bluuebunny/crossref_metadata_2025 huggingface dataset:
Servant and collaborative leadership in the performance of Peruvian tourism organizations: Mediation of social capital
Authors: Anibal Luciano Alipio Rober , Nicanor Suarez Orellana Arturo , Raul Hurtado Tiza David , Perez Sullcaray Willian , Xavier Arevalo Avecillas Danny
Published: September 2024

Leadership plays a crucial role in the performance of organizations and is a fundamental element in the construction of capital. This paper aims to measure the relationship between servant and collaborative leadership with organizational performance and the mediating role of social capital in small companies in the Peruvian tourism sector. The methodology used the quantitative approach at an explanatory level. Data were obtained from 623 representatives of tourism organizations using a 19-item questionnaire; the hypotheses were tested using the SEM model through AMOS and SPSS. The results indicate that servant leadership is largely related to organizational performance (β = 0.566, p < 0.001) and explains 20.5% of this variable. Collaborative leadership has a moderate relationship with organizational performance (β = 0.454, p < 0.001) and explains 21.3%. No evidence demonstrated the relationship between servant leadership and social capital. Collaborative leadership has a low relationship with social capital (β = 0.163, p < 0.001) and explains only 2%. Social capital has a low relationship with organizational performance (β = 0.293, p < 0.001) and explains 10.8%. Furthermore, social capital fully mediates the relationship between servant leadership and organizational performance and partially mediates the relationship between collaborative leadership and organizational performance.
Modificadores de qualidade de vida de pacientes com esclerose múltipla: uma revisão integrativa
Authors: Medeiros Pacheco Ribeiro Fernanda , Da Silva Soares Telles Barbara
Published: September 2024

A esclerose múltipla (EM) é uma  doença degenerativa com desmielinização do sistema nervoso central. É uma das principais causas de incapacidade em jovens adultos, afetando a qualidade de vida. O presente estudo objetiva analisar os principais fatores incapacitantes e as terapêuticas mais eficazes. Foi realizada uma pesquisa no PubMed e BVS com os descritores “multiple sclerosis AND quality of life”. Foram incluídos artigos publicados entre 2021 e 2023, de texto completo gratuito e ensaios clínicos controlados. Os fatores incapacitantes mais citados foram fadiga, alterações de função motora e saúde mental sendo ao menos um deles citado em todos os artigos. Como medidas terapêuticas, foram mais citadas formas regulação emocional e atividades físicas. Conclui-se que a fadiga foi o principal fator incapacitante, presente em 14 estudos e exercícios de Baduanjin, Mindfulness, treinamento de resistência e força muscular têm melhor resultado reduzindo diferentes fatores incapacitantes.
leitura literária e a escrita digital
Authors: Oliveira Ana Carolina Alves de Lima , Mateus Andrea Martins Lameirão , Sousa Antonio Ismael Lopes de
Published: September 2024

Este estudo apresenta discussões e/ou reflexões sobre a leitura e a escrita literária em sala de aula, com ênfase para as potências do gênero fanfiction, envolvendo o aplicativo Wattpad, em aulas de Língua Portuguesa. Para tanto, foi desenvolvida uma pesquisa-ação de cunho qualitativo, fundamentada na inserção de uma atividade atípica no contexto da rotina escolar. Os resultados mostraram que a escrita de fanfiction é significativa, mesmo diante de obstáculos decorrentes de estruturas tecnológicas precárias – a exemplo do acesso limitado à internet e da carência de recursos para aquisição de equipamentos etc. A leitura e a escrita literária, em associação com as TIC’s, são também uma forma de ampliação das chances de desenvolvimento cognitivo, social e cultural, assim como uma possibilidade de ampliar as opções de interação entre as pessoas que são marcadas, sobretudo, pela leitura e pela escrita.
Palavras-chave: Fanfiction; Wattpad; Leitura x escrita; Tecnologia.
Evidence of a Bi-Directional Relationship between Arterial Stiffness and Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies
Authors: L. Beros Angela , Sluyter John D , Scragg Robert KR.
Published: September 2024

Background:

There are numerous cross-sectional studies showing an association between
arterial stiffness and diabetes, but the temporality of the association is unclear.

Objective:

To investigate the temporal relationship between arterial stiffness and diabetes.

Methods::

We searched MEDLINE and Embase from inception to 31 August 2023, to identify
cohort studies that assessed whether arterial stiffness, as measured by pulse wave velocity
(PWV), was predictive of the development of diabetes and vice versa. We summarised study data,
and where possible undertook meta-analysis.

Results:

We identified 19 studies that included people with type 1, type 2 and gestational diabetes.
All 11 studies investigating arterial stiffness as a predictor of diabetes found a significant
relationship. Six of those studies were suitable for meta-analysis. The risk of developing diabetes
was greater in people with higher PWV at baseline than lower PWV (RR = 2.14, 95%CI 1.65
to 2.79, p < 0.00001) and the mean difference in baseline PWV was higher in people who developed
diabetes than those who did not (mean difference: 0.77 m/s, 95%CI 0.47 to 1.06, p <
0.00001). Of 8 studies investigating diabetes as a predictor of arterial stiffness, 7 found a significant
relationship.

Conclusion:

There is evidence of a bidirectional relationship between arterial stiffness and diabetes.
Arterial stiffness may provide a causal link between diabetes and future cardiovascular
disease.
ANALISIS FAKTOR–FAKTOR YANG MEMPENGARUHI FOREIGN DIRECT INVESTMENT DI NEGARA BERKEMBANG KAWASAN ASIA
Authors: Ananda Caesario Fajry , Saputra Putu Mahardika Adi
Published: September 2024

Foreign Direct Investment (FDI) holds a crucial role, benefing not only the investor's home country but also contributing to the prospery of the host nations, especially the developing countries in the Asian region, which stand as the largest recipients of global FDI. This research aims to pinpoint the factors influencing FDI inflows in Asian developing countries from 2012 to 2019. Employing panel data analysis techniques, the study reveals that market size, trade openness, and infrastructure significantly drive FDI inflows. Conversely, human capal and taxation are identified as hindering factors, while the perception of corruption does not notably impact FDI. By enhancing our comprehension of the dynamics shaping FDI trends in Asian developing nations, this research provides valuable insights for policymakers and stakeholders.  serves as a guide for those seeking to create an environment conducive to foreign investment, facilating sustainable economic growth and development in the region.
VALUASI EKONOMI OBJEK WISATA GLAMPING MENOREH DI KAWASAN WISATA ALAM NGLINGGO, KABUPATEN KULON PROGO
Authors: Muhammad Rayhan Ramadhan  , Shofwan
Published: September 2024

Kulon Progo Regency is one of the areas that utilize the cultural ecosystem services of pine forests as a natural tourism area in the form of a glamorous camping (glamping) experience, precisely in the Menoreh hills, Nglinggo, Pagerharjo Village. This tourist attraction has attracted many visitors for five years, from 2018 – 2022. Therefore, this research aims to find out how to assess the economics of cultural environmental services in the Nglinggo pine forest, Kulon Progo Regency. This research uses the Contingent Valuation Method (CVM) approach by calculating the Willingness to Pay (WTP) value. The average value that tourist visitors are willing to serve is IDR 13,779.07 and the total WTP value is IDR 563,701,753.7. The level of satisfaction is a variable that has a significant effect on the willingness of tourist visitors to pay WTP fees.
 
Kabupaten Kulon Progo menjadi salah satu daerah yang memanfaatkan jasa lingkungan budaya hutan pinus sebagai kawasan wisata alam berupa pengalaman glamour camping (glamping), tepatnya di perbukitan Menoreh, Nglinggo, Desa Pagerharjo. Objek wisata tersebut telah menarik banyak pengunjung selama kurun waktu lima tahun, dari tahun 2018 – 2022. Oleh karena itu, penelitian ini bertujuan untuk mengetahui bagaimana menilai ekonomi jasa lingkungan budaya di hutan pinus Nglinggo, Kabupaten Kulon Progo. Penelitian ini menggunakan pendekatan Contingent Valuation Method (CVM) dengan menghitung nilai Willingness to Pay (WTP). Nilai rata-rata yang bersedia dibayarkan oleh pengunjung wisata sebesar Rp13.779,07 dan nilai total WTP sebesar Rp563.701.753,7. Tingkat kepuasan menjadi variabel yang berpengaruh signifikan terhadap kesediaan pengunjung wisata untuk membayar biaya WTP.
PENGARUH PERTUMBUHAN EKONOMI, INVESTASI, DAN UPAH MINIMUM TERHADAP TINGKAT PENGANGGURAN DI JAWA BARAT
Authors: Ramadhani Qatrunnada Nisrina , Ananda Candra Fajri
Published: September 2024

The objective of this study is to find out how the unemployment rate in each of West Java's districts and cities would change between 2018 and 2022 in relation to economic growth, investment, and minimum wages. Over a five-year period, a panel data collection comprising 27 districts and towns was utilized to accomplish this goal. Regression analysis with panel data was applied. The findings indicate that from 2018 to 2022, minimum wage, investment, and economic growth all had a considerable impact on the unemployment rate in all West Javan districts and cities. Economic growth holds a negative and significant effect on the unemployment rate, while investment has a negative and significant impact at 10% alpha on the unemployment rate. The minimum wage significantly and positively affects the unemployment rate. Investments made are mostly capital intensive and not yet equally distributed throughout West Java. Therefore, in order to lower unemployment, local governments are expected to increase labor-intensive investment.
Assessing the Current Limitations of Large Language Models in Advancing Health Care Education
Authors: Kim JaeYong , Vajravelu Bathri Narayan
Published: September 2024

The integration of large language models (LLMs), as seen with the generative pretrained transformers series, into health care education and clinical management represents a transformative potential. The practical use of current LLMs in health care sparks great anticipation for new avenues, yet its embracement also elicits considerable concerns that necessitate careful deliberation. This study aims to evaluate the application of state-of-the-art LLMs in health care education, highlighting the following shortcomings as areas requiring significant and urgent improvements: (1) threats to academic integrity, (2) dissemination of misinformation and risks of automation bias, (3) challenges with information completeness and consistency, (4) inequity of access, (5) risks of algorithmic bias, (6) exhibition of moral instability, (7) technological limitations in plugin tools, and (8) lack of regulatory oversight in addressing legal and ethical challenges. Future research should focus on strategically addressing the persistent challenges of LLMs highlighted in this paper, opening the door for effective measures that can improve their application in health care education.
Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative
Authors: Kumar Komal , Childs Amber W , Kohlmeier Jonathan , Kroll Elizabeth , Zant Izabella , Stolzenbach Stephanie , Fenkel Caroline
Published: September 2024

Background

The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings.

Objective

The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs.

Methods

A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience.

Results

The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05).

Conclusions

Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.
Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study (Preprint)
Authors: Brands Martijn R , Haverman Lotte , Muis Jelmer J , Driessens Mariëtte H E , Meijer Stephan , van der Meer Felix J M , de Jong Marianne , van der Bom Johanna G , Cnossen Marjon H , Fijnvandraat Karin , Gouw Samantha C
Published: September 2024

BACKGROUND

To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial.

OBJECTIVE

This study aims to assess patients’ and health care providers’ perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns.

METHODS

In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities.

RESULTS

Participants expected a PHR would increase the transparency of health information, improve patients’ understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload.

CONCLUSIONS

People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition.
Implementation of Artificial Intelligence–Based Diabetic Retinopathy Screening in a Tertiary Care Hospital in Quebec: Prospective Validation Study (Preprint)
Authors: Antaki Fares , Hammana Imane , Tessier Marie-Catherine , Boucher Andrée , David Jetté Maud Laurence , Beauchemin Catherine , Hammamji Karim , Ong Ariel Yuhan , Rhéaume Marc-André , Gauthier Danny , Harissi-Dagher Mona , Keane Pearse A , Pomp Alfons
Published: September 2024

BACKGROUND

Diabetic retinopathy (DR) affects about 25% of people with diabetes in Canada. Early detection of DR is essential for preventing vision loss.

OBJECTIVE

We evaluated the real-world performance of an artificial intelligence (AI) system that analyzes fundus images for DR screening in a Quebec tertiary care center.

METHODS

We prospectively recruited adult patients with diabetes at the Centre hospitalier de l’Université de Montréal (CHUM) in Montreal, Quebec, Canada. Patients underwent dual-pathway screening: first by the Computer Assisted Retinal Analysis (CARA) AI system (index test), then by standard ophthalmological examination (reference standard). We measured the AI system's sensitivity and specificity for detecting referable disease at the patient level, along with its performance for detecting any retinopathy and diabetic macular edema (DME) at the eye level, and potential cost savings.

RESULTS

This study included 115 patients. CARA demonstrated a sensitivity of 87.5% (95% CI 71.9-95.0) and specificity of 66.2% (95% CI 54.3-76.3) for detecting referable disease at the patient level. For any retinopathy detection at the eye level, CARA showed 88.2% sensitivity (95% CI 76.6-94.5) and 71.4% specificity (95% CI 63.7-78.1). For DME detection, CARA had 100% sensitivity (95% CI 64.6-100) and 81.9% specificity (95% CI 75.6-86.8). Potential yearly savings from implementing CARA at the CHUM were estimated at CAD $245,635 (US $177,643.23, as of July 26, 2024) considering 5000 patients with diabetes.

CONCLUSIONS

Our study indicates that integrating a semiautomated AI system for DR screening demonstrates high sensitivity for detecting referable disease in a real-world setting. This system has the potential to improve screening efficiency and reduce costs at the CHUM, but more work is needed to validate it.
Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study (Preprint)
Authors: Zhang Min Jin , Luk Tzu Tsun , Ho Sai Yin , Wang Man Ping , Lam Tai Hing , Cheung Yee Tak Derek
Published: September 2024

BACKGROUND

The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited.

OBJECTIVE

We used ecological momentary assessment (EMA) to examine both the within-person– and between-person–level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students.

METHODS

From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase.

RESULTS

A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05).

CONCLUSIONS

By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults.
Virtual Reality Training for balance rehabilitation in neurological disorders: A Systematic Review and Meta-Analysis (Preprint)
Authors: JiaDong Lv , Zezhi Ke , Nan Bu , Shuai Yuan , Panbing Zhang , SiJin Meng
Published: September 2024

BACKGROUND

Neurological disorders such as Parkinson's disease, multiple sclerosis, cerebellar ataxia, and Alzheimer's disease often impact the body's balance functions. The primary cause of balance deficits in these conditions is the effect on the sensory-motor system and the pathways controlling neuromuscular functions. This disruption increases the likelihood of falls while walking. Evidence-based research has demonstrated the efficacy of VR in addressing balance issues associated with neurological conditions.

OBJECTIVE

To investigate the efficacy and safety of virtual reality training for treating balance dysfunction in various neurological disorders.

METHODS

Data Sources: PubMed, Cochrane Library, EMBASE, and Web of Science were searched from their inception until June 20th, 2024. The PROSPERO registration number for this study is CRD42024484012.
Study Selection: Randomised controlled trial of the single or combined use of virtual reality technology as an intervention for the treatment of balance disorders caused by various neurological disorders.
Data Extraction: The data was extracted independently by two authors .The quality of the included studies was assessed according to the Cochrane Risk of Bias Tool. The results of continuous variables after treatment were represented by the standardized mean difference (SMD) and its 95% confidence interval (CI). Overall heterogeneity was controlled by excluding a study through sensitivity analysis. Reporting bias was assessed using the Begg’s test and presented in a funnel plot.

RESULTS

A total of 36 studies with 1311 subjects were included in the quantitative evaluation. The neurological disorders were classified into eight distinct groups: stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, Ataxia,
traumatic brain injury, tropical spastic paraparesis and unilateral peripheral vestibular loss. Stroke patients experienced enhanced balance due to VR (SMD = 0.65; 95% CI = 0.40 to 0.90; Z = 5.10; p < 0.001), multiple sclerosis sufferers (SMD = 0.57; 95% CI = 0.29 to 0.86; Z = 3.90; p < 0.001),Parkinson's patients (SMD = 0.49; 95% CI = 0.12 to 0.86; Z = 2.62; p < 0.05) and unilateral peripheral vestibular loss (SMD = 0.61; 95% CI = 0.23 to 0.99; Z = 3.17; p < 0.05) .

CONCLUSIONS

Virtual reality (VR) holds potential as an effective therapy for balance training in adults suffering from neurological conditions.

CLINICALTRIAL

The PROSPERO registration number for this study is CRD42024484012.
Does daily happiness and nervousness differ in adolescents and young adults in three Latin American cities: an experience sampling study (Preprint)
Authors: Vilela-Estrada Ana L. , Villarreal-Zegarra David , Mayo-Puchoc Nikol , Holt Nicola , Flórez-Varela Ángela , Fung Catherine , Ariza-Salazar Karen , Carbonetti Fernando Luis , Flores Sumiko , Carbonel Adriana , Olivar Natividad , Gomez-Restrepo Carlos , Brusco Luis Ignacio , Priebe Stefan , Diez-Canseco Francisco
Published: September 2024

BACKGROUND

Experience Sampling Methods (ESM) have been used in clinical research to collect data on emotional and behavioural states in real life contexts among different populations. Although the use of ESM in mental health has increased, it has not been applied to larger samples of young people in disadvantaged urban settings.

OBJECTIVE

This study aimed to determine the extent to which mood status scores (happiness and nervous) vary during a week as a function of having or not having symptoms of depression and/or anxiety in a sample of adolescents and young adults in the cities of Buenos Aires (Argentina), Bogotá (Colombia) and Lima (Peru). A secondary objective was to identify factors associated with mood scores, including socio-demographics, quality of life, and daily activities.

METHODS

The study was part of the OLA research programme, which focuses on mental health resources for young people. Participants (n=143) aged 15-24 completed daily ESM assessments over a week using the mobile App. Data were analysed using multilevel linear regression to evaluate associations between depressive/anxiety symptoms, mood status variability, and factors influencing mood average.

RESULTS

The analysis revealed that depressive and/or anxiety symptoms were not significantly associated with increased variability in mood scores. However, males exhibited greater variability in happiness and nervousness scores than females. Additionally, young people showed higher variability in nervousness than adolescents.
Regarding average happiness scores, young adults reported higher average happiness than adolescents. Engaging in structured activities (e.g., sports, music lessons, dance classes) was associated with increased happiness. In contrast, instrumental activities (e.g., cleaning, shopping, meal preparation, taking medication) and work-related tasks were linked to lower happiness and higher nervousness. Quality of life was positively correlated with happiness and negatively correlated with nervousness. Finally, as for average scores, a strong negative correlation was found between happiness and nervousness.

CONCLUSIONS

Our study reveals that depressive and anxiety symptoms do not significantly affect the variability in predicted happiness and nervousness scores. However, we observed that demographic factors, such as gender and age, play a role in emotional variability.

CLINICALTRIAL
Examining the Efficacy of a Telemedicine-Based Virtual Reality Clinic in Treating Adults with Specific Phobia: Protocol for A Feasibility Randomized Controlled Efficacy Trial (Preprint)
Authors: Schuler Kaitlyn R. , Ong Triton , Welch Brandon M , Craggs Jason G. , Bunnell Brian E.
Published: September 2024

BACKGROUND

Virtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Further, the majority of VR applications used in therapy are not designed for mental healthcare. VR has the potential to enhance TMH through innovative technology solutions designed specifically for the enhancement of remotely delivered evidence-based practices. This feasibility randomized controlled efficacy trial aims to fill both of these gaps by piloting a novel telemedicine-based VR application (Doxy.me VR) equipped with animal phobia exposure stimuli.

OBJECTIVE

This is a feasibility randomized controlled efficacy trial comparing exposure therapy via a telemedicine-based VR clinic versus standard TMH to adults with intense fear of dogs, snakes, and/or spiders. The primary objective is to assess the feasibility of a fully-powered trial. The secondary objective is to conduct a preliminary examination of clinical outcomes (e.g., specific phobia symptoms).

METHODS

This single-site trial will enroll a minimum of 30 and maximum of 60 adults with self-reported fear of dogs, snakes, and/or spiders. Potential participants will be recruited through online platforms and posting flyers. All procedures will be partially automated using REDCap forms and surveys, but the baseline assessment of phobia symptoms will be administered by the study therapist.

RESULTS

Feasibility of the proposed trial methodology will be assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while co-varying for pre-treatment scores, will be conducted using r-ANOVA along with differences in therapeutic alliance and presence. Data obtained from these analyses will inform power analyses for a fully powered efficacy trial.

CONCLUSIONS

This feasibility RCT comparing Doxy.me VR vs. TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias.

CLINICALTRIAL

This trial was registered on ClinicalTrials.gov [NCT06302868]
Artificial Intelligence and Primary Care: A Scoping Review (Preprint)
Authors: Katonai Gellert , Arvai Nora , Mesko Bertalan
Published: September 2024

UNSTRUCTURED

Introduction: Rapid advancements in artificial intelligence (AI) development are significantly impacting the medical field. Understanding AI's application in primary healthcare (PHC) is crucial for maximizing its benefits in this heavily overburdened branch of medicine. This review aims to synthesize the current state of AI implementation and integration in general practice (GP).
Methods: This scoping review follows the PRISMA-ScR guidelines to screen articles that explore the intersection of AI and primary care. By employing a comprehensive approach, we captured the possible range of AI applications and their implications in PHC. After applying inclusion and exclusion criteria, 107 studies were included in the final analysis.
Results: Thematic analysis revealed three main subtopics. The first theme involves practical and potential usage of this technology, covering administrative tasks, drug management, and disease screening and diagnosis across various fields such as cardiology, dermatology, and ophthalmology. The second theme examines the reactions of the members of healthcare to AI integration, highlighting both enthusiasm and concerns. The third theme addresses broader considerations, including equity, ethics, and research and implementation frameworks.
Discussion: The envisioned uses of AI in PHC align with current efforts, including administrative support, diagnostics, and practice management. However, several key issues require resolution to ensure seamless implementation and equity in AI applications, such as incorporating AI into daily practice, preparing electronic health systems, and maintaining equity while enhancing GP.
Conclusions: AI integration in PHC shows promising, albeit small-scale, findings. With further research and best practices, AI has the potential to significantly support and enhance primary care. Common research areas include administrative support via generative AI, triage, and diagnostic aid. Healthcare professionals often exhibit ambivalence towards AI in PHC, but with further studies, best practices, and active involvement, AI can substantially support this crucial branch of medicine.
A serious game prototype for preschool children with deficits in theory of mind and deception detection abilities: social cognition empowerment game (Preprint)
Authors: Sadri Mona , Rafezi Zohreh , Rahimizadeh Omid
Published: September 2024

BACKGROUND

Deficits in Theory of Mind and deception detection can lead to worsening problems and indirectly impact mental health. The Social Cognition Empowerment game is an app designed to enhance these skills in preschool-aged children.

OBJECTIVE

The aim of this article was to design, develop, validate and test an app prototype using gamification principles to assist preschoolers in theory of mind and deception detection abilities.

METHODS

The game's design, principles and contents were based on theoretical foundations and existing examples in the fields of theory of mind, deception detection and gamification. After developing the game, content validation of the application was conducted by experts' opinions. Then, the game was performed on a sample of 40 female preschoolers in 14 separate sessions. Finally, the data about the effectiveness of this serious game was obtained through interviews with players (n: 40) and their mothers (n: 40).

RESULTS

The results confirmed the overall acceptability of the application. The developed game had sufficient content validity and significantly improved the recognition of emotions and beliefs. However, its influence on deception detection wasn’t definite. In addition, interviews provided more detailed information about the game’s sections and components (rewards, instructions, difficulty level, etc)

CONCLUSIONS

The findings indicated that the social cognition empowerment game partially improved the cognitive and emotional theory of mind. Also, the inclusion of mothers was a helpful strategy for the initial evaluation of the game. Although the current results are still inconclusive as to whether “The Social Cognition Empowerment Game” is effective as a computer-based intervention tool, they warrant further research in this direction. Future studies should utilize quantitative methods under controlled conditions to obtain more definitive results.

CLINICALTRIAL

the relevant Ethics Committee of Allameh Tabataba’i university approved the study. Our ethical code is: IR.ATU.REC.1399.036.
The link of Research Ethics Committees Certificate is here: https://ethics.research.ac.ir/ProposalCertificateEn.php?id=156246&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true
Implementing a digital adherence intervention for tuberculosis patients in China: Qualitative study (Preprint)
Authors: Zhang Weile , Su Min , Li Wenhui , Liu Zelin , Gao Yulong
Published: September 2024

BACKGROUND

Poor adherence to anti-tuberculosis treatment is a main threat for the treatment success. Digital health interventions such as electronic monitors (e-monitors) and the WeChat application (app) may improve treatment adherence in TB patients.

OBJECTIVE

The study aimed to examine the key facilitators, barriers, and drivers of barriers of implementing e-monitors and the WeChat app.

METHODS

Personal, semi-structured interviews with workers in healthcare institutions in three cities in Inner Mongolia were conducted between June and December 2023 when e-monitors and the WeChat app were introduced as part of a TB treatment strategy. The consolidated framework for implementation research (CFIR) was used to develop interview questions.

RESULTS

A total of 143 healthcare workers were interviewed. The key facilitators included the e-monitors helped to improve medication adherence. Second, the intervention itself was cost-effective. Respondents took the initiative to learn about the intervention. Finally, the indicators were implemented through a top-down process, which increased the efficiency of the implementation of this policy decision. The key barriers were insufficient external financial incentives, available resources are inadequate in primary healthcare setting, negative attitudes of the implementers, a lack of feedback in implementation. Drivers of barriers included the values with limited utility of the intervention, rigid organizational administrative hierarchy, and rights and responsibilities mismatch.

CONCLUSIONS

policymakers should pay attention to the barriers and its drivers to implementing the intervention. Adherence to patient-cantered, cultivate a teamwork atmosphere, and improve incentives and performance evaluation systems are necessary to improve the implementation of the intervention.

CLINICALTRIAL

ISRCTN15169616. Registered on 29 July 29, 2023
Assessing the impact of a mHealth intervention (BreMo) on knowledge of breast cancer and breast self-examination (BSE) and evaluating the user experience among nurses in Nepal (Preprint)
Authors: Kanodia Sweekrity , Singh Deependra , Basu Partha , Thalabard Jean-Christophe , Reyal Fabien
Published: September 2024

BACKGROUND

Mobile health (mHealth) applications represent a promising tool to bridge the healthcare
gaps by enhancing knowledge and facilitating early detection practices like breast self-examination
(BSE).

OBJECTIVE

This study aimed to evaluate the effectiveness and usability of BreMo in increasing breast cancer
knowledge and practice of BSE among nurses in Nepal.

METHODS

We conducted a quasi-experimental study involving 92 nurses at Nepalgunj Medical College,
utilizing the BreMo application over a three-month period. Pre- and post-intervention assessments were
conducted to measure changes in knowledge and usability, employing the use of a self-administered
BCAMAQ questionnaire. Change in mean knowledge scores and shift in first quantile of scores, Q1 after
the intervention were evaluated. Using the Likert scale, BreMo’s user experience was also assessed in
terms of usability, content, privacy, acceptability and satisfaction.

RESULTS

We found a significant increase in mean knowledge score (shift from 20.86 to 21.72, p<0.001) of
participants between pre-intervention and post-intervention phases. Similarly, a significant shift in first
quartile (Q1) mean knowledge score (shift from 20.68 to 21.52, p<0.001) was observed between pre-
intervention and post-intervention phases. Highest scores were obtained in BSE knowledge (9.1%
increase) and practice (14.3% increase). BreMo was rated highly (more than 90% rated at higher than 4,
out of 7) in all categories: usability, privacy, content clarity, acceptability and satisfaction except privacy
where 51% participants were found to be unsure.

CONCLUSIONS

We showed the valuable potential of mHealth application to enhance breast cancer
knowledge and BSE practices among nurses in Nepal given that women are educated enough to read
and use the application. The higher usability ratings of the application underscore its feasibility as a health
education tool.
Quantum Ethics: Navigating the Intersection of Quantum Mechanics and Metaethics in the Digital Era for a Just and Equitable Society
Authors: Damayanti Cicilia
Published: September 2024

The advancement of quantum technologies and their integration with digital systems has resulted in enormous changes in society, providing new opportunities for furthering subjects such as artificial intelligence, the internet of things (IoT), and quantum computing. The ethical ramifications of these technologies, however, have not been adequately investigated, raising worries about their possible harmful influence on society. This research examines the convergence of quantum physics, metaethics, and the digital era in order to determine the implications of these technologies and to offer ethical frameworks for maintaining a just and equitable society. It will analyse the obstacles faced by the employment of quantum technologies in the digital era, including concerns relating to privacy, security, and the possibility for biased decision-making, through a thorough analysis of relevant literature. It then investigates the possibilities of multidisciplinary approaches that combine quantum mechanics and metaethics principles to overcome these issues and construct ethical frameworks that emphasize human values. The report suggests that a comprehensive strategy that prioritizes ethical issues is critical for the development of quantum technologies in the digital era. This necessitates a coordinated effort among stakeholders from many sectors such as technology, ethics, policy, and governance. The article provides a complete ethical framework that incorporates quantum mechanics and metaethics principles to ensure that the advantages of new technologies are realized while limiting any negative consequences.
Intimate Language in Traditional Markets: Challenging Public Space Norms through Kristeva’s Intertextuality
Authors: Musliha Ayu , Rosa Dien Vidia , Prasetyo Hery
Published: September 2024

The use of intimate language in public spaces is a phenomenon that emerges in the interactions of economic actors in traditional markets. Therefore, language intimacy deconstructs social norms that should not be displayed in public spaces. However, language intimacy has emerged in traditional markets for a long time in the interactions of economic actors, including sellers, buyers, porters, parking attendants, and the social gathering community. This research explores how intimate language is articulated in an economic space closely related to the ethnic identity of economic actors in traditional markets in the Jember region. The ethnic diversity in question includes Javanese, Madurese, Chinese/Chinese, and Arab. This phenomenon was researched qualitatively using a post-structuralist approach and applying Julia Kristeva's theory of intertextuality. Data analysis uses two Kristeva concepts, namely intertextuality and suprasegmental. The data is processed by looking at the text production process originating inside and outside the text. The research results show that the intimacy of language, usually used in the private sphere, has succeeded in breaking down the rigidity of language in the public sphere, besides dissolving social relations between economic actors with various ethnicities and social classes. Thus, the use of greetings in intimate language closely related to ethnic identity is experiencing development and merging with the space of familiarity and closeness built by economic actors in traditional markets.
THE GUATEMALA TREE FROG, Ecnomiohyla minera (ANURA: HYLIDAE), AN ADDITION TO THE HERPETOFAUNA OF MEXICO
Authors: Barrio-Amorós César Luis , Sánchez-Ochoa Daniel , Kemal Akcali Christopher , Flores-Villela Oscar A. , Palacios-Aguilar Ricardo , Pérez-Mendoza Hibraim Adan
Published: September 2024

The documented species of the genus Ecnomiohyla in Mexico currently include Ecnomiohyla echinata and Ecnomiohyla valancifer. This note highlights a noteworthy expansion of distribution within the Nahá Flora and Fauna Protection Area (ANPFF) involving a species called Ecnomiohyla minera, previously documented in Guatemala and Belize. This encounter holds significant implications for the study of amphibians in Mexico, signifying not only a range expansion but also the identification of a new species within the country.
SEGUNDO REGISTRO DE LA TAPALCUA Gymnopis syntrema (AMPHIBIA: GYMNOPHIONA: DERMOPHIIDAE) PARA MÉXICO EN TRES LAGUNAS, LACANJÁ CHANSAYAB, OCOSINGO, CHIAPAS
Authors: Melgar-Martínez Ana Iris , Chankin-Chankayun Eduardo , Villalobos Juárez Ivan , García-Padilla Elí
Published: September 2024

Presentamos nueva evidencia de la presencia de la Tapalcua (Gymnopis syntrema) dentro del territorio mexicano. El hecho tuvo lugar en el Santuario del Cocodrilo, Tres Lagunas, comunidad de Lacanjá Chansayab, Ocosingo, Chiapas dentro de la región conocida como Montañas del Este o también conocida como Selva Lacandona.
NECROPHAGY IN TWO SNAKE SPECIES OF THE GENUS Leptodeira (SQUAMATA: DIPSADIDAE)
Authors: Gamez Duarte Edgar Alberto , Jacobo González José David , Manríquez Soto José Martin , Castro Bastidas Héctor Alexis , Serrano José Manuel
Published: September 2024

Snakes of the genus Leptodeira are known to be predators with a wide variety of prey known in their diet. The predation observations reported here were made in the state of Sinaloa, in northwestern Mexico. Our study reports the first record of L. splendida and L. septentrionalis consuming dead toads of the species Incilius mazatlanensis. In addition, we report the sighting of L. splendida feeding on a live toad of Rhinella horribilis. Therefore, this is the first report of necrophagy for both Leptodeira species. The possibilities of chemosensory signals for prey detection in these snakes and opportunistic predation when live prey is scarce are discussed.
PRIMER REGISTRO DE DEPREDACIÓN DE ARAÑAS (ARANEA: LYCOSIDAE) POR LA RANA DEL VOLCÁN SAN MARTÍN Craugastor loki (CRAUGASTORIDAE)
Authors: Chávez Ramírez Eduardo Aarón , Oaxaca-Oñate Grisel , Córdova-Ortiz Alberto , Nuñez-Bazán Reinier , de Luna Manuel , Henández-Ordoñez Omar , Guerrero José Antonio , Urbina-Cardona J. Nicolas
Published: September 2024

Reportamos por primera vez un arácnido juvenil de la familia Lycosidae en la dieta de una hembra de la rana del Volcán San Martín (Craugastor loki). El hallazgo fue registrado dentro de la selva alta perennifolia de la Sierra de Santa Marta perteneciente a la Reserva de la Biósfera Los Tuxtlas, Veracruz, México.
APPLICATION OF B.F. SKINNER'S BEHAVIORISM LEARNING THEORY IN ISLAMIC EDUCATION LEARNING FOR HIGH SCHOOL STUDENTS
Authors: Yuli Yunita Nita , Firmansyah Alfitra , Muqowim Muqowim , Nurdin Muhammad Alwi
Published: September 2024

This study aimed to know and describe the application of B.F Skinner's Operant Conditioning Behaviorism Learning Theory in Islamic Education learning at high school students and to know students' responses. In this study, the researchers described the forms of stimulus provision and the principles of Operant Conditioning B.F Skinner applied in Islamic Education learning. This research used qualitative methods. The data collection techniques used observation, interviews, and documentation. While data analysis is done with several stages, namely data reduction, data presentation, and conclusion drawing. The results showed that B.F Skinner's Operant Conditioning Behaviourism Learning Theory in Islamic Education learning was successfully applied. The implication of this research shows that overall the application of the theory resulted in a good response and changes in student behaviour in a positive direction in the form of the formation of learning motivation, activeness, reinforcement and improved student memory.
Network structure of domestic mammal hosts and zoonotic bacteria: implications for pathogen transmission
Authors: Pacheco María , Devoto Mariano
Published: September 2024

Zoonotic diseases account for 75% of emerging infectious diseases,
posing significant global health challenges. Understanding the complex
host-pathogen interactions is crucial for effective disease management.
This study constructs and analyses a global bipartite network of
zoonotic bacteria and their domestic mammal hosts, aiming to explore how
domestication time and phylogenetic relationships influence network
structure. The network, consisting of 24 domestic mammal species and 51
zoonotic bacterial species, reveals a non-random structure with high
nestedness and low modularity. Results indicate that the richness of
zoonotic bacteria per host is positively correlated with domestication
time but not with phylogenetic distance from humans. These findings
suggest that early-domesticated species act as ”sinks” for newly
exposed zoonotic bacteria, driven by preferential attachment dynamics.
This network-level insight provides a valuable framework for predicting
and managing zoonotic disease transmission, emphasising the importance
of targeted interventions for highly connected host species.