Access to internet in rural and remote Canada

Canada is the second largest landmass country in the world, but has one of the lowest population densities. As of 2011, approximately 19% of the Canadian population lives in rural, or remote communities. The purpose of this study was to examine differences in rural and urban access to the Internet and device use in Canada, and to explore differences in access to broadband between Aboriginal and non-Aboriginal communities in Canada. In general rural-dwellers had lower levels of Internet access and despite efforts to increase access to high speed Internet, Aboriginal communities in some regions have limited access. Future research should explore computer and health literacy in the context of rural and remote communities in Canada. © 2014 The authors and IOS Press

Evaluation of the Quality of Occupational Therapy Fieldwork Experiences

Practice education, or fieldwork as it is referred to in occupational therapy, is a fundamental feature of occupational therapy education, priming students to become competent entry-level practitioners. Factors reported as contributing to poor quality fieldwork experiences include: students not receiving enough feedback; lack of opportunity to develop skills; and not being made to feel welcome in the environment. These are significant contributors to the overall development of competence so it is important to understand the current context of fieldwork experiences being offered in relation to the notion of quality in those learning environments. The purpose of this study was to evaluate the quality of the fieldwork learning environment from the perspective of occupational therapists’ working in one region of Canada. A validated survey, the Quality of Occupational Therapy Fieldwork Experience (QOTFE) tool, was used to identify features of what might constitute quality fieldwork education, and to determine whether there was a difference in quality of fieldwork experience between practice settings or types of practice areas. However, there was minimal variability in scores based on practice setting and practice area variables. These findings indicate a consistent quality of fieldwork experience across practice settings and practice areas. This research presents a picture of the current quality of fieldwork experiences available to occupational therapy students. This may be a starting place for further investigation into the factors that contribute to the quality of practice education learning experience

Supernurse:Nurses' workarounds informing the design of interactive technologies for home wound care

The increasing aging population needing homecare is leading to additional clinical work for homecare nurses. Wound care and documentation are substantial components of this work required to monitor patients and make appropriate clinical decisions. However, due to barriers in the systems that nurses are expected to use, and context of their activities, they create and use workarounds to get their job done. In this study, the most common themes of workarounds were identified and used to inform design iterations of a wound documentation application: SuperNurse. The exploratory and experimental design iterations involved homecare nurses, who expressed: curiosity, leading to further reflection; frustration, leading to identifying problems; and surprise, leading to identifying useful and easy to use designs. We found that nurse-centred design, informed by workarounds, led to using mobile, wearable, and speech recognition technology and improving ease of use and usefulness in SuperNurse

Evaluation of quitnow men: An online, men-centered smoking cessation intervention

Background: Men continue to smoke cigarettes in greater numbers than women. There is growing evidence for the value of developing targeted, men-centered health promotion programs. However, few smoking cessation interventions have been designed for men. A gender-specific website, QuitNow Men, was developed based on focus group interview findings, stakeholder feedback, and evidence-based cessation strategies. The website was designed to incorporate a masculine look and feel through the use of images, direct language, and interactive content. Usability experts and end-users provided feedback on navigation and functionality of the website prior to pilot testing. Objectives: The objectives of the pilot study were to describe (1) men’s use and evaluations of the interactive resources and information on the QuitNow Men website, and (2) the potential of QuitNow Men to engage men in reducing and quitting smoking. Methods: A one-group, pretest-posttest study design was used. Men who were interested in quitting were recruited and invited to use the website over a 6-month period. Data were collected via online questionnaires at baseline, 3-month, and 6-month follow-up. A total of 117 men completed the baseline survey. Over half of those (67/117, 57.3%) completed both follow-up surveys. Results: At baseline, participants (N=117) had been smoking for an average of 24 years (SD 12.1) and smoked on average 15 cigarettes a day (SD 7.4). The majority had not previously used a quit smoking website (103/117, 88.0%) or websites focused on men’s health (105/117, 89.7%). At the 6-month follow-up, the majority of men used the QuitNow Men website at least once (64/67, 96%). Among the 64 users, 29 (43%) reported using the website more than 6 times. The men using QuitNow Men agreed or strongly agreed that the website was easy to use (51/64, 80%), the design and images were appealing (42/64, 66%), they intended to continue to use the website (42/64, 66%), and that they would recommend QuitNow Men to others who wanted to quit (46/64, 72%). Participants reported using an average of 8.76 (SD 4.08) of the 15 resources available on the website. At 6-month follow-up, 16 of the 67 participants (24%) had quit, 27 (40%) had reduced their smoking and 24 (36%) had not changed their smoking habits. Repeated measures general linear model showed a significant decrease in the number of cigarettes smoked between the 3-month and 6-month follow-up (F1,63=6.41, P=.01, eta squared=0.09). Number of resources used on the website, quit confidence, nicotine dependence and age significantly predicted number of quit attempts by those still smoking at 6 months (F4,45=2.73, P=.04), with number of resources used being the strongest predictor (P=.02). Conclusions: The results of this research support efforts to integrate gender-sensitive approaches in smoking cessation interventions and indicate that this novel Web-based resource has potential in supporting men’s smoking cessation efforts

A framework for evaluating image segmentation algorithms

The purpose of this paper is to describe a framework for evaluating image segmentation algorithms. Image segmentation consists of object recognition and delineation. For evaluating segmentation methods, three factors—precision (reliability), accuracy (validity), and efficiency (viability)—need to be considered for both recognition and delineation. To assess precision, we need to choose a figure of merit, repeat segmentation considering all sources of variation, and determine variations in figure of merit via statistical analysis. It is impossible usually to establish true segmentation. Hence, to assess accuracy, we need to choose a surrogate of true segmentation and proceed as for precision. In determining accuracy, it may be important to consider different 'landmark' areas of the structure to be segmented depending on the application. To assess efficiency, both the computational and the user time required for algorithm training and for algorithm execution should be measured and analyzed. Precision, accuracy, and efficiency factors have an influence on one another. It is difficult to improve one factor without affecting others. Segmentation methods must be compared based on all three factors, as illustrated in an example wherein two methods are compared in a particular application domain. The weight given to each factor depends on application

A Methodology for Evaluating Image Segmentation Algorithms

The purpose of this paper is to describe a framework for evaluating image segmentation algorithms. Image segmentation consists of object recognition and delineation. For evaluating segmentation methods, three factors - precision (reproducibility), accuracy (agreement with truth), and efficiency (time taken) – need to be considered for both recognition and delineation. To assess precision, we need to choose a figure of merit (FOM), repeat segmentation considering all sources of variation, and determine variations in FOM via statistical analysis. It is impossible usually to establish true segmentation. Hence, to assess accuracy, we need to choose a surrogate of true segmentation and proceed as for precision. To assess efficiency, both the computational and the user time required for algorithm and operator training and for algorithm execution should be measured and analyzed. Precision, accuracy, and efficiency are interdependent. It is difficult to improve one factor without affecting others. Segmentation methods must be compared based on all three factors. The weight given to each factor depends on application

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Application of Two-Eyed Seeing in Adolescent Mental Health to Bridge Design Thinking and Indigenous Collective Storytelling

Background: eMental health apps are increasingly being considered for use in health care with growing recognition of the importance of considering end-user preferences in their design and implementation. The key to the success of using apps with Indigenous youth is tailoring the design and content to include Indigenous perspectives. In this study we used a Two-Eyed Seeing perspective to integrate Indigenous and human computer interaction methodologies to identify end-user preferences for a tablet-based mental health screening app used in a primary care clinic serving Indigenous youth. Objective: The research objectives used a Two-Eyed Seeing approach to (i) collectively create stories about Indigenous youth lived experiences accessing integrated primary care for their mental health concerns; and (ii) engage Indigenous youth in Design Circles to determine their usability preferences for digital mental health screening tools. Method: Eight adolescents (n = 4 young women; n = 3 young men; and n = 1 Two Spirit) between 20 to 24 years old who self-identified as Indigenous participated. Indigenous youth joined Design Circles to co-create a story about accessing mental health care and their needs and preferences for an eMental Health app. Results: Findings highlighted the importance of collective Indigenous storytelling about accessing integrated primary care for mental health needs. Participants created three persona stories about their challenges accessing mental health care and the role of social support. Participants sorted their usability design preferences for an eMental Health app to be inclusive of Indigenous knowledges. Conclusions: A Two-Eyed Seeing perspective was useful to incorporate a design thinking approach as collective storytelling among Indigenous youth. This research may inform and shape the design of eMental health apps used in health clinics to better engage Indigenous youth.Applied Science, Faculty ofEducation, Faculty ofMedicine, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofNursing, School ofPopulation and Public Health (SPPH), School ofReviewedFacult