Wrist-worn optical and chest strap heart rate comparison in a heterogeneous sample of healthy individuals and in coronary artery disease patients

Abstract Background The need for unobtrusive HR (heart rate) monitoring has led to the development of a new generation of strapless HR monitors. The aim of this study was to determine whether such an unobtrusive, wrist-worn optical HR monitor (OHRM) could be equivalent and therefore a valid alternative to a traditional chest strap during a broad range of activities in a heterogeneous healthy population and coronary artery disease (CAD) patients. Methods One hundred ninety-nine healthy volunteers, 84 males and 115 females, including 35 overweight-obese subjects, 53 pregnant women, and 20 CAD patients were tested in the present study. Second-by-second HR measured by the OHRM was concurrently evaluated against an ECG-based chest strap monitor during a broad range of activities (i.e., walking, running, cycling, gym, household, and sedentary activities). Results Data coverage, percentage of time the OHRM provides a HR not larger than 10 bpm from the reference, went from a minimum of 92% of the time in the least periodic activity (i.e., gym), to 95% during the most intense activity (i.e., running), and to a maximum of 98% for sedentary activities. The limits of agreement of the difference between the OHRM and the chest strap HR were within the range of ±15 bpm. The OHRM showed a concordance correlation coefficient of 0.98. Overall, the mean absolute error was not larger than 3 bpm, which can be considered clinically acceptable for a number of applications. A similar performance was found for CAD (94.2% coverage, 2.4 bpm error), but the small sample size does not allow any quantitative comparison. Conclusion Heart rate measured by OHRM at the wrist and ECG-based HR measured via a traditional chest strap are acceptably close in a broad range of activities in a heterogeneous, healthy population, and showed initial promising results also in CAD patients

Data from: Implementation of an automated early warning scoring system in a surgical ward: practical use and effects on patient outcomes

Introduction: Early warning scores (EWS) are being increasingly embedded in hospitals over the world due to their promise to reduce adverse events and improve the outcomes of clinical patients. The aim of this study was to evaluate the clinical use of an automated modified EWS (MEWS) for patients after surgery. Methods: This study conducted retrospective before-and-after comparative analysis of non-automated and automated MEWS for patients admitted to the surgical high-dependency unit in a tertiary hospital. Operational outcomes included number of recorded assessments of the individual MEWS elements, number of complete MEWS assessments, as well as adherence rate to related protocols. Clinical outcomes included hospital length of stay, in-hospital and 28-day mortality, and ICU readmission rate. Results: Recordings in the electronic medical record from the control period contained 7929 assessments of MEWS elements and were performed in 320 patients. Recordings from the intervention period contained 8781 assessments of MEWS elements in 273 patients, of which 3418 were performed with the automated EWS system. During the control period, 199 (2.5%) complete MEWS were recorded versus 3991 (45.5%) during intervention period. With the automated MEWS systems, the percentage of missing assessments and the time until the next assessment for patients with a MEWS of ≥2 decreased significantly. The protocol adherence improved from 1.1% during the control period to 25.4% when the automated MEWS system was involved. There were no significant differences in clinical outcomes. Conclusion: Implementation of an automated EWS system on a surgical high dependency unit improves the number of complete MEWS assessments, registered vital signs, and adherence to the EWS hospital protocol. However, this positive effect did not translate into a significant decrease in mortality, hospital length of stay, or ICU readmissions. Future research and development on automated EWS systems should focus on data management and technology interoperability

Constrained Cramér-Rao Bound of Multilinear Singular Value Decomposition

README file includes the content and instructions. Generates a 3D tensor, calculates the oracle bound and the constrained cramer rao bound. Prints the singular values of the generated tensor, and the condition number of \mat{V}^T\Omega\mat{V}. Runs the simulation for 1000 Monte Carlo simulations, and creates the plot CRB_plot.png. Abstract: Tensor decomposition methods for signal processing applications are an active area of research. Real data are often low-rank, noisy, and come in a higher-order format. As such, low-rank tensor approximation methods that account for the multidimensional structure of the data are often used for denoising. One way to represent a tensor in a low-rank form is to decompose the tensor into a set of orthonormal factor matrices and an all-orthogonal core tensor using multi-linear singular value decomposition. Under noisy measurements, the lower bound for recovering the factor matrices and the core tensor is unknown. In this paper, we exploit the well-studied constrained Cramér-Rao bound to reconstruct the components of the multilinear singular value decomposition under additive white Gaussian noise, and we validate our approach through simulation

RoA: visual analytics support for deconfounded causal inference in observational studies

Rod of Asclepius (RoA) is a proof-of-concept application that provides visual analytics support for deconfounded causal inference in observational studies. For convenience, a virtual appliance file is made available via DropBox that can be imported into software like VirtualBox. The file includes a pre-installed version of RoA inside a virtual machine running a Linux desktop. The virtual appliance can be downloaded below by clicking on the filename RoA.ova. See the Readme.txt for further instructions. Paper: https://doi.org/10.52933/jdssv.v4i3.72 Github: https://github.com/RodofAsclepius/Ro

Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study

Abstract Background Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors. Methods Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed. Results Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy. Conclusions Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size. Trial registration ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015,

A Potential Multimodal Test for Clinical Assessment of Visual Attention in Neurological Disorders

Attention is an important aspect of human brain function and often affected in neurological disorders. Objective assessment of attention may assist in patient care, both for diagnostics and prognostication. We present a compact test using a combination of a choice reaction time task, eye-tracking and EEG for assessment of visual attention in the clinic. The system quantifies reaction time, parameters of eye movements (i.e. saccade metrics and fixations) and event related potentials (ERPs) in a single and fast (15 min) experimental design. We present pilot data from controls, patients with mild traumatic brain injury and epilepsy, to illustrate its potential use in assessing attention in neurological patients. Reaction times and eye metrics such as fixation duration, saccade duration and latency show significant differences (p < .05) between neurological patients and controls. Late ERP components (200–800 ms) can be detected in the central line channels for all subjects, but no significant group differences could be found in the peak latencies and mean amplitudes. Our system has potential to assess key features of visual attention in the clinic. Pilot data show significant differences in reaction times and eye metrics between controls and patients, illustrating its promising use for diagnostics and prognostication

Experimental acoustic characterisation of an endoskeletal antibubble contrast agent: first results

Raw data connected to the journal article: Anastasiia Panfilova, Peiran Chen, Ruud J.G. van Sloun, Hessel Wijkstra, Michiel Postema, Albert T. Poortinga, Massimo Mischi. Experimental acoustic characterisation of an endoskeletal antibubble contrast agent: first results. Medical Physics, American Association of Physicists in Medicine

Simulated data from A Model-based Approach to Generating Annotated Pressure Support Waveforms

This data was generated based on simulations of the patient-ventilator interaction in research by A. van Diepen et al. [1]. The data contains the airway pressure, flow, and volume waveforms including the labeling of patient and ventilator timings resulting from the simulations. In total, the data contains 1405 simulation runs. Subsequently, the simulated data was used in the development of patient-ventilator asynchrony detection and the evaluation of inspiratory effort estimation, in research by T.H.G.F. Bakkes et al. and A. van Diepen et al., respectively [2, 3]. More details on the contents of the files can be found in the 'Read me' file. [1] A. van Diepen et al., A model-based approach to generating annotated pressure support waveforms, DOI: https://doi.org/10.1007/s10877-022-00822-4 [2] T.H.G.F. Bakkes et al., Automated detection and classification of patient-ventilator asynchrony by means of machine learning and simulated data, DOI: https://doi.org/10.1016/j.cmpb.2022.107333 [3] A. van Diepen et al., Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation, DOI: https://doi.org/10.1016/j.heliyon.2023.e1361

Intrauterine resuscitation during the second stage of term labour by maternal hyperoxygenation versus conventional care: study protocol for a randomised controlled trial (INTEREST O2)

Abstract Background Perinatal asphyxia is, even in developed countries, one the major causes of neonatal morbidity and mortality. Therefore, if foetal distress during labour is suspected, one should try to restore foetal oxygen levels or aim for immediate delivery. However, studies on the effect of intrauterine resuscitation during labour are scarce. We designed a randomised controlled trial to investigate the effect of maternal hyperoxygenation on the foetal condition. In this study, maternal hyperoxygenation is induced for the treatment of foetal distress during the second stage of term labour. Methods/design This study is a single-centre randomised controlled trial being performed in a tertiary hospital in The Netherlands. From among cases of a suboptimal or abnormal foetal heart rate pattern during the second stage of term labour, a total of 116 patients will be randomised to the control group, where normal care is provided, or to the intervention group, where before normal care 100% oxygen is supplied to the mother by a non-rebreathing mask until delivery. The primary outcome is change in foetal heart rate pattern. Secondary outcomes are Apgar score, mode of delivery, admission to the neonatal intensive care unit and maternal side effects. In addition, blood gas values and malondialdehyde are determined in umbilical cord blood. Discussion This study will be the first randomised controlled trial to investigate the effect of maternal hyperoxygenation for foetal distress during labour. This intervention should be recommended only as a treatment for intrapartum foetal distress, when improvement of the foetal condition is likely and outweighs maternal and neonatal side effects. Trial registration EudraCT, 2015-001654-15; registered on 3 April 2015. Dutch Trial Register, NTR5461; registered on 20 October 2015

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

Abstract Background Globally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country. Methods A stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick’s classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score. Discussion This stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries. Trial registration ISRCTN98617255 , retrospectively registered July 23, 2018