The effects of a video intervention on posthospitalization pulmonary rehabilitation uptake

Rationale: Pulmonary rehabilitation (PR) after hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life and reduces readmissions. However, posthospitalization PR uptake is low. To date, no trials of interventions to increase uptake have been conducted.Objectives: To study the effect of a codesigned education video as an adjunct to usual care on posthospitalization PR uptake.Methods: The present study was an assessor- and statistician-blinded randomized controlled trial with nested, qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including PR information leaflet) or usual care plus the codesigned education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, FEV1 % predicted, frailty, transport availability, and previous PR experience.Measurements and Main Results: The primary outcome was PR uptake within 28 days of hospital discharge. A total of 200 patients were recruited, and 196 were randomized (51% female, median FEV1% predicted, 36 [interquartile range, 27-48]). PR uptake was 41% and 34% in the usual care and intervention groups, respectively (P = 0.37), with no differences in secondary (PR referral and completion) or safety (readmissions and death) endpoints. A total of 6 of the 15 participants interviewed could not recall receiving the video.Conclusions: A codesigned education video delivered at hospital discharge did not improve posthospitalization PR uptake, referral, or completion

Radio network management in cognitive LTE-Femtocell Systems

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London.There is a strong uptake of femtocell deployment as small cell application platforms in the upcoming LTE networks. In such two-tier networks of LTEfemtocell base stations, a large portion of the assigned spectrum is used sporadically leading to underutilisation of valuable frequency resources. Novel spectrum access techniques are necessary to solve these current spectrum inefficiency problems. Therefore, spectrum management solutions should have the features to improve spectrum access in both temporal and spatial manner. Cognitive Radio (CR) with the Dynamic Spectrum Access (DSA) is considered to be the key technology in this research in order to increase the spectrum efficiency. This is an effective solution to allow a group of Secondary Users (SUs) to share the radio spectrum initially allocated to the Primary User (PUs) at no interference. The core aim of this thesis is to develop new cognitive LTE-femtocell systems that offer a 4G vision, to facilitate the radio network management in order to increase the network capacity and further improve spectrum access probabilities. In this thesis, a new spectrum management model for cognitive radio networks is considered to enable a seamless integration of multi-access technology with existing networks. This involves the design of efficient resource allocation algorithms that are able to respond to the rapid changes in the dynamic wireless environment and primary users activities. Throughout this thesis a variety of network upgraded functions are developed using application simulation scenarios. Therefore, the proposed algorithms, mechanisms, methods, and system models are not restricted in the considered networks, but rather have a wider applicability to be used in other technologies. This thesis mainly investigates three aspects of research issues relating to the efficient management of cognitive networks: First, novel spectrum resource management modules are proposed to maximise the spectrum access by rapidly detecting the available transmission opportunities. Secondly, a developed pilot power controlling algorithm is introduced to minimise the power consumption by considering mobile position and application requirements. Also, there is investigation on the impact of deploying different numbers of femtocell base stations in LTE domain to identify the optimum cell size for future networks. Finally, a novel call admission control mechanism for mobility management is proposed to support seamless handover between LTE and femtocell domains. This is performed by assigning high speed mobile users to the LTE system to avoid unnecessary handovers. The proposed solutions were examined by simulation and numerical analysis to show the strength of cognitive femtocell deployment for the required applications. The results show that the new system design based on cognitive radio configuration enable an efficient resource management in terms of spectrum allocation, adaptive pilot power control, and mobile handover. The proposed framework and algorithms offer a novel spectrum management for self organised LTE-femtocell architecture. Eventually, this research shows that certain architectures fulfilling spectrum management requirements are implementable in practice and display good performance in dynamic wireless environments which recommends the consideration of CR systems in LTE and femtocell networks

Effect of a novel transition program on disability after stroke: A trial protocol

Importance: A gap in care for stroke survivors exists at the point of transition from inpatient rehabilitation to home, when survivors encounter new environmental barriers because of the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have the potential to significantly improve stroke survivors\u27 long-term morbidity. Objective: To investigate the efficacy and safety of a novel enhanced rehabilitation transition program to reduce environmental barriers and improve daily activity performance and community participation among stroke survivors. Design, Setting, and Participants: This is a phase 2b, single-blind, parallel-group, randomized clinical trial. Participants will be randomized using a 1:1 allocation ratio, stratified by Functional Independence Measure and age, to either attentional control or the intervention. Community Participation Transition After Stroke (COMPASS) is a complex intervention that uses 2 complementary evidence-based interventions: home modifications and strategy training delivered in the home. Community participation after stroke, measured by the Reintegration to Normal Living Index, is the primary outcome. Secondary outcomes include quality of life after stroke, measured by the Stroke Impact Scale, and daily activity performance and magnitude of environmental barriers in the home, both measured by the In-Home Occupational Performance Evaluation. An intention-to-treat analysis will be used. A total of 180 participants, who are 50 years or older, were independent in activities of daily living prior to stroke, and are undergoing inpatient rehabilitation following stroke with a plan to be discharged home, will be included in the study. Discussion: Stroke is a leading cause of serious long-term disability in the United States. The COMPASS study is ongoing. To date, 99 participants have been recruited and 77 randomized, with 37 in the treatment group and 40 in the control group. Resumption of previous activities immediately after discharge can improve immediate and long-term community participation. Results from this study will fill a critical gap in stroke rehabilitation evidence by providing important information about the long-term community participation and daily activity performance among stroke survivors as well as environmental barriers in their homes. Trial Registration: ClinicalTrials.gov identifier: NCT03485820

Interference Aware Cognitive Femtocell Networks

Femtocells Access Points (FAP) are low power, plug and play home base stations which are designed to extend the cellular radio range in indoor environments where macrocell coverage is generally poor. They offer significant increases in data rates over a short range, enabling high speed wireless and mobile broadband services, with the femtocell network overlaid onto the macrocell in a dual-tier arrangement. In contrast to conventional cellular systems which are well planned, FAP are arbitrarily installed by the end users and this can create harmful interference to both collocated femtocell and macrocell users. The interference becomes particularly serious in high FAP density scenarios and compromises the ensuing data rate. Consequently, effective management of both cross and co-tier interference is a major design challenge in dual-tier networks. Since traditional radio resource management techniques and architectures for single-tier systems are either not applicable or operate inefficiently, innovative dual-tier approaches to intelligently manage interference are required. This thesis presents a number of original contributions to fulfill this objective including, a new hybrid cross-tier spectrum sharing model which builds upon an existing fractional frequency reuse technique to ensure minimal impact on the macro-tier resource allocation. A new flexible and adaptive virtual clustering framework is then formulated to alleviate co-tier interference in high FAP densities situations and finally, an intelligent coverage extension algorithm is developed to mitigate excessive femto-macrocell handovers, while upholding the required quality of service provision. This thesis contends that to exploit the undoubted potential of dual-tier, macro-femtocell architectures an interference awareness solution is necessary. Rigorous evidence confirms that noteworthy performance improvements can be achieved in the quality of the received signal and throughput by applying cognitive methods to manage interference

A Review on Provisioning Quality of Service of Wireless Telemedicine for E-Health Services

In general, on-line medical consultation reduces time required for medical consultation induces improvement in the quality and efficiency of healthcare services. All major types of current e-health applications such as ECG, X-ray, video, diagnosis images and other common applications have been included in the scope of the study. In addition, the provision of Quality of Service (QoS) for the application of specific healthcare services in e-health, the scheme of priority for e-health services and the support of QoS in wireless networks and techniques or methods for IEEE 802.11 to guarantee the provision of QoS has also been assessed. In e-health, medical services in remote locations such as rural healthcare centers, ambulances, ships as well as home healthcare services can be supported through the applications of e-health services such as medical databases, electronic health records and the routing of text, audio, video and images. Given this, an adaptive resource allocation for a wireless network with multiple service types and multiple priorities have been proposed. For the provision of an acceptable QoS level to users of e-health services, prioritization is an important criterion in a multi-traffic network. The requirement for QoS provisioning in wireless broadband medical networks have paved the pathway for bandwidth requirements and the real-time or live transmission of medical applications. From the study, good performance of the proposed scheme has been validated by the results obtained. The proposed wireless network is capable of handling medical applications for both normal and life-threatening conditions as characterized by the level of emergencies. In addition, the bandwidth allocation and admission control algorithm for IEEE 802.16- based design specifically for wireless telemedicine/e-health services have also been presented in the study. It has been concluded that under busy traffic conditions, the proposed architecture can used as a feasible and reliable infrastructure network for telemedicine

Provisioning Quality of Service of Wireless Telemedicine for E-Health Services: A Review

In general, on-line medical consultation reduces time required for medical consultation and induces improvement in the quality and efficiency of healthcare services. The scope of study includes several key features of present day e-health applications such as X-ray, ECG, video, diagnosis images and other common applications. Moreover, the provision of Quality of Service (QoS) in terms of specific medical care services in e-health, the priority set for e-health services and the support of QoS in wireless networks and techniques or methods aimed at IEEE 802.11 to secure the provision of QoS has been assessed as well. In e-health, medical services in remote places which include rustic healthcare centres, ships, ambulances and home healthcare services can be supported through the applications of e-health services such as medical databases, electronic health data and the transferring of text, video, sound and images. Given this, a proposal has been made for a multiple service wireless networking with multiple sets of priorities. In relation to the terms of an acceptable QoS level by the customers of e-health services, prioritization is an important criterion in a multi-traffic network. The requirement for QoS in medical networking of wireless broadband has paved the way for bandwidth prerequisites and the live transmission or real-time medical applications. The proposed wireless network is capable of handling medical applications for both normal and life-threatening conditions as characterized by the level of emergencies. In addition, the allocation of bandwidth and the system that controls admittance designed based on IEEE 802.16 especially for e-health services or wireless telemedicine will be discussed in this study. It has been concluded that under busy traffic conditions, the proposed architecture can used as a feasible and reliable infrastructure network for telemedicine