The development of an elastic reverse gradient garment to be used as a countermeasure for cardiovascular deconditioning

Using a new Nomex-Lycra elastic fabric and individualized garment engineering techniques, reverse gradient garments (RGG's) were designed, constructed, and tested for effectiveness as a countermeasure against cardiovascular deconditioning. By combining torso-compensated positive pressure breathing with a distally diminishing gradient of counterpressure supplied by the elastic fabric on the limbs, the RGG acts to pool blood in the extremities of recumbent persons much as though they were standing erect in 1 g. It was theorized that through the use of a dynamic pressurization scheme, the RGG would stress the vasculature in a fashion similar to that experienced by the noramlly active man, hence preventing or limiting the development of post-weightlessness orthostatic intolerance and related conditions. Four male, college-age subjects received daily treatments with the RGG during a 15-day bedrest study. Four additional subjects also underwent the bedrest, but received no treatments; they served as controls. The design and construction of the garments are described, and results of the treatment related measurements are given

Estimating pulse wave velocity using mobile phone sensors

Pulse wave velocity has been recognised as an important physiological phenomenon in the human body, and its measurement can aid in the diagnosis and treatment of chronic diseases. It is the gold standard for arterial stiffness measurements, and it also shares a positive relationship with blood pressure and heart rate. There exist several methods and devices via which it can be measured. However, commercially available devices are more geared towards working health professionals and hospital settings, requiring a significant monetary investment and specialised training to operate correctly. Furthermore, most of these devices are not portable and thus generally not feasible for private home use by the common individual. Given its usefulness as an indicator of certain physiological functions, it is expected that having a more portable, affordable, and simple to use solution would present many benefits to both end users and healthcare professionals alike. This study investigated and developed a working model for a new approach to pulse wave velocity measurement, based on existing methods, but making use of novel equipment. The proposed approach made use of a mobile phone video camera and audio input in conjunction with a Doppler ultrasound probe. The underlying principle is that of a two-point measurement system utilising photoplethysmography and electrocardiogram signals, an existing method commonly found in many studies. Data was collected using the mobile phone sensors and processed and analysed on a computer. A custom program was developed in MATLAB that computed pulse wave velocity given the audio and video signals and a measurement of the distance between the two data acquisition sites. Results were compared to the findings of previous studies in the field, and showed similar trends. As the power of mobile smartphones grows, there exists potential for the work and methods presented here to be fully developed into a standalone mobile application, which would bring forth real benefits of portability and cost-effectiveness to the prospective user base

Acoustic sensing as a novel approach for cardiovascular monitoring at the wrist

Cardiovascular diseases are the number one cause of deaths globally. An increased cardiovascular risk can be detected by a regular monitoring of the vital signs including the heart rate, the heart rate variability (HRV) and the blood pressure. For a user to undergo continuous vital sign monitoring, wearable systems prove to be very useful as the device can be integrated into the user's lifestyle without affecting the daily activities. However, the main challenge associated with the monitoring of these cardiovascular parameters is the requirement of different sensing mechanisms at different measurement sites. There is not a single wearable device that can provide sufficient physiological information to track the vital signs from a single site on the body. This thesis proposes a novel concept of using acoustic sensing over the radial artery to extract cardiac parameters for vital sign monitoring. A wearable system consisting of a microphone is designed to allow the detection of the heart sounds together with the pulse wave, an attribute not possible with existing wrist-based sensing methods. Methods: The acoustic signals recorded from the radial artery are a continuous reflection of the instantaneous cardiac activity. These signals are studied and characterised using different algorithms to extract cardiovascular parameters. The validity of the proposed principle is firstly demonstrated using a novel algorithm to extract the heart rate from these signals. The algorithm utilises the power spectral analysis of the acoustic pulse signal to detect the S1 sounds and additionally, the K-means method to remove motion artifacts for an accurate heartbeat detection. The HRV in the short-term acoustic recordings is found by extracting the S1 events using the relative information between the short- and long-term energies of the signal. The S1 events are localised using three different characteristic points and the best representation is found by comparing the instantaneous heart rate profiles. The possibility of measuring the blood pressure using the wearable device is shown by recording the acoustic signal under the influence of external pressure applied on the arterial branch. The temporal and spectral characteristics of the acoustic signal are utilised to extract the feature signals and obtain a relationship with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Results: This thesis proposes three different algorithms to find the heart rate, the HRV and the SBP/ DBP readings from the acoustic signals recorded at the wrist. The results obtained by each algorithm are as follows: 1. The heart rate algorithm is validated on a dataset consisting of 12 subjects with a data length of 6 hours. The results demonstrate an accuracy of 98.78%, mean absolute error of 0.28 bpm, limits of agreement between -1.68 and 1.69 bpm, and a correlation coefficient of 0.998 with reference to a state-of-the-art PPG-based commercial device. A high statistical agreement between the heart rate obtained from the acoustic signal and the photoplethysmography (PPG) signal is observed. 2. The HRV algorithm is validated on the short-term acoustic signals of 5-minutes duration recorded from each of the 12 subjects. A comparison is established with the simultaneously recorded electrocardiography (ECG) and PPG signals respectively. The instantaneous heart rate for all the subjects combined together achieves an accuracy of 98.50% and 98.96% with respect to the ECG and PPG signals respectively. The results for the time-domain and frequency-domain HRV parameters also demonstrate high statistical agreement with the ECG and PPG signals respectively. 3. The algorithm proposed for the SBP/ DBP determination is validated on 104 acoustic signals recorded from 40 adult subjects. The experimental outputs when compared with the reference arm- and wrist-based monitors produce a mean error of less than 2 mmHg and a standard deviation of error around 6 mmHg. Based on these results, this thesis shows the potential of this new sensing modality to be used as an alternative, or to complement existing methods, for the continuous monitoring of heart rate and HRV, and spot measurement of the blood pressure at the wrist.Open Acces

The development of an elastic reverse gradient garment to be used as a countermeasure for cardiovascular deconditioning

Using a new nomex lycra elastic fabric and individualized garment engineering techniques, reverse gradient garments (RGG's) were designed, constructed, and tested for effectiveness as a countermeasure against cardiovascular deconditioning. By combining torso compensated positive pressure breathing with a distally diminishing gradient of counterpressure supplied by the elastic fabric on the limbs, the RGG acts to pool blood in the extremities of recumbent persons much as though they were standing erect in 1 g. The RGG stresses the vasculature in a fashion similar to that experienced by the normally active man, hence preventing or limiting the development of post weightlessness orthostatic intolerance and related conditions. Four male, college age subjects received daily treatments with the RGG during a 15 day bedrest study. Four additional subjects also underwent the bedrest, but received no treatments; they served as controls. The preliminary indication was that the RGG was somewhat effective in limiting the deconditioning process

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology

REDUCTION OF SKIN STRETCH INDUCED MOTION ARTIFACTS IN ELECTROCARDIOGRAM MONITORING USING ADAPTIVE FILTERING

Cardiovascular disease (CVD) is the leading cause of death in many regions worldwide, accounting for nearly one third of global deaths in 2001. Wearable electrocardiographic cardiovascular monitoring devices have contributed to reduce CVD mortality and cost by enabling the diagnosis of conditions with infrequent symptoms, the timely detection of critical signs that can be precursor to sudden cardiac death, and the long-term assessment/monitoring of symptoms, risk factors, and the effects of therapy. However, the effectiveness of ambulatory electrocardiography to improve the treatment of CVD can be significantly impaired by motion artifacts which can cause misdiagnoses, inappropriate treatment decisions, and trigger false alarms. Skin stretch associated with patient motion is a main source of motion artifact in current ECG monitors. A promising approach to reduce motion artifact is the use of adaptive filtering that utilizes a measured reference input correlated with the motion artifact to extract noise from the ECG signal. Previous attempts to apply adaptive filtering to electrocardiography have employed either electrode deformation or acceleration, body acceleration, or skin/electrode impedance as a reference input, and were not successful at reducing motion artifacts in a consistent and reproducible manner. This has been essentially attributed to the lack of correlation between the reference input selected and the induced noise. In this study, motion artifacts are adaptively filtered by using skin strain as the reference signal. Skin strain is measured non-invasively using a light emitting diode (LED) and an optical sensor incorporated in an ECG electrode. The optical strain sensor is calibrated on animal skin samples and finally in-vivo, in terms of sensitivity and measurement range. Skin stretch induced artifacts are extracted in-vivo using adaptive filters. The system and method are tested for different individuals and under various types of ambulatory conditions with the noise reduction performance quantified

The Role of Fluorescence and Human Factors in Quantitative Transdermal Blood and Tissue Analysis Using NIR Raman Spectroscopy

This research is part of an ongoing project aimed at the application of combined near infrared (NIR) Raman and fluorescence spectroscopy to noninvasive in vivo blood analysis including but not limited to glucose monitoring. Coping with practicalities of human factors and exploring ways to obtain and use knowledge gained about autofluorescence to improve algorithms for blood and tissue analysis are the general goals of this research. Firstly, the study investigated the various sources of human factors pertinent to our concerns, such as fingerprints, turgor, skin hydration and pigmentation. We then introduced specialized in vivo apparatus including means for precise and reproducible placement of the tissues relative to the optical aperture, i.e., the position detector pressure monitor (PDPM). Based on solid instrumental performances, appropriate methodology is now provided for applying and maintaining pressure to keep surface tissues immobile during experiments while obtaining the desired blood content and flow. Secondly, in vivo human fingertip skin autofluorescence photobleaching under 200 mW 830 nm NIR irradiation is observed and it is characterized that: i) the majority of the photobleached fluorescence originates from static tissue not blood, ii) the bleaching (1/e point) occurs in 101-102 sec timescale, and also iii) a photobleached region remains bleached for at least 45 min but recovers completely within several hours. A corresponding extensive but not exhaustive in vitro systematic study narrowed down the major contributors of such fluorescence and bleaching to collagen, melanin, plasma and hemoglobin: two major static tissue constituents and two major blood proteins. Thirdly, we established that measuring the inelastic and elastic emissions simultaneously leads to a sensitive probe for volume changes of both red blood cells and plasma. An algorithm based on measurements obtained while performing research needed for this thesis, as well as some empirical calibration approaches, was presented. The calibrated algorithm showed real potential to track hematocrit variations in cardiac pulses, centrifugal loading, blood vessel blockage using tourniquet, and even during as subtle an occurrence as in a Valsalva maneuver. Finally, NIR fluorescence and photochemistry of pentosidine, a representative of the advanced glycation endproducts (AGEs) which accumulate with age and hyperglycemia, was studied. The results indicate that oxygen plays a pivotal role in its photobleaching process. We hypothesized and offered proofs showing that pentosidine is a 1O2 sensitizer that is also subject to attack by the 1O2 resulting in the photobleaching that is observed when probing tissue using NIR. The photobleaching reaction is kinetically first order in pentosidine and ground state oxygen, and in vivo effectively first order with NIR irradiation also