Validation and selection of criteria for evaluating apps for managing depression: a Delphi study

RNA viruses exhibit high mutation rates, leading to multiple haplotypes (also referred to as quasi-species) within infected hosts and have been described in both acute (e.g. Influenza, DENV) and chronic (e.g. HIV, HCV) infections. This study characterises the mutation hotspots in DENV genomes at both consensus and haplotype levels. Near full-length DENV genomes were sequenced using Oxford Nanopore Technology (ONT) from Sri Lankan dengue patients recruited between 2017 and 2020. Consensus sequences were made with Minimap-2, and haplotypes were reconstructed with Nano-Q, a tool designed for estimation of RNA virus haplotypes and their relative abundance. The genomic variability of DENV genomes was assessed using Shannon Entropy (SE). Codons undergoing diversifying selection were identified with three phylogenetics-based algorithms (FEL, MEME, FUBAR) implemented within the Datamonkey suite. Hotspots were defined as the high entropy codons that were also subject to diversifying selection. From 150 samples tested, both consensus and haplotype sequences were characterised in 90 samples (DENV1: 8, DENV2: 51, DENV3: 31). At the consensus level, the NS2A gene had the greatest number of sites with higher Shannon entropy when adjusted for gene length across all serotypes, while at the haplotype level the NS1 gene had the same. Overall, the haplotypes sequences revealed more sites with high mutability and codons under diversifying selection than those visible at consensus level. This provides proof-in-principle that in acute RNA viruses also have high mutability in haplotypes, which may be inapparent with a consensus-level analysis.

Status Deconstruction Theory: Status Conflict's Destabilization of Group Status Hierarchies

BackgroundThe use of apps for weight management has increased over recent years; however, there is a lack of evidence regarding the efficacy and safety of these apps. The EVALAPPS project will develop and validate an assessment instrument to specifically assess the safety and efficacy of weight management apps.ObjectiveThe aim of this study was to reach a consensus among stakeholders on a comprehensive set of criteria to guide development of the EVALAPPS assessment instrument. A modified Delphi process was used in order to verify the robustness of the criteria that had been identified through a literature review and to prioritize a set of the identified criteria.MethodsStakeholders (n=31) were invited to participate in a 2-round Delphi process with 114 initial criteria that had been identified from the literature. In round 1, participants rated criteria according to relevance on a scale from 0 (“I suggest this criterion is excluded”) to 5 (“This criterion is extremely relevant”). A criterion was accepted if the median rating was 4 or higher and if the relative intraquartile range was equal to 0.67 or lower. In round 2, participants were asked about criteria that had been discarded in round 1. A prioritization strategy was used to identify crucial criteria according to (1) the importance attributed by participants (criteria with a mean rating of 4.00 or higher), (2) the level of consensus (criteria with a score of 4 or 5 by at least 80% of the participants).ResultsThe response rate was 83.9% (26/31) in round 1 and 90.3% (28/31) in round 2. A total of 107 out of 114 criteria (93.9%) were accepted by consensus—105 criteria in round 1 and 2 criteria in round 2. After prioritization, 53 criteria were deemed crucial. These related mainly to the dimensions of security and privacy (13/53, 24.5%) and usability (9/53, 17.0%), followed by activity data (5/53, 9.4%), clinical effectiveness (5/53, 9.4%), and reliability (5/53, 9.4%).ConclusionsResults confirmed the robustness of the criteria that were identified, with those relating to security and privacy being deemed most relevant by stakeholders. Additionally, a specific set of criteria based on health indicators (activity data, physical state data, and personal data) was also prioritized.

The global demand for mental health services has significantly increased over the past decade, exacerbated by the COVID-19 pandemic. Digital resources, particularly smartphone apps, offer a flexible and scalable means of addressing the research-to-practice gap in mental health care. Clinicians play a crucial role in integrating these apps into mental health care, although practitioner-guided digital interventions have traditionally been considered more effective than stand-alone apps. This scoping review explored mental health practitioners' views on potential use or integration of smartphone apps into clinical practice. We asked, "What is known about how mental health practitioners view the integration of smartphone apps into their practice?" Further, this scoping review explored the factors that might influence integration of smartphone apps into practice, such as practitioner and client characteristics, app design and functionality, and practitioner views. We conducted a systematic search of 3 databases that yielded 38 studies published between 2018 and 2025, involving 1894 participants across various mental health disciplines, most predominantly psychologists and psychiatrists. Data were collected on practitioner and client characteristics, app functionality, and factors deemed important or influencing practitioners' opinions about app integration. The included studies were most likely to explore use of apps outside the clinical session and focused on self-management apps for mental health monitoring and tracking, and for collecting data from the patient. Fewer studies explored use of apps within-session, or practitioner-guided apps. Practitioners prioritized app features aligned with the American Psychological Association's evaluation criteria, with practitioners prioritizing engagement and interoperability, but also noted the importance of training and resourcing to support integration. While practitioners recognize the potential of apps in mental health care, integration into clinical practice remains limited. This study highlights the need for further research on practical implementation, clinical effectiveness, and practitioner training to facilitate the transition from potential to actual use of apps in mental health care settings. Recommendations include evaluating effectiveness of app integration through experimental studies and developing training modules to develop practitioners' digital competencies and confidence in app use.

Are we on the same page? Multiple stakeholders and service users priorities for dementia care and policy: A Delphi study

Gini index, a measure of statistical dispersion intending to represent inequality within a group, used mainly in economics, becomes in this paper a tool to introduce a new index to measure the level of consensus in Group Decision Making problems. An empirical study reveals that the levels of consensus obtained by this index are similar to those derived through the use of a distance function when fuzzy preference relations are considered. The results obtained suggest that this new index can be satisfactorily used to measure the degree of consensus in this framework.KeywordsGroup decision makingFuzzy preferencesConsensusInequalityGini indexDistance functions

ObjectiveSpeech language pathologists (SLPs) play a crucial role while dealing with tracheostomized patients, particularly in addressing communication impairments and dysphagia. However, in India, there is a lack of standardized guidelines for SLPs in the treatment of tracheostomy patients, resulting in variations in clinical practices and patient care.MethodsAn online survey was conducted among 106 experienced SLPs in India. The survey included questions pertaining to various aspects of assessment and treatment in tracheostomized patients. Survey data were analyzed to identify the level of consensus among SLPs in these areas.ResultsThe survey results revealed varying levels of consensus among SLPs in most of the domains. Most responses fell within the moderate to low consensus range, indicating a lack of standardized practices.ConclusionsThe study highlights the lack of standardized guidelines among SLPs in India when it comes to tracheostomy patient care. Hence, the study recommends collaboration among relevant organizations to enhance knowledge sharing and standardize clinical guidelines to improve the overall quality of care for tracheostomy patients in India.

BackgroundMental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health–related behavior change have not been thoroughly examined.ObjectiveThe objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors.MethodsThis study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables.ResultsParticipants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049).ConclusionsParticipants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.

BackgroundRecently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents’ health literacy.ObjectiveThis study aims to evaluate whether parents’ use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children.MethodsParticipants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits.ResultsIn total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non–app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non–app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non–app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non–app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables.ConclusionsThis study showed a significant association between parents’ use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children’s health care. Future studies are needed to evaluate the association between app use and emergency room visits.

This paper aims to study the consensus approach for the decision making problems with hesitant fuzzy linguistic decision matrices. The distance measure is proposed for the hesitant fuzzy linguistic term sets. Then based on the distance among the individual decision matrices, the group consensus level and some other consensus levels are defined for the hesitant fuzzy decision matrices, and the consensus reaching process is introduced. The model is to make the adjusted elements as little as possible and make the information provided for the experts as much as possible, and is helpful for the experts to determinate the adjusted elements. Finally, a numerical example is used to illustrate the feasibility and practicability of the proposed consensus model.

As an extension of hesitant fuzzy element, probabilistic hesitant fuzzy element (PHFE) has received increasing attention. However, some important issues in PHFE utilization remain to be addressed. This study aims to build a consensus among the decision makers for probabilistic hesitant fuzzy preference relations (PHFPRs) with expected additive consistency. First, several generalized operations that are suitable for PHFPRs are defined. Then, expected additive consistent PHFPRs are introduced, and a theorem is proposed to obtain them. Second, the consistency index is defined based on the Hausdorff distance of PHFEs to measure whether individual PHFPRs exhibit acceptable expected additive consistency. If not, then an automatic iterative algorithm is designed to obtain acceptable ones. Third, group PHFPR is obtained based on the proposed generalized operations, and then the consensus index is determined according to the Hausdorff distance. If at least one of the consensus levels of the decision makers is lower than a given threshold, then an automatic iterative algorithm is used to update the PHFPRs to reach a predefined consensus level. Finally, a numerical example is provided, and comparative analyses with existing methods are performed to demonstrate the validity of the proposed method in addressing group decision-making problems.

Smartphone applications for seizure care and management in children and adolescents with epilepsy: Feasibility and acceptability assessment among caregivers in China

BackgroundMobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients’ and clinicians’ perspectives to guide app development, evaluation, and implementation into models of care.ObjectiveThis study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management.MethodsThis is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12.ResultsA total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients’ mental health and well-being. The main barriers identified were the patients’ unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization.ConclusionsThe use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians.

Radiographer managers and service development: A Delphi study to determine an MRI service portfolio for year 2020