In an attempt to provide a more secure and amiable living environment in our homes, there has been constant effort to develop more efficient and suitable intelligent sensor technology for household application. Wireless sensors provide an efficient means of sensing without the need for messy wiring, and are ideally suited for the household environment. Although many sensor products have been developed (e.g. temperature, humidity and smoke), automated detection and reporting of an incidence occurring in places hard to observe or reach, such as wetting of diapers or water seepage under carpets, are still not readily available at low cost. Most of the existing technologies consist of complex design architecture and follow specific communication protocols which can be overkill for many simple household applications. In this thesis, we present a new wireless sensor system which is based on the detection of just the ON or OFF state of a condition. This approach overcomes the need for complex architecture and design, but is still able to achieve the functionality that is required for many household applications such as water leakage, food rotting, diaper wetting etc. and thus can be made available very cheaply. The sensor system consisting of an interrogator and a sensor circuit is implemented using inductive coupling. A passive L-C circuit is used for the sensor design and the system is tested using diaper wetting as an example of a simple household application. The testing results shows that the sensor can detect an ON and OFF condition for sensor and tag separation of 10 cm which is enough for applications like water leakage behind walls and under carpets, diaper wetting, food rotting etc.

The ongoinging demographic change will increase the demands on health care with an increase of old people suffering from long-term conditions in need of care. One way of meeting this increasing demand is to combine the use of modern technology and the involvement of patients by letting patients monitor their health themselves.  The use of patient-generated health data (PGHD) can benefit both patients and the health care and is an area that is being studied internationally. In this thesis work, two parts of the area of using PGHD in health care have been studied. First eleven professionals from the field of health care (both medical professionals, strategists and project leaders) were interviewed regarding their opinions on PGHD. They were generally positive to the phenomena and mentioned several types of measurements they found to be suited for PGHD. Among these measurement types were blood pressure, weight, blood glucose, electrocardiogram (ECG), peak expiratory flow (PEF), blood oxygen saturation and a variety of blood tests. The professionals found the greatest benets of PGHD to be the increased freedom and quality of life it offers to patients and the increased engagement to their own care it may lead to. The greatest concerns were related to technology problems and the patients using the measurement devices incorrectly. The second part of the work investigated how measurements of weight, blood pressure and ECG would be transferred from the device used by the patient to the electronic health record (EHR) in a standardized way. For the transfer being standardized, the study followed the Continua design guidelines (CDG), which are based on international standards and aim to achieve plug-and-play interoperability among health care devices and systems. This part of the study was carried out by studying the CDG documents as well as the standards to which they refer. The measurement data from the three device types were all described to be handled as numeric values, but in different formats. The weight is a single value, the blood pressure is a compound of values: systolic, diastolic and mean arterial pressure, and the ECG is an array of values. All measurement data is contained in a specic message together with additional data such as device type, device manufacturer, a reference ID and the date and time of the measurement. The data message is transferred from the measurement device to an application hosting device (AHD) with either a touch area network interface (using Near-Field Communications), personal area network interface (using USB or Bluetooth communication) or local area network interface (using ZigBee communication). From the AHD the data transfer chain continues until the data reaches the EHR.

Chronic heart failure (HF) is a condition that affects more than 900,000 people in the UK. Mortality rates associated with the condition are high, with nearly 20% of patients dying within one year of diagnosis. Continuous monitoring and risk stratification can help identify patients at risk of deterioration and may consequently improve patients' likelihood of survival. Current repeated-measure risk stratification techniques for HF patients often rely on subjective perception of symptoms, such as breathlessness, and markers of fluid retention in the body (e.g. weight). Despite the common use of such markers, studies have shown that they offer limited effectiveness in predicting HF-related events. This thesis set out to identify and evaluate new markers for repeated-measure risk stratification of HF patients. It started with an exploration of traditional HF measurements, including weight, blood pressure, heart rate and symptom scores, and aimed to improve the performance of these measurements using a data-driven approach. A multi-variate model was developed from data acquired during a randomised controlled trial of remotely-monitored HF patients. The rare occurrence of HF-related adverse events during the trial required the developement of a careful methodology. This methodology helped identify the markers with most predictive ability, which achieved moderate performance at identifying patients at risk of HF-related adverse events, clearly outperforming commonly-used thresholds. Subsequently, this thesis explored the potential value of additional, accelerometer-derived physical activity (PA) and sleep markers. For this purpose, the ability of accelerometer-derived markers to differentiate between individuals with and without HF was evaluated. It was found that markers that summarise the frequency and duration of different PA intensities performed best at differentiating between the two groups and may therefore be most suitable for future use in repeated-measure applications. As part of the analysis of accelerometer-derived HF markers, a gap in the methodology of automated accelerometer processing was identified, namely the need for self-reported sleep-onset and wake-up information. As a result, Chapter 5 of this thesis describes the development and evaluation of a data-driven solution for this problem. In summary, this thesis explored both traditional and new, accelerometer-derived markers for the early detection of HF deterioration. It utilised sound methodology to overcome limitations faced by sparse and unbalanced datasets and filled a methodological gap in the processing of signals from wrist-worn accelerometers.

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22578号 / 情博第715号 / 新制||情||123(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 守屋 和幸, 教授 吉川 正俊 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

A home automation system usually contains a set of tools that users use to control devices in their homes, often remotely. These devices often include but are not limited to light switches, thermostats, thermometers, window blinds, and climate controls. The potential for these kinds of systems is huge because of the sheer number of devices that could be controlled and managed with minimal and inexpensive extra hardware. Many of the appliances in a normal home could benefit from being connected to a system that allows the owner to manage and control the devices in their home. Thus the number of potential devices is orders of magnitude larger than the number of homes connected to the system. There are several systems on the market that provide systems to monitor and control a home environment, however these systems only support specific in system devices. This uncovers a problem where a homeowner only has the opportunity to use specific products that fit into these systems. By introducing an open platform for the public that are not bound to any system we can allow more devices to be integrated in the home and contribute to further development of smarter homes. The goal with this project was to provide a scalable open platform with the possibility of asynchronous updating. This has been done by implementing multiple logical parts to both provide a web interface for the user and to allow us to handle communication and storage of data. All these parts are linked together to form a system of servers that handles all background operations. This thesis discusses and presents implementations of all of these servers, how they are implemented, communicate with each other, provide secure connections and how they can scale with increasing usage. In this process we also discuss and present techniques that were used, how to use them and their benefits, to help us reach our goal. / ”Home automation” syftar till ett system som låter användaren kontrollera och styra olika apparater i hemmet, ofta sker detta utifrån. Dessa apparater inkluderar, men är inte begränsade till ljusbrytare, termostater, termometrar, persienner eller klimatanläggningar. Potentialen för ett sådant system är enormt då antalet apparater som skulle kunna övervakas med endast minimal och billig extra hårdvara är stort. Många av dessa apparater kan dra nytta av att vara ansluten till ett system som gör det möjligt för ägaren att hantera och styra enheter i deras hem. Antalet apparater är därför mångdubbelt fler än antalet hem som är kopplade till systemet. Det finns flera system på marknaden som ger användaren ett sätt att övervaka och styra en hemmiljö, men dessa system är ofta låsta och stödjer bara specifika enheter. Genom att införa en öppen plattform för allmänheten som inte är bunden till något system, kan vi tillåta att fler enheter kan integreras i hemmet och bidra till ytterligare utveckling av smartare hem. Målet med detta projekt var att skapa en skalbar öppen plattform med möjlighet till asynkron uppdatering. Detta har gjorts genom att implementera flera logiska delar för att förse användaren med ett webbgränssnitt och för att tillåta oss hantera kommunikation och lagring av data. Alla dessa delar är sammanlänkade för att bilda ett system av servrar som hanterar alla bakgrundsprocesser. Denna avhandling diskuterar och presenterar implementeringar av alla dessa servrar, hur de genomförs, kommunicera med varandra, ger säkra anslutningar och hur de kan skala med ökad användning. I denna process diskuterar och presenterar vi de tekniker som använts, hur man använder dem och deras fördelar.

Abstract Sleep Apnea (SA) is a common disorder that affects approximately 2% of middle-aged women and 4% of middle-aged men. It is characterized by repetitive cessation of breathing during sleep. SA has significant health and social consequences such as daytime sleepiness, impaired quality of life, and in the worst case, myocardial infarction and sudden cardiac death. It has been estimated that approximately 80% of individuals with moderate to severe SA syndrome have not been diagnosed. The lack of patient sleep histories has caused low identification of SA and referral rates, especially in primary care facilities. Moreover, due to the inadequate prevalence of overnight polysomnography (PSG) as a standard clinical test of SA, patients suspected of having this sleep disorder have to wait several months for diagnosis and treatment. The costly and time-consuming nature of PSG and the lack of sleep clinics have created a demand for suitable home-based health monitoring devices. Over the years, several devices have been developed to monitor sleep unobtrusively, while an individual is lying in bed. However, most of these devices would either disrupt the sleep of the patient or be disrupted by the patient during routine bed sheet changes. Pressure measurement using a Pressure Sensitive Mat (PSM) enables a non-contact approach for monitoring patient vital signs such as respiration rate. The PSM has the potential to replace obtrusive breathing sensors in the sleep lab and to be used as a pre-screening tool for patients suspected of having sleep apnea. This thesis proposes multiple algorithms applicable to PSM in order to assess sleep quality. First, fusion techniques are proposed to extract a breathing signal from PSM. Second, a wide range of machine learning approaches including a simple threshold-based algorithm, a linear support vector machine (SVM) and two deep learning methods (i.e., a temporal convolutional network (TCN) and a bidirectional long short-term memory (BiLSTM) network) are compared to find a good- iii performing method for automatically detecting central sleep apnea (CSA) events from PSM signals. The results show that the accuracy of the model with the best performance is 95.1% and it is achieved by the BiLSTM network. Finally, by applying SVM, personalized systems are optimized to investigate long-term sleep pattern changes such as central apnea index (CAI), bed occupancy (BO), day-clock, and night-clock from previously recorded data.

Abstract Introduction: The perception of quality of life (QoL) in patients with implantable cardiac devices including implantable cardioverter-defibrillators (ICD), followed by telemonitoring care (Home Monitoring HM), has recently become an extremely hot topic due to constantly increasing number of patients wearing these devices. This increase has resulted in an increased demand for safe, prompt, and more effective out-patient care. Methods: Our research was carried out between December 2016 and March 2017. A cohort of 150 consecutive patients with ICD, followed using the Home Monitoring system (HM+), and 150 consecutive patients with ICD, followed using conventional in-office check-ups (HM-), was retrospectively drawn from the Ceske Budejovice Hospital Patient Information System. A questionnaire, which specifically addressed QoL (EQ5D), level of anxiety and depression (HADS), and a custom questionnaire examining the relationship between patients and the HM system and telecare workflow, was sent out to all patients. Results: For the final statistical analysis, 91 (60.7%) and 104 (69.3%) of the questionnaires were used from the HM+ and HM- groups, respectively. Our results showed that the method of ICD device follow-up did not directly influence QoL. Our statistical comparison of the data did not show any difference between HM+ and HM- patients. A non-significant trend towards better QoL in HM+ compared to HM- patients was noted based on total QoL scores from the EQ5D questionnaire (68.6 ? 19 vs. 64.6 ? 16.5, p = 0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM- patients. However, more than half of the patients in both groups were in the "normal" population range with respect to anxiety and depression. The most striking difference between HM+ and HM- patients was noted in the preference for the type of follow-up: while 54.9% of HM- patients expressed an interest in remote follow-up and 45.1% said they preferred in-office check-ups, only 6.7% (p < 0.0001) of HM+ patients expressed an interest in switching to in-office check-ups with personal contact instead of remote monitoring. Willingness to partially cover the financial costs of telecare was similar in both groups. HM+ patients were more inclined to use remote ICD monitoring (p = 0.007) and had a more positive attitude toward the telecare approach overall, compared to HM- patients (p = 0.034). Conclusion: The method of device follow-up does not significantly affect QoL in patients with ICD devices, nor does it affect levels of anxiety and depression. Generally, patients with ICDs followed using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring. Although, the willingness to, at least partially, cover the costs of the HM system was limited and comparable to that of patients receiving conventional follow-up.

Swedish healthcare is facing a major challenge in the future caused byhigher needs for care, large staff redundancies and increased costs.Chronically ill people who belong to a large part of the care burden arealso expected to increase. To respond to the increased burden, severalcare units around Sweden have turned to the digitalsolution. Digital homemonitoring is a digital tool used in the care of the chronic illness. Thepurpose of this report is to investigate what experiences caregivers havewith digital home monitoring in the care of the chronically ill. The carework for the chronically ill is important because it affects the results of thechronically ill person's health condition. Data collection methods usedwere qualitative interviews with healthcare professionals and reportsfrom reliable sources. The theoretical framework is based on the theorymodel: The eHealth enhanced chronic care model (eCCM) which describesvarious components and how digital tools affect care for the chronicallyill.Results from the study show both positive and negative effectswhen using digital home monitoring. When there is a willingnessfrom patients to use the system, it contributes to a positive effect onthe state of health. Which lead to an indirectly increase of thecaregiver's experience of the tool. When a patient feels reluctant touse the system, the use has a negative effect on both the patientand the caregiver. Suggestions for further research are to dofurther research on digital home monitoring, but also focus on thenegative effects to find future solutions. / Den svenska sjukvården står inför en stor utmaning i framtiden somorsakas av högre behov av vård, stora personalavgångar och ökadekostnader. Kroniskt sjuka som tillhör en stor del av vårdbelastningenförväntas även öka. I ett försök att besvara den ökade belastningen harflera vårdenheter runtom i Sverige vänt sig mot den digitala lösningen.Digital hemmonitorering är ett digitalt verktyg som används vid vård avkroniskt sjuka. Syftet med denna rapport är att undersöka vilkaerfarenheter och upplevelser vårdgivare har med digital hemmonitoreringvid vård av kroniskt sjuka. Vårdarbetet för kroniskt sjuka är viktigteftersom det påverkar resultaten av kroniskt sjukas hälsotillstånd.Datainsamlingsmetoder som användes var kvalitativa intervjuer medvårdpersonal och rapporter från tillförlitliga källor. Det teoretiskaramverket bygger på teorimodellen The eHealth enhanced chronic caremodel (eCCM) som beskriver olika komponenter och hur digitala verktygpåverkar vård vid kroniskt sjuka.Resultat från studien visar både positiva och negativa effekter vidanvändningen av digital hemmonitorering. När det finns en vilja frånpatienter att använda systemet bidrar det till en positiv effekt påhälsotillståndet. Det ökar då indirekt vårdgivarens upplevelse avverktyget. När en patient känner motvilja till att använda systemet,påverkar användningen negativt för både patienten och vårdgivaren.Förslag till vidare forskning är att forska vidare på digital hemmonitorering, men fokusera även på de negativa effekterna för attfinna framtida lösningar.

The Swedish government and the Swedish Association of Local Authorities and Regions, cametogether on a vision that Sweden will be the most advanced country in offering opportunities fordigitalization and e-health by the year of 2025. Self-monitoring is one aspect that can digitizeworkflow in healthcare. This master thesis sought to investigate the opportunities and restrictions when implementingself-monitoring for heart failure patients in Swedish healthcare. Starting from the holisticperspective as an analysis of the clinician’s interest and the need for self-monitoring systemsby conducting a mixed method approach. Surveys were sent out to different county councilsin Sweden working with heart failure patients, and interviews were conducted withrepresentatives from primary care, specialist care, and advanced home health care. Secondly,interviews were conducted with stakeholders from the field of implementation in order togather qualitative results on the organizational, legal, and technical influencing factors,challenges, and requirements in Swedish healthcare. The qualitative data were processedthrough thematic analysis and the quantitative data was processed through descriptive analysis. The results gathered from clinicians consisted of three areas regarding functionality demandsin self-monitoring systems. The results gathered in the aspect of implementation consisted ofthree main organizational influencing aspects, three solution models from a legal perspective,as well as three aspects related in the field of technology and IT. / Sveriges regering och SKR gick samman om en vision om att Sverige ska vara det land somhar kommit längst med att erbjuda möjligheter till digitalisering av vård till år 2025. Egenmon-itorering är en aspekt som kan digitalisera arbetsflöden i vården. Detta masterarbete ämnade att undersöka möjligheter och begränsningar vid implementeringav egenmonitorering för hjärtsviktspatienter i svensk sjukvård. En mixad metodinriktninggenomfördes, som delades upp i två huvudsakliga delar. Första delen ämnade sig till kliniker,där enkäter skickades ut till olika landsting i Sverige som arbetar med hjärtsviktspatienter,samt intervjuer som genomfördes med representanter från primärvård, specialistvård ochavancerad hemsjukvård. Den första delen ämnade till att undersöka klinikers intresse ochbehov av egenmonitorering. Den andra delen bestod av intervjuer med ämnesexperter inomimplementation och digitalisera system för svensk sjukvård. Intervjuerna medimplementationsexperterna genererade kvalitativa resultat utifrån ett organisatoriskt, juridisktoch tekniskt perspektiv. Den kvalitativa datan bearbetades genom en tematisk analys och den kvantitativa datanbearbetades genom en deskriptiv analys. Resultaten som samlats in från kliniker bestod av treområden avseende funktionalitetskrav i egenmonitoreringssystem. Resultaten som samladesin gällande implementationen i svensk sjukvård bestod av tre huvudsakliga organisatoriskapåverkande aspekter, tre lösningsmodeller ur ett juridiskt perspektiv, samt tre aspekterrelaterade till teknik och IT.

Many older adults desire to maintain their quality of life by living and aging independently in their own homes. However, it is difficult for older adults to notice and track the subtle changes in their own abilities because these abilities can change gradually over a long period of time. Technology in the form of ubiquitous sensors embedded in objects in the home can play a role in keeping track of the functional abilities of individuals unobtrusively, objectively, and continuously over a long period of time. This work introduces a sensing technique called “task-based embedded assessment” that monitors how well specific tasks important for independence are carried out using everyday objects found in the home with which individuals regularly interact. Following formative studies on the information needs of older adults and their caregivers, a sensing system called “dwellSense” that can monitor, assess, and provide feedback about how well individuals complete tasks, such as taking medications, using the phone, and making coffee, was designed, built, and evaluated. Multiple longterm (over 10 months) field deployments of dwellSense were used to investigate how the data collected from the system could support greater self-awareness of abilities and intentions to improve in task performance. Presenting and reflecting on data from ubiquitous sensing systems such as dwellSense is challenging because it is both highly dimensional as well as large in volume, particularly if it is collected over a long period of time. Thus, this work also investigates the time dimension of reflection and has identified that real-time feedback is particularly useful for supporting behavior change, and longer-term trended feedback is useful for greater awareness of abilities. Traditional forms of assessing the functional abilities of individuals tend to be either biased, lacking ecological validity, infrequent, or expensive to conduct. An automated sensor-based approach for assessment is compared to traditional performance testing by a trained clinician and found to match well with clinician-generated ratings that are objective, frequent, and ecologically valid. The contributions from this thesis not only advance the state of the art for maintaining quality of life and care for older adults, but also provide the foundations for designing personal sensing systems that aim to assess an individual’s abilities and support behaviors through the feedback of objective, timely sensed information.