welcome to the niosh total worker health webinar series today we focus on where exposure meets sensor technologies a look at the opportunities and complexities i'd like to welcome our moderator and presenter dr paul schulte dr schulte is the director of the division of science integration and co-manager of the nanotechnology research center with the national institute for occupational safety and health with the centers for disease control and prevention dr schulte has 40 years of experience in conducting research and developing guidance on occupational cancer nano materials risk communication workplace well-being and genetics he also has examined the convergence of occupational safety and health in green chemistry and sustainability he is the co-editor of the textbook entitled molecular epidemiology principles and practices he has served as guest editor of the journal of occupational medicine in the american journal of industrial medicine and was on the initial editorial board of cancer epidemiology biomarkers and prevention dr emmanuelle calda is our featured speaker today dr cauda is a senior research engineer at the pittsburgh mining research division in niosh in pittsburgh pennsylvania dr kauda is also the co-director of the niosh center for direct reading and center technologies coordinating several activities and leading the initiative write sensors used right dr cauda completed his phd in chemical engineering at the polytechnico of torino italy in 2005 and he joined niosh in 2007. dr calder's research focuses on monitoring characterization and control of aerosols present in occupational environments in specifically dust silica and diesel particulate matter our next featured presenter will be jennifer sawnell a managing principal scientist with inside exposure and risk sciences in boulder colorado where she works on a wide range of projects related to human health exposure and risk assessment she is a certified industrial hygienist and a certified safety professional with over 23 years of experience in exposure assessment science and workplace health and safety her areas of expertise include exposure assessment and reconstruction qualitative and quantitative dermal exposure assessment methods asian decision analysis and epa exposure assessment tools jennifer earned her mph degree in environmental health and industrial hygiene from the university of california at berkeley in 1996 and is currently working on her phd in environmental health science at the university of minnesota she is a research fellow with the university of minnesota's exposure science and sustainability institute a few housekeeping items have notes before we begin today your audio will be coming from your computer speakers or earphones please ensure that your volume is turned up to a comfortable level for further technical support please contact adobe connect for additional support captions are available for this meeting for anyone who would like to follow along they 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education credits are available for this presentation through the cdc's training and continuing education online system detailed instructions on accessing the training and continuing education office site are available for download please note that the orange activity number is only valid for those watching the live webinar you will need the course access code to receive credit the blue activity number is to be used only by those who viewed the archived webinar this webinar will be recorded and posted in the near future for those who couldn't join us today it is now my pleasure to turn the presentation over to dr paul schulte thank you very much it's a pleasure to be here we have a very interesting program for you today we're going to look at the interface of sensors total worker exposure and total worker health and my job is to try to sort out some of the terms to describe these kinds of holistic approaches uh to work in safety uh and these are the kinds of terms that we will be seeing and hearing about today so clearly total worker health many of you might be familiar with that and i'll talk about it briefly total work or total worker exposure is a term that relates to total worker health particularly focusing on the exposure aspect and then there are two other terms one i have here cumulative risk assessment and i'll talk about that and that feeds into total worker exposure and total worker health and another term you'll hear i don't have it on this slide exposomic and i'll talk a bit about them and so the question arises why do we need uh these kinds of holistic approaches and the answer is it shouldn't be a shock to most of you that the nature of work the workforce in the workplace is rapidly changing and it's getting a lot more complex in many ways many of the easy cause and effect relationships have already been identified that doesn't mean that there aren't some that still need to be assessed the relationship between an exposure and a toxic effect for example for many uh substances is still a question but we have an experience with how to do that we have an awareness of that and so the need now is we're thinking about what the reality is and the reality is that people are exposed to multiple exposures people have multiple exposures the health of the workforce which is intimately tied to its effectiveness and productivity uh relates to a variety of factors and we in the occupational safety and health field have only looked at a limited number of these and the the gist of the holistic approach is to look at more things uh and so our historic approach of taking a measurement of a single substance to see whether it's above or below a limit while still useful doesn't meet the full needs of employers or or other clients they need to know uh what are the factors that keep their workforce happy healthy and productive and indeed uh that's where we're our point of departure and if we can identify those kind of factors and do that kind of analysis we have then the potential for making an improved impact on worker health and on prevention so that's the background uh for this here it is uh pictorially if you will uh so we can talk about what kinds of exposures a person has the totality of worker exposures and as i said one of the terms that relates to that is exposomics and when we know that we can feed uh and potency information into a risk assessment model and that would be cumulative risk assessment and i'll explain these all in more depth they will then help us make risk management decisions and the risk management decisions will be a major part in helping to achieve total worker health now we we know that work is a primary determinant of health often people forget that and indeed that's a critical challenge for us to constantly be reminding people of the importance of work but treating work separately from the rest of life home and and other times of life is problematic because many of the factors that are in work or in home the rest of life they may interact they may be additive they may be synergistic and we need to take a more holistic view of the and that's indeed what that picture shows and so total worker health takes that realization and it puts it into policies programs and practices that integrate the protection of work related safety and health hazards with the promotion of injury and illness prevention efforts and all of that is to advance well-being worker well-being and well-being is a term that has always been used in uh in safety and health literature but often it's and well-being as a conjunctive we're in an era now where countries and disciplines are really examining what is meant by well-being trying to operationalize it trying to use it as dependent or independent variables in research and as uh targets in policy and so total worker health is the foundational effort to advance worker well-being uh here it is formulaically in order to total worker health is keeping workers safe plus establishing policies and practices and programs that grow health to create worker well-being so indeed it's both uh protection and the promotion of health that are critical not one is sufficient for total worker health here's some examples one is the provision of mandatory respiratory protection in workplaces where there are particulate or vapor hazards this is appropriate but it it misses the boat if we don't look at the whole uh the totality of uh things that affect workers and one of the biggest things could be cigarette smoking and so total worker health approach also has a a comprehensive way to or aims to comprehensively address tobacco cessation as well as a respirator and respiratory protection so uh that that's an example there another example is uh in terms of noise and hearing conservation and we know that noise is a significant hazard and so there is a whole panoply of measures for surrounding materials that make noise to reduce reduce the noise and hence reduce the risk to hearing loss but hearing loss is a cumulative outcome and so any noise regard whether it's in work or whether it's in in leisure or at home can contribute to hearing loss so a total worker approach a total worker health approach addresses both the workplace and provides guidance for strategies to limit uh other risks to hearing such as loud music or sound slides and back here the third uh the third example then is uh with the issue of musculoskeletal hazards and um programs uh such as in the healthcare sector uh that address ergonomic issues uh and provide uh ergonomic guidance or in this case patient lift assists will help reduce musculoskeletal hazards at the same time and we're seeing this increasingly as we have an aging population arthritis is a critical chronic disease that burdens workers and then can be addressed also by ergonomic changes and various self-management strategies and so thinking about them together is an example of a total worker health approach now you're all familiar with the hierarchy of controls and total worker health really builds off this hierarchy starting with the most effective the elimination proceeding through substitution redesign education and encouragement and a critical thing with total worker health is that it does not devolve to just the worker it also primarily is a focus for the employers because it's the employers who have the resources to make the changes uh and to protect workers against the hazards workers will have to participate in some of these activities and we'll have to have the same kinds of information but the primary responsibility is with the employers and so we can go back and look at this holistic approach and take apart some of the pieces that lead to total worker health and we can start with uh the whole concept of exposures and as i said there can be exposures in work and there can be exposures at home and what we're trying to do is come up with the totality of worker exposure well that's not an easy task as you uh can well imagine and indeed did i miss one and so one of the terms uh that looks at the totality of exposures is called the x-posome and the exoposome was developed in uh as a term in 2005 by christopher wilde who's the director of the international agency for research on cancer and the concept there is his concept was that societies have spent a lot of money on the genome the uh the totality of genetic material that we have the genes and chromosomes and the stretches of dna and focus on them almost at the expense of the environment and indeed in many cases uh the environment is more causal than the genome and indeed there's much interaction is the reality but uh so christopher wilde wanted to increase the consciousness around the environment and came up with the term extrazone and that's the totality of exposures received by a person during and a more operational definition was uh was put forth by steve rappaport when he talked about all the biologically active chemicals inside a person during life so something that could potentially be accessed by uh by blood or urine or uh or buccal cells uh might be a way to to think about how we start to get our arms around the totality of exposure now as i said we're this is a huge thing we're talking about not only a cross-section what a person is being exposed to at any given time but with the extrasome and with cumulative risk assessment which i'll talk about uh we're looking at along their whole life span and and so this is a huge that of data if we could ever get it and how you put it together how you make sense out of it are all the current questions of the field and so to start on that here's one of the early simplistic approaches this is what's known as the extrazone correlation globe and essentially it just shows the different kinds of exposures that can occur and the correlations between them and the thickness of the line uh indicates the greater the correlation and so as i said we're really getting our hands around we as the field are really getting our hands around how we're going to make sense out of huge amounts of data on all different kinds of exposures uh and so uh when we talk about total worker exposure uh uh we can make a lot of progress but we have a we have a a hard road to hoe uh and then cumulative risk uh assessment is a similar kind of thing it's the combination of risk from exposure to chemical but also non-chemical stressors uh psychosocial stressors for example uh and and including the possibility that these uh these hazards may interact in various ways to modify toxic effects and adverse uh outcomes and so cumulative risk assessment uh follows on from uh exposomics and is a way of putting together exposure uh severity and and the probability of effect and indeed uh it too is a new uh and growing field and so as we move toward uh our uh our featured speakers i just want to identify uh a review for you essentially what most of you are familiar with how we currently assess exposure of workers and we do that in a variety of ways we use questionnaires and job exposure matrices task observation we can do surface and skin monitoring to get a snapshot we can model a lot of different kinds of information we can do biologic monitoring looking at accessible uh bodily fluids and then and particularly what we'll be looking at a lot today we can do air monitoring and we know that we can do air monitoring on an area basis or in the personal breathing zone and one of the things about these kinds of monitoring approaches is that we don't generally get immediate results now you can take the direct reading instruments out in the field when you're doing research but essentially in day-to-day life of workers uh there are no immediate results whereas we're going to hear today about direct reading sensors that generally give immediate results and hence in a sense immediate empowerment maybe to do something about those results or to at least think about them and so we're going to hear a lot about that dynamic of how we can do direct reading and the implications of having that kind of information and that just to to backtrack that then feeds into our better thinking about exposure workers and better thinking about then different ways to put that information together to start to uh get a better handle on the totality of exposures and ultimately total worker health i'm sorry i went too far and so uh just to sum up then uh in terms of exposure we have a variety of components that help us lead to an integrated exposure assessment so we have the traditional hazard and exposure measurements uh in an occupational setting but we also have what we learned from the environmental setting we have biologic markers uh biologic indicators of exposure effect or susceptibility uh and then we have uh large uh data sets of already gathered information and ways of making sense out of that information using uh gis and and other sorting methods and then we have what we're going to be hearing today direct reading and sensor technologies and when we put all these together we can get an integrated exposure assessment and it can lead to the protection of worker health so that's the overview that i wanted to give you uh and i hope that it sets the stage then for the presentations of emmanuel and jennifer which i think really will take this to the next level so without further ado i will then turn the podium over to emmanuel and he will talk about wearable sensors emmanuel thank you very much paul um for for the first introductory content for this webinar so my contribution is going to be a really technical or semi-technical contribution about wearable centers so for monitoring 4.0 where 4.0 stands for the in
4. the fourth industrial revolution or industry 4.0 um we are living in environment so we are living our life um where there are sensors everywhere we have smart cities we have smart houses we are smart industries and we are going to have smart cars quite soon from an elephant safety perspective personal sensor has been common practice in the workplace for a long time we can start from canaries many years ago we have noise level personal monitors we have monitors at the they can record video of what a worker is doing through the day we have gas and vapor monitors or dust or particulate monitors other monitors for other conditions in terms of gas and vapor again to the point of nanoparticles personal monitors when these personal monitors we are containing more internal wearables uh every everybody is thinking in something a monitor that is at our wrist like a counter for steps or or safety glasses or glasses with augmented reality or smart glasses to the point that the old vest or the old clothing and that we're gonna have are gonna be full of sensors or our body is gonna be composed of different sensors so smart clothing for example is a big topic at the moment from a technology perspective um to the point that wearable sensor can be actually inside the body like implantable so they are inside um and they are monitoring different um information that they are needed um all this means integration of monitors monitor they're generating data and they need to interact with each other so from if you want to define exactly what could be considered wearable different from personal monitors one possible distinction can be the wearable sensor integrated into wearable objects something that we already wearing or the actually wearable sensor are directly inside or on the body for monitoring purposes we talk about sensors um i think that is important already to this thing make a distinction between data trading methodologies in real time monitors a data trading methodology can provide information when needed like a scale at your home or a thermometer to check for fever or a glucose meter for diabetes so we get that information when we wanted differently from traditional methods like 50 years ago only 20 years ago a question and i'm going to start asking questions through my slides is is enough to have direct reading or we will need to have real-time monitoring for a certain application and this is the question we need to ask when we adopt a new technology and do we have confidence in the data they are generated by that methodologies or do we need to have confidence are we needed for our objective and can we afford to pay for a certain level of confidence differently from data training methodologies but just one level up can be real-time monitors um if you think about the um the gas level the gas meter in your car that's a real-time monitor is giving you continuous information about the level of gas in your tank or something like a fitbit to check for the level of workout you're doing and then you can check the data that have been recorded continuously and once again also in this case the confidence in the data and how much content we need to have we have is some a question that we need to answer by adopting these technologies so real-time monitors or direct trading methodologies there are indeed several benefits but also new responsibilities for sure and so this idea of the benefit and responsibility is the topic of the niosh center for data trading and sensor technologies and i'm one of the two directors for this center and basically we have an idea to coordinate research about the adoption of new technologies in occupational health and safety with different goals from development of guidance document training documents and trying to be in the mix of the discussion about these methodologies we also have an initiative that is called right sensor user right which i think could be interesting especially from a perspective of wearable sensors the initiative is composed of two components the idea of right sensors so the selection of appropriate sensor methodologies to meet mission objectives and then the sensor needs to be used in the right way so the appropriate usage of a methodology to obtain the data that we wanted we really like the idea to consider of a life cycle for a new technology like sensors um or the use of data from sensors and so things are not really only a gadget but there was a mission evaluation there was a the construction of a prototype there was some testing in the field there's a need of training there is a need of maintenance and calibration in the field in in a frame of health and safety there are different people or group of people that are involved and i have a list here that is definitely not comprehensive but the one that is missing when we talk about data trading methodologies and real-time sensors are really the analytical labs so somebody that is the beacon of the standard quality of the data and that's true if you think about even for wearable sensor that we're already using in our life there's actually nobody that is ensuring that the quality of the data is such based on a certain standard there are standard for the construction not for the performance of the data and so this responsibility is generally for the labs needs to be shared by everybody by adopting a right sensor user right approach so the first step about the use of a new technology like a wearable sensor but actually real time monitors and directory methodologies is to define the objective what is the purpose of using this sensor like personal sensor in elephant safety for example the i listed a few of them just to give you some ideas one possibility can be to alert a person means the worker that a condition is met so other or to do mapping we want to identify the sources for a high concentration of a certain condition or we want to do a survey for task or temper availability whether during the day or through the months and years or we want to evaluate administrative control so are we controlling that exposure are we effective in controlling the exposure by adopting some certain administrative controls or engineering controls ventilation methodologies to reduce the concentration of a certain condition or we want to do a comprehensive risk exposure assessment um or we want to do compliance monitoring so we want to use the personal sensor to monitor the level of compliance to a certain regulation and finally there can be training continuous education that can be facilitated by the use of personal sensor well when we think about these possible objectives and then we think about total worker health or total worker exposure as paul has presented there can be very specific objectives of using wearable sensor in that frame because for example it's possible that the timetable in the time scale can be different we might need to monitor for long time for months in a row or is possible that objective is slightly different based on the need that we have for those data and so when the objectives are clear we can consider better the components of a wearable sensor or a personal monitor generally there's always a sensing element then we have a microprocessor that is crunching the raw data and the signal and there might be a need of power to operate this activity data are generally crucial data management and everything related to internet of things is really key for wearable sensors and finally they can be a display or a graphic user interface to interact with the person that is wearing their personal monitor or wearable so are all these components equally important and the answer is it really depends on the objective there can be a wearable sensor where there's absolutely no graphic user interface we are not giving any feedback to the person wearing the sensor but the data just transfer to the cloud or there can be some wearables where there's no transferring of data but the graphic user interface so the feedback to the user is the most important component so the objective and the goal are critical um when we think about the sensor we really need to think about a process from the generation of a signal to the creation of data through processing and from the data into invaluable information and that's key all the time next step after the objective and the component is think about the characteristics considered how close is the measurement for a wearable sensor to the true value sometimes the true value is not even known think about fatigue sensor we don't even have a metric to measure it that is established and accepted by everybody or is it possible to say that the sensor is going to provide the same output when is exposed to the same condition so in terms of precision or is the sensor able to detect a changing condition and how small is the changing condition for the sensor to be to be detected or what is the variability into inter-unit if we have free identical sensor will they read the same to the same condition or there's going to be availability this is a condition that we need to consider from a scientific perspective from a technical perspective is it possible that a wearable is going to be connected with other wearables that we're going to have on our body or is it possible that it's gonna share the processor the power the graphic user interface so that we're gonna have four or five outputs and monitors on our body um are we gonna have issues in terms of radio frequency for example because one monitor might interfere with another monitor and that's common at the moment and finally is the cost a factor for to characterize a certain wearable sensor if we need to spread these monitors for every single worker or or in a certain population cost might be a factor and so these are technical technological characteristics finally for wearables we also need to consider if a wearable sensor is robust enough because it needs to be sustained the use of a person for who knows how long or is the there is a good user interface or is easy to use easy to learn how to use it and finally what is the burden it depends obviously on how long it's gonna need to be on the body but a burden for a worker or for a human being is an important characteristic to consider and these i think are very specific to wearables finally i'm going to show some information about possible technology already out there from smart glasses that can be used for fatigue studies to for example wristband for ultraviolet exposure detection and the second one the wristband they have no data transferring but just a graphic user interface changing color to alert the worker or the person that is reaching a certain level of exposure to uv from very minimal technology to very high technology of bendable sensor array for a wristband where the transferring the power is actually coming from the worker itself of the person itself or smart glass gloves to detect chemical threats just with integrated sensor inside the gloves for example for other identification and smart textile is honestly a big topic at the moment which is the integration of sensor inside the fibers for the minimization of the burden to the worker that is already wearing a pest or certain piece of clothing but wearable sensor can be also personal protection equipment like smart apps where we have sensor for temperature or sensor for gas in vapor or sensor for noise they can detect and alert the use of personal protection equipment and at the same time the use of augmented reality for safety glasses is definitely a reality at the moment where the augmented reality superimposed can provide guidelines to a worker for a certain activity and the guidelines is coming remotely from a long distance or safety booths there is actually at the moment there are some small study on that where the boots are studying ergonomic effect or musculoskeletal disorders conditions or issues like safety for sleep trip and fall for example and finally probably the most interesting wearables or the most exciting for the future are going to be implantable in the health monitoring or the early detection of conditions it's honestly the most interesting part where we can have bands they are detecting early presence of lung cancer for example at our wrist where there is a sensor that is collecting information inside under the skin or sensor they are biodegradable so they are actually destroying by themselves at a few months to check for recovery for injuries where the sensor is using information about our muscle is easily healing or contact lenses that become smart contact lenses for glucose monitoring in augmented reality um or the or sensor implantable sensor for art conditions in real time and all this is possible through 3d printing of a two-dimensional sensor and circuit and bendable in the use of advanced material one final possibility in terms of implantable is just honestly the idea of ingestible sensor and this is done generally for health conditions where something is ingested collect same information send them out and then it's obviously gone already so i have some final remarks um the idea is definitely that monitoring data and so with the use of um even wearable sensor is going to be an integral part of the fourth industrial revolution because data probably is the fourth industrial revolution if you want to think about it that way um personal monitors is already monitoring is really a reality but we're gonna evolve gradually even more wearable monitoring possibilities that means smaller more of them more spread and less invasive and less burdening but at the same time we're gonna have benefits and responsibility that's going to be possible thanks to 3d printing the idea of new materials the miniaturization data analysis and data sharing as well um i hope that at least with fuselage that i had um i'm gonna i already started give you the impression that definitely all this is very exciting but at the same time we're gonna need to have an appropriate isolation of the sensing technology in a knowledgeable use of the technology and this is possible in in summary with the adoption of the right sensor user right mindset and my last slide is something that i found from a paper in 2018 that is wearable technology from a to z which really it just was it was an exercise um to show how complete complex is the field of wearable technologies and wearable sensor because there are so many aspects that need to be considered that we can go from a to z and with this i'm going to end it over to gen for the next part of this discussion about wearable technology and wearable sensors uh thank you very much emmanuella that was a very interesting uh overview and i'm going to build on that with my presentation next to talk about taking all of these really impressive and amazing technologies that we are developing very rapidly that have incredible potential to uh really improve our understanding of health and and um early detection of disease and and so many benefits that um that can be seen from many different perspectives but also then thinking about how we make sure to manage that appropriately because we have some real questions to consider about privacy and data collection and management of that data and appropriate protection of the privacy of of workers for example so i'm going to talk a little bit about how to take how to take all these data that could be collected and really have an impact on our workers both in the workplace and at home and for their whole lives and and how we might design or develop programs that would be effective and and be positive for the workers and to have them want to be active participants and engaged in those programs so some of this is just a little bit of background but i i wanted to um revisit some of the the key things that we're talking about when we look at exposures and specifically collecting data and information about exposures and i think paul touched on this very nicely at the beginning but we really have when we look at this concept of the exposome and paul had also mentioned the work of dr wild but we have several areas where we can be collecting data now and sensors that increasingly will help us really quantitatively characterize some of these areas of potential exposures from the whole environment and not just the workplace but all of our lives as we're living and that's not just the specific external factors or stressors such as radiation or infectious disease agents or chemicals but also the general external factors that might include education or psychos psychosocial factors dr kauda or emmanuel mentioned fatigue as one that's a very interesting one and how these might interplay and how our use of sensors can help us to really improve our understanding of these complex interactions and ultimately really help to improve the health of of our population and so just a little bit more on the external exposure i think this is where the sensor technology and data collection uh is focused of course we do have the internal exposure as well where we look at metabolism and other sort of genetic susceptibility factors but when we're looking about data collection i think today that's really uh our main focus is is what's the external reaction or interaction i should say with the environment and and how can we collect better information about that to improve the health of the population so this this slide is actually one that i've liberally borrowed from uh paul so he presented this at a previous presentation but i thought it was such a nice um interaction of these different aspects of the exposome and total worker health and you see right in the center there's this really key overarching um factor that we have to consider and and discuss and address up front which is ethics and values and so we really have a very interesting and complex sort of challenge or push and pull when we talk about collecting these data not just in the workplace but outside the workplace between a responsibility to protect the privacy of workers and protect the privacy of individuals and their data but also i think on the other side of responsibility to help to use these technologies to improve health and to improve our understanding of disease agents and other factors that might ultimately negatively affect our health so just again a few more of these issues that we that we have that can really be affected by the total worker health programs and why we really should be thinking more and more about making our programs more holistic there's so many factors that we can improve and and affect with respect to total worker health programs and thinking in a holistic way from you know policy issues and community health community uh support and issues to the way we design our environments that we live in the way we organize the work that we do and then just acknowledging that the workplace itself is changing so dramatically again as paul had mentioned earlier the line between the workplace and the home is is blurred very much so now where um even if we're really focused on uh just protecting the worker in their workplace that workplace is often the home for them and the workplace uh is often the the environment that an individual lives in and not just um a specific place that they may go to for eight hours a day so you know some of the things that are value added for total worker health and and some of our i think ethical responsibility to act to help to understand these things include improved health outcomes early disease detection and prevention of of adverse health outcomes that that can be addressed early through wearable sensors and i think particularly it's very interesting to think about the implantable sensors and being able to get early disease um identification from from folks and and how powerful that could be ultimately for our improvement of health long term some other really i think interesting and striking data that we can consider or use to help advance or promote the notion of why we need total worker health i was looking at some of the just general health trends with respect to the general population of the united states not just the workforce but you can see that from the 80s and 90s to today uh the the percentage of the population that has reported being in excellent health has declined pretty significantly by more than 50 percent uh those individuals who need an assist uh just to walk and and to be able to get around has increased those who are limited in the work that they can do in their functionality has increased as well as those who have functional limitations and we've known for some time that rates of obesity have been increasing in our population that's not a surprise i think to many of us but we also see other concerning trends such as the reduction or decrease in regular exercise by many in the population we have seen some improvements in smoking and that's very good although with some of the new e-cigarette questions that may be something that will be also revisited in the future and so you know why total worker exposure what are the reasons that we would want to really focus on trying to establish these programs to collect these data um through the available technologies that we have we have many outcomes that can be improved through collecting those data to help workers improve their health not just in the workplace but also in their whole lives and those can include productivity outcomes both on and off the job just general well-being of course again as paul had talked about the importance of improvements in physical health healthy behaviors that can be influenced and encouraged and just general health care outcomes for individuals so fewer days of disability and and other lost uh lost days uh to disability from um you know impact and influences on um exposures or uh the exposure and those external factors uh and and then of course you know as uh those of us who are industrial hygienists know we do really have this core competency and and very relevant uh skills to help us uh address some of these questions and collect these data for many of course years we've been collecting data in the more traditional sense again as paul had mentioned earlier where we might collect an air sample in the workplace and then we send off our sample and and receive the results back but i think those those skills that have been learned for exposure assessment and measuring exposures are very directly applicable and relevant to total worker health and total worker exposure and can be i think directly adapted to really beginning to look at these programs though i think we want to acknowledge that there's also a real important other side to this which is um the ethics of of collecting these large amounts of new data with these new technologies that we have and i think two you know many kind of conflicting uh questions that we have to address for example is it unethical to collect sampling data for workers outside the workplace but on the flip side of that do we have an ethical responsibility to collect this information and share it with the workers if we have the technology and ability to do that and then also the use of those data so if we do collect sampling data and that includes data that are relevant to work workplace exposures but also exposures outside the workplace how should these data be used or how can they ethically be used and um how should they never be used how what limitations should be placed on those data that have been collected and and i think also what what are the roles or actions of the health professional or the industrial hygienist and employers that can best serve workers and their health long term so we do have some good research and information that are available to help us design some of these programs for maybe larger scale sensor technology use and and data collection uh so that we really follow what's already been done the great work that's already been um you know kind of the trailblazing that's already been done with respect to ethics and protecting uh the privacy and ethical considerations of workers both inside and outside the workplace we have for example very good ethical statements and contracts and guidelines from organizations such as the american industrial hygiene association and the american board of industrial hygiene which has now changed its name to reflect a broader set of professionals who are included within that certification body but some of the things that are noted there are for example the use of sensitive information and personal data and what we do with that data um we we must always endeavor to protect information and not release it unless we have specific authorization to do that um it's also an ethical responsibility to remove personal identifiers from information before it's disseminated or shared and i think it's interesting for example that we need to even be thinking about samplers that could collect individual personal information that's perhaps difficult to separate from the data itself one example of that could be biological monitoring samples which well collected for a particular purpose to for example look for a particular biomarker may also have other genetic information that is relevant to other questions with respect to the workers health for example blood samples or urine samples i think it's also important to remember that it's not just enough that the greater public health would be improved through the use of sensor technologies or data collection we also need to really respect these other ethical considerations also conflicts of interest need to be carefully navigated and i think those can arise pretty quickly when we start to collect data on total worker exposures if we haven't thought through uh the the way to do that or the best way to do that to protect um the the critical things that we need to protect so there's some very as i mentioned some very good research that's been done already in this area with respect to ethics and ethical considerations related to wearables specifically or nano sensors which is a subset of that area this is a particularly i think helpful article that was recently published in the american medical association journal of ethics and and they point out in this journal that uh we really have this incredible potential and and then i think associated with that a responsibility uh to be able to improve worker health productivity and wellness by monitoring certain types of adverse exposures and early disease indicators and it really creates this is great opportunity to to have a global impact on improvement of health however in this article the author also noted uh that there's historically often been concerns about types of these types of programs looking that were intended well intended for example or intended to improve uh wellness of workers but which were perceived by the workers as being perhaps intrusive or heavy-handed or perhaps required as a condition of employment which i think are some of the real considerations and concerns that we want to address before we start to develop programs that are designed to protect or to collect excuse me information across both the workplace and outside the workplace there are some nice recommendations that have been published with respect to wearable sensors and how we might design programs to really make them as ethical and ethically appropriate and acceptable as possible and here's some nice recommendations that also appeared in the ama journal of ethics that a great way to help improve the ethics of these programs is to start with collecting voluntary uh information versus mandatory participation so um seeking out individuals who are interested in being involved in these programs who'd like to be active partners in the research process who will have something to gain as well from collecting that information and learning about their own health and looking at that is kind of a way to set up a win-win situation that everybody can benefit from and i think there's some critical of course things that need to be set up in advance such as the use of the data ultimately and how it will be used once it's collected and and how transparent that process is so i think participants need to know exactly how their data will be used and how it won't be used prior to agreeing to participate in data collection efforts that are broader than just the workplace i think it's really important also to look at validated technologies and this speaks to something that emanuela also talked about which is the right sensor you know used right and i think i didn't say that exactly right i apologize but but but the point is that that the um validated technologies need to um ensure that the data collected are in fact accurate and appropriate so we don't want to create concerns for help unnecessarily if the sensor technologies we've selected perhaps have a very large uncertainty or don't necessarily provide sufficient accuracy to be helpful with respect to understanding disease questions or or generate concern from the users based on the data or out output that's received and you know i think you know some some folks have advocated that data collection should be limited to the workplace still i think that's something that's open for discussion and some of the other things that i've looked at here in terms of research i think allow consideration for how we might think about collecting data that would cross the bridge between both the workplace and outside the workplace acknowledging that often is difficult to define what the workplace even is uh today and then i think finally the management of the data once it's collected is is critically important and being able to ensure the security and privacy of that data is is of utmost importance prior to um to starting a program of wearable sensor data collection there's some some good resources that can be used to design these programs ahead of time before starting to try to collect data there's some very nice principles of uh data privacy and transporter flows of personal data for example from the oecd and these are available online for free and they have a nice outline of what those principles of data collection are in other words getting permission to access private data protecting any personal information that's been collected and that can be a real challenge in today's world we know we have a lot of issues with computer security and you know ability of hackers to access and examples of hackers accessing tremendous amounts of very sensitive private information and when we talk about uh wearable sensors collecting a tremendous amount of of individual information you know second by second about a about a person or about a population uh that's a tremendous amount of data that then needs to be uh protected and then i think uh as i previously mentioned as well others have also agreed that the use of the data should be transparent there should be disclosures up front about exactly what will be done with an individual's data once it's collected what it will be used for and specifically what it won't be used for as well i think one of the more interesting ideas that i saw in in the course of my research in looking at ethical ways to design programs to collect sensor data in a broader sense is um considering the uh concept of design contractualism and this is a way to basically make agreements with the participants around a proactive initial ethical contract that could upfront address questions of privacy transparency data use and data security so that the that the participants feel comfortable with um the way the program's been designed and that those ethical considerations have been addressed so that they feel more willing and comfortable with with the data being collected and knowing exactly what's going to happen uh with that data once it's been collected uh this is just an example of a social contract similar to that that might be used as sort of a construct for this and the debian social contract relates to development of free software and i think this started with some of the free operating systems for example on computers that have been developed but i like some of the um ways that these this organization especially the debian social contract has been constructed where even though they're offering a free product and giving it away they want to be transparent about the construct and what that means what why they're doing it what that means what isn't what is available what isn't available what's part of that uh agreement to uh give away this this um this free software uh so i think it's an example i would encourage that we that we consider in the field of public health uh to maybe uh help us design our um our social and ethical contracts around these large data collection efforts if we want to undertake them so for example one of the things that this social contract does is um just lays out what what those uh what what the what the agreement will look like it's going to be 100 free all the time we're going to give back to the software community we're not going to hide problems that come up um you know what our priorities will be what the what the ethical priorities will be to this process and what we will and won't provide um you know for for free and so i think when we look at these um programs then are trying to design a program where we can really effectively collect data using the these amazing and and ever improving technical uh wearable sensor uh devices what are the those are the things that we want to make sure we we do so we want to ensure of course data accuracy privacy and security of course this is especially important when collecting broader data outside the workplace as well as inside regarding individuals make sure that we protect what could be potentially enormous amounts of data that might be collected make sure that data is used only in the way that it's initially described to be used or what what do with the data what anybody said they would do with it so that it's not misused or used in ways that were not initially disclosed and then also the use of standardization emanuel also talked about for example rfid technologies and improving standardization to help with both privacy and transparency of of the data that are collected and i think another really critical uh point is as a couple of the other papers i've cited here have have alluded to that perhaps a good way to start with these programs is to recruit volunteers versus forcing participation in these programs empower workers to be voluntarily interested in participating you know help them to become research partners and advocates in this process i think an interesting way uh to do that is through there are some interesting sort of notions that have been uh circulated in some of the literature and that individuals in our population are now very much a part of which is for example the the notion of the quantified self individuals who want more information about their health who want more information about their quantifiable health factors or things that can be collected and we see those through fitbits and through wearables that are used for exercise routines and other types of other types of scenarios people in many instances really want to have that data and are often willing partners with the right kind of contract or ethical contract regarding how that data will be collected and so really this kind of a win-win situation where individuals would like to have that data and then if they agree to share it then it can be used to help improve the greater good uh for all of public health and i think another you know you know case study that we could look at for for that there are several actually programs going on in europe right now which are doing this actively they're participating recruiting participants from the general population to help for example with air quality monitoring a program called city sense in european cities is a project that's been developed in this sensor based project that allows individual private citizens to to collect data to help understand air pollution in european cities and and then there's a couple of other examples as well using smartphone apps to help collect local air quality data or a great example i thought was a program that it recruits volunteers from the public to use low-cost optical attachments to smartphones to help measure the aerosol optical thickness which is also an important indicator of air pollution and air quality so i think there are some good examples that have already been developed and and started in in many instances so in summary i think it's important to think about the ethical questions and considerations that do exist with these data collection efforts i think you know we all i think have a lot of excitement around these opportunities to collect a tremendous amount of additional data and to really have a significant impact on improving the health of individuals through these data that can be collected through wearables and sensor technologies but i think we also want to make sure that we before we start to do that have a um a good process for collecting those data and i think some of the recommendations that i would um see based on the literature that's been published to date would be to to create a social and ethical contract for participation to consider starting with voluntary uh participation versus mandatory programs to really carefully evaluate and consider data accuracy privacy and security prior to starting a program and then and then to recruit volunteers to to help with these programs to make them active and engaged participants in the research process and and then to have them have a real benefit from their own understanding of their own health through that process uh and with that uh i'll i'll wrap it up thank you very much well thank you uh jennifer and thank you emanuel um i think people can see that we are uh on the frontier of exciting and daunting times as far as worker safety and health the technology is going to enable us to do a lot of interesting and important things things that can be helpful but there are many dangers i i think awaiting and the whole interface between work and home and roles of employers and gathering personal information is a slippery slope and we're going to have to pay good attention to that and not just barge forward so let's go to questions uh we have two questions right off uh to a manual uh one on the speciated analysis of uh vocs and another uh on uh selectivity and dynamic range of sensors emanuel you want to speak to some of those issues absolutely i'm going to try to do it as best as i can um so regarding the voc that's that's an interesting question because obviously the use of pid in other portable personal monitors is well established but the the speciation of different voc is still a challenge at the moment there are some personal bulky stirs for example they can be considered personal monitors i would definitely not consider them wearable sensor obviously um but i will report back the idea of the objective if the objective is to have a real-time monitoring um we might be way far in the future for speciation of voc it is a perspective of having a a badge to collect information that can then get information in terms of data trading at the end of the day for speciation micro gc with fid for example uh they can be quite portable and so field deployable um so it really depends on the information that is needed from that perspective um the second question is about dynamic range and selectivity selectivity obviously can be another important characteristic to consider i'm more interested about the dynamic range because sometimes we are tuned to the idea how well a monitor or even a sensor is going to be is going to behave to a certain range and especially when we're talking about lock-off sensor this is the paradigm that probably we need to change because we might not be even in a position to check how accurate can be a sensor to a certain range so sometimes based back go back to the objective do we want to be accurate at each level or do we want to just know if a certain level is reached or is above that level the information that we needed so the identification of the objective is critical um again also in this case good i'm going to throw in just a question for me that follows on from that it seems that most of the things that you were talking about were sensors that uh uh sensed one particular uh uh exposure or hazard uh what is the status of sensors that will be able to sense multiple hazards at the same time that that's a very interesting question so when i was talking about modular wearable technologies for example or the idea of optimizing what we have in terms of space for example is a body um that's one thing that needs to be considered i don't think there's a lot of done on that respect uh there's a little bit in addison monitoring where it's possible to monitor address all at the personal level or multiple size ranges for example but if we're talking about for example more wearable monitors that have sensor for gas and noise and particles as well i think there's very little but there is a lot of room for improvement in that area okay maybe we'll get back to that in a little while uh jen the next question um uh next two questions really look like they relate to you what privacy issues do you see coming forward in sensor use in the non-work world yeah i think that those those are going to be those questions are going to be significant i think that you know we've we've had some um challenges and there's a i think the population of the public is particularly alert uh to data privacy issues you know with some of the questions we've had with large websites which do collect a lot of private information and actively seek out that private information and sometimes sell it to other people so i think that um we are going to very uh be in in a situation where we really need to address these issues carefully and talk about them in a very transparent open way prior to developing and formalizing a lot of these programs and rolling them out because i think the public is very sensitized to to issues of privacy uh with data and um and that's why i think some of these ideas about developing these ethical or social contracts upfront and soliciting volunteers who understand um you know the upfront how their data will and won't be used and what their benefit would be to participating might be a way to really think about improving our opportunities to collect data outside the workplace in addition to inside the workplace i'm going to add a question uh here too um where what do you privacy clearly you identified and then you elaborated on is a critical issue and we'll be even more so when we talk about the outside the workplace information uh and uh one of the things i'm wondering about within the workplace and maybe maybe jen you'll you'll pick up on this emanuel as well to what extent does a worker then have a right to take some action based on a reading on a wearable sensor and what is the status of uh processes and procedures for how individual workers deal with that information and how it's shared with employers what are how immediate actions are taken how long term actions are taken you want to start on that jen and then maybe emanuel might have something to add yeah certainly that's a great question and i think we've seen that actually for a lot of years already with with biological monitoring i think is a is sort of the um really initial the precursor to a lot of these in the concept you know a lot of these um ideas of collecting more robust data that is has potential greater potential to be um maybe to give us information beyond just what we were even looking for initially um and and so i think there are some real ethical considerations are on that but i also think that there's been a lot of concern and i think we find that for example maybe because those questions haven't been adequately addressed uh to date um or just because of the concerns of of employers not to overstep those bounds that we do see i think for example a lot i think less a lower percentage of use of biological monitoring for example than we might otherwise see if those issues maybe hadn't been already better addressed or discussed within the workplace and um and having a better way to have everybody feel comfortable with that process and participation in that process so i think the ethics of this question of yeah using the data collected from a
2021-06-20