Background Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF.

Sustainable development is crucial to securing the future of humanity. Blockchain as a disruptive technology and a driver for social change has exhibited great potential to promote sustainable practices and help organizations and governments achieve the United Nations' Sustainable Development Goals (SDGs). Existing literature reviews on blockchain and sustainability often focus only on topics related to a few SDGs. There is a need to consolidate existing results in terms of SDGs and provide a comprehensive overview of the impacts that blockchain technology may have on each SDG. This paper intends to bridge this gap, presenting a tertiary review based on 42 literature reviews, to investigate the relationship between blockchain and sustainability in light of SDGs. The method used is a consensus-based expert elicitation with thematic analysis. The findings include a novel and comprehensive mapping of impact-based interlinkage of blockchain and SDGs and a systematic overview of drivers and barriers to adopting blockchain for sustainability. The findings reveal that blockchain can have a positive impact on all 17 SDGs though some negative effects can occur and impede the achievement of certain objectives. 76 positive and 10 negative linkages between blockchain adoption and the 17 SDGs as well as 45 factors that drive or hinder blockchain adoption for the achievement of SDGs have been identified. Research gaps to overcome the barriers and enhance blockchain's positive impacts have also been identified. The findings may help managers in evaluating the applicability and tradeoffs, and policymakers in making supportive measures to facilitate sustainability using blockchain.

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In response to new and innovating blockchainbased systems with Internet of Things (IoT), there is a need for consensus mechanisms that can provide high transaction throughput and security, despite varying network quality. Honeybadger was the first practical, asynchronous Byzantine Fault Tolerance (BFT) consensus protocol, achieving high scalability and robustness without making any timing assumptions regarding the network. To improve the current asynchronous consensus protocols, we designed Asynchronous Byzantine Fault Tolerance (ABFT) consensus protocol through integrating threshold Elliptic Curve Digital Signature Algorithm (ECDSA) signatures and optimization of erasure coding parameters, as well as additional implementation-level optimizations. We implement a prototype of ABFT, and evaluate its performance at scale in a global WAN network and a network affected by asymmetric network degradation. Our results show that ABFT provides considerably higher performance, significantly lower computational overhead, and greater scalability than its predecessors. ABFT can reach up to 38.700 transactions per second in throughput. Furthermore, we empirically show that ABFT is unaffected by asymmetric network degradation within the fault threshold.