bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Mechanisms and Key Factors Influencing Melanogenesis
for the Management of Melasma: An Updated Review
Authors: Singh Niraj Kumar , Verma Amnesh Kumar , Gupta Jeetendra Kumar
Published: May 2024

Melanocytes are highly specialized dendritic cells that deliver melanin to keratinocytes in melanosomes, which are subcellular organelles where melanin is produced and stored.
Mammal’s skin, hair, and eyes all contain the complex pigment melanin, which gives them color
and ultraviolet protection. Melanins have the potential to be free radical sinks and are strong
cation chelators. Amino acid tyrosine and its metabolite, dopa, are the precursors to complex
metabolic processes that end with melanin production. Melanocytes generate different types and
amounts of melanin, which is defined genetically and is impacted by several extrinsic and intrinsic factors such as hormone fluctuations, inflammation, age, and ultraviolet radiation exposure,
leading to the stimulation of numerous melanogenesis pathways. Melasma, a common skin pigmentation condition, is associated with the overproduction of melanin and is characterized by
brown to gray-brown and black spots that mostly affect the face. The present review addresses
the regulatory mechanisms and signaling pathways involved in skin pigmentation with an emphasis on the altered melanogenesis that causes melasma and hyperpigmentation. The current
study also illustrates the available treatment options with cellular and molecular mechanisms for
the management of melasma. Understanding the mechanism of the pigmentation process may
help researchers develop new therapeutic strategies and novel drugs for the management of melasma.
Human Papillomavirus Genotype Distribution in a Hospital-based Single-center Study
Authors: Hashemi Seyedeh Razieh , Modarresi Farrokh , Esmailzadeh Arezoo , Sheikhsofla Nazanin Zeinab
Published: May 2024

Background:

Cervical cancer is reported as one of the most prevalent malignancies
worldwide in women. There is a substantial connection between cervical diseases and infection
with Human Papillomavirus (HPV), especially Types 16 and 18 of HPV.

Objective:

This study aimed to assess the HPV genotype distribution to determine its most common
type at a referral hospital in Iran.

Methods:

This cross-sectional study was conducted on 400 women with positive HPV result tests
who visited the gynecologic oncology clinic of Baqiyatallah Hospital from 2017-2021.

Results:

The average age of subjects was 37.46±9.75 years (range=19-74). About 167 (41.8%) of
the patients were between 25 to 35 years. The analysis showed that 137 (34.2%) patients had only
low-risk (LR) typing, 129 (32.2%) patients had only high-risk (HR) typing, and 134 (33.5%) patients had both HR and LR typing. The most frequent LR HPV types were HPV 6 (18.5%) and 11
(17%), and the most frequent HR HPV types were HPV-16 (14.7%), 52 (8.2%), 18, and 31 (6.5%).

Conclusion:

This study showed that the most frequent age category in both low- and HR HPVpositive women is the age 25 to 35 years. The second most common HR-HPV subtypes included
HPV-52, not HPV-18, which indicates variations in HR-HPV subtypes in different populations and
races and warrants further research.
A Typology and Lead Isotope and Cultural Exchange Study on Bronze
Knives from Shuangyuan Cemetery, Chengdu City, Southwest China
Authors: Wang Xiaoting , Yang Yingdong , Wang Tianyou , Luo Wugan
Published: May 2024

Background:

Bronze knives, which have been excavated in large quantities and acquired
hierarchical significance, are essential artifacts in Shu State in Southwest China. Building upon previous typological analyses of bronze knives, it is hypothesized that Shu culture may have imported
foreign-style bronze knives. However, further demonstration of the provenance of metal materials,
the typology of knives, and the cultural exchange necessitates a comprehensive examination through
the lens of scientific analysis. The purpose of this study is to investigate the differences in the manufacturing processes and metal resources of Shu bronze knives with various cultural styles and whether bronze knives in the foreign styles were imported or locally imitated.

Methods:

In this study, the typology, portable X-ray fluorescence spectrometry and multi-collector
inductively coupled plasma mass spectrometry were used to analyze twenty-four bronze knives unearthed from Shuangyuan cemetery, a cemetery of the Eastern Zhou Dynasty in Chengdu City, Sichuan Province, Southwest China.

Results:

The results of the study show that the knives of Shuangyuan Cemetery can be classified
typologically into five types, encompassing both local and foreign styles. The predominant alloy
composition of these knives is lead-tin bronze, characterized by a notably high tin content. Lead
isotope ratios indicate that metal materials from the South China geochemical province and Yangtze
geochemical province were mainly used to manufacture the bronze knives unearthed from the Shu
state

Conclusion:

While the majority of foreign-style knives with ring-shaped heads were likely imported
from neighboring regions like Chu state, distinctively styled type D and type E bronze knives appear
to have been locally imitated by the Shu, showcasing a blend of external influences and indigenous
innovation. The combination of typology and scientific analysis of the bronze knife may shed new
light on the study of the Shu culture of the Eastern Zhou period.
Fabrication and Characterization of Sustained-release Eudragit RSPO Microsphere of Lornoxicam by Spray Drying Technique
Authors: Patel Hiren V. , Ratnakar Nayan C. , Paliwal Himanshu , Prajapati Bhupendra G.
Published: May 2024

Background:

Lornoxicam is a potent non-steroidal anti-inflammatory drug (NSAID) with
strong analgesic properties; however, its short half-life necessitates frequent administration for sustained
efficacy.

Objective:

The objective of the present study was to identify critical formulation parameters affecting
sustained release Eudragit RSPO microsphere of lornoxicam employing the concept of design of experiments.

Method:

The lornoxicam-loaded microspheres were prepared using a spray drying technique by optimizing
the drug:polymer ratio(X1) and inlet air temperature (X2) using a 32 full factorial design.
The percentage drug entrapment (Y1), percentage yield (Y2) and cumulative percentage of the drug
dissolved at 18 hr (Y3) were selected as dependent variables. Microspheres were evaluated for percentage
drug entrapment, mean particle size, percentage yield, in vitro drug release study and scanning
electron microscopy (SEM).

Result:

The optimized batch showed 84.51% drug release after 18 h with significantly higher drug
entrapment and percentage yield. The optimization was further verified using overlay and desirability
plots. The sustained release behavior of the drug from microspheres in GIT was displayed. The predicted
and observed responses for the optimized formulation were in close agreement with the release
profile of the drug.

Conclusion:

The sustained release microspheres of lornoxicam may prove to be an effective analgesic
with excellent anti-inflammatory potential.
Actinobacteria: Smart Micro-Factories for The Health Sector
Authors: Roohi  , Bano Naushin
Published: May 2024

Antibiotics are considered "wonder drugs" due to the fact that they are the
most extensively utilised medication in the world. They are used to cure a broad spectrum
of diseases and lethal infections. A variety of bacteria and fungi produce antibiotics as a
result of secondary metabolism; however, their production is dominated by a special class
of bacteria, namely Actinobacteria. Actinobacteria are gram-positive bacteria with high
G+C content and unparalleled antibiotic-producing ability. They produce numerous polyenes,
tetracyclines, β-lactams, macrolides, and peptides. Actinobacteria are ubiquitous in
nature and are isolated from various sources, such as marine and terrestrial endophytes of
plants and air. They are studied for their relative antibiotic-producing ability along with
the mechanism that the antibiotics follow to annihilate the pathogenic agents that include
bacteria, fungi, protozoans, helminths, etc. Actinobacteria isolated from endophytes of
medicinal plants have amassed significant attention as they interfere with the metabolism
of medicinal plants and acquire enormous benefits from it in the form of conspicuous
novel antibiotic-producing ability. Actinobacteria is not only an antibiotic but also a rich
source of anticancer compounds that are widely used owing to its remarkable tumorigenic
potential. Today, amongst Actinobacteria, class Streptomyces subjugates the area of antibiotic
production, producing 70% of all known antibiotics. The uniqueness of bioactive
Actinobacteria has turned the attention of scientists worldwide in order to explore its potentiality
as effective “micronanofactories”. This study provides a brief overview of the
production of antibiotics from Actinobacteria inhabiting patent environments and the
methods involved in the screening of antibiotics.
HSLE: A Hybrid Ensemble Classifier for Prediction of Heart Disease
Authors: Kushwaha Pradeep Kumar , Dagur Arvind , Shukla Dhirendra
Published: May 2024

Background:

Detecting heart disease in a timely manner is vital for preventing its progression, as it is the primary cause of death across the globe. Machine learning has the potential to
enhance diagnostic accuracy and enable better clinical decision-making. A machine learningpowered hybrid system for diagnosing heart disease may provide a better optimal solution for
heart disease prediction.

Objective:

The overarching objectives include accuracy improvement, enhanced classification
reliability, and the development of high-performance prediction models for heart disease. These
objectives indicate a commitment to advancing methodologies and models in the field of machine
learning and data science, particularly within the domain of healthcare and disease prediction.

Method:

The proposed system was developed using the Cleveland dataset that was preprocessed
and analyzed using Recursive Feature Elimination with Cross-Validation (RFECV) and Least Absolute Shrinkage and Selection Operator (LASSO) feature extraction techniques. Further, a hybrid
feature selection approach using RFECV and K-Best has been proposed for feature selection.
Eight machine learning classifiers such as Multilayer Perceptron (MLP), Random Forest (RF),
Extreme Gradient Boosting (XGB), K-Nearest Neighbours (KNN), Extra Tree (ET), Support Vector Machine (SVC), Adaboost, Decision Tree (DT) were utilized, and the performance of the system was measured in terms of various metrics.

Result:

The results showed that the proposed HSLE algorithm with hybrid feature selection led to
the highest overall accuracy of 98.76%.

Conclusion:

As mentioned, the main cause of adult death worldwide is chronic disease. Early detection can stop the condition from getting worse. Our research presents an innovative hybrid machine-learning approach designed to forecast heart disease.
Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray
Authors:   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University/ Dr.Saiful Anwar General Hospital, Malang Indonesia, Laksono Buyung Hartiyo , Hartono Ruddi ,   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University/ Dr.Saiful Anwar General Hospital, Malang Indonesia, Tamam Abdul Rasyid ,   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University/ Dr.Saiful Anwar General Hospital, Malang Indonesia, Jaya Wiwi ,   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University/ Dr.Saiful Anwar General Hospital, Malang Indonesia
Published: May 2024

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units. Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test. Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters. Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.
Pain and Complications Assessment in Gynecological Cancer Brachytherapy Patients Under Spinal Anesthesia
Authors:   Undergraduate Program in Medicine, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia, Setiawan Alfredo Abrian Erlangga , Fitrisyah Aidyl ,   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Sriwijaya University, Palembang Indonesia, Zainal Rizal ,   Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia, Santoso Budi ,   Department of Physiology, Faculty of Medicine, Sriwijaya University, Palembang Indonesia, Bin Laeto Arwan ,   Department of Physiology, Faculty of Medicine, Sriwijaya University, Palembang Indonesia
Published: May 2024

Background: Brachytherapy is a radiation therapy that can deliver radiation to cancer by minimizing radiation exposure to adjacent organs or tissues. In its implementation, brachytherapy can cause pain so that adequate anesthesia is needed in order to get optimal results. This study was aimed to determine the adequacy of anesthesia and complications that occur in gynecological cancer patients undergoing brachytherapy with spinal anesthesia. Methods: A descriptive observational study using primary data that taken by interviewing the patients who underwent gynecological brachytherapy under spinal anesthesia at dr. Mohammad Hoesin Palembang. The number of samples in this study that met the inclusion criteria was 18 subjects. Pain was assessed using an 11-point numeric rating scale. Data were collected in 5 different times, before procedure, during applicator insertion, during radiation process, during applicator removal, and 4 hours after brachytherapy. in addition, all complications that occurred during the procedure were recorded. Data were analyzed to describe the mean, median, minimum, and maximum of pain scores. Result: The average pain score before brachytherapy was 0.78, at the time of applicator insertion was 0, 0.28 at irradiation, 0,11 at removal of the applicator and 1.33 after the brachytherapy procedure. The most common complications were back pain (27.8%) and urinary retention (27.8%). Conclusion: For most patients, high dose rate (HDR) brachytherapy under spinal anesthesia was well tolerated, in fact most patients experienced no pain and no significant life-threatening complications. The post-brachytherapy pain score had the highest average score. Then, back pain and urinary retention were the most common complications.
Characteristics of Bio-ceramic Coating on Corrosion Rate of Stainless Steel 316L and Titanium (Ti-6Al-4V)
Authors: Puraditya Yohanes De Britto Anugerah , Mahendra Denny Delviano , Setyarini Putu Hadi
Published: May 2024

Thermal spray coating improves SS 316L corrosion resistance using biomaterials like hydroxyapatite (HA), zirconium dioxide (ZrO2), and titanium dioxide (TiO2), promoting bone binding and biological fixation. The study examined the impact of bio-ceramic coatings like HA, HA+TiO2, and HA+ZrO2 on the corrosion rate of stainless steel and titanium in Hank's Balance Salt Solution and artificial saliva media. Electrochemical testing with polarization was carried out to determine the performance of biomaterials against corrosion rates. The addition of TiO2 and ZrO2 to HA in both SS316L and Ti6Al4V materials reduced the corrosion rate more than HA. This study revealed that coating with HA, HA + ZrO2, and HA + TiO2 biomaterials results in varying thicknesses and roughness under the same spraying parameters. Bioceramic coatings on implants offer an alternative coating to improve the performance of biomaterials.
Challenges and Needs in Digital Health Practice and Nursing Education Curricula: Gap Analysis Study
Authors: Livesay Karen , Walter Ruby , Petersen Sacha , Abdolkhani Robab , Zhao Lin , Butler-Henderson Kerryn
Published: May 2024

Background

Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers’ ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates.

Objective

This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators’ confidence and knowledge to teach. The findings will direct a future co-design process.

Methods

This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts.

Results

The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators.

Conclusions

Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study.
Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis
Authors: Frennesson Nessie Felicia , Barnett Julie , Merouani Youssouf , Attwood Angela , Zuccolo Luisa , McQuire Cheryl
Published: May 2024

Background

Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings.

Objective

This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers’ (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020).

Methods

All thread starts mentioning alcohol in the “Pregnancy” forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic.

Results

A total of 395 thread starts were analyzed, and key topics included “Asking for advice on whether it is safe to consume alcohol” or on “safe limits” and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on “Research, guidelines, and official information about alcohol in pregnancy.” Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods.

Conclusions

Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers.
Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model (Preprint)
Authors: El Morr Christo , Tavangar Farideh , Ahmad Farah , Ritvo Paul ,   MVC Team
Published: May 2024

BACKGROUND

Students’ mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly.

OBJECTIVE

The objectives of this study were to investigate (1) whether we can predict MVC’s effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention’s success.

METHODS

Machine learning models were developed to predict MVC’s effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features’ importance.

RESULTS

Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention’s effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week.

CONCLUSIONS

The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students’ exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention.

CLINICALTRIAL

ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616
Suitability of the Current Health Technology Assessment of Innovative Artificial Intelligence-Based Medical Devices: Scoping Literature Review (Preprint)
Authors: Farah Line , Borget Isabelle , Martelli Nicolas , Vallee Alexandre
Published: May 2024

BACKGROUND

Artificial intelligence (AI)–based medical devices have garnered attention due to their ability to revolutionize medicine. Their health technology assessment framework is lacking.

OBJECTIVE

This study aims to analyze the suitability of each health technology assessment (HTA) domain for the assessment of AI-based medical devices.

METHODS

We conducted a scoping literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched databases (PubMed, Embase, and Cochrane Library), gray literature, and HTA agency websites.

RESULTS

A total of 10.1% (78/775) of the references were included. Data quality and integration are vital aspects to consider when describing and assessing the technical characteristics of AI-based medical devices during an HTA process. When it comes to implementing specialized HTA for AI-based medical devices, several practical challenges and potential barriers could be highlighted and should be taken into account (AI technological evolution timeline, data requirements, complexity and transparency, clinical validation and safety requirements, regulatory and ethical considerations, and economic evaluation).

CONCLUSIONS

The adaptation of the HTA process through a methodological framework for AI-based medical devices enhances the comparability of results across different evaluations and jurisdictions. By defining the necessary expertise, the framework supports the development of a skilled workforce capable of conducting robust and reliable HTAs of AI-based medical devices. A comprehensive adapted HTA framework for AI-based medical devices can provide valuable insights into the effectiveness, cost-effectiveness, and societal impact of AI-based medical devices, guiding their responsible implementation and maximizing their benefits for patients and health care systems.
Evaluating the Diagnostic Performance of Large Language Models on Complex Multimodal Medical Cases (Preprint)
Authors: Chiu Wan Hang Keith , Ko Wei Sum Koel , Cho William Chi Shing , Hui Sin Yu Joanne , Chan Wing Chi Lawrence , Kuo Michael D
Published: May 2024

UNSTRUCTURED

Large language models showed interpretative reasoning in solving diagnostically challenging medical cases.
Perception and Evaluation of a Knowledge Transfer Concept in a Digital Health Application for Patients with Heart Failure: A Mixed Methods Study (Preprint)
Authors: Flaucher Madeleine , Berzins Sabrina , Jaeger Katharina M. , Nissen Michael , Rolny Jana , Trißler Patricia , Eckl Sebastian , Eskofier Bjoern M. , Leutheuser Heike
Published: May 2024

BACKGROUND

Digital health education can enhance the quality of life of patients with heart failure by providing accessible and tailored information, which is essential for effective self-care and self-management.

OBJECTIVE

This work aims to develop a mobile health knowledge transfer concept for heart failure in a user-centered design process grounded in theoretical frameworks. This approach centers on enhancing the usability, patient engagement, and meaningfulness of mobile health education in the context of heart failure.

METHODS

A user-centered design process was employed. First, semi-structured stakeholder interviews were conducted with patients (n = 9) and medical experts (n = 5). The results were used to develop a health knowledge transfer concept for a mobile health application for heart failure. This concept was implemented as a digital prototype based on an existing German mobile health application for patients with heart failure. We used this prototype to evaluate our concept with patients with heart failure in a study composed of user testing and semi-structured patient interviews (n = 7).

RESULTS

Stakeholder interviews identified five themes relevant to mobile health education: individualization, content relevance, media diversity, motivation strategies, and trust-building mechanisms. The evaluation of our prototype showed that patients value the adaptation of content to individual interests and prior knowledge. Digital rewards like badges and push notifications can increase motivation and engagement but should be used with care to avoid overload, irrelevance, and repetition.

CONCLUSIONS

Our findings emphasize the importance of tailoring mobile health education to the specific needs and preferences of patients with heart failure. At the same time, they also highlight the careful implementation of motivation strategies to promote user engagement effectively. These implications offer guidance for developing more impactful interventions to improve health outcomes for this population.
A Mobile Health Tool to Capture Social Determinants of Health and their Impact on HIV Treatment Outcomes among People Who Use Drugs: Pilot Study (Preprint)
Authors: Gicquelais Rachel E. , Conway Caitlin , Vjorn Olivia , Genz Andrew , Kirk Gregory , Westergaard Ryan
Published: May 2024

BACKGROUND

Active substance use, food or housing insecurity, and criminal justice system involvement can disrupt HIV care for people living with HIV (PLWH) and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings.

OBJECTIVE

We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral non-suppression and missed HIV care visits to inform future mobile health interventions.

METHODS

We enrolled 59 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) Study in Baltimore, Maryland into a 12-month sub-study between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA ≥1000 copies/mL or a ≥1 month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis through a survey on a mobile health application. We described weekly survey completion and investigated which factors were associated with viral non-suppression (HIV RNA ≥200) or a missed HIV care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use.

RESULTS

Participants were predominately male (61.0%), Black (89.8%), and a median of 53 years old. At baseline, 21.6% (N=8) were virally unsuppressed. Participants completed an average of 23.3 total surveys (SD: 16.3) and reported missing a dose of ART, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD: 9.8) surveys over one year. Reporting use of any drugs (adjusted odds ratio [aOR]: 2.3, 95% Confidence Interval [CI]: 1.4-3.7), injecting drugs (aOR: 2.3, 95% CI: 1.3-3.9), and non-completion of all surveys (aOR: 1.6, 95% CI: 1.1-2.2) were associated with missing a scheduled HIV care visit over the subsequent 30 days. Missing ≥2 antiretroviral medication doses within a one-week period was associated with HIV viral non-suppression (aOR: 3.7, 95% CI: 1.2-11.1) on laboratory tests drawn within the subsequent 30 days.

CONCLUSIONS

Mobile health applications can capture risk factors that predict viral non-suppression and missed clinic visits among PLWH who have OUD. Using mobile health tools to detect socio-behavioral factors that occur prior to treatment disengagement may facilitate early intervention by healthcare teams.
Use of internet-based surveys to collect long-term pediatric outcomes in patients with twin-twin transfusion syndrome treated with fetoscopic laser photocoagulation: A Prospective Observational Study (Preprint)
Authors: Bergh Eric , Rennie Kimberly , Espinoza Jimmy , Johnson Anthony , Papanna Ramesha
Published: May 2024

BACKGROUND

In the U.S., patients with monochorionic diamniotic (MCDA) twins who undergo in-utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost.

OBJECTIVE

To collect long-term pediatric outcomes in patients who underwent FLP for TTTS.

METHODS

We assessed the feasibility of using an internet-based survey designed in REDCap to collect parent-reported outcomes in children treated for TTTS at a single center during 2011-2019. Patients with ≥ 1 neonatal survivor were invited via email to complete three possible questionnaires: CSQ, child status questionnaire; FCQ, fetal center questionnaire; ASQ®-3, ages and stages questionnaire; M-CHAT-R/F,​ modified checklist for autism in toddlers; TYQ, thank you questionnaire. The R programming language was used to automate survey distribution, scoring and creation of customized reports. The survey was performed in 2019 and repeated after 12 months in 2020.

RESULTS

A total of 389 patients in 26 different states and 2 international locations had an email address on file and received an invitation in 2019 to complete the survey (median pediatric age 48.9 months [range 1.0 – 93.6]). Among surveyed mothers in 2019, the overall response rate was 37.3%, and the questionnaire completion rate was 98%, 87.8%, 71.1%, 86.4% and 74.3% for the CSQ, FCQ, ASQ®-3, M-CHAT-R/F and TYQ respectively. In 2020, the overall response rate was 57.8%, and the questionnaire completion rate was 96.4%, 91.1%, 86.1%, 91.7% and 80.4% for the CSQ, FCQ, ASQ®-3, M-CHAT-R/F and TYQ respectively.

CONCLUSIONS

This is the first study to employ both REDCap and computer automation to aid in the dissemination, collection and reporting of surveys to collect long-term pediatric outcomes in the field of fetal medicine.
Correction: Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial (Preprint)
Authors: Miller Hailey N , Gallis John A , Berger Miriam B , Askew Sandy , Egger Joseph R , Kay Melissa C , Finkelstein Eric Andrew , de Leon Mia , DeVries Abigail , Brewer Ashley , Holder Marni Gwyther , Bennett Gary G
Published: May 2024

UNSTRUCTURED
Determining the ideal optotype size for pitch plane interventions: an exploratory study (Preprint)
Authors: Harrell Regan G , Klatt Brooke N , Hovareshti Pedram , Whitney Susan L
Published: May 2024

BACKGROUND

Clinicians prescribe vestibulo-ocular reflex (VOR) exercises when there is a deficit in gaze stability associated with vestibular hypofunction. The exercises aim to maintain focus on an object while the head is moving in the pitch and yaw planes. Many people who complete VOR exercises use progressive or bifocal lens. For multi-focal corrective lenses, the user must look through the correct part of their lens when viewing targets in the pitch plane.

OBJECTIVE

This study aimed to identify if healthy multi-focal corrective lens users had difficulty with VOR exercises in the pitch plane based on optotype size.

METHODS

Participants completed VOR exercises on the VestAid tablet, which can record both eye gaze compliance and head movement compliance. Participants completed pitch plane VOR exercises at 80 bpm with optotype sizes 14-, 16-, 18-, 20-, and 22-point fonts for 30 seconds in the seated position with no visual background. All participants then rated symptom severity (dizziness, nausea, headache, fogginess) and overall level of exercise difficulty.

RESULTS

Twelve healthy multi-focal correct lens users (seven progressive and three bifocal lens users) completed the study. All participants were 100% compliant with moving their head at the correct speed and 100% compliant with maintaining their eyes on the optotype during the exercises regardless of the optotype size. Participants rated all exercises as “extremely easy.”

CONCLUSIONS

There was no difference in optotype performance in healthy multi-focal corrective lens users when completing pitch plane VOR exercises. Additional work is needed to determine if optotype size makes a difference in gaze stability in persons with vestibular hypofunction.
Research Letter: Advancing Public Health Surveillance in Child Care Centers with Stakeholder-Informed Redesign and User Satisfaction Evaluation of the MCRISP Network (Preprint)
Authors: Gribbin William Thomas , Dejonge Peter Mitchell , Rodseth Jakob David Thomas , Hashikawa Andrew N.
Published: May 2024

UNSTRUCTURED

The Michigan Child Care Related Infection Surveillance Program (MCRISP), launched in 2013, has played a crucial role in tracking illness within regional child care centers in Washtenaw County to support public health initiatives. Despite its utility, MCRISP encountered difficulties in effectively presenting data on illness trends to child care directors, who are pivotal in the collection of essential public health data. To address these challenges, we conducted a comprehensive, user-feedback driven redesign of the MCRISP system, emphasizing enhanced data accessibility and functional expansion. This abstract details the redesign process and offers insights for similar initiatives. We evaluated the redesign's impact through a standardized questionnaire administered six months post-implementation.. Feedback from 18 child care providers familiar with both the original and updated systems revealed no significant change in user satisfaction, suggesting that the improvements did not negatively affect the program's usability for end users. The updated MCRISP website now includes advanced disease tracking capabilities and the ability to rapidly develop dashboards for emerging infections, such as COVID-19, enhancing both backend efficiencies and user experience in disease monitoring. This letter details the technologies used and lessons learned in this process to help others who wish to build similar systems.
Explainable machine learning framework for biomarker discovery by combining biological age and frailty prediction (Preprint)
Authors: Wang Xiheng , Ji Jie
Published: May 2024

BACKGROUND

Biological age (BA) and frailty represent two distinct health measures that offer valuable insights into the aging process. Existing machine learning (ML) predictors of BA and frailty, derived from blood-based biomarkers, lack the capability to compare and analyze these biomarkers comprehensively. Such comparisons may provide deeper insights into these two distinct aging pathways. Objective: This study aimed to develop a framework to compare and analyze biomarkers by combining BA and frailty ML predictors with eXplainable Artificial Intelligence (XAI) techniques.

OBJECTIVE

This study aimed to develop a framework to compare and analyze biomarkers by combining BA and frailty ML predictors with eXplainable Artificial Intelligence (XAI) techniques.

METHODS

We utilized data from middle-aged and older Chinese adults (≥45 years) in the 2011/2012 wave (n=9702) and the 2015/2016 wave (n=9455, as test set validation) of the China Health and Retirement Longitudinal Study (CHARLS). Sixteen blood-based biomarkers were used to predict BA and frailty. Four tree-based ML algorithms were employed in the training and validation, and performance metrics were compared to select the best models. Then, SHapley Additive exPlanations (SHAP) analysis was conducted on the selected models.

RESULTS

CatBoost performed the best in the BA predictor, and Gradient Boosting performed the best in the frailty predictor. Traditional ML feature importance identified cystatin C and glycated hemoglobin as the major contributors for their respective models. However, subsequent SHAP analysis demonstrated that only cystatin C was the primary contributor in both models, suggesting that it plays an important role in both pathways.

CONCLUSIONS

Our novel framework integrates BA and frailty predictors with XAI techniques to compare and analyze biomarkers. The present approach leverages routine blood biomarkers and can easily incorporate additional biomarkers, providing a scalable and comprehensive toolset that offers a quantitative understanding of interesting biomarkers and complex physiological traits.

CLINICALTRIAL
Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners (Preprint)
Authors: Beccia Chiara , Hunter Barbara , Manski-Nankervis Jo-Anne , White Mary
Published: May 2024

BACKGROUND

Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay.

OBJECTIVE

In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context.

METHODS

In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework.

RESULTS

Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting—time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs’ needs regarding DIRECT-T1DM; (2) inner setting—DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation—design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets.

CONCLUSIONS

End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its “real-time” nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting.
Digital Teaching and Learning Media for Nursing and Health Care Courses in Germany: Protocol for a Scoping Review (Preprint)
Authors: Vogel Jann Niklas , Letzin Jaqueline , Schmidt Stefan
Published: May 2024

BACKGROUND

In Germany, digital transformation and legal regulations are leading to the need to integrate digital technologies into the nursing profession. In addition, to nursing practice, they are also being incorporated into nursing training. Despite comprehensive regulations regarding the use of digital teaching and learning media in nursing education, their specific applicability and implementation vary.

OBJECTIVE

This study aims to map evidence and identify the main concepts, theories, sources, and knowledge gaps in the use of digital teaching and learning formats in nursing and health care education in Germany.

METHODS

The study is planned as a scoping review. The reporting of the study is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. The sources of information for the review include six bibliographic databases (MEDLINE via PubMed, Cochrane Library, Web of Science Core Collection, ERIC, PROSPERO, and APA PsycInfo). The search results will be presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The eligibility of studies is based on the population, concept, and context criteria: (1) learners of nursing and health care professions, (2) digital teaching and learning formats, and (3) forms of implementation in Germany since 2007.

RESULTS

The literature search is planned for January 2025. The selection of titles, the coding of the data, and the data analysis are expected to be completed by March 2025.

CONCLUSIONS

In Germany, there is a growing interest in integrating digital teaching and learning formats into nursing and health care education. Our scoping review will map applications of digital teaching and learning media in the education of nursing and health care professions in Germany. In this way, the scoping review provides relevant impulses for fields of application and design aspects of digital teaching or learning media for nursing and health care education.

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/60427
Exploring the Icarus Paradox in the Specialist Doctor Education System in Indonesia: Public Perspective from Online Media (Preprint)
Authors: Binsar Faisal , Hamsal Mohammad
Published: May 2024

BACKGROUND

Paradox refers to the tension between the ambition to succeed as a medical specialist and the limitations of the medical education system. Indonesia has big ambitions to produce quality doctors, but there are limited infrastructure and resources that limit the educational journey of prospective specialist doctors.

OBJECTIVE

This research aims to determine the Icarus paradox in the medical education system, which describes prospective specialist medical students, and the quality of health services in Indonesia. Understand how the Icarus paradox is reflected in society's perspective on medical education by paying attention to the quality of services provided.

METHODS

Using a mixed methods approach, integrating quantitative and qualitative analysis.

RESULTS

This results in three cognitive perspectives that show the existence of the Icarus paradox in the Indonesian medical education system, namely the education system perspective, society's view of students, and the health service perspective. Although there are aspirations to improve the quality of health services and medical education, there are also structural challenges that hinder the journey of the medical profession. Students who are prospective specialist doctors face various problems, the quality of health services in Indonesia is influenced by limited resources and accessibility. This perspective was developed into a conceptual model.

CONCLUSIONS

This study provides valuable insight into the Icarus paradox in the context of the medical education system in Indonesia, highlighting its complexity and emphasizing the importance of reform in medical education. This research has limitations, primarily relying on online reviews that may not be representative of the entire population, and primarily focusing on the views of the public and students, thus potentially introducing subjective bias. Therefore, these findings emphasize the importance of improving medical education and health services to effectively address the challenges faced by medical professionals.

CLINICALTRIAL

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