Android Based Application to Ensure Medical Adherence: CareWise

In this fast-paced world, it is difficult to balance one’s domestic and professional life. Often, we have seen our grandparents forget things that are a part of their routine for like their medication. Many of them need to take their medicines at a fixed time, due to their age they often forget their scheduled medicines which can sometimes have consequences on their health. Therefore, we feel that there is need for an application to help our fellow senior citizens with their medication by the usage of image and a general description. By doing so we feel that this application can act as a helping hand to better monitor their health. This application will have features which will help them sort out medicines based on their name, image and description. A scheduled calendar will help them plan their medicine more efficiently. Reminders ensure that they don’t forget the medications. This application will provide a very easy to use interface that the elderly can easily navigate through without any qualms

Monitoring of medication boxes using wireless sensors

Medication adherence is a real problem among older adults which can lead to serious repercussions on their health and life. Adherence is defined by the World Health Organization as the extent to which the behavior of a person corresponds with recommendations from a health care provider. A low medication adherence to a certain prescription can undermine the treatment benefits in many cases. Moreover, taking wrong medication may lead to unwanted secondary effects, adverse health conditions, and visits to the hospital. This dissertation describes the work focused on the design, development, and research of a solution for monitoring medication boxes using attached sensors. The main contributions of this work include the development of a mobile application, a study on how to classify data from medication box gestures, an implementation of the algorithm that retrieves data from sensor boxes, and an integration of the data classification algorithm into the mobile application. A medication reminder proof-of-concept was developed in the scope of this Master’s project. Sensor data is received by the prototype through a module that integrates the connection and data transference from the sensor boxes via wireless communication. Another module implements metric extraction functions that are applied to the inertial sensor data retrieved from the sensor box. The calculated metrics, herein corresponding to features, are passed to a machine learning algorithm, integrated in the data classification and feature extraction module, for posterior data identification. An in-depth analysis on how to classify inertial data from medication box gestures was conducted during the development of the solution. This in-depth analysis included the creation of two datasets with different characteristics which were preprocessed and fed to several machine learning algorithms. The analysis of the results outputted by the algorithms is included in this document. The dataset collection took place in two different locations, corresponding to a controlled environment and to a non-controlled environment. The obtained results showed that it is possible to identify the gestures in the dataset for the controlled environment, with the best results achieving a true positive rate of 97:9%. The results obtained for the dataset of the non-controlled environment (which was created with target users) showed that there are still many aspects that need to be improved before a final version of the solution is released.Uma baixa adesão à terapêutica é um problema real entre os adultos que pode levar a sérias repercussões nas suas vidas. A adesão à terapêutica é definida pela Organização Mundial de Saúde como a medida em que o comportamento de uma pessoa coincide com as recomendações de um prestador de cuidados de saúde. Uma baixa adesão a uma determinada terapêutica pode comprometer, em muitos casos, os benefícios do tratamento. Além disso, tomar medicação errada pode levar a efeitos secundários não desejados, condições de saúde adversas e visitas a hospitais. Esta dissertação descreve um trabalho focado na concepção, desenvolvimento e investigação de uma solução para a monitorização de caixas de medicação com caixas de sensores a elas acopladas. As principais contribuições deste trabalho incluem o desenvolvimento de uma aplicação móvel, um estudo em como classificar dados de gestos de caixas de medicação, uma implementação do algoritmo que obtém dados das caixas de sensores e a integração do algoritmo de aprendizagem automática na aplicação móvel. Foi desenvolvida uma prova-de-conceito de alarmes de medicação no âmbito deste projecto de Mestrado. Os dados dos sensores são recebidos pelo protótipo através de um módulo que integra a ligação e transferência de dados das caixas de sensores via ligação sem fios. Outro módulo implementa funções de extração de métricas que serão usadas sobre os dados dos sensores inerciais contidos nas caixas de sensores. As métricas calculadas, também chamadas de características, são passadas para um algoritmo de aprendizagem automática, que está integrado no módulo de classificação de dados e extração de características, para posterior identificação de dados. No desenvolvimento da solução, foi feito um estudo aprofundado sobre como classificar dados inerciais de gestos de caixas de medicação. Este estudo incluiu a criação de dois conjuntos de dados com diferentes características que, depois de serem pré-processados, foram submetidos a diferentes algoritmos de aprendizagem automática, sendo os seus resultados analisados neste documento. O processo de coleção de dados foi feito em dois locais distintos, correspondendo a um ambiente controlado e um ambiente não controlado. Os resultados obtidos mostram que é possível identificar os gestos considerados no ambiente controlado, tendo os melhores resultados chegado a 97:9% de taxa de acerto. Os resultados obtidos para o conjunto de dados do ambiente não controlado (que contou com a participação dos utilizadores alvo da aplicação) demonstraram que ainda há aspetos a melhorar antes de produzir uma versão final da solução

Implementation of the IoT-Based Technology on Patient Medication Adherence: A Comprehensive Bibliometric and Systematic Review

The dynamic field of the Internet of Things (IoT) is constantly increasing, providing a plethora of potential integration across various sectors, most notably healthcare. The IoT represents a significant technological leap in healthcare management systems, coinciding with the rising preference for personalized, proactive, cost-effective treatment techniques. This review aimed to thoroughly assess the existing literature through a systematic review and bibliometric analysis, identifying untapped research routes and possible domains for further exploration. The overarching goal was to provide healthcare professionals with significant insights into the impact of IoT technology on Patient Medication Adherence (PMA) and related outcomes. An extensive review of 314 scientific articles on the deployment of IoT within pharmaceutical care services revealed a rising trend in publication volume, with a significant increase in recent years. Pertinently, from the 33 publications finally selected, substantial data support the potential of the IoT to improve PMA, particularly among senior patients with chronic conditions. This paper also comments on various regularly implemented IoT-based systems, noting their unique benefits and limitations. In conclusion, the critical relevance of PMA is highlighted, arguing for its emphasis in future discussions. Furthermore, the need for additional research endeavors is proposed to face and overcome existing constraints and establish the long-term effectiveness of IoT technologies in maximizing patient outcomes

Using a mobile pill reminder to support medication compliance in South Africa

This project investigated how to develop a mobile intervention to support medication compliance for patients with chronic and acute diseases. Chronic diseases cannot be cured but can be controlled, usually by taking medication every-day. Therefore, it is very crucial for a patient with a chronic disease to take their medication on time to prevent complications or negative impact on their health. Due to the widespread use of mobile phones, having an automated mobile mechanism to remind patients to take medication is regarded as an effective way of supporting medication compliance. The focus of the research was on investigating how mobile health applications can be used to support patients with chronic and acute diseases in South Africa. Literature identified that medication compliance is low and that a need exists for an intervention to increase compliance. The main goal of this research was to produce a mobile health application to assist medication compliance and support patients with chronic and acute diseases in South Africa and investigate its perceived usefulness. The project made use of two field studies to substantiate its results. The first field study involved patients with chronic diseases and the second one involved patients with acute diseases. The feedback from the first field study and from a literature review was used to redesign the mobile application. The project also investigated the attitude of patients taking medication over a short period of time as well as how such patients compared with those taking chronic medication. The project identified the benefits and disadvantages of using an m-health application to support medication compliance based on the participants’ feedback and behaviour observed in using the application

Adherence to polypharmacy from a pharmaceutical care perspective : evalution of an electronic medication dispenser and of tailored adherence interventions in primary care

Modern medicine offers a multitude of evidence-based treatments for many chronic diseases. Polypharmacy, the prescription of multiple medications to treat one or more conditions in the same patient, has become increasingly common. Non-adherence to medication may be the principal reason for gaps between efficacy and effectiveness of treatments. Medication adherence is not a stable personality trait but a complex behavior influenced by discrete factors. Pharmacists as suppliers of medications with frequent patient contact are in a unique position to interview patients about barriers to treatment and to offer individual support to enhance their adherence. The management of polypharmacy and medication adherence represent important aspects of pharmaceutical care (PhC). Interventions to improve adherence are diverse, often complex, and show inconsistent results. Research about interventions addressing barriers associated with polypharmacy is scarce. Medication management aids (MMA) are widely used tools to overcome challenges with complex regimens. Apart from the visual cue to take their medication, more advanced electronic MMAs (e-MMAs) may offer more explicit reminders, such as visual or audible alerts. Electronic monitoring can be used to provide customized feedback. Various e-MMAs for polypharmacy exist, but only few studies using these devices have been published. The goal of this thesis was to investigate adherence to polypharmacy from a pharmaceutical care perspective. PROJECT A aimed to review existing definitions of PhC and to describe the process of developing a redefined definition. A literature search identified 19 definitions that were paraphrased using a standardized syntax. Twenty-four experts defined PhC during a moderated workshop as “the pharmacist’s contribution to the care of individuals in order to optimize medicines use and improve health outcomes.” PROJECT B aimed to analyze the prescription patterns of split tablets in general and of quetiapine in particular. Out of 4,784,999 tablets that were repacked in 2012 in unit-of-use pouch blisters for 1,321 patients residing in 53 retirement homes in northwestern Switzerland, 8.5% were fragmented. The patients were on average 81.5 years old and obtained 1.7 fragments. A total of 43.7% of patients received two or more fragments. The fragments concerned 132 different active substances, and 50% of them were psycholeptics or psychoanaleptics. Prescription of half quetiapine tablets appeared to be constricted to the region of Basel. For PROJECT C, we investigated an e-MMA for pharmacy-filled blister pouches. PROJECT C1 aimed to collect opinions on MMAs in general and on the abovementioned e-MMA in particular. Six participants completed the 14-day trial and participated in a focus group. Participants rated ten of 17 general attributes as clearly applicable to the e-MMA and five as unsuitable. Attributes pertained to three interrelated themes: product design, patient support, and living conditions. Envisaged target groups were patients with time-sensitive medication regimens, patients with dementia, the visually impaired, and several patients living together to prevent accidental intake of the wrong medication. In PROJECTS C2 – C5, we evaluated the e-MMA in older patients with opioid-assisted treatment (OAT), who often suffer from chronic diseases and disability in addition to their opioid dependence. As a result, they often need to deal with polypharmacy and complex regimens and are at high risk for medication non-adherence. PROJECT C2 confirmed the increasing age and use of polypharmacy for opioid-dependent patients from an Outpatient Addiction Service (OAS) in Basel, Switzerland. In PROJECT C3, we report the first long-term experiences with a novel supply model with the e-MMA for two opioid-dependent patients with HIV. During the entire observation period of 1.7 and 2.6 years, respectively, both patients retrieved over 90% of the pouches within 75 minutes of the scheduled time. Viral loads fell below detection limits during the entire observation period. PROJECT C4 aimed to evaluate for the first time a quantitative and qualitative (mixed-method) single-case study design to investigate the use of the e-MMA in other patients on OAT with polypharmacy. Five patients from the OAS participated in a sequential multiple-baseline single subject study. Between November 2014 and August 2015, 3 women and 2 men (mean age 48 years), taking in addition to OAT a median of 7 medications during 3 dosing times per day were included in the study. An intervention phase with intake reminder was implemented for two participants. For both patients completing the intervention phase, taking adherence increased by more than 25% and no missed doses were observed when audible and visual reminders were introduced. Participants generally accepted the e-MMA, especially for the security of having enough medication at home, the possibility to pre-dispense pocket-doses, and the assurance of regular intakes. Finally, in PROJECT C5, we estimated yearly cost-of-illness (COI) of 109‘611 Swiss Francs (SFr) per patient for patients receiving OAT and polypharmacy, with direct costs accounting for 30% of the total costs. With the novel supply model, total yearly costs per patient increased by SFr 2’509 for repackaging of medication, leasing of the e-MMA, and time spent for travel, refill, and support. Sensitivity analysis showed that the results were robust and overall costs did not substantially change with various estimations. Despite much research, interventions aimed at improving medication adherence report disappointing and inconsistent results. We aimed to assess congruence between patient characteristics and adherence interventions in PROJECT D. In PROJECT D1, we extracted 42 determinants of non-adherence (26 modifiable and 16 unmodifiable) and 103 interventions from published literature, match the modifiable determinants to interventions like locks and keys, and categorized them into 11 domains. In Project D2, we applied the results from Project D1 to a Cochrane database with 190 randomized controlled trials on adherence-enhancing interventions. We correlated a congruence score consisting of 6 features related to inclusion criteria, patient characteristics at baseline, and intervention design with intervention effects regarding adherence and clinical outcomes. The inclusion of non-adherent patients was the single feature significantly associated with effective adherence interventions. However, neither the overall congruence score, nor any other individual feature were significantly associated with intervention effects. Conclusions: - It was possible to paraphrase definitions of PhC using a standardized syntax focusing on the provider, recipient, subject, outcomes, and activities of PhC practice. During a one-day workshop, experts in PhC research agreed on a definition, intended to be applicable for the present time, representative for various work settings, and valid for countries in- and outside of Europe. - Tablet splitting is a pharmaceutical care issue with potential consequences on adherence, which plays a major role in dosage adjustments for geriatric patients and is sometimes prescribed against the recommendations from the manufacturer. - The appearance of MMAs, but also its functionality and the whole medication supply process play an important role with regards to the design and targeting of MMAs. Patients’ living conditions like mobility remain the key determinants for their acceptance of the e-MMA. - The increase in the number of substances and medications for older drug users might lead to an increased risk for drug-drug interactions, adverse events, and non-adherence. Alternative supply models to assist patients with their medication management and to support medication adherence are needed in particular for older patients with OAT and polypharmacy. - A novel supply model with an e-MMA may be feasible to simultaneously monitor and improve implementation of dosing regimens for opioid-dependent patients with polypharmacy. - The use of a mixed-method single-subject design showed promising results for the evaluation of an e-MMA for polypharmacy. Our pilot study showed that the e-MMA may ensure correct implementation of dosing regimens for opioid-substituted patients with polypharmacy when certain prerequisites are considered. Overall, the flexibility of single-subject research designs offers considerable advantages for the evaluation of adherence interventions. - Cost-of-illness for older patients with OAT and polypharmacy is high, especially when considering indirect costs, such as productivity loss due to disability. According to our cost comparison model, the novel electronic medication supply model increases overall costs marginally, but might offset the costs of more expensive alternatives such as nursing homes. - In published trials on medication adherence, the congruence between interventions and determinants can be assessed with matching interventions to determinants. To be successful, interventions in medication adherence should target current modifiable patient determinants and be tailored to the unmodifiable patient determinants. - A 6-item score to assess congruence between patient characteristics and adherence interventions was not significantly associated with intervention effects in 190 RCTs included in a Cochrane review. The presence of only six studies that included non-adherent patients and the inter-dependency of this item with the remaining five precluded a conclusive assessment of congruence between patient characteristics and adherence interventions. Future research about the e-MMA should aim at: - developing and implementing robust care models for older patients with polypharmacy and opioid-assisted therapy. - evaluating the effectiveness of the e-MMA in terms of clinical, humanistic and economic outcomes. - evaluating the long-term benefits and cost-effectiveness of the novel supply model. Future research to improve adherence to polypharmacy should aim at: - providing guidelines for the appropriate design and analyses of single-subject trials in adherence research, including recommendations for statistical analysis. - developing instruments to reliably assess modifiable and unmodifiable determinants of non-adherence and to select appropriate interventions in research and practice

Using a mobile pill reminder to support medication compliance in South Africa

This project investigated how to develop a mobile intervention to support medication compliance for patients with chronic and acute diseases. Chronic diseases cannot be cured but can be controlled, usually by taking medication every-day. Therefore, it is very crucial for a patient with a chronic disease to take their medication on time to prevent complications or negative impact on their health. Due to the widespread use of mobile phones, having an automated mobile mechanism to remind patients to take medication is regarded as an effective way of supporting medication compliance. The focus of the research was on investigating how mobile health applications can be used to support patients with chronic and acute diseases in South Africa. Literature identified that medication compliance is low and that a need exists for an intervention to increase compliance. The main goal of this research was to produce a mobile health application to assist medication compliance and support patients with chronic and acute diseases in South Africa and investigate its perceived usefulness. The project made use of two field studies to substantiate its results. The first field study involved patients with chronic diseases and the second one involved patients with acute diseases. The feedback from the first field study and from a literature review was used to redesign the mobile application. The project also investigated the attitude of patients taking medication over a short period of time as well as how such patients compared with those taking chronic medication. The project identified the benefits and disadvantages of using an m-health application to support medication compliance based on the participants’ feedback and behaviour observed in using the application

NoMoDEI : A framework for Norm Monitoring on Dynamic Electronic Institutions

With the growth of the Internet, computational systems have become more and more complex, often including complicate interconnected networks of autonomous components. The need to bring some organisational structure into autonomous systems becomes urgent, as this allows regulating the behaviour of the different autonomous components to ensure their objectives are aligned with the holistic objectives of the system. Normative Systems are one of the mechanisms that can be applied to define and enforce acceptable behaviour within distributed electronic systems which should comply with some (human) regulations. One of the requirements to effectively implement Normative Systems is to be able to assess, at runtime, the state of the normative environment. Existing lines of research have already tried to tackle this issue on some simple scenarios. However, more complex scenarios may appear, for instance, scenarios where the normative context is not static, but it expands and contracts as new norms are added to the institution and removed from it respectively. As in human legal systems, it is easy to foresee that some of these electronic normative environments will not be static. They should be able to evolve through time as regulations change, effectively adapting to new situations and behaviours. Under these conditions, a monitoring system must be able to continue computing the state of the normative environment at runtime, as often we can not afford to perform the changes on the normative context off-line. Furthermore, it must be guaranteed the monitoring system can keep producing states of the normative environment that are consistent with the changes performed on the normative context. For instance, if a norm has been removed from the normative context, it does not make sense anymore to compute normative states where the norm has been violated. In this thesis we present NoMoDEI, a normative monitoring framework for dynamic Electronic Institutions. We formalize and develop an extended normative framework and architecture to cope with scenarios where the normative context is dynamic, therefore norms can be added, removed and updated. The operations are to be performed at run-time, without having to stop computing the normative state. The normative states computed are consistent with the expansion and contraction operations. NoMoDEI is introduced in three steps. First, we formally define the operations to be supported in order to allow for expanding and contracting the normative context. Then, we instantiate the formal operations, providing implementation details. Finally, we demonstrate our framework by applying it to two use cases: E-health systems and waste-water management on a river basin.Amb l'expansió d'Internet els sistemes computacionals han esdevingut més complexos, sovint incorporant complicades xarxes interconnectades de components autònoms. Es per això que la necessitat d'incorporar estructures organitzacionals en el sistemes autònoms s 'accentua, donat que aquestes estructures permeten regular el comportament dels diferents components autònoms, tot assegurant que els seus objectius es troben alineats amb els objectius generals del sistema. Els Sistemes Normatius (i.e. Normative Systems) són un dels mecanismes que podem aplicar per definir i imposar patrons acceptables de comportament dintre de sistemes electrònics distribuïts. Això esdevé especialment important quan el sistema es troba regimentat per regulacions (normalment humanes). Un dels requeriments per implementar Sistemes Normatius és ser capaços de determinar, en temps d'execució, l'estat de l'entorn normatiu. Existeixen línies de recerca que ja han tractat aquest problema en alguns escenaris simples. El món real però ens ofereix escenaris més complexes, com per exemple, escenaris on el context normatiu no és estàtic, si no que s'expandeix i contrau a mesura que noves normes són afegides o eliminades de la institució. Tal com passa als sistemes legals humans, és fàcil preveure que alguns contextos normatius electrònics no seran estàtics. Aquests contextos haurien de ser capaços d'evolucionar a través del temps a mesura que les regulacions canvien, adaptant-se a noves situacions i comportaments. Sota aquestes condicions, un sistema de monitorització ha de ser capaç de continuar calculant l'estat de l'entorn normatiu en temps d'execució, ja que sovint no ens podem permetre realitzar els canvis a l'entorn normatiu aturant el procés de monitorització. És més s'ha de garantir que el sistema de monitorització sigui capaç de continuar produint es tats de l’entorn normatiu de forma consistent amb els canvis realitzats. Per exemple, el fet d'eliminar una norma fa que no tingui gaire sentit continuar calculant es tats normatius on aquesta norma ha es tat violada. A aquesta Tesi presentem NoMoDEI, una infraestructura de monitorització normativa per institucions electròniques dinàmiques. Formalitzem i desenvolupem una infraestructura de monitorització normativa estesa capaç d'operar en escenaris on el context normatiu es dinàmic. Es a dir, diverses normes poden ser introduïdes, eliminades o actualitzades del context normatiu en qualsevol moment. Aquestes operacions s'han de poder realitzar en temps d'execució, es a dir, sense deixar de calcular l'estat normatiu. Es més, els estats normatius calculats han de ser consistents amb les respectives operacions d'extensió o contracció del context. Durant la Tesi presentem NoMoDEI en tres passos. Primer proporcionem una definició formal de les operacions que la infraestructura ha de suportar per permetre expandir i contraure el context normatiu. A continuació instanciem aquestes operacions proporcionant detalls d'implementació. Finalment demostrem que la nostra infraestructura pot ser aplicada a casos d'ús del món real introduint dos casos: sistemes de salut electrònics (i.e. E-health) i sistemes de tractament d’aigües residuals a la conca d’un riuPostprint (published version

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

NoMoDEI : A framework for Norm Monitoring on Dynamic Electronic Institutions

With the growth of the Internet, computational systems have become more and more complex, often including complicate interconnected networks of autonomous components. The need to bring some organisational structure into autonomous systems becomes urgent, as this allows regulating the behaviour of the different autonomous components to ensure their objectives are aligned with the holistic objectives of the system. Normative Systems are one of the mechanisms that can be applied to define and enforce acceptable behaviour within distributed electronic systems which should comply with some (human) regulations. One of the requirements to effectively implement Normative Systems is to be able to assess, at runtime, the state of the normative environment. Existing lines of research have already tried to tackle this issue on some simple scenarios. However, more complex scenarios may appear, for instance, scenarios where the normative context is not static, but it expands and contracts as new norms are added to the institution and removed from it respectively. As in human legal systems, it is easy to foresee that some of these electronic normative environments will not be static. They should be able to evolve through time as regulations change, effectively adapting to new situations and behaviours. Under these conditions, a monitoring system must be able to continue computing the state of the normative environment at runtime, as often we can not afford to perform the changes on the normative context off-line. Furthermore, it must be guaranteed the monitoring system can keep producing states of the normative environment that are consistent with the changes performed on the normative context. For instance, if a norm has been removed from the normative context, it does not make sense anymore to compute normative states where the norm has been violated. In this thesis we present NoMoDEI, a normative monitoring framework for dynamic Electronic Institutions. We formalize and develop an extended normative framework and architecture to cope with scenarios where the normative context is dynamic, therefore norms can be added, removed and updated. The operations are to be performed at run-time, without having to stop computing the normative state. The normative states computed are consistent with the expansion and contraction operations. NoMoDEI is introduced in three steps. First, we formally define the operations to be supported in order to allow for expanding and contracting the normative context. Then, we instantiate the formal operations, providing implementation details. Finally, we demonstrate our framework by applying it to two use cases: E-health systems and waste-water management on a river basin.Amb l'expansió d'Internet els sistemes computacionals han esdevingut més complexos, sovint incorporant complicades xarxes interconnectades de components autònoms. Es per això que la necessitat d'incorporar estructures organitzacionals en el sistemes autònoms s 'accentua, donat que aquestes estructures permeten regular el comportament dels diferents components autònoms, tot assegurant que els seus objectius es troben alineats amb els objectius generals del sistema. Els Sistemes Normatius (i.e. Normative Systems) són un dels mecanismes que podem aplicar per definir i imposar patrons acceptables de comportament dintre de sistemes electrònics distribuïts. Això esdevé especialment important quan el sistema es troba regimentat per regulacions (normalment humanes). Un dels requeriments per implementar Sistemes Normatius és ser capaços de determinar, en temps d'execució, l'estat de l'entorn normatiu. Existeixen línies de recerca que ja han tractat aquest problema en alguns escenaris simples. El món real però ens ofereix escenaris més complexes, com per exemple, escenaris on el context normatiu no és estàtic, si no que s'expandeix i contrau a mesura que noves normes són afegides o eliminades de la institució. Tal com passa als sistemes legals humans, és fàcil preveure que alguns contextos normatius electrònics no seran estàtics. Aquests contextos haurien de ser capaços d'evolucionar a través del temps a mesura que les regulacions canvien, adaptant-se a noves situacions i comportaments. Sota aquestes condicions, un sistema de monitorització ha de ser capaç de continuar calculant l'estat de l'entorn normatiu en temps d'execució, ja que sovint no ens podem permetre realitzar els canvis a l'entorn normatiu aturant el procés de monitorització. És més s'ha de garantir que el sistema de monitorització sigui capaç de continuar produint es tats de l’entorn normatiu de forma consistent amb els canvis realitzats. Per exemple, el fet d'eliminar una norma fa que no tingui gaire sentit continuar calculant es tats normatius on aquesta norma ha es tat violada. A aquesta Tesi presentem NoMoDEI, una infraestructura de monitorització normativa per institucions electròniques dinàmiques. Formalitzem i desenvolupem una infraestructura de monitorització normativa estesa capaç d'operar en escenaris on el context normatiu es dinàmic. Es a dir, diverses normes poden ser introduïdes, eliminades o actualitzades del context normatiu en qualsevol moment. Aquestes operacions s'han de poder realitzar en temps d'execució, es a dir, sense deixar de calcular l'estat normatiu. Es més, els estats normatius calculats han de ser consistents amb les respectives operacions d'extensió o contracció del context. Durant la Tesi presentem NoMoDEI en tres passos. Primer proporcionem una definició formal de les operacions que la infraestructura ha de suportar per permetre expandir i contraure el context normatiu. A continuació instanciem aquestes operacions proporcionant detalls d'implementació. Finalment demostrem que la nostra infraestructura pot ser aplicada a casos d'ús del món real introduint dos casos: sistemes de salut electrònics (i.e. E-health) i sistemes de tractament d’aigües residuals a la conca d’un ri