Algorithm for evaluating tissue circulation based on spectral changes in wearable photoplethysmography device

Tissue circulation monitoring is an effective method to detect compromised circulation in time after tissue transplantation. Use of flexible photoplethysmography (PPG) devices for tissue circulation monitoring allows the continuous measurement of signals at multiple positions on the tissue. An algorithm of tissue circulation evaluation that considers motion artifacts is also necessary for such devices, although conventional motion evaluation algorithms cannot be used with weak PPG signals during compromised circulation. In this study, we developed an algorithm that discriminates between three states – normal circulation, compromised circulation, and artifacts. We measured the signals from different attachment positions on eight healthy volunteers for investigating the variation of signals between these positions. We then applied the algorithm to evaluate normal and compromised circulations during a resting position and with motion events. The efficiency of the algorithm was evaluated based on the data usage and specificity calculated from one-week continuous measurements. The results show that, for all volunteers, the algorithm correctly identified normal and compromised circulation signals even when the signal was partially corrupted due to motion artifacts. Seriously corrupted data were identified as artifacts. Data usage and specificity during one-week monitoring on volunteers were 89.7 ± 3.0% and 99.3 ± 0.6%, respectively. The results indicate that our device achieves effective one-week monitoring on tissues and our algorithm correctly evaluates tissue circulation with wearable PPG devices. Our device and algorithm have the potential to assist medical staff during post-operative observation of transplanted tissues

Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial

Abstract Background Perinatal mental health problems such as mood disorders are common. We propose a new multidisciplinary health service intervention program providing continuous support to women and their children from the start of pregnancy till after childbirth. The aim of this study was to examine the effects of the program with respect to making women’s mental health better in the postpartum period and improving the state of care for women and their children in the perinatal period. Methods We performed a controlled study to investigate the effectiveness of the program in Suzaka City, Japan. The women’s mental health status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 3 months postpartum. Of 349 women, 210 were allocated to the intervention group and 139 to the control group. From April 2014 to March 2015, the number of the pregnant women who were followed-up by the multidisciplinary meeting in the intervention and control groups were 60 and 4, respectively. In the same period, the number of the pregnant women who were identified as requiring intensive care were 21 and 2, respectively. Results The total EPDS score, which was the primary outcome of the present study, differed significantly between the intervention and control groups (Mean [SD] = 2.74 (2.89) and 4.58 [2.62], respectively; p < 0.001). The number of the women receiving counseling from a public health nurse (5.3% in intervention group, 0.7% in control group, p = 0.02), attending maternal seminars (attendant ratio: 46% whereas 16%, p = 0.01), and receiving home visits by public health nurses (home visit ratio: 93.8% whereas 82.6%, p < 0.001) was significantly higher in the intervention group compared to the control group. Conclusions The present study indicates that continuum support provided by integrated mental health care through a multidisciplinary maternal and child health service in the community can make women's mental health better in the postpartum period and help women and their children receive more health services from public health nurses. Trial registration Name of registry: Research for the effectiveness of a multi-professional health service intervention program of continuum supports for mother and child which starts for pregnancy periods to enhance maternal mental health. UMIN Clinical Trials Registry number: UMIN000032424. Registration date: April 29th, 2018. Registration timing: retrospective

Multipoint Tissue Circulation Monitoring with a Flexible Optical Probe

Abstract Compromised circulation is a potential complication during the postoperative period following tissue transplantation. The use of a monitoring device allows physicians to detect compromised circulation immediately. Such monitoring devices need to be continuously usable, wearable, and area-detectable. However, existing devices fail to satisfy all of these requirements simultaneously. We developed a wearable, multipoint pulse wave-monitoring device. An array of reflective optical sensors implemented on a thin film substrate was used as a lightweight and flexible probe. As a model of tissue transplantation, an inguinal flap in a Wistar rat was dissected and freed from all subcutaneous tissue. By ligating the artery or vein, ischemia or congestion was induced in the tissue. In a human study, ischemia or congestion was induced in the palm by pressing the feeding artery or cutaneous vein, respectively. The amplitude of the pulse wave was evaluated using the power spectrum of Fourier transformed signals. Pulse wave amplitude significantly decreased under compromised circulation in both animal and human models. Moreover, we accomplished 1 week of continuous wireless monitoring in healthy subjects. These results demonstrated the potential utility of the developed device in postoperative blood-flow monitoring to improve the rescue rate of transplanted tissue