Emerging Artificial Intelligence–Empowered mHealth: Scoping Review

Background

Artificial intelligence (AI) has revolutionized health care delivery in recent years. There is an increase in research for advanced AI techniques, such as deep learning, to build predictive models for the early detection of diseases. Such predictive models leverage mobile health (mHealth) data from wearable sensors and smartphones to discover novel ways for detecting and managing chronic diseases and mental health conditions.

Objective

Currently, little is known about the use of AI-powered mHealth (AIM) settings. Therefore, this scoping review aims to map current research on the emerging use of AIM for managing diseases and promoting health. Our objective is to synthesize research in AIM models that have increasingly been used for health care delivery in the last 2 years.

Methods

Using Arksey and O’Malley’s 5-point framework for conducting scoping reviews, we reviewed AIM literature from the past 2 years in the fields of biomedical technology, AI, and information systems. We searched 3 databases, PubsOnline at INFORMS, e-journal archive at MIS Quarterly, and Association for Computing Machinery (ACM) Digital Library using keywords such as “mobile healthcare,” “wearable medical sensors,” “smartphones”, and “AI.” We included AIM articles and excluded technical articles focused only on AI models. We also used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) technique for identifying articles that represent a comprehensive view of current research in the AIM domain.

Results

We screened 108 articles focusing on developing AIM models for ensuring better health care delivery, detecting diseases early, and diagnosing chronic health conditions, and 37 articles were eligible for inclusion, with 31 of the 37 articles being published last year (76%). Of the included articles, 9 studied AI models to detect serious mental health issues, such as depression and suicidal tendencies, and chronic health conditions, such as sleep apnea and diabetes. Several articles discussed the application of AIM models for remote patient monitoring and disease management. The considered primary health concerns belonged to 3 categories: mental health, physical health, and health promotion and wellness. Moreover, 14 of the 37 articles used AIM applications to research physical health, representing 38% of the total studies. Finally, 28 out of the 37 (76%) studies used proprietary data sets rather than public data sets. We found a lack of research in addressing chronic mental health issues and a lack of publicly available data sets for AIM research.

Conclusions

The application of AIM models for disease detection and management is a growing research domain. These models provide accurate predictions for enabling preventive care on a broader scale in the health care domain. Given the ever-increasing need for remote disease management during the pandemic, recent AI techniques, such as federated learning and explainable AI, can act as a catalyst for increasing the adoption of AIM and enabling secure data sharing across the health care industry.

Machine learning for diabetes clinical decision support: a review

Type 2 diabetes has recently acquired the status of an epidemic silent killer, though it is non-communicable. There are two main reasons behind this perception of the disease. First, a gradual but exponential growth in the disease prevalence has been witnessed irrespective of age groups, geography or gender. Second, the disease dynamics are very complex in terms of multifactorial risks involved, initial asymptomatic period, different short-term and long-term complications posing serious health threat and related co-morbidities. Majority of its risk factors are lifestyle habits like physical inactivity, lack of exercise, high body mass index (BMI), poor diet, smoking except some inevitable ones like family history of diabetes, ethnic predisposition, ageing etc. Nowadays, machine learning (ML) is increasingly being applied for alleviation of diabetes health burden and many research works have been proposed in the literature to offer clinical decision support in different application areas as well. In this paper, we present a review of such efforts for the prevention and management of type 2 diabetes. Firstly, we present the medical gaps in diabetes knowledge base, guidelines and medical practice identified from relevant articles and highlight those that can be addressed by ML. Further, we review the ML research works in three different application areas namely—(1) risk assessment (statistical risk scores and ML-based risk models), (2) diagnosis (using non-invasive and invasive features), (3) prognosis (from normoglycemia/prior morbidity to incident diabetes and prognosis of incident diabetes to related complications). We discuss and summarize the shortcomings or gaps in the existing ML methodologies for diabetes to be addressed in future. This review provides the breadth of ML predictive modeling applications for diabetes while highlighting the medical and technological gaps as well as various aspects involved in ML-based diabetes clinical decision support.

The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey

Background

Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter—glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters.

Objective

The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management.

Methods

A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts.

Results

On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices.

Conclusions

Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions.

Heuristic-based channel selection with enhanced deep learning for heart disease prediction under WBAN

The main intention of this proposal is to design and develop a new heart disease prediction model via WBAN using three stages. The first stage is data aggregation, in which data is scheduled in Time Division Multiple Access manner based on priority level, and the data from the public benchmark datasets are collected representing WBAN. In the second stage, a channel selection is performed using a developed hybrid metaheuristic algorithm named Tunicate Swarm-Sail Fish Optimization (TS-SFO) Algorithm. The main intention of the suggested channel selection algorithm is to solve the multi-objective problem based on certain constraints like Reference Signal Received Quality, Signal to Noise Ratio and channel capacity. The third stage is the heart disease prediction stage, in which the feature extraction and prediction are performed. The data transmitted in the selected channel is used for the feature extraction phase, where the weighted entropy-based statistical feature extraction is developed and extracts the essential statistical features. Then, an enhanced Recurrent Neural Network (RNN) is proposed by tuning certain parameters using the proposed TS-SFO for predicting heart disease with the help of extracted statistical features. Test results show that the flexible design and subsequent tuning of RNN hyper-parameters can achieve a high prediction rate.

Design of a rapid diagnostic model for bladder compliance based on real-time intravesical pressure monitoring system

OBJECTIVE

The diagnosis of bladder dysfunction for children depends on the confirmation of abnormal bladder shape and bladder compliance. The existing gold standard needs to conduct voiding cystourethrogram (VCUG) examination and urodynamic studies (UDS) examination on patients separately. To reduce the time and injury of children's inspection, we propose a novel method to judge the bladder compliance by measuring the intravesical pressure during the VCUG examination without extra UDS.

METHODS

Our method consisted of four steps. We firstly developed a single-tube device that can measure, display, store, and transmit real-time pressure data. Secondly, we conducted clinical trials with the equipment on a cohort of 52 patients (including 32 negative and 20 positive cases). Thirdly, we preprocessed the data to eliminate noise and extracted features, then we used the least absolute shrinkage and selection operator (LASSO) to screen out important features. Finally, several machine learning methods were applied to classify and predict the bladder compliance level, including support vector machine (SVM), Random Forest, XGBoost, perceptron, logistic regression, and Naive Bayes, and the classification performance was evaluated.

RESULTS

73 features were extracted, including first-order and second-order time-domain features, wavelet features, and frequency domain features. 15 key features were selected and the model showed promising classification performance. The highest AUC value was 0.873 by the SVM algorithm, and the corresponding accuracy was 84%.

CONCLUSION

We designed a system to quickly obtain the intravesical pressure during the VCUG test, and our classification model is competitive in judging patients' bladder compliance.

SIGNIFICANCE

This could facilitate rapid auxiliary diagnosis of bladder disease based on real-time data. The promising result of classification is expected to provide doctors with a reliable basis in the auxiliary diagnosis of some bladder diseases prior to UDS.

Energy-Efficient IoT e-Health Using Artificial Intelligence Model with Homomorphic Secret Sharing

Internet of Things (IoT) is a developing technology for supporting heterogeneous physical objects into smart things and improving the individuals living using wireless communication systems. Recently, many smart healthcare systems are based on the Internet of Medical Things (IoMT) to collect and analyze the data for infectious diseases, i.e., body fever, flu, COVID-19, shortness of breath, etc. with the least operation cost. However, the most important research challenges in such applications are storing the medical data on a secured cloud and make the disease diagnosis system more energy efficient. Additionally, the rapid explosion of IoMT technology has involved many cyber-criminals and continuous attempts to compromise medical devices with information loss and generating bogus certificates. Thus, the increase in modern technologies for healthcare applications based on IoMT, securing health data, and offering trusted communication against intruders is gaining much research attention. Therefore, this study aims to propose an energy-efficient IoT e-health model using artificial intelligence with homomorphic secret sharing, which aims to increase the maintainability of disease diagnosis systems and support trustworthy communication with the integration of the medical cloud. The proposed model is analyzed and proved its significance against relevant systems.

A Machine Learning SDN-Enabled Big Data Model for IoMT Systems

In recent times, health applications have been gaining rapid popularity in smart cities using the Internet of Medical Things (IoMT). Many real-time solutions are giving benefits to both patients and professionals for remote data accessibility and suitable actions. However, timely medical decisions and efficient management of big data using IoT-based resources are the burning research challenges. Additionally, the distributed nature of data processing in many proposed solutions explicitly increases the threats of information leakages and damages the network integrity. Such solutions impose overhead on medical sensors and decrease the stability of the real-time transmission systems. Therefore, this paper presents a machine-learning model with SDN-enabled security to predict the consumption of network resources and improve the delivery of sensors data. Additionally, it offers centralized-based software define network (SDN) architecture to overcome the network threats among deployed sensors with nominal management cost. Firstly, it offers an unsupervised machine learning technique and decreases the communication overheads for IoT networks. Secondly, it predicts the link status using dynamic metrics and refines its strategies using SDN architecture. In the end, a security algorithm is utilized by the SDN controller that efficiently manages the consumption of the IoT nodes and protects it from unidentified occurrences. The proposed model is verified using simulations and improves system performance in terms of network throughput by 13%, data drop ratio by 39%, data delay by 11%, and faulty packets by 46% compared to HUNA and CMMA schemes.

Toward real-time and efficient cardiovascular monitoring for COVID-19 patients by 5G-enabled wearable medical devices: a deep learning approach

Patients with deaths from COVID-19 often have co-morbid cardiovascular disease. Real-time cardiovascular disease monitoring based on wearable medical devices may effectively reduce COVID-19 mortality rates. However, due to technical limitations, there are three main issues. First, the traditional wireless communication technology for wearable medical devices is difficult to satisfy the real-time requirements fully. Second, current monitoring platforms lack efficient streaming data processing mechanisms to cope with the large amount of cardiovascular data generated in real time. Third, the diagnosis of the monitoring platform is usually manual, which is challenging to ensure that enough doctors online to provide a timely, efficient, and accurate diagnosis. To address these issues, this paper proposes a 5G-enabled real-time cardiovascular monitoring system for COVID-19 patients using deep learning. Firstly, we employ 5G to send and receive data from wearable medical devices. Secondly, Flink streaming data processing framework is applied to access electrocardiogram data. Finally, we use convolutional neural networks and long short-term memory networks model to obtain automatically predict the COVID-19 patient's cardiovascular health. Theoretical analysis and experimental results show that our proposal can well solve the above issues and improve the prediction accuracy of cardiovascular disease to 99.29%.

A Brief Review on the Sensor Measurement Solutions for the Ten-Meter Walk Test

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.

A Systematic Investigation of Models for Color Image Processing in Wound Size Estimation

In recent years, research in tracking and assessing wound severity using computerized image processing has increased. With the emergence of mobile devices, powerful functionalities and processing capabilities have provided multiple non-invasive wound evaluation opportunities in both clinical and non-clinical settings. With current imaging technologies, objective and reliable techniques provide qualitative information that can be further processed to provide quantitative information on the size, structure, and color characteristics of wounds. These efficient image analysis algorithms help determine the injury features and the progress of healing in a short time. This paper presents a systematic investigation of articles that specifically address the measurement of wounds’ sizes with image processing techniques, promoting the connection between computer science and health. Of the 208 studies identified by searching electronic databases, 20 were included in the review. From the perspective of image processing color models, the most dominant model was the hue, saturation, and value (HSV) color space. We proposed that a method for measuring the wound area must implement different stages, including conversion to grayscale for further implementation of the threshold and a segmentation method to measure the wound area as the number of pixels for further conversion to metric units. Regarding devices, mobile technology is shown to have reached the level of reliable accuracy.

CAFD: Context-Aware Fault Diagnostic Scheme towards Sensor Faults Utilizing Machine Learning

Sensors' existence as a key component of Cyber-Physical Systems makes it susceptible to failures due to complex environments, low-quality production, and aging. When defective, sensors either stop communicating or convey incorrect information. These unsteady situations threaten the safety, economy, and reliability of a system. The objective of this study is to construct a lightweight machine learning-based fault detection and diagnostic system within the limited energy resources, memory, and computation of a Wireless Sensor Network (WSN). In this paper, a Context-Aware Fault Diagnostic (CAFD) scheme is proposed based on an ensemble learning algorithm called Extra-Trees. To evaluate the performance of the proposed scheme, a realistic WSN scenario composed of humidity and temperature sensor observations is replicated with extreme low-intensity faults. Six commonly occurring types of sensor fault are considered: drift, hard-over/bias, spike, erratic/precision degradation, stuck, and data-loss. The proposed CAFD scheme reveals the ability to accurately detect and diagnose low-intensity sensor faults in a timely manner. Moreover, the efficiency of the Extra-Trees algorithm in terms of diagnostic accuracy, F1-score, ROC-AUC, and training time is demonstrated by comparison with cutting-edge machine learning algorithms: a Support Vector Machine and a Neural Network.

A Heterogeneous Ensemble Forecasting Model for Disease Prediction

The manuscript presents a bragging-based ensemble forecasting model for predicting the number of incidences of a disease based on past occurrences. The objectives of this research work are to enhance accuracy, reduce overfitting, and handle overdrift; the proposed model has shown promising results in terms of error metrics. The collated dataset of the diseases is collected from the official government site of Hong Kong from the year 2010 to 2019. The preprocessing is done using log transformation and z score transformation. The proposed ensemble model is applied, and its applicability to a specific disease dataset is presented. The proposed ensemble model is compared against the ensemble models, namely dynamic ensemble for time series, arbitrated dynamic ensemble, and random forest using different error metrics. The proposed model shows the reduced value of MAE (mean average error) by 27.18%, 3.07%, 11.58%, 13.46% for tuberculosis, dengue, food poisoning, and chickenpox, respectively. The comparison drawn between the proposed model and the existing models shows that the proposed ensemble model gives better accuracy in the case of all the four-disease datasets.

Privacy-Preserving K-Nearest Neighbors Training over Blockchain-Based Encrypted Health Data

Numerous works focus on the data privacy issue of the Internet of Things (IoT) when training a supervised Machine Learning (ML) classifier. Most of the existing solutions assume that the classifier’s training data can be obtained securely from different IoT data providers. The primary concern is data privacy when training a K-Nearest Neighbour (K-NN) classifier with IoT data from various entities. This paper proposes secure K-NN, which provides a privacy-preserving K-NN training over IoT data. It employs Blockchain technology with a partial homomorphic cryptosystem (PHC) known as Paillier in order to protect all participants (i.e., IoT data analyst C and IoT data provider P) data privacy. When C analyzes the IoT data of P, both participants’ privacy issue arises and requires a trusted third party. To protect each candidate’s privacy and remove the dependency on a third-party, we assemble secure building blocks in secure K-NN based on Blockchain technology. Firstly, a protected data-sharing platform is developed among various P, where encrypted IoT data is registered on a shared ledger. Secondly, the secure polynomial operation (SPO), secure biasing operations (SBO), and secure comparison (SC) are designed using the homomorphic property of Paillier. It shows that secure K-NN does not need any trusted third-party at the time of interaction, and rigorous security analysis demonstrates that secure K-NN protects sensitive data privacy for each P and C. The secure K-NN achieved 97.84%, 82.33%, and 76.33% precisions on BCWD, HDD, and DD datasets. The performance of secure K-NN is precisely similar to the general K-NN and outperforms all the previous state of art methods.

Activities of daily living with motion: A dataset with accelerometer, magnetometer and gyroscope data from mobile devices

The dataset presented in this paper is related to the performance of five Activities of Daily Living (ADL) with motion, such as walking, running, standing, walking upstairs, and walking downstairs. These activities were performed with a mobile device in a waistband, containing the data acquired from accelerometer, magnetometer, and gyroscope sensors. These data include the motion data, which allow the characterization of the different types of movement. The data acquisition was performed in open environments by 25 individuals (15 man, and 10 woman) in the Covilhã, and Fundão municipalities (Portugal). The data related to the different sensors was acquired with a sampling rate of 100 Hz by the accelerometer, 50 Hz by the magnetometer, and 100 Hz by the gyroscope sensors. It includes the captures related to a minimum of 2000 captures for each ADL, which corresponds to 2.8 h (approximately) for each ADL. In total, this dataset includes 13.9 h (approximately) of captures. These data can be reused for the implementation of data processing techniques, and artificial intelligence methods.

An efficient multi-classifier method for differential diagnosis

There are many useful data mining methods for diagnosis of diseases and cancers. However, early diagnosis of a disease or cancer could significantly affect the chance of patient survival in some cases. The objective of this study is to develop a method for helping accurate diagnosis of different diseases based on various classification methods. Knowledge collection from domain experts is challenging, inaccessible and time-consuming; so we design a multi-classifier using a dynamic classifier and clustering selection approach to takes advantages of these methods based on data. We combine Forward-backward and Principal Component Analysis for feature reduction. The multi-classifier evaluates three clustering methods and ascertains the best classification methods in each cluster based on some training data. In this study, we use ten datasets taken from Machine Learning Repository datasets of the University of California at Irvine (UCI). The proposed multi-classifier improves both computation time and accuracy as compared with all other classification methods. It achieves maximum accuracy with minimum standard deviation over the sampled datasets.

Multi-Modal Diagnosis of Infectious Diseases in the Developing World

In low and middle income countries, infectious diseases continue to have a significant impact, particularly amongst the poorest in society. Tetanus and hand foot and mouth disease (HFMD) are two such diseases and, in both, death is associated with autonomic nervous system dysfunction (ANSD). Currently, photoplethysmogram or electrocardiogram monitoring is used to detect deterioration in these patients, however expensive clinical monitors are often required. In this study, we employ low-cost and mobile wearable devices to collect patient vital signs unobtrusively; and we develop machine learning algorithms for automatic and rapid triage of patients that provide efficient use of clinical resources. Existing methods are mainly dependent on the prior detection of clinical features with limited exploitation of multi-modal physiological data. Moreover, the latest developments in deep learning (e.g. cross-domain transfer learning) have not been sufficiently applied for infectious disease diagnosis. In this paper, we present a fusion of multi-modal physiological data to predict the severity of ANSD with a hierarchy of resource-aware decision making. First, an on-site triage process is performed using a simple classifier. Second, personalised longitudinal modelling is employed that takes the previous states of the patient into consideration. We have also employed a spectrogram representation of the physiological waveforms to exploit existing networks for cross-domain transfer learning, which avoids the laborious and data intensive process of training a network from scratch. Results show that the proposed framework has promising potential in supporting severity grading of infectious diseases in low-resources settings, such as in the developing world.

Wearables and the medical revolution

Wearable sensors are already impacting healthcare and medicine by enabling health monitoring outside of the clinic and prediction of health events. This paper reviews current and prospective wearable technologies and their progress toward clinical application. We describe technologies underlying common, commercially available wearable sensors and early-stage devices and outline research, when available, to support the use of these devices in healthcare. We cover applications in the following health areas: metabolic, cardiovascular and gastrointestinal monitoring; sleep, neurology, movement disorders and mental health; maternal, pre- and neo-natal care; and pulmonary health and environmental exposures. Finally, we discuss challenges associated with the adoption of wearable sensors in the current healthcare ecosystem and discuss areas for future research and development.