A Metric for Evaluating a Transformation of Subscription-Based Journals into Open-Access Journals.

Open Access is an upcoming paradigm to communicate scientific knowledge. The Trans-O-MIM Project works on strategies, models, and evaluation metrics for the goal-oriented, stepwise, sustainable, and fair transformation of established subscription-based scientific journals into open-access-based journals. This research intends to present an evaluation metric and the associated identified appropriate parameters for such transformations. To develop the evaluation metric, it has been implemented in the context of a business management method for planning, steering and controlling action and corporate strategies. The central element was a 3-step procedure for developing the metric. In stage 1 necessary preconditions for a transformation were considered. Stage 2 is the actual elaboration of the evaluation metric by means of a scenario analysis and stage 3 comprises the exemplary testing at the journal Methods of Information in Medicine. The three methodological steps have primarily resulted in 5 scenarios with 9 different final states from the scenario analysis. Thus, the metric is now composed of these 5 scenarios, which can be used to evaluate the success or failure of a transformation. A list of 65 suitable parameters to measure changes in scenario were compiled. So, it is possible to evaluate the transformation and to find the current final state. Parameters like submissions, publications, and time as well as the scenario states could be applied to the transformation process of the Methods of Information in Medicine journal. The proposed evaluation metric can be used to evaluate the transformation processes of subscription-based journals into open-access-based journals.

Physical Activity in Bariatric Surgery Patients: Does Temperament Matter?

OBJECTIVE: Our aim was to investigate if physical activity (PA) in bariatric surgery patients is related to temperament. METHODS: Preoperative (n = 70) and post-operative (n = 73) patients were categorized as being physically 'active' versus 'inactive' on the basis of objective PA monitoring. Assessment included the behavioural inhibition system (BIS)/behavioural activation system (BAS) scales, the effortful control (EC) subscale of the Adult Temperament Questionnaire-Short Form, a numeric pain rating scale and measures for depressive and eating disorder symptoms. RESULTS: 'Active' did not differ from 'inactive' patients with regard to temperament (BIS, BAS, and EC). Regressions with PA grouping as dependent variable (adjusted for age, gender, body mass index (BMI), depressive or eating disorder symptoms, or pain intensity) indicated an association between lower BMI and more PA in the preoperative and the post-operative group. In the post-operative group, in addition to lower BMI, also lower age and higher BIS reactivity contributed to more PA. Furthermore, there was a significant interaction between BMI and BIS suggesting that low BMI was only associated with more PA in post-operative patients with high BIS. DISCUSSION: The results indicate that temperament per se does not contribute to the level of PA in bariatric surgery patients. However, in post-operative patients, lower BMI was associated with a higher likelihood of being physically active particularly in patients with anxious temperament. These preliminary findings need further investigation within longitudinal studies. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Feasibility study of a sensor-based autonomous load control exercise training system for COPD patients.

Decision support systems (DSSs) which are able to automatically supervise and control physical exercise training of patients affected by chronic obstructive pulmonary disease (COPD) are regarded as a novel method to promote rehabilitation. The objective of our research work for this paper was to evaluate the feasibility of a rule-based DSS for autonomous bicycle ergometer training of COPD patients. Load control is based on real-time analysis of sensor parameters oxygen saturation and heart rate. Ten COPD patients have participated in a study, performing altogether 18 training sessions. On average, 7.4 rules were fired in each training session. Four sessions had to be stopped for different reasons. The average ergometer training load ranged between 31 and 47 W. The average percentage of heart rate in or lower than the intended target zone was 45.9 and 41.6%, respectively. The average patient-perceived Borg value was 12.6±2.4. Patients reported a high satisfaction for the automatically controlled training. With the help of the DSS, patients may change their training place from a rehabilitation center to their own homes. More studies are needed to assess long-term clinical and motivational effects of the DSS in home environment.

Clinical evaluation of a mobile sensor-based gait analysis method for outcome measurement after knee arthroplasty.

Clinical scores and motion-capturing gait analysis are today's gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients' actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sports. The sensors were taped to the lumbosacral junction and the thigh and shank of the affected limb. The annotated raw data was evaluated using our validated proprietary software. Six patients undergoing knee arthroplasty were examined the day before and 12 months after surgery. All patients reported a satisfactory outcome, although four patients still had limitations in their desired activities. In this context, feasible running speed demonstrated a good correlation with reported impairments in sports-related activities. Notably, knee flexion angle while descending stairs and the ability to stop abruptly when running exhibited good correlation with the clinical stability and proprioception of the knee. Moreover, fatigue effects were displayed in some patients. The introduced system appears to be suitable for outcome measurement after knee arthroplasty and has the potential to overcome some of the limitations of stationary gait labs while gathering additional meaningful parameters regarding the force limits of the knee.

Trans-O-MIM-An International Research Project on Open Access Transformation: Outcomes and Lessons Learned.

BACKGROUND: During the last decades, the Open Access paradigm has become an important approach for publishing new scientific knowledge. From 2015 to 2020, the Trans-O-MIM research project was undertaken with the intention to identify and to explore solutions in transforming subscription-based journals into Open Access journals. Trans-O-MIM stands for strategies, models, and evaluation metrics for the goal-oriented, stepwise, sustainable, and fair transformation of established subscription-based scientific journals into Open-Access-based journals with Methods of Information in Medicine as an example. OBJECTIVES: To present an overview of the outcomes of the Trans-O-MIM research project as a whole and to share our major lessons learned. METHODS: As an approach for transforming journals, a Tandem Model has been proposed and implemented for Methods of Information in Medicine. For developing a metric to observe and assess journal transformations, scenario analysis has been used. A qualitative and a two-tier quantitative study on drivers and obstacles of Open Access publishing for medical informatics researchers was designed and conducted. A project setup with a research team, a steering committee, and an international advisory board was established. Major international medical informatics events have been used for reporting and for receiving feedback. RESULTS: Based on the Tandem Model, the journal Methods of Information in Medicine has been transformed into a journal where, in addition to its subscription-based track, from 2017 onwards a Gold Open Access track has been successfully added. An evaluation metric, composed of 5 scenarios and 65 parameters, has been developed, which can assist respective decision makers in assessing such transformations. The studies on drivers and obstacles of Open Access publishing showed that, while most researchers support the idea of making scientific knowledge freely accessible to everyone, they are hesitant about actually living this practice by choosing Open Access journals to publish their own work. Article-processing charges and quality issues are perceived as the main obstacles in this respect, revealing a two-sided evaluation of Open Access models, reflecting the different viewpoints of researchers as authors or readers. Especially researchers from low-income countries benefit from a barrier-free communication mainly in their role as readers and much less in their role as authors of scientific information. This became also evident at the institutional level, as Open Access policies or financial support through funding bodies are most prevalent in Europe and North America. CONCLUSION: With Trans-O-MIM, an international research project was performed. An existing journal has been transformed. In addition, with the support of the International Medical Informatics Association, as well as of the European Federation for Medical Informatics and of the German Association for Medical Informatics, Biometry and Epidemiology as European and German medical informatics organizations, we did run an international experiment on Open Access incentives. Both together are, as far as the authors know, unique. We therefore expect that this research could add new knowledge on Open Access transformation.

Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups.

BACKGROUND: Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). METHODS: A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493). A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances. RESULTS: The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity. CONCLUSIONS: Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity) reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified automatically from existing geriatric assessment data, especially when combined with domain knowledge in a hybrid classification model. Further work is necessary to validate our approach in a controlled prospective setting.

Facial self-perception, well-being, and aesthetic surgery.

BACKGROUND: It is controversial whether impaired well-being is associated with (a) an increased likelihood of having a negative body/facial image; or (b) dissatisfaction with the postoperative result following aesthetic surgery. We set out to improve current knowledge in this matter. METHODS: A total of 324 subjects (n = 162 females, n = 162 males, 18-30 years) were photographed, asked to complete the adjective mood scale and to rate 46 statements regarding their own appearance, and its impact on social functioning as well as their willingness to undergo aesthetic surgery on a visual analog scale. The photographs of these subjects were also assessed by 50 independent judges. RESULTS: Average self-awarded ratings of appearance were significantly more positive in subjects with normal as compared to those with impaired well-being (P = 0.014). Items regarding the impact of appearance on social functioning were answered significantly more negatively by subjects with impaired well-being as compared with those with the normal well-being (P = 0.001). Subjects with impaired well-being did not declare an increased willingness to undergo aesthetic surgery (P > 0.197). Assessment by the independent judges did not reveal differences in the average level of attractiveness of subjects with impaired well-being and those with normal well-being (P = 0.666). CONCLUSIONS: Impaired well-being is associated with impaired facial selfperception, independent of attractiveness. Willingness to undergo aesthetic surgery seems not to be affected by one's sense of well-being. In the subjects with impaired well-being who undergo aesthetic surgery, facial self-perception seems unlikely to be improved.

Implementation of a Mobile Application in Acute Stroke Care Documentation.

Acute stroke care is a time-critical process. Improving communication and documentation process may support a positive effect on medical outcome. To achieve this goal, a new system using a mobile application has been integrated into existing infrastructure at Hannover Medical School (MHH). Within a pilot project, this system has been brought into clinical daily routine in February 2022. Insights generated may support further applications in clinical use-cases.

Sensors vs. experts - a performance comparison of sensor-based fall risk assessment vs. conventional assessment in a sample of geriatric patients.

BACKGROUND: Fall events contribute significantly to mortality, morbidity and costs in our ageing population. In order to identify persons at risk and to target preventive measures, many scores and assessment tools have been developed. These often require expertise and are costly to implement. Recent research investigates the use of wearable inertial sensors to provide objective data on motion features which can be used to assess individual fall risk automatically. So far it is unknown how well this new method performs in comparison with conventional fall risk assessment tools. The aim of our research is to compare the predictive performance of our new sensor-based method with conventional and established methods, based on prospective data. METHODS: In a first study phase, 119 inpatients of a geriatric clinic took part in motion measurements using a wireless triaxial accelerometer during a Timed Up&Go (TUG) test and a 20 m walk. Furthermore, the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) was performed, and the multidisciplinary geriatric care team estimated the patients' fall risk. In a second follow-up phase of the study, 46 of the participants were interviewed after one year, including a fall and activity assessment. The predictive performances of the TUG, the STRATIFY and team scores are compared. Furthermore, two automatically induced logistic regression models based on conventional clinical and assessment data (CONV) as well as sensor data (SENSOR) are matched. RESULTS: Among the risk assessment scores, the geriatric team score (sensitivity 56%, specificity 80%) outperforms STRATIFY and TUG. The induced logistic regression models CONV and SENSOR achieve similar performance values (sensitivity 68%/58%, specificity 74%/78%, AUC 0.74/0.72, +LR 2.64/2.61). Both models are able to identify more persons at risk than the simple scores. CONCLUSIONS: Sensor-based objective measurements of motion parameters in geriatric patients can be used to assess individual fall risk, and our prediction model's performance matches that of a model based on conventional clinical and assessment data. Sensor-based measurements using a small wearable device may contribute significant information to conventional methods and are feasible in an unsupervised setting. More prospective research is needed to assess the cost-benefit relation of our approach.

Identification of Influencing Factors Regarding the Decision for or Against an Open Access Publication of Scientists of Medical Informatics: Description and First Results of Group Discussions and Interviews.

Open Access provides researchers another opportunity of publishing, besides the traditional publication in subscription-based journals. Providing higher dissemination and therefore visibility as well as better accessibility, among others, Open Access helps to fulfil changed needs of authors and readers in our information and communication society of today. Though this publication model provides a lot of advantages both for readers and authors, there are also some obstacles. In order to identify the incentives that can lead scientists of medical informatics to an Open-Access-publication, we conducted a study consisting of group discussions, interviews, and surveys. This tripartite evaluation starts in its first part with group discussions and interviews. First results of them show that, among others, the higher visibility, indexing, Impact Factor and better accessibility are factors for an Open-Access-publication.

SMS Education for the Promotion of Diabetes Self-Management in Low & Middle Income Countries: A Randomized Controlled Trial in Egypt.

Aiming to assess the impact of SMS messages on glycemic control and self-management, we conducted a 12-week RCT at MUST hospital in Cairo-Egypt. Outcomes included change in HbA1c, BG levels, treatment and medication adherence, self-efficacy, and diabetes knowledge. 34 intervention and 39 control patients completed the study. HbA1c did not differ significantly (p = 0.406) between groups but secondary outcomes varied considerably. The effectiveness of SMS over paper-based methods still needs further investigation.

On Incentives for Open Access Publishing: A Survey at IMIA's Annual General Assembly During HEC2016.

Open access provides an alternative opportunity of publishing research articles besides the traditional subscription-based publication model. Facilitating higher visibility, accessibility, and dissemination, among others, open access addresses modern needs of our information and communication society. Though these factors are vital, there also do exist initial problems to become prevalent. Especially, costs like article publication charges seem to have an impact on the author's decision not to publish open access. In order to gain a deeper insight on incentives for open access publishing (as well as on barriers for not publishing open access), we developed a specific survey within the scope of our Trans-O-MIM project. Conducted at HEC2016, we primarily involved participants of the Annual General Assembly of the International Medical Informatics Association (IMIA). As main incentives and motivation for open access publishing had been identified: article indexing, impact factor, accessibility/availability, dissemination, and visibility.

Exploring Possibilities for Transforming Established Subscription-based Scientific Journals into Open Access Journals. Present Situation, Transformation Criteria, and Exemplary Implementation within Trans-O-MIM.

BACKGROUND: Based on today's information and communication technologies the open access paradigm has become an important approach for adequately communicating new scientific knowledge. OBJECTIVES: Summarizing the present situation for journal transformation. Presenting criteria for adequate transformation as well as a specific approach for it. Describing our exemplary implementation of such a journal transformation. METHODS: Studying the respective literature as well as discussing this topic in various discussion groups and meetings (primarily of editors and publishers, but also of authors and readers), with long term experience as editors and /or publishers of scientific publications as prerequisite. RESULTS: There is a clear will, particularly of political and funding organizations, towards open access publishing. In spite of this, there is still a large amount of scientific knowledge, being communicated through subscription-based journals. For successfully transforming such journals into open access, sixteen criteria for a goal-oriented, stepwise, sustainable, and fair transformation are suggested. The Tandem Model as transformation approach is introduced. Our exemplary implementation is done in the Trans-O-MIM project. It is exploring strategies, models and evaluation metrics for journal transformation. As instance the journal Methods of Information in Medicine will apply the Tandem Model from 2017 onwards. CONCLUSIONS: Within Trans-O-MIM we will reach at least nine of the sixteen criteria for adequate transformation. It was positive to implement Trans-O-MIM as international research project. After first steps for transforming Methods have successfully been made, challenges will remain, among others, in identifying appropriate incentives for open access publishing in order to support its transformation.

Physical Activity, Decision-Making Abilities, and Eating Disturbances in Pre- and Postbariatric Surgery Patients.

BACKGROUND: Physical activity (PA) is considered to have a beneficial influence on executive functioning, including decision-making. Enhanced decision-making after bariatric surgery may strengthen patients' ability to delay gratification, helping to establish appropriate eating behavior. The objectives of this study were to (1) compare a preoperative group with a postoperative group with regard to daily PA, decision-making, and eating disturbances; and (2) investigate the relationship between these variables. METHODS: The study included 71 bariatric surgery candidates (78 % women, BMI [kg/m2] M = 46.9, SD = 6.0) and 73 postoperative patients (78 % women, BMI M = 32.0, SD = 4.1; 89 % Roux-en-Y gastric bypass, 11 % sleeve gastrectomy; months postoperative M = 8.2, SD = 3.5; total weight loss [%] M = 33.2, SD = 8.9) who completed SenseWear Pro2 activity monitoring. Decision-making was assessed using a computerized version of the Iowa Gambling Task and eating disorder psychopathology using the Eating Disorder Examination-Questionnaire. RESULTS: The number of patients who were classified as physically inactive was similarly high in the pre- and postoperative groups. No group differences emerged with regard to decision-making, but the postoperative group exhibited less eating disturbances than the preoperative group. No significant associations were found between PA, decision-making, and eating behavior. CONCLUSIONS: Patients after bariatric surgery were not more physically active than bariatric surgery candidates, which should be considered in care programs. Additionally, future research is needed to explore the possible link between PA, patients' decision-making abilities, and eating disturbances concerning dose-response questions.

Challenges and Opportunities for Harmonizing Research Methodology: Raw Accelerometry.

OBJECTIVES: Raw accelerometry is increasingly being used in physical activity research, but diversity in sensor design, attachment and signal processing challenges the comparability of research results. Therefore, efforts are needed to harmonize the methodology. In this article we reflect on how increased methodological harmonization may be achieved. METHODS: The authors of this work convened for a two-day workshop (March 2014) themed on methodological harmonization of raw accelerometry. The discussions at the workshop were used as a basis for this review. RESULTS: Key stakeholders were identified as manufacturers, method developers, method users (application), publishers, and funders. To facilitate methodological harmonization in raw accelerometry the following action points were proposed: i) Manufacturers are encouraged to provide a detailed specification of their sensors, ii) Each fundamental step of algorithms for processing raw accelerometer data should be documented, and ideally also motivated, to facilitate interpretation and discussion, iii) Algorithm developers and method users should be open about uncertainties in the description of data and the uncertainty of the inference itself, iv) All new algorithms which are pitched as "ready for implementation" should be shared with the community to facilitate replication and ongoing evaluation by independent groups, and v) A dynamic interaction between method stakeholders should be encouraged to facilitate a well-informed harmonization process. CONCLUSIONS: The workshop led to the identification of a number of opportunities for harmonizing methodological practice. The discussion as well as the practical checklists proposed in this review should provide guidance for stakeholders on how to contribute to increased harmonization.

Physical activity is unrelated to cognitive performance in pre-bariatric surgery patients.

OBJECTIVE: To investigate the relationship between physical activity (PA) and cognitive performance in extreme obesity. METHODS: Seventy-one bariatric surgery candidates (77.5% women) with a mean body mass index (BMI) of 46.9 kg/m2 (SD=6.0) and a mean age of 41.4 (SD=11.9) years completed SenseWear Pro2 activity monitoring for seven days. Cognitive functioning was assessed by a computerized test battery including tasks of executive function (Iowa Gambling Task), visuospatial short-term memory (Corsi Block Tapping Test) and verbal short-term memory (Auditory-Verbal Learning Test). Questionnaires assessing eating disturbances and depressive symptoms were administered. Somatic comorbidities were assessed by medical chart review. RESULTS: The level of PA was low with mean steps per day within wear time being 7140 (SD=3422). Most patients were categorized as sedentary (31.0%) or low active (26.8%). No significant association between PA estimates and cognitive performance was found. Lower PA was modestly correlated with higher BMI but not with age, somatic comorbidity or depressive symptoms. Moderated regression analyses suggested a significant interaction effect between depression and PA in predicting performance on the Corsi Block Tapping Test. Patients with (29.6%) and without (70.4%) regular binge eating did not differ with respect to PA or cognitive function. CONCLUSION: The findings indicate no association between daily PA and cognitive performance in morbidly obese patients. Future studies should explore the relationship between the variables with regard to dose-response-questions, a broader BMI range and with respect to potential changes after substantial weight loss due to bariatric surgery.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study.

BACKGROUND: Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. OBJECTIVES: We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. METHODS: Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. RESULTS: The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. DISCUSSION AND CONCLUSIONS: Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

Home monitoring and decision support for international liver transplant children.

Complications may occur after a liver transplantation, therefore proper monitoring and care in the post-operation phase plays a very important role. Sometimes, monitoring and care for patients from abroad is difficult due to a variety of reasons, e.g., different care facilities. The objective of our research for this paper is to design, implement and evaluate a home monitoring and decision support infrastructure for international children who underwent liver transplant operation. A point-of-care device and the PedsQL questionnaire were used in patients' home environment for measuring the blood parameters and assessing quality of life. By using a tablet PC and a specially developed software, the measured results were able to be transmitted to the health care providers via internet. So far, the developed infrastructure has been evaluated with four international patients/families transferring 38 records of blood test. The evaluation showed that the home monitoring and decision support infrastructure is technically feasible and is able to give timely alarm in case of abnormal situation as well as may increase parent's feeling of safety for their children.

Sensor-based fall risk assessment - dagger of the mind?

Fall events and their severe consequences represent not only a threatening problem for the affected individual, but also cause a significant burden for health care systems. Our research work aims to elucidate some of the prospects and problems of current sensor-based fall risk assessment approaches. Selected results of a questionnaire-based survey given to experts during topical workshops at international conferences are presented. The majority of domain experts confirmed that fall risk assessment could potentially be valuable for the community and that prediction is deemed possible, though limited. We conclude with a discussion of practical issues concerning adequate outcome parameters for clinical studies and data sharing within the research community. All participants agreed that sensor-based fall risk assessment is a promising and valuable approach, but that more prospective clinical studies with clearly defined outcome measures are necessary.

Fall prediction with wearable sensors--an empirical study on expert opinions.

Falls represent a considerable problem for many developed societies with a large growth in the elderly population, and they inflict a sizable personal and social cost. Assessment of an individual's risk of falling, facilitated by advanced movement sensing technologies, has been heralded as a potential means to target fall prevention interventions to those most at need. This paper presents the summary of a questionnaire-based survey of expert opinions collected from three major international conference meetings on the topic of fall risk assessment and fall prediction. Specifically, current problems are discussed, both in terms of technology as well as in study design, in order to harmonize and guide future research activities. The analysis of this survey confirms that sensor-based fall prediction is both relevant and promising, and that large-scale prospective studies are needed as well as further harmonization of research methods.