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Agile software development is immensely popular in the industry, but most teams struggle to sustain its use. Human factors like management support, agile training, agile mindset, and team resilience are often neglected, hindering long-term success. However, research has not explored their underlying mechanisms in depth. Therefore, this study examines if management support impacts the sustained usage of agile methodologies within software development teams. It subsequently investigates the individual and serial mediating effects of agile training, the agile mindset, and team resilience on this relationship. Additionally, it compares the importance and performance of management support, agile training, the agile mindset, and team resilience in infusing agile practices. Finally, it determines these antecedents' necessity for the enduring success of agile application. Data collected from 391 agile software development professionals using a structured questionnaire. Partial-least-squares structural equation modelling, importance-performance map analysis and necessary condition analysis were used to investigate relationships. The findings underscore the pivotal role of management support in infusing agile practices. Agile training, mindset, and team resilience emerge as critical mediators, with a strong serial mediation effect. While management support is paramount, its practical implementation falls short within teams. All four antecedents are found to be necessary for optimal agile sustainment. Thus, this study significantly advances theoretical understanding by introducing a serial mediation model that elucidates their mechanisms in impacting agile infusion. It extends prior organisational-level findings to the team-level. The study's quantitative verification of qualitative findings strengthens their generalisability to a broader spectrum of teams. It pioneers in expounding the constructs' relative importance, performance and necessity, to offer actionable insights for agile practitioners. Finally, it provides methodological guidance to apply importance performance map analysis and necessary condition analysis in agile software development research., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Wijesinghe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To improve mental health, diverse mobile applications (apps) have been developed to target those who actively use smartphones and in-phone apps. In this vein, this study developed a mobile app, eRAPPORT, to prevent suicide using ecological momentary assessment and intervention. A brief literature review and mobile app market search were conducted to determine the app's content and modality. The design and contents of eRAPPORT were developed through consulting with contextual and methodological experts for end-users' need assessment and technician review. For implementation, an experienced mobile app developer collaborated with the research team to create the app, which includes a safety plan, a feature to track suicidal risk and mental health status, evidence-based information from international and national authorised organisations, an outreach service with online/offline counselling and pop-ups displaying emergency contacts. Twenty-five general adults participated in the feasibility study. After using eRAPPORT for a month, they completed a self-reported questionnaire, followed by an in-depth interview of functionality, acceptability and safety. Both quantitative and qualitative evaluations assured the moderate level of usability and acceptability due to some features that should be improved before applying those with a high risk of suicide. No critical adverse event was reported. Thus, this eRAPPORT feasibility study provides fundamental information to describe the patient-centred processes on how to develop a mobile app for suicide prevention. Further study will be conducted to test the app's effectiveness and determine the application in clinical practice for monitoring and preventing suicide risk by collecting real-time and longitudinal data., (© 2025 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Since the COVID-19 pandemic, considerable advances have been made to improve epidemic preparedness by accelerating diagnostics, therapeutics, and vaccine development. However, we argue that it is crucial to make equivalent efforts in the field of outbreak analytics to help ensure reliable, evidence-based decision making. To explore the challenges and key priorities in the field of outbreak analytics, the Epiverse-TRACE initiative brought together a multidisciplinary group of experts, including field epidemiologists, data scientists, academics, and software engineers from public health institutions across multiple countries. During a 3-day workshop, 40 participants discussed what the first 100 lines of code written during an outbreak should look like. The main findings from this workshop are summarised in this Viewpoint. We provide an overview of the current outbreak analytic landscape by highlighting current key challenges that should be addressed to improve the response to future public health crises. Furthermore, we propose actionable solutions to these challenges that are achievable in the short term, and longer-term strategic recommendations. This Viewpoint constitutes a call to action for experts involved in epidemic response to develop modern and robust data analytic approaches at the heart of epidemic preparedness and response., Competing Interests: Declaration of interests This Viewpoint was written by the attendees of a workshop held in December, 2022, hosted by Epiverse-TRACE at the Wellcome Trust (London, UK). Epiverse-TRACE is funded by Data.org, which is supported by The Rockefeller Foundation and Mastercard Center for Inclusive Growth. Data.org is also supported by the Wellcome Trust and the International Development Research Centre (IDRC). The authors of this study have not been paid to write this article by a pharmaceutical company or other agency. CTC received funding from Data.org. AC received funding from the UK National Institute of Health Research, UK Medical Research Council, Pfizer, and the Academy of Medical Sciences. ZMC received funding from the Ministry of Science and Technology of Colombia via the AGORA Research Grant and the IDRC via the TRACE-LAC Research Grant; a research grant for enhancing tools for response, analytics, and control of epidemics in Latin America and the Caribbean (Project ID 109848); a mathematical modelling and development of epidemiological analysis, estimates, and projections for priority public health diseases in the Americas region grant; and support for attending meetings and travel from WHO, Pan American Health Organization, and The Lancet Commission. AYB received funding from Medecins Sans Frontières. CC is supported by ETH Zurich and the Centers for Disease Control and Prevention. JAL received funding from Pfizer. JT received funding from the Yeotown Scholarship, awarded by New College, Oxford. DSQ received funding from the Pontificia Universidad Javeriana. AFS received funding from Epiverse-TRACE to attend meetings and travel. AJK received funding from the Wellcome Trust and Data.org. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Primary intracranial germ cell tumors (iGCTs) are highly malignant brain tumors that predominantly occur in children and adolescents, with an incidence rate ranking third among primary brain tumors in East Asia (8%-15%). Due to their insidious onset and impact on critical functional areas of the brain, these tumors often result in irreversible abnormalities in growth and development, as well as cognitive and motor impairments in affected children. Therefore, early diagnosis through advanced screening techniques is vital for improving patient outcomes and quality of life., Objective: This study aimed to investigate the application of facial recognition technology in the early detection of iGCTs in children and adolescents. Early diagnosis through advanced screening techniques is vital for improving patient outcomes and quality of life., Methods: A multicenter, phased approach was adopted for the development and validation of a deep learning model, GVisageNet, dedicated to the screening of midline brain tumors from normal controls (NCs) and iGCTs from other midline brain tumors. The study comprised the collection and division of datasets into training (n=847, iGCTs=358, NCs=300, other midline brain tumors=189) and testing (n=212, iGCTs=79, NCs=70, other midline brain tumors=63), with an additional independent validation dataset (n=336, iGCTs=130, NCs=100, other midline brain tumors=106) sourced from 4 medical institutions. A regression model using clinically relevant, statistically significant data was developed and combined with GVisageNet outputs to create a hybrid model. This integration sought to assess the incremental value of clinical data. The model's predictive mechanisms were explored through correlation analyses with endocrine indicators and stratified evaluations based on the degree of hypothalamic-pituitary-target axis damage. Performance metrics included area under the curve (AUC), accuracy, sensitivity, and specificity., Results: On the independent validation dataset, GVisageNet achieved an AUC of 0.938 (P<.01) in distinguishing midline brain tumors from NCs. Further, GVisageNet demonstrated significant diagnostic capability in distinguishing iGCTs from the other midline brain tumors, achieving an AUC of 0.739, which is superior to the regression model alone (AUC=0.632, P<.001) but less than the hybrid model (AUC=0.789, P=.04). Significant correlations were found between the GVisageNet's outputs and 7 endocrine indicators. Performance varied with hypothalamic-pituitary-target axis damage, indicating a further understanding of the working mechanism of GVisageNet., Conclusions: GVisageNet, capable of high accuracy both independently and with clinical data, shows substantial potential for early iGCTs detection, highlighting the importance of combining deep learning with clinical insights for personalized health care., (©Yanong Li, Yixuan He, Yawei Liu, Bingchen Wang, Bo Li, Xiaoguang Qiu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.01.2025.)

Background: Since 2015, the Complex Reviews Synthesis Unit (CRSU) has developed a suite of web-based applications (apps) that conduct complex evidence synthesis meta-analyses through point-and-click interfaces. This has been achieved in the R programming language by combining existing R packages that conduct meta-analysis with the shiny web-application package. The CRSU apps have evolved from two short-term student projects into a suite of eight apps that are used for more than 3,000 h per month., Aim: Here, we present our experience of developing production grade web-apps from the point-of-view of individuals trained primarily as statisticians rather than software developers in the hopes of encouraging and inspiring other groups to develop valuable open-source statistical software whilst also learning from our experiences., Key Challenges: We discuss how we have addressed challenges to research software development such as responding to feedback from our real-world users to improve the CRSU apps, the implementation of software engineering principles into our app development process and gaining recognition for non-traditional research work within the academic environment., Future Developments: The CRSU continues to seek funding opportunities both to maintain and further develop our shiny apps. We aim to increase our user base by implementing new features within the apps and building links with other groups developing complementary evidence synthesis tools., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: In medical imaging, 3D visualization is vital for displaying volumetric organs, enhancing diagnosis and analysis. Multiplanar reconstruction (MPR) improves visual and diagnostic capabilities by transforming 2D images from computed tomography (CT) and magnetic resonance imaging into 3D representations. Web-based Digital Imaging and Communications in Medicine (DICOM) viewers integrated into picture archiving and communication systems facilitate access to pictures and interaction with remote data. However, the adoption of progressive web applications (PWAs) for web-based DICOM and MPR visualization remains limited. This paper addresses this gap by leveraging PWAs for their offline access and enhanced performance., Objective: This study aims to evaluate the integration of DICOM and MPR visualization into the web using PWAs, addressing challenges related to cross-platform compatibility, integration capabilities, and high-resolution image reconstruction for medical image visualization., Methods: Our paper introduces a PWA that uses a modular design for enhancing DICOM and MPR visualization in web-based medical imaging. By integrating React.js and Cornerstone.js, the application offers seamless DICOM image processing, ensures cross-browser compatibility, and delivers a responsive user experience across multiple devices. It uses advanced interpolation techniques to make volume reconstructions more accurate. This makes MPR analysis and visualization better in a web environment, thus promising a substantial advance in medical imaging analysis., Results: In our approach, the performance of DICOM- and MPR-based PWAs for medical image visualization and reconstruction was evaluated through comprehensive experiments. The application excelled in terms of loading time and volume reconstruction, particularly in Google Chrome, whereas Firefox showed superior performance in viewing slices. This study uses a dataset comprising 22 CT scans of peripheral artery patients to demonstrate the application's robust performance, with Google Chrome outperforming other browsers in both the local area network and wide area network settings. In addition, the application's accuracy in MPR reconstructions was validated with an error margin of <0.05 mm and outperformed the state-of-the-art methods by 84% to 98% in loading and volume rendering time., Conclusions: This paper highlights advancements in DICOM and MPR visualization using PWAs, addressing the gaps in web-based medical imaging. By exploiting PWA features such as offline access and improved performance, we have significantly advanced medical imaging technology, focusing on cross-platform compatibility, integration efficiency, and speed. Our application outperforms existing platforms for handling complex MPR analyses and accurate analysis of medical imaging as validated through peripheral artery CT imaging., (©Mohammed A. AboArab, Vassiliki T. Potsika, Alexis Theodorou, Sylvia Vagena, Miltiadis Gravanis, Fragiska Sigala, Dimitrios I. Fotiadis. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 09.12.2024.)

The AKTIN Emergency Department Registry, a German health data network, faces operational challenges due to rapid growth. Manual data request processes have become inefficient, hindering timely research and straining personnel. To address these challenges, we undertook a user-centered analysis utilizing Design Thinking principles to identify pain points and functional requirements in current data request creation and management processes. Future work will prioritize iterative implementation of the created concepts with continuous user engagement and rigorous software validation.

Medical informatics is a multidisciplinary field combining clinical and technical expertise. Addressing the challenge of aligning software design with clinicians' real-world needs, Dedalus established the Medical Office, a dedicated department designed to integrate clinical expertise directly into the software development process, in 2022. This paper details the approach and impact of the Medical Office. An international team of 15 healthcare professionals with experience in medical informatics was assembled. The team employed a multifaceted approach, incorporating global communication sessions and a ticketing system to track and analyze service requests. Over two years, 398 tickets were received, categorized into nine areas: clinical content curation, medical terminologies, clinical safety, clinical evaluation, design support, clinical UX, research & publication, real-world medical cases, and pre-sales support. The average duration of ticket resolution decreased over time, attributed to process fine-tuning and the formation of a relevant expert group. A preliminary satisfaction survey indicated positive feedback from technical teams. The collaborative model improved software design, usability, and clinical safety, demonstrating the value of clinician involvement. While preliminary results are promising, ongoing evaluation and adaptation are essential. The study emphasizes the importance of interdisciplinary collaboration in medical informatics and the benefits of clinician involvement in healthcare technology development. Future studies should explore this model's long-term impacts and scalability in other organizations and healthcare systems.

There is a growing body of research on the problems older and disabled people face with authentication systems and a range of solutions have been developed. However, this research has not been integrated across user groups and solutions usually only target one or two groups. This research has attempted to integrate the empirical research findings across studies conducted with people with visual, physical, and intellectual disabilities, people dyslexia and older people. It proposes an initial set of 15 recommendations for the universal design of authentication systems. Four recommendations are about authentication systems in general, six about password authentication, two about CAPTCHAs and three about biometric authentication. 40% of the recommendations address problems experienced by at least two different user groups and over 25% address problems experienced by three groups. However, much further work is needed to validate and refine the recommendations and integrate them into a universal design approach.

As artificial intelligence (AI) becomes increasingly integral to various sectors, its potential to enhance accessibility in digital services is of growing interest. This paper explores the influence of AI systems (AIS) on accessibility compliance, specifically within the context of Norway's national e-health service provider Norsk helsenett (NHN). Through a qualitative analysis, we assess how AISs are deployed in frontend programming, user interface design, and accessibility testing at NHN. Our study reveals that while AI has the potential to improve accessibility, it also presents challenges that require robust domain knowledge and effective human oversight. We explore the benefits and limitations using ChatGPT in accessibility testing, GitHub Copilot for generating accessible code, the implications of AI driven design tools, as well as the key differences between developing websites with existing component libraries and developing a simpler website from scratch. This paper aims to contribute to the ongoing discourse on AI and accessibility, offering insights and recommendations for future research and practical applications.

Background: In today's digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. "AgileNudge+" (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions., Objective: This paper aimed to outline the design process, methodologies, and usefulness of "AgileNudge+" for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software's interface usability and usefulness for creating and testing nudge interventions., Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science-based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software's ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool's usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project's sphere., Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software., Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users' needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process., (©Fereshtehossadat Shojaei, Fatemehalsadat Shojaei, Archita P Desai, Emily Long, Jade Mehta, Nicole R Fowler, Richard J Holden, Eric S Orman, Malaz Boustani. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.11.2024.)

Objectives: Visual hierarchy underlies all visual design decisions related to information presentation. This manuscript describes the experience of a multidisciplinary health data visualization and software design team in using visual hierarchy to redesign a hereditary colorectal cancer lab report., Materials and Methods: A series of interviews with representative users were conducted to identify target user groups and determine information hierarchy for each user type. Visual elements (eg, size, color, contrast, etc.) were then assigned to mirror the information hierarchy and workflow for each user type., Results: User research identified 2 distinct user groups as consumers of the redesigned lab report. An interactive design employing a 2-level page hierarchy was developed, which stratified the content to support the needs of each user type., Conclusions: The challenges related to displaying the complex nature of digital and personal health data can be addressed by applying foundational design methods such as visual hierarchy., Discussion: Visual hierarchy, a foundational design principle, can be used by visualization teams to clearly and efficiently present complex datasets associated with healthcare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The functional interaction structure of a team captures the preferences with which members of different roles interact. This paper presents a data-driven approach to detect the functional interaction structure for software development teams from traces team members leave on development platforms during their daily work. Our approach considers differences in the activity levels of team members and uses a block-constrained configuration model to compute interaction preferences between members of different roles. We apply our approach in a case study to extract the functional interaction structure of a product team at the German IT security company genua GmbH. We validate the accuracy of the detected interaction structure in interviews with five team members. Finally, we show how our approach enables teams to compare their functional interaction structure against synthetically created benchmark scenarios. Specifically, we evaluate the level of knowledge diffusion in the team and identify areas where the team can further improve. Our approach is computationally efficient and can be applied in real-time to manage a team's interaction structure. In summary, our approach provides a novel way to quantify and evaluate the functional interaction structure of software development teams that aids in understanding and improving team performance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zingg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people's involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app., Objective: This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform., Methods: Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won't have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups., Results: Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs., Conclusions: A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders., (© Alison Branitsky, Penny Bee, Sandra Bucci, Karina Lovell, Simon Foster, Pauline Whelan. Originally published in JMIR Human Factors (https://humanfactors.jmir.org).)

Objective: to develop and validate the content and technical aspects of a web software program for promoting mental health in the workplace., Method: applied methodological study and technological development, carried out in three stages: 1) Umbrella review development; 2) Web software development; 3) Content and technical validation carried out by 14 judges. The data was submitted to descriptive statistical analysis and calculation of the content validity index., Results: based on the guidelines' recommendations, information was defined and extracted in order to develop the web software consisting of the following dimensions: mental health education, support among coworkers, promotion strategies and mental health self-assessment. For the technical development, the objectives, general functions and technological infrastructure were defined. After development and functional testing, the version was made available for content and technical validation by judges. The overall content validity index was 0.98 and for the technical aspects it was 0.97., Conclusion: the agreement between the judges in relation to the content and technical aspects, as well as the suggestions incorporated, demonstrated the potential for using web software to promote mental health in the workplace.

Purpose: An investigational drug services (IDS) pharmacy plays a vital role in supporting clinical trial research by ensuring the safe and efficient management of investigational products. This article describes the implementation of an electronic project management software to improve an IDS pharmacy's study protocol work. The article describes the implementation of the software and how this approach addressed specific challenges, including project oversight, process standardization, documentation, reporting, accountability, and intrateam communication., Summary: We describe an electronic project management software system used to streamline and standardize the work associated with study protocols. This software provides an organized and customizable workspace to manage tasks associated with each study protocol. The software automates task creation, tracks progress, and ensures comprehensive record keeping. Additionally, the software fosters effective communication within the team and offers real-time reporting to assess team productivity and progress. We have observed improved consistency, enhanced revenue, including approximately $18,000 in additional fee capture, and increased collaboration among pharmacy team members., Conclusion: Implementing an electronic project management software has proven highly beneficial in the IDS pharmacy. The software has significantly improved workflow efficiency by addressing challenges in study protocol management. While initial setup and training required time and resources, the long-term benefits in project oversight, collaboration, and revenue capture justify the investment. An electronic project management software is a valuable tool in managing the complexity of study protocol activities and supports the pharmacy's crucial role in advancing clinical research., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: While Human Factors (HF) methods have been applied to the design of decision support systems (DSS) to aid clinical decision-making, the role of HF to improve decision-support for population health outcomes is less understood. We sought to comprehensively understand how HF methods have been used in designing digital population health DSS., Materials and Methods: We searched English documents published in health sciences and engineering databases (Medline, Embase, PsychINFO, Scopus, Comendex, Inspec, IEEE Xplore) between January 1990 and September 2023 describing the development, validation or application of HF principles to decision support tools in population health., Results: We identified 21,581 unique records and included 153 studies for data extraction and synthesis. We included research articles that had a target end-user in population health and that used HF. HF methods were applied throughout the design lifecycle. Users were engaged early in the design lifecycle in the needs assessment and requirements gathering phase and design and prototyping phase with qualitative methods such as interviews. In later stages in the lifecycle, during user testing and evaluation, and post deployment evaluation, quantitative methods were more frequently used. However, only three studies used an experimental framework or conducted A/B testing., Conclusions: While HF have been applied in a variety of contexts in the design of data-driven DSSs for population health, few have used Human Factors to its full potential. We offer recommendations for how HF can be leveraged throughout the design lifecycle. Most crucially, system designers should engage with users early on and throughout the design process. Our findings can support stakeholders to further empower public health systems., (© 2024. The Author(s).)

Aim: To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software., Design: A systematic review of qualitative studies., Data Sources: A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023., Review Methods: A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted., Results: From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested., Conclusion: Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting., Reporting Method: The ENTREQ reporting guideline was used to support the reporting of this systematic review., Patient or Public Contribution: There was no patient or public contribution., Protocol Registration: The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Clinical decision support systems (CDSS) based on artificial intelligence (AI) are complex socio-technical innovations and are increasingly being used in medicine and nursing to improve the overall quality and efficiency of care, while also addressing limited financial and human resources. However, in addition to such intended clinical and organisational effects, far-reaching ethical, social and legal implications of AI-based CDSS on patient care and nursing are to be expected. To date, these normative-social implications have not been sufficiently investigated. The BMBF-funded project DESIREE (DEcision Support In Routine and Emergency HEalth Care: Ethical and Social Implications) has developed recommendations for the responsible design and use of clinical decision support systems. This article focuses primarily on ethical and social aspects of AI-based CDSS that could have a negative impact on patient health. Our recommendations are intended as additions to existing recommendations and are divided into the following action fields with relevance across all stakeholder groups: development, clinical use, information and consent, education and training, and (accompanying) research., (© 2024. The Author(s).)

Introduction: Existing research agrees that a well-thought design of the user interface is a key point for an mHealth application for animal owners, supporting them obtain information and make decisions regarding their pet's specific situation. However, there is currently a lack of specific advice on the design of such an application., Methods: As part of a user-centered design (UCD) process, a formative, explorative usability test with n = 5 users was conducted for collecting design ideas. The test was conducted for two applications that were already available on the market., Results: The need of supporting comprehensive information input in guided processes that can be adapted to the individual level of knowledge, was identified as a key aspect., Conclusion: In this paper, recommendations for the design of a suitable user interface are suggested to support application developers and designers.

Introduction: In this revolutionized era, thanks to cutting-edge technological breakthroughs like 3-dimensional (3D) computerized environments, physiotherapy trainers can improve their knowledge and confidence by using such training tools. Hence, there is room for developing these technologies for training medical students to expand their skills and expertise. This study aims to identify the design requirements and key functionalities of a 3D simulation software for the clinical education of physiotherapy students in neurology departments., Method: First, by carefully reviewing neurological books, scientific articles, curriculum, and medical records, and consulting with experts, a scenario was compiled. In the next step, a researcher-developed questionnaire was designed. Then, experts' opinions were considered to confirm the validity and reliability of the questionnaire. The designed questionnaire was distributed among several neurological physiotherapists. Finally, the information elements, contents, and functional capabilities of the 3D software were determined by analyzing the data obtained from the questionnaire., Findings: The main components for the design of physiotherapy educational software were identified based on the findings of the literature review, curriculum analysis, and medical record review. A survey of physiotherapy professors was conducted using a questionnaire created by the researcher in order to enhance the capabilities of simulation software and ascertain its primary functions. Following an analysis of the data from the distributed questionnaire, 37 essential features and contents have been proven to be more crucial than the rest for the creation of 3D simulation software. As a result, the essential and fundamental needs for the patient's training in reading their medical records and performing muscle strength assessments were recognized and extracted. Based on these findings, a researcher-developed scenario for the various real cases was then established. In the patient's medical record reading scenario, the student is required to read the patient's record in text format. Similarly, in the section on cranial nerves, pictures are utilised to reinforce the student's assessment skills in addition to textual content. Together with the audio and pop-up texts, the simulated 3D environment also offers training for the assessment of muscle strength., Conclusion: As an educational tool, this software can enhance students' learning and assist in addressing the drawbacks of conventional teaching methods like lectures and hospital visits., (© 2024. The Author(s).)

The field of software engineering is advancing at astonishing speed, with packages now available to support many stages of data science pipelines. These packages can support infectious disease modelling to be more robust, efficient and transparent, which has been particularly important during the COVID-19 pandemic. We developed a package for the construction of infectious disease models, integrated it with several open-source libraries and applied this composite pipeline to multiple data sources that provided insights into Australia's 2022 COVID-19 epidemic. We aimed to identify the key processes relevant to COVID-19 transmission dynamics and thereby develop a model that could quantify relevant epidemiological parameters. The pipeline's advantages include markedly increased speed, an expressive application programming interface, the transparency of open-source development, easy access to a broad range of calibration and optimisation tools and consideration of the full workflow from input manipulation through to algorithmic generation of the publication materials. Extending the base model to include mobility effects slightly improved model fit to data, with this approach selected as the model configuration for further epidemiological inference. Under our assumption of widespread immunity against severe outcomes from recent vaccination, incorporating an additional effect of the main vaccination programs rolled out during 2022 on transmission did not further improve model fit. Our simulations suggested that one in every two to six COVID-19 episodes were detected, subsequently emerging Omicron subvariants escaped 30-60% of recently acquired natural immunity and that natural immunity lasted only one to eight months on average. We documented our analyses algorithmically and present our methods in conjunction with interactive online code notebooks and plots. We demonstrate the feasibility of integrating a flexible domain-specific syntax library with state-of-the-art packages in high performance computing, calibration, optimisation and visualisation to create an end-to-end pipeline for infectious disease modelling. We used the resulting platform to demonstrate key epidemiological characteristics of the transition from the emergency to the endemic phase of the COVID-19 pandemic., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

Background: The increasing demand for remote medical care, driven by digital healthcare advancements and the COVID-19 pandemic, necessitates effective solutions tailored to patients and healthcare practitioners. Co-design, involving collaboration between software developers, patients, and healthcare practitioners, prioritizes end-user needs. Research indicates that integrating patient perspectives enhances user experience and usability. However, its application in healthcare has been limited to small projects. This work focuses on co-designing a technological solution to enhance the monitoring and visual rehabilitation of individuals with Age-Related Macular Degeneration (AMD), a condition that significantly impacts the quality of life in people over 60. Current vision rehabilitation systems lack personalization, motivation, and effective progress monitoring. Involving patients and healthcare practitioners in the design process aims to ensure the final product meets their needs., Methods: The project employs iterative and collaborative principles, involving a vision rehabilitation expert and two AMD patients as active users in the application's development and validation. The process begins by establishing requirements for user accounts and rehabilitation exercises. It continues with an initial approach extended through user validation. Co-design is facilitated by specific workshops marking each project iteration, totaling four workshops, along with continuous communication sessions between experts and developers to validate design decisions. Initial requirements gathering and constant feedback from end-users, the visual rehabilitator, and patients are crucial for refining the product effectively., Results: The workshops produced a prototype featuring a test to monitor changes and progression and 15 visual rehabilitation exercises. Numerous patient and vision rehabilitation-driven software modifications led to a final design that is responsive and adaptive to end-user needs., Conclusions: The Rehab-AMD pilot project aims to develop a collaborative and adaptive software solution for AMD rehabilitation by actively involving stakeholders and applying iterative design principles. Co-design in the Rehab-AMD solution proves to be a methodology that identifies usability issues and needs from the initial design stages. This approach ensures that software developers create a final product that is genuinely useful and manageable for people with AMD and the targeted vision rehabilitators., (© 2024. The Author(s).)

Patient and public involvement (PPI) is a practice for involving future users in the design, development, and research of health technologies. There is increasing interest and demand for PPI, but little evidence based methodological support for integrating PPI in agile development processes. Multiple sclerosis (MS) is a chronic condition that severely impacts the lives of patients and requires active patient involvement. In this paper, we present the results of a case study, examining the adoption and integration of PPI into the development of a digital therapeutics solution for MS. The results highlight five critical phases that proved to be challenging: selecting patient participants, onboarding of patient participants and employees, framing tasks for patient participants, communication between patient participants and the rest of the development team, and reimbursements. The results are useful in creating evidence-based guidelines and methods for supporting the adoption of PPI.

Introduction: The aim of the paper is to establish the requirements and methodology for the development and implementation of a recommender system for mental health apps to support patients in self-managing their mental health while awaiting formal treatment., Methods: The system was developed using an algorithm-based approach, including: (1) user needs assessment through literature review and interviews with various stakeholders, (2) software modelling and prototype creation, and (3) bench testing of the prototype with health experts and users., Results: Based on initial exploration of users' requirements, relevant standards and regulations, a library of trusted mental health apps was compiled and a recommendation engine was built to generate accurate user profiles and deliver personalised health recommendations, which will be further tested to ensure quality., Conclusion: Developing a constructive mental health recommendation system requires the establishment of clear and comprehensive requirements, as well as a robust methodology adressing concerns related to data security, confidentiality, safety, and reliability. Subsequent research may compare various indicators of mental health outcomes at the start and end of patients' waiting period to gain more insights into how the recommender system could be further improved to enhance user experience and their overall well-being.

Currently, there are no adequate methods for dealing with changes in the healthcare system brought about by electronic health applications (eHealth) or the associated ethical implications in practice. This can be attributed to the lack of comprehensive interdisciplinary approaches that could support teams in integrating ethical considerations into the agile software development process. To close this gap, the DARE approach has been developed and tested in interdisciplinary collaborative research. The DARE method is a modular system designed to improve the development of ethically sound software in a deliberative, agile, and responsive manner.

Background: In order to cognitively and physically activate people with dementia (MMD) in institutional settings, there are numerous touch-based multimedia applications specifically designed for this target group that are actually being used in practice. In contrast, the use of similar applications in domestic settings has been relatively limited., Aim and Method: This study is based on 11 expert interviews guided by questions and examines design options and requirements for application content as well as requirements for study designs to provide evidence of the effectiveness of touch-based multimedia applications for MMD and their caregiving relatives (PA)., Results: There is a high degree of consensus regarding the criteria for requirements for touch-based multimedia applications. Acceptance is highly dependent on user competence, usage practices, experiences and incentive structures; however, there are diverse opinions about their structural and content-related design. The quality of life is mentioned as an essential evaluation parameter for multimedia applications., Discussion: The highly variable individual life circumstances of MMD and their PAs, along with limited access options and a lack of suitability of the multimedia applications, may be causal factors for their relatively limited use, especially in domestic settings. Daily performance capabilities and individual disease progression pose special requirements for the scientific evaluation and the demonstration of the effectiveness of touch-based multimedia applications., (© 2024. The Author(s).)

Clinical decision support (CDS) systems play a crucial role in enhancing patient outcomes, but inadequate design contributes to alert fatigue, inundating clinicians with disruptive alerts that lack clinical relevance. This case study delves into a quality improvement (QI) project addressing nursing electronic health record (EHR) alert fatigue by strategically redesigning four high-firing/low action alerts. Employing a mixed-methods approach, including quantitative analysis, empathy mapping sessions, and user feedback, the project sought to understand and alleviate the challenges posed by these alerts. Virtual empathy mapping sessions with clinical nurses provided valuable insights into user experiences. Qualitative findings, CDS design principles, and organizational practice expectations informed the redesign process, resulting in the removal of all four identified disruptive alerts and redesign of passive alerts. This initiative released 877 unactionable disruptive nursing hours, emphasizing the significance of proper alert design and the necessity for organizational structures ensuring sustained governance in healthcare system optimization.

This case study describes the development of a patient facing app to aid the collection of accurate data for nursing assessment for care pathways. The project was led by service leads in co-production with a small supplier. Apps can be a user-friendly solution which enhance patient-centred care and significantly reduce service admin time. The impact shows that the innovation achieved to solve the problems identified at the outset. Digital health innovations are more successful with the engagement of users, and the authors want to encourage colleagues and services across the NHS to lead digital innovation in this case study.

The full potential for electronic health record systems in facilitating a positive transformation in care, with improvements in quality and safety, has yet to be realised. There remains a need to reconceptualise the structure, content and use of the nursing component of electronic health record systems. The aim of this study was to engage and involve a diverse group of stakeholders, including nurses and electronic health record system developers, in exploring together both issues and possible new approaches to documentation that better fit with practice, and that facilitate the optimal use of recorded data. Three focus groups were held in the UK and USA, using a semi-structured interview guide, and a common reflexive approach to analysis. The findings were synthesised into themes that were further developed into a set of development principles that might be used to inform a novel electronic health record system specification to support nursing practice.

Objective: This work sought to develop the Actuasalud platform as a useful tool for nursing that permits assessing health, in term of frailty, in population over 65 years of age., Methods: For the design and development of Actuasalud, two working groups were formed: one from nursing with different profiles, to identify the scientific content and a computer science group responsible for the software programming and development. Both teams adapted the scientific content to the technology so that the tool would allow for population screening with detection of health problems and frailty states., Results: The software was developed in three large blocks that include all the dimensions of frailty: a: sociodemographic variables, b: comorbidities, and c: assessment tools of autonomy-related needs that evaluate the dimensions of frailty. At the end of the evaluation, a detailed report is displayed through bar diagram with the diagnosis of each of the dimensions assessed. The assessment in the participating elderly showed that 44.7% (n = 38) of the population was considered not frail, and 55.3%; (n = 47) as frail. Regarding associated pathologies, high blood pressure (67.1%; n = 57), osteoarthritis and/or arthritis (55.3%; n = 47), diabetes (48.2%; n = 41) and falls during the last year (35.3%; n = 30) were highlighted., Conclusion: Actuasalud is an application that allows nursing professionals to evaluate frailty and issue a quick diagnosis with ordered sequence, which helps to provide individualized care to elderly individuals according to the problems detected during the evaluation., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

With the encouragement of policies and the rapid development of the biopharmaceutical industry, the number of software as medical device (SaMD) registration applications in Shanghai has continued to increase in recent years, and this paper summarizes the GMP nonconformities found in the field inspection of SaMD in Shanghai from 2020 to 2023, and the results show that nearly 70% of the problems were found in the software development process. Through in-depth analysis, this paper proposes the corresponding countermeasures for the problems found in the five most common stages such as software requirements, software design, software testing, software defect management and software configuration management, combined with the characteristics of software development. These suggested measures have certain reference significance for medical device software development and quality control personnel, and technical reviewer and inspectors.

Background: Colorectal cancer (CRC) is the third leading cause of cancer and the second cause of cancer-related deaths in the world. Despite the infrastructure and the availability of organized screening programs, participation in their screening programs is less than the set goals. Considering the importance of informing the society about the prevention and early detection of colorectal cancer symptoms and the positive impact of mobile health technologies, the present research was conducted with the aim of designing and evaluating a colon cancer mobile application., Methods: The present research was conducted in two phases: software design and evaluation. In the first phase, the software was prepared using the cascade method. First, all the educational content related to colorectal cancer was collected through an expert panel with the participation of 10 specialists. Then the software was evaluated with alpha and beta testing, and the initial version was approved by users in terms of simplicity and usability. In the second phase, a parallel clinical randomized trial study was conducted with the aim of investigating the effect of a colon cancer mobile application on the early detection of colorectal cancer. In this stage, 204 volunteers participated; inclusion criteria were age 18-85 years, owning a smartphone and the ability to read and write. Participants were randomized into control and intervention groups. The intervention group was educated with the colon cancer application for education about colorectal cancer, and the control group was educated with a pamphlet. After education, both groups were screened for colorectal cancer symptoms, and the results were compared., Results: In the software evaluation phase, the application was used by 204 users. In this stage, 84 (41.2%) women and 120 (58.8%) men, with an average (Standard Deviation) age of 47.53 (13.68) participated. Participants were randomized in two groups, 103 people with an average (Standard Deviation) age of 47.62 (14.65) in intervention group and 101 people with an average (Standard Deviation) age of 47.44 (12.70) in control group. There were no significant differences between the demographic characteristics of age, gender, marriage, occupation, instruction level, digestive disease history, cancer history, cancer risk factors, and family history of cancer between the two groups (P > 0.05). The Mann-Whitney U test indicated that there is a significant difference between the two groups of participants in self-assessment, willingness to do the screening, and the results of the assessment of colorectal cancer (P < 0.05)., Conclusion: The results of the research indicated the positive impact of the Colon Cancer Application on the abilities of the users of self-assessment of colon cancer. Therefore, based on the findings, it can be concluded that the use of the colon cancer mobile application is effective for colon cancer prevention and self-care., Trial Registration: This study was registered in the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir ) on 13/2/2024, with the IRCT ID: IRCT20210131050189N9., (© 2024. The Author(s).)

This paper extends the FAIR (Findable, Accessible, Interoperable, Reusable) guidelines to provide criteria for assessing if software conforms to best practices in open source. By adding "USE" (User-Centered, Sustainable, Equitable), software development can adhere to open source best practice by incorporating user-input early on, ensuring front-end designs are accessible to all possible stakeholders, and planning long-term sustainability alongside software design. The FAIR-USE4OS guidelines will allow funders and researchers to more effectively evaluate and plan open-source software projects. There is good evidence of funders increasingly mandating that all funded research software is open source; however, even under the FAIR guidelines, this could simply mean software released on public repositories with a Zenodo DOI. By creating FAIR-USE software, best practice can be demonstrated from the very beginning of the design process and the software has the greatest chance of success by being impactful., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sonabend et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Usability evaluation is difficult to reconcile with agile software development for eHealth systems, because traditional usability evaluation is often complex and cumbersome to implement. However, obtaining prospective users' feedback during agile software development is crucial for improving the usability of eHealth systems, which is why there is an increasing need for agile eHealth usability evaluation., Objective: This study investigates whether agile usability evaluations are suitable to evaluate patient-centered eHealth systems being agile developed in health care and are applicable for prospective users, such as older persons suffering from age-related declines., Methods: A triangulation study was conducted combining iterative expert interviews with an exploratory case study., Results: The triangulation study revealed that the implementation of an agile eHealth usability evaluation with prospective users such as older persons proved to be possible., Conclusion: Established eHealth usability evaluation methods must be further evolved to address age-related impairments of older persons.

Introduction: In therapeutic drug monitoring (TDM) of vancomycin (VCM), the area under the concentration-time curve (AUC) is related to the clinical efficacy and toxicity. Therefore, herein, we examined the factors associated with achieving the target AUC at follow-up and developed a decision flowchart for achieving the target AUC in critically ill patients., Methods: This multicenter retrospective observational study was conducted at eight hospitals. We retrospectively analyzed data from patients who had received VCM in the intensive care unit from January 2020 to December 2022. Decision-tree (DT) analysis was performed using factors with p < 0.1 in univariate analysis as the independent variables. Case data were split up to two times, and four subgroups were included. The primary endpoint was achieving the target AUC at the follow-up TDM (AUC follow-up ) and target AUC follow-up achievement was defined as an AUC of 400-600 μg‧h/mL. The initial AUC values were calculated with the 2-point concentrations (peak and trough) using the Bayesian estimation software Practical AUC-guided TDM (PAT)., Results: Among 70 patients (median age [interquartile range], 66 [56, 79] years; 50 % women), the AUC follow-up was achieved in 70 % (49/70). Three factors were selected for the decision flow chart: predicted AUC follow-up of 400-600 μg‧h/mL, dosing at 12-h intervals, and CCr of 130 mL/min/1.73 m 2 or higher; the accuracy was adequate (92 %, R 2  0.52)., Conclusion: We successfully identified the factors associated with achieving the target AUC of VCM at follow-up TDM and developed a simple-to-use DT model. However, the validity of the findings needs to be evaluated., Competing Interests: Declaration of competing interest KM received grant support funding from Meiji Seika Pharma Co., Ltd., Sumitomo Pharma Co., Ltd., and Shionogi & Co., Ltd., and speaker honoraria from Meiji Seika Pharma Co., Ltd. The other authors have no conflicts of interest to declare., (Copyright © 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Purpose: Incidents are recommended to be analyzed by root cause analysis (RCA). Our institution also conducts RCA for incidents and takes measures to prevent recurrence. The purpose of this study was to evaluate the effectiveness of countermeasures against the root causes analyzed by RCA in order to prevent recurrence of incidents., Methods: Since the treatment planning CT scanner was replaced, incidents of failure to zero adjustment the coordinates of the bed position occurred four times during a three-month period. The RCA was used to investigate the root causes of these incidents and to formulate measures to prevent recurrence. To evaluate the effectiveness of the recurrence prevention measures, we collected the number of recurrence of incidents during the first year after the effectiveness of the recurrence prevention measures, and used the chi-square test to determine the significant difference in the probability of an incident occurring at a significance level of 5% or less., Results: The measures to prevent the recurrence of incidents were to double-check that the coordinates of the bed position were adjusted to zero and to simulate operations based on a work flow that incorporated this double-check. During the first year period following the implementation of these recurrence prevention measures, the number of recurrence incidents was zero, and the probability of their occurrence decreased statistically significantly (p<0.05)., Conclusion: Thorough double-checks and work simulation based on the work flow are effective methods for preventing the recurrence of incidents.

Objective: Bilateral tonic-clonic seizures with focal semiology or focal interictal electroencephalography (EEG) can occur in both focal and generalized epilepsy types, leading to diagnostic errors and inappropriate therapy. We investigated the prevalence and prognostic values of focal features in patients with idiopathic generalized epilepsy (IGE), and we propose a decision flowchart to distinguish between focal and generalized epilepsy in patients with bilateral tonic-clonic seizures and focal EEG or semiology., Methods: We retrospectively analyzed video-EEG recordings of 101 bilateral tonic-clonic seizures from 60 patients (18 with IGE, 42 with focal epilepsy). Diagnosis and therapeutic response were extracted after ≥1-year follow-up. The decision flowchart was based on previous observations and assessed concordance between interictal and ictal EEG., Results: Focal semiology in IGE was observed in 75% of seizures and 77.8% of patients, most often corresponding to forced head version (66.7%). In patients with multiple seizures, direction of head version was consistent across seizures. Focal interictal epileptiform discharges (IEDs) were observed in 61.1% of patients with IGE, whereas focal ictal EEG onset only occurred in 13% of seizures and 16.7% of patients. However, later during the seizures, a reproducible pattern of 7-Hz lateralized ictal rhythm was observed in 56% of seizures, associated with contralateral head version. We did not find correlation between presence of focal features and therapeutic response in IGE patients. Our decision flowchart distinguished between focal and generalized epilepsy in patients with bilateral tonic-clonic seizures and focal features with an accuracy of 96.6%., Significance: Focal semiology associated with bilateral tonic-clonic seizures and focal IEDs are common features in patients with IGE, but focal ictal EEG onset is rare. None of these focal findings appears to influence therapeutic response. By assessing the concordance between interictal and ictal EEG findings, one can accurately distinguish between focal and generalized epilepsies., (© 2024 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Background: A pseudotyped modified rabies virus lacking the rabies glycoprotein (G-protein), which is crucial for transsynaptic spread, can be used for monosynaptic retrograde tracing. By coupling the pseudotyped virus with transgene expression of the G-protein and the avian leukosis and sarcoma virus subgroup A receptor (TVA), which is necessary for cell entry of the virus, researchers can investigate specific neuronal populations. Responder mouse lines, like the RΦGT mouse line, carry the genes encoding the G-protein and TVA under Cre-dependent expression. These mouse lines are valuable tools because they reduce the number of viral injections needed compared to when using helper viruses. Since RΦGT mice do not express Cre themselves, introducing the pseudotyped rabies virus into their brain should not result in viral cell entry or spread., Results: We present a straightforward flowchart for adequate controls in tracing experiments, which we employed to demonstrate Cre-independent expression of TVA in RΦGT mice., Conclusions: Our observations revealed TVA leakage, indicating that RΦGT mice should be used with caution for transgene expression of TVA. Inaccurate tracing outcomes may occur if TVA is expressed in the absence of Cre since background leakage leads to nonspecific cell entry. Moreover, conducting appropriate control experiments can identify the source of potential caveats in virus-based neuronal tracing experiments., (© 2024. The Author(s).)

Background: Several markers for the diagnosis of pleural effusion have been reported; however, a comprehensive evaluation using those markers has not been performed. Therefore, this study aimed to develop a diagnostic flowchart for tuberculous pleurisy, pleural infection, malignant pleural effusion, and other diseases by using these markers., Methods: We retrospectively collected data from 174 patients with tuberculous pleurisy, 215 patients with pleural infection other than tuberculous pleurisy, 360 patients with malignant pleural effusion, and 209 patients with other diseases at Fukujuji Hospital from January 2012 to October 2022. The diagnostic flowchart for four diseases was developed by using several previously reported markers., Results: The flowchart was developed by including seven markers: pleural ADA ≥40 IU/L, pleural fluid LDH <825 IU/L, pleural fluid ADA/TP < 14, neutrophil predominance or cell degeneration, peripheral blood WBC ≥9200/μL or serum CRP ≥12 mg/dL, pleural amylase ≥75 U/L, and the presence of pneumothorax according to the algorithm of a decision tree. The accuracy ratio of the flowchart was 71.7 % for the diagnosis of the four diseases, with 79.3 % sensitivity and 75.4 % positive predictive value (PPV) for tuberculosis pleurisy, 75.8 % sensitivity and 83.2 % PPV for pleural infection, 88.6 % sensitivity and 68.8 % PPV for malignant pleural effusion, and 33.0 % sensitivity and 60.0 % PPV for other diseases in the flowchart. The misdiagnosis ratios were 4.6 % for tuberculosis pleurisy, 6.8 % for pleural infection, and 8.3 % for malignant pleural effusion., Conclusion: This study developed a useful diagnostic flowchart for tuberculous pleurisy, pleural infection, malignant pleural effusion, and other diseases., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2023 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Objective: Graphical representation of information organizes and promotes meaningful learning. As an example of graphical organizers, flowcharts can simplify and summarize complex information. The evidence of classroom use of flowcharts as an instructional tool is unclear. We investigated the effectiveness of flowcharts on student learning as an in-class instructional tool in a cardiovascular therapeutic course. Student experiences with the use and application of flowcharts were explored., Methods: An explanatory sequential mixed-methods study was conducted with pharmacy students enrolled in an acute-care cardiovascular course from 2019-2021. The quantitative phase comprised a survey to determine flowchart effectiveness and a comparison of student performance in three content areas. The qualitative phase of the study used focused group interviews to understand student perceptions of flowchart use., Results: Survey results indicated that using flowcharts improved understanding (110/128, 86%), integration of material (114/128, 89%), and overall knowledge (111/128, 87%). Student performance in the 3 content areas, shock, arrhythmia, and acute coronary syndrome were statistically significant with flowcharts implementation. Emerging themes from student interviews were (1) used as a medium for retention and recall, (2) used as a study tool, and (3) used as a decision-making framework., Conclusion: Flowcharts provide an alternative approach to teaching complex content, which allows students to organize and summarize information that promotes meaningful learning. The ease of implementation combined with the generalized nature of flowcharts makes it an effective graphical organizer that can be used across various disciplines., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Users of continuous glucose monitors (CGMs) experience the product in part through software. Smartphone and watch apps empower people affected by diabetes to make real-time treatment decisions based on glucose readings and aggregate data such as medication, nutrition, and activity information. As CGMs evolve and gain greater market adoption, there's opportunity for these apps to play a greater role in users' lives and diabetes management. To do so, designers should follow the best practices established by the broader technology community and apply them to the needs of this community. The process of thorough discovery research, clear problem definition, iterative design, and testing can lower barriers toward broader adoption, and favorably influence the health of users through their mobile apps., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DK, PH, AJ, and AD are full-time employees of Dexcom, Inc.

Background and Aims: Systems existing in hospital or clinic settings offer services within the physical environment. Examples of such systems include picture archiving and communication systems, which provide remote services for patients. To develop a successful system, methods like software development life cycles (SDLCs) and design techniques, such as prototyping, are needed. This study aimed to specify requirements, design, and evaluation of dental image exchange and management system using a user-centered approach., Methods: This cross-sectional study was conducted in four phases, each corresponding to different stages of SDLCs. User-needs data were used to gathered by interviews and observations. A prototype was developed using object-oriented programming and presented to users for feedback. Finally, focus group was used to finalized the prototype into the desired system., Results: User needs were identified and prioritized from the outset, with ease of use, security, and mobile apps being their most essential requirements. The prototype underwent several iterations of design and evaluation in focus group sessions until users were satisfied, and their feedback was incorporated. Eventually, the prototype was refined into the final system with users' consent., Conclusion: The study revealed that instant access to information, voluntary participation, user interface (UI) design, and usefulness were critical variables for users and should be integral to any system. Successful implementation of such a system requires careful consideration of end-users' needs and their application to the system. Moreover, integrating the system with electronic health records can further enhance the treatment process and the efficiency of medical staff. The voluntary perspective of users played a significant role in achieving an exemplary UI and overall satisfaction with the system. Developers and policymakers should consider these aspects in similar system development projects., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Objective: Available guidelines are ambiguous about safe handling monoclonal antibodies (MABs) and whether or not to use a Closed System Drug-Transfer Device (CSTD). In this article we want to describe a standardized working method on handling MABs in a clinical trial setting., Data Sources: The current workflow at the clinical trial unit of the Ghent University Hospital was critically analyzed, after which an extensive literature review was performed using the National Institute for Occupational Safety and Health Working Group guidelines and the database PubMed (Keywords: monoclonal antibodies, closed system transfer devices, safety guidelines, safe handling, management, administration, (bio)compatibility, volume loss, contamination, clinical trial unit. Period: 2020-2022)., Data Summary: Literature data are ambiguous. CSTDs can reduce cross-contamination and minimize exposure to potential hazardous drugs for healthcare professionals. However, in recent years more questions have been raised about their in-use compatibility and their impact on final product quality. This makes the debate on implementing CSTDs a hot topic in daily pharmacy practice and demands a holistic and standardized approach when deciding whether or not to use a CSTD when handling MABs. In a clinical trial setting, where safety data are frequently not available and the compatibility of CSTDs and investigational product is often unknown, this poses additional challenges that need to be taken into account., Conclusion: We developed a flowchart which standardizes the use of a CSTD when handling MABs. It allows other healthcare professionals and clinical trial sponsors to define and evaluate the necessary criteria when standardizing the position of a CSTD in their safe handling procedures., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aimed to determine suitable combinations of text and pictogram sizes for older adults and investigated the visual prioritization of pictogram versus text., Background: Icons have become an indispensable part of application (app) design. Pictogram size and text size of icons influence the usability of apps, especially by aged users. However, few studies have investigated the influences of different pictogram and text size combinations on readability, legibility, and visual search performance for older adults., Method: This study used eye-tracking technology to investigate the effects of different pictogram and text size combinations as well as familiarity on readability, legibility, and visual search performance for older adults. A 3 (pictogram size) × 3 (text size) × 2 (familiarity) repeated-measures experimental design was used., Results: The results of this study suggest that pictogram size and text size significantly affect visual search performance and that familiarity moderates the effect of text size on distribution of fixation duration proportion for text and pictograms., Conclusion: Large pictogram and text sizes improved the readability and legibility of icons for older adults. Furthermore, the older adults fixated the area of text prior to pictograms when the pictogram size was larger than 72 × 72 px (1.38° × 1.38°) in the visual search task., Application: The results of this study suggest using different combinations of pictogram and text sizes for older adults under different scenarios. The findings of this study act as practical support for designers and developers of mobile apps for older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Early leakage detection following bariatric procedures is crucial, but a standardized evaluation method is lacking. The aim was to validate the potential benefits of postoperative day 1 (POD1) C-reactive protein (CRP) levels and white blood cell (WBC) counts in distinguishing at-risk patients following Roux-en-Y gastric bypass (RYGB) while considering the impact of obesity-related chronic inflammation., Methods: Retrospective analysis of 261 consecutive patients aged 18-65 years with a body mass index (BMI) of 32.5-50 kg/m 2 who underwent primary RYGB between 2017 and 2022. Sequential changes in CRP levels and WBC counts measured 48 h preoperatively and on POD1 morning were collected and compared between patients with/without complications and in patients without complications stratified by preoperative CRP levels., Results: Female patients and those with a higher BMI tended to have higher baseline CRP levels, which were positively related to postoperative CRP. Patients experiencing complications had higher WBC counts and a higher prevalence of WBC counts >14,000/μl (77.8% vs. 25.4%; p<0.001) than those without complications. Baseline CRP ≥ 0.3 mg/dl, a longer operative time, and blood loss >10 ml were significantly more common with WBC counts above 14,000/μl; a reasonable range of change in WBC count (∆WBC) derived from its positive correlation to postoperative WBC count (r=0.6695) may serve as a useful complementary indicator., Conclusion: An individualized CRP threshold setting and integrated interpretation of the WBC count can be more appropriate than using static criteria for differentiating at-risk patients after RYGB. Further studies are needed to validate these findings and determine their generalizability., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study developed and evaluated the Rapid Automatized naming, Phonological Awareness, and Letter Identification (RAPALI) flowchart for early dyslexia identification in pediatric settings. Using early literacy skills at kindergarten level from the Thai emergent literacy for predicting dyslexia longitudinal study, the RAPALI flowchart effectively identified dyslexia risk at grade 3 level, boasting an AUC of 0.71, a sensitivity of 95.5%, and a negative predictive value of 99.1%. RAPALI demonstrated acceptable specificity and positive predictive value. The user-friendly flowchart aids early identification, interventions, and preventive measures for dyslexia, benefiting affected children and their families. However, further validation and adaptation are needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest related to this research. The study was conducted with scientific integrity and objectivity, and the authors were not influenced by any financial or personal relationships that could have affected the research design, data analysis, interpretation, or reporting of the findings. This work was carried out with full transparency and adherence to ethical principles in research., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The Monte Carlo N-Particle (MCNP) is often used to calculate the radiation dose during computed tomography (CT) scans. However, the physical calculation process of the model is complicated, the input file structure of the program is complex, and the three-dimensional (3D) display of the geometric model is not supported, so that the researchers cannot establish an accurate CT radiation system model, which affects the accuracy of the dose calculation results. Aiming at these two problems, this study designed a software that visualized CT modeling and automatically generated input files. In terms of model calculation, the theoretical basis was based on the integration of CT modeling improvement schemes of major researchers. For 3D model visualization, LabVIEW was used as the new development platform, constructive solid geometry (CSG) was used as the algorithm principle, and the introduction of editing of MCNP input files was used to visualize CT geometry modeling. Compared with a CT model established by a recent study, the root mean square error between the results simulated by this visual CT modeling software and the actual measurement was smaller. In conclusion, the proposed CT visualization modeling software can not only help researchers to obtain an accurate CT radiation system model, but also provide a new research idea for the geometric modeling visualization method of MCNP.