bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression and Multimorbidity Among Older Indians Residing in Front-runner, Achiever and Aspirant States: Insight From Longitudinal Aeging Study in India (LASI) – Wave I (Preprint)
Authors: Halder Pritam , Das Aritrik , Bhandari Yukti , Mamgai Anshul , Parija Pragyan
Published: July 2024

BACKGROUND

Multimorbidity is gaining prominence as a global public health challenge, with demographic and epidemiologic transitions. Epidemiologically, a bi-directional link exists between depression and multimorbidity, and it is influenced by biological, psycho-social and care-related factors. Variations are expected in the different States with differential performances in the NITI Aayog Annual Health Index.

OBJECTIVE

The objective is to study the association of depression with multimorbidity among the older Indian population living in front-runner, achiever and aspirant States.

METHODS

This is an analytical cross-sectional study, analyzing secondary data collected during the Longitudinal Ageing Study in India (LASI)-1st wave (2017–18). A total of 66,606 Indian participants aged >45 years were included in the analysis. Based on their NITI Aayog Annual Health Index score, the States and UTs are classified into front-runner (top one-third), achiever (middle one-third) and aspirant (lowest one-third). For this study, the Health Index Round IV 2019-20 was used for categorisation of the states. Depression was the outcome variable, classified according to the Composite International Diagnostic Interview-Short Form (CIDISF). Multivariable logistic regeression analysis was conducted to calculate adjusted odds of association between depression and multimorbidity. Association between multimorbidity and depression was stratified according to the categorisation of States into front-runner, achiever and aspirants.

RESULTS

Among those with atleast two co-morbidites, depression was reported in 8.74%. Among those with atleast 4 multimorbidities, depression was reported in 15.56%. Depression was found to most commonly occur along with hypertension (35.8%) and musculoskeletal disorders (21.67%), and least commonly along with cancer (1.09%) and chronic renal failure (1.31%). There was a strong association between depression and multimorbidity in front-runner [aOR = 3.77; 95% C.I. 2.02-7.03], achiever [aOR = 2.10; 95% C.I. 1.84-2.45] and aspirant States [aOR = 3.27; 95% C.I. 1.79-5.95].

CONCLUSIONS

Strong association between depression and multimorbidity across all three State categories indicates a need for inclusion of mental health care components in the composite annual health index. Incorporation of routine and high risk screening for depression among patients with multimorbidity into the Ayushman Bharat Comprehensive Primary Health Care (CPHC) package needs to be tested with health technology assessment studies as potential future policy change.

CLINICALTRIAL

NA
A Review of Medical Data Sharing Initiatives with a focus on the Use of Blockchain Technologies (Preprint)
Authors: Cunningham James , Davies Nigel , Devaney Sarah , Harding Mike , Holm Søren , Neumann Victoria , Smith Clare , Ainsworth John
Published: July 2024

BACKGROUND

Medical data sharing initiatives are crucial for advancing research, improving patient outcomes, and fostering innovation in healthcare. With the advent of blockchain technology, there has been significant interest in exploring its potential to enhance the security, transparency, and efficiency of medical data sharing.

OBJECTIVE

This study aimed to survey and analyse various medical data sharing initiatives, focusing on their use of blockchain technology, incentive structures, ownership models, governance mechanisms, business models, transaction models, and sustainability strategies. The objective is to provide a comprehensive overview of the current landscape and identify factors that contribute to the success and longevity of these initiatives.

METHODS

The study employed a snowball sampling methodology to identify relevant initiatives, using a combination of academic literature reviews, web searches, and consultations with experts. Identified initiatives were screened and analyzed based on predefined criteria, including organization, description, country, blockchain usage, incentives, ownership, governance, business model, transaction model, and sustainability. A re-analysis was conducted to assess the current operational status of the initiatives

RESULTS

The survey identified 42 medical data sharing initiatives. The majority of these initiatives were based in North America and Europe, with a significant number utilizing blockchain technology. Incentives for participation varied, with many initiatives relying on self-interest or altruistic motivations. Ownership models included private, public-private partnerships, and membership-owned structures. Governance models were diverse, with board-based and regulation-based mechanisms being the most common. Business models predominantly focused on for-profit structures, with various transaction models including direct monetary transactions, single token systems, and reward-based mechanisms. Sustainability strategies were varied, with selling access to users and membership fee-based models showing higher rates of continuation.

CONCLUSIONS

The survey highlights a diversity of approaches in medical data sharing, with blockchain technology playing a significant role but not serving as a universal solution. Various incentive, ownership, and governance models reflect the evolving nature of the field, with for-profit business models being predominant. Sustainability strategies range widely, aiming to balance revenue generation with accessible data provision. These findings emphasize the need for context-specific frameworks that address privacy, security, and ethical considerations while promoting efficient and equitable medical data sharing.
The performance of large language models in managing abnormal results of cervical cancer screening: Comparative Study (Preprint)
Authors: Kuerbanjiang Warisijiang , Peng Shengzhe , Jiamaliding Yiershatijiang , Yi Yuexiong
Published: July 2024

BACKGROUND

Cervical cancer remains the fourth leading cause of female death globally. Screening for cervical cancer is an effective preventative strategy. However, its impact is lessened in environments with scarce medical resources due to poor clinical decision-making and improper resource allocation. Large Language Models (LLMs) could significantly enhance medical systems in these settings by improving decision-making processes.

OBJECTIVE

This study aims to evaluate the performance of LLMs in managing abnormal cervical cancer screening results.

METHODS

Models are selected from AlpacaEval leaderboard version 2.0 and the capability of our computer. Questions inputted to models are designed in accordance to CSCCP and ASCCP guidelines. Two experts review the response from each model for accuracy, guideline compliance, clarity, and practicality by grading as A, B, C and D weighted as 3, 2, 1 and 0 scores, respectively. Effective rate is calculated as the ratio of the number of A and B to the number of all designed questions.

RESULTS

Nine models are included in this study, while 33 questions are specifically designed. Seven models (ChatGPT 4.0 Turbo, Claude 2, Gemini Pro, Mistral-7B-v0.2, Starling-LM-7B alpha, HuatuoGPT and BioMedLM 2.7B) provide stable responses. Among all included models, ChatGPT 4.0 Turbo and Claude 2 ranked in first level with mean score 2.30[2.0, 2.60] (effective rate: 88.81%) and 2.21[1.88, 2.54] (effective rate: 78.79%) when compared to the other seven models (P<0.001).

CONCLUSIONS

Proprietary LLMs, particularly ChatGPT 4.0 Turbo and Claude 2, show promise in clinical decision-making involving logical analysis. However, this study underscores the need for further research to explore the practical application of LLMs in medicine.
Leveraging Ecological Momentary Assessment to Evaluate Fluctuations in Cognitive Status: A Rare Disease Population (Preprint)
Authors: Singh Shifali , Kluen Lisa , Curtis Katelin , Norel Raquel , Agurto Carla , Grinspoon Elizabeth , Hawks Zoe , Christ Shawn , Waisbren Susan , Cecchi Guillermo , Germine Laura
Published: July 2024

BACKGROUND

Phenylketonuria (PKU) is a rare, hereditary disease that causes disruption in phenylalanine (Phe) metabolism. Despite early intervention, individuals with PKU may have difficulty in several different cognitive domains, including verbal fluency, processing speed, and executive functioning.

OBJECTIVE

The overarching goal of the Evaluating Fluctuations in Cognitive and Speech Characteristics in Phenylketonuria study (CSP Study) is to characterize the relationships among cognition, speech, mood, and blood-based biomarkers (Phe, Tyr) in individuals with early treated PKU. We describe our initial optimization pilot results that are guiding the ongoing CSP Study, while establishing feasibility and reliability of using ecological momentary assessment (EMA) in this clinical population.

METHODS

Twenty adults with PKU were enrolled in this study between December 2022 and March 2023 through the National PKU Alliance. All participants completed an extended baseline assessment followed by six ecological momentary assessments (EMAs) over the span of one month. The EMAs included digital cognitive tests measuring processing speed, sustained attention, executive functioning, and semantic fluency, as well as speech and mood measures. Participants had 60 minutes to complete the assessment; completion rates were around 70% (on average 4.78 measurements out of six).

RESULTS

Based on scores recorded and completion rates above 70%, results suggest stable performance across EMAs, as well as baseline measures, and reflect the ability of participants to complete this type of repeated assessment. Between person reliability (BP reliability) of the EMA measures, representing the variance that is due to differences between individuals versus within individuals, is satisfactory with values close to (semantic fluency BP reliability: 0.7, sustained attention BP reliability: 0.72) or exceeding (processing speed: 0.93, executive functioning: 0.88) those data collected from a large normative database (N= 5039-10703), as well as slightly below or matching a prior study using a clinical group (N=18).

CONCLUSIONS

: Individuals with PKU face a substantial healthcare burden, often enduring numerous hospital visits and requiring continuous self-monitoring. Preliminary results of this study have demonstrated strong reliability of cognitive EMA, indicating that EMA is a promising tool for evaluating fluctuations in cognitive status this population. Future work should refine and expand the utility of these digital tools, determine how variable EMA frequencies might better characterize changes in functioning as they relate to blood-based biomarkers, and validate a singular battery that could be rapidly administered at scale and in clinical trials to determine progression of disease.
Assessing the Quality and Reliability of ChatGPT's Responses to Radiotherapy-Related Patient Queries: GPT-3.5 versus GPT-4 (Preprint)
Authors: Grilo Ana , Marques Catarina , Corte-Real Maria , Carolino Elisabete , Caetano Marco
Published: July 2024

BACKGROUND

Patients frequently resort to the Internet to access cancer information. Nevertheless, these online websites often need more content accuracy and readability. Recently, ChatGPT, an artificial intelligence-powered chatbot, signifies a potential paradigm shift in how cancer patients can access vast medical information. However, given that ChatGPT was not explicitly trained for oncology-related inquiries, the quality of the information it provides still needs to be verified. Evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and delay appropriate treatment.

OBJECTIVE

This study aims to evaluate the quality and reliability of ChatGPT’s responses to standart patient queries about radiotherapy, comparing the performance of GPT-3.5 and GPT-4.

METHODS

Forty commonly asked radiotherapy questions were selected and inserted into both versions. Responses were evaluated by six radiotherapy experts using a General Quality Score (GQS), assessed for consistency and similarity using the cosine similarity score, and analyzed for readability using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Statistical analysis was performed using the Mann-Whitney test.

RESULTS

GPT-4 demonstrated superior performance, with higher GQS and a complete absence of lower scores compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The cosine similarity score indicated substantial similarity and consistency in responses from both versions. Readability scores for both versions were considered college-level, with GPT-4 scoring slightly better in FRES (35.55) and FKGL (12.71) compared to GPT-3.5 (30.68 and 13.53, respectively). Both versions’ responses were deemed challenging for the public to read.

CONCLUSIONS

While GPT-4 generates more accurate and reliable responses than GPT-3.5, both models present readability challenges for the public. ChatGPT reveals potential as a valuable resource for addressing common patient queries related to radiotherapy. However, it’s crucial to acknowledge its limitations, including the risks of misinformation and readability issues.
Rapid and efficient method to make competent bacterial cells (Preprint)
Authors: Siamalube Beenzu , Ehinmitan Emmanuel , Ngotho Maina , Onguso Justus , Runo Steven
Published: July 2024

BACKGROUND

Genetic transformation involves the alteration of genes when cells take up uncoded Deoxyribonucleic acid from the extracellular environment.

OBJECTIVE

To render competency to untransformeed bacterial cells using the Calcium chloride cation.

METHODS

The heat-shock method perforates the cell membrane to make it permeable for the foreign DNA to penetrate easily.

RESULTS

Viable colonies will take up the gene construct, cloned into a plasmid, thus making the bacterial cells capable of replicating the desired sequence, in sufficient numbers

CONCLUSIONS

Competent bacterial cells can be used in diverse molecular analyses, such as plant genetic transvia Agrobacterium mediated transgenic system.
The use of slope graphs with Rasch model to present performance comparisons for dietetic students during objective structured clinical examinations (OSCE): observational study (Preprint)
Authors: Tu Mei-Yu , Chien Tsair-wei , Chou Willy
Published: July 2024

BACKGROUND

Objective Structured Clinical Examination (OSCE) typically demands a significant amount of scoring time and necessitates identical subjects for students to take the same test for comparison. Previous research has not introduced objective performance sheets that provide visual comparisons of both individual and group results in a time-efficient manner.

OBJECTIVE

This study aims to evaluate the performance of dietetic students in various stages of the OSCE and present their performance sheets using slope graphs(SGs).

METHODS

The Rasch model was used to generate expected scores from 0 to 4 for subjects that students did not participate in, and visual representations such as item-person maps, KIMMAPs, and SGs were provided to enhance the understanding of OSCE performance between and within groups. A total of 87 dietetic students were evaluated in seven time-frame stages, with each student answering different subjects from 10 item pools. Analysis of variance was utilized to compare the performance of each group across OSCEs based on identical 10 subjects.

RESULTS

The study found that the Rasch person-separation reliability for the 87x10 Likert-type OSCE scores was 0.93, and item difficulties ranged from 6.75 to -7.29 logits. Group differences in person measures were detected for stages (F(6, 80)= 18.02, p<0.001) and grades (F(4, 82)= 165.97, p<0.001). A small percentage of students(3.4%=3/87) had extremely high(=4.64) and low(-10.0) measures, and only one student had an abnormal response pattern, an outfit mean square error of 4.4 (which exceeded the standard criterion of 2.0). OSCE performances for the students can be visualized on the SGs, and individual response patterns can be displayed on KIDMAP based on the Rasch model.

CONCLUSIONS

The SGs effectively displayed the performance of dietetic students at different stages of the OSCE, using the Rasch model to overcome the traditional issue of needing significant scoring time and identical subjects in an OSCE. This study provides valuable insights into the use of visualizations and performance comparisons for future OSCEs.
ChatGPT4 Performance on German CME - friend or foe (trick or treat)? (Preprint)
Authors: Burisch Christian , Bellary Abhav , Breuckmann Frank , Ehlers Jan , Thal Serge C , Sellmann Timur , Gödde Daniel
Published: July 2024

BACKGROUND

The increasing development and spread of artificial and assistive intelligence is opening up new areas of application not only in applied medicine but also in related fields such as continuing medical education (CME), which is part of the mandatory training program for medical doctors in Germany.

OBJECTIVE

The aim of our study was to determine whether medical laypersons are able to successfully conduct training courses specifically for physicians with the help of a large language model such as ChatGPT4.

METHODS

We plan to conduct a randomized controlled trial in which high school students use ChatGPT4 to complete special training courses for doctors in the fields of internal medicine, surgery, gynecology, pediatrics, neurology and anesthesiology. Thus, the test is set up with three arms: a) input of full-text and CME questions in ChatGPT4, b) input of CME questions only and c) a solution approach using a keyword search function in the full text. By means of randomization, the participants were evenly distributed among the three arms. The trial was approved by the Ethics Committee of Witten/Herdecke University (No. S-108/2024, date of approval 15 May 2024) and registered on the Open Science Framework (https://doi.org/10.17605/OSF. IO/MZNUF) in advance.

RESULTS

not yet applicable.

CONCLUSIONS

Using this approach, we wanted to test further possible applications of artificial intelligence in the postgraduate medical education setting and obtain results for practical use. Depending on the results, the potential influence of LLMs such as Chat-GPT4 on CME will be discussed, e.g., as part of a SWOT analysis (strengths, weaknesses, opportunities, threats).

CLINICALTRIAL

Open Science Framework (https://doi.org/10.17605/OSF. IO/MZNUF)
Problematic issues of diagnosis and treatment of Boerhaave’s syndrome
Authors: Zhukovskiy V.S. , Trutyak I.R. , Pidhirnyi Ya.M. , Filip Zh.V. , Pankiv M.V. , Kozopas V.S.
Published: July 2024

Boerhaave’s syndrome is a rare disease with an incidence of 3.1/1,000,000 per year, has a high mortality rate due to late diagnosis and difficulty in treatment. The purpose of the message is to draw the attention of doctors to the variety of clinical manifestations of Boerhaave’s syndrome, which complicates early diagnosis and decision making. Clinical observation of two patients with Boerhaave’s syndrome is presented. One patient was hospitalized 7 hours after the onset of pain in the upper left side, nausea, vomiting. Clinical examination, ultrasound and chest X-ray revealed no pathology. However, after 3 hours, the patient’s condition deteriorated sharply, emphysema of the neck and chest appeared. X-ray revealed left-sided pneumohemothorax. Thoracotomy revealed a 3.5-cm long rupture in the lower third of the esophagus on its left lateral wall, which was sutured. The chest cavity and mediastinum are debrided and drained using tubes. A gastrostomy was formed. The postoperative period was complicated by multiple organ failure and sepsis. Patient was in the intensive care unit for 29 days. The esophageal wound healed on the 46th day and the patient was discharged for outpatient observation. Another patient was hospitalized three hours after onset of illness with a left-sided pneumohemothorax and acute abdomen symptoms. Chest tube on the left was placed and a dark brown liquid released under pressure. The peritonitis clinical symptoms prompted surgeons to perform urgent laparotomy during which no pathology of the abdominal organs was detected. Only after computed tomography, a rupture of the esophagus was diagnosed. As a result of delayed surgery, infection complications and sepsis developed, which led to the patient’s death.
Laparoscopic cholecystectomy with or without drainage: a systematic review and meta-analysis
Authors: Chuklin S.S. , Chooklin S.M.
Published: July 2024

Background. The abdominal drainage with a prophylactic purpose was used by surgeons for decades because of the possibility to detect early signs of postoperative complications. However, the real value of routine drainage after abdominal surgery is still debated. There are discrepancies between studies supporting the drain placement only in patients with intraoperative complications and works showing a beneficial effect of prophylactic abdominal drainage on postoperative pain, nausea, and vomiting. However, there is still a lack of evidence on the use of routine abdominal drainage following laparoscopic cholecystectomy and its clinical value. Current guidelines do not mention the role of drainage after laparoscopic cholecystectomy. Objective: to evaluate whether conventional postoperative drainage is more effective than no drainage in patients with non-complicated benign gallbladder disease after laparoscopic cholecystectomy. Materials and methods. A search in the electronic databases MEDLINE, Scopus, Cochrane Library was conducted for randomized controlled trials reporting outcomes of laparoscopic cholecystectomy with and without an abdominal drainage until January 2024. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis — using fixed and random effects models. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated using IBM SPSS Statistics 29.0.2.0. Results. Forty-four randomized controlled trials invol­ving 5,185 patients (2,592 with drains vs 2,593 without them) were included in the meta-analysis. There were no statistically significant differences in the incidence of intra-abdominal fluid accumulation (OR = 0.87; 95% CI: 0.64–1.19; p  =  0.39) between two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (OR = 1.51; 95% CI: 0.85–2.70; p  = 0 .16) or shoulder pain (OR = 0.90; 95% CI: 0.58–1.41; p  =  0.65). The abdominal drain group reported significantly higher pain scores (MD = 0.67; 95% CI: 0.37–0.98; p  <  0.001) than patients without drains. Abdominal drainage increased operative time (MD = 3.82; 95% CI: 1.93–5.70; p < 0.001) but not the length of hospital stay after surgery (MD = 0.42; 95% CI: –0.02–0.85; p  =  0.06). Wound infection (OR = 3.26; 95% CI: 2.35–4.51; p  <  0.001), fever (OR = 4.40; 95% CI: 2.57–7.8554; p <  0.001) and pneumonia (OR = 4.74; 95% CI: 2.25–9.97; p  <  0.001) were found to be associated with the use of abdominal drains. Conclusions. Currently, there is no evidence to support the use of routine drainage after laparoscopic cholecystectomy in non-complicated benign gallbladder disease. No drainage after laparoscopic cholecystectomy is safe and associated with fewer complications. Postoperative recovery is improved if drain is not used. Further well-designed randomized clinical trials are required to confirm this finding.
Adherence to the treatment in patients with hypertension during the war in Ukraine
Authors: Tseluyko V.I. , Yakovleva L.М.
Published: July 2024

Background. The aim of the study: to investigate additional factors that affect the adherence to antihypertensive therapy in patients with hypertension in conditions of war in Ukraine. Materials and methods. The study included 1,299 hypertensive patients with an average age of 65.4 ± 14.8 years, who are residents of different regions of Ukraine. The observation period lasted 3 months, from October 1 to December 12, 2023. All patients were divided into four groups: I — a fixed three-component combination of olmesartan medoxomil/amlodipine/hydrochlorothiazide, II — a fixed two-component combination of olmesartan/hydrochlorothiazide, III — a fixed two-component therapy with olmesartan/amlodipine, IV — any other non-fixed two- or three-component antihypertensive therapy. Adherence to therapy was assessed after 1, 2, and 3 months and statistical analysis of the obtained data was performed. Results. During the first month of observation, 50 (3.8 %) patients stopped or did not even start taking antihypertensive therapy, during the second — 71 (5.5 %), during the third — 127 (9.8 %). Adherence to antihypertensive therapy is higher in younger people (up to 55 years) compared to patients aged over 65, in people with higher education, in patients taking fixed combinations, especially olmesartan/amlodipine, or olmesartan/amlodi-pine/hydrochlorothiazide, while gender had no effect on adherence. Additional factors related to adherence to antihypertensive therapy during the war were as follows: the level of danger in the region of residence, the internally displaced status of the patient or doctor. The lowest adherence to antihypertensive therapy after 3 months was registered in the internally displaced persons who suffered morally or physically and is only 34.5 % compared to patients who stayed in the place of permanent residence — 82.6 % (р = 0.0001), or to those who moved preventively — 74.3 % (р = 0.0001). Adherence to therapy also depends on the status of the doctor. Among doctors with the status of an internally displaced person, patients’ adherence to therapy is lower: 68.3 against 82 % (р = 0.0008). Conclusions. Adherence to antihypertensive therapy in Ukraine during the war depends on known factors influencing the completeness of the doctor’s recommendations, including age, educational level, concomitant diseases, the number of tablets, and specific factors caused by the war, such as activity of hostilities in the region, as well as the status of an internally displaced person, both in patients and doctors.
Damage to the visual analyzer in military personnel with concussion (clinical cases)
Authors: Goncharova N.A. , Kovtun M.I. , Pastukh I.V. , Pavlyuchenko O.S. , Muzhychuk O.P.
Published: July 2024

Background. Concussion is a damage to the body due to a sudden mechanical impact. Organs and tissues may remain undamaged. Concussion symptoms include disorientation, loss of consciousness (duration from a few minutes to several hours); memory impairment or amnesia; severe headache; nausea and vomiting; change in psycho-emotional state; hearing and vision problems. Brain concussion is the most severe, it is characterized by the development of both general disorders (fainting, impaired breathing, blood circulation, etc.) and those related to the localization of brain tissue damage. Traumatic brain injury caused by explosions or other high-intensity events requires immediate care. The purpose of the study is to identify symptoms of a damage to the visual analyzer in military personnel with concussion in order to develop better strategies for early detection, effective treatment and prevention of the consequences of injuries, which will ultimately reduce their impact and improve visual function in war victims. Materials and methods. Five male patients (10 eyes) aged 30.0 ± 8.2 years were under supervision. Both standard ophthalmic methods (visometry, perimetry, tonometry, biomicroophthalmoscopy, keratorefractometry, Schirmer’s test) and modern special additional examinations such as optical coherence tomography of the macula and optic nerve head, computed tomography of the brain were used. Results. According to the results of the exa-mination, almost all patients had a persistent decrease in visual functions and changes in peripheral vision with normal tonometry indicators in both eyes.
Supporting Self-Management of Healthy Behaviors in Chronic Kidney Disease and Hypertension
Authors: Schrauben Sarah J. , Park Diane , Amaral Sandra , Purcell Adriana , Zhang Siqi , Kearney Matthew , Bilger Andrea , Feldman Harold I. , Dember Laura M.
Published: July 2024

Key Points

Support programs for self-management are underutilized among people with CKD.

Implementing a smartphone support tool for self-monitoring physical activity and BP was feasible among people with CKD and hypertension.

Despite low digital health literacy, Supporting Self-Management of Healthy Behaviors was observed to be readily usable because of high levels of adherence and usability scores.

Background

Support programs for self-management are underutilized among people with CKD. We examined the feasibility of a smartphone-based intervention to support physical activity and BP monitoring, Supporting Self-Management of Healthy Behaviors (SMART-HABITS), for individuals with CKD and hypertension.

Methods

SMART-HABITS was piloted in a 12-week randomized cross-over trial among people with CKD and hypertension. Participants were asked to monitor BP ≥3-times/wk and step counts ≥5-times/wk. Participants were randomized to BP communication approach–self-report through text message for 6 weeks versus automatic reporting with a smartphone application (app) paired to a Bluetooth enabled BP machine for the alternate 6 weeks. The approach to monitoring and reporting steps was the same during both phases. Primary outcomes were adoption (retention and use of SMART-HABITS dashboard), adherence (% of transmitted BP and step counts), and acceptability as assessed with surveys and interviews. Secondary outcomes were reach, maintenance, CKD knowledge, digital health literacy, self-management, self-efficacy, quality of life, step counts, and BP values. Interviews were conducted at study end.

Results

Of the 47 randomized participants, 44 (94%) completed the text phase and 43 (92%) completed the app phase. The median age was 63 years, 49% were female, and 45% were Black. Retention was 91%. BP adherence was 87% in the text phase and 74% in the app phase, and step count adherence was 97%. Acceptability scores were high, and interviews largely conveyed acceptance. CKD knowledge increased but remaining survey scores did not change. Mean step counts increased from the prestudy period similarly in both phases. BP did not change over time.

Conclusions

Implementing a smartphone support tool for self-management was feasible among people with CKD and hypertension. The approach can supplement clinic-based care and potentially lead to less cardiovascular disease and CKD progression.

Clinical Trial registry name and registration number:

NCT04858295.

Podcast

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2024_09_23_CJASNSeptember19992.mp3
GENERIC DRUG REGISTRATION AND COUNTRY-SPECIFIC REQUIREMENTS IN SAUDI ARABIA, QATAR, BAHRAIN, AND OMAN
Authors: J. GUNASEELAN , K. M. ASHA SPANDANA
Published: July 2024

Objective: This research aims to examine the regulatory framework and prerequisites for generic drug registration in the Middle East and North Africa (MENA) region, with a specific focus on the countries that make up the Gulf Cooperation Council (GCC). This will enable a deeper understanding of the procedures, records, schedules, and discrepancies related to registration.
Methods: The study makes use of an extensive examination of the rules, regulations, and practices about the registration of generic drugs in the MENA. Official government sites, regulatory agencies, and respectable trade journals for the pharmaceutical sector were used as sources of information. The main procedures for registering generic drugs were explained and inspected, encompassing the submission of documents, dossier preparation, bioavailability/bioequivalence tests, and application filing.
Results: There are substantial growth prospects for generics. Research highlights the sequential registration process for generic drugs, submitting documents electronically using the Common Technical Document (eCTD) method. For registration to be successful, specific records and data such as bioavailability/bioequivalence research data must be provided.
Conclusion: The effective registration of generic medications in the MENA region, especially in the GCC nations, depends on understanding and abiding by nation-specific regulatory standards. The research offers a tactical guide that outlines the essential procedures, paperwork needs, and regional variances in the generic medicine registration process. The goal is to offer affordable healthcare solutions by navigating the regulatory landscape meticulously and streamlining the approval and market entry process for generic pharmaceuticals in the MENA region.
A REVIEW ON THE CHEMICAL-INDUCED EXPERIMENTAL MODEL OF CARDIOTOXICITY
Authors: RAI MONISHAA , SINHA AKSHIT , ROY SUPRIYA
Published: July 2024

Drug-induced cardiotoxicity is a major concern during drug development, prompting the need for reliable experimental models to thoroughly assess potential cardioprotective drugs. The review delves into the intricacies of various models for drug-induced cardiotoxicity in experimental animals, with a specific focus on streptozotocin, isoprenaline, and antineoplastic drugs like cisplatin, doxorubicin, and 5-fluorouracil in rats and mice. Streptozotocin-induced cardiotoxicity is characterized by oxidative stress, inflammation, and mitochondrial dysfunction, resulting in myocardial damage and impaired cardiac function. Preclinical studies employing streptozotocin-induced cardiotoxicity models have revealed crucial pathways related to diabetic cardiomyopathy, aiding the evaluation of potential cardioprotective interventions. Isoprenaline, a beta-adrenergic agonist, is known for inducing acute myocardial injury resembling cardiac ischemia and heart failure in animals. Its mechanism involves overstimulation of beta-adrenergic receptors, calcium overload, oxidative stress, and apoptosis. Isoprenaline-induced models have offered insights into acute myocardial injury pathophysiology and facilitated the screening of cardioprotective agents against Myocardial Infarction (MI) and injury. Antineoplastic drugs, such as cisplatin, doxorubicin, and 5-fluorouracil, are linked to significant cardiotoxic effects, including cardiomyopathy and heart failure. Animal models have revealed dose-dependent cardiomyopathy, shedding light on underlying mechanisms like oxidative stress, Deoxyribonucleic Acid (DNA) damage, and mitochondrial dysfunction. The article aims to consolidate the current understanding of the pathophysiology and mechanisms behind drug-induced cardiac damage. Additionally, it underscores the importance of using animal models in preclinical evaluations to assess drug safety and efficacy and to develop potential cardioprotective therapies.
The Influence of YouTube on the Growth and Success of Over-the-Top (OTT) Media: A Study
Authors: Koushik M. Venkata Sai , Manikandan Dr. A. , Rushikesava Dr. A. , Premraj Dr. J. Anil , Ajayendra R. , Gopikrishna Dr. P. , Dasigan Chen Chen E. , Nivardhan R. , Sriyutha R.L.
Published: July 2024

This study examines how YouTube shapes OTT media. It looks at visual storytelling, marketing, influencer partnerships, and user-generated content that builds audience loyalty. YouTube's discovery features and creator-audience interaction influence content and marketing. The study also explores how YouTube generates revenue for both OTT platforms and creators. Overall, it explores their interconnectedness in today's media world.
Asserting Agency in Negotiating Trauma: A Critical Analysis of Githa Hariharan’s “The Remains of the Feast”
Authors: R Meenakshi , Kindo Dr. Mridula R
Published: July 2024

The emergence of trauma as an alarming global issue has demanded attention and concern worldwide The term trauma comes from the Greek tpaa meaning wound The Longman Dictionary of Contemporary English defines trauma as an unpleasant and upsetting experience that affects you for a long time Trauma as a theory in literature escalated in the 1990s accelerated by the pioneering works of scholars such as Cathy Caruth Geoffrey H Hartman and Shoshana Felman In contemporary Indian English fiction the genre of short stories has consistently represented an essential component of the literary landscape The potency innate in short stories equates to that of novels in their efficacy to provide radical insights into social cultural historical and psychological arenas The Art of Dying 1993 authored by the esteemed contemporary postmodern postcolonial writer Githa Hariharan is a cluster of short stories that reflect on womens lives within the modern Indian setting The Remains of the Feast a short story from this collection unfolds the traumatic events in the life of Rukmini and her response to them as recounted by Ratna her greatgranddaughter The purpose of the study is to inquire into the reactions of Rukmini and Ratna to the events that unwind especially during Rukminis final phase of life This paper employs a feminist lens to examine the responses of these two central characters and brings to light the assertion of agency in the process of negotiating with physical and psychological trauma shedding light on their respective positions within the patriarchal framework
Impacts of Tourism on the Socio-Cultural Aspect of the Dumagat Along Dupinga
Authors: E. Adriano Xenneath Andrea , A. Aldeza Allaiza , Caspillan Will Smith C. , C. Menoncia Edilyn , P. Reyes Ma. Cecilia , L. Santos Francis Matthew , A. Tumibay Adriane Emanuelle , H. Abad Mark Alvin
Published: July 2024

This research paper examines the impacts of tourism on the socio-cultural aspects of the Dumagat community in Dupinga, Gabaldon Nueva Ecija, emphasizing the importance of indigenous perspectives. It combines scholarly knowledge and firsthand insights to assess these impacts comprehensively, advocating for sustainable tourism policies that preserve the cultural integrity of the community. Findings suggest a mixed impact of tourism, with positive economic effects but concerns about the erosion of local traditions. The paper recommends a multifaceted approach, including cultural sensitivity, community involvement, and education, to mitigate negative impacts and empower indigenous communities.
Empirical Investigation into Collaborative Model Development for Resolving Tenure Conflicts in Forested Regions
Authors: Mustika Aungadi Nurahdiat , Iswandi Marsuki , Yunus Lukman , Kasim Safril , Hasddin Hasddin
Published: July 2024

Tenure conflict is a challenge and dilemma experienced by many countries. The dilemma is because on the one hand, there is an interest in preserving forests, on the other hand, there are claims to land ownership in forest areas long before they are designated as forest areas. The next dilemma is that the party claiming property rights is generally used for agricultural activities which have been the main livelihood for generations. This study tries to examine the incidence of tenure conflicts in various countries to map how these conflicts occur, the factors that encourage land tenure approaches in resolving them, and government (state) policies. Using secondary data resulting from a review of previous research published in reputable international journals and other reliable and credible reports. The review study model used is systematic with meta-synthesis. Apart from journals, secondary data comes from other reliable and credible reports. Data and materials consist of 67 reputable international journals and 14 books/reports published in the last ten years. The results of the analysis found that tenure conflicts were caused by many things, motivated by the ownership and interests of natural resources specifically for agriculture for the lives of the surrounding community. An interesting fact is that the handling of tenure conflicts in several countries is considered successful, marked by the provision of access to forest management ownership. Other studies such as those conducted in Latin America, Africa, and Asia offer partnership models to resolve tenure conflicts. Similar things have also been done in Indonesia but have not been completely successful. Learning from this, this research offers a model for developing forest management partnerships to resolve tenure conflicts in forest areas, while also accommodating special agricultural activities for local communities. The model offered theoretically complements and/or perfects the models used so far which have proven unsuccessful in resolving conflicts. The practical implications are a reference for the government and interested parties to resolve tenure conflicts so that forests are maintained and can provide benefits for community welfare.
Edukasi Karakter Anti-Bullying Melalui Metode Sosialisasi Pada Siswa di YLPI Mahyal Ulum Al-Aziziyah Aceh Besar
Authors: Pranajaya Syatria Adymas , Mahmud Salami , Mengki Jias , Shadiqin Sehat Ihsan , Silahuddin Silahuddin
Published: July 2024

Penindasan adalah perilaku agresif yang disengaja dan melibatkan ketidakseimbangan kekuasaan dalam lingkungan sosial. Bullying mempunyai dampak yang serius bagi korbannya, seperti depresi, kecemasan, penurunan prestasi akademik, dan masalah kesehatan lainnya. Pelaku penindasan juga dapat mengalami masalah jangka panjang, seperti masalah perilaku negatif dan kesehatan mental. Tujuan dari pengabdian masyarakat ini adalah untuk memberikan edukasi tentang karakter anti perundungan kepada santriwati YLPI Mahyal Ulum Al-Aziziyah Aceh Besar. Pengabdian masyarakat ini diikuti oleh 132 peserta sosialisasi yang terdiri dari 63 siswa dan 69 siswi, serta beberapa guru yang mendampingi. Metode yang digunakan adalah sosialisasi melalui tahap dakwah, tahap penggunaan Alat Peraga Pendidikan Berbasis Multimedia dan Klasik, serta tahap Diskusi – Tanya Jawab – Dialog – Sharing. Dengan demikian, dengan konsep pengabdian masyarakat ini diharapkan siswa tidak hanya mendapatkan manfaat pengetahuan tentang ruang lingkup anti-bullying tetapi juga membiasakan siswa dalam menyampaikan gagasan, serta dapat menjadi pionir karakter anti-bullying di keluarga, sekolah, dan lingkungan masyarakat.
Social transformation in Russia in 1990: features of the legislative framework
Authors: Рахимьян Галимьянович Юсупов ,   Уфимский университет науки и технологий, Уфа, Россия, Айнур Рауфович Хайбуллин , Евгений Николаевич Григорьев ,   Уфимский университет науки и технологий, Уфа, Россия,   Уфимский университет науки и технологий, Уфа, Россия
Published: July 2024

The article reveals the problem of the formation of social policy in Russia in the 1990s, the features of the formation of the legislative framework.. In the 1990s, Russia faced a dual task – to formulate an economic policy based on market principles and, again based on the experience of Western countries, a new social policy. Western states are not unanimous on social issues, but social policies are formed and implemented by all. There are three basic models of it, in which the participation of the state in the implementation of social tasks is outlined in different ways. Russia faces the problem of adapting the state's social obligations to the consequences of market transformations. The Russian scenario turned out to be painful for the economy and social sphere. In Russia in the 1990s, social transformation laid some of the foundations for social policy. But it did not lead to the formation of social policy itself, which is incorrect to interpret as a certain sum of social measures, because any policy, including social policy, is usually understood as a mechanism developed by the state for regulating social relations, aimed at their harmonization. The authors made an attempt to establish socio-economic changes in society, highlighting individual periods that influenced the features of the formation of the legislative framework of the 1990s.
Trends and prospects’ application of GovTech in the process of public sector digitalization
Authors: Татьяна Валентиновна Подольская ,   Южно-Российский институт управления – филиал Российской академии народного хозяйства и государственной службы при Президенте РФ, Ростов-на-Дону, Россия, Фатимат Далхатовна Ульбашева , Евгения Александровна Васюта ,   Российская академия народного хозяйства и государственной службы при Президенте РФ, Москва, Россия,   Южно-Российский институт управления – филиал Российской академии народного хозяйства и государственной службы при Президенте РФ, Ростов-на-Дону, Россия
Published: July 2024

These days, governments are actively increasing the introduction of new GovTech solutions in order to improve the efficiency of public authorities work. The digital government, as a key concept of the public sector digitalization, is the next stage in the evolution of public administration, which is aimed at accelerating the decision-making process at the state and municipal levels, improving the interaction with citizens and public organizations, as well as increasing the level of trust in the authorities. The article analyses GovTech technologies and the principles of their introduction, the stages of public sector digital maturity. The COVID-19 pandemic was identified as the driver of the government digitization, but in the long run, the reactive policy should move to a complete reorganization of public administration systems in terms of the introduction of new technologies and ensuring cybersecurity. The article assesses the main challenges of GovTech introduction, as well as the key GovTech trends. Additionally, the authors analyzed the European and Russian practices of public administration digitalization. An analysis of GovTech concept, conducted by the authors, allowed to determine the conditions of growth of the Russian GovTech market and its prospects and to draw conclusions about the significant potential of Russia to successfully achieve the stage of the digital government.
Optimalisasi Proses Bisnis Badan Usaha Milik Desa (BUMD) Menggunakan Business Process Management: Studi Kasus Pada Penjualan Ikan di Banda Aceh
Authors: Izzaty Nur , Lufika Raihan Dara , Amalia Fella
Published: July 2024

BJM merupakan Badan Usaha Milik Desa (BUMD) di Banda Aceh yang bergerak dalam bisnis penjualan ikan. Dalam menjalankan unit bisnisnya, BJM belum memiliki pembukuan dan alur proses bisnis yang konsisten dan jelas yang berdampak pada kinerja organisasi, sehingga perlu dilakukan perancangan model dan perbaikan proses bisnis. Penelitian ini menggunakan metode Business Process Management (BPM) khususnya tahap identifikasi, penemuan, analisis dan perancangan ulang proses bisnis serta menggunakan notasi Business Process Model and Notation (BPMN) untuk pemodelan. Pada tahap identifkasi proses dihasilkan arsitektur proses bisnis penjualan ikan, kemudian pada penemuan proses didapatkan informasi detil sebagai acuan memodelkan as-is model. Model tersebut kemudian dianalisis dengan menggunakan 5 Whys analysis sehingga dapat diidentifikasi beberapa permasalahan seperti persediaan ikan tidak mencukupi, jenis ikan tidak sesuai dan tingkat penjualan relatif rendah. Rekomendasi perbaikan berdasarkan permasalahan pada analisis tersebut kemudian dirancang dan menghasilkan to-be model. Simulasi model proses bisnis dengan Bizagi modeler menunjukkan bahwa total waktu as-is model adalah sebesar 600 menit dan to-be model dengan waktu selama 628 menit. Meningkatnya waktu pada to-be model karena mempertimbangkan beberapa aktifitas tambahan yang dibutuhkan seperti sortasi ikan, penjualan secara online, dan pembukuan sehingga dapat menjadi standar dan mengoptimalkan kinerja proses bisnis penjualan ikan di BUMD.