The role of electrocardiography in occupational medicine, from einthoven’s invention to the digital era of wearable devices

Clinical-instrumental investigations, such as electrocardiography (ECG), represent a corollary of a procedures that, nowadays, is called upon as part of the principles of precision medicine. However when carrying out the professional routine examinations, most tend to ignore how a “simple” instrument can offer indispensable support in clinical practice, even in occupational medicine. The advent of the digital age, made of silicon and printed circuit boards, has allowed the miniaturization of the electronic components of these electro-medical devices. Finally, the adoption of patient wearables in medicine has been rapidly expanding worldwide for a number of years. This has been driven mainly by consumers’ demand to monitor their own health. With the ongoing research and development of new features capable of assessing and transmitting real-time biometric data, the impact of wearables on cardiovascular management has become inevitable. Despite the potential offered by this technology, as evident from the scientific literature, the application of these devices in the field of health and safety in the workplace is still limited. This may also be due to the lack of targeted scientific research. While offering great potential, it is very important to consider and evaluate ethical aspects related to the use of these smart devices, such as the management of the collected data relating to the physiological parameters and the location of the worker. This technology is to be considered as being aimed at monitoring the subject’s physiological parameters, and not at the diagnosis of any pathological condition, which should always be on charge of the medical specialist We conducted a review of the evolution of the role that electrophysiology plays as part of occupational health and safety management and on its possible future use, thanks to ongoing technological innovation

HM4All: A vital signs monitoring system based in spatially distributed ZigBee networks

Low power consumption and small footprint make ZigBee based devices well suited for personal healthcare applications, being a promising alternative to general care patient monitoring. However, their use in a healthcare facility to monitor several mobile patients poses several difficulties, mainly because this protocol was primarily designed to operate in low data rate scenarios. This paper introduces HM4All, a remote vital signs monitoring system, and presents a prototype system being deployed in a hospital internment floor. Its architecture, original network topology, software applications and wireless sensors are described.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

Internet of Things-Based ECG and Vitals Healthcare Monitoring System

Health monitoring and its associated technologies have gained enormous importance over the past few years. The electrocardiogram (ECG) has long been a popular tool for assessing and diagnosing cardiovascular diseases (CVDs). Since the literature on ECG monitoring devices is growing at an exponential rate, it is becoming difficult for researchers and healthcare professionals to select, compare, and assess the systems that meet their demands while also meeting the monitoring standards. This emphasizes the necessity for a reliable reference to guide the design, categorization, and analysis of ECG monitoring systems, which will benefit both academics and practitioners. We present a complete ECG monitoring system in this work, describing the design stages and implementation of an end-to-end solution for capturing and displaying the patient’s heart signals, heart rate, blood oxygen levels, and body temperature. The data will be presented on an OLED display, a developed Android application as well as in MATLAB via serial communication. The Internet of Things (IoT) approaches have a clear advantage in tackling the problem of heart disease patient care as they can transform the service mode into a widespread one and alert the healthcare services based on the patient’s physical condition. Keeping this in mind, there is also the addition of a web server for monitoring the patient’s status via WiFi. The prototype, which is compliant with the electrical safety regulations and medical equipment design, was further benchmarked against a commercially available off-the-shelf device, and showed an excellent accuracy of 99.56%

Design and Validation of a Software Defined Radio Testbed for DVB-T Transmission

This paper describes the design and validation of a Software Defined Radio (SDR) testbed, which can be used for Digital Television transmission using the Digital Video Broadcasting - Terrestrial (DVB-T) standard. In order to generate a DVB-T-compliant signal with low computational complexity, we design an SDR architecture that uses the C/C++ language and exploits multithreading and vectorized instructions. Then, we transmit the generated DVB-T signal in real time, using a common PC equipped with multicore central processing units (CPUs) and a commercially available SDR modem board. The proposed SDR architecture has been validated using fixed TV sets, and portable receivers. Our results show that the proposed SDR architecture for DVB-T transmission is a low-cost low-complexity solution that, in the worst case, only requires less than 22% of CPU load and less than 170 MB of memory usage, on a 3.0 GHz Core i7 processor. In addition, using the same SDR modem board, we design an off-line software receiver that also performs time synchronization and carrier frequency offset estimation and compensation

Novel Approaches to Pervasive and Remote Sensing in Cardiovascular Disease Assessment

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, responsible for 45% of all deaths. Nevertheless, their mortality is decreasing in the last decade due to better prevention, diagnosis, and treatment resources. An important medical instrument for the latter processes is the Electrocardiogram (ECG). The ECG is a versatile technique used worldwide for its ease of use, low cost, and accessibility, having evolved from devices that filled up a room, to small patches or wrist- worn devices. Such evolution allowed for more pervasive and near-continuous recordings. The analysis of an ECG allows for studying the functioning of other physiological systems of the body. One such is the Autonomic Nervous System (ANS), responsible for controlling key bodily functions. The ANS can be studied by analyzing the characteristic inter-beat variations, known as Heart Rate Variability (HRV). Leveraging this relation, a pilot study was developed, where HRV was used to quantify the contribution of the ANS in modulating cardioprotection offered by an experimental medical procedure called Remote Ischemic Conditioning (RIC), offering a more objective perspective. To record an ECG, electrodes are responsible for converting the ion-propagated action potential to electrons, needed to record it. They are produced from different materials, including metal, carbon-based, or polymers. Also, they can be divided into wet (if an elec- trolyte gel is used) or dry (if no added electrolyte is used). Electrodes can be positioned either inside the body (in-the-person), attached to the skin (on-the-body), or embedded in daily life objects (off-the-person), with the latter allowing for more pervasive recordings. To this effect, a novel mobile acquisition device for recording ECG rhythm strips was developed, where polymer-based embedded electrodes are used to record ECG signals similar to a medical-grade device. One drawback of off-the-person solutions is the increased noise, mainly caused by the intermittent contact with the recording surfaces. A new signal quality metric was developed based on delayed phase mapping, a technique that maps time series to a two-dimensional space, which is then used to classify a segment into good or noisy. Two different approaches were developed, one using a popular image descriptor, the Hu image moments; and the other using a Convolutional Neural Network, both with promising results for their usage as signal quality index classifiers.As doenças cardiovasculares (DCVs) são a principal causa de morte no mundo, res- ponsáveis por 45% de todas estas. No entanto, a sua mortalidade tem vindo a diminuir na última década, devido a melhores recursos na prevenção, diagnóstico e tratamento. Um instrumento médico importante para estes recursos é o Eletrocardiograma (ECG). O ECG é uma técnica versátil utilizada em todo o mundo pela sua facilidade de uso, baixo custo e acessibilidade, tendo evoluído de dispositivos que ocupavam uma sala inteira para pequenos adesivos ou dispositivos de pulso. Tal evolução permitiu aquisições mais pervasivas e quase contínuas. A análise de um ECG permite estudar o funcionamento de outros sistemas fisiológi- cos do corpo. Um deles é o Sistema Nervoso Autônomo (SNA), responsável por controlar as principais funções corporais. O SNA pode ser estudado analisando as variações inter- batidas, conhecidas como Variabilidade da Frequência Cardíaca (VFC). Aproveitando essa relação, foi desenvolvido um estudo piloto, onde a VFC foi utilizada para quantificar a contribuição do SNA na modulação da cardioproteção oferecida por um procedimento mé- dico experimental, denominado Condicionamento Isquêmico Remoto (CIR), oferecendo uma perspectiva mais objetiva. Na aquisição de um ECG, os elétrodos são os responsáveis por converter o potencial de ação propagado por iões em eletrões, necessários para a sua recolha. Estes podem ser produzidos a partir de diferentes materiais, incluindo metal, à base de carbono ou polímeros. Além disso, os elétrodos podem ser classificados em húmidos (se for usado um gel eletrolítico) ou secos (se não for usado um eletrólito adicional). Os elétrodos podem ser posicionados dentro do corpo (dentro-da-pessoa), colocados em contacto com a pele (na-pessoa) ou embutidos em objetos da vida quotidiana (fora-da-pessoa), sendo que este último permite gravações mais pervasivas . Para este efeito, foi desenvolvido um novo dispositivo de aquisição móvel para gravar sinal de ECG, onde elétrodos embutidos à base de polímeros são usados para recolher sinais de ECG semelhantes a um dispositivo de grau médico. Uma desvantagem das soluções onde os elétrodos estão embutidos é o aumento do ruído, causado principalmente pelo contato intermitente com as superfícies de aquisição. Uma nova métrica de qualidade de sinal foi desenvolvida com base no mapeamento de fase atrasada, uma técnica que mapeia séries temporais para um espaço bidimensional, que é então usado para classificar um segmento em bom ou ruidoso. Duas abordagens diferentes foram desenvolvidas, uma usando um popular descritor de imagem, e outra utilizando uma Rede Neural Convolucional, com resultados promissores para o seu uso como classificadores de qualidade de sinal

M2M 원격심전도를 위한 스케일러블 코딩 및 링크 적응기법

학위논문 (박사)-- 서울대학교 대학원 : 전기·컴퓨터공학부, 2017. 2. 신현식.Medical telemetry is one of the most demanding applications in recent wearable computing era. Telecardiology, which uses the power of telecommunications for the remote diagnosis and treatment of heart diseases, is one of the key telemetry applications that leverages IoT-based technologies to improve patient care. Based on recent advances in wearable sensors and telecommunication technologies, this thesis proposes a universal platform for wearable daily cardiac monitoring service. First, we propose an adaptive framework for layered representation and transmission of ECG (electrocardiography) data that can accommodate a time-varying wireless channel on cellular networks. The representation, combined with the layer-based earliest deadline first (LB-EDF) scheduler, ensures that the perceptual quality of the reconstructed ECG signal does not degrade abruptly under severe channel conditions and that the available bandwidth is utilized efficiently. Simulation shows that the proposed approach significantly improves the perceptual quality of the ECG signal reconstructed at the remote monitoring station. Then we extend the proposed adaptive framework to support time-critical medical applications. In fact, the use of wireless technologies has been avoided for medical situations that demand instantaneous cardiac monitoring because of their considerable and nondeterministic end-to-end latency. This thesis introduces a universal platform for machine-to-machine (M2M) telecardiology over cellular networks, along with a novel conservative modulation and coding scheme to minimize and stabilize the delay down to 10 ms of ultra-low latency level, incurred during the process of ECG transmission over a wireless medium while maintaining the desired level of ECG pattern quality required for improving the chance of its interpretation. Machine-type communication (MTC) system is adopted for the delivery of patient ECG data to benefit from its inherent reliability, pervasiveness, security, and performance of 4G long term evolution (LTE) technologies with reduced cost and enhanced coverage. Extensive evaluations indicate that the proposed system provides a sufficient level of service for medical-grade instantaneous ECG monitoring in significantly deteriorated channel conditions.1.Introduction 1 1.1 Motivation and Objectives 1 1.2 Research Contributions 6 1.3 Orgranization of Thesis 8 2 Background and Related Works 10 2.1 ECG Generals 10 2.2 Wireless ECG 15 2.3 Wireless Medium for Telecardiology 20 2.3.1 Wireless Personal Area Networks 21 2.3.2 Wireless Local Area Networks 22 2.3.3 Cellular Networks 23 3 Scalable ECG Transmission over Cellular Networks 24 3.1 System Architecture 26 3.2 Scalable Representation of ECG Data 27 3.3 ARQ-Based Error Control Using LB-EDF 30 3.4 Performance of Wireless ECG Transmission 33 4 Conservative Modulation and Coding for Instantaneous ECG Monitoring over LTE MTC 37 4.1 Architecture of Universal M2M ECG Platform 39 4.2 Demand for Instantaneous Monitoring 43 4.3 System Requirements for Instantaneous Monitoring Services 45 4.3.1 Latency Requirements and Analysis 45 4.3.2 Presentation Requirements for Sufficient Clinical Accuracy 53 4.4 System Architecture for Instantaneous Wireless ECG Monitoring using LTE MTC 58 4.4.1 Spatio-Temporal Scalable Media Coding for ECG signal 60 4.4.2 Conservative Modulation and Coding to Provide Extra Protection for Higher Prioritized Scalable Layers 64 4.4.3 System Parameter Analysis 68 4.5 Performance Evaluation 72 4.5.1 Simulation Environment 72 4.5.2 Simulation Results 72 4.5.3 Service Level Adjustment 78 5 Conclusion 79 5.1 Summary 79 5.2 Future Research Directions 83 Bibliography 84 Abstract in Korean 103Docto

ТЕЛЕМЕТРИЧЕСКАЯ СВЕРХВЫСОКОЧАСТОТНАЯ ЭКГ-ПРИСТАВКА С ПОТОЧНЫМ КОНВЕЙЕРНЫМ РАСПОЗНАВАНИЕМ ОБРАЗОВ В РЕЖИМЕ РЕАЛЬНОГО ВРЕМЕНИ

Разработана технология распознавания образов в режиме реального времени для диагностики и физиологической электроморфологической кластеризации электрокардиограмм с использованием оцифровки по критерию бинаризации контраста и трансляцией сигнала с дигитайзера, выполненного в конструкте приставки к портативному электрокардиографу, по сверхвысокочастотному / радиочастотному каналу (1.2 ГГц). Обработка телеметрической информации осуществляется после поступления принятого ресивером канала через тюнер с АЦП на ЭВМ. Исходно данная система реализована для анализа многоканальных данных ЭЭГ, однако впоследствии полностью адаптирована для анализа данных c самопишущих приборов ЭКГ, работающих по тому же принципу аналоговой электрофизиологической записи

ТЕЛЕМЕТРИЧЕСКАЯ СВЕРХВЫСОКОЧАСТОТНАЯ ЭКГ-ПРИСТАВКА С ПОТОЧНЫМ КОНВЕЙЕРНЫМ РАСПОЗНАВАНИЕМ ОБРАЗОВ В РЕЖИМЕ РЕАЛЬНОГО ВРЕМЕНИ

Разработана технология распознавания образов в режиме реального времени для диагностики и физиологической электроморфологической кластеризации электрокардиограмм с использованием оцифровки по критерию бинаризации контраста и трансляцией сигнала с дигитайзера, выполненного в конструкте приставки к портативному электрокардиографу, по сверхвысокочастотному / радиочастотному каналу (1.2 ГГц). Обработка телеметрической информации осуществляется после поступления принятого ресивером канала через тюнер с АЦП на ЭВМ. Исходно данная система реализована для анализа многоканальных данных ЭЭГ, однако впоследствии полностью адаптирована для анализа данных c самопишущих приборов ЭКГ, работающих по тому же принципу аналоговой электрофизиологической записи