bluuebunny/crossref_metadata_2025 huggingface dataset:
Excretory system learning in senior high school: comparative analysis of students’ problem solving skills
Authors: Rindah Maharani Aji Kharisma , Dwiastuti Sri , Rinanto Yudi
Published: December 2019

Problem-solving skills are the skills essential for students to have. This research aimed to analyze the problem-solving skills of senior high school students in biology learning of excretory system topics. The method used was descriptive-quantitative. The data were collected using a problem-solving essay test. The subjects were the eleventh-grade students of senior high schools in Surakarta, who were divided into A category (upper class) and B category (low level). Based on the analysis result, it can be seen that the problem-solving skill achievement of the eleventh grade of A group includes: defining the problem (50.78%), examining the problem (40.62%), planning a solution (19.53%), implementing the solution (37.50%), and evaluating (40.62%); while that of B category includes: Defining the problem (46.35%), examining the issue (34.67%), planning a solution (18.54%), implementing the solution (20.96%), and evaluating (32.25%). The lowest percentage in both categories was found in planning the solution and evaluating. Based on the result, the average problem-solving skills in A group is 37.81% and B Category 32,26%. Based on the data, it can be concluded that students' problem-solving skills in A and B categories are still low. The skills can be improved by conducting problem-solving based learning and familiarizing students to solve problems according to problem-solving stages.
Ethnopedagogy of the osing tribe folk song: exploration and formation of biology learning character
Authors: Hariyadi Slamet , Tamalene M. Nasir , Hariyono Aekanu
Published: December 2019

Exploration of ethnopedagogical values of the Osing tribe is essential to uncover the values of biological characters because the Osing tribe 3closely related to the application of biological science, for example, in utilizing plants for traditional ceremonial activities or as medicinal plants. This study aims to explore the character values contained in the folk song of the Osing Banyuwangi tribe, related to the formation of attitudes or characters needed in studying biology. The study was conducted using a survey method using structured interview techniques, semi-structured interviews, and in-depth interviews of 15 informants selected using Purposive Sampling and snowball sampling techniques. Data analysis consists of 3 stages: data reduction, data presentation, and making conclusions. The results of the study mentioned that the ethno-pedagogical values are found in “Tetak-tetak” and “Nggolek Ilmu” folk song of Fatrah-Abal. These two songs express explicit and implicit values of biological characters. The tetak-tetak and nggolek ilmu folk song became a community media in instilling the attitude or character values needed in studying biology at pre-school age. These values ​​will be further developed in learning biology in schools, which are carried out in an integrated manner in affective aspect.
Maden Atık Çamurlarının Denizaltı Depolama Yöntemi ile Bertarafı
Authors: SEZGİN Naim
Published: December 2019

Madencilik endüstrisi modern toplumun gelişmesinde rol
oynayan en önemli endüstriyel faaliyetlerinden biri olmakla birlikte dünyanın
en büyük atık üreten endüstrisidir. Gelişen teknoloji ve endüstriyel
faaliyetlerin ihtiyacı olan hammaddelerin madencilik faaliyetleri ile doğal
kaynaklardan elde edilmesi, biyolojik çeşitliliğin yok edilmesine ve çevre
kirliliği sorunlarına neden olabilmektedir. Madencilik faaliyetlerinden
vazgeçilmesi mümkün olmadığına göre, madenlerin çıkartılmasında kamu yararının
yanında doğal kaynakların korunması ve çevre kirliliği oluşturmaması konusunda
da daha duyarlı olunmalı ve uygun bertaraf yöntemleri için çeşitli mühendislik
tekniklerinin uygulanması hedeflenmelidir. Madencilik faaliyetleri sonucu
oluşan atıklardan olan çamur genel olarak arazilerde (atık barajlarında veya
atık döküm sahalarında) depolanarak bertaraf edilmektedir. Bu depolama
alanlarında ise asit maden drenajı (sülfit oksidasyonundan dolayı), geoteknik
stabilite ve diğer bazı sebeplerden dolayı çevresel sorunlar meydana
gelebilmektedir. Yerüstü atık barajları depolama alanlarında oluşan olumsuz
nedenlerden dolayı maden atığı çamurların sucul alıcı ortamlarda bertarafı,
özellikle sabit indirgeme koşulları altında ve sülfit minerallerinin
jeokimyasal olarak istikrarlı olduğu derin deniz altlarında bertarafı bir
seçenek olarak görülebilir. Bu çalışmada, maden atıklarının ve maden cevheri
zenginleştirme atıklarından olan sulu çamurun (maden atık çamurunun) genel bertaraf
yöntemleri, özellikle denizaltına deşarj ve denizaltında depolama yöntemi
incelenmiştir. Bu yöntemin olası olumlu/olumsuz çevresel etkileri
tartışılmıştır. Türkiye’de bulunan maden atığı çamuru derin denizaltı depolama
(Karadeniz için) tesisi ve bu deşarjın (yöntemin) etkilerini belirlemek için
yapılan deneysel çalışmalar değerlendirilmiştir. Bu kapsamda yapılan deneysel
çalışmalar değerlendirildiğinde, derin deniz deşarjı tesisiyle Karadeniz’e
deşarj edilen maden atık çamurlarının denizin tabanına doğru hareket eden bir
atık olduğu (negatif yüzerliliğe sahip veya batan atık), anoksik bölgeden
oksijenli bölgeye yükselemediği belirlenmiştir.
Selling arak is a business opportunity in sidemen village
Authors: Astuti Ni Wayan Wahyu , Yulianthi Ayu Dwi , Ginaya Gede , Susyarini Ni Putu Wiwiek Ary
Published: December 2019

Arak Bali is a traditional Balinese alcoholic beverage that is still popular in this modern era. Balinese people are already very familiar with this type of alcoholic drink, especially those who are young or who have religious ceremonies.  Arak Bali is widely produced in Sidemen village, Karangasem Regency. This study applies a descriptive qualitative research method. The data were collected through participating observation, interviews with the community in Sidemen village as well as a literature study of Arak Bali.  The study found, so far Arak needs have been widespread, from the religious need to commodify into the needs of tourism, especially in bars and restaurants. The Arak cocktail has become a spirit in beverage blends, which can be found in the bars and restaurants in Bali. Therefore, this type of beverage is still an item that has high value in the economic sector as well as support for the life of farmers in Sidemen village. This condition makes farmers in the village of Sidemen to consistently produce wine and retain their legacy.
Patients’ Measurement Priorities for Remote Measurement Technologies to Aid Chronic Health Conditions: Qualitative Analysis
Authors: Simblett Sara , Matcham Faith , Curtis Hannah , Greer Ben , Polhemus Ashley , Novák Jan , Ferrao Jose , Gamble Peter , Hotopf Matthew , Narayan Vaibhav , Wykes Til ,   Remote Assessment of Disease and Relapse – Central Nervous System (RADAR-CNS) Consortium
Published: December 2019

Background

Remote measurement technology (RMT), including the use of mobile phone apps and wearable devices, may provide the opportunity for real-world assessment and intervention that will streamline clinical input for years to come. In order to establish the benefits of this approach, we need to operationalize what is expected in terms of a successful measurement. We focused on three clinical long-term conditions where a novel case has been made for the benefits of RMT: major depressive disorder (MDD), multiple sclerosis (MS), and epilepsy.

Objective

The aim of this study was to conduct a consultation exercise on the clinical end point or outcome measurement priorities for RMT studies, drawing on the experiences of people with chronic health conditions.

Methods

A total of 24 participants (16/24 women, 67%), ranging from 28 to 65 years of age, with a diagnosis of one of three chronic health conditions―MDD, MS, or epilepsy―took part in six focus groups. A systematic thematic analysis was used to extract themes and subthemes of clinical end point or measurement priorities.

Results

The views of people with MDD, epilepsy, and MS differed. Each group highlighted unique measurements of importance, relevant to their specific needs. Although there was agreement that remote measurement could be useful for tracking symptoms of illness, some symptoms were specific to the individual groups. Measuring signs of wellness was discussed more by people with MDD than by people with MS and epilepsy. However, overlap did emerge when considering contextual factors, such as life events and availability of support (MDD and epilepsy) as well as ways of coping (epilepsy and MS).

Conclusions

This is a unique study that puts patients’ views at the forefront of the design of a clinical study employing novel digital resources. In all cases, measuring symptom severity is key; people want to know when their health is getting worse. Second, symptom severity needs to be placed into context. A holistic approach that, in some cases, considers signs of wellness as well as illness, should be the aim of studies employing RMT to understand the health of people with chronic conditions.
Equipping Learners to Evaluate Online Health Care Resources: Longitudinal Study of Learning Design Strategies in a Health Care Massive Open Online Course
Authors: Blakemore Louise M , Meek Sarah E M , Marks Leah K
Published: December 2019

Background

The digital revolution has led to a boom in the number of available online health care resources. To navigate these resources successfully, digital literacy education is required. Learners who can evaluate the reliability and validity of online health care information are likely to be more effective at avoiding potentially dangerous misinformation. In addition to providing health care education, massive open online courses (MOOCs) are well positioned to play a role in providing digital literacy education in this context.

Objective

This study focused on learners enrolled in a MOOC on cancer genomics. The aim of this study was to evaluate the efficacy of a series of digital literacy–related activities within this course. This was an iterative study, with changes made to digital literacy–related activities in 4 of the 8 runs of the course.

Methods

This mixed methods study focused on learner engagement with the digital literacy–related activities, including the final course written assignment. Quantitative data including the number of references listed in each written assignment were compared between successive runs. Qualitative data in the form of learner comments on discussion forums for digital literacy–related tasks were evaluated to determine the impact of these educational activities.

Results

Using the number of references included for each final course assignment as an indicator of digital literacy skills, the digital literacy–related activities in the final 2 runs were judged to be the most successful. We found a statistically significant increase in the number of references cited by learners in their final written assignments. The average number of references cited in Run 8 was significantly higher (3.5) than in Run 1 (1.8) of the MOOC (P=.001). Learner comments in Runs 7 and 8 showed that a poll in which learners were asked to select which of 4 online resources was reliable was effective in stimulating learner discussion about how to evaluate resource reliability.

Conclusions

Similar to many health care MOOCs, the course studied here had a heterogeneous group of learners, including patients (and their families), the public, health care students, and practitioners. Carefully designing a range of digital literacy–related activities that would be beneficial to this heterogenous group of learners enabled learners to become more effective at evaluating and citing appropriate online resources within their written assignments.
Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments
Authors: Habets Jeroen , Heijmans Margot , Herff Christian , Simons Claudia , Leentjens Albert FG , Temel Yasin , Kuijf Mark , Kubben Pieter
Published: December 2019

Background

Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions.

Objective

This study aimed to develop a Parkinson disease–specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation.

Methods

An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire.

Results

Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=−0.31 to −0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels.

Conclusions

We presented a Parkinson disease–specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA’s potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring.
Promoting Reproducible Research for Characterizing Nonmedical Use of Medications Through Data Annotation: Description of a Twitter Corpus and Guidelines
Authors: O'Connor Karen , Sarker Abeed , Perrone Jeanmarie , Gonzalez Hernandez Graciela
Published: December 2019

Background

Social media data are being increasingly used for population-level health research because it provides near real-time access to large volumes of consumer-generated data. Recently, a number of studies have explored the possibility of using social media data, such as from Twitter, for monitoring prescription medication abuse. However, there is a paucity of annotated data or guidelines for data characterization that discuss how information related to abuse-prone medications is presented on Twitter.

Objective

This study discusses the creation of an annotated corpus suitable for training supervised classification algorithms for the automatic classification of medication abuse–related chatter. The annotation strategies used for improving interannotator agreement (IAA), a detailed annotation guideline, and machine learning experiments that illustrate the utility of the annotated corpus are also described.

Methods

We employed an iterative annotation strategy, with interannotator discussions held and updates made to the annotation guidelines at each iteration to improve IAA for the manual annotation task. Using the grounded theory approach, we first characterized tweets into fine-grained categories and then grouped them into 4 broad classes—abuse or misuse, personal consumption, mention, and unrelated. After the completion of manual annotations, we experimented with several machine learning algorithms to illustrate the utility of the corpus and generate baseline performance metrics for automatic classification on these data.

Results

Our final annotated set consisted of 16,443 tweets mentioning at least 20 abuse-prone medications including opioids, benzodiazepines, atypical antipsychotics, central nervous system stimulants, and gamma-aminobutyric acid analogs. Our final overall IAA was 0.86 (Cohen kappa), which represents high agreement. The manual annotation process revealed the variety of ways in which prescription medication misuse or abuse is discussed on Twitter, including expressions indicating coingestion, nonmedical use, nonstandard route of intake, and consumption above the prescribed doses. Among machine learning classifiers, support vector machines obtained the highest automatic classification accuracy of 73.00% (95% CI 71.4-74.5) over the test set (n=3271).

Conclusions

Our manual analysis and annotations of a large number of tweets have revealed types of information posted on Twitter about a set of abuse-prone prescription medications and their distributions. In the interests of reproducible and community-driven research, we have made our detailed annotation guidelines and the training data for the classification experiments publicly available, and the test data will be used in future shared tasks.
A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study
Authors: Sun Christina J , Anderson Kirsten M , Kuhn Tamara , Mayer Liat , Klein Charles H
Published: December 2019

Background

HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women.

Objective

This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app.

Methods

We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions.

Results

Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively.

Conclusions

This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.
Automatic Work-Hours Recorder for Medical Staff (Staff Hours): Mobile App Development
Authors: Chiang Ting-Wei , Chen Si-Yu , Pan Yuan-Chien , Lin Yu-Hsuan
Published: December 2019

Background

There are numerous mobile apps for tracking work hours, but only a few of them record work hours automatically instead of relying on manual logging. No apps have been customized for medical staff, whose work schedules are highly complicated as they have both regular hours and on-call duties.

Objective

The specific aims of this study were to (1) identify the Staff Hours app users’ GPS-defined work hours, (2) examine the overtime work hours from the app-recorded total work hours and the participants’ self-reported scheduled work hours, and (3) compare these app-recorded total work hours among different occupations.

Methods

We developed an app, Staff Hours, to automatically calculate a user’s work hours via GPS background data. Users can enter their scheduled hours, including regular hours and on-call duties. The app automatically generates overtime reports by comparing the app-recorded total work hours with the user-defined scheduled hours. A total of 183 volunteers (60 females and 123 males; mean age 32.98 years, SD 6.74) were included in this study. Most of the participants (162/183, 88.5%) were medical staff, and their positions were resident physicians (n=89), visiting staff (n=38), medical students (n=10), registered nurses (n=25), and non–health care professionals (non-HCPs; n=21).

Results

The total work hours (mean 55.69 hours, SD 21.34) of the 183 participants were significantly higher than their scheduled work hours (mean 50.67 hours, SD 21.44; P=.01). Medical staff had significantly longer total work hours (mean 57.01 hours, SD 21.20) than non-HCPs (mean 45.48 hours, SD 20.08; P=.02). Residents (mean 60.38 hours, SD 18.67) had significantly longer work hours than visiting staff (mean 51.42 hours, SD 20.33; P=.03) and non-HCPs (mean 45.48 hours, SD 20.08; P=.004).

Conclusions

Staff Hours is the first automatic GPS location–based app designed for medical staff to track work hours and calculate overtime. For medical staff, this app could keep complete and accurate records of work hours in real time, reduce bias, and allow for better complying with labor regulations.
An Internet-Based Consumer Resource for People with Low Back Pain (MyBackPain): Development and Evaluation
Authors: Hodges Paul William , Setchell Jenny , Nielsen Mandy
Published: December 2019

People increasingly use the internet to obtain information about health complaints, including low back pain (LBP). LBP is the leading cause of disability internationally, and outcomes are worsening. There is an urgent need for resources that aid improvement of outcomes. There have been calls to engage consumers in the development of resources, but this has rarely been implemented. MyBackPain is a website that was developed with extensive involvement of consumers to ensure that the resource meets their needs for content and presentation. This paper aimed to describe the multistep process undertaken to develop the MyBackPain website and provide an extensive evaluation of its impact. Development of MyBackPain involved 10 steps, many of which have been published in the academic literature. These steps included consultation regarding consumer needs, evaluation of existing internet resources, identification of key messages to be reinforced, identification of frequently asked questions, consensus for content, content development (including development of algorithms to guide tailoring of the user experience), development of consumer-focused evidence-based treatment summaries, development of descriptions of health care providers, and testing. Evaluation included qualitative examination of people’s interactions with the website and its effects on their daily lives and an ongoing randomized controlled trial of impact of use of the site on people’s LBP-related health literacy, clinical outcomes, and treatment choices. It is hoped that the website can aid in the reduction of the massive burden of LBP and provide a template for the development of resources for other conditions.
Lock to Live—An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults: Pilot Randomized Controlled Trial
Authors: Betz Marian E , Knoepke Christopher E , Simpson Scott , Siry Bonnie J , Clement Ashley , Saunders Tamara , Johnson Rachel , Azrael Deborah , Boudreaux Edwin D , Omeragic Faris , Adams Leah M , Almond Sydney , Juarez-Colunga Elizabeth , Matlock Daniel D
Published: December 2019

Background

Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage.

Objective

This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs).

Methods

At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call.

Results

Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant.

Conclusions

The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means.

Trial Registration

ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501
Delivery of Compassionate Mental Health Care in a Digital Technology–Driven Age: Scoping Review
Authors: Kemp Jessica , Zhang Timothy , Inglis Fiona , Wiljer David , Sockalingam Sanjeev , Crawford Allison , Lo Brian , Charow Rebecca , Munnery Mikayla , Singh Takhar Shuranjeet , Strudwick Gillian
Published: December 2019

Background

Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood.

Objective

This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care.

Methods

We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019.

Results

Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues.

Conclusions

Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.
Feasibility and Accuracy of a Computer-Assisted Self-Interviewing Instrument to Ascertain Prior Immunization With Human Papillomavirus Vaccine by Self-Report: Cross-Sectional Analysis
Authors: Oliveira Carlos R , Avni-Singer Lital , Badaro Geovanna , Sullivan Erin L , Sheth Sangini S , Shapiro Eugene D , Niccolai Linda M
Published: December 2019

Background

Ascertaining history of prior immunization with human papillomavirus (HPV) vaccine can be challenging and resource-intensive. Computer-assisted self-interviewing instruments have the potential to address some of the challenges of self-reporting, and may also reduce the time, costs, and efforts associated with ascertaining immunization status.

Objective

This study assesses both the feasibility and the accuracy of a computer-assisted self-interviewing instrument to ascertain a patient’s history of immunization with the HPV vaccine.

Methods

We developed both a survey and a Web-based data collection system using computer-assisted self-interviewing to ascertain self-reported HPV vaccine immunization history. We implemented the instrument in a sample of adult women enrolled in an ongoing study of the HPV vaccine. Vaccine records from prior sources of care were reviewed to verify reported immunization history.

Results

Among the 312 participants who provided HPV vaccine immunization history by self-report, almost all (99%) were able to do so using the computer-assisted self-interviewing instrument. The median survey completion time was 10 minutes (IQR 7-17). The accuracy of self-report was 84%, sensitivity was 89%, specificity was 80%, and the negative predictive value was 92%.

Conclusions

We found that it is feasible to collect a history of immunization with the HPV vaccine using a computer-assisted self-interviewing instrument. This approach is likely to be acceptable to adult women and is reasonably accurate in a clinical research setting.
Use of Artificial Intelligence for Medical Literature Search: Randomized Controlled Trial Using the Hackathon Format
Authors: Schoeb Dominik , Suarez-Ibarrola Rodrigo , Hein Simon , Dressler Franz Friedrich , Adams Fabian , Schlager Daniel , Miernik Arkadiusz
Published: December 2019

Background

Mapping out the research landscape around a project is often time consuming and difficult.

Objective

This study evaluates a commercial artificial intelligence (AI) search engine (IRIS.AI) for its applicability in an automated literature search on a specific medical topic.

Methods

To evaluate the AI search engine in a standardized manner, the concept of a science hackathon was applied. Three groups of researchers were tasked with performing a literature search on a clearly defined scientific project. All participants had a high level of expertise for this specific field of research. Two groups were given access to the AI search engine IRIS.AI. All groups were given the same amount of time for their search and were instructed to document their results. Search results were summarized and ranked according to a predetermined scoring system.

Results

The final scoring awarded 49 and 39 points out of 60 to AI groups 1 and 2, respectively, and the control group received 46 points. A total of 20 scientific studies with high relevance were identified, and 5 highly relevant studies (“spot on”) were reported by each group.

Conclusions

AI technology is a promising approach to facilitate literature searches and the management of medical libraries. In this study, however, the application of AI technology lead to a more focused literature search without a significant improvement in the number of results.
Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial
Authors: Young Heather M , Miyamoto Sheridan , Dharmar Madan , Tang-Feldman Yajarayma
Published: December 2019

Background

Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital.

Objective

This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes.

Methods

This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change.

Results

We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months).

Conclusions

We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change.

Trial Registration

ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176
Measuring Interests Not Minutes: Development and Validation of the Adolescents’ Digital Technology Interactions and Importance Scale (ADTI)
Authors: Moreno Megan A , Binger Kole , Zhao Qianqian , Eickhoff Jens
Published: December 2019

Background

Interactive digital technology use is integral to adolescents’ lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents’ interactive digital technology use, we need new approaches that consider technology interactions and their importance.

Objective

This study aimed to develop an assessment tool to evaluate adolescents’ digital technology interactions and their perceived importance.

Methods

We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI).

Results

Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8% (402/761) female and 77.5% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one’s identity or offline environment, and (3) technology for social connection.

Conclusions

The resulting Adolescents’ Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes.
Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses
Authors: Timpel Patrick , Oswald Sarah , Schwarz Peter E H , Harst Lorenz
Published: December 2019

Background

Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations.

Objective

The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia.

Methods

We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.

Results

Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low.

Conclusions

The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.
Accuracy and Effects of Clinical Decision Support Systems Integrated With BMJ Best Practice–Aided Diagnosis: Interrupted Time Series Study
Authors: Tao Liyuan , Zhang Chen , Zeng Lin , Zhu Shengrong , Li Nan , Li Wei , Zhang Hua , Zhao Yiming , Zhan Siyan , Ji Hong
Published: December 2019

Background

Clinical decision support systems (CDSS) are an integral component of health information technologies and can assist disease interpretation, diagnosis, treatment, and prognosis. However, the utility of CDSS in the clinic remains controversial.

Objective

The aim is to assess the effects of CDSS integrated with British Medical Journal (BMJ) Best Practice–aided diagnosis in real-world research.

Methods

This was a retrospective, longitudinal observational study using routinely collected clinical diagnosis data from electronic medical records. A total of 34,113 hospitalized patient records were successively selected from December 2016 to February 2019 in six clinical departments. The diagnostic accuracy of the CDSS was verified before its implementation. A self-controlled comparison was then applied to detect the effects of CDSS implementation. Multivariable logistic regression and single-group interrupted time series analysis were used to explore the effects of CDSS. The sensitivity analysis was conducted using the subgroup data from January 2018 to February 2019.

Results

The total accuracy rates of the recommended diagnosis from CDSS were 75.46% in the first-rank diagnosis, 83.94% in the top-2 diagnosis, and 87.53% in the top-3 diagnosis in the data before CDSS implementation. Higher consistency was observed between admission and discharge diagnoses, shorter confirmed diagnosis times, and shorter hospitalization days after the CDSS implementation (all P<.001). Multivariable logistic regression analysis showed that the consistency rates after CDSS implementation (OR 1.078, 95% CI 1.015-1.144) and the proportion of hospitalization time 7 days or less (OR 1.688, 95% CI 1.592-1.789) both increased. The interrupted time series analysis showed that the consistency rates significantly increased by 6.722% (95% CI 2.433%-11.012%, P=.002) after CDSS implementation. The proportion of hospitalization time 7 days or less significantly increased by 7.837% (95% CI 1.798%-13.876%, P=.01). Similar results were obtained in the subgroup analysis.

Conclusions

The CDSS integrated with BMJ Best Practice improved the accuracy of clinicians’ diagnoses. Shorter confirmed diagnosis times and hospitalization days were also found to be associated with CDSS implementation in retrospective real-world studies. These findings highlight the utility of artificial intelligence-based CDSS to improve diagnosis efficiency, but these results require confirmation in future randomized controlled trials.
The Arabic Version of the Mobile App Rating Scale: Development and Validation Study
Authors: Bardus Marco , Awada Nathalie , Ghandour Lilian A , Fares Elie-Jacques , Gherbal Tarek , Al-Zanati Tasnim , Stoyanov Stoyan R
Published: December 2019

Background

With thousands of health apps in app stores globally, it is crucial to systemically and thoroughly evaluate the quality of these apps due to their potential influence on health decisions and outcomes. The Mobile App Rating Scale (MARS) is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality, which has been used to compare medical apps from American and European app stores in various areas, available in English, Italian, Spanish, and German. However, this tool is not available in Arabic.

Objective

This study aimed to translate and adapt MARS to Arabic and validate the tool with a sample of health apps aimed at managing or preventing obesity and associated disorders.

Methods

We followed a well-established and defined “universalist” process of cross-cultural adaptation using a mixed methods approach. Early translations of the tool, accompanied by confirmation of the contents by two rounds of separate discussions, were included and culminated in a final version, which was then back-translated into English. Two trained researchers piloted the MARS in Arabic (MARS-Ar) with a sample of 10 weight management apps obtained from Google Play and the App Store. Interrater reliability was established using intraclass correlation coefficients (ICCs). After reliability was ascertained, the two researchers independently evaluated a set of additional 56 apps.

Results

MARS-Ar was highly aligned with the original English version. The ICCs for MARS-Ar (0.836, 95% CI 0.817-0.853) and MARS English (0.838, 95% CI 0.819-0.855) were good. The MARS-Ar subscales were highly correlated with the original counterparts (P<.001). The lowest correlation was observed in the area of usability (r=0.685), followed by aesthetics (r=0.827), information quality (r=0.854), engagement (r=0.894), and total app quality (r=0.897). Subjective quality was also highly correlated (r=0.820).

Conclusions

MARS-Ar is a valid instrument to assess app quality among trained Arabic-speaking users of health and fitness apps. Researchers and public health professionals in the Arab world can use the overall MARS score and its subscales to reliably evaluate the quality of weight management apps. Further research is necessary to test the MARS-Ar on apps addressing various health issues, such as attention or anxiety prevention, or sexual and reproductive health.
Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study (Preprint)
Authors: Ferguson Caleb , Inglis Sally C , Breen Paul P , Gargiulo Gaetano D , Byiers Victoria , Macdonald Peter S , Hickman Louise D
Published: December 2019

BACKGROUND

New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored.

OBJECTIVE

This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults.

METHODS

A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes.

RESULTS

Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, “the ideal device.”

CONCLUSIONS

There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care.