Smart device delivers results for kids with asthma

Smart device

A new smart asthma inhaler with an audio-visual function has dramatically improved child and adolescent use of preventative asthma medication.

The users also experienced significant improvements to their symptoms, well-being and quality of life and needed their reliever medication less frequently.

The University of Auckland study, funded by Cure Kids and the Health Research Council, showed a significant improvement in night time awakening, coughing and wheezing.

Clinical pharmacist, Amy Chan, a doctoral student with the University of Auckland, is the lead author on the paper.  

“We know one of the key reasons for children not taking their medication is parent and patient forgetfulness.  The Smartinhaler reminder system is now clinically proven to be a real solution to the problem,” she says.

“What we’ve been able to establish for the first time with this study is that the ringtone Smartinhaler significantly improves adherence to preventative medication, which results in improved quality of life for children with asthma. It’s hugely exciting,” says Ms Chan.

Children in the study were also given a Smartinhaler tracker for their rescue or ‘blue’ inhaler to measure the amount of rescue medication they used. The device was able to objectively count date and time of rescue medication use. This provided a good indication of asthma being out of control.

When symptoms worsened participants used their rescue reliever inhaler (blue inhaler), which is also known as a rescue medication because it provides immediate relief.  Recent studies have shown that overuse of the blue inhaler is a predictor of worsening asthma and general morbidity.

The study found that use of the rescue medication was significantly reduced in the group using the Nexus6 Smartinhaler reminder device.

Cure Kids Chair of Child Health Research and Ms Chan's supervisor on the study, Professor Ed Mitchell, says he is “absolutely staggered by the size of the effect. To see the improvement in the lives of these children is astounding.”

The participants also reported taking part in more sports and family activities. Parents reported feeling less frightened by their child’s asthma.

New Zealand has the second highest rates of asthma in the world and one in four Kiwi children experiences asthma symptoms. Despite this, regular adherence to asthma medication is poor.

New Zealand digital health company Nexus6 Ltd created the new Smartinhaler device called the SmartTrack, which was used in the study. The device has 14 different ringtones, which are cycled so users don’t get reminder fatigue. The SmartTrack reminder is only triggered when a dose is missed.

The results were published this month in The Lancet Respiratory Medical Journal.  To the researchers’ knowledge, this is the largest study in the world to investigate the effects of an inhaler device with audio-visual reminder function on asthma adherence and outcomes in children and adolescents.

It is also the first to show significant benefits in asthma outcomes and quality of life. The results are expected to gain international interest.

The controlled trial recruited 220 children between the ages of six and 15 who presented to emergency departments with asthma symptoms.

The study was randomised with half of the participants receiving a SmartTrack device for use with their preventative or ‘orange’ inhaler that had the audiovisual elements turned on, and the other half receiving the same device with the audiovisual elements turned off.

Participants were followed up every two months for six months and general asthma control was checked.

Key findings from the study were:

Medication adherence rate for the patient group given the audiovisual enabled SmartTrack inhaler were 84 percent compared to 30 percent for the control group. This equals a 180% increase in medication adherence.
The use of emergency medication or the ‘blue’ inhaler was significantly reduced. The median percentage days on which a reliever was used in the intervention group was 9.5 percent compared to 17.4 percent in the control group. This equals a 45percentreduction in rescue medication use.
Symptoms, well-being and quality of life for the children was significantly improved.

Source: Auckland University

Tailored 'activity coaching' by smartphone

Tailored activity monitoring. Credit: Image courtesy of University of Twente

Today's smartphone user can obtain a lot of data about his or her health, thanks to built-in or separate sensors. Researcher Harm op den Akker of the University of Twente (CTIT Institute) now takes this health monitoring to a higher level. Using the system he developed, the smartphone also acts as an 'activity coach': it advices the user to walk or take a rest. In what way the user wants to be addressed, is typically something the system learns by itself. Op den Akker conducted his research at Roessingh Research and Development in Enschede. October 17, he defends his PhD-thesis.

The new telemedicine system was tested for three months, among a group of COPD patients -- a chronic lung disease. For these patients, physical activity is very important but it can also lead to an oppressed feeling and thus, to over-cautiousness. Using the coaching system of Van den Akker, the patients carry a small movement sensor and a smartphone. The system calculates if it is advisable to take a rest or, on the other hand, have a walk. The system is 'context aware': it looks at the time of day, the weather, the surroundings of the patient and determines if the time is right for taking some exercise.

Tone of voice

In addition, the system knows how the patient wants to be addressed. Some people don't mind an imperative tone of voice 'go for a 10 minutes' walk', others prefer a more friendly advice: 'what if you would take a walk in the park?' Op den Akker designed learning algorithms for this: the system learns the preferences of the user by itself. Future versions of the system may not use text messages anymore, but an 'avatar' on the screen, enabling interaction with the user as well. For this, Op den Akker has started starting cooperation with the Human Media Interaction group of the University of Twente.

Roessingh Research & Development (RRD) is the research department of Roessingh rehabilitation centre in Enschede, The Netherlands. RRD closely cooperates with the University of Twente in many projects. Op den Akker conducted his research at RRD and UT's CTIT Institute, under supervision of Hermie Hermens, Professor in Neuromuscular Control and Telemedicine. A spin-off company of the university, Inertia Technology, developed the movement sensor used in this project.

Op den Akker's PhD-thesis is titled 'Smart tailoring of real-time physical activity coaching systems'.

Source: University of Twente

Smartphone sensors leave trackable fingerprints

Example demonstrating how accelerometer data shared with separate traffic and health applications could indicate Bob's location. Credit: Image courtesy of University of Illinois College of Engineering

Fingerprints -- those swirling residues left on keyboards and doorknobs -- are mostly invisible. They can affirm your onetime presence, but they cannot be used to track your day-to-day activities.

They cannot tell someone in real time that after exercising at the gym, you went to office in a bus and played video games during lunch. But what if our hand-held electronics are leaving real-time fingerprints instead? Fingerprints that are so intrinsic to the device that, like our own, they cannot be removed?

Research by Associate Professor Romit Roy Choudhury and graduate students Sanorita Dey and Nirupam Roy has demonstrated that these fingerprints exist within smartphone sensors, mainly because of imperfections during the hardware manufacturing process.

In some ways, it's like cutting out sugar cookies. Even using the same dinosaur-shaped cutter, each cookie will come out slightly different: a blemish here, a pock there. For smartphone sensors, these imperfections simply occur at the micro- or nanoscale.

Their findings were published at the Network and Distributed System Security Symposium (NDSS), a major conference on wireless and web security, held last February in San Diego. 

The research also won the best poster award at the HotMobile international workshop in 

2013.

The researchers focused specifically on the accelerometer, a sensor that tracks three-dimensional movements of the phone -- essential for countless applications, including pedometers, sleep monitoring, mobile gaming -- but their findings suggest that other sensors could leave equally unique fingerprints.

"When you manufacture the hardware, the factory cannot produce the identical thing in millions," Roy said. "So these imperfections create fingerprints."

Of course, these fingerprints are only visible when accelerometer data signals are analyzed in detail. Most applications do not require this level of analysis, yet the data shared with all applications -- your favorite game, your pedometer -- bear the mark. Should someone want to perform this analysis, they could do so.

The researchers tested more than 100 devices over the course of nine months: 80 standalone accelerometer chips used in popular smartphones, 25 Android phones, and 2 tablets.

The accelerometers in all permutations were selected from different manufacturers, to ensure that the fingerprints weren't simply defects resulting from a particular production line.

With 96 percent accuracy, the researchers could discriminate one sensor from another.

"We do not need to know any other information about the phone -- no phone number or SIM card number," Dey said. "Just by looking at the data, we can tell you which device it's coming from. It's almost like another identifier."

In the real world, this suggests that even when a smartphone application doesn't have access to location information (by asking "this application would like to use your current location"), there are other means of identifying the user's activities. It could be obtained with an innocuous-seeming game or chatting service, simply by recording and sending accelerometer data. There are no regulations mandating consent.

To collect the data, the researchers -- as with any would-be attacker -- needed to sample the accelerometer data. Each accelerometer was vibrated using a single vibrator motor -- like those that buzz when a text message is received -- for two-second intervals. During those periods, the accelerometer detected the movement and the readings were transmitted to a supervised-learning tool, which decoded the fingerprint.

"Even if you erase the app in the phone, or even erase and reinstall all software," Roy said, "the fingerprint still stays inherent. That's a serious threat."

At this point, however, there is no absolute solution. Smartphone cases made of rubber or plastic do little to mask the signal. Deliberately injecting white noise in the sensor data can smudge the fingerprint, but such noise can also affect the operation of the application, making your pedometer inaccurate and functionally useless.

If accelerometer data were processed directly on the phone or tablet, rather than on the cloud, the fingerprint could be scrubbed before sending information to the application.

That is, the pedometer application might only receive basic information like "300 steps taken," rather than receiving the raw accelerometer data. This, however, imposes a load on the phone's processor and, more importantly, reduces the phone's battery life.

The research also suggests that other sensors in the phone -- gyroscopes, magnetometers, microphones, cameras, and so forth -- could possess the same types of idiosyncratic differences. So even if, at a large scale, the accuracy of accelerometer fingerprints diminishes, when combined with prints from other sensors, an attack could be even more precise.

"Imagine that your right hand fingerprint, by some chance, matches with mine," Roy Choudhury said. "But your left-hand fingerprint also matching with mine is extremely unlikely. So even if accelerometers don't have unique fingerprints across millions of devices, we believe that by combining with other sensors such as the gyroscope, it might still be possible to track a particular device over time and space."

For smartphone users and e-book readers, smartwatch wearers and tablet devotees, perhaps the most critical take-home message, in the short run anyway, is the importance of vigilance.

"Don't share your accelerometer data without thinking about how legitimate or how secure that application is," Dey said. "Even if it's using only the sensor data, still it can attack you in some way. The consumer should be aware."

Source: University of Illinois College of Engineering

That smartphone is giving your thumbs superpowers

While neuroscientists have long studied brain plasticity in expert groups--musicians or video gamers, for instance--smartphones present an opportunity to understand how regular life shapes the brains of regular people. Credit: © Antonioguillem / Fotolia

When people spend time interacting with their smartphones via touchscreen, it actually changes the way their thumbs and brains work together, according to a report in the Cell Press journal Current Biology on December 23. More touchscreen use in the recent past translates directly into greater brain activity when the thumbs and other fingertips are touched, the study shows.

"I was really surprised by the scale of the changes introduced by the use of smartphones," says Arko Ghosh of the University of Zurich and ETH Zurich in Switzerland. "I was also struck by how much of the inter-individual variations in the fingertip-associated brain signals could be simply explained by evaluating the smartphone logs."

It all started when Ghosh and his colleagues realized that our newfound obsession with smartphones could be a grand opportunity to explore the everyday plasticity of the human brain. Not only are people suddenly using their fingertips, and especially their thumbs, in a new way, but many of us are also doing it an awful lot, day after day. Not only that, but our phones are also keeping track of our digital histories to provide a readymade source of data on those behaviors.

Ghosh explains it this way: "I think first we must appreciate how common personal digital devices are and how densely people use them. What this means for us neuroscientists is that the digital history we carry in our pockets has an enormous amount of information on how we use our fingertips (and more)."

While neuroscientists have long studied brain plasticity in expert groups--musicians or video gamers, for instance--smartphones present an opportunity to understand how regular life shapes the brains of regular people.

To link digital footprints to brain activity in the new study, Ghosh and his team used electroencephalography (EEG) to record the brain response to mechanical touch on the thumb, index, and middle fingertips of touchscreen phone users in comparison to people who still haven't given up their old-school mobile phones.

The researchers found that the electrical activity in the brains of smartphone users was 

enhanced when all three fingertips were touched. In fact, the amount of activity in the cortex of the brain associated with the thumb and index fingertips was directly proportional to the intensity of phone use, as quantified by built-in battery logs. The thumb tip was even sensitive to day-to-day fluctuations: the shorter the time elapsed from an episode of intense phone use, the researchers report, the larger was the cortical potential associated with it.

The results suggest to the researchers that repetitive movements over the smooth touchscreen surface reshape sensory processing from the hand, with daily updates in the brain's representation of the fingertips. And that leads to a pretty remarkable idea: "We propose that cortical sensory processing in the contemporary brain is continuously shaped by personal digital technology," Ghosh and his colleagues write.

What exactly this influence of digital technology means for us in other areas of our lives is a question for another day. The news might not be so good, Ghosh and colleagues say, noting evidence linking excessive phone use with motor dysfunctions and pain.

Source: Cell Press