Smart wearable body sensors for patient self-assessment and monitoring

Precision medicine in resistant Tuberculosis: Treat the correct patient, at the correct time, with the correct drug

Human genomic mapping has advanced molecular medicine health care and created a transformative paradigm shift towards Precision Medicine. In 2015, President Obama launched the PM initiative, encapsulated as "unique individualized data-driven treatments". Since then, this field is rapidly advancing both curative treatment and disease prevention by accounting for both individual and environmental variability. While a substantial evidence for accelerating adoption of Precision Medicine in other spheres of medicine exists, application of Precision Medicine in infectious diseases is far more complex. One of the most warranted applications of precision healthcare is in the management and treatment of Drug-resistant Tuberculosis. Application of Precision Medicine to Drug-resistant Tuberculosis could potentially change the landscape of treatment and prevention of a disease affecting vulnerable patients in impoverished communities. Poorly diagnosed and treated Drug-resistant Tuberculosis not only leads to increased mortality and morbidity but also increased transmission of DR-TB strains, fuelling ongoing high incidence rates and further infection. A Precision medicine model using individual clinical case histories used in conjunction with Mycobacterium Tuberculosis infection genomic data will better guide health care practitioners in more appropriate drug selection, and an individualized management approach. This viewpoint deliberates the intricacies of adopting a PM approach in the management of DR-TB. If applied correctly, we postulate that the research, application, and deployment of PM in DR-TB management may address the fundamental rule of PM in infectious disease: to treat the correct patient, at the correct time, with the correct drug.

Significance of Nanomaterials in Wearables: A Review on Wearable Actuators and Sensors

Together with the evolution of digital health care, the wearable electronics field has evolved rapidly during the past few years and is expected to be expanded even further within the first few years of the next decade. As the next stage of wearables is predicted to move toward integrated wearables, nanomaterials and nanocomposites are in the spotlight of the search for novel concepts for integration. In addition, the conversion of current devices and attachment-based wearables into integrated technology may involve a significant size reduction while retaining their functional capabilities. Nanomaterial-based wearable sensors have already marked their presence with a significant distinction while nanomaterial-based wearable actuators are still at their embryonic stage. This review looks into the contribution of nanomaterials and nanocomposites to wearable technology with a focus on wearable sensors and actuators.

Automatic real-time gait event detection in children using deep neural networks

Annotation of foot-contact and foot-off events is the initial step in post-processing for most quantitative gait analysis workflows. If clean force plate strikes are present, the events can be automatically detected. Otherwise, annotation of gait events is performed manually, since reliable automatic tools are not available. Automatic annotation methods have been proposed for normal gait, but are usually based on heuristics of the coordinates and velocities of motion capture markers placed on the feet. These heuristics do not generalize to pathological gait due to greater variability in kinematics and anatomy of patients, as well as the presence of assistive devices. In this paper, we use a data-driven approach to predict foot-contact and foot-off events from kinematic and marker time series in children with normal and pathological gait. Through analysis of 9092 gait cycle measurements we build a predictive model using Long Short-Term Memory (LSTM) artificial neural networks. The best-performing model identifies foot-contact and foot-off events with an average error of 10 and 13 milliseconds respectively, outperforming popular heuristic-based approaches. We conclude that the accuracy of our approach is sufficient for most clinical and research applications in the pediatric population. Moreover, the LSTM architecture enables real-time predictions, enabling applications for real-time control of active assistive devices, orthoses, or prostheses. We provide the model, usage examples, and the training code in an open-source package.

Personalized medicine: motivation, challenges, and progress

There is a great deal of hype surrounding the concept of personalized medicine. Personalized medicine is rooted in the belief that since individuals possess nuanced and unique characteristics at the molecular, physiological, environmental exposure, and behavioral levels, they may need to have interventions provided to them for diseases they possess that are tailored to these nuanced and unique characteristics. This belief has been verified to some degree through the application of emerging technologies such as DNA sequencing, proteomics, imaging protocols, and wireless health monitoring devices, which have revealed great inter-individual variation in disease processes. In this review, we consider the motivation for personalized medicine, its historical precedents, the emerging technologies that are enabling it, some recent experiences including successes and setbacks, ways of vetting and deploying personalized medicines, and future directions, including potential ways of treating individuals with fertility and sterility issues. We also consider current limitations of personalized medicine. We ultimately argue that since aspects of personalized medicine are rooted in biological realities, personalized medicine practices in certain contexts are likely to be inevitable, especially as relevant assays and deployment strategies become more efficient and cost-effective.

Evaluation of a Wearable Device to Determine Cardiorespiratory Parameters From Surface Diaphragm Electromyography

The use of wearable devices in clinical routines could reduce healthcare costs and improve the quality of assessment in patients with chronic respiratory diseases. The purpose of this study is to evaluate the capacity of a Shimmer3 wearable device to extract reliable cardiorespiratory parameters from surface diaphragm electromyography (EMGdi). Twenty healthy volunteers underwent an incremental load respiratory test whilst EMGdi was recorded with a Shimmer3 wearable device (EMGdi_W). Simultaneously, a second EMGdi (EMGdi_L), inspiratory mouth pressure (Pmouth) and lead-I electrocardiogram (ECG) were recorded via a standard wired laboratory acquisition system. Different cardiorespiratory parameters were extracted from both EMGdi_W and EMGdi_L signals: heart rate, respiratory rate, respiratory muscle activity, and mean frequency of EMGdi signals. Alongside these, similar parameters were also extracted from reference signals (Pmouth and ECG). High correlations were found between the data extracted from the EMGdi_W and the reference signal data: heart rate (R = 0.947), respiratory rate (R = 0.940), respiratory muscle activity (R = 0.877), and mean frequency (R = 0.895). Moreover, similar increments in EMGdi_W and EMGdi_L activity were observed when Pmouth was raised, enabling the study of respiratory muscle activation. In summary, the Shimmer3 device is a promising and cost-effective solution for the ambulatory monitoring of respiratory muscle function in chronic respiratory diseases.

Digital Follow-Up and the Perspective of Patient-Centered Care in Oncology: What's the PROblem?

There is accumulating evidence from randomized trials suggesting that digital patient-centered care allows a more reliable detection of tumour-related symptoms and adverse events - with a direct impact on overall survival. Consequently, a variety of unsynchronized approaches were kicked off to (electronically) measure patient-reported outcomes (PROs). Despite increasing evidence that PRO data are highly relevant for patient care, the data generated in these initial projects lack standardized processing pathways in order to impact clinical routine; therefore, potential future routine PRO assessments require adequate analysis, storage and processing to allow a robust, reproducible and reliable incorporation into routine clinical decision-making. Here, we discuss relevant challenges of digital follow-up that need to be tackled to render PRO data as relevant to physicians as laboratory or biomarker data.

Systems Biology, Systems Medicine, Systems Pharmacology: The What and The Why

Systems biology is today such a widespread discipline that it becomes difficult to propose a clear definition of what it really is. For some, it remains restricted to the genomic field. For many, it designates the integrated approach or the corpus of computational methods employed to handle the vast amount of biological or medical data and investigate the complexity of the living. Although defining systems biology might be difficult, on the other hand its purpose is clear: systems biology, with its emerging subfields systems medicine and systems pharmacology, clearly aims at making sense of complex observations/experimental and clinical datasets to improve our understanding of diseases and their treatments without putting aside the context in which they appear and develop. In this short review, we aim to specifically focus on these new subfields with the new theoretical tools and approaches that were developed in the context of cancer. Systems pharmacology and medicine now give hope for major improvements in cancer therapy, making personalized medicine closer to reality. As we will see, the current challenge is to be able to improve the clinical practice according to the paradigm shift of systems sciences.

Potentiometry as a Tool for Monitoring of Antioxidant Activity and Oxidative Stress Estimation in Medicine

The complexity of biological objects and the rapid change in their composition after sampling, the variety of compounds of different chemical nature, possessing oxidative and antioxidant properties, make the task of its estimating extremely nontrivial and important for food, nutrients and human health characterization. The paper discusses the use of potentiometry in determining integral antioxidant/oxidant activity mainly of biological fluids and human skin. The source of information is the electrode potential shift that occurs when the analyzed object is inserted in the solution of the mediator system or when the mediator system is exposed to human skin. The experimental approaches, protocols, calculations are described. A number of examples of antioxidant activity and oxidative stress estimation in medicine are presented. The works show lower levels of antioxidant activity (AOA) of plasma and blood serum in patients with cardiovascular diseases, obesity, and malignant neoplasms as compared with the healthy volunteers. It was found out that antioxidant activity of fertile men semen is higher than AOA of infertile patients. Using the method discussed have shown that in some infertile male patients antioxidant activity of semen has been accompanied by oxidant activity. It has been found, that antioxidant activity of skin increases after intake of ascorbic acid and vitamin-enriched juices. The described approach holds considerable promise for monitoring oxidative stress of the whole organism and its systems, and for selecting effective and safe therapy. Thus, it opens up new opportunities in expanding the use of analytical chemistry in such an important field as medicine.

Materials and Wearable Devices for Autonomous Monitoring of Physiological Markers

Wearable devices are gaining considerable attention owing to the ease with which they can collect crucial information in real-time, both continuously and noninvasively, regarding a wearer's health. A concise summary is given of the three main elements that enable autonomous detection and monitoring of the likelihood or the existence of a health-risk state in continuous and real-time modes, with an emphasis on emerging materials and fabrication techniques in the relevant fields. The first element is the sensing technology used in the noninvasive detection of physiological markers relevant to the state of health. The second element is self-powered devices for longer periods of use by drawing energy from bodily movement and temperature. The third element is the self-healing properties of the materials used in the wearable devices to extended usage if they become scratched or cut. Promises and challenges of the separately reviewed parts and the combined parts are presented and discussed. Ideas regarding further improvement of skin-based wearable devices are also presented and discussed.

Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case-control study

PURPOSE

Reduction of maternal morbidity and mortality is a major worldwide objective anchored in the millennium goals of the United Nations. To improve fetal and maternal care, a constant attempt to discover groundbreaking technologies is ongoing. One approach is the enhancement of non-invasive fetal ECG devices. Most importantly, acceptance of new technologies by pregnant women is a prerequisite for successful implementation.

METHODS

This questionnaire-based study conducted at the University Hospital Heidelberg, Germany between May and June 2017 evaluates pregnant women's attitudes towards a new device for fetal ECG monitoring and its potential home usage. The study population was questioned after exposure to the Parides/Atlantis prototype (Nemo Healthcare, Veldhoven, The Netherlands), whereas the maternal and gestational age-matched control group was left to envision telemedical topics.

RESULTS

The prototype and its potential usage in a clinical and telemedical setting was highly accepted, and its comfort and appearance satisfied participants. Its use caused significantly improved telemedical understanding as envision increased (p = 0.0015). Implementation and integration of telemedical devices into antenatal care was significantly preferred by the study group (p = 0.0011), though participants desire more specific features for their personal use. Optional home-based self-monitoring to reduce scheduled doctoral visits (p = 0.0004) as well as self-assessment prior to self-initiated, unscheduled consultation (p < 0.0001) could be affected positively by such a device. Furthermore, it could reduce face-to-face interaction with the care provider (p = 0.0163).

CONCLUSIONS

The positive feedback on remote self-monitoring might open options for a more "patient as partners" oriented prenatal care in the future. Safety and reliability remain a major issue. More comprehensive studies with new technologies are needed to diligently ensure quality of care. Finally, results for new technologies must be communicated to pregnant women for their acceptance and usage of new devices.

Enabling Technologies for Operator 4.0: A Survey

The fast development of smart sensors and wearable devices has provided the opportunity to develop intelligent operator workspaces. The resultant Human-Cyber-Physical Systems (H-CPS) integrate the operators into flexible and multi-purpose manufacturing processes. The primary enabling factor of the resultant Operator 4.0 paradigm is the integration of advanced sensor and actuator technologies and communications solutions. This work provides an extensive overview of these technologies and highlights that the design of future workplaces should be based on the concept of intelligent space.

Usability Evaluation for the Amulet Wearable Device in Rural Older Adults with Obesity

Mobile health (mHealth) interventions hold the promise of augmenting existing health promotion interventions. Older adults present unique challenges in advancing new models of health promotion using technology including sensory limitations and less experience with mHealth, underscoring the need for specialized usability testing. We use an open-source mHealth device as a case example for its integration in a newly designed health services intervention. We performed a convergent, parallel mixed-methods study including semi-structured interviews, focus groups, and questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting We transcribed the data, developed codes informed by thematic analysis using inductive and deductive methods, and assessed the quantitative data using descriptive statistics. Our results suggest the importance of end-users in user-centered design of mHealth devices and that aesthetics are critically important. The prototype could potentially be feasibly integrated within health behavior interventions. Centralized dashboards were desired by all participants and ecological momentary assessment could be an important part of monitoring. Concerns of mHealth, including the prototype device, include the device's accuracy, its intrusiveness in daily life and privacy. Formative evaluations are critically important prior to deploying large-scale interventions.

A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study

Background

The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed.

Objective

The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine.

Methods

A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior.

Results

In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9%) about the use of telemedicine in obstetrics; however, 55.8% (130/233) recognized its potential. Moreover, 72% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7% rejected) compared with physicians (24/86, 28%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month.

Conclusions

Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring.

Using home sensing technology to assess outcome and recovery after hip and knee replacement in the UK: the HEmiSPHERE study protocol

INTRODUCTION

Over 160 000 people with severe hip or knee pain caused by osteoarthritis undergo total hip (THR) or knee replacement (TKR) surgery each year in the UK within the National Health Service (NHS), and this number is expected to increase. Innovative approaches to evaluating surgical outcomes will be needed to respond to the increasing burden of joint replacement surgery. The Sensor Platform for Healthcare in a Residential Environment, Interdisciplinary Research Collaboration (SPHERE-IRC) have developed a system of sensors that can monitor the health-related behaviours of people living at home. The system includes sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage), a wristband body-worn activity monitor and silhouette (body outline) sensors. The aim of HEmiSPHERE (Hip and knEe study of a Sensor Platform of HEalthcare in a Residential Environment) is to (1) determine the accuracy and feasibility of the sensory data as it compares with conventional assessment of health outcomes after surgery using patient self-reported questionnaires, and (2) to explore how the SPHERE system is useful for everyday clinical decision-making.

METHODS AND ANALYSIS

A feasibility study recruiting and installing the SPHERE system in the homes of up to 30 NHS adult patients as they undergo a THR or TKR. Through a mixed-methods design, the SPHERE system will monitor and record continuous measurements of daily behaviour. Main outcomes will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the standard clinical assessments measuring patient outcomes over time. Patient interviews and focus groups with consultant orthopaedic surgeons will provide in-depth understanding of the acceptability, feasibility and accuracy of the data.

ETHICS AND DISSEMINATION

We aim to disseminate the findings through regional talks and seminars, international conferences and peer-reviewed journals and social media.

Wearable Health Devices-Vital Sign Monitoring, Systems and Technologies

Wearable Health Devices (WHDs) are increasingly helping people to better monitor their health status both at an activity/fitness level for self-health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnostic and guidance of treatment. The technology revolution in the miniaturization of electronic devices is enabling to design more reliable and adaptable wearables, contributing for a world-wide change in the health monitoring approach. In this paper we review important aspects in the WHDs area, listing the state-of-the-art of wearable vital signs sensing technologies plus their system architectures and specifications. A focus on vital signs acquired by WHDs is made: first a discussion about the most important vital signs for health assessment using WHDs is presented and then for each vital sign a description is made concerning its origin and effect on heath, monitoring needs, acquisition methods and WHDs and recent scientific developments on the area (electrocardiogram, heart rate, blood pressure, respiration rate, blood oxygen saturation, blood glucose, skin perspiration, capnography, body temperature, motion evaluation, cardiac implantable devices and ambient parameters). A general WHDs system architecture is presented based on the state-of-the-art. After a global review of WHDs, we zoom in into cardiovascular WHDs, analysing commercial devices and their applicability versus quality, extending this subject to smart t-shirts for medical purposes. Furthermore we present a resumed evolution of these devices based on the prototypes developed along the years. Finally we discuss likely market trends and future challenges for the emerging WHDs area.

Sensors and Functionalities of Non-Invasive Wrist-Wearable Devices: A Review

Wearable devices have recently received considerable interest due to their great promise for a plethora of applications. Increased research efforts are oriented towards a non-invasive monitoring of human health as well as activity parameters. A wide range of wearable sensors are being developed for real-time non-invasive monitoring. This paper provides a comprehensive review of sensors used in wrist-wearable devices, methods used for the visualization of parameters measured as well as methods used for intelligent analysis of data obtained from wrist-wearable devices. In line with this, the main features of commercial wrist-wearable devices are presented. As a result of this review, a taxonomy of sensors, functionalities, and methods used in non-invasive wrist-wearable devices was assembled.

Diffusion of the Digital Health Self-Tracking Movement in Canada: Results of a National Survey

Background

With the ever-increasing availability of mobile apps, consumer wearables, and smart medical devices, more and more individuals are self-tracking and managing their personal health data.

Objective

The aim of this study was to investigate the diffusion of the digital self-tracking movement in Canada. It provides a comprehensive, yet detailed account of this phenomenon. It examines the profile of digital self-trackers, traditional self-trackers, and nontrackers, further investigating the primary motivations for self-tracking and reasons for nontracking; barriers to adoption of connected care technologies; users’ appreciation of their self-tracking devices, including what they perceive to be the main benefits; factors that influence people’s intention to continue using connected care technologies in the future; and the reasons for usage discontinuance.

Methods

We conducted an online survey with a sample of 4109 Canadian adults, one of the largest ever. To ensure a representative sample, quota method was used (gender, age), following stratification by region. The maximum margin of error is estimated at 1.6%, 19 times out of 20.

Results

Our findings reveal that 66.20% (2720/4109) of our respondents regularly self-track one or more aspects of their health. About one in 4 respondents (1014/4109, 24.68%) currently owns a wearable or smart medical device, and 57.20% (580/1014) use their devices on a regular basis for self-tracking purposes. Digital self-trackers are typically young or mature adults, healthy, employed, university educated, with an annual family income of over $80,000 CAD. The most popular reported device is the fitness tracker or smartwatch that can capture a range of parameters. Currently, mobile apps and digital self-tracking devices are mainly used to monitor physical activity (856/1669, 51.13%), nutrition (545/1669, 32.65%), sleep patterns (482/1669, 28.88%) and, to a much lesser extent, cardiovascular and pulmonary biomarkers (215/1669, 12.88%), medication intake (126/1669, 7.55%), and glucose level (79/1669, 4.73%). Most users of connected care technologies (481/580, 83.0%) are highly satisfied and 88.2% (511/580) intend to continue using their apps and devices in the future. A majority said smart digital devices have allowed them to maintain or improve their health condition (398/580, 68.5%) and to be better informed about their health in general (387/580, 66.6%). About 33.80% of our sample (1389/4109) is composed of people who do not monitor their health or well-being on a regular basis.

Conclusions

Our study shows an opportunity to advance the health of Canadians through connected care technologies. Our findings can be used to set baseline information for future research on the rise of digital health self-tracking and its impacts. Although the use of mobile apps, consumer wearables, and smart medical devices could potentially benefit the growing population of patients with chronic conditions, the question remains as to whether it will diffuse broadly beyond early adopters and across cost inequities.

Barriers to the Adoption of Wearable Sensors in the Workplace: A Survey of Occupational Safety and Health Professionals

OBJECTIVE

To gather information on the (a) types of wearable sensors, particularly personal activity monitors, currently used by occupational safety and health (OSH) professionals; (b) potential benefits of using such technologies in the workplace; and (c) perceived barriers preventing the widespread adoption of wearable sensors in industry.

BACKGROUND

Wearable sensors are increasingly being promoted as a means to improve employee health and well-being, and there is mounting evidence supporting their use as exposure assessment and personal health tools. Despite this, many workplaces have been hesitant to adopt these technologies.

METHODS

An electronic survey was emailed to 28,428 registered members of the American Society of Safety Engineers (ASSE) and 1,302 professionals certified by the Board of Certification in Professional Ergonomics (BCPE).

RESULTS

A total of 952 valid responses were returned. Over half of respondents described being in favor of using wearable sensors to track OSH-related risk factors and relevant exposure metrics at their respective workplaces. However, barriers including concerns regarding employee privacy/confidentiality of collected data, employee compliance, sensor durability, the cost/benefit ratio of using wearables, and good manufacturing practice requirements were described as challenges precluding adoption.

CONCLUSION

The broad adoption of wearable technologies appears to depend largely on the scientific community's ability to successfully address the identified barriers.

APPLICATION

Investigators may use the information provided to develop research studies that better address OSH practitioner concerns and help technology developers operationalize wearable sensors to improve employee health and well-being.

Sensors Based on Bio and Biomimetic Receptors in Medical Diagnostic, Environment, and Food Analysis

Analytical chemistry is now developing mainly in two areas: automation and the creation of complexes that allow, on the one hand, for simultaneously analyzing a large number of samples without the participation of an operator, and on the other, the development of portable miniature devices for personalized medicine and the monitoring of a human habitat. The sensor devices, the great majority of which are biosensors and chemical sensors, perform the role of the latter. That last line is considered in the proposed review. Attention is paid to transducers, receptors, techniques of immobilization of the receptor layer on the transducer surface, processes of signal generation and detection, and methods for increasing sensitivity and accuracy. The features of sensors based on synthetic receptors and additional components (aptamers, molecular imprinted polymers, biomimetics) are discussed. Examples of bio- and chemical sensors' application are given. Miniaturization paths, new power supply means, and wearable and printed sensors are described. Progress in this area opens a revolutionary era in the development of methods of on-site and in-situ monitoring, that is, paving the way from the "test-tube to the smartphone".

Review of Stratum Corneum Impedance Measurement in Non-Invasive Penetration Application

Due to advances in telemedicine, mobile medical care, wearable health monitoring, and electronic skin, great efforts have been directed to non-invasive monitoring and treatment of disease. These processes generally involve disease detection from interstitial fluid (ISF) instead of blood, and transdermal drug delivery. However, the quantitative extraction of ISF and the level of drug absorption are greatly affected by the individual's skin permeability, which is closely related to the properties of the stratum corneum (SC). Therefore, measurement of SC impedance has been proposed as an appropriate way for assessing individual skin differences. In order to figure out the current status and research direction of human SC impedance detection, investigations regarding skin impedance measurement have been reviewed in this paper. Future directions are concluded after a review of impedance models, electrodes, measurement methods and systems, and their applications in treatment. It is believed that a well-matched skin impedance model and measurement method will be established for clinical and point-of care applications in the near future.

Willingness of Older Adults to Share Mobile Health Data with Researchers

Abstract. This study explored the use of wearable devices to track self-recorded health data and the willingness to share this data with researchers. Participants aged ≥ 50 years (n = 1,013) were interviewed in a representative telephone survey. Results indicated that 43.3% of all participants used one or more mobile devices (activity tracker, smartwatch, smartphone, or tablet), and that 27.6% used those devices for the purposes of recording health data. Additionally, 57.2% of the participants who tracked their health data were willing to share it with researchers. Income significantly contributed to predicting this willingness, whereas other independent variables were not significant predictors. This study indicates a relatively positive overall willingness to share self-recorded mobile health data with the science community.

Patient Autonomy and Quality of Care in Telehealthcare

Telemedicine is a complex field including various applications and target groups. Especially telehealthcare is seen by many as a means to revolutionize medicine. It gives patients the opportunity to take charge of their own health by using self-tracking devices and allows health professionals to treat patients from a distance. To some, this means an empowerment of patient autonomy as well as an improvement in the quality of care. Others state the dangers of depersonalization of medicine and the pathologization of daily life. This paper examines the ethical implications of telehealthcare, focusing on patient autonomy and quality of care by analyzing metareviews, randomized controlled trials and narrative ethical analyses on the topic. As a result, we conclude that the technically enhanced encounter between patients and health professionals may mean an empowerment of patient autonomy when it goes along with a personal relationship based on trust, assistance and support. When it comes to the quality of care, telehealthcare may lead to an improvement as long it is adopted to the patient's individual needs.

Wearable Chemosensors: A Review of Recent Progress

In recent years, there has been growing demand for wearable chemosensors for their important potential applications in mobile and electronic healthcare, patient self-assessment, human motion monitoring, and so on. Innovations in wearable chemosensors are revolutionizing the modern lifestyle, especially the involvement of both doctors and patients in the modern healthcare system. The facile interaction of wearable chemosensors with the human body makes them favorable and convenient tools for the detection and long-term monitoring of the chemical, biological, and physical status of the human body at a low cost with high performance. In this Minireview, we give a brief overview of the recent advances and developments in the field of wearable chemosensors, summarize the basic types of wearable chemosensors, and discuss their main functions and fabrication methods. At the end of this paper, the future development direction of wearable chemosensors is prospected. With continued interest and attention to this field, new exciting progress is expected in the development of innovative wearable chemosensors.

The usefulness and actual use of wearable devices among the elderly population

BACKGROUND AND OBJECTIVE

Elderly populations are more prone to diseases and need continuous monitoring of parameters to ensure good health. Wearable devices (WDs) can be helpful in the early detection and management of medical conditions. However, less is known about the use of currently available WDs among elderly populations. The objectives of this study were to determine the usefulness and actual use of wearable devices among the elderly population.

METHODS

Our methodology was based on a systematic review and a survey questionnaire. In the systematic review, search was conducted in four databases PubMed, MDPI, Sage, and Scopus with search terms "wearable device" and "elderly", "wearable sensor" and "elderly". The inclusion criteria were the studies which described health-related wearable devices, its use as the outcome, conducted on a minimum of ten participants and published in the last five years. The survey was conducted on the MOOCs (Massive Open Online Course) platform. The questionnaire was related to the use of technology, intention to use, security and privacy concerns, and willingness to pay.

RESULTS

The review identified 4915 articles, of which, 31 studies eventually met the inclusion criteria. All studies reported positive impacts after assessing devices, despite certain drawbacks. The majority of the samples were males. The survey revealed responses from 233 individuals out of the 1100 participants of the course. The survey results were categorized into two age groups: 54.3% were elderly (>65 years) and 45.49% were non-elderly (≤65 years). Very few elderly people were currently using WD. More than 60% of elderly people were interested in the future use of wearable devices, and preferred future use to improve physical and mental activities. A majority of the respondents were female.

CONCLUSIONS

This study suggests awareness should be created among elderly populations regarding the use of WDs for the early detection and prevention of complications and emergencies. Elderly populations are more prone to benefits from using WDs. The review concluded that devices should be tested on elderly groups as well, considering sex equality, and on both healthy and sick participants for better insights. The survey determined the elderly as frequent users of technology, but lack of knowledge of WD and demonstrated female interest in the use of WD. In future research on WDs, it is suggested that clinical studies be conducted for longer durations, and standard protocols such as age and sex equality should be considered. Requirements from both users and physicians should be acknowledged for better cognizance of WDs.

Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review

This systematic literature review investigates the use of technology for the coordination and management of mental health care with an emphasis on outcomes. Searches of MEDLINE/PubMed, Scopus, and EMBASE were conducted between January 1, 2003, and January 4, 2018, to identify articles that assessed patient outcomes associated with care coordination, evaluated technology to improve care, or discussed management of mental health care using technology. A total of 21 articles were included in a qualitative review based on the recommendations set forth by the PRISMA statement. Among the various health technologies, electronic health records were most commonly used for care coordination, with primary care being the most frequent setting. Care coordination was shown to provide easier patient access to health care providers and to improve communication between caregiver and patient, especially in cases where geographic location or distance is a challenge. Barriers to coordinated care included, but were not limited to, insufficient funding for health information technology, deficient reimbursement plans, limited access to technologies, cultural barriers, and underperforming electronic health record templates. In conclusion, many studies showed the benefit of coordinated and collaborative care through the use of technology; however, further research and development efforts are needed to continue technological innovation for advanced patient care.

Comparison of Heart-Rate-Variability Recording With Smartphone Photoplethysmography, Polar H7 Chest Strap, and Electrocardiography

PURPOSE

To establish the validity of smartphone photoplethysmography (PPG) and heart-rate sensor in the measurement of heart-rate variability (HRV).

METHODS

29 healthy subjects were measured at rest during 5 min of guided breathing and normal breathing using smartphone PPG, a heart-rate chest strap, and electrocardiography (ECG). The root mean sum of the squared differences between R-R intervals (rMSSD) was determined from each device.

RESULTS

Compared to ECG, the technical error of estimate (TEE) was acceptable for all conditions (average TEE CV% [90% CI] = 6.35 [5.13; 8.5]). When assessed as a standardized difference, all differences were deemed "trivial" (average standard difference [90% CI] = 0.10 [0.08; 0.13]). Both PPG- and heart-rate-sensor-derived measures had almost perfect correlations with ECG (R = 1.00 [0.99; 1.00]).

CONCLUSION

Both PPG and heart-rate sensors provide an acceptable agreement for the measurement of rMSSD when compared with ECG. Smartphone PPG technology may be a preferred method of HRV data collection for athletes due to its practicality and ease of use in the field.

Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study

BACKGROUND

Convalescence advice is often based on tradition and anecdote from health care providers, rather than being based on experiences from patients themselves. The aim of this study was to analyse recovery in terms of resumption of various daily activities including work, following different laparoscopic and abdominal surgery in order to optimize an expert-based guideline on convalescence recommendations.

METHODS

This is a prospective cohort study conducted in nine general and one university hospital in the Netherlands. Women aged 18-65 years and scheduled for a hysterectomy (laparoscopic, vaginal, abdominal) and/or laparoscopic adnexal surgery (n = 304) were eligible to participate. Preoperatively, participants were provided with tailored expert-based convalescence recommendations on the graded resumption of several daily activities including sitting, standing, walking, climbing stairs, bending, lifting, driving, cycling, household chores, sport activities and return to work (RTW). Postoperatively, time until the resumption of these activities was tracked. Convalescence recommendations were considered correct when at least 25% and less than 50% of the women were able to resume an activity before or at the recommended recovery time.

RESULTS

There was a wide variation in the duration until the resumption of daily activities within and between groups of patients undergoing different types of surgery. Recovery times lengthened with increasing levels of physical burden as well as with increasing levels of invasiveness of the surgery. For the majority of activities actual recovery times exceeded the recovery time recommended by the expert panel.

CONCLUSIONS

This study provided insight in the resumption of daily activities after gynecological surgery and the adequacy of an expert-based convalescence guideline in clinical practice. Patient data was used to optimize the convalescence recommendations.

TRIAL REGISTRATION

Dutch trial registry, NTR2087 (August 2009) and NTR2933 (June 2011).

Yield of atrial fibrillation detection with Textile Wearable Holter from the acute phase of stroke: Pilot study of Crypto-AF registry

BACKGROUND

We describe the feasibility of monitoring with a Textile Wearable Holter (TWH) in patients included in Crypto AF registry.

METHODS

We monitored cryptogenic stroke patients from stroke onset (<3days) continuously during 28days. We employed a TWH composed by a garment and a recorder. We compared two garments (Lead and Vest) to assess rate of undiagnosed Atrial Fibrillation (AF) detection, monitoring compliance, comfortability (1 to 5 points), skin lesions, and time analyzed. We describe the timing of AF detection in three periods (0-3, 4-15 and 16-28days).

RESULTS

The rate of undiagnosed AF detection with TWH was 21.9% (32 out of 146 patients who completed the monitoring). Global time compliance was 90% of the time expected (583/644h). The level of comfortability was 4 points (IQR 3-5). We detected reversible skin lesions in 5.47% (8/146). The comfortability was similar but time compliance (in hours) was longer in Vest group 591 (IQR [521-639]) vs. Lead 566 (IQR [397-620]) (p=0.025). Also, time analyzed was more prolonged in Vest group 497 (IQR [419-557]) vs. Lead (336h (IQR [140-520]) (p=0.001)). The incidence of AF increases from 5.6% (at 3days) to 17.5% (at 15th day) and up to 20.9% (at 28th day). The percentage of AF episodes detected only in each period was 12.5% (0-3days); 21.7% (4-15days) and 19% (16-28days).

CONCLUSIONS

28days Holter monitoring from the acute phase of the stroke was feasible with TWH. Following our protocol, only five patients were needed to screen to detected one case of AF.

Digitally enhanced recovery: Investigating the use of digital self-tracking for monitoring leisure time physical activity of cardiovascular disease (CVD) patients undergoing cardiac rehabilitation

Research has shown that physical activity is essential in the prevention and treatment of chronic diseases like cardiovascular disease (CVD). Smart wearables (e.g., smartwatches) are increasingly used to foster and monitor human behaviour, including physical activity. However, despite this increased usage, little evidence is available on the effects of smart wearables in behaviour change. The little research which is available typically focuses on the behaviour of healthy individuals rather than patients. In this study, we investigate the effects of using smart wearables by patients undergoing cardiac rehabilitation. A field experiment involving 29 patients was designed and participants were either assigned to the study group (N = 13 patients who finished the study and used a self-tracking device) or the control group (N = 16 patients who finished the study and did not use a device). For both groups data about physiological performance during cardiac stress test was collected at the beginning (baseline), in the middle (in week 6, at the end of the rehabilitation in the organized rehabilitation setting), and at the end of the study (after 12 weeks, at the end of the rehabilitation, including the organized rehabilitation plus another 6 weeks of self-organized rehabilitation). Comparing the physiological performance of both groups, the data showed significant differences. The participants in the study group not only maintained the same performance level as during the midterm examination in week 6, they improved performance even further during the six weeks that followed. The results presented in this paper provide evidence for positive effects of digital self-tracking by patients undergoing cardiac rehabilitation on performance of the cardiovascular system. In this way, our study provides novel insight about the effects of the use of smart wearables by CVD patients. Our findings have implications for the design of self-management approaches in a patient rehabilitation setting. In essence, the use of smart wearables can prolong the success of the rehabilitation outside of the organized rehabilitation setting.

Effects of Flexible Dry Electrode Design on Electrodermal Activity Stimulus Response Detection

OBJECTIVE

The focus of this research is to evaluate the effects of design parameters including surface area, distance between and geometry of dry flexible electrodes on electrodermal activity (EDA) stimulus response detection.

METHODS

EDA is a result of the autonomic nervous system being stimulated, which causes sweat and changes the electrical characteristics of the skin. Standard silver/silver chloride (Ag/AgCl) EDA electrodes are rigid and lack conformability in contact with skin. In this study, flexible dry Ag/AgCl EDA electrodes were fabricated on a compliant substrate, used to monitor EDA stimulus responses and compared to results simultaneously collected by rigid dry Ag/AgCl electrodes.

RESULTS

A repeatable fabrication process for flexible Ag/AgCl electrodes has been established. Surface area, distance between and geometry of electrodes are shown to affect the detectability of the EDA response and the minimum number of sweat glands to be covered by the electrodes has been estimated at 140, or more, in order to maintain functionality. The optimal flexible EDA electrode is a serpentine design with a 0.15 cm² surface area and a 0.20 cm distance with an average Pearson correlation coefficient of .

CONCLUSION

Fabrication of flexible electrodes is described and an understanding of the effects of electrode designs on the EDA stimulus response detection has been established and is potentially related to the coverage of sweat glands.

SIGNIFICANCE

This work presents a novel systematic approach to understand the effects of electrode designs on monitoring EDA which is of importance for the design of wearable EDA monitoring devices.

The relationship between physical activity and post-operative length of hospital stay: A systematic review

BACKGROUND

Recovery from surgery has traditionally been measured using specific outcome measures, such as length of hospital stay. However, advances in technology have enabled the measurement of continuous, objective physical activity data in the perioperative period. The aim of this systematic review was to determine the relationship between length of hospital stay and physical activity data for patients undergoing surgery.

METHODS

A systematic search of EMBASE, Medline and the Cochrane Library, from inception until January 2017, was performed to identify all study designs that evaluated physical activity after surgery. Studies were included if a wearable sensor measured patient activity as an in-patient and the length of hospital stay was reported. Only English articles were included.

RESULTS

Six studies with a total of 343 participants were included in this review. All the studies were prospective observational studies. Each study used a different sensor, with the commonest being a tri-axial accelerometer, and multiple different physical activity outcome measures were used, thereby prohibiting meta-analysis. Four of the studies demonstrated a relationship between physical activity levels and length of hospital stay, while two studies did not show any significant relationship.

CONCLUSION

The amount of physical activity performed post-operatively negatively correlates with the length of hospital stay. This suggests that objective physical activity data collected by body worn sensors may be capable of predicting functional recovery post-operatively.

Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Background

Measurement of vital signs in hospitalized patients is necessary to assess the clinical situation of the patient. Early warning scores (EWS), such as the modified early warning score (MEWS), are generally calculated 3 times a day, but these may not capture early deterioration. A delay in diagnosing deterioration is associated with increased mortality. Continuous monitoring with wearable devices might detect clinical deterioration at an earlier stage, which allows clinicians to take corrective actions.

Objective

In this pilot study, the feasibility of continuous monitoring using the ViSi Mobile (VM; Sotera Wireless) and HealthPatch (HP; Vital Connect) was tested, and the experiences of patients and nurses were collected.

Methods

In this feasibility study, 20 patients at the internal medicine and surgical ward were monitored with VM and HP simultaneously for 2 to 3 days. Technical problems were analyzed. Vital sign measurements by nurses were taken as reference and compared with vital signs measured by both devices. Patient and nurse experiences were obtained by semistructured interviews.

Results

In total, 86 out of 120 MEWS measurements were used for the analysis. Vital sign measurements by VM and HP were generally consistent with nurse measurements. In 15% (N=13) and 27% (N=23) of the VM and HP cases respectively, clinically relevant differences in MEWS were found based on inconsistent respiratory rate registrations. Connection failure was recognized as a predominant VM artifact (70%). Over 50% of all HP artifacts had an unknown cause, were self-limiting, and never took longer than 1 hour. The majority of patients, relatives, and nurses were positive about VM and HP.

Conclusions

Both VM and HP are promising for continuously monitoring vital signs in hospitalized patients, if the frequency and duration of artifacts are reduced. The devices were well received and comfortable for most patients.

Advanced Materials for Health Monitoring with Skin-Based Wearable Devices

Skin-based wearable devices have a great potential that could result in a revolutionary approach to health monitoring and diagnosing disease. With continued innovation and intensive attention to the materials and fabrication technologies, development of these healthcare devices is progressively encouraged. This article gives a concise, although admittedly non-exhaustive, didactic review of some of the main concepts and approaches related to recent advances and developments in the scope of skin-based wearable devices (e.g. temperature, strain, biomarker-analysis werable devices, etc.), with an emphasis on emerging materials and fabrication techniques in the relevant fields. To give a comprehensive statement, part of the review presents and discusses different aspects of these advanced materials, such as the sensitivity, biocompatibility and durability as well as the major approaches proposed for enhancing their chemical and physical properties. A complementary section of the review linking these advanced materials with wearable device technologies is particularly specified. Some of the strong and weak points in development of each wearable material/device are highlighted and criticized. Several ideas regarding further improvement of skin-based wearable devices are also discussed.

Ownership and Use of Commercial Physical Activity Trackers Among Finnish Adolescents: Cross-Sectional Study

Background

Mobile phone apps for monitoring and promoting physical activity (PA) are extremely popular among adults. Devices, such as heart rate monitors or sports watches (HRMs/SWs) that work with these apps are at sufficiently low costs to be available through the commercial markets. Studies have reported an increase in PA levels among adults with devices; however, it is unknown whether the phenomena are similar during early adolescence. At a time when adolescents start to develop their own sense of independence and build friendship, the ease of smartphone availability in developed countries needs to be investigated in important health promoting behaviors such as PA.

Objective

The objective of this study was to investigate the ownership and usage of PA trackers (apps and HRM/SW) among adolescents in a national representative sample and to examine the association between use of devices and PA levels.

Methods

The Finnish school-aged physical activity (SPA) study consisted of 4575 adolescents, aged 11-, 13-, and 15-years, who took part in a web-based questionnaire during school time about PA behaviors between April and May 2016. Binary logistic regression analyses were used to test the associations between moderate to vigorous physical activity (MVPA) and devices, after controlling for gender, age, disability, and family affluence.

Results

PA tracking devices have been categorized into two types, which are accessible to adolescents: (1) apps and (2) HRM/SW. Half the adolescents (2351/4467; 52.63%) own apps for monitoring PA, yet 16.12% (720/4467) report using apps. Fewer adolescents (782/4413; 17.72%) own HRM/SW and 9.25% (408/4413) use HRM/SW. In this study, users of HRM/SW were 2.09 times (95% CI 1.64-2.67), whereas users of apps were 1.4 times (95% CI 1.15-1.74) more likely to meet PA recommendations of daily MVPA for at least 60 min compared with adolescents without HRM/SW or without apps.

Conclusions

To our knowledge, this is the first study that describes the situation in Finland with adolescents using PA trackers and its association with PA levels. Implications of the use of apps and HRM/SW by adolescents are discussed.

Is TAVR Ready for the Global Aging Population?

The emergence of the global pandemic of chronic diseases necessitates critical assessment of interventions that can be targeted at both the individual and population levels. Among cardiovascular diseases, the increasing prevalence of valvular heart diseases such as aortic stenosis parallels the rising burden of atherosclerotic cardiovascular diseases. As an alternative to surgical aortic valve replacement, technological innovation has allowed development of minimally invasive transcatheter aortic valve replacement (TAVR). This review examines whether TAVR can be applicable in low-resource regions across the world. Although revolutionary, TAVR is currently complex and requires a "Heart Team" approach for optimized patient care. We propose the emergence of telemedicine networks, newer valve designs that allow implementation of minimal approaches, and the use of minimal numbers of specialists for adapting TAVR to settings where surgical backup is not available. With efforts to reduce resource utilization, these alternate strategies have the potential to affect implementation of TAVR globally.

A novel low-complexity digital filter design for wearable ECG devices

Wearable and implantable Electrocardiograph (ECG) devices are becoming prevailing tools for continuous real-time personal health monitoring. The ECG signal can be contaminated by various types of noise and artifacts (e.g., powerline interference, baseline wandering) that must be removed or suppressed for accurate ECG signal processing. Limited device size, power consumption and cost are critical issues that need to be carefully considered when designing any portable health monitoring device, including a battery-powered ECG device. This work presents a novel low-complexity noise suppression reconfigurable finite impulse response (FIR) filter structure for wearable ECG and heart monitoring devices. The design relies on a recently introduced optimally-factored FIR filter method. The new filter structure and several of its useful features are presented in detail. We also studied the hardware complexity of the proposed structure and compared it with the state-of-the-art. The results showed that the new ECG filter has a lower hardware complexity relative to the state-of-the-art ECG filters.

Wearables for independent living in older adults: Gait and falls

Solutions are needed to satisfy care demands of older adults to live independently. Wearable technology (wearables) is one approach that offers a viable means for ubiquitous, sustainable and scalable monitoring of the health of older adults in habitual free-living environments. Gait has been presented as a relevant (bio)marker in ageing and pathological studies, with objective assessment achievable by inertial-based wearables. Commercial wearables have struggled to provide accurate analytics and have been limited by non-clinically oriented gait outcomes. Moreover, some research-grade wearables also fail to provide transparent functionality due to limitations in proprietary software. Innovation within this field is often sporadic, with large heterogeneity of wearable types and algorithms for gait outcomes leading to a lack of pragmatic use. This review provides a summary of the recent literature on gait assessment through the use of wearables, focusing on the need for an algorithm fusion approach to measurement, culminating in the ability to better detect and classify falls. A brief presentation of wearables in one pathological group is presented, identifying appropriate work for researchers in other cohorts to utilise. Suggestions for how this domain needs to progress are also summarised.

A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Enhanced recovery after surgery: Current research insights and future direction

Since the concept of enhanced recovery after surgery (ERAS) was introduced in the late 1990s the idea of implementing specific interventions throughout the peri-operative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol, leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery, rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes, described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS, e.g., the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better, more reliable patient outcomes.

Photonic crystals: emerging biosensors and their promise for point-of-care applications

Biosensors are extensively employed for diagnosing a broad array of diseases and disorders in clinical settings worldwide. The implementation of biosensors at the point-of-care (POC), such as at primary clinics or the bedside, faces impediments because they may require highly trained personnel, have long assay times, large sizes, and high instrumental cost. Thus, there exists a need to develop inexpensive, reliable, user-friendly, and compact biosensing systems at the POC. Biosensors incorporated with photonic crystal (PC) structures hold promise to address many of the aforementioned challenges facing the development of new POC diagnostics. Currently, PC-based biosensors have been employed for detecting a variety of biotargets, such as cells, pathogens, proteins, antibodies, and nucleic acids, with high efficiency and selectivity. In this review, we provide a broad overview of PCs by explaining their structures, fabrication techniques, and sensing principles. Furthermore, we discuss recent applications of PC-based biosensors incorporated with emerging technologies, including telemedicine, flexible and wearable sensing, smart materials and metamaterials. Finally, we discuss current challenges associated with existing biosensors, and provide an outlook for PC-based biosensors and their promise at the POC.

The use of mobile devices for physical activity tracking in older adults' everyday life

OBJECTIVE

The tracking of one's own physical activity with mobile devices is a way of monitoring and motivating oneself to remain healthy. Older adults' general use of mobile devices for physical activity tracking has not yet been examined systematically. The study aimed to describe the use of physical activity trackers, smartwatches and smartphones, or tablets for tracking physical activity and to examine the reasons for the use of these technologies.

METHODS

Participants aged ≥50 years (N = 1013) living in Switzerland were interviewed in a telephone survey. To address the research questions, we calculated descriptive frequency distributions, tested for differences between groups, and performed logistic regression analyses.

RESULTS

Descriptive and multivariate analyses showed that (a) 20.5% of participants used mobile devices for physical activity tracking; (b) men, younger individuals, those with a strong interest in new technology, and those who frequently exercised had a higher likelihood of using mobile devices for physical activity tracking; and (c) participants more often agreed with reasons for use relating to tracking physical activity and motivating oneself to remain healthy than they did with reasons relating to social factors.

CONCLUSIONS

The study presented representative data about the actual use of mobile tracking technology in persons over 50 years of age. Today, mainly active and younger elderly (mostly men) with a high interest in technology are using tracking technologies. Results indicate a need for further studies on motivational and usability aspects regarding the use of mobile health tracking devices by older adults.

Macro-economic factors influencing the architectural business model shift in the pharmaceutical industry

INTRODUCTION

Technological innovations, new regulations, increasing costs of drug productions and new demands are only few key drivers of a projected alternation in the pharmaceutical industry. The purpose of this review is to understand the macro economic factors responsible for the business model revolution to possess a competitive advantage over market players. Areas covered: Existing literature on macro-economic factors changing the pharmaceutical landscape has been reviewed to present a clear image of the current market environment. Expert commentary: Literature shows that pharmaceutical companies are facing an architectural alteration, however the evidence on the rationale driving the transformation is outstanding. Merger & Acquisitions (M&A) deals and collaborations are headlining the papers. Q1 2016 did show a major slowdown in M&A deals by volume since 2013 (with deal cancellations of Pfizer and Allergan, or the downfall of Valeant), but pharmaceutical analysts remain confident that this shortfall was a consequence of the equity market volatility. It seems likely that the shift to an M&A model will become apparent during the remainder of 2016, with deal announcements of Abbott Laboratories, AbbVie and Sanofi worth USD 45billion showing the appetite of big pharma companies to shift from the fully vertical integrated business model to more horizontal business models.

Emerging Trends in Healthcare Adoption of Wireless Body Area Networks

Real-time personal health monitoring is gaining new ground with advances in wireless communications. Wireless body area networks (WBANs) provide a means for low-powered sensors, affixed either on the human body or in vivo, to communicate with each other and with external telecommunication networks. The healthcare benefits of WBANs include continuous monitoring of patient vitals, measuring postacute rehabilitation time, and improving quality of medical care provided in medical emergencies. This study sought to examine emerging trends in WBAN adoption in healthcare. To that end, a systematic literature survey was undertaken against the PubMed database. The search criteria focused on peer-reviewed articles that contained the keywords "wireless body area network" and "healthcare" or "wireless body area network" and "health care." A comprehensive review of these articles was performed to identify adoption dimensions, including underlying technology framework, healthcare subdomain, and applicable lessons-learned. This article benefits healthcare technology professionals by identifying gaps in implementation of current technology and highlighting opportunities for improving products and services.

Comparison of Consumer and Research Monitors under Semistructured Settings

PURPOSE

This study evaluated the relative validity of different consumer and research activity monitors during semistructured periods of sedentary activity, aerobic exercise, and resistance exercise.

METHODS

Fifty-two (28 male and 24 female) participants age 18-65 yr performed 20 min of self-selected sedentary activity, 25 min of aerobic exercise, and 25 min of resistance exercise, with 5 min of rest between each activity. Each participant wore five wrist-worn consumer monitors [Fitbit Flex, Jawbone Up24, Misfit Shine (MS), Nike+ Fuelband SE (NFS), and Polar Loop] and two research monitors [ActiGraph GT3X+ on the waist and BodyMedia Core (BMC) on the arm] while being concurrently monitored with Oxycon Mobile (OM), a portable metabolic measuring system. Energy expenditure (EE) on different activity sessions was measured by OM and estimated by all monitors.

RESULTS

Mean absolute percent error (MAPE) values for the full 80-min protocol ranged from 15.3% (BMC) to 30.4% (MS). EE estimates from ActiGraph GT3X+ were found to be equivalent to those from OM (± 10% equivalence zone, 285.1-348.5). Correlations between OM and the various monitors were generally high (ranged between 0.71 and 0.90). Three monitors had MAPE values lower than 20% for sedentary activity: BMC (15.7%), MS (18.2%), and NFS (20.0%). Two monitors had MAPE values lower than 20% for aerobic exercise: BMC (17.2%) and NFS (18.5%). None of the monitors had MAPE values lower than 25% for resistance exercise.

CONCLUSION

Overall, the research monitors and Fitbit Flex, Jawbone Up24, and NFS provided reasonably accurate total EE estimates at the individual level. However, larger error was evident for individual activities, especially resistance exercise. Further research is needed to examine these monitors across various activities and intensities as well as under real-world conditions.