bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Stem Cells with Overexpression of Neuronal Markers Enhance Chemoresistance and Invasion in Retinoblastoma
Authors: Balaji Sekaran , Santhi Radhakrishnan , Kim Usha , Muthukkaruppan Veerappan , Priya Chidambaranathan G. , Vanniarajan Ayyasamy
Published: May 2020

Background:

Retinoblastoma is a sight and life-threatening embryonal tumor in children.
Though chemotherapy is the main mode of therapy, evolving resistance remains a major obstacle in
treatment success. The presence of cancer stem cells (CSC) is frequently reported to be responsible
for chemoresistance in multiple tumors.

Objective:

Our study aims to identify the molecular factors that facilitate the chemoresistance
through cancer stem cells in retinoblastoma.

Methods:

We developed etoposide and carboplatin resistant retinoblastoma (Y79) cell lines by
stepwise drug increment treatment, validated with MTT and TUNEL assays. Colony forming and
invasive ability were studied by soft-agar colony forming and transwell assays, respectively. Similar
analysis in non-responsive retinoblastoma tumors were carried out by histopathology. Finally, expression
of CSC/neuronal markers and ABC transporters were examined by quantitative PCR and
protein expression of neuronal stem cell markers was confirmed by Western blot.

Results:

Larger colony size of resistant cells in soft-agar assay provided evidence for increased selfrenewability.
Histopathology in non-responsive tumors showed poorly differentiated cells predominantly.
Besides, both resistant cell lines and non-responsive tumors showed increased invasion with
higher expression of neuronal stem cell markers - SOX2, NANOG, OCT4 and ABC transporters -
ABCB1 and ABCC3. Increased self-renewal ability and invasion along with overexpression of
stemness markers in resistant cells and tumors provide evidence for stemness driving chemoresistance
and invasion in retinoblastoma.

Conclusion:

We have demonstrated Neuronal stem cell/CSC markers that facilitate the maintenance
of cancer stem cells. Developing therapies targeting these factors will help in overcoming resistance
and improving retinoblastoma treatment.
HOTAIR Competitively Binds MiRNA330 as a Molecular Sponge to Increase the Resistance of Gastric Cancer to Trastuzumab
Authors: Bie Liangyu , Luo Suxia , Li Dan , Wei Yan , Mu Yu , Chen Xiaobing , Wang Saiqi , Guo Ping , Lu Xiaoyu
Published: May 2020

Background:

HOTAIR, one of the most widely studied long non-coding RNAs in tumors,
is closely related to tumor proliferation, migration, invasion and chemoresistance.

Objective:

Here, we studied the mechanism behind proliferation and chemoresistance processes.

Methods:

A total of 75 samples were collected from patients who underwent surgical resection of
their gastric cancer and received trastuzumab treatment. Primary cells were isolated and cultured.
We also developed a cell line overexpressing HOTAIR by constructing a lentiviral vector. These cell
lines were studied using an array of established biomolecular methods.

Results:

We found that HOTAIR levels were inversely associated with sensitivity to trastuzumab in
gastric cancer and that overexpression of HOTAIR can promote the proliferation and invasion of
gastric cancer cells. The sensitivity of cells overexpressing HOTAIR to two different types of human
epidermal growth factor receptor 2 (HER2) inhibitors (trastuzumab and afatinib) showed that overexpression
of HOTAIR is specific for trastuzumab resistance. Furthermore, luciferase reporter gene
assay and western blot assay showed that there is a HOTAIR-miRNA330-ERBB4 competitive endogenous
RNA regulatory network with miRNA330 as the core.

Conclusion:

HOTAIR can not only promote tumor proliferation but also enhance the resistance of
tumor cells to drugs. Our experimental data not only showed strong expression of HOTAIR in gastric
cancer, but also that strong expression of HOTAIR caused the sensitivity of gastric cancer cells
to trastuzumab, which is a useful reference for postoperative medication.
Monoaminergic Receptors as Modulators of the Perivascular Sympathetic and Sensory CGRPergic Outflows
Authors: Marichal-Cancino Bruno A. , González-Hernández Abimael , Muñoz-Islas Enriqueta , Villalón Carlos M.
Published: May 2020

Blood pressure is a highly controlled cardiovascular parameter that normally guarantees
an adequate blood supply to all body tissues. This parameter is mainly regulated by peripheral vascular
resistance and is maintained by local mediators (i.e., autacoids), and by the nervous and endocrine
systems. Regarding the nervous system, blood pressure can be modulated at the central level
by regulating the autonomic output. However, at peripheral level, there exists a modulation by activation
of prejunctional monoaminergic receptors in autonomic- or sensory-perivascular fibers.
These modulatory mechanisms on resistance blood vessels exert an effect on the release of neuroactive
substances from the autonomic or sensory fibers that modify blood pressure. Certainly, resistance
blood vessels are innervated by perivascular: (i) autonomic sympathetic fibers (producing
vasoconstriction mainly by noradrenaline release); and (ii) peptidergic sensory fibers [producing
vasodilatation mainly by calcitonin gene-related peptide (CGRP) release]. In the last years, by using
pithed rats, several monoaminergic mechanisms for controlling both the sympathetic and sensory
perivascular outflows have been elucidated. Additionally, several studies have shown the functions
of many monoaminergic auto-receptors and hetero-receptors expressed on perivascular fibers that
modulate neurotransmitter release. On this basis, the present review: (i) summarizes the modulation
of the peripheral vascular tone by adrenergic, serotoninergic, dopaminergic, and histaminergic receptors
on perivascular autonomic (sympathetic) and sensory fibers, and (ii) highlights that these
monoaminergic receptors are potential therapeutic targets for the development of novel medications to
treat cardiovascular diseases (with some of them explored in clinical trials or already in clinical use).
Fingerprint of PGI Mantova Cucumis melo by ICP-MS and Chemometric Analysis
Authors: Mottese Antonio F. , Fede Maria R. , Caridi Francesco , Sabatino Giuseppe , Marcianò Giuseppe , Ravenda Pietro , Gaetano Annamaria D. , Dugo Giacomo
Published: May 2020

Background and Objectives:

In this work, yellow and green varieties of Cucumis melo
fruits belonging to different cultivars were studied. In detail, three Sicilian cultivars of winter melons
tutelated by TAP (Traditional agro-alimentary products) labels were considered, whereas asun protected
the Calabrian winter melon was studied too. With the aim to compare the selective uptakes of
inorganic elements among winter and summer fruits, the “PGI Melone Mantovano” was investigated.
The purpose of this work was to apply the obtained results i) to guarantee the quality and healthiness
of fruits, ii) to producers defend, iii) to help the customers in safe food purchase.

Method:

All samples were analyzed by ICP-MS and the obtained results, subsequently, were subjected
to Cluster analysis (CA), Principal component analysis (PCA) and Canonical discriminant
analysis (CDA).

Results:

CA results were generally in agreement with samples origin, whereas the PCA elaboration
has confirmed the presence of a strong relation between fruit origins and trace element contents. In
particular, two principal components justified the 57.32% of the total variance (PC1= 40.95%, PC2=
16.37%). Finally, the CDA approach has provided several functions with high discrimination power,
confirmed by the correct classification of all samples (100%).

Conclusions:

CA, PCA and CDA could represent an integrated to label to discriminate the origin of
agri-food products and, thus, protect and guarantee their healthiness.
Iota-Carrageenan as an Antiviral Treatment for the Common Cold
Authors: Eccles Ronald
Published: May 2020

Introduction:

The common cold syndrome of acute upper respiratory tract viral infection is the most common disease among mankind and is an extremely common illness in children. There is a great need for a safe and effective antiviral treatment with minimal side effects. The challenge in developing a treatment is the numerous and varied respiratory viruses that cause this common illness and the need for a treatment with good tolerability and safety.

Explanation:

All respiratory viruses must reach the cell surface by passing through respiratory fluid and mucus, and this common feature may allow for the development of antivirals that capture viruses during this transit.

This article discusses how large polyanionic molecules such as iota-carrageenan may trap positively charged respiratory viruses. Iota-carrageenan is a large polysaccharide molecule which is neither absorbed from the respiratory tract nor metabolised. It, therefore, does not have any pharmacological properties. Iota-carrageenan nasal spray has been shown to reduce the titres of respiratory viruses and to reduce the severity of symptoms in placebo-controlled clinical trials, including children and adults. The results of four clinical trials are presented.

Conclusion:

Iota-carrageenan is a good candidate as a safe and effective non-specific antiviral treatment for common cold, and more research is justified on polyanionic molecules like carrageenans as antivirals.
Recensie van: Taal en identiteit in de Rand. Een analyse van de taalsituatie in de Rand rond Brussel op basis van de BRIO-taalbarometer / Rudi Janssens
Authors: Van Velthoven Harry
Published: May 2020

–
Leo Suenens, Hugo Claus en Rik Van de Voorde in kantelende tijden
Authors: De Wever Bruno
Published: May 2020

–
Recensie van: Karel Van Miert. Strijder voor Europa. Een politieke biografie / Bart Hellinck
Authors: Van Velthoven Harry
Published: May 2020

–
Recensie van: Elias of het gevecht met de nachtegalen / Maurice Gilliams
Authors: Van Campenhout Nico
Published: May 2020

–
Лазерное, фотоэмиссионное возбуждение упругих колебаний в микрооптоэлектромеханических системах
Authors: Егоров Ф.А.
Published: May 2020

The possibility and efficiency of laser excitation of elastic vibrations in microoptoelectromechanical systems due to photo-emission recoil force are analyzed. It is shown that in such systems, based on GaAs, this mechanism of excitation of oscillations can turn out to be an order of magnitude more efficient than light pressure. The method of creating such systems proposed in this paper opens up possibilities for the development of new types of high-speed optical functional elements controlled by light.
Use of Machine Learning Techniques for Case-Detection of Varicella Zoster Using Routinely Collected Textual Ambulatory Records: Pilot Observational Study
Authors: Lanera Corrado , Berchialla Paola , Baldi Ileana , Lorenzoni Giulia , Tramontan Lara , Scamarcia Antonio , Cantarutti Luigi , Giaquinto Carlo , Gregori Dario
Published: May 2020

Background

The detection of infectious diseases through the analysis of free text on electronic health reports (EHRs) can provide prompt and accurate background information for the implementation of preventative measures, such as advertising and monitoring the effectiveness of vaccination campaigns.

Objective

The purpose of this paper is to compare machine learning techniques in their application to EHR analysis for disease detection.

Methods

The Pedianet database was used as a data source for a real-world scenario on the identification of cases of varicella. The models’ training and test sets were based on two different Italian regions’ (Veneto and Sicilia) data sets of 7631 patients and 1,230,355 records, and 2347 patients and 569,926 records, respectively, for whom a gold standard of varicella diagnosis was available. Elastic-net regularized generalized linear model (GLMNet), maximum entropy (MAXENT), and LogitBoost (boosting) algorithms were implemented in a supervised environment and 5-fold cross-validated. The document-term matrix generated by the training set involves a dictionary of 1,871,532 tokens. The analysis was conducted on a subset of 29,096 tokens, corresponding to a matrix with no more than a 99% sparsity ratio.

Results

The highest predictive values were achieved through boosting (positive predicative value [PPV] 63.1, 95% CI 42.7-83.5 and negative predicative value [NPV] 98.8, 95% CI 98.3-99.3). GLMNet delivered superior predictive capability compared to MAXENT (PPV 24.5% and NPV 98.3% vs PPV 11.0% and NPV 98.0%). MAXENT and GLMNet predictions weakly agree with each other (agreement coefficient 1 [AC1]=0.60, 95% CI 0.58-0.62), as well as with LogitBoost (MAXENT: AC1=0.64, 95% CI 0.63-0.66 and GLMNet: AC1=0.53, 95% CI 0.51-0.55).

Conclusions

Boosting has demonstrated promising performance in large-scale EHR-based infectious disease identification.
Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study
Authors: Stanyon Miriam , Streater Amy , Coleston-Shields Donna Maria , Yates Jennifer , Challis David , Dening Tom , Hoe Juanita , Lloyd-Evans Brynmor , Mitchell Shirley , Moniz-Cook Esme , Poland Fiona , Prothero David , Orrell Martin
Published: May 2020

Background

Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams.

Objective

The aim of this study is to develop a “best practice model” for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a “best practice model.”

Methods

Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit.

Results

Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice.

Conclusions

This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers.

International Registered Report Identifier (IRRID)

RR1-10.2196/14781
Effect of Testosterone Treatment on Cardiovascular Events in Men: Protocol for a Systematic Literature Review and Meta-Analysis
Authors: Chih HuiJun , Reid Christopher M , Yeap Bu B , Dwivedi Girish
Published: May 2020

Background

Testosterone prescriptions have increased dramatically in recent decades, with increasing usage in men. Despite epidemiological associations reported high circulating concentrations of endogenous androgens and low risk of cardiovascular events and mortality, the effects of exogenous androgens in the form of testosterone therapy for maintaining physiological circulating androgen concentrations on the cardiovascular system remain uncertain with no published meta-analysis on this topic.

Objective

The aim of this study was to investigate the effects of prescribed testosterone treatment, in all forms and durations, from well-developed randomized controlled trials, on cardiovascular events in men aged 18 years or older.

Methods

Peer-reviewed journal articles published from 1980 to 2019 will be searched from databases (ie CINAHL [Cumulated Index to Nursing and Allied Health Literature], Embase, Medline, Scopus, Cochrane Controlled Register of Trials as well as the Clinical Trial Registry). Randomized controlled trials or cluster randomized controlled trials with at least one intervention arm of testosterone and a control group of usual care or no testosterone treatment will be included in this review and meta-analysis. Studies on men with previous cardiovascular events or cardiac vascularization (coronary bypass surgery or percutaneous coronary intervention) will be excluded. Data related to primary outcomes such as clinical events of any type of stroke or transient ischemic attack, nonfatal myocardial infarction or acute coronary syndrome, emergency coronary artery revascularization, carotid surgery, cardiac mortality, and all-cause mortality will be extracted for analysis. The criteria for PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) will be followed in the evaluation of evidence.

Results

Search terms have been piloted and finalized. This study will be completed by the end of 2020.

Conclusions

This protocol will guide a systematic literature review of the evidence around prescribed testosterone and its effect on cardiovascular events in men aged 18 years or older. The findings will inform clinical management of hypogonadal men.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42019134278; https://tinyurl.com/y6t7ggge

International Registered Report Identifier (IRRID)

PRR1-10.2196/15163
Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers
Authors: Adair Kathryn C , Rodriguez-Homs Larissa G , Masoud Sabran , Mosca Paul J , Sexton J Bryan
Published: May 2020

Background

Emotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed.

Objective

This randomized single-exposure trial examined the efficacy of a gratitude letter–writing intervention for improving health care workers’ well-being.

Methods

A total of 1575 health care workers were randomly assigned to one of two gratitude letter–writing prompts (self- vs other focused) to assess differential efficacy. Assessments of EE, subjective happiness, work-life balance, and tool engagement were collected at baseline and 1-week post intervention. Participants received their EE score at baseline and quartile benchmarking scores. Paired-samples t tests, independent t tests, and correlations explored the efficacy of the intervention. Linguistic Inquiry and Word Count software assessed the linguistic content of the gratitude letters and associations with well-being.

Results

Participants in both conditions showed significant improvements in EE, happiness, and work-life balance between the intervention and 1-week follow-up (P<.001). The self-focused (vs other) instruction conditions did not differentially predict improvement in any of the measures (P=.91). Tool engagement was high, and participants reporting higher motivation to improve their EE had higher EE at baseline (P<.001) and were more likely to improve EE a week later (P=.03). Linguistic analyses revealed that participants high on EE at baseline used more negative emotion words in their letters (P=.005). Reduction in EE at the 1-week follow-up was predicted at the level of a trend by using fewer first-person (P=.06) and positive emotion words (P=.09). No baseline differences were found between those who completed the follow-up assessment and those who did not (Ps>.05).

Conclusions

This single-exposure gratitude letter–writing intervention appears to be a promising low-cost, brief, and meaningful tool to improve the well-being of health care workers.
Features of a Patient Portal for Blood Test Results and Patient Health Engagement: Web-Based Pre-Post Experiment
Authors: Struikman Bas , Bol Nadine , Goedhart Annelijn , van Weert Julia C M , Talboom-Kamp Esther , van Delft Sanne , Brabers Anne E M , van Dijk Liset
Published: May 2020

Background

The use of patient portals for presenting health-related patient data, such as blood test results, is becoming increasingly important in health practices. Patient portals have the potential to enhance patient health engagement, but content might be misinterpreted.

Objective

This study aimed to discover whether the way of presenting blood test outcomes in an electronic patient portal is associated with patient health engagement and whether this varies across different blood test outcomes.

Methods

A 2x3 between-subjects experiment was conducted among members of the Nivel Dutch Health Care Consumer Panel. All participants read a scenario in which they were asked to imagine themselves receiving blood test results. These results differed in terms of the presented blood values (ie, normal vs partially abnormal vs all abnormal) as well as in terms of whether the results were accompanied with explanatory text and visualization. Patient health engagement was measured both before (T0) and after (T1) participants were exposed to their fictive blood test results.

Results

A total 487 of 900 invited members responded (response rate 54%), of whom 50.3% (245/487) were female. The average age of the participants was 52.82 years (SD 15.41 years). Patient health engagement saw either a significant decrease or a nonsignificant difference in the experimental groups after viewing the blood test results. The mean difference was smaller in the groups that received blood test results with additional text and visualization (meanT0 5.33, SE 0.08; meanT1 5.14, SE 0.09; mean difference 0.19, SE 0.08, P=.02) compared with groups that received blood test results without explanatory text and visualization (meanT0 5.19, SE 0.08; meanT1 4.55, SE 0.09; mean difference 0.64, SE 0.08, P<.001). Adding text and visualization, in particular, reduced the decline in patient health engagement in participants who received normal results or mixed results (ie, combination of normal and abnormal results).

Conclusions

Adding text and visualization features can attenuate the decrease in patient health engagement in participants who receive outcomes of a blood test via a patient portal, particularly when blood test results are (partly) normal. This suggests that explanatory text and visualization can be reassuring. Future research is warranted to determine whether these results can be generalized to a patient population who receive their actual blood test results.
The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach
Authors: Ector Geneviève ICG , Westerweel Peter E , Hermens Rosella PMG , Braspenning Karin AE , Heeren Barend CM , Vinck Oscar MF , de Jong Jan JM , Janssen Jeroen JWM , Blijlevens Nicole MA
Published: May 2020

Background

With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes.

Objective

The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology.

Methods

The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined.

Results

The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home.

Conclusions

The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves.
Comparison of the Effects of Automated and Manual Record Keeping on Anesthetists’ Monitoring Performance: Randomized Controlled Simulation Study
Authors: Tse Man-Kei , Li Simon Y W , Chiu Tsz Hin , Lau Chung Wai , Lam Ka Man , Cheng Chun Pong Benny
Published: May 2020

Background

Anesthesia information management systems (AIMSs) automatically import real-time vital signs from physiological monitors to anesthetic records, replacing part of anesthetists’ traditional manual record keeping. However, only a handful of studies have examined the effects of AIMSs on anesthetists’ monitoring performance.

Objective

This study aimed to compare the effects of AIMS use and manual record keeping on anesthetists’ monitoring performance, using a full-scale high-fidelity simulation.

Methods

This simulation study was a randomized controlled trial with a parallel group design that compared the effects of two record-keeping methods (AIMS vs manual) on anesthetists’ monitoring performance. Twenty anesthetists at a tertiary hospital in Hong Kong were randomly assigned to either the AIMS or manual condition, and they participated in a 45-minute scenario in a high-fidelity simulation environment. Participants took over a case involving general anesthesia for below-knee amputation surgery and performed record keeping. The three primary outcomes were participants’ (1) vigilance detection accuracy (%), (2) situation awareness accuracy (%), and (3) subjective mental workload (0-100).

Results

With regard to the primary outcomes, there was no significant difference in participants’ vigilance detection accuracy (AIMS, 56.7% vs manual, 56.7%; P=.50), and subjective mental workload was significantly lower in the AIMS condition than in the manual condition (AIMS, 34.2 vs manual, 46.7; P=.02). However, the result for situation awareness accuracy was inconclusive as the study did not have enough power to detect a difference between the two conditions.

Conclusions

Our findings suggest that it is promising for AIMS use to become a mainstay of anesthesia record keeping. AIMSs are effective in reducing anesthetists’ workload and improving the quality of their anesthetic record keeping, without compromising vigilance.
Evaluation and Dissemination of a Checklist to Improve Implementation of Work Environment Initiatives in the Eldercare Sector: Protocol for a Prospective Observational Study
Authors: Rasmussen Charlotte Diana Nørregaard , Højberg Helene , Larsen Anne Konring , Munch Pernille Kold , Osborne Richard , Kwak Lydia , Jensen Irene , Linnan Laura , Jørgensen Marie Birk
Published: May 2020

Background

To measure sustainable improvements in the work environment, a flexible and highly responsive tool is needed that will give important focus to the implementation process. A digital checklist was developed in collaboration with key stakeholders to document the implementation of changes in eldercare sector workplaces.

Objective

This paper describes the study protocol of a dissemination study that aims to examine when, why, and how the digital checklist is spread to the Danish eldercare sector following a national campaign particularly targeting nursing homes and home care.

Methods

This prospective observational study will use quantitative data from Google Analytics describing use of the checklist as documented website engagement, a survey among members in the largest union in the sector, information from a central business register, and monitoring of campaign activities. The evaluation will be guided by the five elements of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance.

Results

The study was approved in June 2016 and began in October 2018. The campaign that is the foundation for the evaluation began in 2017 and ended in 2018. However, the webpage where we collect data is still running. Results are expected in 2020.

Conclusions

This protocol provides a working example of how to evaluate dissemination of a checklist to improve implementation of work environment initiatives in the eldercare sector in Denmark. To our knowledge, implementation in a nationwide Danish work environment has not been previously undertaken. Given that the checklist is sector-specific for work environment initiatives and developed through systematic collaboration between research and practice, it is likely to have high utility and impact; however, the proposed evaluation will determine this. This study will advance dissemination research and, in particular, the evaluation of the impact of these types of studies. Finally, this study advances the field through digital tools that can be used for evaluation of dissemination efforts (eg, Google Analytics associated with website) in the context of a rigorous research design activity.

International Registered Report Identifier (IRRID)

DERR1-10.2196/16039
Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study
Authors: van Egmond Maarten A , Engelbert Raoul H H , Klinkenbijl Jean H G , van Berge Henegouwen Mark I , van der Schaaf Marike
Published: May 2020

Background

Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail.

Objective

The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care.

Methods

A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health.

Results

A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8% in the first 6 weeks and dropped to 75.6% in the following 6 weeks, with a mean difference of −24.3% (95% CI 1.3 to 47.2; P=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group.

Conclusions

This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0.
A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation
Authors: Stevens Timothy , McGinnis Ryan S , Hewgill Blake , Choquette Rebecca H , Tourville Timothy W , Harvey Jean , Lachapelle Richard , Beynnon Bruce D , Toth Michael J , Skalka Christian
Published: May 2020

Background

Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions.

Objective

This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time.

Methods

The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity.

Results

Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed.

Conclusions

RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing.
Web-Based Self-Management for Patients With Lymphoma: Assessment of the Reach of Intervention of a Randomized Controlled Trial
Authors: Arts Lindy P J , Oerlemans Simone , Posthuma Eduardus F M , Issa Djamila E , Oosterveld Margriet , van der Griend René , Nijziel Marten R , van de Poll-Franse Lonneke V
Published: May 2020

Background

Randomized controlled trials (RCTs) often provide accurate estimates of the internal validity of an intervention but lack information on external validity (generalizability). We conducted an RCT on the effectiveness of a self-management intervention among patients with lymphoma in a population-based setting.

Objective

The objectives of the current study were to describe the proportion of RCT participants compared to all patients invited to participate, and compare sociodemographic and clinical characteristics of RCT participants with all respondents, all patients invited to participate, and all patients selected from the Netherlands Cancer Registry (NCR) to determine the reach of the intervention. An additional objective was to assess differences on RCT outcome variables between RCT and paper respondents.

Methods

Patients with lymphoma or chronic lymphocytic leukemia ≥18 years old at diagnosis from 13 hospitals in the Netherlands were selected from the population-based NCR, which routinely collects data on sociodemographic and clinical characteristics. Eligible patients were invited to participate in an RCT and complete a questionnaire. Web-based completion determined RCT enrollment, whereas paper respondents were followed observationally.

Results

A total of 1193 patients were selected from the NCR, 892 (74.77%) of whom were invited to participate in the trial by their hematologist after verifying eligibility. Among those invited, 25.4% (227/892) completed the web-based questionnaire and were enrolled in the RCT. The RCT participants were younger and there was a higher proportion of men than nonparticipants (P<.001). In addition, 25.7% (229/892) of those invited opted to participate in the paper-based observational follow-up study. Compared with paper respondents, RCT participants were younger (P<.001), with a higher proportion of men (P=.002), and had higher education levels (P=.02). RCT participants more often wanted to receive all available information on their disease (P<.001), whereas paper respondents reported higher levels of emotional distress (P=.009).

Conclusions

From a population-based sample of eligible patients, the participation rate in the RCT was approximately 25%. RCT participants may not be representative of the target population because of different sociodemographic and clinical characteristics. Since RCT participants represent a minority of the target population, RCT results should be interpreted with caution as patients in the RCT may be those least in need of a self-management intervention.

Trial Registration

Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790
Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study
Authors: Baptista Shaira , Wadley Greg , Bird Dominique , Oldenburg Brian , Speight Jane ,   The My Diabetes Coach Research Group
Published: May 2020

Background

Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated.

Objective

This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app.

Methods

A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis.

Results

Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions.

Conclusions

These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences.

Trial Registration

Australian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd
Internet of Things Smart Sunscreen Station: Descriptive Proof-of-Concept Study
Authors: Ford Helen , Herbert Jeremy , Horsham Caitlin , Wall Alexander , Hacker Elke
Published: May 2020

Background

Skin cancer is the most prevalent but also most preventable cancer in Australia. Outdoor workers are at increased risk of developing skin cancer, and improvements in sun protection are needed. Sunscreen, when applied at the recommended concentration (2 mg/cm2), has been shown to block the harmful molecular effects of ultraviolet radiation in vivo. However, sunscreen is often not applied, reapplied sufficiently, or stored adequately to yield protection and reduce sunburns.

Objective

The primary aim of this study was to test an Internet of Things approach by deploying a smart sunscreen station to an outdoor regional mining site.

Methods

We deployed a smart sunscreen station and examined the key technological considerations including connectivity, security, and data management systems.

Results

The smart sunscreen station was deployed for 12 days at a mining workplace (Dalby, Australia). The smart sunscreen station’s electrical components remained operational during field testing, and data were received by the message queuing telemetry transport server automatically at the end of each day of field testing (12/12 days, 100% connectivity).

Conclusions

This study highlights that an Internet of Things technology approach can successfully measure sunscreen usage and temperature storage conditions.
Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial
Authors: Pot-Kolder Roos , Veling Wim , Geraets Chris , Lokkerbol Joran , Smit Filip , Jongeneel Alyssa , Ising Helga , van der Gaag Mark
Published: May 2020

Background

Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking.

Objective

This study aimed to determine the short-term cost-effectiveness of VR-CBT.

Methods

The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al’s conversion factor to map a change in the standardized mean difference of Green’s Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained.

Results

The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030.

Conclusions

This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients’ health in a cost-effective manner. Long-term effects need further research.

Trial Registration

International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657
Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study
Authors: Pensak Meredith J , Lundsberg Lisbet S , Stanwood Nancy L , Cutler Abigail S , Gariepy Aileen M
Published: May 2020

Background

Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants.

Objective

This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior.

Methods

This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data.

Results

In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up.

Conclusions

An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.