User preferences on route instruction types for mobile indoor route guidance

Adaptive mobile wayfinding systems are being developed to ease wayfinding in the indoor environment. They present wayfinding information to the user, which is adapted to the context. Wayfinding information can be communicated by using different types of route instructions, such as text, photos, videos, symbols or a combination thereof. The need for a different type of route instruction may vary at decision points, for example because of its complexity. Furthermore, these needs may be different for different user characteristics (e.g., age, gender, level of education). To determine this need for information, an online survey has been executed where participants rated 10 different route instruction types at several decision points in a case study building. Results show that the types with additional text were preferred over those without text. The photo instructions, combined with text, generally received the highest ratings, especially from first-time visitors. 3D simulations were appreciated at complex decision points and by younger people. When text (with symbols) is considered as a route instruction type, it is best used for the start or end instruction

A gamification-based approach on indoor wayfinding research

Indoor environments can be very complex. Due to the challenges in these environments in combination with the absence of mobile wayfinding aids, a great need exists for innovative research on indoor wayfinding. In this explorative study, a game was developed in Unity to investigate whether the concept of gamification could be used in studies on indoor wayfinding so as to provide useful information regarding the link between wayfinding performance, personal characteristics, and building layout. Results show a significant difference between gamers and non-gamers as the complexity of the player movement has an important impact on the navigation velocity in the game. However, further analysis reveals that the architectural layout also has an impact on the navigation velocity and that wrong turns in the game are influenced by the landmarks at the decision points: navigating at deeper decision points in convex spaces is slower and landmarks of the categories pictograms and infrastructural were more effective in this particular building. Therefore, this explorative study, which provides an approach for the use of gamification in indoor wayfinding research, has shown that serious games could be successfully used as a medium for data acquisition related to indoor wayfinding in a virtual environment

On the right track : comfort and confusion in indoor environments

Indoor navigation systems are not well adapted to the needs of their users. The route planning algorithms implemented in these systems are usually limited to shortest path calculations or derivatives, minimalizing Euclidian distance. Guiding people along routes that adhere better to their cognitive processes could ease wayfinding in indoor environments. This paper examines comfort and confusion perception during wayfinding by applying a mixed-method approach. The aforementioned method combined an exploratory focus group and a video-based online survey. From the discussions in the focus group, it could be concluded that indoor wayfinding must be considered at different levels: the local level and the global level. In the online survey, the focus was limited to the local level, i.e., local environmental characteristics. In this online study, the comfort and confusion ratings of multiple indoor navigation situations were analyzed. In general, the results indicate that open spaces and stairs need to be taken into account in the development of a more cognitively-sounding route planning algorithm. Implementing the results in a route planning algorithm could be a valuable improvement of indoor navigation support

Comparing written and photo-based indoor wayfinding instructions through eye fixation measures and user ratings as mental effort assessments

The use of mobile pedestrian wayfinding applications is gaining importance indoors. However, compared to outdoors, much less research has been conducted with respect to the most adequate ways to convey indoor wayfinding information to a user. An explorative study was conducted to compare two pedestrian indoor wayfinding applications, one text-based (Sole-Way) and one image-based (Eyedog), in terms of mental effort. To do this, eye tracking data and mental effort ratings were collected from 29 participants during two routes in an indoor environment. The results show that both textual instructions and photographs can enable a navigator to find his/her way while experiencing no or very little cognitive effort or difficulties. However, these instructions must be in line with a user's expectations of the route, which are based on his/her interpretation of the indoor environment at decision points. In this case, textual instructions offer the advantage that specific information can be explicitly and concisely shared with the user. Furthermore, the study drew attention to potential usability issues of the wayfinding aids (e.g. the incentive to swipe) and, as such, demonstrated the value of eye tracking and mental effort assessments in usability research

The reproducibility of SfM algorithms to produce detailed Digital Surface Models: the example of PhotoScan applied to a high-alpine rock glacier

In geomorphology, PhotoScan is a software that is used to produce Digital Surface Models (DSMs). It constructs 3D environments from 2D imagery (often taken by Unmanned Aerial Vehicles (UAV)) based on Structure-from-Motion (SfM) and Multi- View Stereo (MVS) principles. However, unpublished computer-vision algorithms used, contain random elements which can affect the accuracy of the outputs. For this letter, ten model runs with identical inputs were performed on UAV imagery of a rock glacier to analyse the magnitude of the variation between the different model outputs. This variation was quantified calculating the standard deviation of each cell value in the respective DSMs and derivatives (curvature). Places with steep slope gradients have considerably more DSM variation (up to 10 cm) but stay within the range of the model’s accuracy (10 vertical cm) for 88 – 96% of the area. The edges of the model also show a larger variability (0.10 – 3 m), related to a lower number of overlapping images. These results should be accounted for when performing a geomorphological research at centimetre scale using PhotoScan, especially in areas with a complex relief. Using medium-quality runs, additional oblique viewpoints and respecting a minimum of five overlapping images can minimize the software’s variations

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

Objectives: To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field. Methods: An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items. Results: The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high. Conclusions: These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests