bluuebunny/crossref_metadata_2025 huggingface dataset:
Demographic differences in use of household tap water in a representative sample of US adults, FallStyles 2019
Authors: Vanden Esschert Kayla , Barrett Catherine E. , Collier Sarah A. , Garcia-Williams Amanda G. , Hannapel Elizabeth , Yoder Jonathan S. , Benedict Katharine M.
Published: October 2021

Tap water that is safe to consume may cause respiratory illness (e.g., Legionnaires’ disease) when water conditions allow for proliferation and aerosolization of biofilm-associated pathogens. This study assessed household tap water consumption, exposure to aerosolized tap water, and associated demographics. A nationally representative FallStyles survey administered by Porter Novelli Public Services was sent to 4,677 US adult panelists in October 2019. There were 3,624 adults who completed the survey (77.5% response rate). Respondents were asked about self-reported use of household tap water for consumption (i.e., drinking, rinsing produce, or making ice) and use through water-aerosolizing devices (e.g., showerheads, humidifiers). Demographics included gender, age, race/ethnicity, education, income, region, and health status. Weighted analyses using complex sample survey procedures were used to assess tap water exposure by route and demographics. Most US adults are exposed to aerosolized tap water through showering (80.6%), and one in five are exposed through other water-aerosolizing devices (20.3%). Consumption and showering were greatest among older, White, higher educated, and higher-income adults. Aerosolized tap water can transmit waterborne pathogens and cause respiratory illness, especially among older age groups and people with weakened immune systems. These results will help target health messages for using water-aerosolizing devices safely.
Reducing the conflict of interest in the optimal operation of reservoirs by linking mesohabitat hydraulic modeling and metaheuristic optimization
Authors: Sedighkia Mahdi , Datta Bithin , Abdoli Asghar
Published: October 2021

The present study proposes a novel framework to optimize the reservoir operation through linking mesohabitat hydraulic modeling and metaheuristic optimization to mitigate environmental impact downstream of the reservoir. Environmental impact function was developed by mesohabitat hydraulic simulation. Then, the developed function was utilized in the structure of the reservoir operation optimization. Different metaheuristic algorithms including practice swarm optimization, invasive weed optimization, differential evolution and biogeography-based algorithm were used to optimize reservoir operation. Root mean square error (RMSE) and reliability index were utilized to measure the performance of algorithms. Based on the results in the case study, the proposed method is robust for mitigating downstream environmental impacts and sustaining water supply by the reservoir. RMSE for mesohabitats is 8%, which indicates the robustness of proposed method to mitigate environmental impacts at downstream. It seems that providing environmental requirements might reduce the reliability of water supply considerably. Differential evolution algorithm is the best method to optimize reservoir operation in the case study.
Multi-objective reservoir operation of the Ukai reservoir system using an improved Jaya algorithm
Authors: Kumar Vijendra , Yadav S. M.
Published: October 2021

This paper introduces an effective and reliable approach based on a multi-population approach, namely the self-adaptive multi-population Jaya algorithm (SAMP-JA), to extract multi-purpose reservoir operation policies. The current research focused on two goals: minimizing irrigation deficits and maximizing hydropower generation. Three different models were formulated. The results were compared with those for an ordinary Jaya algorithm (JA), particle swarm optimization (PSO), and an invasive weed optimization (IWO) algorithm. In Model-1, the minimum irrigation deficit obtained by SAMP-JA and JA was 305092.99 . SAMP-JA was better than JA, PSO and IWO in terms of convergence. In Model-2, the maximum hydropower generation achieved by SAMP-JA, JA and PSO was 1723.50 . When comparing the average hydropower generation, SAMP-JA and PSO performed better than JA and IWO. In terms of convergence, SAMP-JA was better than PSO. In Model-3, a self-adaptive multi-population multi-objective Jaya algorithm (SAMP-MOJA) was better than multi-objective particle swarm optimization (MOPSO) and multi-objective Jaya algorithm (MOJA) in terms of maximum hydropower generation, and MOPSO was better than SAMP-MOJA and MOJA in terms of minimum irrigation deficiency. While comparing convergence, SAMP-MOJA was found to be better than MOPSO and MOJA. Overall, SAMP-JA was found to outperform JA, POS and IWO.
Removal of microplastics from wastewater: available techniques and way forward
Authors: Singh Surya , Kalyanasundaram Madhanraj , Diwan Vishal
Published: October 2021

Microplastics are the newly emerged contaminants with a presence in almost every part of the globe. Despite being small in size, microplastic particles have proved to be harmful for plants, animals, humans, and for the ecosystem in general. Water is one of the most important routes through which microplastics transfer from one place to another. Moreover, water is also an important route for the ingestion of microplastics in human, which results in various health issues, such as cancer, mutagenic and teratogenic abnormalities. Thus, microplastics in water is an emerging public health issue which needs attention and, hence, it is important to investigate removal techniques for microplastics in wastewater. Although, there are some biological, chemical/electrochemical, and physical techniques to remove microplastics, their wide scale applicability and cost–effectiveness is an issue. In this review, we have discussed the existing and upcoming treatment technologies for the removal of microplastics from wastewater and also tried to present an overview for the future approaches.
Characterization of algae residue biochar and its application in methyl orange wastewater treatment
Authors: Zhu Hao , Zou Haiming
Published: October 2021

In this work, Spirulina residue was used as the raw material to prepare different biochars by changing the pyrolysis time. Moreover, the obtained products were characterized by scanning electron microscopy, transmission electron microscopy, Raman spectroscopy, Fourier transform infrared spectroscopy, and X-ray diffraction energy spectra. This experiment used the batch adsorption method to study the adsorption effect of pH, dosage, and pyrolysis time on methyl orange. The adsorption of methyl orange onto Spirulina residue biochar (SRBC) were fitted with the Langmuir isotherm model and pseudo-second-order kinetics. The results showed that the surface functional groups of SRBC obtained by dry pyrolysis were abundant, and could effectively adsorb methyl orange dye in an aqueous solution. The sample prepared at 500 °C for 5 h had the best adsorption effect on methyl orange. The change of pyrolysis time will affect the physicochemical properties of biochar from Spirulina residue, thereby affecting its adsorption effect on methyl orange dye. The analysis showed that the chemical adsorption of SRBC on methyl orange might be the primary way of dye removal. The results can provide a reference for preparing biochar from algae residue and biochar application in the removal of dye wastewater.
Click Reaction in the Synthesis of Dendrimer Drug-delivery Systems
Authors: García-Álvarez Fernando , Martínez-García Marcos
Published: October 2021

:

Drug delivery systems are designed for the targeted delivery and controlled re-lease of medicinal agents. Among the materials employed as drug delivery systems, den-drimers have gained increasing interest in recent years because of their properties and structural characteristics. The use of dendrimer-nanocarrier formulations enhances the safety and bioavailability, increases the solubility in water, improves stability and phar-macokinetic profile, and enables efficient delivery of the target drug to a specific site. However, the synthesis of dendritic architectures through convergent or divergent meth-ods has drawbacks and limitations that disrupt aspects related to design and construction, and consequently, slow down the transfer from academia to industry. In that sense, the implementation of click chemistry has received increasing attention in the last years, as it offers new efficient approaches to obtain dendritic species in good yields and higher monodispersity. This review focuses on recent strategies for building dendrimer drug de-livery systems using click reactions from 2015 to early 2021. The dendritic structures showed in this review are based on β-cyclodextrins (β-CD), poly(amidoamine) (PA-MAM), dendritic poly (lysine) (PLLD), dimethylolpropionic acid (bis-MPA), phospho-ramidate (PAD), and poly(propargyl alcohol-4-mercaptobutyric (PPMA).
PCSK9 Inhibition-Based Therapeutic Approaches: An Immunotherapy Perspective
Authors: Momtazi-Borojeni Amir Abbas , Pirro Matteo , Xu Suowen , Sahebkar Amirhossein
Published: October 2021

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (PCSK9-I) are novel therapeutic tools to decrease cardiovascular risk. These agents work by lowering the low-density lipoprotein cholesterol (LDL-C) in hypercholesterolemic patients who are statin resistant/intolerant. Current clinically approved and investigational PCSK9- I act generally by blocking PCSK9 activity in the plasma or suppressing its expression or secretion by hepatocytes. The most widely investigated method is the disruption of PCSK9/LDL receptor (LDLR) interaction by fully-humanized monoclonal antibodies (mAbs), evolocumab and alirocumab, which have been approved for the therapy of hypercholesterolemia and atherosclerotic cardiovascular disease (CVD). Besides, a small interfering RNA called inclisiran, which specifically suppresses PCSK9 expression in hepatocytes, is as effective as mAbs but with administration twice a year. Because of the high costs of such therapeutic approaches, several other PCSK9-I have been surveyed, including peptide-based anti-PCSK9 vaccines and small oral anti-PCSK9 molecules, which are under investigation in preclinical and phase I clinical studies. Interestingly, anti-PCSK9 vaccination has been found to serve as a more widely feasible and more cost-effective therapeutic tool over mAb PCSK9-I for managing hypercholesterolemia. The present review will discuss LDL-lowering and cardioprotective effects of PCSK9-I, mainly immunotherapy- based inhibitors including mAbs and vaccines, in preclinical and clinical studies.
The FIFA 11+ Injury Prevention Program Still not Implemented by the Majority of Professional and Semi-professional Soccer Players and Coaches Globally
Authors: Al Attar Wesam Saleh A. , Alarifi Saud , Alramadhani Ibrahim , Aljabri Majed , Alyami Mashaer , Alsufiany Muhsen , Alzhrani Msaad , Ghulam Hussain S.
Published: October 2021

Background:

The Fédération International de Football Association (FIFA) has promoted and deployed the FIFA 11+ injury prevention program worldwide. Developed by the FIFA Medical Assessment and Research Centre (F-MARC), the program relied on the results of an international randomized controlled trial that aimed to reduce sport-related injuries and healthcare costs.

Objective:

The objective of this study was to assess the awareness level, implementation rate, and opinions about the effectiveness of the FIFA 11+ Injury Prevention Program among professional and semi-professional soccer players and coaches worldwide.

Methods:

In all, 2000 professional and semi-professional soccer players and coaches were invited to complete a self-administered questionnaire. Several authors, who are experts in sports medicine and injury prevention, participated in developing the questionnaire. The primary outcomes were awareness level, implementation rate, and opinion on the FIFA 11+ Program’s effectiveness in reducing injuries.

Results:

A total of 1690 professional and semi-professional soccer players and coaches completed the survey (response rate: 84.5%). A total of 824 professional and semi-professional soccer players and coaches (48.8%) were aware of the FIFA 11+ Program, and 680 (83.8%) reported implementing the program in their practice. The participants who implemented the program reported a positive attitude toward the program’s efficacy, with a score of 8.20 ± 1.10 out of 10.

Conclusion:

More than half of professional and semi-professional soccer players and coaches from different continents are not aware of the FIFA 11+ Injury Prevention Program. Therefore, educating players and coaches is necessary for increased implementation and injury reduction.
Research on Position Recognition and Control Method of Single-leg Joint of Hydraulic Quadruped Robot
Authors: Gao Bingwei , Guan Hao , Tang Wenming , Han Wenlong , Xue Shilong
Published: October 2021

:

In order to obtain the precise mathematical model of the position control system of the
hydraulic quadruped robot, and to meet the requirements of the system parameters in different stages
of motion, this paper studies the position control system of the single-leg joint of the hydraulic
quadruped robot: First of all, this paper uses the closed-loop indirect identification method to identify
the position of the leg joints of the hydraulic quadruped robot to obtain the mathematical model
of the system; And then, the speed PID control algorithm and speed planning algorithm are designed,
so that the system can quickly respond to the changes of system input according to the requirements
of different speeds; Finally, the joint position control system of the hydraulic quadruped
robot is simulated and verified by experiments.

Background:

The mathematical model of the positioning system of the hydraulic quadruped robot is
clear, but the parameters in the model have the characteristics of uncertainty and time-variation. In
the joint position control system of a hydraulic quadruped robot, different motion stages have different
requirements for system parameters.

Objective:

The purpose of this study is to obtain the precise mathematical model of the position control
system of the hydraulic quadruped robot and to meet the requirements of the system parameters
in different stages of motion.

Methods:

This research takes the hydraulic quadruped robot single-leg system as the research object
and uses the closed-loop indirect identification method to identify the position of the leg joints of
the hydraulic quadruped robot to obtain the mathematical model of the system. Then, the speed PID
control method is designed and compared with the ordinary PID control by taking the positioning control
accuracy of the robot before touching the ground as a standard to carry out the controlled trial.

Results:

In this research, the identification method and control algorithm are designed, and finally,
the simulation and experimental research are carried out. The results of the simulation and experiment
verify the correctness of the identification method and the effectiveness of the control algorithm.

Conclusion:

First of all, this paper uses the closed-loop indirect identification method to identify the
position of the leg joints of the hydraulic quadruped robot to obtain the mathematical model of the
system. Then, the speed PID control algorithm and speed planning algorithm are designed so that
the system can quickly respond to the changes of system input according to the requirements of different
speeds.
COVID-19-related acute kidney injury and dialysis: What are the outcomes in South Africa?
Authors: van Hougenhouck-Tulleken Wesley , Hussain Muhammed , do Vale Claudia
Published: October 2021

Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Results: The COVID-19-related AKI mortality rate was 58.9%. Significant predictors included continuous veno-venous haemodialysis therapy, invasive ventilation, use of inotropes and the presence of shock. Ischaemic heart disease, heart failure and admission to a private healthcare facility were associated with lower mortality. No significant associations were found with ethnicity, sex, hypertension, diabetes, HIV infection or the use of other modes of dialysis. Conclusions: In South African patients, we report similar outcomes in critically ill patients requiring dialysis for AKI, relative to international data. The predictors of mortality most likely reflect the severity of the illness in our patients. The data suggest that continuous veno-venous haemodiafiltration or slow low efficiency dialysis may be the preferred dialysis modalities in these patients.
Methods of the Tibia Bone Defect Management in Primary Knee Arthroplasty: Systematic Review
Authors: Gurazhev Mikhail B. , Baitov Vladislav S. , Gavrilov Andrei A. , Pavlov Vitalii V. , Korytkin Andrey A.
Published: October 2021

Background. The problem of management of bone tissue defects remains one of the tasks that a surgeon faces during primary total knee arthroplasty (TKA). Since the number of TKA is increasing every year, modern scientific research aimed at solving the problem of bone defect replacement remains important. The aim of the study was to evaluate the effectiveness of various methods of bone defects management in primary TKA based on the analysis of literature. Materials and Methods. We conducted a search of articles in PubMed, eLIBRARY, Scopus from 2005 to 2020. Results. On the whole our search led to 1217 papers. Finally 19 articles that met inclusion criteria were included in this review. Each of the methods of bone defect replacement has its advantages and disadvantages. The results of the studies show that the he defect size is not a key factor for choosing the method, since with relatively identical defect parameters, different plastic options were used with a satisfactory clinical outcome. The endoprosthesis component should be fixed in at least two zones in every chosen method. In young patients with good bone quality preference in chosen methods should be given to bone grafts, which allow to preserve the bone stock. Based on the papers analysis, we have proposed the algorithm for method choosing for each clinical case. Conclusion. Each surgeon chooses a method for replacing bone defects based on their own preferences and such criteria as the equipment of the operating room, the surgical team experience, the quality of the patients bone and the defect size.
Evaluation of Radiological Parameters of the Spino-Pelvic Complex in Children with Hip Subluxation in Legg-Calve-Perthes Disease
Authors: Bortulev Pavel I. , Vissarionov Sergei V. , Barsukov Dmitry B. , Pozdnikin Ivan Y. , Baskov Vladimir E. , Baskaeva Tamila V. , Poznovich Makhmud S.
Published: October 2021

Background. The natural course of Legg-Calve-Perthes disease (LCPD) in children with subtotal or total lesion, which correspond to group III-IV according to the Catterall classification, it often leads to hip subluxation. Any changes in the vertebral-pelvic complex lead to mutual transformation and aggravation of existing deformities. In the Russian literature, there are no data on the assessment of the state of the frontal and sagittal spino-pelvic ratios in children with hip subluxation in LCPD. Purpose to evaluate the radiological parameters of the frontal and sagittal spino-pelvic relations in children with hip subluxation in LCPD. Materials and Methods. The study is based on the results of radiometry of 20 patients (20 hip joints) at an average age of 8.90.6 years with LCPD. Radiometry of the main frontal and sagittal spino-pelvic indices was performed and the type of vertical posture was determined according to P. Rousoully, as well as correlations between the studied parameters. Results. All patients had a pelvic distortion in the frontal plane. The values of PI had insignificant changes in comparison with similar values in the asymptomatic child population, the values of SS and SSA exceeded them, and the values of PT were significantly lower, which indicates the presence of excessive pelvic anteversion. The GLL values significantly exceeded the average statistical indicators. The global sagittal balance indicator (SVA) had negative values. The correlation analysis showed the presence of a strong positive relationship between PI and SS, SS and GLL, SSA and SS, a moderately pronounced positive relationship between PI and PT and a moderately pronounced negative relationship between PO and SS, PO and GLL. Conslusion. In children with LCPD in the fragmentation stage with subtotal or total epiphysis lesion (Catterall group III-IV) and hip subluxation, excessive pelvic anteversion is characteristic, which is expressed in an increase in the angle of inclination of the sacrum (SS) in combination with hyperlordosis of the lumbar spine and negative imbalance, as well as a pelvic distortion towards the affected limb. The totality of these changes corresponds to the IV type of vertical posture according to R. Roussouly, which can contribute to the development of degenerative-dystrophic processes in the lumbar spine.
Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study
Authors: Ginsburg Amy Sarah , Kinshella Mai-Lei Woo , Naanyu Violet , Rigg Jessica , Chomba Dorothy , Coleman Jesse , Hwang Bella , Ochieng Roseline , Ansermino J Mark , Macharia William M
Published: October 2021

Background

Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization.

Objective

This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting.

Methods

We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software.

Results

Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies.

Conclusions

Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2019-035184
Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review
Authors: Ackermann Khalia , Baker Jannah , Green Malcolm , Fullick Mary , Varinli Hilal , Westbrook Johanna , Li Ling
Published: October 2021

Background

Sepsis is a significant cause of morbidity and mortality worldwide. Early detection of sepsis followed promptly by treatment initiation improves patient outcomes and saves lives. Hospitals are increasingly using computerized clinical decision support (CCDS) systems for the rapid identification of adult patients with sepsis.

Objective

This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of adult inpatients with sepsis.

Methods

The protocol for this scoping review was previously published. A total of 10 electronic databases (MEDLINE, Embase, CINAHL, the Cochrane database, LILACS [Latin American and Caribbean Health Sciences Literature], Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and PQDT [ProQuest Dissertations and Theses]) were comprehensively searched using terms for sepsis, CCDS, and detection to identify relevant studies. Title, abstract, and full-text screening were performed by 2 independent reviewers using predefined eligibility criteria. Data charting was performed by 1 reviewer with a second reviewer checking a random sample of studies. Any disagreements were discussed with input from a third reviewer. In this review, we present the results for adult inpatients, including studies that do not specify patient age.

Results

A search of the electronic databases retrieved 12,139 studies following duplicate removal. We identified 124 studies for inclusion after title, abstract, full-text screening, and hand searching were complete. Nearly all studies (121/124, 97.6%) were published after 2009. Half of the studies were journal articles (65/124, 52.4%), and the remainder were conference abstracts (54/124, 43.5%) and theses (5/124, 4%). Most studies used a single cohort (54/124, 43.5%) or before-after (42/124, 33.9%) approach. Across all 124 included studies, patient outcomes were the most frequently reported outcomes (107/124, 86.3%), followed by sepsis treatment and management (75/124, 60.5%), CCDS usability (14/124, 11.3%), and cost outcomes (9/124, 7.3%). For sepsis identification, the systemic inflammatory response syndrome criteria were the most commonly used, alone (50/124, 40.3%), combined with organ dysfunction (28/124, 22.6%), or combined with other criteria (23/124, 18.5%). Over half of the CCDS systems (68/124, 54.8%) were implemented alongside other sepsis-related interventions.

Conclusions

The current body of literature investigating the implementation of CCDS systems for the early detection of adult inpatients with sepsis is extremely diverse. There is substantial variability in study design, CCDS criteria and characteristics, and outcomes measured across the identified literature. Future research on CCDS system usability, cost, and impact on sepsis morbidity is needed.

International Registered Report Identifier (IRRID)

RR2-10.2196/24899
Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment
Authors: Pearson Keon , Ngo Summer , Ekpo Eson , Sarraju Ashish , Baird Grayson , Knowles Joshua , Rodriguez Fatima
Published: October 2021

Background

Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.

Objective

This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.

Methods

Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non–patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.

Results

A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.

Conclusions

Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).
Transforming Anesthesia Data Into the Observational Medical Outcomes Partnership Common Data Model: Development and Usability Study (Preprint)
Authors: Lamer Antoine , Abou-Arab Osama , Bourgeois Alexandre , Parrot Adrien , Popoff Benjamin , Beuscart Jean-Baptiste , Tavernier Benoît , Moussa Mouhamed Djahoum
Published: October 2021

BACKGROUND

Electronic health records (EHRs, such as those created by an anesthesia management system) generate a large amount of data that can notably be reused for clinical audits and scientific research. The sharing of these data and tools is generally affected by the lack of system interoperability. To overcome these issues, Observational Health Data Sciences and Informatics (OHDSI) developed the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to standardize EHR data and promote large-scale observational and longitudinal research. Anesthesia data have not previously been mapped into the OMOP CDM.

OBJECTIVE

The primary objective was to transform anesthesia data into the OMOP CDM. The secondary objective was to provide vocabularies, queries, and dashboards that might promote the exploitation and sharing of anesthesia data through the CDM.

METHODS

Using our local anesthesia data warehouse, a group of 5 experts from 5 different medical centers identified local concepts related to anesthesia. The concepts were then matched with standard concepts in the OHDSI vocabularies. We performed structural mapping between the design of our local anesthesia data warehouse and the OMOP CDM tables and fields. To validate the implementation of anesthesia data into the OMOP CDM, we developed a set of queries and dashboards.

RESULTS

We identified 522 concepts related to anesthesia care. They were classified as demographics, units, measurements, operating room steps, drugs, periods of interest, and features. After semantic mapping, 353 (67.7%) of these anesthesia concepts were mapped to OHDSI concepts. Further, 169 (32.3%) concepts related to periods and features were added to the OHDSI vocabularies. Then, 8 OMOP CDM tables were implemented with anesthesia data and 2 new tables (EPISODE and FEATURE) were added to store secondarily computed data. We integrated data from 5,72,609 operations and provided the code for a set of 8 queries and 4 dashboards related to anesthesia care.

CONCLUSIONS

Generic data concerning demographics, drugs, units, measurements, and operating room steps were already available in OHDSI vocabularies. However, most of the intraoperative concepts (the duration of specific steps, an episode of hypotension, etc) were not present in OHDSI vocabularies. The OMOP mapping provided here enables anesthesia data reuse.
Correction: A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study (Preprint)
Authors: Singh Devinder Kaur Ajit , Goh Jing Wen , Shaharudin Muhammad Iqbal , Shahar Suzana
Published: October 2021

BACKGROUND

Recent falls prevention guidelines recommend early routine fall risk assessment among older persons.

OBJECTIVE

The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons.

METHODS

FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively.

RESULTS

The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802.

CONCLUSIONS

These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.
Exploring Social Support in an Online Support Community for Tourette Syndrome and Tic Disorders: An Analysis of Postings (Preprint)
Authors: Soós Mercédesz Judit , Coulson Neil S , Davies E Bethan
Published: October 2021

BACKGROUND

Online support communities have become an accessible way of gaining social, emotional, and informational support from peers and may be particularly useful for individuals with chronic conditions. To date, there have been few studies exploring the online support available for tic disorders, such as Tourette syndrome. An exploratory study looking at users’ experiences of using online support communities for tic disorders suggested that members used such communities to share experiences, information, and strategies for tic management.

OBJECTIVE

To build on these preliminary findings, this study examined the provision of social support in an online community for Tourette syndrome.

METHODS

Data were collected from one publicly available online support community for Tourette syndrome and tics, from its inception to December 2019 by randomly selecting 10% of posts and their corresponding comments from each year for analysis. This resulted in 510 unique posts and 3802 comments, posted from 1270 unique usernames. The data was analysed using inductive thematic analysis.

RESULTS

The findings of this study suggest that users utilized the online community as a multifaceted virtual place where they could: share and ask for information about tics; unload and share their feelings arising from living with Tourette syndrome; find people facing similar situations and experiences; and where they could freely share the realities of living with Tourette syndrome.

CONCLUSIONS

The results complement the findings from a preliminary study and suggest that online support communities have a potentially valuable role as a mechanism for sharing and gaining information on illness experiences from similar peers experiencing tics, and can promote self-management of tics. Limitations and recommendations for future research are discussed.

CLINICALTRIAL
Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis (Preprint)
Authors: Struik Laura , Khan Shaheer , Assoiants Artem , Sharma Ramona H
Published: October 2021

BACKGROUND

A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms.

OBJECTIVE

The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts.

METHODS

A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software.

RESULTS

Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time.

CONCLUSIONS

The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation.
Mechanical ventilation in patients with severe traumatic brain injury: modern guidelines review
Authors: Krishtafor D.A. , Klygunenko O.M. , Kravets O.V. , Yekhalov V.V. , Liashchenko O.V.
Published: October 2021

Traumatic brain injury is the most common group of injuries among victims admitted to the emergency departments. Up to 20 % of individuals with brain damage require endotracheal intubation and mechanical ventilation, the duration of which is significantly longer than in non-neurological patients. Such patients have a higher incidence of acute respiratory distress syndrome and ventilator-associated pneumonia, and weaning and extubation are associated with significant difficulties. However, patients with traumatic brain injury are often excluded from randomized trials, and international guidelines for the treatment of severe traumatic brain injury do not provide clear ventilation strategies. Analysis of the literature allowed us to identify modern principles of respiratory support in severe traumatic brain injury, which include: tracheal intubation in Glasgow coma scale score of ≤ 8 points; early mechanical ventilation; PaO2 in the range of 80–120 mm Hg (SaO2 ≥ 95 %), PaCO2 — 35–45 mm Hg; tidal volume ≤ 8 ml/kg; respiratory rate ≈ 20/min; PEEP ≥ 5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning from the respirator through the use of support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheostomy in predicted extubation failure.
Sepsis-associated acute kidney injury
Authors: Maltseva L.A. , Novytska-Usenko L.V. , Nykonov V.V. , Kanchura T.V.
Published: October 2021

Acute kidney injury (AKI) is a condition that develops as a result of a rapid decrease in the glomerular filtration rate, which leads to the accumulation of nitrogenous, including urea and creatinine, and non-nitrogenous metabolic products with electrolytic disorders, impairment of the acid-base balance, and the volume of fluid excreted by the kidneys. Objective: to provide a review of the literature concerning sepsis-associated acute kidney injury. We presented the problems of diagnosis, risk factors, the pathogenesis of sepsis-associated acute kidney injury, as well as to outline terminologically the clinical form of sepsis-associated acute kidney injury: the paradigm shifts from ischemia and vasoconstriction to hyperemia and vasodilation, from acute tubular necrosis to acute tubular apoptosis. Sepsis contributes significantly to the development of AKI: in sepsis, it occurs in 19 % of patients; nevertheless, it is much more frequent in septic shock (45 % of cases), the mortality of individuals with AKI is especially high in non-septic and septic conditions (45 and 73 %, respectively). To effectively diagnose the functional state of the kidneys and conduct nephroprotective therapy, stratification scales for assessing the severity of acute kidney damage are applied, which are based on the determination of plasma creatinine level and urine output: RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure), AKIN (Acute Kidney Injury Network), KDIGO (Kidney Disease Improving Global Outcomes); the experts considered KDIGO scale more modern and perfect. It has been found that plasma creatinine is not an early biomarker of AKI that indicates the advisability of using other integral indicators. AKI biomarkers are substances that either participate in the pathological process or witness it allowing diagnose AKI even before an increase in plasma creatinine level. The characteristics of the structure, role of functions of such biomarkers as neutrophil gelatinase-associated lipocalin, cystatin C, interleukin-18, kidney injury molecule-1 and others are given. Intensive care for sepsis-associated acute kidney injury includes the standard therapy corresponding to 2016 Surviving Sepsis Campaign and KDIGO guidelines. Also, the paper focuses on renal replacement therapy (RRT): renal and extrarenal indications for the initiation, factors affecting the initiation of RRT, the timing of initiation, ways of optimization, the timing of RRT discontinuation, recommendations for the dose of RRT, the dose of renal replacement therapy in sepsis-associated AKI, choice of method, advantages and disadvantages of continuous RRT and intermittent hemodialysis, medication support for continuous therapy, the role of hemodialysis machine in the intensive care unit.
Appeal of Editor-in-Chief
Authors: Pankiv V.I.
Published: October 2021

No abstract
Treatment of neurological complications in patients with type 2 diabetes mellitus at the stage ofrehabilitation after COVID-19
Authors: Pankiv V.I.
Published: October 2021

Although the predominant clinical manifestation of COVID-19 is a respiratory disease, various neurological symptoms are increasingly being diagnosed, in particular, diabetic polyneuropathy is diagnosed in most patients with diabetes, affecting large and small nerve fibers. Drugs that are traditionally used for neuropathic pain (tricyclic antidepressants, gabapentinoids, etc.), despite their positive effect in eliminating the symptoms of polyneuropathy, often cause side effects and do not impact nerve regeneration. Over the last decade, a group of nucleotides has been used quite actively. Additional information on the effects of this group of drugs was accumulated and there is a gradual transformation, including their compositions. Thus, recently the attention of researchers has been devoted to the study of the effectiveness of the combination of uridine, choline, vitamins B1, B6, B12, and folic acid, which is characterized by a fairly high safety profile and regenerative potential. The review highlights the mechanisms of action and results of clinical use of this combination. Uridine monophosphate, B vitamins, folic acid are involved in metabolic processes, enhancing nerve regeneration. This contributes to the development of indirect (secondary) analgesic effect. In addition, the data of new studies indicate the ability of uridine monophosphate derivatives to impact purinergic P2Y receptors, which causes a direct analgesic and direct regenerative effect. Studies have demonstrated the clinical efficacy of this combination in the main types of peripheral neuropathic pain. The combination did not cause side effects and was well tolerated. There was a reduction or complete withdrawal of concomitant analgesics against the background of improving the quality of life of patients. The combination of uridine, choline, vitamin B1, vitamin B6, vitamin B12, and folic acid is a very effective addition to the standard therapy of peripheral neuropathic pain of various genesis and rehabilitation after COVID-19.