The Amulet Project Comes to a Close

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The Amulet project launched in late 2013 with the vision of “bridging the gap between the type of pervasive computing possible with a mobile phone and that enabled by wearable computing.” Now, almost 10 years, 51 publications, and 29 core members (along with many collaborators) later, Amulet is coming to a close.

Amulet was featured in Forbes magazine, has been presented to audiences at many conferences and at an mHealth summit near Washington DC, was evaluated on usability in a study amongst rural older adults with obesity, and is impacting continued health research!

Many of our students have gone on to roles in industry and academia after graduation, and Ryan Halter, the Dartmouth co-PI on the project, co-founded a startup company, SynchroHealth, with technology originating in the Amulet project.

The Amulet prototype remains available (open source, open hardware) on GitHub, and our papers are available through our Zotero library.

We thank the countless number of people who have supported the project — from advisors, to NSF program officers, to graduate and undergraduate students, to study participants, to project leads, and to you all who have kept up with the project for its 10-year run.

New Amulet Dissertation: ‘Information Provenance for Mobile Health Data’

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We are proud to announce an Amulet team members’ successful dissertation. Dr. Taylor Hardin’s dissertation focuses on an end-to-end solution for providing information provenance for mHealth data, which begins by securing mHealth data at its source: the mHealth device.

The dissertation describes a memory-isolation method that combines compiler-inserted code and Memory Protection Unit (MPU) hardware to protect application code and data on ultra-low-power micro-controllers. The security of mHealth data outside of the source (e.g., data that has been uploaded to smartphone or remote-server) is then addressed with Amanuensis, a health-data system, which uses Blockchain and Trusted Execution Environment (TEE) technologies to provide confidential, yet verifiable, data storage and computation for mHealth data. The use of blockchain and TEEs introduce identity privacy and data freshness issues, which are explored. A privacy-preserving solution for blockchain transactions, and a freshness solution for data access-control lists retrieved from the blockchain are presented.

To learn more, check out Dr. Taylor Hardin’s dissertation below. 

Hardin, Taylor A., “Information Provenance for Mobile Health Data” (2022). Dartmouth College Ph.D Dissertations. 79. 
https://digitalcommons.dartmouth.edu/dissertations/79

Usability Assessment of a Bluetooth-Enabled Resistance Exercise

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The Amulet team has developed a Bluetooth-enabled handle for resistance exercise bands, and recently published a paper assessing the usability of the exercise system. The system wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar device.

The team had 32 young adults participate in three exercise sessions with the exercise band and then used an adapted version of the Usefulness, Satisfaction, and Ease (USE) questionnaire to understand the system’s usability. The questionnaire data reported a positive and consistent user experience; this is a promising indication that the device can be successfully incorporated into exercise interventions and that the system can be further developed and tested for the target population of older adults.

Lillian M. Seo, Curtis L. Petersen, Ryan J. Halter, David F. Kotz, Karen L. Fortuna, and John A. Batsis. Usability Assessment of a Bluetooth-Enabled Resistance Exercise Band Among Young Adults. Health Technology, volume 5, number 4. AME Publishing, April 2021. doi:10.21037/ht-20-22. ©Copyright Health Technology.

New grant supports commercialization of Amulet ‘BandPass’ technology

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SynchroHealth, a startup company launched with technology originating in the Amulet project, recently received a grant of almost $225,000 from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). SynchroHealth aims to develop hardware and software solutions for non-invasive detection and acquisition of remote healthcare data. 

Amulet’s Ryan Halter, co-founder of SynchroHealth, says “there’s a huge disparity in what clinicians and physical therapists think goes on in at-home rehabilitation programs and what actually happens. This disconnect […] could ultimately lead to unnecessary interventions that increase costs and potential risks to the patient. We’re aiming to close that gap.”

The current prototype of BandPass, from the SynchroHealth website

SynchroHealth is continuing the development of their ‘BandPass’ technology for the treatment of sarcopenia – loss of muscle mass and strength due to aging. BandPass is capable of monitoring, evaluating, and guiding patients in upper-body strength training in real-time. It includes sensors equipped to an exercise band with custom-designed electronics for the wireless transmission of patient data. It is unique in that the data collected could be monitored by a physician to aid in proper interventions.

Along with continuing the development of the BandPass, the team will develop a mobile application and cloud-based service for data transmission, processing, and storage. Later this year, the team will test their device on a cohort of 16 patients to obtain feedback.

This work is being supported under Award Number R41AG071290 by the National Institute On Aging of the National Institutes of Health. To learn more about BandPass and SynchroHealth, check out their website here. The Dartmouth Engineering article on this work can be found here.

The foundational research is described in academic papers [seo:theraband, peterson:chase, batsis:development].

A Weight-Loss Intervention Augmented by a Wearable Device in Rural Older Adults with Obesity: A Feasibility Study

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The purpose of this pilot study was to evaluate the feasibility, acceptability, and effectiveness of integrating a wearable Fitbit device into a high-touch, multicomponent weight loss intervention at a local community aging center.

Results of this pilot are the first to demonstrate the integration of a commercial wearable into a community-based weight loss program in older adults with obesity residing in rural areas. Despite misconceptions that this demographic is unable to use technology, these results not only showed effectiveness in the primary study outcomes but also showed ease of use, satisfaction, and engagement with the intervention and the technology itself. These findings suggest that wearable fitness devices have the potential to be acceptable and subsequently used in health promotion interventions in older adults.

John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, Francisco Lopez-Jimenez, Rima I. Al-Nimr, Dawna Pidgeon, David Kotz, Todd A. Mackenzie, and Steven J. Bartels. A Weight-Loss Intervention Augmented by a Wearable Device in Rural Older Adults with Obesity: A Feasibility Study. Journals of Gerontology – Series A: Biological Sciences and Medical Sciences, volume 76, number 1, pages 95–100. Oxford Academic, January 2021. doi:10.1093/gerona/glaa115. First published 8 May 2020.

Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity

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We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology.

Participants video-called with registered dietician nutritionists, were guided by a physical therapist in exercise through a tablet device, and wore a Fitbit. On average, participants lost weight, improved their 30 second sit-to-stand, and at least 41% of participants had at least a 30 meter improvement in 6-min walk. Subjective measures of Late-life function and disability instrument (LLFDI) also noted improvements in total, upper, basic lower, and advanced lower extremity function. In conclusion, this technology-based, video-monitoring and remote monitoring intervention is feasible, acceptable, and demonstrates favorable outcomes by overcoming the limitations of existing geriatric weight-loss trials, overcoming a need for proximity to medical facilities.

John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, David Kotz, Tyler L. Gooding, Meredith N. Roderka, Rima I. Al-Nimr, Dawna Pidgeon, Ann Haedrich, K.C. Wright, Christina Aquila, and Todd A. Mackenzie. Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity. BMC Geriatrics, volume 21, article 44, 13 pages. BMC, January 2021. doi:10.1186/s12877-020-01978-x. PMID: 33435877.

Augmenting Traditional User-Centered Design with Natural Language Processing and Sentiment Analysis

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This paper includes patient and clinician feedback to better understand treatment progress and increase compliance in resistance-based physical activity to mitigate the effects of age-associated losses in muscle mass and strengths. This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in natural language processing (NLP) and sentiment analysis. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01), but no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults.

Curtis Lee Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer Cook, Dawna Pidgeon, Brock C. Christensen, and John A. Batsis. Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study. JMIR mHealth and uHealth 8(8), page Article#e16862 (13 pages), August 2020. JMIR Publications. DOI: 10.2196/16862

Willingness to pay for a telemedicine-delivered healthy lifestyle programme

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Recent Amulet paper:

Effective weight-management interventions require frequent interactions with specialised multidisciplinary teams of medical, nutritional and behavioural experts. However, barriers that exist in rural areas, such as transportation and a lack of specialised services, can prevent patients from receiving quality care. We recruited patients from the Dartmouth-Hitchcock Weight & Wellness Center into a single-arm, non-randomised study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Every 4 weeks, participants completed surveys that included their willingness to pay for services like those experienced in the intervention based on commute and copay. Overall, those with a travel duration of 31–45 min had a greater willingness to trade in-person visits for telehealth than any other group. Participants who had a travel duration less than 15 min, 16–30 min and 46–60 min experienced a positive trend in willingness to have telehealth visits until Week 8, where there was a general negative trend in willingness to trade in-person visits for virtual. Participants believed that telemedicine was useful and helpful. In rural areas where patients travel 30–45 min a telemedicine-delivered, intensive weight-loss intervention may be a well-received and cost-effective way for both patients and the clinical care team to connect.

Vanessa K. Rauch, Meredith Roderka, Auden C. McClure, Aaron B. Weintraub, Kevin Curtis, David F. Kotz, Richard I. Rothstein, and John A. Batsis. Willingness to pay for a telemedicine-delivered healthy lifestyle programme. Journal of Telemedicine and Telecare, June 2020. Sage. DOI: 10.1177/1357633X20943337

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

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An Amulet-related paper was published recently.

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation, exploratory measures of program adoption, and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of the Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interview. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.

John Batsis, Auden C. McClure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David F. Kotz, Stephen J. Bartels, Summer B. Cook, and Richard I. Rothstein. Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic. Implementation Science Communications 1, page Article#83 (9 pages), September 2020. BMC. DOI: 10.1186/s43058-020-00075-9

Continuous Detection of Physiological Stress with Commodity Hardware

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A new publication from the Amulet group:

Varun Mishra, Gunnar Pope, Sarah Lord, Stephanie Lewia, Byron Lowens, Kelly Caine, Sougata Sen, Ryan Halter, and David Kotz. “Continuous Detection of Physiological Stress with Commodity Hardware.” ACM Transactions on Computing for Healthcare (HEALTH), volume 1, number 2, article 8, 30 pages. ACM Press, April 2020. doi:10.1145/3361562. ©Copyright the authors.

Abstract: Timely detection of an individual’s stress level has the potential to improve stress management, thereby reducing the risk of adverse health consequences that may arise due to mismanagement of stress. Recent advances in wearable sensing have resulted in multiple approaches to detect and monitor stress with varying levels of accuracy. The most accurate methods, however, rely on clinical-grade sensors to measure physiological signals; they are often bulky, custom made, and expensive, hence limiting their adoption by researchers and the general public. In this article, we explore the viability of commercially available off-the-shelf sensors for stress monitoring. The idea is to be able to use cheap, nonclinical sensors to capture physiological signals and make inferences about the wearer’s stress level based on that data. We describe a system involving a popular off-the-shelf heart rate monitor, the Polar H7; we evaluated our system with 26 participants in both a controlled lab setting with three well-validated stress-inducing stimuli and in free-living field conditions. Our analysis shows that using the off-the-shelf sensor alone, we were able to detect stressful events with an F1-score of up to 0.87 in the lab and 0.66 in the field, on par with clinical-grade sensors.