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.

Smart Spaces and Smart Objects interoperability Architecture (S3OiA)

The presented work aims to contribute towards the standardization and the interoperability off the Future Internet through an open and scalable architecture design. We present S³OiA as a syntactic/semantic Service-Oriented Architecture that allows the integration of any type of object or device, not mattering their nature, on the Internet of Things. Moreover, the architecture makes possible the use of underlying heterogeneous resources as a substrate for the automatic composition of complex applications through a semantic Triple Space paradigm. Created applications are dynamic and adaptive since they are able to evolve depending on the context where they are executed. The validation scenario of this architecture encompasses areas which are prone to involve human beings in order to promote personal autonomy, such as home-care automation environments and Ambient Assisted Living.

Validation tool for smart screening of language disorders in pediatrics care

Primary-care pediatricians could play a key role in early detection of development disorders as quick as they might have enough time and knowledge for suitable screenings at clinical routine. This research paper focuses on the development and validation of a knowledge-based web tool whose aim is to support a smart detection of developmental disorders in early childhood. Thus, the use of the system can trigger the necessary preventive and therapeutic actions from birth until the age of six. The platform was designed on the basis of an analysis of significant 21 cases of children with language disorders that supported the creation of a specific knowledge base, its ontology and a set of description logic relations. The resulting system is being validated in a scalable approach with a team of seven experts from the fields of neonathology, pediatrics, neurology and language therapy.

iCarer Project: Intelligent Care Guidance and Learning Services Platform for Informal Carers of the Elderly

The increasing ageing population is demanding new care approaches to maintain the quality of life of elderly people. Informal carers are becoming crucial agents in the care and support of elderly people, which can lead to those carers suffering from additional stress due to competing priorities with employment or due to lack of knowledge about elderly people?s care needs. Thus, support and stress relief in carers should be a key issue in the home-care process of these older adults. Considering this context, this work presents the iCarer project aimed at developing a personalized and adaptive platform to offer informal carers support by means of monitoring their activities of daily care and psychological state, as well as providing an orientation to help them improve the care provided. Additionally, iCarer will provide e-Learning services and an informal carers learning network. As a result, carers will be able to expand their knowledge, supported by the experience provided by expert counsellors and fellow carers. Additionally, the coordination between formal and informal carers will be improved, offering the informal carers flexibility to organize and combine their assistance and social activities.

El Entorno Aumentado: Imperativo informacional para una ecología digital de lo arquitectónico

Esta tesis se suma a los intentos teóricos de clarificar la impronta del dominio digital en lo arquitectónico. Propone una cartografía crítica para reconstruir el proceso de tal convergencia considerando aquellos acontecimientos reveladores que lo han pautado. La integración de la extensión digital propia las tecnologías de la información y la comunicación en el contexto tradicional arquitectónico ha supuesto el advenimiento de un ecosistema artificial complejo. A esta realidad o proceso concurrente se la denomina el Entorno Aumentado. La línea principal de investigación explora el desarrollo de la interacción hombre-máquina, en sendas trayectorias sincrónicas convergentes. El análisis se aborda por tanto desde la consideración de esa naturaleza dual, atendiendo simultáneamente a la humanización del dominio digital o cómo la computación se adapta a la condición natural de ser humano, y a la digitalización del ser humano o cómo éste asume el imperativo digital. El análisis resulta vertebrado desde la condición panóptica del punto de observación del acontecimiento: la cuarta pared, entendida como pantalla y punto de inflexión que estructura la convergencia de los entornos físico y digital. La reflexión acometida sobre la construcción del Entorno Aumentado procura la verificación de la tesis, que es central en esta investigación: la multiplicación dimensional del lugar físico mediante su extensión con un campo informacional procedente del dominio digital, y sus efectos en la construcción de la nueva ecología digital propia del Entorno Aumentado. Esta circunstancia se produce tras la eclosión de la Revolución Digital en la segunda mitad del siglo XX, el consecuente incremento de la interacción entre los entornos digital y físico, y el alcance de un nivel superior de comunicación en los procesos arquitectónicos. Los síntomas del Entorno Aumentado se hacen notar en nuestra contemporaneidad; en ese sentido, la tesis alcanza un diagnóstico del cambio. La fractura y obsolescencia del límite espacio-temporal establecido por las dicotomías históricas privado-público, casa-ciudad, trabajo-ocio,…etc., o la vigencia del proyecto procedimental son algunas de sus consecuencias en el modo de abordar la disciplina arquitectónica. Abstract This dissertation aims to complete the theoretical attempts to clarify the digital domain imprint on the architectural realm. It constructs a critical cartography to reconstruct the process of such convergence, considering those principal events who have scheduled it. The integration of TIC’s digital extension through the traditional architectural context has meant the advent of an artificial complex ecosystem. This reality or concurrent process is called The Augmented Environment. The key research attempt explores man-machine interaction process in both synchronous converging trajectories. The analysis therefore addresses from the consideration of this dual nature, focusing simultaneously in humanizing digital domain process or how the computer fits the natural condition of human beings, and in digitalizing human beings or how it affords the digital imperative. The analysis is structured from the panoptic condition of the event scope: the fourth wall as screen that structures the convergence of physical and digital environments. The examination of The Augmented Environment’s assembly pretends the verification of the central point of this research: the dimensional multiplication of physical space by extending informational fields from the digital domain, and its effects on the construction of the Augmented Environment new digital ecology. This circumstance occurs after the arrival of the Digital Revolution in the second half of the twentieth century, with the consequent increase in the interaction between digital and physical environments, and the reach of a higher level of communication in architectural processes. The Augmented Environment signs are alive nowadays; in that sense, the thesis reaches a diagnostic of the changes. The fracture and obsolescence of the time-space limit established by historic dichotomies as private-public, home-city, working-leisure...etc., or the validity of the procedural design are some of its consequences on the architectural discipline.

Contribution towards intelligent service management in wearable and ubiquitous devices

Hoy en día asistimos a un creciente interés por parte de la sociedad hacia el cuidado de la salud. Esta afirmación viene apoyada por dos realidades. Por una parte, el aumento de las prácticas saludables (actividad deportiva, cuidado de la alimentación, etc.). De igual manera, el auge de los dispositivos inteligentes (relojes, móviles o pulseras) capaces de medir distintos parámetros físicos como el pulso cardíaco, el ritmo respiratorio, la distancia recorrida, las calorías consumidas, etc. Combinando ambos factores (interés por el estado de salud y disponibilidad comercial de dispositivos inteligentes) están surgiendo multitud de aplicaciones capaces no solo de controlar el estado actual de salud, también de recomendar al usuario cambios de hábitos que lleven hacia una mejora en su condición física. En este contexto, los llamados dispositivos llevables (weareables) unidos al paradigma de Internet de las cosas (IoT, del inglés Internet of Things) permiten la aparición de nuevos nichos de mercado para aplicaciones que no solo se centran en la mejora de la condición física, ya que van más allá proponiendo soluciones para el cuidado de pacientes enfermos, la vigilancia de niños o ancianos, la defensa y la seguridad, la monitorización de agentes de riesgo (como bomberos o policías) y un largo etcétera de aplicaciones por llegar. El paradigma de IoT se puede desarrollar basándose en las existentes redes de sensores inalámbricos (WSN, del inglés Wireless Sensor Network). La conexión de los ya mencionados dispositivos llevables a estas redes puede facilitar la transición de nuevos usuarios hacia aplicaciones IoT. Pero uno de los problemas intrínsecos a estas redes es su heterogeneidad. En efecto, existen multitud de sistemas operativos, protocolos de comunicación, plataformas de desarrollo, soluciones propietarias, etc. El principal objetivo de esta tesis es realizar aportaciones significativas para solucionar no solo el problema de la heterogeneidad, sino también de dotar de mecanismos de seguridad suficientes para salvaguardad la integridad de los datos intercambiados en este tipo de aplicaciones. Algo de suma importancia ya que los datos médicos y biométricos de los usuarios están protegidos por leyes nacionales y comunitarias. Para lograr dichos objetivos, se comenzó con la realización de un completo estudio del estado del arte en tecnologías relacionadas con el marco de investigación (plataformas y estándares para WSNs e IoT, plataformas de implementación distribuidas, dispositivos llevables y sistemas operativos y lenguajes de programación). Este estudio sirvió para tomar decisiones de diseño fundamentadas en las tres contribuciones principales de esta tesis: un bus de servicios para dispositivos llevables (WDSB, Wearable Device Service Bus) basado en tecnologías ya existentes tales como ESB, WWBAN, WSN e IoT); un protocolo de comunicaciones inter-dominio para dispositivos llevables (WIDP, Wearable Inter-Domain communication Protocol) que integra en una misma solución protocolos capaces de ser implementados en dispositivos de bajas capacidades (como lo son los dispositivos llevables y los que forman parte de WSNs); y finalmente, la tercera contribución relevante es una propuesta de seguridad para WSN basada en la aplicación de dominios de confianza. Aunque las contribuciones aquí recogidas son de aplicación genérica, para su validación se utilizó un escenario concreto de aplicación: una solución para control de parámetros físicos en entornos deportivos, desarrollada dentro del proyecto europeo de investigación “LifeWear”. En este escenario se desplegaron todos los elementos necesarios para validar las contribuciones principales de esta tesis y, además, se realizó una aplicación para dispositivos móviles por parte de uno de los socios del proyecto (lo que contribuyó con una validación externa de la solución). En este escenario se usaron dispositivos llevables tales como un reloj inteligente, un teléfono móvil con sistema operativo Android y un medidor del ritmo cardíaco inalámbrico capaz de obtener distintos parámetros fisiológicos del deportista. Sobre este escenario se realizaron diversas pruebas de validación mediante las cuales se obtuvieron resultados satisfactorios. ABSTRACT Nowadays, society is shifting towards a growing interest and concern on health care. This phenomenon can be acknowledged by two facts: first, the increasing number of people practising some kind of healthy activity (sports, balanced diet, etc.). Secondly, the growing number of commercial wearable smart devices (smartwatches or bands) able to measure physiological parameters such as heart rate, breathing rate, distance or consumed calories. A large number of applications combining both facts are appearing. These applications are not only able to monitor the health status of the user, but also to provide recommendations about routines in order to improve the mentioned health status. In this context, wearable devices merged with the Internet of Things (IoT) paradigm enable the proliferation of new market segments for these health wearablebased applications. Furthermore, these applications can provide solutions for the elderly or baby care, in-hospital or in-home patient monitoring, security and defence fields or an unforeseen number of future applications. The introduced IoT paradigm can be developed with the usage of existing Wireless Sensor Networks (WSNs) by connecting the novel wearable devices to them. In this way, the migration of new users and actors to the IoT environment will be eased. However, a major issue appears in this environment: heterogeneity. In fact, there is a large number of operating systems, hardware platforms, communication and application protocols or programming languages, each of them with unique features. The main objective of this thesis is defining and implementing a solution for the intelligent service management in wearable and ubiquitous devices so as to solve the heterogeneity issues that are presented when dealing with interoperability and interconnectivity of devices and software of different nature. Additionally, a security schema based on trust domains is proposed as a solution to the privacy problems arising when private data (e.g., biomedical parameters or user identification) is broadcasted in a wireless network. The proposal has been made after a comprehensive state-of-the-art analysis, and includes the design of a Wearable Device Service Bus (WDSB) including the technologies collected in the requirement analysis (ESB, WWBAN, WSN and IoT). Applications are able to access the WSN services regardless of the platform and operating system where they are running. Besides, this proposal also includes the design of a Wearable Inter-Domain communication Protocols set (WIDP) which integrates lightweight protocols suitable to be used in low-capacities devices (REST, JSON, AMQP, CoAP, etc...). Furthermore, a security solution for service management based on a trustworthy domains model to deploy security services in WSNs has been designed. Although the proposal is a generic framework for applications based on services provided by wearable devices, an application scenario for testing purposes has been included. In this validation scenario it has been presented an autonomous physical condition performance system, based on a WSN, bringing the possibility to include several elements in an IoT scenario: a smartwatch, a physiological monitoring device and a smartphone. In summary, the general objective of this thesis is solving the heterogeneity and security challenges arising when developing applications for WSNs and wearable devices. As it has been presented in the thesis, the solution proposed has been successfully validated in a real scenario and the obtained results were satisfactory.