While several technological solutions are available for older adults to improve their wellbeing and quality of life, little is known about the gaps between the needs, provided solutions, and their adoption from a more pragmatic perspective. This paper reports on reviewing existing technological solutions for older adults, which span the work life, life in the community, and wellbeing at home. We analyzed 50 different solutions to uncover both negative and positive features of these solutions from the perspective of the impact of technology adoption on the quality of life of older adults. Our approach harnesses holistic reasoning to determine the most suitable technologies available today and provides suggestions for improvement toward designing and implementing better solutions. Recently, technological solutions have been discovered to cater for the challenges associated with the ageing population . ConsequHowever, despite the proliferation of technological solutions, and their inherent benefits in improving the QoL of older adults, there seems to be a considerable gap in terms of technology adoption. On one hand, the low level of adoption of new technologies in the ageing population is due to the frequent reluctance and lack of motivation of older adults, and insufficient support available to them , 6. On tFrom a more technical perspective, the inability to meet older adults' requirements, including emotional requirements , in the The overarching goal of this paper is to analyze the existing technical solutions, as contained in the publications, projects, and patents. In the paper, we answered two important research questions: (i) What are the gaps reported in the literature between the needs, production, and adoption of technology for ageing? and (ii) what are the prevalent challenges associated with technology adoption?This paper analyzes a selection of recent and most relevant technical solutions from the technology adoption perspective. The technologies have been selected as part of the SHELDON COST action number CA16226 based on a review of existing work by the members of the action. Due to the very large amount of activity in this domain, it does not constitute an exhaustive overview, however it provides a selection of the current most relevant initiatives identified by the members of the COST action. Firstly, our analysis unveils both negative and positive aspects of technology adoption on QoL of older adults. Secondly, we further evaluate the results of the analysis by means of statistical measures. Thirdly, the main contribution of this paper are the recommendations and policy implications we can deduce from the analysis. Clearly, the focus is to understand the gaps between the needs, production, and adoption of solutions targeted at older adults.The structure of the paper is as follows. Section 2 describes the background and motivation, while Section 3 discusses the theoretical frameworks used as guidelines for analyzing the technical solutions. This is followed by the description of our methodological approach in Section 4. Section 5 contains the analysis of the results and Section 6 presents the discussions. Section 7 presents the strengths and limitations of the study. Finally, Section 8 concludes the paper with some recommendations and suggestions.There is a rapid growth in the number of older adults across all continents. According to Ollevier et al., , the expTechnology has a great potential in providing the support needed for enhancing the healthy lifestyle of older adults –24. The Interestingly, the technologies available for older adults have engendered significant changes in recent times. Notably, we have witnessed the use of assistive technologies , 26, 27,It is noteworthy that the Ambient Assisted Living (AAL) and Enhanced Living Environments (ELE) technologies comprise significant contributions from researchers in ICT and psychology –35. RemaEncouraging older adults to adopt the technologies aimed to improve their health and wellbeing has received a lot of attention in the research literature –40. It iAlthough technological innovation promises to continuously enhance the health and wellbeing of older adults, the seamless adoption of such technologies from both the human and technical perspectives can be a limiting factor for a sustainable breakthrough or progress , 51. TheAlthough the terms “technology acceptance” and “technology adoption” are sometimes used interchangeably, they are not synonymous. On the one hand, “technology acceptance” is a perception of technology that is impacted by various factors. These factors include frequency of use, usage experience, ease of use, usefulness, attitude, usage knowledge and enjoyment . On the TAM is a widely used adoption theory –58 that Further, TAM was formulated to predict and explain technology acceptance and use. In this regard, Davis et al.  proposedOver the years, this area has further developed and TAM has been extended. One such extension is TAM 2, which replaced the attitudinal component of TAM with a social element termed as Subjective Norm (SN) . The theNotably, many studies have shown that a strong intention of technology usage results in a high probability of actual usage . This imEverett Rogers did put forward the Diffusion of Innovation (DOI) theory for examining technology adoption and determining how technological innovations diffuse within communities , 68. On Rogers et al.  distinguWe observed that TAM is limited as a theory because of its position that technology adoption by older adults solely depends on the features of particular technologies to be adopted. In reality, older adults also think about how a technology enables their lifestyle in ways they value . TherefoDifferently, we blended the TAM and DOI theories to provide adequate insight into the analysis of technology adoption among older adults for improving the QoL and facilitating healthy lifestyle. In particular, we used from the TAM model as technological issues the improved wellbeing, ease of use, willingness to accept technology, and understandability. At the same time, we used from the DOI model as technological issues the technological awareness, willingness to accept technology, effectiveness, and understandability. Based on these technological issues identified from the two theories, we formulated hypotheses for statistical analysis.We designed our study using a mixed method consisting of the methods of qualitative explorative approach , and quaplanning, execution , and result analysis , specified the questions for the review, and defined the protocols used for the review. In the “execution” phase, we selected and analyzed the existing technology solutions. Finally, we summarized the review during the “result analysis” phase.In the “Overall, we analyzed 50 existing solutionsAll the authors were involved in reviewing the 50 existing solutions. Based on the guidelines provided by Kitchenham , we adopWe summarize the reviews provided by the authors by identifying the strengths and weaknesses of each existing solution that was analyzed. For that purpose, three analysis questions were asked for each solution as guides for understanding the gap between the need, solution, and technology adoption. These questions also served as the roadmap for understanding the adoption challenges faced by these solutions that have been reported in various documents. The analysis questions were as follows:AQ1: Has the technology been tried out?AQ2: Has the technology been tried out in a case study involving real end users?AQ3: How well did the end users adopt the solution?Additionally, we used ten (10) criteria based on the above analysis questions to elaborate our analysis. H0 and alternative hypothesis H1, which were later subjected to a statistical test to verify their validity. In particular, we used the T-test and correlation analysis. We tested H0 with ten (10) randomly selected people within the age range between 60 and 75 by asking them a number of questions based on the TAM and DOI theoretical frameworks.We employed a quantitative assessment method to establish the suitability of a particular technology for ageing well. Regarding that, we formulated the null hypothesis The structure of the questions that were used to source data from the 10 randomly selected persons is shown in As Additionally, support focuses on improving wellbeing, safety, security, ease of use, privacy and confidentiality, affordability, confidence, trust, willingness to accept technology, satisfaction, effectiveness, and understandability. All these are a mixture of TAM and DOI.This section presents the results based on the theoretical framework explained in Section 3 and methodology presented in Section 4.According to the objectives of our analysis, six of the technological issues identified in Based on the criteria described in From our initial discussion with selected respondents, we found out that they have a significant ability to use technology, especially operating their mobile devices and other digital devices they currently use, to adopt healthier lifestyles. The responses that we received are presented in As We categorized the responses as “Yes,” “No,” and “Neutral.” “Yes” means that the respondent either strongly agreed or partially agreed that a given issue should be among the technology adoption issues to be considered. If the participant strongly agreed that a given issue should be included, 100% was assigned. If the participant partially agreed, 75% was assigned. If the participant's response was neutral and they neither agreed nor disagreed, 50% was assigned. “No” means that the respondent either partially disagreed or strongly disagreed on the matter. If the participant partially disagreed, 25% was assigned and if the participant strongly disagreed, 0% was assigned. The percentages reflecting the responses by the participants to the technology adoption issues are shown in improve wellbeing has the highest relevance.Additionally, we identified from the responses by the participants shown in H0) and alternative hypotheses (H1). t-test analysis. The hypotheses were as follows:We first conducted a statistical test to check the validity of the following null hypotheses  system showed a significant negative correlation with the participants' age. In the HOLOBALANCE project, mock-up interfaces were evaluated in semi-structured focus groups. Interviews were performed across three European countries. Also, a set of proof of concept validation studies were deployed, which aimed at assessing the accuracy of the different components of the sub-modules of the motion capture and assessment. The technology worked out in the project has potential for exploitation and commercialization as a service based on the IoT framework and on the accompanying business model of the continuous care and coaching platform. The validation results provide evidence that the proposed system can accurately support and assess physiotherapy exercises to care for balance disorders. This improves a patient's commitment to rehabilitation programs while enhancing the quality of the performed exercises. At the same time, we also indetified several negative aspects of the project in terms of technology adoption.Solution 2: The My-AHA project is a typical ICT infrastructure with data analytics that is applied to the detection of frailty. The focus is not on technical innovation but on the concept of frailty and how to detect and take care of it. For this project, none of the criteria included by Solution 3: The platform worked out in the HOPE project relies on a universal control box to interconnect a variety of devices. For this platform, the technology adoption involves buying the box and configuring the devices for it.Solution 4: The Agnes project is an integration of ICT and social networking services that aids the detection of user states and activities and meeting the needs of older adults. The solution worked out in the Agnes project has the potential of prolonging for older adults the time spent at home, preserving health and promoting a healthy lifestyle, preventing social isolation, and providing support for (in)formal carers.Solution 9: The FeelGood project provides a roadmap for an ecosystem for Finnish companies to excel in the international competition for services Personal Health Records (PHR). The PHRs form a part of the foundation of the healthcare system in Finland. The motivation of the project was to encourage the continuous utilization of e-services in the healthcare sector. The roadmap serves as a catalyst to transform the current illness-centered healthcare systems into a service landscape that allows patients and citizens to work in a partnership with healthcare providers to manage health issues. Several stakeholders participated in formulating a strategic roadmap for improving the PHR-based services in Finland. The roadmap focuses on providing an enabling environment for supporting and promoting healthcare concerns for the citizens through technology adoption. Although the formulated roadmap seems promising in terms of the approach and strategy employed, it is not certain whether the roadmap will be accepted by all the healthcare professionals and government.Solution 10: The MPOWER project involves the cooperation platform, which is a technical integration platform of various services. It is a multisensor and multidevice environment that can provide support for the ageing population. However, technical solutions included by the platform are not directly applicable to senior users and their environments.Solution 17: This solution systematically extracts and analyzes health and dietary information about older adults. It utilizes the information received from individual devices to form comprehensive and integrated information that can be used by different stakeholders, such as informal caregivers, to gain an insight into the QoL of older adults living at home.Solution 18: This solution makes dietary recommendations and performs dietary monitoring of older adults. The recommendations are made based on the knowledge about the particular older adult rather than by following generic rules.Solution 28: The MobileAge project produced the “Best Practice Guide for Co-creation of Open Public Services,” and is meant for co-design experts rather than end-users. The guide was evaluated in six co-creation case studies in Greece, Germany, the UK, and Spain but not in real-life cases. Unfortunately, the guide contains too many different methods without any clear directions as to in which order and situations one or another method should be applied. Furthermore, we could not find evidence of the OSCPSEP platform having been used in real-life case studies.Solution 30: The SmartHabits project resulted in a system that was validated in a real environment, where a pilot application was set up in the city of Zagreb in cooperation with the foundation taking care of the older adults living alone. The validation confirmed that the proposed system has a potential to improve the quality of care by utilizing simple smart home sensors that can provide essential and continuous information about the occupant's status and environment. This was demonstrated in a scenario focused on prolonging the independence of the older adults living alone while offering peace of mind to their informal and formal caregivers. The system has great potential for adoption because of being non-invasive, self-adaptable to user behavior, zero-touch, and easy to manage. The most significant challenge of the adoption lies in the trust in technology.Solution 32: The I-CARE-SMART project developed the following three methodological materials: ToolBox for Senior Engagement, ToolBox for Business Engagement, and Handbook on Co-Creation and Open Innovation Methods for Smart Care to Older Adults. These methods have not yet been validated in any real-life case studies.Solution 33: The validation results of the pilots of the The SustAGE project have not been yet published. There is an extensive exploitation strategy, but its feasibility is hard to assess without knowing the validation results.Solution 34: In the Intracom Medical ICT Solutions Portfolio project, a cloud-based integrated solution offering the PACS/RIS (Picture Archiving and Communication System / Radiology Information System) functionalities was provided as a service. Older adults are mentioned as potential customers, but there is no information about the actual usage or adoption.Solution 35: In the “Joint deep learning and Internet of medical things based framework for elderly patients” project, the decision agent provides feedback to an inference engine of the target language analysis agent and the dialogue situation determination agent to allow for subjective interpretation of a given situation experienced by the older adult. However, devices that work and that do not require constant recharging remain challenges for this project.Solution 36: In this research paper, an Internet platform for activating older adults was put forward. However, if an older person is unfamiliar with technologies, computers, and mobile devices, the platform is of no use. Therefore, a human assistant is required to get the platform started.Solution 37: For the AIBO robot project, an off-the-shelf animal-like robot was provided to assist patients in hospitals where live animals are not allowed. In this case, a bond with the live animal is required. Additionally, the robot requires charging and has limited capabilities, but can still be beneficial.t-test indicates that the various technology adoption issues identified are statistically significant. For example, according to the statistical analysis, the t-value is bigger than the critical value of t, which is 2.262, at the confidence interval of 95%, degree of freedom of 9, and alpha value of 0.05. This means that technological awareness is statistically significant for older persons' embrace of technology. Moreover, the hypotheses postulated for statistical analysis of other technology adoption issues proved substantial based on the t-test. This means that the identified technology adoption issues should be considered when implementing suitable technologies for the aging population.The validity test is 2-fold (see Section 5.2). First, the p-value of 0.006225. However, we noticed a weak relationship between technological awareness and willingness (readiness) to accept technologies, possibly due to negative feelings about the technology hardware or an inability to operate it. Most profoundly, the correlation analysis revealed that support and improved wellbeing have a moderately positive correlation of 0.5238095, statistically significant at a p-value of 0.1202. This means that supports from Governments or organizations in terms of funding and other motivation will improve the wellbeing of the aging population.Secondly, the correlation analysis further clarifies the relationship between the technology adoption issues identified based on our formulated hypotheses. In addition, the correlation analysis provides evidence of the strength and course of action of the technology adoption issues identified. For example, our correlation analysis revealed a strong statistical relationship between understandability and ease of use based on the value 0.349215 and a Based on our analysis in Section 5.1, many technical solutions are still at the development stages. Because there is no clear implementation plan and funding, only a small percentage of these solutions are currently being used or are about to be used in real life. Therefore, the governments, providers, developers, etc., should be aware that when introducing a technology to older adults, the key drivers that facilitate its adoption should be considered. Also, they should be mindful that older adults may not have the necessary knowledge, skills, motivation, or confidence.T-test and correlation analysis are used. While the T-test was used to statistically reveal the significant level of technology adoption issues, we used correlation analysis to understand the relationship between the several technology adoption problems that we identified.In Section 5.2, we used the quantitative approach to establish the technology's suitability for the ageing population. Regarding that, the null hypotheses and alternative hypotheses were formulated. We subjected these hypotheses to a statistical test to verify their validity. For that, the The fundamental ways to improve technology adoption by older adults are (i) ensuring the motivational support in using these technologies , 82, ii, (iii) eA strength of this study is that many existing technology solutions were analyzed. The analyzed solutions combine different projects, patents, and publications. This technology adoption review provides insight into the negative and positive features of the analyzed solutions for improving the QoL of older adults. Remarkably, the collaborative nature of the review process among the authors was instrumental to understand the current gaps between the needs, provided solutions, and their adoption from different perspectives.Although the sample size of the respondents used for testing the hypotheses in Section 5.2 was small, still, there was diversity in the gender, age, ICT proficiency, and educational level of the older adults who answered the questions. In a small sample size, heterogeneity could be advantageous because it draws attention to critical features of the phenomena through a pattern across variance , 86. HowAnother strength of our study is the combination of the TAM and DOI theoretical frameworks, which ensured that we caught pertinent viewpoints regarding analyzing the technology adoption concerns. A qualitative design was used, which made room for new viewpoints in identifying the strengths and weaknesses of each existing solution analyzed. Also, a quantitative method was used, enabling to test and formulate the hypotheses.There are obviously some drawbacks in this study. First, the sample size used for testing the hypotheses is rather small, which has a detrimental impact on the generalizability of the results. Additionally, the older adults' prevailing circumstances and state of mind when answering the questions may have influenced their narratives and response. This leaves place for future work since a large scale study would bring further benefit to the research community.This paper investigated the technological solutions from the technology adoption perspective based on the TAM and DOI technology adoption frameworks using the mixed method research approach. First, our analysis reveals both the positive and negative aspects of using technologies by older adults to improve their QoL. Second, we used a statistical metric to establish the appropriateness of our analysis further. Thirdly, we made an essential contribution based on our in-depth analysis by providing crucial recommendations and policy implications for consideration below in this section.Consequently, we recommend, as a policy, the full support of governments and private organizations to design and implement holistic solutions. In our opinion, the involvement of governments in driving the campaigns for adopting technologies toward increasing the QoL of older adults is inevitable for successful technology adoption. Support by a government can be implemented in terms of funding and enacting laws that give relevance and attention to the ageing population of a society.Additionally, we recommend that privacy concerns of older adults should be further considered based on, for example, the framework suggested in Khan and Gambo , when imIG, KT, KM, RZ-G, AA, MM, MB-D, FM, and AL: conceptualization and writing—review and editing. IG and KT: methodology and data analysis. IG, KT, KM, RZ-G, AA, MM, and AL: formal analysis and investigation. KT: resources, supervision, and funding acquisition. IG: writing—original draft preparation. KT and KM: project administration. All authors have read and agreed to the published version of the manuscript.


We present several principles upon which we believe the BME 2.0 curriculum should be constructed, and from these principles, we describe what view as the foundations that form the next generations of curricula in support of the BME enterprise. The core principles of BME 2.0 education are (a) educate students bilingually, from day 1, in the languages of modern molecular biology and the analytical modeling of complex biological systems; (b) prepare every student to be a biomedical data scientist; (c) build a unique BME community for discovery and innovation via a vertically integrated and convergent learning environment spanning the university and hospital systems; (d) champion an educational culture of inclusive excellence; and (e) codify in the curriculum ongoing discoveries at the frontiers of the discipline, thus ensuring BME 2.0 as a launchpad for training the future leaders of the biotechnology marketplaces. We envision that the BME 2.0 education is the path for providing every student with the training to lead in this new era of engineering the future of medicine in the 21st century.If the 20th century was the age of mapping and controlling the external world, the 21st century is the biomedical age of mapping and controlling the biological internal world. The biomedical age is bringing new technological breakthroughs for sensing and controlling human biomolecules, cells, tissues, and organs, which underpin new frontiers in the biomedical discovery, data, biomanufacturing, and translational sciences. This article reviews what we believe will be the next wave of biomedical engineering (BME) education in support of the biomedical age, what we have termed BME 2.0. BME 2.0 was announced on October 12 2017 at BMES 49 ( The last 70 years has seen the rapid growth in our ability to acquire, store, and analyze information about the external world. This has been enabled by an accelerating trajectory of digital tools: from the first computers, through read/writable storage, to search engines that launched the information age of big data and the ubiquitous sensors of the internet of things. Scientific progress has rewritten the rules for exploration and control of the external world, enabling exploration of space and the deepest oceans; optimization of energy grids and air traffic networks; taller, greener cities; and a navigator on our phones. The external world around us has been measured, analyzed, and changed through engineering.The greatest opportunities for disruptive change during the 21st century are likely to be in the measurement, analysis, control, and augmentation of the internal world of the human body. Rapid advances are being made possible by a new accelerating trajectory of enabling tools based on advances in imaging, genomics, systems medicine, molecular and cellular engineering, and other biomedical sciences. As with digital storage, we can now not only “read” genes but also “write” genes. Just as every position on the globe has global positioning system (GPS) coordinates, the human body is also being mapped, cell by cell. The National Institutes of Mental Health Brain Initiative Cell Census Network (BICCN) project is cataloguing every cell type in the most complex structure in the known universe—the brain . The genAt the same time, just as earlier industrial revolutions have powered new generations of engineering technologies for understanding the external world, the new third industrial revolution  enabled https://ethw.org/Oral-History:Richard_J._Johns). The curricula were designed as an outgrowth of the more mature engineering disciplines such as electrical engineering (EE), mechanical engineering (ME), and materials science (MS) or chemical engineering (ChE) pathways. Students would declare an area of concentration in EE, ME, MS, or ChE; those students interested in studying neurons or the pacing of the heart would choose focus area concentrations in EE and those interested in biomaterials MS or ChE. As the field has matured, the interdisciplinary nature of applying engineering principles to biology and medicine has became central. Studying the heart or building an auditory or visual neuroprosthesis does not afford BMEs the luxury of studying any single systems theory methodology in isolation, but rather must engage the myriad of chemo–electro–mechano systems.The undergraduate curriculum that has served us well for the first 50 years of BME must evolve to support new innovation. This would not be the first time a classic undergraduate curriculum has undergone a necessary redesign. Physicists had to balance the classical training of 19th century physics with the explosive developments of quantum physics, and in so doing enabled the interdisciplinary sciences that led to semiconductors and solid-state electronics. We too are at a similar inflection point in undergraduate BME education, where the acceleration of new tools and techniques enables interdisciplinary insights, this time into human health and therapies. Thinking historically with the emergence of graduate programs, BME as a discipline emerged in the 1960s and 1970s, birthed early by several cofounders at Case Western University, Duke University, Johns Hopkins University, University of Minnesota (UMN), University of California San Diego, University of Pennsylvania, and University of Rochester programs, several of the programs founded in the 1960s established as divisions within schools of medicine with undergraduate BME curriculum beginning in the 1970s. Herman Schwann and Sam Talbot were early founders at Penn and Johns Hopkins University, respectively .During the 1980s, BME departments were relatively limited. That changed during the transformational era of the Whitaker Foundation years of 1991 to 2006. The Whitaker Foundation was established in 1976, and in 1991, it decided that it would heavily invest all of its resources to enhance biomedical engineering education, that ending in 2006. Spending increased dramatically during this period as a result of this decision, during which period Whitaker invested all of its resources on enhancing BME education resulting in the creation of many new BME undergraduate programs around the country  biomedical engineering was largely involved in the application of more traditional engineering disciplines – e.g. chemical, electrical, and mechanical engineering – to problems in medicine and biology (Paul Citron)what [has] emerged is a new engineering discipline, arguably the only new one in the twentieth century, an engineering discipline that is biology-based (Robert Nerem)https://www.bmes.org/bmes-50-years), an ideal time to consider the philosophy and principles that underlie our next generation of BME education. The next 50 years of understanding biology requires integrative thinking about complex dynamical biologic systems that are heterogeneous in space and changing in time. At the same time, the economics of biomedical technologies have led to a democratization of biosciences so that subjects that might have once focused on theory alone due to the paucity of data, now because of the ubiquity of biosensors—both physical and molecular—provide students with the opportunity to conduct their own research and design projects. In introductory biomedical data science classes, we can use public datasets as motivating examples and case studies, including public health datasets like the National Health and Nutrition Examination Survey (https://www.cdc.gov/nchs/nhanes/index.htm/) and medical imaging and MRICloud [https://www.nitrc.org/projects/mricloud/) and open EEG (https://github.com/meagmohit/EEG-Datasets/) and biosignal data , and open access educational AI/ML benchmark datasets like medical MNIST (https://medmnist.com/) as well as Intensive Care MIMIC (https://www.nature.com/articles/sdata201635) and the Philips eICU (https://www.nature.com/articles/sdata2018178/) databases. The Open Case studies project (https://www.opencasestudies.org/) is an invaluable resource for data, such as the public opioid database creating the opportunity to teach lessons in data wrangling, merging, and exploratory graphics. More than ever, the community can be engaged in building a new generation of data-driven biomedical engineers.We recently celebrated the 50th anniversary of the Biomedical Engineering Society . BME 2.0 will be enabled by tight coupling with the biomedical enterprise within schools of medicine as well as the biotechnology, pharamaceutical and medical technology industries. We envision a curriculum with focus areas that builds on the major discoveries and emerging opportunities in biomedical research. To deal with the dynamism of the biomedical science discovery process, a principle for evolution of the BME 2.0 curriculum is that the most important research discoveries are rapidly conserved through their integration into the BME 2.0 curriculum.We propose the next generation of integration of engineering disciplines in BME, what we term “BME 2.0,” which builds on the process that was initiated during the early post-Whitaker years. BME 2.0 was first announced at the BMES 50th celebration  education at the high school level, today many of our college students are better prepared in key subject matter, including math and biology, and they are eager for advanced undergraduate training. Many of our students are doing activities to prepare them for more advanced training including attending immersive summer programs, and because of early interest, many are attending STEM high school with Advanced Placement (AP) courses, with the national average increasing from 20% to 33% between 2004 and 2014 . States This philosophy meshes well with leading educational practice; the students benefit enormously from a curriculum that emphasizes the more advanced components of active learning—creation of new devices, data, products, or knowledge and self-evaluation and analysis of a student’s own projects—and provides the mentoring and leadership opportunities that will enable students to succeed both pre- and post-graduation. To accomplish this, BME 2.0 is built around several principles.Traditionally, undergraduate engineering programs begin with a baseline year of math, physics, and chemistry courses upon which the remaining curriculum is built. This implies that students are delayed from engaging with BME-specific learning that enables them to identify their interests and to understand the context of their other coursework. We are advocating an increase of engagement of students in their freshman year that includes a life sciences foundations course in which students study molecules, cells, tissues, organs, and diseases, emphasizing the quantitative nature of biology and the biochemistry of biological structures, exploring the multiscale nature of tissues and the dynamics of multicellular morphogenesis. This continues a trend in BME programs requiring freshman engineering curriculum lead by BME faculty . For theThe third and fourth years should bring the student to hands-on and project-focused coursework, which reflect their differentiating interests and goals and prepare the students to practice within the field through project-based laboratories and classes oriented to their future careers in medical devices, biotechnologies, and healthcare analytics. This is depicted in Fig. Interestingly, we believe these 2 years of BME 2.0, life science foundations and quantitative BME boot camp, are well encapsulated by the Harvard Medical School admission requirements:because biology is the most elegant expression of chemistry, physics, and mathematics, computational skills that tie these previously separate disciplines together should be emphasized .The first 2 years of BME 2.0 builds a solid foundation in courses lead by BME faculty focused on BME applications. BME 1.0 required students to focus in mechanical, electrical, or materials engineering and take courses from other departments in signals and systems, thermodynamics, and mechanics. BME 2.0 has foundational courses that include biomechanics, bioelectricity, and biomaterials. Once students have learned how engineering principles apply to physiological, cellular, and genomic systems, they can design their own advanced courses, such as an advanced focus area class such as tissue engineering or biomedical data science, and or an advanced design team or research project allowing students to gain expertise far beyond the classroom –22.In the junior year, every student will have had statistics and linear algebra and are therefore prepared to take biomedical data science. We believe that biomedical data science training is critical for all students in BME—no matter where their professional goals lie, from genetic systems to regenerative engineering to careers in medicine. As discussed by the Council of Chairs of Bioengineering and Biomedical Engineering, there is a growing consensus among BME programs that data science education that teaches not only how to model and interpret complex data but also how to wrangle data is of critical value to BME as a discipline . An undeBiomedical data science uniquely bridges our more classical approaches of systems and analytical approaches to mechanistic modeling of biomedical systems, with the modern approaches of data-driven discovery. With the recent emergence and emphasis on incorporating biophysical models into data science via physics-informed machine learning , it is cStudents will complement their systems modeling techniques by learning data science methods including statistical inference, dimensionality reduction techniques, unsupervised and supervised machine learning, and graph-based techniques and use of cloud computing resources. Examples can be drawn from data analysis of cutting-edge techniques to analyze genomics, transcriptomics, metabolomics, proteomics, physiological, and imaging data to gain a deeper appreciation for how to frame and test biological hypotheses from molecular to tissue scales. Students will learn to choose modeling techniques appropriate to addressing biological problems at different scales, quantitative characterization of biological properties, parameter estimation and sensitivity analysis, model verification and validation, and integration of computational modeling with experimental approaches.BME is of the fastest progressing disciplines of discovery and innovation in biology, biomedicine, and biotechnology. Building discovery and innovation into the curriculum with projects that incorporate laboratory-based research experiences is essential. Having research and team-based projects as part of the cutting-edge laboratories has many benefits for developing skills that are essential to all career paths.Bringing students together in interdisciplinary and multiclass project teams was introduced early on by Rice et al. , with thAs BME has developed, so too have the variety and differentiation of specializations at each of its frontiers, resulting in a convergence of disparate technologies and expertise that cuts across disciplinary boundaries. Convergence as a discipline can be defined as “the coming together of insights and approaches from originally distinct fields” , for ourBME as a relatively young field is already embracing new fields of science and new “convergent technologies” that appear disparate but are incorporated in fundamental ways. The “unsiloed” approaches of convergence lead to new solutions to problems at the intersections of the pharamaceutical, medtech, and digital healthcare industries. As an example, at Johns Hopkins, the BME students are building the bridges for the convergence of new technologies for applications to projects in human health between the schools of medicine and engineering. Figure An example of a curriculum exemplifying convergence is one launched at Johns Hopkins in biomedical data science called precision care medicine, a class bringing together BME and Anesthesia and Critical Care Medicine using de-identified patient data in the education and training of undergraduate and graduate students. The projects are defined by the clinical departments of the school of medicine with teams of 5 to 6 students, the emphasis being on creating teams with a diversity of students including undergraduate and graduate students, medical and/or nursing students, clinical residents and fellows, and clinical faculty. Datasets involve publicly available clinical datasets from the Medical Information Mart for Intensive Care database and the Philips eICU database , as wellDiversity in BME is critical to success in education, research, translation, and impact to society. Diversity is a key component of excellence in all branches of science bringing new ideas and expanding creativity—a key driver of discovery, design, and entrepreneurship. Including diverse perspectives will make our design teams, research laboratories, and start-ups more impactful to society. In fact, as argued by the National Academies, bringing dimensions of diversity to the maintenance of the academic program is inclusive excellence.As defined by the National Academies :Inclusive excellence is a philosophical approach to higher education administration and processes that means attending to both the demographic diversity of faculty/students and the need for developing climates and cultures in institutions so that all have a chance to succeed in STEMM .Clearly, diversity and convergence of ideas present the opportunity for more powerful innovation and greater excellence. Bringing diverse voices together in a successful BME program is both desirable and is already ongoing in many BME departments today . BME 2.0Thinking about specific practices, we envision curriculum changes that collectively can move our BME community toward a culture that is more inclusive and more equitable. Specific programmatic practices that we envision are to introduce into the curriculum classes that explore equitable outcomes in healthcare and BME’s role in attaining that. Our universities are rolling out new design projects and curriculum that engages the students in examining BME’s role in bringing biomedical solutions to our communities. Johns Hopkins has introduced the Health Inequity Design Challenge , asking BME departments can also play a role in instilling in our colleagues and trainees the leadership qualities that embody inclusivity and equitable action. For those departments that participate in the Accreditation Board for Engineering and Technology (ABET) process, the program education objectives (PEOs) provide us with the opportunity to define broad program goals that we expect our trainees to attain subsequent to their graduation. Our Universities are defining PEOs that advocate for equitable access to the field and the technologies it produces by advancing diversity, inclusivity, and accessibility in the profession . FinallyAt the same time as ending systemic biases it is necessary to truly welcome students of all identities into BME. We recognize that the goal is not assimilation into one BME monoculture but rather to enable students from all groups and backgrounds to feel welcome and at home in BME and empowered to speak out about their own individual experiences and perspectives. Specifically, the recommendations here are that diversity and inclusion efforts are transformed by identifying intentional actions, requiring a shift in priorities and a shift in policy. This we believe is exemplified by the new Council of Diversity whose mission is to bring together representatives from every department to discuss and amplify successful practices for all types of departmental structures and available resources.As argued by Linsenmeir at the Council of Chairs , empiricHistorically, the cores and requirements for the departments have been well aligned; however, Gatchell and Linsenmeir’s data emphasizes the dichotomy pointed out by Citron; BME has been historically the application of traditional engineering with physiology. While historic agreement among universities has been compelling, the future focus areas and core curriculum presumably represents the future of BME 2.0, a discipline focused on biomedical imaging and medical devices, biomechanics and mechanobiology, computational medicine, genomics and systems biology, digital health and biomedical data science, neuroengineering, and immuno, regenerative, and tissue engineering. While systems physiology has been a foundational class, now at all biomedical institutions we see an equal role for physiology at the molecular scales as part of the burgeoning fields of modern molecular biology. At the other end of the quantitative spectrum, while circuits and statistics have been a mainstay for the medical technology industries, modern engineering programs are developing data science and machine learning curriculum at a pace that should be paralleled for BME.In thinking about defining the next-generation core curriculum, we take inspiration from physics organized from the smallest quantum scales to the classical macro scales. This is natural for BME organizing the core around the microscales of molecules and cells to the macroscales of the systems physiology of organs and tissues. In physics, the core covers the abstractions associated to the fundamental forces starting from Newton’s laws; for building system biology models including both linear and nonlinear cell networks, linear and nonlinear signal analysis and control theory is arguably the proper abstraction. For BME, the core should be defined through its intellectual support of the focus areas.https://medtech.pharmaintelligence.informa.com/), and medical technology industries  which are continuing to grow, develop, and pivot depending on advances and limitations of new technology.The accompanying The focus area classes should reflect a curriculum that supports and prepares students for the marketplace, and thus, we recommend developing a sequence of classes with names that are well recognized by the respective industries in which BME students are engaged.We also see the continued rollout of BME 2.0 as having a strong influence on ABET and ABET requirements. As BME is a convergence of biology, medicine, and engineering, several of the BME 2.0 courses are neither just science or just engineering, but instead an integration of the two. This highlights the discipline of BME in the 21st century and how it is different from the more traditional engineering disciplines. Statistical physics is thermodynamics, but with the focus on the microscales of molecules inside of cells, instead of the macroscale. Students receive additional thermodynamics training within the biochemistry and molecular engineering course as well. These courses integrate both science and engineering would count fractionally, 50%/50% or 67%/33% in their engineering credit tally. Systems biology is a quantitative engineering course, not a pure science course, and can also count as engineering. As shown in Fig. Another principle of BME 2.0 is that each school features its own strengths, with the advanced curriculum reflecting those strengths. The focus areas can be personalized to the institution building on their individual program strengths and differentiators incorporating the elements of BME 2.0 that capitalize on their unique strengths. The University of Connecticut and UConn Health is leveraging its strengths in regenerative engineering , bringinWe see flexibility in the matching of the curriculum to the local environment. At the same time, the value proposition that biomedical engineers offer in the biomedical science arena is that we are quantitative. Biomedical data sciences is uniquely an area that all BME programs could develop, with data wrangling a part of the core value of biomedical engineers. This is playing out in several of the universities. The University of Virginia’s (UVA) thrust with its new school of data science positions it well for biomedical data sciences with the school’s first dean—a former associate director of Data Science for the NIH and now a professor of BME. Virginia’s core curriculum reflects these strengths including the fact that students can high-throughput sequence their own DNA, with the 2 BME data science courses at UVA focused on genomics, bioinformatics, and gene expression. At Purdue, the Weldon School of BME approved a new data science requirement for all BME students recognizing that the successful integration of engineered medical technologies with digital healthcare delivery modes for diagnosis and treatment is becoming central to translation in personalized medicine. At Weldon, the requirements for core and elective courses in data science for all BME graduates began in 2018. In 2020, a new core course in data science and data analytics for all BME students was implemented. UMN BME has launched over the past 3 years a digital health subplan that has been crafted in partnership with the Department of Computer Science, representing an intentional effort to design courses to best prepare students for the myriad of emerging positions for managing and mining big data.Johns Hopkins is seeing a rapid growth in biomedical data science interest in their BME student bodies. Examining the design teams enrollments, we see a strong proliferation of biomedical data science projects. Figure We conclude our perspective by finishing on what we believe is a particularly high note for the 21st century of biomedical and biological engineering. While the industries focused around BME may have historically been relatively nascent, we see strong markets in biotechnology, pharmaceuticals, and medical technologies. BME 2.0 and the future leaders that emerge from it will play a major role in transforming the local economies. Klepper  argues tAs one example, we take Purdue University, which is now centrally located in a rich ecosystem of orthopedic, medical device, and pharmaceutical industries and partners broadly within the life science industry. Purdue BME has acted as a key driver of economic development within the state of Indiana. The value of a BS/MS degree in BME for the local economy is clear. Purdue's Weldon School of BME reports Purdue graduates average 60% placement into industry positions directly with a BS or BS/MS Weldon School. Purdue has launched more than 30 Indiana medical device and life science companies, raising more than $100 million in venture funding and licensing more than 50 patented technologies to Indiana medical device and pharmaceutical companies. In total, more than 6 million patients worldwide have been directly helped by medical products based on these licensed technologies.With the emergence of biomedical science with engineering at its heart, we should expect to see continued transformation of the economy facilitated by the innovation that is emerging from our BME 2.0 programs. Historically, while interest from industry in hiring BME BS graduates may have been less apparent, this is no longer true for the biomedical science discovery industries. For example, at Johns Hopkins, there is rapid growth in industry interest in BME students as depicted in Fig. In fact, the notion that the BME industry may prefer hiring students from other disciplines such as EE or ME to students graduating from BME departments also does not appear to be true, with clear evidence that the first-tier medical technology companies prefer biomedical engineers for recruitment. The UMN proximity to the medical technology industry as part of the Twin-Cities area provides a university ecosystem that is integrated with medical device technology. Engagement with industry faculty occurs through curriculum such as computer-aided design and computer-aided engineering and prototyping, with the capstone projects mentored by leaders from local companies and faculty working together. The close interplay between industry and the curriculum translates into approximately 70% of UMN BME undergraduates employed by a diverse industrial landscape compared to approximately 40% on average in BME departments across the country  (Fig. 7,We close on a note that was stressed at 2019 Biomedical Engineering Education Summit as part of the academic core competencies and industry-ready skills themes. Industry's goal to hire BMEs with strong engineering skills appears to align precisely with BME 2.0 in which we have argued for more in-depth study and advanced differentiated curriculum focused on the engineering disciplines. This is enabled by taking BME courses from day 1, coupled to basic and advanced programming and data analytics capabilities as evidenced by the emphasis on BME incorporating biomedical data science as a core discipline in the curriculum.Since its inception more than half a decade ago, the discipline of BME has had profound scientific and societal impact. Arguably, its most significant impact has been to change the very nature of biological research and practice of medicine. It is now common for life scientists to harness engineering approaches in their research, and increasingly life scientists are being trained at the undergraduate and graduate levels in similar ways to biomedical engineers. As biomedical technology breakthroughs permeate the marketplace and biomedical research continues to become more quantitative and data intensive and dependent on novel technologies, we are poised to redefine the discipline once again and to change the way we train biomedical engineers for tomorrow. This transition emphasizes the importance of foundational learning of biology and engineering in the first 2 years of undergraduate education, with biology and engineering being taught in the context of each other. The junior and senior years emphasize both building depth in the specialized areas of BME that have emerged over the past several decades, and putting knowledge into practice through project-based learning. Convergence and inclusive excellence are emphasized throughout all years of training. Students pursue the key approaches of working as a team and learn self-motivation through the personalized design of their own curriculum.We emphasize that the BME 2.0 perspective is designed from the point of view of the famous quote from Wayne Gretzky on “where the puck is going to be.” The process of transition from BME 1.0 to BME 2.0 is a process, one that will happen in different ways and on different time scales depending on the institution, its faculty, and the needs of its students. For example, even as increased attention in both medicine and industry is focusing on discovery and innovation on the molecular scale, training in physiology will remain an important aspect. To what extent physiology remains a separate biology course versus becoming integrated into the curriculum of “systems” BME courses will depend on each program. BME programs that grew historically out of founding faculty trained in ChE may more quickly embrace aspects of the molecular focus, just as those BME programs founded by those trained in EE may more quickly embrace the centrality of biomedical data science for all BME students. Thus, BME 2.0 is presented here as a framework and roadmap for BME programs to consider as they navigate the curriculum changes necessary for the 21st century biomedical age. The principles of BME 2.0 will empower us to engineer the future of medicine and healthcare delivery for years to come.


Biological invasions are a major threat to Australia. Information on alien flora in Australia is collated independently by different jurisdictions, which has led to inconsistencies at the national level, hampering efficient management. To harmonise different information sources, we present the Alien Flora of Australia (AFA), a nationally unified dataset. To create the AFA, we developed an R script that compares existing data sources , identifies mismatches among them and integrates the information into unified invasion statuses at the national scale. The AFA follows the taxonomy and nomenclature adopted for the Australian Plant Census, introduction status and impact of plants known to occur in Australia. The up-to-date information presented in this dataset can aid early warning of alien species invasions, facilitate decision-making at different levels, and biosecurity at national scale. The associated script is ready to be implemented into new versions of the AFA with updated releases of any of the data sources, streamlining future efforts to track of alien flora across Australia. Of special concern are alien plant invasions, because of the great number of species  introduced outside their native range compared to other taxa5 with no sign of saturation6.The impact of biological invasions poses one of the greatest threats to nature8. According to the unified invasion status framework proposed by Blackburn et al. (2011), species introduced in a new region are classified differently depending on the barriers they have overcome, regardless of their impact8. As such, casual aliens are those that have been transported beyond the limits of their native range. Only a fraction of casual aliens become naturalised to form self-sustaining populations. Finally, only a fraction of those naturalised become invasive, overcoming local dispersal barriers and spreading in the new region8.Alien plants can be classified based on their position along the introduction–naturalisation–invasion status continuum9.High quality, easy-to-access, standardised and unified data sources are essential for assessing and monitoring the status of biological invasions, making future predictions and for prioritizing management actions. While there are many freely accessible online databases, their ultimate value depends on the feasibility of integrating information provided at different spatial scales, following different criteria, or using different nomenclature10 at the global scale, or the Inventory of alien invasive species in Europe (DAISIE)11.Recently, there have been many initiatives to create and make available large-scale datasets of alien flora. Such is the case, for example, of the Global Naturalized Alien Flora (GloNAF)12 and is one of the world’s biodiversity hotspots and megadiverse countries, which are known to be the most vulnerable to biological invasions13. To prevent biological invasions, $13.6 billion are currently invested every year in environmental biosecurity in Australia14. Australia’s plant censuses, including information on whether a species is native or introduced, have been developed independently by state and territory government environment departments, which has resulted in inconsistencies at the national level. The only national sources about alien flora that exist in Australia are outdated or apply unclear criteria for species’ inclusion and status17 (http://wwf.org.au/publications/ListInvasivePlants/).Australia has the second highest number of endemic plant species in the worldTo overcome mismatches caused by jurisdictional boundaries and enable efficient management, standardised data including invasion status at the national scale are needed.https://biodiversity.org.au/nsl/services/export/index; accessed February 2022), a nationally accepted taxonomy for vascular plants . It is one of the taxonomic resources of the Australian National Species List  and provides authoritative data for names and published taxon concepts for native and naturalised taxa in Australia. Despite being federally managed and endorsed by the Council of Heads of Australasian Herbaria (CHAH), the APC provides information on a state-by-state basis, but is not synthesised nationally. Recently, the Global Register of Introduced and Invasive Species (GRIIS) for Australia18 was published by the Invasive Species Specialist Group (ISSG)19 following the methodology proposed by Pagad et al.20. However, to date, Australia is still lacking a dataset that integrates all the existing data sources across the six Australian states and two main territories (for simplicity hereafter referred to as ‘states’) with those that have been produced at the national scale. In order to deliver standardised up-to-date information and create a unified dataset nationally, an automated system that integrates datasets and specifies plant species origin and introduction status is needed. This will provide a strong evidence-base for planning and informing actions for prevention and to mitigate risks21.The most accessible and comprehensive plant census at the national scale is the Australian Plant Census . By integrating all existing data sources and embedding a technical validation step, this dataset is the first of its kind for Australia.22. Then, we had to develop (i) an R script able to combine the information contained within the APC and Australian state plant censuses, and (ii) updated standardised datasets at the jurisdictional level. Afterwards, we integrated all the information into (iii) the Alien Flora of Australia (AFA), a nationally unified dataset. With its associated script, the dataset presented here can be regularly updated with each new release of the state plant censuses. Hence, the Alien Flora of Australia and its associated script enable users to leverage both Australian state and national plant censuses and create customised data subsets suited to their specific needs regarding both area of interest and desired taxonomy. Through its real time coordination and reconciliation of open-access data, the approach used to create the AFA can help transform knowledge, understanding and the efficacy of invasive plant species ecology, management and policy in Australia.To construct the AFA, we first had to integrate and standardise terminology on plant invasions across Australia and propose prioritisation systems to tackle mismatches existing at different spatial scaleshttps://www.R-project.org/) to create an R script that combines the information recorded on the APC with all the state flora censuses and the GRIIS in order to detect mismatches between species nomenclature and introduction status. The script also allows addressing those mismatches into elucidating a unified introduction status for each species at the national level22. The script can be used with future releases of the APC or any of the state floras, to automate this process. There are seven main steps underpinning the creation of the AFA, which we outline here  is a list of the Australian flora, both native and introduced; it includes accepted names, synonyms and misapplications for these names, and specifies species distribution on a state-by-state basis for continental Australia and its external territories. Taxa known only from cultivation in Australia are excluded in the APC, and therefore also from the AFA database created here. The Australian GRIIS checklist is a species catalogue for introduced and invasive species recorded from Australia that includes taxonomic information based on the Global Biodiversity Information Facility (GBIF).https://www.cpbr.gov.au/cpbr/ACT-census/vascular-gen-alpha.html) and the Northern Territory ), and the six Australian states , Queensland , South Australia , Tasmania , Victoria  and Western Australia )  is available for the latest release of the APC (2022) and the GRIIS v1.9 (2022). Similarly, the state-by-state comparative datasets created here are available for the latest releases of the state plant censuses, ranging from 2019 for the ACT, to the most updated ones for the rest of the states, corresponding to censuses as of 2022 .Herbaria from different states follow various versions of protocols for classification, and display the available data inconsistently, therefore limiting data federation. Thus, after obtaining all the data sources we had to standardise them Fig. .http://www.worldfloraonline.org/) and provide all of them in the AFA. We cross-referenced the taxonomy and nomenclature with the one used in the GBIF taxonomic backbone and with WFO, using rgbif23 and WorldFlora24 R packages, respectively, without fuzzy matching.We followed the taxonomy and nomenclature adopted for the APC as the most recognised authority for the Australian vascular flora, which is endorsed by the Council of Heads of Australasian Herbaria (CHAH). In addition, our script allows matching the taxonomic nomenclature used in the APC, to other taxonomies extensively used internationally, such as the GBIF taxonomic backbone (10.15468/39omei) and the standardised nomenclature provided by WorldFlora Online . Alien species in the AFA can be considered: introduced , naturalised (when forming self-sustaining populations) – it is stated whether, for the two former ones, the status was doubtfully or formerly when that was the case –, or harmful invasive (when recorded as invasive knowing to cause negative impacts). If the origin for a species is uncertain, it is recorded as ‘uncertain origin’, whereas taxa that are no longer present are recorded as ‘presumed extinct’  proposed by the Biodiversity Information Standards (TDWG) to refer to the species origin , and the extent to which an introduced species survives, reproduces, and expands in its introduced range . By including both the Blackburn’s framework and the Darwin Core standard, we intend for the AFA to be as useful as possible for researchers, biosecurity departments, environmental managers, database managers and herbaria alike.In addition, the AFA also includes the Darwin Core Standard , Cartier Island (CaI), Christmas Island (ChI), Cocos Islands (CoI), Coral Sea Islands (CSI), Heard Island (HI), Lord Howe Island (LHI), MacDonald Island (MDI) and Norfolk Island (NI). Although, external territories were excluded from the state-by-state comparison explained below, we still provided, for each of them, the information on the present flora extracted from the APC.We downloaded the APC dataset from the Vascular Plants NSL Service APCet al.22 for discussion on terminology in invasion ecology across Australia).For those species that had a combination of statuses within the same state, we condensed the information into one introduction status per species and state or territory . To do so, we matched each species canonical name  displayed in the state plant census with the APC to obtain the equivalent accepted name from the APC for those species that were known synonyms or had been misapplied. We then developed a conversion procedure to standardise all introduction statuses across Australian states (see Tables 8 was used to combine the information about presence (present/extinct), origin (native/introduced/uncertain) and introduction status  for all data sources. For example, for a species present, introduced, and for which its degree of establishment according to Darwin Core was known as ‘established’, we recorded it directly as naturalised. To facilitate understanding of the different terminology when used at both state and national level, we have provided a glossary with specific meanings for each term at both scales and according to different sources of vocabulary for invasion ecology . The three datasets were merged into one and only the records for plants were kept. The taxa that appeared recorded as ‘invasive’ based on impact were changed to ‘harmful invasive’ according to the definitions provided in detail by Essl et al.26 and Martín-Forés et al.22.The Australian GRIIS is structured in three different datasets that were downloaded from .Once matched, the distribution and introduction status within each Australian state is scored by cross-checking extracted information from the APC and the state flora censuses accessed from the state herbaria. As such, we compared species scientific name (including authorship), canonical name, and introduction status recorded on the state census with those recorded on the APC . In all component datasets developed at the state level, we incorporated a new column with the unified status for each species in such state .The script we created easily identified and tackled mismatches in nomenclature, introduction status or even presence within a certain area . Finally, when the species was recorded in both sources, we integrated the introduction statuses among states into an introduction status at the national scale. To conduct such integration at the national scale, we followed the prioritisation procedure described by Martín-Forés et al.22 to address inconsistencies regarding introduction status at the national level. The prioritisation procedure at the national scale differed from the one used at the state level as follows: if a species was native to at least one state, it was considered native at the national scale. If it was not ‘native’ to any state, but it was recorded as ‘native colonising’  in any state, it was considered as native colonising at the national scale. If a species was neither native in any possible form to any state, nor having uncertain origin, then the introduction status that had advanced the furthest along the continuum was the one prevailing at the national scale. Only if the species was not present in any state was it then recorded as presumed extinct at the national scale .The unified status for each species across all Australian states were combined and integrated into a status at the national level .We then cross-referenced the unified introduction status we obtained at the national scale with the one appearing on the Australian GRIISet al.22 . When other mismatches were identified  in the GRIIS), the AFA status corresponded to the one resulting from integrating the state statuses at the national scale as detailed in the previous step.For species for which the introduction status resulting from combining state data sources at the national scale was alien in any form, and for which the status recorded on the GRIIS was ‘invasive’, the unified AFA status was stated as ‘harmful invasive’. This was due to the fact that the GRIIS classifies invasive species based on negative impact, not only on distribution along the continuum , and the taxon status according to the APC , the unique ID status for each taxon is also provided. Moreover, there are columns with the unified introduction status for all taxa in each state and main territory, and with the introduction statuses populated from the APC for the external territories. Afterwards, there is the national introduction status resulting from the integration at the national scale, the GRIIS status and a column resulting from the comparison between the two. Finally, there is the AFA unified status that corresponds to the unified status for each taxon across all data sources at the national scale. In addition, the AFA unified status has been converted into its corresponding Darwin Core equivalences for the terms establishment means and degree of establishment.27. The first folder is a zip folder called AFA_state-by-state datasets that contains all the state-by-state standardised datasets  in.csv format which were produced as intermediate steps for creating the AFA national dataset. The state-by-state standardised datasets are all displayed following the same structure, including information on the taxonomy recognised by the state censuses and the APC, the introduction status recorded on both the state census and the APC, the taxon status according to APC , a column resulting from the comparison of introduction status between the state census and the APC, and a column with the unified introduction status at the state level. In addition, the unified introduction status at the state level was converted into its corresponding equivalences from the Darwin Core, establishment means and degree of establishment terms.We provide four more folders in FigshareThe second zip folder is called AFA_metadata and contains two.csv with the metadata for the AFA national dataset and the state-by-state datasets.https://github.com/MartinFores/AFA).The third folder is a zip folder called AFA_R_Scripts that contains three R files which were produced as intermediate steps for creating the AFA national dataset. The AFA_main_R_script contains the condensed information on how to reproduce the process to create the AFA dataset. In such instructions, we duplicated the first step to allow for users to either replicate the static copy or the AFA presented here, or alternatively to create updated versions in the future with new releases of the APC and the state censuses. In addition, there are two more R files containing the primary and secondary functions to be used in the main script. These two files containing the functions can be easily loaded following the steps detailed on the main R script. We split the files, so that in the future, the script developed to create this dataset can be easily adapted as needed and reused to create updated versions of the AFA with new releases of the state and main territory plant censuses, and of the Australian Plant Census. The three R files are also accessible via github , and each of the data custodians for each state. We took this step to ensure the conversion of introduction statuses was accurate. As a result of this process, we obtained feedback to incorporate the Darwin Core terminology in our standardised system to also be inclusive of other international standards that may be implemented in the foreseeable future.Additionally, we consulted with a subcommittee of the Council of Heads of Australasian Herbaria (CHAH), the Herbarium Information Systems Committee (HISCOM; Supplementary material for


WorkMyWay, by applying a combination of theory-informed and human-centered design approaches. According to the Medical Research Council’s framework for developing and evaluating complex interventions such as WorkMyWay, process evaluation in the feasibility phase can help establish the viability of novel modes of delivery and identify facilitators and barriers to successful delivery.Encouraging office workers to break up prolonged sedentary behavior (SB) at work with regular microbreaks can be beneficial yet challenging. The Internet of Things (IoT) offers great promise for delivering more subtle and hence acceptable behavior change interventions in the workplace. We previously developed an IoT-enabled SB intervention, called WorkMyWay intervention and its technological delivery system.This study aims to evaluate the feasibility and acceptability of the WorkMyWay during work hours for 6 weeks. Questionnaires were administered before and after the intervention period to assess self-report occupational sitting and physical activity (OSPA) and psychosocial variables theoretically aligned with prolonged occupational SB . Behavioral and interactional data were obtained through the system database to determine adherence, quality of delivery, compliance, and objective OSPA. Semistructured interviews were conducted at the end of the study, and a thematic analysis was performed on interview transcripts.A mixed methods approach was adopted. A sample of 15 office workers were recruited to use t14=2.606; P=.02), retrospective memory of breaks , and prospective memory of breaks . The qualitative analysis identified 6 themes, which lent support to the high acceptability of WorkMyWay, though delivery was compromised by issues concerning Bluetooth connectivity and factors related to user behaviors. Fixing technical issues, tailoring to individual differences, soliciting organizational supports, and harnessing interpersonal influences could facilitate delivery and enhance acceptance.All 15 participants completed the study (attrition=0%) and on average used the system for 25 tracking days . Although no significant change was observed in either objective or self-report OSPA, postintervention improvements were significant in the automaticity of regular break behaviors . More industrial design and technological development work on  In the past decade, ample evidence has accumulated to suggest the unfavorable association between sedentary behavior (SB) and cardiometabolic health, even after adjusting for the amount of exercise -3. MoreoIt is challenging to design an intervention that interrupts users at work at opportune moments and encourages them to move around without causing disturbance or annoyance. Internet of Things (IoT) technologies, characterized by ubiquitous sensing, context-aware computing, and embedded interfaces, have shown great promise for delivering just-in-time adaptive interventions to improve health behaviors nonintrusively in everyday settings ,15, inclWorkMyWay following the Behavior Change Wheel and human-centered design approach . Although some participants did mention vibratory or audible reminders could be more “noticeable,” disturbance to others was raised as a concern.The idea of integrating prompts and cues for breaks with a break activity–related everyday object was evaluated differently across participants. This approach made a lot of sense and worked well to cue and facilitate breaks for some participants.In addition, as a positive spillover effect of this medium of delivery, some participants  reported drinking more liquid. When prompted in interviews, most participants expressed positive attitudes toward the potential addition of technological features to the cup device for tracking, visualizing, and prompting hydration behaviors in the future.However, several participants reported feeling tired of managing multiple devices, partly because of the unreliable connections between the 3 devices in the current system; a few participants suggested combining the wrist and cup device into 1 to reduce the complexity of system setup.WorkMyWay. All participants in the study thought their employers were happy with the behavioral target  promoted by the intervention and permissive of employees’ personal use of technologies as such. However, there were some constraints on break behaviors placed by the nature of the work and the relationships with others involved in the job role.Organizational support was identified as a major facilitator to the uptake of Different views existed regarding who should be held accountable for employees’ health-related behaviors that occurred in the workplace. Some participants thought the organization and management had “an important role to play.” Although the majority held the view that it should be down to the individual to take care of themselves and to choose the appropriate tools, it would be nice if the organization could offer some options. Encouragingly, one of the participants, who was a senior manager, participated in the study with the interest to source an intervention that could be widely implemented at the university to improve staff well-being.WorkMyWay and reducing prolonged SB.The subjective norm, or the perception that a majority in the workplace are trying to take regular breaks, was identified as another facilitator to both using WorkMyWay most of the time. For instance, when a participant did not notice the LED reminder, there was the chance that coworkers who happened to see the LED flashes could remind him or her. The physical artifact of the technology also turned out to be a conversation piece to get people talking about well-being in the workplace and sometimes to prompt them to take a break together.In addition, direct social interactions facilitated the use of For P12, P13, and P14, who shared the same office, participation as an office team enhanced the use and potentially the effectiveness of the intervention through helping each other with troubleshooting, reminding each other to adhere to the study protocol and to comply with the prompts, comparing each other’s data, and competing for fun.WorkMyWay in real-life office settings. On the basis of participant experiences, an IoT-based intervention consisting of multiple interconnected devices was complex yet manageable in the workplace. Office workers accepted and adopted the WorkMyWay system, as demonstrated with a 100% retention with an 8-week delivery protocol and 83% (25/30) adherence on tracking, which were exemplary for technology-based interventions compared with previous studies [WorkMyWay in their own interests after the study ended. While behavior change efficacy is beyond the scope of this study, the significant postintervention improvements in psychosocial determinants of occupational SB suggested high potential for behavior change. Those results together have established WorkMyWay as a promising intervention with high potential for long-term adoption and behavior change.This study evaluated the process of delivering  studies ,41. Blue studies . NonetheWorkMyWay can be improved as an intervention, which relate to broader implications for the design and delivery of digital interventions targeting SB, and potentially other health behaviors. The first lesson we can draw from the study concerns the importance of designing intervention delivery technologies with minimal reliance on users’ memories. The delivery of the current version of WorkMyWay required the user to remember to carry phones even on short breaks, to start and stop tracking on a daily basis, to place the cup device within the field of vision, and to make sure the LED was not facing away from them, which induced uncertainties to the quality and quantity of delivery. From there, we see the need for more engineering work to make data synchronization between different devices more reliable and effortless for the users; we also see a greater role for industrial design in the future to improve the presentation of the LED reminders, for example, by making it an LED ring surrounding a vessel so that it is visible from all directions. These are nontrivial aspects that warrant more considerations and investments in the design and development of digital behavior change interventions.Our study has revealed various ways in which WorkMyWay and mentioned positively by participants. Personalization should also be supported in the choice and deployment of devices, a need transpired by the fact that participants proposed new ways of wearing tracking devices and placing prompting devices to better fit their individual work practices. This echoes the finding from a previous study that calls for a greater choice of behavior change support tools and devices to be offered to satisfy individualized needs of participants [WorkMyWay. Another theory-informed intervention most similar to ours is the Stand More At Work (SMArt Work) intervention [Second, the study highlights the importance of personalization. Indeed, the ability to dynamically adjust the threshold for activity detection by tweaking parameters in the hidden setting menu was an especially useful feature of icipants . Despitervention . Both inUnder this view, many potential interventions might be created, for example, by embedding sensors and displays into all manner of everyday objects, tailoring designs to the preferences and contexts of specific individuals. The idea that our interactions with digital technologies should become more personalized and contextualized underlies much research into contextual and ubiquitous computing and its commercial realization in IoT. A third key implication from this research is therefore the need for future research to explore the wider “design space” of possible IoT-enabled behavior change interventions and to deliver generic design guidelines and toolkits for making them .WorkMyWay. We demonstrated the feasibility of using technology-captured data to monitor user adherence, compliance, and the quality and quantity of intervention delivery. This approach is advantageous as it allows implementation issues to be considered in relation to the fidelity of individual component delivery in feasibility studies and causal pathways to be potentially modeled in future larger-scale evaluations [A main strength of our study is the mixed method approach that combines system logs, activity tracking data, questionnaires, and interviews to shed light on multiple aspects of the processes of delivering luations .WorkMyWay.Nevertheless, this study has several limitations that should be noted. For instance, the intervention did not sufficiently target the constructs of knowledge and intentions, even though they were considered important determinants of the target behavior . InsteadWorkMyWay are viable and it holds great promise to become a successful behavior change intervention. Therefore, it is worth investing in further technological development and industrial design to improve the technology reliability and reduce user burdens. Future research should seek to establish the broad acceptability of similar interventional and technological approaches while expanding the range of digitally augmented objects as modes of delivery to meet diverse needs.It is acceptable and potentially feasible to deliver an SB intervention with an IoT system that involves a wearable activity tracking device, an app, and a digitally augmented everyday object . The findings suggest the interventional contents and technological approach of