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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1

     Chapter 1

    Introduction

    People are currently surrounded by technology, which tries to increase their uality of life

    and facilitate the daily acti!ities" #n addition, the continuous ad!ancement in mobile

    computing makes it possible to obtain information about the conte$t and also to react

     physically to it, in more inno!ati!e ways" Howe!er, there are situations, where technology is

    difficult to be handled or people ha!e lack of knowledge to use it" %or these reasons, ambient

    intelligence &'m#( tries to adapt the technology to the people)s needs by proposing three

     basic concepts* ubiuitous computing, ubiuitous communication, and intelligent user 

    interfaces" #n order to reach this ob+ecti!e, it is necessary to de!elop new frameworks and

    models to allow access to functionalities, regardless of time and location restrictions"

    This report describes a telemonitoring system aimed at impro!ing healthcare and

    assistance to dependent people at their homes" This system makes use of the Services laYers

    over Light   PHysical devices &S-PH( platform" S-PH is based on a ser!ice.oriented

    architecture &S/'( model for integrating heterogeneous wireless sensors networks &WSNs(

    into 'm# systems" S-PH focuses on distributing the systems) functionalities into

    independent functionalities &i"e", ser!ices(" This model pro!ides a fle$ible distribution of 

    resources and facilitates the inclusion of new functionalities in highly dynamic en!ironments"

    1.1 Ambient Intelligence: 

    #n computing, ambient intelligence  &AmI( refers to electronic en!ironments that are

    sensiti!e and responsi!e to the presence of people" 'mbient intelligence is a !ision on the

    future of consumer electronics, telecommunications and computing that was originallyde!eloped in the late 100s for the time frame 21322" #n an ambient intelligence world,

    de!ices work in concert to support people in carrying out their e!eryday life acti!ities, tasks

    and rituals in easy, natural way using information and intelligence that is hidden in the

    network connecting these de!ices" 's these de!ices grow smaller, more connected and more

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 2

    integrated into our en!ironment, the technology disappears into our surroundings until only

    the user interface remains percei!able by users"

    1.2 Service Oriented Architecture*

    #n software engineering, a service-oriented architecture  &SOA( is a style of software

    architecture for designing and de!eloping software in the form of interoperable ser!ices"

    These ser!ices ha!e well.defined business functionalities that are built as software

    components &discrete pieces of code and8or data structures( which can be reused for 

    different purposes" S/' design principles are used during the phases of systems

    de!elopment and integration"

    S/' generally pro!ides a way for consumers of ser!ices, such as web.based

    applications, to be aware of a!ailable S/'.based ser!ices" %or e$ample, se!eral disparate

    departments within a company may de!elop and deploy S/' ser!ices in different

    implementation languages9 their respecti!e clients will benefit from a well.defined interface

    to access them" :;- is often used for interfacing with S/' ser!ices"

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 7

    Chapter 2

    "istor$

    5$cessi!e centrali>ation of ser!ices negati!ely affects the systems) functionalities,

    o!ercharging, or limiting their capabilities" 4lassical functional architectures are

    characteri>ed by trying to find modularity and a structure oriented to the system itself"

    ;odern functional architectures like S/', consider integration and performance aspects that

    must be taken into account when functionalities are created outside the system" 'n S/'.

     based system is a network of independent ser!ices, machines, the people who operate, affect,

    use, and go!ern those ser!ices, as well as the suppliers of euipment and personnel to these

     people and ser!ices" The term ser!ice can be defined as a mechanism that facilitates the

    access to one or more functionalities &e"g", functions, network capabilities, etc"("

    The S/' model is aimed at the interoperability between different systems,

    distribution of resources, and the lack of dependency of programming languages" Ser!ices

    are linked by means of standard communication protocols that must be used by applications

    in order to share resources in the ser!ices network" The compatibility and management of 

    messages that the ser!ices generate to pro!ide their functionalities is an important and

    comple$ element in any of these approaches" ' distributed architecture pro!ides more

    fle$ible ways to mo!e functions to where actions are needed, thus obtaining better responses

    at e$ecution time, autonomy, ser!ices continuity, and superior le!els of fle$ibility and

    scalability than centrali>ed architectures" Unfortunately, the difficulty in de!eloping a

    distributed architecture is higher" This way, it is necessary to ha!e a more comple$ system

    analysis and design, which implies more time to reach the implementation stage"

    'm#.based de!elopments will reuire the use of se!eral sensors and actuatorsstrategically distributed in the en!ironment" This pro!ides the systems with conte$t.aware

    capabilities in order to change its beha!ior automatically" #t is possible to make a difference

     between sensor networks* wired and wireless" There are se!eral technologies for creating

    wired sensors networks, such as :1, -on Works, or ?N:" Howe!er, wired networks are not

    as fle$ible as WSNs and reuire more infrastructural support" /n the other hand, wireless

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare @

    technologies enable easier deployments than the wired ones, a!oiding the need of wiring

    homes or hospitals and decreasing the costs, and drawbacks of the setup phase" The AigBee

    standard allows operating in the freuency range belonging to the radio band known as

    industrial, scientific, and medical S;(, especially in the CDC ;H> band in 5urope, the 01E

    ;H> in the U"S"'", and the 2"@ FH> in almost all o!er the world" The underlying #555

    C2"1E"@ standard is designed to work with low.power and limited computational resources

    nodes" AigBee incorporates additional network, application, and security layers o!er the

    C2"1E"@ standard" The AigBee standard allows up to DE E7@ nodes connected in a star, tree,

    or mesh topology network" 'nother standard to deploy WSNs is Bluetooth" This standard

    allows multiple wireless personal 'rea networks &WP'N( and wireless body area networks

    &WB'N( applications for interconnecting mobile phones, earphones, personal computers,

     printers, etc" Bluetooth operates also in the #S; 2"@ FH> band" #t allows creating star 

    topology networks of up to eight de!ices in which one of them acts as master and the rest as

    sla!es" Se!eral Bluetooth networks can be interconnected by means of Bluetooth de!ices that

     belong simultaneously to two or more networks, creating more e$tensi!e networks"

    'lthough there are plenty of options for creating WSNs, the main problem is the

    difficulty for integrating de!ices from different technologies in a single network" #n addition,

    the lack of a common architecture may lead to additional costs due to the necessity of deploying nontransparent interconnection elements between networks" ;oreo!er, the

    de!eloped elements &e"g", de!ices( are too dependent on the application to which they belong,

    thus complicating their reutili>ation" Some de!elopments try to reach the de!ices integration

     by implementing middleware layers as reduced !ersions of !irtual machines &e"g", Suawk 

    e or more costly miniaturi>ation" These drawbacks are !ery important

    regarding WSNs, as it is essential to deploy applications with reduced resources and low

    infrastructural cost, especially in home care scenarios" The S-PH platform integrates an

    S/' approach for facilitating the distribution and management of resources &i"e", ser!ices(

    into heterogeneous WSNs"

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare E

    There are se!eral attempts to integrate WSNs and an S/' approach" #n S-PH,

    unlike these approaches, ser!ices are directly embedded on the WSN nodes and can be

    in!oked from other nodes in the same network or other network connected to the former one"

    #t is necessary to pro!ide efficient solutions that allow building 'm# en!ironments for 

     pro!iding dependent people healthcare at their homes" /ne of the key aspects for the

    construction of these en!ironments is obtaining conte$t information through sensor networks"

    There are se!eral healthcare de!elopments for telemonitoring based on WSNs" Howe!er,

    these de!elopments do not take into account their integration with other systems and are

    difficult to be adapted to new situations" The use of S-PH is proposed in order to face some

    of the issues"

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare D

    Chapter 3

    Architecture

    3.1 SY"!:

    The following figure 7"1 illustrates the S-PH architecture layers"

    %igure 3.1: SY!" architecture la$ers.

    S-PH can be e$ecuted o!er multiple wireless de!ices independently of their 

    microcontroller or the programming language they use" S-PH works in a distributed way

    so that the application code does not ha!e to reside almost completely on only central node"

    S-PH allows the interconnection of se!eral networks from different wireless technologies,

    such as AigBee or Bluetooth" Thus, a node designed o!er a specific technology can be

    connected to a node from a different technology" #n this case, both WSNs are interconnected

     by means of a set of intermediate gateways connected to se!eral wireless interfaces

    simultaneously" S-PH allows applications to work in a distributed way and independent of 

    the lower layers related to the WSNs formation &i"e", network layer(, and the radio

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare G

    transmission amongst the nodes that conform them &i"e", data link and physical layers("

    S-PH implements an organi>ation based on a stack of layers" %ig" 7"1 shows the different

    layers of S-PH, which are added o!er the application layer of each WSN stack" The

    S-PH message layer &S;-( offers to the upper layers the possibility of sending

    asynchronous messages between two wireless de!ices through the S-PH ser!ices protocol

    &SSP("

      The SSP is the internetworking protocol of the S-PH platform" SSP has

    functionalities similar to those of the internet protocol P(" That is, it allows sending packets

    of data from one node to another node regardless of the WSN to which each one belongs"

    The messages specify the origin and target nodes, and the ser!ice in!ocation in a S-PH

    ser!ices definition language &SS6-( format" The SS6- describes the ser!ice itself and its

     parameters to be in!oked" 'pplications can directly communicate between de!ices, using the

    S;- layer or by means of the S-PH ser!ices directory sub layer &SS6S( that uses in turn

    the mentioned S;- layer" The SS6S offers functionalities related to the disco!ering of the

    ser!ices offered by the network nodes" ' node that stores and maintains ser!ices tables is

    called S-PH directory node &S6N("

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare C

    The figure 7"2 below represents the S-PH basic operation"

    %igure 3.2: SY!" basic operation.

    The main components of S-PH are now described*

    3.2 SY!" Services

    The beha!ior of S-PH is in essence similar to the one of any other S/'" Howe!er,

    S-PH has se!eral characteristics and functionalities that make it different from other 

    models" %ig" 7"2 shows the basic operation of S-PH" %irst, a ser!ice registers itself on the

    S6N and informs its location in the network, the parameters it reuires and the type of 

    returned !alue after its e$ecution" #n order to do this, SS6- is used, which has been created

    to work with limited resources nodes" SS6- is the interface definition language -( used

     by S-PH" 6istributed architectures use an #6- in order to enable communication between

    software components, regardless their programming language or hardware implementation"

    Un. like other #6-s as WS6-, based on e$tensible markup language &:;-( and used on

    web ser!ices" SS6- use a few intermediate separating tags and its ser!ices descriptions are

    short binary data seuences" The reason for these constraints is to reduce processing in the

    de!ices microcontrollers" Using a simple #6- allows, conseuently, utili>ing nodes with

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 0

    fewer resources, less power consumption, and lower cost" #n most cases, it is enough with a

    few float point data for informing the status of a sensor" Thus, most ser!ice definitions

    reuire only a few bytes" SS6- considers the basic types of data &e"g", integer, float, or 

    Boolean(, allowing more comple$ data structures as !ariable length arrays or character 

    strings" #n this way, SS6- is fle$ible enough to specify more comple$ ser!ices if reuired"

    /nce the ser!ice has been registered in the S6N, it can be in!oked by any application by

    means of S-PH" Both the S6N and the ser!ices can be stored in any node of the WSN or in

    other subsystem connected to the WSN" This system can be, for instance, a simple personal

    computer connected through a uni!ersal serial bus &USB( port to a wireless interface" Thus,

    de!elopers decide, which nodes or subsystems will implement each part of the distributed

    application" 'ny node in the network can ask the S6N for the location of a determined

    ser!ice and its specification, using SS6-" This aspect is described in the following section"

    The figure 7"7 below describes the S-PH 6irectory Nodes"

    %igure 3.3: SY!" &irector$ 'odes.

    3.3 SY!" &irector$ 'odes

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1

    With the aim of the architecture to be the more distributed as possible, it is allowed to

     be more than one S6N in the same network, so that can e$ist redundancy or ser!ices

    organi>ed in different directories" The S6N can be stored in a node of the network, with a

    memory e$ternal to the microcontroller if necessary, or be contained on a computationally

    higher machine connected to the WSN, as is the case of a data ser!er or a personal computer 

    with wireless connection" %ig" 7"7 shows how a node can disco!er ser!ices in the network"

    %or e$ample, node 1 registers itself in the WSN by means of S-PH" Then, it sends a

     broadcast message after connecting to the WSN searching for e$isting S6Ns in the network"

    't this moment, only the node is acti!e, therefore, after recei!ing the broadcast message, it

    sends a message to the node 1 informing of its situation &i"e", SSP address( and its setup

     parameters"

     'n e$ample of a setup parameter is whether the S6N will inform periodically of its

     presence or if the nodes will ha!e to poll it" 'fter this, the node 1 is able to communicate

    with the node in order to obtain information about the possible ser!ices e$isting in the

    network" -ater, the node 7 registers itself on the WSN" 's it has S6N functionalities, it

    informs of this to the rest of the nodes by means of a broadcast message" The node 1 stores

    this information on its SS6S entries list and informs node 7 about its role as S6N" 'ny node

    in the network cannot only offer or in!oke S-PH ser!ices, but also includes S6N

    functionalities in order to pro!ide ser!ices descriptions to other network nodes" S6Nsinclude additional information about ser!ices, whose locations in the network maintain as,

    for e$ample, a uality of ser!ice rate and a time stamp that represents the last time the S6N

    checked the ser!ice was a!ailable" 'n S6N can be configured to check the ser!ices, whose

    location stores or can be the ser!ices the responsible for broadcast themsel!es periodically"

    Chapter (

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 11

    )elemonitoring S$stem

    This section describes the main features of a telemonitoring system aimed at impro!ing

    healthcare of dependent people at their homes" The system makes use of se!eral WSNs in

    order to gather conte$t information in an automatic and ubiuitous way" Thus, thetelemonitoring system enables an e$tensi!e integration of WSNs and pro!ides a greater 

    simplicity of deployment, thus optimi>ing the reutili>ation of the a!ailable resources in such

    networks"

    Se!eral functionalities are directly embedded on the WSN nodes and can be in!oked

    from other nodes in the same network or other network connected to the former one by

    means of the S-PH platform" S-PH gateways are used in order to interconnect different

    heterogeneous WSNs" This way, S-PH contemplates the possibility of connecting WSNs

     based on different radio and link technologies &e"g", AigBee, Bluetooth, Wi.%i, etc"(, while

    other approaches do not" #n addition, S-PH focuses specially on de!ices with small

    resources in order to sa!e microcontrollers) computing time, memory data si>e, and energy

    consumption" Biomedical sensors &e"g", electrocardiogram, blood pressure, body temperature,

    etc"( and automation sensors &e"g", building temperature, light, humidity, etc"( ha!e

    significant differences, especially on how they collect data" Biomedical sensors obtain

    continuous information about !ital signs, whose samples are important and should not be

    lost" /n the other hand, automation sensors obtain information at a relati!ely lower 

    freuency compared to biomedical sensors" #n addition, biomedical sensors should be smaller 

    and easier to wear" #t is necessary to interconnect se!eral WSNs from different radio

    technologies in a telemonitoring scenario" Ha!ing a compatible distributed platform for 

    deploying healthcare applications o!er the different networks facilitates the de!elopers) work 

    and the integration of the heterogeneous de!ices"

    The figure @"1 illustrates basic schema of 4ommunication and infrastructure of the

    telemonitoring system as shown below*

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 12

    %igure (.1: Communication and in#rastructure schema o# the telemonitoring s$stem

    ' network of AigBee de!ices has been designed to co!er the home of each patient to

     be monitored" There is a AigBee remote control carried by the monitored patient that

    incorporates a button, which can be pressed in case of remote assistance or urgent help"

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 17

    ;oreo!er, there are a set of AigBee sensors that obtain information about the home

    en!ironment &e"g", light, smoke, temperature, doors) states, etc"( in which the user li!es and

    that physically response to the changes &e"g", light dimmers, fire alarms, or door locks(" 5ach

    of these AigBee nodes includes a 4CE1%121 microcontroller and a 442@2 #555 C2"1E"@

    radio freuency transcei!er" There are also se!eral Bluetooth biomedical sensors placed o!er 

    the monitored patient)s body" Biomedical sensors allow the system to acuire continuously

    data about the !ital signs of the patient" #n the telemonitoring system presented in this paper,

    each patient carries three different biomedical sensors* an 54F monitor, a respiration

    monitor &implemented by means of an air pressure sensor(, and a micro.electro.mechanical

    systems &;5;S( tria$ial accelerometer for detecting possible patient)s falls" These Bluetooth

    nodes use a [email protected]$t chip with a reduced instruction set computer &=#S4(

    microcontroller with @C ?B of ='; and 12@ ?B of e$ternal flash memory, and are

    compatible with the Bluetooth 2" standard" 'll these AigBee and Bluetooth de!ices work as

    S-PH nodes and can both offer and in!oke functionalities &i"e", ser!ices( throughout the

    entire sensor network"

    There is also a computer connected to a remote healthcare telemonitoring center !ia

    #nternet" 'lerts can be forwarded from the patients) homes to the caregi!ers in the remote

    center, allowing them to communicate with patients in order to check the possible incidences"These alerts can be, for instance, the detection of a patient)s fall or a high smoke le!el in the

     patient)s home" This computer acts as a AigBee master node through a physical wireless

    interface &e"g", a AigBee network adapter as a AigBee USB dongle, or a AigBee node

    connected through the computer)s USB port(" The computer is also the master node of a

    Bluetooth network formed by the biomedical sensors working as sla!e nodes" 't the S-PH

    le!el, the computer performs as a S-PH gateway so that it connects both WSNs to each

    other" #f, for instance, the monitored patient falls o!er the floor, his fall detector gets from its

    Bluetooth accelerometer, a measurement higher than a pre!iously specified threshold" This

    sensor &i"e", accelerometer( in!okes a ser!ice stored in the WSNs. #nternet S-PH gateway"

      Such ser!ice initiates a !oice o!er #nternet Protocol &o#P( and webcam connection

    to be established between the telemonitoring center and the patient)s home through #nternet"

    This way, caregi!ers in the remote center can watch the patient)s home and talk with him in

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1@

    order to !erify the accident" 's the telemonitoring center accesses directly to a patients

    database, caregi!ers can see his medical data and home address" #f the accident is confirmed,

    the caregi!ers send an ambulance to his home" 'lthough this system is mainly focused on

    monitoring tasks, it also pro!ides additional useful facilities to the patients and caregi!ers"

    %or e$ample, the remote center can consult really simple syndication &=SS( sources from

    e$ternal and internal web ser!ers in order to obtain weather reports or entertainment options

    for patients and inform them of their scheduled medical staff !isits" Such information is

    shown on a graphical user interface &FU#( on a display connected to the computer at home"

    This display is in fact a touch.sensiti!e screen, so that the interaction is easy and intuiti!e for 

     patients" ;oreo!er, the application includes home automation capabilities, so that a light

    sensor can make a lamp to be switched on or dimmed by means of the in. !ocation, or a

    certain ser!ice stored in a wireless actuator node connected to the relay or dimmer of the

    respecti!e lamp"

    Chapter *

    +esults

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1E

    The telemonitoring system presented in this report impro!es security at home to dependents"

    #t implements monitoring and alerting subsystems, as well as additional ser!ices to

    automatically react to emergency situations" We ha!e done se!eral test cases in order to

    e!aluate the o!erall performance of the system, especially the management of emergency

    situations" The tests, which in!ol!ed 17 patients and si$ caregi!ers, allowed us to e!aluate

    the system" Specifically, the results of the S-PH system were studied o!er a period of four 

    weeks"

    #t has been e!aluated that this approach in terms of the four main ob+ecti!es, defined

    for WSN applied in healthcare de!elopments* minimi>e error rates, conduct diagnosis with

    real time patient data, impro!e efficiency, and reduce costs" We ha!e collected data before

    and after the implantation of the telemonitoring system, with data collected from %eb" 20

    to ;ar" 20" The system was adopted on ;ar" 1, 20"

    %igure *.1: %alse positives occurred during the test period o# the alert subs$stem

    %irstly, our approach pro!ides the system with a higher ability to reco!er from errors"

    %ig" E"1 shows the percentage of error that occurred in the alert subsystem during the tests"

    The initial tests showed an error rate abo!e 10I" This percentage was primarily due to errors

    in the use of the system by the caregi!ers" 'fter the third test, the error rate was reduced to

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1D

    11I" %rom this point the error rate remained stable at @I" This error could be reduced with a

    higher le!el of training in the use of the telemonitoring system" Secondly, we ha!e worked

    with real.time data from the patients"

    These data ha!e not been used for diagnosis, but to assess the need for pro!iding

    healthcare to the patients" #n this sense, S-PH reaches this goal because it can work with

    real.time data" Howe!er, it is necessary to include a reasoning mechanism in order to

    facilitate the decision making for diagnosis" %inally, the efficiency of the telemonitoring

    system has been enhanced and the infrastructure costs ha!e been reduced" S-PH allowed us

    to determine the time needed to respond to alerts generated by the users or the sensors" #n

    order to generali>e reactions to common situations, the system does not only take response

    time into account, but also the time elapsed between alerts and the user)s profile and

    reliability"

    The telemonitoring system allows a reduction of the response time to incidents &i"e",

    alerts(" When comparing data before and after the implantation of the telemonitoring system,

    we concluded that telemonitoring system pro!ides an a!erage response time to incidents of C

    min, which reduces the time employed by the caregi!ers in a GI" ;oreo!er, the a!erage of 

    assisted incidents per day was 12, pro!iding a reduction of 11I" This reduction can be

    directly associated to the impro!ement in the detection of false positi!es" Besides, the time

    employed by the medical staff to attend an alert has been notably reduced"

    Chapter ,

    Conclusion

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    Using Heterogeneous Wireless Sensor Networks in a Telemonitoring System for Healthcare 1G

    S-PH allows wireless sensor de!ices from different radio technologies to work together in

    a distributed way" These sensor de!ices do not ha!e to be pro!ided with large memory chips

    or fast microprocessors" The S-PH model allows the possibility of adding or remo!ing

    components at e$ecution time" This way, it is possible to add a new automation sensor in the

     patient)s home at e$ecution time with no need of reprogram or redeploy the system" #f, for 

    e$ample, it is decided to add a new smoke sensor in the patient)s home, the technician will

     +ust ha!e to fi$ it to the ceiling and supplies it with electrical power" The AigBee node will

     +oin automatically to the AigBee automation network, and its S-PH layers will look for 

    S6Ns and ser!ices in the S-PH network and register its own ser!ices on them" This way, if 

    the new smoke sensor detects a dangerous smoke le!el, it will automatically in!oke the

    smoke alarm ser!ice in the alarm nodes in the home and the WSNs #nternet S-PH gateway"

    The telemonitoring system)s architecture goes a step ahead in designing systems for 

    home care by offering features that make it easily adaptable to any per!asi!e en!ironment"

    Unlike other telemonitoring systems as, the presented system allows to integrate

    heterogeneous sensor networks from different technologies, e!en wired ones" Therefore, it is

     possible to +oin automation and biomedical sensors in the same telemonitoring system, using

    the technology that better fits each sensor)s data characteristics"

    'lthough the initial results are promising, the telemonitoring systems still reuires

    some impro!ements" /ur future work focuses on finding a modeling facility to pro!idelearning and decision.making capabilities to the system"

    +e#erences

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