An innovative approach to the assessment of nutrient intake in adults with type 2 diabetes : the development, trial and evaluation of a mobile phone photo/voice dietary record

Nutrition interventions in the form of both self-management education and individualised diet therapy are considered essential for the long-term management of type 2 diabetes mellitus (T2DM). The measurement of diet is essential to inform, support and evaluate nutrition interventions in the management of T2DM. Barriers inherent within health care settings and systems limit ongoing access to personnel and resources, while traditional prospective methods of assessing diet are burdensome for the individual and often result in changes in typical intake to facilitate recording. This thesis investigated the inclusion of information and communication technologies (ICT) to overcome limitations to current approaches in the nutritional management of T2DM, in particular the development, trial and evaluation of the Nutricam dietary assessment method (NuDAM) consisting of a mobile phone photo/voice application to assess nutrient intake in a free-living environment with older adults with T2DM. Study 1: Effectiveness of an automated telephone system in promoting change in dietary intake among adults with T2DM The effectiveness of an automated telephone system, Telephone-Linked Care (TLC) Diabetes, designed to deliver self-management education was evaluated in terms of promoting dietary change in adults with T2DM and sub-optimal glycaemic control. In this secondary data analysis independent of the larger randomised controlled trial, complete data was available for 95 adults (59 male; mean age(±SD)=56.8±8.1 years; mean(±SD)BMI=34.2±7.0kg/m2). The treatment effect showed a reduction in total fat of 1.4% and saturated fat of 0.9% energy intake, body weight of 0.7 kg and waist circumference of 2.0 cm. In addition, a significant increase in the nutrition self-efficacy score of 1.3 (p<0.05) was observed in the TLC group compared to the control group. The modest trends observed in this study indicate that the TLC Diabetes system does support the adoption of positive nutrition behaviours as a result of diabetes self-management education, however caution must be applied in the interpretation of results due to the inherent limitations of the dietary assessment method used. The decision to use a close-list FFQ with known bias may have influenced the accuracy of reporting dietary intake in this instance. This study provided an example of the methodological challenges experienced with measuring changes in absolute diet using a FFQ, and reaffirmed the need for novel prospective assessment methods capable of capturing natural variance in usual intakes. Study 2: The development and trial of NuDAM recording protocol The feasibility of the Nutricam mobile phone photo/voice dietary record was evaluated in 10 adults with T2DM (6 Male; age=64.7±3.8 years; BMI=33.9±7.0 kg/m2). Intake was recorded over a 3-day period using both Nutricam and a written estimated food record (EFR). Compared to the EFR, the Nutricam device was found to be acceptable among subjects, however, energy intake was under-recorded using Nutricam (-0.6±0.8 MJ/day; p<0.05). Beverages and snacks were the items most frequently not recorded using Nutricam; however forgotten meals contributed to the greatest difference in energy intake between records. In addition, the quality of dietary data recorded using Nutricam was unacceptable for just under one-third of entries. It was concluded that an additional mechanism was necessary to complement dietary information collected via Nutricam. Modifications to the method were made to allow for clarification of Nutricam entries and probing forgotten foods during a brief phone call to the subject the following morning. The revised recording protocol was evaluated in Study 4. Study 3: The development and trial of the NuDAM analysis protocol Part A explored the effect of the type of portion size estimation aid (PSEA) on the error associated with quantifying four portions of 15 single foods items contained in photographs. Seventeen dietetic students (1 male; age=24.7±9.1 years; BMI=21.1±1.9 kg/m2) estimated all food portions on two occasions: without aids and with aids (food models or reference food photographs). Overall, the use of a PSEA significantly reduced mean (±SD) group error between estimates compared to no aid (-2.5±11.5% vs. 19.0±28.8%; p<0.05). The type of PSEA (i.e. food models vs. reference food photograph) did not have a notable effect on the group estimation error (-6.7±14.9% vs. 1.4±5.9%, respectively; p=0.321). This exploratory study provided evidence that the use of aids in general, rather than the type, was more effective in reducing estimation error. Findings guided the development of the Dietary Estimation and Assessment Tool (DEAT) for use in the analysis of the Nutricam dietary record. Part B evaluated the effect of the DEAT on the error associated with the quantification of two 3-day Nutricam dietary records in a sample of 29 dietetic students (2 males; age=23.3±5.1 years; BMI=20.6±1.9 kg/m2). Subjects were randomised into two groups: Group A and Group B. For Record 1, the use of the DEAT (Group A) resulted in a smaller error compared to estimations made without the tool (Group B) (17.7±15.8%/day vs. 34.0±22.6%/day, p=0.331; respectively). In comparison, all subjects used the DEAT to estimate Record 2, with resultant error similar between Group A and B (21.2±19.2%/day vs. 25.8±13.6%/day; p=0.377 respectively). In general, the moderate estimation error associated with quantifying food items did not translate into clinically significant differences in the nutrient profile of the Nutricam dietary records, only amorphous foods were notably over-estimated in energy content without the use of the DEAT (57kJ/day vs. 274kJ/day; p<0.001). A large proportion (89.6%) of the group found the DEAT helpful when quantifying food items contained in the Nutricam dietary records. The use of the DEAT reduced quantification error, minimising any potential effect on the estimation of energy and macronutrient intake. Study 4: Evaluation of the NuDAM The accuracy and inter-rater reliability of the NuDAM to assess energy and macronutrient intake was evaluated in a sample of 10 adults (6 males; age=61.2±6.9 years; BMI=31.0±4.5 kg/m2). Intake recorded using both the NuDAM and a weighed food record (WFR) was coded by three dietitians and compared with an objective measure of total energy expenditure (TEE) obtained using the doubly labelled water technique. At the group level, energy intake (EI) was under-reported to a similar extent using both methods, with the ratio of EI:TEE was 0.76±0.20 for the NuDAM and 0.76±0.17 for the WFR. At the individual level, four subjects reported implausible levels of energy intake using the WFR method, compared to three using the NuDAM. Overall, moderate to high correlation coefficients (r=0.57-0.85) were found across energy and macronutrients except fat (r=0.24) between the two dietary measures. High agreement was observed between dietitians for estimates of energy and macronutrient derived for both the NuDAM (ICC=0.77-0.99; p<0.001) and WFR (ICC=0.82-0.99; p<0.001). All subjects preferred using the NuDAM over the WFR to record intake and were willing to use the novel method again over longer recording periods. This research program explored two novel approaches which utilised distinct technologies to aid in the nutritional management of adults with T2DM. In particular, this thesis makes a significant contribution to the evidence base surrounding the use of PhRs through the development, trial and evaluation of a novel mobile phone photo/voice dietary record. The NuDAM is an extremely promising advancement in the nutritional management of individuals with diabetes and other chronic conditions. Future applications lie in integrating the NuDAM with other technologies to facilitate practice across the remaining stages of the nutrition care process.

Effects of Mobile Phone Distraction at the Onset of Amber Light: Analysis of Driving Simulator Data

Distraction whilst driving on an approach to a signalized intersection is particularly dangerous, as potential vehicular conflicts and resulting angle collisions tend to be severe. This study examines the decisions of distracted drivers during the onset of amber lights. Driving simulator data were obtained from a sample of 58 drivers under baseline and handheld mobile phone conditions at the University of IOWA - National Advanced Driving Simulator. Explanatory variables include age, gender, cell phone use, distance to stop-line, and speed. An iterative combination of decision tree and logistic regression analyses are employed to identify main effects, non-linearities, and interactions effects. Results show that novice (16-17 years) and younger (18-25 years) drivers’ had heightened amber light running risk while distracted by cell phone, and speed and distance thresholds yielded significant interaction effects. Driver experience captured by age has a multiplicative effect with distraction, making the combined effect of being inexperienced and distracted particularly risky. Solutions are needed to combat the use of mobile phones whilst driving.

An implicit RBF meshless method for a fractal mobile/immobile transport model

Fractional differential equation is used to describe a fractal model of mobile/immobile transport with a power law memory function. This equation is the limiting equation that governs continuous time random walks with heavy tailed random waiting times. In this paper, we firstly propose a finite difference method to discretize the time variable and obtain a semi-discrete scheme. Then we discuss its stability and convergence. Secondly we consider a meshless method based on radial basis functions (RBF) to discretize the space variable. By contrast to conventional FDM and FEM, the meshless method is demonstrated to have distinct advantages: calculations can be performed independent of a mesh, it is more accurate and it can be used to solve complex problems. Finally the convergence order is verified from a numerical example is presented to describe the fractal model of mobile/immobile transport process with different problem domains. The numerical results indicate that the present meshless approach is very effective for modeling and simulating of fractional differential equations, and it has good potential in development of a robust simulation tool for problems in engineering and science that are governed by various types of fractional differential equations.

Numerical analysis of the time variable fractional order mobile-immobile advection-dispersion model

Many physical processes exhibit fractional order behavior that varies with time or space. The continuum of order in the fractional calculus allows the order of the fractional operator to be considered as a variable. In this paper, we consider the time variable fractional order mobile-immobile advection-dispersion model. Numerical methods and analyses of stability and convergence for the fractional partial differential equations are quite limited and difficult to derive. This motivates us to develop efficient numerical methods as well as stability and convergence of the implicit numerical methods for the fractional order mobile immobile advection-dispersion model. In the paper, we use the Coimbra variable time fractional derivative which is more efficient from the numerical standpoint and is preferable for modeling dynamical systems. An implicit Euler approximation for the equation is proposed and then the stability of the approximation are investigated. As for the convergence of the numerical scheme we only consider a special case, i.e. the time fractional derivative is independent of time variable t. The case where the time fractional derivative depends both the time variable t and the space variable x will be considered in the future work. Finally, numerical examples are provided to show that the implicit Euler approximation is computationally efficient.

Mobile multimedia : user and technology perspectives

As multimedia-enabled mobile devices such as smart phones and tablets are becoming the day-to-day computing device of choice for users of all ages, everyone expects that all mobile multimedia applications and services should be as smooth and as high-quality as the desktop experience. The grand challenge in delivering multimedia to mobile devices using the Internet is to ensure the quality of experience that meets the users' expectations, within reasonable costs, while supporting heterogeneous platforms and wireless network conditions. This book aims to provide a holistic overview of the current and future technologies used for delivering high-quality mobile multimedia applications, while focusing on user experience as the key requirement. The book opens with a section dealing with the challenges in mobile video delivery as one of the most bandwidth-intensive media that requires smooth streaming and a user-centric strategy to ensure quality of experience. The second section addresses this challenge by introducing some important concepts for future mobile multimedia coding and the network technologies to deliver quality services. The last section combines the user and technology perspectives by demonstrating how user experience can be measured using case studies on urban community interfaces and Internet telephones.

Impact of region-of-interest video coding on perceived quality in mobile video

Effective streaming of video can be achieved by providing more bits to the most important region in the frame at the cost of reduced bits in the less important regions. This strategy can be beneficial for delivering high quality videos in mobile devices, especially when the availability of bandwidth is usually low and limited. While the state-of-the-art video codecs such as H.264 may have been optimised for perceived quality, it is hypothesised that users will give more attention to interesting region/object when watching videos. Therefore, giving a higher quality to region of interest (ROI)while reducing quality of other areas may result in improving the overall perceived quality without necessarily increasing the bitrate. In this paper, the impact of ROI-based encoded video on perceived quality is investigated by conducting a user study for varous target bitrates. The results from the user study demonstrate that ROI-based video coding has superior perceived quality compared to normal encoded video at the same bitrate in the lower bitrate range.

Connection without caution? The role of mobile phone involvement in predicting young people’s intentions to use a mobile phone while driving

The present study examined the predictors of the intentions of young people aged between 17 and 24 years (N = 196) to use their mobile phone while driving. Using convenience sampling, drivers were recruited at petrol station travel centres to complete a cross-sectional survey. The Theory of Planned Behaviour constructs of attitude, subjective norm, and perceived behavioural control (PBC) were measured, as well as mobile phone involvement - a construct based on behavioural addiction components to reflect people’s cognitive and behavioural interaction with their mobile phone. Attitudes, PBC, and mobile phone involvement predicted young people’s intentions to use their mobile phone while driving, highlighting the need for interventions to address the perceived rewards and costs of the behaviour and to challenge the potentially powerful need to be constantly connected with others by technology irrespective of the associated dangers.

Compact arrays for mobile platforms : trade-off between size and performance for SDMA and MIMO applications

Smart antenna receiver and transmitter systems consist of multi-port arrays with an individual receiver channel (including ADC) and an individual transmitter channel (including DAC)at every of the M antenna ports, respectively. By means of digital beamforming, an unlimited number of simultaneous complex-valued vector radiation patterns with M-1 degrees of freedom can be formed. Applications of smart antennas in communication systems include space-division multiple access. If both stations of a communication link are equipped with smart antennas (multiple-input-multiple-output, MIMO). multiple independent channels can be formed in a "multi-path-rich" environment. In this article, it will be shown that under certain circumstances, the correlation between signals from adjacent ports of a dense array (M + ΔM elements) can be kept as low as the correlation between signals from adjacent ports of a conventional array (M elements and half-wavelength pacing). This attractive feature is attained by means of a novel approach which employs a RF decoupling network at the array ports in order to form new ports which are decoupled and associated with mutually orthogonal (de-correlated) radiation patterns.

The use of virtual prototyping to rehearse the sequence of construction work involving mobile cranes

Purpose – Rehearsing practical site operations is without doubt one of the most effective methods for minimising planning mistakes, because of the learning that takes place during the rehearsal activity. However, real rehearsal is not a practical solution for on-site construction activities, as it not only involves a considerable amount of cost but can also have adverse environmental implications. One approach to overcoming this is by the use of virtual rehearsals. The purpose of this paper is to investigate an approach to simulation of the motion of cranes in order to test the feasibility of associated construction sequencing and generate construction schedules for review and visualisation. Design/methodology/approach – The paper describes a system involving two technologies, virtual prototyping (VP) and four-dimensional (4D) simulation, to assist construction planners in testing the sequence of construction activities when mobile cranes are involved. The system consists of five modules, comprising input, database, equipment, process and output, and is capable of detecting potential collisions. A real-world trial is described in which the system was tested and validated. Findings – Feedback from the planners involved in the trial indicated that they found the system to be useful in its present form and that they would welcome its further development into a fully automated platform for validating construction sequencing decisions. Research limitations/implications – The tool has the potential to provide a cost-effective means of improving construction planning. However, it is limited at present to the specific case of crane movement under special consideration. Originality/value – This paper presents a large-scale, real life case of applying VP technology in planning construction processes and activities.

Multi-cursor multi-user mobile interaction with a large shared display

When using a mobile device to control a cursor on a large shared display, the interaction must be carefully planned to match the environment and purpose of the systems use. We describe a ‘democratic jukebox’ system that revealed five recommendations that should be considered when designing this type of interaction relating to providing feedback to the user; how to represent users in a multi-cursor based system; where people tend to look and their expectation of how to move their cursor; the orientation of screens and the social context; and, the use of simulated users to give the real users a sense that they are engaging with a greater audience.

Mystery at the library : encouraging library exploration using a pervasive mobile game

This paper presents Secret SLQ, a pervasive mobile game that aims to encourage eight to fourteen year olds to engage with the State Library of Queensland. The game sets out to encourage people to visit and explore the library, as well as educate a generation of young people and parents who may visit the library but have no idea of the treasures that it holds. The research explores how smartphone technology can be used to deliver an engaging and educational experience. The game aims to provide a fun and interactive way to guide participants through a multi-leveled library building, to search for unique QR codes to unlock clues, answer quiz questions and progress further up a leaderboard. This paper outlines the design and initial deployment of the game, reporting on results from a usability study and discussing initial observations made by librarians. Findings indicate that the mobile platform is suitable for delivering such experiences but consideration is needed when embedding games in such large environments so as not to confuse players as they play.

A gamified mobile application for engaging new students at university orientation

The term gamification describes the addition of game elements to non-game contexts as a means to motivate and engage users. This study investigates the design, delivery and pilot evaluation of a gamified, smartphone application built to introduce new students to the campus, services and people at university during their first few weeks. This paper describes changes to the application made after an initial field study was undertaken and provides an evaluation of the impact of the redesign. Survey responses were collected from thirteen students and usage data was captured from 105 students. Results indicate three levels of user engagement and suggest that there is value in adding game elements to the experience in this way. A number of issues are identified and discussed based on game challenges, input, and facilitating game elements in an event setting such as university orientation.