Paper Hector Galán - OASIS Nutritional Advisor Service: a technical view
OASIS Nutritional Advisor Service: a technical view Héctor Galan Marti1, Ana María Navarro Cerdá2, Juan Carlos Naranjo Martinez3 ITACA, Health and Welbeing Technologies Universidad Politécnica de Valencia 1 email@example.com 2 firstname.lastname@example.org 3 email@example.comAbstract— Aging is usually connected to processes related to • Efficient management. More patients can be treatedcognitive and muscular decline and possible loss of autonomy. simultaneously and patients needs less time to doInappropriate nutrition habits, having a sedentary lifestyle and management tasks. Efficiency in the feedback from thedecreasing the food intake increases the risk for malnutrition, patients is one of the objectives that more potential hasdecline of body functions and developing chronic diseases. Aging thanks to the presence of ICT.and malnutrition have therefore a strong impact on the elderly,lowering their quality of life and independency. For this reason, • Adaptation to changing conditions of elderly users.the Nutritional Advisor Service has been developed in order to • Support in nutritional-related activities of the daily life.control and improve the nutritional habits of the elderly as well Cooking and shopping assistance depend usually onas provide a complete tool for the nutritionists. The service has external support. With ICT systems, support whenbeen integrated into the OASIS framework, achieving a more cooking and automatic generation of shopping can beaccessible user interface, greater interoperability mechanisms for offered to help the elderly in their daily activities.sharing external services functionalities.The purpose of this paper is to give a technical overview of how It is then needed an approach to face this issue by usingthe service was developed and integrated into OASIS, as well as ICT in the promotion of a healthy nutrition. As a result, thethe methodology employed to design the service. Finally adiscussion about the challenges encountered and the future steps Nutritional Advisor Service has been developed, as one theto follow has been also included. available OASIS [5, 6] services. Its objective is to control and greatly improve the nutritional habits of the elderly as well as I. INTRODUCTION provide an integrated tool for nutritionists. Recent studies [1, 2] about ageing in Europe show a The Nutritional Advisor Service (NA)  consists basicallygrowing trend of older population in the next 50-years period. of: (i) a nutritional advisor client (application at user’s home) Aging is usually connected to processes related to cognitive that shows the personalized nutritional content (menus,and muscular decline and possible loss of autonomy. The advises, etc) to the elderly, (ii) a remote server that providesinappropriate food and water ingestion  has a direct the user with nutritional advisor services: user profiling,consequence in the loss of lean body mass such sarcopenia, personalized weekly menus, nutritional tips and shopping anddiabetes, osteoporosis fractures, cardiovascular diseases and cooking assistance, and (iii) a desktop application for thesome cancers. Approximately 25% of the free-living nutritionists, that allows them to manage the elderlyindividuals 65 years of age and older suffers from many of the nutritional information.elements of syndrome of frailty. All the nutritional content provided by the Nutritional Due to all these facts, aging and malnutrition can lead our Advisor Service, is customized for each specific user, takingelderly towards a significant decrease of their quality of life into account the user profile , which gathers the likes, needsand independency, which, in turn, implies an increase of the and requirements of the elderly user.health-system costs that can derive in a critical situation of the Moreover, the Nutritional Advisor is integrated into thepublic health-care system. OASIS platform, which allows the interoperability, the In general, Information and Communication Technologies seamless connectivity and sharing of content between services(ICT) demonstrated to be a good help in many processes of of different application domains.our daily lives as citizens and nutrition is one of them . The II. STATE OF THE ART ON NUTRITION SERVICESreason is mainly because it allows implementing: • Personalization. ICT allows the implementation of Other programmes that aim to promote the elderly nutrition personalized nutritional management services: exist. PIPS [9, 10] and PERSONA , are two European personalized nutritional advices, personalized menus funded projects on which the presented service is based. based on preferences and not only in general indicators, The main purpose of PIPS is to create a health and life personalized motivational strategies. knowledge and Services Support Environment for protecting • Independence from the physical and temporal the health of the individual. This will improve current availability. ICT allows the professional and the user HealthCare (HC) delivery models while creating possibilities participate in the nutritional process whenever and for HC professionals to access relevant-updated medical wherever needed. knowledge and for citizens to choose healthier lifestyles.
PERSONA, is developing a scalable open standard developed and maintained as independent modules, most oftentechnological platform to build a broad range of AAL on separate platforms.Services, to demonstrate and test the concept in real lifeimplementations, assessing their social impact andestablishing the initial business strategy. Within this project anAAL systems reference architecture allowing seamlessintegration of the required devices, sub-systems and ontology-based services was developed. PERSONA and PIPS stress the importance of offeringpersonalized nutritional counseling to each elderly user, so thediet and the recommendations are adapted to the elderly userneeds and preferences. Both projects have developed aprofiling service, in charge of creating a nutritional profilefrom user or professional input. However, elderly users arenot static individuals, more on the contrary, their conditionsand needs change constantly, even daily, so it is necessary tocreate services that dynamically adapt to these changes. Besides the changes of the elderly status, environmentalchanges have also influence on the elderly nutrition. For Fig. 1 Nutritional Advisor architectureinstance, diet changes with seasons and recommendationsdepend strongly on the weather conditions. This brings us to As architectural designing rule, both the elderly and theconsider the importance of taking into account the context nutritionist’s application are as light and tiny as possible,when offering nutritional counseling to the elderly. while the logic and heavy computing workload is placed on In addition, when designing an application for the elderly, the server side.the user interfaces should be easy to use and accessible. This The Nutritional Advisor offers its services to the elderlyissue is critical for the success of the service, since the elderly user through one device: A tablet PC, intended for the use atacceptability depends not only on the content offered but also home. This client will have the following architecture:on the design and the simplicity of the system. Future ICT- • A presentation layer with the Graphical User Interfacebased nutritional services should take into account these (GUI), which presents the nutritional information to theconsiderations and include accessible GUI in their designs. elderly user in an accessible way. • The local business layer, with light functional process III. REFERENCE ARCHITECTURE logic. The subsystems’ logic processes and evaluates The Nutritional Advisor service consists of two main actors. the data received from the elderly user and requests theOn one hand the elderly, who access the service from home, server business processes with web services throughusing a tablet PC; in the other hand the nutritionist who OASIS middleware, which functions in a transparentcontrols and manages the nutritional information. The service way for the application.is placed in different devices that should interoperate, • A local data layer, for storing local data (mainly thefollowing a distributed architecture. Furthermore, the different local profile) that the local business layer will use.subsystems will communicate through OASIS middlewareplatform. As for the server side, it is compound of the following The service is compound of four components (see Figure 1): layers: • Nutritional server: a web server that holds all the • The web service description layer, which offers the information related to the service. web-services descriptions. On the one hand we have the • OASIS middleware: a number of frameworks that allow WSDL Nutritional Advisor services, which offer the the interoperability and access to multiple services. communication layer between the Nutritional Advisor • Elderly application: a desktop application which client and the server business layer. On the other, the requests all data to the Nutritional server through the WSDL Nutritionist services, which provide the OASIS middleware. interface between the Nutritionist GUI and the server • Nutritionist application: a desktop application which business layer: contacts the Nutritional server directly. • The Server Business Layer, which controls the system functionality by performing detailed processing of the In order to assure the flexibility, usability, scalability, and different nutritional algorithms.interoperability among the different subsystems and the • Server Data Layer, where the nutritional database isOASIS platform, a multitier architecture has been adopted. stored in multiple languages.Multitier architecture  is a client–server model in whichthe user interface, the functional process logic ("business The nutritionist is able to access the service through arules"), and the computer data storage and data access are desktop application which employs a GUI that directly
connects with the WSDL services of the Nutritional Server. ingredients, recipes, advises and allergies, among others.This desktop application is called the Nutritionist Service Figure 2 shows a diagram of a section of the nutritionCentre. ontology. The complete listing of ontologies is available at http://orate.iti.gr/ontologies. Using OASIS: Interoperability The Nutritional Advisor Service is based upon the OASIS TABLE I framework and technologies. OASIS framework is a USE OF OTHER SERVICE’S PROFILElarge scale European Integrated Project with aim to developan open and innovative reference architecture, based upon OASIS Useful content for Nutritional Advisor Applicationontologies and semantic services that allow plug-and-play Activity User’s activity, type of exercise, activity levelinterconnection of existing and newly developed services in Coach service and calories consumedall domains required for the independent and autonomous Health User’s health status and health condition,living of older people and their enhanced quality of life. Monitoring chronic diseases, current medication, blood test In order to provide a service available at OASIS, it must resultsaccomplish two requisites: Environmenta Personal habits, room temperature, weather • Describe the service operations in a publicly accessible l control WSDL file Social Friend’s contacts, agenda • Define the service concepts as ontological concepts in Communities the Ontology Web Language and upload them to OASIS’ Ontology Repository. TABLE II The service is then ready to be aligned by using the Content USE OF NUTRITIONAL ADVISOR PROFILE BY EXTERNAL SERVICESAnchoring and Alignment Tool (CAAT) which aligns the OASIS Information provided by Nutritional Advisorfunctionality of the nutritional web service through its WSDL Applicationfile with the ontologies stored at the Ontology Repository]. Activity Ingested calories, nutritional values of theOnce aligned, the service is available to be used by any Coach service nutritional plan, menus, recipesOASIS application/service by use of the AMbient Intelligence Health Food allergies, food intolerances, foodframework [ref 14], a desktop frontend that enables the access Monitoring likes/dislikesto other service’s operations. Brain trainer Shopping list items, recipes The Nutritional Advisor architecture makes use of other Social Favourite recipes, Today’s menuOASIS services such as the Health Monitoring [ref 15], CommunitiesActivity Coach [ref 16] or Social Communities. Theseservices create their own profile with detailed information Accessible and self-adaptive User Interactionabout the user. OASIS provides with a desktop frontend that Developing Graphic User Interfaces that are easy to use,enables different services to have access to other service’s accessible and usable for elderly people is a known challengeprofile: the User Profile. By accessing a user’s profile from . In this matter, OASIS applications make use of aother services it improves and increases the user experience as framework that enables the fast and simple creation ofwell as creates new use cases that expand the possibilities of accessible user interfaces that self-adapt to the user’sthe Nutritional Advisor service by itself. The information read requirements. This is accomplished by using the Adaptivefrom other service’s profile is described in Table 1. Widget Library, a framework that encapsulates all the In the same fashion, other OASIS services are able to use complexity for supporting adaptation (from evaluation requestinformation that the Nutritional Advisor makes available in its to decision application) and may be integrated into commonUser Profile. Table 2 shows a list of the possible usage of the IDEs to facilitate developers while building self-adaptivenutrition profile. interfaces. Nevertheless, the Nutritional Advisor service is able to Depending on the user’s profile, the user interface willwork and perform its tasks with no other applications adapt in many ways to satisfy the user’s needs. Some of theconnected. The connection of new applications (coming or not adaptation capabilities focus on:from OASIS) will result in a value-added service for the • Bigger font sizesNutritional Advisor service. • Lighter / darker backgrounds • Bigger button areas Ontologies The result of using the Adaptive Widget Library is shown As previously mentioned, the service must define the in Figure 3.knowledge exchanged based on ontologies : a set ofconcepts within the nutrition domain and the relationshipbetween those concepts. The ontology is defined in the OWLformat. The nutrition ontology contains all the concepts related tothe service, including such as menus, dishes, foods,
NutritionalProfile::NutritionalProfilingManager sessions, the design team applied the User Centred Design [19, ShoppingAssistant::ShoppingList CookingAssisstant:Recipes «uses» 20], which seeks to place the user at the forefront of the NutritionalPlanBuilder OASIS Agenda design effort. A low-fidelity NA prototype intended for the «uses» user resulted from these workshops.NutritionalQuestionnaires::PersonalisedQuestionnaire «uses» «uses» OASIS «uses» SocialCommunities Nutrition management requirements «uses» NutritionalPlanBuilderManager In order to extract the nutritionists work methodology and NutritionalPlanner +createsNutritionalPlan() 1 NutritionalPlanAccess the nutrition expert’s point of view regarding nutrition of the +createMenuRequest() +changeMenuRequest() 1 +modifiesNutritionalPlan() +showsNutritionalPlan() +downloadsNutritionalPlan() elderly, several sessions with nutritionists were performed. 1 +showsNutritionalPlan() +changesAlternativeMeal() calls 1..* The main requirements and needs of an application that allows 1 1..* MenuDishRecipeRepository the nutritionist to manage the elderly nutrition were extracted. 1 - A low-fidelity nutritionist service centre prototype resulted NutritionalPlan Menu * 1 -NutritionalProperties from these step. -Nutritional Properties 1 1..* 1 1 1 UsersRemoteNutritionalPlanRepository Information exchange between external OASIS services hasDayMenu DayMenu hasMealMenu MealMenu 11 Within OASIS project, several services apart from the 1 Nutritional Advisor have been developed. For instance, health, hasDish UserslocalNutritionalPlanRepository 1 activity data and environmental information coming from the Dish 1 1 Health Monitoring, Activity Coach and the Environmental 1 1..* 1..* Recipe Control services (amongst others) can be used to refine the Food 1..* user’s nutritional profile and the nutritional content provided 11 to the elderly user. In the same way, NA content and services ShoppingAssistant::ShoppingItem can be used as input for different OASIS services. In this step, the interconnection and exchange of data with other services was analysed and the interoperability “use cases” detected.Fig. 2 Nutritional Plan Builder ontology B. Service Subsystems Different subsystems have been developed into the IV. SERVICE DEVELOPED Nutritional Advisor, providing different sevices that can be used separately. A complete nutritional service has been developed: theNutritional Advisor service. It consists of: (i) a nutritional Profile definition & personalization serviceadvisor client (application at user’s home) that shows the This service creates a personalised nutritional habits profilepersonalized nutritional content (menus, advises, etc) to the by collecting the data from the user. It can directly ask theelderly, (ii) a desktop application for the nutritionists, that person or retrieve the data from other OASIS applicationsallows them to manage the elderly nutritional information. such as the activity coach or the health monitoring.A. Methodology Different actors take part in this service. On one hand, the nutritionist creates and manages both the nutritional During the development of the Nutritional Advisor Service questionnaires for explicitly gathering the nutritional profilethe following methodology approach has been followed. information and the user nutritional profile. On the other hand, the user receives the questionnaires at home and answers them, User requirements and use cases sending them back to the nutritionist automatically. The elicitation of requirements of elderly users regarding Therefore, three components are needed:nutrition and analysis of needs was carried out through • Questionnaires Manager server component, forquestionnaires with 100 users living in sheltered homes and managing the nutritional questionnaires.100 users living alone in homes, as well as 80 carers from four • Nutritional Profile Manager server component, forEuropean Centres (Italy, Spain, Germany and Bulgaria). managing user’s nutritional profile.Based on this data, the definition of use cases and application • Nutritional Questionnaires client component, thatscenarios were developed, showing detailed descriptions of allows end-users at home to receive and send back thethe intended functionality of the nutritional advisor services. nutritional questionnaires. Oasis Participatory Analysis Framework Nutritional plan builder service Within OASIS project, several workshops with users This service involves the creation of a nutritionally well-addressing the use cases of the Nutritional Advisor have been balanced plan for the elderly that also fits (as much as possible)performed. These sessions have allowed the extraction of the with his/her preferences and health status. Both elderly useruser requirements and needs, as well as the functionalities and and nutritionist take part in this service: The nutritionistobligations of the NA application for elders. During the manages the menus tailored for the elderly users: creates the
menus, manages the nutritional content and assures that the when getting ready to buy the food: printing the list, sending itnutritional plan provided to each user is tailored to his/her to a carer and having direct access to the shopping list whenspecific needs and the elderly, who receives the Nutritional user is outdoors. It also guides the user to cook a recipe, withPlan at home and may switch some of the dishes of the plan. the needed ingredients and instructions. The elderly user and the carer/family member take part in this service. The elderly user/carer receives the shopping list and is be able to manage it. In order to achieve these features, the following modules are needed: • Shopping List Generator server component: automatically calculates the ingredients needed and creates the shopping list. • Shopping Assistant client component: provides the elderly user with tools to manage the shopping list. • Cooking Assistant client component: guides the user to cook the meals. V. DISCUSSION Having a service to manage, motivate and improve an elderly person’s nutritional habits is a challenge. TheFig. 3 Nutritional Advisor showing an advice. developed tools provide a way of handling every day’s cooking habits, as well as recipe instructions and management Two components are needed: of the shopping list. The development of a nutrition service • Nutritional Plan Builder Manager server component, for involves the management of private user information like life managing the nutritional content: meals, menus and style, meal patterns, cultural background, body measurements, creating the nutritional plan. nutritional preferences, intolerances, allergies and use of • Nutritional Plan client component that shows the menus medicines. Furthermore, the interoperability with other to the elderly user at home. services raises some concerns about privacy issues. Although all information is being treated privately, users feel uneasy Nutritional empowerment & assessment service when they realize their information and behaviour is being This service specifies the creation and reinforcement of tracked.correct nutritional habits by showing messages about things to The nutrition service has proven to be relatively invasive,do, things to do not, etc. Figure 3 shows an advice being since telling an elderly what to eat can be sometimes toodisplayed to the user. These messages will be shown also by restrictive. Consequently, the service could be more flexibletaking the information from other OASIS services like the and provide with a wider selection of meals to choose from.Activity Coach or the Health Monitoring. In order to send themessages, a set of rules (time, schedule) are defined. This VI. FUTURE STEPSallows the creation of smart advices like: “If the user has The Nutritional Advisor Service is currently being tested atexercised and is very hot in the room, remember him to drink pilot sites in three different countries: Bulgaria, Romania andwater” or “If it is the user’s time for lunch and he has to take Italy. The service has been installed in about 30 people’ssome medicines at that time, remind him to take his pills”. houses, with ages that range from 50-70 years old. After the The actors that take part in this service are: the nutritionist, completion of the pilots, a survey will be filled and every pilotwho creates and assigns the messages and the triggering rules user will be asked for feedback. This feedback will be used toto the end-user, and the elderly user, who receives the further improve the service.recommendations and warnings at home. The shopping list assistant could be further improved. A The following components will be developed: greater control over the kitchen’s movements such as what • Nutritional Advises Scheduler client component that items are available in the refrigerator or what needs to be should check when the triggering rule is fulfilled and bought could be of great interest. show the message to the user. Future developments include the creation of a web based • Nutritional Advises Scheduler Manager server tool for the nutritionist. This would allow an easier access to component, for managing the messages and rules. the service, as well as a simplification of the deployment process. Shopping and cooking assistant Tests with nutritionists have demonstrated a big interest of This service involves the automatic creation of a shopping using the application with focus groups of users with specificlist with the necessary items for preparing the meals of each and more demanding nutritional diets. The tool could be veryuser, according to their nutritional plan. It assists the user
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