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Calvo, Mireia, González, Rubèn, Seijas, Núria, Vela, Emili, Hernández, Carme, Batiste, Guillem, Miralles, Felip, Roca, Josep, Cano, Isaac, Jané, Raimon, (2020). Health outcomes from home hospitalization: Multisource predictive modeling Journal of Medical Internet Research 22, (10), e21367

Background: Home hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as well as health value-based generation at the provider and health-system levels. However, health risk assessment was identified as an unmet need with the potential to enhance clinical decision making. Objective: The objective of this study is to generate and assess predictive models of mortality and in-hospital admission at entry and at HH/ED discharge. Methods: Predictive modeling of mortality and in-hospital admission was done in 2 different scenarios: at entry into the HH/ED program and at discharge, from January 2009 to December 2015. Multisource predictive variables, including standard clinical data, patients’ functional features, and population health risk assessment, were considered. Results: We studied 1925 HH/ED patients by applying a random forest classifier, as it showed the best performance. Average results of the area under the receiver operating characteristic curve (AUROC; sensitivity/specificity) for the prediction of mortality were 0.88 (0.81/0.76) and 0.89 (0.81/0.81) at entry and at home hospitalization discharge, respectively; the AUROC (sensitivity/specificity) values for in-hospital admission were 0.71 (0.67/0.64) and 0.70 (0.71/0.61) at entry and at home hospitalization discharge, respectively. Conclusions: The results showed potential for feeding clinical decision support systems aimed at supporting health professionals for inclusion of candidates into the HH/ED program, and have the capacity to guide transitions toward community-based care at HH discharge.

Keywords: Home hospitalization, Health risk assessment, Predictive modeling, Chronic care, Integrated care, Modeling, Hospitalization, Health risk, Prediction, Mortality, Clinical decision support

Vouloutsi, Vasiliki, Verschure, P., (2018). Emotions and self-regulation Living Machines: A Handbook of Research in Biomimetic and Biohybrid Systems (ed. Prescott, T. J., Lepora, Nathan, Verschure, P.), Oxford Scholarship (Oxford, UK) , 327-337

This chapter takes the view that emotions of living machines can be seen from the perspective of self-regulation and appraisal. We will first look at the pragmatic needs to endow machines with emotions and subsequently describe some of the historical background of the science of emotions and its different interpretations and links to affective neuroscience. Subsequently, we argue that emotions can be cast in terms of self-regulation where they provide for a descriptor of the state of the homeostatic processes that maintain the relationship between the agent and its internal and external environment. We augment the notion of homeostasis with that of allostasis which signifies a change from stability through a fixed equilibrium to stability through continuous change. The chapter shows how this view can be used to create complex living machines where emotions are anchored in the need fulfillment of the agent, in this case considering both utilitarian and epistemic needs.

Keywords: Emotion, Motivation, Needs, Appraisal, Self-regulation, Homeostasis, Allostasis, Human–robot interaction, James–Lange theory

Huerta, R., Mosqueiro, T., Fonollosa, J., Rulkov, N.F., Rodríguez-Lujan, I., (2016). Online decorrelation of humidity and temperature in chemical sensors for continuous monitoring Chemometrics and Intelligent Laboratory Systems , 157, 169-176

A method for online decorrelation of chemical sensor signals from the effects of environmental humidity and temperature variations is proposed. The goal is to improve the accuracy of electronic nose measurements for continuous monitoring by processing data from simultaneous readings of environmental humidity and temperature. The electronic nose setup built for this study included eight metal-oxide sensors, temperature and humidity sensors with a wireless communication link to external computer. This wireless electronic nose was used to monitor the air for two years in the residence of one of the authors and it collected data continuously during 537 days with a sampling rate of 1 sample per second. To estimate the effects of variations in air humidity and temperature on the chemical sensors' signals, we used a standard energy band model for an n-type metal-oxide (MOX) gas sensor. The main assumption of the model is that variations in sensor conductivity can be expressed as a nonlinear function of changes in the semiconductor energy bands in the presence of external humidity and temperature variations. Fitting this model to the collected data, we confirmed that the most statistically significant factors are humidity changes and correlated changes of temperature and humidity. This simple model achieves excellent accuracy with a coefficient of determination R2 close to 1. To show how the humidity–temperature correction model works for gas discrimination, we constructed a model for online discrimination among banana, wine and baseline response. This shows that pattern recognition algorithms improve performance and reliability by including the filtered signal of the chemical sensors.

Keywords: Electronic nose, Chemical sensors, Humidity, Temperature, Decorrelation, Wireless e-nose, MOX sensors, Energy band model, Home monitoring

Morgenstern, C., Randerath, W. J., Schwaibold, M., Bolz, A., Jané, R., (2013). Feasibility of noninvasive single-channel automated differentiation of obstructive and central hypopneas with nasal airflow Respiration , 85, (4), 312-318

Background: The identification of obstructive and central hypopneas is considered challenging in clinical practice. Presently, obstructive and central hypopneas are usually not differentiated or scores lack reliability due to the technical limitations of standard polysomnography. Esophageal pressure measurement is the gold-standard for identifying these events but its invasiveness deters its usage in daily practice. Objectives: To determine the feasibility and efficacy of an automatic noninvasive analysis method for the differentiation of obstructive and central hypopneas based solely on a single-channel nasal airflow signal. The obtained results are compared with gold-standard esophageal pressure scores. Methods: A total of 41 patients underwent full night polysomnography with systematic esophageal pressure recording. Two experts in sleep medicine independently differentiated hypopneas with the gold-standard esophageal pressure signal. Features were automatically extracted from the nasal airflow signal of each annotated hypopnea to train and test the automatic analysis method. Interscorer agreement between automatic and visual scorers was measured with Cohen's kappa statistic (κ). Results: A total of 1,237 hypopneas were visually differentiated. The automatic analysis achieved an interscorer agreement of κ = 0.37 and an accuracy of 69% for scorer A, κ = 0.40 and 70% for scorer B and κ = 0.41 and 71% for the agreed scores of scorers A and B. Conclusions: The promising results obtained in this pilot study demonstrate the feasibility of noninvasive single-channel hypopnea differentiation. Further development of this method may help improving initial diagnosis with home screening devices and offering a means of therapy selection and/or control.

Keywords: Central sleep hypopnea, Esophageal pressure, Home monitoring, Obstructive sleep hypopnea, Sleep disordered breathing

Dellaca, Raffaele, Montserrat, Josep M., Govoni, Leonardo, Pedotti, Antonio, Navajas, Daniel, Farre, Ramon, (2011). Telemetric CPAP titration at home in patients with sleep apnea-hypopnea syndrome Sleep Medicine , 12, (2), 153-157

Background: Home continuous positive airway pressure (CPAP) titration with automatic devices is not possible in a non-negligible percentage of patients with sleep apnea-hypopnea syndrome (SAHS). Objectives: To test the feasibility of a novel telemetric system for home CPAP titration. Methods: One-night home CPAP titration was carried out on 20 SAHS patients (56 +/- 3 years; BMI = 35 +/- 2 kg/m(2)). A telemetric unit, based on the conventional GPRS mobile phone network and connected to a commercial CPAP device, allowed the hospital technician to monitor flow, pressure and air leaks by remote control and titrate CPAP (elimination of apneas, hypopneas, flow limitation and snoring) in real time. After 1 week, a full hospital polysomnography was performed while the patient was subjected to the value of CPAP that was previously titrated at home via telemetry. Results: The home-titrated CPAP systematically improved patients' breathing: the apnea-hypopnea index and percentage of sleep time with arterial oxygen saturation below 90% were reduced from 58.1 +/- 5.1 to 3.8 +/- 0.6 events/h and from 19.8 +/- 1.1% to 4.4 +/- 0.7%, respectively. This CPAP value (9.15 +/- 0.47 cmH(2)O) was virtually the same as the pressure that optimized breathing during hospital polysomnography (9.20 +/- 0.41 cmH(2)O; mean difference: 0.02 cmH(2)O, limits of agreement: +/- 1.00 cmH(2)O). Conclusions: This pilot study shows that a simple telemetric system, requiring neither a special telemedicine network nor any infrastructure in the patient's home, made it possible to perform effective remote CPAP titration on SAHS patients.

Keywords: Home CPAP titration by telemetry, Telecare, Telemedicine, E-health, Obstructive sleep apnea, Point of care

Farre, R., Navajas, D., (2009). Quality control: A necessary, but sometimes overlooked, tool for improving respiratory medicine European Respiratory Journal 33, (4), 722-723

The importance of quality control in both general and respiratory medicine has increased in parallel with the complexity of healthcare provision. Only a few decades ago, the respiratory physician and/or scientist had a very limited number of diagnostic and therapeutic tools available and, moreover, medical practice was based almost exclusively on the personal interaction between doctor and patient. Consequently, at that time the quality of the respiratory healthcare depended entirely on the professional competence of the doctor. Although nowadays the relationship between physician and patient undoubtedly still lies at the heart of respiratory medical practice, the quality of the medical service received by the patient also depends on many other participants in a complex healthcare network: various medical specialists, lung function technicians, nurses, respiratory therapists, social workers and administrative staff. Accordingly, several quality control programmes are applied in order to avoid, or at least to reduce, errors in diagnosis, improper performance of procedures, errors in medication, and failure to supervise or monitor care or recognise complications associated with treatment

Keywords: Airway pressure devices, Clinical-trial, Standardization, Spirometry, Lung, Home, Ventilators, Publication, Performance, Technology

Dellaca, R. L., Gobbi, A., Govoni, L., Navajas, D., Pedotti, A., Farre, R., (2009). A novel simple Internet-based system for real time monitoring and optimizing home mechanical ventilation International Conference on Ehealth, Telemedicine, and Social Medicine: Etelemed 2009, Proceedings International Conference on eHealth, Telemedicine, and Social Medicine (ed. Conley E.C., Doarn, C., HajjamElHassani, A.), IEEE Compuer Soc (Cancun, Mexico) , 209-215

The dissemination of the available telemedicine systems for the optimization of home mechanical ventilation (HMV) is prevented by the need of complex infrastructures. We developed a device which, once connected to Internet through the mobile phone network, allows an authorized physician connected to Internet to monitor the ventilator signals and modify the settings in real-time without the need of external data servers. The system was evaluated during experiments performed by tele-controlling a mechanical ventilator in Barcelona from Milano. A bench study verified the reliability and robustness of the system while an in-vivo test showed that it was possible to monitor and tele-control the ventilator to maintain the oxygen saturation of a rat ventilated in Barcelona subjected to interventions. Given that the system avoids the need for any complex telemedicine architecture and allows an individual and independent ventilator tele-control, it can be a new helpful tool to optimize HMV.

Keywords: Home mechanical ventilation, Non-invasive mechanical ventilation, Telemedicine