bluuebunny/crossref_metadata_2025 huggingface dataset:
Prof. Yoshida - Empirical research in management accounting
Authors: Yoshida Eisuke
Published: December 2020

Tension in the form of dilemmas, contradictions and conflicts exists in organisations. It can be managed through management controls, including management accounting, thereby optimising organisational performance. Management accounting uses all quantitative and qualitative information
in addition to accounting information in assisting managerial decisions, ultimately helping a business to achieve its goals. As part of this, tension management, which is a relatively new research topic, can not only enable long-term business goals to be achieved, but can also help attain
the individual wellbeing of employees. This is the premise of the research of Professor Eisuke Yoshida. The research themes of Yoshida, who is based in the Faculty of Business and Commerce, Keio University, Japan, encompass management accounting, business structure and organisation design
and management. This interest stems from a desire to optimise the working environment and ensure that work doesn't come at the expense of other, outside interests. Yoshida says this is because often achieving operational efficiency is associated with negative consequences. Using management
accounting, with incorporated tension management, he believes it is possible to avoid these. For example, in Japan targets tend to be difficult to achieve, and failure to achieve targets has become the norm. 'This creates a state of tension, which is not necessarily a negative thing. It will
be a trigger for creating new ideas and collaborating with others,' outlines Yoshida. From his perspective, creating a theoretical framework for tension management is an important part of addressing this.
Design of a clinical database to support research purposes: Challenges and solutions
Authors:   Department of Computer Science and Information Technology, La Trobe University, Melbourne, Australia, et al. Samra
Published: December 2020

The aim of this paper is to propose solutions to challenges faced by database systems for clinical research purposes. Current clinical databases are primarily based on data acquisition for healthcare intentions. However, these healthcare databases lack the data analysis capability for clinical researchers. In order for clinical researchers to use the healthcare databases in an effective manner, such as in their clinical trial studies, challenges of data integration, data storage, and data retrieval in the current healthcare database settings need to be overcome. Our proposed solutions include using: 1) NoSQL to efficiently integrate clinical databases with legacy healthcare databases, (2) entity attribute value model for data retrieval, and (3) warehouse for big data storage.
Examining a TPB Model towards Intention to Use Biodegradable Drinking Straw Using PLS-SEM
Authors: Mohmad Hassan Nadia Nurul Najwa , Mohd Abdul Kadir Juliana , Abd Aziz Noreen Noor
Published: December 2020

Intention to use biodegradable drinking straw may be affected by psychological factors. Besides, the impact of factors towards intention may be different between gender. Therefore, this paper analyses the effect of attitude, subjective norm, knowledge, and perceived behavioral control towards the intention to use a biodegradable drinking straw and the moderating effect of gender towards the relationship among variables. The results, which were collected by using online questionnaires and analysed by using PLS-SEM; showed that most of the variables except knowledge had a significant impact on intention to use a biodegradable drinking straw, while gender posits no difference towards the usage intention.
Keywords: Intention; Biodegradable Straw; Knowledge; Gender
eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CCBYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.
DOI: https://doi.org/10.21834/ebpj.v5i15.2428..
Ergonomics Concept in Inclusive Public Playground Targeting on Children with Disabilities
Authors: Mohd Radzi Nurul Asyikin , Ismail Kharizam , Ab Wahab Lilawati
Published: December 2020

Nowadays, playgrounds are underused to improve the physical and social development of young children with special needs. Therefore, this study aims to identify the key criteria of ergonomic inclusive public children playground aim for children with disabilities (CWDs). The study explored the process of universal design and the ergonomics function of play equipment that focuses on CWDs through physical site observation and interview protocol done among caregivers, parents of children with disabilities, and all stakeholders involved in the development of the public playground in Malaysia. The result presents three major themes as a guideline to create an ergonomic inclusive playground.
Keywords: Ergonomics; Universal Design; Public Playground; Children with disabilities.
eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BY NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.
DOI: 10.21834/ebpj.v5i15.2499
Behaver and risk factors for health of operators employed in oil production and preparation enterprises
Authors: Latyshevskaya N. I. , Mirochnik V. V. , Davydenko L. A.
Published: December 2020

Objective: to evaluate the behavioral risk factors of the workers of the primary oil refining workshop with the aim of using them as a tool for substantiating management decisions and forming vectors of preventive measures.

Materials and methods: the method of active survey investigated the prevalence of behavioral risk factors among operators in two age groups (20 – 35 and 36 – 60 years old).

Results: the main vectors of behavioral risks for operators of different age groups were established: lack of motor activity, smoking, low medical activity, low perception of behavioral risks. Violations of lifestyle are predominantly combined (violations by 2 – 4 indicators). For older operators are more characterized by low motor and medical activity, disturbances in diet, an overestimation of the degree of influence of environmental and occupational factors on health when the significance of individual behavior is underestimated.

Conclusions: Social policy at the enterprise should take into account the main vectors of behavioral risks, lower motivation and the implementation of a healthy style of behavior typical of older workers.
Relationship of the damage level of cell genetic apparatus with reproductive health disorder degree under conditions of harmful production
Authors: Morgul E. V. , Belik S. N. , Avetisyan Z. E. , Kvasov A. R. , Chebotareva Yu. Yu. , Evdokimova E. P. , Morgul A. R.
Published: December 2020

Purpose: to determine the relationship of the damage level of cell genetic apparatus with reproductive health disorder degree under conditions of harmful production.

Materials and methods: the study involved 36 poultry farm female workers of childbearing age. The first group was made up by 22 workers of the main production. The control group included the other 14 employees who were administrative and managerial personnel. Clinical statistical study of reproductive health was carried out with simultaneous investigation of the cariological indices of buccal epithelium using a fluorescence microscope. At least 1000 cells in a monolayer were analyzed on each micropreparation. Statistical data analysis was made using Statistica 6.0.

Results: in workers of the main production, there was a high spread of inflammatory gynecological diseases (90.9 % versus 57.1 % in the control group), uterine fibroids (9.1 %, versus 7.1 %). At the same time a statistically significant increase in the number of cells with micronuclei was revealed in this group by 2.6 times (p < 0.05), with protrusions by 1.8 times (p < 0.05), an increase in the total proliferation index by 2.3 times (p < 0.05), and the two-nuclear cells made the greatest contribution to these differences. The integral indicator of cytogenetic disorders of women of the 1st group was also significantly higher by 2.0 times (p < 0.05). 

Conclusion: negative influence of factors of poultry house production environment on cell genome stability disturbance was revealed. It has been established that the reproductive health disorder degree has a direct proportional dependence on the damage level of cell genetic apparatus.
The capacity and effectiveness elimination domestic animals allergens: myths and realities
Authors: Pampura A. N. , Migacheva N. B. , Varlamov E. E. , Asmanov A. I.
Published: December 2020

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particular importance is the fact that, unlike other triggers, the elimination of allergens in domestic animals is often associated with internal resistance from patients. Various aspects of this problem are associated with a large number of baseless statement that lead to inadequate prevention and therapy, as well as negatively affecting the social activity of patients and their families. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the allergens of domestic animals, outlines approaches to conducting elimination activities.
Heart rate variability in patients with stable angina pectoris as a risk factor for adverse clinical prognosis: relationship with affective depressive symptoms
Authors: Lobe A. O. , Chebotova A. I. , Ivanchenko D. N. , Dorofeeva N. P. , Pleskachev A. S. , Radchenko E. Yu. , Shlyk S. V.
Published: December 2020

Objective: to investigate the heart rate variability (HRV) parameters of patients with a stable angina pectoris depending of presence depressive disorders; to identify the influence of affective symptoms on the clinical outcome during 12 months of observation.

Material and methods: there are 121 male patients included in research with a stable angina pectoris II – III functional classes, hospitalized for a drug treatment and planned percutaneous coronary intervention (PCI) with stenting. The severity of affective symptoms and HRV are being assessed.

Results: patients with depressive symptoms in the conservative treatment group had low SDNN level; patients with psychoemotional disorders in the surgical treatment group had differences by all HRV parameters (SDNN, SDANN, SDNN, rMSSD pNN50). Clinically unfavorable outcome, including intermediate points such as increase in angina attacks, re-hospitalization, stent’s restenosis, were mostly registered during 12 months of observation in the groups with affective symptoms.

Conclusions: presence of depressive symptoms of patients with stable angina pectoris is accompanied with low HRV parameters, which is connected with worsening of cardiac prognosis.
Cytokine status disorders in children with urticaria
Authors: Maltsev S. V. , Sizyakina L. P. , Lebedenko A. A. , Pampura A. N.
Published: December 2020

Objective: to study the state of cytokine status in children with acute and chronic urticaria.

Materials and methods: 264 children of both sexes aged from 6 to 16 years with different variants of urticaria were examined. Clinical research methods included analysis of anamnestic data, objective examination of the child to determine the severity of urticaria. Immunological research methods included determination of IL-4, IL-6, IL-17, and IFN-γ levels by the method of enzyme immunoassay of blood serum.

Results: cytokine profile analysis revealed hyperproduction of IL-17, γ-IFN with reduced IL-4 synthesis in children with acute urticaria. In children with chronic urticaria, IL-6 hyperproduction is noted against the background of a significant decrease in IL-4 synthesis.

Conclusion: there was a significant relationship between the development of severe acute urticaria and the levels of proinflammatory cytokines IL-6, IL-17, and between the formation of chronic urticaria and the level of IL-6.
Obesity = inflammation. Pathogenesis. How does this threaten men?
Authors: Pavlova Z. Sh. , Golodnikov I. I.
Published: December 2020

Today, adipose tissue has ceased to be perceived only as an energetic substance with its intrinsic properties in the form of thermoregulation and mechanical protection, known since the beginning of the twentieth century. Today, adipose tissue is a fullfledged endocrine organ that is distributed throughout the body — the usefulness of its work directly affects the energy balance, not only through involvement in the metabolism of carbohydrates and fats, but also by the production of many adipokines, a total of more than 600 known today. This review research the causal relationship of subclinical or systemic inflammation of adipose tissue with an excess of energy resources, insulin resistance, leptin, adiponectin, estrogen metabolites and one of the most pro-inflammatory cytokines - interleukin 6. Attention is also paid to the relationship between prostate cancer and obesity, as an ambiguous relationship due to the maximum paying attention to testosterone. Further study of adipose tissue will make it possible to establish specific pathophysiological mechanisms responsible for the development of not only disorders of carbohydrate metabolism, but also a number of other systems in view of the not fully understood systemic action of adipokines and associated inflammatory mediators in obese individuals. Systematic literature search was perform in the Medline, Scopus, Web of Science and elibrary databases.
The effect of renin-angiotensin system blockers on aldosterone levels in patients with chronic heart failure with preserved ejection fraction
Authors: Shevelok A. N.
Published: December 2020

Objective: to evaluate the effect of renin-angiotensin-aldosterone system (RAAS) blockers on aldosterone level in patients with chronic heart failure with preserved ejection fraction (HFpEF).

Materials and methods: the prospective study included 158 patients (58 men and 100 women, mean age 62,3 ± 7,4 years) with HFpEF (> 50 %) and left ventricular diastolic dysfunction. All patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. We evaluated the duration of treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor antagonists (ARA-2) and its average daily dose. The dose of RAAS blockers was assessed during previous 6 months as a percentage of target. Aldosterone plasma concentration was measured and the normal level was 40 – 160 pg/ml.

Results: according to laboratory results 99 patients (62,7 %) had normal aldosterone level (nAld) and 59 patients (37,3 %) had high aldosterone level (hAld). hAld patients had significantly higher duration of RAAS blockers treatment (6 (3; 8) versus 4 (2; 5) years, p < 0,001) and dose (50 (25; 50) % vs 25 (12,5; 50) % of target, р=0,01). Multiple regression analysis showed that after standartization for age, severity of HFpEF, duration of arterial hypertension and comorbidity only long-term (more than 5 years) treatment with RAAS blockers remained the independent risk factor of high aldosterone level (odds ratio 3,16, 95 % confidence interval 2,08 – 8,24).

Conclusions: in HFpEF patients’ plasma aldosterone level is closely associated with RAAS blockers treatment. Long-term (more than 5 years) therapy with ACE inhibitors or ARA-2 is the independent risk factor of secondary hyperaldosteronism.
Hypopituitarism as a result of recurrent craniopharyngioma
Authors: Alimetova Z. R. , Galieva A. I.
Published: December 2020

The article presents a clinical observation of a patient with a complication of endoscopic endonasal removal of craniopharyngioma in the form of hypopituitarism. The peculiarity of this case is a recurrent course of craniopharyngioma, due to which the patient was twice subjected to surgical treatment. This demonstrates the necessity of dynamic monitoring of the patient in the postoperative period.
A rare case of type i glutaric aciduria in an early child
Authors: Lebedenko A. A. , Berezhanskay S. B. , Todorova A. S. , Vostrykh N. N. , Kaushanskay E. Y. , Lukyanova E. A. , Papsheva E. A. , Smykova G. N. , Taranenko L. N.
Published: December 2020

Glutaric aciduria type I (deficiency of glutaryl-COA dehydrogenase, glutaric acidemia type I) is a rare autosomal recessive disease caused by mutations in the gene encoding the enzyme glutaryl – COA - dehydrogenase (GCDH). Cerebral organic aciduria, caused by a deficiency of glutaryl-COA - dehydrogenase, is generally considered a neurological disorder.

The phenotypic spectrum of untreated GA-1 varies from a more common and pronounced form (a disease with infancy) to a low-symptom and less common form. In people with the same genotype, the clinical manifestations and depth of CNS damage can vary widely depending on the age of manifestation of acute encephalopathic crises. It is assumed that with early detection and treatment of “asymptomatic” newborns (in the context of screening for this disease), most people who would have developed manifestations of GA-1 with childhood or late onset will remain asymptomatic.
Some features of the epidemic spread of the new coronavirus infection (COVID-19) in the Rostov Region
Authors: Kovalev E. V. , Slis S. S. , Yanovich E. G. , Pichurina N. L. , Volovikova S. V. , Gaevskaya N. E. , Chemisova O. S. , Karpushchenko G. V. , Litovko A. R. , Noskov A. K.
Published: December 2020

Purpose: to analyze the epidemiological situation for a new coronavirus infection (COVID-19), to identify some regional features of the Rostov region that contribute to spread of infection.

Materials and methods: when assessing the epidemiological situation for a new coronavirus infection in the Rostov region, we used information provided by the Department of the Federal service for supervision of consumer protection and human welfare in the Rostov region. Processing of statistical data was performed by means of generally accepted method.

Results: the spreading of a new coronavirus infection in the Rostov region is uneven in nature. When differentiating the territories of the region we identified groups of municipalities with a very high, medium and low number of patients. The administrative territories division of the Rostov region into the “Rostov urban agglomeration” and cluster of municipalities in which pronounced factors and conditions determining the “pendulum” migration of the population are absent, allow analyzing the specific features of the region and identification of territory with the highest risk of epidemic process intensification of a new coronavirus infection.

Conclusions: the carried out differentiation of municipalities made it possible to identify and analyze some territorial features of the Rostov region, contributing to the spread of a new coronavirus infection. The obtained results could be used for development of measures aimed at reducing intensification of the epidemic process COVID-19 in condition infection.
Rostov Regional Scientific Medical Society of Therapists: History and Present (dedicated to the 90th anniversary)
Authors: Terentyev V. P. , Chesnikova A. I. , Safronenko V. A. , Gasanov M. Z.
Published: December 2020

The article presents historical material revealing the activities of the Rostov Regional Scientific Medical Society of Therapists from its origins to the present day. The chronicle of the scientific therapeutic school is inextricably linked with the history of the development of Don medicine, at the origins of which were outstanding scientists and internists of the South of Russia. In October 2020, the Rostov Regional Scientific Medical Society of Therapists celebrated its 90th anniversary.
«Cholera» summer of doctor Chekhov: on the 160th anniversary of the birth of A.P. Chekhov
Authors: Zharova Yu. S. , Terentyev V. P. , Zharov L. V.
Published: December 2020

The article is devoted to the participation of A.P. Chekhov in the fight against the cholera epidemic of 1892, as well as the first summer he spent at the Melikhovo estate. Today Melikhovo is one of the main Chekhov museums. The materials contain excerpts from the letters of A.P. Chekhov for 1892, as well as the recollections of his friends about this period of the writer's life.
Resistant hypertension: focus on vascular lesions
Authors: Litvinova M. S. , Khaisheva L. A. , Shlyk S. V.
Published: December 2020

The concept of resistant arterial hypertension was introduced many years ago and confirmed in the updated scientific statement of the American Heart Association (AHA) 2018 and the latest recommendations of the European Society of Cardiology (ESC) 2018. Special attention to this group of patients is due to the high risk of adverse outcomes compared with controlled hypertension. In this review, we want to highlight not only the difficulties in identifying, assessing and optimizing therapy for patients with RH, but to a greater extent focus on the main mechanisms of the formation of true resistance, their identification and the search for the optimal path of action.
Psychosocial occupational factors and the risk of health issues in healthcare workers (thematic review)
Authors: Gorblyansky Y. Y. , Kontorovich E. P. , Ponamareva O. P. , Volynskaya E. I. , Krishchenko V. N.
Published: December 2020

Based on the thematic review of the Russian and foreign studies the analysis of the contemporary views on the occupational psychosocial and traditional factors as the determinants of stress in healthcare workers was conducted. The data on the stress-induced health disorders with the psychosomatic pathology, in particular, cardiovascular diseases and occupational burnout syndrome, is provided. The prospects of primary prevention of health disorders based on the use of stress markers to prevent the development of diseases of the circulatory system and occupational burnout in the medical environment are considered
Epidemiological features of epilepsy in the countries of the African continent
Authors: Efremov V. V. , Dolgusheva U. A. , Ndihokubvayo B.
Published: December 2020

This review is devoted to the analysis of the published results of studies conducted in Africa, which studied the clinical and epidemiological features of epilepsy disease in the countries of the African continent. Continental geographic subregions have been identified where the prevalence of epilepsy is particularly high. The relationship between the incidence of epilepsy and the presence of endemic neuroinfections is described. It is concluded that the strengthening of measures aimed at the prevention of infections of the central nervous system can be one of the most effective ways to reduce the morbidity and mortality from epilepsy in Africa
Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation
Authors: Fomin I. V. , Vinogradova N. G.
Published: December 2020

Objectives:to determine the causes of ineffective observation and poor prognosis in patients undergoing ADHF, in real clinical practice and to consider the basics of the formation of specialized medical care for patients with heart failure (HF).

Materials and methods:the study was conducted based on the City Center for the treatment of heart failure (center HF), N. Novgorod. The study consistently included 942 patients with heart failure (HF) at the age of 18 years and older who underwent ADHF and received inpatient treatment in center HF between March 4, 2016 and March 3, 2017. Based on the decisions of patients to continue outpatient monitoring in center HF, two groups of patients were distinguished: patients who continued to be monitored in center HF (group I, n = 510) and patients who continued to be monitored in outpatient clinics at the place of residence (group II, n = 432). The assessment of adherence to treatment, overall mortality, survival and re-admission to a depth of two years of observation was carried out. Statistical data processing was performed using Statistica 7.0 for Windows and the software package R.

Results:all patients in the study groups had high comorbidity. Group 2 patients turned out to be statistically significantly older, more often had III functional class (FC) HF, lower the baseline test score of 6-minute walk, and higher the baseline clinical assessment scale. After 2 years of follow-up in group II, there was a significant deterioration in adherence to basic therapy of HF compared with group I. According to the results of multifactorial proportional risk Cox models, it was shown that observation of patients in the group 1 is an independent factor increasing the risk of overall mortality by 2.8 times by the end of the second year of observation. Survival after two years of follow-up was: in group I — 89.8 %, and in group II — 70.1 % of patients (OR = 0.3, 95 % CI 0.2 – 0.4; p1/2 < 0.001). After two years of follow-up, the proportion of re-hospitalized patients in group II was greater (78.0 % of patients) versus group 1 (50.6 % of patients, OR = 3.5, 95 % CI 2.6 – 4.6; p1/2 <0.001). The independent risk of re-hospitalization according to multinominal logit regression was 3.4 times higher in group II and 2.4 times for III – IV FC HF.Conclusions:the inclusion of patients with HF in the system of specialized medical care improves adherence to treatment, prognosis of life and reduces the risk of repeated hospitalizations. Patients of an older age and with an initially greater clinical severity refused specialized supervision in center HF.
High-frequency electrocardiography as an additional method for diagnosing myocardial ischemia in patients with СHD of various ages
Authors: Kolosova K. S. , Grigoreva N. Y. , Kosuga Y. I.
Published: December 2020

Objectives: to study the relationship between high-frequency electrocardiography (ECG) and selective coronary angiography data.

Materials and methods: the study was conducted on 125 patients with a diagnosis of coronary heart disease (CHD), who were sent for selective coronary angiography. Patients were divided into groups: I group - young age, II group 2- middle age, III group — senile and elderly age. All patients were recorded high-frequency ECG in 12 common leads using a computer electrocardiograph, the data obtained were analyzed by special software.

Results: according to the selective coronary angiography data, hemodynamically insignificant lesions of the coronary arteries were present in 34 (27.2%) people, and in 49 (39.2 %) people - hemodynamically significant lesions of the coronary arteries. Hemodynamically significant coronary artery stenoses are more often detected in elderly and senile patients. Stenotic lesions of the coronary arteries were more common in group 3 as opposed to group 2 (p = 0.002). High-frequency ECG analysis revealed a significant difference in the amount of RAZ between elderly and senile patients compared to young and middle-aged patients (p 1–2 = 0.373; p 1–3 = 0.006; p 2–3 = 0.008). The RAZ parameter of a high-frequency ECG in 12 common leads has a relationship with the age of patients, the number of coronary arteries with stenotic lesions, and the number of hemodynamically significant stenoses.

Conclusion: the results of the study show that high-frequency ECG can be further developed as an additional method for diagnosing myocardial ischemia.
Influence of dosed walking on the course of arterial hypertension in patients with chronic obstructive pulmonary disease
Authors: Kryuchkova O. N. , Bubnova M. A. , Bubnov S. E.
Published: December 2020

Objective: to study the influence of dosed walking on the course of hypertension and quality of life in patients with chronic obstructive pulmonary disease.

Materials and methods: the study included 85 patients with a combination of arterial hypertension and chronic obstructive pulmonary disease, with an average age of 60.9 ± 1.06 years. Group A patients were prescribed dosed walking in addition to medication, while group B patients received only antihypertensive medications, statins, and basic treatment for chronic obstructive pulmonary disease. The effectiveness of treatment was determined after 6 weeks based on a standard examination, daily monitoring of blood pressure and ECG, and quality of life indicators. Long-term results were evaluated after 6 months.

Results: patients whose treatment plan included physical training, in contrast to patients receiving only medication, noted a decrease in complaints of headache (p=0.034), dizziness (p=0.041), tachycardia (p=0.029), general weakness (p=0.003), head noise and tinnitus (p=0.018), sleep disturbance (p=0.010) and shortness of breath (p=0.004). They had normalization of all indicators of quality of life according to the SF-36 questionnaire: scales physical functioning (p<0.001), role functioning due to physical condition (p<0.001), pain intensity (p<0.001), general health (p=0.002), vital activity (p=0.001), social functioning (p=0.013), role functioning due to emotional state (p<0.001), mental health (p=0.008), physical component of health in general (p<0.001) and the mental health component (p=0.002). Improvement of well-being was accompanied by normalization of lipidogram indicators, daily heart rate and blood pressure: reduction of average daily indicators of blood pressure (p<0.001), pressure load index (p<0.001), blood pressure variability (p<0.05), pulse pressure (p<0.001) and the rate of morning rise in blood pressure (p<0.001).

Conclusion: addition to standard medical therapy of dosed walking has a positive effect on the course of arterial hypertension in patients with chronic obstructive pulmonary disease.
Atherosclerotic and non-atherosclerotic changes in brachiocephalic arteries as predictors of cerebral and coronary events (literature review)
Authors: Shavkuta G. V. , Yakovleva N. V. , Shnyukova T. V.
Published: December 2020

The review presents the anatomical and physiological features of the system of brachiocephalic arteries (BCA) ofatherosclerotic and non-atherosclerotic nature. The prevalence of various types of BCA anomalies and the possible impact on the development of cerebral and coronary events are estimated. The modern diagnostic methods and approaches to the treatment of the problem under study are described. The need to prevent ischemia of the brain and heart in individuals with asymptomatic BCA diseases is discussed, as well as an understanding of the anatomy of the abnormal structure and variability of the BCA course, which is of paramount importance during surgical interventions.
Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?
Authors: Golovko L. S. , Safronenko A. V. , Gantsgorn E. V.
Published: December 2020

Objective: to assess the effect of the baseline hemostasiogram and comorbid background on the development of thrombosis and bleeding in the early postoperative period in patients receiving combined hemostatic and anticoagulant pharmacoprophylaxis after arthroplasty of the knee and hip joints.

Materials and Methods: A retrospective analysis of 253 case histories of patients with hip or knee arthroplasty performed. The patients received combined pharmacoprophylaxis with hemostatics and anticoagulants. Two groups were identified according to the time interval (TI) between the appointment of hemostatic and anticoagulant drugs. The first group (57,31%) - n=145 (112 women and 33 men), TI≤17 h, the second group (42,68%) — n=108 (78 women and 30 men), TI 18-24 h. In patients, we analyzed the effect of comorbidity and baseline values of the coagulogram on the risk of thrombosis or bleeding in the early postoperative period.

Results: Thrombohemorrhagic complications were registered in 27 (10,67%) patients, of which 22 (81,48%) were in the first group. Thrombosis in the first group developed in the regimens with tranexamic acid (p=0,038), and their frequency was 2,2 times higher than in the second group (p=0,023). In the first group, the risk of thrombosis in women was increased by the initially low level of international normalized ratio (INR) (relative risk (RR)=13,333, p=0,00032) and activated partial thromboplastin time (APTT) (RR=5,8, p=0,037). The risk of bleeding in the first group among men and women increased with an increased preoperative APTT level (RR=18, p=0,0012 and RR=28, p=0,00022, respectively), and separately for women - with a reduced content of fibrinogen (RR=23,25, p=0,00065) and platelets (RR=10,2, p=0,038). The development of thrombosis as influenced by: degree 2 obesity (RR=8,75, p=0,037), type 2 diabetes mellitus (RR=21, p=0,00001), myocardial infarction (RR=16,875, p=0,00002), venous pathology (RR=8,1, p=0,045), moderate decline in renal function (RR=6,231, p=0,0465) and age over 75 years (RR=6,8, p=0,029). Age over 75 years increased the risk of bleeding 12-fold (RR=12, p=0,015).

Conclusions: to minimize the risk of thrombosis and bleeding after endoprosthetics of large joints of the lower extremities, especially in patients with the above risk factors, in particular, when using tranexamic acid as a hemostatic, it is recommended to observe the TI between hemostatic and anticoagulant pharmacoprophylaxis of at least 18 hours.
Experience of successful use of rituximab in treatment-resistant membranous nephropathy
Authors: Batiushin M. M. , Bronovitskaya N. A. , Sinelnik E. A. , Bondarenko N. B. , Razina A. V. , Bogomolova K. R.
Published: December 2020

The article presents as an introduction a short review on the problem of membranous nephropathy. A patient suffering from membranous nephropathy that is resistant to traditional therapy with glucocorticoids and cyclophosphane, as well as cyclosporine, was selected as a clinical case. The use of rituximab at a dose of 375 mg/m2 twice with a difference of one week led to the development of remission in the patient, normalization of clinical and laboratory parameters. No side effects of rituximab were detected.
Global Collaborative Social Network (Share4Rare) to Promote Citizen Science in Rare Disease Research: Platform Development Study
Authors: Radu Roxana , Hernández-Ortega Sara , Borrega Oriol , Palmeri Avril , Athanasiou Dimitrios , Brooke Nicholas , Chapí Inma , Le Corvec Anaïs , Guglieri Michela , Perera-Lluna Alexandre , Garrido-Aguirre Jon , Ryll Bettina , Nafria Escalera Begonya
Published: December 2020

Background

Rare disease communities are spread around the globe and segmented by their condition. Little research has been performed on the majority of rare diseases. Most patients who are affected by a rare disease have no research on their condition because of a lack of knowledge due to absence of common groups in the research community.

Objective

We aimed to develop a safe and secure community of rare disease patients, without geographic or language barriers, to promote research.

Methods

Cocreation design methodology was applied to build Share4Rare, with consultation and input through workshops from a variety of stakeholders (patients, caregivers, clinicians, and researchers).

Results

The workshops allowed us to develop a layered version of the platform based on educating patients and caregivers with publicly accessible information, a secure community for the patients and caregivers, and a research section with the purpose of collecting patient information for analysis, which was the core and final value of the platform.

Conclusions

Rare disease research requires global collaboration in which patients and caregivers have key roles. Collective intelligence methods implemented in digital platforms reduce geographic and language boundaries and involve patients in a unique and universal project. Their contributions are essential to increase the amount of scientific knowledge that experts have on rare diseases. Share4Rare has been designed as a global platform to facilitate the donation of clinical information to foster research that matters to patients with rare conditions. The codesign methods with patients have been essential to create a patient-centric design.
Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study
Authors: Hentschel Austen , Hsiao Chu J , Chen Lynn Y , Wright Lauren , Shaw Jennifer , Du Xinsong , Flood-Grady Elizabeth , Harle Christopher A , Reeder Callie F , Francois Magda , Louis-Jacques Adetola , Shenkman Elizabeth , Krieger Janice L , Lemas Dominick J
Published: December 2020

Background

Electronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research.

Objective

The aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants’ EHR data for longitudinal research to identify factors affecting their willingness to participate in research.

Methods

We conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison.

Results

Participants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants’ concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research.

Conclusions

This exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns.
Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study
Authors: Kunkle Sarah , Yip Manny , Hunt Justin , Ξ Watson , Udall Dana , Arean Patricia , Nierenberg Andrew , Naslund John A
Published: December 2020

Background

Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities.

Objective

This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety.

Methods

We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement.

Results

Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app-only”). Higher GAD-7 intake scores were also associated with decreased odds of improvement.

Conclusions

This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members.
Public Perspectives on Anti-Diabetic Drugs: Exploratory Analysis of Twitter Posts
Authors: Golder Su , Bach Millie , O'Connor Karen , Gross Robert , Hennessy Sean , Gonzalez Hernandez Graciela
Published: December 2020

Background

Diabetes mellitus is a major global public health issue where self-management is critical to reducing disease burden. Social media has been a powerful tool to understand public perceptions. Public perception of the drugs used for the treatment of diabetes may be useful for orienting interventions to increase adherence.

Objective

The aim of this study was to explore the public perceptions of anti-diabetic drugs through the analysis of health-related tweets mentioning such medications.

Methods

This study uses an infoveillance social listening approach to monitor public discourse using Twitter data. We coded 4000 tweets from January 1, 2019 to October 1, 2019 containing key terms related to anti-diabetic drugs by using qualitative content analysis. Tweets were coded for whether they were truly about an anti-diabetic drug and whether they were health-related. Health-related tweets were further coded based on who was tweeting, which anti-diabetic drug was being tweeted about, and the content discussed in the tweet. The main outcome of the analysis was the themes identified by analyzing the content of health-related tweets on anti-diabetic drugs.

Results

We identified 1664 health-related tweets on 33 anti-diabetic drugs. A quarter (415/1664) of the tweets were confirmed to have been from people with diabetes, 17.9% (298/1664) from people posting about someone else, and 2.7% (45/1664) from health care professionals. However, the role of the tweeter was unidentifiable in two-thirds of the tweets. We identified 13 themes, with the health consequences of the cost of anti-diabetic drugs being the most extensively discussed, followed by the efficacy and availability. We also identified issues that patients may conceal from health care professionals, such as purchasing medications from unofficial sources.

Conclusions

This study uses an infoveillance approach using Twitter data to explore public perceptions related to anti-diabetic drugs. This analysis gives an insight into the real-life issues that an individual faces when taking anti-diabetic drugs, and such findings may be incorporated into health policies to improve compliance and efficacy. This study suggests that there is a fear of not having access to anti-diabetic drugs due to cost or physical availability and highlights the impact of the sacrifices made to access anti-diabetic drugs. Along with screening for diabetes-related health issues, health care professionals should also ask their patients about any non–health-related concerns regarding their anti-diabetic drugs. The positive tweets about dietary changes indicate that people with type 2 diabetes may be more open to self-management than what the health care professionals believe.
Machine Learning–Based Early Warning Systems for Clinical Deterioration: Systematic Scoping Review
Authors: Muralitharan Sankavi , Nelson Walter , Di Shuang , McGillion Michael , Devereaux PJ , Barr Neil Grant , Petch Jeremy
Published: December 2020

Background

Timely identification of patients at a high risk of clinical deterioration is key to prioritizing care, allocating resources effectively, and preventing adverse outcomes. Vital signs–based, aggregate-weighted early warning systems are commonly used to predict the risk of outcomes related to cardiorespiratory instability and sepsis, which are strong predictors of poor outcomes and mortality. Machine learning models, which can incorporate trends and capture relationships among parameters that aggregate-weighted models cannot, have recently been showing promising results.

Objective

This study aimed to identify, summarize, and evaluate the available research, current state of utility, and challenges with machine learning–based early warning systems using vital signs to predict the risk of physiological deterioration in acutely ill patients, across acute and ambulatory care settings.

Methods

PubMed, CINAHL, Cochrane Library, Web of Science, Embase, and Google Scholar were searched for peer-reviewed, original studies with keywords related to “vital signs,” “clinical deterioration,” and “machine learning.” Included studies used patient vital signs along with demographics and described a machine learning model for predicting an outcome in acute and ambulatory care settings. Data were extracted following PRISMA, TRIPOD, and Cochrane Collaboration guidelines.

Results

We identified 24 peer-reviewed studies from 417 articles for inclusion; 23 studies were retrospective, while 1 was prospective in nature. Care settings included general wards, intensive care units, emergency departments, step-down units, medical assessment units, postanesthetic wards, and home care. Machine learning models including logistic regression, tree-based methods, kernel-based methods, and neural networks were most commonly used to predict the risk of deterioration. The area under the curve for models ranged from 0.57 to 0.97.

Conclusions

In studies that compared performance, reported results suggest that machine learning–based early warning systems can achieve greater accuracy than aggregate-weighted early warning systems but several areas for further research were identified. While these models have the potential to provide clinical decision support, there is a need for standardized outcome measures to allow for rigorous evaluation of performance across models. Further research needs to address the interpretability of model outputs by clinicians, clinical efficacy of these systems through prospective study design, and their potential impact in different clinical settings.