bluuebunny/crossref_metadata_2025 huggingface dataset:
SUSTENTABILIDADE E EDUCAÇÃO: UM ESTUDO DA RELAÇÃO DA SUSTENTABILIDADE NO PDI E PNE
Authors: Ávila Lucas Veiga , Wolfart Thays , Damke Luana Inês , Arigony Marcelo Mendes
Published: March 2018

Este artigo tem como finalidade analisar como a sustentabilidade (econômica, social, ambiental, ecológica, política nacional, política internacional e cultural) está sendo pautada nos Planos de Desenvolvimento Institucional - PDI das Instituições Federais de Ensino Superior e no Plano Nacional de Educação – PNE. O percurso metodológico é de caráter qualitativo descritivo, sendo utilizada a análise de conteúdo para análise dos resultados. Como principais resultados, destaca-se que a sustentabilidade vem sendo pautada na missão e visão da sustentabilidade, tendo características e peculiaridades de acordo com a região e tempo dos Planos. As Universidades estão em processo lento para atualização do PDI que é exigida por lei. Quanto ao PNE, verificou-se que há alinhando das diretrizes com as perspectivas da sustentabilidade. 
DESENVOLVIMENTO DE NOVOS MERCADOS: O CASO DA EXPORTAÇÃO DE EQUIPAMENTOS PARA A REGIÃO VITIVINÍCOLA DA ARGENTINA
Authors: Luz Mario Luis Fragoso , Gonçalves Roberto Birch , Vieira Guilherme Bergmann Borges
Published: March 2018

O mercado vitivinícola Sul Americano vem crescendo ao longo dos anos, especificamente o mercado Argentino, que é reconhecido como o 5º maior produtor de vinho no mundo. Tal crescimento desperta o interesse das empresas, de diversos segmentos a fim de abastecer esta indústria de vinhos que necessita de inovação e tecnologia para sustentar seu crescimento e manter a competitividade de seu produto. As empresas que tem como foco ingressar neste mercado, internacionalizando-se, necessita de capacitação e estruturação, com pessoas qualificadas e conhecedores do processo como um todo, a fim de evitar frustrações decorrentes de um processo mal realizado e prosperar em um mercado com potencial. Este trabalho tem como objetivo analisar a viabilidade de exportar postes de aço para o cultivo de uva na Argentina, produto que é conhecido pela maioria das vinícolas, porém pouco utilizado devido ao baixo entendimento sobre a real efetividade do produto. Para tanto realizou-se um estudo exploratório para analisar a viabilidade de exportar postes de aço para Argentina e o resultado deste estudo mostrou que é viável exportar o produto mediante os passos que o estudo descreve
EFECTOS DE LA IMPLEMENTACION DE LOS ESTANDARES INTERNACIONALES DE INFORMACION FINANCIERA Y DE AUDITORIA EN EL EJERCICIO DEL REVISOR FISCAL EN BOGOTA
Authors: Diaz Solano Doris Sofia
Published: March 2018

Los efectos de la Implementación de las normas internacionales de información financiera (NIIF) y de las normas internacionales de auditoria (NIA) en los garantes de la información financiera, permiten hacer un análisis comparativo a nivel nacional e internacional, sobre aspectos que inciden en el desarrollo del ejercicio partiendo de la normativa, en el contexto colombiano como sus antecedentes mundiales e implicaciones actuales; mientras que otros tantos se derivan del ejercicio práctico y real de la labor como revisor fiscal, que aparentemente no resultan ser más que dificultades conceptuales en la aplicación real de las normas vigentes a la fecha, siendo un problema netamente hermenéutico.  La metodología utilizada es de tipo cualitativo fundamentada en fuentes secundarias como doctrina discriminada en (textos y artículos de revistas científicas) y la normatividad como fuente principal. Como herramienta, se utilizó encuestas, para visualizar la percepción de los encuestados sobre el objeto de estudio. Se concluye que los estándares internacionales (NIIF-NIAS) afectan el ejercicio del Revisor Fiscal.
FATORES EXPLICATIVOS DO NÍVEL DE EVIDENCIAÇÃO DOS MAIORES MUNICÍPIOS DO BRASIL
Authors: Machado Vagner Naysinger , Sonza Igor Bernardi , Aires Fabiane Lourenço
Published: March 2018

O objetivo deste estudo é identificar os fatores explicativos do nível de evidenciação municipal (NEM) dos municípios mais populosos do Brasil, nas respectivas páginas eletrônicas publicadas na Internet. Estudos empíricos indicam que os municípios não cumprem com a totalidade das obrigações legais quanto à transparência e evidenciação de informações, e que não há uma uniformidade na quantidade de informações disponíveis quanto à gestão pública das cidades. Desta forma, para mensurar o NEM dos municípios constituiu-se um conjunto de 40 indicadores de informações obrigatórias. E para cada possível fator explicativo deste nível de evidenciação, foi atribuído uma variável independente. Os dados foram submetidos ao tratamento estatístico pelo método dos mínimos quadrados ordinários (OLS) – robusto. Evidências empíricas indicam que nenhum dos municípios evidenciou todas as informações pesquisas. Ademais, os resultados da análise de regressão sugerem que aspectos ligados ao tamanho das cidades, o PIB Per capita, o partido político do prefeito municipal e características sociais como o Índice FIRJAN de Desenvolvimento Municipal (IFDM) podem explicam o nível de evidenciação municipal dos municípios.
Palavras-Chave: Gestão Pública; Transparência; Evidenciação.
PROPOSTA DE MODELO DE GERENCIAMENTO DE RESÍDUOS E EFLUENTES GERADOS NOS LABORATÓRIOS DE UMA UNIVERSIDADE DA REGIÃO DAS MISSÕES, RIO GRANDE DO SUL
Authors: Stracke Marcelo Paulo , Zago Maikow , Rossner Wbatuba Berenice Beatriz
Published: March 2018

A sustentabilidade tem demandado às mais diversas organizações a adotarem um novo estilo de gestão com seus públicos de interesse, que combine a prática e divulgação da eficiência econômica e da responsabilidade social e ambiental, afim de que sejam percebidas como legítimas perante a sociedade. Não obstante a esta realidade,
encontram-se as Instituição de Ensino (IE). Neste sentido, o objetivo do estudo foi propor um sistema de gerenciamento de resíduos e efluentes para uma Universidade da região das Missões do Rio Grande do Sul, considerando os resíduos gerados resíduos gerados nos laboratórios da área da saúde, bem como, dos custos
envolvidos para o tratamento dos mesmos. A metodologia (Vergara, 2015) constitui-se num estudo exploratório, aplicado e de caso. Os resultados verificados com o sistema de gerenciamento de resíduos e efluentes, apontam claramente vantagens de ordem econômica, de redução de espaço físico para armazenamento de resíduos e
efluentes, da redução de concentrações e volumes de soluções e reagentes, além da conscientização, por parte dos docentes e discentes, acerca da importância do gerenciamento de resíduos e efluentes gerados nos laboratórios durante aulas práticas, trabalhos de graduação e projetos de pesquisa.
ANÁLISE DOS RECURSOS DE TI À LUZ DA RBV: UM ESTUDO DE CASO EM UMA INDÚSTRIA ALIMENTÍCIA
Authors: Olesiak Estevo Mateus , Provenzano Márcio , Marquesini Vanessa Heckler , Bonzanini Osmar Antonio , Vanti Adolfo Alberto
Published: March 2018

O objetivo do estudo é analisar a utilização dos recursos de tecnologia da informação à luz da Visão Baseada em Recursos (RBV) em uma empresa do ramo alimentício. Os recursos de tecnologia da informação, além de dar suporte às operações das empresas podem também ser considerados, de acordo como são utilizados, como recursos capazes de proporcionar e manter vantagem competitiva, em especial ao se tratar de ambientes com alto nível de competição. Trata-se de um estudo de caso realizado em uma empresa do ramo alimentício, com matriz no Paraná e filiais no Rio Grande do Sul, Santa Catarina e São Paulo, no segundo semestre de 2016. Os resultados mostraram que na percepção dos entrevistados os recursos de Tecnologia da Informação (TI) utilizados na empresa geram determinado nível de vantagem competitiva, em principal pela utilização da capacidade dos recursos existentes na empresa, e não pelo simples fato de ter o recurso.
MOTIVAÇÃO ORGANIZACIONAL: RELAÇÃO COM O SUPORTE E O CONFLITO TRABALHO-FAMÍLIA
Authors: Cerutti Priscila Sardi , Lopes Rafael Da Silva , Pauli Jandir , Marcos Tatiane Manfron , Görski Francine Minuzzi
Published: March 2018

A motivação é uma das virtudes que move indivíduos a realizarem tarefas que influenciam e estimulam comportamentos. O ambiente organizacional assume uma responsabilidade de oferecer suporte que estimule os trabalhadores a desenvolverem atividades em prol dos resultados planejados, sendo que existe uma parcela de contribuição influenciada pelo conflito trabalho-família nessa relação de motivação organizacional. Essa pesquisa teve como objetivo analisar a influência do suporte organizacional e dos conflitos trabalho-família na motivação de trabalhadoras. Para isso, foi utilizada uma escala do tipo Likert, com 85 trabalhadoras que exercem cargos de gerência, supervisão, coordenação ou donas do próprio negócio. Através da análise dos dados, observou-se que o suporte organizacional influencia na motivação interna e externa das trabalhadoras, ao passo que, o conflito trabalho-família não apresentou relação estatisticamente significativa com a motivação organizacional. Deste modo, recomenda-se que as organizações percebam no SO e conflito trabalho-família uma possibilidade estratégica de motivação para seus trabalhadores, em prol de maior desempenho nas atividades, a fim de maximizar os resultados organizacionais.

Palavras-chave: Motivação. Conflito trabalho-família. Suporte organizacional.
River flood prediction using fuzzy neural networks: an investigation on automated network architecture
Authors: Khan Usman T. , He Jianxun , Valeo Caterina
Published: March 2018

Urban floods are one of the most devastating natural disasters globally and improved flood prediction is essential for better flood management. Today, high-resolution real-time datasets for flood-related variables are widely available. These data can be used to create data-driven models for improved real-time flood prediction. However, data-driven models have uncertainty stemming from a number of issues: the selection of input data, the optimisation of model architecture, estimation of model parameters, and model output. Addressing these sources of uncertainty will improve flood prediction. In this research, a fuzzy neural network is proposed to predict peak flow in an urban river. The network uses fuzzy numbers to account for the uncertainty in the output and model parameters. An algorithm that uses possibility theory is used to train the network. An adaptation of the automated neural pathway strength feature selection (ANPSFS) method is used to select the input features. A search and optimisation algorithm is used to select the network architecture. Data for the Bow River in Calgary, Canada are used to train and test the network.
Neuropharmacological Properties of the Essential Oil of Bergamot for the Clinical Management of Pain-Related BPSDs
Authors: Scuteri Damiana , Rombolá Laura , Tridico Laura , Mizoguchi Hirokazu , Watanabe Chizuko , Sakurada Tsukasa , Sakurada Shinobu , Corasaniti Maria T. , Bagetta Giacinto , Morrone Luigi A.
Published: March 2018

Background:

Alzheimer’s Disease (AD) accounts for approximately 50% of all
cases of dementia and, in spite of the great effort for the development of disease-modifying
drugs, a definitive treatment of cognitive impairment is not available yet. A perfect adherence
to the current therapy of cognitive decline is needed for a better control of the disease and this
is proven to reduce, though not completely abolish, the associated Behavioural and Psychological
Symptoms of Dementia (BPSDs) from occurring. This cluster of symptoms, remarkably
affecting patients’ health-related quality of life (HRQL), is tightly associated with pain states.
Antipsychotics are the only treatment for BPSDs. However, these drugs are more effective
and safer in the short-term (6-12 weeks), they are able to manage aggression but not agitation
and they cannot control pain. Aromatherapy with Melissa officinalis and Lavandula officinalis
has been employed to handle BPSDs, but it has not provided strong evidence to offer relief
from pain.

Objective:

Bergamot Essential Oil (BEO) exerts antinociceptive activity through several
pharmacological mechanisms: in particular, it is able to enhance autophagy, a process undergoing
derangement in chronic pain. Thus, the sound pharmacological basis for clinical translation
of aromatherapy with BEO in the treatment of BPSDs has been pointed out.

Conclusion:

The antinociceptive effects elicited by BEO in experimental pain models make it
a possible candidate for the pharmacological management of pain-related BPSDs.
Hybrid Molecules: Promising Compounds for the Development of New Treatments Against Leishmaniasis and Chagas Disease
Authors: Cardona-G Wilson , Yepes Andres F. , Herrera-R Angie
Published: March 2018

Leishmaniasis and Chagas disease are endemic pathologies in tropical countries. These cause
high morbidity and a public health problem. Current chemotherapies are based on conventional drugs
with variable efficacy and toxicity related with the length of therapeutic schemes and high doses. When
two pharmacological agents are combined into a single molecule, the result is the so-called hybrid molecule.
In the search for new treatments against Chagas disease and leishmaniasis, several studies have
shown that hybrid molecules display high antiprotozoal activity and this emerging strategy is quite
promising in the field of new drug discovery and development. This review focuses on the antiprotozoal
activity of different hybrids obtained from the hybridization of pharmacophores, showing that the most

of the efforts have been concentrated in the molecular hybridization of quinoline, chalcone and hydrazone
moieties.
Involvement of Breast Cancer-Associated Fibroblasts in Tumor Development, Therapy Resistance and Evaluation of Potential Therapeutic Strategies
Authors: Ruocco Maria Rosaria , Avagliano Angelica , Granato Giuseppina , Imparato Valeria , Masone Stefania , Masullo Mariorosario , Nasso Rosarita , Montagnani Stefania , Arcucci Alessandro
Published: March 2018

Breast cancer is the most common cancer in women, which incidence has increased in recent
years. It is constituted by very heterogeneous tissue characterized by an abnormal microenvironment regulating
tumor progression and providing evasion from cancer therapies. Breast cancer-associated fibroblasts
(BCAFs) are the main cell type of breast cancer microenvironment and can represent up to 80% of the tumor
mass. In particular, BCAFs induce cancer initiation, proliferation, invasion and metastasis by undergoing
an activation process associated with the secretion of growth factors, cytokines, and paracrine interactions.
Therapy resistance is the main cause of poor therapeutic results or even failure in breast cancer
patients. Despite recent advances in breast cancer management, there is a need for new prognostic markers
and novel agents for targeting key signalling pathways to either improve the efficacy of the current
therapies, or reduce toxicity. In this view, BCAFs represent markers useful to clinical diagnosis, therapy,
and prognosis of breast cancer. This review focuses on the role of BCAFs in cancer, and describes the
processes of endocrine/chemotherapy resistance linked to BCAFs action. Moreover, it points to molecules
and pathways regulating therapy resistance induced by BCAFs. Finally, potential therapeutic strategies
targeting BCAFs and offering new tools in breast cancer therapy are highlighted.
Parallel Solid-Phase Synthesis using a New Diethylsilylacetylenic Linker and Leading to Mestranol Derivatives with Potent Antiproliferative Activities on Multiple Cancer Cell Lines
Authors: Dutour Raphaël , Maltais René , Perreault Martin , Roy Jenny , Poirier Donald
Published: March 2018

Background:

RM-133 belongs to a new family of aminosteroid derivatives demonstrating interesting
anticancer properties, as confirmed in vivo in four mouse cancer xenograft models. However, the metabolic
stability of RM-133 needs to be improved. After investigation, the replacement of its androstane scaffold by a
more stable estrane scaffold led to the development of the mestranol derivative RM-581.

Methods:

Using solid-phase strategy involving five steps, we quickly synthesized a series of RM-581 analogs
using the recently-developed diethylsilylacetylenic linker. To establish structure-activity relationships, we then
investigated their antiproliferative potency on a panel of cancer cell lines from various cancers (breast, prostate,
ovarian and pancreatic).

Results:

Some of the mestranol derivatives have shown in vitro anticancer activities that are close to, or
better than, those observed for RM-581. Compound 23, a mestranol derivative having a ((3,5-dimethylbenzoyl)-
L-prolyl)piperazine side chain at position C2, was found to be active as an antiproliferative agent (IC50 = 0.38 ±
0.34 to 3.17 ± 0.10 µM) and to be twice as active as RM-581 on LNCaP, PC-3, MCF-7, PANC-1 and
OVCAR-3 cancer cells (IC50 = 0.56 ± 0.30, 0.89 ± 0.63, 1.36 ± 0.31, 2.47 ± 0.91 and 3.17 ± 0.10 µM,
respectively).

Conclusion:

Easily synthesized in good yields by both solid-phase organic synthesis and classic solution-phase
chemistry, promising compound 23 could be used as an antiproliferative agent on a variety of cancers, notably
pancreatic and ovarian cancers, both having very bad prognoses.
Suppression of the Viability and Proliferation of HepG2 Hepatocellular Carcinoma Cell Line by Konjac Glucomannan
Authors: Sawai Sakunie , Mohktar Mas Sahidayana , Safwani Wan Kamarul Zaman Wan , Ramasamy Thamil Selvee
Published: March 2018

Background:

Konjac Glucomannan (KGM) is a water-soluble dietary fibre extracted from Amorphophallus
konjac K. Koch (Araceae). Konjac fibre has been clinically proven as an effective antioxidant agent in
weight control but its traditionally known tumour suppression property remains to be explored.

Objective:

The main objective of this study is to determine the potential anti-proliferative effect of KGM on
cancer and normal human liver cell lines, HepG2 and WRL68, respectively.

Method:

HepG2 and WRL68 cells were treated with KGM, D-mannose, KGM-D-mannose and 5-fluorouracil.
The morphological changes in those treated cells were observed. Cytotoxic effect of the treatments on cell viability
and proliferation, and apoptosis genes expression were assessed by cytotoxicity assay, flow cytometry
and RT-PCR analyses.

Results:

The results show that KGM treatment resulted in reduced viability of HepG2 cells significantly, in line
with the apoptosis-like morphological changes. Up-regulation of BAX and down-regulation of BCL2 genes as
reflected by high Bax to Bcl 2 ratio suggests that the inhibitory effect of KGM on HepG2 cells most likely via
Bcl2/Bax protein pathway. Despite the effectiveness of standard drug 5-FU in suppressing the viability and
proliferation of HepG2 cells, it however, exhibited no selective inhibition of cancer cells as compared to KGM.

Conclusion:

Current findings suggested that KGM is a potential anti-cancer compound/drug entity, which could
be an alternative preventive agent against liver cancer.
Ameliorative Effect of Trans-Sinapic Acid and its Protective Role in Cerebral Hypoxia in Aluminium Chloride Induced Dementia of Alzheimer's Type
Authors: Bais Souravh , Kumari Renu , Prashar Yash
Published: March 2018

Background:

Trans-Sinapic Acid is a bioactive compound. Recent studies showed that it
has a significant potential to attenuate various chemically induced Neurodegenerative toxicities.

Aim:

The present study investigates the potential of trans-Sinapic Acid as neuromodulator and its effect
on release of Monoamine Oxidase (MAO-A, MAO-B), TNF-α, Acetylcholine esterase Enzyme, in
cognitive dysfunctions associated with experimental dementia.

Experiment:

Aluminium chloride was administered at a dose of 175mg/kg, p.o. for a period of 25 days
in rats and then divided into different groups, i.e. Treatment group, negative control and two groups of
trans- Sinapic Acid, (at a dose of 30 and 60mg/kg, p.o.), where these groups treated and observed until
the 35th day of experimental trial. Morris water Maze (MWM) and Photoactometer was used to access
learning, memory and ambulatory movements on 5th, 16th, 26th and 36th day of experiment. Later, the
animals were sacrificed for biochemical and histopahological studies. The oxidative stress was measured
by estimating the levels of Glutathion (GSH), Superoxide dismutase (SOD), Nitrite, Catalase.
Brain acetylcholine esterase (Ache) activity and Monoamine oxidase (MAO-A, MAO-B) were also
estimated. The Brain level of TNF-α was measured as a marker of inflammation.

Results:

Aluminium chloride (AlCl3) produced a marked decline in MWM performance and ambulatory
movements' of animals, reflecting impairment of memory and learning. Trans-Sinapic Acid
treatment significantly modulates AlCl3 induced memory deficits, biochemical and pathological alterations.
The findings demonstrate that the memory restorative ability of trans-Sinapic Acid may be
attributed to its anti-cholinesterase, anti-oxidative and anti-inflammatory potential.
Modeling Storm‐Influenced Suspended Particulate Matter Flocculation Using a Tide‐Wave‐Combined Biomineral Model
Authors: Chen Peihung , Yu Jason C. S. , Fettweis Michael
Published: March 2018

Flocculation of suspended particulate matter (SPM) in marine and estuarine environments is a complex process that is influenced by physical, biological, and chemical mechanisms. The flocculation model of Maggi (2009) was adapted to simulate flocculation under various weather conditions and during different seasons. The adaptation incorporated the effect of tide‐wave‐combined turbulence on floc dynamics. The model was validated using in situ measurements of floc size and SPM concentration from the southern North Sea during both calm and storm conditions. The results show that tide‐wave‐combined turbulence needs to be incorporated when simulating flocculation in a tide‐wave‐dominated environment. The observed seasonal variations in floc size (Fettweis et al., 2014) were reproduced using varying values for various floc strengths in different seasons. The results revealed that the biological effect on floc strength, which enhances aggregation, is stronger during summer, indicating that floc strength in the model should be varied seasonally.
Patient's Perspective on Using Mobile Technology as an Aid to Psychotherapy (Preprint)
Authors: Cristol Samantha
Published: March 2018

UNSTRUCTURED

This piece draws from a patient’s perspective on his treatment using mobile health technology in conjunction with weekly group and individual psychotherapy. Research has demonstrated that using telepsychology as part of mental health treatment shows great promise to help advance the field of psychotherapy. Using mobile health technology such as mobile phone apps allows for collaboration with patients and their providers. This was written after several consultations with an individual diagnosed with borderline personality disorder who prefers to remain anonymous but was forthcoming with information regarding his use of mobile health technology in order to benefit the field of mental telepsychology.
A Platform to Record Patient Events During Physiological Monitoring With Wearable Sensors: Proof-of-Concept Study (Preprint)
Authors: Vo Jonathan Duc Vinh , Gorbach Alexander M
Published: March 2018

BACKGROUND

Patient journals have been used as valuable resources in clinical studies. However, the full potential value of such journals can be undermined by inefficiencies and ambiguities associated with handwritten patient reports. The increasing number of mobile phones and mobile-based health care approaches presents an opportunity to improve communications from patients to clinicians and clinical researchers through the use of digital patient journals.

OBJECTIVE

The objective of this project was to develop a smartphone-based platform that would enable patients to record events and symptoms on the same timeline as clinical data collected by wearable sensors.

METHODS

This platform consists of two major components: a smartphone for patients to record their journals and wireless sensors for clinical data collection. The clinical data and patient records are then exported to a clinical researcher interface, and the data and journal are processed and combined into a single time-series graph for analysis. This paper gives a block diagram of the platform’s principal components and compares its features to those of other methods but does not explicitly discuss the process of design or development of the system.

RESULTS

As a proof of concept, body temperature data were obtained in a 4-hour span from a 22-year-old male, during which the subject simultaneously recorded relevant activities and events using the iPhone platform. After export to a clinical researcher’s desktop, the digital records and temperature data were processed and fused into a single time-series graph. The events were filtered based on specific keywords to facilitate data analysis.

CONCLUSIONS

We have developed a user-friendly patient journal platform, based on widely available smartphone technology, that gives clinicians and researchers a simple method to track and analyze patient activities and record the activities on a shared timeline with clinical data from wearable devices.
HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South (Preprint)
Authors: Stopka Thomas J , Brinkley-Rubinstein Lauren , Johnson Kendra , Chan Philip A , Hutcheson Marga , Crosby Richard , Burke Deirdre , Mena Leandro , Nunn Amy
Published: March 2018

BACKGROUND

In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering.

OBJECTIVE

The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data.

METHODS

We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases.

RESULTS

There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92).

CONCLUSIONS

We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.
Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services (Preprint)
Authors: Prior Sarah Jane , Campbell Steven
Published: March 2018

UNSTRUCTURED

The involvement of patients and their families in the redesign of healthcare services is an important option in providing a service that addresses the patients’ needs and improves health outcomes. However, it is a resource-intensive approach, and it is currently not clear when it should be used, and what should be the reasoning behind this decision. Some health systems of international standing have created a patient engagement program as a selling point. This paper discusses how co-led redesign can be beneficial in improving health service and more effectively engaging patients. Potential barriers for patient involvement are discussed. Patient involvement can be integrated into the health system at three main levels of engagement: direct care, organizational design and governance, and policy-making. The aim of this paper is to describe how co-led redesign is compatible with different levels of patient involvement and to address the challenges in delivering a co-led redesign in healthcare. Co-led redesign not only involves the collection of quantitative data for assessing the current systems but also the collection of qualitative data through patient, family, and staff interviews to determine the barriers to patient satisfaction. Co-led redesign is a resource-rich process that requires expertise in data collection and a clinical group that is devoted to implementing recommended changes. Currently, a number of countries have utilized co-led redesign for many different types of healthcare services. Resource availability and cost, process time, and lack of outcome measures are three major limiting factors.
Issues in Building a Nursing Home Syndromic Surveillance System with Textmining: Longitudinal Observational Study (Preprint)
Authors: Delespierre Tiba , Josseran Loic
Published: March 2018

BACKGROUND

New nursing homes (NH) data warehouses fed from residents’ medical records allow monitoring the health of elderly population on a daily basis. Elsewhere, syndromic surveillance has already shown that professional data can be used for public health (PH) surveillance but not during a long-term follow-up of the same cohort.

OBJECTIVE

This study aimed to build and assess a national ecological NH PH surveillance system (SS).

METHODS

Using a national network of 126 NH, we built a residents’ cohort, extracted medical and personal data from their electronic health records, and transmitted them through the internet to a national server almost in real time. After recording sociodemographic, autonomic and syndromic information, a set of 26 syndromes was defined using pattern matching with the standard query language-LIKE operator and a Delphi-like technique, between November 2010 and June 2016. We used early aberration reporting system (EARS) and Bayes surveillance algorithms of the R surveillance package (Höhle) to assess our influenza and acute gastroenteritis (AGE) syndromic data against the Sentinelles network data, French epidemics gold standard, following Centers for Disease Control and Prevention surveillance system assessment guidelines.

RESULTS

By extracting all sociodemographic residents’ data, a cohort of 41,061 senior citizens was built. EARS_C3 algorithm on NH influenza and AGE syndromic data gave sensitivities of 0.482 and 0.539 and specificities of 0.844 and 0.952, respectively, over a 6-year period, forecasting the last influenza outbreak by catching early flu signals. In addition, assessment of influenza and AGE syndromic data quality showed precisions of 0.98 and 0.96 during last season epidemic weeks’ peaks (weeks 03-2017 and 01-2017) and precisions of 0.95 and 0.92 during last summer epidemic weeks’ low (week 33-2016).

CONCLUSIONS

This study confirmed that using syndromic information gives a good opportunity to develop a genuine French national PH SS dedicated to senior citizens. Access to senior citizens’ free-text validated health data on influenza and AGE responds to a PH issue for the surveillance of this fragile population. This database will also make possible new ecological research on other subjects that will improve prevention, care, and rapid response when facing health threats.
Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm (Preprint)
Authors: Hetrick Sarah Elisabeth , Robinson Jo , Burge Eloise , Blandon Ryan , Mobilio Bianca , Rice Simon M , Simmons Magenta B , Alvarez-Jimenez Mario , Goodrich Simon , Davey Christopher G
Published: March 2018

BACKGROUND

Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice.

OBJECTIVE

The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician.

METHODS

We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups.

RESULTS

The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services.

CONCLUSIONS

The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.
Diurnal Variations of Depression-Related Health Information Seeking: Case Study in Finland Using Google Trends Data (Preprint)
Authors: Tana Jonas Christoffer , Kettunen Jyrki , Eirola Emil , Paakkonen Heikki
Published: March 2018

BACKGROUND

Some of the temporal variations and clock-like rhythms that govern several different health-related behaviors can be traced in near real-time with the help of search engine data. This is especially useful when studying phenomena where little or no traditional data exist. One specific area where traditional data are incomplete is the study of diurnal mood variations, or daily changes in individuals’ overall mood state in relation to depression-like symptoms.

OBJECTIVE

The objective of this exploratory study was to analyze diurnal variations for interest in depression on the Web to discover hourly patterns of depression interest and help seeking.

METHODS

Hourly query volume data for 6 depression-related queries in Finland were downloaded from Google Trends in March 2017. A continuous wavelet transform (CWT) was applied to the hourly data to focus on the diurnal variation. Longer term trends and noise were also eliminated from the data to extract the diurnal variation for each query term. An analysis of variance was conducted to determine the statistical differences between the distributions of each hour. Data were also trichotomized and analyzed in 3 time blocks to make comparisons between different time periods during the day.

RESULTS

Search volumes for all depression-related query terms showed a unimodal regular pattern during the 24 hours of the day. All queries feature clear peaks during the nighttime hours around 11 PM to 4 AM and troughs between 5 AM and 10 PM. In the means of the CWT-reconstructed data, the differences in nighttime and daytime interest are evident, with a difference of 37.3 percentage points (pp) for the term “Depression,” 33.5 pp for “Masennustesti,” 30.6 pp for “Masennus,” 12.8 pp for “Depression test,” 12.0 pp for “Masennus testi,” and 11.8 pp for “Masennus oireet.” The trichotomization showed peaks in the first time block (00.00 AM-7.59 AM) for all 6 terms. The search volumes then decreased significantly during the second time block (8.00 AM-3.59 PM) for the terms “Masennus oireet” (P<.001), “Masennus” (P=.001), “Depression” (P=.005), and “Depression test” (P=.004). Higher search volumes for the terms “Masennus” (P=.14), “Masennustesti” (P=.07), and “Depression test” (P=.10) were present between the second and third time blocks.

CONCLUSIONS

Help seeking for depression has clear diurnal patterns, with significant rise in depression-related query volumes toward the evening and night. Thus, search engine query data support the notion of the evening-worse pattern in diurnal mood variation. Information on the timely nature of depression-related interest on an hourly level could improve the chances for early intervention, which is beneficial for positive health outcomes.
Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that Assists in Post-Traumatic Stress Disorder Therapy (Preprint)
Authors: Tielman Myrthe L , Neerincx Mark A , Brinkman Willem-Paul
Published: March 2018

BACKGROUND

Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages.

OBJECTIVE

The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users’ motivation to continue with therapy, trust in a good therapy outcome, and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors.

METHODS

A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent.

RESULTS

Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome.

CONCLUSIONS

Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people’s motivation and trust in PTSD therapy as well as the user’s feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input.
Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa (Preprint)
Authors: Rice Brian , Boulle Andrew , Baral Stefan , Egger Matthias , Mee Paul , Fearon Elizabeth , Reniers Georges , Todd Jim , Schwarcz Sandra , Weir Sharon , Rutherford George , Hargreaves James
Published: March 2018

UNSTRUCTURED

The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts.
Identifying and Understanding Communities Using Twitter to Connect About Depression: Cross-Sectional Study (Preprint)
Authors: DeJohn Amber D. , Schulz Emily English , Pearson Amber L , Lachmar E Megan , Wittenborn Andrea K
Published: March 2018

BACKGROUND

Depression is the leading cause of diseases globally and is often characterized by a lack of social connection. With the rise of social media, it is seen that Twitter users are seeking Web-based connections for depression.

OBJECTIVE

This study aimed to identify communities where Twitter users tweeted using the hashtag #MyDepressionLooksLike to connect about depression. Once identified, we wanted to understand which community characteristics correlated to Twitter users turning to a Web-based community to connect about depression.

METHODS

Tweets were collected using NCapture software from May 25 to June 1, 2016 during the Mental Health Month (n=104) in the northeastern United States and Washington DC. After mapping tweets, we used a Poisson multilevel regression model to predict tweets per community (county) offset by the population and adjusted for percent female, percent population aged 15-44 years, percent white, percent below poverty, and percent single-person households. We then compared predicted versus observed counts and calculated tweeting index values (TIVs) to represent undertweeting and overtweeting. Last, we examined trends in community characteristics by TIV using Pearson correlation.

RESULTS

We found significant associations between tweet counts and area-level proportions of females, single-person households, and population aged 15-44 years. TIVs were lower than expected (TIV 1) in eastern, seaboard areas of the study region. There were communities tweeting as expected in the western, inland areas (TIV 2). Counties tweeting more than expected were generally scattered throughout the study region with a small cluster at the base of Maine. When examining community characteristics and overtweeting and undertweeting by county, we observed a clear upward gradient in several types of nonprofits and TIV values. However, we also observed U-shaped relationships for many community factors, suggesting that the same characteristics were correlated with both overtweeting and undertweeting.

CONCLUSIONS

Our findings suggest that Web-based communities, rather than replacing physical connection, may complement or serve as proxies for offline social communities, as seen through the consistent correlations between higher levels of tweeting and abundant nonprofits. Future research could expand the spatiotemporal scope to confirm these findings.
Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)
Authors: Hatch Ainslie , Hoffman Julia E , Ross Ruth , Docherty John P
Published: March 2018

BACKGROUND

Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology.

OBJECTIVE

The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness.

METHODS

A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts’ responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals.

RESULTS

Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies.

CONCLUSIONS

These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness.