Mareike Schulze

Wearable sensors in healthcare and sensor-enhanced health information systems: all our tomorrows?

Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuropsychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies – outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL)

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human–machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific “GAL technology”, providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL’s highly inter- and multidisciplinary aspects, with respect to research into GAL’s application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Unobtrusive ambulatory estimation of knee joint angles during walking using gyroscope and accelerometer data - a preliminary evaluation study

Osteoarthritis has the highest prevalence in the elderly population, with a rising tendency. Currently often special gait labs are used for objective diagnostic assessment of functional motion deficits or treatment outcome, e.g in patients suffering from gonarthrosis. The artificial lab setting and short measurement periods affect the explanatory power of this method. Inertial multi-sensor systems in contrast allow for monitoring human gait independent of a lab setting. However, recent approaches concerning important knee function parameter analyses have not been validated for long-term monitoring yet.The aim of our research for this paper is to evaluate our wearable joint kinematics measurement system (KINEMATIC-WEAR) for assessing maximum knee joint angles during extended periods of normal walking. Our prototype consists of small multi-sensor nodes with combined tri-axial accelerometer, gyroscope and magnetometer which were attached with kinesiotape to the thigh and shank of a subject while walking at different speeds on a treadmill. The computed maximum knee joint angles were compared with reference measurements performed by a physician on video frames captured during walking, as was the correlation between both value sets. Our results show an excellent correlation of 0.96 between clinical reference measurements and our computed angles. While the accuracy is good for slow walking speeds of 0.28 m/s (lkm/h, mean error: 2.6 deg±1.5) and 0.56 m/s (2km/h, mean error: 2.0 deg±1.6), our algorithm over-estimates the angles by 6.3±3.6 degrees at 0.83 m/s (3 km/h), likely induced by soft tissue motion during heel-strike. Our preliminary results show that our system allows for unobtrusive, long-term out-of-Iab monitoring of knee joint motion parameters. Further studies are necessary to evaluate the system for arthritis patients.

A sensor-enhanced health information system to support automatically controlled exercise training of COPD patients

For an improvement of the quality of life for patients suffering from chronic obstructive pulmonary disease (COPD) we developed a concept and prototype of a sensor-enhanced health information system. This system includes a component that is monitoring the rehabilitation training and automatically controls the target load for the exercise on the basis of his or her vital data. The system also detects potentially critical health states and communicates alarms to external users. The component interacts with a personal electronic health record (PHR) that provides additional health related information for the decision making process, as feedback to the user and as an opportunity for physicians to optimize the users exercise plan. The PHR uses current medical informatics standards to store and transmit training data to health care professionals and to provide a maximum of interoperability with their information systems. We have integrated these components in a service oriented platform design that is located in the home environment of the user.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study.

Background: Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. Objectives: We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. Methods: Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. Results: The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. Discussion and conclusions: Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

Physical activity is unrelated to cognitive performance in pre-bariatric surgery patients.

OBJECTIVE To investigate the relationship between physical activity (PA) and cognitive performance in extreme obesity. METHODS Seventy-one bariatric surgery candidates (77.5% women) with a mean body mass index (BMI) of 46.9 kg/m2 (SD=6.0) and a mean age of 41.4 (SD=11.9) years completed SenseWear Pro2 activity monitoring for seven days. Cognitive functioning was assessed by a computerized test battery including tasks of executive function (Iowa Gambling Task), visuospatial short-term memory (Corsi Block Tapping Test) and verbal short-term memory (Auditory-Verbal Learning Test). Questionnaires assessing eating disturbances and depressive symptoms were administered. Somatic comorbidities were assessed by medical chart review. RESULTS The level of PA was low with mean steps per day within wear time being 7140 (SD=3422). Most patients were categorized as sedentary (31.0%) or low active (26.8%). No significant association between PA estimates and cognitive performance was found. Lower PA was modestly correlated with higher BMI but not with age, somatic comorbidity or depressive symptoms. Moderated regression analyses suggested a significant interaction effect between depression and PA in predicting performance on the Corsi Block Tapping Test. Patients with (29.6%) and without (70.4%) regular binge eating did not differ with respect to PA or cognitive function. CONCLUSION The findings indicate no association between daily PA and cognitive performance in morbidly obese patients. Future studies should explore the relationship between the variables with regard to dose-response-questions, a broader BMI range and with respect to potential changes after substantial weight loss due to bariatric surgery.

Exploring Possibilities for Transforming Established Subscription-based Scientific Journals into Open Access Journals

BACKGROUND Based on todays information and communication technologies the open access paradigm has become an important approach for adequately communicating new scientific knowledge. OBJECTIVES Summarizing the present situation for journal transformation. Presenting criteria for adequate transformation as well as a specific approach for it. Describing our exemplary implementation of such a journal transformation. METHODS Studying the respective literature as well as discussing this topic in various discussion groups and meetings (primarily of editors and publishers, but also of authors and readers), with long term experience as editors and /or publishers of scientific publications as prerequisite. RESULTS There is a clear will, particularly of political and funding organizations, towards open access publishing. In spite of this, there is still a large amount of scientific knowledge, being communicated through subscription-based journals. For successfully transforming such journals into open access, sixteen criteria for a goal-oriented, stepwise, sustainable, and fair transformation are suggested. The Tandem Model as transformation approach is introduced. Our exemplary implementation is done in the Trans-O-MIM project. It is exploring strategies, models and evaluation metrics for journal transformation. As instance the journal Methods of Information in Medicine will apply the Tandem Model from 2017 onwards. CONCLUSIONS Within Trans-O-MIM we will reach at least nine of the sixteen criteria for adequate transformation. It was positive to implement Trans-O-MIM as international research project. After first steps for transforming Methods have successfully been made, challenges will remain, among others, in identifying appropriate incentives for open access publishing in order to support its transformation.

A novel approach for discovering human behavior patterns using unsupervised methods

BackgroundAs is well known, elderly people gradually lose the ability of self-care. The decline can be reflected in changes in their daily life behavior. A solution to assess their health status is to design sensor-enhanced living environments to observe their behavior, in which unobtrusive sensors are usually used. With respect to information extraction from the dataset collected by means of these kinds of sensors, unsupervised methods have to be relied on for practical application. Under the assumption that human lifestyle is associated with health status, this study intends to propose a novel approach to discover behavior patterns using unsupervised methods.MethodsTo evaluate the feasibility of this approach it was applied to datasets collected in the GAL-NATARS study. The study is part of the Lower Saxony research network Design of Environments for Aging (GAL) and conducted in subjects’ home environments. The subjects recruited in GAL-NATARS study are older people (age ≥ 70 years), who are discharged from hospital to live alone again at their homes after treatment of a femoral fracture.ResultsThe change of lifestyle regularity is measured. By analyzing the correlation between the extracted information and medical assessment results of four subjects, two of them exhibited impressive association and the other two showed less association.ConclusionsThe approach may provide complementary information for health assessment; however, the dominant relationship between the change of behavior patterns and the health status has to be shown and datasets from more subjects must be collected in future studies.LimitationsMerely environmental data were used and no wearable sensor for activity detection or vital parameter measurement is taken into account. Therefore, this cannot comprehensively reflect reality.ZusammenfassungHintergrundDass ältere Menschen allmählich Selbstsorgekompetenzen verlieren, ist weithin bekannt. Der allmähliche Verlust kann sich in Veränderungen des Verhaltens im Alltagsleben widerspiegeln. Eine Möglichkeit zur Überprüfung ihres gesundheitlichen Zustands ist die Entwicklung sensorgestützter Lebensumfelder, um ihr Verhalten zu beobachten. Dabei werden in der Regel unauffällige Sensoren verwendet. Im Hinblick auf die Extrahierung von Informationen aus den so gesammelten Datensätzen verlässt man sich für die praktische Anwendung auf nichtsupervidierte Methoden. Ausgehend von der Annahme, dass Lifestyle und Gesundheitszustand miteinander zusammenhängen, zielt diese Studie auf einen innovativen Ansatz, Verhaltensmuster mit nichtsupervidierten Methoden zu detektieren.MethodenUm die Machbarkeit dieses Ansatzes zu evaluieren wurde er auf die in der GAL-NATARS-Studie generierten Datensätze angewendet; vom niedersächsischen Forschungsnetzwerk Design of Environments for Aging (GAL) wird diese Studie im Wohnumfeld der Probanden durchgeführt. Die allein lebenden Probanden der GAL-NATARS-Studie waren ≥ 70 Jahre alt und nach stationärer Behandlung einer Femurfraktur wieder in ihr häusliches Umfeld entlassen worden.ErgebnisseGemessen wurden die Veränderungen in der Regelmäßigkeit des Lebensstils. Bei 4 Probanden wurden die extrahierten Informationen und die Ergebnissen des medizinischen Assessments miteinander korreliert: Bei 2 von ihnen zeigte sich ein eindrucksvoller Zusammenhang, bei den anderen beiden fand sich weniger Assoziation.SchlussfolgerungenZwar kann der untersuchte Ansatz zusätzliche Informationen für das medizinische Assessment liefern, doch die dominante Beziehung zwischen den Änderungen in Verhaltensmustern und dem Gesundheitszustand ist noch darzustellen. In künftigen Studien müssen noch mehr Patientendatensätze gesammelt werden.EinschränkungenVerwendet werden lediglich Umweltdaten, keine Daten von tragbaren Sensoren zur Registrierung von Aktivität bzw. Vitalparametern. Daher können die Ergebnisse die Wirklichkeit nicht umfassend wiedergeben.

Visual synchronization analysis of simple color stimuli

Color is a basic aspect of human perception and will effect on the peoples spirit as one part of living environments. Some experiments have proved that the different color will play an important role on enhancing cognitive task performance, and the peoples moods and behaviors can also be changed by the colors. It is said that the different color has been shown to have different associations within the cognitive domain. In this paper, we present the results of the subjects watching the colors under the brainwave bands analysis. A simple visual color stimulus is done with the dependence on frequency during subjects watching the stimuli for a long time. By analyzing data after 300ms during the stimuli happened for avoiding the effect of early response, we proposed that the subject could produce visual “synchronization” phenomenon like auditory synchronization.