About David Kotz

David Kotz is the International Paper Professor in the Department of Computer Science and, presently, Visiting Professor in the Center for Digital Health Interventions at ETH Zurich. He previously served as Interim Provost, as Associate Dean of the Faculty for the Sciences, as the Executive Director of the Institute for Security Technology Studies, and on the US Healthcare IT Policy Committee. His research interests include security and privacy, pervasive computing for healthcare, and wireless networks. He has published over 200 refereed papers, obtained over $67m in grant funding, and mentored nearly 100 research students. He is a Fellow of the IEEE, a Distinguished Member of the ACM, a 2008 Fulbright Fellow to India, and an elected member of Phi Beta Kappa. After receiving his A.B. in Computer Science and Physics from Dartmouth in 1986, he completed his Ph.D in Computer Science from Duke University in 1991 and returned to Dartmouth to join the faculty. For more information see http://www.cs.dartmouth.edu/~dfk/.

MobiCom presentation of Amulet

ACM posted a video recording of the presentation of our paper, Experience: Design, Development and Evaluation of a Wearable Device for mHealth, at the annual ACM International Conference on Mobile Computing and Networking (MobiCom) last month in Los Cabos, Mexico.

Abstract: Wrist-worn devices hold great potential as a platform for mobile health (mHealth) applications because they comprise a familiar, convenient form factor and can embed sensors in proximity to the human body. Despite this potential, however, they are severely limited in battery life, storage, bandwidth, computing power, and screen size. In this paper, we describe the experience of the research and development team designing, implementing and evaluating Amulet – an open-hardware, open-software wrist-worn computing device – and its experience using Amulet to deploy mHealth apps in the field. In the past five years the team conducted 11 studies in the lab and in the field, involving 204 participants and collecting over 77,780 hours of sensor data. We describe the technical issues the team encountered and the lessons they learned, and conclude with a set of recommendations. We anticipate the experience described herein will be useful for the development of other research-oriented computing platforms. It should also be useful for researchers interested in developing and deploying mHealth applications, whether with the Amulet system or with other wearable platforms.

George Boateng, Vivian Genaro Motti, Varun Mishra, John A. Batsis, Josiah Hester, and David Kotz. Experience: Design, Development and Evaluation of a Wearable Device for mHealth Applications. In Proceedings of the International Conference on Mobile Computing and Networking (MobiCom), Article #31, October 2019. DOI 10.1145/3300061.3345432.

Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme

Although not specifically involving the Amulet device, John Batsis and members of the Amulet team published a recent feasibility study involving the use of wearables, like Amulet, in support of health monitoring for older adults.

  • John A. Batsis, Auden C. McClure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, and Richard I. Rothstein. Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programmeObesity Science & Practice, 1-10, August 2019. DOI 10.1002/osp4.366.

Abstract: Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. Results: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 +/- 11.6 years (88.9% female), with a mean body mass index of 41.3 +/- 7.1 kg/m2 and mean waist circumference of 120.7 +/- 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 +/- 0.58 on 1-5 Likert scale–low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 +/- 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. Conclusion: A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.

Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity

A qualitative study to determine whether mHealth devices, like Amulet, could be useful in supporting rural-health interventions.

  • John Batsis, Stephen Bartels, Rachel Dokko, Alexandra Zagaria, John Naslund, Elizabeth Carpenter-Song, and David Kotz. Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity. Journal of Community Health, September 2019. DOI 10.1007/s10900-019-00720-y.

Abstract: Older adults with obesity are at a high risk of decline, particularly in rural areas. Our study objective was to gain insights into how a potential Mobile Health Obesity Wellness Intervention (MOWI) in rural older adults with obesity, consisting of nutrition and exercise sessions, could be helpful to improve physical function. A qualitative methods study was conducted in a rural community, community-based aging center. Four community leaders, 7 clinicians and 29 patient participants underwent focus groups and semi-structured interviews. All participants had a favorable view of MOWI and saw its potential to improve health and create accountability. Participants noted that MOWI could overcome geographic barriers and provided feedback about components that could improve implementation. There was expressed enthusiasm over its potential to improve health. The use of technology in older adults with obesity in rural areas has considerable promise. There is potential that this intervention could potentially extend to distant areas in rural America that can surmount accessibility barriers. If successful, this intervention could potentially alter healthcare delivery by enhancing health promotion in a remote, geographically constrained communities. MOWI has the potential to reach older adults with obesity using novel methods in geographically isolated regions.

Development and Usability Assessment of a Connected Resistance Exercise Band Application for Strength-Monitoring

Another recent paper from John Batsis and the Amulet group, highlighting a custom sensor developed by our team and presented at the International Conference on Body Area Networks (ICBAN):

  • John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, and David F. Kotz. Development and Usability Assessment of a Connected Resistance Exercise Band Application for Strength-Monitoring. World Academy of Science, Engineering and Technology, 13(5):340-348, June 2019. DOI 10.5281/zenodo.

Abstract: Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting is fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults with obesity participating in a weight-loss intervention (n=20). The system was favorable, acceptable and provided iterative information that could assist in future deployment on ubiquitous platforms. Our formative work provides the foundation to deliver home-based monitoring interventions in a high-risk, older adult population.

Usability evaluation for the Amulet wearable device in rural older adults with obesity

The following paper dates to last year, but is an important publication from the Amulet group:

  • John A. Batsis, Alexandra Zagaria, David F. Kotz, Stephen J. Bartels, George G. Boateng, Patrick O. Proctor, Ryan J. Halter, and Elizabeth A. Carpenter-Song. Usability evaluation for the Amulet wearable device in rural older adults with obesity. Gerontechnology, 17(3):151-159, 2018. DOI 10.4017/gt.2018.17.3.003.00.

Abstract: Mobile health (mHealth) interventions hold the promise of augmenting existing health promotion interventions. Older adults present unique challenges in advancing new models of health promotion using technology including sensory limitations and less experience with mHealth, underscoring the need for specialized usability testing. We use an open-source mHealth device as a case example for its integration in a newly designed health services intervention. We performed a convergent, parallel mixed-methods study including semi-structured interviews, focus groups, and questionnaires, using purposive sampling of 29 older adults, 4 community leaders, and 7 clinicians in a rural setting. We transcribed the data, developed codes informed by thematic analysis using inductive and deductive methods, and assessed the quantitative data using descriptive statistics. Our results suggest the importance of end-users in user-centered design of mHealth devices and that aesthetics are critically important. The prototype could potentially be feasibly integrated within health behavior interventions. Centralized dashboards were desired by all participants and ecological momentary assessment could be an important part of monitoring. Concerns of mHealth, including the prototype device, include the device’s accuracy, its intrusiveness in daily life and privacy. Formative evaluations are critically important prior to deploying large-scale interventions.

Amulet: Design, Development and Evaluation of a Wearable Device for mHealth Applications

Today we presented an “Experience” paper at ACM MobiCom, summarizing the technology, the studies, and the challenges and lessons learned over seven years of research.

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George Boateng, Vivian Genaro Motti, Varun Mishra, John A. Batsis, Josiah Hester, and David Kotz. Experience: Design, Development and Evaluation of a Wearable Device for mHealth Applications. In Proceedings of the International Conference on Mobile Computing and Networking (MobiCom), October 2019. DOI 10.1145/3300061.3345432.

Abstract: Wrist-worn devices hold great potential as a platform for mobile health (mHealth) applications because they comprise a familiar, convenient form factor and can embed sensors in proximity to the human body. Despite this potential, however, they are severely limited in battery life, storage, bandwidth, computing power, and screen size. In this paper, we describe the experience of the research and development team designing, implementing and evaluating Amulet? an open-hardware, open-software wrist-worn computing device? and its experience using Amulet to deploy mHealth apps in the field. In the past five years the team conducted 11 studies in the lab and in the field, involving 204 participants and collecting over 77,780 hours of sensor data. We describe the technical issues the team encountered and the lessons they learned, and conclude with a set of recommendations. We anticipate the experience described herein will be useful for the development of other research-oriented computing platforms. It should also be useful for researchers interested in developing and deploying mHealth applications, whether with the Amulet system or with other wearable platforms.

Use of Amulet in behavioral change for geriatric obesity management

John Batsis and the Amulet team just published a paper regarding Use of Amulet in behavioral change for geriatric obesity management.

Background: Obesity in older adults is a significant public health concern. Weight-loss interventions are known to improve physical function but risk the development of sarcopenia. Mobile health devices have the potential to augment existing interventions and, if designed accordingly, could improve one’s physical activity and strength in routine physical activity interventions. Methods and results: We present Amulet, a mobile health device that has the capability of engaging patients in physical activity. The purpose of this article is to discuss the development of applications that are tailored to older adults with obesity, with the intention to engage and improve their health. Conclusions: Using a team-science approach, Amulet has the potential, as an open-source mobile health device, to tailor activity interventions to older adults.

John A. Batsis, Alexandra B. Zagaria, Ryan J. Halter, George G. Boateng, Patrick Proctor, Stephen J. Bartels, and David Kotz. Use of Amulet in behavioral change for geriatric obesity management. Journal of Digital Health, 5, June 2019. DOI 10.1177/2055207619858564.

Technology for Behavioral Change in Rural Older Adults with Obesity

A new paper from the extended Amulet group.

John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels & Elizabeth Carpenter-Song. Technology for Behavioral Change in Rural Older Adults with ObesityJournal of Nutrition in Gerontology and Geriatrics, April 2019.DOI: 10.1080/21551197.2019.1600097

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