Robert S H Istepanian

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Advances in Mobile HealthCare In The Nano-Bio
Technology Age

• Robert S H Istepanian
• Professor of Data Communications
• Visiting Professor St. Georges Medical School,
  University of London
• Mobile Information and Network Technologies
  Research Centre
• Faculty of Computing,Information Systems and
  Mathematics
• Kingston University, London, UK
• E-mailr.istepanian_at_kingston.ac.uk

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Summary

• MINT
• Background
• Research Activities and funded projects
• Professional collaborations
• Advances in 3G and 4G m-health Systems

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Mobile Information Network Technologies
Research Centre
MINT Research Centre
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MINT Strategy
Research PhilosophyCognitive Research Approach
and Leadership Vision to transform new research
paradigms into applicable systems for healthcare
Mobile Healthcare Systems (M-Health)
Biological Engineering
2001- 2005
Bio- Communications Bio- Information Processing
Future (B3G) Personalised Healthcare Systems
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MINT Research Centre
Group Leader   Prof. Robert Istepanian BSc.,
MSc., PhD., CEng., FIEE, Sr MIEEE   Academic
Staff   Dr. David Wertheim (Reader) Dr.
Xinheng Wang (Senier Lect.)   Research and
Visiting Researcher staff   Dr. Fabien Courreges
(Univ. of Orlan, France) Mr. Alvaro Alesanco
(Univ. of Zaragoza, Spain)   Mr. Nilesh Prag (
Research Fellow) Ms. Amalia Ojeda (Research
Assistant) Research Students   Mr. Adbul Zahar
Salem Mr. Christos Lionzou Mr. Sotos
Voskarides Mr. Sotiris Avgousti Ms. Nada
Philip Ms. Ying Zou Mr. Ala M. H.
Sungoor Some Medical Collaborations   St.
Georges Medical School, University of London and
NHS Trust Central Middlesex Hospital and North
West NHS Trust University of Wales NHS
Trusts   The group has strong collaborations with
other leading Research Centres in UK Other
International Universities Research
Institutions.  
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Current and ongoing Funded research projects

• Research Income on MINT In Access of 1 M since
  2000
• Funding from
• EU ( IST and e-Ten Programmes)
• Industry
• NHS
• Other UK funding bodies

HEIF2
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PhD Research Projects and Areas of Interest

• Resilient techniques of medical Video streaming
  over 3G-mobile channels.
• Enhanced Medical QoS Models for 3G and Beyond 3G
  for M-health Systems (m-QoS).
• Enhanced medical video streaming techniques for
  3G Mobile Communication Systems.
• Robust 3G Mobile Telecardiology Systems
• Bio-Communication systems

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MINT Publications and Editorial Board

• Publication of more that 140 papers and Three
  Books including (40 IEEE Trans. and IEE
  Proceeding papers)
• Founding Advisory Board of the IEEE Trans.
  Information Technologies in Biomedicine (1997-
  To-date)
• Guest Editorials of three IEEE Transactions
  Special Issues on Mobile Telemedicine (September
  2000) and Mobile Health Systems (Dec. 2004)- in
  IEEE Trans. Information Technologies in
  Biomedicine.
• Editorial Board of the IEEE Transactions on
  NanoBioScience and Guest Editor on Microarray
  Imaging Technologies (Dec. 2003)
• Co-Editor- In-Chief ( Designate) Technology and
  Health Care Journal/ International Journal of
  Health Care Engineering (IOS Press).
• Associate Editor of Journal Health Care
  Technologies and Journal of Mobile Multimedica
  Technologies

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MINT Professional Affiliations

• Mobile Innovation Centre supports through
  Westfocus and HEIF (A Deputy Prime Minister
  funding initiative)
• IEEE Healthcare contacts and collaborations
  (Special Meetings Symposium)
• Strong collaborations with 3G Network Service
  providers
• Collaborations with Harvard Medical School, MIT
  and Partners Telemedicine
• Strong reputation with European Commission
  Information Society Strategic Research Projects
• Strong reputation with NHS Primary Care Trusts
• Links with Welsh Telemedicine Framework
• Links with European Commission

MINT Research Centre
HEIF
Diabetes UK
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Advisory Boards and Conference Technical
Committees
Key Note and Invited Speaker of National and
International Conferences (In 2003-2004)

• Keynote Speech on Research Challenges on 4G
  Mobile Communications for the Next Generation of
  M-Health Systems, 2nd. International Conference
  on Smart Homes and Health Telematics, Singapore,
  Sept. 15-17, 2004.
• Invited Lecture on m-health Emerging Mobile
  Technologies for Health Applications,
• DTI Software Technology Outreach programme
  HealthCare Telematics Meeting- University of
  Surrey- 4th. April 2003 (www.st-outreach.org.uk)

Chair of numerous Conferences and Technical
Committes of IEEE and International Conferences
(In 2003-2005)

• Advisory Board of the International Congress on
  Medical and Care Compunetics (IMCC04), NCC, The
  Hague- Holland, June2-4, 2004.
• Co-Chair of Special Symposium on Mobile Health
  Computing in the 26th. IEEE-EMBS Annual
  International Conference, San Francisco, Sept,
  1-5, 2004.
• The Technical Program Co-Chair of the Special
  topic IEEE Information Technologies Application
  in Biomedicine Conference (IEEE-ITAB03), 22-24
  April, Birmingham, UK.

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MINT National and International Collaborations

• Professor B. Woodward- Loughborough University
• Professors Y.H. Song and X.Liu - Brunel
  University
• Professor G. Y. Zhang- Imperial College
• Professor R. Naguib- Coventry University
• Dr. S. Chen- Southampton University
• Dr. J. Whidborne - Kings College- London
• Professor D. Koutsiris- NTUA- Greece
• Professor C. Pattiches- University of Cyprus
• Professor P. Vieyers, University of Orleans,
  France
• Professor P. Bauer- Univeristy of Notre Dame, USA
• Professor S. Laxminarayan- Idaho University, USA
• Dr. E. May- Sandia National Labs- USA
• Mr. Joe Ternello Partners Telemedicine, Boston
• Mr. Jose Lacal- Motorola, USA
• Dr. D. Olivier, St. Georges Hospital
• Maine eHealth, USA
• Dr. P. Gossett, Vodfone Research, UK
• British Telecom
• France Telecom

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M-health Knowledge to Business Transfer
HEIF Higher Education Innovation Fund
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GSM-based Mobile Telemedical System
First Wireless Telemedicine EPSRC funded project
in the UK, 1997-2000 (In collaboration with
Loughborough University)
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GSM-based Mobile Telemedical System
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GSM Mobile GUI interface
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Research FundingSince 2000 Responsible for
more than 0.75 M of funding from EU, Industry
and the NHSFirst EPSRC GSM-based Mobile
Telemedical System EPSRC Funded Research Grant
GR/L50419/01 - ( In Collaboration with
Loughborough University-1997-2000)
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• M-Health
• Emerging Mobile Communications and Network
  Technologies
• For Healthcare Systems and Applications
• Istepanian (etal.), m-health Beyond Seamless
  Mobility for Global Wireless Healthcare
  Connectivity-Editorial Paper ,
• IEEE Trans. Information Technology in
  Biomedicine, Vol. 8, 4, pp. 405-412, 2004 .
• M-health is the evolution from the wireless
  perspective
• of e-health and telemedicine
• (i) 3G m-health 2002- 2005
• (ii) 4G m-health 2005- 2010

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Advanced 3G m-health Research Examplers
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Areas of m-health

• Prevention - Diagnosis- Monitoring-
  Communication - Treatment

Communication with Patient is the most
challenging issue
Disruptive Technologies V/s Seamless Mobility
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M-Health and the Connected Healthcare Imperative
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The 4 Cs of M-Health and the Connected Health
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Some World Wide Mobile Statistics

• There are now 1.5 billion mobile users
  worldwide,
• growing to 2 billion by 2007.

• In Europe, 10-15 of households now use mobile
  phones only.

• By 2005 the mobile market was worth a staggering
  800billion!
• Source 2005- Research and Market
  (www.researchandmarkets.com)

• On New Year's Day 2005, the total number of text
  messages sent
• In UK reached 133 million with annual SMS totals
  in UK is 24 Billion.
• In August 2005 China Mobile subscribers totals
  363 Million.
• Source 2005 - ITU forum

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Some Healthcare Statistics

• With a worldwide expenditure of US 3,300 billion
  in 2002,
• corresponding to 8 of the worlds gross domestic
  product,
• healthcare is the worlds largest service sector.
• 70 of this amount is spent in 5 countries USA,
  Japan, Germany, France and Italy.
• 62 of healthcare costs are primary care costs
• (physicians salaries and cost of
  hospitalization), 13 are for drug prescriptions,
  9 are for
• nursing and home healthcare.

• Cardio and vascular diseases and cancer are
  responsible
• for approximately 60 of the deaths in the US.

Source Philips Research (Accessed
Sept-2005_ www.research.philips.com
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• Some Interesting Google Statistics
• Search- Sept 2005
• Mobile Healthcare gt 30 M Hits.
• Wireless Healthcare gt 29 M Hits.
• 3G Wireless Healthcare gt 800,000 Hits
• Papers on 3G Mobile Healthcare gt 400,000 Hits

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Source Gartner Inc.
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Source Wireless World Research Forum (WWRF)
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Complexity Gap in 3G Wireless
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Capability Evolution User Data Rates
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• What is 4G ? Todate- No specific and Universal
  Definition
• Examples
• Fourth generation communications systems that are
  characterized
• by high-speed data rates at 20 Mbps, suitable
  for high-resolution
• movies and television. Initial deployments are
  anticipated 2006-2010.Source www.netmotionwirele
  ss.com/resource/glossary_popup.asp

• However, the 4G story is cantered around the
  user experience (Context-based)
• QoE (Simplicity, Performance, Service Richness)
• Security/ Trust
• Price
• Scalability
• Ubiquity
• Open Architecture and Reconfigurability.

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4G Mobile Systems Generic Architecture
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Global Seamless Roam in 4G Heterogeneous Networks
Heterogeneous various access networks
services, different terminals, multimedia sessions
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3G v/s 4G Technologies
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• Expanded 4G Feature Set
• (Although not yet defined, some of the expected
  features in a 4G system include)
• Global access, service portability, and scalable
  mobile services.
• Seamless switching, and a variety of QoS-driven
  services.
• Better scheduling and call-admission-control
  techniques.
• Ad-hoc and multi-hop networks.
• Better spectral efficiency with Seamless network
  of multiple protocols and air interfaces
• (since 4G will be all-IP, look for 4G systems to
  be compatible
• with all common network technologies, including
  802.11, WCDMA,
• Bluetooth, and HyperLAN).
• An infrastructure to handle pre-existing 3G
  systems along with
• other wireless technologies, some of which are
  currently
• under development.

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Vision 2020 from the m-health Perspective New
Mobile/ Roaming (Healthy-User) Medical Care
Requirements
3G/3.5G Mobile Networks
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State of the Art

• De Cuhna (MIDSTEP)
• Mitsuishi (RUDS)
• Salcudean
• Vilchis (TER)
• Masuda

Salcudean
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Robots - Prototypes
2004 OTELO III 5 DOF
OTELO I
2002 - Ground Industrial Device - 6DOF
2000 - Space Industrial Prototype - 4DOF
1998 - Off the shelf Laboratory Prototype - 3DOF
1995 - Tele-echography Concept
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Robotics - Requirements

• Designed to support different kinds of US
  probes
• Designed to perform examination
  in any kind of investigation (cardiac,
  gynaecologic, )
• Probe positioning
• Reliable diagnosis in Routine/ Emergency

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Robot Design

• Designed after a study of the movements
  performed by the expert on the probe

6 dof 3 rotations and 3 translations
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Expert station - Input Device

• To Control the distant robot
• One DOF hand free Input device
• Easy to use, comparable to standard probe
• 6DOF localisation sensor - Flock of BirdTM

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Patient Station
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OTELO Expert and Patient Stations
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OTELO Ffunctional Mmodalities
 
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OTELO 3G Mobile Connectivity and Test Bench
PSTN/ISDN
6 DoF Joystick
Video Camera
Master Station
Downlink
Uplink
Sound, Video, Feedback control, Ultrasound
Image, Ambient Video
Sound, Video Robot Control
PDN Internet Intranet
3G Mobile Terminal or PCMCIA Card
Video Camera
Wired or Bluetooth Interface
Microphone
OTELO DB Server
Robot Arm Ultrasound Device
Slave Station
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Ultrasound Image sequence - 384 kbps/ISDN
Normal gallbladder ?
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Ultrasound Image sequence - 384 kbps/ISDN
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A comparative Latency measurements for different
packet sizes over GPRS UMTS Network
Packet size sent 32Bytes
Latency packet loss for 32Bytes size over GPRS
Latency
packet loss for 32Bytes size over UMTS
Average 250 ms

Average 70 ms
WP 5 Communications
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An optimisation algorithm framework for the
medical ultrasound streaming traffic over the 3G
network
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OTELO Demonstration and Trials in NHS
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The Context for CDM
Young and healthy
Increasingly dependant
Options, convenience access
Development of chronic conditions
Joined up health and social care
Planned and systematic disease management Promotin
g and supporting self management choice
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Pervasive Mobile Chronic Disease Management
System
GPRS/3G Wireless Network
GPRS/3G Wireless Network
Internet
Mobile Doctor Unit
Mobile Patient Unit
GPRS/3G Wireless Network
Specialist Nurse
Data Processing
DB
NHS Net
Stationary Patient Unit
Control Centre Unit
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Pervasive Mobile Chronic Disease Management
System
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• Body Area Networks in Telecardiology

Cardio-BAN
Bluetooth Connectivity
3G Network
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Pacemaker follow-up

• After Implantation
• Programming of the pacemaker
• Basic follow-up (3 12 months interval)
• Pacemaker functionality check
• Battery depletion level (BOL, ERI, EOL)
• Sensing and pacing check
• Extended follow-up (12 18 months interval)
• If necessary Reprogramming

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Reversal of Cardiac Disease and mobile computing
management systems
Background
Methods
Results
Conclusion
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Nano Power-Bio Mobility system for Cardiac
monitoring and Management system
3G Network
Anywhere Specialist Access
Specialist server unit
NHS Data Base
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Coding method
Wavelet Transform
Two Operational modes

• Variable Bit Rate (VBR) Coefficients selected to
  accomplish a fixed reconstruction error
• Constant Bit Rate (CBR) Coefficients selected to
  accomplish a constant transmission rate

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Adhoc Networks for Pervasive Computing Systems

• We consider an integrated architecture that will
  take advantage of Mobile sensor Networks and
  3G Wireless Systems to accommodate multimedia
  medical calls with QoS requirements for m-health
  systems ( Elastic and Non-Elastic Traffic
  Classes)
• Two Issues
• Call Admission Control (CAC) Issues ( Medical
  Calls)
• Data Querys ( From Sensor Networks)

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Motohealth
Motorola A1000
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Aims of Motohealth UK clinical trial studies
The aim of the clinical trials is to
investigate, analyse and assess the Motohealth
applications,the implementation of a robust
seamless 3G-based mobile chronic disease
management m-health platform, and socio-economic
benefits of a seamless Diabetic Management
System.
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Motohealth

• MOTOHEALTH deployment Project with NHS Hospitals

• MINT carries out further scientific research and
  medical trials in UK

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Synopsis of M-Health applications for type 2
diabetes

• There are currently 1.8 million people with
  diagnosed diabetes in the United Kingdom, with a
  potential increase of 2.8 million by 2008.
• Chronic disease management is the greatest
  clinical and financial challenge for healthcare
  systems in the developed world.
• Diabetes is of particular importance for western
  health economies given the epidemic increase due
  to a combination of sedentary lifestyle,
  increasing obesity, ethnic mix and ageing
  populations.

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Motohealth Clinical Trial objectives

• Conduct a pilot study and patient trials for the
  Motorola Mobile Chronic Management Systems at
  leading NHS hospitals in the UK
• Validate the effectiveness of using emerging
  technologies within the NHS environment
• Compare the benefits of using the mobile
  monitoring service to conventional monitoring
• Assess patient acceptability and usability of the
  new service
• Model the health benefit, costs and
  cost-effectiveness of the new service and its
  potential market

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BioCommunication Systems- The Enabling
Technologies
Communication/Microelectronics
Tiny size huge storage device
Wireless communication device
MEMS
Signal/ Image processing
Biosensor and Lab-on-chips
Microarray Image
DNA
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Bio-Communication Systems
Communications System
B
A
Decode
Channel
Encode
Genetic System
Replication
Translation
Transcription
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Personalized Healthcare, Wearable Bio-Computing
Systems and Invisible Mobile Communications

• Embedded and autonomous computing
• and communication systems
• will create a new generation of pervasive and
  ubiquitous
• M-health systems

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Television is Like invention of Indoor
Plumbing. It did not change peoples habits .It
just kept them Inside the House Sir Alfred
Hitchcock- Director
THANK YOU Robert S. H. Istepanian r.istepanian_at_ki
ngston.ac.uk http//cism.kingston.ac.uk//mint
MINT Research Centre