bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Hemodynamic Characterization Super Responders to IV Prostacyclin in Pulmonary Arterial Hypertension
Authors: Conger Adrienne K , Halliday Steven J , Pugh Meredith E , Robbins Ivan M , Hemnes Anna R
Published: February 2021

Background: Parenteral prostacyclins are the only therapy proven to extend survival in pulmonary arterial hypertension (PAH), yet at the bedside clinicians have no tools to predict which patients are most likely to benefit from this medication class. Methods: We retrospectively analyzed all PAH patients treated with IV epoprostenol therapy at our center from 1/1/1996 to 12/31/2016. We analyzed survival in patients and defined the 90 th percentile of survival. Patients were divided into those who survived past this point (super responders) and those who had had an event prior to this time point after initiation of iv epoprostenol (usual responders). Results: The median survival after IV epoprostenol initiation was 4.32 years, and the 90 th percentile of event-free survival was 11.09 years. Fourteen patients met criteria for super responder and 45 had a survival <90 th percentile, comprising the usual responder group. Super responders tended to be younger, have longer six-minute walk distances and higher mean pulmonary arterial pressure (p<0.05 for all). In follow up, super responders continued to have a higher six-minute walk distance and were more likely to have achieved normal or only mildly impaired right ventricular function, though no differences in hemodynamics were observed. Conclusions: There may be a super responder phenotype that can be defined in patients with PAH by >90 th percentile of survival. Super responders were more likely that usual responders to be younger and were more likely to have achieved favorable right ventricular function at follow up, however, differences in hemodynamics were not observed.
A novel non-invasive method allowing for discovery of pathologically relevant proteins from small airways
Authors: Östling Jörgen , Geest Marleen Van , Olsson Henric K , Dahlén Sven-Erik , Viklund Emilia , Gustafsson Per , Mirgorodskaya Ekaterina , Olin Anna-Carin
Published: February 2021

BackgroundBreath contains an aerosol of droplet particles, which are formed from the epithelial lining fluid when the small airways close and re-open during inhalation succeeding a full expiration. These particles can be collected by impaction using the PExA® method (Particles in Exhaled Air), and constitute a potential source of biomarkers reflecting pathological processes in the small airways.ObjectiveOur aim was to investigate if PExA method may be useful for discovery of biomarkers that reflect pathology of small airways.Methods10 healthy controls and 20 subjects with asthma, of whom 10 with small airway involvement as indicated by a high lung clearance index (LCI ≥2.9 z-score), were examined using the PExA instrument. The samples were analysed with the SOMAscan proteomics platform (SomaLogic Inc).ResultsTwo hundred-seven proteins were detected in up to 80% of the samples. Nine proteins showed differential abundance in subjects with asthma and high LCI as compared to healthy controls. Two of these were less abundant (ALDOA4, C4), and seven more abundant (FIGF, SERPINA1, CD93, CCL18, F10, IgM, IL1RAP). sRAGE levels were lower in ex-smokers (n=14) than in never smokers (n=16). Gene Ontology (GO) annotation database analyses revealed that the PEx proteome is enriched in extracellular proteins associated with extracellular exosome-vesicles and innate immunity.ConclusionThe applied analytical method was reproducible and allowed identification of pathologically interesting proteins in PEx samples from asthmatic subjects with high LCI. The results suggest that PEx based proteomics is an novel and promising approach to study respiratory diseases with small airway involvement.
Comparison of Methodologies used to Determine Aromatic Lignin Unit Ratios in Lignocellulosic Biomass
Authors: Happs Renee M. , Addison Bennett , Doeppke Crissa , Donohoe Bryon S. , Davis Mark F. , Harman-Ware Anne Elizabeth
Published: February 2021

Background Multiple analytical methods have been developed to determine the ratios of aromatic lignin units, particularly the syringyl/guaiacyl (S/G) ratio, of lignin biopolymers in plant cell walls. Chemical degradation methods such as thioacidolysis produce aromatic lignin units that are released from certain linkages and may induce chemical changes rendering it difficult to distinguish and determine the source of specific aromatic lignin units released, as is the case with nitrobenzene oxidation methodology. NMR methods provide powerful tools used to analyze cell walls for lignin composition and linkage information. Pyrolysis-mass spectrometry methods are also widely used, particularly as high-throughput methodologies. However, the different techniques used to analyze aromatic lignin unit ratios frequently yield different results within and across particular studies, making it difficult to interpret and compare results. This also makes it difficult to obtain meaningful insights relating these measurements to other characteristics of plant cell walls that may impact biomass sustainability and conversion metrics for the production of bio-derived fuels and chemicals. Results The authors compared the S/G lignin unit ratios obtained from thioacidolysis, pyrolysis-molecular beam mass spectrometry (py-MBMS), HSQC liquid-state NMR and solid-state (ss) NMR methodologies of pine, several genotypes of poplar, and corn stover biomass. An underutilized approach to deconvolute ssNMR spectra was implemented to derive S/G ratios. The S/G ratios obtained for the samples did not agree across the different methods, but trends were similar with the most agreement among the py-MBMS, HSQC NMR and deconvoluted ssNMR methods. The relationship between S/G, thioacidolysis yields, and linkage analysis determined by HSQC is also addressed. Conclusions This work demonstrates that different methods using chemical, thermal, and nondestructive NMR techniques to determine native lignin S/G ratios in plant cell walls may yield different results depending on species and linkage abundances. Spectral deconvolution can be applied to many hardwoods with lignin dominated by S and G units, but the results may not be reliable for some woody and grassy species of more diverse lignin composition. HSQC may be a better method for analyzing lignin in those species given the wealth of information provided on additional aromatic moieties and bond linkages. Additionally, trends or correlations in lignin characteristics such as S/G ratios and lignin linkages within the same species such as poplar may not necessarily exhibit the same trends or correlations made across different biomass types. Careful consideration is required when choosing a method to measure S/G ratios and the benefits and shortcomings of each method discussed here are summarized.
Combined primary hepatic neuroendocrine carcinoma and hepatocellular carcinoma: case report and literature review
Authors: Nakano Akira , Hirabayashi Kenichi , Yamamuro Hiroshi , Mashiko Taro , Masuoka Yoshihito , Yamamoto Seiichiro , Ozawa Soji , Nakagohri Toshio
Published: February 2021

Background: Hepatocellular carcinoma (HCC) can grow in a mosaic pattern, often combined with various non-hepatocellular cells. However, HCC combined with a neuroendocrine carcinoma (NEC) component is rarely reported, and its clinical features, origin, diagnosis, and behavior have not been established. In the literature, mixed HCC–NEC tumors are categorized as either collision type or combined type, depending on their microscopic features. Here we report a patient with a combined-type HCC–NEC tumor.Case presentation: An asymptomatic 84-year-old woman was found to have a solid mass in the right lobe of the liver. Laboratory and radiologic examinations showed typical findings of HCC, including arterial-phase enhancement, and portal- and delay-phase washout. She was treated by partial laparoscopic hepatectomy of segment 5. Pathological examination showed that the tumor was predominantly HCC, partly admixed with an NEC component. A transitional zone between the HCC and NEC tissues was also observed. The tumor was finally diagnosed as a combined-type primary mixed NEC–HCC tumor. After the preoperative diagnosis, the patient underwent somatostatin receptor scintigraphy to detect the primary NEC lesion, but no accumulation was found in any other part of her body. She has been free of recurrence for 9 months since the surgery.Conclusion: Mixed HCC–NEC tumors are extremely rare and Correct diagnosis requires multidisciplinary collaboration. The accumulation of further cases is needed to help understand the exact pathology, diagnosis, and treatment of this disease.
Morphophysiological traits of soybean leaflets and their relationship with crop agronomic performance
Authors: Bahry Carlos André , Carleso Ângela Aparecida , Perboni Anelise Tessari , Prá Françoá Santos Dal , Geraldo Gelson , Petkowicz Leandro André , Ceresoli Leocádio , Junior Américo Wagner , Marchese José Abramo
Published: February 2021

Soybean genotypes have distinct morphophysiological traits, which may influence the crop agronomic performance. The aim of this work was to evaluate the productive parameters of three contrasting soybean genotypes for leaf morphophysiological traits. The experiment was carried out at in a typical Distroferric Red Latosol, located at latitude 25º41'52" S and longitude 53º03'94" W; in the 2015/16 (CY1) and 2016/17 (CY2) seasons. The genotypes tested were: BS 2601 RR® (lanceolate and smaller leaflets); NS 6006 IPRO® (triangular and intermediate leaflets) and homozygous lineage CI 21 IPRO® (oval and larger leaflets). The gas exchange, chlorophyll index, leaf area, leaflet length and width, and petiolulus length were evaluated when plants of each genotype were at the beginning of flowering. At harvest, the variables analyzed were: first pod insertion, plant height, number of pods and grains per plant, grains per pod, mass of one thousand grains and grain yield. The design used was randomized blocks with four replicates. Photosynthesis per leaf area unit was higher in CY2, and is related to greater stomatal conductance, higher chlorophyll index, lower transpiration and lower leaf area of plants. The lanceolate leaf cultivar showed higher grain yield due to the higher number of grains and the greater mass of these grains in the two crop years. In addition, it was the one that obtained lower leaf area and lower transpiration. The cultivar NS 6006 presented greater productive stability, but this trait does not confer greater productive potential.
Özel Yetenekli Öğrencilerin Atık Yönetimi Temalı Doğa Eğitimine Katılma Nedenleri ve Eğitim Sonrası Görüşleri
Authors: CEYLAN Özge , ASLAN Zeynep
Published: February 2021

Giriş: Okul dışı öğrenme ortamlarından olan doğa eğitimi ve bilim kampları, özel yetenekli öğrencilere yönelik zenginleştirilmiş programlar hazırlama fırsatı sunar. TÜBİTAK’ın desteklediği bu çalışmada, özel yetenekli öğrenciler için hazırlanan atık yönetimi temalı doğa eğitimine öğrencilerin katılma nedenleri ve sonrasında görüşlerinin incelenmesi amaçlanmıştır.Yöntem: Nitel araştırma yöntemlerinden durum çalışmasıyla yürütülen araştırmanın çalışma grubu, İstanbul ilindeki BİLSEM’lere kayıtlı 29 özel yetenekli 5. sınıftan 6. sınıfa geçmiş öğrencilerdir. 2019 yılı haziran ayında 5 gün süren projeye dair öğrencilerin görüşleri, içerik analizi kullanılarak incelenmiştir. Veriler, araştırmacılar tarafından hazırlanan başvuru formu ve proje değerlendirme formu ile katılımcı günlükleri aracılığıyla toplanmıştır.Bulgular: Bulgular öğrencilerin çoğunlukla projeye bilgi edinmek, çeşitli becerilerini geliştirmek ve doğaya olan sevgileri sebebiyle katıldıklarını göstermiştir. Projeye katılırken atıklar ile ilgili bilgi düzeylerinin ise temel ve orta düzey olduğu görülmüştür. Ayrıca projeye yönelik olumlu görüşleri olduğu, atık yönetimi konusunda üst düzey bilgi edindikleri, düşünme becerilerini geliştirdikleri, sosyal ve duygusal doyuma ulaştıkları, çevre farkındalığı kazandıkları ortaya çıkmıştır.Tartışma: Elde edilen bulgular alan yazın ile karşılaştırıldığında, birçok çalışmanın bu çalışmayı desteklediği görülmüştür. Araştırmanın özel yeteneklilerde okul dışı öğretim ve doğa eğitimi uygulamaları ile benzer projelere hazırlık aşamasına katkıda bulunması beklenmektedir. Sonuç olarak, özel yetenekli öğrencilerin istek, ilgi ve merakları doğrultusunda katıldıkları atık yönetimi temalı doğa eğitiminin onların üst düzey bilgi edinmelerine, düşünme becerilerini geliştirmelerine, sosyal ve duygusal olarak doyuma ulaştıklarına, çevreye yönelik farkındalık kazanmalarına katkısı olduğu görülmüştür. Özel yetenekli öğrencilerin çevre eğitimi ihtiyaçlarının yeterli düzeyde karşılanması amacıyla çevre sorunlarını temele alan zenginleştirilmiş ya da farklılaştırılmış etkinlikler, programlar hazırlanabilir.
Expedient Microwave-Assisted Synthesis of Bis(n)-lophine Analogues as Selective Butyrylcholinesterase Inhibitors: Cytotoxicity Evaluation and Molecular Modelling
Authors: Câmara Viktor , Soares Ana Julia , Biscussi Brunella , Murray Ana Paula , Guedes Isabella , Dardenne Laurent , Ruaro Thaís , Zimmer Aline , Ceschi Marco
Published: February 2021

In the brain of patients with chronic Alzheimer’s disease (AD), the butyrylcholinesterase (BuChE) levels rise while the acetylcholinesterase (AChE) levels decrease. Therefore, development of new selective BuChE inhibitors is of vital importance. Here we present a series of bis(n)‑lophine analogues, where two lophine derivatives are connected by a methylene chain. The bis(n)-lophine analogues were synthesized through one-pot four component reaction between pyridinecarboxaldehydes, 1,n-alkanediamines, benzil, and ammonium acetate. The reactions were performed in a microwave reactor in one step for symmetrical bis(n)-lophines, and in two steps for unsymmetrical bis(n)-lophines. The compounds are strongly selective to BuChE, since none of them inhibit AChE. All the compounds, except 7a, 7b and 7c, displayed potent inhibitory activity against BuChE at a micromolar and sub-micromolar range (half maximal inhibitory concentration (IC50) 32.25-0.03 μM). The enzyme kinetic and docking studies suggests that the inhibitor act as a dual binding site inhibitor, binding into the bottom of the gorge and in the peripheral anionic site (PAS) of BuChE cavity. Furthermore, in vitro studies showed that compounds 5b and 12b had no cytotoxic effects in kidney Vero, hepatic HepG2 and C6 astroglial cell lines.
Medios y fines del control de la natalidad. Un análisis relacional del campo médico, Argentina (1930-1940)
Authors: Ledesma Prietto Nadia
Published: February 2021

En este trabajo analizamos las ideas y prácticas que desde el campo médico se desplegaron en torno al control de la natalidad. Desde una perspectiva relacional y de género, encontramos divergencias en los planteos en torno a los métodos anticonceptivos, el aborto y la esterilización. En el contexto de la transición demográfica y el auge de las ideas eugénicas, el control voluntario de la natalidad fue un problema para la élite médica. En cambio, los posicionamientos marginales difundieron saberes para acceder al placer sexual sin preocuparse por la reproducción.
Determinantes socioeconómicos y próximos de la mortalidad de niños menores de cinco años en el Perú (2015-2018)
Authors: Paredes Mamani Rene Paz , Yapuchura Saico Cristobal , Arpi Mayta Roberto , Calatayud Mendoza Alfredo Pelayo
Published: February 2021

El objetivo del estudio fue encontrar los determinantes socioeconómicos y próximos de la mortalidad de niños menores de cinco años en el Perú. Con tal propósito el estudio se centra en el enfoque teórico de Mosley y Chen (1984), y en la metodología econométrica de los modelos de duración semi paramétrica de riesgos proporcionales de Cox y no paramétrica de Kaplan y Meier. En lo referente a los determinantes socioeconómicos, los resultados muestran que los años de educación de la madre, el estatus económico del hogar y las coberturas de salud de la madre disminuyen significativamente el riesgo de muerte de los niños menores de cinco años. Asimismo, los años de educación de la madre tienen un efecto interactivo significativo con el nivel socioeconómico del hogar y el acceso a la cobertura de servicio de salud para influir sobre la supervivencia infantil. En cuanto a los determinantes próximos, la edad de la madre, los intervalos entre naci-mientos, el orden de nacimiento de los hijos, y las instalaciones sanitarias predicen el riesgo de muerte de los niños menores de cinco años.
Violencia de género: prevalencia, imaginarios sexistas, y mitos en la juventud universitaria
Authors: Trujillo Cristoffanini Macarena , Contreras Hernández Paola
Published: February 2021

Se presenta una investigación cuyo objetivo fue analizar aspectos relacionados con la violencia de género en el contexto universitario chileno abordando tres ejes en particular: prevalencia de violencia contra las mujeres en relaciones de pareja heterosexuales, pervivencia de constructos tradicionales de género, reproducción de mitos sobre este maltrato, así como imaginarios sexistas presentes en el estudiantado. El sustento teórico viene dado por los enfoques feministas que han examinado las estructuras de poder en las que permanecen y se reproducen estas agresiones, así como las dinámicas sociales que las naturalizan. Los estudios en el área destacan que la educación superior no es necesariamente un factor protector ante la violencia ni una herramienta que, de por sí, desmonte los imaginarios de género que le dan soporte. A nivel metodológico, se aplicaron 1.120 encuestas en tres universidades chilenas, en las que se abordaron los tres ejes de análisis ya señalados. Los resultados muestran un elevado porcentaje de violencia contra las mujeres y, a la vez, evidencian la subsistencia de mitos e imaginarios sexistas que invisibilizan la reproducción de este tipo de relaciones de poder. En la discusión y conclusiones, se releva el papel de la educación y de las instituciones de educación superior a la hora de promover cambios en este ámbito.
THE PREFACE TO THE SIX BOOKS OF THE СOMMONWEALTH BY JEAN BODIN. THE FEATURES OF THE GERMAN TRANSLATION BY JOHANN OSWALDT
Authors: Bayazitova Gulnara I. , Korge Lidiya Yu.
Published: February 2021

This article studies the first German translation of the “Six Books on the Republic” by the French lawyer and philosopher Jean Boden, published in 1592. Particular attention is paid to the preface to the treatise, which was written by the translator, a Lutheran priest Johann Oswaldt. There, Oswaldt sets out his position on the “Republic” as well as points out the need for this translation and the relevance of Boden’s treatise for monarchs and rulers. Oswaldt’s foreword is remarkable, firstly, for the terminological synthesis that he carries out. Relying on Boden’s both French and Latin manuscripts of “The Republic”, he carefully selects appropriate German terms to convey their connotations. Second, the German translation of “The Republic” opens the possibility of following the reception of Jean Boden’s ideas in Germany.
The authors of this article come to the conclusion that Oswaldt had a practical purpose when he translated the main political work that substantiated the theory of sovereignty. The dedication of the translation to the Duke of Württemberg and the Count of Mümpelgard politicizes his scholarly effort. In fact, following Boden himself, Oswaldt aims to make “The Republic” read and utilized by his patrons. In the long term, the implementation of the ideas outlined in “The Republic” will lead to the foundation of the sovereignty of Württemberg.
At the same time, the study of the first German translation has further research implications, since it outlines the area of distribution of Boden’s treatise on the European continent. The German translation followed the Italian and Spanish editions, but appeared earlier than the English translation. Hence, this article might pave the way for studying the reception of the theory of sovereignty in the works of German authors in Russian historiography.
Interplay between RNA Methylation Eraser FTO and Writer METTL3 in Renal Clear Cell Carcinoma Patient Survival
Authors: Zhao Jiaxun , Lu Lingeng
Published: February 2021

Background:

m6A-methyltransferase METTL3 and demethylase FTO regulate gene expression
by dynamically modifying RNA methylation. However, their clinical relevance in renal
Clear Cell Carcinoma (CCRCC) has not been well elucidated.

Objective:

This study aims to investigate prognostic values of FTO and METTL3 mRNA and DNA
methylation, their differential expression and associations with chemokines and inflammation-related
genes in CCRCC.

Methods:

Kaplan-Meier survival curves and multivariate cox regression were performed for survival
analyses, and random-effects meta-analysis was conducted for differential expression of FTO
and METTL3 in CCRCC.

Results:

A significantly negative correlation was observed between mRNA and DNA methylation
for both FTO and METTL3. Survival analysis showed a superior survival in patients with either
high FTO mRNA or low DNA methylation, or low METTL3 mRNA or high DNA methylation.
The adjusted hazard ratios were 0.67 (95% CI: 0.49-0.91, p = 0.01) for high vs. low FTO mRNA,
2.17 (1.38-3.42, p = 0.0008) for high vs. low FTO DNA methylation, 1.97 (1.45-2.68, p<0.0001)
for high vs. low METTL3 mRNA, and 0.49 (0.31-0.79, p = 0.003) for high vs. low METTL3 DNA
methylation, respectively. There was a significant interaction between FTO and METTL3 mRNA
levels (p = 0.024). Upregulation of FTO and METTL3 with 1.64 folds (95% CI: 1.43-1.89) and
1.17 folds (1.02-1.35), respectively, was observed in CCRCC vs. normal kidney tissues. FTO and
METTL3 mRNA showed opposite expressions of CD8+ T cell migration-related chemokines.

Conclusion:

Dysregulated FTO and METTL3 may be involved in the disease development and progression,
affecting immune response in CCRCC. FTO and METTL3 expression and DNA methylation
are potential prognostic markers of CCRCC.
Comparing Adversary Defense Mechanisms in Cognitive Radio Networks
Authors: Kiwan Doaa , Fonseka John P. , Hassan Rana A.
Published: February 2021

BACKGROUND:

In a cognitive radio network, the cognitive transmitter senses the medium to detect spectrum
opportunities and transmits its own data if the channel is sensed to be idle. A jammer can also sense the medium and identify the slots
of successful transmission. The jammer’s main objective is to reduce the throughput of the cognitive transmitter.

METHODS:

Towards this objective, the jammer builds a deep learning classifier in which the most recent sensing results of
acknowledgments (ACKs) sent by the receiver are used to predict the slots of successful transmissions of the cognitive transmitter.
This allows the attacker to reliably predict the successful transmissions and can effectively jam these transmissions. The deep learning
classification soft decision probabilities are used by the jammer for power control subject to a certain power budget. A receiver-based
defense mechanism is developed against the jamming attacks. The receiver purposely takes some wrong actions, i.e., sends ACK
when transmission is not successful and vice versa, to poison the training process of the attacker.

Results:

We show that our receiver’s defense mechanism effectively enhances the throughput of the cognitive transmitter when
compared to the transmitter’s defense mechanism, where the transmitter takes some wrong decisions when it accesses the
medium.

CONCLUSION:

A novel defense mechanism against jamming attacks in cognitive radio networks is introduced.
The Forecasting Method of Central Air Conditioning Load: A Brief
Review
Authors: Zhu Qixin , Zhuang Mengxiang
Published: February 2021

Objective:

In order to better understand the research results of AC load prediction and carry out new research, the Air Conditioning (AC) load forecasting method plays an important role in the energy consumption of AC.

Method:

This paper summarizes the methods of building AC load prediction, mainly from the impact factors of AC operating load and the methods of AC system operating load forecasting to introduce the current status of load prediction. This paper describes some studies on load influencing factors, compares the advantages and disadvantages of modeling methods for AC operation load prediction and points out the research direction of AC load forecasting.

Results:

The current research methods are summarized and analyzed. Traditional forecasting methods are no longer applicable to air conditioning systems. From the current research, combinatorial prediction has become a hot research object. This method combines two or more methods to reduce the prediction error and shorten the prediction time.

Conclusion:

This paper points out some shortcomings of the present research and the future research suggestions are given in the three aspects of sharing AC operation data, selecting the key factors of AC, and exploring the new methods.
Birgitte Possing. Understanding Biographies; Caitríona Ní Dhúill. Metabiography
Authors: Rosengren Henrik
Published: February 2021

Both in the Scandinavian countries and in Germany, the status of biographical writing has changed to a far greater extent in the last fifty years than in the Anglo-Saxon world. In the latter context, biography has been more popular than in Germany and, for example, Denmark and Sweden. It has continuously been regarded as both a genre worthy from a scholarly career point of view and as a means for scholars, such as historians, to reach a wider audience outside the academic ivory tower. Explanations for this difference may lie in diverse scholarly traditions where American and British scholars have consciously strived for a larger readership than the purely specialized and interdisciplinary one. An Anglo-Saxon narrative tradition in which language, style and composition have been key words has supported biography writing.
A Clinical Journey Mobile Health App for Perioperative Patients: Cross-sectional Study
Authors: Willems Stijn J , Coppieters Michel W , Pronk Yvette , Diks Miranda J F , van der Heijden Klaas W A P , Rooker Servan , Scholten-Peeters Gwendolyne G M
Published: February 2021

Background

Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps.

Objective

The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences.

Methods

A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses.

Results

Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users’ confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians.

Conclusions

The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app.
The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data
Authors: Esdar Moritz , Hübner Ursula , Thye Johannes , Babitsch Birgit , Liebe Jan-David
Published: February 2021

Background

Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.

Objective

The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved.

Methods

We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.

Results

The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.

Conclusions

The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners (Preprint)
Authors: Johnsen Tor Magne , Norberg Børge Lønnebakke , Kristiansen Eli , Zanaboni Paolo , Austad Bjarne , Krogh Frode Helgetun , Getz Linn
Published: February 2021

BACKGROUND

The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway.

OBJECTIVE

This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic.

METHODS

A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests.

RESULTS

In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting.

CONCLUSIONS

Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.
A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis (Preprint)
Authors: Yu Jessica , Chiu Carter , Wang Yajuan , Dzubur Eldin , Lu Wei , Hoffman Julia
Published: February 2021

BACKGROUND

Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection.

OBJECTIVE

The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus.

METHODS

A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants’ mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants’ behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals.

RESULTS

In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant’s emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform.

CONCLUSIONS

Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed.
Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation (Preprint)
Authors: Seiler Amber , Biundo Eliana , Di Bacco Marco , Rosemas Sarah , Nicolle Emmanuelle , Lanctin David , Hennion Juliette , de Melis Mirko , Van Heel Laura
Published: February 2021

BACKGROUND

The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics.

OBJECTIVE

This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs.

METHODS

A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature.

RESULTS

A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs.

CONCLUSIONS

The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.

CLINICALTRIAL
DATA QUALITY IN SKILLED NURSING FACILITIES THE COVID-19 PANDEMIC AND INFODEMIC: An Evaluation Study (Preprint)
Authors: Saunders-Russell Carmen , Stumpf Steven H , Schutte Jerald , Lindsey Sawyer , Sullivan Terrin
Published: February 2021

BACKGROUND

The incidence of COVID-19 cases and deaths in Skilled Nursing Facilities (SNFs) has garnered tremendous attention across all media. Data verification weaknesses in the reporting systems of public agencies have become magnified by the devastating impact of COVID-19. The result is a COVID-19 infodemic, i.e., “deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals.” Nonsensical and misleading reports have been submitted to public gatekeepers by Los Angeles County SNFs. The scale of confounding reports suggests intention to mask failure in the management of COVID-19 infections and deaths risk to patients and staff.

OBJECTIVE

Our aim was to evaluate the extent to which COVID-19 data reported by SNFs has contributed to the COVID-19 infodemic.

METHODS

This evaluation covered 22 consecutive weeks of SNF data reported to the California Department of Public Health from May 24 through October 24, 2020. We reviewed COVID-19 outcomes reported by 350 Los Angeles County (LAC) SNFs (90.7% of all LAC SNFs). We examined COVID-19 cases and deaths for SNF residents and staff for logical continuity.

RESULTS

We found illogical reported outcomes for COVID-19 cases and deaths for residents and staff in LAC SNFs.

CONCLUSIONS

Misleading data misleads regulators and the public regarding the true impact of COVID-19 for SNF residents and staff. We propose the implementation of an integrated reporting model is needed to mitigate inaccuracies and establish a new standard for data verification.
CONVALESCENT PLASMA THERAPY FOR COVID-19 PATIENTS: REGULATORY GUIDANCE ON COLLECTION, TESTING, PROCESSING, STORAGE, DISTRIBUTION, AND CLINICAL TRIALS
Authors: PORWAL AMIT , PATHAK KAMLA , PATHAK DEVENDER , YADAV RAMAKANT
Published: February 2021

Convalescent plasma can be transfused to patients suffering from the same infection or for preparing immunoglobulin concentrates. Plasma obtained from recovered patients can be a valuable alternative during the COVID-19 pandemic for supporting its treatment within a randomized or case-control clinical trials or observational studies of plasma transfusion and for preparing plasma-derived biological products. WHO Blood Regulators Network highlighted that a systematic approach for collecting convalescent plasma from patients recovered from COVID-19 could provide a useful intervention. Structured clinical trials can be used to assess safety and effectiveness of convalescent plasma. The convalescent plasma therapy is still in the experimental stage and is currently not included in the interim clinical guidelines of WHO. However, an emergency investigational new drug application (eIND) process has been induced to ensure the availability of COVID-19 convalescent plasma to the patients with severe or life-threatening COVID-19 conditions. USFDA is regularly amending its guidance as new results, and best practices are emerging. The write-up provides an overview of convalescent plasma, from a regulatory considerations viewpoint, systematic workflow protocol, and a cross-section of clinical trials underway.
IN SILICO ANALYSIS OF BRUGUIERA GYMNORRHIZA (L.) – LARGE LEAVED MANGROVE FOR EFFICIENT THERAPEUTIC USES
Authors: A ARUNPRASATH , S SREERAM
Published: February 2021

Objective: The study was focused on obtaining the therapeutic advantages of Bruguiera gymnorrhiza, a large leafed mangrove through in silico studies.

Methods: The collected leaf sample was extracted using ethanol, and the extract was subjected to GCMS analysis to find out the compounds present in them. The obtained compounds underwent absorption, distribution, metabolism, and elimination toxicity test and the chemical structures were obtained from PUBCHEM and the disease which had more susceptibility was taken on the basis of antimicrobial studies and its protein structure was also obtained from Protein Data Bank. Maestro is a freely available, full future molecular visualization tool. It is a powerful tool for interpreting, managing, and sharing the results of computational experiments when coupled with Schrodinger software such as Glide, Prime, or Phase. The compatibility of ligand-protein interaction was visualized through the visualization software that is Pymol.

Results: The retrieved compounds were subjected to analyze the absorption, distribution, metabolism, and excretion properties and the results were tabulated. It was found that the compound 2-Methoxy-4-Vinylphenol; 7786-61-0; 4-Vinylguaiaco from the plant sample B. gymnorrhiza shows a glide score (G. score) −7.2 Kcal/mol. The interactions were observed using Pymol.

Conclusion: It was found that the compound 4-Vinylguaiaco from the plant sample B. gymnorrhiza can be used as potent drug for the treatment of pharyngitis, which is the inflammation of pharynx. This work can be taken as a base for the works that need to be done in future for the development of an effective drug and also addressing the importance of mangroves in the field of ethnobotany.
ANALYTICAL QUALITY BY DESIGN APPROACH IN RP-HPLC METHOD DEVELOPMENT AND VALIDATION FOR THE ESTIMATION OF DUVELISIB
Authors: CH SRUJANI , P ANNAPURNA , KS NATARAJ , MANJARI PAWAR A KRISHNA
Published: February 2021

Objective: A simple, accurate, and robust RP-HPLC method was developed and validated for the estimation of Duvelisib using analytical quality by design approach.

Methods: The critical method parameters (CMP) were systematically optimized using box-Behnken design (BBD). The CMP’s selected were % organic phase composition, column temperature, and flow rate. The critical quality attributes investigated were retention time and theoretical plates.

Results: Chromatographic separation was accomplished on Agilent Zorbax Eclipse C18 (150×4.6 mm, 5 μm) column. The optimized and predicted data from Design Expert software consist of mobile phase 0.1 % orthophosphoric acid (46.3%): Acetonitrile (53.7%), pumped at a flow rate of 0.91 ml/min at 32.6°C gave the highest desirability function of 1. The retention time of the drug was found to be 2.85 min. The developed method was validated as per the ICH Q2 (R1) guidelines.

Conclusion: Based on the analysis of variance values, the selected models were found to be significant with p<0.05. The results of the validation parameters were within the acceptable limit. The stability of the drug was examined under different stress conditions forcibly and significant degradation was found in acidic condition.
PHYSICOCHEMICAL CHARACTERIZATION OF JAMS, ARTINASAL, AND INDUSTRIAL PRODUCED FROM THE PRICKLY PEAR FRUIT OF OPUNTIA FICUS-INDICA L.
Authors: YAMINA BOUDAOUD , DALILA ABDESSEMED
Published: February 2021

Objective: This research work is aimed at production and evaluation of the physical-chemical, and sensory qualities of jam produced from the prickly pear fruit from two varieties: Timgad region (Batna, semi-dry area), Elkseur (Bejaia, temperate zone), and an industrial: Roumais jam (Elkseur).

Methods: The soluble solids content is determined by measuring the Brix at 20°C using a digital refractometer. Ash was determined by combustion of the sample in a muffle furnace at 550°C for 5 h. The total soluble sugar content was examined using phenol-sulfuric acid colorimetric method using a spectrophotometer (UV–VIS, Shimadzu). The total nitrogen content was determined by the micro-Kjeldahl method and total protein content was calculated using a 6.25 factor. Pectin content was determined by method of Golou and Bev. Reducing sugars were determined by the Fehling’s test. The crude fiber content was determined using the traditional Van Soest method. Lipid content was determined using a Soxhlet apparatus HT 1034 according to the procedure described by Huang. Sensory evaluation was carried out by 10 panelists using a 9-point Hedonic scale.

Results: The physical and chemical analysis results give a very moderate total sugars (53.7; 46.4; and 23.2%), pectin (17.1; 16.0; and 12.0%), acidity (1.84; 1.45; and 2.9 g/100 g), °Brix (60; 62.3; and 27%), humidity (30.4; 32.4; and 71.8%), and fiber (13.3; 22.6; and 22.9%). The sensory results give for color (8.10; 6.62; and 7.22), for taste (7.89; 5.81; and 7.44), for odor (8.20; 6.64; and 7.98), and for texture (7.50; 8.30; and 5.23).

Conclusion: It would be good to extend the field of study to a mixture of prickly pear to others fruit to develop other quality products (jam, jelly, syrup, and candy) in the innovation framework.