bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Arabic Learning: Innovative Snakes and Ladders Media Design
Authors: Ariyani Mufarikha , Hikmah Khizanatul
Published: November 2023

This study employs an R&D approach, utilizing the ADDIE model, to investigate the development of snakes and ladders learning media for Arabic instruction. Initial analysis revealed the exclusive use of lecture-based teaching without supplementary media. Subsequently, the researcher designed a snakes and ladders learning module using the Canva application. The designed module underwent validation, with material experts providing unanimous approval and media experts offering constructive feedback. Implementation in a classroom setting garnered positive responses, with 97.50% and 92.50% from small- and large-scale assessments, respectively. Formative evaluation based on student feedback led to further refinements, including an enlargement to A3 size. Both qualitative and quantitative techniques were employed for data analysis, drawing on methods such as observation, interviews, and questionnaires. The study's results demonstrate the efficacy and potential of the innovative snakes and ladders media in enhancing Arabic language learning.
Highlight:

Utilizes R&D approach and ADDIE model for innovative Arabic learning media development.
Validates the snakes and ladders module with expert input and implements it in a classroom setting.
Demonstrates substantial improvement in Arabic language learning through formative evaluation and quantitative analysis.

Keyword: R&D Approach, Arabic Language Learning, Snakes and Ladders Media, ADDIE Model, Innovative Pedagogy
Enhancing Arabic Vocabulary Mastery in Primary Students through Powtoon-Based Web Media
Authors: Rahmah Hasifatur , Fauji Imam
Published: November 2023

This study investigates the impact of utilizing Powtoon-based web media on the mastery of Arabic vocabulary (mufrodaat) among fourth-grade students at SD Muhammadiyah 09 Ngaban. Twenty students participated as research subjects, and quantitative data analysis techniques were employed. Data collection involved pretests, posttests, observations, and documentation. The study revealed a noteworthy average N-Gain score of 0.515, indicating a moderate effect of Powtoon media on students' Arabic vocabulary mastery. These findings underscore the potential of web-based media in augmenting language acquisition and offer practical insights for educators aiming to optimize vocabulary instruction. Highlight: This study assesses the impact of Powtoon-based web media on Arabic vocabulary acquisition in fourth-grade students. Quantitative data analysis and various assessment methods were employed to measure the effectiveness of the intervention. The research highlights the potential of web-based media in enhancing language learning outcomes, providing valuable insights for educators in vocabulary instruction optimization. Keyword: Arabic Vocabulary Mastery, Powtoon-Based Web Media, Language Acquisition, Educational Impact, Vocabulary Instruction Enhancement
Influence Factors on Income Smoothing in Manufacturing Companies: Evidence from Indonesia's Stock Exchange
Authors: Eny Maryanti  , Biduri Sarwenda , Kumala Sari Herlinda Maya , Fauziah Luluk Putri
Published: November 2023

This study investigates the determinants of income smoothing in Indonesian manufacturing firms listed on the stock exchange during 2016-2021. The research examines the impact of Institutional Ownership, Managerial Ownership, Return on Assets, Debt to Equity Ratio, and Ln Total Sales on Income Smoothing using binary logistic regression analysis. The findings reveal that Institutional Ownership, Managerial Ownership, and firm size significantly influence income smoothing, while Financial Leverage and Profitability do not exhibit significant effects on Income Smoothing. These results contribute to the understanding of income smoothing practices and hold implications for corporate governance and financial reporting practices in emerging markets. Highlight: Determinants of Income Smoothing: This study delves into the factors driving income smoothing in Indonesian manufacturing companies listed on the stock exchange between 2016 and 2021. Influential Factors: Institutional Ownership, Managerial Ownership, and firm size are identified as significant influencers of income smoothing, shedding light on their impact within this context. Implications for Governance and Reporting: The study's outcomes offer valuable insights for corporate governance practices and financial reporting strategies, particularly in the dynamic landscape of emerging markets. Keyword: Income Smoothing, Manufacturing Firms, Institutional Ownership, Managerial Ownership, Emerging Markets
Unveiling the Sway of Marketing Mix on Student Decisions: A Study on Higher Learning Institutions
Authors: Febriansah Rizky Eka , Yani Muhammad , Prasojo Bayu Hari
Published: November 2023

This research delves into the pivotal process of student decision-making within higher learning institutions, focusing on the dynamic interplay of marketing mix services encompassing product, price, promotion, and place. Through an analysis of alumni and current student cohorts at a prominent university, this study empirically demonstrates the profound influence exerted by product quality, strategic promotion, and favorable institutional positioning on students' selection choices. Notably, while price emerges as a comparatively weaker determinant, the collective impact of product, place, and promotion proves instrumental in shaping prospective students' decisions. These findings illuminate the complex landscape of student preferences, offering valuable insights for crafting targeted marketing strategies that effectively guide students' educational trajectories. Highlight: Influence of Marketing Mix Dynamics: This study examines the interaction of product, price, promotion, and place in shaping student decisions within higher learning institutions, revealing their collective impact on choice. Empirical Insights: Analysis of alumni and current students from a renowned university highlights the significant sway of product quality, strategic promotion, and favorable institutional positioning on student selection choices. Role of Price in Decision-making: While price emerges as a less potent factor, the study underscores the pivotal role played by the interplay between product, place, and promotion in molding the educational preferences of prospective students. Keyword: Student Decision-Making, Higher Learning Institutions, Marketing Mix Services, Product Quality, Strategic Promotion
Urdu: Evolution, Influence, and Resilience in Indian Linguistic Landscape
Authors: Bhattacharya Deepak
Published: November 2023

This study delves into the rich linguistic tapestry of Urdu, tracing its origins in Sanskrit grammar, its versatile phonetics, and its enduring presence from love poetry to revolutionary discourse. Emerging in India, Urdu played a pivotal role as the lingua franca in the historical Awadh kingdom and served as a vital conduit during the 1857 revolt. Its roots as Proto Urdu, or Hindvi, can be traced to imperial Delhi, prior to Aurangazeb's reign. Following the Indo-Pak partition, Urdu was adopted as the National Language of Pakistan. While the percentage of Urdu speakers in India has remained stable since 1950, its cultural significance has continued to flourish, with substantial governmental support for its promotion. This article underscores the enduring influence of Urdu on Indian society, from Bollywood's pivotal role in sustaining its prominence to its integration with Hindi, exemplified by the commendable linguistic proficiency exhibited by the Indian armed forces. This linguistic legacy remains a cornerstone of Indian identity and a formidable force in the realm of Indian politics, firmly rooted and enduring in its significance.
Highlight:

Urdu's Diverse Roots: This study uncovers the linguistic evolution of Urdu, revealing its diverse origins in Sanskrit grammar and its ability to adapt to various phonetic styles, shaping its enduring presence in poetry and political discourse.

Urdu as a Historical Nexus: Emerging in India, Urdu served as a critical lingua franca in the Awadh kingdom and played a pivotal role during the tumultuous events of the 1857 revolt, highlighting its historical and sociopolitical significance.

Urdu's Contemporary Influence: Despite linguistic demographics remaining stable, Urdu's cultural importance has flourished, supported by substantial governmental backing. Its integration with Hindi and its commendable proficiency within the Indian armed forces illustrate its enduring impact on Indian society and politics.

Keyword: Urdu, Linguistic Heritage, Cultural Significance, Language Evolution, Indian Identity
Impact of supply chain finance on the performance of agricultural small and medium-sized enterprises: Evidence from Chinese listed companies
Authors: Li Wenji , Sutunyarak Chonlavit
Published: November 2023

In the Chinese economic system, agricultural small and medium-sized enterprises (SMEs) play a key role in promoting agricultural development. The problem of financing difficulties for agricultural SMEs has seriously constrained their economic development. The purpose of this paper is to explore the role of supply chain finance in solving the financing constraint problem of agricultural SMEs, which in turn affects the performance level of enterprises. By constructing a theoretical model and selecting the data in Chinese National Small and Medium Enterprises Stock Transfer System from 2011 to 2022 for mediation effect regression analysis, the results show that there is a stable positive correlation between supply chain finance index and return on net assets (β = 0.585, p < 0.05); there is a stable negative correlation between supply chain finance and financing constraints (β = – 0.216, p < 0.05); there is a stable negative correlation between financing constraints and return on net assets (β = –0.893, p < 0.001). This study examines the impact of supply chain finance on the performance of agricultural SMEs from the perspective that supply chain finance can alleviate financing constraints. The results of this study suggest to business stakeholders that agricultural SMEs can choose supply chain finance as a better choice of financial strategy, and the government can formulate corresponding policies to further develop preferential and supportive policies for supply chain finance.
A água como bem comum: Uma revisão integrativa da literatura internacional
Authors: Silva Camila de Assis , Pereira José Roberto , Alcântara Valderí de Castro
Published: November 2023

O presente trabalho tem como objetivo analisar o entendimento da água como bem comum em estudos internacionais a partir de uma revisão integrativa. Na metodologia utilizou-se a revisão integrativa da literatura por meio de buscas nas bases de dados Web of Science e Scopus. A princípio foram encontrados 188 trabalhos publicados nos últimos 10 anos. Considerando, contudo, os critérios preestabelecidos, foram analisados 25 artigos, os quais permitiram atender ao objetivo proposto. Nos resultados apresentou-se uma síntese de como os autores têm tratado a água a partir da perspectiva do bem comum na literatura internacional. Além disso, emergiram sete categorias de análise da leitura dos artigos, a saber: 1 – Bens comuns; 2 – Governança hídrica; 3 – Gestão de recursos hídricos; 4 – Direito à água; 5 – Privatização da água; 6 – Movimentos sociais e ação coletiva e 7 – Políticas públicas. As categorias revelaram entendimentos e disputas em torno das águas em diversos países e as diferentes perspectivas do bem comum.
Scale optimization design and work behavior analysis of a single leg walking mechanism of quadruped robot
Authors: Han Zeguang , Cong Hao , Hao Ruiqin , Qi Qiushi , Chu Zhaolong
Published: November 2023

A general methodology for modeling and analysis of a single leg walking mechanism of quadruped robot is presented in this paper to solve the problems of more drive elements, more complex structure and control system in existing single-leg walking mechanism. The principle scheme and scale optimization design of proposed walking mechanism are completed according to the requirements of the foot end trajectory curve and Grashof’s criterion. The models of kinematics and dynamics of presented mechanism have been built. By numerical calculation, the variations of displacement, the angular velocity and moment of the equivalent crank are discussed. The results indicate that the kinematic and dynamic properties of the optimized mechanism are better than those before optimization. Furthermore, these results provide a basis for the structural design of a single leg walking mechanism of quadruped robot.
Constructed wetlands: an approach toward phytoremediation for wastewater treatment
Authors: Alvi Sahail , Sahu Sai Shankar , Rana Vivek , Maiti Subodh Kumar
Published: November 2023

Constructed wetlands (CWs) have been used as a proven efficient technology for wastewater treatment since the early 1950s. However, the first full-scale operation was conducted in the late 1960s. CW is an engineered system that utilizes various macrophytes to treat wastewater. It is cost effective, easy to operate, and maintain as compared to other conventional wastewater treatment technologies. It works with the mechanisms of different phytoremediation processes (i.e., phytoextraction, phytostabilization, phytovolatization, phytodegradation) and sedimentation, agglomeration and biodegradation of wastewater. CW can be classified on the basis of vegetation types (submerged, emergent, free-floating, and floating leaved), hydrological properties (free water, surface flow, and subsurface flow). Subsurface flow wetlands can be further classified as vertical or horizontal depending on the flow direction. Hybrid systems such as CWs clubbed with tube settler for hospital wastewater, biochar-based CW for manure wastewater are reported to have better treatment efficiency. However, the performance of CWs depends on several factors like vegetation type, type of wetland, type of wastewater treated, design specification of CWs, substrate used, microbiology of CW, climate and hydrological factors, and so on. Therefore, this chapter mainly focuses on all these aspects to fill the knowledge gaps and gives an insight to future research challenges and opportunities to achieve sustainability in the field of wastewater treatment.
Response of hydrological regimes to land use change: A case study of the Han River Basin
Authors: Wang Hongxiang , Yuan Weiqi , Chen Wenxiong , Hong Fengtian , Bai Xiangyu , Guo Wenxian
Published: November 2023

Comprehensive and systematic research linking land-hydrological correlations is lacking in the study of factors driving watershed runoff variations. It quantitatively analyzes the overall watershed hydrological conditions using the range of variability approach (RVA) and applies the Budyko hypothesis to identify driving factors of annual runoff variations. The study also explores the impact of individual land use types on runoff across various timescales using the SWAT model in conjunction with historical and extreme scenarios in the Han River Basin. Results reveal that following abrupt changes, the Han River Basin experiences negative alterations in its hydrological indices and overall conditions. Among the driving factors, the lower cushion surface has the most significant impact on runoff. At an annual scale, runoff increases by 12.57 and 20.4% for cropland and construction land scenarios, while forest and grassland scenarios lead to decreases of 8.45 and 2.32%, respectively. Runoff sensitivity to land use changes is notably higher in the wet season than in the dry season at the quarterly and monthly scales. This study offers valuable insights into the integrated management of land use and water resources in the Han River Basin.
Assessing environmental flow alterations induced by dams and climate change using a distributed hydrological model at catchment scale
Authors: Mineda Haruki , Nukazawa Kei , Suzuki Yoshihiro
Published: November 2023

Hydrological alterations by dams and climate change can reduce aquatic biodiversity by disrupting the life cycles of organisms. Here, we aimed to evaluate and compare the hydrological alterations caused by dams and climate change throughout the Omaru River catchment, Japan, using a distributed hydrological model (DHM). First, to assess the impacts of dam and climate change independently, we performed runoff analyses using either dam discharge or future climatic data (two future periods, 2031–2050 and 2081–2100 × three representative concentration pathways). Subsequently, we derived indicators of hydrologic alterations (IHA) to quantify changes in flow alterations by comparing them to IHA under natural conditions (i.e., without dam or climate change data). We found that dams altered IHAs more than climate change. However, on a catchment-scale standpoint, climate change induced wider ranges of flow alterations, such as a further decrease in low flow metrics along the tributaries and uppermost main stem, suggesting a catchment-level shrinkage in important corridors of aquatic organisms. We also observed that the altered flow by water withdrawals was ameliorated by the confluence of tributaries and downstream hydropower outflows. Our approach using a DHM captured the various patterns of flow alterations by dams and climate change.
Does irrigation water applied in South Australia increase after the end of the Millennium Drought? Application of the difference-in-differences approach
Authors: Noda Koji
Published: November 2023

The Millennium Drought drastically reduced the amount of irrigation water applied and triggered modern water reform, such as water market promotion in the southern Murray–Darling Basin (sMDB), Australia. South Australia (SA), located far downstream in the sMDB, occupies a unique and important position because the amount of water supplied for SA is guaranteed under normal weather conditions. The water availability for SA determines whether severe droughts occur in the sMDB. Based on the Murray–Darling Basin water market catchment dataset 2021, the causal inference of whether irrigation water applied in the SA Murray water system as the main water system in SA increased after water year (WY) 2011 when the percentage of water allocated to high-reliability water entitlements reached 100% was empirically analysed in this article with a difference-in-differences approach. In this article, the SA Murray water system was adopted as the sole treatment group and WY 2011 was selected as the treatment timing. When control variables and the interaction terms between the dummy variable for posttreatment periods and control variables are included, this article statistically demonstrates that irrigation water applied in the SA Murray water system increased after WY 2011.
Sağlık profesyonellerinin fiziksel aktivite seviyesi, depresyon durumu ve yaşam kalitesinin araştırılması
Authors: Arslan Serpil , Camcıoğlu Yılmaz Burcu
Published: November 2023

Amaç: Sağlık profesyonellerinin fiziksel aktivite seviyesi, depresyon düzeyi ve yaşam kalitesini incelemektir.

Yöntemler: Kesitsel olarak planlanan bu çalışmaya Çankırı Devlet Hastanesi’nde çalışan 128 (78 Kadın/50 Erkek, 34,35±8,37 yıl) sağlık profesyoneli dahil edildi. Fiziksel aktivite seviyesi Uluslararası Fiziksel Aktivite Anketi Kısa Form, depresyon düzeyi Beck Depresyon Envanteri ve yaşam kalitesi Dünya Sağlık Örgütü Yaşam Kalitesi Ölçeği kullanılarak değerlendirildi.

Bulgular: Çalışmaya katılan sağlık profesyonellerinin %36,7’si inaktif, %43’ü minimal aktif ve %20,3’ü çok aktifti ve %55,5’i hafif düzeyde depresyona sahipti. Katılımcıların fiziksel aktivite seviyesi ile depresyon düzeyi ve yaşam kalitesi arasında anlamlı bir ilişki yoktu. Depresyon düzeyi ile yaşam kalitesinin bedensel alanı (r= -0,335), ruhsal alanı (r=-0,578), sosyal alanı (r=-0,436) ve çevresel alanı (r=-0,418) arasında negatif orta düzeyde bir ilişki vardı (p
Tecnologias Digitais da Informação e Comunicação como ferramentas de ensino e aprendizagem de deficientes visuais
Authors: Pinho Francisco Victor Alves de , Silva Renata Souza e , Lima Luciana de , Cerqueira Gilberto Santos
Published: November 2023

Estima-se que existam 314 milhões de pessoas com deficiência visual no mundo. Logo, essa manifestação é classificada como de maior prevalência no Brasil, contemplando um total de 18,8%. Com o desenvolvimento das Tecnologias Digitais da Informação e Comunicação (TDIC), a tecnologia assistiva vem sendo aplicada em novos ambientes. Esta revisão bibliográfica, de abordagem quantitativa, tem como objetivo compilar estudos desenvolvidos nas últimas décadas sobre a aplicação de TDIC no processo de ensino e aprendizagem de deficientes visuais. Foi aplicada a Estratégia PICo como norteadora da seleção dos artigos. A coleta dos artigos foi realizada por meio da pesquisa nos bancos de dados Google Scholar, Scielo, Periódicos CAPES, Science direct e NCBI. Leitores de telas e protótipos táteis são alguns exemplos de tecnologias desenvolvidas nos estudos encontrados. Com isso, é compreendido que estas TDICs são aplicadas em diversos locais, e que já é uma realidade que vem sendo estudada e colocada em prática com deficientes visuais.
The Impact of Certain Pharmacogenetic Differences on the Metabolism of
Antiretroviral Drugs Used in A Black South African Population
Authors: Reay Riaan , Viljoen Michelle , Rheeders Malie
Published: November 2023

Background:

Genetic polymorphism of drug-metabolising enzymes and transporters may influence the
effect and toxicity of antiretroviral drugs.

Objectives:

To determine and compare the minimum allele frequency of 20 single nucleotide polymorphisms
(SNPs) with possible involvement in the metabolism of the antiretroviral drugs with other populations. To investigate
the influence of these variants on Reverse transcriptase, Protease and Integrase strand transfer inhibitor drugs.

Method:

DNA samples were collected from 1489 subjects. All SNPs with a gene call score of > 0.6 were selected
for genotyping. The R package calculated call rates, MAF and Hardy-Weinberg equilibrium (HWE), test p-values,
and Chi-squared analysis were performed on the data. The Fisher’s exact test compared the allele frequencies
between the populations.

Results:

The highest similarities in minimum allele frequency (MAF) were between the Prospective Urban and
Rural Epidemiological group (PURE), a Black population in South Africa, and the Yoruba and Luhya populations
in Africa.
The following SNPs were identified with a possible effect on metabolism: CYP2B6 rs28399494 (MAF 11%) is
indicated in the toxicity of Efavirenz and Nevirapine. CYP3A5 rs776746 (MAF 17%) and CYP3A4 rs2749674
(MAF 23%) both cause an increase in the metabolism of the protease inhibitors. The very low MAF values for
both SCL01B1 rs4149056 (MAF 0.6%) and ABCC rs717620 (MAF 2.8%) are indications that OATP1B1 transport
function and glomerular filtration tempo will not be compromised. The high MAF value of 30% for UGTA1
rs10929302 can result in hyperbilirubinemia, which can decrease the clearance of Dolutegravir.

Conclusion:

These results show a possibility of kidney protection and an increase in bilirubin in this population.
Evaluation of Adults' Intention to Quit Smoking and Related Factors in a Primary Care Center
Authors: AYHAN BAŞER Duygu , ÇEVİK Murat
Published: November 2023

Introduction: This study aims to examine the smokers' intention levels to quit smoking and related factors.
Methods: This cross-sectional study was conducted at XXX Family Health Center. The study population consisted of smoker individuals and seeking services at XXX Family Health Center. Research data were collected through face-to-face interviews using a questionnaire (27 questions and the Intention to Quit Smoking Scale) after obtaining informed consent from the participants.
Results: In a study with 268 participants who smoke cigarettes, the mean age of the participants was 41.20, 68.3% of them were male. The mean score for participants' intentions to quit smoking on the Quit Intention Scale was 23.70. According to the self-assessment of dietary habits, individuals who rated themselves as very unhealthy, engaged in physical activity, increased their cigarette consumption over the years, had prior attempts to quit smoking, and those with moderate to high levels of nicotine dependence showed the highest intention to quit smoking scale scores compared to other groups (respectively; p=0.012; p<0.001; p<0.001; p<0.001; p=0.008). In the correlation analysis, a weak negative correlation was found between the intention to quit smoking scale score and age (t=-0.153, p=0.012). According to the regression analysis, while doing physical activity decreased 5.420 times, the amount of smoking over the years increased 3.372 times; previous smoking cessation experience decreased 2.812 times intention to quit smoking.
Conclusions: Health-related behaviors, prior quit attempts, and nicotine dependence were found to be crucial factors influencing quit intentions. The results underscore the importance of considering individual characteristics and experiences when developing smoking cessation interventions.
Editorial
Authors: Trujillo Vargas José Jesús
Published: November 2023

Editorial
Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study
Authors: Schroeder Tanja , Haug Maximilian , Georgiou Andrew , Seaman Karla , Gewald Heiko
Published: November 2023

Background

The enactment of the “Act to Improve Healthcare Provision through Digitalisation and Innovation ” (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany’s medical landscape.

Objective

This study aims to investigate physicians’ responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps.

Methods

Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021.

Results

The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians’ self-perceived digital competence and their evaluation of patients’ digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps.

Conclusions

Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians’ and patients’ sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.
Can OpenEHR, ISO 13606, and HL7 FHIR Work Together? An Agnostic Approach for the Selection and Application of Electronic Health Record Standards to the Next-Generation Health Data Spaces
Authors: Pedrera-Jiménez Miguel , García-Barrio Noelia , Frid Santiago , Moner David , Boscá-Tomás Diego , Lozano-Rubí Raimundo , Kalra Dipak , Beale Thomas , Muñoz-Carrero Adolfo , Serrano-Balazote Pablo
Published: November 2023

In order to maximize the value of electronic health records (EHRs) for both health care and secondary use, it is necessary for the data to be interoperable and reusable without loss of the original meaning and context, in accordance with the findable, accessible, interoperable, and reusable (FAIR) principles. To achieve this, it is essential for health data platforms to incorporate standards that facilitate addressing needs such as formal modeling of clinical knowledge (health domain concepts) as well as the harmonized persistence, query, and exchange of data across different information systems and organizations. However, the selection of these specifications has not been consistent across the different health data initiatives, often applying standards to address needs for which they were not originally designed. This issue is essential in the current scenario of implementing the European Health Data Space, which advocates harmonization, interoperability, and reuse of data without regulating the specific standards to be applied for this purpose. Therefore, this viewpoint aims to establish a coherent, agnostic, and homogeneous framework for the use of the most impactful EHR standards in the new-generation health data spaces: OpenEHR, International Organization for Standardization (ISO) 13606, and Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). Thus, a panel of EHR standards experts has discussed several critical points to reach a consensus that will serve decision-making teams in health data platform projects who may not be experts in these EHR standards. It was concluded that these specifications possess different capabilities related to modeling, flexibility, and implementation resources. Because of this, in the design of future data platforms, these standards must be applied based on the specific needs they were designed for, being likewise fully compatible with their combined functional and technical implementation.
Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT)
Authors: Appel Lora , Appel Eva , Kisonas Erika , Lewis-Fung Samantha , Pardini Susanna , Rosenberg Jarred , Appel Julian , Smith Christopher
Published: November 2023

Background

Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings.

Objective

The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention’s feasibility in terms of acceptability, safety, and patient experience.

Methods

A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses’ daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method.

Results

VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy.

Conclusions

Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments.

Trial Registration

ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119

International Registered Report Identifier (IRRID)

RR2-10.2196/22406
Design and Implementation of Survey Quality Control System for Qatar’s First National Mental Health Survey: Case Study (Preprint)
Authors: Petcu Catalina , Boukhelif Ikram , Davis Veena , Shamsi Hamda , Al-Assi Marwa , Miladi Anis , Khaled Salma M
Published: November 2023

BACKGROUND

All World Mental Health (WMH) Surveys apply high standards of data quality. To date, most of the published quality control (QC) procedures for these surveys were in relation to face-to-face interviews. However, owing to the social restrictions that emerged from the COVID-19 pandemic, telephone interviews are the most effective alternative for conducting complex probability-based large-scale surveys.

OBJECTIVE

In this paper, we present the QC system implemented in the WMH Qatar Survey, the first WMH Survey conducted during the COVID-19 pandemic in the Middle East. The objective of the QC process was to acquire high data quality through the reduction of random errors and bias in data collection.

METHODS

The QC design and procedures in this study were adapted to the telephone survey mode in response to the COVID-19 pandemic. We focus on the design of the QC indicator system and its implementation, including the investigation process, monitoring interviewers’ performance during survey fielding and applying quality-informed interventions.

RESULTS

The study team investigated 11,035 flags triggered during the 2 waves of the survey data collection. The most triggered flags were related to short question administration duration and multiple visits to the same survey questions or responses. Live monitoring of the interviews helped in understanding why certain duration-related flags were triggered and the interviewing patterns of the interviewers. Corrective and preventive actions were taken against interviewers’ behaviors based on the investigation of triggered flags per interviewer and live call monitoring of interviews. Although, in most cases, the interviewers required refresher training sessions and feedback to improve their performance, several interviewers discontinued work because of low productivity and a high number of triggered flags.

CONCLUSIONS

The specific QC procedures implemented in the course of the WMH Qatar Survey were essential for successfully meeting the target number of interviews (N=5000). The QC strategies and the new indicators customized for telephone interviews contributed to the flag investigation and verification process. The QC data presented in this study shed light on the rigorous methods and quality monitoring processes in the course of conducting a large-scale national survey on sensitive topics during the COVID-19 pandemic.
Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study (Preprint)
Authors: De la Cruz-Torralva Kelly , Escobar-Agreda Stefan , Riega López Pedro , Amaro James , Reategui-Rivera C Mahony , Rojas-Mezarina Leonardo
Published: November 2023

BACKGROUND

Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited.

OBJECTIVE

This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health.

METHODS

A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided.

RESULTS

Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website.

CONCLUSIONS

The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants.
A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology (Preprint)
Authors: Hodson Nathan , Woods Peter , Sobolev Michael , Giacco Domenico
Published: November 2023

BACKGROUND

Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry.

OBJECTIVE

We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out.

METHODS

The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach.

RESULTS

Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach.

CONCLUSIONS

We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non–English speakers and individuals who participate in parenting programs in settings outside the United Kingdom.
Optimization of the treatment system for victims with long-bone gunshot fractures
Authors: Burianov O.A. , Yarmoliuk Yu.O. , Derkach S.O. , Klapchuk Yu.V. , Los D.V.
Published: November 2023

Background. The full-scale war with the russian federation on the territory of Ukraine revealed a number of problematic issues regarding medical and evacuation measures for victims with gunshot injuries to the extremities, requiring the search for ways to solve them and substantiate proposals for optimizing the adjusted system of treating victims. Over a 3-month period, the number of patients with gunshot wounds to the limbs and the severity of injuries increased significantly, which is primarily due to the use of weapons with high kinetic energy (Grad, Smerch MLRS systems, air bombs, including cluster munitions, artillery and tanks (large caliber)), which led to an increase in the number of patients with severe gunshot injuries. Given these features, the question arose not only regarding the training of specialists in the treatment of modern combat injuries, but also optimizing the therapeutic process, which made this topic relevant. The aim: to analyze the system of surgical treatment for victims with gunshot wounds to the extremities by optimizing the algorithm of surgical treatment at the levels of medical evacuation. Materials and methods. Statistical materials for the period from February 24 to May 2022 and ATO/JFO data for 2014–2021. Research methods: descriptive, comparative analysis, systematic approach, statistical. Based on study results, a number of debatable issues on organizing a system for the treatment of victims with gunshot wounds were identified: analysis of the distribution of patients by a type of damaging factor; optimization of triage of victims with gunshot wounds to the extremities; general characteristics of the basic principles of treatment at the hospital stage; the presence of errors in the treatment of victims with long-bone gunshot fractures. Conclusions. The widespread use of weapons with high kinetic energy during the full-scale war with the russian federation in Ukraine determined an increase in the proportion of limb lesions and the severity of these injuries. At the same time, there was an increase in the number of victims with amputated limbs, defects in long bones and polystructural trauma. Rational medical triage in the mass admission of patients with limb injuries, which we carried out, made it possible to create conditions for the full implementation of medical and diagnostic measures with the subsequent determination of priority areas.
The Application of Various Fermented Malang Apple Water As A Source of Natural Yeast for Sourdough Bread Processing
Authors: Manshur Hanif Alamudin , Putri Desiana Nuriza , Pakpahan Okta Pringga , Akalentera Qq Wima , Harini Noor
Published: November 2023

The sourdough fermentation method is identified as a complex microbial ecosystem stimulant by the spontaneous natural water starters process. At the fermentation time, lactic acid bacteria and yeast confer the resulting characteristic bread features such as staling of bread, and palatability. With the scope of highlighting fermentation, the investigation of starter culture is relevant in order to determine starch fractions of flour. The present article employed water from apple local varieties of Malang as a mixture of natural yeast. The research was conducted in two stages. The first stage was to get the best apple variety to produce the optimum quality of sourdough starter. The second was applying the best sourdough starter at various concentrations in bread formulation. Parameters observed included yeast, and lactic acid bacteria counts, pH, Total Titratable Acidity (TTA), lactic acid content, hardness, loaf volume, specific volume, and sensory properties of sourdough bread.  There was an influence on the treatment of making a sourdough starter with different types of apple fruit and showed the best treatment if sourdough starter of fermented manalagi apple water with a pH value of 4.5, TTA value of 2.71 mL, the number of lactic acid bacteria of 5.6 × 1010 CFU/mL, and the number of yeast of 2.62 × 1011 CFU/mL.
Chemical Characteristics of Waru Leaf (Hibiscus tiliaceus) As Food Packaging Material
Authors: Iskandar Angela Firdausa Alif , Santoso Umar , Supriyadi Supriyadi
Published: November 2023

Waru leaf (Hibiscus tilaceus) is commonly used as a traditional food packaging material in Indonesia. Waru leaf is known to contain bioactive components with antioxidant and antimicrobial activity. This research aimed to determine the chemical properties of waru leaf of various maturity levels and provide information on the potency of leaf extract that can be used as active packaging additive. The chemical properties include fatty acids, volatile compounds, antioxidant activity, and total phenolic content. It was discovered that both the young and mature waru leaf contained 4 types of fatty acids: predominantly linoleic acid and linolenic acid. In the young waru leaf, the primary volatile compounds were acids, with cis-vaccenic acid (21%) and glycidyl palmitate comprising (16.8%). As for the mature leaf, the main volatile compounds were acids and esters, with glycidyl oleate at (18.52%), glycidyl palmitate (12.28%), and Decocanoic acid, 3-hydroxy- (7.85%). The crude methanol extract was fractionated with hexane, ethyl acetate, and butanol to analyze bioactive compounds. The highest antioxidant activity was found in ethyl acetate fraction with an average of %Radical Scavenging Activity (%RSA) of 36.25% on the young waru leaf and 29.92% on the mature waru leaf. The ethyl acetate fraction had the highest total phenolic content of 164.66 mg GAE/g and 146.50 mg GAE/g for young and mature waru leaves, respectively. The result shows that waru leaf extract is a potential ingredient for developing active packaging.