**3. Environmental monitoring technology**

166 Health Management – Different Approaches and Solutions

turbine is often resulted from deficiency linked to lubrication and component wear (Gray, 2010), pollution control through noise control can be accomplished using the following prognostics approach: A prognostics system typically consists of a variety of onboard sensors, data acquisition systems, and signal processing and analysis algorithm. Application of prognostics based maintenance technology to wind turbine has the potential to significantly reduce induced noise and increase turbine reliability by enabling conditionbased maintenance (CBM) thus enabling advance detection of dry lubricants as well as component tear and wear. Detection of faults in their early stages provides an opportunity to carry out necessary maintenance work prior to a turbine degradation that may generate

Among various energy sources commonly used over the past decade or more, nuclear energy is perhaps the deadiest that can kill many people over a long period of time spanning across decades due to radioactive pollution as a direct cause of many acute and chronic conditions (Andia, 1998). Although excessive discharge of radioactive pollutants does not occur often, once it happens the situation can be critical as radiation is released into the environment that can travel for thousands of miles across the world. Well-known accidents include the 1986 Chernobyl reactor meltdown in the former Soviet Union, Three Mile Island incident in the USA and more recently Fukushima nuclear plant in Japan overheated after an earthquake triggered tsunami damaged the plant's power supply to the cooling system. Note that the word 'meltdown' is appropriately used in a nuclear reactor disaster to describe the blast. This is because commercial nuclear reactor fuel is not enriched to the radioactive materials used in nuclear weapons intended to cause massive explosions. In the case of a meltdown, the core temperature inside the nuclear fuel rods casues the solid rod to melt, turning in liquid. As the happens the molten radioactive materials of the fuel rods would react with ground water (Caldicott, 2006). The wide range of fatal health problems will be seen for the decades to come as there is currently no known cure to

Earlier in the section we have discussed the health management issues related to perception and general awareness. The role of health management and policies can differ significantly from country to country. While this chapter will not touch on politics, there are a number of issues that should be addressed. Take the table salt snatching example in March 2011 following the Fukushima nuclear incident in Japan, rumours triggered panic buying of table salt around the Greater China region (Pierson, 2011). Fear was sparked by internet rumours that salt consumption can ward off radiation exposure. Further panic was also driven by the theory that salt in future may be produced from radiation-contaminated sea water. Without citing any references, it should be obvious to readers that common table salt as a remedy and that production of salt by radioactive-pollution affected sea water cannot possibly be

Sometimes rumours are not totally unfounded. There are perhaps some related facts, such as in this particular example, iodine salt can yield a lower absorption of certain radioactive exposure (Mettler Jr., 2002). People with no knowledge on how radiation may affect human health can be driven to respond to rumours in an inappropriate way. Further, no effort has been made on finding out whether table salt sold on the market is iodized and they lack the knowledge of understanding the difference between iodine tablets and iodized salt. This is a

radioactive poisoning as the damage to human tissue is irreversible.

**2.3 Health management, policies and public reactions** 

classic example of an overreaction by people to rumours.

excessive noise.

true.

To assist with health management for prevention and control of environmentally related diseases, a general understanding of methodologies in monitoring environmental pollutions that cause a range of chronic diseases and premature death is vitally important. Environmental monitoring relies heavily on sensors and wireless networks that connect the sensors together. Wireless sensor networks provide a range of solutions for monitoring different sources of pollutions from the air we breathe to the water we drink. Different sensors exist for different applications.

#### Fig. 2. Environmental health monitoring system

A wide range of sensors are deployed in different locations to monitor different parameters. These cover both human health and the surround environment

#### **3.1 Sensors**

A sensor is defined by (Carstens, 1992) as a device that provides a usable output signal in response to a specified measurement parameter, for example, methane gas concentration, or

Environmental Pollution and Chronic Disease Management – A Prognostics Approach 169

In most sensor networks that are set up for environmental health applications, they typically consist of a combination of different sensor types. Management of different type of disease has different requirements on what and where to measure. Each sensor collects its reading and communicates with a console in a polling system such that all sensors are individually and sequentially addressed one after another. In theory, sensors irrespective of types can be polled together, for example, chemical sensors sensing the presence of gaseous hydrocarbon substances can be connected in the same network as a humidity sensor that senses water vapour. However, each of these sensors requires its own electrical interface in order to

Optical sensors can take the form of photoconductors, photoemissive, photovoltaic, and fibre optic variants. All they have in common is that they all produce an electrical output based on the intensity of light that reaches a photocell. Finally, magnetic sensors respond to




The parameters which are to be monitored in the environment as well as human health can be selected based on their relationship to functions that are vital to the operating conditions, where it is possible to be implicated in an elevated risk of developing a health problem or trigger a symptom of an existing condition. Selection criteria are usually based on knowledge of the critical parameters established by the ambient environment and medical history of the patient. Sensing of multiple parameters can be accomplished using one single sensor system that can measure multiple types of parameters such as temperature, humidity, air pollution, and toxins. Systems that can realize multiple sensing include a sensor array which contains several different sensing elements internally; a sensor system can also include external ports for additional sensors to be attached such that it can support

Physical attributes of a sensor includes its physical size, form factor, weight, case or housing, as well as how it is mounted according to their operating environment. In a body area network (BAN), the sensor's physical size and weight may become the most important selection criterion since limitations of movement for attaching the sensor or due to the inaccessibility of locations to be sensed can affect its wireless communication capability.

A communication network can be either wired or wireless. The former uses conducting wires and the latter relies on electromagnetic waves. Their common task is to convey information from one point to another (point-to-point). A transmitter that sends information from the source to two or more receivers is said to be point-to-multipoint. Generally speaking, the choice between wired and wireless depends on the trade-off between security and reliability versus mobility and flexibility (Varshney, 2002). In particular, the saving in terms of implementation and material costs without wires in point-to-multipoint

convert the reading into a form that is suitable for transmission to the console.


electrical resistance when an external magnetic field is applied

the change of a certain effect such as:

a combination of various sensor nodes.

**3.2 Communication networks** 

material

presence of a quasistatic magnetic field

humidity. A sensor generally operates by translating physical, chemical, or biological phenomena into an electrical signal utilizing physical or chemical effects that corresponds to the measured value or through energy conversion from one form into another. To make any meaningful use of the measurement obtained from a sensor, it is necessary to have some means to connect the sensor to an electronic circuitry so that the raw measured value can be interpreted in a meaningful way. For example, by measuring the relative humidity of air, it would be necessary to have some kind of electronics that reads what the sensor picks up and translate it into an output such as an LCD (liquid crystal display) panel to be read. This is essentially to say that an interface, such as an electronic device, is necessary to connect a sensor to the outside world. In the case of serving environmental health management applications, sensors are broadly classified into three major groups, namely physical, chemical, and biological.

The types of sensors used in environmental monitoring are listed in Table I. Thermal sensors are resistance thermal detectors (RTDs), thermistors, thermocouples, or semiconductor junction diodes. The signals generated by most sensors are in electrical form with an output generated either as a voltage or a current that corresponds to the reading. Four major types of electrical sensor commonly used are inductive, thermal, capacitive, and Hall effect sensors; and these parameters can be used to represent different attributes. Mechanical sensors usually take a direct measurement of a change in property of a certain parameter and convert it into another energy domain. Humidity refers to the water vapour content in the air, usually measured with capacitive, resistive, or thermal conductivity humidity sensor. Absolute humidity is the ratio of the mass of water vapour to the volume of air whereas relative humidity (RH) to the ratio expressed in percentage of the moisture content of air compared to the saturated moisture level at the given ambient temperature and pressure. Biosensor makes use of biological materials or biologically derived materials to detect analyte that combines a biological component with a physicochemical detector component. Different types of biosensors include electrochemical, optical and piezoelectric sensors with enzymatic catalysis, electrodes, or biological receptor elements. Chemical sensors detect composition and concentrations of a substance to be measured. They make use of electrochemical, mass humidity or thermochemical sensors.


Table 1. Types of Environmental Sensors

humidity. A sensor generally operates by translating physical, chemical, or biological phenomena into an electrical signal utilizing physical or chemical effects that corresponds to the measured value or through energy conversion from one form into another. To make any meaningful use of the measurement obtained from a sensor, it is necessary to have some means to connect the sensor to an electronic circuitry so that the raw measured value can be interpreted in a meaningful way. For example, by measuring the relative humidity of air, it would be necessary to have some kind of electronics that reads what the sensor picks up and translate it into an output such as an LCD (liquid crystal display) panel to be read. This is essentially to say that an interface, such as an electronic device, is necessary to connect a sensor to the outside world. In the case of serving environmental health management applications, sensors are broadly classified into three major groups, namely physical,

The types of sensors used in environmental monitoring are listed in Table I. Thermal sensors are resistance thermal detectors (RTDs), thermistors, thermocouples, or semiconductor junction diodes. The signals generated by most sensors are in electrical form with an output generated either as a voltage or a current that corresponds to the reading. Four major types of electrical sensor commonly used are inductive, thermal, capacitive, and Hall effect sensors; and these parameters can be used to represent different attributes. Mechanical sensors usually take a direct measurement of a change in property of a certain parameter and convert it into another energy domain. Humidity refers to the water vapour content in the air, usually measured with capacitive, resistive, or thermal conductivity humidity sensor. Absolute humidity is the ratio of the mass of water vapour to the volume of air whereas relative humidity (RH) to the ratio expressed in percentage of the moisture content of air compared to the saturated moisture level at the given ambient temperature and pressure. Biosensor makes use of biological materials or biologically derived materials to detect analyte that combines a biological component with a physicochemical detector component. Different types of biosensors include electrochemical, optical and piezoelectric sensors with enzymatic catalysis, electrodes, or biological receptor elements. Chemical sensors detect composition and concentrations of a substance to be measured. They make

use of electrochemical, mass humidity or thermochemical sensors.

Thermal Temperature, heat flux, heat dissipation

Humidity Relative humidity, absolute humidity

Chemical Chemical concentration, molecular mass, reactivity

Magnetic Magnetic field, flux density, permeability, direction, flow

Biological pH, molecular concentration

Table 1. Types of Environmental Sensors

Electrical Voltage, current, resistance, inductance, capacitance, impedance

Mechanical Length, acceleration, flow, force, torque, stress, strain, density, strength

Optical Intensity, phase, wavelength, polarization, transmittance, refractive index

pressure, acoustic power

**Type Parameter** 

chemical, and biological.

In most sensor networks that are set up for environmental health applications, they typically consist of a combination of different sensor types. Management of different type of disease has different requirements on what and where to measure. Each sensor collects its reading and communicates with a console in a polling system such that all sensors are individually and sequentially addressed one after another. In theory, sensors irrespective of types can be polled together, for example, chemical sensors sensing the presence of gaseous hydrocarbon substances can be connected in the same network as a humidity sensor that senses water vapour. However, each of these sensors requires its own electrical interface in order to convert the reading into a form that is suitable for transmission to the console.

Optical sensors can take the form of photoconductors, photoemissive, photovoltaic, and fibre optic variants. All they have in common is that they all produce an electrical output based on the intensity of light that reaches a photocell. Finally, magnetic sensors respond to the change of a certain effect such as:


The parameters which are to be monitored in the environment as well as human health can be selected based on their relationship to functions that are vital to the operating conditions, where it is possible to be implicated in an elevated risk of developing a health problem or trigger a symptom of an existing condition. Selection criteria are usually based on knowledge of the critical parameters established by the ambient environment and medical history of the patient. Sensing of multiple parameters can be accomplished using one single sensor system that can measure multiple types of parameters such as temperature, humidity, air pollution, and toxins. Systems that can realize multiple sensing include a sensor array which contains several different sensing elements internally; a sensor system can also include external ports for additional sensors to be attached such that it can support a combination of various sensor nodes.

Physical attributes of a sensor includes its physical size, form factor, weight, case or housing, as well as how it is mounted according to their operating environment. In a body area network (BAN), the sensor's physical size and weight may become the most important selection criterion since limitations of movement for attaching the sensor or due to the inaccessibility of locations to be sensed can affect its wireless communication capability.

#### **3.2 Communication networks**

A communication network can be either wired or wireless. The former uses conducting wires and the latter relies on electromagnetic waves. Their common task is to convey information from one point to another (point-to-point). A transmitter that sends information from the source to two or more receivers is said to be point-to-multipoint. Generally speaking, the choice between wired and wireless depends on the trade-off between security and reliability versus mobility and flexibility (Varshney, 2002). In particular, the saving in terms of implementation and material costs without wires in point-to-multipoint

Environmental Pollution and Chronic Disease Management – A Prognostics Approach 171

Fig. 3. Fresnel zone clearance for wireless environmental monitoring systems

**3.3 Environmental monitoring for asthma patients: A case study** 

Wireless communication systems play a significant role in the monitoring and prevention of environmentally related chronic disease. In addition to pollution monitoring, health monitoring provides information technology (IT) solutions for both passive and active prevention with wireless telehealth technology (Fong, 2011). We shall illustrate this by following through an example with asthma patient care, which is known to be a chronic

Environmental monitoring for asthma patients is an important topic since some ten percent of Americans are reported to be asthma sufferers according to the US Centers for Disease Control and Prevention (CDC) statistics. Air pollution is a well-known trigger for asthma symptoms. Indoor air pollution is becoming a serious health issue as a range of chemicals found in many homes such as acid aerosols and volatile organic compounds (VOCs) can trigger asthma symptoms (Koutrakis, 1992). The biosensors need to measure and record a patient's peak flow breathing for refractory asthma management. Improving indoor air quality by reducing indoor particulate pollutant concentrations will provide a vital means of improving asthma patients' health. Reduction of respiratory health risk to

disease closely associated with both indoor and outdoor air pollution (Koenig, 2005).

communications can sometimes be very significant. In environmental monitoring, an array of sensors is interconnected across different areas, making wireless communications the best option.

Fixed WiMAX networks provide broadband distribution services in urban environments as last mile access for a diverse range of applications with carrier frequencies in excess of 10 GHz (Stamatelos, 1996). There are a number of issues that have to be considered when designing a WiMAX system in the frequency range spanning from 10 to 66 GHz. At these frequencies, multipath does not have any significant impact since high gain antennas with narrow beamwidth can be used for short paths (Fong, 2003). System performance is greatly affected by link availability under various atmospheric conditions. Also, line-of-sight (LOS) or near line-of-sight is normally necessary between antennas. The selection of carrier frequency depends primarily on spectrum allocation by local authorities and operational conditions; the choice of operating frequency is also determined by population density and rainfall statistics.

Although WiMAX offers a more economical alternative to wired networks in many point-tomultipoint scenarios making it particularly suited for environmentally-related chronic disease monitoring, in some areas a WiMAX network may share the same portion of the spectrum with other nearby communication networks and systems. Moreover, data transfer is carried out in a very harsh environment subject to numerous causes of signal degradation and atmospheric phenomena; these include interference, rain-induced attenuation, and depolarization. Frequency planning for an allocated spectrum uses multiple sector systems with each sector supported by a base station of the access service network (ASN) serving a cell site. Uncontrollable factors such as rain-induced attenuation and depolarization must be considered to ensure adequate network availability.

The concept of the Fresnel zone is central to virtually any outdoor environmental monitoring network. The dimensions of the Fresnel Zone can be calculated by simple geometry and the Fresnel zone distance is obtained the difference between the direct path and the indirect path.

Height restriction is often imposed in urban areas where maintaining an unobstructed path for LOS may be virtually impossible. Fig. 3 shows the variation in radio hub distance for first Fresnal zone clearance where the demand for foliage clearance increases as the carrier frequency increases; at least 10 m of clearance is necessary to avoid disproportionate loss. This is a very important consideration for environmental monitoring because any signal that is blocked by physical obstacles would mean the information gathered for a given location is simply lost. Ensuring network reliability and availability entails thorough understanding of the network structure. Similar to passive optical networks (PONs), fixed WiMAX exhibit the same characteristics of the point-to-multipoint topology (Lu, 2007). In this context, network optimization can be realized through deployment of scheme comparable to cascaded arrayed waveguide gratings (AWGs) due to their cyclic property (Zhang, 2009). Both WiMAX and PON share the same topology given a fixed routing such that the position and placement of communicating nodes can be optimized in much the same way as the cascaded AWG structure in PONs so as to optimize how much bandwidth each communicating node can receive. Redundancy is often required in a tree topology to combat the occurrence of link outage that can be addressed by the reliable scheme (Ansari, 2004). Network deployment considerations therefore require careful planning of where each sensor is mounted.

communications can sometimes be very significant. In environmental monitoring, an array of sensors is interconnected across different areas, making wireless communications the best

Fixed WiMAX networks provide broadband distribution services in urban environments as last mile access for a diverse range of applications with carrier frequencies in excess of 10 GHz (Stamatelos, 1996). There are a number of issues that have to be considered when designing a WiMAX system in the frequency range spanning from 10 to 66 GHz. At these frequencies, multipath does not have any significant impact since high gain antennas with narrow beamwidth can be used for short paths (Fong, 2003). System performance is greatly affected by link availability under various atmospheric conditions. Also, line-of-sight (LOS) or near line-of-sight is normally necessary between antennas. The selection of carrier frequency depends primarily on spectrum allocation by local authorities and operational conditions; the choice of operating frequency is also determined by population density and

Although WiMAX offers a more economical alternative to wired networks in many point-tomultipoint scenarios making it particularly suited for environmentally-related chronic disease monitoring, in some areas a WiMAX network may share the same portion of the spectrum with other nearby communication networks and systems. Moreover, data transfer is carried out in a very harsh environment subject to numerous causes of signal degradation and atmospheric phenomena; these include interference, rain-induced attenuation, and depolarization. Frequency planning for an allocated spectrum uses multiple sector systems with each sector supported by a base station of the access service network (ASN) serving a cell site. Uncontrollable factors such as rain-induced attenuation and depolarization must be

The concept of the Fresnel zone is central to virtually any outdoor environmental monitoring network. The dimensions of the Fresnel Zone can be calculated by simple geometry and the Fresnel zone distance is obtained the difference between the direct path

Height restriction is often imposed in urban areas where maintaining an unobstructed path for LOS may be virtually impossible. Fig. 3 shows the variation in radio hub distance for first Fresnal zone clearance where the demand for foliage clearance increases as the carrier frequency increases; at least 10 m of clearance is necessary to avoid disproportionate loss. This is a very important consideration for environmental monitoring because any signal that is blocked by physical obstacles would mean the information gathered for a given location is simply lost. Ensuring network reliability and availability entails thorough understanding of the network structure. Similar to passive optical networks (PONs), fixed WiMAX exhibit the same characteristics of the point-to-multipoint topology (Lu, 2007). In this context, network optimization can be realized through deployment of scheme comparable to cascaded arrayed waveguide gratings (AWGs) due to their cyclic property (Zhang, 2009). Both WiMAX and PON share the same topology given a fixed routing such that the position and placement of communicating nodes can be optimized in much the same way as the cascaded AWG structure in PONs so as to optimize how much bandwidth each communicating node can receive. Redundancy is often required in a tree topology to combat the occurrence of link outage that can be addressed by the reliable scheme (Ansari, 2004). Network deployment considerations therefore require careful planning of where each sensor is

option.

rainfall statistics.

and the indirect path.

mounted.

considered to ensure adequate network availability.

Fig. 3. Fresnel zone clearance for wireless environmental monitoring systems

Wireless communication systems play a significant role in the monitoring and prevention of environmentally related chronic disease. In addition to pollution monitoring, health monitoring provides information technology (IT) solutions for both passive and active prevention with wireless telehealth technology (Fong, 2011). We shall illustrate this by following through an example with asthma patient care, which is known to be a chronic disease closely associated with both indoor and outdoor air pollution (Koenig, 2005).

#### **3.3 Environmental monitoring for asthma patients: A case study**

Environmental monitoring for asthma patients is an important topic since some ten percent of Americans are reported to be asthma sufferers according to the US Centers for Disease Control and Prevention (CDC) statistics. Air pollution is a well-known trigger for asthma symptoms. Indoor air pollution is becoming a serious health issue as a range of chemicals found in many homes such as acid aerosols and volatile organic compounds (VOCs) can trigger asthma symptoms (Koutrakis, 1992). The biosensors need to measure and record a patient's peak flow breathing for refractory asthma management. Improving indoor air quality by reducing indoor particulate pollutant concentrations will provide a vital means of improving asthma patients' health. Reduction of respiratory health risk to

Environmental Pollution and Chronic Disease Management – A Prognostics Approach 173

community well-being. These also have impacts on driving down public healthcare demands and reduce avoidable hospitalization. In a major catastrophe, the risk of causing panic and chaos can further complicate any recovery efforts. Authorities often face the challenges of censoring what kind of information should be released to the media (Massey, 2006). Numerous mismaps throughout the world in recent years have shown that what to release at which stage is vital during a significant event, be it a major disease outbreak or environment disaster. Any inappropriate action can lead to mass hysteria. While the general public usually relies heavily on the media that usually obtain updates from government press releases (Adam, 1999) even though the authorities and the media soemtimes have opposing views regarding sharing and disseminating information to be released to the public. How and when information should be released is therefore an important issue to be

Any situation that may lead to problems related to environment-induced diseases has further implications than the link between authorities and the general public. For example, any disclosure delay may lead to treatment postponement. Sometimes, symptoms may not be detected for a long time, such as the case of short term explosure to a dose of very high energy Gamma-ray radiation (Veenema, 2003). The announcement of any radiation leakage may spark mass evacuation and panic. The legacy may well continue for a long time due to contamination of the food chain (Salunkhe, 1961). The impact on any swift action taken by policy makers can greatly increase the chance of survival for many and health professionals require up-to-date information in anticipation of an influx of patients for urgent treatment. Analysis of disease transmission and control often entails mathematical modelling for integration into the process of public health

Air pollution is one of the major environmental factors in chronic disease. Main sources of air pollution include manufacturing industry, fossil fuel power generation and motor vehicles (Mayer, 1999), this is a far more severe problem in metropolitan cities where roads are crowded with frequent lengthy traffic jams. Over 200 vehicles can be queued up in a kilometer of road that keep releasing contaminants in the exhaust gas emissions like carbon monoxide, toxic hydrocarbons and nitrogen oxides (Zhang, 1995). Rapid industrialisation and urbanisation of many developing countries over the past decades also accelerate the air pollutin problem with pollutants emissions from electricity generation, petrochemical industry and a growing number of motor vehicles. Although individuals can help by reducing the amount of energy usage with a bit of common sense; monitoring, detecting, and, control of urban air pollution, as well as to improve decision making and creation of sustainable air quality strategies are all necessary actions for air quality improvement. This would entail identification of correlations and casual relationships among different social, geographic, networks and environmental factors through data mining and statistical learning models and algorithms. A fuzzy ontology framework with multiple data sources of global satellite aerosols and pollutants data would be necessary to predict impacts on

Monitoring air quality requires handling multiple data sources of pollutants-related data. Within each data source there are usually multiple series. Directly applying existing surveillance algorithms into those multiple datasets will reduce computational complexity.

addressed in response to a crisis.

decision making (Keeling, 2007).

human health in different areas.

**4.1 An overview on air pollution and prediction methods** 

asthma patients through ubiquitous healthcare entails a series of longitudinal health data to be coupled with detailed monitoring of personal exposure is necessary such that an accurate estimation of the exposure-response relation for air pollutants from various sources can be established.

Among a number of environmentally-linked chronic diseases, asthma alone contributes to over 13 million ambulatory care cases annually for outpatients with asthma as primary diagnosis and hospitalization of almost half a million cases with an average length of stay of three and a half days according to the figures published by the US CDC in its report entitled 'Asthma Prevalence, Health Care Use, and Mortality: United States, 2005–2009'. Many of these cases would have been avoidable if appropriate actions were made to prevent asthma symptoms from being triggered. A healthier living environment to reduce asthma symptoms can be provided by ubiquitous healthcare solutions in monitoring environmental pollutions. Wireless sensor networks provide a range of solutions for monitoring different sources of pollutions in the patient's home by monitoring any changes in concentration of various pollutants.

To thoroughly address this problem for patients living in rural areas, the first necessary step is to provide swift response to a patient when the disease symptoms are triggered. This issue is particular important in the context of rural areas where a lack of skilled healthcare professionals can cause substantial delay in getting medical attention. Telemedicine system that supports remote camera control with a stethoscope for remote auscultation implemented for this purpose. The stethoscope installed at the patient's home would allow a remote respiratory therapist to hear the heart tones and oscillations while simultaneously controlling the camera to see the patient. Through technological advances in telecommunications, many people who require special attention can live alone with the assurance that help is always available and they are taken good care of. Wireless telemedicine is particularly suitable for rural areas and people with limited mobility such that support can be provided to those who live alone with the assurance that they are well looked after. For example, a comprehensive system may be installed at an elderly home with features such as fall detection, smoke and flood warning system.

To address the issue of indoor air pollution that affects asthma patients, spatial and spatiotemporal models used to investigate pollutant distribution, so that information about both space (location) and time will be utilized. Pollutant prediction at unmeasured sites, and pollutant prediction over time. One major challenge is to achieve a comprehensive view of air quality by combining time series of multiple pollutants at different rooms, spatiotemporal measurements with different instruments, and different level summary statistics. To integrate multiple data streams and capitalize the complex dependence across time and space, it is of both theoretical and practical importance to develop a hierarchical model with conditional sub-models defined hierarchically at different levels. The uncertainty is apportioned to different levels and propagated through the hierarchy, which also provides a formal way to borrow strength between various components and improve the precision of statistical inference.

### **4. Pollution-induced diseases: Challenges for policy makers, medical professionals, and the general public**

Having looked at various issues surrounding general education and perception, this section will look at how policy makers can strike an optimal balance between business interests and

asthma patients through ubiquitous healthcare entails a series of longitudinal health data to be coupled with detailed monitoring of personal exposure is necessary such that an accurate estimation of the exposure-response relation for air pollutants from various

Among a number of environmentally-linked chronic diseases, asthma alone contributes to over 13 million ambulatory care cases annually for outpatients with asthma as primary diagnosis and hospitalization of almost half a million cases with an average length of stay of three and a half days according to the figures published by the US CDC in its report entitled 'Asthma Prevalence, Health Care Use, and Mortality: United States, 2005–2009'. Many of these cases would have been avoidable if appropriate actions were made to prevent asthma symptoms from being triggered. A healthier living environment to reduce asthma symptoms can be provided by ubiquitous healthcare solutions in monitoring environmental pollutions. Wireless sensor networks provide a range of solutions for monitoring different sources of pollutions in the patient's home by monitoring any changes in concentration of

To thoroughly address this problem for patients living in rural areas, the first necessary step is to provide swift response to a patient when the disease symptoms are triggered. This issue is particular important in the context of rural areas where a lack of skilled healthcare professionals can cause substantial delay in getting medical attention. Telemedicine system that supports remote camera control with a stethoscope for remote auscultation implemented for this purpose. The stethoscope installed at the patient's home would allow a remote respiratory therapist to hear the heart tones and oscillations while simultaneously controlling the camera to see the patient. Through technological advances in telecommunications, many people who require special attention can live alone with the assurance that help is always available and they are taken good care of. Wireless telemedicine is particularly suitable for rural areas and people with limited mobility such that support can be provided to those who live alone with the assurance that they are well looked after. For example, a comprehensive system may be installed at an elderly home with

To address the issue of indoor air pollution that affects asthma patients, spatial and spatiotemporal models used to investigate pollutant distribution, so that information about both space (location) and time will be utilized. Pollutant prediction at unmeasured sites, and pollutant prediction over time. One major challenge is to achieve a comprehensive view of air quality by combining time series of multiple pollutants at different rooms, spatiotemporal measurements with different instruments, and different level summary statistics. To integrate multiple data streams and capitalize the complex dependence across time and space, it is of both theoretical and practical importance to develop a hierarchical model with conditional sub-models defined hierarchically at different levels. The uncertainty is apportioned to different levels and propagated through the hierarchy, which also provides a formal way to borrow strength between various components and improve the precision of

**4. Pollution-induced diseases: Challenges for policy makers, medical** 

Having looked at various issues surrounding general education and perception, this section will look at how policy makers can strike an optimal balance between business interests and

features such as fall detection, smoke and flood warning system.

sources can be established.

various pollutants.

statistical inference.

**professionals, and the general public** 

community well-being. These also have impacts on driving down public healthcare demands and reduce avoidable hospitalization. In a major catastrophe, the risk of causing panic and chaos can further complicate any recovery efforts. Authorities often face the challenges of censoring what kind of information should be released to the media (Massey, 2006). Numerous mismaps throughout the world in recent years have shown that what to release at which stage is vital during a significant event, be it a major disease outbreak or environment disaster. Any inappropriate action can lead to mass hysteria. While the general public usually relies heavily on the media that usually obtain updates from government press releases (Adam, 1999) even though the authorities and the media soemtimes have opposing views regarding sharing and disseminating information to be released to the public. How and when information should be released is therefore an important issue to be addressed in response to a crisis.

Any situation that may lead to problems related to environment-induced diseases has further implications than the link between authorities and the general public. For example, any disclosure delay may lead to treatment postponement. Sometimes, symptoms may not be detected for a long time, such as the case of short term explosure to a dose of very high energy Gamma-ray radiation (Veenema, 2003). The announcement of any radiation leakage may spark mass evacuation and panic. The legacy may well continue for a long time due to contamination of the food chain (Salunkhe, 1961). The impact on any swift action taken by policy makers can greatly increase the chance of survival for many and health professionals require up-to-date information in anticipation of an influx of patients for urgent treatment. Analysis of disease transmission and control often entails mathematical modelling for integration into the process of public health decision making (Keeling, 2007).

#### **4.1 An overview on air pollution and prediction methods**

Air pollution is one of the major environmental factors in chronic disease. Main sources of air pollution include manufacturing industry, fossil fuel power generation and motor vehicles (Mayer, 1999), this is a far more severe problem in metropolitan cities where roads are crowded with frequent lengthy traffic jams. Over 200 vehicles can be queued up in a kilometer of road that keep releasing contaminants in the exhaust gas emissions like carbon monoxide, toxic hydrocarbons and nitrogen oxides (Zhang, 1995). Rapid industrialisation and urbanisation of many developing countries over the past decades also accelerate the air pollutin problem with pollutants emissions from electricity generation, petrochemical industry and a growing number of motor vehicles. Although individuals can help by reducing the amount of energy usage with a bit of common sense; monitoring, detecting, and, control of urban air pollution, as well as to improve decision making and creation of sustainable air quality strategies are all necessary actions for air quality improvement. This would entail identification of correlations and casual relationships among different social, geographic, networks and environmental factors through data mining and statistical learning models and algorithms. A fuzzy ontology framework with multiple data sources of global satellite aerosols and pollutants data would be necessary to predict impacts on human health in different areas.

Monitoring air quality requires handling multiple data sources of pollutants-related data. Within each data source there are usually multiple series. Directly applying existing surveillance algorithms into those multiple datasets will reduce computational complexity.

Environmental Pollution and Chronic Disease Management – A Prognostics Approach 175

need to routinely perform certain tasks are more prone to chronic diseases, such as the case of chronic back pain reported by many health professionals especially among dentists (Andersson, 1999). Ensuring a safe and healthy work environment remains an important

When conducting experiments in a laboratory environment, observation of activities usually include three steps, namely symptom identification through prognosis, detection through diagnosis, and providing subsequent remedies. In carrying out each of these steps and manipulating the captured data, their time values are collected in segments. The treatment time can be defined as the summation of these three time values. Statistically, the probability distribution of the treatment time cannot be defined as a certain known distribution, and how to utilize segmental information for treatment effectiveness verification may differ in a controlled environment so that the result can be far less effective in real-life situations. The observations from laboratory experiments usually do not take into consideration any changes in the ambient environment can commonly occur in real-life, and the symptoms identified in the verification stage are naturally produced during experiment. The two sets of data captured from different environments, that is, the laboratory data verses the field data in real-life situations, do not have a direct relation due to the differences in the experimental environment. In order to make use of laboratory data for chronic disease management in the real-world, data fusion is a necessary step before conducting integrative verification. This is primarily performed to integrate different sources of data in order to yield improved information than can be derived from each single data source. The simplest method of fusion is to take a weighted average of redundant information obtained from

The Bootstrap method is used in statistics as a computer-based method for used for uncertainty analysis that does not require any a prior assumptions for the unknown distribution of experimentally observed data. This is an important feature for disease management since the actual environment surrounding a patient cannot be known. It makes use of the given patient's health information and simulate the unknown distribution through resampling of the available data. Resampling creates an ensemble of data sets, where each set is replicated from the original samples (MacKinnon, 2004) and creates new data sets by sampling with replacement. Given that the laboratory data and the actual field data are two different characterizations from the same sample under two different environments and due to the random nature of the data, these two different data sets can be considered as two evidences from different information sources within the same time frame.

We shall conclude this chapter by covering condition-based monitoring techniques on health deterioration. Prognostics techniques have been proven for effectively predict the remaining useful life of a given system. Similar methodologies can be applied to monitoring the state of human health subject to different environmental impacts, such as chronic

The most common existing methods for detection of an outbreak include temporal and spatial surveillance. In reality, the disease incident data are likely to be heterogeneous,

**5. Prognostics and health management for disease control** 

diseases caused by contaminated water supplies and acid rain.

aspect of reducing the risk of chronic diseases.

multiple data sources.

**4.3 Laboratory vs. real-life chronic disease management** 

Complexity reduction is particularly important in situations where rapid successive measurement is necessary so that any adrupt change can be detected.

### **4.2 Disease transmission and the environment: Infectious vs. chronic**

Infectious disease requires three elements to spread from one person to another as illustrateed in Fig. 4. The pathogen is carried by some kind of medium, such as air and fluid, as in the case of droplet transmission. Once it settles down on a host, it can also travel across the world via airplane passengers or even wild birds as the infected host (Li, 2004). The environmental plays an important part in how quickly a disease is carried over a medium. For example, (Woo, 2006) studied the transmission of infectious disease in a wet market. Regulations governing operation and hygene of places such as markets and restaurants would prevent the transmission of diseases from animals to a human host.

#### Fig. 4. Infectious disease transmission

A person is prone to infection when all these three elements are present. While it is impossible to eliminate the host, certain measures can control the environment to prevent the pathogen from growing. The transmission medium can also be disrupted if appropriate measures are taken. For example, a person uses alcohol-based hand sanitizer can make the environment, i.e. the hands, safe from bateria. Likewise, when the bateria is subdued the likelihood of the hands being the transmission medium for the bateria is significantly reduced.

The transmission of pathogen from a source can be either direct or indirect. The former is usually through close contact with another host whereas the latter often entails a contaminated fomite such as gastrointestinal pathogens. When the pathogen reaches a host via the medium, it needs a portal of entry, usually the respiratory or gastrointestinal tracts, to enter the host in order to cause an infection. Environmental control and policies can. To some extent, reduce the reduce the spread of an infectious disease, these include disinfection or sterilization, and immunization for people who are particularly vunlerable, like small children and chronically ill patients.

Environment and policies also play a significant role in the control and prevention of chronic disease. Section 2.2 briefly discussed a number of occupational hazards related to the coal mining and nuclear power industry. Occupational health and safety is an important topic to prevent environmentally induced chronic diseases. Measures such as prognostics would be able to predict the development of certain chronic diseases related to work activities. Generally, environmental monitoring for infectious diseases require close surveillance of the breeding grounds of pathogens as well as the transmission media. In chronic disease management the concentration of certain pollutants relevant to the particular condition of interest as well as around the patient's body are of primary interest. The ambient environment needs to be safegarded prevention surveillance in chronic disease just as important as providing a safe place to minimize the risk of an injury. People who need to routinely perform certain tasks are more prone to chronic diseases, such as the case of chronic back pain reported by many health professionals especially among dentists (Andersson, 1999). Ensuring a safe and healthy work environment remains an important aspect of reducing the risk of chronic diseases.

#### **4.3 Laboratory vs. real-life chronic disease management**

174 Health Management – Different Approaches and Solutions

Complexity reduction is particularly important in situations where rapid successive

Infectious disease requires three elements to spread from one person to another as illustrateed in Fig. 4. The pathogen is carried by some kind of medium, such as air and fluid, as in the case of droplet transmission. Once it settles down on a host, it can also travel across the world via airplane passengers or even wild birds as the infected host (Li, 2004). The environmental plays an important part in how quickly a disease is carried over a medium. For example, (Woo, 2006) studied the transmission of infectious disease in a wet market. Regulations governing operation and hygene of places such as markets and restaurants would prevent the transmission of diseases from animals to a human host.

A person is prone to infection when all these three elements are present. While it is impossible to eliminate the host, certain measures can control the environment to prevent the pathogen from growing. The transmission medium can also be disrupted if appropriate measures are taken. For example, a person uses alcohol-based hand sanitizer can make the environment, i.e. the hands, safe from bateria. Likewise, when the bateria is subdued the likelihood of the hands being the transmission medium for the bateria is significantly

The transmission of pathogen from a source can be either direct or indirect. The former is usually through close contact with another host whereas the latter often entails a contaminated fomite such as gastrointestinal pathogens. When the pathogen reaches a host via the medium, it needs a portal of entry, usually the respiratory or gastrointestinal tracts, to enter the host in order to cause an infection. Environmental control and policies can. To some extent, reduce the reduce the spread of an infectious disease, these include disinfection or sterilization, and immunization for people who are particularly vunlerable, like small

Environment and policies also play a significant role in the control and prevention of chronic disease. Section 2.2 briefly discussed a number of occupational hazards related to the coal mining and nuclear power industry. Occupational health and safety is an important topic to prevent environmentally induced chronic diseases. Measures such as prognostics would be able to predict the development of certain chronic diseases related to work activities. Generally, environmental monitoring for infectious diseases require close surveillance of the breeding grounds of pathogens as well as the transmission media. In chronic disease management the concentration of certain pollutants relevant to the particular condition of interest as well as around the patient's body are of primary interest. The ambient environment needs to be safegarded prevention surveillance in chronic disease just as important as providing a safe place to minimize the risk of an injury. People who

measurement is necessary so that any adrupt change can be detected.

Fig. 4. Infectious disease transmission

children and chronically ill patients.

reduced.

**4.2 Disease transmission and the environment: Infectious vs. chronic** 

When conducting experiments in a laboratory environment, observation of activities usually include three steps, namely symptom identification through prognosis, detection through diagnosis, and providing subsequent remedies. In carrying out each of these steps and manipulating the captured data, their time values are collected in segments. The treatment time can be defined as the summation of these three time values. Statistically, the probability distribution of the treatment time cannot be defined as a certain known distribution, and how to utilize segmental information for treatment effectiveness verification may differ in a controlled environment so that the result can be far less effective in real-life situations. The observations from laboratory experiments usually do not take into consideration any changes in the ambient environment can commonly occur in real-life, and the symptoms identified in the verification stage are naturally produced during experiment. The two sets of data captured from different environments, that is, the laboratory data verses the field data in real-life situations, do not have a direct relation due to the differences in the experimental environment. In order to make use of laboratory data for chronic disease management in the real-world, data fusion is a necessary step before conducting integrative verification. This is primarily performed to integrate different sources of data in order to yield improved information than can be derived from each single data source. The simplest method of fusion is to take a weighted average of redundant information obtained from multiple data sources.

The Bootstrap method is used in statistics as a computer-based method for used for uncertainty analysis that does not require any a prior assumptions for the unknown distribution of experimentally observed data. This is an important feature for disease management since the actual environment surrounding a patient cannot be known. It makes use of the given patient's health information and simulate the unknown distribution through resampling of the available data. Resampling creates an ensemble of data sets, where each set is replicated from the original samples (MacKinnon, 2004) and creates new data sets by sampling with replacement. Given that the laboratory data and the actual field data are two different characterizations from the same sample under two different environments and due to the random nature of the data, these two different data sets can be considered as two evidences from different information sources within the same time frame.

#### **5. Prognostics and health management for disease control**

We shall conclude this chapter by covering condition-based monitoring techniques on health deterioration. Prognostics techniques have been proven for effectively predict the remaining useful life of a given system. Similar methodologies can be applied to monitoring the state of human health subject to different environmental impacts, such as chronic diseases caused by contaminated water supplies and acid rain.

The most common existing methods for detection of an outbreak include temporal and spatial surveillance. In reality, the disease incident data are likely to be heterogeneous,

Environmental Pollution and Chronic Disease Management – A Prognostics Approach 177

Further, prognostics can be used to identify patients with elevated risk of developing a chronic condition. For example, by monitoring the health condition of an obese patient who is known to be prone to developing diabetes, necessary precautionary actions can be proactively taken to reduce such risk. The patient can be of different stage from free of disease to early stage of disease without exhibiting any signs or symptoms. PHM is particularly suited for managing patients with multiple chronic conditions and special health needs. Based on the definition of data driven prognostics, we can intepretate Fig. 5 as utilizing monitored current environmental conditions and assessment data related to patient health. The principal advantage to data driven prognostics is that it can often be deployed quicker and cheaper compared to other approaches, and that it can provide comprehensive coverage of symptoms and signs; making it particularly suited to managing the fluctuating nature of illness. To the patient, information obtained can also be used for assisting with adjustments of lifestyles based on changes to health condition. Disease management with environmental monitoring technology serves as a means of caring for patients with chronic conditions. Prognostics and health management methodology provides an assistive option

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Fig. 5. A prognostics framework for managing chronic disease

The first step involves an overall environmental assessment, where environmental condition, patient's health, vital signs, current medications taken, and any symptoms exhibited are the inputs to perform an assessment. Based on the assessment results, it is possible to prioritize the necessary actions to take and the potential health risks. The existing sensor data (both ambient environment and patient's health), recent monitored data, and medical history and electronic patient record can also be used to identify the health condition. Based on this information, the monitoring parameters and sensor locations for PHM can be determined.

Chronic Disease management entails an active approach that tackles any signs of symptom at the early stage of the disease cycle to minimize the impact of disease progression and potential health complications. PHM makes use of early warning of health degradation to provide early treatment thereby improving the health of patient diagnosed with certain conditions so to avoid the risk of further complications and interventions at a later stage. Fig. 5 shows the framework for prognostics for managing environmentally linked chronic diseases. Environmental data obtained from various locations of different pollutants can be monitored and analyzed using prognostic methodology. Different implementation approaches can be adopted individually or in combination. The principle of PHM is to utilize current information and forecast the future condition. Information about the patient's current health can be used for prediction of any further complication. Chronic disease management involves the monitoring of environmental conditions that may trigger a symptom and to alert all registered patients who have been diagnosed with chronic disease. Further, prognostics can be used to identify patients with elevated risk of developing a chronic condition. For example, by monitoring the health condition of an obese patient who is known to be prone to developing diabetes, necessary precautionary actions can be proactively taken to reduce such risk. The patient can be of different stage from free of disease to early stage of disease without exhibiting any signs or symptoms. PHM is particularly suited for managing patients with multiple chronic conditions and special health needs. Based on the definition of data driven prognostics, we can intepretate Fig. 5 as utilizing monitored current environmental conditions and assessment data related to patient health. The principal advantage to data driven prognostics is that it can often be deployed quicker and cheaper compared to other approaches, and that it can provide comprehensive coverage of symptoms and signs; making it particularly suited to managing the fluctuating nature of illness. To the patient, information obtained can also be used for assisting with adjustments of lifestyles based on changes to health condition. Disease management with environmental monitoring technology serves as a means of caring for patients with chronic conditions. Prognostics and health management methodology provides an assistive option for decision support and condition-based monitoring for active prevention.

#### **6. References**

176 Health Management – Different Approaches and Solutions

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The first step involves an overall environmental assessment, where environmental condition, patient's health, vital signs, current medications taken, and any symptoms exhibited are the inputs to perform an assessment. Based on the assessment results, it is possible to prioritize the necessary actions to take and the potential health risks. The existing sensor data (both ambient environment and patient's health), recent monitored data, and medical history and electronic patient record can also be used to identify the health condition. Based on this information, the monitoring parameters and sensor locations for

Chronic Disease management entails an active approach that tackles any signs of symptom at the early stage of the disease cycle to minimize the impact of disease progression and potential health complications. PHM makes use of early warning of health degradation to provide early treatment thereby improving the health of patient diagnosed with certain conditions so to avoid the risk of further complications and interventions at a later stage. Fig. 5 shows the framework for prognostics for managing environmentally linked chronic diseases. Environmental data obtained from various locations of different pollutants can be monitored and analyzed using prognostic methodology. Different implementation approaches can be adopted individually or in combination. The principle of PHM is to utilize current information and forecast the future condition. Information about the patient's current health can be used for prediction of any further complication. Chronic disease management involves the monitoring of environmental conditions that may trigger a symptom and to alert all registered patients who have been diagnosed with chronic disease.

Fig. 5. A prognostics framework for managing chronic disease

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PHM can be determined.


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**Epidemiology and Prevention** 

Humberto Guanche Garcell and Carlos Martinez Quesada

At the beginning of the XX century, Cuba's economy was not diversified or developed. The main source of income was sugar cane production, a technology which, seen from nowadays, could be considered almost artisanal. It involved an ox-driven mill which

We must tie the development of the sugar cane, rum and the tobacco industries to the progressive increment of the number of vehicles, as they were also instrumental to that development. The first automobile that circulated in our country made it for the Havana streets in 1898, and it is said that the first accident reported in Cuba was in 1906, in which a pedestrian was implied. That brought along the fact that car accidents began to be considered the eighth cause of death in 1958, from being almost nonexistent (Dirección

> Cardiovascular 9 996 147,8 Malignant Tumor 5 327 78,8 Gastritis, enteritis, duodenitis and colitis 2 784 41,2 Newborn related diseases 2 302 34,0

> Nervous System 2 245 33,2 Pneumonia and flu 1 943 28,7 War injuries 1 635 24,2 Accidents 1 266 18,7 Tuberculosis 1 076 15,9 Nephritis and nephrosis 984 14,5

squeezed the juice out of the cane, first step in order to obtain sugar.

Nacional de Registros Médicos y Estadísticas de Salud [DNE], 2011).

Vascular lesions affecting the Central

Table 1. Deaths and mortality rate (by 100 000 inhabitants). Cuba 1958.

CAUSES OF DEATH

**1. Introduction** 

Source: DNE, 2011.

**of Traffic Accidents in Cuba** 

*University Hospital Joaquín Albarrán, La Habana,* 

Deaths No. rate *Cuba* 

Zhang Y et. Al. (1995). Worldwide On-Road Vehicle Exhaust Emissions Study by Remote Sensing, Environmental Science and Technology, 29(9):2286-2294. **10** 
