Taking the pulse of a classroom with a gamified audience response system.

BACKGROUND AND OBJECTIVE: This paper presents an empirical study of a gamified mobile-based assessment approach that can be used to engage students and improve their educational performance. METHOD: A gamified audience response system called G-SIDRA was employed. Three gamification elements were used to motivate students in classroom activities: badges for achievements to increase engagement, points to indicate progression and performance in the subject and ranking for promoting competitiveness. A total of 90 medical students in a General and Descriptive Anatomy of the Locomotor System course were taught using G-SIDRA in the academic year 2019/2020. Smart bracelets were configured to collect heart rate measurements from 30 students with the aim of evaluating the impact of the gamification elements. The control group consisted of a sample of 110 students enrolled on the same course in the academic year 2016/2017 using non-gamified SIDRA. RESULTS: Statistically significant differences were found between multiple choice questions (MCQ) scores obtained by using SIDRA and G-SIDRA in the four experiments (U = 1.621,50, p < 0,01 for Exp1; U = 1.950,00, p < 0,01 for Exp2; U = 955,00, p < 0,01 for Exp3; U = 2.335,00, p < 0,01 for Exp4). In the students' final exam grades, statistically significant differences between students that used G-SIDRA as opposed to SIDRA (T(157) = 3.992; p = 0.044) were obtained. Concerning gamification elements, statistically significantly differences were found in comparing the pulse increases after and before the badge event in the four experiments (U = 2.484,00, p = 0,038 for Exp1; U = 2.109,50, p = 0,046 for Exp2; U = 1.790,50, p = 0,025 for Exp3; U = 1.557,0, p = 0,048 for Exp4). However, there are not statistically significant differences between the pulse increases after and before the ranking event in the four experiments. In a 5-point Likert-type scale, the students expressed satisfaction with G-SIDRA (M = 4.552) and thought the system helped to better understand both theoretical and practical concepts (M = 4.092). Their global assessment of the G-SIDRA platform was 4.471. CONCLUSIONS: Of the three gamification elements used in the study, only badge has an effect on heart rate. Better student responses and academic performance were achieved when using G-SIDRA. Nevertheless, more research is required to evaluate the impact of the gamification elements on the motivation, engagement and performance of students. Physiological measures are promising approaches for gamification elements evaluation.

Effects of Gamification on the Benefits of Student Response Systems in Learning of Human Anatomy: Three Experimental Studies.

This paper presents three experiments to assess the impact of gamifying an audience response system on the perceptions and educational performance of students. An audience response system called SIDRA (Immediate Audience Response System in Spanish) and two audience response systems with gamification features, R-G-SIDRA (gamified SIDRA with ranking) and RB-G-SIDRA (gamified SIDRA with ranking and badges), were used in a General and Descriptive Human Anatomy course. Students participated in an empirical study. In the academic year 2019-2020, a total of 90 students used RB-G-SIDRA, 90 students employed R-G-SIDRA in the academic year 2018-2019, and 92 students used SIDRA in the academic year 2017-2018. Statistically significant differences were found between final exam grades obtained by using RB-G-SIDRA and SIDRA, U = 39.211 adjusted p = 0.001 and RB-G-SIDRA and R-G-SIDRA U = 31.157 adjusted p = 0.015, thus finding strong evidence with respect to the benefit of the badges used in RB-G-SIDRA. Moreover, in the students' SIDRA systems scores, statistically significant differences were found between RB-G-SIDRA and SIDRA, U = -90.521 adjusted p < 0.001, and between R-G-SIDRA and SIDRA, U = -87.998 adjusted p < 0.001. Significant correlations between individual and team scores were also found in all of the tests in RB-G-SIDRA and G-SIDRA. The students expressed satisfaction, engagement, and motivation with SIDRA, R-G-SIDRA, and RB-G-SIDRA, thus obtaining a final average assessment of 4.28, 4.61, and 4.47 out of 5, respectively. Students perform better academically with gamified versus non-gamified audience response systems. Findings can be used to build a gamified adaptive learning system.

Intracranial pressure analysis software: A mapping study and proposal.

Introduction Intracranial pressure (ICP) monitoring and analysis are techniques that are, each year, applied to millions of patients with pathologies with million of patients annually. The detection of the so called A and B-waves, and the analysis of subtle changes in C-waves, which are present in ICP waveform, may indicate decreased intracranial compliance, and may improve the clinical outcome. Despite the advances in the field of computerized data analysis, the visual screening of ICP continues to be the means principally employed to detect these waves. To the best of our knowledge, no review study has addressed automated ICP analysis in sufficient detail and a need to research the state of the art of ICP analysis has, therefore, been identified. Methodology This paper presents a systematic mapping study to provide answers to 7 research questions: publication time, venue and source trends, medical tasks undertaken, research methods used, computational systems developed, validation methodology, tools and systems employed for evaluation and research problems identified. An ICP software prototype is presented and evaluated as a consequence of the results. Results A total of 23 papers, published between 1990 and 2020, were selected from 6 online databases. After analyzing these papers, the following information was obtained: diagnosis and monitoring medical tasks were addressed to the same extent, and the main research method used was evaluation research. Several computational systems were identified in the papers, the main one being image classification, while the main analysis objective was single pulse analysis. Correlation with expert analysis was the most frequent validation method, and few of the papers stated the use of a published dataset. Few authors referred to the tools used to build or evaluate the proposed solutions. The most frequent research problem was the need for new analysis methods. These results have inspired us to propose a software prototype with which provide an automated solution that integrates ICP analysis and monitoring techniques. Conclusions The papers in this study were selected and classified with regard to ICP automated analysis methods. Several research gaps were identified, which the authors of this study have employed as a based on which to recommend future work. Furthermore, this study has identified the need for an empirical comparison between methods, which will require the use and development of certain standard metrics. An in-depth analysis conducted by means of systematic literature review is also required. The software prototype evaluation provided positive results, showing that the prototype may be a reliable system for A-wave detection.

A Study on the Relationship between Usability of GUIs and Power Consumption of a PC: The Case of PHRs.

Usability is key to achieve quality in software products. The client applications with a high score in usability might impact on the power consumption when they are run in a PC. For this reason, energy savings turn to be critical in green software systems. In this paper the relationship between the usability evaluations of the GUIs and the power consumption measurements of the main components of a PC were analysed. A set of 5 web-based personal health records (PHRs) were selected as a case study. The usability assessment was performed by an expert, employing the 14 principles of design by Alan Dix as heuristics. They were scored on a Likert scale after performing a collection of common tasks in the PHRs. At the same time, an equipment to measure the energy consumption of hard disk drive, graphics card, processor, monitor and power supply was used. Spearman's index was studied for the correlations between the usability assessments and the power consumption measurements. As a results, some weak relationships were found. A total of 5 usability heuristics were observed to may influence energy consumption when they were considered in the implementation of the PHRs. These heuristics were the following ones: consistency, task migratability, observability, recoverability and responsiveness. Based on the results, the usability principles of design cannot always be related to lower energy consumption. Future research should focus on the tradeoffs between usability and power consumption of client applications when they are used in a computer.

Corrigendum to "Energy efficiency in software: A case study on sustainability in personal health records" [J. Clean. Prod. 282 (2021) 124262].

[This corrects the article DOI: 10.1016/j.jclepro.2020.124262.].

Energy efficiency in software: A case study on sustainability in personal health records.

A personal health record is an eHealth technology in which users can observe their progress over time for a given condition. A research gap was identified in the literature concerning the study of the amount of energy that these systems need for their operation, and the energy efficiency that may be attained depending on their design. After the selection of five representative personal health records, a total of 20 tasks commonly done, and based on previous work, were performed with regard to two proposed scenarios, namely patient use and health personnel usage. The power consumption of the main components of a host machine was measured during the performance of the proposed duties. To that end, a hardware tool called the Energy Efficiency Tester was employed. The data collected were analyzed statistically, and significant differences were found in the respective consumption of the display (χ2 (4) = 23.782, p = 0.000), the processor (χ2 (4) = 29.018, p = 0.000) and the whole PC (χ2 (4) = 28.582, p = 0.000). For all of these components, NoMoreClipBoard was the personal health record that required the least energy (57.699 W for the display, 3.162 W for the processor and 181.113 W for the whole PC). A total of two strong correlations were found in the energy consumption between the hard disk and the graphics card (r = 0.791, p < 0.001), and the processor and the PC (r = 0.950, p < 0.001). Some features generated special amounts of power consumption, such as the news wall found on PatientsLikeMe, or the use of load icons that had an impact on most PC components. In addition, an in-depth analysis of the user interfaces was performed. A discussion was carried out on the design of the user interfaces, also taking into account recommendations drawn from the literature, checking for their implementation in the personal health records selected. With the aim of promoting sustainability among software developers, a best practice guideline on sustainable software design was proposed. Basic sustainability recommendations were collected for professionals to consider when developing a software system in general, and a personal health record in particular.

Evaluating the Privacy Policies of Mobile Personal Health Records for Pregnancy Monitoring.

A mobile personal health record (mPHR) for pregnancy monitoring allows the pregnant woman to track and manage her personal health data. However, owing to the privacy and security issues that may threaten the exchange of this sensitive data, a privacy policy should be established. The aim of this study is to evaluate the privacy policies of 19 mPHRs for pregnancy monitoring (12 for iOS and 7 for Android) using a template covering the characteristics of privacy, security, and standards and regulations. The findings of this study show that none of the privacy policies evaluated entirely comply with the characteristics studied. The developers of mPHRs for pregnancy monitoring are, therefore, requested to improve and pay more attention to the structure and the content of the privacy policies of their apps.

Reusable Software Usability Specifications for mHealth Applications.

One of the key factors for the adoption of mobile technologies, and in particular of mobile health applications, is usability. A usable application will be easier to use and understand by users, and will improve user's interaction with it. This paper proposes a software requirements catalog for usable mobile health applications, which can be used for the development of new applications, or the evaluation of existing ones. The catalog is based on the main identified sources in literature on usability and mobile health applications. Our catalog was organized according to the ISO/IEC/IEEE 29148:2011 standard and follows the SIREN methodology to create reusable catalogs. The applicability of the catalog was verified by the creation of an audit method, which was used to perform the evaluation of a real app, S Health, application created by Samsung Electronics Co. The usability requirements catalog, along with the audit method, identified several usability flaws on the evaluated app, which scored 83%. Some flaws were detected in the app related to the navigation pattern. Some more issues related to the startup experience, empty screens or writing style were also found. The way a user navigates through an application improves or deteriorates user's experience with the application. We proposed a reusable usability catalog and an audit method. This proposal was used to evaluate a mobile health application. An audit report was created with the usability issues identified on the evaluated application.

E-health internationalization requirements for audit purposes.

BACKGROUND AND OBJECTIVE: In the 21st century, e-health is proving to be one of the strongest drivers for the global transformation of the health care industry. Health information is currently truly ubiquitous and widespread, but in order to guarantee that everyone can appropriately access and understand this information, regardless of their origin, it is essential to bridge the international gap. The diversity of health information seekers languages and cultures signifies that e-health applications must be adapted to satisfy their needs. METHODS: In order to achieve this objective, current and future e-health programs should take into account the internationalization aspects. This paper presents an internationalization requirements specification in the form of a reusable requirements catalog, obtained from the principal related standards, and describes the key methodological elements needed to perform an e-health software audit by using the internationalization knowledge previously gathered. RESULTS: S Health, a relevant, well-known Android application that has more than 150 million users in over 130 countries, was selected as a target for the e-health internationalization audit method and requirements specification presented above. This application example helped us to put into practice the proposal and show that the procedure is realistic and effective. CONCLUSIONS: The approach presented in this study is subject to continuous improvement through the incorporation of new knowledge originating from additional information sources, such as other standards or stakeholders. The application example is useful for early evaluation and serves to assess the applicability of the internationalization catalog and audit methodology, and to improve them. It would be advisable to develop of an automated tool with which to carry out the audit method.

Software project management tools in global software development: a systematic mapping study.

Global software development (GSD) which is a growing trend in the software industry is characterized by a highly distributed environment. Performing software project management (SPM) in such conditions implies the need to overcome new limitations resulting from cultural, temporal and geographic separation. The aim of this research is to discover and classify the various tools mentioned in literature that provide GSD project managers with support and to identify in what way they support group interaction. A systematic mapping study has been performed by means of automatic searches in five sources. We have then synthesized the data extracted and presented the results of this study. A total of 102 tools were identified as being used in SPM activities in GSD. We have classified these tools, according to the software life cycle process on which they focus and how they support the 3C collaboration model (communication, coordination and cooperation). The majority of the tools found are standalone tools (77%). A small number of platforms (8%) also offer a set of interacting tools that cover the software development lifecycle. Results also indicate that SPM areas in GSD are not adequately supported by corresponding tools and deserve more attention from tool builders.

Mobile personal health records for pregnancy monitoring functionalities: Analysis and potential.

BACKGROUND AND OBJECTIVE: Personal Health Records (PHRs) are a rapidly growing area of health information technology. PHR users are able to manage their own health data and communicate with doctors in order to improve healthcare quality and efficiency. Mobile PHR (mPHR) applications for mobile devices have obtained an interesting market quota since the appearance of more powerful mobile devices. These devices allow users to gain access to applications that used to be available only for personal computers. This paper analyzes the functionalities of mobile PHRs that are specific to pregnancy monitoring. METHODS: A well-known Systematic Literature Review (SLR) protocol was used in the analysis process. A questionnaire was developed for this task, based on the rigorous study of scientific literature concerning pregnancy and applications available on the market, with 9 data items and 35 quality assessments. The data items contain calendars, pregnancy information, health habits, counters, diaries, mobile features, security, backup, configuration and architectural design. RESULTS: A total of 33 mPHRs for pregnancy monitoring, available for iOS and Android, were selected from Apple App store and Google Play store, respectively. The results show that none of the mPHRs selected met 100% of the functionalities analyzed in this paper. The highest score achieved was 77%, while the lowest was 17%. CONCLUSIONS: In this paper, these features are discussed and possible paths for future development of similar applications are proposed, which may lead to a more efficient use of smartphone capabilities.

The evaluation of i-SIDRA - a tool for intelligent feedback - in a course on the anatomy of the locomotor system.

OBJECTIVE: This paper presents an empirical study of a formative mobile-based assessment approach that can be used to provide students with intelligent diagnostic feedback to test its educational effectiveness. METHOD: An audience response system called SIDRA was integrated with a neural network-based data analysis to generate diagnostic feedback for guided learning. A total of 200 medical students enrolled in a General and Descriptive Anatomy of the Locomotor System course were taught using two different methods. Ninety students in the experimental group used intelligent SIDRA (i-SIDRA), whereas 110 students in the control group received the same training but without employing i-SIDRA. RESULTS: In the students' final exam grades, a statistically significant difference was found between those students that used i-SIDRA as opposed to a traditional teaching methodology (T(162)=2.597; p=0.010). The increase in the number of correct answers during the feedback guided learning process from the first submission to the last submission in four multiple choice question tests was also analyzed. There were average increases of 20.00% (Test1), 11.34% (Test2), 8.88% (Test3) and 13.43% (Test4) in the number of correct answers. In a questionnaire rated on a five-point Likert-type scale, the students expressed satisfaction with the content (M=4.2) and feedback (M=3.5) provided by i-SIDRA and the methodology (M=4.2) used to learn anatomy. CONCLUSIONS: The use of audience response systems enriched with feedback such as i-SIDRA improves medical degree students' performance as regards anatomy of the locomotor system. The knowledge state diagrams representing students' behavior allow instructors to study their progress so as to identify what they still need to learn.

An Empirical Study of Neural Network-Based Audience Response Technology in a Human Anatomy Course for Pharmacy Students.

This paper presents an empirical study of a formative neural network-based assessment approach by using mobile technology to provide pharmacy students with intelligent diagnostic feedback. An unsupervised learning algorithm was integrated with an audience response system called SIDRA in order to generate states that collect some commonality in responses to questions and add diagnostic feedback for guided learning. A total of 89 pharmacy students enrolled on a Human Anatomy course were taught using two different teaching methods. Forty-four students employed intelligent SIDRA (i-SIDRA), whereas 45 students received the same training but without using i-SIDRA. A statistically significant difference was found between the experimental group (i-SIDRA) and the control group (traditional learning methodology), with T (87) = 6.598, p < 0.001. In four MCQs tests, the difference between the number of correct answers in the first attempt and in the last attempt was also studied. A global effect size of 0.644 was achieved in the meta-analysis carried out. The students expressed satisfaction with the content provided by i-SIDRA and the methodology used during the process of learning anatomy (M = 4.59). The new empirical contribution presented in this paper allows instructors to perform post hoc analyses of each particular student's progress to ensure appropriate training.

Are the expected benefits of requirements reuse hampered by distance? An experiment.

BACKGROUND: Software development processes are often performed by distributed teams which may be separated by great distances. Global software development (GSD) has undergone a significant growth in recent years. The challenges concerning GSD are especially relevant to requirements engineering (RE). Stakeholders need to share a common ground, but there are many difficulties as regards the potentially variable interpretation of the requirements in different contexts. We posit that the application of requirements reuse techniques could alleviate this problem through the diminution of the number of requirements open to misinterpretation. RESULTS: This paper presents a reuse-based approach with which to address RE in GSD, with special emphasis on specification techniques, namely parameterised requirements and traceability relationships. An experiment was carried out with the participation of 29 university students enrolled on a Computer Science and Engineering course. Two main scenarios that represented co-localisation and distribution in software development were portrayed by participants from Spain and Morocco. The global teams achieved a slightly better performance than the co-located teams as regards effectiveness, which could be a result of the worse productivity of the global teams in comparison to the co-located teams. Subjective perceptions were generally more positive in the case of the distributed teams (difficulty, speed and understanding), with the exception of quality. CONCLUSIONS: A theoretical model has been proposed as an evaluation framework with which to analyse, from the point of view of the factor of distance, the effect of requirements specification techniques on a set of performance and perception-based variables. The experiment utilised a new internationalisation requirements catalogue. None of the differences found between co-located and distributed teams were significant according to the outcome of our statistical tests. The well-known benefits of requirements reuse in traditional co-located projects could, therefore, also be expected in GSD projects.

Teléfonos inteligentes para la tercera edad: una revisión de aplicaciones móviles de salud / Smart Phones for the elderly: a review of mobile health applications

Objetivo: Conocer cuáles aplicaciones para teléfonos inteligentes y su funcionalidad se encuentran disponibles para una persona de la tercera edad en el ámbito de la salud. Métodos: Se realizó una revisión sistemática de la literatura para la selección de publicaciones científicas, y un estudio de aplicaciones en los repositorios de aplicaciones móviles GooglePlay y AppStore. Resultados: Se identificaron 18 aplicaciones, con características muy variadas. Los resultados muestran que las aplicaciones están especializadas en una enfermedad o campo concreto: Alzheimer y demencia, diabetes, enfermedades cardíacas, enfermedades pulmonares y gestión de la salud. Además, se observó que la mayoría de las aplicaciones encontradas no son usables, ni están adaptadas para personas mayores. Conclusiones: Los botones grandes, menús sencillos con pocas opciones y mensajes de voz para sustituir texto en funciones de recordatorios o confirmación de acciones facilitan el uso de las aplicaciones de salud por personas de la tercera edad. El diseño y desarrollo de carpetas personales desarrollo de carpetas personales de salud con funciones orientadas a cubrir la comorbilidad de las personas de la tercera edad es un área de investigación prometedora.

Objective: To discover which smartphone applications and functionality are available to the elderlies in the field of health care. Methods: A systematic literature review was conducted to select scientific publications as well as a study of available applications in the mobile applications repositories GooglePlay and AppStore. Results: Eighteen mobile phone applications with a variety of features were identified. The results show that the applications are focused on a specific disease or field, such as Alzheimer and dementia, diabetes, cardiovascular diseases, respiratory diseases and health management. In addition, the study showed that the majority of the selected applications are neither usable nor adapted to be used by elder adults. Conclusions: Large buttons, simple menus with few options and voice messages replacing text in reminders and confirm dialogs make easier the use of mobile phone applications by the elderly. The design and development of Personal Health Records with functions that cover the comorbidity of elderly people is a promising research area.

Compliance of blood donation apps with mobile OS usability guidelines.

The aim of this paper is to employ the guidelines of Android, iOS, Blackberry and Windows Phone to analyze the usability compliance of free blood donation (BD) apps. An analysis process based on a systematic review protocol is used to select free BD apps. An assessment is conducted using a questionnaire composed of 13 questions concerning the compliance of free BD apps with Android, Blackberry, iOS and Windows Phone usability guidelines. A total of 133 free BD apps have been selected from the 188 BD apps identified. Around 63% of the free BD apps selected have a good compliance with mobile OS usability recommendations. Around 72% of Android, 57% of Windows Phone, 33% of iOS and 33% of Blackberry BD apps have a high usability score. The aspect of BD app behavior should be improved along with some style components: the use of pictures to explain ideas and the adaptation of the app to both horizontal and vertical orientations. Structure patterns should also be used to improve the structure aspect of a BD app. Usability is a quality aspect that should be improved in current BD apps. Our study provides smartphone users with a list of usable free BD apps and BD app developers with recommendations.

Free blood donation mobile applications.

Blood donation (BD) is a noble act and mobile applications (apps) can help increase awareness about it. This paper analyzes and assesses the characteristics of free apps for BD as regards features and functionality. A search in Google Play, Apple Apps store, Blackberry App World and Windows Mobile App store was carried out to select 169 free BD apps from the 188 apps identified. The results presented in this paper show that the majority of the apps selected have been developed for the Android operating system. Moreover, most of the apps selected are available to help users search for donors. Few of the apps could not be installed and/or accessed. Of those that could be installed: half of them do not require any kind of authentication; a few of them are available in more than one language; half of them have a geographical restriction; around 60 % of them do not notify the user of BD events and requests; one, which is available for Android and iOS, can connect with a laboratory; around 45 % of them allow users to share information via social networks, and the majority of them do not provide BD recommendations. These results are used as a basis to provide app developers with certain recommendations. There is a need for better BD apps with more features in order to increase the number of volunteer donors.

Analysis of health professional security behaviors in a real clinical setting: an empirical study.

OBJECTIVE: The objective of this paper is to evaluate the security behavior of healthcare professionals in a real clinical setting. METHOD: Standards, guidelines and recommendations on security and privacy best practices for staff personnel were identified using a systematic literature review. After a revision process, a questionnaire consisting of 27 questions was created and responded to by 180 health professionals from a public hospital. RESULTS: Weak passwords were reported by 62.2% of the respondents, 31.7% were unaware of the organization's procedures for discarding confidential information, and 19.4% did not carry out these procedures. Half of the respondents (51.7%) did not take measures to ensure that the personal health information on the computer monitor could not be seen by unauthorized individuals, and 57.8% were unaware of the procedure established to report a security violation. The correlation between the number of years in the position and good security practices was not significant (Pearson's r=0.085, P=0.254). Age was weakly correlated with good security practices (Pearson's r=-0.169, P=0.028). A Mann-Whitney test showed no significant difference between the respondents' security behavior as regards gender (U=2536, P=0.792, n=178). The results of the study suggest that more efforts are required to improve security education for health personnel. CONCLUSIONS: It was found that both preventive and corrective actions are needed to prevent health staff from causing security incidents. Healthcare organizations should: identify the types of information that require protection, clearly communicate the penalties that will be imposed, promote security training courses, and define what the organization considers improper behavior to be and communicate this to all personnel.

Estudio sobre la importancia y la seguridad de uso de las contraseñas en el ámbito laboral sanitario / Study of the importance and security level of passwords in the healthcare setting

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Empirical studies on usability of mHealth apps: a systematic literature review.

The release of smartphones and tablets, which offer more advanced communication and computing capabilities, has led to the strong emergence of mHealth on the market. mHealth systems are being used to improve patients' lives and their health, in addition to facilitating communication between doctors and patients. Researchers are now proposing mHealth applications for many health conditions such as dementia, autism, dysarthria, Parkinson's disease, and so on. Usability becomes a key factor in the adoption of these applications, which are often used by people who have problems when using mobile devices and who have a limited experience of technology. The aim of this paper is to investigate the empirical usability evaluation processes described in a total of 22 selected studies related to mHealth applications by means of a Systematic Literature Review. Our results show that the empirical evaluation methods employed as regards usability could be improved by the adoption of automated mechanisms. The evaluation processes should also be revised to combine more than one method. This paper will help researchers and developers to create more usable applications. Our study demonstrates the importance of adapting health applications to users' need.