Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study.

BACKGROUND:Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. OBJECTIVE:The objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study. METHODS:Usability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions. RESULTS:During usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements. CONCLUSIONS:Usability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions

Fixed-Mobile Convergence in the 5G era: From Hybrid Access to Converged Core

The availability of different paths to communicate to a user or device introduces several benefits, from boosting enduser performance to improving network utilization. Hybrid access is a first step in enabling convergence of mobile and fixed networks, however, despite traffic optimization, this approach is limited as fixed and mobile are still two separate core networks inter-connected through an aggregation point. On the road to 5G networks, the design trend is moving towards an aggregated network, where different access technologies share a common anchor point in the core. This enables further network optimization in addition to hybrid access, examples are userspecific policies for aggregation and improved traffic balancing across different accesses according to user, network, and service context. This paper aims to discuss the ongoing work around hybrid access and network convergence by Broadband Forum and 3GPP. We present some testbed results on hybrid access and analyze some primary performance indicators such as achievable data rates, link utilization for aggregated traffic and session setup latency. We finally discuss the future directions for network convergence to enable future scenarios with enhanced configuration capabilities for fixed and mobile convergence.Comment: to appear in IEEE Networ

Health Diplomacy the Adaptation of Global Health Interventions to Local Needs in sub-Saharan Africa and Thailand: Evaluating Findings from Project Accept (HPTN 043).

Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of 'global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation. Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of 'youth-friendly' services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective

Rough Sets Clustering and Markov model for Web Access Prediction

Discovering user access patterns from web access log is increasing the importance of information to build up adaptive web server according to the individual user’s behavior. The variety of user behaviors on accessing information also grows, which has a great impact on the network utilization. In this paper, we present a rough set clustering to cluster web transactions from web access logs and using Markov model for next access prediction. Using this approach, users can effectively mine web log records to discover and predict access patterns. We perform experiments using real web trace logs collected from www.dusit.ac.th servers. In order to improve its prediction ration, the model includes a rough sets scheme in which search similarity measure to compute the similarity between two sequences using upper approximation

Modelling multi-tier enterprise applications behaviour with design of experiments technique

Queueing network models are commonly used for performance modelling. However, through application development stage analytical models might not be able to continuously reflect performance, for example due to performance bugs or minor changes in the application code that cannot be readily reflected in the queueing model. To cope with this problem, a measurement-based approach adopting Design of Experiments (DoE) technique is proposed. The applicability of the proposed method is demonstrated on a complex 3-tier e-commerce application that is difficult to model with queueing networks