Wearable bioimpedance measurement for respiratory monitoring during inspiratory loading

Bioimpedance is an unobtrusive noninvasive technique to measure respiration and has a linear relation with volume during normal breathing. The objective of this paper was to assess this linear relation during inspiratory loading protocol and determine the best electrode configuration for bioimpedance measurement. The inspiratory load is a way to estimate inspiratory muscle function and has been widely used in studies of respiratory mechanics. Therefore, this protocol permitted us to evaluate bioimpedance performance under breathing pattern changes. We measured four electrode configurations of bioimpedance and airflow simultaneously in ten healthy subjects using a wearable device and a standard wired laboratory acquisition system, respectively. The subjects were asked to perform an incremental inspiratory threshold loading protocol during the measurements. The load values were selected to increase progressively until the 60% of the subject's maximal inspiratory pressure. The linear relation of the signals was assessed by Pearson correlation (r) and the waveform agreement by the mean absolute percentage error (MAPE), both computed cycle by cycle. The results showed a median greater than 0.965 in r coefficients and lower than 11 % in the MAPE values for the entire population in all loads and configurations. Thus, a strong linear relation was found during all loaded breathing and configurations. However, one out of the four electrode configurations showed robust results in terms of agreement with volume during the highest load. In conclusion, bioimpedance measurement using a wearable device is a noninvasive and a comfortable alternative to classical methods for monitoring respiratory diseases in normal and restrictive breathing.Postprint (published version

Effects of slow and regular breathing exercise on cardiopulmonary coupling and blood pressure

Investigation of the interaction between cardiovascular variables and respiration provides a quantitative and noninvasive approach to assess the autonomic control of cardiovascular function. The aim of this paper is to investigate the changes of cardiopulmonary coupling (CPC), blood pressure (BP) and pulse transit time (PTT) during a stepwise-paced breathing (SPB) procedure (spontaneous breathing followed by paced breathing at 14, 12.5, 11, 9.5, 8 and 7 breaths per minute, 3 min each) and gain insights into the characteristics of slow breathing exercises. RR interval, respiration, BP and PTT are collected during the SPB procedure (48 healthy subjects, 27 ± 6 years). CPC is assessed through investigating both the phase and amplitude dynamics between the respiration-induced components from RR interval and respiration by the approach of ensemble empirical mode decomposition. It was found that even though the phase synchronization and amplitude oscillation of CPC were both enhanced by the SPB procedure, phase coupling does not increase monotonically along with the amplitude oscillation during the whole procedure. Meanwhile, BP was reduced significantly by the SPB procedure (SBP: from 122.0 ± 13.4 to 114.2 ± 14.9 mmHg, p < 0.001, DBP: from 82.2 ± 8.6 to 77.0 ± 9.8 mmHg, p < 0.001, PTT: from 172.8 ± 20.1 to 176.8 ± 19.2 ms, p < 0.001). Our results demonstrate that the SPB procedure can reduce BP and lengthen PTT significantly. Compared with amplitude dynamics, phase dynamics is a different marker for CPC analysis in reflecting cardiorespiratory coherence during slow breathing exercise. Our study provides a methodology to practice slow breathing exercise, including the setting of target breathing rate, change of CPC and the importance of regular breathing. The applications and usability of the study results have also been discussed.National Natural Science Foundation (China) (Grant Number: 61471398)Beijing Natural Science Foundation (Grant Number: 3122034)General Logistics Science Foundation (Grant Number: CWS11C108)National Key Technology Research and Development Program (Grant Numbers: 2013BAI03B04, 2013BAI03B05

Singing for adults with respiratory Illness: a systematic review and evaluation of a community programme

Background: Respiratory disorders manifest themselves with chest symptoms including shortness of breath and decline in lung function. An innovative cost-effective therapy is needed and there is a growing body of evidence to suggest that singing in a group may have health and wellbeing benefits for these patients. Method: The key objectives of this research were to review current knowledge and to evaluate the potential impact of group singing as an intervention for health and wellbeing. The research is divided into three components which aimed to: - Review, synthesise and consolidate current research in the area of singing for COPD. - Evaluate the impact of group singing on health and wellbeing for a group of COPD patients - Evaluate the usability of specially designed resources for home practice for respiratory patients. Results: A broad systematic review showed that availability of high quality evidence that singing for COPD improves physical health, dyspnoea or respiratory-specific quality of life is still very limited. This is due to the low number of high quality studies and small sample sizes. The study reported here found statistically significant positive changes in both total mean Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and COPD Assessment Test (CAT) scores for twenty-one COPD participants of two community singing groups over a twelve-week period. These changes were maintained up to thirty-weeks for sixteen participants that continued. The research also successfully piloted the use of resources designed for self management. Conclusion: There are promising findings from this and other studies on the impact of singing for COPD on health and wellbeing. However, the outcomes of this research are consistent with those outlined in recent reviews and it is recommended that larger randomised controlled trials with longer durations are conducted

Devices and Data Workflow in COPD Wearable Remote Patient Monitoring: A Systematic Review

Background: With global increase in Chronic Obstructive Pulmonary Disease (COPD) prevalence and mortality rates, and socioeconomical burden continuing to rise, current disease management strategies appear inadequate, paving the way for technological solutions, namely remote patient monitoring (RPM), adoption considering its acute disease events management benefit. One RPM’s category stands out, wearable devices, due to its availability and apparent ease of use. Objectives: To assess the current market and interventional solutions regarding wearable devices in the remote monitoring of COPD patients through a systematic review design from a device composition, data workflow, and collected parameters description standpoint. Methods: A systematic review was conducted to identify wearable device trends in this population through the development of a comprehensive search strategy, searching beyond the mainstream databases, and aggregating diverse information found regarding the same device. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and quality appraisal of identified studies was performed using the Critical Appraisal Skills Programme (CASP) quality appraisal checklists. Results: The review resulted on the identification of 1590 references, of which a final 79 were included. 56 wearable devices were analysed, with the slight majority belonging to the wellness devices class. Substantial device heterogeneity was identified regarding device composition type and wearing location, and data workflow regarding 4 considered components. Clinical monitoring devices are starting to gain relevance in the market and slightly over a third, aim to assist COPD patients and healthcare professionals in exacerbation prediction. Compliance with validated recommendations is still lacking, with no devices assessing the totality of recommended vital signs. Conclusions: The identified heterogeneity, despite expected considering the relative novelty of wearable devices, alerts for the need to regulate the development and research of these technologies, specially from a structural and data collection and transmission standpoints.Introdução: Com o aumento global das taxas de prevalência e mortalidade da Doença Pulmonar Obstrutiva Crónica (DPOC) e o seu impacto socioeconómico, as atuais estratégias de gestão da doença parecem inadequadas, abrindo caminho para soluções tecnológicas, nomeadamente para a adoção da monitorização remota, tendo em conta o seu benefício na gestão de exacerbações de doenças crónicas. Dentro destaca-se uma categoria, os dispositivos wearable, pela sua disponibilidade e aparente facilidade de uso. Objetivos: Avaliar as soluções existentes, tanto no mercado, como na área de investigação, relativas a dispositivos wearable utilizados na monitorização remota de pacientes com DPOC através de uma revisão sistemática, do ponto de vista da composição do dispositivo, fluxo de dados e descrição dos parâmetros coletados. Métodos: Uma revisão sistemática foi realizada para identificar tendências destes dispositivos, através do desenvolvimento de uma estratégia de pesquisa abrangente, procurando pesquisar para além das databases convencionais e agregar diversas informações encontradas sobre o mesmo dispositivo. Para tal, foram seguidas as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), e a avaliação da qualidade dos estudos identificados foi realizada utilizando a ferramenta CASP (Critical Appraisal Skills Programme). Resultados: A revisão resultou na identificação de 1590 referências, das quais 79 foram incluídas. Foram analisados 56 dispositivos wearable, com a ligeira maioria a pertencer à classe de dispositivos de wellness. Foi identificada heterogeneidade substancial nos dispositivos em relação à sua composição, local de uso e ao fluxo de dados em relação a 4 componentes considerados. Os dispositivos de monitorização clínica já evidenciam alguma relevância no mercado e, pouco mais de um terço, visam auxiliar pacientes com DPOC e profissionais de saúde na previsão de exacerbações. Ainda assim, é notória a falta do cumprimento das recomendações validadas, não estando disponíveis dispositivos que avaliem a totalidade dos sinais vitais recomendados. Conclusão: A heterogeneidade identificada, apesar de esperada face à relativa novidade dos dispositivos wearable, alerta para a necessidade de regulamentação do desenvolvimento e investigação destas tecnologias, especialmente do ponto de vista estrutural e de recolha e transmissão de dados

Evaluating Blood Pressure and Hypertension Awareness in Municipal Workers in the Southeast US

The primary purpose of this study was to describe municipal workers’ blood pressure (BP) status and awareness; the secondary purpose was to examine the association between BP misconception and department. Municipal employees in a southeastern rural community (n=75) were asked to participate in a 15-minute survey, including the BASIS Hypertension Awareness survey, and blood pressure measurements to determine hypertension risk. Results show a significant difference in diastolic blood pressure (DBP) between police with a higher DBP of 87.64 ± 10.9 mm Hg and fire departments 78.98 ± 11.1 mm Hg (p=0.005), a significant difference in DBP between city hall/public works with a DBP of 86.47 ± 7.8 mm Hg and the lower DBP of the fire department of 78.98 ± 11.1 mm Hg (p=0.039), and a significant difference in total BASIS score between city hall/public works with a higher score of 4.58 ± 2.4 compared to the police department score of 3.01 ± 1.4 (p=0.017). It is recommended that lifestyle changes are utilized with municipal workers to manage blood pressure and improve blood pressure awareness such as regular BP testing, dietary changes, consistent physical activity, reducing physical inactivity, sleeping 6-8 hours per night, and limiting occupational stress

Advanced sensing technologies and systems for lung function assessment

Chest X-rays and computed tomography scans are highly accurate lung assessment tools, but their hazardous nature and high cost remain a barrier for many patients. Acoustic imaging is an alternative to lung function assessment that is non-hazardous, less costly, and has a patient-to-equipment approach. In this thesis, the suitability of acoustic imaging for lung health assessment is proven via systematic review and numerical airway modelling. An acoustic lung sound acquisition system, consisting of an optimal denoising filter translated into imaging for continual and reliable lung function assessment, is then developed. To the author’s best knowledge, locating obstructed airways via an acoustic lung model andthe resulting acoustic lung imaging have yet to be investigated in the open literature; hence,a novel acoustic lung spatial model was first developed in this research, which links acousticlung sounds and acoustic images with pathologic changes. About 89% structural similaritybetween an acoustic reference image based on actual lung sound and the developed modelacoustic image based on the computation of airway impedance was achieved. External interference is inevitable in lung sound recordings; thus, an indirect unifying of wavelet-based total variation (WATV) and empirical Wiener denoising filter is proposed to enhance recorded lung sound signals. To the author’s best knowledge, the integration of WATV and Wiener filters has not been investigated for lung sound signals. Selection and analysis of optimal parameters for the denoising filter were performed through a case study. The optimal parameters achieved through simulation studies led to an average 12.69 ± 5.05 dB improvement in signal-to-noise ratio (SNR), and the average SNR was improved by 16.92 ± 8.51 dB in the experimental studies. The hybrid denoising filter significantly enhances the signal quality of the captured lung sounds while preserving the characteristics of a lung sound signal and is less sensitive to the variation of SNR values of the input signal. A robust system was developed based on the established lung spatial model and denoising filter through hardware redesign and signal processing, which outperformed commercial digital stethoscopes regarding SNR and root mean square error by about 8 dB and 0.15, respectively. Regarding sensing sensitivity power spectrum mapping, the developed system sensors’ position is neutral, as opposed to digital stethoscopes, when representing lung signals, with a signal power loss ratio of around 5 dB compared to 10 dB from digital stethoscopes. The developed system obtains better detection by about 10% in the obstructed airway region compared to digital stethoscopes in the experimental studies

Ultimate Guide to Outpatient Care

The book presents a qualitative and quantitative approach to understanding, managing, and collaborating outpatient care. Utilizing a sound theoretical and practical foundation and illustrating procedural techniques through scientific examples, this book provides a comprehensive overview of outpatient care whether it occurs via telemedicine or in a hospital, clinic, prison, school, or other settings

The relationship between Infantile Postural Asymmetry and unsettled behavior in babies: a quantitative observational study

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateBackground: Unsettled infant behaviour is a common problem of infancy without known aetiology or effective management, and it is costly in both social and economic terms. Some osteopaths propose that musculoskeletal dysfunction contributes to unsettled infant behaviour, yet reported improvement following osteopathic treatment is anecdotal. A primary issue is the absence of a measurement tool to test musculoskeletal dysfunction in infants. Aims and Objectives: This research aimed to investigate: the reliability and validity of the infantile postural asymmetry (IPA) measurement scale; whether there was a relationship between IPA and unsettled infant behaviour as measured by the Revised Infant Behavior Questionnaire – short form (IBQ-Rs); and whether any relationship between IPA and unsettled infant behaviour was mediated by, or confounded with, the demographic variables of age, sex, birth weight and weight gain in twelve- to sixteen-week-old infants. Methods: Fifty-eight infants aged twelve- to sixteen-weeks-old were recruited through public health clinics, and their behaviour was assessed using the parent-report IBQ-Rs. Infantile asymmetry was measured using observer ratings of spontaneous movements in the IPA scale. A quantitative cross-sectional observational design was used to investigate the relationship between IPA and unsettled behaviour. Results: An association between unsettled behaviour and musculoskeletal dysfunction was not found in twelve- to sixteen-week-old infants using the IPA measurement scale. Ratings for the trunk convexity parameter of the IPA scale were unreliable and excluded from statistical analysis. A significant difference between high and low cervical rotation deficit groups for Surgency was detected in female babies and needs further examination. Some subsets of the IBQ-Rs were unstable when measuring behaviour in twelve- to sixteen-week-old infants. Future research targeting infants younger than twelve-weeks-old, and presenting with unsettled behaviour, is indicated. Conclusion: A causal relationship between unsettled infant behaviour and musculoskeletal dysfunction is still unproven. The literature suggests benefits associated with a consistent approach to providing parents with information, support and advice on normal behaviour patterns and optimal handling of infants. Non-specific effects cannot be ruled out in reported improvements following osteopathic treatment. Management strategies require early implementation and a multidisciplinary approach. The absence of common terminology in infant behaviour problems is an obstacle in cross-professional communication. A role for osteopathy may be in developing a shared language to facilitate management and research, and to examine the importance of positioning and handling practices on infant asymmetry and the relationship with the musculoskeletal system