Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health.

This study offers a new perspective on the role of relative humidity in strategies to improve the health and wellbeing of office workers. A lack of studies of sufficient participant size and diversity relating relative humidity (RH) to measured health outcomes has been a driving factor in relaxing thermal comfort standards for RH and removing a lower limit for dry air. We examined the association between RH and objectively measured stress responses, physical activity (PA), and sleep quality. A diverse group of office workers (n = 134) from four well-functioning federal buildings wore chest-mounted heart rate variability monitors for three consecutive days, while at the same time, RH and temperature (T) were measured in their workplaces. Those who spent the majority of their time at the office in conditions of 30%-60% RH experienced 25% less stress at the office than those who spent the majority of their time in drier conditions. Further, a correlational study of our stress response suggests optimal values for RH may exist within an even narrower range around 45%. Finally, we found an indirect effect of objectively measured poorer sleep quality, mediated by stress responses, for those outside this range.

Effects of office workstation type on physical activity and stress.

OBJECTIVE: Office environments have been causally linked to workplace-related illnesses and stress, yet little is known about how office workstation type is linked to objective metrics of physical activity and stress. We aimed to explore these associations among office workers in US federal office buildings. METHODS: We conducted a wearable, sensor-based, observational study of 231 workers in four office buildings. Outcome variables included workers' physiological stress response, physical activity and perceived stress. Relationships between office workstation type and these variables were assessed using structural equation modelling. RESULTS: Workers in open bench seating were more active at the office than those in private offices and cubicles (open bench seating vs private office=225.52 mG (31.83% higher on average) (95% CI 136.57 to 314.46); open bench seating vs cubicle=185.13 mG (20.16% higher on average) (95% CI 66.53 to 303.72)). Furthermore, workers in open bench seating experienced lower perceived stress at the office than those in cubicles (-0.27 (9.10% lower on average) (95% CI -0.54 to -0.02)). Finally, higher physical activity at the office was related to lower physiological stress (higher heart rate variability in the time domain) outside the office (-26.12 ms/mG (14.18% higher on average) (95% CI -40.48 to -4.16)). CONCLUSIONS: Office workstation type was related to enhanced physical activity and reduced physiological and perceived stress. This research highlights how office design, driven by office workstation type, could be a health-promoting factor.

Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients.

BACKGROUND: While various objective tools have been validated for assessing physical frailty in the geriatric population, these are often unsuitable for busy clinics and mobility-impaired patients. Recently, we have developed a frailty meter (FM) using two wearable sensors, which allows capturing key frailty phenotypes (weakness, slowness, and exhaustion), by testing 20-s rapid elbow flexion-extension test. OBJECTIVE: In this study, we proposed an enhanced automated algorithm to identify frailty using a single wrist-worn sensor. METHODS: The data collected from 100 geriatric inpatients (age: 78.9 ± 9.1 years, 49% frail) were reanalyzed to validate the new algorithm. The frailty status of the participants was determined using a validated modified frailty index. Different FM phenotypes (31 features) including velocity of elbow rotation, decline in velocity of elbow rotation over 20 s, range of motion, etc. were extracted. A regression model, bootstrap with 2,000 iterations, and recursive feature elimination technique were used for optimizing the FM parameters and identifying frailty using a single wrist-worn sensor. RESULTS: A strong agreement was observed between two-sensor and wrist-worn sensor configuration (r = 0.87, p < 0.001). Results suggest that the wrist-worn FM with no demographic information still yields a high accuracy of 80.0% (95% CI: 79.7-80.3%) and an area under the curve of 87.7% (95% CI: 87.4-87.9%) to identify frailty status. Results are comparable with two-sensor configuration, where the observed accuracy and area under the curve were 80.6% (95% CI: 80.4-80.9%) and 87.4% (95% CI: 87.1-87.6%), respectively. CONCLUSION: The simplicity of FM may open new avenues to integrate wearable technology and mobile health to capture frailty status in a busy hospital setting. Furthermore, the reduction of needed sensors to a single wrist-worn sensor allows deployment of the proposed algorithm in the form of a smartwatch application. From the application standpoint, the proposed FM is superior to traditional physical frailty-screening tools in which the walking test is a key frailty phenotype, and thus they cannot be used for bedbound patients or in busy clinics where administration of gait test as a part of routine assessment is impractical.

Motor Planning Error: Toward Measuring Cognitive Frailty in Older Adults Using Wearables.

Practical tools which can be quickly administered are needed for measuring subtle changes in cognitive-motor performance over time. Frailty together with cognitive impairment, or 'cognitive frailty', are shown to be strong and independent predictors of cognitive decline over time. We have developed an interactive instrumented trail-making task (iTMT) platform, which allows quantification of motor planning error (MPE) through a series of ankle reaching tasks. In this study, we examined the accuracy of MPE in identifying cognitive frailty in older adults. Thirty-two older adults (age = 77.3 ± 9.1 years, body-mass-index = 25.3 ± 4.7 kg/m², female = 38%) were recruited. Using either the Mini-Mental State Examination or Montreal Cognitive Assessment (MoCA), 16 subjects were classified as cognitive-intact and 16 were classified as cognitive-impaired. In addition, 12 young-healthy subjects (age = 26.0 ± 5.2 years, body-mass-index = 25.3 ± 3.9 kg/m², female = 33%) were recruited to establish a healthy benchmark. Subjects completed the iTMT, using an ankle-worn sensor, which transforms ankle motion into navigation of a computer cursor. The iTMT task included reaching five indexed target circles (including numbers 1-to-3 and letters A&B placed in random order) on the computer-screen by moving the ankle-joint while standing. The ankle-sensor quantifies MPE through analysis of the pattern of ankle velocity. MPE was defined as percentage of time deviation between subject's maximum ankle velocity and the optimal maximum ankle velocity, which is halfway through the reaching pathway. Data from gait tests, including single task and dual task walking, were also collected to determine cognitive-motor performance. The average MPE in young-healthy, elderly cognitive-intact, and elderly cognitive-impaired groups was 11.1 ± 5.7%, 20.3 ± 9.6%, and 34.1 ± 4.2% (p < 0.001), respectively. Large effect sizes (Cohen's d = 1.17-4.56) were observed for discriminating between groups using MPE. Significant correlations were observed between the MPE and MoCA score (r = -0.670, p < 0.001) as well as between the MPE and dual task stride velocity (r = -0.584, p < 0.001). This study demonstrated feasibility and efficacy of estimating MPE from a practical wearable platform with promising results in identifying cognitive-motor impairment and potential application in assessing cognitive frailty. The proposed platform could be also used as an alternative to dual task walking test, where gait assessment may not be practical. Future studies need to confirm these observations in larger samples.

Toward Smart Footwear to Track Frailty Phenotypes-Using Propulsion Performance to Determine Frailty.

Frailty assessment is dependent on the availability of trained personnel and it is currently limited to clinic and supervised setting. The growing aging population has made it necessary to find phenotypes of frailty that can be measured in an unsupervised setting for translational application in continuous, remote, and in-place monitoring during daily living activity, such as walking. We analyzed gait performance of 161 older adults using a shin-worn inertial sensor to investigate the feasibility of developing a foot-worn sensor to assess frailty. Sensor-derived gait parameters were extracted and modeled to distinguish different frailty stages, including non-frail, pre-frail, and frail, as determined by Fried Criteria. An artificial neural network model was implemented to evaluate the accuracy of an algorithm using a proposed set of gait parameters in predicting frailty stages. Changes in discriminating power was compared between sensor data extracted from the left and right shin sensor. The aim was to investigate the feasibility of developing a foot-worn sensor to assess frailty. The results yielded a highly accurate model in predicting frailty stages, irrespective of sensor location. The independent predictors of frailty stages were propulsion duration and acceleration, heel-off and toe-off speed, mid stance and mid swing speed, and speed norm. The proposed model enables discriminating different frailty stages with area under curve ranging between 83.2⁻95.8%. Furthermore, results from the neural network suggest the potential of developing a single-shin worn sensor that would be ideal for unsupervised application and footwear integration for continuous monitoring during walking.

New Rule-Based Algorithm for Real-Time Detecting Sleep Apnea and Hypopnea Events Using a Nasal Pressure Signal.

We developed a rule-based algorithm for automatic real-time detection of sleep apnea and hypopnea events using a nasal pressure signal. Our basic premise was that the performance of our new algorithm using the nasal pressure signal would be comparable to that using other sensors as well as manual annotation labeled by a technician on polysomnography study. We investigated fifty patients with sleep apnea-hypopnea syndrome (age: 56.8 ± 10.5 years, apnea-hypopnea index (AHI): 36.2 ± 18.1/h) during full night PSG recordings at the sleep center. The algorithm was comprised of pre-processing with a median filter, amplitude computation and apnea-hypopnea detection parts. We evaluated the performance of the algorithm a confusion matric for each event and statistical analyses for AHI. Our evaluation achieved a good performance, with a sensitivity of 86.4 %, and a positive predictive value of 84.5 % for detection of apnea and hypopnea regardless of AHI severity. Our results indicated a high correlation with the manually labeled apnea-hypopnea events during PSG, with a correlation coefficient of r = 0.94 (p < 0.0001) and a mean difference of -2.9 ± 11.6 per hour. The proposed new algorithm could provide significant clinical and computational insights to design a PSG analysis system and a continuous positive airway pressure (CPAP) device for screening sleep quality related in patients with sleep apnea-hypopnea syndrome.

Discovery of associative patterns between workplace sound level and physiological wellbeing using wearable devices and empirical Bayes modeling.

We conducted a field study using multiple wearable devices on 231 federal office workers to assess the impact of the indoor environment on individual wellbeing. Past research has established that the workplace environment is closely tied to an individual's wellbeing. Since sound is the most-reported environmental factor causing stress and discomfort, we focus on quantifying its association with physiological wellbeing. Physiological wellbeing is represented as a latent variable in an empirical Bayes model with heart rate variability measures-SDNN and normalized-HF as the observed outcomes and with exogenous factors including sound level as inputs. We find that an individual's physiological wellbeing is optimal when sound level in the workplace is at 50 dBA. At lower (<50dBA) and higher (>50dBA) amplitude ranges, a 10 dBA increase in sound level is related to a 5.4% increase and 1.9% decrease in physiological wellbeing respectively. Age, body-mass-index, high blood pressure, anxiety, and computer use intensive work are person-level factors contributing to heterogeneity in the sound-wellbeing association.

Improving Sleep Quality Assessment Using Wearable Sensors by Including Information From Postural/Sleep Position Changes and Body Acceleration: A Comparison of Chest-Worn Sensors, Wrist Actigraphy, and Polysomnography.

STUDY OBJECTIVES: To improve sleep quality assessment using a single chest-worn sensor by extracting body acceleration and sleep position changes. METHODS: Sleep patterns of 21 participants (50.8 ± 12.8 years, 47.8% female) with self-reported sleep problems were simultaneously recorded using a chest sensor (Chest), an Actiwatch (Wrist), and polysomnography (PSG) during overnight sleep laboratory assessment. An algorithm for Chest was developed to detect sleep/wake epochs based on body acceleration and sleep position/postural changes data, which were then used to estimate sleep parameters of interest. Comparisons between Chest and Wrist with respect to PSG were performed. Identification of sleep/wake epochs was assessed by estimating sensitivity, specificity, and accuracy. Agreement between sensor-derived sleep parameters and PSG was assessed using correlation coefficients and Bland-Altman analysis. RESULTS: Chest identified sleep/wake epochs with an accuracy of on average 6% higher than Wrist (85.8% versus 79.8%). Similar trends were observed for sensitivity/specificity values. Correlation between Wrist and PSG was poor for most of the sleep parameters of interest (r = 0.0-0.3); however, Chest and PSG correlation showed moderate to strong agreement (r = 0.4-0.8) with relatively low bias and high precision bias (precision): 9.2 (13.2) minutes for sleep onset latency; 17.3(34.8) minutes for total sleep time; 7.5 (29.8) minutes for wake after sleep onset; and 2.0 (7.3)% for sleep efficacy. CONCLUSIONS: Combination of sleep postural/position changes and body acceleration improved detection of sleep/wake epochs compared to wrist acceleration alone. The chest sensors also improved estimation of sleep parameters of interest with stronger agreement with PSG. Our findings may expand the application of wearable sensors to clinically assess sleep outside of a sleep laboratory.

Nasal pressure recordings for automatic snoring detection.

This study presents a rule-based method for automated, real-time snoring detection using nasal pressure recordings during overnight sleep. Although nasal pressure recordings provide information regarding nocturnal breathing abnormalities in a polysomnography (PSG) study or continuous positive airway pressure (CPAP) system, an objective assessment of snoring detection using these nasal pressure recordings has not yet been reported in the literature. Nasal pressure recordings were obtained from 55 patients with obstructive sleep apnea. The PSG data were also recorded simultaneously to evaluate the proposed method. This rule-based method for automatic, real-time snoring detection employed preprocessing, short-time energy and the central difference method. Using this methodology, a sensitivity of 85.4% and a positive predictive value of 92.0% were achieved in all patients. Therefore, we concluded that the proposed method is a simple, portable and cost-effective tool for real-time snoring detection in PSG and CPAP systems that does not require acoustic analysis using a microphone.

Development of a noncontact heart rate monitoring system for sedentary behavior based on an accelerometer attached to a chair.

Although people spend a third of their day engaged in sedentary activities, research on heart activity during sitting is almost nonexistent because of the discomfort experienced when electrocardiogram (ECG) measurement electrodes are attached to the body. Accordingly, in this study, a system was developed to monitor heart rate (HR) in a noncontact and unconstrained way while subjects were seated, by attaching an accelerometer on the backrest of a chair. Acceleration signals were obtained three times from 20 healthy adults, a detection algorithm was applied, and HR detection performance was evaluated by comparing the R-peak values from the ECG. The system had excellent performance results, with a sensitivity of 96.10% and a positive predictive value of 96.43%. In addition, the HR calculated by the new system developed in this study was compared with HR calculated using ECG. The new system exhibited excellent performance; its results were strongly correlated with that of ECG (r = 0.97, p [Formula: see text] 0.0001; average difference of -0.08  ±  4.60 [mean ± 1.96∙standard deviation] in Bland-Altman analysis). Accordingly, the method presented in this study is expected to be applicable for evaluating diverse autonomic nervous system components in a noncontact and unconstrained way using an accelerometer to monitor the HR of sedentary workers or adolescents.

Automatic classification of apnea/hypopnea events through sleep/wake states and severity of SDB from a pulse oximeter.

This study proposes a method of automatically classifying sleep apnea/hypopnea events based on sleep states and the severity of sleep-disordered breathing (SDB) using photoplethysmogram (PPG) and oxygen saturation (SpO2) signals acquired from a pulse oximeter. The PPG was used to classify sleep state, while the severity of SDB was estimated by detecting events of SpO2 oxygen desaturation. Furthermore, we classified sleep apnea/hypopnea events by applying different categorisations according to the severity of SDB based on a support vector machine. The classification results showed sensitivity performances and positivity predictive values of 74.2% and 87.5% for apnea, 87.5% and 63.4% for hypopnea, and 92.4% and 92.8% for apnea + hypopnea, respectively. These results represent better or comparable outcomes compared to those of previous studies. In addition, our classification method reliably detected sleep apnea/hypopnea events in all patient groups without bias in particular patient groups when our algorithm was applied to a variety of patient groups. Therefore, this method has the potential to diagnose SDB more reliably and conveniently using a pulse oximeter.

Automatic snoring detection from nasal pressure data.

This study presents a method for automatic snoring detection from a nasal pressure data. First, a spectrogram analysis was performed in order to obtain information about the spectral characteristic of nasal pressure data. The automatic method is based on a simple signal filtering and short-time energy technique. Fifteen patients were participated in order to evaluation the performance of the proposed method. Results are compared with manually labeled snoring events by watching video records. The sensitivity and positive predictivity value were 93.73% and 93.70%, respectively. The results in this study could provide sleep experts with the method to objectively monitor sleep-disordered breathing in CPAP system or PSG study.

Snoring detection using a piezo snoring sensor based on hidden Markov models.

This study presents a snoring detection method based on hidden Markov models (HMMs) using a piezo snoring sensor. Snoring is a major symptom of obstructive sleep apnea (OSA). In most sleep studies, snoring is detected with a microphone. Since these studies analyze the acoustic properties of snoring, they need to acquire data at high sampling rates, so a large amount of data should be processed. Recently, several sleep studies have monitored snoring using a piezo snoring sensor. However, an automatic method for snoring detection using a piezo snoring sensor has not been reported in the literature. This study proposed the HMM-based method to detect snoring using this sensor, which is attached to the neck. The data from 21 patients with OSA were gathered for training and test sets. The short-time Fourier transform and short-time energy were computed so they could be applied to HMMs. The data were classified as snoring, noise and silence according to their HMMs. As a result, the sensitivity and the positive predictivity values were 93.3% and 99.1% for snoring detection, respectively. The results demonstrated that the method produced simple, portable and user-friendly detection tools that provide an alternative to the microphone-based method.

Repeatability of the accelerometric-based method to detect step events for hemiparetic stroke patients.

This study is to evaluate the repeatability of the accelerometric-method to detect step events for hemiparetic stroke patients. To evaluate this method, four adults with chronic hemiparetic stroke were participated. The repeatability of this method using a single three-axis accelerometer was evaluated with a six optical camera motion capture system. The correlation statistics and Bland-Altman plot were then used to evaluate the agreement between the step-time differences from the accelerometer data and the reflective markers data. The correlation coefficient of each two data was 0.99 (p < 0.001) and retest result was 0.99 (p < 0.001). The mean ± standard deviation (SD) between each two data along with the 95% limits of agreement (LOA = ± 1.96 SD) was 2.58 ± 2.37 ms (LOA = -2.07 ms and 7.23 ms), and retest result was 3.73 ± 2.02 ms (LOA = -0.22 ms and 7.68 ms). These results show that the suggested method is useful to detect step events for hemiparetic stroke patients.

Development of a cardiorespiratory monitoring system based on pressure change of aircushion.

Heartbeat and respiration are fundamental vital signs used for estimation of patient's status. In this study, we have proposed a simple method to monitor the heartbeat and respiration based on displacements of human body which occur due to periodic heartbeat and breathing.

Novel algorithm for the hemiplegic gait evaluation using a single 3-axis accelerometer.

This paper suggests the novel algorithm for the estimating gait parameters of the hemiplegic patients using a 3-axis accelerometer. The signal processing for algorithm consists of a bandpass filter and a least square acceleration filter. To evaluate the performance of the algorithm, the correlation coefficients of the stride and the step time between the 3-axis accelerometer and the Vicon motion analysis system are compared. In consequence, correlation coefficient ranged from 0.90 to 0.99 for patients and ranged from 0.92 to 0.99 for normal subjects. The results showed that the novel algorithm is very useful for estimating not only hemiplegic gait but also normal gait.

A new noise reduction method for oscillometric blood pressure measurement.

In this paper, a new noise reduction method was proposed for oscillometric blood pressure measurement. The proposed method uses a capacitive sensor and an adaptive filter to minimize blood pressure measurement error. Noise such as undesired external pressure applied to cuff was focused on. Three types of the distorted oscillation signals (no overlap, non-consecutive overlap, consecutive overlap between the noise and the oscillation) were used to compare the conventional method using linear interpolation and the proposed method using the adaptive filter. The proposed method outperformed the conventional method in the case of consecutive overlap between the noise and the oscillation. The proposed method could be useful for measuring blood pressure in such a noisy environment that the subject is being transported.

The concurrent validity of the body center of mass in accelerometric measurement.

Accurate estimation of the body center of mass (COM) location has important clinical ramifications in locomotion associated with daily activities of living (ADL). This paper compared two computational estimation methods of COM using an accelerometric measurement and a VICON motion analysis system measurement (established or golden standard), respectively. A convenient sample of four healthy subjects participated. The body COM was measured when the subjects walked on the 6-m long walkway at their self-selected speed for 5 trials. VICON and accelerometer COM data signals were computed by VICON Polygon and trapezoidal double integration methods, respectively and compared to determine the concurrent validity of our COM estimation method. Correlation statistics showed excellent relationship between the two methods (r =0.87, P< 0.05), reflecting an acceptable validity. Our results suggest that the COM estimation using the accelerometer method is as accurate as the conventional method and provide clinical insights when designing a portable and inexpensive COM measurement tool for locomotion evaluation.