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Background: Mobile health (mHealth) has the potential to bring preventive healthcare within reach of populations with limited access to preventive services, by delivering personalized support at low cost. Although numerous mHealth interventions are available, very few have been developed following an evidence-based rationale or have been tested for efficacy. This article describes the systematic development of a coach-supported mHealth application to improve healthy lifestyles for the prevention of dementia and cardiovascular disease in the United Kingdom (UK) and China. Methods: Development of the Prevention of Dementia by Mobile Phone applications (PRODEMOS) platform built upon the experiences with the Healthy Aging Through Internet Counseling in the Elderly (HATICE) eHealth platform. In the conceptualization phase, experiences from the HATICE trial and needs and wishes of the PRODEMOS target population were assessed through semi-structured interviews and focus group sessions. Initial technical development of the platform was based on these findings and took place in consecutive sprint sessions. Finally, during the evaluation and adaptation phase, functionality and usability of the platform were evaluated during pilot studies in UK and China. Results: The PRODEMOS mHealth platform facilitates self-management of a healthy lifestyle by goal setting, progress monitoring, and educational materials on healthy lifestyles. Participants receive remote coaching through a chat functionality. Based on lessons learned from the HATICE study and end-users, we made the intervention easy-to-use and included features to personalize the intervention. Following the pilot studies, in which in total 77 people used the mobile application for 6 weeks, the application was made more intuitive, and we improved its functionalities. Conclusion: Early involvement of end-users in the development process and during evaluation phases improved acceptability of the mHealth intervention. The actual use and usability of the PRODEMOS intervention will be assessed during the ongoing PRODEMOS randomized controlled trial, taking a dual focus on effectiveness and implementation outcomes., Competing Interests: AG and MM were employed by Philips VitalHealth. LS and XY were employed by Fuzhou Comvee Network &Technology Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hafdi, Eggink, Hoevenaar-Blom, Witvliet, Andrieu, Barnes, Brayne, Brooks, Coley, Georges, van der Groep, van Marwijk, van der Meijden, Song, Song, Wang, Wang, Wang, Wimo, Ye, van Charante and Richard.)

Introduction: Profiles of high risk for future dementia are well understood and are likely to concern mostly those in low-income and middle-income countries and people at greater disadvantage in high-income countries. Approximately 30%-40% of dementia cases have been estimated to be attributed to modifiable risk factors, including hypertension, smoking and sedentary lifestyle. Tailored interventions targeting these risk factors can potentially prevent or delay the onset of dementia. Mobile health (mHealth) improves accessibility of such prevention strategies in hard-to-reach populations while at the same time tailoring such approaches. In the current study, we will investigate the effectiveness and implementation of a coach-supported mHealth intervention, targeting dementia risk factors, to reduce dementia risk., Methods and Analysis: The prevention of dementia using mobile phone applications (PRODEMOS) randomised controlled trial will follow an effectiveness-implementation hybrid design, taking place in the UK and China. People are eligible if they are 55-75 years old, of low socioeconomic status (UK) or from the general population (China); have ≥2 dementia risk factors; and own a smartphone. 2400 participants will be randomised to either a coach-supported, interactive mHealth platform, facilitating self-management of dementia risk factors, or a static control platform. The intervention and follow-up period will be 18 months. The primary effectiveness outcome is change in the previously validated Cardiovascular Risk Factors, Ageing and Incidence of Dementia dementia risk score. The main secondary outcomes include improvement of individual risk factors and cost-effectiveness. Implementation outcomes include acceptability, adoption, feasibility and sustainability of the intervention., Ethics and Dissemination: The PRODEMOS trial is sponsored in the UK by the University of Cambridge and is granted ethical approval by the London-Brighton and Sussex Research Ethics Committee (reference: 20/LO/01440). In China, the trial is approved by the medical ethics committees of Capital Medical University, Beijing Tiantan Hospital, Beijing Geriatric Hospital, Chinese People's Liberation Army General Hospital, Taishan Medical University and Xuanwu Hospital. Results will be published in a peer-reviewed journal., Trial Registration Number: ISRCTN15986016., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

This paper examines the prospect of PEM (Proton Exchange Membrane) electrolyzers and fuel cells to partake in European electrical ancillary services markets. First, the current framework of ancillary services is reviewed and discussed, emphasizing the ongoing European harmonization plans for future frequency balancing markets. Next, the technical characteristics of PEM hydrogen technologies and their potential uses within the electrical power system are discussed to evaluate their adequacy to the requirements of ancillary services markets. Last, a case study based on a realistic representation of the transmission grid in the north of the Netherlands for the year 2030 is presented. The main goal of this case study is to ascertain the effectiveness of PEM electrolyzers and fuel cells for the provision of primary frequency reserves. Dynamic generic models suitable for grid simulations are developed for both technologies, including the required controllers to enable participation in ancillary services markets. The obtained results show that PEM hydrogen technologies can improve the frequency response when compared to the procurement with synchronous generators of the same reserve value. Moreover, the fast dynamics of PEM electrolyzers and fuel cells can help mitigate the negative effects attributed to the reduction of inertia in the system.

This paper reports on the role users played in the design and development of an electronic patient record. Two key users participated in the project team. All future users received questionnaires and a selection of them was interviewed. Before starting the development of the EPR, the attitude of users towards electronic record keeping, their satisfaction with the paper clinical records, their knowledge of computers, and their needs and expectations of computer applications in health care were measured by means of a questionnaire. The results of the questionnaire were supplemented with in-depth interviews. Users had a neutral attitude towards electronic record keeping. They were more positive about data entry of the paper records than data retrieval. During the development phase, but prior to the implementation of the EPR, a second questionnaire measured satisfaction with the paper records. Satisfaction appeared to be related to self-rated computer experience. Inexperienced computer users tended to be more positive about the paper records. In general, respondents did not have many expectations about electronic record keeping. A second series of interviews zoomed in on the expectations users had. Except for more concise reporting no beneficial effects of electronic record keeping were expected.

In this article the paper record and its position in work practices is discussed, and is related to the situation at an inpatient clinic for which an electronic patient record (EPR) is in development. In addition reported research on innovations is discussed. An analysis of 42 clinical paper records gave insight into existing problems with paper records. The current work practices were analysed based on two periods of observations in the ward and eight in-depth interviews with questions about their daily work, communication in the ward and the role of the paper record in communication. The results indicate that several problems described in the literature were recognised only for a part of the medical and nursing records. One probable cause of insufficient communication between health care workers appeared to be the internal organisation of the paper records. The fact that the experimental EPR system will be small-scaled, introduces specific problems regarding communication with other departments that still work with paper records. Nevertheless, we conclude that also an electronic patient record designed for a specific setting has the potential to improve record keeping and communication between health care workers.

This article presents an electronic patient record (EPR) for stroke patients. At the neurology department of the Maastricht University Hospital, coordination and communication of the multidisciplinary team for stroke patients is intended to be supported by an EPR. Existing, structured, paper nursing and medical records served as a starting point for the development of the EPR. In close cooperation with future users, the database structure, and data entry and data retrieval aspects of the user interface were adapted to the domain of stroke. The result is a combined electronic medical and nursing record that has potential to improve record keeping and to truly support daily routines. The challenges encountered in the development process were maintaining continuous user involvement and conflicting points of view regarding the relevance of clinical data. Conclusively, we state that intensive user participation improved the EPR, coupling with the existing hospital information system and other systems will be advantageous and the fact that the paper records were structured in advance will smooth the unavoidable changes in work patterns.