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This study explores several aspects of a newly created web-based learning environment for learning the topic of conditional probability. The environment assembles granular reusable learning objects (RLO) and presents them to the learner in a block-based fashion. It thus follows the general idea of object-oriented instructional design (OOID). The RLOs are of different types, e.g. text fragments, equations, interactive examples and repeated randomized exercises. The study tries to answer the following research questions and shall also help in evaluating various aspects of the e- learning environment. R1 How does the students’ feeling of flow differ between interactive online self-learning environments and classroom education? R2A How do the students’ assessed learning gains differ between interactive online self-learning environments and classroom education? R2B How do the students’ subjective learning gains differ between interactive online self-learning environments and classroom education? R3 Does the block-based structure in learning environments that use a granular OOID / RLO approach negatively impact the user experience? On important aspect of this particular study is to test the study design and questionnaires (e.g. flow questionnaire) for upcoming studies in the field of adaptive learning environments.

Purpose To assess the test–retest reliability of the EQ-5D-5L and the reworded Quality of Life After Traumatic Brain Injury Overall Scale (QOLIBRI-OS) for the general population of Italy, the Netherlands, and the United Kingdom (UK). Methods The sample contains 1864 members of the general population (aged 18–75 years) of Italy, the Netherlands, and the UK who completed a web-based questionnaire at two consecutive time points. The survey included items on gender, age, level of education, occupational status, household annual income, chronic health status, and the EQ-5D-5L and reworded QOLIBRI-OS instrument. Test–retest reliability of the EQ-5D-5L dimensions, EQ-5D-5L summary index, EQ VAS, reworded QOLIBRI-OS dimensions and reworded QOLIBRI-OS level sum score was examined by Gwet’s Agreement Coefficient (Gwet’s AC) and Intraclass Correlation Coefficient (ICC). Results Gwet’s AC ranged from 0.64 to 0.97 for EQ-5D-5L dimensions. The ICC ranged from 0.73 to 0.84 for the EQ-5D-5L summary index and 0.61 to 0.68 for EQ VAS in the three countries. Gwet’s AC ranged from 0.35 to 0.55 for reworded QOLIBRI-OS dimensions in the three countries. The ICC ranged from 0.69 to 0.77 for reworded QOLIBRI-OS level sum score. Conclusion Test–retest reliability of the EQ-5D-5L administered via a web-based questionnaire was substantial to almost perfect for the EQ-5D-5L dimensions, good for EQ-5D-5L summary index, and moderate for the EQ VAS. However, test–retest reliability was less satisfactory for the reworded QOLIBRI-OS. This indicates that the web-based EQ-5D-5L is a reliable instrument for the general population, but further research of the reworded QOLIBRI-OS is required.

Online self-help programs can serve as accessible mental health resources, allowing users to learn skills for improving their mental health at their own pace. The self-guided nature of these programs allows them to be cost-efficient as compared to traditional therapy and appealing to those who do not want to attend traditional therapy due to stigma or low-perceived need. However, these programs also struggle with low adherence rates, with typically only a small subset of users completing a given program in full. Coaching has been previously explored as a way to increase program adherence, adding a low-intensity human component to self-help programs. Typically, graduate students or mental health professionals serve as coaches, but this is a resource-intensive approach that is difficult to scale-up. The present study tested the efficacy, feasibility, and acceptability of peer-support coaching, which would be feasible to scale-up on account of using undergraduate volunteers as coaches. We conducted a randomized controlled trial with 230 participants assigned across three conditions. All conditions were instructed to use the online self-help program ACT Guide, with one additionally receiving weekly phone coaching, one receiving weekly text coaching, and one receiving no additional coaching. Participants who received either format of coaching completed significantly more modules and were more satisfied with ACT Guide than those who did not receive coaching. Significant improvements in mental health outcomes were observed within both coaching conditions, but a greater number of outcomes improved in the phone condition than the text condition. These findings shed light on peer-support coaching, particularly when delivered over phone calls, as a promising intervention for increasing adherence to and thus the effectiveness of online self-help programs.

BackgroundCOVID19 is a respiratory disease caused by a novel coronavirus. As there has been no definitive treatment for the disease so far, the only way to control the spread is to break the chain of infection. Our study aimed to analyze the preventive behaviors and influencing factors in the Iranian population.MethodsThis cross-sectional study was a web-based survey in the Iranian population. We performed the study during the first peak of COVID-19 outbreak (from March 25th, 2020 to April 5th). We used demographic and Preventive behaviors questionnaires to collect the data. This web-based survey was publicized on the internet through the common platforms used by the Iranian population. This survey was released on the website “Porsline.com”. A total of 2097 acceptable questionnaires were filled. All data were analyzed, using Statistical Package for Social Sciences (SPSS) version 19.Results61.9% of the participants checked the hand-washing question as “Always”. 55.7 and 58.2% checked the wearing masks and gloves as “Always”, respectively. We found a significant relationship between gender and hand washing behavior (P = 0.006) and the use of masks and gloves (P P = 0.029) and economic status (P = 0.011). Wearing masks had a significant relation with economic status (P = 0.032). Overall women had better preventive behaviors.ConclusionsPreventive behaviors have a significant relation with some socio-demographic characteristics. According to the 3 main preventive behaviors of hand-washing, wearing masks and gloves 50% of the population has not taken these behaviors seriously.

Objective: To examine weight loss characteristics relative to education for employees participating in an online weight loss program. Methods: We examined percent weight loss (primary outcome), the achievement of clinical cut-points (secondary outcome) by class attendance, and education strata (High School and Trade through Post-Graduate). Results: Overall, the pooled cohort lost a significant percentage of their starting weight (–2.05%, 95% CI, –2.07, –2.04). Women (–1.95%, 95% CI, –1.97, –1.94) lost significantly less than men (–2.38%, 95% CI, –2.141, –2.35). Those attending less than or equal to seven classes lost significantly less weight (0.75% [95% CI, –0.77, –0.74] vs more than or equal to eight classes attendees [–3.50%, 95% CI, –3.52, –3.48]). Class attendance was significantly correlated to weight loss (r = 0.57, P

Although trauma-focused interventions are effective in treating patients with PTSD, they are not frequently used in clinical practice. To address this gap, the present study aimed to develop and evaluate a web-based training for trauma-focused therapy. Our main objective was to increase the knowledge and competencies of current and future licensed psychotherapists in the core procedures that have been identified as efficacious treatment components. The web-based training consists of modules on diagnostics and psychoeducation, disease models, evidence-based interventions, coping with difficulties in therapy, and exercises to promote self-care and mental hygiene. In a wait-list controlled evaluation study, therapists (N = 499) were randomized into either an intervention or a wait-list control group. Knowledge, competencies, self-efficacy expectations, and willingness to conduct trauma-focused therapy were assessed via self-report in both groups before and after training completion. Results indicate a relatively low dropout rate and a high level of satisfaction with the content and structure of the training. In comparison to the wait-list control group, participants who successfully completed the training showed a significantly greater improvement in subjective ratings of knowledge and perceived treatment competence, perceived emotional competence, self-efficacy, and willingness to conduct trauma-focused therapy. They also improved significantly in their results on the knowledge test. In sum, results of this feasibility study suggest that the web-based training is an acceptable program to increase knowledge and competencies in terms of trauma-focused interventions. Further research should focus on evaluating whether the training increases therapists’ competence in terms of objectively-rated clinical skills.

BACKGROUND: The Alzheimer Prevention Trials (APT) Webstudy is the first stage in establishing a Trial-ready Cohort for Preclinical and Prodromal Alzheimer’s disease (TRC-PAD). This paper describes recruitment approaches for the APT Webstudy. Objectives: To remotely enroll a cohort of individuals into a web-based longitudinal observational study. Participants are followed quarterly with brief cognitive and functional assessments, and referred to Sites for in-clinic testing and biomarker confirmation prior to enrolling in the Trial-ready Cohort (TRC). Design: Participants are referred to the APT Webstudy from existing registries of individuals interested in brain health and Alzheimer’s disease research, as well as through central and site recruitment efforts. The study team utilizes Urchin Tracking Modules (UTM) codes to better understand the impact of electronic recruitment methods. Setting: A remotely enrolled online study. Participants: Volunteers who are at least 50 years old and interested in Alzheimer’s research. Measurements: Demographics and recruitment source of participant where measured by UTM. Results: 30,650 participants consented to the APT Webstudy as of April 2020, with 69.7% resulting from referrals from online registries. Emails sent by the registry to participants were the most effective means of recruitment. Participants are distributed across the US, and the demographics of the APT Webstudy reflect the referral registries, with 73.1% female, 85.0% highly educated, and 92.5% Caucasian. Conclusions: We have demonstrated the feasibility of enrolling a remote web-based study utilizing existing registries as a primary referral source. The next priority of the study team is to engage in recruitment initiatives that will improve the diversity of the cohort, towards the goal of clinical trials that better represent the US population.

Background: The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults.Methods: A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model.Results: A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p = .02). The MVPA was similar in both groups at baseline (mean +/- SD; 176 +/- 13 vs. 172 +/- 15 min/week, p = .72) and higher in the intervention than in the control group at a 3-month follow-up (259 +/- 21 vs. 201 +/- 22 min/week, p = .04). This finding was comparable across women and men (group-by-sex, p = .57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p = .43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p Conclusion: These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions.

Background There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/34530

Background Lassitude and a rather high degree of mistrust toward the authorities can make regular or overly constraining COVID-19 infection prevention and control campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 infection prevention and control guidelines. Escape COVID-19 is a serious game for teaching COVID-19 infection prevention and control practices that has previously been validated in a population of nursing home personnel. Objective We aimed to identify factors learned from playing the serious game Escape COVID-19 that facilitate or impede intentions of changing infection prevention and control behavior in a large and heterogeneous Swiss population. Methods This fully automated, prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on the platform, participants were asked to complete a short demographic questionnaire before accessing the serious game. The only incentive given to the potential participants was a course completion certificate, which participants obtained after completing the postgame questionnaire. The primary outcome was the proportion of participants who reported that they were willing to change their infection prevention and control behavior. Secondary outcomes were the infection prevention and control areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with intention to change infection prevention and control behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness, and usefulness of the serious game; impression of engagement and boredom while playing the serious game; and willingness to recommend its use to friends or colleagues. Results From March 9 to June 9, 2021, a total of 3227 accounts were created on the platform, and 1104 participants (34.2%) completed the postgame questionnaire. Of the 1104 respondents, 509 respondents (46.1%) answered that they intended to change their infection prevention and control behavior after playing the game. Among the respondents who answered that they did not intend to change their behavior, 86.1% (512/595) answered that they already apply these guidelines. Participants who followed the German version were less likely to intend to change their infection prevention and control behavior (odds ratio [OR] 0.48, 95% CI 0.24-0.96; P=.04) and found the game less engaging (P Conclusions Escape COVID-19 is a useful tool to enhance correct infection prevention and control measures on a national scale, even after 2 COVID-19 pandemic waves; however, the serious game's impact was affected by language, age category, and previous educational training, and the game should be adapted to enhance its impact on specific populations.

The era of ‘big data’ promises to provide new hydrologic insights, and open web-based platforms are being developed and adopted by the hydrologic science community to harness these datasets and data services. This shift accompanies advances in hydrology education and the growth of web-based hydrology learning modules, but their capacity to utilize emerging open platforms and data services to enhance student learning through data-driven activities remains largely untapped. Given that generic equations may not easily translate into local or regional solutions, teaching students to explore how well models or equations work in particular settings or to answer specific problems using real data is essential. This article introduces an open web-based module developed to advance data-driven hydrologic process learning, targeting upper level undergraduate and early graduate students in hydrology and engineering. The module was developed and deployed on the HydroLearn open educational platform, which provides a formal pedagogical structure for developing effective problem-based learning activities. We found that data-driven learning activities utilizing collaborative open web platforms like CUAHSI HydroShare and JupyterHub to store and run computational notebooks allowed students to access and work with datasets for systems of personal interest and promoted critical evaluation of results and assumptions. Initial student feedback was generally positive, but also highlighted challenges including trouble-shooting and future-proofing difficulties and some resistance to programming and new software. Opportunities to further enhance hydrology learning include better articulating the benefits of coding and open web platforms upfront, incorporating additional user-support tools, and focusing methods and questions on implementing and adapting notebooks to explore fundamental processes rather than tools and syntax. The profound shift in the field of hydrology toward big data, open data services and reproducible research practices requires hydrology instructors to rethink traditional content delivery and focus instruction on harnessing these datasets and practices in the preparation of future hydrologists and engineers.

Background Chemopreventive agents such as selective estrogen receptor modulators and aromatase inhibitors have proven efficacy in reducing breast cancer risk by 41% to 79% in high-risk women. Women at high risk of developing breast cancer face the complex decision of whether to take selective estrogen receptor modulators or aromatase inhibitors for breast cancer chemoprevention. RealRisks is a patient-centered, web-based decision aid (DA) designed to promote the understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision making about taking chemoprevention. Objective This study aims to understand the perceptions of women at high risk of developing breast cancer regarding their experience with using RealRisks—a DA designed to promote the uptake of breast cancer chemoprevention—and to understand their information needs. Methods We completed enrollment to a randomized controlled trial among 300 racially and ethnically diverse women at high risk of breast cancer who were assigned to standard educational materials alone or such materials in combination with RealRisks. We conducted semistructured interviews with a subset of 21 high-risk women enrolled in the intervention arm of the randomized controlled trial who initially accessed the tool (on average, 1 year earlier) to understand how they interacted with the tool. All interviews were audio recorded, transcribed verbatim, and compared with digital audio recordings to ensure the accuracy of the content. We used content analysis to generate themes. Results The mean age of the 21 participants was 58.5 (SD 10.1) years. The participants were 5% (1/21) Asian, 24% (5/21) Black or African American, and 71% (15/21) White; 10% (2/21) of participants were Hispanic or Latina. All participants reported using RealRisks after being granted access to the DA. In total, 4 overarching themes emerged from the qualitative analyses: the acceptability of the intervention, specifically endorsed elements of the DA, recommendations for improvements, and information needs. All women found RealRisks to be acceptable and considered it to be helpful (21/21, 100%). Most women (13/21, 62%) reported that RealRisks was easy to navigate, user-friendly, and easily accessible on the web. The majority of women (18/21, 86%) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and that RealRisks informed their (17/21, 81%) decision about whether or not to take chemoprevention. Some women (9/21, 43%) shared recommendations for improvements, as they wanted more tailoring based on user characteristics, felt that the DA was targeting a narrow population of Hispanic or Latina by using graphic novel–style narratives, wanted more understandable terminology, and felt that the tool placed a strong emphasis on chemoprevention drugs. Conclusions This qualitative study demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women, who provided some recommendations for improvement.

In ultrasound education there is a need for interactive web-based learning resources. The purpose of this project was to develop a web-based application that enables the generation and exploration of volumetric datasets from cine loops obtained with conventional 2D ultrasound. JavaScript code for ultrasound video loading and the generation of volumetric datasets was created and merged with an existing web-based imaging viewer based on JavaScript and HTML5. The Web Graphics Library was utilized to enable hardware-accelerated image rendering. The result is a web application that works in most major browsers without any plug-ins. It allows users to load a conventional 2D ultrasound cine loop which can subsequently be manipulated with on-the-fly multiplanar reconstructions as in a Digital Imaging and Communications in Medicine (DICOM) viewer. The application is freely accessible at (http://www.castlemountain.dk/atlas/index.php?page=mulreconmulreconPage=sonoviewer) where a demonstration of web-based sharing of generated cases can also be found. The developed web-based application is unique in its ability to easily perform loading of one's own ultrasound clips and conduct multiplanar reconstructions where interactive cases can be shared on the Internet.ZIEL: In der Ultraschallausbildung besteht Bedarf an interaktiven webbasierten Lernressourcen. Ziel dieses Projekts war die Entwicklung einer webbasierten Anwendung, mit der volumetrische Datensätze aus Cine-Loops, die mit konventionellem 2D-Ultraschall erstellt wurden, generiert und untersucht werden können. Javascripts zum Laden von Ultraschallvideos und zum Erzeugen von volumetrischen Datensätzen wurden erstellt und mit einem bestehenden webbasierten Bildbetrachter auf Basis von Javascript und HTML5 zusammengeführt. Die Web-Graphics-Library wurde verwendet, um eine Hardware-beschleunigte Bildwiedergabe zu ermöglichen. Das Ergebnis ist eine Webanwendung, die ohne Plug-Ins in den meisten gängigen Browsern standardmäßig funktioniert. Sie ermöglicht dem Benutzer das Laden einer herkömmlichen 2D-Ultraschall-Cine-Loop, die anschließend mit on-the-fly-multiplanaren Rekonstruktionen wie in einem DICOM-Viewer (Digital Imaging and Communications in Medicine) bearbeitet werden kann. Die Anwendung ist frei zugänglich unter (http://www.castlemountain.dk/atlas/index.php?page=mulreconmulreconPage=sonoviewer). Dort ist auch eine Demonstration der webbasierten Freigabe von generierten Fällen zu finden. Die entwickelte webbasierte Anwendung ist einzigartig in ihrer Fähigkeit, auf einfache Weise eigene Ultraschallclips zu laden und multiplanare Rekonstruktionen durchzuführen, wobei interaktive Fälle im Internet geteilt werden können.

Background: The International Society for Bipolar Disorders Targeting Cognition Task Force recommends the Screen for Cognitive Impairment in Psychiatry (SCIP) to screen for cognitive impairment in bipolar disorder. However, SCIP must be administered by a healthcare professional, which is often impossible due to time and resource constraints. Web-based, self-administered cognition screening tools may enable assessment and monitoring of patients’ cognition at a much larger scale to a reduced cost. For this purpose, we developed the Internet-Based Cognitive Assessment Tool (ICAT) as a modified web-based version of SCIP. This study aimed to investigate the sensitivity and validity of ICAT for cognition assessment in bipolar disorder. Method: Thirty-five patients with bipolar disorder in full or partial remission and 35 healthy controls completed ICAT on a computer, the standard paper-and-pencil SCIP and a subjective cognition questionnaire and were rated for mood symptoms and functioning at the Copenhagen Affective Disorders Research Centre. Results: Patients displayed cognitive impairments compared to controls on the ICAT (t (61)=3.67, p

Brief face-to-face self-confidence workshops were effective in reducing depression among the public. Technological advances have enabled traditional face-to-face interventions to be adapted using unique technology-mediated platforms. This article details the formative development of a self-confidence web-based seminar (webinar) intervention for workplace depression. The first section discusses a qualitative study that explores the feasibility and acceptability of adapting the self-confidence workshops into a webinar platform on employees in the workplace. The second section describes the systematic development of this new webinar intervention informed by the qualitative study findings, a published systematic review, and previous face-to-face self-confidence workshops. The qualitative study involves three focus groups (n = 10) conducted in a small organization. Three themes were identified relevant to the running of the new self-confidence webinars in the workplace: personal (content, time and duration preference, features of the webinar, individual participation, personalization), interpersonal (stigma from others, engagement with participants/presenter, moderated interaction), and organizational (endorsement from management, work demand). For the intervention development, the format, structure, features, and content of the self-confidence webinar intervention are described. Features such as file sharing, virtual whiteboard, live chat, and poll are explained with the intervention primarily based on cognitive behavior therapy and coping flexibility concepts.

Background Active learning strategies such as formative assessment through clinical cases may help to get a deeper learning. We have studied the effect of this kind of online formative assessment in pathophysiology teaching. Methods Seven brief clinical cases were used to give formative assessment in the first semester of a pathophysiology course. To evaluate its effect on learning, we analyzed the proportion of students that passed the end of semester exam with a score above 60 over 100. We also analyzed the effect of the intervention according to the students’ previous academic performance. Results Ninety-six students participated in the study and sat the exam. Sixty-five of them passed it. Students that passed the exam had a higher previous academic performance and had done a higher number of exercises of formative assessment, both in univariate and multivariate analysis. The participants were divided in three groups, according to their previous academic performance. In the intermediate group, the number of cases done by the students who passed the exam was significantly higher than in those who did not pass it (median: 4 versus 0; P = 0.009). Conclusion Formative assessment through web-based clinical cases was followed by an improvement of the academic results in pathophysiology, mainly in students with intermediate performance.

Background In recent years, there has been increased interest in the development of remote psychological assessments. These platforms increase accessibility and allow clinicians to monitor important health metrics, thereby informing patient-centered treatment. Objective In this study, we report the properties and usability of a new web-based neurocognitive assessment battery and present a normative data set for future use. Methods A total of 781 participants completed a portion of 8 tasks that captured performance in auditory processing, visual-spatial working memory, visual-spatial learning, cognitive flexibility, and emotional processing. A subset of individuals (n=195) completed a 5-question survey measuring the acceptability of the tasks. Results Between 252 and 426 participants completed each task. Younger individuals outperformed their older counterparts in 6 of the 8 tasks. Therefore, central tendency data metrics were presented using 7 different age bins. The broad majority of participants found the tasks interesting and enjoyable and endorsed some interest in playing them at home. Only 1 of 195 individuals endorsed not at all for the statement, “I understood the instructions.” Older individuals were less likely to understand the instructions; however, 72% (49/68) of individuals over the age of 60 years still felt that they mostly or very much understood the instructions. Conclusions Overall, the tasks were found to be widely acceptable to the participants. The use of web-based neurocognitive tasks such as these may increase the ability to deploy precise data-informed interventions to a wider population.

Background Searching the internet for cancer-related information helps patients with cancer satisfy their unmet information needs and empowers them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skill to search, select, appraise, and apply web-based health information. Objective We aim to study the operational, navigational, information, and evaluation skills and problems of patients with cancer performing cancer-related search tasks using the internet. Methods A total of 21 patients with cancer were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. Participants performed eight cancer-related search tasks using the internet. The participants were asked to think aloud while performing the tasks, and the screen activities were recorded. The types and frequencies of performance problems were identified and coded into categories following an inductive coding process. In addition, the performance and strategic characteristics of task execution were summarized descriptively. Results All participants experienced problems or difficulties in executing the tasks, and a substantial percentage of tasks (57/142, 40.1%) could not be completed successfully. The participants’ performance problems were coded into four categories, namely operating the computer and web browser, navigating and orientating, using search strategies, and evaluating the relevance and reliability of web-based information. The most frequent problems occurred in the third and fourth categories. A total of 90% (19/21) of participants used nontask-related search terms or nonspecific search terms. A total of 95% (20/21) of participants did not control for the source or topicality of the information found. In addition, none of the participants verified the information on 1 website with that on another website for each task. Conclusions A substantial group of patients with cancer did not have the necessary skills to benefit from cancer-related internet searches. Future interventions are needed to support patients in the development of sufficient internet-searching skills, focusing particularly on information and evaluation skills.

Web-based instruments are being increasingly used in nutrition epidemiology and surveillance. However, the extent to which dietary intake estimates derived from web-based 24-h recalls such as the R24W are consistent with data derived from more traditional interviewer-administered 24-h recalls (TRAD) remains uncertain. Our objective was to compare dietary intake estimates obtained using the R24W and a TRAD instrument in population-based samples from the province of Québec in Canada. This comparison of dietary assessment methods was based on data from two sample survey studies in adults (18–65 years). The R24W was used in a sample of 1,147 French-speaking adults from five regions of Québec as part of the PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study. The TRAD was used in a sample of 875 French-speaking adults from the Canadian Community Health Survey 2015 located in the same five regions. Characteristics of both samples were matched through selection and weighting (language, sex, age, region, education, body mass index, weekend day, and season of survey). Mean and usual intake data of each sample were compared. The plausibility of reported energy intakes was compared using predictive equations of the Institute of Medicine. Mean servings/day from the R24W were higher than with TRAD for vegetables and fruit (+11%, P = 0.003), grain products (+7%, P = 0.06), milk and alternatives (+21%, P < 0.001), and meat and alternatives (+18%, P = 0.001). Intake of low nutritive value foods was also 28% higher with the R24W than with TRAD (mean difference +164 kcal; 95% CI, 107–222). As a result, total energy intakes from the R24W compared with TRAD were 18% higher in women (mean difference +325 kcal; 95% CI, 243–407) and 15% higher in men (mean difference +361 kcal; 95% CI 232–490). The prevalence of underreporting of energy intakes was 10% lower with the R24W than with TRAD (prevalence ratio 0.90; 95% CI, 0.86–0.94). In conclusion, differences between dietary assessment methods in the context of population-based surveys on nutrition have potentially important consequences on the quality of the data and should be carefully considered in future surveys and surveillance strategies.

Background Type 2 diabetes mellitus (T2DM) is among the most prevalent noncommunicable health conditions worldwide, affecting over 500 million people globally. Diet is a key aspect of T2DM management with dietary modification shown to elicit clinically meaningful outcomes such as improved glycemic control, and reductions in weight and cardiovascular disease risk factors. Web-based interventions provide a potentially convenient and accessible method for delivering dietary education, but its effects on dietary behavior in people with T2DM are unknown. Objective The objective of this review was to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in people with T2DM. Methods Per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches were performed using Medline, Embase, The Cochrane Library, and CINAHL to retrieve papers from January 2013 to May 2019. Randomized controlled trials of web-based interventions in adults with T2DM with reported dietary assessment were included. Population and intervention characteristics, dietary guidelines and assessments, and significant clinical outcomes were extracted. Differences between groups and within groups were assessed for dietary behavior and clinical outcomes. Results There were 714 records screened, and five studies comprising 1056 adults were included. Studies measured dietary changes by assessing overall diet quality, changes in specific dietary components, or dietary knowledge scores. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Three studies found significant mean reductions for hemoglobin A1c ranging from –0.3% to –0.8%, and/or weight ranging from –2.3 kg to –12.7 kg, fasting blood glucose (–1 mmol/L), waist circumference (–1 cm), and triglycerides (–60.1 mg/dL). These studies provided varied dietary recommendations from standard dietary guidelines, national health program guidelines, and a very low carbohydrate ketogenic diet. Conclusions This review provided evidence that web-based interventions may be an effective way to support dietary behavior change in people with T2DM, potentially leading to changes in glycemic control and other clinical outcomes. However, the evidence should be viewed as preliminary as there were only five studies included with considerable heterogeneity in terms of the diets recommended, the dietary assessment measures used, the complexity of the interventions, and the modes and methods of delivery.

Background Kahoot! is a web-based technology quiz game in which teachers can design their own quizzes via provided game templates. The advantages of these games are their attractive interfaces, which contain stimulating music, moving pictures, and colorful, animated shapes to maintain students’ attentiveness while they perform the quizzes. Objective The aim of this study was to evaluate the use of Kahoot! compared with a traditional teaching approach as a tool to summarize the essential content of a medical school class in the aspects of final examination scores and the perception of students regarding aspects of their learning environment and of process management. Methods This study used an interrupted time series design, and retrospective data were collected from 85 medical students. Of these 85 students, 43 completed a Kahoot! quiz, while 42 students completed a paper quiz. All students attended a lecture on the topic of bone and joint infection and participated in a short case discussion. Students from both groups received the same content and study material, with the exception that at the end of the lesson, students in the Kahoot! group completed a quiz summarizing the essential content from the lecture, whereas the other group received a paper quiz with the same questions and the teacher provided an explanation after the students had finished. The students’ satisfaction was evaluated after the class, and their final examination was held 2 weeks after the class. Results The mean final examination score in the Kahoot! group was 62.84 (SD 8.79), compared to 60.81 (SD 9.25) in the control group (P=.30). The students’ satisfaction with the class environment, learning process management, and teacher were not significantly different between the 2 groups (all P>.05). Conclusions In this study, it was found that using Kahoot! as a tool to summarize the essential content in medical school classes involving a lecture and case discussion did not affect the students’ final examination scores or their satisfaction with the class environment, learning process management, or teacher.

Objective The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phrase of COVID-19 pandemic. Methods This web-based cross-sectional study recruited 1,138 Hong Kong adults using convenience sampling over a 2-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census. Results The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR=1.57, 1.72, 1.99, and 1.96 respectively, all p, Highlights • Around 30-40% of the respondents felt their sleep worsened since the local outbreak. • The prevalence of insomnia in Hong Kong during the COVID-19 pandemic was high. • An insufficient store of masks for 1-month was associated with worsening of sleep. • A stable supply of masks may play a role in sleep health during an outbreak.

Cognitive defusion may enhance healthy coping with negative self-referential thoughts amongst college students. However, research is needed to examine how to effectively introduce and teach defusion to this population. The current pilot study tested the usability of and satisfaction with the D-FUSE program, a single-session, web-based program for a mixed sample of undergraduates and its effectiveness in producing improvements in cognitive defusion and self-criticism. In an undergraduate sample (N = 141), the D-FUSE program was found to be usable and satisfactory. Program engagement rendered significant reductions in the believability of and emotional discomfort produced by negative self-referential thoughts. Further improvements to program development and administration are considered.

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the time of questionnaire completion, and reported preexisting or new onset depression and/or anxiety during pregnancy (n = 187). Frequency of postpartum SHI (&lsquo, often/sometimes&rsquo, = frequent, &lsquo, hardly ever&rsquo, = sporadic, &lsquo, never&rsquo, ) was measured via the Edinburgh Postnatal Depression Scale (EPDS) item 10, which reads &ldquo, The thought of harming myself has occurred to me&rdquo, Mothers reported their antidepressant use in pregnancy retrospectively. Overall, 52.9% of women took an antidepressant during pregnancy. Frequent SHI postpartum was reported by 15.2% of non-medicated women and 22.0% of women on past antidepressant treatment in pregnancy, this proportion was higher following a single trimester treatment compared to three trimesters (36.3% versus 18.0%). There was no preventative association of antidepressant treatment in pregnancy on reporting frequent SHI postpartum (weighted RR: 1.90, 95% CI: 0.79, 4.56), relative to never/hardly ever SHI. In a population of women with antenatal depression/anxiety, there was no preventative association between past antidepressant treatment in pregnancy and reporting frequent SHI in the postpartum year. This analysis is only a first step in providing evidence to inform psychiatric disorder treatment decisions for pregnant women.

Background Virtual supervisory relationships provide an infrastructure for flexible learning, global accessibility, and outreach, connecting individuals worldwide. The surge in web-based educational activities in recent years provides an opportunity to understand the attributes of an effective supervisor-student or mentor-student relationship. Objective The aim of this study is to compare the published literature (through a critical review) with our collective experiences (using small-scale appreciative inquiry [AI]) in an effort to structure and identify the dilemmas and opportunities for virtual supervisory and mentoring relationships, both in terms of stakeholder attributes and skills as well as providing instructional recommendations to enhance virtual learning. Methods A critical review of the literature was conducted followed by an AI of reflections by the authors. The AI questions were derived from the 4D AI framework. Results Despite the multitude of differences between face-to-face and web-based supervision and mentoring, four key dilemmas seem to influence the experiences of stakeholders involved in virtual learning: informal discourses and approachability of mentors; effective virtual communication strategies; authenticity, trust, and work ethics; and sense of self and cultural considerations. Conclusions Virtual mentorship or supervision can be as equally rewarding as an in-person relationship. However, its successful implementation requires active acknowledgment of learners’ needs and careful consideration to develop effective and mutually beneficial student-educator relationships.