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The pervasive healthcare system focus towards achieving two specific goals: the availability of eHealth applications and medical information anywhere and anytime and the invisibility of computing. Furthermore, pervasive health system encompasses new types of sensing and communication of health information as well as new type of interactions among health providers and people, among patients, among patients and researchers and patients and corporations.

This book aims at promoting the discussion on current trends in technologies and concepts that help integrate health monitoring and healthcare more seamlessly to our everyday lives, regardless of space and time, but also present cutting edge perspectives and visions to highlight future development. The book presents not only the state of the art technologies and solutions to tackle the critical challenges faced by the building and development of the pervasive health system but also potential impact on society at social, medical and technological level.



Pervasive Sensing and M-Health: Vital Signs and Daily Activity Monitoring

Recent advances in pervasive sensing, mobile, and pervasive computing technologies have led to deployment of new smart sensors and smart sensor networks architectures that can be worn or integrated within the living environment without affecting a person’s daily activities. These sensors promise to change vital signs and motor activity monitoring from snapshot mode to continuous monitoring mode, enabling clinicians, therapists but also accompanying persons of elderly or people with chronic diseases or disabilities to provide healthcare services based on remote continuous monitoring of the patient, pervasive health monitoring or pervasive healthcare. Using computer resources expressed by networks of servers, storage applications and Web services health monitoring and healthcare might be rapidly provisioned and released with minimal management effort or service provider interaction by using computational intelligence and Semantic Web.

A brief literature review on healthcare challenges, the deployment of unobtrusive sensors that may be used as part of pervasive sensing systems for vital signs and daily motor activity monitoring, mobile health applications and pervasive computing for pervasive health monitoring and pervasive healthcare are presented in this chapter. The chapter encompasses examples of unobtrusive sensors for health and motor activity monitoring as well as Android OS and iPhone mobile applications from Apps Store for vital and sensory function test, emergency, stress management, brain activity management, nutrition, and physical exercises. Mobile healthcare architectures developed with the contribution of the authors for vital signs and motor activity remote monitoring as well as for indoor air quality monitoring and alert on respiratory distress, which includes wearable devices (wrist worn device) and sensors integrated in objects such as walker and wheelchair are also presented in this chapter.

The presented pervasive sensing and pervasive computing approaches for health monitoring and care underscore the capabilities of this kind of systems to assure more closely coordinated forms of health and social care provision as well as personalized healthcare for better quality of life.

Octavian Postolache, Pedro Silva Girão, Gabriela Postolache

Are Technologies Assisted Homes Safer for the Elderly?

The elderly population of the world is growing rapidly, creating the increasing need for elderly care. The aged people expect that this increased longevity will help them to enjoy living an independent and high quality life. Yet, at the same time they know there is a high risk of injury as many unforeseen accidents can take place. Surely, with the technology of today, there is a better way for these people in the society to resolve this problem. The chapter will present the development work and implementation details of a wireless sensors network based safe home monitoring system targeted for the elder people to provide a safe, sound and secured living environment in the society. The system is designed to support people who wish to live alone but, because of old age, ill health or disability, there is some risk in this, which worries their family or friends.

S. C. Mukhopadhyay, N. K. Suryadevara, R. K. Rayudu

A Large-Area Sensor System Underneath the Floor for Ambient Assisted Living Applications

The SensFloor® is a textile-based large-area sensor system which is installed as an underlay underneath the flooring. It detects people moving across the floor, calculates their trajectories and distinguishes between foot steps and a fall. The use of capacitive proximity sensing instead of pressure sensing gives high flexibility in floor design. Besides elastic flooring like carpet and PVC, even non-elastic flooring like parquet or laminate is suitable. The SensFloor System enables a variety of different applications in the domain of

Ambient Assisted Living

(AAL) like fall detection, activity monitoring, energy savings, control of automatic doors, intrusion alarm and access control. Presence detection and self-test capabilities are additional features valuable in particular for security applications.

C. Lauterbach, A. Steinhage, A. Techmer

Footwear-Based Wearable Sensors for Physical Activity Monitoring

Monitoring of posture allocations and activities is important for such applications as physical activity management, energy expenditure estimation, stroke rehabilitation and others. At present, accurate devices rely on multiple sensors distributed on the body and thus may be too obtrusive for everyday use. This chapter presents an overview of a novel wearable footwear sensor (SmartShoe), which is capable of very accurate recognition of most common postures and activities while being minimally intrusive to the subject. SmartShoe relies on capturing information from patterns of heel acceleration and plantar pressure to differentiate weight-bearing and non-weight-bearing activities (such as for example, sitting and standing, walking/jogging and cycling). Validation results obtained in several studies demonstrate applicability to widely varying populations such as healthy individuals and individuals post-stroke, while achieving high (95%-98%) average accuracy of posture and activity classification, high (root-mean-square error of 0.69 METs) accuracy of energy expenditure prediction, and reliable (error of 2.6- 18.6%) identification of temporal gait parameters. High accuracy and minimal intrusiveness of SmartShoe should enable its use in a wide range of research and clinical applications.

E. Sazonov

Continuous-Wave Photoacoustic-Based Sensor for the Detection of Aqueous Glucose: Towards Non-invasive and Continuous Glycemia Sensing

Measurement of blood glucose levels (BGLs) is a basic procedure that diabetic patients need to perform several times a day. The conventional standard protocol for on-site measurement, despite several advantages such as portability, low cost, fast response time, and ease of operation, is based on the finger-prick technique to extract blood samples. This process is invasive and cannot provide continuous monitoring.

Towards the achievement of non-invasive and continuous BGL monitoring, we have developed two measurement methods based on the continuous-wave photoacoustic (CW-PA) protocol and we performed preliminary

in vitro

tests with aqueous solutions. The first method relies on the measurement of the frequency shift induced by the change in the composition of the propagation medium. This method is equivalent to an acoustic velocity measurement and provides high sensitivity but no selectivity to glucose compound. The second approach utilizes simultaneous optical excitation at two wavelengths for compound-selective measurements. After correcting the frequency shift mentioned previously, this protocol allows measurements equivalent to a differential absorption coefficient one at the two wavelengths used. It then combines the advantages of absorption spectroscopy without the limitation from scattering due to the use of acoustic detection. Furthermore, the combination of the two methods can be generalized to systems involving more than one changing parameter by using not only two optical wavelengths for the excitation sequence but also several pairs of wavelength sequentially.

These methods then represent an important step forward the non-invasive, selective, and continuous measurements of glucose compound concentrations from a complex mixture, typically blood.

S. Camou

From Handheld Devices to Near-invisible Sensors: The Road to Pervasive e-Health

Pervasive computing refers to the increasing integration of information and communication technologies into people’s lives and environments. In particular, pervasive technologies have been identified as a strong asset for achieving the vision of user-centred preventive healthcare. However, there are engineering problems to be solved before many of the envisioned applications in healthcare can become a reality. The objective of this chapter is to present future research demands in pervasive sensing by means of miniaturised wearable and implantable sensors featuring ultra-low power consumption, high portability, and robustness. At the same time, since many emerging non-invasive measurement techniques related to monitoring physiological and psychological status of individuals rely on bioelectrical impedance spectroscopy (BIS), we also consider the perspectives for bioimpedance applications, referring in particular to the use of CMOS technology for chip-scale integration of BIS readout electronics.

J. L. Ausín, J. F. Duque-Carrillo, J. Ramos, G. Torelli

A Universal Wireless Device for Biomedical Signals Recording

The chapter provides a report on the wireless biomedical signal acquisition system that has been developed and applied recently in a hospital. The authors describe a universal wireless device (bioelectric amplifier) with a case study of the wireless communication. Advantages and disadvantages of considered standards have been described. The most important feature of the bioelectric amplifier is the software configuration ability towards specific requirements that occur during the registration of different signals. The study shows examples for ECG (Electrocardiography), EGG (Electrogastrography), EOG (Electro-oculography), EEG (Electroencephalography) with the same wireless device. The portable unit is under clinical trials tests and preliminary evaluation indicates acceptance by medical staff. Additional advantages are the relatively low cost of manufacture and the possibility of application of other wireless transmission standards.

D. Grzechca, D. Komorowski, S. Pietraszek

Wireless Sensing System for Healthcare Monitoring Physiological State and Recognizing Behavior in Daily Life

This paper describes the basic system concept for pervasive healthcare and presents a wireless sensing system for healthcare to monitor physiological state in the living environment. The importance of constantly monitoring, analysing and utilizing human daily information has been growing in the area of healthcare. The introduction of ICT in the areas of medicine and welfare has created new systems and services for healthcare and can help promote disease prevention and health maintenance through wirelessly delivered healthcare and ubiquitous medicine. The availability of information about a person’s daily physiological state and activity makes it possible to judge their health condition and behaviors and provide predictive diagnoses and treatment.

The objective of the work is to establish a wearable wireless body area network (BAN) system that is useful in pervasive healthcare. In this work we developed a wireless sensing system to monitor thermal physiological state. Sensors which make up a wireless system are varied depending on the purpose of use of the system. Wearable small-sized and wireless sensors which consume little power have to be developed to measure the desired vital signals or human data. Moreover, reliable wireless communication network is needed to obtain the data of multiple wearable sensors in real time. BAN can realize wireless connectivity among sensors deployed on human body.

The important indicators for monitoring the thermal physiological state are core body temperature, microclimate within clothing, skin temperature, heart rate and movement. To develop the monitoring system, ear-worn temperature sensors, thermo-hygrometers and skin temperature sensors were newly developed. The earworn temperature sensor enables a continuous non-invasive measurement of the equivalent of core body temperature in daily life. The thermo-hygrometer can measure microclimate within clothing. These sensors transmit data wirelessly in synchronization with each other. Data can be obtained reliably in daily life without restraining wearers’ movements using multiple networked wearable sensors with a reasonable battery life. The level of data loss in wireless communication was low making it possible to estimate physiological state using more than 10 sensors simultaneously, even though both the IEEE 802.15.4 radio and the low power radio coexist.

The application system for the prevention of heat stroke was evaluated on two situations. One is for the prevention of heat stroke and feeling sick during exercise in conditions of high ambient temperature and humidity. The other is for the prevention of indoor heat stroke among the elderly. It is necessary to recognize individual behaviors to be able to provide appropriate support based on the context. Some activities to be recognized at home were learned and identified using the location data. Experiments showed that the detection of the abnormal level of several kinds of physiological data and their change was effective in judging the physiological state and giving a warning on the health condition in the context of the activities and surroundings. This system will be broadly applicable to healthcare in everyday life such as temperature control for heat stroke prevention and lifestyle management based on the circadian rhythm and health condition.

Chika Sugimoto

Automatic Sensing of Speech Activity and Correlation with Mood Changes

The association between social relationships and psychological health has been established fairly recently, in the last 30-40 years, relying on survey-based methods to record past activities and the psychological responses in individuals. However, using the self-reporting methods for capturing social behavior exhibits a number of shortcomings including recall bias, memory dependence, and a high end user effort for a continuous long-term monitoring. In contrast, automated sensing techniques for monitoring social activity, and in general, human behavior, has a potential to provide more objective measurements thus to overcome the shortcomings of self-reporting methods. In this paper, we present a privacy preserving approach to detect one component of social interactions - the speech activity, through the use of off-the-shelf accelerometers. Furthermore, we used the accelerometer based speech detection method to investigate the correlation between the amount of speech (which is an aspect that reflects the participation in verbal social interactions) and mood changes. Our pilot study suggested that verbal interactions are an important factor that has an impact on individuals’ mood, while the study also demonstrated the potential of automated capturing social activity comparable to the use of gold standard surveys.

Aleksandar Matic, Venet Osmani, Oscar Mayora

The Potential of Pervasive Sensors and Computing for Positive Technology: The Interreality Paradigm

Positive Technology is an emerging field that could be defined as the scientific and applied approach to the use of advanced technology for improving the quality of our personal experience. This discipline effectively combines the purposes of Positive Psychology with the enhancements of Information and Communication Technologies to promote individual and social well-being. Here, we suggest that a further advancement for Positive Technology might be offered by a new technological paradigm, namely Interreality. The value of Interreality Paradigm lies in bridging the gap between virtual and real world by integrating different pervasive sensors and computing technologies to create a hybrid, closedloop empowering experience for the assessment and treatment actually missing in the traditional research and clinical approach of psychological disorders. Interreality Paradigm uses biosensors, activity sensors and mobile devices (PDAs, mobile phones, etc.) to conduct the continuous assessment throughout the virtual and real experiences. It enables tracking of the individuals’ general and psychological status over time in several settings. The information collected during the assessment phase is constantly used to monitor individuals’ progress and to precisely calibrate their treatment sessions thanks to a decision support system. Finally, Interreality Paradigm uses advanced simulations (virtual experiences) to transform health guidelines and provision in meaningful and engaging experiences. A recently funded European project “INTERSTRESS – Interreality in the management and treatment of stress-related disorders” will offer the right context to test and tune these ideas.

Silvia Serino, Pietro Cipresso, Andrea Gaggioli, Giuseppe Riva

Utilizing Social Media, Mobile Devices and Sensors for Consumer Health Communication: A Framework for Categorizing Emerging Technologies and Techniques

While the advent of social media, ubiquitous Internet-connected mobile devices and widespread deployment of sensors are still relatively new phenomena, a rapid penetration of these technologies is being seen and their impact in relation to health-related communications is more recently also being considered. In relation to health in particular, these communications systems can also be considered to gain extended capabilities when used in conjunction with each other in relation to consumer health communication. In this paper we introduce a framework to categorize and analyze the emerging types of consumer health-related interactions and communications enabled by these technologies and consider how the techniques fit within this broader framework for the utilization of emerging communications technologies for applications to healthcare.

Robert Steele

EHR Ecosystem

This chapter outlines the challenges of providing accurate and timely health information as a way to improving patient outcomes and reducing costs. The last decades experience shows that computerization alone does not improve quality and safety. In order to achieve the expected effectiveness and a positive return on the investment, EHR should be transform in a clinical workflow management system with built in decision support system. These require adoption of business process management technologies that have to be aware of the detailed context of each individual patient.

There are many challenges which diminish the impact of information technology on healthcare, among them, the limited interoperability, technological barrier for most of the elderly people, security, privacy and trust issues. An overview of the methods and tools able to overcome those limitations are presented, including the use of standards for EHR architecture and communication, the progress in terminology and classification systems adoption and the ways to overcome the security threats.

Mircea Focsa, Gheorghe Ioan Mihalas

Acquisition and Analysis of Biomedical Signals in Case of Peoples Exposed to Electromagnetic Fields

In this paper we present studies on biological and health effects of electromagnetic fields emphasising the aspects related with measurement of the aggressing electromagnetic fields. A brief review of literature on electromagnetic environment is presented, together with some methods aiming to control and eliminate the electromagnetic interferences on medical instrumentation used in the acquisition of the biological signals (electroencephalography - EEG, electrocardiography - ECG). We performed analysis of electromagnetic fields in order to determine the induced current/field and the specific absorption rate in models of human body and also to correlate the exposure fields with some alterations of the biological signals acquired from a subject laid in various electromagnetic environments. The main goal of this research is to design a method for accurate identification and characterization of the aggressing electromagnetic fields on biological signals and human health.

V. David, A. Sǎlceanu, R. G. Ciorap

Modeling Dependability of IT Services Associated with Social and Economic Infrastructure Including Healthcare

Information technology (IT) services have been applied to mission critical businesses such as financial firms or telecommunication firms. And more applications are expected for IT supporting social and economic infrastructures, particularly those for healthcare in the future. However, defects in IT services will have greater negative impacts on social and economic activities in the future, since the risks of such defects are increasing due to their wider applications and the growth of IT systems’ complexity and scale. In this chapter, upon surveying the current state of affairs and seeing that little progress has been made towards understanding and reducing defects in IT services that influence social and economic activities, despite a number of efforts including upgrading software and hardware quality, we propose a new approach to understanding and managing the dependability of IT services by discussing a dependability model. The model consists of not only functions for legacy system dependability but also two types of functions (additional safety and safety operation). Next we evaluate the efficacy of these two types of functions relative to IT dependability, both qualitatively and quantitatively, by using 42 actual cases of IT accidents obtained by the Information technology Promotion Agency, Japan. Moreover, based on the verification, we examine the ways in which improvement of IT dependability associated with social and economic infrastructure, previously dependent on the skill of individual engineers, is eventually achieved as a result of organizational activities.

Hiroshi Ohtaka, Yoshiaki Fukazawa

Requirements and Barriers to Pervasive Health Adoption

An increasingly significant characteristic that has emerged through the use of eHealth applications is the rise in consumer empowerment. The latest advances in sensor technology, sensors implementation, improved wireless telecommunications capabilities, open networks, continued increases in computing power, improved battery technology, and the emergence of flexible software architecture has led to an increased accessibility to healthcare providers, more efficient tasks and processes, and a higher overall quality of healthcare services. Intelligent infrastructures have provided the layers for contextual information gathering, knowledge processing as well as adaptation and optimization mechanisms. Pervasive health monitoring and care (PHMC) would shift the paradigm of healthcare from the traditional reactive, event-driven model, to one were subjects proactively manage their health in a patient centered healthcare system. The objective of this work was to identify requirements and barriers to adoption of pervasive sensing and computing in healthcare. To do so, the authors systematically reviewed published works on health information technology, eHealth, and pervasive health care, since 2005. We found technological, financial, psychological, logistic and liability issues related with requirements and barriers to PHMC adoption. We identified as potential requirements related with adoption of PHMC: optimization of hardware and software for remote, unobtrusive health monitoring; better evaluation of the implemented systems; better coordination of the involved stakeholders; respect and improvement of existing standards for eHealth or new standards realization; collaboration and team work of all stakeholders that may benefits from pervasive health implementation; training in using new technology; training for searching library and information sciences related with health technology and information communication technology; training in thoughtfully analysis of added value associated with new health technology; promotion of healthier lifestyle using health information technology; analysis of social and organizational change process in order to design flexible, adaptive systems for health monitoring and care; adequate policy support for quality improvement of pervasive health systems; transparency with regard to the goal, business plan and process implementation of pervasive healthcare; consideration of patients’ perception as well as healthy individuals perception and patient-physician relationship as a core organizational operational system for PHMC; healthcare equity through improved data collection; education for technology literacy; and education for lifestyle management using new technologies. Barriers to implementation are associated with: financial constraints; privacy policy and related issues; poor transparency towards work plans and with regard to the implementation of health information technology; underestimation of complexity of the technological, clinical process and organizational problem; less or even lack of collaboration and team work of all stakeholders - patients, doctors, therapists, sociologists, engineers, computer technicians, etc.; fragmented or lack of responsibility in management of health information system implementation; low effective, persistent and consistent management of system implementation for more closely coordinated forms of health and social care provision; lack of quality audits of health information technology implementation in some healthcare systems; health professionals perception related mainly with less evidences on added value of some implemented eHealth approaches; aspect of culture associated with all stakeholders involved in health information communication technology. For the future it would be desirable to set up a comprehensive method that provides support in implementing PHMC taking into account quantitative measurements of variable identified in this work and potentially supplemented by others standardized surveys.

Gabriela Postolache, Pedro Silva Girão, Octavian Postolache


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