Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study.

BACKGROUND: Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. METHOD: In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). RESULTS: No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. CONCLUSION: The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. TRIAL REGISTRATION: This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).

Possibilities of Physical-Chemical Sensors' Use for Optimizing the Processing of Metallurgical Melting Based on Computer Systems.

This article presents aspects regarding the possibilities of optimizing the quality of the elaboration of metallurgical melts by determining their physical-chemical properties. Thus, the article analyzes and presents methods for determining the viscosity and electrical conductivity related to metallurgical melts. Among the viscosity determination methods, two methods are presented, namely: the rotary viscometer method and the electro-vibratory viscometer method. Determining the electrical conductivity of a metallurgical melt is also of particular importance for ensuring the quality of the elaboration and refining of the melt. The article also presents the possibilities of using and implementing computer systems that ensure the accuracy of determining the physical-chemical properties of metallurgical melts, as well as examples of the use of physical-chemical sensors and specific computer systems for determining the analyzed parameters. The specific electrical conductivity measurements of oxide melts are performed by direct methods (by contact), with Ohm's law as a starting point. Thus, the article presents the voltmeter-ammeter method and the point method (or the zero method). The novelty of this article is the description and the use of specific methods and sensors for certain determinations (viscosity and electrical conductivity) for metallurgical melts. The motivation here is the presentation of the authors' research in the addressed field. The article presents an original contribution of the adaptation and use of some methods for determining some physico-chemical parameters, including specific sensors, in the field of the elaboration of metal alloys, with the aim of optimizing their quality.

Informatics Methodology Used in the Web-Based Portal of the NASCITA Cohort Study: Development and Implementation Study.

BACKGROUND: Many diseases occurring in adults can be pinned down to early childhood and birth cohorts are the optimal means to study this connection. Birth cohorts have contributed to the understanding of many diseases and their risk factors. OBJECTIVE: To improve the knowledge of the health status of Italian children early on and how it is affected by social and health determinants, we set up a longitudinal, prospective, national-level, population-based birth cohort, the NASCITA study (NAscere e creSCere in ITAlia). The main aim of this cohort is to evaluate physical, cognitive, and psychological development; health status; and health resource use in the first 6 years of life in newborns, and potential associated factors. A web-based system was set up with the aim to host the cohort; provide ongoing information to pediatricians and to families; and facilitate accurate data input, monitoring, and analysis. This article describes the informatics methodology used to set up and maintain the NASCITA cohort with its web-based platform, and provides a general description of the data on children aged over 7 months. METHODS: Family pediatricians were contacted for participation in the cohort and enrolled newborns from April 2019 to July 2020 at their first well-child visit. Information collected included basic data that are part of those routinely collected by the family pediatricians, but also parental data, such as medical history, characteristics and lifestyle, and indoor and outdoor environment. A specific web portal for the NASCITA cohort study was developed and an electronic case report form for data input was created and tested. Interactive data charts, including growth curves, are being made available to pediatricians with their patients' data. Newsletters covering the current biomedical literature on child cohorts are periodically being put up for pediatricians, and, for parents, evidence-based information on common illnesses and problems in children. RESULTS: The entire cohort population consists of 5166 children, with 139 participating pediatricians, distributed throughout Italy. The number of children enrolled per pediatrician ranged from 1 to 100. The 5166 enrolled children represent 66.55% (5166/7763) of the children born in all of 2018 covered by the same pediatricians participating in the cohort. The number of children aged over 7 months at the time of these analyses, and for whom the most complete data were available upon initial analyses, was 4386 (2226/4381 males [50.81%] and 142/4370 twins [3.25%]). The age of the mothers at birth of the 4386 children ranged from 16 to 54 years. Most newborns' mothers (3758/4367, 86.05%) were born in Italy, followed by mothers born in Romania (101/4367, 2.31%), Albania (75/4367, 1.72%), and Morocco (60/4367, 1.37%). Concerning the newborns, 138/4386 (3.15%) were born with malformations and 352/4386 (8.03%) had a disease, most commonly neonatal respiratory distress syndrome (n=52), neonatal jaundice (n=46), and neonatal hypoglycemia (n=45). CONCLUSIONS: The NASCITA cohort is well underway and the population size will permit significant conclusions to be drawn. The key role of pediatricians in obtaining clinical data directly, along with the national-level representativity, will make the findings even more solid. In addition to promoting accurate data input, the multiple functions of the web portal, with its interactive platform, help maintain a solid relationship with the pediatricians and keep parents informed and interested in participating. TRIAL REGISTRATION: ClinicalTrials.gov NCT03894566; https://clinicaltrials.gov/ct2/show/NCT03894566.

[Real-time data from medical care settings to guide public health action]. / Gewinnung von Echtzeitdaten aus der medizinischen Versorgung zur Handlungssteuerung in Public Health.

Real-time data from medical care settings play an increasing role in guiding public health action. The COVID-19 pandemic is a good example; public health decisions depend on current data from the various clinical care settings. The automated processing and communication of health-related data is essential to ensure continuity of reporting and safe resources. So far, various technical, formal, and organizational challenges help back the development of digitally automated real-time systems with scientific quality standards. The COVID-19 pandemic pushed sustainable system developments since it began in early 2020.This article describes how a real-time data system should be structured so that automated data processing is possible. Important aspects in the consolidation of the data and their preparation and communication are presented. The processes implemented for handling routine data from emergency departments in real time and making it available to public health actors is described. As an example, we present the cooperation between the emergency admission registry of the Aktionsbündnis für Informations- und Kommunikationstechnologie in Intensiv- und Notfallmedizin (AKTIN), the Universität Magdeburg, and the RWTH Aachen as well as the Surveillance Monitor (SUMO) hosted at the Robert Koch Institute.The development of modern systems for processing research data in real-time from medical care settings can only succeed through the cooperation of a wide variety of actors. An important basis for long-term success is the development of a legal framework.

Implementation of artificial intelligence (AI) applications in radiology: hindering and facilitating factors.

OBJECTIVE: The objective was to identify barriers and facilitators to the implementation of artificial intelligence (AI) applications in clinical radiology in The Netherlands. MATERIALS AND METHODS: Using an embedded multiple case study, an exploratory, qualitative research design was followed. Data collection consisted of 24 semi-structured interviews from seven Dutch hospitals. The analysis of barriers and facilitators was guided by the recently published Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework for new medical technologies in healthcare organizations. RESULTS: Among the most important facilitating factors for implementation were the following: (i) pressure for cost containment in the Dutch healthcare system, (ii) high expectations of AI's potential added value, (iii) presence of hospital-wide innovation strategies, and (iv) presence of a "local champion." Among the most prominent hindering factors were the following: (i) inconsistent technical performance of AI applications, (ii) unstructured implementation processes, (iii) uncertain added value for clinical practice of AI applications, and (iv) large variance in acceptance and trust of direct (the radiologists) and indirect (the referring clinicians) adopters. CONCLUSION: In order for AI applications to contribute to the improvement of the quality and efficiency of clinical radiology, implementation processes need to be carried out in a structured manner, thereby providing evidence on the clinical added value of AI applications. KEY POINTS: • Successful implementation of AI in radiology requires collaboration between radiologists and referring clinicians. • Implementation of AI in radiology is facilitated by the presence of a local champion. • Evidence on the clinical added value of AI in radiology is needed for successful implementation.

Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys.

BACKGROUND: Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. OBJECTIVE: This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. METHODS: The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. RESULTS: Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. CONCLUSIONS: The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system.

Acceptance of Full Driving Automation: Personally Owned and Shared-Use Concepts.

OBJECTIVE: This study aims to develop user acceptance models for two concepts of full driving automation: personally owned and shared use. BACKGROUND: Many manufacturers have been investing considerably in and actively developing full driving automation. However, factors influencing user acceptance of full driving automation are not yet fully understood. METHOD: This study consisted of two parts: focus group discussions and online surveys. A total of 30 potential users participated in focus groups to discuss their perception of full driving automation acceptance. Based on the findings from focus group discussions, theoretical foundations, and empirical evidence, we hypothesized the acceptance models for both personally owned and shared-use concepts. We tested the models with 310 and 250 participants, respectively, online. RESULTS: The results of focus groups indicated that users' concerns are centered around safety, usefulness, compatibility, trust, and ease of use. The survey results revealed the important roles of perceived usefulness and perceived safety in both models, whereas the direct impact of perceived ease of use was found to be insignificant. The indirect impact of perceived ease of use was less significant in the personally owned than in the shared-use model, whereas usefulness, trust, and compatibility played more important roles in the personally owned when compared with the shared-use model. CONCLUSION: The findings uncovered a chain of constructs that affect behavioral intention to use for both full driving automation concepts. APPLICATION: The framework and outcome of this study provide valuable guidelines that allow better understanding for government agencies, manufacturers, and automation designers regarding users' acceptance of full driving automation.

Multi-Robot Assembly Strategies and Metrics.

We present a survey of multi-robot assembly applications and methods and describe trends and general insights into the multi-robot assembly problem for industrial applications. We focus on fixtureless assembly strategies featuring two or more robotic systems. Such robotic systems include industrial robot arms, dexterous robotic hands, and autonomous mobile platforms, such as automated guided vehicles. In this survey, we identify the types of assemblies that are enabled by utilizing multiple robots, the algorithms that synchronize the motions of the robots to complete the assembly operations, and the metrics used to assess the quality and performance of the assemblies.

Signal Detection Theory (SDT) Is Effective for Modeling User Behavior Toward Phishing and Spear-Phishing Attacks.

OBJECTIVE: To examine the utility of equal-variance signal detection theory (EVSDT) for evaluating and understanding human detection of phishing and spear-phishing e-mail scams. BACKGROUND: Although the majority of cybersecurity breaches are due to erroneous responses to deceptive phishing e-mails, it is unclear how best to quantify performance in this context. In particular, it is unclear whether equal variances can safely be assumed in the SDT model, or, relatedly, whether degree of targeting, or threat level, primarily affects mean separation or evidence variability. METHOD: Through an online inbox simulation, the present research found that differences in susceptibility to phishing and spear-phishing e-mails could be carefully quantified with respect to detection accuracy and response bias through the use of an EVSDT framework. RESULTS: The results indicated that EVSDT-based point metrics are effective for modeling and measuring phishing susceptibility in the inbox task, without the need for parameter estimation or model comparison involving unequal-variance SDT (UVSDT). Threat level modulated mean separation, with no effects on signal variances. CONCLUSION: These findings support the viability of using EVSDT to initially assess and subsequently monitor training effectiveness for phishing susceptibility, thereby providing measures that are superior to more intuitive metrics, which typically confound an individual's bias and accuracy. Effects of threat level mapped clearly onto distribution means with no effect on variances, suggesting phishing susceptibility primarily reflects temporally stable discriminative characteristics of observers. Notably, results indicated that people are particularly poor at identifying spear-phishing e-mail threats (demonstrating only 40% accuracy).

Translation of Real-Time Infectious Disease Modeling into Routine Public Health Practice.

Infectious disease dynamic modeling can support outbreak emergency responses. We conducted a workshop to canvas the needs of stakeholders in Australia for practical, real-time modeling tools for infectious disease emergencies. The workshop was attended by 29 participants who represented government, defense, general practice, and academia stakeholders. We found that modeling is underused in Australia and its potential is poorly understood by practitioners involved in epidemic responses. The development of better modeling tools is desired. Ideal modeling tools for operational use would be easy to use, clearly indicate underlying parameterization and assumptions, and assist with policy and decision making.

Workflow Lexicons in Healthcare: Validation of the SWIM Lexicon.

For clinical departments seeking to successfully navigate the challenges of modern health reform, obtaining access to operational and clinical data to establish and sustain goals for improving quality is essential. More broadly, health delivery organizations are also seeking to understand performance across multiple facilities and often across multiple electronic medical record (EMR) systems. Interpreting operational data across multiple vendor systems can be challenging, as various manufacturers may describe different departmental workflow steps in different ways and sometimes even within a single vendor's installed customer base. In 2012, The Society for Imaging Informatics in Medicine (SIIM) recognized the need for better quality and performance data standards and formed SIIM's Workflow Initiative for Medicine (SWIM), an initiative designed to consistently describe workflow steps in radiology departments as well as defining operational quality metrics. The SWIM lexicon was published as a working model to describe operational workflow steps and quality measures. We measured the prevalence of the SWIM lexicon workflow steps in both academic and community radiology environments using real-world patient observations and correlated that information with automatically captured workflow steps from our clinical information systems. Our goal was to measure frequency of occurrence of workflow steps identified by the SWIM lexicon in a real-world clinical setting, as well as to correlate how accurately departmental information systems captured patient flow through our health facility.

A Multimodal Search Engine for Medical Imaging Studies.

The use of digital medical imaging systems in healthcare institutions has increased significantly, and the large amounts of data in these systems have led to the conception of powerful support tools: recent studies on content-based image retrieval (CBIR) and multimodal information retrieval in the field hold great potential in decision support, as well as for addressing multiple challenges in healthcare systems, such as computer-aided diagnosis (CAD). However, the subject is still under heavy research, and very few solutions have become part of Picture Archiving and Communication Systems (PACS) in hospitals and clinics. This paper proposes an extensible platform for multimodal medical image retrieval, integrated in an open-source PACS software with profile-based CBIR capabilities. In this article, we detail a technical approach to the problem by describing its main architecture and each sub-component, as well as the available web interfaces and the multimodal query techniques applied. Finally, we assess our implementation of the engine with computational performance benchmarks.

Use of theory in computer-based interventions to reduce alcohol use among adolescents and young adults: a systematic review.

BACKGROUND: Alcohol use and binge drinking among adolescents and young adults remain frequent causes of preventable injuries, disease, and death, and there has been growing attention to computer-based modes of intervention delivery to prevent/reduce alcohol use. Research suggests that health interventions grounded in established theory are more effective than those with no theoretical basis. The goal of this study was to conduct a literature review of computer-based interventions (CBIs) designed to address alcohol use among adolescents and young adults (aged 12-21 years) and examine the extent to which CBIs use theories of behavior change in their development and evaluations. This study also provides an update on extant CBIs addressing alcohol use among youth and their effectiveness. METHODS: Between November and December of 2014, a literature review of CBIs aimed at preventing or reducing alcohol in PsychINFO, PubMed, and Google Scholar was conducted. The use of theory in each CBI was examined using a modified version of the classification system developed by Painter et al. (Ann Behav Med 35:358-362, 2008). RESULTS: The search yielded 600 unique articles, 500 were excluded because they did not meet the inclusion criteria. The 100 remaining articles were retained for analyses. Many articles were written about a single intervention; thus, the search revealed a total of 42 unique CBIs. In examining the use of theory, 22 CBIs (52 %) explicitly named one or more theoretical frameworks. Primary theories mentioned were social cognitive theory, transtheoretical model, theory of planned behavior and reasoned action, and health belief model. Less than half (48 %), did not use theory, but mentioned either use of a theoretical construct (such as self-efficacy) or an intervention technique (e.g., manipulating social norms). Only a few articles provided detailed information about how the theory was applied to the CBI; the vast majority included little to no information. CONCLUSIONS: Given the importance of theory in guiding interventions, greater emphasis on the selection and application of theory is needed. The classification system used in this review offers a guiding framework for reporting how theory based principles can be applied to computer based interventions.

Evaluation Methods for Assessing Users' Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review.

BACKGROUND: The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. OBJECTIVE: This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. METHODS: A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. RESULTS: Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users' experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. CONCLUSIONS: There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users' psychological experiences while using an intervention.

DICOM Data Warehouse: Part 2.

In 2010, the DICOM Data Warehouse (DDW) was launched as a data warehouse for DICOM meta-data. Its chief design goals were to have a flexible database schema that enabled it to index standard patient and study information, modality specific tags (public and private), and create a framework to derive computable information (derived tags) from the former items. Furthermore, it was to map the above information to an internally standard lexicon that enables a non-DICOM savvy programmer to write standard SQL queries and retrieve the equivalent data from a cohort of scanners, regardless of what tag that data element was found in over the changing epochs of DICOM and ensuing migration of elements from private to public tags. After 5 years, the original design has scaled astonishingly well. Very little has changed in the database schema. The knowledge base is now fluent in over 90 device types. Also, additional stored procedures have been written to compute data that is derivable from standard or mapped tags. Finally, an early concern is that the system would not be able to address the variability DICOM-SR objects has been addressed. As of this writing the system is indexing 300 MR, 600 CT, and 2000 other (XA, DR, CR, MG) imaging studies per day. The only remaining issue to be solved is the case for tags that were not prospectively indexed-and indeed, this final challenge may lead to a noSQL, big data, approach in a subsequent version.

[Support of the nursing process through electronic nursing documentation systems (UEPD) ­ Initial validation of an instrument]. / Unterstützung des Pflegeprozesses durch die elektronische Pflegeprozessdokumentation (UEPD). Erste Validierung eines Messinstruments.

BACKGROUND: Electronic nursing documentation systems, with standardized nursing terminology, are IT-based systems for recording the nursing processes. These systems have the potential to improve the documentation of the nursing process and to support nurses in care delivery. AIM: This article describes the development and initial validation of an instrument (known by its German acronym UEPD) to measure the subjectively-perceived benefits of an electronic nursing documentation system in care delivery. METHOD: The validity of the UEPD was examined by means of an evaluation study carried out in an acute care hospital (n = 94 nurses) in German-speaking Switzerland. Construct validity was analyzed by principal components analysis. RESULTS: Initial references of validity of the UEPD could be verified. The analysis showed a stable four factor model (FS = 0.89) scoring in 25 items. All factors loaded ≥ 0.50 and the scales demonstrated high internal consistency (Cronbach's α = 0.73 ­ 0.90). Principal component analysis revealed four dimensions of support: establishing nursing diagnosis and goals; recording a case history/an assessment and documenting the nursing process; implementation and evaluation as well as information exchange. CONCLUSIONS: Further testing with larger control samples and with different electronic documentation systems are needed. Another potential direction would be to employ the UEPD in a comparison of various electronic documentation systems.

Use of a Web-based physical activity record system to analyze behavior in a large population: cross-sectional study.

BACKGROUND: The use of Web-based physical activity systems has been proposed as an easy method for collecting physical activity data. We have developed a system that has exhibited high accuracy as assessed by the doubly labeled water method. OBJECTIVE: The purpose of this study was to collect behavioral data from a large population using our Web-based physical activity record system and assess the physical activity of the population based on these data. In this paper, we address the difference in physical activity for each urban scale. METHODS: In total, 2046 participants (aged 30-59 years; 1105 men and 941 women) participated in the study. They were asked to complete data entry before bedtime using their personal computer on 1 weekday and 1 weekend day. Their residential information was categorized as urban, urban-rural, or rural. Participant responses expressed the intensity of each activity at 15-minute increments and were recorded on a Web server. Residential areas were compared and multiple regression analysis was performed. RESULTS: Most participants had a metabolic equivalent (MET) ranging from 1.4 to 1.8, and the mean MET was 1.60 (SD 0.28). The median value of moderate-to-vigorous physical activity (MVPA, ≥3 MET) was 7.92 MET-hours/day. A 1-way ANCOVA showed that total physical activity differed depending on the type of residential area (F2,2027=5.19, P=.006). The urban areas (n=950) had the lowest MET-hours/day (mean 37.8, SD, 6.0), followed by urban-rural areas (n=432; mean 38.6, SD 6.5; P=.04), and rural areas (n=664; mean 38.8, SD 7.4; P=.002). Two-way ANCOVA showed a significant interaction between sex and area of residence on the urban scale (F2,2036=4.53, P=.01). Men in urban areas had the lowest MET-hours/day (MVPA, ≥3 MET) at mean 7.9 (SD 8.7); men in rural areas had a MET-hours/day (MVPA, ≥3 MET) of mean 10.8 (SD 12.1, P=.002). No significant difference was noted in women among the 3 residential areas. Multiple regression analysis showed that physical activity consisting of standing while working was the highest contributor to MVPA, regardless of sex. CONCLUSIONS: We were able to compile a detailed comparison of physical activity because our Web-based physical activity record system allowed for the simultaneous evaluation of physical activity from 2046 Japanese people. We found that rural residents had greater total physical activity than urban residents and that working and transportation behaviors differed depending on region type. Multiple regression analysis showed that the behaviors affected MVPA. People are less physically active while working, and sports and active transportation might be effective ways of increasing physical activity levels.

Judging Thieves of Attention: Commentary on "Assessing Cognitive Distraction in the Automobile," by Strayer, Turrill, Cooper, Coleman, Medeiros-Ward, and Biondi (2015).

The laudable effort by Strayer and his colleagues to derive a systematic method to assess forms of cognitive distraction in the automobile is beset by the problem of nonstationary in driver response capacity. At the level of the overall goal of driving, this problem conflates actual on-road behavior; characterized by underspecified task satisficing, with our own understandable, scientifically inspired aspiration for measuring deterministic performance optimization. Measures of response conceived under this latter imperative are, at best, only shadowy reflections of the actual phenomenological experience involved in real-world vehicle control. Whether we, as a research community, can resolve this issue remains uncertain. However, we believe we can mount a positive attack on what is arguably another equally important dimension of the collision problem.

Driver Compensation: Impairment or Improvement?

Strayer et al.'s conclusion that their "cognitive distraction scale" for auditory-vocal tasks indicates "significant impairments to driving" is not supported by their data. Additional analysis demonstrates that slower brake reaction times during auditory-vocal tasks were fully compensated for by longer following distances to the lead car. Naturalistic driving data demonstrate that cellular conversation decreases crash risk, the opposite of the article's assumption. Hence, the scale's internal and external validities for indicating driving impairment are highly questionable.