Excess body weight, suboptimal diet, physical inactivity, alcohol consumption, sleep disruption, and elevated stress are modifiable risk factors associated with the development of chronic diseases. Digital behavioural interventions targeting these factors have shown promise in improving health and reducing chronic disease risk. The Digital Intervention for behaviouR changE and Chronic disease prevenTION ( DIRECTION ) study is a parallel group, two-arm, randomized controlled trial evaluating the effects of adding healthcare professional guidance and peer support via group-based sessions to a web-based wellness platform (experimental group, n = 90) compared to a self-guided use of the platform (active control group, n = 90) among individuals with a body mass index (BMI) of 30 to <35 kg/m(2)and aged 40-65 years. Obesity is defined by a high BMI. The web-based wellness platform employed in this study is My Viva Plan (MVP)(R), (R), which holistically integrates nutrition, physical activity, and mindfulness programs. Over 16 weeks, the experimental group uses the web-based wellness platform daily and engages in weekly online support group sessions. The active control group exclusively uses the web- based wellness platform daily. Assessments are conducted at baseline and weeks 8 and 16. The primary outcome is between-group difference in weight loss (kg) at week 16, and secondary outcomes are BMI, percent weight change, proportion of participants achieving 5% or more weight loss, dietary intake, physical activity, alcohol consumption, sleep, and stress across the study. A web-based wellness platform may be a scalable approach to promote behavioural changes that positively impact health. This study will inform the development and implementation of interventions using web-based wellness platforms and personalized digital interventions to improve health outcomes and reduce chronic disease risk among individuals with obesity.

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD.

Background Approximately 1 in 3 Canadians will experience an addiction or mental health challenge at some point in their lifetime. Unfortunately, there are multiple barriers to accessing mental health care, including system fragmentation, episodic care, long wait times, and insufficient support for health system navigation. In addition, stigma may further reduce an individual’s likelihood of seeking support. Digital technologies present new and exciting opportunities to bridge significant gaps in mental health care service provision, reduce barriers pertaining to stigma, and improve health outcomes for patients and mental health system integration and efficiency. Chatbots (ie, software systems that use artificial intelligence to carry out conversations with people) may be explored to support those in need of information or access to services and present the opportunity to address gaps in traditional, fragmented, or episodic mental health system structures on demand with personalized attention. The recent COVID-19 pandemic has exacerbated even further the need for mental health support among Canadians and called attention to the inefficiencies of our system. As health care workers and their families are at an even greater risk of mental illness and psychological distress during the COVID-19 pandemic, this technology will be first piloted with the goal of supporting this vulnerable group. Objective This pilot study seeks to evaluate the effectiveness of the Mental Health Intelligent Information Resource Assistant in supporting health care workers and their families in the Canadian provinces of Alberta and Nova Scotia with the provision of appropriate information on mental health issues, services, and programs based on personalized needs. Methods The effectiveness of the technology will be assessed via voluntary follow-up surveys and an analysis of client interactions and engagement with the chatbot. Client satisfaction with the chatbot will also be assessed. Results This project was initiated on April 1, 2021. Ethics approval was granted on August 12, 2021, by the University of Alberta Health Research Board (PRO00109148) and on April 21, 2022, by the Nova Scotia Health Authority Research Ethics Board (1027474). Data collection is anticipated to take place from May 2, 2022, to May 2, 2023. Publication of preliminary results will be sought in spring or summer 2022, with a more comprehensive evaluation completed by spring 2023 following the collection of a larger data set. Conclusions Our findings can be incorporated into public policy and planning around mental health system navigation by Canadian mental health care providers—from large public health authorities to small community-based, not-for-profit organizations. This may serve to support the development of an additional touch point, or point of entry, for individuals to access the appropriate services or care when they need them, wherever they are. International Registered Report Identifier (IRRID) PRR1-10.2196/33717

Purpose Even before the pandemic, clinical training opportunity for brachytherapy (BT) procedures has been decreasing. In locally advanced cervix cancer (CC), this has been linked to declining BT utilization and poorer clinical outcomes. This work describes the culmination of our early exploration into how to augment resident training in CCBT, distilling and integrating educational keys for a first-in-kind immersive, hands-on, and interaction-enabled virtual reality (VR) simulator for CCBT applicator insertion procedures. Materials and Methods Informal needs assessment in consultation with frontline experts and novice stakeholders identified the basic competencies thought to be required to successfully execute a CCBT applicator insertion procedure according to local standards. There was early recognition that, even before a curricular intervention could be designed, a versatile training tool would be needed. After reviewing international guidelines relating to CCBT and BT training, procedure-based learning outcomes were articulated, then selected and simplified for programming a basic goal-oriented simulation (sim) in VR. A clinical vignette of a typical CC case was crafted, with specific narrative stops amenable to building knowledge, skills, and behaviors. Emphasis on the "why" and the "how" of certain BT steps was built in. Procedural milestones were generalizable to trainees with varying degrees of clinical BT experience, with some steps or ‘interactions' made evaluable (go, no go) in this linear design. Gamification expanded options for cross-linking and reinforcing learning concepts. To the extent feasible, realism was incorporated into the physical representation of sim objects, such as CT-scanned surgical instruments and an intracavitary/interstitial BT applicator (Elekta, Netherlands; with permission), extracted as user-configurable additions to the 3D immersive operating room (OR) environment coded on Unreal engine v. 2.46 (Epic Games, US). Results A working prototype was generated for a single-player VR sim, broadly mimicking the procedural steps for actual CCBT applicator insertion. Despite an estimated runtime of 20 minutes, depending on user proficiency with CCBT and with VR technology (headset, hand controllers), the sim can start/stop at user discretion, and be shown on-screen to non-playing observers in a classroom setting. The game can also be run iteratively offline, enabling self-paced study of CCBT procedural steps in sequence, repeated execution for kinesthetic learning, and easy focus on recurring problem areas. The user starts the sim in OR, with a computer-generated patient draped and BT instrument tray at the ready. The case vignette and step-by-step instructions trigger the user to complete specific procedural tasks in the correct order; sim will not advance otherwise. Hints are given when needed. Pop-up multiple choice questions, in between BT sim interactions, are formative, drawing on basic recall, understanding, and application, to strengthen learning of core concepts in CCBT. Further contextual information is given at end of sim, to better situate procedural learnings with post-procedure processes (e.g. applicator verification and BT planning). Conclusions A novel VRsim tool, inspired by educational design principles, was created as proof-of-concept for guided performance-oriented learning of CCBT procedural aspects. Broader range and complexity of simulated procedures is planned, with higher level of user interaction and realism. Prospective evaluation of face (realism) and content (usefulness) validity will inform on its potential, as part of comprehensive CCBT instructional programming.

OBJECTIVES:The study of biological materials under a microscope is known as histology, which is one of the most challenging subjects for students. Our objective was to develop a learning tool that can reduce the extrinsic load of studying histology and make learning enjoyable and flexible. We used augmented reality (AR) to create a cellphone application called Dental AR. With Dental AR, students can use their cellphones as dynamic flashcards to hide or reveal the annotations of a histology slide. Our application enables students to study, practice, and self-test oral histology knowledge at their own pace.METHODS:We used Unity3D with Vuforia to develop Dental AR. To generate a set of target images, oral histology glass slides were scanned and converted to digital images. Annotated versions of the slides were used as output for the corresponding target images. To understand user experiences and satisfaction with Dental AR, first-year dentistry students were invited to complete an online survey.RESULTS:Dental AR was successfully developed and released on both the Apple and Google Play online app stores. The survey of dentistry students indicated overall satisfaction with Dental AR and willingness to use similar applications in other subjects.CONCLUSIONS:Dental AR can be used for in-class activities, gamification, and providing students with practice questions to study and self-test outside the classroom. This application can be expanded in the future to incorporate more target images, videos, and interactive components to make learning histology less challenging and more enjoyable.

Research Objectives To determine user retention of a verbally interactive, augmented reality buddy app that conducts daily reflective journaling for improving mental health. Design Observing retention rates of a free mobile application - YOU-AR-OK (YARO) - released through the iOS and Android App stores. YARO verbally guides daily journaling by prompting verbal responses. Setting General Community. Participants The convenience sample of participants were the general public who installed YARO on their mobile device: 2264 using Android and 568 using iOS from November 2nd to March 6th. Interventions Not applicable. Main Outcome Measures Measures are: the proportion of users who kept YARO installed versus uninstalled; the weekly retention rate after installation spike; and the number of users who regularly use the application over one-week timeframes. Results YARO had 568 installations with 95 deletions on iOS and 2264 installations with 1450 deletions on Android, resulting in 83% retention on iOS and 36% on Android. This rate is higher than other apps on iOS and similar to other apps on Android during COVID. On the day of a marketing push, Android installations spiked at 167 while deletions were 41, resulting in 75% retention after the first day of installations. The corresponding weekly Android retention rate was 59%. Daily usage was approximately 36% continuing for approximately one week after the spike. Conclusions YARO performed much better than other apps in the short term but similar to others in the long term. People may have found YARO useful and engaging for the first week, then got bored due to lack of new content and uninstalled. Improving long-term retention and health may involve continually updating the content to ensure users are regularly excited by YARO and engaged, along with gamification and personalization. Author(s) Disclosures The authors were all involved in the development of the YARO application. One of the authors is CEO for My Viva Inc. which provided branding and marketing for the YARO application. To determine user retention of a verbally interactive, augmented reality buddy app that conducts daily reflective journaling for improving mental health. Observing retention rates of a free mobile application - YOU-AR-OK (YARO) - released through the iOS and Android App stores. YARO verbally guides daily journaling by prompting verbal responses. General Community. The convenience sample of participants were the general public who installed YARO on their mobile device: 2264 using Android and 568 using iOS from November 2nd to March 6th. Not applicable. Measures are: the proportion of users who kept YARO installed versus uninstalled; the weekly retention rate after installation spike; and the number of users who regularly use the application over one-week timeframes. YARO had 568 installations with 95 deletions on iOS and 2264 installations with 1450 deletions on Android, resulting in 83% retention on iOS and 36% on Android. This rate is higher than other apps on iOS and similar to other apps on Android during COVID. On the day of a marketing push, Android installations spiked at 167 while deletions were 41, resulting in 75% retention after the first day of installations. The corresponding weekly Android retention rate was 59%. Daily usage was approximately 36% continuing for approximately one week after the spike. YARO performed much better than other apps in the short term but similar to others in the long term. People may have found YARO useful and engaging for the first week, then got bored due to lack of new content and uninstalled. Improving long-term retention and health may involve continually updating the content to ensure users are regularly excited by YARO and engaged, along with gamification and personalization.