Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends

Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients

Human activity recognition on smartphones using a multiclass hardware-friendly support vector machine

Activity-Based Computing aims to capture the state of the user and its environment by exploiting heterogeneous sensors in order to provide adaptation to exogenous computing resources. When these sensors are attached to the subject’s body, they permit continuous monitoring of numerous physiological signals. This has appealing use in healthcare applications, e.g. the exploitation of Ambient Intelligence (AmI) in daily activity monitoring for elderly people. In this paper, we present a system for human physical Activity Recognition (AR) using smartphone inertial sensors. As these mobile phones are limited in terms of energy and computing power, we propose a novel hardware-friendly approach for multiclass classification. This method adapts the standard Support Vector Machine (SVM) and exploits fixed-point arithmetic for computational cost reduction. A comparison with the traditional SVM shows a significant improvement in terms of computational costs while maintaining similar accuracy, which can contribute to develop more sustainable systems for AmI.Peer ReviewedPostprint (author's final draft

Satellite (IRLS) tracking of elk

The practicability of tracking free roaming animals in natural environments by satellite systems is reported. Satellite systems combine continuous tracking with simultaneous monitoring of physiological and environmental parameters through a combination of radio tracking and biotelemetric ground systems that lead to a better understanding of animal behavior and migration patterns

Real-time sweat pH monitoring based on a wearable chemical barcode micro-fluidic platform incorporating ionic liquids

This work presents the fabrication, characterisation and the performance of a wearable, robust, flexible and disposable chemical barcode device based on a micro-fluidic platform that incorporates ionic liquid polymer gels (ionogels). The device has been applied to the monitoring of the pH of sweat in real time during an exercise period. The device is an ideal wearable sensor for measuring the pH of sweat since it does not contents any electronic part for fluidic handle or pH detection and because it can be directly incorporated into clothing, head- or wristbands, which are in continuous contact with the skin. In addition, due to the micro-fluidic structure, fresh sweat is continuously passing through the sensing area providing the capability to perform continuous real time analysis. The approach presented here ensures immediate feedback regarding sweat composition. Sweat analysis is attractive for monitoring purposes as it can provide physiological information directly relevant to the health and performance of the wearer without the need for an invasive sampling approac

Interstitial Glucose and Physical Exercise in Type 1 Diabetes: Integrative Physiology, Technology, and the Gap In-Between

Continuous and flash glucose monitoring systems measure interstitial fluid glucose concentrations within a body compartment that is dramatically altered by posture and is responsive to the physiological and metabolic changes that enable exercise performance in individuals with type 1 diabetes. Body fluid redistribution within the interstitial compartment, alterations in interstitial fluid volume, changes in rate and direction of fluid flow between the vasculature, interstitium and lymphatics, as well as alterations in the rate of glucose production and uptake by exercising tissues, make for caution when interpreting device read-outs in a rapidly changing internal environment during acute exercise. We present an understanding of the physiological and metabolic changes taking place with acute exercise and detail the blood and interstitial glucose responses with different forms of exercise, namely sustained endurance, high-intensity, and strength exercises in individuals with type 1 diabetes. Further, we detail novel technical information on currently available patient devices. As more health services and insurance companies advocate their use, understanding continuous and flash glucose monitoring for its strengths and limitations may offer more confidence for patients aiming to manage glycemia around exercise

Trial of Remote Continuous versus Intermittent NEWS monitoring after major surgery (TRaCINg): protocol for a feasibility randomised controlled trial

Background: Despite medical advances, major surgery remains high risk. Up to 44% of patients experience postoperative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this study is to evaluate the feasibility, acceptability and clinical impacts of continuous remote monitoring after major surgery. Methods: The study is a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery will be invited to participate if they have the capacity to provided informed, written consent and do not have a cardiac pacemaker or an allergy to adhesives. Participants will be randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring will be achieved using the SensiumVitals® wireless patch which is worn on the patient’s chest and monitors heart rate, respiratory rate and temperature continuously and alerts the nurse when there is deviation from pre-set physiological norms. Participants will be followed up throughout their hospital admission and for 30 days after discharge. Feasibility will be assessed by evaluating recruitment rate, adherence to protocol and randomisation, and the amount of missing data. The acceptability of the patch to nursing staff and patients will be assessed using questionnaires and interviews. Clinical outcomes will include time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of readmission within 30 days of discharge. Discussion: Early detection and treatment of complications minimises the need for critical care, improves patient outcomes, and produces significant cost savings for the healthcare system. Remote continuous monitoring systems have the potential to allow earlier detection of complications, but evidence from the literature is mixed. Demonstrating significant benefit over intermittent monitoring to offset the practical and economic implications of continuous monitoring requires well-controlled studies in high-risk populations to demonstrate significant differences in clinical outcomes; this feasibility trial seeks to provide evidence of how best to conduct such a confirmatory trial. Trial registration: This study is listed on the ISRCTN registry with study ID ISRCTN16601772

Continuous blood glucose monitoring reveals enormous circadian variations in pregnant diabetic rats

Aim: Diabetes in pregnancy is a major burden with acute and long-term consequences. Its treatment requires adequate diagnosis and monitoring of therapy. Many experimental research on diabetes during pregnancy has been performed in rats. Recently, continuous blood glucose monitoring of non-pregnant diabetic rats revealed an increased circadian variability of blood glucose that made a single blood glucose measurement per day inappropriate to reflect glycemic status. Continuous blood glucose measurement has never been performed in pregnant rats. We wanted to perform continuous blood glucose monitoring in pregnant rats to decipher the influence of pregnancy on blood glucose in diabetic and normoglycemic status. Methods: We used the transgenic Tet29 diabetes rat model with an inducible knock down of the insulin receptor via RNA interference upon application of doxycycline (DOX) leading to insulin resistant type II diabetes. All Tet29 rats received a HD-XG telemetry implant (Data Sciences International, USA) that measured blood glucose and activity continuously. Rats were divided into four groups and blood glucose was monitored until end of pregnancy or the corresponding period: Tet29 + DOX (diabetic) non-pregnant, Tet29 + DOX (diabetic) pregnant, Tet29 (normoglycemic) non-pregnant, Tet29 (normoglycemic) pregnant. Results: Allanalyzed rats displayed a circadian variation in blood glucose concentration. Circadian variability was much more pronounced in pregnant diabetic rats than in normoglycemic pregnant rats. Pregnancy ameliorated variation in blood glucose in diabetic situation. Pregnancy continuously decreased blood glucose during normoglycemic pregnancy. Diabetic rats were less active than normoglycemic rats. We performed a calculation showing that application of continuous blood glucose measurement reduces Interpretation: Continuous blood glucose monitoring via a telemetry device in pregnant rats provides a more informative picture of the glycemic situation in comparison to single measurements. This could improve diagnosis and therapy of diabetes, decrease animal numbers within experimental settings, and add another physiological parameter (activity) to the analysis that could be helpful in testing therapeutic concepts targeting blood glucose levels and peripheral muscle function. We propose continuous glucose monitoring as a new tool for the evaluation of pregnant diabetic rats

A review of machine learning techniques in photoplethysmography for the non-invasive cuff-less measurement of blood pressure

Hypertension or high blood pressure is a leading cause of death throughout the world and a critical factor for increasing the risk of serious diseases, including cardiovascular diseases such as stroke and heart failure. Blood pressure is a primary vital sign that must be monitored regularly for the early detection, prevention and treatment of cardiovascular diseases. Traditional blood pressure measurement techniques are either invasive or cuff-based, which are impractical, intermittent, and uncomfortable for patients. Over the past few decades, several indirect approaches using photoplethysmogram (PPG) have been investigated, namely, pulse transit time, pulse wave velocity, pulse arrival time and pulse wave analysis, in an effort to utilise PPG for estimating blood pressure. Recent advancements in signal processing techniques, including machine learning and artificial intelligence, have also opened up exciting new horizons for PPG-based cuff less and continuous monitoring of blood pressure. Such a device will have a significant and transformative impact in monitoring patients’ vital signs, especially those at risk of cardiovascular disease. This paper provides a comprehensive review for non-invasive cuff-less blood pressure estimation using the PPG approach along with their challenges and limitations