bluuebunny/crossref_metadata_2025 huggingface dataset:
Balance a few years after total hip replacement
Authors: Wareńczak Agnieszka , Lisiński Przemysław
Published: July 2019

Background: The aim of the study was to conduct a long-term evaluation of whether total hip replacement permanently affects the quality of postural reactions and body balance.
Material and methods: The unilateral Total Hip Replacement (THR) group consisted of 30 subjects (mean age: 69.4). The control group consisted of 30 healthy subjects (mean age: 68.8). The force platform and functional tests such as Timed Up and Go, 3m walk test, Functional Reach Test, 30s Chair Stand Test, Step Test and Berg Balance Scale were used to assess dynamic balance.
Results: Subjects from the study group exhibited significantly increased time (p=0.002) and distance (p=0.012) in the tests performed on the force platform compared to the control group. We also observed worse balance and functional test scores in the THR group: Timed Up and Go test (p<0.001), 3m walk test (p<0.001), Functional Reach Test (p=0.003), 30s Chair Stand Test (p=0.002) and Step Test (operated leg: p<0.001, non-operated leg: p=0.002). The results obtained in the Berg Balance Scale tests were not significantly different between the groups (p=0.597).
Conclusions: Our research shows that total hip replacement permanently impairs patients’ dynamic balance and functionality in certain lower-extremity activities.

Keywords: balance, total hip replacement, gait, muscle strength
Structure evaluation of the implementation of geriatric models in primary care: A multiple-case study of models involving Advanced Geriatric Nurses in five municipalities in Norway
Authors: Antypas Konstantinos , Kirkevold Marit
Published: July 2019

Background

The Advanced Geriatric Nurse role recently has been introduced into Norway’s primary healthcare system, and our study’s purpose was to examine the implementation of models of care developed to integrate the Advanced Geriatric Nurse role into primary care. With a structure evaluation, we tried to identify conditions that affect the implementation of different models of care and understand how these conditions affected the realisation of each model’s intentions and goals.

Methods

An embedded multiple-case study was used that included five Norwegian municipalities and seven AGNs. The study included data from August 2014 through September 2018. We used data from 25 semi-structured face-to-face interviews with AGNs and stakeholders, documents and statistical information. We used a cross-case procedure with an emphasis on case findings for the analysis of the multiple case study.

Results

We analysed the structure-related conditions on two levels: the meso-level and the micro-level. On the meso-level, we found that the conditions that affected the implementation of the different models of care were related to each municipality’s structural characteristics, stakeholders’ involvement in the design of the models of care, the clarity of the models and their goals, the evaluation of the models and their adaptation. At the micro-level, we found that the conditions that affected the models’ implementation were related to the collaboration within the implemented models of care, the role clarity of Advanced Geriatric Nurses themselves and adjustments within the models.

Conclusions

The implementation of the AGN role in Norway seems to have been implemented in ways that can impact patients and municipalities positively. Potential improvements include extensive stakeholder involvement, improved roles, goal clarity and better documentation of structures and outcomes. The models’ dynamic nature seemed to be a beneficial characteristic, but adaptation should be systematic and a necessary time should be considered for a new model of care to be integrated and produce results.
Correlation between Karyotype, Puberty Stage and Volume of Reproductive Organs in Turner Syndrome: The First Transrectal Sonography Study in Indonesia
Authors: Novina Novina , Sumapraja Kanadi , Gunardi Hartono , Pulungan Aman B
Published: July 2019

Background: Turner syndrome is characterized by the absence of part of or the entire X chromosome in a woman, resulting in short stature, gonadal dysgenesis, and congenital anomaly. Based on karyotype, Turner syndrome is categorized as classical (45XO) and mosaic. The aim of this study is to evaluate the correlation of the karyotype with the puberty stage, volume of the uterus, and ovary in Turner syndrome’s adolescent with estrogen therapy.
Methods: Analytic correlative cross-sectional study was done in Pediatric Endocrinology Outpatient Clinic at Cipto Mangunkusumo National Hospital since July to December 2018. Pubertal staging based on Tanner stage, uterine, and ovary volume were measured by transrectal sonography.
Results: Of 21 study subjects, 8 were having classical karyotype and 13 were having mosaic karyotype in 12–21-year-old subjects. There was a significant correlation between karyotype and Tanner M stage (mammae stage) (p = 0.035). Breasts development in Turner syndrome with mosaic karyotype showed better development compared to classic karyotype. No significant correlation was found between karyotype and uterine and ovary volume in sonography transrectally.
Conclusion: Karyotype correlates to mammae stage of Tanner but not in uterine and ovary volume in adolescents with Turner syndrome who underwent estrogen therapy.
DART-seq
Authors: De Vlaminck Iwijn , Saikia Mridusmita , Burnham Philip , Keshavjee Sara H. , Wang Michael F. Z. , Heyang Michael , Moral-Lopez Pablo , Hinchman Meleana M. , Danko Charles G. , Parker John S. L.
Published: July 2019

Here we describe the step-by-step protocol of Droplet Assisted RNA Targeting by single cell sequencing \(DART-seq). DART-seq allows simultaneous multiplexed amplicon sequencing and transcriptome analysis in single cells. Using a simple and quick modification of commercially available barcoded beads we have expanded the application of droplet microfluidics based high throughput single cell RNA sequencing technology to include non-polyadenylated RNA transcripts. Specific probes targeting RNA of interest were attached to the beads using a T4 DNA Ligase based enzymatic reaction.The modified DART-seq beads were then used in standard Drop-seq platform to generate single cell libraries for sequencing. We have applied DART-seq to analyze reovirus RNA sequences in infected murine L cells. As a second application we used DART-seq to investigate the B cell repertoire in human peripheral blood mononuclear cell \(PBMC) samples.
Assessing the Relationship between Cognitive Load and the Usability of a Mobile Augmented Reality Tutorial System: A Study of Gender Effects
Authors: IBİLİ Emin , BİLLİNGHURST Mark
Published: July 2019

In this study, the relationship between the
usability of a mobile Augmented Reality (AR) tutorial system and cognitive load
was examined. In this context, the relationship between perceived usefulness,
the perceived ease of use, and the perceived natural interaction factors and
intrinsic, extraneous, germane cognitive load were investigated.  In addition, the effect of gender on this
relationship was investigated. The research results show that there was a
strong relationship between the perceived ease of use and the extraneous load
in males, and there was a strong relationship between the perceived usefulness and
the intrinsic load in females. Both the perceived usefulness and the perceived
ease of use had a strong relationship with the germane cognitive load.
Moreover, the perceived natural interaction had a strong relationship with the
perceived usefulness in females and the perceived ease of use in males. This
research will provide significant clues to AR software developers and
researchers to help reduce or control cognitive load in the development of
AR-based instructional software.
ASPECTOS CLÍNICO-PATOLÓGICOS DE QUEILITE GRANULOMATOSA: RELATO DE CASO
Authors: Pinheiro Juliana Campos , Moreira Deborah Lambert Gondim , Morais Everton Freitas de , Silva Gabriel Gomes da , Lima Jabes Genndedyr da Cruz , Barboza Carlos Augusto Galvão , Medeiros Ana Miryam Costa de , Queiroz Lélia Maria Guedes
Published: July 2019

Introdução: A queilite granulomatosa (QG) é uma lesão oral rara, apresentando clinicamente inchaço de aspecto granulomatoso no lábio. Objetivo: O presente estudo, tem como objetivo apresentar um relato de caso de QG, tendo em vista, a dificuldade do diagnóstico e tratamento de condições inflamatórias com etiologias desconhecidas que acometem a cavidade oral. Relato de caso: Paciente do sexo feminino, apresentou aumento de volume no lábio superior exibindo sintomatologia dolorosa, porém, sem relatar associações com alterações sistêmicas. Durante o exame clínico notou-se que o lábio superior apresentava fissuras profundas, observando também edema que se estendia da comissura labial, atravessando a linha média. Levantou-se então, a hipótese diagnóstica de QG. Foi realizada uma biópsia incisional para confirmação do diagnóstico. A análise histopatológica evidenciou, presença de granulomas não caseosos e infiltrado inflamatório linfoplasmocitário perivascular. De acordo com os dados clínicos e análise histopatológica foi dado o diagnóstico inicial de QG. Após o diagnóstico inicial de QG, a paciente foi encaminhada para uma avaliação médica, a fim de avaliar possíveis alterações intestinais que pudessem caracterizar a síndrome de Melkersson-Rosenthal ou Cronh, como também possível reação de hipersensibilidade tardia. Conclusões: O cirurgião-dentista deve estar preparado para diagnosticar aumentos de volume significativos nos lábios, a fim de manejar corretamente o tratamento do paciente, estabelecendo desta forma, prognósticos favoráveis para essas condições.
Physiopathological Premises to Nuclear Medicine Imaging of Pancreatic Neuroendocrine Tumours
Authors: Cuccurullo Vincenzo , Di Stasio Giuseppe Danilo , Mansi Luigi
Published: July 2019

Background:

Pancreatic Neuroendocrine Tumors (P-NETs) are a challenge in terms of both diagnosis and therapy; morphological studies need to be frequently implemented with nonstandard techniques such as Endoscopic Ultrasounds, Dynamic CT, and functional Magnetic Resonance.

Discussion:

The role of nuclear medicine, being scarcely sensitive F-18 Fluorodeoxyglucose, is mainly based on the over-expression of Somatostatin Receptors (SSTR) on neuroendocrine tumor cells surface. Therefore, SSTR can be used as a target for both diagnosis, using radiotracers labeled with gamma or positron emitters, and therapy. SSTRs subtypes are capable of homo and heterodimerization in specific combinations that alter both the response to ligand activation and receptor internalization.

Conclusion:

Although agonists usually provide efficient internalization, also somatostatin antagonists (SS-ANTs) could be used for imaging and therapy. Peptide Receptor Radionuclide Therapy (PRRT) represents the most successful option for targeted therapy. The theranostic model based on SSTR does not work in insulinoma, in which different radiotracers such as F-18 FluoroDOPA or tracers for the glucagon-like peptide-1 receptor have to be preferred.
Imaging of Pancreatic-Neuroendocrine Tumours: An Outline of Conventional Radiological Techniques
Authors: Zamir Muhammad Affan , Hakim Wasim , Yusuf Siraj , Thomas Robert
Published: July 2019

IIntroduction:

Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity and comprise of peptide-secreting tumours often with a functional syndrome.

:

Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging in the form of conventional radiological techniques. It is important for clinicians to have a fundamental understanding of the p-NET appearances to aid prompt identification and to help direct management through neoplastic staging.

Methods:

This article will review the advantages and disadvantages of conventional radiological techniques in the context of p-NETs and highlight features that these tumours exhibit.

Conclusion:

Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined with homogenous enhancement following contrast administration, although larger and less welldifferentiated tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous enhancement characteristics.

:

Prognosis is generally favourable for these tumours with various treatment options available. However, conventional radiological techniques will remain the foundation for the initial diagnosis and staging of these tumours, and a grasp of these modalities is extremely important for physicians.
Self-micro Emulsifying Drug Delivery System “SMEDDS” for Efficient Oral Delivery of Andrographolide
Authors: Nallamolu Sivaram , Jayanti Vijaya R. , Chitneni Mallikarjun , Khoon Liew Y. , Kesharwani Prashant
Published: July 2019

Objective:

Andrographolide has potent anticancer and antimicrobial activity; however, its
clinical application has been limited due to its poor water solubility as well as lack of appropriate formulation.
The objective of this investigation was to formulate Self–Micro Emulsifying Drug Delivery
System (SMEDDS) of andrographolide and explore its oral drug delivery aptitudes.

Methods:

Andrographolide SMEDDS was optimized by ternary phase approach and studied for various
in vitro characteristics: Particle size, electron microscopy, polydispersity index, surface charge, dilution
effect, pH stability, freeze-thaw effect, dissolution profile and stability studies. Further, antimicrobial
and cytotoxic performance of andrographolide SMEDDS were evaluated in MCF–7 breast cancer cell
lines and methicillin-resistant microorganisms, respectively.

Results:

An optimized SMEDDS formulation of andrographolide was successfully prepared and evaluated
for its drug delivery potential. The solubility of andrographolide in the developed SMEDDS formulation
was increased significantly, and the drug loading was enough for making this drug clinically
applicable. The andrographolide SMEDDS formulation competitively inhibited the growth of microorganisms
and showed enhanced anti–microbial activity against MRSA microorganisms.

Conclusion:

The SMEDDS strategy represents one of the best approaches to deliver andrographolide
via oral route, while resolving its solubility limitations.
Recent Patents on Tension Control Device of Wire Electrode in WEDM
Authors: Xie Baocheng , Ni Xiaowei , Jiang Jingang , Zhang Yuan , Dai Ye , Ren Shengle
Published: July 2019

Background:

WEDM (Wire Electrical Discharge Machining) is widely used to machine
difficult-to-machine materials, such as high-strength and high-brittle materials. The research on tension
control device of the wire electrode is mainly to improve the machining precision and surface quality of
WEDM.

Objective:

To meet the growing demand for processing of difficult-to-machine materials, such as highstrength
and high-brittle materials, the machining precision and surface quality of WEDM are improved
continuously.

Methods:

This paper reviews various representative patents related to the tension control device of wire
electrode in WEDM.

Results:

Through retracing the characteristics of different types of the tension control device of wire
electrode in WEDM, the main problems existing in the current development are concluded and analyzed.
The development trend of patents on the tension control device of wire electrode in WEDM is
discussed.

Conclusion:

The optimization and development of the tension control device of wire electrode in
WEDM are beneficial to improve the machining precision and surface quality of WEDM. More related
patents on the tension control device of wire electrode in WEDM will be invented.
Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series
Authors: Thorpe Julia , Forchhammer Birgitte Hysse , Maier Anja M
Published: July 2019

Background

Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia.

Objective

The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior.

Methods

A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy.

Results

Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants’ self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools.

Conclusions

Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come.
Physician Decision-Making Patterns and Family Presence: Cross-Sectional Online Survey Study in Japan
Authors: Tsuda Kenji , Higuchi Asaka , Yokoyama Emi , Kosugi Kazuhiro , Komatsu Tsunehiko , Kami Masahiro , Tanimoto Tetsuya
Published: July 2019

Background

Due to a low birth rate and an aging population, Japan faces an increase in the number of elderly people without children living in single households. These elderly without a spouse and/or children encounter a lack of caregivers because most sources of care for the elderly in Japan are not provided by private agencies but by family members. However, family caregivers not only help with daily living but are also key participants in treatment decision making. The effect of family absence on treatment decision making has not been elucidated, although more elderly people will not have family members to make surrogate decisions on their behalf.

Objective

The aim is to understand the influence of family absence on treatment decision making by physicians through a cross-sectional online survey with three hypothetical vignettes of patients.

Methods

We conducted a cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second was about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned to either of the two versions of the questionnaires—with family or without family—but methods were identical otherwise. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures.

Results

Among 1112 physicians, 454 (40.8%) completed the survey; there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR] 0.55, 95% CI 0.34-0.80; P=.002) and artificial ventilation (OR 0.51, 95% CI 0.35-0.75; P<.001) for a patient from vignette 1 without family. In vignette 2, fewer physicians were willing to perform artificial ventilation (OR 0.59, 95% CI 0.39-0.90; P=.02). In vignette 3, significantly fewer physicians showed willingness to perform wound treatment (OR 0.51, 95% CI 0.31-0.84; P=.007), surgery (OR 0.35, 95% CI 0.22-0.57; P<.001), blood transfusion (OR 0.45, 95% CI 0.31-0.66; P<.001), vasopressor (OR 0.49, 95% CI 0.34-0.72; P<.001), dialysis (OR 0.38, 95% CI 0.24-0.59; P<.001), artificial ventilation (OR 0.25, 95% CI 0.15-0.40; P<.001), and chest compression (OR 0.29, 95% CI 0.18-0.47; P<.001) for a patient without family.

Conclusions

Elderly patients may have treatments withheld because of the absence of family, highlighting the potential importance of advance care planning in the era of an aging society with a declining birth rate.
Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment
Authors: Mikal Jude P , Grande Stuart W , Beckstrand Michael J
Published: July 2019

Background

Social media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media.

Objective

The objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers.

Methods

We conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site.

Results

A novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces.

Conclusions

Given the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange.
Development of Ovarian Tissue Autograft to Restore Ovarian Function: Protocol for a French Multicenter Cohort Study
Authors: Pretalli Jean-Baptiste , Frontczak Franck Sophie , Pazart Lionel , Roux Christophe , Amiot Clotilde ,   DATOR Group
Published: July 2019

Background

Sterility is a major late effect of radiotherapy and chemotherapy treatments. Iatrogenic sterility is often permanent and greatly impacts long-term quality of life. Ovarian tissue cryopreservation (OTC) performed before gonadotoxic treatments with subsequent autograft is a method of fertility preservation available for girls and women. Its application in prepubertal girls is of particular value as it is the only possible approach in this patient group. In addition, it does not require a delay in cancer therapy and no ovarian stimulation is needed.

Objective

The primary aim of this protocol is to help increase the implementation of ovarian tissue autografting in France. Knowledge is still lacking regarding the efficacy of ovarian transplantation in restoring ovarian function and regarding the safety of this procedure, especially the risk of cancer cell reseeding in certain types of cancer. A secondary aim of this study is to generate data to improve our understanding of these two essential aspects.

Methods

The DATOR (Development of Ovarian Tissue Autograft in Order to Restore Ovarian Function) study is ongoing in 17 university hospitals. The DATOR protocol includes the autograft of ovarian cortex fragments. Candidates are identified from an observational prospective cohort (called the Prospective Cohort of Patients Candidates for Ovarian Tissue Autograft [PERIDATOR]) of patients who have undergone OTC. Enrollment in the study is initiated at the patient’s request and must be validated by the center’s multidisciplinary team and by the study steering committee. The DATOR study begins with a total medical checkup. Ovarian tissue qualification and residual disease detection, if required, are performed.

Results

The study is ongoing. Currently, 38 patients have provided informed consent and have been entered into the DATOR study. Graft has been performed for 34 of these patients. An interim analysis was conducted on the first 25 patients for whom the period of at least 1 year posttransplantation was achieved. Out of these 25 patients, 11 women succeeded in becoming pregnant (pregnancy rate=44% [11/25]; delivery rate=40% [10/25]). Among these, 6 women conceived twice, and 1 pregnancy led to a miscarriage.

Conclusions

Our preliminary analysis appears to be coherent with the accumulating body of evidence indicating the potential utility of ovarian tissue autograft for patients with premature ovarian failure. All these elements justify the pursuit of our study.

Trial Registration

ClinicalTrials.gov NCT02846064; https://clinicaltrials.gov/ct2/show/NCT02846064

International Registered Report Identifier (IRRID)

DERR1-10.2196/12944
The Continued Use of Mobile Health Apps: Insights From a Longitudinal Study
Authors: Vaghefi Isaac , Tulu Bengisu
Published: July 2019

Background

Mobile health (mHealth) apps that support individuals pursuing health and wellness goals, such as weight management, stress management, smoking cessation, and self-management of chronic conditions have been on the rise. Despite their potential benefits, the use of these tools has been limited, as most users stop using them just after a few times of use. Under this circumstance, achieving the positive outcomes of mHealth apps is less likely.

Objective

The objective of this study was to understand continued use of mHealth apps and individuals’ decisions related to this behavior.

Methods

We conducted a qualitative longitudinal study on continued use of mHealth apps. We collected data through 34 pre- and postuse interviews and 193 diaries from 17 participants over two weeks.

Results

We identified 2 dimensions that help explain continued use decisions of users of mHealth apps: users’ assessment of mHealth app and its capabilities (user experience) and their persistence at their health goals (intent). We present the key factors that influence users’ assessment of an mHealth app (interface design, navigation, notifications, data collection methods and tools, goal management, depth of knowledge, system rules, actionable recommendations, and user system fit) and relate these factors to previous literature on behavior change technology design. Using these 2 dimensions, we developed a framework that illustrated 4 decisions users might make after initial interaction with mHealth apps (to abandon use, limit use, switch app, and continue use). We put forth propositions to be explored in future research on mHealth app use.

Conclusions

This study provides insight into the factors that shape users’ decisions to continue using mHealth apps, as well as other likely decision scenarios after the initial use experience. The findings contribute to extant knowledge of mHealth use and provide important implications for design of mHealth apps to increase long-term engagement of the users.
A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App
Authors: Li Ling-Jun , Aris Izzuddin M , Han Wee Meng , Tan Kok Hian
Published: July 2019

Background

Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes.

Objective

In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women.

Methods

We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups.

Results

Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group.

Conclusions

Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women.
Underage JUUL Use Patterns: Content Analysis of Reddit Messages
Authors: Zhan Yongcheng , Zhang Zhu , Okamoto Janet M , Zeng Daniel D , Leischow Scott J
Published: July 2019

Background

The popularity of JUUL (an e-cigarette brand) among youth has recently been reported in news media and academic papers, which has raised great public health concerns. Little research has been conducted on the age distribution, geographic distribution, approaches to buying JUUL, and flavor preferences pertaining to underage JUUL users.

Objective

The aim of this study was to analyze social media data related to demographics, methods of access, product characteristics, and use patterns of underage JUUL use.

Methods

We collected publicly available JUUL-related data from Reddit. We extracted and summarized the age, location, and flavor preference of subreddit UnderageJuul users. We also compared common and unique users between subreddit UnderageJuul and subreddit JUUL. The methods of purchasing JUULs were analyzed by manually examining the content of the Reddit threads.

Results

A total of 716 threads and 2935 comments were collected from the subreddit UnderageJuul before it was shut down. Most threads did not mention a specific age, but ages ranged from 13 years to greater than 21 years in those that did. Mango, mint, and cucumber were the most popular among the 7 flavors listed on JUUL’s official website, and 336 subreddit UnderageJuul threads mentioned 7 discreet approaches to circumvent relevant legal regulations to get JUUL products, the most common of which was purchasing JUUL from other Reddit users (n=181). Almost half of the UnderageJuul users (389/844, 46.1%) also participated in discussions on the main JUUL subreddit and sought information across multiple Reddit forums. Most (64/74, 86%) posters were from large metropolitan areas.

Conclusions

The subreddit UnderageJuul functioned as a forum to explore methods of obtaining JUUL and to discuss and recommend specific flavors before it was shut down. About half of those using UnderageJuul also used the more general JUUL subreddit, so a forum still exists where youths can attempt to share information on how to obtain JUUL and other products. Exploration of such social media data in real time for rapid public health surveillance could provide early warning for significant health risks before they become major public health threats.
Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis
Authors: Kehe Kai , Girgensohn Roland , Swoboda Walter , Bieler Dan , Franke Axel , Helm Matthias , Kulla Martin , Luepke Kerstin , Morwinsky Thomas , Blätzinger Markus , Rossmann Katalyn
Published: July 2019

Background

The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases.

Objective

The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp.

Methods

DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation.

Results

For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed.

Conclusions

We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps.
An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study
Authors: Ijaz Kiran , Ahmadpour Naseem , Naismith Sharon L , Calvo Rafael A
Published: July 2019

Background

Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements.

Objective

This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC).

Methods

VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup.

Results

Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87).

Conclusions

The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future.
The Effect of the Interactive Mobile Health and Rehabilitation System on Health and Psychosocial Outcomes in Spinal Cord Injury: Randomized Controlled Trial
Authors: Kryger Michael Alan , Crytzer Theresa M , Fairman Andrea , Quinby Eleanor J , Karavolis Meredith , Pramana Gede , Setiawan I Made Agus , McKernan Gina Pugliano , Parmanto Bambang , Dicianno Brad E
Published: July 2019

Background

Individuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities.

Objective

The main objective of this study was to determine if the use of iMHere would be associated with improved health outcomes over a 9-month period. A secondary objective was to determine if the use of iMHere would be associated with improved psychosocial outcomes. Phone usage, app usage, and training time data were also collected to analyze trends in iMHere use.

Methods

Overall, 38 participants with SCI were randomized into either the intervention group who used the iMHere system and received standard care or the control group who received standard care without any technology intervention. Health outcomes were recorded for the year before entry into the study and during the 9 months of the study. Participants completed surveys at baseline and every 3 months to measure psychosocial outcomes.

Results

The intervention group had a statistically significant reduction in UTIs (0.47 events per person; P=.03; number needed to treat=2.11). Although no psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance. Approximately 34 min per participant per month were needed on average to manage the system and provide technical support through this mHealth system.

Conclusions

The use of the iMHere mHealth system may be a valuable tool in the prevention of UTIs or reductions in depressive symptoms. Given these findings, iMHere has potential scalability for larger populations.

Trial Registration

ClinicalTrials.gov NCT02592291; https://clinicaltrials.gov/ct2/show/NCT02592291.
Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study
Authors: Blok Amanda C , Sadasivam Rajani S , Hogan Timothy P , Patterson Angela , Day Nicole , Houston Thomas K
Published: July 2019

Background

Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with a mobile health (mHealth) intervention using stakeholder-supported strategies.

Objective

The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition.

Methods

We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed.

Results

For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior.

Conclusions

TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed.
Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study
Authors: Felzen Marc , Beckers Stefan Kurt , Kork Felix , Hirsch Frederik , Bergrath Sebastian , Sommer Anja , Brokmann Jörg Christian , Czaplik Michael , Rossaint Rolf
Published: July 2019

Background

As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany.

Objective

We sought to assess the utilization, safety, and technical performance of this telemedical emergency service.

Methods

We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations.

Results

The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations.

Conclusions

The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.
THE FIGHT AGAINST ‘ADATS AND SHARI‘A IN THE FAMILY LIFE OF KUMYKS IN THE FIRST SOVIET DECADES
Authors: GUSEYNOV Yu. M.
Published: July 2019

The article is devoted to the correlation between the norms of ‘adat and shari‘a in the Kumyk family life in the fi rst years of Soviet power. During this period, on the territory of the entire state, including Dagestan, Soviet legal doctrine was actively introduced with its own laws, principles and rules.The new laws of the country of the Soviets sharply contradicted the traditional norms of the Kumyks. This contradiction has been expressed in many issues, including family and domestic. At fi rst, the Soviet leadership strongly supported the norms of ‘adat and shari‘a. This was refl ected in the invitation to the dualistic marriage-according to the Soviet and shari‘a laws. However, by the end of the 20s of the 20th century, an ideological campaign unfolded against the ‘adat and shari‘a norms.
OVERCOMING STEREOTYPES (FACTORS WHICH PROVOKE ISLAMOPHOBIA)
Authors: STEPANYANTS M. T.
Published: July 2019

In the modern world Islamophobia is one of the most dangerous types of negative stereotypes that give rise to prejudices, discrimination and even aggression. Laypeople and politicians, scholars and theologians bear responsibility for multiplication and distribution of stereotyping in media. The journalists too often are not capable to distinguish religion from its believers. Islam and Muslims are not synonyms: in fact, we are talking about behavioral paradigms of the believers, not about their sacred teaching. Evaluation of Islam as radical, fanatic, intolerant, terrorist, etc., is unjustifi ed and inconsistent. The article argues inadmissibility of using the most common polar adjectives like “radical” and “traditional” for defi ning Islam. It is proposed to carry out the fundamental distinction between the actors at the political front and the participants of ideological and theological polemics. In the fi rst case, it would be appropriate to name «the radicals» as the militant fanatics, while «the traditionalists» as the tolerant Muslims. In the second case, it might be more precise to name one side as the Muslim orthodoxy, while the opposite side — renewal movement or religious reconstruction. The need to free debates involving both the reputable theologians and the ordinary Muslims is urgent. This kind of discussion might help both scholars and media representatives to free themselves from stereotypes that instigate Islamophobia.