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Embedded wireless sensors are important components of mobile distributed computing networks, and one of the target applications areas is health care. The preservation of mobility for senior citizens is one of the key issues in maintaining an independent lifestyle. Thus health technologies inside a car can contribute both to safety issues (supervision of driver fitness) as well as healthcare issues by monitoring vitals signs imperceptibly. In this paper, three embedded measurement techniques for non-contact monitoring of vital signals have been investigated. Specifically, capacitive electrocardiogram (cECG) monitoring, mechanical movement analysis (ballistocardiogram, BCG) using piezo-foils and inductive impedance monitoring were examined regarding their potential for integration into car seats. All three sensing techniques omit the need for electroconductive contact to the human body, but require defined mechanical boundary conditions (stable distances or, in the case of BCG, frictional connection). The physical principles of operation, the specific boundary conditions regarding automotive integration and the results during wireless operation in a running car are presented. All three sensors were equipped with local intelligence by incorporating a microcontroller. To eliminate the need for additional cabling, a wireless Bluetooth communication module was added and used to transmit data to a measurement PC. Finally, preliminary results obtained during test drives on German city roads and highways are discussed. [ABSTRACT FROM AUTHOR]

A novel control method for rotary blood pumps is proposed relying on two different objectives: regulation of pump flow in accordance with desired value and the maintenance of partial support with an open aortic valve by the variation of pump speed. The estimation of pump flow and detection of aortic valve state was performed with mathematical models describing the first- and second generation of Sputnik rotary blood pumps. The control method was validated using a cardiovascular system model. The state of the aortic valve was detected with a mean accuracy of 91% for Sputnik 1 and 96.2% for Sputnik 2 when contractility, heart rate, and systemic vascular resistance was changed. In silico results for both pumps showed that the proposed control method can achieve the desired pump flow level and maintain the open state of the aortic valve by periodically switching between two objectives under contractility, heart rate, and systemic vascular resistance changes. The proposed method showed its potential for safe operation without adverse events and for the improvement of chances for myocardial recovery. [ABSTRACT FROM AUTHOR]

The feasibility of bioimpedance spectroscopy (BIS) techniques for monitoring intradialytic changes in body fluids is advancing. The aim of this study was to compare the knee-to-knee (kkBIS) with the traditional whole-body (whBIS) with respect to continuous assessment of fluid volume status in hemodialysis patients. Twenty patients divided into two groups, hemodynamically stable and unstable, were recruited. Bioimpedance data from two different electrodes configurations (hand-to-foot and knee-to-knee) were collected and retrospectively analysed. A good correlation between the two methods with respect to changes in extracellular resistance (Re) and Re normalized for ultrafiltration volume (∆Re/UFV) with p < 0.001 was observed. The relationship between relative change (%) in ∆Re and that in patient weight was most notable with kkBIS (4.82 ± 3.31%/kg) in comparison to whBIS (3.69 ± 2.90%/kg) in unstable patients. Furthermore, results based on kkBIS showed a reduced ability of the thigh compartments to keep up with the volume changes in the trunk for unstable patients. kkBIS provided a comparable sensitivity to whBIS even in patients at risk of intradialytic hypotension while avoiding the need for the complex implementation imposed by whBIS or other configurations. [ABSTRACT FROM AUTHOR]

Diaphragm atrophy is a common side effect of mechanical ventilation and results in prolonged weaning. Electric phrenic nerve stimulation presents a possibility to avoid diaphragm atrophy by keeping the diaphragm conditioned in sedated patients. There is a need of further investigation on how to set stimulation parameters to achieve sufficient ventilation. A prototype system is presented with a systematic evaluation for stimulation pattern adjustments. The main indicator for efficient stimulation was the tidal volume. The evaluation was performed in two pig models. As a major finding, the results for biphasic pulses were more consistent than for alternating pulses. The tidal volume increased for a range of pulse frequency and pulse width until reaching a plateau at 80–120 Hz and 0.15 ms. Furthermore, the generated tidal volume and the stimulation pulse frequency were significantly correlated (0.42–0.84, p < 0.001 ). The results show which stimulation parameter combinations generate the highest tidal volume. We established a guideline on how to set stimulation parameters. The guideline is helpful for future clinical applications of phrenic nerve stimulation. [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation is an essential component in the treatment of patients with acute respiratory distress syndrome. Prompt adaptation of the settings of a ventilator to the variable needs of patients is essential to ensure personalised and protective ventilation. Still, it is challenging and time-consuming for the therapist at the bedside. In addition, general implementation barriers hinder the timely incorporation of new evidence from clinical studies into routine clinical practice. Results: We present a system combing clinical evidence and expert knowledge within a physiological closed-loop control structure for mechanical ventilation. The system includes multiple controllers to support adequate gas exchange while adhering to multiple evidence-based components of lung protective ventilation. We performed a pilot study on three animals with an induced ARDS. The system achieved a time-in-target of over 75 % for all targets and avoided any critical phases of low oxygen saturation, despite provoked disturbances such as disconnections from the ventilator and positional changes of the subject. Conclusions: The presented system can provide personalised and lung-protective ventilation and reduce clinician workload in clinical practice. [ABSTRACT FROM AUTHOR]

With higher levels of automation in vehicles, the need for robust driver monitoring systems increases, since it must be ensured that the driver can intervene at any moment. Drowsiness, stress and alcohol are still the main sources of driver distraction. However, physiological problems such as heart attacks and strokes also exhibit a significant risk for driver safety, especially with respect to the ageing population. In this paper, a portable cushion with four sensor units with multiple measurement modalities is presented. Capacitive electrocardiography, reflective photophlethysmography, magnetic induction measurement and seismocardiography are performed with the embedded sensors. The device can monitor the heart and respiratory rates of a vehicle driver. The promising results of the first proof-of-concept study with twenty participants in a driving simulator not only demonstrate the accuracy of the heart (above 70% of medical-grade heart rate estimations according to IEC 60601-2-27) and respiratory rate measurements (around 30% with errors below 2 BPM), but also that the cushion might be useful to monitor morphological changes in the capacitive electrocardiogram in some cases. The measurements can potentially be used to detect drowsiness and stress and thus the fitness of the driver, since heart rate variability and breathing rate variability can be captured. They are also useful for the early prediction of cardiovascular diseases, one of the main reasons for premature death. The data are publicly available in the UnoVis dataset. [ABSTRACT FROM AUTHOR]

Background: Hemocompatibility of left ventricular assist devices is essential for preventing adverse events. In this study, we compared the hemocompatibility of an axial-flow (Sputnik) to a centrifugal-flow (HeartMate 3) pump. Methods: Both pumps were integrated into identical in vitro test circuits, each filled with 75 mL heparinized human blood of the same donor. During each experiment (n = 7), the pumps were operated with equal flow for six hours. Blood sampling and analysis were performed on a regular schedule. The analytes were indicators of hemolysis, coagulation activation, platelet count and activation, as well as extracellular vesicles. Results: Sputnik induced higher hemolysis compared to the HeartMate 3 after 360 min. Furthermore, platelet activation was higher for Sputnik after 120 min onward. In the HeartMate 3 circuit, the platelet count was reduced within the first hour. Furthermore, Sputnik triggered a more pronounced increase in extracellular vesicles, a potential trigger for adverse events in left ventricular assist device application. Activation of coagulation showed a time-dependent increase, with no differences between both groups. Conclusions: This experimental study confirms the hypothesis that axial-flow pumps may induce stronger hemolysis compared to centrifugal pumps, coming along with larger amounts of circulating extracellular vesicles and a stronger PLT activation. [ABSTRACT FROM AUTHOR]

Bioimpedance spectroscopy (BIS) is suitable for continuous monitoring of body water content. The combination of body posture and time is a well-known source of error, which limits the accuracy and therapeutic validity of BIS measurements. This study evaluates a model-based correction as a possible solution. For this purpose, an 11-cylinder model representing body impedance distribution is used. Each cylinder contains a nonlinear two-pool model to describe fluid redistribution due to changing body position and its influence on segmental and hand-to-foot (HF) bioimpedance measurements. A model-based correction of segmental (thigh) and HF measurements (Xitron Hydra 4200) in nine healthy human subjects (following a sequence of 7 min supine, 20 min standing, 40 min supine) has been evaluated. The model-based compensation algorithm represents a compromise between accuracy and simplicity, and reduces the influence of changes in body position on the measured extracellular resistance and extracellular fluid by up to 75 and 70%, respectively. [ABSTRACT FROM AUTHOR]

Objective: Ventricular assist devices (VADs) are implanted in patients suffering from end-stage heart failure to sustain the blood circulation. Real-time volume measurement could be a valuable tool to monitor patients and enable physiological control strategies to provide individualized therapy. However, volume measurement using one sensor modality requires re-calibration in the critical time post VAD implantation. Methods: To overcome this limitation, we have integrated ultrasound and impedance volume measurement techniques into a cannula of an apical VAD. We tested both modalities across a volume range from 140–420 mL using two differently sized and shaped biventricular silicon heart phantoms, which were subjected to physiological pressures in an in-vitro test bench. We compared results from standard calibrated measurements with calculations found by a quadratic optimization for the single modality and their combination (dual-modality) and validated the results using twofold cross-validation. Results: The dual-modality approach resulted in most favorable limits of agreement (LOA) of −0.83 $\pm$ 1.54% compared to −13.88 $\pm$ 5.90% for ultrasound and −43.45 $\pm$ 10.28% for electric impedance, separately. Conclusion: The results of the dual-modality approach were as accurate as the standard calibrated measurement and valid over a large range of volumes (140–420 mL). In this in-vitro study, we show how a dual-modality ventricular volume measurement of ultrasound and electric impedance increases the robustness and renders calibration obsolete. Significance: Ventricular volumes could be measured accurately in the critical period post VAD implantation despite ventricular remodeling. [ABSTRACT FROM AUTHOR]

Objective: Continuous volume estimation in Ventricular Assist Device (VAD) therapy would be an advantageous measure for identifying suitable pump settings and providing an individual therapy for patients suffering from heart failure. As the integration of electrodes on a catheter-based VAD could easily be realized, estimating the volume from bioimpedance measurement appears suitable. However, a major shortcoming of the established methods is the lack of considering changes in conductivity caused by flowing blood. Approach: In this study, we analyzed the effect of flow-dependent conductivity of blood with a 4D finite element model. Therefore, we developed a simplified model of the heart and the aorta, which models not only the anatomical volume changes and the dielectric properties of tissue, but also the flowdependent conductivity of blood. The resulting impedance was simulated and analyzed using two electrode configurations in the left ventricle and one electrode configuration in the aorta. Main results: Flow-dependent conductivity has a great influence on the measurement signal, especially in regions with high local blood velocities. During systole, the maximum differences to simulations with fixed conductivity were up to 26.8 % in the upper part of the left ventricle, whereas the maximum deviation decreased significantly when the impedance was obtained in the lower part of the ventricle (4.78 %). Furthermore, flow-induced conductivity changes within the aorta led to an admittance increase up to 58.39 %. Significance: We believe that our results contribute to a better understanding of the underlying sources of cardiac impedance signals. For future applications, we propose to measure cardiac output by combining information from measurements in the aorta and from the lower part of the ventricle to be more robust against aggressive flow profiles during VAD therapy. [ABSTRACT FROM AUTHOR]

Objective. Multi-channel bioimpedance spectroscopy (BIS) systems typically sample each channel's impedance sequentially using multiplexers and a single analog-to-digital converter. These systems may lose their real-time capability with an increasing number of channels, especially for low excitation frequencies. We propose a new method, called orthogonal baseband shifting (OBS), for high-speed parallel BIS data acquisition at multiple excitation frequencies with low hardware and computational effort. Approach. Similar to orthogonal frequency-division multiplexing, used for digital data transmission, OBS systems use channel-specific orthogonal carrier frequencies to modulate the voltage response of the tissue. Given a suitable choice of carrier frequencies, the modulated signals of all channels sum up without loss of information and cross-talk. The fast Fourier transform (FFT) of the summed signal reveals a spectrum of non-overlapping, interleaved BIS data from which the corresponding BIS data of each channel can be calculated. Main results. In simulations, the system design requires a minimum signal-to-noise ratio of 30 dB to achieve amplitude errors below 1% and phase errors below 0.8°. The hardware realization, called 'AixBIS', has been evaluated for impedance measurements between 0.1 and 10 Ω with multi-frequency excitations between 45 and 180 kHz. The impedance values acquired had an averaged precision of 3.67 mΩ, which is only 0.65‰ in relation to the measured impedance. The phase had a mean precision of 0.46°. Moreover, in vitro measurements achieved 140 full spectrum acquisitions per second. The impedance change measured in a silicone heart phantom showed a high correlation of 0.83 with the ventricles volume change (flow). Significance. The proposed method enables very fast impedance acquisition of all channels. A complete measurement is performed in the time of a single FFT acquisition, which is equal to the resolution bandwidth of the FFT. In addition, portable and low-power multi-channel BIS devices profit from highly reduced hardware effort. The outstanding performance of OBS measurements with the AixBIS system have the potential for in vivo BIS measurements in real-time. [ABSTRACT FROM AUTHOR]

Background Transcellular fluid shifts during dialysis treatment could be related to the frequency and severity of intradialytic hypotension (IDH). We investigated that (i) in addition to ultrafiltration, extracellular fluid (ECF) is further depleted by transcellular fluid shifts and (ii) changes in intracellular fluid (ICF), which have been overlooked so far, or if they were considered, are not understood, might be due to these fluid shifts. Methods Thirty-six patients were categorized as haemodynamically stable, asymptomatic IDH or unstable (symptomatic IDH) according to their changes in systolic blood pressure and associated clinical symptoms. Their intradialytic changes in body fluids were studied using bioimpedance spectroscopy measurements and compared among groups. Results For IDH-prone patients, data showed a rapid drop in ECF that was more than expected from the ultrafiltration rate (UFR) profile and was associated with a significant increase in ICF (P = 0.001). Study of accumulative loss profiles of ECF revealed a loss in ECF up to 300 ml, more than that predicted from UFR for unstable patients. Conclusions The considerable discrepancy between the expected and measured loss in ECF might provide evidence of transcellular fluid shifts possibly induced by changes in plasma osmolarity due to haemodialysis. Moreover, the results suggest a pattern of fluid removal in IDH-prone patients that significantly differs from that in haemodynamically stable patients. [ABSTRACT FROM AUTHOR]

Ventricular Assist Devices (VADs) are used to treat patients with cardiogenic shock. As the heart is unable to supply the organs with sufficient oxygenated blood and nutrients, a VAD maintains the circulation to keep the patient alive. The observation of the patient's hemodynamics is crucial for an individual treatment; therefore, sensors to measure quantifiable hemodynmaic parameters are desirable. In addition to pressure measurement, the volume of the left ventricle and the progress of muscle recovery seem to be promising parameters. Ongoing research aims to estimate ventricular volume and changes in electrical properties of cardiac muscle tissue by applying bioimpedance measurement. In the case where ventricular insufficiency is treated by a catheter-based VAD, this very catheter could be used to conduct bioimpedance measurement inside the assisted heart. However, the simultaneous measurement of bioimpedance and VAD support has not yet been realized, although this would allow the determination of various loading conditions of the ventricle. For this purpose, it is necessary to develop models to validate and quantify bioimpedance measurement during VAD support. In this study, we present an in silico and an in vitro conductivity model of a left ventricle to study the application of bioimpedance measurement in the context of VAD therapy. The in vitro model is developed from casting two anatomical silicone phantoms: One phantom of pure silicone, and one phantom enriched with carbon, to obtain a conductive behavior close to the properties of heart muscle tissue. Additionally, a measurement device to record the impedance inside the ventricle is presented. Equivalent to the in vitro model, the in silico model was designed. This finite element model offers changes in material properties for myocardium and the blood cavity. The measurements in the in vitro models show a strong correlation with the results of the simulation of the in silico model. The measurements and the simulation demonstrate a decrease in impedance, when conductive muscle properties are applied and higher impedances correspond to smaller ventricle cross sections. The in silico and in vitro models are used to further investigate the application of bioimpedance measurement inside the left heart ventricle during VAD support. We are confident that the models presented will allow for future evaluation of hemodynamic monitoring during VAD therapy at an early stage of research and development. [ABSTRACT FROM AUTHOR]

The early detection of lung pathologies is crucial to improve the outcome of the patient, especially in critically ill, ventilated patients. For this, a continuous monitoring tool available at the bedside would be appreciated. One possible modality for this is Bioimpedance Spectroscopy (BIS), which measures the complex bioimpedance in a frequency range, typically from a few kHz up to 1 MHz. In this paper, we present the results of an experimental validation study in 17 animals to use bioimpedance measurement for the detection and identification of lung pathologies. Three different groups are investigated: in the first two groups, acute respiratory distress syndrome (ARDS) was induced using either an infusion of lipoplysacharide or repetitive lavages, respectively. The third group served as the control group, where no additional intervention took place. The results of the statistical analysis show that the distribution of impedance magnitude features is significantly different in the two pathological groups compared to the control group. Furthermore, the separation between the two pathological groups seems to be possible by feature combination. Hence, the results indicate that bioimpedance spectroscopy is a promising modality to enable bedside monitoring for lung pathology detection. [ABSTRACT FROM AUTHOR]

Highlights • A novel method for estimation of cardiac output using optical pressure sensors mounted on a VAD is introduced. • An extended Kalman filter for state and parameter estimation of a simple cardiovascular system model is proposed. • The cardiac output estimator is tested in a hybrid mock circulatory loop and in an animal study with two sheep. • The estimation errors are in the same range as the accuracy of the gold standard in research for invasive blood flow measurement. Abstract Background and objectives Sufficient cardiac output is one of the main goals of ventricular assist device therapy. To date, there is no adequate method to estimate the combined amount of blood the native heart and a continuous-flow assist device pump through the circulatory system. This paper presents an approach to estimate total cardiac output based on the signals provided by optical pressure sensors mounted on the inlet and outlet of an Abiomed Impella CP pump. Methods Two Kalman filters were used in parallel for joint estimation of the aortic flow rate and the hydraulic resistance of the aortic valve. The filters utilized a third order nonlinear state-space representation of the cardiovascular system with two nominal parameter sets, one for ovine and another for human subjects. The accuracy of the estimated cardiac output has been investigated in a hybrid mock circulatory loop and an animal study involving two sheep with experimentally induced acute ischaemic heart disease supported by a transvalvular left ventricular assist device. Results The in vitro accuracy of the cardiac output estimation is ±3.64%. In an ovine model, the comparison of the estimated cardiac output with an ultrasonic flow measurement in the pulmonary artery showed 95% limits of agreement of −0.004 ± 0.897 L min−1. The estimation errors were comparable to the accuracy of the measurement (±10%), which is the gold standard in research for invasive blood flow diagnostics. Conclusions The online estimation of total cardiac output may give the treating physician a direct and physiologically meaningful feedback on the pump speed setting. One promising possible application of our method is physiological control, where the cardiac output can be used as the control variable for closed-loop ventricular assist device therapy. [ABSTRACT FROM AUTHOR]

Abstract: Classically, mock circulatory loops only simulate mechanical properties of the circulation. To connect the hydraulic world with electrophysiology, we present a real‐time electrical activity model of the heart and show how to integrate this model into a real‐time mock loop simulation. The model incorporates a predefined conduction pathway and a simplified volume conductor to solve the bidomain equations and the forward problem of electrocardiography, resulting in a physiological simulation of the electrocardiogram (ECG) at arbitrary electrode positions. A complete physiological simulation of the heart's excitation would be too CPU intensive. Thus, in our model, complexity was reduced to allow real‐time simulation of ECG‐triggered medical systems in vitro; this decreases time and cost in the development process. Conversely, the presented model can still be adapted to various pathologies by locally changing the properties of the heart's conduction pathway. To simulate the ECG, the heart is divided into suitable areas, which are innervated by the hierarchically structured conduction system. To distinguish different cardiac regions, a segmentation of the heart was performed. In these regions, Prim's algorithm was applied to identify the directed minimal spanning trees for conduction orientation. Each node of the tree was assigned to a cardiac action potential generated by its hybrid automaton to represent the heart's conduction system by the spatial distribution of action potentials. To generate the ECG output, the bidomain equations were implemented and a simple model of the volume conductor of the body was used to solve the forward problem of electrocardiography. As a result, the model simulates potentials at arbitrary electrode positions in real‐time. To verify the developed real‐time ECG model, measurements were made within a hybrid mock circulatory loop, including a simple ECG‐triggered ventricular assist device control. The model's potential value is to simulate physiological and pathological behavior for hardware‐in‐the‐loop testing of medical devices in an ECG‐triggered scenario. [ABSTRACT FROM AUTHOR]

Sensors integrated into objects of everyday life potentially allow unobtrusive health monitoring at home. However, since the coupling of sensors and subject is not as well-defined as compared to a clinical setting, the signal quality is much more variable and can be disturbed significantly by motion artifacts. One way of tackling this challenge is the combined evaluation of multiple channels via sensor fusion. For robust and accurate sensor fusion, analyzing the influence of motion on different modalities is crucial. In this work, a multimodal sensor setup integrated into an armchair is presented that combines capacitively coupled electrocardiography, reflective photoplethysmography, two high-frequency impedance sensors and two types of ballistocardiography sensors. To quantify motion artifacts, a motion protocol performed by healthy volunteers is recorded with a motion capture system, and reference sensors perform cardiorespiratory monitoring. The shape-based signal-to-noise ratio SNRS is introduced and used to quantify the effect on motion on different sensing modalities. Based on this analysis, an optimal combination of sensors and fusion methodology is developed and evaluated. Using the proposed approach, beat-to-beat heart-rate is estimated with a coverage of 99.5% and a mean absolute error of 7.9 ms on 425 min of data from seven volunteers in a proof-of-concept measurement scenario. [ABSTRACT FROM AUTHOR]

Veno-venous extracorporeal lung assist ( ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The ' SmartECLA' system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value <35 mm Hg or >49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min ( P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min ( P < 0.05). The ' SmartECLA' demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. [ABSTRACT FROM AUTHOR]

Several mathematical models of different physiological systems are spread through literature. They serve as tools which improve the understanding of (patho-) physiological processes, may help to meet clinical decisions and can even enhance medical therapies. These models are typically implemented in a signal-flow-oriented simulation environment and focus on the behavior of one specific subsystem. Neglecting other physiological subsystems and using a technical description of the physiology hinders the exchange with and acceptance of clinicians. By contrast, this paper presents a new model implemented in a physical, object-oriented modeling environment which includes the cardiovascular, respiratory and thermoregulatory system. Simulation results for a healthy subject at rest and at the onset of exercise are given, showing the validity of the model. Finally, simulation results showing the interaction of the cardiovascular system with a ventricular assist device in case of heart failure are presented showing the flexibility and mightiness of the model and the simulation environment. Thus, we present a new model including three important physiological systems and one medical device implemented in an innovative simulation environment. [ABSTRACT FROM AUTHOR]

Hydrocephalus is characterized by an excessive accumulation of cerebrospinal fluid (CSF). Therapeutically, an artificial pressure relief valve (so-called shunt) is implanted which opens in case of increased intracranial pressure (ICP) and drains CSF into another body compartment. Today, available shunts are of a mechanical nature and drainage depends on the pressure drop across the shunt. According to the latest data, craniospinal compliance is considered to be even more important than mean ICP alone. In addition, ICP is not constant but varies due to several influences. In fact, heartbeat-related ICP waveform patterns depend on volume changes in the cranial vessels during a heartbeat and changes its shape as a function of craniospinal compliance. In this paper, we present an electromechanical shunt approach, which changes the CSF drainage as a function of the current ICP waveform. A series of 12 infusion tests in patients were analyzed and revealed a trend between the compliance and specific features of the ICP waveform. For waveform analysis of patient data, an existing signal processing algorithm was improved (using a Moore machine) and was implemented on a low-power microcontroller within the electromechanical shunt. In a test rig, the ICP waveforms were replicated and the decisions of the ICP analysis algorithm were verified. The proposed control algorithm consists of a cascaded integral controller which determines the target ICP from the measured waveform, and a faster inner-loop integral controller that keeps ICP close to the target pressure. Feedforward control using measurement data of the patient’s position was implemented to compensate for changes in hydrostatic pressure during change in position. A model-based design procedure was used to lay out controller parameters in a simple model of the cerebrospinal system. Successful simulation results have been obtained with this new approach by keeping ICP within the target range for a healthy waveform. [ABSTRACT FROM PUBLISHER]

A system is presented for long-term monitoring of respiration and pulse. It comprises four non-contact sensors based on magnetic eddy current induction that are textile-integrated into a shirt. The sensors are technically characterized by laboratory experiments that investigate the sensitivity and measuring depth, as well as the mutual interaction between adjacent pairs of sensors. The ability of the device to monitor respiration and pulse is demonstrated by measurements in healthy volunteers. The proposed system (called the MAIN (magnetic induction) Shirt) does not need electrodes or any other skin contact. It is wearable, unobtrusive and can easily be integrated into an individual's daily routine. Therefore, the system appears to be a suitable option for long-term monitoring in a domestic environment or any other unsupervised telemonitoring scenario. [ABSTRACT FROM AUTHOR]

In this paper, the method of noncontact monitoring of cardiorespiratory activity by electromagnetic coupling with human tissue is investigated. Two measurement modalities were joined: an inductive coupling sensor based on magnetic eddy current induction and a capacitive coupling sensor based on displacement current induction. The system’s sensitivity to electric tissue properties and its dependence on motion are analyzed theoretically as well as experimentally for the inductive and capacitive coupling path. The potential of both coupling methods to assess respiration and pulse without contact and a minimum of thoracic wall motion was verified by laboratory experiments. The demonstrator was embedded in a chair to enable recording from the back part of the thorax. [ABSTRACT FROM PUBLISHER]

Body sensor networks (BSN) are an important research topic due to various advantages over conventional measurement equipment. One main advantage is the feasibility to deploy a BSN system for 24/7 health monitoring applications. The requirements for such an application are miniaturization of the network nodes and the use of wireless data transmission technologies to ensure wearability and ease of use. Therefore, the reliability of such a system depends on the quality of the wireless data transmission. At present, most BSNs use ZigBee or other IEEE 802.15.4 based transmission technologies. Here, we evaluated the performance of a wireless transmission system of a novel BSN for biomedical applications in the 433MHz ISM band, called Integrated Posture and Activity NEtwork by Medit Aachen (IPANEMA) BSN. The 433MHz ISM band is used mostly by implanted sensors and thus allows easy integration of such into the BSN. Multiple measurement scenarios have been assessed, including varying antenna orientations, transmission distances and the number of network participants. The mean packet loss rate (PLR) was 0.63% for a single slave, which is comparable to IEEE 802.15.4 BSNs in the proximity of Bluetooth or WiFi networks. Secondly, an enhanced version is evaluated during on-body measurements with five slaves. The mean PLR results show a comparable good performance for measurements on a treadmill (2.5%), an outdoor track (3.4%) and in a climate chamber (1.5%). [ABSTRACT FROM AUTHOR]

Modern automobiles include an increasing number of assistance systems to increase the driver’s safety. This feasibility study investigated unobtrusive capacitive ECG measurements in an automotive environment. Electrodes integrated into the driving seat allowed to measure a reliable ECG in 86% of the drivers; when only (light) cotton clothing was worn by the drivers, this value increased to 95%. Results show that an array of sensors is needed that can adapt to the different drivers and sitting positions. Measurements while driving show that traveling on the highway does not distort the signal any more than with the car engine turned OFF, whereas driving in city traffic results in a lowered detection rate due to the driver’s heavier movements. To enable robust and reliable estimation of heart rate, an algorithm is presented (based on principal component analysis) to detect and discard time intervals with artifacts. This, then, allows a reliable estimation of heart rate of up to 61% in city traffic and up to 86% on the highway: as a percentage of the total driving period with at least four consecutive QRS complexes. [ABSTRACT FROM PUBLISHER]

Capacitive biopotential measurements suffer from strong motion artifacts, which may result in long time periods during which a reliable measurement is not possible. This study examines contact electrification and triboelectricity as possible reasons for these artifacts and discusses local triboelectric effects on the electrode–body interface as well as global electrostatic effects as common-mode interferences. It will be shown that most probably the triboelectric effects on the electrode–body interface are the main reason for artifacts, and a reduction of artifacts can only be achieved with a proper design of the electrode–body interface. For a deeper understanding of the observed effects, a mathematical model for triboelectric effects in highly isolated capacitive biopotential measurements is presented and verified with experiments. Based on these analyses of the triboelectric effects on the electrode–body interface, different electrode designs are developed and analyzed in order to minimize artifacts due to triboelectricity on the electrode–body interface. [ABSTRACT FROM PUBLISHER]

The capacitive electrocardiograph (cECG) has been tested for several measurement scenarios, including hospital beds, car seats and chairs since it was first proposed. The inferior signal quality of the cECG compared to the gold standard ECG guides the ongoing research in the direction of out-of-hospital applications, where unobtrusiveness is sought and high-level diagnostic signal quality is not essential. This study aims to expand the application range of cECG not in terms of the measurement scenario but in the profile of the subjects by including subjects with implanted cardiac pacemakers. Within this study, 20 patients with cardiac pacemakers were recruited during their clinical device follow-up and cECG measurements were conducted using a seat equipped with integrated cECG electrodes. The multichannel cECG recordings of active unipolar and bipolar pacemaker stimulation were analyzed offline and evaluated in terms of F β scores using a pacemaker spike detection algorithm. F β scores from 3652 pacing events, varying from 0.62 to 0.78, are presented with influencing parameters in the algorithm and the comparison of cECG channels. By tuning the parameters of the algorithm, different ranges of F β scores were found as 0.32 to 0.49 and 0.78 to 0.88 for bipolar and unipolar stimulations, respectively. For the first time, this study shows the feasibility of a cECG system allowing health monitoring in daily use on subjects wearing cardiac pacemakers. [ABSTRACT FROM AUTHOR]

Background: Continuous non-invasive urinary bladder volume measurement (cystovolumetry) would allow better management of urinary tract disease. Electrical impedance tomography (EIT) represents a promising method to overcome the limitations of non-continuous ultrasound measurements. The aim of this study was to compare the measurement accuracy of EIT to standard ultrasound in healthy volunteers.Methods: For EIT of the bladder a commercial device (Goe MF II) was used with 4 different configurations of 16 standard ECG electrodes attached to the lower abdomen of healthy participants. To estimate maximum bladder capacity (BCmax) and residual urine (RU) two ultrasound methods (US-Ellipsoid and US-L × W × H) and a bedside bladder scanner (BS), were performed at the point of urgency and after voiding. For volume reference, BCmax and RU were validated by urine collection in a weight measuring pitcher. The global impedance method was used offline to estimate BCmax and RU from EIT.Results: The mean error of US-Ellipsoid (37 ± 17%) and US-L × W × H (36 ± 15%) and EIT (32 ± 18%) showed no significant differences in the estimation of BCmax (mean 743 ± 200 ml) normalized to pitcher volumetry. BS showed significantly worse accuracy (55 ± 9%). Volumetry of RU (mean 152.1 ± 64 ml) revealed comparable higher errors for both EIT (72 ± 58%) and BS (63 ± 24%) compared to US-Ellipsoid (54 ± 25%). In case of RU, EIT accuracy is dependent on electrode configuration, as the Stripes (41 ± 25%) and Matrix (38 ± 27%) configurations revealed significantly superior accuracy to the 1 × 16 (116 ± 62%) configuration.Conclusions: EIT-cystovolumetry compares well with ultrasound techniques. For estimation of RU, the selection of the EIT electrode configuration is important. Also, the development of an algorithm should consider the impact of movement artefacts. Finally, the accuracy of non-invasive ultrasound accepted as gold standard of cystovolumetry should be reconsidered. [ABSTRACT FROM AUTHOR]

Impedance cardiography is a simple and inexpensive method to acquire data on hemodynamic parameters. This study analyzes the influence of four dynamic physiological sources (aortic expansion, heart contraction, lung perfusion and erythrocyte orientation) on the impedance signal using a model of the human thorax with a high temporal resolution (125 Hz) based on human MRI data. Simulations of electromagnetic fields were conducted using the finite element method. The ICG signal caused by these sources shows very good agreement with the measured signals (r = 0.89). Standard algorithms can be used to extract characteristic points to calculate left ventricular ejection time and stroke volume (SV). In the presented model, the calculated SV equals the implemented left ventricular volume change of the heart. It is shown that impedance changes due to lung perfusion and heart contraction compensate themselves, and that erythrocyte orientation together with the aortic impedance basically form the ICG signal while taking its characteristic morphology from the aortic signal. The model is robust to conductivity changes of tissues and organ displacements. In addition, it reflects the multi-frequency behavior of the thoracic impedance. [ABSTRACT FROM AUTHOR]

Measurement of hemodynamic parameters such as stroke volume (SV) via impedance cardiography (ICG) is an easy, non-invasive and inexpensive way to assess the health status of the heart. We present a possibility to use this technology for monitoring risk patients at home. The IMPACT Shirt (IMPedAnce Cardiography Textile) has been developed with integrated textile electrodes and textile wiring, as well as with portable miniaturized hardware. Several textile materials were characterized in vitro and in vivo to analyze their performance with regard to washability, and electrical characteristics such as skin-electrode impedance, capacitive coupling and subjective tactile feeling. The small lightweight hardware measures ECG and ICG continuously and transmits wireless data via Bluetooth to a mobile phone (Android) or PC for further analysis. A lithium polymer battery supplies the circuit and can be charged via a micro-USB. Results of a proof-of-concept trial show excellent agreement between SV assessed by a commercial device and the developed system. The IMPACT Shirt allows monitoring of SV and ECG on a daily basis at the patient’s home. [ABSTRACT FROM AUTHOR]