bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Multiple Layers of Carbon Fiber Reinforced Polymer on Flexural Strength of Reinforced Concrete
Authors: Khoso Ali Raza , Akhund Muhammad Akram , Menghwar Shankar Lal , Siddiqui Fida Hussain
Published: July 2018

Concrete is a very common construction material. As time prevails, cracks often appear in structures that pose a threat to strength and durability, which ultimately affect the structural integrity of concrete. Extensive work has been carried out in past on utilization of Carbon Fiber Reinforced Polymer (CFRP) as a repair material. But, this research particularly focuses on: multiple fiber layers i.e. single and double, traditional concrete mix ratio with locally available materials and varying flexural reinforcement. Furthermore, this work presents an experimental analysis to strengthen the Reinforced Concrete (RC) beams using SikaWrap- 230 C as a CFRP wrap, and Sikadur-330 as a bonding material. The comparison between single and double layers of CFRP is of major interest in this research. Six reinforced concrete beams were repaired with CFRP and tested under three-point bending test. For these specimens, load deflection behavior along with crack propagation and failure of beams were studied. Experimental results show that beams repaired using CFRP wrapping achieved higher flexural capacity and ductility as compared with reference beam. Moreover, results reveal that introduction of second layer of fiber caused around 4-5.2% increment in flexural strength and resulted in higher ductility of RCC beam.
IFRS compliance and stock prices influence: evidence from Jordanian banks
Authors: K. Almasarwah Adel , M. Omoush Ahmad , Alsharari Nizar
Published: July 2018

This study aims to examine the IFRS compliance in Jordanian banks and its relation to stock prices. The impact of compliance with International Financial Reporting Standards (IFRS) on stock prices in Jordanian banks is a rarely researched subject in accounting and finance, but whether IFRS compliance has a serious impact on stock prices, particularly in developing countries, is still unknown. Numerous factors in developing countries, such as cultural, political, and economic circumstances, can create different effects for IFRS compliance from those seen in developed countries.This paper concludes that IFRS compliance negatively affects stock prices, and firm size has a positive relationship with stock prices in Jordanian banks. The paper has significant implications for IFRS compliance research on stock prices, particularly across Jordanian banks, in responding to recent calls to bridge the gap that has been identified as a result of the revolutions in the Middle East. This study has been carried out in order to attract investors to avoid opposite results compared with prior literature that has studied the same subject. Hence, there are essential implications for the way in which successful IFRS compliance can be positively associated with stock prices in Jordanian banks.
TONYUKUK BENGÜ TAŞINDA GEÇEN “BAR MU NE?” (anumRB) İBARESİ BAŞKA NE ŞEKİLDE OKUNABİLİR
Authors: TOKER Mustafa
Published: July 2018

Orhun bengü taşları üzerinde bugüne gelinceye kadar pek çok okuma çalışması yapılmıştır. Vilhelm Thomsen ve Wilhelm Radloff’la başlayan abideleri okuma çalışmaları bugün de yurt içi ve yurt dışındaki Türkologlar tarafından sürdürülmektedir. Bu okumaların temeli abideleri ilk çözen Thomsen’e ve ilk okuyan Radloff’a dayanmaktadır. Radloff’un ve Thomsen’in okumaları ardından yeni görüşlerle birlikte bugün elimizde bulunan çeşitli yayınlardaki hâli ortaya çıkmıştır.Bu bildiride, Tonyukuk abidesinde geçen ve kaynaklar tarafından “bar mu ne?” şeklinde okunan ibare üzerinde durulacaktır. İbarenin değişik bilim insanları tarafından okunuşu ve anlamlandırılışı verildikten sonra konuyla ilgili kendi görüşümüz ortaya konulacaktır.
Retention Mechanism of Proteins in Hydroxyapatite Chromatography – Multimodal Interaction Based Protein Separations: A Model Study
Authors: Itoh Daisuke , Yoshimoto Noriko , Yamamoto Shuichi
Published: July 2018

Background:

Retention mechanism of proteins in hydroxyapatite chromatography (HAC) was investigated by linear gradient elution experiments (LGE).

Materials and Methods:

Several mobile phase (buffer) solution strategies and solutes were evaluated in order to probe the relative contributions of two adsorption sites of hydroxyapatite (HA) particles, C-site due to Ca (metal affinity) and P-site due to PO4 (cation-exchange). When P-site was blocked, two basic proteins, lysozyme (Lys) and ribonuclease A(RNase), were not retained whereas cytochrome C(Cyt C) and lactoferrin (LF) were retained and also retention of acidic proteins became stronger as the repulsion due to P-site was eliminated. The number of the binding site B values determined from LGE also increased, which also showed reduction of repulsion forces.

Conclusion:

The selectivity (retention) of four basic proteins (RNase, Lys, Cyt C, LF) in HAC was different from that in ion-exchange chromatography. Moreover, it was possible to tune the selectivity by using NaCl gradient.
The Role of Ortho-dearomatization Reaction in Constructing Spirocyclic Scaffolds with an All-carbon Ring Junction
Authors: Shi Lili , Zhang Wenge , Chen Shou , Lu Lele , Fan Rong , Tan Jiajing , Zheng Chao
Published: July 2018

Background:

Spiro skeleton is an important structural motif in natural products, usually accounting
for their formidable architectures and remarkable biological profiles. Recent advances demonstrated that a diverse
range of scenarios held the promise for the assembly of spirocenter based on ortho-dearomatization strategy.
In this article, we describe the latest development of ortho-dearomatization reaction in constructing spirocyclic
scaffolds with an all-carbon ring junction from a methodological standpoint.

Objective:

The review focuses on recent progress in the area of ortho-dearomatization reaction in constructing
spirocyclic scaffolds with an all-carbon ring junction.

Conclusion:

In summary, we have summarized the capability of ortho-dearomatization reaction to construct
spirocyclic skeleton, a common structural pattern found at the core of numerous natural products with broad
structural diversities and important bioactivities. Success in this area will benefit not only the area of synthetic
chemistry through methodological development, but also medicinal chemistry and chemical biology by providing
access to rapid assembly of bioactive compounds’ core scaffolds.
In vitro Activity of the Novel Pyrimidines and Their Condensed Derivatives Against Poliovirus
Authors: Solomyannyi Roman , Slivchuk Sergii , Smee Donald , Choi Jung-ae , Rusanov Eduard , Zhirnov Victor , Brovarets Volodymyr
Published: July 2018

Background:

Substituted pyrimidine derivatives (non-nucleoside) are found to be associated
with various biological activities. The various substituted pyrimidines are also having significant in vitro
activity against different DNA and RNA viruses. The present study focuses on the anti-PV activity of
new pyrimidines and their condensed derivatives.

Methods:

A series of novel pyrimidines and their condensed derivatives were synthesized and their
structures were confirmed by spectral data. Their antiviral activities against poliovirus type 3 (PV-3)
were evaluated in vitro. In cell culture, morphological changes observed in cells infected with polioviruses,
including cell rounding and detachment from the substrate, are generally termed cytopathic
effects (CPE). The effects of synthetic pyrimidines on PV amplification in a culture of the heteroploid
cell line, Vero 76 (African green monkey kidney cells) were investigated.

Results:

Bioassays in vitro showed that one of seven synthesized compounds, 7-(Benzenesulfonyl)-5-
benzyl-N-(prop-2-en-1-yl)-5H-pyrrolo[3,2-d]pyrimidin-4-amine, has potent antiviral activity against
PV-3 (EC50 = 0.75 μM). The selectivity index of this compound is similar to that of pirodavir.

Conclusion:

The need for antiviral agents to treat PV-associated diseases remains great, but few options
currently exist. Here we show that substituted pyrimidine derivatives are a promising structure class of
chemical compounds for the development of antiviral drugs against PV infections.
Synthesis, Antitubercular Activity, Molecular Modeling and Docking Studies of Novel Thiazolidin-4-One Linked Dinitrobenzamide Derivatives
Authors: Singh Karanveer , Sinha Manish , Kuletha Shruti , Kaur Baljeet , Kaur Amandeep , Tripathi Dinesh K. , Srivastava Kishore K. , Murugesan Vanangamudi , Srikala Rajala , Chaudhary Amrendra K.
Published: July 2018

Background:

Tuberculosis is a catastrophe sprawled across the world. The World Health
Organization Global Tuberculosis Report 2017 inferred that there were an estimated 10.4 million people
suffered from tuberculosis including 490000 Multidrug-Resistant TB (MDR-TB) cases. Several new
lead molecules like dinitrobenzamide derivatives were found to be highly active against multidrugresistant
strains of M. tuberculosis. To further explore the pharmacophoric space around the
dinitobenzamide moiety, a series of compounds have been synthesized by linking it with the thiazolidin-
4-one. The presented work is an effort to study the biological effect of thiazolidin-4-one scaffold on
dinitrobenzamide derivatives as antitubercular agents. A molecular modeling study was also performed
on the synthesized molecules to reveal the requirements for further lead optimization.

Methods:

The thiazolidin-4-one linked 3,5-dinitrobenzamide derivatives have been synthesized by onepot
three-component condensation reaction of an amine, substituted aldehydes and thioglycolic acid in
presence of N, N'-Dicyclohexylcarbodiimide (DCC). These compounds were evaluated against Mycobacterium
tuberculosis H37Ra. A pharmacophore modeling approach has been used in order to explore
the collection of possible pharmacophore queries of thiazolidin-4-one linked 3, 5-dinitrobenzamide
derivatives against M. tuberculosis. The synthesized compounds were docked on to the M. tuberculosis
DprE1 enzyme to identify the structural features requirement of these analogs against this potential target
of M. tuberculosis.

Results:

The synthesized compounds showed the antitubercular activity in the range of 6.25-50 μg/ml.
The pharmacophore modeling suggests that the presence of aromatic moiety, thiazolidin-4-one ring and one of
the nitro groups are significant for inhibiting the enzymatic activity. While docking studies showed that hydrophobic
and hydrogen bond interactions of the aromatic moiety and nitro group crucial to inactivate the
DprE1 enzyme.

Conclusion:

The study showed that the linking of thiazolidin-4-one with dinitrobenzamide leads to
compounds active against M. tuberculosis. These findings also suggested that further lead optimization
would be carried out by focusing on the aromatic system along with electron-rich substituents placed on
the thiazolidin-4-one for making better hydrophobic and hydrogen bond interactions with the DprE1
target.
Classic and Novel Signaling Pathways Involved in Cancer: Targeting the NF-κB and Syk Signaling Pathways
Authors: Tang Cong , Zhu Guodong
Published: July 2018

The nuclear factor kappa B (NF-κB) consists of a family of transcription factors involved in
the regulation of a wide variety of biological responses. Growing evidence support that NF-κB plays a
major role in oncogenesis as well as its well-known function in the regulation of immune responses
and inflammation. Therefore, we made a review of the diverse molecular mechanisms by which the
NF-κB pathway is constitutively activated in different types of human cancers and the potential role of
various oncogenic genes regulated by this transcription factor in cancer development and progression.
We also discussed various pharmacological approaches employed to target the deregulated NF-κB
signaling pathway and their possible therapeutic potential in cancer therapy. Moreover, Syk (Spleen
tyrosine kinase), non-receptor tyrosine kinase which mediates signal transduction downstream of a
variety of transmembrane receptors including classical immune-receptors like the B-cell receptor
(BCR), which can also activate the inflammasome and NF-κB-mediated transcription of chemokines
and cytokines in the presence of pathogens would be discussed as well. The highlight of this review
article is to summarize the classic and novel signaling pathways involved in NF-κB and Syk signaling
and then raise some possibilities for cancer therapy.
Hypovitaminosis D in Healthy Pregnant Women and their Newborns in Greece
Authors: Sideri Vasiliki , Antonakos George , Fretzayas Andreas , Attilakos Achilleas , Chrelias Charalambos , Papaevangelou Vasiliki , Nicolaidou Polyxeni , Papadopoulou Anna
Published: July 2018

Background/Objectives: The aim of this work was to evaluate the current vitamin D status in healthy pregnant women and their newborns living in Greece and assess possible associations between 25(OH)D and anthropometric features of their fetuses and newborns.  Materials & Methods: 81 healthy women were monitored during pregnancy. Biochemical markers related to bone metabolism, 25(OH)D and PTH levels were measured in serum samples of mothernewborn pairs at 1st trimester of pregnancy and at delivery in mothers, in cord blood and at the 3rd day of life of newborns.

Results:

Maternal 25(OH)D levels at the 1st trimester of pregnancy (22.6±9.2ng/ml) were significantly higher than those at delivery (19.2±9.2ng/ml) (p<0.001). Furthermore, umbilical 25(OH)D levels (21.3±9.3ng/ml) were higher than maternal at delivery (p=0.005) and neonatal levels (19.4±10.4 ng/ml) (p=0.021). Only 57.3% of the mothers at the first trimester and 46.7% at delivery as well as 55.8% of the fetuses and 38.5% of the neonates had adequate vitamin D levels (25(OH)D≥30ng/ml). A significant positive correlation was found between fetal femur length at the 22nd week of gestation and maternal 25(ΟΗ)D at the 1st trimester of pregnancy (r=0.36, p=0.048) while body length was significantly higher in newborns whose mothers had sufficient 25(OH)D levels (51.5±2.1cm) compared with those whose mothers had insufficient or deficient 25(OH)D levels at delivery (50.6±2.0cm) (p=0.047).

Conclusion:

The study confirms inadequate levels of vitamin D in pregnant women in Greece associated with inadequate vitamin D levels of their fetuses and newborns.
Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study (Preprint)
Authors: Khader Yousef , Alyahya Mohammad , Batieha Anwar
Published: July 2018

BACKGROUND

Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan.

OBJECTIVE

This study aimed to assess health professionals’ attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals.

METHODS

A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals.

RESULTS

This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities.

CONCLUSIONS

Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems.
The Internet as a Source of Health Information � the Results of a Polish Survey Study (Preprint)
Authors: Raciborski Filip , Kłak Anna , Samoliński Bolesław
Published: July 2018

BACKGROUND

The popularisation of Internet access has made it one of the basic sources of information (in this article, the term “Internet” is understood as different kinds of: websites, blogs, social networking sites, such as: Facebook, Twitter, etc.; text messages, including: email, skype, other instant messengers; discussion forums). This relates also to health and its correlates.

OBJECTIVE

The main objective of the study was to evaluate the scale of the phenomenon of using the Internet to look for health information in Poland. The aim of the study was also to evaluate the influence of information about health published in the network on the behaviour of internet users.

METHODS

A questionnaire-based survey (face-to-face interview) was carried out among a representative group of 1000 inhabitants of Poland aged 15 years and older.

RESULTS

Among the 1000 respondents surveyed in this study, 670 (67%) declared using the Internet, more than half of which (53.7%) reported seeking, among others, health information. The most commonly sought information included: diet and healthy eating (33.3%), a particular medication or dietary supplement (its effect, dosage, side effects) (28.9%), reviews of doctors (26.7%), and how other people coped with similar health problems (25.3%). More than 53% of Internet health information seekers were driven by curiosity, 46.4% by the ease and speed of finding information, 32.5% by the opportunity of finding a lot of independent reviews in one place, and 29.7% by no extra costs.

CONCLUSIONS

The importance of the Internet as a source of information about health is constantly increasing. Our study presents that in Poland, women, younger, well-educated, living in big cities, especially often look for health information on the web. However most people have limited trust in the data derived from that source. The influence of information about health published in the network on people's behaviour could be less than is commonly believed.
Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review (Preprint)
Authors: Córdova David , Mendoza Lua Frania , Ovadje Lauretta , Hong Ethan , Castillo Berenice , Salas-Wright Christopher P
Published: July 2018

BACKGROUND

HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth.

OBJECTIVE

The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth.

METHODS

We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included.

RESULTS

Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts.

CONCLUSIONS

Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed.
A Review of Portable Digital Assistant (PDA) Implementation process in Low Resource Settings (Preprint)
Authors: AfariKumah Eben
Published: July 2018

UNSTRUCTURED

This paper presents the Portable Digital Assistant Implementation in the Sene District of Ghana. The study sought to understand eHealth implementation in low resource settings through the lens of actor-network theory. Part of this theory is made up of the sociology of translations, which was employed as a crucial framework for exploring the Portable Digital Assistant Set-up. Data was collected between January 2011 – June 2014. Data collection has been through triangulation of qualitative methods: interviews, participant observation, and document analysis. A total of 20 human and non-human actors’ were identified and semi-structured interviews conducted with the human actors using Face to Face (10), Telephone (2). It was deduced from the case that the champion in the case was able to mobilise the various actors to ensure that the project succeeds. His ability to manage the various resources ensured that there were not any lapses.
Lessons From the Implementation of Mo-Buzz, a Mobile Pandemic Surveillance System for Dengue (Preprint)
Authors: Lwin May Oo , Jayasundar Karthikayen , Sheldenkar Anita , Wijayamuni Ruwan , Wimalaratne Prasad , Ernst Kacey C , Foo Schubert
Published: July 2018

BACKGROUND

Approximately 128 countries and 3.9 billion people are at risk of dengue infection. Incidence of dengue has increased over the past decades, becoming a growing public health concern for countries with populations that are increasingly susceptible to this vector-borne disease, such as Sri Lanka. Almost 55,150 dengue cases were reported in Sri Lanka in 2016, with more than 30.40% of cases (n=16,767) originating from Colombo, which struggles with an outdated manual paper-based dengue outbreak management system. Community education and outreach about dengue are also executed using paper-based media channels such as pamphlets and brochures. Yet, Sri Lanka is one of the countries with the most affordable rates of mobile services in the world, with penetration rates higher than most developing countries.

OBJECTIVES

To combat the issues of an exhausted dengue management system and to make use of new technology, in 2015, a mobile participatory system for dengue surveillance called Mo-Buzz was developed and launched in Colombo, Sri Lanka. This paper describes the system’s components and uptake, along with other similar disease surveillance systems.

METHODS

We developed Mo-Buzz and tested its feasibility for dengue. Two versions of the app were developed. The first was for use by public health inspectors (PHIs) to digitize form filling and recording of site visit information, and track dengue outbreaks on a real-time dengue hotspot map using the global positioning system technology. The system also provides updated dengue infographics and educational materials for the PHIs to educate the general public. The second version of Mo-Buzz was created for use by the general public. This system uses dynamic mapping to help educate and inform the general public about potential outbreak regions and allow them to report dengue symptoms and post pictures of potential dengue mosquito–breeding sites, which are automatically sent to the health authorities. Targeted alerts can be sent to users depending on their geographical location.

RESULTS

We assessed the usage and the usability of the app and its impact on overall dengue transmission in Colombo. Initial uptake of Mo-Buzz for PHIs was low; however, after more training and incentivizing of usage, the uptake of the app in PHIs increased from less than 10% (n=3) to 76% (n=38). The general public user evaluation feedback was fruitful in providing improvements to the app, and at present, a number of solutions are being reviewed as viable options to boost user uptake.

CONCLUSIONS

From our Mo-Buzz study, we have learned that initial acceptance of such systems can be slow but eventually positive. Mobile and social media interventions, such as Mo-Buzz, are poised to play a greater role in shaping risk perceptions and managing seasonal and sporadic outbreaks of infectious diseases in Asia and around the world.
Mutual Involvement in Families With Type 2 Diabetes Through Web-Based Health Care Solutions: Quantitative Survey Study of Family Preferences, Challenges, and Potentials (Preprint)
Authors: Vitger Tobias , Langberg Henning , Grabowski Dan
Published: July 2018

BACKGROUND

Type 2 diabetes (T2D) is a prevalent chronic disease that affects not just patients but entire families. Both the patient and the rest of the family may benefit from gaining knowledge about the disease and from supportive interfamilial interaction. The Internet is becoming a widely-used resource for health information, so a Web-based solution could potentially promote awareness and knowledge on how to manage T2D as a family, while also providing support for the family.

OBJECTIVE

We aim to assess the usage of online diabetes information by patients with T2D and their relatives, and explore the families’ needs and preferences regarding online information on diabetes.

METHODS

A quantitative self-reported questionnaire survey was performed with Danish families that had at least one family member diagnosed with T2D. The survey consisted of 36 closed questions on demographics, usage of the Internet, preferences in the source of information, interest in online information on six problem domains within family life related to T2D, preferences towards the delivery format of online information, and peer-to-peer communication. Two open-ended questions were also included to elicit any additional comments or suggestions about improving online information on T2D regarding family life.

RESULTS

Fifty participants from 22 families with T2D answered the questionnaire individually. Relatives (25/28, 89%) and patients (22/22, 100%) indicated that information on T2D is relevant for them, while indicating that the Internet is the first or second preferred source when in need of information on T2D (25/28, 89% vs 21/22, 95%). Only a minority of the participants indicated that they had searched the Internet to gain knowledge on T2D regarding family life (9/28, 32% vs 10/22, 46%). Also, patients were more likely to have used the Internet to gain information on T2D (P=.027). Both groups indicated a preference for watching videos or reading about T2D in relation to family life while a minority of the participants indicated an interest in peer-to-peer communication. Regarding the six problem domains, the domains Support, Knowledge, and Everyday Life were slightly more popular. These three domains were considered interesting by at least 79% (22/28) and 73% (16/22) of the relatives and patients respectively, while the domains Communication, Worries, and Roles were considered interesting by at least 46% (20/28) and 50% (11/22).

CONCLUSIONS

Despite an interest in online information on T2D, there appears to be an unsatisfied need for more supportive online information on T2D aimed at Danish families with T2D. Based on family preferences, online information should focus on the six problem domains and be presented through text and videos by health care practitioners and peers. Peer-to-peer communication elements may be beneficial, but are only expected to be used by a very limited number of families.
Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique (Preprint)
Authors: Saremi AboTaleb , Bahrami Homa , Feizy Fariba
Published: July 2018

BACKGROUND

Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy.

OBJECTIVE

We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures.

METHODS

Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it.

RESULTS

Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018.

CONCLUSIONS

Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications.
A Shared Decision-Making Tool to Prevent Substance Abuse: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Long Ju , Yuan Juntao Michael , Johnson Ron Kim
Published: July 2018

BACKGROUND

Substance use disorder (SUD) affects over 20 million adults and costs over $700 billion annually in the United States. It is one the greatest health care challenges we face.

OBJECTIVE

This research project seeks to enhance the standard practice of Screening, Brief Intervention, and Referral to Treatment (SBIRT) through a mobile solution easily incorporated into primary care that will promote shared decision making and increase referral and adherence to specialty care through continued follow-up care.

METHODS

This research will conduct an Office of Management and Budget (OMB)–approved randomized controlled trial (RCT) in primary care and SUD specialty service providers. The RCT will recruit a total of 500 SUD patients. Recruited patients will be randomized into control and intervention arms. Both arms will take initial baseline and exit (30 days) surveys to evaluate self-reported substance use and specialty service utilization. The control arm patients will receive usual care. The intervention group patients will receive technology-enhanced SBIRT and a mobile follow-up program to track goals and substance use at home. The RCT tracks participants for 30 days after the primary care encounter. We will collect feedback from the patients during the 30 days and count the number of patients who use specialty care services in specialty care programs for tobacco, alcohol, and drug abuse (both from self-reporting and from the service providers).

RESULTS

RCT and data collection are underway. We expect to report the data results in 2018.

CONCLUSIONS

We expect that significantly more intervention group patients will receive specialty SUD care within 30 days following the SBIRT encounter at the primary care clinic compared to the control group. We also expect that the intervention group patients will report a greater reduction in substance use and a greater drop in Drug Abuse Screening Test and Addition Severity Index scores within 30 days.
Internet-Delivered Dialectical Behavioral Therapy Skills Training for Suicidal and Heavy Episodic Drinkers: Protocol and Preliminary Results of a Randomized Controlled Trial (Preprint)
Authors: Wilks Chelsey , Yin Qingqing , Ang Sin Yee , Matsumiya Brandon , Lungu Anita , Linehan Marsha
Published: July 2018

BACKGROUND

The need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individuals.

OBJECTIVE

In the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The aim of the study is to evaluate the feasibility and effectiveness of the therapist-assisted and Internet-delivered intervention, and to inform the design of a subsequent full-scale study.

METHODS

The study was a pilot randomized controlled trial comparing participants receiving immediate-treatment (n=30) to waitlist controls (n=29) over a period of 16 weeks. Intervention effects will be assessed longitudinally using hierarchical linear modeling and generalized estimating equations, along with analyses of effect sizes and clinically significant change. The primary outcomes are suicidal ideation, alcohol problems, and emotion dysregulation. Secondary outcomes include alcohol-related consequences, reasons for living, skills use, and depression.

RESULTS

The trial is ongoing. A total of 60 individuals returned their informed consent and were randomized, of whom 59 individuals were intended to treat. A total of 50 participants in the study were retained through the 16-week enrollment.

CONCLUSIONS

There is a dearth of evidence-based treatment for individuals presenting with high risk and complex behaviors. Furthermore, computerized interventions may provide a beneficial alternative to traditional therapies. The particular clinical features and treatment needs of suicidal individuals who also engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population.

CLINICALTRIAL

Clinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2)
Mindfulness-Based Cognitive Therapy for Cancer Patients Delivered via Internet: Qualitative Study of Patient and Therapist Barriers and Facilitators (Preprint)
Authors: Compen Félix R , Bisseling Else M , Schellekens Melanie PJ , Jansen Ellen TM , van der Lee Marije L , Speckens Anne EM
Published: July 2018

BACKGROUND

The number of patients living with cancer is growing, and a substantial number of patients suffer from psychological distress. Mindfulness-based interventions (MBIs) seem effective in alleviating psychological distress. Unfortunately, several cancer patients find it difficult, if not impossible, to attend a group-based course. Internet-based MBIs (eMBIs) such as Internet-based mindfulness-based cognitive therapy (eMBCT) may offer solutions. However, it is yet to be studied what facilitators and barriers cancer patients experience during eMBCT.

OBJECTIVE

This study aimed to explore facilitators and barriers of individual asynchronous therapist-assisted eMBCT as experienced by both patients and therapists.

METHODS

Patients with heterogeneous cancer diagnoses suffering from psychological distress were offered eMBCT. This 9-week intervention mirrored the group-based MBCT protocol and included weekly asynchronous written therapist feedback. Patients were granted access to a website that contained the eMBCT protocol and a secured inbox, and they were asked to practice and fill out diaries on which the therapist provided feedback. In total, 31 patients participated in an individual posttreatment interview on experienced facilitators and barriers during eMBCT. Moreover, eight therapists were interviewed. The data were analyzed with qualitative content analysis to identify barriers and facilitators in eMBCT.

RESULTS

Both patients and therapists mentioned four overarching themes as facilitators and barriers: treatment setting (the individual and Internet-based nature of the treatment), treatment format (how the treatment and its guidance were organized and delivered), role of the therapist, and individual patient characteristics.

CONCLUSIONS

The eMBCT provided flexibility in when, where, and how patients and therapists engage in MBCT. Future studies should assess how different eMBCT designs could further improve barriers that were found.
Patients� Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test (Preprint)
Authors: Dou Kaili , Yu Ping , Deng Ning , Liu Fang , Guan YingPing , Li Zhenye , Ji Yumeng , Du Ningkai , Lu Xudong , Duan Huilong
Published: July 2018

BACKGROUND

Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology.

OBJECTIVE

The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management.

METHODS

Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model.

RESULTS

The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management.

CONCLUSIONS

This study developed a theoretical model to predict patients’ acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients’ awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community.
Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study (Preprint)
Authors: Jacquemin Charlotte , Servy Hervé , Molto Anna , Sellam Jérémie , Foltz Violaine , Gandjbakhch Frédérique , Hudry Christophe , Mitrovic Stéphane , Fautrel Bruno , Gossec Laure
Published: July 2018

BACKGROUND

Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA).

OBJECTIVE

The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population.

METHODS

This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire.

RESULTS

A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10.

CONCLUSIONS

Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.
A Group of 500 Women Whose Health May Depart Notably From the Norm: Protocol for a Cross-Sectional Survey (Preprint)
Authors: Schnelle Christoph , Minford Eunice J , McHardy Vanessa , Keep Jane
Published: July 2018

BACKGROUND

Longitudinal studies of women’s health often seek to identify predictors of good health. Research has shown that following simple guidelines can halve women’s mortality. The ongoing Australian Longitudinal Study of Women’s Health (ALSWH) shows that Australian women are getting better at reducing their smoking and alcohol use, and are generally diligent about attending recommended health screenings, but are becoming less successful at dealing with obesity. There are communities of women who live unusually healthy lives (Rosetans, Seventh-Day Adventists, traditional Japanese women), but their lifestyles are unlikely to be adopted widely. Universal Medicine (UM) is a complementary-to-medicine approach that emphasizes personal empowerment and the importance of menstrual health symptoms.

OBJECTIVE

This survey investigates whether the approximately 500 women associated with UM exhibit health status significantly above the norm. As part of this investigation, questions for a newly developed menstrual attitudes questionnaire will also be evaluated.

METHODS

A quantitative cross-sectional survey of women in a UM cohort was designed with the help of three focus groups of women at three life stages: in menses, peri-menopausal, and menopausal. The menstrual attitudes portion of the survey incorporates the insights of these women regarding female health issues. The survey also includes 41 questions taken from the ALSWH. Focus groups generated additional questions about symptoms experienced and attitudes toward female health issues. ALSWH questions, including a range of health scales like the Short Form 36 (SF-36), Center for Epidemiologic Studies Depression Scale, Perceived Control Scale, Kessler Psychological Distress Scale, and the Multi-Item Summed Score for Perceived Stress, along with questions about experienced major health events, were investigated and incorporated if considered suitable.

RESULTS

The validity of the menstrual attitudes questionnaire will be evaluated with Cohen’s kappa. ALSWH respondents and UM participants will be compared, using unweighted regression or regression weighted or normalized by age, education, and interest in alternative treatments (to increase comparability), as appropriate. Analyses will determine whether UM-related variables (being a UM participant, length of UM participation, number of UM events attended) are associated with: differences in the number of major health events and health symptoms experienced; SF-36 physical and mental health scores; body mass index; and consumption of alcohol, tobacco, sugar, salt, caffeine, and dairy.

CONCLUSIONS

If women in the UM cohort are truly in substantially better health than the norm, further investigations may be worthwhile to see whether UM plays a causal role, and whether the women’s practices are generalizable.
A platform for cardiovascular disease (CVD) research in Malawi, with an initial focus on the link between infection, vascular damage and hypertension ???? (Preprint)
Authors: Peterson Ingrid , Benjamin Laura , Mwandumba Henry , Ntusi Ntobeko , Diggle Peter , Jambo Kondwani , Afran Louise , Kelly Christine , Sattar Naveed , McInnes Iain , Touyz Rhian
Published: July 2018

UNSTRUCTURED

Background: It is unclear why, compared to other settings, metabolic risk factors are low, yet risk of cardiovascular disease (CVD) and hypertension are high in Africa. One compelling possibility is that an on-going infectious disease burden has consequences for CVD risk in African adults. In Africa, early life exposure to infection and malnutrition may predispose individuals to elevated CVD risk in adulthood, while a high prevalence of herpesviruses (eg. cytomegalovirus [CMV]) promotes on-going inflammation. Chronic viral infection and systemic inflammation are implicated in the development and progression of atherosclerosis, and possibly also hypertension.
Objective: Given the paucity of data on CVD risk in Africa and growing awareness of the role of chronic viral infection and systemic inflammation in promoting arterial damage, this project aims to provide high quality data on viral and inflammation-associated risk of a) raised blood pressure, b) arterial damage and c) endothelial dysfunction in an adult African population.
Methods: We propose to establish a CVD research platform in HIV uninfected Malawian adults with an initial focus on inflammatory and viral risk factors for hypertension and arterial damage. The platform will rapidly generate high quality preliminary data on the role of CMV (and down-stream inflammation) in hypertension, arterial damage and endothelial dysfunction.
Results: Cross-sectional and longitudinal regression analysis of data generated by the platform will be conducted to assess the effect of CMV antibody titre, and markers of immune activation, senescence, inflammation and endothelia dysfunction on hypertension and arterial damage (measured by pulse-wave velocity and carotid-intima media thickness).
Conclusion: Our CVD research platform will generate key preliminary data on the role of inflammatory, pathogenic and metabolic factors in CVD risk in Africa to broaden understanding of CVD risk in this region of the world.