bluuebunny/crossref_metadata_2025 huggingface dataset:
Objectively Measured Preoperative Physical Activity is Associated With Time to Functional Recovery after Hepato-Pancreato-Biliary Cancer Surgery: a Pilot Study
Authors: Mylius Caspar , Krijnen Wim , Takken Tim , Lips Daan , Eker Hasan , Schans Cees van der , Klaase Joost
Published: October 2020

Background: Surgical resection is currently the cornerstone of hepato-pancreato-biliary (HPB) cancer treatment. A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. A person’s aerobic fitness is influenced by performing moderate to vigorous physical activity (MVPA). This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes. Methods: A prospective, observational multi-center cohort pilot study was conducted. Patients enlisted for resection surgery on suspicion of HPB (pre)malignancy were enrolled. Performed MVPA was measured by an Actigraph wGT3X-BT. Additionally, aerobic fitness was measured via the Incremental Shuttle Walk Test, and (post)operative variables were collected from the electronic patient files. The association between MVPA and the pre and postoperative variables was determined by univariate and multivariate (logistic) robust regression. Results: A total of 38 participants, median age 66.0 (IQR 58.25 – 74.75) years, were enrolled. The meadian daily MVPA was 10.7 (IQR 6.9 – 18.0) minutes, only 8 participants met Dutch MVPA guidelines. Participants age, and incremental shuttle walk test score were associated with MVPA by multivariate statistical analysis. Time to functional recovery was 8 (IQR 5 - 12) days and was associated with MVPA and type of surgery (major/minor) in multivariate analysis. Conclusion: 76% of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery.
“My Grandparents Are Separatists”: How Young Ukrainians Perceive Their National Community
Authors: Klymenko Lina
Published: October 2020

Based on focus group discussions with young people in Ukraine, this article analyzes how young Ukrainians conceptualize their national community. The understanding of nationalism in the study rests upon the concept of a discursive formation of a nation. In line with this concept, nationalism is viewed as a certain mode of discourse that reflects citizens’ interpretations of who constitutes a nation. The analysis of the focus group discussions reveals how young Ukrainians perceive the Ukrainian nation in terms of a community with a specific socio-political order, culture, and mentality.
The Life of Hryhorii Skovoroda Revisited
Authors: Stech Marko Robert
Published: October 2020

Review Essay:
Of Leonid Ushkalov. Lovytva nevlovnoho ptakha: Zhyttia Hryhoriia Skovorody [Chasing an Uncapturable Bird: The Life of Hryhorii Skovoroda]. Vydavnytstvo “Dukh i litera,” 2017. Postati kul'tury [Cultural Figures]. 368 pp. UAH 135,00, cloth.
INTERNACIONALIZACIÓN DE LAS INSTITUCIONES DE NIVEL SUPERIOR. FLUJOS DE MOVILIDAD ESTUDIANTIL
Authors: Andrada Marcos Javier
Published: October 2020

Este artículo se trata de un estudio de tipo descriptivo cuyo objetivo es el análisis del flujo de movilidad de los alumnos de 5 países de la región de Latinoamérica. El objetivo del mismo es comprender la dimensión y el sentido de los flujos migratorios de los estudiantes de los países de la región. Se utilizará una metodología comparativa con fuentes de datos secundarias con indicadores provistos por la oficina de estadísticas de la UNESCO. Se espera con este análisis contribuir al conocimiento del volumen y el sentido de los flujos migratorios de estudiantes y las posibles implicancias que la movilidad provoca tanto en los lugares de orígenes como en los de destino.
ORGANISMOS INTERNACIONAIS, ENSINO SUPERIOR, INTERCÂMBIO DE ESTUDANTES E FORMAÇÃO DE PROFESSORES PARA A ESCOLA BÁSICA NO BRASIL (ANOS 1990/2000)
Authors: Cavalcante Maria Juraci Maia
Published: October 2020

Trata do ensino superior no Brasil dos anos 1990/2000, mostrando a interferência de organismos internacionais nas políticas educacionais dirigidas às universidades, que passam a abrigar, programas de formação de professores para a escola básica (PARFOR), fortalecimento do ensino técnico-profissionalizante e de intercâmbio de estudantes de graduação no exterior. Tem apoio na literatura referente a este problemática, como Azevedo (2007), Vidal e Gvirtz (2009), Beench (2012), Ferreira (2012), entre outros, para evidenciar a missão atribuída às universidades, visando a qualificação efetiva e sistêmica do ensino público, com o objetivo de favorecer a formação de quadros técnicos e científicos para o desenvolvimento tecnológico do Brasil. Conclui que, na era da globalização, os dois programas enfocados estão sob a influência de ingerências externas, que atuam poderosamente sobre políticas educacionais, tanto no Brasil, como na Argentina, com vistas à promoção de uma eficiência requerida por setores econômicos nacionais e mercados internacionais.
Shoreline Change with Groin Coastal Protection Structure at North Java Beach
Authors: Setyandito Oki , Purnama Aldo Christanto , Yuwono Nur , Juliastuti Juliastuti , Wijayanti Yureana
Published: October 2020

The research aimed to study the effect of groin application to erosion at the shoreline. The method utilized the bathymetry and topography data of north beach of Balongan, West Java. Modeling of the shoreline change due to groin installment used software called GENESIS. Based on analysis result, it is found that the significant wave direction comes from the southeast with significant wave height of 1,18 meters and surf zone width of 140 meters. It is concluded that at research area of north beach of west Java, I-groin with length of 70 meters and T head groin of 60 meters in long T-groin effectively overcome erosion and advance the coastline by 10786,62 m2 or in average 6,3 meters.
Analytical Hierarchy Process for Enhancing Procurement Decision-Making in Project Phase: A Case Study in the Gold Mining Project
Authors: Saleh Budi Irawan , Anwar Choirul , Abidin Rusman Zaenal , Radyawanto Aris Setyo
Published: October 2020

The aim of the research was to enhance the selection for the process plant equipment supplier based on their country of origin in the gold mining project using the Analytical Hierarchy Process (AHP). The research also intended to investigate how AHP could further enhance the process of the project. The steps for modeling the AHP were identifying the hierarchy by the project team, constructing the AHP model, and calculating the weight for supplier selection. The research object was a gold mining company based in Indonesia. The schedule and resources were calculated, followed by a survey to evaluate the AHP process. After modeling and calculating using AHP, it is found that the three highest criteria for selecting the process plant equipment suppliers are running capacity (14,3 %), efficiency (9,9%), and endurance (9,7%). The overall scores for each supplier show that supplier from United States (25,87%) is in the first rank. It is followed by Germany (25,80%) and Australia (25,20%). Moreover, AHP is proven to enhance the process by not only reducing the time of decision-making for two days but also increasing the resource by almost 23%. Based on the survey to the project team, AHP increases the involvement of the project team in the decision-making process and shows that more than 80% of the project team agrees with the decision. The survey also reveals that almost 63% of the project team decides to use the same tools for the decision-making process.
The Application of Quality Function Deployment in Car Seat Industry
Authors: Purba Humiras Hardi , Sunadi Sunadi , Suhendra Suhendra , Paulina Else
Published: October 2020

The research aimed to ensure the right design of new products based on customer needs and to improve competitiveness based on renewal marketing strategies and customer needs in the car seat industry. Customer satisfaction ratings were used to compare with competitors. Then, the Quality Function Deployment (QFD) was implemented for the analysis. The research used total sampling or complete enumeration. So, the sample size was the same as the population size. Based on calculations using the QFD method, it shows that the seat option has the highest percentage of technical requirements in the car seat industry around 27,39%. The second factor is material about 25,94%, and the third factor is the damping characteristic about 19,17%. For continuous quality improvement in the future, a lot of customer needs regarding the seat car need to be developed.
¿Go-Shops en Lima?
Authors: Granda Boullón Carlos
Published: October 2020

En el presente artículo, el Profesor Carlos Granda explica el concepto de Go-Shop. Para ello, explica los diversos beneficios económicos que posee esta cláusula contractual y qué tan conveniente sería traer aquel sistema a nuestro país.
EFEITO DA MOBILIZAÇÃO PRECOCE NA ALTA HOSPITALAR DE PACIENTES SOB VENTILAÇÃO MECÂNICA NA UNIDADE DE TERAPIA INTENSIVA: REVISÃO SISTEMÁTICA
Authors: Nogueira Francisco Jander de Sousa , Filho Cesário Rui Callou , Vasconcelos Danielle Brandão , Cunha Wiliane Gomes Nepomuceno , Vieira Ethel Esthephane Alves
Published: October 2020

Introdução: A Permanência prolongada na Unidade de Terapia Intensiva (UTI) pode estar relacionada à fraqueza, imobilidade e insuficiência respiratória. A mobilização precoce desempenha um importante papel no processo de recuperação funcional dos pacientes. Objetivo: Descrever por meio da literatura os benefícios proporcionados pela mobilização precoce dos pacientes internados na UTI submetidos a Ventilação Mecânica (VM). Metodologia: Trata-se de uma Revisão Sistemática realizada nas bases de dados eletrônicos PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online – SciELO, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) utilizando os descritores “Deambulação Precoce”, “Unidades de Terapia Intensiva”, “Respiração Artificial ”. Foram incluídos artigos independentes do idioma. Os sujeitos deveriam ter idade superior a 18 anos e estar internados na Unidade de Terapia Intensiva, em Ventilação Mecânica por um período maior que 24 horas. Foram excluídos pesquisas do tipo de revisão, monografias, dissertações, teses, anais, capítulos, livros e ponto de vista ou opinião de especialista e que abordassem os descritores no título mas ao longo do texto não abordasse o tema proposto. Resultados: Foram encontrados 11.586 artigos, sendo selecionados 9 artigos segundo os critérios de inclusão, verficiando amobilização precoce em pacientes críticos se mostrou segura e viável, capaz de reduzir o tempo de VM e permanência na UTI. Conclusão: as intervenções comumente relatadas no estudo, sendo menos frequente durante a assistência ventilatória as atividades que envolviam o ortostatismo e deambulação, resultado esperado, visto que as principais barreiras encontradas foram intubação e sedação.
ANÁLISE ESPACIAL DAS CAUSAS DE MORTALIDADE INFANTIL NO BRASIL DE 2000 A 2015
Authors: Justino Dayane Caroliny Pereira , Andrade Fábia Barbosa de
Published: October 2020

Introdução: A análise dos indicadores de saúde da criança é essencial para identificação das necessidades de melhorias assistenciais à saúde. Objetivo: avaliar a distribuição espacial das causas de mortalidade infantil no Brasil de 2000 a 2015  com cobertura da Atenção Básica e consultas de puericultura. Metodologia: Estudo ecológico de tendência temporal com análise espacial realizado no Brasil utilizando dados disponíveis no Departamento de Informática do Sistema Único de Saúde, nos anos de 2000 a 2015, os quais foram coletados em maio de 2017. Resultados: As principais causas de óbitos infantis são causas consideradas evitáveis pela Atenção Básica e observou-se um comportamento parecido em quatro destas que se mostraram com alta autocorrelação nas regiões norte, nordeste e sudeste, os capítulos 01, 10 16 e 18. É importante destacar que apenas uma mostrou-se alta na região sudeste que foram os óbitos por malformações congênitas, deformidades e anomalias cromossômicas. Ao correlacionar com as consultas de puericultura e cobertura da Atenção Básica observou-se que no período de 2000 a 2004 houve uma baixa atuação na atenção à saúde populacional. Conclusões: Os resultados do presente estudo mostram que embora a atenção à saúde da população venha melhorando ao longo dos anos, ainda se faz necessário dar uma atenção maior à saúde infantil do país para que haja a redução dos óbitos infantis por causas evitáveis.
Role of microRNAs in Hepatic Stellate Cells and Hepatic Fibrosis: An Update
Authors: Zhu Sai , Chen Xin , Chen Yu , Li Xiao-Feng , Chen Si-Yu , Li Juan-Juan , Wang Ao , Huang Cheng , Li Jun
Published: October 2020

MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate the expression of targets
genes by binding to the 3′-untranslated regions. They play vital roles in diverse biological processes, including
the development of hepatic fibrosis (HF). HF is characterized by the accumulation of extracellular matrix
(ECM) and hepatic stellate cells (HSCs) are considered a major cell type for producing ECM. Alteration of the
HSC phenotype plays a crucial role in the HF pathological process. MiRNAs involved in various biological process,
such as differentiation, apoptosis, migration, and their relevant signaling pathways, are expressed in
HSCs; however, emerging evidence indicates that numerous miRNAs are abnormally expressed in activated
HSCs. In this review, we summarize the categorization of miRNAs in HF and describe the relationships among
them. We also discuss miRNAs recently discovered to be related to HF, and attempt to find potential miRNAs
that may serve as novel biomarkers for use in HF treatment.
COVID-19 Vaccines in Clinical Trials and their Mode of Action for Immunity against the Virus
Authors: Tavakol Shima , Alavijeh Mo S. , Seifalian Alexander M.
Published: October 2020

For nearly two decades, coronaviruses have caused many health and economic problems, while no effective
commercial vaccine has yet been developed. It is worth mentioning that despite some mutations and recombination
in SARS-CoV-2, its genotype is very close to the original strain from Wuhan, China. Therefore,
the development of an effective vaccine would be promising. It might be hypothesized that BCG vaccination is
performed in high-risk populations before the commercialization of an effective SARS-CoV-2 vaccine. However,
the development of an effective vaccine without considering the adverse immune reactions derived from
antibody-dependent or cell-based immune enhancement may threaten vaccinated people's lives and long-term
side effects must be considered. To this end, targeting of the receptor-binding domain (RBD) in spike and not
whole spike, glycolization of FC receptors, PD-1 blockers, CPPs, etc., are promising. Therefore, the subunit
vaccines or RNA vaccines that encode the RBP segment of the spike are of interest. To enhance the vaccine efficacy,
its co-delivery with an adjuvant has been recommended. Nanoparticles modulate immune response with
higher efficiency than the soluble form of antigens and can be functionalized with the positively charged moieties
and ligands of targeted cells, such as dendritic cells, to increase cellular uptake of the antigens and their
presentation on the surface of immune cells. This research aimed to discuss the COVID-19 vaccines entering
the clinical trial and their mode of action effective immunity against the virus and discusses their advantages
compared to each other.
Enhancing Therapeutic Efficacy of Donepezil by Combined Therapy: A Comprehensive Review
Authors: Rong Xi , Jiang Liwei , Qu Meijie , Hassan Syed Shams ul , Liu Zongchao
Published: October 2020

Combination therapy involving different therapeutic strategies mostly provides more rapid and effective results as compared to monotherapy in diverse areas of clinical practice. The most worldwide famous acetylcholinesterase inhibitor (AChEIs) donepezil for its dominant role in Alzheimer’s disease (AD) has also attracted the attention of many pharmaceuticals due to its promising pharmacological potencies such as neuroprotective, muscle relaxant, and sleep inducer. Recently, a combination of donepezil with other agents has displayed better desirable results in managing several disorders, including the most common Alzheimer’s disease (AD). This study involves all the data regarding the therapeutic effect of donepezil in its combination with other agents and explains its therapeutic targets and mode of action. Furthermore, this review also puts light on the current status of donepezil with other agents in clinical trials. The combination therapy of donepezil with symptomatic relief drugs and disease-modifying agents opens a new road for treating multiple pathological disorders. To the best of our knowledge, this is the first report encircling all the pharmacologic effects of donepezil in its combination therapy with other agents and their current status in clinical trials.
Inhibition of Virulence Factors and Biofilm Formation ofAcinetobacter Baumanniiby Naturally-derived and Synthetic Drugs
Authors: Bamunuarachchi Nilushi Indika , Khan Fazlurrahman , Kim Young-Mog
Published: October 2020

Acinetobacter baumannii is a gram-negative, aerobic, non-motile, and pleomorphic bacillus. A. baumannii is also a highly-infectious pathogen causing high mortality and morbidity rates in intensive care units. The discovery of novel agents against A. baumannii infections is urgently needed due to the emergence of drug-resistant A. baumannii strains and the limited number of efficacious antibiotics available for treatment. In addition to the production of several virulence factors, A. baumannii forms biofilms on the host cell surface as well. Formation of biofilms occurs through initial surface attachment, microcolony formation, biofilm maturation, and detachment stages, and is one of the major drug resistance mechanisms employed by A. baumannii. Several studies have previously reported the efficacy of naturally-derived and synthetic compounds as anti- biofilm and anti-virulence agents against A. baumannii. Here, inhibition of biofilm formation and virulence factors of A. baumannii using naturally-derived and synthetic compounds are reviewed.
Machine Learning for Mass Spectrometry Data Analysis in Proteomics
Authors: Li Juntao , Zhou Kanglei , Mu Bingyu
Published: October 2020

With the rapid development of high-throughput techniques, mass spectrometry has been
widely used for large-scale protein analysis. To search for the existing proteins, discover biomarkers,
and diagnose and prognose diseases, machine learning methods are applied in mass spectrometry
data analysis. This paper reviews the applications of five kinds of machine learning methods to
mass spectrometry data analysis from an algorithmic point of view, including support vector machine,
decision tree, random forest, naive Bayesian classifier and deep learning.
In silico Approach for Exploring the Role of AT1R Polymorphism on its
Function, Structure and Drug Interactions
Authors: Sharma Bhanu , Jaiswal Varun , Khan Mohammed Azhar
Published: October 2020

Background:

AT1R (Angiotensin II type 1 receptor) is the main component of RAS (renin-angiotensin system)
system which activates when ANG II (angiotensin II) binds to it. AT1R helps in maintaining osmotic homeostasis and
blood pressure regulation. A huge number of polymorphism is associated with AT1R and few of them were studied and
found to be associated with the diseases and drug efficacy. Although it is very important receptor but most of the
polymorphisms (SNPs) were not studied for their implications in diseases. Huge number of polymorphisms is reported in
the databases for AT1R which provide an avenue to explore these polymorphisms for their implications in protein
structure, function and drug efficacy.

Methods:

In the current study all the SNPs (10234) reported in NCBI were analyzed and SNPs which were important in
protein structure and drug interactions were identified. Structures of these polymorphic forms were modeled and in silico
drug interaction studies were carried out.

Results:

Result of the interaction studies with polymorphism was in correlation with the reported case. Two SNP mutated
structures of AT1R i.e. rs780860717 (G288T), rs868647200 (A182C) shows considerably less binding affinities in case of
all angiotensin receptor blockers (ARBs). As a result these polymorphisms may show less efficacy toward these ARBs.
The other mutated structures rs12721226 (A163G), rs749234826 (A292G), rs775810028 (A87G) shows increased binding
affinities in case of Eprosartan and most of the mutated structures shows increased binding affinity toward Telmisartan
than the wild type AT1R. Similarly, these polymorphisms may show increased efficacy in case of these two ARBs.

Conclusion:

The outcome of the study will help in designing better drugs in near future with broader spectrum.
Furthermore in vitro and in vivo studies can be designed according to current results.
Novel Coronavirus SARS-CoV-2 (COVID-19) and Pregnancy: A Hypothetical View
Authors: Ahmed RG
Published: October 2020

The complications of the SARS-CoV-2 infection and its COVID-19 disease on mothers
and their offspring are less known. This review aimed to determine the transmission, severity, and
complications of SARS- CoV-2 infection during pregnancy. This review showed the influence of
COVID-19 disease on neonatal neurogenesis. Owing medicines that were reported for the treatment
of COVID-19 disease, this review suggested some control strategies like treatments (medicinal
plants, antiviral therapy, cellular therapy, and immunotherapy), nutrition uptake, prevention,
and recommendations. This overview showed that severe infection of SARS-CoV-2 during the early
stage of pregnancy might increase the risk of stress, panic, and anxiety. This disorder can disturb
the maternal immune system, and thus causing a neurodevelopmental disturbance. This hypothesis
may be depending on the severity and intensity of the SARS-CoV-2 infection during pregnancy.
However, vertical transmission of SARS-CoV-2 from dams to their fetuses is absent until now.
During this global pandemic disease, maintaining safety during pregnancy, vaginal delivery, and
breastfeeding may play a vital role in a healthy life for the offspring. Thus, international, and national
organizations should be continuing for perinatal management, particularly during the next pandemic
or disaster time.
Lessons Learned to Control COVID-19 to Prevent a Crisis: The Case of Iran
Authors: Nazari Javad , Amini Saeed , Amiresmaili Mohammadreza
Published: October 2020

Following the detection of the first case of infection due to COVID-19 in Iran central province (named Markazi) on 18 Feb 2020, a serious alert was announced at Arak University of Medical Sciences (the main medical university in Markazi province) to prevent a disaster. The performed measures played a unique role in improving patient care and prevention and control of the disease. Previously, it was expected that Markazi province, due to being situated on the junction of the national highways and placing in the center of Iran, was faced with huge health and social crisis. However, fortunately, the disease morbidity and mortality have been placed in a stabilized status after 7 weeks of the epidemic.
The Correlation between Perceived Peer Norms in Attitude and Self-Efficacy Premarital Sexual Behavior
Authors: Vakilian Katayon , Keramat Afsaneh
Published: October 2020

Background and Aims:

Adolescence is a period of life in which high-risk behaviors, including sexual behaviors, put the adolescents at risk for sexually transmitted diseases, including AIDS. This research aimed at studying the relationship between peers' perception of sexual behavior and adolescents' attitudes and self-efficacy.

Materials and Methods:

This cross-sectional study used a multi-stage method to examine 1500 subjects in the universities of Shahroud, Iran. The questionnaires were consisted of sexual abstinence attitude, abstinence self-efficacy and peer subjective norms. To ensure the confidentiality of information, the questionnaire was distributed among 1500 students in six universities anonymously, and students҆ field of study was not mentioned. The collected data was analyzed with descriptive (Mean, Percent) and inferential tests (independent t-test, chi2, and Spearman test) using SPSS 18 software.

Results:

The mean age of the females was 20.26±1.49, and that of males was 20.32±1.575. 59.3% of male students and 86.8% of female students had poor sexual abstinence to sex before marriage. Moreover, the sexual abstinence self-efficacy of 29% of male students and 13.1% of female students, regarding the sexual abstinence before marriage, was strong. Findings showed that the more one believes in his/her abilities in sexual abstinence, the more they believe that their friends will not be involved in sex

Conclusion:

It is required to provide the opportunities to learn and correct the socio-emotional skills required for physical and sexual health in relationships through social interactions with peers. In this context, the reproductive health programs need to be prioritized in the youth health programs and schools
The first case of human otoacariasis in Cyprus
Authors:   Department of Otorhinolaryngology, Faculty of Medicine, Near East University, Nicosia, Cyprus, et al. Safakogullari
Published: October 2020

Otoacariasis is the ear canal infestation by the arthropod Subclass: Acari, usually ticks or mites. It is a common complaint seen in animals. However, there are relatively few documented cases of human otoacariasis. In August 2019, a physically healthy 53-year-old Cypriot man visited Near East University hospital complaining of a blockage, partial deafness, and minor pruritis in his left ear. During the examination of the patient, a mite infestation of his left external auditory canal (EAC) was determined. The mites were removed from the EAC and sent to the laboratory for identification. The mite samples were viewed under Olympus-CX31 light microscopy and identified as Dermatophagoides pteronyssinus. The patient was treated with Permethrin (cream), Xylocaine spray, dilute acetic acid (vinegar), and three ear canal aspirations. After three days, the patient’s ear was re-examined, and the number of mites had greatly decreased within the EAC. Follow up consultations confirmed the eradication of the mite infestation. This is the first case report of human otoacariasis from Cyprus.
Perspectives of Patients, Health Care Professionals, and Developers Toward Blockchain-Based Health Information Exchange: Qualitative Study
Authors: Lee Keehyuck , Lim Kahyun , Jung Se Young , Ji Hyerim , Hong Kyungpyo , Hwang Hee , Lee Ho-Young
Published: October 2020

Background

Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE.

Objective

The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology.

Methods

In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees.

Results

Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established.

Conclusions

The three groups’ perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.
Measurement of Semantic Textual Similarity in Clinical Texts: Comparison of Transformer-Based Models
Authors: Yang Xi , He Xing , Zhang Hansi , Ma Yinghan , Bian Jiang , Wu Yonghui
Published: October 2020

Background

Semantic textual similarity (STS) is one of the fundamental tasks in natural language processing (NLP). Many shared tasks and corpora for STS have been organized and curated in the general English domain; however, such resources are limited in the biomedical domain. In 2019, the National NLP Clinical Challenges (n2c2) challenge developed a comprehensive clinical STS dataset and organized a community effort to solicit state-of-the-art solutions for clinical STS.

Objective

This study presents our transformer-based clinical STS models developed during this challenge as well as new models we explored after the challenge. This project is part of the 2019 n2c2/Open Health NLP shared task on clinical STS.

Methods

In this study, we explored 3 transformer-based models for clinical STS: Bidirectional Encoder Representations from Transformers (BERT), XLNet, and Robustly optimized BERT approach (RoBERTa). We examined transformer models pretrained using both general English text and clinical text. We also explored using a general English STS dataset as a supplementary corpus in addition to the clinical training set developed in this challenge. Furthermore, we investigated various ensemble methods to combine different transformer models.

Results

Our best submission based on the XLNet model achieved the third-best performance (Pearson correlation of 0.8864) in this challenge. After the challenge, we further explored other transformer models and improved the performance to 0.9065 using a RoBERTa model, which outperformed the best-performing system developed in this challenge (Pearson correlation of 0.9010).

Conclusions

This study demonstrated the efficiency of utilizing transformer-based models to measure semantic similarity for clinical text. Our models can be applied to clinical applications such as clinical text deduplication and summarization.
Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study
Authors: Yu Qiao , Zhu Chunpeng , Feng Shuyi , Xu Liyi , Hu Shurong , Chen Hao , Chen Hanwen , Yao Sheng , Wang Xiaoying , Chen Yan
Published: October 2020

Background

The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies.

Objective

The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn’s & Colitis Foundation web-based platform in China.

Methods

Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed.

Results

In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income (P=.001) and higher transportation (P=.004) and accommodation costs (P=.001) were significantly associated with the increased number of emergency visits of the patients.

Conclusions

Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs.
Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review
Authors: Wilcha Robyn-Jenia
Published: October 2020

Background

In December 2019, COVID-19 emerged and rapidly spread worldwide. Transmission of SARS-CoV-2, the virus that causes COVID-19, is high; as a result, countries worldwide have imposed rigorous public health measures, such as quarantine. This has involved the suspension of medical school classes globally. Medical school attachments are vital to aid the progression of students’ confidence and competencies as future physicians. Since the outbreak of COVID-19, medical schools have sought ways to replace medical placements with virtual clinical teaching.

Objective

The objective of this study was to review the advantages and disadvantages of virtual medical teaching for medical students during the COVID-19 pandemic based on the current emerging literature.

Methods

A brief qualitative review based on the application and effectiveness of virtual teaching during the COVID-19 pandemic was conducted by referencing keywords, including medical student virtual teaching COVID-19, virtual undergraduate medical education, and virtual medical education COVID-19, in the electronic databases of PubMed and Google Scholar. A total of 201 articles were found, of which 34 were included in the study. Manual searches of the reference lists of the included articles yielded 5 additional articles. The findings were tabulated and assessed under the following headings: summary of virtual teaching offered, strengths of virtual teaching, and weaknesses of virtual teaching.

Results

The strengths of virtual teaching included the variety of web-based resources available. New interactive forms of virtual teaching are being developed to enable students to interact with patients from their homes. Open-access teaching with medical experts has enabled students to remain abreast of the latest medical advancements and to reclaim knowledge lost by the suspension of university classes and clinical attachments. Peer mentoring has been proven to be a valuable tool for medical students with aims of increasing knowledge and providing psychological support. Weaknesses of virtual teaching included technical challenges, confidentiality issues, reduced student engagement, and loss of assessments. The mental well-being of students was found to be negatively affected during the pandemic. Inequalities of virtual teaching services worldwide were also noted to cause differences in medical education.

Conclusions

In the unprecedented times of the COVID-19 pandemic, medical schools have a duty to provide ongoing education to medical students. The continuation of teaching is crucial to enable the graduation of future physicians into society. The evidence suggests that virtual teaching is effective, and institutions are working to further develop these resources to improve student engagement and interactivity. Moving forward, medical faculties must adopt a more holistic approach to student education and consider the mental impact of COVID-19 on students as well as improve the security and technology of virtual platforms.
Depression and Anxiety in Patients with Primary Biliary Cholangitis: A Systematic Review and Meta-analysis (Preprint)
Authors: Shi Xiao , Chen Qi , Wang Fen
Published: October 2020

BACKGROUND

Previous studies have implicated the co-existence of psychological disorders and primary biliary cholangitis (PBC). However, the exact magnitude of the prevalence and related score of depression and anxiety in patients with PBC are still unclear.

OBJECTIVE

We aimed to assess the prevalence and Hospital Anxiety and Depression Scale (HADS) scores for depression and anxiety in patients with PBC.

METHODS

A comprehensive search of studies published before June 10, 2020 was performed in databases of PUBMED, EMBASE, Cochrane Library and Web of Science. Methodological quality was assessed based on the Newcastle - Ottawa Scale (NOS) tool.

RESULTS

Twelve studies were identified, representing 933 patients with PBC. Pooled prevalence estimates were 27.59% (95% CI 16.75%-38.43%) for depression and 19.87% (95% CI 14.12%-25.62%) for anxiety. The scores of HADS-D and HADS-A were 5.60 (95% CI 4.67-6.52) and 6.56 (95% CI 4.89-8.23) among PBC suffers, respectively.

CONCLUSIONS

This systematic review and meta-analysis indicates that depression and anxiety are prevalent in PBC patients. Physicians should be vigilant for psychiatric symptoms among PBC suffers and provide appropriate interventions for them. Exploration of underlying mechanisms and interactions in the future investigations is warranted.
Gender Prediction for a Multiethnic Population via Deep Learning Across Different Retinal Fundus Photograph Fields: Retrospective Cross-sectional Study (Preprint)
Authors: Betzler Bjorn Kaijun , Yang Henrik Hee Seung , Thakur Sahil , Yu Marco , Quek Ten Cheer , Soh Zhi Da , Lee Geunyoung , Tham Yih-Chung , Wong Tien Yin , Rim Tyler Hyungtaek , Cheng Ching-Yu
Published: October 2020

BACKGROUND

Deep learning algorithms have been built for the detection of systemic and eye diseases based on fundus photographs. The retina possesses features that can be affected by gender differences, and the extent to which these features are captured via photography differs depending on the retinal image field.

OBJECTIVE

We aimed to compare deep learning algorithms’ performance in predicting gender based on different fields of fundus photographs (optic disc–centered, macula-centered, and peripheral fields).

METHODS

This retrospective cross-sectional study included 172,170 fundus photographs of 9956 adults aged ≥40 years from the Singapore Epidemiology of Eye Diseases Study. Optic disc–centered, macula-centered, and peripheral field fundus images were included in this study as input data for a deep learning model for gender prediction. Performance was estimated at the individual level and image level. Receiver operating characteristic curves for binary classification were calculated.

RESULTS

The deep learning algorithms predicted gender with an area under the receiver operating characteristic curve (AUC) of 0.94 at the individual level and an AUC of 0.87 at the image level. Across the three image field types, the best performance was seen when using optic disc–centered field images (younger subgroups: AUC=0.91; older subgroups: AUC=0.86), and algorithms that used peripheral field images had the lowest performance (younger subgroups: AUC=0.85; older subgroups: AUC=0.76). Across the three ethnic subgroups, algorithm performance was lowest in the Indian subgroup (AUC=0.88) compared to that in the Malay (AUC=0.91) and Chinese (AUC=0.91) subgroups when the algorithms were tested on optic disc–centered images. Algorithms’ performance in gender prediction at the image level was better in younger subgroups (aged <65 years; AUC=0.89) than in older subgroups (aged ≥65 years; AUC=0.82).

CONCLUSIONS

We confirmed that gender among the Asian population can be predicted with fundus photographs by using deep learning, and our algorithms’ performance in terms of gender prediction differed according to the field of fundus photographs, age subgroups, and ethnic groups. Our work provides a further understanding of using deep learning models for the prediction of gender-related diseases. Further validation of our findings is still needed.
Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis (Preprint)
Authors: Tremblay Zoë , Mumbere David , Laurin Danielle , Sirois Caroline , Furrer Daniela , Poisblaud Lise , Carmichael Pierre-Hugues , Farrell Barbara , Tourigny André , Giguere Anik , Vedel Isabelle , Morais José , Kröger Edeltraut
Published: October 2020

BACKGROUND

Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions.

OBJECTIVE

This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ≥60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing.

METHODS

Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2).

RESULTS

The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes.

CONCLUSIONS

This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors.

CLINICALTRIAL

PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/25200
The Psychosocial Benefits of Recreational Oncology Camp for Childhood Cancer Patients and Survivors: Study Protocol (Preprint)
Authors: West Sarah L , White Gillian , O'Keeffe Nathan , Wells Greg D
Published: October 2020

BACKGROUND

Patients and survivors of childhood cancer may experience negative outcomes following treatment. This may result in negative developmental experiences such as social isolation, academic delays, and altered elective participation in developmental activities. Opportunities that offer experiences to children who have had cancer are important to help mitigate the potential outcomes of cancer treatment. One such opportunity is recreational oncology camp (“Camp”); the focus of this research project is Camp Ooch and Camp Trillium located in Ontario, Canada.

OBJECTIVE

There are two primary objectives of the current study: 1) examine the impact of recreational overnight Camp on social, psychological, emotional, and physical function in childhood cancer patients; and 2) inform an evidence strategy that can be implemented across the organization.

METHODS

A total of 40 children ages 7 to 18 will be recruited from Camp Ooch and Camp Trillium registration lists. All cancer diagnoses and stages of treatments will be included. No intervention will be added above regular camp programming which participants will opt into, same as campers that are not participating in the study. A No-camp control Group (n=40) will be recruited from The Hospital for Sick Children. Social, Psychological, and emotional functioning will be assessed by questionnaires including the Social Provisions Scale, General Self Efficacy Scale, and The Profile of Mood States (POMS-40). Stress will be measured via salivary cortisol. Physical function will be measured by via activity tracking (FitBit Charge™ 3), and physical literacy will be assessed by the PlaySelf™ scale. Testing will occur pre-camp, during camp, immediately and 6 months post-camp.

RESULTS

We hypothesize that compared to the non-camp control group, the camp experience will lead to improved social connectedness, reduced salivary cortisol levels (i.e., reduced stress), improved mood states, and increased self-efficacy. We also hypothesize that compared to the non-camp control group, children in the camp group will have increased physical activity participation, which will be associated with improved physical literacy. Due to the COVID-19 pandemic, work on this study has been delayed. We are currently completing our application for institutional research ethics approval. Depending on the COVID-19 pandemic status, data collection is projected to begin in the spring of 2021, with the majority occurring during the 2021 summer camp season. Data collection and analyses are expected to be completed by Spring 2022.

CONCLUSIONS

Overall, we expect the current project will increase knowledge on the psychosocial impact of childhood cancer and a prospective model for supporting positive youth development through social connections, self-efficacy, physical activity, and interaction with the natural environment.

CLINICALTRIAL

N/A