bluuebunny/crossref_metadata_2025 huggingface dataset:
The Coronavirus Disease Pandemic 2019 [COVID-19]: Impact on NHS England PET-CT Scanning 
Authors: Wong Wai Lup , Ross Peter , Peters Kevin , Frenz Marion , Hai Tong , Ridgeon Alex , Toop Ralph , Strouhal Peter , Bomanji Jimmy
Published: September 2020

Purpose To examine the impact of the COVID-19 pandemic on PET-CT scanning activity across England. Methods Monthly PET-CT scanning activity was collected from 41/48 NHS England provider sites. Data from 31/41sites was stratified by non-oncology/oncology and cancer type. Lung cancer and lymphoma activity was split into specific indications. The data was compiled in Excel and analysed using Stata software to assess distribution and statistical significance of variation in activity comparing levels before and during the COVID-19 pandemic. Results In April and May 2020 a 32% and 31% decrease in activity was observed; a larger decrease for non-cancer compared with cancer PET-CT. In June 2020 PET-CT activity started to recover with 6% fewer scans recorded compared with June 2019. Decrease and recovery varied according to cancer types. Of the six most common indications for PET CT, lung and oesophageal cancer had the largest decrease in activity: lung -29%, -45% and oesophagus -43%, -59% in April and May respectively, and slowest recovery, -23%, -26% respectively in June. By contrast, lymphoma and melanoma showed the smallest decrease: lymphoma -14%, -9%; melanoma -16%, +5% in April and May respectively, and fastest recovery +12% lymphoma +14% respectively. Specifically, lung cancer PET-CTs related to initial diagnosis and staging saw the largest fall and slowest recovery compared with PET-CTs for people with known lung cancer. Conclusions There was considerable variation in the rate of decline and recovery in PET-CT scanning across cancer types and specific indications related to the cancer type. The causes for the variation remain to be explained.
Clinical characteristics of pediatric cases of SARS-CoV-2 infection in Hunan, China: A retrospective, multi-center case series
Authors: Wu Lei , Zhang Xiao-Fo , Li Jia , Wei Song-Qing , Yang Yong , Yi Xiu-Ying , Jiang Xin-Ping , Han Hai-Ying , Zhong Zhe-Feng , Cao Xiao-Ying , L Feng-Jun , Zhou Ge , Gong Xiao-Hui , Zha Wen-Ting , Xie He-Bin , Wang Tuan-Mei , Wang Man-Zhi
Published: September 2020

Objective To investigate the epidemiological characteristics, clinical features, treatment and short-term prognosis of SARS-CoV-2 infection in children.Methods A retrospective analysis was conducted in children with SARS-CoV-2 admitted to twelve hospitals in eight cities in Hunan province, China, from January 26, 2020 to June 30, 2020.Results A total of 48 children were enrolled in this study. 11 cases (23%) were asymptomatic, 15 cases (31%) were mild, 20 cases (42%) were moderate, and 2 cases (4%) were severe. No children were critical requiring intensive care. The most common symptom was fever (42%), cough (40%), fatigue (17%) and diarrhea (10%). The total peripheral blood leukocytes count decreased in two case (4%), Lymphocytopenia was present in 5 cases (10%). There were abnormal chest CT changes in 22 children (46%), including 15 (68%) with patchy ground glass opacity. In addition to supportive treatment, 41 children (85%) received antiviral therapy, 11 patients and (23%) were treated with antibiotics, 2 children (4%) were treated with methylprednisolone and IVIG. There was no death occurred.Conclusions Most children with SARS CoV-2 infection in Hunan province were asymptomatic, mild or moderate. Severe cases are rare. Close family contact was the main route of infection. The younger the age, the less obvious symptoms for children might be. Epidemiological history, nucleic acid test and chest imaging were important tools for the diagnosis in children.
ANALYSIS OF THE FINANCIAL VIABILITY OF THE AQUAPONICS (FISH FARMING AND HYDROPONICS) SYSTEM USING THE MONTE CARLO METHOD
Authors: Navarro Rodrigo Diana , Kodama Goro , Santos Maísa Joaquim dos , Souza Álvaro Nogueira de , Hundley Guilherme Crispim
Published: September 2020

This study aims to evaluate a particular property in Brasília that uses the aquaponics system on a small production scale. The Monte Carlo method was used to estimate its financial feasibility and the probability of the production volume and, consequently, evaluate the risk of this undertaking. The data analyzed included fixed and variable costs, revenues and financial viability indicators, which are net present value (NPV), periodic economic benefit (PEB) and internal rate of return (IRR). It was identified in this research that the cost with the largest participation was the land acquisition, amounting to more than 60%. According to the survey, the venture showed a 56.69% probability to generate a NPV, PEB and IRR rate, respectively, of R$ 117,784.26, R$ 16,003.11 and 37%. The probability of occurrence of fish volume and plant production were, respectively, 1179.44 kg and 731.26 kg with 74.43% and 76.16%, presenting a probability greater than 50%, which is considered as more reliable than traditional analysis. Therefore, we can conclude that it is economically viable according to the NPV parameters, which was greater than zero, and the IRR, that was higher than the minimum rate of attractiveness.
SUSTENTABILIDADE DE PRODUTORES RURAIS EM CAICÓ, RIO GRANDE DO NORTE
Authors: Lucena Huanna Raíssa Alves de , Andrade Anderson Bruno Anacleto de , Maracajá Patrício Borges , Silva Hugerles Sales , Santos José Lucas Guilherme , Pimenta Thiago Alves
Published: September 2020

Objetivou-se avaliar o nível de sustentabilidade entre produtores que residem na zona rural e urbana do município de Caicó no estado do Rio Grande do Norte, Brasil, identificando as características da população, assim como indicadores relacionados à qualidade de vida, capital social e preservação ambiental. Para isso, realizou-se aplicação de questionários com 40 produtores, com 50% da amostra residindo na sede do município e o restante em comunidades rurais. O município de Caicó apresenta-se com uma maior parcela de produtores do gênero masculino com idades que variaram de 23 a 84 anos. Entre as atividades agropecuárias desenvolvidas pelos produtores as melhores avaliadas em relação ao fator econômico foram à bovinocultura e a ovinocultura, para os dois grupos amostrados. Para Índice de Qualidade de Vida da zona rural observou-se desempenho médio, porém, na zona urbana esse índice se enquadrou como elevado, com valor de 0,992. O Índice de Capital Social também diferenciou entre as populações pesquisadas, para os produtores moradores na zona urbana a caracterização do índice foi baixa com valor de 0,075, para os residentes rurais a classificação foi média, com valor de 0,650. Em relação preservação ambiental dos produtores, essa foi definida como baixa nas duas realidades estudadas, em decorrência principalmente da utilização de fogo nas atividades agropecuárias. Nesse contexto, verificou-se que tanto os produtores da zona rural quanto os que residem da zona urbana apresentam nível médio de sustentabilidade.
DESENVOLVIMENTO E TEOR DE PROTEÍNA EM ORA-PRO-NÓBIS INFLUENCIADOS POR DIFERENTES CONDIÇÕES DE LUMINOSIDADE
Authors: Vieira Joel Soares , Megguer Clarice Aparecida , Cavalcante Ubiramar Ribeiro , Pereira Flávia Dionísio , Vilarinho Muriel Silva
Published: September 2020

A ora-pro-nóbis (Pereskia aculeata Miller) é uma planta nativa do Brasil, considerada uma espécie do grupo das plantas alimentícias não convencionais e se destaca por ser rica em substâncias nutritivas e antioxidantes. O uso de telas fotosseletivas, visa combinar a proteção física das plantas, com a filtragem seletiva da radiação solar para promover respostas fisiológicas desejáveis, reguladas pela luz. Partindo do pressuposto que alterações na qualidade espectral da luz podem proporcionar mudanças fisiológicas e aumento da produção e que não foi encontrada literatura associando o uso de telas ao cultivo de ora-pro-nóbis, neste contexto, objetivou-se com esse estudo avaliar os parâmetros de crescimento inicial e teor de proteína de plantas de ora-pro-nóbis cultivadas, sob telas fotosseletivas e a pleno sol. . O experimento foi conduzido em delineamento de blocos casualizados (DBC), com parcelas subdivididas no tempo, com quatro repetições. As parcelas foram compostas por quatro ambientes (telas ChromatiNet® Leno Azul, ChromatiNet® Leno Pérola, ChromatiNet® Leno Vermelha, todas com 20% de sombreamento e a pleno sol) e as subparcelas constituídas de duas épocas de amostragens, aos 80 e 120 dias após o transplantio (DAT) das mudas. Os parâmetros avaliados foram: teor de proteína das folhas, número de folhas, diâmetro do colo da planta, massa fresca e seca da folha, caule e raiz. Na amostragem aos 120 DAT, as plantas cultivadas sob tela pérola obtiveram as maiores médias para massa fresca de folha, massa seca de folha e caule, diâmetro do colo da planta e número de folhas. O ambiente de cultivo proporcionou alterações no crescimento inicial e teor de proteína de ora-pro-nóbis.
CRESCIMENTO DE MUDAS DE MARACUJAZEIRO EM SUBSTRATO ALTERNATIVO COM FERTILIZANTE DE LIBERAÇÃO CONTROLADA
Authors: Mendes Rosiney França , De Araújo Jamayra Conceição , Andrade Neto Romeu de Carvalho , De Araújo James Maciel , Guilherme João Paulo Maia
Published: September 2020

Na região norte, principalmente, no Acre, Amazonas e Pará são produzidos diversos resíduos provenientes do processamento de frutas nativas que, na maioria dos locais de beneficiamento, são descartados sem nenhum aproveitamento. Portanto, buscar alternativas de aproveitamento, sobretudo, como substrato para produção de mudas é de grande valia para a sustentabilidade do sistema produtivo. Objetivou-se, neste trabalho, avaliar o crescimento de mudas de maracujazeiro em substrato alternativo com adubo de liberação controlada. O experimento foi conduzido na casa de vegetação da Embrapa Acre. O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 5x2, sendo 5 formulações de substrato e 2 doses de adubo (com e sem), com 4 repetições. Os tratamentos foram constituídos da casca de cupuaçu triturada e substrato comercial, puros (100%), e misturados nas proporções 25%, 50% e 75% v/v. Ambos, com e sem o adubo de liberação controlada. Foram avaliadas as variáveis respostas: Porcentagem de germinação, índice de velocidade de emergência, altura de planta, diâmetro do caule, número de folha, massas secas; da parte área, das raízes, total, e relação raiz/parte aérea. Nos tratamentos contendo a mistura dos substratos, bem como, no substrato comercial puro, houve influência significativa (p<0,05) para todas as variáveis analisadas, as quais foram destacadas com a presença do adubo de liberação controlada. O substrato alternativo formado a partir da mistura da casca de cupuaçu triturada com o MECPLANT Florestal nas proporções 25%, 50% e 75%, acrescido do fertilizante de liberação controlada, proporciona elevado crescimento das mudas de maracujazeiro, quando comparado sem a adição do fertilizante.
Özel Yetenekli Çocukların Kendi Arkadaşlık İlişkilerine Yönelik Görüşleri
Authors: ÖZBEY Fidan , ELLİBEŞ CERRAH Hadiye , ARPAZ ÜNSAL Şükran
Published: September 2020

Bu
araştırma özel yetenekli çocukların kendi arkadaşlık ilişkilerine yönelik
görüşlerini belirlemeyi amaçlayan nitel bir araştırmadır. Çalışma grubunu
Düzce, Bolu ve Samsun illerinde yaşayan özel yetenekli 12 öğrenci
oluşturmaktadır. Veriler araştırmacılar tarafından geliştirilen yarı
yapılandırılmış Arkadaşlık İlişkileri Görüşme Formu kullanılarak toplanmıştır.
Verilerin analizi aşamasında 9 tema oluşturulmuş ve bulgular bu temalar altında
düzenlenmiştir. Bu temalar; birliktelik, çatışma, yakınlık, iletişim, yardım,
bağlılık, güven, özdeşim ve sadakat temaları olarak sıralanmaktadır. Bulgulara
göre; öğrenciler arkadaşlarının evlerine sık sık gidip birlikte zaman
geçirdiklerini, onlarla zaman geçirmekten keyif aldıklarını öte yandan yalnız zaman
geçirmeyi de sevdiklerini göstermektedir. İyi bir arkadaşta aradıkları en temel
özelliğin güven olduğu belirlenmiştir. Özel yetenekli çocuklar arkadaşlarıyla
bazı konularda tartışsalar da hata kendilerinde olduğu zaman mutlaka özür
dilediklerini ifade etmişlerdir. Arkadaşlarının fikir ve düşüncelerini
önemsediklerini ve onların sorunları ile yakından ilgilendiklerini dile
getirmişlerdir. Kendilerinin arkadaşları tarafından sevildiğini
belirtmişlerdir. Karşılıklı olarak sırlarını tutuklarını ve birbirlerini
koruduklarını ifade etmişlerdir. Arkadaşlarının yerinde olsaydı kendisi ile
arkadaşlık kurmak isteyebileceğini ifade eden çocuklar, kendilerinin iyi bir
arkadaş olduklarını dile getirmişlerdir. Arkadaşlarının başarıları ile mutlu
olduklarını ve kendi başarıları ile de arkadaşlarının mutlu olduklarını dile
getirmişlerdir. Fakat arkadaşları kendilerini kötü bir yola sürüklerse onlarla
arkadaşlıklarını keseceklerini de açıklamışlardır. Elde edilen bulgular alan
yazın çerçevesinde tartışılmıştır.
Astaxanthin prevents lung injury due to hyperoxia and inflammation
Authors: Akduman Hasan , Tayman Cüneyt , Çakir Ufuk , Çakir Esra , Dilli Dilek , Türkmenoğlu Tuğba Taşkin , Gönel Ataman
Published: September 2020

Background/aim:

We aimed to ascertain the effects of astaxanthin on the lungs of rat pups with bronchopulmonary dysplasia (BPD) induced by hyperoxia and lipopolysaccharide (LPS).

Materials and methods:

Forty-two newborn Wistar rats born to spontaneous pregnant rats were divided into three groups:
Hyperoxia (95% O2) + lipopolysaccharide (LPS) group, hyperoxia + LPS + astaxhantin group and control: no treatment
group (21% O2). Pups in the hyperoxia + LPS + astaxanthin group were given 100 mg/kg/day oral astaxanthin from the first
day to the fifth day. Histopathologic and biochemical evaluations including glutathione (GSH), total antioxidant status
(TAS), total oxidant status (TOS), lipid hydroperoxide (LPO), 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation
protein products (AOPP), myeloperoxidase (MPO), total thiol, tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL1β) and caspase-3 activities were performed.

Results:

A better survival rates and weight gain were demonstrated in the hyperoxia + LPS + astaxanthin group (p <0.001).
In the histopathologic evaluation, the severity of lung damage was significantly reduced in the hyperoxia+LPS+astaxanthin
group, as well as decreased apoptosis (ELİSA for caspase-3) (p <0.001). The biochemical analyses of lung tissues TAS,
GSH, Total thiol levels were significantly higher in the astaxanthin treated group compared to hyperoxia + LPS group (p
<0.05) while TOS, AOPP, LPO, 8-OHdG, MPO levels were significantly lower (p <0.001). In addition, unlike the hyperoxia + LPS group, TNF-α and IL-1β levels in lung tissue were significantly lower in the astaxanthin-treated group (p <0.001).

Conclusion:

Astaxanthin was shown to reduce lung damage caused by inflammation and hyperoxia with its antiinflammatory, anti-oxidant, anti-apoptotic properties and to protect the lung from severe destruction.
Development of Peptides that Inhibit Aminoglycoside-Modifying Enzymes and β-Lactamases for Control of Resistant Bacteria
Authors: Costa Bruna O. , Cardoso Marlon H. , Franco Octávio L.
Published: September 2020

:

Aminoglycosides and β-lactams are the most commonly used antimicrobial agents in clinical
practice. This occurs because they are capable of acting in the treatment of acute bacterial infections.
However, the effectiveness of antibiotics has been constantly threatened due to bacterial pathogens
producing resistance enzymes. Among them, the aminoglycoside-modifying enzymes (AMEs)
and β-lactamase enzymes are the most frequently reported resistance mechanisms. AMEs can inactivate
aminoglycosides by adding specific chemical molecules in the compound, whereas β-lactamases
hydrolyze the β-lactams ring, preventing drug-target interaction. Thus, these enzymes provide a scenario
of multidrug-resistance and a significant threat to public health at a global level. In response to
this challenge, in recent decades, several studies have focused on the development of inhibitors that
can restore aminoglycosides and β-lactams activity. In this context, peptides appear as a promising
approach in the field of inhibitors for future antibacterial therapies, as multiresistant bacteria may be
susceptible to these molecules. Therefore, this review focused on the most recent findings related to
peptide-based inhibitors that act on AMEs and β-lactamases, and how these molecules could be used
for future treatment strategies.
Yoga may Prevent Cytokine Storm in COVID-19
Authors: Gautam Surabhi , Dada Rima
Published: September 2020

The pandemic outbreak of coronavirus disease (COVID-19) has emerged as the most threatening
public health challenge. The clinical presentation ranges from asymptomatic and mild clinical
symptoms to acute respiratory-distress syndrome (ARDS) and death. Apart from the respiratory system,
other organ systems like cardiovascular, renal, and gastrointestinal systems are also involved. Cytokine
storm is a condition of systemic inflammatory cytokine rampage through the bloodstream leading to lifethreatening
complications. There is an urgent need for the prevention of infection and effective management.
Yoga is a profound science with both immunity-boosting and immune-modulating capacity.
We propose that yoga-based intervention may aid in improving health with its immunity-boosting potential
and preventing the exuberant inflammatory cytokine storm, thus reducing the severity of the disease.
It can also reduce stress, anxiety, and co-morbid depression by promoting neuroplasticity and prevents
persistent activation of the hypothalamus pituitary adrenal axis and thus may reduce disease severity. It
may also enhance the immunity of caretakers and make them more emotionally resilient. Thus, yoga can
be useful for enhancing immunity, stress reduction and may prevent the exaggerated immune response
to the cytokine storm.
Assessing User Retention of a Mobile App: Survival Analysis
Authors: Lin Yu-Hsuan , Chen Si-Yu , Lin Pei-Hsuan , Tai An-Shun , Pan Yuan-Chien , Hsieh Chang-En , Lin Sheng-Hsuan
Published: September 2020

Background

A mobile app generates passive data, such as GPS data traces, without any direct involvement from the user. These passive data have transformed the manner of traditional assessments that require active participation from the user. Passive data collection is one of the most important core techniques for mobile health development because it may promote user retention, which is a unique characteristic of a software medical device.

Objective

The primary aim of this study was to quantify user retention for the “Staff Hours” app using survival analysis. The secondary aim was to compare user retention between passive data and active data, as well as factors associated with the survival rates of user retention.

Methods

We developed an app called “Staff Hours” to automatically calculate users’ work hours through GPS data (passive data). “Staff Hours” not only continuously collects these passive data but also sends an 11-item mental health survey to users monthly (active data). We applied survival analysis to compare user retention in the collection of passive and active data among 342 office workers from the “Staff Hours” database. We also compared user retention on Android and iOS platforms and examined the moderators of user retention.

Results

A total of 342 volunteers (224 men; mean age 33.8 years, SD 7.0 years) were included in this study. Passive data had higher user retention than active data (P=.011). In addition, user retention for passive data collected via Android devices was higher than that for iOS devices (P=.015). Trainee physicians had higher user retention for the collection of active data than trainees from other occupations, whereas no significant differences between these two groups were observed for the collection of passive data (P=.700).

Conclusions

Our findings demonstrated that passive data collected via Android devices had the best user retention for this app that records GPS-based work hours.
Recommendations From the Twitter Hashtag #DoctorsAreDickheads: Qualitative Analysis
Authors: Sharma Anjana Estelle , Mann Ziva , Cherian Roy , Del Rosario Jan Bing , Yang Janine , Sarkar Urmimala
Published: September 2020

Background

The social media site Twitter has 145 million daily active users worldwide and has become a popular forum for users to communicate their health care concerns and experiences as patients. In the fall of 2018, a hashtag titled #DoctorsAreDickheads emerged, with almost 40,000 posts calling attention to health care experiences.

Objective

This study aims to identify common health care conditions and conceptual themes represented within the phenomenon of this viral Twitter hashtag.

Methods

We analyzed a random sample of 5.67% (500/8818) available tweets for qualitative analysis between October 15 and December 31, 2018, when the hashtag was the most active. Team coders reviewed the same 20.0% (100/500) tweets and the remainder individually. We abstracted the user’s health care role and clinical conditions from the tweet and user profile, and used phenomenological content analysis to identify prevalent conceptual themes through sequential open coding, memoing, and discussion of concepts until an agreement was reached.

Results

Our final sample comprised 491 tweets and unique Twitter users. Of this sample, 50.5% (248/491) were from patients or patient advocates, 9.6% (47/491) from health care professionals, 4.3% (21/491) from caregivers, 3.7% (18/491) from academics or researchers, 1.0% (5/491) from journalists or media, and 31.6% (155/491) from non–health care individuals or other. The most commonly mentioned clinical conditions were chronic pain, mental health, and musculoskeletal conditions (mainly Ehlers-Danlos syndrome). We identified 3 major themes: disbelief in patients’ experience and knowledge that contributes to medical errors and harm, the power inequity between patients and providers, and metacommentary on the meaning and impact of the #DoctorsAreDickheads hashtag.

Conclusions

People publicly disclose personal and often troubling health care experiences on Twitter. This adds new accountability for the patient-provider interaction, highlights how harmful communication affects diagnostic safety, and shapes the public’s viewpoint of how clinicians behave. Hashtags such as this offer valuable opportunities to learn from patient experiences. Recommendations include developing best practices for providers to improve communication, supporting patients through challenging diagnoses, and promoting patient engagement.
Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study
Authors: Kawadler Jamie M , Hemmings Nicola Rose , Ponzo Sonia , Morelli Davide , Bird Geoffrey , Plans David
Published: September 2020

Background

The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects.

Objective

The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data.

Methods

A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks.

Results

After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend.

Conclusions

The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress.
Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study
Authors: Wild Katherine , Sharma Nicole , Mattek Nora , Karlawish Jason , Riley Thomas , Kaye Jeffrey
Published: September 2020

Background

Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data.

Objective

This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions.

Methods

Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes.

Results

During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use.

Conclusions

Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.
Integrating the Practical Robust Implementation and Sustainability Model With Best Practices in Clinical Decision Support Design: Implementation Science Approach
Authors: Trinkley Katy E , Kahn Michael G , Bennett Tellen D , Glasgow Russell E , Haugen Heather , Kao David P , Kroehl Miranda E , Lin Chen-Tan , Malone Daniel C , Matlock Daniel D
Published: September 2020

Background

Clinical decision support (CDS) design best practices are intended to provide a narrative representation of factors that influence the success of CDS tools. However, they provide incomplete direction on evidence-based implementation principles.

Objective

This study aims to describe an integrated approach toward applying an existing implementation science (IS) framework with CDS design best practices to improve the effectiveness, sustainability, and reproducibility of CDS implementations.

Methods

We selected the Practical Robust Implementation and Sustainability Model (PRISM) IS framework. We identified areas where PRISM and CDS design best practices complemented each other and defined methods to address each. Lessons learned from applying these methods were then used to further refine the integrated approach.

Results

Our integrated approach to applying PRISM with CDS design best practices consists of 5 key phases that iteratively interact and inform each other: multilevel stakeholder engagement, designing the CDS, design and usability testing, thoughtful deployment, and performance evaluation and maintenance. The approach is led by a dedicated implementation team that includes clinical informatics and analyst builder expertise.

Conclusions

Integrating PRISM with CDS design best practices extends user-centered design and accounts for the multilevel, interacting, and dynamic factors that influence CDS implementation in health care. Integrating PRISM with CDS design best practices synthesizes the many known contextual factors that can influence the success of CDS tools, thereby enhancing the reproducibility and sustainability of CDS implementations. Others can adapt this approach to their situation to maximize and sustain CDS implementation success.
Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial
Authors: Hirvonen Maija , Purcell Carrie , Elliott Lawrie , Bailey Julia V , Simpson Sharon Anne , McDaid Lisa , Moore Laurence , Mitchell Kirstin Rebecca ,   The STASH Study Team
Published: September 2020

Background

There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources.

Objective

The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention.

Methods

Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data.

Results

Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to—rather than embedded in—their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied.

Conclusions

Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding.
Trends and Predictors of COVID-19 Information Sources and Their Relationship With Knowledge and Beliefs Related to the Pandemic: Nationwide Cross-Sectional Study
Authors: Ali Shahmir H , Foreman Joshua , Tozan Yesim , Capasso Ariadna , Jones Abbey M , DiClemente Ralph J
Published: September 2020

Background

During the COVID-19 pandemic, there is a heightened need to understand health information seeking behaviors to address disparities in knowledge and beliefs about the crisis.

Objective

This study assessed sociodemographic predictors of the use and trust of different COVID-19 information sources, as well as the association between information sources and knowledge and beliefs about the pandemic.

Methods

An online survey was conducted among US adults in two rounds during March and April 2020 using advertisement-based recruitment on social media. Participants were asked about their use of 11 different COVID-19 information sources as well as their most trusted source of information. The selection of COVID-related knowledge and belief questions was based on past empirical literature and salient concerns at the time of survey implementation.

Results

The sample consisted of 11,242 participants. When combined, traditional media sources (television, radio, podcasts, or newspapers) were the largest sources of COVID-19 information (91.2%). Among those using mainstream media sources for COVID-19 information (n=7811, 69.5%), popular outlets included CNN (24.0%), Fox News (19.3%), and other local or national networks (35.2%). The largest individual information source was government websites (87.6%). They were also the most trusted source of information (43.3%), although the odds of trusting government websites were lower among males (adjusted odds ratio [AOR] 0.58, 95% CI 0.53-0.63) and those aged 40-59 years and ≥60 years compared to those aged 18-39 years (AOR 0.83, 95% CI 0.74-0.92; AOR 0.62, 95% CI 0.54-0.71). Participants used an average of 6.1 sources (SD 2.3). Participants who were male, aged 40-59 years or ≥60 years; not working, unemployed, or retired; or Republican were likely to use fewer sources while those with children and higher educational attainment were likely to use more sources. Participants surveyed in April were markedly less likely to use (AOR 0.41, 95% CI 0.35-0.46) and trust (AOR 0.51, 95% CI 0.47-0.56) government sources. The association between information source and COVID-19 knowledge was mixed, while many COVID-19 beliefs were significantly predicted by information source; similar trends were observed with reliance on different types of mainstream media outlets.

Conclusions

COVID-19 information source was significantly determined by participant sociodemographic characteristics and was also associated with both knowledge and beliefs about the pandemic. Study findings can help inform COVID-19 health communication campaigns and highlight the impact of using a variety of different and trusted information sources.
Artificial Intelligence for the Prediction of Helicobacter Pylori Infection in Endoscopic Images: Systematic Review and Meta-Analysis Of Diagnostic Test Accuracy
Authors: Bang Chang Seok , Lee Jae Jun , Baik Gwang Ho
Published: September 2020

Background

Helicobacter pylori plays a central role in the development of gastric cancer, and prediction of H pylori infection by visual inspection of the gastric mucosa is an important function of endoscopy. However, there are currently no established methods of optical diagnosis of H pylori infection using endoscopic images. Definitive diagnosis requires endoscopic biopsy. Artificial intelligence (AI) has been increasingly adopted in clinical practice, especially for image recognition and classification.

Objective

This study aimed to evaluate the diagnostic test accuracy of AI for the prediction of H pylori infection using endoscopic images.

Methods

Two independent evaluators searched core databases. The inclusion criteria included studies with endoscopic images of H pylori infection and with application of AI for the prediction of H pylori infection presenting diagnostic performance. Systematic review and diagnostic test accuracy meta-analysis were performed.

Results

Ultimately, 8 studies were identified. Pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve of AI for the prediction of H pylori infection were 0.87 (95% CI 0.72-0.94), 0.86 (95% CI 0.77-0.92), 40 (95% CI 15-112), and 0.92 (95% CI 0.90-0.94), respectively, in the 1719 patients (385 patients with H pylori infection vs 1334 controls). Meta-regression showed methodological quality and included the number of patients in each study for the purpose of heterogeneity. There was no evidence of publication bias. The accuracy of the AI algorithm reached 82% for discrimination between noninfected images and posteradication images.

Conclusions

An AI algorithm is a reliable tool for endoscopic diagnosis of H pylori infection. The limitations of lacking external validation performance and being conducted only in Asia should be overcome.

Trial Registration

PROSPERO CRD42020175957; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175957
COVID-19 and the “Film Your Hospital” Conspiracy Theory: Social Network Analysis of Twitter Data
Authors: Ahmed Wasim , López Seguí Francesc , Vidal-Alaball Josep , Katz Matthew S
Published: September 2020

Background

During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are “empty.” Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it.

Objective

This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future.

Methods

Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots.

Results

The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network.

Conclusions

Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content.
Online Health Information Seeking Using “#COVID-19 Patient Seeking Help” on Weibo in Wuhan, China: Descriptive Study
Authors: Zhao Xiaoman , Fan Ju , Basnyat Iccha , Hu Baijing
Published: September 2020

Background

First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state’s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information–seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic.

Objective

The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the “#COVID-19 Patient Seeking Help” hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak?

Methods

Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using “#COVID-19 Patient Seeking Help” and explored their online health information–seeking behavior.

Results

The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients’ social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support.

Conclusions

Overall, the findings contribute to our understanding of health information–seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play.
Guidelines for Regulating or Rating Mental Health Mobile Applications: A Systematic Review (Preprint)
Authors: Cheng Qijin , Chen Zirui
Published: September 2020

BACKGROUND

Increasing number of mobile applications (apps) have been released to the market to address mental health needs; however, their quality varies. Mental health professionals have been advocating to set up regulating policies or rating guidelines to facilitate users to make informed choice.

OBJECTIVE

The study aims to map out the landscape and ecosystem of existing regulating policies and rating guidelines concerning mental health apps, streamline core rating criteria, and identify what knowledge and policy gaps exist.

METHODS

A systematic review was conducted on both English and Chinese literature. Not only academic publication databases but also popular search engines were searched to identify relevant policies or guidelines. Eligible publications were analyzed to identify key stakeholders in the ecosystem of regulating and rating mental health apps, and common approaches and criteria of the regulating or rating. What limitations exist and what improvement should be achieved in order to make good use of mental health apps were then discussed.

RESULTS

56 articles were found to meet our inclusion criteria, covering 31 sets of regulating policies, rating protocols, or specific recommendations. Key stakeholders include app developers, governments, app stores, mental health professionals, and individual users. Only very few countries have released specific regulation policies for mental health apps, whereas app stores were almost absent on this matter. Mental health professionals have been advocating to set up rating guidelines but they did not always engage app developers or ordinary users. Regulation approach is to extend existing regulations on medical devices to mental health apps that self-claim for medical use. Quality rating approach is using either a checklist or a scoring scheme to rate mental health apps’ compliance with some criteria. Specific criteria include privacy and data protection, protecting user safety and minimize risks, evidence-based, usability and front-end accessibility, system interoperability, technical stability, cost, and information timeliness.

CONCLUSIONS

Only very few jurisdictions and professional organizations in the world have released regulating policies or rating guidelines on mental health apps, which can serve as a basis for other policymakers and professional organizations to adapt. The current regulating policies are rather vague with their applicable scope, whereas the current rating guidelines have relatively high requirement with raters’ capability. Future development needs to address the two major limitations.

CLINICALTRIAL

Nil.
Enhancing Perioperative Care by Primary Care Physicians (Preprint)
Authors: Meenrajan Senthil , Belal Amer , Kadri Ferdous , Goede Dianne
Published: September 2020

BACKGROUND

Perioperative medicine, as part of the curriculum is an ACGME requirement in residency programs. There is increased need for primary care physicians to risk stratify and optimize patients with significant comorbidities prior to undergoing complex surgeries. However, minimal data exists in knowledge, perception, and barriers to perioperative medicine in the primary care field.

OBJECTIVE

To survey faculty and residents in the Internal Medicine and Family Medicine program about their training and comfort levels in managing patients perioperatively and to identify potential barriers that physicians have in rendering perioperative care.

METHODS

An online Qualtrics survey was sent to 101 faculty and 144 residents in Internal Medicine and Family Medicine at the University of Florida. Responses on the survey was measured on a Likert scale. Once all responses was received, the data was analyzed with Excel to look at trends in physician perceived deficits and concerns in perioperative management.

RESULTS

Residents were least comfortable doing preoperative evaluations (Average=3.3/5, N=35) especially those planning primary care careers. Amongst faculty, more years in practice is positively correlated with more comfort in perioperative medicine. The survey had a response rate of 16.8% for faculty (17/101) and 24.3% for residents (35/144). A need for additional educational opportunities is noted during residency training and at Continuing Medical Education (CME) events.

CONCLUSIONS

There is a need for additional education in perioperative medicine in the curriculum of Internal Medicine and Family Medicine programs. Over time physicians are more comfortable with perioperative medicine but still need updates at CME events. Structured curriculum, more exposure to preoperative evaluations and management of complex patients may result in primary care physicians getting comfortable with perioperative care.