bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing the Effectiveness of Flipped Classroom in Health Science Education: A State-of-the-art Review
Authors: Oudbier Janique , Spaai Gerard , Timmermans Karline , Boerboom Tobias
Published: July 2021

Background. In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as learning achievement, the achievement of higher learning goals, and student perceptions. Methods. A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method. Results. After screening the studies based on the inclusion-and exclusion criteria, 60 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner’s level of self-regulated learning, teacher’s role and motivation, assessment approach, and guidance during self-study. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom. Conclusion. This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.
Synergistic interaction between propolis extract, essential oils, and antibiotics against Staphylococcus epidermidis and methicillin resistant Staphylococcus aureus
Authors: BELMEHDİ Omar , BOUYAHYA Abdelhakim , JEKŐ József , CZİÁKY Zoltán , ZENGİN Gokhan , SOTKÓ Gyula , EL BAABOUA Aicha , SENHAJİ Nadia Skali , ABRİNİ Jamal
Published: July 2021

The development of multi-drug-resistant bacteria pushed the scientific community to look for new alternatives to solve the problem. Propolis is a beehive substance and one of the richest natural products in bioactive compounds with antibacterial activity. This study was aimed to investigate the possible synergistic interaction between propolis and antibacterial drugs, such as essential oils (EOs) and antibiotics, in order to find increased activity with decreased concentrations. Two ethanol extracts of propolis were used for the test, which were collected from the north of Morocco. The chemical composition was determined by UHPLC-MS. The synergistic effect of propolis extracts with EOs and antibiotics was tested using the checkerboard technique. The chemical analysis showed the presence of more that 100 compounds in propolis extracts, belonging mainly to flavonoids. The combination of propolis with the other antibacterial drugs showed different types of interactions with FIC index values varied from 0.18 to 1, but no antagonist effect was noticed. With FICI<0.5, the synergistic effect was obtained with essential oils as well as with antibiotics. These results indicate that propolis can be a promising source of molecules with medical interest to treat bacterial infection and/or to increase the action of antibiotics.
ZEÓLITA NaA SINTETIZADA SOBRE FIBRA DE VIDRO COMO ESTRATÉGIA PARA OTIMIZAÇÃO DO ABRANDAMENTO DE ÁGUAS DURAS
Authors: Oliveira Edipo , Alves Conceição , França Antonia , Nascimento Ronaldo , Sasaki José , Loiola Adonay
Published: July 2021

NaA ZEOLITE SYNTHESIZED OVER FIBERGLASS AS A STRATEGY FOR OPTIMIZING HARD WATER SOFTENING. Zeolite NaA has been successfully synthesized over glass fiber surface previously activated by alkaline treatment. By varying the time of the treatment and the amount of silica and alumina precursors used in the reaction mixture, a sample with higher zeolite concentration could be obtained. This material was evaluated for water softening process as an alternative substitute for the use of the zeolite in its powder form, in which several drawbacks related to recovery and reuse limit its application. Water softening experiments, carried out in a continuous flow system, with a column containing the glass fiber-zeolite NaA, showed high performance in decreasing the Ca2+ ions, with complete removal achieved for 20 mL of simulated hard water (Ca2+ 100.0 mg L– ¹) by using 200 mg of the sample in form of column (10 mm diameter × 300 mm high). The sample maintained this performance in a wide range of pH (3.0-9.0), and also presented a feasible regenerability, with no decrease in its performance during the first four cycles of use, reaching 87.3% of efficiency over the tenth cycle.
Impact of land-use and land-cover change on soil erosion using the RUSLE model and the geographic information system: a case of Temeji watershed, Western Ethiopia
Authors: Moisa Mitiku Badasa , Negash Daniel Assefa , Merga Biratu Bobo , Gemeda Dessalegn Obsi
Published: July 2021

The impact of land-use land-cover (LULC) change on soil resources is getting global attention. Soil erosion is one of the critical environmental problems worldwide with high severity in developing countries. This study integrates the Revised Universal Soil Loss Equation model with a geographic information system to estimate the impacts of LULC conversion on the mean annual soil loss in the Temeji watershed. In this study, LULC change of Temeji watershed was assessed from 2000 to 2020 by using 2000 Landsat ETM+ and 2020 Landsat OLI/TIRS images and classified using supervised maximum likelihood classification algorithms. Results indicate that the majority of the LULC in the study area is vulnerable to soil erosion. High soil loss is observed when grassland and forest land were converted into cultivated land with a mean soil loss of 88.8 and 86.9 t/ha/year in 2020. Results revealed that about 6,608.5 ha (42.8%) and 8,391.8 ha (54.4%) were categorized under severe classes in 2000 and 2020, respectively. Accordingly, the soil loss severity class is directly correlated with the over-exploitation of forest resources and grasslands for agricultural purposes. These results can be useful for advocacy to enhance local people and stakeholder's participation toward soil and water conservation practices.
Quantifying the effects of watershed subdivision scale and spatial density of weather inputs on hydrological simulations in a Norwegian Arctic watershed
Authors: Bui Minh Tuan , Lu Jinmei , Nie Linmei
Published: July 2021

The effects of watershed subdivisions on hydrological simulations have not been evaluated in Arctic conditions yet. This study applied the Soil and Water Assessment Tool and the threshold drainage area (TDA) technique to evaluate the impacts of watershed subdivision on hydrological simulations at a 5,913-km2 Arctic watershed, Målselv. The watershed was discretized according to four TDA scheme scales including 200, 2,000, 5,000, and 10,000 ha. The impacts of different TDA schemes on hydrological simulations in water balance components, snowmelt runoff, and streamflow were investigated. The study revealed that the complexity of terrain and topographic attributes altered significantly in the coarse discretizations: (1) total stream length (−47.2 to −74.6%); (2) average stream slope (−68 to −83%); and (3) drainage density (−24.2 to −51.5%). The spatial density of weather grid integration reduced from −5 to −33.33% in the coarse schemes. The annual mean potential evapotranspiration, evapotranspiration, and lateral flow slightly decreased, while areal rainfall, surface runoff, and water yield slightly increased with the increases of TDAs. It was concluded that the fine TDAs produced finer and higher ranges of snowmelt runoff volume across the watershed. All TDAs had similar capacities to replicate the observed tendency of monthly mean streamflow hydrograph, except overestimated/underestimated peak flows. Spatial variation of streamflow was well analyzed in the fine schemes with high density of stream networks, while the coarse schemes simplified this. Watershed subdivisions affected model performances, in the way of decreasing the accuracy of monthly streamflow simulation, at 60% of investigated hydro-gauging stations (3/5 stations) and in the upstream. Furthermore, watershed subdivisions strongly affected the calibration process regarding the changes in sensitivity ranking of 18 calibrated model parameters and time it took to calibrate.
Potential production of struvite from the anaerobic digestion of food waste: analysis in one-phase and two-phase configurations
Authors: Parra-Orobio Brayan Alexis , Pérez-Vidal Andrea , Torres-Lozada Patricia
Published: July 2021

Anaerobic digestion (AD) of food waste (FW) has been gaining more interest as it has potential for the production of organic amendments with high struvite (NH4MgPO4·6H2O) content, which is a nutrient of great interest in sustainable agriculture. In this study, the influence of AD of FW in one- and two-phase configurations on methane production and the potential for struvite formation using digestate was evaluated. It was found that the two-phase is more efficient as its organic loading rate is 18% higher than that of one-phase configuration. In addition, the two-phase yielded a higher methane content in biogas (>60%) and a higher organic matter transformation in each of the AD stages (>20%); further, the digestate complied with the regulatory requirements for the use of organic amendments, thereby being deemed as a Type-B material with a struvite precipitation potential, exceeding 80%, as opposed to the digestate from one-phase configuration, which may represent a revenue of up to US$ 26,505 per year.
RESEARCH OF IRP SYSTEMS BASED ON THE ANALYSIS OF MECHANISMS OF RESPONSE TO INFORMATION SECURITY INCIDENTS
Authors:   Kuban State Technological University, OCHEREDKO ANDREY R. , BACHMANOV DMITRIY A. ,   Kuban State Technological University, PUTYATO MICHAEL M. ,   Kuban State Technological University, MAKARYAN ALEXANDER S. ,   Kuban State Technological University
Published: July 2021

The article discusses the features and functions of information security incident response systems. The analysis of modern IRP solutions is presented and the process of responding to typical incidents in systems of this class is described. Based on expert opinions, a list of criteria was formed, which were divided into groups by areas of functional responsibility for further comparison of the work of IRP systems. The assessment of the main and additional characteristics of IRP-systems was carried out using the formed criterion groups. The analysis of the comparison results showed that the most promising solutions are R-Vision IRP, IBM Resilient IRP and open-source solution - The Hive. The algorithm of the module for preventing phishing attacks was developed and presented, the software implementation of which was made using the Python language. As part of the integration capabilities of The Hive, a custom response function was implemented that not only potentially improved the system's performance in preventing phishing attacks, but also increased employee awareness of this threat. The result is an IRP system with personal flexible customization of individual elements and is the basis for the formation of the Security Center (SOC), which will bring the information security of organizations to a new level.
4D-QSAR Models Applied to the Study of TGF- β1 Receptor Inhibitors
Authors: Maria de Assis Tamiris , Ramalho Teodorico Castro , Ferreira da Cunha Elaine Fontes
Published: July 2021

Background:

The quantitative structure-activity relationship is an analysis method that
can be applied for designing new molecules. In 1997, Hopfinger and coworkers developed the 4DQSAR
methodology aiming to eliminate the question of which conformation to use in a QSAR
study. In this work, the 4D-QSAR methodology was used to quantitatively determine the influence
of structural descriptors on the activity of aryl pyrimidine derivatives as inhibitors of the TGF-β1
receptor. The members of the TGF-β subfamily are interesting molecular targets, since they play
an important function in the growth and development of cell cellular including proliferation, apoptosis,
differentiation, Epithelial-Mesenchymal Transition (EMT), and migration. In late stages,
TGF-β exerts tumor-promoting effects, increasing tumor invasiveness, and metastasis. Therefore,
TGF-β is an attractive target for cancer therapy.

Objective:

The major goal of the current research is to develop 4D-QSAR models aiming to propose
new structures of aryl pyrimidine derivatives.

Materials and Methods:

Molecular dynamics simulation was carried out to generate the conformational
ensemble profile of a data set with aryl pyrimidine derivatives. The conformations were overlaid
into a three-dimensional cubic box, according to the three-ordered atom alignment. The occupation
of the grid cells by the interaction of pharmacophore elements provides the Grid Cell Occupancy
Descriptors (GCOD), the dependent variables used to build the 4D-QSAR models. The best
models were validated (internal and external validation) using several statistical parameters. Docking
molecular studies were performed to better understand the binding mode of pyrimidine derivatives
inside the TGF-β active site.

Results :

The 4D-QSAR model presented seven descriptors and acceptable statistical parameters
(R2 = 0.89, q2 = 0.68, R2
pred = 0.65, r2
m = 0.55, R2
P = 0.68 and R2
rand = 0.21) besides pharmacophores
groups important for the activity of these compounds. The molecular docking studies helped to understand
the pharmacophoric groups and proposed substituents that increase the potency of aryl
pyrimidine derivatives.

Conclusion:

The best QSAR model showed adequate statistical parameters that ensure their fitness,
robustness, and predictivity. Structural modifications were assessed, and five new structures
were proposed as candidates for a drug for cancer treatment.
Larrea tridentata and its Biological Activities
Authors: Reyes-Melo Karen Y. , Galván-Rodrigo Adrián A. , Martínez-Olivo Isaí E. , Núñez-Mojica Guillermo , Ávalos-Alanís Francisco G. , García Abraham , del Rayo Camacho-Corona María
Published: July 2021

Background:

Larrea tridentata is a dominant shrub in the deserts of North America and
is recognized for its various traditional uses. More than 50 traditional uses have been recorded. Regarding
its chemical composition, the products of the mevalonate, shikimate, and malonate pathways
are predominant. L. tridentata has nordihydroguaiaretic acid (NDGA), one of its most studied
secondary metabolites that exhibited remarkable different biological activities: sequestration of reactive
oxygen species, inhibition of lipoxygenases (LOX) and activation of the endogenous antioxidant
response mediated by nuclear factor erythroid 2-related factor 2 (NRF2).

Objective and Methods:

This review seeks to draw attention to metabolites other than NDGA and
which also contribute to the various biological activities of L. tridentata. Therefore, the present review
includes those reports focused on the pharmacological properties of the organic extracts of L.
tridentata and its natural products with promising values.

Results and Conclusion:

Among the most promising and widely reported metabolites from L. tridentata,
are: 3’-demethoxy-6-O-demethylisoguaiacin, 3’-O-methyldihydroguaiaretic acid, meso-dihydroguaiaretic
acid, and tetra-O-methylnordihydroguaiaretic acid. These have been reported to exhibit
antibacterial, antiprotozoal, anthelmintic, antifungal, antiviral, anticancer, and antioxidant activities.
Synthesis, Molecular Docking and Mosquitocidal Efficacy of Lawsone and
its Derivatives Against the Dengue Vector Aedes aegypti L. (Diptera:
Culicidae)
Authors: Stalin Antony , Dhivya Paul , Lin Ding , Feng Yue , Asharaja Antony Cruz , Gandhi Munusamy Rajiv , Kannan Balakrishnan Senthamarai , Kandhasamy Subramani , Reegan Appadurai Daniel , Chen Yuan
Published: July 2021

Background:

Aedes aegypti is the primary dengue vector, a significant public health problem in many countries. Controlling the growth of Ae. aegypti is the biggest challenge in the mosquito control program, and there is a need for finding bioactive molecules to control Ae. aegypti in order to prevent dengue virus transmission.

Objective:

To assess the mosquitocidal property of lawsone and its 3-methyl-4H-chromen-3-yl-1-phenylbenzo[6,7]chromeno[2,3,c]pyrazole-dione derivatives (6a-6h) against various life stages of Ae. aegypti. Besides, to study the mode of action of the active compound by molecular docking and histopathological analysis.

Methods:

All derivatives were synthesized from the reaction between 2-hydroxy-1,4-naphthoquinone, chromene-3-carbaldehyde, and 1-phenyl-3-methyl-pyrazol-5-one by using one pot sequential multicomponent reaction. The mosquito life stages were subjected to diverse concentrations ranging from 1.25, 2.5, 5.0, and 10 ppm for lawsone and its derivatives. The structure of all synthesized compounds was characterized by spectroscopic analysis. Docking analysis was performed using autodock tools. Midgut sections of Ae. aegypti larvae were analyzed for histopathological effects.

Results:

Among the nine compounds screened, derivative 6e showed the highest mortality on Ae. aegypti life stages. The analyzed LC50 and LC90 results of derivative 6e were 3.01, 5.87 ppm, and 3.41, 6.28 ppm on larvae and pupae of Ae. aegypti, respectively. In the ovicidal assay, the derivative 6e recorded 47.2% egg mortality after 96-hour post-exposure to 10 ppm concentration. In molecular docking analysis, the derivative 6e confirmed strong binding interaction (-9.09 kcal/mol and -10.17 kcal/mol) with VAL 60 and HIS 62 of acetylcholinesterase 1 (AChE1) model and LYS 255, LYS 263 of kynurenine aminotransferase of Ae. aegypti, respectively. The histopathological results showed that the derivative 6e affected the columnar epithelial cells (CC) and peritrophic membrane (pM).

Conclusion:

The derivative 6e is highly effective in the life stages of Ae. aegypti mosquito and it could be used in the integrated mosquito management programme.
Safety Assessment and Potential Risks of the Glucagon Stimulation Test in
the Diagnosis of Secondary Adrenal Insufficiency
Authors: Ach Taieb , Abdelkrim Asma Ben , Hasni Yosra , Saad Ghada , Kacem Maha , Chaieb Molka , Zaouali Monia , Maaroufi Amel , Ach Koussay
Published: July 2021

Background:

Although it takes more time, the Glucagon Stimulation Test (GST) is a reliable
measure for assessing growth hormone (GH) and Adrenocorticotropic Hormone (ACTH) secretion.
The GST is considered to be a safe test; however, it still has mild side effects and potential
risks.

Objective :

The objective of this study was to analyze the side effects of the GST while testing
adrenal-insufficient patients.

Methods:

This was a prospective study in which GST was performed in eighty-one patients (44
men, 37 women, mean age: 35.83A9.62 years) with the pituitary disorder. The GST consisted of an
intramuscular injection of 1 mg of glucagon. Blood samples were collected at baseline, and 30, 60,
90, 120, 150, 180, and 210 min after glucagon injection for cortisol measurements. All patients
were asked to report side effects associated with this test.

Results:

The mean peak blood glucose level under GST was 9.01A.03 mmol/L, and the mean
glycemic nadir was 4.34A.75 mmol/L most frequently found during the 30th minute (p <10-3).
During the test, 35 subjects (43.2%) had side effects with a mean age of 42.89 A19.75 years. Frequent
side effects included: nausea (29.62%), vomiting (27.16%), abdominal cramps (18.51%) and
hunger (13.58%). All patients tolerated the test until the end. Adverse effects were significantly
more prevalent in patients older than 50 years (p=0.012).

Conclusions:

The GST is a reliable alternative to assess the hypothalamic pituitary adrenal axis
but should be cautiously used especially in the elderly, despite minor side effects.
Potentially Inappropriate Medication Use in Older People: A Crosssectional Study Using Beers Criteria
Authors: Yüksel Gülsüm Hatice , Ozaydin Fuat Nihat , Ozaydin Ayse Nilufer
Published: July 2021

Background:

The use of Potentially Inappropriate Medications (PIMs) is common and negatively affects elderly health and disease prognosis.

Objective:

This study aims to analyze the frequency of PIMs in the elderly health records registered to a family health center and to identify risk factors, prescription/nonprescription distribution, distribution by healthcare institutions, number of doctors visits, and health literacy.

Methods:

In this cross-sectional study, a stratified sampling method was used to select individuals aged ≥ 65 years. The health records of the participants up to the last 12 months were examined, and medicines used by participants were evaluated according to Beers 2019 criteria.

Results:

Most of the participants (89.7%, n:183) had PIMs in health records. The mean number of PIMs used by the elderly was 2.9±1.9 (min:0, max:8). A positive linear relationship was observed between multimorbidity and the number of PIMs (p=0.001). There was no significant difference in terms of PIMs frequency among healthcare institutions. Prescription and non-prescription PIMs were found to belong to the same drug groups (Pain relievers and stomach medications). A linear and significant correlation was found between the number of PIMs and doctor visits (p=0.047).

Conclusion:

The doctor should examine prescription and over-the-counter medications used by the elderly during the visit. It will be useful to establish a warning system stating that PIMs are available while registering the medications in the electronic system. So, it will be possible for health authorities to re-evaluate the treatment and replace PIMs with rational drug options.
Multivariate Information Fusion for Identifying Antifungal Peptides with
Hilbert-Schmidt Independence Criterion
Authors: Zhou Haohao , Wang Hao , Ding Yijie , Tang Jijun
Published: July 2021

Background:

Antifungal Peptides (AFP) have been found to be effective against many fungal
infections.

Objective:

However, it is difficult to identify AFP. Therefore, it is great practical significance to identify
AFP via machine learning methods (with sequence information).

Method:

In this study, a Multi-Kernel Support Vector Machine (MKSVM) with Hilbert-Schmidt Independence
Criterion (HSIC) is proposed. Proteins are encoded with five types of features (188-bit,
AAC, ASDC, CKSAAP, DPC), and then construct kernels using Gaussian kernel function. HSIC are
used to combine kernels and multi-kernel SVM model is built.

Results:

Our model performed well on three AFPs datasets and the performance is better than or comparable
to other state-of-art predictive models.

Conclusion:

Our method will be a useful tool for identifying antifungal peptides.
Parvovirus B19 Seroprevalence in Women with Bad Obstetric History in
Kirkuk
Authors: Alsamarai Abdulghani Mohamed , Hassan Hala Majeed , Alsamarai Mohamed Almoustafa , Aljumaili Zainab Khalil
Published: July 2021

Background:

In the Iraqi community, abnormal pregnancy forms a major social and psychological
health problem. The underlying etiology of this health phenomenon was varied and included
sets of infections and autoimmune diseases. Globally human parvovirus 19 infection is common
and the infection attributes to bad obstetric outcomes. The global maternal parvovirus B19 remote
infection rate was within a range of 13.2% to 97.9%, while the range of acute infection was
between 0.5% to 97.9%. In Arab countries, the IgG seroprevalence was from 53.3% to 74%, while
IgM seroprevalence range was 2.2% to 84%.

Objective:

To evaluate the role of ParvovirusB19 as an etiology of bad obstetric outcome in women
in Kirkuk, Iraq.

Materials and Methods:

Descriptive Case Control Study. Women included in the study were recruited
from Kirkuk General Hospital and their age ranged from 14 to 48 years. A total of 663 women
were included in the study, of them 237 were not pregnant, while 215 were pregnant. Additionally,
the study included 211 women with inevitable abortion. Control group (306 women) women
with a history of normal pregnancy included (Pregnant= 149; non-pregnant= 157). Clinical and laboratory
investigations were conducted on all patients and control groups to exclude other causes.
Medical and obstetric data and demographic characteristics were gathered through interviews according
to a previously designed questionnaire. ELISA kits were used to determine Parvovirus B19
IgM and IgG antibodies.

Results:

The overall parvovirus seroprevalence was 93% and with no significant difference between
women with normal (89.5%) and those with abnormal (93.1%) pregnancy outcomes. In addition,
parvovirus IgM overall seroprevalence was at56.3%. Furthermore, current parvovirus infection
was higher in women with BOH (52.6%) than that in women with normal pregnancy (49.7%)
outcomes. Parvovirus IgM seroprevalence was 52.6% in women with BOH and 49.7% in women
with normal pregnancy, however, the difference was not statistically significant. In contrast, the
acute infection with parvovirus was significantly (X2=11.8, P=0.001) lower in women with normal
pregnancy (49.7%) than in those with inevitable abortion (64.9%). While the IgG seroprevalence
difference was not significant between the two groups, infection seroprevalence was more frequent
in housewives, uneducated women, large families, non-smokers, in rural areas, non-animal exposure
areas, women with repeated abortion, congenital anomalies and anaemia.

Conclusion:

Parvovirus B19 infection may be with bad obstetric outcomes if occurred during pregnancy
and OR confirmed a significant association of the infection with parvovirus with smoking,
occupation, crowding index, education, animal exposure and the number of repeated abortion.
Poznanie i rozumienie natury dziecka warunkiem skutecznego oddziaływania edukacyjnego
Authors:   Mazowiecka Uczelnia Publiczna w Płocku, Marszałek Lidia Dorota
Published: July 2021

Childhood is a special period in human life, and it is characterized by a specific logic of thinking. The way the child perceives and understands the world as regards its material, non-material, and social aspects, is entirely different from that of an adult person. The child experiences emotions and applies moral requirements in his own way. The presented study aims to show the specific functioning of children in the surrounding world. It also undertakes to indicate the possible role of educators in the field of getting to know the essence and nature of a child.
Genetic Screening of Cervical Cancer
Authors:   Division of Obstetrics and Gynecology, San Paolo Private Clinic, Via Bonellina 199 , 51100 Pistoia, Italy, Comparetto Ciro , Borruto Franco ,   Consultant in Public Health, Department of Social Affairs, Principality of Monaco
Published: July 2021

Medical genetics plays an important role in the screening and prevention of numerous diseases. Thus, it is important to develop effective screening and prevention programs and improve the assessment of the susceptibility of diseases. The development of screening and prevention programs depends on the identification of early biomarkers (including functional and behavioral) for the risk and onset of the disease, and such programs need to be designed according to internationally accepted criteria. Cervical cancer represents a very relevant disease from the health and social perspective; around 528,000 new cases are diagnosed every year globally, of which, 85% are from developing countries, representing almost 12% of all cancers in females. Substantial reductions in the incidence of and mortality from cervical cancer have been observed after the introduction of prevention campaigns with the implementation of cervical screening programs through Papanicolaou (Pap) tests and, in particular, following the introduction of organized programs which guarantee a high level of screening coverage, as well as, the quality and continuity of diagnostic-therapeutic procedures. It is estimated that Pap smear screening every 3-5 years provides 80% protection against the onset of cancer. Advances in diagnostic techniques, particularly the development of easy-to-use molecular genetic tests, are replacing the use of the established Pap smear as a screening tool. This is possible owing to the discovery in 1975 that some cellular morphological changes (koilocytosis) were related to the presence of a Human Papillomavirus (HPV) infection. The HPV test is performed on a small sample of cells taken from the cervix, similar to the Pap test; however, it is not a morphological exam but a molecular biology exam that detects the presence of HPV by identifying its deoxyribonucleic acid (DNA) or messenger ribonucleic acid (mRNA). The results of numerous experimental studies have demonstrated a greater sensitivity of this test compared to the sensitivity of the traditional Pap test. However, the HPV test has a lower specificity due to two main factors: 1) The HPV test is based on the search for the types of viruses that have a greater oncogenic potential, and 2) It does not discriminate between transient infections and persistent and productive infections. The most widely used molecular tests are based on the search for HPV sequences and genotyping using molecular biology techniques, such as direct hybridization, qualitative polymerase chain reaction (PCR), and viral nucleotide sequencing.
Enhancing Healthcare Access–Smartphone Apps in Arrhythmia Screening: Viewpoint
Authors: Książczyk Marcin , Dębska-Kozłowska Agnieszka , Warchoł Izabela , Lubiński Andrzej
Published: July 2021

Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health.
The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study
Authors: Jo Youngji , Barthel Nathan , Stierman Elizabeth , Clifton Kathryn , Pak Esther Semee , Ezeiru Sonachi , Ekweremadu Diwe , Onugu Nnaemeka , Ali Zainab , Egwu Elijah , Akoh Ochayi , Uzunyayla Orkan , Van Hulle Suzanne
Published: July 2021

Background

Nigeria has the world’s largest malaria burden, accounting for 27% of the world’s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria.

Objective

This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues.

Methods

Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)–based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system.

Results

The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days.

Conclusions

The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system.
Publication Trends and Their Relationship With Academic Success Among Dermatology Residents: Cross-sectional Analysis
Authors: Anderson J Michael , Wenger David , Johnson Austin L , Walters Corbin , Adewumi Mopileola Tomi , Esmond Lindy , Waddell Jourdan , Vassar Matt
Published: July 2021

Background

Involvement in scholarly activities is considered to be one of the foundational pillars of medical education.

Objective

This study aims to investigate publication rates before, during, and after residency to determine whether research productivity throughout medical training correlates with future academic success and research involvement.

Methods

We successfully identified a list of 296 graduates from 25 US dermatology residency programs from the years 2013-2015. The publication history for each graduate was compiled using Scopus, PubMed, and Google Scholar. The Pearson correlation test and linear regression were used to assess the relationship between research productivity and continued academic success after residency graduation.

Results

Before residency, graduates published a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates published a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications. Graduates who pursued a fellowship had more total publications (t294=−4.0; P<.001), more first-author publications (t294=−3.9; P<.001), and a higher h-index (t294=−3.8; P=.002). Graduates who chose to pursue careers in academic medicine had more mean total publications (t294=−7.5; P<.001), more first-author publications (t294=−5.9; P<.001), and a higher mean h-index (t294=−6.9; P<.001). Graduates with one or more first-author publications before residency were 1.3 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.3, 95% CI 1.1-1.5). Graduates who pursued a fellowship were also 1.9 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.9, 95% CI 1.2-3.2).

Conclusions

Our results suggest that research productivity before and during residency training are potential markers for continued academic success and research involvement after completing dermatology residency training.
Safety and Acceptability of a Natural Language Artificial Intelligence Assistant to Deliver Clinical Follow-up to Cataract Surgery Patients: Proposal (Preprint)
Authors: de Pennington Nick , Mole Guy , Lim Ernest , Milne-Ives Madison , Normando Eduardo , Xue Kanmin , Meinert Edward
Published: July 2021

BACKGROUND

Due to an aging population, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence (AI), in the form of conversational agents, presents a possible opportunity to enable efficiency in the delivery of care.

OBJECTIVE

This study aims to evaluate the effectiveness, usability, and acceptability of Dora agent: Ufonia’s autonomous voice conversational agent, an AI-enabled autonomous telemedicine call for the detection of postoperative cataract surgery patients who require further assessment. The objectives of this study are to establish Dora’s efficacy in comparison with an expert clinician, determine baseline sensitivity and specificity for the detection of true complications, evaluate patient acceptability, collect evidence for cost-effectiveness, and capture data to support further development and evaluation.

METHODS

Using an implementation science construct, the interdisciplinary study will be a mixed methods phase 1 pilot establishing interobserver reliability of the system, usability, and acceptability. This will be done using the following scales and frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire; and the Non-Adoption, Abandonment, and Challenges to the Scale-up, Spread and Suitability framework.

RESULTS

The evaluation is expected to show that conversational technology can be used to conduct an accurate assessment and that it is acceptable to different populations with different backgrounds. In addition, the results will demonstrate how successfully the system can be delivered in organizations with different clinical pathways and how it can be integrated with their existing platforms.

CONCLUSIONS

The project’s key contributions will be evidence of the effectiveness of AI voice conversational agents and their associated usability and acceptability.

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/27227
Examining the Impact of Question Construction on Reporting of Sexual Identity: Survey Experiment Among Young Adults (Preprint)
Authors: Young William J , Bover Manderski Michelle T , Ganz Ollie , Delnevo Cristine D , Hrywna Mary
Published: July 2021

BACKGROUND

Compared with heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers’ ability to conduct meaningful survey research to understand these disparities. Despite the prevalence of additional identities, many national health surveys only offer respondents 3 substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual), which could lead to measurement error via misreporting and item nonresponse.

OBJECTIVE

This study compared the traditional 3-option approach to measuring sexual identity with an expanded approach that offered respondents 5 additional options.

METHODS

An online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1254 young adults (ages 18-21) to answer either the 3-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item nonresponse.

RESULTS

The expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item nonresponse; 12% (77/642) of respondents in the expanded version selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2.1% [10/467] vs. 6.6% [30/457]). Females and Non-Hispanic Whites were slightly more likely to skip the shorter version than the longer version (1.1% [5/457 for females and 3/264 for Non-Hispanic Whites] vs. 0% [0/467 for females and 0/277 for Non-Hispanic Whites]). About 5% (32/642) of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared with respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (odds ratio 9.57, 95% CI 1.21-75.74; P=.03).

CONCLUSIONS

Results favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities.
Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale (Preprint)
Authors: Chen Emily , Jiang Julie , Chang Ho-Chun Herbert , Muric Goran , Ferrara Emilio
Published: July 2021

BACKGROUND

The novel coronavirus, also known as SARS-CoV-2, has come to define much of our lives since the beginning of 2020. During this time, countries around the world imposed lockdowns and social distancing measures. The physical movements of people ground to a halt, while their online interactions increased as they turned to engaging with each other virtually. As the means of communication shifted online, information consumption also shifted online. Governing authorities and health agencies have intentionally shifted their focus to use social media and online platforms to spread factual and timely information. However, this has also opened the gate for misinformation, contributing to and accelerating the phenomenon of misinfodemics.

OBJECTIVE

We carried out an analysis of Twitter discourse on over 1 billion tweets related to COVID-19 over a year to identify and investigate prevalent misinformation narratives and trends. We also aimed to describe the Twitter audience that is more susceptible to health-related misinformation and the network mechanisms driving misinfodemics.

METHODS

We leveraged a data set that we collected and made public, which contained over 1 billion tweets related to COVID-19 between January 2020 and April 2021. We created a subset of this larger data set by isolating tweets that included URLs with domains that had been identified by Media Bias/Fact Check as being prone to questionable and misinformation content. By leveraging clustering and topic modeling techniques, we identified major narratives, including health misinformation and conspiracies, which were present within this subset of tweets.

RESULTS

Our focus was on a subset of 12,689,165 tweets that we determined were representative of COVID-19 misinformation narratives in our full data set. When analyzing tweets that shared content from domains known to be questionable or that promoted misinformation, we found that a few key misinformation narratives emerged about hydroxychloroquine and alternative medicines, US officials and governing agencies, and COVID-19 prevention measures. We further analyzed the misinformation retweet network and found that users who shared both questionable and conspiracy-related content were clustered more closely in the network than others, supporting the hypothesis that echo chambers can contribute to the spread of health misinfodemics.

CONCLUSIONS

We presented a summary and analysis of the major misinformation discourse surrounding COVID-19 and those who promoted and engaged with it. While misinformation is not limited to social media platforms, we hope that our insights, particularly pertaining to health-related emergencies, will help pave the way for computational infodemiology to inform health surveillance and interventions.
Correction: Homes of Stroke Survivors Are a Challenging Environment for Rehabilitation Technologies (Preprint)
Authors: Rennick-Egglestone Stefan , Mawson Sue
Published: July 2021

UNSTRUCTURED

The design of digital technologies that support poststroke rehabilitation at home has been a topic of research for some time. If technology is to have a large-scale impact on rehabilitation practice, then we need to understand how to create technologies that are appropriate for the domestic environment and for the needs and motivations of those living there. This paper reflects on the research conducted in the Motivating Mobility project (UK Engineering and Physical Science Research Council: EP/F00382X/1). We conducted sensitizing studies to develop a foundational understanding of the homes of stroke survivors, participatory design sessions situated in the home, and experimental deployments of prototype rehabilitation technologies. We identified four challenges specific to the homes of stroke survivors and relevant to the deployment of rehabilitation technologies: identifying a location for rehabilitation technology, negotiating social relationships present in the home, avoiding additional stress in households at risk of existential stress, and providing for patient safety. We conclude that skilled workers may be needed to enable successful technology deployment, systematizing the mapping of the home may be beneficial, and education is a viable focus for rehabilitation technologies.