Innovations in health care services: The CAALYX system

Purpose: This paper describes proposed health care services innovations, provided by a system called CAALYX (Complete Ambient Assisted Living eXperiment). CAALYX aimed to provide healthcare innovation by extending the state-of-the-art in tele-healthcare, by focusing on increasing the confidence of elderly people living autonomously, by building on the knowledge base of the most common disorders and respective characteristic vital sign changes for this age group. Methods: A review of the state-of-the-art on health care services was carried out. Then, extensive research was conducted on the particular needs of the elderly in relation to home health services that, if offered to them, could improve their day life by giving them greater confidence and autonomy. To achieve this, we addressed issues associated with the gathering of clinical data and interpretation of these data, as well as possibilities of automatically triggering appropriate clinical measures. Considering this initial work we started the identification of initiatives, ongoing works and technologies that could be used for the development of the system. After that, the implementation of CAALYX was done. Findings: The innovation in CAALYX system considers three main areas of contribution: (i) The Roaming Monitoring System that is used to collect information on the well-being of the elderly users; (ii) The Home Monitoring System that is aimed at helping the elders independently living at home being implemented by a device (a personal computer or a set top box) that supports the connection of sensors and video cameras that may be used for monitoring and for interaction with the elder; (iii) The Central Care Service and Monitoring System that is implemented by a Caretaker System where attention and care services are provided to elders, where actors as Caretakers, Doctors and Relatives are logically linked to elders. Innovations in each of these areas are presented here. Conclusions: The ageing European society is placing an added burden on future generations, as the 'elderly-to-working-age-people' ratio is set to steadily increase in the future. Nowadays, quality of life and fitness allows for most older persons to have an active life well into their eighties. Furthermore, many older persons prefer to live in their own house and choose their own lifestyle. The CAALYX system can have a clear impact in increasing older persons' autonomy, by ensuring that they do not need to leave their preferred environment in order to be properly monitored and taken care of. © 2011 Elsevier B.V. All rights reserved.

Enhancement of a body area network to support smart health monitoring at the digital home

The deployment of home-based smart health services requires effective and reliable systems for personal and environmental data management. ooperation between Home Area Networks (HAN) and Body Area Networks (BAN) can provide smart systems with ad hoc reasoning information to support health care. This paper details the implementation of an architecture that integrates BAN, HAN and intelligent agents to manage physiological and environmental data to proactively detect risk situations at the digital home. The system monitors dynamic situations and timely adjusts its behavior to detect user risks concerning to health. Thus, this work provides a reasoning framework to infer appropriate solutions in cases of health risk episodes. Proposed smart health monitoring approach integrates complex reasoning according to home environment, user profile and physiological parameters defined by a scalable ontology. As a result, health care demands can be detected to activate adequate internal mechanisms and report public health services for requested actions.

[Letter to the Editor] Telemonitoring in Patients with Heart Failure

To the Editor: Chaudhry et al. suggest that enhanced support in the use of a telephone-based interactive voice-response system for patients recently discharged after worsening heart failure does not improve outcomes. This finding is broadly consistent with previous systematic reviews of telephone support1 and contrasts with the substantial effect observed with home telemonitoring of vital signs in similar populations.1 The treatment of patients in the control group was excellent, but unrepresentative of usual clinical care and not inferior to the treatment of patients receiving enhanced support. Monitoring alone is unlikely to improve outcomes but may do so when it improves prescription of or adherence to lifesaving treatments. Given enough resources, traditional methods for delivering care may render an interactive voice-response system or a home telemonitoring system ineffective. Nonetheless, there may be more cost-efficient approaches to ensuring quality care.2 Informal post hoc addition of these data to our recent meta-analysis of telephone support1 does not substantially alter the point estimates for death from any cause or heart-failure−related hospitalizations, but it does nullify the small benefit in hospitalizations for any cause, which may not be reduced by a heart-failure−focused intervention.1 Original article: Telemonitoring in Patients with Heart Failure NEJM. December 9, 2010 | S.I. Chaudhry and Others

Preferences for place of care and place of death among informal caregivers of the terminally ill

Objectives: (1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system. Participants and design: A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death. Results: Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36). Discussion: The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system. © 2005 Edward Arnold (Publishers) Ltd.

Controlo de um sistema domótico KNX

Esta dissertação descreve o estudo, concepção e desenvolvimento de uma aplicação baseada no sistema operativo Windows 8 que interage com um sistema domótico KNX, permitindo ao utilizador controlar a sua instalação domótica. Esta proposta, que combina a área de integração/instalação de sistemas domóticos e a de desenvolvimento de aplicações para Windows 8 e Windows 8 Phone, constitui um desafio particularmente interessante para quem tem experiência profissional nas duas áreas. A domótica surgiu na década de 70 como uma aplicação da eletrónica e das tecnologias da informação às instalações residenciais, comerciais e industriais. Esta nova área desencadeou uma revolução, não só, ao nível da produção e comercialização, mas, também, do ponto de vista do utilizador, ao promover a comodidade, segurança, personalização e o controlo de pessoas e bens. Os smartphones e tablets vieram permitir que o desenvolvimento de aplicações móveis de interacção com os sistemas domóticos. Ao longo desta dissertação são descritas e analisadas as múltiplas áreas de intervenção da domótica assim como as diferentes tecnologias de aplicação e mercados. Também são analisados os sistemas operativos que existentes, as respetivas cotas de mercado e os tipos de dispositivos disponíveis. Por último, a aplicação foi concebida, implementada e testada para verificar a correcta interacção com o sistema domótico KNX e as funcionalidades de controlo da instalação domótica.

Le dépôt électronique au Canada : commentaires sur le Modèle de fournisseur de services de dépôt électronique

"Des spécialistes de la Cour suprême du Canada et de la Cour fédérale du Canada, Bill MURRAY et Gary PINDER, ont entrepris d’explorer les moyens par lesquels ces institutions pourraient prendre le virage vers l’électronique pour leurs échanges et leur gestion de l’information. Deux projets ont initialement été présentés au programme Gouvernement en direct. Ces projets ont progressivement convergés jusqu’au point de n’en former qu’un seul, celui décrit dans le « Document de travail : Modèle de fournisseur de services de dépôt électronique ». Un document, avertissent ses auteurs, qui ne vise pas l’endossement d’un modèle particulier, mais plutôt l’identification des voies par lesquelles un système cohérent de dépôt électronique pourrait être mis en place au Canada. D'emblée, quatre éléments du modèle proposé apparaissent particulièrement remarquables : il offre un cadre d’ensemble plutôt qu’un projet isolé ; il s’appuie sur l’utilisation de normes techniques, « Standard as Key Enabler » écrivent-ils ; il met à profit l’entreprise privée, un partenaire capable de trouver les marchés et de les développer ; il prévoit enfin, et ce n’est pas le moindre de ses mérites, la création d’un environnement compétitif pour le dépôt électronique. Selon nous, la voie qu’ils ont tracée peut être empruntée. Ce n’est pas dire qu’il faille accepter, tels quels, tous les éléments du projet sans examiner d’autres orientations ou poursuivre certaines réflexions. Mais, dans l’ensemble, la direction est juste et nous devrions nous y engager. Nous avons choisi de suggérer des orientations, et elles convergent presque toujours avec celles adoptées par les auteurs du document de travail. Nous ne mentionnons ici que la plus centrale d’entre elles. Le projet de mettre en place un système cohérent de dépôt électronique confirme s’il était nécessaire le besoin maintes fois ressenti d’un conseil canadien de l’information juridique. Un tel conseil pourrait mener des consultations et procéder à l’adoption des normes techniques qui manquent aujourd’hui cruellement au monde juridique canadien. Le présent projet et la réflexion qu’il nous impose nous offrent peut-être l’occasion de nous doter de cet outil qui non seulement pourrait clarifier le cadre du dépôt électronique, mais aussi d’élaborer les autres normes et lignes de conduite nécessaires à notre domaine. Il reste à inviter la magistrature à examiner attentivement le projet avancé par MURRAY et PINDER. Il esquisse une approche audacieuse et nouvelle pour que nos institutions judiciaires évoluent vers une utilisation encore plus efficiente des nouveaux moyens technologiques. L’influence et l’appui éclairé de la magistrature sont essentiels au démarrage d’un tel projet. D’autres aussi auront à examiner les mérites du modèle proposé, notamment les responsables administratifs des grandes institutions judiciaires canadiennes, nous sommes certains qu’ils sauront eux aussi reconnaître les possibilités que recèle ce projet."

Étude de faisabilité du modèle de fournisseur de services de dépôt électronique

"Le présent rapport a pour objet de fournir un commentaire détaillé sur la faisabilité globale d'un portail unique de dépôt électronique hébergé par le secteur privé (modèle transactionnel central de dépôt électronique) fondé sur la norme LegalXML. Le résultat attendu principal est une opinion concernant la faisabilité du modèle à guichet unique (portail électronique). D'autres résultats attendus comprennent : une connaissance accrue chez les intéressés du modèle de fournisseur de services et une évaluation préliminaire de l'appui que le modèle reçoit. Nous avons utilisé deux véhicules d'analyse principaux pour réaliser les objectifs de l'étude susmentionnés : des analyses documentaires et des entretiens auprès d'intéressés. Les analyses visent explicitement à : examiner des approches différentes au dépôt électronique, notamment un système de dépôt électronique comme extension de chaque instance, et l'hébergement par le secteur privé par opposition au secteur public d'un guichet unique; recenser les questions et les facteurs de risque critiques se rapportant à la mise en place de services de dépôt électronique dans les cours, notamment la protection des renseignements personnels, la propriété intellectuelle et la sécurité, et en discuter; opposer chacun de ces points au modèle de FSA; faire des recommandations sur la stratégie permettant de régler les questions et les facteurs de risque critiques. L'étude a révélé que : de nombreux intéressés appuient le dépôt électronique; de nombreux intéressés (p. ex. les avocats) ne font aucune distinction entre les formes différentes de dépôt électronique, tandis que d'autres s'en soucient beaucoup (p. ex. administrateurs de certaines cours); un modèle de fournisseur de services de dépôt électronique (FSDE) à guichet unique offre quelques avantages importants par rapport à une approche de dépôt électronique individuelle, surtout pour ce qui concerne les coûts et la plate-forme de l'avenir; un modèle de FSDE du secteur privé offre des avantages considérables par rapport à un modèle de FSDE du secteur privé, surtout en matière de succès et de coût de la mise en œuvre."

Work Domain Analysis for understanding medication safety in care homes in England: an exploratory study

Medication safety and errors are a major concern in care homes. In addition to the identification of incidents, there is a need for a comprehensive system description to avoid the danger of introducing interventions that have unintended consequences and are therefore unsustainable. The aim of the study was to explore the impact and uniqueness of Work Domain Analysis (WDA) to facilitate an in-depth understanding of medication safety problems within the care home system and identify the potential benefits of WDA to design safety interventions to improve medication safety. A comprehensive, systematic and contextual overview of the care home medication system was developed for the first time. The novel use of the Abstraction Hierarchy (AH) to analyse medication errors revealed the value of the AH to guide a comprehensive analysis of errors and generate system improvement recommendations that took into account the contextual information of the wider system.

OFF-LINE SUPERCRITICAL-FLUID EXTRACTION - HIGH-RESOLUTION GAS-CHROMATOGRAPHY APPLIED TO THE STUDY OF MORACEAE SPECIES

Supercritical fluid extraction with CO2, Performed in a home-made system, of rhizomes of Dorstenia bryoniifolia Mart. ex Miq. (Moraceae) and of bark roots of Brosimum gaudichaudii Trecul (Moraceae) afforded crude extracts that were analysed by high resolution gas chromatography (HRGC). The D. bryoniifolia extract contained, besides the previously reported pimpinelin and isobergapten, the furocoumarins psoralen, bergapten, isopimpinelin and the triterpenes alpha- and beta-amyrin and the acetate of the latter. The B. gaudichaudii extract contained a number of terpenoids as well as the previously reported psoralen and bergapten. Supercritical fluid extraction gave extracts qualitatively similar to those obtained by Soxhlet extraction with hexane and, together with off-line HRGC, was shown to be a fast and accurate technique to be used in rapid phytochemical examination.

Neural network controller for active demand side management with PV energy in the residential sector

In this paper, we describe the development of a control system for Demand-Side Management in the residential sector with Distributed Generation. The electrical system under study incorporates local PV energy generation, an electricity storage system, connection to the grid and a home automation system. The distributed control system is composed of two modules: a scheduler and a coordinator, both implemented with neural networks. The control system enhances the local energy performance, scheduling the tasks demanded by the user and maximizing the use of local generation.

Implementación de sistema domótico con servidor Raspberry

Este proyecto consiste en el diseño e implementación un sistema domótico que puede ser instalado en una vivienda para controlar distintas variables ambientales y conseguir así la máxima comodidad de los habitantes de manera automática o manual según los gustos y necesidades de los usuarios. La característica principal de este sistema, es que cuenta con un funcionamiento distribuido donde entran en juego un servidor, encargado de tomar las decisiones generales para el comportamiento de la casa, y una serie de controladores esclavo cuya función es mantener constantes las variables ambientales con los valores fijados por el servidor. Así se consigue mantener la vivienda en una situación de bienestar constante para cualquier persona que se encuentre dentro. El sistema ha sido pensado de manera que se intenta reducir al máximo el cableado para facilitar su instalación por lo que la comunicación entre los distintos dispositivos se hace de manera inalámbrica por medio de un protocolo descrito en la norma IEEE 802.15.4 llamado ZigBee. Para ello se ha utilizado un módulo de comunicación wireless llamado Xbee, el cual permite la comunicación entre dos dispositivos. Para el control de dicho sistema distribuido se cuenta con una aplicación web, que mediante una interfaz gráfica permite al usuario controlar los distintos dispositivos dentro de la vivienda consiguiendo así controlar las variables ambientales a gusto del usuario. Dicha interfaz gráfica no depende de un software específico, sino que sólo es necesario un cliente http como podría ser Internet Explorer, Mozilla Firefox, Google Chrome, etc. Para integrar dicho sistema se ha usado un mini ordenador de bajo coste llamado RaspBerryPi, en el que se encuentra alojado un servidor Apache con el fin de gestionar y automatizar las variables ambientales. El control de los dipositivos encargados de modificar y estabilizar las variables ambientales se realiza mediante unos controladores genéricos implementados mediante mcontroladores 80C51F410, pertenecientes a la familia 80C51, y una serie de componentes y circuitería que permiten el correcto funcionamiento de éstos. Existen dos tipos de controladores distintos, los cuales son: Controlador Sensor: Encargados de las tomas de valores ambientales como puede ser la luz y la temperatura. Controladores Actuadores: Encargados de actuar sobre los dispositivos que modifican y estabilizan las variables ambientales como pueden ser la calefacción, tiras de leds de iluminación, persianas, alarmas, etc. El conjunto de la RaspBerryPi y los diferentes controladores forman el prototipo diseñado para este proyecto fin de carrera, el cual puede ser ampliado sencillamente para abarcar una amplia gama de posibilidades y funcionalidades dentro de la comodidad de una vivienda. ABSTRACT. The project described in this report consisted designing and implementing a home automation system that could be installed in a house in order to control environmental variables and thus get the maximum comfort of the inhabitant automatically or manually according to their tastes and needs. The main feature of this system consists in a distributed system, formed by a server which is responsible for making the main decisions of the actions performed inside the house. In addition, there are a series of slave controlers whose function consists in keeping the environmental variables within the values established by the server. Thus gets to keep the home in a situation of constant wellbeing to anyone who is inside. The system has been designed in order to reduce the amount of wire needed for the inter-connection of the devices, by means of wireless communication. The devices chosen for the solution are Xbee modules, which use the Zigbee protocol in order to comunicate one between each other. The Zigbee protocol is fully described in the IEEE 802.15.4 standard. A web application has been used to control the distributed system. This application allows users to control various devices inside the house and subsequently the different environmental variables. This implementation allows obtaining the maximum comfort by means of a very simple graphical interface. In addition, the Graphical User Interface (GUI) does not depend on any specific software. This means that it would only be necessary a http client (such as Internet Explorer, Mozilla Firefox, Google Chrome, etc.) for handling the application. The system has been integrated using a low-cost mini computer called RaspBerryPi.This computer has an Apache server allocated which allows to manage and to automatize the different environmental variables. Furthermore, for changing and stabilizing those variables, some generic controllers have been developed, based on mcontrollers 80C51F410. There have been developed mainly two different types of controllers: Sensor Controllers, responsible for measuring the different environmental values, such as light and temperature; and Actuator Controllers, which purpose is to modify and stabilize those environmental variables by actuating on the heating, the led lamps, the blinders, the alarm, etc. The combination of the RaspBerryPi and the different controllers conform the prototype designed during this project. Additionally, this solution could be easily expanded in order to intake further functionalities adapted to new needs that could arise in the future.

Determination of the influence of specific building regulations in smart buildings

The automation of domestic services began to be implemented in buildings since the late nineteenth century, and today we are used to terms like ‘intelligent buildings’, ‘digital home’ or ‘domotic buildings’. These concepts tell us about constructions which integrate new technologies in order to improve comfort, optimize energy consumption or enhance the security of users. In conjunction, building regulations have been updated to suit the needs of society and to regulate these new facilities in such structures. However, we are not always sure about how far, from the quantitative or qualitative point of view, legislation should regulate certain aspects of the building activity. Consequently, content analysis is adopted in this research to determine the influence of building regulations in the implementation of new technologies in the construction process. This study includes the analysis of different European regulations, the collection and documentation of such guidelines that have been established and a study of the impact that all of these have had in the way we start thinking an architectural project. The achievements of the research could be explained in terms of the regulatory requirements that must be taken into account in order to achieve a successful implementation of a home automation system, and the key finding has been the confirmation of how the design of smart buildings may be promoted through specific regulatory requirements while other factors, such as the global economic situation, do not seem to affect directly the rate of penetration of home automation in construction.

Extensão do padrão UPnP para a integração de sistemas de automação residencial.

O presente trabalho discute a compatibilidade e integração entre sistemas e dispositivos de automação residencial, propondo formas de melhorá-la. Essa integração tende a se tornar uma tarefa complexa devido à grande variedade de padrões e tecnologias de integração adotados na automação residencial. O presente trabalho propõe uma extensão do padrão Universal Plug and Play (UPnP) e a utilização de uma arquitetura modular com duas camadas, afim de adaptá-lo à integração dos subsistemas de automação residencial. Esse padrão estendido é, então, utilizado na camada superior, para o controle e integração entre os subsistemas. Já na camada inferior, cada subsistema utiliza a tecnologia de comunicação mais adequada para controlar seus dispositivos, e possui uma interface UPnP para se comunicar com outros subsistemas e permitir seu controle pelo usuário. Dessa forma os subsistemas tornam-se módulos do sistema de automação da residência. Essa proposta permite que o usuário compre e substitua facilmente subsistemas de fabricantes distintos, de forma a integrá-los, resultando em um sistema de automação residencial flexível e independente de fabricante. Para testar a extensão proposta, um caso de uso de um subsistema de iluminação foi criado. A partir deste, foram realizadas simulações computacionais. Os resultados destas foram apresentados e analisados, verificando-se o atendimento aos requisitos do sistema e se as características desejadas foram alcançadas, tais como, a característica plug and play de subsistemas, o aumento da flexibilidade e a modularização do sistema, para facilitar a compra e manutenção de sistemas de automação residencial, gerando o potencial para fomentar a maior adoção de sistemas de automação residencial. No entanto, a extensão proposta também resulta no aumento da complexidade do cliente UPnP que a utiliza para interagir com o sistema, o que pode dificultar a adoção de sistemas de automação residencial no futuro. Por fim, sugestões de continuidade e perspectivas futuras foram apresentadas.

A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

Specification of a smart meter/actuator description mechanism & development of a mobile application

Home Automation holds the potential of realizing cost savings for end users while reducing the carbon footprint of domestic energy consumption. Yet, adoption is still very low. High cost of vendor-supplied home automation systems is a major prohibiting factor. Open source systems such as FHEM, Domoticz, OpenHAB etc. are a cheaper alternative and can drive the adoption of home automation. Moreover, they have the advantage of not being limited to a single vendor or communication technology which gives end users flexibility in the choice of devices to include in their installation. However, interaction with devices having diverse communication technologies can be inconvenient for users thus limiting the utility they derive from it. For application developers, creating applications which interact with the several technologies in the home automation systems is not a consistent process. Hence, there is the need for a common description mechanism that makes interaction smooth for end users and which enables application developers to make home automation applications in a consistent and uniform way. This thesis proposes such a description mechanism within the context of an open source home automation system – FHEM, together with a system concept for its application. A mobile application was developed as a proof of concept of the proposed description mechanism and the results of the implementation are reflected upon.