Common Technological Platform Research Articles

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study.

BackgroundAccording to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning.ObjectiveThis study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study.MethodsA quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto.ResultsThis study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021.ConclusionsThe findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context.Trial RegistrationISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163International Registered Report Identifier (IRRID)PRR1-10.2196/25781

Integrating physical and virtual game-based simulation for operators' training to enhance learning effectiveness: an application in hazardous industrial spaces

Inadequate training and lack of risk awareness are among the main causes of work-related accidents in industrial facilities. Although new learning methods, such as virtual reality (VR), have been deployed, they still do not find implementation on a large-scale. This research proposes the concept of 'virtual training pills' (VTP), i.e. delivering learning content in the form of short educational games by using a common technological platform based on virtual, interactive and immersive reality. An application study has been conducted in the case of a decommissioned nuclear power plant, which is classified as confined and pollution-suspected space. These areas represent a challenging environment for maintenance and inspection activities. The results proved the potential of this novel game-based learning approach: short 'learning pills' are much more effective than long role-playing games. This work also discusses the benefits of workforce training based on VTP as an integration to live exercises for safety management.

Integrating physical and virtual game-based simulation for operators' training to enhance learning effectiveness: an application in hazardous industrial spaces

Inadequate training and lack of risk awareness are among the main causes of work-related accidents in industrial facilities. Although new learning methods, such as virtual reality (VR), have been deployed, they still do not find implementation on a large-scale. This research proposes the concept of 'virtual training pills' (VTP), i.e. delivering learning content in the form of short educational games by using a common technological platform based on virtual, interactive and immersive reality. An application study has been conducted in the case of a decommissioned nuclear power plant, which is classified as confined and pollution-suspected space. These areas represent a challenging environment for maintenance and inspection activities. The results proved the potential of this novel game-based learning approach: short 'learning pills' are much more effective than long role-playing games. This work also discusses the benefits of workforce training based on VTP as an integration to live exercises for safety management.

Transforming an IORT Linac Into a FLASH Research Machine: Procedure and Dosimetric Characterization

Since Favaudon’s paper of 2014, there has been an increasing interest in FLASH radiotherapy. The FLASH modality could represent a breakthrough in radiation oncology; nevertheless, it brings new scientific and technological challenges. Currently, one of the main limits the scientific community has to cope with is the lack of a common technological platform to experiment with. Considering this framework, the possibility of readapting existing linac platforms to produce a FLASH beam is particularly attractive and different attempts have been already made. The purpose of this article is to illustrate how it is possible to transform a dedicated Intra Operative Radio Therapy (IORT) mobile linac into a FLASH research machine. Compared to the modification required by a standard medical linac, such transformation is easier, does not affect the machine settings and can be rapidly performed by the final user. NOVAC 7 is an IORT linac which can reach a maximum dose-per-pulse up to 13 cGy/pulse (average dose rate 39 Gy/min); such dose rate can be significantly increased by modifying the collimation system. Four different Source Surface Distance (SSD) can be obtained: -Clinical reference configuration; -Upper applicator only (SSD 50 cm); -Monitor chambers housing only (SSD 7 cm); -Dismounted monitor chambers (SSD 1.6 cm). The fourth configuration allows reaching values of dose-per-pulse up to around 18 Gy/pulse and dose rates up to around 500 Gy/s, at a Pulse Repetition Frequency (PRF) of 30 Hz. The other three configurations can be obtained without using any tool and without changing NOVAC settings, until reaching a FLASH dose rate in the third configuration. For FLASH configurations, relative and absolute dosimetric characterization of the beam were performed using radiochromic films EBT3. NOVAC7 transformed in FLASH mode can be used both for dosimetric testing and characterization of detectors and for radiobiological studies on cells and organoids, offering a wide range of dose-per-pulse, from 3 cGy/pulse up to 18 Gy/pulse; dose rates correspondingly change from 3 cGy/s up to 540 Gy/s.

Digital transformation of Russia’s thermal power industry management system for optimization of consumers’ expenditures determined by tariffs and prices

The development and implementation of a strategy for organizational reconfiguration of a digital heat and power super system to streamline the processes of providing structured technological zones with heat makes the basis for creating a coordinated system for optimizing the tariff and price load on heat and electricity consumers in the Russian economy. Providing the industry with a mechanism for regulating the processes of rendering heat energy services based on the transition to the system of Unified Heat-Supply Organizations (ETOs) and ensuring a return on price trend investment in the heat market with the possibility of transferring departmental reporting and analytics to a single regulatory legal basis enables regulating the operation of the power system as a subsystem of the Russian energy sector with a common information technology platform. It is proposed to develop a methodology for constructing mathematical estimates of reliability indicators of provided heat and power services in the form of analytical relationships and simulation models, taking into account the complex nature of the operation of electric power transmission and heat transportation networks as well as information systems that provide processing, storage and distribution of digital data and documents. The key activities are: development of a methodology for constructing mathematical estimates of reliability indicators of provided heat and power services in the form of analytical relationships and simulation models; development of digital methods for detecting hazardous effects; development of algorithms for storing information in the presence of natural and artificial interference; development of digital methods for optimization, modernization and transformation of production chains and processes, control models and planning procedures to neutralize threats to the reliability of provided heat and power services. The result should be the creation of a computer-based information system for modeling impacts on the electric and heat grid facilities.

Digitized Нumanism

The humanitarian thought did not encounter such challenges that we face today. Biotechnologies outline the perspectives of “posthuman” personology, while digitalization and robotization of almost all spheres of social practice bring to the fore the idea of homodicy – justifying the need for human existence. The article analyzes four blocks of challenges to humanitarian knowledge: (1) achievements in medicine, prosthetics, transplantology and genetic engineering, which outlined the separation of a sentient subject from traditional anthropomorphism (“posthuman” personology); (2) studies of the brain neurophysiology, which advanced new arguments against free will; (3) costs of ill-considered propaganda of human rights; (4) digitization of almost all socio-cultural practices – from economics and military affairs to the formation and functioning of authority. Digitalization permeates all these “problematization fields,” setting their common conceptual and technological platform. In this regard, the question arises of the humanitarian expertise of modern technologies and the projects of education, communication and management, which implemented with their help. That expertise deals with not only the consequences, progress or even the possibility of implementing such projects, but also with their necessity. The focus and criteria of such expertise are important. Obviously, it cannot be directed only at the preservation of the biological species of homo sapiens and the conditions of its survival. Paradoxical choice arises in a situation where freedom and free will are questioned: which is more important – homo or sapiens? It is time for a clear distinction between the concepts of humanism and humanitarianism, including in the latter the posthuman personology. If humanitarianism is a personology of free spirit, then humanism seems to have a place next to economism and nationalism as forms of confined humanitarianism. This wide range of problems requires comprehension not only of their content but also of the methodology of the humanities and of the prospects of the humanities in modern society.

A Novel Cloud-Based Advanced Distribution Management System Solution

This paper proposes a novel advanced distribution management system (ADMS) solution based on a common operation technology platform implemented on a cloud infrastructure. It introduces a virtualization methodology that is used to transition and deploy a traditional, monolithic ADMS in a cloud environment. First, typical ADMS functional blocks (FBs) are identified and their performance is evaluated with respect to four major metrics: processor, memory, network, and storage utilization. Next, a cloud infrastructure-based ADMS solution is presented, based on a collection of FBs mapped to a set of virtual machines. Finally, the proposed architecture is validated via deployment on a physical hardware platform with two representatively sized distribution networks and emulated workloads. Obtained results show that an ADMS, as a mission-critical system, can be deployed on a cloud infrastructure, providing many benefits of virtualized solutions, without negative impact on system performance.

GIS for Building Smart Cities

Smart city is one where investments in human, social capital, traditional transport and modern communication, infrastructure, sustainable economic development provides a high quality of life by engaging management of natural resources, through participatory action. It is a city equipped with basic infrastructure to give a clean and sustainable environment through application of some smart solutions. Smart Solutions will enable cities to use technology, information and data to improve infrastructure and services. A critical success factor is a need for a common technology platform to enable integration, coordination and synergistic functioning of different participants of the smart city ecosystem. A centralized information system based on GIS provides an IT framework which integrates not only every stakeholder but also every aspect of smart city processes. GIS can play a critical role in enabling government interface where citizens can share grievances, comments on the status of city infrastructure and understand the corrective measure taken by the city authorities. Geospatial data and geographic information system are essential components for building smart cities in a basic way that maps the physical world into virtual environment as a referencing framework. This paper discusses the benefits of GIS in the key 'smart' sectors: •Planning •Energy • Water • Transportation • Governance

Complex care needs in people with chronic diseases: population prevalence and characterization in primary care

Introduction: Risk adjustment variables for population stratification are based, primarily, on the burden of disease and the pattern of use of resources. They do not include other variables that, according to available evidence determines the complexity, such as coordination of care on a regional level, certain patient characteristics (adherence to treatments or visits, mental disorders, etc...) and, especially, socioeconomic, cultural, environmental and behavioural context.In Catalonia, a strategy for proactive identification of complex chronic patients (CCP) by healthcare professionals in primary care, based on clinical judgment and broad criteria, encompassing clinical and psychosocial variables, combined with Clinical Risk Groups (CRG, a risk-adjustment tool and clinically-based classification system used to measure a population’s burden of illness) has been promoted by the Chronicity Prevention and Care Program (CPCP) from the Department of Health. To the best of our knowledge, this strategy of identifying CCP from combination of risk adjustment and clinical judgment is a pioneering and unique experience worldwide. 101415 persons (1.3% of the population of Catalonia) have been identified as CCP by healthcare professionals in primary care between 1st February and 31st December 2013.43.3% of CCP identified (44014 persons) present a complexity not explained by theoretical construct proposed for identifying complex chronic population, defined by mortality, primary care contacts, hospitalization, emergency hospitalizations and pharmaceutical expenditure in the fourth and fifth quintiles of population distribution (CRG 5 severity 6; CRG 6 severity 5-6; CRG 7 severity 2-6, CRG 8 severity 3-6; and CRG 9 severity 2-6), increasing the possibility of being identified in this group when decreases the number of advanced chronic organic failure diseases, visits to primary care, urgent hospitalization and pharmaceutical spending and when increases age. But to date, it is unknown what the variables that would explain this complexity are. On the other hand, prevalence of CCP and, within these group, prevalence of those patients with advanced chronic disease (CCP-ACD) has not been yet established.The objectives of this study are 1) to determine the population prevalence of patients with chronic diseases and complex care needs (CCP and CCP-ACD), according to the construct based on clinical judgment and broad criteria, encompassing clinical and psychosocial variables, promoted by the CPCP in an urban population, 2) to describe the frequency and distribution of CPCP criteria for identifying patients with chronic diseases and complex care needs, and 3) to identify CPCP criteria that predict complexity.Methods: Population-based cross-sectional study based on information contained in the morbidity database of Catalonia in 2015 and professional electronic medical records. Setting: three primary care urban practices placed in Sabadell (Barcelona) belonging to the Catalan Institute of Health (ICS). According to this database, population with CRG≥5 and older than 14 years old (24762 inhabitants) were reviewed and CCP and CCP-ACD were identified and coded in the Shared Clinical Record of Catalonia, a common technological platform accessible to all providers of public health network.Study population is that which was recorded by healthcare professionals as CCP and CCP-ACD in the Shared Clinical Record of Catalonia on 30th September 2015.We will characterize chronic patients and compare the characteristics of people with and without complex care needs, according to professionals’ criteria by using chi-square or t-student tests, as appropriate. We will also compare the characteristics of primary care professionals who report the highest versus the lowest proportions of patients with complex care needs. We will construct a multivariate logistic regression model to identify independent predictors of professional-defined patient complexity with the following steps: a) selection of variables that predict complex care needs identified according to professionals’ criteria (bivariate analysis); b) process of model construction (likelihood ratio test) and c) validation of its predictive ability (goodness of fit) using discrimination index (C statistic) and index calibration (Hosmer-Lemeshow). In addition, there will be a logistic regression tree and, as an exploratory way, a multivariate factor analysis will be performed.Results: (progress report) The identification and data collection was carried out between 1st July and 30th September 2015. It is expected to have the results of the study in February 2016.Discussion: Patient complexity is probably a multifaceted concept not fully captured by the number or type of medical conditions or by previous health care costs. The data provided by this study will allow to characterize the complexity beyond the risk-adjustment tools that, according to available evidence, are not enough to identify people with chronic complex care needs. This research can also help for a deeper understanding of the multiple sources of patient complexity and their interactions.Conclusion: Not applicable

Complex care needs in people with chronic diseases: measurement of the agreement to define complexity between physicians and nurses in primary care

Introduction : Risk adjustment variables for population stratification are based, primarily, on the burden of disease and the pattern of use of resources. They do not include other variables that, according to available evidence determines the complexity, such as coordination of care on a regional level, certain patient characteristics (adherence to treatments or visits, mental disorders, etc...) and, especially, socioeconomic, cultural, environmental and behavioural context. In Catalonia, a strategy for proactive identification of complex chronic patients (CCP) and, within these group, patients with advanced chronic disease and palliative care needs (CCP-ACD), by healthcare professionals in primary care, based on clinical judgment and broad criteria, encompassing clinical and psychosocial variables, combined with Clinical Risk Groups (CRG, a risk-adjustment tool and clinically-based classification system used to measure a population’s burden of illness) has been promoted by the Chronicity Prevention and Care Program (CPCP) from the Department of Health. To the best of our knowledge, this strategy of identifying CCP from combination of risk adjustment and clinical judgment is a pioneering and unique experience worldwide. Professional perspective of what defines complexity, as well as clinical and psychosocial criteria used for identification, may not be matching between physicians and nurses, so identification of people with chronic diseases and complex care needs based on different criteria might be needed. The objectives of this study are 1) to determine the agreement between physicians and nurses in a primary care setting in identifying patients with chronic diseases and complex care needs (CCP and CCP-ACD) and 2) to describe the frequency and distribution of CPCP criteria used in identification by physicians and nurses. Methods : Population-based cross-sectional study based on information contained in the morbidity database of Catalonia in 2015 and professional electronic medical records. Setting: three primary care urban practices placed in Sabadell (Barcelona) belonging to the Catalan Institute of Health (ICS). According to this database, population with CRG≥5 and older than 14 years old (24762 inhabitants) were reviewed and CCP and CCP-ACD were identified and coded in the Shared Clinical Record of Catalonia, a common technological platform accessible to all providers of public health network. Study population is that which was recorded by healthcare professionals as CCP and CCP-ACD in the Shared Clinical Record of Catalonia on 30th September 2015. We will characterize complex patients and compare the characteristics of people with and without chronic complex care needs, according to professionals’ criteria by using chi-square or t-student tests, as appropriate. To examine the variability in identifying people with chronic diseases and complex care needs, we will calculate percentage of agreement and concordance degree using the Cohen's Kappa statistic. Results : (progress report) The identification and data collection was carried out between 1st July and 30th September 2015. It is expected to have the results of the study in February 2016. Discussion : The data provided by this study might confirm the existence of low agreement between physicians and nurses in primary care when identifying people with chronic diseases and complex care needs using clinical judgment and broad criteria, encompassing clinical and psychosocial variables, making advisable, therefore, an inclusive identification strategy in order to avoid health care inequities in these patients. Conclusion : Not applicable

Comparing theoretical and real complex chronic populations: cross-sectional study

Introduction: Population stratification systems are based, primarily, on burden of disease and pattern of use of resources. They do not include other variables that, according to available evidence, determine the complexity, especially environmental and social circumstances. In Catalonia, a strategy for proactive identification of complex chronic patients (CCP) by healthcare professionals in primary care, based on clinical judgment and broad criteria, encompassing adverse psychosocial situations and potential benefit from integrated care strategies, has been promoted by the Chronicity Prevention and Care Program (CPCP) from the Department of Health. The aim of this study is to compare the characteristics of the theoretical complex chronic population (TP) identified by a theoretical construct based on a population stratification system (Clinical Risk Groups, CRG) with the characteristics of the real complex chronic population (RP) identified by professionals according to clinical judgment and broad criteria promoted by CPCP. Methods: Information about CRG, demographic variables, presence of chronic diseases, use of health services and expenditure on pharmaceutical prescriptions was collected from the population morbidity database of Catalonia in 2013 (7.753.482 inhabitants). Identification of CCP was retrieved from the Shared Clinical Record of Catalonia, a common technological platform accessible to all providers of public health network. TP is that which fulfilled the theoretical construct developed by expert consensus based on population stratification variables (CRG 5 severity 6; CRG 6 severities 5-7; CRG 7 severities 2-6; CRG 8 severities 3-6; CRG 9 severities 2-6). RP is that which was recorded by professionals as CCP in the Shared Clinical Record of Catalonia on 31st December 2013. Specific criteria for identification as CCP were not available. For comparisons, odds ratio (OR) of association (and 99.9% confidence interval) were calculated using logistic regression models. Weighted coefficient of variation, percentage of explained variability and discrimination (area under the ROC curve) were also calculated. Results: TP identified by theoretical construct are 320930 persons (4.14% of the population of Catalonia). RP identified by professionals between 1st February and 31st December 2013 are 101415 persons (1.3% of the population of Catalonia). 56.6% of CCP (57401 persons) fulfils the theoretical construct. They are 17.9% of the total TP, increasing the possibility of being identified in this group (compared to non-identified TP) when increases the number of advanced chronic organic failure diseases (OR1=1,26 [1,21-1,31]; OR>2=2,27 [2,11-2,44]), visits to primary care (OR12-14 = 1,63 [1,53-1,75]; OR>24=4,31 [4,12-4,51]), urgent hospitalization (OR1-2 = 1,34 [1,29-1,39]; OR>2=2,17 [2,03-2,33]), age (OR45-64=1,78 [1,54-2,05]; OR>94=6,29 [5,25-7,52]) and pharmaceutical spending (OR500-749€=1,26 [1,19-1,33]; OR>1499€=1,85 [1,77-1,94]). This criteria is consistently observed in 30 studied areas (weighted coefficient of variation ≤2 for all variables, except for immigration). The model has acceptable discrimination (area under the ROC curve = 0.77) and explains 22% of variability. 43.3% of CCP (44014 persons) does not fulfil the theoretical construct, increasing the possibility of being identified in this group (compared with those that fulfil it) when decreases the number of advanced chronic organic failure diseases (OR1 =0,28 [0,26-0,30]; OR3 = 0,01 [0,007-0,02]), visits to primary care (OR12-14=0,84 [0,75-0,92]; OR>24=0,53 [0,49-0,56]), urgent hospitalization (OR1-2=0,33 [0,31-0,35]; OR>2=0,14 [0,11-0,17]) and pharmaceutical spending (OR500-749€=0,61 [0,56-0,66]; OR>1499€=0,43 [0,40-0,47]), and increases age (OR65-74=1,51 [1,22-1,89]; OR>94=3,47 [2,68-4,49]). This criteria is consistently observed in 30 studied areas (weighted coefficient of variation ≤2 for all variables, except for immigration). The model has optimal discrimination (area under the ROC curve = 0.84) and explains 42.9% of variability. Discussion: Theoretical construct appropriateness would be supported by percentage of people identified, near to 5% (reference in developed countries) and by percentage (majority) of CCP identified which fulfils it. Short study period, first 11 months of identification, might explain low percentage of TP identified, being considerable they present a higher severity profile, consistently observed in all studied areas. High percentage of CCP which does not fulfil proposed theoretical construct presents an associated profile that would evidence the existence of a complexity not depending on the burden of disease and the pattern of use of resources, equally consistently observed in all studied areas. Conclusion: Identifying CCP from a combination of population stratification and clinical judgment is, to the best of our knowledge, a pioneering experience worldwide. Consistent criteria for identification is remarkable because it shows the existence of a common clinical judgement among primary care professionals when identifying CCP. Results suggest the convenience to consider additional indicators of complexity, as psychosocial variables, for a more accurate stratification and identification of this population and justify the multidisciplinary, comprehensive and integrated health and social care approach for CCP, as proposed by CPCP. Additional studies are needed to overcome study limitations, to establish the prevalence of RP and to identify additional indicators, as psychosocial variables, that may determine complexity.

Comparing complex chronic patients to advanced chronic patients with palliative care needs: cross-sectional study

Introduction : In Catalonia, a strategy for proactive identification of complex chronic patients (CCP) by healthcare professionals in primary care, based on clinical judgment and broad criteria (encompassing clinical and psychosocial variables), has been promoted by the Chronicity Prevention and Care Program (CPCP) from the Department of Health. Identification of CCP is recorded in the Shared Clinical Record of Catalonia, a common technological platform accessible to all providers of public health network. A differentiated identification and coding of those CCP that suffer from advanced chronic disease and present palliative care needs, coded as CCP-ACD, is recommended. Even though population-based studies determining prevalence and characteristics of CCP-ACD in Catalonia have been performed, comparative studies between this population and those that have been identified as CCP are not available yet. The aim of this study is to compare the characteristics of CCP identified by healthcare professionals in primary care according to clinical judgment and broad criteria with the characteristics of those identified as CCP-ACD. Methods : Information about demographic variables, presence of chronic diseases, use of health services and expenditure on pharmaceutical prescriptions was collected from the population morbidity database of Catalonia in 2013 (7.753.482 inhabitants). Identification of CCP and CCP-ACD was retrieved from the Shared Clinical Record of Catalonia on 31st December 2013. Statistical tests used for comparisons were Pearson's chi-squared test for qualitative variables, parametric test for mean comparison (Student's t test) and non-parametric test for median comparison (U MannWhitney). Results : Total CCP identified by healthcare professionals in primary care between 1st February and 31st December 2013 are 101415 persons (1.3% of the population of Catalonia), which are distributed in 83% PCC itself (84150 persons, 1.1% of the population of Catalonia ) and 17% CCP-ACD (17265 persons, 0.2% of the population of Catalonia ). Ratio CCP/CCP-ACD is 5/1. Descriptive characteristics of individuals identified as CCP itself respect those identified as CCP-ACD present a higher percentage of women (55.5% vs 53% , p 1000 €/year (43.5% vs 38%, p Descriptive characteristics of individuals identified as CCP-ACD respect those identified as CCP itself present a higher percentage of mortality (19.9% vs 4.1%, p 84 years (46.5% vs 35%, p €3000/year (7% vs 3%, p Discussion : Characteristics of individuals identified as CPP-ACD describe a profile, in terms of burden of disease and pattern of use of resources, typically of the end of life phase, clearly different from characteristics of individuals identified as CCP itself, suggesting that clinical judgment, promoted by CPCP as criteria for proactive identification of this population, would allow to differentiate these two groups. Prevalence of individuals identified as CCP-ACD is lower than, according to the literature, would be expected to find at a population level (around 1%), and probably related to limited study period, of only 11 months. Yet, ratio CCP/CCP-ACD found is higher than expected (about 3/1). These results might point out that CPP-ACP population would be under-registered, probably favoured by prognostic uncertainty and difficulties in identifying the typical needs profile of advanced diseases by healthcare professionals. Conclusion : Characteristics, in terms of burden of disease and pattern of use of resources, of individuals identified as CCP-ACD by healthcare professionals in primary care are clearly different from those identified as PCC, which would justify the implementation of health policies and models of care specific to each level of complexity. Additional studies are needed to overcome limitations of the present study, to establish the population prevalence of both CCP and CCP-ACD and to identify the possible causes of under-registration of CCP-ACD by healthcare professionals in primary care.

The importance of socio-technical resources for software ecosystems management

Abstract Software Ecosystem (SECO) is often understood as a set of actors interacting among themselves and manipulating artifacts with the support of a common technology platform. Usually, SECO approaches can be designed as an environment whose component repository is gathering stakeholders as well as software products and components. By manipulating software artifacts, a technical network emerges from interactions made over the component repository in order to reuse artifacts, improving code quality, downloading, selling, buying etc. Although technical repositories are essential to store SECO’s artifacts, the interaction among actors in an emerging social network is a key factor to strengthen the SECO’s through increasing actor’s participation, e.g., developing new software, reporting bugs, and communicating with suppliers. In the SECO context, both the internal and external actors keep the platform’s components updated and documented, and even support requirements and suggestions for new releases and bug fixes. However, those repositories often lack resources to support actors’ relationships and consequently to improve the reuse processes by stimulating actors’ interactions, information exchange and better understanding on how artifacts are manipulated by actors. In this paper, we focused on investigating SECO as component repositories that include socio-technical resources. As such, we present a survey that allowed us to identify the relevance of each resource for a SECO based on component repositories, initially focused on the Brazilian scenario. This paper also describes the analysis of the data collected in that survey. Information of other SECO elements extracted from the data is also presented, e.g., the participants’ profile and how they behave within a SECO. As an evolution of our research, a study for evaluating the availability and the use of such resources on top of two platforms was also conducted with experts in collaborative development in order to analyze the usage of the most relevant resources in real SECO’s platforms. We concluded that socio-technical resources have aided collaboration in software development for SECO, coordination of teams based on more knowledge of actor’s tasks and interactions, and monitoring of quality of SECOs’ platforms through the orchestration of the contributions developed by external actors.

Designing a Learning Space for Unified Collaboration and Communication between Universities, Industry and the Public Sector

The goal of this paper is to present theoretical and technical approaches, which acts as guidelines for the design of multifunctional rooms (MFR) enabling communication and collaboration. Furthermore, to define a method to mix key trends in education technology, pedagogy and room design together to facilitate various types of scenarios and users. The Norwegian Ministry of Foreign Affairs is financing a program in Higher Education, Research and Development in the Western Balkans 2010-2016 (HERD). A sub program within HERD focus on the energy sector. This paper refers to a project within the energy sector called: Quality Improvements of Master Programs in Sustainable Energy and Environment (QIMSEE). The projects members in QIMSEE are eight universities (Trondheim, Belgrade, East Sarajevo, Tuzla, Sarajevo, Banja Luka, Podgorica, and Skopje). The main goal of the project is to improve the quality of education at Master's programs. A milestone in this project process is to enhance interconnections between universities, industry and the public. The need for a common technological platform and standards for cooperation and communication is fundamental. A multifunctional room (MFR) or “learning space” will be set up at each location to support activities defined in the project synopsis.

A mobile device supported blended learning approach for postgraduate students where absenteeism from classes had previously been an issue

While the students on a postgraduate course were reportedly motivated by the course, which was accredited by a professional body, there was a high level of absenteeism in earlier courses years. A blended learning approach was introduced which allowed the students to attend lectures and tutorials but also to access course material, listen to lecture-based podcasts, participate in chat room tutorials and use other resources, such as the library resources, at any time. To ensure a common technology platform, each student was issued with an iPad2. The blended learning approach and the availability of mobile devices gave flexibility to assist and support learning. Lessons learned included (1) that introducing the blended learning approach appeared to have a positive impact on academic results (2) traditional attendance measures became less relevant, (3) that students wanted to retain an amount of face to face time rather than go solely online and (4) that students vary in the enthusiasm with which they embrace the blended learning approach.

Software ecosystems – A systematic literature review

A software ecosystem is the interaction of a set of actors on top of a common technological platform that results in a number of software solutions or services. Arguably, software ecosystems are gaining importance with the advent of, e.g., the Google Android, Apache, and Salesforce.com ecosystems. However, there exists no systematic overview of the research done on software ecosystems from a software engineering perspective. We performed a systematic literature review of software ecosystem research, analyzing 90 papers on the subject taken from a gross collection of 420. Our main conclusions are that while research on software ecosystems is increasing (a) there is little consensus on what constitutes a software ecosystem, (b) few analytical models of software ecosystems exist, and (c) little research is done in the context of real-world ecosystems. This work provides an overview of the field, while identifying areas for future research.

A Real-time Scintillating Fiber Detector to Improve Patient Safety in External Beam Radiation Therapy

The purpose of this study is to improve patient safety in radiation oncology by implementing real time verification of fluence delivered during external beam radiation therapy using a radiation hard scintillating fiber sensor array architecture and real time data acquisition hardware. Radiation oncology patients undergo highly complicated treatment procedures in which delivered dose should be controlled, recorded, and verified for quality and safety. Currently, radiation treatment cumulative dose is measured prior to delivery, which is not sensitive to temporal variations that could occur during imaging or treatment. Therefore, the actual quality and safety of the radiation therapy procedure is unknown and any deviation from the intended dose cannot be identified, thus cannot be corrected. To address this gap in patient safety, we developed scintillating fiber array sensors with real time data acquisition hardware to implement real time fluence verification of photon and electron beams. These on line detectors can operate on a wide range of clinical devices through modification of sensor element geometry and front end electronics operating parameters. This common technological platform provides a simplified method to construct low cost radiation based modality specific dosimeters. As an example, we developed and tested a scintillating fiber array for linac external beam radiation therapy with plastic encapsulated scintillating fibers and photodetectors integrated in a monolithic configuration. This detector has high speed front end amplifiers for real time acquisition and verification of the pulsed linac output during treatment. We determined the detector sensitivity and linearity response with respect to beam intensity and field size for the clinical range of photon beam energies. The scintillating fiber spatial detection sensitivity is 2.3 mV/mm with a statistical error of 0.5 mV. Fiber linearity response with respect to beam intensity and field size was within 2% for all tested beams. The front end amplifiers have a time response of 250 nsec. The fiber dosimeter has a maximum beam attenuation of 2.4% and is used in an online transmission configuration for in vivo treatment delivery accuracy monitoring. The development of this technology addresses the urgent need for in vivo real time quality assurance of external beam therapy to increase patient safety. The developed linear fiber array has high spatial and temporal resolution to provide accurate dose verification, thus providing therapists real time feedback of external beam treatment fluence with minimum beam attenuation to increase patient safety. Configurations for other external beam treatment devices such as tomotherapy machines could be done with little design modification.

Narrowing the gap between breathprinting and disease diagnosis, a sensor perspective

A disease usually manifests itself with the appearance of some associated symptoms. Before or at the same time as their appearance, many biological fluids (including exhaled breath) could reveal the presence of a disease through a characteristic print. Exhaled breath printing is the least invasive diagnostic method, but it still does not pertain clinical practice. The gap standing between fingerprinting and disease diagnosis is due to the complexity of the whole process and the huge variety of available techniques still confined to research. Exploring this gap means underlining sample collection, sensor technology and data analysis. In this work particular attention is devoted to standardization issues. Narrowing this gap means finding a shared path for researchers involved in breathprinting, through a common technological platform and a shared list of standard operating procedures.

Making Strategic Innovation Work: An Interview with Vijay Govindarajan

Vijay Govindarajan talks with RTM Editor-in-Chief James Euchner about how to put his 10 rules for strategic innovators into practice. In 10 Rules for Strategic Innovators, Vijay Govindarajan and co-author Chris Trimble discuss what it takes to innovate inside established companies. He emphasizes three concepts: forgetting lessons from the past that may inhibit progress on a new venture; focusing on learning and clarifying key assumptions in the early stages of innovation, not on financial metrics; and consciously borrowing appropriate assets from the parent organization. These are simple in principle, but they can be difficult to put into practice. In this interview, conducted as part of the 2009 World Innovation Forum, held in New York City in May, we probe the practical implications of these ideas for innovators seeking to innovate within larger organizations. James Euchner [JE]: Vijay, it's great to have the chance to talk with you about innovation. I really enjoyed reading Rules for Strategic Innovators. I'd like to structure the interview around the three principles you discuss in your book, forgetting, learning, and borrowing. Let's start with the difficulties many companies have forgetting lessons that may no longer be relevant. In the book, you suggest hiring people from the outside to bring a fresh perspective. You also suggest starting internal ventures that are quasi-independent from the core business. But you can't really do that in every single case. In your experience, how different does a new venture need to be before it makes sense to set it up with a separate infrastructure? Vijay Govindarajan [VG]: I think probably the criteria to use is whether the innovation is breaking away from your current business model. You need to really think critically about the business model. A business model answers three questions: Who's your customer? What value is the customer seeking? And what is the process by which you're going to create that value? For your core business you have evolved an answer to these three questions. If you are launching a new venture, and the innovation breaks away from your core business in its answer to any one of these three questions, then I'd say that you have to overcome the forgetting challenge. And one of the most effective ways to do that is to set up a separate venture. JE: Won't that end up being a large number of the things that are going to be truly innovative inside of a corporation? VG: No company can launch hundreds of these new ventures. Therefore, each company needs to understand its capacity for new ventures. Only a few such ventures can be launched, and when you launch those, you have to get it right. You may need very different processes for HR, for instance, to support the different business model. As an example, when General Motors created OnStar, which was a fundamentally different business model than making automobiles, they used the same HR process to recruit for it as they used for their core business. Imagine, at the height of the dot-com boom, trying to persuade people from Silicon Valley to move to Detroit on the same pay scale on which General Motors's regular employees were paid. So you get the picture. A company pursuing a new business may need to think about human resources, for instance, very differently. JE: Now in that situation did they actually set it up as a quasi-independent unit in order to move it forward? VG: Initially they did not, and that's why the unit started to struggle--because they had common HR systems, even a common information technology platform with the core business. Again, imagine for a moment: the information technology that supports the automobile business is oriented towards processing efficiency, whereas information technology was the brain of the OnStar program. If you have the same IT department trying to attend to the needs of OnStar and the needs of the automobile business, the priorities will become skewed, and even the capabilities required may not match. …

Dynamics of inter‐organizational knowledge creation and information technology use across object worlds: the case of an innovative construction project

Organizational research argues that under relational forms of governance a high degree of both information pooling and physical interaction are necessary for inter‐organizational knowledge creation. Yet, recent studies of information and communication technologies (ICTs) suggest that both practices at the same time are sometimes unnecessary. We address this discrepancy by developing a framework whereby the intensity and proportion of these inter‐organizational practices are affected by the object world congruence between designers within and across partnering firms, and the level to which a common information technology platform is embedded in their activity. Through a multi‐level case study of a Frank Gehry construction project we illustrate how designers with highly congruent object worlds, due to a strongly embedded common information technology platform, could jointly create knowledge despite decreased physical interaction. Conversely, designers from firms with incongruent object worlds or with congruent object worlds lacking a strongly embedded common ICT platform demanded a higher degree of physical interaction for effective knowledge creation. Our research suggests a dynamic, evolutionary model of inter‐organizational knowledge creation influenced by variation in object world congruence and the levels of embedding a common ICT platform.