bluuebunny/crossref_metadata_2025 huggingface dataset:
Formation of Financial Self-Sufficiency for Local Budgets in Ukraine: Problems and Prospects of Increasing the Revenue Base
Authors: KUZNYETSOVA ANZHELA YA. , ZAKHARKINA LIUDMYLA S. , NOVIKOV VOLODYMYR M. , CHUKHNO RUSLANA YU.
Published: December 2020

The guarantee for stable development of the local community's well-being creates conditions to ensure the financial self-sufficiency for local budgets. Today it is urgent to improve the theoretical and practical approaches to forming the local budget revenue to ensure the necessary financial self-sufficiency level for local budgets. Thus, the purpose of this research is to investigate the level of financial self-sufficiency for local budgets in Ukraine in 1998−2019 by analyzing the revenue side of these budgets. The research used methods of economic, systemic, and structural dynamic analysis. The paper compares different approaches to defining the concept of “financial self-sufficiency for local budgets”. It is determined that the community's success depends on the level of its financial self-sufficiency, which is possible only when the community has financial resources fully to implement local budgets in terms of expenditures. Structural and dynamic analysis of the local budget revenue in Ukraine for 1998-2019 is carried out to assess the level of financial self-sufficiency for local budgets in Ukraine as a whole. The study results indicate the state measures correctness in the reforming of the local taxation system in 2010 and budget decentralization in 2015. However, these measures must be fully implemented and systemic. Conclusions: the composition and structure of the revenues of the local budgets are continually changing, due to the constant changes in the tax system of Ukraine and the state’s efforts to solve the problem of generating local budget revenues, not due to the development of local taxation, but via official transfers. In such conditions, the self-sufficiency of local budgets does not receive the appropriate level. Local budgets are formed on the principle of minimum execution. However, the local taxation system development and the significant increase in tax revenues from local taxes since 2015 allow us to make optimistic forecasts for the growth of the financial self-sufficiency level for local budgets in the future.

Keywords: self-sufficiency, community, budget, taxes.
The Negative Impact of COVID-19 on Region Industries: Health Hazards and Its Forecasting
Authors: LETUNOVSKA NATALIIA Ye. , VASILYEVA TETYANA A. , SMIYANOV VLADYSLAV A.
Published: December 2020

The authors of the article consider the COVID-19 pandemic as a factor that has hurt various world economy sectors. Events caused by restrictive actions by governments in quarantine measures to reduce the spread of coronavirus have worsened the financial and economic situation of several businesses on a regional scale. The situation in the world's economy highlights the need for comprehensive research in forecasting and leveling the harmful effects of epidemics of this scale at different levels of the socio-economic sphere of individual regions. The study aims to summarize the material on the spread of the COVID-19 pandemic and measures to combat it in different countries for use in the development of tools to prevent such negative phenomena on the economy of individual regions. The authors did a comparative analysis of the state of the critical parameters of government action to reduce the negative impact of COVID-19 in the countries leading the rate of spread of this virus. This ranking includes Ukraine, which is in the top twenty countries with the highest number of detected cases. The impact on the processing industry as the sector most affected by the pandemic is significant for the domestic economy, as this industry is one of those that form the largest share of the country's GDP. The article also presents the results of the research of business respondents in the manufacturing sector. If some of them did not experience significant changes in their work, most small and medium-sized companies suffered losses and suspended their production or reduced their scale. The main problems were the transportation of workers to production facilities, problems with product sales, and additional costs associated with countering the pandemic. The authors made conclusions on the most appropriate tools to support Ukraine's processing industry to overcome the challenges posed by a global pandemic.

Key words: COVID-19 pandemic, economic health of a region, economic activity, processing industry, forecast of the socio-economic situation.
Further observations on Meloidogyne enterolobii (Nematoda: Meloidogynidae) infecting guava (Psidium guajava) in India
Authors: Ghule Tushar Manohar , Phani Victor , Somvanshi Vishal Singh , Patil Maya , Bhattacharyya Somnath , Khan Matiyar Rahaman
Published: December 2020

Root-knot nematodes (Meloidogyne spp.) infect a large number of crops including guava. We investigated a population of Meloidogyne sp. infecting guava in the Coimbatore region of Tamil Nadu, India for identification and species confirmation. Detailed morphological and morphometric observations based on second-stage juveniles, males, females, and perineal patterns showed resemblance of the isolated population with the original and subsequent descriptions of M. enterolobii. Isozyme analysis of the young egg-laying females displayed the characteristic esterase phenotype pattern similar to that of M. enterolobii. Additionally, the identity of the nematode population was further validated by M. enterolobii specific SCAR marker and ITS rDNA. Recently published reports on the occurrence and morphological descriptions of M. enterolobii from India are largely incongruent with the original and subsequent redescriptions of the species. Here, we present the most comprehensive morphology and morphometrics of an Indian population of M. enterolobii for its authentic identification.
CORDEN dynamics Stimulator for muscular pain syndromes
Authors: Petrushkina Nadezhda , Kolomiec Olga , Bykov Evgenii , Plachy Judit
Published: December 2020

Introduction: Muscle-pain syndrome is one of the leading neurological disease, and may be cause disability for actve populaton. The rehabilitaton of functonal state of musculoskeletal organs and considerable physical or psychological stress can be treat by physiotherapy exercises and various types of manual and hardware methods. To eliminate muscle spasm, the hardware ofoad spinal moton segments using the simulator CORDEN was used, allowing mainly the deep back muscles in a state of hypertonicity relaxaton. Aim: was to study the efectveness of CORDEN simulator as a means of muscle-pain syndrome management due to the acupressure pressure of the patent’s own body weight on the area of transverse processes and facet joints. Results: According to subjects’ psychological testng results before and afer the course of spine correcton, compared with the control characteristcs, signifcantly lower rates of neurotcism were revealed. The results of the mechanical impact of the device on spinal moton segments in combinaton with the relaxaton efect of the currents on the organism are expressed to improve the well-being, relieve pain and reduce mental stress. Conclusion: The conducted research has shown that CORDEN cardio simulator is an efectve rehabilitatve means for muscle-vertebrogenic pain syndrome.
Use of Un-Prescribed Drugs and Traditional Medications among Pregnant Women Attending Primary Health Centres in Kano, Nigeria
Authors: M Gambo I
Published: December 2020

The use and misuse of drugs in Sub Saharan region are of public health concern. Exposures to un-prescribed drugs and traditional medications are frequent and create a great danger in pregnant women. The use of herbal medicines has been on the increase in many developing and industrialized countries. The study examined the use of traditional medications and un-prescribed orthodox medicines for gestational mothers. A descriptive cross-sectional design & inferential statistic were employed for the study and a total sample of one hundred and ninety-six was used. A standardized data collection form was employed based on the World Health Organization criteria and the obtained data were analyzed using SPSS Version 22.The result showed that most of the respondents were between the age of 22- 27 years with the mean age of 24 years and majority of the respondents (63.3%) used both un-prescribed drugs and traditional medicines during pregnancy, while 27.0% used only un-prescribed drugs and 9.7% use only traditional medications. More so, the results revealed that pain killers’ drug were the leading cause for misused. Also, the results demonstrated a significant relationship between respondent’s awareness of harm associated with use of un-prescribed medications and educational status, (P < 0.01). The study concluded a wide spread use of un-prescribed drugs and traditional medications among pregnant women and therefore, recommend the need for health education and massive campaign with community involvement against the wrong practices by both the healthcare practioners and the government.
Effect of Nursing Intervention on Knowledge of Diabetes Mellitus among Pregnant Women Attending Selected General Hospitals in Lagos, Nigeria
Authors: Y Ademuyiwa I.
Published: December 2020

Inadequate knowledge of Diabetes mellitus (DM) in Pregnancy among diabetic pregnant women could lead to poor skill about self-care, failure to seek timely medical attention and failure to follow medical prescriptions, which could lead to complications and sometimes death of mother and/or fetus/baby. This study seeks to assess the effect of nursing intervention on Knowledge of DM among diabetic pregnant women attending two general hospitals in Lagos Island, Lagos State, Nigeria. This study utilizes one group pretest- posttest experimental research design. The purposive sampling technique and total enumeration sampling size method that included seventy-five participants were used for the study. Instrument for data collection consisted of seven demographic data and forty- two (42) test questions. The study was carried out in three sessions: pre-intervention, intervention and the evaluation sessions over a period of six weeks. Paired t test was used to determine significance level between pre and post-intervention knowledge. Ethical approval and consent were obtained from Babcock University Health Research Ethical committee and Lagos State Heath Service Commission respectively. The results revealed that most of the participants were between the ages of 21 and 45 (88%); most of them had tertiary education (70.7%); most of them (57.3%) had family history of DM. Results also revealed that pre-intervention knowledge among diabetic women was poor (0.28) and the post intervention knowledge was good (0.83). Paired t test results (t= 36.20, p = 0.000) revealed a significant difference between pre-intervention and post-intervention knowledge. This shows that nursing intervention was effective.
Advantages of Cooperative Learning: A Systematic Review
Authors: Yuh Loh Stanley
Published: December 2020

Nursing education is responsible for the production of competent nursing staff with the collaborative skills required by the workforce. Nursing recruitment and retention requirements have made nursing education more challenging. Consequently, alternative teaching methods are being explored in nursing education to narrow the gap between workforce requirements and training. This article contains literature review conducted to examine the advantages of cooperative learning. The purpose of this study is to survey the advantages of cooperative learning using articles outlining the advantages of cooperative learning. A literature search with focus on studies published between 2009 and 2018 was undertaken from four electronic databases. Identified articles were pruned with the help of the Prisma (2009) Flow Diagram. Forty-five articles were identified, 15 reviewed and 11 considered eligible for this study. Significant differences were found in favour of cooperative learning, between the various teaching methods in almost all the studies. Additionally, cooperative learning was noted to markedly enhance human development. The studies reviewed concluded that cooperative learning was better than traditional teaching methods like lecture as cooperative learners were noted to display higher achievements and positive social interdependence than their peers from traditional methods. These results are important for both nursing administrators/managers and faculty in planning lessons; hiring and assigning faculty respectively. The implications of this study are that nursing curricula should be designed to incorporate cooperative learning as a means to enhance learning and hiring of nursing faculty should be based on the appropriate display of cooperative learning skills.
GASES DE NITROGÊNIO REATIVO COMO PRECURSORES DO AEROSSOL ATMOSFÉRICO: REAÇÕES DE FORMAÇÃO, PROCESSOS DE CRESCIMENTO E IMPLICAÇÕES AMBIENTAIS
Authors: Rocha Carolina , Cardoso Arnaldo
Published: December 2020

REACTIVE NITROGEN GASES AS PRECURSORS OF ATMOSPHERIC AEROSOL: FORMATION REACTIONS, GROWTH PROCESSES AND ENVIRONMENTAL IMPLICATIONS. The increased emissions of reactive nitrogen gases from anthropogenic sources to the atmosphere has been pointed out as responsible for triggering a series of environmental problems at the local, regional, and global scale. Among the many consequences associated with the excess of reactive nitrogen in the environment is the increase of atmospheric aerosol formation. In this way, the present review article aims to provide an overview of the main aerosol formation reactions from the reactive nitrogen gases, their growth processes, and removal from the atmosphere. The paper also addresses the implications of increasing the atmospheric aerosol load, including effects on the planet’s radiative forcing, cloud formation and precipitation, macronutrient dispersion, visibility and human health. The possible relationship between the long-term exposure to these pollutants and COVID-19 fatality is also discussed. The need for more information related to reactive nitrogen gases and atmospheric aerosols is urgent since they act on fundamental processes on planet Earth and their quantity and composition have been abruptly changed over the last hundred years. Therefore, further investigations on this topic should be stimulated and better integrated in order to guide normative decisions and the delineation of possible solutions.
Trypanothione Metabolism as Drug Target for Trypanosomatids
Authors: Piñeyro María Dolores , Arias Diego , Parodi-Talice Adriana , Guerrero Sergio , Robello Carlos
Published: December 2020

Chagas Disease, African sleeping sickness, and leishmaniasis are neglected diseases caused by pathogenic
trypanosomatid parasites, which have a considerable impact on morbidity and mortality in poor countries.
The available drugs used as treatment have high toxicity, limited access, and can cause parasite drug resistance.
Long-term treatments, added to their high toxicity, result in patients that give up therapy. Trypanosomatids
presents a unique trypanothione based redox system, which is responsible for maintaining the redox balance.
Therefore, inhibition of these essential and exclusive parasite’s metabolic pathways, absent from the
mammalian host, could lead to the development of more efficient and safe drugs. The system contains different
redox cascades, where trypanothione and tryparedoxins play together a central role in transferring reduced
power to different enzymes, such as 2-Cys peroxiredoxins, non-selenium glutathione peroxidases, ascorbate peroxidases,
glutaredoxins and methionine sulfoxide reductases, through NADPH as a source of electrons. There
is sufficient evidence that this complex system is essential for parasite survival and infection. In this review, we
explore what is known in terms of essentiality, kinetic and structural data, and the development of inhibitors of
enzymes from this trypanothione-based redox system. The recent advances and limitations in the development
of lead inhibitory compounds targeting these enzymes have been discussed. The combination of molecular biology,
bioinformatics, genomics, and structural biology is fundamental since the knowledge of unique features
of the trypanothione-dependent system will provide tools for rational drug design in order to develop better
treatments for these diseases.
Design, Synthesis and Biological Evaluation of New Cycloalkyl Fused Quinolines Tethered to Isatin Schiff Bases as Cholinesterase Inhibitors
Authors: Macha Baswaraju , Kulkarni Ravindra , Garige Anil Kumar , Palabindala Rambabu , Akkinepally Raghuramrao , Garlapati Achaiah
Published: December 2020

Aims and Objective:

Alzheimer’s disease is now a most prevalent neurodegenerative
disease of central nervous system leading to dementia in elderly population. Numerous
pathological changes have been associated in the progression of Alzheimer’s disease. One of
such pathological hypotheses is declined cholinergic activity which eventually leads to
cognitive and memory deficits. Inhibition o f cholinesterases will apparently elevate acetyl
choline levels which is benefactor on cognitive symptoms of the disease. This manuscript
describes the new tacrine derivatives tethered to isatin Schiff bases through alkanoyl linker
and screened for cholinesterase inhibitory activity.

Materials and Methods:

Tacrine and two more cycloalkyl ring fused quinolones were synthesized and converted to Ncycloalkyl fused quinoline chloroamides. Isatin Schiff bases were also synthesized by the reaction between isatin and
substituted aromatic anilines and in subsequent reaction, isatin Schiff bases were reacted with cycloalkyl fused quinolones
to afford anticipated compounds 10a-i, 11a-i and 12a-i. All the compounds have been screened for acetyl and butyryl
cholinesterase inhibitory activity and in vivo behavioral studies. Binding interactions of the desired compounds have also
been studied by docking them in active site of both cholinesterases.

Results:

Three compounds 12d, 12e and 12h with propionyl and butyroyl linker between amine and isatin Schiff base
scaffold have shown potent acetyl and butyryl cholinesterase inhibitory activity. However most potent cholinesterase
inhibitor was 13d with IC50 value of 0.71±0.004 and 1.08±0.02 μM against acetyl and butyryl cholinesterases respectively.
The hepatotoxicity of potent compounds revealed that the tested compounds were less hepatotoxic than tacrine and also
exhibited encouraging in vivo behavioral studies in test animals. Docking studies of all the molecules disclosed close
hydrogen bond interactions within the binding site of both cholinesterases.

Conclusion:

New cycloalkyl fused quinolones tethered with alkoyl linker to isatin Schiff bases endowed significant and
potent cholinesterase inhibitory activities. Few of the compounds have also exhibited lesser hepatotoxicity and all the
synthesized compounds were good in behavioral studies. Molecular docking studies also indicated close interactions in
active site of cholinesterases.
A Fusion Method Based on Alignment Software with SNP and Indel
Detection Methods
Authors: Chen Guobing , Tang Chao , Qi Jun , Wang Ying , Shi Xiaolong
Published: December 2020

Background:

With the advent of the second generation sequencing technology, the discovery of sequence
alignment and sequence variation is a long-standing challenge.

Results:

A method based on general alignment software, SNP and Indel software tools was proposed in this paper. By
comparing the advantages of traditional alignment software, we can produce the best alignment. SNP and Indel detection
tools fusion research found that different depth of sequencing effect is different. When the sequence depth reaches a certain
value, select one of the software for testing.

Conclusions:

Finally, the experimental verification shows that SNP and Indel have certain advantages in the comparison of
the effects of the fusion method.
Cell Free DNA as an Evolving Liquid Biopsy Biomarker for Initial Diagnosis and Therapeutic Nursing in Cancer- An Evolving Aspect in Medical Biotechnology
Authors: Ray Suman Kumar , Mukherjee Sukhes
Published: December 2020

Cell-free DNA (cfDNA) is present in numerous body fluids and generally blood cells. It
is undoubtedly the utmost promising tool among all components of liquid biopsy. Liquid biopsy is
a specialized method investigating the non-solid biological tissue by revealing circulating cells,
cell-free DNA, etc., that enter the body fluids. Since cancer cells disengage from compact tumors
circulating in peripheral blood, evaluating cancer patients' blood profile is essential for the
molecular level analysis of various tumor-derived constituents. Cell-free DNA samples can deliver
a significant diagnosis in oncology, for instance, tumor heterogeneity, rapid tumor development,
response to therapy and treatment, comprising immunotherapy, and mechanisms of cancer
metastasis. Malignant growth at any phase can cause the occurrence of tumor cells in addition to
fragments of neoplasticity. Liquid biopsy indicates diverse blood-based biomarkers comprising
circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) or cfDNA, circulating RNA
(cfRNA), and exosomes. Cell-free DNAs are little DNA fragments circulating in plasma or serum,
just as other fluids present in our body. Cell-free DNA involves primarily double-stranded nuclear
DNA and mitochondrial DNA, present both on a surface level and in the vesicles' lumen. The
probable origins of the tumor-inferred portion of cfDNA are apoptosis or tumor necrosis, lysis of
CTCs or DNA release from the tumor cells into circulation. The evolution of innovations,
refinement, and improvement in therapeutics to determine the fragment size of cfDNA and its
distribution provide essential information related to pathological conditions of the cell, thus
emerging as a promising indicator for clinical output in medical biotechnology.
From Passive Targeting to Personalized Nanomedicine: Multidimensional Insights on Nanoparticles’ Interaction with the Tumor Microenvironment
Authors: Sebak Aya A. , El-Shenawy Basma M. , El-Safy Sara , El-Shazly Mohamed
Published: December 2020

Nanomedicine is revolutionizing the treatment of cancer and has achieved unprecedented
outcomes over the past decades. The accumulation of Nanoparticles (NPs) in different tumors relies
mainly on the Enhanced Permeability and Retention (EPR) effect benefiting from the wide fenestrae
of the tumor vasculature and the lack of lymphatic drainage. However, the EPR effect is recognized
as a heterogeneous phenomenon resulting in heterogeneous outcomes of clinical trials. Extensive
efforts are exerted to enhance the outcomes of nanomedicine in a larger cohort of patients by employing
active targeting strategies. However, actively targeted NPs accumulate in tumors by the
EPR effect and hence fail to achieve convincing therapeutic outcomes. These obstacles are gradually
being removed by improving the understanding of the Tumor Microenvironment (TME) and the
mechanistic interaction of the NPs with its different components. In this review, we provide detailed
insights into the past concerns of drug targeting, the current trends of TME reengineering, and the
future implications for overcoming past hurdles. Strategies explored in this regard included the use
of companion diagnostics and the modulation of the protein corona associated with the systemic
administration of NPs and their interaction with biological macromolecules.
New Paradigms to Help Decisions in Treatment Choice: Head to Head Trial of Biological Therapies in Inflammatory Bowel Diseases
Authors: Loy Laura , Fiorino Gionata , Roda Giulia , Allocca Mariangela , Furfaro Federica , Zilli Alessandra , Gilardi Daniela , Radice Simona , Peyrin-Biroulet Laurent , Danese Silvio
Published: December 2020

The increasing armamentarium of drugs for inflammatory bowel disease (IBD) requires
a direct comparison of different therapeutic options in order to guide physicians in the choice of the
most appropriate treatment for their patients. Head-to-head trials, considered the gold standard in
comparative research in IBD, allow to compare different therapies in the same population and setting,
but also to evaluate different treatment strategies. Although head-to-head trials including biologics
and immunosuppressive therapy in IBD have been performed decades ago, the interest in these
direct comparisons is growing since the publication of the first randomized controlled trial directly
comparing biologic agents with different molecular targets. This review provides an
overview of the past and current IBD head-to-head trials, considering their respective strengths and
limitations in a real-life setting.
Analysis of Thermal Degradation in the Annealing Process of Colored Parts Built by Extrusion-Based 3D Printing
Authors: Castro Vera Kleber Leonardo , Santana Leonardo , Lino Alves Jorge
Published: December 2020

With the ever-increasing request of light materials, poly lactic (acid) PLA, have got much in consideration. Low-cost PLA materials have risen its use. Those possess some benefits but nevertheless insufficient mechanical strength. The printed PLA objects have a stumbling block for practical applications. Thus, annealing is an interested alternative to make 3D printed objects strong. This thermal treatment can significantly develop investigational studies and offer technical data. Hence the purpose of this paper is study and discuss how to increase the flexural strength through annealing process. Geometry distortions and color degradation will be analyzed. Differential Scanning Calorimetry, Taguchi Method (TM) and variance (ANOVA) were applied as part of the design experiments and analysis. Twenty-seven printed specimens were tested and factors as temperature, time and color were selected.
Topology Optimization of Automotive sheet metal part using Altair Inspire
Authors: Ferede Netsanet
Published: December 2020

In an optimization problem, different candidate solutions are compared with each other, and then the best or optimal solution is obtained which means that solution quality is fundamental. Topology optimization is used at the concept stage of design. It deals with the optimal distribution of material within the structure. Altair Inspire software is the industry's most powerful and easy-to-use Generative Design/Topology Optimization and rapid simulation solution for design engineers. In this paper Topology optimization is applied using Altair inspire to optimize the Sheet metal Angle bracket. Different results are conducted the better and final results are fulfilling the goal of the paper which is minimizing the mass of the sheet metal part by 65.9%  part and Maximizing the stiffness with Better Results of Von- Miss Stress Analysis,  Displacement, and comparison with different load cases.  This can lead to reduced costs, development time, material consumption, and product less weight.
Adenylate cyclase activity in sheep platelets following external whole-body gamma-irradiation with different doses
Authors:   Russian Institute of Radiology and Agroecology, Shevchenko T.S. , Kobyalko V.O. ,   Russian Institute of Radiology and Agroecology
Published: December 2020

The paper presents results of study of adenylate cyclase activity in the platelets after external whole-body gamma-irradiation of 32 tsigai rams (Ovis aries) with 2, 4 and 6 Gy, at the dose rate of 1 Gy/hour. The irradiation caused the development of acute radiation damage of a different degree of severity. To detect changes in the basal and prostoglandin E1 stimulated (PGE1-stimulated) adenylate cyclase activity thin-layer chromatography (TLC) was carried out during the first 30 days of the damage development. After external -irradiation directly proportional effect of dose on changes in the basal adenylate cyclase activity in the platelets was registered on the 1 and the 7 days of the damage development, the changes in the PGE1-stimulated activity was registered on the 7 day. The study results allow making the suggestion that detected changes in the adenyl-ate cyclase activity in the platelets of irradiated rams may be resulted from the modification of cy-toplasmic cell membranes and impaired functioning of membrane-bound cAMP-sensitive signal-ing pathway. It may be also caused by new cells with qualitatively new properties released from the bone marrow megakaryocytes pool into the bloodstream.
Health Care Professionals’ Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study
Authors: Eldh Ann Catrine , Sverker Annette , Bendtsen Preben , Nilsson Evalill
Published: December 2020

Background

Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

Objective

The objective of our study was to describe health care staff’s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care.

Methods

In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis.

Results

While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient’s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service—at least for a while—if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers.

Conclusions

A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.
Biological, Chemical, and Nutritional Food Risks and Food Safety Issues From Italian Online Information Sources: Web Monitoring, Content Analysis, and Data Visualization (Preprint)
Authors: Tiozzo Barbara , Ruzza Mirko , Rizzoli Valentina , D'Este Laura , Giaretta Mosè , Ravarotto Licia
Published: December 2020

BACKGROUND

With rapid evolution of the internet and web 2.0 apps, online sources have become one of the main channels for most people to seek food risk information. Thus, it would be compelling to analyze the coverage of online information sources related to biological, chemical, and nutritional food risks, and related safety issues, to understand the type of content that online readers are exposed to, possibly influencing their perceptions.

OBJECTIVE

The aim of this study was to identify the types of online sources that are predominantly covering this theme, and the topics that have received the most attention in terms of coverage and engagement on social media.

METHODS

We performed an analysis of big data related to food risks by combining web monitoring techniques, content analysis, and data visualization of a large amount of unstructured text. Using a dictionary-based approach, a web monitoring app was instructed to automatically collect web content referring to the food risk and safety field. Data were retrieved from March 2017 to February 2018. The validated corpus (N=12,163) was subject to automatic and manual content analysis. Results were combined with descriptive statistics extracted from Web-Live and processed with Qlik Sense.

RESULTS

Nutritional risks and news about outbreaks, controls, and alerts were the most widely covered topics. Thematic sources devoted major attention to nutritional topics, whereas national sources covered food risks, especially during food emergencies. Regarding engagement on social media, readers’ interest was higher for nutritional topics and animal welfare. Although traditional sources still publish a great amount of content related to food risks and safety, new mediators have emerged as alternative sources for food risk information.

CONCLUSIONS

This mixed methodological approach was demonstrated to be a useful means for obtaining an accurate characterization of the online discourse on food risks, and can provide insight into how the monitored sources contribute to the process of risk communication.
Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19 (Preprint)
Authors: Puspitasari Ajeng J , Heredia Dagoberto , Coombes Brandon J , Geske Jennifer R , Gentry Melanie T , Moore Wendy R , Sawchuk Craig N , Schak Kathryn M
Published: December 2020

BACKGROUND

In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent.

OBJECTIVE

This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic.

METHODS

Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk.

RESULTS

Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI –3.6 to –6.2; Cohen d=0.77; P<.001), anxiety (95% CI –3.0 to –4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI –0.5 to –0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI –0.2 to –1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge.

CONCLUSIONS

Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials.
User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study (Preprint)
Authors: Zhang Zhan , Kmoth Lukas , Luo Xiao , He Zhe
Published: December 2020

BACKGROUND

Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results.

OBJECTIVE

The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers.

METHODS

We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results.

RESULTS

The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions.

CONCLUSIONS

We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic.

CLINICALTRIAL
Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)
Authors: Moon Kyoung Ja , Son Chang-Sik , Lee Jong-Ha , Park Mina
Published: December 2020

BACKGROUND

Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring.

OBJECTIVE

This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI).

METHODS

This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized.

RESULTS

We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool.

CONCLUSIONS

This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care.

CLINICALTRIAL

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Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing (Preprint)
Authors: Counson Isabelle , Bartholomew Alexandra , Crawford Joanna , Petrie Katherine , Basarkod Geetanjali , Moynihan Victoria , Pires Josie , Cohen Rachel , Glozier Nicholas , Harvey Samuel , Sanatkar Samineh
Published: December 2020

BACKGROUND

Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking.

OBJECTIVE

This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings.

METHODS

A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians.

RESULTS

Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops.

CONCLUSIONS

This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale.
The Effects of Modified Intermittent Fasting in Psoriasis (MANGO): Protocol for a Two-Arm Pilot Randomized Controlled Open Cross-over Study (Preprint)
Authors: Grine Lynda , Hilhorst Niels , Michels Nathalie , Abbeddou Souheila , De Henauw Stefaan , Lambert Jo
Published: December 2020

BACKGROUND

Psoriasis is a complex disease associated with multiple comorbidities, including metabolic syndrome and leaky gut syndrome. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. It remains unclear how diets affect these comorbidities and the general health in psoriasis patients. Modified intermittent fasting (MIF) on 2 nonconsecutive days has shown beneficial effects on metabolic parameters. A significant advantage of MIF over the currently investigated dietary changes is its feasibility.

OBJECTIVE

Here, we aim to study the effects of MIF on skin, gut, and metabolic health in psoriasis patients.

METHODS

A 2-arm pilot randomized controlled open cross-over study will be performed in 24 patients with psoriasis. Patients will be randomized 1:1 to either start with 12 weeks of MIF and go on a subsequent regular diet for another 12 weeks or start with 12 weeks of regular diet and do subsequent MIF for 12 weeks. The following parameters will be assessed: demographics, disease phenotype, medical and familial history, psoriasis severity, dermatology-specific and general quality of life, nutritional and physical habits, mental and intestinal health, intestinal and cutaneous integrity, inflammatory and metabolic markers, and satisfaction.

RESULTS

A total of 24 participants have been enrolled in the study. The final visit is foreseen for June 2021.

CONCLUSIONS

The aim is to uncover the effects of MIF on psoriasis severity and gut health integrity through clinical and molecular investigation. More precisely, we want to map the evolution of the different markers, such as psoriasis severity, permeability, and inflammation, in response to MIF as compared to a regular diet,. Understanding how dietary lifestyles can affect epithelial lineages, such as the skin and gut, will greatly improve our understanding of the development of psoriasis and may offer a nonpharmacological venue for treatments.

CLINICALTRIAL

ClinicalTrials.gov NCT04418791; https://clinicaltrials.gov/ct2/show/NCT04418791

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/26405
Recursive Partitioning vs Computerized Adaptive Testing to Reduce the Burden of Health Assessments in Cleft Lip and/or Palate: Comparative Simulation Study (Preprint)
Authors: Harrison Conrad J , Sidey-Gibbons Chris J , Klassen Anne F , Wong Riff Karen W Y , Furniss Dominic , Swan Marc C , Rodrigues Jeremy N
Published: December 2020

BACKGROUND

Computerized adaptive testing (CAT) has been shown to deliver short, accurate, and personalized versions of the CLEFT-Q patient-reported outcome measure for children and young adults born with a cleft lip and/or palate. Decision trees may integrate clinician-reported data (eg, age, gender, cleft type, and planned treatments) to make these assessments even shorter and more accurate.

OBJECTIVE

We aimed to create decision tree models incorporating clinician-reported data into adaptive CLEFT-Q assessments and compare their accuracy to traditional CAT models.

METHODS

We used relevant clinician-reported data and patient-reported item responses from the CLEFT-Q field test to train and test decision tree models using recursive partitioning. We compared the prediction accuracy of decision trees to CAT assessments of similar length. Participant scores from the full-length questionnaire were used as ground truth. Accuracy was assessed through Pearson’s correlation coefficient of predicted and ground truth scores, mean absolute error, root mean squared error, and a two-tailed Wilcoxon signed-rank test comparing squared error.

RESULTS

Decision trees demonstrated poorer accuracy than CAT comparators and generally made data splits based on item responses rather than clinician-reported data.

CONCLUSIONS

When predicting CLEFT-Q scores, individual item responses are generally more informative than clinician-reported data. Decision trees that make binary splits are at risk of underfitting polytomous patient-reported outcome measure data and demonstrated poorer performance than CATs in this study.