Validity and reliability of a novel device for bilateral upper extremity functional measurements

Background and objective

This study was designed to establish the validity and reliability of a new device that measures bilateral shoulder and elbow range of motion (ROM) and grip force performance in vivo. A further aim was to investigate the control of inter-limb grip force coordination during isometric force-maintenance tasks. Validity of the ROM and grip force measurements was examined using a validated clinical goniometer and standard weights.

Subjects

Twenty-one healthy adults (six female, 15 male; mean ± standard deviation age = 23.05 ± 3.51) were recruited for this study.

Design

All subjects were asked to perform tests to evaluate the validity and reliability of ROM, grip force maximum voluntary contraction (MVC) and coordination control measurements.

Results

The ROM and grip force measurements were linearly correlated with criterion standards. For reliability testing, all of the intraclass correlation coefficient values were >0.99. The inter-limb grip force coordination control task showed that the force modulation timing during dominant-to-non-dominant hand transition was longer than the non-dominant-to-dominant hand transition (p < 0.05).

Conclusions

These results demonstrate that this device is valid and reliable when used to measure shoulder and elbow ROM and grip force of both hands. Isometric force-maintenance tasks also indicated changes in inter-limb grip force control.     

Infection risk in patients with rheumatoid arthritis treated with etanercept or adalimumab

Objectives

To compare the risk of infection for rheumatoid arthritis (RA) patients who took etanercept or adalimumab medication in a nationwide population.

Methods

RA patients who took etanercept or adalimumab were identified in the Taiwan's National Health Insurance Research Database. The composite outcome of serious infections, including hospitalization for infection, reception of an antimicrobial injection, and tuberculosis were followed for 365 days. A Kaplan–Meier survival curve with a log-rank test and Cox proportional hazards regression were used to compare risks of infection between the two cohorts of tumor necrosis factor (TNF)-α antagonists users. Hazard ratios (HRs) were obtained and adjusted with propensity scores and clinical factors. Sensitivity analyses and subgroup analyses were also performed.

Results

In total, 1660 incident etanercept users and 484 incident adalimumab users were eligible for the analysis. The unadjusted HR for infection of the etanercept users was significantly higher than that of the adalimumab users (HR: 1.93; 95% confidence interval (CI): 1.09–3.42; p = 0.024). The HRs were 2.04 (95% CI: 1.14–3.65; p = 0.016) and 2.02 (95% CI: 1.13–3.61; p = 0.018) after adjusting for propensity scores and for propensity scores in addition to clinical factors, respectively. The subgroup analyses revealed that HRs for composite infection was significantly higher in patient subgroups of older age, female, as well as patients who did not have DM, COPD, and hospitalization history at the baseline.

Conclusion

In this head-to-head cohort study involving a nationwide population of patients with RA, etanercept users demonstrated a higher risk of infection than adalimumab users. Results of this study suggest the possible existence of an intra-class difference in infection risk among TNF-α antagonists.     

A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms

Objective

Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite.

Methods

A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses.

Results

Both the training only intervention (p < 0.001) and the chair with training intervention (p = 0.01) reduced visual symptoms after 12 months.

Conclusion

The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability.     

Optimization of novel spectral estimator for fractionated electrogram analysis is helpful to discern atrial fibrillation type

Introduction

Paroxysmal versus persistent atrial fibrillation (AF) can be distinguished based on differences in the spectral parameters of fractionated atrial electrograms. Maximization of these differences would improve characterization of the arrhythmogenic substrate. A novel spectral estimator (NSE) has been shown previously to provide greater distinction in AF spectral parameters as compared with the Fourier transform estimator. Herein, it is described how the differences in NSE spectral parameters can be further improved.

Method

In 10 persistent and 9 paroxysmal AF patients undergoing electrophysiologic study, fractionated electrograms were acquired from the distal bipolar ablation electrode. A total of 204 electrograms were recorded from the pulmonary vein (PV) antra and from the anterior and posterior left atrial free wall. The following spectral parameters were measured: the dominant frequency (DF), which reflects local activation rate, the DF amplitude (DA), and the mean spectral profile (MP), which represents background electrical activity. To optimize differences in parameters between paroxysmal versus persistent AF patients, the NSE was varied by selectively removing subharmonics, using a threshold. The threshold was altered in steps to determine the optimal subharmonics removal.

Results

At the optimal threshold level, mean differences in persistent versus paroxysmal AF spectral parameters were: ΔDA = +0.371 mV, ΔDF = +0.737 Hz, and ΔMP = −0.096 mV. When subharmonics were not removed, the differences were substantially less: ΔDA = +0.301 mV, ΔDF = +0.699 Hz, and ΔMP = −0.063 mV.

Conclusions

NSE optimization produces greater spectral parameter difference between persistent versus paroxysmal AF data. Quantifying spectral parameter differences can be assistive in characterizing the arrhythmogenic substrate.     

Augment low-field intra-operative MRI with preoperative MRI using a hybrid non-rigid registration method

Background

Preoperatively acquired diffusion tensor image (DTI) and blood oxygen level dependent (BOLD) have been proved to be effective in providing more anatomical and functional information; however, the brain deformation induced by brain shift and tumor resection severely impairs the correspondence between the image space and the patient space in image-guided neurosurgery.

Method

To address the brain deformation, we developed a hybrid non-rigid registration method to register high-field preoperative MRI with low-field intra-operative MRI in order to recover the deformation induced by brain shift and tumor resection. The registered DTI and BOLD are fused with low-field intra-operative MRI for image-guided neurosurgery.

Results

The proposed hybrid registration method was evaluated by comparing the landmarks predicted by the hybrid registration method with the landmarks identified in the low-field intra-operative MRI for 10 patients. The prediction error of the hybrid method is 1.92 ± 0.54 mm, and the compensation accuracy is 74.3 ± 5.0%. Compared to the landmarks far from the resection region, those near the resection region demonstrated a higher compensation accuracy (P-value = .003) although these landmarks had larger initial displacements.

Conclusions

The proposed hybrid registration method is able to bring preoperatively acquired BOLD and DTI into the operating room and compensate for the deformation to augment low-field intra-operative MRI with rich anatomical and functional information.     

Brain mass estimation by head circumference and body mass methods in neonatal glycaemic modelling and control

Introduction

Hyperglycaemia is a common complication of stress and prematurity in extremely low-birth-weight infants. Model-based insulin therapy protocols have the ability to safely improve glycaemic control for this group. Estimating non-insulin-mediated brain glucose uptake by the central nervous system in these models is typically done using population-based body weight models, which may not be ideal.

Method

A head circumference-based model that separately treats small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants is compared to a body weight model in a retrospective analysis of 48 patients with a median birth weight of 750 g and median gestational age of 25 weeks. Estimated brain mass, model-based insulin sensitivity (S_I) profiles, and projected glycaemic control outcomes are investigated. SGA infants (5) are also analyzed as a separate cohort.

Results

Across the entire cohort, estimated brain mass deviated by a median 10% between models, with a per-patient median difference in S_I of 3.5%. For the SGA group, brain mass deviation was 42%, and per-patient S_I deviation 13.7%. In virtual trials, 87–93% of recommended insulin rates were equal or slightly reduced (Δ < 0.16 mU/h) under the head circumference method, while glycaemic control outcomes showed little change.

Conclusion

The results suggest that body weight methods are not as accurate as head circumference methods. Head circumference-based estimates may offer improved modelling accuracy and a small reduction in insulin administration, particularly for SGA infants.     

A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

Objective

Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions.

Methods

Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses.

Results

The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention.

Conclusion

Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms.     

Evaluation of a 3 year intervention to increase adoption of safer nursery crop production practices

Background

We conducted a 3 year intervention to increase awareness and adoption of eight more profitable nursery crop production practices that reduced certain traumatic and musculoskeletal injury hazards.

Methods

We disseminated information to nursery managers across seven states using information channels they were known to rely on (e.g. trade publications, public events, university Extension, other managers). We evaluated rolling, independent, probability samples (n = 1200) with mail questionnaires before the intervention and after each of 3 intervention years. We also evaluated samples (n = 250) from a comparison group of New Zealand nursery managers.

Results

The intervention was associated with increased awareness of four of the eight practices among US managers after year 3 compared to their baseline: zippers (20 vs. 32%, p ≤ 0.000), stools (11 vs. 22%, p ≤ 0.001), pruners (29 vs. 40%, p ≤ 0.014), and tarps (24 vs. 33%, p ≤ 0.009). There were no changes in adoption. New Zealand manager awareness was increased for hoes after year 2 compared to their baseline (35 vs. 52%, p ≤ 0.010).

Conclusions

A modest, regionwide information dissemination intervention was associated with increased awareness, but not adoption.     

Hands-free administration of subjective workload scales: Acceptability in a surgical training environment

Introduction

Subjective workload measures are usually administered in a visual-manual format, either electronically or by paper and pencil. However, vocal responses to spoken queries may sometimes be preferable, for example when experimental manipulations require continuous manual responding or when participants have certain sensory/motor impairments. In the present study, we evaluated the acceptability of the hands-free administration of two subjective workload questionnaires - the NASA Task Load Index (NASA-TLX) and the Multiple Resources Questionnaire (MRQ) - in a surgical training environment where manual responding is often constrained.

Method

Sixty-four undergraduates performed fifteen 90-s trials of laparoscopic training tasks (five replications of 3 tasks - cannulation, ring transfer, and rope manipulation). Half of the participants provided workload ratings using a traditional paper-and-pencil version of the NASA-TLX and MRQ; the remainder used a vocal (hands-free) version of the questionnaires. A follow-up experiment extended the evaluation of the hands-free version to actual medical students in a Minimally Invasive Surgery (MIS) training facility.

Results

The NASA-TLX was scored in 2 ways - (1) the traditional procedure using participant-specific weights to combine its 6 subscales, and (2) a simplified procedure - the NASA Raw Task Load Index (NASA-RTLX) - using the unweighted mean of the subscale scores. Comparison of the scores obtained from the hands-free and written administration conditions yielded coefficients of equivalence of r = 0.85 (NASA-TLX) and r = 0.81 (NASA-RTLX). Equivalence estimates for the individual subscales ranged from r = 0.78 (“mental demand”) to r = 0.31 (“effort”). Both administration formats and scoring methods were equally sensitive to task and repetition effects. For the MRQ, the coefficient of equivalence for the hands-free and written versions was r = 0.96 when tested on undergraduates. However, the sensitivity of the hands-free MRQ to task demands (η_partial² = 0.138) was substantially less than that for the written version (η_partial² = 0.252). This potential shortcoming of the hands-free MRQ did not seem to generalize to medical students who showed robust task effects when using the hands-free MRQ (η_partial² = 0.396). A detailed analysis of the MRQ subscales also revealed differences that may be attributable to a “spillover” effect in which participants’ judgments about the demands of completing the questionnaires contaminated their judgments about the primary surgical training tasks.

Conclusion

Vocal versions of the NASA-TLX are acceptable alternatives to standard written formats when researchers wish to obtain global workload estimates. However, care should be used when interpreting the individual subscales if the object is to make comparisons between studies or conditions that use different administration modalities. For the MRQ, the vocal version was less sensitive to experimental manipulations than its written counterpart; however, when medical students rather than undergraduates used the vocal version, the instrument’s sensitivity increased well beyond that obtained with any other combination of administration modality and instrument in this study. Thus, the vocal version of the MRQ may be an acceptable workload assessment technique for selected populations, and it may even be a suitable substitute for the NASA-TLX.     

A pilot study to compare programming effort for two parallel programming models

Context

Writing software for the current generation of parallel systems requires significant programmer effort, and the community is seeking alternatives that reduce effort while still achieving good performance.

Objective

Measure the effect of parallel programming models (message-passing vs. PRAM-like) on programmer effort.

Design, setting, and subjects

One group of subjects implemented sparse-matrix dense-vector multiplication using message-passing (MPI), and a second group solved the same problem using a PRAM-like model (XMTC). The subjects were students in two graduate-level classes: one class was taught MPI and the other was taught XMTC.

Main outcome measures

Development time, program correctness.

Results

Mean XMTC development time was 4.8 h less than mean MPI development time (95% confidence interval, 2.0-7.7), a 46% reduction. XMTC programs were more likely to be correct, but the difference in correctness rates was not statistically significant (p = .16).

Conclusions

XMTC solutions for this particular problem required less effort than MPI equivalents, but further studies are necessary which examine different types of problems and different levels of programmer experience.     

The relationship between usage intention and adoption of electronic health records at primary care clinics

Objective

Despite of emerging evidence that electronic health records (EHRs) can improve the clinical quality, enhances patient safety and efficiency. Most physicians in primary health care clinics in the Taiwan do not currently adopt EHR at their clinic practices. We aim to measure the relationship between usage intention and adoption behavior.

Study design and methods

We used structured questionnaires distributed both EHRs adopter and non-adopter group to the primary health care physicians which participated in the DOH project to establish the information exchange environment across Taiwan. The response rate of adopter and non-adopter is 54.7% and 55.0% respectively.

Measurements

EHRs adoption behavior.

Results

The EHRs adopter group has higher intention than non-adopter (p = 0.003). From the result of logistic regression analyses, we found the key factors affecting physicians’ adoption pattern were intention to use (OR: 2.85; 95% CI: 2.30–3.54). In addition, higher perceived usefulness (OR: 1.29; 95% CI: 1.06–1.56) and perceived ease to use (OR: 1.48; 95% CI: 1.22–1.79) increase adoption of EHR found.

Conclusion

The intention to use EHR, perceived usefulness and ease to use of primary care physicians were found as key factors influencing EHRs adoption. Thus, we suggest that government should promote the potential benefits of EHR and enhance physicians’ willingness to adopt the EHRs at their clinic practices.     

Impact of test-driven development on productivity, code and tests: A controlled experiment

Context

Test-driven development is an approach to software development, where automated tests are written before production code in highly iterative cycles. Test-driven development attracts attention as well as followers in professional environment; however empirical evidence of its superiority regarding its effect on productivity, code and tests compared to test-last development is still fairly limited. Moreover, it is not clear if the supposed benefits come from writing tests before code or maybe from high iterativity/short development cycles.

Objective

This paper describes a family of controlled experiments comparing test-driven development to micro iterative test-last development with emphasis on productivity, code properties (external quality and complexity) and tests (code coverage and fault-finding capabilities).

Method

Subjects were randomly assigned to test-driven and test-last groups. Controlled experiments were conducted for two years, in an academic environment and in different developer contexts (pair programming and individual programming contexts). Number of successfully implemented stories, percentage of successful acceptance tests, McCabe’s code complexity, code coverage and mutation score indicator were measured.

Results

Experimental results and their selective meta-analysis show no statistically significant differences between test-driven development and iterative test-last development regarding productivity (χ²(6) = 4.799, p = 1.0, r = .107, 95% CI (confidence interval): −.149 to .349), code complexity (χ²(6) = 8.094, p = .46, r = .048, 95% CI: −.254 to .341), branch coverage (χ²(6) = 13.996, p = .059, r = .182, 95% CI: −.081 to .421), percentage of acceptance tests passed (one experiment, Mann-Whitney U = 125.0, p = .98, r = .066) and mutation score indicator (χ²(4) = 3.807, p = .87, r = .128, 95% CI: −.162 to .398).

Conclusion

According to our findings, the benefits of test-driven development compared to iterative test-last development are small and thus in practice relatively unimportant, although effects are positive. There is an indication of test-driven development endorsing better branch coverage, but effect size is considered small.     

Dynamic functional residual capacity can be estimated using a stress-strain approach

Background

Acute Respiratory Distress Syndrome (ARDS) results in collapse of alveolar units and loss of lung volume at the end of expiration. Mechanical ventilation is used to treat patients with ARDS or Acute Lung Injury (ALI), with the end objective being to increase the dynamic functional residual capacity (dFRC), and thus increasing overall functional residual capacity (FRC). Simple methods to estimate dFRC at a given positive end expiratory pressure (PEEP) level in patients with ARDS/ALI currently does not exist. Current viable methods are time-consuming and relatively invasive.

Methods

Previous studies have found a constant linear relationship between the global stress and strain in the lung independent of lung condition. This study utilizes the constant stress-strain ratio and an individual patient's volume responsiveness to PEEP to estimate dFRC at any level of PEEP. The estimation model identifies two global parameters to estimate a patient specific dFRC, β and mβ. The parameter β captures physiological parameters of FRC, lung and respiratory elastance and varies depending on the PEEP level used, and mβ is the gradient of β vs. PEEP.

Results

dFRC was estimated at different PEEP values and compared to the measured dFRC using retrospective data from 12 different patients with different levels of lung injury. The median percentage error is 18% (IQR: 6.49) for PEEP = 5 cm H₂O, 10% (IQR: 9.18) for PEEP = 7 cm H₂O, 28% (IQR: 12.33) for PEEP = 10 cm H₂O, 3% (IQR: 2.10) for PEEP = 12 cm H₂O and 10% (IQR: 9.11) for PEEP = 15 cm H₂O. The results were further validated using a cross-correlation (N = 100,000). Linear regression between the estimated and measured dFRC with a median R² of 0.948 (IQR: 0.915, 0.968; 90% CI: 0.814, 0.984) over the N = 100,000 cross-validation tests.

Conclusions

The results suggest that a model based approach to estimating dFRC may be viable in a clinical scenario without any interruption to ventilation and can thus provide an alternative to measuring dFRC by disconnecting the patient from the ventilator or by using advanced ventilators. The overall results provide a means of estimating dFRC at any PEEP levels. Although reasonable clinical accuracy is limited to the linear region of the static PV curve, the model can evaluate the impact of changes in PEEP or other mechanical ventilation settings.     

Prevalence of carpal tunnel syndrome among employees at a poultry processing plant

Objective

To determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups.

Methods

Performed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios.

Results

Three hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)].

Conclusions

Increasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors.     

The effects of video on cognitive load and social presence in multimedia-learning

Two studies examined the use of video in multimedia learning environments. In Study 1, participants (N = 26) viewed one of two versions of a computer-based multimedia presentation: video, which included a video of a lecture with synchronized slides, or no video, which included the slides but only an audio narration of the lecture. Learning, cognitive load and social presence were assessed, but a significant difference was found only for cognitive load, with video experiencing greater cognitive load, t (24) = 2.45, p < .05. In Study 2, students (N = 25) were randomly assigned to either video or no video condition. Background knowledge and visual/verbal learning preference were assessed before viewing the presentation, and learning, cognitive load, and social presence were assessed after viewing. No significant differences were found for learning or social presence. However, a significant visual/verbal learning preference by condition interaction was found for cognitive load, F (1,21) = 4.51, p < .05: low visual-preference students experienced greater cognitive load in the video condition, while high visual-preference students experienced greater cognitive load in the no video condition.     

Learning performance with interactive simulations in medical education: Lessons learned from results of learning complex physiological models with the HAEMOdynamics SIMulator

Objective

Since simulations are often accepted uncritically, with excessive emphasis being placed on technological sophistication at the expense of underlying psychological and educational theories, we evaluated the learning performance of simulation software, in order to gain insight into the proper use of simulations for application in medical education.

Design

The authors designed and evaluated a software packet, following of user-centered development, which they call Haemodynamics Simulator (HAEMOSIM), for the simulation of complex physiological models, e.g., the modeling of arterial blood flow dependent on the pressure gradient, radius and bifurcations; shear–stress and blood flow profiles depending on viscosity and radius.

Measurements

In a quasi-experimental real-life setup, the authors compared the learning performance of 96 medical students for three conditions: (1) conventional text-based lesson; (2) HAEMOSIM alone and (3) HAEMOSIM with a combination of additional material and support, found necessary during user-centered development. The individual student’s learning time was unvarying in all three conditions.

Results

While the first two settings produced equivalent results, the combination of additional support and HAEMOSIM yielded a significantly higher learning performance. These results are discussed regarding Mayer’s multimedia learning theory, Sweller’s cognitive load theory, and claims of prior research on utilizing interactive simulations for learning.

Conclusion

The results showed that simulations can be beneficial for learning complex concepts, however, interacting with sophisticated simulations strain the limitation of cognitive processes; therefore successful application of simulations require careful additional guidance from medical professionals and a certain amount of previous knowledge on the part of the learners. The inclusion of pedagogical and psychological expertise into the design and development of educational software is essential.     

Effects of disease and leader type on moderators in online support groups

This study examines the effects of illness (cancer and Parkinson’s [PD]) on three moderators, the expression of positive and negative emotions and cognitive mechanisms. Each illness makes its own unique demands on patients and may influence change mechanisms. Similarly, we are asking, what effects do the type of leadership have on mediators that have previously been linked to positive outcomes. Four types of groups were studied, professional, the wellness community (TWC) chat mixed cancer (N groups = 4) and TWC chat PD patient groups (N groups = 6). The two peer groups were bulletin boards for colorectal cancer (N groups = 1) and PD BBs (N groups = 6). The design was a 2×2, disease and leader type. Computer-based text analysis, the linguistic inquiry and word count assessed the dependent variables. The results of the Manova found that; disease is P = NS, leader type, P = .00, interaction, P = .00. The interaction between disease and leader type is statistically significant, indicating that disease in combination with whether the leader is a peer or professional effects the expression of emotions and cognitive mechanisms.     

A usability evaluation of medical software at an expert conference setting

Introduction

A usability test was employed to evaluate two medical software applications at an expert conference setting. One software application is a medical diagnostic tool (electrocardiogram [ECG] viewer) and the other is a medical research tool (electrode misplacement simulator [EMS]). These novel applications have yet to be adopted by the healthcare domain, thus, (1) we wanted to determine the potential user acceptance of these applications and (2) we wanted to determine the feasibility of evaluating medical diagnostic and medical research software at a conference setting as opposed to the conventional laboratory setting.

Methods

The medical diagnostic tool (ECG viewer) was evaluated using seven delegates and the medical research tool (EMS) was evaluated using 17 delegates that were recruited at the 2010 International Conference on Computing in Cardiology. Each delegate/participant was required to use the software and undertake a set of predefined tasks during the session breaks at the conference. User interactions with the software were recorded using screen-recording software. The ‘think-aloud’ protocol was also used to elicit verbal feedback from the participants whilst they attempted the pre-defined tasks. Before and after each session, participants completed a pre-test and a post-test questionnaire respectively.

Results

The average duration of a usability session at the conference was 34.69 min (SD = 10.28). However, taking into account that 10 min was dedicated to the pre-test and post-test questionnaires, the average time dedication to user interaction of the medical software was 24.69 min (SD = 10.28). Given we have shown that usability data can be collected at conferences, this paper details the advantages of conference-based usability studies over the laboratory-based approach. For example, given delegates gather at one geographical location, a conference-based usability evaluation facilitates recruitment of a convenient sample of international subject experts. This would otherwise be very expensive to arrange. A conference-based approach also allows for data to be collected over a few days as opposed to months by avoiding administration duties normally involved in laboratory based approach, e.g. mailing invitation letters as part of a recruitment campaign.Following analysis of the user video recordings, 41 (previously unknown) use errors were identified in the advanced ECG viewer and 29 were identified in the EMS application. All use errors were given a consensus severity rating from two independent usability experts. Out of a rating scale of 4 (where 1 = cosmetic and 4 = critical), the average severity rating for the ECG viewer was 2.24 (SD = 1.09) and the average severity rating for the EMS application was 2.34 (SD = 0.97). We were also able to extract task completion rates and times from the video recordings to determine the effectiveness of the software applications. For example, six out of seven tasks were completed by all participants when using both applications. This statistic alone suggests both applications already have a high degree of usability. As well as extracting data from the video recordings, we were also able to extract data from the questionnaires. Using a semantic differential scale (where 1 = poor and 5 = excellent), delegates highly rated the ‘responsiveness’, ‘usefulness’, ‘learnability’ and the ‘look and feel’ of both applications.

Conclusion

This study has shown the potential user acceptance and user-friendliness of the novel EMS and the ECG viewer applications within the healthcare domain. It has also shown that both medical diagnostic software and medical research software can be evaluated for their usability at an expert conference setting. The primary advantage of a conference-based usability evaluation over a laboratory-based evaluation is the high concentration of experts at one location, which is convenient, less time consuming and less expensive.     

Combined cognitive behavioral therapy and bupropion for the treatment of problematic on-line game play in adolescents with major depressive disorder

The purpose of the current study was to evaluate the efficacy of cognitive behavioral therapy (CBT) in combination with bupropion for treatment of problematic on-line game play in adolescents with co-morbid major depressive disorder. Sixty-five depressed adolescents with excessive on-line game play were randomly assigned to a CBT group (CBT-Med group (N = 32)) or a clinical control group (Med group (N = 33)). Measures of severity of internet use, depressive symptoms, anxiety symptoms, life satisfaction and school adaptation were assessed at baseline, after the 8 week intervention, and at the end of a 4 week follow-up post-treatment period. Young Internet Addiction Scale scores in the CBT-Med group were reduced compared to those of the Med group, but there was no significant difference in the change of depression scores between two groups. The mean anxiety scores in the CBT-Med group did not change while those in the Med group were increased. The mean life satisfaction scores in the CBT-Med group were increased compared to those of the Med group. CBT in combination with bupropion may be effective for the treatment of depressed adolescents with on-line game addiction, particularly in reducing on-line game play and anxiety, as well as in improving life satisfaction.