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.

Visual attention and perception models for assessing quality in 2D and 3D stereoscopic video

La medida de calidad de vídeo sigue siendo necesaria para definir los criterios que caracterizan una señal que cumpla los requisitos de visionado impuestos por el usuario. Las nuevas tecnologías, como el vídeo 3D estereoscópico o formatos más allá de la alta definición, imponen nuevos criterios que deben ser analizadas para obtener la mayor satisfacción posible del usuario. Entre los problemas detectados durante el desarrollo de esta tesis doctoral se han determinado fenómenos que afectan a distintas fases de la cadena de producción audiovisual y tipo de contenido variado. En primer lugar, el proceso de generación de contenidos debe encontrarse controlado mediante parámetros que eviten que se produzca el disconfort visual y, consecuentemente, fatiga visual, especialmente en lo relativo a contenidos de 3D estereoscópico, tanto de animación como de acción real. Por otro lado, la medida de calidad relativa a la fase de compresión de vídeo emplea métricas que en ocasiones no se encuentran adaptadas a la percepción del usuario. El empleo de modelos psicovisuales y diagramas de atención visual permitirían ponderar las áreas de la imagen de manera que se preste mayor importancia a los píxeles que el usuario enfocará con mayor probabilidad. Estos dos bloques se relacionan a través de la definición del término saliencia. Saliencia es la capacidad del sistema visual para caracterizar una imagen visualizada ponderando las áreas que más atractivas resultan al ojo humano. La saliencia en generación de contenidos estereoscópicos se refiere principalmente a la profundidad simulada mediante la ilusión óptica, medida en términos de distancia del objeto virtual al ojo humano. Sin embargo, en vídeo bidimensional, la saliencia no se basa en la profundidad, sino en otros elementos adicionales, como el movimiento, el nivel de detalle, la posición de los píxeles o la aparición de caras, que serán los factores básicos que compondrán el modelo de atención visual desarrollado. Con el objetivo de detectar las características de una secuencia de vídeo estereoscópico que, con mayor probabilidad, pueden generar disconfort visual, se consultó la extensa literatura relativa a este tema y se realizaron unas pruebas subjetivas preliminares con usuarios. De esta forma, se llegó a la conclusión de que se producía disconfort en los casos en que se producía un cambio abrupto en la distribución de profundidades simuladas de la imagen, aparte de otras degradaciones como la denominada “violación de ventana”. A través de nuevas pruebas subjetivas centradas en analizar estos efectos con diferentes distribuciones de profundidades, se trataron de concretar los parámetros que definían esta imagen. Los resultados de las pruebas demuestran que los cambios abruptos en imágenes se producen en entornos con movimientos y disparidades negativas elevadas que producen interferencias en los procesos de acomodación y vergencia del ojo humano, así como una necesidad en el aumento de los tiempos de enfoque del cristalino. En la mejora de las métricas de calidad a través de modelos que se adaptan al sistema visual humano, se realizaron también pruebas subjetivas que ayudaron a determinar la importancia de cada uno de los factores a la hora de enmascarar una determinada degradación. Los resultados demuestran una ligera mejora en los resultados obtenidos al aplicar máscaras de ponderación y atención visual, los cuales aproximan los parámetros de calidad objetiva a la respuesta del ojo humano. ABSTRACT Video quality assessment is still a necessary tool for defining the criteria to characterize a signal with the viewing requirements imposed by the final user. New technologies, such as 3D stereoscopic video and formats of HD and beyond HD oblige to develop new analysis of video features for obtaining the highest user’s satisfaction. Among the problems detected during the process of this doctoral thesis, it has been determined that some phenomena affect to different phases in the audiovisual production chain, apart from the type of content. On first instance, the generation of contents process should be enough controlled through parameters that avoid the occurrence of visual discomfort in observer’s eye, and consequently, visual fatigue. It is especially necessary controlling sequences of stereoscopic 3D, with both animation and live-action contents. On the other hand, video quality assessment, related to compression processes, should be improved because some objective metrics are adapted to user’s perception. The use of psychovisual models and visual attention diagrams allow the weighting of image regions of interest, giving more importance to the areas which the user will focus most probably. These two work fields are related together through the definition of the term saliency. Saliency is the capacity of human visual system for characterizing an image, highlighting the areas which result more attractive to the human eye. Saliency in generation of 3DTV contents refers mainly to the simulated depth of the optic illusion, i.e. the distance from the virtual object to the human eye. On the other hand, saliency is not based on virtual depth, but on other features, such as motion, level of detail, position of pixels in the frame or face detection, which are the basic features that are part of the developed visual attention model, as demonstrated with tests. Extensive literature involving visual comfort assessment was looked up, and the development of new preliminary subjective assessment with users was performed, in order to detect the features that increase the probability of discomfort to occur. With this methodology, the conclusions drawn confirmed that one common source of visual discomfort was when an abrupt change of disparity happened in video transitions, apart from other degradations, such as window violation. New quality assessment was performed to quantify the distribution of disparities over different sequences. The results confirmed that abrupt changes in negative parallax environment produce accommodation-vergence mismatches derived from the increasing time for human crystalline to focus the virtual objects. On the other side, for developing metrics that adapt to human visual system, additional subjective tests were developed to determine the importance of each factor, which masks a concrete distortion. Results demonstrated slight improvement after applying visual attention to objective metrics. This process of weighing pixels approximates the quality results to human eye’s response.

Herramienta de medida y visualización de prestaciones basada en eventos para especificaciones RVC-CAL

Este proyecto fin de grado presenta dos herramientas, Papify y Papify-Viewer, para medir y visualizar, respectivamente, las prestaciones a bajo nivel de especificaciones RVC-CAL basándose en eventos hardware. RVC-CAL es un lenguaje de flujo de datos estandarizado por MPEG y utilizado para definir herramientas relacionadas con la codificación de vídeo. La estructura de los programas descritos en RVC-CAL se basa en unidades funcionales llamadas actores, que a su vez se subdividen en funciones o procedimientos llamados acciones. ORCC (Open RVC-CAL Compiler) es un compilador de código abierto que utiliza como entrada descripciones RVC-CAL y genera a partir de ellas código fuente en un lenguaje dado, como por ejemplo C. Internamente, el compilador ORCC se divide en tres etapas distinguibles: front-end, middle-end y back-end. La implementación de Papify consiste en modificar la etapa del back-end del compilador, encargada de la generación de código, de modo tal que los actores, al ser traducidos a lenguaje C, queden instrumentados con PAPI (Performance Application Programing Interface), una herramienta utilizada como interfaz a los registros contadores de rendimiento (PMC) de los procesadores. Además, también se modifica el front-end para permitir identificar cierto tipo de anotaciones en las descripciones RVC-CAL, utilizadas para que el diseñador pueda indicar qué actores o acciones en particular se desean analizar. Los actores instrumentados, además de conservar su funcionalidad original, generan una serie de ficheros que contienen datos sobre los distintos eventos hardware que suceden a lo largo de su ejecución. Los eventos incluidos en estos ficheros son configurables dentro de las anotaciones previamente mencionadas. La segunda herramienta, Papify-Viewer, utiliza los datos generados por Papify y los procesa, obteniendo una representación visual de la información a dos niveles: por un lado, representa cronológicamente la ejecución de la aplicación, distinguiendo cada uno de los actores a lo largo de la misma. Por otro lado, genera estadísticas sobre la cantidad de eventos disparados por acción, actor o núcleo de ejecución y las representa mediante gráficos de barra. Ambas herramientas pueden ser utilizadas en conjunto para verificar el funcionamiento del programa, balancear la carga de los actores o la distribución por núcleos de los mismos, mejorar el rendimiento y diagnosticar problemas. ABSTRACT. This diploma project presents two tools, Papify and Papify-Viewer, used to measure and visualize the low level performance of RVC-CAL specifications based on hardware events. RVC-CAL is a dataflow language standardized by MPEG which is used to define video codec tools. The structure of the applications described in RVC-CAL is based on functional units called actors, which are in turn divided into smaller procedures called actions. ORCC (Open RVC-CAL Compiler) is an open-source compiler capable of transforming RVC-CAL descriptions into source code in a given language, such as C. Internally, the compiler is divided into three distinguishable stages: front-end, middle-end and back-end. Papify’s implementation consists of modifying the compiler’s back-end stage, which is responsible for generating the final source code, so that translated actors in C code are now instrumented with PAPI (Performance Application Programming Interface), a tool that provides an interface to the microprocessor’s performance monitoring counters (PMC). In addition, the front-end is also modified in such a way that allows identification of a certain type of annotations in the RVC-CAL descriptions, allowing the designer to set the actors or actions to be included in the measurement. Besides preserving their initial behavior, the instrumented actors will also generate a set of files containing data about the different events triggered throughout the program’s execution. The events included in these files can be configured inside the previously mentioned annotations. The second tool, Papify-Viewer, makes use of the files generated by Papify to process them and provide a visual representation of the information in two different ways: on one hand, a chronological representation of the application’s execution where each actor has its own timeline. On the other hand, statistical information is generated about the amount of triggered events per action, actor or core. Both tools can be used together to assert the normal functioning of the program, balance the load between actors or cores, improve performance and identify problems.

Methodology for Dynamic Stability and Robustness Analysis of Commercial-Power-Module-Based DC-Distributed Systems

El propósito de esta tesis es presentar una metodología para realizar análisis de la dinámica en pequeña señal y el comportamiento de sistemas de alimentación distribuidos de corriente continua (CC), formados por módulos comerciales. Para ello se hace uso de un método sencillo que indica los márgenes de estabilidad menos conservadores posibles mediante un solo número. Este índice es calculado en cada una de las interfaces que componen el sistema y puede usarse para obtener un índice global que indica la estabilidad del sistema global. De esta manera se posibilita la comparación de sistemas de alimentación distribuidos en términos de robustez. La interconexión de convertidores CC-CC entre ellos y con los filtros EMI necesarios puede originar interacciones no deseadas que dan lugar a la degradación del comportamiento de los convertidores, haciendo el sistema más propenso a inestabilidades. Esta diferencia en el comportamiento se debe a interacciones entre las impedancias de los diversos elementos del sistema. En la mayoría de los casos, los sistemas de alimentación distribuida están formados por módulos comerciales cuya estructura interna es desconocida. Por ello los análisis presentados en esta tesis se basan en medidas de la respuesta en frecuencia del convertidor que pueden realizarse desde los terminales de entrada y salida del mismo. Utilizando las medidas de las impedancias de entrada y salida de los elementos del sistema, se puede construir una función de sensibilidad que proporciona los márgenes de estabilidad de las diferentes interfaces. En esta tesis se utiliza el concepto del valor máximo de la función de sensibilidad (MPC por sus siglas en inglés) para indicar los márgenes de estabilidad como un único número. Una vez que la estabilidad de todas las interfaces del sistema se han evaluado individualmente, los índices obtenidos pueden combinarse para obtener un único número con el que comparar la estabilidad de diferentes sistemas. Igualmente se han analizado las posibles interacciones en la entrada y la salida de los convertidores CC-CC, obteniéndose expresiones analíticas con las que describir en detalle los acoplamientos generados en el sistema. Los estudios analíticos realizados se han validado experimentalmente a lo largo de la tesis. El análisis presentado en esta tesis se culmina con la obtención de un índice que condensa los márgenes de estabilidad menos conservativos. También se demuestra que la robustez del sistema está asegurada si las impedancias utilizadas en la función de sensibilidad se obtienen justamente en la entrada o la salida del subsistema que está siendo analizado. Por otra parte, la tesis presenta un conjunto de parámetros internos asimilados a impedancias, junto con sus expresiones analíticas, que permiten una explicación detallada de las interacciones en el sistema. Dichas expresiones analíticas pueden obtenerse bien mediante las funciones de transferencia analíticas si se conoce la estructura interna, o utilizando medidas en frecuencia o identificación de las mismas a través de la respuesta temporal del convertidor. De acuerdo a las metodologías presentadas en esta tesis se puede predecir la estabilidad y el comportamiento de sistemas compuestos básicamente por convertidores CC-CC y filtros, cuya estructura interna es desconocida. La predicción se basa en un índice que condensa la información de los márgenes de estabilidad y que permite la obtención de un indicador de la estabilidad global de todo el sistema, permitiendo la comparación de la estabilidad de diferentes arquitecturas de sistemas de alimentación distribuidos. ABSTRACT The purpose of this thesis is to present dynamic small-signal stability and performance analysis methodology for dc-distributed systems consisting of commercial power modules. Furthermore, the objective is to introduce simple method to state the least conservative margins for robust stability as a single number. In addition, an index characterizing the overall system stability is obtained, based on which different dc-distributed systems can be compared in terms of robustness. The interconnected systems are prone to impedance-based interactions which might lead to transient-performance degradation or even instability. These systems typically are constructed using commercial converters with unknown internal structure. Therefore, the analysis presented throughout this thesis is based on frequency responses measurable from the input and output terminals. The stability margins are stated utilizing a concept of maximum peak criteria, derived from the behavior of impedance-based sensitivity function that provides a single number to state robust stability. Using this concept, the stability information at every system interface is combined to a meaningful number to state the average robustness of the system. In addition, theoretical formulas are extracted to assess source and load side interactions in order to describe detailed couplings within the system. The presented theoretical analysis methodologies are experimentally validated throughout the thesis. In this thesis, according to the presented analysis, the least conservative stability margins are provided as a single number guaranteeing robustness. It is also shown that within the interconnected system the robust stability is ensured only if the impedance-based minor-loop gain is determined at the very input or output of each subsystem. Moreover, a complete set of impedance-type internal parameters as well as the formulas according to which the interaction sensitivity can be fully explained and analyzed, is provided. The given formulation can be utilized equally either based on measured frequency responses, time-domain identified internal parameters or extracted analytic transfer functions. Based on the analysis methodologies presented in this thesis, the stability and performance of interconnected systems consisting of converters with unknown internal structure, can be predicted. Moreover, the provided concept to assess the least conservative stability margins enables to obtain an index to state the overall robust stability of distributed power architecture and thus to compare different systems in terms of stability.

Design and implementation of an adaptive dashboard and visualization interface for the dynamic optimization and control of Data Centers

Over the last few years, the Data Center market has increased exponentially and this tendency continues today. As a direct consequence of this trend, the industry is pushing the development and implementation of different new technologies that would improve the energy consumption efficiency of data centers. An adaptive dashboard would allow the user to monitor the most important parameters of a data center in real time. For that reason, monitoring companies work with IoT big data filtering tools and cloud computing systems to handle the amounts of data obtained from the sensors placed in a data center.Analyzing the market trends in this field we can affirm that the study of predictive algorithms has become an essential area for competitive IT companies. Complex algorithms are used to forecast risk situations based on historical data and warn the user in case of danger. Considering that several different users will interact with this dashboard from IT experts or maintenance staff to accounting managers, it is vital to personalize it automatically. Following that line of though, the dashboard should only show relevant metrics to the user in different formats like overlapped maps or representative graphs among others. These maps will show all the information needed in a visual and easy-to-evaluate way. To sum up, this dashboard will allow the user to visualize and control a wide range of variables. Monitoring essential factors such as average temperature, gradients or hotspots as well as energy and power consumption and savings by rack or building would allow the client to understand how his equipment is behaving, helping him to optimize the energy consumption and efficiency of the racks. It also would help him to prevent possible damages in the equipment with predictive high-tech algorithms.

Development of a hand-gesture recognition system for human-computer interaction

The aim of this Master Thesis is the analysis, design and development of a robust and reliable Human-Computer Interaction interface, based on visual hand-gesture recognition. The implementation of the required functions is oriented to the simulation of a classical hardware interaction device: the mouse, by recognizing a specific hand-gesture vocabulary in color video sequences. For this purpose, a prototype of a hand-gesture recognition system has been designed and implemented, which is composed of three stages: detection, tracking and recognition. This system is based on machine learning methods and pattern recognition techniques, which have been integrated together with other image processing approaches to get a high recognition accuracy and a low computational cost. Regarding pattern recongition techniques, several algorithms and strategies have been designed and implemented, which are applicable to color images and video sequences. The design of these algorithms has the purpose of extracting spatial and spatio-temporal features from static and dynamic hand gestures, in order to identify them in a robust and reliable way. Finally, a visual database containing the necessary vocabulary of gestures for interacting with the computer has been created.

Microtubule-based Endoplasmic Reticulum Motility in Xenopus laevis: Activation of Membrane-associated Kinesin during Development

The endoplasmic reticulum (ER) in animal cells uses microtubule motor proteins to adopt and maintain its extended, reticular organization. Although the orientation of microtubules in many somatic cell types predicts that the ER should move toward microtubule plus ends, motor-dependent ER motility reconstituted in extracts of Xenopus laevis eggs is exclusively a minus end-directed, cytoplasmic dynein-driven process. We have used Xenopus egg, embryo, and somatic Xenopus tissue culture cell (XTC) extracts to study ER motility during embryonic development in Xenopus by video-enhanced differential interference contrast microscopy. Our results demonstrate that cytoplasmic dynein is the sole motor for microtubule-based ER motility throughout the early stages of development (up to at least the fifth embryonic interphase). When egg-derived ER membranes were incubated in somatic XTC cytosol, however, ER tubules moved in both directions along microtubules. Data from directionality assays suggest that plus end-directed ER tubule extensions contribute ∼19% of the total microtubule-based ER motility under these conditions. In XTC extracts, the rate of ER tubule extensions toward microtubule plus ends is lower (∼0.4 μm/s) than minus end-directed motility (∼1.3 μm/s), and plus end-directed motility is eliminated by a function-blocking anti-conventional kinesin heavy chain antibody (SUK4). In addition, we provide evidence that the initiation of plus end-directed ER motility in somatic cytosol is likely to occur via activation of membrane-associated kinesin.

Visualizing the dynamics of T cell activation: Intracellular adhesion molecule 1 migrates rapidly to the T cell/B cell interface and acts to sustain calcium levels

T cell recognition typically involves both the engagement of a specific T cell receptor with a peptide/major histocompatibility complex (MHC) and a number of accessory interactions. One of the most important interactions is between the integrin lymphocyte function-associated antigen 1 (LFA-1) on the T cell and intracellular adhesion molecule 1 (ICAM-1) on an antigen-presenting cell. By using fluorescence video microscopy and an ICAM-1 fused to a green fluorescent protein, we find that the elevation of intracellular calcium in the T cell that is characteristic of activation is followed almost immediately by the rapid accumulation of ICAM-1 on a B cell at a tight interface between the two cells. This increased density of ICAM-1 correlates with the sustained elevation of intracellular calcium in the T cell, known to be critical for activation. The use of peptide/MHC complexes and ICAM-1 on a supported lipid bilayer to stimulate T cells also indicates a major role for ICAM-1/LFA-1 in T cell activation but, surprisingly, not for adhesion, as even in the absence of ICAM-1 the morphological changes and adhesive characteristics of an activated T cell are seen in this system. We suggest that T cell antigen receptor-mediated recognition of a very small number of MHC/peptide complexes could trigger LFA-1/ICAM-1 clustering and avidity regulation, thus amplifying and stabilizing the production of second messengers.

Identification of protein oligomerization states by analysis of interface conservation

The discrimination of true oligomeric protein–protein contacts from nonspecific crystal contacts remains problematic. Criteria that have been used previously base the assignment of oligomeric state on consideration of the area of the interface and/or the results of scoring functions based on statistical potentials. Both techniques have a high success rate but fail in more than 10% of cases. More importantly, the oligomeric states of several proteins are incorrectly assigned by both methods. Here we test the hypothesis that true oligomeric contacts should be identifiable on the basis of an increased degree of conservation of the residues involved in the interface. By quantifying the degree of conservation of the interface and comparing it with that of the remainder of the protein surface, we develop a new criterion that provides a highly effective complement to existing methods.

Protein-protein interaction: a genetic selection for compensating mutations at the barnase-barstar interface.

Barnase and barstar are trivial names of the extracellular RNase and its intracellular inhibitor produced by Bacillus amyloliquefaciens. Inhibition involves the formation of a very tight one-to-one complex of the two proteins. With the crystallographic solution of the structure of the barnase-barstar complex and the development of methods for measuring the free energy of binding, the pair can be used to study protein-protein recognition in detail. In this report, we describe the isolation of suppressor mutations in barstar that compensate for the loss in interaction energy caused by a mutation in barnase. Our suppressor search is based on in vivo selection for barstar variants that are able to protect host cells against the RNAse activity of those barnase mutants not properly inhibited by wild-type barstar. This approach utilizes a plasmid system in which barnase expression is tightly controlled to keep the mutant barnase gene silent. When expression of barnase is turned on, failure to form a complex between the mutant barnase and barstar has a lethal effect on host cells unless overcome by substitution of the wild-type barstar by a functional suppressor derivative. A set of barstar suppressors has been identified for barnase mutants with substitutions in two amino acid positions (residues 102 and 59), which are critically involved in both RNase activity and barstar binding. The mutations selected as suppressors could not have been predicted on the basis of the known protein structures. The single barstar mutation with the highest information content for inhibition of barnase (H102K) has the substitution Y30W. The reduction in binding caused by the R59E mutation in barnase can be partly reversed by changing Glu-76 of barstar, which forms a salt bridge with the Arg-59 in the wild-type complex, to arginine, thus completing an interchange of the two charges.

Commercial applications of speech interface technology: an industry at the threshold.

Speech interface technology, which includes automatic speech recognition, synthetic speech, and natural language processing, is beginning to have a significant impact on business and personal computer use. Today, powerful and inexpensive microprocessors and improved algorithms are driving commercial applications in computer command, consumer, data entry, speech-to-text, telephone, and voice verification. Robust speaker-independent recognition systems for command and navigation in personal computers are now available; telephone-based transaction and database inquiry systems using both speech synthesis and recognition are coming into use. Large-vocabulary speech interface systems for document creation and read-aloud proofing are expanding beyond niche markets. Today's applications represent a small preview of a rich future for speech interface technology that will eventually replace keyboards with microphones and loud-speakers to give easy accessibility to increasingly intelligent machines.

Interfacial activation-based molecular bioimprinting of lipolytic enzymes.

Interfacial activation-based molecular (bio)-imprinting (IAMI) has been developed to rationally improve the performance of lipolytic enzymes in nonaqueous environments. The strategy combinedly exploits (i) the known dramatic enhancement of the protein conformational rigidity in a water-restricted milieu and (ii) the reported conformational changes associated with the activation of these enzymes at lipid-water interfaces, which basically involves an increased substrate accessibility to the active site and/or an induction of a more competent catalytic machinery. Six model enzymes have been assayed in several model reactions in nonaqueous media. The results, rationalized in light of the present biochemical and structural knowledge, show that the IAMI approach represents a straightforward, versatile method to generate manageable, activated (kinetically trapped) forms of lipolytic enzymes, providing under optimal conditions nonaqueous rate enhancements of up to two orders of magnitude. It is also shown that imprintability of lipolytic enzymes depends not only on the nature of the enzyme but also on the "quality" of the interface used as the template.

Molecular approaches to smart materials via interface recognition and conformationally switchable cavitands

In this thesis the molecular level design of functional materials and systems is reported. In the first part, tetraphosphonate cavitand (Tiiii) recognition properties towards amino acids are studied both in the solid state, through single crystal X-ray diffraction, and in solution, via NMR and ITC experiments. The complexation ability of these supramolecular receptors is then applied to the detection of biologically remarkable N-methylated amino acids and peptides using complex dynamic emulsions-based sensing platforms. In the second part, a general supramolecular approach for surface decoration with single-molecule magnets (SMMs) is presented. The self-assembly of SMMs is achieved through the formation of a multiple hydrogen bonds architecture (UPy-NaPy complexation). Finally we explore the possibility to impart auxetic behavior to polymeric material through the introduction of conformationally switchable monomers, namely tetraquinoxaline cavitands (QxCav). Their interconversion from a closed vase conformation to an extended kite form is studied first in solution, then in polymeric matrixes via pH and tensile stimuli by UV-Vis spectroscopy.

Desenvolvimento de video educativo para a aprendizagem do autocateterismo vesical intermitente

A bexiga neurogênica é uma disfunção vesical decorrente principalmente da lesão medular. O cateterismo vesical intermitente é o tratamento mais indicado na atualidade, deve ser realizado de 4 a 6 vezes ao dia, durante toda a vida, visando a proteção do trato urinário superior e a aquisição da continência urinária. Na reabilitação desses indivíduos, a autocateterização vesical é um desafio enfrentado na busca pela autonomia, privacidade, inserção social e participação. Os vídeos educativos são utilizados para o aprendizado do autocateterismo em vários países, por serem de fácil utilização e acesso via internet. Apesar disso, não existem vídeos realizados para o contexto brasileiro, levando em consideração os cateteres urinários e a técnica utilizada no Brasil. Este estudo teve como objetivo desenvolver e validar um vídeo educativo para a realização do autocateterismo vesical intermitente limpo. Trata-se de um estudo quantitativo, desenvolvido em duas fases: 1ª fase com a avaliação de vídeos educativos públicos direcionados para a aprendizagem do autocateterismo vesical intermitente com a técnica limpa; e 2ª Fase, com o desenvolvimento e validação de um vídeo educativo voltado para aprendizagem do autocateterismo. O levantamento dos vídeos utilizou um site de compartilhamento de vídeos utilizando o descritor \"autocateterismo\". Os vídeos foram avaliados por três juízes da área de saúde. O processo de desenvolvimento e validação do roteiro do vídeo educativo utilizou questionários previamente ratificados. Participaram dessas etapas, respectivamente, 18 e 17 juízes experts em reabilitação e/ou no ensino em saúde. O levantamento mostrou que apenas 3,5% (172) do total de vídeos disponíveis no site pesquisado eram voltados para o aprendizado do autocateterismo no contexto brasileiro. Seis vídeos eram específicos para o autocateterismo, dos quais quatro tinham informações desatualizadas ou incorretas, apenas dois atingiram a pontuação aceitável. Na validação do roteiro observou-se um predomínio de participantes do sexo feminino (94,44%), com idade de 30 a 60 anos, dos quais 72,22% possuíam mestrado e 50% atuavam há mais de cinco anos na área de reabilitação. O roteiro foi considerado validado com 96,29% das respostas dos juízes \"concordo\" ou \"concordo totalmente\" nas questões referentes ao quesito objetivo, 91,09% para quesito conteúdo, 98,12% em relação ao quesito relevância, 75% quanto ao quesito ambiente, 71,11% no quesito linguagem verbal e 92,70% referente à inclusão de tópicos. A produção do vídeo contou com uso de tecnologia 3D e apoio de uma equipe técnica especializada. No que se refere à validação do conteúdo do vídeo educativo, o conteúdo do vídeo foi considerado validado com 100% dos juízes que responderam \"concordo\" ou \"concordo totalmente\" nas questões referentes à funcionalidade, 86,27% referentes à usabilidade, 97,06% no quesito eficiência, 100% para técnica audiovisual, 94,11% quanto ao ambiente e 97,05% procedimento. O vídeo educativo foi avaliado positivamente tanto pela qualidade das informações quanto pela didática do ensino, mostrando a relevância da validação de materiais educativos. A expectativa é disseminar o vídeo educativo em diferentes centros de reabilitação e Universidades, visando propagar e tornar o conhecimento sobre a temática mais acessível à sociedade e aos profissionais de saúde, em especial os de reabilitação. Além de incentivar e embasar metodologicamente o desenvolvimento de outros vídeos educativos na área da saúde