Affective Medicine: a review of Affective Computing efforts in Medical Informatics

Background: Affective computing (AC) is concerned with emotional interactions performed with and through computers. It is defined as “computing that relates to, arises from, or deliberately influences emotions”. AC enables investigation and understanding of the relation between human emotions and health as well as application of assistive and useful technologies in the medical domain. Objectives: 1) To review the general state of the art in AC and its applications in medicine, and 2) to establish synergies between the research communities of AC and medical informatics. Methods: Aspects related to the human affective state as a determinant of the human health are discussed, coupled with an illustration of significant AC research and related literature output. Moreover, affective communication channels are described and their range of application fields is explored through illustrative examples. Results: The presented conferences, European research projects and research publications illustrate the recent increase of interest in the AC area by the medical community. Tele-home healthcare, AmI, ubiquitous monitoring, e-learning and virtual communities with emotionally expressive characters for elderly or impaired people are few areas where the potential of AC has been realized and applications have emerged. Conclusions: A number of gaps can potentially be overcome through the synergy of AC and medical informatics. The application of AC technologies parallels the advancement of the existing state of the art and the introduction of new methods. The amount of work and projects reviewed in this paper witness an ambitious and optimistic synergetic future of the affective medicine field

Internet of Things-aided Smart Grid: Technologies, Architectures, Applications, Prototypes, and Future Research Directions

Traditional power grids are being transformed into Smart Grids (SGs) to address the issues in existing power system due to uni-directional information flow, energy wastage, growing energy demand, reliability and security. SGs offer bi-directional energy flow between service providers and consumers, involving power generation, transmission, distribution and utilization systems. SGs employ various devices for the monitoring, analysis and control of the grid, deployed at power plants, distribution centers and in consumers' premises in a very large number. Hence, an SG requires connectivity, automation and the tracking of such devices. This is achieved with the help of Internet of Things (IoT). IoT helps SG systems to support various network functions throughout the generation, transmission, distribution and consumption of energy by incorporating IoT devices (such as sensors, actuators and smart meters), as well as by providing the connectivity, automation and tracking for such devices. In this paper, we provide a comprehensive survey on IoT-aided SG systems, which includes the existing architectures, applications and prototypes of IoT-aided SG systems. This survey also highlights the open issues, challenges and future research directions for IoT-aided SG systems

Clinical significance of time to positivity for yeast in candidemia

PurposeCandidemia is an important issue of nosocomial bloodstream infections, and is associated with a high mortality rate. However, little information is available before final species identification, which takes days after the episode of candidemia. This study tried to determine whether time to positivity (TTP) for yeast helps in predicting the species of candidemia.MethodsA retrospective cohort study was conducted in Taiwan, which included 434 episodes of nonduplicated candidemia during the period between 2006 and 2009. The demographic features, clinical characteristics, TTP for yeast, and acute illness scores were included for analysis.ResultsThe mean age of patients with candidemia was 70.4 ± 15.2 years, and the 30-day crude mortality rate was 48.2%. Forty-five percent of patients suffered from shock status with a mean Acute Physiological and Chronic Health Evaluation II score of 27.0 ± 8.7 and a mean Sequential Organ Failure Assessment score of 9.7 ± 4.5, whereas 50% were admitted to the intensive care units. Candida albicans was still the most commonly identified pathogen (58.1%), followed by C. tropicalis (14.7%), C. parapsilosis (13.1%), and C. glabrata (8.3%). Results of multivariate logistic regression showed that TTP for yeast within 48 hours would more favor C. tropicalis (p = 0.044), and less favor C. glabrata (p = 0.025) and C. parapsilosis (p < 0.001). Patients with parenteral nutrition usage were more frequently associated with a TTP for yeast within 48 hours, whereas those with previous exposure to an antifungal agent had a longer TTP for yeast.ConclusionThe TTP for yeast might provide a hint of the responsible Candida species before final identification among critical patients with candidemia. The association between antifungal agents and TTP would need more evidence for elucidation

Distributed Computing and Monitoring Technologies for Older Patients

This book summarizes various approaches for the automatic detection of health threats to older patients at home living alone. The text begins by briefly describing those who would most benefit from healthcare supervision. The book then summarizes possible scenarios for monitoring an older patient at home, deriving the common functional requirements for monitoring technology. Next, the work identifies the state of the art of technological monitoring approaches that are practically applicable to geriatric patients. A survey is presented on a range of such interdisciplinary fields as smart homes, telemonitoring, ambient intelligence, ambient assisted living, gerontechnology, and aging-in-place technology. The book discusses relevant experimental studies, highlighting the application of sensor fusion, signal processing and machine learning techniques. Finally, the text discusses future challenges, offering a number of suggestions for further research directions

Smart Grid Communications: Overview of Research Challenges, Solutions, and Standardization Activities

Optimization of energy consumption in future intelligent energy networks (or Smart Grids) will be based on grid-integrated near-real-time communications between various grid elements in generation, transmission, distribution and loads. This paper discusses some of the challenges and opportunities of communications research in the areas of smart grid and smart metering. In particular, we focus on some of the key communications challenges for realizing interoperable and future-proof smart grid/metering networks, smart grid security and privacy, and how some of the existing networking technologies can be applied to energy management. Finally, we also discuss the coordinated standardization efforts in Europe to harmonize communications standards and protocols.Comment: To be published in IEEE Communications Surveys and Tutorial

Acute myocardial infarction : early diagnosis and the prognostic value of ECG and echocardiography

Introduction Acute myocardial infarction (AMI) is a main cause of death. Despite vast improvements in management and treatment strategies over the past decades, morbidity and mortality after an AMI remains high. For patients with AMI and ST-segment elevations (STEMI), urgent management has been shown to be associated with reductions in both morbidity and mortality. Various pre-hospital management strategies have been implemented, during which STEMI patients can be referred directly to the catheterization laboratory instead of first being assessed in the emergency department. Valuable minutes can thus be saved. However, it is important that the diagnosis is correct which can be more challenging in a setting where the referring cardiologist is not at the same location as the patient and the clinical setting therefore needs to be reported by the paramedic staff. Studies on the accuracy of pre-hospital STEMI diagnoses are limited. In order to expedite management for STEMI patients, international guidelines have included benchmark time targets. Little is known regarding gender differences in the achievement of these time targets, and the feasibility of obtaining a pre-hospital ECG within ten minutes of ambulance arrival has been questioned. For patients who survive an AMI, there is a risk of transient or permanent damage to the left ventricle. Such damage can be quantified by echocardiography. It is shown that patients with a reduced left ventricular ejection fraction (LVEF) have a higher risk of sudden cardiac death than patients with normal LVEF. For patients with reduced LVEF despite optimal medical treatment, an implantable cardioverter defibrillator (ICD) can reduce mortality. This benefit is not seen until after several months have passed since the AMI. This is further complicated by the fact that the risk of death is highest in the early days, weeks and months after an AMI. Therefore, finding predictors in the early phase after an AMI, preferably while the patient is still admitted to the ward, would likely be beneficial in the selection of patients for ICD treatment. Aims The overall aim of this thesis was to find easily obtainable measurements by ECG and echocardiography that could improve the prognosis for patients with acute myocardial infarction. More specifically, the aim was to study the rate of false-positive STEMI diagnoses based on pre-hospital ECGs (study I), study gender differences in time intervals and adherence to guideline set time targets (study II), study the predictive value of low-dose dobutamine stress echocardiography on the improvement of LVEF (study III) and investigate the use of discharge ECG in the early prediction of ICD candidates (study IV). Methods In study I all patients for whom a pre-hospital ECG had been transmitted to the investigating hospital during 2013 were included. In study II, patients with a STEMI diagnosis and a prehospital ECG between December 2010 and July 2015 were included. Information on whether a pre-hospital STEMI diagnosis had been set or not was collected from medical charts and the final diagnosis of STEMI was found in the national quality registry SWEDEHEART. For both study I and study II, information on time intervals were collected from ambulance charts, medical charts, a database collecting information on pre-hospital ECGs, and SWEDEHEART. In studies III and IV, adult patients with an at least moderately reduced left ventricular function (defined as LVEF ≤ 40%) with a life expectancy of more than one year and who were admitted for AMI were invited and followed by clinical visits and echocardiographic examinations. In study III, a low-dose dobutamine stress echocardiogram was performed within one week of the AMI and in study IV, the discharge ECG was reviewed. Results In study I, 16% (95% CI 10 – 23) out of 115 patients with a suspected STEMI based on prehospital ECGs were discharged with alternative diagnoses. Measured as the time from ambulance arrival at the patient’s location, the time target of reperfusion therapy within 90 minutes was achieved for almost all patients (98%), but the achievement of a pre-hospital ECG within ten minutes was only met for 16% of the cohort. The delay time to pre-hospital ECG was significantly longer for women than for men, 20 vs. 13 minutes (p < 0.001). In study II, 539 patients with STEMI and a pre-hospital ECG were included. A pre-hospital ECG was obtained within ten minutes for 22% of the cohort, and the target was more likely to be achieved for men than for women (29% vs. 14%, p = 0.001). Among all patients, 88% reached the target of reperfusion therapy within 90 minutes and there was no difference between men and women. Women had a significantly longer delay time between symptom onset and emergency call than men (median 61 vs. 45 minutes, p = 0.031). In study III, among 96 patients with an at least moderately reduced LVEF after an AMI, 60% had an LVEF ≥ 35% after three months. Patients with an LVEF ≤ 35% after three months had a significantly lower left ventricular function at both resting and stress echocardiography, measured as LVEF, mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (PSV). Baseline LVEF was a good predictor of recovery with a C-statistic of 85% (95% CI 74 – 94). None of the other variables, including the stress echocardiography variables, were better discriminators. In study IV, 87 patients with LVEF ≤ 40% after an AMI were included. Patients who had a pathologic R-wave progression on the discharge ECG were four times more likely to receive an ICD than those with normal R-wave progression (HR 4.0, 95% CI 1.1-14.3, p = 0.033). None of the patients without a pathologic R-wave progression, pathologic Q-waves, or intraventricular conduction abnormalities, received an ICD or suffered from malignant arrhythmias during the follow-up period. Conclusions The rate of false-positive catheterization laboratory activations based on pre-hospital STEMI diagnoses is well in comparison to rates reported based on in-hospital triage. Still, there are gender differences favoring men in regards of delay time from symptom onset to emergency call and ambulance arrival to pre-hospital ECG. The target of obtaining a pre-hospital ECG within ten minutes is met for only around one fifth of the patients, and improvements regarding this are warranted. For patients with heart failure after an AMI, baseline LVEF is a strong predictor of improved recovery while simple measurements of LVEF, MAPSE and PSV during low-dose dobutamine stress echocardiography did not add prognostic information. Patients with a pathologic R-wave progression have a significantly higher risk of receiving an ICD, and patients without pathologic R-wave progression, or Q-waves, or intraventricular conduction abnormalities are unlikely to receive an ICD and could be seen as a low-risk population

Investigation into the impact of wind power generation on demand side management (DSM) practices

The construction of a number of wind farms in South Africa will lay the foundation for the country to embrace the generation of greener energy into the National Grid. Despite the benefits derived from introducing wind power generation into the grid, this source encompasses adverse effects which need to be managed. These adverse effects include the intermittency and lack of predictability of wind. In power systems with a high penetration of wind energy, these effects can severely affect the power system’s security and reliability in the event of significant rapid ramp rates. Recently, many utilities around the world have been exploring the use of Demand Side Management (DSM) and Demand Response (DR) initiatives and programmes to support and manage the intermittency of wind power generation. This report outlines the programmes and benefits of DSM/DR and provides a critical analysis of the challenges facing South Africa with implementing these initiatives. Introducing these programmes necessitates the employment of a number of Smart Grid technologies including Advanced Metering Infrastructure (AMI), next generation telecommunications technologies, smart meters, enterprise system integration and dynamic pricing. These tools and techniques are discussed and their challenges described within the context of South Africa’s current state of the power system. The current practices for DSM/DR in South Africa have been evaluated in this report. Despite, the success of many DSM/DR initiatives in the commercial, industrial and agricultural sectors, it is found that much work is still required in the residential sectors as the current DSM initiatives are not adequate for managing wind power generation. A detailed analysis and recommendations for South Africa’s DR program is then presented based on industry best practices and experiences from other utilities who are currently exploring DSM/DR in the residential sector using Smart Grid technologies