An Analysis of the Opportunities and Challenges Involved in the Formal Delivery of Self-Management Support in Diabetes using Digital Health Initiatives

This thesis will critically analyse self-management (SM) support services available in Scotland in the form of a gap analysis and demonstrate how digital solutions are required to increase the efficiency of health services nationally in order to fill these gaps. Firstly, the overall concept of self-management will be defined, including its importance in the treatment of long term conditions (LTC), using diabetes as an exemplary condition. This will be followed by an overview of the challenges involved in the delivery of self-management support in a ‘pre-digital’ era, where digital solutions have not been widely implemented. A review of the gaps present in the current provision of self-management support services will be demonstrated and an examination of appropriate digital solutions which could fill these gaps will be presented. Emphasis will be placed on projects run by the Digital Health and Care Institute and the challenges faced in implementing them

BIM communication waste

Developments in Information and Communication Technology can bring about significant improvements in the efficiency of the Architecture, Engineering and Construction and Facilities Management industry. Building Information Modelling (BIM), is a term which encompasses a type of software but more importantly a set of processes which, at their core, support an approach for integrated project delivery enabled by interoperable software systems. The last three years have seen intensified and coordinated adoption of BIM in the UK mainly as a result of the mandate of the UK government. One facet of these developments is the growing need for BIM collaboration tools which can interoperate effectively with the various BIM software systems, support the required standards and codes of practice and provide for requirements of construction project information production and management such as model-based workflows, model-based communication, model-based procurement, role-based data access and role-based privileges. The pre-requisites for collaboration can be broadly divided into two categories: (1) coordination of information and responsibilities, and (2) communication. This research recognizes the strong focus of recent and ongoing efforts to provide for coordination and aims to support the communication aspect. Additionally, successful collaborative practice results from (1) the "softer" or "human-aspect" issues: collaborative culture, software training and adherence to protocols as well as from (2) the provision of appropriate, intuitive and configurable collaboration tools and, more generally, digital collaboration environments. This research focuses on the latter. Despite efforts from a variety of software-as-a-service (SaaS) collaboration tool vendors to achieve dominance in the market, there is still uncertainty as to what type of solutions would best support BIM collaboration. Additionally, there is considerable variation in software configurations and a lack of a universally applicable method for evaluating the communication capabilities of BIM collaboration tools in a meaningful way. Vendors lack a robust conceptual framework to guide the long-term development of their tools and evaluate them. The process of requirements engineering, which in this context involves a diversity of stakeholders and involves projects at different BIM maturity levels would benefit significantly from a robust, context-specific conceptual model-ontology. The aim of this research is to produce a context-specific conceptual model-ontology which can support the discourse of requirements engineering and provide a robust and widely applicable framework for evaluating the communication capabilities of BIM collaboration tools. It is anticipated that this would help reduce BIM communication waste . To meet this aim, BIM collaboration tools were studied from five perspectives: 1.Users: their opinions, requirements and requests were collected through an online questionnaire survey. 2.Vendor: their perspective was captured through semi-structured interviews. 3.Schemata for interoperability: effectiveness of tools and schemata was evaluated through analysis of software by data fidelity study and scenario-based testing. 4.Tool use: patterns of digitally-enabled communication were explored through an analysis of communication data and meta-data collected from a collaboration tool. 5.Tool improvement: a successful approach in improving a collaboration tool was examined through the development of a context-specific requirements engineering process. This process was evaluated through semi-structured interviews with collaboration tool implementation consultants. Each perspective helped produce more specific requirements from the model as well as elements of the model itself. The end result was the Model for communication waste in BIM process interactions (WIMBIM). WIMBIM has the BIM process transmission as the fundamental unit of analysis and focuses on BIM communication waste and how it results from sub-optimal collaboration tools and schemata. The ultimate purpose of WIMBIM is to support the development of technology which would reduce this waste. This model was converted into a communicable format and was related to BIM standards to aid contextualization and gap identification. To evaluate the validity and utility of this model, interviews with BIM experts were conducted, and the proposed model was found to be a valid approach to address aspects of BIM waste, which is not usually examined and could potentially complement the existing model for BIM maturity. Additionally, the model provides a useful lens for further academic research into BIM collaboration tools

Granularity in visualisation of 3D BIM models design-science approach

Building Information Modeling (BIM) has gradually grown into one of the key information management platforms in the Architecture, Engineering and Construction industry. With the growing amount of information in and outside the digital construction industry, concepts of information retrieval like relevance and granularity have become relevant in this domain. An increased need for interoperability and easy access to information has caused the industry to look towards concepts like the semantic web and linked data. But within all this, the geometrical visualisation, which is an integral part of the BIM process, has lagged behind on the front of granularity and still seems to be done mainly using the conventional ways. We try to explore ways to introduce granularity in the visualisation of 3D BIM models, and connecting it to the semantic information which is already granular, thus creating a mapping between the two at a granular level. A web-based prototype is implemented and analysed as a proof of the presented concept, with the semantics being represented inside a graph-based data structure. We further present a discussion on the potential applications and use cases of the conceptualised framework in the field of construction and building lifecycle management. The work aims to take the first step towards modularising the visualisation process, and has tried to pave the way for detailed analyses and further improvements that may follow in this direction

Proceedings of the 9th Arab Society for Computer Aided Architectural Design (ASCAAD) international conference 2021 (ASCAAD 2021): architecture in the age of disruptive technologies: transformation and challenges.

The ASCAAD 2021 conference theme is Architecture in the age of disruptive technologies: transformation and challenges. The theme addresses the gradual shift in computational design from prototypical morphogenetic-centered associations in the architectural discourse. This imminent shift of focus is increasingly stirring a debate in the architectural community and is provoking a much needed critical questioning of the role of computation in architecture as a sole embodiment and enactment of technical dimensions, into one that rather deliberately pursues and embraces the humanities as an ultimate aspiration

White Paper on Digital and Complex Information

Information is one of the main traits of the contemporary era. Indeed there aremany perspectives to define the present times, such as the Digital Age, the Big Dataera, the Fourth Industrial Revolution, the fourth Paradigm of science, and in all ofthem information, gathered, stored, processed and transmitted, plays a key role.Technological developments in the last decades such as powerful computers, cheaperand miniaturized solutions as smartphones, massive optical communication, or theInternet, to name few, have enabled this shift to the Information age. This shift hasdriven daily life, cultural and social deep changes, in work and personal activities,on access to knowledge, information spreading, altering interpersonal relations orthe way we interact in public and private sphere, in economy and politics, pavingthe way to globalizationPeer reviewe

Ecological Influences on Dietary Behavior: The Interaction Between Person and Neighborhood Environment in a Low-SES, Hispanic Community

Despite existing knowledge about lifestyle choices and their relationships to obesity and diabetes, the prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing, and the number of Americans at risk is greater than 70% (CDC, 2019). Obesity is a complex, multifactorial, and largely preventable disease, affecting, along with overweight, over a third of the world\u27s population today. A significant factor in lifestyle management is the ecology of food choice. Literature suggests that environment and exposure can predict food-related health risk behaviors and health outcomes. The objective of this dissertation was to conceptualize and carry out a series of pilot studies relative to the refinement of nutrition ecological issues, methodologies, and measures. After a review of methodological difficulties, gaps, and unresolved issues, I propose methodological solutions, present the methodologies and results of pilot studies about the feasibility of these solutions. Study one involved database and windshield survey of more than 200 retail food locations in Jurupa Valley, CA. After redefining criteria for good quality food providers, this area was found to have an abundance of fast food and convenience stores and limited access to stores of the best nutritional quality. Study two included adaptations and implementation of a direct measure of the nutrition environment in Pomona, CA. The target area was a high-risk corridor with a concentration of both community activity and retail locations. Using database analysis and visual assessment, a list of stores was compiled, and of the 91 stores in the target area, 60 were surveyed for overall scores, which was a sum score of quality, accessibility, availability of fresh fruits and vegetables, and price. The results indicated that Grocery, Independent Market, and Ethnic Food outlets could be considered together as high-quality or at least higher quality in that they provided overall, price, access, and quality scores in the modified NEMS survey that were not statistically different from one another in quality of offerings (Kruskal-Wallis H X2(2) .386-6.726, p=. 035 to .832 (only significant value was for availability of fresh fruits and vegetables). Furthermore, all sub-types of convenience stores, including independent locations, those associated with a gas station, and liquor stores can be considered together, Kruskal-Wallis test X2(1.788-5.535) p= .63 to .409 (near-significant values for Price and Quality). Study three presents a methodology for accurately assessing the retail food environment using walking surveys on a GIS enabled mapping application. Results revealed significant inconsistencies between database (GIS) data and survey data acquired from current observations of the actual locations in the community; there was a 31% error in database findings. Additional comparisons were made between GIS results and participant data, which indicated possible patterns of positive or negative health and intake outcomes with neighborhood retail food availability. Results from this series of developmental studies indicated a need for primary data sources whenever possible for compiling information about retail food locations. As well, the methodology for collecting business-types from databases and for completing a safe and thorough environmental scan for retail food locations was presented in this dissertation. Additional findings indicated that a refined methodology to score store quality identified considerable variation between store types. These results may have implications for city planning, diabetes prevention, and lifestyle management programs

Quality framework for semantic interoperability in health informatics: definition and implementation

Aligned with the increased adoption of Electronic Health Record (EHR) systems, it is recognized that semantic interoperability provides benefits for promoting patient safety and continuity of care. This thesis proposes a framework of quality metrics and recommendations for developing semantic interoperability resources specially focused on clinical information models, which are defined as formal specifications of structure and semantics for representing EHR information for a specific domain or use case. This research started with an exploratory stage that performed a systematic literature review with an international survey about the clinical information modelling best practice and barriers. The results obtained were used to define a set of quality models that were validated through Delphi study methodologies and end user survey, and also compared with related quality standards in those areas that standardization bodies had a related work programme. According to the obtained research results, the defined framework is based in the following models: Development process quality model: evaluates the alignment with the best practice in clinical information modelling and defines metrics for evaluating the tools applied as part of this process. Product quality model: evaluates the semantic interoperability capabilities of clinical information models based on the defined meta-data, data elements and terminology bindings. Quality in use model: evaluates the suitability of adopting semantic interoperability resources by end users in their local projects and organisations. Finally, the quality in use model was implemented within the European Interoperability Asset register developed by the EXPAND project with the aim of applying this quality model in a broader scope to contain any relevant material for guiding the definition, development and implementation of interoperable eHealth systems in our continent. Several European projects already expressed interest in using the register, which will now be sustained by the European Institute for Innovation through Health Data

Contributions to interoperability, scalability and formalization of personal health systems

The ageing of the world's population combined with unhealthy lifestyles are contributing to a major prevalence of chronic diseases. This scenario poses the challenge of providing good healthcare services to that people affected by chronic illnesses, but without increasing its costs. A prominent way to face this challenge is through pervasive healthcare. Research in pervasive healthcare tries to shift the current centralized healthcare delivery model focused on the doctors, to a more distributed model focused on the patients. In this context Personal Health Systems (PHSs) consists on approaching sampling technologies into the hands of the patients, without disturbing its activities of the daily life, to monitor patient's physiological parameters and providing feedback on their state. The use of PHSs involves the patients in the management of their illness and in their own well being too. The development of PHSs has to face technological issues in order to be accepted by our society. Within them it is important to ensure interoperability between different systems in order to make them work together. Scalability it is also a concern, as their performance must not decrease when increasing the number of users. Another issue is how to formalize the medical knowledge for each patient, as different patients may have different target goals. Security and privacy are a must feature because of the sensitive nature of medical data. Other issues involve the the integration with legacy systems, and the usability of graphical user interfaces in order to encourage old people with the use these technologies. The aim of this PhD thesis is to contribute into the state-of-the-art of PHSs by tackling together different of the above-mentioned challenges. First, to achieve interoperability we use the CDA standard as a format to encode and exchange health data and alerts related with the status of the patient. We show how these documents can be generated automatically through the use of XML templates. Second, we address the scalability by distributing the computations needed to monitor the patients over their devices, rather than performing them in a centralized server. In this context we develop the MAGPIE agent platform, which runs on Android devices, as a framework able to provide intelligence to PHSs, and generate alerts that can be of interest for the patients and the medical doctors. Third, we focus on the formalization of PHSs by providing a tool for the practitioners where they can define, in a graphical way, monitoring rules related with chronic diseases that are integrated with the MAGPIE agent platform. The thesis also explores different ways to share the data collected with PHSs in order to improve the outcomes obtained with the use of this technology. Data is shared between individuals following a Distributed Event-Based System (DEBS) approach, where different people can subscribe to the alerts produced by the patient. Data is also shared between institutions with a network protocol called MOSAIC, and we focus on the security aspects of this protocol. The research in this PhD focuses in the use case of Diabetes Mellitus; and it has been developed in the context of the projects MONDAINE, MAGPIE, COMMODITY12 and TAMESIS.L'envelliment de la població mundial combinat amb uns estils de vida no saludables contribueixen a una major prevalença d'enfermetats cròniques. Aquest escenari presenta el repte de proporcionar uns bons serveis sanitaris a les persones afectades per aquestes enfermetats, sense incrementar-ne els costos. Una solució prometedora a aquest repte és mitjançant l'aplicació del que en anglès s'anomena "pervasive healthcare". L'investigació en aquesta camp tracta de canviar l'actual model centralitzat de serveis sanitaris enfocat en el personal sanitari, per un model de serveis distribuït enfocat en els pacients. En aquest context, els Personal Health Systems (PHSs) consisteixen en posar a l'abast dels pacients les tecnologies de monitorització, i proporcionar-los informació sobre el seu estat. L'ús de PHSs involucra els pacients en la gestió de la seva enfermetat i del seu propi benestar. L'acceptació dels PHSs per part de la societat implica certs reptes tecnològics en el seu desenvolupament. És important garantir la seva interoperabilitat per tal de que puguin treballar conjuntament. La seva escalabilitat també s'ha de tenir en compte, ja que el seu rendiment no s'ha de veure afectat al incrementar-ne el número d'usuaris. Un altre aspecte a considerar és com formalitzar el coneixement mèdic per cada pacient, ja que cada un d'ells pot tenir objectius diferents. La seguretat i privacitat són característiques desitjades degut a la naturalesa sensible de les dades mèdiques. Altres problemàtiques impliquen la integració amb sistemes heretats, i la usabilitat de les interfícies gràfiques per fomentar-ne el seu ús entre les persones grans. L'objectiu d'aquesta tesi és contribuir a l'estat de l'art dels PHSs tractant de manera conjunta varis dels reptes mencionats. Per abordar l'interoperabilitat s'utilitza l'estàndard CDA com a format per codificar les dades mèdiques i alertes relacionades amb el pacient. A més es mostra com aquests documents poden generar-se de forma automàtica mitjançant l' ús de plantilles XML. Per tractar l'escalabilitat es distribueixen les computacions per monitoritzar els pacients entre els seus terminals mòbils, en comptes de realitzar-les en un servidor central. En aquest context es desenvolupa la plataforma d'agents MAGPIE com a framework per proporcionar intelligència als PHSs i generar alertes d'interès per al metge i el pacient. La formalització s'aborda mitjançant una eina que permet als metges definir de manera gràfica regles de monitorització relacionades amb enfermetats cròniques, que a més estan integrades amb la plataforma d'agents MAGPIE. La tesi també explora diferents maneres de compartir les dades recol·lectades amb un PHS, amb l'objectiu de millorar els resultats obtinguts amb aquesta tecnologia. Les dades es comparteixen entre individus seguint un enfoc de sistemes distribuïts basats en events (DEBS), on diferents usuaris poden subscriure's a les alertes produïdes per el pacient. Les dades també es comparteixen entre institucions mitjançant un protocol de xarxa anomenat MOSAIC. A la tesi es desenvolupen els aspectes de seguretat d'aquest protocol. La test es centra en la Diabetis Mellitus com a cas d'ús, i s'ha realitzat en el context dels projectes MONDAINE, MAGPIE, COMMODITY12 i TAMESIS.El envejecimiento de la población mundial combinado con unos estilos de vida no saludables contribuyen a una mayor prevalencia de enfermedades crónicas. Este escenario presenta el reto de proporcionar unos buenos servicios sanitarios a las personas afectadas por estas enfermedades, sin incrementar sus costes. Una solución prometedora a este reto es mediante la aplicación de lo que en inglés se denomina "pervasive healthcare". La investigación en este campo trata de cambiar el actual modelo centralizado de servicios sanitarios enfocado hacia el personal sanitario, por un modelo distribuido enfocado hacia los pacientes. En este contexto, los Personal Health Systems (PHSs) consisten en poner al alcance de los pacientes las tecnologías de monitorización, y proporcionarles información sobre su estado. El uso de PHSs involucra a los pacientes en la gestión de su enfermedad y en su propio bienestar. La aceptación de los PHSs por parte de la sociedad implica ciertos retos tecnológicos en su desarrollo. Es importante garantizar su interoperabilidad para que puedan trabajar conjuntamente. Su escalabilidad también se debe tener en cuenta, ya que su rendimiento no tiene que verse afectado al incrementar su número de usuarios. Otro aspecto a considerar es cómo formalizar el conocimiento médico para cada paciente, ya que cada uno puede tener objetivos distintos. La seguridad y privacidad son características deseadas debido a la naturaleza sensible de los datos médicos. Otras problemáticas implican la integración con sistemas heredados, y la usabilidad de las interfaces gráficas para fomentar su uso entre las personas mayores. El objetivo de esta tesis es contribuir al estado del arte de los PHSs tratando de manera conjunta varios de los retos mencionados. Para abordar la interoperabilidad se usa el estándar CDA como formato para codificar los datos médicos y alertas relacionados con el paciente. Además se muestra como estros documentos pueden generarse de forma automática mediante el uso de plantillas XML. Para tratar la escalabilidad se distribuye la computación para monitorizar a los pacientes en sus terminales móbiles, en lugar de realizarla en un servidor central. En este contexto se desarrolla la plataforma de agentes MAGPIE como framework para proporcionar inteligencia a los PHSs y generar alertas de interés para el médico y el paciente. La formalización se aborda mediante una herramienta que permite a los médicos definir de manera gráfica reglas de monitorización relacionadas con enfermedades crónicas, que ademas están integradas con la plataforma de agentes MAGPIE. La tesis también explora distintas formas de compartir los datos recolectados con un PHS, con el fin de mejorar los resultados obtenidos mediante esta tecnología. Los datos se comparten entre individuos siguiendo un enfoque de sistemas distribuidos basados en eventos (DEBS), donde distintos usuarios pueden suscribirse a las alertas producidas por el paciente. Los datos también se comparten entre instituciones mediante un protocolo dered llamado MOSAIC. En la tesis se desarrollan los aspectos de seguridad de este protocolo. La tesis se centra en la Diabetes Mellitus como caso de uso, y se ha realizado en el contexto de los proyectos MONDAINE, MAGPIE, COMMODITY12 y TAMESIS.Postprint (published version

Electronic health records in ambulances: the ERA multiple-methods study

Background: Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care. Objective: We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised. Design and setting: We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop. Results: We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care. Limitations: Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality. Conclusions: Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need