The Pain Intervention & Digital Research Program: an operational report on combining digital research with outpatient chronic disease management.

Chronic pain affects up to 28% of U.S. adults, costing ∼$560 billion each year. Chronic pain is an instantiation of the perennial complexity of how to best assess and treat chronic diseases over time, especially in populations where age, medical comorbidities, and socioeconomic barriers may limit access to care. Chronic disease management poses a particular challenge for the healthcare system's transition from fee-for-service to value and risk-based reimbursement models. Remote, passive real-time data from smartphones could enable more timely interventions and simultaneously manage risk and promote better patient outcomes through predicting and preventing costly adverse outcomes; however, there is limited evidence whether remote monitoring is feasible, especially in the case of older patients with chronic pain. Here, we introduce the Pain Intervention and Digital Research (Pain-IDR) Program as a pilot initiative launched in 2022 that combines outpatient clinical care and digital health research. The Pain-IDR seeks to test whether functional status can be assessed passively, through a smartphone application, in older patients with chronic pain. We discuss two perspectives-a narrative approach that describes the clinical settings and rationale behind changes to the operational design, and a quantitative approach that measures patient recruitment, patient experience, and HERMES data characteristics. Since launch, we have had 77 participants with a mean age of 55.52, of which n = 38 have fully completed the 6 months of data collection necessitated to be considered in the study, with an active data collection rate of 51% and passive data rate of 78%. We further present preliminary operational strategies that we have adopted as we have learned to adapt the Pain-IDR to a productive clinical service. Overall, the Pain-IDR has successfully engaged older patients with chronic pain and presents useful insights for others seeking to implement digital phenotyping in other chronic disease settings.

Effects of architecture structure on volatile organic compound and polycyclic aromatic hydrocarbon diffusion in Singapore's Integrated Transport Hubs.

Millions of passengers wait for buses at Integrated Transport Hubs (ITH) daily in metropolitan cities. Environmental exposure and associated risk for passengers is of great public concern. In this study, eight volatile organic compounds (VOCs) and the 16 EPA priority polycyclic aromatic hydrocarbons (PAHs) were analyzed in airborne samples collected from indoor waiting areas (Indoor) and bus parks of nine Singapore ITH, which comprises of two types of architectural structure (i.e., fully sheltered and open/partially enclosed). The median concentrations of total VOCs (TVOCs), total gaseous PAHs (TgPAHs) and total airborne particles-adsorbed PAH (TpPAHs) concentrations in Indoor were 30.42 µg/m3, 18.99 ng/m3 and 1.38 ng/m3; respectively. A strong correlation (r ≥ 0.75, p < 0.001) was observed between Indoor and bus parks air compounds. The "Indoor" to bus park pollutant concentration ratio (I/B ratio) showed lower values in the bus interchanges with fully sheltered bus parks (TVOCs: 0.98; TgPAHs: 0.76; TpPAHs: 0.71) than those with open/partially enclosed ones (TVOCs: 1.28; TgPAHs: 1.31; TpPAHs: 0.90). This result suggests that fully sheltered structure may cause the accumulation of air pollutants. The daily VOC and PAH exposure for commuters were further estimated by considering inhalation and dermal doses using Monte Carlo simulation (n = 100,000). Overall, the result showed that the risk is still within international guideline values. In sum, the effect of architecture structure on the migration of air pollutants should be taken into consideration in future transport hub design to reduce pollutant exposure to commuters.

Exposure and risk assessment of volatile organic compounds and airborne phthalates in Singapore's Child Care Centers.

Infants and children under 6 years old spend most of daily time in Child Care Centers (CCCs), especially in the tropical regions like Singapore. Environmental exposure and associated risk during this early critical developmental stage is of great public concern. In this study, seven representative volatile organic compounds (VOCs) and five typical phthalates were analyzed in the indoor and outdoor air samples collected from 32 Singapore CCCs. The median of total VOC and phthalate concentration in indoor air was 19.03 and 5.41 µg m-3; respectively. For both indoors and outdoors environment, benzene, toluene and xylene were the dominant VOC contributors (more than 68%). For indoor air phthalates, di(2-ethylhexyl) phthalate and di-butyl phthalate (DBP) accounts for 60-76%. The level of both VOCs and phthalates in indoor environment was significantly higher than that in outdoor, with an average indoor/outdoor ratio of 1.24 and 1.45; respectively. A strong correlation (r > 0.50, p < 0.05) was observed between indoor and outdoor air compounds. VOC and phthalate levels have no significant difference between CCCs with split-unit and centrally ventilated air conditioners. Monte Carlo simulation was used to estimate exposure uncertainty and variability for the risk assessment. Overall, the concentrations of VOC were below the healthy reference values from either EPA Integrated Risk Information System (IRIS) or Singapore guideline. However, similar to other countries' report, benzene, DBP, ethylbenzene and naphthalene were at levels that could exceed the stringent standards such as Office of Environmental Health Hazard Assessment (OEHHA) cancer and reproductive health-based benchmarks.