Melanin bias in pulse oximetry explained by light source spectral bandwidth.

BACKGROUND: Pulse oximetry uses noninvasive optical measurements of light transmission from each of two sources through vascularised living tissue over the cardiac cycle (SpO2). From those measurements, the relative amount of oxygenated haemoglobin (SaO2) in circulating blood can be deduced. Recent reports have shown that, compared with SaO2 measurements from blood samples, SpO2 measurements are biased erroneously high for patients with dark skin. METHODS: We developed a new method, spectrally resolved photoplethysmography (srPPG), to examine how spectral bandwidth affects the transmission of polychromatic light through the fingertip across the cardiac cycle. We measured and recorded the spectral transmission through the fingertip as the O2 concentration in inspired air was reduced. We applied digital spectral filters of two different bandwidths, narrow or broad, to the same srPPG recordings to determine whether SpO2 readings systematically varied for the two bandwidths. The srPPG method also allowed us to measure the fractional amount of melanin in the optical path. The effect of melanin content on the ratio of SpO2 readings for narrow and broad spectral bandwidths was analysed. RESULTS: We hypothesised, based upon the Beer-Lambert law, and then showed experimentally, that the light emission spectra of light-emitting diode light sources, as used in commercial pulse oximeters, result in erroneously high SpO2 measurements for patients having greater melanin concentrations in their skin than those of the subject pool used for instrument calibration. CONCLUSIONS: To eliminate melanin bias, pulse oximeters should use much narrower spectral bandwidths than those used in current models.

Impacts of Fog Characteristics, Forward Illumination, and Warning Beacon Intensity Distribution on Roadway Hazard Visibility.

Warning beacons are critical for the safety of transportation, construction, and utility workers. These devices need to produce sufficient luminous intensity to be visible without creating glare to drivers. Published standards for the photometric performance of warning beacons do not address their performance in conditions of reduced visibility such as fog. Under such conditions light emitted in directions other than toward approaching drivers can create scattered light that makes workers and other hazards less visible. Simulations of visibility of hazards under varying conditions of fog density, forward vehicle lighting, warning beacon luminous intensity, and intensity distribution were performed to assess their impacts on visual performance by drivers. Each of these factors can influence the ability of drivers to detect and identify workers and hazards along the roadway in work zones. Based on the results, it would be reasonable to specify maximum limits on the luminous intensity of warning beacons in directions that are unlikely to be seen by drivers along the roadway, limits which are not included in published performance specifications.

Toward Performance Specifications for Flashing Warning Beacons.

Yellow flashing warning beacons help protect front line service workers, including those in transportation, utility and construction sectors. To safeguard these workers, beacons should be readily detected and should provide veridical information about their relative movement. Two psychophysical laboratory experiments were conducted to provide empirical foundations for two aspects of warning beacon performance, detection and judgments of relative movement. In the first experiment reaction times were measured to the onset of flashing warning beacons varying in peak intensity while observers viewed different scene conditions. Observers also judged the visibility of nearby low-contrast targets in the presence of the flashing warning beacons. Asymptotic response times to the onset of beacons occurred when their peak intensity was at least 750 cd during daytime. Visibility of low contrast targets during nighttime, when glare is most critical, did not decrease substantially when the peak intensity was below 2000 cd. In the second experiment response times were measured to warning beacons of different flash-sequence patterns as they approached the observer. Judgments of gap closure were improved, relative to fully-on/fully-off flashing, with flash sequences where the minimum beacon intensity was at least 10% of the peak intensity and with two synchronized flashing beacons rather than one. With regard to performance specifications, the minimum value for the peak intensity of warning beacons should be 750 cd, with a maximum value of 2000 cd for detection. Fully-on/fully-off flash sequences should be changed to fully-on/partial-off to enhance judgments of gap closure on moving vehicles. Moreover, two flashing warning beacons, rather than one, should be mounted on service vehicles to improve gap closure judgments.

The NICU Lighted Environment.

Lighting technologies are rapidly evolving, creating many opportunities for good lighting within the NICU. With the widespread adoption of advanced solid-state lighting technologies, lighting no longer needs to be static. Rather, lighting systems can be more easily adjusted to the different and changing visual and non-visual needs of the professional staff, infants and family members throughout the 24-hour day. This paper provides a conceptual framework for defining good lighting in the NICU, recognizing the needs of various constituent groups, each with very different needs from the lighting. Several other papers on the topic of lighting for various constituent groups at different times of the day in the NICU are summarized. Attention is given specifically to the Recommended Standards for Newborn ICU Design, a consensus standard developed by a wide range of experts, to help the reader translate this conceptual framework to practice.

Daily activity and light exposure levels for five species of lemurs at the Duke Lemur Center.

Light is the primary synchronizer of all biological rhythms, yet little is known about the role of the 24-hour luminous environment on nonhuman primate circadian patterns, making it difficult to understand the photic niche of the ancestral primate. Here we present the first data on proximate light-dark exposure and activity-rest patterns in free-ranging nonhuman primates. Four individuals each of five species of lemurs at the Duke Lemur Center (Eulemur mongoz, Lemur catta, Propithecus coquereli, Varecia rubra, and Varecia variegata variegata) were fitted with a Daysimeter-D pendant that contained light and accelerometer sensors. Our results reveal common as well as species-specific light exposure and behavior patterns. As expected, all five species were more active between sunrise and sunset. All five species demonstrated an anticipatory increase in their pre-sunrise activity that peaked at sunrise with all but V. rubra showing a reduction within an hour. All five species reduced activity during mid-day. Four of the five stayed active after sunset, but P. coquereli began reducing their activity about 2 hours before sunset. Other subtle differences in the recorded light exposure and activity patterns suggest species-specific photic niches and behaviors. The eventual application of the Daysimeter-D in the wild may help to better understand the adaptive evolution of ancestral primates.

Evaluation of a Novel Ambient Light Survey Question in the Cancer Prevention Study-3.

Nighttime light exposure may increase cancer risk by disrupting the circadian system. However, there is no well-established survey method for measuring ambient light. In the Cancer Prevention Study-3, 732 men and women answered a light survey based on seven environments. The light environment in the past year was assessed twice, one year apart, and four one-week diaries were collected between the annual surveys. A total of 170 participants wore a meter to measure photopic illuminance and circadian stimulus (CS). Illuminance and CS values were estimated for lighting environments from measured values and evaluated with a cross validation approach. The kappas for self-reported light environment comparing the two annual surveys were 0.61 on workdays and 0.49 on non-workdays. Kappas comparing the annual survey to weekly diaries were 0.71 and 0.57 for work and non-workdays, respectively. Agreement was highest for reporting of darkness (95.3%), non-residential light (86.5%), and household light (75.6%) on workdays. Measured illuminance and CS identified three peaks of light (darkness, indoor lighting, and outdoor daytime light). Estimated illuminance and CS were correlated with the measured values overall (r = 0.77 and r = 0.67, respectively) but were less correlated within each light environment (r = 0.23-0.43). The survey has good validity to assess ambient light for studies of human health.

Corrigendum: Modeling Circadian Phototransduction: Quantitative Predictions of Psychophysical Data.

[This corrects the article DOI: 10.3389/fnins.2021.615322.].

The circadian stimulus-oscillator model: Improvements to Kronauer's model of the human circadian pacemaker.

Modeling how patterns of light and dark affect circadian phase is important clinically and organizationally (e.g., the military) because circadian disruption can compromise health and performance. Limit-cycle oscillator models in various forms have been used to characterize phase changes to a limited set of light interventions. We approached the analysis of the van der Pol oscillator-based model proposed by Kronauer and colleagues in 1999 and 2000 (Kronauer99) using a well-established framework from experimental psychology whereby the stimulus (S) acts on the organism (O) to produce a response (R). Within that framework, using four independent data sets utilizing calibrated personal light measurements, we conducted a serial analysis of the factors in the Kronauer99 model that could affect prediction accuracy characterized by changes in dim-light melatonin onset. Prediction uncertainty was slightly greater than 1 h for the new data sets using the original Kronauer99 model. The revised model described here reduced prediction uncertainty for these same data sets by roughly half.

Lighting and perceptual cues: effects on gait measures of older adults at high and low risk for falls.

BACKGROUND: The visual system plays an important role in maintaining balance. As a person ages, gait becomes slower and stride becomes shorter, especially in dimly lighted environments. Falls risk has been associated with reduced speed and increased gait variability. METHODS: Twenty-four older adults (half identified at risk for falls) experienced three lighting conditions: pathway illuminated by 1) general ceiling-mounted fixtures, 2) conventional plug-in night lights and 3) plug-in night lights supplemented by laser lines outlining the pathway. Gait measures were collected using the GAITRite© walkway system. RESULTS: Participants performed best under the general ceiling-mounted light system and worst under the night light alone. The pathway plus night lights increased gait velocity and reduced step length variability compared to the night lights alone in those at greater risk of falling. CONCLUSIONS: Practically, when navigating in more challenging environments, such as in low-level ambient illumination, the addition of perceptual cues that define the horizontal walking plane can potentially reduce falls risks in older adults.

The impact of light from computer monitors on melatonin levels in college students.

OBJECTIVES: Self-luminous electronic devices emit optical radiation at short wavelengths, close to the peak sensitivity of melatonin suppression. Melatonin suppression resulting from exposure to light at night has been linked to increased risk for diseases. The impact of luminous cathode ray tube (CRT) computer monitors on melatonin suppression was investigated. DESIGN: Twenty-one participants experienced three test conditions: 1) computer monitor only, 2) computer monitor viewed through goggles providing 40 lux of short-wavelength (blue; peak λ ≈ 470 nm) light at the cornea from light emitting diodes (LEDs), and 3) computer monitor viewed through orange-tinted safety glasses (optical radiation <525 nm ≈ 0). The blue-light goggles were used as a "true-positive" experimental condition to demonstrate protocol effectiveness; the same light treatment had been shown in a previous study to suppress nocturnal melatonin. The orange-tinted glasses served as a "dark" control condition because the short-wavelength radiation necessary for nocturnal melatonin suppression was eliminated. Saliva samples were collected from subjects at 23:00, before starting computer tasks, and again at midnight and 01:00 while performing computer tasks under all three experimental conditions. RESULTS: Melatonin concentrations after exposure to the blue-light goggle experimental condition were significantly reduced compared to the dark control and to the computer monitor only conditions. Although not statistically significant, the mean melatonin concentration after exposure to the computer monitor only was reduced slightly relative to the dark control condition. CONCLUSIONS: Additional empirical data should be collected to test the effectiveness of different, brighter and larger screens on melatonin suppression.

Relative light sensitivities of four retinal hemi-fields for suppressing the synthesis of melatonin at night.

The magnitude of the stimulus to the biological clock will depend upon the distribution of circadian phototransduction circuits across the retinae and the spatial distribution of luminous stimuli in the environment. The present study compared nocturnal melatonin suppression for light exposures to the superior, inferior, nasal, and temporal retina in one eye independent of shading from the brow and the nose. The stimulus was a 40° diameter luminous disc, half of which was blue light (LED, λpeak = 470 nm) and the other amber light (LED, λpeak = 590 nm). Experimentally, the orientation of the bipartite disc was rotated to each of the four cardinal points of the visual field. A full, 40° blue disc was also employed by replacing the amber half-disc with another blue half-disc. The blue full- and half-discs always produced 100 photopic lx at the cornea. As hypothesized, nocturnal melatonin suppression was statistically greatest when the blue half-disc was delivered to the nasal hemi-field (35%); the other three hemi-fields were equally affected by the blue half-disc (≈20%). Melatonin suppression for the full-disc was 24%, which was not statistically different than the average suppression for the four hemi-fields of 27%.

Spatial sensitivity of human circadian response: Melatonin suppression from on-axis and off-axis light exposures.

A better understanding of the spatial sensitivity of the human circadian system to photic stimulation can provide practical solutions for optimized circadian light exposures. Two psychophysical experiments, involving 25 adult participants in Experiment 1 (mean age = 34.0 years [SD 15.5]; 13 females) and 15 adult participants in Experiment 2 (mean age = 43.0 years [SD 12.6]; 12 females), were designed to investigate whether varying only the spatial distribution of luminous stimuli in the environment while maintaining a constant spectrally weighted irradiance at the eye could influence nocturnal melatonin suppression. Two spatial distributions were employed, one where the luminous stimulus was presented On-axis (along the line of sight) and one where two luminous stimuli were both presented Off-axis (laterally displaced at center by 14°). Two narrowband LED light sources, blue (λmax  = 451 nm) for first experiment and green (λmax  = 522 nm) for second experiment, were used in both the On-axis and the Off-axis spatial distributions. The blue luminous stimulus targeting the fovea and parafovea (On-axis) was about three times more effective for suppressing melatonin than the photometrically and spectrally matched stimulus targeting the more peripheral retina (Off-axis). The green luminous stimulus targeting the fovea and parafovea (On-axis) was about two times more effective for suppressing melatonin than the photometrically and spectrally matched stimulus targeting the more peripheral retina (Off-axis).

Modeling Circadian Phototransduction: Quantitative Predictions of Psychophysical Data.

A revised computational model of circadian phototransduction is presented. The first step was to characterize the spectral sensitivity of the retinal circuit using suppression of the synthesis of melatonin by the pineal gland at night as the outcome measure. From the spectral sensitivity, circadian light was defined. Circadian light, thereby rectifies any spectral power distribution into a single, instantaneous photometric quantity. The second step was to characterize the circuit's response characteristic to different amounts of circadian light from threshold to saturation. By doing so a more complete instantaneous photometric quantity representing the circadian stimulus was defined in terms of both the spectral sensitivity and the response magnitude characteristic of the circadian phototransduction circuit. To validate the model of the circadian phototransduction circuit, it was necessary to augment the model to account for different durations of the circadian stimulus and distribution of the circadian stimulus across the retina. Two simple modifications to the model accounted for the duration and distribution of continuous light exposure during the early biological night. A companion paper (https://www.frontiersin.org/articles/10.3389/fnins.2020.615305/full) provides a neurophysiological foundation for the model parameters.

Lack of short-wavelength light during the school day delays dim light melatonin onset (DLMO) in middle school students.

OBJECTIVE: Circadian timing affects sleep onset. Delayed sleep onset can reduce sleep duration in adolescents required to awake early for a fixed school schedule. The absence of short-wavelength ("blue") morning light, which helps entrain the circadian system, can hypothetically delay sleep onset and decrease sleep duration in adolescents. The goal of this study was to investigate whether removal of short-wavelength light during the morning hours delayed the onset of melatonin in young adults. METHODS: Dim light melatonin onset (DLMO) was measured in eleven 8th-grade students before and after wearing orange glasses, which removed short-wavelength light, for a five-day school week. RESULTS: DLMO was significantly delayed (30 minutes) after the five-day intervention, demonstrating that short-wavelength light exposure during the day can be important for advancing circadian rhythms in students. CONCLUSIONS: Lack of short-wavelength light in the morning has been shown to delay the circadian clock in controlled laboratory conditions. The results presented here are the first to show, outside laboratory conditions, that removal of short-wavelength light in the morning hours can delay DLMO in 8th-grade students. These field data, consistent with results from controlled laboratory studies, are directly relevant to lighting practice in schools.

Circadian light.

The present paper reflects a work in progress toward a definition of circadian light, one that should be informed by the thoughtful, century-old evolution of our present definition of light as a stimulus for the human visual system. This work in progress is based upon the functional relationship between optical radiation and its effects on nocturnal melatonin suppression, in large part because the basic data are available in the literature. Discussed here are the fundamental differences between responses by the visual and circadian systems to optical radiation. Brief reviews of photometry, colorimetry, and brightness perception are presented as a foundation for the discussion of circadian light. Finally, circadian light (CLA) and circadian stimulus (CS) calculation procedures based on a published mathematical model of human circadian phototransduction are presented with an example.

Predictions of melatonin suppression during the early biological night and their implications for residential light exposures prior to sleeping.

The magnitude of nocturnal melatonin suppression depends upon the spectrum, amount, and duration of light exposure. The functional relationship between melatonin suppression and the light spectrum and amount have been previously described. Only one duration-dependent parameter was needed to extend this functional relationship to predict nocturnal melatonin suppression during the early biological night from a variety of published studies. Those predictions suggest that ambient lighting commonly found in North American homes will not suppress melatonin for durations up to 3 h, whereas extended use of self-luminous displays in the home prior to sleep can.

Modeling Circadian Phototransduction: Retinal Neurophysiology and Neuroanatomy.

The retina is a complex, but well-organized neural structure that converts optical radiation into neural signals that convey photic information to a wide variety of brain structures. The present paper is concerned with the neural circuits underlying phototransduction for the central pacemaker of the human circadian system. The proposed neural framework adheres to orthodox retinal neuroanatomy and neurophysiology. Several postulated mechanisms are also offered to account for the high threshold and for the subadditive response to polychromatic light exhibited by the human circadian phototransduction circuit. A companion paper, modeling circadian phototransduction: Quantitative predictions of psychophysical data, provides a computational model for predicting psychophysical data associated with nocturnal melatonin suppression while staying within the constraints of the neurophysiology and neuroanatomy offered here.

Declines in Wavelength Discrimination and Shifts in Unique Hue with Hypoxia.

INTRODUCTION: Hypoxia can be a problem for warfighters, compromising visual and cognitive performance. One area of study has been hypoxia-induced decrements in color vision.METHODS: The present study examined how hypoxia affected the perception of wavelengths associated with unique green and with unique yellow as well as discriminability by the blue vs. yellow (b-y) and the red vs. green (r-g) spectrally opponent color channels while breathing O2 levels found at sea level and at 5500 m. Measurements of wavelengths producing unique green (minimizing response by the b-y channel) and unique yellow (minimizing response by the r-g channel) preceded measurements of wavelength discriminability near those unique hues.RESULTS: Relative to sea level, unique yellow shifted to shorter wavelengths (0.54 nm) and unique green shifted to longer wavelengths (2.3 nm) under hypoxia. In terms of an equal psychophysical scale, both unique hues shifted by similar magnitudes. Wavelength discriminability of both color channels was compromised by statistically reliable amounts of 16-17% under hypoxia.DISCUSSION: These results were consistent with previous studies and the inference that postreceptor, M-cone neurons were differentially compromised by hypoxia. However, these measurable changes in color vision due to hypoxia were not perceived by the subjects.Bierman A, LaPlumm T, Rea MS. Declines in wavelength discrimination and shifts in unique hue with hypoxia. Aerosp Med Hum Perform. 2020; 91(5):394-402.

Long-Term, All-Day Exposure to Circadian-Effective Light Improves Sleep, Mood, and Behavior in Persons with Dementia.

BACKGROUND: Persons with Alzheimer's disease and related dementias (ADRD) frequently experience sleep-wake (circadian) cycle disturbances that lead them to remain awake at night, causing stress and fatigue for families and caregivers. Light therapy shows promise as a nonpharmacological treatment for regulating sleep in this population. OBJECTIVE: We investigated the long-term impact of a circadian-effective lighting intervention on sleep, mood, and behavior problems in persons with ADRD. METHODS: This 25-week clinical trial administered an all-day lighting intervention to 47 patients with ADRD in 9 senior-care facilities, employing wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. RESULTS: The intervention significantly improved Pittsburgh Sleep Quality Index scores, from an estimated mean±SEM of 11.89±0.53 at baseline to 5.36±0.63 at the end of the intervention. Additional improvements were noted for sleep efficiency data from actigraph measurements. The intervention significantly reduced Cornell Scale for Depression in Dementia scores (mean±SEM of 11.36±0.74 at baseline and 4.18±0.88 at the end of the intervention) and Cohen-Mansfield Agitation Inventory scores (mean±SEM of 47.10±1.98 at baseline and 35.33±2.23 at the end of the intervention). CONCLUSION: A regular circadian-effective daytime lighting intervention can improve sleep at night and reduce depression and agitation in patients with dementia living in controlled environments. More importantly, the positive effects of the tailored lighting intervention on these outcomes appear to be cumulative over time.