Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

Géneros y formatos para la televisión digital. Análisis en los países andinos

El propósito de la investigación es analizar los formatos de televisión vigentes en la transición hacia la televisión digital terrestre en los países andinos e identificar alternativas para la televisión local. La investigación se justifica en razón del apagón analógico entre el 2018 y 2020. La metodología es cualitativa y cuantitativa; los instrumentos son análisis de contenidos y entrevistas semiestructuradas. Los resultados permiten concluir que los contenidos de producción nacional están vinculados con la actualidad. Los elementos que influyen en la creación de contenidos están relacionados con factores de identidad, recursos económicos, talento humano y narrativas. La hibridación de formatos que promuevan la cultura es una opción para las estaciones locales

Methods matter: computational modelling in public health policy and planning

This work is aimed at understanding and unifying information on epidemiological modelling methods and how those methods relate to public policy addressing human health, specifically in the context of infectious disease prevention, pandemic planning, and health behaviour change. This thesis employs multiple qualitative and quantitative methods, and presents as a manuscript of several individual, data-driven projects that are combined in a narrative arc. The first chapter introduces the scope and complexity of this interdisciplinary undertaking, describing several topical intersections of importance. The second chapter begins the presentation of original data, and describes in detail two exercises in computational epidemiological modelling pertinent to pandemic influenza planning and policy, and progresses in the next chapter to present additional original data on how the confidence of the public in modelling methodology may have an effect on their planned health behaviour change as recommended in public health policy. The thesis narrative continues in the final data-driven chapter to describe how health policymakers use modelling methods and scientific evidence to inform and construct health policies for the prevention of infectious diseases, and concludes with a narrative chapter that evaluates the breadth of this data and recommends strategies for the optimal use of modelling methodologies when informing public health policy in applied public health scenarios.

Computational Foundations for Safe and Efficient Human-Robot Collaboration in Assembly Cells

Human and robots have complementary strengths in performing assembly operations. Humans are very good at perception tasks in unstructured environments. They are able to recognize and locate a part from a box of miscellaneous parts. They are also very good at complex manipulation in tight spaces. The sensory characteristics of the humans, motor abilities, knowledge and skills give the humans the ability to react to unexpected situations and resolve problems quickly. In contrast, robots are very good at pick and place operations and highly repeatable in placement tasks. Robots can perform tasks at high speeds and still maintain precision in their operations. Robots can also operate for long periods of times. Robots are also very good at applying high forces and torques. Typically, robots are used in mass production. Small batch and custom production operations predominantly use manual labor. The high labor cost is making it difficult for small and medium manufacturers to remain cost competitive in high wage markets. These manufactures are mainly involved in small batch and custom production. They need to find a way to reduce the labor cost in assembly operations. Purely robotic cells will not be able to provide them the necessary flexibility. Creating hybrid cells where humans and robots can collaborate in close physical proximities is a potential solution. The underlying idea behind such cells is to decompose assembly operations into tasks such that humans and robots can collaborate by performing sub-tasks that are suitable for them. Realizing hybrid cells that enable effective human and robot collaboration is challenging. This dissertation addresses the following three computational issues involved in developing and utilizing hybrid assembly cells: - We should be able to automatically generate plans to operate hybrid assembly cells to ensure efficient cell operation. This requires generating feasible assembly sequences and instructions for robots and human operators, respectively. Automated planning poses the following two challenges. First, generating operation plans for complex assemblies is challenging. The complexity can come due to the combinatorial explosion caused by the size of the assembly or the complex paths needed to perform the assembly. Second, generating feasible plans requires accounting for robot and human motion constraints. The first objective of the dissertation is to develop the underlying computational foundations for automatically generating plans for the operation of hybrid cells. It addresses both assembly complexity and motion constraints issues. - The collaboration between humans and robots in the assembly cell will only be practical if human safety can be ensured during the assembly tasks that require collaboration between humans and robots. The second objective of the dissertation is to evaluate different options for real-time monitoring of the state of human operator with respect to the robot and develop strategies for taking appropriate measures to ensure human safety when the planned move by the robot may compromise the safety of the human operator. In order to be competitive in the market, the developed solution will have to include considerations about cost without significantly compromising quality. - In the envisioned hybrid cell, we will be relying on human operators to bring the part into the cell. If the human operator makes an error in selecting the part or fails to place it correctly, the robot will be unable to correctly perform the task assigned to it. If the error goes undetected, it can lead to a defective product and inefficiencies in the cell operation. The reason for human error can be either confusion due to poor quality instructions or human operator not paying adequate attention to the instructions. In order to ensure smooth and error-free operation of the cell, we will need to monitor the state of the assembly operations in the cell. The third objective of the dissertation is to identify and track parts in the cell and automatically generate instructions for taking corrective actions if a human operator deviates from the selected plan. Potential corrective actions may involve re-planning if it is possible to continue assembly from the current state. Corrective actions may also involve issuing warning and generating instructions to undo the current task.

Improving the use of G-CSF during chemotherapy using physiological mathematical modelling : a quantitative systems pharmacology approach

La diminution des doses administrées ou même la cessation complète d'un traitement chimiothérapeutique est souvent la conséquence de la réduction du nombre de neutrophiles, qui sont les globules blancs les plus fréquents dans le sang. Cette réduction dans le nombre absolu des neutrophiles, aussi connue sous le nom de myélosuppression, est précipitée par les effets létaux non spécifiques des médicaments anti-cancéreux, qui, parallèlement à leur effet thérapeutique, produisent aussi des effets toxiques sur les cellules saines. Dans le but d'atténuer cet impact myélosuppresseur, on administre aux patients un facteur de stimulation des colonies de granulocytes recombinant humain (rhG-CSF), une forme exogène du G-CSF, l'hormone responsable de la stimulation de la production des neutrophiles et de leurs libération dans la circulation sanguine. Bien que les bienfaits d'un traitement prophylactique avec le G-CSF pendant la chimiothérapie soient bien établis, les protocoles d'administration demeurent mal définis et sont fréquemment déterminés ad libitum par les cliniciens. Avec l'optique d'améliorer le dosage thérapeutique et rationaliser l'utilisation du rhG-CSF pendant le traitement chimiothérapeutique, nous avons développé un modèle physiologique du processus de granulopoïèse, qui incorpore les connaissances actuelles de pointe relatives à la production des neutrophiles des cellules souches hématopoïétiques dans la moelle osseuse. À ce modèle physiologique, nous avons intégré des modèles pharmacocinétiques/pharmacodynamiques (PK/PD) de deux médicaments: le PM00104 (Zalypsis®), un médicament anti-cancéreux, et le rhG-CSF (filgrastim). En se servant des principes fondamentaux sous-jacents à la physiologie, nous avons estimé les paramètres de manière exhaustive sans devoir recourir à l'ajustement des données, ce qui nous a permis de prédire des données cliniques provenant de 172 patients soumis au protocol CHOP14 (6 cycles de chimiothérapie avec une période de 14 jours où l'administration du rhG-CSF se fait du jour 4 au jour 13 post-chimiothérapie). En utilisant ce modèle physio-PK/PD, nous avons démontré que le nombre d'administrations du rhG-CSF pourrait être réduit de dix (pratique actuelle) à quatre ou même trois administrations, à condition de retarder le début du traitement prophylactique par le rhG-CSF. Dans un souci d'applicabilité clinique de notre approche de modélisation, nous avons investigué l'impact de la variabilité PK présente dans une population de patients, sur les prédictions du modèle, en intégrant des modèles PK de population (Pop-PK) des deux médicaments. En considérant des cohortes de 500 patients in silico pour chacun des cinq scénarios de variabilité plausibles et en utilisant trois marqueurs cliniques, soient le temps au nadir des neutrophiles, la valeur du nadir, ainsi que l'aire sous la courbe concentration-effet, nous avons établi qu'il n'y avait aucune différence significative dans les prédictions du modèle entre le patient-type et la population. Ceci démontre la robustesse de l'approche que nous avons développée et qui s'apparente à une approche de pharmacologie quantitative des systèmes (QSP). Motivés par l'utilisation du rhG-CSF dans le traitement d'autres maladies, comme des pathologies périodiques telles que la neutropénie cyclique, nous avons ensuite soumis l'étude du modèle au contexte des maladies dynamiques. En mettant en évidence la non validité du paradigme de la rétroaction des cytokines pour l'administration exogène des mimétiques du G-CSF, nous avons développé un modèle physiologique PK/PD novateur comprenant les concentrations libres et liées du G-CSF. Ce nouveau modèle PK a aussi nécessité des changements dans le modèle PD puisqu’il nous a permis de retracer les concentrations du G-CSF lié aux neutrophiles. Nous avons démontré que l'hypothèse sous-jacente de l'équilibre entre la concentration libre et liée, selon la loi d'action de masse, n'est plus valide pour le G-CSF aux concentrations endogènes et mènerait en fait à la surestimation de la clairance rénale du médicament. En procédant ainsi, nous avons réussi à reproduire des données cliniques obtenues dans diverses conditions (l'administration exogène du G-CSF, l'administration du PM00104, CHOP14). Nous avons aussi fourni une explication logique des mécanismes responsables de la réponse physiologique aux deux médicaments. Finalement, afin de mettre en exergue l’approche intégrative en pharmacologie adoptée dans cette thèse, nous avons démontré sa valeur inestimable pour la mise en lumière et la reconstruction des systèmes vivants complexes, en faisant le parallèle avec d’autres disciplines scientifiques telles que la paléontologie et la forensique, où une approche semblable a largement fait ses preuves. Nous avons aussi discuté du potentiel de la pharmacologie quantitative des systèmes appliquées au développement du médicament et à la médecine translationnelle, en se servant du modèle physio-PK/PD que nous avons mis au point.

Which way out of poverty? the human capital versus human capabilities approaches

La pobreza es un problema mundial que afecta a personas de diferentes maneras. El propósito de este artículo es explorar dos teorías principales que abordan la pobreza y la posibilidad de su superación, que son los enfoques de capital humano y de capacidades humanas. El enfoque del capital humano se centra exclusivamente en la faceta económica de la pobreza; en esta perspectiva, la pobreza se define como la falta de dinero y puede abordarse mediante el aumento de los ingresos financieros de las personas que viven en la pobreza. El enfoque de las capacidades humanas ve la pobreza como un problema multidimensional que va más allá de la economía para áreas como la salud, la educación y la libertad. Este enfoque se orienta hacia el cambio social y ayudar a las personas en situación de pobreza para descubrir y desarrollar su potencial. El autor considera que las capacidades humanas abarcan con mayor precisión el alcance de la pobreza y las personas afectadas por el mismo, aunque debido a su amplia gama ha sido difícil diseñar e implementar políticas eficaces que aborden todas las facetas de la pobreza.

More Than A Movement: Unpacking Contemporary Anti-Human Trafficking Efforts in Washington, D.C.

Trafficking in persons has attracted seemingly boundless attention over the last two decades and the work aimed at fighting it is best understood when this cause is contextualized against the backdrop of other social forces—economic, social, and cultural—shaping contemporary nonprofit activities. This project argues that the paid and volunteer labor that takes place in metro Washington, D.C., to combat trafficking in persons can be understood as both a movement and an industry. In addition to arguing that anti-trafficking work is part of a nonprofit industrial complex that situates activist and advocacy work firmly inside state and economic institutions, this project is concerned with the ways in which trafficking work and workers conduct their business collectively. As an organizational study, it identifies the key players in the D.C. region focused on this issue and traces their interactions, collaborations, and cooperation. Significantly, this project suggests that despite variations in objectives, methods, priorities, and characterizations of trafficking, thirty organizations in metro D.C. working on this issue “get along” because they are bound by the benign common goal of raising awareness. Awareness, in this context, is best understood as both a cultural anchor facilitating cohesion and as a social currency allowing groups to opt into joint efforts. The dissertation concludes that organizations centralize awareness in their collective activities over more drastic priorities around which consensus would need to be gained. This is a lost opportunity for making sense of the ways that individual bodies—men, women, and children—experience not just trafficking, but the world around them.

Forensic Injustice: Human Rights, Archival Science and Racialized Feminicide in Guatemala

The call to access and preserve the state records that document crimes committed by the state during Guatemala’s civil war has become an archival imperative entangled with neoliberal human rights discourses of “truth, justice, and memory.” 200,000 people were killed and disappeared in Guatemala’s civil war including acts of genocide in which 85% of massacres involved sexual violence committed against Mayan women. This dissertation argues that in an attempt to tell the official story of the civil war, American Human Rights organizations and academic institutions have constructed a normative identity whose humanity is attached to a scientific and evidentiary value as well as an archival status representing the materiality and institutionality of the record. Consequently, Human Rights discourses grounded in Western knowledges, in particular archival science and law, which prioritize the appearance of truth erase the material and epistemological experience of indigenous women during wartimes. As a result, the subjectivity that has surfaced on the record as most legible has mostly pertained to non-indigenous, middle class, urban, leftist men who were victims of enforced disappearance not genocide. This dissertation investigates this conflicting narrative that remembers a non-indigenous revolutionary masculine hero and grants him justice in human rights courtrooms simply because of a document attesting to his death. A main research question addressed in this project is why the promise of "truth and justice" under the name of human rights becomes a contentious site for gendered indigenous bodies? I conduct a discursive and rhetorical analysis of documentary film, declassified Guatemalan police and military records such as Operation Sofia, a military log known for “documenting the genocide” during rural counterinsurgencies executed by the military. I interrogate the ways in which racialized feminicides or the hyper-sexualized racial violence that has historically dehumanized indigenous women falls outside of discourses of vision constructed by Western positivist knowledges to reinscribe the ideal human right subject. I argue for alternative epistemological frames that recognize genocide as sexualized and gendered structures that have simultaneously produced racialized feminicides in order to disrupt the colonial structures of capitalism, patriarchy and heterosexuality. Ironically, these structures of power remain untouched by the dominant human rights discourse and its academic, NGO, and state collaborators that seek "truth and justice" in post-conflict Guatemala.

Banca Digital

Em plena quarta revolução industrial, todas as industrias se estão a transformar para se ajustar aos novos paradigmas de relação com os clientes, altamente influenciados pelos pioneiros digitais como a Uber, Netflix ou Amazon, porém no setor financeiro há desafios acrescidos, pois os clientes esperam juntar essas expectativas digitais com a manutenção da iteração humana, enquanto, do lados bancos, em simultâneo, necessitam de recuperar da crise da dívida soberana que impôs necessidades de ajustamento dos balanços. O momento de desenvolvimento tecnológico potenciado pelo forte crescimento do acesso à internet em mobilidade traz novos hábitos e expectativas na relação com as entidades, com dispositivos cada vez mais potentes a cada vez menor custo, o que criou a oportunidade perfeita para o surgimento de startups tecnológicas dispostas a transformar os modelos de negócio de intermediação clássica, dando origem, no setor financeiro, às fintechs – empresas de base tecnológica dedicadas à prestação de serviços financeiros - impondo uma disrupção na industria financeira, com destaque para mercados como os EUA e Reino Unido. Olhando aos últimos cinco anos do setor financeiro, será muito difícil antecipar como estará o setor financeiro dentro de cinco anos, mas sabemos que estará seguramente muito diferente do que conhecemos hoje, por esse fato este trabalho é assente essencialmente em referências bibliográficas dos últimos 5 anos, tendo sido feito utilizados estudos de investigação de empresas e documentos académicos para a caracterização do setor neste contexto de inovação permanente e em que medida este processo de “digitalização” do setor financeiro influencia a propensão dos clientes na contratação de mais produtos e serviços, sendo esse um fator central para os bancos em Portugal recuperarem economicamente. É também analisada a dimensão seguida pelas instituições de regulação e supervisão do setor financeiro com vista a potenciar a concorrência e inovação do setor financeiro, enquanto mantém a garantia de segurança, confiança e controlo de risco sistémico. É bastante escassa a literatura disponível para caracterizar a banca em Portugal numa ótica de inovação e transformação, porém este trabalho procura caracterizar o sistema financeiro português face à forma como está a responder aos desafios de transformação tecnológica e digital. Procurou-se estabelecer uma metodologia de investigação que permita caracterizar a perceção de valor acrescentado para os clientes da utilização de serviços digitais e em que medida estes se podem substituir aos balcões e à intervenção humana dos profissionais dos bancos, tendo-se concluído que estes dois elementos são ainda fatores centrais para os clientes.

Acuerdo de Cooperación en Investigación entre Arthur C. Clarke Centro for Human Imagination y la Universidad de Cuenca

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Modelling and analysing cargo screening processes: a project outline

The efficiency of current cargo screening processes at sea and air ports is unknown as no benchmarks exists against which they could be measured. Some manufacturer benchmarks exist for individual sensors but we have not found any benchmarks that take a holistic view of the screening procedures assessing a combination of sensors and also taking operator variability into account. Just adding up resources and manpower used is not an effective way for assessing systems where human decision-making and operator compliance to rules play a vital role. For such systems more advanced assessment methods need to be used, taking into account that the cargo screening process is of a dynamic and stochastic nature. Our project aim is to develop a decision support tool (cargo-screening system simulator) that will map the right technology and manpower to the right commodity-threat combination in order to maximize detection rates. In this paper we present a project outline and highlight the research challenges we have identified so far. In addition we introduce our first case study, where we investigate the cargo screening process at the ferry port in Calais.

Modelling reactive and proactive behaviour in simulation

This research investigated the simulation model behaviour of a traditional and combined discrete event as well as agent based simulation models when modelling human reactive and proactive behaviour in human centric complex systems. A departmental store was chosen as human centric complex case study where the operation system of a fitting room in WomensWear department was investigated. We have looked at ways to determine the efficiency of new management policies for the fitting room operation through simulating the reactive and proactive behaviour of staff towards customers. Once development of the simulation models and their verification had been done, we carried out a validation experiment in the form of a sensitivity analysis. Subsequently, we executed a statistical analysis where the mixed reactive and proactive behaviour experimental results were compared with some reactive experimental results from previously published works. Generally, this case study discovered that simple proactive individual behaviour could be modelled in both simulation models. In addition, we found the traditional discrete event model performed similar in the simulation model output compared to the combined discrete event and agent based simulation when modelling similar human behaviour.

A HUMAN-CENTERED APPROACH TO IMPROVING THE USER EXPERIENCE OF SOFTWARE UPDATES

Software updates are critical to the security of software systems and devices. Yet users often do not install them in a timely manner, leaving their devices open to security exploits. This research explored a re-design of automatic software updates on desktop and mobile devices to improve the uptake of updates through three studies. First using interviews, we studied users’ updating patterns and behaviors on desktop machines in a formative study. Second, we distilled these findings into the design of a low-fi prototype for desktops, and evaluated its efficacy for automating updates by means of a think-aloud study. Third, we investigated individual differences in update automation on Android devices using a large scale survey, and interviews. In this thesis, I present the findings of all three studies and provide evidence for how automatic updates can be better appropriated to fit users on both desktops and mobile devices. Additionally, I provide user interface design suggestions for software updates and outline recommendations for future work to improve the user experience of software updates.

Global interactions between fire and vegetation, human activities and climate

Doutoramento em Engenharia Florestal - Instituto Superior de Agronomia - UL