Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Constraint-based adaptation for complex space configuration in building services

In this paper an object-based CAD programming is used to take advantage of standardization to handle the schematic design, sizing and layout planning for ceiling mounted fan coil system in a building ceiling void. In order to deal with more complex geometry and real building size, we have used a hybrid approach combining case-based reasoning and constraint programming techniques. Very often, building services engineers use previous solutions and adapt them to new problems. Case-based reasoning mirrors this practical approach and did help us deal effectively with increasingly complex geometry. Our approach combines automation and interactivity. From the specification of the building 3D BIM model, our software prototype proceeds through four steps. First, the user divides the building into zones, each zone being defined by a geometrical primitive (i.e. rectangle zone, triangle zone, curved zone, etc.). Next, for each zone a similar case is retrieved from the case library. The retrieval process will generate a first incomplete 3D solution containing some inconsistencies. Next, the incomplete solution is adapted, using constraint programming techniques, to provide a consistent solution. Finally, distribution routes (i.e. ducts and pipes) are generated using constraint programming techniques. The 3D fan coil solution can be modified or improved by the designer, while providing further contribution by concentrating on interactivity. The project has been funded by the Engineering and Physical Sciences Research Council (EPSRC) in the UK

Regulatory quality and performance in EU network industries: Evidence on telecommunications, gas and electricity

This article provides empirical evidence on ex ante and ex post indicators of regulatory quality and the relationship between those indicators and market performance in liberalised EU-15 network industries. It finds a low level of regulatory independence and competence, a high level of cross-country variations in regulatory quality, and widespread absence of correlation between ex ante regulatory quality and ex post performance indicators. On the basis of these findings, it suggests that the design of national regulatory agencies (NRAs) in Europe is not optimal and may be conducive to regulatory ineffectiveness or outright regulatory failure. Nevertheless, the existence and strengthening of EU-level regulators could enable EU member states to reduce the risk of regulatory failure by encouraging coordination and adoption of best practice