A Study of Maternal and Umbilical Cord Blood Lead Levels in Pregnant Women.

Lead is a highly toxic element which can cross the placental barrier and enter the fetus during pregnancy. Parental lead exposure has adverse effect on infant as well as on maternal health. As part of our program to investigate the lead poisoning in human population we investigated the maternal blood lead levels (MBLL) and umbilical cord blood lead (UBLL) levels in 200 pregnant women and collected their socio-demographic details. In the study we found high lead levels in both maternal and umbilical cord blood samples. The results showed 47.5% maternal blood (n = 95) detected with lead while 38.5% umbilical cord blood (n = 77) samples had lead concentration higher than that of reference range of ≤ 5 µg/dL. We also found that the Spearman's correlation coefficient (rs) revealed a strong positive correlation between the MBLL and UBLL (rs = 0.63). The results from socio-demographic questionnaire demonstrated that the recent home painting (p = 0.002) and residing close proximity to traffic congestion (p = 0.05) were significantly associated with MBLL. Education, mother age, fuel and water sources were not significantly associated with MBLL. Iron and calcium deficiency along with tiredness, lethargy, abdominal pain were also reported in women having high lead level > 5 µg/dL. Concludingly, on the basis of results obtained it may be stated that we found elevated BLLs in both pregnant women as well as in umbilical cord blood. The prevalence of elevated lead levels in mothers will expose the fetus to lead through placental barriers mobilization and it can have long term adverse effects on the developing fetus. Therefore, it is recommended that screening of blood lead levels be carried out in high-risk women based on their social, occupational, environmental, and individual factors. In addition, stringent regulations on lead-based products are also required from government agencies/authorities to reduce environmental lead burden and toxicity. Moreover, public awareness programs should be organized on hazardous effect of lead.

Modelling mobile-based technology adoption among people with dementia.

The work described in this paper builds upon our previous research on adoption modelling and aims to identify the best subset of features that could offer a better understanding of technology adoption. The current work is based on the analysis and fusion of two datasets that provide detailed information on background, psychosocial, and medical history of the subjects. In the process of modelling adoption, feature selection is carried out followed by empirical analysis to identify the best classification models. With a more detailed set of features including psychosocial and medical history information, the developed adoption model, using kNN algorithm, achieved a prediction accuracy of 99.41% when tested on 173 participants. The second-best algorithm built, using NN, achieved 94.08% accuracy. Both these results have improved accuracy in comparison to the best accuracy achieved (92.48%) in our previous work, based on psychosocial and self-reported health data for the same cohort. It has been found that psychosocial data is better than medical data for predicting technology adoption. However, for the best results, we should use a combination of psychosocial and medical data where it is preferable that the latter is provided from reliable medical sources, rather than self-reported.

Using Convolutional Neural Networks with Multiple Thermal Sensors for Unobtrusive Pose Recognition.

The desire to remain living in one's own home rather than a care home by those in need of 24/7 care is one that requires a level of understanding for the actions of an environment's inhabitants. This can potentially be accomplished with the ability to recognise Activities of Daily Living (ADLs); however, this research focuses first on producing an unobtrusive solution for pose recognition where the preservation of privacy is a primary aim. With an accurate manner of predicting an inhabitant's poses, their interactions with objects within the environment and, therefore, the activities they are performing, can begin to be understood. This research implements a Convolutional Neural Network (CNN), which has been designed with an original architecture derived from the popular AlexNet, to predict poses from thermal imagery that have been captured using thermopile infrared sensors (TISs). Five TISs have been deployed within the smart kitchen in Ulster University where each provides input to a corresponding trained CNN. The approach is evaluated using an original dataset and an F1-score of 0.9920 was achieved with all five TISs. The limitations of utilising a ceiling-based TIS are investigated and each possible permutation of corner-based TISs is evaluated to satisfy a trade-off between the number of TISs, the total sensor cost and the performances. These tests are also promising as F1-scores of 0.9266, 0.9149 and 0.8468 were achieved with the isolated use of four, three, and two corner TISs, respectively.

Modelling mortality and discharge of hospitalized stroke patients using a phase-type recovery model.

We model the length of in-patient hospital stays due to stroke and the mode of discharge using a phase-type stroke recovery model. The model allows for three different types of stroke: haemorrhagic (the most severe, caused by ruptured blood vessels that cause brain bleeding), cerebral infarction (less severe, caused by blood clots) and transient ischemic attack or TIA (the least severe, a mini-stroke caused by a temporary blood clot). A four-phase recovery process is used, where the initial phase depends on the type of stroke, and transition from one phase to the next depends on the age of the patient. There are three differing modes of absorption for this phase-type model: from a typical recovery phase, a patient may die (mode 1), be transferred to a nursing home (mode 2) or be discharged to the individual's usual residence (mode 3). The first recovery phase is characterized by a very high rate of mortality and very low rates of discharge by the other two modes. The next two recovery phases have progressively lower mortality rates and higher mode 2 and 3 discharge rates. The fourth recovery phase is visited only by those who experience a very mild TIA, and they are discharged to home after a short stay. The novelty of our approach to phase representation is two-fold: first, it aligns the phases with labelled diagnosis states, representing stages of illness severity; second, the model allows us to obtain expressions for Key Performance Indicators that are of use to healthcare professionals. This allows us to use a backward estimation process where we leverage the fact that we know the phase of admission (the diagnosis), but not which phases are subsequently entered or when this happens; this strategy improves both computational efficiency and accuracy. The model has clear practical value as it yields length of stay distributions by age and type of stroke, which are useful in resource planning. Also, inclusion of the three modes of discharge permits analyses of outcomes.

Modelling assistive technology adoption for people with dementia.

PURPOSE: Assistive technologies have been identified as a potential solution for the provision of elderly care. Such technologies have in general the capacity to enhance the quality of life and increase the level of independence among their users. Nevertheless, the acceptance of these technologies is crucial to their success. Generally speaking, the elderly are not well-disposed to technologies and have limited experience; these factors contribute towards limiting the widespread acceptance of technology. It is therefore important to evaluate the potential success of technologies prior to their deployment. MATERIALS AND METHODS: The research described in this paper builds upon our previous work on modelling adoption of assistive technology, in the form of cognitive prosthetics such as reminder apps and aims at identifying a refined sub-set of features which offer improved accuracy in predicting technology adoption. Consequently, in this paper, an adoption model is built using a set of features extracted from a user's background to minimise the likelihood of non-adoption. The work is based on analysis of data from the Cache County Study on Memory and Aging (CCSMA) with 31 features covering a range of age, gender, education and details of health condition. In the process of modelling adoption, feature selection and feature reduction is carried out followed by identifying the best classification models. FINDINGS: With the reduced set of labelled features the technology adoption model built achieved an average prediction accuracy of 92.48% when tested on 173 participants. CONCLUSIONS: We conclude that modelling user adoption from a range of parameters such as physical, environmental and social perspectives is beneficial in recommending a technology to a particular user based on their profile.

Optimal Parameter Exploration for Online Change-Point Detection in Activity Monitoring Using Genetic Algorithms.

In recent years, smart phones with inbuilt sensors have become popular devices to facilitate activity recognition. The sensors capture a large amount of data, containing meaningful events, in a short period of time. The change points in this data are used to specify transitions to distinct events and can be used in various scenarios such as identifying change in a patient's vital signs in the medical domain or requesting activity labels for generating real-world labeled activity datasets. Our work focuses on change-point detection to identify a transition from one activity to another. Within this paper, we extend our previous work on multivariate exponentially weighted moving average (MEWMA) algorithm by using a genetic algorithm (GA) to identify the optimal set of parameters for online change-point detection. The proposed technique finds the maximum accuracy and F_measure by optimizing the different parameters of the MEWMA, which subsequently identifies the exact location of the change point from an existing activity to a new one. Optimal parameter selection facilitates an algorithm to detect accurate change points and minimize false alarms. Results have been evaluated based on two real datasets of accelerometer data collected from a set of different activities from two users, with a high degree of accuracy from 99.4% to 99.8% and F_measure of up to 66.7%.

A lightweight hierarchical activity recognition framework using smartphone sensors.

Activity recognition for the purposes of recognizing a user's intentions using multimodal sensors is becoming a widely researched topic largely based on the prevalence of the smartphone. Previous studies have reported the difficulty in recognizing life-logs by only using a smartphone due to the challenges with activity modeling and real-time recognition. In addition, recognizing life-logs is difficult due to the absence of an established framework which enables the use of different sources of sensor data. In this paper, we propose a smartphone-based Hierarchical Activity Recognition Framework which extends the Naïve Bayes approach for the processing of activity modeling and real-time activity recognition. The proposed algorithm demonstrates higher accuracy than the Naïve Bayes approach and also enables the recognition of a user's activities within a mobile environment. The proposed algorithm has the ability to classify fifteen activities with an average classification accuracy of 92.96%.

Evaluation of prompted annotation of activity data recorded from a smart phone.

In this paper we discuss the design and evaluation of a mobile based tool to collect activity data on a large scale. The current approach, based on an existing activity recognition module, recognizes class transitions from a set of specific activities (for example walking and running) to the standing still activity. Once this transition is detected the system prompts the user to provide a label for their previous activity. This label, along with the raw sensor data, is then stored locally prior to being uploaded to cloud storage. The system was evaluated by ten users. Three evaluation protocols were used, including a structured, semi-structured and free living protocol. Results indicate that the mobile application could be used to allow the user to provide accurate ground truth labels for their activity data. Similarities of up to 100% where observed when comparing the user prompted labels and those from an observer during structured lab based experiments. Further work will examine data segmentation and personalization issues in order to refine the system.

Behavior life style analysis for mobile sensory data in cloud computing through MapReduce.

Cloud computing has revolutionized healthcare in today's world as it can be seamlessly integrated into a mobile application and sensor devices. The sensory data is then transferred from these devices to the public and private clouds. In this paper, a hybrid and distributed environment is built which is capable of collecting data from the mobile phone application and store it in the cloud. We developed an activity recognition application and transfer the data to the cloud for further processing. Big data technology Hadoop MapReduce is employed to analyze the data and create user timeline of user's activities. These activities are visualized to find useful health analytics and trends. In this paper a big data solution is proposed to analyze the sensory data and give insights into user behavior and lifestyle trends.

An AI-based multiphase framework for improving the mechanical ventilation availability in emergency departments during respiratory disease seasons: a case study.

BACKGROUND: Shortages of mechanical ventilation have become a constant problem in Emergency Departments (EDs), thereby affecting the timely deployment of medical interventions that counteract the severe health complications experienced during respiratory disease seasons. It is then necessary to count on agile and robust methodological approaches predicting the expected demand loads to EDs while supporting the timely allocation of ventilators. In this paper, we propose an integration of Artificial Intelligence (AI) and Discrete-event Simulation (DES) to design effective interventions ensuring the high availability of ventilators for patients needing these devices. METHODS: First, we applied Random Forest (RF) to estimate the mechanical ventilation probability of respiratory-affected patients entering the emergency wards. Second, we introduced the RF predictions into a DES model to diagnose the response of EDs in terms of mechanical ventilator availability. Lately, we pretested two different interventions suggested by decision-makers to address the scarcity of this resource. A case study in a European hospital group was used to validate the proposed methodology. RESULTS: The number of patients in the training cohort was 734, while the test group comprised 315. The sensitivity of the AI model was 93.08% (95% confidence interval, [88.46 - 96.26%]), whilst the specificity was 85.45% [77.45 - 91.45%]. On the other hand, the positive and negative predictive values were 91.62% (86.75 - 95.13%) and 87.85% (80.12 - 93.36%). Also, the Receiver Operator Characteristic (ROC) curve plot was 95.00% (89.25 - 100%). Finally, the median waiting time for mechanical ventilation was decreased by 17.48% after implementing a new resource capacity strategy. CONCLUSIONS: Combining AI and DES helps healthcare decision-makers to elucidate interventions shortening the waiting times for mechanical ventilators in EDs during respiratory disease epidemics and pandemics.

Optimal placement of accelerometers for the detection of everyday activities.

This article describes an investigation to determine the optimal placement of accelerometers for the purpose of detecting a range of everyday activities. The paper investigates the effect of combining data from accelerometers placed at various bodily locations on the accuracy of activity detection. Eight healthy males participated within the study. Data were collected from six wireless tri-axial accelerometers placed at the chest, wrist, lower back, hip, thigh and foot. Activities included walking, running on a motorized treadmill, sitting, lying, standing and walking up and down stairs. The Support Vector Machine provided the most accurate detection of activities of all the machine learning algorithms investigated. Although data from all locations provided similar levels of accuracy, the hip was the best single location to record data for activity detection using a Support Vector Machine, providing small but significantly better accuracy than the other investigated locations. Increasing the number of sensing locations from one to two or more statistically increased the accuracy of classification. There was no significant difference in accuracy when using two or more sensors. It was noted, however, that the difference in activity detection using single or multiple accelerometers may be more pronounced when trying to detect finer grain activities. Future work shall therefore investigate the effects of accelerometer placement on a larger range of these activities.

Automated lead toxicity prediction using computational modelling framework.

Background: Lead, an environmental toxicant, accounts for 0.6% of the global burden of disease, with the highest burden in developing countries. Lead poisoning is very much preventable with adequate and timely action. Therefore, it is important to identify factors that contribute to maternal BLL and minimise them to reduce the transfer to the foetus. Literacy and awareness related to its impact are low and the clinical establishment for biological monitoring of blood lead level (BLL) is low, costly, and time-consuming. A significant contribution to an infant's BLL load is caused by maternal lead transfer during pregnancy. This acts as the first pathway to the infant's lead exposure. The social and demographic information that includes lifestyle and environmental factors are key to maternal lead exposure. Results: We propose a novel approach to build a computational model framework that can predict lead toxicity levels in maternal blood using a set of sociodemographic features. To illustrate our proposed approach, maternal data comprising socio-demographic features and blood samples from the pregnant woman is collected, analysed, and modelled. The computational model is built that learns from the maternal data and then predicts lead level in a pregnant woman using a set of questionnaires that relate to the maternal's social and demographic information as the first point of testing. The range of features identified in the built models can estimate the underlying function and provide an understanding of the toxicity level. Following feature selection methods, the 12-feature set obtained from the Boruta algorithm gave better prediction results (kNN = 76.84%, DT = 74.70%, and NN = 73.99%). Conclusion: The built prediction model can be beneficial in improving the point of care and hence reducing the cost and the risk involved. It is envisaged that in future, the proposed methodology will become a part of a screening process to assist healthcare experts at the point of evaluating the lead toxicity level in pregnant women. Women screened positive could be given a range of facilities including preliminary counselling to being referred to the health centre for further diagnosis. Steps could be taken to reduce maternal lead exposure; hence, it could also be possible to mitigate the infant's lead exposure by reducing transfer from the pregnant woman.

Trends in telemedicine assessment indicate neglect of key criteria for predicting success.

PURPOSE: This innovative analysis aims to quantify the use of evaluation criteria in telemedicine and to identify current trends in metric adoption. The focus is to determine the frequency of actual performance metric reporting in telemedicine evaluation, in contrast to systematic reviews where assessment of study quality is the goal. DESIGN/METHODOLOGY/APPROACH: Automated literature search identified telemedicine studies reporting quantitative performance metrics. Studies were classified by telemedicine class; store-and-forward (SAF), real-time consultation (RTC) and telecare (TC), and study stage. Studies were scanned for evaluation metric reporting, i.e. clinical outcomes, satisfaction, patient quality and cost measures. FINDINGS: Evaluation metric use was compared among telemedicine classes, and between pilot and routine use stages. Diagnostic accuracy was reported significantly more frequently in pilots for RTC and TC. Cost measures were more frequently reported in routine use for TC. Clinical effectiveness and hospital attendance were better reported in routine use for SAF. Comparison also revealed different evaluation strategies. In pilots, SAF favoured diagnostic accuracy, compared to RTC and TC. TC preferred clinical effectiveness evaluations and TC more frequently assessed patient satisfaction. Cost was only reported in less than 20 per cent of studies, but most frequently in RTC. Routine use led to increased reporting of all metrics, except diagnostic accuracy. Clinical effectiveness reporting increased significantly with routine use for RTC and SAF, but declined for TC. ORIGINALITY/VALUE: Clinical outcomes and patient satisfaction were reported frequently in telemedicine studies, but reporting of other performance metrics was rare. Understanding current trends in metric reporting will facilitate better design of future telemedicine evaluations.

Deriving evidence theoretical functions in multivariate data spaces: a systematic approach.

The mathematical theory of evidence is a generalization of the Bayesian theory of probability. It is one of the primary tools for knowledge representation and uncertainty and probabilistic reasoning and has found many applications. Using this theory to solve a specific problem is critically dependent on the availability of a mass function (or basic belief assignment). In this paper, we consider the important problem of how to systematically derive mass functions from the common multivariate data spaces and also the ensuing problem of how to compute the various forms of belief function efficiently. We also consider how such a systematic approach can be used in practical pattern recognition problems. More specifically, we propose a novel method in which a mass function can be systematically derived from multivariate data and present new methods that exploit the algebraic structure of a multivariate data space to compute various belief functions including the belief, plausibility, and commonality functions in polynomial-time. We further consider the use of commonality as an equality check. We also develop a plausibility-based classifier. Experiments show that the equality checker and the classifier are comparable to state-of-the-art algorithms.

Using a multi-state model to enhance understanding of geriatric patient care.

OBJECTIVES: To use multi-state Markov chain modelling to analyse data on geriatric patient care, and to make comparisons between male and female patients. METHODS: Estimation, from observed data, of covariate (age of patient and date of admission to hospital or community care) dependent parameters of statistical models for time in care and subsequent events. RESULTS: Differential effects of these covariates shown on the parameters of the models for female and male patients, where these parameters can be interpreted as affecting different features of the distributions of time in care. CONCLUSIONS: Multi-state modelling is an appropriate means of analysing data on geriatric patient care and can reveal underlying patterns of differential effects, some of which may not be apparent from more routine data processing.

Combining wavelet analysis and Bayesian networks for the classification of auditory brainstem response.

The auditory brainstem response (ABR) has become a routine clinical tool for hearing and neurological assessment. In order to pick out the ABR from the background EEG activity that obscures it, stimulus-synchronized averaging of many repeated trials is necessary, typically requiring up to 2000 repetitions. This number of repetitions can be very difficult, time consuming and uncomfortable for some subjects. In this study, a method combining wavelet analysis and Bayesian networks is introduced to reduce the required number of repetitions, which could offer a great advantage in the clinical situation. 314 ABRs with 64 repetitions and 155 ABRs with 128 repetitions recorded from eight subjects are used here. A wavelet transform is applied to each of the ABRs, and the important features of the ABRs are extracted by thresholding and matching the wavelet coefficients. The significant wavelet coefficients that represent the extracted features of the ABRs are then used as the variables to build the Bayesian network for classification of the ABRs. In order to estimate the performance of this approach, stratified ten-fold cross-validation is used.

The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial.

BACKGROUND: Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. OBJECTIVE: The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. METHODS: The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke "Gray Matters" mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user's performance, calculated from reported behaviors against recommended guidelines. RESULTS: This paper explores the rationale for a mobile phone-led intervention and details the app's effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=-3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = -2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). CONCLUSIONS: In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. TRIAL REGISTRATION: ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm).

Assessing app quality through expert peer review: a case study from the gray matters study.

Health apps focused on inciting behavior change are becoming increasingly popular. Nevertheless, many lack underlying evidence base, scientific credibility and have limited clinical effectiveness. It is therefore important that apps are well-informed, scientifically credible, peer reviewed and evidence based. This paper presents the use of the Mobile App Rating Scale (MARS) to assess the quality of the Grey Matters app, a cross platform app to deliver health education material and track behavior change across multi-domains with the aim of reducing the risk of developing Alzheimer's disease. The Gray Matters app shows promising results following reviews from 5 Expert raters, achieving a mean overall MARS score of 4.45 ± 0.14. Future work will involve undertaking of a detailed content analysis of behavior change apps to identify common themes and features which may lead to the successful facilitation of sustained behavior change.

Technology adoption and prediction tools for everyday technologies aimed at people with dementia.

A wide range of assistive technologies have been developed to support the elderly population with the goal of promoting independent living. The adoption of these technology based solutions is, however, critical to their overarching success. In our previous research we addressed the significance of modelling user adoption to reminding technologies based on a range of physical, environmental and social factors. In our current work we build upon our initial modeling through considering a wider range of computational approaches and identify a reduced set of relevant features that can aid the medical professionals to make an informed choice of whether to recommend the technology or not. The adoption models produced were evaluated on a multi-criterion basis: in terms of prediction performance, robustness and bias in relation to two types of errors. The effects of data imbalance on prediction performance was also considered. With handling the imbalance in the dataset, a 16 feature-subset was evaluated consisting of 173 instances, resulting in the ability to differentiate between adopters and non-adopters with an overall accuracy of 99.42 %.

A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD.

We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. Exclusion criteria were patients who had any respiratory disorder other than COPD, or were cognitively unable to learn the process of monitoring. Patients were randomised to receive six months of home telemonitoring with usual care, or six months of usual care. The primary outcome measure was disease-specific quality of life, as measured by the St George's Respiratory Questionnaire for COPD patients (SGRQ-C). Of 100 patients completing the study, 48 patients were randomised to telemonitoring and 52 patients were randomised to the control group. The SGRQ-C scores improved significantly in the intervention group compared to usual care (P = 0.001). The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group (P = 0.01). There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group (P = 0.029). There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention.