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Background: A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. Objective: The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. Methods: A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors’ perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. Results: The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P

With one in four individuals afflicted with malnutrition, computer vision may provide a way of introducing a new level of automation in the nutrition field to reliably monitor food and nutrient intake. In this study, we present a novel approach to modeling the link between color and vitamin A content using transmittance imaging of a pureed foods dilution series in a computer vision powered nutrient sensing system via a fine-tuned deep autoencoder network, which in this case was trained to predict the relative concentration of sweet potato purees. Experimental results show the deep autoencoder network can achieve an accuracy of 80% across beginner (6 month) and intermediate (8 month) commercially prepared pureed sweet potato samples. Prediction errors may be explained by fundamental differences in optical properties which are further discussed., 3 pages

Purpose This paper presents the first standardized physical environmental assessment tool titled Dining Environment Audit Protocol (DEAP) specifically designed for dining spaces in care homes and reports the results of its psychometric properties. Items rated include: adequacy of lighting, glare, personal control, clutter, staff supervision support, restraint use, and seating arrangement option for social interaction. Two scales summarize the prior items and rate the overall homelikeness and functionality of the space. Methods Ten dining rooms in three long-term care homes were selected for assessment. Data were collected over 11 days across 5 weeks. Two trained assessors completed DEAP independently on the same day. Interrater-reliability was completed for lighting, glare, space, homelike aspects, seating arrangements and the two summary scales, homelikeness and functionality of the space. For categorical measures, measure responses were dichotomized at logical points and Cohen's Kappa and concordance on ratings were determined. Results The two overall rating scales on homelikeness and functionality of space were found to be reliable intraclass correlation coefficient (ICC) (~0.7). The mean rating for homelikeness for Assessor 1 was 3.5 (SD 1.35) and for functionality of the room was 5.3. (SD 0.82; median 5.5). Implications The findings indicate that the tool's interrater-reliability scores are promising. The high concordance on the overall scores for homelikeness and functionality is indicative of the strength of the individual items in generating a reliable global assessment score on these two important aspects of the dining space.

Purpose Malnutrition is common in residential care environments, primarily due to poor intake. Micronutrient deficiency, although poorly investigated to date, is also reported to be high. Improving the nutrient density of consumed foods is a potential mechanism to promote increased nutrient intake. A scoping review was conducted to: (1) explore the evidence on micronutrient food fortification strategies, (2) identify candidate nutrients and food vehicles for successful food fortification, and (3) identify gaps for future research. Methods The scoping review framework of Arksey and O'Malley was used. A comprehensive search strategy of 4 electronic databases (MEDLINE, EMBASE, CINAHL, and Web of Science) was completed. Two reviewers were involved in screening and data extraction for all selected articles. Results A total of 4394 relevant articles were identified for screening, and application of inclusion/exclusion criteria resulted in 6 food fortification studies (8 citations; 1 study had 3 citations). Overall, vitamin D (n = 5 studies) and calcium (n = 4 studies) were the most common micronutrients fortified; milk products, margarine, bread, and pureed foods were fortification vehicles. Most studies fortified below the RDA recommendation and did not include clinical outcomes. Samples were small and intervention periods were short (3–6 months). Conclusions Fortification is a viable strategy for improving the nutrient density of foods consumed in residential care. Although disparate, this literature suggests the potential for further undertaking of fortification to prevent micronutrient deficiencies among residents and future research should consider multinutrient preparations and clinical outcomes.

Vitamin B12 (B12) deficiency, although treatable, impacts up to 43% of community-living older adults; long-term care (LTC) residents may be at greater risk. Recommendations for screening require further evidence on prevalence and incidence in LTC. Small, ungeneralizable samples provide a limited perspective on these issues. The purposes of this study were to report prevalence of B12 deficiency at admission to LTC, incidence 1 year post-admission, and identify subgroups with differential risk. This multi-site (8), retrospective prevalence study used random proportionate sampling of resident charts (n = 412). Data at admission extracted included demographics, B12 status, B12 supplementation, medications, diagnoses, functional independence, cognitive performance, and nutrition. Prevalence at admission of B12 deficiency (300 pmol/L). One year post-admission incidence was 4%. Better B12 status was significantly associated with supplementation use prior to LTC admission. Other characteristics were not associated with status. This work provides a better estimate of B12 deficiency prevalence than previously available for LTC, upon which to base protocols and policy. Prospective studies are needed to establish treatment efficacy and effect on health related outcomes.

Dysphagia (swallowing difficulty) increases risk for malnutrition and affects at least 15p of American older adults, and 590 million people worldwide. Malnutrition is associated with increased mortality, increased morbidity, decreased quality of life, and accounts for over d15 billion (USD) health-care related costs each year. While modified texture diets (e.g., pureed food) reduce the risk of choking, quality assurance is necessary for monitoring nutrient density to ensure food meets nutritional requirements. However, current methods are subjective and time consuming. The purpose of this study was to investigate the feasibility of optical techniques for an objective assessment of food nutrient density in pureed samples. Motivated by a theoretical optical dilution model, broadband spectral images of commercially prepared puree samples were acquired. Specifically, 13 flavors at five dilutions relative to initial concentration, each with six replicates, were acquired for a total of 390 samples. Puree samples were prepared and loaded onto a white reflectance back plane to maximize photon traversal path length through the puree. The sample was illuminated with a tungsten-halogen illumination source fitted with a front glass fabric diffuser for spatially homogeneous illumination. This broadband illuminant was chosen to observe as many food-light spectral absorbance interactions as possible. Flavor-stratified correlation analysis was performed on this food image dataset to investigate the relationship between nutritional information and color space transformations. A special case of blueberry is presented as the effect of anthocyanins was quantitatively observed through normalized spectral trends in response to pH perturbations across dilutions.

Obstructive sleep apnea (OSA) affects 20p of the adult population, and is associated with cardiovascular and cognitive morbidities. However, it is estimated that up to 80p of treatable OSA cases remain undiagnosed. Cur- rent methods for diagnosing OSA are expensive, labor-intensive, and involve uncomfortable wearable sensors. This study explored the feasibility of non-contact biophotonic assessment of OSA cardiovascular biomarkers via photoplethysmography imaging (PPGI). In particular, PPGI was used to monitor the hemodynamic response to obstructive respiratory events. Sleep apnea onset was simulated using Muller's maneuver in which breathing was obstructed by a respiratory clamp. A custom PPGI system, coded hemodynamic imaging (CHI), was positioned 1 m above the bed and illuminated the participant's head with 850 nm light, providing non-intrusive illumination for night-time monitoring. A video was recorded before, during and following an apnea event at 60 fps, yielding 17 ms temporal resolution. Per-pixel absorbance signals were extracted using a Beer-Lambert derived light transport model, and subsequently denoised. The extracted hemodynamic signal exhibited dynamic temporal modulation during and following the apnea event. In particular, the pulse wave amplitude (PWA) decreased during obstructed breathing, indicating vasoconstriction. Upon successful inhalation, the PWA gradually increased toward homeostasis following a temporal phase delay. This temporal vascular tone modulation provides insight into autonomic and vascular response, and may be used to assess sleep apnea using non-contact biophotonic imaging.

Measuring nutritional intake is a tool that is critical to themonitoring of health, both as an individual or of a group. It isespecially important in the monitoring of those at risk formalnutrition, an issue which costs billions of dollars globally, andcurrent methods used in practice are manual, time-consuming,and have inherent biases and inaccuracies. This study proposes anovel imaging system with a superpixel-based segmentationalgorithm as part of an automated nutritional intake system. Thestudy also examines three important parameters of the algorithmand their ideal values; region size and spatial regularization forsuperpixel segmentation, as well as spatial weighting inclustering. The experimental results demonstrate that theproposed system is effective in segmenting an image of a plate intoits constituent foods.

Dysphagia affects 590 million people worldwide and increases risk for malnutrition. Pureed food may reduce choking, however preparation differences impact nutrient density making quality assurance necessary. This paper is the first study to investigate the feasibility of computational pureed food nutritional density analysis using an imaging system. Motivated by a theoretical optical dilution model, a novel deep neural network (DNN) was evaluated using 390 samples from thirteen types of commercially prepared purees at five dilutions. The DNN predicted relative concentration of the puree sample (20%, 40%, 60%, 80%, 100% initial concentration). Data were captured using same-side reflectance of multispectral imaging data at different polarizations at three exposures. Experimental results yielded an average top-1 prediction accuracy of 92.2% ± 0.41% with sensitivity and specificity of 83.0% ± 15.0% and 95.0% ± 4.8%, respectively. This DNN imaging system for nutrient density analysis of pureed food shows promise as a novel tool for nutrient quality assurance.

Cardiovascular monitoring is important to prevent diseases from progressing. The jugular venous pulse (JVP) waveform offers important clinical information about cardiac health, but is not routinely examined due to its invasive catheterisation procedure. Here, we demonstrate for the first time that the JVP can be consistently observed in a non-contact manner using a novel light-based photoplethysmographic imaging system, coded hemodynamic imaging (CHI). While traditional monitoring methods measure the JVP at a single location, CHI's wide-field imaging capabilities were able to observe the jugular venous pulse's spatial flow profile for the first time. The important inflection points in the JVP were observed, meaning that cardiac abnormalities can be assessed through JVP distortions. CHI provides a new way to assess cardiac health through non-contact light-based JVP monitoring, and can be used in non-surgical environments for cardiac assessment., Comment: 10 pages, 8 figures

Impact trauma may cause a hematoma, which is the leakage of venous blood into surrounding tissues. Large hematomas can be dangerous as they may inhibit local blood ow. Hematomas are often diagnosed visually, which may be problematic if the hematoma leaks deeper than the visible penetration depth. Furthermore, vascular wound healing is often monitored at home without the aid of a clinician. We therefore investigated the use of near infrared (NIR) re ectance photoplethysmographic imaging (PPGI) to assess vascular damage resulting from a hematoma, and monitor the healing process. In this case study, the participant experienced internal vascular damage in the form of a hematoma. Using a PPGI system with dual-mode temporally coded illumination for ambient-agnostic data acquisition and mounted optical elements, the tissue was illuminated with a spatially uniform irradiance pattern of 850 nm wavelength light for increased tissue penetration and high oxy-to-deoxyhemoglobin absorption ratio. Initial and follow-up PPGI data collection was performed to assess vascular damage and healing. The tissue PPGI sequences were spectrally analyzed, producing spectral maps of the tissue area. Experimental results show that spatial differences in spectral information can be observed around the damaged area. In particular, the damaged site exhibited lower pulsatility than the surrounding healthy tissue. This pulsatility was largely restored in the follow-up data, suggesting that the tissue had undergone vascular healing. These results indicate that hematomas can be assessed and monitored in a non-contact visual manner, and suggests that PPGI can be used for tissue health assessment, with potential extensions to peripheral vascular disease.

Mealtime satisfaction is an important component of quality of life (QOL) in residential care, yet there currently is no self-administered tool described in the literature. The purpose of this study is to investigate internal and test–retest reliability, and construct validity of a mealtime satisfaction questionnaire (MSQ) designed for residential care, more specifically retirement homes. A 15-item MSQ was developed and eligible participants from four retirement homes (n = 749) were invited to participate. The participation rate was 24% and the median age was 88 years for respondents. The internal consistency of the MSQ was high (Cronbach Alpha = 0.83) and the test–retest reliability was also high (Intraclass coefficient = 0.91, P