Fitbit Data to Assess Functional Capacity in Patients Before Elective Surgery: Pilot Prospective Observational Study.

BACKGROUND: Preoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide less intrusive assessment methods, reduce costs, and improve accuracy. OBJECTIVE: The aim of this study was to present and evaluate the possibility of using commercial smartwatch data, such as those retrieved from the Fitbit Inspire 2 device, to assess functional capacity before elective surgery and correlate such data with the current gold standard measure, the 6-Minute Walk Test (6MWT) distance. METHODS: During the hospital visit, patients were evaluated in terms of functional capacity using the 6MWT. Patients were asked to wear the Fitbit Inspire 2 for 7 days (with flexibility of -2 to +2 days) after the hospital visit, before their surgical operation. Resting heart rate and daily steps data were retrieved directly from the smartwatch. Feature engineering techniques allowed the extraction of heart rate over steps (HROS) and a modified version of Non-Exercise Testing Cardiorespiratory Fitness. All measures were correlated with 6MWT. RESULTS: In total, 31 patients were enrolled in the study (n=22, 71% men; n=9, 29% women; mean age 76.06, SD 4.75 years). Data were collected between June 2021 and May 2022. The parameter that correlated best with the 6MWT was the Non-Exercise Testing Cardiorespiratory Fitness index (r=0.68; P<.001). The average resting heart rate over the whole acquisition period for each participant had r=-0.39 (P=.03), even if some patients did not wear the device at night. The correlation of the 6MWT distance with the HROS evaluated at 1% quantile was significant, with Pearson coefficient of -0.39 (P=.04). Fitbit step count had a fair correlation of 0.59 with 6MWT (P<.001). CONCLUSIONS: Our study is a promising starting point for the adoption of wearable technology in the evaluation of functional capacity of patients, which was strongly correlated with the gold standard. The study also identified limitations in the availability of metrics, variability of devices, accuracy and quality of data, and accessibility as crucial areas of focus for future studies.

Reframing the environment in data-intensive health sciences.

In this paper, we analyse the relation between the use of environmental data in contemporary health sciences and related conceptualisations and operationalisations of the notion of environment. We consider three case studies that exemplify a different selection of environmental data and mode of data integration in data-intensive epidemiology. We argue that the diversification of data sources, their increase in scale and scope, and the application of novel analytic tools have brought about three significant conceptual shifts. First, we discuss the EXPOsOMICS project, an attempt to integrate genomic and environmental data which suggests a reframing of the boundaries between external and internal environments. Second, we explore the MEDMI platform, whose efforts to combine health, environmental and climate data instantiate a reframing and expansion of environmental exposure. Third, we illustrate how extracting epidemiological insights from extensive social data collected by the CIDACS institute yields innovative attributions of causal power to environmental factors. Identifying these shifts highlights the benefits and opportunities of new environmental data, as well as the challenges that such tools bring to understanding and fostering health. It also emphasises the constraints that data selection and accessibility pose to scientific imagination, including how researchers frame key concepts in health-related research.

On evidence fiascos and judgments in COVID-19 policy.

Calls for evidence-based approaches to COVID-19 have sparked up discussions on the use of evidence for policy. In this note, we expand these discussions: while the debate has mostly focused on the types of evidence to be used for policy, we argue that the assessment of judgments involved in data practices and evidence production should play a central role in evaluating policy.

Open science, data sharing and solidarity: who benefits?

Research, innovation, and progress in the life sciences are increasingly contingent on access to large quantities of data. This is one of the key premises behind the "open science" movement and the global calls for fostering the sharing of personal data, datasets, and research results. This paper reports on the outcomes of discussions by the panel "Open science, data sharing and solidarity: who benefits?" held at the 2021 Biennial conference of the International Society for the History, Philosophy, and Social Studies of Biology (ISHPSSB), and hosted by Cold Spring Harbor Laboratory (CSHL).

Putting the exposome into practice: An analysis of the promises, methods and outcomes of the European human exposome network.

OBJECTIVES: Contemporary research on the exposome, i.e. the sum of all the exposures an individual encounters throughout life and that may influence human health, bears the promise of an integrative and policy-relevant research on the effect of environment on health. Critical analyses of the first generation of exposome projects have voiced concerns over their actual breadth of inclusion of environmental factors and a related risk of molecularization of public health issues. The emergence of the European Human Exposome Network (EHEN) provides an opportunity to better situate the ambitions and priorities of the exposome approach on the basis of new and ongoing research. METHODS: We assess the promises, methods, and limitations of the EHEN, as a case study of the second generation of exposome research. A critical textual analysis of profile articles from each of the projects involved in EHEN, published in Environmental Epidemiology, was carried out to derive common priorities, innovations, methodological and conceptual choices across EHEN and to discuss it. RESULTS: EHEN consolidates its integrative outlook by reinforcing the volume and variety of data, its data analysis infrastructure and by diversifying its strategies to deliver actionable knowledge. Yet data-driven limitations severely restrict the geographical and political scope of this knowledge to health issues primarily related to urban setups, which may aggravate some socio-spatial inequalities in health in Europe. CONCLUSIONS: The second generation of exposome research doubles down on the initial ambition of an integrative study of the environmental effects of health to fuel better public health interventions. This intensification is, however, accompanied by significant epistemological challenges and doesn't help to overcome severe restrictions in the geographical and political scope of this knowledge. We thus advocate for increased reflexivity over the limitations of this conceptually and methodologically integrative approach to public and environmental health.

Digital technologies for step counting: between promises of reliability and risks of reductionism.

Step counting is among the fundamental features of wearable technology, as it grounds several uses of wearables in biomedical research and clinical care, is at the center of emerging public health interventions and recommendations, and is gaining increasing scientific and political importance. This paper provides a perspective of step counting in wearable technology, identifying some limitations to the ways in which wearable technology measures steps and indicating caution in current uses of step counting as a proxy for physical activity. Based on an overview of the current state of the art of technologies and approaches to step counting in digital wearable technologies, we discuss limitations that are methodological as well as epistemic and ethical-limitations to the use of step counting as a basis to build scientific knowledge on physical activity (epistemic limitations) as well as limitations to the accessibility and representativity of these tools (ethical limitations). As such, using step counting as a proxy for physical activity should be considered a form of reductionism. This is not per se problematic, but there is a need for critical appreciation and awareness of the limitations of reductionistic approaches. Perspective research should focus on holistic approaches for better representation of physical activity levels and inclusivity of different user populations.

Wearable Technologies and Stress: Toward an Ethically Grounded Approach.

The widespread use of digital technologies that can be worn on our bodies-wearables-is presented as a turning point for various areas of biomedical research and healthcare, such as stress. The ability to constantly measure these parameters, the perceived quality of measurement, and their individual and personal level frame wearable technology as a possibly crucial step in the direction of a more accurate and objective definition and measurement of stress for clinical, research, and personal purposes. In this paper, we discuss the hypothesis that the use of wearables for stress is also beneficial from an ethical viewpoint. We start by situating wearables in the context of existing methods and limitations of stress research. On this basis, we discuss the ethics of wearables for stress by applying ethical principles from bioethics (beneficence, non-maleficence, autonomy, justice), which allows us to identify ethical benefits as well as challenges in this context. As a result, we develop a more balanced view of the ethics of wearables for stress, which we use to present recommendations and indications with a focus on certification, accessibility, and inclusion. This article is, thus, a contribution towards ethically grounded wearable and digital health technology for stress.

Wearable Health Technology for Preoperative Risk Assessment in Elderly Patients: The WELCOME Study.

Preoperative identification of high-risk groups has been extensively studied to improve patients' outcomes. Wearable devices, which can track heart rate and physical activity data, are starting to be evaluated for patients' management. We hypothesized that commercial wearable devices (WD) may provide data associated with preoperative evaluation scales and tests, to identify patients with poor functional capacity at increased risk for complications. We conducted a prospective observational study including seventy-year-old patients undergoing two-hour surgeries under general anesthesia. Patients were asked to wear a WD for 7 days before surgery. WD data were compared to preoperatory clinical evaluation scales and with a 6-min walking test (6MWT). We enrolled 31 patients, with a mean age of 76.1 (SD ± 4.9) years. There were 11 (35%) ASA 3-4 patients. 6MWT results averaged 328.9 (SD ± 99.5) m. Daily steps and 𝑉𝑂2𝑚𝑎𝑥 as recorded using WD and were associated with 6MWT performance (R = 0.56, p = 0.001 and r = 0.58, p = 0.006, respectively) and clinical evaluation scales. This is the first study to evaluate WD as preoperative evaluation tools; we found a strong association between 6MWT, preoperative scales, and WD data. Low-cost wearable devices are a promising tool for the evaluation of cardiopulmonary fitness. Further research is needed to validate WD in this setting.

Challenges and recommendations for wearable devices in digital health: Data quality, interoperability, health equity, fairness.

Wearable devices are increasingly present in the health context, as tools for biomedical research and clinical care. In this context, wearables are considered key tools for a more digital, personalised, preventive medicine. At the same time, wearables have also been associated with issues and risks, such as those connected to privacy and data sharing. Yet, discussions in the literature have mostly focused on either technical or ethical considerations, framing these as largely separate areas of discussion, and the contribution of wearables to the collection, development, application of biomedical knowledge has only partially been discussed. To fill in these gaps, in this article we provide an epistemic (knowledge-related) overview of the main functions of wearable technology for health: monitoring, screening, detection, and prediction. On this basis, we identify 4 areas of concern in the application of wearables for these functions: data quality, balanced estimations, health equity, and fairness. To move the field forward in an effective and beneficial direction, we present recommendations for the 4 areas: local standards of quality, interoperability, access, and representativity.

The paradox of the artificial intelligence system development process: the use case of corporate wellness programs using smart wearables.

Artificial intelligence (AI) systems have been widely applied to various contexts, including high-stake decision processes in healthcare, banking, and judicial systems. Some developed AI models fail to offer a fair output for specific minority groups, sparking comprehensive discussions about AI fairness. We argue that the development of AI systems is marked by a central paradox: the less participation one stakeholder has within the AI system's life cycle, the more influence they have over the way the system will function. This means that the impact on the fairness of the system is in the hands of those who are less impacted by it. However, most of the existing works ignore how different aspects of AI fairness are dynamically and adaptively affected by different stages of AI system development. To this end, we present a use case to discuss fairness in the development of corporate wellness programs using smart wearables and AI algorithms to analyze data. The four key stakeholders throughout this type of AI system development process are presented. These stakeholders are called service designer, algorithm designer, system deployer, and end-user. We identify three core aspects of AI fairness, namely, contextual fairness, model fairness, and device fairness. We propose a relative contribution of the four stakeholders to the three aspects of fairness. Furthermore, we propose the boundaries and interactions between the four roles, from which we make our conclusion about the possible unfairness in such an AI developing process.

Agroecology research in Europe funded by European and transnational programmes: current status and perspectives.

Background: Redesigning the agri-food system through agroecology represents a common ambition among practitioners, activists and scholars to achieve environmental and socio-economic sustainability. Research can have a main role to support this path. Although it seems that there is a gradual increasing body of agroecology research, it clearly lacks good knowledge about this. The main objective of this study was therefore to map research projects related to agroecology in Europe with the aim to characterize European research in terms of implementation of agroecology elements, identify needs for future cross collaboration between countries and networks, and support the setting up of appropriate research agendas fostering agroecology research in Europe. Methods: A desktop research with different databases related to European and transnational funding programmes was carried out to identify funded research projects involved in agroecology. The obtained projects were used to perform a social network analysis. Furthermore, two surveys were conducted, one with coordinators of identified projects and a second one for researchers engaged in agroecology. Results: Our study highlighted a predominant trajectory of agroecology research prone to the transformation of the agri-food system. France, Germany, Italy, Netherlands, Portugal, Spain, and United Kingdom were the most active countries engaged in agroecology research. In all surveys, issues related to efficiency improvement, synergies strengthening, local economy development, and co-creation and sharing of knowledge were the most implemented to support agri-food transformation. Transdisciplinary approaches were mainly addressed by European projects. Surveys reported a limited participation of value chain actors, while researchers, farmers, and their associations were the most involved. Survey respondents suggested to increase project duration and introduce flexibility methods to modulate research actions according to dynamic of the contexts. Conclusion: On the basis of the results, some policy recommendations were provided to fostering agroecology research in Europe and its contribution for transformation of agri-foods systems.

Follow *the* science? On the marginal role of the social sciences in the COVID-19 pandemic.

In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis.

What Is New about the Exposome? Exploring Scientific Change in Contemporary Epidemiology.

In this commentary, I discuss the scientific changes brought by the exposome, asking what is new about this approach and line of research. I place the exposome in a historical perspective, by analyzing the conditions under which the exposome has been conceived, developed and established in the context of contemporary epidemiological research. I argue that the exposome has been developed by transferring approaches, methods and conceptualizations from other lines of research in the life and health sciences. I thus discuss the conceptual and methodological innovations of the exposome as a result of the merging and adaptation of these elements for new uses and purposes. On this basis, I argue that the novelty of the exposome should be seen in incremental rather than revolutionary terms and, in this sense, the exposome shares significant elements with other projects and repertoires in postgenomics. I conclude by discussing the consequences of this analysis for the potential limitations and future development of exposome research.

Making evidential claims in epidemiology: Three strategies for the study of the exposome.

How is scientific data used to represent phenomena and as evidence for claims about phenomena? In this paper, I propose that a specific type of claims - evidential claims - is involved in data practices to define and restrict the representational and evidential content of a dataset. I present an account of data practices in the epidemiology of the exposome based on the notion of evidential claims, which helps unpack the approaches, assumptions and warrants that connect different stages of research. I identify three different strategies to generate different types of evidential claims in this case. The macro strategy, which individuates the dataset that serves as the initial evidential space for research. The micro strategy, which is used to generate evidential claims about the microscopic and individual component of target phenomena. The association strategy, that uses evidence from the other strategies to identify a dataset as representation of the different levels and relations of exposure and disease. Differentiating between these strategies sheds light on the multi-faceted landscape of biomedical research on environment and health; and the roles of data and evidence in the process of inquiry.

Influence of Cover Crop Termination on Ground Dwelling Arthropods in Organic Vegetable Systems.

A key aspect in cover crop management is termination before the cash crop is planted. The aim of this study was to assess the effects of termination methods on ground-dwelling arthropods. The conventional mechanical termination method-i.e., green manuring by means of a disc harrow-was compared to flattening using a roller crimper. Two different crop systems were investigated for two growing seasons; cauliflower was grown in autumn after the termination of a mixture of cowpea, pearl millet, and radish, and tomato was cropped in spring and summer after the termination of a mixture of barley and vetch. Ground beetles (Coleoptera: Carabidae), rove beetles (Coleoptera: Staphylinidae), and spiders (Araneae) were sampled by means of standard pitfall traps throughout the growing season of both cash crops. The roller crimper increased the overall abundance of ground beetles in the first growing season of both cash crops, whereas in the second year, no significant effect could be detected. Rove beetles were more abundant in plots where the cover crops were terminated by the roller crimper. Finally, green manuring increased the abundance of spiders, especially on the first sampling date after cover crop termination. Albeit different taxa showed different responses, the termination of cover crops by a roller crimper generally increased the abundance of ground dwelling arthropods. Given that most of the sampled species were generalist predators, their increased abundance could possibly improve biological control.

Evaluating evidential pluralism in epidemiology: mechanistic evidence in exposome research.

In current philosophical discussions on evidence in the medical sciences, epidemiology has been used to exemplify a specific version of evidential pluralism. According to this view, known as the Russo-Williamson Thesis, evidence of both difference-making and mechanisms is produced to make causal claims in the health sciences. In this paper, I present an analysis of data and evidence in epidemiological practice, with a special focus on research on the exposome, and I cast doubt on the extent to which evidential pluralism holds in this case. I start by focusing on the claim that molecular data allows for the production of mechanistic evidence. On the basis of a close look at the ways in which molecular data is used in exposome research, I caution against interpretations in terms of mechanistic evidence. Secondly, I expand my critical remarks on the thesis by addressing the conditions under which data is categorised as evidence in exposome research. I argue that these show that the classification of a dataset as a type of evidence is dependent on the ways in which the data is used. This is in contrast with the approach of evidential pluralism, where evidence is classified in different types on the basis of its intrinsic properties. Finally, I come back to what I consider the core of the thesis and suggest that the epidemiological research analysed in the paper indicates different interpretations of evidential pluralism and its applicability in the health sciences.

Mycorrhiza-mediated interference between cover crop and weed in organic winter cereal agroecosystems: The mycorrhizal colonization intensity indicator.

The mycorrhizal fungi are symbiotic organisms able to provide many benefits to crop production by supplying a set of ecosystem functions. A recent ecological approach based on the ability of the fungi community to influence plant-plant interactions by extraradical mycelium development may be applied to diversified, herbaceous agroecosystems. Our hypothesis is that the introduction of a winter cereal cover crop (CC) as arbuscular mycorrhizal fungi (AMF)-host plant in an organic rotation can boosts the AMF colonization of the other plants, influencing crop-weed interference. In a 4-years organic rotation, the effect of two winter cereal CC, rye and spelt, on weed density and AMF colonization was evaluated. The AMF extraradical mycelium on CC and weeds roots was observed by scanning electron microscopy analysis. By joining data of plant density and mycorrhization, we built the mycorrhizal colonization intensity of the Agroecosystem indicator (MA%). Both the CC were colonized by soil AMF, being the mycorrhizal colonization intensity (M%) affected by environmental conditions. Under CC, the weed density was reduced, due to the increase of the reciprocal competition in favor of CC, which benefited from mycorrhizal colonization and promoted the development of AMF extraradical mycelium. Even though non-host plants, some weed species showed an increased mycorrhizal colonization in presence of CC respect to the control. Under intense rainfall, the MA% was less sensitive to the CC introduction. On the opposite, under highly competitive conditions, both the CC boosted significantly the mycorrhization of coexistent plants in the agroecosystem. The proposed indicator measured the agroecological service provided by the considered CCs in promoting or inhibiting the overall AMF colonization of the studied agroecosystems, as affected by weed selection and growth: It informs about agroecosystem resilience and may be profitably applied to indicate the extent of the linkage of specific crop traits to agroecosystem services, contributing to further develop the functional biodiversity theory.