Physical Sciences and Mathematics Commons^™

A Smartwatch Step-Counting App For Older Adults: Development And Evaluation Study, George Boateng, Curtis L. Petersen, David Kotz, Karen L. Fortuna, Rebecca Masutani, John A. Batsis

Dartmouth Scholarship

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have …

The Feasibility And Utility Of Harnessing Digital Health To Understand Clinical Trajectories In Medication Treatment For Opioid Use Disorder: D-Tect Study Design And Methodological Considerations, Lisa A. Marsch, Ching-Hua Chen, Sara R. Adams, Asma Asyyed, Monique B. Does, Saeed Hassanpour, Emily Hichborn, Melanie Jackson-Morris, Nicholas C. Jacobson, Heather K. Jones, David Kotz, Chantal A. Lambert-Harris, Zhiguo Li, Bethany Mcleman, Varun Mishra, Catherine Stanger, Geetha Subramaniam, Weiyi Wu, Cynthia I. Campbell

Dartmouth Scholarship

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid …

Detecting Receptivity For Mhealth Interventions In The Natural Environment, Varun Mishra, Florian Künzler, Jan-Niklas Kramer, Elgar Fleisch, Tobias Kowatsch, David Kotz

Dartmouth Scholarship

Just-In-Time Adaptive Intervention (JITAI) is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user's receptivity. To this end, …

Barriers And Facilitators In Implementing A Pilot, Pragmatic, Telemedicine-Delivered Healthy Lifestyle Program For Obesity Management In A Rural, Academic Obesity Clinic, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David Kotz, Stephen Bartels, Summer B. Cook, Richard I. Rothstein

Dartmouth Scholarship

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.

Using Natural Language Processing And Sentiment Analysis To Augment Traditional User-Centered Design: Development And Usability Study, Curtis L. Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer B. Cook, Dawna M. Pidgeon, Brock Christensen, John A. Batsis

Dartmouth Scholarship

Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process.

Objective: This study aims …

The Application Of Digital Health To The Assessment And Treatment Of Substance Use Disorders: The Past, Current, And Future Role Of The National Drug Abuse Treatment Clinical Trials Network, Lisa A. Marsch, Aimee Campbell, Cynthia Campbell, Ching-Hua Chen, Emre Ertin, Udi Ghitza, Chantal Lambert-Harris, Saeed Hassanpour, August F. Holtyn, Yih-Ing Hser, Petra Jacobs, Jeffrey D. Klausner, Shea Lemley, David Kotz, Andrea Meier, Bethany Mcleman, Jennifer Mcneely, Varun Mishra, Larissa Mooney, Edward Nunes, Chrysovalantis Stafylis, Catherine Stanger, Elizabeth Saunders, Geetha Subramaniam, Sean Young

Dartmouth Scholarship

The application of digital technologies to better assess, understand, and treat substance use disorders (SUDs) is a particularly promising and vibrant area of scientific research. The National Drug Abuse Treatment Clinical Trials Network (CTN), launched in 1999 by the U.S. National Institute on Drug Abuse, has supported a growing line of research that leverages digital technologies to glean new insights into SUDs and provide science-based therapeutic tools to a diverse array of persons with SUDs.

This manuscript provides an overview of the breadth and impact of research conducted in the realm of digital health within the CTN. This work has …

Exploring The State-Of-Receptivity For Mhealth Interventions, Florian Künzler, Varun Mishra, Jan-Niklas Kramer, David Kotz, Elgar Fleisch, Tobias Kowatsch

Dartmouth Scholarship

Recent advancements in sensing techniques for mHealth applications have led to successful development and deployments of several mHealth intervention designs, including Just-In-Time Adaptive Interventions (JITAI). JITAIs show great potential because they aim to provide the right type and amount of support, at the right time. Timing the delivery of a JITAI such as the user is receptive and available to engage with the intervention is crucial for a JITAI to succeed. Although previous research has extensively explored the role of context in users’ responsiveness towards generic phone notiications, it has not been thoroughly explored for actual mHealth interventions. In this …

Using Vibrations From A Smartring As An Out-Of-Band Channel For Sharing Secret Keys, Sougata Sen, Varun Mishra, David Kotz

Dartmouth Scholarship

With the rapid growth in the number of Internet of Things (IoT) devices with wireless communication capabilities, and sensitive information collection capabilities, it is becoming increasingly necessary to ensure that these devices communicate securely with only authorized devices. A major requirement of this secure communication is to ensure that both the devices share a secret, which can be used for secure pairing and encrypted communication. Manually imparting this secret to these devices becomes an unnecessary overhead, especially when the device interaction is transient. In this work, we empirically investigate the possibility of using an out-of-band communication channel – vibration, generated …

Saw: Wristband-Based Authentication For Desktop Computers, Shrirang Mare, Reza Rawassizadeh, Ronald Peterson, David Kotz

Dartmouth Scholarship

Token-based proximity authentication methods that authenticate users based on physical proximity are effortless, but lack explicit user intentionality, which may result in accidental logins. For example, a user may get logged in when she is near a computer or just passing by, even if she does not intend to use that computer. Lack of user intentionality in proximity-based methods makes them less suitable for multi-user shared computer environments, despite their desired usability benefits over passwords. \par We present an authentication method for desktops called Seamless Authentication using Wristbands (SAW), which addresses the lack of intentionality limitation of proximity-based methods. SAW …

Detection And Monitoring Of Repetitions Using An Mhealth-Enabled Resistance Band, Curtis L. Peterson, Emily V. Wechsler, Ryan J. Halter, George G. Boateng, Patrick O. Proctor, David F. Kotz, Summer B. Cook, John A. Batsis

Dartmouth Scholarship

Sarcopenia is defined as an age-related loss of muscle mass and strength which impairs physical function leading to disability and frailty. Resistance exercises are effective treatments for sarcopenia and are critical in mitigating weight-loss induced sarcopenia in older adults attempting to lose weight. Yet, adherence to home-based regimens, which is a cornerstone to lifestyle therapies, is poor and cannot be ascertained by clinicians as no objective methods exist to determine patient compliance outside of a supervised setting. Our group developed a Bluetooth connected resistance band that tests the ability to detect exercise repetitions. We recruited 6 patients aged 65 years …

Workshop On Emerging Technology And Data Analytics For Behavioral Health, David Kotz, Sarah E. Lord, A. James O'Malley, Luke Stark, Lisa Marsch

Dartmouth Scholarship

Wearable and portable digital devices can support self-monitoring for patients with chronic medical conditions, individuals seeking to reduce stress, and people seeking to modify health-related behaviors such as substance use or overeating. The resulting data may be used directly by a consumer, or shared with a clinician for treatment, a caregiver for assistance, or a health coach for support. The data can also be used by researchers to develop and evaluate just-in-time interventions that leverage mobile technology to help individuals manage their symptoms and behavior in real time and as needed. Such wearable systems have huge potential for promoting delivery …

Nocloud: Experimenting With Network Disconnection By Design, Reza Rawassizadeh, Timothy Pierson, Ronald Peterson, David Kotz

Dartmouth Scholarship

Application developers often advocate uploading data to the cloud for analysis or storage, primarily due to concerns about the limited computational capability of ubiquitous devices. Today, however, many such devices can still effectively operate and execute complex algorithms without reliance on the cloud. The authors recommend prioritizing on-device analysis over uploading the data to another host, and if on-device analysis is not possible, favoring local network services over a cloud service.

Investigating Intervention Components And Exploring States Of Receptivity For A Smartphone App To Promote Physical Activity: Study Protocol Of The Ally Micro-Randomized Trial, Jan-Niklas Kramer, Florian Künzler, Varun Mishra, Bastien Presset, David Kotz, Shawna Smith, Urte Scholz, Tobias Kowatsch

Dartmouth Scholarship

Background: Smartphones enable the implementation of just-in-time adaptive interventions (JITAIs) that tailor the delivery of health interventions over time to user- and time-varying context characteristics. Ideally, JITAIs include effective intervention components, and delivery tailoring is based on effective moderators of intervention effects. Using machine learning techniques to infer each user’s context from smartphone sensor data is a promising approach to further enhance tailoring.

Objective: The primary objective of this study is to quantify main effects, interactions, and moderators of 3 intervention components of a smartphone-based intervention for physical activity. The secondary objective is the exploration of participants’ states of receptivity, …

Spice: Secure Proximity-Based Infrastructure For Close Encounters, Aarathi Prasad, Xiaohui Liang, David Kotz

Dartmouth Scholarship

We present a crowdsourcing system that extends the capabilities of location-based applications and allows users to connect and exchange information with users in spatial and temporal proximity. We define this incident of spatio-temporal proximity as a \em close encounter. Typically, location-based application users store their information on a server, and trust the server to provide access only to authorized users, not misuse the data or disclose their location history. Our system, called SPICE, addresses these privacy issues by leveraging Wi-Fi access points to connect users and encrypt their information before it is exchanged, so only users in close encounters have …

Toward Accurate And Efficient Feature Selection For Speaker Recognition On Wearables, Rui Liu, Reza Rawassizadeh, David Kotz

Dartmouth Scholarship

Due to the user-interface limitations of wearable devices, voice-based interfaces are becoming more common; speaker recognition may then address the authentication requirements of wearable applications. Wearable devices have small form factor, limited energy budget and limited computational capacity. In this paper, we examine the challenge of computing speaker recognition on small wearable platforms, and specifically, reducing resource use (energy use, response time) by trimming the input through careful feature selections. For our experiments, we analyze four different feature-selection algorithms and three different feature sets for speaker identification and speaker verification. Our results show that Principal Component Analysis (PCA) with frequency-domain …

Activityaware: An App For Real-Time Daily Activity Level Monitoring On The Amulet Wrist-Worn Device, George Boateng, Ryan Halter, John A. Batsis, David Kotz

Dartmouth Scholarship

Physical activity helps reduce the risk of cardiovascular disease, hypertension and obesity. The ability to monitor a person's daily activity level can inform self-management of physical activity and related interventions. For older adults with obesity, the importance of regular, physical activity is critical to reduce the risk of long-term disability. In this work, we present ActivityAware, an application on the Amulet wrist-worn device that measures daily activity levels (sedentary, moderate and vigorous) of individuals, continuously and in real-time. The app implements an activity-level detection model, continuously collects acceleration data on the Amulet, classifies the current activity level, updates the day's …

The Amulet Wearable Platform: Demo Abstract, Josiah Hester, Travis Peters, Tianlong Yun, Ronald Peterson, Joseph Skinner, Bhargav Golla, Kevin Storer, Steven Hearndon, Sarah Lord, Ryan Halter, David Kotz, Jacob Sorber

Dartmouth Scholarship

In this demonstration we present the Amulet Platform; a hardware and software platform for developing energy- and resource-efficient applications on multi-application wearable devices. This platform, which includes the Amulet Firmware Toolchain, the Amulet Runtime, the ARP-View graphical tool, and open reference hardware, efficiently protects applications from each other without MMU support, allows developers to interactively explore how their implementation decisions impact battery life without the need for hardware modeling and additional software development, and represents a new approach to developing long-lived wearable applications. We envision the Amulet Platform enabling long-duration experiments on human subjects in a wide variety of studies.

Implementing An Mhealth System For Substance Use Disorders In Primary Care: A Mixed Methods Study Of Clinicians’ Initial Expectations And First Year Experiences, Marie-Louise Mares, David H. Gustafson, Joseph E. Glass, Andrew Quanbeck, Helene Mcdowell, Fiona Mctavish, Amy Atwood, Lisa Marsch

Dartmouth Scholarship

Millions of Americans need but don’t receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs’ implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients’ health tracking and relapses. We examined (a) clinicians' initial perspectives about implementing Seva, and (b) the first year …

Demo: Wanda, Securely Introducing Mobile Devices, Timothy J. Pierson, Xiaohui Liang, Ronald Peterson, David Kotz

Dartmouth Scholarship

Nearly every setting is increasingly populated with wireless and mobile devices – whether appliances in a home, medical devices in a health clinic, sensors in an industrial setting, or devices in an office or school. There are three fundamental operations when bringing a new device into any of these settings: (1) to configure the device to join the wireless local-area network, (2) to partner the device with other nearby devices so they can work together, and (3) to configure the device so it connects to the relevant individual or organizational account in the cloud. The challenge is to accomplish all …

Privacy And Security In Mobile Health – A Research Agenda, David Kotz, Carl A. Gunter, Santosh Kumar, Jonathan P. Weiner

Dartmouth Scholarship

Mobile health technology has great potential to increase healthcare quality, expand access to services, reduce costs, and improve personal wellness and public health. However, mHealth also raises significant privacy and security challenges.

Zebra: Zero-Effort Bilateral Recurring Authentication, Shrirang Mare, Andrés Molina-Markham, Cory Cornelius, Ronald Peterson, David Kotz

Dartmouth Scholarship

Common authentication methods based on passwords, tokens, or fingerprints perform one-time authentication and rely on users to log out from the computer terminal when they leave. Users often do not log out, however, which is a security risk. The most common solution, inactivity timeouts, inevitably fail security (too long a timeout) or usability (too short a timeout) goals. One solution is to authenticate users continuously while they are using the terminal and automatically log them out when they leave. Several solutions are based on user proximity, but these are not sufficient: they only confirm whether the user is nearby but …

Securing Information Technology In Healthcare, Denise Anthony, Andrew T. Campbell, Thomas Candon, Andrew Gettinger, David Kotz, Lisa A. Marsch, Andrés Molina-Markham, Karen M. Page, Sean W. Smith, Carl A. Gunter, M. Eric Johnson

Dartmouth Scholarship

Information technology (IT) has great potential to improve healthcare quality while also improving efficiency, and thus has been a major focus of recent healthcare reform efforts. However, developing, deploying and using IT that is both secure and genuinely effective in the complex clinical, organizational and economic environment of healthcare is a significant challenge. Further, it is imperative that we better understand the privacy concerns of patients and providers, as well as the ability of current technologies, policies, and laws to adequately protect privacy. The Securing Information Technology in Healthcare (SITH) workshops were created to provide a forum to discuss security …

Provenance Framework For Mhealth, Aarathi Prasad, Ronald Peterson, Shrirang Mare, Jacob Sorber, Kolin Paul, David Kotz

Dartmouth Scholarship

Mobile health technologies allow patients to collect their health information outside the hospital and share this information with others. But how can data consumers know whether to trust the sensor-collected and human-entered data they receive? Data consumers might be able to verify the accuracy and authenticity of the data if they have information about its origin and about changes made to it, i.e., the \emphprovenance\/ of the data. We propose a provenance framework for mHealth devices, to collect and share provenance metadata and help the data consumer verify whether certain provenance properties are satisfied by the data they receive. This …

Privacy In Mobile Technology For Personal Healthcare, Sasikanth Avancha, Amit Baxi, David Kotz

Dartmouth Scholarship

Information technology can improve the quality, efficiency, and cost of healthcare. In this survey, we examine the privacy requirements of \emphmobile\/ computing technologies that have the potential to transform healthcare. Such \emphmHealth\/ technology enables physicians to remotely monitor patients' health, and enables individuals to manage their own health more easily. Despite these advantages, privacy is essential for any personal monitoring technology. Through an extensive survey of the literature, we develop a conceptual privacy framework for mHealth, itemize the privacy properties needed in mHealth systems, and discuss the technologies that could support privacy-sensitive mHealth systems. We end with a list of …

Understanding Sharing Preferences And Behavior For Mhealth Devices, Aarathi Prasad, Jacob Sorber, Timothy Stablein, Denis Anthony, David Kotz

Dartmouth Scholarship

mHealth devices offer many potential benefits to patients, health providers and others involved in the patients' healthcare. If patients are not in control of the collection and sharing of their personal health information, they will have privacy concerns even while enjoying the benefits of the devices. We investigated patients' willingness to share their personal health information, collected using mHealth devices, with their family, friends, third parties and the public. Our findings are based on a user study conducted with 41 participants. The best way to understand people's privacy concerns is to give them the opportunity to use the device and …

Who Wears Me? Bioimpedance As A Passive Biometric, Cory Cornelius, Jacob Sorber, Ronald Peterson, Joe Skinner, Ryan Halter, David Kotz

Dartmouth Scholarship

Mobile and wearable systems for monitoring health are becoming common. If such an mHealth system knows the identity of its wearer, the system can properly label and store data collected by the system. Existing recognition schemes for such mobile applications and pervasive devices are not particularly usable – they require ıt active engagement with the person (e.g., the input of passwords), or they are too easy to fool (e.g., they depend on the presence of a device that is easily stolen or lost). \par We present a wearable sensor to passively recognize people. Our sensor uses the unique electrical properties …

Passive Biometrics For Pervasive Wearable Devices (Poster Paper), Cory Cornelius, Zachary Marois, Jacob Sorber, Ron Peterson, Shrirang Mare, David Kotz

Dartmouth Scholarship

Wearable devices – like the FitBit, MOTOACTV, and Jawbone UP – are increasingly becoming more pervasive whether for monitoring health and fitness, personal assistance, or home automation. While pervasive wearable devices have long been researched, we are now beginning to see the fruits of this research in the form of commercial offerings. Today, many of these commercial wearable devices are closed systems that do not interoperate with other devices a person might carry. We believe, however, these commercial offerings signal the coming of wireless body-area networks that will connect these pervasive wearable devices and leverage existing devices a user already …

An Amulet For Trustworthy Wearable Mhealth, Jacob Sorber, Minho Shin, Ronald Peterson, Cory Cornelius, Shrirang Mare, Aarathi Prasad, Zachary Marois, Emma N. Smithayer, David Kotz

Dartmouth Scholarship

Mobile technology has significant potential to help revolutionize personal wellness and the delivery of healthcare. Mobile phones, wearable sensors, and home-based tele-medicine devices can help caregivers and individuals themselves better monitor and manage their health. While the potential benefits of this “mHealth” technology include better health, more effective healthcare, and reduced cost, this technology also poses significant security and privacy challenges. In this paper we propose \emphAmulet, an mHealth architecture that provides strong security and privacy guarantees while remaining easy to use, and outline the research and engineering challenges required to realize the Amulet vision.

Adapt-Lite: Privacy-Aware, Secure, And Efficient Mhealth Sensing, Shrirang Mare, Jacob Sorber, Minho Shin, Cory Cornelius, David Kotz

Dartmouth Scholarship

As healthcare in many countries faces an aging population and rising costs, mobile sensing technologies promise a new opportunity. Using mobile health (mHealth) sensing, which uses medical sensors to collect data about the patients, and mobile phones to act as a gateway between sensors and electronic health record systems, caregivers can continuously monitor the patients and deliver better care. Although some work on mHealth sensing has addressed security, achieving strong security and privacy for low-power sensors remains a challenge. \par We make three contributions. First, we propose Adapt-lite, a set of two techniques that can be applied to existing wireless …

Adaptive Security And Privacy For Mhealth Sensing, Shrirang Mare, Jacob Sorber, Minho Shin, Cory Cornelius, David Kotz

Dartmouth Scholarship

As healthcare in many countries faces an aging population and rising costs, mobile Health (mHealth) sensing technologies promise a new opportunity. However, the privacy concerns associated with mHealth sensing are a limiting factor for their widespread adoption. The use of wireless body area networks pose a particular challenge. Although there exist protocols that provide a secure and private communication channel between two devices, the large transmission overhead associated with these protocols limit their application to low-power mHealth sensing devices. We propose an adaptive security model that enables use of privacy-preserving protocols in low-power mHealth sensing by reducing the network overhead …