Chapter xCARE: A Development Platform for Supporting Smart and Pervasive Healthcare

We are assisting to an important change in the healthcare domain where healthy citizens and patients are more and more in the center and become active partners in the entire process. In this scenario, smart and pervasive solutions assume a relevant role for remotely assisting citizens and patients together with their carers and supporting the overall team of professionals. From a software-engineering perspective, to follow and/or anticipate changes in requirements, modular solutions must be investigated and developed. Moreover, issues like personalization, adaptation, and scalability must be considered from the very beginning. In this chapter, we present xCARE, a microservices-based platform explicitly implemented to support the development of smart and pervasive healthcare systems. To show the potentiality and adaptability of xCARE, three relevant applications are presented: (i) a self-management system to support chronic complex patients; (ii) a patient management system that allows the team of professionals to assist patients before a major surgery together with a self-management system for the patients themselves; and (iii) an automatic self-management system for healthy citizens that want to follow healthier habits and that supports behavioral change

A multi-domain ontology on healthy ageing for the characterization of older adults status and behaviour

Ageing is a multi-factorial physiological process and the development of novel IoT systems, tools and devices, specifically targeted to older people, must be based on a holistic framework built on robust scientific knowledge in different health domains. Furthermore, interoperability must be guaranteed using standardized frameworks or approaches. These aspects still largely lack in the specific literature. The main aim of the paper is to develop a new ontology (the NESTORE ontology) to extend the available ontologies provided by universAAL-IoT (uAAL-IoT). The ontology is based on a multidomain healthy ageing holistic model, structuring well-assessed scientific knowledge, specifically targeted to healthy older adults aged between 65 and 75. The tool is intended to support, and standardize heterogeneous data about ageing in compliance with the uAAL-IoT framework. The NESTORE ontology covers all the relevant concepts to represent 3 significant domains of ageing: (1) Physiological Status and Physical Activity Behaviour; (2) Nutrition; and (3) Cognitive and Mental Status and Social Behaviour. In total, 12 sub-ontologies were modelled with more than 60 classes and sub-classes referenced among them by using more than 100 relations and around 20 enumerations. The proposed ontology increases the uAAL collection by 40%. NESTORE ontology provides innovation both in terms of semantic content and technological approach. The thorough use of this ontology can support the development of a decision support system, to promote healthy ageing, with the capacity to do dynamic multi-scale modelling of user-specific data based on the semantic annotations of users’ profile

PEGASO: a personalised and motivational ICT system to empower adolescents towards healthy lifestyles

Unhealthy alimentary behaviours and physical inactivity habits are key risk factors for major non communicable diseases. Several researches demonstrate that juvenile obesity can lead to serious medical conditions, pathologies and have important psycho-social consequences. PEGASO is a multidisciplinary project aimed at promoting healthy lifestyles among teenagers through assistive technology. The core of this project is represented by the ICT system, which allows providing tailored interventions to the users through their smartphones in order to motivate them. The novelty of this approach consists of developing a Virtual Individual Model (VIM) for user characterization, which is based on physical, functional and behavioural parameters opportunely selected by experts. These parameters are digitised and updated thanks to the user monitoring through smartphone; data mining algorithms are applied for the detection of activity and nutrition habits and this information is used to provide personalised feedback. The user interface will be developed using gamified approaches and integrating serious games to effectively promote health literacy and facilitate behaviour change

xCARE: A Development Platform for Supporting Smart and Pervasive Healthcare

We are assisting to an important change in the healthcare domain where healthy citizens and patients are more and more in the center and become active partners in the entire process. In this scenario, smart and pervasive solutions assume a relevant role for remotely assisting citizens and patients together with their carers and supporting the overall team of professionals. From a software-engineering perspective, to follow and/or anticipate changes in requirements, modular solutions must be investigated and developed. Moreover, issues like personalization, adaptation, and scalability must be considered from the very beginning. In this chapter, we present xCARE, a microservices-based platform explicitly implemented to support the development of smart and pervasive healthcare systems. To show the potentiality and adaptability of xCARE, three relevant applications are presented: (i) a self-management system to support chronic complex patients; (ii) a patient management system that allows the team of professionals to assist patients before a major surgery together with a self-management system for the patients themselves; and (iii) an automatic self-management system for healthy citizens that want to follow healthier habits and that supports behavioral change

BECOME: A Modular Recommender System for Coaching and Promoting Empowerment in Healthcare

In this chapter, we present BECOME (Behavior Change recOMender systEm), a modular Recommender System built to cope with issues like personalization, adaptation, and delivery of contents pertinently designed to solve idiosyncrasies of various topics in the healthcare field. The main objective is to empower citizens or patients to make informed decisions to improve their health condition. It deals with a double-edged personalization process as one of the key aspects to fostering self-empowerment: content dynamically personalized and adapted as new information is gathered and flexibility in the strategies and timings of the delivery. Thus, we take personalization one step further by not only tailoring the content, which is the standard customization strategy, but also adapting its timings and complexity in a dynamic manner while dealing with the feeling of having an entity (the coach) behind, ready to help. To show the modularity of the system and the diverse ways of interaction, different studies representing various use cases are presented

The NESTORE e-Coach: Designing a Multi-Domain Pathway to Well-Being in Older Age

This article describes the coaching strategies of the NESTORE e-coach, a virtual coach for promoting healthier lifestyles in older age. The novelty of the NESTORE project is the definition of a multi-domain personalized pathway where the e-coach accompanies the user throughout different structured and non-structured coaching activities and recommendations. The article also presents the design process of the coaching strategies, carried out including older adults from four European countries and experts from the different health domains, and the results of the tests carried out with 60 older adults in Italy, Spain and The Netherlands

チュウジョウキュウ ニホンゴ ガクシュウシャ ノ ドッカイ ニオケル コンナンテン think-aloud ホウ ニヨル ジレイ ケンキュウ

研究ノートNotes and Discussio

Measurement of Typhim Vi IgG as a Diagnostic Tool to Determine Anti-polysaccharide Antibody Production Deficiency in Children

Background: The assessment of specific polysaccharide antibody production plays a pivotal role in the diagnosis of humoral primary immunodeficiencies (PID). The response to 23-valent pneumococcal vaccine (PPV) remains the gold standard for the diagnosis of polysaccharide antibodies. However, in Spain, the interpretation of pure polysaccharide 23-valent immunization is hampered by the high endemicity of pneumococcal disease and the generalization of the 13-valent adjuvant pneumococcal vaccination. Specific Typhim Vi vaccination (TV) immunoglobulin G IgG response to immunization is useful in adult PID, but there is no data regarding children.Objectives: To evaluate the clinical utility of TV IgG production as a diagnostic tool to determine anti-polysaccharide antibody production deficiency in children, when the response to PPV is unclear and isolated determination of serotypes is unfeasible.Methods: We conducted a single-institution prospective observational study on 61 children with recurrent infections. Baseline specific antibodies against PPV and TV were evaluated. In 28 children (46%), the response to the production of antibodies confirmed a clinical suspicion of humoral PID, and they were therefore immunized with 23-valent pneumococcal vaccine and Typhim Vi. Both specific antibody responses were measured by ELISA (The Binding Site Group Ltd, Birmingham, UK) using previously published cut-offs.Results: Seventy percent of the 61 children displayed baseline PPV IgG > 27 mg/L, whereas only 8% showed TV IgG > 28 U/mL (p < 0.0001). Twenty-one of 28 children (75%) achieved a 3-fold increase in post-vaccination TV IgG levels, whereas only 3% achieved a 4-fold increase in PPV IgG post vaccination, mainly due to high baseline PPV IgG titers. When we classified children according to their response to TV as responders or non-responders and compared this with the well-known clinical warning signs of the Jeffrey Modell Foundation. The proportions of children with history of pneumonia and the need for intravenous antibiotics were significantly higher in TV IgG non-responders than in TV IgG responders (p = 0.02 and p = 0.01, respectively).Conclusion: Response to TV can be considered an ancillary diagnostic tool to determine polysaccharide antibodies in children, particularly when isolated determination of pneumococcal serotypes is not feasible. TV provides a useful asset for clinicians in the era of conjugate PPV vaccination, with clinical relevance. Further research is warranted for validation

Effect of the relative shift between the electron density and temperature pedestal position on the pedestal stability in JET-ILW and comparison with JET-C

The electron temperature and density pedestals tend to vary in their relative radial positions, as observed in DIII-D (Beurskens et al 2011 Phys. Plasmas 18 056120) and ASDEX Upgrade (Dunne et al 2017 Plasma Phys. Control. Fusion 59 14017). This so-called relative shift has an impact on the pedestal magnetohydrodynamic (MHD) stability and hence on the pedestal height (Osborne et al 2015 Nucl. Fusion 55 063018). The present work studies the effect of the relative shift on pedestal stability of JET ITER-like wall (JET-ILW) baseline low triangularity (\u3b4) unseeded plasmas, and similar JET-C discharges. As shown in this paper, the increase of the pedestal relative shift is correlated with the reduction of the normalized pressure gradient, therefore playing a strong role in pedestal stability. Furthermore, JET-ILW tends to have a larger relative shift compared to JET carbon wall (JET-C), suggesting a possible role of the plasma facing materials in affecting the density profile location. Experimental results are then compared with stability analysis performed in terms of the peeling-ballooning model and with pedestal predictive model EUROPED (Saarelma et al 2017 Plasma Phys. Control. Fusion). Stability analysis is consistent with the experimental findings, showing an improvement of the pedestal stability, when the relative shift is reduced. This has been ascribed mainly to the increase of the edge bootstrap current, and to minor effects related to the increase of the pedestal pressure gradient and narrowing of the pedestal pressure width. Pedestal predictive model EUROPED shows a qualitative agreement with experiment, especially for low values of the relative shift