bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluación del efecto acaricida de Momordica charantia, Megaskepasma erythrochlamys y Gliricidia sepium sobre Rhipicephalus microplus
Authors: Jaramillo Hernández Dumar , González Reina Angélica , Pedraza Castillo Natalia , Sierra Acevedo Jorge Iván , García Martínez Gina Lorena , Jara Agudelo Ricardo
Published: February 2020

Objetivo. Se evaluó la actividad acaricida de Momordica charantia (Mc), Megaskepasma erythrochlamys (Me) y Gliricidia sepium (Gs) sobre Rhipicephalus microplus (Rm). Materiales y métodos. Se realizó la marcha fitoquímica preliminar de hojas del extracto metanólico de Mc (EMc), del extracto etanólico de Me (EMe) y del extracto acetónico de Gs (EGs) a través de la técnica de colorimetría y cromatografía en capa delgada (CCD).  La actividad acaricida se realizó a través de pruebas in-vitro utilizando la prueba de inmersión de larvas  (LIT) y la prueba de inmersión de adultos (AIT). Para las pruebas in-situ se usaron bovinos en pastoreo infestados naturalmente con garrapatas, utilizando las CL50 obtenidas en las pruebas in-vitro AIT; posteriormente las teleoginas se llevaron  a incubación para evaluar su capacidad reproductiva. Resultados. Se determinó la presencia de varios grupos de metabolitos secundarios de interés acaricida. Se demostró el efecto acaricida de los extractos de las plantas sobre teleoginas; aunque sólo EGs mostró actividad larvicida. Los extractos a 160 mg/mL afectaron el ciclo de vida de Rm inhibiendo la ovoposición en un 46.9%, 66.1% y 84.03% (p<0.05) para EGs, EMc y EMe, respectivamente. Por otro lado, en las pruebas in situ se observó diferencia significativa (p<0.05) entre el tratamiento de EMc y EMe respecto a los grupos controles. Conclusiones. Los resultados obtenidos son prometedores para fortalecer la posibilidad de vinculación de los extractos de estas plantas dentro de planes integrados de control de garrapatas en sistemas de producción de bovinos.
Derivation of Breathing Metrics From a Photoplethysmogram at Rest: Machine Learning Methodology
Authors: Prinable Joseph , Jones Peter , Boland David , Thamrin Cindy , McEwan Alistair
Published: February 2020

Background

There has been a recent increased interest in monitoring health using wearable sensor technologies; however, few have focused on breathing. The ability to monitor breathing metrics may have indications both for general health as well as respiratory conditions such as asthma, where long-term monitoring of lung function has shown promising utility.

Objective

In this paper, we explore a long short-term memory (LSTM) architecture and predict measures of interbreath intervals, respiratory rate, and the inspiration-expiration ratio from a photoplethysmogram signal. This serves as a proof-of-concept study of the applicability of a machine learning architecture to the derivation of respiratory metrics.

Methods

A pulse oximeter was mounted to the left index finger of 9 healthy subjects who breathed at controlled respiratory rates. A respiratory band was used to collect a reference signal as a comparison.

Results

Over a 40-second window, the LSTM model predicted a respiratory waveform through which breathing metrics could be derived with a bias value and 95% CI. Metrics included inspiration time (–0.16 seconds, –1.64 to 1.31 seconds), expiration time (0.09 seconds, –1.35 to 1.53 seconds), respiratory rate (0.12 breaths per minute, –2.13 to 2.37 breaths per minute), interbreath intervals (–0.07 seconds, –1.75 to 1.61 seconds), and the inspiration-expiration ratio (0.09, –0.66 to 0.84).

Conclusions

A trained LSTM model shows acceptable accuracy for deriving breathing metrics and could be useful for long-term breathing monitoring in health. Its utility in respiratory disease (eg, asthma) warrants further investigation.
Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study
Authors: Hewage Sumali , Audimulam Jananie , Sullivan Emily , Chi Claudia , Yew Tong Wei , Yoong Joanne
Published: February 2020

Background

Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before.

Objective

This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting.

Methods

This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore.

Results

The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers.

Conclusions

A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.
Sustainability of mHealth Effects on Cardiometabolic Risk Factors: Five-Year Results of a Randomized Clinical Trial
Authors: Bernabe-Ortiz Antonio , Pauschardt Julia , Diez-Canseco Francisco , Miranda J Jaime
Published: February 2020

Background

The long-term effects of mobile health (mHealth) interventions have not been documented, especially in resource-constrained settings.

Objective

This study aimed to assess the effects of a 1-year mHealth intervention on blood pressure levels and body weight in low-resource urban settings in Peru, 4 years after the completion of the original study.

Methods

Four years after the original Grupo de Investigación en Salud Móvil en America Latina (GISMAL) study, we attempted to contact the 212 individuals originally enrolled in the study in Peru. The primary outcomes were systolic and diastolic blood pressure levels and hypertension incidence. Secondary outcome measures were body weight, BMI, and self-reported target behaviors. The study personnel collecting the data were masked to the group assignment. Linear mixed models were used to evaluate the effects of the intervention on primary and secondary outcomes in an intention-to-treat analysis.

Results

Data from 164 (77.4%) of the 212 originally enrolled participants were available and analyzed (80 in the intervention group and 84 in the control group). The intervention did not result in changes in systolic (–2.54 mm Hg, 95% CI –8.23 to 3.15) or diastolic (3.41 mm Hg, 95% CI –0.75 to 7.57) blood pressure compared with the control group. The intervention reduced the risk of developing hypertension, but the result was not significant (risk ratio (RR) 0.76, 95% CI 0.45-1.28). However, those who received the intervention had lower body weight (–5.42 kg, 95% CI –10.4 to –0.48) and BMI (–2.56 kg/m2, 95% CI –4.46 to –0.66). In addition, compared to the control participants, those who received ≥50% of the scheduled calls during the intervention had greater reductions in body weight (–6.23 kg, 95% CI –11.47 to –0.99) and BMI (–2.81 kg/m2, 95% CI –4.77 to –0.85).

Conclusions

An mHealth intervention comprising motivational interview calls and SMS text messaging appears to have effects on health 4 years after intervention completion. Although there were no effects on blood pressure levels, important reductions in body weight and BMI were seen 5 years after randomization. Thus, mHealth appears to be a promising preventive strategy for noncommunicable diseases in resource-constrained settings.

Trial Registration

Clinicaltrials.gov NCT01295216; https://clinicaltrials.gov/ct2/show/NCT01295216
An Internet-Based Psychological Intervention With a Serious Game to Improve Vitality, Psychological and Physical Condition, and Immune Function in Healthy Male Adults: Randomized Controlled Trial
Authors: Schakel Lemmy , Veldhuijzen Dieuwke S , van Middendorp Henriët , Prins Corine , Drittij Anne M H F , Vrieling Frank , Visser Leo G , Ottenhoff Tom H M , Joosten Simone A , Evers Andrea W M
Published: February 2020

Background

Recently, internet-based cognitive behavioral therapy (ICBT) and serious gaming interventions have been suggested to enhance accessibility to interventions and engagement in psychological interventions that aim to promote health outcomes. Few studies, however, have investigated their effectiveness in the context of simulated real-life challenges.

Objective

We aimed to examine the effectivity of a guided ICBT combined with a serious gaming intervention in improving self-reported psychophysiological and immunological health endpoints in response to psychophysiological and immune-related challenges.

Methods

Sixty-nine healthy men were randomly assigned to the intervention condition, receiving ICBT combined with serious gaming for 6 weeks, or the control condition, receiving no intervention. Self-reported vitality was the primary endpoint. Other self-reported psychophysiological and immunological endpoints were assessed following various challenges, including a bacillus Calmette-Guérin vaccination evoking pro-inflammatory responses, 1 and 4 weeks after the intervention period.

Results

Although the intervention did not affect vitality-associated parameters, self-reported sleep problems (P=.027) and bodily sensations (P=.042) were lower directly after the intervention compared with controls. Furthermore, wellbeing (P=.024) was higher in the intervention group after the psychophysiological challenges. Although no significant group differences were found for the psychophysiological and immunological endpoints, the data provided preliminary support for increased immunoglobulin antibody responses at the follow-up time points (P<.05). Differential chemokine endpoints between conditions were observed at the end of the test day.

Conclusions

The present study provides some support for improving health endpoints with an innovative ICBT intervention. Future research should replicate and further extend the present findings by consistently including challenges and a wide range of immune parameters into the study design.

Trial Registration

Nederlands Trial Register NTR5610; https://www.trialregister.nl/trial/5466
Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 2): Patient- and Parent-Centered Outcomes of Decolonization
Authors: Moore Courtney M , Wiehe Sarah E , Lynch Dustin O , Claxton Gina EM , Landman Matthew P , Carroll Aaron E , Musey Paul I
Published: February 2020

Background

Skin and soft tissue infections (SSTIs) due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can lead to a number of significant known medical outcomes including hospitalization, surgical procedures such as incision and drainage (I&D), and the need for decolonization procedures to remove the bacteria from the skin and nose and prevent recurrent infection. Little research has been done to understand patient and caregiver-centered outcomes associated with the successful treatment of MRSA infection.

Objective

This study aimed to uncover MRSA decolonization outcomes that are important to patients and their parents in order to create a set of prototype measures for use in the MRSA Eradication and Decolonization in Children (MEDiC) study.

Methods

A 4-hour, human-centered design (HCD) workshop was held with 5 adolescents (aged 10-18 years) who had experienced an I&D procedure and 11 parents of children who had experienced an I&D procedure. The workshop explored the patient and family experience with skin infection to uncover patient-centered outcomes of MRSA treatment. The research team analyzed the audio and artifacts created during the workshop and coded for thematic similarity. The final themes represent patient-centered outcome domains to be measured in the MEDiC comparative effectiveness trial.

Results

The workshop identified 9 outcomes of importance to patients and their parents: fewer MRSA outbreaks, improved emotional health, improved self-perception, decreased social stigma, increased amount of free time, increased control over free time, fewer days of school or work missed, decreased physical pain and discomfort, and decreased financial burden.

Conclusions

This study represents an innovative HCD approach to engaging patients and families with lived experience with MRSA SSTIs in the study design and trial development to determine meaningful patient-centered outcomes. We were able to identify 9 major recurrent themes. These themes were used to develop the primary and secondary outcome measures for MEDiC, a prospectively enrolling comparative effectiveness trial.

Trial Registration

ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658
The Effect of Shame on Patients With Social Anxiety Disorder in Internet-Based Cognitive Behavioral Therapy: Randomized Controlled Trial
Authors: Wang Haoyu , Zhao Qingxue , Mu Wenting , Rodriguez Marcus , Qian Mingyi , Berger Thomas
Published: February 2020

Background

Prior research has demonstrated the efficacy of internet-based cognitive behavioral therapy (ICBT) for social anxiety disorder (SAD). However, it is unclear how shame influences the efficacy of this treatment.

Objective

This study aimed to investigate the role shame played in the ICBT treatment process for participants with SAD.

Methods

A total of 104 Chinese participants (73 females; age: mean 24.92, SD 4.59 years) were randomly assigned to self-help ICBT, guided ICBT, or wait list control groups. For the guided ICBT group, half of the participants were assigned to the group at a time due to resource constraints. This led to a time difference among the three groups. Participants were assessed before and immediately after the intervention using the Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS).

Results

Participants’ social anxiety symptoms (self-help: differences between pre- and posttreatment SIAS=−12.71; Cohen d=1.01; 95% CI 9.08 to 16.32; P<.001 and differences between pre- and posttreatment SPS=11.13; Cohen d=0.89; 95% CI 6.98 to 15.28; P<.001; guided: SIAS=19.45; Cohen d=1.20; 95% CI 14.67 to 24.24; P<.001 and SPS=13.45; Cohen d=0.96; 95% CI 8.26 to 18.64; P<.001) and shame proneness (self-help: differences between pre- and posttreatment ESS=7.34; Cohen d=0.75; 95% CI 3.99 to 10.69; P<.001 and guided: differences between pre- and posttreatment ESS=9.97; Cohen d=0.88; 95% CI 5.36 to 14.57; P<.001) in both the self-help and guided ICBT groups reduced significantly after treatment, with no significant differences between the two intervention groups. Across all the ICBT sessions, the only significant predictors of reductions in shame proneness were the average number of words participants wrote in the exposure module (β=.222; SE 0.175; t96=2.317; P=.02) and gender (β=−.33; SE 0.002; t77=−3.13; P=.002). We also found a mediation effect, wherein reductions in shame fully mediated the relationship between the average number of words participants wrote in the exposure module and reductions in social anxiety symptoms (SIAS: β=−.0049; SE 0.0016; 95% CI −0.0085 to −0.0019 and SPS: β=−.0039; SE 0.0015; 95% CI −0.0075 to −0.0012).

Conclusions

The findings of this study suggest that participants’ engagement in the exposure module in ICBT alleviates social anxiety symptoms by reducing the levels of shame proneness. Our study provides a new perspective for understanding the role of shame in the treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900021952; http://www.chictr.org.cn/showproj.aspx?proj=36977
Overview of Policies, Guidelines, and Standards for Active Assisted Living Data Exchange: Thematic Analysis
Authors: Fadrique Laura X , Rahman Dia , Vaillancourt Hélène , Boissonneault Paul , Donovska Tania , Morita Plinio P
Published: February 2020

Background

A primary concern for governments and health care systems is the rapid growth of the aging population. To provide a better quality of life for the elderly, researchers have explored the use of wearables, sensors, actuators, and mobile health technologies. The term AAL can be referred to as active assisted living or ambient assisted living, with both sometimes used interchangeably. AAL technologies describes systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives.

Objective

The aim of this study was to understand the standards and policy guidelines that companies use in the creation of AAL technologies and to highlight the gap between available technologies, standards, and policies and what should be available for use.

Methods

A literature review was conducted to identify critical standards and frameworks related to AAL. Interviews with 15 different stakeholders across Canada were carried out to complement this review. The results from interviews were coded using a thematic analysis and then presented in two workshops about standards, policies, and governance to identify future steps and opportunities regarding AAL.

Results

Our study showed that the base technology, standards, and policies necessary for the creation of AAL technology are not the primary problem causing disparity between existing and accessible technologies; instead nontechnical issues and integration between existing technologies present the most significant issue. A total of five themes have been identified for further analysis: (1) end user and purpose; (2) accessibility; (3) interoperability; (4) data sharing; and (5) privacy and security.

Conclusions

Interoperability is currently the biggest challenge for the future of data sharing related to AAL technology. Additionally, the majority of stakeholders consider privacy and security to be the main concerns related to data sharing in the AAL scope. Further research is necessary to explore each identified gap in detail.
Detecting Lung Cancer Trends by Leveraging Real-World and Internet-Based Data: Infodemiology Study
Authors: Xu Chenjie , Yang Hongxi , Sun Li , Cao Xinxi , Hou Yabing , Cai Qiliang , Jia Peng , Wang Yaogang
Published: February 2020

Background

Internet search data on health-related terms can reflect people’s concerns about their health status in near real time, and hence serve as a supplementary metric of disease characteristics. However, studies using internet search data to monitor and predict chronic diseases at a geographically finer state-level scale are sparse.

Objective

The aim of this study was to explore the associations of internet search volumes for lung cancer with published cancer incidence and mortality data in the United States.

Methods

We used Google relative search volumes, which represent the search frequency of specific search terms in Google. We performed cross-sectional analyses of the original and disease metrics at both national and state levels. A smoothed time series of relative search volumes was created to eliminate the effects of irregular changes on the search frequencies and obtain the long-term trends of search volumes for lung cancer at both the national and state levels. We also performed analyses of decomposed Google relative search volume data and disease metrics at the national and state levels.

Results

The monthly trends of lung cancer-related internet hits were consistent with the trends of reported lung cancer rates at the national level. Ohio had the highest frequency for lung cancer-related search terms. At the state level, the relative search volume was significantly correlated with lung cancer incidence rates in 42 states, with correlation coefficients ranging from 0.58 in Virginia to 0.94 in Oregon. Relative search volume was also significantly correlated with mortality in 47 states, with correlation coefficients ranging from 0.58 in Oklahoma to 0.94 in North Carolina. Both the incidence and mortality rates of lung cancer were correlated with decomposed relative search volumes in all states excluding Vermont.

Conclusions

Internet search behaviors could reflect public awareness of lung cancer. Research on internet search behaviors could be a novel and timely approach to monitor and estimate the prevalence, incidence, and mortality rates of a broader range of cancers and even more health issues.
Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial
Authors: Li Shuang , Li Guoqing , Liu Ying , Xu Wanying , Yang Ningning , Chen Haoyuan , Li Ning , Luo Kunpeng , Jin Shizhu
Published: February 2020

Background

Endoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect.

Objective

This study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction.

Methods

The e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non–e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire.

Results

Of the 44 volunteers, 41 (93%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG’s posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85% (17/20) of the participants were satisfied with the e-learning system, and 95% (19/20) of the participants considered it successful.

Conclusions

E-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142
Reducing Burnout and Promoting Health and Wellness Among Medical Students, Residents, and Physicians in Alberta: Protocol for a Cross-Sectional Questionnaire Study
Authors: Kim Esther , Mallett Robert , Hrabok Marianne , Yang Yajing Alicia , Moreau Chantal , Nwachukwu Izu , Kravtsenyuk Maryana , Abba-Aji Adam , Li Daniel , Agyapong Vincent I O
Published: February 2020

Background

Burnout is an increasingly common and insidious phenomenon experienced by workers in many different fields, although it is of particular concern among physicians and trainees due to the nature of their work. It is estimated that one-third of practicing physicians will experience burnout during their career, and this rate is expected to continue to increase. Burnout has significant implications, as it has been identified as a contributor to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide.

Objective

This study will evaluate the prevalence and impact of burnout on physicians, residents, and medical students in Alberta.

Methods

Quantitative and qualitative data collected through self-administered, anonymous, online questionnaires will be used in this cross-sectional provincial study design. Data collection tools were developed based on published literature and questions from previously validated instruments. The tools capture relevant demographic information, mental health status, and rates of burnout, as well as factors contributing to both burnout and resilience among respondents. We anticipate a sample size of 777 medical students, 959 residents, and 1961 physicians to represent the respective ratios of trainees and practicing physicians in the province of Alberta.

Results

Study recruitment will begin in September 2020, with 4 weeks of data collection. The results of this study are anticipated within 12 months from the end of data collection. It is expected that the results will provide an overview of the prevalence of burnout among those training and working in medicine in Alberta, identify contributors to burnout, and help develop interventions aimed at reducing burnout.

Conclusions

This study’s aim is to examine burnout prevalence and contributing factors among medical trainees and physicians in Alberta. It is expected that the results will identify and examine individual and organizational practices that contribute to burnout and help develop strategies and interventions focused on mitigating burnout and its sequelae.

International Registered Report Identifier (IRRID)

PRR1-10.2196/16285
Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study
Authors: Adrian Molly , Coifman Jessica , Pullmann Michael D , Blossom Jennifer B , Chandler Casey , Coppersmith Glen , Thompson Paul , Lyon Aaron R
Published: February 2020

Background

Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential.

Objective

This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting.

Methods

A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES.

Results

Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care.

Conclusions

Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
Performance Evaluation of an Information Technology Intervention Regarding Charging for Inpatient Medical Materials at a Regional Teaching Hospital in Taiwan: Empirical Study
Authors: Liao Min-Chi , Lin I-Chun
Published: February 2020

Background

The process of manually recording the consumption of medical materials can be time consuming and prone to omission owing to its detailed and complicated nature. Implementing an information system will better improve work performance.

Objective

The Information System Success Model was adopted as the theoretical foundation. The opinions of nursing staff were collected to verify the impact of the system intervention on their work performance.

Methods

This cross-sectional study was conducted at a regional teaching hospital. Nursing staff were invited to participate in the field survey. A total of 296 questionnaires were collected, and of these, 284 (95.9%) were valid and returned.

Results

The key findings showed that two critical factors (“subjective norm” and “system quality”) had significant positive effects (both P<.001) on user satisfaction (R2=0.709). The path of “service quality” to “user satisfaction” showed marginal significance (P=.08) under the 92% CI. Finally, the explanatory power of the model reached 68.9%.

Conclusions

Support from the top management, appointment of a nurse supervisor as the change agent, recruitment of seed members to establish a pioneer team, and promotion of the system through the influence of opinion leaders in small groups were critical success factors needed for implementing the system in the case hospital. The target system was proven to be able to improve work performance, and the time saved could be further used for patient care, thereby increasing the value of nursing work. The positive experiences gained from this study could lay the foundation for the further promotion of the new system, and this is for future studies to replicate. The example of the successful experience of the case hospital could also serve as a reference for other hospitals in developing countries like Taiwan with regard to the promotion of nursing informatization.
An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial
Authors: Patel Viraj V , Rawat Shruta , Dange Alpana , Lelutiu-Weinberger Corina , Golub Sarit A
Published: February 2020

Background

Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions.

Objective

The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model.

Methods

Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention.

Results

Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up.

Conclusions

As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates.
Privacy-Preserving Record Linkage of Deidentified Records Within a Public Health Surveillance System: Evaluation Study
Authors: Nguyen Long , Stoové Mark , Boyle Douglas , Callander Denton , McManus Hamish , Asselin Jason , Guy Rebecca , Donovan Basil , Hellard Margaret , El-Hayek Carol
Published: February 2020

Background

The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link individual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures.

Objective

The aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance.

Methods

Although ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs.

Results

Sensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches.

Conclusions

This study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
Development, Implementation, and Evaluation of a Personalized Machine Learning Algorithm for Clinical Decision Support: Case Study With Shingles Vaccination
Authors: Chen Ji , Chokshi Sara , Hegde Roshini , Gonzalez Javier , Iturrate Eduardo , Aphinyanaphongs Yin , Mann Devin
Published: February 2020

Background

Although clinical decision support (CDS) alerts are effective reminders of best practices, their effectiveness is blunted by clinicians who fail to respond to an overabundance of inappropriate alerts. An electronic health record (EHR)–integrated machine learning (ML) algorithm is a potentially powerful tool to increase the signal-to-noise ratio of CDS alerts and positively impact the clinician’s interaction with these alerts in general.

Objective

This study aimed to describe the development and implementation of an ML-based signal-to-noise optimization system (SmartCDS) to increase the signal of alerts by decreasing the volume of low-value herpes zoster (shingles) vaccination alerts.

Methods

We built and deployed SmartCDS, which builds personalized user activity profiles to suppress shingles vaccination alerts unlikely to yield a clinician’s interaction. We extracted all records of shingles alerts from January 2017 to March 2019 from our EHR system, including 327,737 encounters, 780 providers, and 144,438 patients.

Results

During the 6 weeks of pilot deployment, the SmartCDS system suppressed an average of 43.67% (15,425/35,315) potential shingles alerts (appointments) and maintained stable counts of weekly shingles vaccination orders (326.3 with system active vs 331.3 in the control group; P=.38) and weekly user-alert interactions (1118.3 with system active vs 1166.3 in the control group; P=.20).

Conclusions

All key statistics remained stable while the system was turned on. Although the results are promising, the characteristics of the system can be subject to future data shifts, which require automated logging and monitoring. We demonstrated that an automated, ML-based method and data architecture to suppress alerts are feasible without detriment to overall order rates. This work is the first alert suppression ML-based model deployed in practice and serves as foundational work in encounter-level customization of alert display to maximize effectiveness.
Relationship Between Age and Weight Loss in Noom: Quasi-Experimental Study (Preprint)
Authors: DeLuca Laura , Toro-Ramos Tatiana , Michaelides Andreas , Seng Elizabeth , Swencionis Charles
Published: February 2020

BACKGROUND

The prevalence of obesity and diabetes among middle-aged and older adults is on the rise, and with an increase in the world population of adults aged 60 years and older, the demand for health interventions across age groups is growing. Noom is an mHealth behavior change lifestyle intervention that provides users with tracking features for food and exercise logging and weighing-in as well as access to a virtual 1:1 behavior change coach, support group, and daily curriculum that includes diet-, exercise-, and psychology-based content. Limited research has observed the effect of age on a mobile health (mHealth) lifestyle intervention.

OBJECTIVE

The goal of the research was to analyze engagement of middle-aged and older adults using a mobile lifestyle or diabetes prevention intervention.

METHODS

A total of 14,767 adults (aged 35 to 85 years) received one of two curricula via an mHealth intervention in a quasi-experimental study: the Healthy Weight program (HW) by Noom (84%) or the Noom-developed Diabetes Prevention Program (DPP), recognized by the US Centers for Disease Control and Prevention (CDC). The main outcome measure was weight over time, observed at baseline and weeks 16 and 52.

RESULTS

Linear mixed modeling found age to be a significant predictor of weight at week 16 (F2,1398.4=9.20; P<.001; baseline vs week 16: β=–.12, 95% CI –0.18 to –0.07), suggesting that as age increases by 1 year, weight decreased by 0.12 kg. An interaction between engagement and age was also found at week 52 (F1,14680.51=6.70; P=.01) such that engagement was more strongly associated with weight for younger versus older adults (age × engagement: β=.02, 95% CI 0.01 to 0.04). HW users lost 6.24 (SD 6.73) kg or 5.2% of their body weight and DPP users lost 5.66 (SD 7.16) kg or 8.1% of their body weight at week 52, meeting the CDC standards for weight loss effects on health.

CONCLUSIONS

Age and engagement are significant predictors of weight. Older adults lost more weight using an mHealth evidence-based lifestyle intervention compared with younger adults, despite their engagement. These preliminary findings suggest further clinical implications for adapting the program to older adults’ needs.
Analisis Pengaruh Harga dan Kualitas Produk terhadap Volume Penjualan Karet PT. Perkebunan Nusantara IX Semarang
Authors: Rachmasari Mety , Setiawan Bambang Mulyatno , Santoso Siswanto Imam
Published: February 2020

Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi volume penjualan karet PT Perkebunan Nusantara IX Semarang dan untuk menganalisis besarnya pengaruh harga dan kualitas produk terhadap volume penjualan karet PT Perkebunan Nusantara IX Semarang. Penelitian ini dilaksanakan pada bulan Mei - Juni 2018. Metode penelitian yang digunakan adalah studi kasus. Pengumpulan data dengan menggunakan metode wawancara dan studi pustaka. Data yang digunakan adalah data primer dan data sekunder yang dianalisis menggunakan regresi linier berganda. Hasil penelitian menunjukkan bahwa variabel harga dan kualitas produk secara serempak dan parsial berpengaruh terhadap volume penjualan. Uji parsial menunjukkan bahwa variabel harga mempunyai pengaruh lebih besar dibanding dengan kualitas produk.
Vitamin D Receptor Overexpression in β-Cells Ameliorates Diabetes in Mice
Authors: Morró Meritxell , Vilà Laia , Franckhauser Sylvie , Mallol Cristina , Elias Gemma , Ferré Tura , Molas Maria , Casana Estefanía , Rodó Jordi , Pujol Anna , Téllez Noèlia , Bosch Fàtima , Casellas Alba
Published: February 2020

Vitamin D deficiency has been associated with increased incidence of diabetes, both in humans and in animal models. In addition, an association between vitamin D receptor (VDR) gene polymorphisms and diabetes has also been described. However, the involvement of VDR in the development of diabetes, specifically in pancreatic β-cells, has not been elucidated yet. Here, we aimed to study the role of VDR in β-cells in the pathophysiology of diabetes. Our results indicate that Vdr expression was modulated by glucose in healthy islets and decreased in islets from both type 1 diabetes and type 2 diabetes mouse models. In addition, transgenic mice overexpressing VDR in β-cells were protected against streptozotocin-induced diabetes and presented a preserved β-cell mass and a reduction in islet inflammation. Altogether, these results suggest that sustained VDR levels in β-cells may preserve β-cell mass and β-cell function and protect against diabetes.
Inorganic Nitrate Promotes Glucose Uptake and Oxidative Catabolism in White Adipose Tissue Through the XOR-Catalyzed Nitric Oxide Pathway
Authors: McNally Ben D. , Moran Amy , Watt Nicole T. , Ashmore Tom , Whitehead Anna , Murfitt Steven A. , Kearney Mark T. , Cubbon Richard M. , Murray Andrew J. , Griffin Julian L. , Roberts Lee D.
Published: February 2020

An aging global population combined with sedentary lifestyles and unhealthy diets has contributed to an increasing incidence of obesity and type 2 diabetes. These metabolic disorders are associated with perturbations to nitric oxide (NO) signaling and impaired glucose metabolism. Dietary inorganic nitrate, found in high concentration in green leafy vegetables, can be converted to NO in vivo and demonstrates antidiabetic and antiobesity properties in rodents. Alongside tissues including skeletal muscle and liver, white adipose tissue is also an important physiological site of glucose disposal. However, the distinct molecular mechanisms governing the effect of nitrate on adipose tissue glucose metabolism and the contribution of this tissue to the glucose-tolerant phenotype remain to be determined. Using a metabolomic and stable-isotope labeling approach, combined with transcriptional analysis, we found that nitrate increases glucose uptake and oxidative catabolism in primary adipocytes and white adipose tissue of nitrate-treated rats. Mechanistically, we determined that nitrate induces these phenotypic changes in primary adipocytes through the xanthine oxidoreductase–catalyzed reduction of nitrate to NO and independently of peroxisome proliferator–activated receptor-α. The nitrate-mediated enhancement of glucose uptake and catabolism in white adipose tissue may be a key contributor to the antidiabetic effects of this anion.
Impairment in Baroreflex Sensitivity in Recent-Onset Type 2 Diabetes Without Progression Over 5 Years
Authors: Kück Jana-Luise , Bönhof Gidon J. , Strom Alexander , Zaharia Oana-Patricia , Müssig Karsten , Szendroedi Julia , Roden Michael , Ziegler Dan
Published: February 2020

Impaired baroreflex sensitivity (BRS) predicts cardiovascular mortality and is prevalent in long-term diabetes. We determined spontaneous BRS in patients with recent-onset diabetes and its temporal sequence over 5 years by recording beat-to-beat blood pressure and R-R intervals over 10 min. Four time domain and four frequency domain BRS indices were computed in participants from the German Diabetes Study baseline cohort with recent-onset type 1/type 2 diabetes (n = 206/381) and age-matched glucose-tolerant control subjects (control 1/control 2: n = 65/83) and subsets of consecutive participants with type 1/type 2 diabetes who reached the 5-year follow-up (n = 84/137). Insulin sensitivity (M-value) was determined using a hyperinsulinemic-euglycemic clamp. After appropriate adjustment, three frequency domain BRS indices were reduced in type 2 diabetes compared with control 2 and were positively associated with the M-value and inversely associated with fasting glucose and HbA1c (P < 0.05), whereas BRS was preserved in type 1 diabetes. After 5 years, a decrease in one and four BRS indices was observed in patients with type 1 and type 2 diabetes, respectively (P < 0.05), which was explained by the physiologic age-dependent decline. Unlike patients with well-controlled recent-onset type 1 diabetes, those with type 2 diabetes show early baroreflex dysfunction, likely due to insulin resistance and hyperglycemia, albeit without progression over 5 years.