Process Personalization Framework for Service-Driven Enterprises

Service functions and service activities are integral part of enterprises. Although technologies have improved for developing service functions, errors persist in service activities. Noted computer scientist Ramamoorthy describes personalization, customization, and humanization of service functions as an effective approach for reducing error in service activities. This paper argues that current personalization approaches does not effectively address the entire spectrum of service functions. The proposed personalization framework can advance current state of personalization through enabling tools as services and services as tools. We discuss the framework utilizing biological research as a service-driven enterprise example. The proposed framework is based on our enterprise process personalization patent

Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

BACKGROUND: Engaging health care staff in new quality improvement programs is challenging. OBJECTIVE: We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. METHODS: Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). RESULTS: A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77%). CONCLUSIONS: Medical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them

MIGRAINE: A POSSIBLE CAUSE FOR COGNITIVE DECLINE

Objectives:Migraine is the second most common type of headache and seventh most disabling disease worldwide. In general, obesity is often related to headache disorders in several clinical and epidemiologic studies. Obese migraine patients may have an increased attack frequency due to increase in inflammatory response. Cognitive decline is the major pitfall of migraine disorder and there exists a conflicting result between cognition and migraine and the effect of Body Mass Index (BMI) on migraine. So this study is done to find out the relationship between cognition and migraine and its association with BMI.Methods:The study protocol was approved by the ethical committee of SRM Medical College Hospital & Research Centre. The study group consisted of 30 migraine patients and 30 healthy controls aged between 18-40 years of age. Informed consent was obtained from all the participants. Diagnosis of migraine was made using the criteria of 2nd edition of International Headache Classification (IHC). Patients affected by Diabetes mellitus, Hypertension, allergy, inflammation, infection or immune disorders were excluded. Height and weight of the subjects were taken to calculate the BMI. Cognitive tests such as stroop interference trial & trial making tests (A&B) were done to evaluate working memory, mental flexibility and attention.Results:Compared to controls, cases took more time for performing stroop colour card test (106.40 ± 15.87 seconds vs. 132.17±7.027seconds, p<0.001) and trial making pattern B (54.77± 8.169 seconds vs. 56.23 ± 23.457seconds, p=0.004). Among the migraine subjects, obese individuals had an increased frequency of migraine attack per month (Correlation coefficient r=0.797)Conclusion:Cognitive decline in migraine is one of the underestimated problems in migraine. Identifying such problems early can prevent major consequences in day to day activities of migraine patients. Since there is an increased frequency of migraine with increase in BMI, obese migraine subjects can be recommended to do regular exercises.Â

Using a resource effect study pre-pilot to inform a large randomized trial: the Decide2Quit.Org Web-assisted tobacco intervention

Resource effect studies can be useful in highlighting areas of improvement in informatics tools. Before a large randomized trial, we tested the functions of the Decide2Quit.org Web-assisted tobacco intervention using smokers (N=204) recruited via Google advertisements. These smokers were given access to Decide2Quit.org for six months and we tracked their usage and assessed their six months cessation using a rigorous follow-up. Multiple, interesting findings were identified: we found the use of tailored emails to dramatically increase participation for a short period. We also found varied effects of the different functions. Functions supporting seeking social support (Your Online Community and Family Tools), Healthcare Provider Tools, and the Library had positive effects on quit outcomes. One surprising finding, which needs further investigation, was that writing to our Tobacco Treatment Specialists was negatively associated with quit outcomes

Networks Fighting Nicotine: Will Visitors to a Tobacco Cessation Website Engage in an Online Support Community?

Background: Online tobacco cessation social networks may influence effectiveness of Web-Assisted Tobacco Interventions (WATIs). Purpose: To understand characteristics and quit rates of WATI participants navigating to BecomeAnEx.org, an online cessation network. Methods: We recruited 759 smokers to a WATI (decide2quit.org), through in-person primary care and dental office referrals and Google ads. We used online surveys to gather data on sociodemographics, tobacco use, and readiness to quit. Smokers were able to navigate online from the WATI to an online social network supporting cessation (BecomeAnEx.org). We identified visitors to and registrants with BecomeAnEx.org, examining associations between BecomeAnEx.org use and sociodemographic characteristics, patterns of WATI use and likelihood of tobacco cessation. Results: One-quarter (26.0%) of WATI users visited BecomeAnEx.org ; 7.5% registered. BecomeAnEx.org visitors were more likely than nonvisitors to be female (73.0% vs. 62.6% p\u3c0.01) and more likely to have visited a smoking cessation website before (43.9% vs 17.4%, p\u3c.01). Registrants were more likely to engage in other WATI tools including e-mails to trained tobacco specialists (68.4% vs 28.8). No significant association was found between BecomeAnEx.org use (visiting or registration) and tobacco cessation. Conclusions: BecomeAnEx.org navigation from our WATI was limited, attracting those already inclined toward online cessation tools. Future studies must explore whether online cessation social networks may have additional benefits if designed to attract larger audiences

Highly effective liquid and solid phase extraction methods to concentrate radioiodine isotopes for radioiodination chemistry

Radioactive iodine isotopes play a pivotal role in radiopharmaceuticals. Large-scale production of multi-patient dose of radioiodinated nuclear medicines requires high concentration of radioiodine. We demonstrate that tetrabutylammonium chloride and methyltrioctylamonium chloride are effective phase transfer reagents to concentrate iodide-124, iodide-125 and iodide-131 from the corresponding commercial water solutions. The resulting concentrated radioiodide, in the presence of either phase transfer reagent, does not hamper the chemical reactivity of aqueous radioiodide in the copper (II)-mediated one-pot three-component click chemistry to produce radioiodinated iodotriazoles

Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks

BACKGROUND: Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. OBJECTIVE: This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. METHODS: We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. RESULTS: Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers\u27 messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). CONCLUSIONS: Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation. Phillips, Jessica H Williams, Sarah L Cutrona, Midge N Ray, Gregg H Gilbert, Thomas K Houston, QUITPRIMO, National Dental PBRN Collaborative Group. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.05.2020

Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study

BACKGROUND: Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months. METHODS: Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an e-referral tool to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper referral prescription ). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized). RESULTS: Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p \u3c 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04). CONCLUSIONS: Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation. TRIAL REGISTRATION: Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628

Who participates in web-assisted tobacco interventions? The quit-primo and national dental practice-based research network hi-quit studies

INTRODUCTION: Smoking is the most preventable cause of death. Although effective, Web-assisted tobacco interventions are underutilized and recruitment is challenging. Understanding who participates in Web-assisted tobacco interventions may help in improving recruitment. OBJECTIVES: To understand characteristics of smokers participating in a Web-assisted tobacco intervention (Decide2Quit.org). METHODS: In addition to the typical Google advertisements, we expanded Decide2Quit.org recruitment to include referrals from medical and dental providers. We assessed how the expanded recruitment of smokers changed the users\u27 characteristics, including comparison with a population-based sample of smokers from the national Behavioral Risk Factors Surveillance Survey (BRFSS). Using a negative binomial regression, we compared demographic and smoking characteristics by recruitment source, in particular readiness to quit and association with subsequent Decide2Quit.org use. RESULTS: The Decide2Quit.org cohort included 605 smokers; the 2010 BRFSS dataset included 69,992. Compared to BRFSS smokers, a higher proportion of Decide2Quit.org smokers were female (65.2% vs 45.7%, P=.001), over age 35 (80.8% vs 67.0%, P=.001), and had some college or were college graduates (65.7% vs 45.9%, P=.001). Demographic and smoking characteristics varied by recruitment; for example, a lower proportion of medical- (22.1%) and dental-referred (18.9%) smokers had set a quit date or had already quit than Google smokers (40.1%, P CONCLUSIONS: Recruitment from clinical practices complimented Google recruitment attracting smokers less motivated to quit and less experienced with Web-assisted tobacco interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6F3tqz0b3)

Osmoregulators proline and glycine betaine counteract salinity stress in canola

Salt inundation leads to increased salinization of arable land in many arid and semi-arid regions. Until genetic solutions are found farmers and growers must either abandon salt-affected fields or use agronomic treatments that alleviate salt stress symptoms. Here, field experiments were carried out to study the effect of the osmoregulators proline at 200 mg L-1 and glycine betaine at 400 mg L-1 in counteracting the harmful effect of soil salinity stress on canola plants grown in Egypt. We assessed growth characteristics, yield and biochemical constituents. Results show first that all growth characters decreased with increasing salinity stress but applied osmoregulators alleviated these negative effects. Second, salinity stress decreased photosynthetic pigments, K and P contents, whilst increasing proline, soluble sugars, ascorbic acid, Na and Cl contents. Third, application of osmoregulators without salt stress increased photosynthetic pigments, proline, soluble sugars, N, K and P contents whilst decreasing Na and Cl contents. It is concluded that the exogenously applied osmoregulators glycine betaine and proline can fully or partially counteract the harmful effect of salinity stress on growth and yield of canola.© INRA and Springer-Verlag, France 2012