The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines.This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals.The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention , operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis.The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 . After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites.This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions.DERR1-10.2196/25284 The integration of technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery (RAS) is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. RAS cases have tripled over the past decade  largely RAS implementation focuses on establishing the technical skills of the surgeon operating via the robotic console . Howeverwork as done  and work as imagined , illuminating the reality of how work is accomplished outside of an idealized expected or desired occurrence of events. In this paper, we discuss the design of a methodological framework and study execution applied to improve the processes of care in RAS.As models of surgical processes have improved, it has become possible to reliably observe the disruptive effects of systems issues on intraoperative performance and their downstream effects on mortality and morbidity. For nearly 2 decades, direct observation of surgical work has been used to understand potential hazards in the surgical process ,23. DireThis 5-year study will take a human factors engineering approach to improve the safety and efficiency of RAS across 4 US hospitals. The primary objective of this study is to generate a set of integrated, evidence-based tools for improving the safety and efficiency of robotic surgery by (1) improving teamwork and communication skills, (2) improving and standardizing technical tasks such as instrument changes and robotic docking, and (3) improving the working environment. The secondary objectives are to (1) understand the effects of organizational and work context on the spread of good practice in high-technology surgery and (2) generate a computational model of the mechanisms by which small, seemingly innocuous events escalate to create serious surgical complications. This will fundamentally improve our understanding of how innovative surgical technologies can be safely deployed and integrated within clinical work systems.This 6-phase study includes the observation and analysis of RAS cases sampled across 4 hospitals. The study will use a pseudostepped wedge crossover design with 3 individual interventions—teamwork training (TT), task design (TD), and workspace design (WD), introduced in different sequences at each of the 4 hospital sites over 4 phases (phases 3-6) of 8 months each. We elaborate on the proposed interventions below.TT interventions will be built based on teamwork training and nontechnical skills frameworks and will support the skills needed for teams to address RAS-specific communication challenges. The TT approach will consist of a TeamSTEPPS ,25 driveTD interventions will focus on specifying, ordering, and allocating tasks to specific roles to improve efficiency, visibility, and reliability . A previWD involves proposing and implementing new OR layout configurations to improve the use of space in RAS. OR layouts will be configured to ensure (1) the surgeon can see the patient and the team from the console, (2) the team can see the surgeon, (3) staff can move freely in the room, (4) robot docking can occur from multiple angles, (5) minimize cable tensions and trip hazards, and (6) optimization of OR equipment preparation and instrument storage. Key movement-oriented tasks will be used to plot ideal movement paths on existing room layouts, and new layouts will be proposed and tested to reduce unnecessary movement and disruption.Given the close interactions between technology, tasks, teamwork, and process -32, we hwhole  and assuming a normal distribution, 40 observations per site per time per intervention will provide at least 80% power to find a statistically significant effect of the intervention on surgery duration. Achieving this level of statistical power remains possible with 23 observations per phase per site, making our planned sample of 40 robust, should data collection be more challenging than anticipated.safety net hospital, and a small private community hospital. The Medical University of South Carolina (MUSC) is an 864-bed level 1 trauma academic medical center in the southeastern United States. MUSC uses a Si da Vinci robot for general surgery procedures and Xi (X generation) for urology and gynecology procedures. Cedars-Sinai Medical Center (CSMC) is a large nonprofit tertiary care center with 958 beds and a level 1 trauma center designation in the western United States. CSMC currently has 7 da Vinci robots: 5 dual Xi consoles and 2 Xi single consoles. Marina del Rey Hospital (MDRH) is a 145-bed community hospital, acquired by the Cedars-Sinai Health System in 2018. The hospital has a small yet active robotic surgical program dating back to 2012. There is one Si robot that is used daily (up to 10 cases weekly). Ventura County Medical Center (VCMC) is a designated level 2 trauma center safety net hospital in the western United States and acquired its first da Vinci robot (Xi) in 2017, which is actively being used in general surgery, urology, and gynecology.The study will be conducted at 4 hospitals in the United States, which include 2 tertiary centers with very different geography and demographics, a public At MUSC, CSMC, and MDRH, we will sample from the following RAS procedures: urogynecology (sacrocolpopexy with and without hysterectomy), gynecology , general and colorectal surgery , bariatric (sleeve gastrectomy), and urology . These cases are performed with enough volume to facilitate comparison through statistical analysis. At VCMC, an opportunity sampling approach, in which we collect any RAS procedure available, will be used because of the low RAS case volume.Measures will be evaluated across 3 dimensions of RAS—individual (clinicians), process (RAS case), and system  levels—and will be collected using hospital databases, observation, surveys, and interviews .Contextual covariates of known influence include patient details , surgery details , hospital, OR number, approximate room size), and personnel details . These covariates will be collected during the observations and/or retrospectively from the patient’s electronic health record. We will also record operative and in-room time, intraoperative complications, blood loss, conversion to open surgery , and returns to the OR via hospital electronic records for each intervention period.Deviations from the natural progression of a task   were colEach RAS procedure will be evaluated throughout 5 distinct surgical phases: (1) wheels in until incision, (2) incision to the surgeon on console (including the docking process), (3) surgeon on console to surgeon off console, (4) surgeon off console to patient closure, and (5) patient closure to wheels out. The duration of each phase will be recorded by the observers during data collection.The Oxford NOTECHS 2  rating sThe extent to which interventions are fully used following implementation will be assessed using the intervention adherence metric -44, a meSubjective workload ratings will be obtained using the SURG-TLX (Task Load Index) . This viSafety culture will be assessed using the Safety Attitudes Questionnaire (SAQ) , which hTo gauge team members’ responses to the interventions, we will administer the concurrent acceptability  measure noise of otherwise normal system function is a critical requirement for this study [Ensuring observers are effectively trained to perceive FDs and collect data on teamwork above the is study . During Familiarization observations will take place across 3 stages: (1) orientation to the OR, (2) practice observations, and (3) simultaneous observation of interrater reliability . Weekly Before conducting observations, 15-minute in-services will be conducted with the staff on each unit at each study site to explain the research, introduce them to the research team, and allow them to ask questions and express their concerns. In-services will be led by a human factors expert and surgeon team member(s). Furthermore, an information sheet will be provided to staff to educate them about the purpose of the study and provide contact information for members of the study team whether they have any questions.A total of 4 trained human factors researchers will observe 680 RAS cases over the course of the study period. For MUSC, CSMC, and MDRH, observers will capture 40 cases during each of the 5 data collection phases . For VCMC, 40 cases will be captured in each of 2 phases: baseline (which spans across phases 2-4) and intervention , surgery details , personnel details , and robot details . During the intervention phases, the intervention adherence metric will also be collected during each surgical observation to evaluate the use of interventions.Field notes will also be collected monthly by the observers at each of the 4 sites. Field notes generally consist of 2 parts: descriptive and reflective information. Descriptive information attempts to accurately document factual data  and the settings, actions, behaviors, and conversations observed. Reflective information documents your thoughts, ideas, questions, and concerns as you are conducting the observation. These notes will provide additional context for the implementation of the intervention using the Consolidated Framework for Implementation Research (CFIR) .Data will be collected in the OR using Microsoft Surface Pro 6 tablets. Urban Armor Gear Hand Strap & Shoulder Strap Military Drop Tested Cases are also used to provide ergonomic support and handling of tablets for observers standing or seated on stools for long period. XCOREsion 15-45 by J-Go Tech Microsoft Surface Portable Chargers were given to each observer to provide external battery life when collecting data over 2 or more consecutive cases with no opportunity to charge their tablets between cases.The SURG-TLX will be collected in person during direct observation and will be administered on a Microsoft Excel form located on the observer’s Microsoft Surface Pro tablets. The SAQ and concurrent acceptability will each be collected via a REDCap survey emailed to surgeons and OR staff.We will evaluate interventions as multiple case studies using in-depth interviews and observations to gain an understanding of how these process changes are adapted in each setting and what facilitates success and barriers to these changes. A diverse sample of OR managers, nurses, surgeons, assistants, and technical support personnel  will be interviewed using semistructured interview guides to elicit narratives of individual experiences surrounding RAS implementation, teamwork, surgical safety, and facilitators and /barriers to successful RAS workflow. Interviews will be guided by the CFIR  to examiWe will use multivariable regression models to explore the relationship between the covariates  and process measures , examining how these relationships are modified by interventions. The following are the specific questions we seek to answer: (1) What interventions are used (intervention adherence metric)? (2) Did OR staff like the interventions (concurrent acceptability)? (3) Did the interventions change attitudes (SAQ)? (4) Did the interventions change individual workload (TLX) and/or improve teamwork (NOTECHS)? (5) Did the interventions result in a better process (FD)? and (6) Did the interventions reduce surgical durations and/or blood loss and/or OR returns? Statistical analysis will be conducted using the R programming language  and assessed at the significance level of α .05.snowball hypothesis. The rationale behind this hypothesis is that accidents and injuries arise from the sequence of multiple, frequently occurring individual errors. Adverse outcomes can be seen both as the unlucky coincidence of multiple randomly occurring errors and/or as a causative chain of events where one error leads to the next, creating an error cascade . A range of exploratory Markov chain, Poisson process, and changepoint modeling techniques will be applied with the R programming language to analyze data across more than 1000 procedures and identify error causation mechanisms as random coincidences or as a deterministic error cascade. This mode of analysis aims to be a profound advance, not solely in understanding and addressing surgical complications and adverse events but in the entire way in which accidents are viewed.Direct observation of surgical processes may be useful in modeling adverse event causation by looking at the concatenation of smaller, seemingly innocuous errors to larger, more clinically serious situations -50. The An inductive and deductive thematic content analysis approach will be used to analyze the qualitative data . In totaThe study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 .After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of our 4 sites.The overall goal of our research involves conducting multiple system-level interventions in RAS to validate a methodological approach to understanding and addressing latent systemic threats from new surgical technologies and measure both the effects of improvements that result as well as the utility of the interventions. Multiple interventions will be developed, tested, and planned to substantially expand our understanding of surgical safety in high-technology health care settings. This project will be the most comprehensive study to apply a human factors framework to study safety and efficiency, as it relates to technology integration in surgery. Although focused on RAS, the proposed observational, implementation, and evaluative methods of this study can be successfully applied to other health care settings integrating advanced technological systems. The study aims to address challenges and concerns using a mixed methods approach, including interviews, observations, work systems approaches, longitudinal ethnographic sampling techniques, and statistical modeling. This design is intended to capture the etiology of failure modes resulting from the mismatch between technology and existing culture. The combination of approaches will allow us to address how small, otherwise innocuous incidents can snowball into accidents and injuries in health care settings ,49,53,54Our sample includes a high volume of RAS cases performed using the da Vinci robot and conveniently sampled; this will limit the range of surgical procedures observed and will likely result in an unbalanced sample across the 4 sites. Scheduling is complex, and case cancelations and delays are an inherent deficiency in collecting observational data. The presence of the observer impacts the nature of data collected, whether as a result of implicit bias or obstructed views, and will thus affect how the data are analyzed. Although the methods described earlier are imperfect, future research teams may explore better ways to conduct these types of studies, such as through the use of video monitoring and other innovative approaches.Although direct observation provides a unique opportunity to gain a true understanding of the current state of the system , there ain the wild; the nature of partnerships between human factors experts, clinicians, administrators, and OR staff; the integration and understanding of surgical technologies; and the implications for future technological development and clinical practice. Ultimately, this study will fundamentally improve our understanding of how innovative surgical technologies can be safely deployed and integrated into complex clinical work systems. We welcome the development of similar methodologies for the evaluation and integration of various kinds of technology in health care.This project will demonstrate the value of understanding technologies


Improvements in the science of health monitoring and maintenance have facilitated the observation of damage and defects in existing structures and infrastructures, such as bridges and railways. The need to extend sensing technology through the use of wireless sensors as well as the lack of description tools for understanding, visualizing, and documenting sensor outputs has encouraged researchers to use powerful tools such as Building Information Modelling (BIM) systems. BIM has become important because of conducting tools widely used in the Architecture, Engineering, and Construction (AEC) industry to present and manage information on structural systems and situations. Since combining health monitoring and maintenance results with BIM models is a new field of study, and most projects utilize various aspects of it, we have conducted a review of important work related to this subject published from 2010 to November of 2020. After reviewing 278 journal articles, research trends, approaches, methods, gaps, and future agenda related to BIM in monitoring and maintenance were highlighted. This paper, through a bibliometric and content analysis, concludes that besides main improvements, some limitations now exist which affect the modeling and maintenance process. These limitations are related to extending the IFC schema, optimizing sensor data, interoperability among various BIM platforms, optimization of various sensing technologies for fault detection and management of huge amounts of data, besides consideration of environmental effects on monitoring hazards and underground objects. Finally, this paper aims to help to solve the mentioned limitation through a comprehensive review of existing research. Deterioration of concrete structures and infrastructures, such as bridges and railways, is an ongoing challenge for the owners. Assessing the real condition of the deteriorated structures is important to identify types of defects on time, and make appropriate repair strategies ,2,3. DueSpeed and accuracy are two key factors in assessing the condition of constructions during health monitoring which will be heightened by using BIM programs. BIM has been shown to have enormous potential in benefitting the construction industry. BIM has an important role in making the SHM information accessible, practical and understandable. It could improve the quality of the assessment steps and facilities management or monitoring ,12,13,14BIM includes tools, processes, and technologies for documenting and exchanging 3D digital models. BIM is a conventional basis for describing monitoring-related information because it prepares a methodology for interdisciplinary metamodeling to qualify various kinds of information from different fields . DigitalBIM processes are arranged depending on whether the processes are coordinated to the same software called “closed BIM” or to cross-software applications called “open BIM” . The benBIM can facilitate the control and monitoring process of the structures during the entire life cycle through the various stages of design, production of materials, selection of layout, and maintenance such as recycling and reuse of materials .What are the benefits of using high-quality visual programs in monitoring procedures?What are the new subject areas and innovative approaches related to monitoring with BIM?What are the limitations related to performance of BIM in monitoring process?What are the future agenda related to this field?On the whole, the efficiencies of using BIM in SHM and maintenance are summarized as: management and control of SHM data, better interpretation by connecting real-time data in BIM models, and preparation of a confident database for various projects. While BIM programs and health monitoring methods are well known during the last decades, important questions remain considering usage and importance of building information models in health monitoring, including:The current paper will answer to these important questions through a systematic review of BIM in monitoring and maintenance with the summarization of the relevant subject areas, presentation of the approaches of existing research, determination of the limitations of existing studies, and preparation of future research agenda. This study tries to prepare a suitable and efficient literature review about achievements of BIM in monitoring and maintenance to show improvements, limitations, research gaps, and future agenda and emerging technologies due to the rapid growth of this field.The current paper analyses all existing studies related to the performance of BIM in health monitoring with a focus on maintenance and monitoring processes in various fields from the beginning of the last decade until 2020 through both quantitative and qualitative approaches. In this study, the bibliometric analysis utilizes a quantitative method for checking the existing research and consists of five steps.A keyword search was conducted in the Scopus database with different keywords: (1) “Building Information Modelling”; (2) “Building Information Modeling”; (3) “BIM”; (4) “Building Information Model”; (5) “Health Assessment”; (6) “Health Monitoring”; (7) “SHM”; (8) “Structural Health Control”; (9) “Sensor”; (10) “Maintenance” and (11) “Structural monitoring”. This search resulted in 1700 articles.All 1700 selected articles were filtered according to the following limitations: (a) only journal articles, (b) published in English and (c) published from 2010 until 2020. This resulted in 601 articles.A quick read of papers was then performed. This resulted in some papers being omitted for the following reasons: (a) they were related to other fields of study such as medicine and health (b) they were related to the design process whereas the subject under study was existing buildings and their monitoring during their life cycles. Note that although Scopus had subject area filtering, an individual investigation was conducted to identify all related articles. After this step, about 275 journal papers remained.To overcome Scopus limitations and control the results, an individual search was done in Web of Science (WoS) with the same keywords, to check existing papers. The total number of journal papers increased to 280.The two search results were combined in one list by excluding literature reviews and duplicate articles, resulting in 278 articles that fitted our research subject. After reading the articles, they were categorized into various groups considering their subjects. As BIM usage in health monitoring is a recent topic for researchers, there is no comprehensive approach towards a specific subject. Therefore, relevant papers related to BIM in maintenance and monitoring steps were also reviewed. The PRISMA diagram of the systematic literature review (SLR) is shown in The bibliometric analysis showed continued growth in the rate of published articles about using BIM in the monitoring and maintenance process from 2010 to November of 2020, as shown in By means of keyword clustering, the reviewed papers were categorized into groups based on their main purpose and modelling methodology. The dominant aims of each paper determined the category in which they were placed; however, some papers had the potential to be classified in alternate categories. At the end of each section, the forthcoming agenda related to the category was mentioned in order to facilitate future research. This part aims to cover all concepts related to monitoring and maintenance with BIM. The goals of various studies and attitudes towards monitoring and maintenance are summarized in the following sections. At the end of each issue, the future works are mentioned for scientists to follow past studies.Based on explanation of introduction part, Industry Foundation Classes (IFC) is a standard for the interpretation of data of a building or facility during the construction or maintenance phase which is useful for categorizing data as a BIM model. IFC has been developed to enable various platforms integrate building information, i.e., interoperability enabling collaboration. The most common IFC format is known as a STEP file with the extension ‘.ifc’ . All proRio et al.  tried toNot all monitoring information for describing and exchanging building information models is supported by IFC; therefore, researchers have proposed an IFC schema extension to facilitate documenting SHM systems and managing the life-cycle changes ,21.Due to the limitations of previous studies, a formal basis has been prepared for monitoring information by using the IFC. The output information of this model proposes semantic combinations of health monitoring systems, topology conditions and relationships between elements of the health monitoring systems and structural systems in a well-defined format; however, this model does not have the potential of dynamic analyses . Formal In the field of improving the visual properties of the monitoring process, researchers have tried different software and visual programming environment. Connecting environmental sensor data with BIM through Dynamo, Arduino, and Revit API, combining BIM with other tools like building maintenance management tools to gain comprehensive control over project monitoring and integrating BIM with geographic information system (GIS) for better management of building information have been done in this area ,28,29. FResearchers have studied various aspects of BIM approaches to amend the quality of designing and management of buildings by increasing speed and reliability in modelling big data with BIM, such as modelling of concrete structures and optimization of sensor deployment ,35,36,37Most of the studies that have been cited in various parts of this paper utilized real-time and dynamic monitoring; however, they have been categorized under those sections according to the main goal of each study ,42. AfteAs stated before, traditional researchers utilized BIM mostly for design, monitoring, and analyses of the new structures during their lifetime; however, the perspective on BIM has changed so that it has recently been used to increase the quality of visualization for improving decision making ,55,56. MThe future agenda in this field includes: New Spatial Design to Optimized Spatial Design , preparaManaging data challenges in operation and maintenance (O&M) process of structures promote researchers to use BIM in facility management (FM) and combine it with other methods such as Data Mining (DM) to extract useful patterns and data, Performance Information Model (PIM) to obtain an integrated model, Thermal Infrared Sensing (TIS) to prepare a complete as-built BIM, a System Information Model (SIM) for asset management, IoT for helping decision making in facilities management, Quick Response (QR) codes or image algorithms for integration of facility information and repair process, and laser scanning or Radio Frequency Identification (RFID) for indoor localization of facilities ,71,72,73Current research attitudes show increasing the continuous interest in Facility maintenance management (FMM) with BIM which covers over 65% of FM costs. Comprehensive studies were conducted in this area as using BIM with location-aware Augmented Reality (AR) to provide interaction among users and facilities, using Product-Service System (PSS) components in BIM models for managing equipment, combining BIM and IoT for lifecycle FMM, asset managements for improving the information processing, managing rapid-transit facilities such as subways and water treatment plants ,83,84,85Among all benefits, there are major limitations related to some projects which used BIM for FM, for example, some concentrated only on maintenance of certain systems or other has an unsuitable representation of maintenance problems in design review steps . ConsidePreviously, FM was not be considered in the design phase due to the lack of suitable modeling tools or access to facilities. These problems were solved by using a hybrid BIM-AR method for considering maintainability problems in design steps, integrating BIM with virtual reality (VR) and Microsoft Azure, using computer game software with BIM to help designers for saving time and cost and using BIM with digital programming to connect design and construction phase and energy analysis ,103,104.One of the purposes of using BIM in the maintenance and monitoring process is detecting faults which will be useful for the FM process through some Fault Detection and Diagnostics (FDD) algorithms to find damaged components such as heating or air conditioning equipment ,106. ManThe future agenda in this category consists of improving the plug-in for using with different components models , reducinCollecting real-time information of facilities, buildings and other construction-related fields is an effective way for managing construction operations which is accessible through sensing technologies. Wireless Sensor Network (WSN) is a practical technology for remote sensing purposes to control the inherent or environmental condition (temperature and humidity) during life-cycle management even in the non-structural field or hardly maintained cases than fixed monitoring systems . IntegraThe future work in this category involves testing multiple tower cranes navigation through sensors , increasStructural safety is the main goal of engineers all over the world; therefore, they are drawn to investigate novel ways of assessing structural defects, facilitated by BIM. Existing research in this area has focused on: goals such as conflict detection based on the life cycle versus as-built documents by considering all changes in the structure, fault detection of energy-consuming tools in buildings through BIM and simulation tools for energy monitoring, fault detection in buildings and non-structural components, damage detection in timber structures, tunnel flaws diagnosis to find maintenance strategies that are also used for utility tunnels, fault detection of hospitals for rehabilitation, automatic detection, and identification of lamps in a building ,164,165.BIM has a vast performance in modular construction as a suitable management tool and a powerful system, which can be improved by using real-time monitoring data for controlling structural damage ,169,170.Seismic monitoring is an important subject all over the world that is facilitated by using BIM modelling for controlling defects in structural and non-structural components ,173,174.Future research in this category would involve: large-scale sensor monitoring of modular buildings , fully mAs dimensional incompliances prepared main problems for construction projects such as increasing cost and time, reducing safety and structural damages, accurate control is necessary during the construction and maintenance process. Many articles exist in this field that aims to promote the quality of control process through effective methods and BIM. Automated dimensional compliance control of in-place and precast components of concrete structure with terrestrial laser scanning, dimensional or geometric tolerances control of construction project, optimization of scan technologies for large-scale structures, managing LiDAR data by consideration of planar and linear properties, fabrication verification of pipes and flanges and compliance control of deep foundations, are main topics which utilized BIM as leverage for increasing the accuracy of their control phase ,184,185.A future agenda for this category involves dimensional control of rebars in concrete structures with BIM , consideBesides using BIM in monitoring and maintenance of concrete and steel structures that extend to above categories, researchers have also used BIM for energy monitoring as well as monitoring other construction elements such as pipelines, offshore lighthouses, tunnels, airports, highways, subways, hazards, bridges, railways and other vital civil engineering elements, which are summarized in the following sub-chapters.Recently, researchers have worked on using BIM models in novel ways such as for energy and asset monitoring; furthermore, most of the studies have been concentrated on land-based infrastructures such as buildings and bridges ,197,198.Health monitoring through BIM is not restricted to structures and can be applied to practical fields such as underground pipelines . Some reAfter the collapse of the Tacoma Narrows Bridge in the US, bridge safety monitoring received widespread attention, and many bridges were equipped with monitoring sensors, such as Tsingma Bridge in Hong Kong, Sunshine Skyway Bridge in Florida, Akashi Kaikyo Bridge in Japan, and Hangzhou Bay Bridge in China. The efficiency of BIM systems encouraged researchers to use them for enhancing the quality of monitoring of bridges.McGuire et al.  considerThere have been numerous studies related to the health monitoring and maintenance of bridges by using BIM models ,213,214.Like other fields of BIM in the monitoring process, managing a large amount of data or interchanging data in a model is very important and needs more studies especially in transportation infrastructures. In the field of bridge monitoring, BIM-based long-term monitoring, including monitoring of load, fatigue, steel corrosion, and concrete creep beside the study of optimization of sensor placement is important and needs further examination. Other items on the agenda in the future include sensor updating, data mining, longtime monitoring of bridges  and modeBesides all the practical uses of BIM in health monitoring, integrating wireless sensor network data with BIM models creates a remote approach for controlling and monitoring hazards, eliminating and reducing the problems of locating people near hazardous environments during the inspection process by determining and controlling the exact location of each event in an emergency. There have been some limitations in these fields of study that need exact consideration: for example, increasing power supply capacity or introducing an additional power supply for gas detection components, and increasing the intelligent functions of the system for best performance in fire emergency scenes or low-dose hazardous gas exposures . VariousThe future agenda in this category includes estimating the effects of low-dose hazardous gas on human health , consideStructural health monitoring has various fields that affect energy and cost-saving of buildings such as thermal transport, monitoring of thermal condition, air exchange, and moisture control ,243. TheBIM technologies are used for various aspects of construction life-cycle management such as: assessing building performance for improvement requirements, monitoring all activities throughout the project, optimization of cost and time, using BIM for monitoring the sustainability of buildings with technologies such as IoT solution, developing a 5D BIM model for dynamic monitoring of deep foundation by considering time and cost, and real-time online monitoring of underground space to eliminate errors and difficulties related to this area ,260,261.Heritage building information modeling (HBIM) is another widespread research area that is practical for analyzing various case studies such as historical churches and masonry bridges by using active or passive sensors . ResearcThe future work in this category includes considering the inherent value of confined space monitoring system (CoSMoS), advanced methods for achieving patterns in real-time data for creating an intelligent digital built environment , BIM effIn the content analyses based on keyword clustering and individual reviewing, reviewed articles can be divided into two groups. Some papers are highlighted based on their concepts and goals and others are based on their special case studies. Real-time monitoring and standards, diagnosing damages and dimensional compliance control, NDT with sensors and facility management were the main concepts. Main case studies related to bridges, pipelines, railways, tunnels, roads, airports, highways, and others considered controlling fire, indoor safety, worker safety, environmental anomalies, sustainability, safety, and refurbishment. Overall, total modeling problems such as extending IFC standards for exchanging data, managing the various type of sensing data and, interoperability among various BIM platforms were the main challenges among researchers in a wide range of studies that need more analytical and experimental work.Implementing some technologies such as laser scanning, radio frequency, real-time monitoring, closed-circuit television monitoring systems (CCTV), photovoltaic panels (PV), virtual reality, prediction methods such as a convolutional neural network (CNN) and deep neural network (DNN), enhanced the quality of monitoring and accuracy of decision making. However, increasing the intelligent functions of systems for gaining the best algorithms for all conditions, extraction of the information of sophisticated construction components with economic sensors, and examination of various NDT sensing technologies such as spectroradiometer for fault detection purposes remain challenges among researchers and should be followed in the future.The scan-to-BIM method is one of the popular subjects for dimensional compliance control to reduce inspection’ time and cost. Besides all improvement, considering point cloud quality and BIM requirements, element boundaries and overlapping criteria and delivery and storage for cloud servers are some gaps in this field.Combining the building information modelling process with other platforms such as GIS improves the process of monitoring and risk or damage analysis. Furthermore, using upper dimension BIM tools like 6D modelling through considering 3D model information along with time, cost, and carbon footprint analysis improves accuracy of this process. However, long-term monitoring, including monitoring of load, fatigue, steel corrosion, concrete creep and other environmental effects besides the study of mentioned programs is important and needs further consideration.The efficiency of integration of the BIM technologies with real-time remote sensing tools on FM process was examined to show the progress of facility maintenance monitoring and decision making during building life-cycle management. Considering risk actions in the FMM, time saving, and energy simulation in healthcare facility management, considering FM in the design phase, and using BPD to increase reusability in systems were some main improvements in this field. The limitation in using BIM for FM involves reducing the impacts of the environment on facility maintenance process, controlling energy conservation for mechanical, electrical, and plumbing systems, transferring and recording data or parameters in the FM process.Considering the novelty of this research field, there are many research gaps in all current studies; up to now, due to the lack of a standard for all modelling procedures, researchers have examined applications of BIM in monitoring through some assumptions. Extending the IFC schema, optimizing sensor data, and management of huge amounts of data are some major gaps, besides consideration of environmental effects on monitoring hazards and underground objects.The current study prepared a systematic review related to BIM application in health monitoring and maintenance of structures. Generally, 278 papers published between 2010 and 2020 were selected. Limitations and improvements are presented, with a focus on maintenance and monitoring performance. Bibliometric and content examination of these articles revealed the main subject areas and resources wherein using BIM improved project results. Furthermore, this paper has tried to clarify future research attitudes for improving this field of study. However, further reviews or studies should consider the design process and its relationship between entire life-cycle model management through BIM. The bibliometric analysis revealed that most of the relevant articles were published in the Journal of Automation in Construction and 2020; these studies are associated with the benefits of using BIM in cost and time management. About 92% of the reviewed papers were published in the last 7 years, indicating that much research has been devoted to using BIM in monitoring and maintenance. The important findings of this beneficial review paper can be summarized as follows:


In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory’s publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion.A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion.39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, ‘needs assessment’ findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded.This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems. It is widely known that improving the quality of healthcare is one of the most direct ways to address the significant health disparities between Aboriginal and Torres Strait Islander peoples and Australians of other descent. In 2008, the Council of Australian Governments (COAG) committed to ‘work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2023′   have the potential to capture and share data that could improve quality and reporting of Aboriginal health promotion, including details of community participation. Firstly, by facilitating collection, documentation and organization of a vast array of information about health promotion in a structured and systematic way. Secondly, as a source of data to be analyzed and communicated in real-time for quality improvement and performance indicator reporting purposes. A HIS commonly used in hospitals and medical services is the Electronic Medical Record (EMR). EMRs, digital versions of the patient chart, contain information about patient medical and treatment history collected by and for clinicians, usually within a single healthcare institution. EMRs are valuable sources of data that providers can use in making decisions about health care delivery. Indeed, health services have sought innovative ways to utilize these data to report on and improve the quality health care and health system performance for Aboriginal Australians , 13. EMRWithin this broader context, we report a study of Australia’s first investigation of a HIS designed for recording and storing information about Aboriginal health promotion. The Quality Improvement Program Planning System (QIPPS) was an innovative and unique online, project planning and evaluation system for health promotion and community development projects. From 2008 until 2019, when QIPPS was decommissioned and no longer available on the market, it was the centralized online system for recording information about health promotion programs delivered by Northern Territory Health . We were interested in the feasibility of utilizing this information to report on the quality of Aboriginal health promotion. Specifically, our aims were to extract data stored in QIPPS to describe: (1) the scope of Aboriginal health promotion programs; (2) the quality of Aboriginal health promotion program planning, delivery and evaluation; and (3) community participation strategies and processes used in Aboriginal health promotion, using chronic disease prevention activities as exemplars programs. Thereby, we identify the benefits and limitations of HIS’ for health promotion and potential for secondary uses of stored data for quality improvement purposes.The Northern Territory (NT) is arguably Australia’s most challenging health service delivery environment. The NT has the highest proportion of Aboriginal Australian residents compared to other states in Australia. Approximately 30% of the total NT population identify as being Aboriginal peoples compared to 3% of the total Australian population , making The NT Aboriginal population experience a disproportionate burden of chronic disease linked to inactivity, diet, socio-economic disadvantage and access to primary health care services . NT HealTo overcome some of these challenges, NT Health has introduced over the past 10 years a range of initiatives. These have included: (i) a Health Promotion Strategic Framework ; (ii) inhttps://www.infoxchange.org/au).Up until 2019, QIPPS was commercially available; hosted, maintained and supported by Infoxchange; a not-for-profit social enterprise with a focus on smart and creative use of technology to improve the lives of vulnerable people, driving social inclusion and creating stronger communities . Each tab included structured prompts to guide recording of information (mostly free text) related to each stage of the cycle. For example, a tab for “Needs Assessment” included prompts such as ‘describe the issue or problem the project aims to address’, ‘the population group most affected’, and ‘evidence to substantiate the rationale for proceeding with the project’. The “Evaluation” tab was divided into sections for recording findings of process, impact and outcome evaluations. Embedded in each tab were a wide range of supportive information including definitions, research material, references, website links, best practice models and frameworks.QIPPS was also promoted as a mechanism for knowledge exchange. Users could export their program information as a Microsoft Word document to share with other project partners, and were able to search a growing body of community-based initiatives (QIPPS library).In contrast to other health promotion systems which are typically created and used within an organization , QIPPS wSince 2008, NT Health subscribed to QIPPS with the intent of assisting public health staff (i) to design and deliver health promotion projects, and (ii) in documenting their health promotion efforts in a systematic and structured way. A 2017 internal survey identified between 320 and 380 public health staff had used QIPPS to record their health promotion work. Thus, QIPPS provided a potentially valuable, yet relatively unexplored, data source about health promotion in Aboriginal contexts.This study was a retrospective audit of health promotion projects recorded and stored in QIPPS. We included health promotion projects that: addressed chronic diseases, including mental health, environmental health, and/or risk factors , designed to benefit Aboriginal people, families and communities, and that were recorded in QIPPS as delivered between 2013 and 2016. This selection of health promotion projects was made based on NT Health advice and knowledge of health promotion investment and information needs to inform future planning.Our approach to data collection, analysis and reporting draws on a popular continuous quality improvement technique, known as audit and feedback. ‘Audit and feedback’ is a systematic process of gathering information about professional practice and then comparing this with explicit criteria  . The gapWe used a previously validated, paper-based audit tool structured around five indicators of best practice Aboriginal health promotion. Indicators were identified by blending available best practice guidelines and practice-based evidence in Aboriginal health promotion . The fivhttps://www.menzies.edu.au/page/Resources/Health_Promotion_CQI_Tools/).Data on scope and quality of Aboriginal health promotion were collected from information stored in the QIPPS online system. Project records were reviewed and checked for documentation of items specified in the audit tool and described using dichotomous (yes/no) and categorical variables. Categorical variables were not mutually exclusive. For example, ‘do records indicate whether community people participated in planning, implementation or evaluating this activity?’ If yes, select in what areas: ‘identifying the problem’, ‘determining or deciding strategies to address the problem’, ‘implementing the strategies’, ‘evaluating the activity’. This process was repeated for each project. To improve quality and consistency of data collection, an auditing protocol was used to guide data collection. The health promotion audit tool and protocol are available at Four authors independently reviewed projects and recorded their findings in a purpose-built Microsoft Excel spreadsheet. The spreadsheet included each audit tool item. Simple frequency counts were calculated for dichotomous and categorical variables. In addition, we extracted text that described strategies and processes of community participation in health promotion projects. To ensure completeness of data and accuracy, three authors independently conducted audits on an initial sample of five projects. The lead author’s results acted as the ‘gold standard’ against which team members results were compared. Variations in results were discussed to determine reason for difference and strategies for enhancing data collection consistency. This included minor changes to the wording in the audit protocol and amendments to the data entry spreadsheet. Monthly meetings among co-authors were used to discuss and monitor emerging results. One co-author, not involved in the audit process, reviewed findings and interpretation.A total of 39 chronic disease prevention projects were included in the analysis. Most projects addressed nutrition (27 projects), followed by physical activity (7 projects) and mental health  (4 projects). Almost half (19/39) of the projects were considered once off (i.e. delivered only once and not expected to be done again). Five projects were continuous (i.e. delivered on a regular basis through the year e.g. monthly or weekly); and five were described as intermittent . Delivery frequency was unclear for ten projects. The type of health promotion strategies was dominated by health education (23 projects), followed by community action (19 projects), health information (18 projects) and strategies for creating supportive environments (14 projects).Table In 35 of the 39 projects, there was a clear record of the ‘target group’, or, those who would benefit from the project. Most projects were designed for the “general community”, followed by “children”. There was a record of involvement of other organizations or agencies in 26 of the 39 projects, of which, 15 were with agencies or organizations beyond the health sector. Details about evaluation results were reported in approximately one third of projects (15/39); majority of the evaluation documentation was limited to a recording of participant numbers (12/15). The level of detail describing other evaluation findings were mixed, such as reporting changes in participant satisfaction (4/15), knowledge and understanding (6/15), skills and behaviours (3/15) or broader impacts on policy/environments (3/15).How will the target group and community stakeholders be encouraged to actively participate and engage with the project?”.Documentation of community participation in health promotion planning, implementation and evaluation was reported in 20 of the 39 projects  data were based on recorded health promotion practice, which may underestimate breadth and depth of actual health promotion efforts; (ii) given the long-standing use of QIPPS in NT Health, the quality of data reported is likely to be better than for other Aboriginal health services and state/territory government health departments more generally in Australia. Furthermore, NT Health provided support and training for QIPPS users –Aboriginal and non-Aboriginal dedicated health promotion practitioners and non-dedicated health promotion staff including nutritionists and public health staff in hearing, oral and environmental health—thus, staff have a better understanding of the information system which is likely to influence quality of information entered in QIPPS; and (iii) several biases can arise auditing records of health service delivery, including experience and skills of the auditor/s; and the type of data extracted, influencing the reproducibility of quality indicator/s. A strength of the study was the iterative and team-based approach of Aboriginal and non-Aboriginal researchers, policy staff and health promotion practitioners working together.Since completing this study, QIPPS was decommissioned by Infoxchange and is no longer available on the market. NT Health is currently transitioning from using QIPPS to an internal record management system. Study findings will inform the development of customized templates for documenting planning and evaluation of health promotion, and tailored workforce development initiatives to improve quality and accuracy of data entry and recording.We hope this study will also inform future discussions and design of health promotion information systems and promote the potential for secondary uses of stored data for performance reporting and quality improvement purposes. To reap the full potential of health promotion information systems, we recommend continuous use of quality improvement approaches, such as tracking quality indicators using an audit and feedback technique. A continuous quality improvement approach could encourage, monitor, and reward accurate reporting of indicators. This would enhance health information system functionality, the capability of practitioners to use these systems effectively for planning and evaluation, and for monitoring improvements in quality of health promotion.This first Australian study of a purpose-built, health promotion information system demonstrates the potential for utilizing stored data to report on quality of Aboriginal health promotion. More should be done to encourage accurate recording of information about health promotion practice, particularly findings of evaluations and how community are engaged throughout the health promotion project cycle. This would allow the more successful strategies to be identified and replicated to enhance health promotion success, and ultimately improve the health and life expectancy of Aboriginal peoples. Testing and improving the validity and reliability of indicators of Aboriginal health promotion quality is an important area for future research. More specific attention to the development and use of information systems in health promotion should contribute to a more comprehensive understanding of the quality of health services and programs for Aboriginal Australians.


Infectious diseases are one of the main grounds of death and disabilities in human beings globally. Lack of effective treatment and immunization for many deadly infectious diseases and emerging drug resistance in pathogens underlines the need to either develop new vaccines or sufficiently improve the effectiveness of currently available drugs and vaccines. In this review, we discuss the application of advanced tools like bioinformatics, genomics, proteomics and associated techniques for a rational vaccine design. Emerging literature on the development of drug resistance against pathogens compel us to establish and reinforce the fact that immunization is one of the most effective way to provide long-lasting protection against microbial diseases  and Streptococcus pyogenes , S. agalactiae, S. pyogenes, and S. pneumoniae has shown that approximately 50 % of proteins are homologous, signifying substantial overlap in potentially relevant pathogenic mechanisms  and differential fluorescence induction (DFI) has been used to identify bacterial genes by specifically inducing promoters in the infected host  has been successfully applied in case of Mycobacterium tuberculosis. This strategy is based on immunization with plasmid DNA incorporating the whole genome split into small fragments. However, ELI is limited to the study of genes that can be expressed in eukaryotic cells, and it also demands animal models which are suitable for screening purposes , has been used to identify antigens in pathogens that are only expressed during human infection  genome sequence was published, 1000s of bacterial and viral genome sequences have been completed . The generated genomic information is used to screen the inclusive set of potential proteins encoded by pathogens for the search of vaccine candidates—an approach referred to as reverse vaccinology  subcellular localization of vaccine candidate proteins, (II) conserved vaccine candidates among different strains and species, (III) topology of surface proteins, (IV) immunogenicity of different epitopes in vaccine candidate proteins, (V) allergic property of proteins and (VI) 3D structure of vaccine candidate proteins to analyse accessibility of immunologically relevant epitopes with the help of already available bioinformatics tools  mRNA expression levels does not represent the actual amount of active protein in a cell, (2) gene sequence gives incomplete information about post-translational modifications, and (3) genome information does not describe dynamic cellular processes; proteomics has been used in different ways to identify novel vaccine candidates against several human pathogens  were devised to identify the proteins expressed in lower abundance which is not possible by 2-D gel electrophoresis  proteins that have a role in pathogenesis and ultimately assist in identifying a suitable vaccine candidate  and RNA. These vaccines have their own advantages such as (1) induction of both B and T-cell responses; (2) specificity; (3) high stability; (4) economical; (5) no anti-vector immunity. Published research reports show faster progress in nucleic acid based vaccine development against viruses in comparison to bacterial pathogens. Few reports came up showing potential of these vaccines against bacterial pathogens , multi-valent vaccine (Dengue virus and GAS), killed or attenuated whole organisms , and capsular polysaccharide  for vaccine development. The biggest challenge for vaccine development is against highly variable and fast evolving human pathogen like coronaviruses, HIV, Influenza, Ebola and Nipah viruses.The catastrophic pandemic outbreak of the century by Covid-19 killing 1000s and infected millions in the world warrants global proactive and integrated research and vaccine development program. Other pathogens which causes, AIDS, malaria, tuberculosis, meningitis, dengue are also the major concerns for vaccine research. Most research groups are focused on intra-species conserved surface proteins of bacterial pathogens (GAS, We have witnessed the efficiency of powerful genomics, proteomics and bioinformatics approaches for identification of vaccine candidates in last two decades. However, despite the fast and efficient target identification, scientists are still facing the slow and laborious validation steps, use of animal models for the testing of the vaccine candidates and clinical trials. On the other hand, safety and affordability are the two important factors that must be taken under consideration for the development of modern vaccines. In our opinion, new vaccines should have the highest effectiveness in developed and developing countries. The successful use of multi-genome analysis, screening and use of reverse vaccinology approach to develop a universal vaccine against highly variable pathogen like GAS and GBS may open new vistas for the potential development of universal vaccines for other human pathogens.


Development of efficient ways of fabricating chiral light emitting materials is an active area of research due to the vast potential offered by these materials in the field of optoelectronic devices, data storage, and asymmetric synthesis. Among the various methods employed, template assisted generation of chiral luminescence is gaining enormous attention due to its simplicity, applicability over a wide range of fluorescent molecules/dyes, and the display of high anisotropic values. The term polarization of light is enclosed with advanced optical phenomenon which provides vital information on the notable optical features like surface shape, material content etc. Circular polarization is considered to be of significance among the other forms of polarized light as it has gained immense popularity due its inevitable applications in 3D displays, optical sensors, bio-imaging, electroluminescent devices and asymmetric synthesis Schadt, . Single glum), which is described as the ratio of difference in the intensities of the left (IL) and right (IR) circularly polarized light to the average total luminescence intensity  can be obtained (i) directly from cholesteric liquid crystals or (ii) from nematic liquid crystals doped with chiral additives. Owing to their helical order and periodic structure, *NLCs exhibit fascinating optical properties  depends on the helical pitch (P), refractive index of the cholesteric material (n) as well as the angle (θ) between the incident light and the cholesteric layers  was observed for *NLC films embedded with light-emitting dopants . Considerably high CPL response with a glum value of +0.41 was obtained due to the dipolar interactions between polar cyano groups and π-π interactions between binaphthyl moiety of R/S-BINOL-CN and biphenyl/terphenyl groups of the E7 host  have attracted special attention due to their abundance, stability and robustness. Different approaches such as application of stress, addition of metal salt, change in pH and solvent polarity have been employed to tune the CPL emission of achiral luminogens embedded in CNC templates. In most cases, variations in the pitch of the helix induced by external stimuli were the major cause for the changes in optical properties  are an important class of soft materials that have shown a lot of advancement over the last decades. These are another class of molecular self-assembling systems that form nanostructures like strands, tapes, fibers, ribbons, platelets, and other aggregates with high aspect ratio upon gelation  polymers and achiral fluorescent monomer in presence of a rhodium-based catalyst  and fluorophores. The generation of CPL was attributed to the circularly polarized scattering and fluorescence-selective absorption effects of chiral HSPAs  since the scaffold-based approach uses simple achiral fluorescent molecules, a wide range of molecules/dyes can be used, imposing minimal restrictions on the choice of molecular system, (ii) easy tuning of the emission wavelength is facilitated by the proper selection of molecules/dye, (iii) as highly ordered structures are used as templates, the chiral properties can be tailored through the control of template morphologies, (iv) the technique is cost effective as it can be applied on cheap host and guest materials, and (v) simple procedure involving mixing of the chiral host and achiral guest in most cases. While large number of templates have been employed, liquid crystalline materials have shown promise due to their unique selective reflection property. Since any chiral medium can function as a template for CPL generation, research is actively pursued to explore large number of novel templates capable of generating enhanced CPL. The incorporation of simple organic molecules into diverse chiral templates stipulates versatile strategy for the rational design and scalable manufacturing of organic-based CPL materials that can open new avenues for technological advances in field of photonic devices.The major drawback associated with CPL studies on simple organic systems is the tedious protocols associated with the synthesis, purification and characterization of chiral molecules with high enantiopurity. Moreover, the systems exhibit low SM and JK conceived, designed the project, edited, and revised the review. SM, ABJ, and JK contributed to the writing and literature research. All the authors approved the final draft.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.


Digital or video games are played by millions of adolescents and young adults around the world and are one of the technologies used by youths to access mental health services. Youths with mental health problems strongly endorse the use of technologies, including mobile and online platforms, to receive information, support their treatment journeys , and facilitate recovery. A growing body of literature explores the advantages of playing digital games for improving attention span and memory, managing emotions, promoting behavior change, and supporting treatment for mental illness . The research field has also focused on the negative impact of video games, describing potential harms related to aggression, addiction, and depression. To promote clarity on this matter, there is a great need for knowledge synthesis offering recommendations on how video games can be safely and effectively adopted and integrated into youth mental health services.The Gaming My Way to Recovery scoping review project assesses existing evidence on the use of digital game interventions within the context of mental health services for youths (aged 11-29 years) using the stepped care model as the conceptual framework. The research question is as follows: For which youth mental health conditions have digital games been used and what broad objectives  have they addressed?Using the methodology proposed by Arksey and O’Malley, this scoping review will map the available evidence on the use of digital games for youths between 11 and 29 years old with mental health or substance use problems, or both.The review will bring together evidence-based knowledge to assist mental health providers and policymakers in evaluating the potential benefits and risks of these interventions. Following funding of the project in September 2018, we completed the search in November 2018, and carried out data screening and stakeholder engagement activities during preparation of the protocol. We will conduct a knowledge synthesis based on specific disorders, treatment level and modality, type of service, population, settings, ethical practices, and user engagement and offer recommendations concerning the integration of video game technologies and programs, future research and practice, and knowledge dissemination.Digital game interventions employ unique, experiential, and interactive features that potentially improve skills and facilitate learning among players. Digital games may also provide a new treatment platform for youths with mental health conditions. Assessing current knowledge on video game technology and interventions may potentially improve the range of interventions offered by youth mental health services while supporting prevention, intervention, and treatment.PRR1-10.2196/13834 The risk of developing first-time mental health disorders is greatest among adolescents and young adults . Early iResearch in e-mental health is developing rapidly -23 despiAt any given moment, digital or video games are being played by millions of adolescents and young adults around the world. These games are among the preferred and most heavily used technologies among youths who access mental health services ,31. Not International Classification of Diseases, 11th Revision, recently identified a new classification of gaming disorder, defined as a pattern of gaming behavior  characterized by impaired control over gaming, increasing priority given to gaming over other daily life activities, and continuation or escalation of gaming despite the occurrence of negative consequences. This new classification leaves health care providers with unique challenges related to assessment, diagnosis, and treatment for this disorder [Most studies have focused thus far on the negative impact of video games, describing potential harms related to aggression, addiction, and depression ,45. The disorder ,47.In light of these two contrasting realities—the desire of youths to play games and the evidence for gaming disorder—there is a need for critical assessment of the existing evidence on the use of digital game interventions within the context of mental health services for youths and the ways in which such interventions can be implemented in a safe and effective way.Systematic reviews and meta-analyses that assess the accessibility, feasibility, and effectiveness of serious video games for use in mental health have been published -42. HoweThis scoping review will use the stepped care model, a care delivery system in which treatment options are triaged based on relevant criteria  and shared decision-making practices ,49, as aIn light of this model, our primary research question is as follows: For which youth mental health conditions have digital games been used and which broad objectives  have they addressed?Secondary research questions that will help generate a comprehensive picture of the available evidence are as follows: First, regarding equity, effectiveness, and impact: In which youth populations have digital game interventions been used and shown to be effective? What do we know about the experiences of youths and providers in receiving or providing mental health interventions through video game technologies? What are the current research gaps in this area? Second, regarding efficiency and process: How have digital game interventions been employed as prevention and treatment interventions in youth mental health services? What have been the outcomes of these programs? What barriers and enablers affect the use of digital or video games in clinical settings? Third, regarding engagement: What do we know about youth, family, and provider involvement in the creation and evaluation of digital game interventions for prevention and treatment of mental health conditions? Fourth, regarding relevance and sustainability: What evidence exists for the ability of digital game interventions to support youth mental health services? How can this evidence be used to support the integration of digital game interventions into youth mental health services? And fifth, regarding ethical practices: How may video game interventions be used in youth mental health services without doing harm?To answer these research questions, we will conduct a scoping review that will systematically capture the main evidence, types of evidence, key concepts, models, and gaps in research on the use of digital game interventions for youths 11 to 29 years old with mental health and substance use problems. Scoping reviews are useful for the assessment of emerging evidence when it is still unclear whether more specific questions might be posed. A scoping review is the most suitable method for knowledge synthesis, as it considers different types of evidence and publications  while also reporting on the types of evidence that inform practice in the field and the ways in which research has been conducted.We will use the scoping review methodology developed by Arksey and O’Malley to guide this process . BuildinThis scoping review will use the stepped care model as a conceptual framework to systematically guide synthesis of the literature, identify existing evidence and gaps in knowledge, and provide recommendations for future studies and interventions. Model 1  is our aThis knowledge synthesis project will engage stakeholders and partners  within key stages of the project: proposal development, statement of aims and objectives, and data analysis and synthesis, as well as, importantly, the dissemination and translation of findings. The involvement of 3 different stakeholder groups will increase the relevance of the scoping review while enhancing its quality, innovation, and potential for implementation in youth mental health care settings. We will invite youths experiencing mental health problems who are also video game players to participate in this project and share their knowledge and expertise. They have unique experience and insight into their own health conditions and treatment, as well as knowledge and opinions on video game technologies . Caregivers  are experts in how to care for and support those with mental illness or substance use problems and in knowledge of their needs. Thus, they may provide valuable perspectives on how video game interventions can help or hinder the recovery journey of affected family members and friends.ACCESS Open Minds ,52, a paStakeholders, especially youths, may provide insight on how to differentiate between playing video games for fun and the problems that may occur in relation to playing video games ,54, suggMembers of the project team are health care providers from 3 countries , who represent various youth mental health networks . These youth networks will support dissemination of the project among their own members, as well as through professional associations such as the Early Psychosis Intervention Ontario Network and game research programs or groups .The following section describes the 5 stages involved in the Arksey and O’Malley scoping review methodology.We will present this scoping review protocol and proposed research questions to project partners and knowledge users, including youths, families, and providers, to gather feedback and identify missing elements. If required, we will revise the protocol to reflect the input of project partners and knowledge users during the different phases of the project.A systematic search strategy has been constructed by a health sciences librarian in consultation with the research team and reviewed by another librarian as recommended by the Peer Review of Electronic Search Strategies checklist . This stThe review process will comprise 2 levels of screening: (1) a title and abstract review, and (2) a full-text review. We will use Rayyan (Qatar Computing Research institute)  to screeWe will retain studies identified as eligible for phase 2 (full-text review). In this phase, 2 raters will screen the full texts of articles to determine whether they meet the inclusion criteria listed above. We will retain eligible studies for data extraction in stage 4. Differences in ratings will be resolved through discussion until a consensus is reached. If agreement is not reached, the project team leader will intervene to make a final determination.A data extraction sheet will be developed by the research team and consulting partners by adapting relevant critical appraisal tools. This sheet will confirm the eligibility of each study and extract the relevant characteristics. Knowledge users will have the opportunity to provide input to confirm that the information for extraction is relevant. The variables to be extracted from the articles are divided into the following categories: (1) participant characteristics, including age, (2) study characteristics and methodology, (3) game characteristics, (4) youth and family engagement in the design of the digital game intervention, (5) youth and family engagement in the evaluation process, (6) treatment settings, (7) treatment level , (8) level of integration with in-person treatment, (9) game costs, and (10) sustainability. Specific participant and study characteristics include variables such as target group, recruitment, treatment type (single- or multicomponent interventions), primary outcome measures, type and extent of guidance provided during the intervention, setting of the intervention, study conditions, attrition, and results. Game characteristics will comprise variables such as the title of the game used in the study, serious game type, game genre, purpose of the game, and country where the study took place .This scoping review will map knowledge, evidence, and overall findings aligned with the proposed research questions. We will analyze each variable captured on the extraction form based on the type of data and using descriptive statistics, for example, percentages and thematic analysis. We will summarize the data using statistical plots and graphics, as well as through the creation of text tables, to describe key characteristics for each revised study (see Results section). We will further integrate the review findings into model 1. A revised model 1 will provide a synthesis of results for the available evidence on equity, effectiveness, impact, processes, efficiency, sustainability, engagement, and ethical practices in the use of digital game interventions for mental health and substance use conditions in youth populations.Throughout the data extraction process, we will use well-known critical appraisal tools to ensure the extraction of essential information from the articles and to promote rigor. The critical appraisal tools that we plan to use, if appropriate, include Preferred Reporting Items for Systematic Reviews and Meta-Analyses for meta-analyses  and GradWe began the identification of relevant studies in November 2018. Stakeholder engagement began in December 2018. Data extraction (stage 1) was slowly carried out during the publication process for this protocol. We expect that the completion of stages 2 to 4 will take 1 to 2 months. After completion of stages 1 to 3, we will confirm the number of studies that meet the inclusion criteria (title and abstract); the number of studies that meet the inclusion criteria (full-text review); and the number of studies included in full-text data extraction. Stage 5 will include the summary and synthesis of the results using the conceptual framework (model 1) and will take approximately one month to complete.The scoping review will provide knowledge on the use of digital game interventions for youths aged 11 to 29 years with mental health and substance use problems. More specifically, we will synthesize knowledge related to the following subthemes and subpopulations: (1) specific disorders , (2) level of treatment , (3) modality of treatment , (4) type of service , (5) population , (6) settings , (7) ethical practices, and (8) level of user engagement.We will revise and update this list of anticipated outcomes based on project findings.In relation to specific knowledge mobilization outcomes, this review will (1) provide recommendations on how to best integrate video game technologies and programs into youth mental health settings and services, (2) identify research and practice gaps in the literature on video game technologies in youth mental health to inform future research projects, and (3) generate different knowledge dissemination materials to share project results with key knowledge users , as well as pertinent partners, associations, and networks.Overall, digital game interventions and solutions hold promise as learning machines  because Methodological knowledge gained from this scoping review process will be useful in the systematic assessment of other e-mental health technologies: virtual communities, telemedicine, etc. Moreover, this scoping review project will gather valuable knowledge on how to involve different stakeholders in knowledge synthesis activities so that future reviews on e-technologies may use similar processes in seeking input from pertinent stakeholders.Clinical knowledge gleaned from this review will also generate valuable knowledge on how, and for what purpose, video game interventions can be effectively implemented in youth services for mental health and substance misuse, as well as the appropriate conditions for doing so. The assessment of current knowledge on digital game interventions has the potential to improve treatment in youth mental health services.


There is currently no evidence of research priorities from nurses and allied health professionals working in the field of thoracic malignancies, which could provide strategic directions for funders, policy makers, and researchers.The aim of this study is to identify the priorities for lung cancer and other thoracic malignancies research and practice in nurses and allied health professionals.Descriptive cross-sectional web-based international survey conducted through international societies’ membership lists.Participants included 152 nurses and allied health professionals. Key priority categories were related to developing and evaluation interventions; symptom management interventions; health care system issues; treatment-related research ; persistent/late effects management ; risk reduction, and screening research. The specific topic with the highest endorsement (80.9%) was the development of interventions to improve quality of life. Symptom management interventions, particularly for pain, dyspnea, and fatigue, were also highly endorsed. Health care system topics were related to delivery of care and included nurse-/allied health-led care (67.5%), working with the multidisciplinary team (67.5%), continuity of care (69.2%), and access to care (67.5%). Topics around screening/early detection research were highly endorsed too.A clear focus (and need) for research in interventions to improve quality of life and symptom management, particularly for pain, dyspnea, and fatigue was also established, alongside healthcare system issues and screening research.International societies and funding bodies could consider these topics in their funding decisions and in shaping their strategic directions in the care of patients with thoracic malignancies. Shifts in cancer care have seen the introduction of more effective treatments such as precision medicine, targeted therapies, and immunotherapy. These novel agents have led to improvements in survival, clinical outcomes, and more focus on prevention, early detection, survivorship, supportive and palliative care. As cancer care changes, so may be the impact of these changes on the patients and their families, creating new or different unmet needs. Nurses and Allied Health professionals need to continue developing new knowledge and addressing clinical unmet needs in order to provide dynamically efficient and patient-centred care. Information on research priorities can provide strategic directions for a particular area of care, highlight a gap in the current knowledge, can be a resource for researchers, policy makers and funding agencies, and potentially can increase the likelihood of research findings influencing clinical practice, care policies, and education. Furthermore, such surveys setting research agendas can elevate the voices of nurses and allied health professionals to shape innovations in care, add value and impact in such innovations by delivering data, creates engaged professionals and allows them to be advocates for their patients, and families’ issues of importance.Identifying research priorities is often carried out by national or international societies and organisations. For example, the Oncology Nursing Society in USA is conducting research priority surveys almost every four years for the past three decades. Its latest report highlights the priority areas being around patient adherence, screening in minority groups, symptom control, managing late effects, and delivery of survivorship care . Other rThe management of lung cancer and other thoracic malignancies has seen significant changes over the past decade with the development of novel therapies, improvements in palliative and supportive care, and earlier diagnosis . Also, tThis study is a cross-sectional international web-based survey. Survey participants were recruited from the email membership lists of international societies, such as nursing and allied health membership of the International Association for the Study of Lung Cancer (IASLC), International Thoracic Oncology Nursing Forum (ITONF), European Oncology Nursing Society (EONS), Multinational Association of Supportive Care in Cancer (MASCC), and the UK National Lung Cancer Forum(UKNLCF). Individuals participating could have forwarded the survey link to other individuals in their network or even to their national society, as requested through the survey’s information letter. We have also used social media, with the survey being disseminated through Twitter, Facebook, and Linkedin. The survey information letter asked individuals to complete the survey only if they worked exclusively or mostly with lung cancer patients. For nursing, most of the societies were lung cancer specific and hence it was expected that all nursing participants would be working most of their time with lung cancer patients. For allied health professionals, while we left this to be self-defined, we restricted the types of professionals that could participate to a few only by disseminating the survey in societies for occupational and physical therapy, social work, and psycho-oncology only as those work more closely with cancer patients albeit acknowledging this would be a small part of their workload with the exception of psycho-oncology. The sample represents diverse backgrounds in academic and practice settings. The term “lung cancer” in this study reflects patients with any thoracic malignancy. The term “care” includes care provided across the disease trajectory.The survey questionnaire on research priorities developed by the Oncology Nursing Society (ONS)  was the Data analysis was primarily based on descriptive statistics. Frequencies and percentages were calculated for each item of each domain of the survey tool. A rank order of these frequencies was tabulated. The percentage scores refer to proportions of participants who rated the item at a specific priority score (i.e. score 1 for “high priority” to score 4 “low/no priority”). Comparisons were made with regards to education (degree holders or lower vs. postgraduate education) and work setting  without the use of any formal statistics.The sample included 152 participants, most of whom (n = 136) were from the nursing discipline. They had an average of 13.4 (SD = 9.8) years of experience working with patients with thoracic malignancies. Most were coming from the USA, UK or other European countries and were members of IASLC, EONS, or ITONF providing an international reach to the required sample. More details are presented in st topic selected with 61.3%). Palliative care interventions were high in the priority list (72.4%) as was research related to immunotherapy and targeted therapies (around 70%). Health care system topics of high priority included continuity of care, access to care, nurse-led care, and working with the multidisciplinary team. Risk reduction through smoking cessation approaches and screening/early detection, particularly in undeserved and/or uninsured people, accounted for the remaining top priorities. A detailed description of the top twenty priorities is presented in Out of the top twenty priorities, the categories of developing and evaluating interventions, symptom management interventions and health care system topics had four specific items selected each. Persistent/late effects, treatment-related research, risk reduction in cancer patients and survivors and screening research had two items selected as priorities each. As the two topics selected in persistent/late effects included symptoms, this combined with the category of symptom management interventions makes the symptoms research as the top priority area. Also, development of interventions in different categories included primarily interventions for symptom control, containing also self-management symptom interventions (69.7%). Looking at specific items selected as top priorities, the highest priority was on interventions to improve quality of life (80.9%). The next two priorities with 78.8 and 73% each were related to interventions for the management of dyspnea and pain, respectively. Other key symptoms that were in the top twenty priority list included fatigue management, and managing pulmonary toxicity and depression  was related to all 15 statements about research in different types of complementary and alternative medicine. Other low priority areas, selected by less than 30% of participants, included social support and counselling interventions (30%), interventions that use technology to address symptoms (29.6%), spiritual care (29.6%), bereavement research (28.9%), bio-informatics (25%), and non-medical prescribing (24.8%). In relation to the list of 28 symptoms, the item with the lowest endorsement was unexplained weight loss (38.2%), while cough research was endorsed by 54% of participants.th in the list of difficult symptoms to manage in the current study, but was recognized as the 4th most distressing symptom for patients.Endorsement of topics was also assessed in terms of highest degree held (Bachelor degree holders and below vs those having postgraduate education) and the work place . Regarding education level, the key priorities were consistent between the two groups, with symptom management and quality of life being the common priorities. The group with baccalaureate education and below was further concerned on access to care, whereas those with postgraduate education highlighted research in immunotherapy as a key priority for them. In terms of priority endorsement based on work setting, symptom management interventions and interventions to improve quality of life were also common across all three groups. However, the hospital-based group prioritized other clinical topics (i.e. management of pain and dyspnea and immunotherapy research), the community/palliative care group had additional emphasis on psychosocial adjustment, while the education-based group had additional emphasis on self-management interventions and health care system aspects such as continuity of care and access to care Table 4.This is the first survey of nursing and allied health professionals focusing on their research priorities in the field of thoracic malignancies. Key priorities were about developing interventions to improve quality of life, symptom management, and palliative care. Endorsements of high priority also included health care system-related research reflecting issues around the delivery of care, treatment-related research (immunotherapy and targeted therapy), persistent/late effects management of pulmonary toxicity and fatigue, smoking cessation as a way to reduce risk in patients and screening/early detection research. Pain, dyspnea, and fatigue were the highest ranked symptoms both in terms of difficulty in managing them and the distress impacting upon patients.The focus on development and evaluation of interventions to improve quality of life and symptom management reflects the significant unmet needs of patients with lung cancer, who are often diagnosed at a late stage experiencing at the same time a complex array of supportive care needs, while our knowledge on how to manage these needs is fairly fragmented . This isCough is a symptom that 57–67% of patients with lung cancer experience  and is sPsychosocial care topics received low endorsement generally, including coping, psychosocial adjustment, bereavement care, and spiritual care, with the exception of managing depression. Only those participants working in the community and palliative care settings endorsed these higher than the rest of the participants. Psychosocial care is key to improving quality of life, and often a high priority area in many past surveys –3. It woDelivery of care and health care system-related issues have been the focus of nursing and allied health for a couple of decades with the identification and evaluation of service provision, service models and early palliative care, reviewed elsewhere . The chaAn interesting finding was the lowest priority attributed to all the 15 statements about research in different types of complementary and alternative medicine. This finding comes in contrast to studies that demonstrate an uprising in the numbers of patients with cancer (including lung cancer patients) who choose to utilize CAM and CAM use is reported in 42% of lung cancer patients . The freThere is a strong case for more research in screening/early detection for lung cancer . HoweverStrengths of this survey include efforts to represent international perspectives; adaptation of an existing established survey as a base; intended breadth and inclusiveness of survey items by including multiple facets of care; and unique focus on lung cancer specifically. Limitations of this survey are similar to any web-based surveys, including difficulty in establishing a representative sample and difficulties with reach. While a response rate for this survey was not established due to the lack of separate categories available in email lists of large international societies, response rates in similar surveys are typically very small. Indeed the ONS 2013 survey (There is strong support from the data presented that future research should focus on the development and evaluation of interventions to improve quality of life and symptom management, particularly for pain, dyspnea, and fatigue. Palliative care interventions also had strong endorsement. Screening and early detection research should be a priority. It was interesting to see that practice location and highest degree obtained changed the research priorities, which highlights the value of this study since research priorities are often determined by doctors or PhD holders and not other allied-health professionals who have substantial patient-care experience. Of equal importance was what survey respondents did not think should be a research priority, some of which have been the focus of substantial research efforts such as technology to address symptoms and counseling interventions. International societies and funding bodies could consider these topics in their funding decisions and in shaping their strategic directions in the care of patients with lung cancer. These results can also be used as a guide for researchers when thinking about developing research in lung cancer care in a patient-centred research agenda.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study was reviewed and approved by The Hong Kong Polytechnic University ethics committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.AM contributed study conception, development of protocol, data analysis, writing paper. AF, MC, PL, DLC, AC contributed to study design and data collection, and provided critical comments to paper drafts.. 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.