bluuebunny/crossref_metadata_2025 huggingface dataset:
Spacial Economic Model of Sustainability Scuba Diving Tourism at Gili Matra Conservation Area, Indonesia
Authors:   Graduate Program in Tropical Ocean Economics, IPB University, Bogor, Indonesia, Solihin Lalu ,   Graduate Program in Universitas Nusa Bangsa, Bogor, Indonesia, Kusumastanto Tiridoyo ,   Department of Environmental Resource Economic, Faculty of Economic and Management, IPB University, Bogor, Indonesia,   Center for Coastal and Marine Resources Studies, IPB University, Bogor, Indonesia, Fauzi Akhmad ,   Department of Environmental Resource Economic, Faculty of Economic and Management, IPB University, Bogor, Indonesia, Yulianda Fredinan ,   Department of Aquatic Resorce Management, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
Published: December 2021

The development of the marine tourism sector in conservation areas creates a dilemma in its management. When economic interests are prioritized, it will have a negative impact on ecological aspects, so it is necessary to have a balance between environmental conservation activities and tourist activities. Therefore, the purpose of this study is to design a sustainable tourist allocation management model in conservation areas and the optimal economic value of each dive tourism site. The results of the analysis of the carrying capacity of the area per dive location point are then analyzed using dynamic models to predict the growth in tourism demand and supply, so that the economic value of each dive tourism site can be known. The results of the analysis show that not all conservation areas are suitable for diving tourism sites and appropriate locations have varying carrying capacities, depending on the area of the area. The number of offers from each dive tourism location some are more than the capacity and some are still below the capacity, so that in order to achieve sustainable diving tourism management, the allocation of requests is carried out proportionally and does not exceed the level of the area's carrying capacity (supply).
Penentuan Produk Agroindustri Unggulan di Kabupaten Sumedang
Authors:   Program Studi Teknologi Industri Pertanian, Fakultas Teknologi Industri Pertanian, Universitas Padjadjaran, Azhar Nurul , Kastaman Roni , Bunyamin Anas
Published: December 2021

The agricultural, forestry, and fisheries sectors and also the processing industry sectors in Sumedang Regency contributed the highest GDRP value in 2014-2018, so that Sumedang Regency has a potential in agro-industrial sector. This research aims to determined the priority of superior agro-industrial products and public assessment of superior agro-industrial products that have been determined in Sumedang Regency. This research used the Comparison of Exponential Method (MPE) and ANOVA analysis. The data analysis tools were Microsoft Excel and IBM SPSS Statistics 24 Software. The results of the MPE analysis showed that the priority of superior agro-industrial products in Sumedang Regency were ground coffee, roasted coffee, Cilembu roasted sweet potatoes, Cilembu sweet potato chips, red bako mole, opak ketan, white bako mole, Sumedang tofu, tempeh chips, and oncom Pasireungit. ANOVA analysis showed that there were differences of the superior agro-industrial products rank, that is Sumedang tofu, Cilembu roasted sweet potato, oncom Pasireungit, white bako mole, Cilembu sweet potato chips, tempeh chips, roasted coffee, ground coffee, red bako mole, and opak ketan.
Efektivitas Instagram @abangsayurorganik Sebagai Media Pemasaran
Authors:   Program Studi Agribisnis, Fakultas Pertanian, Universitas Brawijaya, Adhefia Ulfa , Ambayoen Mas , Kusuma Bayu
Published: December 2021

Abang Sayur Organik is one of the businesses that uses social media Instagram as a marketing medium. The purpose of this study are (1) to Analyze Instagram marketing conducted by Abang Sayur Organik based on 4Cs. (2) Analyze Instagram effectiveness of Abang Sayur Organik. This type of research is a quantitative approach by selecting the research location purposively and determining the sample using Systematic Random Sampling. The data analysis method used is the Customer Response Index (CRI) model. The results of the analysis are (1) Instagram marketing conducted by Abang Sayur Organik based on 4Cs consists of Contex; uploads with various contents accompanied by captions and hashtags, Communication; communication is done in two ways that are personal (direct message dan admin contact) and impersonal (comment column and group chat), Collaboration; repost consumer instastories is a collaboration conducted by Abang Sayur Organik to increase the confidence of consumers, and Connection; establish good communication, provide agricultural education, and provide rewards to consumers for maintaining and developing existing relationships. The effectiveness of Abang Sayur Organik marketing communication is carried out using the CRI formula that produces unaware is 1%, no interest is 2%, no intentions is 7%, and no action is 31%, and action is 58%. So that it can be said that the marketing of Abang Sayur Organik is effective because the hierarchy value of action exceeds unaware, no interest, no intentions, and no action.
Analisis Daya Saing Ekspor Minyak Atsiri Nilam (Patchouli Essential Oil) Indonesia di Pasar Internasional dengan Negara Brazil, Amerika Serikat, Meksiko, dan Perancis Periode 2001-2018
Authors:   Program Studi Agribisnis, Fakultas Pertanian, Universitas Brawijaya, Huda Fahmi , Meitasari Deny , Widyawati Wiwit
Published: December 2021

Until now, the domestic patchouli essential oil industry in Indonesia is still limited to exporting unprocessed products as finished products. In addition, farmers and cooperatives understanding is still low in implementing a good plantation manufacturing process. One indicator that can be seen is the number of imports of patchouli essential oil derivative products such as semi-finished ingredients from perfume and food flavors by Indonesia in the period of October-December 2008 amounting to US$ 401 million while exports were only US$ 103 million or a deficit of three to four times of exports. The purpose of this research is to analyze the comparative competitiveness, competitive competitiveness, and specialization of Indonesian patchouli essential oil trade in the international market. Countries that are used as comparison for Indonesia (rank 7) based on the average volume of exports are Brazil (rank 1), the United States (rank 2), Mexico (rank 8) and France (rank 9). This study uses the Revealed Comparative Trade Advantage (RCTA) analysis tool to analyze comparative competitiveness, the Export Competitiveness Index (XCI) to analyze competitive competitiveness, and the Trade Specialization Index (ISP) to analyze its trade specialties. The factors that significantly influence the competitiveness and trade specialization are the export and import value of patchouli essential oil and other goods from Indonesia and competing countries, the total export and import value of patchouli essential oil. Based on the results of the RCTA, XCI, and ISP analysis, the values obtained by Indonesia were 2.013, 1.012, and 0.412, respectively. Keywords: patchouli, essential oil, competitiveness, trade specialties
Analisis Efisiensi Saluran Pemasaran Komoditas Salak Pondoh di Desa Girikerto Kecamatan Turi Kabupaten Sleman Yogyakarta
Authors:   Program Studi Agribisnis, Departemen Pertanian, Fakultas Peternakan dan Pertanian, Universitas Diponegoro, Permana Afif , Budiraharjo Kustopo , Setiadi Agus
Published: December 2021

The purpose of this research is to analyze the pattern of salak pondoh marketing channels, marketing margins, farmer profit sharing, marketing efficiency, factors that influence marketing analysis and analysis between marketing analysis with efficiency standards. The choice of research location was determined purposively (purposive sampling). Sampling of respondents using the simple random sampling method in which the researcher selects the sample by giving equal opportunity to all members of the population to be determined as sample members and the determination of the respondent's research using the Slovin method with the number of respondent farmers is 93 while the merchant respondents are determined by snowball sampling based on information from previous respondents of 33 merchant respondents. The analysis of marketing analysis uses. Descriptive methods to determine channel patterns in the area and quantitative methods for marketing margin analysis, farmer share analysis, efficiency analysis, multiple linear regression and analysis. One sample T-test difference. The marketing margins for each pattern I, III, III and IV are respectively Rp 0 / Kg, Rp 3,630 / Kg, Rp 5,984 / Kg and Rp 5,932 / Kg and the value of Farmer's share in patterns I, II, III, IV respectively - 100%, 63%, 39% and 42% respectively, Marketing Efficiency based on the proportion of the total Margin in pattern I of 0% including the efficient category and patterns II, III and IV each of 38%, 62% and 59% are in the less efficient category. . The results of multiple linear regression analysis indicate that the independent variables, namely farmer prices, consumer purchase prices and marketing costs are factors affecting marketing and marketing management. There are differences with marketing marketing standards.
Peranan UMKM Agribisnis Komoditi Apel Melalui Hilirisasi Pertanian dalam Pemulihan Perekonomian di Kota Batu
Authors:   Universitas Islam Malang, Susilowati Dwi , Mardiyani Siti , Suyamto Suyamto
Published: December 2021

MSMEs (Micro, Small, and Medium Enterprises) are important to the national economy. The Covid-19 pandemic has affected a wide variety of sectors, including MSMEs, all over the world. The study's objectives were to: 1. identify agribusiness SMEs in the upstream and downstream parts of the apple commodity chain; 2. investigate the position of upstream and downstream agribusiness in Batu City's GRDP; and 3. determine the impact of the Covid-19 pandemic on tourist visits and the productivity of Medium, Small, and Micro Apple agribusiness businesses. The study location was purposely decided in the city of Batu in March-April 2021. Non-probability and purposive sampling were used to determine the respondents. The information gathered is both secondary and primary. The data was analyzed using a descriptive qualitative approach. Out of 23,544 MSMEs in Assess the impact of the Covid-19 epidemic on the environment. Batu district, 1001 (4.25 %) were upstream and downstream apple agribusinesses, according to the findings. Upstream accounts for 78 % apple agribusiness and 22 % of apple agribusiness. Apple cultivation and sales of equipment for apple cultivation are examples of upstream apple agribusiness MSMEs activities. Meanwhile, the downstream apple agribusiness MSMEs is engaged in apple packaging, sales, processing, and sales of apple processed products. Upstream agribusiness accounts for 12.9 percent of Batu city's GRDP, while downstream agribusiness accounts for 20.3 percent of Batu's GRDP. In the upstream and downstream fields, the Covid-19 pandemic has a negative effect on tourist visits and MSMEs' productivity. To return to pre-Covid-19 conditions, it is recommended that the Batu City Government and MSMEs utilize digitalization technology to enhance efficiency, especially in downstream MSMEs.
Production performance and meat quality of local ducks fed rations containing extract of torch ginger (Etlingera elatior) flowers and betel (Piper Betle linn) leaves
Authors: Handarini Ristika , Dihansih Elis , Wahyuni Dewi , Malik Burhanudin
Published: December 2021

Compared to chickens, ducks still have low productivity and other limitations. One of the causes of these problems might be attributed to the off-odor found in duck meat. Therefore, production performance and meat quality of ducks need to be improved. The inclusion of extracts of betel (Piper betle Linn) leaves and torch ginger (Etlingera elatior) flowers wereas done to improve production performance and meat quality of local ducks. This study was aimed at assessing the effects of the inclusion of betel leaves and torch ginger flowers in the basal rations on production performance and meat quality of local ducks in the growing phase. A completely randomized factorial design in 4 x 4 with three replicates was used. The first factor consisted of four levels of torch ginger flower solution, namely 0, 2.5, 5, and 7.5%. The second factor consisted of four levels of betel leaf solution, namely 0, 2.5, 5, and 7.5%. Results showed that no significant differences (P>0.05) were found in body weight gain, feed intake, feed conversion, mortality rate and meat quality (pH, water holding capacity, tenderness and cooking loss). It was concluded that the inclusion of extract of betel leaves and torch ginger flowers did not improve production performance and meat quality of male local ducks.
Successful Of Embolization Therapy On Recurrent Massive Hemoptysis because of TB Sequelae
Authors: Merdekawati Ratih Dwi ary , Pratiwi Suryanti Dwi , Bayhaqi Ahmad
Published: December 2021

AbstractBackground: Haemoptysis is one of vascular lesions in TB sequelae, with incidence of 28% from 919 cases. It may be recurrent, massive and might cause mortality if left untreated. Embolization procedure with glue and coil can be an alternative to treat patient with recurrent hemoptysis.Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a 34 years old male with intermittent massive haemoptysis. Chest X-ray examination showed Lung Tb far advanced lesion with no acid bacilli found on microbiological examination. Transthoracic FNAB revealed chronic suppurative inflammation, with Cytology sputum Class II. Chest CT Angiography showed Lung TB Far advanced lesions accompanied by mediastinal lymphadenopathy with unsuspecting complications of left supreme intercostal artery aneurysm dd pseudoaneurysm, suggestion embolization. Examination results confirmed the diagnosis of recurrent massive haemoptysis and intercostal artery aneurysm with the history of TB. Embolization procedure was then performed.Conclusion: Angiography CT Scan has better detail in evaluating condition, source, amount, and tract of artery in chest cavity. Bronchial artery embolization as an alternative therapy was found to give better effect of occlusion.Keywords: Massive haemoptysis, chest CT angiography, embolization.
Rare Case Giant Cystic Mediastinal Tumor (Mature Teratoma) in 57 years old Woman
Authors: Akbar Jimmy Akbar , Parsama Ngakan Putu Putra , Erawati Dini Rachma , Wardhana Koernia Kusuma , Yudhanto Hendi Setyo
Published: December 2021

Background : Incidence of mediastinal teratoma 8,5Â -Â 13,6% of all patients in mediastinal tumor. Teratomas are most common in young adults. Mediastinal teratoma is rarely present clinical manifestation. The clinical manifestation present along with increasing size of mass and also reported with chest pain, back pain, shortness of breath and febrile caused by chronic pneumonia. Rupture of a mediastinal teratoma can cause pleural effusion, empyema and cardiac tamponade. CT is first modality of choice for tumour diagnosis. Â Mature teratoma is a type of benign tumor, most patients will recovery after complete resection.Case Report : We report one case at Dr. Saiful Anwar hospital, an elderly woman,Â 57 yearsÂ old with mediastinal teratoma, whose formerly differential diagnosed with empyema. On the diagnostic test found no evidence of empyema but leads to loculated cloudy pleural effusion. Physical and supporting examination showed anterior mediastinal tumors. Based on theÂ CT-Scan and thorax sonography concluded that is a cystic mass on anterior right hemithorax dextra. The patient performed thoracotomy and eksploration with the final diagnosis of giant cystic mediastinum tumour, with the histopathology is mature teratoma.Â Â Conclusion: In this patient, the diagnosis of mediastinalÂ cystic mature teratoma Â with loculated pleural effusion proven through a multidisciplinary approach covering the pulmonology, thoracic and cardiovascular surgery, radiology and histopathology.Â Key words : Mediastinal tumour, Mature teratoma
Three Tuberculosis Spondylitis Patients With Resistant Rifampicin From the Transpedicular Debridement Surgery Network
Authors: Widowati Yenny , Jane Yani , Pratiwi Suryanti Dwi , Asmiragani Syaifullah
Published: December 2021

Background: TB spondylitis is a disease that can cause neurological disorders, ranging from 1-2% of the total cases of tuberculosis where the most frequent infection is the spine followed by other large joints such as hips, knees and shoulders. The increase in TB spondylitis associated with MDR TB in 2015 showed 52% or about 32,000 incidences globally.Collaboration of individual alloy MDR TB therapy with surgery in TB spondylitis can reduce patient mortality and morbidity.Case: We report three cases of patients in 2017-2018 in Dr. Saiful Anwar with complaints of back pain and lumps in the back, from the results of anamnesa, physical examination and supporting examination of patients diagnosed with TB spondylitis, patients were given medical management, operative and rehabilitation.Conclusion: This case is interesting because from the results of Molecular Rapid Tests whose samples were obtained from a biopsy of the transpendicular debridement surgery tissue obtained the results of Resistant Rifampicin, all three patients received individualized OAT treatment, the development of the conditions of the three patients improved and quality of life improved.
Confirmación taxonómica de Gelidium americanum (Gelidiaceae, Rhodophyta) en Tabasco, México, usando un enfoque morfológico y molecular
Authors: Quiroz-González Nataly , Rivas Acuña Ma. Guadalupe , Ponce Márquez Ma. Edith
Published: December 2021

Antecedentes y Objetivos: Gelidium americanum se distribuye ampliamente en la costa Atlántica de México; sin embargo, hasta ahora no se han realizado estudios que confirmen su identidad taxonómica utilizando marcadores moleculares y caracteres morfológicos. El objetivo del presente trabajo fue confirmar la identidad taxonómica con un enfoque morfológico y molecular, de los especímenes identificados como G. americanum recolectados previamente en la laguna costera de Mecoacán, Tabasco, México.Métodos: Se recolectaron tres especímenes de G. americanum en la laguna Mecoacán, Tabasco, México. El material se analizó morfológicamente, mediante observaciones en un microscopio estereoscópico y microscopio óptico. Para el análisis molecular se extrajo ADN de los talos muestreados empleando el método CTAB; se amplificaron los marcadores rbcL y COI-5P con el kit Phire Plant Direct (PCR), las secuencias fueron editadas en Bioedit y alineadas en Clustal W. Enseguida se hizo un análisis de Máxima Verosimilitud en RaxML, otro de Inferencia Bayesiana en MrBayes y se calcularon las distancias genéticas en MEGA. Resultados clave: Las secuencias obtenidas en el presente estudio para los marcadores rbcL y COI-5P se anidaron en el clado de las muestras identificadas previamente con marcadores moleculares como Gelidium americanum. Además, las distancias genéticas fueron mínimas, los caracteres morfológicos coincidieron con lo descrito previamente para otras localidades del Atlántico, a pesar de contar con un limitado número de especímenes.Conclusiones: Utilizando marcadores moleculares y caracteres morfológicos, se confirma la presencia de Gelidium americanum en la laguna Mecoacán a pesar de presentar características ambientales diferentes a las que habitualmente se han descrito para esta especie.
Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis
Authors: Zuelke Andrea E , Luppa Melanie , Löbner Margrit , Pabst Alexander , Schlapke Christine , Stein Janine , Riedel-Heller Steffi G
Published: December 2021

Background

Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking.

Objective

We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement.

Methods

We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes.

Results

In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria.

Conclusions

Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428
Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis
Authors: Alwasel Athary , Stergioulas Lampros , Fakhimi Masoud , Garn Wolfgang
Published: December 2021

International Registered Report Identifier (IRRID)

PRR1-10.2196/30092
Investigation of Prenatal Pesticide Exposure and Neurodevelopmental Deficits in Northern Thailand: Protocol for a Longitudinal Birth Cohort Study
Authors: Baumert Brittney O , Fiedler Nancy , Prapamontol Tippawan , Suttiwan Panrapee , Naksen Warangkana , Panuwet Parinya , Sittiwang Supattra , Dokjunyam Chayada , Smarr Melissa M , Marsit Carmen J , Ryan P Barry , Siriwong Wattasit , Robson Mark G , Barr Dana Boyd
Published: December 2021

Background

Prenatal exposure to pesticides has been linked to adverse neurodevelopmental outcomes. Gaps exist in the current literature about the timing and magnitude of exposures that result in these adverse outcomes.

Objective

The Study of Asian Women and their Offspring’s Development and Environmental Exposures (SAWASDEE) cohort was established to investigate the impact of prenatal exposure to pesticides on early indicators of cognitive and motor skills, inhibitory control, emotion regulation, and memory that have been found to be important in the development of subsequent neurobehavioral and neurodevelopmental diseases. The overarching goal is to find earlier predictors of potential adverse neurologic outcomes in order to enable earlier interventions that could result in better outcome prognoses.

Methods

Recruitment of this prospective, longitudinal birth cohort began in July 2017 and was completed in June 2019 in Chom Thong and Fang, 2 farming districts in Chiang Mai Province in northern Thailand. Follow-up of the study participants is ongoing. During pregnancy, 7 questionnaires were administered. Time-resolved biospecimen samples were collected monthly (for urine) and during each trimester (for blood) during antenatal care visits. Medical records were abstracted. Infants were administered the NICU Network Neurobehavioral Scale (NNNS) test at 1 month of age. A total of 322 mother-child pairs completed the NNNS test. All children will be followed until 3 years of age and undergo a series of neurodevelopmental tests. We will complete several additional exposure related analyses.

Results

A total of 1298 women were screened, and of those, 394 (30.35%) women were enrolled. The mean gestational age at enrollment was 9.9 weeks (SD 2.6). Differences in literacy were observed between Chom Thong and Fang participants. In Fang, about 54 of 105 (51.4%) participants reported being able to read in Thai compared to about 206 of 217 (94.9%) participants in Chom Thong. The percentages were comparable for reporting to be able to write in Thai.

Conclusions

This longitudinal birth cohort study will inform risk assessment standards for pregnant women in Thailand and other countries. Building awareness of how insecticide exposure during specific windows of pregnancy affects the neurodevelopmental trajectories of children in developing countries is a specific need recognized by the World Health Organization.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31696
Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study
Authors: Murphy Matthew , Sosnowy Collette , Rogers Brooke , Napoleon Siena , Galipeau Drew , Scott Ty , Tao Jun , Berk Justin , Clarke Jennifer , Nunn Amy , Chan Philip A
Published: December 2021

Background

HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context.

Objective

The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition.

Methods

This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation.

Results

The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition.

Conclusions

Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31928
The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play
Authors: Bricca Alessio , Pellegrini Alessandro , Zangger Graziella , Ahler Jonas , Jäger Madalina , Skou Søren T
Published: December 2021

Background

Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered.

Objective

We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change.

Methods

We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change.

Results

We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63%), weight and diet (apps: 25/60, 42%), or physical activity (apps: 22/60, 37%) and stress management (apps: 22/60, 37%). Only 8 out of the 60 apps (13%) were completely free.

Conclusions

Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change.
On Missingness Features in Machine Learning Models for Critical Care: Observational Study (Preprint)
Authors: Singh Janmajay , Sato Masahiro , Ohkuma Tomoko
Published: December 2021

BACKGROUND

Missing data in electronic health records is inevitable and considered to be nonrandom. Several studies have found that features indicating missing patterns (missingness) encode useful information about a patient’s health and advocate for their inclusion in clinical prediction models. But their effectiveness has not been comprehensively evaluated.

OBJECTIVE

The goal of the research is to study the effect of including informative missingness features in machine learning models for various clinically relevant outcomes and explore robustness of these features across patient subgroups and task settings.

METHODS

A total of 48,336 electronic health records from the 2012 and 2019 PhysioNet Challenges were used, and mortality, length of stay, and sepsis outcomes were chosen. The latter dataset was multicenter, allowing external validation. Gated recurrent units were used to learn sequential patterns in the data and classify or predict labels of interest. Models were evaluated on various criteria and across population subgroups evaluating discriminative ability and calibration.

RESULTS

Generally improved model performance in retrospective tasks was observed on including missingness features. Extent of improvement depended on the outcome of interest (area under the curve of the receiver operating characteristic [AUROC] improved from 1.2% to 7.7%) and even patient subgroup. However, missingness features did not display utility in a simulated prospective setting, being outperformed (0.9% difference in AUROC) by the model relying only on pathological features. This was despite leading to earlier detection of disease (true positives), since including these features led to a concomitant rise in false positive detections.

CONCLUSIONS

This study comprehensively evaluated effectiveness of missingness features on machine learning models. A detailed understanding of how these features affect model performance may lead to their informed use in clinical settings especially for administrative tasks like length of stay prediction where they present the greatest benefit. While missingness features, representative of health care processes, vary greatly due to intra- and interhospital factors, they may still be used in prediction models for clinically relevant outcomes. However, their use in prospective models producing frequent predictions needs to be explored further.
Prediction Algorithms for Blood Pressure Based on Pulse Wave Velocity Using Health Checkup Data in Healthy Korean Men: Algorithm Development and Validation (Preprint)
Authors: Park Dohyun , Cho Soo Jin , Kim Kyunga , Woo Hyunki , Kim Jee Eun , Lee Jin-Young , Koh Janghyun , Lee JeanHyoung , Choi Jong Soo , Chang Dong Kyung , Choi Yoon-Ho , Chung Ji In , Cha Won Chul , Jeong Ok Soon , Jekal Se Yong , Kang Mira
Published: December 2021

BACKGROUND

Pulse transit time and pulse wave velocity (PWV) are related to blood pressure (BP), and there were continuous attempts to use these to predict BP through wearable devices. However, previous studies were conducted on a small scale and could not confirm the relative importance of each variable in predicting BP.

OBJECTIVE

This study aims to predict systolic blood pressure and diastolic blood pressure based on PWV and to evaluate the relative importance of each clinical variable used in BP prediction models.

METHODS

This study was conducted on 1362 healthy men older than 18 years who visited the Samsung Medical Center. The systolic blood pressure and diastolic blood pressure were estimated using the multiple linear regression method. Models were divided into two groups based on age: younger than 60 years and 60 years or older; 200 seeds were repeated in consideration of partition bias. Mean of error, absolute error, and root mean square error were used as performance metrics.

RESULTS

The model divided into two age groups (younger than 60 years and 60 years and older) performed better than the model without division. The performance difference between the model using only three variables (PWV, BMI, age) and the model using 17 variables was not significant. Our final model using PWV, BMI, and age met the criteria presented by the American Association for the Advancement of Medical Instrumentation. The prediction errors were within the range of about 9 to 12 mmHg that can occur with a gold standard mercury sphygmomanometer.

CONCLUSIONS

Dividing age based on the age of 60 years showed better BP prediction performance, and it could show good performance even if only PWV, BMI, and age variables were included. Our final model with the minimal number of variables (PWB, BMI, age) would be efficient and feasible for predicting BP.
The Impact of Hypoglycemia on Productivity Loss and Utility in Patients With Type 2 Diabetes Treated With Insulin in Real-world Canadian Practice: Protocol for a Prospective Study (Preprint)
Authors: Lambert-Obry Veronique , Lafrance Jean-Philippe , Savoie Michelle , Lachaine Jean
Published: December 2021

BACKGROUND

Type 2 diabetes mellitus (T2DM) imposes a substantial burden owing to its increasing prevalence and life-threatening complications. In patients who do not achieve glycemic targets with oral antidiabetic drugs, the initiation of insulin is recommended. However, a serious concern regarding insulin is drug-induced hypoglycemia. Hypoglycemia is known to affect quality of life and the use of health care resources. However, health economics and outcomes research (HEOR) data for economic modelling are limited, particularly regarding utility values and productivity losses.

OBJECTIVE

This real-world prospective study aims to assess the impact of hypoglycemia on productivity and utility in insulin-treated adults with T2DM from Ontario and Quebec, Canada.

METHODS

This noninterventional, multicenter, 3-month prospective study will recruit patients from 4 medical clinics and 2 endocrinology or diabetes clinics. Patients will be identified using appointment lists and enrolled through consecutive sampling during routinely scheduled consultations. To be eligible, patients must be aged ≥18 years, diagnosed with T2DM, and treated with insulin. Utility and productivity will be measured using the EQ-5D-5L questionnaire and Institute for Medical Technology Assessment Productivity Cost Questionnaire, respectively. Questionnaires will be completed 4, 8, and 12 weeks after recruitment. Generalized estimating equation models will be used to investigate productivity losses and utility decrements associated with incident hypoglycemic events while controlling for individual patient characteristics. A total of 500 patients will be enrolled to ensure the precision of HEOR estimates.

RESULTS

This study is designed to fill a gap in the Canadian evidence on the impact of hypoglycemia on HEOR outcomes. More specifically, it will generate productivity and utility inputs for the economic modeling of T2DM.

CONCLUSIONS

Insulin therapy is expensive, and hypoglycemia is a significant component of economic evaluation. Robust HEOR data may help health technology assessment agencies in future reimbursement decision-making.

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/35461
Серцево-легенева та церебральна реанімація: нові рекомендації Європейської ради з реанімації 2021 року
Authors: Usenko L.V. , Tsarev А.V. , Kobelatsky Yu.Yu.
Published: December 2021

У статті викладені сучасні зміни в алгоритмі серцево-легеневої та церебральної реанімації (СЛЦР), прийняті Європейською радою з реанімації у 2021 р. Наведено принципи базової та розширеної підтримки життя, у тому числі з урахуванням Європейських рекомендацій, опублікованих у 2020 р., присвячених проведенню СЛР за умов пандемії COVID-19. Головний акцент у правилах проведення СЛР в умовах пандемії COVID-19 робиться на тому положенні, що ніколи не можна ставити під загрозу безпеку медичних працівників, а час, необхідний для забезпечення безпеки реаніматорів при наданні допомоги, є прийнятною частиною процесу СЛР. Висвітлено принципи проведення електричної дефібриляції, у тому числі в пацієнтів із коронавірусною хворобою, що перебувають у рrone position, фармакологічного забезпечення СЛР; сучасні можливості моніторингу для оцінки якості реанімаційних заходів та виявлення потенційно оборотних причин зупинки кровообігу; використання технологій екстракорпоральної підтримки життя у процесі СЛР. Окремо викладаються сучасні підходи до інтенсивної терапії постреанімаційного синдрому, що дозволяють забезпечити покращення наслідків у пацієнтів, які перенесли зупинку кровообігу.
Сучасні методи анестезіологічного забезпечення в онкопульмонології (огляд літератури)
Authors: Suprun A.S. , Lysenko V.Y.
Published: December 2021

У даній роботі наведено огляд сучасних методів анестезії та періопераційного забезпечення в онкопульмонології. Проведено пошук літературних джерел за архівами журналів, пошуковою електрон-ною базою даних Medline та наукометричними базами Scopus і Web of Science, The Cochrane Library за останні 7 років. Розглянуто основні методи анестезіологічного забезпечення в торакальній хірургії, сучасні концепції періопераційного ведення пацієнтів, основні принципи запобіжної та мультимодальної аналгезії як складові протоколу прискореного відновлення. Розроблення й введення безпечних та ефективних методів антиноцицептивного захисту пацієнта від гострого хірургічного болю в онкопульмонології залишається важливою проблемою анестезіології.
Періопераційна аналгезія абдомінальних гістеректомій: ретроспективне дослідження
Authors: Filyk O.V. , Ryzhkovskyi A.V.
Published: December 2021

Актуальність. Ефективність та універсальність регіонарних методів знеболювання в поєднанні з мультимодальним підходом до періопераційної аналгезії дозволяють використовувати їх для дедалі більшої кількості пацієнтів, зокрема при проведенні операцій в гінекології. Мета: оцінити анальгетичну ефективність TAP-блоку як компонента мультимодальної аналгезії порівняно з відсутністю застосування регіонарних методів аналгезії при проведенні абдомінальних тотальних гістеректомій. Матеріали та методи. Нами проведено ретроспективне одноцентрове дослідження у відділеннях анестезіології, інтенсивної терапії та гінекології КП «Рівненська обласна клінічна лікарня імені Юрія Семенюка». У дослідження було включено пацієнтів із симптомними фіброміомами, ускладненими кровотечами зі статевих шляхів, які потребували проведення тотальної абдомінальної гістеректомії (надпіхвової ампутації матки з придатками), віком 40–65 років. Критеріями виключення з дослідження були: відмова пацієнта від участі у дослідженні на будь-якому з його етапів, клас за ASA > IV, індекс маси тіла > 40 кг/м2, застосування агоністів/агоністів-антагоністів опіатних рецепторів до операції, неконтрольована артеріальна гіпертензія, порушення ритму серця. До аналізу даних включені 43 пацієнти. Результати. Встановлено, що рівень болю за візуальною аналоговою шкалою у І групі досягав максимальних значень на етапах дослідження h12 та h24 і становив 4,8 [3,3; 5,8] бала та 5,3 [3,9; 6,4] бала, тоді як у пацієнтів ІІ групи на аналогічних етапах дослідження біль було оцінено в 2,7 [2,3; 3,5] бала та 2,1 [1,6; 4,1] бала відповідно (p < 0,05). Виявлено вірогідні відмінності рівня частоти серцевих скорочень між І та ІІ групами пацієнтів на етапі дослідження h24 (93 [87; 98] уд/хв у І групі порівняно з 72 [63; 79] уд/хв у ІІ групі, p = 0,05). Не встановлено вірогідних відмінностей середнього артеріального тиску між І та ІІ групами пацієнтів на всіх етапах дослідження, проте була тенденція до зниження цього показника впродовж усього дослідження в І групі пацієнтів. Середня добова потреба в налбуфіні на етапі дослідження h24 мала тенденцію (p = 0,07) до нижчих показників серед пацієнтів ІІ групи (40,9 ± 1,1 мг/добу) порівняно з показниками пацієнтів І групи (51,4 ± 2,9 мг/добу). На етапі дослідження h72 потреба в налбуфіні була вірогідно нижчою (p < 0,05) в ІІ групі та становила 5,8 ± 0,8 мг/добу порівняно з 22,5 ± 4,1 мг/добу в І групі. Середня тривалість госпіталізації серед пацієнтів І групи становила 6,8 ± 0,5 дня, серед пацієнтів ІІ групи — 4,2 ± 0,2 дня (p < 0,05). Висновки. Застосування двостороннього TAP-блоку із 0,25% бупівакаїном та ад’ювантом дексаметазоном продемонструвало тенденцію до зниження потреби в налбуфіні в першу післяопераційну добу на 25,7 %, на третю післяопераційну добу — в 3,9 раза (p < 0,05). Тривалість госпіталізації у пацієнтів ІІ групи зменшувалася на 2,6 дня (p < 0,05).
Порушення натрієвого балансу у хворих з ураженням гіпоталамо-гіпофізарної ділянки при черепно-мозковій травмі
Authors: Ilchyschyn O.Ya. , Pidhirnyі Ya.M.
Published: December 2021

Актуальність. Черепно-мозкова травма (ЧМТ) до цього часу залишається провідною причиною смерті людей працездатного віку. В Україні частота ЧМТ щорічно становить у різних регіонах від 2,3 до 6 випадків (у середньому 4–4,2) на 1000 населення. Пацієнти з первинним ураженням головного мозку і гіпоталамо-гіпофізарної системи становлять групу ризику з розвитку набряку головного мозку через виникнення у них порушення водно-електролітної рівноваги та відповідно порушення рівноваги осмолярності між клітинним та позаклітинним простором. Порушення водно-електролітного балансу як наслідок ураження гіпоталамо-гіпофізарної системи при ЧМТ в літературі висвітлено недостатньо. Мало вивчені особливості функціонування центральних та периферичних ланцюжків ендокринної системи залежно від локалізації, характеру і тяжкості травми. Недостатньо вивчене питання про діагностичні та прогностичні цінності різних показників волемічного статусу у хворих із ЧМТ. Мета: вивчити види дизнатріємії у хворих з ізольованою ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку; вияснити вплив виду порушення натрієвого балансу на летальність у хворих із ЧМТ та ураженням гіпоталамо-гіпофізарної ділянки головного мозку. Матеріали та методи. Нами було обстежено 74 пацієнтів (чоловіків/жінок = 60/14) із вогнищевим забоєм головного мозку й ураженням гіпоталамічної ділянки. Серед 74 хворих з ізольованою ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку в 47 хворих було діагностовано гіповолемію, що поєднувалась з гіпонатріємією. У 15 хворих було виявлено гіпернатріємію з гіперволемією. Моніторинг внутрішньочерепного тиску здійснювали за допомогою поліфункціонального монітора (Monitor Model BSM-3562 (Nihon Konden Corporation, Японія, 2018)) із лінією для інвазивного вимірювання тиску. Постійне неінвазивне вимірювання оксигенації тканин органів (rSO2) проводили на моніторі Somanetics Invos Oximeter Cerebral/Somatik (Covidien, Mansfield, MA, США, 2020). В усіх хворих визначали рівень електролітів плазми крові. Висновки. У хворих із ЧМТ і ураженням гіпоталамо-гіпофізарної системи виникають різнонаправлені зміни водно-натрієвого балансу, що вимагають диференційованого підходу до їх лікування. Зважаючи на невелику кількість спостережень, ми не наважуємося пов’язувати вид дизнатріємії у хворих із ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку з летальністю. Вважаємо за доцільне продовжувати дослідження в цьому напрямку.