Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’

Objectives: There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services. Therefore, this service evaluation reports on feasibility and outcomes from an eTherapy mental health service. Setting: ‘Self Help Services’, an Increasing Access to Psychological Therapies (IAPT) eTherapy service in Greater Manchester. Participants: 1068 service users referred to the service for secondary care for their mental health difficulties. Interventions: Participants were triaged into one of three eTherapy programmes: ‘Living Life to the Full Interactive’ for low mood, stress and anxiety; ‘Sleepio’ for insomnia; and ‘Breaking Free Online’ for substance misuse, depending on clinical need. Primary outcomes measures: Standardised psychometric assessments of depression, anxiety and social functioning, collected as part of the IAPT Minimum Data Set, were conducted at baseline and post-treatment. Results: Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive (depression CI 1.27 to 3.21, p<0.0001; anxiety CI 077 to 1.72, p<0.0001) and Sleepio (depression CI 1.19 to 4.52, p<0.0001; anxiety CI 2.16 to 5.23, p<0.0001) groups. Promising improvements in mental health scores were found within all three groups (all p<0.0001), as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties (p<0.0001). Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online. Conclusion: Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services

Do (and say) as I say: Linguistic adaptation in human-computer dialogs

© Theodora Koulouri, Stanislao Lauria, and Robert D. Macredie. This article has been made available through the Brunel Open Access Publishing Fund.There is strong research evidence showing that people naturally align to each other’s vocabulary, sentence structure, and acoustic features in dialog, yet little is known about how the alignment mechanism operates in the interaction between users and computer systems let alone how it may be exploited to improve the efficiency of the interaction. This article provides an account of lexical alignment in human–computer dialogs, based on empirical data collected in a simulated human–computer interaction scenario. The results indicate that alignment is present, resulting in the gradual reduction and stabilization of the vocabulary-in-use, and that it is also reciprocal. Further, the results suggest that when system and user errors occur, the development of alignment is temporarily disrupted and users tend to introduce novel words to the dialog. The results also indicate that alignment in human–computer interaction may have a strong strategic component and is used as a resource to compensate for less optimal (visually impoverished) interaction conditions. Moreover, lower alignment is associated with less successful interaction, as measured by user perceptions. The article distills the results of the study into design recommendations for human–computer dialog systems and uses them to outline a model of dialog management that supports and exploits alignment through mechanisms for in-use adaptation of the system’s grammar and lexicon

HERMIONE: a randomized Phase 2 trial of MM-302 plus trastuzumab versus chemotherapy of physician's choice plus trastuzumab in patients with previously treated, anthracycline-naïve, HER2-positive, locally advanced/metastatic breast cancer.

BackgroundHuman epidermal growth factor receptor 2 (HER2)-positive breast cancer is a particularly aggressive form of the disease, and ultimately progresses in patients with metastases on standard therapies. Anthracyclines, such as doxorubicin, are an effective treatment for HER2-positive breast cancer, particularly when administered in combination with trastuzumab - however, doxorubicin-related cardiotoxicity has limited its use. Many patients are therefore never treated with anthracyclines, even upon disease progression, despite the potential for benefit. MM-302 is a novel, HER2-targeted antibody-liposomal doxorubicin conjugate that specifically targets HER2-overexpressing cells. Preclinical and Phase 1 data suggest that MM-302, as a monotherapy or in combination with trastuzumab, could be effective for managing previously treated, anthracycline-naïve, HER2-positive breast cancer, without the cardiotoxicity observed with free doxorubicin formulations.Methods/designHERMIONE is an open-label, multicenter, randomized (1:1) Phase 2 trial of MM-302 plus trastuzumab versus chemotherapy of physician's choice (gemcitabine, capecitabine, or vinorelbine) plus trastuzumab planned to enroll 250 anthracycline-naïve patients with locally advanced/metastatic HER2-positive breast cancer. Key inclusion criteria are: previous treatment with trastuzumab (with or without pertuzumab) in any setting; refractory or intolerant to pertuzumab (refractory to pertuzumab defined as progression in the locally advanced or metastatic setting, or disease recurrence during or within 12 months of completing pertuzumab-containing neoadjuvant and/or adjuvant therapy); and disease progression on, or intolerant to, ado-trastuzumab emtansine for locally advanced or metastatic disease. The trial is currently being conducted at sites in the USA, Canada, and Western Europe. Treatment will be administered in 21-day cycles, and will be continued until disease progression or unacceptable toxicity. The primary endpoint is independently assessed progression-free survival (PFS). Tumor response will be assessed every 6 weeks, and defined according to RECIST v1.1. Secondary endpoints include investigator-assessed PFS, overall survival (OS), OS rates at 6 months and 1 year, objective response rates, safety and tolerability, quality of life, and the pharmacokinetic profile of MM-302 plus trastuzumab.DiscussionThe HERMIONE study will evaluate the efficacy and safety of MM-302 plus trastuzumab in patients with refractory HER2-positive advanced/metastatic breast cancer for whom there are no standard of care therapies with a proven survival advantage.Trial registrationClinicaltrials.gov identifier: NCT02213744 . Registration date: 06AUG2014

Effective Affective User Interface Design in Games

It is proposed that games, which are designed to generate positive affect, are most successful when they facilitate flow (Csikszentmihalyi 1992). Flow is a state of concentration, deep enjoyment, and total absorption in an activity. The study of games, and a resulting understanding of flow in games can inform the design of nonleisure software for positive affect. The paper considers the ways in which computer games contravene Nielsen’s guidelines for heuristic evaluation (Nielsen and Molich 1990) and how these contraventions impact on flow. The paper also explores the implications for research that stem from the differences between games played on a personal computer and games played on a dedicated console. This research takes important initial steps towards defining how flow in computer games can inform affective design

On the Role of Visuals in Multimodal Answers to Medical Questions

This paper describes two experiments carried out in order to investigate the role of visuals in multimodal answer presentations for a medical question answering system. First, a production experiment was carried out to determine which modalities people choose to answer different types of questions. In this experiment, participants had to create (multimodal) presentations of answers to general medical questions. The collected answer presentations were coded on the presence of visual media (i.e., photos, graphics, and animations) and their function. The results indicated that participants presented the information in a multimodal way. Moreover, significant differences were found in the presentation of different answer and question types. Next, an evaluation experiment was conducted to investigate how users evaluate different types of multimodal answer presentations. In this second experiment, participants had\ud to assess the informativity and attractiveness of answer presentations for different types of medical questions. These answer presentations, originating from the production experiment, were manipulated in their answer length (brief vs. extended) and their type of picture (illustrative vs. informative). After the participants had assessed the answer presentations, they received a post-\ud test in which they had to indicate how much they had recalled from the presented answer presentations. The results showed that answer presentations with an informative picture were evaluated as more informative and more attractive than answer presentations with an illustrative picture. The results for the post-test tentatively indicated that learning from answer presentations with an informative picture leads to a better learning performance than learning from purely textual answer presentations

The assessment of usability of electronic shopping: A heuristic evaluation

Today there are thousands of electronic shops accessible via the Web. Some provide user-friendly features whilst others seem not to consider usability factors at all. Yet, it is critical that the electronic shopping interface is user-friendly so as to help users to obtain their desired results. This study applied heuristic evaluation to examine the usability of current electronic shopping. In particular, it focused on four UK-based supermarkets offering electronic services: including ASDA, Iceland, Sainsbury, and Tesco. The evaluation consists of two stages: a free-flow inspection and a task-based inspection. The results indicate that the most significant and common usability problems have been found to lie within the areas of ‘User Control and Freedom’ and ‘Help and Documentation’. The findings of this study are applied to develop a set of usability guidelines to support the future design of effective interfaces for electronic shopping

Evaluation of World Wide Web-based Lessons for a First Year Dental Biochemistry Course

First year dental students at The University of Texas Dental Branch at Houston (Dental Branch) are required to take a basic biochemistry course. To facilitate learning and allow student self-assessment of their progress, WWW-based lessons covering intermediary metabolism were developed as a supplement to traditional lectures. Lesson design combined text, graphics, and animations and included learner control, links to other learning resources, and practice exercises and exams with immediate feedback. Results from an on-line questionnaire completed by students in two different classes showed that they completed 50% of the lessons and spent an average of 4 hrs. on-line. A majority of the students either agreed or strongly agreed that practice exercises were helpful, that the ability to control the pace of the lessons was important, that the lesson structure and presentation was easy to follow, that the illustrations, animations, and hyperlinks were helpful, and that the lessons were effective as a review. The very positive response to the WWW-based lessons indicates the usefulness of this approach as a study aid for dental students

Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process

This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context

The role of avatars in e-government interfaces

This paper investigates the use of avatars to communicate live message in e-government interfaces. A comparative study is presented that evaluates the contribution of multimodal metaphors (including avatars) to the usability of interfaces for e-government and user trust. The communication metaphors evaluated included text, earcons, recorded speech and avatars. The experimental platform used for the experiment involved two interface versions with a sample of 30 users. The results demonstrated that the use of multimodal metaphors in an e-government interface can significantly contribute to enhancing the usability and increase trust of users to the e-government interface. A set of design guidelines, for the use of multimodal metaphors in e-government interfaces, was also produced