An Overview of Smart Shoes in the Internet of Health Things: Gait and Mobility Assessment in Health Promotion and Disease Monitoring

New smart technologies and the internet of things increasingly play a key role in healthcare and wellness, contributing to the development of novel healthcare concepts. These technologies enable a comprehensive view of an individual’s movement and mobility, potentially supporting healthy living as well as complementing medical diagnostics and the monitoring of therapeutic outcomes. This overview article specifically addresses smart shoes, which are becoming one such smart technology within the future internet of health things, since the ability to walk defines large aspects of quality of life in a wide range of health and disease conditions. Smart shoes offer the possibility to support prevention, diagnostic work-up, therapeutic decisions, and individual disease monitoring with a continuous assessment of gait and mobility. This overview article provides the technological as well as medical aspects of smart shoes within this rising area of digital health applications, and is designed especially for the novel reader in this specific field. It also stresses the need for closer interdisciplinary interactions between technological and medical experts to bridge the gap between research and practice. Smart shoes can be envisioned to serve as pervasive wearable computing systems that enable innovative solutions and services for the promotion of healthy living and the transformation of health care

CNN-Based Estimation of Sagittal Plane Walking and Running Biomechanics From Measured and Simulated Inertial Sensor Data

Machine learning is a promising approach to evaluate human movement based on wearable sensor data. A representative dataset for training data-driven models is crucial to ensure that the model generalizes well to unseen data. However, the acquisition of sufficient data is time-consuming and often infeasible. We present a method to create realistic inertial sensor data with corresponding biomechanical variables by 2D walking and running simulations. We augmented a measured inertial sensor dataset with simulated data for the training of convolutional neural networks to estimate sagittal plane joint angles, joint moments, and ground reaction forces (GRFs) of walking and running. When adding simulated data, the root mean square error (RMSE) of the test set of hip, knee, and ankle joint angles decreased up to 17 %, 27 % and 23 %, the RMSE of knee and ankle joint moments up to 6 % and the RMSE of anterior-posterior and vertical GRF up to 2 and 6 %. Simulation-aided estimation of joint moments and GRFs was limited by inaccuracies of the biomechanical model. Improving the physics-based model and domain adaptation learning may further increase the benefit of simulated data. Future work can exploit biomechanical simulations to connect different data sources in order to create representative datasets of human movement. In conclusion, machine learning can benefit from available domain knowledge on biomechanical simulations to supplement cumbersome data collections

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Hidden Markov Model-Based Smart Annotation for Benchmark Cyclic Activity Recognition Database Using Wearables

Activity monitoring using wearables is becoming ubiquitous, although accurate cycle level analysis, such as step-counting and gait analysis, are limited by a lack of realistic and labeled datasets. The effort required to obtain and annotate such datasets is massive, therefore we propose a smart annotation pipeline which reduces the number of events needing manual adjustment to 14%. For scenarios dominated by walking, this annotation effort is as low as 8%. The pipeline consists of three smart annotation approaches, namely edge detection of the pressure data, local cyclicity estimation, and iteratively trained hierarchical hidden Markov models. Using this pipeline, we have collected and labeled a dataset with over 150,000 labeled cycles, each with 2 phases, from 80 subjects, which we have made publicly available. The dataset consists of 12 different task-driven activities, 10 of which are cyclic. These activities include not only straight and steady-state motions, but also transitions, different ranges of bouts, and changing directions. Each participant wore 5 synchronized inertial measurement units (IMUs) on the wrists, shoes, and in a pocket, as well as pressure insoles and video. We believe that this dataset and smart annotation pipeline are a good basis for creating a benchmark dataset for validation of other semi- and unsupervised algorithms

Hidden Markov model-based smart annotation for benchmark cyclic activity recognition database using wearables

Activity monitoring using wearables is becoming ubiquitous, although accurate cycle level analysis, such as step-counting and gait analysis, are limited by a lack of realistic and labeled datasets. The effort required to obtain and annotate such datasets is massive, therefore we propose a smart annotation pipeline which reduces the number of events needing manual adjustment to 14%. For scenarios dominated by walking, this annotation effort is as low as 8%. The pipeline consists of three smart annotation approaches, namely edge detection of the pressure data, local cyclicity estimation, and iteratively trained hierarchical hidden Markov models. Using this pipeline, we have collected and labeled a dataset with over 150,000 labeled cycles, each with 2 phases, from 80 subjects, which we have made publicly available. The dataset consists of 12 different task-driven activities, 10 of which are cyclic. These activities include not only straight and steady-state motions, but also transitions, different ranges of bouts, and changing directions. Each participant wore 5 synchronized inertial measurement units (IMUs) on the wrists, shoes, and in a pocket, as well as pressure insoles and video. We believe that this dataset and smart annotation pipeline are a good basis for creating a benchmark dataset for validation of other semi- and unsupervised algorithms

Smart Annotation of Cyclic Data Using Hierarchical Hidden Markov Models

Cyclic signals are an intrinsic part of daily life, such as human motion and heart activity. The detailed analysis of them is important for clinical applications such as pathological gait analysis and for sports applications such as performance analysis. Labeled training data for algorithms that analyze these cyclic data come at a high annotation cost due to only limited annotations available under laboratory conditions or requiring manual segmentation of the data under less restricted conditions. This paper presents a smart annotation method that reduces this cost of labeling for sensor-based data, which is applicable to data collected outside of strict laboratory conditions. The method uses semi-supervised learning of sections of cyclic data with a known cycle number. A hierarchical hidden Markov model (hHMM) is used, achieving a mean absolute error of 0.041 ± 0.020 s relative to a manually-annotated reference. The resulting model was also used to simultaneously segment and classify continuous, ‘in the wild’ data, demonstrating the applicability of using hHMM, trained on limited data sections, to label a complete dataset. This technique achieved comparable results to its fully-supervised equivalent. Our semi-supervised method has the significant advantage of reduced annotation cost. Furthermore, it reduces the opportunity for human error in the labeling process normally required for training of segmentation algorithms. It also lowers the annotation cost of training a model capable of continuous monitoring of cycle characteristics such as those employed to analyze the progress of movement disorders or analysis of running technique

Synchronized Sensor Insoles for Clinical Gait Analysis in Home-Monitoring Applications

Wearable sensor systems are of increasing interest in clinical gait analysis. However, little information about gait dynamics of patients under free living conditions is available, due to the challenges of integrating such systems unobtrusively into a patient’s everyday live. To address this limitation, new, fully integrated low power sensor insoles are proposed, to target applications particularly in home-monitoring scenarios. The insoles combine inertial as well as pressure sensors and feature wireless synchronization to acquire biomechanical data of both feet with a mean timing offset of 15.0 μs. The proposed system was evaluated on 15 patients with mild to severe gait disorders against the GAITRite® system as reference. Gait events based on the insoles’ pressure sensors were manually extracted to calculate temporal gait features such as double support time and double support. Compared to the reference system a mean error of 0.06 s ±0.06 s and 3.89 % ±2.61 % was achieved, respectively. The proposed insoles proved their ability to acquire synchronized gait parameters and address the requirements for home-monitoring scenarios, pushing the boundaries of clinical gait analysis

Indoor Trajectory Reconstruction of Walking, Jogging, and Running Activities Based on a Foot-Mounted Inertial Pedestrian Dead-Reckoning System

The evaluation of trajectory reconstruction of the human body obtained by foot-mounted Inertial Pedestrian Dead-Reckoning (IPDR) methods has usually been carried out in controlled environments, with very few participants and limited to walking. In this study, a pipeline for trajectory reconstruction using a foot-mounted IPDR system is proposed and evaluated in two large datasets containing activities that involve walking, jogging, and running, as well as movements such as side and backward strides, sitting, and standing. First, stride segmentation is addressed using a multi-subsequence Dynamic Time Warping method. Then, detection of Toe-Off and Mid-Stance is performed by using two new algorithms. Finally, stride length and orientation estimation are performed using a Zero Velocity Update algorithm empowered by a complementary Kalman filter. As a result, the Toe-Off detection algorithm reached an F-score between 90% and 100% for activities that do not involve stopping, and between 71% and 78% otherwise. Resulting return position errors were in the range of 0.5% to 8.8% for non-stopping activities and 8.8% to 27.4% otherwise. The proposed pipeline is able to reconstruct indoor trajectories of people performing activities that involve walking, jogging, running, side and backward walking, sitting, and standing