Competence Training in Higher Education: The case of the Technological Master "Prestación de Servicios Profesionales" from the Colegio de Postgraduados (México).

The Competency-Based Education in the context of training is intended as a comprehensive approach that seeks to link education with the productive sector and increase the potential of individuals, in the face of social, economic, political and cultural transformations that suffers the world and the contemporary society; this is how educational services associated to the rural area takes part of the global revalorization of the role of learning and knowledge. Under the competence approach and taking into account the CONOCER model, we design a Technological Master from the “Colegio de Postgraduados” identifying the competences needed so that the students, professional from different areas of knowledge, managed to develop them, but mainly to achieve the goal of developing the capacities of producers in Mexican rural area.

Towards a Transfer Model of Scientific and Technological Knowledge: the Case of Mexico

This paper shows the development of a science-technological knowledge transfer model in Mexico, as a means to boost the limited relations between the scientific and industrial environments. The proposal is based on the analysis of eight organizations (research centers and firms) with varying degrees of skill in the practice of science-technological knowledge transfer, and carried out by the case study approach. The analysis highlights the synergistic use of the organizational and technological capabilities of each organization, as a means to identification of the knowledge transfer mechanisms best suited to enabling the establishment of cooperative processes, and achieve the R&D and innovation activities results.

An Analysis of the Influence of Students´ Technological Culture on Their Technology

decade has raised the interest among the research community on the acceptance and use of these systems by both teachers and students. At first, the implementation of LMS was based on their technical design and the adaptation of the learning processes to the virtual environment, neglecting students’ characteristics when the systems were deployed, which led to expensive and failing implementations. The Unified Theory of Acceptance and Use of Technology (UTAUT) proposes a framework which allows the study of the acceptance and use of technology that takes into consideration the students’ characteristics and how they affect the acceptance and the degree of use of educational technology. This study questions the role of the user’s attitude towards use of LMS and uses the UTAUT to examine the moderating effect of technological culture in the adoption of LMS in Spain. The results from the comparison and analysis of three different models confirm the relevance of attitude towards use as an antecedent of intention to use the system, as well as the important moderating effect of gender and technological culture. The discussion of results suggests the need for a more in-depth analysis and interrelations of cultural dimensions in the adoption of educational technologies and learning management systems

Applications of Infrared Thermography as innovative technological solution in sports injuries

Infrared thermography IR is a technique, which allows us to get rapidly and non-invasive thermal images from objects or human beings. (Barnes, 1967). In Medicine, its usefulness as diagnosis tool was accepted decades ago (BenEliyahu, 1990), but other techniques with a higher efficiency -such as magnetic resonance or x-rays- ousted it. Nevertheless, the technological improvements on thermographic cameras and new studies on sport injuries are reinforcing new applications (Ring, 2006)

Estudio de las formas de aplicación de la fotografía sobre los materiales pétreos para la arquitectura = Study of photography application methods over architectural stony materials

Desde que el Hombre era morador de las cavernas ha sido manifiesto su deseo innato por grabar y reproducir "instantáneas con las que perpetuarse o sobre las que mirarse ". La aparición y desarrollo de la fotografía como medio para poder captar y fijar "la imagen directa de la realidad circundante " pronto se convierte en un nuevo lenguaje estético y poético que permite al artista la interpretación y reflexión de lo observado. Se imprime a la imagen el carácter de la mirada del fotógrafo, estableciendo un diálogo conceptual con el juego de luces. La presente Tesis plantea la creación de una nueva piel de arquitectura mediante la impresión fotográfica sobre materiales pétreos. La búsqueda de la expresividad de los materiales como soporte de expresión artística implica un cambio de escala al trasladar la instantánea fotográfica a la arquitectura y la aplicación de un nuevo soporte al imprimir la fotografía sobre materiales arquitectónicos. Se justifica la elección del dispositivo láser CO2 como sistema de impresión fotográfica sobre los materiales pétreos arquitectónicos, como la técnica que permite la unión física de la imagen y el proyecto arquitectónico, generando un valor añadido a través del arte de la fotografía. Se justifica la elección de los materiales investigados, Silestone® Blanco Zeus y GRC® con TX Active® Aria, de forma que la investigación de esta nueva piel de arquitectura abarca tanto la envolvente del edificio como su volumen interior, permitiendo cerrar el círculo arquitectónico "in&out" y dota al proyecto arquitectónico de un valor añadido al introducir conceptos sostenibles de carácter estético y medioambiental. Se realiza una consulta a las empresas del sector arquitectónico relacionadas directamente con la producción y distribución de los materiales Silestone® y GRC®, así como a las empresas especializadas en sistemas de impresión fotográfica sobre materiales, acerca del estado del arte. Se recorre la Historia de la fotografía desde sus orígenes hasta el desarrollo de la era digital y se analiza su condición artística. Se recopilan los sistemas de impresión fotográfica que han evolucionado en paralelo con los dispositivos de captura de la instantánea fotográfica y se describe en profundidad el sistema de impresión fotográfica mediante dispositivo láser CO2. Se describen los procesos de fabricación, las características técnicas, cualidades y aplicaciones de los materiales pétreos arquitectónicos Silestone® Blanco Zeus y GRC® con TX Active® Aria. Se explica la técnica utilizada para la captación de la imagen fotográfica, su justificación artística y su proceso de impresión mediante dispositivo láser CO2 bajo diferentes parámetros sobre muestras de los materiales arquitectónicos investigados. Se comprueba la viabilidad de desarrollo de la nueva piel de arquitectura sobre Silestone® Blanco Zeus y GRC® con TX Active® Aria sometiendo a las piezas impresas bajo diferentes parámetros a tres ensayos de laboratorio. En cada uno de ellos se concreta el objetivo y procedimiento del ensayo, la enumeración de las muestras ensayadas y los parámetros bajo los que han sido impresas, el análisis de los resultados del ensayo y las conclusiones del ensayo. Ensayo de amplitud térmica. Se determina el grado de afectación de las imágenes impresas bajo la acción de contrastes térmicos. Series de muestras de Silestone® Blanco Zeus y GRC® con TX Active® Aria impresas con láser CO2 se someten a ciclos de contraste frío-calor de 12 horas de duración para una amplitud térmica total de 102°C. Se realiza una toma sistemática de fotografías microscópicas con lupa de aumento de cada pieza antes y después de los ciclos frío-calor y la observación de las transformaciones que experimentan los materiales bajo la acción del láser CO2. Ensayo de exposición a la acción de la radiación ultravioleta (UV). Se determina el grado de afectación de las imágenes impresas al activar la capacidad autolimpiante de partículas orgánicas. Una serie de muestras de GRC® con TX Active® Aria impresa con láser CO2 se someten a ciclos de exposición de radiación ultravioleta de 26 horas de duración. Se somete la serie a un procedimiento de activación del aditivo TX Active®. Se simula la contaminación orgánica mediante la aplicación controlada de Rodamina B, tinte orgánico, y se simula la radiación UV mediante el empleo de una bombilla de emisión de rayos ultravioleta. Se realiza una toma sistemática de fotografías macroscópicas de la serie de muestras ensayadas: antes de aplicación de la Rodamina B, momento 00:00h, momento 04:00h y momento 26:00h del ensayo. Se procede a la descarga y análisis del histograma de las fotografías como registro de la actividad fotocatalítica. Ensayo de la capacidad autodescontaminante del GRC® con TX Active® impreso con láser CO2. Se comprueba si la capacidad autodescontaminante del GRC® con TX Active® se ve alterada como consecuencia de la impresión de la imagen fotográfica impresa con láser CO2. Serie de muestras de GRC® con TX Active® Aria impresa con láser CO2 se someten a test de capacidad autodescontaminante: atmósfera controlada y contaminada con óxidos de nitrógeno en los que se coloca cada pieza ensayada bajo la acción de una lámpara de emisión de radiación ultravioleta (UV). Se registra la actividad fotocatalítica en base a la variación de concentración de óxido de nitrógeno. Se recopila el análisis e interpretación de los resultados de los ensayos de laboratorio y se elaboran las conclusiones generales de la investigación. Se sintetizan las futuras líneas de investigación que, a partir de las investigaciones realizadas y de sus conclusiones generales, podrían desarrollarse en el ámbito de la impresión fotográfica sobre materiales arquitectónicos. Se describe el rendimiento tecnológico y artístico generado por las investigaciones previas que han dado origen y desarrollo a la Tesis Doctoral. ABSTRACT Since ancient time, humanity has been driven by an innate wish to reproduce and engrave "snapshots that could help to perpetúate or to look at one self". Photography's birth and its development as a mean to capture and fix "the direct image of the surrounding reality" quickly becomes a new aesthetical and poetical language allowing the artist to interpret and think over what has been observed. The photographer's eye is imprinted onto the image, and so the conceptual dialogue between the artist and the light beams begins. The current thesis suggests the creation of a new architectural skin through photography imprinting over stony materials. The search for material's expressiveness as a medium of artistic expression involves a change of scale as it transfers photographic snapshot into architecture and the use of a new photographic printing support over architectural materials. CO2 laser is the chosen printing system for this technique as it allows the physical union of the image and the architectonic project, generating an added value through the art of photography. The researched materials selected were Silestone®, Blanco Zeus and GRC® with TX Active® Aria. This new architectural skin contains the building surrounding as well as its interior volume, closing the architectonic "in & out" circle and adding a value to the project by introducing aesthetical and environmental sustainable concepts. Architecture companies related to the production and distribution of materials like Silestone® and GRC®, as well as companies specialized in photography printing over materials were consulted to obtain a State of the Art. A thorough analysis of photography's History from its origins to the digital era development was made and its artistic condition was studied in this thesis. In this study the author also makes a compilation of several photographic printing systems that evolved together with photographic snapshot devices. The CO2 laser-based photographic printing system is also described in depth. Regarding stony materials of architecture like Silestone®, Blanco Zeus and GRC® with TX Active® Aria, the present study also describes their manufacture processes as well as technical features, quality and application. There is also an explanation about the technique to capture the photographic image, its artistic justification and its CO2 laser-based printing system over the researched materials under different parameters. We also tested the feasibility of this new architectural skin over Silestone® Blanco Zeus and GRC® with TX Active® Aria. The pieces were tested under different parameters in three laboratory trials. Each trial comprises of an explanation of its objective and its process, the samples were numbered and the printing parameters were specified. Finally, with the analysis of the results some conclusions were drawn. In the thermal amplitude trial we tried to determine how printed images were affected as a result of the action of thermal contrasts. Series of samples of Silestone® Blanco Zeus and GRC® with TX Active® Aria printed with CO2 laser were subjected to several 12h warm-cold cycles for thermal total amplitude of 102oc. Each sample was captured systematically with microscopic enhanced lenses before and after cold-warm cycles. The changes experienced by these materials under the effect of CO2 laser were observed and recorded. Trial regarding the Ultraviolet Radiation (UR) effect on images. We determined to which extent printed images were affected once the self-cleaning organic particles were activated. This time GRC® with TX Active® Aria samples printed with CO2 laser were exposed to a 26h UR cycle. The samples were subjected to the activation of TX Active® additive. Through the controlled application of Rodamine B and organic dye we were able to simulate the organic contamination process. UR was simulated using an ultraviolet beam emission bulb. A systematic capture of macroscopic pictures of the tested sample series was performed at different time points: before Rodamine B application, at moment 00:00h, moment 04:00h and moment 26:00h of the trial. Picture's histogram was downloaded and analyzed as a log of photocatalytic activity. Trial regarding the self-decontaminating ability of GRC® with TX Active® printed with CO2 laser. We tested if this self-decontaminating ability is altered as a result of CO2 laser printed image. GRC® with TX Active® Aria samples printed with CO2 laser, were subject to self-decontaminating ability tests with controlled and nitrogen oxide contaminated atmosphere. Each piece was put under the action of an UR emission lamp. Photocatalytic activity was recorded according to the variation in nitrogen oxide concentration. The results of the trial and their interpretation as well as the general conclusions of the research are also compiled in the present study. Study conclusions enable to draw future research lines of potential applications of photographic printing over architecture materials. Previous research generated an artistic and technological outcome that led to the development of this doctoral thesis.

CO2 soil flux baseline at the technological development plant for CO2 injection at Hontomin (Burgos, Spain)

From the end of 2013 and during the following two years, 20 kt of CO2sc are planned to be injected in a saline reservoir (1500 m depth) at the Hontomín site (NE Spain). The target aquifers are Lower Jurassic limestone formations which are sealed by Lower Cretaceous clay units at the Hontomín site (NE Spain). The injection of CO2 is part of the activities committed in the Technology Development phase of the EC-funded OXYCFB300 project (European Energy Program for Recovery – EEPR, http://www.compostillaproject.eu), which include CO2 injection strategies, risk assessment, and testing and validating monitoring methodologies and techniques. Among the monitoring works, the project is intended to prove that present-day technology is able to monitor the evolution of injected CO2 in the reservoir and to detect potential leakage. One of the techniques is the measurement of CO2 flux at the soil–atmosphere interface, which includes campaigns before, during and after the injection operations. In this work soil CO2 flux measurements in the vicinity of oil borehole, drilled in the eighties and named H-1 to H-4, and injection and monitoring wells were performed using an accumulation chamber equipped with an IR sensor. Seven surveys were carried out from November 2009 to summer 2011. More than 4000 measurements were used to determine the baseline flux of CO2 and its seasonal variations. The measured values were low (from 5 to 13 g m−2 day−1) and few outliers were identified, mainly located close to the H-2 oil well. Nevertheless, these values cannot be associated to a deep source of CO2, being more likely related to biological processes, i.e. soil respiration. No anomalies were recognized close to the deep fault system (Ubierna Fault) detected by geophysical investigations. There, the CO2 flux is indeed as low as other measurement stations. CO2 fluxes appear to be controlled by the biological activity since the lowest values were recorded during autumn-winter seasons and they tend to increase in warm periods. Two reference CO2 flux values (UCL50 of 5 g m−2 d−1 for non-ploughed areas in autumn–winter seasons and 3.5 and 12 g m−2 d−1 for in ploughed and non-ploughed areas, respectively, in spring–summer time, and UCL99 of 26 g m−2 d−1 for autumn–winter in not-ploughed areas and 34 and 42 g m−2 d−1 for spring–summer in ploughed and not-ploughed areas, respectively) were calculated. Fluxes higher than these reference values could be indicative of possible leakage during the operational and post-closure stages of the storage project.

FRe building technological products

Nowadays "Flood Resilient (FRe) Building Technological Products" is an undefined concept, and concerned FRe solutions cannot be even easily identified. There is an interest in offering an identification and classification of the referred products, since it will be useful for stakeholders and populations at flood risk for adopting the most adequate protections when facing floods. There are many barriers for the implementation of "FRe building technological products", and particularly their standardization is still a major challenge. To put into contact such solutions with final customers, it appears necessary to protocolize them all. The classification effort achieved in this document shall be considered as a necessary preliminary step in order to open the road to the market to FRe building technological solutions.

A cybernetic theory about computer interfaces and human factors within a framework of technological innovation

This paper is based on the following postulates taken from a book recently published by this author (Sáez-Vacas, 1990(1)): a) technological innovation in a company is understood to be the process and set of changes that the company undergoes as a result of a specific type of technology; b) the incorporation of technology in the company does not necessarily result in innovation, modernization and progress; c) the very words "modernization" and "progress" are completely bereft of any meaning if isolated from the concept of complexity in its broadest sense, including the human factor. Turning to office technology in specific, the problem of managing office technology for business innovation purposes can be likened to the problem of managing third level complexity, following the guidelines of a three-level complexity model proposed by the author some years ago

Polypropylene/glass fiber hierarchical composites incorporating inorganic fullerene-like nanoparticles for advanced technological applications

Novel isotactic polypropylene (iPP)/glass fiber (GF) laminates reinforced with inorganic fullerene-like tungsten disulfide (IF-WS2) nanoparticles as environmentally friendly fillers have been successfully fabricated by simple melt-blending and fiber impregnation in a hot-press without the addition of any compatibilizer. The influence of IF-WS2 concentration on the morphology, viscosity. and thermal and mechanical behavior of the hierarchical composites has been investigated. Results revealed an unprecedented 62 °C increase in the degradation temperature of iPP/GF upon addition of only 4.0 wt % IF-WS2. The coexistence of both micro- and nanoscale fillers resulted in synergistic effects on enhancing the stiffness, strength, crystallinity, thermal stability, glass transition (Tg) and heat distortion temperature (HDT) of the matrix. The approach used in this work is an efficient, versatile, scalable and economic strategy to improve the mechanical and thermal behavior of GF-reinforced thermoplastics with a view to extend their use in advanced technological applications. This new type of composite materials shows great potential to improve the efficiency and sustainability of many forms of transport.

Technological development in Spanish gothic vaults design

The principle of complexity as the evolution vector of the gothic style was an idea largely developed by Paul Frankl. The high complexity reached in the 15th and 16th centuries was possible thanks to the geometrical resources developed in the workshops of the medieval stonemasons. The search for more sophisticated designs was possible also with the higher standardization, so that the most complex ribbed vault could be built with ribs that had all the same curvature and with voussoirs that were therefore identical. Spanish Gothic architecture has been deeply studied from a historical and artistic point of view. The present paper, as a complement to these analyses, aims to point out some of the geometrical methods and technological improvements that late medieval masons were able to develop. In that way, some selected vaults have been measured, in order to study their geometry and design process. Also scale models of some vaults have been built at the Escuela de Arquitectura (Madrid) to validate these geometrical principles. More than just a research method, the scale models allow to understand the medieval construction techniques, and they are a powerful pedagogical tool with which pupils can reach a rewarding experience based on the “medieval-way” praxis.

One or two poles of attraction in the international technological cooperation process?

In recent years, international cooperation processes have become a key mechanism for companies to internationalise their innovative activities, par ticularly in the case of small businesses whose size reduces their possibilities of developing internationalisation strategies autonomously in the same way as larger companies. In Spain, the existence of two parallel programmes with similar structures oriented towards Europe (EUREKA) and Latin America (IBEROEKA) raises the question as to whether the fact that companies participate in only one (unipolar) or both (bipolar) of these programmes is the result of a selection process, which, in turn, results in the existence of different collectives with different efficiency parameters. The aim of this study is to provide a comparative analysis based on the final reports of Spanish companies that have participated in the EUREKA programme. Two groups of companies were compared: one comprising companies that have only had international experience in Europe (EUREKA); and another formed by companies that have also carried out IBEROEKA projects. The conclusions confirm that the behaviour of both groups of companies differs substantially and reveal the importance of geographical perspective in the analysis of international cooperation in technology. This disparate behaviour is a relevant aspect that must be taken into account when designing policies to promote international technological cooperation.

Vigilancia tecnológica: un aprendizaje adaptativo a través del pensamiento divergente Technological surveillance: an adaptive learning through divergent thinking

El estudio de la evolución tecnológica a partir de logros concretos de la humanidad es una forma de aproximación a la enseñanza de la ingeniería. Comprender que las tecnologías existentes son el resultado de un depurado proceso de creación/selección no es trivial. Por ello combinar un conocimiento deductivo profundo con un pensamiento divergente que favorezca la obtención de soluciones viables y creativas es fundamental en el contexto de incertidumbre económica actual. En este ensayo se comparan siete técnicas de enseñanza que pretenden favorecer el PD en una estrategia adaptativa para alumnos con distintos estilos cognitivos (AA) sobre la base de un proceso de vigilancia tecnológica (VT) aplicada a algunos objetos cotidianos y otros muy especializados.

A technological framework based on automatic messaging for improving adherence of diabetic patients

En todo el mundo se ha observado un crecimiento exponencial en la incidencia de enfermedades crónicas como la hipertensión y enfermedades cardiovasculares y respiratorias, así como la diabetes mellitus, que causa un número de muertes cada vez mayor en todo el mundo (Beaglehole et al., 2008). En concreto, la prevalencia de diabetes mellitus (DM) está aumentando de manera considerable en todas las edades y representa un serio problema de salud mundial. La diabetes fue la responsable directa de 1,5 millones de muertes en 2012 y 89 millones de años de vida ajustados por discapacidad (AVAD) (OMS, 2014). Uno de los principales dilemas que suelen asociarse a la gestión de EC es la adherencia de los pacientes a los tratamientos, que representa un aspecto multifactorial que necesita asistencia en lo relativo a: educación, autogestión, interacción entre los pacientes y cuidadores y compromiso de los pacientes. Medir la adherencia del tratamiento es complicado y, aunque se ha hablado ampliamente de ello, aún no hay soluciones “de oro” (Reviews, 2002). El compromiso de los pacientes, a través de la participación, colaboración, negociación y a veces del compromiso firme, aumentan las oportunidades para una terapia óptima en la que los pacientes se responsabilizan de su parte en la ecuación de adherencia. Comprometer e involucrar a los pacientes diabéticos en las decisiones de su tratamiento, junto con expertos profesionales, puede ayudar a favorecer un enfoque centrado en el paciente hacia la atención a la diabetes (Martin et al., 2005). La motivación y atribución de poder de los pacientes son quizás los dos factores interventores más relevantes que afectan directamente a la autogestión de la atención a la diabetes. Se ha demostrado que estos dos factores desempeñan un papel fundamental en la adherencia a la prescripción, así como en el fomento exitoso de un estilo de vida sana y otros cambios de conducta (Heneghan et al., 2013). Un plan de educación personalizada es indispensable para proporcionarle al paciente las herramientas adecuadas que necesita para la autogestión efectiva de la enfermedad (El-Gayar et al. 2013). La comunicación efectiva es fundamental para proporcionar una atención centrada en el paciente puesto que influye en las conductas y actitudes hacia un problema de salud ((Frampton et al. 2008). En este sentido, la interactividad, la frecuencia, la temporalización y la adaptación de los mensajes de texto pueden promover la adherencia a un régimen de medicación. Como consecuencia, adaptar los mensajes de texto a los pacientes puede resultar ser una manera de hacer que las sugerencias y la información sean más relevantes y efectivas (Nundy et al. 2013). En este contexto, las tecnologías móviles en el ámbito de la salud (mHealth) están desempeñando un papel importante al conectar con pacientes para mejorar la adherencia a medicamentos recetados (Krishna et al., 2009). La adaptación de los mensajes de texto específicos de diabetes sigue siendo un área de oportunidad para mejorar la adherencia a la medicación y ofrecer motivación a adultos con diabetes. Sin embargo, se necesita más investigación para entender totalmente su eficacia. Los consejos de texto personalizados han demostrado causar un impacto positivo en la atribución de poder a los pacientes, su autogestión y su adherencia a la prescripción (Gatwood et al., 2014). mHealth se puede utilizar para ofrecer programas de asistencia de autogestión a los pacientes con diabetes y, al mismo tiempo, superar las dificultades técnicas y financieras que supone el tratamiento de la diabetes (Free at al., 2013). El objetivo principal de este trabajo de investigación es demostrar que un marco tecnológico basado en las teorías de cambios de conducta, aplicado al campo de la mHealth, permite una mejora de la adherencia al tratamiento en pacientes diabéticos. Como método de definición de una solución tecnológica, se han adoptado un conjunto de diferentes técnicas de conducta validadas denominado marco de compromiso de retroacción conductual (EBF, por sus siglas en inglés) para formular los mensajes, guiar el contenido y evaluar los resultados. Los estudios incorporan elementos del modelo transteórico (TTM, por sus siglas en inglés), la teoría de la fijación de objetivos (GST, por sus siglas en inglés) y los principios de comunicación sanitaria persuasiva y eficaz. Como concepto general, el modelo TTM ayuda a los pacientes a progresar a su próxima fase de conducta a través de mensajes de texto motivados específicos y permite que el médico identifique la fase actual y adapte sus estrategias individualmente. Además, se adoptan las directrices del TTM para fijar objetivos personalizados a un nivel apropiado a la fase de cambio del paciente. La GST encierra normas que van a ponerse en práctica para promover la intervención educativa y objetivos de pérdida de peso. Finalmente, los principios de comunicación sanitaria persuasiva y eficaz aplicados a la aparición de los mensajes se han puesto en marcha para aumentar la efectividad. El EBF tiene como objetivo ayudar a los pacientes a mejorar su adherencia a la prescripción y encaminarlos a una mejora general en la autogestión de la diabetes mediante mensajes de texto personalizados denominados mensajes de retroacción automáticos (AFM, por sus siglas en inglés). Después de una primera revisión del perfil, consistente en identificar características significativas del paciente basadas en las necesidades de tratamiento, actitudes y conductas de atención sanitaria, el sistema elige los AFM personalizados, los aprueba el médico y al final se transfieren a la interfaz del paciente. Durante el tratamiento, el usuario recopila los datos en dispositivos de monitorización de pacientes (PMD, por sus siglas en inglés) de una serie de dispositivos médicos y registros manuales. Los registros consisten en la toma de medicación, dieta y actividad física y tareas de aprendizaje y control de la medida del metabolismo. El compromiso general del paciente se comprueba al estimar el uso del sistema y la adherencia del tratamiento y el estado de los objetivos del paciente a corto y largo plazo. El módulo de análisis conductual, que consiste en una serie de reglas y ecuaciones, calcula la conducta del paciente. Tras lograr el análisis conductual, el módulo de gestión de AFM actualiza la lista de AFM y la configuración de los envíos. Las actualizaciones incluyen el número, el tipo y la frecuencia de mensajes. Los AFM los revisa periódicamente el médico que también participa en el perfeccionamiento del tratamiento, adaptado a la fase transteórica actual. Los AFM se segmentan en distintas categorías y niveles y los pacientes pueden ajustar la entrega del mensaje de acuerdo con sus necesidades personales. El EBF se ha puesto en marcha integrado dentro del sistema METABO, diseñado para facilitar al paciente diabético que controle sus condiciones relevantes de una manera menos intrusiva. El dispositivo del paciente se vincula en una plataforma móvil, mientras que una interfaz de panel médico permite que los profesionales controlen la evolución del tratamiento. Herramientas específicas posibilitan que los profesionales comprueben la adherencia del paciente y actualicen la gestión de envíos de AFM. El EBF fue probado en un proyecto piloto controlado de manera aleatoria. El principal objetivo era examinar la viabilidad y aceptación del sistema. Los objetivos secundarios eran también la evaluación de la eficacia del sistema en lo referente a la mejora de la adherencia, el control glucémico y la calidad de vida. Se reclutaron participantes de cuatro centros clínicos distintos en Europa. La evaluación del punto de referencia incluía datos demográficos, estado de la diabetes, información del perfil, conocimiento de la diabetes en general, uso de las plataformas TIC, opinión y experiencia con dispositivos electrónicos y adopción de buenas prácticas con la diabetes. La aceptación y eficacia de los criterios de evaluación se aplicaron para valorar el funcionamiento del marco tecnológico. El principal objetivo era la valoración de la eficacia del sistema en lo referente a la mejora de la adherencia. En las pruebas participaron 54 pacientes. 26 fueron asignados al grupo de intervención y equipados con tecnología móvil donde estaba instalado el EBF: 14 pacientes tenían T1DM y 12 tenían T2DM. El grupo de control estaba compuesto por 25 pa cientes que fueron tratados con atención estándar, sin el empleo del EBF. La intervención profesional tanto de los grupos de control como de intervención corrió a cargo de 24 cuidadores, entre los que incluían diabetólogos, nutricionistas y enfermeras. Para evaluar la aceptabilidad del sistema y analizar la satisfacción de los usuarios, a través de LimeSurvey, se creó una encuesta multilingüe tanto para los pacientes como para los profesionales. Los resultados también se recopilaron de los archivos de registro generados en los PMD, el panel médico profesional y las entradas de la base de datos. Los mensajes enviados hacia y desde el EBF y los archivos de registro del sistema y los servicios de comunicación se grabaron durante las cinco semanas del estudio. Se entregaron un total de 2795 mensajes, lo que supuso una media de 107,50 mensajes por paciente. Como se muestra, los mensajes disminuyen con el tiempo, indicando una mejora global de la adherencia al plan de tratamiento. Como se esperaba, los pacientes con T1DM recibieron más consejos a corto plazo, en relación a su estado. Del mismo modo, al ser el centro de T2DM en cambios de estilo de vida sostenible a largo plazo, los pacientes con T2DM recibieron más consejos de recomendación, en cuanto a dietas y actividad física. También se ha llevado a cabo una comparación de la adherencia e índices de uso para pacientes con T1DM y T2DM, entre la primera y la segunda mitad de la prueba. Se han observado resultados favorables para el uso. En lo relativo a la adherencia, los resultados denotaron una mejora general en cada dimensión del plan de tratamiento, como la nutrición y las mediciones de inserción de glucosa en la sangre. Se han llevado a cabo más estudios acerca del cambio a nivel educativo antes y después de la prueba, medidos tanto para grupos de control como de intervención. Los resultados indicaron que el grupo de intervención había mejorado su nivel de conocimientos mientras que el grupo de control mostró una leve disminución. El análisis de correlación entre el nivel de adherencia y las AFM ha mostrado una mejora en la adherencia de uso para los pacientes que recibieron los mensajes de tipo alertas, y unos resultados no significativos aunque positivos relacionados con la adherencia tanto al tratamiento que al uso correlacionado con los recordatorios. Por otra parte, los AFM parecían ayudar a los pacientes que no tomaban suficientemente en serio su tratamiento en el principio y que sí estaban dispuestos a responder a los mensajes recibidos. Aun así, los pacientes que recibieron demasiadas advertencias, comenzaron a considerar el envío de mensajes un poco estresante. El trabajo de investigación llevado a cabo al desarrollar este proyecto ofrece respuestas a las cuatro hipótesis de investigación que fueron la motivación para el trabajo. • Hipótesis 1 : es posible definir una serie de criterios para medir la adherencia en pacientes diabéticos. • Hipótesis 2: es posible diseñar un marco tecnológico basado en los criterios y teorías de cambio de conducta mencionados con anterioridad para hacer que los pacientes diabéticos se comprometan a controlar su enfermedad y adherirse a planes de atención. • Hipótesis 3: es posible poner en marcha el marco tecnológico en el sector de la salud móvil. • Hipótesis 4: es posible utilizar el marco tecnológico como solución de salud móvil en un contexto real y tener efectos positivos en lo referente a indicadores de control de diabetes. La verificación de cada hipótesis permite ofrecer respuesta a la hipótesis principal: La hipótesis principal es: es posible mejorar la adherencia diabética a través de un marco tecnológico mHealth basado en teorías de cambio de conducta. El trabajo llevado a cabo para responder estas preguntas se explica en este trabajo de investigación. El marco fue desarrollado y puesto en práctica en el Proyecto METABO. METABO es un Proyecto I+D, cofinanciado por la Comisión Europea (METABO 2008) que integra infraestructura móvil para ayudar al control, gestión y tratamiento de los pacientes con diabetes mellitus de tipo 1 (T1DM) y los que padecen diabetes mellitus de tipo 2 (T2DM). ABSTRACT Worldwide there is an exponential growth in the incidence of Chronic Diseases (CDs), such as: hypertension, cardiovascular and respiratory diseases, as well as diabetes mellitus, leading to rising numbers of deaths worldwide (Beaglehole et al. 2008). In particular, the prevalence of diabetes mellitus (DM) is largely increasing among all ages and constitutes a major worldwide health problem. Diabetes was directly responsible for 1,5 million deaths in 2012 and 89 million Disability-adjusted life year (DALYs) (WHO 2014). One of the key dilemmas often associated to CD management is the patients’ adherence to treatments, representing a multi-factorial aspect that requires support in terms of: education, self-management, interaction between patients and caregivers, and patients’ engagement. Measuring adherence is complex and, even if widely discussed, there are still no “gold” standards ((Giardini et al. 2015), (Costa et al. 2015). Patient’s engagement, through participation, collaboration, negotiation, and sometimes compromise, enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation. Engaging and involving diabetic patients in treatment decisions, along with professional expertise, can help foster a patient-centered approach to diabetes care (Martin et al. 2005). Patients’ motivation and empowerment are perhaps the two most relevant intervening factors that directly affect self-management of diabetes care. It has been demonstrated that these two factors play an essential role in prescription adherence, as well as for the successful encouragement of a healthy life-style and other behavioural changes (Heneghan et al. 2013). A personalised education plan is indispensable in order to provide the patient with the appropriate tools needed for the effective self-management of the disease (El-Gayar et al. 2013). Effective communication is at the core of providing patient-centred care since it influences behaviours and attitudes towards a health problem (Frampton et al. 2008). In this regard, interactivity, frequency, timing, and tailoring of text messages may promote adherence to a medication regimen. As a consequence, tailoring text messages to patients can constitute a way of making suggestions and information more relevant and effective (Nundy et al. 2013). In this context, mobile health technologies (mHealth) are playing significant roles in improving adherence to prescribed medications (Krishna et al. 2009). The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but further research is needed to fully understand their effectiveness. Personalized text advices have proven to produce a positive impact on patients’ empowerment, self-management, and adherence to prescriptions (Gatwood et al. 2014). mHealth can be used for offering self-management support programs to diabetes patients and at the same time surmounting the technical and financial difficulties involved in diabetes treatment (Free et al. 2013). The main objective of this research work is to demonstrate that a technological framework, based on behavioural change theories, applied to mHealth domain, allows improving adherence treatment in diabetic patients. The framework, named Engagement Behavioural Feedback Framework (EBF), is built on top of validated behavioural techniques to frame messages, guide the definition of contents and assess outcomes: elements from the Transtheoretical Model (TTM), the Goal-Setting Theory (GST), Effective Health Communication (EHC) guidelines and Principles of Persuasive Technology (PPT) were incorporated. The TTM helps patients to progress to a next behavioural stage, through specific motivated text messages, and allow clinician’s identifying the current stage and tailor its strategies individually. Moreover, TTM guidelines are adopted to set customised goals at a level appropriate to the patient’s stage of change. The GST was used to build rules to be applied for enhancing educational intervention and weight loss objectives. Finally, the EHC guidelines and the PPT were applied to increase the effectiveness of messages. The EBF aims to support patients on improving their prescription adherence and persuade them towards a general improvement in diabetes self-management, by means of personalised text messages, named Automatic Feedback Messages (AFM). After a first profile screening, consisting in identifying meaningful patient characteristics based on treatment needs, attitudes and health care behaviours, customised AFMs are selected by the system, approved by the professional, and finally transferred into the patient interface. During the treatment, the user collects the data into a Patient Monitoring Device (PMD) from a set of medical devices and from manual inputs. Inputs consist in medication intake, diet and physical activity, metabolic measurement monitoring and learning tasks. Patient general engagement is checked by estimating the usage of the system and the adherence of treatment and patient goals status in the short and the long term period. The Behavioural Analysis Module, consisting in a set of rules and equations, calculates the patient’s behaviour. After behavioural analysis is accomplished, the AFM library and the dispatch setting are updated by the AFM Manager module. Updates include the number, the type and the frequency of messages. The AFMs are periodically supervised by the professional who also participates to the refinement of the treatment, adapted to the current transtheoretical stage. The AFMs are segmented in different categories and levels and patients can adjust message delivery in accordance with their personal needs. The EBF was integrated to the METABO system, designed to facilitate diabetic patients in managing their disease in a less intrusive approach. Patient device corresponds in a mobile platform, while a medical panel interface allows professionals to monitoring the treatment evolution. Specific tools allow professional to check patient adherence and to update the AFMs dispatch management. The EBF was tested in a randomised controlled pilot. The main objective was to examine the feasibility and acceptance of the system. Secondary objectives were also the assessment of the effectiveness of system in terms of adherence improvement, glycaemic control, and quality of life. Participants were recruited from four different clinical centres in Europe. The baseline assessment included demographics, diabetes status, profile information, knowledge about diabetes in general, usage of ICT platforms, opinion and experience about electronic devices and adoption of good practices with diabetes. Acceptance and the effectiveness evaluation criteria were applied to evaluate the performance of the technological framework. The main objective was the assessment of the effectiveness of system in terms of adherence improvement. Fifty-four patients participated on the trials. Twenty-six patients were assigned in the intervention group and equipped with mobile where the EBF was installed: 14 patients were T1DM and 12 were T2DM. The control group was composed of 25 patients that were treated through a standard care, without the usage of the EBF. Professional’s intervention for both intervention and control groups was carried out by 24 care providers, including endocrinologists, nutritionists, and nurses. In order to evaluate the system acceptability and analyse the users’ satisfaction, an online multi-language survey, using LimeSurvey, was produced for both patients and professionals. Results were also collected from the log-files generated in the PMDs, the professional medical panel and the entries of the data base. The messages sent to and from the EBF and the log-files of the system and communication services were recorded over 5 weeks of the study. A total of 2795 messages were submitted, representing an average of 107,50 messages per patient. As demonstrated, messages decrease over time indicating an overall improvement of the care plan’s adherence. As expected, T1DM patients were more loaded with short-term advices, in accordance with their condition. Similarly, being the focus of T2DM on long-term sustainable lifestyle changes, T2DM received more reminders advices, as for diet and physical activity. Favourable outcomes were observed for treatment and usage adherences of the intervention group: for both the adherence indices, results denoted a general improvement on each care plan’s dimension, such as on nutrition and blood glucose input measurements. Further studies were conducted on the change on educational level before and after the trial, measured for both control and intervention groups. The outcomes indicated the intervention group has improved its level of knowledge, while the control group denoted a low decrease. The correlation analysis between the level of adherences and the AFMs showed an improvement in usage adherence for patients who received warnings message, while non-significantly yet even positive indicators related to both treatment and usage adherence correlated with the Reminders. Moreover, the AFMs seemed to help those patients who did not take their treatment seriously enough in the beginning and who were willing to respond to the messages they received. Even though, patients who received too many Warnings, started to consider the message dispatch to be a bit stressful. The research work carried out in developing this research work provides responses to the four research hypothesis that were the motivation for the work: •Hypothesis 1: It is possible to define a set of criteria to measure adherence in diabetic patients. •Hypothesis 2: It is possible to design a technological framework, based on the aforementioned criteria and behavioural change theories, to engage diabetic patients in managing their disease and adhere to care plans. •Hypothesis 3: It is possible to implement the technological framework in the mobile health domain. •Hypothesis 4: It is possible to use the technological framework as a mobile health solution in a real context and have positive effects in terms of diabetes management indicators. The verification of each hypothesis allowed us to provide a response to the main hypothesis: The Main Hypothesis is: It is possible to improve diabetic adherence through a mHealth technological framework based on behavioural change theories. The work carried out to answer these questions is explained in this research work. The framework was developed and applied in the METABO project. METABO is an R&D project, co-funded by the European Commission (METABO 2008) that integrates mobile infrastructure for supporting the monitoring, management, and treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.