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Continuous monitoring of physiological signals has the potential to greatly improve the quality of life of patients with chronic diseases. Recent advances in sensor technology make the capture of such signals possible. In this paper, we present BioStream, a real-time, and operator-based software solution for managing physiological sensor streams. It is built on top of a general-purpose stream processing software architecture. The system processes data using plug-in analysis components that can be easily composed into plans using a graphical programming environment. The architecture is scalable, allowing implementation on systems ranging from desktops to server farms. It guarantees real-time response and data persistence in a distributed environment. We apply this architecture to the problem of multipatient, real-time, physiological signal monitoring, analysis, indexing and visualization.