Evaluation of the Current State of Chatbots for Digital Health: Scoping Review.

BACKGROUND: Chatbots have become ubiquitous in our daily lives, enabling natural language conversations with users through various modes of communication. Chatbots have the potential to play a significant role in promoting health and well-being. As the number of studies and available products related to chatbots continues to rise, there is a critical need to assess product features to enhance the design of chatbots that effectively promote health and behavioral change. OBJECTIVE: This scoping review aims to provide a comprehensive assessment of the current state of health-related chatbots, including the chatbots' characteristics and features, user backgrounds, communication models, relational building capacity, personalization, interaction, responses to suicidal thoughts, and users' in-app experiences during chatbot use. Through this analysis, we seek to identify gaps in the current research, guide future directions, and enhance the design of health-focused chatbots. METHODS: Following the scoping review methodology by Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, this study used a two-pronged approach to identify relevant chatbots: (1) searching the iOS and Android App Stores and (2) reviewing scientific literature through a search strategy designed by a librarian. Overall, 36 chatbots were selected based on predefined criteria from both sources. These chatbots were systematically evaluated using a comprehensive framework developed for this study, including chatbot characteristics, user backgrounds, building relational capacity, personalization, interaction models, responses to critical situations, and user experiences. Ten coauthors were responsible for downloading and testing the chatbots, coding their features, and evaluating their performance in simulated conversations. The testing of all chatbot apps was limited to their free-to-use features. RESULTS: This review provides an overview of the diversity of health-related chatbots, encompassing categories such as mental health support, physical activity promotion, and behavior change interventions. Chatbots use text, animations, speech, images, and emojis for communication. The findings highlight variations in conversational capabilities, including empathy, humor, and personalization. Notably, concerns regarding safety, particularly in addressing suicidal thoughts, were evident. Approximately 44% (16/36) of the chatbots effectively addressed suicidal thoughts. User experiences and behavioral outcomes demonstrated the potential of chatbots in health interventions, but evidence remains limited. CONCLUSIONS: This scoping review underscores the significance of chatbots in health-related applications and offers insights into their features, functionalities, and user experiences. This study contributes to advancing the understanding of chatbots' role in digital health interventions, thus paving the way for more effective and user-centric health promotion strategies. This study informs future research directions, emphasizing the need for rigorous randomized control trials, standardized evaluation metrics, and user-centered design to unlock the full potential of chatbots in enhancing health and well-being. Future research should focus on addressing limitations, exploring real-world user experiences, and implementing robust data security and privacy measures.

Low temperature decreased insecticidal protein contents of cotton and its physiological mechanism.

Low temperature delayed cotton growth, increased abscission of reproductive organs, and seriously reduced quality and yield. Moreover, failed or unstable performance of insecticidal resistance due to adverse environments have been reported. In order to study the impact of low temperature on the insecticidal protein contents at square stage in Bacillus Thuringenesis (Bt) transgenic cotton, different temperature regimes and durations were imposed on two Bt cotton cultivars, Sikang1 (the conventional cultivar, SK1) and Sikang3 (the hybrid cultivar, SK3). Low temperature stress exhibited a significant inhibitory effect on insecticidal protein expression in squares and leaves of Bt transgenic cotton plants, with insecticidal protein contents decreased up to 30% with decreasing temperature. In addition, the threshold temperature resulting in significant reduction of insecticidal protein contents symbolized a rising trend as stress duration extended, together with a greater reduction observed. Thus, at square stage, the detrimental influence of low temperature on Bt protein contents was closely related to the low temperature level and duration. The square Bt protein content was positively correlated with leaf Bt protein content, but was more sensitive to low temperature. Across the whole treatment duration in both years, square Bt protein level was significantly negatively correlated with malondialdehyde (MDA) contents, as well as the activities of catalase (CAT) and superoxide dismutase (SOD), indicating the negative effect of cold induced oxidative stress on Bt protein contents. The reduced Bt protein contents under low temperature were also related to altered N metabolism. Glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) activities, as well as soluble protein contents in squares reduced, and greater reduction was recorded with decreasing temperature. In contrast, the free amino acid contents, and peptidase and protease activities increased, and greater elevation was noted with decreasing temperature. These results suggested in Bt cotton production, it is necessary to be alert to low temperature disasters that may last for more than 24 hours and lower than 15-17°C during the square stage, which may lead to reduced insecticidal resistance causing serious economic losses.