[How can the mentally ill achieve sustained employment? Supported employment versus pre-vocational training]

People with severe mental disorders are often without work, although work may have a positive effect on their health. The paper presents some results in this field from the German S3 guidelines on psychosocial therapies. In terms of evidence-based medicine supported employment (SE - first place then train) has proven to be most effective. Nevertheless, SE is still rare in Germany. Pre-vocational training, however, follows the concept first train then place and is offered in rehabilitation of the mentally ill (RPK) centres in Germany. There is some evidence that the programs are beneficial for users. The UN Convention for the Rights of Persons with Disabilities outlines an obligation for work on an equal basis with others and for vocational training. So far, the German mental health system only partly meets these requirements.

[Gerodontology consultation in geriatric facilities: general health status (I)]

Dental undertreatment is often seen in the older population. This is particularly true for the elderly living in nursing homes and geriatric hospitals. The progression of chronic diseases results in loss of their independence. They rely on daily support and care due to physical or mental impairment. The visit of a dentist in private praxis becomes difficult or impossible and is a logistic problem. These elderly patients are often not aware of oral and dental problems or these are not addressed. The geriatric hospital Bern, Ziegler, has integrated dental care in the concept of physical rehabilitation of geriatric patients. A total of 139 patients received dental treatment in the years 2005/2006. Their mean age was 83 years, but the segment with > 85 years of age amounted to 46%. The general health examinations reveald multiple and complex disorders. The ASA classification (American Society of Anesthesiologists, Physical Status Classification System) was applied and resulted in 15% = P2 (mild systemic disease, no functional limitation), 47% = P3 (severe systemic disease, definite functional limitations) and 38% = P4 (severe systemic disease, constant threat to life). Eighty-seven of the patients exhibited 3 or more chronic diseases with a prevalence of cardiovascular diseases, musculoskelettal disorders and dementia. Overall the differences between men and women were small, but broncho-pulmonary dieseases were significantly more frequent in women, while men were more often diagnosed with dementia and depression. Verbal communication was limited or not possible with 60% of the patients due to cognitive impairment or aphasia after a stroke. Although the objective treatment need is high, providing dentistry for frail and geriatric patients is characterized by risks due to poor general health conditions, difficulties in communication, limitations in feasibility and lack of adequate aftercare. In order to prevent the problem of undertreatment, elderly independently living people should undergo dental treatment regularly and in time. Training of nurses and doctors of geriatric hospitals in oral hygiene should improve the awareness. A multidisciplinary assessment of geriatric patients should include the oral and dental aspect if they enter the hospital.

Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study

OBJECTIVES: To analyze computer-assisted diagnostics and virtual implant planning and to evaluate the indication for template-guided flapless surgery and immediate loading in the rehabilitation of the edentulous maxilla. MATERIALS AND METHODS: Forty patients with an edentulous maxilla were selected for this study. The three-dimensional analysis and virtual implant planning was performed with the NobelGuide software program (Nobel Biocare, Göteborg, Sweden). Prior to the computer tomography aesthetics and functional aspects were checked clinically. Either a well-fitting denture or an optimized prosthetic setup was used and then converted to a radiographic template. This allowed for a computer-guided analysis of the jaw together with the prosthesis. Accordingly, the best implant position was determined in relation to the bone structure and prospective tooth position. For all jaws, the hypothetical indication for (1) four implants with a bar overdenture and (2) six implants with a simple fixed prosthesis were planned. The planning of the optimized implant position was then analyzed as follows: the number of implants was calculated that could be placed in sufficient quantity of bone. Additional surgical procedures (guided bone regeneration, sinus floor elevation) that would be necessary due the reduced bone quality and quantity were identified. The indication of template-guided, flapless surgery or an immediate loaded protocol was evaluated. RESULTS: Model (a) - bar overdentures: for 28 patients (70%), all four implants could be placed in sufficient bone (total 112 implants). Thus, a full, flapless procedure could be suggested. For six patients (15%), sufficient bone was not available for any of their planned implants. The remaining six patients had exhibited a combination of sufficient or insufficient bone. Model (b) - simple fixed prosthesis: for 12 patients (30%), all six implants could be placed in sufficient bone (total 72 implants). Thus, a full, flapless procedure could be suggested. For seven patients (17%), sufficient bone was not available for any of their planned implants. The remaining 21 patients had exhibited a combination of sufficient or insufficient bone. DISCUSSION: In the maxilla, advanced atrophy is often observed, and implant placement becomes difficult or impossible. Thus, flapless surgery or an immediate loading protocol can be performed just in a selected number of patients. Nevertheless, the use of a computer program for prosthetically driven implant planning is highly efficient and safe. The three-dimensional view of the maxilla allows the determination of the best implant position, the optimization of the implant axis, and the definition of the best surgical and prosthetic solution for the patient. Thus, a protocol that combines a computer-guided technique with conventional surgical procedures becomes a promising option, which needs to be further evaluated and improved.

[The stamp technique for direct composite restoration]

The indications for direct resin composite restorations are nowadays extended due to the development of modern resin materials with improved material properties. However, there are still some difficulties regarding handling of resin composite material, especially in large restorations. The reconstruction of a functional and individual occlusion is difficult to achieve with direct application techniques. The aim of the present publication was to introduce a new "stamp"-technique for placing large composite restorations. The procedure of this "stamp"-technique is presented by three typical indications: large single-tooth restoration, occlusal rehabilitation of a compromised occlusal surface due to erosions and direct fibre-reinforced fixed partial denture. A step-by-step description of the technique and clinical figures illustrates the method. Large single-tooth restorations can be built-up with individual, two- piece silicone stamps. Large occlusal abrasive and/or erosive defects can be restored by copying the wax-up from the dental technician using the "stamp"-technique. Even fiber-reinforced resin-bonded fixed partial dentures can be formed with this intraoral technique with more precision and within a shorter treatment time. The presented "stamp"-technique facilitates the placement of large restoration with composite and can be recommended for the clinical use.

Cardiopulmonary performance testing using a robotics-assisted tilt table: Feasibility assessment in able-bodied subjects

BACKGROUND: Robotics-assisted tilt table technology was introduced for early rehabilitation of neurological patients. It provides cyclical stepping movement and physiological loading of the legs. The aim of the present study was to assess the feasibility of this type of device for peak cardiopulmonary performance testing using able-bodied subjects. METHODS: A robotics-assisted tilt table was augmented with force sensors in the thigh cuffs and a work rate estimation algorithm. A custom visual feedback system was employed to guide the subjects' work rate and to provide real time feedback of actual work rate. Feasibility assessment focused on: (i) implementation (technical feasibility), and (ii) responsiveness (was there a measurable, high-level cardiopulmonary reaction?). For responsiveness testing, each subject carried out an incremental exercise test to the limit of functional capacity with a work rate increment of 5 W/min in female subjects and 8 W/min in males. RESULTS: 11 able-bodied subjects were included (9 male, 2 female; age 29.6 ± 7.1 years: mean ± SD). Resting oxygen uptake (O_{2}) was 4.6 ± 0.7 mL/min/kg and O_{2}peak was 32.4 ± 5.1 mL/min/kg; this mean O_{2}peak was 81.1% of the predicted peak value for cycle ergometry. Peak heart rate (HRpeak) was 177.5 ± 9.7 beats/min; all subjects reached at least 85% of their predicted HRpeak value. Respiratory exchange ratio (RER) at O_{2}peak was 1.02 ± 0.07. Peak work rate) was 61.3 ± 15.1 W. All subjects reported a Borg CR10 value for exertion and leg fatigue of 7 or more. CONCLUSIONS: The robotics-assisted tilt table is deemed feasible for peak cardiopulmonary performance testing: the approach was found to be technically implementable and substantial cardiopulmonary responses were observed. Further testing in neurologically-impaired subjects is warranted.

Is mental practice an effective adjunct therapeutic strategy for upper limb motor restoration after stroke?

Stroke is one of the most common conditions requiring rehabilitation, and its motor impairments are a major cause of permanent disability. Hemiparesis is observed by 80% of the patients after acute stroke. Neuroimaging studies showed that real and imagined movements have similarities regarding brain activation, supplying evidence that those similarities are based on the same process. Within this context, the combination of MP with physical and occupational therapy appears to be a natural complement based on neurorehabilitation concepts. Our study seeks to investigate if MP for stroke rehabilitation of upper limbs is an effective adjunct therapy. PubMed (Medline), ISI knowledge (Institute for Scientific Information) and SciELO (Scientific Electronic Library) were terminated on 20 February 2015. Data were collected on variables as follows: sample size, type of supervision, configuration of mental practice, setting the physical practice (intensity, number of sets and repetitions, duration of contractions, rest interval between sets, weekly and total duration), measures of sensorimotor deficits used in the main studies and significant results. Random effects models were used that take into account the variance within and between studies. Seven articles were selected. As there was no statistically significant difference between the two groups (MP vs Control), showed a – 0.6 (95% CI: –1.27 to 0.04), for upper limb motor restoration after stroke. The present meta-analysis concluded that MP is not effective as adjunct therapeutic strategy for upper limb motor restoration after stroke.

Submaximal cardiopulmonary thresholds on a robotics-assisted tilt table, a cycle and a treadmill: a comparative analysis

BACKGROUND: The robotics-assisted tilt table (RATT), including actuators for tilting and cyclical leg movement, is used for rehabilitation of severely disabled neurological patients. Following further engineering development of the system, i.e. the addition of force sensors and visual bio-feedback, patients can actively participate in exercise testing and training on the device. Peak cardiopulmonary performance parameters were previously investigated, but it also important to compare submaximal parameters with standard devices. The aim of this study was to evaluate the feasibility of the RATT for estimation of submaximal exercise thresholds by comparison with a cycle ergometer and a treadmill. METHODS: 17 healthy subjects randomly performed six maximal individualized incremental exercise tests, with two tests on each of the three exercise modalities. The ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) were determined from breath-by-breath data. RESULTS: VAT and RCP on the RATT were lower than the cycle ergometer and the treadmill: oxygen uptake (V'O2) at VAT was [mean (SD)] 1.2 (0.3), 1.5 (0.4) and 1.6 (0.5) L/min, respectively (p < 0.001); V'O2 at RCP was 1.7 (0.4), 2.3 (0.8) and 2.6 (0.9) L/min, respectively (p = 0.001). High correlations for VAT and RCP were found between the RATT vs the cycle ergometer and RATT vs the treadmill (R on the range 0.69-0.80). VAT and RCP demonstrated excellent test-retest reliability for all three devices (ICC from 0.81 to 0.98). Mean differences between the test and retest values on each device were close to zero. The ventilatory equivalent for O2 at VAT for the RATT and cycle ergometer were similar and both were higher than the treadmill. The ventilatory equivalent for CO2 at RCP was similar for all devices. Ventilatory equivalent parameters demonstrated fair-to-excellent reliability and repeatability. CONCLUSIONS: It is feasible to use the RATT for estimation of submaximal exercise thresholds: VAT and RCP on the RATT were lower than the cycle ergometer and the treadmill, but there were high correlations between the RATT vs the cycle ergometer and vs the treadmill. Repeatability and test-retest reliability of all submaximal threshold parameters from the RATT were comparable to those of standard devices.

Rehabilitación de un paciente desdentado total con sobredentadura

Con el advenimiento de los implantes y con ellos la opción de las sobredentaduras, la pasividad comienza a jugar un papel fundamental para darle mejor pronóstico a la rehabilitación y prolongar la vida útil de los implantes. Dentro de este análisis es que se presenta el caso clínico de un paciente portador de prótesis completa superior e inferior, tratado dentro del marco de la Carrera de Especialista en Prostodoncia de la Universidad Nacional de Cuyo. El tratamiento propuesto al paciente fue: dos implantes en el maxilar inferior con una sobredentadura retenida por pilares esféricos y cuatro implantes superiores con una sobredentadura retenida por una barra, la cual feruliza los implantes. La barra superior fue colada seccionada en cuatro partes, unidas en boca y luego soldadas mediante tecnología láser. De esta forma se busca obtener pasividad para evitar aflojamiento de tornillos de fijación, fractura de tornillos o implantes, reabsorción de los tejidos óseo perimplantarios o pérdida de la oseointegración de los implantes.

Maceral distribution, stratigraphic position and vitrinite reflectance at DSDP Hole 81-555

Twenty-four sediment samples from late Paleocene to early Eocene were studied for maceral content, vitrinite reflectance, and spectral fluorescence in order to determine some parameters of the origin and diagenetic history of their organic fraction. The sediments had been obtained at Site 555 of DSDP Leg 81 in the northeastern North Atlantic. The bulk of the microscopically visible fraction is made up of humic materials; inertinites follow as a distant second; and liptinites are exceedingly rare. No unequivocal evidence of marine organic matter was found. Humic materials are highly decomposed, showing signs of aerobic (frequency of sclerotinites) as well as anaerobic (abundance of and intimate association with framboidal pyrite) microbial degradation. Vitrinite reflectance values vary between 0.26 and 0.35 Ro and show a slight increase with depth. These values, indicative of a low-rank lignite stage of coalification, contrast somewhat with the sporinite fluorescence spectra, which show the configuration typical for the peat stage. In either case, the evidence for such a low stage of coalification is surprising in view of the depth and age of the sediments.

Concienciación para la conservación del patrimonio urbano : los instrumentos de gestión para la recuperación del barrio madrileño de Embajadores

La tesis trata la evolución de la conciencia de la conservación de los centros históricos y de los instrumentos de gestión utilizados en las políticas de rehabilitación del casco antiguo de Madrid, desde las primeras experiencias de los años ‘80 hasta el perfeccionamiento del complejo mecanismo contemporáneo. El proceso de rehabilitación ha demostrado ser extremadamente coherente en cuanto a los objetivos y en cuanto al tema de los instrumentos ha seguido la tendencia de diversificar y flexibilizar. En Madrid se ha utilizado el concepto de rehabilitación en sentido integral, abarca una amplia gama de acciones que implican por una parte, intervenciones directas sobre los edificios y por otra, la valorización del espacio público, de los edificios representativos, la introducción de dotaciones y también un componente social. El tema se analizará desde la perspectiva del barrio de Embajadores, un área muy especial del casco antiguo de la ciudad. Desde 1998 hasta la actualidad allí funciona el Área de Rehabilitación Integral con el nombre de Lavapiés. El barrio de Embajadores representa un caso de extrema complejidad dada su tradición, que mantiene hasta el momento, de barrio popular que ha tenido como consecuencia negativa un grave estado de deterioro de los edificios y de sus estructuras urbanas. Además, presenta una composición socio-cultural muy heterogénea ya que siempre ha alojado oleadas de inmigrantes que llegaban a la capital tanto de las provincias como del extranjero. Los ‘80 marcan en Madrid el inicio de la preocupación por la rehabilitación urbana y de los primeros intentos de definir unos mecanismos. Durante este período el barrio de Embajadores es escenario de los primeros proyectos piloto de rehabilitación. Se sientan las bases del sistema de subvenciones, que empujará hacia un modelo de rehabilitación generalizada. A principios de los años ‘90, la insatisfacción dejada por de los resultados obtenidos, la Administración decide reorganizar la estrategia y se procede a la rehabilitación integral por áreas, concentrando los esfuerzos geográfica y temporalmente. La idea ya se había utilizado diez años antes, pero sin encontrar nunca la voluntad política de aplicarla. En comparación con el casco antiguo, el barrio de Embajadores se dejó para el final del proceso para verificar los métodos en zonas más restringidas en cuanto a superficie y con menos problemas. Desde 1998 hasta hoy, período en que funciona el Área de Rehabilitación Integral de Lavapiés, los distintos tipos de actuaciones, de producción arquitectónica, urbanística y sociocultural, han mostrado su eficacia, de forma que los cambios que aportaron al barrio son evidentes para todos. Mientras que las Áreas de Rehabilitación del centro una vez alcanzados los objetivos, se preparan para su clausura, a nivel administrativo se están definiendo nuevas direcciones y nuevos objetivos para el casco antiguo: subastas para incentivar intervenciones de mejoramiento energético y del nivel de sostenibilidad de los edificios madrileños. La primera parte de la tesis establece las premisas presentando algunos puntos relevantes relativos al desarrollo histórico de los documentos y normativas más importantes que tendrán eco en el proceso de concienciación de la cultura de la conservación del patrimonio urbano de los centros históricos. Después, se habla de la experiencia de rehabilitación urbana en Europa, en España en general y en Madrid en particular, con referencia a los modelos de enfoque, al marco legislativo y a las experiencias relacionadas con el casco antiguo, y en definitiva a la creación de la conciencia de la rehabilitación y conservación de los centros de las ciudades. La segunda parte se centra en el caso de estudio, el barrio de Embajadores. En primer lugar, se presenta en detalle el barrio: ubicación, datos característicos, edificios representativos y flujos que generan, trama urbana, datos sobre la formación histórica, tipologías y características de construcción de los edificios y, para finalizar, algún dato demográfico para introducir la compleja problemática social. Más adelante se exponen las primeras experiencias de rehabilitación: dos proyectos piloto de intervención sobre las viviendas realizados en los años ‘80, uno privado y el otro público. La parte central del trabajo trata sobre la fase intensiva de rehabilitación, proceso puesto en marcha en el año ’98 y que corresponde al período en el que Embajadores es Área de Rehabilitación Integral. Se presentan y analizan los objetivos de la rehabilitación y luego los instrumentos de orden administrativo, normativo y legal que regulan las actuaciones en el barrio. Sucesivamente se afronta la rehabilitación de la parte residencial, en régimen privado y público, que fue el modelo principal que la Administración llevó a cabo. Se presenta todo el proceso, desde la decisión sobre el tipo de rehabilitación, las subvenciones y las soluciones técnicas adoptadas así como la rehabilitación de casos especiales de edificios, que por sus características, el alto nivel de degradación o porque ocupados por inquilinos con dificultades económicas, se realizó con intervención pública. Las enormes dificultades derivadas de la complicada gestión y de las incongruencias de las normativas también se analizan en este trabajo. El autor presenta un dosier de una veintena de trabajos llevados a cobo en el Barrio de Embajadores a lo largo de más de 15 años de experiencia profesional propia. Se intenta, en primer lugar, evaluar la actuación pública en comparación con la privada en cuanto a los modelos propuestos, a las problemáticas que generan y a los resultados obtenidos. Una segunda línea de argumentación se refiere a la relación que se establece entre los instrumentos que se promueven y los que obligan a la conservación y a la rehabilitación de los edificios. Quizás el elemento más interesante, por su conocida innovación, de la experiencia de la obligación de conservación a cargo de los propietarios y la introducción de una revisión periódica del estado de los edificios (ITE), que conduce a su mantenimiento permanente a lo largo del tiempo. El ultimo instrumento aparecido y de por si el más novedoso se refiere a la política de rehabilitación energética iniciada en los últimos años por el Ayuntamiento de Madrid. ABSTRACT Starting from the early experiences of the ‘80s and tackling the complex and improved contemporary techniques of development, the present thesis focuses on raising awareness of the conservation of urban heritage and deals with the evolution of rehabilitation policies adopted in the historical center of Madrid. The rehabilitation process has proven to be extremely coherent in terms of its objectives and, consequently, the subject of the instruments has forged ahead a trend of diversification and flexibility. Madrid has used the concept of rehabilitation in a comprehensive manner, encompassing a wide range of actions, which involved on the one hand, direct interventions on buildings and on the other, the appreciation of the public space with its representative edifices and endowments. Confident that the social components have not been neglected during the rehabilitation proceedings, the topic will be analysed in relation to the neighbourhood of Embajadores, an authentic area of the old town. From 1998 onwards, this quarter serves as a Comprehensive Rehabilitation Area under the name of Lavapies. Considering the tradition and popularity of the district, Embajadores represents a challenging case for rehabilitation projects, aiming to improve the severe state of deterioration of buildings and urban structures. Having a heterogeneous sociocultural dynamic, the neighbourhood has always hosted waves of immigrants who come to the capital both from other provinces and abroad. The 1980s in Madrid marked the beginning of concerns with urban regeneration and the first attempts to define feasible restoration techniques. During this period, the district of Embajadores has benefited from various pilot projects. The financial investments have significant effects on the overall environment, so the model of general rehabilitation has been encouraged throughout the years. In the early 90s, left by the dissatisfaction of the results obtained, the authorities proposed to reorganise the strategy and proceed to the full rehabilitation of areas, concentrating efforts geographically and temporally. The idea had already been used ten years before, but never encountered the political force to be implemented. Compared to the old town, the Embajadores neighbourhood has been left for the end of the process, which focused on verifying the methods in more restricted areas that caused fewer disruptions. For the Comprehensive Rehabilitation Area of Lavapies, the various types of administrative implementations from architectural to urban and socio-cultural productions have proved effective. The improvements experienced by the neighbourhood from 1998 are obvious to all. However, while the areas of rehabilitation of the city centre have achieved their objectives and prepare for closure, the administration is still generating new directions and new targets for the ancient surroundings: auctions to encourage the improvement of energy interventions and the sustainability level for the buildings of Madrid. Therefore, the first part of the thesis establishes the premises and introduces some relevant points concerning the entire city. It describes the historical development of urban projects, indicating the events that will echo in the rehabilitation process. This paper then turns to discuss the experience of urban regeneration in Spain, emphasising the case of Madrid with reference to models of approach, legislative frameworks and appreciation of the old structures. The second part reveals an in depth case study of the district of Embajadores. At first, the thesis provides insights into the neighbourhood: location, general data on representative buildings and propagated trends, urban, historical data on training, building typologies and characteristics. The section introduces some demographic data to complete the portrait of the elaborate social problems encountered in this district, also outlining the first experiences of rehabilitation: two pilot projects on housing intervention made in the 80s, one private and one public. The central part of the thesis deals with the intensive phase of rehabilitation developments launched in the year '98 when Embajadores joined the Comprehensive Rehabilitation Area. It analyses the goals of rehabilitation and the instruments of administrative, regulatory and governing legal proceedings of the neighbourhood. The following chapter addresses the privately and publicly founded plan of residential rehabilitation that constituted the main model conducted by the authorities. It describes the entire process: deciding the type of restoration, subsidies and technical solutions as well as the degree of rehabilitation for special buildings, which either have a high level of degradation or require public intervention when tenants face financial difficulties. The administrative difficulties caused by the enormous bureaucratic machinery and the inconsistencies in regulations are also discussed in this paper. Thus, a just evaluation of the public and private performances regarding the proposed models of rehabilitation, along with the problems they generate and the results obtained is desired throughout the thesis. A second line of argument concerns the relationship established between the instruments that are promoted and requiring conservation and the building restoration. Perhaps the most interesting and innovative element of the new rehabilitation policies is the owners' obligation to preserve their properties and the introduction of a periodic review for the state of the buildings (ITE). These thorough and meticulous regulations lead to an ongoing maintenance of constructions, preventing them from severe or sudden deteriorations.

Estudio de rehabilitación acústica de los edificios del barrio de Lavapiés

Los tejidos urbanos, los barrios y los edificios en proceso de degradación física, social o ambiental requieren acciones de rehabilitación urbana que garanticen el bienestar de las personas. La sociedad demanda, cada vez más, el derecho al descanso y a una vida sin ruidos, como signo de desarrollo y progreso. Es por ello, que se debe conducir el comportamiento de la edificación y del metabolismo urbano hacia unos mínimos de calidad acústica que permitan mejorar las deficiencias de aislamiento acústico que presentan los edificios existentes de gran parte de las ciudades y sus centros históricos. En este sentido, el objetivo de este Trabajo de Fin de Máster es el de contribuir al estudio de las acciones de rehabilitación y las soluciones técnicas que permitan desarrollar edificios acústicamente eficientes en el barrio de Lavapiés. Como punto de partida se realizará la caracterización urbanística del barrio, analizando la calidad de la edificación, la geometría de las calles, los principales viarios, para posteriormente estudiar la cartografía acústica de Lavapiés a través de los Mapas Estratégicos de Ruido. Porque el ruido tiene una importante componente subjetiva, se realizará además una encuesta de calidad acústica para conocer la opinión del ciudadano de Lavapiés, tratando de comprender la problemática de ruido en el barrio y cómo afecta ésta a sus vecinos. Por último se desarrollarán unas directrices generales para la rehabilitación acústica de los edificios existentes, y se llevarán a la práctica realizando una propuesta de rehabilitación acústica de un edificio del siglo XIX situado en la Calle Ave María de Lavapiés. Cada obra de rehabilitación es una oportunidad de mejorar las deficientes condiciones acústicas de los edificios dentro de lo viable técnica y económicamente, a pesar de que puede que no se lleguen a alcanzar los niveles exigidos en el DB HR. SUMMARY. The urban network, the neighborhoods and the buildings in progress of physical, social and environmental degradation require actions of urban restoration to guarantee people’s welfare. Society demands, more every time, the right to rest and to life without noise, as an evidence of development and progress. That is why, the behavior of building and the urban metabolism must be lead to the best acoustic quality allowing to improve the acoustic sound proofing deficiencies that now a days some of the existing buildings present in most of the cities and its historical downtowns. In this direction, the goal of this “Trabajo de Fin de Master” is to contribute to the study of the rehabilitation actions and the technical solutions that will make possible to develop acoustically efficient buildings in Lavapies area. To begin a urbanistic classification of the neighborhood will be done, analyzing the quality of construction, the geometry of the streets, the main road routes to study, afterwards,the acoustic cartography of Lavapies through the Strategic Maps of Noise. Also because noise has an important subjective component, a survey about acoustic quality will be made to know the opinion of Lavapies citizens, trying to understand the problems of noise in the neighborhood and how this may affect its neighbors. Finally some general guidelines of the acoustic rehabilitation of the buildings will be shown and materialized in a proposal of an acoustic rehabilitation of a XIX century building placed in Ave María Street in Lavapies. Each rehabilitation work is a chance to improve the insufficient acoustic conditions of the buildings within technical and economical possibilities, despite of the fact that it might not be possible to reach the levels demand by the DB HR anyway.

Condicionantes de la adherencia y anclaje en el refuerzo de muros de fábrica con elementos de fibras

Es cada vez más frecuente la rehabilitación de patrimonio construido, tanto de obras deterioradas como para la adecuación de obras existentes a nuevos usos o solicitaciones. Se ha considerado el estudio del refuerzo de obras de fábrica ya que constituyen un importante número dentro del patrimonio tanto de edificación como de obra civil (sistemas de muros de carga o en estructuras principales porticadas de acero u hormigón empleándose las fábricas como cerramiento o distribución con elementos autoportantes). A la hora de reparar o reforzar una estructura es importante realizar un análisis de las deficiencias, caracterización mecánica del elemento y solicitaciones presentes o posibles; en el apartado 1.3 del presente trabajo se refieren acciones de rehabilitación cuando lo que se precisa no es refuerzo estructural, así como las técnicas tradicionales más habituales para refuerzo de fábricas que suelen clasificarse según se trate de refuerzos exteriores o interiores. En los últimos años se ha adoptado el sistema de refuerzo de FRP, tecnología con origen en los refuerzos de hormigón tanto de elementos a flexión como de soportes. Estos refuerzos pueden ser de láminas adheridas a la fábrica soporte (SM), o de barras incluidas en rozas lineales (NSM). La elección de un sistema u otro depende de la necesidad de refuerzo y tipo de solicitación predominante, del acceso para colocación y de la exigencia de impacto visual. Una de las mayores limitaciones de los sistemas de refuerzo por FRP es que no suele movilizarse la resistencia del material de refuerzo, produciéndose previamente fallo en la interfase con el soporte con el consecuente despegue o deslaminación; dichos fallos pueden tener un origen local y propagarse a partir de una discontinuidad, por lo que es preciso un tratamiento cuidadoso de la superficie soporte, o bien como consecuencia de una insuficiente longitud de anclaje para la transferencia de los esfuerzos en la interfase. Se considera imprescindible una caracterización mecánica del elemento a reforzar. Es por ello que el trabajo presenta en el capítulo 2 métodos de cálculo de la fábrica soporte de distintas normativas y también una formulación alternativa que tiene en cuenta la fábrica histórica ya que su caracterización suele ser más complicada por la heterogeneidad y falta de clasificación de sus materiales, especialmente de los morteros. Una vez conocidos los parámetros resistentes de la fábrica soporte es posible diseñar el refuerzo; hasta la fecha existe escasa normativa de refuerzos de FRP para muros de fábrica, consistente en un protocolo propuesto por la ACI 440 7R-10 que carece de mejoras por tipo de anclaje y aporta valores muy conservadores de la eficacia del refuerzo. Como se ha indicado, la problemática principal de los refuerzos de FRP en muros es el modo de fallo que impide un aprovechamiento óptimo de las propiedades del material. Recientemente se están realizando estudios con distintos métodos de anclaje para estos refuerzos, con lo que se incremente la capacidad última y se mantenga el soporte ligado al refuerzo tras la rotura. Junto con sistemas de anclajes por prolongación del refuerzo (tanto para láminas como para barras) se han ensayado anclajes con llaves de cortante, barras embebidas, o anclajes mecánicos de acero o incluso de FRP. Este texto resume, en el capítulo 4, algunas de las campañas experimentales llevadas a cabo entre los años 2000 y 2013 con distintos anclajes. Se observan los parámetros fundamentales para medir la eficacia del anclajes como son: el modo de fallo, el incremento de resistencia, y los desplazamientos que permite observar la ductilidad del refuerzo; estos datos se analizan en función de la variación de: tipo de refuerzo incluyéndose el tipo de fibra y sistema de colocación, y tipo de anclaje. Existen también parámetros de diseño de los propios anclajes. En el caso de barras embebidas se resumen en diámetro y material de la barra, acabado superficial, dimensiones y forma de la roza, tipo de adhesivo. En el caso de anclajes de FRP tipo pasador la caracterización incluye: tipo de fibra, sistema de fabricación del anclajes y diámetro del mismo, radio de expansión del abanico, espaciamiento longitudinal de anclajes, número de filas de anclajes, número de láminas del refuerzo, longitud adherida tras el anclaje; es compleja la sistematización de resultados de los autores de las campañas expuestas ya que algunos de estos parámetros varían impidiendo la comparación. El capítulo 5 presenta los ensayos empleados para estas campañas de anclajes, distinguiéndose entre ensayos de modo I, tipo tracción directa o arrancamiento, que servirían para sistemas NSM o para cuantificar la resistencia individual de anclajes tipo pasador; ensayos de modo II, tipo corte simple, que se asemeja más a las condiciones de trabajo de los refuerzos. El presente texto se realiza con objeto de abrir una posible investigación sobre los anclajes tipo pasador, considerándose que junto con los sistemas de barra embebida son los que permiten una mayor versatilidad de diseño para los refuerzos de FRP y siendo su eficacia aún difícil de aislar por el número de parámetros de diseño. Rehabilitation of built heritage is becoming increasingly frequent, including repair of damaged works and conditioning for a new use or higher loads. In this work it has been considered the study of masonry wall reinforcement, as most buildings and civil works have load bearing walls or at least infilled masonry walls in concrete and steel structures. Before repairing or reinforcing an structure, it is important to analyse its deficiencies, its mechanical properties and both existing and potential loads; chapter 1, section 4 includes the most common rehabilitation methods when structural reinforcement is not needed, as well as traditional reinforcement techniques (internal and external reinforcement) In the last years the FRP reinforcement system has been adopted for masonry walls. FRP materials for reinforcement were initially used for concrete pillars and beams. FRP reinforcement includes two main techniques: surface mounted laminates (SM) and near surface mounted bars (NSM); one of them may be more accurate according to the need for reinforcement and main load, accessibility for installation and aesthetic requirements. One of the main constraints of FRP systems is not reaching maximum load for material due to premature debonding failure, which can be caused by surface irregularities so surface preparation is necessary. But debonding (or delamination for SM techniques) can also be a consequence of insufficient anchorage length or stress concentration. In order to provide an accurate mechanical characterisation of walls, chapter 2 summarises the calculation methods included in guidelines as well as alternative formulations for old masonry walls as historic wall properties are more complicated to obtain due to heterogeneity and data gaps (specially for mortars). The next step is designing reinforcement system; to date there are scarce regulations for walls reinforcement with FRP: ACI 440 7R-10 includes a protocol without considering the potential benefits provided by anchorage devices and with conservative values for reinforcement efficiency. As noted above, the main problem of FRP masonry walls reinforcement is failure mode. Recently, some authors have performed studies with different anchorage systems, finding that these systems are able to delay or prevent debonding . Studies include the following anchorage systems: Overlap, embedded bars, shear keys, shear restraint and fiber anchors. Chapter 4 briefly describes several experimental works between years 2000 and 2013, concerning different anchorage systems. The main parameters that measure the anchorage efficiency are: failure mode, failure load increase, displacements (in order to evaluate the ductility of the system); all these data points strongly depend on: reinforcement system, FRP fibers, anchorage system, and also on the specific anchorage parameters. Specific anchorage parameters are a function of the anchorage system used. The embedded bar system have design variables which can be identified as: bar diameter and material, surface finish, groove dimensions, and adhesive. In FRP anchorages (spikes) a complete design characterisation should include: type of fiber, manufacturing process, diameter, fan orientation, anchor splay width, anchor longitudinal spacing and number or rows, number or FRP sheet plies, bonded length beyond anchorage devices,...the parameters considered differ from some authors to others, so the comparison of results is quite complicated. Chapter 5 includes the most common tests used in experimental investigations on bond-behaviour and anchorage characterisation: direct shear tests (with variations single-shear and double-shear), pullout tests and bending tests. Each of them may be used according to the data needed. The purpose of this text is to promote further investigation of anchor spikes, accepting that both FRP anchors and embedded bars are the most versatile anchorage systems of FRP reinforcement and considering that to date its efficiency cannot be evaluated as there are too many design uncertainties.

A model to develop a platform for personalised health applications

Antecedentes Europa vive una situación insostenible. Desde el 2008 se han reducido los recursos de los gobiernos a raíz de la crisis económica. El continente Europeo envejece con ritmo constante al punto que se prevé que en 2050 habrá sólo dos trabajadores por jubilado [54]. A esta situación se le añade el aumento de la incidencia de las enfermedades crónicas, relacionadas con el envejecimiento, cuyo coste puede alcanzar el 7% del PIB de un país [51]. Es necesario un cambio de paradigma. Una nueva manera de cuidar de la salud de las personas: sustentable, eficaz y preventiva más que curativa. Algunos estudios abogan por el cuidado personalizado de la salud (pHealth). En este modelo las prácticas médicas son adaptadas e individualizadas al paciente, desde la detección de los factores de riesgo hasta la personalización de los tratamientos basada en la respuesta del individuo [81]. El cuidado personalizado de la salud está asociado a menudo al uso de las tecnologías de la información y comunicación (TICs) que, con su desarrollo exponencial, ofrecen oportunidades interesantes para la mejora de la salud. El cambio de paradigma hacia el pHealth está lentamente ocurriendo, tanto en el ámbito de la investigación como en la industria, pero todavía no de manera significativa. Existen todavía muchas barreras relacionadas a la economía, a la política y la cultura. También existen barreras puramente tecnológicas, como la falta de sistemas de información interoperables [199]. A pesar de que los aspectos de interoperabilidad están evolucionando, todavía hace falta un diseño de referencia especialmente direccionado a la implementación y el despliegue en gran escala de sistemas basados en pHealth. La presente Tesis representa un intento de organizar la disciplina de la aplicación de las TICs al cuidado personalizado de la salud en un modelo de referencia, que permita la creación de plataformas de desarrollo de software para simplificar tareas comunes de desarrollo en este dominio. Preguntas de investigación RQ1 >Es posible definir un modelo, basado en técnicas de ingeniería del software, que represente el dominio del cuidado personalizado de la salud de una forma abstracta y representativa? RQ2 >Es posible construir una plataforma de desarrollo basada en este modelo? RQ3 >Esta plataforma ayuda a los desarrolladores a crear sistemas pHealth complejos e integrados? Métodos Para la descripción del modelo se adoptó el estándar ISO/IEC/IEEE 42010por ser lo suficientemente general y abstracto para el amplio enfoque de esta tesis [25]. El modelo está definido en varias partes: un modelo conceptual, expresado a través de mapas conceptuales que representan las partes interesadas (stakeholders), los artefactos y la información compartida; y escenarios y casos de uso para la descripción de sus funcionalidades. El modelo fue desarrollado de acuerdo a la información obtenida del análisis de la literatura, incluyendo 7 informes industriales y científicos, 9 estándares, 10 artículos en conferencias, 37 artículos en revistas, 25 páginas web y 5 libros. Basándose en el modelo se definieron los requisitos para la creación de la plataforma de desarrollo, enriquecidos por otros requisitos recolectados a través de una encuesta realizada a 11 ingenieros con experiencia en la rama. Para el desarrollo de la plataforma, se adoptó la metodología de integración continua [74] que permitió ejecutar tests automáticos en un servidor y también desplegar aplicaciones en una página web. En cuanto a la metodología utilizada para la validación se adoptó un marco para la formulación de teorías en la ingeniería del software [181]. Esto requiere el desarrollo de modelos y proposiciones que han de ser validados dentro de un ámbito de investigación definido, y que sirvan para guiar al investigador en la búsqueda de la evidencia necesaria para justificarla. La validación del modelo fue desarrollada mediante una encuesta online en tres rondas con un número creciente de invitados. El cuestionario fue enviado a 134 contactos y distribuido en algunos canales públicos como listas de correo y redes sociales. El objetivo era evaluar la legibilidad del modelo, su nivel de cobertura del dominio y su potencial utilidad en el diseño de sistemas derivados. El cuestionario incluía preguntas cuantitativas de tipo Likert y campos para recolección de comentarios. La plataforma de desarrollo fue validada en dos etapas. En la primera etapa se utilizó la plataforma en un experimento a pequeña escala, que consistió en una sesión de entrenamiento de 12 horas en la que 4 desarrolladores tuvieron que desarrollar algunos casos de uso y reunirse en un grupo focal para discutir su uso. La segunda etapa se realizó durante los tests de un proyecto en gran escala llamado HeartCycle [160]. En este proyecto un equipo de diseñadores y programadores desarrollaron tres aplicaciones en el campo de las enfermedades cardio-vasculares. Una de estas aplicaciones fue testeada en un ensayo clínico con pacientes reales. Al analizar el proyecto, el equipo de desarrollo se reunió en un grupo focal para identificar las ventajas y desventajas de la plataforma y su utilidad. Resultados Por lo que concierne el modelo que describe el dominio del pHealth, la parte conceptual incluye una descripción de los roles principales y las preocupaciones de los participantes, un modelo de los artefactos TIC que se usan comúnmente y un modelo para representar los datos típicos que son necesarios formalizar e intercambiar entre sistemas basados en pHealth. El modelo funcional incluye un conjunto de 18 escenarios, repartidos en: punto de vista de la persona asistida, punto de vista del cuidador, punto de vista del desarrollador, punto de vista de los proveedores de tecnologías y punto de vista de las autoridades; y un conjunto de 52 casos de uso repartidos en 6 categorías: actividades de la persona asistida, reacciones del sistema, actividades del cuidador, \engagement" del usuario, actividades del desarrollador y actividades de despliegue. Como resultado del cuestionario de validación del modelo, un total de 65 personas revisó el modelo proporcionando su nivel de acuerdo con las dimensiones evaluadas y un total de 248 comentarios sobre cómo mejorar el modelo. Los conocimientos de los participantes variaban desde la ingeniería del software (70%) hasta las especialidades médicas (15%), con declarado interés en eHealth (24%), mHealth (16%), Ambient Assisted Living (21%), medicina personalizada (5%), sistemas basados en pHealth (15%), informática médica (10%) e ingeniería biomédica (8%) con una media de 7.25_4.99 años de experiencia en estas áreas. Los resultados de la encuesta muestran que los expertos contactados consideran el modelo fácil de leer (media de 1.89_0.79 siendo 1 el valor más favorable y 5 el peor), suficientemente abstracto (1.99_0.88) y formal (2.13_0.77), con una cobertura suficiente del dominio (2.26_0.95), útil para describir el dominio (2.02_0.7) y para generar sistemas más específicos (2_0.75). Los expertos también reportan un interés parcial en utilizar el modelo en su trabajo (2.48_0.91). Gracias a sus comentarios, el modelo fue mejorado y enriquecido con conceptos que faltaban, aunque no se pudo demonstrar su mejora en las dimensiones evaluadas, dada la composición diferente de personas en las tres rondas de evaluación. Desde el modelo, se generó una plataforma de desarrollo llamada \pHealth Patient Platform (pHPP)". La plataforma desarrollada incluye librerías, herramientas de programación y desarrollo, un tutorial y una aplicación de ejemplo. Se definieron cuatro módulos principales de la arquitectura: el Data Collection Engine, que permite abstraer las fuentes de datos como sensores o servicios externos, mapeando los datos a bases de datos u ontologías, y permitiendo interacción basada en eventos; el GUI Engine, que abstrae la interfaz de usuario en un modelo de interacción basado en mensajes; y el Rule Engine, que proporciona a los desarrolladores un medio simple para programar la lógica de la aplicación en forma de reglas \if-then". Después de que la plataforma pHPP fue utilizada durante 5 años en el proyecto HeartCycle, 5 desarrolladores fueron reunidos en un grupo de discusión para analizar y evaluar la plataforma. De estas evaluaciones se concluye que la plataforma fue diseñada para encajar las necesidades de los ingenieros que trabajan en la rama, permitiendo la separación de problemas entre las distintas especialidades, y simplificando algunas tareas de desarrollo como el manejo de datos y la interacción asíncrona. A pesar de ello, se encontraron algunos defectos a causa de la inmadurez de algunas tecnologías empleadas, y la ausencia de algunas herramientas específicas para el dominio como el procesado de datos o algunos protocolos de comunicación relacionados con la salud. Dentro del proyecto HeartCycle la plataforma fue utilizada para el desarrollo de la aplicación \Guided Exercise", un sistema TIC para la rehabilitación de pacientes que han sufrido un infarto del miocardio. El sistema fue testeado en un ensayo clínico randomizado en el cual a 55 pacientes se les dio el sistema para su uso por 21 semanas. De los resultados técnicos del ensayo se puede concluir que, a pesar de algunos errores menores prontamente corregidos durante el estudio, la plataforma es estable y fiable. Conclusiones La investigación llevada a cabo en esta Tesis y los resultados obtenidos proporcionan las respuestas a las tres preguntas de investigación que motivaron este trabajo: RQ1 Se ha desarrollado un modelo para representar el dominio de los sistemas personalizados de salud. La evaluación hecha por los expertos de la rama concluye que el modelo representa el dominio con precisión y con un balance apropiado entre abstracción y detalle. RQ2 Se ha desarrollado, con éxito, una plataforma de desarrollo basada en el modelo. RQ3 Se ha demostrado que la plataforma es capaz de ayudar a los desarrolladores en la creación de software pHealth complejos. Las ventajas de la plataforma han sido demostradas en el ámbito de un proyecto de gran escala, aunque el enfoque genérico adoptado indica que la plataforma podría ofrecer beneficios también en otros contextos. Los resultados de estas evaluaciones ofrecen indicios de que, ambos, el modelo y la plataforma serán buenos candidatos para poderse convertir en una referencia para futuros desarrollos de sistemas pHealth. ABSTRACT Background Europe is living in an unsustainable situation. The economic crisis has been reducing governments' economic resources since 2008 and threatening social and health systems, while the proportion of older people in the European population continues to increase so that it is foreseen that in 2050 there will be only two workers per retiree [54]. To this situation it should be added the rise, strongly related to age, of chronic diseases the burden of which has been estimated to be up to the 7% of a country's gross domestic product [51]. There is a need for a paradigm shift, the need for a new way of caring for people's health, shifting the focus from curing conditions that have arisen to a sustainable and effective approach with the emphasis on prevention. Some advocate the adoption of personalised health care (pHealth), a model where medical practices are tailored to the patient's unique life, from the detection of risk factors to the customization of treatments based on each individual's response [81]. Personalised health is often associated to the use of Information and Communications Technology (ICT), that, with its exponential development, offers interesting opportunities for improving healthcare. The shift towards pHealth is slowly taking place, both in research and in industry, but the change is not significant yet. Many barriers still exist related to economy, politics and culture, while others are purely technological, like the lack of interoperable information systems [199]. Though interoperability aspects are evolving, there is still the need of a reference design, especially tackling implementation and large scale deployment of pHealth systems. This thesis contributes to organizing the subject of ICT systems for personalised health into a reference model that allows for the creation of software development platforms to ease common development issues in the domain. Research questions RQ1 Is it possible to define a model, based on software engineering techniques, for representing the personalised health domain in an abstract and representative way? RQ2 Is it possible to build a development platform based on this model? RQ3 Does the development platform help developers create complex integrated pHealth systems? Methods As method for describing the model, the ISO/IEC/IEEE 42010 framework [25] is adopted for its generality and high level of abstraction. The model is specified in different parts: a conceptual model, which makes use of concept maps, for representing stakeholders, artefacts and shared information, and in scenarios and use cases for the representation of the functionalities of pHealth systems. The model was derived from literature analysis, including 7 industrial and scientific reports, 9 electronic standards, 10 conference proceedings papers, 37 journal papers, 25 websites and 5 books. Based on the reference model, requirements were drawn for building the development platform enriched with a set of requirements gathered in a survey run among 11 experienced engineers. For developing the platform, the continuous integration methodology [74] was adopted which allowed to perform automatic tests on a server and also to deploy packaged releases on a web site. As a validation methodology, a theory building framework for SW engineering was adopted from [181]. The framework, chosen as a guide to find evidence for justifying the research questions, imposed the creation of theories based on models and propositions to be validated within a scope. The validation of the model was conducted as an on-line survey in three validation rounds, encompassing a growing number of participants. The survey was submitted to 134 experts of the field and on some public channels like relevant mailing lists and social networks. Its objective was to assess the model's readability, its level of coverage of the domain and its potential usefulness in the design of actual, derived systems. The questionnaires included quantitative Likert scale questions and free text inputs for comments. The development platform was validated in two scopes. As a small-scale experiment, the platform was used in a 12 hours training session where 4 developers had to perform an exercise consisting in developing a set of typical pHealth use cases At the end of the session, a focus group was held to identify benefits and drawbacks of the platform. The second validation was held as a test-case study in a large scale research project called HeartCycle the aim of which was to develop a closed-loop disease management system for heart failure and coronary heart disease patients [160]. During this project three applications were developed by a team of programmers and designers. One of these applications was tested in a clinical trial with actual patients. At the end of the project, the team was interviewed in a focus group to assess the role the platform had within the project. Results For what regards the model that describes the pHealth domain, its conceptual part includes a description of the main roles and concerns of pHealth stakeholders, a model of the ICT artefacts that are commonly adopted and a model representing the typical data that need to be formalized among pHealth systems. The functional model includes a set of 18 scenarios, divided into assisted person's view, caregiver's view, developer's view, technology and services providers' view and authority's view, and a set of 52 Use Cases grouped in 6 categories: assisted person's activities, system reactions, caregiver's activities, user engagement, developer's activities and deployer's activities. For what concerns the validation of the model, a total of 65 people participated in the online survey providing their level of agreement in all the assessed dimensions and a total of 248 comments on how to improve and complete the model. Participants' background spanned from engineering and software development (70%) to medical specialities (15%), with declared interest in the fields of eHealth (24%), mHealth (16%), Ambient Assisted Living (21%), Personalized Medicine (5%), Personal Health Systems (15%), Medical Informatics (10%) and Biomedical Engineering (8%) with an average of 7.25_4.99 years of experience in these fields. From the analysis of the answers it is possible to observe that the contacted experts considered the model easily readable (average of 1.89_0.79 being 1 the most favourable scoring and 5 the worst), sufficiently abstract (1.99_0.88) and formal (2.13_0.77) for its purpose, with a sufficient coverage of the domain (2.26_0.95), useful for describing the domain (2.02_0.7) and for generating more specific systems (2_0.75) and they reported a partial interest in using the model in their job (2.48_0.91). Thanks to their comments, the model was improved and enriched with concepts that were missing at the beginning, nonetheless it was not possible to prove an improvement among the iterations, due to the diversity of the participants in the three rounds. From the model, a development platform for the pHealth domain was generated called pHealth Patient Platform (pHPP). The platform includes a set of libraries, programming and deployment tools, a tutorial and a sample application. The main four modules of the architecture are: the Data Collection Engine, which allows abstracting sources of information like sensors or external services, mapping data to databases and ontologies, and allowing event-based interaction and filtering, the GUI Engine, which abstracts the user interface in a message-like interaction model, the Workow Engine, which allows programming the application's user interaction ows with graphical workows, and the Rule Engine, which gives developers a simple means for programming the application's logic in the form of \if-then" rules. After the 5 years experience of HeartCycle, partially programmed with pHPP, 5 developers were joined in a focus group to discuss the advantages and drawbacks of the platform. The view that emerged from the training course and the focus group was that the platform is well-suited to the needs of the engineers working in the field, it allowed the separation of concerns among the different specialities and it simplified some common development tasks like data management and asynchronous interaction. Nevertheless, some deficiencies were pointed out in terms of a lack of maturity of some technological choices, and for the absence of some domain-specific tools, e.g. for data processing or for health-related communication protocols. Within HeartCycle, the platform was used to develop part of the Guided Exercise system, a composition of ICT tools for the physical rehabilitation of patients who suffered from myocardial infarction. The system developed using the platform was tested in a randomized controlled clinical trial, in which 55 patients used the system for 21 weeks. The technical results of this trial showed that the system was stable and reliable. Some minor bugs were detected, but these were promptly corrected using the platform. This shows that the platform, as well as facilitating the development task, can be successfully used to produce reliable software. Conclusions The research work carried out in developing this thesis provides responses to the three three research questions that were the motivation for the work. RQ1 A model was developed representing the domain of personalised health systems, and the assessment of experts in the field was that it represents the domain accurately, with an appropriate balance between abstraction and detail. RQ2 A development platform based on the model was successfully developed. RQ3 The platform has been shown to assist developers create complex pHealth software. This was demonstrated within the scope of one large-scale project, but the generic approach adopted provides indications that it would offer benefits more widely. The results of these evaluations provide indications that both the model and the platform are good candidates for being a reference for future pHealth developments.

AMELIE: Authoring Multimedia-Enhanced Learning Interactive Environment for e-Health Contents

This paper presents the AMELIE Authoring Tool for e-health applications. AMELIE provides the means for creating video-based contents with a focus on e-learning and telerehabilitation processes. The main core of AMELIE lies in the efficient exploitation of raw multimedia resources, which may be already available at clinical centers or recorded ad hoc for learning purposes by health professionals. Three real use cases scenarios involving different target users are presented: (1) cognitive skills? training of surgeons in minimally invasive surgery (medical professionals), (2) training of informal carers for elderly home assistance and (3) cognitive rehabilitation of patients with acquired brain injury. Preliminary validation in the field of surgery hints at the potential of AMELIE; and its versatility in different medical applications is patent from the use cases described. Regardless, new validation studies are planned in the three main application areas identified in this work.