bluuebunny/crossref_metadata_2025 huggingface dataset:
The Regulation of E3 Ubiquitin Ligases Cbl and its Cross-talking in Bone Homeostasis
Authors: Yang Xiaobin , Hao Dingjun , He Baorong
Published: July 2020

The E3 ubiquitin ligases Cbl has been found play an important role in regulating cellular
proliferation and migration. Whereas, the excessive differentiation of osteoclast and/or its overexpressing
of resorptive functions could lead the pathological bone homeostasis by overly bone matrix degradation.
Since the first time of the important role of Cbl in the regulating osteoclast differentiation (also
named osteoclastogenesis) has been reported in decades ago. The extensively studies have been conducted
for in-depth exploring Cbl’s definite role during osteoclastogenesis, as well as its cross talking
with other signaling pathways (such as: Src and PI3K signaling) in bone homeostasis. Herein, our current
study aims to briefly conclude the current studies of osteoclastogenesis and the regulatory role of
Cbl, as well as its cross-talking in bone homeostasis.
Insight into Delivery Approaches for Biopharmaceutics Classification System Class II and IV Drugs
Authors: Chaturvedi Shashank , Mishra Raghav
Published: July 2020

:

Formulation development of BCS Class II and IV drugs is a challenging task due to their
poor solubility and permeability issue.

:

An extensive literature survey was conducted to explore the relevant pharmaceutical approaches that
have been used for solving the issue of poor solubility and permeability in the recent past.

:

It has been found that a plethora of approaches have been investigated for addressing the issue of poor
solubility and or permeability. These include physical modifications (modification of crystal habit, particle
size reduction, complexation, polymorphism and drug dispersion in carriers), chemical modifications
(salt formation), and formulation modifications (Nanotechnology-based approaches and hydrotropy).

:

The physical and chemical modification approaches can be effectively used to enhance the solubility
and dissolution rate of poorly soluble drugs, but the additional problem of poor permeability has been
better addressed by lipid-based drug delivery systems. As the latter presents the drug in the solubilized
state, bypass first-pass effects, circumvent the effect of Para-glycoprotein mediated efflux of drugs,
hence contributing to overall bioavailability enhancement.
Emerging Toxicity Aspects of Silver Nanoparticles: An Overview
Authors: Suravajhala Renuka , Bhagat Madhulika , Malik Babita
Published: July 2020

Silver nanoparticles (AgNPs) have been widely used in a broad spectrum
of applications due to their unique properties. AgNPs are known to have a potential
impact that varies based on their size, dosage, exposure time and state. Various green
synthesized AgNPs have been extensively explored to treat potential anti-bacterial,
anti-microbial, anti-fungal agents revealing bioaccumulation in various biological
systems that have increased toxicity. We review the impact of AgNPs on the
environment and biological systems and deliberate the toxicity associated with it.
Annelerin Bebek Bakımında Kullandıkları Geleneksel Uygulamaların Kuşaklararası Boyutu
Authors: PEKYİĞİT Aylin , YILDIZ Dilek , EREN FİDANCI Berna , ÇALIK BAĞRIYANIK Burcu , DEHMEN Özgenur , KOÇAK Tuğba , ALTINTAŞ Sema
Published: July 2020

Amaç: Toplumun kültürel değerleri, insanların yaşam ve sağlık koşullarını etkilemektedir. Birbirine yakın yıllarda doğan insanlar, hayata bakış açısından benzer özellikler taşımaktadırlar. Bu durum kuşaklararası farklılığı ortaya çıkartmaktadır. Araştırmamız, Bebek Patlaması, X, Y ve Z Kuşağı annelerinin bebek bakımında kullandıkları geleneksel uygulamaları belirlemek ve karşılaştırmak amacıyla yapılmıştır. Yöntem: Bu araştırma kesitsel, tanımlayıcı ve karşılaştırmalı bir araştırma olup 10.04.2018-10.07.2018 tarihleri arasında, bir devlet hastanesinin kadın doğum polikliniklerine başvuran, araştırmaya katılmaya gönüllü 273 anne ile yürütülmüştür. Veriler, anket formu aracılığı ile yüz yüze görüşülerek toplanmıştır. Çalışma için etik kurul izni ve gerekli izinler alınmıştır. Verilerin değerlendirilmesinde IBM SPSS Statistics 21 paket programından yararlanılmıştır. Bulgular: Araştırmaya katılan annelerin, %65,93’ü Y Kuşağı’ndandır. Doğumdan sonra bebeği beslemek için ezan sesinin beklenmesi, ilk sütün sağılıp atılması, bebeğe ilk şekerli suyun verilmesi, göbek bağının düştükten sonra anlamlı bir yere (cami, okul vb.) gömülmesi, çok terleyen bölgelerine tuz sürülmesi açısından önemli bir farklılık vardır (p<0,05). Diğer uygulamalar yönünden kuşaklararasında önemli bir farklılık görülmemiştir. Sonuç: Araştırmamızda bebeğe zararı olmayan geleneksel uygulamaların yansıra zararı olan geleneksel uygulamaların da kullanıldığı saptanmıştır. Kuşaklararası karşılaştırmada zararlı uygulamaları çoğunlukla Bebek Patlaması Kuşağı kullanmıştır.
Artificial Intelligence–Based Chatbot for Anxiety and Depression in University Students: Pilot Randomized Controlled Trial (Preprint)
Authors: Klos Maria Carolina , Escoredo Milagros , Joerin Angela , Lemos Viviana Noemí , Rauws Michiel , Bunge Eduardo L
Published: July 2020

BACKGROUND

Artificial intelligence–based chatbots are emerging as instruments of psychological intervention; however, no relevant studies have been reported in Latin America.

OBJECTIVE

The objective of the present study was to evaluate the viability, acceptability, and potential impact of using Tess, a chatbot, for examining symptoms of depression and anxiety in university students.

METHODS

This was a pilot randomized controlled trial. The experimental condition used Tess for 8 weeks, and the control condition was assigned to a psychoeducation book on depression. Comparisons were conducted using Mann-Whitney U and Wilcoxon tests for depressive symptoms, and independent and paired sample t tests to analyze anxiety symptoms.

RESULTS

The initial sample consisted of 181 Argentinian college students (158, 87.2% female) aged 18 to 33. Data at week 8 were provided by 39 out of the 99 (39%) participants in the experimental condition and 34 out of the 82 (41%) in the control group. On an average, 472 (SD 249.52) messages were exchanged, with 116 (SD 73.87) of the messages sent from the users in response to Tess. A higher number of messages exchanged with Tess was associated with positive feedback (F2,36=4.37; P=.02). No significant differences between the experimental and control groups were found from the baseline to week 8 for depressive and anxiety symptoms. However, significant intragroup differences demonstrated that the experimental group showed a significant decrease in anxiety symptoms; no such differences were observed for the control group. Further, no significant intragroup differences were found for depressive symptoms.

CONCLUSIONS

The students spent a considerable amount of time exchanging messages with Tess and positive feedback was associated with a higher number of messages exchanged. The initial results show promising evidence for the usability and acceptability of Tess in the Argentinian population. Research on chatbots is still in its initial stages and further research is needed.
Share to Seek: The Effects of Disease Complexity on Health Information–Seeking Behavior (Preprint)
Authors: Alasmari Ashwag , Zhou Lina
Published: July 2020

BACKGROUND

Web-based question and answer (Q&A) sites have emerged as an alternative source for serving individuals’ health information needs. Although a number of studies have analyzed user-generated content in web-based Q&A sites, there is insufficient understanding of the effect of disease complexity on information-seeking needs and the types of information shared, and little research has been devoted to the questions concerning multimorbidity.

OBJECTIVE

This study aims to investigate seeking of health information in Q&A sites at different levels of disease complexity. Specifically, this study investigates the effects of disease complexity on information-seeking needs, types of information shared, and stages of disease development.

METHODS

First, we selected a random sample of 400 questions separately from each of the Q&A sites: Yahoo Answers and WebMD Answers. The data cleaning resulted in a final set of 624 questions from the two sites. We used a mixed methods approach, including qualitative content analysis and quantitative statistical analysis.

RESULTS

The one-way results of ANOVA showed significant effects of disease complexity (single vs multimorbid disease questions) on two information-seeking needs: diagnosis (F1,622=5.08; P=.02) and treatment (F1,622=4.82; P=.02). There were also significant differences between the two levels of disease complexity in two stages of disease development: the general health stage (F1,622=48.02; P<.001) and the chronic stage (F1,622=54.01; P<.001). In addition, our results showed significant effects of disease complexity across all types of shared information: demographic information (F1,622=32.24; P<.001), medical diagnosis (F1,622=11.04; P<.001), and treatment and prevention (F1,622=14.55; P<.001).

CONCLUSIONS

Our findings present implications for the design of web-based Q&A sites to better support health information seeking. Future studies should be conducted to validate the generality of these findings and apply them to improve the effectiveness of health information in Q&A sites.
The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study
(Preprint)
Authors: Rayward Anna T , Vandelanotte Corneel , Van Itallie Anetta , Duncan Mitch J
Published: July 2020

BACKGROUND

Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data.

OBJECTIVE

This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement.

METHODS

A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups’ engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression.

RESULTS

App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] −6.9, 95% CI −7.6 to −6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR −0.7, 95% CI −0.9 to −0.4) and Fitbit Only (OR −0.5, 95% CI −0.7 to −0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR −201.9, 95% CI −387.7 to −116.0) and Fitbit Only (OR −492.9, 95% CI −679.9 to −305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups.

CONCLUSIONS

Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement.
Surgeon’s and trainee’s attitudes towards surreptitious recordings by patients: An Institutional Survey (Preprint)
Authors: Ullah Shahnoor Mohammed , Sevigny Marika , Cil Tulin , Devon Karen
Published: July 2020

UNSTRUCTURED

Recently, cases of patients recording clinical encounters without the physician's knowledge have been reported, raising ethical and legal questions. No study to date has examined surgeon's and trainee's attitudes towards this practice.

An anonymous online survey was developed and administered to surgeons and trainees in a large academic department of surgery. The responses between the surgeons and trainees were then compared.

There were a total of 114 responses (response rate of 12.6%). Attitudes on the utility of recording clinical encounters varied. When comparing surgeons to trainees, 22% of surgeons disagreed that memory aide alone was sufficient when discussing difficult information while only 5.3% of trainees (p<0.05) did. Surgeons were more likely to think it was reasonable (38.8%) for patients to request recording their clinical encounter than trainees (13.5%, p<0.05). Trainees were also more likely to agree that this would hinder their therapeutic relationship (62.2%) compared to surgeons (38.8%, p<0.05). Trainees were more likely to believe this could be used against them in a medico-legal dispute (52.8%) compared to surgeons (29.25, p<0.05). Trainees were also more concerned that these clinical recordings could be taken out of context (86.1%) compared to surgeons (54.2%, p<0.05).

In summary, surgeons' opinion on patient recording of clinical encounters vary. Few were aware of the legal implications. Trainees are even less likely to value recording clinical encounters and more likely to believe that these recordings could be harmful.
Online Patient Recruitment in Clinical Trials: Systematic Review and Meta-Analysis (Preprint)
Authors: Brøgger-Mikkelsen Mette , Ali Zarqa , Zibert John R , Andersen Anders Daniel , Thomsen Simon Francis
Published: July 2020

BACKGROUND

Recruitment for clinical trials continues to be a challenge, as patient recruitment is the single biggest cause of trial delays. Around 80% of trials fail to meet the initial enrollment target and timeline, and these delays can result in lost revenue of as much as US $8 million per day for drug developing companies.

OBJECTIVE

This study aimed to conduct a systematic review and meta-analysis examining the effectiveness of online recruitment of participants for clinical trials compared with traditional in-clinic/offline recruitment methods.

METHODS

Data on recruitment rates (the average number of patients enrolled in the study per month and per day of active recruitment) and conversion rates (the percentage of participants screened who proceed to enroll into the clinical trial), as well as study characteristics and patient demographics were collected from the included studies. Differences in online and offline recruitment rates and conversion rates were examined using random effects models. Further, a nonparametric paired Wilcoxon test was used for additional analysis on the cost-effectiveness of online patient recruitment. All data analyses were conducted in R language, and P<.05 was considered significant.

RESULTS

In total, 3861 articles were screened for inclusion. Of these, 61 studies were included in the review, and 23 of these were further included in the meta-analysis. We found online recruitment to be significantly more effective with respect to the recruitment rate for active days of recruitment, where 100% (7/7) of the studies included had a better online recruitment rate compared with offline recruitment (incidence rate ratio [IRR] 4.17, P=.04). When examining the entire recruitment period in months we found that 52% (12/23) of the studies had a better online recruitment rate compared with the offline recruitment rate (IRR 1.11, P=.71). For cost-effectiveness, we found that online recruitment had a significantly lower cost per enrollee compared with offline recruitment (US $72 vs US $199, P=.04). Finally, we found that 69% (9/13) of studies had significantly better offline conversion rates compared with online conversion rates (risk ratio 0.8, P=.02).

CONCLUSIONS

Targeting potential participants using online remedies is an effective approach for patient recruitment for clinical research. Online recruitment was both superior in regard to time efficiency and cost-effectiveness compared with offline recruitment. In contrast, offline recruitment outperformed online recruitment with respect to conversion rate.
Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Kramer Lean L , Mulder Bob C , van Velsen Lex , de Vet Emely
Published: July 2020

BACKGROUND

An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner.

OBJECTIVE

We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA.

METHODS

The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome—use—will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview.

RESULTS

As of July 2020, we have begun recruiting participants.

CONCLUSIONS

By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context.

CLINICALTRIAL

ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/22186
Development and External Validation of Diagnostic Model for Periprocedural Bradycardia during Primary Percutaneous Coronary Intervention: Algorithm Development and Validation (Preprint)
Authors: Li Yong , Lyu Shuzheng
Published: July 2020

BACKGROUND

Periprocedural bradycardia weaks the benefit of primary percutaneous coronary intervention (PPCI) and has deleterious effects on organ perfusion of patients with acute ST elevation myocardial infarction (STEMI).

OBJECTIVE

The objective of our study was to develop and externally validate a diagnostic model of periprocedural bradycardia. .

METHODS

Design: Multivariate logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1820 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2015 in Beijing Anzhen Hospital, Capital Medical University. External validation: Totally 716 acute STEMI patients who were treated with PPCI from January 2016 to June 2018 in Beijing Anzhen Hospital, Capital Medical University. Outcomes: Periprocedural bradycardia during PPCI. Periprocedural bradycardia was defined as preoperative heart rate ≥ 50 times / min, intraoperative heart rate <50 times / min persistent or transient. We used logistic regression analysis to analyze the risk factors of periprocedural bradycardia in the development data set. We developed a diagnostic model of periprocedural bradycardia and constructed a nomogram.We assessed the predictive performance of the diagnostic model in the validation data sets by examining measures of discrimination, calibration, and decision curve analysis (DCA).

RESULTS

Periprocedural bradycardia occurred in 332 out of 1,820 participants (18.2%)
in the development dataset. The strongest predictors of periprocedural bradycardia were intra-procedural hypotension, the culprit vessel was not left anterior descending (LAD), using thrombus aspiration devices during procedure, sex, history of coronary artery disease, total occlusion of culprit vessel, and no-reflow. We developed a diagnostic model of periprocedural bradycardia.The area under the receiver operating characteristic(ROC) curve(AUC) was was.8384 ±.0122, 95% confidence interval(CI)=.81460~.86225in the development set. We constructed a nomogram based on predictors of periprocedural bradycardia.
Periprocedural bradycardia occurred in 102 out of 716 participants (14.2%)in the validation dataset.
The AUC was was .8437 ±.0203, 95% CI= .80390 ~ .88357. Discrimination, calibration, and DCA were satisfactory.
Date of approved by ethic committee:16 May 2019. Date of data collection start: 1 June 2019. Numbers recruited as of submission of the manuscript:2,536.

CONCLUSIONS

We developed and externally validated a diagnostic model of periprocedural bradycardia during PPCI.

CLINICALTRIAL

We registered this study with WHO International Clinical Trials Registry Platform（ICTRP）. Registration number: ChiCTR1900023214. Registered Date :16 May 2019. http://www.chictr.org.cn/edit.aspx?pid=39087&htm=4.
Acceptance and Use of Telepsychology From the Clients’ Perspective: Questionnaire Study to Document Perceived Advantages and Barriers (Preprint)
Authors: Sora Beatriz , Nieto Rubén , Montesano del Campo Adrian , Armayones Manuel
Published: July 2020

BACKGROUND

Telepsychology is increasingly being incorporated in clinical practice, being offered in many psychotherapy centers, especially after
the impact of the pandemic. However, there seems to be a remarkable discrepancy between the offer, or interest in, and real-world
uptake of e-mental health interventions among the population. A critical precondition is clients’ willingness to accept and use
telepsychology, although this issue has thus far been overlooked in research.

OBJECTIVE

The aim of this study was to examine people’s acceptance and use of telepsychology by adopting an extended model of the unified theory of acceptance and use of technology (UTAUT) that integrates perceived telepsychology advantages and barriers, usefulness perceptions, behavioral intention, and telepsychology use.

METHODS

An online survey was conducted with a convenience sample of 514 participants. Structural equation models were computed to
test a mediation model.

RESULTS

Results supported the UTAUT model to explain participants’ acceptance and use of telepsychology. They showed a causal chain
in which perceived telepsychology advantages and barriers were related to telepsychology use through the perceived usefulness of and
intention to use telepsychology.

CONCLUSIONS

Telepsychology use may be explained according to the UTAUT model when coupled with participants’ perceptions of telepsychology advantages and barriers. Mental health stakeholders could consider these factors in order to increase the acceptance and use of telepsychology.
A review of mHealth depression apps: Assessing app functions for the Self-Determination Theory (Preprint)
Authors: Brownlow Luke
Published: July 2020

BACKGROUND

Smartphone applications (apps) are an ideal tool that is highly accessible to people who wish to begin self-treatment for depression. While many studies have performed content analyses on healthcare apps, few studies have reviewed these apps for adherence to behavior theory. Furthermore, apps for depression management are underrepresented in healthcare research.

OBJECTIVE

The objective of this study is to assess mHealth depression apps using SDT as a theoretical framework for meeting needs of autonomy, competence and, relatedness

METHODS

All depression healthcare apps available in Australia from the iTunes and Google Play app stores that met the inclusion criteria were analyzed. Each app was reviewed based on price options, store availability, download rates, and how in-app functions met the three basic needs for motivation towards health behavior change outlined in the Self-Determination Theory (SDT).

RESULTS

The analysis of the apps showed that most apps were free to download (69.9%) and addressed at least one of the three needs (81.4%) of SDT. However, few apps addressed all three of the basic needs through their functions (7.7%), and no apps hosted all functions expected to stimulate motivation for health behavior change. Furthermore, neither store availability, price option nor download rate were accurate predictors that apps hosted in-app functions expected to meet the basic needs.

CONCLUSIONS

The results suggest that some depression healthcare apps that meet the basic needs would effectively stimulate motivation (i.e., autonomy, competence, and relatedness). However, each individual app is limited in its number of functions that meet the basic needs. People who want access to more functions would need to download a suite of apps.
Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data (Preprint)
Authors: Schuler Miriam , Gieseler Hannes , Schweder Katharina W , von Heyden Maximilian , Beier Klaus M
Published: July 2020

BACKGROUND

Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively).

OBJECTIVE

The aim of this study was to describe the characteristics of the users of the Troubled Desire app.

METHODS

The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire.

RESULTS

The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities.

CONCLUSIONS

The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending.
Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint (Preprint)
Authors: Fernandez M Isabel , Harper Gary W , Hightow-Weidman Lisa B , Kapogiannis Bill G , Mayer Kenneth H , Parsons Jeffrey T , Rotheram-Borus Mary Jane , Seña Arlene C , Sullivan Patrick S
Published: July 2020

UNSTRUCTURED

Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN’s research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.
Electronic Health Records–Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study (Preprint)
Authors: Chandra Alvin , Philips Steven T , Pandey Ambarish , Basit Mujeeb , Kannan Vaishnavi , Sara Evan J , Das Sandeep R , Lee Simon J C , Haley Barbara , Willett DuWayne L , Zaha Vlad G
Published: July 2020

BACKGROUND

Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions.

OBJECTIVE

The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients.

METHODS

We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy.

RESULTS

Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT.

CONCLUSIONS

EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations.
Understanding the African Continental Free Trade Area: Beyond “Single Market” to “Africa’s Rejuvenation” Analysis
Authors: Armel Dr. Kaze
Published: July 2020

While global trends continue to move from integration towards heightened protectionism, and retaliatory trade measures, African countries improved their intra-regional trade levels and deepened their regional integration by launching the African Continental Free Trade Area (AfCFTA). The AfCFTA seeks to deepen Africa’s market integration at regional and continental levels; smash down tariff barriers within Africa; boost intra-Africa trade; promote regional and continental value chains; and hopefully deliver Africa’s rejuvenation. However, Africa as a continent is facing many challenges, especially its notions and concepts of development, plus the complications caused by the outbreak of the COVID-19 pandemic. However, questions are being aroused on whether African policy makers are prepared enough to overcome the AfCFTA related challenges. This article examines the mechanisms needed to fully implement the recently signed continental free trade area deal, its impact on Africa’s Regional Economic Communities (RECs), and what’s in it for Africa’s major economic partners. In this article, the author will also point out existing daunting challenges and give a series of policy recommendations.
Endüstri 4.0’ın Proje Yönetim Etmenlerine Etkisi
Authors: TANER Zafer Tarık , PARLAK BİÇER Zübeyde Özlem
Published: July 2020

Yönetim, modern bilimsel anlayışına ulaşana kadar pek çok aşamadan geçmiş ve her zaman pratikte var olmuştur. Dünya nüfusunun artması ve kentleşmeye bağlı olarak çevresel, sosyal ve ekonomik faaliyetler için endüstrileşmeye duyulan ihtiyaçlar artmıştır. Gelişen teknoloji sayesinde endüstriyel ürünlerin daha hızlı ve esnek üretilebilmesi yönündeki beklentilerin iyi bir yönetimle karşılanması; çevresel, sosyal ve ekonomik sorunların azalması için elzemdir. Yapı endüstrisindeki her projenin kendi özgün olmasından dolayı proje yönetiminin önemi gün geçtikçe artmıştır. Bu doğrultuda günümüzde birçok alanda çığır açan teknolojik uygulamalarla dolu bir çağı yansıtan Endüstri 4.0’ın proje yönetimine etkisi önemli bir araştırma konusudur. Bu çalışmada öncelikle Endüstri 4.0’ın beraberinde getirdiği dönüşümler hakkında literatür araştırması yapılmıştır. Sonrasında bu dönüşümlerin proje yönetim etmenleri üzerinde etkisinin ortaya koyulması için yönetim etmenleri açıklanmış ve endüstri 4.0’ın getirileri üzerine analiz gerçekleştirilmiştir. Endüstri 4.0 teknolojilerinin proje yönetim etmenlerinde kullanılması ile sorunlara gerçek zamanlı çözüm önerileri getirerek başarılı proje yönetiminin sağlanacağı öngörülmüştür. Elde edilen verilerin proje paydaşlarına yol gösterici olması ve alana katkı sağlaması amaçlanmaktadır.
THE QUALITY OF FINANCIAL STATEMENTS ANTECEDENTS AND CONSEQUENCES TOWARDS FINANCIAL ACCOUNTABILITY
Authors: Karyatni Ni Made Dwi , Handajani Lilik
Published: July 2020

Based on this research, low quality of financial statement presentation, especially regional government level accounting entity. Presentation of the financial statements of the Regional Government Unit was not fully appropriate with the Governmental Accounting Standards and Accounting Policies so that affects the accuracy of the information presented in the financial statements. Inaccurate financial reports has a negative impact to users in policy decision. This study aimed to test empirically the factors that affect the quality of the financial statements and the problems were faced by regional government unit (SKPD) in preparing the financial statements and the implications for the financial accountability. The population in this research was 292 respondents. The sample was determined by purposive sampling technique amount 97 respondents including the Financial Administration Officer (PPK) SKPD, PPK staff at 44 SKPD staff and staff in accounting staff and reporting on SKPKD. Data analysis was used on Partial Least Square (PLS). The findings of this study indicate that the quality of SKPD financial    statements was affected by the application of completion of audit findings, but this study is not affected by the reconciliation, competence of human resources and the leadership support. Other findings indicate that the financial statements SKPD have implications for financial accountability. The implications of this study can contribute some ideas for the Central Lombok regency government to increase financial assistance to personnel managers through education and training so that it can make good quality in the financial statements and practical contribution in formulating the direction and policies related to the accountability of local government financial reporting.
An Analysis of University Students’ Perspective On Online Learning in The Midst of Covid-19 Pandemic
Authors: Sujarwo Sujarwo , Sukmawati Sukmawati , Akhiruddin Akhiruddin , Ridwan Ridwan , Suharti Siradjuddin Suharti Siradjuddin
Published: July 2020

In this study we address and investigate university students’ perspective on utilizing online learning in the midst of COVID-19 pandemic. This research used qualitative descriptive method. The subject of this research were the learners of Elementary School Teacher Education, Physical Education, Sociology Education and English Education Department of Universitas Megarezky in 2019/2020 academic year. The number of respondents was 40 respondents. The research instruments were questionnaire that was obtained by google form through analyzing participants’ response to know their perspective in using online learning and in-depth interview.  The study showed that previously, students did not use online learning before the pandemic because learning was conducted in the classroom. In the midst of covid-19 pandemic, the students are interested in using online learning in which can be accessed flexible, anywhere and everywhere. The best application used by lecturers and students was WhatsApp application. It can be concluded that the students’ perspective on online learning had a positive impact in the midst of the covid-19 pandemic.
Teachers' Readiness in Inserting the 21st Century Skills in the Lesson Plan in Teaching English
Authors: Luciana Ni Luh Ratih
Published: July 2020

The 21st-century learning outcomes are essential to be achieved by the students nowadays. A lesson plan is one of the mediums used to insert the skills of the 21st century, which needed to be improved by the students. This study examined English teachers’ readiness in inserting the 21st-century skills in planning the lesson in the city area and suburb area of Badung Regency. This study belonged to a case study and was conducted using a sequential embedded mixed-method, in which mixed the quantitative results with qualitative results to get more valid data. A questionnaire consisted of 17 items used to know the readiness of English teachers, combined with the results on document analysis. Based on the results of the investigation, it showed inconsistent answers of English teachers in the city area and suburb area based on the results on questionnaire and document analysis. English teachers perceived they were ready to insert the 21st-century skills but, based on results on document analysis, it showed English teachers mostly added learning and innovation skills and information, media, and technology skills in the lesson plan. It is suggested English teachers should be more ready by looking up at the standardization of the 21st-century education then combined it with attending seminars on related topics about the implementation of the 21st-century skills.
Application of Differential Transform Method to Integral and Integro-Differential Equations
Authors: George Sudha , Sivakumar T. R.
Published: July 2020

In this paper, Differential Transform Method (DTM) has been used to solve some systems of linear and nonlinear Integro-differential equations. The approximate solution in the form of a series are calculated with easily computable terms. The solution obtained using this method is compared with the solution obtained using existing methods.
Art and Nihilism at the Dawn of the Twentieth Century
Authors: Quintana Esteban Andrés Sanchez
Published: July 2020

In this text we will deal with some nuances of the relationship between nihilism and art in the context of the cultural crisis of the early twentieth century. To carry out this task, the following approach is proposed: first, some generalities of nihilism are established. Second, the perspective of Nietzsche is outlined, he is the one who detects that the cause of the devaluation of values has its origin in the Platonist tradition of the Western thought, proposing that, in order to overcome this situation, it is necessary to transvalue values towards a new direction. Next, we seek to reflect how nihilism took over as a crisis of civilization at the beginning of the twentieth century, to do this we will review some perspectives of artists and men of letters who developed their work in this era. Finally, a conclusion is proposed.
Psoriasis with End Stage Renal Disease Successfully Treated with Ustekinumab: A Case Report
Authors: Fisher Kaylee , Meister Harry , Shihab Nahla , Lebwohl Mark
Published: July 2020

Many biologic agents are available to treat psoriasis, however only a few reports describe the efficacy and safety for patients with psoriasis complicated by kidney failure. In this report we demonstrated a case of severe plaque psoriasis complicated with end-stage renal disease (ESRD,) successfully treated with ustekinumab without the necessity for dose adjustment.
Renal Cell Carcinoma (RCC) Stain Negative Metastatic Clear Cell Renal Cell Carcinoma Masquerading as a Pyogenic Granuloma on the Scalp
Authors: Vasile Gabriella Francesca , Levin Adam , Kleinfelder Raymond , Rivlin Daniel , Glick Brad
Published: July 2020

Metastasis occurs in 25-50% of patients diagnosed with primary renal cell carcinoma (RCC), although only 6% of RCC metastases manifest on the skin. We present a unique case of a slowly growing clear cell RCC metastasis of the scalp in a middle-aged male that was RCC stain negative. The lesion clinically appeared to be a benign pyogenic granuloma, however, the diagnosis of metastatic clear cell renal cell carcinoma was made based on histology. Because cutaneous metastases may masquerade as other more benign tumors, the physician must be clinically suspicious of vascular appearing lesions on the scalp.
Interdigital Tinea: The Forerunner of Infectious Eczematoid Dermatitis
Authors: Bhatia Kyle R , Brodell Robert T , Bhatia Ashish C , Mockbee Chelsea S
Published: July 2020

Infectious eczematoid dermatitis (IED) is defined as an acute, eczematous eruption that occurs secondary to autosensitization to purulent drainage from a primary infected site. The condition is believed to develop when bacterial products, most often the result of Staphylococcal or Streptococcal species, act as haptens and stimulate an immune response. IED typically manifests as a plaque with associated vesicles and pustules surrounding drainage from a central infectious source, or as oozing, erythema, crusting, and scaling spreading peripherally from a central infectious source. Management of IED includes both targeting the causative primary infection and suppressing the immune response producing a hypersensitivity reaction. This report details two cases. Case 1 describes a common presentation of tinea pedis. Case 2 is that of a 28 year-old-male who presented with an acute onset tender, pruritic, weeping rash after wearing boots for two straight days, and who was subsequently diagnosed and treated for IED.
Photodynamic Therapy with δ-Aminolevulinic Acid and Blue Light for the Treatment of Actinic Cheilitis
Authors: Paul Joan , Dagrosa Alicia T. , Chen Youdinghuan , Gangar Pamela , Ressler Daniel , Chapman M. Shane
Published: July 2020

ABSTRACTBackground:  Actinic cheilitis is a common precancerous disorder of the lower lip caused by ultraviolet radiation. Photodynamic therapy (PDT) is a potential treatment for actinic cheilitis, however controlled clinical trials regarding this treatment are needed.Objective:  To evaluate the safety and efficacy of PDT with blue light and topical δ-aminolevulinic acid (Levulan®) in the treatment of actinic cheilitis.Methods:  We conducted a single center, investigator-initiated, nonrandomized, open-label, proof of concept study of PDT with blue light for the treatment of actinic cheilitis. We enrolled 24 subjects, 20 meeting inclusion and exclusion criteria. One subject withdrew from the study prior to treatment. The study consisted of a screening visit, one to three scheduled treatments, and two follow-up visits. The primary outcome was clinical improvement in actinic cheilitis from baseline, estimated as no (0%), mild (25%), moderate (50%), marked (75%), or excellent improvement (100%). Post-treatment assessment of swelling, erythema, flaking/scaling, crusting, vesiculation/pustulation, and erosion/ulceration was also recorded. Subjects completed the Dermatological Life Quality Index questionnaire, subject global assessment of improvement, and pain assessment at each visit.Results:  65% of subjects achieved clinical improvement of 75% or greater and 20% achieved 100% improvement by the end of the study. Treatments were well tolerated with minimal discomfort. Subjects experienced transient mild adverse effects.Conclusion:  Overall, our study supports using PDT for the treatment of actinic cheilitis.
Aseptic Syphilitic Meningitis in an HIV-Negative Patient with Concomitant Primary and Secondary Syphilis
Authors: Jimenez Antonio Roberto , Hoyer Paige , Wilkerson Michael
Published: July 2020

Background: Syphilis is a sexually and vertically transmitted disease caused by the Treponema pallidum species. Aseptic syphilitic meningitis (ASM) is a subcategory of neurosyphilis. Neurosyphilis is typically considered a tertiary manifestation of syphilis; however, ASM typically occurs within 6 months of exposure and may be concurrent with the rash of secondary syphilis. Case Presentation: A 58-year-old immunocompetent male presented to the dermatology clinic with an erythematous morbilliform rash that involved his trunk and upper extremities. He was prescribed benzonatate 100 mg 3 weeks prior for cough and was diagnosed with a drug-induced morbilliform rash. The patient was seen 1 month later by urology for a penile ulcer. At his urology appointment, an RPR test was done and resulted positive with a titer of 1:256. He was referred to dermatology again and was noted to have a diffuse, copper-colored maculopapular rash involving the palms and soles. During this appointment, the patient complained of a 4-week headache and was found to have nuchal rigidity. He was admitted for neurosyphilis work up, including CSF and CSF-VDRL examination. His neurologic symptoms improved on IV Penicillin G. Repeat RPR testing at 6 months follow up confirmed adequate treatment and his RPR declined from 1:256 to 1:4.  Conclusion: We present a case of ASM in an immunocompetent individual with concomitant primary and secondary syphilis. Dermatologists are trained to recognize the cutaneous manifestations of syphilis, but also should be familiar with the variable presentations of the disease, including the early neurological findings of ASM.