East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Evaluation of Whole-Brain Resting-State Functional Connectivity in Spinal Cord Injury - A Large-Scale Network Analysis Using Network Based Statistic

Large-scale network analysis characterizes the brain as a complex network of nodes and edges to evaluate functional connectivity patterns. The utility of graph-based techniques has been demonstrated in an increasing number of restingstate functional MRI (rs-fMRI) studies in the normal and diseased brain. However, to our knowledge, graph theory has not been used to study the reorganization pattern of resting-state brain networks in patients with traumatic complete spinal cord injury (SCI). In the present analysis, we applied a graph-theoretical approach to explore changes to global brain network architecture as a result of SCI. Fifteen subjects with chronic (\u3e 2 years) complete (American Spinal Injury Association [ASIA] A) cervical SCI and 15 neurologically intact controls were scanned using rs-fMRI. The data were preprocessed followed by parcellation of the brain into 116 regions of interest (ROI) or nodes. The average time series was extracted at each node, and correlation analysis was performed between every pair of nodes. A functional connectivity matrix for each subject was then generated. Subsequently, the matrices were averaged across groups, and network changes were evaluated between groups using the network-based statistic (NBS) method. Our results showed decreased connectivity in a subnetwork of the whole brain in SCI compared with control subjects. Upon further examination, increased connectivity was observed in a subnetwork of the sensorimotor cortex and cerebellum network in SCI. In conclusion, our findings emphasize the applicability of NBS to study functional connectivity architecture in diseased brain states. Further, we show reorganization of large-scale resting-state brain networks in traumatic SCI, with potential prognostic and therapeutic implications

Multimedia sensors embedded in smartphones for ambient assisted living and e-health

The final publication is available at link.springer.com[EN] Nowadays, it is widely extended the use of smartphones to make human life more comfortable. Moreover, there is a special interest on Ambient Assisted Living (AAL) and e-Health applications. The sensor technology is growing and amount of embedded sensors in the smartphones can be very useful for AAL and e-Health. While some sensors like the accelerometer, gyroscope or light sensor are very used in applications such as motion detection or light meter, there are other ones, like the microphone and camera which can be used as multimedia sensors. This paper reviews the published papers focused on showing proposals, designs and deployments of that make use of multimedia sensors for AAL and e-health. We have classified them as a function of their main use. They are the sound gathered by the microphone and image recorded by the camera. We also include a comparative table and analyze the gathered information.Parra-Boronat, L.; Sendra, S.; Jimenez, JM.; Lloret, J. (2016). Multimedia sensors embedded in smartphones for ambient assisted living and e-health. Multimedia Tools and Applications. 75(21):13271-13297. doi:10.1007/s11042-015-2745-8S13271132977521Acampora G, Cook DJ, Rashidi P, Vasilakos AV (2013) A survey on ambient intelligence in healthcare. Proc IEEE 101(12):2470–2494Al-Attas R, Yassine A, Shirmohammadi S (2012) Tele-Medical Applications in Home-Based Health Care. In proceeding of the 2012 I.E. International Conference on Multimedia and Expo Workshops (ICMEW 2012). Jul. 9–13, 2012. Melbourne, Australia. (pp. 441–446)Alemdar H, Ersoy C (2010) Wireless sensor networks for healthcare: a survey. Comput Netw 54(15):2688–2710Alqassim S, Ganesh M, Khoja S, Zaidi M, Aloul F, Sagahyroon A (2012) Sleep apnea monitoring using mobile phones. 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Biomed Eng Online 10(1):24Bourouis A, Feham M, Hossain MA, Zhang L (2014) An intelligent mobile based decision support system for retinal disease diagnosis. Decis Support Syst 59(2014):341–350Bourouis A, Zerdazi A, Feham M, Bouchachia A (2013) M-health: skin disease analysis system using Smartphone’s camera. Procedia Comput Sci 19(2013):1116–1120M.W. Brault, (2010). Americans With Disabilities: 2010. Household Economic Studies. In United States Census Bureau website. Available at: www.census.gov/prod/2012pubs/p70-131.pdf Last Access 16 Dec 2014Breath Counter App. In Google Play website. Available at: https://play.google.com/store/apps/details?id=com.softrove.app.bc Last Access 30 Nov 2014Cardinaux F, Bhowmik D, Abhayaratne C, Hawley MS (2011) Video based technology for ambient assisted living: a review of the literature. J Ambient Intell Smart Environ 3(3):253–269Cardiograph App. In Google Play website. 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Last Access 30 Nov 2014Dale O, Solheim I, Halbach T, Schulz T, Spiru L, Turcu I (2013) What seniors want in a mobile Help-On-Demand service. In proceedings of the Fifth International Conference on eHealth, Telemedicine, and Social Medicine (eTELEMED 2013). Feb. 24 – Mar. 1, 2013. Nice, France. (pp. 96–101)Estepa AJ, Estepa R, Vozmediano J, Carrillo P (2014) Dynamic VoIP codec selection on smartphones. Netw Protoc Algoritm 6(2):22–37Falk TH, Maier M (2013) Context awareness in WBANs: a survey on medical and non-medical applications. IEEE Wirel Commun 20(4):30–37Franco C, Fleury A, Guméry PY, Diot B, Demongeot J, Vuillerme N (2013) iBalance-ABF: a smartphone-based audio-biofeedback balance system. IEEE Trans Biomed Eng 60(1):211–215García M, Lloret J, Bellver I, Tomás J (2013) Intelligent IPTV Distribution for Smart Phones (Book Chapter 13). In Intelligent Multimedia Technologies for Networking Applications. IGI GlobalGregoski MJ, Mueller M, Vertegel A, Shaporev A, Jackson BB, Frenzel RM, Treiber FA (2012) Development and validation of a smartphone heart rate acquisition application for health promotion and wellness telehealth applications. Int J Telemed Appl 2012, 1. Article ID 696324Grimaldi D, Kurylyak Y, Lamonaca F, Nastro A (2011) Photoplethysmography detection by smartphone’s videocamera. In proceedings of the 6th International Conference on Intelligent Data Acquisition and Advanced Computing Systems (IEEE IDAACS 2011), Sep. 15–17, 2011. Prague, Czech Republic. (Vol. 1, pp. 488–491)Gurrin C, Qiu Z, Hughes M, Caprani N, Doherty AR, Hodges SE, Smeaton AF (2013) The smartphone as a platform for wearable cameras in health research. Am J Prev Med 44(3):308–313Haché G, Lemaire ED, Baddour N (2011) Wearable mobility monitoring using a multimedia smartphone platform. IEEE Trans Instrum Meas 60(9):3153–3161Heathers JA (2013) Smartphone-enabled pulse rate variability: an alternative methodology for the collection of heart rate variability in psychophysiological research. Int J Psychophysiol 89(3):297–304Hoseini-Tabatabaei SA, Gluhak A, Tafazolli R (2013) A survey on smartphone-based systems for opportunistic user context recognition. ACM Comput Surv (CSUR) 45(3):1–51, Paper No. 27Illiger K, Hupka M, von Jan U, Wichelhaus D, Albrecht UV (2014) Mobile technologies: expectancy, usage, and acceptance of clinical staff and patients at a University Medical Center. JMIR mHealth uHealth 2(4), e42Kanjo E (2012) Tools and architectural support for mobile phones based crowd control systems. Netw Protoc Algoritm 4(3):4–14Kawano Y, Yanai K (2014) FoodCam: a real-time food recognition system on a smartphone. Multimedia Tools and Applications,Published online:April 2014: 1–25Khan FH, Khan ZH (2010) A systematic approach for developing mobile information system based on location based services. Netw Protoc Algoritm 2(2):54–65Kochanov D, Jonas S, Hamadeh N, Yalvac E, Slijp H, Deserno TM (2014) Urban Positioning Using Smartphone-Based Imaging. In Bildverarbeitung für die Medizin, 2014: 186–191Kurniawan S (2008) Older people and mobile phones: a multi-method investigation. Int J Human-Comput Stud 66(12):889–901Lacuesta R, Lloret J, Sendra S, Peñalver L (2014) Spontaneous Ad Hoc mobile cloud computing network. Sci World J 2014:1–19Lakens D (2013) Using a Smartphone to measure heart rate changes during relived happiness and anger. IEEE Trans Affect Comput 5(3):217–226Larson EC, Goel M, Boriello G, Heltshe S, Rosenfeld M, Patel SN (2012) Spirosmart: using a microphone to measure lung function on a mobile phone, In proceedings of the 2012 ACM Conference on Ubiquitous Computing (UBIComp 2012). Sep. 05–08, 2012. Pittsburgh, USA. (pp. 280–289)Lee J, Reyes BA, McManus DD, Mathias O, Chon KH (2012) Atrial fibrillation detection using a smart phone. In proceedings of the 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC 2012). Aug.28-Sep.1, 2012. San Diego, (pp. 1177–1180)Lloret J, Garcia M, Bri D, Diaz JR (2009) A cluster-based architecture to structure the topology of parallel wireless sensor networks. Sensors (Basel) 9(12):10513–10544Lu H, Frauendorfer D, Rabbi M, Mast MS, Chittaranjan GT, Campbell AT, Gatica-Perez D, Choudhury T (2012) StressSense: detecting stress in unconstrained acoustic environments using smartphones. In Proceedings of the 2012 ACM Conference on Ubiquitous Computing (UBIComp 2012). Sep. 05–08, 2012. Pittsburgh, USA. (pp. 351–360)Macías E, Abdelfatah H, Suárez A, Cánovas A (2011) Full geo-localized mobile video in Android mobile telephones. Netw Protoc Algoritm 3(1):64–81Macias E, Lloret J, Suarez A, Garcia M (2012) Architecture and protocol of a semantic system designed for video tagging with sensor data in mobile devices. Sensors 12(2):2062–2087Macias E, Suarez A, Lloret J (2013) Mobile sensing systems. Sensors 13(12):17292–17321MedCam App. In Google Play website. Available at: https://play.google.com/store/apps/details?id=com.cupel.MedCam . Last Access 30 Nov 2014Monteiro DM, Rodrigues JJ, Lloret J, Sendra S (2014) A hybrid NFC–Bluetooth secure protocol for Credit Transfer among mobile phones. Secur Commun Netw 7(2):325–337Mosa ASM, Yoo I, Sheets L (2012) A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak 12(1):67MyEarDroid App. In Google Play website. Available at: https://play.google.com/store/apps/details?id=com.tecnalia.health.myeardroid . Last Access 30 Nov 2014O’Grady MJ, Muldoon C, Dragone M, Tynan R, O’Hare GM (2010) Towards evolutionary ambient assisted living systems. 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In Pew Research Center’s Internet & American Life Project website. Available at: http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/ Last Access 25 Nov 2014SnoreClock App. In Google Play website. Available at: https://play.google.com/store/apps/details?id=de.ralphsapps.snorecontrol Last Access 30 Nov 2014Storf H, Kleinberger T, Becker M, Schmitt M, Bomarius F, Prueckner S (2009) An event-driven approach to activity recognition in ambient assisted living. Lect Notes Comput Sci 5859:123–132Su X, Tong H, Ji P (2014) Activity recognition with smartphone sensors. Tsinghua Sci Technol 19(3):235–249Tapu R, Mocanu B, Bursuc A, Zaharia T (2013) A smartphone-based obstacle detection and classification system for assisting visually impaired people. In proceedings of the 2013 I.E. International Conference on Computer Vision Workshops (ICCVW 2013). Dec. 2–8, 2013. Sydney, Australia. (pp. 444–451)The vOICe for Android App. In Google Play website. 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Effects of physical exercise on outcomes of cardiac (dys)function in women with breast cancer undergoing anthracycline or trastuzumab treatment: study protocol for a systematic review

Background: Cardiotoxicity is a known complication and one of the most adverse effects from the use of conventional treatments such as anthracyclines and trastuzumab in breast cancer (BC) care. This phenomenon has been associated with the restriction of therapeutic options and the increase of cardiovascular complications, which may compromise the survival of patients. Implementation of preventive strategies is an important approach for the management of this issue. Physical exercise has been proposed as a non-pharmacological strategy to counteracting cardiotoxicity. The aim of this protocol is to describe the rationale and methods for a systematic review of published randomized controlled trials (RCTs) that have analysed the effects of physical exercise on outcomes of cardiac (dys)function in women with BC undergoing neoadjuvant or adjuvant treatment containing anthracyclines and/or trastuzumab. Methods and analysis: This is a protocol for a systematic review reported according to the PRISMA-P 2015 checklist. Randomized controlled trials (RCTs) will be included. The literature will be screened on MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus. The risk of bias of the included RCTs will be assessed using the Cochrane Collaboration’s tool. The primary outcomes will be systolic function (left ventricular ejection fraction), diastolic function (E/A’ ratio, deceleration time of early left ventricular filling, isovolumetric relaxation time, E/E’ septal and lateral ratio) and myocardial deformation imaging outcomes (strain and strain rate [measured in longitudinal, radial, or circumferential directions]). Secondary outcomes will be cardiac biomarkers (troponin I or T, highsensitivity troponin I or T, brain natriuretic peptide, amino terminal of B-type natriuretic peptide). Data will be descriptively reported, and quantitative synthesis will also be considered if the included studies are sufficiently homogenous. Discussion: This systematic review will help to understand the effectiveness of physical exercise on counteracting cardiotoxicity related to anticancer therapies in women with BC.publishe

Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study

Functional magnetic resonance imaging (fMRI) studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI) patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity). However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI) study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (\u3e2 years post injury) and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI) based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system

Physiological and behavior monitoring systems for smart healthcare environments: a review

Healthcare optimization has become increasingly important in the current era, where numerous challenges are posed by population ageing phenomena and the demand for higher quality of the healthcare services. The implementation of Internet of Things (IoT) in the healthcare ecosystem has been one of the best solutions to address these challenges and therefore to prevent and diagnose possible health impairments in people. The remote monitoring of environmental parameters and how they can cause or mediate any disease, and the monitoring of human daily activities and physiological parameters are among the vast applications of IoT in healthcare, which has brought extensive attention of academia and industry. Assisted and smart tailored environments are possible with the implementation of such technologies that bring personal healthcare to any individual, while living in their preferred environments. In this paper we address several requirements for the development of such environments, namely the deployment of physiological signs monitoring systems, daily activity recognition techniques, as well as indoor air quality monitoring solutions. The machine learning methods that are most used in the literature for activity recognition and body motion analysis are also referred. Furthermore, the importance of physical and cognitive training of the elderly population through the implementation of exergames and immersive environments is also addressedinfo:eu-repo/semantics/publishedVersio

State of the art of audio- and video based solutions for AAL

Working Group 3. Audio- and Video-based AAL ApplicationsIt is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living (AAL) technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters (e.g., heart rate, respiratory rate). Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals (e.g., speech recordings). Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary 4 debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely (i) lifelogging and self-monitoring, (ii) remote monitoring of vital signs, (iii) emotional state recognition, (iv) food intake monitoring, activity and behaviour recognition, (v) activity and personal assistance, (vi) gesture recognition, (vii) fall detection and prevention, (viii) mobility assessment and frailty recognition, and (ix) cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed.publishedVersio

Central monitoring system for ambient assisted living

Smart homes for aged care enable the elderly to stay in their own homes longer. By means of various types of ambient and wearable sensors information is gathered on people living in smart homes for aged care. This information is then processed to determine the activities of daily living (ADL) and provide vital information to carers. Many examples of smart homes for aged care can be found in literature, however, little or no evidence can be found with respect to interoperability of various sensors and devices along with associated functions. One key element with respect to interoperability is the central monitoring system in a smart home. This thesis analyses and presents key functions and requirements of a central monitoring system. The outcomes of this thesis may benefit developers of smart homes for aged care