Article

Mobile Medical Apps and mHealth Devices: A Framework to Build Medical Apps and mHealth Devices in an Ethical Manner to Promote Safer Use-A Literature Review

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Abstract

This paper presents a preliminary literature review in the area of ethics in the development of Mobile Medical Apps and mHealth. The review included both direct health apps and also apps marketed under the area of well-being in addition to mHealth devices. The following words and combinations of them were used to carry out the search for publications, mHealth, Apps, Ethics. The search engines used were Google Scholar, and PubMed. The paper is restricted to publications since 2012. The total number of papers found was 1,920 of which 84 were reviewed. The reason for so few being reviewed was that the majority only considered security. The search revealed many papers dealing with security for all types of apps and mHealth devices but there are very few papers dealing with the ethical issues related to Apps or mHealth devices in the area. It is noted however that the number of apps is increasing in number exponentially and therefore it is argued that it is necessary to pay attention to the ethical aspects. There are now estimated to be 165,000 apps available in this area. How ethics are addressed in health and well-being apps is important as they can have an effect on the health of the individual using them. In a similar way, the need for addressing ethical issues for development of well-being apps is evident. In a study [1] it was noted that even though Electronic Health Record (EHR) was the highest ranked tablet-related task only one third of clinicians said that EHR was optimized for smartphones. When apps are integrated with the EHR they fully optimize productivity. In the same study the significant challenges identified included the method of evaluation and selection of mobile health solutions in order to ensure that clinical outcomes, care and efficiency are included. Security is mentioned but again wider ethical issues were not a consideration. From the literature review it is clear that there is a need for guidelines for how developers of medical ad well-being apps and mHealth devices should address ethical issues during development, and the generation of these guidelines is the subject of ongoing research by the authors. © 2017 European Federation for Medical Informatics (EFMI) and IOS Press.

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... While it promotes the establishment of more equitable health care systems globally, digital health fosters tangible ethical concerns pertaining to human rights like patient autonomy, safety, and justice [3][4][5][6]. The concerns most often raised are breaches in patient privacy as individual data are transmitted and circulated, lack of control over secondary use of data, threats to patient safety due to a range of potential errors, and the loss of self-determination among patients and frontline workers when digital routines are put into place. ...
... They underpin the conception of digital health solutions and promote and safeguard good ethical conduct. They find echo in recent publications providing guidance in mitigating negative ethical consequences of digital technologies [5,6,8]. The pillars are listed in Table 1, each with a brief explanation. ...
... design of digital technology and app creators should be made aware of the consequences of errors. [6] As of now, as developers are not covered by acts and codes of conduct like the Health Information Portability and Privacy Act (HIPAA) or the International Medical Informatics Association (IMIA) code, and they lack incentive to provide robust security for patient information or to build in "error trackers". Tying into the international principles behind the frameworks in place pertain to good clinical conduct and has the additional advantage of aiding harmonization within and among health systems. ...
... Low-resource countries, especially in Africa, are frequent environments for clinician-toclinician applications dedicated to diagnostic and management assistance, several of which are non-medical like WhatsApp ®. Despite noteworthy individual and societal potential benefits addressing the human right for health care [7], those applications foster tangible ethical concerns pertaining to other human rights like patient autonomy, safety, and justice [8][9][10][11][12][13][14][15]. At the forefront lie the loss of privacy inherent in how information is handled, and threats to patient safety emerging from weaknesses in the quality of the digital information inherent in the iterative development process of mHealth apps [1,6,14,16]. ...
... Despite noteworthy individual and societal potential benefits addressing the human right for health care [7], those applications foster tangible ethical concerns pertaining to other human rights like patient autonomy, safety, and justice [8][9][10][11][12][13][14][15]. At the forefront lie the loss of privacy inherent in how information is handled, and threats to patient safety emerging from weaknesses in the quality of the digital information inherent in the iterative development process of mHealth apps [1,6,14,16]. Errors as well as mischievous additions are a main concern, from silent ones, built-in during the app development [17,18], to those due to the clinical users' limited qualifications [18,19], or the unstandardized and unsupervised environments of use [6,16,19]. ...
... medical research and education). Instant messaging has spread as a practice and support physician-to-physician systems in many parts of the world across all resource levels [23,24], but it presents particular ethical concerns [14]. As for multimedia information, clinical images are transmitted or published without having either the clinician or the patient fully aware of the breach in individual privacy that may occur [20,25]. ...
Article
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Background: mHealth applications assist workflow, help move towards equitable access to care, and facilitate care delivery. They have great potential to impact care in low-resource countries, but have significant ethical concerns pertaining to patient autonomy, safety, and justice. Objective: To achieve consensus among stakeholders on how to address concerns pertaining to autonomy, safety, and justice among mHealth developers and users in low-resource settings, in particular for the application of image-based consultation for diagnostic support. Methods: A consensus approach was taken during a three-day workshop using a purposive sample of global mHealth stakeholders (n = 27) professionally and geographically spread. Throughout a series of introductory talks, group brainstorming, plenary reviews, and synthesis by the moderators, lists of actions were generated that address the concerns engendered by mHealth applications on autonomy, justice and safety, taking into account the development, implementation, and scale-up phases of an mHealth application lifecycle. Results: Several types of actions were recommended; key ones among them included building in risk mitigation measures from the development stage, establishing inclusive consultation processes, using open sources platform whenever possible, training all clinical users, and bearing in mind that the gold standard of care is face-to-face consultation with the patient. Recommendations of patient, community and health system participation and of governance were identified as cutting across the mHealth lifecycle. Conclusion: Priorities agreed-upon at the meeting echo those put forward concerning other domains and locations of application of mHealth. Those more forcefully articulated are the need to adopt and maintain participatory processes as well as promoting self-governance. They are expected to cut across the mHealth lifecycle and are prerequisites to the safeguard of autonomy, safety and justice.
... [21] Of mHealth apps that do have appropriate "Terms and Conditions" attached to them, most are so onerous that few people read them before downloading the app. [22] Users of mHealth apps are almost always obliged to agree to the terms of use that the underregulated commercial entities supplying the services require. [23] However, the General Data Protection Regulation prohibits making consent to data processing a precondition of service unless the service is dependent on it. ...
... • The European Union-led Human Brain Project (HBP), which seeks to 'create ICT based scientific research infrastructure for brain research, cognitive neuroscience, and brain-inspired computing' 20 , is made up of over 100 partner institutions in 19 countries 21 . As well as being international, it is also interdisciplinary as it includes such disciplines as cognitive neuroscience, neuro-informatics, medical informatics, brain simulation and neurorobotics; and transdisciplinary covering computing, informatics, mathematics, as well as philosophy 22 . • The International Brain Initiative (IBI), an international brain research collaborative project that is still at the proposal stage 23 . ...
... [21] Of mHealth apps that do have appropriate "Terms and Conditions" attached to them, most are so onerous that few people read them before downloading the app. [22] Users of mHealth apps are almost always obliged to agree to the terms of use that the underregulated commercial entities supplying the services require. [23] However, the General Data Protection Regulation prohibits making consent to data processing a precondition of service unless the service is dependent on it. ...
... • The European Union-led Human Brain Project (HBP), which seeks to 'create ICT based scientific research infrastructure for brain research, cognitive neuroscience, and brain-inspired computing' 20 , is made up of over 100 partner institutions in 19 countries 21 . As well as being international, it is also interdisciplinary as it includes such disciplines as cognitive neuroscience, neuro-informatics, medical informatics, brain simulation and neurorobotics; and transdisciplinary covering computing, informatics, mathematics, as well as philosophy 22 . • The International Brain Initiative (IBI), an international brain research collaborative project that is still at the proposal stage 23 . ...
Conference Paper
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Foreword This sixth health IT workshop signals the growing importance of ethics, law and governance of emerging technologies and of the power of sustained international collaborations. The stakes could not be higher. From the evolution of learning healthcare systems and ever-new and tricky privacy challenges, to identification of appropriate uses and users of intelligent machines, the need to ensure that we get it right is of the highest importance. People cannot "get it right" without the kind of research and scholarship brought to bear in forums like this one. This year's programme is thematically and professionally diverse. It addresses the development and applications of extraordinarily powerful machines, and features speakers who have made ethics and health information technology their focus. The speakers' contributions document the breadth and creativity of the emergence of one of the world's leading forums for addressing ethical and legal issues raised by a health technology with unprecedented global reach and effect. It is said that science and technology often outstrip ethics and the law, and that people's ability to design new tools is superior to, or at least more rapid than, their capacity to ensure that these tools are used wisely. This workshop and its antecedents are important counterexamples to such a position. With speakers from academia, government and industry, the workshop continues a decade-long initiative. It makes plain a collective commitment to the kind of values and governance that both advance the benefits of new technology, and protect human rights and honour universal values. This transcontinental partnership, linking the University of Miami with Middlesex University, The Castlegate Consultancy and The European Centre for Ethics, Law and Governance in Health Information Technology, is perhaps unique in its topics and foci. It has simultaneously fostered innovative scholarship and provided rare opportunities for students to participate in an exciting new area of inquiry and practice. It seems clear that this is not solely a valuable partnership, it might even be a fundamentally necessary one. The flow of both data and discovery has been enough to render the world a very different place in a very short time. As that world is too often a place of conflict and discord, these kinds of collaborations point the way to doing things better. This, precisely, is how we will get it right.
... 8 DCT has shown promise in helping to improve medication adherence. [9][10][11][12][13][14][15] In particular, DCT can help address category 1 of the 3 World Health Organization categories for nonadherence. ...
... [30][31][32] However, the conclusion that such interventions can disseminate into routine practice is tempered by the recognition that many of these were small studies that screened patients, offered incentives, and had a short follow-up. [11][12][13] In this pragmatic trial, the DCT intervention was delivered to a large patient population in routine care, with few exclusion criteria and with 1-year follow-up. ese results add new insight into the dissemination of DCT in routine care and clearly demonstrate the challenges of gaining and maintaining patient interest in DCT. ...
Article
Background: Use of digital communication technology has shown potential to improve asthma adherence and outcomes. Few studies have looked at patient preference around mode of medication reminders used to improve and maintain asthma medication adherence. Objective: To determine if, in a population already receiving automated medication reminders, offering a choice for preferred mode of reminder (text, email, phone) would improve their adherence and asthma outcomes over a 1-year period. Methods: This was a pragmatic, randomized controlled trial conducted at Kaiser Permanente Colorado involving 7522 adult patients with persistent asthma. Study patients were randomized to receive usual care or their choice of medication reminder. Differences between the 2 groups in both medication adherence and asthma outcomes were then assessed over the following year. Results: Only 30% of those offered a choice of medication reminder modality responded by making a choice, with 52% preferring text messaging. There was less of a decrease in adherence rate over the 1-year period in those who made a choice regarding the mode of medication refill reminder. There was no difference in asthma outcomes between those who did make a choice compared with those who did not make a choice regarding the mode of medication refill reminder. Conclusion: In a patient population already receiving medication reminders, offering a choice about what type of technology-enabled asthma medication reminder patients wanted did not improve outcomes but did enable a subgroup to better maintain their medication adherence.
... [2] Use of clinician-to-clinician mHealth has proved particularly important during the COVID-19 pandemic, given movement restrictions, the risk of infection spread, and reduced clinical services. However, digital communication raises substantial ethical concerns [3][4][5][6][7][8][9] around the loss of privacy and self-determination inherent in how information is handled, and threats to patient safety emerging from weaknesses in the quality of the digital information deep-rooted in the iterative development process of mHealth apps. Errors and mischievous additions are silent and built in during the app development, [10,11] or result from issues such as clinical users' failure to use mHealth apps and/or devices appropriately, [11,12] or unstandardised and unsupervised environments of use. ...
... The pillars forming the basis for the workshop discussion broadly endorsed what other publications have recommended when developing, introducing and implementing mHealth technologies. [7,11,15,16] These pillars touched upon critical ethical issues in the SA context, such as 'What security standards and procedures should apply to mobile devices used by healthcare workers?' or 'Can informed consent be collected remotely from clients using mobile devices or applications?' [14] There are multiple examples of SA legislation that apply to mHealth projects and applications that handle client information, ...
Article
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Digital technologies continue to penetrate the South African (SA) healthcare sector at an increasing rate. Clinician-to-clinician diagnostic and management assistance through mHealth is expanding rapidly, reducing professional isolation and unnecessary referrals, and promoting better patient outcomes and more equitable healthcare systems. However, the widespread uptake of mHealth use raises ethical concerns around patient autonomy and safety, and guidance for healthcare workers around the ethical use of mHealth is needed. This article presents the results of a multi-stakeholder workshop at which the 'dos and don'ts' pertaining to mHealth ethics in the SA context were formulated and aligned to seven basic recommendations derived from the literature and previous multi-stakeholder, multi-country meetings.
... Due to various reasons, mHealth became more popular in the past few years, spreading as a practice working style for doctor-to-doctor frameworks in numerous countries worldwide over all asset levels (Blom, 2018;Thomas, 2018). However, it presents specific moral concerns (Sharp & O'Sullivan, 2017). Concerning media data used for interactions, clinical pictures are communicated or distributed without having either the clinician or the patient utterly mindful of the break-in only security glitch that may happen (McCartney, 2018). ...
... Further, sometimes clinical pictures at this point exclusively, if not taken by proficient professionals at the same time, may need explicit capability (Palacios- Gonzalez, 2015;Sharp and O'Sullivan, 2017). Suggestions to alleviate concerns relating to the moral standards of self-rule, well-being, and equity are accessible in analytical writing and proficient rules, such as medication, nursing, or designing (Albrecht & Fangerau, 2015;Carter, Liddle, & Hall, 2015). ...
Chapter
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Ultraviolet (UV) sterilization technology is widely used to reduce microorganisms that may remain on the surfaces after a standard cleaning to the minimum number. In this chapter we have proposed a robot named for disinfection, which consists of the UV light and hence the robot is a disinfection robot. It can be deployed at a variety of locations, especially due to the COVID-19 pandemic. Our UV bot has six 15 W of UV lamps mounted on top of the UV bot platform covering 360 degrees. Our UV bot employs an embedded system based on a Raspberry Pi to aid in navigation and obstacle avoidance.
... Potential data security and privacy breaches are an increasing concern in mobile medicine. (8,9) One study identified potential data security and privacy breaches in 95.63%, 17,193/17,979 of mobile iOS apps. (10) In our project, patient confidentiality and data security were built into the design from the beginning, starting with the hospital firewall for data repository and with the use of protected institutional emails. ...
Article
Background: We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. Objective: The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. Methods: Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. Results: We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to "I would recommend the Remote Monitoring System program to future patients" was 4.5 (interquartile range 4-5), with 1 being "strongly disagree" and 5 "strongly agree." At 30 days postop, there was no mortality or readmission. Conclusions: This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. Trial registration: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk).
... Unlike other available design frameworks that are used to explain or describe how mHealth design should be embarked on, the proposed model also offers a series of illustrative design questions that can be used by designers to better understand the problem at hand and how to address it. The need for more concrete guidance in mHealth design has been highlighted often [75,137] and can be particularly important, keeping in mind that the bulk of consumer health informatics mHealth solutions seem to be designed by small companies and entrepreneurs [100,101]. ...
Preprint
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UNSTRUCTURED Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency towards the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through the use of mobile technologies (mHealth) has grown exponentially in recent years. However, only a fraction of these solutions takes into consideration the views of relevant stakeholders like healthcare professionals or even patients. The use of behavioral change models (BCM) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. The focus of this work is to discover factors for the design of mHealth solutions for chronic patients; to do so, negotiations between medical knowledge, BCM, and gamification were explored through an embedded case study research methodology. The data obtained was thematically analyzed to create the Model for Motivational Mobile-health Design for chronic conditions (3MD). The 3MD model guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are: 1) Condition-specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; 2) Motivation-related; which are factors that address how to influence behaviors in an engaging manner; and 3) Technology-based, which are factors that are directly connected to the technical capabilities of mobile technologies. 3MD also provides a series of high level illustrative design questions for designers to use and consider during the design process. The present work addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients.
... Unlike other available design frameworks that are used to explain or describe how mHealth design should be embarked on, the proposed model also offers a series of illustrative design questions that can be used by designers to better understand the problem at hand and how to address it. The need for more concrete guidance in mHealth design has been highlighted often [75,136] and can be particularly important, keeping in mind that the bulk of consumer health informatics mHealth solutions seem to be designed by small companies and entrepreneurs [100,101]. ...
Article
Full-text available
Background: Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency toward the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through mobile technologies (mobile health, mHealth) has grown exponentially in recent years. However, only a fraction of these solutions take into consideration the views of relevant stakeholders such as health care professionals or even patients. The use of behavioral change models (BCMs) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. Objective: The goal of this work is to discover factors for the design of mHealth solutions for chronic patients using negotiations between medical knowledge, BCMs, and gamification. Methods: This study uses an embedded case study research methodology consisting of 4 embedded units: 1) cross-sectional studies of mHealth applications; 2) statistical analysis of gamification presence; 3) focus groups and interviews to relevant stakeholders; and 4) research through design of an mHealth solution. The data obtained was thematically analyzed to create a conceptual model for the design of mHealth solutions. Results: The Model for Motivational Mobile-health Design (3MD) for chronic conditions guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are (1) condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; (2) motivation related, which are factors that address how to influence behaviors in an engaging manner; and (3) technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. The 3MD also provides a series of high-level illustrative design questions for designers to use and consider during the design process. Conclusions: This work addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients.
... These characteristics were based on some of the existing literature on the legal and ethical issues related to data collected by commercial mobile health apps [30][31][32][33][34][35] and ethics of secondary data analysis and big data [19,23,36]. We included criteria such as data ownership, data sharing, data usage, personally identifiable information, privacy and informed consent. ...
Article
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Background: The need for a better understanding of food consumption behaviour within its behavioural context has sparked the interest of nutrition researchers for user-documented food consumption data collected outside the research context using publicly available nutrition apps. The study aims to characterize the scientific, technical, legal and ethical features of this data in order to identify the opportunities and challenges associated with using this data for nutrition research. Method: A search for apps collecting food consumption data was conducted in October 2016 against UK Google Play and iTunes storefronts. 176 apps were selected based on user ratings and English language support. Publicly available information from the app stores and app-related websites was investigated and relevant data extracted and summarized. Our focus was on characteristics related to scientific relevance, data management and legal and ethical governance of user-documented food consumption data. Results: Food diaries are the most common form of data collection, allowing for multiple inputs including generic food items, packaged products, or images. Standards and procedures for compiling food databases used for estimating energy and nutrient intakes remain largely undisclosed. Food consumption data is interlinked with various types of contextual data related to behavioural motivation, physical activity, health, and fitness. While exchange of data between apps is common practise, the majority of apps lack technical documentation regarding data export. There is a similar lack of documentation regarding the implemented terms of use and privacy policies. While users are usually the owners of their data, vendors are granted irrevocable and royalty free licenses to commercially exploit the data. Conclusion: Due to its magnitude, diversity, and interconnectedness, user-documented food consumption data offers promising opportunities for a better understanding of habitual food consumption behaviour and its determinants. Non-standardized or non-documented food data compilation procedures, data exchange protocols and formats, terms of use and privacy statements, however, limit possibilities to integrate, process and share user-documented food consumption data. An ongoing research effort is required, to keep pace with the technical advancements of food consumption apps, their evolving data networks and the legal and ethical regulations related to protecting app users and their personal data.
... Some definitions of telehealth also include mobile apps that allow for communication between health care provider and patient. 2,3 Telemedicine is defined as synchronous ("real time") direct patient care that occurs remotely via telecommunication channels -usually intended to be both audio and video although telephone advice could be construed as telemedicine. Store-and-forward is asynchronous ("not in real time") interpretation of study data (EEG, EKG, echocardiography, images, or structured developmental examinations) by a provider remotely. ...
Article
Over the past 2 decades, various telehealth technologies, in particular synchronous video teleconferencing between provider and patient, have been incorporated into the practice of neurology. The practice of child neurology is now starting to take advantage of these rapidly evolving resources. This review describes the evolution of tele-neurology, starting with adult tele-stroke services and expanding to the management of both adults and children with a variety of chronic neurologic disorders including epilepsy, headache, movement disorders, and neurodevelopmental disabilities. Resources required for the development and sustainment of a child neurology telemedicine program are discussed together with requirements for licensure, and credentialing, and the importance of educating current and future neurology practitioners in how to provide this clinical service.
... Quality of the data is not only related to the patients' input but also to the app itself. Thus far, no specific quality label for mHealth apps is in place (41) , although there are sites establishes by clinicians and other experts which evaluate apps for clinical safety and quality, such as Medappcare and dmdSanté in France, HealthOn in Germany, iMedicalApps in the US, and Our Mobile ...
... A recent review identified more than 165,000 available health apps, of which 84 were included in published reviews. 22 A second large metasystematic review identified 10,689 articles addressing the use of short message service texts to improve self-management in patients with a chronic illness. 23 The 2 reviews warned of lowquality studies and a need for better-controlled trials to fully assess the emerging technologies and associated software. ...
... This app combines symptom monitoring, Quality of the data is not only related to the patients' input but also to the app itself. Thus far, no specific quality label for mHealth apps is in place (41) , although there are sites establishes by clinicians and other experts which evaluate apps for clinical safety and quality, such as Medappcare and dmdSanté in France, HealthOn in Germany, iMedicalApps in the US, and Our Mobile ...
Article
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The second European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held on 9-10th November 2017, combined with a specific symposium on air pollution and mobile Health technology (mHealth) with the GARD (Global Alliance against Chronic Respiratory Diseases) initiative of WHO (World Health Organization). Physicians from different specialties, researchers, as well as patients and industry representatives from more than 40 countries took part in the Forum. Relevant topics were debated with the aim of allowing the implementation of precision medicine (PM) in daily respiratory care. All debates started with positioning the current state of the art: identification of current gaps in practice, the current consensus and the need for implementation of novel approaches such as endotype-driven treatment, patient empowerment and eHealth tools. This report provides a summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2017, highlighting the research needs in PM, with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key drivers for improving current clinical practice.
... As the course of the disease can last decades, patients are required to comply with therapeutic scheduling and disease management, closely followed by doctors and other healthcare professionals. Various mHealth devices are endowed with features for self-monitoring, motivational support, behavioral feedback, health information education, and healthcare decision-making [13]. The portability and connectivity of mHealth can potentially serve as an effective tool in facilitating the long-term follow-up and facilitating the healthcare delivery to reach hard-to-reach populations [14]. ...
Article
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Purpose of the Review Spondyloarthritis (SpA) is a group of inflammatory diseases characterized by inflammation in the spine, peripheral joints, and entheses that usually start at the prime of one’s life and lead to impaired physical function and reduced quality of life. Ankylosing spondylitis (AS) is prototype of SpA. This article reviews the opportunities and challenges of using mobile health (mHealth) in managing SpA, and report some of our experiences using a mHealth solution for management of SpA patients and performing related research in China. Recent Findings The recent rapid development of mobile communications and the common use of intelligent electronic devices have led to the increasing application of mHealth for chronic disease management by healthcare providers and patients alike. This is a promising new technology that can help mitigate limitations in time and space for patient management, promote easier communication between patients and their healthcare providers, reduce medical expenses, and optimize medical services. We have developed a smartphone-based mHealth SpA management system (SpAMS) that also helps the patients to monitor, manage, and share information on their disease with their physician at regular intervals. Summary There is a shift from a paternalistic model of healthcare to more personalized healthcare in which disease management is conducted by the patient together with their healthcare providers. The increasing utility of mHealth is expected to benefit disease management, promote patient–doctor communication, reduce medical expenses, and optimize medical services.
... Patients are more knowledgeable and informed, and in the position to demand innovative and effective treatments. Real-world evidence [9], molecular information generated from next-generation sequencing [10] [11], data from wearable devices [12] and mobile apps [13] and novel clinical trials [14] [15] are increasing our understanding of health and disease. The regulatory environment needs to and is evolving and adjusting for these novel approaches to healthcare [16]. ...
Article
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Medicine has entered the digital era, driven by data from new modalities, especially genomics and imaging, as well as new sources such as wearables and Internet of Things. As we gain a deeper understanding of the disease biology and how diseases affect an individual, we are developing targeted therapies to personalize treatments. There is a need for technologies like Artificial Intelligence (AI) to be able to support predictions for personalized treatments. In order to mainstream AI in healthcare we will need to address issues such as explainability, liability and privacy. Developing explainable algorithms and including AI training in medical education are many of the solutions that can help alleviate these concerns.
... App quality and safety do not necessarily align with functionality and must be considered separately. Ethics in the area of IT in general is lacking, and in the development of mHealth services it is close to nonexistent [75]. Designers of health and well-being apps need to consider the consequences of errors in the development. ...
Article
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Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it
... The ethical aspects of app design are addressed by Sharp and O'Sullivan (2017). Their literature review revealed that while privacy and security are commonly taken up in academic research, ethical issues receive only limited attention. ...
Chapter
Digital health technologies are driving change toward a more individually centered, self-responsible, and empowered healthcare (Banos et al., 2016). With a mHealth market share of 6.7%, mHealth offers a vast array of applicability, e.g., remote monitoring, diagnosing symptoms, consulting doctors, and complying with treatment regimes (Statista, 2017d). mHealth, thus, benefits individuals, the healthcare system, holding the potential to reduce healthcare costs, doctor consultations, examinations, and the length of hospital stays (Statista, 2017c). The present investigation will look at theories and studies dealing with mHealth in both developed and developing countries to carve out the potential for stakeholders with diverse interests, also paying attention to previously identified research gaps regarding the usability, design, and acceptance of mHealth services (Hether et al., 2016). This research article will conclude by highlighting existing theoretical research in mHealth as well as future research agendas in the mHealth context.
... A majority of patients from both our multinational survey and focus group expressed a wish to be able to choose if and which health care providers could access their health data. Previous work has proposed or summarized existing regulations on the safety and security of mobile apps [32][33][34][35]. Moreover, apps and any other e-device should follow the EU General Data Protection Regulation (GDPR) and US Health Insurance Portability and Accountability Act (HIPAA). ...
Article
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Background Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, patients are rarely directly consulted and involved in the app development process. Objective This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps. Methods The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia. Results The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7%), and 86.8% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53%), with 42% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9%) and disease activity (221/346, 63.9%) or communicate directly with their health care provider (200/346, 57.8%). Conclusions Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control.
... These reviews represent a concentrated body of knowledge about the challenges and solutions on security for resource-VOLUME X, 2020 constrained devices and cloud services, so as to ensure confidentiality of data in-transit (over network) and at-rest (residing in devices or servers). It is also worth mentioning that some systematic reviews go beyond the scope of security and privacy, addressing ethics altogether in the context of mHealth apps [53] and passive data collection in healthcare [54]. ...
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An increased adoption of mobile health (mHealth) and ubiquitous health (uHealth) systems empower users with handheld devices and embedded sensors for a broad range of healthcare services. However, m/uHealth systems face significant challenges related to data security and privacy that must be addressed to increase the pervasiveness of such systems. This study aims to systematically identify, classify, compare, and evaluate state-of-the-art on security and privacy of m/uHealth systems. We conducted a systematic mapping study (SMS) based on 365 qualitatively selected studies to (i) classify the types, frequency, and demography of published research and (ii) synthesize and categorize research themes, (iii) recurring challenges, (iv) prominent solutions (i.e., research outcomes) and their (v) reported evaluations (i.e., practical validations). Results suggest that the existing research on security and privacy of m/uHealth systems primarily focuses on select group of control families (compliant with NIST800-53), protection of systems and information, access control, authentication, individual participation, and privacy authorisation. In contrast, areas of data governance, security and privacy policies, and program management are under-represented, although these are critical to most of the organizations that employ m/uHealth systems. Most research proposes new solutions with limited validation, reflecting a lack of evaluation of security and privacy of m/uHealth in the real world. Empirical research, development, and validation of m/uHealth security and privacy is still incipient, which may discourage practitioners from readily adopting solutions from the literature. This SMS facilitates knowledge transfer, enabling researchers and practitioners to engineer security and privacy for emerging and next generation of m/uHealth systems.
... These reviews represent a concentrated body of knowledge about the challenges and solutions on security for resourceconstrained devices and cloud services, so as to ensure VOLUME X, 2020 confidentiality of data in-transit (over network) and at-rest (residing in devices or servers). It is also worth mentioning that some systematic reviews go beyond the scope of security and privacy, addressing ethics altogether in the context of mHealth apps [54] and passive data collection in healthcare [55]. ...
Article
Full-text available
An increased adoption of mobile health (mHealth) and ubiquitous health (uHealth) systems empower users with handheld devices and embedded sensors for a broad range of healthcare services. However, m/uHealth systems face significant challenges related to data security and privacy that must be addressed to increase the pervasiveness of such systems. This study aims to systematically identify, classify, compare, and evaluate state-of-the-art on security and privacy of m/uHealth systems. We conducted a systematic mapping study (SMS) based on 365 qualitatively selected studies to (i) classify the types, frequency, and demography of published research, (ii) synthesize and categorize research themes, (iii) recurring challenges, (iv) prominent solutions (i.e., research outcomes) and their (v) reported evaluations (i.e., practical validations). Results suggest that the existing research on security and privacy of m/uHealth systems primarily focuses on select group of control families (compliant with NIST800-53), protection of systems and information, access control, authentication, individual participation, and privacy authorisation. In contrast, areas of data governance, security and privacy policies, and program management are under-represented, although these are critical to most of the organizations that employ m/uHealth systems. Most research proposes new solutions with limited validation, reflecting a lack of evaluation of security and privacy of m/uHealth in the real world. Empirical research, development, and validation of m/uHealth security and privacy is still incipient, which may discourage practitioners from readily adopting solutions from the literature. This SMS facilitates knowledge transfer, enabling researchers and practitioners to engineer security and privacy for emerging and next generation of m/uHealth systems.
... The ethical aspects of app design are addressed by Sharp and O'Sullivan (2017). Their literature review revealed that while privacy and security are commonly taken up in academic research, ethical issues receive only limited attention. ...
... The definition of e-health system is loose; the term refers to electronic health records (EHR) and tele-consultation [1], but has recently expanded to include the various mobile apps used to aid diagnosis and monitor patients' conditions [2] [3] [4]. The e-healthcare industry has changed the way of patient's healthcare and contributes in improving the quality of patient care by reducing the cost [5]. ...
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The expeditious growth of the wearable and implantable body sensors and wireless communication technologies have provided both inspiration and motivation for increasingly development of m-healthcare information systems as a promising next generation e-health system. In m-healthcare systems, the authorized mobile patients with the same disease symptoms can constitute a social group to share their health condition and medical experience. The privacy of social communication transferred over open wireless channels is an essential system requirement. Furthermore, the m-healthcare system on contrary to the traditional e-Health system allows mobile patients to move across distinguished location domains during different time periods. The mobility of patients considerably increases the cost of key management in terms of communication overhead if it is addressed with a naïve solution such as treating as a leave in the old location and a new join in the visited location. This paper proposes a privacy-preserving scheme, which maintains the secrecy of patients’ personal health information using secure group communication in m-healthcare information systems while supporting mobility of patients. The scheme is highly scalable, and treats patients’ mobility with the minimum rekeying cost, as such efficiently preserve secrecy of communication between patients associated with a social group. The security properties of the proposed scheme as well as its performance based on simulation experiments are evaluated. The experimental results demonstrate that the proposed scheme outperforms the existing solution in terms of communication overhead.
... Further work can include activities for patients -as individuals and as a group -to improve adherence and outcomes. (Table 1) focused on access, HPGD application development, and ethics [55]. Standardization and compliance pose a difficult challenge due to the dynamic nature of technologies and regulations [56]. ...
... 2) Health Surveillance & Data Collection -With actively engaged participants, the mHealth Sensing apps and systems collect health-related data from participants in their daily life scenarios [11], [54], then store and offload the sensing data with security and privacy-protection guarantees [55]- [58]. 3) Data Analysis & Knowledge Discovery -With healthrelated data collected, the mHealth Sensing apps and systems carry out data processing and analysis under ethical certification [59]- [61] to predict health-related events for individuals [62], [63] and discover determi-nants of health [40] -i.e., knowledge about population health and well-beings [10], [64]. Based on above two mHealth sensing design paradigms and the pipeline of three stages, this work provides two taxonomy systems that cover the major technical challenges and methodologies in this area. ...
... When apps are integrated with the EHR, they fully optimize its efficiency. 58 One limitation to our study is that most studies did not report detailed app capabilities such as alerts, sensors, and so on. So no conclusions can be drawn about the impact of these factors on app effectiveness. ...
Article
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Background and aims: Chronic respiratory diseases are prominent causes of morbidity worldwide that impose significant social and economic burdens on individuals and communities. Pulmonary rehabilitation is one of the main aspects of medical rehabilitation. Nowadays, mobile health apps deliver pulmonary rehabilitation support via smartphones. This article presents a systematic review of the literature on m-Health apps used in respiration disorders rehabilitation. Methods: A systematic search was performed on MEDLINE (through PubMed), Web of Science, and Scopus in May 2021 without any date limitation. This study was using a combination of keywords and MeSH terms associated with pulmonary rehabilitation. Relevant studies were selected by two independents and were categorized studies results. The inclusion criterion was m-Health apps for pulmonary rehabilitation and exclusion criteria mobile-based interventions, by voice call or short message service and cardiopulmonary articles. Results: Searching scientific databases yielded 161 relevant articles. Then, 27 articles were included in the study with a complete evaluation of the articles. Sixty percent of them were related to patients with chronic obstructive pulmonary disease (COPD). Rehabilitation aiming to improve the quality of life, promote self-management, encourage physical activity, and reduce the symptoms as the most common goals of pulmonary rehabilitation using m-Health apps; 89% of these studies showed that m-Health apps can be effective in improving pulmonary rehabilitation. In addition, 37% of studies reported high usability and acceptance. However, the results of some studies show that adherence to apps decreases in the long run. Conclusion: Our study shows that m-Health pulmonary rehabilitation apps are effective in improving the quality of life, self-management, and physical activity. According to the results, it seems that using the m-Health apps for pulmonary rehabilitation can be useful in the COVID-19 pandemic and help reduce respiratory disorders in patients with COVID-19 disease.
Article
Mobile applications (Apps) may become effective aids in health care. Health Apps could reduce barriers such as access and costs and could be used to monitor symptoms, behaviors and even treatments. There is more evidence of their usefulness in nutrition, cardiovascular and mental health. Despite this, its current use is predominantly for information purposes. Healthcare App quality evaluation should consider both clinical and technological aspects since the evidence on its clinical effectiveness is still incipient and they have associated risks. In Chile, the use of mobile technology and Apps is increasing, but there are no regulations for their use. There are few national institutions oriented to the creation and development of Apps for healthcare, highlighting the Digital Transformation Committee, part of the Corporation for the Promotion of Production (CORFO) and the National Center for Health Information Systems (CENS). General recommendations for healthcare App development and use have been established. In this process, it would be beneficial to include actors involved in care. Given the progress of healthcare Apps worldwide and nationally, it is important that health professionals develop digital skills to maximize the potential benefit of these technologies.
Article
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Background Mobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking. Objectives The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs. Methods A systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting. Results Three overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10. Conclusion These EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.
Article
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The goal of the study is to conduct a market research and an evaluation of the consumer preferences related to the use of mobile healthcare apps (mHealth) in Russia to support and promote patients' adherence to drugs. Materials and methods. The survey involved 1,099 mHealth consumers from two target segments. The first segment (S1) included intermediate consumers: real (264 pharmacists from 22 regions of Russia) and potential (293 students with major in Pharmacy). The second segment (S2) included 542 final consumers, or members of the general public, from 28 regions of Russia. Field studies were conducted using the oral survey (27 %) and web-based survey (73 %) methods with a structured questionnaire. The qualitative method with a two-dimensional perception chart and the quantitative method of individual point estimates with the calculation of integral indicators were used for positioning. Results and discussion. The marketing study of drug adherence has revealed that over 50 % of the respondents in S2 have low degree of adherence. The most common ways to support adherence were to take medications as part of the normal daily routine (87.1 %) and to use mobile healthcare apps (66.4 %). According to 98.2 % of the pharmacists and students (S1), mHealth apps could be more widely recommended for use. The leaders among mobile apps for drug control in Russia have been established as a result of positioning using qualitative and quantitative methods. A mechanism for promoting mHealth has been proposed in order to more fully satisfy consumer preferences. Conclusion. The obtained results provide the basis for the development of a set of strategic measures for the further development of the basic segment of the mobile healthcare app market to support drug adherence and to increase the competitive advantages of mHealth, which will contribute to the effective treatment and prevention of chronic diseases in Russia.
Article
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The use of mobile devices and applications dedicated to different medical fields has improved the quality and facilitated medical care, especially in the last 10 years. The number of applications running on the software platforms of smart phones or other smart devices is constantly growing. Radiotherapy also benefits from applications (apps) for TNM staging of cancers, for target volume delineation and toxicity management but also from radiobiological apps for calculating equivalent dose schemes for different dose fractionation regimens. In the context of the increasingly frequent use of altered fractionation schemes, the use of radiobiological models and calculations based on the linear quadratic model (LQ) becomes a necessity. We aim to evaluate free radiobiology apps for the Android software platform. Given the global educational deficit, the lack of experts and the concordance between radiobiology education and the need to use basic clinical notions of modern radiotherapy, the existence of free apps for the Android platform running on older generation processors can transform even an old smart device in a powerful “radiobiology station.” Apps for radiobiology can help the radiation oncologist and medical physicist with responsibilities in radiotherapy treatment planning in the context of accelerated adoption of hypo-fractionation regimens and calculation of the effect of treatment gaps, a topic of interest in the COVID-19 pandemic context. Radiobiology apps can also partially fill the educational gap in radiobiology by arousing the interest of young radiation oncologists to deepen the growing universe of fundamental and clinical radiobiology.
Chapter
Mobile health (mHealth), an abbreviated term used for portable healthcare, is characterized by the World Health Organization (WHO) as an utilization of portable healthcare monitoring equipments by the health care delivery system. The review article is based on the utilization of the mobile phones in the form of text information, image sharing, video call, doctor appointment, and auto-generated schedule during the global pandemics situations. Initially the motivation behind the technology was the availability of physical and psychological care for unreached communities. But, in the situation of pandemics, there is a high momentum to the mHealth application in the healthcare delivery system. The differential utilization of cell phone has led to the multiplication of health-related personalized applications day by day for the human race; there are numerous expected roads for mHealth to be fill in as an aide instrument to general health care when most of the developed and developing nations are in a cyclic process of lockdown of the century. In the present times, people are advised by the WHO to make a physical distance from everyone; hence the mHealth promptly came into existence with its importance. However, there are both pros and cons of every technology; here mHealth helps to provide improved treatment availability due to its promptness, ease, accessibility but on the another hand, there is the limitation of mHealth applications as personal data sharing with the network providers is easier. There are concerns like moral, legitimate, and clinical issues identified with mHealth usage, incorporating issues with information security, protection issues with limits, and interjurisdictional practice concerns. The technology-centric model launching incorporates the traditional medical approaches and training through the emerging technology-centric model into medical and educational systems to support medical practitioners and the patients. The review article presents the proof for the focal points and impediments of rebuilding a medicinal service framework on essential considerations. It depends on a fast, however, orderly audit of critical sources of strewn writing. The results are unpredictable for various reasons, including varying meanings of administrations, staff and the limits among essential and auxiliary consideration, changing hierarchical structures, and expanding dependence on essential consideration groups for mHealth.
Chapter
The use of health apps on mobile devices by healthcare providers and receivers (patients) is proliferating. This has elevated cybersecurity concerns owing to the transmittal of personal health information through the apps. Research literature has mostly focused on the technology aspects of cybersecurity in mobile healthcare. It is equally important to focus on the ethical and regulatory perspectives. This article discusses cybersecurity concerns in mobile healthcare from the ethical perspective, the regulatory/compliance perspective, and the technology perspective. The authors present a comprehensive framework (DeTER) that integrates all three perspectives through which cybersecurity concerns in mobile healthcare could be viewed, understood, and acted upon. Guidance is provided with respect to leveraging the framework in the decision-making process that occurs during the system development life cycle (SDLC). Finally, the authors discuss a case applying the framework to a situation involving the development of a contact tracing mobile health app for pandemics such as COVID-19.
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