SMART BEAR: A large scale pilot supporting the independent living of the seniors in a smart environment.

SMART BEAR is a multinational European research project implementing an innovative, secure and privacy-preserving platform with market available wearable and medical devices, along with smart home sensors. The solution will target the elderly population who suffer from Hearing Loss, Cardio Vascular Diseases, Cognitive Impairments, Mental Health Issues and Balance Disorders. The platform will be tested and validated in five large scale pilots, in six different countries and 5100 individuals, providing evidenced-based interventions on lifestyle, medical significant risk factors, and chronic disease management. The present work demonstrates the initial requirements collection and analysis, along with the architecture and the Decision Support System, which will provide the evidence on the recommendations to the individuals.

HOLOBALANCE: An Augmented Reality virtual trainer solution forbalance training and fall prevention.

Balance disorders affect a large number of older people, leading to falls. To promote independence, self-care and the quality of living of the long-lived population, an innovative solution is devoped to act as a virtual trainer for people that suffer from vestibular dysfunction related balance disorders. Our solution offers a virtual balance therapy, supported by Information and Communication Technology devices, to monitor user's activity during the day and provide real time feedback for the correct execution of physiotherapy exercises. Wearable sensors are utilized to monitor user activity, while during the execution of exercises, cameras are used to track the body of the user. An Augmented Reality headset is used to project the virtual trainer's 3D avatar in front of the user, providing real time guidance for the correct execution of the exercises.

Classification algorithms for microcalcifications in mammograms (Review).

Early detection is the key to improve breast cancer prognosis. The only proven effective method of breast cancer early detection is mammography. An early sign of 30-50% of breast cancer is the appearance of clusters of fine, granular microcalcifications and 60-80% of breast carcinomas reveal microcalcification clusters upon histological examination. The high correlation between the appearance of the microcalcification clusters and diseases, proves that computer aided diagnosis (CAD) systems for automated classification of microcalcification clusters will be very useful and helpful for breast cancer control. The fuzzy nature of microcalcification, the low contrast and the low ability of distinguishing them from their surroundings make automated characterization of them extremely difficult. In this study, we give an overview of the currently available literature on characterization of malignant and benign microcalcifications. We compare and evaluate some of the classification algorithms on microcalcifications in mammograms used in various CAD systems, which are separated into categories according to the method in use. Neural networks are used in applications where only a few decisions are required concerning an amount of data. The k-nearest neighbour classifier distinguishes unknown patterns based on the similarity to known samples and the decision tree approach is much simpler than neural networks and does not need extensive knowledge of the probability distribution of the features.

Secure and efficient health data management through multiple watermarking on medical images.

The landscape of healthcare delivery and medical data management has significantly changed over the last years, as a result of the significant advancements in information and communication technologies. Complementary and/or alternative solutions are needed to meet the new challenges, especially regarding security of the widely distributed sensitive medical information. Digital watermarking is a recently established research area with many applications; nevertheless, the potential of this technology to contribute value-added services to medical information management systems has only recently started to be realized by the research community. The paper presents a review of research efforts in the area of medical-oriented watermarking and proposes a wavelet-based multiple watermarking scheme; this scheme aims to address critical health information management issues, including origin and data authentication, protection of sensitive data, and image archiving and retrieval. In accordance with the strict limitations applying to medical images, the scheme allows the definition of a region of interest (ROI) whose diagnostic value is protected, since the only additional information embedded therein aims at integrity control. The robustness of the method is enhanced through a form of hybrid coding, which includes repetitive embedding of BCH encoded watermarks. The experimental results on different medical imaging modalities demonstrate the efficiency and transparency of the watermarking scheme.

Advanced image fusion algorithms for Gamma Knife treatment planning. Evaluation and proposal for clinical use.

Image fusion is a process of combining information from multiple sensors. It is a useful tool implemented in the treatment planning programme of Gamma Knife Radiosurgery. In this paper we evaluate advanced image fusion algorithms for Matlab platform and head images. We develop nine level grayscale image fusion methods: average, principal component analysis (PCA), discrete wavelet transform (DWT) and Laplacian, filter - subtract - decimate (FSD), contrast, gradient, morphological pyramid and a shift invariant discrete wavelet transform (SIDWT) method in Matlab platform. We test these methods qualitatively and quantitatively. The quantitative criteria we use are the Root Mean Square Error (RMSE), the Mutual Information (MI), the Standard Deviation (STD), the Entropy (H), the Difference Entropy (DH) and the Cross Entropy (CEN). The qualitative are: natural appearance, brilliance contrast, presence of complementary features and enhancement of common features. Finally we make clinically useful suggestions.

Mining balance disorders' data for the development of diagnostic decision support systems.

In this work we present the methodology for the development of the EMBalance diagnostic Decision Support System (DSS) for balance disorders. Medical data from patients with balance disorders have been analysed using data mining techniques for the development of the diagnostic DSS. The proposed methodology uses various data, ranging from demographic characteristics to clinical examination, auditory and vestibular tests, in order to provide an accurate diagnosis. The system aims to provide decision support for general practitioners (GPs) and experts in the diagnosis of balance disorders as well as to provide recommendations for the appropriate information and data to be requested at each step of the diagnostic process. Detailed results are provided for the diagnosis of 12 balance disorders, both for GPs and experts. Overall, the reported accuracy ranges from 59.3 to 89.8% for GPs and from 74.3 to 92.1% for experts.

Thermal transitions of red blood cell deformability. Correlation with membrane rheological properties.

Red blood cell deformability has been studied by the initial filtration flow rate as a function of temperature. The well-known transition at 49-50 degrees C (probably due to spectrin denaturation) is shown. Another transition is demonstrated around 18 degrees C (the cell becomes stiffer below this temperature range). The erythrocyte membranes prepared by a mild dialysis technique have the same deformability as intact erythrocytes at room temperature; they also show the same low-temperature transition. No such transition has been found for hemoglobin solutions of viscosity 30 g X dl-1. It is interesting to compare these results with those obtained by other methods which measure the properties of natural or artificial lipid membranes and which also demonstrate a thermal transition at 15-20 degrees C. Therefore, the deformability of intact normal erythrocytes seems to depend mainly on the rheological properties of the membrane.

An integrated computer supported acquisition, handling, and characterization system for pigmented skin lesions in dermatological images.

This paper describes an integrated prototype computer-based system for the characterization of skin digital images. The first stage includes an image acquisition arrangement designed for capturing skin images, under reproducible conditions. The system processes the captured images and performs unsupervised image segmentation and image registration utilizing an efficient algorithm based on the log-polar transform of the images' Fourier spectrum. Border- and color-based features, extracted from the digital images of skin lesions, were used to construct a classification module for the recognition of malignant melanoma versus dysplastic nevus. Different methods, drawn from the fields of artificial intelligence (neural networks) and statistical modeling (discriminant analysis), were used in order to find the best classification rules and to compare the results of different approaches to the problem.

Monitoring of compliance on an individual treatment through mobile innovations.

The present work examines the potential of smartphone usage for offering health services to elderly patients. The purpose of this work is the design, development, and implementation of a telemedicine application. This application aims to improve the monitoring mode and increase patient adherence to the instructions assigned by the medical staff. It consists of three parts: the doctor's application (Web Application), the patient's application (Android Application) and the Web Server of the platform, where the database is stored necessary for the smooth operation of the platform. Also the Web Server hosts the doctor's Web Application. The Web Application is based on web front-end technologies, providing the medical personnel with a variety of features and useful actions. These actions and capabilities are mainly relevant to the assignment of instructions to patients and the monitoring of their health progress. The Android Application has been implemented and validated for the Android-based mobile devices operating system and consists of a handy and user-friendly environment, equipped with the right tools so that the patient has the ability to update the system on the progress of his/her health by storing the appropriate measurements. Both applications also provide customization capabilities in regards to the patients' and doctors' profile.

Erythrocyte deformability in diabetes and erythrocyte membrane lipid composition.

Erythrocyte deformability was assessed in 40 diabetic patients, 24 insulin-dependent (IDD) and 16 non-insulin-dependent (NIDD), by measuring the initial filtration flow rate of whole blood, isolated red blood cells (RBC), and isolated RBC membranes with the Hanss hemorheometer, and its relationship to the plasma and ghost membrane lipid composition was investigated. RBC deformability was significantly reduced, whereas the deformability of the isolated RBC membranes did not differ significantly from the controls. In the plasma, the triglycerides were high, the high-density lipoprotein (HDL) cholesterol was reduced, and the ratio of total cholesterol over HDL cholesterol was high as compared with the controls. The RBC lipid composition expressed in mumol lipids/10(10) RBC showed significantly lower levels of free cholesterol, sphingomyelines, and phosphatidylcholine, which are the lipids principally located on the outer layer of the RBC membranes. These data suggest that in both IDD and NIDD patients, there may be a relation between these modifications in the RBC lipid composition and rheological impairment of the RBC.

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support.

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.

Interoperability among healthcare organizations acting as certification authorities.

One of the main problems in public key infrastructures (PKI) is currently the lack of interoperability at international level, which is greatly dependent on the automation of the cross-certification procedure using certificate policies (CP). This paper addresses the aforementioned need by presenting a method for the automated development and comparison of CPs, with main emphasis on healthcare environments. The basic elements of this method include standardization of the CP content for healthcare, a prototype decision-making algorithm for CPs comparison, representation of CPs in extensible markup language, as well as a JAVA-based CP comparison tool. The final aim of the paper is to contribute toward the technical implementation of an on-line automated cross-certification service, yielding PKI interoperability and promoting information exchange between healthcare establishments.

A novel emergency telemedicine system based on wireless communication technology--AMBULANCE.

Recent studies conclude that early and specialized prehospital management contributes to emergency case survival. We have developed a portable medical device that allows telediagnosis, long distance support, and teleconsultation of mobile healthcare providers by expert physicians. The device allows the transmission of vital biosignals and still images of the patient from the emergency site to the consultation site using the GSM mobile telephony network. The device can telematically "bring" an expert specialist doctor at the site of the medical emergency, allow him/her to evaluate patient data, and issue directions to the emergency personnel on treatment procedures until the patient is brought to be hospital. Legal reasons mandated the inclusion at the consultation site of a multimedia database able to store and manage the data collected by the system. The performance of the system has been validated in four different countries using a controlled medical protocol and a set of 100 patients per country treated has been collected and analyzed.

Simulated generation of evoked potentials components using networks with distinct excitatory and inhibitory neurons.

Long latency evoked potentials (EP's) are electrical potentials related to brain information processing mechanisms. In this paper, three-layered neurophysiologically based artificial neural network model is presented whose neurons obey to Dale's law. The first two layers of the network can memorize and recall sparsely coded patterns, oscillating at biologically plausible frequencies. Excitatory low-pass filtering synapses, from the second to the third layer, create evoked current dipoles, when the network retrieves memories related to stimuli. Based on psychophysiological indications, simulated intracranial dipoles are straightforwardly transformed into long latency EP components such as N100 and P300 that match laboratory-measured scalp EP's.

CT-based software for 3-D localization and reconstruction in stepping source brachytherapy.

This paper describes innovative software for catheter localization and three-dimensional (3-D) reconstruction in stepping source brachytherapy applications. Patient information is a set of computed tomography (CT) slices scanned during the implantation of brachytherapy catheters. Catheter geometry and patient anatomy are exported for use with dose calculation software modules. The errors produced by the system are also encouragingly low. Time saving was achieved, in terms of other traditional reconstruction techniques. Various automated procedures, 3-D graphics and a user-friendly GUI, have contributed to providing a powerful, comprehensive software tool, directly useable in the clinical practice.

Determination of erythrocytes transit times through a 5 mu "nuclepore" filter.

Filtration experiments through 5 or 3 mu Nuclepore membranes are often performed in order to assess the so-called erythrocyte deformability. The relation between this parameter and the RBC filterability is not straightforward. A simple theoretical treatment relating filtration index (as determined by the initial flow rate method) to the average RBC flow resistance through an average pore is presented. In order to deduce the average RBC transit time through the membrane from the initial flow rate data, the suspension hematocrit change after filtration has been determined. The calculated average transit time is comparable to experimental values, as determined by KIESEWETTER et al. with the single pore technique.

Physico-chemical factors of erythrocyte deformability.

The aim of this study is to assess the role of different physico-chemical factors on the deformability measurements by using the initial filtration flow rate method, and to differentiate between the membrane or internal origin of some rigidity changes. The deformability is maximum for the physiological pH value and it decreases sharply for hypotonic and hypertonic buffer. For normal RBC, the deformability is independent of the pO2 level and a small decrease is observed for increasing pCO2 values (with constant pH). A theoretical model of filtration for the "Hemorheometre" will be also developed.

Determination of erythrocyte transit times through micropores. II-- Influence of experimental and physicochemical factors.

A new red blood cell filtration system, termed the Cell Transit Time Analyzer (CTTA), has been developed in order to measure the individual transit times of a large number of cells through cylindrical micropores in special "oligopore" filters: the system operates on the electrical conductometric principle and employs special computer software to provide several measures of the resulting transit time histogram. Using this system with filters having pore diameters of 4.5 or 5.0 cm and length to diameter ratios of 3.0 to 4.7, we have evaluated the effects of several experimental factors on the flow behavior of normal and modified human RBC. Our results indicate : 1) linear PBC pressure - flow behavior over a driving pressure range of 2 to 10.5 cm H2O with zero velocity intercepts at delta P = 0, thus suggesting the Poiseuille - like nature of the flow; 2) resistance to flow or "apparent viscosities" for normal RBC which are between 3.1 to 3.9 cPoise and are independent of driving pressure and pore geometry; 3) increased flow resistance (i.e., increased transit times) for old versus young RBC and for RBC made less deformable by DNP-induced crenation or by heat treatment at 48 degrees C; 4) increased mean transit time and poorer reproducibility when using EDTA rather than heparin as the anticoagulant agent. Further, using mixtures of heat-treated and normal RBC and various percentile values of the transit time histogram. We have been able to demonstrate the presence of sub-populations of rigid cells and thus the value of measurements which allow statistical analyses of RBC populations.

Determination of erythrocyte transit times through micropores. II. Influence of experimental and physicochemical factors.

A new red blood cell filtration system, termed the Cell Transit Time Analyzer (CTTA), has been developed in order to measure the individual transit times of a large number of cells through cylindrical micropores in special "oligopore" filters; the system operates on the electrical conductometric principle and employs special computer software to provide several measures of the resulting transit time histogram. Using this system with filters having pore diameters of 4.5 or 5.0 microns and length to diameter ratios of 3.0 to 4.7, we have evaluated the effects of several experimental factors on the flow behavior of normal and modified human RBC. Our results indicate: 1) linear RBC pressure-flow behavior over a driving pressure range of 2 to 10.5 cm H2O with zero velocity intercepts at delta P = 0, thus suggesting the Poiseuille-like nature of the flow; 2) resistance to flow or "apparent viscosities" for normal RBC which are between 3.1 to 3.9 cPoise and are independent of driving pressure and pore geometry; 3) increased flow resistance (i.e., increased transit times) for old versus young RBC and for RBC made less deformable by DNP-induced crenation or by heat treatment at 48 degrees C; 4) increased mean transit time and poorer reproducibility when using EDTA rather than heparin as the anticoagulant agent. Further, using mixtures of heat-treated and normal RBC and various percentile values of the transit time histogram, we have been able to demonstrate the presence of sub-populations of rigid cells and thus the value of measurements which allow statistical analyses of RBC populations.

Determination of erythrocyte transit times through micropores. I--Basic operational principles.

To study the transit times of each red blood cell passing through cylindrical micropores and in order to evaluate sub-population of cells with regard to their deformability, we have developed a new system called the cell transit time analyser (CTTA). By using an AC voltage (100 KHz) across a special filter, we measure the electrical conductance change produced by the cells passing through the pores under a known driving pressure. This computer based device provides the distribution of transit times tau for 2000 cells in 1 minute and as a result the mean transit time [tau]. Experiments with red cells were designed to evaluate the flow behavior of both normal cells and cells whose mechanical properties were artificially altered. Cell volume was changed by use of non-isotonic media. Cell shape and cell volume were modified by varying the pH of the suspending buffer. Results of these experiments are: 1) a skew distribution of transit times towards high tau values for both control cells and artificially altered cells is observed: 2) [tau] is minimum for isotonic conditions and increases sharply for either hypotonic or hypertonic media: 3) [tau] is minimum at physiological pH and increases for either acid or alcaline changes of pH.