bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmentation of freshwater productivity in single slope solar still using Luffa acutangula fibres
Authors: Suraparaju Subbarama Kousik , Natarajan Sendhil Kumar
Published: July 2021

The prime intention of the current research is to enhance the freshwater productivity of the solar still (SS) by using Luffa acutangula fibres (LAF). The dried LA fibres were introduced into the absorber basin of a solar still to enhance the wet surface area through its porous structure that leads to augmented evaporation of water from the absorber basin. The effect of the number of LAF in the absorber basin such as 10,13,14,15,16,20 and 25 on freshwater productivity was estimated. The results revealed that SSLAF with 15 fibres in the absorber basin increased the yield by 25.23%. Besides, a solar still with 10,13,14,16,20 and 25 fibres in the absorber basin increased the yield by 12.27%, 17.45%, 22.04%, 22.69%, 14.64% and 4.09% respectively when compared to conventional solar still (CSS). The average thermal efficiency of the SSLAF with 15 LAF was increased by 28.35% whereas, for 10,13,14,16,20 and 25 LAF, the average thermal efficiency was increasedby 11.05%, 16.99%, 22.53%, 19.93%, 11.29% and 3.9% respectively when compared to CSS.The economic analysis resulted that the cost per litre freshwater yield from the SSLAF is 22.5% lower than CSS. Also, the payback period of SSLAF is comparatively lesser than that of CSS.
DUXAP8: A Promising lncRNA with Carcinogenic Potential in
Cancer
Authors: Zhou Gang , Yuan Chengfu , Wang Bei , Xu Wen , Cai Yuxuan , Chen Jinlan , Guo Chong
Published: July 2021

Background:

Long non-coding RNAs (lncRNA) have influenced numerous
biology processes, which has provoked great interest. Not only that, LncRNA DUXAP8
mediates tumorigenesis by affecting the activity of miRNAs, signaling pathways, and oncogene.

Methods:

The functions of DUXAP8 have been summarized by reading relevant articles
on PubMed.

Results:

lncRNA DUXAP8 acts as an oncogene in most tumors. The abnormal overexpression
is associated with the proliferation, invasion, migration, and anti-autophagy of
tumors. DUXAP8 exerts promotion on Akt / mTOR signaling pathway, facilitating the
occurrence of tumors. Furthermore, DUXAP8 affects the activity of miRNAs and proteins,
showing its significant potential as a therapeutic target in human cancers.

Conclusion:

LncRNA DUXAP8 has been identified as an indispensable therapeutic target
of the tumors, providing clinical treatment plans.
Neutrophil-to-lymphocyte Ratio Predicts the Outcome of Cerebral Venous Thrombosis
Authors: Zhao Jiawei , Liu Kai , Li Shen , Gao Yuan , Zhao Lu , Liu Hongbing , Fang Hui , Song Bo , Xu Yuming
Published: July 2021

Background:

Increasing evidences suggest that Neutrophil-to-Lymphocyte Ratio (NLR)
is an independent predictor of poor prognosis in patients with cardiovascular disease. However, the
relationship between NLR and prognosis in patients with Cerebral Venous Thrombosis (CVT) has
not been studied.

Methods:

Consecutive CVT patients from November 2011 through April 2019 were retrospectively
identified. Poor outcome was defined as a modified Rankin Scale (mRS) of 3-6. Multivariate regression
analysis was conducted to assess the relationship between total and differential leukocyte
counts, NLR and clinical outcome in CVT patients. The Receiver Operating Characteristic (ROC)
analysis was further performed to evaluate the ability to predict mortality, and subgroup analysis
was conducted to explore the potential interaction effects.

Results:

A total of 360 CVT patients were included, and the median duration of follow-up was 9.0
months. Multivariate logistic regression analysis suggested that NLR value, as a continuous variable,
was significantly associated with a high risk of poor outcome (adjusted odds ratio [OR]=1.06,
95% confidence intervals [CI] 1.01-1.11, P = 0.013) and mortality (adjusted OR = 1.08; 95% CI,
1.03-1.14; P = 0.002). Compared with the total and differential leukocyte counts, the best discriminating
variable to predict the risk of mortality was NLR, and the area under the receiver operating
curve was 0.81. The optimal cut-off value of NLR to predict mortality was 5.6 (sensitivity 84.2%,
specificity 69.9%). Multivariate Cox regression analysis indicated that the mortality rate was significantly
higher in patients with a high NLR level group (>5.6) (adjust hazard ratio=5.65, 95% CI
2.33-12.73, P<0.001). There was no potential heterogeneity in the further subgroup analysis across
age (above vs. below 45 years old), sex, history of infections and pregnancy/postpartum, presence
of coma and intracerebral hemorrhage.

Conclusion:

Elevated NLR value is associated with a high risk of poor outcomes in CVT patients.
Cloning, Expression and Biochemical Characterization of the Recombinant
α-amylase from Bacillus subtilis YX48
Authors: Shang Junjie , Wei Yunlin , Shan Yan , Zhang Dongfang , Cui Yinshan , Wang Yi , Zhu Jie , Ma Yongkai , Song Pengfei , Qin Kunhao , Ji Xiuling , Wu Lijun
Published: July 2021

Background:

Amylase used in the market is mostly medium-temperature enzyme or
high-temperature enzyme and has poor enzyme activity under low-temperature environment. Acid
α-amylase can be used to develop digestion additives in the pharmaceutical and healthcare industries.
The amino acid sequence and structural differences among α-amylases obtained from various
organisms are high enough to confer interesting biochemical diversity to the enzymes. However,
low- temperature (0-50°C) amylase, with an optimum temperature and heat sensitivity, has a
greater potential value than medium (50-80°C) and high (80-110°C) temperature amylases.

Methodology:

The gene amy48 from encoding extracellular α-amylase in Bacillus subtilis YX48
was successfully cloned into the pET30a (+) vector and expressed in Escherichia coli BL21 (DE3)
for biochemical characterization.

Results and Conclusion:

The molecular weight of α-amylase was 75 kDa. The activity of α-amylase
was not affected by Ca2+, and Amy48 had the best activity at pH 5.0 and 37°C. AMY48 has
high stability over a narrow pH and temperature range (5.0-8.0 and 30-45°C). Amylase activity
was strongly inhibited by Zn2+, Mn2+, Cu2+, and Fe2+ ions, but Na+, K+, and Co2+ ions stimulate its activity
slightly. The purified enzyme showed gradually reduced activity in the presence of detergents.
However, it was remarkably stable against EDTA and urea.
A Systematic Review and Meta-Analysis of the Safety of Hydroxychloroquine
in a Randomized Controlled Trial and Observational Studies
Authors: Bose Debdipta , Konwar Mahanjit , Maurya Miteshkumar , Thatte Urmila M. , Gogtay Nithya J.
Published: July 2021

Introduction:

Hydroxychloroquine (HCQ) has recently become the focus of attention in the
current COVID-19 pandemic. With an increase in the off-label use of HCQ, concern for the safety of
HCQ has been raised. We, therefore, performed this systematic review to analyze the safety data of
HCQ against placebo and active treatment in various disease conditions.

Methods:

We searched PubMed, Embase, and Cochrane for Randomized Controlled Trials (RCTs)
and Observational Studies (OSs) that evaluated HCQ for the treatment of any disease other than
COVID19 in adult patients up to May 2020. We assessed the quality of the included studies using
Risk of Bias 2 (for RCTs) and Newcastle–Ottawa Scale (for OSs). Data were analyzed with randomeffect
meta-analysis. Sensitivity and subgroup analyses were performed to identify heterogeneity.

Results:

A total of 6641 studies were screened, and 49 studies (40 RCTs and 9 OSs) with a total sample
size of 35044 patients were included. The use of HCQ was associated with higher risks of TDAEs
as compared to placebo/no active treatment [RR 1.47, 95%CI 1.03-2.08]. When HCQ was compared
with active treatments, the risks of AEs [RR 0.74, 95% CI 0.63-0.86] and TDAEs were less in the
HCQ arm [RR 0.57, 95% CI 0.39-0.81]. The outcomes did not differ in the sensitivity analysis.

Conclusion:

The results suggest that the use of HCQ was associated with a lower risk of AEs and
TDAEs as compared to active treatment, whereas posing higher risk of TDAEs as compared to placebo.
Effect of Crude Leaves Extract of Bersama abyssinica on Blood Glucose
Level and Serum Lipid Level of Streptozotocin-Induced Diabetic Mice:
Evidence for in vivo Antidiabetic Activity
Authors: Kifle Zemene Demelash , Alehegn Agumas Alemu , Adugna Baye Yrga , Mekuria Abebe Basazn , Enyew Engidaw Fentahun
Published: July 2021

Background:

Diabetes mellitus is one of the major and common metabolic and chronic
disorders in the world. Several medicinal plants have been used globally for the management of diabetes
mellitus. The current study aimed to study the antihyperglycemic and antihyperlipidemic effects
of Bersama abyssinica.

Methods:

Antidiabetic effect of 80% methanolic crude extract of Bersama abyssinica was studied
in a repeated dose-treated STZ-induced diabetic mice model. The activities of Bersama abyssinica
on serum lipid level and body weight were investigated on STZ-induced diabetic mice. Data were
analyzed using one-way ANOVA and were significant when the p-value was less than 0.05.

Results:

All doses of the crude 80% methanolic extract of Bersama abyssinica (100 mg/kg, 200
mg/kg, and 400 mg/kg) exhibited a noticeable BGL reduction when compared with baseline blood
glucose level and diabetic control on the 7th and 14th days of administration. Moreover, higher dose
of the extract (at 400 mg/kg) significantly (p < 0.001, 54.3%) decreased the BGL in STZ-induced
diabetic mice. The maximum decrement in fasting BGL was achieved at the 14th days: 34.92%,
41.10%, 54.30%, and 59.66%, respectively for BAC 100 mg/kg, BAC 200 mg/kg, BAC 400
mg/kg, and GLC 5 mg/kg treated groups. Bersama abyssinica also displayed a significant (p <
0.05) improvement of serum lipid levels and body weight.

Conclusion:

Bersama abyssinica crude extract exhibited a significant antidiabetic effect and prevented
body weight loss in streptozotocin-induced diabetic mice. The finding also confirmed the
valuable biochemical activity of Bersama abyssinica by improving serum lipid levels.
APPLICATION OF MACHINE LEARNING IN ANALYSING HISTORICAL AND NON-HISTORICAL CHARACTERISTICS OF HERITAGE PRE-WAR SHOPHOUSES
Authors: Ja'afar Nur Shahirah , Mohamad Junainah
Published: July 2021

Real estate is complex and its value is influenced by many characteristics. However, the current practice in Malaysia shows that historical characteristics have not been given primary consideration in determining the value of heritage properties. Thus, the accuracy of the values produced is questionable. This paper aims to determine whether the historical characteristics of the pre-war shophouses at North-East Penang Island, Malaysia contribute any significance to their value. Several Machine Learning algorithms have been developed for this purpose namely Random Forest, Decision Tree, Lasso Regression, Ridge Regression and Linear Regression. The result shows that the Random Forest Regressor with historical characteristics is the best fitting model with higher values of R-squared (R²) and lowest value of Root Mean Square Error (RMSE). This indicates that the historical characteristics of the heritage property under study contribute to its significant value. By considering the historical characteristics, the property’s value can be better predicted.
ATTACHMENT AND FACTORS OF INVOLVEMENT AMONG YOUTH TO PADDY FIELD ACTIVITIES IN HOMESTAY PROGRAMMES
Authors: Samsudin Puteri Yuliana , Maliki Nor Zarifah , Rahman Suraiyati , Wan Omar Wan Rabiah
Published: July 2021

The homestay programme is a community-based tourism that offers tourists to experience the local lifestyle and heritage culture. Many studies focused on challenges of homestay programme, place attachment of hosts, contribution of homestay programme to rural economy. However, very few studies have focused on youths’ involvement in homestay activities. This paper aims to examine the youth’s involvement in homestay activities. A focus group discussion was conducted among the youth aged 20 - 34 years old. A non-probability sampling, that is, purposive sampling was employed. Multiple case studies in Homestay Kampung Jeruju, Homestay Kampung D’Belimbing and Homestay Kampung were selected to determine the differences between the locality factors. These findings indicate that youth's involvement in paddy field activities is based on social, physical, and economic factors. Thus, to attract youth to be involved in paddy field activities, it is recommended for the tourism players to pay attention to these three factors.
TREE CROWN MAPPING BASED ON UNMANNED AERIAL VEHICLE (UAV) TOWARDS A GREEN-SUSTAINABLE RESIDENTIAL
Authors: Abdullah Suzanah , Abdul Rashid Mohd Fadzil , Tahar Khairul Nizam , Osoman Muhammad Ariffin
Published: July 2021

Tree crown plays a crucial role in creating urban characters and spatial arrangements of living environment towards a green-sustainable city. It provides the fundamental needs for human’s living quality and health conditions such as improving water quality, preserving energy, minimising greenhouse gasses, and beautification and comfortable purposes. Therefore, there is a need for urban planners to recognise its importance and plan for it wisely. This paper attempts to demonstrate a mapping tree crowns for a case of the residential neighbourhood using Unmanned Aerial Vehicle (UAV) based GIS technologies. Four main stages involved in a mapping tree crown process namely: flight planning, data acquisition, data processing and analyses and results. As a result, this paper able to show the capabilities of the technologies in measuring and mapping tree crowns for the residential neighbourhood. Moreover, it provides urban planners with informative scenario of the tree planting and clarifies its importance for future planning and benefits – in creating and promoting a green-sustainable and healthy living environment.
THE SIGNIFICANCE OF NATURAL AND SERENE ENVIRONMENT TO IMPROVE THE QUALITY OF LIVING IN TINY HOMES
Authors: Zainal Murni , Abdul Aziz Azhan
Published: July 2021

Tiny homes are defined as a small dwelling in the form of a moveable unit, cabin or detached house which is sized to meet its occupants’ needs. Besides affordability, sustainability and minimalist lifestyle, the occupants’ demand for a cosy environment with a window or porch overlooking a garden. The objectives of the study are to investigate the benefits of utilising nature and serenity in promoting a supportive environment to achieve user well-being. Quantitative methodology was applied in this study using three case studies (CS1 at Urban area: Prototype Model of Microhouse, CS2 at Sub urban area: The Cabin Boutique Resort and SC3 at Outskirts area: Meraki Tiny House). The tool, ``Perceived Sensory Dimensions “(PSDs)” was used for respondents to evaluate the surrounding environment of the case studies by showing photos of two sensory dimension models (PSDs Nature and Serene). Close-ended questionnaires were distributed to the 21 respondents from the millennials group, to rate each perception for each case study. The results have shown that a natural and serene environment for CS3 is most preferred because of the aspirational quality of its PSDs, followed by CS2 and CS1.
STRESSED ADULT’S PREFERENCES FOR OUTDOOR RECREATIONAL ACTIVITY IN URBAN PARKS
Authors: Mohd Shobri Nor Izana , Abdul Rahman Norhafizah , Md Saman Nor Hisham
Published: July 2021

Albeit the importance of the urban parks to serve as physical, physiological, and health relief platforms, little attention has been paid to the study of the adult’s preferences of outdoor recreational activity that is based on the human stress level. Therefore, the aim of this paper is to unveil the preference for outdoor recreational activity according to the human stress levels. Accordingly, this paper adopts a quantitative method through a web-based questionnaire survey that rests upon Kuala Lumpur’s urban population as the representative sample. The questionnaire consists of three parts- personal data, the preference of outdoor recreational activity, and a self-reported health status. This paper reveals from a pilot study of 62 respondents only, as the actual questionnaires’ survey and data analysis are still in progress. The data was analysed using factor and descriptive statistics in order to identify the most preferred outdoor recreational activity by a stressed adult. The result showed that the 20 items of outdoor recreational activities load into two dimensions, i.e., passive activity and active activity. The preferred passive activities by the adult who is reporting stress are enjoying the peace, resting and relaxation, enjoying the fresh air, releasing stress, enjoying nature, enjoying the sun and the sound of birds. For active activities, most of the adults who are reporting stress prefer to jog and do brisk walking. Significantly, the study’s findings enlighten the urban park planners - including the landscape architects, to design parks for outdoor recreation that could correspond and accommodate the different levels of stress.
DETERMINING THE FEATURES OF AGE FRIENDLY FOR CITY DEVELOPMENT
Authors: Rashid Kushairi , Mohamed Thuraiya , Azyze Ellah Azyze Siti Noorhawa , Hazim Zulkarnain , Abdul Aziz Azhan , Che Hashim Izrahayu
Published: July 2021

Malaysia is projected to become an aging nation in the year 2035. As a significant fraction of the elderly is anticipated to be residing in urban areas, therefore it is critically important for local and relevant government agencies to prepare the city environment for the increasing aging population. Age-friendly city is a concept emerged to address the urban aged population through various strategies. Although a significant number of studies were conducted on age-friendly cities, nevertheless, city features that are important to achieve the state of an age friendly city environment remain a subject for exploration. Therefore, this study primarily aims to document the development of the age-friendly features in various countries, in understanding common features that underlie its implementation. The research applies the deductive research approach that includes descriptive and content analyses. A total of 60 important features were commonly used across the report. The findings of the study provide significance as a key input for developing embedding age-friendly city development in Malaysia.
EXPLORING THE THEORY PLANNED BEHAVIOUR TO DERIVE THE FACTORS OF HUMAN BEHAVIOUR FOR DOMESTIC WASTE RECYCLING
Authors: Abd Rauf Nurul Rif’ah Afiqah , Yakob Hamizah , Abdullah Yusfida Ayu , Oliver Hoon Leh Ling , Marzukhi Marlyana Azyyati , Raja Othman Raja Norashekin
Published: July 2021

Malaysia is experiencing waste disposal management issues involving the lack of recycling practices among human behaviour, the absence of domestic waste recycling mechanisms, and poor enforcement for recycling activities. Previous studies revealed that households generate domestic waste hence requires changes in domestic waste management. This paper aims to establish the conceptual framework of solid waste recycling practice by employing the Theory of Planned Behaviour (TPB). Content analysis was employed to verify the trends of research in the related topic. From prior related studies, a variety of approaches based on the TPB model were examined. Results demonstrated that many factors influence the household’s behaviour in domestic waste recycling using the TPB model. The outcome of this study was a conceptual framework in determining the factors of human behaviour in domestic waste recycling. The framework can therefore be a mechanism for authority in managing domestic waste.
MOSS AS BIOINDICATORS FOR POLLUTION AT FRASER HILL AND CAMERON HIGHLAND PAHANG MALAYSIA
Authors: Baharuddin Zainul Mukrim , Zuhairi Ainna Hanis
Published: July 2021

Tropical Montane Cloud Forest (TMCF) is one of Earth’s most neglected ecosystems around the globe. More than half of these forests are situated within Southeast Asia. Malaysia is known for its numerous mountains that are exceptionally rich in biodiversity and locally endemic species, but they are also threatened by expanding human activity such as forestry, agriculture, infrastructure, and climate change. The study aims to critically assess the current state of moist TMCF, focusing on their physical and biological potentials as Bio indicators through Bio monitoring at Fraser Hill and Cameron Highland, Pahang, Malaysia. The mix-methods of observation surveys are to identify physical attributes such as light intensity, altitudes, temperature, wind velocity and air humidity. Secondly, laboratory tests are to identify heavy metal contamination absorbed by mosses. Based on the findings collected around the trails, a connection between altitude and microclimate could be found. The study finds that as the altitude increases and the temperature decreases, the vegetation becomes more dwarfed. Secondly, results from the analysis at Abu Suradi trail within Fraser Hill and Brinchang Trail within Cameron Highland have a higher average of aluminium and iron concentration. Mosses were manifested as good key indicators of air pollution with heavy metals to Malaysia highland forest ecosystems. It showed differential accumulation of heavy metals located near sources of pollution. Thus, the moss data confirms the persistence of risk of pollution of highland forest ecosystems in Malaysia, which demands environmental management. Furthermore, decision makers, planners and designers around the region can evaluate and improve their local strategies related to Tropical Montane Cloud Forest (TMCF) conservation and preservation, especially highlands such as Fraser Hill and Cameron Highland.
Prediction Model of Anastomotic Leakage Among Esophageal Cancer Patients After Receiving an Esophagectomy: Machine Learning Approach
Authors: Zhao Ziran , Cheng Xi , Sun Xiao , Ma Shanrui , Feng Hao , Zhao Liang
Published: July 2021

Background

Anastomotic leakage (AL) is one of the severe postoperative adverse events (5%-30%), and it is related to increased medical costs in cancer patients who undergo esophagectomies. Machine learning (ML) methods show good performance at predicting risk for AL. However, AL risk prediction based on ML models among the Chinese population is unavailable.

Objective

This study uses ML techniques to develop and validate a risk prediction model to screen patients with emerging AL risk factors.

Methods

Analyses were performed using medical records from 710 patients who underwent esophagectomies at the National Clinical Research Center for Cancer between January 2010 and May 2015. We randomly split (9:1) the data set into a training data set of 639 patients and a testing data set of 71 patients using a computer algorithm. We assessed multiple classification tools to create a multivariate risk prediction model. Our ML algorithms contained decision tree, random forest, naive Bayes, and logistic regression with least absolute shrinkage and selection operator. The optimal AL prediction model was selected based on model evaluation metrics.

Results

The final risk panel included 36 independent risk features. Of those, 10 features were significantly identified by the logistic model, including aortic calcification (OR 2.77, 95% CI 1.32-5.81), celiac trunk calcification (OR 2.79, 95% CI 1.20-6.48), forced expiratory volume 1% (OR 0.51, 95% CI 0.30-0.89); TLco (OR 0.56, 95% CI 0.27-1.18), peripheral vascular disease (OR 4.97, 95% CI 1.44-17.07), laparoscope (OR 3.92, 95% CI 1.23-12.51), postoperative length of hospital stay (OR 1.17, 95% CI 1.13-1.21), vascular permeability activity (OR 0.46, 95% CI 0.14-1.48), and fat liquefaction of incisions (OR 4.36, 95% CI 1.86-10.21). Logistic regression with least absolute shrinkage and selection operator offered the highest prediction quality with an area under the receiver operator characteristic of 72% in the training data set. The testing model also achieved similar high performance.

Conclusions

Our model offered a prediction of AL with high accuracy, assisting in AL prevention and treatment. A personalized ML prediction model with a purely data-driven selection of features is feasible and effective in predicting AL in patients who underwent esophagectomy.
Understanding Adolescents’ Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study
Authors: Jee Muhammad , Khan Alsa , Nazneen Nazneen
Published: July 2021

Background

Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends.

Objective

The aim of this formative study was to understand adolescents' perception of their own and others’ relationship with personal technology.

Methods

A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future.

Results

"Essential,” “Distractive,” and “Addictive” were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1%; distractive: 105/619, 17%; addictive: 88/619, 14.2% ) and others’ relationship as well (essential: 96/619, 15.6%; distractive: 88/619, 14.3%; addictive: 90/619, 14.5%). Adolescents selected “Provides an escape” more to describe their own relationship with technology. Whereas, they selected “It's just a tool” and “Creates Barrier” more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was “best friend”, 16 to 17-year olds’ top choice was “I don't believe in personal connection with mobile technology,” and 18 to 19-year olds’ top choice was “My personal assistant.”

Conclusions

Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research.
A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study
Authors: Leong Victoria , Raheel Kausar , Sim Jia Yi , Kacker Kriti , Karlaftis Vasilis M , Vassiliu Chrysoula , Kalaivanan Kastoori , Chen S H Annabel , Robbins Trevor W , Sahakian Barbara J , Kourtzi Zoe
Published: July 2021

Background

The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies.

Objective

This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT).

Methods

A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures.

Results

The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication.

Conclusions

These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality—particularly for studies involving high-risk or rare cohorts—and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance.
Stepwise-Hierarchical Pooled Analysis for Synergistic Interpretation of Meta-analyses Involving Randomized and Observational Studies: Methodology Development
Authors: Shin In-Soo , Rim Chai Hong
Published: July 2021

Background

The necessity of including observational studies in meta-analyses has been discussed in the literature, but a synergistic analysis method for combining randomized and observational studies has not been reported. Observational studies differ in validity depending on the degree of the confounders’ influence. Combining interpretations may be challenging, especially if the statistical directions are similar but the magnitude of the pooled results are different between randomized and observational studies (the ”gray zone”).

Objective

To overcome these hindrances, in this study, we aim to introduce a logical method for clinical interpretation of randomized and observational studies.

Methods

We designed a stepwise-hierarchical pooled analysis method to analyze both distribution trends and individual pooled results by dividing the included studies into at least three stages (eg, all studies, balanced studies, and randomized studies).

Results

According to the model, the validity of a hypothesis is mostly based on the pooled results of randomized studies (the highest stage). Ascending patterns in which effect size and statistical significance increase gradually with stage strengthen the validity of the hypothesis; in this case, the effect size of the observational studies is lower than that of the true effect (eg, because of the uncontrolled effect of negative confounders). Descending patterns in which decreasing effect size and statistical significance gradually weaken the validity of the hypothesis suggest that the effect size and statistical significance of the observational studies is larger than the true effect (eg, because of researchers’ bias).

Conclusions

We recommend using the stepwise-hierarchical pooled analysis approach for meta-analyses involving randomized and observational studies.
The Role of Machine Learning in Diagnosing Bipolar Disorder: Scoping Review
Authors: Jan Zainab , AI-Ansari Noor , Mousa Osama , Abd-alrazaq Alaa , Ahmed Arfan , Alam Tanvir , Househ Mowafa
Published: July 2021

Background

Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients. Approximately 60% of patients with BD are treated for depression. However, machine learning provides advanced skills and techniques for better diagnosis of BD.

Objective

This review aims to explore the machine learning algorithms used for the detection and diagnosis of bipolar disorder and its subtypes.

Methods

The study protocol adopted the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We explored 3 databases, namely Google Scholar, ScienceDirect, and PubMed. To enhance the search, we performed backward screening of all the references of the included studies. Based on the predefined selection criteria, 2 levels of screening were performed: title and abstract review, and full review of the articles that met the inclusion criteria. Data extraction was performed independently by all investigators. To synthesize the extracted data, a narrative synthesis approach was followed.

Results

We retrieved 573 potential articles were from the 3 databases. After preprocessing and screening, only 33 articles that met our inclusion criteria were identified. The most commonly used data belonged to the clinical category (19, 58%). We identified different machine learning models used in the selected studies, including classification models (18, 55%), regression models (5, 16%), model-based clustering methods (2, 6%), natural language processing (1, 3%), clustering algorithms (1, 3%), and deep learning–based models (3, 9%). Magnetic resonance imaging data were most commonly used for classifying bipolar patients compared to other groups (11, 34%), whereas microarray expression data sets and genomic data were the least commonly used. The maximum ratio of accuracy was 98%, whereas the minimum accuracy range was 64%.

Conclusions

This scoping review provides an overview of recent studies based on machine learning models used to diagnose patients with BD regardless of their demographics or if they were compared to patients with psychiatric diagnoses. Further research can be conducted to provide clinical decision support in the health industry.
Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study
Authors: Fang Heping , Xian Ruoling , Ma Zhuoying , Lu Mingyue , Hu Yan
Published: July 2021

Background

A web-based survey is a novel method for data capture. Some studies have applied web-based surveys in pediatrics, but few of them have reported data on the differences between web-based and traditional questionnaire surveys.

Objective

The objective of our study was to evaluate the internal consistency of a web-based survey and compare it with a traditional questionnaire survey in pediatrics.

Methods

A convenience sample of caregivers was invited to participate in the survey on feeding patterns and their children’s eating behaviors if their children were aged 2 to 7 years. A web-based survey and a traditional questionnaire survey were carried out between October 2018 and July 2019. A total of 1085 caregivers were involved in this study, and they were divided into the following three groups based on methods and sources: (1) web-based survey from a web source, (2) web-based survey from a hospital source, and (3) traditional questionnaire survey from a hospital source. The data were then compared and analyzed.

Results

A total of 735 caregivers participated in the web-based survey and 350 caregivers participated in the traditional questionnaire survey, and 816 cases were then included in the analyses after data processing. The effective rate of the web-based survey was 70.1% (515/735), and the completeness rate of the traditional questionnaire survey was 86.0% (301/350). There were no significant differences between web-based surveys from different sources. However, demographic characteristics were significantly different between the web-based and traditional questionnaire surveys, mainly in terms of age and caregivers (χ²4=16.509, P=.002 and χ²4=111.464, P<.001, respectively). Caregivers of children aged 2 to 3 years and grandparents were more likely to respond to the web-based survey. Age-specific stratified analysis showed that the score of “monitoring” and the reporting rate of “poor appetite” in children aged 2 to 3 years were significantly higher in the web-based survey compared to the traditional questionnaire survey after adjusting for demographic characteristics.

Conclusions

A web-based survey could be a feasible tool in pediatric studies. However, differences in demographic characteristics and their possible impacts on the results should be considered in the analyses.
User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale (Preprint)
Authors: Hägglund Maria , Scandurra Isabella
Published: July 2021

BACKGROUND

Transparency is increasingly called for in health care, especially, when it comes to patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness.

OBJECTIVE

The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region.

METHODS

A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency.

RESULTS

During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user’s experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Skåne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Skåne, whereas 331 participants had received care in Region Uppsala. Uppsala’s mean SUS score was 80.71 (SD 13.41), compared with Skåne’s mean of 79.37 (SD 13.78).

CONCLUSIONS

The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required.
Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study (Preprint)
Authors: Schnitzer Kristina , Maravić Melissa Culhane , Arntz Diana , Phillips Nathaniel L , Pachas Gladys , Evins A Eden , Fetters Michael
Published: July 2021

BACKGROUND

Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors.

OBJECTIVE

This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention.

METHODS

Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data.

RESULTS

The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention.

CONCLUSIONS

The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/25390
The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial (Preprint)
Authors: Vandormael Alain , Adam Maya , Greuel Merlin , Gates Jennifer , Favaretti Caterina , Hachaturyan Violetta , Bärnighausen Till
Published: July 2021

BACKGROUND

Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience.

OBJECTIVE

The objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention.

METHODS

In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments.

RESULTS

Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors.

CONCLUSIONS

Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises.

CLINICALTRIAL

German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn

INTERNATIONAL REGISTERED REPORT

RR2-10.1186/s13063-020-04942-7
Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study (Preprint)
Authors: Zhang Nasen Jonathan , Rameau Philippe , Julemis Marsophia , Liu Yan , Solomon Jeffrey , Khan Sundas , McGinn Thomas , Richardson Safiya
Published: July 2021

BACKGROUND

Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for the diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy.

OBJECTIVE

We aimed to create an automated process to calculate the Wells score for pulmonary embolism for patients in the ED, which could potentially reduce unnecessary CTPA testing.

METHODS

We designed an automated process using electronic health records data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Wells scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at 2 tertiary care hospitals in New York, over a 2-month period. To validate the automated process, the scores were compared to those derived from a 2-clinician chart review.

RESULTS

A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as “PE likely” by the automated process (126/202, 62%) had a PE prevalence of 15.9%, whereas those classified as “PE unlikely” (76/202, 38%; Wells score >4) had a PE prevalence of 7.9%. With respect to classification of the patient as “PE likely,” the automated process achieved an accuracy of 92.1% when compared with the chart review, with sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 90.5%, 94.4%, and 88.2%, respectively.

CONCLUSIONS

This was a successful development and validation of an automated process using electronic health records data elements, including free-text fields, to classify risk for PE in ED visits.