bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and the associated factors of burnout among the critical healthcare professionals during the post-pandemic era: a multi-institutional survey in Taiwan with a systematic review of the Asian literatures
Authors: Lee Yueh-Lin , Dai Jhih-Wei , Li Xiu-Wei , Chiang Min-Ying , Chen Po-Ting , Lin Yu-Chen , Wang Chien-Ho
Published: July 2024

Background & Aims:
Burnout is a global concern, and critical healthcare professionals have been identified as a high-risk population of burnout. Early identification is crucial, but the prevalence of burnout and its risk factors demonstrate significant geographical variations. This study aims to investigate the prevalence of burnout among critical healthcare professionals and explore potential risk factors during the post-pandemic era in Taiwan.
Methods:
A web-based questionnaire survey was conducted from December 1, 2023, to January 31, 2024, targeting critical healthcare professionals employed in selected medical institutions affiliated with the Chang Gung Memorial Hospital Foundation, one of Taiwan's largest healthcare organizations. Demographic information, the Subjective Happiness Scale (SHS), current work stressors and self-reported general health data were collected. The study utilized the MBI-Human Services Survey for Medical Personnel (MBI-MP). Univariate and multivariate logistic regression were employed to investigate the association between risk factors and each burnout subscales. A systematic review of Asian literature concerning burnout among critical care practitioners was also conducted in accordance with PRISMA guideline.
Results:
In our study, 254 participants were enrolled, with an overall burnout rate of 35.4%. The prevalence of high emotional exhaustion (EE) was 70.9%, high depersonalization (DP) was 56.3%, and low personal accomplishment (PA) was 60.6%. Young, unmarried populations, individuals with limited work experience, longer working hours, and night shifts are potential vulnerable groups susceptible to burnout. The top three stressors identified were excessive workload, the burden of administrative tasks, and a shortage of vacation time. Our systematic review included 20 Asian studies on the same issue, with variable burnout prevalence ranging from 16.3–82.1%.
Conclusion:
The prevalence of burnout was high among critical healthcare professionals in post-pandemic Taiwan, particularly affecting younger, unmarried populations and individuals with limited work experience, longer hours, and more night shifts. The influence of pandemic-related factors has decreased. Regional variations in burnout have been observed across Asia, highlighting the need for further research to identify local risk factors and protect the well-being of professionals and healthcare quality.
Postoperative blood pressure variability as a risk factor for postoperative delirium in the patients receiving cardiac surgery
Authors: Shen# Xiao , Tao# Hong , Chen Wenxiu , Sun Jiakui , Jin Renhua , Zhang Wenhao , Hong Liang , Zhang Cui
Published: July 2024

Background: Delirium is one of the most common neurological complications after cardiac surgery. The purpose of our study was to assess the relationship between perioperative blood pressure variability (BPV) and postoperative delirium (POD) in the patients after cardiac surgery.
Methods: Adult patients received cardiac surgery and stayed in Cardiovascular Intensive Care Unit (ICU) for more than 24h after surgery during the study period between June 2019 and December 2022 were included in this study. Baseline characteristics, perioperative hemodynamic variables and postoperative laboratory results of the cardiac patients were collected and analyzed. Perioperative BPV was quantified by calculating the standard deviation (SD) and average real variability (ARV) of blood pressure. Assessment of delirium was based on the mental status of the patients and CAM-positive. The relationship between perioperative BPV and POD was analyzed by LASSO and logistic regression using R (R package, 4.3.2).
Results: The incidence of POD was 15.0% (324/2164) in the patients receiving cardiac surgery, and the average day for POD occurred at day 3 after surgery. Patients with delirium had markedly lower levels of intraoperative mean blood pressure (BP_mean, P=0.015) and BP variability (BP_arv, P<0.001) as well as postoperative mean blood pressure within 24h (PM_IBPm_24h_mean, P=0.003) when compared to those patients without delirium. Whereas, postoperative ARV for systolic blood pressure (PM_IBPs_24h_arv, 8.64 [7.32, 10.2] vs. 7.91 [6.57, 9.43] mmHg, P<0.001), diastolic blood pressure (PM_IBPd_24h_arv, 4.00 [3.17, 4.83] vs. 3.77 [3.11, 4.60] mmHg, P=0.014) and mean blood pressure (PM_IBPm_24h_arv, 5.23 [4.46, 6.19] vs. 4.94 [4.11, 5.94] mmHg, P=0.001) at 24h was significantly higher in the patients with POD than those without. LASSO regression and further logistic regression revealed that intraoperative BP_arv (OR:0.92, 95%CI: 0.89-0.96, P<0.001), PM_CVPm_24h_mean (mean central venous pressure at 24h postoperatively, OR:1.05, 95%CI: 1.00-1.10, P=0.048) and PM_IBPs_24h_arv (OR:1.17, 95%CI: 1.06-1.30, P=0.002) were independent risk factors for POD.
Conclusions: Postoperatively high BPV exposure rather than hypotension contributed to the occurrence of POD in the patients after cardiac surgery. Maintaining a relatively stable blood pressure after surgery might be beneficial in reducing the incidence of POD in the patients receiving cardiac surgery.
iTRAQ proteomic analysis of exosomes derived from synovial fluid reveals disease patterns and potential biomarkers of Osteoarthritis
Authors: Wu Xiaomin , Li Huaiming , Zou Huichun , Li Jianchi , Meng Fengzhen , Li Zhongjie , Pan Yu , Lui Tun Hing , Pan Xiaohua
Published: July 2024

The exosomes derived from synovial fluid (SF-exo) are indicative of the condition of the originating cell. The proteomics profiles of SF-exo are of great interest for the diagnosis of Osteoarthritis (OA). To delineate the proteomic differences between SF-exo from OA patients and those from healthy individuals, an iTRAQ quantitative proteomics was performed. A total of 439 proteins were identified, with 20 proteins exhibiting increased expression and 5 showing decreased expression in OA group. Bioinformatic analysis showed these differentially expressed proteins (DEPs) were involved in various immunity-related process terms, including complement activation and antigen binding. For further screening, we download a publicly dataset of synovial fluid and compared with our dataset. This comparison identified 5 DEPs were overlapping in two datasets, Protein-protein interaction showed C3, C4B and APOM were part of a tight interaction network. Receiver operating characteristic curve analysis and enzyme-linked immunosorbent assay implied that the 5 DEPs (C3, C4B, APOM, MMP3, DPYSL2) derived from SF-exo were potential diagnostic biomarkers for OA. In conclusion, our study first described the proteomic landscape of SF-exo in OA and identified several potential biomarkers. These findings may provide valuable insights for diagnosis and treatment of OA.
Facile preparation of hydrophobic coatings using modified ZnO/Silica composite nanoparticles
Authors: Kianpour Amir Hossein , Ahmadi-hamedani Mahmood , Alamdari Sanaz
Published: July 2024

Collecting urine samples from cats, which instinctively bury their waste, is challenging for veterinarians. Superhydrophobic cat litter offers a solution by preventing urine absorption, making it easier to collect uncontaminated samples. This innovation simplifies diagnostics for veterinarians and reduces stress for both pets and their owners. In the present study, the hydrophobic coating was synthesized by zinc oxide/silica composite nanoparticles (ZnO/SiO2 CNPs) modified with perfluorodecyltrichlorosilane (FDTS) compounds for soil/stone/grain sand and glass surfaces. Tetraethoxysilane (TEOS) and zinc acetate dihydrate were used as precursors and FDTS was used to modify the surface of a synthesized composite nanoparticles. Prepared modified ZnO/SiO2 composite sol was sprayed on various coatings (usual/cat soil, sand, stone, glass) and the water contact angles were measured. The all surfaces became hydrophobic after applying the modified composite coating; For the cat litter, the average contact angle of 110.3° was achieved that confirm the hydrophobicity properties. XRD, FTIR, EDX and FESEM analyzes were performed to investigate the structural and morphological features of the synthesized ZnO/SiO2 CNPs. The coated stone's chemical resistance was tested by subjecting it to acidic and neutral environments for 20 hours and it was found that the coating was more hydrophobic in the neutral environment than in the acidic one. Obtained results showed that facile synthesized composite has the potential to improve agricultural practices in dry areas, gather pet urine for use in veterinary medicine, and have a number of environmental benefits.
Replacement of elephant grass with urea lime molasses straw mixed on rumen metabolite, digestibility, and blood chemistry of Etawah crossbred goat
Authors: Cakra I G L O , Trisnadewi A A A S , Melati N P Y , Nuriyasa I M
Published: July 2024

This study aims to examine the level of use of Urea Lime Molasis Straw (ULMS) as a substitute for elephant grass in the Etawah crossbreed goat ration. The study used four female goats weighing 25 - 36 kg with a 4 x 4 Latin square design. Livestock were placed in the metabolism cage individually. The provision of ration was conducted according to the dry material requirement, which is 3% of body weight. Feeding was carried out twice daily in the mornings at 08.00 and afternoons at 16.00, and drinking water was provided ad libitum. The variables observed were consumption, coefficient of dry matter and nutrients, rumen metabolite products and blood chemistry propyl. The variables measured were the nutritional content, consumption, rumen metabolite products, digestibility coefficient, and blood chemistry levels. The replacement of elephant grass with ULMS up to 40% of the 60% forage in the ration did not significantly affect digestibility, rumen fluid pH, BUN, or total blood protein, but had a significant effect on the consumption of dry matter, and organic matter, rumen NH3, and VFA levels.
Vagueza, força argumentativa e dêixis pessoal nos discursos políticos presidenciais de comemoração de Abril
Authors: Marques Maria Aldina
Published: July 2024

Os discursos presidenciais de comemoração de Abril são discursos de influência. São um exercício de autoridade para apresentar ao Parlamento e ao país a visão do presidente sobre a revolução, sobre o passado de Portugal como nação entre as nações, mas também sobre o seu futuro político, económico e social, que antevê e deseja ver cumprido. Neste quadro político e discursivo, centrámo-nos na análise da dêixis pessoal e da sua força argumentativa, a partir da manifestação discursiva, nomeadamente, de usos categorizados como aproximativos ou vagos. Os dados para análise fazem parte de um corpus de discursos presidenciais de celebração do 25 de Abril (até ao centenário da República), de que foram selecionados os primeiros discursos proferidos por cada um dos quatro presidentes da República envolvidos neste evento discursivo de comemoração nacional.
Pengaruh Pembelajaran Berbasis Kecerdasan Majemuk Terhadap Komunikasi Verbal Anak
Authors: Sani Fadilah , Khadijah Khadijah
Published: July 2024

Tujuan dari penelitian ini adalah untuk memastikan dampak penggunaan pendekatan pembelajaran ini kemampuan komunikasi lisan anak. Penelitian ini menggunakan metodologi eksperimental yang melibatkan desain one-group pretest-posttest. Metode pengumpulan data menggunakan lembar observasi. Jumlah sampel adalah dua puluh anak yang berpartisipasi selama dua bulan. Uji t sampel berpasangan digunakan untuk melakukan analisis data. Hasil temuan menunjukkan tingkat signifikansi 0,001 yang lebih rendah dari 0,05. Oleh karena itu, dapat disimpulkan bahwa pelaksanaan pembelajaran berbasis berbagai kecerdasan mempunyai pengaruh yang cukup besar terhadap kemampuan komunikasi verbal anak. Temuan penelitian ini menekankan pentingnya pemanfaatan strategi pembelajaran inklusif dan divergen untuk Mutu pendidikan anak usia dini harus ditingkatkan, khususnya pada bidang-bidang yang berhubungan dengan pengembangan keterampilan komunikasi verbal.
Pengembangan Media Pop-Up Book IPAS Berbasis Living Values Education Program untuk Peserta Didik SD
Authors: Harwati Tantri , Apriani An-Nisa , Sari Indah Perdana , Shidiq Galih Albarra
Published: July 2024

Religious character is important to be applied from an early age to prevent moral decadence. Inserting or incorporating religious characters can be done in learning activities by using learning media. Pop-up book media is a book-shaped media with a real-like image display and can move. Meanwhile, LVEP is a value education that offers value activities so that students are able to explore and develop life values. The purpose of this research is to produce LVEP-based IPAS pop-up book media to improve religious character, teacher and student responses to the media. LVEP-based IPAS pop-up book media uses the 4D model which goes through 4 stages, namely the defining stage (define), the planning stage (design), the development stage (development), and the dissemination stage (disseminate). The data collection technique is qualitative from the results of interviews and quantitative data from the validation of material experts, media experts and teacher and student responses. Interviews were conducted with one class teacher, validation by one material expert, one media expert and 9 students. On the validation of the material that gets an average score of 4.6 with the category "Very Good" comes from the feasibility of presentation 3.9 and the feasibility of language 4. While the media validation obtained an average score of 3.95 with the category "Good" which comes from the feasibility of language of 4.5 plus the feasibility of language 4.8 and the feasibility of language 4.8. and feasibility of supporting learning 4.7. After that, an assessment was carried out to find out the responses of teachers and students to the LVEP-based IPAS pop-up book. The results of the teacher's assessment received a response with an average score of 4 with the category "Good" and the response given by students was 87% with the criteria "Very Good". Based on the results of the validation recapitulation, the LVEP-based IPAS pop-up book is suitable for use to improve the religious character of elementary school students. This research can be developed again or as reference material for further researchers in similar studies.
Standardizing Corneal Transplantation Records Using openEHR: Case Study
Authors: Ferreira Diana , Neto Cristiana , Hak Francini , Abelha António , Santos Manuel , Machado José
Published: July 2024

Background

Corneal transplantation, also known as keratoplasty, is a widely performed surgical procedure that aims to restore vision in patients with corneal damage. The success of corneal transplantation relies on the accurate and timely management of patient information, which can be enhanced using electronic health records (EHRs). However, conventional EHRs are often fragmented and lack standardization, leading to difficulties in information access and sharing, increased medical errors, and decreased patient safety. In the wake of these problems, there is a growing demand for standardized EHRs that can ensure the accuracy and consistency of patient data across health care organizations.

Objective

This paper proposes the use of openEHR structures for standardizing corneal transplantation records. The main objective of this research was to improve the quality and interoperability of EHRs in corneal transplantation, making it easier for health care providers to capture, share, and analyze clinical information.

Methods

A series of sequential steps were carried out in this study to implement standardized clinical records using openEHR specifications. These specifications furnish a methodical approach that ascertains the development of high-quality clinical records. In broad terms, the methodology followed encompasses the conduction of meetings with health care professionals and the modeling of archetypes, templates, forms, decision rules, and work plans.

Results

This research resulted in a tailored solution that streamlines health care delivery and meets the needs of medical professionals involved in the corneal transplantation process while seamlessly aligning with contemporary clinical practices. The proposed solution culminated in the successful integration within a Portuguese hospital of 3 key components of openEHR specifications: forms, Decision Logic Modules, and Work Plans. A statistical analysis of data collected from May 1, 2022, to March 31, 2023, allowed for the perception of the use of the new technologies within the corneal transplantation workflow. Despite the completion rate being only 63.9% (530/830), which can be explained by external factors such as patient health and availability of donor organs, there was an overall improvement in terms of task control and follow-up of the patients’ clinical process.

Conclusions

This study shows that the adoption of openEHR structures represents a significant step forward in the standardization and optimization of corneal transplantation records. It offers a detailed demonstration of how to implement openEHR specifications and highlights the different advantages of standardizing EHRs in the field of corneal transplantation. Furthermore, it serves as a valuable reference for researchers and practitioners who are interested in advancing and improving the exploitation of EHRs in health care.
True Mitotic Count Prediction in Gastrointestinal Stromal Tumors: Bayesian Network Model and PROMETheus (Preoperative Mitosis Estimator Tool) Application Development
Authors: Renne Salvatore Lorenzo , Cammelli Manuela , Santori Ilaria , Tassan-Mangina Marta , Samà Laura , Ruspi Laura , Sicoli Federico , Colombo Piergiuseppe , Terracciano Luigi Maria , Quagliuolo Vittorio , Cananzi Ferdinando Carlo Maria
Published: July 2024

Background

Gastrointestinal stromal tumors (GISTs) present a complex clinical landscape, where precise preoperative risk assessment plays a pivotal role in guiding therapeutic decisions. Conventional methods for evaluating mitotic count, such as biopsy-based assessments, encounter challenges stemming from tumor heterogeneity and sampling biases, thereby underscoring the urgent need for innovative approaches to enhance prognostic accuracy.

Objective

The primary objective of this study was to develop a robust and reliable computational tool, PROMETheus (Preoperative Mitosis Estimator Tool), aimed at refining patient stratification through the precise estimation of mitotic count in GISTs.

Methods

Using advanced Bayesian network methodologies, we constructed a directed acyclic graph (DAG) integrating pertinent clinicopathological variables essential for accurate mitotic count prediction on the surgical specimen. Key parameters identified and incorporated into the model encompassed tumor size, location, mitotic count from biopsy specimens, surface area evaluated during biopsy, and tumor response to therapy, when applicable. Rigorous testing procedures, including prior predictive simulations, validation utilizing synthetic data sets were employed. Finally, the model was trained on a comprehensive cohort of real-world GIST cases (n=80), drawn from the repository of the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, with a total of 160 cases analyzed.

Results

Our computational model exhibited excellent diagnostic performance on synthetic data. Different model architecture were selected based on lower deviance and robust out-of-sample predictive capabilities. Posterior predictive checks (retrodiction) further corroborated the model’s accuracy. Subsequently, PROMETheus was developed. This is an intuitive tool that dynamically computes predicted mitotic count and risk assessment on surgical specimens based on tumor-specific attributes, including size, location, surface area, and biopsy-derived mitotic count, using posterior probabilities derived from the model.

Conclusions

The deployment of PROMETheus represents a potential advancement in preoperative risk stratification for GISTs, offering clinicians a precise and reliable means to anticipate mitotic counts on surgical specimens and a solid base to stratify patients for clinical studies. By facilitating tailored therapeutic strategies, this innovative tool is poised to revolutionize clinical decision-making paradigms, ultimately translating into improved patient outcomes and enhanced prognostic precision in the management of GISTs.
Targeted Development and Validation of Clinical Prediction Models in Secondary Care Settings: Opportunities and Challenges for Electronic Health Record Data
Authors: van Maurik I S , Doodeman H J , Veeger-Nuijens B W , Möhringer R P M , Sudiono D R , Jongbloed W , van Soelen E
Published: July 2024

Before deploying a clinical prediction model (CPM) in clinical practice, its performance needs to be demonstrated in the population of intended use. This is also called “targeted validation.” Many CPMs developed in tertiary settings may be most useful in secondary care, where the patient case mix is broad and practitioners need to triage patients efficiently. However, since structured or rich datasets of sufficient quality from secondary to assess the performance of a CPM are scarce, a validation gap exists that hampers the implementation of CPMs in secondary care settings. In this viewpoint, we highlight the importance of targeted validation and the use of CPMs in secondary care settings and discuss the potential and challenges of using electronic health record (EHR) data to overcome the existing validation gap. The introduction of software applications for text mining of EHRs allows the generation of structured “big” datasets, but the imperfection of EHRs as a research database requires careful validation of data quality. When using EHR data for the development and validation of CPMs, in addition to widely accepted checklists, we propose considering three additional practical steps: (1) involve a local EHR expert (clinician or nurse) in the data extraction process, (2) perform validity checks on the generated datasets, and (3) provide metadata on how variables were constructed from EHRs. These steps help to generate EHR datasets that are statistically powerful, of sufficient quality and replicable, and enable targeted development and validation of CPMs in secondary care settings. This approach can fill a major gap in prediction modeling research and appropriately advance CPMs into clinical practice.
Enhancing Surgery Scheduling in Health Care Settings With Metaheuristic Optimization Models: Algorithm Validation Study
Authors: Lopes João , Guimarães Tiago , Duarte Júlio , Santos Manuel
Published: July 2024

Background

Health care is facing many challenges. The recent pandemic has caused a global reflection on how clinical and organizational processes should be organized, which requires the optimization of decision-making among managers and health care professionals to deliver care that is increasingly patient-centered. The efficiency of surgical scheduling is particularly critical, as it affects waiting list management and is susceptible to suboptimal decisions due to its complexity and constraints.

Objective

In this study, in collaboration with one of the leading hospitals in Portugal, Centro Hospitalar e Universitário de Santo António (CHUdSA), a heuristic approach is proposed to optimize the management of the surgical center.

Methods

CHUdSA’s surgical scheduling process was analyzed over a specific period. By testing an optimization approach, the research team was able to prove the potential of artificial intelligence (AI)–based heuristic models in minimizing scheduling penalties—the financial costs incurred by procedures that were not scheduled on time.

Results

The application of this approach demonstrated potential for significant improvements in scheduling efficiency. Notably, the implementation of the hill climbing (HC) and simulated annealing (SA) algorithms stood out in this implementation and minimized the scheduling penalty, scheduling 96.7% (415/429) and 84.4% (362/429) of surgeries, respectively. For the HC algorithm, the penalty score was 0 in the urology, obesity, and pediatric plastic surgery medical specialties. For the SA algorithm, the penalty score was 5100 in urology, 1240 in obesity, and 30 in pediatric plastic surgery. Together, this highlighted the ability of AI-heuristics to optimize the efficiency of this process and allowed for the scheduling of surgeries at closer dates compared to the manual method used by hospital professionals.

Conclusions

Integrating these solutions into the surgical scheduling process increases efficiency and reduces costs. The practical implications are significant. By implementing these AI-driven strategies, hospitals can minimize patient wait times, maximize resource use, and enhance surgical outcomes through improved planning. This development highlights how AI algorithms can effectively adapt to changing health care environments, having a transformative impact.
Fact or Fiction—Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study
Authors: DeMatteo Carol , Randall Sarah , Jakubowski Josephine , Stazyk Kathy , Obeid Joyce , Noseworthy Michael , Mazurek Michael , Timmons Brian W , Connolly John , Giglia Lucia , Hall Geoffrey , Lin Chia-Yu , Perrotta Samantha
Published: July 2024

Background

Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1‐17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population.

Objective

This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury.

Methods

Children and youth (N=139) aged 5‐18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution.

Results

For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3).

Conclusions

Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols.
How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research
Authors: Staehelin Dario , Dolata Mateusz , Stöckli Livia , Schwabe Gerhard
Published: July 2024

Background

Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers’ workflow.

Objective

This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication.

Methods

We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians.

Results

PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal.

Conclusions

The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care.
Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study
Authors: Musheghyan Lusine , Harutyunyan Nika M , Sikder Abu , Reid Mark W , Zhao Daniel , Lulejian Armine , Dickhoner James W , Andonian Nicole T , Aslanyan Lusine , Petrosyan Varduhi , Sargsyan Zhanna , Shekherdimian Shant , Dorian Alina , Espinoza Juan C
Published: July 2024

Background

The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program.

Objective

The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings.

Methods

Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms.

Results

Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified.

Conclusions

This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program’s success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments.
Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire–15-Item: Questionnaire Development and Validation Study
Authors: Bisby Madelyne A , Jones Michael P , Staples Lauren , Dear Blake , Titov Nickolai
Published: July 2024

Background

A large number of modifiable and measurable daily actions are thought to impact mental health. The “Things You Do” refers to 5 types of daily actions that have been associated with mental health: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Previous studies have reported the psychometric properties of the Things You Do Questionnaire (TYDQ)–21-item (TYDQ21). The 21-item version, however, has an uneven distribution of items across the 5 aforementioned factors and may be lengthy to administer on a regular basis.

Objective

This study aimed to develop and evaluate a brief version of the TYDQ. To accomplish this, we identified the top 10 and 15 items on the TYDQ21 and then evaluated the performance of the 10-item and 15-item versions of the TYDQ in community and treatment-seeking samples.

Methods

Using confirmatory factor analysis, the top 2 or 3 items were used to develop the 10-item and 15-item versions, respectively. Model fit, reliability, and validity were examined for both versions in 2 samples: a survey of community adults (n=6070) and adults who completed an assessment at a digital psychology service (n=14,878). Treatment responsivity was examined in a subgroup of participants (n=448).

Results

Parallel analysis supported the 5-factor structure of the TYDQ. The brief (10-item and 15-item) versions were associated with better model fit than the 21-item version, as revealed by its comparative fit index, root-mean-square error of approximation, and Tucker-Lewis index. Configural, metric, and scalar invariance were supported. The 15-item version explained more variance in the 21-item scores than the 10-item version. Internal consistency was appropriate (eg, the 15-item version had a Cronbach α of >0.90 in both samples) and there were no marked differences between how the brief versions correlated with validated measures of depression or anxiety symptoms. The measure was responsive to treatment.

Conclusions

The 15-item version is appropriate for use as a brief measure of daily actions associated with mental health while balancing brevity and clinical utility. Further research is encouraged to replicate our psychometric evaluation in other settings (eg, face-to-face services).

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12613000407796; https://tinyurl.com/2s67a6ps
Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics
Authors: Wunderlich Maximilian Markus , Frey Nicolas , Amende-Wolf Sandro , Hinrichs Carl , Balzer Felix , Poncette Akira-Sebastian
Published: July 2024

Background

In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue.

Objective

We aimed to compare alarm situations between provisional COVID-19 ICUs and non–COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff.

Methods

Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non–COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel.

Results

COVID-19 ICUs had significantly more alarms per bed per day than non–COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19–specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04).

Conclusions

Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings.
Designing electronic health interventions for pediatric emergency departments: Usability testing methods for youth, parent and clinician participants (Preprint)
Authors: Somerville Mari , Wozney Lori , Gallant Allyson , Curran Janet A
Published: July 2024

BACKGROUND

Usability tests provide important insight into user preferences, functional issues and differences between target groups for health interventions and products. However, there is limited guidance on how to adapt the usability testing approach for a youth audience, especially for digital health interventions.

OBJECTIVE

Therefore, this methods paper outlines a novel approach for conducting usability tests with a diverse audience of youth, parents and clinicians in the development of two digital health tools for the pediatric emergency department (ED) setting.

METHODS

This paper outlines the methods for usability testing as part of a broader study aimed at co-designing ED discharge communication tools with youth, parents and clinicians. The broader study involved co-designing two digital tools: one for asthma and one for concussion. A mixed methods approach to usability testing was used to assess the functionality of these tools through two rounds of testing. A mix of youth, parents and ED clinicians were invited to participate in each round of usability testing. Participants were asked to provide feedback on the tools through quantitative surveys and open-ended qualitative questions. The usability testing approach was adapted to suit each target group, such as including a youth in the data collection process, to enhance the quality of the data. The severity of usability problems was analyzed following the first round of testing and each tool was refined based on this feedback. The second round of usability tests involved collecting both qualitative and quantitative feedback on the revised tools.

RESULTS

Outcomes from the usability tests will be disseminated through a subsequent publication. Results will include demographic characteristics from each user group from both rounds of testing, severity of usability scores, qualitative and quantitative feedback, and differences between test outcomes between each target group.

CONCLUSIONS

This paper provides novel guidance for conducting usability tests with youth participants when designing digital health tools. This approach may be adapted to different healthcare contexts for other youth participants. Further research should continue to explore ways to design usability tests that are suitable for youth audiences as there is still a significant gap in the literature around this topic.
Assessing the Role of Blood Group Genotyping in Predicting Hemolysis in Thalassemia Beta Major Patients with Repeated Transfusions: Study Protocol (Preprint)
Authors: Indriani Vitasari , Triyono Teguh , Mulyono Budi
Published: July 2024

BACKGROUND

Hemolytic transfusion reactions are a major complication in patients with thalassemia beta major receiving regular transfusions. Blood group compatibility may play a major role in the incidence of these reactions. However, there is a lack of studies in Indonesia assessing the role of blood group genotyping in hemolytic transfusion.

OBJECTIVE

This study aims to analyze the association between blood group genotyping and the incidence of hemolysis in thalassemia patients undergoing repeated transfusions.

METHODS

This is a cross-sectional study involving patients with thalassemia beta major under 18 years old who received regular transfusion with intervals of 2-4 weeks and have received more than 20 units of transfusion. Subjects with leukemia, lymphoproliferative diseases, diabetes, solid tumors, and immunosuppression disorders were excluded from the study. Genotyping examination was conducted using PCR ASP while phenotyping was examined using immunoserology. Follow-up gene sequencing was conducted to observe the blood group variants. Hemolysis was assessed using several markers such as haptoglobulin, free hemoglobin, LDH, bilirubin, hemoglobinurin, measured by Cobas C113, ELISA and urinalysis.

RESULTS

Clinical and laboratory data is completed. A total of 134 samples were collected, data analyses are undertaken, and the first results reporting findings is expected to be in July 2024

CONCLUSIONS

The results of this study will provide information on blood groups system that can predict hemolysis occurrence in thalassemia beta major patients with repeated transfusion. This data will contribute to the best possible patient care management and blood transfusion therapy, thereby reducing the risk of hemolysis and improving the quality of life for thalassemia patients in Indonesia.

CLINICALTRIAL

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Protocol for the Move Often eVery Day (MOV’D) Pilot: A Multi-Component, Fully-Remote, Peer-Supported Exercise Snack Behavior Change Intervention (Preprint)
Authors: Moore Jessie , Monteiro Ashley , Aikens Rocky , Duckworth Angela , Gross James J , Schwartz Dan , Baiocchi Mike , Prochaska Judith J , Oppezzo Marily
Published: July 2024

BACKGROUND

Prolonged sitting and lack of moderate to vigorous physical activity represent two independent risk factors for myriad poor health outcomes. The negative effects of prolonged sitting can be ameliorated with as little as 2 minutes of large muscle movement. Further, cardiovascular benefits from moderate to vigorous activity can be accumulated throughout the day in short bouts rather than require continuous long bouts. Taken together, “exercise snacks” provide a way to both interrupt prolonged sitting and accumulate moderate to vigorous physical activity during a sedentary work day.

OBJECTIVE

The current protocol describes the feasibility and acceptability pilot of Move Often eVery Day (MOV'D), a fully-remote, peer-supported behavioral intervention to interrupt prolonged bouts of sitting at work with exercise snack breaks.

METHODS

The MOV’D pilot study aimed to recruit approximately 60-80 participants who work full-time in a sedentary occupation. Using a randomized 2-group design, participants were randomly assigned either to the “Fitbit Control'' or the “MOV’D” experimental group. The pilot study had a 4-week active intervention and a 4-week follow-up with assessments at baseline, 4-weeks, and 8-weeks. The Fitbit control group received a Fitbit to self-monitor their physical activity prior to getting intervention material at the end of the study. In addition to the Fitbit, the MOV’D intervention features included: a private social support group chat seeded with daily experimenter prompts; weekly, 5-minute behavior change technique videos; daily self-monitoring, and daily exercise snack suggestion videos.

RESULTS

Study enrollment began in March 2022 and concluded in June 2022. Data collection concluded in October 2022. We enrolled 70 participants and 68 participants completed all study assessments.

CONCLUSIONS

This protocol integrates findings from education, behavioral sciences, sedentary behavior, and exercise physiology to promote building an exercise snack habit at work: taking short, intense exercise breaks to break up prolonged sitting. Results from this pilot study will assess the feasibility and acceptability of the MOV’D intervention.

CLINICALTRIAL

NCT05360485
Tindak Tutur Ekspresif Keluhan dalam Drama Korea “My Liberation Notes”
Authors: Anjani Shofi Hawa , Rosyadi Alfiana Amrin
Published: July 2024

This article discusses the complaint speech acts found in the dialogues of “My Liberation Notes” drama. This study aimed to identify strategies and linguistic features of each complaint speech act found in the drama. The collected data were analyzed with qualitative descriptive method using Kim Kyung-Ryung’s theory by classifying data in six complaint speech act strategies that appeared in the dialogues. Each strategy and sub-strategy had different linguistic features such as a variety of the words, grammars, sentence types, expressions, etc. 암시하기(amsihagi)/hints strategy used question form sentence and expression of carefulness, 질책하기 (jilchaekhagi)/rebuking used expression of surprise, 비난하기 (binanhagi)/criticism used form of negation, 짜증나기 (jjajeungnagi)/annoyance used interjection and word with annoying meaning, 내적수식어 (naejeoksusikeo)/internal modification used expression and word that highlight politeness, and 외적수식어 (wejeoksusikeo)/external modification appeared with usage of word and expression that weaken and strengthen the meaning of the action.
Microbial Induced Biotechnological Processes for Biofuel Production from Waste Organics Conversion
Authors: Pillai Sruthy MS , Srivastava Rajesh Kumar , Singh Sujeet Pratap
Published: July 2024

In the current era there are huge quantities of waste organic matter available, creating a big burden to the environment. To address these issues, researchers started to apply effective and microbial induced biotechnological processes that can mitigate these waste matters. In this context, different nature of microbial systems are involved in hydrolysing the waste organic material into fermentable sugar. These can be easily consumed by specific microbial systems like Saccharomyces cerevisiae MTCC 3821 and Clostridium acetobutylicum that produced bioethanol and biobutanol, respectively. Saccharomyces cerevisiae was cultured in specific media and incubated at rotary shaker with 150 rpm at 30°C for 72 to 96 hours. Ethanol concentrations from different waste matters were found in the range of 1.2-1.5 g.L-1. Ethanol synthesis was done by shake flask experiment with addition of glucose (50 g.L-1) to waste organic hydrolyzed solution. Non-glucose media produced less than 3 g.L-1 ethanol but glucose media produced 4.5 g.L-1. Next, Clostridium acetobutylicum was grown in culture media containing waste organics as sole carbon substrate with pH 7 and then was incubated in anaerobic conditions at 35°C for 72 hours, produced butanol (0.7 to 1.25 g.L-1). This research work promoted biofuels synthesis by keeping a waste mitigation strategy.