A Review of Photoplethysmography-based Physiological Measurement and Estimation, Part 2: Multi-input Methods.

Photoplethysmography can be used to estimate many physiological parameters based on features extracted from the measured waveform. Following the single parameter estimations that have been reviewed in part 1 of this paper, we here review methods where the waveform is used in conjunction with other measured physiological signals. Being a low-cost, non-invasive, and user friendly technique, many PPG-based physiological data extraction methods are being researched. The parameters reviewed that can be estimated using the PPG waveform plus additional inputs include cardiac output, blood pressure, venous function assessment, blood oxygen saturation, and fetal heart rate and fetal oxygen saturation. The different processing techniques, algorithms and methods are reviewed in addition to providing a comparison of results with the reference standards to validate the different methods. Future research considerations for each parameter estimation are also discussed. This paper could be helpful for future research on PPG based wearable devices for physiological multi-parameter estimations.

A Review of Photoplethysmography-based Physiological Measurement and Estimation, Part 1: Single Input Methods.

Photoplethysmography is a non-invasive and easy to administer optical method used primarily to mea-sure blood oxygen saturation, but also used widely to estimate and measure various other physiological parameters. /is paper reviews several physiological parameter estimations that have been done with just this waveform signal, i.e. heart rate, lipid profiling by morphological PPG analysis, blood glucose, ankle brachial pressure, and respiratory rate. Additional physiological estimations which use additional input measurements are reviewed in Part 2 of this paper. The different methods and signal processing techniques based on the principle of operation are discussed in this review. /e validity of each of these optical measurement techniques are reviewed where the results were compared with the results obtained using the gold reference standards. Future research considerations for non-invasive wearable devices for physiological parameter measurements are also highlighted in this review which could be helpful for future research.

A Secure Privacy Preserving Cloud-based Framework for Sharing Electronic Health Data.

There exists a need for sharing user health data, especially with institutes for research purposes, in a secure fashion. This is especially true in the case of a system that includes a third party storage service, such as cloud computing, which limits the control of the data owner. The use of encryption for secure data storage continues to evolve to meet the need for flexible and fine-grained access control. This evolution has led to the development of Attribute Based Encryption (ABE). The use of ABE to ensure the security and privacy of health data has been explored. This paper presents an ABE based framework which allows for the secure outsourcing of the more computationally intensive processes for data decryption to the cloud servers. This reduces the time needed for decryption to occur at the user end and reduces the amount of computational power needed by users to access data.

Blockchain Technology in Healthcare: A Systematic Review.

Since blockchain was introduced through Bitcoin, research has been ongoing to extend its applications to non-financial use cases. Healthcare is one industry in which blockchain is expected to have significant impacts. Research in this area is relatively new but growing rapidly; so, health informatics researchers and practitioners are always struggling to keep pace with research progress in this area. This paper reports on a systematic review of the ongoing research in the application of blockchain technology in healthcare. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and a systematic mapping study process, in which a well-designed search protocol is used to search four scientific databases, to identify, extract and analyze all relevant publications. The review shows that a number of studies have proposed different use cases for the application of blockchain in healthcare; however, there is a lack of adequate prototype implementations and studies to characterize the effectiveness of these proposed use cases. The review further highlights the state-of-the-art in the development of blockchain applications for healthcare, their limitations and the areas for future research. To this end, therefore, there is still the need for more research to better understand, characterize and evaluate the utility of blockchain in healthcare.

Copepods drive large-scale trait-mediated effects in marine plankton.

Fear of predation may influence food webs more than actual predation. However, the mechanisms and magnitude of nonconsumptive predator effects are largely unknown in unicellular-dominated food webs such as marine plankton. We report a general mechanism of chemically induced predator effects in marine plankton. Copepods, the most abundant zooplankton in the oceans, imprint seawater with unique polar lipids-copepodamides-which trigger toxin production and bioluminescence in harmful dinoflagellates. We show that copepodamides also elicit defensive traits in other phytoplankton, inducing the harmful algal bloom-forming diatom Pseudo-nitzschia seriata to produce 10 times more toxins, and colony-forming diatoms to decrease colony size by half. A 1-year study in the northeast Atlantic revealed that natural copepodamide concentrations are high enough to induce harmful algal toxins and size reduction in dominant primary producers when copepods are abundant. We conclude that copepodamides will structure marine plankton toward smaller, more defended life forms on basin-wide scales.

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology.

BACKGROUND: Anxiety and mood disorders are the most common mental illnesses, peaking during adolescence and affecting approximately 25% of Canadians aged 14-17 years. If not successfully treated at this age, they often persist into adulthood, exerting a great social and economic toll. Given the long-term impact, finding ways to increase the success and cost-effectiveness of mental health care is a pressing need. Cognitive behavior therapy (CBT) is an evidence-based treatment for mood and anxiety disorders throughout the lifespan. Mental health technologies can be used to make such treatments more successful by delivering them in a format that increases utilization. Young people embrace technologies, and many want to actively manage their mental health. Mobile software apps have the potential to improve youth adherence to CBT and, in turn, improve outcomes of treatment. OBJECTIVE: The purpose of this project is to improve homework adherence in CBT for youth anxiety and/or depression. The objectives are to (1) design and optimize the usability of a mobile app for delivering the homework component of CBT for youth with anxiety and/or depression, (2) assess the app's impact on homework completion, and (3) implement the app in CBT programs. We hypothesize that homework adherence will be greater in the app group than in the no-app group. METHODS: Phase 1: exploratory interviews will be conducted with adolescents and therapists familiar with CBT to obtain views and perspectives on the requirements and features of a usable app and the challenges involved in implementation. The information obtained will guide the design of a prototype. The prototype will be optimized via think-aloud procedures involving an iterative process of evaluation, modification, and re-evaluation, culminating in a fully functional version of the prototype that is ready for optimization in a clinical context. Phase 2: a usability study will be conducted to optimize the prototype in the context of treatment at clinics that provide CBT treatment for youth with anxiety and/or depression. This phase will result in a usable app that is ready to be tested for its effectiveness in increasing homework adherence. Phase 3: a pragmatic clinical trial will be conducted at several clinics to evaluate the impact of the app on homework adherence. Participants in the app group are expected to show greater homework completion than those in the no-app group. RESULTS: Phase 3 will be completed by September 2019. CONCLUSIONS: The app will be a unique adjunct to treatment for adolescents in CBT, focusing on both anxiety and depression, developed in partnership with end users at every stage from design to implementation, customizable for different cognitive profiles, and designed with depression symptom tracking measures for youth made interoperable with electronic medical records.

Maintaining knife sharpness in industrial meat cutting: A matter of knife or meat cutter ability.

Knife sharpness is imperative in meat cutting. The aim of this study was to compare the impact of knife blade steel quality with meat cutters' individual ability to maintain the cutting edge sharp in an industrial production setting. Twelve meat cutters in two different companies using three different knives during normal production were studied in this quasi-experimental study. Methods included were measuring knife cutting force before and after knife use, time knives were used, ratings of sharpness and discomfort and interviews. Results showed that the meat cutters' skill of maintaining sharpness during work had a much larger effect on knife sharpness during work than the knife steel differences. The ability was also related to feelings of discomfort and to physical exertion. It was found that meat cutters using more knives were more likely to suffer from discomfort in the upper limbs, which is a risk for developing MSD.

Perspectives on recycling centres and future developments.

The overall aim of this paper is to draw combined, all-embracing conclusions based on a long-term multidisciplinary research programme on recycling centres in Sweden, focussing on working conditions, environment and system performance. A second aim is to give recommendations for their development of new and existing recycling centres and to discuss implications for the future design and organisation. Several opportunities for improvement of recycling centres were identified, such as design, layout, ease with which users could sort their waste, the work environment, conflicting needs and goals within the industry, and industrialisation. Combining all results from the research, which consisted of different disciplinary aspects, made it possible to analyse and elucidate their interrelations. Waste sorting quality was recognized as the most prominent improvement field in the recycling centre system. The research identified the importance of involving stakeholders with different perspectives when planning a recycling centre in order to get functionality and high performance. Practical proposals of how to plan and build recycling centres are given in a detailed checklist.

Automated detection of atrial fibrillation episode using novel heart rate variability features.

Atrial fibrillation (AF) is one of the most common life-threatening arrhythmia affecting around six million adults in the US. Typical detection of AF requires tedious and manual analysis of ECG which can often delay medical intervention. With the advent of wearable devices that can accurately record the time interval between two heartbeats (RR interval), automated and timely detection of AF is now possible. In this paper, we engineer novel heart rate variability features based on linear and non-linear dynamics of RR intervals. Unlike complex features extracted from ECG signals, these features can be easily obtained using wearable sensors. We propose automated classifiers to detect AF episodes and also compare the performance of different classifiers. Our proposed classifier has a very high sensitivity (98%) and specificity (95%) and outperforms prior published works.

Real-Time and Retrospective Health-Analytics-as-a-Service: A Novel Framework.

BACKGROUND: Analytics-as-a-service (AaaS) is one of the latest provisions emerging from the cloud services family. Utilizing this paradigm of computing in health informatics will benefit patients, care providers, and governments significantly. This work is a novel approach to realize health analytics as services in critical care units in particular. OBJECTIVE: To design, implement, evaluate, and deploy an extendable big-data compatible framework for health-analytics-as-a-service that offers both real-time and retrospective analysis. METHODS: We present a novel framework that can realize health data analytics-as-a-service. The framework is flexible and configurable for different scenarios by utilizing the latest technologies and best practices for data acquisition, transformation, storage, analytics, knowledge extraction, and visualization. We have instantiated the proposed method, through the Artemis project, that is, a customization of the framework for live monitoring and retrospective research on premature babies and ill term infants in neonatal intensive care units (NICUs). RESULTS: We demonstrated the proposed framework in this paper for monitoring NICUs and refer to it as the Artemis-In-Cloud (Artemis-IC) project. A pilot of Artemis has been deployed in the SickKids hospital NICU. By infusing the output of this pilot set up to an analytical model, we predict important performance measures for the final deployment of Artemis-IC. This process can be carried out for other hospitals following the same steps with minimal effort. SickKids' NICU has 36 beds and can classify the patients generally into 5 different types including surgical and premature babies. The arrival rate is estimated as 4.5 patients per day, and the average length of stay was calculated as 16 days. Mean number of medical monitoring algorithms per patient is 9, which renders 311 live algorithms for the whole NICU running on the framework. The memory and computation power required for Artemis-IC to handle the SickKids NICU will be 32 GB and 16 CPU cores, respectively. The required amount of storage was estimated as 8.6 TB per year. There will always be 34.9 patients in SickKids NICU on average. Currently, 46% of patients cannot get admitted to SickKids NICU due to lack of resources. By increasing the capacity to 90 beds, all patients can be accommodated. For such a provisioning, Artemis-IC will need 16 TB of storage per year, 55 GB of memory, and 28 CPU cores. CONCLUSIONS: Our contributions in this work relate to a cloud architecture for the analysis of physiological data for clinical decisions support for tertiary care use. We demonstrate how to size the equipment needed in the cloud for that architecture based on a very realistic assessment of the patient characteristics and the associated clinical decision support algorithms that would be required to run for those patients. We show the principle of how this could be performed and furthermore that it can be replicated for any critical care setting within a tertiary institution.

Increased work pace is unprofitable: a beef-cutting case study.

The beef industry worldwide is showing a trend towards increased cutting pace aimed at higher profits. However, prior research in the duck meat industry suggested that a higher cutting pace reduced quality and yield, leading to losses. This study aimed to test this hypothesis by investigating the effects of varying beef-cutting paces on yield, quality and economy. A field experiment was conducted on six workers cutting beef fillet, sirloin and entrecôte. Three types of paces were sequentially tested: Baseline (i.e., status quo), 'Quantity focus' (i.e., pace required to maximise quantity) and 'Quality focus' (i.e., pace required to minimise errors). The results showed a significant drop in yield, increased rate of quality deficiency and economic losses with the change to 'Quantity focus' (from Baseline and 'Quality focus') for all meat types. Workers supported these results and also added health problems to the list. The results confirmed that an increased cutting pace is unprofitable.

Female Baltic herring Clupea harengus allocate resources from growth to reproduction in poor feeding conditions.

The trade-off between somatic growth and reproduction in the female Baltic herring Clupea harengus was investigated from 1984 to 2002. During the study period, growth decreased, as a consequence of decreasing salinity and weakening of feeding conditions. Production of muscle and ovarian tissue decreased in repeat spawners, but investment in reproduction took an increasing amount of the total production of new tissues. This suggested that a shift in allocation to reproduction takes precedence over body growth in the reproductive strategy of C. harengus. The process also indicated one possible mechanism leading to dwarf forms in fish populations.

Vision, light and aging: a literature overview on older-age workers.

BACKGROUND: In many western countries individuals will need to continue their professional careers beyond the current retirement age. This requires adaptation of the working conditions to compensate for age related visual changes. OBJECTIVE: The aim of this paper is to compile and structure knowledge concerning age related changes in visual and non-visual functions among older-age workers and to describe in what way these changes relate to light and work performance. METHOD: An overview of the literature was performed in PubMed and EMBASE concerning visual changes among elderly people, light, visual ergonomics and consequences at work. RESULTS: Visual conditions and lighting design have an impact on work performance in those over age 65 even if there are few studies available. Natural age related changes in the eyes or ocular diseases can result in reduced visual function and performance. Moreover, evidence of the importance of light and dark rhythms for circadian regulation is mounting; there are indications that the older-age population might need specific attention related to this issue. Finally, visual deteriorations might also, secondarily, induce strained postures and musculoskeletal symptoms, pain and injury. CONCLUSION: Age-related changes in the eyes and also ocular diseases among older-age people have an impact on well-being and work performance, and therefore call for reconsideration of their working conditions. Knowledge about how visual functions, light and ocular diseases is needed for work design and preventive actions.

Remote, real-time monitoring and analysis of vital signs of neonatal graduate infants.

This paper presents a system for the remote monitoring of a newborn infant's physiological data outside the Neonatal Intensive Care Unit. By providing a simple means for parents to enable monitoring, and physicians a simple mobile application to monitor live and historical physiological information, this system provides the insight once only possible in an Intensive Care Unit. The system utilizes a variety of connectivity means such as Wi-Fi and 3G to facilitate the communication between a multitude of industry standard vital sign monitor and a remote server. A system trial monitoring an infant to simulate neonatal graduate monitoring has determined the system was able to successfully transmit 99.99% of data generated from the vital sign monitor.

Optimal correction in spectacles: intervention effects on eyestrain and musculoskeletal discomfort among postal workers.

BACKGROUND: The static posture of postal workers when sorting mail can lead to musculoskeletal discomfort. Research has shown a connection between eyestrain and upper-body musculoskeletal discomfort in general, including postal workers. A previous study of postal workers found that most of those with eye strain were in need of a new correction in their existing spectacles. OBJECTIVE: Evaluate intervention effects on eyestrain and musculoskeletal discomfort with new spectacles for postal workers. METHODS: Postal workers subjectively reported eyestrain, musculoskeletal discomfort and their opinions of the visual environment via questionnaires pre- and post-intervention. After an eye examination the postal workers were divided into two groups: those who needed new spectacles and those who did not. RESULTS: Those who needed new spectacles showed a higher prevalence of eyestrain and musculoskeletal discomfort pre-intervention. Post-intervention, the postal workers rated their vision better and the average eyestrain and musculoskeletal discomfort decreased for both groups. These workers also experienced a decrease in discomfort on the left (static) side of the neck while sorting mail. CONCLUSION: An intervention providing the optimal correction reduces eyestrain and decreases musculoskeletal discomfort, especially from the neck.

Detection of apnoea from respiratory time series data using clinically recognizable features and kNN classification.

Apnoea is a sleep related breathing disorder that is common in adults and can be described as a temporary closure in the upper airway during sleep. A system using time series analysis of one minute epochs of respiratory impedance signals to detect apnoea is described. An algorithm has been developed using MATLAB for extracting clinically recognizable features from the respiratory impedance signal. One minute samples are classified using kNN classification of the feature set. The output of the system has been shown to detect apnoeic episodes in eight eight-hour patient records collected from the PhysioNet database. The specificity of the classifier is 88.1% and the sensitivity is 95.7%. ROC analysis was performed and the area under the ROC curve is 0.9604. Future research will include testing the classifier in a much larger dataset and also a novel method for the presentation of classification results to physicians.

Improving meat cutters' work: changes and effects following an intervention.

Meat cutters face higher risks of injury and musculoskeletal problems than most other occupational groups. The aims of this paper were to describe ergonomics changes implemented in three meat cutting plants and to evaluate effects related to ergonomics on the individual meat cutters and their work. Data was collected by interviews, observations, document studies and a questionnaire (n = 247), as a post intervention study. The changes implemented consisted of reducing knife work to a maximum of 6 h per day and introducing a job rotation scheme with work periods of equal length. Tasks other than traditional meat cutting were added. A competence development plan for each meat cutter and easy adjustment of workplace height were introduced. The questionnaire showed a reduction in perceived physical work load. In general, the changes were perceived positively. Figures from the company showed a positive trend for injuries and sick leave.

Ten years of experience from interactive ergonomics projects.

This paper highlights experiences from ergonomics projects, applying an interactive research approach. The aim of this paper is to summarise experiences from seven interactive ergonomics projects with the aim to improve ergonomics and organizational performance jointly. Results from these seven projects were analysed with a model for assessing sustainable change, including the factors active ownership, professional management, competent project leadership, and involved participants. All factors were found giving support to impact and sustainability of the change projects. However, the role of the researcher is difficult and demanding.

Visual ergonomics interventions in mail sorting facilities.

This study was performed between 2004 and 2011 at mail sorting facilities in Sweden. During this time, different interventions were performed. The first was a lighting intervention that had a positive impact on the postal workers, especially those with eyestrain. A new lighting system also improved the illuminance and gave better light distribution. The second intervention involved new personal spectacles for the postal workers who needed them and this had a positive effect on eyestrain. The third intervention involved a specific type of sorting spectacles for the postal workers who already used progressive lenses privately. The reading distances that the postal workers had while sorting the mail was inverted to the distances in their regular progressive lenses. The new sorting spectacles had a positive effect on head postures and on muscular activity.

Reported occupational injuries at Swedish recycling centres - based on official statistics.

Swedish recycling centres are manned facilities for waste collection. There is no special category in the official injury statistics for employees at recycling centres, which precludes a straightforward analysis of reported occupational injuries. This study aimed at identifying the frequency of reported accidents and diseases and the type of events that contribute to such injuries at recycling centres, based on official injury statistics. The employees were identified as being affected by more than three to five times as many accidents compared with the total workforce in Sweden. The reported accidents had occurred during a wide range of situations, but most frequently during manual handling of waste. Reported work-related diseases were mostly associated with musculoskeletal disorders, mainly due to heavy lifting. A more detailed classification of sanitation professions and workplaces in the official injury statistics would facilitate future studies of injuries in a specific professional category, e.g. employees at recycling centres. Suggestions for prevention are given. STATEMENT OF RELEVANCE: The present article describes all reported work accidents and diseases among employees at recycling centres from 1992 to February 2005. It also highlights the problem of identifying new working groups in the official statistics and gives advice for a detailed classification to facilitate such future studies of injuries.