Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol

<b>Background </b>Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying ‘programme theory’ of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. <p></p> <b>Methods</b> Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. <p></p> <b>Discussion </b>This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. Systematic review registration PROSPERO CRD4201400939

Context-awareness for mobile sensing: a survey and future directions

The evolution of smartphones together with increasing computational power have empowered developers to create innovative context-aware applications for recognizing user related social and cognitive activities in any situation and at any location. The existence and awareness of the context provides the capability of being conscious of physical environments or situations around mobile device users. This allows network services to respond proactively and intelligently based on such awareness. The key idea behind context-aware applications is to encourage users to collect, analyze and share local sensory knowledge in the purpose for a large scale community use by creating a smart network. The desired network is capable of making autonomous logical decisions to actuate environmental objects, and also assist individuals. However, many open challenges remain, which are mostly arisen due to the middleware services provided in mobile devices have limited resources in terms of power, memory and bandwidth. Thus, it becomes critically important to study how the drawbacks can be elaborated and resolved, and at the same time better understand the opportunities for the research community to contribute to the context-awareness. To this end, this paper surveys the literature over the period of 1991-2014 from the emerging concepts to applications of context-awareness in mobile platforms by providing up-to-date research and future research directions. Moreover, it points out the challenges faced in this regard and enlighten them by proposing possible solutions

Real-Time Context-Aware Microservice Architecture for Predictive Analytics and Smart Decision-Making

The impressive evolution of the Internet of Things and the great amount of data flowing through the systems provide us with an inspiring scenario for Big Data analytics and advantageous real-time context-aware predictions and smart decision-making. However, this requires a scalable system for constant streaming processing, also provided with the ability of decision-making and action taking based on the performed predictions. This paper aims at proposing a scalable architecture to provide real-time context-aware actions based on predictive streaming processing of data as an evolution of a previously provided event-driven service-oriented architecture which already permitted the context-aware detection and notification of relevant data. For this purpose, we have defined and implemented a microservice-based architecture which provides real-time context-aware actions based on predictive streaming processing of data. As a result, our architecture has been enhanced twofold: on the one hand, the architecture has been supplied with reliable predictions through the use of predictive analytics and complex event processing techniques, which permit the notification of relevant context-aware information ahead of time. On the other, it has been refactored towards a microservice architecture pattern, highly improving its maintenance and evolution. The architecture performance has been evaluated with an air quality case study

Utilising semantic technologies for decision support in dementia care

The main objective of this work is to discuss our experience in utilising semantic technologies for building decision support in Dementia care systems that are based on the non-intrusive on the non-intrusive monitoring of the patient’s behaviour. Our approach adopts context-aware modelling of the patient’s condition to facilitate the analysis of the patient’s behaviour within the inhabited environment (movement and room occupancy patterns, use of equipment, etc.) with reference to the semantic knowledge about the patient’s condition (history of present of illness, dependable behaviour patterns, etc.). The reported work especially focuses on the critical role of the semantic reasoning engine in inferring medical advice, and by means of practical experimentation and critical analysis suggests important findings related to the methodology of deploying the appropriate semantic rules systems, and the dynamics of the efficient utilisation of complex event processing technology in order to the meet the requirements of decision support for remote healthcare systems

Semantic-based decision support for remote care of dementia patients

This paper investigates the challenges in developing a semantic-based Dementia Care Decision Support System based on the non-intrusive monitoring of the patient's behaviour. Semantic-based approaches are well suited for modelling context-aware scenarios similar to Dementia care systems, where the patient's dynamic behaviour observations (occupants movement, equipment use) need to be analysed against the semantic knowledge about the patient's condition (illness history, medical advice, known symptoms) in an integrated knowledgebase. However, our research findings establish that the ability of semantic technologies to reason upon the complex interrelated events emanating from the behaviour monitoring sensors to infer knowledge assisting medical advice represents a major challenge. We attempt to address this problem by introducing a new approach that relies on propositional calculus modelling to segregate complex events that are amenable for semantic reasoning from events that require pre-processing outside the semantic engine before they can be reasoned upon. The event pre-processing activity also controls the timing of triggering the reasoning process in order to further improve the efficiency of the inference process. Using regression analysis, we evaluate the response-time as the number of monitored patients increases and conclude that the incurred overhead on the response time of the prototype decision support systems remains tolerable

The Internet-of-Things Meets Business Process Management: Mutual Benefits and Challenges

The Internet of Things (IoT) refers to a network of connected devices collecting and exchanging data over the Internet. These things can be artificial or natural, and interact as autonomous agents forming a complex system. In turn, Business Process Management (BPM) was established to analyze, discover, design, implement, execute, monitor and evolve collaborative business processes within and across organizations. While the IoT and BPM have been regarded as separate topics in research and practice, we strongly believe that the management of IoT applications will strongly benefit from BPM concepts, methods and technologies on the one hand; on the other one, the IoT poses challenges that will require enhancements and extensions of the current state-of-the-art in the BPM field. In this paper, we question to what extent these two paradigms can be combined and we discuss the emerging challenges

A unified view of data-intensive flows in business intelligence systems : a survey

Data-intensive flows are central processes in today’s business intelligence (BI) systems, deploying different technologies to deliver data, from a multitude of data sources, in user-preferred and analysis-ready formats. To meet complex requirements of next generation BI systems, we often need an effective combination of the traditionally batched extract-transform-load (ETL) processes that populate a data warehouse (DW) from integrated data sources, and more real-time and operational data flows that integrate source data at runtime. Both academia and industry thus must have a clear understanding of the foundations of data-intensive flows and the challenges of moving towards next generation BI environments. In this paper we present a survey of today’s research on data-intensive flows and the related fundamental fields of database theory. The study is based on a proposed set of dimensions describing the important challenges of data-intensive flows in the next generation BI setting. As a result of this survey, we envision an architecture of a system for managing the lifecycle of data-intensive flows. The results further provide a comprehensive understanding of data-intensive flows, recognizing challenges that still are to be addressed, and how the current solutions can be applied for addressing these challenges.Peer ReviewedPostprint (author's final draft