Personal Health Care Research Articles

Merkel cell-inspired skin-like hybrid hydrogels for wearable health monitoring

High-performance strain/pressure sensors are receiving much attention in soft robotics, motion detection and healthcare. Inspired by the sensing function of Merkel cells, bionic skin-like strain/pressure sensors with great elasticity (1500 %), low hysteresis (7.1 %), low pressure detection limit (0.508 Pa), high sensitivity (14.117 kPa−1) and excellent cycling performance (4000 cycles) were designed, benefiting from the excellent skin-like properties of polyacrylamide/gelatin/MXene hybrid hydrogels with rich porous dual networks and micro-cylinder arrays patterned on the surface of hydrogel. Particularly, the hydrogel sensors exhibited resistance–capacitance dual response signals, and the basic understanding of this phenomenon was proposed through a simplified circuit model and finite element method analysis. Furthermore, to mimic the regionalization of Merkel cells in the skin, a multiplexed sensing array was implemented and then successfully applied in the field of wireless wearable health monitoring, providing a promising strategy for the development of smart personalized healthcare.

High-performance flexible and stretchable self-powered surface engineered PDMS-TiO2 nanocomposite based humidity sensors driven by triboelectric nanogenerator with full sensing range

Harvesting electrical charge using triboelectrification provides a promising path to realizing uninterrupted self-powered sensors with application in wearable electronics and personal healthcare. This paper reports a high-performance flexible and stretchable self-powered humidity sensor based on triboelectric nanogenerators (TENG) that provides extreme responsivity, excellent repeatability with fast recovery time, and high selectivity. The device relies on a surface-engineered titanium oxide nanoparticle-silicone nanocomposite that generates triboelectric charge density strongly dependent on ambient humidity. The performance of the nanoengineered humidity sensor was systematically investigated at different humidity levels, which exhibits high responsivity (90% change for 75% RH change), a fast response time (1 s for 50% RH), a fast recovery time (3 s for 50% RH), and nearly full sensing range (0–99%). When activated by vertical contact separation at 2 Hz, the device generates a power density as high as 90 mW.m−2 and an open-circuit voltage of 50 V. An analytical model is derived to understand the underlying mechanism. The theoretical data explain the role of dielectric permittivity and surface area on the device operation, and the results are in good agreement with the experiments. The excellent combination of the properties suggests that these flexible TENGs can serve as reliable self-powered motion-driven humidity sensor.

Do urban tourists prefer vegetarianism? An urban-rural comparison of vegetarian consumption in China.

The adoption of a vegetarian diet might have public health and environmental benefits. However, little is known about urban and rural Generation Z tourists' attitudes toward vegetarianism or vegetarian consumption within the Chinese urban and rural settings. Hence, to address this gap, the present study adopted a sequential and mixed research approach based on a survey (n = 212) and laddering interviews (n = 20) to validate post-millennial tourists' motives for adopting a vegetarian diet. The results identified the top four motives as environmental protection and resource conservation, ethical consideration, personal taste and choice, and personal healthcare issues. The top four barriers to vegetarianism were unavailability and limited choice, peer pressure, traditional prejudice/habit, and the inability to change. The results also demonstrated that both rural and urban tourists adopt vegetarianism mainly for environmental protection and ethical consideration, a subtle difference between them is that urban vegetarians emphasized ethical considerations more but rural ones emphasized food and variety. Urban consumers considered unavailability and limited choice as the topmost barriers to being vegetarian, while rural vegetarians found traditional prejudice to be restricting. Due to traditional dietary habits and peer influence, rural tourists face many more challenges when adopting a vegetarian diet. Understanding the perceived benefits and barriers to being vegetarian in different regions will not only enrich the theory of food nutrition but also expand Generation Z tourists' consumption behavior and practices.

REVIEW ON A POTENTIAL OF ANTIBIOTICS

Since the beginning of time, man and microbes have coexisted. While certain microbes were capable of living successfully with humans, acting as resident germs that protect and balance the body, harmful bacteria enter and develop in man's tissues, producing infections and physical harm that can occasionally result in death. In the 1940s, antibiotics were discovered and put to use as a result of man's effort for a treatment for her and her numerous bacterial enemies. Antimicrobial are reported to have negative impacts on the beneficial and healthy bacteria of the animal living process while combating disease-causing microorganisms. Antimicrobial use hence depends on the total expected effect while taking into account any adverse side effects. Therefore, it is essential to accurately identify and know the mechanism of action of antimicrobial in order to protect person's health care system. Knowing how medicines fight bacteria has tremendously benefited from modern molecular biology techniques. The classifications of antibiotics are therefore addressed in this work. Key Words: Antimicrobial, Bacteria, Beta-lactums, Macrolides, Tetracyclines

Main Causal Agents of Occupational Asthma in France, Reported to the National Network for Occupational Disease Vigilance and Prevention (RNV3P) 2001-2018.

The definition of work-related Asthma (WRA) has changed in recent years and new etiologies and agents have been identified. The aim of this study is to describe the main causal agents of WRA in France in the period 2001-2018 in the main work sectors. Data were collected from the French national network of occupational health surveillance and prevention [Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)], Data between 2001 and 2018 with at least a probable or certain association with one occupational agent, were included. Work sectors with more cases OF WRA included personal service activities (10.6%), food industry (10.2%) and healthcare activities (7.6%). WRA cases were most frequently related to flour (10%), quaternary ammoniums compounds (5.3%), isocyanates (5.1%) and cleaning products (4.8%). Occupational exposure to specific agents capable of causing WRA is still present, and four agents represent more than 25% of the cases. Actions to prevent respiratory exposure are still relevant.

A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study.

People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. The aim of this study is to assess an app's utility in promoting health-related knowledge in people aged ≥65 years. We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II - Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool's utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app's ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II - Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. PRR1-10.2196/29675.

Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey.

Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities' knowledge of equity along digital health use patterns. This study aims to identify the social determinants of digital health tool adoption in Georgia. Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions.

Thermoelectric energy harvesting for personalized healthcare

AbstractIn recent decades, there has been increased research interest in miniaturizing and decentralizing diagnostic platforms to enable continuous personalized healthcare and free patients from long‐term hospitalization. However, the lack of reliable and portable power supplies has limited the working time of the personalized healthcare platform. Compared with the current power supplies (e.g., batteries and supercapacitors) that require manual intervention, thermoelectric devices promise to continuously harvest waste heat from the human body to satisfy the energy consumption of personalized healthcare platforms. Herein, this review discusses thermoelectric energy harvesting for personalized healthcare. It begins with the fundamental concepts of different thermoelectric materials, including electron thermoelectric generators (TEGs), ionic thermogalvanic cells (TGCs), and ionic thermoelectric capacitors (TECs). Then, the wearable and implantable applications of thermoelectric devices are presented. Finally, future directions of next‐generation thermoelectric devices for personalized healthcare are discussed. It is hoped that developing high‐performance thermoelectric devices will change the landscape of personalized healthcare in the future.

Hexapole-Assisted Continuous Atmospheric Pressure Interface for a High-Pressure Photoionization Miniature Ion Trap Mass Spectrometer.

Miniature mass spectrometers are powerful tools for on-site chemical analysis in the fields of homeland security, personal healthcare, and environmental monitoring. This study presents a novel hexapole-assisted continuous atmospheric pressure interface for a high-pressure photoionization miniature ion trap mass spectrometer (HA-HPPI-IT). Efficient ion transmission was achieved by combining radial focusing by an RF electric field and axial driving by gas flow, which was demonstrated by SIMION simulation and experimental verification. The pressure in the ionization-transmission chamber and the inner diameter of the skimmer were optimized, which helped in determining the number density of product ions and affected the ion transmission in the hexapole, respectively. After systematic optimizations, about 16-fold increase in signal intensity was achieved as the RF amplitude was varied from 140 to 400 Vpp, and a limit of detection of 1 ppbv was obtained. In addition, the HA-HPPI-IT exhibited high stability and the relative standard deviation was as low as 5.47%. Finally, the apparatus was applied for discovering the simulated spot for illicit drug synthesis by detecting toluene and propiophenone released to air and monitoring the evolutions of perchloroethylene residues from dry-cleaned clothes.

Intrinsic mechanism and multiphysics analysis of electromagnetic wave absorbing materials: New horizons and breakthrough

• The simulation and numerical analysis of EM materials are reviewed, from numerical analysis of dielectric parameters, simulation of wave absorbing performance, electromagnetic performance improvement, and structural construction optimization. • For the EM response mechanism, radiation-dependent relaxation and charge transport energy transitions are dissected. • For the EM calculation section, two leading roles are highlighted, including the purposeful design of EM and the provision of theoretical guidance for optimizing electromagnetic absorption performance. • In addition, this paper points out the current problems and potential opportunities in the numerical simulation of absorbing materials, point out the new development direction and proposes prospects. Electromagnetic absorbers (EMA) have driven the development of Electromagnetic (EM) technology and advanced EM devices. Utilizing the EM energy conversion of EM absorbers to design various devices is attractive and promising, especially in personal protection and healthcare. In this review article, the simulation and numerical analysis of EM materials are reviewed, from numerical analysis of dielectric parameters, simulation of wave absorbing performance, electromagnetic performance improvement, and structural construction optimization. For the EM response mechanism, radiation-dependent relaxation and charge transport energy transitions are dissected. For the EM calculation section, two leading roles are highlighted, including the purposeful design of EM and the provision of theoretical guidance for optimizing electromagnetic absorption performance. In addition, this work points out the current problems and potential opportunities in the numerical simulation of absorbing materials, points out the new development direction, and proposes prospects. Graphical Abstract .

'It's a different way to do medicine': Exploring the affordances of telehealth for hepatitis C healthcare.

While the use of telehealth was common in hepatitis C healthcare in Australia in remote and regional areas prior to the COVID-19 pandemic, it has been used more broadly to improve access to hepatitis C heathcare during the pandemic. Despite its widespread uptake, little research has explored how telehealth shapes hepatitis C healthcare. In this article, we draw on the concept ofaffordances (Latour, 2002)and interviews with 25 healthcare practitioners to explore the emergent possibilities for hepatitis C care that take shape through telehealth. Despite suggestions that telehealth is comparable to in-person care, healthcare practitioners' accounts suggest that telehealth significantly changes the nature of their experience of providing healthcare for hepatitis C. According to these service practitioners, while it increased access to hepatitis C healthcare during the pandemic, it also afforded narrower, less personal healthcare encounters, with a focus on simple and singular issues, and reduced opportunities for communication and rapport. These affordances also discouraged the use of interpreters and by extension the inclusion of patients from non-English speaking backgrounds. However, the data collected also suggest that telehealth has the potential to afford more informal and relaxed healthcare environments and dispositions between healthcare practitioners and patients, potentially disrupting classic practitioner-patient power dynamics. In concluding, the article considers how telehealth models of care might better afford quality hepatitis C healthcare and care beyond COVID-19 pandemic conditions.

Joint Optimization of Energy and QoS for Smart Clothing With Multiposture Participation

The rising aging population, inequality of medical resources, and severe COVID-19 infection rate raise inevitable individual and social contradictions. One of the representative developing technologies, smart wearables, is dedicated to offering accurate personal healthcare. Nevertheless, energy constraints as well as unpredictable data transmission are critical in the development of wearable devices. In this regard, we investigate the key concerns of energy life and quality of service (QoS) for smart clothing. Unlike general wireless sensing networks (WSNs), the wireless body area network (WBAN) embedded in smart clothing is highly affected by human postural changes. In this article, we formulate the smart clothing with multiposture participated from two perspectives: 1) for energy life, we address the energy consumption, the energy harvested by the nodes, and the battery discharge and 2) the QoS involves the path loss and time delay. Moreover, five typical daily activity states have been discussed to model the impact of posture changes. Under the influence of the posture state, the tradeoff between the collected tribological electrical energy and the consumed energy is also presented in the article. We parameterize the path loss, transmission delay, energy consumption, and collection in each posture and integrally formulate the energy problem and QoS to a joint optimization problem. Particle swarm optimization (PSO), sine cosine algorithm (SCA), and Q-learning algorithm are adopted to optimize the overall cost, time delay, and energy consumption. In addition, a comparison of the battery power of the nodes is conducted. Simulation results show that each algorithm achieves certain optimization effects, for example, PSO, SCA, and Q-learning reduce total costs by 14%, 22%, and 30%, respectively. Q-learning is also effectively decreasing latency and energy consumption and improving battery life.

Citrus Essential Oils in Aromatherapy: Therapeutic Effects and Mechanisms.

Citrus is one of the main fruit crops cultivated in tropical and subtropical regions worldwide. Approximately half (40-47%) of the fruit mass is inedible and discarded as waste after processing, which causes pollution to the environment. Essential oils (EOs) are aromatic compounds found in significant quantities in oil sacs or oil glands present in the leaves, flowers, and fruit peels (mainly the flavedo part). Citrus EO is a complex mixture of ~400 compounds and has been found to be useful in aromatic infusions for personal health care, perfumes, pharmaceuticals, color enhancers in foods and beverages, and aromatherapy. The citrus EOs possess a pleasant scent, and impart relaxing, calming, mood-uplifting, and cheer-enhancing effects. In aromatherapy, it is applied either in message oils or in diffusion sprays for homes and vehicle sittings. The diffusion creates a fresh feeling and enhances relaxation from stress and anxiety and helps uplifting mood and boosting emotional and physical energy. This review presents a comprehensive outlook on the composition, properties, characterization, and mechanism of action of the citrus EOs in various health-related issues, with a focus on its antioxidant properties.

Effectiveness of a community-integrated intermediary care (CIIC) service model to enhance family-based long-term care for Thai older adults in Chiang Mai, Thailand: a cluster-randomized controlled trial TCTR20190412004

BackgroundPopulations around the world are ageing faster, with the majority living in low- and middle-income countries where health and social care are yet to be universal and inclusive for the ageing population. This community-integrated intermediary care (CIIC) model is a novel prevention-based, long-term care model enhancing the family-based care system traditionally practised in Thailand and neighbouring Asian countries, and many low-and middle-income countries globally. This study assessed the effectiveness of the CIIC model in Chiang Mai, Thailand.MethodsThe two-arm parallel intervention study was designed as a cluster-randomized controlled trial. The study population at randomization and analysis was 2788 participants: 1509 in six intervention clusters and 1279 in six control clusters. The research protocol was approved by the WHO Research Ethics Review Committee (WHO/ERC ID; ERC.0003064).The CIIC service intervention model is a combination of formal care and informal care in a subdistrict setting consisting of three components: (1) care prevention delivered as community group exercise and home exercise; (2) care capacity-building of the family caregiver; and (3) community respite service. The primary outcome was family caregivers’ burden at 6-month follow-up, and secondary outcome was activities of daily living. Analysis applied the intention-to-treat approach using cluster-level analysis via STATA 16 SE.ResultsBaseline characteristics did not differ between the two arms. Loss of follow up was 3.7%. Mean age of the participants was 69.53 years. Women constituted 60%. The COVID-19 pandemic caused delayed implementation. The proportion of families with reduced caregiver burden at 6-month follow-up was higher among the intervention clusters (mean 39.4%) than control clusters (mean 28.62%). The intervention clusters experienced less functional decline and fewer people with depression.ConclusionsWhen communities are integrated for preventing care, and families are empowered for giving care, it is possible to secure universal access to health and social care for the older persons, with basic resources mobilized from communities. This study had shown the CIIC model as an effective and potential step to the realization of universal health and long-term care coverage being inclusive of ageing populations in Thailand and globally.Trial registration: This trial was registered at the Thailand Clinical Trial Registry—Trial registration number TCTR20190412004, https://www.thaiclinicaltrials.org/#

Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model.

In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.

Self-Adhesive and Conductive Dual-Network Polyacrylamide Hydrogels Reinforced by Aminated Lignin, Dopamine, and Biomass Carbon Aerogel for Ultrasensitive Pressure Sensor.

Conductive hydrogels have attracted extensive interest owing to its potential in soft robotics, electronic skin, and human monitoring. However, insufficient mechanical properties, lower adhesivity, and unsatisfactory conductivity seriously hinder potential applications in this emerging field. Herein, a highly elastic conductive hydrogel with a combination of favorable mechanical properties, self-adhesiveness, and excellent electrical performance was achieved by the synergistic effect of aminated lignin (AL), polydopamine (PDA), polyacrylamide (PAM) chains, and biomass carbon aerogel (C-SPF). In detail, AL was applied to induce slow oxidative polymerization of DA for preparing the sticky hydrogel containing PDA. Then, C-SPF carbon aerogel was used as a matrix to construct a dual-network structured composite hydrogel by combining with the hydrogels derived from PDA, AL, and PAM. The as-prepared conductive hydrogel displayed excellent mechanical performance, strong adhesive strength, and repeatable adhesivity. The prepared hydrogel-based pressure sensor possessed fast response (0.6 s loading and 0.8 s unloading stress time), high response (maximum RCR = 1.8 × 104), wide working pressure range (from 0 to 240.0 kPa), and excellent durability (stable 500 compression cycles with 30% deformation). In addition, the prepared sensor also displayed ultrahigh sensitivity (170 kPa-1), which was near 4 orders of magnitude higher than the conventional lignin-modified PAM hydrogels. The multiple interactions between hydrogel components and the mechanical properties of hydrogel were also verified by molecular dynamics investigation. Moreover, the excellent cytocompatibility and antibacterial activity of this composite hydrogel ensured high potential in various applications such as human/machine interaction, artificial intelligence, personal healthcare, and wearable devices.

Associations Between Mental Health and Oral Health in Saudi Arabia: An Online Survey-Based Cross-Sectional Study.

Background Mental disorders cause psychological stress and lead to poor lifestyle behaviors and an increased risk of poor oral health. This study aims to explore the potential association between mental illnesses with oral health and personal oral care in the Saudi population. Methodology Saudi Arabians aged ≥18 years were eligible to participate in this cross-sectional study. The study questionnaire had the following five sections: demographics, a brief depression severity measure (Patient Health Questionnaire-9), a brief generalized anxiety disorder measurement tool (Generalized Anxiety Disorder-7), an oral health measurement tool, and personal oral health care. The data were analyzed using SPSS software version 26 (IBM Corp., Armonk, NY, USA). The results were presented as numbers and (percentages) or mean and standard deviations (SD). Results This study included a total of 522 participants. The mean scorefor dental health and care was 4 (SD = 1.9) and 13.6 (SD = 1.9), respectively, reflecting a moderate level of dental health and positive dental care. Males had better oral health, whereas females had better dental care. A college degree or higher was linked to better dental care, and chronic diseases were linked to lower dental health scores. Minimal depression had a significantly higher dental care score than mild-to-severe depression. Depression and anxiety did not affect dental health. Conclusions This study showed that minimal depression was associated with a higher dental care score than mild-to-severe depression. However, the degree of depression was not associated with dental health. Furthermore, anxiety had no association with dental health or care.

SENSIBLE: SEquestered aNd SynergIstic BLockchain Ecosystem

AbstractHealth care interoperability unfolds the way for personalized health care services at a reduced cost. Furthermore, a decentralized system holds the promise to prevent compromises such as cyber‐attacks due to data breaches. Hence, there is a need for a framework that seamlessly integrates and shares data across the system stakeholders. We propose SEquestered aNd SynergIstic BLockchain Ecosystem (SENSIBLE), a blockchain‐powered, knowledge‐driven data‐sharing framework that gives patients complete control of their medical history and can extract rich information hidden in it using knowledge graphs (KGs). By incorporating both blockchain and KGs, we can provide a platform for secure data sharing among stakeholders by maintaining data privacy and integrity through data authentication and robust data integration. We present a Proof‐of‐Concept of the SENSIBLE network with Ethereum to share dynamic knowledge across stakeholders. Dynamic knowledge generation on the blockchain provides a two‐fold advantage of cooperation and communication amongst the stakeholders in the health care ecosystem. This leads to operational ease through sharing relevant portions of complex information while also ensuring the isolation of sensitive medical data.

Design and Evaluation Challenges of Conversational Agents in Health Care and Well-being: Selective Review Study.

Health care and well-being are 2 main interconnected application areas of conversational agents (CAs). There is a significant increase in research, development, and commercial implementations in this area. In parallel to the increasing interest, new challenges in designing and evaluating CAs have emerged. This study aims to identify key design, development, and evaluation challenges of CAs in health care and well-being research. The focus is on the very recent projects with their emerging challenges. A review study was conducted with 17 invited studies, most of which were presented at the ACM (Association for Computing Machinery) CHI 2020 conference workshop on CAs for health and well-being. Eligibility criteria required the studies to involve a CA applied to a health or well-being project (ongoing or recently finished). The participating studies were asked to report on their projects' design and evaluation challenges. We used thematic analysis to review the studies. The findings include a range of topics from primary care to caring for older adults to health coaching. We identified 4 major themes: (1) Domain Information and Integration, (2) User-System Interaction and Partnership, (3) Evaluation, and (4) Conversational Competence. CAs proved their worth during the pandemic as health screening tools, and are expected to stay to further support various health care domains, especially personal health care. Growth in investment in CAs also shows the value as a personal assistant. Our study shows that while some challenges are shared with other CA application areas, safety and privacy remain the major challenges in the health care and well-being domains. An increased level of collaboration across different institutions and entities may be a promising direction to address some of the major challenges that otherwise would be too complex to be addressed by the projects with their limited scope and budget.

Patients' spiritual concerns and needs and how to address them during advance care planning conversations: Healthcare chaplains' perspectives.

Advance care planning (ACP) conversations require the consideration of deeply held personal values and beliefs and the discussion of uncertainty, fears, and hopes related to current and future personal healthcare. However, empirical data are limited on how such spiritual concerns and needs are supported during ACP. This study explored board-certified healthcare chaplains' perspectives of patients' spiritual needs and support in ACP conversations. An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey included 3 open-ended questions about patients' hopes and fears and about how the chaplains addressed them during ACP conversations. Written qualitative responses provided by 244 of the chaplains were examined with content analysis. The majority of the 244 chaplains were White (83.6%), female (59%), Protestant (63.1%), and designated to one or more special care units (89.8%). Major themes on patients' hopes and fears expressed during ACP were (1) spiritual, religious, and existential questions; (2) suffering, peace, and comfort; (3) focus on the present; (4) hopes and fears for family; and (5) doubt and distrust. Major themes on how chaplains addressed them were (1) active listening to explore and normalize fears, worries, and doubts; (2) conversations to integrate faith, values, and preferences into ACP; and (3) education, empowerment, and advocacy. ACP conversations require deep listening and engagement to address patients' spiritual needs and concerns - an essential dimension of engaging in whole-person care - and should be delivered with an interdisciplinary approach to fulfill the intended purpose of ACP.