Entornos de ayuda a la vida independiente de personas mayores sobre servicios de redes de próxima generación

El progresivo envejecimiento de la población está produciendo una elevada demanda de servicios socio‐asistenciales por parte de las personas mayores para mantener su vida independiente y el consiguiente “envejecimiento activo”. La iniciativa Ambient Assisted Living (AAL) promueve el “envejecimiento activo” a través de las Tecnologías de la Información y las Comunicaciones (TIC) y es en ella donde se centrará el trabajo de esta tesis doctoral. Una característica fundamental de los servicios AAL es su adaptación y personalización a las características y preferencias del usuario y su contexto. Así, el paradigma “context awareness” presenta una gran relevancia en la provisión de servicios AAL y en el soporte a la vida independiente de las personas mayores. Concretamente, la utilización de ontologías permite crear modelos de usuarios y contexto que pueden ser utilizadas para los mecanismos de razonamiento incluidos en los servicios context‐aware. Por otra parte, los usuarios actualmente precisan acceder a un conjunto de servicios desde cualquier red de acceso y desde cualquier dispositivo. Las redes de próxima generación (Next Generation Networks‐NGN) lo hacen posible pues ofrecen una convergencia dispositivo‐red‐servicio. La tecnología IMS (IP Multimedia Subsystem) es una arquitectura que implementa el paradigma NGN y ofrece una serie de servicios de red genéricos llamados servicios habilitadores o enablers que pueden ser reutilizados en cualquier aplicación, soportando mecanismos de interoperabilidad entre aplicaciones y permitiendo un desarrollo robusto, rápido y sencillo. Además, los servicios enablers permiten mecanismos de gestión de la información de usuario para realizar una provisión adaptada del servicio en función de la información del estado del usuario. El objetivo de esta tesis doctoral se centra en establecer un marco de convergencia entre estos dos campos diseñando y desarrollando un conjunto de servicios enablers soportados en una arquitectura IMS implementada para soportar la provisión de aplicaciones AAL bajo el paradigma context‐awareness y la triple convergencia reddispositivo‐ servicio cubriendo así las necesidades y requisitos de las personas mayores. Entre las aportaciones de la presente tesis se destaca la realización de un modelo de plataforma servicios AAL, denominado Residencia Virtual Asistiva, para su provisión en el domicilio de la persona mayor, así como la propuesta de implementación de sus servicios a través de servicios enablers. Por otra parte se define una ontología destinada a modelar servicios AAL así como sus usuarios (personas mayores) para lograr una provisión personalizada y adaptada de servicios AAL. Esta ontología se ha implementado a través del servicio de presencia de la arquitectura IMS para poder crear perfiles de usuario y así poder realizar dicha provisión personalizada. Además, se desarrolla una aplicación de teleconsulta, como ejemplo de servicio AAL, que utiliza una serie de servicios enablers desarrollados para ofrecer funcionalidades avanzadas a la aplicación. Bajo el paradigma contex‐awareness se ha desarrollado y evaluado técnicamente un servicio enabler para ofrecer soporte a la movilidad y a la independencia de las personas mayores con deterioro cognitivo que sufren episodios de desorientación espacial. ABSTRACT The progressive ageing of the population is making elderly people demand sociohealthcare services to maintain an independent living and therefore an “active ageing”. The initiative Ambient Assisted Living (AAL), on which the current PhD thesis is focused, promotes the “active ageing” by means of Information and Communication Technologies (ICT). Essential features of AAL services are the adaptation and personalization to the user’s characteristics and preferences as well as user’s context. Thus, the “context‐awareness” paradigm implies a great importance in the AAL service provision and the elderly independent living support. In particular, the usage of ontologies allows creating user and contexts models to be employed in the reasoning mechanism of context‐aware services. On the other hand, users currently require accessing to a set of services from anywhere and any device. Next‐Generation Networks (NGN) support this need by offering a service‐network‐device convergence. The IP Multimedia Subsystem (IMS) technology is an architecture that implements the NGN paradigm and offers a generic network services know as service enabler which can be reused by any application supporting application interoperability mechanism as well as allowing a simple, fast and robust application development. Furthermore, the service enablers offer user’s information management procedures to achieve and adapt service provision considering the user’s status. The objective of this PhD thesis is focused on establishing a convergence framework between these two previous fields by designing and developing a group of service enablers that will be deployed in an IMS architecture. The enablers developed will support the AAL applications provision from the context‐awareness paradigm and service‐network‐device convergence in order to cover the elderly people’s requirements and needs. Among the contributions achieved in this PhD thesis, the definition of an AAL platform service model, named as “Assited Virtual Nursing Home”, for being deployed in the older adult home is emphasised. In addition, a proposal of service enablers to support the AAL service defined in the model is made. Otherwise, an ontology is defined to model AAL services as well as their users with the aim at achieve a personalized and adapted AAL service. This ontology has been implemented by means of the IMS service presence in order to create users profiles to be used in the personalized AAL services. As an example of AAL service, a teleconsulting application has been developed to employ a group of service enablers developed using a set of advanced functionalities. Considering the context‐paradigm, a service enabler has been developed and technologically evaluated to support the mobility and independence of elderly people with mild cognitive impairment who suffers spatial disorientation episodes.

A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

BACKGROUND: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. METHODOLOGY: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. FINDINGS: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. CONCLUSIONS: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. TRIAL REGISTRATION: Clinical-Trials.gov: NCT01117675.

Integration of multisensor hybrid reasoners to support personal autonomy in the smart home.

The deployment of the Ambient Intelligence (AmI) paradigm requires designing and integrating user-centered smart environments to assist people in their daily life activities. This research paper details an integration and validation of multiple heterogeneous sensors with hybrid reasoners that support decision making in order to monitor personal and environmental data at a smart home in a private way. The results innovate on knowledge-based platforms, distributed sensors, connected objects, accessibility and authentication methods to promote independent living for elderly people. TALISMAN+, the AmI framework deployed, integrates four subsystems in the smart home: (i) a mobile biomedical telemonitoring platform to provide elderly patients with continuous disease management; (ii) an integration middleware that allows context capture from heterogeneous sensors to program environment¿s reaction; (iii) a vision system for intelligent monitoring of daily activities in the home; and (iv) an ontologies-based integrated reasoning platform to trigger local actions and manage private information in the smart home. The framework was integrated in two real running environments, the UPM Accessible Digital Home and MetalTIC house, and successfully validated by five experts in home care, elderly people and personal autonomy.