bluuebunny/crossref_metadata_2025 huggingface dataset:
The Melatonin and Enriched Environment Ameliorated Low Protein-Induced Intrauterine Growth Retardation by IGF-1 And mtor Signaling Pathway and Autophagy Inhibition in Rats
Authors: Wang Dan , Wu Xiao , Lu Dan , Li Yan , Zhang Peng
Published: July 2020

Aim:

The present study investigated whether melatonin (MEL) and enriched
environment (EE) might protect against intrauterine growth retardation (IUGR) in rats.

Methods:

Sprague-Dawley rats were randomly allocated to 3 groups: control (C), model
(M) and EE+MEL group. Animals were housed in an enriched environment (EE+MEL
group) or remained in a standard environment (C group, M group). IUGR rat model was
built by feeding a low protein diet during pregnancy. MEL was administered by gavaging.
At day 1 post-birth, the baseline characteristics and serum biochemical parameters,
morphology of liver and small intestine, enzyme activities, and mRNA expression levels
of fetal rats were determined. The autophagy marker LC3 and Beclin1 were determined
by western blot analysis.

Results:

EE+MEL markedly improved the baseline characteristics, hepatic and intestinal
morphology of IUGR fetuses. In addition, the lactase activities in the fetal intestine were
markedly increased by the EE+MEL. The levels of serum somatostatin (SST), Growth
hormone (GH), GH releasing hormone (GHRH), Insulin-like Growth Factor 1 (IGF-1),
triiodothyronine (T3), and tetraiodothyronine (T4) were found to be recovered by
EE+MEL. In addition, the EE+MEL significantly ameliorated the mRNA expression of
SST, GHRH, and GHRH receptor (GHRHR), GH, GHR, IGF-1, and IGF-1 receptor
(IGF1R), IGF binding protein-1 (IGFBP1), mammalian target of rapamycin (mTOR), S6
kinase 1 (S6K1) and eukaryotic initiation factor 4E (eIF4E)-binding protein 1 (4EBP1) in
fetuses. In IUGR fetal livers, LC3 and Beclin1 were found to be increased at birth, while
LC3 and Beclin1 were observed to be significantly decreased in the EE+MEL group.

Conclusion:

EE+MEL could improve fetal rats' baseline characteristics, serum
biochemical parameters, birth weight, intestinal and hepatic morphology and enzyme
activities. These effects could be explained by the activation of the IGF-1/IGFBP1 and
IGF-1/mTOR/S6K1/4EBP1 signaling pathway and autophagy inhibition.
Design, Synthesis and In Vitro Biological Evaluation of Pyridine, Thiadazole,
Benzimidazole and Acetyl Thiophene Analogues as Anti Tubercular
Agents Targeting Enzyme Inh A
Authors: Suresh Ayyadurai J , Nandini Sivashankar , Sangeetha Krishnanmurthy , Dhivya Loganathan S , Surya Parakkot R
Published: July 2020

Background:

Tuberculosis, is a chronic infectious disease, affects one third of the global population. Emergence
of Multi-resistant (MDR) strains and high susceptibility of human immunodeficiency virus (HIV) infected persons to the
disease forced to develop novel anti-tuberculosis agents and preferably have a novel mechanism of action as to avoid crossresistant with other agents. Literature survey evidences that, Pyridine, Thiadiazole , Benzimidazole; and Acetyl thiophene
derivatives exhibit various pharmacological activities, including anti-mycobacterial activity.

Methods:

Thus, a series of Pyridine, Thiadiazole, Benzimidazole; and Acetyl thiophene based molecules were designed and
docked against crucial mtb enzyme target InhA (Enoyl Acyl Carrier Protein Reductase) Enzyme. The docked molecules
were screened against good docking-score and multiple interactions and opted for synthesis. Synthesized molecules were re
crystallized to obtain the purity. All the purified compounds were characterized by various spectral analyses and evaluated
for anti- mycobacterial activity against tuberculosis H37RV strain by Microplate Alamar Blue Assay (MABA) method.

Results:

The experimental results shown that schiff base of Pyridine (Compounds ‘d’ ) and Benzimidazole derivatives
(Compounds ‘i’ ) possesses good anti-tubercular activity with a MIC below 1.6 μg /mL. Further compound ‘e’ of
benzimdazole derivative showed good anti tubercular activity with an MIC below 6.25 μg /mL. Whereas 2 - acetyl thiopene
compounds exhibited moderate anti tubercular activity at below 50μg/mL.

Conclusion:

The comparative in vitro and molecular docking study analysis reveals that, compared to chalcones of Acetyl
thiophne derivatives, Pyridine, thiadazole and Benzimidazole based schiff bases exhibited best anti tubercular activity.
UPLC-MS/MS Determination of Chlorogenic Acid, Hyperoside and Astragalin in Plasma and its Pharmacokinetic Application in Liver Injury Rats
Authors: Zhang Ying , Xu Shu-ya , Jia Zhe , Han Ting , Liu Meng-nan , Jia Tian-ying , Qu Wen-jia , Xu Xinfang , Li Xiang-ri
Published: July 2020

Background:

Cuscutae Semen (CS) is reported to show a hepatoprotective effect. Chlorogenic
acid, hyperoside and astragalin are three major biologically active components from CS.

Objective:

A sensitive method based on ultra-high performance liquid chromatography-tandem mass
spectrometry (UPLC-MS/MS) was developed and validated to quantify the three components in rat
plasma and was successfully used to study pharmacokinetics in liver injury rats.

Methods:

Plasma samples were prepared with protein precipitation by acetonitrile. Chromatographic separation
was achieved on ACQUITY-XBridge BEH C18 column with gradient elution using the mobile phase
containing 0.05% formic acid in water (A) and acetonitrile (B). The three components were quantified using
Electrospray Ionization (ESI) source in the negative multiple Reaction Monitoring (MRM) mode.

Results:

Calibration curves of each analyte showed good linearity with correlation coefficients over
0.99. Accuracies (RE%) and precisions (RSD%) were within 15%. The method was stable. Recovery
of the target compounds in plasma samples ranged from 87.00% to 102.29%. No matrix effect was found
to influence the quantitative method.

Conclusion:

The UPLC-MS/MS method met the acceptance criteria and was successfully applied to
the simultaneous determination of chlorogenic acid, hyperoside and astragalin in rat plasma for the first
time. It is suitable for pharmacokinetic application in liver injury rats. It provides the foundation for
further development and utilization of the hepatoprotective effect of cuscutae semen.
An Unbiased Predictive Model to Detect DNA Methylation Propensity of CpG Islands in the Human Genome
Authors: Yalcin Dicle , Otu Hasan H.
Published: July 2020

Background:

Epigenetic repression mechanisms play an important role in gene regulation, specifically in cancer development. In many cases, a CpG island’s (CGI) susceptibility or resistance to methylation is shown to be contributed by local DNA sequence features.

Objective:

To develop unbiased machine learning models–individually and combined for different biological features–that predict the methylation propensity of a CGI.

Methods:

We developed our model consisting of CGI sequence features on a dataset of 75 sequences (28 prone, 47 resistant) representing a genome-wide methylation structure. We tested our model on two independent datasets that are chromosome (132 sequences) and disease (70 sequences) specific.

Results:

We provided improvements in prediction accuracy over previous models. Our results indicate that combined features better predict the methylation propensity of a CGI (area under the curve (AUC) ~0.81). Our global methylation classifier performs well on independent datasets reaching an AUC of ~0.82 for the complete model and an AUC of ~0.88 for the model using select sequences that better represent their classes in the training set. We report certain de novo motifs and transcription factor binding site (TFBS) motifs that are consistently better in separating prone and resistant CGIs.

Conclusion:

Predictive models for the methylation propensity of CGIs lead to a better understanding of disease mechanisms and can be used to classify genes based on their tendency to contain methylation prone CGIs, which may lead to preventative treatment strategies. MATLAB® and Python™ scripts used for model building, prediction, and downstream analyses are available at https://github.com/dicleyalcin/methylProp_predictor.
Ascorbic Acid-mediated Reactions in Organic Synthesis
Authors: Das Aparna , Yadav Ram Naresh , Banik Bimal Krishna
Published: July 2020

Ascorbic acid is the most well-known vitamin found in different types of food. It has
tremendous medical applications in several different fields such as in pharmaceuticals, cosmetics,
and in organic synthesis. Ascorbic acid can be used as a substrate or mediator in organic synthesis.
In this review, we report ascorbic acid-catalyzed reactions in organic synthesis. Several examples
are included in this review to demonstrate that ascorbic acid is a versatile catalyst for the synthesis
of diverse organic compounds. Reactions catalyzed by ascorbic acid are performed in organic or
aqueous media. The ready availability and easy handling features of ascorbic acid make these procedures
highly fascinating.
Mobile Mental Health Apps in China: Systematic App Store Search
Authors: Yin Huifang , Wardenaar Klaas J , Wang Yuhao , Wang Nan , Chen Wenjin , Zhang Yan , Xu Guangming , Schoevers Robert A
Published: July 2020

Background

Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health.

Objective

The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018.

Methods

A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app’s affiliation, cost, target users, information security, and evidence-based nature were evaluated.

Results

Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps.

Conclusions

Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed.
Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy
Authors: Rabinovich Lila , Molton James Steven , Ooi Wei Tsang , Paton Nicholas Iain , Batra Shelly , Yoong Joanne
Published: July 2020

Background

Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high.

Objective

We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia).

Methods

We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization.

Results

Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants.

Conclusions

While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally.
Influence of Scanner Precision and Analysis Software in Quantifying Three-Dimensional Intraoral Changes: Two-Factor Factorial Experimental Design
Authors: O'Toole Saoirse , Bartlett David , Keeling Andrew , McBride John , Bernabe Eduardo , Crins Luuk , Loomans Bas
Published: July 2020

Background

Three-dimensional scans are increasingly used to quantify biological topographical changes and clinical health outcomes. Traditionally, the use of 3D scans has been limited to specialized centers owing to the high cost of the scanning equipment and the necessity for complex analysis software. Technological advances have made cheaper, more accessible methods of data capture and analysis available in the field of dentistry, potentially facilitating a primary care system to quantify disease progression. However, this system has yet to be compared with previous high-precision methods in university hospital settings.

Objective

The aim of this study was to compare a dental primary care method of data capture (intraoral scanner) with a precision hospital-based method (laser profilometer) in addition to comparing open source and commercial software available for data analysis.

Methods

Longitudinal dental wear data from 30 patients were analyzed using a two-factor factorial experimental design. Bimaxillary intraoral digital scans (TrueDefinition, 3M, UK) and conventional silicone impressions, poured in type-4 dental stone, were made at both baseline and follow-up appointments (mean 36 months, SD 10.9). Stone models were scanned using precision laser profilometry (Taicaan, Southampton, UK). Three-dimensional changes in both forms of digital scans of the first molars (n=76) were quantitatively analyzed using the engineering software Geomagic Control (3D Systems, Germany) and freeware WearCompare (Leeds Digital Dentistry, UK). Volume change (mm3) was the primary measurement outcome. The maximum point loss (μm) and the average profile loss (μm) were also recorded. Data were paired and skewed, and were therefore compared using Wilcoxon signed-rank tests with Bonferroni correction.

Results

The median (IQR) volume change for Geomagic using profilometry and using the intraoral scan was –0.37 mm3 (–3.75-2.30) and +0.51 mm3 (–2.17-4.26), respectively (P<.001). Using WearCompare, the median (IQR) volume change for profilometry and intraoral scanning was –1.21 mm3 (–3.48-0.56) and –0.39 mm3 (–3.96-2.76), respectively (P=.04). WearCompare detected significantly greater volume loss than Geomagic regardless of scanner type. No differences were observed between groups with respect to the maximum point loss or average profile loss.

Conclusions

As expected, the method of data capture, software used, and measurement metric all significantly influenced the measurement outcome. However, when appropriate analysis was used, the primary care system was able to quantify the degree of change and can be recommended depending on the accuracy needed to diagnose a condition. Lower-resolution scanners may underestimate complex changes when measuring at the micron level.
Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review
Authors: Kruse Clemens Scott , Ehrbar Nolan
Published: July 2020

Background

Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes.

Objective

The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried.

Methods

Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting.

Results

Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs.

Conclusions

Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
Usability of Individualized Head-Related Transfer Functions in Virtual Reality: Empirical Study With Perceptual Attributes in Sagittal Plane Sound Localization
Authors: Jenny Claudia , Reuter Christoph
Published: July 2020

Background

In order to present virtual sound sources via headphones spatially, head-related transfer functions (HRTFs) can be applied to audio signals. In this so-called binaural virtual acoustics, the spatial perception may be degraded if the HRTFs deviate from the true HRTFs of the listener.

Objective

In this study, participants wearing virtual reality (VR) headsets performed a listening test on the 3D audio perception of virtual audiovisual scenes, thus enabling us to investigate the necessity and influence of the individualization of HRTFs. Two hypotheses were investigated: first, general HRTFs lead to limitations of 3D audio perception in VR and second, the localization model for stationary localization errors is transferable to nonindividualized HRTFs in more complex environments such as VR.

Methods

For the evaluation, 39 subjects rated individualized and nonindividualized HRTFs in an audiovisual virtual scene on the basis of 5 perceptual qualities: localizability, front-back position, externalization, tone color, and realism. The VR listening experiment consisted of 2 tests: in the first test, subjects evaluated their own and the general HRTF from the Massachusetts Institute of Technology Knowles Electronics Manikin for Acoustic Research database and in the second test, their own and 2 other nonindividualized HRTFs from the Acoustics Research Institute HRTF database. For the experiment, 2 subject-specific, nonindividualized HRTFs with a minimal and maximal localization error deviation were selected according to the localization model in sagittal planes.

Results

With the Wilcoxon signed-rank test for the first test, analysis of variance for the second test, and a sample size of 78, the results were significant in all perceptual qualities, except for the front-back position between own and minimal deviant nonindividualized HRTF (P=.06).

Conclusions

Both hypotheses have been accepted. Sounds filtered by individualized HRTFs are considered easier to localize, easier to externalize, more natural in timbre, and thus more realistic compared to sounds filtered by nonindividualized HRTFs.
Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study
Authors: Acharya Ajay , Cunningham Kenda , Manandhar Shraddha , Shrestha Niva , Chen Mario , Weissman Amy
Published: July 2020

Background

With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal.

Objective

This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions.

Methods

We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos.

Results

The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers.

Conclusions

A text message–based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message–based mHealth intervention design in under-resourced settings.
Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record
Authors: Kunstler Breanne E , Furler John , Holmes-Truscott Elizabeth , McLachlan Hamish , Boyle Douglas , Lo Sean , Speight Jane , O'Neal David , Audehm Ralph , Kilov Gary , Manski-Nankervis Jo-Anne
Published: July 2020

Background

Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options.

Objective

This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations.

Methods

The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification.

Results

Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities.

Conclusions

GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study
Authors: Stunden Chelsea , Zasada Julie , VanHeerwaarden Nicole , Hollenberg Elisa , Abi-Jaoudé Alexxa , Chaim Gloria , Cleverley Kristin , Henderson Joanna , Johnson Andrew , Levinson Andrea , Lo Brian , Robb Janine , Shi Jenny , Voineskos Aristotle , Wiljer David
Published: July 2020

Background

Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help.

Objective

The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada.

Methods

A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes.

Results

Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help.

Conclusions

Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.
Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework
Authors: Mackey Tim Ken , Miyachi Ken , Fung Danny , Qian Samson , Short James
Published: July 2020

Background

An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse.

Objective

The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse.

Methods

We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation).

Results

Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network.

Conclusions

The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.
Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis
Authors: Leng Minmin , Zhao Yajie , Xiao Hongmei , Li Ce , Wang Zhiwen
Published: July 2020

Background

Caring for people with dementia is perceived as one of the most stressful and difficult forms of caring. Family caregivers always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet-based supportive interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care.

Objective

This review aimed to (1) assess the efficacy of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate the potential effects of internet-based supportive intervention access by caregivers on their care recipients.

Methods

An electronic literature search of the PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases was conducted up to January 2020. Two reviewers (ML and YZ) worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and independently extracted data. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) with 95% CIs were applied to calculate the pooled effect sizes.

Results

In total, 17 RCTs met the eligibility criteria and were included in this systematic review. The meta-analysis showed that internet-based supportive interventions significantly ameliorated depressive symptoms (SMD=–0.21; 95% CI –0.31 to –0.10; P<.001), perceived stress (SMD=–0.40; 95% CI –0.55 to –0.24; P<.001), anxiety (SMD=–0.33; 95% CI –0.51 to –0.16; P<.001), and self-efficacy (SMD=0.19; 95% CI 0.05-0.33; P=.007) in dementia caregivers. No significant improvements were found in caregiver burden, coping competence, caregiver reactions to behavioral symptoms, or quality of life. Six studies assessed the unintended effects of internet-based supportive intervention access by caregivers on their care recipients. The results showed that internet-based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients.

Conclusions

Internet-based supportive interventions are generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self-efficacy in dementia caregivers and have potential benefits on care recipients. Future studies are encouraged to adopt personalized internet-based supportive interventions to improve the health of family caregivers and their care recipients.

Trial Registration

PROSPERO CRD42020162434; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162434
Digital Cardiovascular Biomarker Responses to Transcutaneous Cervical Vagus Nerve Stimulation: State-Space Modeling, Prediction, and Simulation
Authors: Gazi Asim H , Gurel Nil Z , Richardson Kristine L S , Wittbrodt Matthew T , Shah Amit J , Vaccarino Viola , Bremner J Douglas , Inan Omer T
Published: July 2020

Background

Transcutaneous cervical vagus nerve stimulation (tcVNS) is a promising alternative to implantable stimulation of the vagus nerve. With demonstrated potential in myriad applications, ranging from systemic inflammation reduction to traumatic stress attenuation, closed-loop tcVNS during periods of risk could improve treatment efficacy and reduce ineffective delivery. However, achieving this requires a deeper understanding of biomarker changes over time.

Objective

The aim of the present study was to reveal the dynamics of relevant cardiovascular biomarkers, extracted from wearable sensing modalities, in response to tcVNS.

Methods

Twenty-four human subjects were recruited for a randomized double-blind clinical trial, for whom electrocardiography and photoplethysmography were used to measure heart rate and photoplethysmogram amplitude responses to tcVNS, respectively. Modeling these responses in state-space, we (1) compared the biomarkers in terms of their predictability and active vs sham differentiation, (2) studied the latency between stimulation onset and measurable effects, and (3) visualized the true and model-simulated biomarker responses to tcVNS.

Results

The models accurately predicted future heart rate and photoplethysmogram amplitude values with root mean square errors of approximately one-fifth the standard deviations of the data. Moreover, (1) the photoplethysmogram amplitude showed superior predictability (P=.03) and active vs sham separation compared to heart rate; (2) a consistent delay of greater than 5 seconds was found between tcVNS onset and cardiovascular effects; and (3) dynamic characteristics differentiated responses to tcVNS from the sham stimulation.

Conclusions

This work furthers the state of the art by modeling pertinent biomarker responses to tcVNS. Through subsequent analysis, we discovered three key findings with implications related to (1) wearable sensing devices for bioelectronic medicine, (2) the dominant mechanism of action for tcVNS-induced effects on cardiovascular physiology, and (3) the existence of dynamic biomarker signatures that can be leveraged when titrating therapy in closed loop.

Trial Registration

ClinicalTrials.gov NCT02992899; https://clinicaltrials.gov/ct2/show/NCT02992899

International Registered Report Identifier (IRRID)

RR2-10.1016/j.brs.2019.08.002
App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data
Authors: Zens Martin , Brammertz Arne , Herpich Juliane , Südkamp Norbert , Hinterseer Martin
Published: July 2020

Background

COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients.

Objective

To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool.

Methods

The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous.

Results

In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value.

Conclusions

Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection.
Robust Feature Engineering for Parkinson Disease Diagnosis: New Machine Learning Techniques (Preprint)
Authors: Wang Max , Ge Wenbo , Apthorp Deborah , Suominen Hanna
Published: July 2020

BACKGROUND

Parkinson disease (PD) is a common neurodegenerative disorder that affects between 7 and 10 million people worldwide. No objective test for PD currently exists, and studies suggest misdiagnosis rates of up to 34%. Machine learning (ML) presents an opportunity to improve diagnosis; however, the size and nature of data sets make it difficult to generalize the performance of ML models to real-world applications.

OBJECTIVE

This study aims to consolidate prior work and introduce new techniques in feature engineering and ML for diagnosis based on vowel phonation. Additional features and ML techniques were introduced, showing major performance improvements on the large mPower vocal phonation data set.

METHODS

We used 1600 randomly selected /aa/ phonation samples from the entire data set to derive rules for filtering out faulty samples from the data set. The application of these rules, along with a joint age-gender balancing filter, results in a data set of 511 PD patients and 511 controls. We calculated features on a 1.5-second window of audio, beginning at the 1-second mark, for a support vector machine. This was evaluated with 10-fold cross-validation (CV), with stratification for balancing the number of patients and controls for each CV fold.

RESULTS

We showed that the features used in prior literature do not perform well when extrapolated to the much larger mPower data set. Owing to the natural variation in speech, the separation of patients and controls is not as simple as previously believed. We presented significant performance improvements using additional novel features (with 88.6% certainty, derived from a Bayesian correlated t test) in separating patients and controls, with accuracy exceeding 58%.

CONCLUSIONS

The results are promising, showing the potential for ML in detecting symptoms imperceptible to a neurologist.
An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial (Preprint)
Authors: Edridge Chloe , Wolpert Miranda , Deighton Jessica , Edbrooke-Childs Julian
Published: July 2020

BACKGROUND

Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs.

OBJECTIVE

The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people.

METHODS

The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up.

RESULTS

There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone.

CONCLUSIONS

It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted.

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/resprot.7019
“Of Belonging or Not”: Counter-Canons of Britishness in the Novels of Hanif Kureishi and Andrea Levy
Authors: Nunziata Daniele
Published: July 2020

This article analyses two novels, Hanif Kureishi’s The Buddha of Suburbia (1990) and Andrea Levy’s Small Island (2004), to elaborate on how they form postcolonial literary visions of metropolitan Britain, in resistance to colonialist depictions of the setting which have been disseminated across the world. The two works share related themes and motifs in their representations of the experiences of first- and second-generation migrants from Britain’s (former) colonies. Kureishi’s novel, set in the 1970s, relates the teenage life of Karim, the son of an Indian migrant, Haroon, as he navigates his sense of being a “funny kind of Englishman” (3). Levy’s novel, on the other hand, relates the experiences of a Jamaican couple, Hortense and Gilbert, as they arrive in Britain in 1948 within a fictionalised representation of the Empire Windrush. Comparable images within their works, including allusions to George Lamming’s writing from the 1950s and Stuart Hall’s depiction of the West End as it has existed in colonial imaginings, demonstrate how the two novelists participate in – and, therefore, help construct – a counter-canon of writing about post-war and postcolonial Britishness.
Robert Frost’s North of Boston: A Poetry of Resistance
Authors: Richard Dominic
Published: July 2020

This article explores the idea that Robert Frost’s North of Boston can be interpreted as a poetry of resistance in terms of methodology and subject matter. The methodological thread pertains to Frost’s poetics whilst the subject matter pertains to the historical and socio-political beings which Frost dramatises and records.
Daya Tetas Telur Penyu Belimbing (Dermochelis Coriacea) Hasil Pemasaran Masyarakat Di Kawasan Pantai Lampuuk Kecamatan Lhoknga Kabupaten Aceh Besar
Authors: Ali Muhammad , Maslim Maslim
Published: July 2020

Tujuan penelitian adalah untuk (1) mengetahui waktu penetasan pertama dan terakhir telur penyu belimbing (Dermochelys coriacea), dan (2) mengetahui persentase penetasan telur penyu belimbing (Dermochelys coriacea) yang telah dipasarkan masyarakat kawasan Lampuuk Kecamatan Lhoknga Kabupaten Aceh Besar. Kegiatan penelitian dilakukan pada kawasan penangkaran penyu pantai Lampuuk Kecamatan Lhoknga Kabupaten Aceh Besar, pada tanggal 26 Desember 2012 pukul 10.00 WIB sampai tanggal 28 Februari 2013 pukul 21.00 Wib. Jumlah telur yang diperlakukan 20 butir, dalam sarang yang digali sedalam 75 cm. Metode yang digunakan adalah metode eksperimen, yang memperlakukan kegiatan penetasan langsung di kawasan penangkaran Pantai Lampuuk Kecamatan Lhoknga Kabupaten Aceh Besar. Analisis waktu yang digunakan dalam penetasan dilakukan secara deskriptif, sedangkan jumlah telur yang menetas dianalisis dengan persentase. Hasil yang diperoleh adalah telur pertama menetas pada pukul 18.00 WIB Tanggal 28 Febrauri 2013 hari ke 64 membutuhkan waktu 1544 jam setelah perlakuan, dan penetasan terakhir terjadi pada pukul 21.00 WIB hari ke 64 tanggal 28 Februari 2013 setelah perlakukan membutuhkan waktu 1547 jam. Persentase telur yang menetas adalah 85 % (17 butir telur), sedangkan yang tidak menetas adalah 15 % (3 butir). Kesimpulan diperoleh adalah persentase telur yang menetas sangat tinggi, dan waktu penetasan telur pertama memiliki waktu lebih cepat jika dibandingkan dengan penetasan telur perlakuan yang lain.

Kata Kunci: Penyu, Dermochelis dan Pantai Lampuuk

The purposes of this study are to (1) know the first and last time of eggs hatched of leatherback turtle (Dermochelys coriacea), and (2) know the percentage of eggs hatching of leatherback turtle (Dermochelys coriacea), which has marketed by community of Lampuuk in Lhoknga district Aceh Besar. The research activities carried on Lampuuk beach turtle breeding area in Lhoknga, Aceh Besar, on 26 of December 2012 at 10.00 WIB until 28 of February 2013 at 21.00 WIB. The amount of treated eggs were 20 eggs, put in nests dug as deep as 75 cm. The method used was the experimental method at hatchery breeding areas in Lampuuk Beach, Lhoknga, Aceh Besar. The analysis of time spent in the hatchery done descriptively, while the number of eggs hatched analyzed by using percentage. The results showed that the first eggs hatched at 18:00 WIB on 28 of February 2013, day 64th. It needed time about 1544 hours after treatment. The last eggs hatched at 21.00 WIB day 64th on 28 of February 2013 after treatment. It needed time about 1547 hours. The percentage of eggs that hatched was 85% (17 eggs), whereas there was 15% (3 items) of the eggs did not hatch. The conclusion were the percentage of eggs that hatched was very high and the time for the first eggs hatched was faster than the other ones on the treatment.

Keywords: Turtle, Dermochelys coreacea and Lampuuk Beach