TV's greatest ? and not-so-good ? moms

16 hours ago

Ah, Mother's Day. Have your flowers? A card? Dinner reservations? Well, if you'd been brought up by some of TV's best mother figures, you'd be all prepared for Sunday.

On the other hand, there are some TV mamas out there who never got the memo on raising kids right. According to a recent Harris Poll, June Cleaver (of "Leave it to Beaver") may remain the iconic image of television motherhood -- she's topped their list for the second year in a row, followed by "The Cosby Show's" Clair Huxtable and "The Brady Bunch's" Carol Brady -- but we came up with our own list of favorites. Plus a few whose methods leave much to be desired.

Enjoy, and call your mother!

The Best

Clair Huxtable, 'The Cosby Show'

She hasn't been on TV for 20 years, but her shoulder-padded, 1980s-jumpsuit-rocking self remains the mom who tops all moms, the queen who will never be dethroned. She was beautiful, yes, and had an angel?s voice (just watch her sing solo in the ?Hillman? episode). She was smart -- though we didn?t see as much of Clair?s lawyering as we did Cliff?s baby-delivering -- and she could take down Theo?s junior-high bluster with the same devastating debate tactics you imagine she used in the courtroom. She loved her kids like a lioness, but was never afraid to tell them when they were being idiots. And that went for their significant others, too -- Sondra?s bozo boyfriend-eventual-husband Elvin learned quickly never to make assumptions around his soon-to-be mother-in-law, as in a classic clip where Clair explained the give-and-take of marriage while at the same time blasting his anti-feminist attitudes. Do not mess with Queen Clair. -- Gael Fashingbauer Cooper

Roseanne Conner, 'Roseanne'

With her loud mouth, blue-collar clothing and no-nonsense attitude, Roseanne Conner was certainly no June Cleaver. Yet like the idyllic TV moms that came before her, Roseanne was attentive, caring and would do anything necessary to take care of her family, whether that meant taking a mind-numbing job at a plastics factory or wearing a ridiculous waitress outfit to serve burgers at the mall. She gave everything she had to her family, including the occasional snide remark or snarky comment, and made sure they knew they were loved, as in the "Mall Story" episode, episode where she explained to Becky that they couldn't afford an expensive dress for her to wear to the dance ... and then got Dan to return a pair of shoes he spent the day shopping for so that ultimately they could pony up for Becky's special night. -- Ashley Majeski

Tami Taylor, 'Friday Night Lights'

Tami made all women look bad because she was so gosh-darned perfect. As the loyal, loving wife of a high school football coach, Tami was the heart and soul of her household and a generous mother who always put her two daughters first -- and backed them all the way. When she took daughter Julie to visit Boston College and Julie snapped that it was Tami's dream, not her own, Tami reminded her that her dream already came through because she had her family. Beautiful, sexy, witty and always present, Tami is the one Taylor the household never could do without. -- Maria Elena Fernandez

Kristina Braverman, 'Parenthood'

Kristina Braverman's valiant fight against cancer this season only served to show what an amazing mother she is. Despite rigorous chemotherapy treatments and a life-or-death struggle in the hospital, Kristina made sure her eldest daughter was worry-free at college, her autistic son got some undevoted attention, and her baby girl got plenty of cuddle time. Kristina is the epitome of a selfless mother who loves unconditionally. -- MEF

Alicia Florrick, 'The Good Wife'

Despite the show's name, "The Good Wife" is also about a good mom in Alicia Florrick, who has proved to be a terrific role model for her two teenaged children. After being cheated on, she dusted off her law degree, got a job and in a matter of years was made partner at her firm. But beyond that, she's a mom who actually listens to her kids and treats them -- however hesitantly -- like the adults they're slowly becoming. When her daughter Grace develops an interest in religion, she's not thrilled but keeps a watchful eye to ensure it doesn't turn into a cultlike devotion, and when her son Zach stands up to a corrupt police officer she's there to back him all the way into court. -- Randee Dawn

The Not-So-Good

Gemma Teller Morrow, 'Sons of Anarchy'

Oh sure, Gemma may have killed Jax's dad, but she had her reasons. (At least, better reasons than Queen Gertrude in "Hamlet," on which "Sons" is loosely based.) Jax wouldn't be president of SAMCRO without its matriarch's help, and her mama grizzly protectiveness extends to her grandsons. Her methods may be unorthodox (like forcing Jax's baby mama to attempt suicide), but no one can question her fierce devotion to her family. -- Dru Moorhouse

Betty Francis, 'Mad Men'

Let's be real: Betty Draper Francis will never win the Mother-of-the-Year Award. That was established early in season one, when she expressed more concern about her clothes than her daughter potentially suffocating in a dry cleaning bag. She's selfish, childlike and connects more deeply with other children (like the creepy Glen) than her own. However, as January Jones told TODAY before the start of season six, Betty and Sally shared a "very sweet" moment last season, "when Sally got her period and she went to her mother. You see that they do have a connection -- it's just a work in progress." -- DM

Sarah Linden, 'The Killing'

AMC

Sarah Linden (Mireille Enos) from "The Killing."

Clap. Clap. Clap. Linden, you are unofficially the the worst mother currently on scripted TV. For this obsessed detective, the job always came first, and she routinely handed off her son to anyone who would have him. As a single mom she always ensured Jack had some kind of shelter (even if it's a shabby hotel) and food (even if it came out of a snack machine). Fortunately (for Jack's sake), her routine neglect -- including abandoning the 13-year-old alone at a motel with a 103-degree fever -- will apparently find her losing custody in the upcoming third season. -- DM

Source: http://www.today.com/entertainment/moms-word-tvs-greatest-mothers-few-who-need-retraining-1C9875178

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Bloomberg bars reporters from client activity

LOS ANGELES (AP) ? Financial data and news company Bloomberg LP says it has corrected a "mistake" in its newsgathering policies and cut off its journalists' special access to client log-in activity on the company's ubiquitous trading information terminals after Goldman Sachs complained about the matter last month.

A person familiar with the matter said Friday that Goldman Sachs became concerned about outside access after a Bloomberg reporter, investigating what she thought was the departure of a Goldman employee, told the securities firm that the employee had not logged into a Bloomberg terminal for a number of weeks.

The person was not authorized to speak publicly and gave the information on condition of anonymity.

In a memo sent to staff Friday, Bloomberg CEO Daniel Doctoroff said the company had "long made limited customer relationship data available to our journalists," but added, "we realize this was a mistake."

After the complaint last month, Bloomberg "immediately" turned off its journalists' special access and limited it to what clients can see themselves, he said.

The dispute was earlier reported by The Wall Street Journal.

Bloomberg News reporters had been able to see when any of the company's 315,000 paying subscribers, mostly stock and bond traders, had last logged into the service. They could also view the types of "functions" individual subscribers had accessed.

For instance, reporters could see if subscribers had been looking at top news stories, or if they had been gathering data on stocks or bonds, but not which stories or bonds and stocks they had looked up, said Ty Trippet, a Bloomberg LP spokesman. He said reporters could also see if subscribers were using "message" or "chat" functions to send messages to each other over the terminals, but not the recipient of the messages or their content.

Reporters were mostly getting contact information for subscribers, like telephone numbers and email addresses, Trippet said.

In his staff memo, Doctoroff said that access did not extend to "trading, portfolio, monitor, blotter or other related systems or our clients' messages."

He said senior executive Steve Ross had been appointed to the new position of client data compliance officer to review Bloomberg's policies.

No reporters have been fired over the matter, Trippet said. He declined to comment on whether any other disciplinary measures have been taken or if the company had plans to do so.

Although Goldman's concerns caused the change, JPMorgan Chase & Co. had also expressed concerns about Bloomberg journalists' access to sensitive data.

A person familiar with the matter at JPMorgan said multiple Bloomberg reporters had used the data to try to break news in the last several years. The person said Bloomberg journalists used their access attempting to find out whether disciplinary action had been taken against Bruno Iksil, a JPMorgan trader nicknamed the "London whale" who was blamed for a $6 billion trading loss last year.

One reporter knew details about the log-in times of multiple traders on a single desk and called daily to ask about potential layoffs, the person said. JPMorgan complained to the reporters about the technique but Bloomberg managers weren't made aware of a formal complaint.

The person was not authorized to speak publicly about the matter and requested anonymity.

Bloomberg's Trippet said he was unaware of complaints from JP Morgan to reporters or editors.

It's not clear exactly how long Bloomberg reporters have been accessing subscriber information.

"Limited customer relationship data has long been available to our journalists," Trippet wrote in an email. The access dates back to the 1990s, when Bloomberg's news operation began. Journalists would join sales representatives on calls to clients, he said, to explain how Bloomberg's news functions work.

Bloomberg journalists are renowned for aggressive techniques in a competitive field. Bloomberg LP, whose main business is selling terminals to clients in the financial industry, employs more than 2,400 journalists.

In November 2010, the news service reported on the earnings of The Walt Disney Co. and NetApp Inc. well before the companies' scheduled releases by guessing the unprotected website addresses of the press releases before they were made public.

The public relations gaffes, which resulted in immediate but fleeting dips in the stock prices of both companies, resulted in the companies taking action to prevent a recurrence.

__

Associated Press Business Writer Bernard Condon contributed to this report from New York.

Source: http://news.yahoo.com/bloomberg-bars-reporters-client-activity-174947142.html

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US appeals panel speaks well of Google book plans

NEW YORK (AP) ? Judges on a federal appeals court panel spoke excitedly Wednesday about Google Inc.'s plan to create the world's largest digital library, signaling that the court has a favorable opinion about the value of the project.

Three judges on the 2nd U.S. Circuit Court of Appeals in Manhattan were considering an appeal by Mountain View, Calif.-based Google of a judge's decision last year to grant class status to authors represented in an 8-year-old lawsuit by lawyers for the Authors Guild.

The judges seemed eager to stray from the narrow legal question to talk about the merits of Google's effort, which has already resulted in the copying of more than 20 million books made available in their entirety or in snippets, generally depending on the copyright or publishers' restrictions.

Judge Pierre N. Leval said the digital library would seem a "huge advantage" for "perhaps many" authors who would want the operator of the world's largest search engine to provide snippets to potential customers who might buy their books.

Judge Barrington D. Parker cited the "enormous societal benefit" that would result when someone at home in Muncie, Ind., accessed books that otherwise would require a trip to a distant library.

Leval belittled an argument by a lawyer for the Authors Guild who suggested that people might read enough snippets of a book that they would not want to purchase it.

"And if you spend 780 hours doing this, you'll save four dollars," Leval said, adding that he was "skeptical there will be millions of Americans lining up to use this method to save $13 on a book."

The judge also referred to the "logic of the thing" as he described how an academic author eager to get a treatise read by other researchers might welcome Google copying the work rather than collecting "a few dollars in damages because Google put it in their database."

The Authors Guild is seeking $750 in damages for each copyrighted book Google copied, which would cost Google more than $3 billion, Google attorney Seth Waxman said. The guild argues Google is not making "fair use" of copyrighted material by offering snippets of works. Google has defended its library, saying it is fully compliant with copyright law.

The appeals judges said they may not rule on the class-action issue until the trial judge decides whether Google is making "fair use" of the books if it only offers snippets to the public and directs customers elsewhere to view or purchase it.

Parker at one point asked Robert J. LaRocca, a lawyer for the Authors Guild, if the litigation had "effectively scuttled this project that many want to succeed."

LaRocca said the legal issues would not take another decade or more to resolve. He said one possible outcome was that Google would be banned from going ahead with its plans, although he called that outcome "very remote" and said it was more likely that the Authors Guild, if victorious, would ask the judge to order a compulsory license requiring Google to pay $750 for each new copyrighted book it copied.

"We're not trying to sandbag Google, if that's what you're suggesting," LaRocca told the judges.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/495d344a0d10421e9baa8ee77029cfbd/Article_2013-05-08-Google%20Book%20Battle/id-d66d19e60e5349d2acd322828fc13d29

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Adult Swim plans a cartoon show to star Mike Tyson

Mike Tyson, a cast member in "Scary Movie V," poses at the Los Angeles premiere of the film at the Cinerama Dome on Thursday, April 11, 2013 in Los Angeles. (Photo by Chris Pizzello/Invision/AP)

Mike Tyson, a cast member in "Scary Movie V," poses at the Los Angeles premiere of the film at the Cinerama Dome on Thursday, April 11, 2013 in Los Angeles. (Photo by Chris Pizzello/Invision/AP)

NEW YORK (AP) ? Adult Swim says it's turning Mike Tyson into a cartoon detective.

The network announced Friday a new animated series called "Mike Tyson Mysteries" that will feature the retired boxing champ.

On the show, a cartoon version of Tyson will solve wacky problems, assisted by a trusty associate: a foul-mouthed pet pigeon. The network said Tyson will voice the animated character, as well as make live-action appearances.

The show is targeted for next season, but no premiere date was specified.

Among other programming planned for its 2013-14 season, Adult Swim announced "Robot Chicken DC Comics Special II." It's a second spinoff of the cable network's long-running stop-motion sketch comedy series.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/4e67281c3f754d0696fbfdee0f3f1469/Article_2013-05-10-US-TV-Tyson-Cartoon-Series/id-cd75e83d3e83496484432b53aba64c36

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S&P 500 ends down, breaks string of record closes

By Caroline Valetkevitch

NEW YORK (Reuters) - The S&P 500 broke a five-day string of record closing highs on Thursday, ending a fairly volatile session lower as recent momentum lost steam and Apple shares declined.

The Dow also broke its two-day string of all-time closing highs, but still ended above 15,000.

The length of the recent rally has surprised many investors. Analysts said it's difficult for the upward momentum to continue without further catalysts, such as first-quarter earnings reports, which are nearing an end.

Volume has been weak for much of this year's rally. In fact, volume has been below average all week.

"This market is so stretched to the upside that if we get some little wiggle somewhere, I can easily see us getting back down to 1,580" on the S&P 500, said Stephen Massocca, managing director of Wedbush Equity Management LLC in San Francisco.

Apple , down 0.9 percent at $456.77, led the declines of both the S&P 500 and the Nasdaq, while International Business Machines , down 0.8 percent at $203.24, was the biggest drag on the Dow.

The day's economic data was mostly positive, but failed to give much of a boost to stocks. The number of Americans filing new claims for unemployment benefits fell last week to the lowest level in almost 5-1/2 years - contrary to economists' forecast of a gain - U.S. Labor Department data showed.

The Dow Jones industrial average fell 22.50 points, or 0.15 percent, to end at 15,082.62. The Standard & Poor's 500 Index declined 6.02 points, or 0.37 percent, to finish at 1,626.67. The Nasdaq Composite Index slipped 4.10 points, or 0.12 percent, to close at 3,409.17.

Despite the declines for the day, both the Dow and the S&P 500 reached all-time intraday highs - with the Dow touching 15,144.83 and the S&P 500 reaching 1,635.01.

The market, which had been down slightly from the opening bell through midday, reversed course and began to edge higher in early afternoon. Stocks lost steam later in the session.

Limiting losses on the S&P 500, News Corp shares gained 4.5 percent to $33.29. It reported earnings late Wednesday that beat expectations while revenue rose 14 percent. Rupert Murdoch's media company also said it was on track to split off its slow-growing publishing business by the end of June.

Among other top advancers, Tesla Motors Inc surged 24.4 percent to $69.40 a day after posting adjusted earnings that were three times what analysts were expecting as the company sold more cars than it had initially forecast.

Shares of Barnes & Noble Inc shot up 24.3 percent to $22.08, after hitting a fresh 52-week high of $22.25. The stock's sharp advance followed a report by web publication TechCrunch that Microsoft Corp was considering an offer to acquire all of Nook Media's digital assets for $1 billion. Microsoft shares slipped 1 percent to $32.66.

Volume was roughly 6.3 billion shares traded on the New York Stock Exchange, the Nasdaq and the NYSE MKT, slightly below the average daily closing volume of about 6.4 billion this year.

Decliners outnumbered advancers on the NYSE by a ratio of nearly 2 to 1 and on the Nasdaq, about three stocks fell for every two that rose.

(Editing by Nick Zieminski and Jan Paschal)

Source: http://news.yahoo.com/wall-st-resumes-advance-boosted-earnings-182719911.html

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17 days on, Bangladesh survivor found

DHAKA, Bangladesh (AP) -- A seamstress buried in the wreckage of a collapsed garment factory building for 17 days was rescued Friday, a miraculous moment set against a scene of unimaginable horror, where the death toll shot past 1,000.

Reshma survived, in remarkably good shape, by eating dried food that was in her area and drinking spare amounts of water with her. She was discovered on the second floor of the eight-story Rana Plaza building, where crews have been focused on recovering bodies, not rescuing survivors, for much of the past two weeks.

"I heard voices of the rescue workers for the past several days. I kept hitting the wreckage with sticks and rods just to attract their attention," she told the private Somoy TV from her hospital bed as doctors and nurses milled about, giving her saline and checking her condition.

"No one heard me. It was so bad for me. I never dreamed I'd see the daylight again," she said.

"There was some dried food around me. I ate the dried food for 15 days. The last two days I had nothing but water. I used to drink only a limited quantity of water to save it. I had some bottles of water around me," she said.

Once Reshma finally got their attention, the crews ordered the cranes and bulldozers to immediately stop work and used handsaws and welding and drilling equipment to cut through the iron rod and debris still trapping her. They gave her water, oxygen and saline as they worked to free her.

When Reshma was freed after 40 minutes, the crowd erupted in wild cheers. She was rushed to a military hospital in an ambulance, but her rescuers said she was in shockingly good condition, despite her ordeal.

Abdur Razzak, a warrant officer with the military's engineering department who first spotted her in the wreckage, said she could even walk.

"She was fine, no injuries. She was just trapped. The space was wide," said Lt. Col. Moyeen, an army official at the scene.

Reshma told her rescuers there were no more survivors in her area. Workers began tearing through the nearby rubble anyway, hoping to find another person alive.

"Reshma told me there were three others with her. They died. She did not see anybody else alive there," said Maj. Gen. Chowdhury Hasan Suhrawardy, the head of the local military units. "We will continue our search until a survivor or a dead body is there."

The woman survived for more than two weeks in temperatures that touched the mid 90s (mid 30s Celsius). She scrounged for whatever food she could find, Suhrawardy said.

Then, when the workers with bulldozers and cranes got close to the area where she was trapped, she took a steel pipe and began banging it to attract attention, Razzak said. The workers ran into the dark rubble, eventually getting flashlights, to free her, he said.

Reshma's mother and her sister, Asma, rushed to the hospital to meet her.

Hundreds of people who had been engaged in the grim job of removing decomposing bodies from the site raised their hands together in prayer for her survival.

"Allah, you are the greatest, you can do anything. Please allow us all to rescue the survivor just found," said a man on a loudspeaker leading the supplicants. "We seek apology for our sins. Please pardon us, pardon the person found alive."

Workers at the site had been clearing the rubble since the collapse April 24. More than 2,500 people were rescued in the immediate aftermath of the disaster. However, no survivors had been found in the wreckage since April 28, when Shahin Akter was found amid the wreckage. As workers tried to free her, a fire broke out and she died of smoke inhalation.

Prime Minister Sheikh Hasina, called Reshma in the hospital, and the rescued woman began crying on the phone, Suhrawardy said. She told Hasina: "I am fine, please pray for me," he said.

Hasina, whose government has come under criticism for its lax oversight over the powerful garment industry, was racing to the hospital by helicopter to meet her, and congratulated the rescuers, officials said.

"This is an unbelievable feat," Hasina was quoted as saying by her assistant, Mahbubul Haque Shakil.

The death toll from the disaster soared past 1,000 Friday, with officials confirming that 1,038 bodies had been recovered from the rubble of the fallen building, which had housed five garment factories employing thousands of workers.

The disaster has raised alarm about the often deadly working conditions in Bangladesh's $20 billion garment industry, which provides clothing for major retailers around the globe.

Brig. Gen. Mohammed Siddiqul Alam Shikder, an army official overseeing the recovery work said the bodies being recovered were badly decomposed and identification was difficult.

"We are working carefully," he said. "If we get any ID card or mobile phone with them, we can still identify them. Our sincere effort is to at least hand over the bodies to the families."

Brig. Gen. Azmal Kabir, a top official of the military's engineering section, said more than half of the estimated 7,000 tons of debris have been removed from the site but he did not know when the work would be finished.

Source: http://news.yahoo.com/bangladesh-workers-survivor-factory-rubble-104205204.html

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JMIR--Which Bundles of Features in a Web-Based Personally ...

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Original Paper

Which Bundles of Features in a Web-Based Personally Controlled Health Management System Are Associated With Consumer Help-Seeking Behaviors for Physical and Emotional Well-Being?

Annie YS Lau¹, PhD; Judith Proudfoot², PhD; Annie Andrews³; Siaw-Teng Liaw⁴, MBBS, PhD; Jacinta Crimmins⁵, MBBS; Ama?l Arguel¹, PhD; Enrico Coiera¹, MBBS, PhD

¹Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
²School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia
³UNSW Counselling and Psychological Services, University of New South Wales, Sydney, Australia
⁴School of Public Health & Community Medicine, UNSW Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
⁵University Health Service, University of New South Wales, Sydney, Australia

Corresponding Author:
Annie YS Lau, PhD

Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales
Level 1, AGSM Building (G27) UNSW
Sydney, 2052
Australia
Phone: 61 431 599 890
Fax: 61 2 9385 8692
Email:

---

ABSTRACT

Background: Personally controlled health management systems (PCHMS), which include a personal health record (PHR), health management tools, and consumer resources, represent the next stage in consumer eHealth systems. It is still unclear, however, what features contribute to an engaging and efficacious PCHMS.
Objective: To identify features in a Web-based PCHMS that are associated with consumer utilization of primary care and counselling services, and help-seeking rates for physical and emotional well-being concerns.
Methods: A one-group pre/posttest online prospective study was conducted on a university campus to measure use of a PCHMS for physical and emotional well-being needs during a university academic semester (July to November 2011). The PCHMS integrated an untethered personal health record (PHR) with well-being journeys, social forums, polls, diaries, and online messaging links with a health service provider, where journeys provide information for consumer participants to engage with clinicians and health services in an actionable way. 1985 students and staff aged 18 and above with access to the Internet were recruited online. Logistic regression, the Pearson product-moment correlation coefficient, and chi-square analyses were used to associate participants? help-seeking behaviors and health service utilization with PCHMS usage among the 709 participants eligible for analysis.
Results: A dose-response association was detected between the number of times a user logged into the PCHMS and the number of visits to a health care professional (P=.01), to the university counselling service (P=.03), and help-seeking rates (formal or informal) for emotional well-being matters (P=.03). No significant association was detected between participant pre-study characteristics or well-being ratings at different PCHMS login frequencies. Health service utilization was strongly correlated with use of a bundle of features including: online appointment booking (primary care: OR 1.74, 95% CI 1.01-3.00; counselling: OR 6.04, 95% CI 2.30-15.85), personal health record (health care professional: OR 2.82, 95% CI 1.63-4.89), the poll (health care professional: OR 1.47, 95% CI 1.02-2.12), and diary (counselling: OR 4.92, 95% CI 1.40-17.35). Help-seeking for physical well-being matters was only correlated with use of the personal health record (OR 1.73, 95% CI 1.18-2.53). Help-seeking for emotional well-being concerns (including visits to the university counselling service) was correlated with a bundle comprising the poll (formal or informal help-seeking: OR 1.03, 95% CI 1.00-1.05), diary (counselling: OR 4.92, 95% CI 1.40-17.35), and online appointment booking (counselling: OR 6.04, 95% CI 2.30-15.85).
Conclusions: Frequent usage of a PCHMS was significantly associated with increased consumer health service utilization and help-seeking rates for emotional health matters in a university sample. Different bundles of PCHMS features were associated with physical and emotional well-being matters. PCHMS appears to be a promising mechanism to engage consumers in help-seeking or health service utilization for physical and emotional well-being matters.

(J Med Internet Res 2013;15(5):e79)
doi:10.2196/jmir.2414

KEYWORDS

personal health record; Web-based intervention; health service; help-seeking; emotional well-being; physical well-being; preventative health; eHealth; consumer; university

Worldwide, governments have made multibillion dollar investments in eHealth to modernize health services delivery, with many questions still unanswered about the uptake, benefits, and cost-effectiveness of these investments [1,2]. In particular, personal health records (PHRs) now form a crucial component in many large-scale national eHealth reform strategies. However, uptake and utilization of PHRs is not as widespread as anticipated [1,2], and there are often gaps between proposed and actual benefits [3]. Finding approaches that effectively engage consumers in the use of PHRs, with the intention to improve health outcomes and reduce attrition rates, remains a high priority in consumer eHealth research [4-6].

PHRs have been advocated as the next generation tool that significantly improves consumers? health behaviors and health outcomes [7]. In a key discussion on personal health records (PHRs) presented by Tang and colleagues, a PHR is an electronic application through which individuals can access, manage, and share their health information [8]. A tethered PHR allows patients to view their own health information that is stored in their health care provider?s electronic health record, whereas an untethered PHR is a stand-alone application that does not connect with any other system [8]. A personally controlled health management system (PCHMS) in this instance is a health management system that allows consumers and patients to connect and engage with their health services online to access tools and resources to manage their health. In this paper, our PCHMS integrated an untethered PHR with well-being journeys, social forums, polls, diaries, and online messaging links with a health service provider.

However, a PCHMS often consists of multiple features, which refer to the functionalities available on the system. What are the features in a PCHMS that encourage consumers and patients to seek help or engage with health services for their well-being concerns? To date, it is still unclear what features contribute to an engaging and efficacious PCHMS.

Past studies have resulted in guidelines for the development of Internet interventions for consumer health [9-12]. Other studies have found features such as personalization, tailoring, and behavior feedback associated with significant consumer health behaviors when applied in the right context [13,14]. Researchers have also advocated for the use of behavioral theories, such as the health belief model (HBM) [15], social cognitive theory (SCT) [16], transtheoretical model (TTM) [17], and the theory of reasoned action / planned behavior [18], in the development of eHealth applications to increase their acceptability and efficacy. Yet, there is currently little literature to guide the features of PCHMS.

In parallel, the idea of creating a ?bundle? of actions has recently been advocated as a way to address system inertia to change [19]. While its clinical applications have been shown to improve the quality and safety in managing ventilation-assisted pneumonia [20] and sepsis in intensive care [21], its applicability in eHealth has not been examined previously. A care bundle is a grouping of care elements for a particular symptom, procedure, or treatment [22]. It follows the holistic principle where a bundle, as a grouping of several evidence-based practices, when used in combination or as a cluster, should have a greater effect on the positive outcome of patients [22]. In eHealth, while evidence is emerging on which ?individual? features are associated with significant consumer health behaviors, the concept of identifying a ?bundle? of effective features in eHealth interventions has not been addressed previously.

For this reason, identifying features (or ?bundles of features?) in a PCHMS that are associated with changes in consumers? health behaviors remains a crucial area for research. In response, we designed an online prospective study to examine how a group of participants in a university setting used a PCHMS to manage their physical and emotional well-being. University students are known to experience elevated distress levels over an academic semester [3,23-30]. Yet, they are infrequent users of health services and hardly engage with services for assistance [31-33]. The aim of this study is to (1) examine whether use of a PCHMS is associated with increased rates of health service utilization and help-seeking behaviors for physical and/or emotional well-being, and (2) identify whether use of any specific PCHMS feature (ie, journey, personal health record, forum, poll, diary, or online appointment service), or bundles of features, is associated with help-seeking behaviors and health service utilization for well-being matters.

Trial Design and Participants

A one-group pre/posttest online prospective study was conducted over a university academic semester (July to November 2011). Inclusion criteria were (1) aged 18 or above, and (2) with access to the Internet and email at least on a monthly basis.

Study Protocol

Students and staff were approached via email lists and advertisements in online print publications, which described the study and invited interested parties to use a PCHMS called Healthy.me developed at the University of New South Wales (UNSW) to manage their physical and emotional well-being for an academic semester. Written informed consent was sought online from each participant. Participants then completed a 15-minute online pre-study survey, followed by a 5-minute mandatory online tutorial about Healthy.me prior to using the site. At study completion (end of semester), participants received an email asking them to complete a 15-minute online post-study survey. Two follow-up emails 5 days apart were sent as reminders to noncompleters. Those who completed all surveys were entered into a draw for an AU$500 gift voucher. A researcher was available via a dedicated telephone line and email to answer participants? questions and concerns during the study. Ethics approval was obtained from the UNSW ethics committee.

Measures

At baseline, demographic information (such as age and gender) was collected, as well as information about their use of social networking websites, use of the Internet to find health-related information, and visits to a health professional (including whether they visited prior to the study a health care professional, University Health Service, and the University Counselling and Psychological Services).

In the pre- and post-study questionnaires, measures 1-3 were administered and additional measures (4-5) were administered in the postintervention questionnaire: (more details on each measure are available in Multimedia Appendix 1):

1. COOP/WONCA charts were used to evaluate participants? functional status, defined as physical, emotional, and social status. These scales, which have been demonstrated to be a valid and feasible one-time screening assessment for mental disorders in primary care [34], measure six domains, namely physical fitness, feelings, daily activities, social activities, change in health, and overall health. Responses are via a 1-5 Likert-scale where higher scores indicate a poorer functional status.
2. Well-being self-ratings and lifestyle intention: adapted from the last question in the standardized instrument EUROQOL (EQ-5D) [35], which measures health status, participants were asked to rate their physical and emotional well-being on a scale from 0 to 100. They were also asked to select one of four statements that best describes their intention to practice a lifestyle that benefits their well-being according to the transtheoretical model of behavior change [17].
3. Health advice-seeking and health advice-providing networks: adapted from the Norbeck Social Support Questionnaire [36], participants were asked to nominate up to 5 people they have sought advice from, or provided advice to, before and during the study.
4. Help-seeking behaviors and health service utilization: Help-seeking is defined as the behavior of actively seeking assistance [37], regardless of whether the source is informal or formal. A new scale was developed by the authors, adapted from the Actual Help-seeking Questionnaire (AHSQ) [37]. The scale covers help-seeking behaviors for physical and emotional well-being, informal and formal sources, as well as for self or others.
5. Feedback on Healthy.me: participants were asked to provide feedback on their overall experience of using Healthy.me, as well as their feedback on specific features on the website, using a range of scale items such as Likert scale, free-text comments, and checkbox answer options.

This paper focuses on usage of PCHMS features with consumers? health behaviors and thus only reports participants? help-seeking behaviors and health service utilization rates collected at post-study.

PCHMS Usage Metrics

A recent review by Danaher and Seeley [38] concluded there is no single, universally accepted measure for website usage, and researchers are still debating the best methods for defining and measuring website engagement [38].

In this study, we used simple website engagement measures to track participants? activity on the website (ie, PCHMS login frequency and whether participants accessed, or did not access, each website feature). These measures were used to assess whether (1) there was a dose-response effect, that is, was the frequency of PCHMS login associated with rates of health service utilization and help-seeking behaviors, and whether (2) access to PCHMS feature(s) (ie, journey, personal health record, forum, poll, diary, and/or online appointment service) was associated with participants? health service utilization and help-seeking behaviors for physical and/or emotional well-being.

PCHMS Web logs were analyzed to determine whether participants accessed (or did not access) any of the features at any time during the study. Some of these website engagement measures have previously been used to measure user engagement of PHR systems [39].

Intervention

Theoretical Construct

The dose-response phenomenon tested in this study is related to the familiarity principle, reinforcement effect, and the mere exposure effect described by Zajonc [40], where the level of repeated exposure to an intervention is associated with participants developing a familiarity and preference for the intervention and thus increasing the likelihood to use it at times of need. Features such as length of exposure, the spread of experiences, the partitioning of episodes, the peak-and-end events in an incident, and the degradation or improvement in experience over time have been reported to influence a person?s overall impression of an experience [41]. While exposure to a website can be described using different measures, such as number of logins, repeated visits, and duration of visits, we used number of logins as our primary measure since it is one of the most common measures to describe participants? engagement with a website.

Healthy.me

Healthy.me was iteratively developed, and its first version was tested in other settings such as in vitro fertilization and influenza vaccination [42,43]. The first version contained features such as journey, the personal health record, and online appointment booking with the university primary care service. The version of Healthy.me (version 2.0) that was used in this study contained the above-mentioned features as well as online appointment booking with the university primary care and counselling services, a diary, forum, and poll. Details of each feature are described below:

1. Personal Health Record (PHR) for self-recording of medical test results, medications, scheduled appointments, and personnel looking after one?s health (see Figure 1).
2. Online appointment booking with the University Health Service (primary care) and the UNSW Counselling and Psychological Services (sent via email using the ?Book now? button in the PCHMS).
3. Diary for participants to write down their thoughts about their health. By default, the diary is private. However, participants can select to share their diary with all participants enrolled in the PCHMS.
4. Social communication spaces, which support interaction across the continuum of care between fellow participants and clinicians. Features include the poll system and forums moderated by clinicians. Poll system in which participants answer simple health questions (eg, how much sleep did you get last night?), where they can view and compare their response with other participants? aggregated answers in graph format (Figure 2). Forums moderated by clinicians (a primary care physician and a psychologist), where participants can either post their entries on the forum or send one-on-one email messages to other participants in the PCHMS (including clinicians). Guidelines on forum use and the protocol for responding to concerns reported in the forum were approved from the UNSW ethics committee. Posts sent by participants to the ?Report concern? feature on the forum were emailed to clinical and research personnel during the study, who investigated any reported concerns. A Uniform Resource Locator (URL) available in the email to the dedicated staff allowed them to withdraw the forum post. The primary care physician and the psychologist not only moderated the forum but were also available to answer questions posted on the forums. No harm from the use of the forum or the PCHMS was reported by participants during the study.
5. Journeys that provide information for consumer participants to engage with clinicians and health services in an actionable way. Participants in this study had access to four well-being journeys for physical and emotional well-being: ?Stay Healthy?, ?Stressed out??, ?Feeling Anxious about the Exams??, and ?My Emotional Well-being Program?.

The four well-being journeys for physical and emotional well-being were designed and developed in consultation with University Counselling and Psychological Services psychologists and University Health Service primary care physicians, utilizing evidence-based consumer education material routinely used at UNSW to promote physical and emotional well-being. Written in youth-friendly language, using evidence-based mental health, psychoeducational, and psychosocial material, the journeys consisted of skills-focused content delivered online, as well as well-being workshops that participants could attend in-person at the University Counselling and Psychological Services. Participants could learn about mindfulness meditation, anxiety management, time management, and stress management at these workshops.

Journeys were delivered via the PCHMS at four pivotal time-points during a university academic semester (ie, beginning of semester, 4 weeks into semester, after mid-semester break, and before exams) to address physical and emotional well-being concerns likely to be concerning participants at each time-point. Participants were alerted with an email when a new journey became available on the PCHMS. These journeys provided task specific knowledge in an actionable way. For example, as participants read the journey for advice on physical or emotional well-being, they could immediately:

• book an appointment with a university primary care physician or a psychologist from the journey page,
• register to attend a well-being workshop,
• post a question on a forum to seek advice from fellow participants or a clinician (primary care physician or a psychologist), or
• send themselves an email reminder to do so later.

A pilot study was conducted in a controlled setting with 15 university staff and students of different ages, gender, and familiarity with computers to test the intervention, the measures, and the research design. Substantive usability issues were resolved before recruiting participants in their real-life setting.

Data Analysis

Analysis was conducted on an intention-to-treat basis. Sequential logistic regression analyses were undertaken to prospectively examine the crude and adjusted odds ratios (ORs) for participants? health service utilization and help-seeking behaviors for physical and emotional well-being matters [44]. Independent variables assessed included whether participants accessed (or did not access) each specific PCHMS feature (journey, personal health record, forum, poll, diary, and online appointment service), controlling for participant?s gender, age, and potential confounders (eg, whether the participant was a university service patient/client prior to the study) to provide a stratified estimate of intervention effect. The Pearson product-moment correlation coefficient was used to examine correlations among usage of features that were associated with consumers? behaviors.

Participants? health service utilization rates (ie, visits to a health professional, University Health Service, or the University Counselling and Psychological Services), and their help-seeking behaviors for physical or emotional well-being matters were compared at different PCHMS login frequency thresholds (zero logins, once only, two to five times, six to 10 times, more than 10 times). The rationale for selecting these login frequency cutoffs is based on using heuristics to ensure important login frequency thresholds are covered (ie, zero, once only, and ? a high login frequency threshold) and that there are sufficient data points in each frequency threshold to conduct analyses.

Between group analyses were conducted using chi-square analysis. Participants? pre-study characteristics (namely use of the Internet to find health information, use of social networking websites, visits to a health care professional in the past 6 months, and their self-rated well-being ratings classified as over or below 50 at pre-study) were compared between different PCHMS login frequencies using chi-square to assess whether these characteristics were associated with PCHMS usage levels. Descriptive analyses were conducted on participants? reasons for not seeking help during study.

Data analysis was performed using IBM SPSS Statistics 20 [45]. Tests performed were two-tailed and assumed a cutoff of P<.05 for statistical significance.

Source: http://www.jmir.org/2013/5/e79/

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