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.

Learning Sustainability with EPS@ISEP – Development of an Insectarium

8th International Symposium on Project Approaches in Engineering Education (PAEE)

Learning Sustainability with EPS@ISEP – Development of a Water Disinfection System

Proceedings of the 8th International Symposium on Project Approaches in Engineering Education (PAEE), Guimarães, 2016

Ambulatory electrocardiogram prototype

The use of electrocardiogram nowadays, is very important in diagnosis of heart disease. The emergent increase of portable technology provides medica] monitoring of vital signs allowing freedom ofmovement and watching during normal activity of the patient. In this shidy, it is described the development of a prototype of an ambulatory cardiac monitoring system using 3 leads. The systems consists on conversion of an analog signal, having been previously processed and conditioned, into digital ECG signal and after processed with a microcontroller (MCU). The heartbeat rate can be observed in an LCD display. The LCD display is also used as the interface during the setup process. Ali digital data stream can be stored on a SD memory card llowing the ECG signa] to be accessed later on a PC.

SQMS – A prototype for a supplier quality management system

Within the supply chain, the customer does not simply buy parts or services from suppliers, but also buys supplier capabilities, which results in quality products and services. Having a tool that handles the Inspection as well as the Nonconformance, Complaint, Corrective Action and Concession processes is key to successfully track the supplier performance. Taking as a case study a Supplier Quality Management (SQM) currently in operation in an Original Equipment Manufacturer (OEM) for automotive industry, this paper presents a platform to support a Supplier Quality Management System (SQMS), that fits the technical specification ISO/TS 16949 requirements. This prototype is composed by a web platform and a mobile App, having flexibility and mobility as key main characteristics.

Development of the gas chromatograph – mass spectrometer to investigate volatile species in the lunar soil for the Luna-Resurs mission

Since the analysis of the lunar rocks and soil samples, brought to Earth by the Apollo missions, it is believed that the Moon has a waterless nature and also other volatile species are strongly depleted. Advancement in analysis techniques helped to identify water and other volatile species in lunar volcanic glasses. Additionally, recent lunar space missions detected water and volatile organic compounds in the region of the lunar poles where permanently shadowed craters are existing. All known lunar soil samples available on Earth come from the lunar near side, close to the equator. To verify the most recent measurement results and to enhance the knowledge of the geological history of the Moon it is of high interest to perform in situ measurements on the lunar poles. For this reason the Russian space agency, Roskosmos, developed aprogram for the scientific exploration of the lunar poles. The Gas Analysis Package (GAP) is part of the selected scientific payload aboard the Luna-Resurs Lander. This instrument uses pyrolytic cells and will apply laser spectroscopy, gas chromatography and mass spectrometry to detect and analyze volatile components trapped in the lunar soil. An existing ion optical design of a compact reflectron type time-of-flight mass spectrometer, originally built for the MEAP/P-BACE balloon mission, was chosen as a part of the GAP instrument. The scope of this thesis is the development of the interface between gas chromatography (GC) and this Neutral Gas Mass Spectrometer (NGMS) to perform coupled GC-MS measurements. In the first part of this thesis the interfacing concept was developed and verified by coupling the NGMS prototype to gas chromatography. The second part of this thesis is devoted to the development of the NGMS flight version.

The Development of Calibrants through Characterization of Volatile Organic Compounds from Peroxide Based Explosives and a Non-target Chemical Calibration Compound

Detection canines represent the fastest and most versatile means of illicit material detection. This research endeavor in its most simplistic form is the improvement of detection canines through training, training aids, and calibration. This study focuses on developing a universal calibration compound for which all detection canines, regardless of detection substance, can be tested daily to ensure that they are working with acceptable parameters. Surrogate continuation aids (SCAs) were developed for peroxide based explosives along with the validation of the SCAs already developed within the International Forensic Research Institute (IFRI) prototype surrogate explosives kit. Storage parameters of the SCAs were evaluated to give recommendations to the detection canine community on the best possible training aid storage solution that minimizes the likelihood of contamination. Two commonly used and accepted detection canine imprinting methods were also evaluated for the speed in which the canine is trained and their reliability. As a result of the completion of this study, SCAs have been developed for explosive detection canine use covering: peroxide based explosives, TNT based explosives, nitroglycerin based explosives, tagged explosives, plasticized explosives, and smokeless powders. Through the use of these surrogate continuation aids a more uniform and reliable system of training can be implemented in the field than is currently used today. By examining the storage parameters of the SCAs, an ideal storage system has been developed using three levels of containment for the reduction of possible contamination. The developed calibration compound will ease the growing concerns over the legality and reliability of detection canine use by detailing the daily working parameters of the canine, allowing for Daubert rules of evidence admissibility to be applied. Through canine field testing, it has been shown that the IFRI SCAs outperform other commercially available training aids on the market. Additionally, of the imprinting methods tested, no difference was found in the speed in which the canines are trained or their reliability to detect illicit materials. Therefore, if the recommendations discovered in this study are followed, the detection canine community will greatly benefit through the use of scientifically validated training techniques and training aids.

Development of a responsive fisheries management system for the Portuguese crustacean bottom trawl fishery: Lessons learnt

A prototype for a Responsive Fisheries Management System (RFMS) was developed in the context of the European FP7 project EcoFishMan and tested on the Portuguese crustacean trawl fishery. Building on Results Based Management principles, RFMS involves the definition of specific and measurable objectives for a fishery by the relevant authorities but allows resource users the freedom to find ways to achieve the objectives and to provide adequate documentation. Taking into account the main goals of the new Common Fisheries Policy, such as sustainable utilization of the resources, end of discards and unwanted catches, a management plan for the Portuguese crustacean trawl fishery was developed in cooperation with the fishing industry, following the process and design laid out in the RFMS concept. The plan considers biological, social and economic goals and assigns a responsibility for increased data collection to the resource users. The performance of the plan with regard to selected indicators was evaluated through simulations. In this paper the process towards a RFMS is described and the lessons learnt from the interaction with stakeholders in the development of an alternative management plan are discussed. (C) 2014 Elsevier Ltd. All rights reserved.

Design, development, and analysis of hybrid metal-composite tube for industrial application

In the aerospace, automotive, printing, and sports industries, the development of hybrid Carbon Fiber Reinforced Polymer (CFRP)-metal components is becoming increasingly important. The coupling of metal with CFRP in axial symmetric components results in reduced production costs and increased mechanical properties such as bending, torsional stiffness, mass reduction, damping, and critical speed compared to the single material-built ones. In this thesis, thanks to a novel methodology involving a rubbery/viscoelastic interface layer, several hybrid aluminum-CFRP prototype tubes were produced. Besides, an innovative system for the cure of the CFRP part has been studied, analyzed, tested, and developed in the company that financed these research activities (Reglass SRL, Minerbio BO, Italy). The residual thermal stresses and strains have been investigated with numerical models based on the Finite Element Method (FEM) and compared with experimental tests. Thanks to numerical models, it was also possible to reduce residual thermal stresses by optimizing the lamination sequence of CFRP and determining the influence of the system parameters. A novel software and methodology for evaluating mechanical and damping properties of specimens and tubes made in CFRP were also developed. Moreover, to increase the component's damping properties, rubber nanofibers have been produced and interposed throughout the lamination of specimens. The promising results indicated that the nanofibrous mat could improve the material damping factor over 77% and be adopted in CFRP components with a negligible increment of weight or losing mechanical properties.

Development of a thermochemical/biological process to convert waste biomass into new resources

The increasing attention to environmental issues of recent times encourages us to find new methods for the production of energy from renewable sources, and to improve existing ones, increasing their energy yield. Most of the waste and agricultural residues, with a high content of lignin and non-hydrolysable polymers, cannot be effectively transformed into biofuels with existing technology. The purpose of the study was to develop a new thermochemical/ biological process (named Py-AD) for the valorization of scarcely biodegradable substances. A complete continuous prototype was design built and run for 1 year. This consists into a slow pyrolysis system coupled with two sequential digesters and showed to produce a clean pyrobiogas (a biogas with significant amount of C2-C3 hydrocarbons and residual CO/H2), biochar and bio-oil. Py-AD yielded 31.7% w/w biochar 32.5% w/w oil and 24.8% w/w pyrobiogas. The oil condensate obtained was fractionated in its aqueous and organic fraction (87% and 13% respectively). Subsequently, the anaerobic digestion of aqueous fraction was tested in a UASB reactor, for 180 days, in increasing organic loading rate (OLR). The maximum convertible concentration without undergoing instability phenomena and with complete degradation of pyrogenic chemicals was 1.25 gCOD L digester-1 d-1. The final yield of biomethane was equal to 40% of the theoretical yield and with a noticeable additional production equal to 20% of volatile fatty acids. The final results confirm that anaerobic digestion can be used as a useful tool for cleaning of slow pyrolysis products (both gas and condensable fraction) and the obtaining of relatively clean pyrobiogas that could be directly used in internal combustion engine.

Development of thermochemiluminescence-based sensitive probes: synthesis, optimization, and characterization of c2- and c7-substituted acridine-containing 1,2-dioxetanes

After initial efforts in the late 1980s, the interest in thermochemiluminescence (TCL) as an effective detection technique has gradually faded due to some drawbacks, such as the high temperatures required to trigger the light emission and the relatively low intensities, which determined a poor sensitivity. Recent advances made with the adoption of variably functionalized 1,2-dioxetanes as innovative luminophores, have proved to be a promising approach for the development of reagentless and ultrasensitive detection methods exploitable in biosensors by using TCL compounds as labels, as either single molecules or included in modified nanoparticles. In this PhD Thesis, a novel class of N-substituted acridine-containing 1,2-dioxetanes was designed, synthesized, and characterized as universal TCL probes endowed with optimal emission-triggering temperatures and higher detectability particularly useful in bioanalytical assays. The different decorations introduced by the insertion of both electron donating (EDGs) and electron withdrawing groups (EWGs) at the 2- and 7-positions of acridine fluorophore was found to profoundly affect the photophysical properties and the activation parameters of the final 1,2-dioxetane products. Challenges in the synthesis of 1,2-dioxetanes were tackled with the recourse to continuous flow photochemistry to achieve the target parent compound in high yields, short reaction time, and easy scalability. Computational studies were also carried out to predict the olefins reactivity in the crucial photooxygenation reaction as well as the final products stability. The preliminary application of TCL prototype molecule has been performed in HaCaT cell lines showing the ability of these molecules to be detected in real biological samples and cell-based assays. Finally, attempts on the characterization of 1,2-dioxetanes in different environments (solid state, optical glue and nanosystems) and the development of bioconjugated TCL probes will be also presented and discussed.

Development of textile wearable chemical sensors

In this elaborate, a textile-based Organic Electrochemical Transistor (OECT) was first developed for the determination of uric acid in wound exudate based on the conductive polymer poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS), which was then coupled to an electrochemically gated textile transistor consisting of a composite of iridium oxide particles and PEDOT:PSS for pH monitoring in wound exudate. In that way a sensor for multiparameter monitoring of wound health status was assembled, including the ability to differentiate between a wet-dry status of the smart bandage by implementing impedance measurements exploiting the OECT architecture. Afterwards, for both wound management as well as generic health status tracking applications, a glass-based calcium sensor was developed employing polymeric ion-selective membranes on a novel architecture inspired by the Wrighton OECT configuration, which was later converted to a Proof-of-Concept textile prototype for wearable applications. Lastly, in collaboration with the King Abdullah University of Science and Technology (KAUST, Thuwal, Saudi Arabia) under the supervision of Prof. Sahika Inal, different types of ion-selective thiophene-based monomers were used to develop ion-selective conductive polymers to detect sodium ion by different methods, involving standard potentiometry and OECT-based approaches. The textile OECTs for uric acid detection performances were optimized by investigating the geometry effect on the instrumental response and the properties of the different textile materials involved in their production, with a special focus on the final application that implies the operativity in flow conditions to simulate the wound environment. The same testing route was followed for the multiparameter sensor and the calcium sensor prototype, with a particular care towards the ion-selective membrane composition and electrode conditioning protocol optimization. The sodium-selective polymer electrosynthesis was optimized in non-aqueous environments and was characterized by means of potentiostatic and potentiodynamic techniques coupled with Quartz Crystal Microbalance and spectrophotometric measurements.

Fighting child marriage in developing countries: design and development of a mobile application

Child marriage is still a great issue in developing countries and even if the interventions to prevent it are having results, they are not enough to eliminate the problem. Among the strategies that seem to work most to fight child marriage, there is the empowerment of girls with information combined with education of parents and community. As smartphones are more accessible year after year in developing countries, this thesis wants to investigate if a mobile app could be effective in fighting child marriage and which characteristics such an app should have. The research was organized in four phases and used design and creation and case study methodologies. Firstly, the literature was analyzed and an initial design was proposed. Secondly, expert interviews were performed to gain feedback on the proposed design, and afterwards prototype was built. Thirdly, a case study in the Democratic Republic of Congo (DRC) was performed to test the prototype, gaining insights and improvements through group interviews with 26 girls aged 15-19. Finally, a first version of the app was developed and a second phase of the case study was run in the DRC to understand if the girls were able to use the app. This phase included 14 girls of which 6 had participated in the prototype testing and used questionnaires as a data generation method. The app was built following the Principles for Digital Development. Even if this app is built based on the case study in DRC is modular and easily adaptable to other contexts as it is not content-specific. It was shown that is worth continuing to study this topic and it was defined a conceptual framework for designing learning apps for developing countries, in particular, to fight child, early, and forced marriage.

[the Use Of Fish On Buccal Smear To Investigate Mosaicism With A 45,x Cell Line: Study On Healthy Men And Patients With Disorders Of Sex Development].

To verify whether fluorescence in situ hybridization (FISH) of cells from the buccal epithelium could be employed to detect cryptomosaicism with a 45,X lineage in 46,XY patients. Samples of nineteen 46,XY healthy young men and five patients with disorders of sex development (DSD), four 45,X/46,XY and one 46,XY were used. FISH analysis with X and Y specific probes on interphase nuclei from blood lymphocytes and buccal epithelium were analyzed to investigate the proportion of nuclei containing only the signal of the X chromosome. The frequency of nuclei containing only the X signal in the two tissues of healthy men did not differ (p = 0.69). In all patients with DSD this frequency was significantly higher, and there was no difference between the two tissues (p = 0.38), either. Investigation of mosaicism with a 45,X cell line in patients with 46,XY DSD or sterility can be done by FISH directly using cells from the buccal epithelium.

The Influence Of The Environment On The Development Of Thyroid Tumors: A New Appraisal.

Most epidemiological studies concerning differentiated thyroid cancers (DTC) indicate an increasing incidence over the last two decades. This increase might be partially explained by the better access to health services worldwide, but clinicopathological analyses do not fully support this hypothesis, indicating that there are carcinogenetic factors behind this noticeable increasing incidence. Although we have undoubtedly understood the biology and molecular pathways underlying thyroid carcinogenesis in a better way, we have made very little progresses in identifying a risk profile for DTC, and our knowledge of risk factors is very similar to what we knew 30-40 years ago. In addition to ionizing radiation exposure, the most documented and established risk factor for DTC, we also investigated the role of other factors, including eating habits, tobacco smoking, living in a volcanic area, xenobiotics, and viruses, which could be involved in thyroid carcinogenesis, thus, contributing to the increase in DTC incidence rates observed.