Background: Digital short cognitive tests administered by medical assistants (MAs) in general practitioners’ (GPs) practices have great potential for the timely identification of patients with dementia, because they can lead to targeted specialist referrals or to immediate reassurance of patients regarding their perceived concerns. However, integration of this testing approach into clinical practice requires good usability for the test itself, especially for cognitively impaired older adults. Objective: In this implementation study, the digital version of the Montreal Cognitive Assessment (MoCA) Duo was conducted by MAs in general practice. We tested if the interaction with the test is associated with usability problems for the patients and aimed to find additional relevant constructs that should be considered for the potential implementation of such digital tests into clinical practice. We focused the study on subjective success, usability, and workload as well as their association with the result of the cognitive test to assess whether the MoCA Duo can be implemented into general practice. Methods: In total, 10 GPs took part in the study. Within their practices, 299 GP patients (aged 51-97 years) with cognitive concerns completed the MoCA Duo administered by MAs. Subsequently, patients and MAs completed digital questionnaires regarding the interaction with the app. Usability was measured using the adapted System Usability Scale, and perceived workload using the National Aeronautics and Space Administration Task Load Index. For the perceived workload, we included an assessment of the patient by the MA. Results of the MoCA Duo were supplied to the GPs for their consultation with the patient. Results: The results indicated good usability for the MoCA Duo. Self-assessment by the patients indicated that 64% (191/299) could perform in the test to the best of their ability, affected by their MoCA score. We found significant higher usability ratings by patients with better MoCA scores as well as by younger patients. Furthermore, the perceived workload showed overall medium workload. We found significant correlations between the subjective perceived workload of the patients and the assessment by MAs. Self-assessments as well as assessments by the MAs were significantly influenced by the MoCA scores and the age of the participants. Conclusions: The results indicate good usability of the digital MoCA within the sample, supporting the idea that the resulting scores are adequate to assess cognitive status without dependence on technological affinity. Furthermore, the results highlight the relevance of heterogenous samples for comparable evaluation studies, based on the significant effect of cognitive status and age on usability and workload.

Background: The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality. Objective: This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach. Methods: KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player’s real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires. Results: The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited. Conclusions: The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion. International Registered Report Identifier (IRRID): DERR1-10.2196/55156

Visual impairment is a widespread global health issue that affects millions of people across all ages and backgrounds. Timely intervention is essential for the effective management of eye diseases. Smartphones offer the possibility of continuously recording facial gestures during interaction with the device, whereby changes such as squinting of the eyes could indicate progressive vision loss. In this context, a mobile health application was developed to conduct a digital logMAR test while simultaneously capturing real-time facial features. A total of 37 participants took part in a controlled mobile eye test study. The facial landmarks recorded during the test were analyzed to identify patterns that can distinguish between sequences of letters that were read correctly, partially, or not at all. Specifically, explorative data analysis and receiver operating characteristic curves were employed to determine facial landmarks with high discriminative power in relation to reading ability. The predominant facial regions that showed the most significant change under reduced performance during the vision test were the nose, mouth, and cheeks. Notably, the characteristic maximum squinting of the cheeks stood out with an area under the curve of 0.82. The analysis showed the potential of tracking specific facial features for continuous and unobtrusive vision assessment. It motivates to integrate facial feature analysis into an everyday application such as a web browser and to conduct a study in a non-standardized environment on a larger scale.

Background: There is an increased need for physical activity among children and adolescents. KIJANI, a mobile augmented reality game, is designed to increase physical activity through gamified exercises. Objectives: The primary aim of this study is to get feedback on the design and implementation of potentially physical activity-increasing features in KIJANI. Methods: A mixed-method study (n=13) evaluates newly implemented game design features quantitatively through measuring physical activity and qualitatively through participant feedback. Results: Preliminary results are limited and need further studies. Participants’ feedback shows a positive trend and highlights the game’s potential effectiveness. Conclusion: KIJANI shows potential for increasing physical activity among children and adolescents through gamified exercise. Future work will refine the game based on user feedback and findings presented in related work. The game’s long-term impact is to be explored.

We present a low-cost, fully reproducible software and hardware protocol for smartphone sensor battery cost tests. Our pipeline combines a rigorous hardware checklist and light-sealed enclosure, a software checklist for iOS devices, and a BatteryTest app to control sensor configurations and log battery state during tests. Methodologically, we applied this standardized protocol in 30 independent analyzed test runs using six iPhone 14 Pro and three iPhone 13 Pro devices, and compared battery-life outcomes across predefined sensor conditions (idle, TrueDepth, GPS, accelerometer, pedometer, gyroscope, and rear camera), sampling rates, and sensor-specific settings. Key findings include: (i) Baseline battery life was approximately 10% higher on the 14 Pro versus the 13 Pro models under idle conditions. Sensor activation substantially reduced battery life, with GPS and camera usage exhibiting the strongest impact. (ii) Software parameters matter: the sampling rate change from 27 s to 3 s led to significantly decreased battery life in several scenarios, while reducing the location accuracy in GPS tests increased battery life by up to 20 h on the 13 Pro devices. (iii) Cross-device-generation consistency is heterogeneous. The iPhone 14 Pro lasts up to 50% longer on GPS tests, yet drains about an hour faster than the 13 Pro in camera tests. This work introduces the first standardized, and fully reproducible protocol for quantifying sensor-specific battery consumption on iPhones, enabling consistent, comparable, and low-cost energy benchmarking across device generations.

Background: Timely recognition of cognitive impairment and Alzheimer's disease (AD) is crucial for providing appropriate care to elderly individuals affected by these conditions. Digital short tests may help general practitioners (GPs) make more targeted referrals to specialists. Objective: We studied the real-world effectiveness of a referral pathway including the digital Montreal Cognitive Assessment (MoCA Duo), administered by medical assistants (MAs) in general practitioner (GP) offices, to identify mild or major neurocognitive impairment. Ancillary studies examined the procedure's feasibility, usability, and barriers in the care pathway. Methods: Ten GPs participated, one or two MAs per practice administered the MoCA Duo to patients with cognitive concerns. Patients with likely or questionable impairment were offered a referral to a memory clinic (MC) if deemed clinically appropriate. At the MC, patients received a comprehensive neuropsychological examination and a geriatric assessment. Results: Of the 299 patients tested in GP practices (mean age: 73; 65% female), 100 achieved MoCA Duo scores in the presumably unimpaired range. 93 patients (46.73%) scoring below 27 points were referred to the MC; of those, 66 attended an appointment. 40 patients had major cognitive impairment, including 9 diagnosed with AD or vascular dementia, and 15 had mild cognitive impairment (MCI). 83.33% of patients who screened positive on the MoCA Duo at the GP practice and were assessed at the MC had at least MCI. Conclusions: Digital tests administered by MAs can help to effectively screen for cognitive impairment in primary care, supporting targeted referrals of patients with likely cognitive impairment.