Mistreatment and self-neglect in community dwelling older adults: Studies of construct validity, measurement invariance and latent classes

Mistreatment and self-neglect significantly increase the risk of dying in older adults. It is estimated that 1 to 2 million older adults experience elder mistreatment and self-neglect every year in the United States. Currently, there are no elder mistreatment and self-neglect assessment tools with construct validity and measurement invariance testing and no studies have sought to identify underlying latent classes of elder self-neglect that may have differential mortality rates. Using data from 11,280 adults with Texas APS substantiated elder mistreatment and self-neglect 3 studies were conducted to: (1) test the construct validity and (2) the measurement invariance across gender and ethnicity of the Texas Adult Protective Services (APS) Client Assessment and Risk Evaluation (CARE) tool and (3) identify latent classes associated with elder self-neglect. Study 1 confirmed the construct validity of the CARE tool following adjustments to the initial hypothesized CARE tool. This resulted in the deletion of 14 assessment items and a final assessment with 5 original factors and 43 items. Cross-validation for this model was achieved. Study 2 provided empirical evidence for factor loading and item-threshold invariance of the CARE tool across gender and between African-Americans and Caucasians. The financial status domain of the CARE tool did not function properly for Hispanics and thus, had to be deleted. Subsequent analyses showed factor loading and item-threshold invariance across all 3 ethnic groups with the exception of some residual errors. Study 3 identified 4-latent classes associated with elder self-neglect behaviors which included individuals with evidence of problems in the areas of (1) their environment, (2) physical and medical status, (3) multiple domains and (4) finances. Overall, these studies provide evidence supporting the use of APS CARE tool for providing unbiased and valid investigations of mistreatment and neglect in older adults with different demographic characteristics. Furthermore, the findings support the underlying notion that elder self-neglect may not only occur along a continuum, but that differential types may exist. All of which, have very important potential implications for social and health services distributed to vulnerable mistreated and neglected older adults.^

Self -management behavior in patients with cystic fibrosis

Self-management is being promoted in cystic fibrosis (CF). However, it has not been well studied. Principal aims of this research were (1) to evaluate psychometric properties of a CF disease status measure, the NIH Clinical Score; (2) to develop and validate a measure of self-management behavior, the SMQ-CF scale, and (3) to examine the relation between self-management and disease status in CF patients over two years.^ In study 1, NIH Clinical Scores for 200 patients were used. The scale was examined for internal consistency, interrater reliability, and content validity using factor analysis. The Cronbach's alpha (.81) and interrater reliability (.90) for the total scale were high. General scale items were less reliable. Factor analysis indicated that most of the variance in disease status is accounted for by Factor 1 which consists of pulmonary disease items.^ The SMQ-CF measures the performance of CF self-management. Pilot testing was done with 98 CF primary caregivers. Internal consistency reliability, social desirability bias, and content validity using factor analysis were examined. Internal consistency was good (alpha =.95). Social desirability correlation was low (r =.095). Twelve factors identified were consistent with conceptual groupings of behaviors. Around two hundred caregivers from two CF centers were surveyed and multivariate analysis of variance was used to assess construct validity. Results confirmed expected relations between self-management, patient age, and disease status. Patient age accounted for 50% and disease status 18% of the variance in the SMQ-CF scale.^ It was hypothesized that self-management would positively affect future disease status. Data from 199 CF patients (control and education intervention groups) were examined. Models of hypothesized relations were tested using LISREL structural equation modeling. Results indicated that the relations between baseline self-management and Time 1 disease status were not significant. Significant relations were observed in self-management behaviors from time 1 to time 2 and patterns of significant relations differed between the two groups.^ This research has contributed to refinements in the ability to measure self-management behavior and disease status outcomes in cystic fibrosis. In addition, it provides the first steps in exploratory behavioral analysis with regard to self-management in this disease. ^

Corporate Governance in Indonesia: A Study on Governance of Business Groups

This study deals with the issue of corporate governance in the case of Indonesian business groups. It examines what factors can be attributed to failures of corporate governance. Through case studies of six different types of business groups, it evidences that self-governance by owner-managers can function well if there is no other key stakeholder and no collusion with the government. When this is not the case, however, self-governance does not work, and governance by creditors or professional managers over owner-managers has limitations. For better corporate governance, there is a need not only for building internal governance mechanism of business groups, but also for strengthening external monitoring institutions including creditors, capital markets, the governmental as well as non-governmental systems.

Unsupervised system to classify SO2 pollutant concentrations in Salamanca, Mexico

Salamanca is cataloged as one of the most polluted cities in Mexico. In order to observe the behavior and clarify the influence of wind parameters on the Sulphur Dioxide (SO2) concentrations a Self-Organizing Maps (SOM) Neural Network have been implemented at three monitoring locations for the period from January 1 to December 31, 2006. The maximum and minimum daily values of SO2 concentrations measured during the year of 2006 were correlated with the wind parameters of the same period. The main advantages of the SOM Neural Network is that it allows to integrate data from different sensors and provide readily interpretation results. Especially, it is powerful mapping and classification tool, which others information in an easier way and facilitates the task of establishing an order of priority between the distinguished groups of concentrations depending on their need for further research or remediation actions in subsequent management steps. For each monitoring location, SOM classifications were evaluated with respect to pollution levels established by Health Authorities. The classification system can help to establish a better air quality monitoring methodology that is essential for assessing the effectiveness of imposed pollution controls, strategies, and facilitate the pollutants reduction.

The influence of transparency on self-evaluation as part of the university accreditation process in Peru.

In order to show the choice of transparency as the guiding principle of the accreditation process, the article evaluates its influence on the fundamental subprocess of self-evaluation, thereby confirming that transparency is an essential tool for continuous improvement of academic processes and those of educational quality management. It fosters educational innovation and permits the sustainability of the continuous accreditation process over time, resulting in greater probabilities of university self-regulation through systemization of the process, with the objective of continuous improvement of university degree programs. The article analyzes the influence of transparency on each activity of the self-evaluation process according to the Peruvian accreditation model prepared under the total quality approach, as a reference for other accreditation models, proposing concrete transparency actions and evaluating its influence on the stakeholder groups in the self-evaluation process, as well as on the efficiency and effectiveness of the process. It is concluded that transparency has a positive influence on the training of human capital and the formation of the university?s organizational culture, facilitating dissemination, understanding and involvement of the stakeholder groups in the continuous improvement of accreditation activities and increasing their acceptance of change and commitment to the process. It is confirmed that transparency contributes toward increasing the efficiency index of the self-evaluation process by reducing operating costs through adequate, accessible, timely contribution of information by the stakeholders and through the optimization of the time spent gathering relevant information. In addition, it is concluded that transparency contributes toward increasing the effectiveness index of self-evaluation by facilitating the achievement of its objectives through synthetic, useful, reliable interpretation of the education situation and the formulation of feasible improvement plans based on the adequacy, relevance, visibility, pertinence and truthfulness of the information analyzed.

Peer Assessment and Self-assessment: Effective Learning Tools in Higher Education.

When used appropriately, self- and peer-assessment are very effective learning tools. In the present work, instructor formative assessment and feedback, self-assessment (SA), and peer-assessment (PA) have been compared. During the first part of a semester, the students followed a continuous formative assessment. Subsequently, they were divided into two subgroups based on similar performances. One subgroup performed SAs, and the other followedPAduring the last part of the course. The performances of the two groups in solving problems were compared. Results suggest that PA is a more effective learning tool than SA, and both are more effective than instructor formative assessment. However, a survey that was conducted at the end of the experiment showed higher student confidence in instructor assessment than in PA. The students recognized the usefulness of acting as peer assessors, but believed that SA helped them more than PA.

Parametric and structural self-adaptation of embedded systems using evolvable hardware

Los sistemas empotrados han sido concebidos tradicionalmente como sistemas de procesamiento específicos que realizan una tarea fija durante toda su vida útil. Para cumplir con requisitos estrictos de coste, tamaño y peso, el equipo de diseño debe optimizar su funcionamiento para condiciones muy específicas. Sin embargo, la demanda de mayor versatilidad, un funcionamiento más inteligente y, en definitiva, una mayor capacidad de procesamiento comenzaron a chocar con estas limitaciones, agravado por la incertidumbre asociada a entornos de operación cada vez más dinámicos donde comenzaban a ser desplegados progresivamente. Esto trajo como resultado una necesidad creciente de que los sistemas pudieran responder por si solos a eventos inesperados en tiempo diseño tales como: cambios en las características de los datos de entrada y el entorno del sistema en general; cambios en la propia plataforma de cómputo, por ejemplo debido a fallos o defectos de fabricación; y cambios en las propias especificaciones funcionales causados por unos objetivos del sistema dinámicos y cambiantes. Como consecuencia, la complejidad del sistema aumenta, pero a cambio se habilita progresivamente una capacidad de adaptación autónoma sin intervención humana a lo largo de la vida útil, permitiendo que tomen sus propias decisiones en tiempo de ejecución. Éstos sistemas se conocen, en general, como sistemas auto-adaptativos y tienen, entre otras características, las de auto-configuración, auto-optimización y auto-reparación. Típicamente, la parte soft de un sistema es mayoritariamente la única utilizada para proporcionar algunas capacidades de adaptación a un sistema. Sin embargo, la proporción rendimiento/potencia en dispositivos software como microprocesadores en muchas ocasiones no es adecuada para sistemas empotrados. En este escenario, el aumento resultante en la complejidad de las aplicaciones está siendo abordado parcialmente mediante un aumento en la complejidad de los dispositivos en forma de multi/many-cores; pero desafortunadamente, esto hace que el consumo de potencia también aumente. Además, la mejora en metodologías de diseño no ha sido acorde como para poder utilizar toda la capacidad de cómputo disponible proporcionada por los núcleos. Por todo ello, no se están satisfaciendo adecuadamente las demandas de cómputo que imponen las nuevas aplicaciones. La solución tradicional para mejorar la proporción rendimiento/potencia ha sido el cambio a unas especificaciones hardware, principalmente usando ASICs. Sin embargo, los costes de un ASIC son altamente prohibitivos excepto en algunos casos de producción en masa y además la naturaleza estática de su estructura complica la solución a las necesidades de adaptación. Los avances en tecnologías de fabricación han hecho que la FPGA, una vez lenta y pequeña, usada como glue logic en sistemas mayores, haya crecido hasta convertirse en un dispositivo de cómputo reconfigurable de gran potencia, con una cantidad enorme de recursos lógicos computacionales y cores hardware empotrados de procesamiento de señal y de propósito general. Sus capacidades de reconfiguración han permitido combinar la flexibilidad propia del software con el rendimiento del procesamiento en hardware, lo que tiene la potencialidad de provocar un cambio de paradigma en arquitectura de computadores, pues el hardware no puede ya ser considerado más como estático. El motivo es que como en el caso de las FPGAs basadas en tecnología SRAM, la reconfiguración parcial dinámica (DPR, Dynamic Partial Reconfiguration) es posible. Esto significa que se puede modificar (reconfigurar) un subconjunto de los recursos computacionales en tiempo de ejecución mientras el resto permanecen activos. Además, este proceso de reconfiguración puede ser ejecutado internamente por el propio dispositivo. El avance tecnológico en dispositivos hardware reconfigurables se encuentra recogido bajo el campo conocido como Computación Reconfigurable (RC, Reconfigurable Computing). Uno de los campos de aplicación más exóticos y menos convencionales que ha posibilitado la computación reconfigurable es el conocido como Hardware Evolutivo (EHW, Evolvable Hardware), en el cual se encuentra enmarcada esta tesis. La idea principal del concepto consiste en convertir hardware que es adaptable a través de reconfiguración en una entidad evolutiva sujeta a las fuerzas de un proceso evolutivo inspirado en el de las especies biológicas naturales, que guía la dirección del cambio. Es una aplicación más del campo de la Computación Evolutiva (EC, Evolutionary Computation), que comprende una serie de algoritmos de optimización global conocidos como Algoritmos Evolutivos (EA, Evolutionary Algorithms), y que son considerados como algoritmos universales de resolución de problemas. En analogía al proceso biológico de la evolución, en el hardware evolutivo el sujeto de la evolución es una población de circuitos que intenta adaptarse a su entorno mediante una adecuación progresiva generación tras generación. Los individuos pasan a ser configuraciones de circuitos en forma de bitstreams caracterizados por descripciones de circuitos reconfigurables. Seleccionando aquellos que se comportan mejor, es decir, que tienen una mejor adecuación (o fitness) después de ser evaluados, y usándolos como padres de la siguiente generación, el algoritmo evolutivo crea una nueva población hija usando operadores genéticos como la mutación y la recombinación. Según se van sucediendo generaciones, se espera que la población en conjunto se aproxime a la solución óptima al problema de encontrar una configuración del circuito adecuada que satisfaga las especificaciones. El estado de la tecnología de reconfiguración después de que la familia de FPGAs XC6200 de Xilinx fuera retirada y reemplazada por las familias Virtex a finales de los 90, supuso un gran obstáculo para el avance en hardware evolutivo; formatos de bitstream cerrados (no conocidos públicamente); dependencia de herramientas del fabricante con soporte limitado de DPR; una velocidad de reconfiguración lenta; y el hecho de que modificaciones aleatorias del bitstream pudieran resultar peligrosas para la integridad del dispositivo, son algunas de estas razones. Sin embargo, una propuesta a principios de los años 2000 permitió mantener la investigación en el campo mientras la tecnología de DPR continuaba madurando, el Circuito Virtual Reconfigurable (VRC, Virtual Reconfigurable Circuit). En esencia, un VRC en una FPGA es una capa virtual que actúa como un circuito reconfigurable de aplicación específica sobre la estructura nativa de la FPGA que reduce la complejidad del proceso reconfiguración y aumenta su velocidad (comparada con la reconfiguración nativa). Es un array de nodos computacionales especificados usando descripciones HDL estándar que define recursos reconfigurables ad-hoc: multiplexores de rutado y un conjunto de elementos de procesamiento configurables, cada uno de los cuales tiene implementadas todas las funciones requeridas, que pueden seleccionarse a través de multiplexores tal y como ocurre en una ALU de un microprocesador. Un registro grande actúa como memoria de configuración, por lo que la reconfiguración del VRC es muy rápida ya que tan sólo implica la escritura de este registro, el cual controla las señales de selección del conjunto de multiplexores. Sin embargo, esta capa virtual provoca: un incremento de área debido a la implementación simultánea de cada función en cada nodo del array más los multiplexores y un aumento del retardo debido a los multiplexores, reduciendo la frecuencia de funcionamiento máxima. La naturaleza del hardware evolutivo, capaz de optimizar su propio comportamiento computacional, le convierten en un buen candidato para avanzar en la investigación sobre sistemas auto-adaptativos. Combinar un sustrato de cómputo auto-reconfigurable capaz de ser modificado dinámicamente en tiempo de ejecución con un algoritmo empotrado que proporcione una dirección de cambio, puede ayudar a satisfacer los requisitos de adaptación autónoma de sistemas empotrados basados en FPGA. La propuesta principal de esta tesis está por tanto dirigida a contribuir a la auto-adaptación del hardware de procesamiento de sistemas empotrados basados en FPGA mediante hardware evolutivo. Esto se ha abordado considerando que el comportamiento computacional de un sistema puede ser modificado cambiando cualquiera de sus dos partes constitutivas: una estructura hard subyacente y un conjunto de parámetros soft. De esta distinción, se derivan dos lineas de trabajo. Por un lado, auto-adaptación paramétrica, y por otro auto-adaptación estructural. El objetivo perseguido en el caso de la auto-adaptación paramétrica es la implementación de técnicas de optimización evolutiva complejas en sistemas empotrados con recursos limitados para la adaptación paramétrica online de circuitos de procesamiento de señal. La aplicación seleccionada como prueba de concepto es la optimización para tipos muy específicos de imágenes de los coeficientes de los filtros de transformadas wavelet discretas (DWT, DiscreteWavelet Transform), orientada a la compresión de imágenes. Por tanto, el objetivo requerido de la evolución es una compresión adaptativa y más eficiente comparada con los procedimientos estándar. El principal reto radica en reducir la necesidad de recursos de supercomputación para el proceso de optimización propuesto en trabajos previos, de modo que se adecúe para la ejecución en sistemas empotrados. En cuanto a la auto-adaptación estructural, el objetivo de la tesis es la implementación de circuitos auto-adaptativos en sistemas evolutivos basados en FPGA mediante un uso eficiente de sus capacidades de reconfiguración nativas. En este caso, la prueba de concepto es la evolución de tareas de procesamiento de imagen tales como el filtrado de tipos desconocidos y cambiantes de ruido y la detección de bordes en la imagen. En general, el objetivo es la evolución en tiempo de ejecución de tareas de procesamiento de imagen desconocidas en tiempo de diseño (dentro de un cierto grado de complejidad). En este caso, el objetivo de la propuesta es la incorporación de DPR en EHW para evolucionar la arquitectura de un array sistólico adaptable mediante reconfiguración cuya capacidad de evolución no había sido estudiada previamente. Para conseguir los dos objetivos mencionados, esta tesis propone originalmente una plataforma evolutiva que integra un motor de adaptación (AE, Adaptation Engine), un motor de reconfiguración (RE, Reconfiguration Engine) y un motor computacional (CE, Computing Engine) adaptable. El el caso de adaptación paramétrica, la plataforma propuesta está caracterizada por: • un CE caracterizado por un núcleo de procesamiento hardware de DWT adaptable mediante registros reconfigurables que contienen los coeficientes de los filtros wavelet • un algoritmo evolutivo como AE que busca filtros wavelet candidatos a través de un proceso de optimización paramétrica desarrollado específicamente para sistemas caracterizados por recursos de procesamiento limitados • un nuevo operador de mutación simplificado para el algoritmo evolutivo utilizado, que junto con un mecanismo de evaluación rápida de filtros wavelet candidatos derivado de la literatura actual, asegura la viabilidad de la búsqueda evolutiva asociada a la adaptación de wavelets. En el caso de adaptación estructural, la plataforma propuesta toma la forma de: • un CE basado en una plantilla de array sistólico reconfigurable de 2 dimensiones compuesto de nodos de procesamiento reconfigurables • un algoritmo evolutivo como AE que busca configuraciones candidatas del array usando un conjunto de funcionalidades de procesamiento para los nodos disponible en una biblioteca accesible en tiempo de ejecución • un RE hardware que explota la capacidad de reconfiguración nativa de las FPGAs haciendo un uso eficiente de los recursos reconfigurables del dispositivo para cambiar el comportamiento del CE en tiempo de ejecución • una biblioteca de elementos de procesamiento reconfigurables caracterizada por bitstreams parciales independientes de la posición, usados como el conjunto de configuraciones disponibles para los nodos de procesamiento del array Las contribuciones principales de esta tesis se pueden resumir en la siguiente lista: • Una plataforma evolutiva basada en FPGA para la auto-adaptación paramétrica y estructural de sistemas empotrados compuesta por un motor computacional (CE), un motor de adaptación (AE) evolutivo y un motor de reconfiguración (RE). Esta plataforma se ha desarrollado y particularizado para los casos de auto-adaptación paramétrica y estructural. • En cuanto a la auto-adaptación paramétrica, las contribuciones principales son: – Un motor computacional adaptable mediante registros que permite la adaptación paramétrica de los coeficientes de una implementación hardware adaptativa de un núcleo de DWT. – Un motor de adaptación basado en un algoritmo evolutivo desarrollado específicamente para optimización numérica, aplicada a los coeficientes de filtros wavelet en sistemas empotrados con recursos limitados. – Un núcleo IP de DWT auto-adaptativo en tiempo de ejecución para sistemas empotrados que permite la optimización online del rendimiento de la transformada para compresión de imágenes en entornos específicos de despliegue, caracterizados por tipos diferentes de señal de entrada. – Un modelo software y una implementación hardware de una herramienta para la construcción evolutiva automática de transformadas wavelet específicas. • Por último, en cuanto a la auto-adaptación estructural, las contribuciones principales son: – Un motor computacional adaptable mediante reconfiguración nativa de FPGAs caracterizado por una plantilla de array sistólico en dos dimensiones de nodos de procesamiento reconfigurables. Es posible mapear diferentes tareas de cómputo en el array usando una biblioteca de elementos sencillos de procesamiento reconfigurables. – Definición de una biblioteca de elementos de procesamiento apropiada para la síntesis autónoma en tiempo de ejecución de diferentes tareas de procesamiento de imagen. – Incorporación eficiente de la reconfiguración parcial dinámica (DPR) en sistemas de hardware evolutivo, superando los principales inconvenientes de propuestas previas como los circuitos reconfigurables virtuales (VRCs). En este trabajo también se comparan originalmente los detalles de implementación de ambas propuestas. – Una plataforma tolerante a fallos, auto-curativa, que permite la recuperación funcional online en entornos peligrosos. La plataforma ha sido caracterizada desde una perspectiva de tolerancia a fallos: se proponen modelos de fallo a nivel de CLB y de elemento de procesamiento, y usando el motor de reconfiguración, se hace un análisis sistemático de fallos para un fallo en cada elemento de procesamiento y para dos fallos acumulados. – Una plataforma con calidad de filtrado dinámica que permite la adaptación online a tipos de ruido diferentes y diferentes comportamientos computacionales teniendo en cuenta los recursos de procesamiento disponibles. Por un lado, se evolucionan filtros con comportamientos no destructivos, que permiten esquemas de filtrado en cascada escalables; y por otro, también se evolucionan filtros escalables teniendo en cuenta requisitos computacionales de filtrado cambiantes dinámicamente. Este documento está organizado en cuatro partes y nueve capítulos. La primera parte contiene el capítulo 1, una introducción y motivación sobre este trabajo de tesis. A continuación, el marco de referencia en el que se enmarca esta tesis se analiza en la segunda parte: el capítulo 2 contiene una introducción a los conceptos de auto-adaptación y computación autonómica (autonomic computing) como un campo de investigación más general que el muy específico de este trabajo; el capítulo 3 introduce la computación evolutiva como la técnica para dirigir la adaptación; el capítulo 4 analiza las plataformas de computación reconfigurables como la tecnología para albergar hardware auto-adaptativo; y finalmente, el capítulo 5 define, clasifica y hace un sondeo del campo del hardware evolutivo. Seguidamente, la tercera parte de este trabajo contiene la propuesta, desarrollo y resultados obtenidos: mientras que el capítulo 6 contiene una declaración de los objetivos de la tesis y la descripción de la propuesta en su conjunto, los capítulos 7 y 8 abordan la auto-adaptación paramétrica y estructural, respectivamente. Finalmente, el capítulo 9 de la parte 4 concluye el trabajo y describe caminos de investigación futuros. ABSTRACT Embedded systems have traditionally been conceived to be specific-purpose computers with one, fixed computational task for their whole lifetime. Stringent requirements in terms of cost, size and weight forced designers to highly optimise their operation for very specific conditions. However, demands for versatility, more intelligent behaviour and, in summary, an increased computing capability began to clash with these limitations, intensified by the uncertainty associated to the more dynamic operating environments where they were progressively being deployed. This brought as a result an increasing need for systems to respond by themselves to unexpected events at design time, such as: changes in input data characteristics and system environment in general; changes in the computing platform itself, e.g., due to faults and fabrication defects; and changes in functional specifications caused by dynamically changing system objectives. As a consequence, systems complexity is increasing, but in turn, autonomous lifetime adaptation without human intervention is being progressively enabled, allowing them to take their own decisions at run-time. This type of systems is known, in general, as selfadaptive, and are able, among others, of self-configuration, self-optimisation and self-repair. Traditionally, the soft part of a system has mostly been so far the only place to provide systems with some degree of adaptation capabilities. However, the performance to power ratios of software driven devices like microprocessors are not adequate for embedded systems in many situations. In this scenario, the resulting rise in applications complexity is being partly addressed by rising devices complexity in the form of multi and many core devices; but sadly, this keeps on increasing power consumption. Besides, design methodologies have not been improved accordingly to completely leverage the available computational power from all these cores. Altogether, these factors make that the computing demands new applications pose are not being wholly satisfied. The traditional solution to improve performance to power ratios has been the switch to hardware driven specifications, mainly using ASICs. However, their costs are highly prohibitive except for some mass production cases and besidesthe static nature of its structure complicates the solution to the adaptation needs. The advancements in fabrication technologies have made that the once slow, small FPGA used as glue logic in bigger systems, had grown to be a very powerful, reconfigurable computing device with a vast amount of computational logic resources and embedded, hardened signal and general purpose processing cores. Its reconfiguration capabilities have enabled software-like flexibility to be combined with hardware-like computing performance, which has the potential to cause a paradigm shift in computer architecture since hardware cannot be considered as static anymore. This is so, since, as is the case with SRAMbased FPGAs, Dynamic Partial Reconfiguration (DPR) is possible. This means that subsets of the FPGA computational resources can now be changed (reconfigured) at run-time while the rest remains active. Besides, this reconfiguration process can be triggered internally by the device itself. This technological boost in reconfigurable hardware devices is actually covered under the field known as Reconfigurable Computing. One of the most exotic fields of application that Reconfigurable Computing has enabled is the known as Evolvable Hardware (EHW), in which this dissertation is framed. The main idea behind the concept is turning hardware that is adaptable through reconfiguration into an evolvable entity subject to the forces of an evolutionary process, inspired by that of natural, biological species, that guides the direction of change. It is yet another application of the field of Evolutionary Computation (EC), which comprises a set of global optimisation algorithms known as Evolutionary Algorithms (EAs), considered as universal problem solvers. In analogy to the biological process of evolution, in EHW the subject of evolution is a population of circuits that tries to get adapted to its surrounding environment by progressively getting better fitted to it generation after generation. Individuals become circuit configurations representing bitstreams that feature reconfigurable circuit descriptions. By selecting those that behave better, i.e., with a higher fitness value after being evaluated, and using them as parents of the following generation, the EA creates a new offspring population by using so called genetic operators like mutation and recombination. As generations succeed one another, the whole population is expected to approach to the optimum solution to the problem of finding an adequate circuit configuration that fulfils system objectives. The state of reconfiguration technology after Xilinx XC6200 FPGA family was discontinued and replaced by Virtex families in the late 90s, was a major obstacle for advancements in EHW; closed (non publicly known) bitstream formats; dependence on manufacturer tools with highly limiting support of DPR; slow speed of reconfiguration; and random bitstream modifications being potentially hazardous for device integrity, are some of these reasons. However, a proposal in the first 2000s allowed to keep investigating in this field while DPR technology kept maturing, the Virtual Reconfigurable Circuit (VRC). In essence, a VRC in an FPGA is a virtual layer acting as an application specific reconfigurable circuit on top of an FPGA fabric that reduces the complexity of the reconfiguration process and increases its speed (compared to native reconfiguration). It is an array of computational nodes specified using standard HDL descriptions that define ad-hoc reconfigurable resources; routing multiplexers and a set of configurable processing elements, each one containing all the required functions, which are selectable through functionality multiplexers as in microprocessor ALUs. A large register acts as configuration memory, so VRC reconfiguration is very fast given it only involves writing this register, which drives the selection signals of the set of multiplexers. However, large overheads are introduced by this virtual layer; an area overhead due to the simultaneous implementation of every function in every node of the array plus the multiplexers, and a delay overhead due to the multiplexers, which also reduces maximum frequency of operation. The very nature of Evolvable Hardware, able to optimise its own computational behaviour, makes it a good candidate to advance research in self-adaptive systems. Combining a selfreconfigurable computing substrate able to be dynamically changed at run-time with an embedded algorithm that provides a direction for change, can help fulfilling requirements for autonomous lifetime adaptation of FPGA-based embedded systems. The main proposal of this thesis is hence directed to contribute to autonomous self-adaptation of the underlying computational hardware of FPGA-based embedded systems by means of Evolvable Hardware. This is tackled by considering that the computational behaviour of a system can be modified by changing any of its two constituent parts: an underlying hard structure and a set of soft parameters. Two main lines of work derive from this distinction. On one side, parametric self-adaptation and, on the other side, structural self-adaptation. The goal pursued in the case of parametric self-adaptation is the implementation of complex evolutionary optimisation techniques in resource constrained embedded systems for online parameter adaptation of signal processing circuits. The application selected as proof of concept is the optimisation of Discrete Wavelet Transforms (DWT) filters coefficients for very specific types of images, oriented to image compression. Hence, adaptive and improved compression efficiency, as compared to standard techniques, is the required goal of evolution. The main quest lies in reducing the supercomputing resources reported in previous works for the optimisation process in order to make it suitable for embedded systems. Regarding structural self-adaptation, the thesis goal is the implementation of self-adaptive circuits in FPGA-based evolvable systems through an efficient use of native reconfiguration capabilities. In this case, evolution of image processing tasks such as filtering of unknown and changing types of noise and edge detection are the selected proofs of concept. In general, evolving unknown image processing behaviours (within a certain complexity range) at design time is the required goal. In this case, the mission of the proposal is the incorporation of DPR in EHW to evolve a systolic array architecture adaptable through reconfiguration whose evolvability had not been previously checked. In order to achieve the two stated goals, this thesis originally proposes an evolvable platform that integrates an Adaptation Engine (AE), a Reconfiguration Engine (RE) and an adaptable Computing Engine (CE). In the case of parametric adaptation, the proposed platform is characterised by: • a CE featuring a DWT hardware processing core adaptable through reconfigurable registers that holds wavelet filters coefficients • an evolutionary algorithm as AE that searches for candidate wavelet filters through a parametric optimisation process specifically developed for systems featured by scarce computing resources • a new, simplified mutation operator for the selected EA, that together with a fast evaluation mechanism of candidate wavelet filters derived from existing literature, assures the feasibility of the evolutionary search involved in wavelets adaptation In the case of structural adaptation, the platform proposal takes the form of: • a CE based on a reconfigurable 2D systolic array template composed of reconfigurable processing nodes • an evolutionary algorithm as AE that searches for candidate configurations of the array using a set of computational functionalities for the nodes available in a run time accessible library • a hardware RE that exploits native DPR capabilities of FPGAs and makes an efficient use of the available reconfigurable resources of the device to change the behaviour of the CE at run time • a library of reconfigurable processing elements featured by position-independent partial bitstreams used as the set of available configurations for the processing nodes of the array Main contributions of this thesis can be summarised in the following list. • An FPGA-based evolvable platform for parametric and structural self-adaptation of embedded systems composed of a Computing Engine, an evolutionary Adaptation Engine and a Reconfiguration Engine. This platform is further developed and tailored for both parametric and structural self-adaptation. • Regarding parametric self-adaptation, main contributions are: – A CE adaptable through reconfigurable registers that enables parametric adaptation of the coefficients of an adaptive hardware implementation of a DWT core. – An AE based on an Evolutionary Algorithm specifically developed for numerical optimisation applied to wavelet filter coefficients in resource constrained embedded systems. – A run-time self-adaptive DWT IP core for embedded systems that allows for online optimisation of transform performance for image compression for specific deployment environments characterised by different types of input signals. – A software model and hardware implementation of a tool for the automatic, evolutionary construction of custom wavelet transforms. • Lastly, regarding structural self-adaptation, main contributions are: – A CE adaptable through native FPGA fabric reconfiguration featured by a two dimensional systolic array template of reconfigurable processing nodes. Different processing behaviours can be automatically mapped in the array by using a library of simple reconfigurable processing elements. – Definition of a library of such processing elements suited for autonomous runtime synthesis of different image processing tasks. – Efficient incorporation of DPR in EHW systems, overcoming main drawbacks from the previous approach of virtual reconfigurable circuits. Implementation details for both approaches are also originally compared in this work. – A fault tolerant, self-healing platform that enables online functional recovery in hazardous environments. The platform has been characterised from a fault tolerance perspective: fault models at FPGA CLB level and processing elements level are proposed, and using the RE, a systematic fault analysis for one fault in every processing element and for two accumulated faults is done. – A dynamic filtering quality platform that permits on-line adaptation to different types of noise and different computing behaviours considering the available computing resources. On one side, non-destructive filters are evolved, enabling scalable cascaded filtering schemes; and on the other, size-scalable filters are also evolved considering dynamically changing computational filtering requirements. This dissertation is organized in four parts and nine chapters. First part contains chapter 1, the introduction to and motivation of this PhD work. Following, the reference framework in which this dissertation is framed is analysed in the second part: chapter 2 features an introduction to the notions of self-adaptation and autonomic computing as a more general research field to the very specific one of this work; chapter 3 introduces evolutionary computation as the technique to drive adaptation; chapter 4 analyses platforms for reconfigurable computing as the technology to hold self-adaptive hardware; and finally chapter 5 defines, classifies and surveys the field of Evolvable Hardware. Third part of the work follows, which contains the proposal, development and results obtained: while chapter 6 contains an statement of the thesis goals and the description of the proposal as a whole, chapters 7 and 8 address parametric and structural self-adaptation, respectively. Finally, chapter 9 in part 4 concludes the work and describes future research paths.

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

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

Clinica psicanalítica: o sentimento de solidão e a saúde mental de mulheres casadas

Este trabalho teve como objetivo principal investigar o sentimento de solidão e a saúde mental de mulheres casadas, procurando comparar a maneira de compreender e vivenciar este sentimento em mulheres solteiras e casadas, bem como verificar em que medida este sentimento pode ser mitigado pela presença do outro no casamento (coabitação) e em que condições isto ocorria. Partiu-se da hipótese de que esse sentimento é compartilhado por todas as pessoas, já que o ser humano é uno e individual. Logo, a separação eterna do outro, que se inicia quando o bebê percebe que é diferente da mãe e, assim, um indivíduo único, está associado a uma sensação de solidão que acompanha o ser humano por toda a vida. Desta forma, é muito comum ver pessoas se envolver em relacionamentos para diminuir este sentimento, que se vê intensificado a cada dia em função da superficialidade dos vínculos emocionais. A presença de outrem pode ser aproveitada numa relação interpessoal quando se diminui a intensidade da hostilidade, associada ao sentimento de solidão. O antídoto contra tal sentimento vem do fortalecimento do auto-conhecimento, da autonomia, e da amizade por um companheiro que mostra aceitação incondicional pelo verdadeiro self. Para análise deste sentimento em mulheres casadas, foi realizada uma pesquisa quantitativa e qualitativa com mulheres solteiras e universitárias. A escolha da amostra foi aleatória e por conglomerado, em três estágios. Participaram do estudo 184 mulheres, 38% casadas, 7,6% separadas e 52,7% solteiras. Da pesquisa quantitativa foi possível analisar que a percepção das mulheres sobre a solidão vem, em muitos aspectos, de encontro com a teoria psicanalítica. Pelas respostas encontradas percebeu-se que a grande maioria das participantes tem um baixo sentimento de solidão (58,7%) e 41,3% se classificaram com um escore de alto a médio sentimento de solidão, nestes dois grupos a maioria são de mulheres casadas e separadas, sendo que quanto mais nova a mulher maior a tendência a buscar um relacionamento para fugir da solidão, sendo entre as casadas também que isto ocorre com mais freqüência. A partir destes escores, 18 mulheres foram convidadas a participar de uma entrevista diagnóstica. Destas dezoito, seis mulheres apresentavam alto sentimento de solidão, sendo duas casadas, duas solteiras e duas separadas. Da mesma forma as mulheres com média e baixa solidão. Os resultados encontrados nestas entrevistas foram que todas as mulheres que apresentaram um alto sentimento de solidão demonstram uma adaptação ineficaz perante a vida, enquanto que aquelas que apresentaram médio ou baixo sentimento de solidão dificilmente apresentam adaptação ineficaz. Do grupo de médio sentimento de solidão, três mulheres apresentaram adaptação eficaz, e do grupo de baixo sentimento de solidão apenas uma participante apresentou adaptação ineficaz leve. Com isso concluímos que a solidão, quando em alta medida, além de dolorosa indica uma grande dificuldade do indivíduo em lidar com seus aspectos emocionais e produtivos, necessitando de ajuda psíquica.

Clinica psicanalítica: o sentimento de solidão e a saúde mental de mulheres casadas

Este trabalho teve como objetivo principal investigar o sentimento de solidão e a saúde mental de mulheres casadas, procurando comparar a maneira de compreender e vivenciar este sentimento em mulheres solteiras e casadas, bem como verificar em que medida este sentimento pode ser mitigado pela presença do outro no casamento (coabitação) e em que condições isto ocorria. Partiu-se da hipótese de que esse sentimento é compartilhado por todas as pessoas, já que o ser humano é uno e individual. Logo, a separação eterna do outro, que se inicia quando o bebê percebe que é diferente da mãe e, assim, um indivíduo único, está associado a uma sensação de solidão que acompanha o ser humano por toda a vida. Desta forma, é muito comum ver pessoas se envolver em relacionamentos para diminuir este sentimento, que se vê intensificado a cada dia em função da superficialidade dos vínculos emocionais. A presença de outrem pode ser aproveitada numa relação interpessoal quando se diminui a intensidade da hostilidade, associada ao sentimento de solidão. O antídoto contra tal sentimento vem do fortalecimento do auto-conhecimento, da autonomia, e da amizade por um companheiro que mostra aceitação incondicional pelo verdadeiro self. Para análise deste sentimento em mulheres casadas, foi realizada uma pesquisa quantitativa e qualitativa com mulheres solteiras e universitárias. A escolha da amostra foi aleatória e por conglomerado, em três estágios. Participaram do estudo 184 mulheres, 38% casadas, 7,6% separadas e 52,7% solteiras. Da pesquisa quantitativa foi possível analisar que a percepção das mulheres sobre a solidão vem, em muitos aspectos, de encontro com a teoria psicanalítica. Pelas respostas encontradas percebeu-se que a grande maioria das participantes tem um baixo sentimento de solidão (58,7%) e 41,3% se classificaram com um escore de alto a médio sentimento de solidão, nestes dois grupos a maioria são de mulheres casadas e separadas, sendo que quanto mais nova a mulher maior a tendência a buscar um relacionamento para fugir da solidão, sendo entre as casadas também que isto ocorre com mais freqüência. A partir destes escores, 18 mulheres foram convidadas a participar de uma entrevista diagnóstica. Destas dezoito, seis mulheres apresentavam alto sentimento de solidão, sendo duas casadas, duas solteiras e duas separadas. Da mesma forma as mulheres com média e baixa solidão. Os resultados encontrados nestas entrevistas foram que todas as mulheres que apresentaram um alto sentimento de solidão demonstram uma adaptação ineficaz perante a vida, enquanto que aquelas que apresentaram médio ou baixo sentimento de solidão dificilmente apresentam adaptação ineficaz. Do grupo de médio sentimento de solidão, três mulheres apresentaram adaptação eficaz, e do grupo de baixo sentimento de solidão apenas uma participante apresentou adaptação ineficaz leve. Com isso concluímos que a solidão, quando em alta medida, além de dolorosa indica uma grande dificuldade do indivíduo em lidar com seus aspectos emocionais e produtivos, necessitando de ajuda psíquica.

CLÍNICA PSICANALÍTICA: O SENTIMENTO DE SOLIDÃO E A SAÚDE MENTAL DE MULHERES CASADAS

Este trabalho teve como objetivo principal investigar o sentimento de solidão e a saúde mental de mulheres casadas, procurando comparar a maneira de compreender e vivenciar este sentimento em mulheres solteiras e casadas, bem como verificar em que medida este sentimento pode ser mitigado pela presença do outro no casamento (coabitação) e em que condições isto ocorria. Partiu-se da hipótese de que esse sentimento é compartilhado por todas as pessoas, já que o ser humano é uno e individual. Logo, a separação eterna do outro, que se inicia quando o bebê percebe que é diferente da mãe e, assim, um indivíduo único, está associado a uma sensação de solidão que acompanha o ser humano por toda a vida. Desta forma, é muito comum ver pessoas se envolver em relacionamentos para diminuir este sentimento, que se vê intensificado a cada dia em função da superficialidade dos vínculos emocionais. A presença de outrem pode ser aproveitada numa relação interpessoal quando se diminui a intensidade da hostilidade, associada ao sentimento de solidão. O antídoto contra tal sentimento vem do fortalecimento do auto-conhecimento, da autonomia, e da amizade por um companheiro que mostra aceitação incondicional pelo verdadeiro self. Para análise deste sentimento em mulheres casadas, foi realizada uma pesquisa quantitativa e qualitativa com mulheres solteiras e universitárias. A escolha da amostra foi aleatória e por conglomerado, em três estágios. Participaram do estudo 184 mulheres, 38% casadas, 7,6% separadas e 52,7% solteiras. Da pesquisa quantitativa foi possível analisar que a percepção das mulheres sobre a solidão vem, em muitos aspectos, de encontro com a teoria psicanalítica. Pelas respostas encontradas percebeu-se que a grande maioria das participantes tem um baixo sentimento de solidão (58,7%) e 41,3% se classificaram com um escore de alto a médio sentimento de solidão, nestes dois grupos a maioria são de mulheres casadas e separadas, sendo que quanto mais nova a mulher maior a tendência a buscar um relacionamento para fugir da solidão, sendo entre as casadas também que isto ocorre com mais freqüência. A partir destes escores, 18 mulheres foram convidadas a participar de uma entrevista diagnóstica. Destas dezoito, seis mulheres apresentavam alto sentimento de solidão, sendo duas casadas, duas solteiras e duas separadas. Da mesma forma as mulheres com média e baixa solidão. Os resultados encontrados nestas entrevistas foram que todas as mulheres que apresentaram um alto sentimento de solidão demonstram uma adaptação ineficaz perante a vida, enquanto que aquelas que apresentaram médio ou baixo sentimento de solidão dificilmente apresentam adaptação ineficaz. Do grupo de médio sentimento de solidão, três mulheres apresentaram adaptação eficaz, e do grupo de baixo sentimento de solidão apenas uma participante apresentou adaptação ineficaz leve. Com isso concluímos que a solidão, quando em alta medida, além de dolorosa indica uma grande dificuldade do indivíduo em lidar com seus aspectos emocionais e produtivos, necessitando de ajuda psíquica.

CLÍNICA PSICANALÍTICA: O SENTIMENTO DE SOLIDÃO E A SAÚDE MENTAL DE MULHERES CASADAS

Este trabalho teve como objetivo principal investigar o sentimento de solidão e a saúde mental de mulheres casadas, procurando comparar a maneira de compreender e vivenciar este sentimento em mulheres solteiras e casadas, bem como verificar em que medida este sentimento pode ser mitigado pela presença do outro no casamento (coabitação) e em que condições isto ocorria. Partiu-se da hipótese de que esse sentimento é compartilhado por todas as pessoas, já que o ser humano é uno e individual. Logo, a separação eterna do outro, que se inicia quando o bebê percebe que é diferente da mãe e, assim, um indivíduo único, está associado a uma sensação de solidão que acompanha o ser humano por toda a vida. Desta forma, é muito comum ver pessoas se envolver em relacionamentos para diminuir este sentimento, que se vê intensificado a cada dia em função da superficialidade dos vínculos emocionais. A presença de outrem pode ser aproveitada numa relação interpessoal quando se diminui a intensidade da hostilidade, associada ao sentimento de solidão. O antídoto contra tal sentimento vem do fortalecimento do auto-conhecimento, da autonomia, e da amizade por um companheiro que mostra aceitação incondicional pelo verdadeiro self. Para análise deste sentimento em mulheres casadas, foi realizada uma pesquisa quantitativa e qualitativa com mulheres solteiras e universitárias. A escolha da amostra foi aleatória e por conglomerado, em três estágios. Participaram do estudo 184 mulheres, 38% casadas, 7,6% separadas e 52,7% solteiras. Da pesquisa quantitativa foi possível analisar que a percepção das mulheres sobre a solidão vem, em muitos aspectos, de encontro com a teoria psicanalítica. Pelas respostas encontradas percebeu-se que a grande maioria das participantes tem um baixo sentimento de solidão (58,7%) e 41,3% se classificaram com um escore de alto a médio sentimento de solidão, nestes dois grupos a maioria são de mulheres casadas e separadas, sendo que quanto mais nova a mulher maior a tendência a buscar um relacionamento para fugir da solidão, sendo entre as casadas também que isto ocorre com mais freqüência. A partir destes escores, 18 mulheres foram convidadas a participar de uma entrevista diagnóstica. Destas dezoito, seis mulheres apresentavam alto sentimento de solidão, sendo duas casadas, duas solteiras e duas separadas. Da mesma forma as mulheres com média e baixa solidão. Os resultados encontrados nestas entrevistas foram que todas as mulheres que apresentaram um alto sentimento de solidão demonstram uma adaptação ineficaz perante a vida, enquanto que aquelas que apresentaram médio ou baixo sentimento de solidão dificilmente apresentam adaptação ineficaz. Do grupo de médio sentimento de solidão, três mulheres apresentaram adaptação eficaz, e do grupo de baixo sentimento de solidão apenas uma participante apresentou adaptação ineficaz leve. Com isso concluímos que a solidão, quando em alta medida, além de dolorosa indica uma grande dificuldade do indivíduo em lidar com seus aspectos emocionais e produtivos, necessitando de ajuda psíquica.

Controlling cell attachment on contoured surfaces with self-assembled monolayers of alkanethiolates on gold.

This paper describes a method based on experimentally simple techniques--microcontact printing and micromolding in capillaries--to prepare tissue culture substrates in which both the topology and molecular structure of the interface can be controlled. The method combines optically transparent contoured surfaces with self-assembled monolayers (SAMs) of alkanethiolates on gold to control interfacial characteristics; these tailored interfaces, in turn, control the adsorption of proteins and the attachment of cells. The technique uses replica molding in poly(dimethylsiloxane) molds having micrometer-scale relief patterns on their surfaces to form a contoured film of polyurethane supported on a glass slide. Evaporation of a thin (< 12 nm) film of gold on this surface-contoured polyurethane provides an optically transparent substrate, on which SAMs of terminally functionalized alkanethiolates can be formed. In one procedure, a flat poly(dimethylsiloxane) stamp was used to form a SAM of hexadecanethiolate on the raised plateaus of the contoured surface by contact printing hexadecanethiol [HS(CH2)15CH3]; a SAM terminated in tri(ethylene glycol) groups was subsequently formed on the bare gold remaining in the grooves by immersing the substrate in a solution of a second alkanethiol [HS(CH2)11(OCH2CH2)3OH]. Then this patterned substrate was immersed in a solution of fibronectin, the protein adsorbed only on the methyl-terminated plateau regions of the substrate [the tri(ethylene glycol)-terminated regions resisted the adsorption of protein]; bovine capillary endothelial cells attached only on the regions that adsorbed fibronectin. A complementary procedure confined protein adsorption and cell attachment to the grooves in this substrate.

Self-assembly of a heteroduplex helicate from two different ligand strands and Cu(II) cations.

Cu(II) ions have been reacted with a 1/1 mixture of two linear ligands, one containing three 2,2'- bipyridine groups and the other three 2,2':6',2"-terpyridine groups. Absorption spectroscopy and fast atom bombardment mass spectrometry indicate the formation of a trinuclear complex containing one ligand of each kind. Determination of the crystal structure of this compound has confirmed that it is indeed a linear trinuclear complex in which two different ligands are wrapped in a helical fashion around the pentacoordinated metal ions. The central coordination geometry is trigonal bipyramidal; the two lateral Cu(II) ions are in a square pyramidal environment. Thus, a heteroduplex helicate is formed by the self-assembly of two different ligand strands and three specific metal ions induced by the coordination number and geometry of the latter. The self-assembly process may be considered to result from the reading of the steric and binding information present in the two ligands by Cu(II) ions through a pentacoordination algorithm. The same ligands have been shown earlier to yield homoduplex helicates from ions of tetrahedral and octahedral coordination geometry and strands of bidentate bipyridines and tridentate terpyridines, respectively. These two types of artificial double helical species may be related on one hand to the natural homoduplex nucleic acids and on the other hand to the DNA:RNA heteroduplex.

Quantifying the contamination by old main-sequence stars in young moving groups: the case of the Local Association

Context. The associations and moving groups of young stars are excellent laboratories for investigating stellar formation in the solar neighborhood. Previous results have confirmed that a non-negligible fraction of old main-sequence stars is present in the lists of possible members of young stellar kinematic groups. A detailed study of the properties of these samples is needed to separate the young stars from old main-sequence stars with similar space motion, and identify the origin of these structures. Aims. Our intention is to characterize members of the young moving groups, determine their age distribution, and quantify the contamination by old main-sequence stars, in particular, for the Local Association. Methods. We used stars possible members of the young (~10-650 Myr) moving groups from the literature. To determine the age of the stars, we used several suitable age indicators for young main sequence stars, i.e., X-ray fluxes from the Rosat All-sky Survey database, photometric data from the Tycho-2, Hipparcos, and 2MASS database. We also used spectroscopic data, in particular the equivalent width of the lithium line Li I λ6707.8 Å and H_α, to constrain the range of ages of the stars. Results. By combining photometric and spectroscopic data, we were able to separate the young stars (10-650 Myr) from the old (> 1 Gyr) field ones. We found, in particular, that the Local Association is contaminated by old field stars at the level of ~30%. This value must be considered as the contamination for our particular sample, and not of the entire Local Association. For other young moving groups, it is more difficult to estimate the fraction of old stars among possible members. However, the level of X-ray emission can, at least, help to separate two age populations: stars with <200 Myr and stars older than this. Conclusions. Among the candidate members of the classical moving groups, there is a non-negligible fraction of old field stars that should be taken into account when studying the stellar birthrate in the solar neighborhood. Our results are consistent with a scenario in which the moving groups contain both groups of young stars formed in a recent star-formation episode and old field stars with similar space motion. Only by combining X-ray and optical spectroscopic data is it possible to distinguish between these two age populations.