No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Diabetes, built environments and (un)healthy lifestyles
Abstract
Purpose
– Diabetes mellitus is the most common non-communicable medical condition worldwide, yet little is known about the relationship this disease has to the built environment. The purpose of this paper is to throw some much needed light on the matter by shifting attention away from the epidemiology of the medical condition and towards the anthropology of the unhealthy lifestyles whose habit-persistent practices are associated with the spread of the disease.
Design/methodology/approach
– The paper reviews the delicate relation between diabetes, unhealthy lifestyles and built environments. It discusses the potential of smart city technologies to promote healthy lifestyles, particularly for diabetic patients.
Findings
– Smart cities currently being developed in the Kingdom of Saudi Arabia (KSA) do not highlight the health-related benefits of their design and layout and there are currently no plans for the community to address the unhealthy lifestyles of existing neighbourhoods as part of a sustainable urban development programme. So, realising the health-related benefits of smart city neighbourhoods in the KSA shall be challenging.
Research limitations/implications
– In attempting to tackle diabetes, cities not only need to be “green and lean” in planning the healthy lifestyles they set out for the development of communities, but also “get smart” about the digital technologies and platform of electronically enhanced services which are required to meet the design and layout challenges smart city neighbourhoods pose.
Originality/value
– Gulf and Saudi cities should adopt the IntelCities analogy, so the virtual planning and development of “smart city neighbourhoods”, along with their design and layout of buildings, can tackle the underlying causes.
... The main feature of smart cities is the tracking and reporting system available to monitor vehicular movement and the urban environment. SIM808 combined the features of GPS with and complete quad-band global system for mobile communications to track the location of vehicles and people instantaneously [73][74][75][76]. SIM808 is a smart grid along with Arduino capable of creating interactive electronic objects such as text, audio, animation and other forms of visualisation that are important to smart city development [74][75][76]. ...
... SIM808 combined the features of GPS with and complete quad-band global system for mobile communications to track the location of vehicles and people instantaneously [73][74][75][76]. SIM808 is a smart grid along with Arduino capable of creating interactive electronic objects such as text, audio, animation and other forms of visualisation that are important to smart city development [74][75][76]. A smart campus can exist seamlessly within a smart city if the local authority provides the required elements and infrastructure. ...
... Modularity 3-Smart city (Sources:[1,8,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]). ...
Sustainable development can be attained at a microlevel and having smart campuses around the world presents an opportunity to achieve city-wide smartness. In the process of attaining smartness on campuses, the elements requiring attention must be investigated. There are many publications on smart campuses, and this investigation used the bibliometric analysis method to identify such publications produced over the last decade. A matrix of 578 nodes and 3217 edges was developed from 285 publications on smart campus construction and procurement. Fifteen cluster themes were produced from the bibliometric analysis. The findings revealed that China contributed 48.4% of all published articles on the smart campus. The findings presented a framework from the cluster themes under the four broad infrastructure areas of building construction or repurposing, technology and IT network, continuous improvement, and smart learning and teaching management. The implications of the findings identified that IT project management, traditional procurement strategy, and standard forms of contracts such as the New Engineering Contract (NEC) and the Joint Contract Tribunal (JCT) are applicable in the procurement of smart cities.
... These design choices are often based on the potential influence these factors have on the physical health of the occupants. Examples of negative physical health outcomes studied with respect to building factors include obesity, [18][19][20] diabetes 21,22 and respiratory disease. 23,24 A connection between buildings and impaired cognitive performance has also been investigated. ...
Global urbanization, combined with evidence of increased prevalence of mental illness in urban environments, highlights a need to investigate potential connections between the built environment and mental health. Previous research has shown that the built environment may impact occupant mental health through its effects on connection to nature, personal control and indoor air quality. Contact with the natural environment has physiological and psychological benefits; consequently, reduced contact or exposure leads to negative mental health outcomes. The control an occupant has in the built environment can alter the mental health of individuals through direct pathways, such as prevention of exposures to environmental stressors and indirect pathways, such as social connections to others. Indoor air quality is connected to the mental health of built environment occupants, as particulate matter, malodorous irritants and toxins have all been shown to alter mental well-being. Opportunities for architects and engineers to optimize building designs that improve occupant mental health include planned urban greenspace, personalized temperature control and building ventilation. To understand optimization targets, interdisciplinary research utilizing controlled experiments are needed to confirm causality and improve our current understanding of mechanisms underlying the association between the built environment and mental health.
The study investigated the level of awareness and aspiration of residents for smart building features in Lagos, Nigeria. This is with a view to determining the extent of residents' level of familiarity and desire for smart homes in the country. Questionnaires were administered on 586 residents selected through systematic random sampling technique in the study area. Having identified the major streets in the study area, the first building along the major streets was selected randomly and every fifth building formed the subsequent unit of study. Data were analyzed with the use of frequency distribution, percentages, and measures of residents' aspiration index. The results showed that the awareness of smart building technologies was just fair in the study area as almost half of the respondents (49.21%) were not aware of smart building features. The results also indicated that internet facility ranked highest as the medium of awareness for the residents who were aware of smart building features. It was revealed that the aspiration of the residents for smart features was above average (2.98 on a five-point scale). The results showed that the features mostly aspired were features relating to "security and safety" (CCTV, Intrusion detection system and fire detection and alarm), while those relating to building maintenance (Moisture and humidity sensor and building performance analytic devices) were the least category of smart features desired.
Background:
The prevalence of Type-2 Diabetes is dramatically increasing in urban areas within Saudi Arabia. Hence, Type-2 Diabetes has now become the most common public health problem. Understanding the major risk factors for and barriers to control Type-2 Diabetes may lead to strategies to prevent, control, and reduce in the burden of disease cases.
Objective:
To describe risk factors for and barriers to control Type- 2 Diabetes in Saudi Arabia.
Methods:
The literature search was conducted on risk factors for and barriers to control Type- 2 Diabetes in Saudi Arabia using the databases PubMed, MEDLINE, and Google Scholar (2007-2015). The literature search yielded 80 articles, of which 70 articles were included in this review after excluding non-relevant articles.
Results:
The literature review revealed that obesity, physical inactivity, unhealthy diet, smoking, and aging are the major risk factors for Type-2 Diabetes in Saudi Arabia. Further, the review allocated a complex set of barriers including, lack of education, social support, and healthy environment. These barriers may hinder Saudis with Type-2 Diabetes from controlling their disease.
Conclusion:
The prevalence of Type-2 Diabetes is high among the Saudi population and represents a major public health problem. Effective research programs are needed to address the modifiable risk factors for and barriers to control Type-2 Diabetes among Saudi population.
This paper presents the first comprehensive investigation of PM2.5 and PM10 composition and sources in Saudi Arabia. We conducted a multi-week multiple sites sampling campaign in Jeddah between June and September, 2011, and analyzed samples by XRF. The overall mean mass concentration was 28.4 ± 25.4 μg/m(3) for PM2.5 and 87.3 ± 47.3 μg/m(3) for PM10, with significant temporal and spatial variability. The average ratio of PM2.5/PM10 was 0.33. Chemical composition data were modeled using factor analysis with varimax orthogonal rotation to determine five and four particle source categories contributing significant amount of for PM2.5 and PM10 mass, respectively. In both PM2.5 and PM10 sources were (1) heavy oil combustion characterized by high Ni and V; (2) resuspended soil characterized by high concentrations of Ca, Fe, Al, and Si; and (3) marine aerosol. The two other sources in PM2.5 were (4) Cu/Zn source; (5) traffic source identified by presence of Pb, Br, and Se; while in PM10 it was a mixed industrial source. To estimate the mass contributions of each individual source category, the CAPs mass concentration was regressed against the factor scores. Cumulatively, resuspended soil and oil combustion contributed 77 and 82% mass of PM2.5 and PM10, respectively.
THIS paper outlines the research that has been carried out
to understand Large Urban Distressed Areas (LUDAs)
and the community-based approach to sustainable
urban regeneration that cities are developing to meet the challenges
LUDAs pose.1 After exposing the limits of current government
policy towards LUDAs and offering a critique of the
property-market based approaches underlying them, the paper
goes on to highlight the key roles community participation and
futures workshops2 can play in sustaining their regeneration and
bringing about improvements in the quality of life.
The following examination goes against the current
trend in policy on urban regeneration partnerships by
relaxing the assumption that they represent virtuous
circles of mutually reinforcing actions that are good in their own right. It does this by offering a critique of the market-led urban regeneration initiatives and suggesting that they be replaced by a plan-led alternative. This would entail strategic actions being based on a sufficiently “place-based” knowledge of what communities need to be sustainable.
Urban regeneration now uses partnerships, with cities, regional development agencies, and businesses seeking to leverage resources from the private sector and channel money, capital, and professional expertise into the development of villages and neighborhoods as part of
the search for sustainable communities.
By focusing on the social capital of collaborative platforms and consensus building, it has become possible to recognize the critical role networks, innovation, and creative partnerships play in representing places that are not only sites of ecological integrity, equity, and democratic renewal, but that are also locations where socially inclusive decision making can institutionalize the civic values required for the regeneration of urban villages and neighborhoods as self-sustaining communities.
At present, Diabetes mellitus is considered as one of the main threats to the human health in the 21st century. It may lead to severe conditions such as blindness, end-stage of renal disease, limb amputation and a variety of debilitating neuropathies. Previous researches indicated that diabetes is caused by a complex interaction of patient's genetics, life-style and environmental factors. They also highlighted that providing quality and healthy built environment to citizens including diabetic patients would prevent poor and unhealthy condition. The Kingdom of Saudi Arabia (KSA) is one of top ten countries in the prevalence of diabetes. Little researches though were conducted in KSA in regards to the effect of environmental conditions of the built environment. In 2011, the present researchers have carried out a pilot survey on a number of diabetic patients to find out the possible impact of built environment settings on the patient's lifestyle. The research explored whether diabetic patients use smart tools in their daily life to overcome the daily life's difficulties and perform their life as normal as possible. The results showed a close link between a poor home and environmental settings, the patient's lifestyle, and the patient's health status. It also highlighted the absence of smart tools and systems use. The paper argues that certain changes to the built environment must be done and to provide a healthy and safe environment for diabetic patients. This would help these patients to abandon their bad habits and adopt healthier lifestyle.
The purpose of this paper is to evaluate the progress made by European cities in relation to Healthy Urban Planning (HUP) during Phase IV of the World Health Organization's Healthy Cities programme (2003-2008). The introduction sets out the general principle of HUP, identifying three levels or phases of health and planning integration. This leads on to a more specific analysis of the processes and substance of HUP, which provide criteria for assessment of progress. The assessment itself relies on two sources of data provided by the municipalities: the Annual Review Templates (ARTs) 2008 and the response to the Phase IV General Evaluation Questionnaire. The findings indicate that the evidence from different sources and questions in different sections are encouragingly consistent. The number of cities achieving a good level of understanding and activity in HUP has risen very substantially over the period. In particular, those achieving effective strategic integration of health and planning have increased. A key challenge for the future will be to develop planning frameworks which advance public health concerns in a spatial policy context driven often by market forces. A health in all policies approach could be valuable.
In the digital city of the future there is the vision of seamless virtual and physical access for every home and between each home and the workplace, as well as critical city infrastructure such as the post office, the bank, hospitals, transportation systems, and other entities. This paper provides an overview of technical and other issues in extending at home (@home) assistive technologies for the elderly and the disabled. The paper starts by giving a vision of what this city is supposed to look like and how a human is to act, navigate and function in it. A framework for extending assistive technologies is proposed that considers individuals belonging to special groups of interest and locations other than their home. Technology has already reached the state of ubiquitous and pervasive sensor devices measuring everything, from temperature to human behavior. Implanting intelligence into and connecting such devices will be of immense use in preventive healthcare, security in industrial installations, greater energy efficiency, and numerous other applications. The paper reviews enabling technologies that exist and focuses on healthcare applications that support a longer and higher quality of life at home for the elderly and the disabled. It discusses intelligent platforms involving agents, context-aware and location-based services, and classification systems that enable advanced monitoring and interpretation of patient status and optimization of the environment to improve medical assessments. The paper concludes with a discussion of some of the challenges that exist in extending @home assistive technologies to @city assistive technologies.
An increasingly aged, overweight, and sedentary population has resulted in elevated risk of cardiovascular disease (CVD). The escalating incidence of diabetes and other chronic illnesses, deficits in health care budgets, and physician shortages, especially in rural communities, have prompted investigations of feasible solutions. The Diabetes and Technology for Increased Activity (DaTA) study was designed to test the effectiveness of a lifestyle intervention driven by self-monitoring of blood glucose (BG), blood pressure (BP), physical activity (PA), and weight to positively impact CVD risk factors in a medically underserviced rural population with a high incidence of metabolic syndrome (MS).
Conducted in a community-based research setting, this single-center open feasibility study used smart phones to transmit BP, BG, pedometer, weight, heart rate, and activity measurements to a database. Technology allowed participants to interface with the clinical team and self-monitor their personal health indicators.
Twenty-four participants aged 30 to 71 years completed the 8-week intervention. Participants had significant improvement in clinic (p = .046) and self-monitored diastolic BP (p = .001), body mass index (p = .002), and total cholesterol (p = .009), and steps per day. Daily PA increased as well as participants' interest in and willingness to make lifestyle changes that impact health outcomes.
The DaTA study demonstrated that self-monitoring of the risk factors for MS and increased PA improved the participant's CVD risk profile. Considering the 8-week time period of this intervention, results are encouraging. This lifestyle intervention, which uses education and technology as tools, confirms the utility of remote health monitoring.
In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a comparison of three iPhone diabetes data management applications: the Diamedic Diabetes Logbook, Blood Sugar Diabetes Control, and WaveSense Diabetes Manager. These applications provide patients the ability to enter blood glucose readings manually, view graphs and simple statistics, and email data to health care providers. While these applications show promise, they are limited in their current forms. All require manual data entry and none convert insulin-to-carbohydrate ratios to insulin dose. Future development of these types of technology should consider integration with blood glucose meters and expanded calculation capabilities, as well as monitoring of other risk factors, e.g., blood pressure and lipids, and tracking of preventive examinations, e.g., eye, foot, and renal.
Recent studies have drawn attention to the adverse effects of ambient air pollutants such as particulate matter 2.5 (PM2.5) on human health. We evaluated the association between PM2.5 exposure and diabetes prevalence in the U.S. and explored factors that may influence this relationship.
The relationship between PM2.5 levels and diagnosed diabetes prevalence in the U.S. was assessed by multivariate regression models at the county level using data obtained from both the Centers for Disease Control and Prevention (CDC) and U.S. Environmental Protection Agency (EPA) for years 2004 and 2005. Covariates including obesity rates, population density, ethnicity, income, education, and health insurance were collected from the U.S. Census Bureau and the CDC.
Diabetes prevalence increases with increasing PM2.5 concentrations, with a 1% increase in diabetes prevalence seen with a 10 μg/m(3) increase in PM2.5 exposure (2004: β = 0.77 [95% CI 0.39-1.25], P < 0.001; 2005: β = 0.81 [0.48-1.07], P < 0.001). This finding was confirmed for each study year in both univariate and multivariate models. The relationship remained consistent and significant when different estimates of PM2.5 exposure were used. Even for counties within guidelines for EPA PM2.5 exposure limits, those with the highest exposure showed a >20% increase in diabetes prevalence compared with that for those with the lowest levels of PM2.5, an association that persisted after controlling for diabetes risk factors.
Our results suggest PM2.5 may contribute to increased diabetes prevalence in the adult U.S. population. These findings add to the growing evidence that air pollution is a risk factor for diabetes.
Background:
Software to help control diabetes is currently an embryonic market with the main activity to date focused mainly on the development of noncomputerized solutions, such as cardboard calculators or computerized solutions that use "flat" computer models, which are applied to each person without taking into account their individual lifestyles. The development of true, mobile device-driven health applications has been hindered by the lack of tools available in the past and the sheer lack of mobile devices on the market. This has now changed, however, with the availability of pocket personal computer handsets.
Method:
This article describes a solution in the form of an intelligent neural network running on mobile devices, allowing people with diabetes access to it regardless of their location. Utilizing an easy to learn and use multipanel user interface, people with diabetes can run the software in real time via an easy to use graphical user interface. The neural network consists of four neurons. The first is glucose. If the user's current glucose level is within the target range, the glucose weight is then multiplied by zero. If the glucose level is high, then there will be a positive value multiplied to the weight, resulting in a positive amount of insulin to be injected. If the user's glucose level is low, then the weights will be multiplied by a negative value, resulting in a decrease in the overall insulin dose.
Results:
A minifeasibility trial was carried out at a local hospital under a consultant endocrinologist in Belfast. The short study ran for 2 weeks with six patients. The main objectives were to investigate the user interface, test the remote sending of data over a 3G network to a centralized server at the university, and record patient data for further proofing of the neural network. We also received useful feedback regarding the user interface and the feasibility of handing real-world patients a new mobile phone. Results of this short trial confirmed to a large degree that our approach (which also can be known as intensive insulinotherapy) has value and perhaps that our neural network approach has implications for future intelligent insulin pumps.
Conclusions:
Currently, there is no software available to tell people with diabetes how much insulin to inject in accordance with their lifestyle and individual inputs, which leads to adjustments in software predictions on the amount of insulin to inject. We have taken initial steps to supplement the knowledge and skills of health care professionals in controlling insulin levels on a daily basis using a mobile device for people who are less able to manage their disease, especially children and young adults.
Shaping Neighbourhoods is unique in combining all aspects of the spatial planning of neighbourhoods and towns whilst emphasising positive outcomes for people’s health and global sustainability. This new edition retains the combination of radicalism, evidence-based advice and pragmatism that made earlier editions so popular.
This updated edition strengthens guidance in relation to climate change and biodiversity, tackling crises of population health that are pushing up health-care budgets, but have elements of their origins in poor place spatial planning – such as isolation, lack of everyday physical activity, and respiratory problems. It is underpinned by new research into how people use their localities, and the best way to achieve inclusive, healthy, low-carbon settlements.
The guide can assist with:
• Understanding the principles for planning healthy and sustainable neighbourhoods and towns
• Planning collaborative and inclusive processes for multi-sectoral working
• Developing know-how and skills in matching local need with urban form
• Discovering new ways to integrate development with natural systems
• Designing places with character and recognising good urban form
Whether you are a student faced with a local planning project; a public health professional, planner, urban designer or developer involved in new development or regeneration; a council concerned with promoting healthy and sustainable environments; or a community group wanting to improve your neighbourhood – you will find help here.
The paper examines the IntelCities Community of Practice (CoP) supporting the development of the organization's capacity-building, co-design, monitoring, and evaluation of e-government services. It begins by outlining the IntelCities CoP and goes on to set out the integrated model of electronically enhanced government (e-government) services developed by the CoP to build the capacity to co-design, monitor, and evaluate the IntelCities' e-Learning platform, knowledge-management system, and digital library. The paper goes on to examine the information technology (IT) underlying this set of semantically interoperable e-government services supporting the crime, safety, and security initiatives of socially-inclusive and participatory urban regeneration programs.
This paper develops the notion of the intelligent city as the smart provider of electronically enhanced services. It identifies how this growing interest in intelligent cities has led universities to exploe the opportunities “communities of practice” (CoPs) offer industry to become smart providers of online services. With this aim, it reports on the efforts a number of leading European cities have recently made to be intelligent in exploiting the opportunities CoPs offer industry to become smart providers. That is, smart in developing online presence via integrated models of eGovernment services, which are in turn capable of meeting the learning needs, knowledge requirements and capacity-building commitments of the socially inclusive and participatory urban regeneration programs they promote.
While considerable attention has been paid to the public-health-related impacts of air pollution, relatively little research has been done to understand how other aspects of the built environment impact health. Americans are increasingly sedentary; erstwhile the rate of increase in obesity is alarming. New research suggests that increased auto dependence, and limited opportunities to walk for utilitarian purposes, has contributed to this emerging obesity epidemic. Within sociodemographic strata, land use patterns and transportation investments collectively shape the desire to walk, drive, or to travel via other means. Mixed use and more compact community designs show significant promise for the promotion of physical activity and the reduction of regional air pollution levels. Opportunities exist to increase physical activity and improve regional air quality through more compact development. However, increased compactness, or density, often exacerbates traffic congestion and can increase exposure of harmful emissions within central areas. Therefore, strategies to reduce localized air pollution in existing and developing centers are required to enable larger health benefits from smart growth to be realized.
Taking Hollands' previous statement on the transition from intelligent to smart cities as its point of departure (‘Will the real smart city stand up?’ City 12(3), 302–320), this article reflects upon the anxieties currently surrounding such developments. In particular, it considers the suggestion that such developments have more to do with cities meeting the corporate needs of marketing campaigns than the social intelligence required for them to be smart. Focusing on the social intelligence of such developments, this article captures the information-rich and highly communicative qualities of the transition. In particular, it examines the methodological issues that smart communities pose cities and the critically insightful role which the networks of innovation and creative partnerships set up to embed such intelligence play in the learning, knowledge transfer and capacity-building exercises servicing this community-led transition to smart cities. This, the article suggests, is what existing representations of smart cities miss. This article offers a critically insightful account of the transition.
Sustainability has become an increasingly important element to be considered in the planning of urban areas. Although it is central in the consideration of cities, for some reason it has received less attention in the development of neighbourhoods. Yet cities cannot be considered sustainable if their component parts, such as neighbourhoods, do not meet sustainability criteria. Surprisingly, it is perfectly feasible to include sustainability elements in neighbourhood consideration. If one follows the development of neighbourhood theory from Howard and Perry through to more recent contributions, it can be seen that the ideas of sustainability, although not by that name, are central to these various contributions. Neighbourhood sustainability criteria mirror those used in sustainability analysis for higher level cities and towns, including consideration of the economic, the social, the technical and the environmental.Unfortunately, the application of these theoretical concepts to the neighbourhoods of modern Arab cities, such as Riyadh, leads to disappointing results. In the case of Riyadh, this appears to be due to a number of factors: the rapid urbanization, the relative scarcity of public shared facilities such as schools and green areas, and the adaptations that have been made to the original plan devised for the city. Interestingly, it is in the newer, planned neighbourhoods on the periphery of the city that these sustainability criteria might be most closely met. This suggests that success in neighbourhood sustainability may well be as dependent upon marketing as on urban planning.
The purpose of the present study is to establish a foundation for participatory design (PD) between IT professionals and people with chronic diseases resulting in IT-supported compensation in daily life. This paper presents results from a qualitative study working on understanding everyday life with diabetes. The participants in the study are eight families with one or more diabetic members. The paper reports on their lives with the condition based on interviews and 'reflective probes' from the families. The analysis outlines perspectives, activities, locations and information related to daily life with diabetes. Design implications are in line with the term 'design for more' a central prerequisite for working with IT-support for diabetes providing an ambient perspective to technology assisted living.
Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner.
Information and communication technologies have long been acknowledged to support information sharing along the whole chain of care, from the clinic to the homes of patients and their relatives. Thus they are increasingly being considered for improving the delivery of health care services also in light of clinical and technological achievements that propose new treatments requiring a tighter interaction among patients and physicians.
The multiagent paradigm has been utilized within an architecture for delivering telemedicine services to chronic outpatients at their domiciles and enforcing cooperation among patients, caregivers, and different members of the health care staff. The architecture sees each communication device such as a palmtop, smart phone, or personal digital assistant as a separate agent upon which different services are deployed, including telemetry, reminders, notifications, and alarms. Decoupling services from agents account for a highly configurable environment applicable to almost any context that can be customized as needed.
The architecture has been used for designing and implementing a prototypical software infrastructure, called LifePhone, that runs on several communication devices. A basic set of services has been devised with which we were able to configure two different applications that address long-term and short-term monitoring scenarios for diabetes patients. The long-term scenario encompasses telemetry and reminder services for patients undergoing peritoneal dialysis, which is a treatment for chronic renal failure, a diabetes complication. The short-term scenario incorporates telemetry and remote alarms and is applicable for training patients to use an artificial pancreas.
Our experiments proved that an infrastructure such as LifePhone can be used successfully for bridging the interaction gap that exists among all the components of a health care delivery process, improving the quality of service and possibly reducing the overall costs of health care. Furthermore, the modularity of services allows for more complex scenarios encompassing data analysis or even involving actors at multiple institutions in order to better support the overall health care organization.
Several disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowledge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood.
To qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes.
We identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent "wall posts" and the 15 most recent discussion topics from the 10 largest groups.
Four hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics.
Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data.
Patients with diabetes, family members, and their friends use Facebook to share personal clinical information, to request disease-specific guidance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approximately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, "natural" products. Clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants.
Facebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal data collection are also common, with no accountability or checks for authenticity.
Studies have indicated that sharing of self-monitoring of blood glucose (SMBG) data and subsequent feedback from the health care provider (HCP) can help achieve glycemic goals such as a reduction in glycated hemoglobin. Electronic SMBG data management and sharing tools for the PC and smartphones may help in reducing the effort to manage SMBG data.
We reviewed software and top-ranking applications (Apps) for the iPhone platform to document the variety of useful features. Additionally, in an attempt to assess metrics such as task analysis and user friendliness of diabetes Apps, we observed and surveyed patients with diabetes as they recorded and relayed sample SMBG results to their hypothetical HCP using three Apps.
Observation and survey demonstrated that the WaveSense Diabetes Manager allowed the participants to complete preselected SMBG data entry and relay tasks faster than other Apps. The survey revealed patient behavior patterns that would be useful in future App development.
Being able to record, analyze, seamlessly share, and obtain feedback on the SMBG data using an iPhone/iTouch App might potentially benefit patients. Trends in SMBG data management and the possibility of having interoperability of blood glucose monitors and smartphones may open up new avenues of diabetes management for the technologically savvy patient.
The primary objective of this review was to determine the strength of evidence for the effectiveness of self-monitoring devices and technologies for individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on specific health-related outcome measures. Self-monitoring devices included those that assist patients with managing diabetes and preventing cardiovascular complications (CVCs). A secondary objective was to explore issues of feasibility, usability, and compliance among patients and providers.
Study criteria included individuals >or=14 years and youth (7-14 years) with T1DM or T2DM, intervention with a self-monitoring device, assessment of clinical outcomes with the device, literature in English, and >or=10 participants. Relevant published literature was searched from 1985 to 2008. Randomized controlled trials and observational studies were included. Data were extracted for clinical outcomes, feasibility and compliance methods, and results. Selected studies were independently evaluated with a validated instrument for assessing methodological quality.
Eighteen trials were selected. Predominant types of device interventions included self-monitoring of blood glucose, pedometers, and cell phone or wireless technologies. Feasibility and compliance were measured in the majority of studies.
Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies can improve diabetes self-care, and pedometers are effective lifestyle modification tools. The results of this review indicate a need for additional controlled trial research on existing and novel technologies for diabetes self-monitoring, on health outcomes associated with diabetes and CVCs, and device feasibility and compliance.
Background:
To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature.
Methods:
We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles.
Results:
A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving.
Interpretation:
Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.
There is a strong link between urbanization and type 2 diabetes mellitus. Although a multitude of mechanisms have been proposed, there are no studies evaluating the impact of ambient air pollutants and the propensity to develop type 2 diabetes mellitus. We hypothesized that exposure to ambient fine particulate matter (<2.5 mum; PM(2.5)) exaggerates diet-induced insulin resistance, adipose inflammation, and visceral adiposity.
Male C57BL/6 mice were fed high-fat chow for 10 weeks and randomly assigned to concentrated ambient PM(2.5) or filtered air (n=14 per group) for 24 weeks. PM(2.5)-exposed C57BL/6 mice exhibited marked whole-body insulin resistance, systemic inflammation, and an increase in visceral adiposity. PM(2.5) exposure induced signaling abnormalities characteristic of insulin resistance, including decreased Akt and endothelial nitric oxide synthase phosphorylation in the endothelium and increased protein kinase C expression. These abnormalilties were associated with abnormalities in vascular relaxation to insulin and acetylcholine. PM(2.5) increased adipose tissue macrophages (F4/80(+) cells) in visceral fat expressing higher levels of tumor necrosis factor-alpha/interleukin-6 and lower interleukin-10/N-acetyl-galactosamine specific lectin 1. To test the impact of PM(2.5) in eliciting direct monocyte infiltration into fat, we rendered FVBN mice expressing yellow fluorescent protein (YFP) under control of a monocyte-specific promoter (c-fms, c-fms(YFP)) diabetic over 10 weeks and then exposed these mice to PM(2.5) or saline intratracheally. PM(2.5) induced YFP cell accumulation in visceral fat and potentiated YFP cell adhesion in the microcirculation.
PM(2.5) exposure exaggerates insulin resistance and visceral inflammation/adiposity. These findings provide a new link between air pollution and type 2 diabetes mellitus.
Reaching a better understanding of the modifiable factors associated with inflammatory and oxidative biomarkers in children would be relevant to the design of further investigation and prevention strategies.
To determine the association of air pollution as well as dietary and physical activity habits with markers of inflammation, oxidative stress and insulin resistance for the first time in a population-based sample of children.
We conducted a population-based study of 374 children, aged 10-18 years, and assessed the exposure of participants to air pollutants as well as their dietary and physical activity habits. In addition to anthropometric and blood pressure measurements, we determined the fasting serum levels of lipid profile, insulin and markers of inflammation and oxidation.
We found independent associations between improper air quality and plasma markers of inflammation, oxidative stress and insulin resistance. The Pollutant Standard Index (PSI) and the level of fine particulate matter were significantly associated to all biomarkers studied. The associations between different markers of air pollutants and markers of inflammation, oxidative stress and insulin resistance remained significant after adjustment for age, gender, body mass index, waist circumference, healthy eating index and physical activity level. The association of healthy eating score with CRP and insulin resistance was mediated through anthropometric indices, and physical activity had independent association with insulin resistance.
The independent influence of inflammatory/oxidative mechanisms of air pollution effects on surrogate markers of atherosclerosis from early life should be highlighted.
Many office environments give rise to complaints from occupants relating to thermal and ventilation conditions; problems experienced indude: discomfort, draughts, stuffiness, headaches, general malaise and even illness. The phenomenon has become known as the ‘sick building’ syndrome. Whilst much attention is being directed towards the effects, less consideration is being given to causes and prevention. Examples demonstrate that many cases of complaints can be directly attributed to aspects of the building services and fabric. Attention to design, specification and detailing mechanical systems could avert some problems; dependable in-service operation and maintenance could avert others. Modern developments, including advances in controls technology and the implementation of energy conservation measures, can help alleviate problems but may generate others.
Higher indoor concentrations of air pollutants due, in part, to lower ventilation rates are a potential cause of sick building syndrome (SBS) symptoms in office workers. The indoor carbon dioxide (CO2) concentration is an approximate surrogate for indoor concentrations of other occupant-generated pollutants and for ventilation rate per occupant. Using multivariate logistic regression (MLR) analyses, we evaluated the relationship between indoor CO2 concentrations and SBS symptoms in occupants from a probability sample of 41 U.S. office buildings. Two CO2 metrics were constructed: average workday indoor minus average outdoor CO2 (dCO2, range 6-418 ppm), and maximum indoor 1-h moving average CO2 minus outdoor CO2 concentrations (dCO2MAX). MLR analyses quantified dCO2/SBS symptom associations, adjusting for personal and environmental factors. A dose-response relationship (p < 0.05) with odds ratios per 100 ppm dCO2 ranging from 1.2 to 1.5 for sore throat, nose/sinus, tight chest, and wheezing was observed. The dCO2MAX/SBS regression results were similar.
This study was undertaken to determine whether variations in concentrations of particulates in the ambient air of Montreal, Quebec, during the period 1984 to 1993, were associated with daily variations in cause-specific daily mortality. Fixed-site air pollution monitors in Montreal provided daily mean levels of various measures of particles and gaseous pollutants. Total sulfate was also measured daily (1986-1993) at a monitoring station 150 km southeast of the city (Sutton, Quebec). We used coefficient of haze (COH), extinction coefficient, and sulfate from the Sutton station to predict fine particles and sulfate from fine particles for days that were missing. We estimated associations between cause-specific mortality and PM(2.5), PM(10), predicted fine particles and fine sulfate particles, total suspended particles, coefficient of haze, extinction coefficient, and total sulfate measured at the Sutton station. We selected a set of underlying causes of death, as recorded on the death certificates, as the endpoint and then regressed the logarithm of daily counts of cause-specific mortality on the daily mean levels for the above measures of particulates, after accounting for seasonal and subseasonal fluctuations in the mortality time series, non-Poisson dispersion, weather variables, and gaseous pollutants. We found positive and statistically significant associations between the daily measures of ambient particle mass and sulfate mass and the deaths from respiratory diseases and diabetes. The mean percentage change in daily mortality (MPC), evaluated at the interquartile range for pollutants averaged over the day of death and the preceding 2 days, for deaths from respiratory diseases was MPC(COH)=6.90% (95% CI: 3.69-10.21%), MPC(Predicted PM2.5)= 9.03% (95% CI: 5.83- 12.33%), and MPC(Sutton sulfate)=4.64% (95% CI: 2.46-6.86%). For diabetes, the corresponding estimates were MPC(COH)=7.50% (95% CI: 1.96-13.34%), MPC(Predicted PM2.5)=7.59% (95% CI: 2.36-13.09%), and MPC(Sutton sulfate)=4.48% (95% CI: 1.08-7.99%). Among individuals older than 65 years at time of death, we found consistent associations across our metrics of particles for neoplasms and coronary artery diseases. Associations with sulfate mass were also found among elderly persons who died of cardiovascular diseases and of lung cancer. These associations were consistent with linear relationships. The associations found for respiratory diseases and for cardiovascular diseases, especially in the elderly, are in line with some of the current hypotheses regarding mechanisms by which ambient particles may increase daily mortality. The positive associations found for cancer and for diabetes may be understood through a general hypothesis proposed by Frank and Tankersley, who suggested that persons in failing health may be at higher risk for external insults through the failure of regulating physiological set points. The association with diabetes may be interpreted in light of recent toxicological findings that inhalation of urban particles in animals increases blood pressure and plasmatic levels of endothelins that enhance vasoconstriction and alter electrophysiology. Further research to confirm these findings and to determine whether they are causal is warranted.
We aimed to examine geographic differences, risk factors and mortality associated with amputation.
Data from 10 of the original 14 centres of the WHO Multinational Study of Vascular Disease in Diabetes were used. This included 3443 men and women aged 35 to 55 years at baseline.
Incidences of amputation, adjusted for sex and duration in Type I (insulin-dependent) diabetes mellitus, were 31.0, 8.2, 3.5 and 1.0 per 1,000 person years in the American Indian, Cuban, European and East Asian centres respectively. In Type II (non-insulin-dependent) diabetes mellitus, incidences of amputation were 9.7, 2.0, 2.5 and 0.7 per 1000 person years in the American Indian, Cuban, European and East Asian centres respectively. Key risk factors for amputation included glucose, triglyceride, and retinopathy, and were similar for American Indians and Europeans. The age, duration and sex adjusted relative risk for amputation in American Indians compared with Europeans was 11.48 (95% CI 3.56, 36.98) in Type I diabetes and 3.86 (95 % CI 2.36, 6.32) in Type II diabetes. Adjusting for heart disease, retinopathy, proteinuria, glucose, blood pressure and triglyceride attenuated these relative risks to 10.83 (95 % CI 3.20, 36.65) and 3.15 (1.91, 5.20) in Type I and Type II diabetes respectively. Amputation doubled mortality rates in all groups.
Vascular complications and their risk factors are themselves risk factors for amputation in both Type I and Type II diabetes and are common to several geographical regions worldwide. However, reasons for differences between geographical regions and the degree to which different health care systems could be responsible is not clear.
Pollution by particulates has been consistently associated with increased cardiovascular morbidity and mortality. However, the mechanisms responsible for these effects are not well-elucidated.
To assess to what extent and how rapidly inhaled pollutant particles pass into the systemic circulation, we measured, in 5 healthy volunteers, the distribution of radioactivity after the inhalation of "Technegas," an aerosol consisting mainly of ultrafine (99m)Technetium-labeled carbon particles (<100 nm). Radioactivity was detected in blood already at 1 minute, reached a maximum between 10 and 20 minutes, and remained at this level up to 60 minutes. Thin layer chromatography of blood showed that in addition to a species corresponding to oxidized (99m)Tc, ie, pertechnetate, there was also a species corresponding to particle-bound (99m)Tc. Gamma camera images showed substantial radioactivity over the liver and other areas of the body.
We conclude that inhaled (99m)Tc-labeled ultrafine carbon particles pass rapidly into the systemic circulation, and this process could account for the well-established, but poorly understood, extrapulmonary effects of air pollution.
During the past two decades, the prevalence of obesity in children has risen greatly worldwide. Obesity in childhood causes a wide range of serious complications, and increases the risk of premature illness and death later in life, raising public-health concerns. Results of research have provided new insights into the physiological basis of bodyweight regulation. However, treatment for childhood obesity remains largely ineffective. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist.
To report the occurrence of registered blindness among diabetes patients in Arhus County, Denmark during 1993-2002.
Data were obtained from a database of 7527 diabetes patients, which included all patients in the county who had been treated for or had experienced visual loss due to diabetic retinopathy since 1992. Of these, 1949 had type 1 diabetes and represented 90% of the type 1 diabetes patient population in the county, and 5459 had type 2 diabetes and represented 40% of the type 2 diabetes patient population in the county.
The point prevalence of legal blindness was 0.6% for type 1 and 1.5% for type 2 diabetes patients at January 1st, 2003. In type 1 diabetes patients, the major cause of blindness was proliferative diabetic retinopathy (PDR) (66.2% of all blind eyes); in type 2 diabetes patients the major causes were age-related macular degeneration (21.9%), PDR (18.0%) and diabetic maculopathy (DMac) (18.5%). During 1993-2002 there was a significant decrease in the number of blind eyes secondary to PDR (p = 0.008) in type 1 diabetes patients, and a significant increase in the number of blind eyes secondary to DMac (p = 0.005) in type 2 diabetes patients.
The major challenge in reducing diabetes-related blindness is related to the detection and treatment of an increased incidence of diabetic maculopathy in type 2 diabetes patients.
This work has been made available to the staff and students of the University of Sydney for the purposes of research and study only. It constitutes material that is held by the University for the purposes of reporting for HERDC and the ERA. This work may not be downloaded, copied and distributed to any third party
.
Recent studies suggest that persons with diabetes and with cardiovascular disease may be at higher risk for the short-term effects of air pollution. We carried out this mortality time series study in Montreal, Quebec, Canada to confirm these observations and to determine whether diabetics who had other health conditions were also at higher risk of dying when air pollution increases.
In one analysis, we related daily deaths from diabetes (using the underlying cause) to daily concentrations of particles and gaseous pollutants. In another analysis, we created subgroups by identifying subjects diagnosed 1 year before death with diabetes and other major health conditions from billing and prescription data from the universal Quebec Health Insurance Plan. The analysis made use of parametric log-linear Poisson models that were adjusted for long-term temporal trends and daily weather conditions. We found positive associations between most air pollutants and daily mortality from diabetes as well as among subjects diagnosed with diabetes 1 year before death. In the latter group of subjects, greater effects were found generally in the warm season and especially among subjects who had diabetes and who also had any cardiovascular disease, chronic coronary disease, and atherosclerosis. We did not find evidence of associations among persons who only had diabetes (i.e., did not also have cancer, cardiovascular disease, or lower respiratory disease).
These data indicate that individuals with diabetes who also have cardiovascular disease may be susceptible to the short-term effects of air pollution.
The assessment of air pollution exposure using only community average concentrations may lead to measurement error that lowers estimates of the health burden attributable to poor air quality. To test this hypothesis, we modeled the association between air pollution and mortality using small-area exposure measures in Los Angeles, California.
Data on 22,905 subjects were extracted from the American Cancer Society cohort for the period 1982-2000 (5,856 deaths). Pollution exposures were interpolated from 23 fine particle (PM2.5) and 42 ozone (O3) fixed-site monitors. Proximity to expressways was tested as a measure of traffic pollution. We assessed associations in standard and spatial multilevel Cox regression models.
After controlling for 44 individual covariates, all-cause mortality had a relative risk (RR) of 1.17 (95% confidence interval=1.05-1.30) for an increase of 10 mug/m PM2.5 and a RR of 1.11 (0.99-1.25) with maximal control for both individual and contextual confounders. The RRs for mortality resulting from ischemic heart disease and lung cancer deaths were elevated, in the range of 1.24-1.6, depending on the model used. These PM results were robust to adjustments for O3 and expressway exposure.
Our results suggest the chronic health effects associated with within-city gradients in exposure to PM2.5 may be even larger than previously reported across metropolitan areas. We observed effects nearly 3 times greater than in models relying on comparisons between communities. We also found specificity in cause of death, with PM2.5 associated more strongly with ischemic heart disease than with cardiopulmonary or all-cause mortality.
Over the past decade, there has been a worldwide largely unexplained increase in the incidence of type 1 diabetes in young children. This study explores the quantitative role of exposure to specific air pollutants in the development of type 1 diabetes in children.
A total of 402 children were retrospectively studied. Zip code-related, time-specific birth-to-diagnosis exposure to five ambient air pollutants was obtained for 102 children with type 1 diabetes and 300 healthy children receiving care at a single hospital. Pollution exposure levels were created by summing up zip code-specific pollution data and dividing by months of exposure from birth to diagnosis. Analysis employed chi2, two-tailed independent sample t-test and unconditional logistic regression.
Odds ratio (OR) was significantly high for cumulative exposure to ambient ozone (O3) and sulfate (SO4) in cases compared with controls, OR = 2.89 [95% confidence interval (CI) = 1.80-4.62] and OR = 1.65 (CI = 1.20-2.28), respectively, even after adjustment for several potential confounders. Passive smoking was more frequent in children with diabetes (30 vs. 10%, p = 0.001). Attending day care and breast feeding in infancy were less frequent in children with diabetes (14 vs. 23%, p = 0.025; 59 vs. 78%, p = 0.001). Family history of diabetes, autoimmune disease and drug abuse was more frequent in cases (p < 0.01).
Cumulative exposure to ozone and sulfate in ambient air may predispose to the development of type 1 diabetes in children. Early infant formula feeding and passive smoking in the household may precipitate or accelerate the onset of type 1 diabetes.
The physical environment plays an important role in influencing participation in physical activity, although the specific factors that are correlated with different patterns of walking remain to be determined. We examined correlations between physical environmental factors and self-reported walking for recreation and transport near home.
The local neighborhood environments (defined as a 400-m radius from the respondent's home) of 1678 adults were assessed for their suitability for walking. The environmental data were collected during 2000 using the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument together with information from other sources. We used logistic regression modeling to examine the relationship between the attributes of the physical environment and the self-reported walking behavior undertaken near home.
Functional features were correlated with both walking for recreation (odds ratio (OR) 1.62; 95% confidence interval (CI): 1.20-2.19) and for transport (OR 1.30; 95% CI: 0.97-1.73). A well-maintained walking surface was the main functional factor associated with walking for recreation (OR 2.04; 95% CI: 1.43-2.91) and for transport (OR 2.13; 95% CI: 1.53-2.96). Destination factors, such as shops and public transport, were significantly correlated with walking for transport (OR 1.80; 95% CI: 1.33-2.44), but not recreation.
The findings suggest that neighborhoods with pedestrian facilities that are attractive and comfortable and where there are local destinations (such as shops and public transport) are associated with walking near home.
Home telemonitoring represents a patient management approach combining various information technologies for monitoring patients at distance. This study presents a systematic review of the nature and magnitude of outcomes associated with telemonitoring of four types of chronic illnesses: pulmonary conditions, diabetes, hypertension, and cardiovascular diseases.
A comprehensive literature search was conducted on Medline and the Cochrane Library to identify relevant articles published between 1990 and 2006. A total of 65 empirical studies were obtained (18 pulmonary conditions, 17 diabetes, 16 cardiac diseases, 14 hypertension) mostly conducted in the United States and Europe.
The magnitude and significance of the telemonitoring effects on patients' conditions (e.g., early detection of symptoms, decrease in blood pressure, adequate medication, reduced mortality) still remain inconclusive for all four chronic illnesses. However, the results of this study suggest that regardless of their nationality, socioeconomic status, or age, patients comply with telemonitoring programs and the use of technologies. Importantly, the telemonitoring effects on clinical effectiveness outcomes (e.g., decrease in the emergency visits, hospital admissions, average hospital length of stay) are more consistent in pulmonary and cardiac studies than diabetes and hypertension. Lastly, economic viability of telemonitoring was observed in very few studies and, in most cases, no in-depth cost-minimization analyses were performed.
Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers.
Diabetes and the built environment: contributions from an emerging interdisciplinary research programme
- L Allanah
- K Ashley
- E Farley
Promoting public health through smart growth: building healthier communities through transportation and land use policies and practices
- L Frank
- S Kavage
- T Litman
Intelligent by design: technology and intelligent cities in Saudi Arabia
- N Komninos
Integrating social networks and sensor networks
- S Breslin
- D Manfred
- G Hauswirth
- L P Danh
- A Passant
- A Polleres
- C Rabsch
- V Reynolds
The IntelCities community of practice: the eGov services model for socially inclusive and participatory urban regeneration programs”, A Handbook of Research on Strategies for Local E-Government Adoption and Implementation: Comparative Studies
- M Deakin