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Showing papers in "IEEE Journal of Biomedical and Health Informatics in 2016"


Journal ArticleDOI
TL;DR: A systematic review of current techniques for quantitative gait analysis is provided and key metrics for evaluating both existing and emerging methods for qualifying the gait features extracted from wearable sensors are proposed.
Abstract: After decades of evolution, measuring instruments for quantitative gait analysis have become an important clinical tool for assessing pathologies manifested by gait abnormalities. However, such instruments tend to be expensive and require expert operation and maintenance besides their high cost, thus limiting them to only a small number of specialized centers. Consequently, gait analysis in most clinics today still relies on observation-based assessment. Recent advances in wearable sensors, especially inertial body sensors, have opened up a promising future for gait analysis. Not only can these sensors be more easily adopted in clinical diagnosis and treatment procedures than their current counterparts, but they can also monitor gait continuously outside clinics – hence providing seamless patient analysis from clinics to free-living environments. The purpose of this paper is to provide a systematic review of current techniques for quantitative gait analysis and to propose key metrics for evaluating both existing and emerging methods for qualifying the gait features extracted from wearable sensors. It aims to highlight key advances in this rapidly evolving research field and outline potential future directions for both research and clinical applications.

293 citations


Journal ArticleDOI
TL;DR: In this article, the authors quantify a comprehensive range of gait characteristics measured using a single triaxial accelerometer-based monitor, and examine outcomes and monitor performance in measuring gait in older adults and those with Parkinson's disease.
Abstract: Measurement of gait is becoming important as a tool to identify disease and disease progression, yet to date its application is limited largely to specialist centers. Wearable devices enables gait to be measured in naturalistic environments, however questions remain regarding validity. Previous research suggests that when compared with a laboratory reference, measurement accuracy is acceptable for mean but not variability or asymmetry gait characteristics. Some fundamental reasons for this have been presented, (e.g., synchronization, different sampling frequencies) but to date this has not been systematically examined. The aims of this study were to: 1) quantify a comprehensive range of gait characteristics measured using a single triaxial accelerometer-based monitor; 2) examine outcomes and monitor performance in measuring gait in older adults and those with Parkinson's disease (PD); and 3) carry out a detailed comparison with those derived from an instrumented walkway to account for any discrepancies. Fourteen gait characteristics were quantified in 30 people with incident PD and 30 healthy age-matched controls. Of the 14 gait characteristics compared, agreement between instruments was excellent for four (ICCs 0.913–0.983); moderate for four (ICCs 0.508–0.766); and poor for six characteristics (ICCs 0.637–0.370). Further analysis revealed that differences reflect an increased sensitivity of accelerometry to detect motion, rather than measurement error. This is most likely because accelerometry measures gait as a continuous activity rather than discrete footfall events, per instrumented tools. The increased sensitivity shown for these characteristics will be of particular interest to researchers keen to interpret “real-world” gait data. In conclusion, use of a body-worn monitor is recommended for the measurement of gait but is likely to yield more sensitive data for asymmetry and variability features.

257 citations


Journal ArticleDOI
TL;DR: A new privacy- Preserving patient-centric clinical decision support system, which helps clinician complementary to diagnose the risk of patients' disease in a privacy-preserving way and can efficiently calculate patient's disease risk with high accuracy in a Privacy-Preserving way is proposed.
Abstract: Clinical decision support system, which uses advanced data mining techniques to help clinician make proper decisions, has received considerable attention recently. The advantages of clinical decision support system include not only improving diagnosis accuracy but also reducing diagnosis time. Specifically, with large amounts of clinical data generated everyday, naive Bayesian classification can be utilized to excavate valuable information to improve a clinical decision support system. Although the clinical decision support system is quite promising, the flourish of the system still faces many challenges including information security and privacy concerns. In this paper, we propose a new privacy-preserving patient-centric clinical decision support system, which helps clinician complementary to diagnose the risk of patients’ disease in a privacy-preserving way. In the proposed system, the past patients’ historical data are stored in cloud and can be used to train the naive Bayesian classifier without leaking any individual patient medical data, and then the trained classifier can be applied to compute the disease risk for new coming patients and also allow these patients to retrieve the top- $k$ disease names according to their own preferences. Specifically, to protect the privacy of past patients’ historical data, a new cryptographic tool called additive homomorphic proxy aggregation scheme is designed. Moreover, to leverage the leakage of naive Bayesian classifier, we introduce a privacy-preserving top- $k$ disease names retrieval protocol in our system. Detailed privacy analysis ensures that patient's information is private and will not be leaked out during the disease diagnosis phase. In addition, performance evaluation via extensive simulations also demonstrates that our system can efficiently calculate patient's disease risk with high accuracy in a privacy-preserving way.

210 citations


Journal ArticleDOI
TL;DR: A wearable system for recognizing ASL in real time is proposed, fusing information from an inertial sensor and sEMG sensors, and an information gain-based feature selection scheme is used to select the best subset of features from a broad range of well-established features.
Abstract: A sign language recognition system translates signs performed by deaf individuals into text/speech in real time. Inertial measurement unit and surface electromyography (sEMG) are both useful modalities to detect hand/arm gestures. They are able to capture signs and the fusion of these two complementary sensor modalities will enhance system performance. In this paper, a wearable system for recognizing American Sign Language (ASL) in real time is proposed, fusing information from an inertial sensor and sEMG sensors. An information gain-based feature selection scheme is used to select the best subset of features from a broad range of well-established features. Four popular classification algorithms are evaluated for 80 commonly used ASL signs on four subjects. The experimental results show 96.16% and 85.24% average accuracies for intra-subject and intra-subject cross session evaluation, respectively, with the selected feature subset and a support vector machine classifier. The significance of adding sEMG for ASL recognition is explored and the best channel of sEMG is highlighted.

196 citations


Journal ArticleDOI
TL;DR: Data from the smartphone's built-in accelerometer is used to detect behavior that correlates with subjects stress levels, and a maximum overall accuracy of 71% for user-specific models and an accuracy of 60% for the use of similar-users models are achieved, relying solely on data from a single accelerometer.
Abstract: Increase in workload across many organizations and consequent increase in occupational stress are negatively affecting the health of the workforce. Measuring stress and other human psychological dynamics is difficult due to subjective nature of selfreporting and variability between and within individuals. With the advent of smartphones, it is now possible to monitor diverse aspects of human behavior, including objectively measured behavior related to psychological state and consequently stress. We have used data from the smartphone's built-in accelerometer to detect behavior that correlates with subjects stress levels. Accelerometer sensor was chosen because it raises fewer privacy concerns (e.g., in comparison to location, video, or audio recording), and because its low-power consumption makes it suitable to be embedded in smaller wearable devices, such as fitness trackers. About 30 subjects from two different organizations were provided with smartphones. The study lasted for eight weeks and was conducted in real working environments, with no constraints whatsoever placed upon smartphone usage. The subjects reported their perceived stress levels three times during their working hours. Using combination of statistical models to classify selfreported stress levels, we achieved a maximum overall accuracy of 71% for user-specific models and an accuracy of 60% for the use of similar-users models, relying solely on data from a single accelerometer.

182 citations


Journal ArticleDOI
TL;DR: Results show that the proposed method can be used to design an accurate classification system for epilepsy diagnosis, and high accuracy rates were obtained.
Abstract: The study reported herein proposes a new method for the diagnosis of epilepsy from electroencephalography (EEG) signals based on complex classifiers. To carry out this study, first the features of EEG data are extracted using a dual-tree complex wavelet transformation at different levels of granularity to obtain size reduction. In subsequent phases, five features (based on statistical measurements maximum value, minimum value, arithmetic mean, standard deviation, median value) are obtained by using the feature vectors, and are presented as the input dimension to the complex-valued neural networks. The evaluation of the proposed method is conducted using the k -fold cross-validation methodology, reporting on classification accuracy, sensitivity, and specificity. The proposed method is tested using a benchmark EEG dataset, and high accuracy rates were obtained. The stated results show that the proposed method can be used to design an accurate classification system for epilepsy diagnosis.

171 citations


Journal ArticleDOI
TL;DR: A novel approach based on a deformable model is proposed to handle the segmentation of skin lesions in dermoscopic images and it is shown that the novel algorithm outperformed other state-of-the-art algorithms.
Abstract: Dermoscopy is an imaging technique that has been widely used in the diagnosis of skin lesions. However, its accuracy largely depends on the dermatologist's experience; thus, computer-aided diagnosis techniques are required. In this paper, a novel approach based on a deformable model is proposed to handle the segmentation of skin lesions in dermoscopic images. The RGB color space is converted so that the color information contained in the images can be used effectively to differentiate normal skin and skin lesions; and the differences in the color channels are combined together to define the speed function and the stopping criterion of the deformable model. This novel approach is robust against the noise, and provides an effective and flexible segmentation. Two image databases were used to test the performance of the novel approach and the segmentation results obtained were satisfactory. Quantitative analysis on 250 dermoscopic images showed that the novel algorithm outperformed other state-of-the-art algorithms. Also, using comparative data, the reliability and the implementation issues of the approach are discussed in this paper.

149 citations


Journal ArticleDOI
TL;DR: Quantitative as well as qualitative results show that the proposed methods could differentiate the bleeding areas from neighborhoods correctly, and provide an exciting performance for bleeding classification.
Abstract: Wireless capsule endoscopy (WCE) enables noninvasive and painless direct visual inspection of a patient's whole digestive tract, but at the price of long time reviewing large amount of images by clinicians. Thus, an automatic computer-aided technique to reduce the burden of physicians is highly demanded. In this paper, we propose a novel color feature extraction method to discriminate the bleeding frames from the normal ones, with further localization of the bleeding regions. Our proposal is based on a twofold system. First, we make full use of the color information of WCE images and utilize K -means clustering method on the pixel represented images to obtain the cluster centers, with which we characterize WCE images as words-based color histograms. Then, we judge the status of a WCE frame by applying the support vector machine (SVM) and K -nearest neighbor methods. Comprehensive experimental results reveal that the best classification performance is obtained with YCbCr color space, cluster number 80 and the SVM. The achieved classification performance reaches 95.75% in accuracy, 0.9771 for AUC, validating that the proposed scheme provides an exciting performance for bleeding classification. Second, we propose a two-stage saliency map extraction method to highlight bleeding regions, where the first-stage saliency map is created by means of different color channels mixer and the second-stage saliency map is obtained from the visual contrast. Followed by an appropriate fusion strategy and threshold, we localize the bleeding areas. Quantitative as well as qualitative results show that our methods could differentiate the bleeding areas from neighborhoods correctly.

141 citations


Journal ArticleDOI
TL;DR: This study investigates various functions to perform the training to obtain blood pressure and proposes training to specific posture and individual for further improving accuracy.
Abstract: Noninvasive continuous blood pressure (BP) monitoring is not yet practically available for daily use. Challenges include making the system easily wearable, reducing noise level and improving accuracy. Variations in each person's physical characteristics, as well as the possibility of different postures, increase the complexity of continuous BP monitoring, especially outside the hospital. This study attempts to provide an easily wearable solution and proposes training to specific posture and individual for further improving accuracy. The wrist watch-based system we developed can measure electrocardiogram and photoplethysmogram. From these two signals, we measure pulse transit time through which we can obtain systolic and diastolic blood pressure through regression techniques. In this study, we investigate various functions to perform the training to obtain blood pressure. We validate measurements on different postures and subjects, and show the value of training the device to each posture and each subject. We observed that the average RMSE between the measured actual systolic BP and calculated systolic BP is between 7.83 to 9.37 mmHg across 11 subjects. The corresponding range of error for diastolic BP is 5.77 to 6.90 mmHg. The system can also automatically detect the arm position of the user using an accelerometer with an average accuracy of 98%, to make sure that the sensor is kept at the proper height. This system, called BioWatch, can potentially be a unified solution for heart rate, SPO2 and continuous BP monitoring.

136 citations


Journal ArticleDOI
TL;DR: The preliminary efforts to achieve a submilliwatt system ultimately powered by the energy harvested from thermal radiation and motion of the body are described with the primary contributions being an ultralow-power ozone sensor, an volatile organic compounds sensor, spirometer, and the integration of these and other sensors in a multimodal sensing platform.
Abstract: We present our efforts toward enabling a wearable sensor system that allows for the correlation of individual environmental exposures with physiologic and subsequent adverse health responses. This system will permit a better understanding of the impact of increased ozone levels and other pollutants on chronic asthma conditions. We discuss the inefficiency of existing commercial off-the-shelf components to achieve continuous monitoring and our system-level and nano-enabled efforts toward improving the wearability and power consumption. Our system consists of a wristband, a chest patch, and a handheld spirometer. We describe our preliminary efforts to achieve a submilliwatt system ultimately powered by the energy harvested from thermal radiation and motion of the body with the primary contributions being an ultralow-power ozone sensor, an volatile organic compounds sensor, spirometer, and the integration of these and other sensors in a multimodal sensing platform. The measured environmental parameters include ambient ozone concentration, temperature, and relative humidity. Our array of sensors also assesses heart rate via photoplethysmography and electrocardiography, respiratory rate via photoplethysmography, skin impedance, three-axis acceleration, wheezing via a microphone, and expiratory airflow. The sensors on the wristband, chest patch, and spirometer consume 0.83, 0.96, and 0.01 mW, respectively. The data from each sensor are continually streamed to a peripheral data aggregation device and are subsequently transferred to a dedicated server for cloud storage. Future work includes reducing the power consumption of the system-on-chip including radio to reduce the entirety of each described system in the submilliwatt range.

131 citations


Journal ArticleDOI
TL;DR: Experimental results show that the proposed vessel segmentation method outperforms state-of-the-art algorithms reported in the recent literature, both visually and in terms of quantitative measurements.
Abstract: Accurate vessel detection in retinal images is an important and difficult task. Detection is made more challenging in pathological images with the presence of exudates and other abnormalities. In this paper, we present a new unsupervised vessel segmentation approach to address this problem. A novel inpainting filter, called neighborhood estimator before filling, is proposed to inpaint exudates in a way that nearby false positives are significantly reduced during vessel enhancement. Retinal vascular enhancement is achieved with a multiple-scale Hessian approach. Experimental results show that the proposed vessel segmentation method outperforms state-of-the-art algorithms reported in the recent literature, both visually and in terms of quantitative measurements, with overall mean accuracy of 95.62% on the STARE dataset and 95.81% on the HRF dataset.

Journal ArticleDOI
TL;DR: Joint analysis of respiration and HRV obtains a more reliable characterization of autonomic nervous response to stress, with the respiratory rate being higher and less stable during stress than during relax.
Abstract: Respiratory rate and heart rate variability (HRV) are studied as stress markers in a database of young healthy volunteers subjected to acute emotional stress, induced by a modification of the Trier Social Stress Test. First, instantaneous frequency domain HRV parameters are computed using time-frequency analysis in the classical bands. Then, the respiratory rate is estimated and this information is included in HRV analysis in two ways: 1) redefining the high-frequency (HF) band to be centered at respiratory frequency; 2) excluding from the analysis those instants where respiratory frequency falls within the low-frequency (LF) band. Classical frequency domain HRV indices scarcely show statistical differences during stress. However, when including respiratory frequency information in HRV analysis, the normalized LF power as well as the LF/HF ratio significantly increase during stress ( $p$ -value $ 0.05 according to the Wilcoxon test), revealing higher sympathetic dominance. The LF power increases during stress, only being significantly different in a stress anticipation stage, while the HF power decreases during stress, only being significantly different during the stress task demanding attention. Our results support that joint analysis of respiration and HRV obtains a more reliable characterization of autonomic nervous response to stress. In addition, the respiratory rate is observed to be higher and less stable during stress than during relax ( $p$ -value $ 0.05 according to the Wilcoxon test) being the most discriminative index for stress stratification (AUC = 88.2 $\%$ ).

Journal ArticleDOI
TL;DR: This review summarizes the key milestones in continuous BP measurement; that is, kymograph, intraarterial BP monitoring, arterial tonometry, volume clamp method, and cuffless BP technologies.
Abstract: The year 2016 marks the 200th birth anniversary of Carl Friedrich Wilhelm Ludwig (1816–1895). As one of the most remarkable scientists, Ludwig invented the kymograph, which for the first time enabled the recording of continuous blood pressure (BP), opening the door to the modern study of physiology. Almost a century later, intraarterial BP monitoring through an arterial line has been used clinically. Subsequently, arterial tonometry and volume clamp method were developed and applied in continuous BP measurement in a noninvasive way. In the last two decades, additional efforts have been made to transform the method of unobtrusive continuous BP monitoring without the use of a cuff. This review summarizes the key milestones in continuous BP measurement; that is, kymograph, intraarterial BP monitoring, arterial tonometry, volume clamp method, and cuffless BP technologies. Our emphasis is on recent studies of unobtrusive BP measurements as well as on challenges and future directions.

Journal ArticleDOI
TL;DR: Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements, this is the first elderly focused exergaming platform intensively evaluated with more than 100 participants.
Abstract: Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre–postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

Journal ArticleDOI
TL;DR: The actual benefits of smart home-based analysis by monitoring daily behavior in the home and predicting clinical scores of the residents are examined, suggesting that it is feasible to predict clinical scores using smart home sensor data and learning-based data analysis.
Abstract: Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behavior in the home and predicting clinical scores of the residents. To accomplish this goal, we propose a clinical assessment using activity behavior (CAAB) approach to model a smart home resident's daily behavior and predict the corresponding clinical scores. CAAB uses statistical features that describe characteristics of a resident's daily activity performance to train machine learning algorithms that predict the clinical scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from $18$ smart homes over two years. We obtain a statistically significant correlation ( $r=0.72$ ) between CAAB-predicted and clinician-provided cognitive scores and a statistically significant correlation ( $r=0.45$ ) between CAAB-predicted and clinician-provided mobility scores. These prediction results suggest that it is feasible to predict clinical scores using smart home sensor data and learning-based data analysis.

Journal ArticleDOI
Gang Wang1, Chaolin Teng1, Kuo Li1, Zhonglin Zhang1, Xiangguo Yan1 
TL;DR: By using independent component analysis (ICA) and multivariate empirical mode decomposition (MEMD), the ICA-based MEMD method was proposed to remove EOG artifacts (EOAs) from multichannel EEG signals and preserve useful EEG information with little loss.
Abstract: The recorded electroencephalography (EEG) signals are usually contaminated by electrooculography (EOG) artifacts. In this paper, by using independent component analysis (ICA) and multivariate empirical mode decomposition (MEMD), the ICA-based MEMD method was proposed to remove EOG artifacts (EOAs) from multichannel EEG signals. First, the EEG signals were decomposed by the MEMD into multiple multivariate intrinsic mode functions (MIMFs). The EOG-related components were then extracted by reconstructing the MIMFs corresponding to EOAs. After performing the ICA of EOG-related signals, the EOG-linked independent components were distinguished and rejected. Finally, the clean EEG signals were reconstructed by implementing the inverse transform of ICA and MEMD. The results of simulated and real data suggested that the proposed method could successfully eliminate EOAs from EEG signals and preserve useful EEG information with little loss. By comparing with other existing techniques, the proposed method achieved much improvement in terms of the increase of signal-to-noise and the decrease of mean square error after removing EOAs.

Journal ArticleDOI
TL;DR: A novel meal-detection algorithm based on continuous glucose measurements that is used to administer insulin boluses and prevent most of postprandial hyperglycemia without any manual meal announcements is developed.
Abstract: A novel meal-detection algorithm is developed based on continuous glucose measurements. Bergman's minimal model is modified and used in an unscented Kalman filter for state estimations. The estimated rate of appearance of glucose is used for meal detection. Data from nine subjects are used to assess the performance of the algorithm. The results indicate that the proposed algorithm works successfully with high accuracy. The average change in glucose levels between the meals and the detection points is 16( $\bm{\pm}$ 9.42) ${[\rm mg/dl]}$ for 61 successfully detected meals and snacks. The algorithm is developed as a new module of an integrated multivariable adaptive artificial pancreas control system. Meal detection with the proposed method is used to administer insulin boluses and prevent most of postprandial hyperglycemia without any manual meal announcements. A novel meal bolus calculation method is proposed and tested with the UVA/Padova simulator. The results indicate significant reduction in hyperglycemia.

Journal ArticleDOI
TL;DR: The experimental results confirm the discriminative ability and the efficiency of the proposed LBDP for biomedical image indexing and retrieval and prove the outperformance of existing biomedical image retrieval approaches.
Abstract: A novel image feature descriptor based on the local bit-plane decoded pattern (LBDP) is introduced for indexing and retrieval of biomedical images in this paper. A local bit-plane transformation scheme is proposed to compute the local bit-plane transformed values for each image pixel from the bit-plane binary contents of its each neighboring pixels. The introduced LBDP is generated by finding a binary pattern using the difference of center pixel's intensity value with the local bit-plane transformed values. The efficacy of the LBDP is tested under biomedical image retrieval using average retrieval precision and average retrieval rate. Three benchmark databases Emphysema-CT, NEMA-CT, and Open Access Series of Imaging Studies magnetic resonance imaging are used for the evaluation and comparison of the proposed approach with recent state-of-art methods. The experimental results confirm the discriminative ability and the efficiency of the proposed LBDP for biomedical image indexing and retrieval and prove the outperformance of existing biomedical image retrieval approaches.

Journal ArticleDOI
TL;DR: A novel classification-based optic disc segmentation algorithm that detects the OD boundary and the location of vessel origin (VO) pixel and can be used for automated detection of retinal pathologies, such as glaucoma, diabetic retinopathy, and maculopathy is presented.
Abstract: This paper presents a novel classification-based optic disc (OD) segmentation algorithm that detects the OD boundary and the location of vessel origin (VO) pixel. First, the green plane of each fundus image is resized and morphologically reconstructed using a circular structuring element. Bright regions are then extracted from the morphologically reconstructed image that lie in close vicinity of the major blood vessels. Next, the bright regions are classified as bright probable OD regions and non-OD regions using six region-based features and a Gaussian mixture model classifier. The classified bright probable OD region with maximum Vessel-Sum and Solidity is detected as the best candidate region for the OD. Other bright probable OD regions within 1-disc diameter from the centroid of the best candidate OD region are then detected as remaining candidate regions for the OD. A convex hull containing all the candidate OD regions is then estimated, and a best-fit ellipse across the convex hull becomes the segmented OD boundary. Finally, the centroid of major blood vessels within the segmented OD boundary is detected as the VO pixel location. The proposed algorithm has low computation time complexity and it is robust to variations in image illumination, imaging angles, and retinal abnormalities. This algorithm achieves 98.8%–100% OD segmentation success and OD segmentation overlap score in the range of 72%–84% on images from the six public datasets of DRIVE, DIARETDB1, DIARETDB0, CHASE_DB1, MESSIDOR, and STARE in less than 2.14 s per image. Thus, the proposed algorithm can be used for automated detection of retinal pathologies, such as glaucoma, diabetic retinopathy, and maculopathy.

Journal ArticleDOI
TL;DR: The development of the exercise system, the results of the recent field pilot study with six independently living elderly individuals, and the lessons learned relating to the in-home system setup, user tracking, feedback, and exercise performance evaluation are highlighted.
Abstract: Although the positive effects of exercise on the well-being and quality of independent living for older adults are well accepted, many elderly individuals lack access to exercise facilities, or the skills and motivation to perform exercise at home. To provide a more engaging environment that promotes physical activity, various fitness applications have been proposed. Many of the available products, however, are geared toward a younger population and are not appropriate or engaging for an older population. To address these issues, we developed an automated interactive exercise coaching system using the Microsoft Kinect. The coaching system guides users through a series of video exercises, tracks and measures their movements, provides real-time feedback, and records their performance over time. Our system consists of exercises to improve balance, flexibility, strength, and endurance, with the aim of reducing fall risk and improving performance of daily activities. In this paper, we report on the development of the exercise system, discuss the results of our recent field pilot study with six independently living elderly individuals, and highlight the lessons learned relating to the in-home system setup, user tracking, feedback, and exercise performance evaluation.

Journal ArticleDOI
TL;DR: Although the presence of HW demonstrated the strongest association with type 2 diabetes, the predictive power of the combined measurements of the actual WC and TG values may not be the best manner of predicting type 1 diabetes.
Abstract: The hypertriglyceridemic waist (HW) phenotype is strongly associated with type 2 diabetes; however, to date, no study has assessed the predictive power of phenotypes based on individual anthropometric measurements and triglyceride (TG) levels. The aims of the present study were to assess the association between the HW phenotype and type 2 diabetes in Korean adults and to evaluate the predictive power of various phenotypes consisting of combinations of individual anthropometric measurements and TG levels. Between November 2006 and August 2013, 11 937 subjects participated in this retrospective cross-sectional study. We measured fasting plasma glucose and TG levels and performed anthropometric measurements. We employed binary logistic regression (LR) to examine statistically significant differences between normal subjects and those with type 2 diabetes using HW and individual anthropometric measurements. For more reliable prediction results, two machine learning algorithms, naive Bayes (NB) and LR, were used to evaluate the predictive power of various phenotypes. All prediction experiments were performed using a tenfold cross validation method. Among all of the variables, the presence of HW was most strongly associated with type 2 diabetes ( $p , adjusted odds ratio (OR) = 2.07 [95% CI, 1.72–2.49] in men; $p , adjusted OR = 2.09 [1.79–2.45] in women). When comparing waist circumference (WC) and TG levels as components of the HW phenotype, the association between WC and type 2 diabetes was greater than the association between TG and type 2 diabetes. The phenotypes tended to have higher predictive power in women than in men. Among the phenotypes, the best predictors of type 2 diabetes were waist-to-hip ratio + TG in men (AUC by NB = 0.653, AUC by LR = 0.661) and rib-to-hip ratio + TG in women (AUC by NB = 0.73, AUC by LR = 0.735). Although the presence of HW demonstrated the strongest association with type 2 diabetes, the predictive power of the combined measurements of the actual WC and TG values may not be the best manner of predicting type 2 diabetes. Our findings may provide clinical information concerning the development of clinical decision support systems for the initial screening of type 2 diabetes.

Journal ArticleDOI
TL;DR: An adaptive load control algorithm is proposed for ZigBee-based WBAN/WiFi coexistence environments, with the aim of guaranteeing that the delay experienced by ZigBee sensors does not exceed a maximally tolerable period of time.
Abstract: The development of telemonitoring via wireless body area networks (WBANs) is an evolving direction in personalized medicine and home-based mobile health. A WBAN consists of small, intelligent medical sensors which collect physiological parameters such as electrocardiogram, electroencephalography, and blood pressure. The recorded physiological signals are sent to a coordinator via wireless technologies, and are then transmitted to a healthcare monitoring center. One of the most widely used wireless technologies in WBANs is ZigBee because it is targeted at applications that require a low data rate and long battery life. However, ZigBee-based WBANs face severe interference problems in the presence of WiFi networks. This problem is caused by the fact that most ZigBee channels overlap with WiFi channels, severely affecting the ability of healthcare monitoring systems to guarantee reliable delivery of physiological signals. To solve this problem, we have developed an algorithm that controls the load in WiFi networks to guarantee the delay requirement for physiological signals, especially for emergency messages, in environments with coexistence of ZigBee-based WBAN and WiFi. Since WiFi applications generate traffic with different delay requirements, we focus only on WiFi traffic that does not have stringent timing requirements. In this paper, therefore, we propose an adaptive load control algorithm for ZigBee-based WBAN/WiFi coexistence environments, with the aim of guaranteeing that the delay experienced by ZigBee sensors does not exceed a maximally tolerable period of time. Simulation results show that our proposed algorithm guarantees the delay performance of ZigBee-based WBANs by mitigating the effects of WiFi interference in various scenarios.

Journal ArticleDOI
TL;DR: This paper employs a graph-based query-specific fusion approach where multiple retrieval results are integrated and reordered based on a fused graph, capable of combining the strengths of local or holistic features adaptively for different inputs.
Abstract: In the analysis of histopathological images, both holistic (e.g., architecture features) and local appearance features demonstrate excellent performance, while their accuracy may vary dramatically when providing different inputs. This motivates us to investigate how to fuse results from these features to enhance the accuracy. Particularly, we employ content-based image retrieval approaches to discover morphologically relevant images for image-guided diagnosis, using holistic and local features, both of which are generated from the cell detection results by a stacked sparse autoencoder. Because of the dramatically different characteristics and representations of these heterogeneous features (i.e., holistic and local), their results may not agree with each other, causing difficulties for traditional fusion methods. In this paper, we employ a graph-based query-specific fusion approach where multiple retrieval results (i.e., rank lists) are integrated and reordered based on a fused graph. The proposed method is capable of combining the strengths of local or holistic features adaptively for different inputs. We evaluate our method on a challenging clinical problem, i.e., histopathological image-guided diagnosis of intraductal breast lesions, and it achieves $91.67\%$ classification accuracy on $120$ breast tissue images from $40$ patients.

Journal ArticleDOI
TL;DR: This paper provides a comprehensive overview of the current state of the art in endoscopic image stitching and surface reconstruction, and examines the technological maturity of the methods and current challenges and trends.
Abstract: Endoscopic procedures form part of routine clinical practice for minimally invasive examinations and interventions. While they are beneficial for the patient, reducing surgical trauma and making convalescence times shorter, they make orientation and manipulation more challenging for the physician, due to the limited field of view through the endoscope. However, this drawback can be reduced by means of medical image processing and computer vision, using image stitching and surface reconstruction methods to expand the field of view. This paper provides a comprehensive overview of the current state of the art in endoscopic image stitching and surface reconstruction. The literature in the relevant fields of application and algorithmic approaches is surveyed. The technological maturity of the methods and current challenges and trends are analyzed.

Journal ArticleDOI
TL;DR: It is shown that respiratory rates from the nasal sound can be accurately estimated even if a smartphone's microphone is as far as 30 cm away from the nose, and that tracheal breath sounds recorded by the built-in microphone of a smartphone placed on the paralaryngeal space can be used to estimate different respiratory rates.
Abstract: This paper proposes accurate respiratory rate estimation using nasal breath sound recordings from a smartphone. Specifically, the proposed method detects nasal airflow using a built-in smartphone microphone or a headset microphone placed underneath the nose. In addition, we also examined if tracheal breath sounds recorded by the built-in microphone of a smartphone placed on the paralaryngeal space can also be used to estimate different respiratory rates ranging from as low as 6 breaths/min to as high as 90 breaths/min. The true breathing rates were measured using inductance plethysmography bands placed around the chest and the abdomen of the subject. Inspiration and expiration were detected by averaging the power of nasal breath sounds. We investigated the suitability of using the smartphone-acquired breath sounds for respiratory rate estimation using two different spectral analyses of the sound envelope signals: The Welch periodogram and the autoregressive spectrum. To evaluate the performance of the proposed methods, data were collected from ten healthy subjects. For the breathing range studied (6–90 breaths/min), experimental results showed that our approach achieves an excellent performance accuracy for the nasal sound as the median errors were less than 1% for all breathing ranges. The tracheal sound, however, resulted in poor estimates of the respiratory rates using either spectral method. For both nasal and tracheal sounds, significant estimation outliers resulted for high breathing rates when subjects had nasal congestion, which often resulted in the doubling of the respiratory rates. Finally, we show that respiratory rates from the nasal sound can be accurately estimated even if a smartphone's microphone is as far as 30 cm away from the nose.

Journal ArticleDOI
TL;DR: This paper presents an automatic food classification method, DietCam, which specifically addresses the variation of food appearances, and presents reliability and outperformance in recognition of food with complex ingredients on a database including 15,262 food images of 55 food types.
Abstract: Food recognition is a key component in evaluation of everyday food intakes, and its challenge is due to intraclass variation. In this paper, we present an automatic food classification method, DietCam, which specifically addresses the variation of food appearances. DietCam consists of two major components, ingredient detection and food classification. Food ingredients are detected through a combination of a deformable part-based model and a texture verification model. From the detected ingredients, food categories are classified using a multiview multikernel SVM. In the experiment, DietCam presents reliability and outperformance in recognition of food with complex ingredients on a database including 15,262 food images of 55 food types.

Journal ArticleDOI
TL;DR: The EEG features responsible for the detection of seizures from nonseizure epochs have been found to be easily distinguishable after artifacts are removed, and consequently, the false alarms in seizure detection are reduced.
Abstract: This paper presents a method to reduce artifacts from scalp EEG recordings to facilitate seizure diagnosis/detection for epilepsy patients. The proposed method is primarily based on stationary wavelet transform and takes the spectral band of seizure activities (i.e., 0.5–29 Hz) into account to separate artifacts from seizures. Different artifact templates have been simulated to mimic the most commonly appeared artifacts in real EEG recordings. The algorithm is applied on three sets of synthesized data including fully simulated, semi-simulated, and real data to evaluate both the artifact removal performance and seizure detection performance. The EEG features responsible for the detection of seizures from nonseizure epochs have been found to be easily distinguishable after artifacts are removed, and consequently, the false alarms in seizure detection are reduced. Results from an extensive experiment with these datasets prove the efficacy of the proposed algorithm, which makes it possible to use it for artifact removal in epilepsy diagnosis as well as other applications regarding neuroscience studies.

Journal ArticleDOI
TL;DR: An automated fall detection system based on smartphone audio features is developed and the best performance is achieved using spectrogram features with ANN classifier with sensitivity, specificity, and accuracy all above 98%.
Abstract: An automated fall detection system based on smartphone audio features is developed. The spectrogram, mel frequency cepstral coefficents (MFCCs), linear predictive coding (LPC), and matching pursuit (MP) features of different fall and no-fall sound events are extracted from experimental data. Based on the extracted audio features, four different machine learning classifiers: k -nearest neighbor classifier ( k -NN), support vector machine (SVM), least squares method (LSM), and artificial neural network (ANN) are investigated for distinguishing between fall and no-fall events. For each audio feature, the performance of each classifier in terms of sensitivity, specificity, accuracy, and computational complexity is evaluated. The best performance is achieved using spectrogram features with ANN classifier with sensitivity, specificity, and accuracy all above $98\%$ . The classifier also has acceptable computational requirement for training and testing. The system is applicable in home environments where the phone is placed in the vicinity of the user.

Journal ArticleDOI
TL;DR: Novel acellular and atypical cell concentration features computed from vertical segment partitions of the epithelium region within digitized histology images to quantize the relative increase in nuclei numbers as the CIN grade increases are introduced.
Abstract: Cervical cancer, which has been affecting women worldwide as the second most common cancer, can be cured if detected early and treated well. Routinely, expert pathologists visually examine histology slides for cervix tissue abnormality assessment. In previous research, we investigated an automated, localized, fusion-based approach for classifying squamous epithelium into Normal, CIN1, CIN2, and CIN3 grades of cervical intraepithelial neoplasia (CIN) based on image analysis of 61 digitized histology images. This paper introduces novel acellular and atypical cell concentration features computed from vertical segment partitions of the epithelium region within digitized histology images to quantize the relative increase in nuclei numbers as the CIN grade increases. Based on the CIN grade assessments from two expert pathologists, image-based epithelium classification is investigated with voting fusion of vertical segments using support vector machine and linear discriminant analysis approaches. Leave-one-out is used for the training and testing for CIN classification, achieving an exact grade labeling accuracy as high as 88.5%.

Journal ArticleDOI
TL;DR: Qualitative evaluation of the reconstructed EEG signals demonstrates that the proposed automatic algorithm can effectively enhance the signal quality, especially the quality of ERPs, even for those that barely display ERPs in the raw EEG.
Abstract: Electroencephalography (EEG) is the recording of electrical activity produced by the firing of neurons within the brain. These activities can be decoded by signal processing techniques. However, EEG recordings are always contaminated with artifacts which hinder the decoding process. Therefore, identifying and removing artifacts is an important step. Researchers often clean EEG recordings with assistance from independent component analysis (ICA), since it can decompose EEG recordings into a number of artifact-related and event-related potential (ERP)-related independent components. However, existing ICA-based artifact identification strategies mostly restrict themselves to a subset of artifacts, e.g., identifying eye movement artifacts only, and have not been shown to reliably identify artifacts caused by nonbiological origins like high-impedance electrodes. In this paper, we propose an automatic algorithm for the identification of general artifacts. The proposed algorithm consists of two parts: 1) an event-related feature-based clustering algorithm used to identify artifacts which have physiological origins; and 2) the electrode-scalp impedance information employed for identifying nonbiological artifacts. The results on EEG data collected from ten subjects show that our algorithm can effectively detect, separate, and remove both physiological and nonbiological artifacts. Qualitative evaluation of the reconstructed EEG signals demonstrates that our proposed method can effectively enhance the signal quality, especially the quality of ERPs, even for those that barely display ERPs in the raw EEG. The performance results also show that our proposed method can effectively identify artifacts and subsequently enhance the classification accuracies compared to four commonly used automatic artifact removal methods.