bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records
Authors: Lewkowicz Daniel , Wohlbrandt Attila , Boettinger Erwin 
Published: May 2020

Abstract
BackgroundUnnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects onreducing healthcare expenditure. Inthis articleweevaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR).MethodsWe searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registrydatabases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practiceapplication areas and categorized the investigated interventions according to an existing taxonomy of front-endCDS tools. Results and discussionTwenty-sevenstudies are investigated in this review. Of those, twenty-twostudies indicate a reduction of healthcare expenditure after implementingan EHRbased CDS system, especiallytowardsprevalent application areas, such as unnecessarylaboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions.On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems. ConclusionCurrent research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, thepositive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.
A rational drug designing: What bioinformatics approach tells about the wisdom of practicing traditional medicines for screening the potential of Ayurvedic and natural compounds for their inhibitory effect against COVID-19 Spike, Indian strain Spike, Papain-like protease and Main Protease protein
Authors: Ranjan Prashant , Mohapatra Bhagyalaxmi , Das Parimal 
Published: May 2020

Abstract
The new outbreak of Coronavirus disease (COVID-19) has been entitled as a pandemic by W.H.O. It spreads to almost 211 countries due to its contagious nature. There is an urgent need for developing specific therapeutic agents against COVID-19. We have performed virtual screening of 52 ligands; most of which are essential components of traditional Ayurvedic medicine as well as natural compounds and three were standard repurposing drugs against COVID-19 Spike, Indian strain Spike (IS-Spike), PL-Pro and M-Pro to find potential inhibitor effects. Based on the docking results, it is estimated that compounds have a better binding affinity with M-Pro and PL-Pro than Spike as well as IS-Spike so it can be beneficial as therapeutics against COVID-19. We also conclude that the binding affinity of ligands with IS-Spike gets low as compared to Spike so the inhibitory potential of drugs may get weak. Based on the calculation of average binding energy (B.E) with the three targets, Spike, PL-Pro, and M-Pro, we found10 best ligands viz. (1) Punicafolin (2) Emblicanin A (3) Punigluconin (4) Lopinavir (5) Kuwanon X (6) Rutin (7) Lithospermic Acid (8) Phyllanemblinin A (9) Amarogentin and (10) Amaroswerin for inhibition. These ligands may act as potential inhibitors against COVID-19 druggable tri-targets. Network analysis revealed that four ligands out of 10 leading compounds are common in all four different networks (Spike, IS-Spike, PL-Pro, and M-Pro) which come under Phyllanthus emblica. Notably, a compound of Azadirachta indica out of 4 and a single compound of Swertia chirata was found common in all networks. Additionally, a standard drug Lopinavir and a compound of Salvia miltiorrhiza are frequently found in all networks. In principle, it appears plausible that the compounds which are common in the entire network should have more inhibitory potential against COVID19 due to the better binding potential among all targets, thus providing better candidacy for drug development.
Aminoalkylated Phenolic Chalcones: Investigation of Biological Effects on Acetylcholinesterase and Carbonic Anhydrase I and II as Potential Lead Enzyme Inhibitors
Authors: Yamali Cem , Gul Halise Inci , Cakir Tahir , Demir Yeliz , Gulcin Ilhami 
Published: May 2020

Background:
Phenolic Mannich bases have been reported as acetylcholinesterase
(AChE) inhibitors for the medication of Alzheimer's disease. Carbonic Anhydrases (CAs) are molecular
targets for anticonvulsant, diuretic and antiglaucoma drugs in the clinic. Phenolic compounds
have also been mentioned as CA inhibitors. The importance of Mannich bases in drug design inspired
our research group to design novel phenolic Mannic bases as potent enzyme inhibitors.

Objective:
In this study, novel Mannich bases, 1-(3,5-bis-aminomethyl-4-hydroxyphenyl)-3-(4-
substitutedphenyl)-2-propen-1-ones (1-9), were designed to discover new and potent AChE inhibitors
for the treatment of Alzheimer's disease and also to report their carbonic anhydrase inhibitory
potency against the most studied hCA I and hCA II isoenzymes with the hope to find out promising
enzyme inhibitors.

Methods:
Mannich bases were synthesized by the Mannich reaction. The structures of the compounds
were elucidated by 1H NMR, 13C NMR, and HRMS. Enzyme inhibitory potency of the compounds
was evaluated spectrophotometrically towards AChE, hCA I and hCA II enzymes.

Results and Discussion:
The compounds showed inhibition potency in nanomolar concentrations
against AChE with Ki values ranging from 20.44±3.17 nM to 43.25±6.28 nM. They also showed
CAs inhibition potency with Ki values in the range of 11.76±1.29-31.09±2.7 nM (hCA I) and 6.08 ±
1.18-23.12±4.26 nM (hCA II). Compounds 1 (hCA I), 5 (hCA II), and 4 (AChE) showed significant
inhibitory potency against the enzymes targeted.

Conclusion:
Enzyme assays showed that Mannich derivatives might be considered as lead enzyme
inhibitors to design more selective and potent compounds targeting enzyme-based diseases.
Study of Plasmid-Mediated Quinolone Resistance in Escherichia coli from Nosocomial Urinary Tract Infections
Authors: Zaki Maysaa El Sayed , El Salam Mostafa Abd , Faried Osama Ahmed 
Published: May 2020

Objective:
The aim of the present study was to study the prevalence of plasmid-mediated
quinolone resistance (PMQR) genes (qnrA, qnrB, qnrC, qnrD, qnrS, qepA, oqxA, oqxB and aac)
in Escherichia coli (E. coli) isolated from patients with nosocomial urinary tract infections (UTIs)
and its relation to the extended-spectrum β-lactamase (ESBL) production.

Methods:
A cross-sectional study was carried out on 200 non-duplicated isolates of E. coli isolated
from patients with nosocomial UTIs. E.coli isolates were subjected to antibiotic susceptibility testing
by disc diffusion method, determination of minimum inhibitory concentrations (MICs) of
ciprofloxacin by Epsillometer (E) test strips, detection of ESBL production by double disc synergy
method and detection of qnrA, qnrB, qnrC, qnrD, qnrS, qepA, oqxA, oqxB and aac genes by polymerase
chain reaction (PCR).

Results:
The antimicrobial susceptibility testing of the isolated E. coli revealed a high frequency of
resistance to ampicillin (73.5%), ceftazidime (72%) and imipenem (71.5%). The less frequent resistance
was for aztreonam (21.5%), amikacin (36.5%) and gentamicin (38.5%). ESBL production
was found in 131 isolates (65.5%) and phenotypic quinolone resistance was detected by MIC in 65
isolates (32.5%), with 52.3% of them showed high resistance to ciprofloxacin with an MIC more
than 32 μg/ml. PMQR genes were found in 40 isolates. The frequency of the detected genes was
40%, 37.5%, 35%, 20% and 5% for qnrA, qnrS, qepA, qnrB and oqxA, respectively. Significant association
was found between the presence of PMQR genes and ESBL production (P=0.0001).

Conclusion:
The study highlights the prevalence of PMQR genes in E. coli with high association
with the ESBL phenotype. This finding is a sign of limited therapeutic options for E. coli.
Incidence of ESBL-Producing Gram-Negative Bacteria of Lower Respiratory Tract Infection in Bharatpur Hospital, Nepal
Authors: Lamichhane Asmita , Sapkota Sanjeep , Khadka Sujan , Adhikari Sanjib , Thapa Alina , Rana Jid Chani , Ghimire Albert , Thagunna Shova , Pathak Sudipa , Koirala Niranjan 
Published: May 2020

Background:
Antimicrobial resistance is a global threat in the medical society. Extended-
Spectrum β-lactamase (ESBL) producing bacteria are increasing worldwide, including Nepal and
causing more severe infections because of their continuous mutation and multidrug resistance
(MDR) nature.

Objective:
The objective of this study was to assess Gram-negative bacterial etiology of lower respiratory
tract infections (LRTIs) and determine their antibiotic susceptibility pattern with a special
focus on MDR, including ESBL production.

Methods:
A total of 109 sputum specimens were analyzed. The bacterial isolates were identified by
standard microbiological procedures, including Analytical Profile Index (API) 20E test panels for
Enterobacteriaceae and subjected to antimicrobial susceptibility testing. Screening of ESBL producers
among Gram-negative isolates was done by using third-generation cephalosporins (ceftazidime
and cefotaxime) and confirmed by the combined disk method as recommended by CLSI (2019).

Results:
Out of 109 sputum specimens, Gram-negative bacterial etiology was determined in
31(28.4%) cases. The age-wise distribution of LRTIs patients was found to be statistically significant
with bacterial incidence (p<0.05). Altogether, 15(46.9%) isolates were multidrug-resistant.
ESBL producers were observed only among Klebsiella spp. and Escherichia coli isolates. On the
ESBL screening test of 9 isolates (3 of E. coli and 6 of Klebsiella spp.) 5(55.6%) gave a positive result,
and only 3(33.3%) of them were further confirmed as ESBL producers. The majority of ESBL
producers (66.7%) were Klebsiella spp.

Conclusion:
The present study revealed that multidrug resistance is prevalent among Gram-negative
bacterial pathogens isolated from the patients with lower respiratory tract infections, requiring routine
laboratory testing for MDR and ESBL production in clinical isolates for better prophylaxis and
reducing the risk of ESBL transmission.
Evidence-Based Decision Aid for Patients With Parkinson Disease: Protocol for Interview Study, Online Survey, and Two Randomized Controlled Trials
Authors: Bientzle Martina , Kimmerle Joachim , Eggeling Marie , Cebi Idil , Weiss Daniel , Gharabaghi Alireza 
Published: May 2020

Background
Shared decision making is particularly important in situations with different treatment alternatives. For the treatment of idiopathic Parkinson disease, both pharmacological and surgical approaches can be applied.

Objective
In this research project, a series of studies will be conducted to investigate how decision aids for patients with idiopathic Parkinson disease should be designed in order to support the decision-making process.

Methods
In Study 1a, qualitative interviews will be conducted to determine which needs frequently occur for patients with idiopathic Parkinson disease. In Study 1b, the identified needs will then be rated for personal relevance by an independent group of patients in an online survey. In Study 2, a randomized controlled trial will be used to pretest different decision aids in a sample group of people who do not have a medical background and who do not have Parkinson disease. In Study 3, a randomized controlled trial will be used to investigate the effect of the decision aids that had been evaluated as positive in Study 2 with patients who have idiopathic Parkinson disease.

Results
This series of studies received ethical approval in January 2020. As of June 2020, data collection for Study 1a has started, and it is estimated that Studies 1a, 1b, 2, and 3 will take approximately 4, 4, 6, and 6 months to complete, respectively. It is planned to present the results and analyses at international conferences and to submit the results to peer-reviewed journals for publication, once the studies have been completed. The findings will also be shared with clinicians and patients through presentations at information events.

Conclusions
This series of studies is intended to result in an evidence-based decision aid for patients with idiopathic Parkinson disease in order to support the informed and reflected shared decision-making process. We further intend to contribute to a deeper understanding of the individual preferences of patients with idiopathic Parkinson disease and the impact of those preferences on treatment decisions.
Wearable Device Heart Rate and Activity Data in an Unsupervised Approach to Personalized Sleep Monitoring: Algorithm Validation
Authors: Liu Jiaxing , Zhao Yang , Lai Boya , Wang Hailiang , Tsui Kwok Leung 
Published: May 2020

Background
The proliferation of wearable devices that collect activity and heart rate data has facilitated new ways to measure sleeping and waking durations unobtrusively and longitudinally. Most existing sleep/wake identification algorithms are based on activity only and are trained on expensive and laboriously annotated polysomnography (PSG). Heart rate can also be reflective of sleep/wake transitions, which has motivated its investigation herein in an unsupervised algorithm. Moreover, it is necessary to develop a personalized approach to deal with interindividual variance in sleep/wake patterns.

Objective
We aimed to develop an unsupervised personalized sleep/wake identification algorithm using multifaceted data to explore the benefits of incorporating both heart rate and activity level in these types of algorithms and to compare this approach’s output with that of an existing commercial wearable device’s algorithms.

Methods
In this study, a total of 14 community-dwelling older adults wore wearable devices (Fitbit Alta; Fitbit Inc) 24 hours a day and 7 days a week over period of 3 months during which their heart rate and activity data were collected. After preprocessing the data, a model was developed to distinguish sleep/wake states based on each individual’s data. We proposed the use of hidden Markov models and compared different modeling schemes. With the best model selected, sleep/wake patterns were characterized by estimated parameters in hidden Markov models, and sleep/wake states were identified.

Results
When applying our proposed algorithm on a daily basis, we found there were significant differences in estimated parameters between weekday models and weekend models for some participants.

Conclusions
Our unsupervised approach can be effectively implemented based on an individual’s multifaceted sleep-related data from a commercial wearable device. A personalized model is shown to be necessary given the interindividual variability in estimated parameters.
Googling for Ticks and Borreliosis in Germany: Nationwide Google Search Analysis From 2015 to 2018
Authors: Scheerer Cora , Rüth Melvin , Tizek Linda , Köberle Martin , Biedermann Tilo , Zink Alexander 
Published: May 2020

Background
Borreliosis is the most frequently transmitted tick-borne disease in Europe. It is difficult to estimate the incidence of tick bites and associated diseases in the German population due to the lack of an obligation to register across all 16 federal states of Germany.

Objective
The aim of this study is to show that Google data can be used to generate general trends of infectious diseases on the basis of borreliosis and tick bites. In addition, the possibility of using Google AdWord data to estimate incidences of infectious diseases, where there is inconsistency in the obligation to notify authorities, is investigated with the perspective to facilitate public health studies.

Methods
Google AdWords Keyword Planner was used to identify search terms related to ticks and borreliosis in Germany from January 2015 to December 2018. The search volume data from the identified search terms was assessed using Excel version 15.23. In addition, SPSS version 24.0 was used to calculate the correlation between search volumes, registered cases, and temperature.

Results
A total of 1999 tick-related and 542 borreliosis-related search terms were identified, with a total of 209,679,640 Google searches in all 16 German federal states in the period under review. The analysis showed a high correlation between temperature and borreliosis (r=0.88), and temperature and tick bite (r=0.83), and a very high correlation between borreliosis and tick bite (r=0.94). Furthermore, a high to very high correlation between Google searches and registered cases in each federal state was observed (Brandenburg r=0.80, Mecklenburg-West Pomerania r= 0.77, Saxony r= 0.74, and Saxony-Anhalt r=0.90; all P<.001).

Conclusions
Our study provides insight into annual trends concerning interest in ticks and borreliosis that are relevant to the German population exemplary in the data of a large internet search engine. Public health studies collecting incidence data may benefit from the results indicating a significant correlation between internet search data and incidences of infectious diseases.
Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis
Authors: Chattopadhyay Debaleena , Ma Tengteng , Sharifi Hasti , Martyn-Nemeth Pamela 
Published: May 2020

Background
Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications.

Objective
The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined.

Methods
Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed.

Results
Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1).

Conclusions
We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.
Karier Subkultural dan Kritisisme Street Artist Yogyakarta
Authors: Jati Jagat Hidayat , Widhyharto Derajad 
Published: May 2020

This article is based on research in 2017 about street artists in Yogyakarta. The study uses qualitative method with following issue and visuals approach on six street artists to extract 3 aspects: issue, medium, and actor. Street artist as subcultural career is a process of creating space and efforts to maintain it. Street artists is mentally affected through perception of surroundings, then their awareness of reality and hopes for public spaces collide so that alternative spaces are created in the street walls, in the end the walls become space wich symbolically interpreted by the viewer. To be able to create space and maintain it, street artists have a side of criticism. Starting from the awareness of differences in public space, selection of street as a core element in the city, as well as accuracy in momentum. Criticism is carried out repeatedly and build a resistance identity. Each street artist is in a position to oppose and criticize the various problems that surround them through two work patterns, issue first or place first. The pattern is also carried out together to form a collective identity.
USO E A DIFUSÃO DA LÍNGUA BRASILEIRA DE SINAIS NA ESCOLA COMUM
Authors: Corá Pamela Estefani , De Abreu Anderson , Graff Patrícia 
Published: May 2020

O uso e a difusão da Libras, por estudantes ouvintes que têm acesso a esta língua no decorrer do processo de escolarização, constituem o tema dessa pesquisa, cujo objetivo foi identificar se, no cotidiano escolar, os alunos difundem e fazem uso desta língua como meio de comunicação com os surdos. Trata-se de uma pesquisa de campo de natureza qualitativa e de cunho etnográfico, observando o comportamento de um grupo de indivíduos no cotidiano escolar. A pesquisa mostra que os alunos ouvintes fizeram uso da língua de sinais dentro da escola, com algumas especificidades como: a) diferença de uso da língua entre os gêneros masculino e feminino; b) maior aproximação com a língua de sinais no grupo de escolares que frequentam os Anos Iniciais do Ensino Fundamental; c) importância do professor bilíngue dentro da escola, no diálogo com todos os alunos. Conclui-se que a língua de sinais é importante para os alunos ouvintes e surdos dentro da escola comum, possibilitando a inclusão do aluno surdo.