Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking.

BACKGROUND: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. OBJECTIVE: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. METHODS: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. RESULTS: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. CONCLUSIONS: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy.

Factors that Influence the Daily Living Skills of Autistic Adults: The Importance of Opportunity.

While existing literature has demonstrated that Daily Living Skills (DLS) performance of autistic individuals is lower than what is expected of their age and cognitive abilities, limited studies have examined DLS in autistic adults. This study aimed to understand the influence of intellectual function (IQ) and contextual factors (i.e., provision of opportunities) on autistic individuals' DLS performance. Participants included 33 autistic individuals ranging in age from 16 to 35 years. Their caregivers were administered the Vineland Adaptive Behavior Scales, 3rd edition's (Vineland-3) caregiver interview form. A novel coding system was developed to capture the frequency of reasons for participants' non-performance of DLS tasks, based on caregiver's report. "Target" scores reflecting expected possible score if reasons for nonperformance could be addressed were computed. Qualitative analysis of parental responses indicated that, for adults with average or higher IQ, lack of opportunity to learn and/or implement the skill was the most frequent reason for not performing DLS. Lack of opportunity was also the second most common reason provided for adults with NVIQ below 85, following cognitive ability. Taking into account reasons for nonperformance, "Target" scores were, on average, 7.65 points higher for the NVIQ ≥ 85 group. These findings highlight a need for multi-dimensional assessment to go beyond individual strengths and difficulties to also include contextual factors that may influence adults' skill acquisition and performance. It is essential that clinicians ensure that adequate opportunities for learning and performance are available to promote acquisition of important DLS.

Green extraction of phenolics and flavonoids from black mulberry fruit using natural deep eutectic solvents: optimization and surface morphology.

This study deployed ultrasonic-assisted extraction (UAE), combined with natural deep eutectic solvents (NADES), to extract phenolics and flavonoids from the black mulberry fruit, and the antioxidant activity was examined. The extraction yields of NADES-based UAE were assessed based on the yields of phenolics and flavonoids extracted from the black mulberry fruit. This study selected the molar ratios of hydrogen bond acceptors (HBA) and hydrogen bond donors HBD at 1:2 from previous studies. Choline chloride-lactic acid showed the highest solubility with phenolics and flavonoids among NADES systems. One-factor experiments evaluated the effect of UAE conditions (liquid-to-solid ratio (LSR), water content in NADES, temperature, and time) on TPC, TFC, and antioxidant activity. The suitable NADES-based UAE conditions for extracting phenolics and flavonoids from the black mulberry fruit were 60 ml/g of LSR, 40% water content, 70 °C, and 15 min. Response surface methodology with the Box-Behnken design model optimized the NADES-based UAE process based on response (TPC, TFC, ABTS, OH, and DPPH). The optimal conditions for the NADES-based UAE process were 70 ml/g of LSR, 38.9% water content in NADES, 67.9 °C, and 24.2 min of extraction time. The predicted values of the Box-Behnken design were compatible with the experimental results. Moreover, scanning electron microscopy (SEM) was used to survey the surface of black mulberry fruit with and without sonication. SEM can assist in demonstrating the destructive effect of NADES and ultrasonic waves on material surfaces. SEM findings indicated the high surface destruction capacity of NADES, which partially contributed to a superior extraction yield of NADES than conventional organic solvents. The study proposes an efficient and green method for extracting bioactive compounds from black mulberry fruits. The black mulberry fruit extracts can be applied to meat preservation and beverages with high antioxidants.

Ultrasonic-Assisted and Microwave-Assisted Extraction of Phenolics and Terpenoids from Abelmoschus sagittifolius (Kurz) Merr Roots Using Natural Deep Eutectic Solvents.

This research extracted phenolics and terpenoids from Abelmoschus sagittifolius (Kurz) Merr roots using natural deep eutectic solvent-based novel extraction techniques. Twelve natural deep eutectic solvents (NADESs) were produced for recovering phenolics and terpenoids. Citric acid/glucose and lactic acid/glucose, with a molar ratio of 2:1, were determined as the most appropriate NADESs for extracting phenolics and terpenoids, respectively. Afterward, the proper conditions for NADES-based ultrasonic-assisted and microwave-assisted extraction were investigated. Then, the time and liquid-to-solid ratios of ultrasonic- and microwave-combined extraction methods and the sequence of ultrasound and microwave treatments were examined. The conditions of ultrasonic-assisted extraction were 40 mL/g liquid-to-solid ratio, 40% water content, 30°C, 5 min, and 600 W ultrasonic power for the highest terpenoid recovery at 69 ± 2 mg UA/g dw, while 150 W ultrasonic power was suitable for phenolic recovery at 9.56 ± 0.17 mg GAE/g dw. The conditions of microwave-assisted extraction were 50 mL/g liquid-to-solid ratio, 20% water content, 400 W microwave power, and 2 min to acquire the highest phenolics and terpenoids at 22.13 ± 0.75 mg GAE/g dw and 90 ± 1 mg UA/g dw, respectively. Under appropriate conditions, the biological activities, phenolic content, and terpenoid content of obtained extracts from four extraction methods, including ultrasonic-assisted, microwave-assisted, ultrasonic-microwave-assisted, and microwave-ultrasonic-assisted extraction, were compared to select the most proper method. The conditions of ultrasonic-microwave-assisted extraction were 40 mL/g liquid-to-solid ratio, 5 min sonication, and 1 min microwave irradiation to obtain the highest phenolic and terpenoid contents (27.07 ± 0.27 mg GAE/g dw and 111 ± 3 mg UA/g dw, respectively). Ultrasonic-microwave-assisted extraction showed the highest phenolic content, terpenoid content, and biological activities among the four extraction techniques. The changes in the surface morphology were determined using scanning electron microscopy. This study demonstrated that ultrasonic-microwave-assisted extraction was an effective and sustainable method in food and pharmaceutical industries for recovering phenolics and terpenoids from Abelmoschus sagittifolius (Kurz) Merr.

Green extraction of total phenolic and flavonoid contents from mangosteen (Garcinia mangostana L) rind using natural deep eutectic solvents.

This research combined ultrasonic-assisted extraction (UAE) and natural deep eutectic solvent (NADES) to recover phenolic and flavonoid components from mangosteen rind. The antioxidant activities were determined using DPPH, ABTS+, and hydroxyl assays. NADES prepared from lactic and 1,2-propanediol had the highest extraction efficiency based on the total flavonoid content (TFC) and phenolic contents (TPC). Single-factor experiments were employed to assess the influence of UAE conditions (liquid-to-solid ratio, temperature, water content in NADES, and time) on TFC, TPC, and antioxidant activities. NADES-based UAE conditions were optimized using response surface methodology with the Box-Behnken design model on five dependent responses (TPC, TFC, DPPH, ABTS, and OH). The optimal conditions for the lactic-1,2-Propanediol-based UAE process were 76.7 ml liquid/g solid with 30.3% of water content at 57.5 °C for 9.1 min. Scanning electron microscopy (SEM) was applied to examine the surface morphology of mangosteen rind before and after sonication. This study proposes an efficient, green, and practical approach for recovering phenolics and flavonoids from mangosteen rinds.

Parent-Reported Strengths and Positive Qualities of Adolescents and Adults with Autism Spectrum Disorder and/or Intellectual Disability.

Despite increasing attention to understanding strengths in those on the autism spectrum, few studies have explored this in older individuals. The present study provides a qualitative analysis of parent-reported strengths and positive qualities of 68 15-30-year-olds with autism and/or intellectual disability (ID). Most parents (97%) reported at least one positive quality. Themes were consistent with previous studies; Personality characteristics (82%) and Sociability (53%) were reported most frequently. A Work Ethic/Motivation category not previously reported emerged. Autistic individuals (with/without ID) were more likely than those with ID-only to have a Specific Skill. Findings highlight the importance of recognizing strengths of autistic adults. Research is needed to understand how to best leverage positive qualities to promote goal achievement and quality of life.