This project proposes the development of a digital intelligent and self-adapting ‘carer - liaison’ for bilateral communication. The word ‘liaison’ is important because besides having some autonomous function such as bed position steering, turning on/off lights, choosing music etc…it’s the direct connection with the medical and nursing staff for the ‘higher level’ of help. The digital carer is self adapting according to the evolution of the patient. This means that at one side there is the digital carer (an intelligent interface), represented by an on screen virtual character showing human like features with whom the patient can communicate in classical terms (language) but at the other side there is the miniaturized PatientInspect system that comes in when the patient is too tired to express his/her needs in a common way.

This project proposes a game that is played with several children all over Europe and can be shortly described as follows. The child logs in on the internet with his PDA using GPRS or UMTS or other protocols. This initiates a human like dialogue with a digital assistant represented as a mascot on the screen of the PDA. After analyzing the latest data (weight, calorie consumption, level and kind of activity) the mascot declares the child how his behavior has influenced ‘the game’. Based on the analysis and the talk new directives are given to the child. This can be an educational task or physical training. Imagine that the child is at the seaside (this will be detected by the GPS) a location based action such as running can be initiated, being at the countryside a search for healthy vegetables can be one of the purposes. Speed can be matched with another child that runs somewhere at the other side of Europe. The knowledge what healthy food is can give the child some additional points in the game. If required an adapted diet will be automatically generated and send to the parents by a simple SMS message.

This project in the domain of Anaesthesiology focuses on the development of a responsive environment for technologyenhanced learning in anaesthesiology that inspires and assists teachers, trainees and professionals. This novel pedagogicallyinspired solution combines top research in sensor technology, medical education, human resources management and intuitive learning systems. The proposed research considers anaesthesiology education as total experience, contextualized and adaptable to different medical professional training and career levels. This pan European approach will radically change the current inconsistent, fragmented and thus vulnerable training system. It is believed that this attempt is aimed the first time in the world. The innovative nature lies in the combination of profiling and training. For this reason the consortium will develop a new expert system that will use a combination of quantitative physiological data and qualitative methods of knowledge use, workload and performance. The result will be a multidimensional representation of all necessary knowledge and skills required for an optimal professional performance. With this comes the potential to transform anaesthesiology education and improve the safety and quality of patient care across Europe

Rare diseases (RD) are life-threatening, chronically debilitating diseases with a low prevalence and a high level of complexity. Understanding this complexity requires a global vision but at the same time a strong, integrated research. Expert teams from all over Europe have been underlining the importance of such an integrated research as being the only guarantee for dealing appropriately with morbidity prevention and premature mortality in these isolated groups. Appropriate coding and classification systems are the keys to targeted treatments and improved quality of life. Their development must be checked in the agenda of tomorrow, if not today and have to be merged with health care information systems to make these patients visible to all levels of care. The focus on RD is new in Europe and we welcome the policy makers who have opened their eyes for a neglected domain. This means that there is hope at the horizon. Indeed the public consultation on Rare Diseases has recognized the importance of pooling together resources in this domain and to optimize coordination. It strongly encourages participation in collaborative research projects relevant for this field as well as the establishment of shared infrastructures for registries, databases, repositories and technical platforms. This new élan motivated the Faculty of Medicine and Pharmacy of Targu Mures to organize a conference meeting with the aim to focus the attention of researchers from all over Europe to the importance of ICT for building efficient registries, databases, repositories etc…The group attending the meeting, eulogized about the new Public Health Programme (2008-20013) that puts RD into the picture, however some were afraid that ICT does not belong to the Public Health Programme but either to the FP7-ICT. Indeed ICT deals with ‘disease management’ and ‘information distribution’, the real pillars of sustainable and personalised healthcare. Sustainability is extremely important for a fragile research domain such as rare diseases where too much responsibility is shared by only a few people. Therefore knowledge and intelligence should be intertwined with the databases, spreading existing knowledge to all corners of Europe and at the same time collecting new one. Therefore the conclusion of the conference converged to 4 key action points: 1. Making communication among clinics & laboratories appropriate. Therefore an optimal and intelligent use of modern communication technology is needed. But it goes far beyond this. The communication technology must be self-adaptable according to geographical locations and special circumstances (for example low bandwidth or unavailability of the internet). Communication needs bi-directionality: experts send correct information on diagnosis and treatment to localities, and receive correct data in return to populate the databases; these databases generate new knowledge that can on its turn be distributed to the user. 2. Intelligent databases tuning laboratories Research is always refreshed by looking at information from different angles. The use of expert systems, neural networks and AI are of paramount importance. They can handle tons of information in a way the human being is not able to do. Surpassing here the state of the art will yield new, never thought, insights in science and changes the way of how actual labs work in areas of rare diseases. 3. From ‘expert opinion’ to clinical guideline There is a paucity of controlled studies on the treatment of rare diseases, making levels of evidence sometimes doubtable. Till now consensus algorithms for diagnosis, therapy, and management of rare diseases were only formed through the meeting and agreement of patient care professionals along with patient group representatives and individual patients. New advances in trend detection and causality analysis will be able to track and analyse historical series of thousands of patients across Europe and yield new guidelines based on trends and causality. It will merge specific medical data with general data and this on standardized e-health platforms. 4. Make the evidence applicable everywhere anytime Increase the awareness of rare diseases among all levels of medical care by interfacing the existing and new emerging knowledge with medical education programs. Europe wants to certify equal quality of treatment all over Europe. A first step is to make evidence based guidelines applicable to particular areas. Therefore intelligent algorithms are to be created that takes into account the characteristics of a particular setting. By doing so optimal quality can be guaranteed in unfavorable situations, which catalyze fast improvements. Because of the strong link of our planned endeavors with a former FP7-ICT-call, all subscribers of the described vision would like to ask the EC to reedit Challenge 5: Sustainable and personalized healthcare. We honestly think that rare diseases merit more attention. Therefore we also dare to suggest widening the definition of ‘chronic diseases’ in the way that they also entail ‘rare diseases’. The subscribers of this letter belief that a highly multidisciplinary consortium can be built with ICT as the beating heart for sustainability. This consortium is willing to put all efforts in a high quality proposal serving a neglected minority of people suffering from diseases that need more attention.

A computerized in real time monitoring system that understands the course of the disease and copes with each minor loss of functionality by emulating a correct functional Electrical Stimulation (FES) driven motor action for the intended task, can compensate for the deterioration of daily living activities in multiple sclerosis. The loss of myelin cells will continue, but without a noticeable change in everyday performance of the patient. The quality of life remains optimal and besides this, physical condition is well kept till time is ripe for stem cell implants that might cure the disease.

When we look at human behaviour, performance is expressed by the number of qualified skills it has acquired. Skills are learned from different and multiple interactions between multiple sources of information as they try to find interpretations of messages that help to better interact with a real or a virtual environment. Each source of information can be considered as an agent containing some limited data. “Gaming” is an excellent example of such a complex behaviour as it occurs in society. The sociological and dynamic structure of a game makes it suitable for mastering large learning systems in various area of ICT. A game can be very flexible in terms of interactions and considering augmented reality it goes far beyond current physical limitations. To make it robust and reliable the ‘game’ must have the capability of automatic reconfiguration with a complexity that is selfadapting ensuring operations in nonpredetermined environments. This selfaware ‘game’ that creates collective goals needs a real time structure for its communication with the human being. The latter will be part of an extremely fast feedback loop connecting him to the system, which has a global selfregulating control. This radical new design of tight but smooth coupling will make disappear the conventional ‘masterslave’ paradigm, which has always been a hurdle for the creation of bidirectional, multimodal and intelligent interfaces. This emerging field of combined biotechnical systems deals with a number of agents that can increase rapidly according to the nature of the application and depending on the intelligence needed. Mutually distrusting agents with different preferences of communication must ensure a high plasticity to fulfil collective tasks wherein important local knowledge repositories are exchanged and a fast decision can be guaranteed. Forcing this trend will lead to the broad acceptance being suitable in the area of skill and task adaptation, a prime requisite for human support and augmentation. However the large number of agents encapsulated in the game structure burdens the actual available processing speed so that grid computing that couples resources that cannot be replicated at a single side becomes of paramount importance. Intelligent behaviour is a consequence of system architecture, organisation of memory and rules for learning and adaptation. The basic structure of the proposed system consists of three agents representing the game, the interface and the human being. Each of them has an individual behaviour that can be updated by sharing knowledge. Many demonstrators can be built with minor or no change within the system. Only the game has to be changed. It may seem ridiculous but this system is applicable for the rehabilitation of neurological patients as well as for investment planning on the stock market. In the rehabilitation example the game may be an instructive ball game, which challenges most features of sensorymotor control. The player is embedded in a robot and both are acting in a virtual environment. Since the robot likes the game he wants to improve its skills. The game is intelligent and learns the capabilities of the player. Since the player (patient) is embedded in robot, the latter has to perform a system identification, based on dynamic and kinematical constrains or/and by integrating information from biosensors attached or implanted in the player. When the game throws a ball to the player, the robot will launch his arm to the object. When the player is paralysed the robot will learn that no resistance to the reach means cooperation or passiveness. Integrating EMG and EEG data the robot knows the difference and can adapt the system. The game understands it and the next throw will be according to it. This is an example of mutual learning. In the same way a neural prosthesis will learn to behave according a variety of circumstances. Rehabilitation goes even far beyond sensorymotor recovery. Since the player lives in symbiosis with the system he need to talk with it in a natural way, telling it what he feels. The game and the robot must be able to understand this and an emotional link will increase bidirectional compliance. When we look at a complete different example, namely the stock market nothing essential has to be changed. Only the game that now can be a geographic representation of the markets designed as buildings or natural surroundings. The player is again embedded in a robotic/interface structure and linked to the game. Being an eagle he can fly around in the virtual world that adapts in real time. Other birds act as messengers speaking and understanding the language of the player or make connection flights between different industries. As player you have to defend your position and your objective is to grow. The results of your actions will be reflected in the game as changing landscapes or a changing climate that makes you feel uncomfortable. Building a collective behaviour by a smooth integration between the thoughts of the player and the probalistic approach of the robot decision making will speed up substantially in a domain where slowness means a waste of money.

This project idea creates an all-in floor as a carpet that cares for the older person and carries him/her to stay independent. A floor means that it is completely integrated with the existing environment and for this reason invisible. All in, because it represents the interface between the ‘person’ and ‘environment’, it detects problems and remedies.