bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Bisphosphonates on Managing Osteoporosis After Spinal Cord Injury: A Meta-Analysis
Authors: Xinghua Ji , Junjie Wang , Yao Guo , Peng Shang , Jianzhong Huo
Published: May 2020

Background:

The increased bone loss after spinal cord injury (SCI) is associated with an increase in
the morbidity and mortality of fragility fractures, which can constitute a substantial cost to health care systems.
Bisphosphonates (BPs) are now the principal class of medications used for osteoporosis.

Objective:

To demonstrate the effect of BPs on treating osteoporosis after SCI.

Methods:

A comprehensive search in PubMed, EMBASE, Web of Science and Cochrane Central databases was
undertaken for randomized controlled trials (RCTs), exploring the effect of BPs on osteoporosis after SCI. The
primary outcome measures were the BMD of different locations, serum bone turnover marker levels, serum biochemistry
marker levels and adverse effect (AE) risks. The final search was performed in September 2019. Reporting
was carried out according to PRISMA Guidelines.

Results:

Six RCTs were included. A total of 147 patients met the inclusion criteria. BPs were found to statistically
prevent bone loss in the total hip, femoral neck and trochanter at the 6- and 12-month follow-up points and
to increase the BMD of the lumbar spine at the 12-month follow-up time point. BPs had no clear effect on serum
PINP or serum calcium levels at the 12-month follow-up time point.

Conclusion:

BP therapy may prevent bone loss in the lumbar spine and hip when administered early after SCI
and has relatively high safety.
MicroRNA-126: Dual Role in Angiogenesis Dependent Diseases
Authors: Nammian Pegah , Razban Vahid , Tabei Seyed Mohammad Bagher , Asadi-Yousefabad Seyedeh-Leili
Published: May 2020

Background:

MicroRNA-126, a microRNA implicated in blood vessel integrity and angiogenesis is
significantly up/down regulated in different physiological and pathological conditions related to angiogenesis
such as cardiovascular formation and angiogenesis dependent diseases. MicroRNA-126 plays a critical role in
angiogenesis via regulating the proliferation, differentiation, migration, and apoptosis of angiogenesis related
cells such as endothelial cells.

Objective:

The aim of this review is to investigate the molecular mechanisms and the effects of microRNA-126
on the process of angiogenesis in pathophysiological conditions.

Methods:

To conduct this review, related articles published between 2001 and 2019 were collected from the
PubMed, Web of Science, Google Scholar, Scopus and Scientific Information Database using search terms such
as microRNA-126, angiogenesis, cardiovascular disorders, hypoxia, VEFG-A, endothelial cells, VEGF pathway,
and gene silencing. Then, the qualified articles were reviewed.

Result:

MicroRNA-126 regulates the response of endothelial cells to VEGF, through directly repressing multiple
targets, including Sprouty-related EVH1 domain-containing protein 1 (SPRED1) and phosphoinositol-3 kinase
regulatory subunit 2 (PIK3R2/p85-b). MicroRNA-126 -3p and microRNA-126 -5p have cell-type and strandspecific
functions and also various targets in angiogenesis that lead to the regulation of angiogenesis via different
pathways and consequently diverse responses.

Conclusion:

MicroRNA-126 can bind to multiple targets and potentially be both positive and negative regulators
of gene expression. Thus, microRNA-126 could cause the opposite biological effects depending on the context.
As a result, understanding the different cellular pathways through which microRNA-126 regulates angiogenesis
in various situations is a critical aspect in the development of novel and effective treatments for diseases with
insufficient angiogenesis.
Withdrawal Notice: Magnetically Recoverable Nickel Ferrite (NiFe2O4) Nanocatalysts in the Synthesis of Heterocycles
Authors: Kazemi Mosstafa
Published: May 2020

The article has been withdrawn at the request of the authors of the journal Mini-Reviews in Organic Chemistry.

Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused.

The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php

Bentham Science Disclaimer:

It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously
submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere
must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting
the article for publication the authors agree that the publishers have the legal right to take appropriate action against the
authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright
of their article is transferred to the publishers if and when the article is accepted for publication.
Polyunsaturated Fatty Acid and Sphingolipid Measurements by Tandem Mass Spectrometry
Authors: Aslan Mutay
Published: May 2020

Linoleic Acid (LA) (omega-6) and Alpha-Linolenic Acid (ALA) (omega-3) are essential
fatty acids and give rise to Arachidonic Acid (AA), Eicosapentaenoic Acid (EPA) and Docosahexaenoic
Acid (DHA) that are important in metabolic homeostasis. The omega-6:omega-3 ratio can be
a prognostic consideration in cardiovascular and inflammatory diseases. Sphingolipids are bioactive
lipids found in cell membranes that play a role in cell growth, differentiation and apoptosis. Electrospray
Ionization (ESI) coupled with tandem Mass Spectrometry (MS/MS) is a simple and speedy
method to identify and quantify these lipids in various biological matrices. Tandem mass spectrometric
analyses can be performed on cell lysates, tissue homogenates and serum samples to measure
quantitative changes directly in lipid extracts from these different matrices. The present review summarizes
measurement of omega-3 (n-3) and omega-6 (n-6) Polyunsaturated Fatty Acids (PUFAs),
their metabolism to eicosanoids and their role in certain disease states. Altered sphingolipid metabolism
is also associated with a number of human diseases. Therefore, understanding sphingolipid metabolism
is important to comprehend the function of sphingolipids in cellular processes. In this review,
we focus on pathways of Ceramide (CER) and Sphingomyelin (SM) synthesis and discuss altered
levels reported in disease states. Results of reported studies herein clearly show that PUFAs,
SMs and CERs carry out a large number of fundamental functions. They serve as structural elements
in cellular membranes, and they work as signaling molecules. Alterations in their amounts of expression
occurring in diabetes, obesity, inflammation and ER stress-related conditions lead to dysfunctions
contributing to disease pathogenesis.
Annurca Apple Biophenols’ Effects in Combination with Cisplatin on A549 Cells
Authors: Boccellino Mariarosaria , Quagliuolo Lucio , D’Angelo Stefania
Published: May 2020

Background:

The role of a healthy and balanced diet in cancer prevention should never be
underestimated; some nutritional factors can reduce the side effects of chemotherapy or radiotherapy
and contribute to increasing its effectiveness. Therefore, in recent years, it has been thought to associate
the administration of antioxidants to the chemotherapy approach that can protect non-tumor
cells from the cytotoxic action of these drugs. However, the protective action of these substances
could also limit the chemotherapy effects against the neoplastic cells themselves.

Objective:

In this context, the goal of this work was to test the viability of cultured human non-small
lung cancer A549 cells in response to the combined administration of cisplatin (CDDP) and polyphenols.
In particular, Annurca apple flesh polyphenol extract (AFPE) action was examined.

Methods:

A549 cells were treated with AFPE alone or in combination with CDDP and then cell viability
was measured by the MTT assay. The effects of constituent polyphenols (+)-catechin, (-)-
epicatechin, and caffeic acid) in AFPE were also evaluated. The cell morphology was observed by an
inverted phase-contrast microscope.

Results:

CDDP reduced A549 cell viability in both concentration- and time-dependent manners. Polyphenols
and CDDP co-administration did not interfere with the CDDP efficacy, in fact, the cellular
vitality was found to be similar to that detected in the samples treated with CDDP alone.

Conclusion:

In conclusion, the co-administration of AFPE with CDDP does not interfere with its
chemotherapy efficacy. Therefore, Annurca apple could be a good candidate to act as an antioxidant
and potentially reduce the side effects of CDDP therapy, although the joint effect of AFPE and
CDDP on normal cells is still unclear. More studies will be needed to analyze the molecular mechanism
of AFPE and in vivo studies will also be needed to verify the anticancer effects. These findings
may represent a starting point for the design of new clinical trials for use in cancer treatment.
The Shift of HbF to HbA under Influence of SKA2 Gene; A Possible Link between Cortisol and Hematopoietic Maturation in Term and Preterm Newborns
Authors: Ijabi Janat , Afrisham Reza , Moradi-Sardareh Hemen , Roozehdar Parisa , Seifi Fatemeh , Sahebkar Amirhossein , Ijabi Roghayeh
Published: May 2020

Background:

We hypothesized that the SKA2 gene can convert hemoglobin F to A leading
to the maturity of the hematopoietic system by glucocorticoid hormone; so, the present study aimed to
investigate the health outcome of newborns by using the effect of SKA2 gene on hematopoietic maturation.

Methods:

At first, 142 samples were divided into term and preterm. After sampling from the umbilical
cord blood, the expression of SKA2 genes and HbA and F were evaluated by quantitative RT-PCR.
The blood gases were measured by Campact 3 device. Finally, the cortisol level was measured by
ELISA method and HbA and F levels were investigated by capillary electrophoresis.

Results:

The blood gases and Apgar scores were more favorable in term newborns (P <0.001). Levels
of protein/expression of HbF in newborns with Apgar score greater than 7 was lower than that of the
newborns with Apgar score below 7 (P <0.001). Cortisol and HbA levels were considerably higher in
term newborns compared to the preterm ones (P <0.001). In the preterm and term groups, SKA2 gene
expression had a positive and significant relationship with cortisol and HbA levels as well as a negative
relationship with the HbF level. In the preterm group, a positive and significant relationship was
observed between the expression of SKA2 and HbF genes.

Conclusion:

The results revealed that the SKA2 gene affected hematopoietic maturation in preterm
and term newborns and the health outcome of newborns improved by increasing HbA level.
Lead Anti-Obesity Compounds from Nature
Authors: Dahiya Vinesh , Vasudeva Neeru , Sharma Sunil , Kumar Ashok , Rowley David
Published: May 2020

Background :

Obesity has become a global issue, leading to increased risk of metabolic
syndrome, which encompasses diabetes, cardiovascular disease, stroke, hypertension, and certain cancers.
However, obesity is difficult to control through diet and exercise alone, as they are difficult to
implement.

Objective:

The objective of this review is to elucidate the active constituents that can be obtained from
various natural sources that act as anti-obesity agents. Due to the global rise in the prevalence of obesity,
an urgent need to prevent and control it has arisen.

Methods:

For this review, we compiled information about natural anti-obesity products through an
electronic search of the articles available via PubMed, Scopus, and other internet sources for the period
1975-2019 and included our own research. We analyzed and organized data on various natural products
in popular use in addition to relevant pharmacognostic and biological studies. The products’
mechanisms of action were also investigated.

Conclusion:

Consumption of diets that include high amounts of active anti-obesity natural compounds
is a promising strategy for the suppression of lipid accumulation and adipogenesis in obese individuals.
Signalement van: Gezelliana. Kroniek van de Gezellestudie, nummer 2011 / Piet Couttenier e.a. (red.)
Authors: Van den Bossche Stefan
Published: May 2020

–
Signalement van: Cahiers Staf De Clercq. Bijdragen ter bevordering van de studie van Staf De Clercq en tijdgenoten, 6 / Pieter Jan Verstraete (red.)
Authors: De Wever Bruno
Published: May 2020

–
De ongeschikte zesde provincie van Vlaanderen
Authors: Verdoodt Frans-Jos
Published: May 2020

–
Recensie van: Memoires. Van kernfysicus tot Vlaams communist / Jef Turf
Authors: Van Velthoven Harry
Published: May 2020

–
Het verdriet is gans het volk. Over Hugo Claus en de Vlaamse beweging
Authors: Absillis Kevin , Lemmens Wendy
Published: May 2020

Vijf jaar na zijn overlijden werd de Vlaamse schrijver Hugo Claus in 2013 uitgebreid en in majeur herdacht. In intellectuele en culturele kringen wordt hij onmiskenbaar nog altijd op handen gedragen. Dat heeft uiteraard te maken met zijn grote artistieke verdiensten, maar ook, zo blijkt, omdat Claus’ rijke erfenis ‘geoperationaliseerd’ kan worden in de strijd tegen het Vlaams-nationalisme in het algemeen en tegen het electorale succes van de N-VA in het bijzonder. Het is zonder meer zo dat Claus zich in interviews en in zijn literaire werk een bijzonder lucide criticus heeft getoond van het discours van de Vlaamse beweging. Toch blijft het recente gedweep met Claus als de grote anti-Vlaams-nationalist blind voor enkele belangrijke nuances. Dit artikel wil de verhouding tussen Claus en de Vlaamse Beweging op essayistische wijze kritisch belichten. Het streeft geen volledigheid na, maar test enkele probleemstellingen door een selectie van bekende en minder bekende teksten van Claus te analyseren en in verband te brengen met de biografische achtergrond van de auteur. Hierbij vormt Claus’ ambivalente verhouding tot het werk van Hendrik Conscience de rode draad.________The ‘Sorrow (of Belgium)’ applies to the entire nation. About Hugo Claus and the Flemish MovementIn 2013, five years after his death the Flemish author Hugo Claus was commemorated extensively and on a major scale. Clearly, he is still much admired in intellectual and cultural circles. This is obviously related to his great artistic merits, but also it appears, because Claus’s rich heritage can be ‘operationalised’ in the struggle against Flemish Nationalism in general, and the electoral success of the N-VA in particular. It is undeniable that during interviews and in his literary work Clause proved to be a particularly lucid critic of the discourse of the Flemish movement. However, the recent passion for Claus as the great anti-Flemish Nationalist ignores some important nuances. This article in the form of an essay is intended to take a critical look at the relationship between Claus and the Flemish Movement. It does not attempt to be complete, but only tests out some premises by analysing some well known and lesser known texts by Claus and by putting them into the context of the biographical background of the author. The leitmotiv hereby is Claus’s ambivalent attitude to the writings of Hendrik Conscience.
Signalement van: Joris van Severen. Zijn persoon zijn gedachten zijn invloed zijn werk. Jaarboek 17
Authors: Wils Lode
Published: May 2020

–
De lijken van de kiosk. Op zoek naar een graf voor de 21 slachtoffers van Abbeville
Authors: Cobbaert Tom
Published: May 2020

–
“Het Europa van de regio’s is een vage en dubbelzinnige ambitie”. Een interview met Anwan Elias over nationalisme en Europese integratie
Authors: Cobbaert Tom
Published: May 2020

–
Recensie van: Het (on)Verenigd Koninkrijk 1815-1830 > 2015. Een politiek experiment in de Lade Landen / Remieg Aerts & Gita Deneckere (red.)
Authors: Wils Lode
Published: May 2020

–
Recensie van: En nu gaan ze boeten! Repressie tegen zwarten in Vlaanderen na WO II / Geert Clerbout
Authors: Van Campenhout Nico
Published: May 2020

–
Signalement van: Onwillig Brussel. Een verhaal over Jodenvervolging en verzet / Lieven Saerens
Authors: Wils Lode
Published: May 2020

–
Signalement van: De Franse Nederlanden, Jaarboeken 38 en 39 en van The Low Countries. Arts and Society in Flanders and the Netherlands, 22
Authors: Seberechts Frank
Published: May 2020

–
Signalement van: Robrecht Mortier / Antoon Dieusaert, Luc Dieusaert & Paul Dieusaert
Authors: Verdoodt Frans-Jos
Published: May 2020

–
Recensie van: Frans Van Cauwelaert. Politieke biografie / Lode Wils
Authors: Scheltiens Vincent
Published: May 2020

–
Автоволновой импульс в среде с дисбалансом между тепловыделением и теплоотводом при произвольной величине тепловой дисперсии
Authors: Молевич Н.Е. , Рящиков Д.С.
Published: May 2020

An analytical method for determining the amplitude and velocity of an autowave pulse emerging in isentropically unstable heat-releasing media is presented. The method is suitable for any values of acoustic dispersion and growth rate and requires the knowledge of heat-loss function only without the need for a numerical solution of a complete system of gas-dynamic equations.
Высокоэффективные фотоэлектрические модули с концентраторами солнечного излучения
Authors: Чекалин А.В. , Андреева А.В. , Давидюк Н.Ю. , Малевский Д.А. , Покровский П.В. , Потапович Н.С. , Садчиков Н.А. , Андреев В.М.
Published: May 2020

High efficiency concentrator photovoltaic modules have been designed and manufactured. Each module consists of a lens panel with 32 Fresnel lenses 12x12 cm2 each, 32 multijunction solar cells with focons as secondary concentrators and electro insulated heatsinks made of alumina ceramics mounted on aluminum sheet. The module with a total area of 0.46 m2 measured under solar simulator with a spectrum AM 1.5D and irradiance 1000 W/m2 demonstrated an efficiency of 32.2%. Meanwhile, a single submodule with an area of 144 cm2 demonstrated an efficiency equal to 33.9%.
Фотоэлектрические параметры фотоприемников на основе тонких микрокристаллических пленок перовскита CH-=SUB=-3-=/SUB=-NH-=SUB=-3-=/SUB=-PbI-=SUB=-3-=/SUB=-
Authors: Амасев Д.В. , Савин К.А. , Николаев С.Н.
Published: May 2020

The photoelectric characteristics of photoresistance type photodetectors based on microcrystalline films of organometallic perovskite CH3NH3PbI3 with gold and aluminum contacts were investigated. The maximum photosensitivity of the photodetectors was 30 A / W. The rise and fall times of photoconductivity ranged from 2.7 to 15.3 μs.
Эффект спиновой аккумуляции в эпитаксиальной структуре Fe-=SUB=-3-=/SUB=-Si/n-Si и влияние на него электрического смещения
Authors: Тарасов А.С. , Лукьяненко А.В. , Бондарев И.А. , Яковлев И.А. , Варнаков С.Н. , Овчинников С.Г. , Волков Н.В.
Published: May 2020

The electrical injection of a spin-polarized current into silicon was demonstrated in the Fe3Si/n-Si epitaxial structure. The spin accumulation effect was studied by measuring local and nonlocal voltage signals in a specially prepared 4-terminal device. The detected effect of electrical bias on the spin signal is discussed and compared with other results reported for ferromagnet/semiconductor structures.
Internet-Based Self-Management Support After High-Altitude Climate Treatment for Severe Asthma: Randomized Controlled Trial
Authors: Beerthuizen Thijs , Rijssenbeek-Nouwens Lucia H , van Koppen Sophia M , Khusial Rishi J , Snoeck-Stroband Jiska B , Sont Jacob K
Published: May 2020

Background

In patients with severe asthma, high-altitude climate treatment has been shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and returning to sea level.

Objective

We assessed the effectiveness of a patient-tailored, internet-based, self-management strategy in addition to usual care after finishing high-altitude climate treatment.

Methods

We performed a randomized controlled trial with a 1-year follow-up in patients from a high-altitude asthma center in Davos, Switzerland. At the end of a 12-week multidisciplinary rehabilitation program, 62 adults with asthma were randomized to receive either internet-based self-management support in addition to usual care (n=33) or usual care only after discharge (n=29). The endpoints were changes in asthma-related quality of life according to the Asthma Quality of Life Questionnaire (AQLQ) (a higher score is better) and asthma control according to the Asthma Control Questionnaire (ACQ) (a lower score is better), with a minimally important difference of 0.5 points for both.

Results

Asthma-related quality of life and asthma control declined over time in the usual care strategy group, whereas there was a slower decline in the internet-based strategy group. For both endpoints, mixed-model analysis showed a significant positive effect in favor of internet-based self-management during follow-up (mean AQLQ score difference 0.39, 95% CI 0.092-0.69; P=.01 and ACQ score difference −0.50, 95% CI −0.86 to −0.15; P=.006), which was prominent among patients with uncontrolled asthma at discharge (AQLQ score difference 0.59, 95% CI 0.19-0.99; P=.003 and ACQ score difference −0.73, 95% CI −1.18 to −0.28; P=.002).

Conclusions

Internet-based self-management support was associated with a smaller decline in quality of life and asthma control as compared with usual care, especially in patients with lower asthma control, after completion of high-altitude climate treatment. Internet-based self-management support in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control.

Trial Registration

The trial is registered in the Netherlands Trial Register (NTR1995).
Understanding the Association Between Electronic Health Record Satisfaction and the Well-Being of Nurses: Survey Study
Authors: Khairat Saif , Xi Lin , Liu Songzi , Shrestha Shilpa , Austin Charles
Published: May 2020

Background

Intensive care unit (ICU) nurses experience high levels of burnout related to the high-stress environment. Management of electronic health records (EHR) is a contributing factor to physician burnout. However, limited research has established the relationship between the nurse’s well-being and EHR use.

Objective

The objective of this study was to examine the association between EHR use and the well-being of nurses.

Methods

We surveyed registered nurses employed at a major Southeastern medical center in the United States about their demographics, experience with EHRs, satisfaction with EHRs, and elements of well-being. The correlation between subgroup demographics and survey questions was examined using Kendall and Fisher tests.

Results

A total of 113 ICU registered nurses responded to the survey, of which 93 (82.3%) were females. The population had a mean age of 35.18 years (SD 10.65). A significant association was found between satisfaction and well-being scores, where higher EHR satisfaction was associated with higher self-reported well-being (correlation 0.35, P<.001). Nurses who were unhappy with the time spent in EHR use compared with direct patient care reported higher levels of stress (P<.001) and isolation (P=.009). Older nurses reported higher dissatisfaction with the amount of time spent on EHR tasks related to direct patient care compared to younger nurses (P<.001).

Conclusions

Although nurses reported acceptable satisfaction scores with EHR use, deeper analysis suggests that EHR indirectly affects the well-being of nurses. These findings strongly indicate that lower EHR satisfaction can impact the well-being of nurses. More research is needed to optimize the nurse-EHR experience through more user-centered design approaches.
Privacy-Preserving Deep Learning for the Detection of Protected Health Information in Real-World Data: Comparative Evaluation
Authors: Festag Sven , Spreckelsen Cord
Published: May 2020

Background

Collaborative privacy-preserving training methods allow for the integration of locally stored private data sets into machine learning approaches while ensuring confidentiality and nondisclosure.

Objective

In this work we assess the performance of a state-of-the-art neural network approach for the detection of protected health information in texts trained in a collaborative privacy-preserving way.

Methods

The training adopts distributed selective stochastic gradient descent (ie, it works by exchanging local learning results achieved on private data sets). Five networks were trained on separated real-world clinical data sets by using the privacy-protecting protocol. In total, the data sets contain 1304 real longitudinal patient records for 296 patients.

Results

These networks reached a mean F1 value of 0.955. The gold standard centralized training that is based on the union of all sets and does not take data security into consideration reaches a final value of 0.962.

Conclusions

Using real-world clinical data, our study shows that detection of protected health information can be secured by collaborative privacy-preserving training. In general, the approach shows the feasibility of deep learning on distributed and confidential clinical data while ensuring data protection.
An Objective Structured Clinical Examination for Medical Student Radiology Clerkships: Reproducibility Study
Authors: Staziaki Pedro Vinícius , Sarangi Rutuparna , Parikh Ujas N , Brooks Jeffrey G , LeBedis Christina Alexandra , Shaffer Kitt
Published: May 2020

Background

Objective structured clinical examinations (OSCEs) are a useful method to evaluate medical students’ performance in the clerkship years. OSCEs are designed to assess skills and knowledge in a standardized clinical setting and through use of a preset standard grading sheet, so that clinical knowledge can be evaluated at a high level and in a reproducible way.

Objective

This study aimed to present our OSCE assessment tool designed specifically for radiology clerkship medical students, which we called the objective structured radiology examination (OSRE), with the intent to advance the assessment of clerkship medical students by providing an objective, structured, reproducible, and low-cost method to evaluate medical students’ radiology knowledge and the reproducibility of this assessment tool.

Methods

We designed 9 different OSRE cases for radiology clerkship classes with participating third- and fourth-year medical students. Each examination comprises 1 to 3 images, a clinical scenario, and structured questions, along with a standardized scoring sheet that allows for an objective and low-cost assessment. Each medical student completed 3 of 9 random examination cases during their rotation. To evaluate for reproducibility of our scoring sheet assessment tool, we used 5 examiners to grade the same students. Reproducibility for each case and consistency for each grader were assessed with a two-way mixed effects intraclass correlation coefficient (ICC). An ICC below 0.4 was deemed poor to fair, an ICC of 0.41 to 0.60 was moderate, an ICC of 0.6 to 0.8 was substantial, and an ICC greater than 0.8 was almost perfect. We also assessed the correlation of scores and the students’ clinical experience with a linear regression model and compared mean grades between third- and fourth-year students.

Results

A total of 181 students (156 third- and 25 fourth-year students) were included in the study for a full academic year. Moreover, 6 of 9 cases demonstrated average ICCs more than 0.6 (substantial correlation), and the average ICCs ranged from 0.36 to 0.80 (P<.001 for all the cases). The average ICC for each grader was more than 0.60 (substantial correlation). The average grade among the third-year students was 11.9 (SD 4.9), compared with 12.8 (SD 5) among the fourth-year students (P=.005). There was no correlation between clinical experience and OSRE grade (−0.02; P=.48), adjusting for the medical school year.

Conclusions

Our OSRE is a reproducible assessment tool with most of our OSRE cases showing substantial correlation, except for 3 cases. No expertise in radiology is needed to grade these examinations using our scoring sheet. There was no correlation between scores and the clinical experience of the medical students tested.
User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study
Authors: Korpershoek Yvonne J G , Hermsen Sander , Schoonhoven Lisette , Schuurmans Marieke J , Trappenburg Jaap C A
Published: May 2020

Background

Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD.

Objective

This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD.

Methods

The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process.

Results

The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan.

Conclusions

By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.
Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Liu Kaifeng , Xie Zhenzhen , Or Calvin Kalun
Published: May 2020

Background

Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence.

Objective

A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes.

Methods

We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A1c (HbA1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis.

Results

A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA1c levels (standardized mean difference [SMD] −0.44, 95% CI −0.59 to −0.29; P<.001), SBP (SMD −0.17, 95% CI −0.31 to −0.03, P=.02), and DBP (SMD −0.17, 95% CI −0.30 to −0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found.

Conclusions

Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient–care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination.
Exploring Features of the Pervasive Game Pokémon GO That Enable Behavior Change: Qualitative Study
Authors: Arjoranta Jonne , Kari Tuomas , Salo Markus
Published: May 2020

Background

Digital gaming is one of the most popular forms of entertainment in the world. While prior literature concluded that digital games can enable changes in players’ behaviors, there is limited knowledge about different types of behavior changes and the game features driving them. Understanding behavior changes and the game features behind them is important because digital games can motivate players to change their behavior for the better (or worse).

Objective

This study investigates the types of behavior changes and their underlying game features within the context of the popular pervasive game Pokémon GO.

Methods

We collected data from 262 respondents with a critical incident technique (CIT) questionnaire. We analyzed the responses with applied thematic analysis with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software.

Results

We discovered 8 types of behavior changes and 13 game features relevant to those behavior changes. The behavior changes included added activity in life, enhancing routines, exploration, increased physical activity, strengthening social bonds, lowering social barriers, increased positive emotional expression and self-treatment. The game features included reaching a higher level, catching new Pokémon, evolving new Pokémon, visiting PokéStops, exploring PokéStops, hatching eggs, fighting in gyms, collaborative fighting, exploiting special events, finding specific Pokémon, using items, Pokémon theme, and game location tied to physical location. The behavior changes were connected to specific game features, with game location tied to physical location and catching new Pokémon being the most common and connected to all behavior changes.

Conclusions

Our findings indicate that the surveyed players changed their behaviors while or after playing Pokémon GO. The respondents reported being more social, expressed more positive emotions, found more meaningfulness in their routines, and had increased motivation to explore their surroundings.
Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach
Authors: Peng Li-Ning , Hsiao Fei-Yuan , Lee Wei-Ju , Huang Shih-Tsung , Chen Liang-Kung
Published: May 2020

Background

Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice.

Objective

This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship.

Methods

In this study, we used Taiwan’s National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality.

Results

The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes.

Conclusions

The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society.
Mobile Health for Pediatric Weight Management: Systematic Scoping Review
Authors: Tully Louise , Burls Amanda , Sorensen Jan , El-Moslemany Riyad , O'Malley Grace
Published: May 2020

Background

The prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions.

Objective

We aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies.

Methods

We conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured.

Results

We identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69% (29/42) of the studies specified a BCT used.

Conclusions

Pediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies.
Usability of a Mobile App for Improving Literacy in Children With Hearing Impairment: Focus Group Study
Authors: DeForte Shelly , Sezgin Emre , Huefner Janelle , Lucius Shana , Luna John , Satyapriya Anand A , Malhotra Prashant
Published: May 2020

Background

Children with hearing loss, even those identified early and who use hearing aids or cochlear implants, may face challenges in developing spoken language and literacy. This can lead to academic, behavioral, and social difficulties. There are apps for healthy children to improve their spoken language and literacy and apps that focus on sign language proficiency for children with hearing loss, but these apps are limited for children with hearing loss. Therefore, we have developed an app called Hear Me Read, which uses enhanced digital stories as therapy tools for speech, language, and literacy for children with hearing loss. The platform has therapist and parent/child modes that allow (1) the selection of high-quality, illustrated digital stories by a speech-language pathologist, parent, or child; (2) the modification of digital stories for a multitude of speech and language targets; and (3) the assignment of stories by a therapist to facilitate individualized speech and language goals. In addition, Hear Me Read makes the caregiver a core partner in engagement through functionality, whereby the caregiver can record video and audio of themselves to be played back by the child.

Objective

This study aimed to evaluate the user experience of the Hear Me Read app through a focus group study with caregivers and their children.

Methods

We recruited 16 participants (8 children with and without hearing loss and 8 caregivers) to participate in 1-hour focus groups. Caregivers and children interacted with the app and discussed their experiences through a semistructured group interview. We employed thematic analysis methods and analyzed the data. We used feedback from the focus group to improve the elements of the app for a larger clinical trial assessing the impact of the app on outcomes.

Results

We identified three themes: default needs, specific needs, and family needs. Participants found the app to be esthetically pleasing and easy to use. The findings of this study helped us to identify usability attributes and to amend app functionalities to best fit user needs. Caregivers and children appreciated the enhancements, such as highlighting of parts of speech and caregiver reading of video playback, which were made possible by the digital format. Participants expressed that the app could be used to enhance family reading sessions and family interaction.

Conclusions

The findings from this focus group study are promising for the use of educational apps designed specifically for those with hearing loss who are pursuing listening and spoken language as a communication outcome. Further investigation is needed with larger sample sizes to understand the clinical impact on relevant language and literacy outcomes in this population.
Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework
Authors: Krohn Stephan , Tromp Johanne , Quinque Eva M , Belger Julia , Klotzsche Felix , Rekers Sophia , Chojecki Paul , de Mooij Jeroen , Akbal Mert , McCall Cade , Villringer Arno , Gaebler Michael , Finke Carsten , Thöne-Otto Angelika
Published: May 2020

Virtual reality (VR) represents a key technology of the 21st century, attracting substantial interest from a wide range of scientific disciplines. With regard to clinical neuropsychology, a multitude of new VR applications are being developed to overcome the limitations of classical paradigms. Consequently, researchers increasingly face the challenge of systematically evaluating the characteristics and quality of VR applications to design the optimal paradigm for their specific research question and study population. However, the multifaceted character of contemporary VR is not adequately captured by the traditional quality criteria (ie, objectivity, reliability, validity), highlighting the need for an extended paradigm evaluation framework. To address this gap, we propose a multidimensional evaluation framework for VR applications in clinical neuropsychology, summarized as an easy-to-use checklist (VR-Check). This framework rests on 10 main evaluation dimensions encompassing cognitive domain specificity, ecological relevance, technical feasibility, user feasibility, user motivation, task adaptability, performance quantification, immersive capacities, training feasibility, and predictable pitfalls. We show how VR-Check enables systematic and comparative paradigm optimization by illustrating its application in an exemplary research project on the assessment of spatial cognition and executive functions with immersive VR. This application furthermore demonstrates how the framework allows researchers to identify across-domain trade-offs, makes deliberate design decisions explicit, and optimizes the allocation of study resources. Complementing recent approaches to standardize clinical VR studies, the VR-Check framework enables systematic and project-specific paradigm optimization for behavioral and cognitive research in neuropsychology.