13.

20 Technical and Economic Feasibility of Sensor Technology

for Health/Environmental Condition Monitoring
ANM Karim and AN Nordin, International Islamic University Malaysia, Kuala Lumpur, Malaysia
S Begum, Universiti Tenaga Nasional, Selangor, Malaysia
Ó 2014 Elsevier Ltd. All rights reserved.

13.20.1 Introduction 499

13.20.2 Health Condition Monitoring 499
13.20.2.1 MEMS Sensors 500
13.20.2.1.1 MEMS Glucose Sensors 500
13.20.2.1.2 Glucose Sensor with Copper Nanoparticle Modified Graphene Electrode 503
13.20.2.2 Wearable Wireless Health Monitoring System 503
13.20.2.3 Contact-Lens System for Wireless Health Monitoring 503
13.20.2.3.1 Wireless Body Area Network 504
13.20.3 Environmental Condition Monitoring 506
13.20.3.1 Air Pollution – Sources and Effects 506
13.20.3.1.1 Gas Sensors for Emission Monitoring 507
13.20.3.2 Water Pollution 508
13.20.3.2.1 Remote Sensing of Water Quality 509
13.20.3.2.2 Advances in Toxicant Detection Sensors 509
13.20.3.2.3 Autonomous Detection of Harmful Algal Species and Toxins 511
13.20.3.3 Sensor Use in Health/Environment Monitoring – Economic Feasibility 511
13.20.4 Concluding Remarks 512
References 513

13.20.1 Introduction

Continuous monitoring of health and environmental conditions is expected to be very helpful in identifying problem at an early
stage and taking necessary measures and remedial actions. Analyzing an environment that has complex and highly variable
emission sources at appropriate spatial and temporal scales is essential to understanding, monitoring, and controlling the system
(1). The environmental condition in which a person lives largely determines the quality of his or her health. Detrimental effects due
to increased levels of environmental (air and water) pollution can be mitigated, controlled, or avoided in many cases if early
cautionary information is obtained. One cannot overemphasize the need for a reliable monitoring and controlling system for both
the environment and health in order to create such a safe and secure situation (2). In this respect, the application of sensor and
sensor technology has been playing a significant role. The recently acquired information and the technological capability to
precisely engineer material property and behavior have offered opportunities to develop new sensor materials and innovative
products, and to meet the demands for novel applications (3). Online sensing of material properties, combined with real-time
control, has paved the way to achieving the lofty goals of self-directed and intelligent processing of information. In this regard,
there has been a push to adopt the monitoring and controlling of human health and environmental conditions in many real-life
problems. The benefits from the successful implementation and operation of such systems could be enormous.
Naturally, environmental pollution is of great concern at present because of the imminence of the anticipated negative impact on
the climate. This concern is worldwide as environmental pollution cannot be restricted within the boundaries of any country. Due
to the rapid development and industrialization occurring globally, large amounts of pollutant gases and other toxic wastes are
generated (4). The emission of such gases and the disposal of industrial waste are contributing greatly to increasing levels of
pollution in the environment, and consequently the public is exposed to health risks and detrimental effects. Focusing on early
detection and the prevention of environmental deterioration can help to mitigate the damages in various aspects of health, thus
preventing catastrophic disaster. Recent developments in sensor technology make it possible to monitor personal exposure to air
pollutants directly, despite the fact that the activity spaces through which a person is moving have changing concentration fields (5).

13.20.2 Health Condition Monitoring

With the current economic, social, and demographic trends in almost all the developed countries, including the United States,
a serious crisis, especially in the context of soaring expenditure, is predicted to affect the health-care system. Existing health-care
systems are structured and geared to react to a crisis and to manage illness rather than focusing on wellness. A focus on prevention

Comprehensive Materials Processing, Volume 13 http://dx.doi.org/10.1016/B978-0-08-096532-1.01322-4 499

500 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

and early detection of diseases or optimal maintenance of chronic conditions will improve the current state of health-care systems
(6). Recently, there have been significant developments in biosensors such as nonenzymatic cholesterol sensors, acoustic-wave-
based microelectromechanical system (MEMS) devices for biosensing, cell-based hybrid acoustic-wave biosensors, etc. (7–9).
However, rather than using a single sensor to diagnose a particular disease, attempts are being made to adopt systems for
continuous health monitoring to offer more proactive and affordable health care. During the past few years, there has been
a significant increase in the number and variety of wearable health monitoring devices, ranging from simple pulse monitors, activity
monitors, and portable Holt monitors, to sophisticated and expensive implantable devices (10). The development of MEMS sensors
through batch production has led to a reduction in fabrication costs and created a situation for expanded application. To highlight
the current trend of the miniaturization of sensors and integration with electronics, this chapter will review MEMS glucose sensors or
glucose sensors with integrated electronics.

13.20.2.1 MEMS Sensors

Electromechanical microstructures were invented in the early 1940s. They depended on the success of integrated circuits (ICs),
which compacted millions of transistors on a 1-mm-square area using a complex fabrication process involving a series of lithog-
raphy, deposition, and patterning techniques. By the early twenty-first century, semiconductor manufacturers perfected the IC
process such that they can fabricate 13-nm-wide transistors, and the industry generated a whopping $300 billion worth of products
in 2011 alone. The microelectromechanical systems, more popularly known as MEMS, are mechanical actuators, that is, sensors that
are combined with electronics and are manufactured using a hybrid version of the standard IC fabrication process. Despite their
promise and potential, MEMS devices experienced a slower growth compared to ICs; their market was estimated to be worth $10
billion in 2011. The recent and sudden explosive growth of MEMS devices on the market can be attributed to the recent popularity
of smart phones, which utilize a wide array of MEMS devices, ranging from accelerometers to gyroscopes.
MEMS sensors are characterized by their miniature size, which enables them to be fabricated in batches, thus reducing the cost
and time required to produce a single device. To ensure compatibility with electronics, MEMS devices are often manufactured on
silicon substrates (11). Using IC fabrication techniques, arrays of small mechanical devices can be manufactured on a single wafer,
resulting in cost and performance advantages. MEMS devices have dimensions in the submillimeter to micron range, where
mechanical microstructures such as beams, diaphragms, grooves, and others are constructed using IC-friendly layers such as
crystalline silicon, polycrystalline silicon, aluminum, and silicon dioxide. Miniaturized sensors often have better sensitivity,
improved accuracy, better selectivity, and a wider dynamic range (12).
At present, there is a vast range of MEMS products that have been developed. Examples include, among various other industrial
applications, soil and moisture sensors in the precision agriculture field, and glucose and cancer sensors in the health industry. Due
to its emerging potential and the current trend for personalized health care, in this chapter we focus on one of the most important
and widely used health sensors: the glucose sensor. Self-monitoring of blood glucose has become the norm in modern societies to
prevent the advent of coronary heart disease and blindness in diabetes patients. This self-monitoring requires easy-to-use, cost-
effective, safe, and reliable blood glucose sensors. Since its conception in the 1960s, there have been a wide variety of glucose sensors
available on the market.

13.20.2.1.1 MEMS Glucose Sensors

Diabetes mellitus is an incurable chronic disease, which creates a metabolic disorder in the body, causing it to either produce excess
or insufficient insulin. The function of insulin is to regulate the blood sugar concentration in the body, where the normal blood
sugar concentration ranges from 80 to 120 mg dL
1 (4.4–6.6 mM). Diabetes sufferers require constant monitoring of their blood
sugar levels to avoid complications such as heart disease, kidney failure, and blindness. In the year 2000, there were 171 million
diabetes sufferers in the world, and this number is expected to reach a staggering value of 366 million by the year 2030 (13).
Glucose biosensors dominate 85% of the biosensor world’s market, and it is estimated that they were worth around US$5 billion in
2004 (14).
Typically, a blood glucose biosensor uses glucose oxidase, an enzyme that catalyzes the oxidation of glucose to
gluconolactone (15):
Glucose þ O2 / GOx / gluconolactone þ H2 O2 [1]
The amount of glucose in the blood can be quantified through measurement of the current derived from the electrochemical
reaction of H2O2 since the amount of the produced H2O2 is proportional to the amount of glucose (16). The concentration of
hydrogen peroxide is measured by applying a voltage on metal or carbon electrodes and measuring the current. Oxidation occurs at
the anode, and the current or electron flow is proportional to the number of glucose molecules in the blood (17). As shown in
Figure 1, because this method is typically employed for first-generation glucose sensors, it has the advantage of being relatively
simple and also easy to miniaturize. However, this device has drawbacks in that it requires high voltages at the anode to induce
oxidation. High oxidation voltages may cause ascorbic and uric acid to be electroactive and generate current of their own. When this
happens, the sensor is no longer selective and measurements will be inaccurate (18). The presence of dissolved oxygen in biological
fluids also results in errors in the measurements. The second-generation glucose biosensors substituted oxygen with artificial redox
mediators such as ferrocene, ferricyanide, quinines, tetrathialfulvalene, tetracyanoquinodimethane, thionine, methylene blue, and
methyl viologen, which were used to mobilize electrons from the enzyme to the surface of the working electrode. The mediator was
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 501

Figure 1 Schematics of different generations of amperometric glucose biosensors. Reproduced from Scognamiglio, V. Nanotechnology in
Glucose Monitoring: Advances and Challenges in the Last 10 Years. Biosens. Bioelectron. 15 September 2013, 47, 12–25.

reduced in the reaction and reoxidized at the electrode, providing an amperometric signal and regenerating the oxidized form of the
mediator. Finally, the third-generation glucose biosensor allowed direct electrical communication between the enzyme and the
electrode surface (19).
All the first-generation glucose sensors, as mentioned earlier, suffer from drawbacks such as interference from electroactive
chemicals and a potential change in the equilibrium glucose concentration due to irreversible consumption of glucose during
detection. These drawbacks generate errors which may require frequent (once every 12 h) calibration by pricking fingers (20).
Various efforts have been made to reduce the errors in existing glucose sensors.
Researchers either focus on enhancing the sensing method via modifications of the sensor, or improving the signal obtained by
the glucose sensor by upgrading the signal processing circuit. In this section, both methods are illustrated using MEMS glucose
sensors. The first sensor integrates the signal processing circuit on the same wafer as the sensor using the complementary metal-oxide
semiconductor (CMOS)-MEMS fabrication process. The second sensor detects glucose using a microcantilever which is placed in
a microchamber. The working principles, advantages, and disadvantages of both devices are highlighted.

13.20.2.1.1.1 CMOS-MEMS glucose sensor

This glucose sensor applies the working principle of first-generation glucose sensors by detecting the concentration of glucose
oxidase (21). However, instead of measuring it through electrochemical methods, the device uses capacitive sensing to detect
changes in the dielectric constant of the material. The capacitive sensor is formed using interdigitated composite gold and oxide
electrodes placed on a silicon substrate, as shown in Figure 2. Based on eqn [1], the glucose oxidase enzyme converts glucose and
oxygen into gluconolactone and hydrogen peroxide. Oxygen is derived from water surrounding the sensor. When glucose is
oxidized, the concentration of water decreases and the concentration of hydrogen peroxide increases, resulting in a change in the
dielectric constant of the area between the sensing electrodes.
The dielectric constant of water and hydrogen peroxide is 78 and 60, respectively. Measurement of the fluctuation of dielectric
constants can be detected by observing the change in capacitance of the sensor. As shown in Figure 2, the sensing capacitors are
connected to a series of odd-numbered inverters such that they form an oscillator circuit. The oscillator circuit generates a frequency
output ranging from 17 to 25 MHz, depending on the sensor’s capacitance.
Using this simple circuit, the change in capacitance can now be easily monitored by observing the oscillator’s output since the
frequency change is proportional to the change in capacitance and thus the change in glucose concentration. The sensitivity of the
glucose sensor was about 1.48 MHz mM
1.

13.20.2.1.1.2 MEMS affinity sensor

To improve the reliability of glucose sensors and to allow capabilities for subcutaneous continuous glucose monitoring, researchers
have looked into other methods for glucose detection other than through electrochemical detection of hydrogen peroxide. Recently,
researchers from Columbia University have designed a MEMS affinity glucose sensor which utilizes a microcantilever as its sensing
element (22). A cantilever vibrates in a glucose-sensitive polymer solution inside a microchamber. Glucose permeates through
a semipermeable membrane, changing the solution viscosity and vibration damping.
502 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Figure 2 (a) Schematic of integrated glucose sensor. (b) Cross-section and layers of the CMOS-MEMS glucose sensor. Reproduced from
Yang, M. Z.; Dai, C. L.; Hung, C. B. Fabrication of a Glucose Sensor with Oscillator Circuit Using CMOS-MEMS Technique. Microelectron. Eng.
September 2012, 97, 353–356.

As delineated in Figure 3 a magnetically driven parylene microcantilever is placed in a microchamber which is covered with
a semipermeable membrane. The semipermeable membrane allows glucose to diffuse into the silicon microchamber but does not
allow the polymer solution to escape. The PAA-ran-PAAPBA polymer is glucose-sensitive, and changes its viscosity when exposed to
glucose. The cantilever vibrates when actuated using magnets placed adjacent and perpendicular to the cantilever. Changes in
viscosity can be detected optically by measuring the damped resonant frequency vibrations of the cantilever. This novel MEMS
affinity sensor has shown a faster response time of 3 min compared to commercially available electrochemical continuous glucose
monitoring sensors. The affinity sensor is also very sensitive, successfully detecting glucose concentrations of 0.1 mg dL
1 over
a range of 27–324 mg dL
1. Measurements also indicate that the device’s response is reversible (within 1.2%) and stable (within
0.5% h
1). The device has a high potential to be used as a subcutaneous implant since the presence of the semipermeable
membrane allows equilibration of the glucose concentrations inside and outside the chamber.

13.20.2.1.1.3 Contact-lens glucose sensor

An innovative glucose sensor on a contact lens was recently developed by a group of researchers from the University of Washington.
A primary drawback of the current enzyme-based finger-pricking method is that it is invasive, inconvenient, and may cause
infection. The usage of a contact lens coupled with tear fluid allows both noninvasive and continuous detection of glucose. Tear
fluid contains a variety of biomarkers, namely glucose, cholesterol, sodium, and potassium (23). The concentration of glucose in
tear fluid is much lower compared to blood and is in the range of 0.1–0.6 mM L
1 (24).
The design and fabrication of the contact-lens sensor are illustrated in Figure 4. To mimic an actual contact lens, the sensor was
fabricated on a 100-mm-thick film of flexible and transparent polyethylene terephthalate polymer. The electrodes were formed using
three layers of metal, namely titanium, palladium, and platinum. Three electrodes were used for the electrochemical sensor, namely
the working, counter, and reference electrodes.

Figure 3 Continuous glucose monitoring MEMS affinity sensor (dimensions for a prototype device are given in micrometers). Reproduced from
Huang, X.; Li, S.; Schultz, J. S.; Wang, Q.; Lin, Q. A MEMS Affinity Glucose Sensor Using a Biocompatible Glucose-Responsive Polymer. Sens.
Actuators B 2009, 140 (2), 603–609.
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 503

Figure 4 (a) Design and (b) fabrication of contact-lens glucose sensor. Reproduced from Liao, Y. T.; Yao, H.; Parviz, B.; Otis, B. A 3uW
Wirelessly Powered CMOS Glucose Sensor for an Active Contact Lens. IEEE J. Solid-State Circuits 2012, 47 (1), 38–40.

A constant voltage of 0.4 V was applied to the working and reference electrodes, while current measurements were taken via the
working electrode. The counter electrode acts as a current drain and was connected to the auxiliary lead of the potentiostat (25).
Similar to other electrochemical glucose sensors, the measured current is proportional to the concentration of glucose in the fluid.
The sensor was tested using a polydimethlylsiloxane (PDMS) eye model to mimic a real eye. To mimic tears, glucose was dispensed
via a syringe pump on top of the contact lens while another syringe pump aspirated the fluid via the tear ducts. Experimental
measurements indicate that the sensor has good sensitivity and is able to detect very low concentrations of glucose of 0.01 mM,
which is below the normal level of glucose in human tears of 0.1–0.6 mM. The contact-lens sensor also has very good response rates
and produces measurements that reach 90% of the maximum value in fewer than 20 s.

13.20.2.1.2 Glucose Sensor with Copper Nanoparticle Modified Graphene Electrode

Nanotechnology-based sensors known as nanosensors are reported to provide better solutions to sense or monitor both physical
and chemical environments and biological conditions, enabling enhanced detection sensitivity, specificity, and multiplexing
capability for a broad range of environment, health, and safety-related assessments (26,27). Traditionally glucose sensors rely on
glucose oxidase enzyme to oxidize glucose into gluconolactone. While the enzyme is highly selective and sensitive to glucose, it has
poor stability, a complicated immobilization procedure, and is costly. To overcome these problems, recent research often focused
on nonenzymatic glucose detection methods. One such example is given by Luo et al., who utilized graphene sheets as the sensor’s
electrodes. Plenary graphene sheets were chosen as the sensor’s electrode since they have a large specific surface area, making them
highly sensitive to the adsorbed glucose molecules. To further increase the device’s sensitivity, the electrodes were coated with
copper nanoparticles, which are highly conductive. Using both increased surface area plus increased conductivity enhances electron
transfer for oxidation of glucose (28). Unlike the first-generation glucose sensor, which was purely electrochemical, this sensor used
electrochemical impedance spectroscopy (EIS) techniques to measure the level of glucose. The EIS technique is a combination of
impedance measurements at different frequencies and electrochemical current measurements. The copper-enhanced graphene
sensor produced very good results; it had very low detection limits of 0.5 mM, very fast response rates of 2 s, and a moderate
oxidation potential of 0.5 V.

13.20.2.2 Wearable Wireless Health Monitoring System

The reliable monitoring of public health through a wireless system with real-time feedback can create a paradigm shift in the existing
health care and wellness sector. More proactive and affordable health care with continuous health monitoring can be established
through such a wearable system. There are a number of researches presenting the necessary hardware and software architecture of
a working sensor network system for ambulatory health status monitoring (6). Two conceptual systems are briefly discussed in this
chapter: one on a design with a single glucose sensor and the other on a wireless body area sensor network equipped with multiple
sensors. This kind of wireless technique of ubiquitous health monitoring, if successfully implemented by overcoming the chal-
lenges, is expected to revolutionize the current health-care systems.

13.20.2.3 Contact-Lens System for Wireless Health Monitoring

The contact-lens sensor as described in Section 13.20.2.1.1.3 can also be equipped with readout circuitry, an antenna, and
a communication interface, forming a complete active contact-lens system as illustrated in Figure 5. All these circuit components
have to fit in an extremely small area of 0.36 mm2 since it is also placed on the contact lens. The operating principle of the system is
504 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Figure 5 (a) Conceptual diagram of an active contact-lens system for wireless health monitoring. (b) Measurement setup for the on-lens glucose
sensor with continuous flow. Reproduced from Liao, Y. T.; Yao, H.; Parviz, B.; Otis, B. A 3uW Wirelessly Powered CMOS Glucose Sensor for an
Active Contact Lens. IEEE J. Solid-State Circuits 2012, 47 (1), 38–40.

as follows: the glucose sensor on the contact lens measures the level of glucose in the tear fluid and sends this information wirelessly
via the antenna to an external circuit. To be able to sustain itself on the lens and to measure extremely low levels of glucose, the
system has to be low-power (less than 5 mW) and have low-current noise (less than 1 nA rms). To satisfy this, researchers designed
the system to include a potentiostat, a current-to-frequency converter, a modulator, and an antenna. The potentiostat generates the
voltage required by the glucose sensor to perform oxidation (0.4 V).
The current-to-frequency converter amplifies the current measured by the sensor and converts it into pulses proportional to the
glucose level. These pulses are then transmitted wirelessly to an interrogator using backscatter modulation. To avoid the usage of
a battery on the lens, the contact-lens system receives power externally in the form of rf energy via an antenna. The loop antenna was
fabricated on a lens using gold traces as presented in Figure 5. The received rf power is converted to dc using on-chip rectifiers and
voltage regulator. While this on-lens tear glucose system has shown good sensitivity, it still has to be improved in terms of protein-
caused desensitivity, sensor lifespan, and it has yet to complete any clinical testing for technical reliability.

13.20.2.3.1 Wireless Body Area Network

A wireless sensor network known as ALARM-NET, introduced by Wood et al. (10), is integrated with environmental and physio-
logical sensors, which is useful for assisted-living and residential monitoring wearable systems. It is facilitated with Internet
communication to allow an individual to closely observe changes in the important signs or symptoms occurring in her or his body,
and to provide feedback to help maintain a good health status. An emerging wireless body area network (WBAN) can be utilized as
part of a wearable health monitoring system. The WBAN is composed of multiple sensor nodes with capabilities of sampling,
processing, and communicating vital signs (e.g., heart rate, blood pressure, oxygen saturation, activity) or environmental parameters
such as location, temperature, humidity, light, etc. These sensors are typically placed in strategic locations of the human body as tiny
patches or hidden in a user’s clothes, allowing ubiquitous health monitoring. If this system is properly integrated into a telemedical
system, it is possible to even alert medical personnel in the case of a life-threatening situation. Apart from these, the wearable
systems can be helpful for monitoring the health of patients in ambulatory settings (29). For instance, the system can act as part of
a diagnostic procedure, safeguard a chronic condition, monitor a recovery process from an acute event or surgery, supervise the
compliance level of treatment guidelines (e.g., regular cardiovascular exercise), or check the effects of drug therapy.
As illustrated in Figure 6, a wireless body area sensor network is proposed for real-time health monitoring integrated into
a broader multitier telemedicine system.
As stated by Qureshi et al. (30), the early and quick diagnosis of any disease, such as cardiovascular disease, is vital and crucial
not only for the patient’s survival but also to save money and time in a successful prognosis. The wireless body area sensor network,
acting as a pivotal part of the telemedical system, can play an important role in this regard. As mentioned earlier, WBAN is to consist
of a number of intelligent nodes. Each of the nodes should be capable of sensing, sampling, processing, and communicating
physiological signals. There can be a number of sensors, such as ECG, electromyography (EMG), and electroencephalography
(EEG), for monitoring, respectively, heart, muscle, and brain electrical activities. Similarly, blood pressure, tilt, and breathing
sensors can monitor, respectively, the blood pressure, trunk position, and respiration while the motion sensors can be used to
differentiate the user’s status and quantify the person’s level of activity.
In designing the WBAN nodes, the requirements for minimal weight, miniature form factor, low power consumption, etc. must
be satisfied to facilitate prolonged ubiquitous monitoring. These wireless network nodes can be incorporated into clothes or shoes
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 505

Figure 6 Health Monitoring System Network Architecture.

or implemented as tiny patches. The nodes are to collect and process raw information continuously, store them locally, and send
processed event notifications to the personal server. However, patient privacy is an outstanding issue and it is a requirement by law
and must be maintained at all tiers in the health-care system. All sensitive information related to personal health must be encrypted
during data transfer between the user’s personal server and the medical server (6).
A hypothetical case as presented by Otto et al. (6) in Figure 7 illustrates the usefulness of the proposed health-care system. A
patient named Juan Lopez, as portrayed in the case, is fictitious but representative of the common issues faced by a patient
recovering from a heart attack. After getting released from the hospital, Juan had to undergo supervised physical rehabilitation for
a few weeks. During this period, it was easy to monitor whether he completed his exercises as prescribed by the physicians. But after
leaving the hospital, unfortunately he became reluctant to follow the exercise as prescribed in terms of intensity and duration.

Figure 7 Data flow in the proposed health-care monitoring system.

506 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Consequently, recovery was slower than expected, which led to concerns about Juan’s health prognosis, and his physician had no
means to quantify the level of his adherence to the program.
In such a situation, the health monitoring system proposed by Otto et al. (6) offers a solution for Juan. Equipped with a WBAN,
tiny sensors provide constant observation of vital statistics, estimate induced energy expenditure, and assist Juan with his exercises.
The time, duration, and level of intensity of the exercise can be easily evaluated through the estimated energy expenditure. Juan’s
physician does not need to rely on Juan’s testament; he can collect and review data to verify whether Juan is exercising regularly. If
needed, the physician can issue a new prescribed exercise regime, adjust data threshold values, and schedule office visits. Conse-
quently, these remote stress tests and data collection for in-office could possibly be substituted by the proposed system. Moreover,
Juan’s physician reduces the number of office visits, cuts health-care costs, and makes better use of his time. For urgent cases,
however, provision can be kept so that the personal server can directly contact Emergency Medical Services.

13.20.3 Environmental Condition Monitoring

Although human exposure to environmental pathogens, particularly air pollutants, is of great concern and is a highly addressed
topical issue, the importance of water quality monitoring has also gained profound attention and become critical for water resource
management programs. So as part of environment monitoring, recent initiatives in measuring air and water quality at appropriate
spatial and temporal scales by using state-of-the-art sensors and sensor technology are highlighted in this chapter.

13.20.3.1 Air Pollution – Sources and Effects

Due to rapid industrialization and urbanization, the emission of harmful exhaust from various industries and transport vehicles is
on the rise. The number of automotive vehicles has increased rapidly, and the exhaust thereof is acting as a source of emission of
great amounts of pollutant gases, causing serious problems for human health and the environment. Different industrial processes
are generating a large number of environmentally hazardous gases, such as NO2, NO, N2O, H2S, CO, NH3, SO2, and CO2, which are
both toxic and greenhouse gases (GHGs). Nitrogen oxide (NO2 and NO) is produced through combustion in chemical plants and
automobiles. The main component of exhaust gas from a power station is NOx. Acid rain, photochemical fogs, and the depletion of
the ozone layer are caused by NOx. Hydrogen sulfide (H2S) is produced by anaerobic decomposition of organic materials and from
petrochemical and coal manufacturing industries. It can react with blood hemoglobin and can cause instant paralysis and death.
Carbon monoxide is produced due to incomplete combustion of fuels, and it is found in the emission of automobile exhaust.
Ammonia is a precursor to the food and fertilizer industry and it is also a building block for the synthesis of many pharmaceuticals.
Despite its usefulness, it is hazardous to human health at concentrations exceeding 25 ppm.
Carbon dioxide (CO2) is emitted into the air by humans exhaling, the burning of fossil fuels for energy, and deforestation. It is
a prominent GHG. Methane is formed by the decay of natural materials and from landfills, marshes, septic systems, and sewers. It is
a 21 times more potent GHG than CO2 (32). In the United States, the distribution of GHG emissions according to the economic
sector is shown in Figure 8 (31).
The problem of GHGs was first recognized in the 1960s in California. Subsequently, emission control was initiated and later
extended for gasoline powered vehicles to control carbon monoxide and hydrocarbons. During the 1970s, emission control was
extended to all over the United States (33). The 1997 Kyoto Protocol, in which international leaders of major industrialized
countries agreed to reduce their overall emissions of GHGs to an average of 5.2% below 1990 levels by the period 2008–2012 and

Figure 8 Total US greenhouse gas emissions by economic sectors in 2011. Reproduced from www.epa.gov/cllimatechange/ghgemissions/sources.
html (accessed Apr, 2013).
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 507

also brought attention to the climate change issue. However, the Kyoto Protocol has never been ratified, and therefore countries
have only implemented changes where they have desired to do so. The more recent 2001 Marrakech climate change talks resulted in
a reduced target of approximately 5% below 1990 levels by 2012 (34).
Various fuels are used in light vehicles, but two of them deserve special mention: gasoline (hegemonic fuel in the world
scenario) and ethanol (a renewable fuel that mitigates emissions of carbon dioxide). Anthropogenic activities have increased the
concentration of pollutant gases which is a major worrying factor in the world scenario as environmental problem such as ozone
layer depletion, acid deposition, photochemical smog, and global warming have increased at an alarming rate (33–35).
Furthermore, studies indicate the relationship between the increased concentration of pollutant gases and the higher incidence of
respiratory and cardiovascular diseases (36–38). The three environmentally important gases are carbon monoxide, nitrogen
dioxide, and sulfur dioxide. Carbon monoxide is a toxic gas that can cause many respiratory and cardiovascular diseases,
insomnia, headache, fatigue, decreased physical capacity, dizziness, vertigo, nausea, vomiting, visual disturbances, heading
disorders, cardiac ischemia, heart disease, and arteriosclerosis. It can also cause death in high concentrations (39,40). Acid rain is
caused by nitrogen dioxide and the sulfur dioxide, which can also cause health diseases (41,42). Furthermore, the tropospheric
ozone is also formed by CO and NO, which is an important GHG (43–45). The lung function is decreased due to an increase in
particulate material (PM) (small particles are inhaled and trapped in the lungs) and hence an increase in breathing problems,
hospitalization, and premature death.
However, gasoline or diesel in an internal combustion engine (ICE) is currently the cheapest system, and it is likely to remain so
through 2020. As a result, these vehicles will continue to evolve with improvements in performance, safety, fuel economy, and lower
pollution emissions. Not only that, a more sustainable system or one that emits significantly less GHGs can be implemented if
society desires it and consumers are willing to pay more for an alternative fuel or propulsion system (4).

13.20.3.1.1 Gas Sensors for Emission Monitoring

To decrease the emission from automobiles, lean burn engines have been in operation since the 1980s. Both stoichiometric and lean
burn operation require exhaust gas oxygen (EGO) sensors to control the engine so that the emissions are within regulations. The
engine emissions can also be improved by using alternative fuels, in particular methanol or ethanol or a combination of the two
with gasoline. Therefore, for effective control, an optimum ratio of blended fuel must be maintained. To control critical pollutants
such as carbon monoxide, hydrocarbons, and nitrogen oxide, a feedback control of the air–fuel ratio in a gasoline engine with
a three-way catalyst is needed. As shown in Figure 9, the oxidation of CO, HC, and the maximum reduction of NOx only occurs very
close to the stoichiometric ratio.
Figure 9 shows the emissions of HC, CO, and NOx above and below stoichiometry (l ¼ 1), showing the emission levels without
a catalyst (broken curves) and with a catalyst (full curves). Also shown is the voltage curve of the EGO (l) sensor as the air–fuel ratio
passes through stoichiometry (33). The sensors are mainly constructed from zirconia materials, as presented in Figure 10.
The sensors work effectively over the normal range of exhaust temperature (350–800  C). However, the response is not accurate
if the temperature is below 350  C. Hence, the heated version of EGO sensors is more affective. Shulman and Hamburg (46) have
reported that the air–fuel set ratio in a feedback system can shift to lean as the engine load increases. TiO2-based EGO sensors are
also available due to the simplicity of fabrication, compactness, and low cost, but they have not replaced zirconia sensors because
they are less reliable. A new type of zirconia-based sensor has been developed that can detect total NOx content in the temperature
range of 600–700  C showing the response as impedance with a nearly linear correlation (47,48). Cobalt, niobium dioxides,
strontium, lanthum, and tin are also investigated as possible oxygen sensors, where the resistance change due to oxidation or

Figure 9 Effect of a three-way catalyst on emissions of HC, CO, and NOx.

508 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Figure 10 Construction of zirconia ceramic sensors. Reproduced from Westbrook, M. H.; Turner, J. D. Automotive Sensors, Sensor Series;
Institute of Physics Publishing: Bristol and Philadelphia, 1994.

reduction reactions with oxygen is monitored. However, development has not progressed far enough to challenge the dominance of
zirconia-based EGO sensors.
Varieties of gas sensors have been developed for sensing and controlling hazardous emissions from automotive, energy, and
other industries (49–51). However, for different pollutants the sensor materials are different, and it is a challenging task to develop
sensors with high accuracy, selectivity, and reliability (52). The main classes of gas sensing materials include metal oxide semi-
conductors, intrinsically conducting polymer and polymer composite, metal-oxide/polymer composite, and other novel materials
(52). Hydrogen is a flammable gas, and because it is colorless, odorless, and tasteless, it cannot be detected by human senses. As
reported in the literature, there are an immense number of hydrogen sensors using different technologies (53). Rapid and accurate
hydrogen gas concentration measurement is essential to warn of potentially explosive mixtures with air and to help prevent the risk
of explosion. On the other hand, for detecting trace level impurities in hydrogen fuel, an optical sensor has been developed by
Tripathi et al. (54) that depends on laser-induced breakdown spectroscopy.
Information and communication technologies also have an impact on the environment. This impact can be classified as direct
impact, which includes pollution related to the production of infrastructure and devices, electricity consumption of hardware, and
electronic waste disposal. Indirect impacts are related to production processes, products, and distribution systems. However,
because the effects of ICTs on economic activity are pervasive, their impacts on the environment are difficult to trace and measure,
and this is a ‘productivity paradox.’ Hence in the long term, the net environmental effect of the information revolution will depend
on the balance between these ‘dematerializing’ effects, and the counter ‘rematerializing’ influences of economic growth and
complementarity effects. The positive impacts must also be balanced against a range of countervailing effects, including direct
impacts of electronic devices and in compensating behavioral changes that may be enabled by ICTs (55).

13.20.3.2 Water Pollution

The physical, chemical, thermal, and/or biological characteristics in general are good descriptors of water quality. As water is used
for various purposes, it is difficult to define a single water quality standard to meet all uses and user needs. The physical, chemical,
and biological parameters of water that are suitable for human consumption are different from those parameters of water suitable
for irrigating a crop. Materials are delivered to a water body from either point or nonpoint sources, which also affects the water
quality. The point source is a single source that can be traced easily, such as a ditch or a pipe. Nonpoint sources are associated with
landscape, and water quality is dependent on various factors such as water movement, land use and management, and/or other
human and natural activities on the watershed.
Anthropogenic sources of point and nonpoint substances originate from agriculture, industrial, and urban areas. Freshwater and
estuarine ecosystems in the world are mostly affected by polluting substances that lead to the deterioration of water quality (56). A
high level of ammonia (NH3) detected in residential tap water has frequently led the Malaysian Water Distribution Company
(Syabas) to cut off the water supply to millions of homes. Extensive and excessive use of NH3-containing chemicals in agricultural
and industrial sectors has been shown to result in such severe environmental contamination (57). In the United States, it is esti-
mated that billions of dollars per year are spent to maintain the quality of deteriorated water in off-site downstream areas (58).
Effective water quality monitoring has become critical for water resource management programs, as water quality perturbations
related to escalating human population growth and industry pressures continue to increase in coastal and inland areas (59–61). To
assess the state of the world’s water resources adequately, to achieve effective preservation, and to evaluate remediation success
properly, there must be accurate, intensive, and long-term data acquisition.
Suspended sediments (turbidity), algae (i.e., chlorophylls, carotenoids), chemicals (i.e., nutrients, pesticides, metals), dissolved
organic matter (DOM), thermal releases, aquatic vascular plants, pathogens, and oils are the major factors affecting water quality in
water bodies across the landscape. Remote sensing techniques can be used to detect the change in energy spectra of reflected solar
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 509

and/or emitting thermal radiation from surface waters which is caused by suspended sediments, algae, DOM, oils, and aquatic
vascular plants. The spectral or thermal properties of surface waters are not changed or affected directly by most chemicals and
pathogens, but they can only be inferred indirectly from measurements of other water quality parameters affected by these
chemicals. However, due to the expense and difficulty involved, toxic substances such as heavy metals and organic chemicals (e.g.,
pesticides, herbicides, solvents, and PCBs) are monitored by analyzing the collected water at accredited labs.
Stream flow, dissolved oxygen and biochemical oxygen demand, temperature, pH, turbidity, phosphorus, nitrates, total solids,
conductivity, total alkalinity, and fecal bacteria are the parameters most commonly monitored in streams. The first five are the most
basic, and they are the foundation of almost any water quality monitoring program. Relatively inexpensive and simple-to-use kits
are available from scientific supply houses to monitor these pollutants effectively. Although meters and sophisticated lab equip-
ment are more accurate, but they are also more expensive, less flexible (e.g., meters generally have to be read in the field), and
require periodic calibration.

13.20.3.2.1 Remote Sensing of Water Quality

For decades, water quality evaluation has been depending on costly, time-, and labor-intensive on-site sampling and data collection,
as well as transport to land-based or shipboard laboratories for evaluation. Although these research and monitoring efforts are
episodically intensive, they generally have been limited on temporal and spatial scales to adequately address the influence of events
such as harmful algal blooms, oxygen depletion, fish kills, and contamination of shellfish beds by enteric bacteria (62). Moreover,
due to inadequate quality-control and quality-assurance protocols, the holding times for samples before analysis are long and the
use of nonstandardized methodologies can also cause compromised results, and the data are frequently susceptible to recording and
georeferencing errors during transcription (63). Remote sensing tools provide spatial and temporal views of surface water quality
parameters, thus making it possible to monitor the landscape effectively and efficiently, and thereby making the water quality
parameters and the identification and quantification of problems more realistic.
The U.S. Geological Survey (USGS) (64) began experimenting with satellite telemetry for remote hydrologic data collection in
1972. The use of satellite-relay systems significantly reduced the requirement of manpower resources to operate large data-collection
networks and processed data automatically (65,66). In 1977–1978, a study was conducted in which the data collected by the USGS
using three data-relay systems among nine stations in west-central Florida were compared with the data collected by using a ‘land-
line’ system wherein data were manually transmitted via telephone lines. Telephone line interference, low battery voltage, and
vandalism contributed to a disappointing 94% data accuracy rate (62).
Different Landsats are used for remote monitoring, of which Landsat-7 (67) is the latest generation remote sensing satellite
operated for the USGS. It was built for NASA and was launched in April 1999. The incorporation of different instruments with new
features makes it a more versatile and efficient instrument for global change studies, land cover monitoring and assessment, and
large area mapping than its design forebears.
The Landsat Mission has been providing detailed observations on the surface of the Earth for more than 29 years. Different
applications, such as agricultural evaluations, forest management inventories, geological surveys, water resource estimates, coastal
zone appraisals, and a host of other applications, have been performed with Landsat data to meet the needs of business,
government, science, and education (Figure 11). Landsat technology has inspired a new generation of commercial satellites that
provide site-specific and real-time telemetry operations for land-based remote monitoring of water quality parameters using
a satellite-relay system and land-based telemetry.
The first members of the new satellite generation are instrumented with sensors to measure Earth-emitted and reflected radiation
from which atmospheric temperature, winds, moisture, and cloud cover can be derived. The U.S. Geostationary Operational
Environmental Satellite (GOES) system is managed, operated, and maintained by the National Environmental Satellite, Data, and
Information Service (68). The GOES system continuously observes changing weather phenomena to improve (1) water quality and
quantity assessments, (2) forecasts of precipitation and daily crop water use aimed at the reduction of irrigation, and (3) seasonal
predictions for optimum vegetation selection and water use efficiency.
The data collected by the GOES system are updated to the World Wide Web, and the total time from field transmission to the
Web is usually 7–8 min (Figure 12).
Not only is the satellite technology needed for remote controlling, but also computer interfacing, processors and software
universal serial bus interfere, an Ethernet communication interface, and a FireWire (IEEE, 1394) high-performance serial bus
interface are also needed. Figure 13 shows the real-time monitoring.
The platforms provide a secure, stable environment for monitoring equipment. Data from the systems are transmitted via
cellular telemetry to the CAAE (Centre for Applied Aquatic Ecology) and then to www.ncsu.edu/wq. The CAAE profiler system
contains a network of biological, chemical, and hydrological sensors profiled through the water column by a computer-controlled
winch. The system is adaptable for use with multiple sensors (62).

13.20.3.2.2 Advances in Toxicant Detection Sensors

Determination of the amount of toxicants in marine, estuarine, and freshwater systems, including potable water supplies, is crucial,
hence there is an increasing interest and demand for the development of molecular, optical, biosensor, and analytical detectors.
There are various biosensors using plant chloroplasts (pea seedlings or lettuce) by Merz et al. (69), green alga Scenesdesmus sub-
spicatus, for the detection of herbicides in wastewater by Frense et al. (70) and Rizzuto et al. (71). Photothermal sensors are used to
detect organophosphate and carbamate pesticides in spiked potable water (72). Fiber-optic biosensors where algae are entrapped in
510 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Figure 11 (a) Remote Sensing Advanced Technology (RSAT) Landsat satellite imagery developed to assess the biological, chemical, and physical
properties of coastal waters and coral reefs along the Florida Keys. (b) A 30-m resolution zoom from Landsat satellite imagery showing the
shallow waters and underwater reefs along the northeast coast of Florida. Reproduced from Glasgow, H. B.; Burkholder, J. M.; Reed, R. E.;
Lewitus, A. J.; Kleinman, J. E. Real-Time Remote Monitoring of Water Quality: A Review of Current Applications, and Advancements in Sensor,
Telemetry, and Computing Technologies. J. Exp. Mar. Biol. Ecol. 2004, 300, 409–448.

Figure 12 Overview of real-time data acquisition system using GOES satellite relay. Reproduced from Glasgow, H. B.; Burkholder, J. M.;
Reed, R. E.; Lewitus, A. J.; Kleinman, J. E. Real-Time Remote Monitoring of Water Quality: A Review of Current Applications, and Advancements
in Sensor, Telemetry, and Computing Technologies. J. Exp. Mar. Biol. Ecol. 2004, 300, 409–448.
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 511

Figure 13 (a) Diagram of a fully equipped CAAE RTRM platform. (b) Example of a CAAE profiler system.

membranes are developed to monitor the effects of herbicides and other toxicants. Reproducible signals can be transmitted rapidly
with fiber optics. The membranes are inexpensive to prepare and easy to handle.
There is an increase in awareness worldwide of the possibility of attacks on metropolitan areas using chemical and biological
warfare agents in waterways. Although the solubility is low, it will increase with turbulence, high pH, and heat. Moreover, the
contaminant can persist for a longer period and can release slowly over time (72,73). A miniaturized analytical system combined
with on-chip micellar electrokinetic chromatographic separation for amperometric detection of organophosphate nerve agents at
a level 2.4  10
6 M for methyl parathion is developed which can provide early warning detection capabilities in freshwater,
estuarine, and marine resources. Solid-phase microextraction is a new technique that has been developed in the past decade for low-
level detection of chemical toxicants (74) and organophosphate pesticides (75) in freshwater samples.

13.20.3.2.3 Autonomous Detection of Harmful Algal Species and Toxins

In order to provide coastal resource managers with advanced warning of bloom development, or the presence of harmful species
and their toxins at low but potentially problematic concentrations, suitable methods and instruments are needed. However, it is in
large measure dependent on regulatory requirements.
Networking and arrays of in situ sensors could provide the data streams needed to drive biophysical models designed to forecast
the development and movement of harmful algal blooms, and the ecosystem can be restored and economic impacts linked to
harmful algae can be mitigated (76,77). Harmful algal taxa in natural samples can be identified by using several approaches: (1)
direct visualization of individual cells using microscopy (78), (2) portable and in situ sensors capable of detecting optical features of
cells (79), and (3) molecular probes that detect individual taxa (80). The techniques that use real-time detection systems can be
either human-assisted (e.g., shipboard or dockside) or deployed for remote operation. In an effort to meet some of the challenges of
detecting harmful algal taxa and toxins in situ, scientists and engineers at the Monterey Bay Aquarium Research Institute have
developed a patented experimental instrument known as the Environmental Sample Processor (ESP), as shown in Figure 14.
The ESP collects discrete water samples, and the present sample processing options automated by the ESP are (1) preservation
of microorganisms (particulate matter) for light and electron microscopy; (2) preservation of microorganisms (particulate
matter) for nucleic acid and toxin analyses; (3) application of molecular probes (DNA, antibody) for identification of specific
organisms using techniques for whole-cells; and, (4) application of molecular probes (DNA, antibody) using cell homogenate
formats, the latter including nucleic acid extraction and custom DNA probe arrays for real-time detection of multiple organisms
simultaneously.

13.20.3.3 Sensor Use in Health/Environment Monitoring – Economic Feasibility

Human health and urban air pollution are closely linked. Cardiovascular disease, respiratory problems, quality of life, and mortality
rates are very much dependent on gas phase pollutants or PMs in the air (1). Hence, monitoring of air quality is done routinely all
over the world. The costs of setting up fixed site monitoring stations using traditional technologies and the cost of individual
512 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring

Figure 14 The environmental sample processor (ESP) for some harmful algal species and their toxins. Reproduced from Glasgow, H. B.;
Burkholder, J. M.; Reed, R. E.; Lewitus, A. J.; Kleinman, J. E. Real-Time Remote Monitoring of Water Quality: A Review of Current Applications,
and Advancements in Sensor, Telemetry, and Computing Technologies. J. Exp. Mar. Biol. Ecol. 2004, 300, 409–448.

instruments are between £5000 and £60,000. Significant additional costs are incurred for maintenance and calibration (81). The US
Environmental Protection Agency (EPA) (82) has analyzed the retrospective and prospective benefits and costs of the 1970 Clean
Air Act (and its subsequent amendments). As the benefit-cost analysis is a complex issue, the direct cost associated with lowering
emissions, a reduction of morbidity and mortality, and a reduction of acid precipitation can provide guidance as to the feasibility of
using sensors for monitoring health and the environment.
Both the benefits and costs from 1970 to 1990 and from 1990 to 2010 were estimated by the EPA considering all relevant
factors and issues related to the environment and human and ecological health. Health was found to be mostly affected by small
particles suspended in the air (PM10), and hence almost the entire calculated benefits stem from these estimated health effects as
evaluated by the EPA. The economics literature justifies a high dollar value for the benefit of preventing premature death ($4.8
million, according to the EPA). The prevention of premature death contributed almost 90% of the benefit of abating air pollution.
The benefits of lessening NOx, CO, and volatile organic compounds (VOC) were ignored. Not only that, other categories of
benefits, such as the ecology, damages to materials and visibility, and more general benefits of abating air pollution are also
ignored in the analysis as the scientific literature provides little basis for estimating the benefits of abatement. The benefits of
reduced hazardous air pollutants are also not included because the scientific literature does not provide an adequate basis for
estimation.

13.20.4 Concluding Remarks

The prospect of closely monitoring and controlling the environment and human health has received an impetus in recent times due
to the advances in relevant fields such as sensor material design and development, manufacturing capability of intricate and delicate
shapes, low-power microelectronics and miniaturization, wireless networking and Internet, etc. Early detection of causes leading to
deterioration of both health and the environment paves the way for taking necessary measures before a catastrophic level is reached.
Tackling a situation at an early stage is equivalent to the well-known saying ‘a stitch in time saves nine.’ It is realizable that the
advantages to be accrued through the implementation of sensors and sensor technology in different spheres of our day-to-day life
should outweigh the costs involved.
The prospect of a reliable monitoring of public health through a wireless system and controlling with real-time feedback is
enormous, and it can bring about a paradigm shift in the existing health care and wellness sector. More proactive and affordable
health care can be ensured through such a wearable system. After more than 50 years of vigorous development, glucose sensors have
evolved to be simple to use, reliable, and less expensive. It was possible to improve the detection limit and sensitivity of the sensor
through research carried out by using various materials for the sensor’s electrode and nanoparticles for coating. However, despite the
success of the current blood glucose biosensors, there is a perceived need for continuous sensing using noninvasive methods. A very
likely alternative is the monitoring of the glucose in tears instead of in blood via a contact-lens sensor. This sensor, if equipped with
the necessary hardware and software, could come out as a device for ubiquitous wireless health monitoring subject to successful
clinical trial. The current achievements of some researches on an ambitious WBAN equipped with multiple sensors have provided
the hope of mitigating real-life health-care problems in a better way.
 Technical and Economic Feasibility of Sensor Technology for Health/Environmental Condition Monitoring 513

Although there are no detailed studies and in-depth research literature on the economic feasibility or benefit-cost ratio of
a ubiquitous health or environmental condition monitoring system, the proponents advocated in favor of improved environment
and health-care services with an overall reduction in expenses. However, the majority of the articles on the ambitious application of
sensor technology for ubiquitous health and environmental condition monitoring and controlling are at their earliest stage, and
further studies and more detailed analyses are required to assess the feasibility in the context of both the economy and reliable
technical performance.

See also: Commercialization and Application-Driven Economic Viability of Sensor Technology; Sensor Technology for Monitoring of
Health-Related Conditions; Sensor Technology for a Safe and Smart Living Environment for the Aged and Infirm at Home.

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