Charting Complex Changes: Application of the eHealth Implementation Toolkit (e-HIT) in the Delivering Assisted Living Lifestyles at Scale (dallas) Programme

The 'dallas' (Delivering Assisted Living Lifestyles at Scale) programme is a UK-wide digital healthcare initiative that has been designed to support independent living, enhance preventative care, and improve lifestyles by harnessing the potential of e-health technologies and digital services. This short paper presents a brief update on one strand of the University of Glasgow evaluation of the dallas programme. We have used the e-Health Implementation Toolkit (e-HIT) to investigate processes involved in the implementation of e-health tools and digital services being developed and deployed across the dallas communities and to assess 'distance travelled' by communities from baseline to midpoint of a three year programme. Qualitative data analysis was guided by the Normalisation Process Theory (NPT) and Framework Analysis. The e-HIT scores indicated that the dallas communities had underestimated the amount of work involved in implementing at scale. Qualitative data analysis showed that communities have successfully navigated barriers in order to make significant progress in strategic areas, including the development of new models of partnership working resulting in brand recognition and agile service design. The dallas communities are now sharing lessons learned and generating new professional knowledge, skills and understanding across several key strategic areas required for operationalising the implementation of e-health technologies and digital services at scale. The new knowledge being generated through the dallas programme will contribute to the ongoing transformation of digitally enabled healthcare based on more personalised flexible models of provision which resonates with the current e-health policy environment

ABO blood group and other genetic variants associated with pancreatic cancer

Pancreatic adenocarcinoma is the fourth leading cause of cancer death in the United States. Recent reports, including genome-wide association studies and self-reported blood serotype studies, have shown that individuals of European ancestry who carry non-O blood group are at an increased risk of developing pancreatic cancer. Two recent genome-wide association studies of pancreatic cancer have identified associations between pancreatic cancer risk and genetic variants in the ABO blood group gene, the locus containing the telomerase reverse transcriptase (hTERT) gene, the nuclear receptor family gene NR5A2 and a non-genic region on chromosome 13q22.1

Inkjet Patterned Anodic Aluminum Oxide for Rear Metal Contacts of Silicon Solar Cells

AbstractLocal rear metal contacting through passivating dielectric layers has the ability to increase silicon solar cell efficiencies to over 20%. To-date most contact schemes have involved the formation of localised aluminium-alloyed regions through patterned AlOx or SiNx passivating layers. Recently electrochemically-formed anodic aluminium oxide (AAO) layers have been shown to enhance minority carrier lifetimes of phosphorus–diffused p-type CZ wafers when formed over an intervening layer of SiO2 or SiNx, suggesting that these layers may find applications as passivation layers for cells. We report here on the inkjet patterning of AAO layers formed over a thermally-grown thin oxide layer on p-type silicon surfaces. The process, which involves the inkjet printing of 50% (w/w) phosphoric acid, was used to form well-resolved arrays of holes with a diameter as small as 20-40μm in the dielectric stack. Alloying of aluminium, which was evaporated over the patterned dielectric stack, resulted in the formation of localised back surface field (BSF) regions having a thickness up to 8μm. Future work will focus on adapting this process for use in local rear metal contacting of silicon solar cells

Should we be aiming to engage drivers more with others on-road? Driving moral disengagement and self-reported driving aggression

Aggressive driving behaviours may be associated with greater crash risk in situations where drivers engage in riskier types of behaviours such as following too closely. It also appears that many drivers who do not normally regard themselves as angry or aggressive report engaging in aggressive driving acts. Qualitative studies have suggested that drivers explain these behaviours with reference to justified retaliation or beliefs that such acts ‘teach’ other drivers a ‘lesson’ or to exercise better driving manners or etiquette. Drivers may also argue that their behaviour does not have a negative impact on others. Such descriptions of motives bear a strong resemblance to the psychological mechanisms of moral disengagement. Moral disengagement is where individuals detach themselves from their usual self-regulatory processes or morality in order to behave in ways that run counter to their normal moral standards. Moral disengagement offers a potential explanation of how apparently ‘good’ or moral people commit ‘bad’ or immoral behaviours. Categories of moral disengagement are: cognitively misinterpreting the behaviour (e.g euphemistic labelling); disconnecting with the target (e.g. attributing blame to the target); and distorting or denying the impact of the behaviour. An on-line survey with a convenience sample of general drivers (N = 294) was used to explore the potential utility of moral disengagement in explaining self-reported driving aggression over and above the explanatory power provided by constructs that are normally associated with self-reported on-road aggression. Hierarchical regression analysis was used with measures of trait anger, driving anger (DAS), moral disengagement, and driving moral disengagement (an adaptation of the measure of moral disengagement for the driving context). Results revealed that the independent variables together explained 37% of the variation in self-reported driving aggression (as measured by the Driving Anger Expression scale, DAX). Driving moral disengagement was a significant predictor of driving aggression (p < .001) after accounting for the contribution of age, gender, driving anger, and moral disengagement. Moreover, inspection of the beta weights suggested that driving moral disengagement (beta = .57) was the strongest predictor for this sample, accounting for 20% of the unique variance in driving aggression (sr2 = .20). The pattern of results suggests drivers with higher tendencies to morally disengage in the driving context may respond to others more aggressively on-road. Moreover, driving moral disengagement appeared to add to our understanding of why some angry drivers do not respond aggressively on-road while others do. Seeking to prevent drivers from activating moral disengagement while driving may be worthy of exploration as a way of reducing non-violent, yet potentially still risky, forms of driving aggression

Letting the world see through your eyes : using photovoice to explore the role of technology in physical activity for adolescents living with type 1 diabetes

This paper qualitatively explores how technologies and physical activity are experienced by adolescents with type 1 diabetes. Type 1 diabetes is a life-threatening autoimmune condition, which is highly prevalent in young children. Physical activity is underutilised as part of treatment goals due to multifactorial challenges and lack of education in both the family setting and across society as a whole. Using photovoice methodology, 29 participants (parents and adolescents), individually or as dyads, shared and described in reflective journal format examples of technology and physical activity in their lives. In total, 120 personal photographs with accompanying narratives were provided. The data were thematically coded by the researcher and then collaboratively with participants. Four key themes (and 12 subthemes) were generated including: (i) benefits of technology; (ii) complexity and difficulty; (iii) emotional impact; (iv) reliance and risk. Findings demonstrate that current technology does not address the complex needs of adolescents with type 1 diabetes to enable participation in physical activity without life risk. We conclude from our findings that future technologies for supporting engagement in physical activity as part of diabetes management need to be: more interoperable, personalised and integrated better with ongoing education and support

A qualitative study for co-designing the future of technology to support physical activity for adolescents living with type 1 diabetes

Aim: The aims of this study were to (i) understand what adolescents (and their parents) identify as positive and negative experiences with technology for engaging in physical activity (PA) when living with type 1 diabetes (T1D) and (ii) identify possible future design considerations for supporting or enabling technologies for this population. Methods: Nine online collaborative workshops (n = 25 people) were held over a month with participants who were either adolescents attending with (n = 22) or without (n = 3, aged 16 and over) parents. Each workshop involved (1) a training activity, (2) a design task involving describing a good day vs. a bad day, and (3) a design task asking people to consider future design changes for technology to support them in engaging with physical activity. Results: The following key themes emerged from the first design task: (1) Wearable factors; (2) Social acceptance & identity; (3) Negative emotions; (4) Glycaemic stability offers positive emotions and PA Enjoyment; and (5) Presence, preparation & prevention. The second design task identified the following additional key themes: (6) Improve attachment experiences; (7) Connected devices reduce user burden; (8) Improve accuracy; (9) Personalisation of devices; (10) Funding and policy changes – health equity. Conclusion: Technology can reduce the burden and improve PA support, but there are still gaps in how these technologies can be better designed to consider the psychosocial and emotional factors of both adolescents and their parents as co-users

Exploring the use of Fitbit consumer activity trackers to support active lifestyles in adults with Type 2 Diabetes : a mixed methods study

Background: People with type 2 diabetes are less active than those without the condition. Physical activity promotion within diabetes health care is limited. This project explored the use of Fitbit activity trackers (Fitbit, San Francisco, CA, USA) to support active lifestyles in adults with type 2 diabetes through a mixed-methods study. Methods: Two stages were conducted. In stage 1, adults with type 2 diabetes used a Fitbit Charge 4 (Fitbit, San Francisco, CA, USA) for 4 weeks. Fitbit and self-reported physical activity data was examined through quantitative analysis. Qualitative analysis was conducted to explore the experiences of participants. In stage 2, health professionals were interviewed to examine their views on using Fitbit activity trackers within type 2 diabetes care. Results: Adults with type 2 diabetes were recruited for stage 1 and adult health care and fitness professionals were recruited for stage 2. Stage 1 participants’ self-reported increases in physical activity (mean weekly minutes of walking increased from 358.75 to 507.50 min, p = 0.046) and a decrease in sedentary behaviour (mean daily hours of sedentary behaviour decreased from 10.65 to 10.05 h, p = 0.575). Fitbit activity data ranges identified individuals who led inactive and sedentary lifestyles below levels recommended and in need of physical activity support to reduce the risk to their health. During interviews, participants stated that the Fitbit activity tracker motivated them to be more active. Stage 2 participants intimated that Fitbit activity trackers could improve the promotion of physical activity within type 2 diabetes care. Interventions involving the Fitbit premium service, community prescription and combined use of Fitbits with physical activity behaviour change models were recommended by stage 2 participants. Conclusion: This study found that there is future scope for using Fitbit activity trackers to support active lifestyles in adults diagnosed with type 2 diabetes

Methods for combining continuously measured glucose and activity data in people with Type 2 diabetes : challenges and solutions

Aims: To present the novel application of combining continuously measured glucose with continuous accelerometer measured physical activity and sedentary behaviour data and discusses the principles used and challenges faced in combining and analysing these two sets of data in the context of diabetes management. Methods: The background and rationale for exploring glucose, physical activity and sedentary behaviour in people with Type 2 diabetes is presented, the paper outlines the technologies used, the individual data extraction and finally the combined data analysis. A case study approach is used to illustrate the application of the combined data processing and analysis. Results: The data analytic principles used could be transferred to different conditions where continuous data sets are being combined to help individuals or health professionals better manage and care for people with long term conditions. Conclusions: Future work should focus on generating validated techniques to visualise combined data sets and explore ways to present data back to the individual in an effective way to support health care management and rehabilitation

Factors affecting participation in the eRedBook:A personal child health record

A personal child health record called the eRedBook was recently piloted in the United Kingdom. A qualitative exploratory case study was used to examine how public health nurses engaged or recruited parents and what factors hindered participation. Interviews and focus groups were conducted with those implementing the eRedBook and those taking part in the pilot study. A range of project documentation was also reviewed. Thematic analysis using the framework approach was applied to draw out themes. Numerous socio-technical factors such as the usability of the software, concerns over data protection and costs, poor digital literacy skills and a lack of Internet connectivity emerged. These barriers need to be addressed before the eRedBook is implemented nationwide