z

To Prompt or Not to Prompt? A Microrandomized Trial of Time-Varying Push Notifications to Increase Proximal Engagement With a Mobile Health App

Thu, 29 Nov 2018 00:00:00 GMT

To Prompt or Not to Prompt? A Microrandomized Trial of Time-Varying Push Notifications to Increase Proximal Engagement With a Mobile Health App Bidargaddi, Niranjan; Almirall, Daniel; Murphy, Susan; Nahum-Shani, Inbal; Kovalcik, Michael; Pituch, Timothy; Maaieh, Haitham; Strecher, Victor Background: Mobile health (mHealth) apps provide an opportunity for easy, just-in-time access to health promotion and self-management support. However, poor user engagement with these apps remains a significant unresolved challenge. Objective: This study aimed to assess the effect of sending versus not sending a push notification containing a contextually tailored health message on proximal engagement, measured here as self-monitoring via the app. Secondary aims were to examine whether this effect varies by the number of weeks enrolled in the program or by weekday versus weekend. An exploratory aim was to describe how the effect on proximal engagement differs between weekday versus weekend by the time of day. Methods: The study analyzes the causal effects of push notifications on proximal engagement in 1255 users of a commercial workplace well-being intervention app over 89 days. The app employs a microrandomized trial (MRT) design to send push notifications. At 1 of 6 times per day (8:30 am, 12:30 pm, 5:30 pm, 6:30 pm, 7:30 pm, and 8:30 pm; selected randomly), available users were randomized with equal probability to be sent or not sent a push notification containing a tailored health message. The primary outcome of interest was whether the user self-monitored behaviors and feelings at some time during the next 24 hours via the app. A generalization of log-linear regression analysis, adapted for use with data arising from an MRT, was used to examine the effect of sending a push notification versus not sending a push notification on the probability of engagement over the next 24 hours. Results: Users were estimated to be 3.9% more likely to engage with the app in the next 24 hours when a tailored health message was sent versus when it was not sent (risk ratio 1.039; 95% CI 1.01 to 1.08; P<.05). The effect of sending the message attenuated over the course of the study, but this effect was not statistically significant (P=.84). The effect of sending the message was greater on weekends than on weekdays, but the difference between these effects was not statistically significant (P=.18). When sent a tailored health message on weekends, the users were 8.7% more likely to engage with the app (95% CI 1.01 to 1.17), whereas on weekdays, the users were 2.5% more likely to engage with the app (95% CI 0.98 to 1.07). The effect of sending a tailored health message was greatest at 12:30 pm on weekends, when the users were 11.8% more likely to engage (90% CI 1.02 to 1.13). Conclusions: Sending a push notification containing a tailored health message was associated with greater engagement in an mHealth app. Results suggested that users are more likely to engage with the app within 24 hours when push notifications are sent at mid-day on weekends. Copyright ©Niranjan Bidargaddi, Daniel Almirall, Susan Murphy, Inbal Nahum-Shani, Michael Kovalcik, Timothy Pituch, Haitham Maaieh, Victor Strecher. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 29.11.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

Use of ticagrelor alongside fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

Sat, 11 Aug 2018 00:00:00 GMT

Use of ticagrelor alongside fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study Berwanger, Otavio; Abdelhamid, Magdy; Alexander, Thomas; Averkov, Oleg; Aylward, Philip Edmund; Contreras Zuniga, Eduardo; Halvorsen, Sigrun; Iglesias, Ricardo; Abdul Kader, Muhamad A SK; Zubaid, Mohammad; Al Habib, Khalid F Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST‐segment elevation myocardial infarction (STEMI). In patients with STEMI who cannot undergo timely primary PCI, pharmacoinvasive treatment is recommended, comprising immediate fibrinolytic therapy with subsequent coronary angiography and rescue PCI if needed. Improving clinical outcomes following fibrinolysis remains of great importance for the many patients globally for whom rapid treatment with primary PCI is not possible. For patients with acute coronary syndrome who underwent primary PCI, the PLATO trial demonstrated superior efficacy of ticagrelor relative to clopidogrel. Results in the predefined subgroup of patients with STEMI were consistent with the overall PLATO trial. Patients who received fibrinolytic therapy in the 24 hours before randomization were excluded from PLATO, and there is thus a lack of data on the safety of using ticagrelor in conjunction with fibrinolytic therapy in the first 24 hours after STEMI. The TREAT study addresses this knowledge gap; patients with STEMI who had symptom onset within the previous 24 hours and had received fibrinolytic therapy (of whom 89.4% had also received clopidogrel) were randomized to treatment with ticagrelor or clopidogrel (median time between fibrinolysis and randomization: 11.5 hours). At 30 days, ticagrelor was found to be non‐inferior to clopidogrel for the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI)‐defined first major bleeding. Considering together the results of the PLATO and TREAT studies, initiating or switching to treatment with ticagrelor within the first 24 hours after STEMI in patients receiving fibrinolysis is reasonable. All Clinical Cardiology articles are published under the terms of the Creative Commons Attribution License (CC BY) which allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed. Copyright on any research article published by a Wiley Open Access journal is retained by the author(s).

New models to study vulvodynia: Hyperinnervation and nociceptor sensitization in the female genital tract

Mon, 15 Oct 2018 00:00:00 GMT

New models to study vulvodynia: Hyperinnervation and nociceptor sensitization in the female genital tract Barry, Christine M; Huilgol, Kalyani; Haberberger, Rainer Viktor Vulvodynia is a prevalent form of chronic pain, most commonly affecting the vaginal vestibule (vestibulodynia) (Pukall et al., 2016). Women with vulvodynia describe intense pain in response to light touch of the affected region, such that sexual function and other activities can be severely limited. Medical costs associated with vulvodynia are high, exceeding $21 billion annually in the United States (Xie et al., 2012). The high level of direct medical costs has been linked to high treatment failure rates. Many women with the disorder consult multiple practitioners and undergo multiple courses of treatment with limited benefit. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Distributed reading: Literary reading in diverse environments

Mon, 01 Jan 2018 00:00:00 GMT

Distributed reading: Literary reading in diverse environments Barnett, Tully Sarah Reading has always been a contentious and political practice, but this is heightened in the contemporary moment both because of the way the environments in which we read are changing so radically. For Katherine Hayles reading is “a powerful technology for reconfiguring activity patterns in the brain” [Hayles 2010, 193], a view representative of attempts to connect the new neuroscience of reading with age old practices of literary endeavour. For Sven Birkerts, however, “the Internet and the novel are opposites” [Birkerts 2010], a view that suggests that a hierarchy of reading that locks digital readers out of higher order thinking and literary experience. Meanwhile, Anne Mangen finds that electronic reading environments “negatively aﬀect emotional aspects of reading” [Mangen 2016]. But these approaches tend to understand reading as something static that occurs in one space or another. However, in practice our reading is increasingly distributed. Reading can occur in multiple formats, across multiple platforms for the one text or reading experience. A novel begun in print can be read online in a born-digital format and concluded in a scanned digital format, for example. These journeys across platform require deeper investigation. If we think of the printed book as an interface between two orders of thinking, we need to consider how the experience of reading a digitized version of a formerly printed and bound book alters literary reception and student experience. How does the experience of reading across different technological platforms change the reader’s relationship to the content? As more and more electronic reading platforms take on the physical attributes of material reading experiences either by retaining material traces or by emulating them, we might question what experience How do the material traces left on digitised works impact the reading process for reading in literary studies? The lively discourse surrounding Google Books and the human breaches of the material into the immaterial, as the work crosses the borders of formats and interfaces, raises valuable questions about the future of the book, reading in the twenty-first century, and the long and formidable shadow that centuries of material text production casts over Google Books’ electronic utopia. This paper uses both book history and new media interface theory to consider the multitude of diverse experiences that is literary reading across different platforms in and out of the classroom and to consider whether distracted reading can be better understood as distributed reading. It considers critical infrastructure studies as a useful framework through which to think about reading in the digital age. Copyright the author. This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.