bluuebunny/crossref_metadata_2025 huggingface dataset:
Time domain response analysis of multi-flow channel hydraulic mount
Authors: Lin Zhihong , Wang Chunrong , Chen Yunxiao , Wu Mingzhong , Zheng Feijie , Wei Jian
Published: December 2023

In order to analyze the effect of the combination of long and short inertia channels and orifice flow channels on the time domain response of hydraulic mounts. Firstly, six hydraulic mounts with different combinations of inertia channels and orifice flow channels are proposed. And then, the transfer functions of dynamic stiffness and upper chamber pressure for six structures of hydraulic mounts are derived using the lumped parameter method. Next, the time domain analytic formulas for the transfer force and upper chamber pressure for six structural hydraulic mounts under steady-state excitation and step excitation are obtained using the convolution method. Finally, the analytical formula is compared with the hydraulic mount’s model built by AMEsim; Meanwhile, the effects of inertia terms of inertia channels, damping, and damping of orifice flow channels on hydraulic mounts transfer forces are analyzed; Analyze the effect of transfer force variation and excitation amplitude on hydraulic mounts damping for different configurations of structures. Research shows that inertia channels and orifice flow channels directly affect the low-frequency dynamic characteristics of hydraulic mounts. At the same time, the effective damping height of the hydraulic mounts depends on the excitation amplitude.
Stormwater reuse for water-sensitive city – Integrated analysis of urban hydrology for efficient alternatives of Amaravati city, India
Authors: Rentachintala Lakshmi Raghu Nagendra Prasad , Mutukuru Gangireddy Muni Reddy , Mohapatra Pranab Kumar
Published: December 2023

In the present study, Amaravati, a proposed city of Andhra Pradesh, India, is identified for stormwater reuse analysis and for various efficient options for reuse. Peak runoff from the entire catchment is determined for the management of stormwater using different models such as soil and water assessment tool (SWAT), stormwater management model, and intensity–duration–frequency curves by the log Pearson Type III method. Further, the bio-retention cell low-impact development option with 60% impervious area, 60% zero depression impervious area, bio-retention cell for 40% area for each sub-catchment, and the underground stormwater network system, for part of peak runoff reduction, remaining peak runoff is considered for reuse. The remaining peak runoff is proposed to be reused for irrigation purposes (option 1), and storage retention ponds as extended detention ponds (option 2). Also, in situ storage/percolation is recommended for unaccounted stormwater within or around each premise. The findings can help to propose, implement, and maintain various stormwater reuse measures and/or practices for any city.
Identification of Porous Materials Rheological Coefficient Using Experimental Determination of the Radial and Longitudinal Strain Rate Ratio
Authors: Raisson G.
Published: December 2023

Abstract. Traditional approach of identification of the f1 and f2 function of the Green plasticity criterion [1] for porous materials is based on the two experiments: isostatic pressing of samples in the interrupted cycles (determining density as a function of pressure providing the f2 values) and upsetting providing an equation for determining the f1 values responsible for the shear deformations. Treatment of HIP dilatometer data allows to get an independent f1 evaluation which shows that upsetting is not representative of stress state met during powder HIP densification. In the second part, a new approach is suggested allowing to determine these two functions using only the deviations from the isotropic shrinkage obtained in the interrupted cycles. This anisotropy is characterized by the ψ coefficient ratio between the radial and the axial strain rate.
Investigetion of Pressure Sores Frequency and Risk Factors of Patients Registered to Home Health Unit
Authors: SALAR Osman Buğra , TUNCER Özge
Published: December 2023

Aim: The study was to investigate the frequency of pressure sores, the risk factors causing their formation, and their relationship with nutrition in patients receiving home health services.
Materials and Methods: After scanning all 4098 patients registered with the Home Health Unit of an Education and Research Hospital in İzmir, Turkey, it was discovered that 186 of them had pressure sores. The study concluded with 151 patients as 35 patients passed away during the data collection process. The questionnaire employed in the study comprised two parts: The first part examined patients' sociodemographic and clinical characteristics, while the second part utilized the Pressure Ulcer Scale for Healing, Braden Pressure Ulcer Risk Assessment Scale, and Malnutrition Universal Screening Tool.
Results: Pressure sores were found in 3.69% of the 4098 patients. The mean age of the patients was 78.29 (78.28±14.51), and 103 (68.2%) were female patients. Upon analyzing patients based on the presence of chronic diseases, it was noted that the risk of pressure sore development was notably higher in the high and very high-risk groups, particularly among those with neurological diseases. Approximately 44.4% of the patients utilized nutritional products. A statistically significant correlation was observed between the use of high-protein dietary products and the Braden scale score..
Conclusion: This study shows that the patients receiving Home Health Care Services are in the risky group in terms of pressure sores and malnutrition, but the incidence decreases with good care and caregiver education. The most important factors that increased the risk of pressure sore formation and the severity of pressure sores were neurological disease, nutritional status, and urinary and fecal incontinence.
ARALIKLI ORUCUN OBEZİTE TEDAVİSİNDEKİ YERİ
Authors: KARAHAN Figen , YEŞİL Esen
Published: December 2023

Obezite; yaşam kalitesini düşüren ve uzun süreli tıbbi müdahale gerektiren yüksek morbidite ve mortalite riskleriyle ilişkili, 21. yüzyılın en önemli toplumsal salgını olup, sıklığı yıldan yıla artan kronik bir hastalıktır. Dünya Sağlık Örgütü verilerine göre; dünya çapında obezite prevalansı 1975-2016 arasında yaklaşık üç katına çıkmıştır. Obezitenin tıbbi beslenme tedavisinin amacı, kişiye özgü enerji kısıtlaması içeren uygun beslenme programları oluşturmaktır. Ancak günlük kalori kısıtlama diyetlerinde enerji gereksinimi her gün kısıtlandığı için diyete bağlılık düşüktür. Geleneksel günlük enerji kısıtlama modeline bir alternatif olarak aralıklı oruç, insanlar tarafından büyük ilgi görmüştür. Aralıklı oruç; yemek yeme dönemleriyle birlikte dönüşümlü olarak yemek yememe (oruç) dönemlerini de kapsayan benzersiz bir diyet stratejisini oluşturmaktadır. Aralıklı oruç modelleri; alternatif gün orucu, düzenlenmiş aralıklı oruç (5:2 yöntemi) ve zaman kısıtlı aralıklı oruç yöntemi olmak üzere 3 ana başlıkta sınıflanmaktadır. Yapılan birçok çalışmada, aralıklı orucun klasik kalori kısıtlama diyetleriyle benzer oranda ağırlık kaybı sağladığı bulunmuştur. Bu derlemede aralıklı orucun obezitenin tıbbi beslenme tedavisinde etkin olup olmadığını tartışmak amaçlanmıştır.
Pengaruh Kombinasi Media Tanam dan Umur Pindah Bibit terhadap Pertumbuhan Bibit Bud Chip Tanaman Tebu (Saccharum officinarum L.) Varietas PS 862
Authors: Airivia Tyary , Suryanto Agus
Published: December 2023

Tanaman tebu (Saccharum officinarum L.) termasuk tanaman famili graminae atau rumput-rumputan. Peningkatan produksi bibit dilakukan melalui penggunaan bibit bud chip yang mudah. Pemindahan bibit dengan umur tanam serta pemberian media tanam yang sesuai mampu membantu meningkatkan pertumbuhan tanaman tebu saat fase vegetatif. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh umur pindah bibit dan media tanam terhadap pertumbuhan bibit bud chip tanaman tebu. Penelitian dilaksanakan pada bulan Februari hingga Juni 2023 di Kebun Percobaan Jatimulyo yang terletak di Kelurahan Jatimulyo, Kecamatan Lowokwaru, Kota Malang, Jawa Timur. Penelitian ini menggunakan metode Rancangan Acak Kelompok (RAK) Kombinasi menggunakan 9 kombinasi yang diulang 3 kali dengan perlakuan umur pindah tanam 14 HST, 21 HST, dan 28 HST yang dikombinasikan dengan media tanam tanah, tanah + pupuk kandang, dan tanah + blotong. Hasil penelitian menunjukkan bahwa perlakuan media tanam tanah - blotong pada berbagai umur bibit menghasilkan pertumbuhan panjang tanaman, diameter batang, dan jumlah anakan per rumpun yang lebih baik pada 30 HST saja. Pada pengamatan 90 HST, kombinasi media tanam tanah - blotong dengan berbagai umur bibit mempunyai luas daun dan jumlah daun yang relatif sama. Umur bibit bud chip pada 14 HST - 28 HST kombinasi media tanam memiliki hasil bobot kering relatif sama, kecuali pada umur bibi 14 HST dan 28 HST kombinasi media tanam tanah dan 21 HST dengan kombinasi media tanam tanah - blotong memiliki nilai bobot kering yang lebih rendah.
Green Marble 2023. Estudos sobre o Antropoceno e Ecocrítica / Studies on the Anthropocene and Ecocriticism
Authors: Mendes João , Leão Isabel Ponce de , Mendes Maria do Carmo Pinheiro e Silva Cardoso , Mendes Rui Paes
Published: December 2023

Compilação de comunicações científicas selecionadas do Green Marble 2023-Encontro Internacional de Estudos do Antropoceno e Ecocrítica, realizado entre 1 e 3 de julho no Mosteiro de Ancede-Centro Cultural em Baião, onde foi explorado o papel do Ecoturismo e das Ecoviagens na construção de um Bom Antropoceno.
Sustainable value chain of dry hard corn within the analysis of food sovereignty
Authors: Vergara-Romero Arnaldo , Analuisa Aroca Iván , Alcácer Santos Cesar
Published: December 2023

This book presents four essays starting from searching key pieces to deepen and analyse the structure and actors involved in the interaction of models and supply chains. Estimating a documentary and numerical review for decision-makers, and estimating economic relations at the national level and the foreign sector. Thereafter, strengthening the right to food sovereignty as a prevailing factor or mainstay for people. The first chapter analyzes a knowledge gap to expand the cognition of agriculture value chains through bibliometric analysis, in which the review of multiple scientific works investigative, and methodological development is evaluated. A point to consider in the research is that local governments develop agricultural policies with regulations based on socioeconomic results, management systems improvement and food sovereignty promotion. The second chapter deepens the analysis of the current structures from the value chains in Ecuadorian territory, regarding dry hard corn and its relationship with the actors that guide the various models in the food supply chain. It incorporates decision-makers for evaluating economic systems under the Food Sovereignty approach in synergy with the social and ecological process. The third chapter critically reviews the information in documents and national statistics in high-impact databases, as well as specialized institutions at the international and national levels. It describes the agricultural raw material markets performance, especially the Corn Value Chain in Ecuador under the Food Sovereignty approach. The fourth chapter estimates possible imports of products, such as fertilizer, oil derivates, agricultural chemicals, telephone, and communication equipment; related to agriculture for a defined short-term objective committed in guaranteeing food Sovereignty in Ecuador. It will be analyzed using homogeneous time series models with adjustments for partial periods such as AR, MA and ARMA.
Desarrollo Sostenible y Responsabilidad Social: Análisis de Diferentes Sectores en Ecuador
Authors: Vergara-Romero Arnaldo
Published: December 2023

Los Objetivos de Desarrollo Sostenible ha impulsado de forma significativa la tendencia de la Responsabilidad Social Empresarial en el mundo, mediante iniciativas coherentes con prioridades ambientales, sociales y en algunos casos de gobierno. Ecuador no se escapa de tomar estas iniciativas, reflexionar en todas las etapas de producción y los diversos sectores económicos. El libro presenta capítulos que abordan un sector diferente, donde se puede visualizar como estas iniciativas presentan una gama de influencias sociales, externas e internas que se relacionan con la naturaleza y las comunidades. El primer capítulo valora como se encuentra la estrategia de Responsabilidad Social Empresarial (RSE) del sector alimentario de Guayaquil en función del Objetivo de Desarrollo Sostenible 2: Hambre cero. Donde se plantea una idea a defender que, una correcta estrategia de responsabilidad social empresarial está estrechamente ligada a la mejora de la valoración de la empresa y al desarrollo sostenible y sus objetivos. El segundo capítulo busca establecer la relación del teletrabajo y la responsabilidad social empresarial, y su impacto en el desarrollo sostenible de la empresa. Donde se parte de la premisa que, el teletrabajo y la responsabilidad social son mecanismos necesarios para el desarrollo sostenible de la empresa, mediante la aplicación de normas que le permita encontrar el balance entre propósito y ganancia. El tercer capítulo analiza la aplicación del Modelo SCOR en la cadena de abastecimiento de una empresa del sector acuícola, cuya idea a defender es que, El modelo SCOR se ajusta a la realidad de la cadena de abastecimiento de la empresa del sector acuícola y contribuye a mejorarla. El cuarto capítulo analiza el impacto de la RSE en los rendimientos económicos y la acumulación de activos reportados en los estados financieros de los organismos de control societario en Ecuador.
Variables sociodemográficas y niveles de educación financiera en jóvenes universitarios de Ecuador
Authors: Peñarreta-Quezada Miguel-Ángel , Salas-Tenesaca Eulalia-Elizabeth , Álvarez-García José , de la Cruz del Río-Rama María
Published: December 2023

Este estudio investiga la relación entre variables sociodemográficas y el nivel de educación financiera en jóvenes universitarios de Ecuador. Utilizando datos de 1.011 encuestas y el contraste no paramétrico, se analiza cómo la edad, el género, el estatus laboral y el campo de formación se relacionan con el conocimiento, comportamiento y la actitud financiera de los estudiantes universitarios. Los resultados revelan que la mayoría de los estudiantes en Ecuador poseen un nivel medio de educación financiera, lo que implica habilidades para aplicar conceptos financieros básicos en situaciones cotidianas, pero con limitaciones en escenarios más complejos. Además, se encontró que la edad, el campo de formación y el estatus laboral influyen significativamente en las dimensiones de la educación financiera. Este estudio pionero en el contexto ecuatoriano subraya la importancia de considerar factores sociodemográficos al diseñar estrategias de educación financiera dirigidas a jóvenes universitarios, con el objetivo de fortalecer la educación financiera de esta población.
Prácticas de manejo sostenible para fertilización y riego de aguacate Hass en el departamento del Cauca
Authors: Burbano Diaz Ronal Arturo , Rodríguez León Adriana Katherine , Grajales Guzmán Luis Carlos , Rebolledo Roa Alexander
Published: December 2023

Este manual contiene información de referencia sobre aspectos generales del cultivo de aguacate y sobre prácticas de manejo agronómico que se basan en el diagnóstico de las limitantes del cultivo y la descripción de tecnologías disponibles de fertilización y riego. En particular, se enfatiza en la necesidad de conocer el estado nutricional del suelo y de la planta, las condiciones fisicoquímicas del suelo y los parámetros climáticos predominantes de cada zona productora, los cuales pueden afectar los requerimientos hídricos y nutricionales del cultivo. Con este propósito, se documentan estudios de caso enfocados en pequeños y medianos productores para facilitar los procesos de adopción tecnológica y avanzar en el cambio técnico que contribuya a la disminución de la brecha tecnológica identificada para el cultivo de aguacate Hass en el departamento del Cauca. El manual contiene criterios y recomendaciones técnicas para el manejo tecnificado del cultivo de aguacate Hass, presentadas y esquematizadas de manera sencilla y en un lenguaje accesible.
Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study
Authors: Zeng Chengbo , Zhang Jiajia , Li Zhenlong , Sun Xiaowen , Ning Huan , Yang Xueying , Weissman Sharon , Olatosi Bankole , Li Xiaoming
Published: December 2023

Background

COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation.

Objective

We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation.

Methods

An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model.

Results

As of October 19, 2022, among the 418 counties, the median of booster uptake was 40% (IQR 37.8%-43%). Compared with older adults (ie, at least 65 years; median 63.1%, IQR 59.5%-66.5%), youth (ie, 12 to 17 years; median 14.1%, IQR 11.3%-17.4%) and adults (ie, 18 to 64 years; median 33.4%, IQR 30.5%-36.5%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups.

Conclusions

The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities.
Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019
Authors: Jiang Bo , Wu Tianhong , Liu Weiming , Liu Gaoqin , Lu Peirong
Published: December 2023

Background

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking.

Objective

This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years.

Methods

Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034.

Results

Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of –0.37 (95% CI –0.44 to –0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease.

Conclusions

While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.
Introducing a Regulatory Sandbox Into the Indonesian Health System Using e-Malaria as a Use Case: Participatory Action Study
Authors: Fuad Anis , Tiara Agi , Kusumasari Rizqiani Amalia , Rimawati Rimawati , Murhandarwati E Elsa Herdiana
Published: December 2023

Background

Regulatory sandboxes offer an alternative solution to address regulatory challenges in adopting disruptive technologies. Although regulatory sandboxes have been widely implemented in the financial sector across more than 50 countries, their application to the health sector remains limited.

Objective

This study aims to explore stakeholders’ perspectives on introducing a regulatory sandbox into the Indonesian health system using e-malaria as a use case.

Methods

Using a participatory action research approach, this study conducted qualitative research, including desk reviews, focus group discussions, and in-depth interviews with stakeholders. This study sought to understand stakeholders’ concerns and interests regarding the regulatory sandbox and to collaboratively develop a regulatory sandbox model to support the malaria program.

Results

The study revealed that most stakeholders had limited awareness of the regulatory sandbox concept. Concerns have been raised regarding the time required to establish regulations, knowledge gaps among stakeholders, data protection issues, and limited digital infrastructure in malaria endemic areas. Existing regulations have been found to be inadequate to accommodate disruptive healthtech for malaria. Nevertheless, through a collaborative process, stakeholders successfully developed a regulatory sandbox model specifically for e-malaria, with the crucial support of the Ministry of Health.

Conclusions

The regulatory sandbox holds the potential for adoption in the Indonesian health system to address the limited legal framework and to facilitate the rapid and safe adoption of disruptive healthtech in support of the malaria elimination program. Through stakeholder involvement, guidelines for implementing the regulatory sandbox were developed and innovators were successfully invited to participate in the first-ever trial of a health regulatory sandbox for e-malaria in Indonesia. Future studies should provide further insights into the challenges encountered during the e-malaria regulatory sandbox pilot study, offering a detailed account of the implementation process.
Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study
Authors: Li Catherine Yan Hei , Platkin Charles , Chin Jonathan , Khan Asia , Bennett Jaleel , Speck Anna , Nielsen Annette , Leung May May
Published: December 2023

Background

Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP.

Objective

The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students.

Methods

College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test.

Results

A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively).

Conclusions

Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses.
Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study (Preprint)
Authors: Alkuran Oqba , Al-Mehaisen Lama , Abu Mahfouz Ismaiel , Al-Kuran Lena , Asali Fida , Khamees Almu’atasim , AL-Shatanawi Tariq , Jaber Hatim
Published: December 2023

BACKGROUND

Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions.

OBJECTIVE

This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan.

METHODS

We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL.

RESULTS

A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice.

CONCLUSIONS

DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction.
Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study (Preprint)
Authors: Zeng Chengbo , Zhang Jiajia , Li Zhenlong , Sun Xiaowen , Ning Huan , Yang Xueying , Weissman Sharon , Olatosi Bankole , Li Xiaoming
Published: December 2023

BACKGROUND

COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation.

OBJECTIVE

We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation.

METHODS

An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model.

RESULTS

As of October 19, 2022, among the 418 counties, the median of booster uptake was 40% (IQR 37.8%-43%). Compared with older adults (ie, at least 65 years; median 63.1%, IQR 59.5%-66.5%), youth (ie, 12 to 17 years; median 14.1%, IQR 11.3%-17.4%) and adults (ie, 18 to 64 years; median 33.4%, IQR 30.5%-36.5%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups.

CONCLUSIONS

The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities.
Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019 (Preprint)
Authors: Jiang Bo , Wu Tianhong , Liu Weiming , Liu Gaoqin , Lu Peirong
Published: December 2023

BACKGROUND

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking.

OBJECTIVE

This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years.

METHODS

Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034.

RESULTS

Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of –0.37 (95% CI –0.44 to –0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease.

CONCLUSIONS

While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.

CLINICALTRIAL
ChatGPT Versus Consultants: Blinded Evaluation on Answering Otorhinolaryngology Case–Based Questions (Preprint)
Authors: Buhr Christoph Raphael , Smith Harry , Huppertz Tilman , Bahr-Hamm Katharina , Matthias Christoph , Blaikie Andrew , Kelsey Tom , Kuhn Sebastian , Eckrich Jonas
Published: December 2023

BACKGROUND

Large language models (LLMs), such as ChatGPT (Open AI), are increasingly used in medicine and supplement standard search engines as information sources. This leads to more “consultations” of LLMs about personal medical symptoms.

OBJECTIVE

This study aims to evaluate ChatGPT’s performance in answering clinical case–based questions in otorhinolaryngology (ORL) in comparison to ORL consultants’ answers.

METHODS

We used 41 case-based questions from established ORL study books and past German state examinations for doctors. The questions were answered by both ORL consultants and ChatGPT 3. ORL consultants rated all responses, except their own, on medical adequacy, conciseness, coherence, and comprehensibility using a 6-point Likert scale. They also identified (in a blinded setting) if the answer was created by an ORL consultant or ChatGPT. Additionally, the character count was compared. Due to the rapidly evolving pace of technology, a comparison between responses generated by ChatGPT 3 and ChatGPT 4 was included to give an insight into the evolving potential of LLMs.

RESULTS

Ratings in all categories were significantly higher for ORL consultants (P<.001). Although inferior to the scores of the ORL consultants, ChatGPT’s scores were relatively higher in semantic categories (conciseness, coherence, and comprehensibility) compared to medical adequacy. ORL consultants identified ChatGPT as the source correctly in 98.4% (121/123) of cases. ChatGPT’s answers had a significantly higher character count compared to ORL consultants (P<.001). Comparison between responses generated by ChatGPT 3 and ChatGPT 4 showed a slight improvement in medical accuracy as well as a better coherence of the answers provided. Contrarily, neither the conciseness (P=.06) nor the comprehensibility (P=.08) improved significantly despite the significant increase in the mean amount of characters by 52.5% (n= (1470-964)/964; P<.001).

CONCLUSIONS

While ChatGPT provided longer answers to medical problems, medical adequacy and conciseness were significantly lower compared to ORL consultants’ answers. LLMs have potential as augmentative tools for medical care, but their “consultation” for medical problems carries a high risk of misinformation as their high semantic quality may mask contextual deficits.
Clinical Study to Measure the Impact of Fortified Malt-Based Food on Immunity Outcomes in School Children in India: Epidemiology, Baseline Characteristics, and Design Science (Use of multi-nutrient supplement in school children) (Preprint)
Authors: Khadilkar Anuradha , Rawat Vinay , Chaturvedi Devyani , Bhatt Jaladhi , Garg Vivek , Verma Pankaj , Pareek Manoj
Published: December 2023

BACKGROUND

Nutritional inadequacy and consequent diminished immunity among school age children is a public health problem in India.

OBJECTIVE

We tested the hypothesis that daily administration of a fortified malt-based food (FMBF), a multi-nutrient supplement, would improve immunity outcomes against common infectious diseases, nutritional status (biochemical, anthropometric, and dietary) and gut health in Indian school-age children.

METHODS

This report presents the study design attributes and the baseline characteristics of the study population. This was an open-label, two-arm, parallel-group, matched-pair cluster randomized controlled trial (RCT), stratified by gender, in children aged ≥7 to ≤10 years old with height-for-age Z-scores (HAZ) of ≥-3 to ≤-1 and good general health. Four schools located in Pune city in India participated in the study. Each school was deemed as a cluster and was randomized to test group (FMBF + dietary counselling) or control group (dietary counselling alone).

RESULTS

A total of 924 participants from the 4 randomized schools were enrolled in the study. A very large proportion of children had micronutrient inadequacies in terms of vitamin D (97.51%), folate (79.18%), zinc (66.05%), and vitamin A (34.27%) at baseline. Cluster RCT design was effectively used in this nutritional intervention trial with high compliance (97%) and overall high retention (98%).

CONCLUSIONS

The findings highlight the extent of nutritional inadequacies in Indian school-age children, reaffirming the need for nutritional strategies to optimize the nutritional status among these children.

CLINICALTRIAL

Clinicaltrial.gov: NCT02542865
Correction: Three Contactless Sleep Technologies Compared With Actigraphy and Polysomnography in a Heterogeneous Group of Older Men and Women in a Model of Mild Sleep Disturbance: Sleep Laboratory Study (Preprint)
Authors: G Ravindran Kiran K , della Monica Ciro , Atzori Giuseppe , Lambert Damion , Hassanin Hana , Revell Victoria , Dijk Derk-Jan
Published: December 2023

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The Impact of Mobile Health Technology Interventions on Physiological State, Self-Efficacy, and Quality of Life in Patients with Chronic Diseases: A Systematic Review and Meta-Analysis (Preprint)
Authors: Tsai Tsai-Hsuan
Published: December 2023

BACKGROUND

This study furnishes a theoretical framework designed to systematize the existing body of research, revealing that the sustained integration of mHealth technology across a duration exceeding three months correlates with considerable enhancements in the physiological condition of patients afflicted by chronic diseases.

OBJECTIVE

The objective of this study is to examine the effectiveness of mobile health technology in enhancing the physiological state of patients with chronic diseases, including conditions such as blood pressure, blood sugar, blood lipids, and obesity. Furthermore, it aims to explore the influence of artificial intelligence on self-efficacy, self-care behaviors, and their subsequent impact on quality of life and treatment adherence.

METHODS

A systematic search was conducted on various databases, including PubMed, Science Direct, Scopus, Web of Science, and IEEE Xplore, up until 20th October 2022, with a search date of 21st October 2022. The search focused on identifying meta-analyses of randomized controlled trials that compared the effects of mobile health technology interventions on self-efficacy, quality of life, behavioral motivation, weight, body fat, blood pressure, and HbA1c in patients with chronic diseases. The experimental group (EG) received health technology interventions, while the control group (CG) received routine interventions, including home phone calls. Two independent reviewers screened potential eligible trials, extracted and categorized data using standardized forms, and resolved discrepancies through discussions with a third reviewer.

RESULTS

A total of 930 articles were retrieved through the search strategy, indicating the practicality and benefits of health technology-based interventions for chronic diseases. However, further research is necessary to gain a comprehensive understanding of their potential for long-term management. Due to limitations in the available research, this study focused solely on self-efficacy, quality of life, behavioral motivation, body weight, body fat, blood pressure, and HbA1c. Future investigations should prioritize assessing the impact and compliance of patients with chronic diseases following mobile health technology interventions.

CONCLUSIONS

The evidence obtained from this study suggests that mobile health technology interventions can significantly enhance outcomes for individuals with chronic diseases. The integration of artificial intelligence into mobile health technology has the potential to augment self-efficacy, self-care behaviors, and treatment adherence, ultimately leading to improved patient outcomes.
Increase of adherence, and disease-related functionality in patients with musculoskeletal pain using a supportive digital application („tiNa-start”) with their home-based TENS treatment. An Interim Analysis. (Preprint)
Authors: Gottschling Sven , Scholler Patrik , Hövelmann Rolf , Seißler David , Schefer Quirino , Straub Matthias
Published: December 2023

BACKGROUND

Globally, musculoskeletal diseases are the leading cause of chronic pain, physical impairments, and loss of quality of life. Transcutaneous electrical nerve stimulation (TENS) is used to modulate pain sensation. tiNa-start is a digital treatment support for patients with musculoskeletal pain diagnoses who receive a TENS device to self-administer at home. tiNa-start provides educational content, a therapy phase concept, recommendations and reminders, self-monitoring, mental training and more.

OBJECTIVE

The study was designed to test the hypothesis that the digital support provided by tiNa-start for a TENS therapy results in an increase of treatment adherence accompanied by improved patient functionality leading to a positive health care effect in patients with musculoskeletal pain.

METHODS

The study was a two-arm multi-center, parallel group, randomised, controlled trial with an open-label study design. This interim analysis included a total of 87 patients (37% men, 63% women) aged 45.7 ± 14.3 years undergoing interventional treatment with tiNa-start (N=45) versus a control group (N=42) receiving usual care of treatment. The primary objective of the study was to evaluate the number of adherent treatment days following tiNa-start compared to the control group. Secondary aims included treatment effects on patient reported outcome questionnaires related to the patient´s primary area of disability.

RESULTS

The primary study endpoint patient’s adherence significantly (P=.04) improved following tiNa-start compared with the control group. Changes in patient reported outcome scores were correlated with the degree of patient adherence for all disease related specific instruments, KOOS-ADL, and ODI and NDI. A trend for a clinically relevant improvement on patient functionality between the intervention groups could be observed for KOOS-ADL. All adverse events were observed in the control group and were related to pain in patients with knee injury and neck pain. The Net Promotor Score of the application was +32%.

CONCLUSIONS

Treatment intervention with the tiNA-start showed increased adherence to the prescribed TENS therapy schedule accompanied with improvements of patient functionality scores and a reduction of adverse events. More severely impacted pain patients and higher adherence scores provided better patient clinical outcomes.

CLINICALTRIAL

German registry for clinical trials (DRKS00030387).
Evaluating the effect of note-taking app use by Japanese resident physicians: A nationwide cross-sectional study (Preprint)
Authors: Miyagami Taiju , Nishizaki Yuji , Shimizu Taro , Yamamoto Yu , Shikino Kiyoshi , Kataoka Koshi , Nojima Masanori , Deshpande Gautam. A , Naito Toshio , Tokuda Yasuharu
Published: December 2023

BACKGROUND

Note-taking is a method that has long been used to optimize studying. Recent innovations have seen the introduction of digital note-taking using software applications (“apps”), the effectiveness of which has been verified mainly among students; however, the utilization and efficacy of digital note-taking by physicians in actual clinical practice remain unknown.

OBJECTIVE

This study investigated the characteristics of Japanese resident physicians using digital note-taking apps and evaluated their effectiveness compared to physicians not using this technology.

METHODS

This cross-sectional descriptive study was conducted in conjunction with the GM-ITE, a clinical competency examination for resident physicians. In addition to basic information on resident physicians, the use of an app for note-taking to record case experience was investigated. A multivariate analysis of the background factors among app users and non-users was conducted. Additionally, the total GM-ITE score was used as the objective variable to evaluate its association with app use.

RESULTS

The analyses of this study included 3,862 participants; 1,253 (32.4%) were women, 2,000 (51.8%) were postgraduate year 1 residents, 1,211 (31.4%) were training in an urban area, and 3,261 (84.6%) were in community-based hospitals. App users were more likely to be in their second year of residency, work in community-based hospitals, rotate in general medicine, use online medical resources more frequently, and demonstrate longer self-study times. App users had higher score on the GM-ITE than non-app users (47.1±8.3 vs 45.0±8.0, P-value<0.001).

CONCLUSIONS

To the best of our knowledge, this is the first study to investigate note-taking by physicians using apps. App users may be more motivated and IT literate than non-users. In the future, we would like to conduct more in-depth research on the effectiveness and issues of note-taking using apps based on these results.