bluuebunny/crossref_metadata_2025 huggingface dataset:
Participatory Disease Surveillance Systems: Ethical Framework (Preprint)
Authors: Geneviève Lester Darryl , Martani Andrea , Wangmo Tenzin , Paolotti Daniela , Koppeschaar Carl , Kjelsø Charlotte , Guerrisi Caroline , Hirsch Marco , Woolley-Meza Olivia , Lukowicz Paul , Flahault Antoine , Elger Bernice Simone
Published: October 2018

UNSTRUCTURED

Advances in information technology are changing public health at an unprecedented rate. Participatory surveillance systems are contributing to public health by actively engaging digital (eg, Web-based) communities of volunteer citizens to report symptoms and other pertinent information on public health threats and also by empowering individuals to promptly respond to them. However, this digital model raises ethical issues on top of those inherent in traditional forms of public health surveillance. Research ethics are undergoing significant changes in the digital era where not only participants’ physical and psychological well-being but also the protection of their sensitive data have to be considered. In this paper, the digital platform of Influenzanet is used as a case study to illustrate those ethical challenges posed to participatory surveillance systems using digital platforms and mobile apps. These ethical challenges include the implementation of electronic consent, the protection of participants’ privacy, the promotion of justice, and the need for interdisciplinary capacity building of research ethics committees. On the basis of our analysis, we propose a framework to regulate and strengthen ethical approaches in the field of digital public health surveillance.
Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study (Preprint)
Authors: Quinn Charlene C. , Staub Sheila , Barr Erik , Gruber-Baldini Ann
Published: October 2018

BACKGROUND

Evaluation of digital health applications to support older adults’ independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers.

OBJECTIVE

The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ≥65 years. The app was designed to improve engagement of the patient-informal caregiver team.

METHODS

This observational usability study was conducted in participants’ homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ≥65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS).

RESULTS

The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1).

CONCLUSIONS

Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping.
Social Media Coverage of Scientific Articles Immediately After Publication Predicts Subsequent Citations - #SoME_Impact Score: Observational Analysis (Preprint)
Authors: Sathianathen Niranjan Jude , Lane III Robert , Murphy Declan G , Loeb Stacy , Bakker Caitlin , Lamb Alastair D , Weight Christopher J
Published: October 2018

BACKGROUND

Social media coverage is increasingly used to spread the message of scientific publications. Traditionally, the scientific impact of an article is measured by the number of citations. At a journal level, this conventionally matures over a 2-year period, and it is challenging to gauge impact around the time of publication.

OBJECTIVE

We, therefore, aimed to assess whether Web-based attention is associated with citations and to develop a predictive model that assigns relative importance to different elements of social media coverage: the #SoME_Impact score.

METHODS

We included all original articles published in 2015 in a selection of the highest impact journals: The New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, Nature, Cell, and Science. We first characterized the change in Altmetric score over time by taking a single month’s sample of recently published articles from the same journals and gathered Altmetric data daily from the time of publication to create a mixed effects spline model. We then obtained the overall weighted Altmetric score for all articles from 2015, the unweighted data for each Altmetric component, and the 2-year citation count from Scopus for each of these articles from 2016 to 2017. We created a stepwise multivariable linear regression model to develop a #SoME_Score that was predictive of 2-year citations. The score was validated using a dataset of articles from the same journals published in 2016.

RESULTS

In our unselected sample of 145 recently published articles, social media coverage appeared to plateau approximately 14 days after publication. A total of 3150 articles with a median citation count of 16 (IQR 5-33) and Altmetric score of 72 (IQR 28-169) were included for analysis. On multivariable regression, compared with articles in the lowest quantile of #SoME_Score, articles in the second, third, and upper quantiles had 0.81, 15.20, and 87.67 more citations, respectively. On the validation dataset, #SoME_Score model outperformed the Altmetric score (adjusted R2 0.19 vs 0.09; P<.001). Articles in the upper quantile of #SoME_Score were more than 5 times more likely to be among the upper quantile of those cites (odds ratio 5.61, 95% CI 4.70-6.73).

CONCLUSIONS

Social media attention predicts citations and could be used as an early surrogate measure of scientific impact. Owing to the cross-sectional study design, we cannot determine whether correlation relates to causation.
Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study (Preprint)
Authors: Shum Leia C , Valdés Bulmaro A , Van der Loos HF Machiel
Published: October 2018

BACKGROUND

As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications.

OBJECTIVE

This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space.

METHODS

Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units.

RESULTS

It was found that the maximum position accuracy error of the system was 3.5 ± 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 ± 9.9% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system.

CONCLUSIONS

The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy.
Mental Health Apps in Psychiatric Treatment: A Patient Perspective on Real World Technology Usage (Preprint)
Authors: Chiauzzi Emil , Newell Amy
Published: October 2018

UNSTRUCTURED

For many people who use mobile apps, the primary motivations are entertainment, news, gaming, social connections, or productivity. For those experiencing health problems, particularly those with chronic conditions such as psychiatric disorders, the stakes are much higher. The digital tools that they select may be the difference between improvement and decompensation or even life and death. Although there has been a wide expansion of mental health apps with promise as well as hype, the current means of researching, evaluating, and deploying effective tools have been problematic. As a means of gaining a perspective that moves beyond usability testing, surveys, and app ratings, the primary objective of this patient perspective is to question the killer app and condition-specific mentality of current mental health app development. We do this by reviewing the current mobile mental health app literature, identifying ways in which psychiatric patients use apps in their lives, and then exploring how these issues are experienced by a software engineer who has struggled with her bipolar disorder for many years. Her lived experience combined with a technology perspective offers potential avenues for using technology productively in psychiatric treatment. We believe that this responds to JMIR Publications’ call for patient perspective papers and provides encouragement for patients to share their views on mental health and technology.
A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia (Preprint)
Authors: Dodd Rachael H , Obermair Helena M , McCaffery Kirsten J
Published: October 2018

BACKGROUND

In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously.

OBJECTIVE

The aim of the study was to explore in depth women’s understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017.

METHODS

A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis.

RESULTS

Around one-third (34.55%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test).

CONCLUSIONS

Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients.
Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda (Preprint)
Authors: Apodaca Kevin , Doshi Reena Hemendra , Ogwal Moses , Kiyingi Herbert , Aluzimbi George , Musinguzi Geofrey , Lutalo Ibrahim , Akello Evelyn , Hladik Wolfgang
Published: October 2018

BACKGROUND

Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers.

OBJECTIVE

The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda.

METHODS

We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis.

RESULTS

We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono.

CONCLUSIONS

The CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.
Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study (Preprint)
Authors: Du Preez Vikki , De La Harpe Retha
Published: October 2018

BACKGROUND

Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement.

OBJECTIVE

The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP.

METHODS

The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz’s approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH).

RESULTS

The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services.

CONCLUSIONS

In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions.
Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey (Preprint)
Authors: Ojikutu Bisola O , Bogart Laura M , Mayer Kenneth H , Stopka Thomas J , Sullivan Patrick S , Ransome Yusuf
Published: October 2018

BACKGROUND

Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed.

OBJECTIVE

We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP.

METHODS

We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code–level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables.

RESULTS

All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]).

CONCLUSIONS

Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.
Data Analysis and Visualization of Newspaper Articles on Thirdhand Smoke: A Topic Modeling Approach (Preprint)
Authors: Liu Qian , Chen Qiuyi , Shen Jiayi , Wu Huailiang , Sun Yimeng , Ming Wai-Kit
Published: October 2018

BACKGROUND

Thirdhand smoke has been a growing topic for years in China. Thirdhand smoke (THS) consists of residual tobacco smoke pollutants that remain on surfaces and in dust. These pollutants are re-emitted as a gas or react with oxidants and other compounds in the environment to yield secondary pollutants.

OBJECTIVE

Collecting media reports on THS from major media outlets and analyzing this subject using topic modeling can facilitate a better understanding of the role that the media plays in communicating this health issue to the public.

METHODS

The data were retrieved from the Wiser and Factiva news databases. A preliminary investigation focused on articles dated between January 1, 2013, and December 31, 2017. Use of Latent Dirichlet Allocation yielded the top 10 topics about THS. The use of the modified LDAvis tool enabled an overall view of the topic model, which visualizes different topics as circles. Multidimensional scaling was used to represent the intertopic distances on a two-dimensional plane.

RESULTS

We found 745 articles dated between January 1, 2013, and December 31, 2017. The United States ranked first in terms of publications (152 articles on THS from 2013-2017). We found 279 news reports about THS from the Chinese media over the same period and 363 news reports from the United States. Given our analysis of the percentage of news related to THS in China, Topic 1 (Cancer) was the most popular among the topics and was mentioned in 31.9% of all news stories. Topic 2 (Control of quitting smoking) was related to roughly 15% of news items on THS.

CONCLUSIONS

Data analysis and the visualization of news articles can generate useful information. Our study shows that topic modeling can offer insights into understanding news reports related to THS. This analysis of media trends indicated that related diseases, air and particulate matter (PM2.5), and control and restrictions are the major concerns of the Chinese media reporting on THS. The Chinese press still needs to consider fuller reports on THS based on scientific evidence and with less focus on sensational headlines. We recommend that additional studies be conducted related to sentiment analysis of news data to verify and measure the influence of THS-related topics.
Website Analytics of a Google Ads Campaign for a Men’s Mental Health Website: Comparative Analysis (Preprint)
Authors: Murphy Andrea Lynn , Peltekian Sophie , Gardner David M
Published: October 2018

BACKGROUND

Men with mental health and addictions problems seek information and help from health service providers and community support less often than women with such problems. Online health resources offer men rapid access to self-care recommendations and resources and anonymity; however, only a few websites are specifically developed for men. Headstrong - Taking Things Head-On was a community pharmacy and online health promotion initiative for men living with mental health and addictions problems. The Headstrong website was developed to offer a curated collection of print and online recommended resources (primarily self-help oriented) for depression, anxiety, insomnia, tobacco and alcohol use problems, and suicide. To increase awareness of the initiative and use of the website’s content and resource recommendations, a Google Ads campaign was developed.

OBJECTIVE

This study aimed to compare user acquisition and behavior on the Headstrong website during and after a Google Ads campaign.

METHODS

The Google Ads campaign was launched on December 21, 2017, and run until February 28, 2018. Website analytics (acquisition of new users, behavior in terms of at-website actions and duration, devices used, and conversions [link-outs to recommended resources]) in a 30-day period during the campaign (January 26, 2018 to February 24, 2018) were compared to a similar 30-day period after the campaign (March 23, 2018 to April 21, 2018). A cost analysis of the ad campaign was also performed.

RESULTS

The ad campaign generated 3011 clicks and 4.5 million impressions in total. In addition, the campaign received 1311 website users during the 30-day period of the ad campaign as compared to 241 users during the 30-day period after the ad campaign (P<.001). Return visitor (17.7% vs 27.8%) and nonbounce (19.5% vs 39.8%) user rates as well as session duration (42 vs 102 seconds) and page views per session (1.4 vs 2.1) were lower during the ad campaign than after the campaign (P<.01 for all). The 30-day period of the ad campaign included 9 sessions with conversions initiated by an ad click. Paid and display ads accounted for 63% of the site traffic during the ad campaign, most of which came from mobile phone users. Desktops were the most-common device used after the ad campaign acquired the website via direct and organic searches primarily (92%). The estimated cost per session with one or more conversions was Can $54.69 and cost per conversion was Can $32.81.

CONCLUSIONS

A Google Ads campaign designed to direct men to the Headstrong website increased the number of user visits by more than five-fold. However, engagement by users responding to the ad campaign was substantially lower than that by users who visited the website via other acquisition methods, possibly reflecting the nonspecific online targeting of men by the ad campaign. General targeting of men online to promote men’s mental health appears to have limited value.
(Preprint)
Authors: Verschueren Sarah , van Aalst June , Bangels Anne-Marie , Toelen Jaan , Allegaert Karel , Buffel Connor , Vander Stichele Geert
Published: October 2018

BACKGROUND

Increasing numbers of children undergo ambulatory surgery each year and a significant proportion experiences substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts physical, psychosocial, and economic outcomes. Existing non-pharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, non-pharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games for health (SGHs) hold unique potential to change health beliefs and behaviors in children.

OBJECTIVE

The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, an SGH aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery.

METHODS

The SERES framework for SGH development was used to create the SGH, CliniPup. In particular, a mixed-methods approach was applied that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting SGH was relevant, realistic, and theory-driven. A participatory design approach was applied wherein clinical experts qualitatively reviewed several versions of the SGH and an iterative creative process was used to integrate the applicable feedback.

RESULTS

CliniPup, an SGH, was developed to incorporate (1) scientific evidence base from a structured literature review, (2) realistic content collected during ethnographic research such as expert interviews, (3) explicit pedagogical objectives from scientific literature, and (4) game mechanics and user interface design that address key aspects of the evidence.

CONCLUSIONS

This report details the systematic development of CliniPup, an SGH aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.
A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability (Preprint)
Authors: Allman-Farinelli Margaret , Ijaz Kiran , Tran Helen , Pallotta Hermes , Ramos Sidney , Liu Junya , Wellard-Cole Lyndal , Calvo Rafael A
Published: October 2018

BACKGROUND

Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries.

OBJECTIVE

The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices.

METHODS

Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed.

RESULTS

One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1).

CONCLUSIONS

Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy.
Efficacy of a Web-Based Self-Management Enhancing Program for Patients with Rheumatoid Arthritis: Explorative Randomized Controlled Trial (Preprint)
Authors: Zuidema Rixt , van Dulmen Sandra , Nijhuis-van der Sanden Maria , Meek Inger , van den Ende Cornelia , Fransen Jaap , van Gaal Betsie
Published: October 2018

BACKGROUND

Web-based self-management enhancing programs have the potential to support patients with rheumatoid arthritis (RA) in their self-management; for example, improve their health status by increasing their self-efficacy or taking their prescribed medication. We developed a Web-based self-management enhancing program in collaboration with RA patients and professionals as co-designers on the basis of the intervention mapping framework. Although self-management programs are complex interventions, it is informative to perform an explorative randomized controlled trial (RCT) before embarking on a larger trial.

OBJECTIVE

This study aimed to evaluate the efficacy of a Web-based self-management enhancing program for patients with RA and identify outcome measures most likely to capture potential benefits.

METHODS

A multicenter exploratory RCT was performed with an intervention group and a control group. Both groups received care as usual. In addition, the intervention group received 12 months of access to a Web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included self-management behavior (Patient Activation Measurement, Self-Management Ability Scale), self-efficacy (Rheumatoid Arthritis task-specific Self-Efficacy, Perceived Efficacy in Patient-Physician Interaction), general health status (RAND-36), focus on fatigue (Modified Pain Coping Inventory for Fatigue), and perceived pain and fatigue (Numeric Rating Scales). A linear mixed model for repeated measures, using the intention-to-treat principle, was applied to study differences between the patients in the intervention (n=78) and control (n=79) groups. A sensitivity analysis was performed in the intervention group to study the influence of patients with high (N=30) and low (N=40) use of the intervention.

RESULTS

No positive effects were found regarding the outcome measurements. Effect sizes were low.

CONCLUSIONS

Based on these results, it is not possible to conclude on the positive effects of the intervention or to select outcome measures to be regarded as the primary/main or secondary outcomes for a future trial. A process evaluation should be performed to provide more insight into the low compliance with and effectiveness of the intervention. This can determine for whom this sort of program will work and help to fine-tune the inclusion criteria.

CLINICALTRIAL

Netherlands Trial Register NTR4871; https://www.trialregister.nl/trial/4726
Suplemento 2 Parte A
Authors: Saúde Revista
Published: October 2018

I Simpósio de Saúde Coletiva – Caminhos da Pesquisa no Interior do Brasil - Parte A
On the structure of random hypergraphs
Authors: Kuzeljevic Borisa
Published: October 2018

Let Hn be a countable random n-uniform hypergraph for n > 2, and P(Hn) =
{f[Hn] : f : Hn ? Hn is an embedding}. We prove that a linear order L is
isomorphic to the maximal chain in the partial order ?P(Hn)?{?},?? if and
only if L is isomorphic to the order type of a compact set of reals whose
minimal element is nonisolated.
Sarcoidosis Appearing in a Tattoo
Authors: Ali Saba M. , Gilliam Anita C. , Brodell Robert T.
Published: October 2018

Background:

Sarcoidosis is a systemic disease that may present as tattoo granulomas.

Objective:

A patient with systemic sarcoidosis who developed a granulomatous reaction within a tattoo is presented to stimulate interest in this unusual phenomenon.

Methods and Results:

A patient with a 6-year history of pulmonary sarcoidosis developed sarcoidal granulomas restricted to one pigment of a tattoo. Previous reports of sarcoidal granulomas within tattoos are reviewed, and information about the pathogenesis of this process is explored.

Conclusion:

Sarcoid granulomas may develop in tattoos as an isolated local reaction or as the presenting sign of systemic sarcoidosis. The reaction itself may provide insight into further understanding the pathogenesis of sarcoidosis.
Use of Pimecrolimus Cream in Disorders Other than Atopic Dermatitis
Authors: Day Isaiah , Lin Andrew N.
Published: October 2018

Background:

Pimecrolimus is indicated for treatment of atopic dermatitis and has been evaluated in many other disorders.

Objective:

To review the efficacy of pimecrolimus in treatment of disorders other than atopic dermatitis.

Methods:

We performed a PubMed search of the English-language literature using the key word “pimecrolimus.” We reviewed articles reporting the use of pimecrolimus in disorders other than atopic dermatitis and classified them by the type of study used to evaluate efficacy.

Results:

Randomized, double-blind studies have shown that pimecrolimus is superior to vehicle in treatment of seborrheic dermatitis, hand dermatitis, and asteatotic eczema but have yielded conflicting results regarding intertriginous psoriasis and vitiligo. Open-label studies involving four or more patients have shown favorable results in many disorders, including contact dermatitis, rosacea, lichen sclerosus, and oral and genital lichen planus. Case reports have shown that topical pimecrolimus may be useful in cutaneous graft-versus-host disease, lichen striatus, cutaneous lichen planus, and many other disorders.

Conclusions:

Topical pimecrolimus appears to be an effective treatment for many disorders other than atopic dermatitis, especially seborrheic dermatitis, hand dermatitis, and asteatoic eczema. It may be effective in many other disorders, but its role in these disorders remains to be clarified by additional studies.
Laser Therapy for Onychomycosis
Authors: Gupta Aditya K. , Simpson Fiona C.
Published: October 2018

Background:

Laser therapy is a rapidly expanding new treatment modality for onychomycosis.

Objective:

To review current and prospective laser systems for the treatment of onychomycosis.

Method:

We searched the PubMed database, the Food and Drug Administration 510(k) database, ClinicalTrials.gov , and Google Scholar for in vitro studies, peer-reviewed clinical trials, manufacturers' white papers, and registered clinical trials of laser systems indicated for the treatment of onychomycosis. All published clinical trials were assessed on a 20-point methodological quality scale.

Results:

We identified three basic science articles, five peer-reviewed articles, three white papers, and four pending clinical trials, as well as numerous gray literature documents. The overall methodological score for the clinical trials was 9.1 ± 1.1, with peer-reviewed studies showing a higher score (9.8 ± 1.5) than white papers (7.5 ± 0.7). We also identified 11 commercial laser device systems of varying global availability.

Conclusion:

Laser therapy has been tested and approved as a cosmetic treatment only for onychomycosis. It cannot be recommended as a therapeutic intervention to eradicate fungal infection at this time as more rigorous randomized, controlled trials are required to determine if laser therapy is efficacious on par with oral and topical interventions.
Familial Classic Kaposi Sarcoma in Two Siblings: Case Report and Literature Review
Authors: Almohideb Mohammad , Waiters A. Kevin , Gerstein William
Published: October 2018

Background:

Kaposi sarcoma (KS) is a cutaneous endothelial vascular proliferation with four subtypes: iatrogenic, acquired immune deficiency syndrome (AIDS) related, African, and classic. Familial cases of KS are rare, with 72 cases reported to date, and all were described with the classic variant. The occurrence of classic KS in the Jewish population is well documented, and most of the familial classic KS cases were also reported in Jewish families.

Objective:

We briefly present the history, biopsies, laboratory data, diagnosis, and treatment of localized lower limb classic KS in two siblings of Jewish Eastern European ethnic descent with their response to different therapy modalities. One of our cases had the second longest reported period of follow-up for familial classic KS of 40 years.
Clinical and Immunologic Characterization in 26 Indian Pemphigus Patients
Authors: Tsuruta Daisuke , Kanwar Amrinder J. , Vinay Keshavamurthy , Fukuda Shunpei , Koga Hiroshi , Dainichi Teruki , Ohata Chika , Ishii Norito , Hashimoto Takashi
Published: October 2018

Background:

Pemphigus shows geographically variable characteristics.

Objective:

To study the clinical and immunologic characteristics of Indian pemphigus patients before and after treatment.

Methods:

Twenty-six Indian pemphigus patients were analyzed with regard to age, gender, clinical features, treatments and response, the results of histopathology, direct and indirect immunofluorescence (IF), enzyme-linked immunosorbent assay (ELISA), and immunoblot analyses.

Results:

There were 22 pemphigus vulgaris (PV) and 4 pemphigus foliaceus (PF) patients. Direct and indirect IF was positive in 95.8% and 56% of patients, respectively. Indices of ELISA were lower in our study. Immunoblot assays detected the 130 kDa desmoglein-3 in 10 PV patients and the 160 kDa desmoglein-1 in 1 PV patient; 190 kDa periplakin was unexpectedly detected in 8 patients.

Conclusion:

Indian pemphigus patients showed several unique characteristics, including younger population, predominance of PV, low ELISA indices, lower sensitivity of indirect IF and immunoblotting, and the presence of the 190 kDa periplakin in nearly one-third of patients.
Mycophenolic Acid for Lymphomatoid Papulosis
Authors: Champagne Trevor , Walsh Scott
Published: October 2018

Background:

Lymphomatoid papulosis is a rare CD30+ lymphoproliferative T-cell disorder with limited effective treatments.

Objective:

We describe the case of a 50-year-old woman diagnosed with lymphomatoid papulosis who was unable to access phototherapy and who failed to clear while on systemic treatment with methotrexate.

Methods:

The patient was initiated on mycophenolate mofetil (MMF), a prodrug of mycophenolic acid, at a dose of 2 g divided twice daily.

Results:

MMF produced a rapid response with complete clearing within 8 weeks, and the patient has been successfully maintained for 2 years at the same dose with no noted side effects. Other patients in our clinic have had similar success.

Conclusions:

Mycophenolic acid is a safe and well-tolerated therapy for lymphomatoid papulosis.
Intralesional Candida Antigen for Common Warts in People with HIV
Authors: Wong Aaron , Crawford Richard I.
Published: October 2018

Background:

Intralesional Candida antigen has been used as immunotherapy to treat refractory warts in the immunocompetent pediatric and adult populations but has not been reported in individuals with human immunodeficiency virus (HIV).

Purpose:

To examine if Candida antigen resulted in clearance of medically refractory, long-standing common warts in a series of HIV patients.

Method:

At a hospital-based, adult, outpatient dermatology clinic, seven patients with HIV with common warts of the hands and feet were treated with intralesional Candida antigen. The warts had been resistant to standard patient- and physician-applied modalities.

Results:

Clearance was achieved in three of seven patients, whereas four of seven did not respond due to a lack of effectiveness or an inability to tolerate treatment. Adverse events included injection-site redness, pruritus, and pain.

Conclusion:

This is the first reported case series using Candida antigen for warts in individuals with HIV. The use of Candida antigen represents a simple and novel approach to the management of treatment-refractory warts in those with HIV. This case series provides a foundation for future larger, randomized trials.
Compact Fluorescent Lamps and Risk of Skin Cancer
Authors: Korgavkar Kaveri , Xiong Michael , Weinstock Martin A.
Published: October 2018

Background:

Previously considered safe for typical use, concerns have recently been expressed regarding the potential effect of compact fluorescent lamps (CFLs) on human skin and, in particular, on skin cancer risk.

Objective:

We sought to address this concern by reviewing the current literature on CFLs, ultraviolet (UV) radiation, and photocarcinogenic exposure.

Results:

On average, the UV radiation from CFLs and subsequent carcinogenic exposure is lower than that from incandescent bulbs. However, defective bulbs can emit higher levels of UV radiation, which may cause significant damage.

Conclusion:

Our review calls for further investigation to determine how frequently these bulbs are sufficiently defective to lead to adverse effects.
Giant Merkel Cell Carcinoma of the Lower Limb: Case Report and Review of the Literature
Authors: Marchesi Andrea , Parodi Pier Camillo , Brioschi Marco , Sileo Giorgio , Marchesi Matteo , Vaienti Luca
Published: October 2018

Background:

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine malignancy that usually grows rapidly at the head and neck. Giant forms at the lower limbs are rarely reported and usually affect patients in the eighth decade or older.

Methods:

We report the case of a 60-year-old man who presented with a giant MCC on his right thigh. We managed this case by applying the 2012 updated guidelines and reviewed all cases of giant MCC of the lower limbs reported in the literature.

Results:

At the 4-month follow-up, the patient showed complete remission.

Conclusion:

Giant forms of MCC are still treated as typical cases of MCC, when these patients show a very poor prognosis. In young and adult people, such as our case, wide surgical excisions, sentinel lymph node biopsy in clinically negative node cases, radiotherapy of the regional drain area, and a strict follow-up should be routinely performed to improve patients' survival.
Preparing for Subsequent Entry Biologies in Dermatology and Rheumatology in Canada
Authors: Papp Kim , Bourcier Marc , Ho Vincent , Burke Karen , Haraoui Boulos
Published: October 2018

Background:

Patents on several biologies will expire in Canada in the coming years. As they expire, applications to market subsequent entry biologies (SEBs) may be filed in Canada.

Objective:

To provide an understanding of the regulatory pathway and types of trials used for SEB authorization in Canada.

Methods:

Health Canada's draft guidance on SEBs was reviewed in regards to key issues and challenges in the development and authorization of SEBs.

Results:

Health Canada states that SEBs are not “generic biologies” and their authorization is not a declaration of pharmaceutical or therapeutic equivalence to the originator. The agency recommends that physicians make well-informed decisions regarding therapeutic interchange.

Conclusions:

Decisions on how to determine the place of SEBs in clinical practice for biologic-naive patients and those already receiving biologies should be made on a case-by-case basis, considering the patient's needs, the characteristics of the biologic required, and the clinical development programs of the applicable SEB.
Perceptions, Attitudes, and Satisfaction concerning Resident Participation in Health Care among Dermatology Outpatients
Authors: AlGhamdi Khalid M. , AlMohanna Hind M. , AlKeraye Salim S. , AlSaif Fahad M. , AlRasheed Saleh K.
Published: October 2018

Background:

A limited number of published studies have discussed patient attitudes toward resident physicians' participation in dermatology clinics. A literature search failed to identify any such study in the Middle East.

Objective:

The aim of this study was to explore patient perceptions and attitudes toward resident participation in dermatology outpatient clinics.

Methods:

A self-administered questionnaire focused on patient attitudes toward dermatology resident participation was distributed randomly to all adult outpatients attending dermatology clinics at a university hospital in Saudi Arabia between July and September 2010.

Results:

The questionnaire was returned by 742 of 900 patients, for an 82% response rate. The mean patient age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The major reason for visiting the hospital was a medical dermatology consultation (80.4%). Only 35% of the patients self-reported an accurate understanding of the “resident” designation. In total, 86.4% of patients were satisfied with the residents' behavior. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the residents. The patients agreed with resident participation in their health care. The majority of the patients expressed their willingness to provide a medical history and receive counseling from residents (87.6% and 86.3%, respectively). There was no gender-associated effect on the understanding of the resident position or the decision to receive a physical examination by a resident.

Conclusion:

Dermatology outpatients are satisfied and have positive perceptions and attitudes toward resident participation in the dermatology clinic.