Mobile health systems and emergence

Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth and mHealth services enabled by advances in ICT are frequently cited as providing part of the solution to this crisis in future provision. As part of this picture, self-monitoring and remote monitoring of patients, for example by means of smartphone apps and body-worn sensors, is on the way to becoming mainstream. In future, each individual’s personal health system may be able to access a large number of devices, including sensors embedded in the environment as well as in-body smart medical implants, in order to provide (semi-)autonomous health-related services to the user. This article presents some examples of mHealth systems based on emerging technologies, including body area networks (BANs), wireless and mobile technologies, miniature body-worn sensors and distributed decision support. Applications are described in the areas of management of chronic illnesses and management of (large- scale) emergency situations. In the latter setting BANs form part of an advanced ICT system proposed for future major incident management; including BANs for monitoring casualties and emergency services personnel during first response. Some challenges and possibilities arising from current and future emerging mHealth technologies, and the question of how emergence theory might have a bearing on understanding these challenges, is discussed here

Some problems in the computation of sociolinguistic data

PhD ThesisThe research described in this thesis is concerned with some of the problems encountered in the processing of sociolinguistic data. Different methodologies are seen as different sets of strategies for coping with the problems which arise from investigations of sociolinguistic variability within any speech community. One early approach to the analysis of sociolinguistic variation (that of Labov: 1963, 1966) is discussed, and some of the difficulties raised by this approach are indicated. One investigation of sociolinguistic variability in a British urban setting (Trudgill: 1974) is also described (Trudgill' s study is based on Labov's (J 966) general methodology). FN The Tyneside Linguistic Survey (T.L.S.) is offered as an alternative approach, which overcomes some of the problems inherent in Labov's methodsThe Department of Education and Science, Newcastle University

Cluster Analysis of the Newcastle Electronic Corpus of Tyneside English: In A Comparison of Methods

This article examines the feasibility of an empirical approach to sociolinguistic analysis of the Newcastle Electronic Corpus of Tyneside English using exploratory multivariate methods. It addresses a known problem with one class of such methods, hierarchical cluster analysis—that different clustering algorithms can yield different analyses of the same data set, and that there is no obvious way of selecting the best one. The proposed solution is to analyze the data using hierarchical methods in conjunction with one or more fundamentally different types of clustering method, and then to select the analysis on which the hierarchical and the other method(s) agree most closely. A dimensionality reduction method, the self-organizing map (SOM), is used to exemplify this approach. The result is a close though not perfect match between the SOM and complete-link hierarchical analyses, but there is an important reservation—the SOM results vary with changes in user-defined training parameters, and are consequently also open to the criticism of inconsistency. The SOM cannot therefore be an objective arbiter for hierarchical clustering, but the analysis on which they agree gives a better basis for understanding the structure of the data than either method can provide on its own

Telecare and self-management: a guideline for anticipating future care in scenario-based design

An important aim of telecare technologies for chronic patients is supporting self-management. Although patient involvement is crucial for successful implementation, any adaptation of telecare systems to needs of users requires explicit reflection regarding which form of self-management it should support. Scenario-based methods (SBDs) are proposed to involve users in the earlier phases of development. This paper aims to extend SBDs by incorporating explicit exploration of self-management forms. We first analyzed what self-management forms were inscribed in the design of a telecare system for COPD patients. These were mainly based on compliance to medical treatment. However, our study shows that many patients thrive better on self-management based on cooperation and concordance with healthcare professionals. To overcome this discrepancy between design and use practices we developed a guideline enabling designers to anticipate and reflect on which form of self-management is desirable to incorporate in the design of telecare technologies for chronic patients

A Context-Aware Adaptive Feedback System for Activity Monitoring

An active lifestyle is an important factor in the prevention of deconditioning and many negative secondary effects in chronic diseases (e.g. COPD). A number of studies have been conducted with the aim of gaining insight into the daily activity patterns of these patients. Current research is focussing on motivating patients to stay physically active and balancing their activity patterns by using an activity sensor combined with remote monitoring and smart, personalised feedback

IUPHAR-DB: An Expert-Curated, Peer-Reviewed Database of Receptors and Ion Channels

The International Union of Basic and Clinical Pharmacology database (IUPHAR-DB) integrates peer-reviewed pharmacological, chemical, genetic, functional and anatomical information on the 354 non-sensory G protein-coupled receptors (GPCRs), 71 ligand-gated ion channel subunits and 141 voltage-gated ion channel subunits encoded by the human, rat and mouse genomes. These genes represent the targets of about a third of currently approved drugs and are a major focus of drug discovery and development programs in the pharmaceutical industry. Individual gene pages provide a comprehensive description of the genes and their functions, with information on protein structure, ligands, expression patterns, signaling mechanisms, functional assays and biologically important receptor variants (e.g. single nucleotide polymorphisms and splice variants). The phenotypes resulting from altered gene expression (e.g. in genetically altered animals) and genetic mutations are described. Links are provided to bioinformatics resources such as NCBI RefSeq, OMIM, PubChem, human, rat and mouse genome databases. Recent developments include the addition of ligand-centered pages summarising information about unique ligand molecules in IUPHAR-DB. IUPHAR-DB represents a novel approach to biocuration because most data are provided through manual curation of published literature by a network of over 60 expert subcommittees coordinated by NC-IUPHAR. Data are referenced to the primary literature and linked to PubMed. The data are checked to ensure accuracy and consistency by the curators, added to the production server using custom-built submission tools and peer-reviewed by NC-IUPHAR, before being transferred to the public database. Data are reviewed and updated regularly (at least biennially). Other website features include comprehensive database search tools, online and downloadable gene lists and links to recent publications of interest to the field, such as reports on receptor-ligand pairings. The database is freely available at "http://www.iuphar-db.org":http://www.iuphar-db.org. Curators can be reached at curators [at] iuphar-db.org. We thank British Pharmacological Society, UNESCO (through the ICSU Grants Programme), Incyte, GlaxoSmithKline, Novartis, Servier and Wyeth for their support

Guideline-based decision support for the mobile patient incorporating data streams from a body sensor network

We present a mobile decision support system (mDSS) which helps patients adhere to best clinical practice by providing pervasive and evidence-based health guidance via their smartphones. Similar to some existing clinical DSSs, the mDSS is designed to execute clinical guidelines, but it operates on streaming data from, e.g., body sensor networks instead of persistent data from clinical databases. Therefore, we adapt the typical guideline-based architecture by basing the mDSS design on existing data stream management systems (DSMSs); during operation, the mDSS instantiates from the guideline knowledge a network of concurrent streaming processes, avoiding the resource implications of traditional database approaches for processing patient data which may arrive at high frequencies via multiple channels. However, unlike typical DSMSs, we distinguish four types of streaming processes to reflect the full disease management process: Monitoring, Analysis, Decision and Effectuation. A prototype of the mDSS has been developed and demonstrated on an Android smartphone

Requirements for a Nutrition Education Demonstrator

[Context and Motivation] Development of innovative ICT-based applications is a complex process involving collaboration of all relevant disciplines. This complexity arises due to differences in terminology, knowledge and often also the ways of working between developers in the disciplines involved. [Question/problem] Advances in each discipline bring a rich design environment of theories, models, methods and techniques. Making a selection from these makes the development of distributed applications very challenging, often requiring a holistic approach to address the needs of the disciplines involved. This paper describes early stage requirements acquisition of a mobile nutrition education demonstrator which supports overweight persons in adopting healthier dietary behaviour. [Principal idea/results] We present a novel way to combine and use known requirements acquisition methods involving a two stage user needs analysis based on scenarios which apply a theory-based model of behavioural change and are onstructed in two phases. The first phase scenarios specify an indicative description reflecting the use of the transtheoretical model of behavioural change. In the second phase, a handshake protocol adds elements of optative system-oriented descriptions to the scenarios such that the intended system can support the indicative description. [Contribution] The holistic and phased approach separates design concerns to which each of the disciplines contributes with their own expertise and domain principles. It preserves the applied domain principles in the design and it bridges gaps in terminology, knowledge and ways of working

Molecular Targeting of Carbonic Anhydrase IX in Mice with Hypoxic HT29 Colorectal Tumor Xenografts

Background: Carbonic anhydrase IX (CAIX) is a membrane spanning protein involved in the enzymatic regulation of tumor acid-base balance. CAIX has been shown to be elevated in a number of hypoxic tumor types. The purpose of this study was to determine the efficiency of intact and IgG fragments of cG250 to target CAIX in vivo in a hypoxic tumor model. Methodology/Principal Findings: Conventional biodistribution studies were performed with 111 In-DO3A-cG250, 111 In-DO3A-F(ab’)2-cG250 and 111 In-DO3A-Fab-cG250. Additional ex vivo analysis of the tumor was performed with markers for tumor hypoxia, blood perfusion and endogenous CAIX expression. All four data sets were digitally correlated to determine the optimal agent for determining hypoxia in a HT29 colon cancer xenograft. The HT29 human colorectal tumor xenografts show strong CAIX expression in hypoxic areas of poor blood perfusion. The intact IgG had an initial high focal uptake at the periphery of these hypoxic regions and penetration into the areas of highest CAIX expression over the 7-day study period. The lower molecular weight antibody fragments had a faster uptake into areas of high CAIX expression, but had a much lower absolute uptake at the optimal imaging times. Conclusions/Significance: For the clinical detection of hypoxia induced CAIX using cG250 antibody based agents, imagin