Effectiveness of healthcare waste management interventions in developing countries

Inefficiencies during the management of healthcare waste can give rise to undesirable health effects such as transmission of infections and environmental pollution within and beyond the health facilities generating these wastes. Factors such as prevalence of diseases, conflicts, and the efflux of intellectual capacity make low income countries more susceptible to these adverse health effects. The purpose of this systematic review was to describe the effectiveness of interventions geared towards better managing the generation, collection, transport, treatment and disposal of medical waste, as they have been applied in lower and middle income countries.^ Using a systematic search strategy and evaluation of study quality, this study reviewed the literature for published studies on healthcare waste management interventions carried out in developing countries, specifically the low and lower middle income countries from year 2000 to the current year. From an initially identified set of 829 studies, only three studies ultimately met all inclusion, exclusion and high quality criteria. A multi component intervention in Syrian Arab Republic, conducted in 2007 was aimed at improving waste segregation practice in a hospital setting. There was an increased use of segregation boxes and reduced rates of sharps injury among staff as a result of the intervention. Another study, conducted in 2008, trained medical students as monitors of waste segregation practice in an Indian teaching hospital. There was improved practice in wards and laboratories but not in the intensive care units. The third study, performed in 2008 in China, consisted of modification of the components of a medical waste incinerator to improve efficiency and reduce stack emissions. Gaseous pollutants emitted, except polychlorodibenzofurans (PCDF) were below US EPA permissible exposure limits. Heavy metal residues in the fly ash remained unchanged.^ Due to the paucity of well-designed studies, there is insufficient evidence in literature to conclude on the effectiveness of interventions in low income settings. There is suggestive but insufficient evident that multi-component interventions aimed at improving waste segregation through behavior modification, provision of segregation tools and training of monitors are effective in low income settings.^

A systematic review of telemedicine interventions for type 2 diabetes patients

Telemedicine is the use of telecommunications to support health care services and it incorporates a wide range of technology and devices. This systematic review seeks to determine which types of telemedicine technologies have been the most effective at improving the major health factors of subjects with type 2 diabetes. The major health factors identified were blood glucose, systolic and diastolic blood pressure, LDL cholesterol, weight, BMI, triglyceride levels, and waist circumference. A literature search was performed using peer reviewed, scholarly articles focused on the health outcomes of type 2 diabetes patients served by various telemedicine interventions. A total of 15 articles met the search criteria and were then analyzed to determine the significant health outcomes of each telemedicine interventions for type 2 diabetes patients. Results showed that telemedicine interventions using videoconferencing technology resulted in significant improvements in five health factor outcomes (total body weight, BMI, blood glucose, LDL cholesterol, and blood pressure), while telemedicine interventions using web applications and health monitors/modems only produced significant improvements in blood glucose. Future research should focus on examining the costs and benefits of videoconferencing and other telemedicine technologies for type 2 diabetes patients.^

Ozone and fine particulate matter association with CVD and COPD emergency room visits in Harris County, Texas: Spatiotemporal analysis

This study represents a secondary analysis of the merging of emergency room visits and daily ozone and PM2.5. Although the adverse health effects of ozone and fine particulate matter have been documented in the literature, evidence regarding the health risks of these two pollutants in Harris County, Texas, is limited. Harris County (Houston) has sufficiently unique characteristics that analysis of these relationships in this setting and with the ozone and industry issues in Houston is informative. The objective of this study was to investigate the association between the joint exposure to ozone and fine particulate matter, and emergency room diagnoses of chronic obstructive pulmonary disease and cardiovascular disease in Harris County, Texas, from 2004 to 2009, with zero and one day lags. ^ The study variables were daily emergency room visits for Harris County, Texas, from 2004 to 2009, temperature, relative humidity, east wind component, north wind component, ozone, and fine particulate matter. Information about each patient's age, race, and gender was also included. The two dichotomous outcomes were emergency room visits diagnoses for chronic obstructive pulmonary disease and cardiovascular disease. Estimates of ozone and PM2.5 were interpolated using kriging, in which estimates of the two pollutants were predicted from monitoring data for every case residence zip code for every day of the six years, over 3 million estimates (one of each pollutant for each case in the database). ^ Logistic regressions were conducted to estimate odds ratios of the two outcomes. Three analyses were conducted: one for all records, another for visits during the four months of April and September of 2005 and 2009, and a third one for visits from zip codes that are close to PM2.5 monitoring stations (east area of Harris County). The last two analyses were designed to investigate special temporal and spatial characteristics of the associations. ^ The dataset included all ER visits surveyed by Safety Net from 2004 to 2009, exceeding 3 million visits for all causes. There were 95,765 COPD and 96,596 CVD cases during this six year period. A 1-μg/m3 increase in PM2.5 on the same day was associated with a 1.0% increase in the odds of chronic obstructive pulmonary disease emergency room diagnoses, a 0.4% increase in the odds of cardiovascular disease emergency room diagnoses, and a 0.2% increase in the odds of cardiovascular disease emergency room diagnoses on the following day. A 1-ppb increase in ozone was associated with a 0.1% increase in the odds of chronic obstructive pulmonary disease emergency room diagnoses on the same day. These four percentages add up to 1.7% of ER visits. That is, over the period of six years, one unit increase for both ozone and PM2.5 (joint increase), resulted in about 55,286 (3,252,102 * 0.017) extra ER visits for CVD or COPD, or 9,214 extra ER visits per year. ^ After adjustment for age, race, gender, day of the week, temperature, relative humidity, east wind component, north wind component, and wind speed, there were statistically significant associations between emergency room chronic obstructive pulmonary disease diagnosis in Harris County, Texas, with joint exposure to ozone and fine particulate matter for the same day; and between emergency room cardiovascular disease diagnosis and exposure to PM2.5 of the same day and the previous day. ^ Despite the small association between the two air pollutants and the health outcomes, this study points to important findings. Namely, the need to identify reasons for the increase of CVD and COPD ER visits over the course of the project, the statistical association between humidity (or whatever other variables for which it may serve as a surrogate) and CVD and COPD cases, and the confirmatory finding that males and blacks have higher odds for the two outcomes, as consistent with other studies. ^ An important finding of this research suggests that the number and distribution of PM2.5 monitors in Harris County - although not evenly spaced geographically—are adequate to detect significant association between exposure and the two outcomes. In addition, this study points to other potential factors that contribute to the rising incidence rates of CVD and COPD ER visits in Harris County such as population increases, patient history, life style, and other pollutants. Finally, results of validation, using a subset of the data demonstrate the robustness of the models.^

On Bayesian seamless phase I-II designs

Early phase clinical trial designs have long been the focus of interest for clinicians and statisticians working in oncology field. There are several standard phse I and phase II designs that have been widely-implemented in medical practice. For phase I design, the most commonly used methods are 3+3 and CRM. A newly-developed Bayesian model-based mTPI design has now been used by an increasing number of hospitals and pharmaceutical companies. The advantages and disadvantages of these three top phase I designs have been discussed in my work here and their performances were compared using simulated data. It was shown that mTPI design exhibited superior performance in most scenarios in comparison with 3+3 and CRM designs. ^ The next major part of my work is proposing an innovative seamless phase I/II design that allows clinicians to conduct phase I and phase II clinical trials simultaneously. Bayesian framework was implemented throughout the whole design. The phase I portion of the design adopts mTPI method, with the addition of futility rule which monitors the efficacy performance of the tested drugs. Dose graduation rules were proposed in this design to allow doses move forward from phase I portion of the study to phase II portion without interrupting the ongoing phase I dose-finding schema. Once a dose graduated to phase II, adaptive randomization was used to randomly allocated patients into different treatment arms, with the intention of more patients being assigned to receive more promising dose(s). Again simulations were performed to compare the performance of this innovative phase I/II design with a recently published phase I/II design, together with the conventional phase I and phase II designs. The simulation results indicated that the seamless phase I/II design outperform the other two competing methods in most scenarios, with superior trial power and the fact that it requires smaller sample size. It also significantly reduces the overall study time. ^ Similar to other early phase clinical trial designs, the proposed seamless phase I/II design requires that the efficacy and safety outcomes being able to be observed in a short time frame. This limitation can be overcome by using validated surrogate marker for the efficacy and safety endpoints.^

Age determination of sediment core SO75-26KL, Portuguese margin

A benthic isotope record has been measured for core SO75-26KL from the upper Portuguese margin (1099 m water depth) to monitor the response of thermohaline overturn in the North Atlantic during Heinrich events. Evaluating benthic delta18O in TS diagrams in conjunction with equilibrium deltac fractionation implies that advection of Mediterranean outflow water (MOW) to the upper Portuguese margin was significantly reduced during the last glacial (< 15% compared to 30% today). The benthic isotope record along core SO75-26KL therefore primarily monitors variability of glacial North Atlantic conveyor circulation. The 14C-accelerator mass spectrometry ages of 13.54±.07 and 20.46±.12 ka for two ice-rafted detritus (IRD) layers in the upper core section and an interpolated age of 36.1 ka for a third IRD layer deeper in the core are in the range of published 14C ages for Heinrich events H1, H2, and H4. Marked depletion of benthic delta13C by 0.7-1.1 per mil during the Heinrich events suggests reduced thermohaline overturn in the North Atlantic during these events. Close similarity between meltwater patterns (inferred from planktonic delta18O) at Site 609 and ventilation patterns (inferred from benthic delta13C) in core SO75-26KL implies coupling between thermohaline overturn and surface forcing, as is also suggested by ocean circulation models. Benthic delta13C starts to decrease 1.5-2.5 kyr before Heinrich events Hl and H4, fully increased values are reached 1.5-3 kyr after the events, indicating a successive slowdown of thermohaline circulation well before the events and resumption of the conveyor's full strength well after the events. Benthic delta13C changes in the course of the Heinrich events show subtle maxima and minima suggesting oscillatory behavior of thermohaline circulation, a distinct feature of thermohaline instability in numerical models. Inferrred gradual spin-up of thermohaline circulation after Hl and H4 is in contrast to abrupt wanning in the North Atlantic region that is indicated by sudden increases in Greenland ice core delta18O and in marine faunal records from the northern North Atlantic. From this we infer that thermohaline circulation can explain only in part the rapid climatic oscillations seen in glacial sections of the Greenland ice core record.

Geochemisty at DSDP Hole 62-465A

Very significant enhancements of the element iridium have been observed in association with the Cretaceous/ Tertiary boundary in marine sediments laid down 65 m.y. ago and subsequently uplifted above the ocean's surface. If our hypothesis for the origin of the iridium and the cause of the Cretaceous/Tertiary life extinctions (the asteroid-impact theory) (Alvarez et al., 1980) is correct, the Ir anomaly should be associated with the Cretaceous/ Tertiary boundary region wherever it is intact. The present work was undertaken to search for the Ir anomaly in a deep-sea-drilling core, in order to check this aspect of the asteroid-impact theory.

Stable isotope record of benthic and planktonic foraminifera from ODP Site 175-1087 in the southern Cape Basin, Atlantic Ocean

High-resolution planktonic and benthic stable isotope records from Ocean Drilling Program Site 1087 off southeast Africa provide the basis for a detailed study of glacial-interglacial (G-IG) cycles during the last 500 k.y. This site is located in the Southern Cape Basin at the boundary of the coastal upwelling of Benguela and close to the gateway between the South Atlantic and the Indian Oceans. It therefore monitors variations of the hydrological fronts associated with the upwelling system and the Atlantic-Indian Ocean interconnections, in relation to global climate change. The coldest period of the last 500 k.y. corresponds to marine isotope Stage (MIS) 12, when surface water temperature was 4°C lower than during the last glacial maximum (LGM) as recorded by the surface-dwelling foraminifer Globigerinoides ruber. The warmest periods occurred during MISs 5 and 11, a situation slightly different to that observed at Site 704, which is close to the Polar Front Zone, where there is no significant difference between the interglacial stages for the past 450 k.y., except the long period of warmth during MIS 11. The planktonic and benthic carbon isotope records do not follow the G-IG cycles but show large oscillations related to major changes in the productivity regime. The largest positive 13C excursion between 260 and 425 ka coincides with the global mid-Brunhes event of carbonate productivity. The oxygen and carbon isotopic gradients between surface and deep waters display long-term changes superimposed on rapid and high-frequency fluctuations that do not follow the regular G-IG pattern; these gradients indicate modifications of the temperature, salinity, and productivity gradients due to changes in the thermocline depth, the position of the hydrological fronts, and the strength of the Benguela Current.

Chemical element concentrations in sediments from DSDP Holes 60-458 and 60-459

The development of laser ablation-inductively coupled plasma-mass spectrometry has revolutionized the analysis of tephras by providing (1) an efficient and precise method for determining abundances of a wide variety of trace elements at low concentrations in individual glass shards and (2) assessment of geochemical heterogeneities within individual ash horizons. This development is important for petrogenetic studies of intraoceanic arc systems, where tephras provide the most complete temporal record of magmatism. Results from the Izu-Bonin and Mariana arc systems indicate that despite close geographical proximity and similar tectonic evolution, they contrast strongly in terms of geochemical evolution since 35 Ma. Whereas the Mariana tephras have exceptional compositional diversity, ranging from low-K (Oligocene), to high-K (Miocene), and subsequently medium-K compositions (Pliocene-Quaternary), the Izu-Bonin arc has been dominated by low-K compositions throughout. The Mariana increases in K are paralleled by increases in abundances of incompatible trace elements and by increased values of diagnostic ratios (e.g., Nb/yb and Th/yb) regarded as monitors of potential mantle-source fertility. The relative uniformity of Nb/yb and Nb/Zr ratios in Izu-Bonin tephras indicates that cyclic processes of backarc basin development and mantle depletion do not necessarily induce large-scale temporal geochemical variations in the associated arc. Temporal variability within the Mariana arc, and its divergence from the Izu-Bonin arc ca. 13 Ma, can be traced to a major injection of subducted sediment in the Mariana system at this time.

Grain characteristics and XRD raw data of ODP Sites 162-981 and 162-984

Multisensor track data, including magnetic susceptibility, gamma-ray attenuation porosity evaluator (GRAPE) wet bulk density, and natural gamma emission, were collected on all cores recovered during Ocean Drilling Program Leg 162. Data from the upper Pliocene and lower Pleistocene of Sites 981 and 984 are here compared to results from analyses of a limited set of discrete samples, including benthic foraminiferal isotopic composition, grain size, carbonate content, abundance of foraminifers and lithic particles, and clay mineralogy. Natural gamma emission most closely monitors the input of felsic terrigenous material to these two sites. Magnetic susceptibility also tracks felsic terrigenous input at Site 981 but appears to reflect a separate, more mafic, terrigenous component at Site 984. The GRAPE record does not correlate well with any discretely measured variable at Sites 981 or 984.

Pleistocene stable isotope record of planktonic foraminifera of ODP Site 138-847

We present Pleistocene oxygen and carbon isotope records from two planktonic foraminifer species (Globigerinoides sacculifer and Neogloboquadrina dutertrei) from Ocean Drilling Program Site 847 (0°16'N, 95°19'W; 3334 m water depth). An average sample resolution of 4500 yr was obtained by sampling at an interval of 15 cm through a continuous 35-m section from 0 to 1.15 Ma. Our d18O-based chronology is similar to that derived independently by astronomically tuning the gamma-ray attenuation porosity evaluator (GRAPE) record (Shackleton et al., 1995), though offsets as large as ± 30 k.y. occur on occasion. The surface waters at eastern equatorial Pacific Site 847, 380 km west of the Galapagos, are characterized by strong and constant upwelling, elevated nutrient concentrations, and high productivity. The isotopic composition of G. sacculifer (300-355 µm) reflects conditions in the thin-surface mixed layer, and the composition of N. dutertrei (355-425 µm) monitors the subsurface waters of the permanent shallow (10-40 m) thermocline. The Pleistocene d18O difference (N. dutertrei minus G. sacculifer, Dd18Od-s) averages 0.9 per mil and ranges from 0 per mil to 1.7 per mil. Neglecting species effects and shell size, the average Pleistocene d13C difference (G. sacculifer minus N. dutertrei, Dd13Cs-d) is 0.0 per mil and ranges from -0.5 per mil to 0.5 per mil. The Dd18Od-s and Dd13Cs-d records are used to infer vertical contrasts in upper ocean water temperature and nutrient concentration, though d13C may also be influenced by other factors, such as CO2 gas exchange. Variations in the isotopic differences are often synchronous with glacial/interglacial climate change. Glacial periods are characterized by smaller vertical contrasts in both temperature and nutrient concentration, and by notably greater accumulation rates of N. dutertrei and CaCO3. We attribute these responses to greater upwelling at the equatorial divergence. Superimposed on the glacial/interglacial Dd18Od-s pattern is a long-term trend possibly associated with the advection of Peru Current waters. The temporal fluctuations in the isotopic contrasts are strikingly similar to those observed at Site 851 (Ravelo and Shackleton, this volume), suggesting that the inferred changes in thermal and chemical profiles occurred over a broad region in the equatorial Pacific.

Biogenic opal and carbonate concentration in late Neogene sediments of ODP Site 114-704

A preliminary composite depth section was generated for Site 704 by splicing Holes 704A and 704B together over the interval 0-350 mbsf (0-9 m.y.). High-resolution carbonate and opal data from the cores were correlated with the calcium and silicon signals from the GST logging run in Hole 704B to identify missing and disturbed intervals in the cores. Paleomagnetic and biostratigraphic age boundaries were then transferred to the composite depth records to obtain an age model, and sedimentation rates were calculated by linear interpolation between datums. Algorithms relating measured dry-bulk density to carbonate content and depth were generated to produce predicted values of density for every sample. Accumulation rates of bulk, carbonate, opal, and terrigenous sediment components were then computed to generate a record of sediment deposition on the Meteor Rise that has a resolution of better than 200,000 yr for the period from 8.6 to 1.0 m.y. From 8.6 to 2.5 m.y., bulk-accumulation rates on the Meteor Rise averaged less than 2 g/cm**2/1000 yr and were dominated by carbonate deposition. The first significant opal deposition (6.0 m.y.) punctuated a brief (less than 0.6 Ma) approach of the Polar Front Zone (PFZ) northward that heralded a period of increasing severity of periodic carbonate dissolution events (terrigenous maxima) that abruptly terminated at 4.8 m.y. (base of the Thvera Subchron), synchronous with the reflooding of the Mediterranean after the Messinian salinity crisis. From 4.8 to 2.5 m.y., carbonate again dominated deposition, and the PFZ was far south except during brief northward excursions bracketing 4.2-3.9, 3.3-2.9, and 2.8-2.7 m.y. At 2.5 m.y., all components of bulk-accumulation rates increased dramatically (up to 15 g/cm2/1000 yr), and by 2.4 m.y., a pattern of alternating, high-amplitude carbonate and opal cyclicity marked the initiation of rapid glacial to interglaci·l swings in the position of the PFZ, synchronous with the "onset" of major Northern Hemisphere glaciation. Both mass-accumulation rates and the amplitude of the cycles decreased by about 2 m.y., but opal accumulation rates remained high up through the base of the Jaramillo (0.98 m.y.). From 1.9 to 1 m.y., the record is characterized by moderate amplitude fluctuations in carbonate and opal. This record of opal accumulation rates is interpreted as a long-term "Polar Front Indicator" that monitors the advance and retreat of the opal-rich PFZ northward (southward) toward (away from) the Meteor Rise in the subantarctic sector of the South Atlantic Ocean. The timing of PFZ migrations in the subantarctic South Atlantic Ocean is remarkably similar to Pliocene-Pleistocene climate records deduced from benthic oxygen isotope records in the North Atlantic Ocean (Raymo et al., 1989, doi:10.1029/PA004i004p00413; Ruddiman et al., 1989, doi:10.1029/PA004i004p00353). These include northward migrations during "cold" intervals containing strong glacial isotope stages (2.4-2.3, 2.1-2.0, 1.95-1.55, 1.45-1.30 m.y. and at about 1.13 and 1.09 m.y.) and southward migrations during "warm" intervals containing weak glacial and/or strong interglacial stages (2.45-2.40, 2.30-2.10, 2.00-1.95, 1.52-1.45, 1.30-1.18, 1.11, and 1.06-0.93 m.y.). Although our preliminary composite record is not continuous (some stages are obviously missing), there is hope that future work will identify these missing intervals in the as yet incomplete Hole 704B and will extend this high-resolution Southern Hemisphere climate record back to 8.6 m.y.

Major and trace element abundances at DSDP Hole 72-516F

Anomalously high values of Ir have been detected in association with the Cretaceous/Tertiary boundary in about a dozen marine or continental sections laid down about 65 Ma in many different parts of the world (Alvarez et al., 1981). One possible exception is the Cretaceous/Tertiary boundary region in DSDP Site 356, in the South Atlantic off the coast of South America. In a detailed study of that section, the maximum Ir abundance was about 0.2 ppb, much lower than the 3-90 ppb found in most of the other marine locations (authors' unpublished data on the Cretaceous/Tertiary region of Site 356, 1982). A study of Hole 516F, which is not too far from Site 356, could show whether the very low (or missing) Cretaceous/Tertiary Ir anomaly at Site 356 is characteristic of this region of the South Atlantic.

Application of Deadlock Risk Evaluation of Architectural Models

Software architectural evaluation is a key discipline used to identify, at early stages of a real-time system (RTS) development, the problems that may arise during its operation. Typical mechanisms supporting concurrency, such as semaphores, mutexes or monitors, usually lead to concurrency problems in execution time that are difficult to be identified, reproduced and solved. For this reason, it is crucial to understand the root causes of these problems and to provide support to identify and mitigate them at early stages of the system lifecycle. This paper aims to present the results of a research work oriented to the development of the tool called ‘Deadlock Risk Evaluation of Architectural Models’ (DREAM) to assess deadlock risk in architectural models of an RTS. A particular architectural style, Pipelines of Processes in Object-Oriented Architectures–UML (PPOOA) was used to represent platform-independent models of an RTS architecture supported by the PPOOA –Visio tool. We validated the technique presented here by using several case studies related to RTS development and comparing our results with those from other deadlock detection approaches, supported by different tools. Here we present two of these case studies, one related to avionics and the other to planetary exploration robotics. Copyright © 2011 John Wiley & Sons, Ltd.

Modelado de sistemas de inteligencia ambiental para el entrenamiento de las cualidades físicas

En un ejercicio no extenuante la frecuencia cardíaca (FC) guarda una relación lineal con el consumo máximo de oxígeno (V O2max) y se suele usar como uno de los parámetros de referencia para cuantificar la capacidad del sistema cardiovascular. Normalmente la frecuencia cardíaca puede remplazar el porcentaje de V O2max en las prescripciones básicas de ejercicio para la mejora de la resistencia aeróbica. Para obtener los mejores resultados en la mejora de la resistencia aeróbica, el entrenamiento de los individuos se debe hacer a una frecuencia cardíaca suficientemente alta, para que el trabajo sea de predominio dinámico con la fosforilación oxidativa como fuente energética primaria, pero no tan elevada que pueda suponer un riesgo de infarto de miocardio para el sujeto que se está entrenando. Los programas de entrenamiento de base mínima y de base óptima, con ejercicios de estiramientos para prevenir lesiones, son algunos de los programas más adecuados para el entrenamiento de la resistencia aeróbica porque maximizan los beneficios y minimizan los riesgos para el sistema cardiovascular durante las sesiones de entrenamiento. En esta tesis, se ha definido un modelo funcional para sistemas de inteligencia ambiental capaz de monitorizar, evaluar y entrenar las cualidades físicas que ha sido validado cuando la cualidad física es la resistencia aeróbica. El modelo se ha implementado en una aplicación Android utilizando la camiseta inteligente “GOW running” de la empresa Weartech. El sistema se ha comparado en el Laboratorio de Fisiología del Esfuerzo (LFE) de la Universidad Politécnica de Madrid (UPM) durante la realización de pruebas de esfuerzo. Además se ha evaluado un sistema de guiado con voz para los entrenamientos de base mínima y de base óptima. También el desarrollo del software ha sido validado. Con el uso de cuestionarios sobre las experiencias de los usuarios utilizando la aplicación se ha evaluado el atractivo de la misma. Por otro lado se ha definido una nueva metodología y nuevos tipos de cuestionarios diseñados para evaluar la utilidad que los usuarios asignan al uso de un sistema de guiado por voz. Los resultados obtenidos confirman la validez del modelo. Se ha obtenido una alta concordancia entre las medidas de FC hecha por la aplicación Android y el LFE. También ha resultado que los métodos de estimación del VO2max de los dos sistemas pueden ser intercambiables. Todos los usuarios que utilizaron el sistema de guiado por voz para entrenamientos de 10 base mínima y de base óptimas de la resistencia aeróbica consiguieron llevar a cabo las sesiones de entrenamientos con un 95% de éxito considerando unos márgenes de error de un 10% de la frecuencia cardíaca máxima teórica. La aplicación fue atractiva para los usuarios y hubo también una aceptación del sistema de guiado por voz. Se ha obtenido una evaluación psicológica positiva de la satisfacción de los usuarios que interactuaron con el sistema. En conclusión, se ha demostrado que es posible desarrollar sistemas de Inteligencia Ambiental en dispositivos móviles para la mejora de la salud. El modelo definido en la tesis es el primero modelo funcional teórico de referencia para el desarrollo de este tipo de aplicaciones. Posteriores estudios se realizarán con el objetivo de extender dicho modelo para las demás cualidades físicas que suponen modelos fisiológicos más complejos como por ejemplo la flexibilidad. Abstract In a non-strenuous exercise, the heart rate (HR) shows a linear relationship with the maximum volume of oxygen consumption (V O2max) and serves as an indicator of performance of the cardiovascular system. The heart rate replaces the %V O2max in exercise program prescription to improve aerobic endurance. In order to achieve an optimal effect during endurance training, the athlete needs to work out at a heart rate high enough to trigger the aerobic metabolism, while avoiding the high heart rates that bring along significant risks of myocardial infarction. The minimal and optimal base training programs, followed by stretching exercises to prevent injuries, are adequate programs to maximize benefits and minimize health risks for the cardiovascular system during single session training. In this thesis, we have defined an ambient intelligence system functional model that monitors, evaluates and trains physical qualities, and it has been validated for aerobic endurance. It is based on the Android System and the “GOW Running” smart shirt. The system has been evaluated during functional assessment stress testing of aerobic endurance in the Stress Physiology Laboratory (SPL) of the Technical University of Madrid (UPM). Furthermore, a voice system, designed to guide the user through minimal and optimal base training programs, has been evaluated. Also the software development has been evaluated. By means of user experience questionnaires, we have rated the attractiveness of the android application. Moreover, we have defined a methodology and a new kind of questionnaires in order to assess the user experience with the audio exercise guide system. The results obtained confirm the model. We have a high similarity between HR measurements made of our system and the one used by SPL. We have also a high correlation between the VO2max estimations of our system and the SPL system. All users, that tried the voice guidance system for minimal and optimal base training programs, were able to perform the 95% of the training session with an error lower than the 10% of theoretical maximum heart rate. The application appeared attractive to the users, and it has also been proven that the voice guidance system was useful. As result we obtained a positive evaluation of the users' satisfaction while they interacted with the system. In conclusion, it has been demonstrated that is possible to develop mobile Ambient Intelligence applications for the improvement of healthy lifestyle. AmIRTEM model is the first theoretical reference functional model for the design of this kind of applications. Further studies will be realized in order to extend the AmIRTEM model to other physical qualities whose physiological models are more complex than the aerobic endurance.

Content Delivery System for Optimal VoD Streaming

The demand of video contents has rapidly increased in the past years as a result of the wide deployment of IPTV and the variety of services offered by the network operators. One of the services that has especially become attractive to the customers is real-time video on demand (VoD) because it offers an immediate streaming of a large variety of video contents. The price that the operators have to pay for this convenience is the increased traffic in the networks, which are becoming more congested due to the higher demand for VoD contents and the increased quality of the videos. As a solution, in this paper we propose a hierarchical network system for VoD content delivery in managed networks, which implements redistribution algorithm and a redirection strategy for optimal content distribution within the network core and optimal streaming to the clients. The system monitors the state of the network and the behavior of the users to estimate the demand for the content items and to take the right decision on the appropriate number of replicas and their best positions in the network. The system's objectives are to distribute replicas of the content items in the network in a way that the most demanded contents will have replicas closer to the clients so that it will optimize the network utilization and will improve the users' experience. It also balances the load between the servers concentrating the traffic to the edges of the network.