DHRS 2009 Proceedings of the Ninth Danish Human-Computer Interaction Research Symposium.

Since 2001 the annual Danish Human-Computer Interaction Research Symposium has been a platform for networking, and provided an opportunity to get an overview across the various parts of the Danish HCI research scene. This years symposium was held in Aarhus, Denmark on December 14, 200

A Fit between Clinical Workflow and Health Care Information Systems: Not waiting for Godot but making the journey

Health care has long suffered from inefficiencies due to the fragmentation of patient care information and the lack of coordination between health professionals [1]. Health care information systems (HISs) have been lauded as tools to remedy such inefficiencies [2, 3]. The primary idea behind the support of their implementation in health care is that these systems support clinical workflow and thereby decrease medical errors [2]. However, their introduction to health care settings have been accompanied by a transformation of the way their primary users, care providers, carry out clinical tasks and establish or maintain work relationships [4]. Studies have shown that these transformations have not always been productive [5, 6]

The effect of bright light on rest-activity rhythms and behavioural and psychological symptoms of dementia

De fleste som lever med demens har også atferdsmessige- og psykologiske symptomer ved demens (APSD) som for eksempel depresjon, angst, agitasjon, og søvnforstyrrelser. APSD påvirker livskvalitet og pleiebehov. Aktivitetsrytmen er ofte endret hos personer med demens. For eksempel kan søvn og våkenhet forekomme uregelmessig, med rastløshet og atferdsforstyrrelser på kvelds- og nattestid, og søvn på dagtid. Forstyrrelser i søvn og våkenhet har negative konsekvenser for daglig fungering, kognisjon, og affekt. I tillegg er det trolig at denne typen problemer gjenspeiler forstyrrelse av den endogene cirkadiane rytmen. APSD, inkludert søvnproblemer, behandles ofte medikamentelt, på tross av at slik behandling har begrenset effekt og kan medføre alvorlige bivirkninger. Lys påvirker den cirkadiane rytmen, og kan i tillegg ha en innvirkning på våkenhet og humør. Disse omtales som ikke-visuelle effekter av lys. Lysterapi er en ikke-medikamentell behandling som ifølge noen tidligere studier kan ha en positiv effekt på affekt, agitasjon, søvnforstyrrelser og aktivitetsrytmer hos personer med demens, men resultatene fra ulike studier har ikke vært entydige. Målet med denne avhandlingen var å undersøke effekten av lysterapi på APSD og aktivitetsrytmer, gjennom en klynge-randomisert placebo-kontrollert studie over 24 uker – DEM.LIGHT studien. Et sekundært mål, og et forarbeid til hovedstudien, var å undersøke lysforholdene ved demensenheter på sykehjem. Artikkel 1 presenterte en undersøkelse av lys på 15 demensenheter i Bergen kommune, gjennomført ved to årstider og med lysmålinger i ulike retninger. Lysmålingene ble sammenlignet med grenseverdier basert på anbefalinger og tidligere forskning. Lysverdiene ble oppgitt i måleenheter som er relevante for ikkevisuelle effekter av lys. Artikkel 2 og 3 rapporterte resultater fra DEM.LIGHTstudien, gjennomført på 8 sykehjem med 69 deltagere. Intervensjonen besto av takmonterte LED-lys i fellesstuen på 4 demensenheter, som gav lys av ulik styrke og fargetemperatur gjennom dagen. Maksimalt nivå for intervensjonen var ~1000 lx og 6000 K, mellom kl. 10:00 og 15:00, målt vertikalt 1.2 m over gulvet. Kontrollgruppen (4 demensenheter) hadde standard innendørsbelysning (~150–300 lx, 3000 K). Data ble innhentet ved baseline, og etter 8, 16 og 24 uker. Artikkel 2 undersøkte effekten av lysbehandlingen på aktivitetsrytmer registrert med aktigrafi, og artikkel 3 undersøkte effekten på proxy-vurderte APSD-mål (Cornell Scale for Depression in Dementia, CSDD og Neuropsychiatric Inventory – Nursing Home Version, NPI-NH). Effekten av behandlingen ble analysert ved bruk av blandede regresjonsmodeller (multilevel models), med demensstadium (Functional Assessment Staging Tool, FAST skåre) ved baseline som en a priori bestemt kovariat. I tillegg ble baselineskårer på utfallsmålene inkludert som kovariater i analysene til artikkel 3. I artikkel 1 fant vi at de fleste målingene av lyset på demensenhetene var under terskelverdiene, uavhengig av årstid og måleretning. I artikkel 2 fant vi ingen forbedring av aktivitetsrytmen etter BLT hos personer med demens når vi korrigerte for multippel testing. Uten slik korreksjon var akrofasen (tidspunktet for aktivitetrytmens makspunkt) signifikant mindre forsinket (med en time) i uke 16 i intervensjonsgruppen sammenlignet med kontrollgruppen. Artikkel 3 rapporterte blandede resultater for effekten av lysintervensjonen på APSD. Det var en signifikant effekt på underskalaer som måler affektive symptomer i uke 16, men ikke i uke 8 eller 24, etter korreksjon for multippel testing. Det var en signifikant effekt på CSDD og NPI-NH total-skårer i uke 16 før, men ikke etter, korreksjon for multippel testing. Det var ingen signifikant effekt på andre underskalaer. Oppsummert peker funnene fra artikkel 1 mot at lyset på demensenheter er utilstrekkelig sett opp mot terskelverdier for ikke-visuelle effekter av lys. Likevel var resultatene fra DEM.LIGHT-studien, som økte belysningen på demensenheter, blandede. Basert på disse resultatene kan vi ikke anbefale takmontert lysterapi ved demensenheter. Det er imidlertid flere metodologiske utfordringer og karakteristikker ved utvalget som begrenser generaliserbarheten til disse funnene.Most people living with dementia have behavioural and psychological symptoms of dementia (BPSD), such as depression, anxiety, agitation, and disturbed sleep, that strongly affect well-being and care needs. The rest-activity rhythm (RAR), i.e., the diurnal pattern of activity, is often altered in individuals with dementia. Sleep and wakefulness may, for instance, occur at irregular intervals, characterised by restlessness and behavioural disturbances at night, and napping during the day. This disruption of the sleep-wake pattern is detrimental to functioning and well-being. It is also thought to reflect deterioration of the endogenous circadian rhythm. Pharmacotherapy is often used to treat BPSD, including sleep disturbances, but has limited efficacy and is associated with severe side effects. Light influences the circadian rhythm, and can also have effects on alertness and mood. These are collectively referred to as non-image forming (NIF) effects of light. Bright light treatment (BLT) is a non-pharmacological intervention that has been found to improve affective symptoms, agitation, sleep disorders, and RARs in people with dementia in some studies, but results have been mixed. The main aim of this thesis was to investigate the effect of BLT on RARs and BPSD in a 24-week cluster randomised controlled trial - the DEM.LIGHT trial (ClinicalTrials.gov identifier: NCT03357328). A secondary aim, and preparation for the trial, was to investigate the illumination in nursing home dementia units. Paper 1 was a field study investigating nursing home illumination in 15 dementia units across seasons and gaze directions. Measured illuminances were compared to thresholds suggested by industry standards and research, and measurement units relevant to NIF effects of light were used. Paper 2 and 3 reported results from the DEM.LIGHT trial, conducted at 8 dementia units, with 69 participants. In the intervention group (4 units), ceiling mounted LED-panels provided ambient light of varying illuminance and correlated colour temperature throughout the day, with a peak of ~1000 lx and 6000 K (measured vertically at 1.2 m) between 10:00 and 15:00. In the control group (4 units), standard indoor light of ~150–300 lx, 3000 K was used. Data were collected at baseline and at 8, 16, and 24 weeks. Paper 2 investigated the effect of the intervention on actigraphy-measured RARs, and paper 3 investigated the effect on proxy-rated BPSD measures: the Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). Treatment effects were analysed using multilevel regression models, with dementia stage (score on the Functional Assessment Staging Tool, FAST) at baseline as a pre-determined covariate. In addition, baseline scores on the outcome measures were included as covariates in the models in paper 3. In paper 1 we found that, regardless of season and gaze direction, nearly all measured illuminances in dementia units fell below the thresholds. In paper 2, we found that there was no effect of BLT on RAR outcomes in people with dementia when controlling for multiple testing. Without controlling for multiple testing, the acrophase (i.e., timing of the activity peak) was significantly less delayed (by one hour) in the intervention group compared to the control group, in week 16. Paper 3 found mixed results for the effect of BLT on BPSD. There was a significant reduction of scores on affective subscales in the intervention group in week 16, but not at other follow-ups, after controlling for multiple testing. There was a significant effect on the NPI-NH and CSDD total scores in week 16 before, but not after, controlling for multiple testing. There were no significant effects on other subscales. In conclusion, the findings in paper 1 suggest that illumination in dementia units is inadequate compared to thresholds suggested for NIF effects of light. However, the results of the DEM.LIGHT trial, which increased the indoor illumination in dementia units, were mixed. Based on our results, we cannot make clear recommendations regarding the use of ambient BLT in dementia units. Several methodological challenges and sample characteristics may limit the generalisability of these results.Doktorgradsavhandlin

Rhythms of information infrastructure cultivation: the case of e-Mobility in Berlin

This thesis investigates the importance of temporal rhythms in the study of information infrastructures (IIs), responding to the call to address an II’s “biography” by focusing on its evolution over time. It enriches understanding of how socially constructed rhythms, a temporal structure under-examined in the II literature, influence II cultivation. A strategic niche project to develop an e-mobility II in Berlin is used as the case study and reveals the influence of rhythm in disciplining (constraining) and modeling (motivating) II cultivation. It demonstrates how the intermediary may mediate these influences through the interventions of harmonising, riffing and composing. Based on these interventions, the study develops the concept of facilitated II cultivation, which adds to the emergent literature exploring the tension between planned and emergent infrastructure work. In doing so, the study presents a framework that helps combine short-term implementation concerns (strategic interventions by the intermediary) with long-term path dependency and evolutionary concerns (influences of past and future temporal rhythms) for IIs

Democracy’s Fourth Wave? Digital Media and the Arab Spring

Did digital media really "cause" the Arab Spring, or is it an important factor of the story behind what might become democracy's fourth wave? An unlikely network of citizens used digital media to start a cascade of social protest that ultimately toppled four of the world's most entrenched dictators. Howard and Hussain find that the complex causal recipe includes several economic, political and cultural factors, but that digital media is consistently one of the most important sufficient and necessary conditions for explaining both the fragility of regimes and the success of social movements. This book looks at not only the unexpected evolution of events during the Arab Spring, but the deeper history of creative digital activism throughout the region.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117564/1/Democracy's Fourth Wave.pdfDescription of Democracy's Fourth Wave.pdf : PD