An experimental method for bio-signal denoising using unconventional sensors

In bio-signal denoising, current methods reported in literature consider purely simulated envi-ronments, requiring high computational powers and signal processing algorithms that may in-troduce signal distortion. To achieve an efficient noise reduction, such methods require previous knowledge of the noise signals or to have certain periodicity and stability, making the noise es-timation difficult to predict. In this paper, we solve these challenges through the development of an experimental method applied for bio-signal denoising using a combined approach. This is based on the implementation of unconventional electric field sensors used for creating a noise replica required to obtain the ideal Wiener filter transfer function and achieve further noise reduction. This work aims to investigate the suitability of the proposed approach for the real-time noise reduction affecting bio-signal recordings. The experimental evaluation presented considers two scenarios: a) human bio-signals trials including electrocardiogram, electromyogram and elec-trooculogram; and b) bio-signal recordings from the MIT-MIH arrhythmia database. The per-formance of the proposed method is evaluated using qualitative (i.e. power spectral density) and quantitative criteria (i.e. signal-to-noise ratio and mean square error) followed by a comparison between the proposed methodology and state of the art denoising methods. The results indicate that the combined approach proposed in this paper can be used for noise reduction in electro-cardiogram, electromyogram and electrooculogram signals achieving noise attenuation levels of 26.4 dB, 21.2 dB and 40.8 dB, respectively

Neo-SENSE: a non-invasive smart sensing mattress for cardiac monitoring of babies

Within the first minute of life a newborn must take its first breath to make the transition from life inside the womb to the outside world. If a baby does not start breathing, its heart rate will drop and the circulation of blood carrying oxygen to the organs will be seriously affected. The damage done to a newborn who is deprived of oxygen happens so quickly that rapid response is imperative. During birth, the attending neonatal staff manually listen to the baby´s heart and count the heart rate; however, this has proven inaccurate and inefficient. Nowadays, there is not a reliable method to monitor newborn heart rate promptly throughout birth. In this paper, we report the design and development of a novel smart mattress device to measure the babies’ electrocardiogram and respiration non-invasively. The device is based on electrometer-based amplifier sensors combined with novel screen-printing techniques. Proof of concept tests are carried out to demonstrate the suitability of the smart-mattress for new born ECG monitoring. We perform tests with a young infant and demonstrate the potential of this sensing technology to provide a quick and reliable application as ECG readings were displayed within a time < 30 seconds. This will aid the neonatal staff to assess the success of the resuscitation technology aiming to lower the incidence of long-term consequences of poor adaptation to life outside the womb

A Team Observed Structured Clinical Encounter (TOSCE) for Pre-Licensure Learners in Maternity Care: A Short Report on the Development of an Assessment Tool for Collaboration

Background: Despite the support for Interprofessional Education (IPE) among policymakers, educators and professional regulating bodies, the research literature is limited with respect to the evaluation of effective assessment strategies. This short report outlines the development of a Team Observed Structured Clinical Encounter (TOSCE), which brings together learners from three health professions involved in primary care obstetrics-family physicians, midwives, and obstetricians-as a strategy for assessing collaborative competencies.Methods: An interprofessional research team was brought together to develop and implement the TOSCE. The process by which the team generated TOSCE scenario stations is outlined, including the consensus-building process, based on a modified Delphi technique, to include expert input from others in the field of practice.Findings: The scenarios developed by the research team for the TOSCE are highlighted including the assessment criteria, based on the Canadian InterprofessionalHealth Collaborative's National Competency Framework.Conclusions: The TOSCE is an emerging and innovative learning tool that encourages the development of essential collaborative competencies. The process of developing a TOSCE outlined in this report offers an affordable, streamlined approach that could be used by educators in many disciplines as a summative or formative assessment strategy

Characterisation of textile embedded electrodes for use in a neonatal smart mattress electrocardiography system

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system

Evaluation of screen-printing techniques for embedding ECG sensors in medical devices

Heart rate monitoring is the most important indicator to evaluate the clinical status of a newborn during birth. Approximately 90% of newborn infants make the transition from the intrauterine to extra uterine environment without major complications; however, the remaining 10% of newborn infants require assistance during this transition. Heart rate monitoring is required for guiding further interventions in the event of complications such as the need for resuscitation. In this work we evaluate the suitability of embedding electrometer-based-amplifier sensors employing novel screen-printing techniques into medical devices. We compare our results with traditional copper based wired electrodes. Our implementation was able to acquire electrocardiogram with enough signal to noise ratio, suitable for heart rate detection with a 1% loss of heart rate accuracy, compared with the copper-based electrodes. Our device has the potential to be embedded in devices for assisting births though heart rate monitoring

Non-invasive sensor methods used in monitoring newborn babies after birth, a clinical perspective

Background Reducing the global new-born mortality is a paramount challenge for humanity. There are approximately 786,323 live births in the UK each year according to the office for National Statistics; around 10% of these newborn infants require assistance during this transition after birth. Each year around, globally around 2.5 million newborns die within their first month. The main causes are complications due to prematurity and during delivery. To act in a timely manner and prevent further damage, health professionals should rely on accurate monitoring of the main vital signs heart rate and respiratory rate. Aims To present a clinical perspective on innovative, non-invasive methods to monitor heart rate and respiratory rate in babies highlighting their advantages and limitations in comparison with well-established methods. Methods Using the data collected in our recently published systematic review we highlight the barriers and facilitators for the novel sensor devices in obtaining reliable heart rate measurements. Details about difficulties related to the application of sensors and interfaces, time to display, and user feedback are explored. We also provide a unique overview of using a non-invasive respiratory rate monitoring method by extracting RR from the pulse oximetry trace of newborn babies. Results Novel sensors to monitor heart rate offer the advantages of minimally obtrusive technologies but have limitations due to movement artefact, bad sensor coupling, intermittent measurement, and poor-quality recordings compared to gold standard well established methods. Respiratory rate can be derived accurately from pleth recordings in infants. Conclusion Some limitations have been identified in current methods to monitor heart rate and respiratory rate in newborn babies. Novel minimally invasive sensors have advantages that may help clinical practice. Further research studies are needed to assess whether they are sufficiently accurate, practical, and reliable to be suitable for clinical use

Longitudinal Cognitive Changes in Genetic Frontotemporal Dementia Within the GENFI Cohort

Background and ObjectivesDisease-modifying therapeutic trials for genetic frontotemporal dementia (FTD) are underway, but sensitive cognitive outcome measures are lacking. The aim of this study was to identify such cognitive tests in early stage FTD by investigating cognitive decline in a large cohort of genetic FTD pathogenic variant carriers and by investigating whether gene-specific differences are moderated by disease stage (asymptomatic, prodromal, and symptomatic).MethodsC9orf72, GRN, and MAPT pathogenic variant carriers as well as controls underwent a yearly neuropsychological assessment covering 8 cognitive domains as part of the Genetic FTD Initiative, a prospective multicenter cohort study. Pathogenic variant carriers were stratified according to disease stage using the global Clinical Dementia Rating (CDR) plus National Alzheimer\u27s Coordinating Center (NACC) FTLD score (0, 0.5, or ≥1). Linear mixed-effects models were used to investigate differences between genetic groups and disease stages as well as the 3-way interaction between time, genetic group, and disease stage.ResultsA total of 207 C9orf72, 206 GRN, and 86 MAPT pathogenic variant carriers and 255 controls were included. C9orf72 pathogenic variant carriers performed lower on attention, executive function, and verbal fluency from CDR plus NACC FTLD 0 onwards, with relatively minimal decline over time regardless of the CDR plus NACC FTLD score (i.e., disease progression). The cognitive profile in MAPT pathogenic variant carriers was characterized by lower memory performance at CDR plus NACC FTLD 0.5, with decline over time in language from the CDR plus NACC FTLD 0.5 stage onwards, and executive dysfunction rapidly developing at CDR plus NACC FTLD ≥1. GRN pathogenic variant carriers declined on verbal fluency and visuoconstruction in the CDR plus NACC FTLD 0.5 stage, with progressive decline in other cognitive domains starting at CDR plus NACC FTLD ≥1.DiscussionWe confirmed cognitive decline in the asymptomatic and prodromal stage of genetic FTD. Specifically, tests for attention, executive function, language, and memory showed clear differences between genetic groups and controls at baseline, but the speed of change over time differed depending on genetic group and disease stage. This confirms the value of neuropsychological assessment in tracking clinical onset and progression and could inform clinical trials in selecting sensitive end points for measuring treatment effects as well as characterizing the best time window for starting treatment

IL28B, HLA-C, and KIR Variants Additively Predict Response to Therapy in Chronic Hepatitis C Virus Infection in a European Cohort: A Cross-Sectional Study

Vijayaprakash Suppiah and colleagues show that genotyping hepatitis C patients for the IL28B, HLA-C, and KIR genes improves the ability to predict whether or not patients will respond to antiviral treatment

MBOAT7 rs641738 increases risk of liver inflammation and transition to fibrosis in chronic hepatitis C

Cirrhosis likely shares common pathophysiological pathways despite arising from a variety of liver diseases. A recent GWAS identified rs641738, a polymorphism in the MBOAT7 locus, as being associated with the development of alcoholic cirrhosis. Here we explore the role of this variant on liver inflammation and fibrosis in two cohorts of patients with chronic hepatitis C. In 2,051 patients, rs641738 associated with severe hepatic inflammation and increased risk of fibrosis, as well as fast fibrosis progression. At functional level, rs641738 associated with MBOAT7 transcript and protein levels in liver and blood, and with serum inflammatory, oxidative stress and macrophage activation markers. MBOAT7 was expressed in immune cell subsets, implying a role in hepatic inflammation. We conclude that the MBOAT7 rs641738 polymorphism is a novel risk variant for liver inflammation in hepatitis C, and thereby for liver fibrosis