Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study.

BACKGROUND: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. OBJECTIVE: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. METHODS: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. RESULTS: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. CONCLUSIONS: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size.

Real-time detection of active bleeding in laparoscopic colectomy using artificial intelligence.

BACKGROUND: Most intraoperative adverse events (iAEs) result from surgeons' errors, and bleeding is the majority of iAEs. Recognizing active bleeding timely is important to ensure safe surgery, and artificial intelligence (AI) has great potential for detecting active bleeding and providing real-time surgical support. This study aimed to develop a real-time AI model to detect active intraoperative bleeding. METHODS: We extracted 27 surgical videos from a nationwide multi-institutional surgical video database in Japan and divided them at the patient level into three sets: training (n = 21), validation (n = 3), and testing (n = 3). We subsequently extracted the bleeding scenes and labeled distinctively active bleeding and blood pooling frame by frame. We used pre-trained YOLOv7_6w and developed a model to learn both active bleeding and blood pooling. The Average Precision at an Intersection over Union threshold of 0.5 (AP.50) for active bleeding and frames per second (FPS) were quantified. In addition, we conducted two 5-point Likert scales (5 = Excellent, 4 = Good, 3 = Fair, 2 = Poor, and 1 = Fail) questionnaires about sensitivity (the sensitivity score) and number of overdetection areas (the overdetection score) to investigate the surgeons' assessment. RESULTS: We annotated 34,117 images of 254 bleeding events. The AP.50 for active bleeding in the developed model was 0.574 and the FPS was 48.5. Twenty surgeons answered two questionnaires, indicating a sensitivity score of 4.92 and an overdetection score of 4.62 for the model. CONCLUSIONS: We developed an AI model to detect active bleeding, achieving real-time processing speed. Our AI model can be used to provide real-time surgical support.

Capture of emotional responses under a simulated earthquake experience using near-infrared spectroscopy and virtual reality.

AIM: In a previous study, we reported that watching two-dimensional videos of earthquakes significantly reduced sympathetic nerve activity in healthy young adults. In the present study, we aimed to investigate the emotional responses to earthquakes using immersive virtual reality (VR), which can provide a more realistic experience. METHODS: In total, 24 healthy young adults (12 males, 21.4 ± 0.2 years old) participated. Participants were required to watch earthquake and neutral videos while wearing a head-mounted display and near-infrared spectroscopy (NIRS), during which physiological signals, including pulse rate and cerebral blood flow (CBF) in the dorsolateral prefrontal cortex, were measured. We also analyzed changes in sympathetic and parasympathetic indices and obtained seven emotion ratings: valence, arousal, dominance, fear, astonishment, anxiety, and panic. RESULTS: The VR earthquake videos evoked negative subjective emotions, and the pulse rate significantly decreased. Sympathetic nerve activity tended to decrease, whereas CBF in the left prefrontal cortex showed a slight increase, although this was not significant. CONCLUSIONS: This study showed that measurements combined with NIRS and immersive VR have the potential to capture emotional responses to different stimuli.

Individual Activity Anomaly Estimation in Operating Rooms Based on Time-Sequential Prediction.

Surveillance videos of operating rooms have potential to benefit post-operative analysis and study. However, there is currently no effective method to extract useful information from the long and massive videos. As a step towards tackling this issue, we propose a novel method to recognize and evaluate individual activities using an anomaly estimation model based on time-sequential prediction. We verified the effectiveness of our method by comparing two time-sequential features: individual bounding boxes and body key points. Experiment results using actual surgery videos show that the bounding boxes are suitable for predicting and detecting regional movements, while the anomaly scores using key points can hardly be used to detect activities. As future work, we will be proceeding with extending our activity prediction for detecting unexpected and urgent events.

PreFlap: From Photoacoustic Tomography Images to Vascular Mapping Sheets for Improved Preoperative Flap Evaluation.

OBJECTIVE: Advancements in technology have improved image acquisition and processing in the field of medical imaging, giving medical doctors the tools to implement effective medical care. In plastic surgery, despite advances in anatomical knowledge and technology, problems in preoperative planning for flap surgery remain. METHODS: In this study, we propose a new protocol to analyze three-dimensional (3D) Photoacoustic tomography images and generate two-dimensional (2D) mapping sheets that can help surgeons identify perforators and the perfusion territory during preoperative planning. The core of this protocol is PreFlap, a new algorithm that converts 3D photoacoustic tomography images into 2D vascular mapping images. CONCLUSION: Experimental results demonstrate that PreFlap can improve preoperative flap evaluation, thus can greatly saving surgeons' time and improving surgical outcomes.

Preoperative visualization of midline-crossing subcutaneous arteries in transverse abdominal flaps using photoacoustic tomography.

BACKGROUND: Photoacoustic tomography is a noninvasive vascular imaging modality that uses near-infrared pulsed laser light and ultrasound to visualize vessels. We previously demonstrated the utility of photoacoustic tomography for anterolateral thigh flap surgery involving body-attachable vascular mapping sheets. However, it was not possible to obtain clear separate images of arteries and veins. In this study, we tried to visualize subcutaneous arteries that cross the midline of the abdomen, since these arteries are known to be important for obtaining large perfusion areas in transverse abdominal flaps. METHODS: Four patients scheduled to undergo breast reconstruction with abdominal flaps were examined. Photoacoustic tomography was performed preoperatively. The tentative arteries and veins were traced according to the S-factor, an approximate hemoglobin oxygen saturation parameter calculated using 2 laser excitation wavelengths (756 and 797 nm). Intraoperatively, arterial-phase indocyanine green (ICG) angiography was performed after abdominal flap elevation. Images of vessels speculated to be arteries by preoperative photoacoustic tomography were merged with those of intraoperative ICG angiography and analyzed in an 8 × 4-cm2 area below the umbilical region. RESULTS: The S-factor was used to visualize the midline-crossing subcutaneous arteries in all 4 patients. A matching analysis compared preoperative tentative arteries according to photoacoustic tomography with ICG angiography results in the 8 × 4-cm2 area below the umbilical region and indicated a 71.3-82.1% match (average: 76.9% match). CONCLUSIONS: This study demonstrates that the S-factor, a noninvasive, label-free imaging modality, can be used to successfully visualize subcutaneous arteries. This information can aid in selecting perforators for abdominal flap surgery.

Study of Sharing Patient Information by Nurses Between Inpatient and Outpatient Wards in Japan.

Shortening hospital stays increases communication needs between nurses in inpatient and outpatient wards. Smooth information sharing is required to reduce the workload of nurses and improve the quality of patient care. However, electronic medical records (EMR) system does not have sufficient functions to support information sharing between wards, because EMR has been developed mainly for recording. This study led to three improvements; unified communication tool, common patient list linked to EMR, and outpatient nursing diagnosis.

Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial.

BACKGROUND: Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players' lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior. OBJECTIVE: The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity. METHODS: Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. RESULTS: A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6% (SE 7.2%) (week 2), 591.5 (SE 2414.5)/2.4% (SE 4.7%) (week 3), and -1041.8 (SE 1992.7)/0.6% (SE 4.4%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0% (SE 8.7%) (week 2), 9567.3 (SE 2631.5)/23.0% (SE 5.1%) (week 3), and 7648.7 (SE 3900.9)/13.9% (SE 8.0%) (week 4). The result of the analysis of the group effect was significant (absolute change: η2=0.31, P=.04; proportional change: η2=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95% CI 0.32 to 0.77; proportional change: r=0.39, 95% CI 0.08 to 0.64). CONCLUSIONS: The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity. TRIAL REGISTRATION: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy).

Robust Reflectance Estimation for Projection-Based Appearance Control in a Dynamic Light Environment.

We present a novel method that robustly estimates the reflectance, even in an environment with dynamically changing light. To control the appearance of an object by using a projector-camera system, an appropriate estimate of the object's reflectance is vital to the creation of an appropriate projection image. Most conventional estimation methods assume static light conditions; however, in practice, the appearance is affected by both the reflectance and environmental light. In an environment with dynamically changing light, conventional reflectance estimation methods require calibration every time the conditions change. In contrast, our method requires no additional calibration because it simultaneously estimates both the reflectance and environmental light. Our method is based on the concept of creating two different light conditions by switching the projection at a rate higher than that perceived by the human eye and captures the images of a target object separately under each condition. The reflectance and environmental light are then simultaneously estimated by using the pair of images acquired under these two conditions. We implemented a projector-camera system that switches the projection on and off at 120 Hz. Experiments confirm the robustness of our method when changing the environmental light. Further, our method can robustly estimate the reflectance under practical indoor lighting conditions.

Visualizing the Cascade Effect of Redesigning Features in an EMR System.

Electronic Medical Record (EMR) systems are complex systems with interdependent features. Redesigning one feature of the system can create a cascade effect affecting the other features. By calculating the cascade effect, the designers can understand how each individual feature could be affected. This understanding allows them to maximize the positive effects and avoid negative consequences of their redesign activities. To understand the cascade effect, the designers can look at their computations' results; a task that becomes more difficult when the number of features grows. To reduce their task load, we propose a tool for visualizing the cascade effect of redesigning features in an EMR system. Our preliminary evaluation with six graduate students shows that visualizing the cascade effect reduces the task load and slightly improves their performance when analyzing the cascade effect. Ways for improving the tool include (i) showing the computation results within the visualization, and (ii) allowing the designers to compare the cascade effect generated by redesigning different features.

Detecting Severe Incidents from Electronic Medical Records Using Machine Learning Methods.

The goal of this research was to design a solution to detect non-reported incidents, especially severe incidents. To achieve this goal, we proposed a method to process electronic medical records and automatically extract clinical notes describing severe incidents. To evaluate the proposed method, we implemented a system and used the system. The system successfully detected a non-reported incident to the safety management department.

Preliminary Evaluation of Market Mechanism-Based Bed Allocation System.

Effective bed management is important for hospital management. Until now, bed allocation process is generally controlled by administrative staffs in centralized manner but it is not always effective. In the present study, we proposed and evaluated new method for bed allocation applying market mechanism via token. Evaluation was performed with newly-developed game-type simulation. Nurse managers as research participants played it and answered for survey. The result showed that the proposed method can be useful with appropriate operational design.

Preoperative vascular mapping for anterolateral thigh flap surgeries: A clinical trial of photoacoustic tomography imaging.

BACKGROUND: Photoacoustic tomography (PAT) is a noninvasive vascular imaging modality that uses near-infrared pulse laser beams and ultrasound (US) to visualize vessels. We previously demonstrated the utility of PAT for visualizing anterolateral thigh (ALT) perforators in a clinical study of 10 thighs in 5 healthy adults. Evaluation of the correlation between PAT and US findings showed that PAT had comparable diagnostic potential but was superior in visualizing subcutaneous microvessels; however, there was no comparison with intraoperative findings. In this study, we used a newly developed technique to transfer a PAT image to a body-attachable transparent sheet to compare PAT and intraoperative findings. METHODS: Eight patients were recruited in this prospective study. Patient age ranged from 32 to 79 years (average 60). Seven ALT flaps were applied in head and neck reconstruction. One flap was elevated in chest wall reconstruction. Each PAT scan of an 18 cm × 13.5 cm region took approximately 5 min. Acquired data were processed three-dimensionally using a novel imaging software program. Perforator vessel data from PAT imaging were traced and corrected for projection onto medical film sheets. The correlation between the perforator stem portions predicted by PAT and the intraoperative findings at the level of the fascia-penetrating points was evaluated, and distal branching patterns were analyzed. RESULTS: PAT imaging showed 16 perforators in 8 thighs. Intraoperative surgical findings revealed that all the perforator penetrating points at the deep fascia level matched the PAT findings within 10 mm. None of the eight ALT flaps demonstrated postoperative complications. The perforator complexes were classified as type I in three cases (19%), type II in eight cases (50%), and type III in five cases (31%). CONCLUSIONS: PAT imaging matched the intraoperative findings within 10 mm. Preoperative vascular evaluation allows for the creation of a vascular map for facilitating ALT flap surgeries.

Prioritizing Features to Redesign in an EMR System.

Redesigning Electronic Medical Record (EMR) systems is needed to improve their usefulness and usability. For user-centered redesign, designers should consider which EMR features are the most important to the users. However, prioritizing the EMR features is complicated because: (i) EMR systems involve multiple users with different, and sometimes conflicting, priorities and (ii) targeting one feature will affect other features of the EMR system. In this work, we propose a method for prioritizing the features to target when redesigning an EMR system. The method takes into consideration the different priorities of the users and the relationships between the different features. We illustrate the method through a case study on redesigning EMR systems in Japanese antenatal care settings. Our results show the importance of considering the different types of EMR users and the relationships between different EMR features. Designers could use the proposed method as a decision-aid tool in EMR redesign projects.

Early Nephrosis Detection Based on Deep Learning with Clinical Time-Series Data.

Nephrosis is disease characterized by abnormal protein loss from impaired kidney. We constructed early prediction model using machine learning from clinical time series data, that can predict onset of nephrosis for more than one month. Long short-term memory capable of recognizing temporal sequential data patterns, was adopted as early prediction model for nephrosis. We verified our proposed prediction model has higher accuracy compared with those of baseline classifiers by 5-fold cross validation.

Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study.

BACKGROUND: The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior. OBJECTIVE: The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity. METHODS: Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. RESULTS: A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and -106.1 (SE 979.9)/-2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: η2=.19, P=.01; proportional change: η2=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not. CONCLUSIONS: Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect. TRIAL REGISTRATION: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy).

Understanding the Situated Roles of Electronic Medical Record Systems to Enable Redesign: Mixed Methods Study.

BACKGROUND: Redesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system's situated roles can expose the unarticulated needs of the users and enable redesign opportunities. OBJECTIVE: This study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings. METHODS: We conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system. RESULTS: We identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers' reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system. CONCLUSIONS: Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users' wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.

Pervasive game design to evaluate social interaction effects on levels of physical activity among older adults.

INTRODUCTION: Promoting active lifestyles among older adults can bring drastic benefits for their quality of life. The innovative mechanics of pervasive games - that mix real and virtual worlds - can further engage and motivate elderly people into that goal. Using social interaction as a study case, we designed and evaluated the feasibility of a pervasive game to investigate how game design elements can affect the levels of physical activity of older adults. METHODS: A mobile, location-based pervasive game was developed, and a study with community dwelling elderly volunteers from Kyoto, Japan was performed to evaluate its feasibility as an experiment system. RESULTS: Participants reported that the theme and visual style of the game was adequate, and that game rules and goals could be easily understood. The game was considered enjoyably challenging and engaging. Further analysis showed that next iterations of the system must pay special attention to the level of complexity of controls, and that new ways to connect players when there are few people playing or when they are too far apart are necessary. CONCLUSIONS: The design allowed to test for variations on pervasive mechanics and was effective to engage elderly people, encouraging further investigation.

Understanding the Roles of EMR Systems in Japanese Antenatal Care Settings.

Electronic Medical Records (EMR)s are intrinsic to modern-day clinics. Understanding the roles, i.e., the unintended functions of EMR systems in their context of use can guide the design of EMR systems and clinics to better integrate them. To understand the roles of EMR systems in antenatal care check-ups, we conducted a field-based observational study at an antenatal care clinic in a Japanese university hospital. We observed 37 antenatal care check-ups where we looked at how the EMR system affects the communication between the involved parties and supports or hinders the clinical process. Our data analysis resulted in 10 EMR roles, namely: the wingman, the third wheel, the accomplice, the bouncer, the messenger, the summarizer, the bureaucrat, the assistant, the gossip, and the alien. Through the roles, this study reveals multiple EMR design considerations and opportunities for improving both the human-EMR and human interactions in antenatal care settings.

Handheld Guides in Inspection Tasks: Augmented Reality versus Picture.

Inspection tasks focus on observation of the environment and are required in many industrial domains. Inspectors usually execute these tasks by using a guide such as a paper manual, and directly observing the environment. The effort required to match the information in a guide with the information in an environment and the constant gaze shifts required between the two can severely lower the work efficiency of inspector in performing his/her tasks. Augmented reality (AR) allows the information in a guide to be overlaid directly on an environment. This can decrease the amount of effort required for information matching, thus increasing work efficiency. AR guides on head-mounted displays (HMDs) have been shown to increase efficiency. Handheld AR (HAR) is not as efficient as HMD-AR in terms of manipulability, but is more practical and features better information input and sharing capabilities. In this study, we compared two handheld guides: an AR interface that shows 3D registered annotations, that is, annotations having a fixed 3D position in the AR environment, and a non-AR picture interface that displays non-registered annotations on static images. We focused on inspection tasks that involve high information density and require the user to move, as well as to perform several viewpoint alignments. The results of our comparative evaluation showed that use of the AR interface resulted in lower task completion times, fewer errors, fewer gaze shifts, and a lower subjective workload. We are the first to present findings of a comparative study of an HAR and a picture interface when used in tasks that require the user to move and execute viewpoint alignments, focusing only on direct observation. Our findings can be useful for AR practitioners and psychology researchers.