Tag Archives: mHealth

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.

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.

MobiCom presentation of Amulet

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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

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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 programme. Obesity 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.

Use of Amulet in behavioral change for geriatric obesity management

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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.

Amulet: an open-source wrist-worn platform for mHealth research and education

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David Kotz recently presented a paper titled Amulet: an open-source wrist-worn platform for mHealth research and education.

Abstract: The advent of mobile and wearable computing technology has opened up tremendous opportunities for health and wellness applications. It is increasingly possible for individuals to wear devices that can sense their physiology or health-related behaviors, collecting valuable data in support of diagnosis, treatment, public health, or other applications. From a researcher’s point of view, the commercial availability of these “mHealth” devices has made it feasible to conduct scientific studies of health conditions and to explore health-related interventions. It remains difficult, however, to conduct systems work or other experimental research involving the hardware, software, security, and networking aspects of mobile and wearable technology. In this paper we describe the Amulet platform, an open-hardware, open-software wrist-worn computing device designed specifically for mHealth applications. Our position is that the Amulet is an inexpensive platform for research and education, and we encourage the mHealth community to explore its potential.

In Workshop on Networked Healthcare Technology (NetHealth), pages 891-897, January 2019. IEEE Computer Society Press.

DOI 10.1109/COMSNETS.2019.8711407.

Technology for Behavioral Change in Rural Older Adults with Obesity

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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 Obesity. Journal of Nutrition in Gerontology and Geriatrics, April 2019.DOI: 10.1080/21551197.2019.1600097

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