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.

Behavioral economics, wearable devices, and cooperative games: results from a population-based intervention to increase physical activity

Background: Health care literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the role of Superusers, the small percentage of unusually engaged digital health participants who may influence other members. Objective: The objective of this preliminary study is to analyze descriptive data from GOODcoins, a self-guided, free-to-consumer engagement and rewards platform incentivizing walking, running and cycling. Registered members accessed the GOODcoins platform through PCs, tablets or mobile devices, and had the opportunity to sync wearables to track activity. Following registration, members were encouraged to join gamified group challenges and compare their progress with that of others. As members met challenge targets, they were rewarded with GOODcoins, which could be redeemed for planet- or people-friendly products. Methods: Outcome data were obtained from the GOODcoins custom SQL database. The reporting period was December 1, 2014 to May 1, 2015. Descriptive self-report data were analyzed using MySQL and MS Excel. Results: The study period includes data from 1298 users who were connected to an exercise tracking device. Females consisted of 52.6% (n=683) of the study population, 33.7% (n=438) were between the ages of 20-29, and 24.8% (n=322) were between the ages of 30-39. 77.5% (n=1006) of connected and active members met daily-recommended physical activity guidelines of 30 minutes, with a total daily average activity of 107 minutes (95% CI 90, 124). Of all connected and active users, 96.1% (n=1248) listed walking as their primary activity. For members who exchanged GOODcoins, the mean balance was 4,000 (95% CI 3850, 4150) at time of redemption, and 50.4% (n=61) of exchanges were for fitness or outdoor products, while 4.1% (n=5) were for food-related items. Participants were most likely to complete challenges when rewards were between 201-300 GOODcoins. Conclusions: The purpose of this study is to form a baseline for future research. Overall, results indicate that challenges and incentives may be effective for connected and active members, and may play a role in achieving daily-recommended activity guidelines. Registrants were typically younger, walking was the primary activity, and rewards were mainly exchanged for fitness or outdoor products. Remaining to be determined is whether members were already physically active at time of registration and are representative of healthy adherers, or were previously inactive and were incentivized to change their behavior. As challenges are gamified, there is an opportunity to investigate the role of superusers and healthy adherers, impacts on behavioral norms, and how cooperative games and incentives can be leveraged across stratified populations. Study limitations and future research agendas are discussed.

Use of fused airborne scanning laser altimetry and digital map data for urban flood modelling

Flood modelling of urban areas is still at an early stage, partly because until recently topographic data of sufficiently high resolution and accuracy have been lacking in urban areas. However, Digital Surface Models (DSMs) generated from airborne scanning laser altimetry (LiDAR) having sub-metre spatial resolution have now become available, and these are able to represent the complexities of urban topography. The paper describes the development of a LiDAR post-processor for urban flood modelling based on the fusion of LiDAR and digital map data. The map data are used in conjunction with LiDAR data to identify different object types in urban areas, though pattern recognition techniques are also employed. Post-processing produces a Digital Terrain Model (DTM) for use as model bathymetry, and also a friction parameter map for use in estimating spatially-distributed friction coefficients. In vegetated areas, friction is estimated from LiDAR-derived vegetation height, and (unlike most vegetation removal software) the method copes with short vegetation less than ~1m high, which may occupy a substantial fraction of even an urban floodplain. The DTM and friction parameter map may also be used to help to generate an unstructured mesh of a vegetated urban floodplain for use by a 2D finite element model. The mesh is decomposed to reflect floodplain features having different frictional properties to their surroundings, including urban features such as buildings and roads as well as taller vegetation features such as trees and hedges. This allows a more accurate estimation of local friction. The method produces a substantial node density due to the small dimensions of many urban features.

Innovative implementation of iLearn e-Portfolio for Personal Development Planning

iLearn is a Web 2.0 tool developed in Blackboard to help students with Personal Development Planning (PDP). This paper describes a case study on how the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP benefits the students. The e-Portfolio tool benefits students as it enables them to create and share portfolios, record achievements and reflections that support future job applications and promotion. Students find it beneficial because they can make use of iLearn e-Portfolio to keep academic records and achievements, activities and interests, work experience, reflective practice, employer information and some other useful resources, and also to tailor their CV and covering letters including evidence to support their CV, transferable skills and selling points. Useful information for preparing for an interview, reflecting after an event and any thoughts and evaluation can be kept in iLearn e-Portfolio. Keeping assessment and feedback records in iLearn e-Portfolio enables students to know their progress, to identify any gaps they need to fill to develop their study practices and areas for development. The key points from the feedback on the assignments and assessments are beneficial for future improvement. The reflections on the assignments and how students make use of the advice are particularly useful to improve their overall performance. In terms of pedagogical benefits, the “Individual Learner Profile” records and reviews evidence in verbal communication, basic and higher academic skills, time management, numeracy skill and IT skills, students become increasingly aware of their own strengths and any weaker areas that may require development. The e-Portfolio also provides opportunity for students to reflect on the experience and skills they have gained whilst participating in activities outside their studies. As the iLearn e-Portfolio is a reflective practice tool, it is consistent with the principle of Schon's reflective practitioner to reframe problems and to explore the consequences of actions. From the students’ feedback, for those who engage regularly in iLearn, they are better able to set agendas for their Personal Tutorial meetings and provide their Personal Tutor with a unique record of their achievements, skills and attributes which help them writing effective references for them. They make the most of their student experience in general. They also enhance their transferable skills and employability overall. The iLearn e-Portfolio prepares for the workplace and life beyond University including continuing professional development. Students are aware of their transferable skills, evidence of the skills and skill level, including award or accreditation, and their personal reflection on their transferable skills. It is beneficial for students to be aware of their transferable skills, to produce evidence of the skills and skills level such as award and accreditation, and to record their personal reflection on their transferable skills. Finally, the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP will improve their employability.

Innovative use of e-portfolio for personal development

iLearn is a quasi-Web 2.0 tool developed in Blackboard to help users with Personal Development Planning (PDP). This paper describes a case study on how the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP benefits the users, who are training to be professionals in construction management and surveying, The e-Portfolio tool benefits users as it enables them to create and share portfolios, record achievements and reflections that support future job applications and promotion. Users find it beneficial because they can make use of iLearn e-Portfolio to keep academic records and achievements, activities and interests, work experience, reflective practice, employer information and some other useful resources, and also to tailor their CV and covering letters including evidence to support their CV, transferable skills and selling points. Useful information for preparing for an interview, reflecting after an event and any thoughts and evaluation can be kept in iLearn e-Portfolio. Keeping assessment and feedback records in iLearn e-Portfolio enables learners to know their progress, to identify any gaps they need to fill to develop their study practices and areas for development. The key points from the feedback on the assignments and assessments are beneficial for future improvement. The reflections on the tasks and how they make use of the advice are particularly useful to improve their overall performance. In terms of pedagogical benefits, the “Individual Learner Profile” records and reviews evidence in verbal communication, basic and higher academic skills, time management, numeracy skill and IT skills, learners become increasingly aware of their own strengths and any weaker areas that may require development. The e-Portfolio also provides opportunity for them to reflect on the experience and skills they have gained whilst participating in activities outside their studies. As the iLearn e-Portfolio is a reflective practice tool, it is consistent with the principle of Schon's reflective practitioner to reframe problems and to explore the consequences of actions. From the users’ feedback, for those who engage regularly in iLearn, they are better able to set agendas for their supervision meetings and provide their supervisor with a unique record of their achievements, skills and attributes which help them writing effective references for them. They make the most of their learning experience in general. They also enhance their transferable skills and employability overall. The iLearn e-Portfolio prepares them for the workplace including continuing professional development. Users are aware of their transferable skills, evidence of the skills and skill level, including award or accreditation, and their personal reflection on their transferable skills. It is beneficial for them to be aware of their transferable skills, to produce evidence of the skills and skills level such as award and accreditation, and to record their personal reflection on their transferable skills. Finally, the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP will improve their employability.

The Namib Sand Sea digital database of aeolian dunes and key forcing variables

A new digital atlas of the geomorphology of the Namib Sand Sea in southern Africa has been developed. This atlas incorporates a number of databases including a digital elevation model (ASTER and SRTM) and other remote sensing databases that cover climate (ERA-40) and vegetation (PAL and GIMMS). A map of dune types in the Namib Sand Sea has been derived from Landsat and CNES/SPOT imagery. The atlas also includes a collation of geochronometric dates, largely derived from luminescence techniques, and a bibliographic survey of the research literature on the geomorphology of the Namib dune system. Together these databases provide valuable information that can be used as a starting point for tackling important questions about the development of the Namib and other sand seas in the past, present and future.

The application of affine projection to the development of a siren noise cancellation system

Emergency vehicles use high-amplitude sirens to warn pedestrians and other road users of their presence. Unfortunately, the siren noise enters the vehicle and corrupts the intelligibility of two-way radio voice com-munications from the emergency vehicle to a control room. Often the siren has to be turned off to enable the control room to hear what is being said which subsequently endangers people's lives. A digital signal processing (DSP) based system for the cancellation of siren noise embedded within speech is presented. The system has been tested with the least mean square (LMS), normalised least mean square (NLMS) and affine projection algorithm (APA) using recordings from three common types of sirens (two-tone, wail and yelp) from actual test vehicles. It was found that the APA with a projection order of 2 gives comparably improved cancellation over the LMS and NLMS with only a moderate increase in algorithm complexity and code size. Therefore, this siren noise cancellation system using the APA offers an improvement in cancellation achieved by previous systems. The removal of the siren noise improves the response time for the emergency vehicle and thus the system can contribute to saving lives. The system also allows voice communication to take place even when the siren is on and as such the vehicle offers less risk of danger when moving at high speeds in heavy traffic.

Construction safety and digital design: a review

As digital technologies become widely used in designing buildings and infrastructure, questions arise about their impacts on construction safety. This review explores relationships between construction safety and digital design practices with the aim of fostering and directing further research. It surveys state-of-the-art research on databases, virtual reality, geographic information systems, 4D CAD, building information modeling and sensing technologies, finding various digital tools for addressing safety issues in the construction phase, but few tools to support design for construction safety. It also considers a literature on safety critical, digital and design practices that raises a general concern about ‘mindlessness’ in the use of technologies, and has implications for the emerging research agenda around construction safety and digital design. Bringing these strands of literature together suggests new kinds of interventions, such as the development of tools and processes for using digital models to promote mindfulness through multi-party collaboration on safety

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

Acceptable use policy and employee computer usage: case of Sri Lankan software development industry

Organizations introduce acceptable use policies to deter employee computer misuse. Despite the controlling, monitoring and other forms of interventions employed, some employees misuse the organizational computers to carry out their personal work such as sending emails, surfing internet, chatting, playing games etc. These activities not only waste productive time of employees but also bring a risk to the organization. A questionnaire was administrated to a random sample of employees selected from large and medium scale software development organizations, which measured the work computer misuse levels and the factors that influence such behavior. The presence of guidelines provided no evidence of significant effect on the level of employee computer misuse. Not having access to Internet /email away from work and organizational settings were identified to be the most significant influences of work computer misuse.

The influence of vegetation and building morphology on shadow patterns and mean radiant temperatures in urban areas: model development and evaluation

The solar and longwave environmental irradiance geometry (SOLWEIG) model simulates spatial variations of 3-D radiation fluxes and mean radiant temperature (T mrt) as well as shadow patterns in complex urban settings. In this paper, a new vegetation scheme is included in SOLWEIG and evaluated. The new shadow casting algorithm for complex vegetation structures makes it possible to obtain continuous images of shadow patterns and sky view factors taking both buildings and vegetation into account. For the calculation of 3-D radiation fluxes and T mrt, SOLWEIG only requires a limited number of inputs, such as global shortwave radiation, air temperature, relative humidity, geographical information (latitude, longitude and elevation) and urban geometry represented by high-resolution ground and building digital elevation models (DEM). Trees and bushes are represented by separate DEMs. The model is evaluated using 5 days of integral radiation measurements at two sites within a square surrounded by low-rise buildings and vegetation in Göteborg, Sweden (57°N). There is good agreement between modelled and observed values of T mrt, with an overall correspondence of R 2 = 0.91 (p < 0.01, RMSE = 3.1 K). A small overestimation of T mrt is found at locations shadowed by vegetation. Given this good performance a number of suggestions for future development are identified for applications which include for human comfort, building design, planning and evaluation of instrument exposure.

Effect of acceptable use policy on employee computer use : case of Sri Lankan software development organizations

It is a known fact that some employees misuse the organizational computers to do their personal work such as sending emails, surfing the Internet, chatting, playing games. These activities not only waste productive time of employees but also bring a risk factor to the organization. This affects organizations in the software industry very much as almost all of their employees are connected to the Internet throughout them day./ By introducing an Acceptable Use Policy (AUP) for an organization, it is believed that the computer misuse by its employees could be reduced. In many countries Acceptable Use Policies are used and they have been studied with various perspectives. In Sri Lankan context research on these areas are scarce. This research explored the situation in Sri Lanka with respect to AUPs and their effectiveness./ A descriptive study was carried out to identify the large and medium scale software development organizations that had implemented computer usage guidelines for employees. A questionnaire was used to gather information regarding employee’s usual computer usage behavior. Stratified random sampling was employed to draw a representative sample from the population./ Majority of the organizations have not employed a written guideline on acceptable use of work computers. The study results did not provide evidence to conclude that the presence or non presence of an AUP has a significant difference in computer use behaviors of employees. A significant negative correlation was observed between level of awareness about AUP and misuse. Access to the Internet and organizational settings were identified as significant factors that influence employee computer misuse behavior.

Digital technology and creative arts career patterns in the UK creative economy

The creative industries have attracted the attention of academics and policy makers for the complexity surrounding their development, supply-chains and models of production. In particular, many have recognised the difficulty in capturing the role that digital technologies play within the creative industries. Digital technologies are embedded in the production and market structures of the creative industries and are also partially distinct and discernible from it. This paper unfolds the role played by digital technologies focusing on a key aspect of its development: human capital. Using student micro-data collected by the Higher Education Statistical Agency (HESA) in the United Kingdom, we investigate the characteristics and location determinants of digital graduates. The paper deals specifically with understanding whether digital skills in the UK are equally embedded across the creative industries, or are concentrated in other sub-sectors. Furthermore, it explores the role that these graduates play in each sub-sector and their financial rewards. Findings suggest that digital technology graduates tend to concentrate in the software and gaming sub-sector of the creative industries but also are likely to be in embedded creative jobs outside of the creative industries. Although they are more likely to be in full-time employment than part-time or self-employment, they also suffer from a higher level of unemployment.

Improving the TanDEM-X Digital Elevation Model for flood modelling using flood extents from Synthetic Aperture Radar images

The topography of many floodplains in the developed world has now been surveyed with high resolution sensors such as airborne LiDAR (Light Detection and Ranging), giving accurate Digital Elevation Models (DEMs) that facilitate accurate flood inundation modelling. This is not always the case for remote rivers in developing countries. However, the accuracy of DEMs produced for modelling studies on such rivers should be enhanced in the near future by the high resolution TanDEM-X WorldDEM. In a parallel development, increasing use is now being made of flood extents derived from high resolution Synthetic Aperture Radar (SAR) images for calibrating, validating and assimilating observations into flood inundation models in order to improve these. This paper discusses an additional use of SAR flood extents, namely to improve the accuracy of the TanDEM-X DEM in the floodplain covered by the flood extents, thereby permanently improving this DEM for future flood modelling and other studies. The method is based on the fact that for larger rivers the water elevation generally changes only slowly along a reach, so that the boundary of the flood extent (the waterline) can be regarded locally as a quasi-contour. As a result, heights of adjacent pixels along a small section of waterline can be regarded as samples with a common population mean. The height of the central pixel in the section can be replaced with the average of these heights, leading to a more accurate estimate. While this will result in a reduction in the height errors along a waterline, the waterline is a linear feature in a two-dimensional space. However, improvements to the DEM heights between adjacent pairs of waterlines can also be made, because DEM heights enclosed by the higher waterline of a pair must be at least no higher than the corrected heights along the higher waterline, whereas DEM heights not enclosed by the lower waterline must in general be no lower than the corrected heights along the lower waterline. In addition, DEM heights between the higher and lower waterlines can also be assigned smaller errors because of the reduced errors on the corrected waterline heights. The method was tested on a section of the TanDEM-X Intermediate DEM (IDEM) covering an 11km reach of the Warwickshire Avon, England. Flood extents from four COSMO-SKyMed images were available at various stages of a flood in November 2012, and a LiDAR DEM was available for validation. In the area covered by the flood extents, the original IDEM heights had a mean difference from the corresponding LiDAR heights of 0.5 m with a standard deviation of 2.0 m, while the corrected heights had a mean difference of 0.3 m with standard deviation 1.2 m. These figures show that significant reductions in IDEM height bias and error can be made using the method, with the corrected error being only 60% of the original. Even if only a single SAR image obtained near the peak of the flood was used, the corrected error was only 66% of the original. The method should also be capable of improving the final TanDEM-X DEM and other DEMs, and may also be of use with data from the SWOT (Surface Water and Ocean Topography) satellite.