Processing Diabetes mellitus composite events in MAGPIE

The focus of this research is in the definition of programmable expert Personal Health Systems (PHS) to monitor patients affected by chronic diseases using agent oriented programming and mobile computing to represent the interactions happening amongst the components of the system. The paper also discusses issues of knowledge representation within the medical domain when dealing with temporal patterns concerning the physiological values of the patient. In the presented agent based PHS the doctors can personalize for each patient monitoring rules that can be defined in a graphical way. Furthermore, to achieve better scalability, the computations for monitoring the patients are distributed among their devices rather than being performed in a centralized server. The system is evaluated using data of 21 diabetic patients to detect temporal patterns according to a set of monitoring rules defined. The system’s scalability is evaluated by comparing it with a centralized approach. The evaluation concerning the detection of temporal patterns highlights the system’s ability to monitor chronic patients affected by diabetes. Regarding the scalability, the results show the fact that an approach exploiting the use of mobile computing is more scalable than a centralized approach. Therefore, more likely to satisfy the needs of next generation PHSs. PHSs are becoming an adopted technology to deal with the surge of patients affected by chronic illnesses. This paper discusses architectural choices to make an agent based PHS more scalable by using a distributed mobile computing approach. It also discusses how to model the medical knowledge in the PHS in such a way that it is modifiable at run time. The evaluation highlights the necessity of distributing the reasoning to the mobile part of the system and that modifiable rules are able to deal with the change in lifestyle of the patients affected by chronic illnesses.Peer ReviewedPostprint (author's final draft

Contributions to interoperability, scalability and formalization of personal health systems

The ageing of the world's population combined with unhealthy lifestyles are contributing to a major prevalence of chronic diseases. This scenario poses the challenge of providing good healthcare services to that people affected by chronic illnesses, but without increasing its costs. A prominent way to face this challenge is through pervasive healthcare. Research in pervasive healthcare tries to shift the current centralized healthcare delivery model focused on the doctors, to a more distributed model focused on the patients. In this context Personal Health Systems (PHSs) consists on approaching sampling technologies into the hands of the patients, without disturbing its activities of the daily life, to monitor patient's physiological parameters and providing feedback on their state. The use of PHSs involves the patients in the management of their illness and in their own well being too. The development of PHSs has to face technological issues in order to be accepted by our society. Within them it is important to ensure interoperability between different systems in order to make them work together. Scalability it is also a concern, as their performance must not decrease when increasing the number of users. Another issue is how to formalize the medical knowledge for each patient, as different patients may have different target goals. Security and privacy are a must feature because of the sensitive nature of medical data. Other issues involve the the integration with legacy systems, and the usability of graphical user interfaces in order to encourage old people with the use these technologies. The aim of this PhD thesis is to contribute into the state-of-the-art of PHSs by tackling together different of the above-mentioned challenges. First, to achieve interoperability we use the CDA standard as a format to encode and exchange health data and alerts related with the status of the patient. We show how these documents can be generated automatically through the use of XML templates. Second, we address the scalability by distributing the computations needed to monitor the patients over their devices, rather than performing them in a centralized server. In this context we develop the MAGPIE agent platform, which runs on Android devices, as a framework able to provide intelligence to PHSs, and generate alerts that can be of interest for the patients and the medical doctors. Third, we focus on the formalization of PHSs by providing a tool for the practitioners where they can define, in a graphical way, monitoring rules related with chronic diseases that are integrated with the MAGPIE agent platform. The thesis also explores different ways to share the data collected with PHSs in order to improve the outcomes obtained with the use of this technology. Data is shared between individuals following a Distributed Event-Based System (DEBS) approach, where different people can subscribe to the alerts produced by the patient. Data is also shared between institutions with a network protocol called MOSAIC, and we focus on the security aspects of this protocol. The research in this PhD focuses in the use case of Diabetes Mellitus; and it has been developed in the context of the projects MONDAINE, MAGPIE, COMMODITY12 and TAMESIS.L'envelliment de la població mundial combinat amb uns estils de vida no saludables contribueixen a una major prevalença d'enfermetats cròniques. Aquest escenari presenta el repte de proporcionar uns bons serveis sanitaris a les persones afectades per aquestes enfermetats, sense incrementar-ne els costos. Una solució prometedora a aquest repte és mitjançant l'aplicació del que en anglès s'anomena "pervasive healthcare". L'investigació en aquesta camp tracta de canviar l'actual model centralitzat de serveis sanitaris enfocat en el personal sanitari, per un model de serveis distribuït enfocat en els pacients. En aquest context, els Personal Health Systems (PHSs) consisteixen en posar a l'abast dels pacients les tecnologies de monitorització, i proporcionar-los informació sobre el seu estat. L'ús de PHSs involucra els pacients en la gestió de la seva enfermetat i del seu propi benestar. L'acceptació dels PHSs per part de la societat implica certs reptes tecnològics en el seu desenvolupament. És important garantir la seva interoperabilitat per tal de que puguin treballar conjuntament. La seva escalabilitat també s'ha de tenir en compte, ja que el seu rendiment no s'ha de veure afectat al incrementar-ne el número d'usuaris. Un altre aspecte a considerar és com formalitzar el coneixement mèdic per cada pacient, ja que cada un d'ells pot tenir objectius diferents. La seguretat i privacitat són característiques desitjades degut a la naturalesa sensible de les dades mèdiques. Altres problemàtiques impliquen la integració amb sistemes heretats, i la usabilitat de les interfícies gràfiques per fomentar-ne el seu ús entre les persones grans. L'objectiu d'aquesta tesi és contribuir a l'estat de l'art dels PHSs tractant de manera conjunta varis dels reptes mencionats. Per abordar l'interoperabilitat s'utilitza l'estàndard CDA com a format per codificar les dades mèdiques i alertes relacionades amb el pacient. A més es mostra com aquests documents poden generar-se de forma automàtica mitjançant l' ús de plantilles XML. Per tractar l'escalabilitat es distribueixen les computacions per monitoritzar els pacients entre els seus terminals mòbils, en comptes de realitzar-les en un servidor central. En aquest context es desenvolupa la plataforma d'agents MAGPIE com a framework per proporcionar intelligència als PHSs i generar alertes d'interès per al metge i el pacient. La formalització s'aborda mitjançant una eina que permet als metges definir de manera gràfica regles de monitorització relacionades amb enfermetats cròniques, que a més estan integrades amb la plataforma d'agents MAGPIE. La tesi també explora diferents maneres de compartir les dades recol·lectades amb un PHS, amb l'objectiu de millorar els resultats obtinguts amb aquesta tecnologia. Les dades es comparteixen entre individus seguint un enfoc de sistemes distribuïts basats en events (DEBS), on diferents usuaris poden subscriure's a les alertes produïdes per el pacient. Les dades també es comparteixen entre institucions mitjançant un protocol de xarxa anomenat MOSAIC. A la tesi es desenvolupen els aspectes de seguretat d'aquest protocol. La test es centra en la Diabetis Mellitus com a cas d'ús, i s'ha realitzat en el context dels projectes MONDAINE, MAGPIE, COMMODITY12 i TAMESIS.El envejecimiento de la población mundial combinado con unos estilos de vida no saludables contribuyen a una mayor prevalencia de enfermedades crónicas. Este escenario presenta el reto de proporcionar unos buenos servicios sanitarios a las personas afectadas por estas enfermedades, sin incrementar sus costes. Una solución prometedora a este reto es mediante la aplicación de lo que en inglés se denomina "pervasive healthcare". La investigación en este campo trata de cambiar el actual modelo centralizado de servicios sanitarios enfocado hacia el personal sanitario, por un modelo distribuido enfocado hacia los pacientes. En este contexto, los Personal Health Systems (PHSs) consisten en poner al alcance de los pacientes las tecnologías de monitorización, y proporcionarles información sobre su estado. El uso de PHSs involucra a los pacientes en la gestión de su enfermedad y en su propio bienestar. La aceptación de los PHSs por parte de la sociedad implica ciertos retos tecnológicos en su desarrollo. Es importante garantizar su interoperabilidad para que puedan trabajar conjuntamente. Su escalabilidad también se debe tener en cuenta, ya que su rendimiento no tiene que verse afectado al incrementar su número de usuarios. Otro aspecto a considerar es cómo formalizar el conocimiento médico para cada paciente, ya que cada uno puede tener objetivos distintos. La seguridad y privacidad son características deseadas debido a la naturaleza sensible de los datos médicos. Otras problemáticas implican la integración con sistemas heredados, y la usabilidad de las interfaces gráficas para fomentar su uso entre las personas mayores. El objetivo de esta tesis es contribuir al estado del arte de los PHSs tratando de manera conjunta varios de los retos mencionados. Para abordar la interoperabilidad se usa el estándar CDA como formato para codificar los datos médicos y alertas relacionados con el paciente. Además se muestra como estros documentos pueden generarse de forma automática mediante el uso de plantillas XML. Para tratar la escalabilidad se distribuye la computación para monitorizar a los pacientes en sus terminales móbiles, en lugar de realizarla en un servidor central. En este contexto se desarrolla la plataforma de agentes MAGPIE como framework para proporcionar inteligencia a los PHSs y generar alertas de interés para el médico y el paciente. La formalización se aborda mediante una herramienta que permite a los médicos definir de manera gráfica reglas de monitorización relacionadas con enfermedades crónicas, que ademas están integradas con la plataforma de agentes MAGPIE. La tesis también explora distintas formas de compartir los datos recolectados con un PHS, con el fin de mejorar los resultados obtenidos mediante esta tecnología. Los datos se comparten entre individuos siguiendo un enfoque de sistemas distribuidos basados en eventos (DEBS), donde distintos usuarios pueden suscribirse a las alertas producidas por el paciente. Los datos también se comparten entre instituciones mediante un protocolo dered llamado MOSAIC. En la tesis se desarrollan los aspectos de seguridad de este protocolo. La tesis se centra en la Diabetes Mellitus como caso de uso, y se ha realizado en el contexto de los proyectos MONDAINE, MAGPIE, COMMODITY12 y TAMESIS.Postprint (published version

Pengembangan Aplikasi Android untuk Pelayanan DM Tipe 2

Deteksi dini Diabetes Mellitus (DM) tipe 2 berbasis android saat ini telah banyak berkembang. Namun pengembangan aplikasi tersebut belum melibatkan ahli seperti ahli dalam bidang kesehatan. Penelitian ini bertujuan untuk mengembangkan deteksi dini penyaikit DM berbasis aplikasi android. Penelitian ini menggunakan desain research and development (RnD). Instrumen penelitian yang digunakan adalah kuisioner, sedangkan analisis data menggunakan deskriptif kuantitatif dalam bentuk persentase. Responden yang terlibat pada penelitian ini mayoritas berusia 50-59 tahun (35%), berjenis kelamin perempuan (80%), seorang pekerja (58%), pendidikan setara SMP (40%). Hasil analisis pada kelompok kecil, menunjukkan bahwa 74% responden menilai aplikasi ini jelas, mudah, dan sesuai untuk digunakan. Sedangkan hasil analisis pada kelompok sasaran sebesar 77% responden menilai bahwa aplikasi ini jelas, mudah dan sesuai untuk digunakan. Sehingga aplikasi ini dinilai layak digunakan oleh berbagai kalangan masyarakat yang berbeda usia, jenis kelamin, status pekerjaan, dan tingkat pendidikan

Placental growth factor; potential for its use in twin pregnancy and evaluation of its benefit in singletons with suspected preterm pre-eclampsia

Hypertensive Disorders of Pregnancy are common and may result in increased maternal and neonatal morbidity and mortality. Twin pregnancies confer an increased risk of development of a hypertensive disorder of pregnancy. Placental growth factor is an angiogenic protein highly expressed during pregnancy. The pro-angiogenic/anti-angiogenic synergism of PlGF and its receptors is critical for successful placentation in early pregnancy. Circulating maternal levels of placental growth factor correlate well with placental function. Women presenting with suspected pre-eclampsia are currently triaged based on hypertension and dipstick proteinuria. Numerous studies advocate a role for placental growth factor testing as a useful adjunct in the management of women presenting with preterm pre-eclampsia. Several automated immunoassay platforms to quantify placental growth factor are currently available. Comparative studies of these immunoassays are limited. Current reference values and clinical cut-offs for PlGF were constructed from singleton pregnancy cohorts. Given the larger placental volume present in a twin pregnancy, separate reference ranges are likely required. Pregnant women are seldom included in randomised controlled trials and their attitudes and experiences of this are not often investigated. Gathering feedback of their experience is paramount for future trial design to facilitate participation. In this thesis, I reviewed nine years of clinical data in twin pregnancies from a single maternity unit to understand the impact of hypertensive disorders on maternal and neonatal outcomes. I examined cross sectional values from uncomplicated twin pregnancies to assess the potential for using PlGF in this population. I compared the PlGF results obtained from an ELISA to an automated immunoassay, to determine if clinical cut-offs developed for one platform were transferrable to another. I conducted a national multi-site randomised control trial; PARROT Ireland, to evaluate the impact of incorporation of PlGF testing into routine clinical care. Lastly, through one on one interviews with trial participants, I investigated the barriers and facilitators to pregnant women taking part in clinical research. The data from these studies revealed that maternal age >40 years, nulliparity, conception through use of a donor oocyte, and presence of obstetric cholestasis are all important risk factors for the development of a hypertensive disorder in a twin pregnancy. The incidence of iatrogenic late prematurity and neonatal hypoglycaemia are increased when a hypertensive disorder complicates a twin pregnancy. PlGF levels in twin pregnancy differ significantly between those women with a pregnancy that will later be complicated by preeclampsia and those that will not. The difference is present many weeks before clinical signs or symptoms are present, indicating that PlGF has potential to aid diagnosis of pre-eclampsia in twin pregnancies. A dichorionic twin pregnancy specific reference range for PlGF has been developed, which may be utilised for further interventional research on PlGF in twins. The findings also indicate that PlGF biomarker levels vary significantly between different immunoassay platforms, highlighting the importance of developing validated clinical cut-offs for any automated immunoassay before they can be clinically applied. The result of the interim analysis from the PARROT Ireland trial is of no significant reduction in either maternal or neonatal morbidity with the integration of point of care PlGF based testing. These are interim results only however and the final results may differ. Should the final trial results demonstrate a positive impact on maternal morbidity, without a negative impact on neonatal morbidity, it would indicate that PlGF testing should be incorporated into routine clinical investigations for women presenting with suspected pre-eclampsia before 37 weeks’ gestation. The final study of the thesis highlights that pregnant women are interested and willing to participate in research. Identifying the correct timepoint and location to approach women, as well as the manner and language used to communicate with them, are key elements in ensuring their participation. The findings from this thesis, though supportive of the current literature in relation to the potential of PlGF, highlight that there is more research required

The Effect of Antenatal Magnesium Sulphate for Fetal Neuroprotection in Threatened Preterm Labour: A Prospective Cohort Study

Due to the advances in perinatal care, the survival rate of premature babies is also increasing. This lead to the increase in the learning disabilities, medical disabilities, behavioral and psychological problems among these surviving premature babies. The risk of neurological impairments such as cerebral palsy, blindness, deafness, and cognitive dysfunction are high in preterm babies. Magnesium sulphate used as the seizure prophylaxis in severe pre-eclamptic women and as a tocolytic found to have neuroprotective action in the preterm babies. Several studies concluded that exposure to both antenatal corticosteroids and magnesium sulphate was associated with lower rates of severe neurodevelopmental impairment or mortality.To determine the role of magnesium sulphate given for fetal neuro protection to women at risk of preterm birth in preventing neonatal mortality and neuro developmental morbidity

2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

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Atención prenatal durante embarazo y su efecto sobre resultados maternos y fetales

Aim: to evaluate the antenatal care booking during pregnancy and its effects on maternal and fetal outcomes. (in pre-eclamptic patients) Methods: This study was conducted to evaluate the importance of antenatal care booking on pre-eclampsia risk factors and its effect on maternal and fetal outcomes. It was carried on 150 pregnant women diagnosed with pre-eclampsia attending the Department of Obstetrics and Gynaecology. The included women were interviewed and Number of antenatal care visits was recorded. Blood pressure control, cardiotocography (CTG), ultrasonographic and Doppler evaluations and administration of methyldopa were also reported. INTRODUCTION AND RATIONALE Hypertension is a frequently encountered complication of pregnancy. It may predate a pregnancy or develop during the antenatal, intrapartum or post-partum course. In some cases it is associated with proteinuria, and this usually indicates a multi-system disease known as pre-eclampsia. Pre-eclampsia is a major cause of maternal and fetal mortality and morbidity. Its incidence ranges from 2-10%, depending on the population studied and definitions of pre-eclampsia. The National Institute for Clinical Excellence (NICE) guidelines on antenatal care has reduced the number of antenatal visits recommended for healthy woman at low risk. 2 As the randomized controlled trials on which this recommendation was based were never powered to identify important outcomes such as mortality, and as the failure to identify and act on known risk factors at booking contributes to deaths from pre-eclampsia, it is important to define risk at the beginning of pregnancy. The importance of antenatal care booking of risk factors for early onset pre-eclampsia has been greatly underestimated. Many risk factors that can be assessed at antenatal care booking including history (age, parity, previous pre-eclampsia, family history of pre-eclampsia, multiple pregnancy, and pre-existing medical conditions as; insulin dependent diabetes (IDDM), chronic hypertension, renal disease, autoimmune disease and antiphospholipid syndrome) and physical examination (body mass index (BMI), blood pressure, and proteinuria). This prospective study was carried out to reach an overall estimate for the importance of antenatal care booking of the risk of pre-eclampsia. This provides an evidence base from which healthcare professionals can assess each pregnant woman's risk of pre-eclampsia at her booking visit and tailor her antenatal care according to need. Methods: This study was conducted to evaluate the importance of antenatal care booking on pre-eclampsia risk factors and its effect on maternal and fetal outcomes. It was carried on 150 pregnant women diagnosed with pre-eclampsia attending the Department of Obstetrics and Gynaecology. The included women were interviewed and Number of antenatal care visits was recorded. Blood pressure control, cardiotocography (CTG), ultrasonographic and Doppler evaluations and administration of methyldopa were also reported. Results: There were significantly higher incidence rate and higher risk of postpartum hemorrhage, eclampsia and ICU admission among women with inadequate booking visits than among women with adequate booking visits. Overall, there was 12-folds higher risk of bad maternal outcome among women with inadequate booking visits than among women with adequate booking visits (P<0.0001). There were also significantly higher incidence rate and higher risk of bad fetal and neonatal mortality among women with inadequate booking visits than among women with adequate booking visits. Overall, there was 53-folds higher risk of bad fetal outcome among women with inadequate booking visits than among women with adequate booking visits (P<0.0001). Conclusions: The antenatal care booking visits during pregnancy have significant effects of on maternal and fetal outcomes among pre-eclamptic patient

Magnesium and Microelements in Older Persons

In recent years, the interest in magnesium and in microelements in older people has exponentially increased. The deficiency of either magnesium and microelements, in fact, is associated with several negative outcomes in older people. Therefore, in this book, we decided to report the most novel and important research findings regarding these important topics. In particular, authoritative authors in the field of nutritional research in older people reported their experience in magnesium research, including articles on metabolic and cardiovascular aspects of magnesium deficiency. Moreover, we speculated the importance of magnesium in infectious diseases, including COVID-19. In this book, we also report some important findings regarding other microelements, such as iron and sodium or potassium, extremely important in older people

Investigation of mobile devices usage and mobile augmented reality applications among older people

Mobile devices such as tablets and smartphones have allow users to communicate, entertainment, access information and perform productivity. However, older people are having issues to utilise mobile devices that may affect their quality of life and wellbeing. There are some potentials of mobile Augmented Reality (AR) applications to increase older users mobile usage by enhancing their experience and learning. The study aims to investigate mobile devices potential barriers and influence factors in using mobile devices. It also seeks to understand older people issues in using AR applications