bluuebunny/crossref_metadata_2025 huggingface dataset:
SPPB reference values and performance in assessing sarcopenia in community-dwelling Singaporeans – Yishun Study
Authors: Lee Shuen Yee , Choo Pei Ling , Pang Benedict Wei Jun , Lau Lay Khoon , Jabbar Khalid Abdul , Seah Wei Ting , Chen Kenneth Kexun , Ng Tze Pin , Wee Shiou-Liang
Published: February 2021

Background: The Short Physical Performance Battery (SPPB) is an established test of physical performance. We provide reference values for SPPB and determine SPPB performance and cut-offs in assessing sarcopenia for Asian community-dwelling older adults.Methods: 538 (57.8% women) community-dwelling adults aged 21–90 years were recruited. SPPB and its subtest scores and timings (8ft gait speed (GS), five-times repeated chair sit-to-stand (STS) and balance) were determined. Appendicular lean mass divided by height-squared, muscle strength (handgrip) and physical performance (6m GS, STS and SPPB) were assessed to define sarcopenia for various Asian criteria. Area under the ROC curve (AUC) was used to assess performance of SPPB and subtests in discriminating sarcopenia. Optimal SPPB and GS subtest cut-offs for each sarcopenia criterion were determined by maximizing sensitivity and specificity.Results: The mean SPPB score was 11.6(SD 1.1) in men and 11.5(SD1.2) in women. Majority of participants(≥50%) aged 21–80 years achieved the maximum SPPB score. SPPB total and subtest scores generally decreased with age (all p<0.001), but did not differ between sex. SPPB was limited in assessing sarcopenia (AUC 0.56–0.64) but had moderate-to-excellent performance in assessing severe sarcopenia (AUC 0.69–0.98), with optimal cut-off of ≤11points. SPPB GS subtest had moderate-to-excellent performance in assessing sarcopenia (AUC 0.62–0.72) and severe sarcopenia (AUC 0.81–0.95). The optimal GS cut-off for sarcopenia was 1.0m/s.Conclusions: Population-specific normative SPPB values are important for use in diagnostic criteria and to interpret results of studies evaluating and establishing appropriate treatment goals. Performance on the SPPB should be reported in terms of the total sum score and registered time to complete the repeated-chair STS and 8-ft walk tests. An SPPB cut-off of ≤11points was optimal in assessing sarcopenia. GS subtest could be an independent criterion for discriminating sarcopenia in community-dwelling older adults.
Deficiency in vitamin B12 and ferritin is associated with epigenetic alterations in cancer patients
Authors: Elawdan Khaled A. , Farouk Sabah , Araf Salah , Khalil Hany
Published: February 2021

Background: Cancer is the second-leading cause of death worldwide, caused by several mutations in DNA within the cells including epigenetic alteration. The epigenetic changes are external modifications to the DNA that switch “on” or “off” gene expression. The present study was conducted to investigate the epigenetic modifications and its correlation with the levels of vitamin B12 and ferritin in cancer patients with hepatocellular carcinoma (HCC), breast cancer (BC), lung cancer (LC), or colon cancer (CC). Methods and Results: A total of 200 blood samples were obtained from cancer patients and healthy individuals. The relative expression of DNA methyltransferases (DNMTs), Ten-Eleven translocation (TET), and methionine synthase (MS) was evaluated in patients with the normal level of vitamin B12/ferritin and patients with the deficient levels of them. DNA methylation within the promoter regions was investigated of each indicated genes using the methylation-sensitive restriction enzyme HpaII and bisulfite PCR. Interestingly, the expression of DNMT1, DNMT3a, and DNMT3b was increased in patients with low levels of vitamin B12 and ferritin, while the expression of MS, TET1, and TET3 was significantly decreased. DNA methylation analysis in patients with deficient levels of vitamin B12/ferritin showed a methylated-cytosine within the location 318/CG and 385/CG in the promoter region of TET1 and TET3, respectively. Moreover, the bisulfite PCR assay further confirmed the methylation changes in the promoter region of TET1 and TET3 at the indicated locations. Conclusion: These data indicate that the deficiency in vitamin B12 and ferritin in cancer patients plays a key role in the epigenetic exchanges during cancer development.
Generalised SEIR modelling of the COVID-19 pandemic course: data quality issues and structural analysis
Authors: Mendes Jorge Morais , Coelho Pedro S.
Published: February 2021

Successive generalisations of the basic SEIR model have been proposed to accommodate the different needs of the organisations handling the SARS-CoV-2 epidemic. These generalisations have not been able until today to represent the potential of the epidemic to overwhelm hospital capacity until today. This work builds on previous generalisations, including a new compartment for hospital occupancy that allows accounting for the infected patients that need for specialised medical attention. Consequently, a deeper understanding of the hospitalisations rate and probability as well as of the recovery rates for hospitalised and non-hospitalised individuals is achieved, offering new information and predictions of crucial importance for the planning of the health systems and global epidemic response. Additionally, a new methodology to calibrate epidemic flows between compartments is proposed. We conclude that the two-step calibration procedure is able to recalibrate non-error-free data and showed crucial to reconstruct the series in a specific situation characterised by significant errors over the official recovery cases. The performed modelling also allowed to understand how effective the several interventions (lockdown or other mobility restriction measures) were, offering insight for helping public authorities to set the timing and intensity of the measures in order to avoid the implosion of the health systems.
RE: Association of Abnormal Pulmonary Vasculature on CT Scan for COVID-19 Infection with Decreased Diffusion Capacity in Follow Up: a retrospective cohort study.
Authors: Salerno Daniel , Oriaku Ifeoma , Darnell Melinda , Lanclus Maarten , Backer Jan De , Lavon Ben , Gupta Rohit , Jaffe Fredric , Sanchez Maria Elena Vega , Kim Victor
Published: February 2021

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas exchange at short term follow-up.Methods: We studied subjects who were hospitalized for COVID-19 pneumonia and then discharged. Serum inflammatory biomarkers, CT scan, and clinical characteristics were assessed during the hospitalization. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross sectional area were analyzed. Additionally, the amount of opacification on CT (i.e. ground glass opacities) was quantified in each patient. Pulmonary function tests were performed 2-3 months after discharge. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO ≥80% predicted (Normal DLCO) based on these pulmonary function tests. Results: 38 subjects were included in our analysis. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the Normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r=-0.343, p=0.035). Conclusions: Low DLCO is common after COVID-19 infection, and abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. These findings suggest that pulmonary vascular abnormalities during hospitalization with COVID-19 might have long-lasting effects on pulmonary function.
Patient-identified early clinical warning signs of nodular melanoma: A qualitative study
Authors: Coroiu Adina , Moran Chelsea , Davine Jessica A. , Brophy Kyla , Bergeron Catherine , Tsao Hensin , Körner Annett , Swetter Susan M. , Geller Alan C.
Published: February 2021

Background: Nodular (NM) and superficial spreading melanoma (SSM) show different disease trajectories, with more rapid development in NM and fewer opportunities for early detection often resulting in worse outcomes. Our study described the patient-identified early signs of thin NM via comparisons to thin (≤ 2 mm) SSM and thick (>2 mm) NM. Methods: We conducted semi-structured interviews with NM and SSM patients and analyzed the data using thematic analysis. Results: We enrolled 34 NM and 32 SSM patients. Melanoma early signs uniquely identified by patients with thin NM included white, blue or black coloration, “dot-like” size, fast changes in shape and color observed over 2 weeks, elevation and texture or “puffiness” over 6-12 months, and the sensation that the mole “did not feel right”. Early signs reported by both thin NM and thin SSM patients included round or oblong shape, “jagged” border, pink/red, brown/reddish or dark coloration, “elevated like a pimple” or “tiny bump”, fast color darkening, diameter growth, and border irregularity, and mole feeling “really itchy”.Conclusions: We found evidence that early signs of NM can be self-identified, which has important implications for the earlier detection of this most aggressive type of melanoma by both health professionals and patients.
Yaw stability control of automated guided vehicle under the condition of centroid variation
Authors: Liu Wei , Zhang Qingjie , Wan Yidong , Liu Ping , Yu Yue , Guo Jun
Published: February 2021

The centroid of an automated guided vehicle changes due to the irregular position and unbalanced weight of the merchandises on the load platform, which affects the completion of the handling task between stations in intelligent factories. This paper presents a hierarchical control strategy to improve yaw stability considering centroid variation. Firstly, the vehicle body and hub motor models are established based on dynamics. Secondly a hierarchical controller is designed by using the method of extension theory, model predictive control (MPC) and sliding mode control. Then based on CarSim and Simulink, the step co-simulation of the low-speed condition of the automated guided vehicle is carried out. Compared with the uncontrolled condition, the maximum deviation of the yaw rate is reduced from 0.58 rad/s to 0.52 rad/s, and the error with the theoretical value is reduced from 16% to 4%; the maximum deviation of the centroid sideslip angle is reduced from -0.84 rad to -0.77 rad, and the error with the theoretical value is reduced from 12% to 3%. Finally, a four-wheel drive and four-wheel steering automated guided vehicle is manufactured to carry out inter station steering experiments in simulated factory environment. The error between simulation and experiment is less than 5%. The results show that the designed controller is effective, and the research can provide theoretical and experimental basis for the low-speed steering control stability of automated guided vehicle.
The mirror mechanism in schizophrenia spectrum disorders: Protocol for a systematic review and meta-synthesis
Authors: Valizadeh Amir , Amlashi Nazanin Hedayati , Rasooli Anita , Mbwogge Mathew , Haadi Ainaaz
Published: February 2021

Introduction: Mirror neurons are visuomotor neurons that perform mirror mechanisms, meaning each time an individual observes another individual performing an action, these neurons which encode that action, are activated in the observer’s cortical motor system. One of the cognitive domains of controversy in schizophrenia is Motor Resonance, also known as the Mirror Neuron System (MNS). In the current paper, we aim to review all the available literature regarding mirror mechanism examination in patients with schizophrenia and present an explicit summary of the available findings up to this date.Methods: We will search MEDLINE (through PubMed), Embase, and Web of Science for papers which evaluated the functional integrity of MNS, using Electroencephalography (EEG), Magnetoencephalography (MEG), Transcranial magnetic stimulation (TMS), Functional magnetic resonance imaging (fMRI), near-infrared spectroscopy (NIRS), Eye tracking, and muscle activation (EMG) in schizophrenia spectrum disorders. We will perform a meta-synthesis based on vote counting methods on the data. We will also evaluate the publication bias using Funnel plots and assess the confidence in cumulative evidence using CERQual.
FokI polymorphism of the vitamin D receptor (VDR) gene and susceptibility to tuberculosis: evidence through a meta-analysis
Authors: Yadav Upendra , Kumar Pradeep , Rai Vandana
Published: February 2021

Background: Tuberculosis is one of the top ten causes of deaths worldwide. The deficiency of vitamin D was reported to be associated with the increased susceptibility of tuberculosis. Various previous reports were published to check the association of FokI polymorphism of the vitamin D receptor gene with tuberculosis risk. But their results were inconsistent so, we performed a meta-analysis to know the exact relation of the two.Methods: Different databases were screened up to November, 2020 with the keywords “Vitamin D receptor”, “VDR”, and “FokI”, along with “Tuberculosis” and “TB” to find the suitable articles. All the statistical analyses were performed by the Open Meta-Analyst program and all p-values were two-tailed with a significance level of 0.05.Results: No statistically significant association was observed in the allele contrast model (ORfvs.F= 1.11, 95%CI= 0.99-1.24, p= 0.05, I2= 73.46%), in the dominant model (ORff+Ffvs.FF= 1.11, 95%CI= 0.96-1.28, p= 0.14, I2= 71.39%), and in the co-dominant model (ORFfvs.FF= 1.05, 95%CI= 0.92-1.21, p= 0.41, I2= 65.97%). However, a significant association was found in the homozygote model (ORffvs.FF= 1.32, 95%CI= 1.03-1.69, p= 0.02, I2= 67.02%) and in the recessive model (ORFF+Ff vs.ff= 1.26, 95%CI= 1.03-1.54, p= 0.02, I2= 58.01%). Further analysis was performed on the bases of the ethnicity. In Asian population a significant association was found in the homozygote model (ORffvs.FF= 1.57, 95%CI= 1.12-2.21, p= 0.008, I2= 70.37%) and in the recessive model (ORFF+Ff vs.ff= 1.43, 95%CI= 1.08-1.89, p= 0.01, I2= 63.13%).Conclusion: In conclusion, a significant association of FokI with tuberculosis susceptibility was found in the overall analysis and in the Asian population.
Allocation of Photoassimilates in Bud and Fruit from Different Leaf Nodes of Camellia oleifera
Authors: Wen Yue , Su Shu-chai , Jia Ting-ting , Wang Xiang-nan
Published: February 2021

The periods of flower bud differentiation and fruit growth for Camellia oleifera overlap greatly affect the allocation of photoassimilates to flower buds and fruit, resulting in obvious alternate bearing. To export the cause and mitigate alternate bearing of Camellia oleifera, the allocation of photoassimilates to buds and fruit supplied by leaves at different node positions was studied by the addition of labeled 13CO2 during the slow fruit growth stage. The fate of 13C photoassimilated carbon was followed during four periods: slow fruit growth (4 hours and 10 days after 13C labeling); rapid growth (63 days after 13C labeling); oil conversion (129 days after 13C labeling); and maturation (159 days after 13C labeling). Photosynthetic parameters and leaf areas of the leaves shared a common pattern (fifth > third > first), and the order of photosynthetic parameters of different fruit growth stages was as follows: oil conversion > maturation > rapid growth > slow growth. The most intense competition between flower bud differentiation and fruit growth occurred during the oil conversion stage. Dry matter accumulation in different sinks occurred as follow: fruit > flower bud > leaf bud. Photoassimilates from the labeled first leaf were mainly translocated to the first flower bud, and the upper buds were always differentiated into flower buds. The photoassimilates from the labeled third leaf were distributed disproportionately to the third flower bud and fruit. They distributed more to the third flower bud, and the middle buds formed either flower or leaf buds. However, the photoassimilates from the labeled fifth leaf were primarily allocated to the fruit that bore on the first node of last year’s bearing shoot, and basal buds did not form flower buds. Based on our results, the basal leaves should be retained for a high yield in the current year, and the top leaves should be retained for a high yield in the following year. Our results have important implications for understanding the management of flower and fruit in C. oleifera. The thinning of fruit during the on-crop year can promote flower bud formation and increase the yield of C. oleifera crops in the following year. During the off-year, more fruit should be retained to maintain the fruit yield. The thinning of middle-upper buds could promote more photoassimilates allocate to the fruit.
Quality of Life with Gestational Diabetes
Authors: Elzeblawy Hassan Hanan
Published: February 2021

Diabetes is a demanding disease, so it can affect life in many ways. Managing diabetes can be stressful. The way feel when the blood glucose levels are low or high adds to the stress. On top of that, there are the worries that might develop complications, and the burden of dealing with any complications may already have. It is no wonder that many people feel that diabetes affects their quality of life
Narodziny terapii filozoficznej z ducha antyku. W kierunku stawania się osobą
Authors: Femiak Tomasz
Published: February 2021

Autor wylicza problemy, którymi zajmuje się terapia filozoficzna i podejmuje próbę podania jej definicji. W tekście znajdziemy odwołania do psychologii homeryckiej, współczesnych nurtów terapeutycznych oraz przykładów zastosowania terapii filozoficznej (zapisy obserwacji osób po odbyciu indywidualnej sesji terapii filozoficznej lub pracy grupowej). W artykule ukazany został związek terapii filozoficznej ze starożytnym pojmowaniem filozofii (antyczne ćwiczenia duchowe). Główną osią, wokół której prowadzone są rozważania jest zastosowanie terapii filozoficznej w procesie stawania się osobą.
O sensowności uczuć. Dziedzictwo myśli Edyty Stein
Authors: Janik Piotr
Published: February 2021

Koncepcja Edyty Stein rozumienia drugiego człowieka jest znana z jej dysertacji O zagadnieniu wczucia. Niemniej, gruntowne przebadanie struktury osobowości ludzkiej, jakie podjęła w Filozofii psychologii i humanistyki, rzuca nowe światło na tę kwestię. Stein dokonuje swoistej syntezy Husserlowskiego prymatu prawdy i Schelerowskiej koncepcji miłości, unikając przy tym idealizmu i woluntaryzmu, którym obarczone są te stanowiska. Steinowska koncepcja znajduje kontynuację w fenomenologii Merleau-Ponty’ego i R. Barbarasa.
Dog-bone Samples may not Provide Direct Access to the Longitudinal Tensile Strength of Clear-wood
Authors: Balduzzi Giuseppe , Zelaya-Lainez Luis , Hochreiner Georg , Hellmich Christian
Published: February 2021

Background:

Testing standards prescribe dog-bone samples for the determination of clear-wood longitudinal tensile strength. However, the literature reports a high number of invalid tests due to the unexpected failure of the sample outside the gauge length.

Motivation:

The paper aims at understanding the reason for the premature failure of dog-bone samples and suggesting possible strategies for improving testing protocols.

Methods:

The paper starts with a comparative review of standards for different orthotropic materials. Thereafter, it analyzes the stress distribution in a clear-wood dog-bone sample using a recently proposed stress-recovery procedure and Finite Elements. Finally, the sample failure is considered applying Tsai-Wu and SIA criteria.

Results:

Comparative review highlights the controversy on the choice of the sample geometry. Both analytical and numerical results confirm the presence of shear and transversal stresses in necking regions, overlapping with axial stress greater (up to 2%) than the one in the gauge region. As a consequence, clear-wood dog-bone samples fail not due to a pure axial stress state in the gauge region (as expected), but due to complex stress state in necking region, where failure index is 4 ~ 5% greater than the one in gauge region.

Conclusion:

Assuming that dog-bone samples fail in the gauge region due to pure axial stress is simplistic, as demonstrated by analytical and numerical evidence. As a consequence, interpretations of experimental results based on this belief are misleading and testing protocols should be refined. Indeed, the presence of spurious stresses interfering with expected pure axial stress seems unavoidable. Therefore, clear-wood testing standards should allow to use prismatic samples or, alternatively, to consider as valid also tests on samples breaking outside the gauge region. Both the proposed solutions apparently reduce the accuracy of the experiments, while in contrast, they provide the best achievable results, speeding up the testing procedure and reducing the testing costs.
Case Report: False-Positive Dengue Non-Structural Protein 1 Antigen in a Patient with COVID-19 Infection
Authors: Firmansyah Yohanes , Elizabeth Jessica , Hendsun Hendsun , Gosal Darren
Published: February 2021

Abstract: Early diagnosis of dengue fever and COVID-19 is made very easy due to technological advancements. The  non-structural protein 1 antigen test strips are widely used in various regions; however, false-positive events have begun to be reported in the dengue-endemic areas with the COVID-19 pandemic, even though statistically non-structural protein 1 antigens are very specific to dengue infection. We reported a case of the false-positive non-structural protein 1 test in a patient with COVID-19 infection.
Early Prevention of Occlusal Disorders of Dental Arches
Authors: Oleksyn Khrystyna , Rozhko Mykola
Published: February 2021

Abstract. Occlusion is the joining of dental arches or individual groups of teeth over longer or shorter periods of time. Dental caries is one of the main factors of occlusal disorders. In economically developed countries, it affects 95-98% of the population. Dental caries results in changing location of occlusal contact points and is the cause of atypical mandibular movements. As a result, occlusal overloading and trauma are observed.

The objective of the research was to carry out early prevention of occlusal disorders in patients with carious lesions using modern restorative methods.

Materials and Methods. There were examined 90 first-/second-/third-year students of the Ivano-Frankivsk National Medical University at the age of 17-20 years living in the regions with low fluoride level in order to prevent occlusal disorders using the methods of restorations of the affected occlusal surfaces considering functional anatomy and subsequent checking of occlusal relationships with the help of the T-Scan Novus occlusal analysis system. Among them, 45 students were diagnosed with fissure caries of the first molars, 45 students underwent the restoration of the first molars without considering functional anatomy. Treatment was carried out by the methods of direct and indirect restorations.

          Results. The paper contains the results of redistribution of occlusal contacts in carious lesions of the first molar (decrease in the occlusal load on the affected tooth, occurrence of overloading on the tooth with larger chewing area) and restoration of the first molar without considering the principles of functional anatomy (bite force directly on the tooth restored). Further restorations of the chewing surfaces of the first molars considering the occlusal determinants led to an even distribution of the occlusal force on the molars.

          Conclusions. The results of our study demonstrated the effectiveness of the developed treatment and prevention complex.
Sofia Parfanovych - a Woman Doctor, an Innovator of Medical Education in Ukraine: some actual issues
Authors: Stytsiuk Nataliya
Published: February 2021

Abstract: The article analyzes the main milestones of the prominent Ukrainian doctor, public figure, writer of the early to mid-twentieth century Sofia Parfanovych. There are three main aspects of her historical heritage: scientific, educational and literary. New variants of topics of lectures and seminars for studying the history of Ukrainian medicine of the beginning of the XX century in the course of disciplines “History of medicine” and “Development of medical knowledge” are offered.
Relationship between autism and mind perception of selves, others, and toy objects
Authors: Au Rachel Hoi Yan
Published: February 2021

Autism is found to be associated with mind perception, in particular reduced perception of human agency. Prior work has shown that more autistic individuals in the general population tend to view others as less capable of doing and thinking. Autism is, by contrast, not meaningfully associated with the mind attribution to other types of entities examined in past work, including children, nonhuman animals, supernatural agents, and so forth. In this paper, more types of entities—toy objects and selves—were investigated. Across two normal adult samples and a meta-analysis, autism was found to be associated with decreased perception of both experiential and agentic mental capacity in other adult humans, as well as in oneself. More autistic individuals tend to consider others and themselves less capable of both doing and feeling. Autism was also associated with increased mind perception of toy objects, such that more autistic individuals tend to consider toy objects more capable of doing and feeling. These findings partially replicated and meaningfully extended previous work on autism and mind perception, thus providing insight into the relationship of autism with potentially different perceptions and treatments of others, selves, and toy objects.
A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke
Authors:   Research in Aging and Dysphagia Lab, Department of Communication Sciences and Disorders, Pennsylvania State University, University Park, PA 16802, USA, Madhavan Aarthi , Sia Isaac , Carnaby Giselle , Crary Michael
Published: February 2021

Individuals with acute stroke on nonoral feeding regimens frequently develop pneumonia, questioning the long-held belief that pneumonia in stroke patients is a caused by food and liquid aspiration alone. Refluxate and colonized oral secretions are thought to contribute to an acidic oropharyngeal environment. If aspirated, these colonized oral secretions with increased acidity, can result in increased risk to the respiratory system. This study aimed to investigate the relationship between pharyngeal acidity, dysphagia, and pneumonia in acute stroke patients. Twenty-one patients (mean age 67 years) admitted to a stroke unit were recruited into this study. We evaluated their stroke and dysphagia severity via clinical measures. Pharyngeal acidity was measured using a Restech Dx-pH measurement probe placed transnasally for 24 hours. Sixty two (62%) patients presented with moderate to severe stroke and 38% with dysphagia. Seven patients (33%) were positive for pharyngeal acidity. Two patients with pharyngeal acidity were diagnosed with chest infection. Pharyngeal acidity was significantly correlated with stroke severity (r = 0.487, P = 0.03) and significantly and inversely correlated to clinical swallow performance (rho = -0.626, p = 0.02). Additionally, pharyngeal acidity was significantly associated with categorical dysphagia scores (c2(3,21) = 10.5, p<0.01), functional oral intake (c2(3,21) = 15.7, p<0.001), presence of modified diets (χ2(1,21) = 14.0, p=0.0001), and tube feeding (χ2 (1,21) = 9.992, p = 0.002). Preliminary results suggest that acute stroke patients with dysphagia may present with increased risk for increased pharyngeal acidity. Pharyngeal acidity can result in negative sequelea, including respiratory complications. A better understanding of these potential relationships may lead to enhanced assessment and treatment approaches that limit pharyngeal acidity and resulting respiratory complications in acute stroke patients.
Evaluation of a New Personalized Health Dashboard in Preventive Child Health Care: Protocol for a Mixed Methods Feasibility Randomized Controlled Trial
Authors: Weijers Miriam , Feron Frans , van der Zwet Jonne , Bastiaenen Caroline
Published: February 2021

Background

A new dashboard, the 360ºCHILD-profile, was developed to adopt personalized health care within preventive child health care. On this profile, holistic health data are visualized in a single image to provide parents, adolescents, and caregivers direct access to a manageable résumé of a child’s medical record. Theoretical ordering, conforming to “International Classification of Functioning, Disability and Health for Children and Youth”, guides clinical reasoning toward the biopsychosocial concept of health. It is yet unknown if and how this promising tool functions in practice, and a variety of feasibility questions must be addressed.

Objective

This paper describes the design and methods of a feasibility randomized controlled trial (RCT), with the aim of evaluating the RCT’s feasibility (recruitment, response, measure completion, and intervention allocation) and 360ºCHILD-profile’s feasibility (usability and potential effectiveness).

Methods

A pragmatic mixed methods study design was chosen, starting with an RCT to measure feasibility and health literacy in 2 parallel groups (1:1). Qualitative research will then be used to understand and explain quantitative findings and to explore the stakeholders' perspectives on the potential of the 360ºCHILD-profile. Participants will include child health care professionals (n≥30), parents (n≥30), and caregivers (n≥10) of children who experience developmental problems (age 0-16 years). Children will only be able to participate if they are older than 11 years (adolescents, n≥10). The 2 groups included in the study will receive standard care. The experimental group will additionally receive personalized 360ºCHILD-profiles.

Results

After an intervention period of 6 months, quantitative outcomes will be measured, analyzed (descriptive feasibility statistics and preliminary between-group differences) and used to purposively sample for semistructured interviews.

Conclusions

Study results will provide knowledge for building theory on the 360ºCHILD-profile and designing future (effect) studies.

Trial Registration

Netherlands Trial Register NTR6909; https://www.trialregister.nl/trial/6731

International Registered Report Identifier (IRRID)

DERR1-10.2196/21942
Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study
Authors: Taeymans Jan , Luijckx Eefje , Rogan Slavko , Haas Karin , Baur Heiner
Published: February 2021

Background

The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures.

Objective

The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]), alcohol consumption habits, and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences.

Methods

All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5% α level of error.

Results

Prevalence of non-health-enhancing PA was 37.1%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3%. Prevalence of low sleeping quality was 44.7%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations.

Conclusions

In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students, Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions.

Trial Registration

ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108
Effects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis (Preprint)
Authors: Duan Yanping , Shang Borui , Liang Wei , Du Gaohui , Yang Min , Rhodes Ryan E
Published: February 2021

BACKGROUND

Noncommunicable diseases (NCDs) are associated with the burden of premature deaths and huge medical costs globally. There is an increasing number of studies combining a multiple health behavior change (MHBC) intervention paradigm with eHealth approaches to jointly promote weight-related health behaviors among people with NCD; yet, a comprehensive summary of these studies is lacking.

OBJECTIVE

This review aims to meta-analyze the effectiveness and systematically summarize the characteristics of the relevant intervention studies for improving the outcomes of physical activity, healthy diet, and weight among people with NCD.

METHODS

Following PRISMA guidelines, 4 electronic databases (PsycINFO, PubMed, Scopus, SPORTDiscus) were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Article selection, quality assessment, and data extraction were independently performed by 2 authors. The standardized mean difference (SMD) was calculated to evaluate the effectiveness of interventions for 3 intervention outcomes (physical activity, healthy diet, and weight), and subsequent subgroup analyses were performed for gender, age, intervention duration, channel, and theory. Calculations were conducted, and figures were produced in SPSS 22 and Review Manager 5.3.

RESULTS

Of the 664 original hits generated by the systematic searches, 15 eligible studies with moderate to high quality were included. No potential publication bias was detected using statistical analyses. Studies varied in intervention channel, intensity, and content. The meta-analysis revealed that the eHealth MHBC interventions significantly promoted physical activity (SMD 0.85, 95% CI 0.23 to 1.47, P=.008) and healthy diet (SMD 0.78, 95% CI 0.13 to 1.43, P=.02), but did not contribute to a healthy weight status (SMD –0.13, 95% CI= –0.47 to 0.20, P=.43) among people with NCDs, compared to the control conditions. Results from subgroup analysis indicated that theory-based interventions achieved greater effect than nontheory-based interventions in promoting physical activity, and interventions with traditional approaches (SMS, telephone) were more effective than those with modern internet-based approaches in promoting healthy diet.

CONCLUSIONS

The results of this review indicates that eHealth MHBC interventions achieve preliminary success in promoting physical activity and healthy diet behaviors among people with NCD. Future studies could improve the intervention design to achieve better intervention effectiveness.

CLINICALTRIAL

PROSPERO International Prospective Register of Systematic Reviews CRD42019118629; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=118629
Digital Pathology During the COVID-19 Outbreak in Italy: Survey Study (Preprint)
Authors: Giaretto Simone , Renne Salvatore Lorenzo , Rahal Daoud , Bossi Paola , Colombo Piergiuseppe , Spaggiari Paola , Manara Sofia , Sollai Mauro , Fiamengo Barbara , Brambilla Tatiana , Fernandes Bethania , Rao Stefania , Elamin Abubaker , Valeri Marina , De Carlo Camilla , Belsito Vincenzo , Lancellotti Cesare , Cieri Miriam , Cagini Angelo , Terracciano Luigi , Roncalli Massimo , Di Tommaso Luca
Published: February 2021

BACKGROUND

Transition to digital pathology usually takes months or years to be completed. We were familiarizing ourselves with digital pathology solutions at the time when the COVID-19 outbreak forced us to embark on an abrupt transition to digital pathology.

OBJECTIVE

The aim of this study was to quantitatively describe how the abrupt transition to digital pathology might affect the quality of diagnoses, model possible causes by probabilistic modeling, and qualitatively gauge the perception of this abrupt transition.

METHODS

A total of 17 pathologists and residents participated in this study; these participants reviewed 25 additional test cases from the archives and completed a final psychologic survey. For each case, participants performed several different diagnostic tasks, and their results were recorded and compared with the original diagnoses performed using the gold standard method (ie, conventional microscopy). We performed Bayesian data analysis with probabilistic modeling.

RESULTS

The overall analysis, comprising 1345 different items, resulted in a 9% (117/1345) error rate in using digital slides. The task of differentiating a neoplastic process from a nonneoplastic one accounted for an error rate of 10.7% (42/392), whereas the distinction of a malignant process from a benign one accounted for an error rate of 4.2% (11/258). Apart from residents, senior pathologists generated most discrepancies (7.9%, 13/164). Our model showed that these differences among career levels persisted even after adjusting for other factors.

CONCLUSIONS

Our findings are in line with previous findings, emphasizing that the duration of transition (ie, lengthy or abrupt) might not influence the diagnostic performance. Moreover, our findings highlight that senior pathologists may be limited by a digital gap, which may negatively affect their performance with digital pathology. These results can guide the process of digital transition in the field of pathology.
Investigating the Ethical and Data Governance Issues of Artificial Intelligence in Surgery: Protocol for a Delphi Study (Preprint)
Authors: Lam Kyle , Iqbal Fahad M , Purkayastha Sanjay , Kinross James M
Published: February 2021

BACKGROUND

The rapid uptake of digital technology into the operating room has the potential to improve patient outcomes, increase efficiency of the use of operating rooms, and allow surgeons to progress quickly up learning curves. These technologies are, however, dependent on huge amounts of data, and the consequences of their mismanagement are significant. While the field of artificial intelligence ethics is able to provide a broad framework for those designing and implementing these technologies into the operating room, there is a need to determine and address the ethical and data governance challenges of using digital technology in this unique environment.

OBJECTIVE

The objectives of this study are to define the term digital surgery and gain expert consensus on the key ethical and data governance issues, barriers, and future research goals of the use of artificial intelligence in surgery.

METHODS

Experts from the fields of surgery, ethics and law, policy, artificial intelligence, and industry will be invited to participate in a 4-round consensus Delphi exercise. In the first round, participants will supply free-text responses across 4 key domains: ethics, data governance, barriers, and future research goals. They will also be asked to provide their understanding of the term digital surgery. In subsequent rounds, statements will be grouped, and participants will be asked to rate the importance of each issue on a 9-point Likert scale ranging from 1 (not at all important) to 9 (critically important). Consensus is defined a priori as a score of 7 to 9 by 70% of respondents and 1 to 3 by less than 30% of respondents. A final online meeting round will be held to discuss inclusion of statements and draft a consensus document.

RESULTS

Full ethical approval has been obtained for the study by the local research ethics committee at Imperial College, London (20IC6136). We anticipate round 1 to commence in January 2021.

CONCLUSIONS

The results of this study will define the term digital surgery, identify the key issues and barriers, and shape future research in this area.

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/26552
Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Dol Justine , Aston Megan , McMillan Douglas , Tomblin Murphy Gail , Campbell-Yeo Marsha
Published: February 2021

BACKGROUND

Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum.

OBJECTIVE

The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program.

METHODS

This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant’s age and the woman’s self-selected preference for breastfeeding or formula feeding and tailored with the infant’s name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant’s date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention.

RESULTS

Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022.

CONCLUSIONS

This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program.

CLINICALTRIAL

ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/27138
The Use of Natural Language Processing to Ascertain Suicide Ideation/Attempt from Clinical Notes Within a Large Integrated Healthcare System (Preprint)
Authors: Xie Fagen , Ling-Grant Deborah S , Chang John , Amundsen Britta I , Hechter Rulin C
Published: February 2021

UNSTRUCTURED

Purpose: Identifying risk factors for suicide using progress notes and administrative data is time consuming and usually requires manual case review. In this study, a natural language processing computerized algorithm was developed and implemented to automatically ascertain suicide ideation/attempt from clinical notes in a large integrated healthcare system, Kaiser Permanente Southern California.
Methods: Clinical notes containing prespecified relevant keywords and phrases related to suicidal ideation/attempt between 2010 and 2018 were extracted from our organization’s electronic health record system. A random sample of 864 clinical notes was selected and equally divided into four subsets. These subsets were reviewed and classified as one of the following three suicide ideation/attempt categories: “Current”, “Historical” and “No” for each note by experienced research chart abstractors. The first three training datasets were used to develop the rule-based computerized algorithm sequentially and the fourth validation dataset was used to evaluate the algorithm performance. The validated algorithm was then applied to the entire study sample of clinical notes.
Results: The computerized algorithm ascertained 23 of the 26 confirmed “Current” suicide ideation/attempt events and all 10 confirmed “Historical” suicide ideation/attempt events in the validation dataset. This algorithm produced a 88.5% sensitivity and 100.0% positive predictive value (PPV) for “Current” suicide ideation/attempt, and a 100.0% sensitivity and 100.0% PPV for “Historical” suicide ideation/attempt. After applying the computerized process to the entire study population sample, we identified a total of 1,050,289 “Current” ideation/attempt events and 293,038 “Historical” ideation/attempt events during the study period. Among the 400,436 individuals who were identified as having a “Current” suicide ideation/attempt event, 115,197 (28.8%) were 15-24 years old at the first event, 234,924 (58.7%) were female, 165,084 (41.7%) were Hispanic, and 150,645 (37.6%) had two or more events in the study period.
Conclusions: Our study demonstrated that a natural language processing computerized algorithm can effectively ascertain suicide ideation/attempt from the free-text clinical notes in the electronic health record of a diverse patient population. This algorithm can be utilized in support of suicide prevention programs and patient care management.