Interoperable and standard e-Health solution over Bluetooth

The new paradigm of e-Health demands open sensors and middleware components that permit transparent integration and end-to-end interoperability of new personal health devices. The use of standards seems to be the internationally adopted way to solve these problems. This paper presents the implementation of an end-to-end standards-based e-Health solution. This includes ISO/IEEE11073 standard for the interoperability of the medical devices in the patient environment and EN13606 standard for the interoperable exchange of the Electronic Healthcare Record. The design strictly fulfills all the technical features of the most recent versions of both standards. The implemented prototype has been tested in a laboratory environment to demonstrate its feasibility for its further transfer to the healthcare system.

Prevalence and magnitude of body weight and image dissatisfaction among women in dietetics majors

Some authors have suggested that body weight dissatisfaction may be high in students majoring in dietetics. Therefore, this study was conducted to examine the extent of body weight and image dissatisfaction in a sample of women in dietetics major. Additionally, predictors of magnitude of body weight dissatisfaction were analyzed. Participants were 62 volunteers with normalweight whose mean age was 21.87 +/- 1.89 years old (non-random sample). The assessment instruments included anthropometric measurements, a somatomorphic matrix test and an eating disorders inventory (EDI-2). Data were analyzed using SPSS vs. 15.0. A larger proportion of students chose an ideal body weight lower than actual weight (67.7%) and body image with less body fat and more muscle mass than actual values (56.4%). The magnitude of body weight dissatisfaction was associated with muscle mass and body fat dissatisfaction, and with the subscale of EDI-2 "body dissatisfaction". So, from a public health standpoint, we consider important to continue working in this line of research with the aim of better understanding the extent of body weight dissatisfaction in women dietitians, and how this dissatisfaction could interfere with their professional practice.

[eOphthalmology: current state and future tendencies]

eOphthalmology can be defined as the use of information and telecommunications technologies to provide or support a group of activities related to ophthalmic care. The same concept applied to ophthalmic care would be eOphthalmology. This paper describes the current state of eOphthalmology-based models in diabetic retinopathy screening and in the diagnosis and follow-up of chronic glaucoma and age-related macular degeneration. Furthermore, the main advantages of these models and the technological requirements needed for their implementation are described. Finally, a prediction of the impact of eOphthalmology on the future of health care is offered.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

ADAN: a database for prediction of protein-protein interaction of modular domains mediated by linear motifs

MOTIVATION

Most of the structures and functions of proteome globular domains are yet unknown. We can use high-resolution structures from different modular domains in combination with automatic protein design algorithms to predict genome-wide potential interactions of a protein. ADAN database and related web tools are online resources for the predictive analysis of ligand-domain complexes. ADAN database is a collection of different modular protein domains (SH2, SH3, PDZ, WW, etc.). It contains 3505 entries with extensive structural and functional information available, manually integrated, curated and annotated with cross-references to other databases, biochemical and thermodynamical data, simplified coordinate files, sequence files and alignments. Prediadan, a subset of ADAN database, offers position-specific scoring matrices for protein-protein interactions, calculated by FoldX, and predictions of optimum ligands and putative binding partners. Users can also scan a query sequence against selected matrices, or improve a ligand-domain interaction.

AVAILABILITY

ADAN is accessible at http://adan-embl.ibmc.umh.es/ or http://adan.crg.es/.

Optimization proposal of a standard-based patient monitoring platform for ubiquitous environments

This article describes the optimization of a patient telemonitoring platform based on the ISO/IEEE11073 (X73) standard to enable medical device interoperability. In order to achieve this, principal advantages and remaining improvements are evaluated to include in further upgrades towards the new profile evolution, oriented to ubiquitous environments and wearable devices (Personal Health Devices, X73-PHD), and opened to additional plug-and-play features and remote management. After evaluating the possibilities, we describe the platform porting process, a required step to adapt it to the new functionalities and allowing the development of end-to-end standard based systems. The paper details the implementation of the agent-manager architecture, particularized on the X73-PHD communication protocol between a Medical Device (MD) and a central gateway (Compute Engine, CE). Lastly, the obtained results are evaluated, oriented to constitute an X73-PHD tester to prove the challenges currently under discussion in the European Standardization Committee (CEN).

[Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients]

PURPOSE

To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training.

METHODS

The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (+/-5%) with a confidence level of 95% was considered adequate.

RESULTS

The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%.

CONCLUSIONS

After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention.

TCF bleaching of soda-anthraquinone and diethanolamine pulp from oil palm empty fruit bunches

The AOpAZRP bleaching sequence (A is an acid treatment, Op an oxygen and peroxide stage, Z an ozone stage, R a reductive treatment and P a peroxide stage) have been applied to oil palm empty fruit bunches (EFB) soda-anthraquinone and diethanolamine pulp. On similar Kappa numbers for the two types of pulp (14.2 and 17.3), paper from unbleached soda-anthraquinone pulp exhibited increased tensile index (25.8 Nm/g), stretch (2.35%), burst index (1.69 kN/g), tear index (0.50 mN m(2)/g) and brightness (60.6%) relative to paper for unbleached diethanolamine pulp; but the latter type of pulp exhibited higher viscosity (659 mL/g) than the former. Upon bleaching with the AOpAZRP sequence, diethanolamine pulp exhibited higher viscosity (783 mL/g), and the properties of the paper sheets were close to or even better to those from soda-anthraquinone pulp, namely: 22.2 vs 20.4 Nm/g tensile index, 1.30 vs 1.42 kN/g burst index, 0.71 vs 0.70 mN m(2)/g tear index and 71.3% vs 77.5% brightness. Therefore, the properties of paper from diethanolamine pulp evolved more favourably during bleaching than did those of paper from soda-anthraquinone pulp.

Soda-anthraquinone pulping of palm oil empty fruit bunches and beating of the resulting pulp

The influence of soda-anthraquinone pulping variables (temperature, time and soda concentration) and beating (number of PFI beating revolution) of palm oil empty fruit bunches (EFB) on the resulting paper sheets was studied, with a view to identifying the optimum operating conditions. Equations were derived that reproduced the properties of the paper sheets with errors less than 10-12% in 90-95% of cases. An optimum compromise was found as regards operating conditions (15% soda, 170 degrees C, 70 min and 2400 number of PFI beating revolutions) that provided paper properties departing by less than 12% from their optimum values (59.63 Nm/g tensile index, 4.48% stretch, 4.17 kN/g burst index and 7.20 m Nm(2)/g tear index), and a beating grade of 47.5 degrees SR, acceptable to obtain paper sheets. Because these conditions involve a lower soda, temperature, time and beating than those required to maximize the studied paper properties, they can save chemical reagents, energy and immobilized capital for industrial facilities. On the other hand, the stretch properties of these pulp beaten are higher than those of others non-wood pulps, as wheat straw and olive wood.

Implementing ISO/IEEE 11073: proposal of two different strategic approaches

This paper explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. In this way a framework for MDs can be obtained. Second one is focused on more powerful machines such as data loggers or gateways (aka. computer engines (CE)), which do not have the MDs' memory and processor usage constraints. For CEs a more intelligent and adaptative Plug&Play (P&P) solution is provided. It consists on a general platform that can access to any device supported by the standard. Combining both strategies will cut developing time for applications based on ISO/EEE 11073.

Integration proposal through standard-based design of an end-to-end platform for p-Health environments

Interoperability among medical devices and compute engines in the personal environment of the patient, and with healthcare information systems in the remote monitoring and management process is a key need that requires developments supported on standard-based design. Even though there have been some international initiatives to combine different standards, the vision of an entire end-to-end standard-based system is the next challenge. This paper presents the implementation guidelines of a ubiquitous platform for Personal Health (p-Health). It is standard-based using the two main medical norms in this context: ISO/IEEE11073 in the patient environment for medical device interoperability, and EN13606 to allow the interoperable communication of the Electronic Healthcare Record of the patient. Furthermore, the proposal of a new protocol for End-to-End Standard Harmonization (E2ESHP) is presented in order to make possible the end-to-end standard integration. The platform has been designed to comply with the last ISO/IEEE11073 and EN13606 available versions, and tested in a laboratory environment as a proof-of-concept to illustrate its feasibility as an end-to-end standard-based solution.

Reproducibility of sonographic measurements of carotid intima-media thickness

BACKGROUND

Carotid intima-media thickness (IMT), measured with B-mode ultrasound, is a marker for atherosclerosis and widely used as an outcome in intervention trials.

PURPOSE

To evaluate the reproducibility of carotid intima-media thickness measurements using tissue harmonic imaging (THI) sonography between two observers with different levels of experience.

MATERIAL AND METHODS

IMT measurement was performed in 40 patients: 26 males and 14 females, with a mean age of 62.6 years. The measurements were taken on the posterior wall of the right common carotid artery using a standardized protocol. Observer measurement of the IMT was independent and blind. Statistical analysis was done with parametric tests and Pearson's correlation coefficient.

RESULTS

The measurements of the IMT were taken satisfactorily in all cases. IMT measurement time was 5 min/study. No significant differences were noted between the means obtained by the two observers. The interobserver correlation of the measurements was very high (97.2%).

CONCLUSION

The results of this study show that carotid IMT measurement using THI sonography and a standardized protocol is accurate and reproducible.

Municipal wastewater treatment in an anaerobic digester-constructed wetland system

An experimental plant was constituted for an upflow anaerobic sludge blanket (UASB) reactor with an active volume of 25.5 m3 and two horizontal constructed wetlands of 75 m2 each. The first wetland was a superficial flow (SF) system and the second a subsurface flow (SSF) system. The UASB reactor was fed with 60-73 m3 d(-1) of raw domestic wastewater from the municipal treatment plant (MTP) of the city of Santiago de Compostela. Part of the effluent from the UASB reactor (15 m3 d(-1)) passed through the SF wetland and then went into the SSF. In the first ten months of operation, from July 2005 to April 2006, the hydraulic retention time for the UASB system was in the range of 7-14 hours and the organic loading rate (OLR) was between 0.3 and 1.1 g COD l(-1) d(-1). The organic load in the wetlands was in the range of 5-40 g BOD5 m(-2) d(-1). The global results achieved for total suspended solids (TSS), chemical oxygen demand (COD) and biological oxygen demand (BOD5) removal efficiencies were 85-96%, 65-90% and 69-93%, respectively. The average monthly concentrations in the final effluent were 8-73 mg BOD5 l(-1), 25-120 mg COD l(-1) and 6-20 mg TSS l(-1). The global balance of VSS in the UASB reactor shows that purge accounted for 19.6% and hydrolysis accounted for 47.7% of influent VSS. Data from suspended solids balance in the constructed wetlands, at the end of the operation period, show a TSS and VSS accumulation of 48% and 16%, respectively.

Implementation experience of a patient monitoring solution based on end-to-end standards

This paper presents a proof-of-concept design of a patient monitoring solution for Intensive Care Unit (ICU). It is end-to-end standards-based, using ISO/IEEE 11073 (X73) in the bedside environment and EN13606 to communicate the information to an Electronic Healthcare Record (EHR) server. At the bedside end a plug-and-play sensor network is implemented, which communicates with a gateway that collects the medical information and sends it to a monitoring server. At this point the server transforms the data frame into an EN13606 extract, to be stored on the EHR server. The presented system has been tested in a laboratory environment to demonstrate the feasibility of this end-to-end standards-based solution.

Role of specific microbial communities in the bioavailability of iron in Doñana National Park

The Doñana National Park contains highly complex microbial communities that play critical roles in the bioavailability and biogeochemical cycling of elements. In this study, we analyzed the formation of Fe-rich films on the surface of shallow waters at Doñana National Park as a model for future applications in bioremediation. Phytoplankton composition and abundance, physicochemical measurements, culture enrichments, and molecular detection of microorganisms were determined during this study. Natural samples were incubated in the laboratory and enrichments producing similar phenomena were obtained. Bacteria belonging to the genera Enterobacter were the major participants in surface Fe-film formation in laboratory enrichments. Film formation was dependent on wind exposure and only those sites protected from the direct influence of wind developed these films. A higher concentration of euglenophytes was found in the proximity of film-covered waters. Available iron (Fe2+) and total Fe concentrations were high (18.8 and 46.6 mg/L, respectively) underneath the surface film, and higher than in film-free waters and pore-sediment water. The concentration of phosphate and its availability were higher in the iron-rich film sediment, as 61% of total P was bound to iron oxy-hydroxides. Our results provide evidence of the link between P and Fe biogeochemical cycling in aquatic systems on sandy soils at the Doñana National Park. In addition, they provide significant insights into the bioavailability of these elements with potential interest in the role of microorganisms for metal sequestration in natural environments and utilization in bioremediation processes.

Telemonitoring systems interoperability challenge: an updated review of the applicability of ISO/IEEE 11073 standards for interoperability in telemonitoring

Advances in Information and Communication Technologies, ICT, are bringing new opportunities and use cases in the field of systems and Personal Health Devices used for the telemonitoring of citizens in Home or Mobile scenarios. At a time of such challenges, this review arises from the need to identify robust technical telemonitoring solutions that are both open and interoperable. These systems demand standardized solutions to be cost effective and to take advantage of standardized operation and interoperability. Thus, the fundamental challenge is to design plug-&-play devices that, either as individual elements or as components, can be incorporated in a simple way into different Telecare systems, perhaps configuring a personal user network. Moreover, there is an increasing market pressure from companies not traditionally involved in medical markets, asking for a standard for Personal Health Devices, which foresee a vast demand for telemonitoring, wellness, Ambient Assisted Living (AAL) and e-health applications. However, the newly emerging situations imply very strict requirements for the protocols involved in the communication. The ISO/IEEE 11073 family of standards is adapting and moving in order to face the challenge and might appear the best positioned international standards to reach this goal. This work presents an updated survey of these standards, trying to track the changes that are being fulfilled, and tries to serve as a starting-point for those who want to familiarize themselves with them.

Towards e-Health device interoperability: the Spanish experience in the telemedicine research network

The expansion of e-Health solutions is hindered by the high costs and low flexibility of home and mobile telemonitoring systems. This situation may be improved by the use of standards to design open, plug-and-play and interoperable devices. This work describes the joint efforts of three research groups in Spain towards the interoperability of their telemonitoring solutions based on the ISO11073/IEEE1073 family of standards.

Inter- and intra-specific variation on sensitivity of larval amphibians to nitrite

Several authors have suggested that nitrogen-based fertilizers may be contributing to the global amphibian decline. We have studied the impact of sodium nitrite on early aquatic stages of Epidalea calamita, Pelophylax perezi and Hyla meridionalis larvae from Doñana National Park (coastal wetland) and P. perezi from Gredos Mountain (high mountain ponds), exposed during 10 to 16 days. After 8 days of exposure all P. perezi larvae from Doñana presented 100% mortality at 5 mg l(-1)N-NO2(-) while E. calamita larvae mortality rates were significantly lower at that concentration after 15 days. However, for H. meridionalis at day 15 no deaths were registered at 5 mg l(-1)N-NO2(-) and at 20 mg l(-1)N-NO2(-) presented intermediate mortality rates. In Doñana the 10 d LC50 of older H. meridionalis larvae was between 20 and 30 mg l(-1)N-NO2(-) whilst for P. perezi it was below 5 mg l(-1)N-NO2(-). These results indicate inter-specific variation of the sensitivity of larval amphibians to nitrite. Gredos Mountain P. perezi larvae exposed since the egg stage were highly sensitive to nitrite, with a 16 d LC50 below 0.5 mg l(-1)N-NO2(-). The same species in Doñana had a 15 d LC50 between 5 and mg l(-1)N-NO2(-). These results suggest that there is also intra-specific variation in sensitivity of amphibian larvae to nitrite: mountain amphibian populations appear to be more sensitive to polluted environments than coastal populations. Geographic and genetic variation and evolutionary adaptation of tolerance may also be the keys to variation amongst populations of the same species.