bluuebunny/crossref_metadata_2025 huggingface dataset:
Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety
Authors: Bangash Madeeha , Mustafa Laila , Irshad Muhammad , Omer Qaiser , Alam Mohammad Khursheed
Published: August 2022

Background:

Dental procedures profoundly affect a child's dental fear and anxiety, ren-dering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in appre-hensive children to help them relax and accept dental treatment. This, however, can have both short-and long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores.

Methods:

This analytical cross-sectional study was conducted at the Department of Paediatric Den-tistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores.

Results:

Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with in-halation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001).

Conclusion:

Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.
Sonographic Features of Primary Breast Lymphoma: An Analysis of 10
Cases
Authors: Liu Xinying , Liu Jingyun , Chen Shuangxi
Published: August 2022

Background:

Primary breast lymphoma (PBL) is a rare malignant breast tumor. The literature
concerning PBL ultrasound is based primarily on case reports, with only a few cases reported to
date.

Purpose:

This study aimed to elucidate the sonographic characteristics of PBL and explore the value of
ultrasonography in the preoperative diagnosis of PBL using the Breast Imaging Reporting and Data
System (BI-RADS).

Methods:

A retrospective review of files involving a diagnosis of PBL (2013–2020) was conducted in
the Department of Pathology, Zhejiang Provincial People’s Hospital, Hangzhou, and the First Affiliated
Hospital of Wenzhou Medical University, Wenzhou. The clinical characteristics and sonographic
features of 12 lesions in 10 patients were analyzed and discussed in light of the literature.

Results:

All patients, aged 50.40 ± 14.31 years (range 30–66 years), had clinically palpable lumps.
Most cases were on the right breast and were unilateral. Only one patient had mucosa-associated lymphoma.
The histological type of the other patients was diffuse large B-cell lymphoma (DLBCL). Ultrasonography
revealed nodular and diffuse PBL lesions without internal calcification. The nodular PBL
was hypoechoic or mixed hypo- to hyperechoic, with a differential lobulated shape and horizontal
growth. Although color Doppler flow imaging (CDFI) showed no significant features, the ultrasound
findings were categorized as BI-RADS 4 in 10 of the 12 lesions and BI-RADS 5 in two lesions. All
patients were suspected of having malignancies (BI-RADS 4 or 5).

Conclusion:

PBL was mostly found in middle-aged and elderly women, and the right breast was more
prone to the development of malignancies. PBL lesions were classified as either nodular or diffuse
based on the boundaries of the tumors in the ultrasound images. Typical PBL was characterized by
hypoechoic or heterogeneous lesions with circumscribed or microlobulated margins and horizontal
growth. The sonographic features of the PBL lesions and the BI-RADS categorizations of the lesions
analyzed suggested malignancy.
CT Reconstruction Algorithm and Low Contrast Detectability of Phantom
Study: A Systematic Review and Meta-Analysis
Authors: Adibah Yusof Nur Aimi , Abdul Karim Muhammad Khalis , Asikin Nursyazalina Mohd , Paiman Suriati , Awang Kechik Mohd Mustafa , Abdul Rahman Mohd Amiruddin , Noor Noramaliza Mohd
Published: August 2022

Background:

For almost three decades, computed tomography (CT) has been extensively used in medical diagnosis which led researchers to conduct linking of CT dose exposure with image quality

Methods:

In this study, a systematic review and a meta-analysis study were conducted on CT phantom for resolution study especially based on the low contrast detectability (LCD). Furthermore, the association between the CT parameter such as tube voltage and the type of reconstruction algorithm and amount of phantom scanning in affecting the image quality and the exposure dose were also investigated in this study. We utilize PubMed, ScienceDirect, Google Scholar and Scopus databases to search related published articles from year 2011 until 2020. The notable keyword comprises of “computed tomography”, “CT phantom”, “low contrast detectability”. Of 52 articles, 20 articles is within the inclusion criteria in this systematic review.

Results:

The dichotomous outcomes were chosen to represent the results in terms of risk ratio as per meta-analysis study. Notably, the noise in iterative reconstruction (IR) reduced by 24%,33% and 36% with the use of smooth, medium and sharp filters, respectively. Furthermore, adaptive iterative dose reduction (AIDR 3D) improved image quality and the visibility of smaller less dense objects compared to filtered back-projection. Most of the researchers used 120 kVp tube voltage to scan phantom for quality assurance study.

Conclusion:

Hence, the optimization of primary factor such as tube potential reduce the dose exposure significantly and with the optimize IR technique could substantially reduce the radiation dose whilst maintaining the image quality.
Identification of Potential Drug Therapy for Dermatofibrosarcoma Protuberans
with Bioinformatics and Deep Learning Technology
Authors: Xu Yingbin , Liu Muge , Yang Fan
Published: August 2022

Background:

Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchymal tumor that is
primarily treated with surgery. Targeted therapy is a promising approach to help reduce the high rate of
recurrence. This study aims to identify the potential target genes and explore the candidate drugs acting
on them effectively with computational methods.

Methods:

dentification of genes associated with DFSP was conducted using the text mining tool pubmed2ensembl. Further gene screening was carried out by conducting Gene Ontology (GO) and Kyoto
Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Protein-Protein Interaction
(PPI) network was constructed by using the Search Tools for the Retrieval of Interacting (STRING) database and visualized in Cytoscape. The gene candidates were identified after a literature review. Drugs
targeting these genes were selected from Pharmaprojects. The binding affinity scores of Drug-Target Interaction (DTI) were predicted by a deep learning algorithm Deep Purpose.

Results:

total of 121 genes were found to be associated with DFSP by text mining. The top 3 statistically functionally enriched pathways of GO and KEGG analysis included 36 genes, and 18 hub genes
were further screened out by constructing a PPI networking and literature retrieval. A total of 42 candidate drugs targeted at hub genes were found by Pharmaprojects under our restrictions. Finally, 10 drugs
with top affinity scores were predicted by DeepPurpose, including 3 platelet-derived growth factor receptor beta kinase (PDGFRB) inhibitors, 2 platelet-derived growth factor receptor alpha kinase (PDGFRA)
inhibitors, 2 Erb-B2 receptor tyrosine kinase 2 (ErbB-2) inhibitors, 1 tumor protein p53 (TP53) stimulant,
1 vascular endothelial growth factor receptor (VEGFR) antagonist, and 1 prostaglandin-endoperoxide
synthase 2 (PTGS2) inhibitor.

Conclusion:

Text mining and bioinformatics are useful methods for gene identification in drug discovery.
DeepPurpose
Acute Myocardial Infarction in Young Patients and its Correlation with Obesity Status at Pre-adolescent Stage: A Narrative Review
Authors: Chrissini Maria K. , Panagiotakos Demosthenes B.
Published: August 2022

Background:

Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century.

Objective:

To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults.

Methods:

This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar.

Results:

There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age.

Conclusion:

Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.
Status of Childhood Eye Care Services in the Kingdom of Saudi Arabia: Eye Care Professionals’ Perspectives
Authors: Moafa Majid A. , Alrasheed Saif H.
Published: August 2022

Background:

The World Health Organization (WHO) reported that there are approximately 19 million visually impaired children worldwide, and most of the conditions are treatable by early intervention at the primary, secondary, and tertiary levels.

Objective:

To assess the status of paediatric eye care services in the Kingdom of Saudi Arabia

Methods:

A cross-sectional study was conducted among eye care professionals (optometrists and ophthalmologists) in public sector hospitals in various regions of Saudi Arabia. Data were collected through an online self-administered paediatric eye care service questionnaire based on a validated questionnaire.

Results:

A total of 137 completed questionnaires were obtained, with a response rate of 83%. The highest percentage of trained paediatric teams at hospitals was recorded at 95% in the eastern region (p= 0.024), while the lowest percentage was 44% in the southern region. Trained paediatric nurses were available in 88% of the eastern region hospitals, followed by 56% of the central region hospitals (p= 0.001). Services such as separate paediatric optometry clinics, dedicated ophthalmology outpatient clinics, and advanced diagnostic equipment were significantly higher in number in the eastern region than in the other regions (p˂0.001). The general status of human resources of eye professionals reveals that 73% of the facilities had both trained optometrists and ophthalmologists, approximately 70.8% had anaesthesiologists available, and almost 73.7% had easy access to available paediatricians.

Conclusion:

The overall quality of paediatric eye-related health care is satisfactory in most Saudi regions. However, there are some discrepancies among the regions in paediatric eye care services and facility types, which may need to be addressed by decision-makers in the Ministry of Health.
Validated Reverse Phase-High-Performance Liquid Chromatography
Method for Simultaneous Determination of Vanillic acid and Glyburide in
Amphiphilic Polymeric Micelles
Authors: Singh Sachin Kumar , Kaur Jaskiran , Gulati Monica , Pandey Narendra Kumar , Kumar Bimlesh , Singh Saurabh
Published: August 2022

Background:

A new sensitive and rapid reverse phase HPLC method was developed for the
simultaneous determination of vanillic acid (VA) and glyburide in the formulation and validated according
to (ICH) Q2 (R1) guidelines.

Methods:

The HPLC analysis was performed using the C-18 reverse phase column and a mobile phase
consisting of acetonitrile and orthophosphoric acid (0.1% v/v) of ratio 70:30 v/v at 1 mL/min of flow rate.
The detection was performed at the wavelength (λ) of 234 nm (isosbestic point), and the retention time of
VA and glyburide was found around 2.6 and 5.4 min. The calibration plot gave a linear relationship over
the concentration range of 2–10 μg/mL with a regression coefficient of 0.999. The LOD and LOQ for VA
were 0.34 and 1.04 μg/mL, while for glyburide it was 0.38 μg/mL and 1.17 μg/mL respectively. The accuracy
of the proposed method was determined by recovery studies and was in the range of 95% to 105%.
The RSD% of the determination of precision was <2%.

Results:

The results of the robustness study were within the acceptable limits in response to changes in
flow rate, ratio of mobile phase, and pH. The method was successfully applied for the determination of
EE% and drug release from amphiphilic polymeric micelles.

Conclusion:

The EE% of both the drugs prepared in a liquid formulation of amphiphilic polymeric micelles
was found to be greater than 90%. The results of drug release studies indicated almost 100% VA
and 85.3% glyburide release using pH-gradient method within 4 and 48 h respectively.
Selection of Suitable Dielectric Substrate for Miniaturization of Microstrip
Patch Antenna Using DGS Fractals
Authors: Mohanty Saumendra Kumar , Dash Shibanee
Published: August 2022

Background:

Antennas size reduction with good performance characteristics is an essential part of designing a microstrip patch antenna (MPA) to select a suitable dielectric substrate.

Methods:

A conventional MPA is designed at 10GHz frequency, and later Minkowski fractal (1st
iteration) defected ground structure (DGS) technique is applied for size reduction. The design is
made to keep the radiation and reflection characteristics in contention.

Results:

A miniaturized MPA with 11% size reduction has been simulated using HFSS. The simulation results show the realization and selection of the substrate materials in the design process. Here,
five different substrates are judiciously implemented and later compared. The comparison is made
based on return loss, bandwidth, impedance, gain and efficiency

Conclusion:

We found a miniaturized MPA using the proposed first iteration of Minkowski fractal
DGS. This MPA is suitable for X-band satellite communication and may be applied in government
institutions, civil, military, monitoring weather, air traffic, defence tracking, maritime vessel traffic,
etc., due to conformal and planar shape with reduced electrical length at 10GHz operating frequency
Controlled impacts for structure formation and properties of cement concretes
Authors: Ivaschenko Yu. G. , Mameshov R. T.
Published: August 2022

Objective. The paper considers controlled effects on changes in the properties of components and the control effect of technological methods and techniques for obtaining composite building materials with a set of specified properties.

Method. Methods of mechano-physical, physicochemical, nanotechnological influence were applied.

Result. The system-structural approaches are systematized and generalized by control actions at the stage of structure formation, technological stages, formation of the optimal structure and properties of cement concrete. The physicochemical principles and mechanisms of structure formation are given, based on establishing the role of controlling the mechano-physical, physico-chemical, nanotechnological methods of influencing the cement-water system. The possibility of controlling structural transformations in binder systems, including through the use of technological influences, has been revealed.

Conclusion. The implementation of the impacts on the components of cement concretes will ensure the targeted design of the structures of modern building materials.
Investigation of various types of biological corrosion of concrete
Authors: Loginova S. A. , Petrenko A. A.
Published: August 2022

Objective. Determination of the degree of development of various types of microorganisms and their effect on the physical and mechanical properties of concrete.

Method. Assessment of the possibility of concrete to serve as a substrate for various types of biodestructors was carried out using the determination of moisture absorption and pH of water drawing of concrete samples.

Result. Experimental mechanism of action of various microorganisms on concrete is established. Taxonomic composition of microorganisms most aggressive to concrete is determined. The impact of biofouling on the physical and mechanical properties of concrete was assessed.

Conclusion. The results of the investigation serve as the basis for competent selection of the most effective methods of corrosion protection of concrete structures operating in biologically aggressive environments.
Information security of business networks
Authors: Losev A. S.
Published: August 2022

Objectives. The aim of the work is to improve the information security of businesstype networks, as the most susceptible to external threats for the purpose of commercial espionage.

Method. The study is based on the use of an original mathematical algorithm that allows clustering networks of arbitrary topology and constructing a partial order matrix. On the one hand, clustering allows you to identify network agents that have the same information access to the network, on the other hand, partial order reflects the position of a single cluster in the hierarchical structure of the entire network.

Result. This approach allows assessing the potential threat to the network depending on the position of the agent in the network that has been attacked. On its basis, a methodology has been developed to determine the degree of openness of an entrepreneurial network to the influence of external factors for each agent of the network. It allows you to identify network agents that require increased security in relation to external influences, since a potential attack on them has the most negative consequences for the entire connection, which emphasizes the practical significance of the result.

Conclusion. The developed technique is practically significant and can be used to assess the information security or integrity of a network of any nature, represented as a directed graph.
Invariants in problems of pattern recognition and control of states of complex objects
Authors: Melekhin V. B. , Khachumov V. M. , Khachumov M. V.
Published: August 2022

Objective. The aim of the study is to build emulators of the main sensors of a small spacecraft (SC).

Method. The quality of recovery is determined by the standard deviation (RMS) of the data from the standards. The study is based on the application of the dynamic programming method.

Result. A review of works in the field of application of stable characteristics - invariants, in the applied areas of pattern recognition and state control of complex technical systems is carried out. A method aimed at identifying failures and building small spacecraft sensor emulators based on the analysis of stable indicators: correlation and covariance coefficients is proposed and tested. The proposed approach makes it possible to increase the overall reliability of the information-measuring system of a small spacecraft (SC). In the future, to emulate a failed sensor, it is planned to use multiple correlation of time sequences.

Conclusion. In the general case, recognition is reduced to comparing the graph structures of objects to the correct matching of hierarchical image models based on various invariants. Control of the states of complex systems is based on the use of stable characteristics that act as invariant or subinvariant descriptors. Invariants in various applications help to recognize the current situation with a sufficient degree of accuracy, usually reducing the dimension of the problem.
Review of the Carbon Management Strategies of Retail Industry in Energy Consumption and the Whole Value-Chain of the Product - A Case Study of Auchan Holding
Authors: Shrader-Frechette Kristin
Published: August 2022

Scientific data are almost nonexistent regarding the health-protectiveness of most hazardous-waste-site remediation. Given this data-gap, recently the World Health Organization (WHO) urged scientists to develop methods of “cost-efficient health surveillance” of toxics’ cleanups, including any “illegal operations”. Following WHO, this article’s importance is to develop one such cost-efficient method. Given the assumption that remediators’-redevelopers’ public misrepresentations of their cleanups’ safety may warrant independently assessing the health-adequacy of their remediation, the article asks the question: “For US hazardous-waste sites, deemed by the courts ‘Imminent and Substantial Endangerment’ (ISE) health threats, are remediators’ public representations of testing-cleanup quality consistent with what their more private technical documents say?” The working hypothesis is that for representative toxic sites, remediators’-redevelopers’ public representations of cleanup often contradict their private technical documents. Using the US Environmental Protection Agency (EPA) weight-of-evidence method, the article (1) develops 5 transparent, reproducible criteria for discovering representative, ISE-designated, US toxic-waste sites; (2) develops 3 transparent, reproducible criteria to discover remediators’-redevelopers’ public representations of their testing-cleanup; (3) uses these 3 criteria to discover what remediators’-redevelopers’ private or technical documents say about the health-adequacy of their testing/cleanup; (4) investigates whether any public representations in (2) contradict any of (3)’s private or technical documents; and (5) discusses the degree to which such contradictions, if any, suggest waste-site threats to health or environmental justice. Our results show that for the representative hazardous sites assessed, many remediator-redeveloper public guarantees of testing-cleanup quality contradict their private or technical documents. The discussion suggests that such contradictions likely violate EPA scientific-integrity regulations, threaten public health, jeopardize environmental justice, thus may require independent investigation of the adequacy of testing-cleanup. For representative, US toxic-waste sites, posing court-determined ISE, remediators’-developers’ public representations of testing-cleanup quality threaten health by often contradicting their private technical documents. The article closes by outlining two scientific strategies to promote health-protective, hazardous-waste testing/remediation.
Patients’ and Health Care Providers’ Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study
Authors: Khusial Rishi , van Koppen Sophia , Honkoop Persijn , Rijssenbeek-Nouwens Lucia , Fieten Karin Berthine , Keij Sascha , Drijver-Messelink Marieke , Sont Jacob
Published: August 2022

Background

Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users.

Objective

In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers.

Methods

In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT.

Results

In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients).

Conclusions

Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users.
Collaborative Challenges of Multi-Cohort Projects in Pharmacogenetics—Why Time Is Essential for Meaningful Collaborations
Authors: Franchini Filippo , Kusejko Katharina , Marzolini Catia , Tellenbach Christoph , Rossi Simona , Stampf Susanne , Koller Michael , Stoyanov Jivko , Möller Burkhard , Leichtle Alexander Benedikt
Published: August 2022

Multi-cohort projects in medicine provide an opportunity to investigate scientific questions beyond the boundaries of a single institution and endeavor to increase the sample size for obtaining more reliable results. However, the complications of these kinds of collaborations arise during management, with many administrative hurdles. Hands-on approaches and lessons learned from previous collaborations provide solutions for optimized collaboration models. Here, we use our experience in running PGX-link, a Swiss multi-cohort project, to show the strategy we used to tackle different challenges from project setup to obtaining the relevant permits, including ethics approval. We set PGX-link in an international context because our struggles were similar to those encountered during the SYNCHROS (SYNergies for Cohorts in Health: integrating the ROle of all Stakeholders) project. We provide ad hoc solutions for cohorts, general project management strategies, and suggestions for unified protocols between cohorts that would ease current management hurdles. Project managers are not necessarily familiar with medical projects, and even if they are, they are not aware of the intricacies behind decision-making and consequently, of the time needed to set up multi-cohort collaborations. This paper is meant to be a brief overview of what we experienced with our multi-cohort project and provides the necessary practices for future managers.
Digital Health Care Industry Ecosystem: Network Analysis
Authors: Park Yoonseo , Park Sewon , Lee Munjae
Published: August 2022

Background

As the need for digital health care based on mobile devices is increasing, with the rapid development of digital technologies, especially in the face of the COVID-19 pandemic, gaining a better understanding of the industrial structure is needed to activate the use of digital health care.

Objective

The aim of this study was to suggest measures to revitalize the digital health care industry by deriving the stakeholders and major issues with respect to the ecosystem of the industry.

Methods

A total of 1822 newspaper articles were collected using Big Kings, a big data system for news, for a limited period from 2016 to August 2021, when the mobile health care project was promoted in Korea centered on public health centers. The R and NetMiner programs were used for network analysis.

Results

The Korean government and the Ministry of Health and Welfare showed the highest centrality and appeared as major stakeholders, and their common major issues were “reviewing the introduction of telemedicine,” “concerns about bankruptcy of local clinics,” and “building an integrated platform for precision medicine.” In addition, the major stakeholders of medical institutions and companies were Seoul National University Hospital, Kangbuk Samsung Hospital, Ajou University Hospital, Samsung, and Vuno Inc.

Conclusions

This analysis confirmed that the issues related to digital health care are largely composed of telemedicine, data, and health care business. For digital health care to develop as a national innovative growth engine and to be institutionalized, the development of a digital health care fee model that can improve the regulatory system and the cost-effectiveness of patient care, centering on the Ministry of Health and Welfare as a key stakeholder, is essential.
Ranolazine Versus Allopurinol for Eligible Symptomatic Patients With a History of Angioplasty: Comparative Efficacy Study
Authors: Rahmani Reza , Moradi Farsani Ehsan , Bahrami Sima
Published: August 2022

Background

Recurrent angina, which is defined as a return of chest pain or chest discomfort, occurs in many patients undergoing coronary interventions.

Objective

This study aims to compare the antianginal efficacy of ranolazine versus allopurinol for eligible symptomatic patients with a history of angioplasty.

Methods

A total of 62 eligible symptomatic patients with a history of angioplasty were randomly allocated into two groups. For group A, 300 mg of allopurinol was administered twice daily, while for group B, 1000 mg of ranolazine daily was prescribed for a duration of 4 weeks. An initial screening visit was done for all participants where patients’ medical history was recorded and a physical examination was given; electrocardiography, blood pressure, and heart rate measurements were done as well. The patients were also given a blood and exercise test. At the end of the medication period, participants were revisited, and the tests were done again. All the required data were collected via a researcher-made form, and data analysis was conducted using SPSS. The study was approved by a formal ethics committee.

Results

The mean age of participants in the two groups (A and B) was 57.36 (SD 8.36) and 60.27 (SD 9.17) years, respectively. Among the 62 patients, 34 (59%) were men, while 28 (41%) were women. Creatinine, fasting blood sugar, C-reactive protein, N-terminal prohormone of brain natriuretic protein, uric acid, white blood cell, and hemoglobin levels of participants were not significantly different between groups (P>.05). Both allopurinol and ranolazine increased the total exercise time and decreased the ST depression of the patients. Additionally, they both improved the chest pain severity and Duke Treadmill Score of patients. At the same time, ranolazine had a statistically greater effect on ST depression reduction (mean 2.64, SD 0.74 vs mean 1.57, SD 0.49), while allopurinol showed better efficacy in reducing chest pain severity (mean 1.86, SD 0.37 vs mean 0.59, SD 0.21) and the Duke Treadmill Score (mean –14.77, SD 3.65 vs mean –6.88, SD 1.93).

Conclusions

Based on the results, the antianginal efficacy of allopurinol and ranolazine was approved but with different effects on ST depression, chest pain severity, and the Duke Treadmill Score. Therefore, the precise differences in their effects need to be explored further.
The Effects of Virtual Reality Tele-exergaming on Cardiometabolic Indicators of Health Among Youth With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial
Authors: Lai Byron , Davis Drew , Young Raven , Kimani-Swanson Erin , Wozow Cynthia , Wen Huacong , Kim Yumi , Wilroy Jereme , Rimmer James
Published: August 2022

Background

Youth with cerebral palsy do not have enjoyable, accessible, and scalable exercise options that can empower them to independently maintain their cardiometabolic health.

Objective

The primary aim is to examine the preliminary efficacy of a 12-week home-based virtual reality tele-exergaming intervention on several indicators of cardiometabolic health in youth with cerebral palsy compared to the wait list control. A secondary aim is to describe feasibility metrics, namely, recruitment, retention, and adherence rates; perceived enjoyment; intervention safety; and management issues. The tertiary aim is to generate a theory that reveals critical behavioral mechanisms of adherence to tele-exergaming.

Methods

In this parallel group design randomized controlled trial, 34 inactive youths with cerebral palsy are randomly allocated to one of two groups: a group that immediately receives 12 weeks of virtual reality exergaming with tele–physical education or a wait list control group that undergoes their habitual activity for 12 weeks. Participants are recruited from a Children’s Hospital and community network. At baseline (week 0), week 6, and week 12, high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, cholesterol, and pressure are measured by the youth and a caregiver at home using a blood spot test kit and blood pressure cuff. They will also self-measure their lung function and body weight using a peak flow meter and bathroom scale, respectively. Collections are supervised by research staff via videoconference. Changes in outcomes are compared between and within groups using exploratory statistical analyses and descriptive statistics. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underly participation.

Results

Recruitment procedures started in June 2022. All data are expected to be collected by October 2023. Full trial results are expected to be published by February 2024. Secondary analyses of data will be subsequently published.

Conclusions

This trial tests an innovative serious exergaming virtual reality program that includes a completely remote enrollment, assessment, and intervention tele-protocol. The knowledge obtained will inform the development of a larger effectiveness trial for improving the health and well-being of youth with cerebral palsy.

Trial Registration

ClinicalTrials.gov NCT05336227; https://clinicaltrials.gov/ct2/show/NCT05336227

International Registered Report Identifier (IRRID)

PRR1-10.2196/40708
Keeping Telehealth an Equalizer in the Age of COVID-19
Authors: Marcin James
Published: August 2022

Background

Telehealth has historically been used to increase access to care for marginalized populations living in rural and underserved communities and those who require frequent medical care. Video visits have been used to address distance barriers for routine and specialty care, and remote patient monitoring has been used to help those with chronic medical conditions. However, following the COVID-19 pandemic, telehealth has become standard and is less likely to be used by the populations who could benefit most from its use.

Objective

This review aimed to evaluate whether telemedicine use is lower among patients without insurance, racial/ethnic minority individuals, and non–English-speaking patients.

Methods

From reviews of the literature and US data, comparisons of telehealth use between different populations were conducted. Utilization rates were compared between racial/ethnic groups (Black, Asian, and White; Hispanic and non-Hispanic) and among different telehealth use cases: on-demand, direct-to-consumer care; scheduled ambulatory video visits; and remote patient monitoring applications.

Results

Among telehealth users in the United States, the highest share of visits that used video services occurred among young adults aged 18-24 years (72.5%), those earning at least US $100,000 (68.8%), those with private insurance (65.9%), and White individuals (61.9%). Video telehealth rates were lowest among those without a high school diploma (38.1%); adults aged ≥65 years (43.5%); and Hispanic (50.7%), Asian (51.3%), and Black individuals (53.6%).

Conclusions

Telehealth use increased dramatically during the COVID-19 pandemic, but research suggests that access to telehealth was not equitable across different population subgroups. Following the pandemic, the use of telehealth has gone from a tool that was used to primarily address barriers in access among minority populations to a model of care that serves those who are better insured, English-speaking, and White. Interventions to address inequities involve payment policies, ambulatory operations, and investments in making telehealth more accessible by underserved populations.
International Collaboration to Develop a Remote Monitoring Web Application for COVID-19 Patients in Armenia Using an Agile Methodology (Preprint)
Authors: Sikder Abu , Dickhoner James , Kysh Lynn , Musheghyan Lusine , Shekerdimian Shant , Levine Barry , Espinoza Juan
Published: August 2022

BACKGROUND

Coronavirus disease 2019 (COVID-19) has led to over 500 million cases and 6.2 million deaths around the world. Low and middle income countries (LMICs) like Armenia have faced unique infrastructure, financial, and capacity challenges that in many cases resulted in worse outcomes. Healthcare facilities across Armenia experienced a shortage of resources including hospital beds and oxygen which was further exacerbated by the war with neighboring Azerbaijan. Without a framework for home-based care, healthcare facilities were severely strained by COVID-19 patients who had prolonged oxygen requirements but were otherwise clinically stable.

OBJECTIVE

This paper describes our approach to establishing an international collaboration to develop a web application to support home monitoring for patients with COVID-19 with persistent oxygen requirement.

METHODS

The app was developed using a rapid, coordinated, and collaborative approach involving an international group of clinicians, developers, and collaborators. Health screening, monitoring, and discharge forms were developed into a lightweight OpenMRS web-app and customized for the local Armenian context.

RESULTS

The software was designed and developed over 2 months using human centered design and agile sprints. Once live, 5,022 patient records were created for 439 unique patients.

CONCLUSIONS

This project suggests a promising framework for designing and implementing remote monitoring programs in LMICs despite pandemic and geopolitical challenges.
Mental health-related healthcare utilization and psychotropic drug dispensation trends in British Columbia during the COVID-19 pandemic: Observational Study (Preprint)
Authors: Zandy Moe , ElKurdi Sylvia , Samji Hasina , McKee Geoff , Dheri Aman , Smolina Kate
Published: August 2022

BACKGROUND

The impact of the coronavirus disease (COVID-19) pandemic on mental health of the population is important for informing public health policy and decision-making. However, there is limited information on trends in mental health-related healthcare service utilization during the pandemic.

OBJECTIVE

This study aimed to describe patterns of mental health-related healthcare service utilisation and psychotropic drug dispensations in British Columbia, Canada, during the COVID-19 pandemic compared to a pre-pandemic period. We explored trajectories of use across multiple data sources to determine whether the patterns were similar or different in acute and outpatient settings, and how these patterns differed by age, sex and type of condition.

METHODS

We conducted a population-based study using administrative health data to capture outpatient physician visits, emergency department visits, hospital admissions, and psychotropic drug dispensations. We examined time trends of mental health-related healthcare utilisation and psychotropic drug dispensations between January 2019 and December 2021. We calculated age-standardised rates and rate ratios to compare healthcare service utilisation before and during the COVID-19 pandemic and stratified by year, sex, age and condition.

RESULTS

Results: In April 2020, compared to the same period in 2019, we observed a 26% and 16% decrease in acute care visits for mental health-related emergency department visits and hospital admissions, respectively. By late 2020, with the exception of emergency department visits, healthcare service utilisation recovered to pre-pandemic (2019) levels. In 2021, overall mental health-related healthcare service utilisation increased to above pre-pandemic levels, with an increase in the monthly average rate of 22% for outpatient physician visits only and not in other datasets. However, notable and statistically significant increases in healthcare utilisation were observed across all data sources among 10-14 year olds (45% in outpatient physician visits, 31% in emergency department visits, 55% in hospital admissions, and 36% in psychotropic drug dispensations), and 15-19 year olds (51% in outpatient physician visits, 19% in emergency department visits, 13% in hospital admissions, and 39% in psychotropic drug dispensations). Increases were more prominent among females than males, but there was some variation for specific mental health-related conditions.

CONCLUSIONS

The increase in mental health-related healthcare utilisation and psychotropic drug dispensations in 2020 and 2021 likely reflects important societal consequences of both the pandemic itself and the associated measures. Recovery efforts in British Columbia should take these findings into consideration, especially among most affected sub-populations, such as adolescents.

CLINICALTRIAL

Not applicable.
Games in Times of a Pandemic: Structured Overview of COVID-19 Serious Games (Preprint)
Authors: Kermavnar Tjaša , Visch Valentijn T , Desmet Pieter M A
Published: August 2022

BACKGROUND

The COVID-19 pandemic introduced an urgent need for effective strategies to disseminate crucial knowledge and improve people’s subjective well-being. Complementing more conventional approaches to knowledge dissemination, game-based interventions were developed to create awareness and educate people about the pandemic, hoping to change their attitudes and behavior.

OBJECTIVE

This study provided an overview and analysis of digital and analog game-based interventions in the context of the COVID-19 pandemic. As major pandemics and other large-scale disruptive events are expected to increase in frequency in the coming decades, this analysis aimed to inform the design, uptake, and effects of similar future interventions.

METHODS

From November 2021 to April 2022, Scopus, Google, and YouTube were searched for articles and videos describing COVID-19–themed game-based interventions. Information regarding authorship, year of development or launch, country of origin, license, deployment, genre or type, target audience, player interaction, in-game goal, and intended transfer effects was extracted. Information regarding intervention effectiveness was retrieved where possible.

RESULTS

A diverse assortment of 23 analog and 43 digital serious games was identified, approximately one-third of them (25/66, 38%) through scientific articles. Most of these games were developed by research institutions in 2020 (13/66, 20%) and originated in Europe and North America (38/66, 58%). A limited number (20/66, 30%) were tested on relatively small samples, using a diversity of research methods to assess the potential changes in participants’ knowledge, attitudes, and behaviors as well as their gameplay experience. Although most of the evaluated games (11/20, 55%) effectively engaged and motivated the players, increased awareness, and improved their understanding of COVID-19–related issues, the games’ success in influencing people’s behavior was often unclear or limited.

CONCLUSIONS

To increase the impact of similar future interventions aimed at disseminating knowledge and influencing people’s attitudes and behaviors during a large-scale crisis, some considerations are suggested. On the basis of the study results and informed by existing game theories, recommendations are made in relation to game development, deployment, and distribution; game users, design, and use; game design terminology; and effectiveness testing for serious games.
Understanding Digital Mental Health Needs and Usage with an AI-led Mental Health App (Wysa) during the COVID-19 Pandemic: Retrospective Analysis (Preprint)
Authors: Sinha Chaitali , Meheli Saha , Kadaba Madhura
Published: August 2022

BACKGROUND

There has been a surge in mental health concerns during the pandemic, which has prompted increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to answer these questions through the analysis of real world data collected from users of a digital mental health app (Wysa) around their engagement patterns and behaviors as shown by their usage of the service.

OBJECTIVE

This study aimed: (1) To examine the relationship between mental health distress, digital health uptake and COVID-19 case numbers (2) to evaluate engagement patterns with the app during the study period (3) to examine the efficacy of the app in improving mental health outcomes for its users during the pandemic.

METHODS

The study used a retrospective observational design. During COVID-19, the app’s installations and emotional utterances were measured during March 2020 to October 2021, for the United Kingdom, United States of America and India and mapped against COVID-19 case numbers and their peaks. The engagement of the users in this period (N= 4541) with the Wysa app was compared to equivalent samples of users from a pre-COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (N=2061) and anxiety (N= 1995) on PHQ-9 and GAD-7 test measures.

RESULTS

Findings demonstrate a significant positive correlation between the increase in installs of mental health app Wysa and the peaks of COVID-19 case numbers in UK (P=.018) and India (P=.0001). Findings indicate that users during the COVID period had a significantly higher degree of engagement than the pre-COVID period, with a medium to large effect size for 80% of these samples observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with medium effect size (P= 0.569 for PHQ-9 and P=0.562 for GAD-7).

CONCLUSIONS

This study demonstrated that emotional distress increased substantially during the pandemic prompting increased uptake of an AI led mental health app Wysa, and also offered evidence that the app Wysa could support its users and lead to a significant reduction in symptoms of anxiety and depression. The study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care.

CLINICALTRIAL