Part 2: Health apps, wearables, and sensors: The advancing frontier of digital health

10.Selfie Sticks
2010年最让人痴迷的东西是备受期待的iPhone,其他受关注的对象还有女演员林赛 罗韩、iPad、电视节目《欢乐合唱团》和《泽西海岸》。
The registered urban unemployment rate stood at 4.02 percent at year-end 2016, the lowest level in years.
The annual national civil service exam kicked off last Sunday, and some recent hot topics - such as college graduates starting their own businesses and the Yutu (Jade Rabbit) lunar rover - appeared in the exam questions.
圣文森特(St. Vincent),《数码证人》(Digital Witness), Loma Vista/Republic
10. Am I worrying about the future? Worrying about something that hasn’t even happened yet causes stress and anxiety. Focus on the moment in front of you and realize that it is all that exists.
香港科技大学(Hong Kong University of Science and Technology)和凯洛格管理学院(Kellogg School of Management)合办的中美EMBA项目重新夺回英国《金融时报》100个最佳EMBA项目排行榜的冠军宝座。
埃尔多安表示,德国总理安格拉?默克尔(Angela Merkel)“与荷兰没有什么不同”,并敦促移居海外的土耳其人不要在即将到来的欧洲选举中投票支持“现任政府和种族主义者”。要在今年9月成功竞选连任,默克尔面临一场硬仗。
The online notice about the retraction lists all 107 articles and 524 authors, nearly all of whom are clinical cancer specialists from China. The hospitals named are all top public institutions.
去字典里查一下“side-splitting humor”(令人捧腹大笑的幽默感)这个词,你可能会看到《嗨翻姐妹行》的预告片,这是2017年最搞笑的电影,没有争议。
In truth, slower growth of about 8 per cent could be better for China and for the world. More environmentally sustainable and equitable outcomes would ease popular concerns and higher consumption would ease tensions over global trade.
The year’s most compelling makeup and hair designs have been almost characters themselves (and are certainly more dynamic than some of those who appear on-screen). But while physical features are obvious right away, they can also give shape and nuance to the performances of those who assume them. Sometimes, a big nose creates a window of understanding.
CANCER: THE EMPEROR OF ALL MALADIES (PBS, March 30) Barak Goodman (“Scottsboro: An American Tragedy,” “My Lai”) is the director and Ken Burns is an executive producer of this six-hour series based on the Pulitzer Prize-winning book “The Emperor of All Maladies: A Biography of Cancer” by Dr. Siddhartha Mukherjee.
On Tuesday Saarland became the first German region to ban campaigning by foreign politicians. Several German local councils had called off planned Turkish ministers’ campaign meetings on technical grounds, such as fire safety.
A Florida teen is causing strangers to freeze and stare because of her uncanny likeness to Queen Elsa from the Disney movie Frozen.
It is just a common sense that no one wants to see chaos at his doorstep.
A research team at the University of Chicago has solved this problem, producing hands that send electric signals to the brain. They've begun with monkeys as test subjects, studying the animals to see how their brains respond to touch. When outfitted with prosthetic hands that stimulate their brains that way, the monkeys respond just as though they physically touch objects themselves.

据Bryan Wang说,腾讯跟最近几年在海外特别是新兴市场销量越来越大的那些中国手机厂商达成了预装软件的协议,这给它提供了助力。
其他在定制课程排名中表现突出的学校包括哈佛商学院(Harvard Business School),该院取得了今年最大幅度的排名攀升,上升9位至第5名。两年前,这所位于马萨诸塞州的学院还排在第18位。

With the increasing proliferation and sophistication of mobile phones, wearable devices such as smart watches, and sensors that can measure and gather a variety of data, public interest is growing in using consumer electronics to take ownership of personal health and wellness. A 2015 survey found that 66% of Americans age 66 and older want to use mobile technologies to improve their health by receiving medication reminders and tracking diet and nutrition, physical activity, and symptoms.[1

对于英国广播公司文化部门来说,戛纳期间堆满了工作,而派对是少之又少。但是,影展之外的电影节给小镇描上了醉人的红色。在2013年,我们试图联系白雪香槟酒庄(Piper Heidsieck)计算电影节期间香槟的消费数量,但作为提供“官方饮品”的白雪香槟酒庄拒绝回应。不过看看克鲁瓦塞特(Croisette)大道上那些微醺的脸庞以及踉跄的步态,我们可以合理的推测香槟的消费数量十分庞大。电影节的第一周,在为马提欧?加洛尼影片《故事的故事》(Tale of Tales)举办的派对上香槟成河,狂欢者嗨至凌晨。次日早晨,英国广播公司的瑞贝卡?劳伦斯与某位明星进行访谈,询问其在采访前休息了多久。这位明星只是眯起了惺忪的眼睛,抬起了2根手指。
Federal, state and local government job cutbacks are slowing. More than 250,000 workers at all levels of government lost jobs last year. This year, so far, about 20,000 have gained jobs. Worries about the nation's debt and deficits likely will keep a lid on government spending and investments, economists say, but any jumps in, say, infrastructure spending would create jobs. At the least, government will be less of a drag.[qh]

Health apps and wearables
Health apps and wearables can unobtrusively gauge physiological and emotional states and collect, quantify, and monitor data regarding a user’s day-to-day behaviors. This “quantified self” can increase users’ self-awareness regarding their behavior and encourage positive changes to their overall health and well-being.[2] These commercially available devices also integrate an array of features to provide motivation through reward systems, opportunities for social in-teraction, tools for self-improvement, and prompts. The novelty, affordability, practicality, and ease of use have resulted in increased consumer enthusiasm and the pervasiveness of these devices.[3,4] With this growing interest in personal health, members of the general public are becoming more involved in monitoring and improving their own health habits.[5-10

Undoubtedly, merely tracking data through a device is not enough to maintain good health-related behaviors long-term, and the software must also incorporate motivational constructs important for the adoption and habituation of behaviors. For instance, a systematic review of studies that considered the use of electronic activity monitor systems found short-term changes in physical activity with self-monitoring, but no demonstration of superiority when the systems were compared with other interventions.[11] Another review of studies on the viability of using mobile technology for measuring and influencing physical activity found that most apps allow users to document their activity, set goals, review real-time feedback, connect to a social support network, and access online expertise.[12] However, less common among these apps were prompts to act and opportunities for problem solving and action planning, which are crucial constructs that translate intention into long-term behavior change.[13]

Sensor technologies
Sensor technologies have begun to enter the telehealth landscape and are primarily focused on continuous monitoring and precise diagnostics to inform management of various health conditions and diseases.[14-17] Sensors can be integrated into a watch or arm band or adhesive bandages and clothing, and then programmed to collect data on cardiac rhythm, heart rate, blood pressure, respiration, oxygen saturation, galvanic skin response, glucose levels, body temperature, body motions, ambient temperature, and global positioning. For health care providers, sensor inputs can permit remote monitoring, real-time teleconferencing, and timely care for patients with chronic diseases. For both patients and clinicians, telehealth supported by sensors can have profound implications. Clinicians can provide timely and patient-centred care to those living at a distance with chronic disease and can coordinate care when multiple providers are involved, reducing costs to the health care system.

A current clinical example is the management of paroxysmal atrial fibrillation with a mobile ECG and app that monitors the patient’s electrical rhythm to detect frequency and patterns of arrhythmias, and may even allow patients to share ultrasound and electrocardiogram data with their health care provider.[18-20] Telemonitoring with sensors can also support self-management of chronic diseases and detect early signs of deterioration in health requiring immediate treatment and advice.[21] Studies to date have demonstrated some clinical promise for the use of home telemonitoring in the context of heart failure and diabetes. A recent Cochrane review found that telemonitoring was an effective way to lower levels of glycated hemoglobin and low-density lipoprotein.[22] Although several studies on heart failure have produced conflicting results regarding the overall benefits of home monitoring,[23-26] systematic reviews have suggested that home telemonitoring reduces all-cause mortality and hospitalizations, and improves quality of life compared with usual care.[22,27] In addition, features such as automated and mobile telemonitoring appear to be more effective compared with other forms of home telemonitoring.[27]

Further studies are needed to determine how home health monitoring can improve patient safety during the transition from acute care to community care, and to examine the impact of home monitoring on health care costs. TEC4Home (Telehealth for Emergency-Community Continuity of Care Connectivity via Home Tele-monitoring), an initiative of the University of British Columbia and Vancouver Coastal Health, is seeking to do this with prospective trials designed to uncover how telemonitoring can support the safety of heart failure patients discharged from hospital to home.[28]

Mobile apps, wearables, and sensors in the clinical setting
Even though mobile apps, wearables, and sensor technologies are promising, further research is needed to validate their use and long-term impact.[29] This research will require the collaboration of clinicians, health researchers, engineers, and computer scientists.[30] Understanding the possible risks of using these technologies, from physiological harm to breaching of privacy and confidentiality with insecure devices, and how to mitigate any risks is also important. Other important issues to consider include patient anxiety with overuse of technologies, health data piracy, self-diagnosis resulting from overreliance on self-monitoring, and patients not seeking help appropriately. These technologies should be used only as complementary tools in the treatment and prevention of health conditions and disease and should not be used in isolation by patients who self-diagnose and self-manage without consulting a health professional. 

A report on entrepreneurship among Chinese college students published by Renmin University of China revealed an inverse proportion between the level of students' academic degrees and their intentions to start their own businesses.

Instant Heart Rate by Azumio.[31] A free app downloadable to both Apple and Android operating systems that measures heart rate and displays a monitoring strip. As well as helping users accurately track their heart rates, the app is capable of detecting irregular rhythms when palpitations occur. 

Sleep Time by Azumio.[32] A free app that monitors sleep patterns, sleep efficiency, and also acts as an alarm clock. Users can know how often they go into light and deep sleep, and recognize how much of these types of sleep will be necessary for them to feel rested, thereby quantifying the amount of true sleep they need and not just how long they should stay in bed. 

Bellybio Interactive Breating by RelaxLine.[33] A free app that helps users pace their breathing to achieve calmness. Placing the mobile phone against the abdomen, users can follow the sounds emitted to practise deep, abdominal breathing using this simple yet surprisingly effective tool. 

'Short Term 12' is one of those small indie features that stays with you in a big way. It's only 96 minutes long, a modest production set in a foster-care facility for troubled teens. Yet Destin Cretton's direction and Brie Larson's performance elevate the film to, well, one of the year's very best. Ms. Larson is almost a sure thing for not getting an Oscar-this year's competition is unusually fierce-but do catch up with her portrayal of Grace, a 20-something supervisor who is far from untroubled in her own life.
13. 还有更好的。10月,《洛杉矶时报》报道,平等工作机会委员会正在调查这个行业内的性别歧视现象,美国民权同盟要求各州与联邦机构继自己之后各自进行调查。

You see all kinds of grisly, hairy characters on the Tube but few commuters would've expected to see a pack of pandas on the platform.
One of the most discouraging aspects of 2014 for professional investors has been the start-and-stop nature of the recovery. We coasted into January on a trend of strengthening economic reports. Within a few weeks, a nationwide snowstorm seemingly drove the economic data off the side of the road.
1. Cannes has a dirty underbelly

Discernment to determine whether a particular app, wearable, or sensor can be effective.
Expertise and experience to guide patients on the use of technology.
Partnership with patients in pursuit of optimal health through technology use.
Trials to closely monitor benefits and drawbacks.
Humility to recognize that patients may know and invest much more time than physicians in looking for these tools.34

Based on today’s rapid pace of development and public enthusiasm for the technology marketplace, health apps, wearables, and sensors will soon become integral to our patients’ pursuits of good health and will need to be integrated in clinical practice. Physicians must be active agents in these evolutionary times, guiding patients, advocating for evidence to support the use of technologies, and participating in the development and incorporation of technology in patient wellness journeys. Through clinical stewardship and partnership with patients, physicians can use their expertise and experience to guide the growth of innovations into mainstream health care.

Competing interests
Dr Ho receives no personal financial compensation as the principal investigator of TEC4Home (Telehealth for Emergency-Community Continuity of Care Connectivity via Home Tele-monitoring), a project funded by a Canadian Institutes of Health Research grant. This grant is matched by the Michael Smith Foundation for Health Research and the BC Ministry of Health, with additional support provided by TELUS Health and Sentrian. TELUS Health, Cisco, and Avizia have also provided equipment for display in Dr Ho’s Demonstration and Simulation Studio for Health (DaSSH) at UBC. Mr Yao and Dr Lauscher have no competing interests to declare.



1. Cision PR Newswire. Fifth annual Pulse of Online Health survey finds 66% of Americans eager to leverage digital tools to manage personal health. Posted 24 February 2015. Accessed 28 August 2017.

2. Swan M. Emerging patient-driven health care models: An examination of health social networks, consumer personalized medicine and quantified self-tracking. Int J Environ Res Public Health 2009;6:492-525.

3. Gao Y, Li H, Luo Y. An empirical study of wearable technology acceptance in healthcare. Ind Manag Data Syst 2010;115:1704-1723.

4. Kim KJ, Shin DH. An acceptance model for smart watches: Implications for the adoption of future wearable technology. Internet Res 2015;25:527-541.

5. West JH, Hall PC, Hanson CL, et al. There’s an app for that: Content analysis of paid health and fitness apps. J Med Internet Res 2012;14:e72.

6. Abroms LC, Padmanabhan N, Thaweethai L, Phillips T. iPhone apps for smoking cessation: A content analysis. Am J Prev Med 2011;40:279-285.

7. Cowan LT, Van Wagenen SA, Brown BA, et al. Apps of steel: Are exercise apps providing consumers with realistic expectations? A content analysis of exercise apps for presence of behavior change theory. Health Educ Behav 2013;40:133-139.

8. Azar KM, Lesser LI, Laing BY, et al. Mobile applications for weight management. Am J Prev Med 2013;45:583-589.

9. Breland JY, Yeh VM, Yu J. Adherence to evidence-based guidelines among diabetes self-management apps. Transl Behav Med 2013;3:277-286.

10. Lyons EJ, Lewis ZH, Mayrsohn BG, Rowland JL. Behavior change techniques implemented in electronic lifestyle activity monitors: A systematic content analysis. J Med Internet Res 2014;16:e192.

11. Lewis ZH, Lyons EJ, Jarvis JM, Baillargeon J. Using an electronic activity monitor system as an intervention modality: A systematic review. BMC Public Health 2015;15:585.

12. Bort-Roig J, Gilson ND, Puig-Ribera A, et al. Measuring and influencing physical activity with smartphone technology: A systematic review. Sports Med 2014;44:671-686.

13. Rhodes RE, Yao CA. Models accounting for intention-behavior discordance in the physical activity domain: A user’s guide, content overview, and review of current evidence. Int J Behav Nutr Phys Act 2015;12:1-14.

14. Chen M, Gonzalez S, Vasilakos A, et al. Body area networks: A survey. Mob Networks Appl 2011;16:171-193.

15. Appelboom G, Camacho E, Abraham ME, et al. Smart wearable body sensors for patient self-assessment and monitoring. Arch Public Health 2014;72:28.

16. Chan M, Estève D, Fourniols JY, et al. Smart wearable systems: Current status and future challenges. Artif Intell Med 2012;56:137-156.

17. Alemdar H, Ersoy C. Wireless sensor networks for healthcare: A survey. Comput Networks 2010;54:2688-2710.

18. Haberman ZC, Jahn RT, Bose R, et al. Wireless smartphone ECG enables large-scale screening in diverse populations. J Cardiovasc Electrophysiol 2015;26:520-526.

19. Ferdman DJ, Liberman L, Silver ES. A smartphone application to diagnose the mechanism of pediatric supraventricular tachycardia. Pediatr Cardiol 2015;36:1452-1457.

20. Baquero GA, Banchs JE, Ahmed S, et al. Surface 12 lead electrocardiogram recordings using smart phone technology. J Electrocardiol 2015;48:1-7.

21. Wootton R. Twenty years of telemedicine in chronic disease management—An evidence synthesis. J Telemed Telecare 2012;18:211-220.

22. Flodgren G, Rachas A, Farmer A, et al. Interactive telemedicine: Effects on professional practice and health care outcomes. Cochrane Database System Rev 2015;(9):CD002098.

23. Mortara A, Pinna GD, Johnson P, et al. Home telemonitoring in heart failure patients: The HHH study (Home or Hospital in Heart Failure). Eur J Heart Fail 2009;11:312-318.

24. Dar O, Riley J, Chapman C, et al. A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: Results of the Home-HF study. Eur J Heart Fail 2009;11:319-325.

25. Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med 2010;363:2301-2309.

26. Koehler F, Winkler S, Schieber M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: The Telemedical Interventional Monitoring in Heart Failure study. Circulation 2011;123:1873-1880.

27. Kitsiou S, Pare G, Jaana M. Effects of home telemonitoring interventions on patients with chronic heart failure: An overview of systematic reviews. J Med Internet Res 2015;17:e63.

28. TEC4Home Healthcare Innovation Community. Supporting heart failure patient transitions from acute to community care with home telemonitoring technology: A protocol for a provincial randomized controlled trial (TEC4Home). JMIR Res Protoc 2016;5:e198. 

29. Yao C, Ho K. Mobile sensors and wearable technologies. In: Amelung VE, Stein V, Goodwin N, et al., editors. Handbook integrated care. Cham, Switzerland: Springer; 2017.

30. Ho K, Borycki E, Kushniruk A, et al. The health perspective in using digital media for health and wellness. Presented at the IEEE International Digital Media Industry Forum, Boston, MA, 4-6 July 2016.

31. Azumio Inc. Instant heart rate. Accessed 28 August 2017. 

32. Azumio Inc. Sleep time. Accessed 28 August 2017. 

33. RelaxLine. BellyBio. Accessed 28 August 2017.

34. Ho K. How health information technologies are enhancing health of patients and their doctors. Presentation at the Alberta Medical Association 2015 Spring Representatives Forum, Edmonton, AB, 13 March 2015.

The actor - who is heavily tipped for his first Oscar this year - won the gong for best actor in a film drama for his role in The Revenant, beating rivals including Eddie Redmayne who was nominated for The Danish Girl.
Many entrepreneurs already have a Gmail address, but not every ‘trep knows about the power of Google Docs. By utilizing Google Docs, you can instantly create shareable documents, spreadsheets and presentations that can be updated by any team member with an Internet connection. Take that “track changes”!
Paris is the only Eurozone country in the top 10, and sees a drop of three places, which the report says may be due to falling confidence in the euro.

Kendall Ho, MD, FRCPC, Christopher Yao, MSc, Helen Novak Lauscher, PhD. Part 2: Health apps, wearables, and sensors: The advancing frontier of digital health. BCMJ, Vol. 59, No. 10, December, 2017, Page(s) 503-506 - Clinical Articles.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the 凯莎《彩虹》 to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

Warm greetings and best wishes for happiness and good luck in the coming year.衷心祝福来年快乐、幸运!
Successful CEOs tend to follow a structured, daily schedule of rising early, exercising, having snacks on hand for fuel and socializing many evenings of the week.
James Bond is one of the few constants that movie lovers have in this crazy world of ours. We seem to know that, no matter what, a new Bond movie is always on the way.


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