bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexible Access Control Mechanism for Cloud stored EHR using Consortium Blockchain
Authors: C Eben Exceline , Nagarajan Sivakumar
Published: April 2021

The persevering pursuit of security has proved historically limiting the implementation of significant design improvements for Electronic Health Records (EHR). Such a vital requirement for these kinds of technical development is revamped now. This is because the patients are motivated by personalization and data science to participate in the health information sharing. The implementation of cloud computing has already shown substantial benefits for both clinical organizations and patients in managing electronic health records. The prime security issue of cloud-based electronic health records is that the patient is physically unable to own a medical record whereas a clinical organization can maintain one for them. The latter may collude with centralized cloud servers. So, there is a vulnerability of such records being tampered with in order to hide the medical malpractices. So, maintaining data integrity and data privacy becomes a significant challenge when deploying cloud computing. Therefore, in this paper, a consortium blockchain-based cloud-stored electronic health record is proposed which provides data integrity, data privacy, storage scalability, and fine-grained access control. Each process in outsourcing electronic health records to the cloud is incorporated as a transaction in a consortium ethereum blockchain through smart contracts. Through smart contracts, an attribute-based contract key is generated for the users that can decrypt the encrypted data stored in the cloud. The attribute-based contract key allows only users who are authorized to access the information ensuring data privacy and fine-grained access control. Moreover, the proposed scheme is proved to provide tamper-proof although the medical records are controlled by a group of clinical organizations.
In-vitro study of antiproliferative and anthelminthic property of medicinal plants of Kokrajhar, Assam
Authors: Swargiary Ananta , Roy Mritunjoy Kumar , Verma Akalesh Kumar
Published: April 2021

People living in far-flung areas of the world, especially ethnic tribal people practice traditional medicine as the first choice of disease treatment. The present study investigates the antioxidant, cytotoxicity, and anthelmintic activity of four medicinal plants traditionally used by tribal communities of Bodoland Region of Assam. Total phenolic and flavonoid content was estimated following spectrophotometry method. Antioxidant activity was measured by total antioxidant assay, FRAP, DPPH, ABTS, and TBARS assay. Antiproliferative and apoptosis-inducing activity of plants were carried out in DL cells. Cells were treated for 24 h with different doses of plant extracts. Furthermore, anthelmintic study was carried out by treating the helminth parasite at different doses of plant extracts. Phytochemical and antioxidant study showed rich TPC, TFC, and free radical scavenging activity in H. japonicum and H. sibthorpioides. Both the antiproliferative and anthelmintic activity showed a dose-dependent efficacy in all the plants. H. japonicum showed the strongest anthelmintic activity with LC50 212.78 µg/mL followed by H. sibthorpioides (5.36 mg/mL), C. halicacabum (13.40 mg/mL), and A. scholaris (18.40 mg/mL). On the other hand, H. sibthorpioides showed stronger antiproliferative and apoptosis-inducing activity compared to other plants. The study observed a positive correlation between the antioxidant property and antiproliferative and anthelmintic activities of the plants. We, therefore, conclude that the secondary metabolites along with antioxidant molecules may have combined effects contributing the antiproliferative and anthelmintic activity of the plants.
Drug Repurposing for Alzheimer’s Disease based on Protein-Protein Interaction Network
Authors: Zakeri Negar Sadat Soleimani , Pashazadeh Saeid , MotieGhader Habib
Published: April 2021

Background: Alzheimer's disease (AD) is known as a critical neurodegenerative disorder. It worsens as symptoms concerning dementia grow severe over the years. Due to the globalization of Alzheimer’s disease, its prevention and treatment is vital. This study proposes a method to extract substantial gene complexes and accomplish an enrichment analysis to introduce the most significant biological procedures. The next step is extracting the drugs related to AD and introduce some new drugs which may be useful for this disease. Results: To this end, protein-protein interactions (PPI) network was utilized to extract five meaningful gene complexes functionally interconnected. The next step was to construct a five bipartite network representing the genes of each group and their target miRNAs. Finally, a complete network including all the genes related to each gene complex group and genes’ target drug was illustrated. medical studies and publications were analyzed thoroughly to introduce AD-related drugs. Conclusions: This analysis proves the accuracy of the proposed method in this study. Then, new drugs were introduced that can be experimentally examined as future work. RALOXIFENE, GENTIAN VIOLET are two new drugs, which have not been introduced as AD-related drugs in previous scientific and medical studies, recommended by the method of this study. These two drugs.
Extended JAZ degron sequence for plant hormone binding in jasmonate co-receptor of tomato SlCOI1-SlJAZ
Authors: Ueda Minoru , Saito Rina , Hayashi Kengo , Nomoto Haruna , Nakayama Misuzu , Takaoka Yousuke , Saito Hiroaki , Muto Toshiya , Yamagami Souhei
Published: April 2021

(+)-7-iso-jasmonoyl-L-isoleucine (JA-Ile) is a lipid-derived phytohormone implicated in plant development, reproduction, and defense in response to pathogens and herbivorous insects. All these effects are instigated by the perception of JA-Ile by the COI1-JAZ co-receptor in the plant body, which in Arabidopsis thaliana, is profoundly influenced by the short JAZ degron sequence (V/L)P(Q/I)AR(R/K) of the JAZ protein. Here, we report that SlJAZ-SlCOI1, the COI1-JAZ co-receptor found in the tomato plant, relies on the extended JAZ degron sequence (V/L)P(Q/I)AR(R/K)XSLX instead of the canonical JAZ degron. This finding illuminates our understanding of the mechanism of JA-Ile perception in this plant, and will inform the genetic modification of the SlCOI1-SlJAZ co-receptor to improve JA-Ile perception and the development of the synthetic agonists / antagonists.
Spinal metastasis of bronchopulmonary cancer: Interest of a Spine surgery and prognostic scales value
Authors: Faye Mohameth , Barry Louncény Fatoumata , Kaya Jean Marc , Sy El Hadji Cheikh Ndiaye , Diallo Moussa , Roche Pierre Hugues
Published: April 2021

Backgroundlung cancer is the first mortality cause by cancer around the world. Bones metastasis occurrence is a common eventuality in case of lung cancer (40% at the diagnosis). In order to evaluate the indications and measure the effectiveness of surgery in the management of PBC spinal metastases, we report a series of 52 patients.MethodsDuring 6 years, from January 2009 to December 2014 at the Neurosurgery Unit of Marseille North Hospital (France), we studied retrospectively 52 patients records, who underwent a surgery for spinal metastasis of lung cancer. The study was only about patients which metastases were surgically treated. We used Stata software for the computation, and concerning the linear regression, all values under 0.1 were considered significant.Resultsthe average age was 63.6 years (39–80 years) with a sex ratio of 3. Non-small cell lung cancer was the most common, ie 36 cases (69.2%). Rachialgia associated to vertebral fracture with medullar compression was the most common clinical presentation (31 cases or 59.6%). SINS score (spinal instability neoplastic score) was equal or above 7 in 41 cases (78.9%). The general condition (Karnofski) was medium in 35 cases (67.4%). Survival prediction beyond 12 months was null according to Tokuhashi Index. The surgical indication was essentially palliative. Evolution was characterised by painful symptomatology regression in 44 cases (84.6%), stabilization of initially unstable lesion and motor deficit improvement in 48.3 % of cases. The average survival time following the surgery was 16 months.ConclusionOur results show the interest of surgery for pain relief and spinal stabilization in patient with spinal metastasis of lung cancer, and the relativity of predictive survival score.
Characterization of metabolome-wide biomarkers associated with kidney function in the Chinese population
Authors: Peng Hongquan , Liu Xun , Ieong Chi wa Ao , Tao Tao , Tsai Tsung yang , Leong Ngai kam , Cheang hao I , Liu Zhi , Liu Peijia
Published: April 2021

Background Chronic kidney disease (CKD) is a global public health problem. Identifying sensitive filtration biomarkers is a key diagnostic value contributing to an understanding of CKD at the molecular level. A metabolomics study indicated a snapshot of the biochemical activity of the human body at a particular time in the progression of CKD. This metabolome-wide biomarker study verified whether plasma or serum metabolite profiles are significantly different in CKD at various stages and characterized potential markers to assess kidney function in the Chinese population.Methods: An analysis of plasma and serum metabolites using ultrahigh-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was performed on 198 participants (53 serum samples and 145 plasma samples) based on their measured GFR (by iohexol plasma clearance). Participants started recruiting in late 2019, and untargeted metabolomics assays (N ¼ 214) were conducted at the Calibra-Metabolon Joint Laboratory (Hangzhou, China) using Metabolon's HD4 Discovery untargeted metabolomics platform in early 2021.Results A large number of metabolomics related to the mGFR were selected as the top 30 metabolites by the random forest method, and we found 15 amino acids, 8 nucleotides, and 2 carbohydrates strongly related to kidney function in the combined group (serum and plasma). Thirteen amino acids, 9 nucleotides, and 3 carbohydrates were identified in the plasma group, while 13 amino acids, 7 nucleotides, and 3 carbohydrates were found in the serum group. We observed that 10 of the top 15 ranked metabolites were concordant between the plasma and serum groups. Major differences in metabolite profiles with increasing stage of CKD were observed, including altered tryptophan metabolism and pyrimidine metabolism.Conclusions Global metabolite profiling of plasma/serum uncovered potential biomarkers of stages of CKD. In addition, these novel biomarkers provide insight into possible pathophysiologic processes that may contribute to the progression of CKD and a higher risk of comorbidities and mortality.
Brain and Lung Cross-Protection against Ancestral or Emerging SARS-CoV-2 by Intranasal Lentiviral Vaccination in a New hACE2 Transgenic Murine Model
Authors: Ku Min-Wen , Authié Pierre , Bourgine Maryline , Anna François , Noirat Amandine , Moncoq Fanny , Vesin Benjamin , Nevo Fabien , Lopez Jodie , Souque Philippe , Blanc Catherine , Fert Ingrid , Chardenoux Sébastien , Lafosse llta , Cussigh Delphine , Hardy David , Nemirov Kirill , Guinet Françoise Guinet , Vives Francina Langa , Majlessi Laleh , Charneau Pierre
Published: April 2021

COVID-19 vaccines already in use or in clinical development may have safety concerns, limited immunogenicity in high-risk groups or reduced efficacy against emerging SARS-CoV-2 variants. In addition, although the neurotropism of SARS-CoV-2 is well established, the vaccine strategies currently developed have not taken into account the protection of the central nervous system. Here, we generated a transgenic mouse strain expressing the human Angiotensin Converting Enzyme 2, with unprecedented brain as well as lung permissibility to SARS-CoV-2 replication. Using this stringent transgenic model, we demonstrated that a non-integrative lentiviral vector, encoding for the spike glycoprotein of the ancestral Wuhan SARS-CoV-2, used in intramuscular prime and intranasal boost elicits sterilizing protection of lung and brain against both the Wuhan and the most genetically distant Manaus P.1 SARS-CoV-2 variants. Beyond the induction of strong neutralizing antibodies, the mechanism underlying this broad protection spectrum involves a robust protective spike-specific CD8+ T-cell immunity, unaffected by the recent mutations accumulated in the emerging SARS-CoV-2 variants.
PAYLI MÜLKİYET VE MİRAS ORTAKLIĞININ SONA ERMESİNDE TAHKİMİN VEYA ARABULUCULUĞUN CAİZ OLUP OLMADIĞI
Authors: TOPAL Önder
Published: April 2021

Paylı mülkiyet ve miras ortaklığı çeşitli şekillerde sona ermektedir; ancak esas olan söz konusu birlikte mülkiyet çeşitlerinin taraf iradelerine dayalı olarak sona ermesidir. Paylı mülkiyet ve miras ortaklığının taraf iradelerine dayalı olarak sona erme mümkün olmazsa, taraflar anılan ortaklıkları dava açarak sona erdirebilirler. Bir başka ifadeyle, paydaş veya mirasçılar kendi aralarında anlaşarak paylı mülkiyeti ve miras ortaklığın sona erdiremez ise, paydaş veya mirasçılardan her biri ortaklığın giderilmesi davası açarak, paylı mülkiyetin ve miras ortaklığının sona erdirilmesini talep edebilir. Paylı mülkiyet ve miras ortaklığının tarafların anlaşması ile sona ermesinin mümkün olması durumunda, arabuluculuğun ve tahkimin bu hususların sona erdirilmesinde işlerlik kazanıp kazanmayacağının irdelenmesi gerekmektedir. Bu çerçevede paylı mülkiyetin ve miras ortaklığının sona ermesinde tahkim ve arabulculuğun işlerlik kazanabileceği söylenebilir. Zira arabuluculuk ve tahkimin işlerlik kazanmasında tümüyle uyuşmazlığın taraflarının iradeleri egemendir. Dolayısıyla taraf iradelerine dayalı olarak sona erdirilebilen bu tarz birlikte mülkiyet çeşitlerinin arabuluculuk ve tahkimle de sona erdirilmesinde bir engelin bulunmaması gerekir. Çalışmamızda esas olarak tahkim ve arabuluculuğun caiz olup olmadığı incelenecektir.
Violations of the laws or customs of war under military law: comparative analysis of international and internal legislation of Ukraine
Authors: Cherviakova Oksana , Mekheda Vladyslav
Published: April 2021

This paper addresses the question of the criminalization of war crimes, which are compared at the international and internal legislative level under military law. Considering current threats to the international legal order and security system, justice and defence sector actors, military lawyers and research fellows in military law are faced with the problems of the concept of responsibility for the most serious crimes in the world. The adoption of the Rome Statute of the International Criminal Court in 1998 raises the question of the internal legislation validity. The states Parties to International Criminal Court should revise the established conceptual approaches of responsibility for war crimes. The comparative analysis was made of the core and international military law.
Genetic programming for hydrological applications: to model or to forecast that is the question
Authors: Herath Herath Mudiyanselage Viraj Vidura , Chadalawada Jayashree , Babovic Vladan
Published: April 2021

Genetic programming (GP) is a widely used machine learning (ML) algorithm that has been applied in water resources science and engineering since its conception in the early 1990s. However, similar to other ML applications, the GP algorithm is often used as a data fitting tool rather than as a model building instrument. We find this a gross underutilization of the GP capabilities. The most unique and distinct feature of GP that makes it distinctly different from the rest of ML techniques is its capability to produce explicit mathematical relationships between input and output variables. In the context of theory-guided data science (TGDS) which recently emerged as a new paradigm in ML with the main goal of blending the existing body of knowledge with ML techniques to induce physically sound models. Hence, TGDS has evolved into a popular data science paradigm, especially in scientific disciplines including water resources. Following these ideas, in our prior work, we developed two hydrologically informed rainfall-runoff model induction toolkits for lumped modelling and distributed modelling based on GP. In the current work, the two toolkits are applied using a different hydrological model building library. Here, the model building blocks are derived from the Sugawara TANK model template which represents the elements of hydrological knowledge. Results are compared against the traditional GP approach and suggest that GP as a rainfall-runoff model induction toolkit preserves the prediction power of the traditional GP short-term forecasting approach while benefiting to better understand the catchment runoff dynamics through the readily interpretable induced models.
Detecting the dominant contributions of runoff variance across the source region of the Yellow River using a new decomposition framework
Authors: Xie Jingkai , Xu Yue-Ping , Guo Yuxue , Wang Yitong
Published: April 2021

Quantifying the contributions of climatic variables to runoff variance is still a great challenge to water resource management. This study adopted an extended Budyko framework to investigate the effects of terrestrial water storage changes (ΔS) on runoff variance across the source region of the Yellow River, China, during the period of 2003–2014. A new decomposition framework based on the extended Budyko framework was proposed to effectively quantify the contributions of different climatic variables including precipitation, PET and ΔS to runoff variance. The results demonstrated that the extended Budyko framework showed a better performance in presenting the water and energy balance than the original Budyko framework, especially at fine time scales. Meanwhile, the variance in runoff estimated by the new decomposition framework was close to that of runoff observations, indicating that this framework can effectively capture the variation in runoff during 2003–2014. It was also found that precipitation was the most important factor that contributed to runoff changes, while PET made a slightly smaller contribution compared to precipitation. Notably, the results also emphasized the important effects of ΔS on runoff variance at fine time scales, which was useful to better understand the interactions between atmospheric and hydrological processes for regions.
Activation of peroxymonosulfate by biochar and biochar-based materials for degrading refractory organics in water: a review
Authors: Luo Jiacheng , Gao Yanjiao , Song Tiehong , Chen Yu
Published: April 2021

Water pollution caused by refractory organics has attracted widespread concern in recent years. At this time peroxymonofulfate (PMS) has been widely used to generate sulfate radicals with high reactivity and potential. The direct reaction rate between PMS and organics is very low. However, the activated PMS has a strong oxidizing ability on organics due to its conversion into sulfate radicals. Recently, the free radicals generated by oxidant PMS and catalyst biochar have proven to be an effective species in dealing with refractory organics. In order to enable researchers to better understand the current research status of PMS/biochar, and to promote the development and application of PMS/biochar system, we have written this review. This review in detail described the mechanism of PMS activated by biochar materials, and summarized the influencing factors of refractory organics degradation in the PMS/biochar system. In addition, the active sites of PMS/biochar, the degradation mechanism of refractory organics, and the reusability of biochar catalysts were also discussed. Finally, the concluding remarks and perspectives were made for future research on the PMS/biochar system in the degradation of refractory organics.
Emerging Trends in Cross-Border Mergers and Their Tax Implications in India: A Critical Appraisal
Authors: Tiwari A. , Shukla G.
Published: April 2021

The Indian economy has seen steady and sustainable growth over the past decade, even though other countries have been cash-strapped and suffering from stagnation. Most of this development is due to the inflow of foreign direct investment (FDI) into India through cross-border mergers and acquisitions (M&A) and the unparalleled rise in the size and number of cross-border M&A in India with a favourable market climate for such trade. As a business strategy, cross-border M&As in India are rife with many legal complexities and issues. This paper documents the steady growth of cross-border M&A activity in India over the years and presents a comprehensive depiction of cross-border M&As, what the applicable laws are, what the legal issues and complexities involved are, and finally how they can be offset. The paper highlights the tax implications and issues involved in a cross-border M&A and how far the Income Tax Act, 1961 is attuned with the corporate laws in force to promote cross-border M&As in India. The paper concludes with a broader observation that cross-border M&As bring massive economic benefits and global stature to a growing economic superpower like India. For this reason, the business and legal environment should be made more conducive to cross-border M&A activity.
International Seminar “Labour Relations in the BRICS Countries in the Conditions of Precarization of Employment”
Authors: Anbrekht T.
Published: April 2021

.
Física de vuelos espaciales
Authors:   Universidad de Bogotá Jorge Tadeo Lozano, Isaza Delgado José Fernando , Campos Romero Diógenes ,   Universidad de Bogotá Jorge Tadeo Lozano, Colombia
Published: April 2021

La era espacial inició a mediados del siglo XX, cuando la ahora extinta Unión Soviética lanzó el Sputnik 1 el 4 de octubre de 1957, el cual se convirtió en el primer satélite artiﬁcial de la historia. Los Estados Unidos, por su parte, lanzaron con éxito el Explorer 1 el 31 de enero de 1958. Estos dos eventos constituyen el inicio de la carrera espacial entre las dos superpotencias de la Guerra Fría, que concluyó con la caída del muro de Berlín en 1989. La misión Apolo-Soyuz, lanzada el 15 de julio de 1975, constituye la primera misión conjunta entre los antiguos rivales (EE.UU. - URSS) para dar paso a la participación de varios países en la conquista del espacio. Este libro introduce al lector en ideas que están en la base de los avances cientíﬁcos y tecnológicos y que se desarrollaron en las décadas pasadas, desde 1957, sin desconocer el conocimiento ya distante de las leyes de Kepler, la fuerza de gravitación de Newton o las ideas de los pioneros de la conquista del espacio. Hoy en día, la humanidad dispone de sistemas GPS, sondas que han visitado varios planetas, asteroides y cometas; algunas han regresado a la Tierra con muestras de material espacial, otros se encuentran viajando por el espacio interestelar.
Género, Seguridad y Fuerza Pública
Authors: Cabrera Cabrera Leidy Johana , Fernández Osorio Andrés Eduardo , Corcione Nieto Maria Antonieta
Published: April 2021

Este libro constituye una apuesta formativa en la que se reafirma el papel de la mujer en el escenario militar, desde el fortalecimiento de una cultura de equidad en las Fuerzas Militares. En sus líneas, se retoma el espíritu de liderazgo en el cumplimiento de la misión constitucional que han asumido hombres y mujeres con la más alta calidad. Además, se presentan los avances investigativos que se han adelantado desde el Observatorio Militar de Género de la Escuela Militar de Cadetes. En síntesis, se trata de una herramienta de estudio para quienes estén interesados en comprender los conceptos, metodologías y retos que se desarrollan en el marco de la transversalización del enfoque de género en las Fuerzas Militares. Al tratarse de un trabajo innovador, se proyecta su uso como insumo para la reflexión y el análisis, así como instrumento por medio del cual los lectores podrán desarrollar ejercicios prácticos, consultar referencias actualizadas y analizar —desde el contexto normativo y reflexivo, establecido para instituciones militares— temáticas relacionadas con género, seguridad y fuerza pública, comprendidas en conjunto como un campo de estudio.
THE CONCEPT OF HUMAN DIGNITY AS A BASIS FOR COOPERATION OF THE CATHOLIC CHURCH WITH STATE AND PUBLIC ORGANIZATIONS
Authors: Laputko Anna
Published: April 2021

The article investigates the understanding of the concept of human dignity in the Catholic social doctrine and secular legal declarations aimed at the protection of personality rights. It is shown that notwithstanding the essential basic prerequisites, the concept of human dignity is foundational for the solution of new social problems. Consequently, human dignity is a basis for a fruitful dialog between the Catholic Church and world in order to create the society of peace, respect and well-being. It is proved that the turn to the systematic use of human right language and the strategies of the protection of human dignity occurred during the Second Vatican Council. This process is a part of the anthropological turn of the Christian religion within the global transformations of religious worldview in the age of late modern and postmodernism. Refreshment of the social teaching of Catholicism occurs within the last encyclical “Fratelli tutti” by the Pope Francis. The principle of the absolute value of human dignity becomes primary for the social teaching of the “Fratelli tutti” encyclical by the Pope Francis. This principle is fully substantiated. The Pope recognize that the absoluteness of human dignity is not obvious for the contemporary social discourse, the personality is more and more reduced to the individual who can be manipulated destroying the natural context of life which for the individual have always been communities. The Pope provides arguments about the dignity of the individual, which are revealed through faith, love, reflection and social dialogue.
The Fryderyk Chopin heritage legacy in the perspective of the local community and tourists
Authors: Ostrowska-Tryzno Anna , Pawlikowska-Piechotka Anna
Published: April 2021

Although cultural tourism has been known since the very beginning of the European civilisation (the Ancient Greeks and Romans peregrines’), nowadays cultural events are a great attraction not only for a local community, but they are also a strong motivation for tourists to travel. It seems that one of the special research value is to consider how deeply cultural events, connected with ‘high art’ (museums, classical music, art events of superior quality), motivate a local community and tourists. Therefore, the main aim of our survey was to recognize the role and contribution of top cultural events (on the example of ‘the Chopin Year 2010’) in marketing a city’s image and to evaluate its significance as a tourist attraction and its meaning to the local community. To examine the cultural tourism from visitors and the local community perspective and to obtain primary data, we undertook the explanatory and evaluative research. We also used (as secondary data) an academic literature review results, statistic information and materials obtained from the Chopin Museum in Warsaw, the Fryderyk Chopin Association and the Fryderyk Chopin Institute. This paper describes the main outcomes of the survey conducted in 2011–2015. In the past, cultural activities were rarely regarded as part of the tourism industry in Warsaw. The International Fryderyk Chopin Festivals and the International Fryderyk Chopin Piano Competitions were considered as different. From the beginning, they were aimed to be widely recognised international events, rather than attractions organised to meet the needs of the residents and domestic tourists. However, ‘the Chopin Year 2010’ celebrations remained highly exceptional as many different events took place, including ‘street music.’ They were aimed broader than to satisfy only a rather narrow niche of professional musicians. In 2010 both the International Fryderyk Chopin Festival and the 16th International Fryderyk Chopin Piano Competition were events not only shaped for special groups of music lovers, but also for the local community who was able to actively participate in these two big festivals.
„Eden” – mistyczny ogród mariawicki w Felicjanowie
Authors: Markowski Sławomir
Published: April 2021

Celem artykułu jest próba przedstawienia zespołu cech o mistycznej tożsamości zabytkowego ogrodu w Felicjanowie. Unikatowy charakter ogrodu, choć wynika z pozornie banalnego widzenia jego przestrzeni, sam w sobie niesie wielki ładunek sacrum, zawierający istotne dla wyznania mariawickiego symbole. Kontekst przyrodniczo-przestrzenny zawarty został w mistycznym odniesieniu do ogrodu Eden.
Machine Learning Methods for the Diagnosis of Chronic Obstructive Pulmonary Disease in Healthy Subjects: Retrospective Observational Cohort Study
Authors: Muro Shigeo , Ishida Masato , Horie Yoshiharu , Takeuchi Wataru , Nakagawa Shunki , Ban Hideyuki , Nakagawa Tohru , Kitamura Tetsuhisa
Published: April 2021

Background

Airflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances, including tobacco smoke, is an established risk. However, not all long-term smokers develop COPD, meaning that other risk factors exist.

Objective

This study aimed to predict the risk factors for COPD diagnosis using machine learning in an annual medical check-up database.

Methods

In this retrospective observational cohort study (ARTDECO [Analysis of Risk Factors to Detect COPD]), annual medical check-up records for all Hitachi Ltd employees in Japan collected from April 1998 to March 2019 were analyzed. Employees who provided informed consent via an opt-out model were screened and those aged 30 to 75 years without a prior diagnosis of COPD/asthma or a history of cancer were included. The database included clinical measurements (eg, pulmonary function tests) and questionnaire responses. To predict the risk factors for COPD diagnosis within a 3-year period, the Gradient Boosting Decision Tree machine learning (XGBoost) method was applied as a primary approach, with logistic regression as a secondary method. A diagnosis of COPD was made when the ratio of the prebronchodilator forced expiratory volume in 1 second (FEV1) to prebronchodilator forced vital capacity (FVC) was <0.7 during two consecutive examinations.

Results

Of the 26,101 individuals screened, 1213 met the exclusion criteria, and thus, 24,815 individuals were included in the analysis. The top 10 predictors for COPD diagnosis were FEV1/FVC, smoking status, allergic symptoms, cough, pack years, hemoglobin A1c, serum albumin, mean corpuscular volume, percent predicted vital capacity, and percent predicted value of FEV1. The areas under the receiver operating characteristic curves of the XGBoost model and the logistic regression model were 0.956 and 0.943, respectively.

Conclusions

Using a machine learning model in this longitudinal database, we identified a number of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of COPD. Further research to confirm our results is warranted, as our analysis involved a database used only in Japan.
Social Media and Medical Education in the Context of the COVID-19 Pandemic: Scoping Review (Preprint)
Authors: Katz Marc , Nandi Neilanjan
Published: April 2021

BACKGROUND

The COVID-19 pandemic has brought virtual web-based learning to the forefront of medical education as training programs adapt to physical distancing challenges while maintaining the rigorous standards of medical training. Social media has unique and partially untapped potential to supplement formal medical education.

OBJECTIVE

The aim of this review is to provide a summary of the incentives, applications, challenges, and pitfalls of social media–based medical education for both trainees and educators.

METHODS

We performed a literature review via PubMed of medical research involving social media platforms, including Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts. Papers were reviewed for inclusion based on the integrity and power of the study.

RESULTS

The unique characteristics of social media platforms such as Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts endow them with unique communication capabilities that serve different educational purposes in both formal and informal education settings. However, contemporary medical education curricula lack widespread guidance on meaningful use, application, and deployment of social media in medical education.

CONCLUSIONS

Clinicians and institutions must evolve to embrace the use of social media platforms for medical education. Health care professionals can approach social media engagement in the same ethical manner that they would with patients in person; however, health care institutions ultimately must enable their health care professionals to achieve this by enacting realistic social media policies. Institutions should appoint clinicians with strong social media experience to leadership roles to spearhead these generational and cultural changes. Further studies are needed to better understand how health care professionals can most effectively use social media platforms as educational tools. Ultimately, social media is here to stay, influencing lay public knowledge and trainee knowledge. Clinicians and institutions must embrace this complementary modality of trainee education and champion social media as a novel distribution platform that can also help propagate truth in a time of misinformation, such as the COVID-19 pandemic.
Supporting Heart Transplantation Aftercare through Mobile Access to Medical Records: Feasibility and Usability of the App “phellow” (Preprint)
Authors: Müller Julia , Weinert Lina , Svensson Laura , Rivinius Rasmus , Kreusser Michael M , Heinze Oliver
Published: April 2021

BACKGROUND

Giving patients access to their medical records can improve health literacy, adherence to therapy, patients’ health-related self-care, doctor-patient communication, and quality of care. The application (app) phellow (“personal health fellow”) was developed to provide patients with mobile access to selected content of their medical records (i.e. physician letters, drug trough levels). It was tested at the heart transplantation (HTx) outpatient clinic at Heidelberg University Hospital among volunteer patients after heart transplantation from late 2018 onward.

OBJECTIVE

The aims of this study were (1) to assess whether the phellow app can be effectively used by all participating parties (usability) and (2) to determine if the app is feasible to be further implemented in routine care (feasibility).

METHODS

Usability was quantitatively measured through the System Usability Scale (SUS) among patients who actively used phellow. In addition, usability and feasibility were qualitatively measured through semi-structured guide-based interviews with patients (users, non-users) and health care providers (medical staff, physicians) from the HTx outpatient clinic. Quantitative data were analyzed descriptively and through correlation analyses. Qualitative data were pseudonymized, audiotaped, and transcribed verbatim. Themes were identified through thematic analysis.

RESULTS

The usability rating measured with the SUS questionnaire (n=31) was 79,9 (SD 14,1) which indicates a high usability. No statistically significant correlation was found between SUS scores and patients’ age, gender, or frequency or duration of phellow use. A more in-depth view on usability and feasibility was obtained from interviews with 16 patients (5 non-users, 11 users) and 7 health care providers (HCPs; 4 medical staff members, 3 physicians) (n=23). App appreciation, interest, and willingness-to-use were high. Tasks fit with clinic workflow and were perceived as clear. An improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were requested for further implementation. Usability problems such as incompleteness of record, incomprehensible presentation of content, technical issues (e.g. sudden app crashes), and complex registration procedures were reported. Participants recommended usability improvements (e.g. chronically plausible presentation of record content, simplified registration and log-in) and suggested new functionalities (e.g. access to full record, communication module, appointments, medication refill requests).

CONCLUSIONS

Despite some usability issues, usability of the phellow app was considered high. To be feasible for an implementation in routine care, usability problems should be solved. Accompanying research is crucial to monitor usability improvements and to assess effects of app use on patients and clinic workflow.
The Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) as an eHealth Approach to Presurgical Hip Replacement Education: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Miller William C , Mohammadi Somayyeh , Watson Wendy , Crocker Morag , Westby Marie
Published: April 2021

BACKGROUND

Osteoarthritis (OA), leading to hip replacement (THR), is a primary contributor to global mobility impairment. In 2018, more than 59,000 THR surgeries were performed in Canada. Health promotion education, such as prehabilitation, is vital to optimizing surgical outcomes.

OBJECTIVE

This study aims to evaluate the feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education.

METHODS

A single-blind (assessor-blind), 2-arm, feasibility randomized controlled trial will be conducted. We will recruit 40 (HIPPER group, n=20; control group, n=20) older adults with hip OA and on a waitlist for a THR. The HIPPER intervention consists of 12 online, interactive modules. The control group will receive the current standard practice consisting of 2 online educational sessions lasting 2 hours each (webinars). Feasibility outcomes (eg, recruitment and retention rates) will be evaluated.

RESULTS

Recruitment started in March 2021. As of April 20, 2021, 18 participants were recruited. All 18 completed T1 measures. Only 1 participant has been scheduled to have a surgery and therefore has been scheduled to complete T2 measures. The remainder of the participants are waiting to be notified of their surgery date. This project was funded by a Canadian Institutes of Health Research Project Grant. Our institute’s research ethics board approved this study in November 2016.

CONCLUSIONS

Results will lead to refinement of the HIPPER protocol in order to evaluate a standardized and geographically accessible prehabilitation program.

CLINICALTRIAL

ClinicalTrials.gov NCT02969512; https://clinicaltrials.gov/ct2/show/NCT02969512

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/29322
Impactability Modeling for Reducing Medicare Accountable Care Organization Payments and Hospital Events in High-Need High-Cost Patients: Longitudinal Cohort Study (Preprint)
Authors: Smith Maureen A , Yu Menggang , Huling Jared D , Wang Xinyi , DeLonay Allie , Jaffery Jonathan
Published: April 2021

BACKGROUND

Impactability modeling promises to help solve the nationwide crisis in caring for high-need high-cost patients by matching specific case management programs with patients using a “benefit” or “impactability” score, but there are limitations in tailoring each model to a specific program and population.

OBJECTIVE

We evaluated the impact on Medicare accountable care organization savings from developing a benefit score for patients enrolled in a historic case management program, prospectively implementing the score, and evaluating the results in a new case management program.

METHODS

We conducted a longitudinal cohort study of 76,140 patients in a Medicare accountable care organization with multiple before-and-after measures of the outcome, using linked electronic health records and Medicare claims data from 2012 to 2019. There were 489 patients in the historic case management program, with 1550 matched comparison patients, and 830 patients in the new program, with 2368 matched comparison patients. The historic program targeted high-risk patients and assigned a centrally located registered nurse and social worker to each patient. The new program targeted high- and moderate-risk patients and assigned a nurse physically located in a primary care clinic. Our primary outcomes were any unplanned hospital events (admissions, observation stays, and emergency department visits), count of event-days, and Medicare payments.

RESULTS

In the historic program, as expected, high-benefit patients enrolled in case management had fewer events, fewer event-days, and an average US $1.15 million reduction in Medicare payments per 100 patients over the subsequent year when compared with the findings in matched comparison patients. For the new program, high-benefit high-risk patients enrolled in case management had fewer events, while high-benefit moderate-risk patients enrolled in case management did not differ from matched comparison patients.

CONCLUSIONS

Although there was evidence that a benefit score could be extended to a new case management program for similar (ie, high-risk) patients, there was no evidence that it could be extended to a moderate-risk population. Extending a score to a new program and population should include evaluation of program outcomes within key subgroups. With increased attention on value-based care, policy makers and measure developers should consider ways to incorporate impactability modeling into program design and evaluation.
Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis (Preprint)
Authors: Nimmanterdwong Zethapong , Boonviriya Suchaya , Tangkijvanich Pisit
Published: April 2021

BACKGROUND

The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality.

OBJECTIVE

This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population.

METHODS

We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies’ qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed.

RESULTS

Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210.

CONCLUSIONS

Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted.
Обоснование способа определения клинико-рентгенограммометрических показателей тазобедренного сустава у пациентов с ДЦП
Authors: Hoshko V.Yu. , Naumenko N.O. , Yatsuliak M.B. , Cheverda A.I. , Nemesh M.M. , Martsyniak S.M.
Published: April 2021

Актуальность. Трудности диагностики, которые возникают при выборе лечебно-профилактических мероприятий, направленных на предупреждение подвывиха, вывиха и контрактур в тазобедренном суставе у пациентов с детским церебральным параличом, являются актуальным объектом исследований. Цель исследования: улучшить результаты диагностики патологии тазобедренного сустава путем установления объективных рентгенограммометрических показателей. Материалы и методы. Общее количество пациентов составило 20 (40 суставов): 10 мальчиков и 10 девочек, возраст которых колебался от 3 до 15 лет. Были прооперированы 16 суставов. Рентгенограммометрически определяли: шеечно-диафизарный угол (ШДУ) и торсию бедра проекционные и истинные по Ковалю (с помощью таблиц), ацетабулярный угол и угол наклона впадины (угол Шарпа). Клинически определяли торсии бедра по Ruwe. Интраоперационно определяли торсии собственным методом (патент № a200512793). Всех пациентов обследовали собственным методом (патент № 137567). Результаты. С помощью критерия Стьюдента для независимых выборок было проведено сравнение показателей тазобедренного сустава и обнаружены достоверные различия между ШДУ в стандартной укладке и ШДУ в укладке собственным методом (p < 0,05), а также между ШДУ в стандартной укладке и ШДУ истинным по Ковалю (p < 0,05). По критерию Фишера установлено, что торсия по Ruwe и торсия по Ковалю достоверно отличаются (p < 0,05): Fемп 1,87 > Fкр 1,7. С помощью метода «отношение шансов» мы определили, что чувствительность измерения торсии по Ruwe равняется 0,7, специфичность измерения торсии по Ruwe — 0,83 (OR 11,67, ДИ 1,94–70,18), что свидетельствует о том, что шанс получить совпадение, измеряя торсии по Ruwe, в 11,67 раза больше, чем по Ковалю, по сравнению с интраоперационными данными. Точно определенная величина торсии бедра по Ruwe обеспечивает получение истинных показателей состояния тазобедренного сустава собственным методом. Выводы. Собственный метод обеспечивает определение объективных клинико-рентгенограммометрических (диагностических) показателей у пациентов с патологией тазобедренного сустава. При выполнении одной рентгенограммы можно определить все основные параметры тазобед-ренного сустава (торсия бедра, ШДУ, угол Виберга, индекс Реймерса, индекс вертикальной миграции, ацетабулярный угол, угол наклона впадины) и стандартизировать обследования пациентов с детским церебральным параличом, которые подлежат скринингу в течение всего периода их развития. Таким способом можно получить рентгенограмму и метрические показатели у пациентов с выраженными нервно-мышечными расстройствами (III и IV GMFCS).