The COVID-19 pandemic has created multiple opportunities to deploy artificial intelligence (AI)-driven tools and applied interventions to understand, mitigate, and manage the pandemic and its consequences. The disproportionate impact of COVID-19 on racial-ethnic and socially disadvantaged populations underscores the need to anticipate and address social inequalities and health disparities in AI development and application. Before the pandemic, there was growing optimism about AI's role in addressing inequities and enhancing personalized care. Unfortunately, ethical and social issues that are encountered in scaling, developing, and applying advanced technologies in healthcare settings have intensified during the rapidly evolving public health crisis. Critical voices concerned with the 'disruptive' potentials and risk for 'engineered inequities' have called for reexamining ethical guidelines in the development and application of AI. This paper proposes a framework to incorporate ethical AI principles into the development process in ways that intentionally promote racial health equity and social justice. Without centering on equity, justice and ethical AI, these tools may exacerbate structural inequities that can lead to disparate health outcomes.
This paper summarizes the 2020 Diversity in Radiology and Molecular Imaging: What We Need to Know Conference, a three-day virtual conference held September 9-11, 2020. The World Molecular Imaging Society (WMIS) and Stanford University jointly organized this event to provide a forum for WMIS members and affiliates worldwide to openly discuss diversity in science, technology, engineering, and mathematics (STEM). The participants discussed three main conference themes, “Racial Diversity in STEM,” “Women in STEM,” and “Global Health,” which were discussed through seven plenary lectures, twelve scientific presentations, and nine roundtable discussions. Breakout sessions were designed to flip the classroom and seek input from attendees on important topics such as increasing the representation of underrepresented minority (URM) members and women in STEM, generating pipeline programs in the fields of molecular imaging, supporting existing URM and women members in their career pursuits, developing mechanisms to effectively address microaggressions, providing leadership opportunities for URM and women STEM members, improving global health research, and developing strategies to advance culturally competent healthcare.
Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home.
Methods: The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper.
Results: The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory.
Conclusions: Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.
Keywords: Remote monitoring technology, assistive living, COVID-19, pandemics, user requirements, safety, public health informatics, health informatics
The COVID-19 pandemic has created multiple opportunities to implement Artificial Intelligence (AI) technologies in new ways that address the initial infectious curve (e.g., triaging patients and disseminating information during disease outbreaks), as well as the subsequent curves of pandemic sequelae (managing gaps in care of chronic conditions, addressing new and exacerbated mental health needs, and rectifying worsening health disparities. However, numerous challenges limit scaling development and application of AI technologies in healthcare settings, especially in the context of a rapidly evolving public health emergency. Data representing diverse patient cohorts are necessary both to train and to test systems but often are labor intensive to create and deidentify. The need for new codes and concepts can delay data availability. Biases in data must be identified, evaluated, and managed to mitigate downstream effects. System performance must be continuously monitored and validated as clinical information, such as disease transmission characteristics, become available. This panel will discuss these challenges and propose solutions that include ensuring adequate, equitable, and unbiased data sources are used for AI development, validation of AI in clinical settings, with the context of the rapidly evolving COVID-19 public health crisis as a discussion focus.
Global standardization of outcome measures for disease states can help researchers and healthcare providers compare healthcare institutions’ and populations' health outcomes. Despite the creation of standardized outcome sets, clinical institutions' adoption of these sets is not common. A literature review shows that among the challenges to standardizing outcome measures include the difficulties of achieving consensus in the working groups creating these outcome sets, the tradeoffs made when selecting outcome measurement tools, and the high costs of implementing a new or different set of outcome measures. The duplication of effort to create these standard sets can also limit standardization, which could be minimized through increased transparency of how these standard sets are developed. We propose some approaches to improve how to create and implement standard sets to broaden their usability across institutions.
Aims: Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.'
Materials and methods: A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique.
Results: Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%.
Conclusions: Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.
This study evaluates mobile apps using a theory-based evaluation framework to discover their applicability for patients at risk of gestational diabetes. This study assessed how well the existing mobile apps on the market meet the information and tracking needs of patients with gestational diabetes and evaluated the feasibility of how to integrate these apps into patient care. A search was conducted in the Apple iTunes and Google Play store for mobile apps that contained keywords related to the following concepts of nutrition: diet, tracking, diabetes, and pregnancy. Evaluation criteria were developed to assess the mobile apps on five dimensions. Overall, the apps scored well on education and information functions and scored poorly on engagement functions. There are few apps that provide comprehensive evidence-based educational content, tracking tools, and integration with electronic health records. This study demonstrates the need to develop apps that have comprehensive content, tracking tools, and ability to bidirectionally share data.
Although prostate cancer is the leading cause of cancer mortality for African men, the vast majority of known disease associations have been detected in European study cohorts. Furthermore, most genome-wide association studies have used genotyping arrays that are hindered by SNP ascertainment bias. To overcome these disparities in genomic medicine, the Men of African Descent and Carcinoma of the Prostate (MADCaP) Network has developed a genotyping array that is optimized for African populations. The MADCaP Array contains more than 1.5 million markers and an imputation backbone that successfully tags over 94% of common genetic variants in African populations. This array also has a high density of markers in genomic regions associated with cancer susceptibility, including 8q24. We assessed the effectiveness of the MADCaP Array by genotyping 399 prostate cancer cases and 403 controls from seven urban study sites in sub-Saharan Africa. Samples from Ghana and Nigeria clustered together, whereas samples from Senegal and South Africa yielded distinct ancestry clusters. Using the MADCaP array, we identified cancer-associated loci that have large allele frequency differences across African populations. Polygenic risk scores for prostate cancer were higher in Nigeria than in Senegal. In summary, individual and population-level differences in prostate cancer risk were revealed using a novel genotyping array.
Significance: This study presents an Africa-specific genotyping array, which enables investigators to identify novel disease associations and to fine-map genetic loci that are associated with prostate and other cancers.
This report represents a key step toward that goal. It presents a Framework that a) identifies critical issues that must be addressed in designing and evaluating apps, and b) outlines criteria and protocols for rigorously evaluating these issues to generate the evidence needed by those looking for credible apps. This type of Framework is novel and groundbreaking.
Abstract—There has been a tremendous increase in the costs of caring for older adults owing to the fact that societies are aging around around the world. This has led to a decrease in the number of caregivers who are able to assist. Investigative studies indicate that older adults require social as well as physical support for their well-being which prompted researchers to use social and cognitive robots and advanced human machine interaction devices. However, most of these studies have shortcomings when it comes to providing means of a natural interaction with the machine. With speech being the most natural way for human communication and the huge developments in the Internet of Things and smart homes, equipping a robotic system with powerful natural speech interaction capabilities to maintain a conversation with an elderly while being linked to other smart home devices shows a promising direction. This paper describes a scalable and expandable system with main goal of designing a natural speech-enabled system for older adults that is capable of linking to multiple active agents with minimal integration efforts. The system makes use of the power of commercially available digital assistant systems, integrated with an intelligent conversational agent, robotics, and smart wearables. The main advantage of the system is that it could provide a portion of the population, namely older adults and the disabled, the flexibility of interacting naturally with powerful social robots in smart home environments, hence providing them with much needed independence.
Index Terms—Social robots, Human-Robot Interaction, Elderly care, Artificial Intelligence, Speech Interaction, Ambient Assisted Living
This report provides an overview of published evidence pertaining to apps. The report indicates that at this stage, although there is some evidence related to the value of some apps, evaluations have been limited and incomplete. There is an urgent need for systematic, thorough, objective evaluation of apps to inform decisions about which apps are safe and effective.
Background: Health research apps often do not focus on usability as a design priority. This is problematic when the population of interest is disproportionately underrepresented as users of mobile apps, especially observed with aging older adults (> = 75). Challenges with the adoption of health information technology (HIT) among this group are exacerbated by poor design and user interface/experience (UI/UX) choices. This protocol describes the testing and evaluation process of one HIT app for the family-based collaboration platform InfoSAGE.
Methods: We aim to recruit twenty subjects from both informal family-caregivers and aging older adults to examine the usability of the InfoSAGE mobile medication manager. Participants will be audio and visually recorded, in addition to the use of screen capture recordings, while ‘thinking aloud’ as they complete eight common usecase scenarios. Multiple independent reviewers will code video and audio recordings for thematic analysis and use problems will be evaluated. Success and failure of each scenario will be determined by completion of sub-events. Time-to-complete analysis will be used to ascertain the learning curve associated with the app.
Discussion: Frequently observed problem areas will be used as the basis of further evolution of the app, and will further inform generalized recommendations for the design of HIT apps for research and public use. This study aims to improve the model of development for dual user populations with dissimilar technological literacy to improve retention and use. Results of this study will form the foundation of a design framework for mobile health apps. Keywords: mHealth, Usability, Older adults, Health information technology, User interface design
The design of a mobile medication manager within a broader family and elder-centric collaboration platform faces challenges of usability and wide applicability. To inform the development and use cases of eldercare apps, we present the preliminary results of a usability study of an iOS and Android app intended for both family members and aging adults for the mobile management of medication lists. Seven participants were recorded during the performance of eight typical use-case scenarios of the medication portion of the InfoSAGE app. Audio and video recordings were analyzed for themes and events. The aim of this paper is to help inform future design choices for eldercare mobile app
Background: Longevity creates increasing care needs for healthcare providers and family caregivers. Increasingly, the burden of care falls to one primary caregiver, increasing stress and reducing health outcomes. Additionally, little has been published on adults’, over the age of 75, preferences in the development of health information sharing with family members using online platforms. This study aims to assess a novel, Internet based, family-centric communication and collaboration platform created to address the information needs of elders and their informal caregivers in a community setting.
Methods: This study is an internet-based, open prospective cohort study, enrolling dyad pairs of one adult over the age of 75 with one informal caregiver. Dyads will be offered to use the InfoSAGE online platform without prospective assignment. Participants will consent using an online process that enables participation from any location and shares important study and privacy details. The platform will enable the capture of search queries and tracking of functions such as tasks and discussions. Surveys every six months assess health status, health and social needs, and caregiver burden using validated instruments over a two-year period. We will use a mixed methods approach, utilizing qualitative survey data along with website usage analytic data.
Discussion: Analysis of the longitudinal usage and survey data will help to examine the patterns of family communication and health information seeking as the central older adult ages. We will use the study data to inform design recommendations relevant to a complex mixture of users, with special consideration to the needs of older adult users and potential physical limitations.
Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA.
We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers partnering with five US centers to study the genetics and epidemiology of CaP in SSA. We developed common data elements and instruments, regulatory infrastructure, and biosample collection, processing, and shipping protocols. We tested this infrastructure by collecting epidemiologic, medical record, and genomic data from a total of 311 patients with CaP and 218 matched controls recruited at the seven SSA centers. We extracted genomic DNA from whole blood, buffy coat, or buccal swabs from 265 participants and shipped it to the Center for Inherited Disease Research (Baltimore, MD) and the Centre for Proteomics and Genomics Research (Cape Town, South Africa), where genotypes were generated using the UK Biobank Axiom Array.
We used common instruments for data collection and entered data into the shared database. Double-entered data from pilot participants showed a 95% to 98% concordance rate, suggesting that data can be collected, entered, and stored with a high degree of accuracy. Genotypes were obtained from 95% of tested DNA samples (100% from blood-derived DNA samples) with high concordance across laboratories.
We provide approaches that can produce high-quality epidemiologic and genomic data in multicenter studies of cancer in SSA.
Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Projectmanagement is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostatecancer in Africa, focusing on building strategic and operational capacity.
Applying a learning organizational framework, we developed and implemented a projectmanagement toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics.
The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required.
The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in projectmanagement resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.
Adherence to antiretroviral therapy (ART) is paramount to successful long-term suppression of human immunodeficiency virus (HIV). For poorly adherent patients with HIV, barriers to remaining adherent may be overcome by the implementation of targeted interventions delivered via mobile devices. This systematic review is focused specifically on mobile phone technologies to deliver adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS) populations.
This review (PROSPERO #CRD42017065131) systematically extracted data from published literature from five databases on mobile phone interventions to improve adherence to ART for HIV. The reported studies had been conducted between 2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each criterion as low, high, or unclear risk of bias.
Of the 835 articles returned, we identified 26 randomized controlled trials (RCTs), retrospective and prospective cohort trials, or mixed method studies with a comparison group that fit criteria for inclusion. No standard measure of adherence was consistent throughout the examined studies, and assessments by self-report, pill counting, and medication event monitoring system (MEMS) were utilized. The studies reported mixed results, with 17 reporting significant improvements to adherence, 3 reporting improvements without supplying p-values, and 6 reporting no significant change or a reduction in adherence.
The mixed nature of the results exemplifies the need for more comprehensive approaches and larger scale trials to confirm results observed in limited cohort sizes. To better retain satisfactory adherence within the HIV population, and especially in low-resource settings, we recommend that future interventions incorporate multiple strategies: mobile-based reminders, social support structures, and personalized content.
A major challenge in global health is improving newborn and maternal health. A variety of economic, geopolitical, socio-cultural, and technical factors are involved. Online and mobile technologies hold the potential to improve maternal and newborn health by supporting access to education, improving coordinated care, and facilitating patient support. These online and mobile systems have been designed to address a variety of maternal and newborn health outcomes, including: increasing antenatal care attendance; cessation of unhealthy behaviors, such as smoking and drinking alcohol; and increasing vaccination rates of newborns. The success of these systems, however, is very much dependent on how—and whether—they can effect behavioral changes in culturally appropriate ways. This chapter reviews the design of these systems in both developed and developing countries, the technologies and behavioral frameworks used, and the evaluation outcomes. The acceptance of these new patient support networks requires the trust of patients and healthcare providers. Hence, this chapter also reviews the evolution of these systems, and the potential benefits of, and challenges for, their sustained operation.
Los juegos aplicados en salud educan, entretienen y favorecen un mejor acceso de los usuarios al mundo sanitario en todas sus vertientes. Además, para este sector suponen una oportunidad sin precedentes en lo relativo a la motivación y el cambio de conducta de las personas en relación a sus enfermedades y dolencias. Estos juegos se diseñan para promover mejores resultados en la salud de los pacientes, para mejorar la formación de los profesionales implicados y promover la educación al servicio de la salud. La industria del juego aplicado en salud está valorada en miles de millones de euros y dispone de centenares de productos y prototipos que se han diseñado desde los ámbitos académico y comercial. Este libro analiza las mejoras en el sector y nos proporciona un marco de evaluación, diseño y estrategia que además quiere ser sostenible.
The book is available for ordering online at this web page and Amazon in Spain and USA.
Serious games for health educate, entertain and improve access to healthcare services. In addition, they represent an unprecedented opportunity to motivate and change people's behavior in relation to their illnesses and conditions. These games are designed to promote better health outcomes for patients, and also to improve the training of the professionals involved in promoting education and health services. The health gaming industry is valued at billions of euros and has hundreds of products and prototypes that have been designed from the academic and commercial fields. This book analyzes the improvements in the sector and provides us with an evaluation, design and strategy framework for sustainable systems
Aging creates new information and communication needs for families who are helping to coordinate care for frail parents. To identify how information and communication needs evolve with the aging process, we created a living laboratory of families, supported by an online private social network with tools for care coordination. Site registrants are invite to participate in a more in-depth survey-based longitudinal study. In year one, we assessed the feasibility of an online living laboratory. During this first year, 155 individuals registered on InfoSAGE, and 26% opted into the more in-depth longitudinal study. The survey response rate for those in the study was 61%. We present here a descriptive analysis of our early participants and networks, as well as barriers to participation that the study team encountered. PubMed PMID: 28186055.