A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study.

BACKGROUND: When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. OBJECTIVE: The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. METHODS: This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. RESULTS: Data collected during usability testing concerned the 6 domains of the app-food and diet, activity, fluid intake, sleep, good mental health, and financial well-being-and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented-including shift management and catch-up cards-during this cycle of development. CONCLUSIONS: This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change.

Optimal digital filter selection for remote photoplethysmography (rPPG) signal conditioning.

Remote photoplethysmography (rPPG) using camera-based imaging has shown excellent potential recently in vital signs monitoring due to its contactless nature. However, the optimum filter selection for pre-processing rPPG data in signal conditioning is still not straightforward. The best algorithm selection improves the signal-to-noise ratio (SNR) and therefore improves the accuracy of the recognition and classification of vital signs. We recorded more than 300 temporal rPPG signals where the noise was not motion-induced. Then, we investigated the best digital filter in pre-processing temporal rPPG data and compared the performances of 10 filters with 10 orders each (i.e., a total of 100 filters). The performances are assessed using a signal quality metric on three levels. The quality of the raw signals was classified under three categories; Q1 being the best and Q3 being the worst. The results are presented in SNR scores, which show that the Chebyshev II orders of 2nd, 4th, and 6th perform the best for denoising rPPG signals.

Effects of illuminance intensity on the green channel of remote photoplethysmography (rPPG) signals.

Point-of-care remote photoplethysmography (rPPG) devices that utilize low-cost RGB cameras have drawn considerable attention due to their convenience in contactless and non-invasive vital signs monitoring. In rPPG, sufficient lighting conditions are essential for obtaining accurate diagnostics by observing the complete signal morphology. The effects of illuminance intensity and light source settings play a significant role in rPPG assessment quality, and it was previously observed that different lighting schemes result in different signal quality and morphology. This study presents a quantitative empirical analysis where the quality and morphology of rPPG signals were assessed under different light settings. Participants' faces were exposed to the white LED spotlight, first when the sources were installed directly behind the video camera, and then when the sources were installed in a cross-polarized scheme. Hence, the effect of specular reflectance on rPPG signals could be observed in an increasing projection. The signal qualities were analyzed in each intensity level using a signal-to-noise (SNR) ratio metric. In 3 of 7 participants, placing the video camera on the same level as the light source led to signal quality loss of up to 3 dB for the range 30-60 Lux. In addition, two fundamental morphological features were analyzed, and the derivative-related feature was found to be increasing with illuminance intensity in 6 of 7 participants.

Detecting physical abilities through smartphone sensors: an assistive technology application.

PURPOSE: It is important to promote assistive technologies to improve quality of life. The proposed SmartAbility Android Application recommends assistive technologies for people with reduced physical abilities, by focussing on actions that can be performed independently. MATERIALS AND METHODS: The SmartAbility Application uses Android built-in sensors, e.g., accelerometer and gyroscope and application programming interfaces (APIs) to detect physical abilities, e.g., head movements and blowing and recommend suitable assistive technologies. This is supported by a MySQL database that stores assistive technologies and mappings between abilities. The underpinning research is the SmartAbility Framework that culminates the knowledge obtained during previously feasibility trials and usability evaluations. RESULTS: The Application was evaluated by pupils (n = 18) at special educational needs schools with physical conditions, including cerebral palsy, autism and Noonan syndrome, and assessed through the NASA Task Load Index (TLX) and System Usability Scale (SUS). Analysis using the Adjective Rating Scale highlighted that the Application achieves "Good Usability". CONCLUSION: The SmartAbility Application demonstrates that built-in sensors of Android devices and their APIs, can detect actions that users perform, e.g., head movements and speaking. The Application contains a database where assistive technologies are mapped to physical abilities, in order to provide suitable recommendations. It will be disseminated to assistive technology charities and manufacturers and be used by healthcare professionals as part of the rehabilitation process. Future developments of SmartAbility include the creation of a second Application designed specifically to recommend assistive technologies for the education sector, based on users' physical and cognitive abilities.IMPLICATIONS FOR REHABILITATIONAssistive technology is any item, equipment or piece of software designed to increase, maintain or improve the functional capabilities of people with disabilities.SmartAbility should be introduced into rehabilitation to promote awareness of assistive technologies that are suitable for the physical abilities of the user.Our research highlighted that physical abilities can be detected using built-in sensors of Android devices, e.g. accelerometer and gyroscope.Involvement of the intended user community during evaluations is essential to ensure that a smartphone application is suitable for people with reduced physical abilities.Assistive technologies can support the rehabilitation of people with reduced physical abilities by providing increased independence and improved quality of life.

Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study.

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. OBJECTIVE: The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users' unique requirements throughout the design, build, prototyping, and testing stages. METHODS: Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. RESULTS: The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users' needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. CONCLUSIONS: This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue.

Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings.

BACKGROUND: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. OBJECTIVE: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. METHODS: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. RESULTS: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift-an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. CONCLUSIONS: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users.

Use of Technology to Promote Health and Wellbeing of People Who Are Homeless: A Systematic Review.

BACKGROUND: People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: 'what mobile health (mHealth) related technology is used by homeless populations' and 'what is the health impact of mobile technology for homeless populations'? METHODS: An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. RESULTS: Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. CONCLUSION: It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.

Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review.

Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed.

How Do People Who Are Homeless Find Out about Local Health and Social Care Services: A Mixed Method Study.

BACKGROUND: There are significant numbers of people experiencing homelessness both in the UK and internationally. People who are homeless are much more likely to die prematurely and, therefore, need strong access to ongoing health and social care support if we hope to address the health disparity they face. OBJECTIVES: The aim of the research was to explore how people who are homeless identify and locate appropriate health and social care services. DESIGN: A mixed methods research study was applied on people who are currently homeless or had previously experienced homelessness. SETTINGS: The research study was based in an urban area in the southwest of England. The area was chosen as it was identified to be in the top 24 local authorities for the number of homeless individuals. PARTICIPANTS: A hundred individuals participated in the survey, of those 32% were living on the streets whilst 68% were living in temporary accommodation such as a charity home, shelter or a hotel paid for by the local authority. In addition, 16 participated in either a focus group or one-to-one interview Methods: The quantitative component consisted of a paper-based questionnaire whilst the qualitative aspect was focus groups/one-to-one interviews. The COREQ criteria were used in the report of the qualitative aspects of the study. RESULTS: Quantitative data identified poor health in 90% of the sample. Access to both healthcare and wider wellbeing services (housing and food) was problematic and support for this was largely through third sector charity organisations. Qualitative data identified numerous systemic, individual and cultural obstacles, leaving difficulty for people in terms of knowing who to contact and how to access services, largely relying on word of mouth of other people who are homeless. CONCLUSIONS: In order to address health inequities experienced by people who are homeless, there is a need to review how information regarding local health and wider wellbeing services is provided in local communities.

A Web-Based Intervention for Social Media Addiction Disorder Management in Higher Education: Quantitative Survey Study.

BACKGROUND: Social media addiction disorder has recently become a major concern and has been reported to have negative impacts on postgraduate studies, particularly addiction to Facebook. Although previous studies have investigated the effects of Facebook addiction disorder in learning settings, there still has been a lack of studies investigating the relationship between online intervention features for Facebook addiction focusing on postgraduate studies. OBJECTIVE: In an attempt to understand this relationship, this study aimed to carry out an investigation on online intervention features for effective management of Facebook addiction in higher education. METHODS: This study was conducted quantitatively using surveys and partial least square-structural equational modeling. The study involved 200 postgraduates in a Facebook support group for postgraduates. The Bergen Facebook Addiction test was used to assess postgraduates' Facebook addiction level, whereas online intervention features were used to assess postgraduates' perceptions of online intervention features for Facebook addiction, which are as follows: (1) self-monitoring features, (2) manual control features, (3) notification features, (4) automatic control features, and (5) reward features. RESULTS: The study discovered six Facebook addiction factors (relapse, conflict, salience, tolerance, withdrawal, and mood modification) and five intervention features (notification, auto-control, reward, manual control, and self-monitoring) that could be used in the management of Facebook addiction in postgraduate education. The study also revealed that relapse is the most important factor and mood modification is the least important factor. Furthermore, findings indicated that notification was the most important intervention feature, whereas self-monitoring was the least important feature. CONCLUSIONS: The study's findings (addiction factors and intervention features) could assist future developers and educators in the development of online intervention tools for Facebook addiction management in postgraduate education.

Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews.

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS-a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)-developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. OBJECTIVE: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. METHODS: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. RESULTS: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management. CONCLUSIONS: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution.

COPE.er Method: Combating Digital Addiction via Online Peer Support Groups.

Digital addiction (hereafter DA) denotes a problematic relationship with technology described by being compulsive, obsessive, impulsive and hasty. New research has identified cases where users' digital behaviour shows symptoms meeting the clinical criteria of behavioural addiction. The online peer groups approach is one of the strategies to combat addictive behaviours. Unlike other behaviours, intervention and addictive usage can be on the same medium; the online space. This shared medium empowers influence techniques found in peer groups, such as self-monitoring, social surveillance, and personalised feedback, with a higher degree of interactivity, continuity and real-time communication. Social media platforms in general and online peer groups, in particular, have received little guidance as to how software design should take it into account. Careful theoretical understanding of the unique attributes and dynamics of such platforms and their intersection with gamification and persuasive techniques is needed as the ad-hoc design may cause unexpected harm. In this paper, we investigate how to facilitate the design process to ensure a systematic development of this technology. We conducted several qualitative studies including user studies and observational investigations. The primary contribution of this research is twofold: (i) a reference model for designing interactive online platforms to host peer groups and combat DA, (ii) a process model, COPE.er, inspired by the participatory design approach to building Customisable Online Persuasive Ecology by Engineering Rehabilitation strategies for different groups.

Renal function and diffusion-weighted imaging: a new method to diagnose kidney failure before losing half function.

AIM: To diagnose earlier kidney failure, we investigated renal functions with diffusion-weighted imaging (DWI). METHODS: We evaluated the DWI of 62 patients with chronic kidney disease (CKD) and compared it with creatinine clearance provided by daily urine collection. The apparent diffusion coefficient (ADC) values were compared with the five stages of CKD. RESULTS: For each stage of CKD, the ADC values were found to be significantly different (p < 0.01) and allowed the differentiation of stage 1 of the disease from the other stages. CONCLUSION: Renal ADC values show a significant correlation with the clinical stages of CKD. DWI may detect renal failure prior to a rise in creatinine.

New fully automated software for assessment of brachial artery flow- mediated dilation with advantages of continuous measurement.

OBJECTIVE: Flow-mediated dilation (FMD) is used to evaluate endothelial functions. Computer-assisted analysis utilizing edge detection permits continuous measurements along the vessel wall. We have developed a new fully automated software program to allow accurate and reproducible measurement. METHODS: FMD has been measured and analyzed in 18 coronary artery disease (CAD) patients and 17 controls both by manually and by the software developed (computer supported) methods. The agreement between methods was assessed by Bland-Altman analysis. RESULTS: The mean age, body mass index and cardiovascular risk factors were higher in CAD group. Automated FMD% measurement for the control subjects was 18.3±8.5 and 6.8±6.5 for the CAD group (p=0.0001). The intraobserver and interobserver correlation for automated measurement was high (r=0.974, r=0.981, r=0.937, r=0.918, respectively). Manual FMD% at 60th second was correlated with automated FMD % (r=0.471, p=0.004). CONCLUSIONS: The new fully automated software© can be used to precise measurement of FMD with low intra- and interobserver variability than manual assessment.

1-[6-(6-Acetyl-pyridin-2-yl)pyridin-2-yl]ethanone.

In the title compound, C(14)H(12)N(2)O(2), the asymmetric unit comprises one half-mol-ecule with an inversion center between the pyridine rings. The rings are trans coplanar with the acetyl groups deviating slightly from the mean planes, making a dihedral angle of 4.63 (4)°. In the crystal, mol-ecules are linked by weak inter-molecular C-H⋯O hydrogen bonds, forming a supra-molecular sheet parallel to (100).