Initial User Research Articles

An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial.

In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. DERR1-10.2196/45887.

The BciAi4SLA Project: Towards a User-Centered BCI

The brain–computer interfaces (BCI) are interfaces that put the user in communication with an electronic device based on signals originating from the brain. In this paper, we describe a proof of concept that took place within the context of BciAi4Sla, a multidisciplinary project involving computer scientists, physiologists, biomedical engineers, neurologists, and psychologists with the aim of designing and developing a BCI system following a user-centered approach, involving domain experts and users since initial prototyping steps in a design–test–redesign development cycle. The project intends to develop a software platform able to restore a communication channel in patients who have compromised their communication possibilities due to illness or accidents. The most common case is the patients with amyotrophic lateral sclerosis (ALS). In this paper, we describe the background and the main development steps of the project, also reporting some initial and promising user evaluation results, including real-time performance classification and a proof-of-concept prototype.

P717 Use of tramadol versus traditional opioids and adverse outcomes of Inflammatory Bowel Diseases: a Danish nationwide cohort study

Abstract Background Patients with inflammatory bowel diseases (IBD) commonly suffer from pain that requires analgesic therapies such as tramadol and opioids. However, use of traditional opioids (TOs) has been associated with severe infections and mortality in this population. Tramadol, a partial agonist of opioid receptors, has been considered to have less abuse potential compared to TOs. It is unknown if tramadol is associated with fewer IBD-related complications compared to TOs. Methods This was a Danish nationwide cohort study examining adverse outcomes associated with use of tramadol vs TOs in the IBD population. Patients with IBD (ICD-10 codes K50 and K51) diagnosed 1995-2021 in Denmark with subsequent prescriptions for tramadol or TOs were included. For each drug exposure, two populations were defined: initial users (“IUs”; first prescription after IBD diagnosis) and persistent users (“PUs”; first 3 consecutive prescriptions within 365 days after IBD diagnosis). Outcomes included severe (hospital-diagnosed) infection, bowel obstruction or ileus, IBD surgery, and mortality within 90 days after the IU index date (i.e. date of first prescription) and within 365 days after the PU index date (i.e. date of third prescription) (Figure 1). Multivariable logistic regression was performed to determine associations of tramadol vs TOs with outcomes while adjusting for age, sex, Charlson comorbidity index, year of IBD diagnosis, IBD type, IBD duration, and prior immunomodulator use, corticosteroid use, IBD hospitalization, severe infection, bowel obstruction or ileus, and IBD surgery within 6 months before the index date. A sensitivity analysis was performed in which patients with any diagnosis of a malignant neoplasm (ICD-10 codes C00-99) <1 year prior to the first tramadol or TO prescription were excluded. Results We identified 37,377 IUs and 15,237 PUs of tramadol or TOs. Baseline characteristics are presented in Table 1. IUs of tramadol had lower odds of severe infection (adjusted odds ratio [aOR] 0.80, 95% CI 0.65-0.99), bowel obstruction or ileus (aOR 0.74, 95% CI 0.53-1.03), and mortality (aOR 0.43, 95% CI 0.35-0.55), and higher odds of IBD surgery (aOR 1.27, 95% CI 1.02-1.60) vs TOs. PUs of tramadol had lower odds of severe infection (aOR 0.69, 95% CI 0.55-0.86), bowel obstruction or ileus (aOR 0.58, 95% CI 0.39-0.85), and mortality (aOR 0.35, 95% CI 0.28-0.44) but no difference in IBD surgery (aOR 1.13, 95% CI 0.86-1.47) vs TOs (Table 2). Results were unchanged after excluding patients with malignancy (Table 3). Conclusion Use of tramadol was associated with lower odds of severe infection, bowel obstruction or ileus, and mortality vs use of TOs among patients with IBD. Safety comparisons of tramadol to other analgesics are needed.

Adherence and treatment patterns of disease-specific drugs among patients with pulmonary arterial hypertension: A nationwide, new-user cohort study.

Background: Pulmonary arterial hypertension (PAH) is an incurable pulmonary disease that might result in right heart failure and death. Treatment guidelines recommend upfront or sequential combination therapy for patients with PAH. Recently, several PAH-targeted medications have been approved in Taiwan. This study aimed to investigate treatment patterns and medication adherence in real-world settings. Method: This was a new-user design study on patients treated with PAH-specific medication between 1 January 2014, and 31 December 2019. Data were extracted from the National Health Insurance Research Database. Medication adherence was evaluated by the proportion of days covered (PDC). Adherence was defined as PDC ≥ .8. Statistical analyses were performed to compare the study outcomes. Logistic regression analysis was performed to identify the association between baseline characteristics and adherence. P < .05 indicated statistical significance. Results: A total of 1,900 patients with PAH were identified, and 75.3% of them were females. The mean (standard deviation (SD)) age was 57.2 (17.5)years. Only 23 (1.2%) patients began the initial combination therapy. A total of 148 (7.8%) patients switched their initial treatment to another treatment, and 159 (8.4%) patients had sequential combination therapy. The most common combination therapy was endothelin receptor antagonist (ERA) plus phosphodiesterase-5 inhibitor (PDE5i), mostly macitentan plus sildenafil, for initial or sequential combination. The mean (SD) PDC was .71 (.33), and 1,117 (58.8%) patients were adherent. A significant difference in mean PDC was observed between initial ERA users and PDE5i users (p < .0001). No factor was significantly associated with medication adherence. Conclusion: Patients with PAH mostly initiated sildenafil as monotherapy, and macitentan was added as a sequential combination therapy. The initial ERA and combination groups showed higher medication adherence. Further investigations are needed to identify other factors associated with adherence.

Adaptation of a Personalized Electronic Care Planning Tool for Cancer Follow-up Care: Formative Study.

Most patients diagnosed with colorectal cancer will survive for at least 5 years; thus, engaging patients to optimize their health will likely improve outcomes. Clinical guidelines recommend patients receive a comprehensive care plan (CP) when transitioning from active treatment to survivorship, which includes support for ongoing symptoms and recommended healthy behaviors. Yet, cancer care providers find this guideline difficult to implement. Future directions for survivorship care planning include enhancing information technology support for developing personalized CPs, using CPs to facilitate self-management, and assessing CPs in clinical settings. We aimed to develop an electronic tool for colorectal cancer follow-up care (CFC) planning. Incorporating inputs from health care professionals and patient stakeholders is fundamental to the successful integration of any tool into the clinical workflow. Thus, we followed the Integrate, Design, Assess, and Share (IDEAS) framework to adapt an existing application for stroke care planning (COMPASS-CP) to meet the needs of colorectal cancer survivors (COMPASS-CP CFC). Constructs from the Consolidated Framework for Implementation Research (CFIR) guided our approach. We completed this work in 3 phases: (1) gathering qualitative feedback from stakeholders about the follow-up CP generation design and workflow; (2) adapting algorithms and resource data sources needed to generate a follow-up CP; and (3) optimizing the usability of the adapted prototype of COMPASS-CP CFC. We also quantitatively measured usability (target average score ≥70; range 0-100), acceptability, appropriateness, and feasibility. In the first phase, health care professionals (n=7), and patients and caregivers (n=7) provided qualitative feedback on COMPASS-CP CFC that informed design elements such as selection, interpretation, and clinical usefulness of patient-reported measures. In phase 2, we built a minimal viable product of COMPASS-CP CFC. This tool generated CPs based on the needs identified by patient-completed measures (including validated patient-reported outcomes) and electronic health record data, which were then matched with resources by zip code and preference to support patients' self-management. Elements of the CFIR assessed revealed that most health care professionals believed the tool would serve patients' needs and had advantages. In phase 3, the average System Usability Scale score was above our target score for health care professionals (n=5; mean 71.0, SD 15.2) and patients (n=5; mean 95.5, SD 2.1). Participants also reported high levels of acceptability, appropriateness, and feasibility. Additional CFIR-informed feedback, such as desired format for training, will inform future studies. The data collected in this study support the initial usability of COMPASS-CP CFC and will inform the next steps for implementation in clinical care. COMPASS-CP CFC has the potential to streamline the implementation of personalized CFC planning to enable systematic access to resources that will support self-management. Future research is needed to test the impact of COMPASS-CP CFC on patient health outcomes.

Data-Aided Active User Detection With False Alarm Correction in Grant-Free Transmission

In most existing grant-free (GF) studies, the two key tasks, namely active user detection (AUD) and payload data decoding, are handled separately. In this letter, a two-step data-aided AUD scheme is proposed, namely the initial AUD step and the false alarm correction step respectively. To implement the initial AUD step, an embedded low-density-signature (LDS) based preamble pool is constructed. In addition, two message passing algorithm (MPA) based initial estimators are developed. In the false alarm correction step, a redundant factor graph is constructed based on the initial active user set, on which MPA is employed for data decoding. The remaining false detected inactive users will be further detected by the false alarm corrector with the aid of decoded data symbols. Simulation results reveal that both the data decoding performance and the AUD performance are significantly enhanced by more than 1.5 dB at the target accuracy of <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$10^{-3}$ </tex-math></inline-formula> compared with the traditional compressed sensing (CS) based counterparts.

Extended Dependency Modeling Technique for Cyber Risk Identification in ICS

Complex systems such as Industrial Control Systems (ICS) are designed as a collection of functionally dependent and highly connected units with multiple stakeholders. Identifying the risk of such complex systems requires an overall view of the entire system. Dependency modelling (DM) is a highly participative methodology that identifies the goals and objectives of a system and the required dependants to satisfy these goals. Researchers have proved DM to be suitable for identifying and quantifying impact and uncertainty in complex environments. However, there exist limitations in the current expressions of DM that hinder its complete adaptation for risk identification in a complex environment such as ICS. This research investigates how the capability of DM could be extended to address the identified limitations and proposes additional variables to address phenomena that are unique to ICS environments. The proposed extension is built into a system-driven ICS dependency modeller, and we present an illustrative example using a scenario of a generic ICS environment. We reflect that the proposed technique supports an improvement in the initial user data input in the identification of areas of risk at the enterprise, business process, and technology levels.

마이데이터 서비스 이용자의 수용의도에 미치는 영향 연구 - 혁신저항의 조절효과를 중심으로

MyData service has been providing a lot of information and benefits to users since the service began in January 2022. The government is promoting various services (medical, health, insurance, etc.) so that MyData services can be activated in the industry. This study has recognized the MyData service as a type of new information technology and examined the acceptance intention of the initial app users who use the MyData service. Users still have new innovations called MyData services and resistance to change. It is intended to find a way to resolve innovation resistance for early users who use the MyData service app. This study was conducted Unified Theory of Acceptance and Use of Technology(UTAUT) to examine the effect of perceptual value and reliability on the acceptance intention of MyData service users on performance expectations and effort expectations. In addition, the moderating effect of each group was examined by classifying them into groups with high and low innovation resistance. As a result of the analysis, it was found that all the hypotheses presented in this study were adopted and had an effect. In the analysis result of the moderating effect by group, the hypothesis of reliability and effort expectation was rejected. This suggests that users with high resistance to MyData service innovation have low cognitive of service use. Therefore, MyData service apps should make more efforts to expect performance, effort, and acceptance intention through perceived value to users.

ACCOUNTING FOR DIVERSITY IN COGNITIVE STATUS IN THE DESIGN AND EVALUATION OF INCLUSIVE PROSPECTIVE MEMORY SOLUTIONS

Abstract Technology holds tremendous promise for supporting older adults' performance of important everyday activities. However, truly inclusive design of technology-based solutions must account for diversity with respect to cognitive status. This talk will focus on empirical studies conducted under the umbrella of the Enhancing Neurocognitive Health, Abilities, Networks, &amp; Community Engagement (ENHANCE) Center with an emphasis on designing inclusive prospective memory solutions for older adults with cognitive impairments. Initial usability studies will be discussed examining the usability and efficacy of novel technology solutions, including the use of smartwatches and digital assistants, to support prospective memory, the ability to remember and carry out an intention in the future, which is crucial for maintaining health, independence, and social connections.

Assessing the sustainability impacts of food sharing initiatives: User testing The Toolshed SIA

The food system is unsustainable and requires reconfiguration, however more data is required to assess the impacts of action which might contribute to a more sustainable food future. Responding to this, extensive research with food sharing initiatives—activities which have been flagged for their potential sustainability credentials—led to the co-design of an online sustainability impact assessment (SIA) tool to support food sharing initiatives to asses and evidence their sustainability impacts. This paper reports on the initial user testing of the resulting online tool: The Toolshed which forms the indicator based SIA element of the SHARE IT platform. Feedback gathered from the initiatives testing the tool are analyzed and summaries of their reported impacts detailed. This analysis confirms the need for the tool, the relevance of the indicators included and the value of SIA reports for internal reflection and external communication. Nonetheless, challenges remain in relation to resourcing the practice of SIA reporting. We conclude with a plan for expanding engagement with The Toolshed and the wider SHARE IT platform.

R2Play development: Fostering user-driven technology that supports return-to-play decision-making following pediatric concussion.

To design a multi-domain return-to-play assessment system (R2Play) for youth athletes with concussion. The R2Play system was developed using an overarching user-centered approach, the Design Thinking Framework, and research activities included: 1) structured brainstorming within our research team, 2) interviews with clinician and youth sports coaches, 3) building a testable prototype, and 4) interface testing through cognitive walkthroughs with clinician partners. Clinician and coach participants provided feedback on the R2Play concept, which was integrated into the design process and provided future directions for research. Examples of feedback-driven design choices included reducing assessment time, increasing ecological validity by adding in background noise, and developing youth-friendly graphical results screens. Following refinement based on stakeholder feedback, the R2Play system was outlined in detail and a testable prototype was developed. It is made up of two parts: a clinician tablet, and a series of tablet "buttons" that display numbers and letters. Youth athletes run between the buttons to connect a "trail" in ascending alphanumeric order, 1-A-2-B, etc. Their performance across a series of levels of increasing difficulty is logged on the clinician tablet. Initial testing with five clinicians showed the system's interface to have excellent usability with a score of 81% (SD = 8.02) on the System Usability Scale. Through this research, a prototype of the R2Play system was innovated and evaluated by clinician and coach stakeholders. Initial usability was excellent and directions for future iterations were highlighted. Outcomes suggest the potential benefits of using technologies to assist in complex clinical assessment, as well as utilizing a user-centered approach to design.

A tangible interface approach to the codesign of a literacy platform for deaf users

We report initial results of the codesign process of a software platform aimed to support the development of reading and writing skills among deaf students at the elementary level. This platform is one of the main outcomes set out for a broad multi-institutional, multi-disciplinary deaf literacy project. As one of the initial user research activities, we held a co-creation workshop with six deaf participants, one sign language interpreter, and four hearing researchers. In this workshop we explored the application of a design technique intended to enhance participation and communication by relying on low-tech tangible representations of interface components that can be combined to generate interaction designs. Through observation during the workshop and analysis of video recordings we have derived adaptations and adjustments to our approach for its application in upcoming codesign activities.

Design and Development of a qPCR-Based Mitochondrial Analysis Workflow for Medical Laboratories

Mitochondrial DNA (mtDNA) damage is closely associated with typical diseases of aging, such as Alzheimer’s or Parkinson’s disease, and other health conditions, such as infertility. This damage manifests in reduced mitochondrial copy number and deletion mutations in mtDNA. Consequently, the analysis of mitochondrial damage by determining the parameters copy number and deletion ratio using quantitative real-time PCR (qPCR) is of interest for clinical diagnostics. To bring the findings from research into laboratory practice, a suitable and reliable process is needed, which must be thoroughly validated. This process includes the software used for the analysis, which must meet extensive regulatory and process requirements. Existing software does not adequately implement the requirements of laboratories and, in particular, does not provide direct support for the calculation of the aforementioned mtDNA parameters. The paper discusses the development of a new software-based analysis workflow that is designed specifically for laboratories to help with the calculation of mtDNA parameters. The software was developed using the User-Centered Design method and is based on the recently introduced prototype, “PlateFlow”. Initial user tests provide positive feedback. In the future, this workflow could form the basis for validations of mitochondrial tests in medical laboratories.

A user-guided innovization-based evolutionary algorithm framework for practical multi-objective optimization problems

The knowledge of experienced users in solving real-world optimization problems can be formulated as inter-variable relationships to guide an optimization algorithm towards good solutions faster. Alternatively, such interactions can be learned algorithmically during the optimization by analysing good solutions—a process called innovization. Any common pattern extracted from good solutions can be used as a repair operator to modify candidate solutions. The key aspect is to strike a balance between the relevance of the pattern and the extent of its use in the repair operator. This article proposes a multi-objective evolutionary algorithm framework that combines problem-specific knowledge and online innovization approaches to solve two real-world large-scale multi-objective problems: a 879- and 1479-variable truss design and a 544-variable solid fuel rocket design. Four repair operators suitable for uncovering monotonic relations involving multiple decision variables are proposed. Performance variations resulting from different combinations of initial user knowledge and repair operators are also presented.

PoRi device: portable hand assessment and rehabilitation after stroke

Abstract Frequent rehabilitation exercises can accelerate the recovery of patient’s hand impairments after stroke. In conjunction with conventional therapy, the use of robot-assisted training has been proposed to increase the frequency of the latter, thus improving the overall recovery of patients. However, the COVID-19 pandemic has reduced or even halted related programs in clinical rehabilitation centers that often utilize costly, complex, and non-transportable robotic devices. A possible therapy alternative is using low-cost in-home solutions which integrate well in home-based settings due to reduced size, weight, and complexity. Therefore, we propose a new portable hand training and assessment device which supports hand opening/closing and wrist exercises. The device also enables tasks related to the identification of vibration stimuli to be used both for training as well as for assessment of sensory-motor hand function of patients. To this end, a cable-driven capstan transmission mechanism, a controller to regulate the extension angle, and touch pads equipped with vibration motors were designed and integrated into a hand-held device. Initial user studies indicate that the prototype can support stroke patients in extending their fingers. In further experiments targeting the identification of vibration stimuli, assessment results comparable with those obtained via a standard clinical somatosensory assessment test were achieved. Given these initial findings, our low-cost system shows the potential to allow in-home rehabilitation exercises in daily life, thus maximizing exposure and frequency, even during a forced lockdown caused by a pandemic.

Point of Care Peritoneal Dialysis: Initial Usability Assessments

Point of Care Peritoneal Dialysis: Initial Usability Assessments

The effect of transparency and trust on intelligent system acceptance: Evidence from a user-based study

Contemporary decision support systems are increasingly relying on artificial intelligence technology such as machine learning algorithms to form intelligent systems. These systems have human-like decision capacity for selected applications based on a decision rationale which cannot be looked-up conveniently and constitutes a black box. As a consequence, acceptance by end-users remains somewhat hesitant. While lacking transparency has been said to hinder trust and enforce aversion towards these systems, studies that connect user trust to transparency and subsequently acceptance are scarce. In response, our research is concerned with the development of a theoretical model that explains end-user acceptance of intelligent systems. We utilize the unified theory of acceptance and use in information technology as well as explanation theory and related theories on initial trust and user trust in information systems. The proposed model is tested in an industrial maintenance workplace scenario using maintenance experts as participants to represent the user group. Results show that acceptance is performance-driven at first sight. However, transparency plays an important indirect role in regulating trust and the perception of performance.

Writing library database descriptions in Plain Language

Plain Language is writing intended to be easily comprehensible by its intended audience. Used in government, legal, medical, and now educational writing, the primary goals of Plain Language are greater usability and equitable access. Current practices of describing databases to library users prioritizes marketing language and targets an audience of experts. In this article, the authors share applying Plain Language to library database descriptions to make them more understandable to novice undergraduate researchers. In revising the entire database list using Plain Language principles, they identified best practices for database descriptions. Initial usability results from the project are included.

A Robotic System for Solo Surgery in Flexible Ureterorenoscopy

Urolithiasis is a common disease with increasing prevalence across all ages. A common treatment option for smaller kidney stones is flexible ureterorenoscopy (fURS), where a flexible ureteroscope (FU) is used for stone removal and to inspect the renal collecting system. The handling of the flexible ureteroscope and end effectors (EEs), however, is challenging and requires two surgeons. In this article, we introduce a modular robotic system for endoscope manipulation, which enables solo surgery (SSU) and is adaptable to various hand-held FUs. Both the developed hardware components and the proposed workflow and its representation in software are described. We then present and discuss the results of an initial user study. Finally, we describe subsequent developmental steps towards more extensive testing by clinical staff.

A Conceptual Design Specification Based on User Aesthetic Information Analysis and Product Functional Reasoning

User satisfaction with a product plays a direct role in the purchasing decisions. With the enrichment of material life and the growth of individual requirements, this satisfaction is derived from the requirement for functionality to aesthetics. Conventional product design methods normally focus on achieving the required functions where its design specifications are mainly related to certain functional or usability requirements. In recent years, researchers have made efforts to develop methods for supporting aesthetic design activities during the product conceptual design phase. However, most of these methods hardly consider product aesthetics or the consumers’ emotional needs. Therefore, this study proposed a user-driven conceptual design specification integrating functional reasoning with aesthetic information analysis. The method consisted of two tasks, the construction of a mapping model and the implementation of the mapping model. Firstly, the mapping model was constructed for capturing the relationships between initial design specifications and user experience (UX). Secondly, the proposed design specifications were selected, refined, and optimized based on the mapping model. A case study on digital camera design was carried out to demonstrate the feasibility and effectiveness of the proposed method. The results showed that, compared with the initial design specification candidates, the UX was enhanced by applying the improved design specifications.