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Buts: Le but de ce travail était de décrire les aspects épidémiologiques, cliniques et thérapeutiques de la cryptorchidie dans le service de Chirurgie Pédiatrique en milieu africain. Patients et méthodes: Il s’agissait d’une étude rétrospective sur 123 cas de cryptorchidie colligés du 1er Mai 2000 au 30 Avril 2008 au service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar. Les paramètres étudiés étaient la fréquence par rapport aux autres pathologies du canal inguinal, l’âge, les motifs de consultation, l’examen physique, le constat opératoire, la durée d’hospitalisation et les suites opératoires en particulier les résultats cosmétiques et morphologiques. Résultats: La cryptorchidie était la troisième anomalie congénitale du canal inguinal après les hernies (1537 cas) et les hydrocèles (327 cas). L’âge moyen de nos patients était de 5,7 ans. La vacuité scrotal était le principal motif de consultation chez 105 patients (84,5%). La cryptorchidie était unilateral chez 111 patients (90,5%). Dans 34,5% des cas seulement le testicule était palpable. L’exploration chirurgicale avait retrouvé dans 93,43% des cas un testicule en position inguinale et dans 2,5% des cas un testicule en position abdominale. Un sac herniaire a été retrouvé dans 84,7% des cas. La connexion épididymo-testiculaire était mauvaise dans 43,1% des cas. L’abaissement « in dartos » a été realisé dans 97,5% des cas. La durée d’hospitalisation était en moyenne de 14,5 heures. Les suites opératoires étaient simples dans 87,8% des cas. Onze cas de complications ont été notés dont 5 cas de suppuration, 2 cas d’hématome du cordon, 2 cas d’atrophie testiculaire et 2 cas de récidive. Conclusion: La cryptorchidie est vue à un âge tardif dans notre contexte rendant l’intervention immédiate. A cet âge, il existe de possibles lésions dysplasiques justifiant une surveillance prolongée jusqu’à la puberté où un spermogramme sera réalisé.

Bias in computer vision systems can perpetuate or even amplify discrimination against certain populations. Considering that bias is often introduced by biased visual datasets, many recent research efforts focus on training fair models using such data. However, most of them heavily rely on the availability of protected attribute labels in the dataset, which limits their applicability, while label-unaware approaches, i.e., approaches operating without such labels, exhibit considerably lower performance. To overcome these limitations, this work introduces FLAC, a methodology that minimizes mutual information between the features extracted by the model and a protected attribute, without the use of attribute labels. To do that, FLAC proposes a sampling strategy that highlights underrepresented samples in the dataset, and casts the problem of learning fair representations as a probability matching problem that leverages representations extracted by a bias-capturing classifier. It is theoretically shown that FLAC can indeed lead to fair representations, that are independent of the protected attributes. FLAC surpasses the current state-of-the-art on Biased-MNIST, CelebA, and UTKFace, by 29.1%, 18.1%, and 21.9%, respectively. Additionally, FLAC exhibits 2.2% increased accuracy on ImageNet-A and up to 4.2% increased accuracy on Corrupted-Cifar10. Finally, in most experiments, FLAC even outperforms the bias label-aware state-of-the-art methods.

Background: Interstitial lung disease (ILD) is common in primary Sjögren's disease (pSD); its functional course is poorly known. Our aim was to characterise the long-term functional course and prognosis in patients with pSD-ILD. We determined the role of baseline demographic and clinical variables in the evolution of lung function and identified risk factors for death or transplantation., Methods: In a retrospective observational cohort study, patients with pSD and ILD were retrospectively identified from two French ILD centres. Forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide ( D LCO ) slopes were obtained from joint models. Latent class mixed models identified clusters of FVC and D LCO trajectories., Results: We included 73 patients (63% women, mean age 63 years), with a median follow-up of 9.3 years. At baseline, mean FVC was 73±21% and D LCO 51±16%. On average, FVC was stable, while there was an annual decline in D LCO of 1% of the predicted value. Male sex, a pattern of usual interstitial pneumonia (UIP) or indeterminate for UIP on high-resolution computed tomography (HRCT), and features of fibrosis on HRCT, were associated with an accelerated decline in FVC and D LCO ., Conclusion: We identified clusters of lung function evolution. 1) Two FVC trajectories: patients with stable FVC (n=56, 78%); patients with FVC decline (n=16, 22%) of 2.4% per year, characterised by a low baseline D LCO (39%) and a higher risk of death or transplantation (HR 52, 95% CI 10-273). 2) Three D LCO trajectories: patients with stable D LCO (n=44, 66%); patients with a slow decline in D LCO (n=12, 18%) of 2.8% per year; patients with a rapid decline in D LCO (n=11, 16%) of 4.8% per year, characterised by a low baseline D LCO (41%) and a higher risk of death or transplantation (HR 156, 95% CI 18-1352)., Competing Interests: Conflict of interest: M-P. Debray declares honoraria for lectures or presentations from Boehringer Ingelheim and Sanofi, and support for attending meetings and/or travel from Boehringer Ingelheim, outside the submitted work. Conflict of interest: R. Borie declares relationships and activities with Boehringer Ingelheim, Ferrer, Sanofi, Chiesi and Roche. Conflict of interest: H. Nunes declares consulting fees, honoraria for lectures or presentations, and support for attending meetings and/or travel from Boehringer Ingelheim outside the submitted work; and reports participation on a data safety monitoring board with Galapagos. Conflict of interest: Y. Uzunhan reports relationships and activities with Boehringer Ingelheim, Pfizer, Sanofi, GlaxoSmithKline and Oxyvie. Conflict of interest: B. Crestani reports relationships and activities with Boehringer Ingelheim, BristolMyersSquibb, Unimed, AstraZeneca, Glycocore, GlaxoSmithKline, Roche, Menarini, CSL Behring, Chiesi, Novartis and Sanofi; and is member of the board of trustees of the Fondation du Souffle, a French charity. Conflict of interest: The remaining authors have no relationships or activities to declare., (Copyright ©The authors 2024.)

Background: Obesity in childhood and adolescence represents a major public health problem, mostly attributed to dietary and physical activity factors. We aimed to determine the dietary and physical activity habits of participants before and after the implementation of a personalized, multidisciplinary, lifestyle intervention program for the management of obesity in the context of the Horizon Research Project 'BigO: Big Data against Childhood Obesity'., Methods: Three hundred and eighty-six (n = 386) children and adolescents (mean age ± SD: 12.495 ± 1.988 years, 199 males and 187 females) participated in the study prospectively. Based on body mass index (BMI), subjects were classified as having obesity (n = 293, 75.9%) and overweight (n = 93, 24.1%) according to the International Obesity Task Force (IOTF) cut-off points. We implemented a personalized, multidisciplinary, lifestyle intervention program providing guidance on diet, sleep, and exercise, and utilized the BigO technology platform to objectively record data collected via a Smartphone and Smartwatch for each patient., Results: Following the intervention, a statistically significant decrease was noted in the consumption of cheese, cereal with added sugar, savory snacks, pasta, and fried potatoes across both BMI categories. Also, there was an increase in daily water intake between meals among all participants ( p = 0.001) and a reduction in the consumption of evening snack or dinner while watching television ( p < 0.05). Boys showed a decrease in the consumption of savory snacks, fried potato products, and pasta ( p < 0.05), an increase in the consumption of sugar-free breakfast cereal ( p < 0.05), and drank more water between meals daily ( p < 0.001)., Conclusions: Our findings suggest that a personalized, multidisciplinary, lifestyle intervention improves the dietary habits of children and adolescents.

Treatment effect estimation is of high-importance for both researchers and practitioners across many scientific and industrial domains. The abundance of observational data makes them increasingly used by researchers for the estimation of causal effects. However, these data suffer from several weaknesses, leading to inaccurate causal effect estimations, if not handled properly. Therefore, several machine learning techniques have been proposed, most of them focusing on leveraging the predictive power of neural network models to attain more precise estimation of causal effects. In this work, we propose a new methodology, named Nearest Neighboring Information for Causal Inference (NNCI), for integrating valuable nearest neighboring information on neural network-based models for estimating treatment effects. The proposed NNCI methodology is applied to some of the most well established neural network-based models for treatment effect estimation with the use of observational data. Numerical experiments and analysis provide empirical and statistical evidence that the integration of NNCI with state-of-the-art neural network models leads to considerably improved treatment effect estimations on a variety of well-known challenging benchmarks.

Background: The COVID-19 pandemic has impacted children's lifestyles, including dietary behaviors. Of particular concern among these behaviors is the heightened prevalence of ultra-processed food (UPF) consumption, which has been linked to the development of obesity and related non-communicable diseases. The present study examines the changes in (1) UPF and (2) vegetable and/or fruit consumption among school-aged children in Greece and Sweden before and during the COVID-19 pandemic., Methods: The analyzed dataset consisted of main meal pictures (breakfast, lunch, and dinner) captured by 226 Greek students (94 before the pandemic and 132 during the pandemic) and 421 Swedish students (293 before and 128 during the pandemic), aged 9-18, who voluntarily reported their meals using a mobile application. The meal pictures were collected over four-month periods over two consecutive years; namely, between the 20th of August and the 20th of December in 2019 (before the COVID-19 outbreak) and the same period in 2020 (during the COVID-19 outbreak). The collected pictures were annotated manually by a trained nutritionist. A chi-square test was performed to evaluate the differences in proportions before versus during the pandemic., Results: In total, 10,770 pictures were collected, including 6474 pictures from before the pandemic and 4296 pictures collected during the pandemic. Out of those, 86 pictures were excluded due to poor image quality, and 10,684 pictures were included in the final analyses (4267 pictures from Greece and 6417 pictures from Sweden). The proportion of UPF significantly decreased during vs. before the pandemic in both populations (50% vs. 46%, p = 0.010 in Greece, and 71% vs. 66%, p < 0.001 in Sweden), while the proportion of vegetables and/or fruits significantly increased in both cases (28% vs. 35%, p < 0.001 in Greece, and 38% vs. 42%, p = 0.019 in Sweden). There was a proportional increase in meal pictures containing UPF among boys in both countries. In Greece, both genders showed an increase in vegetables and/or fruits, whereas, in Sweden, the increase in fruit and/or vegetable consumption was solely observed among boys., Conclusions: The proportion of UPF in the Greek and Swedish students' main meals decreased during the COVID-19 pandemic vs. before the pandemic, while the proportion of main meals with vegetables and/or fruits increased.

The progress in artificial intelligence and machine learning algorithms over the past decade has enabled the development of new methods for the objective measurement of eating, including both the measurement of eating episodes as well as the measurement of in-meal eating behavior. These allow the study of eating behavior outside the laboratory in free-living conditions, without the need for video recordings and laborious manual annotations. In this paper, we present a high-level overview of our recent work on intake monitoring using a smartwatch, as well as methods using an in-ear microphone. We also present evaluation results of these methods in challenging, real-world datasets. Furthermore, we discuss use-cases of such intake monitoring tools for advancing research in eating behavior, for improving dietary monitoring, as well as for developing evidence-based health policies. Our goal is to inform researchers and users of intake monitoring methods regarding (i) the development of new methods based on commercially available devices, (ii) what to expect in terms of effectiveness, and (iii) how these methods can be used in research as well as in practical applications., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The relation among the various causal factors of obesity is not well understood, and there remains a lack of viable data to advance integrated, systems models of its etiology. The collection of big data has begun to allow the exploration of causal associations between behavior, built environment, and obesity-relevant health outcomes. Here, the traditional epidemiologic and emerging big data approaches used in obesity research are compared, describing the research questions, needs, and outcomes of 3 broad research domains: eating behavior, social food environments, and the built environment. Taking tangible steps at the intersection of these domains, the recent European Union project "BigO: Big data against childhood obesity" used a mobile health tool to link objective measurements of health, physical activity, and the built environment. BigO provided learning on the limitations of big data, such as privacy concerns, study sampling, and the balancing of epidemiologic domain expertise with the required technical expertise. Adopting big data approaches will facilitate the exploitation of data concerning obesity-relevant behaviors of a greater variety, which are also processed at speed, facilitated by mobile-based data collection and monitoring systems, citizen science, and artificial intelligence. These approaches will allow the field to expand from causal inference to more complex, systems-level predictive models, stimulating ambitious and effective policy interventions., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

The importance of automated and objective monitoring of dietary behavior is becoming increasingly accepted. The advancements in sensor technology along with recent achievements in machine-learning-based signal-processing algorithms have enabled the development of dietary monitoring solutions that yield highly accurate results. A common bottleneck for developing and training machine learning algorithms is obtaining labeled data for training supervised algorithms, and in particular ground truth annotations. Manual ground truth annotation is laborious, cumbersome, can sometimes introduce errors, and is sometimes impossible in free-living data collection. As a result, there is a need to decrease the labeled data required for training. Additionally, unlabeled data, gathered in-the-wild from existing wearables (such as Bluetooth earbuds) can be used to train and fine-tune eating-detection models. In this work, we focus on training a feature extractor for audio signals captured by an in-ear microphone for the task of eating detection in a self-supervised way. We base our approach on the SimCLR method for image classification, proposed by Chen et al. from the domain of computer vision. Results are promising as our self-supervised method achieves similar results to supervised training alternatives, and its overall effectiveness is comparable to current state-of-the-art methods. Code is available at https://github.com/mug-auth/ssl-chewing.

Background: Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project "BigO: Big Data Against Childhood Obesity" aims to tackle childhood obesity by creating new sources of evidence based on big data., Objective: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app., Methods: The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children's obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard's functionality was evaluated during a focus group discussion with public health experts., Results: The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children's eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children's physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard's potential to aid in a better understanding of the interplay between children's obesogenic behaviors and the environment, and improvements were suggested., Conclusions: Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment., (©Dimitris Filos, Irini Lekka, Vasileios Kilintzis, Leandros Stefanopoulos, Youla Karavidopoulou, Christos Maramis, Christos Diou, Ioannis Sarafis, Vasileios Papapanagiotou, Leonidas Alagialoglou, Ioannis Ioakeimidis, Maria Hassapidou, Evangelia Charmandari, Rachel Heimeier, Grace O'Malley, Shane O’Donnell, Gerardine Doyle, Anastasios Delopoulos, Nicos Maglaveras. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 09.07.2021.)

Fast self-reported eating rate (SRER) has been associated with increased adiposity in children and adults. No studies have been conducted among high-school students, and SRER has not been validated vs. objective eating rate (OBER) in such populations. The objectives were to investigate (among high-school student populations) the association between OBER and BMI z-scores (BMIz), the validity of SRER vs. OBER, and potential differences in BMIz between SRER categories. Three studies were conducted. Study 1 included 116 Swedish students (mean ± SD age: 16.5 ± 0.8, 59% females) who were eating school lunch. Food intake and meal duration were objectively recorded, and OBER was calculated. Additionally, students provided SRER. Study 2 included students ( n = 50, mean ± SD age: 16.7 ± 0.6, 58% females) from Study 1 who ate another objectively recorded school lunch. Study 3 included 1832 high-school students (mean ± SD age: 15.8 ± 0.9, 51% females) from Sweden ( n = 748) and Greece ( n = 1084) who provided SRER. In Study 1, students with BMIz ≥ 0 had faster OBER vs. students with BMIz < 0 (mean difference: +7.7 g/min or +27%, p = 0.012), while students with fast SRER had higher OBER vs. students with slow SRER (mean difference: +13.7 g/min or +56%, p = 0.001). However, there was "minimal" agreement between SRER and OBER categories (κ = 0.31, p < 0.001). In Study 2, OBER during lunch 1 had a "large" correlation with OBER during lunch 2 ( r = 0.75, p < 0.001). In Study 3, fast SRER students had higher BMIz vs. slow SRER students (mean difference: 0.37, p < 0.001). Similar observations were found among both Swedish and Greek students. For the first time in high-school students, we confirm the association between fast eating and increased adiposity. Our validation analysis suggests that SRER could be used as a proxy for OBER in studies with large sample sizes on a group level. With smaller samples, OBER should be used instead. To assess eating rate on an individual level, OBER can be used while SRER should be avoided.

The increased worldwide prevalence of obesity has sparked the interest of the scientific community towards tools that objectively and automatically monitor eating behavior. Despite the study of obesity being in the spotlight, such tools can also be used to study eating disorders (e.g. anorexia nervosa) or provide a personalized monitoring platform for patients or athletes. This paper presents a complete framework towards the automated i) modeling of in-meal eating behavior and ii) temporal localization of meals, from raw inertial data collected in-the-wild using commercially available smartwatches. Initially, we present an end-to-end Neural Network which detects food intake events (i.e. bites). The proposed network uses both convolutional and recurrent layers that are trained simultaneously. Subsequently, we show how the distribution of the detected bites throughout the day can be used to estimate the start and end points of meals, using signal processing algorithms. We perform extensive evaluation on each framework part individually. Leave-one-subject-out (LOSO) evaluation shows that our bite detection approach outperforms four state-of-the-art algorithms towards the detection of bites during the course of a meal (0.923 F1 score). Furthermore, LOSO and held-out set experiments regarding the estimation of meal start/end points reveal that the proposed approach outperforms a relevant approach found in the literature (Jaccard Index of 0.820 and 0.821 for the LOSO and held-out experiments, respectively). Experiments are performed using our publicly available FIC and the newly introduced FreeFIC datasets.

Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients., Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity., Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the "mHealth evidence reporting and assessment checklist," and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance., Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a 'Good' grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected., Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk., (©Billy Langlet, Christos Maramis, Christos Diou, Nikolaos Maglaveras, Petter Fagerberg, Rachel Heimeier, Irini Lekka, Anastasios Delopoulos, Ioannis Ioakimidis. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 21.07.2020.)

Obesity affects a rising percentage of the children and adolescent population, contributing to decreased quality of life and increased risk for comorbidities. Although the major causes of obesity are known, the obesogenic behaviors manifest as a result of complex interactions of the individual with the living environment. For this reason, addressing childhood obesity remains a challenging problem for public health authorities. The BigO project (https://bigoprogram.eu) relies on large-scale behavioral and environmental data collection to create tools that support policy making and intervention design. In this work, we propose a novel analysis approach for modeling the expected population behavior as a function of the local environment. We experimentally evaluate this approach in predicting the expected physical activity level in small geographic regions using urban environment characteristics. Experiments on data collected from 156 children and adolescents verify the potential of the proposed approach. Specifically, we train models that predict the physical activity level in a region, achieving 81% leave-one-out accuracy. In addition, we exploit the model predictions to automatically visualize heatmaps of the expected population behavior in areas of interest, from which we draw useful insights. Overall, the predictive models and the automatic heatmaps are promising tools in gaining direct perception for the spatial distribution of the population's behavior, with potential uses by public health authorities.

Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.

Obesity is currently affecting very large portions of the global population. Effective prevention and treatment starts at the early age and requires objective knowledge of population-level behavior on the region/neighborhood scale. To this end, we present a system for extracting and collecting behavioral information on the individual-level objectively and automatically. The behavioral information is related to physical activity, types of visited places, and transportation mode used between them. The system employs indicator-extraction algorithms from the literature which we evaluate on publicly available datasets. The system has been developed and integrated in the context of the EU-funded BigO project that aims at preventing obesity in young populations.

Obesity in childhood and adolescence represents a major health problem. Novel e-Health technologies have been developed in order to provide a comprehensive and personalized plan of action for the prevention and management of overweight and obesity in childhood and adolescence. We used information and communication technologies to develop a "National Registry for the Prevention and Management of Overweight and Obesity" in order to register online children and adolescents nationwide, and to guide pediatricians and general practitioners regarding the management of overweight or obese subjects. Furthermore, intelligent multi-level information systems and specialized artificial intelligence algorithms are being developed with a view to offering precision and personalized medical management to obese or overweight subjects. Moreover, the Big Data against Childhood Obesity platform records behavioral data objectively by using inertial sensors and Global Positioning System (GPS) and combines them with data of the environment, in order to assess the full contextual framework that is associated with increased body mass index (BMI). Finally, a computerized decision-support tool was developed to assist pediatric health care professionals in delivering personalized nutrition and lifestyle optimization advice to overweight or obese children and their families. These e-Health applications are expected to play an important role in the management of overweight and obesity in childhood and adolescence., Competing Interests: The authors declared no conflicts of interest.

Overweight and obesity are both associated with in-meal eating parameters such as eating speed. Recently, the plethora of available wearable devices in the market ignited the interest of both the scientific community and the industry toward unobtrusive solutions for eating behavior monitoring. In this paper, we present an algorithm for automatically detecting the in-meal food intake cycles using the inertial signals (acceleration and orientation velocity) from an off-the-shelf smartwatch. We use five specific wrist micromovements to model the series of actions leading to and following an intake event (i.e., bite). Food intake detection is performed in two steps. In the first step, we process windows of raw sensor streams and estimate their micromovement probability distributions by means of a convolutional neural network. In the second step, we use a long short-term memory network to capture the temporal evolution and classify sequences of windows as food intake cycles. Evaluation is performed using a challenging dataset of 21 meals from 12 subjects. In our experiments, we compare the performance of our algorithm against three state-of-the-art approaches, where our approach achieves the highest F1 detection score (0.913 in the leave-one-subject-out experiment). The dataset used in the experiments is available at https://mug.ee.auth.gr/intake-cycle-detection/.

Obesity is a preventable disease that affects the health of a significant population percentage, reduces the life expectancy and encumbers the health care systems. The obesity epidemic is not caused by isolated factors, but it is the result of multiple behavioural patterns and complex interactions with the living environment. Therefore, in-depth understanding of the population behaviour is essential in order to create successful policies against obesity prevalence. To this end, the BigO system facilitates the collection, processing and modelling of behavioural data at population level to provide evidence for effective policy and interventions design. In this paper, we introduce the behaviour profiles mechanism of BigO that produces comprehensive models for the behavioural patterns of individuals, while maintaining high levels of privacy protection. We give examples for the proposed mechanism from real world data and we discuss usages for supporting various types of evidence-based policy design.

Certain patterns of eating behaviour during meal have been identified as risk factors for long-term abnormal eating development in healthy individuals and, eventually, can affect the body weight. To detect early signs of problematic eating behaviour, this paper proposes a novel method for building behaviour assessment models. The goal of the models is to predict whether the in-meal eating behaviour resembles patterns associated with obesity, eating disorders, or low-risk behaviours. The models are trained using meals recorded with a plate scale from a reference population and labels annotated by a domain expert. In addition, the domain expert assigned scores that characterise the degree of any exhibited abnormal patterns. To improve model effectiveness, we use the domain expert's scores to create training error regularisation weights that alter the importance of each training instance for its class during model training. The behaviour assessment models are based on the SVM algorithm and the fuzzy SVM algorithm for their instance-weighted variation. Experiments conducted on meals recorded from 120 individuals show that: (a) the proposed approach can produce effective models for eating behaviour classification (for individuals), or for ranking (for populations); and (b) the instance-weighted fuzzy SVM models achieve significant performance improvements, compared to the non-weighted, standard SVM models.

Automated and objective monitoring of eating behavior has received the attention of both the research community and the industry over the past few years. In this paper we present a method for automatically detecting meals in free living conditions, using the inertial data (acceleration and orientation velocity) from commercially available smartwatches. The proposed method operates in two steps. In the first step we process the raw inertial signals using an End-to-End Neural Network with the purpose of detecting the bite events throughout the recording. During the next step, we process the resulting bite detections using signal processing algorithms to obtain the final meal start and end timestamp estimates. Evaluation results obtained from our Leave One Subject Out experiments using our publicly available FIC and FreeFIC datasets, exhibit encouraging results by achieving an F1/Average Jaccard Index of 0.894/0.804.

Large portion sizes and a high eating rate are associated with high energy intake and obesity. Most individuals maintain their food intake weight (g) and eating rate (g/min) rank in relation to their peers, despite food and environmental manipulations. Single meal measures may enable identification of "large portion eaters" and "fast eaters," finding individuals at risk of developing obesity. The aim of this study was to predict real-life food intake weight and eating rate based on one school lunch. Twenty-four high-school students with a mean (±SD) age of 16.8 yr (±0.7) and body mass index of 21.9 (±4.1) were recruited, using no exclusion criteria. Food intake weight and eating rate was first self-rated ("Less," "Average" or "More than peers"), then objectively recorded during one school lunch (absolute weight of consumed food in grams). Afterwards, subjects recorded as many main meals (breakfasts, lunches and dinners) as possible in real-life for a period of at least two weeks, using a Bluetooth connected weight scale and a smartphone application. On average participants recorded 18.9 (7.3) meals during the study. Real-life food intake weight was 327.4 g (±110.6), which was significantly lower ( p = 0.027) than the single school lunch, at 367.4 g (±167.2). When the intra-class correlation of food weight intake between the objectively recorded real-life and school lunch meals was compared, the correlation was excellent ( R = 0.91). Real-life eating rate was 33.5 g/min (±14.8), which was significantly higher ( p = 0.010) than the single school lunch, at 27.7 g/min (±13.3). The intra-class correlation of the recorded eating rate between real-life and school lunch meals was very large ( R = 0.74). The participants' recorded food intake weights and eating rates were divided into terciles and compared between school lunches and real-life, with moderate or higher agreement (κ = 0.75 and κ = 0.54, respectively). In contrast, almost no agreement was observed between self-rated and real-life recorded rankings of food intake weight and eating rate (κ = 0.09 and κ = 0.08, respectively). The current study provides evidence that both food intake weight and eating rates per meal vary considerably in real-life per individual. However, based on these behaviours, most students can be correctly classified in regard to their peers based on single school lunches. In contrast, self-reported food intake weight and eating rate are poor predictors of real-life measures. Finally, based on the recorded individual variability of real-life food intake weight and eating rate, it is not advised to rank individuals based on single recordings collected in real-life settings.

The structure of the cumulative food intake (CFI) curve has been associated with obesity and eating disorders. Scales that record the weight loss of a plate from which a subject eats food are used for capturing this curve; however, their measurements are contaminated by additive noise and are distorted by certain types of artifacts. This paper presents an algorithm for automatically processing continuous in-meal weight measurements in order to extract the clean CFI curve and in-meal eating indicators, such as total food intake and food intake rate. The algorithm relies on the representation of the weight-time series by a string of symbols that correspond to events such as bites or food additions. A context-free grammar is next used to model a meal as a sequence of such events. The selection of the most likely parse tree is finally used to determine the predicted eating sequence. The algorithm is evaluated on a dataset of 113 meals collected using the Mandometer, a scale that continuously samples plate weight during eating. We evaluate the effectiveness for seven indicators and for bite-instance detection. We compare our approach with three state-of-the-art algorithms, and achieve the lowest error rates for most indicators (24 g for total meal weight). The proposed algorithm extracts the parameters of the CFI curve automatically, eliminating the need for manual data processing, and thus facilitating large-scale studies of eating behavior.

Background: The available methods for monitoring food intake-which for a great part rely on self-report-often provide biased and incomplete data. Currently, no good technological solutions are available. Hence, the SPLENDID eating detection sensor (an ear-worn device with an air microphone and a photoplethysmogram [PPG] sensor) was developed to enable complete and objective measurements of eating events. The technical performance of this device has been described before. To date, literature is lacking a description of how such a device is perceived and experienced by potential users., Objective: The objective of our study was to explore how potential users perceive and experience the SPLENDID eating detection sensor., Methods: Potential users evaluated the eating detection sensor at different stages of its development: (1) At the start, 12 health professionals (eg, dieticians, personal trainers) were interviewed and a focus group was held with 5 potential end users to find out their thoughts on the concept of the eating detection sensor. (2) Then, preliminary prototypes of the eating detection sensor were tested in a laboratory setting where 23 young adults reported their experiences. (3) Next, the first wearable version of the eating detection sensor was tested in a semicontrolled study where 22 young, overweight adults used the sensor on 2 separate days (from lunch till dinner) and reported their experiences. (4) The final version of the sensor was tested in a 4-week feasibility study by 20 young, overweight adults who reported their experiences., Results: Throughout all the development stages, most individuals were enthusiastic about the eating detection sensor. However, it was stressed multiple times that it was critical that the device be discreet and comfortable to wear for a longer period. In the final study, the eating detection sensor received an average grade of 3.7 for wearer comfort on a scale of 1 to 10. Moreover, experienced discomfort was the main reason for wearing the eating detection sensor <2 hours a day. The participants reported having used the eating detection sensor on 19/28 instructed days on average., Conclusions: The SPLENDID eating detection sensor, which uses an air microphone and a PPG sensor, is a promising new device that can facilitate the collection of reliable food intake data, as shown by its technical potential. Potential users are enthusiastic, but to be successful wearer comfort and discreetness of the device need to be improved., (©Janet van den Boer, Annemiek van der Lee, Lingchuan Zhou, Vasileios Papapanagiotou, Christos Diou, Anastasios Delopoulos, Monica Mars. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.09.2018.)

In this paper, we propose an end-to-end neural network (NN) architecture for detecting in-meal eating events (i.e., bites), using only a commercially available smartwatch. Our method combines convolutional and recurrent networks and is able to simultaneously learn intermediate data representations related to hand movements, as well as sequences of these movements that appear during eating. A promising F-score of 0.884 is achieved for detecting bites on a publicly available dataset with 10 subjects.

Subjects eat food from a plate that sits on a scale connected to a computer that records the weight loss of the plate during the meal and makes up a curve of food intake, meal duration and rate of eating modeled by a quadratic equation. The purpose of the method is to change eating behavior by providing visual feedback on the computer screen that the subject can adapt to because her/his own rate of eating appears on the screen during the meal. The data generated by the method is automatically analyzed and fitted to the quadratic equation using a custom made algorithm. The method has the advantage of recording eating behavior objectively and offers the possibility of changing eating behavior both in experiments and in clinical practice. A limitation may be that experimental subjects are affected by the method. The same limitation may be an advantage in clinical practice, as eating behavior is more easily stabilized by the method. A treatment that uses this method has normalized body weight and restored the health of several hundred patients with anorexia nervosa and other eating disorders and has reduced the weight and improved the health of severely overweight patients.

Automatic objective monitoring of eating behavior using inertial sensors is a research problem that has received a lot of attention recently, mainly due to the mass availability of IMUs and the evidence on the importance of quantifying and monitoring eating patterns. In this paper we propose a method for detecting food intake cycles during the course of a meal using a commercially available wristband. We first model micro-movements that are part of the intake cycle and then use HMMs to model the sequences of micro-movements leading to mouthfuls. Evaluation is carried out on an annotated dataset of 8 subjects where the proposed method achieves 0:78 precision and 0:77 recall. The evaluation dataset is publicly available at http://mug.ee.auth.gr/intake-cycle-detection/.

Monitoring of eating behavior using wearable technology is receiving increased attention, driven by the recent advances in wearable devices and mobile phones. One particularly interesting aspect of eating behavior is the monitoring of chewing activity and eating occurrences. There are several chewing sensor types and chewing detection algorithms proposed in the bibliography, however no datasets are publicly available to facilitate evaluation and further research. In this paper, we present a multi-modal dataset of over 60 hours of recordings from 14 participants in semi-free living conditions, collected in the context of the SPLENDID project. The dataset includes raw signals from a photoplethysmography (PPG) sensor and a 3D accelerometer, and a set of extracted features from audio recordings; detailed annotations and ground truth are also provided both at eating event level and at individual chew level. We also provide a baseline evaluation method, and introduce the "challenge" of improving the baseline chewing detection algorithms. The dataset can be downloaded from http: //dx.doi.org/10.17026/dans-zxw-v8gy, and supplementary code can be downloaded from https://github. com/mug-auth/chewing-detection-challenge.git.

Detecting chewing sounds from a microphone placed inside the outer ear for eating behaviour monitoring still remains a challenging task. This is mainly due the difficulty in discriminating non-chewing sounds (e.g. speech or sounds caused by walking) from chews, as well as due to to the high variability of the chewing sounds of different food types. Most approaches rely on detecting distictive structures on the sound wave, or on extracting a set of features and using a classifier to detect chews. In this work, we propose to use feature-learning in the time domain with 1-dimensional convolutional neural networks for for chewing detection. We apply a network of convolutional layers followed by fully connected layers directly on windows of the audio samples to detect chewing activity, and then aggregate individual chews to eating events. Experimental results on a large, semi-free living dataset collected in the context of the SPLENDID project indicate high effectiveness, with an accuracy of 0.980 and F1 score of 0.883.

In the context of dietary management, accurate monitoring of eating habits is receiving increased attention. Wearable sensors, combined with the connectivity and processing of modern smartphones, can be used to robustly extract objective and real-time measurements of human behavior. In particular, for the task of chewing detection, several approaches based on an in-ear microphone can be found in the literature, while other types of sensors have also been reported, such as strain sensors. In this paper, performed in the context of the SPLENDID project, we propose to combine an in-ear microphone with a photoplethysmography (PPG) sensor placed in the ear concha, in a new high accuracy and low sampling rate prototype chewing detection system. We propose a pipeline that initially processes each sensor signal separately, and then fuses both to perform the final detection. Features are extracted from each modality, and support vector machine (SVM) classifiers are used separately to perform snacking detection. Finally, we combine the SVM scores from both signals in a late-fusion scheme, which leads to increased eating detection accuracy. We evaluate the proposed eating monitoring system on a challenging, semifree living dataset of 14 subjects, which includes more than 60 h of audio and PPG signal recordings. Results show that fusing the audio and PPG signals significantly improves the effectiveness of eating event detection, achieving accuracy up to 0.938 and class-weighted accuracy up to 0.892.

Monitoring of human eating behaviour has been attracting interest over the last few years, as a means to a healthy lifestyle, but also due to its association with serious health conditions, such as eating disorders and obesity. Use of self-reports and other non-automated means of monitoring have been found to be unreliable, compared to the use of wearable sensors. Various modalities have been reported, such as acoustic signal from ear-worn microphones, or signal from wearable strain sensors. In this work, we introduce a new sensor for the task of chewing detection, based on a novel photoplethysmography (PPG) sensor placed on the outer earlobe to perform the task. We also present a processing pipeline that includes two chewing detection algorithms from literature and one new algorithm, to process the captured PPG signal, and present their effectiveness. Experiments are performed on an annotated dataset recorded from 21 individuals, including more than 10 hours of eating and non-eating activities. Results show that the PPG sensor can be successfully used to support dietary monitoring.

Monitoring and modification of eating behaviour through continuous meal weight measurements has been successfully applied in clinical practice to treat obesity and eating disorders. For this purpose, the Mandometer, a plate scale, along with video recordings of subjects during the course of single meals, has been used to assist clinicians in measuring relevant food intake parameters. In this work, we present a novel algorithm for automatically constructing a subject's food intake curve using only the Mandometer weight measurements. This eliminates the need for direct clinical observation or video recordings, thus significantly reducing the manual effort required for analysis. The proposed algorithm aims at identifying specific meal related events (e.g. bites, food additions, artifacts), by applying an adaptive pre-processing stage using Delta coefficients, followed by event detection based on a parametric Probabilistic Context-Free Grammar on the derivative of the recorded sequence. Experimental results on a dataset of 114 meals from individuals suffering from obesity or eating disorders, as well as from individuals with normal BMI, demonstrate the effectiveness of the proposed approach.

Cervical cancer (CxCa) is currently the second leading cause of cancer-related deaths, for women between 20 and 39 years old. As infection by the human papillomavirus (HPV) is considered as the central risk factor for CxCa, current research focuses on the role of specific genetic and environmental factors in determining HPV persistence and subsequent progression of the disease. ASSIST is an EU-funded research project that aims to facilitate the design and execution of genetic association studies on CxCa in a systematic way by adopting inference and semantic technologies. Toward this goal, ASSIST provides the means for seamless integration and virtual unification of distributed and heterogeneous CxCa data repositories, and the underlying mechanisms to undertake the entire process of expressing and statistically evaluating medical hypotheses based on the collected data in order to generate medically important associations. The ultimate goal for ASSIST is to foster the biomedical research community by providing an open, integrated and collaborative framework to facilitate genetic association studies.