The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature

Background: Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective: Our aim was to systematically review the (1) impact of IT platforms used to promote patients' engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods: PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results: A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions: In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes. [JMIR Med Inform 2016;4(1):e1

Evaluating survey methods for bat roost detection in ecological impact assessment

International audienceThe disturbance, damage and destruction of roosts are key drivers of bat population declines worldwide. In countries where bats are protected by law, bat roost surveys are often required to inform ecological impact assessments. Yet, evidence-based information on survey methodology to detect bat roosts is crucially lacking, and failing to detect a roost can lead to serious errors during decision-making processes. Here, we assess the efficacy of bat roost surveys in buildings as implemented in the UK. These consist of a daytime inspection of buildings, followed by a series of acoustic surveys at dusk/dawn if during the daytime inspection evidence of bats is found, or if the absence of bats cannot be verified. We reviewed 155 ecological consultants’ reports to (1) compare survey outcome between daytime inspection and acoustic surveys and (2) determine the minimum sampling effort required during acoustic surveys to be confident that no bats are roosting within a building. We focused on two genera of bats most frequently found in buildings in Europe – Pipistrellus (crevice roosting species with high-intensity echolocation calls that can be easily detected by ultrasound detectors) and Plecotus (species that roost in open spaces and which emit faint echolocation calls that are difficult to detect). Daytime inspections were efficient in detecting open-roosting species such as Plecotus species but were likely to miss the presence of crevice-dwelling ones (here Pipistrellus species) which may lead to erroneous conclusions if no acoustic surveys are subsequently prescribed to confirm their absence. A minimum of three and four acoustic surveys are required to be 95% confident that a building does not host a roost of Pipistrellus species and Plecotus species, respectively, thus exceeding current recommendations. Overall, we demonstrated that reports submitted as part of an ecological impact assessment provide suitable data to test and improve survey methods

"An invisible map" - maternal perceptions of hunger, satiation and 'enough' in the context of baby led and traditional complementary feeding practices

YesMothers' responsiveness to hunger and fullness cues has been implicated in the development of infant over-weight, and baby led weaning (BLW) is argued to be one way to protect against overfeeding. Whilst studies have examined maternal perceptions of hunger, fullness and adequate intake to some degree in traditional weaning (TW) contexts, less is known about this in BLW. This study therefore aimed to understand and compare maternal perceptions of cues and intake in BLW and TW. Eleven mothers of infants (7–24m) participated in semi-structured interviews based on discussions of short videos featuring participants feeding their infants. Interviews were read and transcribed in full. Data were selected for coding which addressed mothers' perceptions of infant hunger, fullness and sufficient consumption and subsequently subjected to template analysis. A sample of data was coded to produce an initial template which was applied to all interviews and revised in an iterative process to produce a final template for interpreting findings. Mothers in the study were adept at recognising fullness cues and gauging feeding state. Both groups perceived similar hunger cues although TW mothers reported a wider range of fullness cues. Both groups used numerous strategies for judging the adequacy of their babies’ intake. These included the use of infant cues, however perceived adequacy of intake was also influenced by factors such as infant tiredness and maternal worries about over and under-eating. Findings have implications for the development of responsive feeding interventions while also highlighting the utility of video elicited interviews for understanding feeding interactions.This work was supported by a White Rose Doctoral Training Partnership Economic and Social Research Council PhD studentship (UK) to Janet McNally

Empowering Learners to Choose the Difficulty Level of Problems Based on Their Learning Needs

ABSTRACT Research has found that increasing learner control offers several benefits, including increased motivation, attitude, and learning. The goal of the present study was to determine how prior math achievement influences students' selection of the difficulty level of problems within Math Pursuits, a hypermedia learning program. Math Pursuits was designed to help children understand mathematics by discovering how it relates to the world around them. The program presented each learner with an adjustable level of challenge, along with the necessary scaffolding to support success. The researchers hypothesized that students with lower math skills would choose to start with a lower difficultly level; whereas, students with higher math skills would begin the program by choosing a question with a higher level of difficulty. Results supported these hypotheses. This research also examined the motivational framework guiding students' selection of problem difficulty

Displaced but not replaced: the impact of e-learning on academic identities in higher education.

Challenges facing universities are leading many to implement institutional strategies to incorporate e-learning rather than leaving its adoption up to enthusiastic individuals. Although there is growing understanding about the impact of e-learning on the student experience, there is less understanding of academics’ perceptions of e-learning and its impact on their identities. This paper explores the changing nature of academic identities revealed through case study research into the implementation of e-learning at one UK university. By providing insight into the lived experiences of academics in a university in which technology is not only transforming access to knowledge but also influencing the balance of power between academic and student in knowledge production and use, it is suggested that academics may experience a jolt to their ‘trajectory of self’ when engaging with e-learning. The potential for e-learning to prompt loss of teacher presence and displacement as knowledge expert may appear to undermine the ontological security of their academic identity

Phase I study of TP300 in patients with advanced solid tumors with pharmacokinetic, pharmacogenetic and pharmacodynamic analyses

Background: A Phase I dose escalation first in man study assessed maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended Phase II dose of TP300, a water soluble prodrug of the Topo-1 inhibitor TP3076, and active metabolite, TP3011. <p/>Methods: Eligible patients with refractory advanced solid tumors, adequate performance status, haematologic, renal, and hepatic function. TP300 was given as a 1-hour i.v. infusion 3-weekly and pharmacokinetic (PK) profiles of TP300, TP3076 and TP3011 were analysed. Polymorphisms in CYP2D6, AOX1 and UGT1A1 were studied and DNA strand-breaks measured in peripheral blood mononuclear cells (PBMCs). <p/>Results: 32 patients received TP300 at 1, 2, 4, 6, 8, 10, 12 mg/m2. MTD was 10 mg/m2; DLTs at 12 (2/4 patients) and 10 mg/m2 (3/12) included thrombocytopenia and febrile neutropenia; diarrhea was uncommon. Six patients (five had received irinotecan), had stable disease for 1.5-5 months. TP3076 showed dose proportionality in AUC and Cmax from 1--10 mg/m2. Genetic polymorphisms had no apparent influence on exposure. DNA strand-breaks were detected after TP300 infusion. <p/>Conclusions: TP300 had predictable hematologic toxicity, and diarrhea was uncommon. AUC at MTD is substantially greater than for SN38. TP3076 and TP3011 are equi-potent with SN38, suggesting a PK advantage

Beluga whales in the western Beaufort Sea : current state of knowledge on timing, distribution, habitat use and environmental drivers

ECG was supported by a National Research Council-National Academy of Sciences Postdoctoral Fellowship.The seasonal and geographic patterns in the distribution, residency, and density of two populations (Chukchi and Beaufort) of beluga whales (Delphinapterus leucas) were examined using data from aerial surveys, passive acoustic recordings, and satellite telemetry to better understand this arctic species in the oceanographically complex and changing western Beaufort Sea. An aerial survey data-based model of beluga density highlights the Beaufort Sea slope as important habitat for belugas, with westerly regions becoming more important as summer progresses into fall. The Barrow Canyon region always had the highest relative densities of belugas from July-October. Passive acoustic data showed that beluga whales occupied the Beaufort slope and Beaufort Sea from early April until early November and passed each hydrophone location in three broad pulses during this time. These pulses likely represent the migrations of the two beluga populations: the first pulse in spring being from Beaufort animals, the second spring pulse Chukchi belugas, with the third, fall pulse a combination of both populations. Core-use and home range analyses of satellite-tagged belugas showed similar use of habitats as the aerial survey data, but also showed that it is predominantly the Chukchi population of belugas that uses the western Beaufort, with the exception of September when both populations overlap. Finally, an examination of these beluga datasets in the context of wind-driven changes in the local currents and water masses suggests that belugas are highly capable of adapting to oceanographic changes that may drive the distribution of their prey.PostprintPeer reviewe

The challenge of enterprise/innovation: a case study of a modern university

In the prevailing economic and political climate for Higher Education a greater emphasis has been placed on diversifying the funding base. The present study was undertaken between 2012 and 2014 and addressed the implementation of an approach to the transformation of one academic school in a medium-sized modern university in Wales to a more engaged enterprise culture. A multimethod investigation included a bi-lingual (English and Welsh) online survey of academic staff and yielded a 71% response rate (n = 45). The findings informed a series of in-depth interviews (n = 24) with a representative sample of those involved in enterprise work (support staff, managers, senior managers), and those who were not. The results provided the platform for the ‘S4E model’ for effective engagement with enterprise: (1) Strategic significance for Enterprise, (2) Support for Enterprise, (3) Synergy for Enterprise, and (4) Success for Enterprise. The outcomes of the research and the recommendations from it have potential to inform practice in other academic schools within the university and, in a wider context, within other Schools of Education regionally, nationally and internationally. Its original empirical exploration of enterprise within education studies is a significant contribution to that body of knowledge

Humidified and standard oxygen therapy in acute severe asthma in children (HUMOX): A pilot randomised controlled trial.

BackgroundOxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing humidified O2 to standard O2 in children is feasible, and specifically to obtain data on recruitment, tolerability and outcome measure stability.MethodsHeated humidified, cold humidified and standard O2 treatments were compared for children (2-16 years) with acute severe asthma in a multi-centre, open, parallel, pilot randomised controlled trial (RCT). Multiple outcomes were assessed.ResultsOf 258 children screened, 66 were randomised (heated humidified O2 n = 25; cold humidified O2 n = 21; standard O2 n = 20). Median (IQR) length of stay (hours) in hospital was 37.9 (29.1), 52 (35.4) and 49.1 (29.7) for standard, heated humidified and cold humidified respectively and time (hours) on O2 was 15.9 (9.4), 13.6 (14.9) and 13.1 (14.9) for the three groups respectively. The mean (standard deviation) time (hours) taken to step down nebulised to inhaled treatment was 5.6 (14.3), 35.1 (28.2) and 32.7 (20.1). Asthma Severity Score decreased in all three groups similarly, although missing data prevented complete analysis. Humidified O2 was least well tolerated with eight participants discontinuing their randomised treatment early. An important barrier to recruitment was research nurse availability.ConclusionAlthough, the results of this pilot study should not be extrapolated beyond the study sample and inferential conclusions should not be drawn from the results, this is the first RCT to compare humidified and standard O2 therapy in acute severe asthmatics of any age. These findings and accompanying screening data show that a large RCT of O2 therapy is feasible. However, challenges associated with randomisation and data collection should be addressed in any future trial design