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Meijer HAW, Graafland M, Obdeijn MC, Schijven MP, Goslings JC. Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation. Eur J Trauma Emerg Surg 2021; 48:1317-1325. [PMID: 33885912 PMCID: PMC9001232 DOI: 10.1007/s00068-021-01657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. METHODS As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test-retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland-Altman plots. RESULTS Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of - 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion-extension arc and the radial deviation-ulnar deviation arc. CONCLUSION The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test-retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. TRIAL REGISTRATION NUMBER (internal hospital registration only) MEC-AMC W17_003 #17.015.
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Affiliation(s)
- Henriëtte A W Meijer
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Abstract
The wide-spread use of wearables and the adoption of the Internet of Things (IoT) paradigm provide an opportunity to use mobile-device sensors for medical applications. Sensors available in the commonly used devices may inspire innovative solutions for physiotherapy striving for accurate and early identification of various pathologies. An essential and reliable performance measure is the ten-meter walk test, which is employed to determine functional mobility, gait, and vestibular function. Sensor-based approaches can identify the various test phases and their segmented duration, among other parameters. The measurement parameter primarily used is related to the tests’ duration, and after identifying patterns, a variety of physical treatments can be recommended. This paper reviews multiple studies focusing on automated measurements of the ten-meter walk test with different sensors. Most of the analyzed studies measure similar parameters as traditional methods, such as velocity, duration, and other involuntary and dangerous patients’ movements after stroke. That provides an opportunity to measure different parameters that can be later fed into machine learning models for analyzing more complex patterns.
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Kim H, Kim S, Lee M, Rhee Y, Lee S, Jeong YR, Kang S, Naqi M, Hong S. Smart Patch for Skin Temperature: Preliminary Study to Evaluate Psychometrics and Feasibility. SENSORS 2021; 21:s21051855. [PMID: 33800920 PMCID: PMC7961890 DOI: 10.3390/s21051855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
There is a need for continuous, non-invasive monitoring of biological data to assess health and wellbeing. Currently, many types of smart patches have been developed to continuously monitor body temperature, but few trials have been completed to evaluate psychometrics and feasibility for human subjects in real-life scenarios. The aim of this feasibility study was to evaluate the reliability, validity and usability of a smart patch measuring body temperature in healthy adults. The smart patch consisted of a fully integrated wearable wireless sensor with a multichannel temperature sensor, signal processing integrated circuit, wireless communication feature and a flexible battery. Thirty-five healthy adults were recruited for this test, carried out by wearing the patches on their upper chests for 24 h and checking their body temperature six times a day using infrared forehead thermometers as a gold standard for testing validity. Descriptive statistics, one-sampled and independent t-tests, Pearson’s correlation coefficients and Bland-Altman plot were examined for body temperatures between two measures. In addition, multiple linear regression, receiver operating characteristic (ROC) and qualitative content analysis were conducted. Among the 35 participants, 29 of them wore the patch for over 19 h (dropout rate: 17.14%). Mean body temperature measured by infrared forehead thermometers and smart patch ranged between 32.53 and 38.2 °C per person and were moderately correlated (r = 0.23–0.43) overall. Based on a Bland-Altman plot, approximately 94% of the measurements were located within one standard deviation (upper limit = 4.52, lower limit = −5.82). Most outliers were identified on the first measurement and were located below the lower limit. It is appropriate to use 37.5 °C in infrared forehead temperature as a cutoff to define febrile conditions. Users’ position while checking and ambient temperature and humidity are not affected to the smart patch body temperature. Overall, the participants showed high usability and satisfaction on the survey. Few participants reported discomfort due to limited daily activity, itchy skin or detaching concerns. In conclusion, epidermal electronic sensor technologies provide a promising method for continuously monitoring individuals’ body temperatures, even in real-life situations. Our study findings show the potential for smart patches to monitoring non-febrile condition in the community.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seoul 03722, Korea;
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea
| | - Sunkook Kim
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Mingoo Lee
- Korea Electronics Technology Institute, Seongnam 13509, Korea; (M.L.); (S.L.)
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Sungho Lee
- Korea Electronics Technology Institute, Seongnam 13509, Korea; (M.L.); (S.L.)
| | - Yi-Rang Jeong
- Department of Nursing, Samsung Medical Center, Seoul 06351, Korea;
| | - Sunju Kang
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Muhammad Naqi
- Multifunctional Nano Bio Electronics Lab, Department of Advanced Materials and Science Engineering, Sungkyunkwan University, Suwon 16419, Korea; (S.K.); (S.K.); (M.N.)
| | - Soyun Hong
- College of Nursing, Yonsei University, Seoul 03722, Korea;
- Correspondence:
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Leenen JPL, Dijkman EM, van Dijk JD, van Westreenen HL, Kalkman C, Schoonhoven L, Patijn GA. Feasibility of continuous monitoring of vital signs in surgical patients on a general ward: an observational cohort study. BMJ Open 2021; 11:e042735. [PMID: 33597138 PMCID: PMC7893648 DOI: 10.1136/bmjopen-2020-042735] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward. DESIGN Observational cohort study. SETTING Tertiary teaching hospital. PARTICIPANTS Postoperative abdominal surgical patients (n=30) and nurses (n=23). INTERVENTIONS Patients were continuously monitored with the SensiumVitals wearable device until discharge in addition to usual care, which is intermittent Modified Early Warning Score measurements. Heart rate, respiratory rate and axillary temperature were monitored every 2 min. Values and trends were visualised and alerts sent to the nurses. OUTCOMES System fidelity was measured by analysis of the monitoring data. Acceptability by patients and nurses was assessed using questionnaires. RESULTS Thirty patients were monitored for a median duration of 81 hours (IQR 47-143) per patient, resulting in 115 217 measurements per parameter. In total, 19% (n=21 311) of heart rate, 51% (n=59 184) of respiratory rate and 9% of temperature measurements showed artefacts (n=10 269). The system algorithm sent 972 alerts (median alert rate of 4.5 per patient per day), of which 90.3% (n=878) were system alerts and 9.7% (n=94) were vital sign alerts. 35% (n=33) of vital sign alerts were true positives. 93% (n=25) of patients rated the patch as comfortable, 67% (n=18) felt safer and 89% (n=24) would like to wear it next time in the hospital. Nurses were neutral about usefulness, with a median score of 3.5 (IQR 3.1-4) on a 7-point Likert scale, ease of use 3.7 (IQR 3.2-4.8) and satisfaction 3.7 (IQR 3.2-4.8), but agreed on ease of learning at 5.0 (IQR 4.0-5.8). Neutral scores were mostly related to the perceived limited fidelity of the system. CONCLUSIONS Continuous monitoring of vital signs with a wearable device was well accepted by patients. Nurses' ratings were highly variable, resulting in on average neutral attitude towards remote monitoring. Our results suggest it is feasible to monitor vital signs continuously on general wards, although acceptability of the device among nurses needs further improvement.
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Affiliation(s)
- Jobbe P L Leenen
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Center, Isala, Zwolle, The Netherlands
| | | | | | | | - Cor Kalkman
- Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Design and validation of a smart garment to measure positioning practices of parents with young infants. Infant Behav Dev 2021; 62:101530. [PMID: 33548894 DOI: 10.1016/j.infbeh.2021.101530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/26/2022]
Abstract
The aim of this cross-sectional study was to evaluate the feasibility, construct validity, and reliability of a smart garment to characterize parent-child positioning practices in infants less than six months old. The smart garment (Get Around Garment, GG) was developed through feedback from seven infants and their parents. The final system was then tested with sixteen infants (M = 3.1 ± 1.1 months) assessed in their homes during one visit that consisted of a: 1) Structured Play Assessment (2.5 min): infant was placed in each of five positions (prone, supine, reclined/inclined, and upright) for 30 s, 2) Free Play Assessment (40-60 min): parents were asked to engage in typical daily activities, and 3) second Structured Play Assessment. Infants' body position was both coded from video and identified from sensor data using a custom program. Feasibility was measured by data from a Daily Wearing Log and Garment Perception Questionnaire. Validity was evaluated by comparing the coding and sensor data. Reliability was measured by comparing the sensor data between the two Structured Play Assessments. The GG was considered feasible for use. The smart wearable system showed high levels of accuracy for classifying body position secondby- second and when comparing cumulative duration across time. Reliability of the smart garment was excellent. Young infants spent more time in supine and supported upright positions relative to prone, reclined, or inclined positions. The results suggest that accelerometers can be integrated into garments in a manner that is feasible to provide accurate and consistent data about positioning practices of parents with young infants. Monitoring early positioning practices is important because these practices impact future motor and cognitive developmental trajectories.
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Brajcich BC, Fischer CP, Ko CY. Administrative and Registry Databases for Patient Safety Tracking and Quality Improvement. Surg Clin North Am 2021; 101:121-134. [DOI: 10.1016/j.suc.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Li F, Tao Z, Li R, Qu Z. The early warning research on nursing care of stroke patients with intelligent wearable devices under COVID-19. PERSONAL AND UBIQUITOUS COMPUTING 2021; 27:767-779. [PMID: 33526997 PMCID: PMC7837337 DOI: 10.1007/s00779-021-01520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 05/27/2023]
Abstract
Stroke patients under the background of the new crown epidemic need to be home-based care. However, traditional nursing methods cannot take care of the patients' lives in all aspects. Based on this, based on machine learning algorithms, our work combines regression models and SVM to build a smart wearable device system and builds a system prediction module to predict patient care needs. The node is used to collect human body motion and physiological parameter information and transmit data wirelessly. The software is used to quickly process and analyze the various motion and physiological parameters of the patient and save the analysis and processing structure in the database. By comparing the results of nursing intervention experiments, we can see that the smart wearable device designed in this paper has a certain effect in stroke care.
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Affiliation(s)
- Fengxia Li
- Huaihe Hospital of Henan University, College of Nursing and Health, Henan University, Kaifeng, 475001 China
| | - Zhimin Tao
- College of Nursing and Health, Henan University, Kaifeng, 475001 China
| | - Ruiling Li
- College of Nursing and Health, Henan University, Kaifeng, 475001 China
| | - Zhi Qu
- College of Nursing and Health, Henan University, Kaifeng, 475001 China
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Tabatabaei SAH, Fischer P, Schneider H, Koehler U, Gross V, Sohrabi K. Methods for Adventitious Respiratory Sound Analyzing Applications Based on Smartphones: A Survey. IEEE Rev Biomed Eng 2021; 14:98-115. [PMID: 32746364 DOI: 10.1109/rbme.2020.3002970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Detection and classification of adventitious acoustic lung sounds plays an important role in diagnosing, monitoring, controlling and, caring the patients with lung diseases. Such systems can be presented as different platforms like medical devices, standalone software or smartphone application. Ubiquity of smartphones and widespread use of the corresponding applications make such a device an attractive platform for hosting the detection and classification systems for adventitious lung sounds. In this paper, the smartphone-based systems for automatic detection and classification of the adventitious lung sounds are surveyed. Such adventitious sounds include cough, wheeze, crackle and, snore. Relevant sounds related to abnormal respiratory activities are considered as well. The methods are shortly described and the analyzing algorithms are explained. The analysis includes detection and/or classification of the sound events. A summary of the main surveyed methods together with the classification parameters and used features for the sake of comparison is given. Existing challenges, open issues and future trends will be discussed as well.
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Ali Khan MU, Raad R, Tubbal F, Theoharis PI, Liu S, Foroughi J. Bending Analysis of Polymer-Based Flexible Antennas for Wearable, General IoT Applications: A Review. Polymers (Basel) 2021; 13:polym13030357. [PMID: 33499265 PMCID: PMC7865813 DOI: 10.3390/polym13030357] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/04/2022] Open
Abstract
Flexible substrates have become essential in order to provide increased flexibility in wearable sensors, including polymers, plastic, paper, textiles and fabrics. This study is to comprehensively summarize the bending capabilities of flexible polymer substrate for general Internet of Things (IoTs) applications. The basic premise is to investigate the flexibility and bending ability of polymer materials as well as their tendency to withstand deformation. We start by providing a chronological order of flexible materials which have been used during the last few decades. In the future, the IoT is expected to support a diverse set of technologies to enable new applications through wireless connectivity. For wearable IoTs, flexibility and bending capabilities of materials are required. This paper provides an overview of some abundantly used polymer substrates and compares their physical, electrical and mechanical properties. It also studies the bending effects on the radiation performance of antenna designs that use polymer substrates. Moreover, we explore a selection of flexible materials for flexible antennas in IoT applications, namely Polyimides (PI), Polyethylene Terephthalate (PET), Polydimethylsiloxane (PDMS), Polytetrafluoroethylene (PTFE), Rogers RT/Duroid and Liquid Crystal Polymer (LCP). The study includes a complete analysis of bending and folding effects on the radiation characteristics such as S-parameters, resonant frequency deviation and the impedance mismatch with feedline of the flexible polymer substrate microstrip antennas. These flexible polymer substrates are useful for future wearable devices and general IoT applications.
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Affiliation(s)
- Muhammad Usman Ali Khan
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
| | - Raad Raad
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
| | - Faisel Tubbal
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
| | - Panagiotis Ioannis Theoharis
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
| | - Sining Liu
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
| | - Javad Foroughi
- School of Electrical Computer and Telecommunication Engineering, University of Wollongong, Wollongong, NSW 2522, Australia; (M.U.A.K.); (R.R.); (F.T.); (P.I.T.); (S.L.)
- Westgerman Heart and Vascular Center, University of Duisburg-Essen, 45122 Essen, Germany
- Correspondence: ; Tel.: +61-405-817-010
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Yin TC, Huang CW, Tsai HL, Su WC, Ma CJ, Chang TK, Wang JY. Smartband Use During Enhanced Recovery After Surgery Facilitates Inpatient Recuperation Following Minimally Invasive Colorectal Surgery. Front Surg 2021; 7:608950. [PMID: 33585547 PMCID: PMC7874082 DOI: 10.3389/fsurg.2020.608950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Enhanced recovery after surgery (ERAS) is valuable in perioperative care for its ability to improve short-term surgical outcomes and facilitate patient recuperation after major surgery. Early postoperative mobilization is a vital component of the integrated care pathway and is a factor strongly associated with successful outcomes. However, early mobilization still has various definitions and lacks specific strategies. Methods: Patients who underwent minimally invasive surgery for colorectal cancer followed our perioperative ERAS program, including mobilization from the first postoperative day. After perioperative care skills were improved in our well-established program, compliance, inpatient surgical outcomes, and complications associated with adding smartband use were evaluated and compared with the outcomes for standard protocol. Quality of recovery was evaluated using patient-rated QoR-40 questionnaires the day before surgery, on postoperative days 1 and 3, and on the day of discharge. Results: Smartband use after minimally invasive colorectal surgery failed to increase compliance with early mobilization or reduce the occurrence of postoperative complications significantly compared with standard ERAS protocol. However, when smartbands were utilized, quality of recovery was optimized and patients returned to their preoperative status earlier, at postoperative day 3. The length of hospital stay, as defined by discharge criteria, and hospital stay of patients without complications was reduced by 1.1 and 0.9 days, respectively (P = 0.009 and 0.049, respectively). Conclusions: Smartbands enable enhanced communication between patients and surgical teams and strengthen self-management in patients undergoing minimally invasive colorectal resection surgery. Accelerated recovery to preoperative functional status can be facilitated by integrating smartbands into the process of early mobilization during ERAS.
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Affiliation(s)
- Tzu-Chieh Yin
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Predel C, Steger F. Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes? Front Cardiovasc Med 2021; 7:615927. [PMID: 33521064 PMCID: PMC7843431 DOI: 10.3389/fcvm.2020.615927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation is the most common persistent arrhythmia. It is associated with increased mortality and morbidity such as stroke. The early detection of atrial fibrillation can significantly reduce the risk of stroke through preventive anticoagulation. Smartwatches offer the opportunity to screen for atrial fibrillation in the general population. This paper aims to analyze the ethical challenges associated with screening for atrial fibrillation using smartwatches. Methods: This is an ethical analysis. The methodology is based on the principle-orientated approach of Beauchamp and Childress. The principles of beneficence, non-maleficence, justice, and autonomy have to be guaranteed given the influence of private companies, privacy protection, liability and doctor-patient-relationship. The work is based on a systematic literature research. Results: There is currently no evidence that screening for atrial fibrillation with smartwatches improves the outcome and reduces the number of adverse events. The high number of false-positive results can lead to harm. The principle of non-maleficence is violated. The over-reliance on and the lack of adequate education by smartwatches can worsen the doctor-patient relationship. However, the relationship can also be improved by the proactive participation of the patient, which leads to greater autonomy, compliance and in the end beneficence. Since smartwatches are consumer goods, there is a risk for greater disparities in the poor and rich population. There is also a risk of discrimination against ethnic minorities due to underrepresentation in training data and study cohorts. The principle of justice is violated. The storage of sensitive medical data by private companies also raises many ethical and legal concerns. Conclusion: This analysis has shown that the use of smartwatches to detect atrial fibrillation is currently in an ethical perspective problematic. The lack of evidence and the high number of false-positive results can lead to harm. As smartwatches provide only little information about the possible consequences, informed consent cannot be assumed. Ethical implementation could be archived if doctors provide smartwatches to patients who have been shown to benefit from them. The implementation and education should be managed by the doctor.
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Affiliation(s)
- Christopher Predel
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Wearable Devices for Ambulatory Cardiac Monitoring: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1582-1592. [PMID: 32241375 DOI: 10.1016/j.jacc.2020.01.046] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 12/14/2022]
Abstract
Ambulatory monitoring devices are enabling a new paradigm of health care by collecting and analyzing long-term data for reliable diagnostics. These devices are becoming increasingly popular for continuous monitoring of cardiac diseases. Recent advancements have enabled solutions that are both affordable and reliable, allowing monitoring of vulnerable populations from the comfort of their homes. They provide early detection of important physiological events, leading to timely alerts for seeking medical attention. In this review, the authors aim to summarize the recent developments in the area of ambulatory and remote monitoring solutions for cardiac diagnostics. The authors cover solutions based on wearable devices, smartphones, and other ambulatory sensors. The authors also present an overview of the limitations of current technologies, their effectiveness, and their adoption in the general population, and discuss some of the recently proposed methods to overcome these challenges. Lastly, we discuss the possibilities opened by this new paradigm, for the future of health care and personalized medicine.
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Areia C, Young L, Vollam S, Ede J, Santos M, Tarassenko L, Watkinson P. Wearability Testing of Ambulatory Vital Sign Monitoring Devices: Prospective Observational Cohort Study. JMIR Mhealth Uhealth 2020; 8:e20214. [PMID: 33325827 PMCID: PMC7773507 DOI: 10.2196/20214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Timely recognition of patient deterioration remains challenging. Ambulatory monitoring systems (AMSs) may provide support to current monitoring practices; however, they need to be thoroughly tested before implementation in the clinical environment for early detection of deterioration. Objective The objective of this study was to assess the wearability of a selection of commercially available AMSs to inform a future prospective study of ambulatory vital sign monitors in an acute hospital ward. Methods Five pulse oximeters (4 with finger probes and 1 wrist-worn only, collecting pulse rates and oxygen saturation) and 2 chest patches (collecting heart rates and respiratory rates) were selected to be part of this study: The 2 chest-worn patches were VitalPatch (VitalConnect) and Peerbridge Cor (Peerbridge); the 4 wrist-worn devices with finger probe were Nonin WristOx2 3150 (Nonin), Checkme O2+ (Viatom Technology), PC-68B, and AP-20 (both from Creative Medical); and the 1 solely wrist-worn device was Wavelet (Wavelet Health). Adult participants wore each device for up to 72 hours while performing usual “activities of daily living” and were asked to score the perceived exertion and perception of pain or discomfort by using the Borg CR-10 scale; thoughts and feelings caused by the AMS using the Comfort Rating Scale (CRS); and to provide general free text feedback. Median and IQRs were reported and nonparametric tests were used to assess differences between the devices’ CRS scores. Results Quantitative scores and feedback were collected in 70 completed questionnaires from 20 healthy volunteers, with each device tested approximately 10 times. The Wavelet seemed to be the most wearable device (P<.001) with an overall median (IQR) CRS score of 1.00 (0.88). There were no statistically significant differences in wearability between the chest patches in the CRS total score; however, the VitalPatch was superior in the Attachment section (P=.04) with a median (IQR) score of 3.00 (1.00). General pain and discomfort scores and total percentage of time worn are also reflective of this. Conclusions Our results suggest that adult participants prefer to wear wrist-worn pulse oximeters without a probe compressing the fingertip and they prefer to wear a smaller chest patch. A compromise between wearability, reliability, and accuracy should be made for successful and practical integration of AMSs within the hospital environment.
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Affiliation(s)
- Carlos Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Jody Ede
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Mauro Santos
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
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Moulaei K, Malek M, Sheikhtaheri A. A smart wearable device for monitoring and self-management of diabetic foot: A proof of concept study. Int J Med Inform 2020; 146:104343. [PMID: 33260090 DOI: 10.1016/j.ijmedinf.2020.104343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Diabetic foot is one of the important complications of diabetes, which is occurred due to the destructive parameters in different anatomical sites of feet. Management and monitoring of these parameters are very important to decrease or prevent foot ulcers. We aimed to develop a smart wearable device to monitor these parameters to prevent diabetic foot. METHODS Following literature review and expert panel discussions, we considered pressure, temperature and humidity to develop the system. During these sessions, we also developed the system architecture and determined the required technologies. We also developed a mobile application. Finally, all sensors were evaluated for accurate monitoring of pressure, temperature and humidity. A standard protocol was used to evaluate each of these sensors. To this end, five people (four with diabetes and one healthy person) participated. They did a series of movements including walking, sitting, and standing. We considered the pressure measured by Pedar system as the gold standard. Furthermore, we changed the environment temperature and humidity during several experiments and considered the environment temperature and humidity as gold standard. We compared the measured values by sensors with these gold standards. RESULTS The evaluation indicated the accurate performance of pressure, humidity and temperature sensors. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the system to provide alarms based on the pressure measured using Pedar were 100, 50, 92.5, 91.8, and 100 %, respectively. The performance of temperature sensors in smart shoes was confirmed by slight differences compared to thermometers. Relatively equal values of humidity measured by two sensors on the left and right feet and the increased difference with the environment humidity showed the exact humidity measured using these sensors. CONCLUSION This smart shoes monitors pressure, humidity, and temperature of patients' feet and sends this data to their smart phone by the Bluetooth module. Furthermore, it controls these parameters; as each of these parameters exceeds the defined threshold, alerts are given to patients for self-management.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Routhier F, Duclos NC, Lacroix É, Lettre J, Turcotte E, Hamel N, Michaud F, Duclos C, Archambault PS, Bouyer LJ. Clinicians' perspectives on inertial measurement units in clinical practice. PLoS One 2020; 15:e0241922. [PMID: 33186363 PMCID: PMC7665628 DOI: 10.1371/journal.pone.0241922] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/23/2020] [Indexed: 01/29/2023] Open
Abstract
Inertial measurement units (IMUs) have been increasingly popular in rehabilitation research. However, despite their accessibility and potential advantages, their uptake and acceptance by health professionals remain a big challenge. The development of an IMU-based clinical tool must bring together engineers, researchers and clinicians. This study is part of a developmental process with the investigation of clinicians’ perspectives about IMUs. Clinicians from four rehabilitation centers were invited to a 30-minute presentation on IMUs. Then, two one-hour focus groups were conducted with volunteer clinicians in each rehabilitation center on: 1) IMUs and their clinical usefulness, and 2) IMUs data analysis and visualization interface. Fifteen clinicians took part in the first focus groups. They expressed their thoughts on: 1) categories of variables that would be useful to measure with IMUs in clinical practice, and 2) desired characteristics of the IMUs. Twenty-three clinicians participated to the second focus groups, discussing: 1) functionalities, 2) display options, 3) clinical data reported and associated information, and 4) data collection duration. Potential influence of IMUs on clinical practice and added value were discussed in both focus groups. Clinicians expressed positive opinions about the use of IMUs, but their expectations were high before considering using IMUs in their practice.
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Affiliation(s)
- François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
- * E-mail:
| | - Noémie C. Duclos
- Handicap Activity Cognition Health Team-U1219 BPH, University of Bordeaux, Bordeaux, France
- Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, Bordeaux, France
| | - Émilie Lacroix
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Josiane Lettre
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Elizabeth Turcotte
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Nathalie Hamel
- IntRoLab–Laboratoire de Robotique Intelligente/Interactive/Intégrée/Interdisciplinaire, Institut Interdisciplinaire d’Innovation Technologique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Michaud
- IntRoLab–Laboratoire de Robotique Intelligente/Interactive/Intégrée/Interdisciplinaire, Institut Interdisciplinaire d’Innovation Technologique, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Cyril Duclos
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Philippe S. Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Jewish Rehabilitation Hospital, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC, Canada
| | - Laurent J. Bouyer
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
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Lorenzoni G, Azzolina D, Fraccaro C, Di Liberti A, D'Onofrio A, Cavalli C, Fabris T, D'Amico G, Cibin G, Nai Fovino L, Ocagli H, Gerosa G, Tarantini G, Gregori D. Using Wearable Devices to Monitor Physical Activity in Patients Undergoing Aortic Valve Replacement: Protocol for a Prospective Observational Study. JMIR Res Protoc 2020; 9:e20072. [PMID: 33180023 PMCID: PMC7691084 DOI: 10.2196/20072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022] Open
Abstract
Background In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice. Objective This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients. Methods This is a prospective observational study. The enrollment will be conducted 1 month before patients’ SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin vívoactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality. Results The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing. Conclusions The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients. Trial Registration Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y International Registered Report Identifier (IRRID) DERR1-10.2196/20072
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Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Di Liberti
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Cavalli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tommaso Fabris
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianpiero D'Amico
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luca Nai Fovino
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Homogeneous Data Normalization and Deep Learning: A Case Study in Human Activity Classification. FUTURE INTERNET 2020. [DOI: 10.3390/fi12110194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
One class of applications for human activity recognition methods is found in mobile devices for monitoring older adults and people with special needs. Recently, many studies were performed to create intelligent methods for the recognition of human activities. However, the different mobile devices in the market acquire the data from sensors at different frequencies. This paper focuses on implementing four data normalization techniques, i.e., MaxAbsScaler, MinMaxScaler, RobustScaler, and Z-Score. Subsequently, we evaluate the impact of the normalization algorithms with deep neural networks (DNN) for the classification of the human activities. The impact of the data normalization was counterintuitive, resulting in a degradation of performance. Namely, when using the accelerometer data, the accuracy dropped from about 79% to only 53% for the best normalization approach. Similarly, for the gyroscope data, the accuracy without normalization was about 81.5%, whereas with the best normalization, it was only 60%. It can be concluded that data normalization techniques are not helpful in classification problems with homogeneous data.
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Sevil M, Rashid M, Maloney Z, Hajizadeh I, Samadi S, Askari MR, Hobbs N, Brandt R, Park M, Quinn L, Cinar A. Determining Physical Activity Characteristics from Wristband Data for Use in Automated Insulin Delivery Systems. IEEE SENSORS JOURNAL 2020; 20:12859-12870. [PMID: 33100923 PMCID: PMC7584145 DOI: 10.1109/jsen.2020.3000772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Algorithms that can determine the type of physical activity (PA) and quantify the intensity can allow precision medicine approaches, such as automated insulin delivery systems that modulate insulin administration in response to PA. In this work, data from a multi-sensor wristband is used to design classifiers to distinguish among five different physical states (PS) (resting, activities of daily living, running, biking, and resistance training), and to develop models to estimate the energy expenditure (EE) of the PA for diabetes therapy. The data collected are filtered, features are extracted from the reconciled signals, and the extracted features are used by machine learning algorithms, including deep-learning techniques, to obtain accurate PS classification and EE estimation. The various machine learning techniques have different success rates ranging from 75.7% to 94.8% in classifying the five different PS. The deep neural network model with long short-term memory has 94.8% classification accuracy. We achieved 0.5 MET (Metabolic Equivalent of Task) root-mean-square error for EE estimation accuracy, relative to indirect calorimetry with randomly selected testing data (10% of collected data). We also demonstrate a 5% improvement in PS classification accuracy and a 0.34 MET decrease in the mean absolute error when using multi-sensor approach relative to using only accelerometer data.
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Affiliation(s)
- Mert Sevil
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Mudassir Rashid
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Zacharie Maloney
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Iman Hajizadeh
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Sediqeh Samadi
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Mohammad Reza Askari
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Nicole Hobbs
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Rachel Brandt
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Minsun Park
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Laurie Quinn
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
| | - Ali Cinar
- Mert Sevil, Rachel Brandt, Nicole Hobbs and Zacharie Maloney are with the Department of Biomedical Engineering (BME); Mudassir Rashid, Mohammad Reza Askari, Iman Hajizadeh and Sedigeh Samadi are with the Department of Chemical and Biological Engineering (ChBE); Ali Cinar is with the Departments of ChBE and BME, Illinois Institute of Technology, Chicago, IL 60616; Minsun Park and Laurie Quinn are with the College of Nursing, University of Illinois at Chicago, IL, 60616
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Ahmadzadeh S, Luo J, Wiffen R. Review on Biomedical Sensors, Technologies and Algorithms for Diagnosis of Sleep Disordered Breathing: Comprehensive Survey. IEEE Rev Biomed Eng 2020; 15:4-22. [PMID: 33104514 DOI: 10.1109/rbme.2020.3033930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper provides a comprehensive review of available technologies for measurements of vital physiology related parameters that cause sleep disordered breathing (SDB). SDB is a chronic disease that may lead to several health problems and increase the risk of high blood pressure and even heart attack. Therefore, the diagnosis of SDB at an early stage is very important. The essential primary step before diagnosis is measurement. Vital health parameters related to SBD might be measured through invasive or non-invasive methods. Nowadays, with respect to increase in aging population, improvement in home health management systems is needed more than even a decade ago. Moreover, traditional health parameter measurement techniques such as polysomnography are not comfortable and introduce additional costs to the consumers. Therefore, in modern advanced self-health management devices, electronics and communication science are combined to provide appliances that can be used for SDB diagnosis, by monitoring a patient's physiological parameters with more comfort and accuracy. Additionally, development in machine learning algorithms provides accurate methods of analysing measured signals. This paper provides a comprehensive review of measurement approaches, data transmission, and communication networks, alongside machine learning algorithms for sleep stage classification, to diagnose SDB.
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Sartori F. An API for Wearable Environments Development and Its Application to mHealth Field †. SENSORS 2020; 20:s20215970. [PMID: 33105574 PMCID: PMC7659971 DOI: 10.3390/s20215970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022]
Abstract
Wearable technologies are transforming research in traditional paradigms of software and knowledge engineering. Among them, expert systems have the opportunity to deal with knowledge bases dynamically varying according to real-time data collected by position sensors, movement sensors, etc. However, it is necessary to design and implement opportune architectural solutions to avoid expert systems are responsible for data acquisition and representation. These solutions should be able to collect and store data according to expert systems desiderata, building a homogeneous framework where data reliability and interoperability among data acquisition, data representation and data use levels are guaranteed. To this aim, the wearable environment notion has been introduced to treat all those information sources as components of a larger platform; a middleware has been designed and implemented, namely WEAR-IT, which allows considering each sensor as a source of information that can be dynamically tied to an expert system application running on a smartphone. As an application example, the mHealth domain is considered.
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Mohan A, Rajendran V, Mishra RK, Jayaraman M. Recent advances and perspectives in sweat based wearable electrochemical sensors. Trends Analyt Chem 2020. [DOI: 10.1016/j.trac.2020.116024] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Modi N, Singh J. A survey of research trends in assistive technologies using information modelling techniques. Disabil Rehabil Assist Technol 2020; 17:605-623. [PMID: 32996798 DOI: 10.1080/17483107.2020.1817992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the rapid proliferation and emphasis on technology, the use of assistive technology among individuals with varying disabilities and age is different. This situation instigates the need for a systematic review to gain a realistic understanding of prominent issues, research trends and assistive technology applications with minimal bias. OBJECTIVE Identification of leading researchers and prominent publications in assistive technologies. Subsequently, semantic relation between qualitative and quantitative research literature on assistive technologies was explored to future research directions. METHODS A manual search across reputed research databases was done to find out relevant literature from January 2005 to April 2020. In this paper, latent semantic analysis (LSA) was done to develop an information model for achieving defined objectives. RESULTS A corpus of 367 research papers published during 2005-2020 was processed using LSA. Term frequency, inverse document frequency of high loading terms provided five major topic solutions. Marcia Scherer, Rory Cooper and Stefano Federici are most noticed authors in assistive technology research. "Smart Assistive Technologies" and "Wearable Technologies for Rehabilitation" came out as contemporary research trends within assistive technologies. CONCLUSIONS The manuscript concludes the fact that assistive technologies for rehabilitation are experiencing a transition from standalone mechanical devices towards smart, wearable and connected devices.Implications for RehabilitationCustomized assistive devices could be programmed for multiple uses.User data privacy and internet dependency of smart assistive technologies must be taken care of while designing smart assistive devices for rehabilitation.Fog devices could eliminate the latency issues associated with cloud-based rehabilitation services.
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Affiliation(s)
- Nandini Modi
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, India
| | - Jaiteg Singh
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, India
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Christen T, Nagale S, Reinitz S, Narayanan S, Roy K, Allocco DJ, Osattin A. Using digital health technology to evaluate the impact of chocolate on blood pressure: Results from the COCOA-BP study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:89-96. [PMID: 35265879 PMCID: PMC8890357 DOI: 10.1016/j.cvdhj.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD). Consumption of dark chocolate, which is high in flavonoids that may reduce CVD risk, is an attractive intervention to reduce to BP. Additionally, the use of mobile health (mHealth) technologies (eg, telehealth, smartphones, and wearable devices) can improve outcomes in patients with CVD. Objective The purpose of this study was to investigate the impact of dark chocolate intake on BP, subject use of mHealth, and integration of mHealth into a clinical trial. Methods The COCOA-BP (ChOcolate COnsumption And Blood Pressure) study was a prospective, single-center, pre-/postintervention study that enrolled 62 healthy volunteers. The study consisted of 3 phases: smartwatch/smart BP monitor familiarization and washout from chocolate (week 1); control (week 2); and intervention (weeks 3 and 4). During the intervention phase, subjects consumed 50 g of dark chocolate per day. The primary endpoint was change in resting systolic BP between the intervention and control phases. Additional endpoints included device accuracy and correlation with physical activity. Results Mean resting systolic BP was 116.4 mm Hg before chocolate intake among 62 participants (mean age 37 years; 61% female). After chocolate intake, mean resting systolic BP was 116.0 mm Hg (difference –0.4; P = .69). These findings suggest that 2 weeks of dark chocolate intake did not reduce resting systolic BP. There was poor agreement between mHealth device and standard (nurse-performed) measurements. Conclusion In this study, short-term dark chocolate intake did not seem to reduce BP. mHealth technology shows great potential for use in clinical studies, but challenges related to device accuracy and compliance need to be addressed.
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Affiliation(s)
| | - Sandra Nagale
- Boston Scientific Corporation, Marlborough, Massachusetts
| | - Steve Reinitz
- Boston Scientific Corporation, Marlborough, Massachusetts
| | | | - Kristine Roy
- Boston Scientific Corporation, Marlborough, Massachusetts
| | | | - Alison Osattin
- Boston Scientific Corporation, Marlborough, Massachusetts
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Chen M, Nguyen TT, Varongchayakul N, Grazon C, Chern M, Baer RC, Lecommandoux S, Klapperich CM, Galagan JE, Dennis AM, Grinstaff MW. Surface Immobilized Nucleic Acid-Transcription Factor Quantum Dots for Biosensing. Adv Healthc Mater 2020; 9:e2000403. [PMID: 32691962 DOI: 10.1002/adhm.202000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/17/2020] [Indexed: 12/23/2022]
Abstract
Immobilization of biosensors on surfaces is a key step toward development of devices for real-world applications. Here the preparation, characterization, and evaluation of a surface-bound transcription factor-nucleic acid complex for analyte detection as an alternative to conventional systems employing aptamers or antibodies are described. The sensor consists of a gold surface modified with thiolated Cy5 fluorophore-labeled DNA and an allosteric transcription factor (TetR) linked to a quantum dot (QD). Upon addition of anhydrotetracycline (aTc)-the analyte-the TetR-QDs release from the surface-bound DNA, resulting in loss of the Förster resonance energy transfer signal. The sensor responds in a dose-dependent manner over the relevant range of 0-200 µm aTc with a limit of detection of 80 nm. The fabrication of the sensor and the subsequent real-time quantitative measurements establish a framework for the design of future surface-bound, affinity-based biosensors using allosteric transcription factors for molecular recognition.
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Affiliation(s)
- Mingfu Chen
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
| | - Thuy T. Nguyen
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
| | | | - Chloé Grazon
- Department of Chemistry Boston University Boston MA 02215 USA
- CNRS Bordeaux INP LCPO UMR 5629 Univ. Bordeaux Pessac F‐33600 France
| | - Margaret Chern
- Division of Materials Science and Engineering Boston University Boston MA 02215 USA
| | - R. C. Baer
- Department of Microbiology Boston University Boston MA 02118 USA
| | | | - Catherine M. Klapperich
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
- Division of Materials Science and Engineering Boston University Boston MA 02215 USA
| | - James E. Galagan
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
- Department of Microbiology Boston University Boston MA 02118 USA
| | - Allison M. Dennis
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
- Division of Materials Science and Engineering Boston University Boston MA 02215 USA
| | - Mark W. Grinstaff
- Department of Biomedical Engineering Boston University Boston MA 02215 USA
- Department of Chemistry Boston University Boston MA 02215 USA
- Division of Materials Science and Engineering Boston University Boston MA 02215 USA
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Padash M, Enz C, Carrara S. Microfluidics by Additive Manufacturing for Wearable Biosensors: A Review. SENSORS 2020; 20:s20154236. [PMID: 32751404 PMCID: PMC7435802 DOI: 10.3390/s20154236] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/04/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022]
Abstract
Wearable devices are nowadays at the edge-front in both academic research as well as in industry, and several wearable devices have been already introduced in the market. One of the most recent advancements in wearable technologies for biosensing is in the area of the remote monitoring of human health by detection on-the-skin. However, almost all the wearable devices present in the market nowadays are still providing information not related to human ‘metabolites and/or disease’ biomarkers, excluding the well-known case of the continuous monitoring of glucose in diabetic patients. Moreover, even in this last case, the glycaemic level is acquired under-the-skin and not on-the-skin. On the other hand, it has been proven that human sweat is very rich in molecules and other biomarkers (e.g., ions), which makes sweat a quite interesting human liquid with regards to gathering medical information at the molecular level in a totally non-invasive manner. Of course, a proper collection of sweat as it is emerging on top of the skin is required to correctly convey such liquid to the molecular biosensors on board of the wearable system. Microfluidic systems have efficiently come to the aid of wearable sensors, in this case. These devices were originally built using methods such as photolithographic and chemical etching techniques with rigid materials. Nowadays, fabrication methods of microfluidic systems are moving towards three-dimensional (3D) printing methods. These methods overcome some of the limitations of the previous method, including expensiveness and non-flexibility. The 3D printing methods have a high speed and according to the application, can control the textures and mechanical properties of an object by using multiple materials in a cheaper way. Therefore, the aim of this paper is to review all the most recent advancements in the methods for 3D printing to fabricate wearable fluidics and provide a critical frame for the future developments of a wearable device for the remote monitoring of the human metabolism directly on-the-skin.
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Affiliation(s)
- Mahshid Padash
- Laboratory of Integrated Circuits, École Polytechnique Fédérale de Lausanne, CH-2002 Neuchâtel, Switzerland or (M.P.); (C.E.)
- Chemistry Department, Shahid Bahonar University of Kerman, Kerman 76169-13439, Iran
| | - Christian Enz
- Laboratory of Integrated Circuits, École Polytechnique Fédérale de Lausanne, CH-2002 Neuchâtel, Switzerland or (M.P.); (C.E.)
| | - Sandro Carrara
- Laboratory of Integrated Circuits, École Polytechnique Fédérale de Lausanne, CH-2002 Neuchâtel, Switzerland or (M.P.); (C.E.)
- Correspondence:
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Nayak SP, Rai S, Pradhan S, Mantri J. RELAS: A reliable authentication system for patient monitoring using IoT. INTERNATIONAL JOURNAL OF KNOWLEDGE-BASED AND INTELLIGENT ENGINEERING SYSTEMS 2020. [DOI: 10.3233/kes-200032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Samaleswari Pr. Nayak
- Department of Computer Science and Engineering, Silicon Institute of Technology, Bhubaneswar, India
| | - S.C. Rai
- Department of IT, Silicon Institute of Technology, Bhubaneswar, India
| | - Sipali Pradhan
- Department of Computer Application, North Orissa University, Bhubaneswar, India
| | - J.K. Mantri
- Department of Computer Application, North Orissa University, Bhubaneswar, India
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Timmers T, Janssen L, Stohr J, Murk JL, Berrevoets MAH. Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study. JMIR Mhealth Uhealth 2020; 8:e19822. [PMID: 32516750 PMCID: PMC7313382 DOI: 10.2196/19822] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) situation demands a lot from citizens, health care providers, and governmental institutions. Citizens need to cope with guidelines on social interaction, work, home isolation, and symptom recognition. Additionally, health care providers and policy makers have to cope with unprecedented and unpredictable pressure on the health care system they need to manage. By providing citizens with an app, they always have access to the latest information and can assess their own health. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. OBJECTIVE The aim of this observational study is to assess people's use of an app to support them with COVID-19 education, self-assessment, and monitoring of their own health for a 7-day period. In addition, we aim to assess the usability of this data for health care providers and policy makers by applying it to an interactive map and combining it with hospital data. The secondary outcomes of the study were user's satisfaction with the information provided in the app, perceived usefulness of the app, health care providers they contacted, and the follow-up actions from this contact. METHODS This observational cohort study was carried out at the nonacademic teaching hospital "Elisabeth Twee Steden" (ETZ) in Tilburg, Netherlands. From April 1, 2020, onwards ETZ offered the COVID-19 education, self-assessment, and symptom tracking diary to their already existing app for patient education and monitoring. RESULTS Between April 1 and April 20, 2020, a total of 6194 people downloaded the app. The self-assessment functionality was used abundantly to check one's health status. In total, 5104 people responded to the question about severe symptoms, from which 242 indicated to suffer from severe symptoms. A total of 4929 people responded to the question about mild symptoms, from which 3248 indicated to suffer from these. The data was successfully applied to an interactive map, displaying user demographics and health status. Furthermore, the data was linked to clinical data. App users were satisfied with the information in the app and appreciated the symptom diary functionality. In total, 102 users reached out to a health care provider, leading to 91 contacts. CONCLUSIONS Our study demonstrated the successful implementation and use of an app with COVID-19 education, self-assessment, and a 7-day symptom diary. Data collected with the app were successfully applied to an interactive map. In addition, we were able to link the data to COVID-19 screening results from the hospital's microbiology laboratory. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. TRIAL REGISTRATION Netherlands Trial Register NL8501; https://www.trialregister.nl/trial/8501.
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Affiliation(s)
- Thomas Timmers
- Interactive Studios, Rosmalen, Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | | | - Joep Stohr
- Elisabeth Twee Steden Hospital, Tilburg, Netherlands
| | - J L Murk
- Elisabeth Twee Steden Hospital, Tilburg, Netherlands
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Leenen JPL, Leerentveld C, van Dijk JD, van Westreenen HL, Schoonhoven L, Patijn GA. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J Med Internet Res 2020; 22:e18636. [PMID: 32469323 PMCID: PMC7351263 DOI: 10.2196/18636] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/07/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. OBJECTIVE The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. METHODS A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. RESULTS In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. CONCLUSIONS Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.
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Affiliation(s)
| | | | | | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Weenk M, Bredie SJ, Koeneman M, Hesselink G, van Goor H, van de Belt TH. Continuous Monitoring of Vital Signs in the General Ward Using Wearable Devices: Randomized Controlled Trial. J Med Internet Res 2020; 22:e15471. [PMID: 32519972 PMCID: PMC7315364 DOI: 10.2196/15471] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Wearable devices can be used for continuous patient monitoring in the general ward, increasing patient safety. Little is known about the experiences and expectations of patients and health care professionals regarding continuous monitoring with these devices. Objective This study aimed to identify positive and negative effects as well as barriers and facilitators for the use of two wearable devices: ViSi Mobile (VM) and HealthPatch (HP). Methods In this randomized controlled trial, 90 patients admitted to the internal medicine and surgical wards of a university hospital in the Netherlands were randomly assigned to continuous vital sign monitoring using VM or HP and a control group. Users’ experiences and expectations were addressed using semistructured interviews. Nurses, physician assistants, and medical doctors were also interviewed. Interviews were analyzed using thematic content analysis. Psychological distress was assessed using the State Trait Anxiety Inventory and the Pain Catastrophizing Scale. The System Usability Scale was used to assess the usability of both devices. Results A total of 60 patients, 20 nurses, 3 physician assistants, and 6 medical doctors were interviewed. We identified 47 positive and 30 negative effects and 19 facilitators and 36 barriers for the use of VM and HP. Frequently mentioned topics included earlier identification of clinical deterioration, increased feelings of safety, and VM lines and electrodes. No differences related to psychological distress and usability were found between randomization groups or devices. Conclusions Both devices were well received by most patients and health care professionals, and the majority of them encouraged the idea of monitoring vital signs continuously in the general ward. This comprehensive overview of barriers and facilitators of using wireless devices may serve as a guide for future researchers, developers, and health care institutions that consider implementing continuous monitoring in the ward. Trial Registration Clinicaltrials.gov NCT02933307; http://clinicaltrials.gov/ct2/show/NCT02933307.
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Affiliation(s)
- Mariska Weenk
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Mats Koeneman
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Gijs Hesselink
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Harry van Goor
- Radboud University Medical Center, Nijmegen, Netherlands
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Dimaguila GL, Gray K, Merolli M. Patient-Reported Outcome Measures of Utilizing Person-Generated Health Data in the Case of Simulated Stroke Rehabilitation: Development Method. JMIR Res Protoc 2020; 9:e16827. [PMID: 32379052 PMCID: PMC7243131 DOI: 10.2196/16827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/12/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Person-generated health data (PGHD) are health data that people generate, record, and analyze for themselves. Although the health benefits of PGHD use have been reported, there is no systematic way for patients to measure and report the health effects they experience from using their PGHD. Patient-reported outcome measures (PROMs) allow patients to systematically self-report their outcomes of a health care service. They generate first-hand evidence of the impact of health care services and are able to reflect the real-world diversity of actual patients and management approaches. Therefore, this paper argues that a PROM of utilizing PGHD, or PROM-PGHD, is necessary to help build evidence-based practice in clinical work with PGHD. OBJECTIVE This paper aims to describe a method for developing PROMs for people who are using PGHD in conjunction with their clinical care-PROM-PGHD, and the method is illustrated through a case study. METHODS The five-step qualitative item review (QIR) method was augmented to guide the development of a PROM-PGHD. However, using QIR as a guide to develop a PROM-PGHD requires additional socio-technical consideration of the PGHD and the health technologies from which they are produced. Therefore, the QIR method is augmented for developing a PROM-PGHD, resulting in the PROM-PGHD development method. RESULTS A worked example was used to illustrate how the PROM-PGHD development method may be used systematically to develop PROMs applicable across a range of PGHD technology types used in relation to various health conditions. CONCLUSIONS This paper describes and illustrates a method for developing a PROM-PGHD, which may be applied to many different cases of health conditions and technology categories. When applied to other cases of health conditions and technology categories, the method could have broad relevance for evidence-based practice in clinical work with PGHD.
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Affiliation(s)
- Gerardo Luis Dimaguila
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Mark Merolli
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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Babusiak B, Borik S, Smondrk M. Two-Electrode ECG for Ambulatory Monitoring with Minimal Hardware Complexity. SENSORS 2020; 20:s20082386. [PMID: 32331326 PMCID: PMC7219345 DOI: 10.3390/s20082386] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
This article introduces a two-electrode ground-free electrocardiogram (ECG) with minimal hardware complexity, which is ideal for wearable battery-powered devices. The main issue of ground-free measurements is the presence of noise. Therefore, noise suppression methods that can be employed for a two-electrode ECG acquisition system are discussed in detail. Experimental measurements of a living subject and patient simulator are used to investigate and compare the performance of the three proposed methods utilizing the ADS1191 analogue front-end for biopotential measurements. The resulting signals recorded for the simulator indicate that all three methods should be suitable for suppressing power-line noise. The Power Spectral Density (PSD) of the signals measured for a subject exhibits differences across methods; the signal power at 50 Hz is −28, −24.8, and −26 dB for the first, second, and third method, respectively. The digital postprocessing of measured signals acquired a high-quality ECG signal comparable to that of three-electrode sensing. The current consumption measurements demonstrate that all proposed two-electrode ECG solutions are appropriate as a battery-powered device (current consumption < 1.5 mA; sampling rate of 500 SPS). The first method, according to the results, is considered the most effective method in the suppression of power-line noise, current consumption, and hardware complexity.
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Van Til K, McInnis MG, Cochran A. A comparative study of engagement in mobile and wearable health monitoring for bipolar disorder. Bipolar Disord 2020; 22:182-190. [PMID: 31610074 PMCID: PMC7085979 DOI: 10.1111/bdi.12849] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Self-monitoring is recommended for individuals with bipolar disorder, with numerous technological solutions available. This study aimed to identify basic components of these solutions that increase engagement with self-monitoring. METHODS Participants with bipolar disorder (n = 47) monitored their symptoms with a Fitbit and a smartphone app and were randomly assigned to either review or not review recorded symptoms weekly. We tested whether individuals would better adhere to and prefer monitoring with passive monitoring with an activity tracker compared to active monitoring with a smartphone app and whether individuals would better adhere to self-monitoring if their recorded symptoms were reviewed with an interviewer. RESULTS Monitoring with a smartphone app achieved similar adherence and preference to Fitbit (P > .85). Linear mixed effects modeling found adherence decreased significantly more over the study for the Fitbit (12% more, P < .001) even though more participants reported they would use the Fitbit over a year compared to the app (72.3% vs 46.8%). Reviewing symptoms weekly did not improve adherence, but most participants reported they would prefer to review symptoms with a clinician (74.5%) and on monthly basis (57.5%) compared to alternatives. Participants endorsed sleep as the most important symptom to monitor, forgetfulness as the largest barrier to self-monitoring, and raising self-awareness as the best reason for self-monitoring. CONCLUSIONS We recommend a combined strategy of wearable and mobile monitoring that includes reminders, targets raising self-awareness, and tracks sleep. A clinician may want to review symptoms on a monthly basis. TRIAL REGISTRATION ClinicalTrials.gov NCT03358238.
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Affiliation(s)
| | | | - A Cochran
- University of Wisconsin-Madison,Corresponding author:
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Areia C, Vollam S, Piper P, King E, Ede J, Young L, Santos M, Pimentel MAF, Roman C, Harford M, Shah A, Gustafson O, Rowland M, Tarassenko L, Watkinson PJ. Protocol for a prospective, controlled, cross-sectional, diagnostic accuracy study to evaluate the specificity and sensitivity of ambulatory monitoring systems in the prompt detection of hypoxia and during movement. BMJ Open 2020; 10:e034404. [PMID: 31932393 PMCID: PMC7044954 DOI: 10.1136/bmjopen-2019-034404] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Automated continuous ambulatory monitoring may provide an alternative to intermittent manual vital signs monitoring. This has the potential to improve frequency of measurements, timely escalation of care and patient safety. However, a major barrier to the implementation of these wearable devices in the ward environment is their uncertain reliability, efficiency and data fidelity. The purpose of this study is to test performance of selected devices in a simulated clinical setting including during movement and low levels of peripheral oxygen saturation. METHODS AND ANALYSIS This is a single centre, prospective, controlled, cross-sectional, diagnostic accuracy study to determine the specificity and sensitivity of currently available ambulatory vital signs monitoring equipment in the detection of hypoxia and the effect of movement on data acquisition. We will recruit up to 45 healthy volunteers who will attend a single study visit; starting with a movement phase and followed by the hypoxia exposure phase where we will gradually decrease saturation levels down to 80%. We will simultaneously test one chest patch, one wrist worn only and three wrist worn with finger probe devices against 'clinical standard 'and 'gold standard' references. We will measure peripheral oxygen saturations, pulse rate, heart rate and respiratory rate continuously and arterial blood gases intermittently throughout the study. ETHICS AND DISSEMINATION This study has received ethical approval by the East of Scotland Research Ethics Service REC 2 (19/ES/0008). The results will be broadly distributed through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN61535692 registered on 10/06/2019.
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Affiliation(s)
- Carlos Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Philippa Piper
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Elizabeth King
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jody Ede
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Marco A F Pimentel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Mirae Harford
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Owen Gustafson
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Matthew Rowland
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter J Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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Schulz J, Kvaløy JT, Engan K, Eftestøl T, Jatosh S, Kidanto H, Ersdal H. State transition modeling of complex monitored health data. J Appl Stat 2019; 47:1915-1935. [PMID: 35707576 PMCID: PMC9041820 DOI: 10.1080/02664763.2019.1698523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article considers the analysis of complex monitored health data, where often one or several signals are reflecting the current health status that can be represented by a finite number of states, in addition to a set of covariates. In particular, we consider a novel application of a non-parametric state intensity regression method in order to study time-dependent effects of covariates on the state transition intensities. The method can handle baseline, time varying as well as dynamic covariates. Because of the non-parametric nature, the method can handle different data types and challenges under minimal assumptions. If the signal that is reflecting the current health status is of continuous nature, we propose the application of a weighted median and a hysteresis filter as data pre-processing steps in order to facilitate robust analysis. In intensity regression, covariates can be aggregated by a suitable functional form over a time history window. We propose to study the estimated cumulative regression parameters for different choices of the time history window in order to investigate short- and long-term effects of the given covariates. The proposed framework is discussed and applied to resuscitation data of newborns collected in Tanzania.
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Affiliation(s)
- Jörn Schulz
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Kjersti Engan
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Samwel Jatosh
- Research Institute, Haydom Lutheran Hospital, Manyara, Tanzania
| | - Hussein Kidanto
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Hege Ersdal
- Department of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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86
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Whelan ME, Orme MW, Kingsnorth AP, Sherar LB, Denton FL, Esliger DW. Examining the Use of Glucose and Physical Activity Self-Monitoring Technologies in Individuals at Moderate to High Risk of Developing Type 2 Diabetes: Randomized Trial. JMIR Mhealth Uhealth 2019; 7:e14195. [PMID: 31661077 PMCID: PMC6913728 DOI: 10.2196/14195] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-monitoring of behavior (namely, diet and physical activity) and physiology (namely, glucose) has been shown to be effective in type 2 diabetes (T2D) and prediabetes prevention. By combining self-monitoring technologies, the acute physiological consequences of behaviors could be shown, prompting greater consideration to physical activity levels today, which impact the risk of developing diabetes years or decades later. However, until recently, commercially available technologies have not been able to show individuals the health benefits of being physically active. OBJECTIVE The objective of this study was to examine the usage, feasibility, and acceptability of behavioral and physiological self-monitoring technologies in individuals at risk of developing T2D. METHODS A total of 45 adults aged ≥40 years and at moderate to high risk of T2D were recruited to take part in a 3-arm feasibility trial. Each participant was provided with a behavioral (Fitbit Charge 2) and physiological (FreeStyle Libre flash glucose monitor) monitor for 6 weeks, masked according to group allocation. Participants were allocated to glucose feedback (4 weeks) followed by glucose and physical activity (biobehavioral) feedback (2 weeks; group 1), physical activity feedback (4 weeks) followed by biobehavioral feedback (2 weeks; group 2), or biobehavioral feedback (6 weeks; group 3). Participant usage (including time spent on the apps and number of glucose scans) was the primary outcome. Secondary outcomes were the feasibility (including recruitment and number of sensor displacements) and acceptability (including monitor wear time) of the intervention. Semistructured qualitative interviews were conducted at the 6-week follow-up appointment. RESULTS For usage, time spent on the Fitbit and FreeStyle Libre apps declined over the 6 weeks for all groups. Of the FreeStyle Libre sensor scans conducted by participants, 17% (1798/10,582) recorded rising or falling trends in glucose, and 24% (13/45) of participants changed ≥1 of the physical activity goals. For feasibility, 49% (22/45) of participants completed the study using the minimum number of FreeStyle Libre sensors, and a total of 41 sensors were declared faulty or displaced. For acceptability, participants wore the Fitbit for 40.1 (SD 3.2) days, and 20% (9/45) of participants and 53% (24/45) of participants were prompted by email to charge or sync the Fitbit, respectively. Interviews unearthed participant perceptions on the study design by suggesting refinements to the eligibility criteria and highlighting important issues about the usability, wearability, and features of the technologies. CONCLUSIONS Individuals at risk of developing T2D engaged with wearable digital health technologies providing behavioral and physiological feedback. Modifications are required to both the study and to commercially available technologies to maximize the chances of sustained usage and behavior change. The study and intervention were feasible to conduct and acceptable to most participants. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 17545949; isrctn.com/ISRCTN17545949.
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Affiliation(s)
- Maxine E Whelan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Mark W Orme
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre-Respiratory, Leicester, United Kingdom
| | - Andrew P Kingsnorth
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Lauren B Sherar
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Institute for Health Research Leicester Biomedical Research Centre-Lifestyle, Leicester, United Kingdom
| | - Francesca L Denton
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Dale W Esliger
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Institute for Health Research Leicester Biomedical Research Centre-Lifestyle, Leicester, United Kingdom
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87
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Li W, Chen R, Qi W, Cai L, Sun Y, Sun M, Li C, Yang X, Xiang L, Xie D, Ren T. Reduced Graphene Oxide/Mesoporous ZnO NSs Hybrid Fibers for Flexible, Stretchable, Twisted, and Wearable NO 2 E-Textile Gas Sensor. ACS Sens 2019; 4:2809-2818. [PMID: 31566369 DOI: 10.1021/acssensors.9b01509] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
E-textiles are gaining growing popularity recently due to low cost, light weight, and conformable compatibility with clothes in wearable and portable smart electronics. Here, an easy-handing, low cost, and scalable fabricating strategy is reported to fabricate conductive, highly flexible, and mechanically stretchable/twisted fiber gas sensor with great wearability and knittability. The proposed gas sensor is built using commercially available cotton/elastic threads as flexible/stretchable templates and reduced graphene oxide/mesoporous zinc oxide nanosheets as sensing layers to form conducting fibers. The as-prepared fiber demonstrates sensitive sensing response, excellent long-term stability (84 days), low theoretical detection limit (43.5 ppb NO2), great mechanical deformation tolerance (3000 bending cycles, 1000 twisting cycles and 65% strain strength), and washing durability in room-temperature gas detection. More significantly, scalable wearable characteristics including repairability, reliability, stability, and practicability have been efficiently improved, which are achieved by knotting the fractured fibers, incorporating multiple sensors in series/parallel and weaving multisensor array networks integrated into clothes. The good sensing properties, superior flexibility, and scalable applications of wearable fibers may provide a broad window for widespread monitoring of numerous human activities in personal mobile electronics and human-machine interactions.
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Affiliation(s)
- Weiwei Li
- Department of Basic Sciences, Air Force Engineering University, Xi’an 710051, China
| | | | | | - Li Cai
- Department of Basic Sciences, Air Force Engineering University, Xi’an 710051, China
| | | | | | - Chuang Li
- Department of Basic Sciences, Air Force Engineering University, Xi’an 710051, China
| | - Xiaokuo Yang
- Department of Basic Sciences, Air Force Engineering University, Xi’an 710051, China
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88
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Riggare S, Hägglund M. Precision Medicine in Parkinson's Disease - Exploring Patient-Initiated Self-Tracking. JOURNAL OF PARKINSONS DISEASE 2019; 8:441-446. [PMID: 30124453 PMCID: PMC6130409 DOI: 10.3233/jpd-181314] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Individually tailored healthcare, in the form of precision medicine, holds substantial potential for the future of medicine, especially for a complex disorder like Parkinson’s disease (PD). Patient self-tracking is an under-researched area in PD. Objective: This study aimed to explore patient-initiated self-tracking in PD and discuss it in the context of precision medicine. Methods: The first author used a smartphone app to capture finger-tapping data and also noted times for medication intakes. Results: Data were collected during four subsequent days. Only data from the first two days were complete enough to analyze, leading to the realization that the collection of data over a period of time can pose a significant burden to patients. From the first two days of data, a dip in finger function was observed around the time for the second medication dose of the day. Conclusions: Patient-initiated self-tracking enabled the first author to glean important insights about how her PD symptoms varied over the course of the day. Symptom tracking holds great potential in precision medicine and can, if shared in a clinical encounter, contribute to the learning of both patient and clinician. More work is needed to develop this field and extra focus needs to be given to balancing the burden of tracking for the patient against any expected benefit.
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Affiliation(s)
- Sara Riggare
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hägglund
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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89
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Baumert M, Linz D, Stone K, McEvoy RD, Cummings S, Redline S, Mehra R, Immanuel S. Mean nocturnal respiratory rate predicts cardiovascular and all-cause mortality in community-dwelling older men and women. Eur Respir J 2019; 54:13993003.02175-2018. [PMID: 31151958 DOI: 10.1183/13993003.02175-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/21/2019] [Indexed: 11/05/2022]
Abstract
Respiratory frequency (f R) predicts in-hospital and short-term mortality in patients with a variety of pathophysiological conditions, but its predictive value for long-term cardiovascular and all-cause mortality in the general population is unknown. Here, we investigated the relationship between mean nocturnal f R and mortality in community-dwelling older men and women.We measured mean nocturnal f R during sleep from overnight polysomnography in 2686 men participating in the Osteoporotic Fractures in Men Study (MrOS) Sleep study and 406 women participating in the Study of Osteoporotic Fractures (SOF) to investigate the relationship between mean nocturnal f R and long-term cardiovascular and all-cause mortality.166 (6.1%) men in the MrOS cohort (8.9±2.6 years' follow-up) and 46 (11.2%) women in the SOF cohort (6.4±1.6 years' follow-up) died from cardiovascular disease. All-cause mortality was 51.2% and 26.1% during 13.7±3.7 and 6.4±1.6 years' follow-up in the MrOS Sleep study and the SOF cohorts, respectively. Multivariable Cox regression analysis adjusted for significant covariates demonstrated that f R dichotomised at 16 breaths·min-1 was independently associated with cardiovascular mortality (MrOS: hazard ratio (HR) 1.57, 95% CI 1.14-2.15; p=0.005; SOF: HR 2.58, 95% CI 1.41-4.76; p=0.002) and all-cause mortality (MrOS: HR 1.18, 95% CI 1.04-1.32; p=0.007; SOF: HR 1.50, 95% CI 1.02-2.20; p=0.04).In community-dwelling older men and women, polysomnography-derived mean nocturnal f R ≥16 breaths·min-1 is an independent predictor of long-term cardiovascular and all-cause mortality. Whether nocturnal mean f R can be used as a risk marker warrants further prospective studies.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
| | - Dominik Linz
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Steve Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Dept of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Reena Mehra
- Center of Sleep Disorders, Neurologic Institute, Respiratory Institute, Heart and Vascular Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Immanuel
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health and Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
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90
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Periyaswamy T, Balasubramanian M. Ambulatory cardiac bio-signals: From mirage to clinical reality through a decade of progress. Int J Med Inform 2019; 130:103928. [PMID: 31434042 DOI: 10.1016/j.ijmedinf.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly. OBJECTIVES The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis. RESULTS Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance. CONCLUSIONS Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.
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Affiliation(s)
- Thamizhisai Periyaswamy
- Department of Human Environmental Studies, 117 Wightman Hall, Central Michigan University, Mount Pleasant, Michigan, 48859, United States.
| | - Mahendran Balasubramanian
- Apparel Merchandising and Product Development, School of Human Environmental Science, 118 Home Economic Building, University of Arkansas, Fayetteville, Arkansas, 72701, United States.
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91
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Brieger K, Zajac GJM, Pandit A, Foerster JR, Li KW, Annis AC, Schmidt EM, Clark CP, McMorrow K, Zhou W, Yang J, Kwong AM, Boughton AP, Wu J, Scheller C, Parikh T, de la Vega A, Brazel DM, Frieser M, Rea-Sandin G, Fritsche LG, Vrieze SI, Abecasis GR. Genes for Good: Engaging the Public in Genetics Research via Social Media. Am J Hum Genet 2019; 105:65-77. [PMID: 31204010 PMCID: PMC6612519 DOI: 10.1016/j.ajhg.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/08/2019] [Indexed: 01/06/2023] Open
Abstract
The Genes for Good study uses social media to engage a large, diverse participant pool in genetics research and education. Health history and daily tracking surveys are administered through a Facebook application, and participants who complete a minimum number of surveys are mailed a saliva sample kit ("spit kit") to collect DNA for genotyping. As of March 2019, we engaged >80,000 individuals, sent spit kits to >32,000 individuals who met minimum participation requirements, and collected >27,000 spit kits. Participants come from all 50 states and include a diversity of ancestral backgrounds. Rates of important chronic health indicators are consistent with those estimated for the general U.S. population using more traditional study designs. However, our sample is younger and contains a greater percentage of females than the general population. As one means of verifying data quality, we have replicated genome-wide association studies (GWASs) for exemplar traits, such as asthma, diabetes, body mass index (BMI), and pigmentation. The flexible framework of the web application makes it relatively simple to add new questionnaires and for other researchers to collaborate. We anticipate that the study sample will continue to grow and that future analyses may further capitalize on the strengths of the longitudinal data in combination with genetic information.
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Affiliation(s)
- Katharine Brieger
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Gregory J M Zajac
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anita Pandit
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Johanna R Foerster
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin W Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aubrey C Annis
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ellen M Schmidt
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Wellcome Sanger Institute, Hinxton CB10 1SA, UK
| | - Chris P Clark
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Karly McMorrow
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Jingjing Yang
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Alan M Kwong
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew P Boughton
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jinxi Wu
- School of Information, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chris Scheller
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tanvi Parikh
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Alejandro de la Vega
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA
| | - David M Brazel
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Maia Frieser
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Psychology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Gianna Rea-Sandin
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Lars G Fritsche
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Scott I Vrieze
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Gonçalo R Abecasis
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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92
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Learning the Orientation of a Loosely-Fixed Wearable IMU Relative to the Body Improves the Recognition Rate of Human Postures and Activities. SENSORS 2019; 19:s19132845. [PMID: 31248016 PMCID: PMC6651658 DOI: 10.3390/s19132845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 01/06/2023]
Abstract
Features were developed which accounted for the changing orientation of the inertial measurement unit (IMU) relative to the body, and demonstrably improved the performance of models for human activity recognition (HAR). The method is proficient at separating periods of standing and sedentary activity (i.e., sitting and/or lying) using only one IMU, even if it is arbitrarily oriented or subsequently re-oriented relative to the body; since the body is upright during walking, learning the IMU orientation during walking provides a reference orientation against which sitting and/or lying can be inferred. Thus, the two activities can be identified (irrespective of the cohort) by analyzing the magnitude of the angle of shortest rotation which would be required to bring the upright direction into coincidence with the average orientation from the most recent 2.5 s of IMU data. Models for HAR were trained using data obtained from a cohort of 37 older adults (83.9 ± 3.4 years) or 20 younger adults (21.9 ± 1.7 years). Test data were generated from the training data by virtually re-orienting the IMU so that it is representative of carrying the phone in five different orientations (relative to the thigh). The overall performance of the model for HAR was consistent whether the model was trained with the data from the younger cohort, and tested with the data from the older cohort after it had been virtually re-oriented (Cohen's Kappa 95% confidence interval [0.782, 0.793]; total class sensitivity 95% confidence interval [84.9%, 85.6%]), or the reciprocal scenario in which the model was trained with the data from the older cohort, and tested with the data from the younger cohort after it had been virtually re-oriented (Cohen's Kappa 95% confidence interval [0.765, 0.784]; total class sensitivity 95% confidence interval [82.3%, 83.7%]).
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93
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Kyritsis AI, Willems G, Deriaz M, Konstantas D. Gait Pattern Recognition Using a Smartwatch Assisting Postoperative Physiotherapy. INTERNATIONAL JOURNAL OF SEMANTIC COMPUTING 2019. [DOI: 10.1142/s1793351x19400117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postoperative rehabilitation is led by physiotherapists and is a vital program that re-establishes joint motion and strengthens the muscles around the joint after an orthopedic surgery. Modern smart devices have affected every aspect of human life. Newly developed technologies have disrupted the way various industries operate, including the healthcare one. Extensive research has been carried out on how smartphone inertial sensors can be used for activity recognition. However, there are very few studies on systems that monitor patients and detect different gait patterns in order to assist the work of physiotherapists during the said rehabilitation phase, even outside the time-limited physiotherapy sessions. In this paper, we are presenting a gait recognition system that was developed to detect different gait patterns. The proposed system was trained, tested and validated with data of people who have undergone lower body orthopedic surgery, recorded by Hirslanden Clinique La Colline, an orthopedic clinic in Geneva, Switzerland. Nine different gait classes were labeled by professional physiotherapists. After extracting both time and frequency domain features from the time series data, several machine learning models were tested including a fully connected neural network. Raw time series data were also fed into a convolutional neural network.
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Affiliation(s)
- Athanasios I. Kyritsis
- Information Science Institute, GSEM/CUI, University of Geneva, Battelle A, Route de Drize 7, 1227 Carouge, Switzerland
| | - Geoffrey Willems
- Physiotherapy Center, Hirslanden Clinique La Colline, Avenue de la Roseraie 76 A, 1205 Geneva, Switzerland
| | - Michel Deriaz
- Information Science Institute, GSEM/CUI, University of Geneva, Battelle A, Route de Drize 7, 1227 Carouge, Switzerland
| | - Dimitri Konstantas
- Information Science Institute, GSEM/CUI, University of Geneva, Battelle A, Route de Drize 7, 1227 Carouge, Switzerland
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94
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Støve MP, Larsen BT. Self-monitoring – usability evaluation of heart rate monitoring using wearable devices in patients with acquired brain injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1628300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Morten P. Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Birgit T. Larsen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
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95
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Al-Nasri I, Price AD, Trejos AL, Walton DM. A Commercially Available Capacitive Stretch-Sensitive Sensor for Measurement of Rotational Neck Movement in Healthy People: Proof of Concept. IEEE Int Conf Rehabil Robot 2019; 2019:163-168. [PMID: 31374624 DOI: 10.1109/icorr.2019.8779483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Freedom of neck range of motion has been identified for decades as an important indicator of neck health. In the past, neck motion has been measured in clinical settings using straight-plane movements that do not represent real-world 'ecological' performance. The tools currently used are low-fidelity analog or digital tools that rely greatly on the orientation of the person with respect to gravity, or the evaluator's ability to accurately align protractor arms with key surface markers for angle measurement. A possible solution lies in the use of wearable sensors for tracking the motion of the neck without clinical instruction. For this purpose, the focus of this paper is on the assessment of a commercially available stretch sensitive sensor, C-Stretch® against a gold standard for motion tracking. The sensor's accuracy and agreement for measuring neck rotations were evaluated. The results show that the stretch sensitive sensor was accurate with an average RMSE of 5.86° (SD=$4.38^{\circ}, \mathrm{n}=2$) and highly correlated $r=0.88-0.99,(p\lt0.01)$ with Aurora, an electromagnetic tracking system. This work may lead to using wearable sensors as a cost-effective, lightweight, and safe alternative to assess real-world neck range of motion for clinical application.
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96
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Gunduz A, Opri E, Gilron R, Kremen V, Worrell G, Starr P, Leyde K, Denison T. Adding wisdom to 'smart' bioelectronic systems: a design framework for physiologic control including practical examples. ACTA ACUST UNITED AC 2019; 2:29-41. [PMID: 33868718 PMCID: PMC7610621 DOI: 10.2217/bem-2019-0008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This perspective provides an overview of how risk can be effectively considered in physiological control loops that strive for semi-to-fully automated operation. The perspective first introduces the motivation, user needs and framework for the design of a physiological closed-loop controller. Then, we discuss specific risk areas and use examples from historical medical devices to illustrate the key concepts. Finally, we provide a design overview of an adaptive bidirectional brain–machine interface, currently undergoing human clinical studies, to synthesize the design principles in an exemplar application.
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Affiliation(s)
- Aysegul Gunduz
- Department of Biomedical Engineering, University of Florida Gainesville, Gainesville, FL 32611, USA
| | - Enrico Opri
- Department of Biomedical Engineering, University of Florida Gainesville, Gainesville, FL 32611, USA
| | - Ro'ee Gilron
- School of Medicine, University of California San Francisco, San Francisco CA 94143, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Phil Starr
- School of Medicine, University of California San Francisco, San Francisco CA 94143, USA
| | - Kent Leyde
- Cadence Neuroscience Inc, Sammamish, WA 98074, USA
| | - Timothy Denison
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, UK
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97
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Batsis JA, Naslund JA, Zagaria AB, Kotz D, Dokko R, Bartels SJ, Carpenter-Song E. Technology for Behavioral Change in Rural Older Adults with Obesity. J Nutr Gerontol Geriatr 2019; 38:130-148. [PMID: 30971189 PMCID: PMC6999857 DOI: 10.1080/21551197.2019.1600097] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population. METHODS We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics. RESULTS All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth could track health. Participants believed they could improve patient insight into health, motivating change and assuring accountability. Barriers to using technology were described, including infrastructure. CONCLUSIONS Older rural adults with obesity expressed excitement about the use of mHealth technologies to improve their health, yet barriers to implementation exist.
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Affiliation(s)
- John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
- Dartmouth Weight & Wellness Center, Lebanon, NH
| | - John A. Naslund
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH
| | - Alexandra B. Zagaria
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
| | - David Kotz
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH
- Department of Computer Science, Dartmouth College, Hanover, NH
| | - Rachel Dokko
- Department of Biology, Dartmouth College, Hanover, NH
| | - Stephen J. Bartels
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Elizabeth Carpenter-Song
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice
- Department of Anthropology, Dartmouth College, Hanover, NH
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Falter M, Budts W, Goetschalckx K, Cornelissen V, Buys R. Accuracy of Apple Watch Measurements for Heart Rate and Energy Expenditure in Patients With Cardiovascular Disease: Cross-Sectional Study. JMIR Mhealth Uhealth 2019; 7:e11889. [PMID: 30888332 PMCID: PMC6444219 DOI: 10.2196/11889] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/05/2018] [Accepted: 12/09/2018] [Indexed: 01/20/2023] Open
Abstract
Background Wrist-worn tracking devices such as the Apple Watch are becoming more integrated in health care. However, validation studies of these consumer devices remain scarce. Objectives This study aimed to assess if mobile health technology can be used for monitoring home-based exercise in future cardiac rehabilitation programs. The purpose was to determine the accuracy of the Apple Watch in measuring heart rate (HR) and estimating energy expenditure (EE) during a cardiopulmonary exercise test (CPET) in patients with cardiovascular disease. Methods Forty patients (mean age 61.9 [SD 15.2] yrs, 80% male) with cardiovascular disease (70% ischemic, 22.5% valvular, 7.5% other) completed a graded maximal CPET on a cycle ergometer while wearing an Apple Watch. A 12-lead electrocardiogram (ECG) was used to measure HR; indirect calorimetry was used for EE. HR was analyzed at three levels of intensity (seated rest, HR1; moderate intensity, HR2; maximal performance, HR3) for 30 seconds. The EE of the entire test was used. Bias or mean difference (MD), standard deviation of difference (SDD), limits of agreement (LoA), mean absolute error (MAE), mean absolute percentage error (MAPE), and intraclass correlation coefficients (ICCs) were calculated. Bland-Altman plots and scatterplots were constructed. Results SDD for HR1, HR2, and HR3 was 12.4, 16.2, and 12.0 bpm, respectively. Bias and LoA (lower, upper LoA) were 3.61 (–20.74, 27.96) for HR1, 0.91 (–30.82, 32.63) for HR2, and –1.82 (–25.27, 21.63) for HR3. MAE was 6.34 for HR1, 7.55 for HR2, and 6.90 for HR3. MAPE was 10.69% for HR1, 9.20% for HR2, and 6.33% for HR3. ICC was 0.729 (P<.001) for HR1, 0.828 (P<.001) for HR2, and 0.958 (P<.001) for HR3. Bland-Altman plots and scatterplots showed good correlation without systematic error when comparing Apple Watch with ECG measurements. SDD for EE was 17.5 kcal. Bias and LoA were 30.47 (–3.80, 64.74). MAE was 30.77; MAPE was 114.72%. ICC for EE was 0.797 (P<.001). The Bland-Altman plot and a scatterplot directly comparing Apple Watch and indirect calorimetry showed systematic bias with an overestimation of EE by the Apple Watch. Conclusions In patients with cardiovascular disease, the Apple Watch measures HR with clinically acceptable accuracy during exercise. If confirmed, it might be considered safe to incorporate the Apple Watch in HR-guided training programs in the setting of cardiac rehabilitation. At this moment, however, it is too early to recommend the Apple Watch for cardiac rehabilitation. Also, the Apple Watch systematically overestimates EE in this group of patients. Caution might therefore be warranted when using the Apple Watch for measuring EE.
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Affiliation(s)
- Maarten Falter
- Cardiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Cardiology Department, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Cardiology Department, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Single-Molecule Detection of DNA in a Nanochannel by High-Field Strength-Assisted Electrical Impedance Spectroscopy. MICROMACHINES 2019; 10:mi10030189. [PMID: 30875869 PMCID: PMC6470947 DOI: 10.3390/mi10030189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/17/2022]
Abstract
Many researchers have fabricated micro and nanofluidic devices incorporating optical, chemical, and electrical detection systems with the aim of achieving on-chip analysis of macromolecules. The present study demonstrates a label-free detection of DNA using a nanofluidic device based on impedance measurements that is both sensitive and simple to operate. Using this device, the electrophoresis and dielectrophoresis effect on DNA conformation and the length dependence were examined. A low alternating voltage was applied to the nanogap electrodes to generate a high intensity field (>0.5 MV/m) under non-faradaic conditions. In addition, a 100 nm thick gold electrode was completely embedded in the substrate to allow direct measurements of a solution containing the sample passing through the gap, without any surface modification required. The high intensity field in this device produced a dielectrophoretic force that stretched the DNA molecule across the electrode gap at a specific frequency, based on back and forth movements between the electrodes with the DNA in a random coil conformation. The characteristics of 100 bp, 500 bp, 1 kbp, 5 kbp, 10 kbp, and 48 kbp λ DNA associated with various conformations were quantitatively analyzed with high resolution (on the femtomolar level). The sensitivity of this system was found to be more than about 10 orders of magnitude higher than that obtained from conventional linear alternating current (AC) impedance for the analysis of bio-polymers. This new high-sensitivity process is expected to be advantageous with regard to the study of complex macromolecules and nanoparticles.
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Schlomann A, Seifert A, Rietz C. Relevance of Activity Tracking With Mobile Devices in the Relationship Between Physical Activity Levels and Satisfaction With Physical Fitness in Older Adults: Representative Survey. JMIR Aging 2019; 2:e12303. [PMID: 31518263 PMCID: PMC6715045 DOI: 10.2196/12303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/22/2018] [Accepted: 12/17/2018] [Indexed: 01/26/2023] Open
Abstract
Background Physical activity has been shown to positively affect many aspects of life, and the positive relationship between physical activity levels and health is well established. Recently, research on the interrelationship between physical activity levels and subjective experiences has gained attention. However, the underlying mechanisms that link physical activity levels with subjective experiences of physical fitness have not been sufficiently explained. Objective This study aimed to explore the role of physical activity tracking (PAT) in the relationship between physical activity levels and satisfaction with physical fitness in older adults. It is hypothesized that higher levels of physical activity are associated with a higher satisfaction with physical fitness in older adults and that this positive association is stronger for older people who use mobile devices for PAT. Methods As part of this study, 1013 participants aged 50 years or older and living in Switzerland were interviewed via computer-assisted telephone interviews. Bivariate and multivariate analyses were applied. The interaction effects between physical activity levels and PAT were evaluated using multiple linear regression analysis. Results Descriptive analyses showed that 719 participants used at least 1 mobile device and that 136 out of 719 mobile device users (18.9%) used mobile devices for PAT. In the multivariate regression analysis, frequent physical activity was found to have a positive effect on satisfaction with physical fitness (beta=.24, P<.001). A significant interaction effect between physical activity levels and PAT (beta=.30, P=.03) provides some first evidence that the positive effects of physical activity on satisfaction with physical fitness can be enhanced by PAT. Conclusions The results indicate the potential of PAT to enhance the physical fitness of older adults. However, the results also raise new issues in this context. Recommendations for further research and practice include the acquisition of longitudinal data, a more detailed observation of durations of use, and the development of devices for PAT considering health psychology and gerontology theories.
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Affiliation(s)
- Anna Schlomann
- Department of Special Education and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Alexander Seifert
- "Dynamics of Healthy Aging" University Research Priority Program, University of Zurich, Zurich, Switzerland.,Center of Competence for Gerontology, University of Zurich, Zurich, Switzerland
| | - Christian Rietz
- Mixed Methods Research, Heidelberg University of Education, Heidelberg, Germany
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