Analysis of Consistency of Transthoracic Bioimpedance Measurements Acquired with Dry Carbon Black PDMS Electrodes, Adhesive Electrodes, and Wet Textile Electrodes

The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing components to be embedded into a monitoring vest for measuring TBI and the electrocardiogram (ECG). We recruited N = 20 subjects to collect TBI and ECG data. The TBI parameters were different between the various types of electrodes. Inter-subject variability for copper-mesh CB/PDMS electrodes and Ag/AgCl electrodes was lower compared to textile electrodes, and the intra-subject variability was similar between the copper-mesh CB/PDMS and Ag/AgCl. We concluded that the copper mesh CB/PDMS (CM/CB/PDMS) electrodes are a suitable alternative for textile electrodes for TBI measurements, but with the benefit of better skin adherence and without the requirement of wetting the electrodes, which can often be forgotten by the stressed HF subjects

Machine Learning Model Based on Transthoracic Bioimpedance and Heart Rate Variability for Lung Fluid Accumulation Detection: Prospective Clinical Study

BACKGROUND: Accumulation of excess body fluid and autonomic dysregulation are clinically important characteristics of acute decompensated heart failure. We hypothesized that transthoracic bioimpedance, a noninvasive, simple method for measuring fluid retention in lungs, and heart rate variability, an assessment of autonomic function, can be used for detection of fluid accumulation in patients with acute decompensated heart failure. OBJECTIVE: We aimed to evaluate the performance of transthoracic bioimpedance and heart rate variability parameters obtained using a fluid accumulation vest with carbon black-polydimethylsiloxane dry electrodes in a prospective clinical study (System for Heart Failure Identification Using an External Lung Fluid Device; SHIELD). METHODS: We computed 15 parameters: 8 were calculated from the model to fit Cole-Cole plots from transthoracic bioimpedance measurements (extracellular, intracellular, intracellular-extracellular difference, and intracellular-extracellular parallel circuit resistances as well as fitting error, resonance frequency, tissue heterogeneity, and cellular membrane capacitance), and 7 were based on linear (mean heart rate, low-frequency components of heart rate variability, high-frequency components of heart rate variability, normalized low-frequency components of heart rate variability, normalized high-frequency components of heart rate variability) and nonlinear (principal dynamic mode index of sympathetic function, and principal dynamic mode index of parasympathetic function) analysis of heart rate variability. We compared the values of these parameters between 3 participant data sets: control (n=32, patients who did not have heart failure), baseline (n=23, patients with acute decompensated heart failure taken at the time of admittance to the hospital), and discharge (n=17, patients with acute decompensated heart failure taken at the time of discharge from hospital). We used several machine learning approaches to classify participants with fluid accumulation (baseline) and without fluid accumulation (control and discharge), termed with fluid and without fluid groups, respectively. RESULTS: Among the 15 parameters, 3 transthoracic bioimpedance (extracellular resistance, R0; difference in extracellular-intracellular resistance, R0 - Rinfinity, and tissue heterogeneity, alpha) and 3 heart rate variability (high-frequency, normalized low-frequency, and normalized high-frequency components) parameters were found to be the most discriminatory between groups (patients with and patients without heart failure). R0 and R0 - Rinfinity had significantly lower values for patients with heart failure than for those without heart failure (R0: P=.006; R0 - Rinfinity: P=.001), indicating that a higher volume of fluids accumulated in the lungs of patients with heart failure. A cubic support vector machine model using the 5 parameters achieved an accuracy of 92% for with fluid and without fluid group classification. The transthoracic bioimpedance parameters were related to intra- and extracellular fluid, whereas the heart rate variability parameters were mostly related to sympathetic activation. CONCLUSIONS: This is useful, for instance, for an in-home diagnostic wearable to detect fluid accumulation. Results suggest that fluid accumulation, and subsequently acute decompensated heart failure detection, could be performed using transthoracic bioimpedance and heart rate variability measurements acquired with a wearable vest. Emily Ensom, Eric Ding, Anna Hayes, Jarno Riistama, Chad Darling, David McManus, Ki H. Chon. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 27.08.2020

Analysis of Consistency of Transthoracic Bioimpedance Measurements Acquired with Dry Carbon Black PDMS Electrodes, Adhesive Electrodes, and Wet Textile Electrodes

The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing components to be embedded into a monitoring vest for measuring TBI and the electrocardiogram (ECG). We recruited N = 20 subjects to collect TBI and ECG data. The TBI parameters were different between the various types of electrodes. Inter-subject variability for copper-mesh CB/PDMS electrodes and Ag/AgCl electrodes was lower compared to textile electrodes, and the intra-subject variability was similar between the copper-mesh CB/PDMS and Ag/AgCl. We concluded that the copper mesh CB/PDMS (CM/CB/PDMS) electrodes are a suitable alternative for textile electrodes for TBI measurements, but with the benefit of better skin adherence and without the requirement of wetting the electrodes, which can often be forgotten by the stressed HF subjects

Electrodermal Activity: What it can Contribute to the Assessment of the Autonomic Nervous System

About 70 million people worldwide are affected by dysfunction of the autonomic nervous system (ANS). These dysfunctions can lead to life-threatening conditions, because ANS controls vital functions like heart rate, digestion, respiration, among others. Spectral analysis of heart rate variability (HRV) allows noninvasive assessment of the ANS. However, the low frequencies (0.04-0.15 Hz) of HRV are influenced by the two complementary branches of the ANS, the sympathetic and parasympathetic nervous systems; hence, the spectral analysis cannot separate the dynamics of these autonomic tones. Developing reliable noninvasive techniques for assessment of the ANS dynamics remains a challenge for scientists. Recently, measure of electrodermal activity (EDA) has gained popularity for ANS assessment. EDA signal represents the changes of conductance in the skin, produced by purely sympathetic innervation of sweat glands. Time-domain measures of EDA, such as the skin conductance level (SCL) and skin conductance responses (SCR), are correlated to the sympathetic control, but they lack of consistency. Surprisingly, EDA has been analyzed only in time domain. In this work, using a frequency domain measure via the spectral analysis, we established for the first time that frequency bands of the sympathetic tone in EDA is mostly confined to the 0.045-0.25 Hz range. We termed this power the EDASymp. Furthermore, utilizing a high-resolution time-varying approach we found that the frequency band of 0.08-0.24 Hz is most responsive to sympathetic tone, which we termed, the TVSymp. The EDASymp and TVSymp are more sensitive and consistent discriminators of orthostatic, physical and cognitive stress than time-domain measures of EDA and can quantitatively assess the sympathetic function. Moreover, we found that the sympathetic tone in EDA dynamically changes to higher frequencies when subjects exercise. This result can be useful for adjusting the bounds of HRV when heart rate increases. Currently, the same frequency bounds for the ANS for resting and exercise conditions have been used. Another application of EDA is monitoring of sleep deprivation. Using 24-hour sleep deprivation experiments, we found that high-frequencies (SCR) of EDA relate to vigilance whereas low-frequencies (SCL) relate to reactiveness. Based on these results, we found that EDA could potentially be used to assist in prevention of fatigue and stress which are the direct and dire consequences of prolonged wakefulness. As a final aim of my dissertation work, evaluations of novel dry carbon/salt/adhesive (CSA) electrodes for obtaining electrocardiogram, surface electromyogram and EDA were investigated. We found non-statistical difference between the carbon/salt/adhesive electrodes for the above mentioned applications when the electrodes were compared to the gold standard silver/silver chloride electrodes. Moreover, it was found that carbon electrodes exhibited better response to noise and motion artifacts when compared to hydrogel Ag/AgCl electrodes. Hence, we concluded that CSA electrodes can be reliably used as a surrogate of the Ag/AgCl electrodes along with the advantage of being more cost effective alternative as they have longer shelf-life

Machine Learning models for the Identification of Cognitive Tasks using Autonomic Reactions from Heart Rate Variability and Electrodermal Activity

Indices of heart rate variability (HRV) and electrodermal activity (EDA), in conjunction with machine learning models, were used to identify one of three tasks a subject is performing based on autonomic response elicited by the specific task. Using non-invasive measures to identify the task performed by a subject can help to provide individual monitoring and guidance to avoid the consequences of reduced performance due to fatigue or other stressors. In the present study, sixteen subjects were enrolled to undergo three tasks: The psychomotor vigilance task (PVT), an auditory working memory task (the n-back paradigm), and a visual search (ship search, SS). Electrocardiogram (ECG) (for HRV analysis) and EDA data were collected during the tests. For task-classification, we tested four machine learning classification tools: k-nearest neighbor classifier (KNN), support vector machines (SVM), decision trees, and discriminant analysis (DA). Leave-one-subject-out cross-validation was used to evaluate the performance of the constructed models to prevent overfitting. The most accurate models were the KNN (66%), linear SVM (62%), and linear DA (62%). The results of this study showed that it is possible to identify the task a subject is performing based on the subject’s autonomic reactions (from HRV and EDA). This information can be used to monitor individuals within a larger group to assist in reducing errors caused by uncoordinated or poor performance by allowing for automated tracking of and communication between individuals

Innovations in Electrodermal Activity Data Collection and Signal Processing: A Systematic Review

The electrodermal activity (EDA) signal is an electrical manifestation of the sympathetic innervation of the sweat glands. EDA has a history in psychophysiological (including emotional or cognitive stress) research since 1879, but it was not until recent years that researchers began using EDA for pathophysiological applications like the assessment of fatigue, pain, sleepiness, exercise recovery, diagnosis of epilepsy, neuropathies, depression, and so forth. The advent of new devices and applications for EDA has increased the development of novel signal processing techniques, creating a growing pool of measures derived mathematically from the EDA. For many years, simply computing the mean of EDA values over a period was used to assess arousal. Much later, researchers found that EDA contains information not only in the slow changes (tonic component) that the mean value represents, but also in the rapid or phasic changes of the signal. The techniques that have ensued have intended to provide a more sophisticated analysis of EDA, beyond the traditional tonic/phasic decomposition of the signal. With many researchers from the social sciences, engineering, medicine, and other areas recently working with EDA, it is timely to summarize and review the recent developments and provide an updated and synthesized framework for all researchers interested in incorporating EDA into their research

Analysis of Risk Factors and Symptoms of Burnout Syndrome in Colombian School Teachers under Statutes 2277 and 1278 Using Machine Learning Interpretation

In 2002, the Colombian ministry of education released statute 1278, for teaching professionalization, superseding statute 2277 of 1977. Although statute 1278 was intended to increase the quality of the education service and teachers’ remuneration, there is evidence that the abundant evaluations and hindered promotion system introduced by statute 1278 resulted in an impairment of the quality of life of the teachers, and a higher incidence of burnout syndrome. We used two techniques for machine learning interpretability, SHapley Additive exPlanation summary plots and predictor importance, to interpret support vector machine and decision tree machine learning models, respectively, to better understand the differences on risk factors and symptoms of burnout syndrome in school teachers under statutes 2277 and 1278. We have surveyed 54 school teachers between August and October 2018, 17 under statute 2277, and 37 under statute 1278. Among the risk factors and symptoms of burnout syndrome considered in this study, we found that the satisfaction with earnt income was the most relevant risk factor, followed by the overtime work and the perceived severity of the sanctions on lower performance. The most relevant symptoms of burnout were fatigue at the end of the day, and frequent headaches. This methodology can be potentially used in other contexts and social groups, allowing institutional authorities and policy makers to allocate resources to specific issues affecting a particular group of workers

Sympathetic Arousal Detection in Horses Using Electrodermal Activity

The continuous monitoring of stress, pain, and discomfort is key to providing a good quality of life for horses. The available tools based on observation are subjective and do not allow continuous monitoring. Given the link between emotions and sympathetic autonomic arousal, heart rate and heart rate variability are widely used for the non-invasive assessment of stress and pain in humans and horses. However, recent advances in pain and stress monitoring are increasingly using electrodermal activity (EDA), as it is a more sensitive and specific measure of sympathetic arousal than heart rate variability. In this study, for the first time, we have collected EDA signals from horses and tested the feasibility of the technique for the assessment of sympathetic arousal. Fifteen horses (six geldings, nine mares, aged 13.11 ± 5.4 years) underwent a long-lasting stimulus (Feeding test) and a short-lasting stimulus (umbrella Startle test) to elicit sympathetic arousal. The protocol was approved by the University of Connecticut. We found that EDA was sensitive to both stimuli. Our results show that EDA can capture sympathetic activation in horses and is a promising tool for non-invasive continuous monitoring of stress, pain, and discomfort in horses

Comparison of Electrodermal Activity from Multiple Body Locations Based on Standard EDA Indices’ Quality and Robustness against Motion Artifact

The most traditional sites for electrodermal activity (EDA) data collection, palmar locations such as fingers or palms, are not usually recommended for ambulatory monitoring given that subjects have to use their hands regularly during their daily activities, and therefore, alternative sites are often sought for EDA data collection. In this study, we collected EDA signals (n = 23 subjects, 19 male) from four measurement sites (forehead, back of neck, finger, and inner edge of foot) during cognitive stress and induction of mild motion artifacts by walking and one-handed weightlifting. Furthermore, we computed several EDA indices from the EDA signals obtained from different sites and evaluated their efficiency to classify cognitive stress from the baseline state. We found a high within-subject correlation between the EDA signals obtained from the finger and the feet. Consistently high correlation was also found between the finger and the foot EDA in both the phasic and tonic components. Statistically significant differences were obtained between the baseline and cognitive stress stage only for the EDA indices computed from the finger and the foot EDA. Moreover, the receiver operating characteristic curve for cognitive stress detection showed a higher area-under-the-curve for the EDA indices computed from the finger and foot EDA. We also evaluated the robustness of the different body sites against motion artifacts and found that the foot EDA location was the best alternative to other sites