http://www.hindawi.comThe latest articles from Hindawi Publishing Corporation© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/405796Daisuke Takahashi, Yang Xiao, Fei Hu, and Michael Lewis© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/763534Electronic health record (EHR) projects have been launched in most developed countries to increase the quality of healthcare while decreasing its cost. The benefits provided by centralizing the healthcare information in database systems are unquestionable in terms of information quality, availability, and protection against failure. Yet, patients are reluctant to give to a distant server the control over highly sensitive data (e.g., data revealing a severe or shameful disease). This paper capitalizes on a new hardware portable device, associating the security of a smart card to the storage capacity of a USB key, to give back to the patient the control over his medical data. This paper shows how this device can complement a traditional EHR server to (1) protect and share highly sensitive data among trusted parties and (2) provide a seamless access to the data even in disconnected mode. The proposed architecture is experimented in the context of a medicosocial network providing medical care and social services at home for elderly people.Nicolas Anciaux, Morgane Berthelot, Laurent Braconnier, Luc Bouganim, Martine De la Blache, Georges Gardarin, Philippe Kesmarszky, Sophie Lartigue, Jean-François Navarre, Philippe Pucheral, Jean-Jacques Vandewalle, and Karine Zeitouni© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/753064Patients suffering from chronic respiratory disease need to follow a rehabilitative exercise programme, in order to self-manage their illness and improve quality of life. Adherence to the programme is highly dependent on professional support from a physiotherapist and hence declines when patients seek to self-manage in the home. A number of requirements were identified for a Smartphone-based application in which patients are supported remotely and given automatic feedback during exercise. An application is described which will improve adherence during pulmonary rehabilitation.A. Marshall, O. Medvedev, and A. Antonov© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/459185New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation.Sunil Kumar, Kashyap Kambhatla, Fei Hu, Mark Lifson, and Yang Xiao© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/739385We survey blood glucose control schemes for insulin-dependent diabetes therapies and systems. These schemes largely rely on mathematical models of the insulin-glucose relations, and these models are typically derived in an empirical or fundamental way. In an empirical way, the experimental insulin inputs and resulting blood-glucose outputs are used to generate a mathematical model, which includes a couple of equations approximating a very complex system. On the other hand, the insulin-glucose relation is also explained from the well-known facts of other biological mechanisms. Since these mechanisms are more or less related with each other, a mathematical model of the insulin-glucose system can be derived from these surrounding relations. This kind of method of the mathematical model derivation is called a fundamental method. Along with several mathematical models, researchers develop autonomous systems whether they involve medical devices or not to compensate metabolic disorders and these autonomous systems employ their own control methods. Basically, in insulin-dependent diabetes therapies, control methods are classified into three categories: open-loop, closed-loop, and partially closed-loop controls. The main difference among these methods is how much the systems are open to the outside people.Daisuke Takahashi, Yang Xiao, and Fei Hu© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/436870A novel method of detecting mechanical movement of the heart, Mechanocardiography (MCG), with no connection to the subject's body is presented. This measurement is based on radar technology and it has been proven through this research work that the acquired signal is highly correlated to the phonocardiograph signal and acceleration-based ballistocardiograph signal (BCG) recorded directly from the sternum. The heart rate and respiration rate have been extracted from the acquired signal as two possible physiological monitoring applications of the radar-based MCG device.Kouhyar Tavakolian, Faranak M. Zadeh, Yindar Chuo, Ali Vaseghi, and Bozena Kaminska© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/135808We present a framework for a wireless health monitoring system using wireless networks such as ZigBee. Vital signals are collected and processed using a 3-tiered architecture. The first stage is the mobile device carried on the body that runs a number of wired and wireless probes. This device is also designed to perform some basic processing such as the heart rate and fatal failure detection. At the second stage, further processing is performed by a local server using the raw data transmitted by the mobile device continuously. The raw data is also stored at this server. The processed data as well as the analysis results are then transmitted to the service provider center for diagnostic reviews as well as storage. The main advantages of the proposed framework are (1) the ability to detect signals wirelessly within a body sensor network (BSN), (2) low-power and reliable data transmission through ZigBee network nodes, (3) secure transmission of medical data over BSN, (4) efficient channel allocation for medical data transmission over wireless networks, and (5) optimized analysis of data using an adaptive architecture that maximizes the utility of processing and computational capacity at each platform.S. Dağtaş, G. Pekhteryev, Z. Şahinoğlu, H. Çam, and N. Challa© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/136054This research takes place in the S(MA)2D project which proposes software architecture to monitor elderly people in their own homes. We want to build patterns dynamically from data about activity, movements, and physiological information of the monitored people. To achieve that, we propose a multiagent method of classification: every agent has a simple know-how of classification. Data generated at this local level are communicated and adjusted between agents to obtain a set of patterns. The patterns are used at a personal level, for example to raise an alert, but also to evaluate global risks (epidemic, heat wave). These data are dynamic; the system has to maintain the built patterns and has to create new patterns. So, the system is adaptive and can be spread on a large scale.Ali Rammal, Sylvie Trouilhet, Nicolas Singer, and Jean-Marie Pécatte© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/290431Sleeping disorders affect a large percentage of the population, and many of them go undiagnosed each year because the method of diagnosis is to stay overnight at a sleep center. Because pervasive technologies have become so prevalent and affordable, sleep monitoring is no longer confined to a permanent installation, and can therefore be brought directly into the user home. We present a unique solution to the problem of home sleep monitoring that has the possibility to take the place of and expand on the data from a sleep center. PATHOS focuses not only on analyzing patterns during the night, but also on collecting data about the subject lifestyle that is relevant and important to the diagnosis of his/her sleep. PATHOS means “evoking emotion.” Here, we mean Pathos will help us to keep healthy: both mentally and physically. Our solution uses existing technology to keep down cost and is completely wireless in order to provide portability and be easily to customize. The daytime collection also utilizes existing technology and offers a wide range of input methods to suit any type of person. We also include an in-depth look at the hardware we used to implement and the software providing user interaction. Our system is not only a viable alternative to a sleep center, it also provides functions that a static, short-term solution cannot provide, allowing for a more accurate diagnosis and treatment.Ian Obermiller and Sheikh I. Ahamed© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/142803In the context of a constantly increasing aging population with cognitive deficiencies, insuring the autonomy of the elders at home becomes a priority. The DOMUS laboratory is addressing this issue by conceiving a smart home which can both assist people and preserve their quality of life. Obviously, the ability to monitor properly the occupant’s activities and thus provide the pertinent assistance depends highly on location information inside the smart home. This paper proposes a solution to localize the occupant thanks to Bayesian filtering and a set of anonymous sensors disseminated throughout the house. The localization system is designed for a single person inside the house. It could however be used in conjunction with other localization systems in case more people are present. Our solution is functional in real conditions. We conceived an experiment to estimate precisely its accuracy and evaluate its robustness. The experiment consists of a scenario of daily routine meant to maximize the occupant’s motion in meaningful activities. It was performed by 14 subjects, one subject at a time. The results are satisfactory: the system’s accuracy exceeds 85% and is independent of the occupant’s profile. The system works in real time and behaves well in presence of noise.Youcef Rahal, Hélène Pigot, and Philippe Mabilleau© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/678302We propose a method utilizing a derived social security number with the same reliability as the social security number. We show the anonymity techniques classically based on unidirectional hash functions (such as the secure hash algorithm (SHA-2) function that can guarantee the security, quality, and reliability of information if these techniques are applied to the Social Security Number). Hashing produces a strictly anonymous code that is always the same for a given individual, and thus enables patient data to be linked. Different solutions are developed and proposed in this article. Hashing the social security number will make it possible to link the information in the personal medical file to other national health information sources with the aim of completing or validating the personal medical record or conducting epidemiological and clinical research. This data linkage would meet the anonymous data requirements of the European directive on data protection.Catherine Quantin, François-André Allaert, Paul Avillach, Maniane Fassa, Benoît Riandey, Gilles Trouessin, and Olivier Cohen© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/328597A new system-on-a-chip radar sensor for next-generation wearable wireless interface applied to the human health care and safeguard is presented. The system overview is provided and the feasibility study of the radar sensor is presented. In detail, the overall system consists of a radar sensor for detecting the heart and breath rates and a low-power IEEE 802.15.4 ZigBee radio interface, which provides a wireless data link with remote data acquisition and control units. In particular, the pulse radar exploits 3.1–10.6 GHz ultra-wideband signals which allow a significant reduction of the transceiver complexity and then of its power consumption. The operating principle of the radar for the cardiopulmonary monitoring is highlighted and the results of the system analysis are reported. Moreover, the results obtained from the building-blocks design, the channel measurement, and the ultra-wideband antenna realization are reported.Domenico Zito, Domenico Pepe, Bruno Neri, Fabio Zito, Danilo De Rossi, and Antonio Lanatà© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/132890The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.Jane Clemensen, Simon B. Larsen, Marit Kirkevold, and Niels Ejskjaer© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/639019This paper surveys diabetes therapies from telemedicine viewpoint. In type 1 diabetes therapies, the exogenous insulin replacement is generally considered as a primary treatment. However, the complete replacement of exogenous insulin is still a challenging issue because of its complexity of modeling the dynamics, which is typically modeled nonlinearly. On the other hand, thanks to the progress of medical devices, currently the diabetes therapies are being automated. These medical devices include automated insulin pumps and blood glucose sensors. Insulin pumps are designed to create artificial insulin perfusion while they largely rely on the blood glucose profile measurements and these measurements are achieved by one or more blood glucose sensors. The blood glucose measurements are also important for the insulin-dependent diabetes therapies. An insulin pump along with sensors establishes a good feedback system providing the appropriate amount of the exogenous insulin on demand. Controlling the amount of exogenous insulin to suppress the blood glucose levels requires complicated computations. This paper mostly explains both type 1 and 2 diabetes and their mechanisms accompanied by descriptions of diabetes therapy and medical devices currently utilized in the therapy.Daisuke Takahashi, Yang Xiao, Fei Hu, and Michael Lewis© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/217909Transtelephonic electrocardiographic transmission (TET) is the most widespread form of telecardiology since it enables clinicians to assess patients at a distance. The purpose of this study was to assess the efficacy and effectiveness of TET either by fixed telephone line (POTS) or by mobile phone in the preparticipation screening of young athletes. A total of 506 players, aged 20.5 ± 6.2 years, from 23 soccer clubs in the prefecture of Thessaloniki, Greece, were physically examined in their playfields by a general practitioner (GP) and had their ECG recorded. In 142 cases, and on the judgment of the GP, the ECG was transmitted via POTS and/or global system for mobile communications (GSM) to a specialised medical centre where it was evaluated by a cardiologist. The mean total time for recording, storing, and transmitting the ECG was four minutes per subject. It was found that the success rate for transmission at first attempt was similar for both fixed and mobile networks, that is, 93% and 91%, respectively. The failure rate in the GSM network was correlated to the reception level at the site of transmission. Only in about half (n = 74) of the transmitted ECGs did the cardiologist confirm “abnormal” findings, although in 16, they were considered to be clinically insignificant. Consequently, 58 athletes were referred for further medical examination. Our results indicate that TET (either by fixed telephone line or by mobile phone) can ensure valid, reliable, and objective measurements, and significantly contribute to the application of medical screening in a great number of athletes. Therefore, it is recommended as an alternative diagnostic tool for the preparticipation screening of athletes living in remote areas.Theodoros Samaras, Savvato Karavasiliadou, Evangelia Kouidi, John N. Sahalos, and Asterios Deligiannis© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/159276Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP) and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P<.05) in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist.David A. Bergman, Paul J. Sharek, Kathryn Ekegren, Shannon Thyne, Michelle Mayer, and Mara Saunders© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/235031An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine.Pennie S. Seibert, Tiffany A. Whitmore, Carin Patterson, Patrick D. Parker, Caitlin Otto, Jean Basom, Nichole Whitener, and Christian G. Zimmerman© 2008, Hindawi Publishing Corporation. All rights reserved.