iPod Touch Devices Research Articles

Inequalities in Uptake and Use of Digital Applications for Home-Monitoring of Neovascular Age-Related Macular Degeneration in an Elderly Visually Impaired Population: The MONARCH Study.

To describe inequalities in the Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home (MONARCH) diagnostic test accuracy study for: recruitment; participants' ability to self-test; and adherence to testing using digital applications during follow-up. Home-monitoring vision tests included two tests implemented as software applications (apps: MyVisionTrack and MultiBit) on an iPod Touch device. Patients were provided with all hardware required to participate (iPod and MIFI device) and trained to use the apps. Regression models estimated associations of age, sex, Index of Multiple Deprivation, strata of time since first diagnosis, and baseline visual acuity at study entry on outcomes of willingness to participate, ability to perform tests, and adherence to weekly testing. A minority of patients who were approached were willing-in-principle to participate. Increasing age was associated with being unwilling-in-principle to participate. Patients from the most deprived areas had a 47% decrease in odds of being willing compared to those from the middle quintile deprived areas (odds ratio, 0.53; 95% confidence interval = 0.32, 0.88). Increasing age and worse deprivation were not consistently associated either with ability to self-monitor with the index tests, or adherence to weekly testing. Associations of increasing age and worse deprivation index were associated with unwillingness-in-principle to participate despite the provision of hardware' highlighting the potential for inequality with interventions of the kind evaluated. The clear evidence of inequalities in participation should prompt future research on ways to encourage adoption of mobile health technologies by underserved populations.

Feasibility and Impact of Remote Glucose Monitoring Among Patients With Newly Diagnosed Type 1 Diabetes: Single-Center Pilot Study.

BackgroundCaregivers of children with newly diagnosed type 1 diabetes (T1D) maintain close contact with providers for several weeks to facilitate rapid adjustments in insulin dosing regimens. Traditionally, patient glucose values are relayed by telephone for provider feedback, but digital health technology can now enable the remote sharing of glucose data via mobile apps.ObjectiveThe aim of this study was to test the feasibility of remote glucose monitoring in a population of children and adolescents with newly diagnosed T1D and to explore whether remote monitoring alters habits for self-review of glucose data or perceived ease of provider contact in this population as compared to a nonrandomized control group.MethodsData were collected from families who chose to participate in remote monitoring (intervention group) as well as from patients receiving usual care (control group). The intervention group received Bluetooth-capable glucose meters and Apple iPod Touch devices. Patient-generated glucose data were passively relayed from the meter to the iPod Touch and then to both the electronic health record (EHR) and a third-party diabetes data platform, Tidepool. The principal investigator reviewed glucose data daily in the EHR and Tidepool and contacted the participants as needed for insulin dose adjustments during the time between hospital discharge and first clinic appointment. Families in the control group received usual care, which involved keeping written records of glucose values and contacting the diabetes team daily by telephone to relay data and receive treatment recommendations. A total of 40 families (20 for the intervention group and 20 for the control group) participated in the study. All families were surveyed at 1 month and 6 months regarding self-review of glucose data and ease of contacting the diabetes team.ResultsPatient-generated glucose data were remotely accessible for 100% of the participants via Tidepool and for 85% via the EHR. Survey data indicated that families in the intervention group were more likely than those in the control group to review their glucose data using mobile health apps after 1 month (P<.001), but by 6 months, this difference had disappeared. Perceived ease of contacting the clinical team for assistance was lower for the intervention group after 6 months (when receiving usual care) in comparison to during the intervention period (P=.48) and compared with a control group who did not have exposure to remote monitoring (P=.03).ConclusionsRemote glucose monitoring is feasible among pediatric patients with newly diagnosed T1D and may be associated with the earlier adoption of mobile health apps for self-management. The use of broadscale remote monitoring for T1D in the future will depend on improved access to Bluetooth-enabled mobile devices for all patients, improved interoperability of mobile health apps to enable data transfer on Android as well as Apple devices, and new provider workflows to handle large-scale panel management based on patient-generated health data.Trial RegistrationClinicalTrials.gov NCT04106440; https://clinicaltrials.gov/ct2/show/NCT04106440

Using a mobile app to estimate whole-body vibration and seat isolation performance in surface mining

The objectives for this study were twofold: (1) to determine whether the whole-body vibration application (WBV app) may effectively serve as a simple tool for monitoring WBV exposure; and (2) to assess when vehicle seats may need adjustment, repair, or replacement. Data were collected on 17 mobile mining vehicles and equipment at six surface operations. Comparing the WBV app to the Siemens/LMS reference system showed excellent correlation (r = 0.998 and 0.987, respectively) for frequency-weighted-root-mean-square acceleration (aw) and vibration dose value (VDV) normalised to an 8-hour shift. Seat performance, using the mobile app showed greater variation, yet high positive correlations (r = 0.896 and 0.936) for the aw and VDV computational methods, respectively. Hence, the WBV app demonstrates potential as a low-cost instrument to measure WBV exposures for mobile equipment operators and the capability to estimate seat performance or seat effective amplitude transmissibility (SEAT) when utilised on two iPod Touch devices.

56 Adding Patient Photos to the Electronic Health Record to Improve Patient Identification and Reduce Wrong Patient Order Errors

The emergency department (ED) is a fast paced and pressured environment and providers sometimes have more than one patient record open at a time. Health care providers must be in the correct patient’s electronic health record (EHR) when performing any actions, especially computerized provider order entry otherwise orders may be placed for the wrong patient, and sometimes not caught. Wrong patient orders are estimated to occur in 2/1,000 orders and can lead to serious adverse events, including death. Other studies have reported that pop-up alerts containing the patient’s photo displayed before placing or signing orders can reduce the rate of wrong patient orders, but these alerts are highly interruptive and associated with alert fatigue. The goal of this project is to determine if displaying patient photos passively in the EHR header can reduce wrong patient orders in the ED. This project, piloted at a large urban academic medical center’s ED, required that we increase the number of patient photos in the EHR for ED patients and analyze the impact to the rate of wrong orders. We created a new standard of care and implemented a new workflow for ED registration staff. Using iPod touch devices, ED registration staff take photos of consenting patients either at the front desk when patients check-in, or at the end of the registration process. A report was created and used to identify the number of ED patients who have a photo in the EHR. An ED patient advisory committee was consulted to gain insight into tactics to increase patient awareness and participation of the new policy. A previously validated “Retract-and-Reorder”(RAR) measure was used to identify the number of orders that were ordered, cancelled, and re-ordered on another patient within a 10 minute time period in the ED – essentially the rate of “near misses.” We developed a RAR report and used this to identify the “wrong-patient retract-and-reorder” (WP-RAR) rate for orders placed for patients with and without photos in the ED for the analysis period July 1, 2017 through December 31, 2018. We compared the relative risk of the WP-RAR rate for ED patients with and without photos in their EHRusing the chi-squared statistic and Fisher’s exact test. The rate of ED patients with photos in the banner of their EHR record exceeded 50% at the time of the analysis. There were 1,210,876 ED orders placed during the 18 month analysis period; 996,223 (82%) without a photo and 213,643 (18%) with a photo. There were 312 total ED WP-RAR (near miss) events; 275 (88%) without photo and 37 (12%) with photo. The overall ED WP-RAR rate was 25.7 per 100,000 orders and was statistically significantly lower for patients who had photos: ED WP-RAR with Photos = 17.2/100,000 orders compared to ED WP-RAR without Photos = 27.6 /100,000 orders. Relative Risk = 0.625 (95% CI = 0.44 – 0.88, p = 0.0025). A passive display of patient photos in the EHR is associated with reduced rates of wrong patient orders and near misses in an ED setting. Since passive patient photo display is a common feature supported by EHR vendors, EDs should consider investing in photo capture hardware (smart devices, cables, and locks) and including photo capture in ED registration workflow as a way to improve patient safety in the ED.

Risk Assessment of Recreational Noise-Induced Hearing Loss from Exposure through a Personal Audio System-iPod Touch.

Recreational noise-induced hearing loss (RNIHL) is a major health issue and presents a huge economic burden on society. Exposure to loud music is not considered hazardous in our society because music is thought to be a source of relaxation and entertainment. However, there is evidence that regardless of the sound source, frequent exposure to loud music, including through personal audio systems (PAS), can lead to hearing loss, tinnitus, difficulty processing speech, and increased susceptibility to age-related hearing loss. Several studies have documented temporary threshold shifts (TTS) (a risk indicator of future permanent impairment) in subjects that listen to loud music through their PAS. However, there is not enough information regarding volume settings that may be considered to be safe. As a primary step toward quantifying the risk of RNIHL through PAS, we assessed changes in auditory test measures before and after exposure to music through the popular iPod Touch device set at various volume levels. This project design incorporated aspects of both between- and within-subjects and used repeated measures to analyze individual groups. A total of 40 adults, aged 18-31 years with normal hearing were recruited and randomly distributed to four groups. Each group consisted of five males and five females. Subjects underwent two rounds of testing (pre- and postmusic exposure), with a 30-min interval, where they listened to a playlist consisting of popular songs through an iPod at 100%, 75%, 50%, or 0% volume (no music). Based on our analysis on the Knowles Electronic Manikin for Acoustic Research, with a standardized 711 coupler, it was determined that listening to the playlist for 30 min through standard earbuds resulted in an average level of 97.0 dBC at 100% volume, 83.3 dBC at 75% volume, and 65.6 dBC at 50% volume. Pure-tone thresholds from 500-8000 Hz, extended high-frequency pure tones between 9-12.5 kHz, and distortion product otoacoustic emissions (DPOAE) were obtained before and after the 30-min music exposure. Analysis of variance (ANOVA) was performed with two between-subjects factors (volume and gender) and one within-subjects factor (frequency). Change (shift) in auditory test measures was used as the outcome for the ANOVA. Results indicated significant worsening of pure-tone thresholds following music exposure only in the group that was exposed to 100% volume at the following frequencies: 2, 3, 4, 6 and 8 kHz. DPOAEs showed significant decrease at 2000 and 2822 Hz, also only for the 100% volume condition. No significant changes were found between pre- and postmusic exposure measures in groups exposed to 75%, 50%, or 0% volume conditions. Follow-up evaluations conducted a week later indicated that pure-tone thresholds had returned to the premusic exposure levels. These results provide quantifiable information regarding safe volume control settings on the iPod Touch with standard earbuds. Listening to music using the iPod Touch at 100% volume setting for as little as 30 min leads to TTS and worsening of otoacoustic emissions, a risk for permanent auditory damage.

Apple Configurator 2 (version 2.3)

Apple Configurator 2 (AC2) is a free mass-deployment utility that allows you to update multiple iPads, iPhones, iPod Touch devices, and Apple TVs at the same time, including apps, website links, iBooks, and software updates.

What Will It Take to End the HIV/AIDS Epidemic? Linking the Most Disenfranchised Into Care Through Outreach

The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs.

Technology and Dynamic Pathways: How to Improve Nursing Care, Documentation, and Efficiency

Background: Approximately 60% of adverse events in skilled nursing facilities are likely preventable. This provides an opportunity to improve care and decrease costs for ill, and especially aged, patients. The primary line of defense against adverse events in these facilities are the nurses caring for these patients each day. Nurses are responsible for recognizing early warning signs of illness and preventing falls and other complications. The care of patients with multiple comorbidities requires nurses to attend to an often overwhelming set of interacting details. Objective: Our goal is to operationalize standards of care that can be implemented by nursing staff at skilled nursing and long-term care facilities in a manner complementing their natural workflow and facilitating patient interaction and shift documentation. To improve point of care patient management, nurses require a mobile solution that can guide their patient care unobtrusively. Methods: Nurses at a Boston-area 100-bed skilled nursing/long-term care facility used our solution consisting of an app on a mobile device together with a Web-based administration and reporting system. Our custom software running on an iPod Touch device implements an adaptive methodology for succinctly guiding nurses through a systematic review of systems, a physical exam, a fall risk protocol, and other assessments suitable to their roles in the nursing facility. Dynamically created checklists that prescribe appropriate and immediate nursing interventions are automatically presented to the nurses following each assessment based on the data collected. The software utilizes behavioral “nudges” to nurse-users to minimize errors and improve speed of data entry. Additionally, a custom content creation system allows for high-level abstraction of protocol logic, enabling real-time improvement and customization of complex protocol algorithms without the need for error-prone software programming. These methods facilitate automated reporting that aids the structured thought processes of providers and caregivers. Results: Pilot results were acquired using qualitative surveys and free-form interviews. Nurses reported a high facility after only an initial 15-minute training session. All nurses confirmed that having access to an efficient and mobile care facilitation device improved the likelihood of identifying patient complications. They also felt that a mobile documentation system lowered error rates by encouraging real-time documentation. Furthermore, systematic data gathering provided an improved level of documentation both in terms of comprehensiveness and clarity. Nurses claimed the system increased efficiency and lowered the overall time required for combined patient assessment and documentation. Most importantly, staff satisfaction was highly positive, encouraging continued usage of the intervention. Conclusions: Technological interventions at skilled nursing facilities, when implemented to address the point-of-care needs of nursing personnel, can positively impact quality improvement goals, empower nursing staff, and improve patient care. The suite of tools developed here enables the operationalization of standards of care with sufficient comprehensiveness to address a sufficient portion of the complexity faced in daily nursing duties. We conclude that access to real-time protocols has a highly beneficial effect on nursing care. [iproc 2016;2(1):e31]

Assessment of an Electronic Intervention in Young Women with Heavy Menstrual Bleeding

Study Objective, Design, Setting, Participants, Interventions, and Main Outcome MeasuresBleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to health care providers because of the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. The aim of the study was to use an electronic approach to enhance patient compliance with medications used to treat their HMB, and to provide educational access to adolescents with BD. This was a prospective cohort study involving patients in a Young Women's Bleeding Disorder Clinic at a single children's hospital. Subjects were given an iPod Touch (Apple Inc, Cupertino, CA) device (ITD), preloaded with the iPeriod (Winkpass Creations) application. Participants recorded information about their BD that they learned about on BD Web sites, and menses, and medications. Electronic and charted data were collected to monitor compliance with prescribed treatment regimens. All ITD allowed Wi-Fi access to allow teens to explore BD Web sites and knowledge was assessed. ResultsTwenty-three of 45 subjects completed the study. The mean age was 14.1 ± 1.9 years. Subjects who were compliant with the ITD (group 1), charted on baseline symptoms, menstrual flow (83.3%), cramps (100%, 23/23), breakthrough bleeding (95.6%, 22/23), mood (95.6%, 22/23), and medication use (91.7%) for a mean of 9.3 ± 3.1 months. Subjects who were nonusers (group 2) did not report on symptoms, their condition, or medication use in the device (n = 22). More than 75% (17/23) of subjects in group 1 used hormones alone or hormones with antifibrinolytic agents to control HMB. No subjects stopped or missed medications who were in group 1 intentionally, and also there were 9 enrollees within this same group who missed a medication related to awaiting the prescription to be filled from pharmacy. In group 2, 17 enrollees missed medications, resulting in 19% (4/22) of these enrollees being admitted to hospital for 1-2 days. In addition, enrollees in group 2 missed more medications on average compared with group 1. No subjects in group 1 required admission for HMB treatment failure during the study period, compared with those in group 2 (P = .006). All subjects in group 1 reported accessing Web sites using their ITD to learn about their BD. Groups 1 and 2 did not differ in the number of medications that were prescribed during the time frame (P = .77) or the number of follow-up clinic visits (P = .49). Furthermore, those in group 1 reported fewer breakthrough bleeding episodes than those in group 2 according to clinic notes (P = .03). Users of the ITD were given a set of knowledge questions. Group 2 subjects were not consistent users of the ITD use and did not complete the knowledge questions. Group 1 and 2 could not be compared with regard to knowledge as a result. ConclusionITD is an excellent tool for adolescents with HMB and BD to allow self-monitoring, provider monitoring, and improve educational access through engaging technology; compliance with device use was associated with several parameters suggestive of improved clinical outcomes.

Whole-Body Vibration Exposures in Undeground Coal Mining Operations

Studies conducted on surface coal mining equipment have identified whole-body vibration as a significant hazard. Operators of underground mobile equipment, particularly shuttle cars and transport vehicles, are likely to be exposed to significant levels of whole-body vibration. To date, measuring whole-body vibration from underground mining mobile equipment has been difficult due to the strict guidelines governing the use of electrical equipment in underground mines. This paper presents data obtained from two low-methane coal mines using an iOS application installed on iPod Touch devices. The majority of measurements taken from a range of mobile plant and equipment in use at the underground coal mines exceeded the ISO2631.1 Health Guidance Caution Zone. Further investigations are being undertaken to develop a thorough understanding of whole-body vibration exposures to which operators of mobile equipment used in underground coal mines are exposed and the opportunities for application of this information to assist mine site safety, health and risk management processes.

Feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South.

As with many infectious diseases throughout history, stigma is a part of the trajectory of the HIV disease process. HIV-related stigma impedes women from being tested for HIV. Once infected, HIV-related stigma hinders women from disclosing their HIV status to sexual partners and health care providers, engaging in medical care, effectively self-managing the disease after infection, and adhering to anti-retroviral therapy. After three decades of the HIV epidemic, no evidenced-based, culturally relevant, gender-specific interventions exist to help women infected with HIV manage the stigma associated with HIV infection. This manuscript reports the feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South in a mixed-method, randomized clinical trial. Results from the study demonstrate that it is feasible to utilize an iPod touch device to deliver an HIV-related stigma intervention to women. Further, women report that the HIV-related stigma intervention is acceptable and meaningful.

A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South.

The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.

Mediating sociality: the use of iPod Touch™ devices in the classrooms of students with autism in Canada

This study explores the roles that lower-cost, handheld touch technologies might play in the communication functions of children diagnosed on the autism spectrum. It reports on a case study of the use of Apple iPod Touch mobile digital devices in a public elementary school in downtown Toronto, Canada. Drawing from Vygotskian sociocultural theory researchers examined the consequences of handheld touch technologies on the communication and sociality of children with communicative disorders, with a primary emphasis on nonverbal autistic children. In the period between January 2010 and June 2010, iPod Touch devices were introduced into six elementary classrooms. While there were gains in communication for all participants, ranging from mild to significant, nine of the 12 students for whom we collected detailed data demonstrated statistically significant improvement in communication skills. Observations are made about the heightened levels of motivation, increased attention spans, and increased social interaction that students with autism spectrum disorder (ASD) exhibited when using these devices. Future research should explore the connection of touch-sensory inputs on the communication development of children with ASDs.

Using the iPod Touch for Patient Health Behavior Assessment and Health Promotion in Primary Care.

BackgroundThere is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient–physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients’ health behavior data and facilitate patient–physician communication.ObjectiveThe aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient–physician collaborative goal-setting for health promotion in primary care.MethodsA total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch–based HBA and resultant patient–physician communication.ResultsPatients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch–based HBA.ConclusionsIt is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient–physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases.

Use of an electronic decision support tool improves management of simulated in-hospital cardiac arrest

IntroductionAdherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA. MethodsAfter IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists. ResultsPerformance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p<0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p<0.012). ConclusionUse of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.

Care at just a touch

As NHS trusts across the UK strive to make better use of information technology to improve patient safety, some nurses are using an electronic observation system called Wardware on iPod Touch devices. It not only saves time on paperwork and reduces errors, but alerts nurses when action needs to be taken and allows patient data to be shared at once with doctors.

Mobile learning technology based on iOS devices to support students with special education needs

Students with special education have difficulties to develop cognitive abilities and acquire new knowledge. They could also need to improve their behavior, communication and relationships with their environment. The development of customizable and adaptable applications tailored to them provides many benefits as it helps mold the learning process to different cognitive, sensorial or mobility impairments. We have devised a mobile platform (based on iPad and iPod touch devices), called Picaa and designed to cover the main phases of the learning process: preparation, use and evaluation. It includes four kinds of educational activities (Exploration, Association, Puzzle and Sorting), which can be personalized by educators at content and user interface levels through a design mainly centered on student requirements, whose user profiles can also be adapted. We have performed a pre-experimental study about the use of Picaa by 39 students with special education needs from Spain, including an evaluation based on pre/post testing. The use of the learning platform Picaa is associated with positive effects in the development of learning skills for children who have special educational needs, observing that the basic skills (language, math, environmental awareness, autonomy and social) have been improved. Besides, in many cases they have the opportunity to perform activities that previously were not accessible to them, because of the interface and contents of the activities have been adapted specifically to them. The study also suggests that the repertoire of types of activities provided is suitable for learning purposes with students with impairments. Finally, the use of electronic devices and multimedia contents increases their interest in learning and attention.

Establishment of a locally-assembled image viewer system using ultra-books, tablet PC′s and smartphones for research, education, training and medical diagnosis

In the field of diagnostic radiological imaging, new challenges, particularly the gigabyte storage, display and wireless transfer/transmission of images among medical professionals have led to the use of ultra-books, iPad-like tablets and smartphones, along with the use of innovative medical imaging software, in view of their several advantages. The article reviews the special features of these devices and their ubiquitous applications, along with their practical selection for medical imaging. A prototype home-assembled low-cost image-viewer system using the latest Windows 8.1 based Acer ultra-book computer/monitor system connected to Apple iPad Mini/iPod Touch/iPod classic devices as well as to an high-definition TV viewing unit is described. This ultra-book is selected for its touch-screen graphics display, optical drive facility (for reading the CD-ROM containing images) and for easy portability. Both Wi-Fi broadband and cellular network are provided for transmitting/receiving images. A novel, elegant and versatile FDA-approved medical imaging (MIM) software, suitable for analysis and display of images from all modalities, with cloud facility, was used for long-term storage, display and transmission of Digital Imaging and Communications in Medicine patient images. The system has been tested with a variety of educational patient, experimental phantom and resolution images as well as the images supplied by Apple/MIM. Results show that the ultra-book with Windows 8.1 capability, in association with MIM software, can serve as a mini-workstation for analysis/processing and for providing wireless and portable access to all medical (including mammography) images. The optional pocket type iPod Touch and iPad Mini (with light weight and moderate size display) devices enable easy accessibility of images at any site. The system with their present resolution will certainly fulfill their role in education, training and research and is well-suited for diagnosis.

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Effects of Socioeconomic diversity on iPod Touch Device Use in Real-World Environments

The iPod Touch provides portable and personalized information, entertainment, and communication resources for users. The goal of this study was to assess the influence of user diversity on how these handheld mobile computers are employed in real environments. Using an unobtrusive, longitudinal methodology to collect data, we explored how different socioeconomic groups personalize and operate iPod Touches. The lower income group used the instrumented iPod Touch more often and for different purposes. Design implications for newer-generation handheld devices and content are discussed.