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Significance: Despite the ample progress made toward faster and more accurate Monte Carlo (MC) simulation tools over the past decade, the limited usability and accessibility of these advanced modeling tools remain key barriers to widespread use among the broad user community. Aim: An open-source, high-performance, web-based MC simulator that builds upon modern cloud computing architectures is highly desirable to deliver state-of-the-art MC simulations and hardware acceleration to general users without the need for special hardware installation and optimization. Approach: We have developed a configuration-free, in-browser 3D MC simulation platform—Monte Carlo eXtreme (MCX) Cloud—built upon an array of robust and modern technologies, including a Docker Swarm-based cloud-computing backend and a web-based graphical user interface (GUI) that supports in-browser 3D visualization, asynchronous data communication, and automatic data validation via JavaScript Object Notation (JSON) schemas. Results: The front-end of the MCX Cloud platform offers an intuitive simulation design, fast 3D data rendering, and convenient simulation sharing. The Docker Swarm container orchestration backend is highly scalable and can support high-demand GPU MC simulations using MCX over a dynamically expandable virtual cluster. Conclusion: MCX Cloud makes fast, scalable, and feature-rich MC simulations readily available to all biophotonics researchers without overhead. It is fully open-source and can be freely accessed at http://mcx.space/cloud.

Objectives Evaluation of a computerised electrocardiogram algorithm compared to the interpretation of a team of board-certified veterinary cardiologists. Materials and methods This was a cross-sectional retrospective cohort study. A total of 399 electronic canine electrocardiogram recordings screened from 1391 electrocardiograms were enrolled in the study. A panel of seven cardiologists, masked to patient information, evaluated electrocardiograms for the following: P-wave amplitude and duration; PR-interval; R-wave amplitude; QRS duration; heart rate; mean electrical axis; and final overall diagnosis for the detection of arrhythmia and any abnormal electrocardiogram anomaly. Results The sensitivity of the electrocardiogram algorithm for detecting arrhythmias was 99.7% (95% confidence intervals, CI: 98.5 to 99.9) and the specificity was 99.5% (95% CI: 98.0 to 99.9) compared to the consensus result created by panel of cardiologists. The sensitivity of the algorithm for the detection of any electrocardiogram anomaly, including abnormal measurements, was 71.3% (95% CI: 65.5 to 76.7) and the specificity was 35.1% (95% CI: 27.0 to 43.8) compared to the panel of cardiologists. Clinical significance The electrocardiogram algorithm was shown to have high sensitivity for the detection of arrhythmias, but not all electrocardiogram anomalies. The results support the use of this algorithm as a tool to aid in the triage of the electrocardiogram workflow.

The mesh-based Monte Carlo (MMC) algorithm is increasingly used as the gold-standard for developing new biophotonics modeling techniques in 3-D complex tissues, including both diffusion-based and various Monte Carlo (MC)-based methods. Compared to multilayered and voxel-based MCs, MMC can utilize tetrahedral meshes to gain improved anatomical accuracy but also results in higher computational and memory demands. Previous attempts of accelerating MMC using graphics processing units (GPUs) have yielded limited performance improvement and are not publicly available. We report a highly efficient MMC—MMCL—using the OpenCL heterogeneous computing framework and demonstrate a speedup ratio up to 420× compared to state-of-the-art single-threaded CPU simulations. The MMCL simulator supports almost all advanced features found in our widely disseminated MMC software, such as support for a dozen of complex source forms, wide-field detectors, boundary reflection, photon replay, and storing a rich set of detected photon information. Furthermore, this tool supports a wide range of GPUs/CPUs across vendors and is freely available with full source codes and benchmark suites at http://mcx.space/#mmc.

Objective The purpose of the present research is to establish measurement equivalence and test differences in reliability between computerized and pencil-and-paper-based tests of spatial cognition. Background Researchers have increasingly adopted computerized test formats, but few attempt to establish equivalence for computer-based and paper-based tests. The mixed results in the literature on the test mode effect, which occurs when performance differs as a function of test medium, highlight the need to test for, instead of assume, measurement equivalence. One domain that has been increasingly computerized and is thus in need of tests of measurement equivalence across test mode is spatial cognition. Method In the present study, 244 undergraduate students completed two measures of spatial ability (i.e., spatial visualization and cross-sectioning) in either computer- or paper-and-pencil-based format. Results Measurement equivalence was not supported across computer-based and paper-based formats for either spatial test. The results also indicated that test administration type affected the types of errors made on the spatial visualization task, which further highlights the conceptual differences between test mediums. Paper-based tests also demonstrated increased reliability when compared with computerized versions of the tests. Conclusion The results of the measurement equivalence tests caution against treating computer- and paper-based versions of spatial measures as equivalent. We encourage subsequent work to demonstrate test mode equivalence prior to the utilization of spatial measures because current evidence suggests they may not reliably capture the same construct. Application The assessment of test type differences may influence the medium in which spatial cognition tests are administered.

This article reports our experience in developing a computerized cognitive assessment method in a nurse-led clinic. The assessment and report-writing time and the accuracy of using a computer as an assessment medium were compared with assessments that use the traditional pencil-and-paper method. The attitudes of professionals and service users toward the computerized approach were also collected. The results found that the computerized approach not only helped to reduce the time spent making assessments and writing reports but also improved the accuracy of the assessment when compared with the pencil-and-paper method. Most of the professionals and service users who were interviewed responded positively toward computerized assessments. The experience gained in this study will also help us to standardize our assessment procedures, promote communication among members of the clinical team, and facilitate data management and clinical research.

Knowledge about the total waste generated by the production of consumer goods can help raise awareness among policy-makers, producers and consumers of the benefits of closing loops in a future circular economy, avoiding unnecessary production and production steps and associated generation of large amounts of waste. In strict life cycle assessment practice, information on waste outputs from intermediate industrial processes of material and energy transformation is translated into and declared as potential environmental impacts, which are often not reported in the final results. In this study, a procedure to extract available intermediate data and perform a systematic pre-consumer waste footprint analysis was developed. The pre-consumer waste footprint concept was tested to analyse 10 generic products, which provided some novel and interesting results for the different product categories and identified a number of challenges that need to be resolved in development of the waste footprint concept. These challenges include standardised data declaration on waste in life cycle assessment, with a separation into waste categories illustrating the implicit environmental and scale of significance of waste types and quantities (e.g. hazardous waste, inert waste, waste for recycling/incineration) and establishment of a common definition of waste throughout sectors and nations.

O BESITY IS A PUBLIC HEALTH burden associated with a number of adverse health conditions and high health care costs. As an integral part of standard behavior-based therapy, selfmonitoring has been used in many lifestyle intervention programs to address the obesity epidemic. In weight management, self-monitoring usually consists of tracking dietary intake, physical activity, body weight, and/ or other health measurements. Previous research examined the efficacy of dietary self-monitoring on weight management. However, most of those studies addressed self-monitoring using traditional paper methods. The subsequent development and use of advanced technology-based self-monitoring approaches shows promising effects inweight loss.We evaluated the emerging evidence on the efficacy and adherence to different types of dietary self-monitoring, including traditional paper methods, web-based self-monitoring, and the use of mobile devices such as personal digital assistants, wearables, and tablets/mobile smartphones. Motivations and barriers to dietary selfmonitoring are described and strategies to improve adherence are identified. A discussion on future directions of dietary self-monitoring approaches in research and practice is also provided.

In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a ‘direct’ method, by asking patients to assess their understanding of genetic testing, and with a ‘composite’ score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients

Clinical reasoning competency is essential for an appropriate clinical dental treatment. Among the tools for the assessment of clinical reasoning competency, computer-based testing (CBT) is considered more useful than paper-based testing (PBT), because teachers can control the timing of information given to the examinees. Such timings could possibly affect the thinking process of examinees. However, few studies reported differences of reasoning between the two testing modes. In the present study, we developed an assessment of clinical reasoning and applied it using CBT and PBT to compare the examinees' performance. The participants comprised 60 students in the fifth-year class in 2012 of the School of Dentistry, Faculty of Dentistry, Tokyo Medical and Dental University. The tests comprised 25 problems, each with four questions, totaling 100 questions. The contents of the questions were the same in CBT and PBT. The students were assigned to CBT (Group C, n = 30) and PBT (Group P, n = 30) groups, with an almost equal gender ratio in the groups. The difference between scores was analyzed with a univariate analysis of variance. No significant intergroup differences were found regarding the test duration, total score, and average score of each question. The number of problems with perfect marks was higher in Group P than in Group C (P0.05), probably because Group P students could access the information of the previous question (s) within a problem. Thus, the differences of the examinees' performance between the two testing modes were small.

This report is a synthesis of the technical assistance (TA) and recommendations, carried out by the World Bank water and sanitation program (WSP) since September 2014. To achieve the target of 100 percent improved sanitation, there is a national drive to improve fecal sludge management (FSM). This TA recognizes that to achieve the goals it is necessary to support the development of national FSM policies, regulations, and guidelines, while also improving capacity at the local level by supporting the implementation of improved FSM models in target cities. The objective of the TA was to provide government with tested advice on how to scale up improved septage management nationwide through: (i) improvement of septage management in three cities through the application of new management models (local level); and (ii) assistance to national government in training and capacity building and the formulation of policies and regulations to improve septage management at scale (national level). This report is structured as follows: chapter one is the executive summary; chapter two gives the background to sanitation in Indonesia and to fecal sludge management in particular; chapter three provides an overview of the TA approach; chapter four gives details of the implementation of the TA; chapter five summarizes the lessons learned; and chapter six outlines the recommendations and next steps.

Four experiments were conducted to test whether recent developments in display technology would suffice to eliminate the well-known disadvantages in reading from screen as compared with paper. Proofreading speed and performance were equal for a TFT-LCD and a paper display, but there were more symptoms of eyestrain in the screen condition accompanied by a strong preference for paper (Experiment 1). These results were replicated using a longer reading duration (Experiment 2). Additional experiments were conducted to test hypotheses about the reasons for the higher amount of eyestrain associated with reading from screen. Reduced screen luminance did not change the pattern of results (Experiment 3), but positioning both displays in equal inclination angles eliminated the differences in eyestrain symptoms and increased proofreading speed in the screen condition (Experiment 4). A paper-like positioning of TFT-LCDs seems to enable unimpaired reading without evidence of increased physical strain. Practitioner Summary: Given the developments in screen technology, a re-assessment of the differences in proofreading speed and performance, well-being, and preference between computer screen and paper was conducted. State-of-the-art TFT-LCDs enable unimpaired reading, but a book-like positioning of screens seems necessary to minimise eyestrain symptoms.

The purpose of this study is to construct an approach and a methodology to estimate the future outflows of electronic waste (e-waste) in India. Consequently, the study utilizes a time-series multiple lifespan end-of-life model proposed by Peralta and Fontanos for estimating the current and future quantities of e-waste in India. The model estimates future e-waste generation quantities by modeling their usage and disposal. The present work considers two scenarios for the approximation of e-waste generation based on user preferences to store or to recycle the e-waste. This model will help formal recyclers in India to make strategic decisions in planning for appropriate recycling infrastructure and institutional capacity building. Also an extension of the model proposed by Peralta and Fontanos is developed with the objective of helping decision makers to conduct WEEE estimates under a variety of assumptions to suit their region of study. During 2007-2011, the total WEEE estimates will be around 2.5 million metric tons which include waste from personal computers (PC), television, refrigerators and washing machines. During the said period, the waste from PC will account for 30% of total units of WEEE generated.

HLA-D/DR alleles as defined by cellular and serological typing can also be identified by biochemical methods. The Southern blot technique provides an additional typing facility which can be applied to DNA obtained from any source of nucleated cells. The polymorphism revealed by Southern blot analyses, the so-called restriction fragment length polymorphism (RFLP), depends upon the restriction enzyme and cDNA probes used. To identify HLA-DR specificities a protocol was developed based on the use of the results of southern blot analyses with several restriction enzymes and cDNA probes within a panel of HLA-D/DR homozygous cells representing the DR1 to DRw8 alleles. First, hybridizations with the 3' untranslated sequence of the DR beta cDNA probe, after digestion of the DNA with PvuII (PvuII-DR beta 3') allows the selective identification of DR1, DR2 and DRw8; DR3, DR5 and DRw6 are found as one group as well as DR4 and DR7 as another. Second, TaqI-DQ alpha hybridization allows the splitting of DRw6-Dw18, DRw6-Dw19 and DRw6-Dw9 from the DR3, DR5 and DRw6 group. The other alleles DR3, DR4, DR5, DRw6-Dw16 and DR7 are revealed by dehybridization and rehybridization of the blot with a DR beta cDNA probe. This protocol was used to test whether in a panel of 30 randomly chosen individuals the HLA-DR typing could be performed. The results were highly concordant to the serotyping. Furthermore by adding the Pst-DR beta and TaqI-DQ alpha RFLPs, most of the MLC defined Dw specificities could also be identified. An overview of the specific fragments described here has been summarized in matrices which can be used as references for DNA-typing in computerized analyses.

To compare data based on computerized and paper versions of health status questionnaires (HSQs) for sampling patient-reported outcomes (PROs) in patients with fibromyalgia (FM). In addition, to examine associations between patient characteristics (age, education, computer experience) and differences between versions. Finally, to evaluate the acceptability of computer-based questionnaires among patients with FM.Method: The study population comprised female patients diagnosed with FM. All patients completed six HSQs: the Fibromyalgia Impact Questionnaire (FIQ), the Major Depression Inventory (MDI), the 36-item Short Form Health Survey (SF-36), the painDETECT questionnaire (PDQ), the Coping Strategies Questionnaire (CSQ), and the Generalized Anxiety Disorder Self-Assessment Questionnaire (GAD-10), both on paper and using a touch screen. One HSQ was tested at a time in a repeated randomized cross-over design. The two versions were completed with a 5-min interval and between each HSQ the participants had a 5-min break. Means, mean differences with 95% confidence intervals (CIs), medians, median differences, and intraclass correlation coefficients (ICCs) were calculated for all HSQs, including relevant subscales. Associations between patient characteristics and differences between versions were explored using Spearmans correlation coefficients.Results: Twenty women, mean age 48.4 years, participated in the study. Except for one item, ICCs between touch-screen and paper versions of the HSQs examined indicated acceptable agreement (ICC = 0.71-0.99). Overall, mean and median differences revealed no differences between versions. No significant associations were observed for patient characteristics. None of the participants preferred paper questionnaires over computerized versions.Conclusions: The computerized HSQs using a touch screen gave comparable results to answers given on paper and were generally preferred by the participants.

CONSTRUCT: In this study, we examine the differences in test performance between the paper-based and the computer-based version of the Berlin formative Progress Test. In this context it is the first study that allows controlling for students' prior performance.Computer-based tests make possible a more efficient examination procedure for test administration and review. Although university staff will benefit largely from computer-based tests, the question arises if computer-based tests influence students' test performance.A total of 266 German students from the 9th and 10th semester of medicine (comparable with the 4th-year North American medical school schedule) participated in the study (paper = 132, computer = 134). The allocation of the test format was conducted as a randomized matched-pair design in which students were first sorted according to their prior test results. The organizational procedure, the examination conditions, the room, and seating arrangements, as well as the order of questions and answers, were identical in both groups.The sociodemographic variables and pretest scores of both groups were comparable. The test results from the paper and computer versions did not differ. The groups remained within the allotted time, but students using the computer version (particularly the high performers) needed significantly less time to complete the test. In addition, we found significant differences in guessing behavior. Low performers using the computer version guess significantly more than low-performing students in the paper-pencil version.Participants in computer-based tests are not at a disadvantage in terms of their test results. The computer-based test required less processing time. The reason for the longer processing time when using the paper-pencil version might be due to the time needed to write the answer down, controlling for transferring the answer correctly. It is still not known why students using the computer version (particularly low-performing students) guess at a higher rate. Further studies are necessary to understand this finding.

Background: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. Objective: The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women’s preferences for e-screening and disclosure of mental health concerns. Methods: Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin’s tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P

Background: Electronic patient-reported outcomes (PRO) provide quick and usually reliable assessments of patients’ health-related quality of life (HRQL). Objective: An electronic version of the Patient-Reported Outcomes Quality of Life-human immunodeficiency virus (PROQOL-HIV) questionnaire was developed, and its face validity and reliability were assessed using standard psychometric methods. Methods: A sample of 80 French outpatients (66% male, 52/79; mean age 46.7 years, SD 10.9) were recruited. Paper-based and electronic questionnaires were completed in a randomized crossover design (2-7 day interval). Biomedical data were collected. Questionnaire version and order effects were tested on full-scale scores in a 2-way ANOVA with patients as random effects. Test-retest reliability was evaluated using Pearson and intraclass correlation coefficients (ICC, with 95% confidence interval) for each dimension. Usability testing was carried out from patients’ survey reports, specifically, general satisfaction, ease of completion, quality and clarity of user interface, and motivation to participate in follow-up PROQOL-HIV electronic assessments. Results: Questionnaire version and administration order effects (N=59 complete cases) were not significant at the 5% level, and no interaction was found between these 2 factors ( P =.94). Reliability indexes were acceptable, with Pearson correlations greater than .7 and ICCs ranging from .708 to .939; scores were not statistically different between the two versions. A total of 63 (79%) complete patients’ survey reports were available, and 55% of patients (30/55) reported being satisfied and interested in electronic assessment of their HRQL in clinical follow-up. Individual ratings of PROQOL-HIV user interface (85%-100% of positive responses) confirmed user interface clarity and usability. Conclusions: The electronic PROQOL-HIV introduces minor modifications to the original paper-based version, following International Society for Pharmacoeconomics and Outcomes Research (ISPOR) ePRO Task Force guidelines, and shows good reliability and face validity. Patients can complete the computerized PROQOL-HIV questionnaire and the scores from the paper or electronic versions share comparable accuracy and interpretation. [J Med Internet Res 2014;16(4):e115]

This pilot study compared a prototype electronic menstrual calendar on a handheld computer with a paper calendar for data quality and participants' perceptions.Twenty-three women completed identical information about menstrual bleeding and symptoms using paper and electronic calendars for 1 month each.Use of the paper calendar resulted in more missing data than the electronic calendar for bleeding characteristics (13% vs. 4%) and symptoms (35% vs. 4%). The electronic calendar's ability to log data entries revealed retrospective entry for 61% of the data. Total data entry and cleaning time was reduced by 81% with the electronic calendar. Overall, participants preferred the electronic (70%) to the paper (22%) calendar.Data quality with conventional paper calendars may be poorer than recognized. The data-logging feature, unique to the electronic calendar, is critical for assessing data quality. Electronic menstrual calendars can be useful data collection tools for research in women's health.

Background Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE. The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats. Methods Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured. Results Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format. Conclusions Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.

The quantities of e-waste are expected to increase sharply in Chile. The purpose of this paper is to provide a quantitative data basis on generated e-waste quantities. A material flow analysis was carried out assessing the generation of e-waste from computer equipment (desktop and laptop PCs as well as CRT and LCD-monitors). Import and sales data were collected from the Chilean Customs database as well as from publications by the International Data Corporation. A survey was conducted to determine consumers' choices with respect to storage, re-use and disposal of computer equipment. The generation of e-waste was assessed in a baseline as well as upper and lower scenarios until 2020. The results for the baseline scenario show that about 10,000 and 20,000 tons of computer waste may be generated in the years 2010 and 2020, respectively. The cumulative e-waste generation will be four to five times higher in the upcoming decade (2010-2019) than during the current decade (2000-2009). By 2020, the shares of LCD-monitors and laptops will increase more rapidly replacing other e-waste including the CRT-monitors. The model also shows the principal flows of computer equipment from production and sale to recycling and disposal. The re-use of computer equipment plays an important role in Chile. An appropriate recycling scheme will have to be introduced to provide adequate solutions for the growing rate of e-waste generation.

Background To see if there is a difference in performance when students switch from traditional paper-and-pencil examinations to computer-based examinations, and to determine whether there are gender differences in student performance in these two examination formats. Methods This study involved first year medical students at the University of Illinois at Urbana-Champaign over three Academic Years 2002–03/2003–04 and 2003–05. Comparisons of student performance by overall class and gender were made. Specific comparisons within courses that utilized both the paper-and-pencil and computer formats were analyzed. Results Overall performance scores for students among the various Academic Years revealed no differences between exams given in the traditional pen-and-paper and computer formats. Further, when we looked specifically for gender differences in performance between these two testing formats, we found none. Conclusion The format for examinations in the courses analyzed does not affect student performance. We find no evidence for gender differences in performance on exams on pen-and-paper or computer-based exams.

Background Longitudinal assessments of quality of life are needed to measure changes over the course of a disease and treatment. Computer versions of quality of life instruments have increased the feasibility of obtaining longitudinal measurements. However, there remain occasions when patients are not able to complete these questionnaires. This study examined whether changes measured using a computer version of the Functional Assessment of Cancer Therapy – General (FACT-G) on two occasions would be obtained if patients completed a paper version on one of the two occasions. Methods Gynecologic oncology patients completed a computer version of the FACT-G pre-operatively and at six months. Patients were given the option of using the paper version instead of the computer at either time point. Repeated measures analysis of variance was used. Results One hundred nineteen patients completed the FACT-G at both time points. Seventy-one (60%) patients used the computer at both visits, 26 (21.8%) used the computer followed by the paper version, 17 (14.3%) used the paper version followed by the computer version, and five patients (4.2%) used the paper version at both visits. Significant effects over time were obtained in the physical, functional, and emotional well-being domains, and in total scores, but there were no effects of method of administration of the questionnaires and no interaction between method of administration and changes over time. Conclusions These data indicate that women are responding to the content of the questionnaire and not method of data collection. Although using the same method of administration of instruments over time is desirable, using alternate methods is preferable to forgoing data collection entirely. Large scale studies should be conducted to determine if the multiple methods of data collection that are becoming increasingly available are producing interchangeable information.