bluuebunny/crossref_metadata_2025 huggingface dataset:
Caspase1/11 signaling affects muscle regeneration and recovery following ischemia, and can be modulated by chloroquine
Authors: Sachdev Ulka , Ferrari Ricardo , Cui Xiangdong , Pius Abish , Sahu Amrita , Reynolds Michael , Liao Hong , Sun Ping , Shinde Sunita , Ambrosio Fabrisia , Shiva Sruti , Scott Melanie
Published: May 2020

Background: We previously showed that the autophagy inhibitor chloroquine (CQ) increases inflammatory cleaved caspase-1 activity in myocytes, and that caspase-1/11 is protective in sterile liver injury. However, the role of caspase-1/11 in the recovery of muscle from ischemia caused by peripheral arterial disease is unknown. We hypothesized that caspase-1/11 mediates recovery in muscle via effects on autophagy and that this is modulated by CQ.Methods: C57Bl/6J (WT) and caspase-1/11 double-knockout (KO) mice underwent femoral artery ligation (a model of hind-limb ischemia) with or without CQ (50mg/kg IP every 2 nd day). CQ effects on autophagosome formation, microtubule associated protein 1A/1B-light chain 3 (LC3), and caspase-1 expression was measured using electron microscopy and immunofluorescence. Laser Doppler perfusion imaging documented perfusion every 7 days. After 21 days, i n situ physiologic testing in tibialis anterior muscle assessed peak force contraction, and myocyte size and fibrosis was also measured. Muscle satellite cell (MuSC) oxygen consumption rate (OCR) and extracellular acidification rate was measured. Caspase-1 and glycolytic enzyme expression was detected by Western blot.Results: CQ increased autophagosomes, LC3 consolidation, total caspase-1 expression and cleaved caspase-1 in muscle. Perfusion, fibrosis, myofiber regeneration, muscle contraction, MuSC fusion, OCR, ECAR and glycolytic enzyme expression was variably affected by CQ depending on presence of caspase-1/11. CQ decreased perfusion recovery, fibrosis and myofiber size in WT but not caspase-1/11KO mice. CQ diminished peak force in whole muscle, and myocyte fusion in MuSC and these effects were exacerbated in caspase-1/11KO mice. CQ reductions in maximal respiration and ATP production were blunted in caspase-1/11KO mice. Caspase-1/11KO MuSC had significant increases in protein kinase isoforms and aldolase.Conclusion: Caspase-1/11 signaling affects the response to ischemia in muscle and effects are variably modulated by CQ. This may be critically important for disease treated with CQ and its derivatives, including novel viral diseases (e.g. COVID-19) that are expected to affect patients with comorbidities like cardiovascular disease.
Dietary Mannose Supplementation in Phosphomannomutase 2 Deficiency (PMM2-CDG)
Authors: Taday Roman , Grüneberg Marianne , DuChesne Ingrid , Reunert Janine , Marquardt Thorsten
Published: May 2020

BackgroundPMM2-CDG (CDG-Ia) is the most frequent N-glycosylation disorder. While supplying mannose to PMM2-deficient fibroblasts corrects the altered N-glycosylation in vitro, short term therapeutic approaches with mannose supplementation in PMM2-CDG patients have been unsuccessful. Mannose found no further mention in the design of a potential therapy for PMM2-CDG in the past years, as it applies as ineffective. This retrospective study analyzes the first long term mannose supplementation in 20 PMM2-CDG patients. Mannose was given at a total of 1–2 g mannose/kg b.w./d divided into 5 single doses over a mean time of 60,7 months. Protein glycosylation, blood mannose concentration and clinical presentation were monitored in everyday clinical practice.ResultsAfter a mean time period of more than 1 year the majority of patients showed significant improvements in protein glycosylation.ConclusionLong-term dietary D-mannose supplementation shows biological effects in PMM2-CDG, an inherited disorder of mannose metabolism. It improves glycosylation in the majority of patients and could become the first cornerstone in the treatment of this disease.
Strategic Management in Local Hospital Markets: Service Duplication or Service Differentiation
Authors: Trinh Hanh Q.
Published: May 2020

Background: The purpose of this study is to assess the influences of market structure on hospitals’ strategic decision to duplicate or differentiate services and to assess the relationship of duplication and differentiation to hospital performance. This study is different from previous research because it examines how a hospital decides which services to be duplicated or differentiated in a dyadic relationship embedded in a complex competitive network. Methods: We use Linear Structural Equations (LISREL) to simultaneously estimate the relationships among market structure, duplicated and differentiated services, and performance.Results: The findings provide support for duplicating and differentiating arrangement among rivals in a local market. Size asymmetry between hospitals is related to both service duplication (negatively) and service differentiation (positively), while geographic distance and market competition are related only to service duplication (positively and negatively, respectively). Both strategic activities are associated with lower market share, higher costs, and lower profits. Conclusions: The findings underscore the role of market structure as a check and balance on the provision of high-tech services. Hospital management should consider cutting back some services that are oversupplied and/or unprofitable and analyze the supply and demand in the market to avoid overdoing both service duplication and service differentiation.
Chest CT For Early Detection And Management Of Coronavirus Disease (COVID-19): A Report Of 314 Patients Admitted To Emergency Department With Suspected Pneumonia
Authors: Cartocci Gaia , Colaiacomo Maria Chiara , Lanciotti Silvia , Andreoli Chiara , Cicco Maria Luisa De , Brachetti Giulia , Pugliese Silvia , Capoccia Lucia , Tortora Alessandra , Scala Annarita , Valentini Cristina , Almberger Maria , D'Aprile Maria Rosaria , Avventurieri Giacinta , Giura Riccardo , Kharrub Zaher , Leonardi Andrea , Boccia Maddalena , Catalano Carlo , Ricci Paolo
Published: May 2020

PURPOSE: The purpose of our study was to assess the potential role of chest CT for the early detection of COVID-19 pneumonia and to explore its role in patient management in an adult Italian population admitted to the Emergency Department.METHODS: 314 patients presented with clinically suspected COVID-19, From March 3 rd to 23 th 2020, were evaluated with PaO2/FIO2 ratio from arterial blood gas, RT-PCR assay from nasopharyngeal swab sample and chest CT. Patients were classified as COVID-19 negative and COVID-19 positive according to RT-PCR results, considered as a reference. Images were independently evaluated by two radiologists blinded to the RT-PCR results and classified as “CT positive” or “CT negative” for COVID-19, according to CT findings.RESULTS: According to RT-PCR results, 152 patients were COVID-19 negative (48%) and 162 were COVID-19 positive (52%). We found substantial agreement between RT-PCR results and CT findings (p<0.000001), as well as an almost perfect agreement between the two readers. Mixed GGO and consolidation pattern with peripheral and bilateral distribution, multifocal or diffuse abnormalities localized in both upper and lower lung, in association with interlobular septal thickening, bronchial wall thickening and air bronchogram, showed higher frequency in COVID positive patients. We also found a significant correlation between CT findings and patient’s oxygenation status expressed by PaO2/FIO2 ratio.CONCLUSION: Chest CT is a vital component in the early detection and in patients management of COVID-19 pneumonia in a pandemic. It allows to identify suspected patients, cutting off the route of transmission and avoiding further spread of infection.
Dynamics of the COVID-19 pandemic in India
Authors: Khajanchi Subhas , Sarkar Kankan , Mondal Jayanta , Perc Matjaz
Published: May 2020

Understanding the dynamics of the COVID-19 pandemic is crucial for improved control and social distancing strategies. To that effect, we have employed the susceptible-exposed-infectious-recovered model, refined by contact tracing and hospitalization data from Indian provinces Kerala, Delhi, Maharashtra, and West Bengal, as well as from overall India. We have performed a sensitivity analysis to identify the most crucial input parameters, and we have calibrated the model to describe the data as best as possible. Short-term predictions reveal an increasing and worrying trend of COVID-19 cases for all four provinces and India as a whole, while long-term predictions also reveal the possibility of oscillatory dynamics. Our research thus leaves the option open that COVID-19 might become a seasonal occurrence. We also simulate and discuss the impact of media on the dynamics of the COVID-19 pandemic.
The role of Kazakhstan’s oil policy in foreign policy
Authors: Khvostenko Vladyslav , Memmedli Marziye , Milevskyi Stanislav
Published: May 2020

Since gained its independence in 1991, energy management has become the most important factor in the development of Kazakhstan’s economic and foreign policy. This is due to the presence of widespread deposits of natural energy resources in the bowels of Kazakhstan. This forms the energy security and essential basis for the economic independence of the Republic of Kazakhstan. The study, first of all, looks at Kazakhstan’s foreign policy and the links between foreign policy and energy sources. In particular, attention is paid to the role of oil in shaping Kazakhstan’s foreign policy as an active participant in the highly competitive energy resources market. The energy potential of Kazakhstan, the entry of Kazakh oil into the world market and the obstacles created by Russia for Kazakhstan in this process are investigated next. Other problems in the region are analyzed, including border issues with neighboring countries, as well as the impact of energy demand in China on Kazakhstan’s foreign policy. In this regard, the main focus of the study is the analysis of Kazakhstan’s energy resources rich in oil reserves, and the analysis of the multilateral energy policy of the Astana Government since independence and has been gained since.
Improved modelling of a Prairie catchment using a progressive two-stage calibration strategy with in situ soil moisture and streamflow data
Authors: Budhathoki Sujata , Rokaya Prabin , Lindenschmidt Karl-Erich
Published: May 2020

Dynamic contributing areas, various fill-and-spill mechanisms and cold-region processes make the hydrological modelling of the Prairies very challenging. Several models (from simple conceptual to advanced process-based) are available, but the focus has been largely in reproducing streamflow. Few studies have assimilated soil moisture and other hydrological fluxes for improved simulation, but the emphasis has been predominately on simulating contributing areas. However, previous research has shown that the contributing areas are dynamic, and can vary from one year to the next, depending on hydro-meteorological conditions. Therefore, the areas deemed non-contributing can also occasionally contribute to streamflow. In this study, we introduce a progressive two-stage calibration strategy to constrain soil moisture in non-contributing areas. We demonstrate that constraining soil moisture in non-contributing areas can result in improved hydrological simulations and more realistic process representations. The Nash–Sutcliffe efficiency (NSE) values for simulated soil moisture in contributing areas increased by 68% at 20 cm and 25% at 50 cm soil depths during validation when non-contributing areas were constrained. This further led to increases in NSE values in streamflow simulation during calibration (6%) and validation (12%). Our findings suggest that soil moisture in non-contributing areas should be properly constrained for improved modelling of Prairie catchments.
Experimental evaluation of two consecutive air-gap membrane distillation modules with heat recovery
Authors: Abu-Zeid Mostafa Abd El-Rady , ElMasry Gamal
Published: May 2020

Two rectangular modules with a total interior membrane surface area of 13.53 m2 were consecutively combined to evaluate the use of heat recovery in an air-gap membrane distillation (AGMD) system. Several operating inlet parameters including feed water temperature, mass water flow rate and salinity were investigated. The experimental results revealed that the performance of the system was improved by virtue of efficient heat recovery resulting from combining two AGMD membrane modules in series. Under optimal inlet operating parameters of cooling water temperature of 20 °C, salinity of 0.05% and flow rate of 3 l/min, the system productivity (Pp) increased up to 192.9%, 179.3%, 176.5% and 179.2%, and the thermal efficiency (ηth) by 261.5%, 232.6%, 239.4% and 227.3% at feed water temperatures of 45 °C, 55 °C, 65 °C and 75 °C, respectively. Concurrently, the specific waste heat input (Ew.h.i) decreased by 6.7%, 4.7%, 5.6% and 2.7% due to the efficient heat recovery. The results confirmed that heat recovery is an important factor affecting the AGMD system that could be improved by designing one of the two AGMD modules with polytetrafluoroethylene (PTFE) hollow fibers with a flow length shorter than the other one having a salt rejection rate of 99%.
Grójec w akwarelach Leonarda Pękalskiego
Authors: Olszewski Andrzej K.
Published: May 2020

Krótki komunikat na temat zespołu akwarel Leonarda Pękalskiego (1896-1944) przedstawiających Grójec, miasto urodzenia artysty.

Brief announcement relevant to Leonard Pękalski’s water-colours paintings depicting Grójec – the place of artist’s birth.
Voltage-Gated Sodium Channel Blockers: Synthesis of Mexiletine Analogues and Homologues
Authors: Catalano Alessia , Franchini Carlo , Carocci Alessia
Published: May 2020

Mexiletine is an antiarrhythmic drug belonging to IB class, acting as sodium channel
blocker. Besides its well-known activity on arrhythmias, its usefulness in the treatment of
myotonia, myotonic dystrophy and amyotrophic lateral sclerosis is now widely recognized.
Nevertheless, it has been retired from the market in several countries because of its undesired
effects. Thus, several papers were reported in the last years about analogues and homologues
of mexiletine being endowed with a wider therapeutic ratio and a more selectivity of action.
Some of them showed sodium channel blocking activity higher than the parent compound. It
is noteworthy that mexiletine is used in therapy as a racemate even though a difference in the
activities of the two enantiomers was widely demonstrated, with (–)-(R)-enantiomer being
more active: this finding led several research groups to study mexiletine and its analogues and
homologues in their optically active forms. This review summarizes the different synthetic
routes used to obtain these compounds. They could represent an interesting starting point to
new mexiletine-like compounds without common side effects related to the use of mexiletine.
Targeting Mammalian Target of Rapamycin: Prospects for the Treatment of Inflammatory Bowel Diseases
Authors: Lashgari Naser-Aldin , Roudsari Nazanin Momeni , Momtaz Saeideh , Ghanaatian Negar , Kohansal Parichehr , Farzaei Mohammad Hosein , Afshari Khashayar , Sahebkar Amirhossein , Abdolghaffari Amir Hossein
Published: May 2020

:

Inflammatory bowel disease (IBD) is a general term for a group of chronic and progressive
disorders. Several cellular and biomolecular pathways are implicated in the pathogenesis of
IBD, yet the etiology is unclear. Activation of the mammalian target of rapamycin (mTOR) pathway
in the intestinal epithelial cells was also shown to induce inflammation. This review focuses
on the inhibition of the mTOR signaling pathway and its potential application in treating IBD. We
also provide an overview of plant-derived compounds that are beneficial for the IBD management
through modulation of the mTOR pathway. Data were extracted from clinical, in vitro and in vivo
studies published in English between 1995 and May 2019, which were collected from PubMed,
Google Scholar, Scopus and Cochrane library databases. Results of various studies implied that
inhibition of the mTOR signaling pathway downregulates the inflammatory processes and cytokines
involved in IBD. In this context, a number of natural products might reverse the pathological
features of the disease. Furthermore, mTOR provides a novel drug target for IBD. Comprehensive
clinical studies are required to confirm the efficacy of mTOR inhibitors in treating IBD.
Regulation of Cl- Electrolyte Permeability in Epithelia by Active Traditional Chinese Medicine Monomers for Diarrhea
Authors: Chen Lei , Ding Yan , Hou Yapeng , Liu Yanhong , Nie Hongguang
Published: May 2020

The epithelial layer, lining the inner surface of the mammalian alveolar, kidney, brain and
colon, is a typical electrolyte transporting tissue. Large quantities of salt and fluid are actively moved
from the mucosal side toward the blood vessel. Transepithelial salt re-absorption in epithelial tissues
plays an important role in maintaining fluid homeostasis. In absorptive epithelium, fluid and salt flux
is controlled by the machinery mainly composed of epithelial sodium channel, cystic fibrosis transmembrane
conductance regulator, Na+-K+-2Cl- cotransporter, Na+/H+ exchanger, and Na+/K+-ATPase.
Dysregulation of salt permeability across epithelium contributes to the pathogenesis of organ edema.
In numerous ion transporters, epithelial Cl- transportation plays an important role in water secretion
across epithelial tissues and regulation of body fluid content. Many traditional Chinese medicines treat
diarrhea by regulating the Cl- electrolyte transport. We systematically summarized the recent progress
regarding the traditional Chinese medicine on Cl- electrolyte transport in the intestinal epithelial tissues.
The pharmaceutical relevance of developing advanced strategies to mitigate edematous disorders
is also implicated. In conclusion, the crosstalk between Cl- electrolyte transport and active traditional
Chinese medicine monomers may lead to the development of new strategies for diarrhea by manipulating
the function and expression of ion channels.
Nutritional Support and Probiotics as a Potential Treatment of IBD
Authors: Tarasiuk Aleksandra , Eibl Guido
Published: May 2020

The pathogenesis of inflammatory bowel disease (IBD) remains unknown. However, there
is growing evidence that the increase in the overall incidence of IBD relates to the improvement of
sanitary and hygienic conditions of the society leading to lower exposure to both bacterial and parasitic
infections. IBD is incurable and characterized by alternating periods of exacerbation and remission
of symptoms. Therefore, the main goal of treatment strategies in IBD patients is the most effective
maintenance of clinical and endoscopic remission, which does allow patients to function normally for
a significant part of life. Taking into account the evidence from different areas, there is a strong rationale
supporting the concept that bacteria are important in gut inflammation and that probiotic bacteria
may modulate the host-microbe interaction in a way that is directly beneficial to IBD patients along
with nutritional support. In this review, we focus on the potential role of gastrointestinal microbiota in
the pathogenesis of IBD and the possible value of probiotics, prebiotics, and symbiotics as well as nutritional
support in the treatment of IBD.
Immunotherapy: A Potential Approach to Targeting Cancer Stem Cells
Authors: Wang Wenjun , Bai Ling , Xu Dongsheng , Li Wei , Cui Jiuwei
Published: May 2020

Tumor recurrence and drug resistance are two of the key factors affecting the prognosis of
cancer patients. Cancer stem cells (CSCs) are a group of cells with infinite proliferation potential
which are not sensitive to traditional therapies, including radio- and chemotherapy. These CSCs are
considered to be central to tumor recurrence and the development of drug resistance. In addition,
CSCs are important targets in cancer immunotherapy because of their expression of novel tumorassociated
antigens, which result from mutations in cancer cells over the course of treatment. Emerging
immunotherapies, including cancer vaccines, checkpoint blockade therapies, and transferred
immune cell therapies, have all been shown to be more effective when they selectively target CSCs.
Such therapies may also provide novel additions to the current therapeutic milieu and may offer new
therapeutic combinations for treatment. This review summarizes the relationships between various
immunotherapies and CSCs and provides novel insights into potential therapeutic applications for
these approaches in the future.
Oxidative Halogenation of Arenes, Olefins and Alkynes Mediated by Iodine(III) Reagents
Authors: Segura-Quezada Luis A. , Torres-Carbajal Karina R. , Satkar Yuvraj , Juárez Ornelas Kevin A. , Mali Narendra , Patil Dipak B. , Gámez-Montaño Rocío , Zapata-Morales Juan R. , Lagunas-Rivera Selene , Ortíz-Alvarado Rafael , Solorio-Alvarado César R.
Published: May 2020

Iodine(III)-based reagents have been broadly used in oxidative reactions for structural
functionalization with several functional groups. Among the more relevant and useful synthetic
transformations using these hypervalent λ3-reagents, the fluorination, chlorination, bromination, as
well as the iodination protocols, can be found. Herein, we present some of the most representative
oxidative halogenation procedures of arenes, olefins and alkynes dating from the oldest to the more
recent advances in the area, highlighting the discovery and application of new iodine(III)-based halogenating
species.
Anti-Inflammatory Agents Produced from Plant Latex
Authors: da Silva Souza Bruna , Barbosa Mayck Silva , Sales Ana Clara Silva , Moita Lucas Arruda , de Moraes Oliveira Naylla Veras , de Sousa Jhoana D’arc Lopes , da Silva Francisca Dayane Soares , de Oliveira Jefferson Soares
Published: May 2020

Plants have been the main source of molecules for the treatment of diseases over the
years. They have been used in traditional medicine based on experience and practice. Many molecules
from plant latex have been isolated, identified and tested for pharmacological activities, including
reduction of inflammation. This review provides an overview of the latexes released from
different plant species and their anti-inflammatory properties. Different in vivo and in vivo assays
have been performed trying to confirm this pharmacological potential. Many studies suggest that
latexes from plants have therapeutic potential to treat inflammatory diseases and support their traditional
medicinal use.
Willingness of Patients Prescribed Medications for Lifestyle-Related Diseases to Use Personal Health Records: Questionnaire Study
Authors: Hirano Ryoma , Yamaguchi Satoko , Waki Kayo , Kimura Yoshihiko , Chin Keiichi , Nannya Yasuhito , Nangaku Masaomi , Kadowaki Takashi , Ohe Kazuhiko
Published: May 2020

Background

Personal health record (PHR) systems let individuals utilize their own health information to maintain and improve quality of life. Using PHRs is expected to support self-management in patients with lifestyle-related diseases.

Objective

The aim of this study was to identify predictors of the willingness to use PHRs among patients who are prescribed medications for lifestyle-related diseases.

Methods

We recruited pharmacy patrons, aged 20 years or older, who had received at least one medication indicated for hypertension, dyslipidemia, or diabetes. Participants completed self-administered questionnaires regarding their previous diseases, awareness of health care, experience in using PHRs, willingness to use PHRs, and barriers to using PHRs. Data were analyzed using multivariate logistic regression models.

Results

Of the 3708 subjects meeting eligibility criteria, 2307 replies (62.22%) were collected. While only 174 (7.54%) participants had previous PHR experience, 853 (36.97%) expressed willingness to use PHRs. In the multivariate analysis, considering exercise to be important for health management (odds ratio [OR] 1.57, 95% CI 1.12-2.21; P=.009), obtaining medical information from books or magazines (OR 1.23, 95% CI 0.96-1.59; P=.10), and obtaining medical information from the internet (OR 1.45, 95% CI 1.13-1.87; P=.004) were newly identified predictors. These were in addition to known predictors, such as being employed, owning information terminals, and previous PHR experience.

Conclusions

Patients who have an active and positive attitude toward health seem to be more willing to use PHRs. Investigating willingness should contribute to the development of more useful PHRs for self-management among patients prescribed medications for lifestyle-related diseases.
Development of an Emotion-Sensitive mHealth Approach for Mood-State Recognition in Bipolar Disorder
Authors: Daus Henning , Bloecher Timon , Egeler Ronny , De Klerk Richard , Stork Wilhelm , Backenstrass Matthias
Published: May 2020

Internet- and mobile-based approaches have become increasingly significant to psychological research in the field of bipolar disorders. While research suggests that emotional aspects of bipolar disorders are substantially related to the social and global functioning or the suicidality of patients, these aspects have so far not sufficiently been considered within the context of mobile-based disease management approaches. As a multiprofessional research team, we have developed a new and emotion-sensitive assistance system, which we have adapted to the needs of patients with bipolar disorder. Next to the analysis of self-assessments, third-party assessments, and sensor data, the new assistance system analyzes audio and video data of these patients regarding their emotional content or the presence of emotional cues. In this viewpoint, we describe the theoretical and technological basis of our emotion-sensitive approach and do not present empirical data or a proof of concept. To our knowledge, the new assistance system incorporates the first mobile-based approach to analyze emotional expressions of patients with bipolar disorder. As a next step, the validity and feasibility of our emotion-sensitive approach must be evaluated. In the future, it might benefit diagnostic, prognostic, or even therapeutic purposes and complement existing systems with the help of new and intuitive interaction models.
Can Social Communication Skills for Children Diagnosed With Autism Spectrum Disorder Rehearsed Inside the Video Game Environment of Minecraft Generalize to the Real World?
Authors: Cadieux Lee , Keenan Mickey
Published: May 2020

In this paper, we outline opportunities within the video game environment for building skills applicable to real-world issues faced by some children. The game Minecraft is extremely popular and of particular interest to children diagnosed with autism spectrum disorder. Although the game has been used by support communities to facilitate the social interaction of children and peer support for their parents, little has been done to examine how social skills developed within the game environment generalize to the real world. Social Craft aims to establish a framework in which key social communication skills would be rehearsed in-game with a view to facilitating their replication in a similarly contained real-world environment. Central to this approach is an understanding of the basic principles of behavior and the engagement of a sound methodology for the collection of data inside and outside the respective environments.
Identifying the Medical Lethality of Suicide Attempts Using Network Analysis and Deep Learning: Nationwide Study
Authors: Kim Bora , Kim Younghoon , Park C Hyung Keun , Rhee Sang Jin , Kim Young Shin , Leventhal Bennett L , Ahn Yong Min , Paik Hyojung
Published: May 2020

Background

Suicide is one of the leading causes of death among young and middle-aged people. However, little is understood about the behaviors leading up to actual suicide attempts and whether these behaviors are specific to the nature of suicide attempts.

Objective

The goal of this study was to examine the clusters of behaviors antecedent to suicide attempts to determine if they could be used to assess the potential lethality of the attempt. To accomplish this goal, we developed a deep learning model using the relationships among behaviors antecedent to suicide attempts and the attempts themselves.

Methods

This study used data from the Korea National Suicide Survey. We identified 1112 individuals who attempted suicide and completed a psychiatric evaluation in the emergency room. The 15-item Beck Suicide Intent Scale (SIS) was used for assessing antecedent behaviors, and the medical outcomes of the suicide attempts were measured by assessing lethality with the Columbia Suicide Severity Rating Scale (C-SSRS; lethal suicide attempt >3 and nonlethal attempt ≤3).

Results

Using scores from the SIS, individuals who had lethal and nonlethal attempts comprised two different network nodes with the edges representing the relationships among nodes. Among the antecedent behaviors, the conception of a method’s lethality predicted suicidal behaviors with severe medical outcomes. The vectorized relationship values among the elements of antecedent behaviors in our deep learning model (E-GONet) increased performances, such as F1 and area under the precision-recall gain curve (AUPRG), for identifying lethal attempts (up to 3% for F1 and 32% for AUPRG), as compared with other models (mean F1: 0.81 for E-GONet, 0.78 for linear regression, and 0.80 for random forest; mean AUPRG: 0.73 for E-GONet, 0.41 for linear regression, and 0.69 for random forest).

Conclusions

The relationships among behaviors antecedent to suicide attempts can be used to understand the suicidal intent of individuals and help identify the lethality of potential suicide attempts. Such a model may be useful in prioritizing cases for preventive intervention.
Effect of Speech Recognition on Problem Solving and Recall in Consumer Digital Health Tasks: Controlled Laboratory Experiment
Authors: Chen Jessica , Lyell David , Laranjo Liliana , Magrabi Farah
Published: May 2020

Background

Recent advances in natural language processing and artificial intelligence have led to widespread adoption of speech recognition technologies. In consumer health applications, speech recognition is usually applied to support interactions with conversational agents for data collection, decision support, and patient monitoring. However, little is known about the use of speech recognition in consumer health applications and few studies have evaluated the efficacy of conversational agents in the hands of consumers. In other consumer-facing tools, cognitive load has been observed to be an important factor affecting the use of speech recognition technologies in tasks involving problem solving and recall. Users find it more difficult to think and speak at the same time when compared to typing, pointing, and clicking. However, the effects of speech recognition on cognitive load when performing health tasks has not yet been explored.

Objective

The aim of this study was to evaluate the use of speech recognition for documentation in consumer digital health tasks involving problem solving and recall.

Methods

Fifty university staff and students were recruited to undertake four documentation tasks with a simulated conversational agent in a computer laboratory. The tasks varied in complexity determined by the amount of problem solving and recall required (simple and complex) and the input modality (speech recognition vs keyboard and mouse). Cognitive load, task completion time, error rate, and usability were measured.

Results

Compared to using a keyboard and mouse, speech recognition significantly increased the cognitive load for complex tasks (Z=–4.08, P<.001) and simple tasks (Z=–2.24, P=.03). Complex tasks took significantly longer to complete (Z=–2.52, P=.01) and speech recognition was found to be overall less usable than a keyboard and mouse (Z=–3.30, P=.001). However, there was no effect on errors.

Conclusions

Use of a keyboard and mouse was preferable to speech recognition for complex tasks involving problem solving and recall. Further studies using a broader variety of consumer digital health tasks of varying complexity are needed to investigate the contexts in which use of speech recognition is most appropriate. The effects of cognitive load on task performance and its significance also need to be investigated.
A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial
Authors: Kelechi Teresa J , Prentice Margaret A , Mueller Martina , Madisetti Mohan , Vertegel Alexey
Published: May 2020

Background

Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity.

Objective

The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function.

Methods

In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance.

Results

A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85% of the time for duration, whereas 33% (8/24) of patients adhered more than 85% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from −0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app.

Conclusions

The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features.

Trial Registration

ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695
Assessing Bias in Population Size Estimates Among Hidden Populations When Using the Service Multiplier Method Combined With Respondent-Driven Sampling Surveys: Survey Study
Authors: Chabata Sungai T , Fearon Elizabeth , Webb Emily L , Weiss Helen A , Hargreaves James R , Cowan Frances M
Published: May 2020

Background

Population size estimates (PSEs) for hidden populations at increased risk of HIV, including female sex workers (FSWs), are important to inform public health policy and resource allocation. The service multiplier method (SMM) is commonly used to estimate the sizes of hidden populations. We used this method to obtain PSEs for FSWs at 9 sites in Zimbabwe and explored methods for assessing potential biases that could arise in using this approach.

Objective

This study aimed to guide the assessment of biases that arise when estimating the population sizes of hidden populations using the SMM combined with respondent-driven sampling (RDS) surveys.

Methods

We conducted RDS surveys at 9 sites in late 2013, where the Sisters with a Voice program (the program), which collects program visit data of FSWs, was also present. Using the SMM, we obtained PSEs for FSWs at each site by dividing the number of FSWs who attended the program, based on program records, by the RDS-II weighted proportion of FSWs who reported attending this program in the previous 6 months in the RDS surveys. Both the RDS weighting and SMM make a number of assumptions, potentially leading to biases if the assumptions are not met. To test these assumptions, we used convergence and bottleneck plots to assess seed dependence of RDS-II proportion estimates, chi-square tests to assess if there was an association between the characteristics of FSWs and their knowledge of program existence, and logistic regression to compare the characteristics of FSWs attending the program with those recruited to RDS surveys.

Results

The PSEs ranged from 194 (95% CI 62-325) to 805 (95% CI 456-1142) across 9 sites from May to November 2013. The 95% CIs for the majority of sites were wide. In some sites, the RDS-II proportion of women who reported program use in the RDS surveys may have been influenced by the characteristics of selected seeds, and we also observed bottlenecks in some sites. There was no evidence of association between characteristics of FSWs and knowledge of program existence, and in the majority of sites, there was no evidence that the characteristics of the populations differed between RDS and program data.

Conclusions

We used a series of rigorous methods to explore potential biases in our PSEs. We were able to identify the biases and their potential direction, but we could not determine the ultimate direction of these biases in our PSEs. We have evidence that the PSEs in most sites may be biased and a suggestion that the bias is toward underestimation, and this should be considered if the PSEs are to be used. These tests for bias should be included when undertaking population size estimation using the SMM combined with RDS surveys.
Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study
Authors: Desai Sonali , Stevens Emma , Emani Srinivas , Meyers Peter , Iversen Maura , Solomon Daniel H
Published: May 2020

Background

Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology.

Objective

The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management.

Methods

Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process.

Results

From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit.

Conclusions

We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits.
Participatory Interventions for Sexual Health Promotion for Adolescents and Young Adults on the Internet: Systematic Review
Authors: Martin Philippe , Cousin Lorraine , Gottot Serge , Bourmaud Aurelie , de La Rochebrochard Elise , Alberti Corinne
Published: May 2020

Background

The World Health Organization recommends the development of participatory sexuality education. In health promotion, web-based participatory interventions have great potential in view of the internet’s popularity among young people.

Objective

The aim of this review is to describe existing published studies on online participatory intervention methods used to promote the sexual health of adolescents and young adults.

Methods

We conducted a systematic review based on international scientific and grey literature. We used the PubMed search engine and Aurore database for the search. Articles were included if they reported studies on participatory intervention, included the theme of sexual health, were conducted on the internet (website, social media, online gaming system), targeted populations aged between 10 and 24 years, and had design, implementation, and evaluation methods available. We analyzed the intervention content, study implementation, and evaluation methods for all selected articles.

Results

A total of 60 articles were included, which described 37 interventions; several articles were published about the same intervention. Process results were published in many articles (n=40), in contrast to effectiveness results (n=23). Many of the 37 interventions were developed on websites (n=20). The second most used medium is online social networks (n=13), with Facebook dominating this group (n=8). Online peer interaction is the most common participatory component promoted by interventions (n=23), followed by interaction with a professional (n=16). Another participatory component is game-type activity (n=10). Videos were broadcast for more than half of the interventions (n=20). In total, 43% (n=16) of the interventions were based on a theoretical model, with many using the Information-Motivation-Behavioral Skills model (n=7). Less than half of the interventions have been evaluated for effectiveness (n=17), while one-third (n=12) reported plans to do so and one-fifth (n=8) did not indicate any plan for effectiveness evaluation. The randomized controlled trial is the most widely used study design (n=16). Among the outcomes (evaluated or planned for evaluation), sexual behaviors are the most evaluated (n=14), followed by condom use (n=11), and sexual health knowledge (n=8).

Conclusions

Participatory online interventions for young people’s sexual health have shown their feasibility, practical interest, and attractiveness, but their effectiveness has not yet been sufficiently evaluated. Online peer interaction, the major participatory component, is not sufficiently conceptualized and defined as a determinant of change or theoretical model component. One potential development would be to build a conceptual model integrating online peer interaction and support as a component.
Perceived Need for Psychosocial Support After Aortic Dissection: Cross-Sectional Survey
Authors: Meinlschmidt Gunther , Berdajs Denis , Moser-Starck Roger , Frick Alexander , Gross Sebastian , Schurr Ulrich , Eckstein Friedrich S , Hunziker Sabina , Schaefert Rainer
Published: May 2020

Background

The gold standard management of aortic dissection, a life-threatening condition, includes multidisciplinary approaches. Although mental distress following aortic dissection is common, evidence-based psychosocial interventions for aortic dissection survivors are lacking.

Objective

The aim of this study is to identify the perceived psychosocial needs of aortic dissection survivors by surveying patients, their relatives, and health professionals to inform the development of such interventions.

Methods

This study used a cross-sectional survey and collected responses from 41 participants (27 patients with aortic dissection, 8 relatives of patients with aortic dissection, and 6 health professionals) on key topics, types of interventions, best timing, anticipated success, and the intended effects and side effects of psychosocial interventions after aortic dissection.

Results

The principal intervention topics were “changes in everyday life” (28/41, 68%, 95% CI 54.5%-82.9%), “anxiety” (25/41, 61%, 95% CI 46.2%-76.2%), “uncertainty” (24/41, 59%, 95% CI 42.9%-73.2%), “tension/distress” (24/41, 59%, 95% CI 43.9%-73.8%), and “trust in the body” (21/41, 51%, 95% CI 35.9%-67.5%). The most commonly indicated intervention types were “family/relative therapy” (21/41, 51%, 95% CI 35%-65.9%) and “anxiety treatment” (21/41, 51%, 95% CI 35%-67.5%). The most recommended intervention timing was “during inpatient rehabilitation” (26/41, 63%, 95% CI 47.6%-77.5%) followed by “shortly after inpatient rehabilitation” (20/41, 49%, 95% CI 32.4%-65%). More than 95% (39/41) of respondents anticipated a benefit from psychosocial interventions following aortic dissection dissection, expecting a probable improvement in 68.6% (95% CI 61.4%-76.2%) of aortic dissection survivors, a worse outcome for 5% (95% CI 2.9%-7.9%), and that 6% (95% CI 1.8%-10.4%) would have negative side effects due to such interventions.

Conclusions

Our findings highlight a substantial need for psychosocial interventions in aortic dissection survivors and indicate that such interventions would be a success. They provide a basis for the development and evaluation of interventions as part of state-of-the-art aortic dissection management.