bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Criteria-Based Intelligent Techniques for Efficient Handover in Next-Generation Networks
Authors: Pahal Sudesh , Nandal Priyanka , Gupta Nidhi , Sehrawat Neetu
Published: October 2024

Background:

Several wireless technologies are assumed to be operating in cooperation
for next-generation networks. These networks offer various services to mobile users; however, efficient
handover between different networks is the most challenging task in high mobility scenarios.
The traditional signal strength-based handover algorithms are not able to cope with mobile users'
high-quality requirements.

Methods:

In this paper, multiple criteria-based intelligent techniques are proposed to deal with inefficiencies
related to handover. This technique makes use of artificial neural networks that take multiple
parameters as inputs in order to predict the degradation of parameters. These predictions are
further used to design rules for initiating handover procedures prior to service quality degradation.

Results:

Based on the prediction results obtained by deep neural networks, the handover decisions
are recommended according to the type of application: conversational or streaming.

Conclusion:

The simulation results demonstrate the efficacy of the proposed method as there is an
improvement of up to 40% and 25% in terms of handover rate and service disruption time, respectively,
with an acceptable prediction error of 0.05.
Comparative Analysis of Different Transport Layer Protocol Techniques Incognitive Network
Authors: Kumar Ajay , Hemrajani Naveen
Published: October 2024

Most of the networks employ TCP protocol for transmission control in transport
mechanism. Although it offers numerous services such as reliability, end-to-end delivery, secure
transmission of data, and so on to applications functioning across the World Wide Web,
TCP needs to have effective congestion management techniques in order to handle traffic with
a lot of data. Still, TCP have poor performance during data transmission in the network. The
network community continues conducting research to develop a method that should provide a
fair and effective transmission bandwidth distribution. Numerous congestion control strategies
have been developed based on previous research in this area. This work discusses, identifies,
compares, and analyses the behaviour of a few network congestion control strategies to determine
their benefits and limitations. The widely known network simulator ns2 is employed for the
simulation. The performance metrics for QTCP, TCP new Reno, TCP- Hybla, L-TCP and RLTCP
are throughput, average delay, PDR, packet loss, average jitter, latency and fairness are considered.
The RL-TCP exhibits superior performance in multiple measures when it is compared to
alternative TCP protocols, as indicated by simulation results. These metrics encompass throughput,
average delay, packet delivery ratio (PDR), packet loss, jitter, latency, and fairness. Furthermore,
several TCP protocols, such as L-TCP, TCP-Hybla, QTCP, and TCP-New Reno, have undergone
evaluation, uncovering disparities in their individual performance attributes. Nevertheless,
the RL-TCP regularly demonstrates superior performance in all aspects.
Comparing Health Anxiety and Social Exclusion in the Elderlies and Adults Referring to the Veterans Foundation in COVID-19 Pandemic
Authors: Ranjbar Kouchaksaraei Sajjad , Vizeshfar Fatemeh , Ghaemmaghami Parvin , Abbasi Fatemeh
Published: October 2024

Objective:

Covid-19 pandemic is a global challenge negatively affecting various aspects
of health of different age groups. One of the groups involved with the psychological challenges of
Covid-19 were the veterans and their families. So, this study was conducted to compare the health
anxiety and social exclusion in elderlies and youths referring to the Veteran Foundation in Covid-19
pandemic.

Methods:

This descriptive study was conducted on 114 clients of the Veterans Foundation in order to
compare the health anxiety and social exclusion in the elderlies and adults referring to Veterans
Foundation in the Covid-19 pandemic. The participants were collected through convenience sampling.
Data were collected using demographic, health anxiety and social exclusion questionnaires.

Results:

In the comparison of social exclusion and its sub-dimensions, the variables of Out-group
social support, participation and shame have a significant difference (P<0.05) and the average of outgroup
support in the adults is more than in the elderlies, while the average of participation and social
shame is higher in the elderlies than the adults. There is an inverse and significant correlation between
the indicators of social relations, participation and the total social exclusion with health anxiety
in youths (P<0.05).

Conclusion:

Given the risks of social exclusion on the physical and mental health of the elderlies
and its correlation with health anxiety, it seems that, more attention should be paid to the effects of
the disease on the mental and social health of the elderlies in Covid-19 prevention programs.
Bleeding vs Thrombosis: Treatment Strategy for Women Having Large Uterine Fibroids and DVT
Authors: Sharma Kiran
Published: October 2024

Large uterine fibroids (UFs) are clonal neoplasms of the uterus that form during the mid
and late-aged women. Such women generally consume oral contraceptive pills, tranexamic acid, or
NSAIDS to manage heavy menstrual bleeding (HMB) and associated complications while waiting
for a conclusive procedure or avoiding hysterectomy. The procoagulant effect of these medicinal
agents can result in venous stasis of the lower limbs, leading to deep vein thrombosis (DVT), a
challenging complication with HMB. We examine the complicated state of heavy bleeding with
thrombosis and explore better management options. It has been seen that women with hypothyroidism
have an increased risk of getting DVT due to an alteration in the coagulation system. These incidences
are mostly associated with higher uterine weight, which is related to the extrinsic compression
of the inferior vena cava. In such cases, the occurrence of postoperative thrombosis is riskier if
hysterectomy/myomectomy is the only option. Utilization of appropriate anticoagulants with modification
of the steroid-hormone system using hormone agonists or antagonists (e.g., levonorgestrel
intrauterine system, high-dose progestin-only therapy, danazol, aromatase inhibitors, Vitamin-D
supplements or selective estrogen receptor modulators) could be an effective technique, but adverse
consequences of continued use should be monitored. More research is needed into the basic biology
associated with the role of growth factors and genetic alterations in these malignancies. The development
of new leiomyomas following conservative therapy is also a significant issue.
Object Detection for Healthcare Data Using Deep Convolutional Neural Networks
Authors: A Veena , S Gowrishankar
Published: October 2024

Gallstone disease is a prevalent chronic condition impacting individuals
worldwide, posing significant challenges to healthcare systems globally. It ranks
among the most common ailments encountered by individuals seeking emergency care
due to abdominal discomfort. The complexity of gallbladder ultrasound scans arises
from numerous factors, including variations in gallbladder anatomy. In this study, we
propose a healthcare informatics system aimed at identifying and analyzing gallstones.
We conduct a thorough examination of several state-of-the-art object detection
algorithms, including Faster Region-based Convolutional Neural Network (Faster RCNN), Mask Region-based Convolutional Neural Network (Mask R-CNN), and Single
Shot Detector (SSD) Our approach, which combines elements of Mask R-CNN, SSD,
and Faster R-CNN, facilitates the precise detection of gallstones within the gallbladder
by leveraging region-based proposals. We specifically focus on training the Mask RCNN model with various backbone networks. Ultrasound images utilized in our
experiments were sourced from medical professionals, encompassing diverse
demographic characteristics such as gender, age, and urban/rural residence. Our
findings demonstrate that the Mask R-CNN model, with a Resnet-101-FPN backbone
network, excels in gallstone detection, surpassing alternative techniques in object
localization accuracy.
PENGARUH SOLVABILITAS, LIKUIDITAS, DAN HARGA KOMODITAS TERHADAP HARGA SAHAM MELALUI PROFITABILITAS SEBAGAI VARIABEL MEDIASI
Authors: Siradj Rana Raisya , Islami Muhammad Irfan
Published: October 2024

This study aims to analyze the relationship between financial performance and commodity prices on the share prices of coal mining companies listed on the Indonesian Stock Exchange during the period 2015- 2022. The research method used is quantitative-descriptive with a multiple linear regression approach. This research focuses on Debt to Equity Ratio (DER), Current Ratio (CR), Return on Assets (ROA), and coal prices. Through path analysis, the research indicate that ROA significantly mediates the impact of DER, CR, and Coal Price on the Stock Prices of coal mining companies. These finding contribute to understanding the factors influencing the stock prices of coal mining companies and have implication for investors, providing information for consideration in making investment decisions
Use of neural networks for safe collision avoidance for groups of autonomous vessels
Authors: Tripolets O. Y.
Published: October 2024

This article analyzes and compares the effectiveness of two algorithms for collision avoidance in groups of autonomous vessels: one based on geometric analysis of vessel approach and cost function minimization for calculating a safe maneuver (traditional algorithm), and an algorithm utilizing a neural network. Both algorithms assume external control of a group of vessels within a specific area using a vessel traffic management system and coordinated maneuvering of dangerously approaching vessels. Descriptions of these algorithms are provided along with their simplified block diagrams; to solve the task of safely maneuvering a group of vessels, a sequential analysis of all possible vessel pairs in the group and changes in their courses is proposed. The process of creating three test datasets is described, two of which were generated using a program and included 100 scenarios each, while the third was manually composed and included 30 scenarios for different vessel group approach variations. During the testing of the neural network algorithm, two neural networks trained to predict safe courses for vessel pairs were utilized. The neural network used in the algorithm, trained on 743671 samples, allowed the processing of test vessel approach scenarios with an accuracy comparable to the traditional algorithm. Depending on the number of dangerously approaching vessels in the area, the neural network algorithm processed test scenarios 2–14 times faster than the traditional algorithm. The paper highlights the limitations of the described algorithms and outlines planned improvements for subsequent research, including the optimization of the safe maneuver selection methodology and further training of the neural network on larger data volumes.
Gamified mHealth System for Evaluating Upper Limb Motor Performance in Children: Cross-Sectional Feasibility Study
Authors: Mia Md Raihan , Ahamed Sheikh Iqbal , Nemanich Samuel
Published: October 2024

Background

Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions.

Objective

This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to (1) design and develop novel mHealth gamified software tools to examine theory-driven features of UL movement, (2) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and (3) validate assessment methods with healthy participants from schools.

Methods

Elementary school children (N=31, median 9.0, IQR 4.0-14.0 years old) participated by playing 5 games. The game tasks were focused on key features of skilled motor control: (1) whole limb reaching, (2) fine motor control and manual dexterity, and (3) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (ie, the pruned exact linear time method), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (ie, Pearson correlation, mean, standard deviation, P value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance.

Results

A negative correlation was identified between speed and accuracy in the whole limb movement (r=–0.30 to –0.42). Significant relationships between age and upper limb performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (in-phase congruent [mean 28.85, SD 18.97] vs antiphase congruent [mean 112.64, SD 25.82] and in-phase mirrored [mean 23.78, SD 16.07] vs antiphase mirrored [mean 121.39, SD 28.19]). Moreover, the average speed (revolutions per second) and travel distance (m) of the in-phase mode were significantly higher than those of the antiphase coordination.

Conclusions

Results of this feasibility study show that spatiotemporal data captured from the mHealth app can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment.
Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review
Authors: White Brianna M , Prasad Rameshwari , Ammar Nariman , Yaun Jason A , Shaban-Nejad Arash
Published: October 2024

Background

Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual’s life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood.

Objective

This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth.

Methods

Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability.

Results

Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder.

Conclusions

The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need.
Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study
Authors: Stachura Nicole Kasia , Brar Sukham K , Davidson Jacob , Wilson Claire A , Dann Celia , Apostol Mike , Vecchio John , Bilodeau Shannon , Gunz Anna , Casas-Lopez Diana Catalina , Noppens Ruediger , Leslie Ken , Strychowsky Julie E
Published: October 2024

Background

In Canada, the health care system has been estimated to generate 33 million metric tons of greenhouse gas emissions annually. Health care systems, specifically operating rooms (ORs), are significant contributors to greenhouse gas emissions, using 3 to 6 times more energy than the hospital’s average unit.

Objective

This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff members and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation.

Methods

A total of 2 surveys were developed, consisting of 27 questions for staff members and 22 questions for patients and caregivers. Topics included demographics, knowledge and attitudes regarding environmental sustainability, opportunities for initiatives, and perceived barriers. Multiple-choice, Likert-scale, and open-ended questions were used.

Results

A total of 174 staff members and 37 patients participated. The majority (152/174, 88%) of staff members had received no and minimal training on sustainability, while 93% (162/174) cited practicing sustainability at work as moderately to extremely important. Among patients and caregivers, 54% (20/37) often or always noticed when a hospital is being eco-friendly. Both staff members and patients agreed that improving sustainability would boost satisfaction (125/174, 71.8% and 22/37, 59.4%, respectively) and hospital reputation (22/37, 59.4% and 25/37, 69.5%, respectively). The staff members’ highest-rated environmental initiatives included transitioning to reusables, education, and improved energy consumption, while patients prioritized increased nature, improved food sourcing, and education. Perceived barriers to these initiatives included cost, lack of education, and lack of incentives.

Conclusions

Staff members and patients and caregivers in a large academic health care center acknowledge the significance of environmental sustainability in the OR. While they do not perceive a direct impact on patient care, they anticipate positive effects on satisfaction and hospital reputation. Aligning initiatives with staff members and patient and caregiver preferences can help drive meaningful change within the OR and beyond.
Effect of Physical Exercise on Telomere Length: Umbrella Review and Meta-Analysis
Authors: Sánchez-González Juan Luis , Sánchez-Rodríguez Juan Luis , González-Sarmiento Rogelio , Navarro-López Víctor , Juárez-Vela Raúl , Pérez Jesús , Martín-Vallejo Javier
Published: October 2024

Background

Telomere length (TL) is a marker of cellular health and aging. Physical exercise has been associated with longer telomeres and, therefore, healthier aging. However, results supporting such effects vary across studies. Our aim was to synthesize existing evidence on the effect of different modalities and durations of physical exercise on TL.

Objective

The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a virtual reality physical activity platform in a community organization.

Methods

We performed an umbrella review and meta-analysis. Data sources included PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We selected systematic reviews and meta-analyses of randomized and nonrandomized controlled clinical trials evaluating the effect of physical exercise on TL.

Results

Our literature search retrieved 12 eligible systematic reviews, 5 of which included meta-analyses. We identified 22 distinct primary studies to estimate the overall effect size of physical exercise on TL. The overall effect size was 0.28 (95% CI 0.118-0.439), with a heterogeneity test value Q of 43.08 (P=.003) and I² coefficient of 51%. The number of weeks of intervention explained part of this heterogeneity (Q_B=8.25; P=.004), with higher effect sizes found in studies with an intervention of less than 30 weeks. Exercise modality explained additional heterogeneity within this subgroup (Q_B=10.28, P=.02). The effect sizes were small for aerobic exercise and endurance training, and moderate for high-intensity interval training.

Conclusions

Our umbrella review and meta-analysis detected a small-moderate positive effect of physical exercise on TL, which seems to be influenced by the duration and type of physical exercise. High quality studies looking into the impact of standardized, evidence-based physical exercise programs on TL are still warranted.
Establishment, Implementation, Initial Outcomes, and Lessons Learned from Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection Among Persons Newly Diagnosed With HIV in Thailand: Implementation Study
Authors: Srithanaviboonchai Kriengkrai , Yingyong Thitipong , Tasaneeyapan Theerawit , Suparak Supaporn , Jantaramanee Supiya , Roudreo Benjawan , Tanpradech Suvimon , Chuayen Jarun , Kanphukiew Apiratee , Naiwatanakul Thananda , Aungkulanon Suchunya , Martin Michael , Yang Chunfu , Parekh Bharat , Northbrook Sanny Chen
Published: October 2024

Background

A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand as a small-scale pilot project in October 2020.

Objective

We aimed to describe the lessons learned and initial outcomes obtained after the establishment of the nationwide recent HIV infection surveillance project from April through August 2022.

Methods

We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the Asanté HIV-1 Rapid Recency Assay. The duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 counts <200 cells/mm3 or those having opportunistic infections were classified as RITA-CS-long-term. Individuals testing RTRI-recent with CD4 counts >200 cells/mm3, no opportunistic infections, and not on antiretroviral treatment were classified as RITA-CS-recent.

Results

Two hundred and one hospitals in 14 high-burden HIV provinces participated in the surveillance. Of these, 69 reported ≥1 HIV diagnosis during the surveillance period. Of 1053 newly diagnosed cases, 64 (6.1%) were classified as RITA-CS-recent. On multivariate analysis, self-reporting as transgender women (adjusted odds ratio [AOR] 7.41, 95% CI 1.59‐34.53) and men who have sex with men (AOR 2.59, 95% CI 1.02‐6.56) compared to heterosexual men, and students compared to office workers or employers (AOR 3.76, 95% CI 1.25‐11.35) were associated with RITA-CS-recent infection. The proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow-up and supervision visits were the most commonly cited lessons learned to inform the next surveillance phase.

Conclusions

Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. The key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HIV testing service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices.
Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study (Preprint)
Authors: Châtel Bas D L , Janssen Jeroen H M , Peeters Geeske M E E , Corten Rense , Tieben Rob , Deen Menno , Hendriks Elmy J M , Olde Rikkert Marcel G M
Published: October 2024

BACKGROUND

Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact.

OBJECTIVE

This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity.

METHODS

This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback.

RESULTS

The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9% and aged less than 65 years: n=121, 78.1%) provided informed consent, yielding a conversion rate of 0.08%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98%) than a campaign focusing on research participation (click-through rate=0.51%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4%) remained active after the first week, and 32 (5.8%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48%) participants (aged 65-79 years; female: n=12, 83%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46% at baseline to 10% at follow-up.

CONCLUSIONS

These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions.
The Effects of Electronic Health Records on Medical Error Reduction: Extension of the DeLone and McLean Information System Success Model (Preprint)
Authors: Chimbo Bester , Motsi Lovemore
Published: October 2024

BACKGROUND

Medical errors are becoming a major problem for health care providers and those who design health policies. These errors cause patients’ illnesses to worsen over time and can make recovery impossible. For the benefit of patients and the welfare of health care providers, a decrease in these errors is required to maintain safe, high-quality patient care.

OBJECTIVE

This study aimed to improve the ability of health care professionals to diagnose diseases and reduce medical errors.

METHODS

Data collection was performed at Dr George Mukhari Academic Hospital using convenience sampling. In total, 300 health care professionals were given a self-administered questionnaire, including doctors, dentists, pharmacists, physiologists, and nurses. To test the study hypotheses, multiple linear regression was used to evaluate empirical data.

RESULTS

In the sample of 300 health care professionals, no significant correlation was found between medical error reduction (MER) and knowledge quality (KQ) (β=.043, P=.48). A nonsignificant negative relationship existed between MER and information quality (IQ) (β=–.080, P=.19). However, a significant positive relationship was observed between MER and electronic health records (EHR; β=.125, 95% CI 0.005-0.245, P=.042).

CONCLUSIONS

Increasing patient access to medical records for health care professionals may significantly improve patient health and well-being. The effectiveness of health care organizations’ operations can also be increased through better health information systems. To lower medical errors and enhance patient outcomes, policy makers should provide financing and support for EHR adoption as a top priority. Health care administrators should also concentrate on providing staff with the training they need to operate these systems efficiently. Empirical surveys in other public and private hospitals can be used to further test the validated survey instrument.
Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review (Preprint)
Authors: Rachmayanti Riris D , Dewi Fatwa Sari Tetra , Setiyawati Diana , Megatsari Hario , Diana Rian , Vinarti Retno
Published: October 2024

BACKGROUND

Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems.

OBJECTIVE

This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths.

METHODS

The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted.

RESULTS

The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education.

CONCLUSIONS

The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents’ resilience skills.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/58681
FHIR-Based, EHR Connected, Population Level COVID-19 Vaccine Dashboard (Preprint)
Authors: Braunstein Mark , Grimes John , Lawley Michael , Hansen David
Published: October 2024

UNSTRUCTURED

We illustrate cost effective, easily implemented and operated tooling for surveillance of patient subpopulations at risk or otherwise of interest in a population or public health context. HL7’s Fast Healthcare Interoperability Resources (FHIR) standard for representing and accessing patient data is being adopted around the world. Our solution leverages FHIR and our free, open FHIR-based tools to identify and reach out to patients meeting criteria for COVID-19 vaccination using electronic health record data for a group of 1205 (1124 adult) synthetic patients. A facile data collection and analysis system that is integrated into the clinical workflow, process and existing clinical systems could provide more accurate, timely and detailed data. This could help public health become more responsive and effective in managing fast evolving challenges such as was presented by COVID-19.
Emergency Department Patient Journey Prediction with Machine Learning (Preprint)
Authors: Kovoor Joshua George , Carmichael Gavin John , Stretton Brandon , Gupta Aashray K , Kleinig Oliver S. , Ittimani Mana , Fabian Jack , Tan Sheryn , Ng Jeng Sweng , Sateakeerthy Shrirajh , Booth Andrew , Beath Alexander , Kefalianos John , Jacob Mathew Ollapallil , Ahmed Sadeya , Chan Weng Onn , Kovoor Pramesh , Gluck Samuel , Gilbert Toby , Malycha James , Reddi Benjamin A. , Padbury Robert T. , Trochsler Markus I. , Maddern Guy J. , Chew Derek P. , Zannettino Andrew C. , Liew Danny , Beltrame John F. , O’Callaghan Patrick G. , Papendick Cynthia , Bacchi Stephen
Published: October 2024

UNSTRUCTURED

N/A
Would not let me proceed without entering an abstract despite this paper being a Letter to the Editor.
Large Language Models in Randomized Controlled Trials Design (Preprint)
Authors: Jin Liyuan , Ong Jasmine Chiat Ling , Elangovan Kabilan , Ke Yuhe , Pyle Alexandra , Ting Daniel Shu Wei , Liu Nan
Published: October 2024

BACKGROUND

Randomized controlled trials (RCTs) face challenges such as limited generalizability, insufficient recruitment diversity, and high failure rates, often due to restrictive eligibility criteria and inefficient patient selection. Large language models (LLMs) have shown promise in various clinical tasks, but their potential role in RCT design remains underexplored.

OBJECTIVE

This study investigates the ability of LLMs, specifically GPT-4-Turbo-Preview, to assist in designing RCTs that enhance generalizability, recruitment diversity, and reduce failure rates, while maintaining clinical safety and ethical standards.

METHODS

We conducted a non-interventional, observational study analyzing 20 parallel-arm RCTs, comprising 10 completed and 10 ongoing studies published after January 2024 to mitigate pretraining biases. The LLM was tasked with generating RCT designs based on input criteria, including eligibility, recruitment strategies, interventions, and outcomes. The accuracy of LLM-generated designs was quantitatively assessed by comparing them to clinically validated ground truth data from ClinicalTrials.gov. Qualitative assessments were performed using Likert scale ratings (1–3) for domains such as safety, accuracy, objectivity, pragmatism, inclusivity, and diversity.

RESULTS

The LLM achieved an overall accuracy of 72% in replicating RCT designs. Recruitment and intervention designs demonstrated high agreement with the ground truth, achieving 88% and 93% accuracy, respectively. However, LLMs showed lower accuracy in designing eligibility criteria (55%) and outcomes measurement (53%). Qualitative evaluations showed that LLM-generated designs scored above 2 points across all domains, indicating strong clinical alignment. In particular, LLMs enhanced diversity and pragmatism, which are key factors in improving RCT generalizability and addressing failure rates.

CONCLUSIONS

LLMs, such as GPT-4-Turbo-Preview, have demonstrated potential in improving RCT design, particularly in recruitment and intervention planning, while enhancing generalizability and addressing diversity. However, expert oversight and regulatory measures are essential to ensure patient safety and ethical standards. The findings support further integration of LLMs into clinical trial design, although continued refinement is necessary to address limitations in eligibility and outcomes measurement.
A Real-World Experience of Integrating Patient-Reported Outcomes into Electronic Hospital Records Using a Mobile Messaging App in Patients Undergoing Radiation Treatment for Breast Cancer: A Cross-Sectional Retrospective Study (Preprint)
Authors: Baek Jong Yun , Kim Haeyoung , Cho Won Kyung , Kim Nalee , Lee Tae Hoon , Cha Won Chul
Published: October 2024

BACKGROUND

Integrating electronic patient-reported outcomes (ePRO) into electronic health records (EHR) can enhance cancer care. However, effective integration remains challenging, especially in real-world settings.

OBJECTIVE

This study aims to evaluate the effectiveness of integrating ePRO into EHR using a mobile messaging app for patients with breast cancer.

METHODS

We conducted a retrospective analysis of prospectively collected ePRO data using the Breast-Q questionnaire from breast cancer patients who received adjuvant radiotherapy (RT) at our institution between May 2023 and April 2024. During the study period, each patient encountered ePRO requests one to three times according to their scheduled hospital visits before and after RT. Our ePRO system delivered questionnaires through the app, with responses automatically integrated into the EHR. Response rate was calculated as the percentage of patients whose responses were successfully recorded in the EHR among those asked to respond. Complete response (CR) was defined

RESULTS

A total of 1,488 patients’ data were analyzed, including 2,431 encounters (median of one encounter per patient). The CR rate across the first to the third ePRO encounter was 89.9%, 98.3%, and 97.3%, respectively. Younger patients had a significantly higher CR rate (90.9% in patients < 60 years vs. 87.0% in patients ≥ 60 years, p = 0.03). The timing of questionnaire dispatch also influenced CR, with higher rates observed when questionnaires were sent more than one hour before the visit (93.3%) or in the afternoon of the previous day (92.7%) compared to other timings, which were approximately 80% (p < 0.01). Both factors of age and the timing remained significant in multivariate analysis (both, p < 0.01).

CONCLUSIONS

This study demonstrates that integrating ePRO into EHR through the app is feasible and shows high patient adherence. Factors including age and timing of questionnaire requests influence ePRO response rates. These findings provide insights for optimizing ePRO systems in clinical oncology practice.
Early Effects of the ESRD Treatment Choices Model on Kidney Transplant Waitlist Additions
Authors: Potluri Vishnu S. , Reddy Yuvaram N.V. , Tummalapalli Sri Lekha , Peng Chen , Huang Qian , Zhao Yueming , Kanter Genevieve P. , Zhu Jingsan , Liao Joshua M. , Navathe Amol S.
Published: October 2024

Key Points

The ESRD Treatment Choices model did not lead to an increase in kidney transplant waitlisting.

The COVID-19 pandemic had a substantial impact on kidney transplant waitlist additions.

Financial incentives alone, in the short term, did not lead to a substantial effect on kidney transplant waitlisting practices.

Background

Despite the mortality benefit of kidney transplantation over dialysis, only 13% of patients with ESKD are on the transplant waitlist. Given the low rates of transplant waitlisting in the United States, Medicare launched the ESRD Treatment Choices (ETC) model in 2021, the largest mandatory trial of payment incentives in kidney disease, which randomized 30% of health care markets to financial bonuses/penalties to improve kidney transplantation and home dialysis use. This study examines the effect of ETC payment adjustments on US kidney transplant waitlist additions.

Methods

Using data from the Organ Procurement and Transplantation Network registry, we examined kidney transplant waitlisting trends between January 1, 2017, and June 30, 2022. Participants were divided into intervention and control arms of the ETC model. Using an interrupted time series design, we compared slope changes in waitlist additions after ETC model implementation (implementation date: January 01, 2021) between the two arms, while accounting for differential changes during the coronavirus disease 2019 pandemic. Results were stratified by race and ethnicity (White, Black, Hispanic, and other). To examine balance between the two ETC arms, we conducted supplementary analyses using United States Renal Data System and Medicare data.

Results

After implementation of the ETC model, there were 5550 waitlist additions in the intervention arm and 11,332 additions in the control arm (versus 14,023 and 30,610 additions before the ETC model). After ETC model implementation, there were no significant differences in kidney transplant waitlist additions between the two arms for the overall cohort (slope difference 6.9 new listings/mo; 95% confidence interval [CI], −7.4 to 21.1) or among White (slope difference 2.6/mo; 95% CI, −3.0 to 8.1), Black (slope difference 2.2/mo; 95% CI, −4.3 to 8.7), or Hispanic (slope difference 0.2/mo; 95% CI, −4.5 to 4.9) patients.

Conclusions

In the 18 months after implementation, the ETC model was not associated with significant changes in new kidney transplant waitlist additions.
Decomposing the Cognition-influential Aspects of Instructional Designs A Systematic Review of Induced Causal Relationships by the Constructional Components of the Direct Instruction and Productive Failure Designs
Authors: Wu Bin
Published: October 2024

A substantial debate on the effectiveness of two instructional designs, namely “Productive Failure (PF)” and “Direct Instruction (DI)” has been prolonged for almost two decades. Indeed, from many studies we have seen if being deliberately designed and carried out, then both designs can be sophisticated not only in instructional procedures but also in how each function takes effect on learning. The constituting components could each be specified preceding the instruction as a design, but these activities carry its own goal in facilitating learning. In this article, we summarized the reasoning in the specifications of connection, construction and criticization. Thus, from our review, we debated how instructional stages, problem-led learning and failure-driven learning can each deliver good outcomes for learners.
El pensamiento Latinoamericano y el centenario de Leopoldo Zea (1912-2012)
Authors: Santana Adalberto , Guadarrama González Pablo , López Portillo T. Felícitas , Rodríguez Ozán María Elena , Auffant Vázquez Vivian , Pensado Leglise María de los Ángeles , Rojas Reinaldo , Morales Campos Estela , Saladino García Alberto
Published: October 2024

A lo largo de su trayectoria, Leopoldo Zea recibió distintos homenajes y reconocimientos en el ámbito nacional y mundial, al plantear una filosofía original y alentar los Estudios Latinoamericanos. Por ello, la obra que el lector tiene en sus manos El pensamiento Latinoamericano y el centenario de Leopoldo Zea (1912-2012), se suma a los reconocimientos recibidos por el maestro Zea, tanto en vida como posteriores a su deceso. En la conmemoración del centenario de su nacimiento (30 de junio de 2012) y del décimo aniversario de su fallecimiento (8 de junio de 2014), se reúnen en este volumen un conjunto de aportaciones que representan un esfuerzo colectivo de discípulos, colaboradores y continuadores de la obra latinoamericanista de tan insigne pensador.
Informative value of diagnostic imaging methods in the detection of subepithelial formations of the stomach: a clinical case
Authors: Varlamova N. N. , Hamid S. S. , Minkova Yu. V.
Published: October 2024

INTRODUCTION: Subepithelial formations (SubEO) of the upper gastrointestinal tract (GI tract) are asymptomatic in most cases, and are a diagnostic finding in routine studies. Given the risk of malignancy of some SubEO, the question of treatment tactics remains relevant today: observation or surgical intervention.

PURPOSE: To demonstrate diagnostic capabilities at the outpatient stage when choosing observational tactics in a patient with SubEO.

MATERIALS AND METHODS: A dynamic observation of a 68-year-old woman with a randomly identified SubEO was demonstrated. The patient has been observed by a gastroenterologist since 2005 with a diagnosis of functional disorder of the gallbladder and sphincter of Oddi. In August 2022, when contacting the clinic with complaints of epigastric pain and heartburn, the following studies were performed: gastroscopy (FGDS), endoscopic ultrasound (EUS) with fine needle puncture, transabdominal ultrasound (TAUZI), computed tomography (CT) of the abdominal cavity, during which a submucosal formation of the stomach was diagnosed. The picture is more consistent with a gastrointestinal stromal tumor (GISO). Given the small size of the formation, the surveillance tactic was chosen. At the time of 12.2023, according to the results of control studies of the SubEO without dynamics.

RESULTS: The follow-up period was 17 months, the results of the control studies justified the wait-and-see tactics and allowed avoiding unjustified surgical interventions and intraoperative complications.

CONCLUSION: The combined use of TAUZI with endoscopy contributes to a better differential diagnosis and the choice of adequate treatment tactics.