bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and rationale of a randomized, double-blind, placebo-controlled, Phase 2/3 study to evaluate the safety and efficacy of dociparstat sodium (DSTAT) in adults with acute lung injury associated with severe COVID-19
Authors: Lasky Joseph A. , Fuloria Jyotsna , Morrison Marion E. , Lanier Randall , Naderer Odin , Brundage Tom , Melemed Allen
Published: August 2020

Background: The COVID-19 Global Pandemic caused by the novel coronavirus, SARS-CoV-2, and the consequent morbidity and mortality attributable to progressive hypoxemia and subsequent respiratory failure, threaten to overrun hospital critical care units globally. New agents that can address the hyperinflammatory “cytokine storm” and hypercoagulable pathology seen in these patients may be a promising approach to treat patients, minimize hospital stays, and ensure hospital wards and critical care units are able to operate effectively. Dociparstat sodium (DSTAT) is a glycosaminoglycan derivative of heparin with robust anti-inflammatory properties, including the potential to address underlying causes of coagulation disorders with substantially reduced risk of bleeding complications compared to commercially available forms of heparin. Methods: This study is a randomized, double-blind, placebo-controlled, Phase 2/3 trial to determine the safety and efficacy of DSTAT added to standard of care versus placebo, in adults with COVID-19 who require hospitalization and supplemental oxygen therapy. The Phase 2 portion will enroll 12 participants in each of two dose escalating cohorts, to confirm the safety of DSTAT in this population. Following a data monitoring committee review of the data, an additional 50 participants will be enrolled. Contingent upon positive results, the Phase 3 portion of the study will enroll approximately 450 participants randomized 1:1 to DSTAT or placebo. The primary endpoint, agreed on by the US FDA, is the proportion of participants who survive and do not require mechanical ventilation through day 28. Discussion: Advances in standard of care regimens and the recent emergency use authorization of remdesivir and positive data with dexamethasone, has likely contributed to an increasing proportion of patients who are surviving without the need for mechanical ventilation. Therefore, examining the time to improvement of NIAID score will be essential to provide a more continuous measure of drug effect on recovery. Additional analysis of other endpoints, including supportive biomarkers (e.g., IL-6, HMGB1, soluble RAGE, D-dimer) will be performed at the conclusion of Phase 2 to further define the effect of DSTAT in patients hospitalized with COVID-19 infection. Trial Registration: ClinicalTrials.gov identifier NCT04389840, Registered 13 May 2020, https://clinicaltrials.gov/ct2/keydates/NCT04389840
The yellow perch (Perca flavescens) microbiome revealed resistance to colonisation mostly associated with neutralism driven by rare taxa under cadmium disturbance
Authors: Cheaib Bachar , Seghouani Hamza , Llewellyn Martin Stephen , Vandal-Lenghan Katherine , Mercier Pierre-Luc , Derome Nicolas
Published: August 2020

Background: Disentangling the dynamics of microbial interactions within communities improves our comprehension of metacommunity assembly of microbiota during host development and under perturbations. To assess the impact of stochastic variation of neutral processes on microbiota structure and composition under disturbance, two types of microbial habitats, free-living (water), and host-associated (skin and gut) were experimentally exposed to either a constant or gradual selection regime exerted by two sublethal cadmium chloride dosages (CdCl2). Yellow Perch (Perca flavescens) was used as a piscivorous ecotoxicological model. Using 16S rDNA gene based metataxonomics, quantitative metrics of water, skin and gut microbial communities were characterized along with development and across experimental conditions. Results: After 30 days, constant and gradual selection regimes drove a significant alpha diversity increase for both skin and gut microbiota. In the skin, pervasive negative correlations between taxa in both selection regimes in addition to the taxonomic convergence with the environmental bacterial community, suggest a loss of colonisation resistance resulting in the dysbiosis of yellow perch microbiota. Furthermore, the network connectivity in gut microbiome was exclusively maintained by rare (low abundance) OTUs, while most abundant OTUs were mainly composed of opportunistic invaders such as Mycoplasma and other genera related to fish pathogens such as Flavobacterium. Finally, the mathematical modelling of community assembly using both non-linear least squares models (NLS) and normalized stochasticity ratios (NST) based beta-diversity distances suggested neutral processes drove by taxonomic drift in host and water communities for almost all treatments. The NLS models predicted higher stochasticity in the cadmium-free host and water communities, however, NST models suggested higher stochasticity ratios under disturbance. Conclusions: Neutral models agree that water and host-microbiota assembly promoted by the occurrence frequence of rare taxa have evolved predominantly under neutral processes with potential involvement of deterministic forces sourced from host filtering and cadmium selection. The early signals of perturbations in the skin microbiome revealed antagonistic interactions by preponderance of negative correlations in the co-abundace networks. Our findings enhance our understanding of community assembly host-associated and free-living under anthropogenic selective pressure.
Mind Theory and the Role of Financial Decision and Process Role of Optogenetics
Authors: Njegovanović Ana
Published: August 2020

This paper is devoted to the study of functional relationships between behavioral finance, in particular when making decisions in the financial market, and the theory of reason and optogenetics. The purpose of this paper is to analyze the interaction of financial decision-making processes with the key principles of the mental state model (theory of mind) and define the role of optogenetics. The author notes that the use of the theory of reason in behavioral finance allows us to consider the key characteristics of the mental state of the subject of economic relations (thoughts, perceptions, desires, intentions, feelings have an internal mentalistic and experimental content). The author notes that decision-making at any level characterizes the complex network of scientific industries that allow us to understand the complexity of financial decision-making and the role and significance of the laws of thermodynamics and entropy. Modeling neural networks (based on the experimental approach), the paper presents the results of research in the context of analyzing behavioral changes in our brain under the following scenarios: at the stage of awareness of certain processes; if we participate (or do not) participate in these processes. The following conclusions are made in the paper: for the normal states of anxiety, the greatest number of possible configurations of interactions between brain networks, which represent the highest values of entropy is characteristic. These results are obtained from the study of a small number of participants in the experiment, but give an objective assessment and understanding of the complexity of the research and the guidance that include a scientific basis in the process of solving problems in the financial sphere (as an example: when trading in the financial market).

Keywords: behavioral finance; theory of mind, financial decision making, optogenetics.
The Nexus between Co-production and Willingness: Business Counselling in the Microfinance Sector
Authors: Abeysekera Ruwan
Published: August 2020

Microfinance plays a vital role to alleviate poverty through the development of micro-enterprises. Microfinance Institutions (MFIs) provide services such as microcredit, savings, insurance, and business development services (BDS) to their clients. BDS are non-financial services such as business training, market linkages, and information services which are provided by Microfinance Institutions (MFIs) to its clients. BDS helps owner-managers improve sales and profits and enable MFIs to achieve higher loan repayment rates and higher potential for client retention. The counselors of MFIs provide BDS to owner-managers of micro-enterprises. This study focuses on the co-production of BDS where a counselor of MFI and the owner-manager of a microenterprise engage in the co-production of services. For a successful co-production, the client (i.e. owner-manager in this study) has to play an active role by exercising three client factors, namely ability, clarity of the role, and motivation. Thus, the objective of this study is to explore how the client/owner-manager motivation (i.e. willingness) affects the co-production of BDS in counseling within a microfinance setting. A multiple case study method was used to conduct the present study by choosing six Sri Lankan MFIs as cases, where the selection of cases and respondents was based on a purposive sampling method. A counselor and an owner-manager representing each MFI were interviewed for data collection and thematic analysis was used to analyze the data. The findings show that economic factors, sanctions, and contextual factors influence the willingness of owner-managers to co-produce BDS with counselors of microfinance institutions (MFIs). The findings contribute to knowledge and practice domains related to microfinance.

Keywords: willingness, motivation, business counseling, co-production, microfinance.
PROGNOSTICATION OF STORAGE TERMS FOR PASTEURIZED SAUSAGES WITH ACTIVE PACKAGE ELEMENTS
Authors: Pasichnyi Vasyl , Shevchenko Oleksandr , Khrapachov Oleg , Marynin Andriy , Radzievskaya Irina , Matsuk Yuliiа , Geredchuk Alina , Kuligin Mikhail
Published: August 2020

The work is devoted to optimization modeling of an influence of pasteurization with oxygen absorbers on spoilage processes of lipids of boiled sausage products. According to the results, the influence on changes of peroxide and acid numbers of lipids of small sausages, pasteurized at presence of an oxygen absorber, has been mathematically prognosticated.

At mathematical modeling, mathematic packages MathCad and «Data analysis» (ЕТ) MSExcel were used. The experiment was planned according to the plan of full factorial experiment.

The dependence as to the influence of the recipe composition of sausage products at their storage on peroxide and acid number values has been revealed.

The conducted modeling allows to state the adequacy of obtained regressive equations. The obtained empirical dependencies allow to prognosticate a storage term of boiled sausages products, pasteurized with elements of active package at using protecting barrier multi-layer polymeric materials.

The optimization modeling was conducted by structuring a mathematical model as an analytic expression that reflects the connection of factor signs with a parametric index. The obtained response functions are adequate and have a high correspondence to real experimental data.

Storage terms were substantiated for small sausages, which recipe included beef, pork, poultry meat and also food emulsions, based on animal proteins. The process of repeated pasteurization was conducted at temperature 85–90 °С during 15–20 minutes
Site Suitability Analysis for Solid Waste Disposal of Bolpur Municipality, Birbhum District of West Bengal (India): Remote Sensing and AHP Approach
Authors: Das Goutam Kumar
Published: August 2020

The aim of present study is to find out suitable sites for solid waste disposal (SWD) in the tropical moist sub-humid region of Bolpur municipality, Birbhum district, West Bengal, India using Remote Sensing (RS), Geographic Information System (GIS) and Analytical Hierarchy Process (AHP) techniques. Saaty’s AHP technique was used to delineate the suitable sites for SWD using thematic layers such as land use/land cover, geology, slopes and soils. The ranks were assigned for each individual sub-criterion of thematic layers and weights assigned to each thematic layer for selection of suitable sites for SWD using Arc-GIS environment. Possible landfill sites were categorized into five classes as highly suitable, suitable, moderately suitable and unsuitable. About 16.43% (1.97 km2) and 28 % (3.42 km2) area in the region show as highly suitable and suitable sites for SWD, respectively. On the other hand, 39.13 % (4.69 km2), 9.49 % (1.14 km2) and 6.38% (0.77km2) area show moderately suitable, less suitable and unsuitable for solid waste dumping.
Os novos e velhos contextos de ação coletiva em educação: Elementos de reflexão sobre a complexidade das políticas educativas e da liderança educacional
Authors: Neves Claudia
Published: August 2020

Neste artigo pretendemos demostrar como o processo de construção das políticas educativas se reveste de uma multiplicidade de atores que atuam em níveis e contextos diversos atribuindo diversos significados às políticas. Analisar a complexidade dos processos políticos e relacioná-los com as interações que caracterizam as lideranças educacionais é um desafio interessante que exige que se pense em novos métodos de recolha e análise de dados. Com base na teoria da complexidade, lançamos novas pistas para a investigação sobre as políticas educativas e as lideranças educacionais.
GESTÃO ESCOLAR: UM OLHAR SOBRE A FORMAÇÃO INICIAL DOS DIRETORES DAS ESCOLAS PÚBLICAS BRASILEIRAS
Authors: Oliveira Ana Cristina Prado de , Paes de Carvalho Cynthia , Brito Murillo Marschner Alves de
Published: August 2020

A literatura educacional documenta recorrentemente a importância do trabalho do diretor escolar para os resultados educacionais (LEITHWOOD, 2009 e outros). Mas, os diretores são preparados em sua formação inicial para tais funções? Este artigo apresenta uma análise das grades curriculares de uma amostra de cursos de licenciatura, com foco na oferta de formação em gestão escolar. Discutimos a hipótese de que os cursos que oferecem a formação inicial da maioria destes profissionais não conseguem prepará-los para os desafios que a função de diretor apresenta nas escolas públicas brasileiras.
PROTEÇÃO INTEGRAL À CRIANÇAS E ADOLESCENTES
Authors: Telles Pedro Paulo , Sotte Sara Dutra
Published: August 2020

O Conselho Tutelar é um órgão autônomo e não jurisdicional com responsabilidade adquirida pela sociedade em garantir e proteger os direitos de crianças e adolescentes. Normatizado pelo Estatuto da Criança e do Adolescente em 1990, o Conselho Tutelar passou a ter o Estatuto não só como um parâmetro legal para sua atuação, mas como instrumento que maior simbolizou e materializou a mudança de paradigmas na sociedade brasileira para com crianças e adolescentes, inserindo-os como detendentores de direitos e autonomia, fazendo modificar o entendimento das politicas de atendimentos e tomadas de decisões. A presente discussão é uma reflexão da atuação do conselheiro tutelar no processo de garantia de direitos à crianças e adolescentes, construída a partir da atuação psicossocial junto a pratica cotidiana do Conselho Tutelar e em processo de formações para conselheiros tutelares, lócus de surgimento das problemáticas presente na atuação cotidiana dos conselheiros tutelares. Atenua-se na perspectiva de que o Estatuto da Criança e do Adolescente constitui um aparato legal para atuação do conselheiro tutelar, todavia, muita das vezes o cotidiano de atuação do conselheiro tutelar não é abarcado pelo Estatuto. A proposta do presente artigo buscou construir um referencial teórico para pratica do conselheiro tutelar atrelado as suas atribuições já previstas no Estatuto da Criança e do Adolescente e assim elencar as problemáticas postas no caminho entre o legal e o real para garantia dos direitos de crianças e adolescentes, partindo da perspectiva de analise, para construção presente artigo, de município de pequeno porte populacional, que por si só atribui problemáticas para o efetivo funcionamento do Conselho Tutelar.
DERMATOMIOSITE COMO DIAGNÓSTICO DIFERENCIAL DE DEPRESSÃO MAIOR: RELATO DE CASO
Authors: Miranda Natália Tomich de Paiva , Rocha Luciane De Andrade , Barbosa Maíra De Paula , Penatti Vinícius Schammas
Published: August 2020

A dermatomiosite (DM) é uma doença que acomete o tecido conjuntivo cuja etiologia é de origem desconhecida, podendo ser subaguda, aguda e crônica. A doença tem início insidioso com evolução lenta, apresentando edema de membros superiores e inferiores seguido de dermatite e acometimento muscular. Os principais sintomas são fraqueza muscular proximal, principalmente do tríceps e quadríceps, ocorrendo de forma simétrica, além de exantemas cutâneas característicos. As principais complicações da DM são perda dos reflexos tendinosos profundos, atrofia muscular, disfonia, disfagia e elevado risco para doença pulmonar intersticial. A principal forma de diagnóstico é através do exame clinico, devendo observar as pápulas de Gottron, as quais são consideradas sinais patognomônicos, também deve-se aplicar critérios diagnósticos específicos, podendo ser complementado por exames laboratoriais e de imagem, os quais se destacam a dosagem de creatinocinase e a eletromiografia. O tratamento é realizado com glicocorticoide, possibilitando bom prognóstico e controle da doença. O caso relatado e análise de publicações levantadas trazem à luz a discussão da importância de se fazer um diagnóstico precoce para definição de uma adequada terapêutica para dermatomiosite, com o intuito de evitar a evolução para complicações, as quais podem se tornar irreversíveis, bem como utilizar o caso clínico para corroborar com as informações disponíveis pela literatura, tanto em termos de diagnóstico como de terapêutica. As informações foram levantadas com base na entrevista com a paciente e sua acompanhante, revisão do prontuário, revisão sistemática de artigos e literaturas específicas, as quais envolveram livros, cartilhas e protocolos específicos para a patologia abordada.
RELATO DE EXPERIÊNCIA DA FORMAÇÃO DE UM GRUPO DE PROMOÇÃO DE SAÚDE NA ESTRATÉGIA DE SAÚDE DA FAMÍLIA
Authors: Schiochet Gabriela Fernanda , Christ Veridiane Gemelli , Soares Naiara Lago , Carneiro Taynara De Souza , Wosgerau Vera Lucia Leal , Silva Junior Manoelito Ferreira
Published: August 2020

A Estratégia de Saúde da Família tem como principal foco as ações de prevenção e promoção à saúde. A formação de redes de apoio tem sido uma estratégia efetiva na interação entre os membros da comunidade para solucionar problemas de natureza individual e coletiva, considerando a necessidade e realidade local. O objetivo foi relatar a formação e efetivação de grupo de apoio para promoção da saúde na Estratégia de Saúde da Família. O estágio obrigatório extracurricular do curso de Odontologia da Universidade Estadual de Ponta Grossa tem como um dos seus objetivos a elaboração de projeto de intervenção conforme a necessidade local e governabilidade da equipe de saúde e dos acadêmicos envolvidos. Na Unidade de Saúde da Família Aurélio Grott, Ponta Grossa-PR, foi criado em setembro de 2018, um grupo de tabagismo conforme metodologia preconizada pelo Ministério da Saúde e executado com apoio do Núcleo Ampliado de Saúde da Família. Após o encerramento das cinco cartilhas semanais, houve a realização pelos acadêmicos de avaliação do grupo. Os participantes avaliaram como importante a manutenção do grupo, com atividades desenvolvidas com familiares e de forma quinzenal, no entanto, com outro sem enfoque na cessação do uso do tabaco. O nome do grupo foi discutido e ficou estabelecido como ``Mentes Saudáveis``. O objetivo do grupo é o crescimento e desenvolvimento saudável dos participantes e da comunidade. Após 18 meses, o grupo mantém-se ativo, mesmo com interrupção da participação dos acadêmicos no primeiro semestre, com grande adesão e ampla variação de faixa etária dos participantes. O grupo realiza palestras, dinâmicas e colabora com atividades dentro e fora da unidade. O grupo tem apoiado em ações de promoção de saúde, e favorecido o desenvolvimento individual e coletivo, promovendo saúde e qualidade de vida para os acadêmicos, profissionais de saúde e comunidade.
IMPLICAÇÕES DAS CONDIÇÕES DE TRABALHO NA PRÁTICA PEDAGÓGICA DE PROFESSORES DE EDUCAÇÃO FÍSICA INICIANTES NA EDUCAÇÃO BÁSICA
Authors: Krug Hugo Norberto , Krug Marilia De Rosso , Krug Rodrigo De Rosso , Krug Moane Marchesan
Published: August 2020

O estudo objetivou analisar as implicações das condições de trabalho na prática pedagógica de professores de Educação Física (EF) iniciantes na Educação Básica (EB), de uma rede pública de ensino, de uma cidade do interior do estado do Rio Grande do Sul (Brasil). A pesquisa caracterizou-se como qualitativa do tipo estudo de caso. O instrumento para a coleta de informações foi um questionário, sendo a interpretação efetuada por meio da análise de conteúdo. Participaram cinco professores de EF iniciantes na EB das referidas redes de ensino e cidade. Concluímos que, as implicações das condições de trabalho na prática pedagógica dos professores de EF iniciantes na EB estudados, compõem um cenário de precarização do trabalho docente, tendo efeitos negativos sobre a profissão professor.
The Frequency of Food Allergy Among Children With Migraine Headache; A Descriptive Cross-Sectional Study
Authors: Ahmadiafshar Akefeh , Vafaee-Shahi Mohammad , Ghasemi Saeide , Khosroshahi Fariba , Riahi Aina
Published: August 2020

Background:

Headache and particularly migraine headaches are considered as a debilitating disease worldwide that can adversely affect the quality of life of children and adults. Various factors can play a critical role in the development of migraine headache attacks. The food allergens are considered as important factors. This study aimed to determine the frequency of food allergy in children with migraine headaches.

Methods:

Forty patients aged <16 years with a migraine headache were entered into the study. A questionnaire was provided in which data on demographic information and skin test results for various allergens were recorded. Dietary allergies were defined based on a positive skin test plus a patient's history of food allergies. The severity of migraine was evaluated using the Migraine disability assessment score (MIDAS) questionnaire.

Results:

The present study showed 32.5% of our participants had a food allergy. No significant association was detected between sex (p=58) and age (p=0.14) with food allergy. However, the frequency of food allergy was significantly higher in patients aged ≥12 years old (44.4%) than those aged <12 (22.7%). A significant relationship was found between the number of attacks after prophylaxis and the frequency of food allergies (p=0.032). Individuals with lower attacks had a lower food allergy.

Conclusion:

Our findings revealed that about one-third of children with a migraine headache had a food allergy. This frequency was significantly higher in children with migraines than that of the general population based on the results of previous studies. It is recommended that these patients receive a skin allergy test while preparing a strong history of food allergies or when the frequency of migraine attacks does not decrease significantly despite proper prophylaxis.
Relationship between Helicobacter pylori and Periodontal Diseases: A Meta-Analysis Study and Systematic Review
Authors: Jalili Mahsa , Mahmoodabadi Khadijeh Abdal , Sayehmiri Kourosh
Published: August 2020

Objective:

The present study aimed at the evaluation of the association between H. pylori and periodontal diseases by systematic review and meta-analysis study.

Materials and Methods:

We searched databases, including PubMed, SID, Magiran, Google Scholar, and Iranmedex using the following keywords in English: H. pylori, tooth decay, oral infection, dental infection, gingival infection and periodontal diseases. Data was analyzed using a meta-analysis and random effect model. Heterogeneity of studies was assessed using the I2 index, and data was finally analyzed with STATA (Version 11.2).

Results:

Among 10 articles reviewed that included 56,334 samples, results showed that association between H. pylori and periodontal diseases was significant with OR (odds ratio) = 1.13 (95% CI: 1.04 to 1.24).

Conclusion:

The results reveal that H. pylori can be one of the main causes of periodontal diseases. Thus, a novel way should be employed for the complete management of H. pylori infections.
User Experiences With and Recommendations for Mobile Health Technology for Hypertensive Disorders of Pregnancy: Mixed Methods Study
Authors: Jongsma Karin Rolanda , van den Heuvel Josephus F M , Rake Jasmijn , Bredenoord Annelien L , Bekker Mireille N
Published: August 2020

Background

Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide. For women at risk of hypertensive complications, guidelines recommend frequent surveillance of blood pressure and signs of preeclampsia. Clinic visits range from every 2 weeks to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies, including mobile health (mHealth), constitute a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how mHealth can be aligned with their needs and preferences.

Objective

The objectives were twofold: (1) to explore the experiences of Dutch women who had an increased risk of HDP with a blended care approach (mHealth combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms and (2) to formulate recommendations for the use and integration of mHealth in clinical care.

Methods

Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with mHealth technology, a mixed methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically.

Results

Of the 4 themes, 2 themes were related to the technologies themselves (expectations, usability), and 2 themes were related to the interaction and use of mHealth (autonomy and responsibilities of patients, responsibilities of health care professionals). First, the digital platform met the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly, and patients favored different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data, which translates to subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded.

Conclusions

Blended care using an mHealth tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to 7 recommendations for designing and implementing similar interventions and to enhance future, morally sound use of digital technologies in clinical care.
Web-Based Virtual Learning Environment for Medicine Administration in Pediatrics and Neonatology: Content Evaluation
Authors: Pereira Alayne Larissa Martins , Leon Casandra Genoveva Rosales Martins Ponce , Ribeiro Laiane Medeiros , Brasil Guilherme Da Costa , Carneiro Karen Karoline Gouveia , Vieira Géssica Borges , Barbalho Yuri Gustavo De Sousa , Silva Izabel Cristina Rodrigues Da , Funghetto Silvana Schwerz
Published: August 2020

Background

Worldwide, patient safety has been a widely discussed topic and has currently become one of the greatest challenges for health institutions. This concern is heightened when referring to children.

Objective

The goal of this study was to develop a virtual learning environment for medication administration, as a tool to facilitate the training process of undergraduate nursing students.

Methods

Descriptive research and methodological development with a quantitative and qualitative approach were used with stages of design-based research as methodological strategies. For the development of the virtual environment, 5 themes were selected: rights of medication administration, medication administration steps, medication administration routes, medication calculation, and nonpharmacological actions for pain relief. After development, 2 groups—expert judges in the field of pediatrics and neonatology for environment validation and undergraduate nursing students for the assessment—were used to assess the virtual learning environment. For the validation of the virtual learning environment by expert judges, the content validity index was used, and for the evaluation of the students, the percentage of agreement was calculated.

Results

The study included 13 experts who positively validated the virtual environment with a content validity index of 0.97, and 26 students who considered the content suitable for nursing students, although some adjustments are necessary.

Conclusions

The results show the benefit of the virtual learning environment to the training of nursing students and professional nurses who work in health care. It is an effective educational tool for teaching medication administration in pediatrics and neonatology and converges with the conjectures of active methodologies.
Lessons Learned From an Evaluation of Serious Gaming as an Alternative to Mannequin-Based Simulation Technology: Randomized Controlled Trial
Authors: Benda Natalie C , Kellogg Kathryn M , Hoffman Daniel J , Fairbanks Rollin J , Auguste Tamika
Published: August 2020

Background

The use of new technology like virtual reality, e-learning, and serious gaming can offer novel, more accessible options that have been demonstrated to improve learning outcomes.

Objective

The aim of this study was to compare the educational effectiveness of serious game–based simulation training to traditional mannequin-based simulation training and to determine the perceptions of physicians and nurses. We used an obstetric use case, namely electronic fetal monitoring interpretation and decision making, for our assessment.

Methods

This study utilized a mixed methods approach to evaluate the effectiveness of the new, serious game–based training method and assess participants’ perceptions of the training. Participants were randomized to traditional simulation training in a center with mannequins or serious game training. They then participated in an obstetrical in-situ simulation scenario to assess their learning. Participants also completed a posttraining perceptions questionnaire.

Results

The primary outcome measure for this study was the participants’ performance in an in-situ mannequin-based simulation scenario, which occurred posttraining following a washout period. No significant statistical differences were detected between the mannequin-based and serious game–based groups in overall performance, although the study was not sufficiently powered to conclude noninferiority. The survey questions were tested for significant differences in participant perceptions of the educational method, but none were found. Qualitative participant feedback revealed important areas for improvement, with a focus on game realism.

Conclusions

The serious game training tool developed has potential utility in providing education to those without access to large simulation centers; however, further validation is needed to demonstrate if this tool is as effective as mannequin-based simulation.
Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov (Preprint)
Authors: Minen Mia Tova , Reichel Julia Frederica , Pemmireddy Pallavi , Loder Elizabeth , Torous John
Published: August 2020

BACKGROUND

The development of mobile health (mHealth) technologies is progressing at a faster pace than that of the science to evaluate their validity and efficacy. Under the International Committee of Journal Medical Editors (ICMJE) guidelines, clinical trials that prospectively assign people to interventions should be registered with a database before the initiation of the study.

OBJECTIVE

The aim of this study was to better understand the smartphone mHealth trials for high-burden neuropsychiatric conditions registered on ClinicalTrials.gov through November 2018, including the number, types, and characteristics of the studies being conducted; the frequency and timing of any outcome changes; and the reporting of results.

METHODS

We conducted a systematic search of ClinicalTrials.gov for the top 10 most disabling neuropsychiatric conditions and prespecified terms related to mHealth. According to the 2016 World Health Organization Global Burden of Disease Study, the top 10 most disabling neuropsychiatric conditions are (1) stroke, (2) migraine, (3) major depressive disorder, (4) Alzheimer disease and other dementias, (5) anxiety disorders, (6) alcohol use disorders, (7) opioid use disorders, (8) epilepsy, (9) schizophrenia, and (10) other mental and substance use disorders. There were no date, location, or status restrictions.

RESULTS

Our search identified 135 studies. A total of 28.9% (39/135) of studies evaluated interventions for major depressive disorder, 14.1% (19/135) of studies evaluated interventions for alcohol use disorders, 12.6% (17/135) of studies evaluated interventions for stroke, 11.1% (15/135) of studies evaluated interventions for schizophrenia, 8.1% (11/135) of studies evaluated interventions for anxiety disorders, 8.1% (11/135) of studies evaluated interventions for other mental and substance use disorders, 7.4% (10/135) of studies evaluated interventions for opioid use disorders, 3.7% (5/135) of studies evaluated interventions for Alzheimer disease or other dementias, 3.0% (4/135) of studies evaluated interventions for epilepsy, and 3.0% (4/135) of studies evaluated interventions for migraine. The studies were first registered in 2008; more than half of the studies were registered from 2016 to 2018. A total of 18.5% (25/135) of trials had results reported in some publicly accessible location. Across all the studies, the mean estimated enrollment (reported by the study) was 1078, although the median was only 100. In addition, across all the studies, the actual reported enrollment was lower, with a mean of 249 and a median of 80. Only about a quarter of the studies (35/135, 25.9%) were funded by the National Institutes of Health.

CONCLUSIONS

Despite the increasing use of health-based technologies, this analysis of ClinicalTrials.gov suggests that only a few apps for high-burden neuropsychiatric conditions are being clinically evaluated in trials.
Identification of Semantically Similar Sentences in Clinical Notes: Iterative Intermediate Training Using Multi-Task Learning (Preprint)
Authors: Mahajan Diwakar , Poddar Ananya , Liang Jennifer J , Lin Yen-Ting , Prager John M , Suryanarayanan Parthasarathy , Raghavan Preethi , Tsou Ching-Huei
Published: August 2020

BACKGROUND

Although electronic health records (EHRs) have been widely adopted in health care, effective use of EHR data is often limited because of redundant information in clinical notes introduced by the use of templates and copy-paste during note generation. Thus, it is imperative to develop solutions that can condense information while retaining its value. A step in this direction is measuring the semantic similarity between clinical text snippets. To address this problem, we participated in the 2019 National NLP Clinical Challenges (n2c2)/Open Health Natural Language Processing Consortium (OHNLP) clinical semantic textual similarity (ClinicalSTS) shared task.

OBJECTIVE

This study aims to improve the performance and robustness of semantic textual similarity in the clinical domain by leveraging manually labeled data from related tasks and contextualized embeddings from pretrained transformer-based language models.

METHODS

The ClinicalSTS data set consists of 1642 pairs of deidentified clinical text snippets annotated in a continuous scale of 0-5, indicating degrees of semantic similarity. We developed an iterative intermediate training approach using multi-task learning (IIT-MTL), a multi-task training approach that employs iterative data set selection. We applied this process to bidirectional encoder representations from transformers on clinical text mining (ClinicalBERT), a pretrained domain-specific transformer-based language model, and fine-tuned the resulting model on the target ClinicalSTS task. We incrementally ensembled the output from applying IIT-MTL on ClinicalBERT with the output of other language models (bidirectional encoder representations from transformers for biomedical text mining [BioBERT], multi-task deep neural networks [MT-DNN], and robustly optimized BERT approach [RoBERTa]) and handcrafted features using regression-based learning algorithms. On the basis of these experiments, we adopted the top-performing configurations as our official submissions.

RESULTS

Our system ranked first out of 87 submitted systems in the 2019 n2c2/OHNLP ClinicalSTS challenge, achieving state-of-the-art results with a Pearson correlation coefficient of 0.9010. This winning system was an ensembled model leveraging the output of IIT-MTL on ClinicalBERT with BioBERT, MT-DNN, and handcrafted medication features.

CONCLUSIONS

This study demonstrates that IIT-MTL is an effective way to leverage annotated data from related tasks to improve performance on a target task with a limited data set. This contribution opens new avenues of exploration for optimized data set selection to generate more robust and universal contextual representations of text in the clinical domain.
Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study (Preprint)
Authors: Sajnani Jocelyn , Swan Kimberly , Wolff Sharon , Drummond Kelsi
Published: August 2020

BACKGROUND

With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction.

OBJECTIVE

 This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population.

METHODS

 We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient.

RESULTS

 A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ≥9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ≥9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ≥9).

CONCLUSIONS

 Postoperative text messages increased patients’ perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate.
An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Kazi Abdul Momin , Qazi Saad Ahmed , Khawaja Sadori , Ahsan Nazia , Ahmed Rao Moueed , Sameen Fareeha , Khan Mughal Muhammad Ayub , Saqib Muhammad , Ali Sikander , Kaleemuddin Hussain , Rauf Yasir , Raza Mehreen , Jamal Saima , Abbasi Munir , Stergioulas Lampros K
Published: August 2020

BACKGROUND

The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI.

OBJECTIVE

The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement.

METHODS

A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage.

RESULTS

Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age.

CONCLUSIONS

This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs.

CLINICALTRIAL

ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/22996
Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial (Preprint)
Authors: Dimeff Linda A , Jobes David A , Koerner Kelly , Kako Nadia , Jerome Topher , Kelley-Brimer Angela , Boudreaux Edwin D , Beadnell Blair , Goering Paul , Witterholt Suzanne , Melin Gabrielle , Samike Vicki , Schak Kathryn M
Published: August 2020

BACKGROUND

Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices.

OBJECTIVE

This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs.

METHODS

Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted.

RESULTS

Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants’ app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual.

CONCLUSIONS

Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services.

CLINICALTRIAL

ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386