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

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WTF.2: They Believe You Can Fly
o Battery power may turn out to be a transition technology. Cost reductions have been slow in coming, and Tesla needs a 30% improvement in order to build the $35,000 Model 3 it has promised for 2017. Toyota’s recent move was eye-opening. It is allowing a battery-supply deal with Tesla to expire and instead will redouble its work on hydrogen fuel cells. The cost of fuel cells is coming down faster than batteries and fuel cell proponents believe drivers will prefer a relatively rapid refuel with hydrogen to waiting hours to recharge their batteries.
In the original casting, Michael Keaton was set to play the character. However, ABC executives begged the writers and producers to keep Jack alive. They believed the character was too likeable to die off so quickly. The writers agreed. Michael Keaton was not interested in signing up for a long-running show. Instead, the role of Jack was given to Matthew Fox. The rest is TV history.
“One person said he was going to the men’s room and didn’t return.”
The report said families back home receive an average of $200 a month, which makes up 60 percent of the household income.Using the steady flow of remittances, families can buy food, get housing, go to school, access healthcare, improve sanitation, or even invest in a business and have some savings, the report said.
The Global Obesity Epidemic
单词accomplished 联想记忆:
《警察故事》(Babylon),Sundance,周四播出。詹姆斯·内斯比特(Jame Nesbitt)最近在《失踪》(The Missing)中出演了一个孩子失踪多年、备受折磨的父亲,他在这部剧中饰演的是完全不同的角色:一个斤斤计较的老派警官,雇用一个美国公关专家(布里特·马灵[Brit Marling]饰),来改善苏格兰场的形象。这部讽刺剧集由《贫民窟的百万富翁》(Slumdog Millionaire)的导演丹尼·博伊尔(Danny Boyle)执导,有点像阿尔曼多·伊安努奇(Armando Iannucci)的政治喜剧片《灵通人士》(In the Loop)。
Video footage recorded by the RSPCA shows the house littered with mess, including animal faeces.
“我们的目标是修建尽可能多的单元,同时确保这样做能够维持和提高居民社区的健康运转。”城市规划部(Department of City Planning)部长卡尔·魏斯布罗德(Carl Weisbrod)说。
Banks just cannot afford to keep up. At Goldman Sachs, for example, net revenues have dropped about a third since 2009, beaten down by structural shifts in trading and new rules crimping risk-taking. The bank tries to keep its pay ratio stable, so that means smaller total packages for the typical employee.
The programme focuses on the early careers of the children that are enrolled in the Abby Lee Dance Company in Pittsburgh, Pennsylvania.

美国国际集团(AIG)首席执行长本默切(Robert Benmosche)将当选年度CEO。
Make sure you've got a good plan for seeing that your children are cared for when you're scheduled to be in class, and when you need to study. It really is possible to raise children while you're going to school. People do it every day.

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

Besides, Japan and the United States are still innovation hot spots and chemical, semiconductor and electronic components and autos are the top innovative industries, according to the report.

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. 


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. 

日历一页一页地翻到了12月,一些球队是时候考虑垫底的不可避免性了。那么,哪些球队应该开始着手垫底,哪些球队还需要观望,而哪些球队应该放弃这种打算呢。Flanns 和Zillz将会就这一问题展开讨论。

单词surrogate 联想记忆:
It is also reported that Chinese citizens made 1.26 billion cinema visits in 2015, a roughly 51 percent increase from a year earlier.
May everything beautiful and best be condensed into this card. I sincerely wish you happiness, cheerfulness and success.

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.

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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.

They're the top three most unaffordable housing markets in the world, according to the 13th Annual Demographia International Housing Affordability Survey: 2017, published recently.
n. 慈善,慈善机关(团体), 仁慈,宽厚
改编自上世纪70年代真实贿赂事件的影片《美国骗局》当晚表现更加抢眼,埃米?亚当斯(Amy Adams)和珍妮弗?劳伦斯(Jennifer Lawrence)凭此片分获最佳女主角和最佳女配角奖。《为奴十二年》虽在提名数量上与《美国骗局》打平,参与了七个奖项的角逐,但当晚只摘得最佳剧情片一个奖项。
Whatever she needs to invoke the weightlessness of life in our new not-normal, she takes. "Is it the end of an era? Is it the end of America?" she intones in "When the World Was at War We Kept Dancing." "No, it's only the beginning."
Aspiring young leaders already place more emphasis on using their influence, rather than trying to exert power through the embedded authority of their position or their assigned title. Many are already gaining leadership experience, not through promotion at established institutions but by running bottom-up movements and voluntary groups, or by shaping their own start-ups.

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.

About the ICMJE and citation styles

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 The EU’s Americas gambits to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

十年前,斯蒂尔作为一名成功的投资顾问在世界电信展(ITU World)上发言。世界电信展是联合国主导的一项活动,重点是科技在政府中的应用。同一周,加州经历了史上第一次州长罢免选举。斯蒂尔不敢相信,在如此重要的选举中,会出现这种不合时宜的平台故障(三年前才刚刚发生了臭名昭著的佛罗里达州总统选举罢免),所以她决定凭一己之力来解决这个问题。到目前为止,共有169个国家使用了Everyone Counts的电子投票平台,包括波斯尼亚黑塞哥利亚和奥斯卡奖评审委员会。
10. “Sixty Six” Lewis Klahr’s beautiful compilation of digital short works, which refashion pop culture in a heroic key, played for only one night at the Museum of Modern Art. But his work shows up in cities like Los Angeles and San Francisco, too, so if you’re in the neighborhood, look for his next show.

We think of the passage of NBA time in seasons, for obvious reasons. There's connection, a continuum. It's how we remember things that happen, in the course of a season of play. But there's some benefit to looking back at a calendar year, January 1 to December 31, and what we've learned in that process. After all, many say the "unofficial start" to the NBA season is Christmas, with the new year starting soon after. So here are the lessons we learned about the NBA in the year 2017.

  • Only the first three authors are listed, followed by "et al."
  • 家居经销商看好西藏智能家居市场
  • 看好“文旅+电竞” 融创联合主办“全国移动电竞超级联赛”

Captain America: Civil War will hit theatres May 6, 2016. Who's side are you on?
《危险!》(Jeopardy!):这个游戏节目今年已播出50年(1964年3月30日首播),它证明自己不仅能难住观众,而且能令他们感到意外。不仅是因为主持人亚历克斯·特里贝克(Alex Trebek)留起了胡子(之前13年他都是把胡子剃得干干净净),而且是因为仍有些选手表明自己能刺激观众。今年刺激观众的是亚瑟·朱(Arthur Chu),他采用闪电战式的答题方式,在网上引起一片哗然。他的策略令人兴奋,当然也很奏效:他在锦标赛中夺得第二名(友善的本·因格拉姆[Ben Ingram]最后得了第一)。

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