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BackgroundBreast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. ObjectiveThis nested qualitative substudy explored women’s views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. MethodsA total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. ResultsThe interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A “missed opportunity” in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. ConclusionsThere is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics.

Introduction Reviews of commercial and publicly available smartphone (mobile) health applications (mHealth app reviews) are being undertaken and published. However, there is variation in the conduct and reporting of mHealth app reviews, with no existing reporting guidelines. Building on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we aim to develop the Consensus for APP Review Reporting Items (CAPPRRI) guidance, to support the conduct and reporting of mHealth app reviews. This scoping review of published mHealth app reviews will explore their alignment, deviation, and modification to the PRISMA 2020 items for systematic reviews and identify a list of possible items to include in CAPPRRI.Method and analysis We are following the Joanna Briggs Institute approach and Arksey and O’Malley’s five-step process. Patient and public contributors, mHealth app review, digital health research and evidence synthesis experts, healthcare professionals and a specialist librarian gave feedback on the methods. We will search SCOPUS, CINAHL Plus, AMED, EMBASE, Medline, APA PsycINFO and the ACM Digital Library for articles reporting mHealth app reviews and use a two-step screening process to identify eligible articles. Information on whether the authors have reported, or how they have modified the PRISMA 2020 items in their reporting, will be extracted. Data extraction will also include the article characteristics, protocol and registration information, review question frameworks used, information about the search and screening process, how apps have been evaluated and evidence of stakeholder engagement. This will be analysed using a content synthesis approach and presented using descriptive statistics and summaries. This protocol is registered on OSF (https://osf.io/5ahjx).Ethics and dissemination Ethical approval is not required. The findings will be disseminated through peer-reviewed journal publications (shared on our project website and on the EQUATOR Network website where the CAPPRRI guidance has been registered as under development), conference presentations and blog and social media posts in lay language.

BackgroundPoor mental health is associated with obesity, but existing studies are either cross-sectional or have long time periods between measurements of mental health and weight. It is, therefore, unclear how small fluctuations in mental wellbeing within individuals predict bodyweight over short time periods, e.g. within the next month. Studying this could identify modifiable determinants of weight changes and highlight opportunities for early intervention.Methods2,133 UK adults from a population-based cohort completed monthly mental health and weight measurements using a mobile app over a period of 6-9 months. We used random intercept regression models to examine longitudinal associations of depressive symptoms, anxiety symptoms and stress with subsequent weight. In sub-group analyses, we included interaction terms of mental health variables with baseline characteristics. Mental health variables were split into "between-individual" measurements (= the participant's median score across all timepoints) and "within-individual" measurements (at each timepoint, the difference between the participant's current score and their median).ResultsWithin-individual variation in depressive symptoms predicted subsequent weight (0.045kg per unit of depressive symptom severity, 95% CI 0.021-0.069). We found evidence of a moderation effect of baseline BMI on the association between within-individual fluctuation in depressive symptoms and subsequent weight: The association was only apparent in those with overweight/obesity, and it was stronger in those with obesity than those with overweight (BMIConclusionIn this exploratory study, individuals with overweight or obesity were more vulnerable to weight gain following higher-than-usual (for that individual) depressive symptoms than individuals with a BMI

BackgroundBreast cancer is the most common form of cancer in women, and around 20% of cases are associated with factors such as adult weight gain, overweight and obesity, and potentially modifiable health behaviors including high alcohol intake, smoking, lack of physical activity, and breastfeeding. Significant weight gain occurs between the ages of 18 and 35 years; hence, this age group could benefit from weight gain prevention interventions. Population studies have reported that women at increased risk of breast cancer account for a disproportionate amount of cases. Thus, there is a particular need to target weight gain prevention and other health behavior interventions for women at increased risk. A literature review identified no evidence-based apps that cover all relevant health behaviors. With patient and participant involvement from the target population, we have developed a new app to promote healthy behaviors among young women at increased risk of breast cancer. Alongside the app, a Facebook group provides peer support, and a virtual welcome event provides an overview of the project and the opportunity to meet the research team and other study participants. The aim of the intervention is to prevent weight gain via changes to eating habits and physical activity levels, and improve other health behaviors associated with breast cancer. The app includes goal setting and self-monitoring of health behaviors and provides education about breast cancer. ObjectiveThis study aims to assess the acceptability and usability of the app in young women at increased risk of breast cancer, and the feasibility of the study procedures for a future, larger efficacy study. MethodsYoung women (n=35, age 18-35 years) at increased risk of breast cancer (>17% lifetime risk) will be recruited via 2 recruitment procedures: mailed invite from the local breast cancer family history, risk and prevention clinic, and advertisements on social media and websites. Participants will have access to the app and the private Facebook group for 2 months. They will complete questionnaires regarding their health behaviors and breast cancer risk belief at the start and end of the study, complete app rating scales in the middle and at the end of the study, and be invited to give feedback on the app during the study period. Approximately 20 participants will have a semistructured interview at the end of the study regarding their views on the app and trial procedures. ResultsThe trial is ongoing, and the publication of results is anticipated in 2023. ConclusionsThe trial will provide evidence regarding the acceptability and usability of the newly developed app for young women at increased risk of breast cancer. Feedback obtained will be used to improve the app. The trial will also assess the feasibility of the study procedures and how these can be refined for a future efficacy study. Trial RegistrationClinicalTrials.gov NCT05460650; https://clinicaltrials.gov/ct2/show/NCT05460650 International Registered Report Identifier (IRRID)PRR1-10.2196/41246

Introduction Diabetes and related metabolic disorders such as obesity and cardiovascular diseases (CVD) are a growing global issue. Equipping individuals with the necessary ‘knowledge, skills and confidence to self-manage their health’ (ie, patient activation (PAct)) may lead to improvements in health outcomes. It is unclear whether existing evidence allows us to assume a causal relationship. We aim to synthesise and critically appraise evidence on the relationship between PAct and self-management behaviours and clinical outcomes of people living with diabetes and related metabolic disorders.Methods and analysis The protocol is based on guidance on Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will search Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL using search terms related to PAct, diabetes, pre-diabetes, obesity and CVD. Any quantitative study design is eligible provided studies assess the association between PAct and clinical outcomes and/or self-management behaviours of diabetes and related metabolic disorders. Outcomes include behavioural (eg, diet) and clinical (eg, blood pressure) outcomes. Two reviewers will independently screen titles/abstracts and full texts and assess risk of bias using the revised Cochrane risk-of-bias tool for randomised trials or the Risk of Bias Assessment Tool for Nonrandomised Studies (RoBANS).One reviewer will extract data, with independent checking by a second reviewer. We will critically assess the level of evidence available for assuming a causal association between PAct and outcomes. Data permitting, we will use the Hunter-Schmidt random-effects method to meta-analyse correlations across studies.Ethics and dissemination Ethical approval is not required. The review will be disseminated in the form of a peer-reviewed journal article, at conferences and other presentations. The findings of the review will be of interest to clinical commissioning groups, policymakers and intervention deliverers/developers.PROSPERO registration number CRD42021230727.

The ascomycete, Sclerotinia sclerotiorum, has a broad host range and causes yield loss in dicotyledonous crops world wide. Genomic diversity was determined in a population of 127 isolates obtained from individual canola (Brassica napus) fields in western Canada. Genotyping with 39 simple sequence repeat (SSR) markers revealed each isolate was a unique haplotype. Analysis of molecular variance showed 97% was due to isolate and 3% due to geographical location. Testing of mycelium compatibility among 133 isolates identified clones of mutually compatible isolates with 86-95% similar SSR haplotype, whereas incompatible isolates were highly diverse. In the Province of Manitoba, 61% of isolates were compatible forming clones and stings of pairwise compatible isolates not described before. In contrast, only 35% of isolates were compatible in Alberta without forming clones and strings, while 39% were compatible in Saskatchewan with a single clone, but no strings. These difference can be explained by wetter growing seasons and more susceptible crop species in Manitoba favouring frequent mycelium interaction and more life cycles over time, which might also explain similar differences observed in other geographical areas and host crops. Analysis of linkage disequilibrium rejected random recombination, consistent with a self-fertile fungus, restricted outcrossing due to mycelium incompatibility, and only a single annual opportunity for genomic recombination during meiosis in the ascospore stage between non-sister chromatids in the rare event nuclei from different isolates come together. More probable sources of genomic diversity is slippage during DNA replication and point mutation affecting single nucleotides that accumulate and likely increase mycelium incompatibility in a population over time. A phylogenetic tree based on SSR haplotype grouped isolates into 17 sub-populations. Aggressiveness was tested by inoculating one isolate from each sub-population onto B. napus lines with quantitative resistance. Analysis of variance was significant for isolate, line, and isolate by line interaction. These isolates represent the genomic and pathogenic diversity in western Canada, and are suitable for resistance screening in canola breeding programs.

Objectives Until this point there was no national core competency framework for clinical informatics in the UK. We report on the final two iterations of work carried out in the formation of a national core competency framework. This follows an initial systematic literature review of existing skills and competencies and a job listing analysis.Methods An iterative approach was applied to framework development. Using a mixed-methods design we carried out semi-structured interviews with participants involved in informatics (n=15). The framework was updated based on the interview findings and was subsequently distributed as part of a bespoke online digital survey for wider participation (n=87). The final version of the framework is based on the findings of the survey.Results Over 102 people reviewed the framework as part of the interview or survey process. This led to a final core competency framework containing 6 primary domains with 36 subdomains containing 111 individual competencies.Conclusions An iterative mixed-methods approach for competency development involving the target community was appropriate for development of the competency framework. There is some contention around the depth of technical competencies required. Care is also needed to avoid professional burnout, as clinicians and healthcare practitioners already have clinical competencies to maintain. Therefore, how the framework is applied in practice and how practitioners meet the competencies requires careful consideration.

Interactive digital notebooks provide an opportunity for researchers and educators to carry out data analysis and report the results in a single digital format. Further to just being digital, the format allows for rich content to be created in order to interact with the code and data contained in such a notebook to form an educational narrative. This primer introduces some of the fundamental aspects involved in using Jupyter notebooks in an educational setting for teaching in the bio/health informatics disciplines. We also provide 2 case studies that detail how we used Jupyter notebooks to teach non-coders programming skills on a blended Master's degree module for a Health Informatics programme and a fully online distance learning unit on Programming for a postgraduate certificate (PG Cert) in Clinical Bioinformatics with a more technical audience.

Background People with lung cancer often wait for several months before presenting symptoms to health services. Some patients report seeking information online to help them appraise symptoms. No research has evaluated whether websites about lung cancer present information in an optimal manner to encourage help-seeking. Objective To evaluate the effectiveness of an online, tailored, theory-based intervention in encouraging help-seeking behaviour among people with potential lung cancer symptoms. Methods The intervention consisted of a specialised website which provided tailored information about lung cancer and included a component to address beliefs about help-seeking, based on the Theory of Planned Behaviour (TPB-component). Individuals with undiagnosed symptoms were randomised to receive information about lung cancer in a factorial design (tailored/untailored × TPB-component/no TPB-component). Pre and post viewing webpages, participants reported perceived likelihood of seeking help. Data were analysed using robust mixed factorial ANOVA. Results Data from 253 participants (73.9% female) were analysed. No effect for the TPB-component was found ( p = 0.16), nor for tailoring ( p = 0.27). Self-reported likelihood of seeking help increased significantly from pre to post ( p

Drug-induced long QT syndrome (diLQTS), characterized by a prolongation of the QT-interval on the electrocardiogram (ECG), is a serious adverse drug reaction that can cause the life-threatening arrhythmia Torsade de Points (TdP). Self-monitoring for diLQTS could therefore save lives, but detecting it on the ECG is difficult, particularly at high and low heart rates. In this paper, we evaluate whether using a pseudo-colouring visualisation technique and changing the coordinate system (Cartesian vs. Polar) can support lay people in identifying QT-prolongation at varying heart rates. Four visualisation techniques were evaluated using a counterbalanced repeated measures design including Cartesian no-colouring, Cartesian pseudo-colouring, Polar no-colouring and Polar pseudo-colouring. We used a multi-reader, multi-case (MRMC) receiver operating characteristic (ROC) study design within a psychophysical paradigm, along with eye-tracking technology. Forty-three lay participants read forty ECGs (TdP risk n = 20, no risk n = 20), classifying each QT-interval as normal/abnormal, and rating their confidence on a 6-point scale. The results show that introducing pseudo-colouring to the ECG significantly increased accurate detection of QT-interval prolongation regardless of heart rate, T-wave morphology and coordinate system. Pseudo-colour also helped to reduce reaction times and increased satisfaction when reading the ECGs. Eye movement analysis indicated that pseudo-colour helped to focus visual attention on the areas of the ECG crucial to detecting QT-prolongation. The study indicates that pseudo-colouring enables lay people to visually identify drug-induced QT-prolongation regardless of heart rate, with implications for the more rapid identification and management of diLQTS.

The Code/Theory workshop explored the process of translating between theory and code, from the perspective of those who do this work on a day to day basis. This report contains individual contributions from participants reflecting on their own experiences, along with summaries of their lightning talks and outputs from the discussion sessions. We conclude that translating between theory and code successfully requires a diversity of roles, all of which are central to the process of research.

This paper examines the role that lived experience plays in the human capacity to reason about uncertainty. Previous research shows that people are more likely to provide accurate responses in Bayesian tasks when the data are presented in natural frequencies, the problem in question describes a familiar event, and the values of the data are in line with beliefs. Precisely why these factors are important remains open to debate. We elucidate the issue in two ways. Firstly, we hypothesize that in a task that requires people to reason about conditional probabilities, they are more likely to respond accurately when the values of the problem reflect their own lived experience, than when they reflect the experience of the average participant. Secondly, to gain further understanding of the underlying reasoning process, we employ a novel interaction analysis method that tracks mouse movements in an interactive web application and applies transition analysis to model how the approach to reasoning differs depending on whether data are presented using percentages or natural frequencies. We find (1) that the closer the values of the data in the problem are to people's self-reported lived experience, the more likely they are to provide a correct answer, and (2) that the reasoning process employed when data are presented using natural frequencies is qualitatively different to that employed when data are presented using percentages. The results indicate that the benefits of natural frequency presentation are due to a clearer representation of the relationship between sets and that the prior humans acquire through experience has an overwhelming influence on their ability to reason about uncertainty.

Does reading a description of an artwork affect how a person subsequently views it? In a controlled study, we show that in most cases, textual description does not influence how people subsequently view paintings, contrary to participants’ self-report that they believed it did. To examine whether the description affected transition behaviour, we devised a novel analysis method that systematically determines Units of Interest (UOIs), and calculates transitions between these, to quantify the effect of an external factor (a descriptive text) on the viewing pattern of a naturalistic stimulus (a painting). UOIs are defined using a grid-based system, where the cell-size is determined by a clustering algorithm (DBSCAN). The Hellinger distance is computed for the distance between two Markov chains using a permutation test, constructed from the transition matrices (visual shifts between UOIs) of the two groups for each painting. Results show that the description does not affect the way in which people transition between UOIs for all but one of the paintings -- an abstract work -- suggesting that description may play more of a role in determining transition behaviour when a lack of semantic cues means it is unclear how the painting should be interpreted. The contribution is twofold: to the domain of art/curation, we provide evidence that descriptive texts do not effect how people view paintings, with the possible exception of some abstract paintings; to the domain of eye-movement research, we provide a method with the potential to answer questions across multiple research areas, where the goal is to determine whether a particular factor or condition consistently affects viewing behaviour of naturalistic stimuli.