bluuebunny/crossref_metadata_2025 huggingface dataset:
'We always support each other – no matter what': a qualitative analysis of work-related psychosocial demands, stressors and resources in general practice teams
Authors: Tsarouha Elena , Preiser Christine , Weltermann Birgitta , Junne Florian , Seifried-Dübon Tanja , Stuber Felicitas , Hartmann Sigrid , Wittich Andrea , Rieger Monika A , Rind Esther , Consortium IMPROVEjob-
Published: April 2020

Background Work-related stress has been associated with poor psychological and physical outcomes. A better understanding of work-related psychosocial demands, risks and resources can therefore contribute to the prevention of work-related stress. Compared to the general population, medical staff have reported a higher prevalence of chronic stress. Using general practices as an example for small enterprises, this study aims to gain a deeper understanding of work-related psychosocial demands, stressors and resources in the primary care setting. Methods We applied an ethnographic design, comprising a combination of participating observations, individual interviews with physicians (N = 6) and focus group discussion with physician assistants and administrative staff (N = 19) in five general practices in Germany. Access to the practice teams was established via a local general practice network. A grounded theory approach was applied to analyze all data. Results Our results identified specific psychosocial demands, stressors and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial risks included factors related to work content and tasks (eg, incompleteness of task), organization of work (eg, frequent interruptions), and the working environment (eg, noise). Work-related resources comprised staff’s influence on aspects related to work organization (eg, scope for action) and social support (eg, positively perceived teamwork). Conclusion Although work processes in general practices are complex and partly regulated by law, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.
Investigating the pharmacological mechanisms of SheXiang XinTongNing against coronary heart disease based on network pharmacology
Authors: Jia Li-ying , Li Jia , Cao Gui-yun , Meng Zhao-qing , Gan Lu , Li Jin-xin , Lan Xin-yi , Yang Chao-lin , Zhang Chun-Feng
Published: April 2020

Background SheXiang XinTongNing, a commercially available Chinese patent medicine, has been widely used in the treatment of coronary heart disease. However, the mechanisms of SheXiang XinTongNing are still unclear. The aim of this study was to investigate the pharmacological mechanisms of SheXiang XinTongNing against coronary heart disease via network analysis. Method The traditional Chinese medicine system pharmacology analysis platform was used to screen the potential active constituents of the six traditional Chinese medicines in SheXiang XinTongNing, and the potential targets were obtained from PharmMapper. The genome annotation database platform was used to screen the candidate targets related to coronary heart disease. Then the drug-components-targets network and protein interaction network were built by Cytoscape 3.6.0 software. Further, GO bio-functional enrichment analysis and KEGG pathway enrichment analysis were performed through annotation, visualization and integrated discovery database. Results Results showed that the drugs-components-targets network contains 104 targets and 62 key components. The protein interaction network consisted of 107 nodes; key targets included Bcl2l1, IGF1, SRC, CASP3, et al. Functionally, the candidate targets were significantly associated with multiple pathways such as PI3K-Akt signaling pathway, MAPK signaling pathway, Ras signaling pathway, FoxO signaling pathway, Endocrine resistance. Given the above, the pharmacological activities of SheXiang XinTongNing may be predominantly related to several factors such as cell apoptosis, inflammation and angiogenesis. Conclusion XTN can effectively attenuate the symptoms of coronary heart disease through diverse pathways. The research proves that network pharmacology can successfully reveal the mechanisms of traditional Chinese medicine in a holistic view. Our systematic analysis lays a foundation for further studying.
Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis
Authors: Shao Peng , Guo Shujuan , Li Guimei , Qin Daogang , Li Sen , Ying Luan
Published: April 2020

Background: Sick euthyroid syndrome is frequent in children admitted with diabetic ketoacidosis (DKA). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children admitted for management of DKA.Methods: 194 children admitted for management of DKA were selected from hospital records. Children on thyroxine replacement or those with overt hypothyroidism or anti-TPO antibody positive were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done for all. Children were divided into a euthyroid group (n=88) and an euthyroid sick syndrome（ESS）group (n=106).Results:The ESS group had a higher WBC, PG, β-HB, TG, AG, and HbA1c and lower HCO3-, PA, and ALB levels compared with the euthyroid group (P<0.05). FT3 levels were significantly correlated to β-HB, HCO3-, AG, PA, and HbA1c. (r=-0.642, 0.681, -0.377, 0.581, -0.309, respectively; P<0.01) FT4 levels were significantly correlated to β-HB, HCO3-, and ALB levels (r=-0.489, 0.338, 0.529, respectively; P<0.01). TSH levels were significantly affected by HCO3– only (r=-0.28; P<0.01). HCO3– level was the most important factor deciding adjudication to euthyroid or ESS group on logistic regression analysis (OR=0.844, P=0.004, 95%CI=0.751­-0.948).Conclusions: Lower levels of free thyroid hormones and occurrence of ESS is associated with a higher degree of acidosis in children admitted with DKA. Lower levels of markers of nutrition such as serum albumin and pre-albumin levels are associated with lower levels of free thyroid hormone concentrations in children with DKA.
Potential Risks in Sentinel Lymph Node Biopsy for Cervical Cancer: A Single-Institution Pilot Study
Authors: Tu Hua , Wan Ting , Zhang Xinke , Gu Haifeng , Huang He , Feng Yanling , Liu Jihong
Published: April 2020

Background: Sentinel lymph node (SLN) biopsy is an attractive technique that widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear. Methods: Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered as successful. Patients’ clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed. Results: Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in obturator area (52 of 69 patients, 75.4%) and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P<0.001) and lymph node metastasis (40.9% versus 3.8%, P<0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis. The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also has high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected. Conclusions: In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection, which harbors the risk of omitting nodal metastasis. The risk of having undetected metastasis is high when SLN is positive, therefore further lymphadenectomy may be necessary for these patients.
Analysis of dynamic disturbance in blood coagulation function of 261 patients with Coronavirus Disease 2019
Authors: Chen Nian , Li Yu-Wen , Fan Hao-Zhi , Tian An-Ran , Yuan Hui , Jiang Zheng-Yi , Yu Yun-Xi , Ruan Li-Li , Hu Ping-Ping , Yue Ming , Li Jun , Zhu Chuan-Long
Published: April 2020

Background: With the spread of SARS-CoV-2 around the world, a rising number of studies have been conducted on the epidemiological and clinical characteristics of COVID-19. However, studies about the effect of SARS-CoV-2 on coagulation function are rare. Hence, we aimed to assess the differences and dynamic changes of blood coagulation function in ordinary, severe and critical patients with COCID-19. Methods: A retrospective study was conducted. Clinical information, including age, routine blood and blood coagulation function, was collected from medical records of COVID-19 patients from January 24 to March 25, 2020 in Huangshi, Hubei Province. According to new pneumonia diagnosis and treatment of COVID-19 (trial version seventh), the patients were divided into ordinary, severe and critical groups. Results: 261 COVID-19 patients (186 ordinary, 45 severe and 30 critical ones) were enrolled. Average age in critical group (71.47±11.48 years) was the oldest of three subgroups. At admission, statistically differences could be observed for D-dimer, FDP, Platelet and lymphocyte count among three subgroups (P<0.05). During hospitalization, the peak values of coagulation and valley values of blood routine were monitored, and there were significant differences among ordinary, severe and critical patients in D-dimer (0.26±0.46, 1.39±1.51 and 2.89±1.68 mg/L), FDP (3.29±5.52, 23.68±39.07 and 56.11±49.94 μg/ml), platelet [(164±55.53), (171±69.96) and (84±57.80) ×109/L)] and lymphocyte counts [(1.10±0.46), (0.65±0.35) and (0.55±0.31) ×109/L)], respectively (P<0.001). In the critical group, D-dimer and FDP were significantly increased, while platelet count and lymphocyte count were obviously decreased. D-dimer and FDP in the course of disease in severe/critical groups showed a first upward and then downward trend. Conclusions: Close monitoring of coagulation function could help predict the severity of COVID-19, and guide treatment.
Measuring social media attention of scientific research on Novel Coronavirus Disease 2019 (COVID-19): An investigation on article-level metrics data of Dimensions
Authors: Batooli Zahra , Sayyah Mansour
Published: April 2020

The purpose of this research was to evaluate the rate of attention to the scientific productions on COVID-19 in social media over a period of four months. The present research was an applied descriptive-analytical study that used Scientometrics analysis. The population study included research papers about the COVID-19 indexed in Dimensions platform from December 2019 to March 2020. Information of 20% of the articles with the highest citation count and 20% of the articles with the highest number of Altmetric Attention Score (AAS), including title, journal, citation and Altmetrics indicators for each article were extracted. These data were analyzed by SPSS 16.0. The results showed that 1910 scientific productions about the COVID-19 were indexed in the Dimensions platform. A considerable number of these articles were accessible via preprint services and were published in journals such as The Lancet, JAMA, BMJ and NEJM. Authors from China and Japan were the most active authors. All of the 382 articles had AAS, that is, all of these articles received attention at least in one of the social media. The highest and lowest AAS for these articles were 14030 and 6, respectively. These results show a high rate of attention by researches and users of social media to the articles presented on COVID-19. The result of this research also showed a significant positive relationship between the citations and Altmetric indicators. As the results of this research showed, the “information supply” in the field of COVID-19 was remarkably high. Also, the “information demand” by the social media audiences was high.
Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil
Authors: Magno Laio , Leal Andrea Fachel , Knauth Daniela , Dourado Ines , Guimarães Mark Guimarães Drew Crosland , Santana Elis Santana Passos , Jordão Tiago Jordão , Rocha Gustavo Rocha Machado , Veras Maria Amélia Amélia , Kendall Carl Kendall , Pontes Alexandre Pontes Kerr , Brito Ana Maria , Kerr Ligia Kerr
Published: April 2020

Background: Brazil has a lot of people living with HIV (PLWH) that are still unaware of their own serostatus and has recently integrated HIV self-test (HIVST) into its public health system and offered to key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and its associated factors. Methods: Respondent-driven sampling (RDS) was used in behavioral and biological surveillance to recruit 4,176 MSM in 12 Brazilian cities in 2016. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted according to Gile’s estimator using RDS Analyst Software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or at least once in a lifetime). Results: We included 3,605 MSM who did not previously know they were PLWH. The HIVST acceptability was 49.1%, lower among those had done HIV test during lifetime compared to those who have never done it (42.7% vs 50.1%), especially among who are in a less vulnerable social context. In the subgroups of MSM who had never had an HIV test, those with complete secondary or incomplete higher school, who reported discrimination, who with a medical appointment in the last 12 months, with high levels of knowledge of HIV/AIDS and who took part in LGBT nongovernmental organization (LGBT-NGO) had higher HIVST acceptability. Among MSM who had taken an HIV test, those who took part in LGBT NGOs had greater HIVST acceptability. We observed a dose-response effect of schooling and knowledge of HIV/AIDS on HIVST acceptability: an increase in both levels was associated with greater acceptability. Conclusions: The findings highlight that it is necessary to improve information about HIVST among MSM more vulnerable in Brazil. Given the acceptability of self-testing and its current adoption in Brazil, we can also point to the need for policies that build on this and enhance timely access to health services and prevention information.
Piperaquine resistant Cambodian Plasmodium falciparum clinical isolates: in vitro genotypic and phenotypic characterization
Authors: Boonyalai Nonlawat , Vesely Brian A , Thamnurak Chatchadaporn , Praditpol Chantida , Fagnark Watcharintorn , Kirativanich Kirakarn , Saingam Piyaporn , Chaisatit Chaiyaporn , Lertsethtakarn Paphavee , Gosi Panita , Kuntawunginn Worachet , Vanachayangkul Pattaraporn , Spring Michele D , Fukuda Mark M , Lon Chanthap , Smith Philip L , Waters Norman C , Saunders David L , Wojnarski Mariusz
Published: April 2020

Background: High rates of dihydroartemisinin-piperaquine (DHA-PPQ) treatment failures have been documented for uncomplicated Plasmodium falciparum in Cambodia. It is essential to establish sensitive and reliable markers of PPQ resistance which can be adopted for monitoring the prevalence of drug resistance and guide drug policy change. Several genetic markers have been proposed such as copy numbers of P. falciparum multidrug resistance 1 ( pfmdr1 ) and plasmepsin 2 (PM2), and mutations in exonuclease (exo-E415G) and P. falciparum chloroquine resistance transporter (PfCRT) genes.Methods: To examine the relative contribution of each marker to PPQ resistance, in vitro culture and the PPQ survival assay were performed on seventeen P. falciparum isolates from northern Cambodia and the presence of exo-E415G and PfCRT mutations as well as PM2 copy number polymorphisms were determined. Parasites were then cloned by limiting dilution and the cloned parasites were tested for drug susceptibility. The efficacy of several drug combinations between standard clones and newly cloned P. falciparum Cambodian isolates was also measured.Results: The characterization of culture-adapted isolates revealed that exo-E415G and novel PfCRT mutations can confer PPQ-resistance, in the absence of PM2 amplification. In vitro testing of PPQ resistant parasites showed bimodal dose-response phenotype as previously reported in both Cambodian isolates and genome-edited Dd2 strains. Our finding is the first PPQ resistant clinical isolate with documented swollen digestive vacuole phenotype. From the field isolates, we were able to clone a new parasite line, 14-B5, which is sensitive to arteminsinin and piperaquine but resistant to chloroquine. Most of the drug combinations tested revealed antagonistic interaction against the 14-B5 line, indicating its different genetic background from other P. falciparum laboratory reference lines.Conclusions: Surveillance for PPQ resistance in regions that rely on DHA-PPQ as the first line treatment should depend on the monitoring of the reflective molecular markers. Bimodal dose response curves and swelling of the food vacuole can be used as PPQ resistant phenotype. The use of currently circulating parasite isolates is necessary for relevant drug combination development against current P. falciparum resistance profiles.
Severe Acute Respiratory Syndrome Coronavirus-2 and Pulmonary Tuberculosis Coinfection: Double Trouble
Authors: Singh Abhijeet , Gupta Ayush , Das Kamanashish
Published: April 2020

The ongoing pandemic of novel coronavirus Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2) has received worldwide attention by becoming a major global health threat. We encountered one case of SARS-CoV-2 and pulmonary tuberculosis (TB) coinfection which has not been frequently reported. A 76 year old female presented with acute respiratory symptoms superimposed on chronic symptoms, suggestive to have pneumonia. Oropharyngeal throat swab sample for SARS-CoV-2 infection was positive as detected by real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay. Sputum smear staining was positive for acid fast bacilli. Clinicians should suspect coinfection with pulmonary TB while treating Coronavirus disease 2019 (COVID-19) during ongoing pandemic as therapeutic strategies need to be determined accordingly to improve outcome and prevent transmission in community.
Lymphopenia acted as an adverse factor for severity in patients with COVID-19: a single-centered, retrospective study
Authors: Liu Jiheng , Li Heng , Luo Ming , Liu Jiyang , Wu Lingzhen , Lin Xianfeng , Li Ruijuan , Wang Zhihua , Zhong Haiying , Zheng Wenli , Zhou Yan , Jiang Dixuan , Tan Xin , Zhou Zhiguo , Peng Hongling , Zhang Guangsen
Published: April 2020

Purpose: The outbreak of SARS-CoV-2 began in December and rapidly caused a pandemic. To investigate the significance of lymphopenia for the severity of the disease, this study was performed.Methods: 115 patients confirmed COVID-19 from a tertiary hospital in Changsha, China were enrolled. The clinical, laboratory, treatment and outcome data were collected and compared between patients with lymphopenia or not.Results: The median age was 42 years (1-75). 54 patients (47.0%) of the patients had lymphopenia on admission. In the group of lymphopenia, more patients had hypertension (30.8% vs 10.0%, P=0.006) and coronary heart disease (3.6% vs 0%, P=0.029) and more patients with leucopenia (48.1% vs 14.8%, P<0.001) and eosinophilia (92.6% vs 54.1%, P<0.001) were observed. Lymphopenia was also correlated with severity grades of pneumonia (P<0.001) and C-reactive protein (CRP) level (P=0.0014). Lymphopenia was associated with a prolonged duration of hospitalization (17.0 days vs 14.0 days, P=0.002). Moreover, the recovery of lymphocyte appeared the earliest before CRP and chest radiographs in severe cases, suggesting its predictive value for disease improvement. Conclusion: Our results showed the clinical significance of lymphopenia for predicting the severity of COVID-19 and the recovery of the disease, emphasizing the need to monitor the lymphocyte count dynamically.
Overexpression of miR-26a-5p Suppresses Tau Phosphorylation and Aβ Accumulation in the Alzheimer’s Disease Mice by Targeting DYRK1A
Authors: Liu Yanni , Wang Lin , Xie Fuheng , Wang Xiao , Hou Yuanyuan , Wang Xiaomeng , Liu Juan
Published: April 2020

Objective:

It is reported that miR-26a-5p could regulate neuronal development, but its
underlying mechanisms in Alzheimer’s disease (AD) progression is unclear.

Methods:

APP (swe)/PS1 (ΔE9) transgenic mice served as AD mice. Morris water maze test was
used to measure the spatial learning and memory ability of mice. The expressions of miR-26a-5p,
DYRK1A, phosphorylated-Tau, Aβ40, and Aβ42 were detected. The relationship between miR-
26a-5p and DYRK1A was explored using dual luciferase reporter assay. The effects of miR-26a-
5p on AD mice was determined.

Results:

AD mice walked a lot of wrong ways to find the platform area and the latency time to
reach the platform was longer. There was low expression of MiR-26a-5p in AD mice. Overexpression
of miR-26a-5p inhibited Tau phosphorylation and Aβ accumulation. MiR-26a-5p negatively
regulated DYRK1A via targeting its 3’UTR. In vivo, increased miR-26a-5p down-regulated Aβ40,
Aβ42, p-APP and p-Tau levels in AD mice through decreasing DYRK1A. Meanwhile, the swimming
path and the latency time, to reach the platform, was shorten after enhancing miR-26a-5p expression.

Conclusion:

Overexpression of miR-26a-5p could repress Tau phosphorylation and Aβ accumulation
via down-regulating DYRK1A level in AD mice.
Marijuana Use in Young Adults: What Do We Know?
Authors: Wenzinger Michael , Fears Fayola
Published: April 2020

Cannabis is the most commonly used illicit drug in the United States. Over the past decade its use has increased, with young adults/college aged individuals having the highest proportion of users compared to any other age group. Given the high rates of usage in this age group, cannabis use is an important aspect of mental and physical health in collegeaged adults. Current evidence indicates that marijuana use, especially early and dosedependent use, can have significant negative ramifications on general functioning, academic performance, psychiatric wellness, and may be causally related to development of other substance use disorders and risky behaviors. No strong evidence supports marijuana as a beneficial treatment for any psychiatric indication, however there is evidence supporting the use of cannabidiol (CBD) in illnesses such as epilepsy. Providers must be well apprised of the current evidence base for both detecting and treating marijuana use disorder given its increasing prevalence and decreasing perception of risk. Screening of cannabis use disorder and treatment with appropriate therapy is highly important for college mental health.
Development of a cooling system for 6U module based on Elbrus microprocessor
Authors: Sazho Sh. M. , Vorobushkov V. V. , Gladkih A. S. , Senchenkov S. V.
Published: April 2020

The article discusses the design features of cooling systems for compact Eurocard format modules based on the Elbrus microprocessor. The issue of ensuring the necessary thermal regime of the processor module in the space shortage conditions in order to accommodate the cooling system has been solved. The estimated calculation showed the underperformance of the passive cooling of the Elbrus-4S microprocessor with a heat output of 60 W. In this regard, a 3D model of an active cooling system with 5.5×10.3×4.6 cm dimensions was developed. Thermal calculations were performed using the SolidWorks Flow Simulation program in order to optimize the radiator geometry and fan speed. It was assumed that an optimized cooling system will ensure that the chip temperature of the Elbrus-4S processor is no more than +87 °C (at an ambient temperature of +55 °C). Based on the results of the study, three prototypes were produced for testing. Further tests conducted on prototypes showed the efficiency of the cooling system and the high accuracy of the simulation results. During tests in a climatic chamber at a temperature of +55 °C, the temperature on the microprocessor chip did not exceed +84 °C (a difference of 3 °C compared to the estimated one).
Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review
Authors: Zhao Yinan , Feng Hui , Wu Xinyin , Du Yan , Yang Xiufen , Hu Mingyue , Ning Hongting , Liao Lulu , Chen Huijing , Zhao Yishan
Published: April 2020

Background

Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities.

Objective

The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory.

Methods

We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools.

Results

Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate.

Conclusions

Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population.
Artificial Intelligence and Big Data in Diabetes Care: A Position Statement of the Italian Association of Medical Diabetologists
Authors: Musacchio Nicoletta , Giancaterini Annalisa , Guaita Giacomo , Ozzello Alessandro , Pellegrini Maria A , Ponzani Paola , Russo Giuseppina T , Zilich Rita , de Micheli Alberto
Published: April 2020

Since the last decade, most of our daily activities have become digital. Digital health takes into account the ever-increasing synergy between advanced medical technologies, innovation, and digital communication. Thanks to machine learning, we are not limited anymore to a descriptive analysis of the data, as we can obtain greater value by identifying and predicting patterns resulting from inductive reasoning. Machine learning software programs that disclose the reasoning behind a prediction allow for “what-if” models by which it is possible to understand if and how, by changing certain factors, one may improve the outcomes, thereby identifying the optimal behavior. Currently, diabetes care is facing several challenges: the decreasing number of diabetologists, the increasing number of patients, the reduced time allowed for medical visits, the growing complexity of the disease both from the standpoints of clinical and patient care, the difficulty of achieving the relevant clinical targets, the growing burden of disease management for both the health care professional and the patient, and the health care accessibility and sustainability. In this context, new digital technologies and the use of artificial intelligence are certainly a great opportunity. Herein, we report the results of a careful analysis of the current literature and represent the vision of the Italian Association of Medical Diabetologists (AMD) on this controversial topic that, if well used, may be the key for a great scientific innovation. AMD believes that the use of artificial intelligence will enable the conversion of data (descriptive) into knowledge of the factors that “affect” the behavior and correlations (predictive), thereby identifying the key aspects that may establish an improvement of the expected results (prescriptive). Artificial intelligence can therefore become a tool of great technical support to help diabetologists become fully responsible of the individual patient, thereby assuring customized and precise medicine. This, in turn, will allow for comprehensive therapies to be built in accordance with the evidence criteria that should always be the ground for any therapeutic choice.
Categorization of Third-Party Apps in Electronic Health Record App Marketplaces: Systematic Search and Analysis
Authors: Ritchie Jordon , Welch Brandon
Published: April 2020

Background

Third-party electronic health record (EHR) apps allow health care organizations to extend the capabilities and features of their EHR system. Given the widespread utilization of EHRs and the emergence of third-party apps in EHR marketplaces, it has become necessary to conduct a systematic review and analysis of apps in EHR app marketplaces.

Objective

The goal of this review is to organize, categorize, and characterize the availability of third-party apps in EHR marketplaces.

Methods

Two informaticists (authors JR and BW) used grounded theory principles to review and categorize EHR apps listed in top EHR vendors’ public-facing marketplaces.

Results

We categorized a total of 471 EHR apps into a taxonomy consisting of 3 primary categories, 15 secondary categories, and 55 tertiary categories. The three primary categories were administrative (n=203, 43.1%), provider support (n=159, 33.8%), and patient care (n=109, 23.1%). Within administrative apps, we split the apps into four secondary categories: front office (n=77, 37.9%), financial (n=53, 26.1%), office administration (n=49, 24.1%), and office device integration (n=17, 8.4%). Within the provider support primary classification, we split the apps into eight secondary categories: documentation (n=34, 21.3%), records management (n=27, 17.0%), care coordination (n=23, 14.4%), population health (n=18, 11.3%), EHR efficiency (n=16, 10.1%), ordering and prescribing (n=15, 9.4%), medical device integration (n=13, 8.2%), and specialty EHR (n=12, 7.5%). Within the patient care primary classification, we split the apps into three secondary categories: patient engagement (n=50, 45.9%), clinical decision support (n=40, 36.7%), and remote care (n=18, 16.5%). Total app counts varied substantially across EHR vendors. Overall, the distribution of apps across primary categories were relatively similar, with a few exceptions.

Conclusions

We characterized and organized a diverse and rich set of third-party EHR apps. This work provides an important reference for developers, researchers, and EHR customers to more easily search, review, and compare apps in EHR app marketplaces.
Perspectives of Patients and Professionals on Information and Education After Myocardial Infarction With Insight for Mixed Reality Implementation: Cross-Sectional Interview Study
Authors: Hilt Alexander D , Mamaqi Kapllani Kevin , Hierck Beerend P , Kemp Anne C , Albayrak Armagan , Melles Marijke , Schalij Martin J , Scherptong Roderick W C
Published: April 2020

Background

Patient education is crucial in the secondary prevention of cardiovascular disease. Novel technologies such as augmented reality or mixed reality expand the possibilities for providing visual support in this process. Mixed reality creates interactive digital three-dimensional (3D) projections overlaying virtual objects on the real-world environment. While augmented reality only overlays objects, mixed reality not just overlays but anchors virtual objects to the real world. However, research on this technology in the patient domain is scarce.

Objective

The aim of this study was to understand how patients perceive information provided after myocardial infarction and examine if mixed reality can be supportive in this process.

Methods

In total, 12 patients that experienced myocardial infarction and 6 health care professionals were enrolled in the study. Clinical, demographic, and qualitative data were obtained through semistructured interviews, with a main focus on patient experiences within the hospital and the knowledge they gained about their disease. These data were then used to map a susceptible timeframe to identify how mixed reality can contribute to patient information and education.

Results

Knowledge transfer after myocardial infarction was perceived by patients as too extensive, not personal, and inconsistent. Notably, knowledge on anatomy and medication was minimal and was not recognized as crucial by patients, whereas professionals stated the opposite. Patient journey analysis indicated the following four critical phases of knowledge transfer: at hospital discharge, at the first outpatient visit, during rehabilitation, and during all follow-up outpatient visits. Important patient goals were understanding the event in relation to daily life and its implications on resuming daily life. During follow-up, understanding physical limitations and coping with the condition and medication side effects in daily life emerged as the most important patient goals. The professionals’ goals were to improve recovery, enhance medication adherence, and offer coping support.

Conclusions

There is a remarkable difference between patients’ and professionals’ goals regarding information and education after myocardial infarction. Mixed reality may be a practical tool to unite perspectives of patients and professionals on the disease in a more even manner, and thus optimize knowledge transfer after myocardial infarction. Improving medication knowledge seems to be a feasible target for mixed reality. However, further research is needed to create durable methods for education on medication through mixed reality interventions.
Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers (Preprint)
Authors: Fagherazzi Guy , Goetzinger Catherine , Rashid Mohammed Ally , Aguayo Gloria A , Huiart Laetitia
Published: April 2020

UNSTRUCTURED

The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients’ symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users’ cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis.
Association of Serum Uromodulin with Death, Cardiovascular Events, and Kidney Failure in CKD
Authors: Steubl Dominik , Schneider Markus P. , Meiselbach Heike , Nadal Jennifer , Schmid Matthias C. , Saritas Turgay , Krane Vera , Sommerer Claudia , Baid-Agrawal Seema , Voelkl Jakob , Kotsis Fruzsina , Köttgen Anna , Eckardt Kai-Uwe , Scherberich Jürgen E. ,   GCKD Study Investigators
Published: April 2020

Background and objectives

Uromodulin is exclusively produced by tubular epithelial cells and released into urine and serum. Higher serum uromodulin has been associated with lower risk for kidney failure in Chinese patients with CKD and with lower risk for mortality in the elderly and in patients undergoing coronary angiography. We hypothesized that lower serum uromodulin is associated with mortality, cardiovascular events, and kidney failure in white patients with CKD.

Design, setting, participants, & measurements

We measured serum uromodulin in 5143 participants enrolled in the German CKD (GCKD) study. The associations of baseline serum uromodulin with all-cause mortality, major adverse cardiovascular events (MACE; a composite of cardiovascular mortality, nonfatal myocardial infarction or stroke, or incident peripheral vascular disease), and kidney failure (dialysis or transplantation) were evaluated using multivariable Cox proportional hazard regression analyses in a cohort study design, adjusting for demographics, eGFR, albuminuria, cardiovascular risk factors, and medication.

Results

The mean age of participants was 60±12 years, 60% were male. Mean serum uromodulin concentration was 98±60 ng/ml, eGFR was 49±18 ml/min per 1.73 m2, and 78% had eGFR <60 ml/min per 1.73 m2. Participants in lower serum uromodulin quartiles had lower eGFR and higher albuminuria, prevalence of diabetes, hypertension, coronary artery disease, and more frequent history of stroke at baseline. During a follow-up of 4 years, 335 participants died, 417 developed MACE, and 229 developed kidney failure. In multivariable analysis, the highest serum uromodulin quartile was associated with lower hazard for mortality (hazard ratio [HR], 0.57; 95% CI, 0.38 to 0.87), MACE (HR, 0.63; 95% CI, 0.45 to 0.90), and kidney failure (HR, 0.24; 95% CI, 0.10 to 0.55) compared with the lowest quartile.

Conclusions

Higher serum uromodulin is independently associated with lower risk for mortality, cardiovascular events, and kidney failure in white patients with CKD.

Clinical Trial registry name and registration number

Deutsches Register für Klinische Studien (DRKS; German national database of clinical studies), DRKS00003971.
A Pharmacologic “Stress Test” for Assessing Select Antioxidant Defenses in Patients with CKD
Authors: Zager Richard A. , Johnson Ali C.M. , Guillem Alvaro , Keyser Jeff , Singh Bhupinder
Published: April 2020

Background and objectives

Oxidative stress is a hallmark and mediator of CKD. Diminished antioxidant defenses are thought to be partly responsible. However, there is currently no way to prospectively assess antioxidant defenses in humans. Tin protoporphyrin (SnPP) induces mild, transient oxidant stress in mice, triggering increased expression of select antioxidant proteins (e.g., heme oxygenase 1 [HO-1], NAD[P]H dehydrogenase [quinone] 1 [NQO1], ferritin, p21). Hence, we tested the hypothesis that SnPP can also variably increase these proteins in humans and can thus serve as a pharmacologic “stress test” for gauging gene responsiveness and antioxidant reserves.

Design, setting, participants, & measurements

A total of 18 healthy volunteers and 24 participants with stage 3 CKD (n=12; eGFR 30–59 ml/min per 1.73 m2) or stage 4 CKD (n=12; eGFR 15–29 ml/min per 1.73 m2) were injected once with SnPP (9, 27, or 90 mg). Plasma and/or urinary antioxidant proteins were measured at baseline and for up to 4 days post-SnPP dosing. Kidney safety was gauged by serial measurements of BUN, creatinine, eGFR, albuminuria, and four urinary AKI biomarkers (kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, cystatin C, and N-acetyl glucosaminidase).

Results

Plasma HO-1, ferritin, p21, and NQO1 were all elevated at baseline in CKD participants. Plasma HO-1 and urine NQO1 levels each inversely correlated with eGFR (r=−0.85 to −0.95). All four proteins manifested statistically significant dose- and time-dependent elevations after SnPP injection. However, marked intersubject differences were observed. p21 responses to high-dose SnPP and HO-1 responses to low-dose SnPP were significantly suppressed in participants with CKD versus healthy volunteers. SnPP was well tolerated by all participants, and no evidence of nephrotoxicity was observed.

Conclusions

SnPP can be safely administered and, after its injection, the resulting changes in plasma HO-1, NQO1, ferritin, and p21 concentrations can provide information as to antioxidant gene responsiveness/reserves in subjects with and without kidney disease.

Clinical Trial registry name and registration number

A Study with RBT-1, in Healthy Volunteers and Subjects with Stage 3–4 Chronic Kidney Disease, NCT0363002 and NCT03893799
COVID 19 Cure Technique
Authors: Adel Louis Rimon
Published: April 2020

The cure presents in this study is course of techniques depend on three methods to neutralize the virus threat’s in both sides to prevent it from replication and mutation as the principle acknowledge the speed time of recovery and show the weakness parts in the virus itself by using effective strategy. The cure include three specific procedure first step is to attack both infected cells and the virus molecules with plasma represented in ionic treatment by ionizing the air inside lung and allow the Zinc particles to attack the infected cells membrane which diffused in the body, second step supply and stimulate the immune system in order to complete the attack of the virus by changing the environment required for replication then destroy the damaged cells in order to force the virus to shrink finally the last step is to evacuate the body from the trash of the virus by using organic antioxidants plants help in extract mucus of dead viruses that technique is highly recommended to dismiss the dead virus bodies outside the patients and that will help to kill the virus and avoid it’s side effects in the long term as it is not confirmed that the virus mutate to latency stage then back to attack the body again specially there is no evidence for the full recovery of the patients as the tests done after a while and some of them return to positive results again which lead to some of them suffering from the virus again after recovery in addition to the randomly behavior of the virus that has been shown in the European countries unlike the Chinese virus which put the world in obstacle of speed mutation and that is so dangerous if we put in our consideration the huge numbers of the infected and dead persons, the strategy strongly remark the weakness points in the virus in order to neutralize it even in the late stages for the patients who suffering from immunity issues as the benefits from Cure can recover the actual infected and realistic for the numbers of the persons infected unlike the vaccine that required to be injected for billions of people.
THE JET/COUNTERJET SYMMETRY OF THE HH 212 OUTFLOW
Authors: Noriega-Crespo A. , Raga A. C. , Lora V. , Rodrı́guez-Ramı́rez J. C.
Published: April 2020

We present Spitzer (IRAC) images and a VLT 2.1 μm image of the HH 212 outflow. We find that this outflow has a strong symmetry, with jet/counterjet knot pairs with ∆x < 1 00 position offsets. We deduce that the jet/counterjet knots are ejected with time differences ∆τ 0 ≈ 6 yr and velocity differences ∆v 0 ≈ 2 km s^−1 . We also analyze the deviations of the knot positions perpendicular to the outflow axis, and interpret them in terms of a binary orbital motion of the outflow source. Through this model, we deduce a ≈ 0.7 M mass for the outflow source, and a sep- aration of ≈ 80 AU between the components of the binary (assuming equal masses for the two components). Finally, using the IRAC data and the VLT 2.1 μm image we measure the proper motion velocities, obtaining values from 50 to 170 km s^−1 .
Model Pembelajaran Talking Stick Melalui Permainan Truth or Dare Pada Tari Bungong Jeumpa Kelas IV Sekolah Dasar
Authors: Restian Arina , Muzakki Abdurrohman , Purnamasari Wahyu Intan
Published: April 2020

Kurangnya kesadaran pentingnya penggunaan permainan dalam pembelajaran menyebabkan siswa cenderung sibuk sendiri dan proses pembelajaran yang kurang menyenangkan. Hal inilah yang terjadi pada guru di SDN 2 Saptorenggo. Model pembelajaran yang sering digunakan yaitu model pembelajaran yang umum, seperti secara individu atau kelompok. Akibatnya, siswa kurang memiliki motivasi belajar dan kurang memahami materi yang disampaikan guru. Penelitian ini bertujuan mendeskripsikan pengembangan model pembelajaran Talking Stick materi tari bungong jeumpa melalui permainan truth or dare terhadap siswa kelas IV sekolah dasar. Penelitian dilakukan dengan menggunakan model ADDIE, yaitu Analyze (analisis) digunakan untuk menganalisis kebutuhan, Design (perencanaan) menentukan kompetensi khusus berupa produk model Talking Stick melalui permainan truth or dare, development (pengembangan) membuat pengembangan yang telah direncanakan, implementation (penerapan) melakukan penerapan terhadap pengembangan yang telah dibuat, dan evaluation (evaluasi) melakukan evaluasi terhadap pengembangan model Talking Stick melalui permainan truth or dare. Hasil penelitian menunjukkan dari hasil validasi lembar angket model, materi, dan media layak untuk digunakan. Begitupun lembar angket respon siswa dan guru memperlihatkan hasil yang sama. Berdasarkan hasil penelitian tersebut dapat disimpulkan bahwa pengembangan model pembelajaran Talking Stick materi tari bungong jeumpa melalui permainan truth or dare dapat digunakan sebagai penunjang proses pembelajaran siswa kelas IV Sekolah Dasar Saptorenggo 02 Pakis.