Healthcare digitalization and pay-for-performance incentives in smart hospital project financing

This study aims to explore the impact of healthcare digitalization on smart hospital project financing (PF) fostered by pay-for-performance (P4P) incentives. Digital platforms are a technology-enabled business model that facilitates exchanges between interacting agents. They represent a bridging link among disconnected nodes, improving the scalable value of networks. Application to healthcare public-private partnerships (PPPs) is significant due to the consistency of digital platforms with health issues and the complexity of the stakeholder’s interaction. In infrastructural PPPs, public and private players cooperate, usually following PF patterns. This relationship is complemented by digitized supply chains and is increasingly patient-centric. This paper reviews the literature, analyzes some supply chain bottlenecks, addresses solutions concerning the networking effects of platforms to improve PPP interactions, and investigates the cost-benefit analysis of digital health with an empirical case. Whereas diagnostic or infrastructural technology is an expensive investment with long-term payback, leapfrogging digital applications reduce contingent costs. “Digital” savings can be shared by key stakeholders with P4P schemes, incentivizing value co-creation patterns. Efficient sharing may apply network theory to a comprehensive PPP ecosystem where stakeholding nodes are digitally connected. This innovative approach improves stakeholder relationships, which are re-engineered around digital platforms that enhance patient-centered satisfaction and sustainability. Digital technologies are useful even for infectious disease surveillance, like that of the coronavirus pandemic, for supporting massive healthcare intervention, decongesting hospitals, and providing timely big data

Validation and analysis of regional present-day climate and climate change simulations over Europe

In the European Commission (EC) project "Regionalization of Anthropogenic Climate Change Simulations, RACCS, recently terminated, 11 European institutions have carried out tests of dynamical and statistical regionalization techniques. The outcome of the "dynamical part" of the project, utilizing a series of high resolution LAMs and a variable resolution global model (all of which we shall refer to as RCMs, Regional Climate Models), is presented here. The per- formance of the dqterent LAMs had first, in a preceding EC project, been tested with "perfect" boundary forcing fields (ECMWF analyses) and also multi-year present-day climate simula- tions with AMIP "perfect ocean " or mixed layer ocean GCM boundary conditions had been validated against available climatological data. The present report involves results of vali- dation and analysis of RCM present-day climate simulations and anthropogenic climate change experiments. Multi-year (5 - 30 years) present-day climate simulations have been per- formed with resolutions between 19 and 70 km (grid lengths) and with boundary conditions from the newest CGCM simulations. The climate change experiments involve various 2xCO2 - ]xCO2 transient greenhouse gas experiments and in one case also changing sulphur aerosols. A common validation and inter-comparison was made at the coordinating institution, MPIfor Meteorology. The validation of the present-day climate simulations shows the importance of systematic errors in the low level general circulation. Such errors seem to induce large errors in precipitation and surface air temperature in the RCMs as well as in the CGCMs providing boundary conditions. Over Europe the field of systematic errors in the mean sea level pressure (MSLP) usually involve an area of too low pressure, often in the form of an east-west trough across Europe with too high pressure to the north and south. New storm-track analyses confirm that the areas of too low pressure are caused by enhanced cyclonic activity and similarly that the areas of too high pressure are caused by reduced such activity. The precise location and strength of the extremes in the MSLP error field seems to be dependent on the physical param- eterization package used. In model pairs sharing the same package the area of too low pressure is deepened further in the RCM compared to the corresponding CGCM, indicating an increase of the excessive cyclonic activity with increasing resolution. From the experiments performed it seems not possible to decide to what extent the systematic errors in the general circulation are the result of local errors in the physical parameterization schemes or remote errors trans- mitted to the European region via the boundary conditions. Additional errors in precipitation and temperature seems to be due to direct local effects of errors in certain parameterization schemes and errors in the SSTs taken from the CGCMs. For all seasons many biases are fOund to be statistically significant compared to estimates of the internal model variability of the time- slice mean values. In the climate change experiments statistically significant European mean temperature changes which are large compared to the corresponding biases are found. How- ever, the changes in the deviations from the European mean temperature as well as the changes in precipitation are only partly sign wcan ce and are of the same order of magnitude or smaller than the corresponding biases found in the present-day climate simulations. Cases of an inter- action between the systematic model errors and the radiative forcing show that generally the errors are not canceling out when the changes are computed. Therefore, reliable regional cli- mate changes can only be achieved after model improvements which reduce their systematic errors sufficiently. Also in future RCM experiments sujiciently long time-slices must be used in order to obtain statistically sign ijicant climate changes on the sub-continental scale aimed at with the present regionalization technique

A Differential Inertial Wearable Device for Breathing Parameter Detection: Hardware and Firmware Development, Experimental Characterization

Breathing monitoring is crucial for evaluating a patient’s health status. The technologies commonly used to monitor respiration are costly, bulky, obtrusive, and inaccurate, mainly when the user moves. Consequently, efforts have been devoted to providing new solutions and methodologies to overcome these limitations. These methods have several uses, including healthcare monitoring, measuring athletic performance, and aiding patients with respiratory diseases, such as COPD (chronic obtrusive pulmonary disease), sleep apnea, etc. Breathing-induced chest movements can be measured noninvasively and discreetly using inertial sensors. This research work presents the development and testing of an inertia-based chest band for breathing monitoring through a differential approach. The device comprises two IMUs (inertial measurement units) placed on the patient’s chest and back to determine the differential inertial signal, carrying out information detection about the breathing activity. The chest band includes a low-power microcontroller section to acquire inertial data from the two IMUs and process them to extract the breathing parameters (i.e., RR—respiration rate; TI/TE—inhalation/exhalation time; IER—inhalation-to-exhalation time; V—flow rate), using the back IMU as a reference. A BLE transceiver wirelessly transmits the acquired breathing parameters to a mobile application. Finally, the test results demonstrate the effectiveness of the used dual-inertia solution; correlation and Bland–Altman analyses were performed on the RR measurements from the chest band and the reference, demonstrating a high correlation (r = 0.92) and low mean difference (MD = -0.27 BrPM (breaths per minute)), limits of agreement (LoA = +1.16/-1.75 BrPM), and mean absolute error (MAE = 1.15%). Additionally, the experimental results demonstrated that the developed device correctly measured the other breathing parameters (TI, TE, IER, and V), keeping an MAE of <=5%. The obtained results indicated that the developed chest band is a viable solution for long-term breathing monitoring, both in stationary and moving users

Wearable Sensors and Smart Devices to Monitor Rehabilitation Parameters and Sports Performance: An Overview

A quantitative evaluation of kinetic parameters, the joint’s range of motion, heart rate, and breathing rate, can be employed in sports performance tracking and rehabilitation monitoring following injuries or surgical operations. However, many of the current detection systems are expensive and designed for clinical use, requiring the presence of a physician and medical staff to assist users in the device’s positioning and measurements. The goal of wearable sensors is to overcome the limitations of current devices, enabling the acquisition of a user’s vital signs directly from the body in an accurate and non–invasive way. In sports activities, wearable sensors allow athletes to monitor performance and body movements objectively, going beyond the coach’s subjective evaluation limits. The main goal of this review paper is to provide a comprehensive overview of wearable technologies and sensing systems to detect and monitor the physiological parameters of patients during post–operative rehabilitation and athletes’ training, and to present evidence that supports the efficacy of this technology for healthcare applications. First, a classification of the human physiological parameters acquired from the human body by sensors attached to sensitive skin locations or worn as a part of garments is introduced, carrying important feedback on the user’s health status. Then, a detailed description of the electromechanical transduction mechanisms allows a comparison of the technologies used in wearable applications to monitor sports and rehabilitation activities. This paves the way for an analysis of wearable technologies, providing a comprehensive comparison of the current state of the art of available sensors and systems. Comparative and statistical analyses are provided to point out useful insights for defining the best technologies and solutions for monitoring body movements. Lastly, the presented review is compared with similar ones reported in the literature to highlight its strengths and novelties

Development of a self-powered piezo-resistive smart insole equipped with low-power BLE connectivity for remote gait monitoring

The evolution of low power electronics and the availability of new smart materials are opening new frontiers to develop wearable systems for medical applications, lifestyle monitoring, and performance detection. This paper presents the development and realization of a novel smart insole for monitoring the plantar pressure distribution and gait parameters; indeed, it includes a piezoresistive sensing matrix based on a Velostat layer for transducing applied pressure into an electric signal. At first, an accurate and complete characterization of Velostat-based pressure sensors is reported as a function of sizes, support material, and pressure trend. The realization and testing of a low-cost and reliable piezoresistive sensing matrix based on a sandwich structure are discussed. This last is interfaced with a low power conditioning and processing section based on an Arduino Lilypad board and an analog multiplexer for acquiring the pressure data. The insole includes a 3- axis capacitive accelerometer for detecting the gait parameters (swing time and stance phase time) featuring the walking. A Bluetooth Low Energy (BLE) 5.0 module is included for transmitting in real-time the acquired data toward a PC, tablet or smartphone, for displaying and processing them using a custom Processing® application. Moreover, the smart insole is equipped with a piezoelectric harvesting section for scavenging energy from walking. The onfield tests indicate that for a walking speed higher than 1 ms−1, the device’s power requirements (i.e., P = 5.84 mW ) was fulfilled. However, more than 9 days of autonomy are guaranteed by the integrated 380-mAh Lipo battery in the total absence of energy contributions from the harvesting section

Dislocation density in GaN determined by photoelectrochemical and hot-wet etching

Defects in GaN layers grown by hydride vapor-phase epitaxy have been investigated by photoelectrochemical ~PEC! etching, and by wet etching in hot H3PO4 acid and molten potassium hydroxide ~KOH!. Threading vertical wires ~i.e., whiskers! and hexagonal-shaped etch pits are formed on the etched sample surfaces by PEC and wet etching, respectively. Using atomic-force microscopy, we find the density of ‘‘whisker-like’’ features to be 23109 cm22, the same value found for the etch-pit density on samples etched with both H3PO4 and molten KOH. This value is comparable to the dislocation density obtained in similar samples with tunneling electron microscopy, and is also consistent with the results of Youtsey and co-workers

Architettura e Realismo. Programma

Il convegno "«Uno spazio reale adeguato»: architettura e realismo", la giornata di studi e mostra "«Il sempre teorizzar nulla rileva...»: nuovo realismo e architettura della città", il convegno "Per una nozione operativa di realismo: espressione critica e impegno civile e la mostra Il realismo nella didattica del progetto: Torino Napoli Milano", uniti sotto il titolo comune di Architettura e realismo sono promossi da un gruppo di lavoro costituito da giovani ricercatori e docenti delle facoltà di Architettura di Torino, Milano e Napoli, a partire dalla avvertita esigenza di aggiornare la riflessione sulla architettura come pratica costruttiva e sulla città come luogo per eccellenza della vita dell'uomo a partire da una analisi critica di quanto si è prodotto negli ultimi decenni. Da un lato grandi architetture spettacolari che rispondono alle logiche del mercato e della comunicazione e, dall'altro - in una sorta di inspiegabile paradosso - la de- regolazione della città diffusa priva di struttura, elementi riconoscibili e spazio pubblico. In entrambi i casi, pur nella loro diversità, si è prodotto un pericoloso distacco della architettura dal suo obiettivo ultimo: conformare lo spazio fisico dei manufatti e della città, del territorio e del paesaggio, per determinare in maniera consistente lo scenario della vita dell'uomo, nella sua dimensione, innanzitutto, collettiv

MEMS-based Micro-scale Wind Turbines as Energy Harvesters of the Convective Airflows in Microelectronic Circuits

As an alternative to conventional batteries and other energy scavenging techniques, this paper introduces the idea of using micro-turbines to extract energy from wind forces at the microscale level and to supply power to battery-less microsystems. Fundamental research efforts on the design, fabrication, and test of micro-turbines with blade lengths of just 160 μm are presented in this paper along with analytical models and preliminary experimental results. The proof-of-concept prototypes presented herein were fabricated using a standard polysilicon surface micro-machining silicon technology (PolyMUMPs) and could effectively transform the kinetic energy of the available wind into a torque that might drive an electric generator or directly power supply a micro-mechanical system. Since conventional batteries do not scale-down well to the microscale, wind micro-turbines have the potential for becoming a practical alternative power source for microsystems, as well as for extending the operating range of devices running on batteries

A prototype of an Electronic Pegboard Test to measure Hand-Time Dexterity with impaired hand functionality

This paper proposes an electronic prototype of the Grooved Pegboard Test (GPT), which is normally used to test the presence of hand dexterity. The prototype imitates the geometrical dimensions of an on-the-market GPT device, but it is electronic, not manual like the one available now for users. The suggested electronic GPT device makes automated time calculation between placing the first and the last peg in their designated locations, instead of manually observing a stopwatch normally used during the GPT. The electronic GPT prototype consists of a fabricated wooden box, electronics (switches and microcontroller), and liquid crystal display (LCD). A set of 40 normal volunteers, 20 females and 20 males, tested the designed prototype. A set of six volunteers with chronic medical conditions also participated in evaluating the proposed model. The results on normal volunteers showed that the proposed electronic GPT device yielded time calculations that match the population mean value of similar calculations by the GPT device. The one-sample t-test showed no significant difference in calculations between the new electronic GPT and the manual GPT device. The p-value was much higher than 0.05, indicating the possible use of the suggested electronic GPT device

Stress Response to Winter Warfare Training: Potential Impact of Location

Winter Warfare Training (WWT) is a critical component of military training to prepare individuals to move effectively in harsh conditions. Moving through snow and heavy terrain increases overall stress to the entire human system. PURPOSE: The purpose of this effort was to quantify the stress response during WWT to determine the level of physiological adaptation to extreme environments. METHODS: Mountain and mobility operators (age: 31.5±1.4 years; height: 71.1±0.5 inches; weight: 192.5±6.6 lbs.; body fat percentage: 18.0±5.0%) were recruited for this effort. Participants engaged in baseline laboratory metrics at their home station located in Colorado (CO) prior to WWT for one week in Montana (MT) and one week in Alaska (AK). WWT was separated by approximately one month. Blood was collected upon wake on the first and last day at each location. Plasma was analyzed for anabolic and stress-related hormones via enzyme-linked immunoassay (ELISA). RESULTS: Plasma adrenocorticotropic hormone (ACTH) levels increased from baseline to pre- (p=0.004), decreased from pre- to post-WWT in MT (p=0.004), and increased in from pre- to post-WWT in AK (p=0.005). Plasma cortisol levels decreased from pre- to post-WWT in MT (p=0.001) and, conversely, increased from pre- to post-WWT in AK (pCONCLUSION: The increase in stress-related hormones (i.e., ACTH and cortisol) exhibited throughout during WWT in AK suggest that operators experienced heightened physiological strain during WWT in AK compared to MT, despite similar training. We speculate that differences in sleep environment, changes in environmental temperature and terrain between MT and AK, and cumulative training load may have exacerbated the overall physiological strain on the operators