Architecting for Connected Healthcare

2012 ◽  
pp. 306-325
Author(s):  
Torben Tambo ◽  
Nikolai Hoffmann-Petersen ◽  
Karsten Bejder
Keyword(s):  
Healthcare System ◽  
Change Process ◽  
Large Scale ◽  
Enterprise Architecture ◽  
Self Care ◽  
Home Monitoring ◽  
Technological Changes ◽  
The Everyday ◽  
Scale Population ◽  
Hospital Stays

The healthcare system is in many countries operated by the governments, and interaction with the healthcare system is one of the most frequent interactions between citizen and government. Demographic, medical, and technological changes are likely to bring new aspects of connectedness into the everyday life of people and place healthcare and homecare professionals in new roles. A transformation is taking place where hospital best practices are constantly reducing patient’s in-hospital stays to alternative, less-costly care—notably at home. Telemedicine, telehealth, eHealth, home monitoring, and self-care are essential aspects of this transformation. Many issues are influencing this transformation, and new barriers are showing up where others are removed. A broadly oriented enterprise architecture effort is presented for the underpinning of the change process. The architectural approach encompasses views of the citizen, the healthcare system, the information infrastructure, and the citizen-oriented technology. A case of telemonitoring and self-care is presented using mobile hypertension measurement on a large-scale population cohort. Evaluation of the acceptance and success of the solutions is done within a combined understanding including technology, economy, organization, and culture.

An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial

2016 ◽  
Vol 23 (6) ◽  
pp. 595-604 ◽  
Author(s):  
Jae Hyoung Cho ◽  
Hun-Sung Kim ◽  
Seung Hyun Yoo ◽  
Chang Hee Jung ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Healthcare System ◽  
Glucose Control ◽  
Large Scale ◽  
Diabetes Management ◽  
Intervention Group ◽  
Diabetes Control ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Automatic Data

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population.

scholarly journals The role of partners in promoting self-care for misoprostol and subcutaneous DMPA in Pakistan

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Qudsia Uzma ◽  
Nausheen Hamid ◽  
Rizwana Chaudhri ◽  
Nadeem Mehmood ◽  
Atiya Aabroo ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Private Sector ◽  
Healthcare System ◽  
Sexual And Reproductive Health ◽  
Health Workers ◽  
Self Care ◽  
Essential Element ◽  
Scaling Up ◽  
Reproductive Health Services

Abstract Background Pakistan is among a number of countries facing protracted challenges in addressing maternal mortality with a concomitant weak healthcare system complexed with inequities. Sexual and reproductive health and rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. A prospective qualitative study design was used and a semi-structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include the use of misoprostol for postpartum hemorrhage and the use of subcutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephone follow-up calls. Results Nine of the 13 partners consulted for the study responded. The two selected self-care interventions are mainly supported by private sector partners (national and international nongovernmental organizations) having national or subnational existence. Their mandates include all relevant areas, such as policy advocacy, field implementation, trainings, supervision and monitoring. A majority of partners reported experience related to the use of misoprostol; it was introduced more than a decade ago, is registered and is procured by both public and private sectors. Subcutaneous DMPA is a new intervention, having been introduced only recently, and commodity availability remains a challenge. It is being delivered through health workers/providers and is not promoted as a self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation; however, no beneficiary data was collected for the study. Training approaches differ considerably, are standalone or integrated with SRHR topics and their duration varies between 1 and 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support, as well as the leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting are required together with integration of self-care in routine capacity building activities (pre- and in-service) on sexual and reproductive health in the country.

scholarly journals Colonial management as a social field: The Palestinian remaking of Israel’s system of spatial control

2021 ◽  
pp. 001139212110246
Author(s):  
Walid Habbas ◽  
Yael Berda
Keyword(s):  
Large Scale ◽  
Central Component ◽  
Colonial Rule ◽  
Spatial Mobility ◽  
The West ◽  
Social Field ◽  
Spatial Control ◽  
Racial Hierarchy ◽  
Economic Elite ◽  
The Everyday

This article delves into the everyday dynamics of colonial rule to outline a novel way of understanding colonized–colonizer interactions. It conceives colonial management as a social field in which both the colonized and colonizers negotiate and exchange resources, despite their decidedly unequal positions within a racial hierarchy. Drawing their example from the West Bank, the authors argue that a Palestinian economic elite has proactively participated in the co-production of the colonial management of spatial mobility, a central component of Israeli colonial rule. The study employs interviews and document analysis to investigate how the nexus between Palestine’s commercial-logistical needs and Israel’s security complex induced large-scale Palestinian producers to exert agency and reorder commercial mobility. The authors describe and explain the evolution of a ‘Door-to-Door’ logistical arrangement, in which large-scale Palestinian traders participate in extending Israeli’s system of spatial control in exchange for facilitating logistical mobility. This horizontal social encounter that entails pay-offs is conditioned, but not fully determined, by vertical relations of domination and subordination.

scholarly journals Publisher Correction: A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Youn Young Park ◽  
Kil‑yong Lee ◽  
Seong Taek Oh ◽  
Sang Hyun Park ◽  
Kyung Do Han ◽  
...  
Keyword(s):  
Cohort Study ◽  
Large Scale ◽  
Population Based ◽  
Gastrointestinal Cancers ◽  
Scale Population

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

scholarly journals Using Bus Ticketing Big Data to Investigate the Behaviors of the Population Flow of Chinese Suburban Residents in the Post-COVID-19 Phase

2021 ◽  
Vol 18 (11) ◽  
pp. 6066
Author(s):  
Yanbing Bai ◽  
Lu Sun ◽  
Haoyu Liu ◽  
Chao Xie
Keyword(s):  
Travel Behavior ◽  
Large Scale ◽  
Behavior Patterns ◽  
Population Movements ◽  
Economic Level ◽  
Passenger Travel ◽  
Scale Population ◽  
Travel Behaviors ◽  
Railway Passenger ◽  
And Control

Large-scale population movements can turn local diseases into widespread epidemics. Grasping the characteristic of the population flow in the context of the COVID-19 is of great significance for providing information to epidemiology and formulating scientific and reasonable prevention and control policies. Especially in the post-COVID-19 phase, it is essential to maintain the achievement of the fight against the epidemic. Previous research focuses on flight and railway passenger travel behavior and patterns, but China also has numerous suburban residents with a not-high economic level; investigating their travel behaviors is significant for national stability. However, estimating the impacts of the COVID-19 for suburban residents’ travel behaviors remains challenging because of lacking apposite data. Here we submit bus ticketing data including approximately 26,000,000 records from April 2020–August 2020 for 2705 stations. Our results indicate that Suburban residents in Chinese Southern regions are more likely to travel by bus, and travel frequency is higher. Associated with the economic level, we find that residents in the economically developed region more likely to travel or carry out various social activities. Considering from the perspective of the traveling crowd, we find that men and young people are easier to travel by bus; however, they are exactly the main workforce. The indication of our findings is that suburban residents’ travel behavior is affected profoundly by economy and consistent with the inherent behavior patterns before the COVID-19 outbreak. We use typical regions as verification and it is indeed the case.

scholarly journals Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028843 ◽  
Author(s):  
Danmeng Liu ◽  
Yue Cheng ◽  
Shaonong Dang ◽  
Duolao Wang ◽  
Yaling Zhao ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Large Scale ◽  
Northwest China ◽  
Population Based ◽  
Shaanxi Province ◽  
Micronutrient Supplementation ◽  
Cross Sectional Survey ◽  
Start Time ◽  
Cross Sectional ◽  
Scale Population

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

Evidence for a large-scale population structure among accessions of Arabidopsis thaliana: possible causes and consequences for the distribution of linkage disequilibrium

2006 ◽  
Vol 15 (6) ◽  
pp. 1507-1517 ◽  
Author(s):  
MARIE-FRANCE OSTROWSKI ◽  
JACQUES DAVID ◽  
SYLVAIN SANTONI ◽  
HEATHER MCKHANN ◽  
XAVIER REBOUD ◽  
...  
Keyword(s):  
Arabidopsis Thaliana ◽  
Population Structure ◽  
Linkage Disequilibrium ◽  
Large Scale ◽  
Scale Population

Large- and small-scale vortical motions in a shear layer perturbed by tabs

1999 ◽  
Vol 382 ◽  
pp. 307-329 ◽  
Author(s):  
JUDITH K. FOSS ◽  
K. B. M. Q. ZAMAN
Keyword(s):  
Shear Layer ◽  
Pitch Angle ◽  
Large Scale ◽  
Dimensional Space ◽  
Three Dimensional ◽  
Small Scale ◽  
Streamwise Vortices ◽  
Streamwise Vorticity ◽  
Cross Sectional ◽  
Scale Population

The large- and small-scale vortical motions produced by ‘delta tabs’ in a two-stream shear layer have been studied experimentally. An increase in mixing was observed when the base of the triangular shaped tab was affixed to the trailing edge of the splitter plate and the apex was pitched at some angle with respect to the flow axis. Such an arrangement produced a pair of counter-rotating streamwise vortices. Hot-wire measurements detailed the velocity, time-averaged vorticity (Ωx) and small-scale turbulence features in the three-dimensional space downstream of the tabs. The small-scale structures, whose scale corresponds to that of the peak in the dissipation spectrum, were identified and counted using the peak-valley-counting technique. The optimal pitch angle, θ, for a single tab and the optimal spanwise spacing, S, for a multiple tab array were identified. Since the goal was to increase mixing, the optimal tab configuration was determined from two properties of the flow field: (i) the large-scale motions with the maximum Ωx, and (ii) the largest number of small-scale motions in a given time period. The peak streamwise vorticity magnitude [mid ]Ωx−max[mid ] was found to have a unique relationship with the tab pitch angle. Furthermore, for all cases examined, the overall small-scale population was found to correlate directly with [mid ]Ωx−max[mid ]. Both quantities peaked at θ≈±45°. It is interesting to note that the peak magnitude of the corresponding circulation in the cross-sectional plane occurred for θ≈±90°. For an array of tabs, the two quantities also depended on the tab spacing. An array of contiguous tabs acted as a solid deflector producing the weakest streamwise vortices and the least small-scale population. For the measurement range covered, the optimal spacing was found to be S≈1.5 tab widths.

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