Global software development and collaboration

While organisations recognise the advantages offered by global software development, many socio-technical barriers affect successful collaboration in this inter-cultural environment. In this paper, we present a review of the global software development literature where we highlight collaboration problems experienced by a cross-section of organisations in twenty-six studies. We also look at the literature to answer how organisations are overcoming these barriers in practice. We build on our previous study on global software development where we define collaboration as four practices related to agreeing, allocating, and planning goals, objectives, and tasks among distributed teams.

We found that the key barriers to collaboration are geographic, temporal, cultural, and linguistic distance; the primary solutions to overcoming these barriers include site visits, synchronous communication technology, and knowledge sharing infrastructure to capture implicit knowledge and make it explicit.

Nutritional status of an adult cystic fibrosis population

Nutritional management and dietary recommendations in patients with cystic fibrosis (CF) have changed considerably over the past 10-15 y. The nutritional status of adult CF patients was assessed in a clinical survey before these changes in nutritional management. The aim of the study was to assess the current nutritional status of the CF population and compare the results with those of the previous study. Forty-three (24 male, 19 female) subjects participated in this study. Subjects' height, weight, mid-upper-arm circumference, and skinfolds at four sites were measured. Nutritional intake was measured by using a 7-d food intake diary including documentation of supplements taken. Compared with the 1983 study, the incidence of malnutrition, as indicated by a body mass index of less than 20, has decreased from 62% to 9%. Furthermore, there have been significant improvements in the weight, height, and body mass index of both males (P < 0.001) and females (P < 0.04). Individuals with CF are no longer subject to growth arrest, as their mean height is now comparable to the Australian average. Mid-upper-arm circumference (P < 0.0001), triceps skinfold (P < 0.0001), and percentage of body fat (P < 0.05) of males and females have also significantly increased. The fat intake (P < 0.02) of females and males and energy intake (P < 0.03) of females have increased significantly, and the mean energy intake of subjects has exceeded the recommended 120% of the recommended daily intake. A significant number of patients in the present study receive dietary oral and/or enteral supplements. Multiple linear regression analysis indicated that nutritional management was principally responsible for improvements in nutritional status. The findings suggest that there has been a significant improvement in the nutritional status of the adult CF population, which may be due primarily to changes in nutritional management.

Improving access to optometry services for people at risk of preventable sight loss: a qualitative study in five UK locations

Background

Reducing preventable sight loss is an increasing priority for public health and health care providers. We examined the factors affecting people's use of optometry services in population groups at increased risk of sight loss.

Methods

This is a qualitative study in five UK locations. In England, participants were from the Pakistani and Black Caribbean communities; in Scotland from the Pakistani community; and in Northern Ireland and Wales from white socio-economically deprived communities. Thirty-four focus groups were conducted (n = 289). The study included people who attend optometry services and people not engaged with services.

Results

Barriers to access included limited awareness of eye health and eye disease, concern about the cost of spectacles and the appropriateness of optometry in a commercial setting. Attendance at the optometrist was primarily symptom led. A positive previous experience or continuing relationship with the optometrist helped to alleviate the barriers and promote attendance.

Conclusion

Addressing the disparity between the broader messages about eye health and the current perception of the function of optometry could help improve access to services. Uptake may be improved through the co-production of interventions that better resonate with local communities. Non-retail service delivery options should be explored.

Trace metal abnormalities in long-stay hyperactive mentally handicapped children and agitated senile dements

Gross metal poisoning as a causative factor in mental handicap is now relatively rare although historically it was important. Currently attention is being focused on the importance of chronic metal poisoning, there being much debate on, for instance, the possible effects of low levels of lead on intelligence in childhood. This paper examines the levels of a number of metals, both toxic and essential, in two groups of agitated patients in a long-stay psychiatric hospital in the UK. The two groups examined comprise 'hyperactive' mentally handicapped children and senile dementia patients, all of whom showed moderate to severe agitation. Blood and hair tissue were used to assess the body status of a number of metals and the results were compared with controls matched as closely as possible and from a similar hospital environment. The most significant findings are the raised levels of aluminium in the agitated senile dementia patients and the low levels of zinc and raised levels of lead in the hyperactive children.

A comparison of anxiety treatments with adults who have moderate and severe mental retardation

Several authors have suggested that Abbreviated Progressive Relaxation may not be effective with clients who have moderate and severe mental retardation. Because of this the authors were interested in the development of behavioural relaxation which is a more simple technique and does not require a conceptual awareness of internal states of tension. These two treatments were compared in group and individual forms with four groups of subjects. Subjects were assessed using measures of rated anxiety and pulse rate before, during, and after treatment. The rated anxiety measures suggest Behavioural Relaxation Training is more effective than Abbreviated Progressive Relaxation in both group and individual formats. There were no significant differences on the pulse rate measures.

The effect of advanced recovery room care on postoperative outcomes in moderate-risk surgical patients: a multicentre feasibility study

Postoperative complications are common and may be under-recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in-hospital complications in moderate- and high-risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12-18 h postoperatively in the post-anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in-hospital and post-discharge events. This was a multicentre, prospective, feasibility before-and-after trial of moderate-risk patients (predicted 30-day mortality of 1-4%) undergoing non-cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post-anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of > 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted.

Mapping a Careflow Network to assess the connectedness of Connected Health

Connected Health is an emerging and rapidly developing field which has the potential to transform healthcare service systems by increasing its safety, quality and overall efficiency. From a healthcare perspective, process improvement models have mainly focused on the static workflow viewpoint. The objective of this article is to study and model the dynamic nature of healthcare delivery, allowing us to identify where potential issues exist within the service system and to examine how Connected Health technological solutions may support service efficiencies. We explore the application of social network analysis (SNA) as a modelling technique which captures the dynamic nature of a healthcare service. We demonstrate how it can be used to map the 'Careflow Network' and guide Connected Health innovators to examine specific opportunities within the healthcare service. Our results indicate that healthcare technology must be correctly identified and implemented within the Careflow Network to enjoy improvements in service delivery. Oftentimes, prior to making the transformation to Connected Health, researchers use various modelling techniques that fail to identify where Connected Health innovation is best placed in a healthcare service network. Using SNA allows us to develop an understanding of the current operation of healthcare system within which they can effect change. It is important to identify and model the resource exchanges to ensure that the quality and safety of care are enhanced, efficiencies are increased and the overall healthcare service system is improved. We have shown that dynamic models allow us to study the exchange of resources. These are often intertwined within a socio-technical context in an informal manner and not accounted for in static models, yet capture a truer insight on the operations of a Careflow Network.

Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature

BACKGROUND

Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are.

OBJECTIVE

This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app.

METHODS

A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing.

RESULTS

Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app.

CONCLUSIONS

In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.

Crystallization and preliminary crystallographic investigation of methanol dehydrogenase from Methylobacterium extorquens AM1

Single crystals of methanol dehydrogenase (MDH) from Methylobacterium extorquens AM1 have been grown by the vapour diffusion method. These crystals diffract to beyond 2 A resolution and are suitable for X-ray crystallography. They belong to the orthorhombic space group P2(1)2(1)2(1) and have the following unit cell parameters: a = 66.79 A, b = 108.9 A, c = 188.9 A. One asymmetric unit contains an alpha 2 beta 2 tetramer of MDH and the location of the non-crystallographic 2-fold symmetry axis of this tetramer is defined by the paired positions of the binding sites of heavy atoms in four MDH-derivatives.

Public opinion of the Irish “COVID Tracker” digital contact tracing App: A national survey

Objective

This study aims to gather public opinion on the Irish “COVID Tracker” digital contact tracing (DCT) App, with particular focus on App usage, usability, usefulness, technological issues encountered, and potential changes to the App.

Methods

A 35-item online questionnaire was deployed for 10 days in October 2020, 3 months after the launch of the Irish DCT App.

Results

A total of 2889 completed responses were recorded, with 2553 (88%) respondents currently using the App. Although four in five users felt the App is easy to download, is easy to use and looks professional, 615 users (22%) felt it had slowed down their phone, and 757 (28%) felt it had a negative effect on battery life. Seventy-nine percent of respondents reported the App's main function is to aid contact tracing. Inclusion of national COVID-19 trends is a useful ancillary function according to 87% of respondents, and there was an appetite for more granular local data. Overall, 1265 (44%) respondents believed the App is helping the national effort, while 1089 (38%) were unsure.

Conclusions

DCT Apps may potentially augment traditional contact tracing methods. Despite some reports of negative effects on phone performance, just 7% of users who have tried the App have deleted it. Ancillary functionality, such as up-to-date regional COVID-19, may encourage DCT App use. This study describes general positivity toward the Irish COVID Tracker App among users but also highlights the need for transparency on effectiveness of App-enabled contact tracing and for study of non-users to better establish barriers to use.

Sentiment analysis of user feedback on the HSE's Covid-19 contact tracing app

BACKGROUND

Digital Contact Tracing is seen as a key tool in reducing the propagation of Covid-19. But it requires high uptake and continued participation across the population to be effective. To achieve sufficient uptake/participation, health authorities should address, and thus be aware of, user concerns.

AIM

This work manually analyzes user reviews of the Irish Heath Service Executive's (HSE) Contact Tracker app, to identify user concerns and to lay the foundations for subsequent, large-scale, automated analyses of reviews. While this might seem tightly scoped to the Irish context, the HSE app provides the basis for apps in many jurisdictions in the USA and Europe.

METHODS

Manual analysis of (1287) user reviews from the Google/Apple playstores was performed, to identify the aspects of the app that users focused on, and the positive/negative sentiment expressed.

RESULTS

The findings suggest a largely positive sentiment towards the app, and that users thought it handled data protection and transparency aspects well. But feedback suggests that users would appreciate more targeted feedback on the incidence of the virus, and facilities for more proactive engagement, like notifications that prompt users to submit their health status daily. Finally, the analysis suggests that the "android battery" issue and the backward-compatibility issue with iPhones seriously impacted retention/uptake of the app respectively.

CONCLUSION

The HSE have responded to the public's desire for targeted feedback in newer versions, but should consider increasing the app's proactive engagement. The results suggest they should also raise the backward compatibility issue, regarding older iPhones, with Apple.

Sensorial quality and bone strength of female and male broiler chickens are influenced by weight and growth rate

1. An experiment was conducted with 98 male and 98 female broiler chickens (Ross 308) to study the effect of growth rate, induced by different dietary means, sex and live weight (1500 g and 2000 g) at slaughter on production parameters, bone strength and sensorial characteristics of the breast meat. 2. The birds were divided into four groups and individually fed a standard commercial diet, a high energy diet or low energy diet from d 11 to slaughter at between d 28 and 39. Three groups were fed ad libitum and a further group was fed a restricted amount of the high energy feed. Half of the birds in each group were slaughtered at approximately 1500 g and the other half at 2000 g live weight. 3. The diets resulted in different growth rates. The chickens fed the high energy and the commercial diet had the highest growth rate at both live weights at slaughter. The restricted fed chickens had lower bone strength than the chickens fed the low energy diet. 4. Breast meat from male broilers was juicer, more tender and less hard than breast meat from females. Chickens slaughtered at 2000 g live weight were juicer than those slaughtered at 1500 g. Chickens given the high energy feed ad libitum and restricted had different growth rates, but the sensory parameter related to texture showed no difference. 5. It was concluded that an increased slaughter weight might improve meat quality due to improved juiciness.

Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework

BACKGROUND

The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens' privacy while gleaning their close contacts and as much epidemiological information as possible.

OBJECTIVE

In this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs.

METHODS

The framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper.

RESULTS

The final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs.

CONCLUSIONS

Our CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available.

Pathways, technology and the patient-connected health through the lifecycle

Connected Health solutions are ubiquitous in providing patient centered care and in responding to a new paradigm of care pathways where Health Information Technology is being introduced. This paper defines Connected Health, and, in particular, describes standards and regulations which are important to the implementation of safe, effective and secure Connected Health solutions. This paper provides: a holistic view of Connected Health; provides a standards and regulations based view of the lifecycle of the Health IT system; and identifies the relevant roles and responsibilities at the various stages of the lifecycle for both manufacturers of connected health solution and healthcare delivery organization solutions. We discuss how the implementation of standards and regulations, while implementing and using Health IT infrastructure, requires close collaboration and ongoing communication between Healthcare Delivery Organizations and Accountable Manufacturers throughout the lifecycle of the health IT system. Furthermore, bringing technology into the healthcare system requires a robust and comprehensive approach to Clinical Change Management to support the business and clinical changes that the implementation of such solutions requires. Ultimately, to implement safe, effective, and secure Connected Health solutions in the healthcare ecosystem, it requires that all those involved work together so that the main requirement-patient-centered care-is realized.

Enablers and barriers for hospital pharmacy information systems

Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.

Cybersecurity Risk Management Framework for Blockchain Identity Management Systems in Health IoT

Blockchain (BC) has recently paved the way for developing Decentralized Identity Management (IdM) systems for different information systems. Researchers widely use it to develop decentralized IdM systems for the Health Internet of Things (HIoT). HIoT is considered a vulnerable system that produces and processes sensitive data. BC-based IdM systems have the potential to be more secure and privacy-aware than centralized IdM systems. However, many studies have shown potential security risks to using BC. A Systematic Literature Review (SLR) conducted by the authors on BC-based IdM systems in HIoT systems showed a lack of comprehensive security and risk management frameworks for BC-based IdM systems in HIoT. Conducting a further SLR focusing on risk management and supplemented by Grey Literature (GL), in this paper, a security taxonomy, security framework, and cybersecurity risk management framework for the HIoT BC-IdM systems are identified and proposed. The cybersecurity risk management framework will significantly assist developers, researchers, and organizations in developing a secure BC-based IdM to ensure HIoT users' data privacy and security.

"Follow the Musical Road": Selecting Appropriate Music Experiences for People with Dementia Living in the Community

There are many music experiences for people with dementia and their caregivers including but not limited to individualized playlists, music and singing groups, dementia-inclusive choirs and concerts, and music therapy. While the benefits of these music experiences have been well documented, an understanding of the differences between them is often absent. However, knowledge of and distinction between these experiences are crucial to people with dementia and their family members, caregivers, and health practitioners to ensure a comprehensive music approach to dementia care is provided. Considering the array of music experiences available, choosing the most appropriate music experience can be challenging. This is an exploratory phenomenological study with significant Public and Patient Involvement (PPI). Through consultation with PPI contributors with dementia via an online focus group and senior music therapists working in dementia care via online semi-structured interviews, this paper aims to identify these distinctions and to address this challenge by providing a visual step-by-step guide. This guide can be consulted when choosing an appropriate music experience for a person with dementia living in the community.

Exploring the perspectives of people with stroke, caregivers and healthcare professionals on the design and delivery of a mHealth adaptive physical activity intervention: a qualitative study protocol

Background: Despite recent advances in acute stroke intervention, secondary prevention strategies are lacking. Physical activity (PA) is the second-largest predictor of stroke and a cornerstone of secondary prevention therapies. Interventions to promote PA post-stroke include components aimed at reducing sedentary behaviour and increasing participation in lifestyle PA and structured exercise. Despite guidelines to adapt PA to individuals’ needs, there is no evidence on the empirical development of adaptive PA interventions post-stroke. This study will explore patient, caregiver and multidisciplinary healthcare professional perspectives on the design and delivery of adaptive, personalised PA interventions, delivered using a smartphone application, following mild-to-moderate stroke. Findings will directly inform the protocol of an experimental trial, using a novel adaptive trial design.   Methods: A descriptive qualitative study will be undertaken to inform the design, delivery and subsequent acceptability of a smartphone application to reduce sedentary behaviour and promote PA post-stroke. Data will be collected via one-to-one interviews and focus groups and analysed according to a six-step thematic analysis. Findings will be reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. One-to-one interviews and focus group interviews will be conducted with three stakeholder groups: 1) People post-stroke, who are independently mobile, without communication and cognitive deficits, living in the community, and without other diagnosed neurological conditions. 2) Caregivers (formal and informal) involved in post-stroke care.  3) Healthcare professionals who are members of multidisciplinary stroke teams. Ethics and dissemination: Ethical approval has been granted by the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick [Ref: 2019_10_03_ EHS]. Findings will be shared locally with all stakeholder groups, submitted for publication, and will inform the protocol and conduct for a novel and flexible experimental trial, examining the effectiveness of an adaptive PA intervention post-stroke.