Engagement Markers Research Articles

The Effect of Lifestyle Coaching Design on Patient Engagement and Weight Loss in Non-diabetic Patients of a Semaglutide-Supported Digital Obesity Program in the UK: A Comparative Retrospective Cohort Study.

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching design influences patient engagement and program effectiveness is unknown. This study retrospectively analysed several engagement markers and weight loss percentage over 16 weeks in a large semaglutide-supported DWLS in the UK (n=154). The comparative analysis found that patients who received lifestyle coaching that was proactive and personalised sent a statistically higher number of messages to their health coach (Mean=19.37 vs Mean=8.55) and opened the program app more frequently (Mean = 49.31 days vs Mean = 40.06 days) than patients whose coaching was reactive and standardised. Mean 16-week weight loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (Mean = 9.76%) tended to lose more weight than male patients (Mean = 6.88%), (t(152) = 1.89, p = 0.04). The findings add vital layers of nuance to the emerging literature on semaglutide-supported DWLSs, indicating that a proactive, personalised coaching approach leads to better patient engagement, but that such engagement is not correlated with better short-term weight-loss or program adherence outcomes. Moreover, the cohort's comparably higher mean weight loss relative to previous real-world semaglutide studies lend support to the advice of leading global health institutions of using the medication only as an adjunct to multidisciplinary lifestyle therapy. Investigators should expand on this research by conducting comparable studies over a longer period and with medication-only control groups.

A Study on the Construction of Environmental Image of Four Chinese Banks: Based on Metadiscourse Analysis

With the escalating global concern for environmental issues and China's commitment to achieving carbon peaking and neutrality goals, this study aims to investigate how four leading Chinese banks have constructed environmental images through their CSR reports from 2016 to 2021. Utilizing Hyland's (2005) Metadiscourse model and AntConc 3.5.9 for corpus analysis, we quantitatively and qualitatively examine the strategic use of Metadiscourse in these reports. Our findings reveal a dominance of interactive Metadiscourse, particularly transitions and frame markers, which facilitate coherent and structured environmental disclosures. Interactional Metadiscourse, featuring self-mentions and engagement markers etc., underscores the banks' authority and reader engagement. The banks' CSR reports demonstrate commitments to carbon reduction, green finance and credit, ecological agriculture support, and environmental risk management, and then portray proactive environmental images. This research provides insights into how Metadiscourse constructs sustainability discourse in the financial sector, informing ESG reporting and environmental communication strategies.

Comprehensive biomarker and modeling approach to support dose finding for BI 836880, a VEGF/Ang-2 inhibitor

BackgroundBI 836880 is a humanized bispecific nanobody® that binds to and blocks vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). A comprehensive biomarker and modeling approach is presented here that supported dose finding for BI 836880.MethodsTwo Phase I dose-escalation studies (1336.1 [NCT02674152], 1336.6 [NCT02689505]) assessed BI 836880 in adults with confirmed locally advanced or metastatic solid tumors, refractory to standard therapy or for which standard therapy was not reliably effective. Two dosing schedules were investigated, 3 weeks (q3w) or once weekly (qw), starting at a dose of 40 mg. In a comprehensive biomarker approach, soluble pharmacodynamic markers (free and total plasma VEGF-A and Ang-2), as well as circulating angiogenic factors (soluble VEGF3, soluble Tie2 and placenta growth factor, amongst others) were analyzed to assess target engagement in peripheral blood for q3w doses. A Population based pharmacokinetics/pharmacodynamics (PopPK/PD) model was built using the limited Phase I dataset to support dose finding by simulations. In order to demonstrate drug activity in the tumor, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was applied.ResultsDCE-MRI scans supported target engagement in the tumor. Free VEGF-A was depleted at all doses, whereas free Ang-2 decreased dose-dependently, reaching depletion in most patients from 360 mg q3w onwards. While total VEGF-A levels increased in a dose-dependent manner, reaching saturation at 360 mg q3w, total Ang-2 levels increased, but did not plateau. Angiogenic biomarkers showed changes from doses ≥ 360 mg q3w. PopPK/PD modeling showed that doses ≥ 360 mg q3w led to > 90% inhibition of free Ang-2 at steady-state in most patients. By increasing the dose to ≥ 500 mg q3w, > 90% of patients are expected to achieve this level.ConclusionsThe comprehensive analyses of multiple target engagement markers support BI 836880 720 mg q3w as a biologically relevant monotherapy dose schedule.Trial registration: NCT02674152 and NCT02689505.

Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation.

Patient portals allowing access to electronic health care records and services can inform and empower but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care. A retrospective single site cross-sectional study was undertaken to examine patient portal adoption amongst families of children receiving care for chronic or complex disorders within the United Kingdom. Descriptive and multivariable regression analysis was undertaken to describe associations between predictors (Race/Ethnicity, age, socio-economic deprivation status based on family residence, and previous non-attendance to outpatient consultations) and outcome. A sample of 3687 children, representative of the diverse 'real world' patient population, was identified. Of these 37% (1364) were from a White British background, 71% (2631) had English as the primary family spoken language (PSL), 14% (532) lived in areas of high deprivation, and 17% (643) had high (>33%) rates of non-attendance. The families of 73% (2682) had activated the portal. In adjusted analyses, English as a PSL (adjusted odds ratio [aOR] 1.58, 95% confidence interval 1.29-1.95) and multi-morbidity (aOR 1.26, 1.22-1.30) was positively associated with portal activation, whilst families from British Black African backgrounds (aOR 0.68, 0.50-0.93), and those with high rates of non-attendance (aOR 0.48, 0.40-0.58) were less likely to use the portal. Family race/ethnicity and previous low engagement with health care services are potentially key drivers of widening inequity in access to health care following the implementation of patient portals, a digital health innovation intended to inform and empower. Health care providers should be aware that innovative human-driven engagement approaches, targeted towards previously underserved communities, are needed to ensure equitable access to high quality patient-centred care.

Metadiscourse Markers in Greta Thunberg’s Speeches

<p><em>This study aims at discussing the type of metadiscourse markers and explain the metadiscourse used in Thunberg’s speeches. This study used qualitative method to describe the types and the function of metadiscourse markers in Greta Thunberg’s speeches. The result shows that there are interactive and interactional metadiscourse in the speeches. Interactive metadiscourse markers in the speech are transition, frame marker, endophoric marker and code gloss. Transition became the highest marker, because transition is conjunction that functions to coherent and to relate between argument with another argument. Meanwhile, interactional metadiscourse markers in the speech are hedges, booster, attitude marker, engagement marker, and self-mention. In the interactional category, engagement and self-mention are dominant, because the engagement marker helps Thunberg to build a relationship with the audience and address the audience into the discourse, while when to express her opinion and to emphasize herself as a speaker in personal responsibility for the argument, Thunberg used self-mention marker.</em></p>

METADISCOURSE MARKERS IN INTRODUCTION SECTION OF MASTER THESES IN ENGLISH EDUCATION STUDY PROGRAM STUDENTS AT UNIVERSITY OF BENGKULU

Metadiscourse refers to the language elements that writers or speakers use to organize, guide, and comment on their text, helping readers understand the structure and connect ideas. This study investigates the critical role of metadiscourse markers in the introduction sections of master's theses, focusing on how these markers enhance clarity and organization, making the text more accessible and engaging. The research aimed to analyze the types and frequencies of both interactive and interactional metadiscourse markers in the introductions of theses by students in the English Education Study Program at Bengkulu University. A mixed-methods approach was employed to analyze 30 introduction sections. The findings show that writers predominantly use interactive markers, especially transitions (70.7%), evidentials (11.7%), and frame markers (8.3%), more than interactional markers like hedges (52.2%) and engagement markers (24.8%). The frequent use of transition markers suggests a focus on guiding readers through the text rather than direct engagement. These results underscore the importance of metadiscourse markers in creating a well-structured and persuasive introduction. Mastering these markers can significantly enhance the quality of academic writing. Future research could extend this analysis to other thesis sections or different academic contexts.

Network state dynamics underpin basal craving in a transdiagnostic population.

Emerging fMRI methods quantifying brain dynamics present an opportunity to capture how fluctuations in brain responses give rise to individual variations in affective and motivation states. Although the experience and regulation of affective states affect psychopathology, their underlying time-varying brain responses remain unclear. Here, we present a novel framework to identify network states matched to an affective experience and examine how the dynamic engagement of these network states contributes to this experience. We apply this framework to investigate network state dynamics underlying basal craving, an affective experience with important clinical implications. In a transdiagnostic sample of healthy controls and individuals diagnosed with or at risk for craving-related disorders (total N = 252), we utilized connectome-based predictive modeling (CPM) to identify brain networks predictive of basal craving. An edge-centric timeseries approach was leveraged to quantify the moment-to-moment engagement of the craving-positive and craving-negative subnetworks during independent scan runs. We found that dynamic markers of network engagement, namely more persistence in a craving-positive network state and less dwelling in a craving-negative network state, characterized individuals with higher craving. We replicated the latter results in a separate dataset, incorporating distinct participants (N = 173) and experimental stimuli. The associations between basal craving and network state dynamics were consistently observed even when craving-predictive networks were defined in the replication dataset. These robust findings suggest that network state dynamics underpin individual differences in basal craving. Our framework additionally presents a new avenue to explore how the moment-to-moment engagement of behaviorally meaningful network states supports our affective experiences.

Cross-cultural adaptation of the writer-reader relationship in non-translated and translated English health information websites on HIV and TB diagnostic testing

The ideal multilingual health information website is relatable to all readers. Natives and immigrants should have a culturally adapted website in their language hosted by their place of residence that imparts the facts and incites a call to action to improve health, and ultimately reduces disease in the diverse community. The writer’s word choices and attitude as conveyed through the text influence the reader’s decision-making process. This paper will examine the differences between the non-translated and translated English versions of multilingual health information websites on HIV and TB diagnostic testing. These samples pertain to a large interdisciplinary study whose purpose is to determine whether the multilingual health communication websites are appropriately written regarding health literacy, and whether each cultural population, in terms of language adaptation, would receive the health information as intended. The study questions whether there exist differences between the translated and non-translated texts in English, Spanish and Catalan; this paper focuses on the two English sub-corpora. A comparable corpus of seventy-three multilingual health information websites underwent a quantitative and a qualitative analysis. The methodology is based on adaptations of Clerehan et al.’s (2005) Evaluative Linguistic Framework to assess the writer-reader relationship. The findings show statistically significant differences between the two English subcorpora as regards the writers’ and translators’ approach; the non-translated English sub-corpus contained more relational and engagement markers, whereas the translated English sub-corpus had more persuasion markers. These results should serve researchers and professionals in the translation and language sciences as well as the public health field for, respectively, future studies and techniques to improve the composition of multilingual health information texts in culturally diverse countries.

Which pediatric practices use substance use consultation services?

Substance use disorders (SUD) are common in adolescents and young adults, though few youth with SUD receive treatment, and rates of medication for substance use disorder treatment are much lower in youth compared to adults. Pediatric primary care could present an opportunity for youth with SUD to access medication, though pediatric providers may need support. Massachusetts has provided a substance use consultation line for pediatric providers since 2018. One large network of independent primary care practices within the state has been further supported by access to resources provided through a grant from the Substance Abuse and Mental Health Services Administration. In this paper, we describe the services provided in Massachusetts and examine whether additional resources are associated with increased use of the consultation line as a marker of provider engagement in SUD treatment.

Service development project to pilot a digital technology innovation for video direct observation of therapy in adult patients with asthma

BackgroundAdherence to pharmacotherapy and use of the correct inhaler technique are important basic principles of asthma management. Video- or remote-direct observation of therapy (v-DOT) could be a feasible approach to...

Framing the Research and Engaging the Reader in Graduate Engineering Students’ Abstracts

Abstract Writing an abstract is a challenging assignment for graduate students as it requires condensing all the extensive research into a few sentences, providing sufficient background knowledge, and presenting findings compellingly to the academic community. This study observes how graduate engineering students cope with writing their abstracts for their first published papers, with a specific focus on metadiscourse. The study is based on the learner corpus of 1,746 abstracts (117,535 words) written by non-native English speakers in English and Serbian during their Master’s studies. The research follows Hyland’s taxonomy, focusing on interactive frame markers and interactional engagement markers, together with metadiscursive nouns in order to uncover cross-linguistic patterns and pedagogical implications. The comparison of the absolute and relative frequency with statistical significance and log likelihood between Serbian and English sub-corpora demonstrates that students tend to use frame markers with greater frequency in Serbian abstracts than in English ones. Additionally, engagement markers, and especially directives, are used twice as often as frame markers in both sub-corpora, with a higher prevalence in English abstracts. Following the qualitative and quantitative analyses, the findings offer pedagogical implications related to the range of frame markers and metadiscursive nouns used by students to introduce their research aims and the range of engagement markers used to engage readers in their research and thus claim their credibility in academic writing.

Metadiscourse in MOOC Video Lectures: Comparison with University Lectures and Disciplinary Variation

Abstract Based on Hyland’s (2018) interpersonal model of metadiscourse, this study explores MOOC video lecturers’ use of metadiscourse and compares it to traditional university lecturers’. Disciplinary variation in metadiscourse in the MOOC video lectures has also been investigated. The MOOC corpus consists of sixteen MOOCs across three disciplinary areas, including Arts and Humanities, Engineering and Physical Sciences, and Social Sciences. The results suggest that despite slight differences, the most frequently appearing metadiscourse in the MOOC corpus resembles the patterns found in university lectures, which reveals the remarkable similarities in using metadiscourse between MOOCs and traditional face-to-face lectures. However, different instructional contexts and teacher-student relationships indeed contribute to the variance in the employment of metadiscourse. Overall, MOOC video lecturers employed more interactive metadiscourse but less interactional metadiscourse than university lecturers. Cross-disciplinarily, the use of metadiscourse in MOOC video lectures is considerably influenced by disciplinary features. MOOCs containing more discipline-specific content and requiring intensive cognitive effort tend to use more interactive metadiscourse and engagement markers; while for MOOCs that may include more perspectives than basic facts, boosters and attitude markers seem to be employed more frequently. Possible reasons and purposes of the differentiated use of metadiscourse across disciplines are discussed in detail.

Investigating Stance and Engagement Markers in Ph.D. Theses of Libyan EFL Postgraduates

Investigating Stance and Engagement Markers in Ph.D. Theses of Libyan EFL Postgraduates

A first-in-human trial of selective CDK7 inhibitor Q901, in patients with advanced solid tumors: Interim results of a phase I study (QRNT-009).

3078 Background: Q901 is a potent, covalently binding CDK7 inhibitor with excellent specificity for CDK7 against other protein kinases. Transcriptional regulation by CDK7 inhibition in cancer cells leads to DNA damage repair response inhibition and increased genomic instability. Q901 also regulates cell cycle checkpoints by inhibiting T-loop phosphorylation and transcriptionally downregulating CDK1, 2 and 4. In preclinical in vivo models, intravenous (iv) administration of Q901 once a week and once every three-week dosing regimen was well tolerated and showed significant antitumor activity. The safety profile, pharmacokinetics (PK), pharmacodynamics (PD) and efficacy data for 18, 36 and 60 mg/m2 are presented. Methods: QRNT-009 (NCT05394103) is an ongoing Phase 1/2 multicenter, open-label, dose escalation and expansion study. Q901 is administered iv once weekly for four weeks, then once every two weeks thereafter in patients with advanced or metastatic ovarian cancer, castration-resistant prostate cancer (CRPC), breast cancer, endometrial cancer, colorectal cancer, small cell lung cancer (SCLC), or pancreatic cancers. Results: As of data cutoff (12Jan2024), 17 patients received Q901 across 3 dose levels: 5 patients at 18 mg/m2, 4 patients at 36 mg/m2, and 8 patients at 60 mg/m2. The median prior lines of systemic therapy were 4 (range 2 - 17). Of 17 patients who received Q901 across all doses, there were no treatment related SAEs, treatment discontinuations, or dose reductions. Most common TRAEs ≥ 15% were nausea (29.4%), anemia (23.6%) and fatigue (23.5%). As of data cutoff, no DLTs were observed. All plasma PK analyses across dose levels showed dose dependent increase of AUC0-last and Cmax. No major metabolite was observed. POLR2A, which is a CDK7 target engagement marker showed biologically effective change starting from 18 mg/m2. 1 patient with pancreatic cancer who received 18 mg/m2 had a partial response with CA19-9 reduction from 4,632 to 219. 2 patients at 18 mg/m2 and 2 patients at 36 mg/m2 had stable disease. Additional safety and efficacy data will be presented. Conclusions: Preliminary data from QRNT-009 study showed that selective CDK7 inhibitor Q901 is well tolerated. Preliminary antitumor activity and pharmacodynamic observations are encouraging. Dose escalation is ongoing to identify MTD or recommended dose for further studies. Clinical trial information: NCT05394103 .

Utilization of fluid-based biomarkers as endpoints in disease-modifying clinical trials for Alzheimer’s disease: a systematic review

BackgroundClinical trials in Alzheimer’s disease (AD) had high failure rates for several reasons, including the lack of biological endpoints. Fluid-based biomarkers may present a solution to measure biologically relevant endpoints. It is currently unclear to what extent fluid-based biomarkers are applied to support drug development.MethodsWe systematically reviewed 272 trials (clinicaltrials.gov) with disease-modifying therapies starting between 01–01-2017 and 01–01-2024 and identified which CSF and/or blood-based biomarker endpoints were used per purpose and trial type.ResultsWe found that 44% (N = 121) of the trials employed fluid-based biomarker endpoints among which the CSF ATN biomarkers (Aβ (42/40), p/tTau) were used most frequently. In blood, inflammatory cytokines, NFL, and pTau were most frequently employed. Blood- and CSF-based biomarkers were used approximately equally. Target engagement biomarkers were used in 26% (N = 72) of the trials, mainly in drugs targeting inflammation and amyloid. Lack of target engagement markers is most prominent in synaptic plasticity/neuroprotection, neurotransmitter receptor, vasculature, epigenetic regulators, proteostasis and, gut-brain axis targeting drugs. Positive biomarker results did not always translate to cognitive effects, most commonly the small significant reductions in CSF tau isoforms that were seen following anti-Tau treatments. On the other hand, the positive anti-amyloid trials results on cognitive function were supported by clear effect in most fluid markers.ConclusionsAs the field moves towards primary prevention, we expect an increase in the use of fluid-based biomarkers to determine disease modification. Use of blood-based biomarkers will rapidly increase, but CSF markers remain important to determine brain-specific treatment effects. With improving techniques, new biomarkers can be found to diversify the possibilities in measuring treatment effects and target engagement. It remains important to interpret biomarker results in the context of the trial and be aware of the performance of the biomarker. Diversifying biomarkers could aid in the development of surrogacy biomarkers for different drug targets.

EEG band power and phase‐amplitude coupling in patients with Dravet syndrome

AbstractObjectiveDravet syndrome (DS) is an epileptic encephalopathy caused by haploinsufficiency of the SCN1A gene. SCN1A gene deficiency limits the firing rates of fast‐spiking inhibitory interneurons, which should reflect in abnormal aggregate network oscillatory electroencephalography (EEG) activity that can be measured by spectral power and phase‐amplitude coupling (PAC) analysis. In this retrospective pilot study, we tested whether spectral EEG frequency band power and PAC metrics distinguish children with DS from age‐matched controls, an early step toward establishing EEG markers of target engagement by gene or drug therapy.MethodsEEG data were collected from patients with DS (N = 6) and age‐matched control pediatric participants (N = 11) and analyzed for cumulative spectral power and PAC and classification capacity of these metrics, by logistic regression analysis. For this initial spectral and PAC analysis, we focused on sleep EEG, where myogenic artifact is minimal and where δ–γ and θ–γ coupling is otherwise expected to be robust.ResultsCumulative δ (1– <4 Hz) and θ (4–7 Hz) power was significantly reduced in the DS group, compared with age‐matched controls (p = 0.001 and p = 0.02, respectively). The δ power was a stronger classifier of separating DS from controls than θ power, with 87% and 83% accuracy, respectively. The γ power trended toward significant reduction (p = 0.08) in the DS group. We found significantly lower PAC between 1–2 Hz phase and 63–80 Hz amplitude in patients with DS compared with the age‐matched controls (p = 0.003), with 78% classification accuracy between groups for PAC.InterpretationIn this pilot study assessing EEG patterns during sleep, we found lower δ–θ power and PAC in patients with DS versus controls, which may reflect abnormal aggregate macroscale network communication patterns resulting from SCN1A deficiency. These measures may be useful metrics of therapeutic target engagement, particularly if the therapy restores the underlying DS pathophysiology. The sorting capacity of these metrics distinguished patients with DS from patients without DS and may in turn facilitate near‐future development of disease and therapy target engagement biomarkers in this syndrome.

The Use of Interactional Metadiscourse Markers in the Discussion Section of Master’s Theses Written in English by Algerian Students: An Investigation of Gender Variation

Metadiscourse analysis plays an important role in exploring the rhetorical structure of different academic genres including master’s theses. Gender differences in writing the discussion section within this genre has been unexplored in the Algerian setting. Therefore, this study employs Hyland’s framework of metadiscourse (2005) to investigate gender variation in Algerian master’s theses discussion sections written in English within the field of applied linguistics. It seeks to examine possible similarities and differences in the use of interactional resources across the two gender groups. A mixed-methods approach was opted for to study the frequency and functions of these resources. The findings revealed a higher frequency of occurrence of interactional markers among female writers. Attitude markers were the most preferred interactional resources for both groups of writers with more diversity of lexical choices noticed within the female sub-corpus. Hedges were also significantly frequent among females while males exhibited more preference for using boosters. Self-mentions and engagement markers were found to be the least used interactional categories among both genders. This study also revealed that interactional metadiscourse markers perform different rhetorical functions in the discussion of master’s theses. Keywords: Applied linguistics, Discussion sections, Gender differences, Interactional resources, Metadiscourse

Neural signatures of shared subjective affective engagement and disengagement during movie viewing.

When watching a negative emotional movie, we differ from person to person in the ease with which we engage and the difficulty with which we disengage throughout a temporally evolving narrative. We investigated neural responses of emotional processing, by considering inter-individual synchronization in subjective emotional engagement and disengagement. The neural underpinnings of these shared responses are ideally studied in naturalistic scenarios like movie viewing, wherein individuals emotionally engage and disengage at their own time and pace throughout the course of a narrative. Despite the rich data that naturalistic designs can bring to the study, there is a challenge in determining time-resolved behavioral markers of subjective engagement and disengagement and their underlying neural responses. We used a within-subject cross-over design instructing 22 subjects to watch clips of either neutral or sad content while undergoing functional magnetic resonance imaging (fMRI). Participants watched the same movies a second time while continuously annotating the perceived emotional intensity, thus enabling the mapping of brain activity and emotional experience. Our analyses revealed that between-participant similarity in waxing (engagement) and waning (disengagement) of emotional intensity was directly related to the between-participant similarity in spatiotemporal patterns of brain activation during the movie(s). Similar patterns of engagement reflected common activation in the bilateral ventromedial prefrontal cortex, regions often involved in self-referenced evaluation and generation of negative emotions. Similar patterns of disengagement reflected common activation in central executive and default mode network regions often involved in top-down emotion regulation. Together this work helps to better understand cognitive and neural mechanisms underpinning engagement and disengagement from emotionally evocative narratives.

Characteristics of Students Engaged in Spontaneous Problem-Posing

Spontaneous problem posing is a basic concept of spontaneous mathematical thinking and science learning. Students generate problems without systematic encouragement and pose problems based on the student's desire to develop their skills. As a result, they can serve as important markers of constructive mathematical and science engagement, particularly affective engagement, for problem solvers and their classroom communities. We used a qualitative approach to analyze student characteristics, especially in the affective domain, when presenting random problems. We used an observational approach and experience sampling in each class to observe students' engagement in spontaneous problem posing both individually and in groups. The findings revealed that each student showed different characteristics when presenting problems suddenly (spontaneous problem posing). The submission of the first subject problem was categorized as problem-as-exercise, satisfying the characteristics of spontaneous originality, where constructive emotional experiences impressed more on the teacher, while negative emotional experiences impressed more on oneself (self), classmates, and mathematical activities. The submission of the second subject problem is classified as a problematic problem, fulfilling the characteristics of spontaneous originality. Negative emotional experiences are more visible in me (myself), while constructive emotional experiences are more visible in teachers, classmates, and math activities

User Engagement, Acceptability, and Clinical Markers in a Digital Health Program for Nonalcoholic Fatty Liver Disease: Prospective, Single-Arm Feasibility Study.

Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the world. Common comorbidities are central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Cardiovascular disease is the most common cause of death among people with NAFLD, and lifestyle changes can improve health outcomes. This study aims to explore the acceptability of a digital health program in terms of engagement, retention, and user satisfaction in addition to exploring changes in clinical outcomes, such as weight, cardiometabolic risk factors, and health-related quality of life. We conducted a prospective, open-label, single-arm, 12-week study including 38 individuals with either a BMI >30, metabolic syndrome, or type 2 diabetes mellitus and NAFLD screened by FibroScan. An NAFLD-specific digital health program focused on disease education, lowering carbohydrates in the diet, food logging, increasing activity level, reducing stress, and healthy lifestyle coaching was offered to participants. The coach provided weekly feedback on food logs and other in-app activities and opportunities for participants to ask questions. The coaching was active throughout the 12-week intervention period. The primary outcome was feasibility and acceptability of the 12-week program, assessed through patient engagement, retention, and satisfaction with the program. Secondary outcomes included changes in weight, liver fat, body composition, and other cardiometabolic clinical parameters at baseline and 12 weeks. In total, 38 individuals were included in the study (median age 59.5, IQR 46.3-68.8 years; n=23, 61% female). Overall, 34 (89%) participants completed the program and 29 (76%) were active during the 12-week program period. The median satisfaction score was 6.3 (IQR 5.8-6.7) of 7. Mean weight loss was 3.5 (SD 3.7) kg (P<.001) or 3.2% (SD 3.4%), with a 2.2 (SD 2.7) kg reduction in fat mass (P<.001). Relative liver fat reduction was 19.4% (SD 23.9%). Systolic blood pressure was reduced by 6.0 (SD 13.5) mmHg (P=.009). The median reduction was 0.14 (IQR 0-0.47) mmol/L for triglyceride levels (P=.003), 3.2 (IQR 0.0-5.4) µU/ml for serum insulin (s-insulin) levels (P=.003), and 0.5 (IQR -0.7 to 3.8) mmol/mol for hemoglobin A1c (HbA1c) levels (P=.03). Participants who were highly engaged (ie, who used the app at least 5 days per week) had greater weight loss and liver fat reduction. The 12-week-long digital health program was feasible for individuals with NAFLD, receiving high user engagement, retention, and satisfaction. Improved liver-specific and cardiometabolic health was observed, and more engaged participants showed greater improvements. This digital health program could provide a new tool to improve health outcomes in people with NAFLD. Clinicaltrials.gov NCT05426382; https://clinicaltrials.gov/study/NCT05426382.