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.

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.

Understanding digital literacies: a practical introduction

Understanding Digital Literacies provides an accessible and timely introduction to new media literacies. It supplies readers with the theoretical and analytical tools with which to explore the linguistic and social impact of a host of new digital literacy practices. Each chapter in the volume covers a different topic, presenting an overview of the major concepts, issues, problems and debates surrounding the topic, while also encouraging students to reflect on and critically evaluate their own language and communication practices. Features include: coverage of a diverse range of digital media texts, tools and practices including blogging, hypertextual organisation, Facebook, Twitter, YouTube, Wikipedia, websites and games an extensive range of examples and case studies to illustrate each topic, such as how blogs have affected our thinking about communication, how the creation and sharing of digital images and video can bring about shifts in social roles, and how the design of multiplayer online games for children can promote different ideologies a variety of discussion questions and mini-ethnographic research projects involving exploration of various patterns of media production and communication between peers, for example in the context of Wikinomics and peer production, social networking and civic participation, and digital literacies at work end of chapter suggestions for further reading and links to key web and video resources a companion website providing supplementary material for each chapter, including summaries of key issues, additional web-based exercises, and links to further resources such as useful websites, articles, videos and blogs.

Research methods in TESOL and digital literacies

One of the biggest challenges of integrating research in TESOL with research in digital literacies is that the research methodologies of these two traditions have developed out of different ontological and episte- mological assumptions about what is being researched (the object of study), where the research is located (the research site), and who is being researched (the research participants).

Dancing, skating and sex: action and text in the digital age

This paper explores the relationship between discourse and action in practices involved in making and consuming texts. Texts are produced through the process of ‘entextualization’ in which strips of action and discourse are extracted from their original contexts and recontextualized into other situations. Different technologies for turning actions into texts affect the kinds of social actions and social identities that are made possible both at moments of entextualization and at future moments of recontextualization. In particular, I focus on how digital technologies affect the practices and participation structures around entextualization. Digital photography and video have had a profound effect on social practices and relationships around the making of texts. Specifically, they have made processes of entextualization more immediate, more contingent and more communal. Implications of these features of digital text making are discussed in light of previous work on literacy and orality.

e-Leadership through strategic alignment: an empirical study of small and medium sized enterprises in the digital age

Small and medium sized enterprises (SMEs) play an important role in the European economy. A critical challenge faced by SME leaders, as a consequence of the continuing digital technology revolution, is how to optimally align business strategy with digital technology to fully leverage the potential offered by these technologies in pursuit of longevity and growth. There is a paucity of empirical research examining how e-leadership in SMEs drives successful alignment between business strategy and digital technology fostering longevity and growth. To address this gap, in this paper we develop an empirically derived e-leadership model. Initially we develop a theoretical model of e-leadership drawing on strategic alignment theory. This provides a theoretical foundation on how SMEs can harness digital technology in support of their business strategy enabling sustainable growth. An in-depth empirical study was undertaken interviewing 42 successful European SME leaders to validate, advance and substantiate our theoretically driven model. The outcome of the two stage process – inductive development of a theoretically driven e-leadership model and deductive advancement to develop a complete model through in-depth interviews with successful European SME leaders – is an e-leadership model with specific constructs fostering effective strategic alignment. The resulting diagnostic model enables SME decision makers to exercise effective e-leadership by creating productive alignment between business strategy and digital technology improving longevity and growth prospects.

Geography, skills and careers patterns at the boundary of creativity & innovation: digital technology and creative arts graduates in the UK

In the last decades, research on knowledge economies has taken central stage. Within this broader research field, research on the role of digital technologies and the creative industries has become increasingly important for researchers, academics and policy makers with particular focus on their development, supply-chains and models of production. Furthermore, many have recognised that, despite the important role played by digital technologies and innovation in the development of the creative industries, these dynamics are hard to capture and quantify. Digital technologies are embedded in the production and market structures of the creative industries and are also partially distinct and discernible from it. They also seem to play a key role in innovation of access and delivery of creative content. This chapter tries to assess the role played by digital technologies focusing on a key element of their implementation and application: human capital. Using student micro-data collected by the Higher Education Statistical Agency (HESA) in the United Kingdom, we explore the characteristics and location patterns of graduates who entered the creative industries, specifically comparing graduates in the creative arts and graduates from digital technology subjects. We highlight patterns of geographical specialisation but also how different context are able to better integrate creativity and innovation in their workforce. The chapter deals specifically with understanding whether these skills are uniformly embedded across the creative sector or are concentrated in specific sub-sectors of the creative industries. Furthermore, it explores the role that these graduates play in different sub-sector of the creative economy, their economic rewards and their geographical determinants.

Collabowrighting the hyper(play)text: a postdramatic digital poetics

The aim of this research is to exhibit how literary playtexts can evoke multisensory trends prevalent in 21st century theatre. In order to do so, it explores a range of practical forms and theoretical contexts for creating participatory, site-specific and immersive theatre. With reference to literary theory, specifically to semiotics, reader-response theory, postmodernism and deconstruction, it attempts to revise dramatic theory established by Aristotle’s Poetics. Considering Gertrude Stein’s essay, Plays (1935), and relevant trends in theatre and performance, shaped by space, technology and the everchanging role of the audience member, a postdramatic poetics emerges from which to analyze the plays of Mac Wellman and Suzan-Lori Parks. Distinguishing the two textual lives of a play as the performance playtext and the literary playtext, it examines the conventions of the printed literary playtext, with reference to models of practice that radicalize the play form, including works by Mabou Mines, The Living Theatre and Fiona Templeton. The arguments of this practice-led Ph.D. developed out of direct engagement with the practice project, which explores the multisensory potential of written language when combined with hypermedia. The written thesis traces the development process of a new play, Rumi High, which is presented digitally as a ‘hyper(play)text,’ accessible through the Internet at www.RumiHigh.org. Here, ‘playwrighting’ practice is expanded spatially, collaboratively and textually. Plays are built, designed and crafted with many layers of meaning that explore both linguistic and graphic modes of poetic expression. The hyper(play)text of Rumi High establishes playwrighting practice as curatorial, where performance and literary playtexts are in a reciprocal relationship. This thesis argues that digital writing and reading spaces enable new approaches to expressing the many languages of performance, while expanding the collaborative network that produces the work. It questions how participatory forms of immersive and site-specific theatre can be presented as interactive literary playtexts, which enable the reader to have a multisensory experience. Through a reflection on process and an evaluation of the practice project, this thesis problematizes notions of authorship and text.