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.

Revealing the whiteboard to blind students: An inclusive approach to provide mediation in synchronous e-learning activities

Promoting the inclusion of students with disabilities in e-learning systems has brought many challenges for researchers and educators. The use of synchronous communication tools such as interactive whiteboards has been regarded as an obstacle for inclusive education. In this paper, we present the proposal of an inclusive approach to provide blind students with the possibility to participate in live learning sessions with whiteboard software. The approach is based on the provision of accessible textual descriptions by a live mediator. With the accessible descriptions, students are able to navigate through the elements and explore the content of the class using screen readers. The method used for this study consisted of the implementation of a software prototype within a virtual learning environment and a case study with the participation of a blind student in a live distance class. The results from the case study have shown that this approach can be very effective, and may be a starting point to provide blind students with resources they had previously been deprived from. The proof of concept implemented has shown that many further possibilities may be explored to enhance the interaction of blind users with educational content in whiteboards, and further pedagogical approaches can be investigated from this proposal. (C) 2009 Elsevier Ltd. All rights reserved.

A linear optimization approach to the combined production planning model

Two fundamental processes usually arise in the production planning of many industries. The first one consists of deciding how many final products of each type have to be produced in each period of a planning horizon, the well-known lot sizing problem. The other process consists of cutting raw materials in stock in order to produce smaller parts used in the assembly of final products, the well-studied cutting stock problem. In this paper the decision variables of these two problems are dependent of each other in order to obtain a global optimum solution. Setups that are typically present in lot sizing problems are relaxed together with integer frequencies of cutting patterns in the cutting problem. Therefore, a large scale linear optimizations problem arises, which is exactly solved by a column generated technique. It is worth noting that this new combined problem still takes the trade-off between storage costs (for final products and the parts) and trim losses (in the cutting process). We present some sets of computational tests, analyzed over three different scenarios. These results show that, by combining the problems and using an exact method, it is possible to obtain significant gains when compared to the usual industrial practice, which solve them in sequence. (C) 2010 The Franklin Institute. Published by Elsevier Ltd. All rights reserved.

Approach to Equilibrium for a Class of Random Quantum Models of Infinite Range

We consider random generalizations of a quantum model of infinite range introduced by Emch and Radin. The generalizations allow a neat extension from the class l (1) of absolutely summable lattice potentials to the optimal class l (2) of square summable potentials first considered by Khanin and Sinai and generalised by van Enter and van Hemmen. The approach to equilibrium in the case of a Gaussian distribution is proved to be faster than for a Bernoulli distribution for both short-range and long-range lattice potentials. While exponential decay to equilibrium is excluded in the nonrandom l (1) case, it is proved to occur for both short and long range potentials for Gaussian distributions, and for potentials of class l (2) in the Bernoulli case. Open problems are discussed.

An entropy-based approach to automatic image segmentation of satellite images

An entropy-based image segmentation approach is introduced and applied to color images obtained from Google Earth. Segmentation refers to the process of partitioning a digital image in order to locate different objects and regions of interest. The application to satellite images paves the way to automated monitoring of ecological catastrophes, urban growth, agricultural activity, maritime pollution, climate changing and general surveillance. Regions representing aquatic, rural and urban areas are identified and the accuracy of the proposed segmentation methodology is evaluated. The comparison with gray level images revealed that the color information is fundamental to obtain an accurate segmentation. (C) 2010 Elsevier B.V. All rights reserved.

A pattern recognition approach to complex networks

Complex networks exist in many areas of science such as biology, neuroscience, engineering, and sociology. The growing development of this area has led to the introduction of several topological and dynamical measurements, which describe and quantify the structure of networks. Such characterization is essential not only for the modeling of real systems but also for the study of dynamic processes that may take place in them. However, it is not easy to use several measurements for the analysis of complex networks, due to the correlation between them and the difficulty of their visualization. To overcome these limitations, we propose an effective and comprehensive approach for the analysis of complex networks, which allows the visualization of several measurements in a few projections that contain the largest data variance and the classification of networks into three levels of detail, vertices, communities, and the global topology. We also demonstrate the efficiency and the universality of the proposed methods in a series of real-world networks in the three levels.

Estimating losses in an entanglement concentration scheme using the phenomenological operator approach to dissipation in cavity quantum electrodynamics

In a previous paper, we developed a phenomenological-operator technique aiming to simplify the estimate of losses due to dissipation in cavity quantum electrodynamics. In this paper, we apply that technique to estimate losses during an entanglement concentration process in the context of dissipative cavities. In addition, some results, previously used without proof to justify our phenomenological-operator approach, are now formally derived, including an equivalent way to formulate the Wigner-Weisskopf approximation.

Arylbutyltellurides as precursors of dilithium arylthienylcyanocuprates in a straightforward approach to phenethylamine derivatives

The ring opening reaction of N-tosyl aziridines with dilithium arylthienylcyanocuprates generated from arylbutyltellurides produced phenethylamine derivatives in good to excellent yields. (C) 2007 Elsevier Ltd. All rights reserved.

Seeing the Whole Elephant in the Room: A Holistic approach to ebooks

This presentation was offered as part of the CUNY Library Assessment Conference, Reinventing Libraries: Reinventing Assessment, held at the City University of New York in June 2014.

Granularity and disaggregation in compositional modelling with applications to ecological systems

In the past decade, compositional modelling (CM) has established itself as the predominant knowledge-based approach to construct mathematical (simulation) models automatically. Although it is mainly applied to physical systems, there is a growing interest in applying CM to other domains, such as ecological and socio-economic systems. Inspired by this observation, this paper presents a method for extending the conventional CM techniques to suit systems that are fundamentally presented by interacting populations of individuals instead of physical components or processes. The work supports building model repositories for such systems, especially in addressing the most critical outstanding issues of granularity and disaggregation in ecological systems modelling.

An auction theoretical approach to fiscal wars

I examine a situation where a firm has to choose to locate a new factory in one of several jurisdictions and it depends on the private information held by each jurisdiction. Jurisdiction compete for the location of the new factory. This competition may take the form of expenditures already incurred on infraestructure, commitments to spend on infraestructure, tax incentives or even cash payments. The model combines two elements that are usually considered separately; competition is desirable because we want the factory to be located in the jurisdiction that values it the most, but competition in itself is wasteful. I show that expected total amount paid to the firm under a large family of arrangements. Moreover, I show that the ex-ante optimal mechanism that guarantees that the firm chooses the jurisdiction with the highest value for the factory, minimizes the total expected payment to the firm, and balances the budget in an ex-ante sense - can be implemented by running a standard auction and subsidizing participation.

Optimal IV estimation of systems with stochastic regressors and var disturbances with applications to dynamic systems

This paper considers the general problem of Feasible Generalized Least Squares Instrumental Variables (FG LS IV) estimation using optimal instruments. First we summarize the sufficient conditions for the FG LS IV estimator to be asymptotic ally equivalent to an optimal G LS IV estimator. Then we specialize to stationary dynamic systems with stationary VAR errors, and use the sufficient conditions to derive new moment conditions for these models. These moment conditions produce useful IVs from the lagged endogenous variables, despite the correlation between errors and endogenous variables. This use of the information contained in the lagged endogenous variables expands the class of IV estimators under consideration and there by potentially improves both asymptotic and small-sample efficiency of the optimal IV estimator in the class. Some Monte Carlo experiments compare the new methods with those of Hatanaka [1976]. For the DG P used in the Monte Carlo experiments, asymptotic efficiency is strictly improved by the new IVs, and experimental small-sample efficiency is improved as well.

Organizations redesign and building of information systems

Develop software is still a risky business. After 60 years of experience, this community is still not able to consistently build Information Systems (IS) for organizations with predictable quality, within previously agreed budget and time constraints. Although software is changeable we are still unable to cope with the amount and complexity of change that organizations demand for their IS. To improve results, developers followed two alternatives: Frameworks that increase productivity but constrain the flexibility of possible solutions; Agile ways of developing software that keep flexibility with less upfront commitments. With strict frameworks, specific hacks have to be put in place to get around the framework construction options. In time this leads to inconsistent architectures that are harder to maintain due to incomplete documentation and human resources turnover. The main goals of this work is to create a new way to develop flexible IS for organizations, using web technologies, in a faster, better and cheaper way that is more suited to handle organizational change. To do so we propose an adaptive object model that uses a new ontology for data and action with strict normalizing rules. These rules should bound the effects of changes that can be better tested and therefore corrected. Interfaces are built with templates of resources that can be reused and extended in a flexible way. The “state of the world” for each IS is determined by all production and coordination acts that agents performed over time, even those performed by external systems. When bugs are found during maintenance, their past cascading effects can be checked through simulation, re-running the log of transaction acts over time and checking results with previous records. This work implements a prototype with part of the proposed system in order to have a preliminary assessment its feasibility and limitations.

Layer-by-Layer Technique as a New Approach to Produce Nanostructured Films Containing Phospholipids as Transducers in Sensing Applications

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

New approach to ideal inductors stored energy nature

Nonlinear load compensation required the definition of new concepts of electric power. With basis on these new concepts the nature of the stored energy stored in ideal inductors is theoreticaly characterized in this work. Computer simulation and theory agree when applied to an isolated alternator.