Iterative Development Approach Research Articles

Development, Acceptability, and Initial Implementation of an Interactive Text-Messaging Program for Fathers with Low Income.

This study describes the development, acceptability, and implementation of an interactive text messaging program to engage fathers enrolled in home visitation programs. We used an iterative development approach that integrated rapid testing of intervention content with acceptability feedback from program participants to examine the processes of implementation. In Study 1, we describe the rapid testing framework and present data from 171 men who provided feedback on Text4Dad content via three online surveys. In Study 2, a case study, we use administrative data from 108 fathers with whom we pilot-tested Text4Dad in three community-based home visiting programs, with the program implemented by fatherhood program community health workers (F-CHWs). Content analysis of exchanges between F-CHWs and fathers describes the specific use of Text4Dad. Across all three online surveys, fathers reported positive reviews of the Text4Dad content. The F-CHWs used Text4Dad mainly to push out information, especially that related to home visit scheduling and local events, instead of engaging in bidirectional interactions with fathers. We conclude with a set of recommendations for social service and maternal and child health providers regarding the feasibility of implementing text messaging to support home visiting in community-based settings.

Empowering Sports Enthusiasts and Facility Owners: An Online Sports Field Booking System for Bhutan

With the country’s growing interest in games and sports, it is observed that there is a need for efficient sports field management. This project introduces an Online Sports Field Booking system, with an aim to have efficient sports management. The study identified the challenges posed by manual data recording and the absence of a centralized system. Therefore, our web-based solution which utilizes the Laravel framework, PHP, and MySQL for efficient backend operations aims to overcome these challenges. It employs an iterative development approach, the system allowing users to effortlessly check real-time field availability, search based on criteria such as field name and location, and effortlessly book sports facilities. Through iterative cycles of analysis, design, implementation, and evaluation, the project successfully overcame challenges, reducing risks and ensuring a high-quality system. This initiative not only addresses the growing demand for sports facilities in Bhutan but also aligns with the nation's technological progress, offering a user-friendly platform for both sports enthusiasts and facility owners/managers. By providing real-time updates and customer support, the Online Sports Field Booking system contributes to optimizing facility usage and enhancing overall customer satisfaction, and ultimately promoting an improved and connected sporting community in Bhutan.

A maintainable and iterative development approach of critical systems with FoCaLiZe

The life-cycle development of critical systems follows mainly a V-cycle process overlapped with proofs and/or verification techniques. At the first development stage, a critical system must be, precisely, and as completely as possible described. Thus, it is recommended to use a graphical modeling language standard such as the Unified Modeling Language (UML) and the Object Constraint Language (OCL), to which both customers and developers could contribute. Then, the graphical design with its formal specification (requirements) is mapped into a complete formal development environment, using an MDE (Model-driven engineering) approach. The formal environment has to assess the development until the generation of a secure code. In this context, we propose a life-cycle development approach that combines UML/OCL and the FoCaLiZe formal environment for the secure development of critical systems. The proposed approach ensures essential development constraints such as strict boundaries and traceability between development phases. It also ensures a secure maintenance phase using partial transformation techniques from UML/OCL to FoCaLiZe. The latter enhances the transformation from UML/OCL into FoCaLiZe to support incremental development and assist developers in correcting modeling errors. The proposed approach is mostly dedicated to secure and maintainable lifecycle development processes of critical systems. The formal environment assesses the development process until the generation of a secure code. To illustrate the proposed approach, we present the stages of development of a constrained system controlling military objects. The development of this system uses the iterative, incremental, and maintainability stages as described by the development approach, until the generation of secure code.

Agile-Scrum Implementation in The Development of Kampus Merdeka Information System

Merdeka Belajar Kampus Merdeka (MBKM) program is a program initiated by the Minister of Education and Culture to encourage students to master various disciplines for their preparation in the job market. At the Institut Teknologi Del, the MBKM program is also offered to students. However, its implementation is not yet fully automated and utilizes various different platforms. This research aims to design and develop the Independent Internship & Study Implementation Information System in the Merdeka Campus at the Institut Teknologi Del using the Agile-Scrum approach. The Scrum method is an iterative software development approach that is flexible to changes. The implementation of Agile-Scrum in the development of the MBKM information system helps achieve goals and automate existing systems. This research involves Scrum activities such as sprint planning, daily scrum, sprint review, and sprint retrospective to produce an information system that meets the requirements. The Scrum product backlog is used as a reference during system development throughout the sprint. The development of the information system through agile-scrum has received feedback during the sprint review and has been functionally tested using several testing methods.

Advance Care Planning Website for People With Dementia and Their Family Caregivers: Protocol for a Development and Usability Study.

Web-based tools for people with dementia and their family caregivers have considerably increased over the years and offer promising solutions to several unmet needs such as supporting self-care in daily life, facilitating treatment delivery, or ensuring their ability to communicate. The use of web-based tools in the field of advance care planning (ACP) for people with dementia and their family caregivers has yet to be explored and requires careful consideration, given the sensitive topic and the specific needs of people with dementia and their families. This paper reports the protocol for a study aiming to develop and simultaneously test the usability of an ACP website designed for, and with, people with dementia and their families. The development of the website is based on a process map for the development of web-based decision support interventions and on the Medical Research Council framework for complex intervention development and evaluation. Additionally, we apply a user-centered approach in combination with patient and public involvement (PPI) throughout the development process. We describe our iterative development approach to the website. Participants and a PPI group give feedback on 4 prototypes of the ACP website. For each iteration, we aim to include 12 participants (3 people with dementia, 3 family caregivers, and 3 dyads) in usability testing. In the first 3 iterations, usability testing includes (1) a think-aloud exercise, (2) researcher observations, and (3) the System Usability Scale questionnaire. The last iteration of usability testing is composed of a semistructured interview assessing the layout, content, face validity, and readability of the website. Qualitative data from the think-aloud exercises and interviews are analyzed using thematic analysis. Mean scores are calculated for the System Usability Scale questionnaire. This study received approval from the Ethical Review Board of Brussels University Hospital of the Vrije Universiteit Brussel. Recruitment began in October 2021. The target date for paper submission of the results of the development and usability testing will be in 2023. The methods in this protocol describe a feasible and inclusive approach to the development of an ACP website together with people with dementia, their family caregivers, and other stakeholders. We provide a clear overview of how to combine PPI input and user-centered development methods, leading to a transparent and reliable development process. This protocol might stimulate the active participation of people with dementia, their caregivers, and regional stakeholders in future studies on web-based technologies. The results of this study will be used to refine the design and create a relevant and user-friendly ACP website that is ready to be tested in a larger evaluation study. DERR1-10.2196/46935.

IMPLEMENTASI METODE AGILE PADA PEMBUATAN E – REPORT LITTLE CLOUD BERBASIS WEB MENGGUNAKAN FRAMEWORK CODEIGNETER

This website-based E – Report Little Cloud is specifically for the kindergarten level first, with restrictions on several access rights depending on the user who will use it. The output provided from the website-based Little Cloud E-Report is in the form of a report card which can be downloaded independently by the student's guardian at any time. The purpose of making the website-based Little Cloud E-Report is expected to make it easier for teachers in the process of filling out report cards because everything is computerized properly so that it can minimize the time for filling out report cards. In addition, it makes it easier for parents and students to view report cards anywhere and anytime. The Little Cloud e-Report is created using the Agile method. The agile method is a conceptual framework with an iterative and incremental development approach [7]. The programming language used for the creation of the Little Cloud e-Report is PHP, for database management it uses MySql, and this application uses the CodeIgniter framework.

Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study.

BackgroundImplementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App.ObjectiveThis study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app.MethodsWe used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage.ResultsMost health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app.ConclusionsHealth professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users’ experience of the most and least useful components of the app is needed.

A taxonomy of scaling agility

Driven by environmental uncertainty, many organizations today attempt to achieve agility at scale. However, given the variety and complexity of these efforts, there is currently a limited understanding in terms of their most relevant configurations, especially over the process of change. Based on an iterative taxonomy development approach grounded in design science, we present a taxonomy to structure, configure, and update scaling agility. The resulting multi-dimensional classification system offers an integrative view on elements only selectively considered in prior research. While offering a conceptual anchor for further research, we also provide specific configurations covering three different stages of scaling agility.

576-P: Cocreating a Virtual Care Platform That Delivers Mental Health Support to Adults with Type 1 Diabetes (T1D) Living in Rural and Remote Communities

Introduction: While mental health (MH) is the cornerstone of diabetes care, access to MH support in rural and remote communities in British Columbia (BC) is limited. The purpose of this study was to design REACHOUT, a virtual care platform, to deliver peer-led MH support to adults with T1D in geographically marginalized communities in BC. Methods: The REACHOUT platform was co-created by our T1D Patient Partner Team (n=16) and experts in digital health, biomedical engineering, behavioural science, and rural health. REACHOUT is built as a customizable extension to the Rocket.chat open-source platform, deployed privately on Amazon Web Services servers in Canada; it offers various forms of encryption to maintain data security. We applied an Agile iterative development approach with multi-staged feedback from T1D Patient Partners and key stakeholders in a participatory action framework. Results: The REACHOUT app has three support delivery features: 1) 1-ON-1 SUPPORT delivered by an individual Peer Supporter (PS) self-selected by the participant from a library of PS profiles. Profiles include descriptors such as stage of life, hobbies, and interests, sociodemographic information, diabetes history and treatment etc. Mode, content, and structure of communication are driven entirely by participants’ support preferences and needs; 2) 24/7 COMMUNITY CHAT ROOMoffers “just-in-time” group support and accommodates needs for emotional validation, normalization, and non-judgmental acceptance; 3) VIDEO HUDDLES are monthly PS-led virtual group sessions highlighting a distress or resilience related theme (e.g. workplace bias and discrimination, cooking low-carb, insurance coverage challenges) . Conclusions: Launched in November 2021, the REACHOUT pilot supports 40 participants with 40 PS. Adoption and utilization patterns for each of the support delivery mechanisms are being monitored and will be compared in mid-2022. Disclosure T.S.Tang: None. P.Johal: None. A.Azhar: None. L.Fisher: Consultant; Ascensia Diabetes Care, Research Support; Eli Lilly and Company. W.H.Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., Provention Bio, Inc., Sanofi. M.Görges: Research Support; Careteam Technologies Inc, Excelar Technologies, IDENTOS Inc, MedStack Inc, SecureKey Technologies Inc, Smile CDR Inc, Thrive Health, Xerus Medical. Funding Juvenile Diabetes Research Foundation (2-SRA-2020-986-S-B)

Preclinical development of the quadrivalent meningococcal (ACYW) tetanus toxoid conjugate vaccine, MenQuadfi®

Bacterial capsular polysaccharide vaccines are generally poorly immunogenic in infants and older adults. The immunogenicity of capsular polysaccharide vaccines can be improved by conjugating them to immunogenic carrier proteins. One of the most recently licensed conjugate vaccines is the quadrivalent meningococcal vaccine with serogroups A, C, Y, and W conjugated to a tetanus toxoid protein carrier (MenACYW-TT; MenQuadfi, Sanofi Pasteur, Swiftwater, PA, USA). MenACYW-TT was developed to induce optimal immune responses against each of the meningococcal serogroups A, C, W, and Y, and across all age groups, especially infants and older adults (those aged ≥ 50 years). Here, we detail the early iterative vaccine development approach taken, whereby many different ‘small-scale’ conjugate vaccine candidates were prepared and examined for immunogenicity in a mouse model to identify the most immunogenic vaccine. Additional insights from phase I clinical studies informed further optimization of the vaccine candidates by tailoring their conjugation parameter attributes for the optimal immune response in humans. The parameters studied included: different carrier proteins [PR]; polysaccharide [PS] sizes; conjugation chemistries [linker vs. no-linker; lattice vs. neoglycoprotein; activation/derivatization levels]; conjugate size; PS:PR loading ratio; percent free PS; percent free PR; and O-acetylation content. The lead quadrivalent conjugate vaccine (polysaccharides of > 50 kDa size conjugated to TT at a high PS:PR ratio via reductive amination for serogroups C, W and Y, and carbonyldiimidazole/adipic acid dihydrazide linker chemistry for serogroup A) empirically identified from the extensive preclinical studies, was ultimately confirmed by the robust antibody responses observed in all age groups in the various clinical studies, including in the most challenging infant and older adult age groups, and subsequently led to the licensed formulation.Graphical abstract

Project Management Methodologies for Engineering KMS based on PMBOK Approach: A Systematic Literature Review

The process of creating, sharing, discovering, and capturing knowledge becomes an intangible asset for an organization. As a valuable asset, Knowledge needs to be managed. There is a tool called Knowledge Management System (KMS). The latest technology and social or structural mechanisms are components to develop KMS. But developing an IT project has a high risk of failure, so it should be managed using a project management approach. A project is a temporary endeavor to make a product or service. It means that a project has a start and an end project phase. Some methodologies which exist do not offer complete stages of development KMS. They do not cover feasibility study activities, lack of clear specification, and lack of closing project phase. The study gap is expected to be loaded up and well explained in this paper through a systematic review of the published literature over the last six years using the Kitchenham method. The results show that most researchers used a predictive approach compared to an iterative, incremental, or adaptive development approach to build KMS. The main result of this study we found 36 processes in the developing KMS. The novelty of this research, we generated a table to map the processes into the model, method, artifact and presented it by group process based on the Project Management Body of Knowledge (PMBOK). The table can help the organization develop the KMS project to improve its effectiveness and competitiveness.

A Mobile App to Improve Patient Management in Emergency Departments: Caregiver Needs Analysis, Design and Early Technology Acceptance Assessment.

Emergency care is very complex in that it requires patient-centered care in a coordinated manner among multiple providers in a highly distractible, unpredictable and stressful environment. Sharing information efficiently between providers in this context is difficult. Connecting emergency providers with each other through a digital communication channel could improve the efficiency of information sharing and emergency care. This study describes the development process of PIMPmyHospital, a mobile app dedicated to emergency department physicians and nurses to collaboratively manage their patients. We relied on a user-centered design process involving caregivers from a pediatric emergency department. The process started with semi-structured interviews that informed the specifications of the app, followed by an iterative design and development approach. The resulting prototype was evaluated by end-users using the perceived usefulness dimension of the technology acceptance model questionnaire. Early user engagement during the design and development of a dedicated mobile app must be taken into account to improve its perceived usefulness and future adoption.

Using Feasibility Data and Codesign to Refine a Group-Based Health Literacy Intervention for New Parents.

Few health literacy interventions exist for new parents. We developed a group-based health literacy program (“Parenting Plus”), which was initially tested in a feasibility study in 2018. In this brief report, we describe how feasibility findings were incorporated into the Parenting Plus program. Using a codesign process with patient partners (feasibility study participants) and health staff to revise the program, version 2 was tested in a single-site pilot using pre- and post-intervention testing. Parents older than age 16 years whose child was between ages 4 and 26 weeks were recruited from nurse home visits in western Sydney, Australia. Interested participants attended the free 4-week health literacy program (four 2-hour sessions) delivered by a trained facilitator. Piloting suggested the revised program is acceptable to new parents, has good retention (93% over the course of 4 weeks), and can improve health literacy skills, including access to reliable health information and services. Our iterative development and codesign approach integrated learnings from various sources to inform the design of an evidence-based health literacy intervention. We now move to an effectiveness implementation hybrid trial to test intervention effectiveness (health literacy skill development) and support translation of research findings into routine practice. [HLRP: Health Literacy Research and Practice. 2021;5(4):e276–e282.]

Agile Software Development Techniques: A Survey

In this IT era, where there is a race of software development, it is necessary to introduce such types of software development techniques which will help the practitioners to deliver fast solutions. In the past, various traditional approaches were used for this purpose, but now agile techniques are getting more popular because conventional software development approaches are not efficient in managing the changing requirements. The agile software development process is one of the most emerging lightweight software development methodologies, which uses iterative and prototype development approaches to accommodate changes in software requirements. Final software products are delivered to the end-users in short iterations. One of the most noticeable drawbacks of agile methods is their limited courtesy to the structured and architectural design of the system. Hence this development approach will restrict small to medium design decisions only. In this paper, we have performed the analysis of different agile techniques, which will help the readers to understand their positive and negative points and select the most appropriate technique suited to their projects.

Optimizing a decision support system for damage-control resuscitation using mixed methods human factors analysis.

Damage-control resuscitation (DCR) improves trauma survival; however, consistent adherence to DCR principles through multiple phases of care has proven challenging. Clinical decision support may improve adherence to DCR principles. In this study, we designed and evaluated a DCR decision support system using an iterative development and human factors testing approach. The phases of analysis included initial needs assessment and prototype design (Phase 0), testing in a multidimensional simulation (Phase 1), and testing during initial clinical use (Phase 2). Phase 1 and Phase 2 included hands-on use of the decision support system in the trauma bay, operating room, and intensive care unit. Participants included trauma surgeons, trauma fellows, anesthesia providers, and trauma bay and intensive care unit nurses who provided both qualitative and quantitative feedback on the initial prototype and all subsequent iterations. In Phase 0, 14 (87.5%) of 16 participants noted that they would use the decisions support system in a clinical setting. Twenty-four trauma team members then participated in simulated resuscitations with decision support where 178 (78.1%) of 228 of tasks were passed and 27 (11.8%) were passed with difficulty. Twenty-three (95.8%) completed a postsimulation survey. Following iterative improvements in system design, Phase 2 evaluation included 21 trauma team members during multiple real-world trauma resuscitations. Of these, 15 (71.4%) completed a formal postresuscitation survey. Device-level feedback on a Likert scale (range, 0-4) confirmed overall ease of use (median score, 4; interquartile range, 4-4) and indicated the system integrated well into their workflow (median score, 3; interquartile range, 2-4). Final refinements were then completed in preparation for a pilot clinical study using the decision support system. An iterative development and human factors testing approach resulted in a clinically useable DCR decision support system. Further analysis will determine its applicability in military and civilian trauma care. Therapeutic/Care Management, Level V.

Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda

BackgroundAccessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda.MethodsThis quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed.ResultsA preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70–0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders.ConclusionsThis set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.

Healthcare Process Modeling to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals): Development and evaluation of a conceptual framework.

ObjectiveThere are signals of clinicians’ expert and knowledge-driven behaviors within clinical information systems (CIS) that can be exploited to support clinical prediction. Describe development of the Healthcare Process Modeling Framework to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals).Materials and MethodsWe employed an iterative framework development approach that combined data-driven modeling and simulation testing to define and refine a process for phenotyping clinician behaviors. Our framework was developed and evaluated based on the Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) predictive model to detect and leverage signals of clinician expertise for prediction of patient trajectories.ResultsSeven themes—identified during development and simulation testing of the CONCERN model—informed framework development. The HPM-ExpertSignals conceptual framework includes a 3-step modeling technique: (1) identify patterns of clinical behaviors from user interaction with CIS; (2) interpret patterns as proxies of an individual’s decisions, knowledge, and expertise; and (3) use patterns in predictive models for associations with outcomes. The CONCERN model differentiated at risk patients earlier than other early warning scores, lending confidence to the HPM-ExpertSignals framework.DiscussionThe HPM-ExpertSignals framework moves beyond transactional data analytics to model clinical knowledge, decision making, and CIS interactions, which can support predictive modeling with a focus on the rapid and frequent patient surveillance cycle.ConclusionsWe propose this framework as an approach to embed clinicians’ knowledge-driven behaviors in predictions and inferences to facilitate capture of healthcare processes that are activated independently, and sometimes well before, physiological changes are apparent.

Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis.

BackgroundEarly nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating.ObjectiveThis study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app.MethodsAn interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained.ResultsThe environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%).ConclusionsFoodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition.

Sowing Across a State: Development and Delivery of a Grassroots Pediatric Palliative Care Nursing Curriculum.

Rural pediatricians and adult-trained hospice teams report feeling ill-prepared to care for children at end of life, resulting in geographies in which children are not able to access home-based services. To develop a pediatric palliative care curriculum for inpatient nurses and adult-trained hospice teams caring for children in a rural region. Curriculum design and delivery was informed by local culture through an interdisciplinary, iterative development approach with confidence, intention, and support measured pre-, post-, and 4 months after delivery. A needs assessment was completed by pediatric nurses caring for children receiving palliative or end-of-life care to inform curricular content (phase 1). A curriculum was designed by an interdisciplinary pediatric palliative care team and piloted with nursing cohorts annually through educational conferences with monthly discussion series for 3 consecutive years (phase 2). Curricular content was then provided for 31 rural hospice team members (phase 3). Self-reported confidence in caring for children increased by 1.1/10 points for adult-trained hospice team members. Mean score for intention to care for children increased by 5.2 points (sustained 5.1 points above baseline at 4 months). Perception of support in caring for children increased by 5 points (mean sustained 5.4 points above baseline at 4 months). Family needs, care goals, and symptom management were prioritized learning topics. Rural hospices previously unwilling to accept children enrolled pediatric patients in the 4 months following the conference. Grassroots curricular initiatives and ongoing educational mentorship can grow pediatric palliative and hospice services in rural regions.

AIDA

With the tremendous growth in data science and machine learning, it has become increasingly clear that traditional relational database management systems (RDBMS) are lacking appropriate support for the programming paradigms required by such applications, whose developers prefer tools that perform the computation outside the database system. While the database community has attempted to integrate some of these tools in the RDBMS, this has not swayed the trend as existing solutions are often not convenient for the incremental, iterative development approach used in these fields. In this paper, we propose AIDA - an abstraction for advanced in-database analytics. AIDA emulates the syntax and semantics of popular data science packages but transparently executes the required transformations and computations inside the RDBMS. In particular, AIDA works with a regular Python interpreter as a client to connect to the database. Furthermore, it supports the seamless use of both relational and linear algebra operations using a unified abstraction. AIDA relies on the RDBMS engine to efficiently execute relational operations and on an embedded Python interpreter and NumPy to perform linear algebra operations. Data reformatting is done transparently and avoids data copy whenever possible. AIDA does not require changes to statistical packages or the RDBMS facilitating portability.