Dissertations / Theses on the topic 'E-health monitoring system'

With the high-level developments in the information technologies, there is a big movement in the e-health area both to give better healthcare services and to reduce cost. Monitoring the patients from their home location is one of the important branches of e-health with the aging societies. In this work, an agentbased alert system is introduced which analyzes the alert message requests and sends the alert messages within the appropriate structure and communication channel to the related healthcare user. A guideline execution system produces the alert requests based on sensor data and informs the alert agents. A multi-agent platform is developed which proactively sends the alert messages on behalf of the system with acknowledgement and message routing abilities. The multi-agent platform has patient alert agents for each patient in the system. A rule engine is cooperated with agents for the analysis of the alert message requests to bind these requests with the healthcare user specifications. E-mail messaging, SMS and MSN Instant messaging are used to reach the healthcare users. Additionally, web-based user interfaces are developed for healthcare users to manage the alert system for intelligent healthcare monitoring by specifying alert message receiving rules, personal and contact information, and some more additional options. The work presented in this thesis is realized as a part of the SAPHIRE project funded by the European Commission.

In this thesis, a novel graphene (GN) based electrocardiogram (ECG) sensor is designed, constructed and tested to validate the concept of coating GN, which is a highly electrically conductive material, on Ag substrates of conventional electrodes. The background theory, design, experiments and results for the proposed GN-based ECG sensor are also presented. Due to the attractive electrical and physical characteristics of graphene, a new ECG sensor was investigated by coating GN onto itself. The main focus of this project was to examine the effect of GN on ECG monitoring and to compare its performance with conventional methods. A thorough investigation into GN synthesis on Ag substrate was conducted, which was accompanied by extensive simulation and experimentation. A GN-enabled ECG electrode was characterised by Raman spectroscopy, scanning electron microscopy along with electrical resistivity and conductivity measurements. The results obtained from the GN characteristic experimentation on Raman spectroscopy, detected a 2D peak in the GN-coated electrode, which was not observed with the conventional Ag/AgCl electrode. SEM characterisation also revealed that a GN coating smooths the surface of the electrode and hence, improves the skin-to-electrode contact. Furthermore, a comparison regarding the electrical conductivity calculation was made between the proposed GN-coated electrodes and conventional Ag/AgCl ones. The resistance values obtained were 212.4 Ω and 28.3 Ω for bare and GN-coated electrodes, respectively. That indicates that the electrical conductivity of GN-based electrodes is superior and hence, it is concluded that skin-electrode contact impedance can be lowered by their usage. Additional COMSOL simulation was carried out to observe the effect of an electrical field and surface charge density using GN-coated and conventional Ag/AgCl electrodes on a simplified human skin model. The results demonstrated the effectiveness of the addition of electrical field and surface charge capabilities and hence, coating GN on Ag substrates was validated through this simulation. This novel ECG electrode was tested with various types of electrodes on ten different subjects in order to analyse the obtained ECG signals. The experimental results clearly showed that the proposed GN-based electrode exhibits the best performance in terms of ECG signal quality, detection of critical waves of ECG morphology (P-wave, QRS complex and T-wave), signal-to-noise ratio (SNR) with 27.0 dB and skin-electrode contact impedance (65.82 kΩ at 20 Hz) when compared to those obtained by conventional a Ag/AgCl electrode. Moreover, this proposed GN-based ECG sensor was integrated with core body temperature (CBT) sensor in an ear-based device, which was designed and printed using 3D technology. Subsequently, a finger clipped photoplethysmography (PPG) sensor was integrated with the two-sensors in an Arduino based data acquisition system, which was placed on the subject's arm to enable a wearable multiple physiological measurement system. The physiological information of ECG and CBT was obtained from the ear of the subject, whilst the PPG signal was acquired from the finger. Furthermore, this multiple physiological signal was wirelessly transmitted to the smartphone to achieve continuous and real-time monitoring of physiological signals (ECG, CBT and PPG) on a dedicated app developed using the Java programming language. The proposed system has plenty of room for performance improvement and future development will make it adaptabadaptable, hence being more convenient for the users to implement other applications than at present.

We describe the development of a cyber-physical system (Rehab Tracker) for improving patient compliance with at-home physical rehabilitation using neuromuscular electrical stimulation (NMES) therapy. Rehab Tracker consists of three components: 1) hardware modifications to sense and store use data from an FDA-approved NMES therapy device and provide Bluetooth communication capability, 2) an iOS-based smartphone/tablet application to receive and transmit NMES use data and serve as a conduit for patient-provider interactions and 3) a back-end server platform to receive device use data, display compliance data for provider review and provide automated positive and remedial push notifications to patients to improve compliance. This system allows for near real-time compliance monitoring via a secure web portal and offers a novel conduit for patient-provider communication during at-home rehabilitation to improve compliance. The system was tested in patients (n=5) who suffered anterior cruciate ligament rupture and surgical repair to provide proof-of-principal evidence for system functionality and an initial assessment of system usability. The system functioned as designed, recording 89% of rehabilitation sessions. Thus, Rehab Tracker is a functionally correct system with the potential to be used as a tool for studying NMES and mobile communication methodologies at scale and improving compliance with at-home rehabilitation programs.

Healthcare in Saudi Arabia has been lagging behind the developed countries of the world, due to the insufficient number of healthcare practitioners and the lack of applications of tracking and monitoring technology. These shortages have contributed to problems such as patient misidentification, long patient waiting times, and the inability to locate medical equipment efficiently. The country’s Vision 2030 plan outlines ways to solve the deficient workforce problem by promoting more local health-related educational outlets, and by funding this expanding sector. Consequently, Saudi Arabia needs to adapt to the demanding nature of modern healthcare, which presents major problems that this research aims to help solve. The literature has shown that Information Technology systems have begun to be implemented in some hospitals across Saudi Arabia, but even in those hospitals these technologies are being under-utilised. The intention of this thesis is to provide an appropriate choice for a real-time tracking and monitoring technology in healthcare, in the form of an integrated RFID/ZigBee system. This thesis develops a holistic framework for healthcare institutions, to be followed for customised solutions in improving staff efficiency and productivity, and for better patient care, while minimising long-term costs. This holistic framework incorporates contextual elements from both the Information System Strategy Triangle (ISST) and the Human, Organisation and Technology-fit factors (HOT-fit) frameworks, in a way that ensures the new framework addresses technology, organisational, human and business factors. The holistic model is refined through Communities of Practice (CoPs), one of which was developed and utilised for the research purposes of this thesis, and assisted in the creation of a questionnaire for assessing the requirements and challenges of the KSA healthcare system. This questionnaire was based on 220 usable responses. It also helped to refine the framework for its final version, which included all identified factors relevant to the decision a healthcare institution faces in choosing a health information technology system. Various cases were analysed to improve the hospitals workflow, using the proposed technology and including processes such as relocating staff and medical assets. This led to the need for visualisation and knowledge management, to support real-time data analysis for business intelligence decision making. The end goal of this analysis is to provide interactive platforms to healthcare staff for use in improving efficiency and productivity. The outcomes of these improvements will be to ensure better patient care, lower patient waiting time, reduced healthcare costs, and to allow more time for staff to provide improved patient-centric care in the Saudi healthcare sector.

Rare disorders are a numerous group of pathologies, characterized by extreme heterogeneity and at the same time sharing some common characteristics, involving nearly all the ages and all the etiologies. Furthermore, rare disorders often represent chronic conditions; as regards natural history, they are characterized by adverse outcomes, in terms of disability and quality of life and in many cases lead to a long terminal illness phase. Rare disorders don't represent a defined nosological group; an exact list of these disorders shared by the majority doesn't exist, as it strictly depends on the context we refer to (geographical, legislative, epidemiological, etc.). Many countries have adopted definitions based on prevalence criteria, but the cut-off limits used to define as rare a disorder affecting the population are different. For all these reasons rare disorders represent a very complex topic from the health planning point of view of. Three main priority areas can be identified: - the planning of services/interventions and the related process of resources' allocation; - the creation of monitoring systems, allowing the collection of useful information; - the relationship existing between the clinical activities and research activities. As an example of planning strategies implemented in the first area, the process of selection of Reference Centers for rare disorders in the Veneto Region and in a Wide-Area context is presented. For what concerns the second area, due to rare disorders' extreme variability and cross-sectional age distribution, it is extremely difficult to calculate or just estimate their whole impact on the population's health. Therefore, very little can be said about the effects that new knowledge advances and research progress in this field can have at a wide population level. To tackle these questions, it is necessary to have an area wide enough to be completely monitored for all rare disorders, which is very difficult to be pursued. The Registries focused on a specific disease, or on a group of diseases, despite their importance in improving the knowledge on specific disorders, are of limited usefulness from a health care planning point of view. To properly determine the impact of the complex phenomenon "rare disorders" at a population level, area-based surveillance systems are needed, monitoring not the single conditions but the whole group of rare disorders. In enforcing the rare disorders' national law, issued in 2001, specific health policies and integrated planning strategies were developed by the Veneto Region. Since 2002 a unique computerized monitoring system allowing diagnosis recording, exemption leading to benefits - entitlement and cases - enrollment in the Register was implemented. This system connects all the identified centers of excellence, all the health districts and the local pharmaceutical services. The patient enters the surveillance system after a specific diagnosis of rare disease has been made, which is followed by the exemption issued by the local health districts. More than 12,000 patients are now enrolled in the Register. The information collected by the Register is useful for epidemiological studies, but can be also the starting point for the implementation of services for the patients. The example of the supply of diet products free of charge for metabolic patients is presented. Patients with rare disorders are burdened by extremely complex health care histories. The lack of case notification systems and the common non univocal correspondence between rare disease entity and disease code reported in the International Classification of Diseases (ICD), commonly used in current data flows, allow only estimate of affected patients. At the same time the patient's clinical history collected by the Register can be enriched with the information coming from other current data flows. Another part of the thesis focuses on the identification of rare disorders' patients and their history of hospitalisations using Hospital Discharge Records. From a health planning point of view the interactions between the three areas of interventions above mentioned need to be further studied in order to identify which tools can be used to achieve a better integration. These tools essentially belong to two dimensions: culture, which results from the combination of knowledge and attitudes, and information. For the first topic, the experience of the definition of therapeutic protocols for patients affected by neurological rare diseases is described. This agreement process implies the shift from the activity of collecting information to the elaboration of consensus guidelines, improving clinical practice standardization and progressively increasing the quality of the interventions. As regards information, this represents a very crucial issue speaking of rare disorders, since they are characterized by paucity of available sources. The patients seek information both on topics related to the disease itself as well as information on which are the laboratories performing diagnoses or the centres with the best clinical expertise. Furthermore, lack of information characterizes also the knowledge of legislative aspects, especially the ones potentially leading to benefits entitlement. Two concrete applications, aiming at improving the spreading of information, reducing the existing gap in this field are presented: the web-site and the help-line of the Veneto Region Register for Rare Disorders. Finally, the application of translational research in the field of rare disorders is discussed. Translational research refers to translating research into practice. It aims at ensuring that new treatments, devices, and research knowledge reach the patients for whom they are developed. In the context of health planning, a translational approach can be applied when population-based interventions and practice-based research bring the results of the first kind of research to the public. In the field of rare disorders both the translational approaches have to be implemented. Rare disorders' patients could benefit not only from translation of biotechnological and novel therapies, but also from interventions aimed at improving access, reorganizing and properly coordinating systems of care.

Il benessere degli animali è uno dei temi più discussi temi delle scienze animali. Molti ricercatori hanno provato a darne una definizione e a sviluppare strumenti utili alla sua valutazione negli allevamenti di vacche da latte. Nel presente lavoro viene discussa la possibilità di valutare il benessere degli animali, attraverso sistemi di innovazione da diversi punti di vista: scientifico, economico e zootecnico. Quattro differenti ricerche sono state sviluppate per confrontare i risultati sulla valutazione del benessere degli animali negli allevamenti da latte ottenuti con: indici fisiologici, modello SDIB e un sistema di monitoraggio della ruminazione.<br>Animal welfare is one of the most discussed topic in the animal science. Many researchers have been proving to define animal welfare and to develop tools useful to assess its levels in dairy farms. In the present issue it is discussed with different point of view (scientific, economical and zootechnic) the opportunity to assess the animal welfare through innovations system. Our different research was develop to compare the results about animal welfare in dairy herds obtained by physiological indices as well as blood variables, a model for animal welfare assessment as well as IDSW model, a rumination monitoring system.

Il benessere degli animali è uno dei temi più discussi temi delle scienze animali. Molti ricercatori hanno provato a darne una definizione e a sviluppare strumenti utili alla sua valutazione negli allevamenti di vacche da latte. Nel presente lavoro viene discussa la possibilità di valutare il benessere degli animali, attraverso sistemi di innovazione da diversi punti di vista: scientifico, economico e zootecnico. Quattro differenti ricerche sono state sviluppate per confrontare i risultati sulla valutazione del benessere degli animali negli allevamenti da latte ottenuti con: indici fisiologici, modello SDIB e un sistema di monitoraggio della ruminazione.<br>Animal welfare is one of the most discussed topic in the animal science. Many researchers have been proving to define animal welfare and to develop tools useful to assess its levels in dairy farms. In the present issue it is discussed with different point of view (scientific, economical and zootechnic) the opportunity to assess the animal welfare through innovations system. Our different research was develop to compare the results about animal welfare in dairy herds obtained by physiological indices as well as blood variables, a model for animal welfare assessment as well as IDSW model, a rumination monitoring system.

Selon les projections de l'Organisation mondiale de la santé (OMS), il est estimé qu'en 2050, plus de 22 % de la population mondiale aura 60 ans ou plus. Cette évolution démographique s'accompagne d'une prévalence croissante des maladies chroniques. En France, une personne sur quatre souffre actuellement d'une maladie chronique, un chiffre qui atteint trois personnes sur quatre chez les personnes âgées de 65 ans et plus. Ces maladies contribuent de manière significative à la mortalité, représentant 74 % du nombre total de décès en 2019. Heureusement, bon nombre de ces affections peuvent être prévenues ou retardées en suivant les recommandations d'activité physique de l'OMS. De nombreuses études ont démontré l'impact profond de l'activité physique sur la prolongation de l'espérance de vie et l'amélioration de la qualité de vie de la population. Dans cette optique, les objectifs de recherche de cette étude s'inscrivent dans le domaine de la Gestion de la santé prédictive (PHM) et de la prescription du sport, en mettant l'accent sur le parcours de soins des patients atteints de maladies chroniques. Cependant, la modalité précise du contrôle, en particulier le mécanisme de rétroaction concernant le comportement des individus pendant l'activité physique, reste à déterminer. Pour relever ce défi, le projet propose la mise en place d'un dispositif médical connecté, spécifiquement un vélo à assistance électrique intégré à une intelligence artificielle embarquée. Cette combinaison vise à recueillir des données et à contribuer à la prévention des pathologies chroniques chez les individus. L'effort scientifique principal consiste à concevoir et intégrer une architecture matérielle et logicielle innovante et adaptable, en incorporant des capteurs de pointe utilisant une technologie flexible. Ce cadre permet la surveillance à la fois des cyclistes occasionnels et expérimentés pendant leur pratique, en permettant un contrôle intelligent du niveau d'assistance électrique et la mise en œuvre d'instructions médicales basées sur des évaluations médicales préalables<br>According to projections by the World Health Organization (WHO), it is estimated that by 2050, more than 22% of the global population will be aged 60 years or older. This demographic shift is accompanied by a growing prevalence of chronic diseases. In France, one in four individuals currently suffers from a chronic condition, a proportion that rises to three out of four among those aged 65 and above. These diseases significantly contribute to mortality, accounting for 74% of total deaths in 2019. Fortunately, many of these conditions can be prevented or delayed by adhering to the physical activity recommendations provided by the WHO. Extensive research has demonstrated the profound impact of physical activity on prolonging lifespan and enhancing overall quality of life across populations. With this perspective in mind, the research objectives of this study lie within the realm of Prognosis Health Management (PHM) and prescription sports, with a specific emphasis on the healthcare trajectory of patients with chronic conditions. However, the precise methodology for control, particularly the feedback mechanism pertaining to individuals' behavior during physical activity, remains to be delineated. To tackle this challenge, the project proposes the implementation of a connected medical device, specifically an electric-assisted bicycle integrated with embedded artificial intelligence. This combination aims to collect data and contribute to the prevention of chronic pathologies for individuals. The primary scientific endeavor entails designing and integrating an innovative and adaptable hardware and software architecture, incorporating state-of-the-art sensors that utilize flexible technology. This framework facilitates the monitoring of both occasional and experienced cyclists during their practice, enabling intelligent control of the level of electrical assistance and the implementation of medical instructions based on prior medical assessments

La rééducation fonctionnelle classique comprend des séances thérapeutiques, des exercices à domicile et des mouvements avec ou sans l'aide de thérapeutes. Cette approche classique souffre de nombreuses limitations, en raison de l’incapacité de l’expert à suivre les séances à domicile du patient et du manque de motivation du patient pour répéter les exercices sans retour. Les jeux sérieux ont été présentés comme une solution à ces problèmes. Premièrement, des exergames ont été développés à l’aide d’une méthodologie de codesign, où patients, experts et développeurs ont pris part aux procédures de conception. Le capteur Kinect a été utilisé pour capturer la cinématique en temps réel au cours de l’exercice. Ensuite, une fusion de données a été étudier entre le capteur Kinect et les unités de mesure inertielles, afin d’augmenter la précision de l’estimation de l’angle des articulations, à l’aide d’une approche système de systèmes. Le système a été évalué par des patients avec différentes pathologies au cours de multiples campagnes d'évaluation. Les résultats obtenus montrent que les jeux sérieux peuvent être une solution pour des pathologies spécifiques. En outre, les experts ont été convaincus de la pertinence clinique de ce dispositif et ont estimé que les données proposées étaient suffisantes pour évaluer la situation du patient. La mise en place de tels systèmes maximiserait l’efficacité du programme de réadaptation. D'autre part, ce système permettrait également de réduire les limitations actuellement présentes dans les programmes de rééducation classiques, permettant aux patients de visualiser leurs mouvements et aux experts de suivre l'exécution de l'exercice à domicile<br>Conventional musculoskeletal rehabilitation consists of therapeutic sessions, home exercise assignment, and movement execution with or without the assistance of therapists. This classical approach suffers from many limitations, due to the expert’s inability to follow the patient’s home sessions, and the patient’s lack of motivation to repeat the same exercises without feedback. Serious games have been presented as a possible solution for these problems. This thesis was carried out in the eBioMed experimental platform of the Université de technologie de Compiège, and in the framework of the Labex MS2T. The aim of this thesis is to develop a real-time, serious gaming system for home-based musculoskeletal rehabilitation. First, exergames were developed, using a codesign methodology, where the patients, experts and developers took part in the design and implementation procedures. The Kinect sensor was used to capture real-time kinematics during each exercise. Next, data fusion was implemented between the Kinect sensor and inertial measurement units, to increase the accuracy of joint angle estimation, using a system of systems approach. In addition, graphical user interfaces were developed, for experts and patients, to suit the needs of different end-users, based on the results of an end-user acceptability study. The system was evaluated by patients with different pathologies through multiple evaluation campaigns. Obtained results showed that serious games can be a good solution for specific types of pathologies. Moreover, experts were convinced of the clinical relevance of this device, and found that the estimated data was more than enough to assess the patient’s situation during their home-based exercise sessions. Finally, during these three years, we have set the base for a home-based rehabilitation system that can be deployed at home or in a clinical environment. The implementation of such systems would maximize the efficiency of rehabilitation program, while saving the patient’s and expert’s time and money. On the other hand, this system would also reduce the limitation that are currently present in classical rehabilitation programs, allowing the patients to visualize their movements, and the experts to follow the home exercise execution

This study examined privacy legislation in California to identify those electronic Protected Health Information (e-PHI) privacy policies that are suited to seniors using in-home health monitoring systems. Personal freedom and independence are essential to a person's physical and mental health, and mobile technology applications provide a convenient and economical method for monitoring personal health. Many of these apps are written by third parties, however, which poses serious risks to patient privacy. Current federal regulations only cover applications and systems developed for use by covered entities and their business partners. As a result, the responsibility for protecting the privacy of the individual using health monitoring apps obtained from the open market falls squarely on the states. The goal of this study was to conduct an exploratory study of existing legislation to learn what was being done at the legislative level to protect the security and privacy of users using in-home mobile health monitoring systems. Specifically, those developed and maintained by organizations or individuals not classified as covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The researcher chose California due to its reputation for groundbreaking privacy laws and high population of seniors. The researcher conducted a content analysis of California state legislation, federal and industry best practices, and extant literature to identify current and proposed legislation regarding the protection of e-PHI data of those using in-home health monitoring systems. The results revealed that in-home health monitoring systems show promise, but they are not without risk. The use of smartphones, home networks, and downloadable apps puts patient privacy at risk, and combining systems that were not initially intended to function together carries additional concerns. Factors such as different privacy-protection profiles, opt-in/opt-out defaults, and privacy policies that are difficult to read or are not adhered to by the application also put user data at risk. While this examination showed that there is legislative support governing the development of the technology of individual components of the in-home health monitoring systems, it appears that the in-home health monitoring system as a whole is an immature technology and not in wide enough use to warrant legislative attention. In addition – unlike the challenges posed by the development and maintenance of the technology of in-home health monitoring systems – there is ample legislation to protect user privacy in mobile in-home health monitoring systems developed and maintained by those not classified as covered entities under HIPAA. Indeed, the volume of privacy law covering the individual components of the system is sufficient to ensure that the privacy of the system as a whole would not be compromised if deployed as suggested in this study. Furthermore, the legislation evaluated over the course of this study demonstrated consistent balance between technical, theoretical, and legal stakeholders. This study contributes to the body of knowledge in this area by conducting an in-depth review of current and proposed legislation in the state of California for the past five years. The results will help provide future direction for researchers and developers as they struggle to meet the current and future needs of patients using this technology as it matures. There are practical applications for this study as well. The seven themes identified during this study can serve as a valuable starting point for state legislators to evaluate existing and proposed legislation within the context of medical data to identify the need for legislation to assist in protecting user data against fraud, identity theft, and other damaging consequences that occur because of a data breach.

Monitoramento da integridade estrutural (Structural health monitoring - SHM) está relacionado à implementação de alguma estratégia para a detecção de dano em estruturas de engenharia. Este estudo geralmente envolve a observação do sistema no tempo, utilizando amostras periódicas de medições da resposta dinâmica, a partir de um grupo de sensores, a fim de verificar alterações nos parâmetros modais, que podem indicar a presença do dano. Entretanto, especialmente para estruturas treliçadas, este processo tornase difícil principalmente porque nem todos os deslocamentos ou rotações nodais modelados numericamente podem ser medidos experimentalmente. Desta forma, o presente estudo tem por objetivo tratar algumas das ainda correntes questões dos sistemas de monitoramento da integridade estrutural baseados em registros de vibração. Primeiramente aborda-se um tema que, apesar de recentemente ter se mostrado importante, ainda apresenta muito poucos estudos: a influência da variação dos efeitos ambientais, especialmente a temperatura, sobre as características dinâmicas de estruturas. Com o intuito de verificar tal influência em pontes metálicas, os resultados apresentados por Ni et al. (2005) são utilizados para a realização de estudos de correlação, através de uma comparação entre equações de regressão linear e um modelo, proposto no presente trabalho, em Redes Neurais Artificiais (RNA). A seguir são estudados procedimentos de identificação estocástica de sistemas, passo fundamental para o monitoramento da integridade estrutural. Realiza-se uma revisão bibliográfica nesta área abordando a evolução dos métodos que utilizam apenas dados de resposta para a identificação. Enfoque principal é dado nos métodos de identificação estocástica de subespaço (SSI), pois se mostram os mais práticos e robustos para a determinação dos parâmetros modais da estrutura.Finalmente, o método dos vetores de localização de dano (Damage locating vector method- DLV), introduzido por Bernal (2002), é extensivamente discutido. Esta é umatécnica eficaz quando operando com um número arbitrário de sensores, modos truncados e em cenários de dano múltiplo, mantendo as operações numéricas simples. Além disto, a influência do ruído na precisão do método dos vetores de localização de dano é avaliada. Com o intuito de verificar o comportamento do método DLV perante diferentes intensidades de dano e, principalmente, na presença de ruído de medição, um estudo paramétrico é conduzido. Distintas excitações, como também diferentes cenários de dano, são numericamente testadas em uma treliça Warren contínua considerando um limitado conjunto de sensores, através de cinco níveis de ruído. Além disto, é proposto um caminho alternativo para determinar os vetores de localização de dano no procedimento do método DLV. A idéia é oferecer uma opção alternativa para a solução do problema utilizando um método algébrico amplamente difundido. A formulação original via decomposição em valores singulares é subsituída pela solução mais trivial de um problema de valores próprios. Isto é possível graças à relação algébrica entre a decomposição em valores singulares de uma matriz e a solução do problema de autovalores desta matriz pré-multiplicada por sua transposta. Os resultados finais mostraram que o método DLV, considerando a soluça alternativa, foi capaz de corretamente localizar as barras danificadas, utilizando dados somente de resposta da estrutura, mesmo considerando pequenas intesidades de dano e moderados níveis de ruído.<br>Structural health monitoring (SHM) refers to the implementation of some strategy for damage detection in engineering structures. This study generally involves the observation of a system over time using periodically sampled dynamic response measurements from a set of sensors in order to verify changes in modal parameters, which may indicate damage or degradation. However, especially for truss structures this process sounds difficulty mainly because not all nodal displacements or rotations in the numerical model can be experimentally measured. In this context, the present thesis aims to address some still current issues of the vibration-based structural health monitoring systems. Firstly it is introduced a subject that, although has recently shown important, still presents very few studies: the environmental effects, mainly temperature, on the structural modal properties. Seeking to address this influence on steel bridges, the results presented by Ni et al. (2005) are used to conduct correlations studies, comparing linear equation regression with an artificial neural network model (ANN), proposed in the present thesis. Procedures for stochastic systems identification are studied next, which is a fundamental phase for the SHM systems. A literature review in this field addressing the evolution of the methods that just use response data for identification is carried out. Main focus is given in the stochastic subspace identification methods (SSI), because they have been known as the most practical and robust methods to determine the structure’s modal parameters. Finally, the damage locating vector (DLV) method, introduced by Bernal (2002), is extensively discussed. This is a useful approach because is effective when operating with an arbitrary number of sensors, a truncated modal basis and multiple damage scenarios, while keeping the calculation at a low level. In addition, the noise influence on the accuracy of the damage locating vector method is evaluated. In order to verify the DLV behavior in front of different damages intensities and, mainly, in presence of measurement noise, a parametric study had been carried out. Different excitations as well as damagescenarios are numerically tested in a continuous Warren truss structure with a set of limited measurement sensors through five noise levels. Besides this, it is proposed another way to determine the damage locating vectors in the DLV procedure. The idea is to offer an alternative option to solve the problem with a more widespread algebraic method. The original formulation via singular value decomposition (SVD) is replaced by a common solution of an eigenvector and eigenvalue problem. This is possible thanks to the algebraic relationship between the singular value decomposition of a matrix and the eigenproblem solution of this matrix pre-multiplied by its transpose. The final results show that the DLV method, adopting the alternative, was able to correct locate the damaged bars, using an output-only system identification procedure, even considering small intensities of damage and moderate noise levels.

ABSTRACT PATIENT MONITORING VIA MOBILE AD HOC NETWORK - MAXIMIZING RELIABILITY WHILE MINIMIZING POWER USAGE AND DELAYS BY SWETA SNEHA May 22nd, 2008 Committee Chair: Dr. Upkar Varshney Major Department: Computer Information Systems Comprehensive monitoring of patients based on wireless and mobile technologies has been proposed for early detection of anomalies, provision of prompt medical attention, and corresponding reduction in healthcare expenses associated with unnecessary hospitalizations and treatment. However the quality and reliability of patient monitoring applications have not been satisfactory, primarily due to their sole dependence on infrastructure-oriented wireless networks such as wide-area cellular networks and wireless LANs with unpredictable and spotty coverage. The current research is exploratory in nature and seeks to investigate the feasibility of leveraging mobile ad hoc network for extending the coverage of infrastructure oriented networks when the coverage from the latter is limited/non-existent. Although exciting, there are several challenges associated with leveraging mobile ad hoc network in the context of patient monitoring. The current research focuses on power management of the low-powered monitoring devices with the goal to maximize reliability and minimize delays. The PRD protocols leveraging variable-rate transmit power and the PM-PRD scheme are designed to achieve the aforementioned objective. The PRD protocols manage power transmitted by the source and intermediate routing devices in end to end signal transmission with the obejective to maximize end to end reliability. The PM-PRD scheme operationalizes an appropriate PRD protocol in end to end signal transmission for diverse patient monitoring scenarios with the objective to maximize reliability, optimize power usage, and minimize delays in end to end signal transmission. Analytical modeling technique is utilized for modeling diverse monitoring scenarios in terms of the independent variables and assessing the performance of the research artifacts in terms of the dependent variables. The evaluation criterion of the research artifacts is maximization of reliability and minimization of power usage and delays for diverse monitoring scenarios. The performance evaluation of the PRD protocols is based on maximization of end to end reliability in signal transmission. The utility of the PM-PRD scheme is associated with operationalizing an appropriate protocol for a given monitoring scenario. Appropriateness of a protocol for a given scenario is based on the performance of the PRD protocols with respect to the dependent variables (i.e., end to end reliability, end to end power usage, and end to end delays). Hence the performance evaluation of the PRD protocols in terms of the dependent variables is utilized to (a) discover the best protocol and (b) validate the accuracy and utility of the PM-PRD scheme in allocating the best protocol for diverse monitoring scenarios. The results validate the effectiveness of the research artifacts in maximizing reliability while minimizing power usage and delays in end to end signal transmission via a multi-hop mobile ad hoc network. Consequently the research establishes the feasibility of multi-hop mobile ad hoc network in supplementing the spotty network coverage of infrastructure oriented networks thereby enhancing the quality and dependability of the process of signal transmission associated with patient monitoring applications.

Le vieillissement de la population est l'un des problèmes clés pour la grande majorité de nombreux pays. Le nombre de personnes âgées souffrant de multiples maladies et nécessitant une surveillance continue de leurs signes vitaux augmente chaque jour, entraînant des coûts de santé supplémentaires. Les systèmes de santé modernes en médecine gériatrique nécessitent souvent la présence de personnes âgées à l'hôpital, ce qui est en conflit avec leur exigence d'indépendance et d'intimité. Les développements récents sur la télésurveillance e-santé offrent une large gamme de solutions. Cependant, la plupart des appareils sont conçus pour une détection médicale spécifique et fonctionnent indépendamment les uns des autres. Il y a toujours un manque de cadre intégré avec une interopérabilité élevée et un support de surveillance en ligne continu pour une analyse de corrélation plus approfondie. Cette thèse est une étape vers un système de collecte de données à distance, complet et continu pour les personnes âgées présentant divers types de problèmes de santé. Notre esprit de recherche est motivé par la demande immédiate d'un système de surveillance de la santé à distance sans fil sécurisé et fiable pour les personnes âgées en résidence assistée, combinant diverses sources de données. Pour créer un système aussi complet, nous le divisons en sous-systèmes, afin de le rendre réalisable et facile à mettre en œuvre, nous permettant ainsi de mettre à jour chaque sous-système individuellement dans les études futures sans affecter les autres sous-systèmes intégrés. L'accent est mis sur un système complet de surveillance à distance de l'e- santé. La liste des principales contributions contient (1) proposer une nouvelle approche pour la sécurité des appareils surveillés et proposer une solution pour prévenir les attaques MiTM et réduire la consommation d'énergie, (2) nous proposons une détection de chute fiable, (3) étudier et développer une nouvelle méthode de reconnaissance des activités quotidiennes des patients âgés surveillés, (4) proposer une approche pour améliorer la fiabilité du système et réduire les fausses alarmes et les interventions inutiles, (5) proposer et développer un algorithme de conversion de la langue des signes en texte utilisant une analyse de fusion multi-capteurs. En conséquence, nous prévoyons de fournir un système de surveillance avec une précision fiable dans la détection d'événements anormaux et de déclencher une alarme lors de la détection de tels événements pour demander de l'aide et de l'assistance<br>Aging population is one of the key problems for the vast majority of many countries. The number of elderly people who suffer from multiple diseases and need continuous monitoring of their vital signs increases everyday, resulting in additional healthcare costs. Modern healthcare systems in geriatric medicine often require elderly presence at the hospital which conflict with their demand for independence and privacy. Recent developments on remote e-health monitoring, provides a wide range of solutions. However, most of the devices are designed for specific medical sensing and operate independently from each other. There is still a lack of integrated framework with high interoperability and continuous online monitoring support for further correlation analysis. This thesis is a step towards a remote, complete, and continuous data gathering system for elderly people with various types of health problems. Our research spirit is motivated by immediate demand in a secured and trusted remote wireless health monitoring System for assisted living Elderly people, combining various data sources. To create such a complete system we divide it into subsystems, in order to make it feasible and easy to implement, thus allowing us to update each subsystem individually in the future studies without affecting other integrated subsystems. The main focus is on a complete remote e-health monitoring system. The list of main contributions contains (1) propose a new approach for security of monitored devices and propose a solution to prevent MiTM attacks and reduce energy consumption, (2) we propose reliable fall detection,(3) investigating and developing a novel recognition method of daily activities for monitored elderly patient, (4) propose an approach to enhance the reliability of the system and to reduce false alarms and unnecessary interventions, (5) propose and develop a sign language to text converter algorithm using multi-sensor fusion analysis. As a result, we expect to provide a monitoring system with reliable accuracy in the detection of abnormal events, and raise an alarm upon detection of such events to seek help and assistance

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-07T19:39:46Z No. of bitstreams: 1 Claudia Maria Scheffel Corrêa da Silva.pdf: 2016853 bytes, checksum: f5d5261b705656a755b11441e297653d (MD5)<br>Made available in DSpace on 2015-07-07T19:39:47Z (GMT). No. of bitstreams: 1 Claudia Maria Scheffel Corrêa da Silva.pdf: 2016853 bytes, checksum: f5d5261b705656a755b11441e297653d (MD5) Previous issue date: 2013-08-20<br>CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>Este estudo pretendeu conhecer o estágio em que se encontra o processo de integração entre a Atenção Básica e a Vigilância em Saúde em um município da região metropolitana de Porto Alegre/RS. Acredita-se que a integração entre estas duas áreas é fundamental para se alcançar a integralidade da atenção, um dos princípios do Sistema Único de Saúde. O município escolhido tem investido em inovações gerenciais, contando com a presença do apoiador institucional, que valoriza as ações intersetoriais, buscando a articulação entre as diversas áreas do sistema de saúde e de outros setores fora dele. Espera-se que esta opção favoreça a integração entre a Atenção Básica e a Vigilância em Saúde. O estudo teve como objetivo conhecer os entraves existentes e as conquistas já vivenciadas durante o processo de integração entre a Atenção Básica e a Vigilância em Saúde em um município da região metropolitana de Porto Alegre/RS. O delineamento da pesquisa é o Estudo de Caso. As técnicas de pesquisa utilizadas foram a entrevista semiestruturada, o grupo de discussão focal e a pesquisa documental. A análise interpretativa chamada de hermenêutica dialética foi a técnica utilizada nesse estudo para a análise dos dados. Verificou-se que grande parte das ações de vigilância epidemiológica foi descentralizada e é executada pela Atenção Básica (AB). A vigilância ambiental é a área com menos ações descentralizadas e atividades realizadas de forma conjunta. O território da AB é respeitado pelos servidores da Vigilância em Saúde. O maior desafio encontrado para a integração entre a AB e a vigilância foi a troca de servidores não estáveis por funcionários concursados em 2012. Em torno de 80% dos servidores da Atenção Básica precisou ser substituído. Tal quadro se refletiu na rotina de trabalho e na integração entre as áreas. O quadro funcional ainda sofre alterações. Sabe-se que vai levar algum tempo para que a rede esteja novamente completa. Entretanto, passado esse período difícil, acredita-se que funcionários estáveis e com plano de carreira definido se fixem, o que tornaria a rotatividade bem menos frequente. Por isso, pensa-se que o cenário futuro tende a ser melhor do que era antes da troca de funcionários e que o processo de integração tenda a se efetivar.<br>This study aimed to learn about the status of the integration process between the Primary Health Care and the Health Monitoring System in a city of the metropolitan area of de Porto Alegre/RS. It is believed that the integration between such areas is fundamental for the integrality of Health Care, one of the principles of the Unified Health System. The chosen city has invested in management innovation, relying on the presence of the intitutional supporter, who prioritizes intersectoral actions, seeking articulation among the several areas of the health care system as well as of other segments external to it. It is expected that such option favors the integration between the Primary Health Care and the Health Surveillance. This study had the intent of making known the existing obstacles and the conquests already experienced throughout the integration process between the Primary Health Care and the Health Surveillance in a city of the metropolitan area of de Porto Alegre/RS. The outline of the research is based on a Case Study method. The survey techniques used were: semi-structured interview, focus group discussion, and desk research. The interpretative analysis type called Dialectical Hermeneutics was the technique used in the group for the data analysis. It has been demonstrated that the integration process between the Primary Health Care and the Health Surveillance in the city is at an advanced stage. Most of the actions are already done conjunctively and the territory of the Basic Health Care is respected by the workers in the Health Surveillance. The greatest challenge for the integration of the Primary Health Care and the Health Surveillance was the exchange of non-tenured workers for long-tenured ones in 2012. About 80% of the workers in Primary Health Care needed to be replaced. Such scenario reflected on the work routine and on the integration between the areas. The staff are still undergoing changes. Still, it is known that it will be a long time until the network is again settled. Nevertheless, after such a difficult time, it is believed that the long-tenured workers with a career plan will end up settling down, making the turnover quite less frequent. For that reason, it is thought that the future prospect tends to be better than it was before the replacement of workers and that the integration process is prone to be achieved.

No Brasil, a construção bem como as mudanças nos mais de vinte anos do Sistema Único de Saúde (SUS) tem demandado um crescente interesse em estratégias que valorizem o uso da informação em saúde. Cada vez mais as incertezas entre a complexidade deste sistema e as intervenções necessárias para atender os seus preceitos e as necessidades da população precisam de respostas ágeis e efetivas. A efetividade dos serviços e a equidade em sua prestação são cruciais na atenção à saúde e mostram-se como desafio frente à dificuldade de avaliação dos resultados das ações pela demora no impacto nos indicadores epidemiológicos clássicos. O monitoramento é uma prática que pode ser destacada pela agilidade nas respostas, porém é nítido o quanto a discussão sobre o assunto é pouco estabelecida na literatura disponível. Se apresenta como uma prática interativa e proativa que utiliza informações disponíveis com o potencial de organizar e divulgar rapidamente as descobertas feitas, gerar um aprendizado organizacional e apoiar o processo decisório. A proposta deste estudo considerou o Painel de Monitoramento da Secretaria Municipal da Saúde de São Paulo como ponto de partida para pesquisar sobre as potencialidades do monitoramento na gestão. Uma pesquisa de métodos mistos foi a opção metodológica para este trabalho que buscou aprofundar o marco referencial teórico sobre monitoramento, descrever e analisar criticamente as referências técnicas utilizadas para a construção da proposta e realizar um estudo de caso único em território descentralizado do município de São Paulo sobre a rotina local na sua utilização e com isso analisar as potencialidades e os alcances desta experiência na gestão municipal. Concluiu-se que o monitoramento por meio de indicadores selecionados a partir de dados secundários é uma estratégia oportuna de acompanhar a tendência de determinadas ações possibilitando assim a emissão de juízo de valor e tomada de decisão com rapidez. O aplicativo propicia aos gestores e técnicos informações relevantes que apoiam o processo decisório, além de possibilitar a sua utilização em diferentes contextos da gestão e portes territoriais. Por outro lado, a prática cotidiana é pautada por prioridades normativas, onde a precisão do registro, a coerência das fontes e a quantidade apontada sobrepõem-se à informação em si, o seu significado e as ações necessárias para o enfrentamento dos problemas. O uso da informação é cultura em construção e o Painel de Monitoramento traz a possibilidade de organizar, qualificar e difundir dados secundários dos diferentes sistemas de informação do Sistema Único de Saúde (SUS). Além disso, tem contribuído também no papel de fomentar as discussões sobre os diferentes temas que envolvem as prioridades de uma gestão em todos os níveis do sistema de saúde do município de São Paulo.<br>In Brazil, construction and changes in more than twenty years of the Unified Health System (SUS) has demanded an increasing interest in strategies to enhance the use of health information. Increasingly, uncertainties between the complexity of this system and the interventions required to meet its precepts and the population\'s needs require agile and effective responses. The effectiveness of services and equity in its provision are crucial in health care and shows up as large challenge facing the difficulty of effective evaluation of this attention for the delay in the impact on classical epidemiological indicators. Monitoring is a practice that can be highlighted by the responsiveness, but it is clear how the discussion on the subject not yet established in the available literature. It is presented as an interactive and proactive practice using information available with the potential to quickly organize and disseminate discoveries made, generate organizational learning and support decision making. This study considered the Monitoring Panel of the Health Department of São Paulo as a starting point to research on the potential monitoring in a management. A survey of mixed methods was the method chosen for this work that sought to deepen the theoretical framework on monitoring, review and critically analyze the theoretical foundations of tool construction and conduct a case study in a decentralized space in São Paulo on the routine site on its use and thus evaluate the potential and scope of this experience in municipal management. It was concluded that monitoring through indicators from secondary data is an agile strategy to follow the trend of certain actions thus enabling value-issue and decision making quickly. The application provides managers and technical relevant information supporting the decisionmaking process, and enable its use in different areas of management and territorial sizes. On the other hand, everyday practice is still guided by normative priorities, where the accuracy of the record, the consistency of sources, pointed amount, overrides the information itself, its meaning and the necessary actions to face the problems. The use of information is culture construction and Monitoring Panel brings the ability to organize, disseminate and qualify secondary data from different information systems of the National Health System (SUS). Moreover, it has also contributed in part to encouraging discussions on the different issues involving the priorities of management at all levels of the São Paulo municipal health system.

E-hälsa blir allt mer relevant i och med att IT utvecklas i samhället, och kan hjälpa sjukvården att bli effektivare. Det finns stora svårigheter för läkare att få en samlad hälsobild över patientens läkemedelsanvändning, vilket gör att läkaren har svårt att fatta beslut rörande patientens medicinering. Dessa problem grundar sig i den bristfälliga informationsöverföringen mellan vårdinstanser. Ehälsomyndigheten har tagit sig ann denna utmaning genom att skapa en plattform som ska göra det enklare för patienten att hantera all sin hälsoinformation. Till denna plattform kan utvecklare utveckla mobilapplikationer med fokus på hälsa. Vilket kan skapa nya utmaningar då de ska anpassas för att alla ska kunna använda dem. En grupp som vanligen kan känna sig utanför är seniorer och speciellt de över 75 år. Seniorer kan inte alltid använda sig av de applikationer som finns tillgängliga i samma utsträckning, då de oftast är utformade efter en mer generell användare. Studien har undersökt vilka brister det finns i de generella designprinciperna och riktlinjer riktade till seniorer och hur dessa behöver anpassas för att få ett mer användbart gränssnitt. Studien utformade en prototyp utifrån etablerade designprinciper som adresserar problemet med läkemedelsuppföljning och utförde sedan användbarhetstester av denna prototyp. Seniorer fick interagera med prototypen under observationer, där fokuset låg i att finna vilka svårigheter som kan finnas med gränssnittet. Svårigheterna respondenterna upplevde analyserades och genererade rekommendationer på förändringar som till viss del implementerades i prototypen innan studien utförde sitt andra användbarhetstest. Resultatet visar att de etablerade designprinciperna till stor del kan följas vid utformandet av gränssnitt för seniorer men det finns behov av att prioritera vissa principer framför andra samt att dra vissa principer till sin spets vilket redogörs för i slutet av denna studie.<br>E-health is becoming more and more relevant in society since IT is growing, which can help the health care to be more effective. Doctors have big problems to get a collected health view of the patient’s drug usage, which makes it hard for doctors to prescribe new drugs to the patient. These problems are based on the lack of information transfer between health care agencies. The department of E-health (Ehälsomyndigheten) are creating a platform to take on this problem. This platform will make it easier for patients to handle their health information. System developers can develop mobile applications, focused on health, to this platform. Applications need to be customized so that everyone can use them, but are usually designed for the general user. Seniors, especially those over 75 years of age, can’t always make use of the applications to the same extent which can make them feel left out. This study has investigated what flaws there are to the general design principles and guidelines for the senior citizens. And how the design principles should be customized to make a more useful interface. The study developed a prototype from established design principles that addresses the problem with drug monitoring. The prototype was tested in usability tests where seniors interacted with the application during observations. The focus was to find what difficulties the seniors had interacting with the interface. The findings of the test were analyzed and generated recommendations on changes that were partially implemented in the prototype before the study conducted its second usability test. The results show that the established design principles can be followed for the most part, in the design of interfaces for seniors, but there is a need to prioritize certain principles over others. The results also indicate that some design principles need to be intensified for the senior citizens to find the interface useful. The thesis is written in Swedish.Keywords:

碩士<br>國立清華大學<br>資訊系統與應用研究所<br>101<br>Recently, each field of technologies has been substantially improved, such as wireless network and communication, embedded systems and sensor network. The system combining with all the mentioned technologies above is a so-called cyber-physical system. Cyber-physical systems are kind of interactive network of physical devices. Cyber-physical systems can be applied in more aspect by the improvement of technologies and we apply cyber-physical system in medical information field. We apply the technologies, such as wireless communication network and, embedded systems and the improvement of hardware development, in monitoring the patients’ health. In this paper, we have proposed a Smart First Aid System in Android with Cyber Physical System. We integrated bio-sensors on Android platform, developing a wearable bio-information monitoring device. We can collect user’s vital signals by this wearable bio-information monitoring device and immediately show the bio-information on the display module of wearable bio-information monitoring device. Furthermore, these vital signals would be sent to the other devices in our system by internet. The server in our system would store those vital signals in database and provide graphical user interface for healthcare center to monitoring the health of user. In case of emergency, we could send voice instructions by our healthcare application to the wearable bio-information monitoring device, and the voice instructions would be broadcasting by the voice module of the wearable bio-information monitoring device for the first-aid. In the same time, our server would send the user’s GPS location and the planning path to the external emergency center, in order not to waste times for the emergency aid.

The growth of the smartphones market share has driven the entry of a large number of new opportunities to launch new applications/mobile tools both by companies but also by individuals’ entities. The prototype solution presented here fits in the increasing emerging of smartphones applications for the health sector. This dissertation presents a solution to prevent a sudden infant death syndrome. It includes biofeedback monitoring of babies, using body sensors to collect data that will be presented in two different mobile applications: the Main Application and the Client Application. Breathing, temperature, position, and heart rate are used, and placed to the baby’s body. The Main Application will receive the data collected by the sensors via Bluetooth. This contains a monitoring tool, which parses and transforms raw data to be readable and understandable for users. This application will send the data to a Web service to be stored in a database that supports the entire created solution. The Client Application will consume the data stored in the database every previous second. Both applications have an important functionality that allows the trigger of alert notifications when an error occurs with the data collected by the sensors and the caregiver is informed with an alert in a short time. This document describes in detail the whole process done to deploy a prototype that demonstrates and validates the proposed solution and is ready for use.

A área da saúde foi uma das muitas beneficiadas com a evolução tecnológica, dando origem a novos conceitos que visam melhorar ou mesmo prolongar a vida das pessoas. Os sistemas de monitorização vestíveis, juntamente com as comunicações sem fios, são a base de uma classe emergente de redes de sensores. Estas tecnologias de informação permitem a deteção precoce de condições anormais e ajudam na sua prevenção. O objetivo é criar um destes sistemas compostos por uma rede de sensores que é implementada numa peça de roupa através de fios condutores com sensores conectados. Em contato com o corpo humano tem a função de fazer várias leituras, e.g., temperatura corporal, pulsação, entre outras. Outro objetivo é detetar quedas do utilizador. A deteção de quedas é cada vez mais importante para o utilizador, pois é uma situação que pode colocar em risco a sua saúde. Para o desenvolvimento deste conceito, são utilizadas Comunicações Móveis e o Sistema de Posicionamento Global. A primeira é uma tecnologia que permite criar chamadas de emergência em resposta a alarmes do sistema, o segundo indica qual a sua posição geográfica. Para complementar o sistema, existe uma plataforma online que regista a posição do utilizador tal como os seus dados. Tem também uma área de alertas no qual o utilizador pode verificar os seus valores preocupantes. Em caso de emergência o sistema contacta os serviços de emergência ou em casos especiais a ajuda pode ser obtida através de um UAV.<br>The health area was one of the many beneficiaries of technological evolution, giving rise to new concepts that aim to improve or even prolong people’s lives. Wearable monitoring systems, along with wireless communications, form the basis of an emerging class of sensor networks. These information technologies enable the early detection of abnormal conditions and help in their prevention. The goal is to create one of these systems composed by a network of sensors that is implemented in a garment through conductive wires with connected sensors. In contact with the human body it has the function of doing several readings, e.g., body temperature, heartbeat, among others. Another goal is to detect user falls. The detection of falls is increasingly important for the user, as it is a situation that can endanger people’s health. For the development of this concept, Mobile Communications and the Global Positioning System are used. The first is a technology that allows to create emergency calls in response to system alarms, the second indicates the geographical location. To complement the system there is an online platform that registers the position of the user as well as his data. There is also an alert area in which the user can check his alarming values. In case of emergency the system contacts the emergency services or in special cases help can be obtained through an UAV.

Significant challenges to patient monitoring systems in a hospital environment include the reliable and energy-efficient transmission of data and their real-time display. This thesis proposes innovative and novel mechanisms for the reliable transmission of patient data in Body Area Network (BAN) communication, which simultaneously ensure high throughput, low data latency, and low energy consumption by implementing energy and QoS aware routing protocols. Five main contributions are made in this regard. Firstly, a novel patient monitoring system (ZK-BAN peering framework) is proposed for real-time hospital BAN communication that displays patient data on the display units by considering data privacy, low energy consumption, better control on the devices, and patient mobility. Secondly, a novel energy-aware peering routing protocol (EPR) is introduced in which the choice of next hop is based on the residual energy and geographic information of the neighbor nodes. EPR contains three main components: a Hello protocol, a neighbor table constructor algorithm, and a routing table constructor algorithm. Thirdly, a new modular QoS-aware routing protocol (QPRD) is designed to handle the ordinary and delay-sensitive data for BAN communication in hospitals. QPRD provides an end-to-end path delay mechanism to calculate the path delays of all possible paths from a source to destination and then chooses the best path with the lowest path delay for delay-sensitive packets. Fourthly, a novel modular QoS-aware routing protocol (QPRR) is developed to handle ordinary and reliability-sensitive data for BAN communication in hospitals. The modular architecture of QPRR includes five modules: a reliability module, a packet classifier, a Hello protocol module, a routing services module, and a QoS-aware queuing module. The proposed mechanisms for end-to-end path reliability calculation and data transmission using redundant paths ensure more reliable BAN communication. Finally, a new integrated energy and QoS aware routing protocol (ZEQoS) is designed to deal with ordinary, delay-sensitive, and reliability-sensitive data packets. Extensive simulations in the OMNeT++ based Castalia 3.2 simulator show that EPR, QPRD, QPRR, and ZEQoS perform better than other similar energy and QoS aware routing protocols.

Space is known as a very aggressive and hostile environment and its degradative effects on spacecraft materials can compromise the success of the entire mission. A few types of space weather impacts on spacecrafts have been detected and the main ones are for example: space-plasma that causes surface charging on the structures with consequently biasing of instrument and physical damages; microparticles and space debris which can cause abrasions on surfaces and structural damages; UV radiation, galactic cosmic rays and solar particle events that lead to a thermal, electrical, optical and structural integrity degradation of materials and many damages in the electronic components; large gradients of temperature when, for example, space vehicles are illuminated or not by sunlight lead to a degradation of polymeric materials as well as the presence of atomic oxygen, especially in LEO orbit, that corrodes the exposed polymeric material surfaces. It is therefore necessary to provide and find solution to protect and properly isolate the spacecraft components from the external space environment. Multifunctional coatings could play a key-role in protecting and safeguarding the various spacecraft components, of different nature, from the surrounding environment. For example, it’s well known that the non-linear nature of the MLI details, such as its shape, finishing details, grounding hardware and perforation patterns, as well as the nonlinear response of metallic contact points, contribute to passive intermodulation products. For these reasons, ESA has recently funded research projects (Artes 5.1 and 5.2) to find a solution for this problem. One of the most promising concepts is the use of frequency selective surfaces as layers of the MLI. This is accomplished by using nanostructured carbon-based films on membranes, which can also improve the protection of the payload by the MLI (and in general by flexible membranes) with respect to space radiations and impact events. Multifunctional films containing carbon nanoparticles are currently investigated also to create sensors for monitoring the radiation absorbed by astronauts during extra vehicular activities (EVA) or as new and advanced grounding systems to mitigate plasma-induced spacecrafts charging. Further novel space-based applications of carbon-based multifunctional films are future membrane reflector spacecraft. These ones are a promising key technology to deliver cost-effective space-based applications such as communication antennae, optical telescopes and solar energy collectors. The main objectives of my Ph.D. research are to design and realize carbon-based nanocomposite coatings with tailored multifunctional properties for spacecraft components. The research was focused on the development and design of nanocomposite films containing carbon nanoparticles, namely carbon nanotubes and graphene nanoplatelets, which have unique multifunctional properties. The selected carbon nanoparticles were added to different types of aerospace-grade polymer matrices at several concentrations. Nanocomposite films will be fabricated on different types of substrates like Mylar sheets, carbon-fibers reinforced polymer (CFRP) composite laminates or metal substrates that are widely used in spacecraft sub-systems. Such multifunctional coatings were fabricated on one side with the aim to protect and safeguard the various spacecraft components, of different nature, from the surrounding hostile space environment, especially from ultraviolet radiations in C band (UV-C) and electrically charged particles coming from space-plasma, and on the other side to achieve thermal performance of the unit increased over time, by increasing the heat transfer coefficients, resulting in an ideal design of heat exchangers widely used in the aerospace field to control, for example, the temperature of on-board electronic components. The development of polymeric nanocomposites films with tailored excellent and multifunctional mechanical, electrical, thermal and hydrophobic properties depends on the properties and geometrical features of the nanofillers, CNTs or graphene, their grade of dispersion within the polymeric matrix as nano-reinforcements, their interaction with the polymeric matrix and the alignment of the nanofillers in the matrix as well as the fabrication process of films. For these reasons, the definition of the carbon nanoparticles, their concentration and dispersion process in the polymer matrices, the investigation and optimization of different deposition techniques such as spin-coating, spray-coating, drop-casting and bar-coating, were important preliminary steps of my PhD research, in order to optimize the wanted multifunctional properties of the film. This Ph.D. research can be summarized in 5 research activities. The first one concerns the analysis and the investigation of the effects of space-abundant UV-C radiation on the surface (hydrophobic and electrical) properties of carbon-based nanocomposite films deposited on flexible Mylar substrates by spin-coating process. The second one is about the study of the spray-coating deposition process and the investigation of the role of its working parameters in setting the morphology and the electrical performance of MWCNT-based nanocomposite films. The spray-coating technique, as opposed to the previous used spin-coating one, allows to fabricate larger polymeric coatings in terms of covered area on planar and not substrates, becoming an attractive method for large scale production of coatings. In particular, the fabrication of uniformly electrically-conductive coatings on Mylar substrate can allow the mitigation of electromagnetic interferences and plasma-induced spacecraft charging, and so this aspect it was assessed. The third study is the design of nanocomposite coatings by bar-coating process on carbon/fibers reinforced polymer (CFRP) composite structures for electrostatic charge (ESC) build-up mitigation for spacecraft and with the aim to realize new and innovative advanced grounding systems for charging mitigation as well. The fourth research activity concerns the application of the electrical resistance tomography (ERT) technique to the detection of surface conductivity changes induced by UV exposure. This technique in combination with the fabricated UV-sensitive coatings containing DNA-functionalized graphene can provide a health monitoring method for composite materials and structures that are exposed to damaging levels of UV radiation. At last, the main idea of the fifth study is to fabricate hydrophobic and, in the same time, thermal conductive efficient nanocomposite coatings applied on aluminum substrate that can reduce the filmwise condensation encouraging the dropwise one leading to increased thermal performances resulting in an ideal design of heat exchangers, used for example in the aerospace sector to control the temperature of on-board electronic components.

This dissertation examined the application of a monitoring system in football(soccer). An observational design was adopted to analyse training load (TL) andphysical fitness measurements of two professional male football teams duringtheir regular training and match routines. During the competitive period, a highertraining volume was observed before and after playing against top-levelopponents (1st to 5th in the league rank), and after losing a match. Additionally, theamount of high-intensity activity performed during training was higher whenpreparing a game against a top-level opponent. Regarding TL-induced effects onphysical fitness, training volume was associated to a reduction of heart rateresponse during the submaximal Yo-Yo Intermittent Recovery Test - level 1,indicating improved cardiorespiratory fitness. Regarding the proper choice ofexternal TL quantification method, the use of arbitrary or individualised speedbasedintensity zones adjusted to player's physical fitness (maximal aerobicspeed and maximal sprinting speed) showed similar sensitivity in the estimationof external TL magnitude (based on correlation) but differed at their absolute level(based on measurement bias). Notwithstanding, when external TL was adjustedto individual physical fitness, it revealed slightly stronger associations withperceptual responses to training, rather than when calculated using arbitraryintensity zones. Additionally, reporting external TL values as percentage valuesof distance does not inform about player's perceptual responses to training. Thepresent findings can be considered by coaching and medical departments, andanyone involved with fitness testing and TL monitoring in football players.<br>Na presente dissertação foi examinada a aplicação de um sistema de avaliaçãoe controlo do treino em futebol. Os dados de carga de treino (CT) e a aptidãofísica foram recolhidos em duas equipas de futebol masculino profissional noâmbito das rotinas de treino e de jogo. Durante o período competitivo foiobservado um volume de treino mais elevado nas semanas antes e depois dacompetição contra adversários de topo (entre as primeiras 5 equipas daclassificação da liga) e depois dos jogos cujo resultado final foi a derrota.Adicionalmente, o volume de atividade intensa durante o treino foi mais elevadonas semanas antecedentes aos jogos contra adversários de topo. O volume detreino mostrou-se associado à redução na resposta da frequência cardíaca naversão submáxima do teste Yo-Yo Intermittent Recovery Test - level 1,sugerindo uma melhor aptidão cardiorrespiratória. Relativamente aos cuidadosa ter na escolha do método de quantificação da CT externa (CTE), a utilizaçãode zonas de intensidade baseadas em velocidades determinadas de formaarbitrária ou individualizada (ajustadas à aptidão física [velocidade aeróbiamáxima e velocidade máxima do jogador]) mostrou sensibilidade semelhantecom o cálculo da magnitude da CTE (estudo da correlação), mas diferiu emtermos de cálculo absoluto da CTE (estudo do viés de medição). A perceção daintensidade da sessão associou-se mais fortemente com a CTE ajustada áaptidão física individual do que quantificada com zonas de intensidade arbitrária.Além disto, a interpretação da CTE baseada em percentagens de distância nãoinformou acerca da perceção da carga em resposta ao treino. Estes resultadospodem ser considerados por profissionais envolvidos na área da avaliação físicae fisiológica do jogador de futebol.Palavras chave: Fisiologia, Desempenho, Aptidão física, Fadiga, Avaliação.

This dissertation examined the application of a monitoring system in football(soccer). An observational design was adopted to analyse training load (TL) andphysical fitness measurements of two professional male football teams duringtheir regular training and match routines. During the competitive period, a highertraining volume was observed before and after playing against top-levelopponents (1st to 5th in the league rank), and after losing a match. Additionally, theamount of high-intensity activity performed during training was higher whenpreparing a game against a top-level opponent. Regarding TL-induced effects onphysical fitness, training volume was associated to a reduction of heart rateresponse during the submaximal Yo-Yo Intermittent Recovery Test - level 1,indicating improved cardiorespiratory fitness. Regarding the proper choice ofexternal TL quantification method, the use of arbitrary or individualised speedbasedintensity zones adjusted to player's physical fitness (maximal aerobicspeed and maximal sprinting speed) showed similar sensitivity in the estimationof external TL magnitude (based on correlation) but differed at their absolute level(based on measurement bias). Notwithstanding, when external TL was adjustedto individual physical fitness, it revealed slightly stronger associations withperceptual responses to training, rather than when calculated using arbitraryintensity zones. Additionally, reporting external TL values as percentage valuesof distance does not inform about player's perceptual responses to training. Thepresent findings can be considered by coaching and medical departments, andanyone involved with fitness testing and TL monitoring in football players.<br>Na presente dissertação foi examinada a aplicação de um sistema de avaliaçãoe controlo do treino em futebol. Os dados de carga de treino (CT) e a aptidãofísica foram recolhidos em duas equipas de futebol masculino profissional noâmbito das rotinas de treino e de jogo. Durante o período competitivo foiobservado um volume de treino mais elevado nas semanas antes e depois dacompetição contra adversários de topo (entre as primeiras 5 equipas daclassificação da liga) e depois dos jogos cujo resultado final foi a derrota.Adicionalmente, o volume de atividade intensa durante o treino foi mais elevadonas semanas antecedentes aos jogos contra adversários de topo. O volume detreino mostrou-se associado à redução na resposta da frequência cardíaca naversão submáxima do teste Yo-Yo Intermittent Recovery Test - level 1,sugerindo uma melhor aptidão cardiorrespiratória. Relativamente aos cuidadosa ter na escolha do método de quantificação da CT externa (CTE), a utilizaçãode zonas de intensidade baseadas em velocidades determinadas de formaarbitrária ou individualizada (ajustadas à aptidão física [velocidade aeróbiamáxima e velocidade máxima do jogador]) mostrou sensibilidade semelhantecom o cálculo da magnitude da CTE (estudo da correlação), mas diferiu emtermos de cálculo absoluto da CTE (estudo do viés de medição). A perceção daintensidade da sessão associou-se mais fortemente com a CTE ajustada áaptidão física individual do que quantificada com zonas de intensidade arbitrária.Além disto, a interpretação da CTE baseada em percentagens de distância nãoinformou acerca da perceção da carga em resposta ao treino. Estes resultadospodem ser considerados por profissionais envolvidos na área da avaliação físicae fisiológica do jogador de futebol.Palavras chave: Fisiologia, Desempenho, Aptidão física, Fadiga, Avaliação.

Tese de Doutoramento em Engenharia Civil<br>Hoje em dia, a gestão de um vasto acervo de estruturas complexas e infraestruturas, que se encontram próximo ou para lá do seu fim de vida útil, constitui um importante desafio para os países desenvolvidos. Neste contexto, a manutenção e a prevenção têm vindo a representar custos muito significativos, sendo necessário adotar estratégias de gestão com relação custo-benefício otimizada, mas que ainda se encontram em desenvolvimento. Com a Monitorização da Integridade de Estruturas (em inglês, Structural Health Monitoring, SHM) pretende-se garantir a identificação imediata de danos, de forma a permitir uma avaliação automatizada da integridade dos sistemas estruturais. O desenvolvimento desta área de investigação visa a obtenção de métodos adequados e fiáveis para detetar os danos o mais cedo possível, e para que estes sejam encarados de forma imediata, focada e económica. A deteção de danos pode ser formulada como um problema de classificação com uma única classe e pode ser tratada de forma eficaz por meio de ferramentas numéricas bioinspiradas, como o Algoritmo de Seleção Negativa (NSA). A presente tese tem como objetivo desenvolver e testar uma metodologia de deteção de danos baseada numa versão inovadora do NSA com geração determinística. A metodologia é composta por vários recursos numéricos, para ultrapassar as deficiências identificadas na revisão da literatura. A metodologia proposta é validada em análises numéricas e estudos de caso, considerando cenários de danos múltiplos e incrementais, e condições ambientais e operacionais variáveis. Todas as conclusões são baseadas na análise experimental e estatística da aplicação dos algoritmos desenvolvidos, procurando-se desenvolver uma comparação justa com técnicas alternativas. A metodologia proposta revela-se apropriada para a deteção de danos em estado inicial de desenvolvimento. Pode ser adaptada a diferentes tipos de estruturas e propriedades estruturais sensíveis à ocorrência de dano. É robusta em relação a fontes de incerteza como o ruído nos sinais adquiridos, ao erro induzido pela extração das propriedades ou à flutuação devida às condições ambientais variáveis. O seu desempenho é fortemente afetado pela configuração dos parâmetros do algoritmo. Deste modo, são apresentadas diferentes abordagens de configuração, bem como se recomendam valores ou intervalos para parametrização da metodologia. Em conclusão, a estratégia de deteção de danos baseada em NSA, que é validada no contexto da presente tese, é considerada eficaz e os resultados promissores recomendam mais pesquisas e novas aplicações.<br>Nowadays, developed countries are challenged by the management of a wide estate inventory of complex existing structures and infrastructures, which are either close or beyond the end of their service life. Maintenance and prevention have become a significant item of expenditure, while cost-effective strategies are required but still under development. Structural Health Monitoring (SHM) aims at the prompt identification of damage in order to allow an automated health condition assessment of structural systems. The development of such a field of investigation shall provide suitable and reliable methods for detecting the damage outbreak at the earliest possible stage, thus for facing it in a quick, focused and economic way. To this end, damage detection can be formulated as a one-class classification problem and effectively addressed through bio-inspired numerical tools, as the Negative Selection Algorithm (NSA). This thesis aims at developing and testing a damage detection methodology based on an innovative version of NSA with deterministic generation. The methodology is composed of several numerical features to tackle the relevant shortcomings that emerged during the literature review and the pilot tests. The individual features and the global methodology are validated on numerical instances and field-testing case studies, considering multiple and increasing damage scenarios and varying environmental and operational conditions. All the conclusions drawn in the present work are based on experimental analyses of the algorithms, performed based on a proper statistical design. Additional attention is paid to provide a fair comparison with alternative existing techniques. The proposed methodology results suitable for early-stage damage detection. It can be adapted to different types of structures and damage-sensitive features. It might be suitable for sensor embedment, by performing the detection on the acquisition of a single sensor. It is independent of the type of monitoring tools or excitation. It is robust against sources of uncertainties as the noise in the signals, the error induced by feature extraction and the fluctuation in the monitored features due to varying environmental conditions. Its performance is, instead, largely affected by the algorithm parameter setting. Therefore, different suitable setting designs are presented together with recommended values or ranges. In conclusion, the damage detection strategy based on NSA, that is validated in the context of the present thesis, is deemed effective and the promising results foster more research and further applications.<br>This work is financed by national funds through FCT - Foundation for Science and Technology, under grant agreement SFRH/BD/115188/2016. Moreover, it is partly financed by FCT/MCTES through national funds (PIDDAC) under the R&D Unit Institute for Sustainability and Innovation in Structural Engineering (ISISE), under reference UIDB/04029/2020.

Text in English with abstracts and keywords in English and Setswana<br>Aim: The purpose of the research was to determine the magnitude and factors associated with gestational diabetes mellitus (GDM), and to explore the experiences of gynaecologists/obstetricians and midwives in the monitoring and prevention of GDM- related adverse maternal outcomes in order to propose best practice guidelines which may be implemented to overcome the problem. Methods: A concurrent mixed methods design was used. Participants for the quantitative study were selected using systematic random sampling, with purposive sampling being used for the qualitative part of the study. A total of 2000 medical records were reviewed using a checklist, in addition to which 7 gynaecologists/obstetricians and 12 midwives were interviewed using an in-depth interview guide. Descriptive and inferential statistics were used for the quantitative part, while Colaizzi’s manual qualitative data analysis method wasused for the qualitative part of the study. Findings: The magnitude of GDM was found to be 2.2%. Age and family history of diabetes mellitus were found to be factors associated with GDM (at p < 0.001). Other factors such as obesity, previous GDM, previous history of fetal macrosomia and multiple gestations were identified by respondents as factors related with GDM. In addition, the study explored the experiences of health professionals (HPs) in the monitoring and prevention of adverse maternal outcomes related to GDM, with the results showing some differences in screening and diagnostic techniques. It was also shown that lifestyle modification (physical exercise, diet management) and medication were utilised for managing women with GDM. In this regard, all the HPs agreed that creating awareness is the best intervention for preventing GDM as well as its adverse maternal outcomes. Conclusions: The magnitude of GDM is increasing, and much needs to be done to draw attention to the burden that GDM places on the health of pregnant women and the public. Since GDM is not considered a public health problem, little is being done to monitor the condition and its adverse maternal outcomes. It is hoped that the best practice guidelines developed from this research study may assist in reducing the adverse maternal outcomes of GDM in Ethiopia<br>Maikaelelo: Lebaka la patlisiso e ne e le go tlhotlhomisa go nna teng le mabaka a a golaganeng le bolwetsi jwa sukiri jwa baimana (GDM), le go tlhotlhomisa maitemogelo a dingaka tsa malwetsi a basadi (gynaeologists/ obstetricians) le babelegisi mo go tlhokomeleng le go thibeleng ditlamorago tse di maswe mo baimaneng tse di amanang le GDM gore go tshitshinngwe dintlhakaelo tse di gaisang tse di ka diragadiwang go fenya bothata. Mekgwa: Go dirisitswe thadiso ya mekgwa e e tlhakantsweng. Banni-le-seabe ba thutopatlisiso e e lebelelang dipalopalo ba ne ba tlhophiwa go diriswa go tlhopha sampole ka go se latele thulaganyo, mme go tlhopha sampole ka maikaelelo go ne ga diriswa mo karolong ya thutopatlisiso e e lebelelang mabaka. Go sekasekilwe palogotlhe ya direkoto tsa kalafi tse 2 000 go diriswa lenanetshekatsheko, mme mo godimo ga moo, go ne ga nna le dipotsolotso le dingaka tsa malwetsi a basadi di le supa le babelegisi ba le 12 go diriswa kaedi ya dipotsolotso tse di tseneletseng. Dipalopalo tse di tlhalosang le tse go sweditsweng ka tsona di ne tsa diriswa mo karolong ya dipalopalo ya thutopatlisiso, fa go dirisitswe mokgwa wa ga Colaizi wa tokololo ya data ya mabaka mo karolong e e lebelelang mabaka. Diphitlhelelo: Go nna teng ga GDM go ne ga fitlhelwa e le 2.2%. Dingwaga le hisetori ya bolwetsi jwa sukiri ya baimana mo lelapeng di fitlhetswe e le dintlha tse di golaganeng le GDM (ka p < 0.001). Dintlha dingwe, jaaka go nona phetelela, GDM mo nakong e e fetileng, go nna teng ga macrosomia ya masea mo nakong e e fetileng le boimana jwa masea a feta bongwe di ne tsa supiwa ke batsibogi jaaka dintlha tse di golaganeng le GDM. Go tlaleletsa foo, thuto e ne ya sekaseka maitemogelo a baporofešenale ba boitekanelo (HPs) mo tlhokomelong le thibelo ya ditlamorago tse di sa siamang mo baimaneng tse di golaganeng le GDM, mme dipholo di bontshitse dipharologano dingwe mo dithekeniking tsa go sekirina le go phekola. Go bonagetse gape gore phetolo ya mokgwa wa botshelo (katiso ya mmele, tsamaiso ya mokgwa wa go ja) le kalafi di ne tsa diriswa go laola bolwetsi jwa basadi ba ba nang le GDM. Mo lebakeng le, baporofešenale botlhe ba boitekanelo ba ne ba dumelana gore go dira temoso ke tsereganyo e e gaisang ya go thibela GDM ga mmogo le ditlamorago tsa yona tse di sa siamang mo baimaneng. Ditshwetso: Go nna teng ga GDM go a oketsega, mme go tshwanetse go dirwa go le gontsi go lemosa ka mokgweleo o bolwetse jono bo o bayang mo boitekanelong jwa baimana le setšhaba. Ka ntlha ya gore GDM ga e kaiwe jaaka bothata jwa boitekanelo jwa setšhaba, ga go dirwe go le kalo go tlhokomela bolwetsi le ditlamorago tsa jona tse di sa siamang mo baimaneng. Go solofelwa gore dintlhakaelo tsa tiriso e e gaisang tse di dirilweng mo thutopatlisisong eno di ka thusa go fokotsa ditlamorago tse di sa siamang tsa GDM mo baimaneng kwa Ethiopia.<br>Health Studies<br>D. Litt. et Phil. (Public Health)