Development and Performance Evaluation of a Connected Vehicle Application Development Platform (CVDeP)

Connected vehicle (CV) application developers need a development platform to build, test and debug real-world CV applications, such as safety, mobility, and environmental applications, in edge-centric cyber-physical systems. Our study objective is to develop and evaluate a scalable and secure CV application development platform (CVDeP) that enables application developers to build, test and debug CV applications in realtime. CVDeP ensures that the functional requirements of the CV applications meet the corresponding requirements imposed by the specific applications. We evaluated the efficacy of CVDeP using two CV applications (one safety and one mobility application) and validated them through a field experiment at the Clemson University Connected Vehicle Testbed (CU-CVT). Analyses prove the efficacy of CVDeP, which satisfies the functional requirements (i.e., latency and throughput) of a CV application while maintaining scalability and security of the platform and applications

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

Digital transformation in healthcare: an innovative business plan for an application digitizing physical rehabilitation

The health care system adapts to innovations very slowly, as strict rules control all measures. It is even more challenging when one wants to introduce a digital solution for the healthcare market. Even minor changes to the code can mean major hurdles for approvals. This challenge was taken up in the following master thesis. The status quo of gait analysis has hardly been innovated for decades. The approach of reha buddy is to analyze how a human walks through wireless sensors. This represents an innovation that will revolutionize the market for gait analysis. Above all, trends of the last two years, which were pushed even more by the last pandemic, have shown that there is probably no better time to pursue this project. Additionally, a literature review and expert interviews were conducted to support all statements in the thesis. What is more, for a precise examination of each chapter of the business plan, a market analysis was carried out focusing on all specific characteristics of the health care market. The team of reha buddy has to overcome some major obstacles in the next few years but is well-positioned with their team of experts who set some important milestones for managing those hurdles. The result of this work is a business plan which clarifies that reha buddy's vision has an entrepreneurial foundation and that the team's idea should be pursued.O Sistema de Saúde adapta-se às inovações muito lentamente, uma vez que regras rígidas controlam todas as medidas. É um desafio ainda maior quando se deseja introduzir uma solução digital no setor da Saúde. Mesmo pequenas alterações no código podem significar grandes dificuldades para aprovações. Este desafio é abordado na presente tese de mestrado. O status quo da locomoção praticamente não foi inovado durante décadas. A abordagem do Reha Buddy passa por analisar como um humano se desloca através de sensores sem fios, o que representa uma inovação que irá revolucionar o mercado da locomoção. Acima de tudo, as tendências dos últimos dois anos, que foram impulsionadas ainda mais pela última pandemia, mostraram que provavelmente não há melhor momento para avançar com este projeto. Foi realizada uma revisão de literatura, assim como entrevistas com especialistas com o objetivo de apoiar todas as afirmações. Adicionalmente, para uma análise eficaz de cada capítulo do plano de negócios, foi realizada uma análise de mercado com foco em todas as características específicas do mercado da Saúde. A equipa do Reha Buddy terá que superar alguns obstáculos importantes nos próximos anos; está, no entanto, bem posicionada com a sua equipa de especialistas que estabeleceu alguns marcos importantes para gerir esses obstáculos. O resultado do presente projeto é um plano de negócios que esclarece que a visão do Reha Buddy tem uma base empreendedora e que a ideia apresentada pela equipa deve ser concretizada

Corona Health -- A Study- and Sensor-based Mobile App Platform Exploring Aspects of the COVID-19 Pandemic

Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July, 2020) in 8 languages and attracted 7,290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures

Medical Devices Information Systems in Primary Care

People who suffer from chronic diseases are becoming more involved in remote monitoring processes each year. The market acceptance of remote care programmes, connecting patients through medical devices as part of the treatment regime, is spreading worldwide. Healthcare providers use medical devices to monitor, in various ways, the chronically ill population, namely people with diabetes and hypertension. However, most hospital and service provider information systems do not conform to the same important data standards, making interoperability and information sharing difficult. In this sense, the Multimorbidity Health Information System (METHIS) project is a multidisciplinary, goal-oriented, design-science-based intervention aiming to improve physician-patient communication and patient engagement. It focuses on multimorbidity and ageing, encompassing patients with more than one chronic disease and over 65 years old. The proposed solution is a Clinical Medical Devices Information (CMDI) system and data model which contains standardised information about chronic patients, medical devices and other data sets to be included in the METHIS System. With this framework, the system can perform consistently and reliably while meeting all relevant regulatory requirements or standards. Based on this dissertation and the METHIS project’s complementary work, implementing the CMDI in various Family Health Unit (FHU) in Portugal will make it possible to combat the diversity and loss of telemonitoring information.A cada ano, os doentes crónicos estão mais envolvidos em processos de telemonitorização. A aceitação pelo mercado de programas de cuidados à distância, ligando doentes através de dispositivos médicos como parte do regime de tratamento, está a espalhar-se por todo o mundo. Os prestadores de cuidados de saúde utilizam dispositivos médicos para monitorizar, de várias formas, a população cronicamente doente, nomeadamente as pessoas com diabetes e hipertensão arterial. No entanto, a maioria dos sistemas de informação dos hospitais e prestadores de serviços não estão em conformidade com as mesmas normas, o que dificulta a interoperabilidade e a partilha de informação. Neste sentido, o projeto METHIS é uma intervenção multidisciplinar, baseada em Design Science, que visa melhorar a comunicação entre médico e doente e o envolvimento do mesmo. Tem como foco a multimorbidade e o envelhecimento, englobando doentes com várias doenças crónicas e com idade superior a 65 anos. A solução proposta é um sistema e o correspondente modelo de dados CMDI que contém informação padronizada sobre doentes crónicos, dispositivos médicos e outros conjuntos de dados a serem incluídos no Sistema METHIS. Com este modelo de dados, o sistema possui a informação para poder funcionar de forma consistente e fiável, cumprindo todos os requisitos ou normas regulamentares relevantes. Com base nesta dissertação e no trabalho complementar do projeto METHIS, a implementação da base de dados CMDI em vários Unidades de Saúde em Portugal tornará possível combater a diversidade e a perda de informação na telemonitorização

Studies to inform the development and practical roll-out of a digital adherence intervention, Video-Observed Therapy (VOT)

BACKGROUND: Prior to the COVID-19 pandemic, globally, tuberculosis (TB) was the leading cause of death from a single infectious agent. It is an important example of a curable condition which has well-documented treatment adherence challenges. WHO recommends the use of video-observed therapy (VOT) as a flexible alternative to DOT (Directly Observed Treatment). There is limited evidence of VOT’s acceptability and how it may enable patients to engage with their treatment to elicit optimal adherence outcomes. This PhD thesis aims to improve understanding of patient groups who may benefit most from VOT. METHODS: Drawing upon a narrative literature review, this PhD thesis includes: a) a study to identify factors that predict non-completion of TB treatment through a retrospective cohort analysis of cases with TB notified to the Enhanced TB Surveillance System in England, Wales and Northern Ireland between 2010 and 2017; b) a study comparing VOT to in-person DOT to examine the factors which affect the levels of engagement with DOT and VOT and whether these affect the level of treatment observation achieved in DOT and VOT groups through a secondary analysis of the UK DOT/VOT trial dataset using descriptive analysis and logistic regression; c) a qualitative study exploring the lived experiences and perspectives of DOT and VOT users in two settings, the UK and Republic of Moldova using semi-structured interviews with 16 UK DOT/VOT trial participants and 22 Moldovan DOT/VOT trial participants. Themes were mapped onto the Capability Opportunity Motivation Behaviour (COM-B) model, Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) to identify how the VOT and DOT functions, strategies and its policy categories elicit treatment adherence outcomes to support decision-making on commissioning of DOT and VOT interventions. RESULTS: Recent migration to the UK (0 -1 years from entry to the UK to TB notification), multidrug resistance, increasing social complexity and a previous TB diagnosis were significantly associated with non-completion of TB treatment. Higher levels of initial engagement with VOT (90% initially engaged) rather than DOT (49% initially engaged) were observed amongst all patient groups. Amongst those who initially engaged with either DOT or VOT, patients with TB on VOT had improved TB treatment adherence compared those on DOT. Women were less likely to adhere and those with a history of being lost to follow-up were also less likely to adhere. The COM-B model and TDF provided explanatory frameworks highlighting how VOT acted on key behaviour change domains and utilised key strategies to facilitate adherence behaviour change. VOT facilitated patient-provider interactions served as a prompt/reminder to address forgetfulness through regular personalised messages from VOT observers, building rapport and habit-forming practices. VOT was a flexible, time- and cost-saving alternative to DOT and supported patients with split dosing or negotiated timing of dosing to manage side effects and pill burden. VOT also served as an incentive through the provision of a smartphone and data plan, free domestic calls, text messages and internet access linking patients to providers, banking and social support services. In turn these ‘capability and ‘opportunity’ components of the model enhanced ‘motivation’ by supporting patients to re-gain autonomy, self-responsibility and establish regular dosing. There were mixed views on privacy with participants expressing concerns on how video clips would be used, shared and may compromise confidentiality and increase stigma. The Behaviour Change Wheel identified seven key functions (‘active ingredients’) of VOT: Enablement (increasing means/reducing barriers to increase capability), Education (increasing knowledge or understanding), Persuasion (using communication to induce positive or negative feelings or stimulate action), Training (imparting skills), Incentivisation (creating expectation of reward), Restriction (using rules to reduce opportunity to engage in target behaviour) and Environmental restructuring (changing the physical or social context). While participants on DOT felt cared for, they had doubts about their personal necessity for treatment, found DOT invasive and stigmatising, time-consuming and costly. At a health system level, DOT was resource-intensive and batch collections of medicines made it difficult to prove fidelity. CONCLUSION: VOT promotes engagement and adherence to TB treatment in all groups at risk of non-adherence, which suggest it is a more acceptable approach to TB treatment observation compared to DOT. VOT can be universally applied to all patient groups in need of adherence support, including inclusion health groups (those with a current or history of homelessness, imprisonment, drug misuse and current alcohol misuse, vulnerable migrant groups (asylum seekers and refugees), in low TB incidence settings. DOT is an acceptable intervention to some groups with multiple needs (participants who were aged over 55, had a prison history, a history of homelessness (more than 5 years ago) and those with current alcohol problems). The evidence from this research could be used to develop a personalised decision support tool to support clinicians to offer VOT to groups based on risk of poor adherence and quantitative and qualitative assessment of acceptability and engagement. Use of the e-Health Implementation Toolkit (e-HIT) supports the national and practical roll-out of VOT to all patient groups in need of adherence support, including those with social complexity. In the era of COVID-19 and acceleration of the use of digital innovations, monitoring the roll-out of VOT should also involve engagement with patients on privacy and confidentiality issues. Engagement with the TB workforce is needed to examine staff attitudes to support learning on what adaptations could be made to VOT and to inform their needs and health system readiness, strengthen health protection and global health security. Further engagement with healthcare professionals to secure their buy-in, address their concerns and to minimise “technology fatigue” is needed. VOT has shown that it improves treatment adherence and while trials are yet to provide convincing evidence to data that it enhances final outcomes, the technology itself does have the potential to reduce treatment-related costs at a patient and health service level. In 2020 WHO proposed VOT as one of the options to support adherence in its target product profiles for TB preventative treatment. Further real-world programmatic evidence on how VOT works and health system cost-effectiveness should continue to be conducted under different conditions of care, including in different geographical settings, patient sub-groups and at different stages of treatment. FUNDING: UCL discretionary funds, Royal Society of Tropical Medicine and Hygiene and UCL Public Policy small grant award

ĐỔI MỚI DIY: TACTICAL RURALISM AND TANGIBLE MODELING IN THE MEKONG DELTA

In recent years, the integrity of the Mekong Delta has been put at risk by a combination of environmental and institutional factors. Understanding that the degradation of the Delta would have far-reaching socioeconomic implications for both Vietnam and the Indochinese Peninsula, The World Bank has responded to the situation by implementing initiatives for climate-smart planning tools and improved water management practices throughout the lower Mekong basin. Seeing the potential for tangible modeling as a participatory planning tool, the Bank has hired a team of consultants from Louisiana State University to introduce a methodology called Tangible Landscape to its climate resilience toolkit. This thesis aims to contribute to the consultancy by using literature review, interpretive case studies in a design approach called tactical ruralism, and geospatial analysis to inform the design and fabrication of a conceptual Tangible Landscape model for the Mekong Delta. The author identifies the environmental problems facing the delta, compiles an array of relevant design solutions that can be used to address those problems at the site scale, and creates a series of mappings that identify suitable sites to apply those solutions. He also develops a conceptual transect of rural livelihoods of the Mekong Delta which can be used to inform a forthcoming Tangible Landscape workshop to be held in Viet Nam as part of the World Bank Consultancy. Providing solutions at every scale and level of governance is of particular importance to this project, especially those considered to be “grassroots” or “bottom-up” interventions implemented by individual households, communes, wards, and districts

Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru.

BACKGROUND: Cash transfers are key interventions in the World Health Organisation's post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project. METHODS: Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support. Economic support was provided to patient households through cash transfers on meeting the following conditions: screening for TB in household contacts and MDR TB in patients; adhering to TB treatment and chemoprophylaxis; and engaging with CRESIPT social support (household visits and community meetings). To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders. RESULTS: Over 7 months, 135 randomly-selected patients and their 647 household contacts were recruited from 32 impoverished shantytown communities. Of 1299 potential cash transfers, 964 (74 %) were achieved, 259 (19 %) were not achieved, and 76 (7 %) were yet to be achieved. Of those achieved, 885/964 (92 %) were achieved optimally and 79/964 (8 %) sub-optimally. Key project successes were identified during 135 formative activities and included: strong multi-sectorial collaboration; generation of new evidence for TB-specific cash transfer; and the project being perceived as patient-centred and empowering. Challenges included: participant confidence being eroded through cash transfer delays, hidden account-charges and stigma; access to the initial bank-provider being limited; and conditions requiring participation of all TB-affected household members (e.g. community meetings) being hard to achieve. Refinements were made to improve project acceptability and future impact: the initial bank-provider was changed; conditional and unconditional cash transfers were combined; cash transfer sums were increased to a locally-appropriate, evidence-based amount; and cash transfer size varied according to patient household size to maximally reduce mitigation of TB-related costs and be more responsive to household needs. CONCLUSIONS: A novel TB-specific socioeconomic intervention including conditional cash transfers has been designed, implemented, refined and is ready for impact assessment, including by the CRESIPT project. The lessons learnt during this research will inform policy-makers and decision-makers for future implementation of related interventions