bluuebunny/crossref_metadata_2025 huggingface dataset:
The Food Aspect of the Daily Life of Logging Workers of the Volga Region during the Years of Pre-war Modernization
Authors:   Penza State University, Voeikov Evgeny V.
Published: April 2024

The issues of nutrition and food security comprise an important part in the scholarship on the history of everyday life. This article addresses this topic with regard to logging workers of the forest trusts of the Middle Volga region in comparison with all-Union trends. The territorial framework includes the modern regions of Penza, Samara, Ulianovsk, and the Republic of Mordovia. The article shows the dynamics of solving the food problem in the region. The food shortage in logging camps was most acute in 1930–1931. With the creation of a food supply system for forest workers, the unresolved issues in the second half of the 1930s were the production of low-quality bread and interruptions in the supply of flour, pasta, sugar, and other food products to individual forest posts. The author of the article for the first time introduces into the scholarship quantitative indicators of the presence of shopping units and bakeries in the logging camps of the Kuibyshev region and the Autonomous Soviet Socialist Republic of Mordovia in the third five-year plan. The article also analyses the degree of food provision of timber farms of forestry trusts. In the Middle Volga region, food supply in the third five-year plan was best established in the “Sredles” trust of the People’s Commissariat of Heavy Industry. In the “Kuibyshevles” system of the People’s Commissariat of Forestry, the forest camps were provided with shopping units and bakeries to an insufficient extent. The food problem was exacerbated by organizational deficiencies in the trading system.
A Belarusian Trace in the Murder of Voikov in Historiography and New Sources
Authors:   Brest State A. S. Pushkin University, Savich Aleksandr A.
Published: April 2024

The article examines how the assassination of the Soviet ambassador to Poland P. Voikov in Warsaw on June 7, 1927 is reflected in the Belarusian historiography in the context of the Belarusian national liberation movement as part of interwar Poland. Currently, the widely known information about Voikov’s involvement in the murder of the royal family and the availability of unfavourable information about his character and diplomatic career have overshadowed the image of Voikov an ardent revolutionary and Soviet diplomat. Modern Belarusian authors view Voikov negatively as a person involved in the murder of the royal family, and as an unlucky, unscrupulous and unsuccessful diplomat. As far as the circumstances of Voikov’s assassination are concerned, Belarusian authors address the ethnicity and ideological and political beliefs of his killer, B. Koverda; they disagree with his interpretation as a Russian emigrant, a member of the White Guard and monarchist. There are opposing views regarding his commitment to the Belarusian revolutionary liberation ideals. The article presents the main motives of the murder of Voikov, including the version about the involvement of the Soviet special services in his elimination, which is confirmed by the archival documents identified by the author. Archival documents reveal the existence of contradictions within the community of representatives of Soviet political, diplomatic, and intelligence structures in Poland, which could also have led to the physical elimination of P. Voikov.
Unraveling the Mystery: Paraganglioma in the Urinary Bladder. A Case Report
Authors: Saud Iqbal  , Nadeem Bin Nusrat  , Nauman Zafar  , Assad ur Rehman  , Saira Imtiaz
Published: April 2024

The bladder paraganglioma, which makes up 0.06% of all bladder tumors, is a highly uncommon condition. A 30-year-old female patient who was diagnosed with bladder paragangliomas at our hospital. The study covers the patient's journey from the first clinical presentation to the follow-up after surgery, providing insight into this uncommon illness. Urinary bladder tumour shown on CT KUB. The case was established by a transurethral resection biopsy. In order to completely remove the tumour, the patient had a radical cystectomy along with a hysterectomy and a bilateral salpingo-oophorectomy. A tumour mostly seen in the detrusor muscle that is organised in zellbellen pattern and is bordered by pushing fibrovascular stroma. Upon CT follow-up at three and six months, the results were generally unremarkable in terms of margins, metastasis, and local recurrence. Urinary tract hyperplasia is the most typical sign in our instance of bladder paraganglioma, a very uncommon tumour. A tumour called a polypoid in the bladder's posterior wall suggests cancer. More investigation into this uncommon ailment is necessary, as surgical extraction is still the only treatment available to these people.
Evaluating Arterial Blood Gas Modifications Before and After Corticosteroid Intervention in Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Authors: Sami Ahmad  , Muhammad Sajjad Sarwar  , Ghazanfar Ali  , Saeed Rabia , Bushra Latif  , Kanwal Naeem
Published: April 2024

Background: Chronic Obstructive Pulmonary Disease (COPD), a prevalent and progressive respiratory disorder characterized by airflow limitation and chronic inflammation from prolonged exposure to harmful particles and gases, significantly affects patients' quality of life.
Objective: This study examines the impact of corticosteroid therapy on arterial blood gas (ABG) parameters in patients with acute exacerbations of COPD (AECOPD), evaluating ABG values before and after treatment to determine therapeutic effectiveness.
Methods: Conducted at Bahawal Victoria Hospital's Pulmonology Department from August 15, 2022, to January 15, 2023, this quasi-experimental study included 202 COPD patients meeting exacerbation criteria. Exclusions included severe systemic illness, unconsciousness, inability to clear airways, arterial blood pH < 7.26, hemodynamic instability, or cor-pulmonale. Patients consented to a 7-day regimen of nebulized corticosteroid (beclomethasone), with ABG parameters like PaO2, PaCO2, and pH measured before and after treatment. Data analysis was performed using SPSS Version 24.
Results: Treatment significantly increased mean PaO2 (from 58.78 to 69.41) and decreased mean PaCO2 (from 57.34 to 47.70), with notable improvements across age groups and genders and minimal side effects.
Conclusion: Nebulized corticosteroid therapy markedly improved arterial oxygenation and CO2 elimination in AECOPD patients, demonstrating efficacy and safety across demographics. These findings support nebulized corticosteroids as a viable alternative to systemic corticosteroids in AECOPD management.
A synergistic framework for dynamic water scarcity assessment: integrated blue and green water
Authors: Liu Jianwei , Pang Xiaoteng , Yan Xiaohui , Chen Xiaoqiang , Wang Mingwei , Ma Ruixue , Ma Liguo
Published: April 2024

Dynamic assessment of water scarcity utilising blue and green water can enhance water resource management. The traditional water scarcity assessment mainly considers blue water, ignoring green water, for static evaluation. The improvement objective of this study is dynamically quantifying water scarcity, integrated blue and green water. This study proposed a framework to present an overview of water scarcity within multiple indicators and pinpoint water-stressed areas within an ever-changing process. The framework is based on the theorem of mutual change of quality and quantity to assess the spatiotemporal variability of blue and green water availability and to quantify water scarcity in watersheds. A case study was carried out in Taoer River Basin, a semiarid region of China, to demonstrate the use of the framework. The anthropogenic elements (such as water demand) and natural conditions were combined to quantify water scarcity, as measured by blue and green water scarcity indices. This study also analysed the variation of water scarcity on different spatiotemporal scales. The findings demonstrate that severe water scarcity has been occurring downstream with a tendency towards upstream of the watershed. Collectively, this study provides a useful tool for dynamic water scarcity assessment, helping develop policies to promote sustainable development.
Prioritization of strategies for urban water circular economy using water circularity indicator
Authors: Kakwani Nikita S. , Kalbar Pradip P.
Published: April 2024

Global water scarcity is aggravating with increasing urbanization and inappropriate urban water management. Implementing Circular Economy (CE) strategies in the water sector followed by their assessment can prove to be beneficial. Recently, the Water Circularity Indicator (WCI) has been developed to measure, monitor, improve and promote urban water circularity using the 5Rs (Reduce, Reuse, Recycle, Reclaim, Restore). Apprehending the role and scope of each strategy is crucial while planning future water infrastructure, as each strategy has inherent advantages and limitations in application. This study aims to facilitate decision-makers with an approach to prioritize 5Rs CE strategies, which will be helpful in the efficient allocation of funds and resources related to water infrastructure. A methodology is proposed to prioritize and weigh 5Rs based on the effort required to fulfill the application of each strategy. Using weights assigned to each R, WCI is improved to WCI-2.0 and is evaluated for the region under the jurisdiction of Pimpri-Chinchwad Municipal Corporation. The results from WCI-2.0 suggest which strategy to focus on out of the 5Rs to accelerate water circularity and effective infrastructure planning. Benchmarking of WCI-2.0 and its use to propose policies supporting urban water balance has the potential to change the prospects of the water sector.
Bioactive Components in Senna Alata L. Roxb
Authors: Pamulaparthi Archana , Prathap Vamshi Ramana , Nanna Ramaswamy
Published: April 2024

Senna alata is an ethnomedicinal plant. The crude extracts of the plants are
said to have a large number of medicinal properties due to their phytochemicals. In the
present study, we made an attempt to isolate and screen the phytochemical constituents
present in the species. In order to determine the bioactive constituents present in S.
alata, and the effect of drying on the loss of bioactive constituents, studies on a set of
pharmacognostical parameters were conducted on seeds, shade and sun-dried leaves of
S. alata as per US pharmacopeia and WHO guidelines. The results of the present
studies showed the presence of various important bioactive molecules that are
responsible for the medicinal properties of the species. The phytochemical analysis of
seed extracts revealed the presence of alkaloids, flavonoids, tannins, saponins,
anthraquinones, resins and glycosides in all the extracts, while coumarins, phenols,
terpenoids, phlobatannins and quinines are completely absent in all the seed extracts.
Preliminary phytochemical investigations from shade and sun-dried leaf extracts
showed alkaloids, flavonoids, anthraquinones, saponins, glycosides and tannins in high
amounts in all the extracts, resins and phenols are present in moderate amounts.
Terpenoids and phlobatannins are present only in fresh leaf extracts. Studies were also
conducted on the physicochemical and organoleptic properties of leaves of S. alata that
help in the identification and standardization of the leaf extracts for manufacturing of
plant-based drugs of S. alata.
In Vitro Propagation and Phytochemical Screening of Some Important Medicinal Plants of Northern India-A Review
Authors: Lone Rafiq , Mochi Shakir Ahmad , Hajam Younis Ahmad , Khurshid Ibraq , Kamili Azra N.
Published: April 2024

Plants are indispensable for the preservation of human life. They supply us
with oxygen, food, fuel, and shelter while also holding a crucial role in disease
treatment, such as cancer, diabetes, and tumors. Medicinal plants are harnessed across
various cultures and nations as medicinal precursors. In today's era, biotechnological
methods like tissue culture are vital for selecting, multiplying, and conserving
medicinal plant genotypes. Regeneration under in vitro conditions notably enhances the
production of high-quality plant-based medicines. Plant tissue culture techniques offer
a unified approach for producing standardized phytopharmaceuticals, yielding
consistent plant material for physiological characterization and active phytoconstituent
assessment. While many medicinal plants are successfully regenerated under in vitro
conditions, there are certain species that continue to be cultivated in soil, with their
large-scale development through micropropagation remaining uncommon. The
micropropagation technique employed for cloning these medicinal plants involves the
utilization of various concentrations of plant growth regulators within a media variant
(MS 1962). The process of plant regeneration is achieved through both organogenesis
and embryogenesis, facilitated by the supplementation of auxins and cytokinins. In this
context, this chapter provides a concise overview of the integrated micropropagation
culture system designed for the effective propagation of medicinally significant
specimens.
Plant Tissue Culture: A Perpetual Source for the Production of Therapeutic Compounds from Rhubarb
Authors: Pandith Shahzad A. , Khan Mohd. Ishfaq
Published: April 2024

Plants are interesting natural resources that have had a close association with mankind since their existence. Their utility ranges from simple food, fodder, varied commercial and industrial products, and above all, as efficacious medical agents to cure various human health ailments. Amongst this vast reservoir of natural economical wealth, Rhubarb (Rheum Linn; Family: Polygonaceae), a perennial herb represented by about 60 extant species occurring across Asian (mostly restricted to China) and European countries, is one of the oldest and best-known medicinal plant species which finds extensive use in different traditional medical systems. Over the past several decades, and owing to the pharmacological efficacy of Rhubarb, the plant species has been subjected to different natural and anthropogenic pressures in the regions of its occurrence, rendering it threatened. In this context, the present chapter provides the basic account of Rhubarb while giving a gist of its therapeutic potential vis-à-vis major bio-active secondary chemical constituents. Additionally, the focus has been given to the in vitro production system of this wondrous drug for its sustainable conservation and meticulous utilization while highlighting various attributes of the technique of tissue culture such as somatic embryogenesis, cell suspension cultures, hairy roots, etc. , as projected potential approaches for desirable benefits from the genus Rheum.
Meer openbare ruimte voor Munchen?
Authors: Schmidt Mareike
Published: April 2024

Bij het testen van autoreducerende maatregelen ter verbetering van de leefbaarheid in twee wijken in München ontstond een emotioneel debat onder de buurtbewoners. Hoe kan men grote controverses vermijden bij tijdelijke projecten die steden ruimte bieden voor experiment?
Innovative Mosque Management Activities for Income Generation and Community Inclusion
Authors: Ismail Zuraidah , Hashim Rugayah , Mohd Aminudin Zaidi , Saidon Janiffa , Zainudin Ahmad Zuhairi
Published: April 2024

Mosques play an important role in Malaysia’s moslem communities. However, mosque management and upkeep depend on the committee members, location and the surrounding community. The paper aims at showcasing the innovative management strategies for income generation effectiveness in organizing community engagement activities towards poverty alleviation and inclusion in their qaryah or locality. These qaryah mosques are situated in the states of Perak and Negeri Sembilan, Malaysia. Through a qualitative design study, the findings from this project will describe and discuss the mosques’ management and strategies for continuity in ensuring income generation for the stakeholders’ wellbeing and sustainability.
Non-Governmental Organizations (NGOs) Perspective on The Use of Sukuk for Humanitarian Initiatives
Authors: Kamarul Bahrin Nurul Fathiyah , Muhamat Amirul Afif , Abdul Karim Norzitah , Jaafar Mohamad Nizam , Zainol Nurul Najihah
Published: April 2024

The matter of inadequate financial resources for humanitarian missions has provoked a significant discourse on a global scale. The current capacity for aid is insufficient to adequately address the escalating demand, and there is growing interest in the use of sukuk, also known as Islamic bonds, as a potential new instrument for humanitarian financing. This study provides preliminary findings (from a bigger research project) based on an interview with three key informants affiliated with a non-governmental organization (NGOs) in Malaysia. While acknowledging the limitations of a small sample size, this study offers valuable insights that can inform future research endeavors.
Potentials of Blockchain for Claim Management of Islamic Insurance (Takaful) Operators in Malaysia
Authors: Ibrahim Nur Izzati , Muhamat Amirul Afif , Abdul Karim Norzitah Abdul Karim , Jaafar Mohamad Nizam
Published: April 2024

As a result of its rapid rate of change, the takaful industry is now one of the most exciting industries in the digital era. Emerging technologies and innovations are now a means of streamlining and simplifying the current system. Blockchain technology has also piqued the industry's interest in innovations that enhance how takaful is traditionally assembled, purchased, and experienced. Therefore, this paper aims to investigate the potential for implementing blockchain technology in claim processing in Malaysia's takaful industry, where innovation is believed to serve the takaful participants as the primary beneficiaries and the takaful operators to a greater height
A Comparative Analysis on Islamic Bank Performance and Efficiency Risk: Pre and Post IFSA 2013
Authors: Haris Balkis , Abd Rahman Badrul Hisham , Sahudin Zahariah , Osman Ismah
Published: April 2024

It is recognized that performance of the banking industry has an impact to the economic growth of a developed economies. The performance of the bank may impact the growth of the economy, as profits may shape the customers’ decision on investments and savings. Regulation affecting the design of banking governance structure; hence, it plays a vital role in determination of banking industry performance. IFSA 2013 was established to promote financial stability and compliance to Shariah and further strengthen the regulation of Islamic financial institutions. This paper aims to examine whether IFSA 2013, bank’s risk-taking behavior and efficiency will enhance or impede performance of Islamic banks in Malaysia.
Capital Decision of Islamic Banks in Developing Countries
Authors: Rokeman Nur Syahirah , Ahmad Wahida
Published: April 2024

The study investigates capital decisions of Islamic banks in developing countries. The study uses 96 Islamic banks in developing countries from period of 2007 to 2021. By applying the random effect model with cluster regression, the findings reveal that all variables are found to be negatively correlated with the capital buffer. The results recommend regulators in developing countries to ensure Islamic banks maintain consistent capital ratios at all times to address the moral hazard issue that is apparent in larger banks. In response to economic cycles, Islamic banks are also encouraged to manage their capital buffers in a counter-cyclical manner.
Role of Parasocial Interaction and Credibility in Beauty Influencer to Improve Purchase Intention
Authors: Purnamaningsih Purnamaningsih , Choirisa Septi Fahmi , Rizkalla Nosica , Lestari Elissa Dwi
Published: April 2024

Beauty brand owners are trying to increase the sales growth rate, which has been unstable due to the COVID-19 pandemic. This study explores the intention to purchase beauty products through the role of beauty influencers by examining parasocial interaction and credibility factors. Eight hypotheses were tested and analyzed using a structural equation model. The study showed that parasocial interaction and credibility positively impact purchase intention. Meanwhile, only social attractiveness influences parasocial interaction, while physical and social attractiveness affects credibility.
Issues and Challenges of Optimizing Production Rate during COVID-19: A case study on an electronic equipment manufacturer in Malaysia
Authors: Haizan Mohd Hazril , Shariff Siti Halijjah , Nik Hassan Nik Muhamad Nor , Khalip4 Eldina
Published: April 2024

This study helps assess the issues and challenges that affect the rate of production and process and proposes an operational strategy to optimise the production rate at an electronic equipment manufacturer in Malaysia. The study was qualitative research, and the information gathered was analysed using the Ishikawa Diagram to find the most prominent issue affecting their production rate. Two main factors were found to have the most impact on the production rate, namely manpower and material issues. This study suggests the need for manpower reallocation and alternative suppliers to mitigate the problems faced by the company.
Blockchain Revolutionizing Supply Chain Management: A bibliometric review of emerging research trends and challenges
Authors: Hassam Siti Fairuza , Talip Adila , Jamaludin Mohd Fazil , Antara Purnomo M
Published: April 2024

Blockchain technology has garnered substantial attention for promoting sustainability in economic, social, and environmental domains. This study employs a knowledge-based visualization approach to present an extensive review of blockchain-based supply chains. Examining 1276 articles from Scopus databases between 2016 and December 2022, the research utilizes bibliometric analysis and statistical techniques for data analysis. Notably, China and the United States lead the field, investigating the integration of blockchain with emerging technologies for applications in supply chain management, finance, intellectual property, digital currency, and transaction costs. This study provides a comprehensive overview, guiding future research in blockchain within management and economics.
Exploring the Influence of Organizational Culture, Organisational Structure and Pay Structure on Career Progression for Women in the Tech Industry
Authors: Ramli Suriana , Shaari Noremi , Rosnan Herwina , Mat Nor Norzanah
Published: April 2024

Women's career progression in the tech industry is stagnant, which causes concern about the opportunities for women in this sector. This study explores the complex relationship between organisational culture, structure, and pay in shaping the progression of women's careers. The proposed conceptual framework illustrates the significant factors in promoting inclusive environments to facilitate women's professional development. The glass ceiling theory explains the systemic organisational obstacles that prevent women from advancing inside organisations. The results emphasise that organisations and policymakers need to tackle these barriers to promoting gender equality and establishing conditions that support women's success and economic empowerment.
An Overview of Information Overload, System Feature Overload, Social Overload and Communication Overload
Authors: Noor Azri Muhammad Danish , Abdull Malek Siti Nadia Nadirah , Tuan Besar Tuan Badrol Hisham
Published: April 2024

Social media has faced difficulties in recent years due to users ceasing to use them, but little is known about the relationships between the various aspects of overload and how this negatively impacts users' social media exhaustion. Additionally, it described social media overload as a multidimensional construct made up of four types of overloads: information overload, system feature overload, social overload and communication overload. This investigation will be conducted among Malaysian Facebook users through online surveying techniques along with a quantitative approach with the sample size of 74 using non-probability sampling approaches then will be analysed using the IBM SPSS.
Effect of Digital Early Warning Scores on Hospital Vital Sign Observation Protocol Adherence: Stepped-Wedge Evaluation
Authors: Wong David Chi-Wai , Bonnici Timothy , Gerry Stephen , Birks Jacqueline , Watkinson Peter J
Published: April 2024

Background

Early warning scores (EWS) are routinely used in hospitals to assess a patient’s risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed.

Objective

This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention.

Methods

We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient’s first elevated EWS (EWS ≥3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey.

Results

We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73).

Conclusions

We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes.
Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System (Preprint)
Authors: Palakshappa Jessica A , Hale Erica R , Brown Joshua D , Kittel Carol A , Dressler Emily , Rosenthal Gary E , Cutrona Sarah L , Foley Kristie L , Haines Emily R , Houston II Thomas K
Published: April 2024

BACKGROUND

Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic.

OBJECTIVE

This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges.

METHODS

A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations.

RESULTS

A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (“Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?”) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73).

CONCLUSIONS

During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.
An Empirical Evaluation of Prompting Strategies for Large Language Models in Zero-Shot Clinical Natural Language Processing: Algorithm Development and Validation Study (Preprint)
Authors: Sivarajkumar Sonish , Kelley Mark , Samolyk-Mazzanti Alyssa , Visweswaran Shyam , Wang Yanshan
Published: April 2024

BACKGROUND

Large language models (LLMs) have shown remarkable capabilities in natural language processing (NLP), especially in domains where labeled data are scarce or expensive, such as the clinical domain. However, to unlock the clinical knowledge hidden in these LLMs, we need to design effective prompts that can guide them to perform specific clinical NLP tasks without any task-specific training data. This is known as in-context learning, which is an art and science that requires understanding the strengths and weaknesses of different LLMs and prompt engineering approaches.

OBJECTIVE

The objective of this study is to assess the effectiveness of various prompt engineering techniques, including 2 newly introduced types—heuristic and ensemble prompts, for zero-shot and few-shot clinical information extraction using pretrained language models.

METHODS

This comprehensive experimental study evaluated different prompt types (simple prefix, simple cloze, chain of thought, anticipatory, heuristic, and ensemble) across 5 clinical NLP tasks: clinical sense disambiguation, biomedical evidence extraction, coreference resolution, medication status extraction, and medication attribute extraction. The performance of these prompts was assessed using 3 state-of-the-art language models: GPT-3.5 (OpenAI), Gemini (Google), and LLaMA-2 (Meta). The study contrasted zero-shot with few-shot prompting and explored the effectiveness of ensemble approaches.

RESULTS

The study revealed that task-specific prompt tailoring is vital for the high performance of LLMs for zero-shot clinical NLP. In clinical sense disambiguation, GPT-3.5 achieved an accuracy of 0.96 with heuristic prompts and 0.94 in biomedical evidence extraction. Heuristic prompts, alongside chain of thought prompts, were highly effective across tasks. Few-shot prompting improved performance in complex scenarios, and ensemble approaches capitalized on multiple prompt strengths. GPT-3.5 consistently outperformed Gemini and LLaMA-2 across tasks and prompt types.

CONCLUSIONS

This study provides a rigorous evaluation of prompt engineering methodologies and introduces innovative techniques for clinical information extraction, demonstrating the potential of in-context learning in the clinical domain. These findings offer clear guidelines for future prompt-based clinical NLP research, facilitating engagement by non-NLP experts in clinical NLP advancements. To the best of our knowledge, this is one of the first works on the empirical evaluation of different prompt engineering approaches for clinical NLP in this era of generative artificial intelligence, and we hope that it will inspire and inform future research in this area.
Insight inTo Stress and POOping on work TIME (ITS POO TIME): an online and cross-sectional study protocol (Preprint)
Authors: Tully Phillip , Cosh Suzanne , Wittert Gary , Martin Sean , Vincent Andrew , Mikocka-Walus Antonina , Turnbull Deborah
Published: April 2024

BACKGROUND

Long occupational work hours, paid or unpaid overtime, and shift work are a common component of the labor force in high, middle, and lower-income economies globally. Bowel movement frequency and stool form in occupational settings may be important markers of stressful working conditions as well as diurnal gut microbiota action, gastrointestinal discomfort, and disorders of gut-brain interaction (DGBI). Characterizing DGBI in shift and non-shift workers could help identify the impact of diurnal work patterns on worker’s physical and mental health, including anxiety related to bowel movements.

OBJECTIVE

The paper outlines the ITS POO TIME protocol describing a web-based multi-methods research project on DGBI, stool characteristics, psychological factors, sleep, diet and anxiety related to bowel movements in occupational settings.

METHODS

Study 1 comprises a web-based survey to acquire quantitative data from adults who are engaged in paid employment. We seek to assess occupational characteristics, organizational factors concerning toilets, as well as standardized questionnaires for stool form and frequency, DGBI assessed by Rome-IV criteria, sleep, diet, bowel movement anxiety (i.e. parcopresis), and distress. Study 2 is a qualitative study (Poo Story) which asks open-ended questions about respondents’ attitudes to defecation at work as well as patterns, behaviours, as well as strategies utilized to reduce anxiety or embarrassment.

RESULTS

The findings of ITS POO TIME will elicit important information on what factors are associated with bowel movements and stool types in occupational settings and identify associations pertinent to occupational health. Data collection commenced in January 2019 and finished enrolment in December 2023. Study 1 obtained 1872 responses, while Study 2 received 337 responses, and the primary results are expected to be published in 2024.

CONCLUSIONS

The results of the research described in this research protocol will have direct implications for industry, employers, and policy makers concerning DGBI, stress, and worker health.

CLINICALTRIAL

NA
The McMaster Health Information Research Unit: Over a Quarter-Century of Health Informatics Supporting Evidence-Based Medicine (Preprint)
Authors: Lokker Cynthia , McKibbon K Ann , Afzal Muhammad , Navarro Tamara , Linkins Lori-Ann , Haynes R Brian , Iorio Alfonso
Published: April 2024

UNSTRUCTURED

Evidence-based medicine (EBM) emerged from McMaster University in the 1980-1990s, which emphasizes the integration of the best research evidence with clinical expertise and patient values. The Health Information Research Unit (HiRU) was created at McMaster University in 1985 to support EBM. Early on, digital health informatics took the form of teaching clinicians how to search MEDLINE with modems and phone lines. Searching and retrieval of published articles were transformed as electronic platforms provided greater access to clinically relevant studies, systematic reviews, and clinical practice guidelines, with PubMed playing a pivotal role. In the early 2000s, the HiRU introduced Clinical Queries—validated search filters derived from the curated, gold-standard, human-appraised Hedges dataset—to enhance the precision of searches, allowing clinicians to hone their queries based on study design, population, and outcomes. Currently, almost 1 million articles are added to PubMed annually. To filter through this volume of heterogenous publications for clinically important articles, the HiRU team and other researchers have been applying classical machine learning, deep learning, and, increasingly, large language models (LLMs). These approaches are built upon the foundation of gold-standard annotated datasets and humans in the loop for active machine learning. In this viewpoint, we explore the evolution of health informatics in supporting evidence search and retrieval processes over the past 25+ years within the HiRU, including the evolving roles of LLMs and responsible artificial intelligence, as we continue to facilitate the dissemination of knowledge, enabling clinicians to integrate the best available evidence into their clinical practice.
Correction: Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review (Preprint)
Authors: Gheisari Mehdi , Ghaderzadeh Mustafa , Li Huxiong , Taami Tania , Fernández-Campusano Christian , Sadeghsalehi Hamidreza , Afzaal Abbasi Aaqif
Published: April 2024

UNSTRUCTURED

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Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom (Preprint)
Authors: Wilkes Matt , Kramer Annabel , Pugmire Juliana , Pilkington Christopher , Zaniello Benjamin , Zahradka Nicole
Published: April 2024

UNSTRUCTURED

The COVID-19 pandemic, patient preference, and economic opportunity are shifting acute care from the hospital to the home, supported by the transformation in remote monitoring technology. Monitoring patients with digital medical devices gives unprecedented insight into their physiology. However, this technology does not exist in a vacuum. Distinguishing pathology from physiological variability, user error, or device limitations is challenging. In a hospital, patients are monitored in a contrived environment. Monitoring at home instead captures activities of daily living alongside patients’ trajectory of disease and recovery. Both settings make for “noisy” data. However, we are familiar with hospital noise, accounting for it in our practice and perceptions of normal. Home monitoring as a diagnostic intervention introduces a new set of downstream consequences, dependent on device, cadence of collection, adherence, duration, alarm thresholds, and escalation criteria. We must accept greater ambiguity and contextualize vital signs. All devices balance accuracy with acceptability, so compromises are inevitable and perfect data should not be expected. Alarms must be specific as well as sensitive, balancing clinical risk with capacity for response. By setting expectations around data from the home, we can smooth the adoption of remote monitoring and accelerate the transition of acute care.
Twenty-Five Years of Evolution and Hurdles in Electronic Health Records and Interoperability in Medical Research: Comprehensive Review (Preprint)
Authors: Shen Yun , Yu Jiamin , Zhou Jian , Hu Gang
Published: April 2024

BACKGROUND

Electronic health records (EHRs) facilitate the accessibility and sharing of patient data among various health care providers, contributing to more coordinated and efficient care.

OBJECTIVE

This study aimed to summarize the evolution of secondary use of EHRs and their interoperability in medical research over the past 25 years.

METHODS

We conducted an extensive literature search in the PubMed, Scopus, and Web of Science databases using the keywords Electronic health record and Electronic medical record in the title or abstract and Medical research in all fields from 2000 to 2024. Specific terms were applied to different time periods.

RESULTS

The review yielded 2212 studies, all of which were then screened and processed in a structured manner. Of these 2212 studies, 2102 (93.03%) were included in the review analysis, of which 1079 (51.33%) studies were from 2000 to 2009, 582 (27.69%) were from 2010 to 2019, 251 (11.94%) were from 2020 to 2023, and 190 (9.04%) were from 2024.

CONCLUSIONS

The evolution of EHRs marks an important milestone in health care’s journey toward integrating technology and medicine. From early documentation practices to the sophisticated use of artificial intelligence and big data analytics today, EHRs have become central to improving patient care, enhancing public health surveillance, and advancing medical research.
Understanding the factors influencing adoption of mHealth in Rural Patients: A Case of Embu, Kenya (Preprint)
Authors: Kirengo Thomas , Bellows Scott
Published: April 2024

BACKGROUND

Kenya and other low-income countries face healthcare challenges such as affordability, access, and health worker shortages. Digital technologies have disrupted traditional service delivery in industries such as banking and retail. Significant changes have not yet affected healthcare. Technological advancements in healthcare may help to leapfrog barriers such as the cost of physical infrastructure.

OBJECTIVE

The study examined the influence of technical, social, and individual factors in adopting mHealth products in Embu, Kenya.

METHODS

A cross-sectional quantitative study using a structured close-ended questionnaire was conducted in Embu, Kenya, between August and December 2019. Correlation and regression analysis were used to determine the effect of the influential factors on adopting mHealth products.

RESULTS

207 (75%) randomly selected respondents over 18 years completed the survey, with the largest group (39.4%) aged between 35-44 years and 43% holding a Post-Secondary school diploma. Correlation analysis showed that social factors positively and significantly correlate to mHealth products' adoption (r(207) = .793, P < .05), reflecting a generally favourable view towards using mobile phones for seeking healthcare. Similarly, technical factors showed a significant correlation with mHealth adoption (r(207) = .931, P < .05), supported by widespread smartphone ownership and access to high-speed internet. Individual factors, including perceptions of the time-saving benefits of seeking healthcare services using a mobile phone, also demonstrated a positive correlation with the adoption of mHealth (r(207) = .708, P < .05).

CONCLUSIONS

Our study underscores the significant relationship of social, technical, and individual factors in adopting mHealth products. Digital health implementers should leverage increasing access to technical factors such as the Internet, smartphones, good mobile network coverage, and high utilization of social media to facilitate the positive adoption of mHealth. Our research provided insights from Embu; however, expansive studies encompassing rural and urban demographics are required to enhance generalizability.

CLINICALTRIAL

N/A
Effectiveness of a dyadic pain management program for community-dwelling older adults with chronic pain: a cluster randomized controlled trial (Preprint)
Authors: Tse Mimi Mun Yee , Ng Shamay Sheung Mei , Lou Vivian , Lo Raymond SK , Cheung Daphne Sze Ki , Lee Paul H , Tang Angel Shuk Kwan , Tse Percy Poo-See
Published: April 2024

BACKGROUND

The demand for digital-supported chronic pain management has grown, especially since the COVID-19 pandemic. Yet, the employment of a well-structured and sustainable program for older adults is limited due to insufficient research studies involving both older adult participants and their informal caregivers.

OBJECTIVE

This study aimed to test the effectiveness of the Dyadic Pain Management (DPM) in reducing pain, psychological health symptoms, and improving pain self-efficacy, physical well-being, and quality of life. Besides, this study evaluated the efficacy of the digital component of the DPM in increasing older adults’ engagement in managing pain individually, despite the social distancing restrictions.

METHODS

A cluster randomized controlled trial was conducted with socially vulnerable older adults (n=75) and their informal caregivers (n=75) for 8 weeks, which involved 4 weeks of on-campus activities and another 4 weeks of WhatsApp-based activities. The design of the intervention was based on the Pender’s Health Promotion Model, with the purpose to equip participants with essential knowledge and skills to manage their pain individually. After recruitment, participants were randomly placed into the experimental group that received the intervention, and control group which received lesson pamphlets. The evaluation of pain situation, physical and psychological health, caregiver burden inventory, and a semi-structured interview were conducted before the intervention (T0), at week 8 (T1), and week 16 (T2).

RESULTS

The results showed that participants’ pain situation was significantly improved. The between group P values for pain self-efficacy, pain intensity, and pain interference were P<.001, P=.003, and P<.001, respectively. Additionally, the differences in depression (P=.004), anxiety (P=.010), and stress (P=.021) were significant between the two groups after the intervention. Finally, caregiver burden was significantly reduced after the intervention, where it was P=.008 for the experimental group and P=.001 for differences between groups.

CONCLUSIONS

The findings implied the effectiveness of non-pharmacological chronic pain methods integrated with a digital add-on for community-dwelling older adults and their informal caregivers.

CLINICALTRIAL

ClinicalTrials.gov NCT05056623

INTERNATIONAL REGISTERED REPORT

RR2-DOI: 10.3390/ijerph191912186