Background:Health care has seen several new disruptive technologies. One such innovation is the introduction of blockchain smart contracts. These smart contracts are activated automatically once preprogrammed conditions are met. Smart contracts have improved patient outcomes, the efficiency of care delivery, and reduced costs. Despite their benefits, patients have had limited interactions with smart contracts in primary care; therefore, they may not trust blockchain-based smart contracts and may perceive them as risky or have concerns about their security. Objective:This study aimed to evaluate how patients' perceptions of smart contracts affect their adoption in primary care. Specifically, we investigated the impact of patients' perceptions of smart contract security, risk, and trust in their health care providers. Methods:This study used an experimental survey design to evaluate acceptance of smart contracts. Patients were randomly assigned to 1 of 2 research scenarios proposing either the positive use of blockchain smart contracts or the loss of benefits if a patient opted out. We collected data from a total of 387 participants. The Likert survey used 3 items to measure 5 constructs in the conceptual model. The 5 hypotheses were that gain-loss-framed messaging, perceived security, and trust would have a positive impact on the adoption of smart contracts, whereas perceived risk and the clinical setting would have a negative impact on patients' intention to adopt smart contracts. The conceptual model was tested using structural equation modeling, and the model fit indices suggested a good fit. Results:Most of the hypotheses were supported, except for the gain-loss-framing effect. As hypothesized, perceived security had the strongest positive influence on the intention to use smart contracts (β=.50; P<.001). Trust in health care providers also showed a significant positive relationship (β=.43; P<.001), while perceived risk had a smaller but still significant negative impact (β=-.071; P.048). Patients in clinic-based settings had a lower intention to use smart contracts than patients in telehealth settings, and male patients had a lower intention to use smart contracts than female patients. Conclusions:The results of this study have implications for health care providers who intend to adopt smart contracts early, that is, early majority or late adopters. To facilitate their implementation, providers should highlight the security benefits of smart contracts and leverage patient trust. Providers should customize smart contract implementation strategies based on patient demographics such as age, health status, and gender. By understanding these factors, health care organizations can more effectively promote the adoption of smart contracts and realize the potential benefits of this disruptive technology in primary care.

Background Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person’s COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved. Objective This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals’ perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status. Methods The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling. Results After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (β=0.688; P<.001), self-efficacy (β=0.292; P<.001), and an individual’s prior infection with COVID-19 (β=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β=−0.360; P<.001), risk aversion (β=−0.150; P=.09), and a family member’s prior infection with COVID-19 (β=−0.139; P=.02) had statistically significant negative influences on a person’s intention to use mobile tracing apps. Conclusions This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement.

Background and objectiveThe Global Registry of Acute Coronary Events (GRACE) study showed poor outcomes in ST-elevation myocardial infarction (STEMI) patients with acute heart failure (AHF) at hospital admission in terms of increased in-hospital and six-month mortality and readmission rates. In this study, we aimed to examine the effects of AHF at the time of admission on the coronary thrombus burden and post-primary percutaneous coronary intervention (PPCI) coronary flow among STEMI patients.MethodsWe conducted a cohort study involving 210 consecutive STEMI patients who presented to a single PPCI centre between June 2016 and January 2017. We classified them into two groups based on their Killip class at the time of presentation to the emergency department: no heart failure (NHF) and AHF groups. The primary outcome was the incidence of Thrombolysis In Myocardial Infarction (TIMI) flow grade of less than 3 in the stented coronary artery in the absence of mechanical obstruction or dissection (also known as no-reflow). The secondary outcome was the presence of a heavy thrombus burden (TIMI grade 4 or 5) at the time of angiography.ResultsThe AHF group had a significantly higher incidence of no-reflow than the NHF group (25% vs. 8.4%, p=0.019). However, the prevalence of heavy thrombus burden did not differ significantly between the two groups (50% in the AHF group vs. 43.16% in the NHF group, p=0.557). The multivariable logistic regression analysis showed that AHF was an independent predictor of no-reflow in STEMI patients post-PPCI [Odds ratio (OR): 3.59, 95% confidence interval (CI): 1.09-11.83, p=0.035].ConclusionBased on our findings, AHF is associated with an increased risk of no-reflow in STEMI patients post-PPCI, irrespective of the coronary thrombus load.

Aim of the present report was to assess the feasibility, toxicity, short and long term outcome in addition to assessing the ability to produce pathological complete response to therapy of using a SCRT and SCRT followed by delayed surgical resection, in patients with a middle and/or low LARC.Patients and methods:we prospectively assessed 60 patients who were diagnosed with middle and/or low LACR we divided them into; 35 patients underwent SCRT only and 25 patients underwent SCRT followed by delayed surgical resection (SCRT-DS group). We compare between both included groups regarding; short term, long term, surgical and survival outcomes.Results:All included patients showed disappearance of cancer-related hemorrhage. Cancer-related pelvic pain disappearance happened in80%of patients.In patients who underwent SCRT alone; complete pathologic response was reported in15%of patients, partial response was reported in 15% of patients and no response was reported in70%of patients. In patients who underwent SCRT-DS complete pathologic response was reported in30%of patients, partial response was reported in 40% of patients and no response was reported in 30% of patients. All the patients have R0 resection margin.In all included patients down-staging of cancer occurred78.9%of patients without statistically significant differences between both included groups of patients. Median OS rate and DFS rate were better in the SCRT-DS group than in SCRT group (p =0.049and0.036respectively). Conclusions:we demonstrated that using SCRT followed by a delayed surgery in patients with a low/middle LARC which were considered “unfit” for LCRT is a feasible and safe management strategy regarding both surgical and oncologic outcomes

Introduction Trials showed that multivessel disease (MVD) was associated with increased cardiovascular morbidity and mortality in STEMI patients. There is no available evidence on the validity of non-invasive clinical parameters to predict the presence of MVD in the available literature. We aimed to find the relationship between acute heart failure (AHF) at the time of presentation of STEMI patients to the emergency department and the number of diseased coronary arteries on the angiogram. The latter is vital in determining those patients9 morbidity and mortality during hospitalisation. Methods We ran a retrospective cohort study that included 210 consecutive STEMI patients who presented to a single PPCI centre. We excluded post-fibrinolysis patients, patients with old stents, and those who presented more than 24 hours after the onset of pain. We divided the studied cohort into two subgroups based on the presence of AHF on presentation to the emergency department, the AHF and the no-HF groups. We obtained Informed consent from all patients, and all procedures were done in compliance with the Helsinki declaration for research on human beings. Two blinded interventional cardiology consultants assessed the number of diseased coronaries in the angiograms of the patients before the PPCI was done. A diseased vessel was defined as one that showed 70% stenosis in the left anterior descending, left circumflex, and right coronary artery, or 50% stenosis in the case of the left main coronary artery. Results The baseline characteristics of the studied groups are presented in table 1. The HF group represented 9.5% of the studied patients. The modal of the number of diseased coronaries was significantly higher in the AHF group compared to the no-HF group (3 vs one vessel, respectively, p=0.036). (figure 1) A point biserial correlation analysis illustrated a positive correlation between the presence of AHF and the number of diseased coronary arteries ( rpb=0.16, p=0.02). A multivariate logistic regression analysis confirmed that admission AHF was an independent predictor of having three-vessel coronary artery disease in STEMI patients (OR= 3.79, 95% CI 1.38-10.37, p=0.01). Conclusion AHF in STEMI patients is associated with a higher risk of multivessel disease (MVD) on angiography. This information is crucial in managing those patients, as studies showed higher morbidity and mortality in MVD patients. Conflict of Interest None

Background:The Global Registry of Acute Coronary Events (GRACE) study showed that admission HF is associated with longer hospital stay and higher mortality in ST-elevation myocardial infarction (STEMI) patients. No data are available on the effect of heart failure (HF) on the length of cardiac care unit (CCU) stay and in-hospital major adverse cardiac events (MACEs). The link between the severity of HF and the in-hospital prognosis is not established. Therefore, we aimed to investigate the unstudied outcomes in HF patients as well as to compare the outcomes across the spectrum of HF presentations.Methods:We studied 210 STEMI patients presenting to a single primary percutaneous coronary intervention (PPCI) center in a retrospective cohort pattern. We excluded those who received fibrinolysis, those who had chest pain for more than 24 h and those with previous stents and presenting with stent thrombosis. All the procedures followed the ethical standards of Alexandria University and the Helsinki Declaration.Results:STEMI patients with HF had significantly longer CCU stay (mean value of 3.6 vs. 2.87 days, P = 0.009), higher in-hospital MACE (55% vs. 4.7%, P < 0.001) and higher mortality (15% vs. 0.53%, P < 0.001). Multivariate logistic regression analysis revealed that HF is an independent predictor of in-hospital mortality (odds ratio (OR) = 9.11, 95% confidence interval (CI): 1.66 - 49.9, P = 0.01). The patients with severe HF on admission (Killip III and IV) tended to stay longer in the CCU (4.13 ± 1.89 days vs. 3.25 ± 1.54 days, P = 0.069) and the hospital (5.88 ± 3.09 vs. 4.42 ± 2.47 days, P = 0.077), compared to those with mild HF (Killip II). There was a tendency for a higher incidence of in-hospital MACE (75% vs. 33%, P = 0.068) and mortality (16.7% vs. 12.5%, P = 0.798) in the former group compared to the latter. The differences among HF subgroups did not reach the point of statistical significance though.Conclusions:The presence of HF on the admission of STEMI patients undergoing PPCI is associated with longer CCU stay, higher in-hospital MACE and mortality.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background: Fitness trackers allow users to collect, manage, track, and monitor fitness-related activities, such as distance walked, calorie intake, sleep quality, and heart rate. Fitness trackers have become increasingly popular in the past decade. One in five Americans use a device or an app to track their fitness-related activities. These devices generate massive and important data that could help physicians make better assessments of their patients' health if shared with health providers. This ultimately could lead to better health outcomes and perhaps even lower costs for patients. However, sharing personal fitness information with health care providers has drawbacks, mainly related to the risk of privacy loss and information misuse. Objective: This study investigates the influence of granting users granular privacy control on their willingness to share fitness information. Methods: The study used 270 valid responses collected from Mtrurkers through Amazon Mechanical Turk (MTurk). Participants were randomly assigned to one of two groups. The conceptual model was tested using structural equation modeling (SEM). The dependent variable was the intention to share fitness information. The independent variables were perceived risk, perceived benefits, and trust in the system. Results: SEM explained about 60% of the variance in the dependent variable. Three of the four hypotheses were supported. Perceived risk and trust in the system had a significant relationship with the dependent variable, while trust in the system was not significant. Conclusions: The findings show that people are willing to share their fitness information if they have granular privacy control. This study has practical and theoretical implications. It integrates communication privacy management (CPM) theory with the privacy calculus model.

Online gaming has grown to be a very popular electronic entertainment for people throughout the world. However, the burgeoning popularity of online games in some cases leads to addiction, a phenomenon that has received considerable attention. The purpose of this study is to examine the effects of psychological ownership, gaming motivation, and primary–secondary control on online game addiction (OGA). Based on 436 valid responses collected from online questionnaires, the partial least squares structural equation modeling approach was employed to test the research model. Findings show that the motivations of achievement and escapism are positively associated with psychological ownership toward a virtual gaming environment. Of particular interest is the inverted-U relationship between psychological ownership and OGA, suggesting that too little or too much psychological ownership is associated with less OGA. Finally, individuals with high levels of primary (secondary) control are more (less) inclined to be addicted to online games. This study provides practical implications and strategies to address the alarming increase in OGA. First, families, communities, and universities should encourage outdoor activities, such as sports competitions, and offline cosplay games to address the need for achievement and escapism. Second, individuals who play online games for relaxation should choose a relatively easy or hard mode to avoid game addiction. Finally, parents, teachers, and employers are encouraged to pay attention to individuals who have a high level of primary control since they can be susceptible to OGA. This study provides several theoretical contributions. First, the study enriches OGA and the gaming motivation literature by exploring the roles of gaming motivation, psychological ownership, and personal control strategies as they can be a factor in OGA. In addition, this study is the first to investigate the dark side of psychological ownership in terms of negative outcomes for OGA. This study also advances the personal control strategy literature by understanding the roles of primary and secondary control on OGA.

Background: Chronic threatening limb ischemia (CTLI) is a major medical problem affecting limbs, quality of life and survival. Angioplasty is considered as the first choice for treatment. Neither definite strategy was defined as the best option nor intraoperative endpoint for successful angioplasty for infragenicular vessles. Aim: to investigate angiosomal concept and wound blush in wound healing after infra-genicular angioplasty. Methods: 40 patients with CTLI affecting the infra-genicular arteries. Patients were divided into two groups; Direct revascularization (DR) and Indirect Revascularization groups (This was done if the direct revascularization was not technically possible). According to post intervention wound blush, patients were categorized into WB-positive and WB-negative groups. Follow up was done on 1, 3, 6 and 12 months postoperatively. Results: 60% (24/40) underwent DR, whereas 40% (16/40) underwent IR. ABPI was improved significantly postoperatively. For DR group, 14 (87.5%) patients had their wounds completely epithelialized (P=0.005) and overall limb salvage was 70% (P=0.03). For the IR group, six (54.5%) patients had limb salvage, two (28.57%) had major amputation. From the 40 endovascular interventions, 8 limbs showed positive WB and 32 showed negative WB. Limbs with positive WB healed in a significantly shorter duration (2.82±0.49 months) than did limbs with negative WB (3.2±0.63 months). Conclusion: DR technique should be the first therapeutic choice for infragenicular angioplasty as it is associated with higher wound healing and limb salvage rates. Presence of wound blush post intervention is a good predictor of wound healing rate and time.

Purpose: The purpose is to compare the changes in the peripapillary blood flow in primary open-angle glaucoma (POAG) after administration of dorzolamide 2%/timolol 0.5% fixed combination versus latanoprost 0.005%/timolol 0.5% fixed combination, using spectral-domain optical coherence tomography angiography (OCTA). Patients and Methods: In this prospective, comparative, nonrandomized study, patients with POAG received simultaneous treatment with dorzolamide 2%/timolol 0.5% fixed combination in the right eye (Group 1) and latanoprost 0.005%/timolol 0.5% fixed combination in the left eye (Group 2) for 1 week. Intraocular pressure (IOP) was measured using applanation tonometry; and peripapillary capillary density and retinal nerve fiber layer (RNFL) thickness was assessed using OCTA before starting treatment and 1 week after the treatment. Results: IOP reduction was superior in Group 2; however, this was not statistically significant. Both groups showed an increase in the peripapillary capillary density and RNFL thickness after 1 week of the treatment as evaluated by OCTA angiography. However, this increase was not statistically significant. There was only a statistically positive correlation between IOP reduction and increase in the superior-hemiradial peripapillary capillary density (P = 0.037) in Group 1 and between IOP reduction and increase in the total RNFL thickness and superior hemi-RNFL thickness (P = 0.044, 0.032, respectively) in Group 1. Conclusion: Intraocular pressure decreased in both groups with no significant difference between both groups. There was more increase in radical peripapillary capillary density and RNFL thickness following treatment in dorzolamide 2%/timolol 0.5% group compared to the other groups; however, the difference between the two groups was not statistically significant.

Background Phishing is a cybercrime in which the attackers usually impersonate a trusted source. The attackers usually send an email that contains a link that allows them to steal the receiver’s personal information. In the United States, phishing is the number one cybercrime by victim count according to the Federal Bureau of Investigation’s 2019 internet crime report. Several studies investigated ways to increase awareness and improve employees’ resistance to phishing attacks. However, in 2019, successful phishing attacks continued to rise at a high rate Objective The objective of this study was to investigate the influence of personality-based antecedents on phishing susceptibility in a health care context. Methods Survey data were collected from participants through Amazon Mechanical Turk to test a proposed conceptual model using structural equation modeling. Results A total of 200 participants took part. Health concerns, disposition to trust, and risk-taking propensity yielded higher phishing susceptibility. This highlights the important of personality-based factors in phishing attacks. In addition, females had a higher phishing susceptibility than male participants Conclusions While previous studies used health concerns as a motivator for contexts such as sharing personal health records with providers, this study shed light on the danger of higher health concerns in enabling the number one cybercrime.