bluuebunny/crossref_metadata_2025 huggingface dataset:
The COX-2-derived PGE2 Autocrine Contributes to Bradykinin-induced Matrix Metalloproteinase-9 Expression and Astrocytic Migration via STAT3 Signaling
Authors: Lee Tsong-Hai , Liu Pei-Shan , Tsai Ming-Ming , Chen Jiun-Liang , Wang Su-Jane , Hsieh Hsi-Lung
Published: July 2020

Background
The matrix metalloproteinase-9 (MMP-9) is up-regulated by several proinflammatory mediators in the central nervous system (CNS) diseases. Increasing reports show that MMP-9 expression is an inflammatory biomarker of several CNS disorders, including the CNS inflammation and neurodegeneration. Bradykinin (BK) is a common proinflammatory mediator and elevated in several brain injury and inflammatory disorders. The raised BK may be detrimental effects on the CNS that may aggravate brain inflammation through MMP-9 up-regulation or cyclooxygenase-2 (COX-2)-derived prostaglandin E2 (PGE2) production in brain astrocytes. However, the relationship between BK-induced MMP-9 expression and COX-2-derived PGE2 release in brain astrocytes remains unclear.
Methods
Herein we used rat brain astrocytes (RBA) to investigate the role of the COX-2/PGE2 system in BK-induced MMP-9 expression. We used zymographic, RT-PCR, EIA, and Western blotting analyses to confirm that BK induces MMP-9 expression via a COX-2/PGE2-dependent pathway.
Results
Our results show activation of native COX-2 by BK led to PGE2 production and release. Subsequently, PGE2 induced MMP-9 expression via PGE2 receptor (EP)-mediated c-Src, Jak2, ERK1/2, and then activated signal transducer and activator of transcription 3 (STAT3) signaling pathway. Finally, up-regulation of MMP-9 by BK via the pathway may promote astrocytic migration.
Conclusion
These results demonstrated that a novel autocrine pathway for BK-induced MMP-9 protein expression is mediated through activation of STAT3 by native COX-2/PGE2-mediated c-Src/Jak2/ERK cascades in brain astrocytes.
Improvement in BMI z-score following Adenotonsillectomy in Adolescents Aged 12-18 Years: A Retrospective Cohort Study
Authors: Nathan Keren , Livnat Galit , Feraru Liat , Pillar Giora
Published: July 2020

Background: obstructive sleep apnea (OSA) is associated with different patient characteristics according to age groups. OSA in babies and in prepubertal children is usually accompanied by a failure to thrive (FTT) and underweight. Adenotonsillectomy (T&A) is the first line of treatment for obstructive sleep apnea (OSA) in childhood. In the adult population and partly in adolescents OSA is commonly associated with obesity and the metabolic syndrome. In adolescents with OSA managed with a T&A the change in BMI was only occasionally studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. Methods: in Israel, Clalit Health Services is the largest health care organization with the largest patient registry (more than 50% of the population). From the Clalit registry, 242 adolescents aged 12-18 who underwent T&A between 2006-2015 were retrospectively studied. BMI z-score changes from up to 3 months prior to T&A were compared to BMI measures in the following 3 years post T&A.Results: there were changes to all directions with overall small increase, not statistically significant (P=0.26) in BMI Z-score with a median of 0.79 prior to and 0.835 following T&A. Overweight children (n=74) tended to reduce their BMI z-score from 1.508 to 1.48 following T&A (p=NS), and in obese children (n=33) BMI z-score decreased from 2.288 to 2.000 accordingly (P=0.06, 2 tailed). Interestingly thin individuals (n=6) increased their BMI z-score following T&A from -2.4 to -0.59 (p=0.046).Conclusions: adolescents managed with T&A show variable changes in their BMI z-score following the procedure. In this regard their BMI z-score change is closer to the change seen in adults treated for OSA and not young children. The changes observed show trend to normalize the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.
Inhibition of let-7b-5p contributes to anti-tumorigenic macrophage phenotype through SOCS1/STAT pathway in prostate cancer
Authors: Rong Jiping , Xu Lu , Hu Yinying , Liu Fan , Yu Yanrong , Guo Hongyan , Ni Xudong , Huang Yanqin , Zhao Lin , wang zhigang
Published: July 2020

BackgroundDysfunction of microRNAs (miRNAs) is a major cause of aberrant expression of inflammatory cytokines and contributes to macrophage polarization. Previous studies have shown that miRNA let-7 is associated with cell differentiation, and the expression of let-7b-5p is significantly increased in M2 macrophages. However, the mechanism by which let-7b-5p regulates macrophage differentiation in prostate cancer (PCa) remains largely unknown.MethodsHuman macrophages were induced by the blood monocytes from healthy male donors. M1 macrophages were polarized by stimulating overnight with 100 ng/ml lipopolysaccharides and 100 ng/ml IFN-γ, while conditioned medium from PC-3 cells were used to induce prostatic macrophages (M-CMs) in vitro, and then let-7b-5p mimics or inhibitors were transfected into M1 and M-CMs for 72 hours respectively. The expression of cluster of differentiation 206 (CD206) in each group was detected by a High Throughput Connotation of Imaging System. Quantitative real-time polymerase chain reaction (qRT-PCR) was executed to examine the expression of inflammatory cytokines IL-10, IL-12, IL-13, TNF-alpha and let-7b in macrophages. SOCS1 protein level was evaluated by ELISA, and the phosphorylation difference of STAT family member proteins was analysized by CST signal pathway chip. Phagocytosis of macrophages and the effect of macrophages on the proliferation of prostate cancer cell PC-3 were evaluated by phagocytosis assay or Cell Counting Kit-8 (CCK-8). The relationship between SOCS1 and let-7b-5p was confirmed with the dual-luciferase reporter.ResultsThe expression of cluster of differentiation 206 (CD206), an M2-like macrophage surface molecule, was significantly increased in M1 macrophages treated with let-7b-5p mimics, while CD206 expression was decreased in M-CMs treated with let-7b-5p inhibitors. Overexpression or knockdown of let-7b-5p significantly affected the expression of inflammatory factors in macrophages including interleukin 10 (IL-10), IL-12, IL-13, and tumor necrosis factor alpha. Let-7b-5p downregulated the expression of suppressor of cytokine signaling 1 (SOCS1) and increased the phosphorylation of signal transducer and activator of transcription 1 (STAT1), STAT3, and STAT5a proteins in M-CMs and M1 macrophages with let-7b-5p mimics compared with the other groups. In addition, with high expression of let-7b-5p, the phagocytosis of macrophages showed a significant decrease. As a result, M-CMs treated with let-7b-5p inhibitors reduced the proliferation of PC-3 PCa cells.ConclusionsCollectively, these data indicate that let-7b-5p may regulate M2 polarization through the SOCS1/STAT pathway, and reversal of M2 differentiation by let-7b-5p inhibitors can enhance macrophage phagocytosis, ultimately inhibiting the proliferation of PCa cells.Trial registrationNot applicable
Comparison of Acute Pneumonia Caused by SARS-COV-2 and Other Respiratory Viruses in Children: A Retrospective Multi-Centered Cohort Study During COVID-19 Outbreak
Authors: Ren Guangli , Wang Xianfeng , Xu Jun , Li Jun , Meng Qiong , Xie Guoqiang , Huang Bo , Zhu Weichun , Lin Jing , Tang Chenghe , Ye Sheng , Li Zhuo , Zhu Jie , Tang Zhen , Ma Mingxin , Xie Cong , Yang Fang , Zhou Yuzong , Zheng Ying , Lan Shuling , Chen Jianfeng , Ye Feng , He Yu , Wu Benqing , Fu Simao , Chen Long , Zheng Chengzhong , Shi Yuan
Published: July 2020

Background Coronavirus disease-2019 (COVID-19) has got more than 12 million infections and causing a certain degree of panic. We conducted this study to describe the clinical manifestations, treatment and outcome of COVID-19 in children, as compared to other viral pneumonia diagnosed during COVID-19 outbreak. Methods Children with COVID-19 and viral pneumonia of 20 hospitals were enrolled in this retrospective multi-centered cohort study. 64 children with COVID-19 were defined as the COVID-19 cohort, of which 40 cases developed to pneumonia were defined as the COVID-19 pneumonia cohort, while 284 pneumonia cases caused by other viruses were defined as the viral pneumonia cohort. Results Compared to the viral pneumonia cohort, children in the COVID-19 cohort were mostly exposed to confirmed family members (53/64 vs 23/284), with older median age (6.3 vs 3.2 yr), and shown higher proportion of ground-glass opacity (GGO) on computed tomography (18/40 vs 0/38), all P＜0.001. Children in the COVID-19 pneumonia cohort had lower proportion of severe cases (1/40 vs 38/284, P=0.048), cases with high fever (3/40 vs 167/284, P＜0.001), cases required intensive care (1/40 vs32/284, P＜0.047) and the symptomatic duration was shorter (median 5 vs 8 days, P＜0.001). The proportion of cases with evaluated inflammatory indicators, biochemical indicators related to organ or tissue damage, D-dimer and secondary infection with bacteria were lower in the COVID-19 pneumonia cohort than that of viral pneumonia cohort (all P＜0.05). There was no statistic difference in the duration of positive PCR results from pharyngeal swabs when antiviral drugs (Lopinavir-ritonavir, ribavirin, and arbidol) were used in 25 children with COVID-19 as compared to 39 cases without antiviral therapy [median 10 vs 9 days, P=0.885].Conclusions The symptoms and severity of COVID-19 pneumonia in children were no more severe than those of other viral pneumonia. Lopinavir-ritonavir, ribavirin and arbidol cannot shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19 in this study. Children with other pathogens infection should be paid attention to even though the COVID-19 outbreak.
Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective.
Authors: Hilbert-Carius P. , Braun Jörg , Abu-Zidan Fikri , Adler Jörn , Knapp Jürgen , Dandrifosse Didier , Braun Désirée , Pietsch Urs , Adamczuk Patrick , Rognås Leif , Albrecht Roland
Published: July 2020

Background: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services—particularly helicopter services—caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients.Methods: Nine different HEMS providers across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers agreed and reported their data. 385 COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions.Results: All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 3 (1-7) compared with 4 (2-5), needed significantly more medical interventions, were significantly younger (59.6±16 vs 65±21 years), and were significantly more often male (73% vs 60.5%). Conclusions: All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.
Long-Period Ground Motion Simulation Based on Three-dimensional Centroid Moment Tensor Inversion Solutions in the Kanto Region, Japan
Authors: Takemura Shunsuke , Yoshimoto Kazuo , Shiomi Katsuhiko
Published: July 2020

We conducted centroid moment tensor (CMT) inversions of moderate (Mw 4.5–6.5) earthquakes in the Kanto region, Japan, using a local three-dimensional (3D) model. We then investigated the effects of our 3D CMT solutions on long-period ground motion simulations. Grid search CMT inversions were conducted using displacement seismograms for periods of 25–100 s. By comparing our 3D CMT solutions with those from the local one-dimensional (1D) catalog, we found that our 3D CMT inversion systematically provides magnitudes smaller than those in the 1D catalog. The Mw differences between 3D and 1D catalogs tend to be significant for earthquakes within the oceanic slab. By comparing ground motion simulations between 1D and 3D velocity models, we confirmed that observed Mw differences could be explained by differences in the rigidity structures around the source regions between 3D and 1D velocity models. The 3D velocity structures (especially oceanic crust and mantle) are important for estimating seismic moments in intraslab earthquakes. The seismic moments directly affect the amplitudes of ground motions. Thus, 3D CMT solutions are essential for the precise forward and inverse modeling of long-period ground motion. We also conducted long-period ground motion simulations using our 3D CMT solutions to evaluate reproducibility of long-period ground motions at stations within the Kanto Basin. The simulations of our 3D CMT inversion well-reproduced observed ground motions for periods longer than 10 s, even at stations within the Kanto Basin.
Radiomic model for differentiating parotid pleomorphic adenoma from parotid adenolymphoma based on MRI images
Authors: Song Le-le , Chen Shun-jun , Chen Wang , Shi Zhan , Wang Xiao-dong , Song Li-na , Chen Dian-sen
Published: July 2020

Background: Magnetic resonance imaging (MRI) is used routinely in the clinical management, and we explored the diagnostic value of radiomic signatures based on MRI to distinguish parotid pleomorphic adenoma from parotid adenolymphoma. Methods: The clinical characteristics and images data were retrospectively collected from 252 cases (126 cases in training cohort and 76 patients in verification cohort) in this study. And 429 radiomic features of T1-weighted imaging (T1WI) sequence and 414 radiomic features of T2-weighted imaging (T2WI) were extracted from MRI images. We selected the radiomic features from three sequences (T1WI, T2WI and T1-2WI) by univariate analysis, lasso correlation and spearman correlation. Then we built six quantitative radiological models based on the selected radiomic features using two machine learning methods (multivariable logistic regression, MLR and support vector machine, SVM). We assessed the performance of the six radiomic models, and an ideal radiomic signature was chosen to compare its diagnosis efficacy with that of the clinical model. ﻿Results: The radiomic model based on features of T1-2WI sequence by MLR showed optimal discriminatory (accuracy = 0.87 and 0.86, F-1score = 0.88 and 0.86, Sensitivity= 0.90 and 0.88, Specificity=0.82 and 0.80 positive predictive value=0.86 and 0.84, negative predictive value=0.86 and 0.84 in training and validation cohorts, respectively) and its good calibration was also observed (p>0.05). The area under the receiver operating characteristic curve (AUC) of the T1-2WI radiomic model was significantly better than that of the clinical model for both the training (0.95 vs. 0.74, p=0.000) and validation (0.90 vs. 0.73, p=0.001) cohorts. Conclusions: The radiomic model based on MRI in our study is complementary to the current knowledge of differential diagnosis for parotid pleomorphic adenoma and parotid adenolymphoma.
Quantitative Assessment of Retinal Thickness and Vessel Density Using Optical Coherence Tomography Angiography in Patients with Alzheimer’s Disease and Glaucoma
Authors: Zabel Przemyslaw , Kaluzny Jakub J. , Zabel Katarzyna , Kaluzna Martyna , Lamkowski Aleksander , Jaworski Damian , Makowski Jaroslaw , Kucharski Robert
Published: July 2020

Background
Retinal imaging using optical coherence tomography (OCT) and OCT angiography (OCTA) may serve as an alternative approach to monitoring and diagnosing neurodegenerative diseases such as Alzheimer's disease (AD) and primary open-angle glaucoma (POAG). In this study, we performed direct comparisons of retinal vessel density with the thickness of inner retinal layer (IRL) and outer retinal layer (ORL) in patients with AD and POAG.
Methods
In this cross-sectional study, we analyzed data from 48 eyes of healthy control (HC) participants, 71 eyes of POAG patients, and 49 eyes of AD patients with confirmed presence of fibrillar brain amyloid on positron emission tomography (PET) imaging with florbetapir F 18. Ophthalmic examination included OCT imaging to measure IRL and ORL thickness in the macula and OCTA in the same region for the imaging of vessel density in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) of the retina. A direct comparison of vessels density and retinal layers thickness, which different dynamic ranges, was obtained by normalizing values as percentage losses. Values were adjusted for inter-eye correlation, age, gender, and scan quality, where applicable.
Results
Patients with AD presented significantly greater losses of vascular density in the DVP and ORL thickness compared to POAG (p < 0.001), but percentage losses of vessel density in SVP and IRL thickness were considerable in POAG compared to AD eyes (p < 0.001). Positive associations among presence of AD were observed primarily in outer retina where a 1% decrease of ORL thickness was associated with about 24–29% increase in odds of the presence of AD. According to OCTA measurements, a 1% decrease of vessel density in DVP was positively associated with a 4–9% increase in odds of the presence of AD. In POAG positive associations among presence of disease were observed only in inner retina where 1% loss of IRL thickness and a 1% loss of vessel density in the SVP were positively associated with a 13–23% increase in risk of presence of the disease.
Conclusions
Analysis of ORL thickness and vessel density in DVP could potentially improve diagnostic capabilities and may provide a valuable approach for predicting of AD.
A Quantitative Site-Specific Classification Approach Based on Affinity Propagation Clustering
Authors: Moustafa Sayed , Khan Farhan , Metwaly Mohamed , A.Elawadi Eslam , Al-Arifi Nassir
Published: July 2020

Investigations made to evaluate the site effect characteristics and develop a reliable site classification scheme have received the paramount importance for the planning of urban areas and for a reliable site-specific seismic hazard assessment. This paper presents a new approach for site classification based on affinity propagation (AP) along with a selected set of representative horizontal to vertical spectral ratio (HVSR) curves inside King Saud University (KSU) campus. Measurements of the ambient vibrations were performed to cover the entire campus area by about 307 stations with 20 minutes recording length and sample rate of 128 Hz for each station to satisfy the criteria for reliable and unambiguous HVSR results. Predominant period values were used for identifying of site response and subsequent site classification. Empirical equations from the literature relating frequency of HVSR peak to average shear wave velocity in the upper 30m, commonly used as a proxy for site classification, were found to be unreliable, making site classification difficult. To overcome this problem, Affinity propagation clustering algorithm is used. The obtained results illustrated that microtremors spectral ratios can be remarkably robust tool in determining site effects. The survey results concluded to the preliminary seismic site classification map for the mapped area, which would be useful for future safe design of structures. Finally, the results presented in this study are encouraging prolongation of this type of study in other parts of Saudi Arabia using the microtremors data and site response functions.
Comprehensive analysis of the functions and prognostic significance of RNA-binding proteins in bladder urothelial carcinoma
Authors: Guo Changgang , Shao Ting , Wei Dadong , Wang Zhanhua , Li Mingyang , Jiang Xiling , Bao Guochang
Published: July 2020

Background

Alterations in RNA-binding proteins (RBPs) are reported in various cancer types; however, the role of RBPs in bladder urothelial cancer (BLCA) remains unknown. This study aimed to systematically examine the function and prognostic significance of RBPs in bladder cancer using bioinformatics analyses.
Methods

RNA sequencing and clinical data for BLCA were downloaded from The Cancer Genome Atlas (TCGA) database, and differentially expressed RBPs (DERBPs) between normal and cancer tissues were identified. Protein-protein interaction (PPI) network of DERBPs was established, and enrichment analysis and visualizations were performed. A total of 404 patients with BLCA from TCGA database were randomly divided into training and testing groups. A prognostic model was constructed using the data from training group, and validated in the testing group. Receiver operating characteristic (ROC) curve and survival analysis were performed to explore the prognostic value of the model. A nomogram was established to predict survival in bladder cancer patients. Finally, the verification of prognosis-related hub RBP survival analysis were performed.
Results

A total of 388 DERBPs were identified, including 219 upregulated and 169 downregulated RBPs. All RBPs were screened for prognostic model establishment and 9 RBPs (TRIM71, YTHDC1, DARS2, XPOT, ZNF106, FTO, IPO7, EFTUD2, and CTU1) were regarded as prognosis-related hub RBPs in BLCA. Further analysis revealed worse overall survival (OS) in the high-risk cohort compared to the model-based low-risk cohort. The area under the ROC curve was 0.752 in the training group and 0.701 in the testing group, which confirms the good prediction ability. A nomogram was established according to nine prognosis-related RBPs, which showed well predicting ability for BLCA. BLCA patients with high DARS2, XPOT, ZNF106, FTO, and IPO7 expression (on the contrary, low YTHDC1 and CTU1 expression) were correlated to poor overall survival.
Conclusions

The prognosis-related hub RBPs may be involved in oncogenesis, development, and metastasis of BLCA. Our results will be of great significance in revealing the pathogenesis of BLCA, and developing new therapeutic targets and prognostic molecular markers.
Overview of Current Phosphoric Acid Production Processes and a New Idea of Kiln Method
Authors: Zheng Guangya , Xia Jupei , Chen Zhengjie
Published: July 2020

China primarily contains medium and low-grade phosphorus ores that are used to produce
phosphoric acid. Here, we provide an overview of phosphoric acid production processes, including
wet, thermal, and Kiln methods, as well as the fundamental principles, major equipment, and technological
aspects of each process. Progress in the Kiln method using low-grade phosphate rock is described,
which involves the KPA and CDK processes. The literature shows that the addition of admixtures
adds great competitiveness to Kiln phosphate production methods and has considerable development
prospects.
Intermolecular Haloamination: Double Functionalization for Accesses to Vicinal Haloamines Involving Alkenes and Alkynes
Authors: Wang Yi-Ning , Qi Gang , Sun Guo-Xiang
Published: July 2020

Haloamination (or called aminohalogenation) upon the C-C unsaturated bonds is an important
amino functionalization, which can introduce the halogen atoms accompanying with the amino
groups into the substrate backbones in a tandem manner. Over the past two decades, it has drawn
increasing attention due to its versatile applications. In this review, we will mainly focus on the synthetic
strategies anchoring the intermolecular haloamination reactions achieved in the past few years.
Limited by the length of the context, the intramolecular haloamination and the applications of the
vicinal haloamines will not be involved.
New Trends of Deep Learning in Clinical Cardiology
Authors: Chen Zichao , Zhou Qi , Khan Aziz , Jill Jordan , Xiong Rixin , Liu Xu
Published: July 2020

Deep Learning (DL) is a novel type of Machine Learning (ML) model. It is showing an
increasing promise in medicine, study and treatment of diseases and injuries, to assist in data
classification, novel disease symptoms and complicated decision making. Deep learning is one of
form of machine learning typically implemented via multi-level neural networks. This work
discusses the pros and cons of using DL in clinical cardiology that is also applied in medicine in
general while proposing certain directions as more viable for clinical use. DL models called Deep
Neural Networks (DNNs), Recurrent Neural Networks (RNNs) and Convolutional Neural
Networks (CNNs) have been applied to arrhythmias, electrocardiogram, ultrasonic analysis,
genomes and endomyocardial biopsy. Convincingly, the results of the trained model are
satisfactory, demonstrating the power of more expressive deep learning algorithms for clinical
predictive modeling. In the future, more novel deep learning methods are expected to make a
difference in the field of clinical medicines.
STAKEHOLDER MANAGEMENT OF CONSERVATION IN LOWER KINABATANGAN SABAH
Authors: Pimid Marcela , Abdul Latip Normah , Marzuki Azizan , Umar Mohd Umzarulazijo , Krishnan Kumara Thevan
Published: July 2020

Effective conservation measures are essential to protect nature and wildlife which act as flagship attraction for ecotourism to flourish. The study focuses on conservation management of natural forests and wildlife by multiple stakeholders in Lower Kinabatangan Sabah. Rare and endangered wildlife species is the main attraction for ecotourism development in this area. The study employed a mixed method research by integrating quantitative and qualitative approaches. Analyses revealed contradictory findings whereby local indigenous communities were unaware about progress of established Lower Kinabatangan Wildlife Sanctuary and thereby requested for enhancing current conservation management. However, other stakeholders reported that the sanctuary fulfilled its objectives. The study further proposed solutions to improve current conservation by considering the viewpoints of all stakeholders involved in conservation initiatives in the Lower Kinabatangan Sabah.
Including Social and Behavioral Determinants in Predictive Models: Trends, Challenges, and Opportunities
Authors: Tan Marissa , Hatef Elham , Taghipour Delaram , Vyas Kinjel , Kharrazi Hadi , Gottlieb Laura , Weiner Jonathan
Published: July 2020

In an era of accelerated health information technology capability, health care organizations increasingly use digital data to predict outcomes such as emergency department use, hospitalizations, and health care costs. This trend occurs alongside a growing recognition that social and behavioral determinants of health (SBDH) influence health and medical care use. Consequently, health providers and insurers are starting to incorporate new SBDH data sources into a wide range of health care prediction models, although existing models that use SBDH variables have not been shown to improve health care predictions more than models that use exclusively clinical variables. In this viewpoint, we review the rationale behind the push to integrate SBDH data into health care predictive models and explore the technical, strategic, and ethical challenges faced as this process unfolds across the United States. We also offer several recommendations to overcome these challenges to reach the promise of SBDH predictive analytics to improve health and reduce health care disparities.
A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study
Authors: Ryan Kelly Ann , Babu Pallavi , Easter Rebecca , Saunders Erika , Lee Andy Jinseok , Klasnja Predrag , Verchinina Lilia , Micol Valerie , Doil Brent , McInnis Melvin G , Kilbourne Amy M
Published: July 2020

Background

There is considerable scientific interest in finding new and innovative ways to capture rapid fluctuations in functioning within individuals with bipolar disorder (BD), a severe, recurrent mental disorder associated with frequent shifts in symptoms and functioning. The use of smartphones can provide valid and real-world tools for use in measurement-based care and could be used to inform more personalized treatment options for this group, which can improve standard of care.

Objective

We examined the feasibility and usability of a smartphone to capture daily fluctuations in mood within BD and to relate daily self-rated mood to smartphone use behaviors indicative of psychomotor activity or symptoms of the illness.

Methods

Participants were 26 individuals with BD and 12 healthy control individuals who were recruited from the Prechter Longitudinal Study of BD. All were given a smartphone with a custom-built app and prompted twice a day to complete questions of mood for 28 days. The app automatically and unobtrusively collected phone usage data. A poststudy satisfaction survey was also completed.

Results

Our sample showed a very high adherence rate to the daily momentary assessments (91% of the 58 prompts completed). Multivariate mixed effect models showed that an increase in rapid thoughts over time was associated with a decrease in outgoing text messages (β=–.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration (β=–.29; P=.02). Participants generally reported positive experiences using the smartphone and completing daily prompts.

Conclusions

Use of mobile technology shows promise as a way to collect important clinical information that can be used to inform treatment decision making and monitor outcomes in a manner that is not overly burdensome to the patient or providers, highlighting its potential use in measurement-based care.
TeleWound Practice Within the Veterans Health Administration: Protocol for a Mixed Methods Program Evaluation
Authors: Etingen Bella , Patrianakos Jamie , Wirth Marissa , Hogan Timothy P , Smith Bridget M , Tarlov Elizabeth , Stroupe Kevin T , Kartje Rebecca , Weaver Frances M
Published: July 2020

Background

Chronic wounds, such as pressure injuries and diabetic foot ulcers, are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound Practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the rollout of the TWP, starting with regional implementation.

Objective

This paper aims to describe the protocol for a mixed-methods program evaluation to assess the implementation and outcomes of TWP in VA.

Methods

We are conducting a mixed-methods evaluation of 4 VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from veterans, VA health care team members, and other key stakeholders (eg, clinical leadership). We will use qualitative methods (ie, semistructured interviews), site visits, and quantitative methods (ie, surveys, national VA administrative databases) to assess the process and reach of TWP implementation and its impact on veterans’ clinical outcomes and travel burdens and costs.

Results

This program evaluation was funded in October 2019 as a Partnered Evaluation Initiative by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310).

Conclusions

Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful rollout of the TWP nationally. Our evaluation work will inform future efforts to scale up the TWP across VA and optimize reach of the program to veterans across the nation.

International Registered Report Identifier (IRRID)

DERR1-10.2196/20139
Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review (Preprint)
Authors: Poly Tahmina Nasrin , Islam Md.Mohaimenul , Yang Hsuan-Chia , Li Yu-Chuan (Jack)
Published: July 2020

BACKGROUND

The clinical decision support system (CDSS) has become an indispensable tool for reducing medication errors and adverse drug events. However, numerous studies have reported that CDSS alerts are often overridden. The increase in override rates has raised questions about the appropriateness of CDSS application along with concerns about patient safety and quality of care.

OBJECTIVE

The aim of this study was to conduct a systematic review to examine the override rate, the reasons for the alert override at the time of prescribing, and evaluate the appropriateness of overrides.

METHODS

We searched electronic databases, including Google Scholar, PubMed, Embase, Scopus, and Web of Science, without language restrictions between January 1, 2000 and March 31, 2019. Two authors independently extracted data and crosschecked the extraction to avoid errors. The quality of the included studies was examined following Cochrane guidelines.

RESULTS

We included 23 articles in our systematic review. The range of average override alerts was 46.2%-96.2%. An average of 29.4%-100% of the overrides alerts were classified as appropriate, and the rate of appropriateness varied according to the alert type (drug-allergy interaction 63.4%-100%, drug-drug interaction 0%-95%, dose 43.9%-88.8%, geriatric 14.3%-57%, renal 27%-87.5%). The interrater reliability for the assessment of override alerts appropriateness was excellent (kappa=0.79-0.97). The most common reasons given for the override were “will monitor” and “patients have tolerated before.”

CONCLUSIONS

The findings of our study show that alert override rates are high, and certain categories of overrides such as drug-drug interaction, renal, and geriatric were classified as inappropriate. Nevertheless, large proportions of drug duplication, drug-allergy, and formulary alerts were appropriate, suggesting that these groups of alerts can be primary targets to revise and update the system for reducing alert fatigue. Future efforts should also focus on optimizing alert types, providing clear information, and explaining the rationale of the alert so that essential alerts are not inappropriately overridden.
Experiences With Wearable Activity Data During Self-Care by Chronic Heart Patients: Qualitative Study (Preprint)
Authors: Andersen Tariq Osman , Langstrup Henriette , Lomborg Stine
Published: July 2020

BACKGROUND

Most commercial activity trackers are developed as consumer devices and not as clinical devices. The aim is to monitor and motivate sport activities, healthy living, and similar wellness purposes, and the devices are not designed to support care management in a clinical context. There are great expectations for using wearable sensor devices in health care settings, and the separate realms of wellness tracking and disease self-monitoring are increasingly becoming blurred. However, patients’ experiences with activity tracking technologies designed for use outside the clinical context have received little academic attention.

OBJECTIVE

This study aimed to contribute to understanding how patients with a chronic disease experience activity data from consumer self-tracking devices related to self-care and their chronic illness. Our research question was: “How do patients with heart disease experience activity data in relation to self-care and chronic illness?”

METHODS

We conducted a qualitative interview study with patients with chronic heart disease (n=27) who had an implanted cardioverter-defibrillator. Patients were invited to wear a FitBit Alta HR wearable activity tracker for 3-12 months and provide their perspectives on their experiences with step, sleep, and heart rate data. The average age was 57.2 years (25 men and 2 women), and patients used the tracker for 4-49 weeks (mean 26.1 weeks). Semistructured interviews (n=66) were conducted with patients 2–3 times and were analyzed iteratively in workshops using thematic analysis and abductive reasoning logic.

RESULTS

Of the 27 patients, 18 related the heart rate, sleep, and step count data directly to their heart disease. Wearable activity trackers actualized patients’ experiences across 3 dimensions with a spectrum of contrasting experiences: (1) knowing, which spanned gaining insight and evoking doubts; (2) feeling, which spanned being reassured and becoming anxious; and (3) evaluating, which spanned promoting improvements and exposing failure.

CONCLUSIONS

Patients’ experiences could reside more on one end of the spectrum, could reside across all 3 dimensions, or could combine contrasting positions and even move across the spectrum over time. Activity data from wearable devices may be a resource for self-care; however, the data may simultaneously constrain and create uncertainty, fear, and anxiety. By showing how patients experience self-tracking data across dimensions of knowing, feeling, and evaluating, we point toward the richness and complexity of these data experiences in the context of chronic illness and self-care.
Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study (Preprint)
Authors: Mena Luis J , Félix Vanessa G , Ostos Rodolfo , González Armando J , Martínez-Peláez Rafael , Melgarejo Jesus D , Maestre Gladys E
Published: July 2020

BACKGROUND

Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension.

OBJECTIVE

This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people.

METHODS

The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor.

RESULTS

The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds.

CONCLUSIONS

With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations.
Virtual Reality Self-help Treatment for Aviophobia: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Fehribach Jamie Rhiannon , Toffolo Marieke Bianca Jolien , Cornelisz Ilja , van Klaveren Chris , van Straten Annemieke , van Gelder Jean-Louis , Donker Tara
Published: July 2020

BACKGROUND

Aviophobia (the fear of flying) can greatly impact the daily life functioning of people with the condition. Traditional exposure-based treatment is hampered by the limited availability of airplane practice situations, which is a result of economical and practical concerns. Easily accessible and low-cost virtual reality exposure therapy may address these challenges.

OBJECTIVE

The purpose of our study is to investigate the effectiveness of ZeroPhobia: Aviophobia (a self-help mobile app–based treatment) in reducing flight anxiety symptoms and depressive and anxiety symptoms. We will also investigate the effects of usage intensity, the sense of immersion, inherent absorption ability, and perceived user-friendliness on the treatment effect.

METHODS

Participants (N=114) who are aged 18-64 years and experience at least mild symptoms of aviophobia will be recruited from the general Dutch population and randomized into a treatment group or waitlist control group. By using their own phones and rudimentary mobile virtual reality headsets, participants will receive six modules of psychoeducation and cognitive behavioral therapy, which will include six levels of virtual reality exposure therapy over a period of 6 weeks. Assessments will be conducted at baseline, posttest (ie, after 6 weeks), and 3- and 12-month follow-ups. The primary outcome measure of our study is the Flight Anxiety Situations Questionnaire. The secondary outcome measures include anxiety and depression measures and additional covariates (including usage intensity, the degree of immersion, etc). We will test treatment effectiveness by conducting an intention-to-treat analysis and estimating average treatment effects on the treated. The mechanisms of treatment effect will also be explored.

RESULTS

The study was funded on September 25, 2018. Ethical approval was received on October 11, 2019. Recruitment closed on May 7, 2020.

CONCLUSIONS

Our study will further the scientific understanding and clinical implications of technology’s current ability to aid in providing effective, accessible treatment for the fear of flying.

CLINICALTRIAL

Netherlands Trial Registry NL70238.029.19; https://www.trialregister.nl/trial/8257.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/22008
Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study (Preprint)
Authors: Gordon Kayleigh , Dainty Katie N , Steele Gray Carolyn , DeLacy Jane , Shah Amika , Resnick Myles , Seto Emily
Published: July 2020

BACKGROUND

Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs.

OBJECTIVE

This study aims to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care.

METHODS

A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor.

RESULTS

In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs.

CONCLUSIONS

Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team.
Patient and health professional’s perception of available mobile applications (app) for managing gestational diabetes mellitus (GDM) (Preprint)
Authors: Ding Mingshuang
Published: July 2020

BACKGROUND

Gestational diabetes mellites (GDM) is a type of diabetes that commonly occur in the second part of the pregnancy and usually goes away once the baby is born. Maternal risk associated with GDM are pre-eclampsia, caesarean delivery, perineal trauma, post-partum haemorrhage and delayed breastfeeding. Possible neonatal risk also included macrosomia growth restriction, birth injuries, respiratory distress, hypoglycaemia and jaundice. Dietary advice and blood glucose monitoring and glucose-lowering therapy should be offered to diagnosed patients.
The increasing ownership of mobile phones and advances in mobile applications (apps) provide an innovative personalised management among women with GDM.
Numerous mobile phone apps are available for women to gain access via app stores, however to our knowledge, no review has documented both health professional and patient’s perception of those apps. The use of telemedicine was convincingly shown to result in better glucose control, but reduced costs to the health system or patients, and patient or health-carer acceptability were not clearly demonstrated due to limited data.

OBJECTIVE

This review was aimed to discover patient and health professional’s perception of mobile apps available for managing GDM via both app stores and 5 relevant electronic databases.

METHODS

Two separate searches were conducted, i.e. app stores (iTunes and Google Play store), electronic databases CINAHL, Cochrane library, Medline, PsycINFO and PubMed using major key words: patient, health professional, perception, mobile application and gestational diabetes.

RESULTS

Seven studies were included in the final analysis. We categorised articles under two themes: 1) patient’s experiences of available mobile apps focused on GDM and 2) health professional’s feedback on mobile apps focused on GDM. Only two studies focused on both patient and health professional’s perception on mobile apps to manage GDM.

CONCLUSIONS

There is a limited body of research on mobile apps in relation to both patient and health professional’s perception of GDM management. Mobile apps can be an effective way to manage GDM, but apps should not be restricted to collecting and providing information only. Collected data should be shared as a communication platform for both patients and health professional to be utilised as an active tool to update GDM treatment plans.

CLINICALTRIAL

N/A