Development and use of a computerized system to track the competency development of family medicine residents: analysis of the convergence between system proposals and assessor decisions

In recent decades, a number of training environments have moved toward program approaches targeting the development of competencies. Because of their complexity, monitoring the development of those competencies is a considerable challenge. Our hypothesis is that a computerized system could help overcome this challenge if it is well accepted by its users. We first summarize the context surrounding the implementation of such approaches. Next, we present a computerized assessment system established in the Family Medicine Residency Program of Laval University (Québec, Canada) that we have developed for tracking the development of residents’ competencies. We then present the analysis of interactions between the system and users and the various proposals that were made to improve the system and longitudinal tracking of the development of the targeted competencies. We consider that this research provides useful guidelines for the computerized monitoring of learners' competencies development and for the design of such systems.

The Efficacy of a Commercial Physical Activity Monitor in Longitudinal Tracking of Pulmonary Hypertension Patients

Patients with pulmonary arterial hypertension (PAH) have quality of life (QoL) limitations, decreased exercise capacity, and poor prognosis if left untreated. Standard exercise testing is routinely performed for the evaluation of patients with PAH but may be limited in its ability to monitor activity levels in daily living. We evaluated the validity of the commercial Fitbit Charge HR as a tool to assess real time exercise capacity as compared to standard exercise testing in patients with PAH. Ambulatory pediatric and adult PAH patients were enrolled and given a Fitbit with instructions to continuously wear during waking hours. Subjects underwent a 6-minute walk test (6MWT), cardiopulmonary exercise test (CPET) and an SF-36 QoL survey on the day of enrollment and follow-up. Twenty-seven ambulatory subjects with PH were enrolled and 21 had sufficient data for analyses (median age 25, range 13-59, 14 F) were enrolled. Daily steps measured by the Fitbit had a positive correlation with 6MWT distance (r = 0.72, p = 0.03) and an inverse correlation with WHO functional class. On the QoL survey, 77% reported improvement in energy/fatigue (p = 0.055). At follow up there was a strong correlation between Fitbit steps and role limitations due to physical problems (r = 0.88, p = 0.020) and weaker correlations with less related QoL markers. These findings suggest activity monitors may have potential as a simple/novel method of assessing longitudinal exercise capacity and activity levels in PAH patients. Further study in larger cohorts of patients is warranted to determine the best accelerometric correlates with outcomes.

Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study

Background Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used “mobile health (mHealth)” strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked. Objective We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China. Methods In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups. Results In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=−1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=−122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=−151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=−143.68; P=.03). Conclusions Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady.

A Computational Solution to Bolster Epigenetic Clock Reliability for Clinical Trials and Longitudinal Tracking

Epigenetic clocks are widely used aging biomarkers, but they are calculated from methylation data for individual CpGs that can be surprisingly unreliable. We report that technical noise causes six major epigenetic clocks to deviate by 3 to 9 years between replicates. We present a novel computational solution: we perform principal component analysis followed by biological age prediction using principal components, extracting shared age-related changes across CpGs while ignoring noise from individual CpGs. Our novel principal-component versions of six clocks show agreement between most technical replicates within 1 year, and increased stability in short- and long-term longitudinal studies. This requires only one additional step compared to traditional clocks, does not require prior knowledge of CpG reliabilities, and can improve the reliability of any existing or future epigenetic biomarker. The extremely high reliability of principal component epigenetic clocks makes them particularly useful for personalized medicine and clinical trials evaluating novel aging interventions.

High incidence of Trypanosoma cruzi infections in dogs directly detected through longitudinal tracking at 10 multi-dog kennels, Texas, USA

Canine Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is increasingly recognized as a health concern for dogs in the USA, and infected dogs may signal geographic regions of risk for human disease. Dogs living in multi-dog kennel environments (kennels with more than one dog) where triatomine vectors are endemic may be at high risk for infection. We monitored a cohort of 64 T. cruzi-infected and uninfected dogs across 10 kennels in Texas, USA, to characterize changes in infection status over one year. We used robust diagnostic criteria in which reactivity on multiple independent platforms was required to be considered positive. Among the 30 dogs enrolled as serologically- and/or PCR-positive, all but one dog showed sustained positive T. cruzi diagnostic results over time. Among the 34 dogs enrolled as serologically- and PCR-negative, 10 new T. cruzi infections were recorded over a 12-month period. The resulting incidence rate for dogs initially enrolled as T. cruzi-negative was 30.7 T. cruzi infections per 100 dogs per year. This study highlights the risk of T. cruzi infection to dogs in kennel environments. To protect both dog and human health, there is an urgent need to develop more integrated vector control methods as well as prophylactic and curative antiparasitic treatment options for T. cruzi infection in dogs.

Boston Cognitive Assessment (BOCA) — a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance

Longitudinal cognitive testing is essential for developing novel preventive interventions for dementia and Alzheimer’s disease; however, the few available tools have significant practice effect and depend on an external evaluator. We developed a self-administered 10-minute at-home test intended for longitudinal cognitive monitoring, Boston Cognitive Assessment or BOCA. The goal of this project was to validate BOCA. BOCA uses randomly selected non-repeating tasks to minimize practice effects. BOCA evaluates eight cognitive domains: 1) Memory/Immediate Recall, 2) Language Comprehension/Prefrontal Synthesis, 3) Visuospatial Reasoning / Mental rotation, 4) Executive function / Clock Test, 5) Attention, 6) Mental math, 7) Orientation, and 8) Memory/Delayed Recall. BOCA was administered to patients with cognitive impairment (n = 50) and age- and education-matched controls (n = 50). Test scores were significantly different between patients and controls (p < 0.001) suggesting good discriminative ability. The Cronbach’s alpha was 0.87 implying good internal consistency. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MOCA) (R= 0.90, p <0.001). The study revealed strong (R=0.94, p <0.001) test-retest reliability of the total BOCA score one week after participants’ initial administration. The practice effect tested by daily BOCA administration over 10 days was insignificant (β=0.03, p=0.74). BOCA has the potential to reduce the cost and improve the quality of longitudinal cognitive tracking essential for testing novel interventions designed to reduce or reverse cognitive aging. BOCA is available online gratis at www.bocatest.org.

Measurements of EEG Alpha Peak Frequencies Over the Lifespan: Validating Target Ranges on an In-Clinic Platform

Background: Peak individual alpha frequencies (IAF) extracted from an EEG exam can provide novel sources of information regarding brain function. This information can help measure and track changes in cognition arising from conditions such as concussion or unhealthy aging. Objective 1: To validate a method for combining eyes-closed EEG with eyes-closed audio P300 ERP in order to streamline testing times involved in IAF extraction. Objective 2: To validate age-stratified target ranges of IAF collected in clinic against published research. Objective 3: To validate the stability of IAF for data collected in routine clinical settings. Participants: Two thousand twenty-five subjects aged 13-90. Methods: EEG with audio P300 was collected as part of a health screening exam for studies through Colorado University, Children's Hospital Colorado, Boone Heart Institute, WAVi Co., and various clinics alongside other clinical evaluations. Results: (1) No differences were seen between IAF extracted during an eyes-closed resting and the P300 protocol. (2) The age-related AF trends measured in clinic match the age-related trends from previous research. (3) IAF remained stable over the course of 0-2 years in a test-retest dataset. Conclusion: In-clinic measures of peak EEG frequency corroborate the age-related trends of published research taken over the last several decades and IAF. These results also confirm that IAF is a stable trait, making it useful for within-person longitudinal tracking. By following changes in IAF over time, deviations from normal CNS functioning, such as onset or progression of disease, can be monitored.