Non‐invasive recordings of fetal electrocardiogram during pregnancy using electric potential sensors

In this letter, we report the early detection of fetal cardiac electrical activity recorded from the maternal abdomen non-invasively. We developed a portable and non-invasive, prototype based on electric potential sensing technology to monitor both: the mother and fetal heart activity during pregnancy. In this proof of principle demonstration, we show the suitability of our technology to monitor the fetal heart development starting at week twenty, when the fetus heart is approximately one-tenth the size of an adult’s heart. The study was conducted for ten weeks to demonstrate how the maturation of the fetus leads to a change on the heart rate dynamics as it approaches birth. Importantly, electrocardiogram information is presented without any post processing given that our device eliminates the requirement of signal conditioning algorithms such as having to un-mix both, the maternal and fetal cardiac waveforms. The provided ECG trace allows extracting the heart rate and other heart activity parameters useful for further diagnostics. Finally, our device does not require any gels to be applied so movement induced potential is eliminated. This technology has the potential to be used for determining possible heart related congenital disorders during pregnancy

Quantification of aortic valvuloplasty catheter size using a metrology system based on brightfield microscopy

Balloon aortic valvuloplasty (BAV) has been employed [1] as a simple and low-cost treatment method for patients with severe aortic stenosis, for symptom palliation in patients considered inoperable, for aortic valve replacement and to select the proper transcatheter heart valve (THV) size. During THV implantation choosing the correct balloon size is paramount for minimizing the risks of coronary occlusion, annular damage or THV embolization. Current methods for selecting the proper balloon dimensions are based on transesophageal echocardiography and computed tomography requiring trained staff for image interpretation, expensive equipment and high doses of patient radiation exposure. Alternative methods propose the use of BAV to determine the correct THV size before its implantation [2]. The strategy is based on determining the BAV aortic anulus using a sterile caliper. Any slight pressure to the balloon may compromise the measurement accuracy. In this paper, we present a non-contact metrology system for BAV measurement based on bright field microscopy (BFM). The balloons under test (MedTek-22 and TrueDilation-22) were clamped vertically, employing a tension spring to restrict movement and ensure perpendicularity to the microscope optical axis. The BFM is based on an Olympus PLN 4X WD~18.5mm, NA 0.1, a tube lens (f~180mm) and a FL3-U3- 13S2M-CS camera mounted on top of a custom-made linear stage having a coarse resolution of ~ 3.3µm. Balloon expansion was performed using a Boston scientific Encore 26 inflation device. The balloons are made up of an outer shell with an internal catheter tube (Ø~2mm). By focusing the microscope on the internal tube, then moving the linear stage to refocus on the balloon outer wall, the inner tube to outer wall dimension (see figure inset) can be accurately measured using the linear stage digital readout. The balloon was inflated up to six times recording the pressure and radius at each stage of inflation (twice the amount required for THV). Our non-contact method preserves the catheter sterile conditions and allows the accurate measurement of the BAV anulus showing: a) repeatability of the achieved balloon radius within all the inflation rounds, b) accurate measurements with a standard error of ±200 µm c) and a variation of 1.38 ±0.0387 mm from the manufacturer data. Knowing the exact balloon dimensions is crucial for avoiding the adverse consequences of THV oversizing. Our method may potentially improve the safety and efficacy of THV implantation

A novel non-invasive biosensor based on electric field detection for cardio-electrophysiology in zebrafish embryos

In this paper we report a novel biosensor based on electric field detection for recording cardiac electrical activity in zebrafish embryos. Using Sussex patented Electric Potential Sensing technology, a portable, non-invasive and cost-effective platform is developed to monitor in vivo electrocardiogram activity from the zebrafish heart. Cardiac activity signals were successfully detected from living zebrafish embryos starting at 3 days-post-fertilizatio

Measuring consumer grade face masks degradation upon sterilization using bright field microscopy

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Automated carotid endarterectomy surgery using a low cost remodelled industrial robotic arm

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QoSatAr: a cross-layer architecture for E2E QoS provisioning over DVB-S2 broadband satellite systems

This article presents QoSatAr, a cross-layer architecture developed to provide end-to-end quality of service (QoS) guarantees for Internet protocol (IP) traffic over the Digital Video Broadcasting-Second generation (DVB-S2) satellite systems. The architecture design is based on a cross-layer optimization between the physical layer and the network layer to provide QoS provisioning based on the bandwidth availability present in the DVB-S2 satellite channel. Our design is developed at the satellite-independent layers, being in compliance with the ETSI-BSM-QoS standards. The architecture is set up inside the gateway, it includes a Re-Queuing Mechanism (RQM) to enhance the goodput of the EF and AF traffic classes and an adaptive IP scheduler to guarantee the high-priority traffic classes taking into account the channel conditions affected by rain events. One of the most important aspect of the architecture design is that QoSatAr is able to guarantee the QoS requirements for specific traffic flows considering a single parameter: the bandwidth availability which is set at the physical layer (considering adaptive code and modulation adaptation) and sent to the network layer by means of a cross-layer optimization. The architecture has been evaluated using the NS-2 simulator. In this article, we present evaluation metrics, extensive simulations results and conclusions about the performance of the proposed QoSatAr when it is evaluated over a DVB-S2 satellite scenario. The key results show that the implementation of this architecture enables to keep control of the satellite system load while guaranteeing the QoS levels for the high-priority traffic classes even when bandwidth variations due to rain events are experienced. Moreover, using the RQM mechanism the user’s quality of experience is improved while keeping lower delay and jitter values for the high-priority traffic classes. In particular, the AF goodput is enhanced around 33% over the drop tail scheme (on average)

Characterization of magnetically triggerable millirobots for on demand drug delivery using a brightfield microscopy metrology system

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Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362