Introduction to the mathematical theory of knowledge conceptualization: Conceptual systems and structures

The paper departs from the general problem of knowledge integration and the basic strategies that can be adopted to confront this challenge. With the purpose of providing a sound meta-theoretical framework to facilitate knowledge conceptualization and integration, as well as assessment criteria to evaluate achievements regarding knowledge integration, the paper first reviews the previous work in the field of conceptual spaces. It subsequently gives an overview of structural tools and mechanisms for knowledge representation, recapped in the modal stratified bond model of global knowledge. On these groundings, a novel formalized representation of conceptual systems, structures, spaces and algebras is developed through a set of definitions which goes beyond the exploration of mental knowledge representation and the semantics of natural languages. These two components provide a sound framework for the development of the glossaLAB international project with respect to its two basic objectives, namely (i) facilitating knowledge integration in general and particularly in the context of the general study of information and systems; (ii) facilitating the assessment of the achievements as regards knowledge integration in interdisciplinary settings. An additional article tackles the solutions adopted to integrate these results in the elucidation of the conceptual network of the general study of information and systems.2019-2

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

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