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.

Monitor sísmico interactivo

Este trabajo tiene como objetivos la monitorización en tiempo real de la actividad sísmica, tanto próxima como lejana, a partir de los datos sísmicos registrados por una estación de banda ancha, y el desarrollo de un sistema de difusión interactiva de información actualizada de terremotos, destinado al público general. Ambas fuentes de información se mostrarán a través de una Unidad de Visualización denominada “Monitor Sísmico Interactivo”. El registro de los datos sísmicos se realiza utilizando el sensor de tres componentes de la estación sísmica GUD, perteneciente a la Red Digital de Banda Ancha y transmisión digital del Instituto Geográfico Nacional, instalada en la Basílica del Valle de los Caídos, en lalocalidad de Guadarrama (Madrid). En la E.T.S.I. Topografía, Geodesia y Cartografía se ha instalado un ordenador con conexión a Internet, para la recepción y almacenamiento de los datos, y los programas Scream y Drumplot desarrollados por Guralp, necesarios para la monitorización de la señal sísmica en tiempo real. A partir de estos datos, mediante aplicaciones desarrolladas bajo programación Linux y haciendo uso de las herramientas que ofrece el software SAC (Seismic Analysis Code), se genera además un registro gráfico y una película animada de dicha segmentación para cada evento. Se ha configurado un servidor de correo y una cuenta para la recepción de dos tipos de mensajes de correo, enviados desde la sede central del Instituto Geográfico Nacional, con la información de los eventos registrados por GUD una vez revisados: - Mensajes enviados diariamente, con un listado de eventos ocurridos en los 30 últimos días. - Mensajes con la información en cuasi tiempo real de la última alerta sísmica. Se ha desarrollado el programa “saco” para la gestión del correo recibido que analiza la información sísmica, la almacena en ficheros y ejecuta sobre ellos las aplicaciones de dibujo. Estas aplicaciones han sido previamente desarrolladas bajo programación Linux y software GMT (Generic Mapping Tools), y a partir de ellas se generan automáticamente las distintas imágenes que se visualizan en el Monitor Sísmico: un mapa de sismicidad próxima en la Península Ibérica, un mapa de sismicidad lejana en el mundo, un mapa de detalle para localizar y representar la última alerta generada, los listados con la información de los eventos representados en los mapas, los registros gráficos y las películas animadas de dichos sismogramas. Monitor Sísmico Interactivo ha sido desarrollado para ofrecer además la posibilidad de interactuar con la Unidad de Visualización: se ha creado una base de datos para uso científico donde se almacenan todos los eventos registrados por GUD. Así el usuario puede realizar una petición, a través del envío de un mensaje de correo, que le permite visualizar de forma instantánea las imágenes que muestran la información de cualquier terremoto de su interés. ABSTRACT This study is aimed at real-time monitoring of both near and distant seismic activityfrom the seismic data recorded by a broadband seismic station, and the development of an interactive broadcast system of updated information of earthquakes, for the general public. Bothsources of information are displayed through a display unit called "Interactive Seismic Monitor". The seismic data recording is carried out by using the three-component sensor of the GUD seismic station, which belongs to the Digital Network Broadband and digital broadcast of the National Geographic Institute, housed in the Basilica of The Valley of the Fallen, in the town of Guadarrama (Madrid). A computer with Internet connection has been installed in E.T.S.I. Surveying, Geodesy and Cartography for receiving and storing data, together with Scream and Drumplot programs, developed by Guralp, which are necessary for monitoring the real time seismic signal. Based on the data collected, through programming applications developed under Linux system and using the software tools provided by the SAC (Seismic Analysis Code), a chart recorder and an animated gif image of the segmentation for each event are also generated. A mail server and a mail account have been configured for the receipt of two types of email messages, sent from the National Geographic Institute head office, with the information of the events recorded by GUD after being reviewed: - Messages sent daily, providing a list of events in the past 30 days. - Messages containing information on near real-time seismic of the last seismic alert. A program called "saco" has also been developed for handling mail received that analyzes the seismic data, which stores it in files and runs drawing applications on them. These applications have been previously developed under Linux system and software programming GMT (Generic Mapping Tools), and from them different images that are displayed on the Seismic Monitor are automatically generated: a near seismicity Iberian peninsula map, a distant seismicity world map, a detailed map to locate and represent the last seismic alert generated, the lists with the information of the events depicted in the maps,together with the charts and the animated gif image of such seismograms. Interactive Seismic Monitor has been developed to offer any user the possibility of interacting with the display unit: a database has been created for scientific use which stores all the events recorded by GUD. Thus, any user could make a request, by sending an e-mail that allows them to view instantly all the images showing the information of any earthquake of interest on the display unit.

BioMet®Phon: A system to monitor phonation quality in the clinics

BioMet®Phon is a software application developed for the characterization of voice in voice quality evaluation. Initially it was conceived as plain research code to estimate the glottal source from voice and obtain the biomechanical parameters of the vocal folds from the spectral density of the estimate. This code grew to what is now the Glottex®Engine package (G®E). Further demands from users in laryngology and speech therapy fields instantiated the development of a specific Graphic User Interface (GUI’s) to encapsulate user interaction with the G®E. This gave place to BioMet®Phon, an application which extracts the glottal source from voice and offers a complete parameterization of this signal, including distortion, cepstral, spectral, biomechanical, time domain, contact and tremor parameters. The semantic capabilities of biomechanical parameters are discussed. Study cases from its application to the field of laryngology and speech therapy are given and discussed. Validation results in voice pathology detection are also presented. Applications to laryngology, speech therapy, and monitoring neurological deterioration in the elder are proposed.

On the harmonic analysis of cup anemometer rotation speed: A principle to monitor performance and maintenance status of rotating meteorological sensors

The calibration results of one anemometer equipped with several rotors, varying their size, were analyzed. In each case, the 30-pulses pert turn output signal of the anemometer was studied using Fourier series decomposition and correlated with the anemometer factor (i.e., the anemometer transfer function). Also, a 3-cup analytical model was correlated to the data resulting from the wind tunnel measurements. Results indicate good correlation between the post-processed output signal and the working condition of the cup anemometer. This correlation was also reflected in the results from the proposed analytical model. With the present work the possibility of remotely checking cup anemometer status, indicating the presence of anomalies and, therefore, a decrease on the wind sensor reliability is revealed.

Passive neutron area monitor with pairs of TLDs as neutron detector

A passive neutron area monitor has been designed using Monte Carlo methods; the monitor is a polyethylene cylinder with pairs of thermoluminescent dosimeters (TLD600 and TLD700) as thermal neutron detector. The monitor was calibrated with a bare and a thermalzed 241AmBe neutron sources and its performance was evaluated measuring the ambient dose equivalent due to photoneutrons produced by a 15 MV linear accelerator for radiotherapy and the neutrons in the output of a TRIGA Mark III radial beam port.

Use of infrared thermography as a tool to monitor skin temperature along the recovery process of an anterior cruciate ligament surgery

Infrared thermography (IRT) is a safe and non-invasive tool used for examining physiological functions based on skin temperature (Tsk) control. Thermograms from 25 anterior cruciate ligament (ACL) surgically operated patients (2 female, 23 male) were taken with a FLIR infrared camera according to the protocol established by the International Academy of Clinical Thermology (IACT). This work consists of 4 studies. Studies 1 and 3 were related to establish the probable thermal difference among different moments of an ACL rupture after surgery: before starting the rehabilitation (P0), at the end of rehabilitation (P1) and 18 months from the end of rehabilitation (P2). For this purpose, on the other hand, studies 2 and 4 were related to establish the skin thermal difference (Tsk) between the injured and the non-injured leg in P0, P1 and P2. Results of the first study showed significant temperature increases in the posterior thigh area between P0 and P1 probably due to a compensatory mechanism. According to this, we can conclude that temperature of the posterior area of the injured and noninjured leg has increased from the first to the last day of the rehabilitation process. In the second study we found significant temperature differences between the injured and non-injured leg in both stages of rehabilitation (p<.01). On the one hand, the temperature of the injured leg is higher in the anterior view and the temperature of the non-injured leg is higher in the posterior view. By the time the patients had recovered from the reconstruction, thermal imbalances should have not been shown between symmetrical parts, but differences seemed to be still latent.. Study 3 shows that temperatures seem to be higher after a year and a half (P2) than in P1. Study 4 shows how thermal values 18 months later seemed to be normalized between both legs. No significant differences were found between the injured leg and the noninjured leg after one year and a half of the rehabilitation process. Considering results from Study 3 and 4 we can conclude that patients seemed to have recovered from a thermal point of view. The temperature in P2 was higher but symmetrical. RESUMEN La termografía infrarroja (IRT) es una herramienta segura y no invasiva utilizada para examinar funciones fisiológicas que se basan en el control de temperatura de la piel (Tsk). Termogramas de 25 pacientes intervenidos quirúrgicamente del ligamento cruzado anterior (LCA) (2 mujeres, 23 hombres) fueron tomadas con una cámara de infrarrojos FLIR de acuerdo con el protocolo establecido por la Academia Internacional de Termología Clínica (IACT). Este trabajo consiste en 4 estudios. Los estudios 1 y 3 describen la diferencia térmica entre los diferentes momentos tras la operación del ligamento cruzado anterior: antes de comenzar la rehabilitación (P0), al final de la rehabilitación (P1) y 18 meses tras finalizar la rehabilitación (P2). Por otra parte, los estudios 2 y 4 describen la diferencia de temperatura de la piel (Tsk) entre la pierna lesionada y la pierna no lesionada en P0, P1 y P2. Los resultados del primer estudio mostraron aumentos significativos de temperatura en la zona posterior de los muslos entre P0 y P1, probablemente debido a un mecanismo de compensación. De acuerdo con esto, se puede concluir que la temperatura de la zona posterior de la pierna lesionada y no lesionada se ha incrementado desde el primero hasta el último día del proceso de rehabilitación. En el segundo estudio se encontraron diferencias significativas de temperatura entre la pierna lesionada y no lesionada en ambas etapas de la rehabilitación (p<.01). Por un lado, la temperatura de la pierna lesionada es mayor en la vista anterior. Por otro lado, la temperatura de la pierna no lesionada es mayor en la vista posterior. Una vez que los pacientes se han recuperado de todo el proceso, no deberían existir desequilibrios térmicos entre partes simétricas del cuerpo, pero las diferencias todavía estaban latentes. El tercer estudio muestra que la temperatura es más alta en P2 que en P1. El cuarto estudio muestra cómo los valores térmicos entre ambas piernas en P2 se han normalizado entre ambas piernas. No se encontraron diferencias significativas entre la pierna lesionada y la pierna no lesionada después de 18 meses tras el proceso de rehabilitación. Considerando los resultados del studio 3 y 4, podemos concluir que se ha llegado a la recuperación total desde un punto de vista térmico. La temperatura es más elevada en P2 pero simétrica.