Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study.

Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ≥65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47% and smartwatch: n=9, 53%) and 16 relatives (tablet computer: n=7, 44% and smartwatch: n=9, 56%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs.

Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care.

BACKGROUND: Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia. METHODS: This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity. RESULTS: We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027. CONCLUSIONS: Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention's effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system. TRIAL REGISTATION: Clinicaltrials.gov: NCT06090578 (registered 10/24/23).

Enhancing self-regulation and learner engagement in L2 speaking: exploring the potential of intelligent personal assistants within a learning-oriented feedback framework.

INTRODUCTION: Developing L2 speaking proficiency can be challenging for learners, particularly when it comes to fostering self-regulation and maintaining engagement. Intelligent Personal Assistants (IPAs) offer a potential solution by providing accessible, interactive language learning opportunities. METHODS: This mixed-methods study investigated the effectiveness of using Google Assistant within a learning-oriented feedback (LOA) framework to enhance L2 speaking proficiency, self-regulation, and learner engagement among 54 university-level EFL learners in China. Convenience sampling assigned participants to either an experimental group (n = 27) using Google Assistant with tailored activities or a control group (n = 27) using traditional methods. The Oral Proficiency Interview (OPI) assessed speaking performance. Self-reported questionnaires measured L2 motivation and the Scale of Strategic Self-Regulation for Speaking English as a Foreign Language (S2RS-EFL) evaluated speaking self-regulation. Additionally, semi-structured interviews with a subsample of the experimental group provided qualitative insights. RESULTS: The Google Assistant group demonstrated a statistically significant improvement in speaking performance compared to the control group. While no significant difference in motivation was found, thematic analysis of interviews revealed perceived benefits of Google Assistant, including increased accessibility, interactivity, and immediate pronunciation feedback. These features likely contributed to a more engaging learning experience, potentially fostering self-regulation development in line with the core principles of LOA. CONCLUSION: This study suggests Google Assistant as a promising supplementary tool for enhancing L2 speaking proficiency, learner autonomy, and potentially self-regulation within an LOA framework. Further research is needed to explore its impact on motivation and optimize engagement strategies.

(The limits of) eye-tracking with iPads.

Applications for eye-tracking-particularly in the clinic-are limited by a reliance on dedicated hardware. Here we compare eye-tracking implemented on an Apple iPad Pro 11" (third generation)-using the device's infrared head-tracking and front-facing camera-with a Tobii 4c infrared eye-tracker. We estimated gaze location using both systems while 28 observers performed a variety of tasks. For estimating fixation, gaze position estimates from the iPad were less accurate and precise than the Tobii (mean absolute error of 3.2° ± 2.0° compared with 0.75° ± 0.43°), but fixation stability estimates were correlated across devices (r = 0.44, p < 0.05). For tasks eliciting saccades >1.5°, estimated saccade counts (r = 0.4-0.73, all p < 0.05) were moderately correlated across devices. For tasks eliciting saccades >8° we observed moderate correlations in estimated saccade speed and amplitude (r = 0.4-0.53, all p < 0.05). We did, however, note considerable variation in the vertical component of estimated smooth pursuit speed from the iPad and a catastrophic failure of tracking on the iPad in 5% to 20% of observers (depending on the test). Our findings sound a note of caution to researchers seeking to use iPads for eye-tracking and emphasize the need to properly examine their eye-tracking data to remove artifacts and outliers.

Mobile Media Content Exposure and Toddlers' Responses to Attention Prompts and Behavioral Requests.

Importance: With personalized touch-screen tablets, young children can choose content and engage in play-like activities. However, tablets may also reduce shared engagement as the action of viewing or touching the screen is often not visible to nearby adults. This may impact communicative gazing and pointing, which is critical to the formation of shared awareness and in turn supports language development. Objective: To assess the association of tablet media content with toddlers' responses to joint attention prompts and behavioral requests. Design, Setting, and Participants: This cohort study took place at a behavioral research laboratory and included toddlers who were aged 18 to 32 months with neurotypical development who were recruited from a volunteer and community sample. Toddlers engaged with a real toy or 3 different types of tablet content (ie, viewing video of toy play, playing with a digital toy, or playing a commercial game) while an experimenter delivered joint attention prompts. Data were acquired from June 2021 November XX 2022, and data analysis occurred from January 2023 to May 2024. Main Outcomes and Measures: Main outcomes included child response to joint attention (number of prompts with joint attention response per number of prompts delivered) and child response to behavioral request (ie, the prompt on which the child responded to the behavioral request). Measures included crossed random effects, Wald tests, and likelihood ratio tests. Results: In this study, 63 toddlers were enrolled, and data from 62 were included (31 female [49%]; mean [SD] age, 26.1 [3.4] months; median [IQR] age, 25.0 [18.6-32.6] months). When toddlers were playing a commercial game on a tablet, they responded to fewer joint attention prompts (crossed random effects model, -0.15; 95% CI, -0.24 to -0.06 prompts) and male toddlers took longer to acknowledge a behavioral request (interaction of content and sex, -0.75; 95% CI, -1.36 to -0.17). The negative impact of the tablet game was larger as child age increased (τ = -2.30; 95% CI, -0.05 to 0; P = .03). Greater media use at home was associated with decreased responding to joint attention prompts during the tablet game (ρ = -0.47; P < .001), while better language skills were associated with more joint attention during play with a real toy (ρ = 0.31; P = .02). Conclusions and Relevance: In this cohort study, a touch-screen tablet game was associated with decreased joint attention among toddlers and they were less likely to respond to a behavioral request. In a laboratory setting, it was difficult for toddlers to engage in social-communicative interactions with adults when using a tablet media device.

Introduction of Mobile Technology to Improve Emergency Department BCMA Rates.

Barcode Medication Administration (BCMA) is a proven process for maintaining patient safety during medication administration. However, maintaining compliance with BCMA scanning in the Emergency Department has its challenges. To overcome these challenges handheld devices, enabled with scanning technology, were provided to each nurse. BCMA compliance rates increased by 20% over a 6-month period. Handheld devices work to improve BCMA compliance in the ED environment when using a 1:1 model.

Visual-Motor Integration (VMI) Is Also Relevant for Computer, Smartphone, and Tablet Use by Adults: Introducing the Brief Box Clicking Test.

IMPORTANCE: Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use. OBJECTIVE: To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI. DESIGN: Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients. PARTICIPANTS: A total of 11,114 adults. MEASURES: Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation). RESULTS: Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals. CONCLUSIONS AND RELEVANCE: The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use. Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.

Development of a Standardized Nursing Handoff With Tablet Technology: A Quality Improvement Initiative.

BACKGROUND: Nursing handoff of complete and accurate information is critical for patient safety yet is often difficult to achieve with consistency between nursing departments. OBJECTIVE: This quality improvement project aims to describe the development and piloting of a standardized handoff tool for administration by computer tablet for nursing report. METHODS: This descriptive quality improvement initiative was conducted in an 885-bed Level I trauma center in the Southeast Region of the United States. The study was completed in three phases. First, emergency department and trauma intensive care unit nurses were surveyed to determine handoff barriers and best practices. Second, the survey information was used to develop a standardized handoff tool incorporating tablet technology. Third, staff pilot testing was performed, followed by a final survey to ascertain staff feedback on the tool. RESULTS: A total of n = 120 nurses completed the surveys, and pilot testing was conducted on n = 177 patient handoffs. Ninety-five percent of nurses expressed satisfaction with the tool and 65% with the tablet. CONCLUSION: This study supported using a standardized handoff tool between the emergency department and trauma intensive care unit and substantiated the benefits of using a tablet for face-to-face communication.

Tablet-based Rey-Osterrieth Complex Figure copy task: a novel application to assess spatial, procedural, and kinematic aspects of drawing in children.

The paper-and-pencil Rey-Osterrieth Complex Figure (ROCF) copy task has been extensively used to assess visuo-constructional skills in children and adults. The scoring systems utilized in clinical practice provide an integrated evaluation of the drawing process, without differentiating between its visuo-constructional, organizational, and motor components. Here, a tablet-based ROCF copy task capable of providing a quantitative assessment of the drawing process, differentiating between visuo-constructional, organizational, and motor skills, is trialed in 94 healthy children, between 7 and 11 years of age. Through previously validated algorithms, 12 indices of performance in the ROCF copy task were obtained for each child. Principal component analysis of the 12 indices identified spatial, procedural, and kinematic components as distinct dimensions of the drawing process. A composite score for each dimension was determined, and correlation analysis between composite scores and conventional paper-and-pencil measures of visuo-constructional, procedural, and motor skills performed. The results obtained confirmed that the constructional, organizational, and motor dimensions underlie complex figure drawing in children; and that each dimension can be measured by a unique composite score. In addition, the composite scores here obtained from children were compared with previsions results from adults, offering a novel insight into how the interplay between the three dimensions of drawing evolves with age.

Virtual resonance: analyzing IPA usage intensity under COVID-19's isolating canopy.

The widespread adoption of smartphones coupled with advancements in artificial intelligence has significantly propelled the use of intelligent personal assistants (IPAs). These digital assistants have become indispensable for many users, particularly during the COVID-19 pandemic. Employing coviance-based structural equation modeling (CB-SEM) and analyzing data from 260 participants, this study explores the key factors influencing IPA usage intensity. Contrary to expectations, affective risk perception showed no significant impact on either IPA usage or parasocial interaction during the pandemic. In stark contrast, cabin fever syndrome significantly influenced both IPA usage and parasocial interaction, underscoring the role of environmental and psychological stressors in shaping technology use. Furthermore, loneliness was found to significantly enhance parasocial interaction with IPAs, though it did not affect usage intensity. The findings highlight a substantial connection between parasocial interaction and IPA usage intensity, suggesting that users who engage in human-like interactions with IPAs tend to use them more extensively. These insights not only deepen our understanding of how IPAs are utilized during health crises but also point to potential directions for developing IPAs that are more responsive to users' emotional and social needs.

Child and adolescent exposure to unhealthy food marketing across digital platforms in Canada.

BACKGROUND: Children and adolescents are exposed to a high volume of unhealthy food marketing across digital media. No previous Canadian data has estimated child exposure to food marketing across digital media platforms. This study aimed to compare the frequency, healthfulness and power of food marketing viewed by children and adolescents across all digital platforms in Canada. METHODS: For this cross-sectional study, a quota sample of 100 youth aged 6-17 years old (50 children, 50 adolescents distributed equally by sex) were recruited online and in-person in Canada in 2022. Each participant completed the WHO screen capture protocol where they were recorded using their smartphone or tablet for 30-min in an online Zoom session. Research assistants identified all instances of food marketing in the captured video footage. A content analysis of each marketing instance was then completed to examine the use of marketing techniques. Nutritional data were collected on each product viewed and healthfulness was determined using Health Canada's 2018 Nutrient Profile Model. Estimated daily and yearly exposure to food marketing was calculated using self-reported device usage data. RESULTS: 51% of youth were exposed to food marketing. On average, we estimated that children are exposed to 1.96 marketing instances/child/30-min (4067 marketing instances/child/year) and adolescents are exposed to 2.56 marketing instances/adolescent/30-min (8301 marketing instances/adolescent/year). Both children and adolescents were most exposed on social media platforms (83%), followed by mobile games (13%). Both age groups were most exposed to fast food (22% of marketing instances) compared to other food categories. Nearly 90% of all marketing instances were considered less healthy according to Health Canada's proposed 2018 Nutrient Profile Model, and youth-appealing marketing techniques such as graphic effects and music were used frequently. CONCLUSIONS: Using the WHO screen capture protocol, we were able to determine that child and adolescent exposure to the marketing of unhealthy foods across digital media platforms is likely high. Government regulation to protect these vulnerable populations from the negative effects of this marketing is warranted.

Introducing the portable AttentionTrip: An engaging tool for measuring the networks of attention.

BACKGROUND: Measurement of the efficacy of the networks of attention is a frequent component of research in cognitive and clinical neuroscience. Developed in 2002, the Attention Network Test (ANT), has become the most widely used tool for this purpose. NEW METHOD: In 2017 a more engaging, game-like tool based on the ANT, called the AttentionTrip was described. The network scores from five studies which used AttentionTrip are shown to be robust. NEWER METHOD: That version of AttentionTrip required a steering wheel and desk-top computer. Here we describe a new, portable version of the AttentionTrip that is administered using a hand-held tablet (iPad) RESULTS: Three samples of participants (total = 44) completed the portable version of AttentionTrip. The network scores generated using the portable AttentionTrip were also robust. Effect sizes compare favourably with those generated by the ANT and the desktop version. CONCLUSIONS: The findings support the use of the portable AttentionTrip as an alternative to the ANT when user engagement is important, such as when participants are prone to boredom, and when repeated administrations are required.

Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial.

BACKGROUND: One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep. OBJECTIVE: We aim to verify the effectiveness of mindful breathing exercises using a tablet device. METHODS: In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated. RESULTS: On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5. CONCLUSIONS: The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep. TRIAL REGISTRATION: UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks.

Perceptions of digital technology use for monitoring health in people living with neurological disorders.

BACKGROUND: Digital technology offers individuals the opportunity to monitor their symptoms. Information gathered from apps, devices, and web platforms may be used to direct clinical care and to support research. AIM: Using this survey, we aim to explore the views of people attending the Anne Rowling Regenerative Neurology Clinic (ARRNC) and their relatives/caregivers regarding the use of digital health technologies to monitor health. METHOD: People attending the ARRNC were invited to complete a structured 18-item questionnaire evaluating their experience and attitudes to using technology for monitoring health. People with neurodegenerative disease (pwND) and their caregivers completed a mix of closed and open-ended questions. RESULTS: 249 people responded, 51 relatives/caregivers and 198 pwND. 67.1% (n= 167) of respondents do not use technology for monitoring their health, but 98.2% (n = 164) of these are interested in their future use. 29.7% (n = 74) respondents currently use a smartphone for health monitoring, 20.9% (n = 52) use a wearable device, and 13.3% (n = 33) use a tablet. 79.3% (n = 65) of users use their technology for monitoring physical activity, 37.8% (n = 31) use it for assisting with self-management, and 41.5% (n = 34) use it for tracking sleep. Factors which would encourage use of technology are ease of access to devices and ability to monitor health. Respondents reported data security concerns and difficulty using technology as potential barriers. CONCLUSION: People attending a neurology clinic, and their relatives/caregivers, support the use of digital technologies as an adjunct to routine care. There is a need for coordinated digital strategies for development and delivery of validated measures.

Comparative Evaluation of Digital Cephalometric Tracing Applications on Mobile Devices and Manual Tracing.

BACKGROUND Cephalometric radiography evaluates facial skeleton development and aids in diagnosis and treatment phases (pre and post) in orthodontics. This study aimed to compare digital cephalometric tracing using a smartphone application (App), a tablet-based platform, and manual tracing in 30 orthodontic patients. MATERIAL AND METHODS Thirty orthodontic pretreatment, criteria based, lateral cephalometric radiographs were analyzed/grouped for Steiner analysis parameters (5 skeletal, 3 dentals, 1 soft tissue) by 3 tracing methods [manual - group (Gp M), smartphone (Android - OS9) - Gp S, tablet (Apple - IOS13) - Gp T) after mandatory standardization/calibration. Measurements include 5 angular (SNA, SNB, ANB, SNMPA, SNOP), 3 linear U1NA, L1NB, U1L1, and 1 soft tissue (S line) (millimeters and degrees). Inter-examiner rating was determined using Dahlberg's test. After normality distribution testing (Shapiro-Wilk), data were analyzed using one-way analysis of variance (ANOVA) for group differences. Homogeneity of variance was verified using the Levene test. Differences were determined on probability value of (p≤0.05). RESULTS The results showed that Steiner's analysis parameters were similar in all groups with homogenous variances. Highest differences in mean values were found for L1NB, U1L1, and S line measurement, with higher values being observed in Gp S tracings. However, these differences were not statistically significant (p≤0.05). All parameters, irrespective of being measured in either degrees or millimeters, had means comparable to each other. CONCLUSIONS Smartphone and tablet-based applications produced tracings that were comparable and reliable when compared to conventional manual tracings. Standardization of images, processing, printing, and calibration of devices is important to achieve good results.

Association of digital device usage and dry eye disease in school children.

PURPOSE: To investigate the influence of digital device use (computers, laptops, tablets, smartphones) on dry eye disease (DED) in a pediatric population. SETTINGS AND DESIGN: This was a cross-sectional study. School children studying in grades 5-9 at two private schools in the city of Ahmedabad, the capital city of Gujarat, India were invited to participate in the study. METHODS: In this study, 462 children underwent ocular examination including tear film breakup time (TBUT) and Schirmer's test. Questionnaires were administered for collecting information on the type and duration of digital device usage separately for academic and leisure activities and the Ocular Surface Disease Index (OSDI) score. RESULTS: The mean age of participants was 11.2 + 1.4 years, and 63% were boys. The mean OSDI score was 37.2 + 11.8, and 90.5% had symptoms of DED. Children with moderate to severe DED (n = 88, 19%) had longer daily duration of device use and lower Schirmer's test and TBUT values compared to children with mild DED (P = 0.001). A cumulative exposure time of more than 3-3.5 h per day had a significantly increased risk of DED. Multivariable logistic regression analysis showed that increment in computer usage (odds ratio [OR] 1.94 for every half an hour increase, 95% confidence interval [CI] = 1.2-3.1) and children studying in higher grades (OR 1.30, 95% CI = 1.1-1.6) had a higher risk of moderate to severe dry eye. CONCLUSION: Cumulative device exposure time of more than 3-3.5 h per day had a significantly increased risk of pediatric DED. Children with an increment in computer usage by half an hour per day had a higher chance of experiencing moderate to severe dry eye. Policymakers should aim to restrict the screen time below 3 h on a daily basis.

Enhancing neurosurgical navigation operation flow management through personal digital assistant technology: a prospective cohort study.

Purpose: This prospective cohort study aims to evaluate the impact of digital health technology especially Personal Digital Assistants (PDA) in neurosurgical procedure management, focusing on surgical safety check accuracy, efficiency, and patient satisfaction. Methods: The study included 211 neurosurgical cases from January to December 2022. The control group of 106 patients followed traditional verification methods, while the experimental group of 105 patients used PDA. The PDA system facilitated real-time data collection, verification, and transmission. The study compared both groups in terms of check times, accuracy rates, and patient satisfaction, and used multivariate regression to assess the impact of baseline parameters on these outcomes. Results: The study found that the experimental group using the PDA system reduced the average verification time by approximately 8 min, achieving 100.0% accuracy in preoperative and postoperative checks, significantly better than the control group (91.5% pre- and post-operation). Multivariate regression confirmed a 48.1% reduction in postoperative verification time due to the PDA system (p < 0.001), with the model showing high explanatory power (R2 = 0.911). Other examined factors, including patient age and nurse experience, had no significant effects. Similarly, the PDA's introduction markedly improved verification accuracy, with no significant impact from other variables (p = 0.010). Conclusion: The application of the PDA system in neurosurgical operations significantly enhanced the accuracy and efficiency of surgical safety checks, reduced nursing errors, optimized nursing workflows, and improved patient satisfaction. These results provide valuable insights for the application of PDA technology in high-risk medical fields, demonstrating potential of digital health tools in enhancing surgical safety and efficiency.

Digital symbol-digit modalities test with modified flexible protocols in patients with CNS demyelinating diseases.

Cognitive impairment (CI) is prevalent in central nervous system demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). We developed a novel tablet-based modified digital Symbol Digit Modalities Test (MD-SDMT) with adjustable protocols that feature alternating symbol-digit combinations in each trial, lasting one or two minutes. We assessed 144 patients (99 with MS and 45 with NMOSD) using both MD-SDMT protocols and the traditional paper-based SDMT. We also gathered participants' feedback through a questionnaire regarding their preferences and perceived reliability. The results showed strong correlations between MD-SDMT and paper-based SDMT scores (Pearsons correlation: 0.88 for 2 min; 0.85 for 1 min, both p < 0.001). Among the 120 respondents, the majority preferred the digitalized SDMT (55% for the 2 min, 39% for the 1 min) over the paper-based version (6%), with the 2 min MD-SDMT reported as the most reliable test. Notably, patients with NMOSD and older individuals exhibited a preference for the paper-based test, as compared to those with MS and younger patients. In summary, even with short test durations, the digitalized SDMT effectively evaluates cognitive function in MS and NMOSD patients, and is generally preferred over the paper-based method, although preferences may vary with patient characteristics.

Evaluation of 3D tablet-based stereoacuity test ASTEROID in children with normal and abnormal visual acuity.

PURPOSE: To assess the utility of 3D, tablet-based, glasses-free Accurate STEReotest (ASTEROID) in children compared with the Titmus test. METHODS: Children aged 5-13 years were enrolled in a single-center, nonrandomized, observational comparison study and analyzed by age (5-7 vs 8-13 years) and visual acuity (20/25 or better in both eyes vs abnormal). Each participant underwent both the ASTEROID and Titmus stereoacuity tests. Stereoacuity was defined as fine (≤60 arcsec), moderate (61-200 arcsec), coarse (201-1199 arcsec), or very coarse to nil (≥1200 arcsec). Agreement between the tests was assessed using a weighted kappa (κ) statistic based on all four categories. RESULTS: A total of 112 children were included: 28 aged 5-7 with normal visual acuity, 30 aged 5-7 with abnormal visual acuity, 34 aged 8-13 with normal visual acuity, and 20 aged 8-13 with abnormal visual acuity. Mean ASTEROID score was 688 ± 533 arcsec (range, 13-1200 arcsec). Agreement between ASTEROID and Titmus test scores for participants overall was moderate (κ = 0.52). By subgroup, agreement was fair for children 5-7 with abnormal visual acuity (κ = 0.31), moderate for children 5-7 with normal visual acuity (κ = 0.47) and children 8-13 with normal visual acuity (κ = 0.42), and substantial for children 8-13 with abnormal visual acuity (κ = 0.76). Where ASTEROID and Titmus score group varied, ASTEROID score was poorer in 94% (47/50) of cases. CONCLUSIONS: ASTEROID is a digital, tablet-based test that evaluates global stereopsis, does not require glasses, and provides a continuum of scores. Among children, ASTEROID has good agreement with the Titmus test; however, it may be more sensitive at detecting stereovision deficits. Further study is necessary to determine which test is more accurate.

Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study.

BACKGROUND: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking. OBJECTIVE: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia. METHODS: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest. RESULTS: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions. CONCLUSIONS: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation.