A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice

In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.

High proportion of healthcare-associated urinary tract infection in the absence of prior exposure to urinary catheter: a cross-sectional study

Exposure to urinary catheters is considered the most important risk factor for healthcare-associated urinary tract infection (UTI) and is associated with significant morbidity and substantial extra-costs. In this study, we assessed the impact of urinary catheterisation (UC) on symptomatic healthcare-associated UTI among hospitalized patients.

Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey.

BACKGROUND In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.

Low correlation between self-report and medical record documentation of urinary tract infection symptoms.

BACKGROUND Correlations between symptom documentation in medical records and patient self-report (SR) vary depending on the condition studied. Patient symptoms are particularly important in urinary tract infection (UTI) diagnosis, and this correlation for UTI symptoms is currently unknown. METHODS This is a cross-sectional survey study in hospitalized patients with Escherichia coli bacteriuria. Patients were interviewed within 24 hours of diagnosis for the SR of UTI symptoms. We reviewed medical records for UTI symptoms documented by admitting or treating inpatient physicians (IPs), nurses (RNs), and emergency physicians (EPs). The level of agreement between groups was assessed using Cohen κ coefficient. RESULTS Out of 43 patients, 34 (79%) self-reported at least 1 of 6 primary symptoms. The most common self-reported symptoms were urinary frequency (53.5%); retention (41.9%); flank pain, suprapubic pain, and fatigue (37.2% each); and dysuria (30.2%). Correlation between SR and medical record documentation was slight to fair (κ, 0.06-0.4 between SR and IPs and 0.09-0.5 between SR and EDs). Positive agreement was highest for dysuria and frequency. CONCLUSION Correlation between self-reported UTI symptoms and health care providers' documentation was low to fair. Because medical records are a vital source of information for clinicians and researchers and symptom assessment and documentation are vital in distinguishing UTI from asymptomatic bacteriuria, efforts must be made to improve documentation.

Comparison of hand hygiene evaluations: A literature review

Background. Because our hands are the most common mode of transmission for bacteria causing hospital acquired infections, hand hygiene practices are the most effective method of preventing the spread of these pathogens, limiting the occurrence of healthcare-associated infections and reducing transmission of multi-drug resistant organisms. Yet, compliance rates are below 40% on the average. ^ Objective. This culminating experience project is primarily a literature review on hand hygiene to help determine the barriers to hand hygiene compliance and offer solutions on improving these rates and to build on a hand hygiene evaluation performed during my infection control internship completed at Memorial Hermann Hospital during the fall semester of 2005. ^ Method. A review of peer-reviewed literature using Ovid Medline, Ebsco Medline and PubMed databases using keywords: hand hygiene, hand hygiene compliance, alcohol based handrub, healthcare-associated infections, hospital-acquired infections, and infection control. ^ Results. A total of eight hand hygiene studies are highlighted. At a children's hospital in Seattle, hand hygiene compliance rates increases from 62% to 81% after five periods of interventions. In Thailand, 26 nurses dramatically increased compliance from 6.3% to 81.2% after just 7 months of training. Automated alcohol based handrub dispensers improved compliance rates in Chicago from 36.3% to 70.1%. Using education and increased distribution of alcohol based handrubs increased hand hygiene rates from 59% to 79% for Ebnother, from 54% to 85% for Hussein and from 32% to 63% for Randle. Spartanburg Regional Medical Center increased their rates from 72.5% to 90.3%. A level III NICU achieved 100% compliance after a month long educational campaign but fell back down to its baseline rate of 89% after 3 months. ^ Discussion. The interventions used to promote hand hygiene in the highlighted studies varied from low tech approaches such as printed materials to advanced electronic gadgets that alerted individuals automatically to perform hand hygiene. All approaches were effective and increased compliance rates. Overcoming hand hygiene barriers, receiving and accepting feedback is the key to maintaining consistently high hand hygiene adherence. ^

Impact of maternal Tdap vaccination on pertussis infection in young infants

Undiagnosed infected mothers often are the source of pertussis illness in young infants. The Centers for Disease Control and Prevention (CDC) recommends Tdap vaccine for post-partum women before hospital discharge. This intervention has been implemented at Ben Taub General Hospital (BTGH) in Houston, TX since January 2008. Our objective was to compare the proportion of infants born at BTGH and developing pertussis to the total number of pertussis cases before and after the intervention. Methods. We conducted a cross-sectional comparative study between the pre-intervention (7/2000 to 12/2007) and post-intervention (1/2008 to 5/2009) periods. Information on pertussis diagnosis was determined using ICD-9 codes, infection control records, and molecular microbiology reports from Texas Children's Hospital (TCH) and BTGH. Only patients ≤ 6 months of age with laboratory-confirmed B. pertussis infection were included in the study. Results. 481 infants had pertussis illness; 353 (73.3%) during pre-intervention and 128 (26.6%) during post-intervention years. The groups were comparable in all measures including age (median 73 vs. 62.5 days; p=0.08), gender (males 54.2%; p=0.47), length of hospitalization (median 9.8 vs. 4 9.5 days; p=0.5), outcomes (2 deaths in each period; p=0.28) and pertussis illness at TCH (95.2% vs. 95.3%; p=0.9). The proportion of pertussis patients born at BTGH, and thus amenable to protection by the intervention, was not statically different between the two periods after adjusting for age, gender and ethnicity (7.3% vs. 9.3%; an OR=1.05, 95% CI 0.5-2.1, p=0.88). Conclusions. Vaccinating only mothers with Tdap in the post-partum period does not reduce the proportion of pertussis in infants age ≤ 6 months. Efforts should be directed at Tdap immunization of not only mothers, but also all household and key contacts of newborns to protect them against pertussis illness before the primary DTaP series is completed.^

Use of intranet and other interventions to increase influenza vaccination among health care workers

Influenza (the flu) is a serious respiratory illness that can cause severe complications, often leading to hospitalization and even death. Influenza epidemics occur in most countries every year, usually during the winter months. Despite recommendations from the Centers for Disease Control and Prevention (CDC) and efforts by health care institutions across the United States, influenza vaccination rates among health care workers in the United States remain low. How to increase the number of vaccinated health care workers is an important public health question and is examined in two journal articles included here. ^ The first journal article evaluates the effectiveness of an Intranet intervention in increasing the proportion of health care workers (HCWs) who received influenza vaccination. Hospital employees were required go to the hospital's Intranet and select "vaccine received," "contraindicated," or "declined" from the online questionnaire. Declining employees automatically received an online pop-up window with education about vaccination; managers were provided feedback on employees' participation rates via e-mail messages. Employees were reminded of the Intranet requirement in articles in the employee newsletter and on the hospital's Intranet. Reminders about the Intranet questionnaire were provided through managers and newsletters to the HCWs. Fewer than half the employees (43.7%) completed the online questionnaire. Yet the hospital witnessed a statistically significant increase in the percentage of employees who received the flu vaccine at the hospital – 48.5% in the 2008-09 season as compared to 36.5%, 38.5% and 29.8% in the previous three years (P < 0.05). ^ The second article assesses current interventions employed by hospitals, health systems and nursing homes to determine which policies have been the most effective in boosting vaccination rates among American health care workers. A systematic review of research published between January 1994 and March 2010 suggests that education is necessary but not usually sufficient to increase vaccine uptake. Education about the flu and flu vaccines is most effective when complemented with easy access and making the vaccine free, although this combination may not be sufficient to achieve the desired vaccination levels among HCWs. The findings point toward adding incentives for HCWs to get vaccinated and requiring them to record their vaccination status on a declination/consent form – either written or electronic. ^ Based on these findings, American health care organizations, such as hospitals, nursing homes, and long-term care facilities, should consider using online declination forms as a method for increasing influenza vaccination rates among their employees. These online forms should be used in conjunction with other policies, including free vaccine, mobile distribution and incentives. ^ To further spur health care organizations to adopt policies and practices that will raise influenza vaccination rates among employees, The Joint Commission – an independent, not-for- profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States – should consider altering its standards. Currently, The Joint Commission does not require signed declination forms from employees who eschew vaccination; it only echoes the CDC's recommendations: "Health care facilities should require personnel who refuse vaccination to complete a declination form." Because participation in Joint Commission accreditation is required for Medicare reimbursement, action taken by the Joint Commission to require interventions such as mandatory declination/consent forms might result in immediate action by health care organizations to follow these new standards and lead to higher vaccination rates among HCWs.^ 1“Frequently Asked Questions for H1N1 and Seasonal Influenza.” The Joint Commission - Infection Control: http://www.jointcommission.org/PatientSafety/InfectionControl/h1n1_faq.htm. ^

Neural bruise prediction models for fruit handling and machinery evaluation.

Some neural bruise prediction models have been implemented in the laboratory, for the most traded fruit species and varieties, allowing the prediction of the acceptability or rejectability for damages, with respect to the EC Standards. Different models have been built for both quasi-static (compression) and dynamic (impact) loads covering the whole commercial ripening period of fruits. A simulation process has been developed gathering the information on laboratory bruise models and load sensor calibrations for different electronic devices (IS-100 and DEA-1, for impact and compression loads respectively). Some evaluation methodology has been designed gathering the information on the mechanical properties of fruits and the loading records of electronic devices. The evaluation system allows to determine the current stage of fruit handling process and machinery.

Conductivity variations of multi-walled carbon nanotubes oriented in liquid crystal cells

The control of carbon nanotubes conductivity is generating interest in several fields since it may be relevant for a number of applications. The self-organizing properties of liquid crystals may be used to impose alignment on dispersed carbon nanotubes,thus control-ling their conductivity and its anisotropy. This leads to a number of possible applications in photonic and electronic devices such as electrically controlled carbon nanotube switch- es and crossboards. In this work, cells of liquid crystals doped with multi-walled nanotubes have been prepared in different configurations. Their conductivity variations upon switching have been investigated. It turns out that conductivity evolution depends on the initial configuration (either homogeneous, homeotropic or in-plane switching), the cell thickness and the switching record. The control of these manufacturing paramenters allows the modulation of the electrical behavior of carbon nanotubes.

Desarrollo de un entorno inteligente en el contexto del hogar digital

A lo largo de las últimas décadas el desarrollo de la tecnología en muy distintas áreas ha sido vertiginoso. Su propagación a todos los aspectos de nuestro día a día parece casi inevitable y la electrónica de consumo ha invadido nuestros hogares. No obstante, parece que la domótica no ha alcanzado el grado de integración que cabía esperar hace apenas una década. Es cierto que los dispositivos autónomos y con un cierto grado de inteligencia están abriéndose paso de manera independiente, pero el hogar digital, como sistema capaz de abarcar y automatizar grandes conjuntos de elementos de una vivienda (gestión energética, seguridad, bienestar, etc.) no ha conseguido extenderse al hogar medio. Esta falta de integración no se debe a la ausencia de tecnología, ni mucho menos, y numerosos son los estudios y proyectos surgidos en esta dirección. Sin embargo, no ha sido hasta hace unos pocos años que las instituciones y grandes compañías han comenzado a prestar verdadero interés en este campo. Parece que estamos a punto de experimentar un nuevo cambio en nuestra forma de vida, concretamente en la manera en la que interactuamos con nuestro hogar y las comodidades e información que este nos puede proporcionar. En esa corriente se desarrolla este Proyecto Fin de Grado, con el objetivo de aportar un nuevo enfoque a la manera de integrar los diferentes dispositivos del hogar digital con la inteligencia artificial y, lo que es más importante, al modo en el que el usuario interactúa con su vivienda. Más concretamente, se pretende desarrollar un sistema capaz de tomar decisiones acordes al contexto y a las preferencias del usuario. A través de la utilización de diferentes tecnologías se dotará al hogar digital de cierta autonomía a la hora de decidir qué acciones debe llevar a cabo sobre los dispositivos que contiene, todo ello mediante la interpretación de órdenes procedentes del usuario (expresadas de manera coloquial) y el estudio del contexto que envuelve al instante de ejecución. Para la interacción entre el usuario y el hogar digital se desarrollará una aplicación móvil mediante la cual podrá expresar (de manera conversacional) las órdenes que quiera dar al sistema, el cual intervendrá en la conversación y llevará a cabo las acciones oportunas. Para todo ello, el sistema hará principalmente uso de ontologías, análisis semántico, redes bayesianas, UPnP y Android. Se combinará información procedente del usuario, de los sensores y de fuentes externas para determinar, a través de las citadas tecnologías, cuál es la operación que debe realizarse para satisfacer las necesidades del usuario. En definitiva, el objetivo final de este proyecto es diseñar e implementar un sistema innovador que se salga de la corriente actual de interacción mediante botones, menús y formularios a los que estamos tan acostumbrados, y que permita al usuario, en cierto modo, hablar con su vivienda y expresarle sus necesidades, haciendo a la tecnología un poco más transparente y cercana y aproximándonos un poco más a ese concepto de hogar inteligente que imaginábamos a finales del siglo XX. ABSTRACT. Over the last decades the development of technology in very different areas has happened incredibly fast. Its propagation to all aspects of our daily activities seems to be inevitable and the electronic devices have invaded our homes. Nevertheless, home automation has not reached the integration point that it was supposed to just a few decades ago. It is true that some autonomic and relatively intelligent devices are emerging, but the digital home as a system able to control a large set of elements from a house (energy management, security, welfare, etc.) is not present yet in the average home. That lack of integration is not due to the absence of technology and, in fact, there are a lot of investigations and projects focused on this field. However, the institutions and big companies have not shown enough interest in home automation until just a few years ago. It seems that, finally, we are about to experiment another change in our lifestyle and how we interact with our home and the information and facilities it can provide. This Final Degree Project is developed as part of this trend, with the goal of providing a new approach to the way the system could integrate the home devices with the artificial intelligence and, mainly, to the way the user interacts with his house. More specifically, this project aims to develop a system able to make decisions, taking into account the context and the user preferences. Through the use of several technologies and approaches, the system will be able to decide which actions it should perform based on the order interpretation (expressed colloquially) and the context analysis. A mobile application will be developed to enable the user-home interaction. The user will be able to express his orders colloquially though out a conversational mode, and the system will also participate in the conversation, performing the required actions. For providing all this features, the system will mainly use ontologies, semantic analysis, Bayesian networks, UPnP and Android. Information from the user, the sensors and external sources will be combined to determine, through the use of these technologies, which is the operation that the system should perform to meet the needs of the user. In short, the final goal of this project is to design and implement an innovative system, away from the current trend of buttons, menus and forms. In a way, the user will be able to talk to his home and express his needs, experiencing a technology closer to the people and getting a little closer to that concept of digital home that we imagined in the late twentieth century.

Integration of embedded data processing algorithms inside PAMELA devices

PAMELA (Phased Array Monitoring for Enhanced Life Assessment) SHMTM System is an integrated embedded ultrasonic guided waves based system consisting of several electronic devices and one system manager controller. The data collected by all PAMELA devices in the system must be transmitted to the controller, who will be responsible for carrying out the advanced signal processing to obtain SHM maps. PAMELA devices consist of hardware based on a Virtex 5 FPGA with a PowerPC 440 running an embedded Linux distribution. Therefore, PAMELA devices, in addition to the capability of performing tests and transmitting the collected data to the controller, have the capability of perform local data processing or pre-processing (reduction, normalization, pattern recognition, feature extraction, etc.). Local data processing decreases the data traffic over the network and allows CPU load of the external computer to be reduced. Even it is possible that PAMELA devices are running autonomously performing scheduled tests, and only communicates with the controller in case of detection of structural damages or when programmed. Each PAMELA device integrates a software management application (SMA) that allows to the developer downloading his own algorithm code and adding the new data processing algorithm to the device. The development of the SMA is done in a virtual machine with an Ubuntu Linux distribution including all necessary software tools to perform the entire cycle of development. Eclipse IDE (Integrated Development Environment) is used to develop the SMA project and to write the code of each data processing algorithm. This paper presents the developed software architecture and describes the necessary steps to add new data processing algorithms to SMA in order to increase the processing capabilities of PAMELA devices.An example of basic damage index estimation using delay and sum algorithm is provided.

A technological framework based on automatic messaging for improving adherence of diabetic patients

En todo el mundo se ha observado un crecimiento exponencial en la incidencia de enfermedades crónicas como la hipertensión y enfermedades cardiovasculares y respiratorias, así como la diabetes mellitus, que causa un número de muertes cada vez mayor en todo el mundo (Beaglehole et al., 2008). En concreto, la prevalencia de diabetes mellitus (DM) está aumentando de manera considerable en todas las edades y representa un serio problema de salud mundial. La diabetes fue la responsable directa de 1,5 millones de muertes en 2012 y 89 millones de años de vida ajustados por discapacidad (AVAD) (OMS, 2014). Uno de los principales dilemas que suelen asociarse a la gestión de EC es la adherencia de los pacientes a los tratamientos, que representa un aspecto multifactorial que necesita asistencia en lo relativo a: educación, autogestión, interacción entre los pacientes y cuidadores y compromiso de los pacientes. Medir la adherencia del tratamiento es complicado y, aunque se ha hablado ampliamente de ello, aún no hay soluciones “de oro” (Reviews, 2002). El compromiso de los pacientes, a través de la participación, colaboración, negociación y a veces del compromiso firme, aumentan las oportunidades para una terapia óptima en la que los pacientes se responsabilizan de su parte en la ecuación de adherencia. Comprometer e involucrar a los pacientes diabéticos en las decisiones de su tratamiento, junto con expertos profesionales, puede ayudar a favorecer un enfoque centrado en el paciente hacia la atención a la diabetes (Martin et al., 2005). La motivación y atribución de poder de los pacientes son quizás los dos factores interventores más relevantes que afectan directamente a la autogestión de la atención a la diabetes. Se ha demostrado que estos dos factores desempeñan un papel fundamental en la adherencia a la prescripción, así como en el fomento exitoso de un estilo de vida sana y otros cambios de conducta (Heneghan et al., 2013). Un plan de educación personalizada es indispensable para proporcionarle al paciente las herramientas adecuadas que necesita para la autogestión efectiva de la enfermedad (El-Gayar et al. 2013). La comunicación efectiva es fundamental para proporcionar una atención centrada en el paciente puesto que influye en las conductas y actitudes hacia un problema de salud ((Frampton et al. 2008). En este sentido, la interactividad, la frecuencia, la temporalización y la adaptación de los mensajes de texto pueden promover la adherencia a un régimen de medicación. Como consecuencia, adaptar los mensajes de texto a los pacientes puede resultar ser una manera de hacer que las sugerencias y la información sean más relevantes y efectivas (Nundy et al. 2013). En este contexto, las tecnologías móviles en el ámbito de la salud (mHealth) están desempeñando un papel importante al conectar con pacientes para mejorar la adherencia a medicamentos recetados (Krishna et al., 2009). La adaptación de los mensajes de texto específicos de diabetes sigue siendo un área de oportunidad para mejorar la adherencia a la medicación y ofrecer motivación a adultos con diabetes. Sin embargo, se necesita más investigación para entender totalmente su eficacia. Los consejos de texto personalizados han demostrado causar un impacto positivo en la atribución de poder a los pacientes, su autogestión y su adherencia a la prescripción (Gatwood et al., 2014). mHealth se puede utilizar para ofrecer programas de asistencia de autogestión a los pacientes con diabetes y, al mismo tiempo, superar las dificultades técnicas y financieras que supone el tratamiento de la diabetes (Free at al., 2013). El objetivo principal de este trabajo de investigación es demostrar que un marco tecnológico basado en las teorías de cambios de conducta, aplicado al campo de la mHealth, permite una mejora de la adherencia al tratamiento en pacientes diabéticos. Como método de definición de una solución tecnológica, se han adoptado un conjunto de diferentes técnicas de conducta validadas denominado marco de compromiso de retroacción conductual (EBF, por sus siglas en inglés) para formular los mensajes, guiar el contenido y evaluar los resultados. Los estudios incorporan elementos del modelo transteórico (TTM, por sus siglas en inglés), la teoría de la fijación de objetivos (GST, por sus siglas en inglés) y los principios de comunicación sanitaria persuasiva y eficaz. Como concepto general, el modelo TTM ayuda a los pacientes a progresar a su próxima fase de conducta a través de mensajes de texto motivados específicos y permite que el médico identifique la fase actual y adapte sus estrategias individualmente. Además, se adoptan las directrices del TTM para fijar objetivos personalizados a un nivel apropiado a la fase de cambio del paciente. La GST encierra normas que van a ponerse en práctica para promover la intervención educativa y objetivos de pérdida de peso. Finalmente, los principios de comunicación sanitaria persuasiva y eficaz aplicados a la aparición de los mensajes se han puesto en marcha para aumentar la efectividad. El EBF tiene como objetivo ayudar a los pacientes a mejorar su adherencia a la prescripción y encaminarlos a una mejora general en la autogestión de la diabetes mediante mensajes de texto personalizados denominados mensajes de retroacción automáticos (AFM, por sus siglas en inglés). Después de una primera revisión del perfil, consistente en identificar características significativas del paciente basadas en las necesidades de tratamiento, actitudes y conductas de atención sanitaria, el sistema elige los AFM personalizados, los aprueba el médico y al final se transfieren a la interfaz del paciente. Durante el tratamiento, el usuario recopila los datos en dispositivos de monitorización de pacientes (PMD, por sus siglas en inglés) de una serie de dispositivos médicos y registros manuales. Los registros consisten en la toma de medicación, dieta y actividad física y tareas de aprendizaje y control de la medida del metabolismo. El compromiso general del paciente se comprueba al estimar el uso del sistema y la adherencia del tratamiento y el estado de los objetivos del paciente a corto y largo plazo. El módulo de análisis conductual, que consiste en una serie de reglas y ecuaciones, calcula la conducta del paciente. Tras lograr el análisis conductual, el módulo de gestión de AFM actualiza la lista de AFM y la configuración de los envíos. Las actualizaciones incluyen el número, el tipo y la frecuencia de mensajes. Los AFM los revisa periódicamente el médico que también participa en el perfeccionamiento del tratamiento, adaptado a la fase transteórica actual. Los AFM se segmentan en distintas categorías y niveles y los pacientes pueden ajustar la entrega del mensaje de acuerdo con sus necesidades personales. El EBF se ha puesto en marcha integrado dentro del sistema METABO, diseñado para facilitar al paciente diabético que controle sus condiciones relevantes de una manera menos intrusiva. El dispositivo del paciente se vincula en una plataforma móvil, mientras que una interfaz de panel médico permite que los profesionales controlen la evolución del tratamiento. Herramientas específicas posibilitan que los profesionales comprueben la adherencia del paciente y actualicen la gestión de envíos de AFM. El EBF fue probado en un proyecto piloto controlado de manera aleatoria. El principal objetivo era examinar la viabilidad y aceptación del sistema. Los objetivos secundarios eran también la evaluación de la eficacia del sistema en lo referente a la mejora de la adherencia, el control glucémico y la calidad de vida. Se reclutaron participantes de cuatro centros clínicos distintos en Europa. La evaluación del punto de referencia incluía datos demográficos, estado de la diabetes, información del perfil, conocimiento de la diabetes en general, uso de las plataformas TIC, opinión y experiencia con dispositivos electrónicos y adopción de buenas prácticas con la diabetes. La aceptación y eficacia de los criterios de evaluación se aplicaron para valorar el funcionamiento del marco tecnológico. El principal objetivo era la valoración de la eficacia del sistema en lo referente a la mejora de la adherencia. En las pruebas participaron 54 pacientes. 26 fueron asignados al grupo de intervención y equipados con tecnología móvil donde estaba instalado el EBF: 14 pacientes tenían T1DM y 12 tenían T2DM. El grupo de control estaba compuesto por 25 pa cientes que fueron tratados con atención estándar, sin el empleo del EBF. La intervención profesional tanto de los grupos de control como de intervención corrió a cargo de 24 cuidadores, entre los que incluían diabetólogos, nutricionistas y enfermeras. Para evaluar la aceptabilidad del sistema y analizar la satisfacción de los usuarios, a través de LimeSurvey, se creó una encuesta multilingüe tanto para los pacientes como para los profesionales. Los resultados también se recopilaron de los archivos de registro generados en los PMD, el panel médico profesional y las entradas de la base de datos. Los mensajes enviados hacia y desde el EBF y los archivos de registro del sistema y los servicios de comunicación se grabaron durante las cinco semanas del estudio. Se entregaron un total de 2795 mensajes, lo que supuso una media de 107,50 mensajes por paciente. Como se muestra, los mensajes disminuyen con el tiempo, indicando una mejora global de la adherencia al plan de tratamiento. Como se esperaba, los pacientes con T1DM recibieron más consejos a corto plazo, en relación a su estado. Del mismo modo, al ser el centro de T2DM en cambios de estilo de vida sostenible a largo plazo, los pacientes con T2DM recibieron más consejos de recomendación, en cuanto a dietas y actividad física. También se ha llevado a cabo una comparación de la adherencia e índices de uso para pacientes con T1DM y T2DM, entre la primera y la segunda mitad de la prueba. Se han observado resultados favorables para el uso. En lo relativo a la adherencia, los resultados denotaron una mejora general en cada dimensión del plan de tratamiento, como la nutrición y las mediciones de inserción de glucosa en la sangre. Se han llevado a cabo más estudios acerca del cambio a nivel educativo antes y después de la prueba, medidos tanto para grupos de control como de intervención. Los resultados indicaron que el grupo de intervención había mejorado su nivel de conocimientos mientras que el grupo de control mostró una leve disminución. El análisis de correlación entre el nivel de adherencia y las AFM ha mostrado una mejora en la adherencia de uso para los pacientes que recibieron los mensajes de tipo alertas, y unos resultados no significativos aunque positivos relacionados con la adherencia tanto al tratamiento que al uso correlacionado con los recordatorios. Por otra parte, los AFM parecían ayudar a los pacientes que no tomaban suficientemente en serio su tratamiento en el principio y que sí estaban dispuestos a responder a los mensajes recibidos. Aun así, los pacientes que recibieron demasiadas advertencias, comenzaron a considerar el envío de mensajes un poco estresante. El trabajo de investigación llevado a cabo al desarrollar este proyecto ofrece respuestas a las cuatro hipótesis de investigación que fueron la motivación para el trabajo. • Hipótesis 1 : es posible definir una serie de criterios para medir la adherencia en pacientes diabéticos. • Hipótesis 2: es posible diseñar un marco tecnológico basado en los criterios y teorías de cambio de conducta mencionados con anterioridad para hacer que los pacientes diabéticos se comprometan a controlar su enfermedad y adherirse a planes de atención. • Hipótesis 3: es posible poner en marcha el marco tecnológico en el sector de la salud móvil. • Hipótesis 4: es posible utilizar el marco tecnológico como solución de salud móvil en un contexto real y tener efectos positivos en lo referente a indicadores de control de diabetes. La verificación de cada hipótesis permite ofrecer respuesta a la hipótesis principal: La hipótesis principal es: es posible mejorar la adherencia diabética a través de un marco tecnológico mHealth basado en teorías de cambio de conducta. El trabajo llevado a cabo para responder estas preguntas se explica en este trabajo de investigación. El marco fue desarrollado y puesto en práctica en el Proyecto METABO. METABO es un Proyecto I+D, cofinanciado por la Comisión Europea (METABO 2008) que integra infraestructura móvil para ayudar al control, gestión y tratamiento de los pacientes con diabetes mellitus de tipo 1 (T1DM) y los que padecen diabetes mellitus de tipo 2 (T2DM). ABSTRACT Worldwide there is an exponential growth in the incidence of Chronic Diseases (CDs), such as: hypertension, cardiovascular and respiratory diseases, as well as diabetes mellitus, leading to rising numbers of deaths worldwide (Beaglehole et al. 2008). In particular, the prevalence of diabetes mellitus (DM) is largely increasing among all ages and constitutes a major worldwide health problem. Diabetes was directly responsible for 1,5 million deaths in 2012 and 89 million Disability-adjusted life year (DALYs) (WHO 2014). One of the key dilemmas often associated to CD management is the patients’ adherence to treatments, representing a multi-factorial aspect that requires support in terms of: education, self-management, interaction between patients and caregivers, and patients’ engagement. Measuring adherence is complex and, even if widely discussed, there are still no “gold” standards ((Giardini et al. 2015), (Costa et al. 2015). Patient’s engagement, through participation, collaboration, negotiation, and sometimes compromise, enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation. Engaging and involving diabetic patients in treatment decisions, along with professional expertise, can help foster a patient-centered approach to diabetes care (Martin et al. 2005). Patients’ motivation and empowerment are perhaps the two most relevant intervening factors that directly affect self-management of diabetes care. It has been demonstrated that these two factors play an essential role in prescription adherence, as well as for the successful encouragement of a healthy life-style and other behavioural changes (Heneghan et al. 2013). A personalised education plan is indispensable in order to provide the patient with the appropriate tools needed for the effective self-management of the disease (El-Gayar et al. 2013). Effective communication is at the core of providing patient-centred care since it influences behaviours and attitudes towards a health problem (Frampton et al. 2008). In this regard, interactivity, frequency, timing, and tailoring of text messages may promote adherence to a medication regimen. As a consequence, tailoring text messages to patients can constitute a way of making suggestions and information more relevant and effective (Nundy et al. 2013). In this context, mobile health technologies (mHealth) are playing significant roles in improving adherence to prescribed medications (Krishna et al. 2009). The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but further research is needed to fully understand their effectiveness. Personalized text advices have proven to produce a positive impact on patients’ empowerment, self-management, and adherence to prescriptions (Gatwood et al. 2014). mHealth can be used for offering self-management support programs to diabetes patients and at the same time surmounting the technical and financial difficulties involved in diabetes treatment (Free et al. 2013). The main objective of this research work is to demonstrate that a technological framework, based on behavioural change theories, applied to mHealth domain, allows improving adherence treatment in diabetic patients. The framework, named Engagement Behavioural Feedback Framework (EBF), is built on top of validated behavioural techniques to frame messages, guide the definition of contents and assess outcomes: elements from the Transtheoretical Model (TTM), the Goal-Setting Theory (GST), Effective Health Communication (EHC) guidelines and Principles of Persuasive Technology (PPT) were incorporated. The TTM helps patients to progress to a next behavioural stage, through specific motivated text messages, and allow clinician’s identifying the current stage and tailor its strategies individually. Moreover, TTM guidelines are adopted to set customised goals at a level appropriate to the patient’s stage of change. The GST was used to build rules to be applied for enhancing educational intervention and weight loss objectives. Finally, the EHC guidelines and the PPT were applied to increase the effectiveness of messages. The EBF aims to support patients on improving their prescription adherence and persuade them towards a general improvement in diabetes self-management, by means of personalised text messages, named Automatic Feedback Messages (AFM). After a first profile screening, consisting in identifying meaningful patient characteristics based on treatment needs, attitudes and health care behaviours, customised AFMs are selected by the system, approved by the professional, and finally transferred into the patient interface. During the treatment, the user collects the data into a Patient Monitoring Device (PMD) from a set of medical devices and from manual inputs. Inputs consist in medication intake, diet and physical activity, metabolic measurement monitoring and learning tasks. Patient general engagement is checked by estimating the usage of the system and the adherence of treatment and patient goals status in the short and the long term period. The Behavioural Analysis Module, consisting in a set of rules and equations, calculates the patient’s behaviour. After behavioural analysis is accomplished, the AFM library and the dispatch setting are updated by the AFM Manager module. Updates include the number, the type and the frequency of messages. The AFMs are periodically supervised by the professional who also participates to the refinement of the treatment, adapted to the current transtheoretical stage. The AFMs are segmented in different categories and levels and patients can adjust message delivery in accordance with their personal needs. The EBF was integrated to the METABO system, designed to facilitate diabetic patients in managing their disease in a less intrusive approach. Patient device corresponds in a mobile platform, while a medical panel interface allows professionals to monitoring the treatment evolution. Specific tools allow professional to check patient adherence and to update the AFMs dispatch management. The EBF was tested in a randomised controlled pilot. The main objective was to examine the feasibility and acceptance of the system. Secondary objectives were also the assessment of the effectiveness of system in terms of adherence improvement, glycaemic control, and quality of life. Participants were recruited from four different clinical centres in Europe. The baseline assessment included demographics, diabetes status, profile information, knowledge about diabetes in general, usage of ICT platforms, opinion and experience about electronic devices and adoption of good practices with diabetes. Acceptance and the effectiveness evaluation criteria were applied to evaluate the performance of the technological framework. The main objective was the assessment of the effectiveness of system in terms of adherence improvement. Fifty-four patients participated on the trials. Twenty-six patients were assigned in the intervention group and equipped with mobile where the EBF was installed: 14 patients were T1DM and 12 were T2DM. The control group was composed of 25 patients that were treated through a standard care, without the usage of the EBF. Professional’s intervention for both intervention and control groups was carried out by 24 care providers, including endocrinologists, nutritionists, and nurses. In order to evaluate the system acceptability and analyse the users’ satisfaction, an online multi-language survey, using LimeSurvey, was produced for both patients and professionals. Results were also collected from the log-files generated in the PMDs, the professional medical panel and the entries of the data base. The messages sent to and from the EBF and the log-files of the system and communication services were recorded over 5 weeks of the study. A total of 2795 messages were submitted, representing an average of 107,50 messages per patient. As demonstrated, messages decrease over time indicating an overall improvement of the care plan’s adherence. As expected, T1DM patients were more loaded with short-term advices, in accordance with their condition. Similarly, being the focus of T2DM on long-term sustainable lifestyle changes, T2DM received more reminders advices, as for diet and physical activity. Favourable outcomes were observed for treatment and usage adherences of the intervention group: for both the adherence indices, results denoted a general improvement on each care plan’s dimension, such as on nutrition and blood glucose input measurements. Further studies were conducted on the change on educational level before and after the trial, measured for both control and intervention groups. The outcomes indicated the intervention group has improved its level of knowledge, while the control group denoted a low decrease. The correlation analysis between the level of adherences and the AFMs showed an improvement in usage adherence for patients who received warnings message, while non-significantly yet even positive indicators related to both treatment and usage adherence correlated with the Reminders. Moreover, the AFMs seemed to help those patients who did not take their treatment seriously enough in the beginning and who were willing to respond to the messages they received. Even though, patients who received too many Warnings, started to consider the message dispatch to be a bit stressful. The research work carried out in developing this research work provides responses to the four research hypothesis that were the motivation for the work: •Hypothesis 1: It is possible to define a set of criteria to measure adherence in diabetic patients. •Hypothesis 2: It is possible to design a technological framework, based on the aforementioned criteria and behavioural change theories, to engage diabetic patients in managing their disease and adhere to care plans. •Hypothesis 3: It is possible to implement the technological framework in the mobile health domain. •Hypothesis 4: It is possible to use the technological framework as a mobile health solution in a real context and have positive effects in terms of diabetes management indicators. The verification of each hypothesis allowed us to provide a response to the main hypothesis: The Main Hypothesis is: It is possible to improve diabetic adherence through a mHealth technological framework based on behavioural change theories. The work carried out to answer these questions is explained in this research work. The framework was developed and applied in the METABO project. METABO is an R&D project, co-funded by the European Commission (METABO 2008) that integrates mobile infrastructure for supporting the monitoring, management, and treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.

Ludomática, herramienta de aprendizaje

Desde los comienzos de la enseñanza, siempre se han buscado formas innovadoras para transmitir el conocimiento de profesor a alumno. Desde recursos materiales hasta sistemas de enseñanza complejos, todos juegan un papel esencial en el aprendizaje del alumno. Durante el siglo XVII comienzan a desarrollarse nuevas corrientes de enseñanza cuyo objetivo era el aprendizaje ameno del individuo. Hoy en día pueden utilizarse multitud de medios para desarrollar estos métodos pedagógicos, entre ellos, los juegos interactivos. Con el boom de la tecnología y el desarrollo de las tecnologías de la información, los tutores encuentran en los dispositivos electrónicos todo un apoyo para realizar esta tarea, lo cual viene acompañado de una revolución inminente en la enseñanza. El objetivo de este proyecto es la creación de un videojuego educativo que permita tanto aprender más fácilmente a los alumnos como evaluar los conocimientos adquiridos por éstos a los profesores. Se ha creado Ludomática, un videojuego de tipo juego de mesa donde los jugadores tendrán que utilizar sus conocimientos en determinados temas para ganar la partida. El videojuego puede ser configurado con distintas preguntas del tema que se desee y en tres niveles de dificultad. Además, cuenta con la posibilidad de configurar el número de jugadores, de preguntas y de puntuación máxima, con objeto de crear partidas más o menos largas. Ludomática se constituye como una herramienta educativa completa y personalizable, además de atractiva, mediante la cual los profesores pueden innovar su forma de enseñanza y los alumnos pueden aprender divirtiéndose---ABSTRACT---Since the beginning of teaching, professors have always looked for innovative ways to transmit knowledge from teacher to student. From material resources to teaching complex systems, they all play a vital role in student learning. The development of new forms of education aimed to create enjoyable ways to teach started during the XVII century. Nowadays, It’s easy to find multiple elements to develop this pedagogical methods, including interactive games. Because of the “tech boom” and the rise of the Information and Communication Technologies, teachers can have a lot of support in electronic devices to carry out this task, which comes with an inminent revolution of teaching. The objective of this project is to create an educational video game that allows not only learn much more easily for students, but also evaluate the knowledge acquired by these for teachers. Ludomática has been created as a board videogame where players have to use their knowledge in specific topics to win the game. The game can be configured with different questions of the topic desired and three difficulty levels. It also has the ability to set the number of players, questions and maximum score, in order to control the duration of the game. Ludomática constitutes a complete and customizable educational tool, also attractive, whereby teachers can innovate their teaching forms and students can learn while having fun.

Ti/Pd/Ag Contacts to n-Type GaAs for High Current Density Devices

The metallization stack Ti/Pd/Ag on n-type Si has been readily used in solar cells due to its low metal/semiconductor specific contact resistance, very high sheet conductance, bondability, long-term durability, and cost-effectiveness. In this study, the use of Ti/Pd/Ag metallization on n-type GaAs is examined, targeting electronic devices that need to handle high current densities and with grid-like contacts with limited surface coverage (i.e., solar cells, lasers, or light emitting diodes). Ti/Pd/Ag (50 nm/50 nm/1000 nm) metal layers were deposited on n-type GaAs by electron beam evaporation and the contact quality was assessed for different doping levels (from 1.3 × 1018 cm−3 to 1.6 × 1019 cm−3) and annealing temperatures (from 300°C to 750°C). The metal/semiconductor specific contact resistance, metal resistivity, and the morphology of the contacts were studied. The results show that samples doped in the range of 1018 cm−3 had Schottky-like I–V characteristics and only samples doped 1.6 × 1019 cm−3 exhibited ohmic behavior even before annealing. For the ohmic contacts, increasing annealing temperature causes a decrease in the specific contact resistance (ρ c,Ti/Pd/Ag ~ 5 × 10−4 Ω cm2). In regard to the metal resistivity, Ti/Pd/Ag metallization presents a very good metal conductivity for samples treated below 500°C (ρ M,Ti/Pd/Ag ~ 2.3 × 10−6 Ω cm); however, for samples treated at 750°C, metal resistivity is strongly degraded due to morphological degradation and contamination in the silver overlayer. As compared to the classic AuGe/Ni/Au metal system, the Ti/Pd/Ag system shows higher metal/semiconductor specific contact resistance and one order of magnitude lower metal resistivity.

Sistema domótico controlado por mensajería instantánea Whatsapp para personas con discapacidad

El presente PFC tiene como objetivo el desarrollo de un gestor domótico basado en el dictado de voz de la red social WhatsApp. Dicho gestor no solo sustituirá el concepto dañino de que la integración de la domótica hoy en día es cara e inservible sino que acercará a aquellas personas con una discapacidad a tener una mejora en la calidad de vida. Estas personas, con un simple comando de voz a su aplicación WhatsApp de su terminal móvil, podrán activar o desactivar todos los elementos domóticos que su vivienda tenga instalados, “activar lámpara”, “encender Horno”, “abrir Puerta”… Todo a un muy bajo precio y utilizando tecnologías OpenSource El objetivo principal de este PFC es ayudar a la gente con una discapacidad a tener mejor calidad de vida, haciéndose independiente en las labores del hogar, ya que será el hogar quien haga las labores. La accesibilidad de este servicio, es por tanto, la mayor de las metas. Para conseguir accesibilidad para todas las personas, se necesita un servicio barato y de fácil aprendizaje. Se elige la red social WhatsApp como interprete, ya que no necesita de formación al ser una aplicación usada mayoritariamente en España y por la capacidad del dictado de voz, y se eligen las tecnologías OpenSource por ser la gran mayoría de ellas gratuitas o de pago solo el hardware. La utilización de la Red social WhatsApp se justifica por sí sola, en septiembre de 2015 se registraron 900 millones de usuarios. Este dato es fruto, también, de la reciente adquisición por parte de Facebook y hace que cumpla el primer requisito de accesibilidad para el servicio domotico que se presenta. Desde hace casi 5 años existe una API liberada de WhatsApp, que la comunidad OpenSource ha utilizado, para crear sus propios clientes o aplicaciones de envío de mensajes, usando la infraestructura de la red social. La empresa no lo aprueba abiertamente, pero la liberación de la API fue legal y su uso también lo es. Por otra parte la empresa se reserva el derecho de bloquear cuentas por el uso fraudulento de su infraestructura. Las tecnologías OpenSource utilizadas han sido, distribuciones Linux (Raspbian) y lenguajes de programación PHP, Python y BASHSCRIPT, todo cubierto por la comunidad, ofreciendo soporte y escalabilidad. Es por ello que se utiliza, como matriz y gestor domotico central, una RaspberryPI. Los servicios que el gestor ofrece en su primera versión incluyen el control domotico de la iluminación eléctrica general o personal, el control de todo tipo de electrodomésticos, el control de accesos para la puerta principal de entrada y el control de medios audiovisuales. ABSTRACT. This final thesis aims to develop a domotic manager based on the speech recognition capacity implemented in the social network, WhatsApp. This Manager not only banish the wrong idea about how expensive and useless is a domotic installation, this manager will give an opportunity to handicapped people to improve their quality of life. These people, with a simple voice command to their own WhatsApp, could enable or disable all the domotics devices installed in their living places. “On Lamp”, “ON Oven”, “Open Door”… This service reduce considerably the budgets because the use of OpenSource Technologies. The main achievement of this thesis is help handicapped people improving their quality of life, making independent from the housework. The house will do the work. The accessibility is, by the way, the goal to achieve. To get accessibility to a width range, we need a cheap, easy to learn and easy to use service. The social Network WhatsApp is one part of the answer, this app does not need explanation because is used all over the world, moreover, integrates the speech recognition capacity. The OpenSource technologies is the other part of the answer due to the low costs or, even, the free costs of their implementations. The use of the social network WhatsApp is explained by itself. In September 2015 were registered around 900 million users, of course, the recent acquisition by Facebook has helped in this astronomic number and match the first law of this service about the accessibility. Since five years exists, in the internet, a free WhatsApp API. The OpenSource community has used this API to develop their own messaging apps or desktop-clients, using the WhatsApp infrastructure. The company does not approve officially, however le API freedom is legal and the use of the API is legal too. On the other hand, the company can block accounts who makes a fraudulent use of his infrastructure. OpenSource technologies used in this thesis are: Linux distributions (Raspbian) and programming languages PHP, Python and BASHCSRIPT, all of these technologies are covered by the community offering support and scalability. Due to that, it is used a RaspberryPI as the Central Domotic Manager. The domotic services that currently this manager achieve are: Domotic lighting control, electronic devices control, access control to the main door and Media Control.