HealthMap: A cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

Background The leading causes of morbidity and mortality for people in high-income countries living with HIV are now non-AIDS malignancies, cardiovascular disease and other non-communicable diseases associated with ageing. This protocol describes the trial of HealthMap, a model of care for people with HIV (PWHIV) that includes use of an interactive shared health record and self-management support. The aims of the HealthMap trial are to evaluate engagement of PWHIV and healthcare providers with the model, and its effectiveness for reducing coronary heart disease risk, enhancing self-management, and improving mental health and quality of life of PWHIV. Methods/Design The study is a two-arm cluster randomised trial involving HIV clinical sites in several states in Australia. Doctors will be randomised to the HealthMap model (immediate arm) or to proceed with usual care (deferred arm). People with HIV whose doctors are randomised to the immediate arm receive 1) new opportunities to discuss their health status and goals with their HIV doctor using a HealthMap shared health record; 2) access to their own health record from home; 3) access to health coaching delivered by telephone and online; and 4) access to a peer moderated online group chat programme. Data will be collected from participating PWHIV (n = 710) at baseline, 6 months, and 12 months and from participating doctors (n = 60) at baseline and 12 months. The control arm will be offered the HealthMap intervention at the end of the trial. The primary study outcomes, measured at 12 months, are 1) 10-year risk of non-fatal acute myocardial infarction or coronary heart disease death as estimated by a Framingham Heart Study risk equation; and 2) Positive and Active Engagement in Life Scale from the Health Education Impact Questionnaire (heiQ). Discussion The study will determine the viability and utility of a novel technology-supported model of care for maintaining the health and wellbeing of people with HIV. If shown to be effective, the HealthMap model may provide a generalisable, scalable and sustainable system for supporting the care needs of people with HIV, addressing issues of equity of access. Trial registration Universal Trial Number (UTN) U111111506489; ClinicalTrial.gov Id NCT02178930 submitted 29 June 2014

Understanding the Knowledge Needs of Designers During Design Process in Industry

Product success is substantially influenced by satisfaction of knowledge needs of designers, and many tools and methods have been proposed to support these needs. However, adoption of these methods in industry is minimal. This may be due to an inadequate understanding of the knowledge needs of designers in industry. This research attempts to develop a better understanding of these needs by undertaking descriptive studies in an industry. We propose a taxonomy of knowledge, and evaluate this by analyzing the questions asked by the designers involved in the study during their interactions. Using the taxonomy, we converted the questions asked into a generic form. The generic questions provide an understanding about what knowledge must be captured during design, and what its structure should be.

Decision support requirements for intelligent operation of southern grid in India

Control centers (CC) play a very important role in power system operation. An overall view of the system with information about all existing resources and needs is implemented through SCADA (Supervisory control and data acquisition system) and an EMS (energy management system). As advanced technologies have made their way into the utility environment, the operators are flooded with huge amount of data. The last decade has seen extensive applications of AI techniques, knowledge-based systems, Artificial Neural Networks in this area. This paper focuses on the need for development of an intelligent decision support system to assist the operator in making proper decisions. The requirements for realization of such a system are recognized for the effective operation and energy management of the southern grid in India The application of Petri nets leading to decision support system has been illustrated considering 24 bus system that is a part of southern grid.

Information Technology Development Needs in Community Pharmacies : A Strategic Approach

In the context of health care, information technology (IT) has an important role in the operational infrastructure, ranging from business management to patient care. An essential part of the system is medication management in inpatient and outpatient care. Community pharmacists strategy has been to extend practice responsibilities beyond dispensing towards patient care services. Few studies have evaluated the strategic development of IT systems to support this vision. The objectives of this study were to assess and compare independent Finnish community pharmacy owners and staff pharmacists priorities concerning the content and structure of the next generation of community pharmacy IT systems, to explore international experts visions and strategic views on IT development needs in relation to services provided in community pharmacies, to identify IT innovations facilitating patient care services and to evaluate their development and implementation processes, and to assess community pharmacists readiness to adopt innovations. This study applied both qualitative and quantitative methods. A qualitative personal interview of 14 experts in community pharmacy services and related IT from eight countries and a national survey of Finnish community pharmacy owners (mail survey, response rate 53%, n=308), and of a representative sample of staff pharmacists (online survey, response rate 22%, n=373) were conducted. Finnish independent community pharmacy owners gave priority to logistical functions but also to those related to medication information and patient care. The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies. A majority of the international experts shared the vision of community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Community pharmacy IT innovations were rare, which is paradoxical because owners and staff pharmacists perception of their innovativeness was seen as being high. Community pharmacy IT systems development processes usually had not undergone systematic needs assessment research beforehand or evaluation after the implementation and were most often coordinated by national governments without subsequent commercialization. Specifically, community pharmacy IT developments lack research, organization, leadership and user involvement in the process. Those responsible for IT development in the community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies. This could provide systematic guidance for future projects to ensure that potential innovations are based on a sufficient understanding of pharmacy practice problems that they are intended to solve, and to encourage strong leadership in research, development of innovations so that community pharmacists potential innovativeness is used, and that professional needs and strategic priorities will be considered even if the development process is led by those outside the profession.

Support for Integrated Ecosystem Assessments of NOAA’s National Estuarine Research Reserves System (NERRS), Volume I: The Impacts of Coastal Development on the Ecology and Human Well-being of Tidal Creek Ecosystems of the US Southeast

A study was conducted, in association with the Sapelo Island and North Carolina National Estuarine Research Reserves (NERRs), to evaluate the impacts of coastal development on sentinel habitats (e.g., tidal creek ecosystems), including potential impacts to human health and well-being. Uplands associated with southeastern tidal creeks and the salt marshes they drain are popular locations for building homes, resorts, and recreational facilities because of the high quality of life and mild climate associated with these environments. Tidal creeks form part of the estuarine ecosystem characterized by high biological productivity, great ecological value, complex environmental gradients, and numerous interconnected processes. This research combined a watershed-level study integrating ecological, public health and human dimension attributes with watershed-level land use data. The approach used for this research was based upon a comparative watershed and ecosystem approach that sampled tidal creek networks draining developed watersheds (e.g., suburban, urban, and industrial) as well as undeveloped sites. The primary objective of this work was to clearly define the relationships between coastal development with its concomitant land use changes and non-point source pollution loading and the ecological and human health and well-being status of tidal creek ecosystems. Nineteen tidal creek systems, located along the southeastern United States coast from southern North Carolina to southern Georgia, were sampled during summer (June-August), 2005 and 2006. Within each system, creeks were divided into two primary segments based upon tidal zoning: intertidal (i.e., shallow, narrow headwater sections) and subtidal (i.e., deeper and wider sections), and watersheds were delineated for each segment. In total, we report findings on 24 intertidal and 19 subtidal creeks. Indicators sampled throughout each creek included water quality (e.g., dissolved oxygen concentration, salinity, nutrients, chlorophyll-a levels), sediment quality (e.g., characteristics, contaminants levels including emerging contaminants), pathogen and viral indicators, and abundance and genetic responses of biological resources (e.g., macrobenthic and nektonic communities, shellfish tissue contaminants, oyster microarray responses). For many indicators, the intertidally-dominated or headwater portions of tidal creeks were found to respond differently than the subtidally-dominated or larger and deeper portions of tidal creeks. Study results indicate that the integrity and productivity of headwater tidal creeks were impaired by land use changes and associated non-point source pollution, suggesting these habitats are valuable early warning sentinels of ensuing ecological impacts and potential public health threats. For these headwater creeks, this research has assisted the validation of a previously developed conceptual model for the southeastern US region. This conceptual model identified adverse changes that generally occurred in the physical and chemical environment (e.g., water quality indicators such as indicator bacteria for sewage pollution or sediment chemical contamination) when impervious cover levels in the watershed reach 10-20%. Ecological characteristics responded and were generally impaired when impervious cover levels exceed 20-30%. Estimates of impervious cover levels defining where human uses are impaired are currently being determined, but it appears that shellfish bed closures and the flooding vulnerability of headwater regions become a concern when impervious cover values exceed 10-30%. This information can be used to forecast the impacts of changing land use patterns on tidal creek environmental quality as well as associated human health and well-being. In addition, this study applied tools and technologies that are adaptable, transferable, and repeatable among the high quality NERRS sites as comparable reference entities to other nearby developed coastal watersheds. The findings herein will be of value in addressing local, regional and national needs for understanding multiple stressor (anthropogenic and human impacts) effects upon estuarine ecosystems and response trends in ecosystem condition with changing coastal impacts (i.e., development, climate change). (PDF contaions 88 pages)

Ecosystem science capabilities required to support NOAA’s mission in the year 2020

The mission of the National Oceanic and Atmospheric Administration (NOAA) is to understand and predict changes in the Earth’s environment and conserve and manage coastal and marine resources to meet our nation’s economic, social and environmental needs (NOAA, 2004). In meeting its marine stewardship responsibilities, NOAA seeks to ensure the sustainable use of resources and balance competing uses of coastal and marine ecosystems, recognizing both their human and natural components (NOAA, 2004). Authorities for executing these responsibilities come from over 90 separate pieces of Federal legislation, each with unique requirements and responsibilities. Few of these laws explicitly mandate an ecosystem approach to management (EAM) or supporting science. However, resource managers, the science community, and increasingly, the public, are recognizing that significantly greater connectedness among the scientific disciplines is needed to support management and stewardship responsibilities (Browman and Stergiou, 2004; 2005). Neither NOAA nor any other science agency can meet the increasing demand for ecosystem science products addressing each of its mandates individually. Even if it was possible, doing so would not provide the integration necessary to solve the increasingly complex array of management issues. This focus on the integration of science and management responsibilities into an ecosystem view is one of the centerpieces of the U.S. Commission on Ocean Policy’s report (USCOP, 2004), and the Administration’s response to that report in the U.S. Ocean Action Plan (CEQ, 2004). (PDF contains 100 pages)

Modelling the dynamics of phytoplankton with the needs of the end user in mind

How to regulate phytoplankton growth in water supply reservoirs has continued to occupy managers and strategists for some fifty years or so, now, and mathematical models have always featured in their design and operational constraints. In recent years, rather more sophisticated simulation models have begun to be available and these, ideally, purport to provide the manager with improved forecasting of plankton blooms, the likely species and the sort of decision support that might permit management choices to be selected with increased confidence. This account describes the adaptation and application of one such model, PROTECH (Phytoplankton RespOnses To Environmental CHange) to the problems of plankton growth in reservoirs. This article supposes no background knowledge of the main algal types; neither does it attempt to catalogue the problems that their abundance may cause in lakes and reservoirs.

Computer system support for data analysis

This thesis is an investigation into the nature of data analysis and computer software systems which support this activity.

The first chapter develops the notion of data analysis as an experimental science which has two major components: data-gathering and theory-building. The basic role of language in determining the meaningfulness of theory is stressed, and the informativeness of a language and data base pair is studied. The static and dynamic aspects of data analysis are then considered from this conceptual vantage point. The second chapter surveys the available types of computer systems which may be useful for data analysis. Particular attention is paid to the questions raised in the first chapter about the language restrictions imposed by the computer system and its dynamic properties.

The third chapter discusses the REL data analysis system, which was designed to satisfy the needs of the data analyzer in an operational relational data system. The major limitation on the use of such systems is the amount of access to data stored on a relatively slow secondary memory. This problem of the paging of data is investigated and two classes of data structure representations are found, each of which has desirable paging characteristics for certain types of queries. One representation is used by most of the generalized data base management systems in existence today, but the other is clearly preferred in the data analysis environment, as conceptualized in Chapter I.

This data representation has strong implications for a fundamental process of data analysis -- the quantification of variables. Since quantification is one of the few means of summarizing and abstracting, data analysis systems are under strong pressure to facilitate the process. Two implementations of quantification are studied: one analagous to the form of the lower predicate calculus and another more closely attuned to the data representation. A comparison of these indicates that the use of the "label class" method results in orders of magnitude improvement over the lower predicate calculus technique.

Meteorological and hydrologic studies in the Alaskan Arctic in support of long-term ecological research

Long-term hydrologic studies in the Arctic simply do not exist. Although the Arctic has been identified as an area that is extremely sensitive to climate change, continuous scientific research has been limited to the past seven years. Earlier research was spotty, of short duration, and directed at only one or two hydrologic elements. Immediate future research needs to encompass all the major hydrologic elements, including winter processes, and needs to address the problem of scaling from small to larger areas in hydrologic models. Also, an international program of cooperation between northern countries is needed to build a greater scientific base for monitoring and identifying potential changes wrought by the climate.

A Plant Needs Ants like a Dog Needs Fleas: Myrmelachista schumanni Ants Gall Many Tree Species to Create Housing

Hundreds of tropical plant species house ant colonies in specialized chambers called domatia. When, in 1873, Richard Spruce likened plant-ants to fleas and asserted that domatia are ant-created galls, he incited a debate that lasted almost a century. Alth

Dealing with affective needs in e-learning: Contrasting two cases in two cultures.

This chapter presents and contrasts descriptions of two cases of online affective support provided to support students engaged in higher level learning tasks. The cases are set in different cultures, centre upon different intended learning outcomes, and follow different tutorial styles. One (Eastern) tutor acted as a “shepherd leader” in response to needs arising in the Confucian Heritage Culture as the teacher promoted critical thinking, according to the Western model. The other (Western) tutor provided Rogerian facilitation of reflective learning journals, kept by students seeking to develop personal and professional capabilities. In both styles, affective support features strongly. The cultural and pedagogical comparisons between the cases have proved useful to the writers. These distinctions together with the similarities between the two online styles emerge in the comparisons. Keywords: affective needs, asynchronous discussion, Confucian Heritage Culture, constructivism, critical thinking, facilitation, reflection, reflective learning journals, Rogerian, shepherd leadership, social-constructivist, student-centred, support.

NHS Wales user needs study including knowledgebase tools report. Report for Informing Healthcare Strategy implementation programme.

Thomas, R., Spink, S., Durbin, J. & Urquhart, C. (2005). NHS Wales user needs study including knowledgebase tools report. Report for Informing Healthcare Strategy implementation programme. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: Informing Healthcare, NHS Wales

Training needs analysis of healthcare library staff, undertaken for South Yorkshire Workforce Development Confederation

Urquhart, C., Durbin, J. & Spink, S. (2004). Training needs analysis of healthcare library staff, undertaken for South Yorkshire Workforce Development Confederation. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: South Yorkshire WDC (NHS)

Assessing training and professional development needs of library staff. Report for National Library of Health

Urquhart, C., Spink, S. & Thomas, R., Assessing training and professional development needs of library staff. Report for National Library of Health. (2005). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth Sponsorship: National Library for Health (NHS Information Authority)

Caregivers of people with neurodegenerative diseases: profile and unmet needs from a population-based survey in South Australia.

INTRODUCTION: Neurodegenerative diseases (NDD) are characterized by progressive decline and loss of function, requiring considerable third-party care. NDD carers report low quality of life and high caregiver burden. Despite this, little information is available about the unmet needs of NDD caregivers. METHODS: Data from a cross-sectional, whole of population study conducted in South Australia were analyzed to determine the profile and unmet care needs of people who identify as having provided care for a person who died an expected death from NDDs including motor neurone disease and multiple sclerosis. Bivariate analyses using chi(2) were complemented with a regression analysis. RESULTS: Two hundred and thirty respondents had a person close to them die from an NDD in the 5 years before responding. NDD caregivers were more likely to have provided care for more than 2 years and were more able to move on after the death than caregivers of people with other disorders such as cancer. The NDD caregivers accessed palliative care services at the same rate as other caregivers at the end of life, however people with an NDD were almost twice as likely to die in the community (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.30 to 3.01) controlling for relevant caregiver factors. NDD caregivers reported significantly more unmet needs in emotional, spiritual, and bereavement support. CONCLUSION: This study is the first step in better understanding across the whole population the consequences of an expected death from an NDD. Assessments need to occur while in the role of caregiver and in the subsequent bereavement phase.