bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record
Authors: Kunstler Breanne E , Furler John , Holmes-Truscott Elizabeth , McLachlan Hamish , Boyle Douglas , Lo Sean , Speight Jane , O'Neal David , Audehm Ralph , Kilov Gary , Manski-Nankervis Jo-Anne 
Published: July 2020

Background
Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options.

Objective
This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations.

Methods
The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification.

Results
Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities.

Conclusions
GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study
Authors: Stunden Chelsea , Zasada Julie , VanHeerwaarden Nicole , Hollenberg Elisa , Abi-Jaoudé Alexxa , Chaim Gloria , Cleverley Kristin , Henderson Joanna , Johnson Andrew , Levinson Andrea , Lo Brian , Robb Janine , Shi Jenny , Voineskos Aristotle , Wiljer David 
Published: July 2020

Background
Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help.

Objective
The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada.

Methods
A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes.

Results
Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help.

Conclusions
Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.
Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework
Authors: Mackey Tim Ken , Miyachi Ken , Fung Danny , Qian Samson , Short James 
Published: July 2020

Background
An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse.

Objective
The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse.

Methods
We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation).

Results
Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network.

Conclusions
The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.
Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis
Authors: Leng Minmin , Zhao Yajie , Xiao Hongmei , Li Ce , Wang Zhiwen 
Published: July 2020

BackgroundCaring for people with dementia is perceived as one of the most stressful and difficult forms of caring. Family caregivers always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet-based supportive interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care.ObjectiveThis review aimed to (1) assess the efficacy of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate the potential effects of internet-based supportive intervention access by caregivers on their care recipients.MethodsAn electronic literature search of the PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases was conducted up to January 2020. Two reviewers (ML and YZ) worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and independently extracted data. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) with 95% CIs were applied to calculate the pooled effect sizes.ResultsIn total, 17 RCTs met the eligibility criteria and were included in this systematic review. The meta-analysis showed that internet-based supportive interventions significantly ameliorated depressive symptoms (SMD=–0.21; 95% CI –0.31 to –0.10; P<.001), perceived stress (SMD=–0.40; 95% CI –0.55 to –0.24; P<.001), anxiety (SMD=–0.33; 95% CI –0.51 to –0.16; P<.001), and self-efficacy (SMD=0.19; 95% CI 0.05-0.33; P=.007) in dementia caregivers. No significant improvements were found in caregiver burden, coping competence, caregiver reactions to behavioral symptoms, or quality of life. Six studies assessed the unintended effects of internet-based supportive intervention access by caregivers on their care recipients. The results showed that internet-based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients.ConclusionsInternet-based supportive interventions are generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self-efficacy in dementia caregivers and have potential benefits on care recipients. Future studies are encouraged to adopt personalized internet-based supportive interventions to improve the health of family caregivers and their care recipients.Trial RegistrationPROSPERO CRD42020162434; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162434
Digital Cardiovascular Biomarker Responses to Transcutaneous Cervical Vagus Nerve Stimulation: State-Space Modeling, Prediction, and Simulation
Authors: Gazi Asim H , Gurel Nil Z , Richardson Kristine L S , Wittbrodt Matthew T , Shah Amit J , Vaccarino Viola , Bremner J Douglas , Inan Omer T 
Published: July 2020

BackgroundTranscutaneous cervical vagus nerve stimulation (tcVNS) is a promising alternative to implantable stimulation of the vagus nerve. With demonstrated potential in myriad applications, ranging from systemic inflammation reduction to traumatic stress attenuation, closed-loop tcVNS during periods of risk could improve treatment efficacy and reduce ineffective delivery. However, achieving this requires a deeper understanding of biomarker changes over time.ObjectiveThe aim of the present study was to reveal the dynamics of relevant cardiovascular biomarkers, extracted from wearable sensing modalities, in response to tcVNS.MethodsTwenty-four human subjects were recruited for a randomized double-blind clinical trial, for whom electrocardiography and photoplethysmography were used to measure heart rate and photoplethysmogram amplitude responses to tcVNS, respectively. Modeling these responses in state-space, we (1) compared the biomarkers in terms of their predictability and active vs sham differentiation, (2) studied the latency between stimulation onset and measurable effects, and (3) visualized the true and model-simulated biomarker responses to tcVNS.ResultsThe models accurately predicted future heart rate and photoplethysmogram amplitude values with root mean square errors of approximately one-fifth the standard deviations of the data. Moreover, (1) the photoplethysmogram amplitude showed superior predictability (P=.03) and active vs sham separation compared to heart rate; (2) a consistent delay of greater than 5 seconds was found between tcVNS onset and cardiovascular effects; and (3) dynamic characteristics differentiated responses to tcVNS from the sham stimulation.ConclusionsThis work furthers the state of the art by modeling pertinent biomarker responses to tcVNS. Through subsequent analysis, we discovered three key findings with implications related to (1) wearable sensing devices for bioelectronic medicine, (2) the dominant mechanism of action for tcVNS-induced effects on cardiovascular physiology, and (3) the existence of dynamic biomarker signatures that can be leveraged when titrating therapy in closed loop.Trial RegistrationClinicalTrials.gov NCT02992899; https://clinicaltrials.gov/ct2/show/NCT02992899International Registered Report Identifier (IRRID)RR2-10.1016/j.brs.2019.08.002
App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data
Authors: Zens Martin , Brammertz Arne , Herpich Juliane , Südkamp Norbert , Hinterseer Martin 
Published: July 2020

Background
COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients.

Objective
To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool.

Methods
The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous.

Results
In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value.

Conclusions
Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection.
Pembelajaran Sistem Reproduksi Manusia Dengan Pendekatan Contextual Teaching And Learning Untuk Meningkatkan Pemahaman Konsep Dan Sikap Siswa MAN Darussalam Aceh
Authors: Fuadi Tuti Marjan , Adlim Adlim , Sabri Mustafa 
Published: July 2020

Penelitian ini bertujuan untuk mengkaji pembelajaran sistem reproduksi manusia dengan pendekatan Contextual Teaching and Learning (CTL) untuk meningkatkan pemahaman konsep dan sikap siswa. Penelitian ini didesain dengan metode Quasi Experiment dengan One Group Pretest-Postest Design. Penelitian dilaksanakan di MAN Darussalam Aceh Besar kelas XI IPA 1 yang melibatkan 23 siswa dan lima observer serta satu guru biologi. Hasil dari penelitian ini diperoleh bahwa modul untuk pembelajaran sistem reproduksi manusia dengan pendekatan CTL terdiri dari tujuan pembelajaran, pokok bahasan, contoh kasus, uraian materi dan evaluasi yang dilengkapi dengan LKS/pedoman untuk aktivitas konstruktivisme, inkuiri, masyarakat belajar, bertanya, pemodelan, refleksi dan penilaian sebenarnya. Berdasarkan tanggapan dari peserta didik dan guru dapat disimpulkan bahwa penerapan pembelajaran sistem reproduksi manusia dengan pendekatan CTL telah mampu mengaitkan materi yang diajarkan dengan situasi kehidupan nyata siswa. Siswa dapat membangun pengetahuan melalui keterlibatan aktif dalam proses belajar mengajar dan pemahaman mereka tentang konsep sistem reproduksi manusia meningkat (N-gain = 71%) dan dapat meningkatkan sikap terhadap sistem reproduksi (N-gain = 50%).

Kata Kunci: Sistem Reproduksi Manusia, Contextual Teaching and Learning, Pemahaman Konsep dan Sikap Siswa.

This study was conducted to apply Contextual Teaching and Learning (CTL) approach to human reproductive system to improve students' understanding of concepts and attitudes. This study was designed with Quasi Experimental methods by One Group Pretest-posttest design. It was conducted in MAN Darussalam Aceh Besar class XI IPA 1 involving 23 students and five observer as well as a biology teacher. The results of this study found that the design of modules for teaching human reproduction system with CTL approach consists of learning objectives, subject matter, case examples, description and evaluation materials. Learning CTL have 7 activities which must be applied in teaching learning process namely constructivism, inquiry, learning society, questioning, modelling, reflection and authentic assessment. Based on the feedbacks got from students and teachers, it can be concluded that the application of CTL approach to the concept of the human reproductive system have been able to relate the material taught to students' real life situations. Students can construct knowledge through active involvement in the learning process. Their understanding of the concept of the human reproductive system was increases.

Keywords:	Human Reproduction System, Contextual Teaching and Learning, Concept Understanding and Attitude
Upaya Meraih Standar Kompetensi Mengendalikan Hama Tanaman Melalui Cooperative Learning Berorientasi Forward Looking Siswa Kelas XI SMKN 1 Karang Baru
Authors: Tampubolon Lusni 
Published: July 2020

Penelitian ini bertujuan untuk memperbaiki kualitas proses belajar melalui pendekatan cooperative learning berorientasi forward looking sehingga dapat meningkatkan hasil belajar mata diklat Mengendalikan Hama Tanaman. Metode yang digunakan dalam penelitian ini adalah metode Penelitian Tindakan Kelas (PTK) yang terdiri dari 3 (tiga) siklus. Langkah-langkah dalam setiap siklus terdiri dari perencanaan (planning), pelaksanaan (acting), pengamatan (observing), dan refleksi (reflecting). Hasil penelitian menunjukan bahwa sebelum ada intervensi tindakan cooperative learning berorientasi forward looking hasil belajar pada ulangan harian pertama, nilai rata-rata siswa adalah 6,0. Setelah dilakukan intervensi secara berturut-turut selama tiga siklus, nilai aspek kognitif berangsur meningkat. Pada siklus pertama nilai rata-rata 6,6, pada siklus kedua 6,7 dan pada siklus ketiga 7,1. Presentase ketuntasan siklus pertama 30%, siklus kedua 50% dan siklus ketiga 75%. Setelah diselenggerakan remidiasi menjadi tuntas 100% dengan nilai berkisar 7,0 sampai 8,0. Perkembangan tugas rumah, unjuk kerja, dan laporan praktek selalu meningkat antara 7,0 sampai 9,0. Ketuntasan pada aspek sikap masih rendah, pada siklus pertama 5,3%, siklus kedua 18,4% dan siklus ketiga 34,2%. Pada akhir periode penelitian, ternyata ada 14 peserta didik yang memenuhi standar kompetensi atau baru mencapai 36,8%.

Kata Kunci: Pendekatan CLFL (Cooperative Learning Berorientasi Forward Looking), Hasil Belajar, dan Mengendalikan Hama

This research aimed at improving studentsâ€™ learning outcomes by implementing cooperative learning forward-looking-oriented in the material of plantsâ€™ pest. This is a Classroom Action Research which consisted of three cycles. The steps in each cycles were planning, acting, observing, and reflecting. The results showed that before treatment of cooperative learning forward-looking oriented, the studentsâ€™ learning outcomes for the first daily test got the average score of 6.0. After the treatment in three cycles, the average score of cognitive aspect was increased gradually, they were 6.6, 6.7 and 7.1. The Percentage of completeness for the first cycle was 30%, meanwhile, the second and the third ones were 50% and 75%. After remedial was conducted, the percentage of completeness reaches 100% with scores range from 7.0 to 8.0. The development of homeworks, performance, and practice report were improved from 7.0 to 9.0. The completeness of the aspects of attitude was still low. It reached 5.3% in the first cycle, 18.4% in the second, and 34.2% in the third one. At the end of the study, there were 14 students who met the standards of competence or only reached 36.8%.

Keywords:	CLFL Approach (Cooperative Learning Oriented Forward Looking), Learning Outcomes, and Controlling Pests
Penerapan Model Pembelajaran Problem Based Learning Dan Inkuiri Untuk Meningkatkan Kemampuan Berpikir Kritis Mahasiswa Pada Konsep Dampak Pencemaran Lingkungan Terhadap Kesehatan
Authors: Apriana Evi , Anwar Anwar 
Published: July 2020

Penelitian ini bertujuan untuk mengetahui peningkatkan kemampuan berpikir kritis mahasiswa melalui penerapan model pembelajaran Problem Based Learning (PBL) dan Inkuiri pada konsep dampak pencemaran lingkungan terhadap kesehatan, menggunakan metode eksperimen dengan rancangan Statistic group pretes-postes design. Populasi dalam penelitian ini adalah mahasiswa Fakultas Kesehatan Masyarakat Universitas Muhamadiyah Aceh. Kelas pertama dibelajarkan dengan model pembelajaran PBL dan kelas kedua dibelajarkan dengan model pembelajaran Inkuiri. Analisis data tentang model pembelajaran PBL dan Inkuiri terhadap peningkatan kemampuan berpikir kritis mahasiswa. Data penelitian diuji dengan t-test, menggunakan program statistik software komputer. Hasil penelitian menunjukkan nilai kemampuan berpikir kritis pada model pembelajaran PBL dan Inkuiri dengan t-hitung > t-tabel (3,20 > 2,00), dengan nilai postest mean PBL = 72,25 dan mean Inkuiri = 81,00. Maka dapat disimpulkan bahwa terdapat peningkatan kemampuan berpikir kritis mahasiswa pada model PBL dan Inkuiri.

Kata Kunci:	Model Pembelajaran Problem Based Learning, Inkuiri, Kemampuan Berpikir Kritis, dan Pencemaran Lingkungan

This study aims to determine the improvement of students' critical thinking skills through the application of the Problem Based Learning (PBL) and Inquiry on the concept of the impact of environmental pollution on health, using experimental methods to design pretest-posttest Statistic group design. The population in this study were students of the Faculty of Public Health, University of Muhammadiyah in Aceh. First class learned with PBL learning model and the second class learned with inquiry learning model. Analysis of data on PBL and inquiry learning model to increase students' critical thinking skills. Data were tested by t-test, using a statistical software program computer. The results show the value of critical thinking skills in the PBL and inquiry learning model with t count> t-table (3.20> 2.00), with a mean post-test score and the mean PBL = 72.25 and mean Inquiry = 81.00. It can be concluded that there is an increase in students' critical thinking skills and inquiry PBL model.

Keyword: Learning Model of Problem Based Learning, Inquiry, Critical Thinking Skills, and Environmental Pollution