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Population Stratification Into Demographic Environments
California’s population was stratified into demographic environments based on socioeconomic information. A total of 24 features, including age, gender, spoken language, nationality, access to the health system, income, education, as well as race and ethnicity, were gathered for the state of California from the American...
PMC10267788
Curating Digital Content About Organ Donation
The digital contents were short videos curated from YouTube by a clinical psychologist with experience in health education. The curation consisted of 4 steps: search, selection based on inclusion and exclusion criteria, classification, and tailoring. The main search strategy used the keywords organ donation, organ dono...
PMC10267788
Digital Content Delivery Using Facebook
In a CRT research design, ZCTAs from each uncovered demographic environment were randomly assigned to 2 intervention arms. The first arm, nonoptimal SNI, received the SNI with equal exposure to digital contents, and the second arm, optimal SNI, received the SNI with tailored exposure to digital contents (The framework ...
PMC10267788
ACT Using Proportional-Integral-Derivative
PID
The ACT mechanism was used to enable optimal SNI (The ACT mechanism was modeled as a PID controller, which is widely applied in control systems engineering. This mechanism was implemented in the SNI software to enable the daily budget adjustments of each content in the Meta Business Ads Manager platform. On a daily bas...
PMC10267788
Statistical Analysis
REGRESSION
The average daily difference between the number of clicks between phases (C) was estimated using 1000 bootstrap samples with a replacement for each group. Ordinary least squares (OLS) regression was used to model the C/I as a function of both the intervention arm (β
PMC10267788
Ethics Approval
This study was approved by the institutional review board of the University of California, Davis, US (1596733-2). The study was registered on ClinicalTrials.gov (NTC04850287).
PMC10267788
Results
PMC10267788
PID Controller Optimizes Social Network Interventions
PID
In the postoptimization phase, the PID control component daily adjusted the budget for the intervention units in the optimal arm (Taking cluster 4 as an example, it is possible to understand the behavior of the PID component given the levels of exposure (impressions) and engagement (link clicks). At the end of the preo...
PMC10267788
Discussion
PMC10267788
Principal Results
PID
PID
In this work, we proposed an SNI mechanism that uses high-resolution assessments and controllability in adaptive interventions to increase the engagement in organ donation campaigns by tailoring educational content to different population groups. The Meta Business Ads Manager platform was used to deliver the SNI with 3...
PMC10267788
PID Controller Enables Tailored Educational Content per Demographic Environment and Increases Content Efficiency
diabetes
PID, DIABETES
PID controllers are loop-based control mechanisms used to maintain process variables close to desired set points. The PID controller acts as a physician analyzing the glucose level of a patient with diabetes; if the glucose level goes up, the insulin dosage should increase proportionally, and the opposite would happen ...
PMC10267788
Cluster Characterization and Content Optimization per Demographic Environment
EdC-3
REGRESSION, PID
This study aimed to use systems control theory for ACT in a SNI to promote awareness regarding organ donation. In particular, an ACT mechanism enabled the efficient automation of budget adjustments given each content’s level of engagement.The population stratification prior to the ACT-enabled content tailoring for each...
PMC10267788
Limitations
PID
Even though the study addressed the California state disparities by stratifying the zip codes into distinct and meaningful demographic environments, the digital divide among minorities may still be biasing the results. This study did not assess the intervention’s effect on the number of organ donor registrations in Cal...
PMC10267788
Conclusions
PID, EVENT
We proposed an SNI framework with an ACT mechanism that learns and delivers, in real-time, for distinct subpopulations, the most tailored educational content and establishes new avenues to improve the future design of precision public health interventions using digital social media that are equitable, efficient, and co...
PMC10267788
Future Works
PID, HEART
In future works, we intend to investigate other strategies to perform content optimization per demographic environment, including the parameter tuning for the PID controller and the use of other optimization techniques such as Genetic and Swarm-based algorithms. Although the PID controller optimization based on the dif...
PMC10267788
Abbreviations
adaptive content tuningnumber of clicks per 1000 impressionscluster-randomized trialeducational contentordinary least squaresproportional-integral-derivativesocial network interventionzip code tabulation area
PMC10267788
Objective
Alzheimer's disease, AD
ALZHEIMER'S DISEASE
Edited by: Madhan Balasubramanian, Flinders University, AustraliaReviewed by: Kofi Boamah Mensah, Kwame Nkrumah University of Science and Technology, Ghana; Chen Li, Shanghai University of Engineering Sciences, ChinaThis article was submitted to Aging and Public Health, a section of the journal Frontiers in Public Heal...
PMC9911520
Methods
Alzheimer's Disease Knowledge Scale
A total of 763 people from 12 community health service centers were investigated using a self-created general situation questionnaire and the Alzheimer's Disease Knowledge Scale (ADKS). Among the participants, 261 people who were willing to receive training were randomly divided into two groups according to the institu...
PMC9911520
Results
DISEASE COURSE
The average ADKS score was 19.77, and the awareness rate was 65.92%; the results for every field were as follows: treatment and management (81.32%); life impact (77.76%); disease course (75.23%); assessment and diagnosis (68.94%); risk factors (65.05%); symptoms (57.90%); caregiving (44.06%). Education and profession h...
PMC9911520
Conclusion
Community health service center staff in Jiaxing had limited knowledge of AD, particularly in the “symptom” and “caregiving” dimensions. One instance of training on AD-related knowledge to some degree helped to improve this but still fell short of meeting the national requirements. No significant differences were found...
PMC9911520
Background
dementia, behavioral impairment, cognitive dysfunction, Alzheimer's disease, AD
ALZHEIMER'S DISEASE, DISEASE
Alzheimer's disease (AD) is a neurodegenerative condition characterized by progressive cognitive dysfunction and behavioral impairment that occurs in pre-old age and old age (The focus on dementia and Alzheimer's disease has continued to increase in recent years. In September 2020, the National Health Commission announ...
PMC9911520
Method
PMC9911520
Sample and settings
MAY, DISEASES
Jiaxing includes three districts, as well as two county and three county-level cities, each with 4–12 streets or towns. From May to November 2020, 12 representative streets/towns were randomly selected by stratification according to geographical location and size. Following on, all the staff of community health service...
PMC9911520
Survey instruments
Alzheimer's Disease Knowledge Scale, dementia
DISEASE COURSE
A self-designed questionnaire for collecting general information, including name, gender, age, institution of employment, educational background, professional title, and current professions years of employment, whether any previous training related to AD had been received in the past, and whether participants' relative...
PMC9911520
Data collection and quality control
PMC9911520
Questionnaire survey
Before and immediately after completing the training, the self-designed questionnaire and ADKS were completed in two ways; the offline training group filled in paper, and the online training group completed the questionnaire digitally using a provided link. Additionally, the online training group was invited to evaluat...
PMC9911520
Training methods
The offline training group engaged in traditional learning, i.e., by gathering in a specific area where a lecturer presented a slide presentation and content explanations. For the online training group, the lecturer pre-recorded the training information and uploaded it to either the DingTalk or WeChat platforms. The me...
PMC9911520
Statistical analysis
REGRESSION
Data were input into Microsoft Excel 2019, and the SPSS Statistics 25.0 software program was used to conduct statistical analysis. Quantitative data were presented in the form of median and interquartile spacing, which did not conform to normal distribution; a rank-sum test was conducted for making comparisons between ...
PMC9911520
Results
PMC9911520
Participant characteristics
AD, dementia
ALZHEIMER'S DISEASE
A total of 763 individuals from 12 community health service centers participated in the study. Most of the participants were female (73.0%), with an average age of 35.09 years; most had a bachelor's degree (71.6%), as well as junior or intermediate titles (74.2%), and 49.0% had majored in internal medicine. Their avera...
PMC9911520
Alzheimer's Disease Knowledge Scale scores
anxiety, Alzheimer's disease” (19.79%), and “Tremor, Alzheimer's disease, Alzheimer's disease” (26.87%)., depression
DISEASE, ALZHEIMER'S DISEASE, DISEASE COURSE
The average ADKS score of 763 staff members was 19.77, and the awareness rate was 65.92%. The awareness rate of each specific field (from high to low) was as follows: treatment and management (81.32%); life impact (77.76%); disease course (75.23%); assessment and diagnosis (68.94%); risk factors (65.05%); symptoms (57....
PMC9911520
Feedback information
A total of 111 of 119 participants of the online training group provided feedback information, most of whom agreed or agreed to some extent that “online training was an acceptable form of training,” “the training generally felt good,” “the training would be of great help to their future work,” and “they would also be w...
PMC9911520
Discussion
Cognitive Disorders, AD, dementia
REGRESSION, CORONAVIRUS
This is the first study to use ADKS to investigate the knowledge of Alzheimer's disease among community health service center staff in Jiaxing, and to conduct training and evaluate the effectiveness of the training. At present, the consultation rate of patients with dementia in China is not high, and most patients live...
PMC9911520
Conclusion
1. The staff of community health service centers in Jiaxing had a low awareness rate of AD-related knowledge, particularly in the “symptoms” and “caregiving” dimensions. 2. Education background and occupation are the influencing factors of ADKS score, and those with higher education background and physicians score more...
PMC9911520
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
PMC9911520
Ethics statement
This study was conducted with approval from the Ethics Committee of the Second Affiliated Hospital of Jiaxing University (No. JXEY-2020JX065). The patients/participants provided their written informed consent to participate in this study.
PMC9911520
Author contributions
WM and XZ: conception and design of the research and obtaining financing. WM, LZ, JT, WD, LQ, and XF: acquisition of data. WM, LZ, JT, and XZ: analysis and interpretation of the data. WM, WD, LQ, and XF: statistical analysis. WM: writing of the manuscript. XZ: critical revision of the manuscript for intellectual conten...
PMC9911520
Conflict of interest
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.
PMC9911520
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or ...
PMC9911520
Supplementary material
The Supplementary Material for this article can be found online at: Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.
PMC9911520
References
PMC9911520
Key Points
PMC10559185
Question
schizophrenia
What is the therapeutic efficacy of multigenic pharmacogenomics–guided treatment in patients with schizophrenia?
PMC10559185
Findings
SYNDROME, POSITIVE
In this randomized clinical trial that included 210 Chinese Han men, patients treated with multigenetic pharmacogenomics–guided treatment had a greater symptom improvement than those treated with treatment as usual after a 6-week treatment, measured as the mean difference in percentage change of Positive and Negative S...
PMC10559185
Meaning
schizophrenia
Multigenetic pharmacogenomic testing can be an effective tool to guide the treatment of schizophrenia.This randomized clinical trial evaluates the clinical effectiveness of multigenetic pharmacogenomics–guided treatment in schizophrenia among Han men in China.
PMC10559185
Importance
schizophrenia
Limited evidence supports multigenetic pharmacogenomics–guided treatment (MPGT) in schizophrenia.
PMC10559185
Objective
schizophrenia
To evaluate the clinical effectiveness of MPGT in schizophrenia in a randomized clinical trial (RCT).
PMC10559185
Design, Setting, and Participants
schizophrenia
POSITIVE
This RCT was conducted from March 2020 to March 2022. Male Chinese Han inpatients aged 18 to 60 years diagnosed with schizophrenia with a Positive and Negative Symptom Scale (PANSS) score of 60 or more from 2 selected study hospitals were included. Patients and raters were masked to MPGT or treatment as usual (TAU) ran...
PMC10559185
Interventions
Participants were randomly assigned in a 1:1 ratio to receive either MPGT or TAU for 12 weeks.
PMC10559185
Main Outcomes and Measures
SECONDARY, REMISSION
The primary efficacy outcome was the percentage change in PANSS total scores (range, 30 to 210) from baseline to week 6 analyzed by a modified intention-to-treat mixed model for repeated measures. The secondary outcome included response and symptomatic remission rates.
PMC10559185
Results
A total of 210 participants (mean [SD] age, 29.2 [8.8] years) were enrolled and analyzed, with 113 assigned to MPGT and 97 to TAU. Compared with those randomized to TAU, participants randomized to MPGT demonstrated a significantly higher percentage change in PANSS score (74.2% vs 64.9%; adjusted mean difference, 9.2 pe...
PMC10559185
Conclusions and Relevance
schizophrenia
In this RCT of MPGT, MPGT was more effective than TAU in treating patients with schizophrenia. These findings suggest that multigenetic pharmacogenomic testing could serve as an effective tool to guide the treatment of schizophrenia.
PMC10559185
Trial Registration
Chinese Clinical Trial Registry Identifier:
PMC10559185
Introduction
Schizophrenia, schizophrenia
DISORDER
Schizophrenia is a complex polygenic disorder characterized by disturbances in multiple mental modalities.In recent years, pharmacogenomic testing has been widely used to guide drug therapy and has yielded exciting results.Based on these foundations, we conducted an RCT to evaluate the efficacy of MPGT in male Chinese ...
PMC10559185
Methods
PMC10559185
Study Design and Participants
schizophrenia
This study is a 12-week, 2-center, parallel RCT evaluating the therapeutic effects of MPGT compared with TAU in patients with schizophrenia. Patients and raters were masked to MPGT or TAU randomization. The trial protocol can be found in Participants were enrolled at the Peking University Sixth Hospital, Beijing, China...
PMC10559185
Randomization and Masking
Participants enrolled were randomly assigned to the MPGT or the TAU group in a 1:1 ratio using a preplanned randomization list. Raters were masked to the study group. Participants were masked to the study group and their pharmacogenomics report until the end of the trial. Clinicians who took care of participants in the...
PMC10559185
Multigenetic Pharmacogenomic Testing
ADVERSE EFFECTS
In this study, we detected single-nucleotide variant loci of 26 alleles or variants across 11 genes that are reported to be associated with antipsychotic medication metabolism, efficacy, or adverse effects (eTable 1 in
PMC10559185
Trial Procedure
Detailed procedures are described in the eMethods in
PMC10559185
Outcome Measures
schizophrenia, first-episode schizophrenia
SECONDARY, REMISSION
The primary efficacy outcome of this trial was the percentage PANSS score change from baseline to the end of week 6. Percentage PANSS score change was calculated using the difference between the baseline and follow-up scores divided by the baseline score minus 30.The secondary outcome was response or remission rates at...
PMC10559185
Power Calculations
depressive disorder
Based on a previous study of pharmacogenomics-guided treatment on major depressive disorder,
PMC10559185
Statistical Analysis
For baseline characteristics analysis, variables were properly described as means and SDs, medians and IQRs, or counts and frequencies. For normally distributed data, unpaired The primary outcome (percentage PANSS score change) was evaluated by a mixed model for repeated measures (MMRM), which is a better approach than...
PMC10559185
Results
PMC10559185
Demographic Characteristics
first-episode schizophrenia
A total of 360 patients were screened for eligibility, of whom 213 patients entered the trial and 210 were included in the modified intention-to-treat analyses, with 113 randomized to MPGT and 97 to TAU. The mean (SD) age of the 210 included participants was 29.2 (8.8) years, and 63 participants (30.0%) had first-episo...
PMC10559185
Baseline Characteristics of the Modified Intention-to-Treat Population
high-density lipoprotein
SYNDROME, POSITIVE
Abbreviations: HDL, high-density lipoprotein; LDL, low-density lipoprotein; MPGT, multigenetic pharmacogenomics–guided treatment; PANSS, Positive and Negative Syndrome Scale; TAU, treatment as usual.SI conversion factor: To convert triglycerides to mmol/L, multiply by 0.0113; cholesterol to mmol/L, multiply by 0.0259; ...
PMC10559185
Study Flowchart
mITT indicates modified intention to treat; MPGT, multigenetic pharmacogenomics–guided treatment; TAU, treatment as usual.
PMC10559185
Primary Outcome
schizophrenia
The time course of schizophrenia severity represented by PANSS scores and the percentage PANSS score change throughout the whole study are shown in
PMC10559185
Secondary Outcomes
REGRESSION
The early response rate was not statistically significantly different between treatment groups, as assessed by the odds ratio estimated by the logistic regression model. The response rates at the end of week 6 were 82.3% (93 of 113) for the MPGT group and 64.9% (63 of 97) for the TAU group (adjusted odds ratio, 2.48; 9...
PMC10559185
Secondary Outcomes
posturing, mannerisms, hallucinatory behavior, delusions
REMISSION, SYNDROME, POSITIVE, POSTURING
Abbreviations: MPGT, multigenetic pharmacogenomics–guided treatment; OR, odds ratio; TAU, treatment-as-usual.Early response was defined as a percentage Positive and Negative Syndrome Scale score change of 20% or more at the end of postrandomized week 2.Response was defined as a percentage Positive and Negative Syndrome...
PMC10559185
Exploratory Outcomes
first-episode, schizophrenia
The difference in percentage PANSS score change between those with first-episode and relapsed schizophrenia in the MPGT group was not statistically significant, indicating a similar therapeutic effect of MPGT on both first-episode and relapsed schizophrenia (We found lower chlorpromazine equivalents were assigned to pa...
PMC10559185
Discussion
schizophrenia, psychiatric, Psychotic symptoms
REMISSION
To our knowledge, this study is the first RCT to evaluate the therapeutic efficacy of MPGT in Chinese Han patients with schizophrenia. Consistent with our hypotheses, patients with schizophrenia randomized to MPGT achieved greater improvements in symptoms and reported lower plasma prolactin levels.Several studies have ...
PMC10559185
Limitations
treatment-resistant
REMISSION
There are several limitations of our study. We only included male Chinese Han patients, and the response and remission rate in our study is relatively higher than in previous studies. Caution is needed in generalizing the findings to other populations, especially the treatment-resistant population. Moreover, to choose ...
PMC10559185
Conclusions
schizophrenia
ADVERSE EFFECTS
In summary, our study showed that pharmacogenomics-guided treatment of antipsychotics significantly improved the clinical outcomes in terms of drug efficacy and adverse effects of prolactin elevation in patients with schizophrenia. Multigenetic pharmacogenomics testing can be an effective tool to guide the treatment of...
PMC10559185
2. Materials and Methods
PMC9914784
2.1. Setting and Eligibility Criteria
Ovarian Cancer
DER, OVARIAN CANCER, BREAST
The study was conducted between 2019 and 2021 at six study centers in Germany that belong to the Familial Breast and Ovarian Cancer consortium (University Hospital of Cologne, University Hospital of Würzburg, University Hospital Schleswig-Holstein Campus Kiel, University Hospital Heidelberg, University Hospital Carl Gu...
PMC9914784
2.2. Data Collection and Measures
depression, Depression, cancer, Anxiety
CANCER, EVENT
The data were collected from a self-administered questionnaire that participants received after giving informed consent. Participants were able to take the questionnaire home and were asked to return the questionnaire within one week. Data were collected on age, marital status, highest level of education, employment st...
PMC9914784
2.3. Statistical Methods
All statistical analyses were performed using SPSS Version 27.0 ) (IBM, Armonk, New York, USA). All results were interpreted using a two-sided
PMC9914784
3. Results
Overall, 130 women with a newly found
PMC9914784
3.1. Demographic Data
To identify potential covariates in the relationship between coping self-efficacy and psychological morbidity, age, BRCA mutation, and parity were analyzed. Age was not significantly correlated to any variable of interest. When comparing
PMC9914784
3.2. Anxiety and Coping Self-Efficacy
anxiety, non-elevated anxiety
The sample’s overall anxiety mean measured by the HADS was just under the threshold of borderline clinical anxiety at When categorized into groups, almost half of the sample (45.4%, For problem-based coping (CSE-PF), post hoc tests showed that participants with non-elevated anxiety were significantly better at problem-...
PMC9914784
3.3. Depression and Coping Self-Efficacy
depression
The sample showed a mean score of depression of
PMC9914784
3.4. Impact of Event Scale
EVENT
The mean score for the impact of event scale was
PMC9914784
3.5. Decision Making and Coping Self-Efficacy
Frequency analysis of the SDMS (missing n = 7) yielded that very few participants (3.8%) had not thought about the preventive options yet (stage 1). Most participants (42.3%) reported that they were currently thinking about the different preventive options (stage 2), while 16.9% reported being close to making a decisio...
PMC9914784
4. Discussion
anxiety, breast cancer, psychological distress, depressed, cancer worry, depression
BREAST CANCER
In this study, we identified high rates of anxiety, with over half of newly found cancer-unaffected The present study addresses a gap in the literature by investigating coping self-efficacy and its relationship with psychological and decision-related outcomes after genetic test result disclosure in cancer-unaffected fe...
PMC9914784
5. Conclusions
The aim of this study was to obtain insights into the relationship between coping self-efficacy and psychological morbidity in newly found
PMC9914784
Author Contributions
Conceptualization, S.S., R.S. and K.R.; methodology, S.S., R.S., K.R., F.V., A.S. and J.K.-N.; software, A.I. and Z.L.; formal analysis, A.I. and Z.L.; investigation, S.S., K.R. and R.S.; resources, F.V., H.F., A.S., B.B.-H., J.K.-N. and K.B.; data curation, M.T. and Z.L.; writing—original draft preparation, A.I.; writ...
PMC9914784
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki. Ethical approval to conduct the trial was obtained from the University Hospital of Cologne Research Ethics committee (no. 19-1110_1) on 19 August 2019. The trial was registered in the German Clinical Trial Register (WHO Registry Network...
PMC9914784
Data Availability Statement
All data are available from authors upon reasonable request.
PMC9914784
Conflicts of Interest
The authors declare no conflict of interest.
PMC9914784
References
depression, Depression, Anxiety, anxiety
Demographic frequencies in the sample.Note. No demographic variable showed significant differences within its subgroups in terms of coping self-efficacy.Means, standard deviation, and correlations among all continuous psychological and decision-making variables.HADS—DepressionHADS—AnxietyDCS—InformedDCS—Value ClarityDC...
PMC9914784
Subject terms
grey matter alterations
SECONDARY
The combination of repeated behavioral training with transcranial direct current stimulation (tDCS) holds promise to exert beneficial effects on brain function beyond the trained task. However, little is known about the underlying mechanisms. We performed a monocenter, single-blind randomized, placebo-controlled trial ...
PMC10238397
Introduction
brain impairment
Developing effective cognitive interventions to reduce or even prevent age-associated brain impairment has received substantial scientific attention in aging societies worldwide. Preliminary evidence suggests that the combination of behavioral training and concurrent transcranial electrical stimulation (tES), one of th...
PMC10238397
Study flow chart.
Following a pre-assessment of performance on the cognitive tasks, a pre-intervention MRI was conducted; the intervention commenced two days later and lasted for three weeks (with active (anodal) or sham tDCS + training administered three times per week). A post-intervention MRI session was conducted two days after the ...
PMC10238397
White matter microstructure is modulated after brain stimulation
We performed individual probabilistic tractography seeding from the stimulation target (left middle frontal gyrus, defined to represent the gyrus below the anodal electrode, picked from the Harvard-Oxford atlas
PMC10238397
Gray matter microstructure is altered after brain stimulation
CORTEX
Gray matter regions in the cortex underneath the anode (left middle frontal cortex) were segmented using Freesurfer
PMC10238397
Functional connectivity is increased after brain stimulation
To investigate whether functional connectivity was modulated by anodal tDCS, we performed seed-to-voxel correlational analyses on resting-state fMRI data using CONN
PMC10238397
Pathways‘ microstructure change is associated with performance gain
performance gain
In order to explore linear relationships between the effects on different MR markers as well as with performance gain (LU and N-back change), correlation matrices were generated, illustrating scatterplots and Spearman correlation coefficients for all bivariate associations (Fig. 
PMC10238397
Scatterplots for correlations between Post-Pre differences in FA, MD, and FC with individual performance gain (LU and N-back change).
BRAIN
Brain images were created with MRIcroGL (Bivariate scatterplots also revealed that microstructural plasticity in the stimulation target was associated with functional connectivity modulation: Higher decreases in gray matter MD were associated with increases in FC due to the intervention (As a control, we explored bivar...
PMC10238397
Discussion
behavioral performance gain, stroke
STROKE, CORTEX
Three-week brain stimulation-assisted cognitive training in healthy older adults resulted in modifications of microstructure in white matter pathways and gray matter cortical target area as well as functional connectivity changes in a broader frontoparietal network. FA in prefrontal tracts originating from the stimulat...
PMC10238397
Methods
PMC10238397