Review on Smart Electro-Clothing Systems (SeCSs)

This review paper presents an overview of the smart electro-clothing systems (SeCSs) targeted at health monitoring, sports benefits, fitness tracking, and social activities. Technical features of the available SeCSs, covering both textile and electronic components, are thoroughly discussed and their applications in the industry and research purposes are highlighted. In addition, it also presents the developments in the associated areas of wearable sensor systems and textile-based dry sensors. As became evident during the literature research, such a review on SeCSs covering all relevant issues has not been presented before. This paper will be particularly helpful for new generation researchers who are and will be investigating the design, development, function, and comforts of the sensor integrated clothing materials

Wearable devices for remote vital signs monitoring in the outpatient setting: an overview of the field

Early detection of physiological deterioration has been shown to improve patient outcomes. Due to recent improvements in technology, comprehensive outpatient vital signs monitoring is now possible. This is the first review to collate information on all wearable devices on the market for outpatient physiological monitoring. A scoping review was undertaken. The monitors reviewed were limited to those that can function in the outpatient setting with minimal restrictions on the patient’s normal lifestyle, while measuring any or all of the vital signs: heart rate, ECG, oxygen saturation, respiration rate, blood pressure and temperature. A total of 270 papers were included in the review. Thirty wearable monitors were examined: 6 patches, 3 clothing-based monitors, 4 chest straps, 2 upper arm bands and 15 wristbands. The monitoring of vital signs in the outpatient setting is a developing field with differing levels of evidence for each monitor. The most common clinical application was heart rate monitoring. Blood pressure and oxygen saturation measurements were the least common applications. There is a need for clinical validation studies in the outpatient setting to prove the potential of many of the monitors identified. Research in this area is in its infancy. Future research should look at aggregating the results of validity and reliability and patient outcome studies for each monitor and between different devices. This would provide a more holistic overview of the potential for the clinical use of each device

Occupational physical activity in sedentary and active workers

2017 Spring.Includes bibliographical references.With the increasing use of technology in the workplace, many jobs are becoming more sedentary. The purpose of this study was to establish a quantitative baseline measure of occupational physical activity (OPA) in active and sedentary workers. Two activity trackers (Fitbit Charge HR™ and Hexoskin) were used to assess activity measures (step count, heart rate and energy expenditure) among workers during their work shift. The first objective of the study was to assess the agreement between two types of accelerometer-based activity trackers as measures of OPA. The second objective of this study was to assess differences in measures of OPA among workers in physically active and sedentary work environments. There was a statistically significant difference in measures of total step counts between the two devices. When comparing active and sedentary workers there were also statistically significant differences in measures of step counts, mean percent heart rate increase, maximum heart rate range and energy expenditure. Conclusion: The Fitbit Charge HR™ and Hexoskin had significant differences in measures of step counts and heart rate. When comparing active and sedentary workers, there were significant differences in measures of step counts, mean heart rate, maximum heart rate range required by job, and energy expenditure. The results of the present study provide quantitative evidence that active workers require greater physiologic demands than sedentary workers

Smart vest for respiratory rate monitoring of COPD patients based on non-contact capacitive sensing

In this paper, a first approach to the design of a portable device for non-contact monitoring of respiratory rate by capacitive sensing is presented. The sensing system is integrated into a smart vest for an untethered, low-cost and comfortable breathing monitoring of Chronic Obstructive Pulmonary Disease (COPD) patients during the rest period between respiratory rehabilitation exercises at home. To provide an extensible solution to the remote monitoring using this sensor and other devices, the design and preliminary development of an e-Health platform based on the Internet of Medical Things (IoMT) paradigm is also presented. In order to validate the proposed solution, two quasi-experimental studies have been developed, comparing the estimations with respect to the golden standard. In a first study with healthy subjects, the mean value of the respiratory rate error, the standard deviation of the error and the correlation coefficient were 0.01 breaths per minute (bpm), 0.97 bpm and 0.995 (p < 0.00001), respectively. In a second study with COPD patients, the values were -0.14 bpm, 0.28 bpm and 0.9988 (p < 0.0000001), respectively. The results for the rest period show the technical and functional feasibility of the prototype and serve as a preliminary validation of the device for respiratory rate monitoring of patients with COPD.Ministerio de Ciencia e Innovación PI15/00306Ministerio de Ciencia e Innovación DTS15/00195Junta de Andalucía PI-0010-2013Junta de Andalucía PI-0041-2014Junta de Andalucía PIN-0394-201

Incorporating End-User Feedback in the Development and Validation of a Smart Textile for assessing Sports Training and Performance

Objectives: The aims of the research project were to explore the need and desire of a new sport wearable within applied practice by creating dialogue with the end-users. Furthermore, the research project sets out to quantify the reliability and validity a new sports wearable, KiTT (Knitted intelligent Textile Tracker), against the current gold-standard three-dimensional motion-analysis counter-part. Methods: Study 1 will utilise semi-structured interviews to create dialogue between the researcher and end-users. This will help provide an image into the current use of technology within applied practice. Furthermore, study 2 will capture and calculate the relative knee angles from KiTT’s raw resistance, and compare the results to that of Vicon, where reliability and validity will be assessed; this is imperative before task-specific research. Results: Study 1 identified a need, and requirement for new sport wearables, specifically in the form of e-textiles. This would enable end-users to adopt technology into their work, potentially enhancing their output. In addition, study 2 suggests that KiTT serves as a valid and reliable tool at recording relative knee angle across five commonly used sporting exercises, with high degrees of accuracy. Conclusion: End-users stated a need and requirement for technology such as KiTT to be created for adoption within their practice. Current systems are often inaccessible and can lead to performance losses. KiTT serves as a valid alternative to motion-capture, whilst offering more benefits to the user (cost-friendly, easy to use, and portable). When investigating an individual’s relative knee angle, KiTT should be considered especially in specific testing conditions

Continuous monitoring of vital parameters for clinically valid assessment of human health status

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Sinais e Imagens Médicas) Universidade de Lisboa, Faculdade de Ciências, 2019The lack of devices suitable for acquiring accurate and reliable measures of patients' physiolog-ical signals in a remote and continuous manner together with the advances in data acquisition technol-ogies during the last decades, have led to the emergence of wearable devices for healthcare. Wearable devices enable remote, continuous and long-term health monitoring in unattended setting. In this con-text, the Swiss Federal Laboratories for Material Science and Technology (Empa) developed a wearable system for long-term electrocardiogram measurements, referred to as textile belt. It consists of a chest strap with two embroidered textile electrodes. The validity of Empa’s system for electrocardiogram monitoring has been proven in a clinical setting. This work aimed to assess the validity of the textile belt for electrocardiogram monitoring in a home setting and to supplement the existing system with sensors for respiratory monitoring. Another objective was to evaluate the suitability of the same weara-ble, as a multi-sensor system, for activity monitoring. A study involving 12 patients (10 males and 2 females, interquartile range for age of 48–59 years and for body mass indexes of 28.0–35.5 kg.m-2) with suspected sleep apnoea was carried out. Overnight electrocardiogram was measured in a total of 28 nights. The quality of recorded signals was assessed using signal-to-noise ratio, artefacts detection and Poincaré plots. Study data were compared to data from the same subjects, acquired in the clinical setting. For respiratory monitoring, optical fibre-based sensors of different geometries were integrated into the textile belt. Signal processing algorithms for breathing rate and tidal volume estimation based on respiratory signals acquired by the sensors were developed. Pilot studies were conducted to compare the different approaches for respiratory monitoring. The quality of respiratory signals was determined based on signal segments “sinusoidality”, evaluated through the calculation of the cross-correlation between signal segments and segment-specific reference waves. A method for accelerometry-based lying position recognition was proposed, and the proof of concept of activity intensity classification through the combination of subjects’ inertial acceleration, heart rate and breathing rate data, was presented. Finally, a study with three participants (1 male and 2 females, aged 21 ± 2 years, body mass index of 20.3 ± 1.5 kg.m-2) was conducted to assess the validity of the textile belt for respiratory and activity monitoring. Electrocardiogram signals acquired by the textile belt in the home setting were found to have better quality than the data acquired by the same device in the clinical setting. Although a higher artefact percentage was found for the textile belt, signal-to-noise ratio of electrocardiogram signals recorded by the textile belt in the home setting was similar to that of signals acquired by the gel electrodes in the clinical setting. A good agreement was found between the RR-intervals derived from signals recorded in home and clinical settings. Besides, for artefact percentages greater than 3%, visual assessment of Poincaré plots proved to be effective for the determination of the primary source of artefacts (noise or ectopic beats). Acceleration data allowed posture recognition (i.e. lying or standing/sitting, lying position) with an accuracy of 91% and positive predictive value of 80%. Lastly, preliminary results of physical activity intensity classification yielded high accuracy, showing the potential of the proposed method. The textile belt proved to be appropriate for long-term, remote and continuous monitoring of subjects’ physical and physiological parameters. It can monitor not only electrocardiogram, but also breathing rate, body posture and physical activity intensity, having the potential to be used as tool for disease prediction and diagnose support.Contexto: A falta de dispositivos adequados para a monitorização de sinais fisiológicos de um modo remoto e contínuo, juntamente com avanços tecnológicos na área de aquisição de dados nas últimas décadas, levaram ao surgimento de wearable devices, i.e. dispositivos vestíveis, no sector da saúde. Wearable devices possibilitam a monitorização do estado de saúde, de uma forma remota, contínua e de longa duração. Quando feito em ambiente domiciliar, este tipo de monitorização (i.e. contínua, remota e de longa duração) tem várias vantagens: diminui a pressão posta sobre o sistema de saúde, reduz despesas associadas ao internamento e acelera a resposta a emergências, permitindo deteção precoce e prevenção de condições crónicas. Neste contexto, a Empa, Laboratórios Federais Suíços de Ciência e Tecnologia de Materiais, desenvolveu um sistema vestível para a monitorização de eletrocardiograma de longa duração. Este sistema consiste num cinto peitoral com dois elétrodos têxteis integrados. Os elétrodos têxteis são feitos de fio de polietileno tereftalato revestido com prata e uma ultrafina camada de titânio no topo. De modo a garantir a aquisição de sinais de alta qualidade, o cinto tem nele integrado um reservatório de água que liberta vapor de água para humidificar os elétrodos. Este reservatório per-mite a monitorização contínua de eletrocardiograma por 5 a 10 dias, sem necessitar de recarga. A vali-dade do cinto para a monitorização de eletrocardiograma em ambiente clínico já foi provada. Objetivo: Este trabalho teve por objetivo avaliar a validade do cinto para a monitorização de eletrocar-diograma em ambiente domiciliar e complementar o sistema existente com sensores para monitorização respiratória. Um outro objetivo foi analisar a adequação do cinto, como um sistema multisensor, para monitorização da atividade física. Métodos: Um estudo com 12 pacientes com suspeita de apneia do sono (10 homens e 2 mulheres, am-plitude interquartil de 48–59 anos para a idade e de 28.0–35.5 kg.m-2 para o índice de massa corporal) foi conduzido para avaliar a qualidade do sinal de eletrocardiograma medido em ambiente domiciliar. O sinal de eletrocardiograma dos pacientes foi monitorizado continuamente, num total de 28 noites. A qualidade dos sinais adquiridos foi analisada através do cálculo da razão sinal-ruído; da deteção de ar-tefactos, i.e., intervalos RR com um valor inviável de um ponto de vista fisiológico; e de gráficos de Poincaré, um método de análise não linear da distribuição dos intervalos RR registados. Os dados ad-quiridos neste estudo foram comparados com dados dos mesmos pacientes, adquiridos em ambiente hospitalar. Para a monitorização respiratória, sensores feitos de fibra óptica foram integrados no cinto. Al-gorítmicos para a estimar a frequência respiratória e o volume corrente dos sujeitos tendo por base o sinal medido pelas fibras ópticas foram desenvolvidos neste trabalho. As diferentes abordagens foram comparadas através de estudos piloto. Diferentes métodos para avaliação da qualidade do sinal adquirido foram sugeridos. Um método de reconhecimento da postura corporal através do cálculo de ângulos de orientação com base na aceleração medida foi proposto. A prova de conceito da determinação da intensidade da atividade física pela combinação de informações relativas á aceleração inercial e frequências cardíaca e respiratória dos sujeitos, é também apresentada neste trabalho. Um estudo foi conduzido para avaliar a validade do cinto para monitorização da respiração e da atividade física. O estudo contou com 10 parti-cipantes, dos quais 3 vestiram o cinto para monitorização da respiração (1 homem e 2 mulheres, idade 21 ± 2 anos, índice de massa corporal 20.3 ± 1.5 kg.m-2). Resultados: O estudo feito com pacientes com suspeita de apneia do sono revelou que os sinais eletro-cardiográficos adquiridos pelo cinto em ambiente domiciliar foram de melhor qualidade que os sinais adquiridos pelo mesmo dispositivo em ambiente hospitalar. Uma percentagem de artefacto de 2.87% ±4.14% foi observada para os dados adquiridos pelos elétrodos comummente usados em ambiente hospi-talar, 7.49% ± 10.76% para os dados adquiridos pelo cinto em ambiente domiciliar e 9.66% ± 14.65% para os dados adquiridos pelo cinto em ambiente hospitalar. Embora tenham tido uma maior percenta-gem de artefacto, a razão sinal-ruído dos sinais eletrocardiográficos adquiridos pelo cinto em ambiente domiciliar foi semelhante á dos sinais adquiridos pelos elétrodos de gel em ambiente hospitalar. Resul-tados sugerem uma boa concordância entre os intervalos RR calculados com base nos eletrocardiogra-mas registados em ambientes hospitalar e domiciliar. Além disso, para sinais com percentagem de arte-facto superior a 3%, a avaliação visual dos gráficos de Poincaré provou ser um bom método para a determinação da fonte primária de artefactos (batimentos irregulares ou ruído). A monitorização da aceleração dos sujeitos permitiu o reconhecimento da postura corporal (isto é, deitado ou sentado/em pé) com uma exatidão de 91% e valor preditivo positivo de 80%. Por fim, a classificação da intensidade da atividade física baseado na aceleração inercial e frequências cardíaca e respiratória revelou elevada exatidão, mostrando o potencial desta técnica. Conclusão: O cinto desenvolvido pela Empa provou ser apropriado para monitorização de longa-dura-ção de variáveis físicas e fisiológicos, de uma forma remota e contínua. O cinto permite não só monito-rizar eletrocardiograma, mas também frequência respiratória, postura corporal e intensidade da atividade física. Outros estudos devem ser conduzidos para corroborar os resultados e conclusões deste trabalho. Outros sensores poderão ser integrados no cinto de modo a possibilitar a monitorização de outras vari-áveis fisiológicas de relevância clínica. Este sistema tem o potencial de ser usado como uma ferramenta para predição de doenças e apoio ao diagnóstico

Validity of the Hexoskin intelligent textile criterion for evaluating cardiorespiratory function in a healthy population

L’Hexoskin est un vêtement intelligent, qui permet le télé-monitorage des signaux physiologiques en temps réel. Parmi ces signaux, on retrouve la fonction cardiorespiratoire, qui est caractérisée par la fréquence cardiaque, la fréquence respiratoire et la ventilation. Objectif : Mesurer l’intensité de la relation entre les variables cardiorespiratoires mesurées avec l’Hexoskin et celles mesurées avec l’équipement standard de référence. Méthodes : Trente participants en santé (15 hommes et 15 femmes). La variable d’intérêt est la fonction cardiorespiratoire mesurée simultanément avec l’équipement de référence (système Cosmed) et avec l’Hexoskin. Les participants ont été soumis à une épreuve d’effort maximale selon le protocole BSU/Bruce RAMP permettant de mesurer la fréquence cardiaque, la fréquence respiratoire et la ventilation et d’estimer le volume maximal d’oxygène (VO2max). Afin de documenter la validité de l’Hexoskin pendant des efforts effectués à des intensités sous maximales, les participants ont effectué un test d’effort sous-maximal à quatre intensités : 2 Mets, 3 Mets, 4Mets et 6 Mets. Des analyses statistiques descriptives (erreur RMS, graphique Bland-Altman) et des coefficients de corrélation de Pearson ont été réalisés. Résultats : Les résultats obtenus lors d’une épreuve d’effort maximale se présentent comme suit : la fréquence cardiaque (r = allant de 0,97 à 0,99 ; RMS = 0,05±0,02 ; p<0,05), la fréquence respiratoire (r = allant de 0,89 à 0,99 ; RMS = 0,07±0,03 ; p<0,05) et la ventilation (r = allant de 0,16 à 0,37 ; RMS= 0,89±0,35 ; p<0,05). Les résultats des tests d’effort sous maximaux sont les suivants pour la fréquence cardiaque à 2 Mets (r = 0,99 ; RMS= 0,03±0,003); 3 Mets (r = 0,99 ; 0,04±0,017); 4 Mets (r = 0,99 ; 0,02±0,015) et à 6 Mets (r =0,99; 0,03±0,005). Pour la frequence respiratoire à 2 Mets (r = 0,98 ; RMS = 0,09±0,003); à 3 Mets (r = 0,99; 0,06±0,003); à 4 Mets (r = 0,99; 0,03±0,008) et à 6 Mets (r =0,98; 0,04±0,006). Les résultats de la ventilation sont: à 2 Mets (r =0,55 ; RMS = 0,38±0,02) ; à 3 Mets (r =0,48; 0,43±0,04); à 4 Mets (r =0,45; 0,52±0,03) et à 6 Mets (r =0,43; 0,62±0,03). Conclusion: L’excellente corrélation ainsi que la faible erreur RMS obtenus pour la fréquence cardiaque, la fréquence respiratoire lors d'un effort maximal et aux efforts sous maximaux confirment la validité concourante de l'Hexoskin. L’absence de corrélation pour la ventilation peut-être expliquée par l’équation d’estimation de ce paramètre.Abstract: Hexoskin is an intelligent clothing, which allows the remote monitoring of physiological signals in real-time. These signals include cardiorespiratory function, which is characterized by various parameters such as heart rate, respiratory frequency and ventilation. Aim. The objective of this study is to measure the intensity of the relationship between cardiorespiratory variables measured with Hexoskin and those measured with standard reference equipment (contributing criterion validity study). Methods: Thirty voluntary and healthy participants (15 men and 15 women) were recruited to participate in this validation study. The variable of interest is the cardiorespiratory function measured simultaneously with the reference equipment (COSMED system) and the Hexoskin. Participants were subjected to a maximum stress test during treadmill walking according to the BSU/Bruce RAMP protocol, which measures heart rate, respiratory rate and ventilation and estimates the maximum oxygen volume (VO2max). To document the validity of the Hexoskin during efforts at submaximum intensities, the participants then carried out three walking tests on the treadmill at four intensities: 2 Mets, 3 Mets, 4Mets and 6 Mets. Descriptive statistical analyses (RMS error, Bland-Altman graph) and Pearson correlation coefficients were performed. Results: Maximum stress test results show that the heart rate (r = 0.97 to 0.99; RMS = 0.05±0.02; p<0.05), respiratory rate (r = 0.89 to 0.99; RMS = 0.07±0.03; p<0.05) and ventilation (r = 0.16 to 0.37; RMS = 0.89± The results of the submaximum stress tests are as follows for heart rate at 2 Mets (r = 0.99; RMS= 0.03±0.003); 3 Mets (r = 0.99;0.04±0.017); 4 Mets (r = 0.99;0.02±0.015) and 6 Mets (r =0.99;0.03±0.005). For respiratory frequency, the results are 2 Mets (r = 0.98; RMS = 0.09±0.003); 3 Mets (r = 0.99;0.06±0.003); 4 Mets (r = 0.99;0.03±0.008) and 6 Mets (r = 0.98;0.04±0.006). Finally, the results of the breakdown at the 4 physical activity intensities are as follows: 2 Mets (r =0.55; MSR = 0.38±0.02); 3 Mets (r =0.48;0.43±0.04); 4 Mets (r =0.45;0.52±0.03) and 6 Mets (r =0.43;0.62±0.03). Conclusion: the excellent correlation and low RMS error for heart rate, respiratory rate at maximum effort and submaximum stress confirm the concurrent validity of Hexoskin for these two parameters. The lack of correlation for the breakdown may be explained by the estimation equation for this parameter

Improving clinician burnout factors during emergency care of COVID-19 through rapidly adaptive simulation and a randomized control trial

BACKGROUND: In March of 2020, the novel coronavirus 2019 (COVID-19) pandemic required healthcare systems to be rapidly responsive to adapt hospital guidelines for the most up-to-date care and safety protocols as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate, and non-COVID-19 patients have now returned to the emergency department for care. This increase in patient volume leads to new challenges and threats to patient and clinician safety as suspected COVID-19 patients need to be quickly detected and isolated amongst other patients with non-COVID-19 related illnesses. In addition, emergency physicians face continued personal safety concerns and increased work burden on the front lines, heightening stress and anxiety. Burnout is a serious concern for emergency physicians due to the cumulative pressures of their daily practice, even under non-pandemic circumstances. Given the prolonged course of the pandemic, burnout may likely present as a longer-term outcome of these acute stressors. METHODS: A rapidly adaptive simulation-based approach was implemented to understand and improve physician preparedness while decreasing physician stress and anxiety. A randomized control trial was conducted to test the effectiveness of a simulation preparedness intervention on physician physiologic stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory. OUTCOMES: Front-line EM physicians participated in a simulation-based educational intervention aimed to facilitate the adoption of protocols and treatment algorithms. Four virtual simulation scenarios highlighted the care pathways a practitioner might implement when managing a COVID-19 positive patient. A debriefing session followed each scenario to interactively analyze the learners' management decisions. The discussion focused on the most current hospital protocols so that any gaps in knowledge could be successfully addressed. The scenarios were iteratively updated, and the debriefing emphasis changed to deliver the newest clinical guidance and operational procedures as they evolved while continuing to highlight the aspects of care that remained challenging. Ongoing analysis of the physiological data is still being conducted. NEXT-STEPS: Mixed model analysis of physiologic and self-report measures of stress and anxiety will be used to determine if this virtual simulation intervention improves adherence to guidelines and protocols in the clinical setting and its impact on physicians while on shift. The next steps include further dissemination and objective feedback from institutions that may adopt this learning intervention

Open Source Quantitative Stress Prediction Leveraging Wearable Sensing and Machine Learning Methods

The ability to monitor physiological parameters in an individual is paramount for the evaluation of physical health and the detection of many ailments. Wearable technologies are being introduced on a widening scale to address the absence of low-cost and non-invasive health monitoring as compared to medical grade equipment and technologies. By leveraging wearable technologies to supplement or replace traditional gold-standard measurement techniques, the research community can develop a deeper multifaceted understanding of the relationship between specific physiological parameters and particular health conditions. One particular research area in which wearable technologies are beginning to see application is the quantification of physical and mental stress levels in individuals through brainwave and physiological feature monitoring. At present, these methods are time consuming, invasive, expensive, or some combination of the three. This thesis chronicles the development and application of a novel open source wearable sensing platform to the field of stress and fatigue estimation and quantization. More specifically, the garment in its current configuration monitors heart rate, blood oxygen saturation, skin temperature, respiration rate, and skin conductivity parameters to explore the relationship between these parameters and various self-reported stress measures. Utilizing machine-learning methods, subject-specific models were generated in an n=1 study which predicts the self-perceived stress level of the subject with an accuracy of between 92% and 100%. The garment was developed with a modular interface and open source code base to allow and encourage reconfiguration and customization of the sensor array for other research applications. The dataset generated in this effort spans the early stages of the COVID-19 pandemic as the subject experienced increasing levels of isolation and tracks physiological parameters across two months via daily measurements