bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating a Machine Learning System Into Clinical Workflows: Qualitative Study (Preprint)
Authors: Sandhu Sahil , Lin Anthony L , Brajer Nathan , Sperling Jessica , Ratliff William , Bedoya Armando D , Balu Suresh , O'Brien Cara , Sendak Mark P
Published: July 2020

BACKGROUND

Machine learning models have the potential to improve diagnostic accuracy and management of acute conditions. Despite growing efforts to evaluate and validate such models, little is known about how to best translate and implement these products as part of routine clinical care.

OBJECTIVE

This study aims to explore the factors influencing the integration of a machine learning sepsis early warning system (Sepsis Watch) into clinical workflows.

METHODS

We conducted semistructured interviews with 15 frontline emergency department physicians and rapid response team nurses who participated in the Sepsis Watch quality improvement initiative. Interviews were audio recorded and transcribed. We used a modified grounded theory approach to identify key themes and analyze qualitative data.

RESULTS

A total of 3 dominant themes emerged: perceived utility and trust, implementation of Sepsis Watch processes, and workforce considerations. Participants described their unfamiliarity with machine learning models. As a result, clinician trust was influenced by the perceived accuracy and utility of the model from personal program experience. Implementation of Sepsis Watch was facilitated by the easy-to-use tablet application and communication strategies that were developed by nurses to share model outputs with physicians. Barriers included the flow of information among clinicians and gaps in knowledge about the model itself and broader workflow processes.

CONCLUSIONS

This study generated insights into how frontline clinicians perceived machine learning models and the barriers to integrating them into clinical workflows. These findings can inform future efforts to implement machine learning interventions in real-world settings and maximize the adoption of these interventions.
Patients’ and Clinicians’ Visions of a Future Internet-of-Things System to Support Asthma Self-Management: Mixed Methods Study (Preprint)
Authors: Hui Chi Yan , McKinstry Brian , Fulton Olivia , Buchner Mark , Pinnock Hilary
Published: July 2020

BACKGROUND

Supported self-management for asthma reduces acute attacks and improves control. The internet of things could connect patients to health care providers, community services, and their living environments to provide overarching support for self-management.

OBJECTIVE

We aimed to identify patients’ and clinicians’ preferences for a future internet-of-things system and explore their visions of its potential to support holistic self-management.

METHODS

In an exploratory sequential mixed methods study, we recruited patients from volunteer databases and charities’ social media. We purposively sampled participants to interview them about their vision of the design and utility of the internet of things as a future strategy for supporting self-management. Respondents who were not invited to participate in the interviews were invited to complete a web-based questionnaire to prioritize the features suggested by the interviewees. Clinicians were recruited from professional networks. Interviews were transcribed and analyzed thematically using PRISMS self-management taxonomy.

RESULTS

We interviewed 12 patients and 12 clinicians in the United Kingdom, and 140 patients completed the web-based questionnaires. Patients expressed mostly wanting a system to log their asthma control status automatically; provide real-time advice to help them learn about their asthma, identify and avoid triggers, and adjust their treatment. Peak flow (33/140, 23.6%), environmental (pollen, humidity, air temperature) (33/140, 23.6%), and asthma symptoms (25/140, 17.9%) were the specific data types that patient most wanted. Information about asthma and text or email access to clinical advice provided a feeling of safety for patients. Clinicians wanted automated objective data about the patients’ condition that they could access during consultations. The potential reduction in face-to-face consultations was appreciated by clinicians which they perceived could potentially save patients’ travel time and health service resources. Lifestyle logs of fitness regimes or weight control were valued by some patients but were of less interest to clinicians.

CONCLUSIONS

An automated internet-of-things system that requires minimal input from the user and provides timely advice in line with an asthma action plan agreed by the patient with their clinician was preferred by most respondents. Links to asthma information and the ability to connect with clinicians by text or email were perceived by patients as features that would provide a sense of safety. Further studies are needed to evaluate the usability and effectiveness of internet-of-things systems in routine clinical practice.
A Comparison of Blood Pressure Data Obtained From Wearable, Ambulatory, and Home Blood Pressure Monitoring Devices: Prospective Validation Study (Preprint)
Authors: Islam Sheikh Mohammed Shariful , Maddison Ralph
Published: July 2020

BACKGROUND

Blood pressure (BP) is an important marker for cardiovascular health. However, a person’s BP data cannot usually be obtained simultaneously from different sources.

OBJECTIVE

This study aimed to analyze and compare BP data obtained from 3 different sources, namely, wearable, ambulatory, and home BP monitoring devices.

METHODS

During recruitment, we recorded participants’ BP using a standardized digital BP monitoring device and simultaneously over 24 hours using wearable and ambulatory devices. In addition, participants’ BP was measured over 7 days using wearable and home BP monitoring devices. Data from the wearable BP monitoring devices were extracted. The 24-hour ambulatory BP data were downloaded from the device to a computer. Home BPs were recorded 3 times per day (in the morning, afternoon, and evening, at regular times convenient to the participants) for 7 days and on a BP sheet.

RESULTS

A total of 9090 BP measurements were collected from 20 healthy volunteer participants (females: n=10; males: n=10, mean age 20.3 years, SD 5.4 years). The mean (SD) systolic BP and diastolic BP values measured at enrollment were 112.35 (9.79) mm Hg and 73.75 (9.14) mm Hg, respectively. The 24-hour mean (SD) systolic BP and diastolic BP values measured using the wearable device were 125 (5) mm Hg and 77 (9) mm Hg, respectively. The 24-hour mean (SD) systolic BP and diastolic BP values recorded using the ambulatory device were 126 (10) mm Hg and 75 (6) mm Hg, respectively. The 7-day mean (SD) systolic BP and diastolic BP values measured using the wearable device were 125 (4) mm Hg and 77 (3) mm Hg, respectively. The 7-day mean (SD) systolic BP and diastolic BP values measured using the home device were 112 (10) mm Hg and 71 (8) mm Hg, respectively.

CONCLUSIONS

Our datasets serve as the basis for further studies where these data can be combined reasonably with data from similar studies to understand the impact of different devices on BP measurement. Moreover, the BP data acquired noninvasively from wearable, ambulatory, and home devices can be integrated with similar data from other studies to determine the utility of wearable BP monitoring devices in different groups of people.
Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey (Preprint)
Authors: Chandrasekaran Ranganathan , Katthula Vipanchi , Moustakas Evangelos
Published: July 2020

BACKGROUND

Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults.

OBJECTIVE

The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults.

METHODS

Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis.

RESULTS

About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health.

CONCLUSIONS

The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society.
Investigating Users' and Other Stakeholders' Needs in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People with Dementia or Parkinson Disease: Protocol for a Mixed Methods Study (Preprint)
Authors: Ahmed Mona , Marín Mayca , Bouça-Machado Raquel , How Daniella , Judica Elda , Tropea Peppino , Bentlage Ellen , Brach Michael
Published: July 2020

BACKGROUND

Dementias—including Alzheimer disease—and Parkinson disease profoundly impact the quality of life of older population members and their families. PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older Adults) is a European project that recognizes the benefit of technology-based integrated care models in improving the care coordination and the quality of life of these target groups. This project proposes an integrated, scalable, and interactive care platform targeting older people suffering from neurodegenerative diseases, their caregivers, and socio-health professionals. PROCare4Life adopts a user-centered design approach from the early stage and throughout platform development and implementation, during which the platform is designed and adapted to the needs and requirements of all the involved users.

OBJECTIVE

This paper presents the study protocol for investigating users’ needs and requirements regarding the design of the proposed PROCare4Life platform.

METHODS

A mixed qualitative and quantitative study design is utilized, including online surveys, interviews, and workshops. The study aimed to recruit approximately 200 participants, including patients diagnosed with dementia or Parkinson disease, caregivers, socio-health professionals, and other stakeholders, from five different European countries: Germany, Italy, Portugal, Romania, and Spain.

RESULTS

The study took place between April and September 2020. Recruitment is now closed, and all the data have been collected and analyzed in order to be used in shaping the large-scale pilot phase of the PROCare4Life project. Results of the study are expected to be published in spring 2021.

CONCLUSIONS

This paper charts the protocol for a user-centered design approach at the early stage of the PROCare4Life project in order to shape and influence an integrated health platform suitable for its intended target group and purpose.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/22463
MHealth Applications for People with Cognitive Impairment and Their Caregivers: A Scoping Review (Preprint)
Authors: Zhao Qing , Chen Pei , Zhang Yu , Liu Haining , Li Xianwen
Published: July 2020

BACKGROUND

Mobile health application has become an important tool for healthcare systems. One such tool is the delivery of assisting in people with cognitive impairment and their caregivers.

OBJECTIVE

This scoping review aims to explore and evaluate the existing evidence and challenges on the use of mHealth applications that assisting in people with cognitive impairment and their caregivers.

METHODS

Nine databases, including PubMed, EMBASE, Cochrane, PsycARTICLES, CINAHL, Web of Science, Applied Science & Technology Source, IEEE Xplore and the ACM Digital Library were searched from inception through June 2020 for the studies of mHealth applications on people with cognitive impairment and their caregivers. Two reviewers independently extracted, checked synthesized data independently.

RESULTS

Of the 6101 studies retrieved, 64 studies met the inclusion criteria. Three categories emerged from this scoping review. These categories are ‘application functionality’, ‘evaluation strategies’, ‘barriers and challenges’. All the included studies were categorized into 7 groups based on functionality: (1) cognitive assessment; (2) cognitive training; (3) life support; (4) caregiver support; (5) symptom management; (6) reminiscence therapy; (7) exercise intervention. The included studies were broadly categorized into four types: (1) Usability testing; (2) Pilot and feasibility studies; (3) Validation studies; and (4) Efficacy or Effectiveness design. These studies had many defects in research design such as: (1) small sample size; (2) deficiency in active control group; (3) deficiency in analyzing the effectiveness of intervention components; (4) lack of adverse reactions and economic evaluation; (5) lack of consideration about the education level, electronic health literacy and smartphone proficiency of the participants; (6) deficiency in assessment tool; (7) lack of rating the quality of mHealth application. Some progress should be improved in the design of smartphone application functionality, such as: (1) the design of cognitive measurements and training game need to be differentiated; (2) reduce the impact of the learning effect. Besides this, few studies used health behavior theory and performed with standardized reporting.

CONCLUSIONS

Preliminary results show that mobile technologies facilitate the assistance in people with cognitive impairment and their caregivers. The majority of mHealth application interventions incorporated usability outcome and health outcomes. However, these studies have many defects in research design that limit the extrapolation of research. The content of mHealth application is urgently improved to adapt to demonstrate the real effect. In addition, further research with strong methodological rigor and adequate sample size are needed to examine the feasibility, effectiveness, and cost-effectiveness of mHealth applications for people with cognitive impairment and their caregivers.
Habit Formation in Wearable Activity Tracker Use Among Older Adults: Qualitative Study (Preprint)
Authors: Peng Wei , Li Lin , Kononova Anastasia , Cotten Shelia , Kamp Kendra , Bowen Marie
Published: July 2020

BACKGROUND

Wearable activity trackers are popular devices used to motivate behavior change. Wearable activity trackers are especially beneficial for encouraging light physical activity such as walking, which is an ideal behavior for older adults or individuals who cannot be physically active at moderate and vigorous levels. A common problem is that people do not continue to use these wearable devices, with initial behavioral change gains eroding as people disengage. Limited research is available regarding the continued use of wearable activity trackers. The habit formation literature may provide insights into the long-term use of wearables and other health informatics devices.

OBJECTIVE

This study aims to uncover the mechanism underlying the long-term continued use of wearable devices among older adults through the theoretical lens of habit formation.

METHODS

In-depth interviews were conducted with 20 participants who were aged 65 years or older and had used wearable activity trackers for more than 6 months to understand their experiences and the strategies they employed to support continued use.

RESULTS

Thematic analysis of data revealed 8 themes related to habit formation, including aspects in initiation and goal setting, use of contextual cues, action planning, and coping planning. Long-term users tended to have meaningful initiation of wearable activity trackers. They usually started with a small behavioral change goal and gradually increased it. They used consistent time and locational cues to make the use of wearable activity trackers routine. Long-term users also used creative contextual cues and reminders to facilitate action planning, engaged in coping planning to deal with anticipated problems, and had a positive mindset and inventive strategies for managing unfulfillment and lapses.

CONCLUSIONS

The results of this qualitative study of long-term users of wearable activity trackers suggest specific ways to enhance long-term habit formation among older adults. These best practices by long-term users can inform the future design of technology-based behavior interventions.

CLINICALTRIAL
Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App (Preprint)
Authors: Shin Yu-Bin , Kim Jae-Jin , Kim Hyunji , Kim Soo-Jeong , Eom Hyojung , Jung Young Hoon , Kim Eunjoo
Published: July 2020

BACKGROUND

Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others.

OBJECTIVE

This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls.

METHODS

In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents’ perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one’s gaming behavior.

RESULTS

The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients’ gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training.

CONCLUSIONS

The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others).
Internet Access and Usage Survey among Stroke Survivors and Informal Caregivers (Preprint)
Authors: Naqvi Imama Ali , Casameni Montiel Tahani , Bittar Yazan , Hunter Norma , Okpala Munachi , Johnson Constance , Weiner Mark , Savitz Sean , Sharrief Anjail , Beauchamp Jennifer Elizabeth Sanner
Published: July 2020

BACKGROUND

Web-based telehealth interventions have shown promise for chronic disease management but have not been widely applied to stroke populations. Limited information is known about the accessibility and usability of web-based electronics post-stroke. The purpose was to explore internet access and use of web-based electronics in stroke survivors (SS) and their informal caregivers (IC).

OBJECTIVE

To describe access and usage of web-based electronics in a cohort of SS and IC.

METHODS

A cross-sectional survey of 378 participants (SS=251; IC=127). Descriptive statistics were generated.

RESULTS

Internet-users were on average 8 years younger than non-users (Mean years; SS 59; IC 51) and the majority were Non-Hispanic White men. Two hundred (81%) stroke survivors reported internet access compared to 123 (97%) caregivers (p<0.001). Smart phones were the most common device used to access the internet.

CONCLUSIONS

Web-based telehealth stroke interventions should consider participant age and race/ethnicity, the role of the IC to positively impact SS internet accessibility and usability, and the use of smartphone applications.
Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App (Preprint)
Authors: Resnick Daniel , Schapira Marilyn M , Smith Jazmine M , Bautista Allison , Xu Chang , Jones Liz , Aysola Jaya
Published: July 2020

BACKGROUND

Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients.

OBJECTIVE

This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change.

METHODS

In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app’s acceptability by qualitatively analyzing open-ended responses regarding participants’ overall experience with the app. We assessed participants’ engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study.

RESULTS

The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app’s ease of use and health behavior–promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study.

CONCLUSIONS

The implementation of a mobile cancer prevention goal–setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients.
Effectiveness of a web-based, electronic medical records-integrated patient agenda tool to improve doctor-patient communication in primary care consultations: a pilot cluster randomized controlled trial study (Preprint)
Authors: Lee Yew Kong , Ng Chirk Jenn , Syahirah Mohamed Reza , Tun Firzara Abdul Malik , Chiew Thiam Kian , Lee Ping Yein , Abdullah Adina , Lee Charity , Khaizura Khalid , Mohd Yamin Ahmad , Mohamad Zahir Ahmad
Published: July 2020

BACKGROUND

Doctors may struggle to identify patient agendas during consultations. Patients who fail to discuss their agenda with their doctor feel dissatisfied. Therefore, an online patient agenda tool (the Values in Shared Interactions Tool- VISIT) was developed which allowed patients to enter their agenda items pre-consultation for doctors to view on their electronic medical records (EMR).

OBJECTIVE

To measure the impact of an EMR-integrated patient agenda website on patient satisfaction, number of agenda items discussed and consultation time.

METHODS

An unblinded cluster randomized controlled trial was conducted in a university-based primary care clinic between June-October 2019. Twenty-five family medicine trainees were randomized into using the VISIT tool (intervention) and usual care (control). 236 chronic patients were recruited when they came for their follow-up appointments. Descriptive statistics were used to analyze the control and trial arms. There were significant differences between trial and control arms for age, occupation and mobile device proficiency scores. These were entered as covariates in the trial analyzes. Primary outcome was mean self-reported patient satisfaction score using the Healthcare Provider-Patient Communication (HCPPC) questionnaire, secondary outcomes were average agenda items per consultation and consultation time.

RESULTS

The intervention arm had 12 doctors and 98 patients, while the control arm had 13 doctors and 129 patients. The participation rate was 25.5% for intervention vs 53.6% for control. There was no difference between arms for HCPPC patient satisfaction scores (134.0 +1.32 in intervention, 134.2 +1.14 in control, P=.917) and consultation duration (15.13 + 6.418 minutes in intervention, 14.96 + 6.074 minutes in control, P=.791). The only significant outcome was for mean number of agenda items discussed (2.25 + 0.098 items in intervention; 1.95 + 0.085 in control, P<.05). Consultation time showed no significant difference between arms.

CONCLUSIONS

Integrating patient agendas into the EMR did not affect patient satisfaction compared to usual care but was associated with an increased number of agenda items without an increase in consultation time. This shows it may be useful for a busy primary care setting with multiple comorbidities and short consultation times.

CLINICALTRIAL

Australian New Zealand Clinical Trials Registry (Registration number: ACTRN12619000499189)
A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Reback Cathy J , Fletcher Jesse B , Mata Raymond P
Published: July 2020

BACKGROUND

Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content.

OBJECTIVE

In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence).

METHODS

Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n=~600) who received the brick-and-mortar group-based Getting Off intervention.

RESULTS

Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023.

CONCLUSIONS

By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM.

CLINICALTRIAL

Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/22572
Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis (Preprint)
Authors: Paganini Sarah , Terhorst Yannik , Sander Lasse Bosse , Catic Selma , Balci Sümeyye , Küchler Ann-Marie , Schultchen Dana , Plaumann Katrin , Sturmbauer Sarah , Krämer Lena Violetta , Lin Jiaxi , Wurst Ramona , Pryss Rüdiger , Baumeister Harald , Messner Eva-Maria
Published: July 2020

BACKGROUND

Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers.

OBJECTIVE

This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed.

METHODS

A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps.

RESULTS

Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not.

CONCLUSIONS

Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers.
Using the Ensuring Quality Information for Patients Tool to Assess Patient Information on Appendicitis Websites: Systematic Search and Evaluation (Preprint)
Authors: Ghani Shahi , Fan Ka Siu , Fan Ka Hay , Lenti Lorenzo , Raptis Dimitri
Published: July 2020

BACKGROUND

Appendicitis is a common surgical problem among the young adult population, who are likely to use the internet to obtain medical information. This information may determine the health-seeking behavior of an individual and may delay medical attention. Little is known regarding the quality of patient information on appendicitis on the internet, as this has not been previously studied.

OBJECTIVE

The aim of our study was to identify the quality of information regarding appendicitis on websites intended for the public.

METHODS

We conducted a systematic review of information on appendicitis available online using the following 4 search terms in google: “appendicitis,” “appendix,” “appendectomy,” and “appendicectomy”. The top 100 websites of each search term were assessed using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36).

RESULTS

A total of 119 websites met the eligibility criteria for evaluation. The overall median EQIP score for all websites was 20 (IQR 18-22). More than half the websites originated from the USA (65/119, 54.6%), and 45.4% (54/119) of all websites originated from hospitals, although 43% (23/54) of these did not mention qualitative risks from surgery. Incidence rates were only provided for complications and mortality in 12.6% (15/119) and 3.3% (4/119) of all websites, respectively.

CONCLUSIONS

The assessment of the quality and readability of websites concerning appendicitis by the EQIP tool indicates that most sites online were of poor credibility, with minimal information regarding complication rates and mortality. To improve education and awareness of appendicitis, there is an immediate need for more informative and patient-centered websites that are more compatible with international quality standards.
Pharmacokinetic Study and Incurred Sample Stability of Esomeprazole in Dried Blood Spot Sample Using High Performance Liquid Chromatography-Photodiode Array
Authors: Harahap Yahdiana , Tamabri Anja , Vicha Vicha , Suryadi Herman , Sunarsih Sunarsih , Mulyadi Callista Andinie
Published: July 2020

In the past years, Esomeprazole (EMP) was analyzed in human plasma samples, which still has stability issues; thus, the new biosampling technique known as Dried Blood Spot (DBS) might solve the issue. This research aims to evaluate the incurred sample stability of esomeprazole in dried blood spot using high performance liquid chromatography-photodiode array with lansoprazole as an internal standard. The analytical separation was performed on a C-18 column (Waters, Sunfire™ 5 μm; 250 × 4.6 mm) at 40 °C. The mobile phase used was acetonitrile–phosphate buffer pH 7.6 (40:60% v/v) with a flow rate of 1.00 mL/min; and was detected at 300 nm. The analyte was extracted from dried blood spot by methanol. Incurred sample stability was evaluated from 6 healthy subjects on day 0, 7, 14, and 28, respectively. This method was linear in the range concentration of 70–1400 ng/mL with r > 0.98. Pharmacokinetic study shows that the average of AUC0–t of EMP in the DBS sample was 1765.41 ngh/mL. The highest percent difference value of esomeprazole’s incurred samples stability on day 7, 14, and 28 from 6 healthy subjects were 9.81%. This result fulfilled the acceptance criteria, which is the percent difference should not be greater than 20%, and 67% of total samples have to fulfill the criteria. The incurred sample stability result showed that esomeprazole was stable in the DBS sample at least until 28 days with the highest value of percent difference is 9.81%.
Catalytic and Thermal Cracking of Bio-Oil from Oil-Palm Empty Fruit Bunches, in Batch Reactor
Authors: Wibowo Santiyo , Efiyanti Lisna , Pari Gustan
Published: July 2020

The world’s potency of fossil-derived petroleum fuels has declined steadily, while its consumption continues to rise ominously. Therefore, several countries have started to develop renewable fuels like bio-oil from biomass. Relevantly, the aim of this research was to explore the technical feasibility of upgrading the qualities of crude bio-oil (CBO) produced from the pyrolysis on oil-palm empty fruit bunches (OPEFB) using Ni/NZA catalyst in a batch reactor. The natural zeolite (NZ) was activated by HCL 6 N and NH4Cl (obtained sample NZA). Supporting Ni onto NZA was conducted with an impregnation method using a salt precursor of Ni(NO3)2·6H2O followed by calcination with a temperature of 500 °C. Catalyst characterization includes determining the site of TO4 (T = Si or Al) in zeolites, acidity, crystallinity, and catalyst morphology. Cracking reaction of CBO was carried out in batch reactor in varied temperatures of 250 and 300 °C with the variation of catalyst weight of 0, 4, 6, and 8% toward CBO. Several analyses of the liquid product such as product yield, specific gravity, pH, viscosity, calorific value, and chemical compound were conducted. The results showed that acidification and Ni loading on zeolite samples increased their acidity. The optimum CBO’s cracking condition was judged to be the temperature of 300 °C with 6% Ni/NZA catalyst use, whereby the fuel yield reached 26.42% and dominated by particular compounds comprising phenol, octanoic acid, and alkane hydrocarbons. Under such conditions, the characteristics of fuel were pH 3.54, specific gravity 0.995, viscosity 14.3 cSt, and calorific value 30.85 MJ/kg.
Synthesis 1,1-Dibutoxybutane from Single Reagent of n-Butanol Using Cr/Activated Carbon Catalyst
Authors: Falah Iip Izul , Pradipta Mokhammad Fajar , Rinaldi Alvan Luthfi , Trisunaryanti Wega
Published: July 2020

Synthesis of 1,1-dibutoxybutane from the single reagent of n-butanol using Cr/Activated Carbon (Cr/AC) as a catalyst has been done. The aims of this research were to evaluate the effect of temperature, amount of catalyst, and alcohol flow rate towards the yield of 1,1-dibutoxybutane. Activated carbon (AC) was prepared by activating coconut shell carbon at 650 °C in the atmosphere of H2 at a flow rate of 15 mL/min for 4 h, and then it was washed using acetone in a Soxhlet for 15 rounds, washed 3 times by 1.0 M HCl, and finally, it was sieved at 60–80 mesh. Metal content was analyzed using atomic absorption spectroscopy (AAS) of Na, Ca, and Fe. The AC was impregnated with Cr(VI) solution and reduced with H2 at 650 °C. The acidity of Cr/AC catalyst was determined by the adsorption of ammonia vapor. Optimization of n-butanol conversion to 1,1-dibutoxybutane using Cr/AC catalyst was conducted in an oven using variations of temperature of 450, 500, and 550 °C, catalyst amount of 5, 10, and 15 g, under an alcohol flow rate of 0.10, 0.50, and 0.90 mL/min. The conversions of 1,1-dibutoxybutane were analyzed by GC-MS and 1H-NMR. The results showed that after washing by acetone and 1.0 M HCl, the content of metals in the AC was significantly decreased. The AC and Cr/AC showed acidity of 2.49 and 8.27 mmol/g, respectively. The highest product of 1,1-dibutoxybutane (53.42%) was reached at 450 °C using 5 g catalyst of Cr/AC under the alcohol flow rate of 0.10 mL/min.
Chemical Investigation and Antimicrobial Activity of Medicinal Plant Toddalia asiatica Lam
Authors: Maarisit Wilmar , Lawani Misran
Published: July 2020

Medicinal plants have become important sources of natural products, which have been used in the development of therapeutic agents. Four new coumarins (1-4) have been isolated together with five known metabolites (5-9) from the medicinal plant T. asiatica. The structures of 1-9 were assigned based on their spectroscopic data. Compounds (1-9) inhibited the growth of the Gram-negative bacteria E. coli and Gram-positive bacteria S. aureus at a concentration of 25 and 50 μg/disc. Compounds (2-4) inhibited the phytopathogenic fungus C. cucurbitarum at 50 μg/disc.
Determination of Total Flavonoid Content in Medicinal Plant Leaves Powder Using Infrared Spectroscopy and Chemometrics
Authors: Wulandari Lestyo , Permana Bayu Dwi , Kristiningrum Nia
Published: July 2020

Flavonoid is phenolic compounds consisting of fifteen carbon atoms and is commonly found in plants. Infrared (IR) spectroscopy combined with chemometrics, has been developed for a simple analysis of flavonoid in the medicinal plant leaves powder. IR spectra of selected medicinal plant powder were correlated with flavonoid content using chemometrics. The chemometric methods used for calibration analysis were Partial Least Square (PLS), Principal Component Regression (PCR), and Support Vector Regression (SVR). After the calibration model was formed, it was then validated using Leave-One-Out-Cross-Validation (LOOCV) and 2-fold cross-validation. In this study, the PLS of the Near-infrared (NIR) calibration model showed the best calibration with R-Square and RMSEC values of 0.9676524 and 0.0978202, respectively. The LOOCV of PLS of the NIR calibration model has the R-square and RMSE values of 0.9850164 and 0.067663, respectively. The 2-fold cross-validation gave the R-square and RMSE values of 0.9857071 and 0.2104665, respectively. PLS of the NIR calibration model was further used to predict unknown flavonoid content in commercial samples. The significance of flavonoid content that has been measured by NIR and UV-Vis spectrophotometry was evaluated with paired samples T-test. The flavonoid content that has been measured with both methods gave no significant difference.
Varietal Discrimination of Pineapple (Ananas comosus L.) Using Chromatographic Fingerprints and Chemometrics
Authors: Munaras Khan Almie Amira , Saim Norashikin , Dol Hamid Rossuriati , Osman Rozita , Zakaria Siti Raihan
Published: July 2020

Online solid-phase extraction-liquid chromatography (online SPE-LC) with diode array detector (DAD) was used to obtain the chromatographic fingerprint of bioactive compounds of pineapple (Ananas comosus L.). The extracts from 40 samples of three different varieties of pineapple (Morris, MD2, and Josaphine) were obtained using pressurized liquid extraction (PLE) prior to separation using online SPE-LC. The SPE-LC method was optimized and validated and applied to 40 pineapple samples of those three varieties. Seven bioactive compounds identified include catechin, epicatechin, chlorogenic acid, ferulic acid, quercetin, myricetin, and bromelain. For varietal discrimination, the relative areas of 16 selected peaks were subjected to chemometric techniques. The three pineapple varieties were successfully discriminated using cluster analysis (CA) and principal component analysis (PCA).
Cellulose Acetate of Rice Husk Blend Membranes: Preparation, Morphology and Application
Authors: Suhartini Meri , Ernawati Engela Evy , Roshanova Anisa , Haryono Haryono , Mellawati June
Published: July 2020

Cellulose acetate blend membranes in this study synthesized from cellulose acetate (CA) of rice husk and NaA zeolites (Z) with N,N’-Methylene bis acrylamide (MBA) as cross-linker agent and gamma-rays from cobalt-60 source as a reaction initiator. Application of the membrane was carried out to increase the concentration of vetiverol in vetiver oil. The steps in this study were isolation the cellulose rice husk with alkali treatment, delignification, acetylation, preparation the cellulose acetate-NaA zeolites NaA-membrane by inverse phase technique, addition N,N’-Methylene bis acrylamide, and irradiation by gamma-rays. Swelling degree, crosslinking yield, tensile strength, membrane performance, FTIR, and SEM analysis were observed. The results obtained that the optimal irradiation dose for synthesis CA-Z-MBA membrane is 20 kGy. The CA-Z-MBA membrane has swelling degree of 4.44%, the tensile strength of 656.40 kg/cm2, and crosslinking yield of 6.61%. Performance of the CA-Z-MBA membrane reached the flux of 60.58 g/m2.h, and permeate concentration (CP) of 11.67%, the CP increase 5 times from 2.40% to 11.67%.
Microwave-Assisted Preparation of Magnetic Citric Acid-Sugarcane Bagasse for Removal of Textile Dyes
Authors: Anh Nguyen Thi Hong , Phuc Tran Thanh , An Tran Nguyen Minh , Hue Pho Quoc , Cuong Nguyen Van
Published: July 2020

Wastewater from industries has been a serious issue that both manufactures and authorities raise concerns since it brings tremendous demerits to the surrounding environment and human well-being. Therefore, an appropriate treatment method should be applied before being discharged into the environment. In this paper, sugarcane bagasse was modified with citric acid and then used to load the suspension of Fe3O4 nanoparticles to form a nanocomposite of magnetic citric acid-modified sugarcane bagasse. The properties of prepared materials were investigated by a variety of modern methods such as X-ray diffraction (XRD), Fourier transforms infrared spectroscopy (FT-IR), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM) and a Vibrating sample magnetometer (VSM). The adsorptive capacity of prepared materials was investigated with methylene blue as the typical adsorbate. The decolonization effectiveness was increased with increasing contact time and declined with rising initial dye concentration. The higher removal efficiency was observed for the basic medium in comparison with the acidic medium. Additionally, the results showed that more than 12.42 mg/g (98%) of cationic yellow 51, and basic red 46 dyes were removed after 30 min.