Mark Hawley

Medical imaging with a microwave tomographic scanner

A microwave tomographic scanner for biomedical applications is presented. It consists of a 64-element circular array with a useful diameter of 20 cm. Electronically scanning the transmitting and receiving antennas allows multiview measurements with no mechanical movement. Imaging parameters-a spatial resolution of 7 mm and a contrast resolution of 1% for a measurement time of 3 s-are appropriate for medical use. Measurements on tissue-simulating phantoms and volunteers, together with numerical simulations, are presented to assess the system for absolute imaging of tissue distribution and for differential imaging of physiological, pathological, and induced changes in tissues.<<ETX>>

Video based technology for ambient assisted living: A review of the literature

Ambient assisted living (AAL) has the ambitious goal of improving the quality of life and maintaining independence of older and vulnerable people through the use of technology. Most of the western world will see a very large increase in the number of older people within the next 50 years with limited resources to care for them. AAL is seen as a promising alternative to the current care models and consequently has attracted lots of attention. Recently, a number of researchers have developed solutions based on video cameras and computer vision systems with promising results. However, for the domain to reach maturity, several challenges need to be faced, including the development of systems that are robust in the real-world and are accepted by users, carers and society. In this literature review paper we present a comprehensive survey of the scope of the domain, the existing technical solutions and the challenges to be faced.

Interventions employing mobile technology for overweight and obesity: an early systematic review of randomized controlled trials

Obesity is a global epidemic with major healthcare implications and costs. Mobile technologies are potential interventions to promote weight loss. An early systematic review of this rapidly growing area of research was conducted. Electronic databases were searched for articles published between January 1998 and October 2011. Data sources included Medline, Embase and the Cochrane Central Register of Controlled Trials. Ongoing research was searched for using clinical trials databases and registers. Out of 174 articles retrieved, 21 met the inclusion criteria of randomized controlled trials (RCTs) on mobile technology interventions facilitating weight loss in overweight and obese adults with any other comparator. A narrative synthesis was undertaken. Seven articles were included and appraised using the Cochrane risk of bias tool: four presented a low risk of bias and three presented a high risk of bias. There is consistent strong evidence across the included multiple high‐quality RCTs that weight loss occurs in the short‐term because of mobile technology interventions, with moderate evidence for the medium‐term. Recommendations for improving the reporting and quality of future trials are made including reporting weight loss in percent to meet clinical standards, and including features such as long‐term follow‐up, cost‐effectiveness and patient acceptability.

An evaluation of second and third generation telecare services in older people's housing

Summary In a controlled study of older people living in sheltered housing (retirement housing), 24 people provided with telecare were compared with a control group of 28 people. The intervention consisted of second generation telecare equipment, such as automatic flood or falls detectors, a third generation lifestyle reassurance system and an Internet café. After a 12-month monitoring period, there was no noticeable change in the fear of falling. There was no significant difference for eight of the nine SF-36 domains. However, the Social Functioning domain showed a significant difference (P = 0.049), with scores 8% higher in the intervention group, suggesting a beneficial effect of telecare. Positive trends were also evident in areas such as an increase in the length of time spent out of the home, improved feelings of safety during the day and night, and a reduction in the fear of crime. The Internet café was used by 25% of people for at least 20 min per week. The results suggest that second generation telecare systems and Internet facilities could be more widely used in service delivery, but that lifestyle reassurance requires further development.

Factors affecting front line staff acceptance of telehealth technologies: a mixed‐method systematic review

AIM To synthesize qualitative and quantitative evidence of front-line staff acceptance of the use of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. BACKGROUND The implementation of telehealth at scale is a governmental priority in countries including the UK, USA and Canada, but little research has been conducted to analyse the impact of implementation on front-line nursing staff. DATA SOURCES Six relevant data bases were searched between 2000-2012. DESIGN Mixed-method systematic review including all study designs. REVIEW METHODS Centre for Reviews and Dissemination approach with thematic analysis and narrative synthesis of results. RESULTS Fourteen studies met the review inclusion criteria; 2 quantitative surveys, 2 mixed-method studies and 10 using qualitative methods, including focus groups, interviews, document analysis and observations. Identified factors affecting staff acceptance centred on the negative impact of service change, staff-patient interaction, credibility and autonomy, and technical issues. Studies often contrasted staff and patient perspectives, and data about staff acceptance were collected as part of a wider study, rather than being the focus of data collection, meaning data about staff acceptance were limited. CONCLUSION If telehealth is to be implemented, studies indicate that the lack of acceptance of this new way of working may be a key barrier. However, recommendations have not moved beyond barrier identification to recognizing solutions that might be implemented by front-line staff. Such solutions are imperative if future roll-out of telehealth technologies is to be successfully achieved.

Automatic fall detectors and the fear of falling

We studied the effect of automatic fall detection units on the fear of falling. Participants were community alarm users living in the community aged over 75 years or those aged 60–74 years who had experienced a fall in the previous six months. Of those approached, 31% consented to take part; the main reason given for potential participants declining involvement was that they were happy with the technology they already had. Subjects were assigned to a control group (n = 21) or intervention group (n = 34) based on age, the number of self-reported falls in the previous six months and their score on the self-administered Falls Efficacy Scale (FES), which measures fear of falling on a scale of 0–100, with higher scores indicating less fear. The monitoring period lasted a mean of 17 weeks (SD 3.1). There was no significant difference between the intervention and control groups in their mean ratings of fear of falls (40.3 vs 37.5, difference 2.8, 95% CI 6.2 to 11.8), health-related quality of life or morale. Differences in fear of falling between an intervention subgroup who wore their detector at least occasionally (62%) and those who did not (38%) suggested that some people may benefit from a fall detector while others may lose confidence if they are provided with one. Most users who wore their detectors at least occasionally felt more confident and independent and considered that the detector improved their safety.

Attitudes to telecare among older people, professional care workers and informal carers: a preventative strategy or crisis management?

This paper reports findings from an attitudinal survey towards telecare that emerged from 22 focus groups comprising 92 older people, 55 professional stakeholders and 39 carers. These were convened in three different regions of England as a precursor to telecare service development. The results from this study suggest that informants’ views were shaped by prior knowledge of conventional health and social care delivery in their locality, and the implication is that expectations and requirements with respect to telecare services in general are likely to be informed by wider perceptions about the extent to which community care should operate as a preventative strategy or as a mechanism for crisis management.

A systematic review of lifestyle monitoring technologies

The evidence base for lifestyle monitoring is relatively weak, even though there are significant numbers of commercial installations around the world. We conducted a literature review to summarize the current position with regard to lifestyle monitoring based on sensors in the home. In total, 74 papers met the inclusion criteria. Only four papers reported trials involving 20 or more subjects, with a further 21 papers reporting trials involving one or more subjects. Most papers (n = 49) were concerned with technology development. Motion detection was the most common of the technologies employed, followed by door and electrical appliance usage. The predominant monitoring strategy was that of detecting changes in activity. However, little attention has been given to determining when or how changes in the profile of activity should be used to raise a call for assistance from a health or care professional. Lifestyle monitoring remains a relatively immature research area in which there is little detailed understanding of how to provide comprehensive and effective systems.

Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review.

BackgroundHome telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved.PurposeThe aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth.MethodsThis research performs a narrative synthesis of the results from included studies.ResultsThirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified.ConclusionsResearch reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth.

Automatic Speech Recognition and Training for Severely Dysarthric Users of Assistive Technology: The STARDUST Project.

The STARDUST project developed robust computer speech recognizers for use by eight people with severe dysarthria and concomitant physical disability to access assistive technologies. Independent computer speech recognizers trained with normal speech are of limited functional use by those with severe dysarthria due to limited and inconsistent proximity to “normal” articulatory patterns. Severe dysarthric output may also be characterized by a small mass of distinguishable phonetic tokens making the acoustic differentiation of target words difficult. Speaker dependent computer speech recognition using Hidden Markov Models was achieved by the identification of robust phonetic elements within the individual speaker output patterns. A new system of speech training using computer generated visual and auditory feedback reduced the inconsistent production of key phonetic tokens over time.