Using technology in service delivery to families, children and young people

This paper provides an overview of how the innovative use of technology can add value to service delivery in organisations working with families, children and young people.Key messages:Most Australians have access to the Internet and use mobile devices to connect from anywhere, at any time. Research suggests that even isolated and marginalised groups are using technology in their everyday lives.For some groups (e.g., young people), technology may be their preferred method of communication.There appears to be a difference between how people are using the Internet (regularly, from anywhere, connecting with social networks, investigating services) and how some organisations are engaging with it (infrequently, in one direction).Technology works best when used to augment or improve existing services for clients, or to offer innovative approaches to existing services.Technology can be used in diverse ways for organisational improvement (e.g., remote access, staff training, professional development) or client services (e.g., online counselling, SMS appointment reminders, access to resources).Using technology does not necessarily involve large monetary investments or reinventing the wheel in terms of policy and procedures. Often it is a matter of adapting and refining existing services and policies to better suit the online world.Incorporating technology into services takes time, and will need continued assessment and refinement to be successful

Smartphone apps for calculating insulin dose: a systematic assessment

Background: Medical apps are widely available, increasingly used by patients and clinicians, and are being actively promoted for use in routine care. However, there is little systematic evidence exploring possible risks associated with apps intended for patient use. Because self-medication errors are a recognized source of avoidable harm, apps that affect medication use, such as dose calculators, deserve particular scrutiny. We explored the accuracy and clinical suitability of apps for calculating medication doses, focusing on insulin calculators for patients with diabetes as a representative use for a prevalent long-term condition. Methods: We performed a systematic assessment of all English-language rapid/short-acting insulin dose calculators available for iOS and Android. Results: Searches identified 46 calculators that performed simple mathematical operations using planned carbohydrate intake and measured blood glucose. While 59% (n = 27/46) of apps included a clinical disclaimer, only 30% (n = 14/46) documented the calculation formula. 91% (n = 42/46) lacked numeric input validation, 59% (n = 27/46) allowed calculation when one or more values were missing, 48% (n = 22/46) used ambiguous terminology, 9% (n = 4/46) did not use adequate numeric precision and 4% (n = 2/46) did not store parameters faithfully. 67% (n = 31/46) of apps carried a risk of inappropriate output dose recommendation that either violated basic clinical assumptions (48%, n = 22/46) or did not match a stated formula (14%, n = 3/21) or correctly update in response to changing user inputs (37%, n = 17/46). Only one app, for iOS, was issue-free according to our criteria. No significant differences were observed in issue prevalence by payment model or platform. Conclusions: The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control. Healthcare professionals should exercise substantial caution in recommending unregulated dose calculators to patients and address app safety as part of self-management education. The prevalence of errors attributable to incorrect interpretation of medical principles underlines the importance of clinical input during app design. Systemic issues affecting the safety and suitability of higher-risk apps may require coordinated surveillance and action at national and international levels involving regulators, health agencies and app stores.Published versio

A strategic framework to support the implementation of citizen science for environmental monitoring. Final report to SEPA

In this report we provide a decision framework that can be used to guide whether and when to use a citizen science approach for environmental monitoring. Before using the decision framework we recommend that five precursors to a citizen science approach are considered

The Revolution of Mobile Phone-Enabled Services for Agricultural Development (m-Agri Services) in Africa: The Challenges for Sustainability

The provision of information through mobile phone-enabled agricultural information services (m-Agri services) has the potential to revolutionise agriculture and significantly improve smallholder farmers’ livelihoods in Africa. Globally, the benefits of m-Agri services include facilitating farmers’ access to financial services and sourcing agricultural information about input use, practices, and market prices. There are very few published literature sources that focus on the potential benefits of m-Agri services in Africa and none of which explore their sustainability. This study, therefore, explores the evolution, provision, and sustainability of these m-Agri services in Africa. An overview of the current landscape of m-Agri services in Africa is provided and this illustrates how varied these services are in design, content, and quality. Key findings from the exploratory literature review reveal that services are highly likely to fail to achieve their intended purpose or be abandoned when implementers ignore the literacy, skills, culture, and demands of the target users. This study recommends that, to enhance the sustainability of m-Agri services, the implementers need to design the services with the users involved, carefully analyse, and understand the target environment, and design for scale and a long-term purpose. While privacy and security of users need to be ensured, the reuse or improvement of existing initiatives should be explored, and projects need to be data-driven and maintained as open source. Thus, the study concludes that policymakers can support the long-term benefit of m-Agri services by ensuring favourable policies for both users and implementers

Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content

Background: Internet websites and smartphone apps have become a popular resource to guide parents in their children’s feeding and nutrition. Given the diverse range of websites and apps on infant feeding, the quality of information in these resources should be assessed to identify whether consumers have access to credible and reliable information.Objective: This systematic analysis provides perspectives on the information available about infant feeding on websites and smartphone apps.Methods: A systematic analysis was conducted to assess the quality, comprehensibility, suitability, and readability of websites and apps on infant feeding using a developed tool. Google and Bing were used to search for websites from Australia, while the App Store for iOS and Google Play for Android were used to search for apps. Specified key words including baby feeding, breast feeding, formula feeding and introducing solids were used to assess websites and apps addressing feeding advice. Criteria for assessing the accuracy of the content were developed using the Australian Infant Feeding Guidelines.Results: A total of 600 websites and 2884 apps were screened, and 44 websites and 46 apps met the selection criteria and were analyzed. Most of the websites (26/44) and apps (43/46) were noncommercial, some websites (10/44) and 1 app were commercial and there were 8 government websites; 2 apps had university endorsement. The majority of the websites and apps were rated poor quality. There were two websites that had 100% coverage of information compared to those rated as fair or poor that had low coverage. Two-thirds of the websites (65%) and almost half of the apps (47%) had a readability level above the 8th grade level.Conclusions: The findings of this unique analysis highlight the potential for website and app developers to merge user requirements with evidence-based content to ensure that information on infant feeding is of high quality. There are currently no apps available to consumers that address a variety of infant feeding topics. To keep up with the rapid turnover of the evolving technology, health professionals need to consider developing an app that will provide consumers with a credible and reliable source of information about infant feeding, using quality assessment tools and evidence-based content

Developing a Vacant Property Inventory through Productive Partnerships: A University, NGO, and Municipal Planning Collaboration in Trenton, New Jersey

This paper analyzes the development of an inventory of vacant buildings and land in Trenton, New Jersey that resulted from a research partnership between the Rutgers University Center for Urban Environmental Sustainability; Isles, Inc. a Trenton-based non-governmental organization; and the City of Trenton. Participatory research design between university and NGO staff led to a smartphone GIS survey tool that functioned through web and desktop GIS. University students and community residents collected data through a smartphone GIS application and visually inspected almost every property within the city’s boundaries. Although many vacant land inventories have successfully used secondary data, this project required fieldwork to identify vacant properties because data were unavailable through secondary data. The survey was developed collaboratively with the NGO for their use and modification of it in future work, and to understand locally-specific visual markers of vacancy. The data informed the City of Trenton’s vacant property management policy, and served as a foundation for a variety of Isles’ community development programs. While smartphone applications may improve NGO access to GIS, the need for web and desktop GIS to complete data collection and analysis requires expertise and time that pose additional challenges

Lessons from the pandemic: new best practices in selecting molecular diagnostics for point-of-care testing of infectious diseases in sub-Saharan Africa

Introduction: Point-of-care molecular diagnostics offer solutions to the limited diagnostic availability and accessibility in resource-limited settings. During the COVID-19 pandemic, molecular diagnostics became essential tools for accurate detection and monitoring of SARS-CoV-2. The unprecedented demand for molecular diagnostics presented challenges and catalyzed innovations which may provide lessons for the future selection of point-of-care molecular diagnostics. Areas Covered: We searched PubMed from January 2020 to August 2023 to identify lessons learned from the COVID-19 pandemic which may impact the selection of point-of-care molecular diagnostics for future use in sub-Saharan Africa. We evaluated this in the context of REASSURED criteria (Real-time connectivity; Ease of specimen collection; Affordable; Sensitive; Specific; User-friendly; Rapid and robust; Equipment free; and Deliverable to users at the point of need) for point-of-care diagnostics for resource-limited settings. Expert Opinion: The diagnostic challenges and successes during the COVID-19 pandemic affirmed the importance of the REASSURED criteria but demonstrated that these are not sufficient to ensure new diagnostics will be appropriate for public health emergencies. Capacity for rapid scale-up of diagnostic testing and transferability of assays, data, and technology are also important, resulting in updated REST-ASSURED criteria. Few diagnostics will meet all criteria, and trade-offs between criteria will need to be context-specific

Feasibility of a Reimbursement Pathway for Mobile Medical Applications (MMA) in Australia

Introduction: Mobile health (mHealth) applications (apps) are currently changing Australian healthcare. mHealth apps which have a therapeutic and diagnostic intended purpose are called mobile medical applications (MMA), and are being integrated into healthcare by patients and practitioners in Australia. MMAs have the potential to decrease the health burden of some chronic conditions as well as improve the delivery of healthcare. Any harms produced by the technology are mainly through the information provided and how it is used in clinical decision-making. The nature of apps presents unique challenges (such as their rapid lifecycle) to regulatory and reimbursement processes. There are currently no policies or frameworks available that can be used to conduct a health technology assessment (HTA) on MMAs. Therefore, the aim of this research was to determine what policy changes and assessment criteria are needed to facilitate the development of a system that evaluates MMAs for regulatory and reimbursement purposes in Australia. Methodology: In order to achieve this overall aim, the research was divided into four parts. Firstly, I reviewed the Australian Therapeutic Goods Administration (TGA) regulation of MMAs by evaluating it against international counterparts and the International Medical Devices Regulator’s Forum’s (IMDRF) guidance document for clinically evaluating medical software. This was achieved through the use of a policy analysis and case studies. The policy analysis evaluated MMA regulations internationally to determine whether the regulatory bodies of the IMDRF members addressed the IMDRF guidance on clinically evaluating software as a medical device (SaMD). The case studies reviewed how different MMAs in Australia and the United States of America (USA) were regulated to determine to what extent the SaMD: Clinical Evaluation (2017) guidance was applied. The second section evaluated existing frameworks for assessing MMAs and determined whether any were suitable for use in HTA and reimbursement decision-making. This was achieved through a methodological systematic review. The systematic searches were conducted in seven bibliographic databases in order to identify literature on MMA evaluation frameworks published between 2008 and 2016. Frameworks were only eligible for inclusion in the review if they evaluated one of the HTA domains of safety, cost-effectiveness and/or effectiveness of an MMA. Once a framework had been included into the review it was evaluated to determine what other elements of an HTA the framework addressed. The third section detailed the creation and testing of an MMA HTA evaluation module which was used to modify the current HTA guidelines in Australia. The use of the module ensures that the technology specific characteristics of apps would be properly appraised during an assessment. The module’s transferability to comparable HTA jurisdictions was also assessed. This was achieved in two stages. The first stage were in-depth interviews with stakeholders (healthcare practitioners, application developers, and policymakers) to determine possible impediments and pathways to MMA reimbursement in Australia. The findings of the interviews were integrated with those from the first and second sections of this research on MMA reimbursement and regulation to create an MMA evaluation module. The fourth and final section determined the feasibility of MMA reimbursement in Australia through the integration and synthesis of all the evidence generated from the preceding three sections. Results: The research found that there were policy gaps in the regulatory and reimbursement criteria used to evaluate MMAs. Regarding current regulatory policy, the TGA does not adequately evaluate MMAs according to the IMDRF criteria. Policy changes to current regulation processes should include an assessment of the harm from misinformation as well as potential risks associated with information and connectivity compatibilities, such as cybersecurity threats. Similarly, there were a number of policy changes that could be made to support the reimbursement of MMAs in Australia. The systematic literature review of MMA evaluation frameworks found that there was a greater need to evaluate the harms posed by MMAs (i.e. misinformation) as well as a fuller consideration of the likely comparator for the technology. Other considerations included, but were not limited to, equity of access to MMAs (i.e. by way of age, literacy, user disability, etc.), as well as the importance of secure and proper management of confidential data. Other technology specific concerns included: the possible effect of software updates on the effectiveness and safety of MMAs and possible variation in app performance on different operating systems (OS), mobile platforms, and generations of the same platform. Interviews conducted with stakeholders sought to explore possible pathways and impediments to MMA reimbursement in Australia and, highlighted a few policy challenges. These included: clarification around where the responsibly lies regarding data ownership, cybersecurity, and professional liability in the use of app data; the digital health literacy of healthcare practitioners, patients, and any other MMA users (i.e. carers); and finally, developing evaluative measures which address the technological evolution of MMAs, such as the technology’s rapid lifecycle and software updates. Contrastingly, the interviews indicated that stakeholders trust the evidence-based approach used by the Australian Medical Services Advisory Committee (MSAC) to conduct HTAs and make public funding decisions and felt it would be an appropriate evaluation mechanism for MMAs. Given these policy concerns, proper evaluation of MMA’s is needed before they can be reimbursed in Australia. To ensure that MMAs are properly evaluated, a module was developed which could modify the current HTA framework employed by MSAC. The module addressed both regulatory and reimbursement policy concerns. This is to ensure that the regulatory issues are addressed, as the current TGA process does not properly evaluate them. The utility of the MMA HTA evaluation module was assessed for adaptation to other comparable HTA jurisdictional bodies, such as the European Economic Area (EEA), Canada, and the United States of America (USA). Minimal modifications would need to be made to the module for it to be used by other HTA agencies in these jurisdictions. These adaptations would include the removal of any of the unique MMA items (e.g. software, updates, cybersecurity) that were already addressed by the jurisdiction’s regulatory authority. Adaptations to the cost-effectiveness domain would be dependent on the individual economic evaluations conducted by the respective jurisdictional HTA agencies, and their individual healthcare contexts. The development of the MMA HTA evaluation module, and the research that informed it, shows that MMA reimbursement in Australia is feasible. Thus, it is feasible to tailor the regulatory and reimbursement processes in Australia to evaluate MMAs properly. Conclusion: In conclusion, it is possible to tailor regulation and reimbursement processes in Australia to address the evaluation of MMAs. These modifications to current processes can be made through a variety of key policy and process changes. One process change would be the adoption of the MMA evaluation module as it is capable of adapting the existing MSAC evaluation framework to assess this technology. Other policy changes would include: facilitating the digital health literacy of MMA users (i.e. healthcare practitioners, patients, carers, etc.); providing clarification around who and where the responsibility lies regarding use of MMAs (i.e. data ownership, professional liability, and cybersecurity), and, finally, stipulating evaluative procedures which address the challenges posed by the ongoing technological evolution of apps (i.e. rapid lifecycle, software updates, etc.).Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202

Strengthening Food Security through Technologies

Securing food for 1.35 billion Indians and doubling the income of farmers by 2022, as stated by the government, are challenging tasks. India’s performance is below average in all three aspects of food security: availability, affordability, and quality and safety. It is an irony that the nation with largest cultivable land in the world (142 million ha) is facing food insecurity in spite of wide agro-ecoregions that enable cultivation of land even for three seasons in the large area. A large population (58%) depends on agriculture for its livelihood but the contribution of this sector to country's gross domestic product (GDP) has declined continuously since 1950 and was 15% in 2018. Although, the country has transformed itself from dependency on imports to selfsufficiency still the challenge is to remove the farm distress in the country. Current farmers’ field yields are lower by two to four folds than the achievable potential. In addition, the value realisation from the market is 30 to 35% only. This is because 59 % of the farmers in India do not get essential information from any agency. The major hurdles for achieving the goals set by the government are low investment in agricultural technologies, low adoption of key technologies by the farmers largely due to lack of knowledge/information, poor physical infrastructure, and involvement of large number of intermediaries in the value chains. Lack of awareness among farmers about good agricultural management practices is a key factor for stagnant productivity levels. The mind-set of all actors involved in agriculture needs to change so that they work collectively as a team instead of working independently in silos if the agrarian situation is to be transformed

Photometric compliance of tablet screens and retro-illuminated acuity charts as visual acuity measurement devices

Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc.) and three ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off) exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2) providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90%) regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%). Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off) had adequate mean luminance (≥ 120 cd/m2) and Weber contrast (≥ 90%), but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%). Two charts were operating beyond manufacturer’s recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out-performed ETDRS charts in terms of photometric compliance with high contrast acuity standards