How Continuous Monitoring Changes the Interaction of Patients with a Mobile Telemedicine System

The use of continuous glucose monitor changes the way patients manage their diabetes, as observed in the increased number of daily insulin bolus, the increased number of daily BG measurements, and the differences in the distribution of BG measurements throughout the day. Continuous monitoring also increases the interaction of patients with the information system and modifies their patterns of use.

Application of PZT and FBG impedance sensors for structural health monitoring of reinforced concrete beams strengthened with FRP composite materials

Esta Tesis tiene como objetivo principal el desarrollo de métodos de identificación del daño que sean robustos y fiables, enfocados a sistemas estructurales experimentales, fundamentalmente a las estructuras de hormigón armado reforzadas externamente con bandas fibras de polímeros reforzados (FRP). El modo de fallo de este tipo de sistema estructural es crítico, pues generalmente es debido a un despegue repentino y frágil de la banda del refuerzo FRP originado en grietas intermedias causadas por la flexión. La detección de este despegue en su fase inicial es fundamental para prevenir fallos futuros, que pueden ser catastróficos. Inicialmente, se lleva a cabo una revisión del método de la Impedancia Electro-Mecánica (EMI), de cara a exponer sus capacidades para la detección de daño. Una vez la tecnología apropiada es seleccionada, lo que incluye un analizador de impedancias así como novedosos sensores PZT para monitorización inteligente, se ha diseñado un procedimiento automático basado en los registros de impedancias de distintas estructuras de laboratorio. Basándonos en el hecho de que las mediciones de impedancias son posibles gracias a una colocación adecuada de una red de sensores PZT, la estimación de la presencia de daño se realiza analizando los resultados de distintos indicadores de daño obtenidos de la literatura. Para que este proceso sea automático y que no sean necesarios conocimientos previos sobre el método EMI para realizar un experimento, se ha diseñado e implementado un Interfaz Gráfico de Usuario, transformando la medición de impedancias en un proceso fácil e intuitivo. Se evalúa entonces el daño a través de los correspondientes índices de daño, intentando estimar no sólo su severidad, sino también su localización aproximada. El desarrollo de estos experimentos en cualquier estructura genera grandes cantidades de datos que han de ser procesados, y algunas veces los índices de daño no son suficientes para una evaluación completa de la integridad de una estructura. En la mayoría de los casos se pueden encontrar patrones de daño en los datos, pero no se tiene información a priori del estado de la estructura. En este punto, se ha hecho una importante investigación en técnicas de reconocimiento de patrones particularmente en aprendizaje no supervisado, encontrando aplicaciones interesantes en el campo de la medicina. De ahí surge una idea creativa e innovadora: detectar y seguir la evolución del daño en distintas estructuras como si se tratase de un cáncer propagándose por el cuerpo humano. En ese sentido, las lecturas de impedancias se emplean como información intrínseca de la salud de la propia estructura, de forma que se pueden aplicar las mismas técnicas que las empleadas en la investigación del cáncer. En este caso, se ha aplicado un algoritmo de clasificación jerárquica dado que ilustra además la clasificación de los datos de forma gráfica, incluyendo información cualitativa y cuantitativa sobre el daño. Se ha investigado la efectividad de este procedimiento a través de tres estructuras de laboratorio, como son una viga de aluminio, una unión atornillada de aluminio y un bloque de hormigón reforzado con FRP. La primera ayuda a mostrar la efectividad del método en sencillos escenarios de daño simple y múltiple, de forma que las conclusiones extraídas se aplican sobre los otros dos, diseñados para simular condiciones de despegue en distintas estructuras. Demostrada la efectividad del método de clasificación jerárquica de lecturas de impedancias, se aplica el procedimiento sobre las estructuras de hormigón armado reforzadas con bandas de FRP objeto de esta tesis, detectando y clasificando cada estado de daño. Finalmente, y como alternativa al anterior procedimiento, se propone un método para la monitorización continua de la interfase FRP-Hormigón, a través de una red de sensores FBG permanentemente instalados en dicha interfase. De esta forma, se obtienen medidas de deformación de la interfase en condiciones de carga continua, para ser implementadas en un modelo de optimización multiobjetivo, cuya solución se haya por medio de una expansión multiobjetivo del método Particle Swarm Optimization (PSO). La fiabilidad de este último método de detección se investiga a través de sendos ejemplos tanto numéricos como experimentales. ABSTRACT This thesis aims to develop robust and reliable damage identification methods focused on experimental structural systems, in particular Reinforced Concrete (RC) structures externally strengthened with Fiber Reinforced Polymers (FRP) strips. The failure mode of this type of structural system is critical, since it is usually due to sudden and brittle debonding of the FRP reinforcement originating from intermediate flexural cracks. Detection of the debonding in its initial stage is essential thus to prevent future failure, which might be catastrophic. Initially, a revision of the Electro-Mechanical Impedance (EMI) method is carried out, in order to expose its capabilities for local damage detection. Once the appropriate technology is selected, which includes impedance analyzer as well as novel PZT sensors for smart monitoring, an automated procedure has been design based on the impedance signatures of several lab-scale structures. On the basis that capturing impedance measurements is possible thanks to an adequately deployed PZT sensor network, the estimation of damage presence is done by analyzing the results of different damage indices obtained from the literature. In order to make this process automatic so that it is not necessary a priori knowledge of the EMI method to carry out an experimental test, a Graphical User Interface has been designed, turning the impedance measurements into an easy and intuitive procedure. Damage is then assessed through the analysis of the corresponding damage indices, trying to estimate not only the damage severity, but also its approximate location. The development of these tests on any kind of structure generates large amounts of data to be processed, and sometimes the information provided by damage indices is not enough to achieve a complete analysis of the structural health condition. In most of the cases, some damage patterns can be found in the data, but none a priori knowledge of the health condition is given for any structure. At this point, an important research on pattern recognition techniques has been carried out, particularly on unsupervised learning techniques, finding interesting applications in the medicine field. From this investigation, a creative and innovative idea arose: to detect and track the evolution of damage in different structures, as if it were a cancer propagating through a human body. In that sense, the impedance signatures are used to give intrinsic information of the health condition of the structure, so that the same clustering algorithms applied in the cancer research can be applied to the problem addressed in this dissertation. Hierarchical clustering is then applied since it also provides a graphical display of the clustered data, including quantitative and qualitative information about damage. The performance of this approach is firstly investigated using three lab-scale structures, such as a simple aluminium beam, a bolt-jointed aluminium beam and an FRP-strengthened concrete specimen. The first one shows the performance of the method on simple single and multiple damage scenarios, so that the first conclusions can be extracted and applied to the other two experimental tests, which are designed to simulate a debonding condition on different structures. Once the performance of the impedance-based hierarchical clustering method is proven to be successful, it is then applied to the structural system studied in this dissertation, the RC structures externally strengthened with FRP strips, where the debonding failure in the interface between the FRP and the concrete is successfully detected and classified, proving thus the feasibility of this method. Finally, as an alternative to the previous approach, a continuous monitoring procedure of the FRP-Concrete interface is proposed, based on an FBGsensors Network permanently deployed within that interface. In this way, strain measurements can be obtained under controlled loading conditions, and then they are used in order to implement a multi-objective model updating method solved by a multi-objective expansion of the Particle Swarm Optimization (PSO) method. The feasibility of this last proposal is investigated and successfully proven on both numerical and experimental RC beams strengthened with FRP.

Sistema de comunicaciones para una planta fotovoltaica

Las plantas solares fotovoltaicas, que son cada vez más habituales en nuestra sociedad, necesitan contar con un sistema de comunicaciones que permita la monitorización continua del funcionamiento de los diferentes equipos así como el control remoto de los mismos y la regulación de la producción. En este Proyecto se ha estudiado la estructura eléctrica y constructiva de una planta fotovoltaica genérica, prestando especial atención a los requerimientos que debe reunir el sistema de comunicaciones. El diseño del sistema de comunicaciones se ha realizado sobre una planta solar ficticia aún sin construir analizando su estructura sobre plano y aproximando la topología de red que se necesita implementar. Partiendo de esta estructura y de las cualidades de este tipo de instalaciones se ha realizado un análisis de las tecnologías disponibles, optando por una solución inalámbrica mixta, utilizando enlaces WiMAX y WiFi, manteniendo tecnología cableada únicamente para interconexión cercana de equipos. Esta elección se ha realizado con la intención de dotar a la planta de un sistema fiable, robusto y flexible sin descuidar el factor económico; para eso se ha cuidado la selección de equipamiento, su disposición en la planta y su configuración básica de funcionamiento. A partir de la solución definitiva se ha obtenido un presupuesto económico de la instalación. Se ha completado el diseño mediante simulaciones radioeléctricas, para asegurar un correcto funcionamiento de los diferentes enlaces. The photovoltaic solar power plants, which are becoming more common in our society, need a communications system that allowing continuous monitoring of the operation of the different devices as well as their remote control and regulation of the production. In this Project, electrical structure and construction of a generic photovoltaic solar plant have been studied, paying special attention to the essential requirements which must be fulfilled by the communication system. The communication system design is was carried out assuming that photovoltaic solar plant is fictitious and before its construction, analysing its structure over site plan and approximating the net topology in order to implement it. The analysis of the available technologies was performed basing on this structure as well as the qualities of this kind of facilities. As a result, a wireless mix option with WIMAX and WiFi links was chosen, using cable technology only to the close interconnection between equipments. This choice was made with the intention of giving the plant with a reliable, robust and flexible system without neglecting the economic factor, so that, the selection of equipment, the layout at the plant and operating basic configuration have been paid great attention. From the final solution is obtained a financial budget of the facility. Design is completed by radioelectric simulations to ensure the operation of the several links properly.

PREDIRCAM eHealth platform for individualized telemedical assistance for lifestyle modification in the treatment of obesity, diabetes, and cardiometabolic risk prevention: a pilot study (PREDIRCAM 1)

Background: Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention. Methods: PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform. Results: The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible. Conclusions: The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.

Improving brain injury cognitive rehabilitation by personalized telerehabilitation services: Guttmann neuropersonal trainer

Cognitive rehabilitation aims to remediate or alleviate the cognitive deficits appearing after an episode of acquired brain injury (ABI). The purpose of this work is to describe the telerehabilitation platform called Guttmann Neuropersonal Trainer (GNPT) which provides new strategies for cognitive rehabilitation, improving efficiency and access to treatments, and to increase knowledge generation from the process. A cognitive rehabilitation process has been modeled to design and develop the system, which allows neuropsychologists to configure and schedule rehabilitation sessions, consisting of set of personalized computerized cognitive exercises grounded on neuroscience and plasticity principles. It provides remote continuous monitoring of patient's performance, by an asynchronous communication strategy. An automatic knowledge extraction method has been used to implement a decision support system, improving treatment customization. GNPT has been implemented in 27 rehabilitation centers and in 83 patients' homes, facilitating the access to the treatment. In total, 1660 patients have been treated. Usability and cost analysis methodologies have been applied to measure the efficiency in real clinical environments. The usability evaluation reveals a system usability score higher than 70 for all target users. The cost efficiency study results show a relation of 1-20 compared to face-to-face rehabilitation. GNPT enables brain-damaged patients to continue and further extend rehabilitation beyond the hospital, improving the efficiency of the rehabilitation process. It allows customized therapeutic plans, providing information to further development of clinical practice guidelines.

Identification of intermediate debonding damage in FRP-plated RC beams based on multi-objective particle swarm optimization without updated baseline model

Fiber reinforced polymer composites (FRP) have found widespread usage in the repair and strengthening of concrete structures. FRP composites exhibit high strength-to-weight ratio, corrosion resistance, and are convenient to use in repair applications. Externally bonded FRP flexural strengthening of concrete beams is the most extended application of this technique. A common cause of failure in such members is associated with intermediate crack-induced debonding (IC debonding) of the FRP substrate from the concrete in an abrupt manner. Continuous monitoring of the concrete?FRP interface is essential to pre- vent IC debonding. Objective condition assessment and performance evaluation are challenging activities since they require some type of monitoring to track the response over a period of time. In this paper, a multi-objective model updating method integrated in the context of structural health monitoring is demonstrated as promising technology for the safety and reliability of this kind of strengthening technique. The proposed method, solved by a multi-objective extension of the particle swarm optimization method, is based on strain measurements under controlled loading. The use of permanently installed fiber Bragg grating (FBG) sensors embedded into the FRP-concrete interface or bonded onto the FRP strip together with the proposed methodology results in an automated method able to operate in an unsupervised mode.

Validación de HP UV-LED para la detección en continuo de contaminantes en aguas continentales mediante fluorescencia

La preservación del medio ambiente, el avance en las técnicas para que el impacto de la actividad humana sobre la fauna y flora sea lo menor posible, hacen que se deban monitorizar los diversos indicadores de calidad. El presente estudio viene motivado debido a que actualmente existen sistemas de medida y control en continuo de la calidad de las aguas, al margen de los estudios de laboratorio por toma de muestras, a través de los cuales se obtienen indicadores de calidad. El desarrollo tecnológico en analizadores en continuo para la medida de fósforo, amonio, DBO y otros, hacen que cada vez se consiga un control más exhaustivo de la calidad en tiempo real. Sin embargo, la detección temprana de contaminantes que no deben encontrarse presentes en el agua, hacen que el desarrollo de sensores de detección de estos contaminantes sea de gran utilidad. A este respecto, las técnicas mediante fluorescencia presentan enormes ventajas, ya que no existe contacto directo con la muestra, reduciéndose el desgaste y alargando el tiempo entre mantenimientos, como se ha comprobado en numerosos desarrollos con tecnología láser. Para la producir fluorescencia, tradicionalmente se vienen utilizando en el laboratorio principalmente lámparas de gas y monocromadores. Los nuevos LED de alta potencia en el espectro ultravioleta son una alternativa muy interesante que además puede ser aplicada en los mencionados sistemas de medición en continuo. En este trabajo se realiza un estudio de viabilidad de estos dispositivos como fuentes de excitación para la producción de fluorescencia tomando como contaminantes los hidrocarburos. El funcionamiento en estaciones en continuo hace que se tenga que realizar además ensayos de vida acelerados, así como estudios de modos de trabajo. Al respecto de la fluorescencia producida, se estudia la influencia de factores que pueden afectar a las medidas, tales como la temperatura. El estudio del espectro y su análisis para la identificación del contaminante es otro de los puntos desarrollados en este trabajo. Por último, y dado que la monitorización se realiza en modo continuo, es necesario un sistema de comunicaciones compacto y fiable: en este apartado se analizan los metamateriales como solución tecnológica, ya que se adapta perfectamente a la filosofía de estas estaciones de medición. ABSTRACT Currently the monitoring of quality indicators is a need to preserve the environment and minimize the impact of human activity on the fauna and flora. Currently there are measuring systems and continuous monitoring of water quality, regardless of sampling laboratory studies, through which quality indicators are obtained. Technological development in continuous analyzers for the measurement of phosphorus, ammonia, BOD and others increasingly make a more comprehensive real-time quality control is achieved. However, early detection of contaminants that should not be present in the water, make the development of sensors for detecting these contaminants is very useful. In this regard, fluorescence techniques have huge advantages, since there is no direct contact with the sample, reducing wear and extending the time between maintenance, as has been demonstrated in numerous developments in laser technology. To produce fluoresce, traditionally are being used mainly gas lamps and monochromators at the laboratory. The new high-power LEDs in the ultraviolet spectrum are a very interesting alternative that can also be applied in the above continuous measurement systems. In this paper a viability study of these devices as excitation sources to produce fluorescence using hydrocarbon as contaminants is performed. The stations in continuous operation makes it necessary to also perform accelerated life tests and studies operating modes. In regard to the fluorescence produced, the influence of factors that may affect the measurements, such as temperature is studied. The study of the spectrum and analysis to identify the contaminant is another of the points developed in this work. Finally, since the monitoring is carried out in continuous mode, a compact and reliable communication is necessary: in this section metamaterials as a technological solution is analyzed since it fits perfectly with the philosophy of these measuring stations.

Approaches Regarding the Competition in Romanian Sugar Market

This paper proposes an economic instrument designed to assess the competitive nature of the sugar industry in Romania. In the first part of the paper is presented the theoretical background underlying index (HHI) and its calculation methodology. Then comes the results of a first application of this index for a total of 10 plants in the sugar industry, the robustness of these results is discussed. We believe HHI is a proactive tool that may prove useful competition authority, in its pursuit of continuous monitoring of various industries in the economy and in the internal decision-making on resource allocation institution (Peacock, and Prisecaru, 2013).The starting point of our research is to free competition in the European market with competitors much stronger than Romanian plants, plants that produce at a price lower than the domestic ones. In our study we will see if it is a concentration of production in factories around the strongest in Romania, concentration accompanied by the collapse of those who could not resist the market.The market concentration, competition policy, we will follow using the HHI index, for evaluation of impact analysis on existing trade, the number and size of competitors, protecting existing sales structures, avoiding disruptions in the competitive environment, etc.

Heart Failure Monitoring System Based on Wearable and Information Technologies

In Europe, Cardiovascular Diseases (CVD) are the leading source of death, causing 45% of all deceases. Besides, Heart Failure, the paradigm of CVD, mainly affects people older than 65. In the current aging society, the European MyHeart Project was created, whose mission is to empower citizens to fight CVD by leading a preventive lifestyle and being able to be diagnosed at an early stage. This paper presents the development of a Heart Failure Management System, based on daily monitoring of Vital Body Signals, with wearable and mobile technologies, for the continuous assessment of this chronic disease. The System makes use of the latest technologies for monitoring heart condition, both with wearable garments (e.g. for measuring ECG and Respiration); and portable devices (such as Weight Scale and Blood Pressure Cuff) both with Bluetooth capabilities

Analysis, monitoring, and management of quality of experience in video delivery services over IP

Esta tesis estudia la monitorización y gestión de la Calidad de Experiencia (QoE) en los servicios de distribución de vídeo sobre IP. Aborda el problema de cómo prevenir, detectar, medir y reaccionar a las degradaciones de la QoE desde la perspectiva de un proveedor de servicios: la solución debe ser escalable para una red IP extensa que entregue flujos individuales a miles de usuarios simultáneamente. La solución de monitorización propuesta se ha denominado QuEM(Qualitative Experience Monitoring, o Monitorización Cualitativa de la Experiencia). Se basa en la detección de las degradaciones de la calidad de servicio de red (pérdidas de paquetes, disminuciones abruptas del ancho de banda...) e inferir de cada una una descripción cualitativa de su efecto en la Calidad de Experiencia percibida (silencios, defectos en el vídeo...). Este análisis se apoya en la información de transporte y de la capa de abstracción de red de los flujos codificados, y permite caracterizar los defectos más relevantes que se observan en este tipo de servicios: congelaciones, efecto de “cuadros”, silencios, pérdida de calidad del vídeo, retardos e interrupciones en el servicio. Los resultados se han validado mediante pruebas de calidad subjetiva. La metodología usada en esas pruebas se ha desarrollado a su vez para imitar lo más posible las condiciones de visualización de un usuario de este tipo de servicios: los defectos que se evalúan se introducen de forma aleatoria en medio de una secuencia de vídeo continua. Se han propuesto también algunas aplicaciones basadas en la solución de monitorización: un sistema de protección desigual frente a errores que ofrece más protección a las partes del vídeo más sensibles a pérdidas, una solución para minimizar el impacto de la interrupción de la descarga de segmentos de Streaming Adaptativo sobre HTTP, y un sistema de cifrado selectivo que encripta únicamente las partes del vídeo más sensibles. También se ha presentado una solución de cambio rápido de canal, así como el análisis de la aplicabilidad de los resultados anteriores a un escenario de vídeo en 3D. ABSTRACT This thesis proposes a comprehensive approach to the monitoring and management of Quality of Experience (QoE) in multimedia delivery services over IP. It addresses the problem of preventing, detecting, measuring, and reacting to QoE degradations, under the constraints of a service provider: the solution must scale for a wide IP network delivering individual media streams to thousands of users. The solution proposed for the monitoring is called QuEM (Qualitative Experience Monitoring). It is based on the detection of degradations in the network Quality of Service (packet losses, bandwidth drops...) and the mapping of each degradation event to a qualitative description of its effect in the perceived Quality of Experience (audio mutes, video artifacts...). This mapping is based on the analysis of the transport and Network Abstraction Layer information of the coded stream, and allows a good characterization of the most relevant defects that exist in this kind of services: screen freezing, macroblocking, audio mutes, video quality drops, delay issues, and service outages. The results have been validated by subjective quality assessment tests. The methodology used for those test has also been designed to mimic as much as possible the conditions of a real user of those services: the impairments to evaluate are introduced randomly in the middle of a continuous video stream. Based on the monitoring solution, several applications have been proposed as well: an unequal error protection system which provides higher protection to the parts of the stream which are more critical for the QoE, a solution which applies the same principles to minimize the impact of incomplete segment downloads in HTTP Adaptive Streaming, and a selective scrambling algorithm which ciphers only the most sensitive parts of the media stream. A fast channel change application is also presented, as well as a discussion about how to apply the previous results and concepts in a 3D video scenario.

A telehealth system for Parkinson's disease remote monitoring. The PERFORM approach.

This paper summarizes the experience and the lessons learned from the European project PERFORM (A sophisticated multi-parametric system FOR the continuous effective assessment and monitoring of motor status in Parkinson's disease and other neurodegenerative diseases). PERFORM is aimed to provide a telehealth system for the remote monitoring of Parkinson's disease patients (PD) at their homes. This paper explains the global experience with PERFORM. It summarizes the technical performance of the system and the feedback received from the patients in terms of usability and wearability.