An ICT-based closed-loop model to improve care for heart failure patients

Durante las últimas décadas se ha producido un fenómeno global de envejecimiento en la población. Esta tendencia se puede observar prácticamente en todos los países del mundo y se debe principalmente a los avances en la medicina, y a los descensos en las tasas de fertilidad y mortalidad. El envejecimiento de la población tiene un gran impacto en la salud de los ciudadanos, y a menudo es la causa de aparición de enfermedades crónicas. Este tipo de enfermedades supone una amenaza y una carga importantes para la sociedad, especialmente en aspectos como la mortalidad o los gastos en los sistemas sanitarios. Entre las enfermedades cardiovasculares, la insuficiencia cardíaca es probablemente la condición con mayor prevalencia y afecta a 23-26 millones de personas en todo el mundo. Normalmente, la insuficiencia cardíaca presenta un mal pronóstico y una tasa de supervivencia bajas, en algunos casos peores que algún tipo de cáncer. Además, suele ser la causa de hospitalizaciones frecuentes y es una de las enfermedades más costosas para los sistemas sanitarios. La tendencia al envejecimiento de la población y la creciente incidencia de las enfermedades crónicas están llevando a una situación en la que los sistemas de salud no son capaces de hacer frente a la demanda de la sociedad. Los servicios de salud existentes tendrán que adaptarse para ser efectivos y sostenibles en el futuro. Es necesario identificar nuevos paradigmas de cuidado de pacientes, así como mecanismos para la provisión de servicios que ayuden a transformar estos sistemas sanitarios. En este contexto, esta tesis se plantea la búsqueda de soluciones, basadas en las Tecnologías de la Información y la Comunicación (TIC), que contribuyan a realizar la transformación en los sistemas sanitarios. En concreto, la tesis se centra en abordar los problemas de una de las enfermedades con mayor impacto en estos sistemas: la insuficiencia cardíaca. Las siguientes hipótesis constituyen la base para la realización de este trabajo de investigación: 1. Es posible definir un modelo basado en el paradigma de lazo cerrado y herramientas TIC que formalice el diseño de mejores servicios para pacientes con insuficiencia cardíaca. 2. El modelo de lazo cerrado definido se puede utilizar para definir un servicio real que ayude a gestionar la insuficiencia cardíaca crónica. 3. La introducción, la adopción y el uso de un servicio basado en el modelo definido se traducirá en mejoras en el estado de salud de los pacientes que sufren insuficiencia cardíaca. a. La utilización de un sistema basado en el modelo de lazo cerrado definido mejorará la experiencia del usuario de los pacientes. La definición del modelo planteado se ha basado en el estándar ISO / EN 13940- Sistema de conceptos para dar soporte a la continuidad de la asistencia. Comprende un conjunto de conceptos, procesos, flujos de trabajo, y servicios como componentes principales, y representa una formalización de los servicios para los pacientes con insuficiencia cardíaca. Para evaluar el modelo definido se ha definido un servicio real basado en el mismo, además de la implementación de un sistema de apoyo a dicho servicio. El diseño e implementación de dicho sistema se realizó siguiendo la metodología de Diseño Orientado a Objetivos. El objetivo de la evaluación consistía en investigar el efecto que tiene un servicio basado en el modelo de lazo cerrado sobre el estado de salud de los pacientes con insuficiencia cardíaca. La evaluación se realizó en el marco de un estudio clínico observacional. El análisis de los resultados ha comprendido métodos de análisis cuantitativos y cualitativos. El análisis cuantitativo se ha centrado en determinar el estado de salud de los pacientes en base a datos objetivos (obtenidos en pruebas de laboratorio o exámenes médicos). Para realizar este análisis se definieron dos índices específicos: el índice de estabilidad y el índice de la evolución del estado de salud. El análisis cualitativo ha evaluado la autopercepción del estado de salud de los pacientes en términos de calidad de vida, auto-cuidado, el conocimiento, la ansiedad y la depresión, así como niveles de conocimiento. Se ha basado en los datos recogidos mediante varios cuestionarios o instrumentos estándar (i.e. EQ-5D, la Escala de Ansiedad y Depresión (HADS), el Cuestionario de Cardiomiopatía de Kansas City (KCCQ), la Escala Holandesa de Conocimiento de Insuficiencia Cardíaca (DHFKS), y la Escala Europea de Autocuidado en Insuficiencia Cardíaca (EHFScBS), así como cuestionarios dedicados no estandarizados de experiencia de usuario. Los resultados obtenidos en ambos análisis, cuantitativo y cualitativo, se compararon con el fin de evaluar la correlación entre el estado de salud objetivo y subjetivo de los pacientes. Los resultados de la validación demostraron que el modelo propuesto tiene efectos positivos en el cuidado de los pacientes con insuficiencia cardíaca y contribuye a mejorar su estado de salud. Asimismo, ratificaron al modelo como instrumento válido para la definición de servicios mejorados para la gestión de esta enfermedad. ABSTRACT During the last decades we have witnessed a global aging phenomenon in the population. This can be observed in practically every country in the world, and it is mainly caused by the advances in medicine, and the decrease of mortality and fertility rates. Population aging has an important impact on citizens’ health and it is often the cause for chronic diseases, which constitute global burden and threat to the society in terms of mortality and healthcare expenditure. Among chronic diseases, Chronic Heart Failure (CHF) or Heart Failure (HF) is probably the one with highest prevalence, affecting between 23 and 26 million people worldwide. Heart failure is a chronic, long-term and serious condition with very poor prognosis and worse survival rates than some type of cancers. Additionally, it is often the cause of frequent hospitalizations and one of the most expensive conditions for the healthcare systems. The aging trends in the population and the increasing incidence of chronic diseases are leading to a situation where healthcare systems are not able to cope with the society demand. Current healthcare services will have to be adapted and redefined in order to be effective and sustainable in the future. There is a need to find new paradigms for patients’ care, and to identify new mechanisms for services’ provision that help to transform the healthcare systems. In this context, this thesis aims to explore new solutions, based on ICT, that contribute to achieve the needed transformation within the healthcare systems. In particular, it focuses on addressing the problems of one of the diseases with higher impact within these systems: Heart Failure. The following hypotheses represent the basis to the elaboration of this research: 1. It is possible to define a model based on a closed-loop paradigm and ICT tools that formalises the design of enhanced healthcare services for chronic heart failure patients. 2. The described closed-loop model can be exemplified in a real service that supports the management of chronic heart failure disease. 3. The introduction, adoption and use of a service based on the outlined model will result in improvements in the health status of patients suffering heart failure. 4. The user experience of patients when utilizing a system based on the defined closed-loop model will be enhanced. The definition of the closed-loop model for health care support of heart failure patients have been based on the standard ISO/EN 13940 System of concepts to support continuity of care. It includes a set of concept, processes and workflows, and services as main components, and it represent a formalization of services for heart failure patients. In order to be validated, the proposed closed-loop model has been instantiated into a real service and a supporting IT system. The design and implementation of the system followed the user centred design methodology Goal Oriented Design. The validation, that included an observational clinical study, aimed to investigate the effect that a service based on the closed-loop model had on heart failure patients’ health status. The analysis of results comprised quantitative and qualitative analysis methods. The quantitative analysis was focused on determining the health status of patients based on objective data (obtained in lab tests or physical examinations). Two specific indexes where defined and considered in this analysis: the stability index and the health status evolution index. The qualitative analysis assessed the self-perception of patients’ health status in terms of quality of life, self-care, knowledge, anxiety and depression, as well as knowledge levels. It was based on the data gathered through several standard instruments (i.e. EQ-5D, the Hospital Anxiety and Depression Scale, the Kansas City Cardiomyopathy Questionnaire, the Dutch Heart Failure Knowledge Scale, and the European Heart Failure Self-care Behaviour Scale) as well as dedicated non-standardized user experience questionnaires. The results obtained in both analyses, quantitative and qualitative, were compared in order to assess the correlation between the objective and subjective health status of patients. The results of the validation showed that the proposed model contributed to improve the health status of the patients and had a positive effect on the patients’ care. It also proved that the model is a valid instrument for designing enhanced healthcare services for heart failure patients.

Towards Closed-loop Deep Brain Stimulation: Behavior Recognition from Human STN

Deep brain stimulation (DBS) provides significant therapeutic benefit for movement disorders such as Parkinson’s disease (PD). Current DBS devices lack real-time feedback (thus are open loop) and stimulation parameters are adjusted during scheduled visits with a clinician. A closed-loop DBS system may reduce power consumption and side effects by adjusting stimulation parameters based on patient’s behavior. Thus behavior detection is a major step in designing such systems. Various physiological signals can be used to recognize the behaviors. Subthalamic Nucleus (STN) Local field Potential (LFP) is a great candidate signal for the neural feedback, because it can be recorded from the stimulation lead and does not require additional sensors. This thesis proposes novel detection and classification techniques for behavior recognition based on deep brain LFP. Behavior detection from such signals is the vital step in developing the next generation of closed-loop DBS devices. LFP recordings from 13 subjects are utilized in this study to design and evaluate our method. Recordings were performed during the surgery and the subjects were asked to perform various behavioral tasks. Various techniques are used understand how the behaviors modulate the STN. One method studies the time-frequency patterns in the STN LFP during the tasks. Another method measures the temporal inter-hemispheric connectivity of the STN as well as the connectivity between STN and Pre-frontal Cortex (PFC). Experimental results demonstrate that different behaviors create different m odulation patterns in STN and it’s connectivity. We use these patterns as features to classify behaviors. A method for single trial recognition of the patient’s current task is proposed. This method uses wavelet coefficients as features and support vector machine (SVM) as the classifier for recognition of a selection of behaviors: speech, motor, and random. The proposed method is 82.4% accurate for the binary classification and 73.2% for classifying three tasks. As the next step, a practical behavior detection method which asynchronously detects behaviors is proposed. This method does not use any priori knowledge of behavior onsets and is capable of asynchronously detect the finger movements of PD patients. Our study indicates that there is a motor-modulated inter-hemispheric connectivity between LFP signals recorded bilaterally from STN. We utilize a non-linear regression method to measure this inter-hemispheric connectivity and to detect the finger movements. Our experimental results using STN LFP recorded from eight patients with PD demonstrate this is a promising approach for behavior detection and developing novel closed-loop DBS systems.

Closed loop control of automotive engines. Final report.

National Highway Traffic Safety Administration, Office of Research and Development, Washington, D.C.

Study of the performance of aids to navigation systems : phase 1, closed loop model of the process of navigation /

Final report; March 1978.

Closed-Loop Deep Brain Stimulation: Bidirectional Neuroprosthetics for Tremor and BCI

Thesis (Ph.D.)--University of Washington, 2016-06

IT support for managing aircraft spares in a closed-loop supply chain

This paper reports on the development of elements of an e-supply chain management system for managing maintenance, repair and overhaul (MRO) relationships in the aerospace industry. A standard systems development methodology has been followed to produce a process model (i.e. the AMSCR model); an information model (i.e. business rules) and a computerised information management capability (i.e. automated optimisation). The proof of concept for this web-based MRO supply chain system has been established through the collaboration with a sample of the different types of supply chain members. The proven benefit is a reduction in the stock-holding costs for the whole supply chain whilst also minimising non-flying time of the aircraft that the supply chain supports. This type of system is now vital in an industry that has continuously decreasing profit margins, which in turn means pressure to reduce servicing times and increase the interval between maintenance actions.

The Closed Loop Model by Regional Economics or How Big is the Ants’ Footprint?

The economy is communication between Man and Nature. It is an interaction-network between our outside and inside Nature, that is, the external Nature surrounding us and the internal nature expressing our human essence. Money is an institution of the society, an infrastructure that ensures division of labour, enables the flow of information and material between the participants. The concept of regional material and financial circular flow will be more important with the oncoming peak-oil and post-carbon era. We should describe in time the outlines of closed or semi-closed loops economy. The fundamentals of Input-Output will flourish once again; it could help us formulate the link between the efficiency and resiliency of a regional complex system.

A Closed Loop Brain-machine Interface for Epilepsy Control Using Dorsal Column Electrical Stimulation

Although electrical neurostimulation has been proposed as an alternative treatment for drug-resistant cases of epilepsy, current procedures such as deep brain stimulation, vagus, and trigeminal nerve stimulation are effective only in a fraction of the patients. Here we demonstrate a closed loop brain-machine interface that delivers electrical stimulation to the dorsal column (DCS) of the spinal cord to suppress epileptic seizures. Rats were implanted with cortical recording microelectrodes and spinal cord stimulating electrodes, and then injected with pentylenetetrazole to induce seizures. Seizures were detected in real time from cortical local field potentials, after which DCS was applied. This method decreased seizure episode frequency by 44% and seizure duration by 38%. We argue that the therapeutic effect of DCS is related to modulation of cortical theta waves, and propose that this closed-loop interface has the potential to become an effective and semi-invasive treatment for refractory epilepsy and other neurological disorders.

Ecologie industrielle de l'aluminium, flux de matières et d'énergie : réalités et enjeux du recyclage

Dans les dernières années du 20ème siècle, l'aluminium a fait l'objet de beaucoup de communications outrancières et divergentes cautionnées par des scientifiques et des organismes faisant autorité. En 1986, la société PECHINEY le décrète perpétuel tel le mouvement « L'aluminium est éternel. Il est recyclable indéfiniment sans que ses propriétés soient altérées », ce qui nous avait alors irrité. Peu de temps après, en 1990, une communication tout aussi outrancière et irritante d'une grande organisation environnementale, le World Wild Fund, décrète que « le recyclage de l'aluminium est la pire menace pour l'environnement. Il doit être abandonné ». C'est ensuite à partir de la fin des années 1990, l'explosion des publications relatives au développement durable, le bien mal nommé. Au développement, synonyme de croissance obligatoire, nous préférons société ou organisation humaine et à durable, mauvaise traduction de l'anglais « sustainable », nous préférons supportable : idéalement, nous aurions souhaité parler de société durable, mais, pour être compris de tous, nous nous sommes limités à parler dorénavant de développement supportable. Pour l'essentiel, ces publications reconnaissent les très graves défauts de la métallurgie extractive de l'aluminium à partir du minerai et aussi les mérites extraordinaires du recyclage de l'aluminium puisqu'il représente moins de 10% de la consommation d'énergie de la métallurgie extractive à partir du minerai (on verra que c'est aussi moins de 10% de la pollution et du capital). C'est précisément sur le recyclage que se fondent les campagnes de promotion de l'emballage boisson, en Suisse en particulier. Cependant, les données concernant le recyclage de l'aluminium publiées par l'industrie de l'aluminium reflètent seulement en partie ces mérites. Dans les années 1970, les taux de croissance de la production recyclée sont devenus plus élevés que ceux de la production électrolytique. Par contre, les taux de recyclage, établis à indicateur identique, sont unanimement tous médiocres comparativement à d'autres matériaux tels le cuivre et le fer. Composante de l'industrie de l'aluminium, le recyclage bénéficie d'une image favorable auprès du grand public, démontrant le succès des campagnes de communication. A l'inverse, à l'intérieur de l'industrie de l'aluminium, c'est une image dévalorisée. Les opinions émises par tous les acteurs, commerçants, techniciens, dirigeants, encore recueillies pendant ce travail, sont les suivantes : métier de chiffonnier, métier misérable, métier peu technique mais très difficile (un recycleur 15 d'aluminium n'a-t-il pas dit que son métier était un métier d'homme alors que celui du recycleur de cuivre était un jeu d'enfant). A notre avis ces opinions appartiennent à un passé révolu qu'elles retraduisent cependant fidèlement car le recyclage est aujourd'hui reconnu comme une contribution majeure au développement supportable de l'aluminium. C'est bien pour cette raison que, en 2000, l'industrie de l'aluminium mondiale a décidé d'abandonner le qualificatif « secondaire » jusque là utilisé pour désigner le métal recyclé. C'est en raison de toutes ces données discordantes et parfois contradictoires qu'a débuté ce travail encouragé par de nombreuses personnalités. Notre engagement a été incontestablement facilité par notre connaissance des savoirs indispensables (métallurgie, économie, statistiques) et surtout notre expérience acquise au cours d'une vie professionnelle menée à l'échelle mondiale dans (recherche et développement, production), pour (recherche, développement, marketing, stratégie) et autour (marketing, stratégie de produits connexes, les ferro-alliages, et concurrents, le fer) de l'industrie de l'aluminium. Notre objectif est de faire la vérité sur le recyclage de l'aluminium, un matériau qui a très largement contribué à faire le 20ème siècle, grâce à une revue critique embrassant tous les aspects de cette activité méconnue ; ainsi il n'y a pas d'histoire du recyclage de l'aluminium alors qu'il est plus que centenaire. Plus qu'une simple compilation, cette revue critique a été conduite comme une enquête scientifique, technique, économique, historique, socio-écologique faisant ressortir les faits principaux ayant marqué l'évolution du recyclage de l'aluminium. Elle conclut sur l'état réel du recyclage, qui se révèle globalement satisfaisant avec ses forces et ses faiblesses, et au-delà du recyclage sur l'adéquation de l'aluminium au développement supportable, adéquation largement insuffisante. C'est pourquoi, elle suggère les thèmes d'études intéressant tous ceux scientifiques, techniciens, historiens, économistes, juristes concernés par une industrie très représentative de notre monde en devenir, un monde où la place de l'aluminium dépendra de son aptitude à satisfaire les critères du développement supportable. ABSTRACT Owing to recycling, the aluminium industry's global energetic and environmental prints are much lower than its ore extractive metallurgy's ones. Likewise, recycling will allow the complete use of the expected avalanche of old scraps, consequently to the dramatic explosion of aluminium consumption since the 50's. The recycling state is characterized by: i) raw materials split in two groups :one, the new scrap, internal and prompt, proportional to semi-finished and finished products quantities, exhibits a fairly good and regular quality. The other, the old scrap, proportional to the finished products arrivïng at their end-of--life, about 22 years later on an average, exhibits a variable quality depending on the collect mode. ii) a poor recycling rate, near by that of steel. The aluminium industry generates too much new internal scrap and doesn't collect all the availa~e old scrap. About 50% of it is not recycled (when steel is recycling about 70% of the old scrap flow). iii) recycling techniques, all based on melting, are well handled in spite of aluminium atiiníty to oxygen and the practical impossibility to purify aluminium from any impurity. Sorting and first collect are critical issues before melting. iv) products and markets of recycled aluminium :New scraps have still been recycled in the production lines from where there are coming (closed loop). Old scraps, mainly those mixed, have been first recycled in different production lines (open loop) :steel deoxidation products followed during the 30's, with the development of the foundry alloys, by foundry pieces of which the main market is the automotive industry. During the 80's, the commercial development of the beverage can in North America has permitted the first old scrap recycling closed loop which is developing. v) an economy with low and erratic margins because the electrolytic aluminium quotation fixes scrap purchasing price and recycled aluminium selling price. vi) an industrial organisation historically based on the scrap group and the loop mode. New scrap is recycled either by the transformation industry itself or by the recycling industry, the remelter, old scrap by the refiner, the other component of the recycling industry. The big companies, the "majors" are often involved in the closed loop recycling and very seldom in the open loop one. To-day, aluminium industry's global energetic and environmental prints are too unbeara~ e and the sustainaЫe development criteria are not fully met. Critical issues for the aluminium industry are to better produce, to better consume and to better recycle in order to become a real sustainaЫe development industry. Specific issues to recycling are a very efficient recycling industry, a "sustainaЫe development" economy, a complete old scrap collect favouring the closed loop. Also, indirectly connected to the recycling, are a very efficient transformation industry generating much less new scrap and a finished products industry delivering only products fulfilling sustainaЫe development criteria.

Recycled asphalt mixtures with foamed bitumen: an alternative to build ecofriendly road pavements

Nowadays, recycling has become a very important objective for the society in the scope of a closed loop product life cycle. In recent years, new recycling techniques have been developed in the area of road pavements that allow the incorporation of high percentages of reclaimed asphalt (RA) materials in recycled asphalt mixtures. The use of foamed bitumen for production of recycled asphalt mixtures is one of those techniques, which also allows the reduction of the mixing temperatures (warm mix technology). However, it is important to evaluate if this solution can maintain or improve the performance of the resulting mixtures. Thus, the main aim of the present study is to assess the performance of warm recycled asphalt mixtures incorporating foamed bitumen as the new binder and 50% RA, in comparison with a control mixture using conventional bitumen. Four mixtures have been produced with 50% RA, one of them at typical high mixing temperatures with a conventional bitumen (control mixture) and the other three with foamed bitumen at different production temperatures. These four mixtures were tested to evaluate their compactability and water sensitivity. The laboratory test results showed that the production of recycled mixtures with foamed bitumen can be reduced by 40ºC without changing the performance of the resulting mixtures.

Oscillating holograms recorded in photorefractive crystals by a frequency detuned feedback loop

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

PD controller synthesis from open-loop response measurements of rotating system

In this work, a method of computing PD stabilising gains for rotating systems is presented based on the D-decomposition technique, which requires the sole knowledge of frequency response functions. By applying this method to a rotating system with electromagnetic actuators, it is demonstrated that the stability boundary locus in the plane of feedback gains can be easily plotted, and the most suitable gains can be found to minimise the resonant peak of the system. Experimental results for a Laval rotor show the feasibility of not only controlling lateral shaft vibration and assuring stability, but also helps in predicting the final vibration level achieved by the closed-loop system. These results are obtained based solely on the input-output response information of the system as a whole.

A STUDY ON REGIONAL CIRCULAR ECONOMY SYSTEM AND ITS CONSTRUCTION, OPERATION AND SUGGESTION FOR SHANGHAI

The characteristics of the traditional linear economic model are high consumption, high emission and low efficiency. Economic development is still largely at the expense of the environment and requires a natural resource investment. This can realize rapid economic development but resource depletion and environmental pollution become increasingly serious. In the 1990's a new economic model, circular economics, began to enter our vision. The circular economy maximizes production and minimizes the impact of economic activities on the ecological environment through organizing the activities through the closed-loop feedback cycle of "resources - production - renewable resource". Circular economy is a better way to solve the contradictions between the economic development and resource shortages. Developing circular economy has become the major strategic initiatives to achieving sustainable development in countries all over the world. The evaluation of the development of circular economics is a necessary step for regional circular economy development. Having a quantitative evaluation of circular economy can better monitor and reveal the contradictions and problems in the process of the development of recycling economy. This thesis will: 1) Create an evaluation model framework and new types of industries and 2) Make an evaluation of the Shanghai circular economy currently to analyze the situation of Shanghai in the development of circular economy. I will then propose suggestions about the structure and development of Shanghai circular economy.