been threatened with elimination by the health message. Our results show that participants who watched the sugar video did not arouse intent to restore freedom significantly more or less than the placebo videos. Therefore, we cannot support our second hypothesis.An important contribution of our study is that we modelled the effect of the reactance components on behavioral intent and direct restoration outcomes. This was made possible by recent advances in list regression methods . Our anaOur study has several strengths. First, we used an RCT design, which is the gold standard for evaluating the causal impact of an intervention on a health behavior outcome. Here, we randomized participants to either the sugar video intervention, a content placebo (the sunscreen video) or a placebo (the earthquake video). The content placebo is an innovative feature of our study, which enabled us to quantify the content effect as the difference in mean behavioral intent between the sugar video (the intervention) and the sunscreen video (the content placebo). Since both videos promote a health message, and because of randomization, any significant difference in mean scores should be due to the sugar reduction content of the intervention video. Similarly, we calculated the total intervention effect as the difference in mean scores between the sugar video and the earthquake video (the placebo). We are not aware of any previous study that has used an experimental approach to partition the effect of a SAS intervention video in this way. A third strength is that we used list experiments to indirectly obtain truthful responses and reduce social desirability bias. Here, we assumed that most participants know that consuming added sugars is unhealthy and that they will give socially desirable responses. By asking participants to count their agreement with six items, we could indirectly estimate the prevalence of participants that truly intend (in the next week) to reduce their consumption of added sugars.In a previous study using the same data , we evalOur study has several limitations. One limitation is that we financially compensated participants, which was unavoidable given the web-based format of our study. Because of financial compensation, some studies may attract economically disadvantaged participants, who will be disproportionately represented and may have less individual autonomy when given the choice for a lucrative incentive . In our Overall, the findings of this study demonstrate that our SAS intervention can successfully attenuate reactance and improve short-term behavioral intent to reduce the consumption of added sugars. Importantly, our SAS video did not arouse the participants’ motivation to restore their freedom, indicating the positive impact of the video on the behavioral change. In addition, the results of this study confirm that positive source appraisal and attitude towards the message can serve as reliable predictors of higher behavioral intent and lower freedom restoration, whereas greater threat to freedom and reactance (composed of anger and negative cognition) may result in lower behavioral intent and higher freedom restoration. These findings can be further used to inform the design of SAS videos and are aligned with existing evidence about the use of powerful video-based messages in health communication ,6,39. Th


BackgroundTo improve their standing in residency selection, many osteopathic medical students choose to take the United States Medical Licensing Examination (USMLE). Although scores on USMLE Step 1 and Level 1 of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) are known to be highly correlated, scarce data exist on the association between COMLEX-USA Level 2-Cognitive Evaluation (CE) and USMLE Step 2 Clinical Knowledge (CK) scores. In this study, we aimed to determine the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores and derive an equation to predict performance on USMLE Step 2 CK for applicants who have only taken COMLEX-USA.MethodologyWe reviewed COMLEX-USA Level 2-CE and USMLE Step 2 CK scores for all students at the Lake Erie College of Osteopathic Medicine from May 2020 to April 2021. Linear regression was used to evaluate the relationship between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores.Results2 = 0.64).A total of 340 students took both COMLEX-USA Level 2-CE and USMLE Step 2 CK. There was a linear association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores such that every one-point increase in COMLEX-USA was associated with a 0.13-point increase in USMLE Step 2 CK score  + 163.5. To graduate from an osteopathic medical school, the Commission on Osteopathic College Accreditation requires that students pass both the Level 1 and Level 2 Cognitive Examination (CE) of the Comprehensive Osteopathic Medical Examination (COMLEX-USA) . This isNumerous studies have demonstrated a linear association between osteopathic medical student performance on the COMLEX-USA Level 1 and the USMLE Step 1 examinations -13. HoweSetting and participantsWe reviewed the COMLEX-USA Level 2-CE and USMLE Step 2 CK scores for all students at the Lake Erie College of Osteopathic Medicine (LECOM) who took both exams during the testing cycle between May 1, 2020, and April 30, 2021. COMLEX-USA and USMLE scores were obtained from school records. This data included those who took both examinations as well as those who only took COMLEX-USA Level 2-CE. For students who took either exam more than once, performance on the first exam attempt was analyzed.Statistical analysisWe calculated descriptive statistics (including median and interquartile ranges [IQRs] for performance on each test) for the study population. To evaluate the association between COMLEX-USA and USMLE scores, we performed simple linear regression. A two-sided significance level of 0.05 was set for all tests. All statistical analyses were performed using SPSS version 27 .Ethical approvalBecause the investigators received only deidentified paired score data from the campus registrar, the LECOM Institutional Review Board (IRB) determined this research to be IRB-exempt and waived the need for consent.From May 2020 to April 2021, there were 552 LECOM students who took the COMLEX-USA Level 2-CE examination. Of these, 340 (61.6%) also took the USMLE Step 2 CK examination. Among all test-takers, the median COMLEX-USA Level 2-CE score was 578 . The median USMLE Step 2 CK score was 240 .Students who took both the COMLEX Level 2-CE and the USMLE Step 2 CK exams scored higher on COMLEX-USA Level 2-CE than those who did not take both exams . Overall, 23/552 (4.2%) of students failed COMLEX-USA Level 2-CE, while 10/340 (2.9%) failed USMLE Step 2 CK. Two examinees failed both tests. Students who did not take USMLE Step 2 CK were more likely to have failed COMLEX-USA Level 2-CE than those who took both exams .2 of 0.64.Pairs of COMLEX-USA Level 2-CE and USMLE Step 2 CK scores are shown in the scatterplot in Figure 2 = 0.56) [Here, we present the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores among 340 students from a single osteopathic medical school, the largest in the country, who took both examinations from May 2020 to April 2021. There was a relatively positive linear relationship between performance on these exams, with variation in COMLEX-USA scores explaining approximately 64% of the variation in USMLE Step 2 CK performance, and every one-point increase in COMLEX-USA Level 2-CE score corresponding to a 0.13-point increase in USMLE Step 2 CK score. This linear relationship is similar to the relationship between USMLE Step 1 and COMLEX-USA Level 1 scores from students at the same institution, in which a one-point increase in COMLEX-USA Level 1 was associated with a 0.15-point increase in USMLE Step 1 , the authors did not report the slope or intercept of their regression equation, making it difficult for a given student to predict his or her performance. More recently, Kane et al. [2 values of 0.52 and 0.49, respectively. Although these studies included some students who took these licensing examinations within the past decade, both included only applicants to a single residency program, and only Russman et al. reported a full regression equation (USMLE Step 2 CK = 0.16(COMLEX-USA Level 2-CE) + 134.1) [These data fill an important knowledge gap. Although numerous studies have explored the relationship between COMLEX-USA Level 1 and USMLE Step 1 scores, few have evaluated the association between scores on Level 2-CE and Step 2 CK, with each having important limitations. In 2010, Chick et al.  reportede et al.  evaluateThe contemporary data reported here may be helpful to osteopathic medical students and their advisors in considering whether to take the USMLE Step 2 CK examination. While a high Step 2 CK score may enhance a student’s residency application, a low score or an exam failure is unlikely to do so. Before electing to take an expensive examination that is not required for graduation or licensure, applicants and their advisors may wish to consider the likelihood of achieving a beneficial score against the risk of a harmful one.The findings here may also be useful to residency program directors in evaluating osteopathic applicants. Even after the realization in 2020 of a single accreditation system  and the This work has many strengths. It is the most recent study in the last 10 years that has evaluated the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores using recent score data and includes a large sample of students from the largest medical school in the country. With USMLE Step 2 CK scores likely to increase in importance after the transition to pass/fail score reporting for USMLE Step 1, this work provides data that will be useful to osteopathic medical students and their faculty advisors, as well as residency program directors.Nonetheless, there are important limitations to the findings reported here. First, there are important differences in content between the COMLEX-USA Level 2-CE and USMLE Step CK examinations. While the basic concepts, disease pathology, and treatments are standardized and uniform between the two exams based on the Blueprints of each examination ,30, the Second, the equation here is derived from students at a single osteopathic medical school. Overall, 62% of LECOM students took both the COMLEX-USA Level 2-CE and the USMLE Step 2 CK exams, but there were significant differences in test performance among students who chose to take the USMLE and those who did not. From our data, it cannot be determined why some students chose to take USMLE Step 2 CK and some did not, but reasons likely relate to the applicants’ perceived competitiveness and the requirements of the programs to which they intend to apply. Importantly, however, students who chose to take USMLE Step 2 CK had higher performance on COMLEX-USA Level 2-CE than those who took only that test. Based on the data collected, if a larger portion of osteopathic students decided to take the USMLE Step 2 CK, their performance could differ systematically from the performance of the group in whom the regression equation was derived. Common reasons for this are likely explained by the overall competitiveness of the students taking both exams, as well as the specialties chosen by the students taking both exams. The more competitive osteopathic students applying for specialties such as anesthesiology or surgery are more likely to have higher GPAs and COMLEX-USA Level 1 scores than those applying to primary care specialties such as internal medicine and family medicine. Moreover, because these data were obtained in 2020-2021, these students had their medical education disrupted by the novel coronavirus disease 2019 pandemic. Extrapolating these results to populations that systematically differ from the study population may influence the accuracy of the prediction equation. However, in reporting our full linear regression model, we make it possible for other investigators to prospectively validate our findings in other populations.Third, our analysis was limited only to scores on the USMLE and COMLEX-USA examinations, which were obtained and analyzed in a de-identified format. Other variables that might impact test performance, such as previous standardized tests, dedicated preparation time, or the use of particular test preparation resources, were not considered.Fourth, the confidence interval for a point estimate derived from our equation is wide: the standard error was 9.1 points. Yet, any prediction of USMLE performance will necessarily be limited by the inherent imprecision of the test itself: the USMLE Step 2 CK examination has a standard error of measurement of approximately six points . In otheA linear relationship exists between osteopathic medical student performance on the COMLEX-USA Level 2-CE and the USMLE Step 2 CK examinations. Approximately 64% of the variation in USMLE Step 2 CK scores is explained by variation in COMLEX-USA Level 2-CE performance, and every one-point increase in COMLEX-USA Level 2-CE is associated with a 0.13-point increase in USMLE Step 2 CK score. Potential examinees and program directors interested in predicting performance on USMLE Step 2 CK from an individual COMLEX-USA Level 2-CE score can do so using the following equation: USMLE Step 2 CK = 0.13(COMLEX-USA Level 2-CE) + 163.5.


Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical treatment of choice of patients with ulcerative colitis (UC) or familial adenomatous polyposis who require the removal of the colon. While this reconstructive surgery significantly improves patients’ quality of life, post-operative structural, inflammatory, and functional complications are common. In our Pouch Center, we have noticed a growing number of patients presenting with dyschezia, feeling of incomplete evacuation, and frequent bowel movements. Clinical, endoscopic, and radiographic evaluation of cohorts of patients has identified a cluster of disease phenotypes that are collectively diagnosed with floppy pouch complex (FPC) . Common A 48-year-old female patient developed worsening daily dyschezia with excessive straining, a sensation of incomplete evacuation, frequent bowel movement, daytime or nocturnal seepage, and perianal discomfort since staged laparoscopic restorative proctocolectomy and IPAA for refractory UC 5 years prior. She suffered from early satiety, bloating, and weight loss of 15 lbs from her healthy baseline. She had no fever or night sweat. She was diagnosed as having pouchitis and was treated with antibiotics. Her diarrhea and bloating symptoms partially responded to antibiotic therapy. However, her symptoms almost became antibiotic-dependent. Her past medical history included hypothyroidism. She had three vaginal deliveries before colectomy and 10 years ago underwent hysterectomy for uterine fibroid bleeding. Physical examination showed well-healed skin scars at the stoma site and suprapubic area. There was evidence of perianal dermatitis. She was able to expel the balloon in office-based anopouch manometry. The manometry showed no paradoxical contractions. Barium defecography showed anterior pouchocele and partial obstruction of the pouch outlet. Magnetic resonance imaging 1 year prior showed no fistula, presacral sinus, or abscess.The diagnosis of pouch prolapse was suspected. After obtaining diagnostic and therapeutic information, we performed an elective outpatient pouchoscopy with the patient under conscious sedation. The patient was put in a left lateral position. The absence of the cuff was consistent with the patient’s history of IPAA with mucosectomy and hand-sewn anastomosis. The mucosa and lumen of the afferent limb, pouch inlet, and tip of the ‘J’ were normal. However, mucosal prolapse at the anterior wall of the distal pouch was found, almost blocking 80% of the lumen of the anal canal during endoscopic suction (Pouch prolapse along with other phenotypes of FPC that cause significant morbidities and compromise the quality of life is increasingly being recognized. The etiology and pathogenesis are largely unknown. The diagnosis of pouch prolapse is based on clinical, endoscopic, radiographic, and histologic evaluation. Common presentations include dyschezia, the sensation of incomplete evacuation, frequent bowel movements, perianal discomfort, and bloating. Patients may have a partial response to antibiotic therapy, probably thanks to the component of small-intestinal bacterial overgrowth. Pouch prolapse may coexist with functional dyssynergic defecation or structural complications of the pouch, such as anterior cuffitis and pouch–vaginal fistula. The prolapsed portion of the pouch can easily be detected by positioning the tip of the endoscopy at the anal canal and suction. The classic endoscopic feature of pouch prolapse is a protruding bowel wall under suction, typically at the anterior wall, completely or partially blocking the pouch outlet. Prolapse of the distal anterior pouch body or anterior cuff may be associated with endoscopic inflammation in the area. Barium defecography plays an important role in the diagnosis of pouch prolapse and other forms of FPC. On an X-ray, pouch prolapse often presents with distal pouchocele and outlet obstruction. Histologic evaluation often shows classic features of prolapse, such as elongated mucosal crypts and intramucosal fibrosis.The management of pouch prolapse can be challenging. Patients with concurrent pouch prolapse and distal pouchitis or cuffitis may respond to therapy with topical agents, such as mesalamine, corticosteroids, or valium. Patients with concurrent paradoxical contractions on manometry may benefit from pelvic-floor biofeedback therapy. Digital vaginal pushing during defecation may also help. Patients refractory to the conservative therapy have traditionally required surgical intervention. The surgical modalities for pouch prolapse include pouch pexy, mesh placement, and mucosal excision . The outEndoscopic treatment of prolapsed bowel has been explored. Small prolapse can be endoscopically resected with hot snares . EndoscoThis case demonstrates that the efficacy and safety of combined endoscopic banding and submucosal injection of hypertonic glucose for pouch prolapse. We anticipate that there will be a growing number of patients with pouch prolapse in clinical practice and the novel endoscopic approach may be considered as one of the first-line therapies.None.None declared.


Some patients with glaucoma will experience permanent vision loss. The correct low vision advice and support will enable them to carry out their daily activities with greater ease and comfort.People with glaucoma have specific vision-related problems that will affect their daily activities in various ways .1 LearniFirst ask questions (and observe) what your clients need and what they now find difficult when performing their daily activities. Use different tests  to assess distance and near visual acuity, visual field, contrast sensitivity, and light sensitivity. The CEHJ article ‘When someone has low vision’ lists useful methods.Here are some ideas you can suggest to your client.Sunglasses can help to reduce the effects of glare and improve contrast. Try a few different coloured lenses to find the ones that work best .Improve lighting. Consider quantity, type, and direction. E.g., try a reading lamp with a flexible arm in a position that avoids creating glare.Ensure enough ambient lighting in dimly lit rooms and prevent large differences in lighting levels.Reduce glare by closing curtains or changing position so that you have less excess light.Add contrasting strips to steps. Line the borders of the garden with bricks painted white.Remove clutter and dispose of little-used items in your kitchen.Always carry a torch with you.Move closer to the TV.Use felt-tipped pens, which are bolder and easier to see.Enlarge the labels on your medication or colour code them.Provide (or advise the client to undergo) compensatory visual field training to enable people with visual field defects to improve navigation and avoid obstacles. For example: “Pause regularly when walking and move your head slowly up and down, then from left to right, to scan the area in front of you. For example, if you scan the area before crossing the street, you may notice a car parked on the street corner which you did not see when looking straight ahead. Then you can avoid bumping into it.”Refer the client to appropriate peer support groups and to counselling services; these can be of real benefit to them.Other interventions that some  people need:Orientation and mobility training to learn to walk using a white cane, for people who have lost all their vision or have very low visual acuity.optical magnifiers  and smartphone apps that magnify.handheld video magnifier can offer a significantly larger field of view at a given level of magnification and contrast can be enhanced.Magnifiers, after refraction, correction of presbyopia and prescription of glasses has been done (see Case study 2). These can include Text-to-speech software, e.g., the free application ‘Non-visual Desktop Access’ (NVDA).Reverse telescopes: objects look smaller so that more information fits into a small field of vision (only people with a good distance acuity will benefit).The client is a 68-year-old woman with glaucoma in both eyes. She has no spectacles and reports problems moving around at night and when the sun shines. She also finds it difficult to see what she is doing when gardening.Main need identifiedBetter vision to move around and do her gardening.AssessmentShe has no spectacles.Uncorrected distance visual acuity (VA): 6/60. With a -6.00D correction, VA is 6/36.Uncorrected near VA: 2M at 9 cm; best corrected near VA: 1.25M at 10 cm (near add +3.00D).Contrast sensitivity: 10%.Assessed for magnifier but she does not need it, she says.InterventionsBifocals and cover spectacles Ensure even lighting levels throughout the house, to reduce risk of falling over (unexpected) obstacles.Client’s comment“Now I can do my gardening again, and I can do it in comfort.”The client is a 15-year-old boy with pseudophakic glaucoma in both eyes. He attends primary school and has been on timolol eye drops since infancy.AssessmentHe only has vision in his left eye: uncorrected 6/36 and with spectacles 6/18.InterventionsOptical magnification (used since 2014):Monocular 4x telescope which gives 6/6 distance VA.20.00D (6x) handheld magnifier which gives near VA of 0.8M at 25 cm.Client’s comments“Before 2014, even though I had glasses, I still had difficulties in class, e.g., in reading the blackboard and small print in textbooks. Since I was given the telescope and the magnifier, I can read the blackboard without asking for help and all small print.“These devices make me more confident and my position in class has increased from 65th out of 105 to 14th out of 101 in a school with normally sighted peers.”


Eyewitnesses to crimes sometimes search for a culprit on social media before viewing a police lineup, but it is not known whether this affects subsequent lineup identification accuracy. The present online study was conducted to address this. Two hundred and eighty-five participants viewed a mock crime video, and after a 15–20 min delay either (i) viewed a mock social media site including the culprit, (ii) viewed a mock social media site including a lookalike, or (iii) completed a filler task. A week later, participants made an identification from a photo lineup. It was predicted that searching for a culprit on social media containing the lookalike (rather than the culprit) would reduce lineup identification accuracy. There was a significant association between social media exposure and lineup accuracy for the Target Present lineup , but for the Target Absent lineup  there was no significant association with lineup identification accuracy. The results suggest that if an eyewitness sees a lookalike (where they are expecting to see the culprit) when conducting a self-directed search on social media, they are less likely to subsequently identify the culprit in the formal ID procedure. Websleuthing has become widespread on crime-solving can both contribute to, and hamper, police investigations, as described below.“Websleuthing” describes amateur online crime investigations . If a witness searches for the culprit on social media, finds a plausible “lookalike” individual and reports them to the police, the witness might then either “unconsciously transfer” or “commit” to that face such that they would identify this individual in a subsequent lineup. Of course, if the witness finds an image of the culprit on social media, then the same commitment effect would make them more likely to select that face in a lineup, although the identification might be more based on the more recent viewing of social media than their actual memory of the crime. In addition, a witness who sees a lookalike on social media but then sees the V = 0.29, df = 4)    that indicates a large effect size (Cramer's ) Cohen, . Given t) Cohen, , we aim ) Cohen, . The pow) Cohen, .via social media and university research participation sites. Of these, 273 provided their age , and 277 provided their gender: 231 identified as female; 44 as male; one as androgynous; and one as non-binary. Two hundred and twenty-eight provided their ethnicity: 171 identified as Caucasian; 34 as Asian (14 of which identified as Far East Asian while four identified as South Asian); four as Mixed Race; two as Black; two as Mediterranean; and one as Arab; one as Hispanic; and one as Jewish.We sampled 285 participants with access to the internet (149 in the Target Present (TP) condition, and 136 in the Target Absent (TA) condition) see . The samParticipants did not receive compensation for their participation.social media search, with three levels: Culprit , Lookalike , Control . The second independent variable was lineup type, with two levels: TP (culprit in the lineup) and TA . The first dependent variable was identification accuracy. In the TP lineups, participants could make one of three responses: a correct identification, a misidentification, or an incorrect rejection. In TA lineups, participants could make one of two responses: a correct rejection, or a misidentification. Data from the TP and TA lineups were analyzed separately. The second dependent variable was confidence, measured on a 7-point scale from 1 (very unsure) to 7 (very sure).The experiment employed a 3 × 2 between participant design. The first independent variable was self-directed The experiment was built as a series of simple webpages (hosted on the research group website), consisting of two sessions.Session one presented an information page, a consent page, a mock crime video, a 15–20 min survey (exploring online police/citizen communication), which acted as a filler task and informed the development of measures for a police/citizen app scoping study. Participants then either viewed a simulated social media site (FriendFace) or took part in an alternative activity [Ministry of Sharing, Session two consisted of a photo lineup display consisting of six simultaneously presented faces and two response boxes. The lineup was created using PROMAT Video Identification Parade Software. Photos showed the head and shoulders of each individual against a green PROMAT background, photographed in the same lighting conditions. The target present display contained an image of the culprit, while the target absent display contained an image of the lookalike. These were placed in the same position in their display. As participants saw the lineup online, on personal devices, we could not control the size or color saturation of the images between participants. The method described by Tredoux  was usedThe mock crime video was created with a Caucasian male actor as the target (the culprit). The video shows two women seated at a bar while the culprit walks in and steals a handbag hanging from a stool. The culprit then leaves the bar. The film lasts ~30 s, and the culprit is visible from multiple viewpoints and close up during the film.FriendFace was created to mimic a social network site and was populated with content relating to the community event, where the mock crime took place. The home page contained event photos, and names and thumbnail pictures of 14 people who had indicated interest in attending (seven men and seven women). Thumbnails consisted of a color close up of the head and shoulders, taken in natural settings. By clicking on the thumbnails, participants could view the “profiles” of each potential attendee, including a larger version of the thumbnail, and two additional images of them, where their face could be seen from another viewpoint and in different lighting conditions see . For theParticipants were invited to take part in an online study. In the first session, after participants viewed the mock crime and completed the survey, they were assigned to one of three conditions. There were two experimental conditions , and one control condition see . ParticiThe second session took place 7–8 days later and was triggered by an automated email. The delay was chosen to mimic a minimum forensically realistic delay. Participants viewed a photo lineup and were given the following instructions. “Last week you watched a video of a mock crime and browsed a social media page. Now you will see photos of people. Each photo will be numbered. The man you saw in the crime video may or may not be included. Please decide if you see the man from the crime video. If you see him, please write down what number he is. When they saw the lineup they were asked, “Is the person you saw in the crime video also in the lineup?” Participants could select “yes” or “no.” If they selected “yes” they were asked to provide the number of the individual that they thought was the culprit. All participants were then asked, “How sure do you feel that your answer is right on a 1–7 scale?” They responded from 1 (very unsure) to 7 (very sure). Some saw a lineup that contained the culprit (TP), while others saw a lineup that contained the lookalike (TA). They were asked to provide their identification decision and their confidence in that decision in the response boxes provided. 24% did not return for the second session, so their data were excluded from the final sample.The experiment received approval from the Open University Research Ethics Committee (Reference: HREC/3264/Elphick).n = 171), and those who did not (n = 41) and found no difference in accuracy between the two ethnic categories, X2(1) = 0.002, p = 0.96, V = 0.003. Therefore, all participants were retained for subsequent analyses.As participants of different ethnicities took part and the images were of white faces, we started by exploring whether the “other race effect”  spent between 144 and 2312 s looking at FriendFace . Despite this large range, a logistic regression revealed that there was no statistical significance between time spent on FriendFace and lineup identification accuracy, X2(1) = 0.002, p = 0.97 . Longer search times were not associated with more accurate identifications. Therefore, all participants were retained for the following analyses.Participants in the experimental conditions  and identification response . A Chi Square analysis revealed a significant relationship, X2(4) = 16.27, p = 0.01, V = 0.23 with a medium-large effect size. Inspection of In the TP condition, 34.9% of participants correctly identified the target, 25.5% misidentified a distractor, and 39.6% incorrectly rejected the faces. We explored relationships between social media condition  and identification response . However, we found no significant relationship, X2(2) = 0.58, p = 0.75, V = 0.07  = 3.22, p = 0.20, V = 0.24. Despite this non-significant result, inspection of When examining the proportion of lookalike misidentifications in each TA condition compared to misidentifications of another distractor, it was revealed that the lookalike was misidentified 40% of the time, and that participants in any one condition were not significantly more or less likely to misidentify the lookalike than in either of the other two conditions, d' and C for each condition. For d', which is a measure of sensitivity, this yielded values of 0.15 in the control condition, 0.23 in the culprit condition and −1.21 in the lookalike condition. Criterion (C) provides a measure of bias. Mean criterion in the control condition (−0.10) and the culprit condition (−0.11) indicates fairly balanced responding, with only a small liberal bias, while the positive criterion value in the lookalike condition (0.36) indicates a conservative bias. This again suggests that the difference in conditions is driven by poor performance in the lookalike condition, where (unlike the other two conditions) participants were more likely to make a misidentification than a correct identification.Comparing conditions by analyzing TP and TA lineups separately can be problematic as participants may adopt different thresholds for selection. For example, they may be more conservative in one condition meaning they are less likely to select someone from the lineup. In light of this, accuracy was also analyzed by computing the signal detection measures r (143) = 0.15, p < 0.05 (1-tailed), and “non-choosers,” where the relationship was non-significant, r (143) = 0.02, p = 0.84 (2-tailed). Noting the limitations of using point-biserial correlations, confidence-accuracy characteristic (CAC) analysis was conducted using the procedure described by Mickes . The results indicate that if an eyewitness seeks a culprit on social media that contains a lookalike (between witnessing a crime and doing a lineup where the culprit is present), they are less likely to make a positive identification in the lineup. The research also explored the effect in TA lineups, but no significant relationship was found. The study indicated that the effects of reinforcing and conflicting post-event information were asymmetrical, as the negative effect on accuracy in TP lineups of seeing a lookalike during a social media search was not mirrored by a positive effect on accuracy of seeing the culprit.The present study provides evidence that searching for a culprit on social media can negatively affect identification accuracy in TP lineups. Participants who saw a The present research is the first to investigate the effect of self-directed social media searching on identification accuracy. The results support previous eyewitness research showing that mugshot exposure  when making their identification decision. Thus, not only do eyewitnesses have to be good at both tasks, but the additional task of “telling people together” could be the harder of the two , and it might have influenced subsequent lineup response decisions (supporting the notion of a “commitment effect,” e.g., Godfrey and Clark, via social media. However, some care in this communication may be needed, given the tendency of law enforcement personnel to value positive lineup outcomes even if these occur at the expense of misidentifications (Pike et al., The results presented here have implications for police and legal contexts, as they suggest that an eyewitness who searches social media and sees someone resembling the perpetrator may be more likely to make a misidentification than to correctly identify the culprit. In one sense this seems to support a fairly straightforward warning for criminal justice practitioners to be wary of an eyewitness who conducts their own investigation The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by The Human Research Ethics Committee, The Open University. The patients/participants provided their written informed consent to participate in this study.CE: conceptualization, methodology, verification, formal analysis, investigation, data collection, data curation, writing–original draft, writing–review and editing, visualization, and project administration. RP: conceptualization, methodology, formal analysis, and writing–review and editing. AStu, ZW, LF, and ML: conceptualization, methodology, and writing–review and editing. MZ: conceptualization and methodology. AStr: conceptualization, methodology, verification, resources, writing–review and editing, and supervision. CH: conceptualization, methodology, verification, resources, and writing–review and editing. GP: conceptualization, methodology, verification, resources, writing–review and editing, supervision, and funding acquisition. BP and BN: conceptualization, methodology, supervision, and funding acquisition. AB: conceptualization, methodology, writing–review and editing, supervision, and funding acquisition. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the clinical management of patients with combined pulmonary fibrosis and emphysema (CPFE), early recognition and appropriate treatment is essential. This study was designed to develop an accurate prognostic nomogram model to predict the presence of CPFE.We retrospectively enrolled 85 patients with CPFE and 128 patients with idiopathic pulmonary fibrosis (IPF) between January 2015 and January 2020. Clinical characteristics were compared between groups. A multivariable logistic regression analysis was performed to identify risk factors for CPFE. Then, and a nomogram to predict the presence of CPFE was constructed for clinical use. Concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration plot was used to evaluate the efficiency of the nomogram.P = 0.307).Compared to the IPF group, the proportion of patients with male, smoking and allergies were significantly higher in the CPFE group. In terms of pulmonary function tests, patients with CPFE had lower FEV1/FVC%, DLCO/VA% pred, and higher RV, RV%pred, VC, VC%pred, TLC%pred, VA, TLC, TLC%pred, FVC, FVC%pred and FEV1 with significant difference than the other group. Positive correlation was found between DLCO and VA%, RV%, TLC% in patients with IPF but not in patients with CPFE. By multivariate analysis, male, smoking, allergies, FEV1/FVC% and DLCO/VA%pred were identified as independent predictors of the presence of CPFE. The nomogram was then developed using these five variables. After 1000 internal validations of bootstrap resampling, the C-index of the nomogram was 0.863 (95% CI 0.795–0.931) and the AUC was 0.839 (95% CI 0.764–0.913). Moreover, the calibration plot showed good concordance of incidence of CPFE between nomogram prediction and actual observation (Hosmer–Lemeshow test: Patients of CPFE have a characteristic lung function profile including relatively preserved lung volumes and ventilating function, contrasting with a disproportionate reduction of carbon monoxide transfer. By incorporating clinical risk factors, we created a nomogram to predict the presence of CPFE, which may serve as a potential tool to guide personalized treatment. Pulmonary interstitial fibrosis and emphysema have long been perceived as two separate diseases. Interstitial lung diseases (ILD) encompass a large and heterogeneous group of diffuse parenchymal lung disorders characterized by distinct forms and severity of inflammation and fibrosis in alveolar walls and cavities . IdiopatPatients with CPFE are characterized by a relatively normal lung function due to the counterbalancing effects of fibrotic (restrictive factor) and emphysematous (obstructive factor) components , 7, whicThe nomogram provides a visualization of the regression equation, which has been accepted as a reliable tool to create a simple intuitive graph of a statistical predictive model that quantifies the risk of a clinical event . In thisThis retrospective study involved 85 patients with CPFE and 128 patients with IPF during the period between January 2015 to January 2020, from Beijing Hospital. Diagnosis of IPF was made according to an official ATS/ERS/JRS/ALAT guideline : subpleuThe following demographic and clinical data were extracted from electronic medical records at the time of the initial high-resolution computed tomography (HRCT) of the chest study: population characteristics , smoking history, thoracic operation history, allergies , and occupational dust exposure), comorbidities , pulmonary function tests , data required for the Charlson Comorbidity Index (CCI) , and com2 test or the Fisher exact test. Correlations between variables were analyzed using the Spearman's rank correlation. Correlation strength was selected by an absolute correlation (|r|> 0.2) and the selected correlation was plotted as an undirected network graph. Multivariable logistic regression analysis was implemented to identify the powerful combination of significant factors which were utilized to build a prediction model and a nomogram was used to visualize the model.Continuous variables were described using median and interquartile range (IQR). Categorical variables were described as number (%). Non-normal distributed continuous data were compared using Mann–Whitney-U test. Categorical data were compared using XThe nomogram was subjected to 1000 bootstrap resamples for internal validation and the performance was assessed by discrimination and calibration . HarrellThe statistical analyses were performed with IBM SPSS 25.0 and R 3.4.3 with the rms statistical packages for all the analyses. All tests were 2-sides, and a P value < 0.05 was considered statistically significant.P = 0.000), smoking  and allergies  were significantly higher in the CPFE group. No statistical difference was found in terms of age, BMI, most personal history and comorbidities between two groups (P > 0.05). In addition, according to the CCI and CPI assessment, the differences of indexes were not statistically significant (P > 0.05) . Conversely, RV, RV%pred, VC, VC%pred, VA, TLC, TLC%pred, FVC, FVC%pred and FEV1 were significantly higher than those in IPF group (P < 0.05) , RV%  and TLC%  in IPF group but no correlation was observed in CPFE group.Patients were admitted primarily for identifying the causes and confirming diagnosis, and pulmonary function was measured as physically permissible for medical purpose. FEV1/FVC% and DLCO/VA in CPFE group were significantly lower than those in IPF group (5) Table . Moreove5) Table . The linP < 0.05 level, including gender , smoking, allergies and key pulmonary function index , were entered into the multivariable logistic regression analysis. As shown in the Table P = 0.025), smoking (P = 0.044), allergies (P = 0.006), FEV1/FVC% (P = 0.003), DLCO/VA% pred (P = 0.017).The variables univariately associated with CPFE at The nomogram was constructed based on five independent variables , smoking, allergies, FEV1/FVC%, and DLCO/VA% pred) Fig. . Each vaP = 0.307)  and the AUC was 0.839 (95% CI 0.764–0.913), both indicating stable and favorable performance of the model. Moreover, the calibration plot showed good concordance of incidence of CPFE between nomogram prediction and actual observation  may be associated with the development of disease. Several studies have demonstrated that air contamination is closely related to emphysema and pulmonary fibrosis . AllergySmoking is undoubtedly a main factor, but not all CPFE patients in this study had a history of smoking (88%). On the one hand, patients with second-hand smoke who are not easily defined may be ignored; on the other hand, it is currently believed that multiple factors are involved in the development of CPFE. Besides inflammation, gene-mediated alveolar damage processes may also lead to CPFE . OxidatiIn our study, we use multivariable logistic regression analysis to identify significant factors associated with CPFE. Consequently, gender , smoking, allergies, FEV1/FVC%, DLCO/VA% pred were identified and used to develop the prognostic nomogram. This nomogram demonstrated good discrimination as assessed by the C-index, AUC value and calibration plot indicating good performance. Nomogram models are used to assess the risks associated with CPFE and they also provide a reference for the clinical management.Although our study lies in the intuitive characteristics of the disease based on the real-world data and the relatively complete information, which can ensure the accuracy of the model, there are still some limitations. First, the data for the nomogram were retrospectively derived from a single center and may suffer from selection bias. Second, only internal verification was performed and the results may overestimate the effectiveness of the model. Thus, external verification will be optimal for further investigation.In conclusion, our nomogram incorporating several important clinical variables into the estimate of the risk of CPFE may serve as a potential tool to help inform decision-making by physicians and patients.