Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Factors affecting regional SMEs progression to Digital Business Ecosystems

SMEs are widely recognized as an important driving force of economic growth, yet, their uptake of ICT is still very low. Tosupport SMEs ICT adoption and to foster regional development, in 2000, the Lisbon Strategy on the Information Society andKnowledge-based economy created a vision for 2010 towards the creation of the European Digital Business Ecosystems(DBE). This paper is positioned within that context and reports upon a project involving 6000 SMEs whose aim was tosupport ICT adoption and to encourage SME networks through the creation of a Regional Business Portal. The papere xplores factors affecting the regional SMEs participating in the DBE. An in-depth longitudinal case study approach was adopted and multiple sources of evidence were used. Many factors affecting SMEs progression to DBE were identified:including people and organization, environmental, diffusion networks, technological, regional and time factors

Matching roots to their environment

Background Plants form the base of the terrestrial food chain and provide medicines, fuel, fibre and industrial materials to humans. Vascular land plants rely on their roots to acquire the water and mineral elements necessary for their survival in nature or their yield and nutritional quality in agriculture. Major biogeochemical fluxes of all elements occur through plant roots, and the roots of agricultural crops have a significant role to play in soil sustainability, carbon sequestration, reducing emissions of greenhouse gasses, and in preventing the eutrophication of water bodies associated with the application of mineral fertilisers. ● Scope This article provides the context for a Special Issue of Annals of Botany on ‘Matching Roots to Their Environment’. It first examines how land plants and their roots evolved, describes how the ecology of roots and their rhizospheres contributes to the acquisition of soil resources, and discusses the influence of plant roots on biogeochemical cycles. It then describes the role of roots in overcoming the constraints to crop production imposed by hostile or infertile soils, illustrates root phenotypes that improve the acquisition of mineral elements and water, and discusses high-throughput methods to screen for these traits in the laboratory, glasshouse and field. Finally, it considers whether knowledge of adaptations improving the acquisition of resources in natural environments can be used to develop root systems for sustainable agriculture in the future.

English teachers in the digital age – a case study of policy and expert practice from England

This article is a case study of how English teachers in England have coped with the paradigm shift from print to digital literacy. It reviews a large scale national initiative that was intended to upskill all teachers, considers its weak impact and explores the author’s involvement in the evaluation of the project’s direct value to English teachers. It explores how this latter evaluation revealed how best practice in English using ICT was developing in a variable manner. It then reports on a recent small scale research project that investigated how very good teachers have adapted ICT successfully into their teaching. It focuses on how the English teachers studied in the project are developing a powerful new pedagogy situated in the life worlds of their students and suggests that this model may be of benefit to many teachers. The issues this article reports on have resonance in all English speaking countries. This article is also a personal story of the author’s close involvement with ICT and English over 20 years, and provides evidence for his conviction that digital technologies will eventually transform English teaching.

This is me: digital identity and reputation on the Internet

The chapter reports on the ‘This Is Me’ project, that aimed to help students and the wider public to be aware of the impact that online material, particularly that on the Internet, has on their identity and reputation. The chapter explores practical aspects of Digital Identity, relating to issues such as employability, relationships and even death. For example, understanding the impact a photograph posted on a social networking website might have for different groups of people, ranging from friends or parents to future employers. As part of the ‘This is Me’ project stories were collected from students and others about Digital Identity matters, a grounded methodological approach based on action research was used to establish issues related to Digital Identity particularly relevant to those in academia. Drawing from these issues, resources were developed to help inform and educate people about how they can understand and control their own Digital Identity. A number of these resources are presented here, along with reflections on how they are used and can be adapted.

The use of land-sea warming contrast under climate change to improve impact metrics

A favoured method of assimilating information from state-of-the-art climate models into integrated assessment models of climate impacts is to use the transient climate response (TCR) of the climate models as an input, sometimes accompanied by a pattern matching approach to provide spatial information. More recent approaches to the problem use TCR with another independent piece of climate model output: the land-sea surface warming ratio (φ). In this paper we show why the use of φ in addition to TCR has such utility. Multiple linear regressions of surface temperature change onto TCR and φ in 22 climate models from the CMIP3 multi-model database show that the inclusion of φ explains a much greater fraction of the inter-model variance than using TCR alone. The improvement is particularly pronounced in North America and Eurasia in the boreal summer season, and in the Amazon all year round. The use of φ as the second metric is beneficial for three reasons: firstly it is uncorrelated with TCR in state-of-the-art climate models and can therefore be considered as an independent metric; secondly, because of its projected time-invariance, the magnitude of φ is better constrained than TCR in the immediate future; thirdly, the use of two variables is much simpler than approaches such as pattern scaling from climate models. Finally we show how using the latest estimates of φ from climate models with a mean value of 1.6—as opposed to previously reported values of 1.4—can significantly increase the mean time-integrated discounted damage projections in a state-of-the-art integrated assessment model by about 15 %. When compared to damages calculated without the inclusion of the land-sea warming ratio, this figure rises to 65 %, equivalent to almost 200 trillion dollars over 200 years.

The unsteady flow of a weakly compressible fluid in a thin porous layer. I: Two-dimensional theory

We consider the problem of determining the pressure and velocity fields for a weakly compressible fluid flowing in a two-dimensional reservoir in an inhomogeneous, anisotropic porous medium, with vertical side walls and variable upper and lower boundaries, in the presence of vertical wells injecting or extracting fluid. Numerical solution of this problem may be expensive, particularly in the case that the depth scale of the layer h is small compared to the horizontal length scale l. This is a situation which occurs frequently in the application to oil reservoir recovery. Under the assumption that epsilon=h/l<<1, we show that the pressure field varies only in the horizontal direction away from the wells (the outer region). We construct two-term asymptotic expansions in epsilon in both the inner (near the wells) and outer regions and use the asymptotic matching principle to derive analytical expressions for all significant process quantities. This approach, via the method of matched asymptotic expansions, takes advantage of the small aspect ratio of the reservoir, epsilon, at precisely the stage where full numerical computations become stiff, and also reveals the detailed structure of the dynamics of the flow, both in the neighborhood of wells and away from wells.

Fine wire resistance thermometer amplifier for atmospheric measurements

An improved amplifier for atmospheric fine wire resistance thermometry is described. The amplifier uses a low excitation current (50 mu A). This is shown to ensure negligible self-heating of the low mass fine wire resistance sensor, compared with measured nocturnal surface air temperature fluctuations. The system provides sufficient amplification for a +/- 50 degrees C span using a +/- 5 V dynamic range analog-to-digital converter, with a noise level of less than 0.01 degrees C. A Kelvin four-wire connection cancels the effect of long lead resistances: a 50 m length of screened cable connecting the Reading design of fine wire thermometer to the amplifier produced no measurable temperature change at 12 bit resolution.

Thermopile radiometer signal conditioning for surface atmospheric radiation measurements

A highly stable microvolt amplifier for use with atmospheric broadband thermopile radiometers is described. The amplifier has a nominal gain of 500, for bipolar input signals in the range +/- 10 mV from a floating source. The noise level at the input is less than 5 mu V (at 100 k Omega input impedance), permitting instantaneous diffuse solar radiation measurements to 0.5 W m(-2) resolution with 12 bit analog to digital conversion. The temperature stability of gain is better than 5 ppm/degrees C (-4 to 20 degrees C). Averaged over a decade of use, the long term drift of the amplifier gain is less than similar to 0.02%/yr. As well as radiometers measuring solar and terrestrial radiations, the amplifier has also been successfully used with low level signals from thermocouples and ground heat flux plates.

Development of a capillary electrophoresis method for the simultaneous analysis of artificial sweeteners, preservatives and colours in soft drinks

A rapid capillary electrophoresis method was developed simultaneously to determine artificial sweeteners, preservatives and colours used as additives in carbonated soft drinks. Resolution between all additives occurring together in soft drinks was successfully achieved within a 15-min run-time by employing the micellar electrokinetic chromatography mode with a 20 mM carbonate buffer at pH 9.5 as the aqueous phase and 62 mM sodium dodecyl sulfate as the micellar phase. By using a diode-array detector to monitor the UV-visible range (190-600 nm), the identity of sample components, suggested by migration time, could be confirmed by spectral matching relative to standards.

Are herbal remedies and dietary supplements safe and effective for breast cancer patients?

There remains limited scientific evidence on the efficacy and safety of 'natural' therapies such as herbal remedies and dietary supplements. Nevertheless, breast cancer patients are particularly prone to purchasing such products because of the perception that 'natural' products are less toxic than conventional prescribed medicines. However, the potential for interactions of supplements with current medications, the potential for adverse effects from consumption at high levels, and the lack of disclosure of such treatments by the patient to their doctor are serious public health issues. Robust clinical trials are required to prove the efficacy and lack of adverse effects of such preparations, and communication between patients and doctors must be improved and doctors made more aware that their patients may be seeking advice and treatment from sources outside conventional medicine.

Theoretical perspectives on the development of a meta-methodology for value management

This paper provides a new set of theoretical perspectives on the topic of value management in building procurement. On the evidence of the current literature it is possible to identify two distinct methodologies which are based on different epistemological positions. An argument is developed which sees these two methodologies to be complementary. A tentative meta-methodology is then outlined for matching methodologies to different problem situations. It is contended however that such a meta-methodology could never provide a prescriptive guide. Its usefulness lies in the way in which it provides the basis for reflective practice. Of central importance is the need to understand the problem context within which value management is to be applied. The distinctions between unitary, pluralistic and coercive situations are seen to be especially significant.