Comparative analysis of meta-analysis methods: when to use which?

Background: Several meta-analysis methods can be used to quantitatively combine the results of a group of experiments, including the weighted mean difference, statistical vote counting, the parametric response ratio and the non-parametric response ratio. The software engineering community has focused on the weighted mean difference method. However, other meta-analysis methods have distinct strengths, such as being able to be used when variances are not reported. There are as yet no guidelines to indicate which method is best for use in each case. Aim: Compile a set of rules that SE researchers can use to ascertain which aggregation method is best for use in the synthesis phase of a systematic review. Method: Monte Carlo simulation varying the number of experiments in the meta analyses, the number of subjects that they include, their variance and effect size. We empirically calculated the reliability and statistical power in each case Results: WMD is generally reliable if the variance is low, whereas its power depends on the effect size and number of subjects per meta-analysis; the reliability of RR is generally unaffected by changes in variance, but it does require more subjects than WMD to be powerful; NPRR is the most reliable method, but it is not very powerful; SVC behaves well when the effect size is moderate, but is less reliable with other effect sizes. Detailed tables of results are annexed. Conclusions: Before undertaking statistical aggregation in software engineering, it is worthwhile checking whether there is any appreciable difference in the reliability and power of the methods. If there is, software engineers should select the method that optimizes both parameters.

State of the Art and Future Trends in Grid Codes Applicable to Isolated Electrical Systems

Electrical power systems are changing their traditional structure, which was based on a little number of large generating power plants placed at great distances from loads by new models that tend to split the big production nodes in many smaller ones. The set of small groups which are located close to consumers and provide safe and quality energy is called distributed generation (DG). The proximity of the sources to the loads reduces losses associated with transportation and increases overall system efficiency. DG also favors the inclusion of renewable energy sources in isolated electrical systems or remote microgrids, because they can be installed where the natural resource is located. In both cases, as weak grids unable to get help from other nearby networks, it is essential to ensure appropriate behavior of DG sources to guarantee power system safety and stability. The grid codes sets out the technical requirements to be fulfilled for the sources connected in these electrical networks. In technical literature it is rather easy to find and compare grid codes for interconnected electrical systems. However, the existing literature is incomplete and sparse regarding isolated electrical systems and this happens due to the difficulties inherent in the pursuit of codes. Some countries have developed their own legislation only for their island territory (as Spain or France), others apply the same set of rules as in mainland, another group of island countries have elaborated a complete grid code for all generating sources and some others lack specific regulation. This paper aims to make a complete review of the state of the art in grid codes applicable to isolated systems, setting the comparison between them and defining the guidelines predictably followed by the upcoming regulations in these particular systems.

Decodificar Sejima‐SANAA: Estrategias formales y estructurales en su trayectoria de proyecto, 1987 a 2010; de la Casa Platform I al Centro Rolex

La Tesis decodifica una selección de veinte proyectos representativos de Sejima-SANAA, desde su primer proyecto construido, la Casa Platform I, 1987, hasta el Centro Rolex, 2010, año en que Sejima y Nishizawa –SANAA- reciben el Premio Pritzker. De los veinte proyectos once son de Sejima: Casa Platform I, Casa Platform II, Residencia de Mujeres, Casa N, Pachinco Parlor I, Villa en el Bosque, Comisaría en Chofu, Casa Y, Apartamentos en Gifu, Edificio de equipamientos en la Expo Tokio 96, Pachinko Parlor III; y nueve de SANAA: edificio Multimedia en Oogaki, estudio de viviendas metropolitanas,Park Café en Koga, De Kunstlinie en Almere, Museo de Kanazawa, Pabellón de Toledo, Escuela de Zollverein, Casa Flor y Centro Rolex. La decodificación lee la obra de Sejima-SANAA a la inversa para ‘reconstruir’, en un ejercicio de simulación ficticia, una versión verosímil y coherente de los que podrían haber sido sus procesos proyectuales; podrían, porque los verdaderos son imposibles de dilucidar. Los que se proponen se pretenden exclusivamente verosímiles y plausibles. Con ello se pretende contribuir al entendimiento y comprensión de la arquitectura de Sejima-SANAA y, tangencialmente y en menor medida, a la teoría sobre el ejercicio proyectual arquitectónico. La decodificación se centra en dos aspectos concretos: la forma arquitectónica y el papel proyectual de la estructura portante. Ambas decodificaciones se extienden inevitablemente a otros aspectos relacionados, como, por ejemplo, la naturaleza del espacio arquitectónico. El procedimiento de investigación partió de una descripción objetiva y pormenorizada de los significantes formales y estructurales de cada proyecto desde su propia configuración física y geométrica. Esa descripción ‘objetiva’, llevada al límite, permitió que afloraran estructuras conceptuales y lógicas subyacentes de cada proyecto. Unida a interpretación crítica, –mediante su relación y confrontación con otras arquitecturas y otros modos de hacer conocidos- permitió trazar la reconstitución ficticia que persigue la decodificación. Ese trabajo se materializó en veinte ensayos críticos y se acompañó de un conjunto de otros textos sobre temas sugeridos o reclamados por el proceso de investigación. El conjunto de todos esos textos constituye el material de trabajo de la tesis. A partir de ahí, con una visión de conjunto, la tesis identifica una trayectoria de estrategias formales y una trayectoria de estrategias proyectuales relacionadas con lo portante. Juntas conforman el grueso de la tesis que se expone en los cuatro capítulos centrales. Los precede un capítulo introductorio que expone el recorrido biográfico de K. Sejima y la trayectoria profesional de Sejima-SANAA; y los siguen de unos textos transversales sobre forma, lugar y espacio. La tesis termina con una síntesis de sus conclusiones. Las estrategias formales se exponen en tres capítulos. El primero, ‘Primeras estrategias formales’ agrupa proyectos de la primera etapa de Sejima. El segundo capítulo está dedicado enteramente al proyecto de los apartamentos en Gifu, 1994-98, que según esta tesis, supuso un importante punto de inflexión en la trayectoria de Sejima; tanto el tercer capítulo lleva por nombre ‘Estrategias formales después de Gifu’ y recoge los proyectos que le siguieron. Las ‘Primeras estrategias formales’, varias y balbucientes, se mueven en general en torno a dos modos o procedimientos de composición, bien conocidos: por partes y sistemático. Éste última inicia en la trayectoria de SANAA un aspecto que va a ser relevante de aquí en adelante: entender el proyecto como propuesta genérica en la que, más allá de su realidad específica y tangible, subyace una lógica, en cada proyecto la suya, extrapolable a otros lugares, otras dimensiones, incluso otros programas: cada proyecto podría dar lugar a otros proyectos de la misma familia. La composición sistemática incluye, entre otros, la Casa Platform II, basada en la definición de un elemento constructivo, y la formulación de unas leyes de repetición y de posibles modos de agrupación. Incluye también la Residencia de Mujeres Saishunkan Seiyaku- proyecto que lanzó a Sejima a la fama internacional-, que también sería un sistema, pero distinto: basado en la repetición regular de una serie de elementos a lo largo de una directriz generando un hipotético contenedor infinito del que el proyecto sería tan solo un fragmento. La estrategia formal del edificio de Gifu ahondaría en la voluntad genérica del proyecto, adoptando la lógica de un juego. El proyecto sería una partida del juego, pero no la única posible, podrían jugarse otras. Esta hipótesis del juego está verificada en ‘El Juego de Gifu’ que - tras formular el juego identificando sus elementos (tablero y fichas), reglas y procedimientos- juega una partida: la que habría dado lugar al edificio proyectado por Sejima. Gifu extiende el concepto de ‘repetir’ un elemento constructivo a la de repetir un patrón espacial, lo que conlleva: la desvinculación entre forma y función; y un nuevo concepto de flexibilidad, que deja de referirse al uso flexible del edificio construido para pertenecer al momento proyectual en que se asignan funciones específicas a los patrones espaciales. Esta tesis propone que esa asignación de funciones sería uno de los últimos eslabones del proceso proyectual, algo opuesto a la premisa moderna de “la forma sigue a la función”. Las estrategias formales ‘Después de Gifu’ tienen también lógicas de juego, pero cada estrategia responde a un juego distinto, como dejan entrever sus nombres: ‘Tableros de Juego’, que con distintos grados de madurez estaría presente en varios proyectos; ‘Elementos de Catálogo’ en el Museo de Kanazawa; ‘Forma apriorística’, en la Casa Flor y ‘Repetición de una situación topológica’, en el Centro Rolex. Todas esas estrategias, o juegos, mantienen aspectos comunes relativos a la forma arquitectónica, precisamente los aspectos Gifu: la repetición aplicada al patrón espacial, y lo que conlleva: desvinculación entre forma y función y la nueva acepción de flexibilidad. ‘Tableros de Juego’ consiste en configurar cada sistema de proyecto (estructura, cerramientos, particiones y mobiliario) eligiendo elementos ofrecidos por una geometría de base, en cada proyecto la suya, en general reticular: intersecciones, líneas, módulos. Cada sistema se configura, en principio, sin relación de subordinación con cualquiera de los demás; cuando esa subordinación es ineludible, el juego determina que el sistema portante no puede materializar el orden geométrico de base, lo que se traduce en que no ejerce el papel dominante. Por lo tanto, ‘Tableros de Juego’ transgrede la lógica de la planta libre moderna: la estructura ni refleja ni revela el orden de base y los sistemas no respetan las relaciones de subordinación jerárquica y encadenada que aquella determinaba. Esta estrategia de ‘Tableros de juego’ deriva en soluciones y proyectos formales muy distintos: los proyectos de Oogaki y Park Café, que presentarían ‘Tableros de Juego’ incipientes; De Kunstlinie en Almere y la Escuela de Zollverein, que presentarían una consolidación de esta estrategia; y el Pabellón de Vidrio de Toledo que resultaría de la subversión de la estrategia. Este último proyecto, además, lleva el concepto de repetición más allá del elemento constructivo y del patrón espacial (que en este caso tiene forma de burbuja) parar acabar afectando a la propia experiencia del espectador, que esté donde esté, siempre tiene la sensación de estar en el mismo sitio. Esta tesis denomina a ese espacio repetitivo como ‘espacio mantra’. La estrategia ‘Elementos de Catálogo’ se ilustra con el Museo de Kanazawa. Su lógica parte de la definición de una serie de elementos, muy pocos, y se basa en el ingente número de posibles combinaciones entre sí. Gifu habría anunciado el catalogo de elementos en la caracterización de sus patrones espaciales. La estrategia ‘Forma Apriorística’ se ilustra con la Casa Flor. La decisión sobre el tipo de forma -en este caso la de una ameba- estaría al principio del proceso proyectual, lo que no quiere decir que sea una forma arbitraria: la forma de la ameba lleva implícita la repetición de un patrón espacial (el seudópodo) y una apoteosis del concepto de repetición que, alcanzando la experiencia espacial, da lugar a un espacio repetitivo o mantra. El ‘Espacio Mantra’ es uno de los leitmotivs, que se emplean como argumento en la última estrategia formal que la Tesis decodifica: el Centro Rolex. Con respecto a la estructura portante, la tesis identifica y traza una trayectoria de cinco estrategias proyectuales: preeminencia, ocultación, disolución, desaparición y desvirtuación. --Ocultación, reduce el papel dominante de la estructura. Al principio es una ocultación literal, casi un tapado de los elementos estructurales, como en Gifu; luego se hace más sofisticada, como la ocultación por camuflaje o la paradójica ocultación por multiplicación de Park Café. --La disolución merma la condición dominante de la estructura que en lugar de configurarse como sistema unitario u homogéneo se fragmenta en varios subsistemas. --La desaparición se refiere a estructuras que desaparecen como sistemas propios y autónomos, a proyectos en los que la función portante es desempeñada por otros sistemas como el de las particiones. La desaparición culmina con la Casa Flor, cuyo perímetro ejerce la función portante y además es transparente, está desmaterializado: la estructura se ha hecho invisible, ha desaparecido. --La desvirtuación se refiere a estructuras que sí se presentan como sistemas propios y autónomos, pero dejan de tener un papel preeminente por cuanto no materializan el orden de base: esta estrategia es correlativa a la estrategia formal ‘Tableros de juego’. Las conclusiones de la tesis están en la propia organización de la tesis: la identificación de las estrategias. Aún así, y como epílogos, se exponen seis. Las dos primeras subrayan el hilo conductor del trabajo realizado, que radica en la cualidad genérica de las estrategias proyectuales en Sejima-SANAA. Las cuatro siguientes dilucidan hasta qué punto hay, en sus proyectos, rasgos o significantes formales y/o estructurales que sean a su vez señales características del panorama arquitectónico contemporáneo; y plantean la pregunta estrella: ¿hay algunos que, apuntando más lejos, supongan aportaciones originales? --Como aportaciones originales la tesis destaca: la identificación entre el ideal genérico y proyecto concreto; y la propuesta de un espacio nuevo, híbrido, una suerte de estadio intermedio entre el espacio subdividido y compartimentado de la tradición y el continuo moderno. --Como síntomas de contemporaneidad se destacan: respecto de la forma, la traslación de la especificidad formal de la parte al conjunto; y respecto de la estructura, la tendencia contemporánea a hacer estructuras cada vez más ligeras y livianas, que tienden a lo evanescente. Ésta última, la tendencia al evanescencia estructural, podría tener la condición de aportación original, no en vano la desaparición de la estructura lleva la evanescencia hacia sus últimas consecuencias, y en el caso de estructuras con presencia física, hace que dejen de ser el sistema ordenador orquestador del proceso proyectual. ABSTRACT The Thesis decodes a selection of twenty representative Sejima-SANAA projects, from the first one built, the Platform I House in 1987, to the Rolex Center in 2010, year in which Sejima and Nishizawa –SANAA- received the Pritzker Prize. Eleven projects are from Sejima: Platform I, Platform II, Saishunkan Seiyaku Women´s Dormitory, N- House, Pachinco Parlor I, Villa in the Forest, Policy Box at Chofu Station, Y-House, Gifu Kitigata Apartment, World City Expo ´96 Facilities Building, Pachinko Parlor III; and nine from SANAA: Multimedia Workshop in Ogaki, Metropolitan Housing Studies, Park Café in Koga, De Kunstlinie in Almere, Kanazawa Museum, Glass Pavilion at the Toledo Museum of Art, Zollverein School, Flower House and the Rolex Center. This decoding reads the Sejima-SANAA’s projects inversely aiming ‘to reconstruct', in a fictitious simulation exercise, a likely and coherent version of what her/their projectual processes ‘could’ have been; ‘could’, because the true ones are impossible to explain. The ones proposed here pretend only to be likely and reasonable. By so doing the Thesis tries to contribute to the understanding and comprehension of Sejima-SANAA architecture and, tangentially and to a lesser extent, to the theory of architectural projects exercise. Decoding centers in two specific aspects: architectural form, and projectual role of the load bearing structure. Both decodes inevitably extend to other related aspects such as, for example, the nature of space. The research procedure begun by carrying out an objective and detailed description of the formal and structural signifiers of each project; looking at them from their physical and geometric configuration. Taken to the limit, the ‘objective’ descriptions allowed the conceptual structures and underlying logics of each project to arise. Together with critical interpretations, which related and confronted them with other architectures and well-known projectual working ways, it became possible to outline and trace the intended fictitious reconstruction decodes. The descriptive analytical work materialized in twenty critical essays, and was accompanied by a set of other essays on subjects suggested or demanded by the research process. Together, all those texts were the material basis on which thesis work was built. Looking at the whole and taking it from there, the thesis identifies two related projectual trajectories: a trajectory of formal strategies and a trajectory of strategies having to do with structural systems and components. Both, together, constitute the bulk of the thesis, as presented in the four central chapters. Preceding them there is an introductory chapter outlining the biographical path of Kazuyo Sejima and the professional trajectory of Sejima-SANAA. And following them there is another one containing transversal texts on form, place and space. The thesis ends with a synthesis on conclusions. The formal strategies are displayed in three chapters. The first one, `Early formal strategies' groups the first phase projects by Sejima. The second one, ‘Formal strategies of Gifu’s paradigm’, is entirely dedicated to the Gifu apartments project, 1994-98, which according to this thesis meant an important inflexion point in Sejima’s trajectory; so much so that the third chapter is named `Formal strategies after Gifu' and gathers the selected projects that followed it. The ‘Early formal strategies', diverse and tentative, move in general around two well-known projectual composition methods ‘composition by parts’, and ‘systematic composition’. This last one –systematic composition- begins and leads in SANAA’s trajectory an aspect which will remain relevant from here on: the understanding of the project as if it were an specific instance of a generic proposal in which -below and beyond the project tangible reality- there lays a logic that could be applicable at other places, for other dimensions, even with other programs; from each project, other projects of the same family could rise. The set of projects using this systematic composition method include, among others, the ‘Platform II House, based on the definition of a constructive element and of rules having to do with its replicas and their possible groupings. It also includes the Saishunkan Seiyaku Women Residence -project that launched Sejima to international fame- that could also be seen as a system, but of a different kind: a system based on the regular repetition of a series of elements along a directive line, thus generating a hypothetical infinite container of which the project would be only a fragment. The formal strategy of the Gifu apartments building would push further towards the generic project concept, adopting the logic of a game. The project would be a bout, a round, one play…, but not the only possible one; others could be played. The thesis confirms this game hypothesis -after having formulated `The Game of Gifu' and identified its elements (board, chips, rules and procedures)- playing the one play from which the building as projected by Sejima would have raised. Gifu extends the concept of ‘repeating a constructive element’ to that of ‘repeating a space pattern element’, and to what it implies: the decoupling of form and function, leading to a new concept of flexibility that no longer refers to the flexible use of the constructed building but to the projectual moment at which the specific functions are assigned to the space patterns. This thesis proposes that this allocation of functions would be one of the last steps in projectual process, quite opposite from the modern premise: “form follows function”. The Formal strategies after Gifu do also have a game logic; but, as their names reveal, each strategy responds to a different game: ‘Game Boards’, present with different maturity levels in several projects; ‘Elements from a Catalogue’, in the Kanazawa Museum; ‘Aprioristic Form’, in the Flower House; and ‘Repetition of a topologic situation', in the Rolex Center. All of these strategies, or games, maintain common aspects having to do with architectural form; aspects that were already present, precisely, in Gifu: repetition of space pattern units, uncoupling of form and function, and a new meaning of flexibility. -`Game Boards’ consists on setting up a base geometry -each project his, generally reticular- and give form to each project system (structure, closings, partitions and furniture) by choosing elements -intersections, lines, modules- it offers. Each project system is formed, in principle, with no subordinated relation with any of the others; when subordination is unavoidable, the game rules determine that the load bearing structural system may not be the one to materialize the base geometric order, which means that it does not exert the dominant role. Therefore, ‘Game Boards' transgresses the Modern logic, because the structure neither reflects nor reveals the base order, and because the systems do not respect any of the hierarchic and chained subordination relations that the ‘free plan’ called for. ‘Game Boards' leads to quite different solutions and formal projects: the Oogaki and Park Coffee projects show incipient Game Boards; The Almere Kunstlinie and the Zollverein School present consolidations of this strategy; and the Toledo’s Glass Pavilion results from subverting the strategy. In addition, the Toledo project takes the repetition concept beyond that of using a constructive element and a space pattern element (in this case with a bubble form) to end up affecting the personal experience of the spectator, who, wherever he is, feels to always be in the same place. This thesis denominates that repetitive space as ‘Mantra space '. -‘Elements from a Catalogue’ is shown with the Kanazawa Museum. Its logic starts from the definition of a series of elements, very few, and it is based on the huge number of possible combinations among them. The ‘Elements from a Catalogue’ approach was announced in the Gifu project when characterizing its space pattern elements. -Aprioristic Form' is illustrated by the Flower House. The decision on the type of form -in this case the form of an amoeba- would be the beginning of the projectual process, but it does not mean it is arbitrary form: the amoeba form implies repeating a space pattern (pseudopodia) and an apotheosis of the repetition concept: embracing the space experience, it gives rise to a repetitive or mantra space. ‘Mantra Space’ is one of leitmotivs used as an argument in the last formal strategy Thesis decodes: the Rolex Center. With respect to the ‘Projectual strategies of the load bearing structure’, the thesis finds and traces a trajectory of five projectual strategies: ‘preeminence, concealment, dissolution, disappearance and desvirtuación’. --Preeminence is present in Sejima’s first works in which she resorts to structures which have a dominant preeminent role in the project in so far as they impersonate the greater scale and/or materialize the base geometric order. In later works that preeminence will be inverted, the projects aiming towards its opposite: lighter, slighter, smaller structures. -Concealment reduces the dominant role of the structure. At the outset concealment is literal, almost hiding the structural elements, as in Gifu; soon it will become more sophisticated, such as the concealment by camouflage or the paradoxical concealment by multiplication in the Koga Park Café. -Dissolution diminishes the dominant condition of the structure: instead of its’ being configured as unitary or homogenous system is fragmented in several subsystems. -Disappearance talks about structures that fade away as self referred and independent systems; projects in which the load bearing function is carried out by other systems such as the set of partitions. Disappearance reaches its zenith at the Flower House, whose perimeter functions structurally being, in addition, transparent, immaterial: its structure has become invisible, has disappeared. -Desvirtuación talks about structures that do appear like independent self-systems, but which that do not longer have a preeminent paper, inasmuch as they do not materialize the base order. This strategy correlates with the ‘Game Boards’ formal strategy. The thesis conclusions are show by the organization of the thesis itself: its identification of the different strategies. Even so, as epilogues, the thesis exposes six ‘Conclusions’. The first two emphasize the leading thread of the work done, rooted in the generic quality of the Sejima-SANAA projectual strategies. The following four expound to what extent their projects show features, or formal and/or structural signifiers, which also are or can be read as characteristic signals of the contemporary architectonic panorama, and raise the key question: aiming farther, may some of them be taken as original contributions? -As original contributions the conclusions highlight: the identification between the generic ideal and the concrete project; and the proposal of a new, hybrid space, kind of an intermediate stage between the traditional subdivided compartmented space and the continuous modern. -As symptoms of contemporaneousness: in relation to the form it highlights the transferring of the formal specificity from the part to the whole; and in relation to the structure, it underscore the contemporary tendency towards lighter and growingly slimmer structures, tending to the evanescent. This last one, the tendency towards structural evanescence, could have condition of being an original contribution, not in vain it carries the structural disappearance towards its last consequences; and in the case of structures with physical presence, it makes them to cease being the ordering system orchestrating the projectual process.

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.

Modeling the dynamics of human hair cycles by a follicular automaton

The hair follicle cycle successively goes through the anagen, catagen, telogen, and latency phases, which correspond, respectively, to hair growth, arrest, shedding, and absence before a new anagen phase is initiated. Experimental observations collected over a period of 14 years in a group of 10 male volunteers, alopecic and nonalopecic, allowed us to determine the characteristics of scalp hair follicle cycles. On the basis of these observations, we propose a follicular automaton model to simulate the dynamics of human hair cycles. The automaton model is defined by a set of rules that govern the stochastic transitions of each follicle between the successive states anagen, telogen, and latency, and the subsequent return to anagen. The transitions occur independently for each follicle, after time intervals given stochastically by a distribution characterized by a mean and a variance. The follicular automaton model accounts both for the dynamical transitions observed in a single follicle and for the behavior of an ensemble of independently cycling follicles. Thus, the model successfully reproduces the evolution of the fractions of follicle populations in each of the three phases, which fluctuate around steady-state or slowly drifting values. We apply the follicular automaton model to the study of spatial patterns of follicular growth that result from a spatially heterogeneous distribution of parameters such as the mean duration of anagen phase. When considering that follicles die or miniaturize after going through a critical number of successive cycles, the model can reproduce the evolution to hair patterns similar to well known types of diffuse or androgenetic alopecia.

Evaluating knowledge-based approaches to the multilingual extension of a temporal expression normalizer

The extension to new languages is a well known bottleneck for rule-based systems. Considerable human effort, which typically consists in re-writing from scratch huge amounts of rules, is in fact required to transfer the knowledge available to the system from one language to a new one. Provided sufficient annotated data, machine learning algorithms allow to minimize the costs of such knowledge transfer but, up to date, proved to be ineffective for some specific tasks. Among these, the recognition and normalization of temporal expressions still remains out of their reach. Focusing on this task, and still adhering to the rule-based framework, this paper presents a bunch of experiments on the automatic porting to Italian of a system originally developed for Spanish. Different automatic rule translation strategies are evaluated and discussed, providing a comprehensive overview of the challenge.

Address of the Trustees of a London Charity School to the Parent of a proposed scholar, 1776 June 24

This two-and-a-half-page handwritten document contains a copy of a set of rules for a parent of a school identified as "Saint Mary Rotherhith United Society."

Economic Implications of Enlargement. Bruges European Economic Policy (BEEP) Briefing 1/2002

The Eastern enlargement is about to be decided by the European Council. As expected, the “end game “ of the negotiations and assessments is heavily biased by a narrow perspective on net transfers, on income compensations to Central European farmers and on the psychological politics of a single “big bang “. None of these three so-called key items of the end game are of much relevance to appreciate the significance of enlargement. Net transfers have little to do with the costs and benefits of club membership for countries which pay, and can lead to addiction and lethargy rather than extra growth if market integration, macro-economic stability and domestic reforms are not taken serious (as the case of Greece before 1997 has demonstrated). Income compensations for Eastern farmers are crucial for this pressure group, and symbolically of some importance in domestic politics because of the perversity that rich farmers get more, but their absence is likely to serve the public interest in candidate countries far better. And being part of the big bang, as against getting in one or three years later, has assumed a dramatic meaning during this end game, far beyond its true proportions. This hectic European theatre tends to obscure what enlargement is mainly about, now that the stability and values have been secured for the peoples from Central Europe. In a guaranteed setting of peace, freedom and security, enlargement is about greater prosperity.

The Political Logic of Disintegration: Seven Lessons from the Soviet Collapse. CEPS Essay (No. 1), September 2012

In short, the European Union, as we know it, no longer exists. The very foundations on which it was built are eroding. Shared memories of the Second World War have faded away – half the 15- and 16-year-olds in German high schools do not know that Hitler was a dictator, while a third believe that he protected human rights. The collapse of the Soviet Union has stripped away the geopolitical rationale for European unity. The democratic welfare state that was at the heart of the post-war political consensus is under siege by, among other things, sheer demographics. And the prosperity that bolstered the European project’s political legitimacy is vanishing. More than six out of ten Europeans believe that the lives of today’s children will be more difficult than those of people from their own generation. Against this background, how unthinkable is the EU’s disintegration? Should Europeans make the mistake of taking the Union for granted? Should they assume that the Union would not collapse because it should not collapse? Here, Europe’s capacity to learn from the Soviet precedent could play a crucial part. For the very survival of the EU may depend on its leaders’ ability to manage a similar mix of political, economic and psychological factors that were in play in the process of the Soviet collapse. The game of disintegration is primarily a political one driven much more by the perceptions and misperceptions of the political actors than simply by the constellation of the structural factors – institutional and economic.

Updating on the Credences of Others: Disagreement, Agreement, and Synergy

We introduce a family of rules for adjusting one’s credences in response to learning the credences of others. These rules have a number of desirable features. 1. They yield the posterior credences that would result from updating by standard Bayesian conditionalization on one’s peers’ reported credences if one’s likelihood function takes a particular simple form. 2. In the simplest form, they are symmetric among the agents in the group. 3. They map neatly onto the familiar Condorcet voting results. 4. They preserve shared agreement about independence in a wide range of cases. 5. They commute with conditionalization and with multiple peer updates. Importantly, these rules have a surprising property that we call synergy — peer testimony of credences can provide mutually supporting evidence raising an individual’s credence higher than any peer’s initial prior report. At first, this may seem to be a strike against them. We argue, however, that synergy is actually a desirable feature and the failure of other updating rules to yield synergy is a strike against them.

Directory of department-related boards and commissions /

Identifies boards and commissions on which either the Director or the Director's designee serve or which have an interest in the Department's activities.

Michigan Stadium, Syracuse game, 1998

[Opening game of enlarged Michigan Stadium, attendance 111,012, view from the north]

Michigan Stadium, Syracuse game, 1998

[Opening game of enlarged Michigan Stadium, attendance 111,012, view from the north]

Fish and game code.

The ed. issued by the Board of Fish and Game Commissioners (the under its earlier name: State Board of Fish Commissioners); -28th, 35th- by the Division of Fish and Game of the Dept. of Natural Resources (on cover of 27th ed.: Pub. by the Fish and Game Commission); 29th-34th comp. by the Bureau of Game Conservation of the Division of Fish and Game

Structural basis and prediction of substrate specificity in protein serine/threonine kinases

The large number of protein kinases makes it impractical to determine their specificities and substrates experimentally. Using the available crystal structures, molecular modeling, and sequence analyses of kinases and substrates, we developed a set of rules governing the binding of a heptapeptide substrate motif (surrounding the phosphorylation site) to the kinase and implemented these rules in a web-interfaced program for automated prediction of optimal substrate peptides, taking only the amino acid sequence of a protein kinase as input. We show the utility of the method by analyzing yeast cell cycle control and DNA damage checkpoint pathways. Our method is the only available predictive method generally applicable for identifying possible substrate proteins for protein serine/threonine kinases and helps in silico construction of signaling pathways. The accuracy of prediction is comparable to the accuracy of data from systematic large-scale experimental approaches.