Overcoming the Impedance Range Limitations of Portable Bioelectrical Impedance Spectroscopy Clinical Devices.

Several portable commercial bioimpedance spectroscopy (BIS) devices are used in clinical research, but are limited by their reduced impedance measuring range to less demanding four-electrode configuration measurements. Some of these devices provide raw bioimpedance data for research purposes. The SFB7 device from ImpediMed® is a typical portable clinical device which perform 256 measurement points from 3 kHz to 1 MHz, providing for each point the resistance R and the reactance X. Its main drawback is its impedance range, limited to only 1100 Ω, making it less suitable for more demanding, higher impedance, two-electrode measurements which are potentially of great clinical interest. Some benchtop reference devices have larger frequency and impedance ranges than the SFB7 but are not portable and are not designed specifically for BIS measurement on humans.This article proposes a method to overcome the impedance range limitation of the SFB7 by connecting in parallel to the investigated bioimpedance a fixed and known impedance, whose value (and hence that of the total measured impedance) is within the device's range. The investigated impedance is then calculated by eliminating the contribution of the known impedance via a post processing of the data.This concept has been successfully tested on a physical model, and an in vivo example has validated the practicality of performing demanding two-electrode measurements on individuals using a SFB7, with relative errors of R and X inferior to 2.5% and 7% respectively.Clinical Relevance- Using the proposed setup and after post processing of the data, the SFB7 BIS device can now be used to perform demanding two-electrode measurements, hitherto impossible, enabling a range of novel clinical, high-impedance studies, for example for localized skin characterization.

Recording of bruxism events in sleeping humans at home with a smart instrumented splint.

Objective: The aim of this paper is to report quantitative and qualitative characteristics of bruxism events recorded in sleeping humans with a new smart ambulatory system specifically designed to measure dental clenching and grinding forces. The device is wireless and rechargeable, which enables its use over extended periods.Methods: Thirty recordings were obtained from volunteer subjects who wore the device at home during 10 consecutive nights (Clinicaltrials.gov N° NCT03363204).Results: The recordings showed that the system was able to successfully monitor bruxism during 10 consecutive nights, allowing a quantitative (number, duration, intensity, distribution during the night), as well as a qualitative characterization of the bruxism events (clenching vs. grinding).Discussion: This system could offer new perspectives in the field of bruxism, either as a research tool for clinical studies or as a medical device for the ambulatory home-based monitoring of bruxism.

Pulse wave velocity measurement along the ulnar artery in the wrist region using a high frequency ultrasonic array.

A pulse wave velocity (PWV) measurement method performed above a small blood vessel using an ultrasonic probe is studied and reported in this paper. These experimentations are carried out using a high-frequency probe (14-22 MHz), allowing a high level of resolution compatible with the vessel dimensions, combined with an open research ultrasound scanner. High frame-rate (HFR) imaging (10 000 frames per second) is used for a precise PWV estimation. The measurements are performed in-vivo on a healthy volunteer. The probe is placed above the ulnar artery on the wrist in order to make longitudinal scans. In addition to conventional duplex ultrasound evaluation, the measurement of the PWV using this method at this location could strengthen the detection and diagnosis of cardiovascular diseases (CVDs), in particular for arm artery diseases (AADs). Moreover, these experimentations are also carried out within the scope of a demonstration for a potential miniaturized and wearable device (i.e., a probe with fewer elements, typically less than 32, and its associated electronics). The study has shown results coherent with expected PWV and also promising complementary results such as intima-media thickness (IMT) with spatiotemporal resolution on the order of 6.2 µm and 0.1 ms.

Pupillary behavior during wakefulness, non-REM sleep, and REM sleep in birds is opposite that of mammals.

Mammalian pupils respond to light1,2 and dilate with arousal, attention, cognitive workload, and emotions,3 thus reflecting the state of the brain. Pupil size also varies during sleep, constricting during deep non-REM sleep4-7 and dilating slightly during REM sleep.4-6 Anecdotal reports suggest that, unlike mammals, birds constrict their pupils during aroused states, such as courtship and aggression,8-10 raising the possibility that pupillary behavior also differs between mammals and birds during sleep. Here, we measured pupil size in awake pigeons and used their translucent eyelid to investigate sleep-state-dependent changes in pupil size. Male pigeons constricted their pupils during courtship and other male-female interactions but not while engaging in other waking behaviors. Unlike mouse pupils, the pigeons' pupils were dilated during non-REM sleep, while over 1,000 bursts of constriction and relaxation, which we call rapid iris movements (RIMs), occurred primarily during REM sleep. Consistent with the avian iris being composed largely of striated muscles,11-15 rather than smooth muscles, as in mammals, pharmacological experiments revealed that RIMs are mediated by nicotinic cholinergic receptors in the iris muscles. Despite receiving input from a parasympathetic nucleus, but consistent with its striated nature, the avian iris sphincter muscle behaves like skeletal muscles controlled by the somatic nervous system, constricting during courtship displays, relaxing during non-REM sleep, and twitching during REM sleep. We speculate that during wakefulness, pupillary constrictions are involved in social communication, whereas RIMs occurring during REM sleep might maintain the efficacy of this motor system and/or reflect the processing of associated memories.

Optical flow sensor as a reference for reduction of motion artefacts in photoplethysmographic measurements.

Methods commonly used for reduction of motion artefacts in photoplethysmography employ accelerometry as a reference for adaptive filtering and signal processing. In this paper, we propose the use of an optical flow sensor to measure the relative displacement between a photoplethysmographic sensor and the measurement site. In order to evaluate the performances of this novel method, a wrist-worn device that enables simultaneous acquisition of physiological information and relative motion has been developed. The optical flow sensor provides a two-dimensional information source correlated with artefacts contained in the cardiac frequency band. Preliminary results show a clear correlation between motion recorded by the sensor and artefacts contained in the photoplethysmographic signal. In association with adaptive filtering, the proposed technique shows efficient reduction of motion artefacts during physical activity.

An Implantable, Low-Power Instrumentation for the Long Term Monitoring of the Sleep of Animals under Natural Conditions.

Sleep is a universal and complex state and it is widely agreed that this state is present in every animal species. However, the evolutionary origins of sleep remain ignored or misunderstood, which has led researchers to study, in various species, this common behaviour of all living organisms. Sleep is commonly studied at various levels under laboratory conditions, using tethered devices which record electroencephalographic or electromyographic readings. These artificial settings tend to induce stress, reduce animal freedom and prevent the use of sleeping shelters. In this paper, we present a novel, implantable instrumentation for a complete characterization of sleep under natural conditions suitable for a wide range of animal species, even for animals as small as pigeons or mice. Several configurations of this system are possible to enable the measurement of up to 16 electrophysiology channels, 3 temperature channels as well as 3-axes accelerometry. With an embedded flash memory card for the storage of data collected, the system can be used as a datalogger for the recording of signals in the field.

ONEIROS, a new miniature standalone device for recording sleep electrophysiology, physiology, temperatures and behavior in the lab and field.

BACKGROUND: Sleep is an inactive state of reduced environmental awareness shared by all animals. When compared to wakefulness, sleep behavior is associated with changes in physiology and brain activity. The nature of these changes varies considerably across species, and therefore is a rich resource for gaining insight into the evolution and functions of sleep. A major obstacle to capitalizing on this resource is the lack of a small device capable of recording multiple biological parameters for extended periods of time both in the laboratory and the field. NEW METHOD: ONEIROS is a new tool designed for conducting sleep research on small, freely moving animals. The miniature, standalone system is capable of recording up to 26 electrophysiological signals (electroencephalogram, electromyogram, electrooculogram, electrocardiogram), metabolic (3 temperature channels) and behavior via an accelerometer for several days. In addition, the device is equipped with a vibrating motor which can be used to assess arousal thresholds and to disrupt sleep. The system is available in telemetric or data-logger configuration useable in the field. RESULTS: To demonstrate the efficacy of this tool, we simultaneously recorded for the first time, electroencephalogram, hippocampal local field potential, electromyogram, electrooculogram, brain, body and ambient temperature, and 3D accelerometry. We also deprived rats of paradoxical sleep by triggering the vibrating motor after online recognition of the state. Finally, by successfully recording a pigeon in an 8 m3 aviary in a social context with the device in the logger configuration, we demonstrate the feasibility of using the device in the field.

Evaluation of a real-time low-power cardiorespiratory sensor for the IoT.

A wide variety of sensors have been developed in the biomedical engineering community for telemedicine and personalized healthcare applications. However, they usually focus on sensor connectivity and embedded signal processing, at the expense of the sensing part. This observation lead to the development and exhaustive evaluation of a new ECGbased cardiorespiratory IoT sensor. In order to improve the robustness of our IoT-based sensor, we discuss in detail the influence of electrodes placement and nature. Performance assessment of our sensor resulted in a best-case sensitivity of 99.95% and a precision of 99.89% for an abdominal positioning of wet electrodes, while a sensitivity of 99.47% and a precision of 99.31% were observed using a commercialgrade dry electrodes belt. Consequently, we prove that our sensor is fit for the comfortable medical-grade monitoring of the cardiorespiratory activity in order to provide insights of patients health in a telemedicine context.

Ambulatory sensor for circumference monitoring of lower limbs.

The continuous monitoring of edema in the lower limbs of the human body is presently not possible as suitable devices are not available. This paper presents the characterization and the testing of a novel ambulatory device dedicated to the monitoring of circumference variations in the lower limb. The sensor, based on an inductive loop integrated into a textile band, is connected to a miniaturized electronic system which wirelessly sends the calculated perimeter value of the leg to a smart mobile device. In-vitro tests have demonstrated that the device enables the measurement of perimeters ranging from 25 cm to 33 cm with an accuracy of 0.3 cm. This result was obtained using a circular loop, which assumes that the shape of the leg remains circular at the location where the loop is positioned. To investigate the influence of the loop shape on the sensor response, three physical models of different shapes (circular, elliptic and triangular) were tested. It was found that self-inductance values of the loop can be predicted in an acceptable way using a theoretical model for the three different shapes. Experimental tests showed that the error in the perimeter value is around 5% of the full scale when changing the geometry from circular to elliptic but can reach 11 % from circular to triangular. The application interface developed for a smartphone is presented, which will enable the ambulatory monitoring of leg edemic swelling during daily activity and facilitate its assessment by the clinician.

Partial homologies between sleep states in lizards, mammals, and birds suggest a complex evolution of sleep states in amniotes.

It is crucial to determine whether rapid eye movement (REM) sleep and slow-wave sleep (SWS) (or non-REM sleep), identified in most mammals and birds, also exist in lizards, as they share a common ancestor with these groups. Recently, a study in the bearded dragon (P. vitticeps) reported states analogous to REM and SWS alternating in a surprisingly regular 80-s period, suggesting a common origin of the two sleep states across amniotes. We first confirmed these results in the bearded dragon with deep brain recordings and electro-oculogram (EOG) recordings. Then, to confirm a common origin and more finely characterize sleep in lizards, we developed a multiparametric approach in the tegu lizard, a species never recorded to date. We recorded EOG, electromyogram (EMG), heart rate, and local field potentials (LFPs) and included data on arousal thresholds, sleep deprivation, and pharmacological treatments with fluoxetine, a serotonin reuptake blocker that suppresses REM sleep in mammals. As in the bearded dragon, we demonstrate the existence of two sleep states in tegu lizards. However, no clear periodicity is apparent. The first sleep state (S1 sleep) showed high-amplitude isolated sharp waves, and the second sleep state (S2 sleep) displayed 15-Hz oscillations, isolated ocular movements, and a decrease in heart rate variability and muscle tone compared to S1. Fluoxetine treatment induced a significant decrease in S2 quantities and in the number of sharp waves in S1. Because S2 sleep is characterized by the presence of ocular movements and is inhibited by a serotonin reuptake inhibitor, as is REM sleep in birds and mammals, it might be analogous to this state. However, S2 displays a type of oscillation never previously reported and does not display a desynchronized electroencephalogram (EEG) as is observed in the bearded dragons, mammals, and birds. This suggests that the phenotype of sleep states and possibly their role can differ even between closely related species. Finally, our results suggest a common origin of two sleep states in amniotes. Yet, they also highlight a diversity of sleep phenotypes across lizards, demonstrating that the evolution of sleep states is more complex than previously thought.

Design and development of an impedimetric-based system for the remote monitoring of home-based dialysis patients.

A key clinical challenge is to determine the desired 'dry weight' of a patient in order to terminate the dialysis procedure at the optimal moment and thus avoid the effects of over- and under-hydration. It has been found that the effects of haemodialysis on patients can be conveniently monitored using whole-body bioimpedance measurements. The identified need of assessing the hydrational status of patients undergoing haemodialysis at home gave rise to the present Dialydom (DIALYse à DOMicile) project. The aim of the project is to develop a convenient miniaturised impedance monitoring device for localised measurements (on the calf) in order to estimate an impedimetric hydrational index of the home-based patient, and to transmit this and other parameters to a remote clinical site. Many challenges must be overcome to develop a robust and valid home-based device. Some of these are presented in the paper.

Detection of collaborative activity with Kinect depth cameras.

The health status of elderly subjects is highly correlated to their activities together with their social interactions. Thus, the long term monitoring in home of their health status, shall also address the analysis of collaborative activities. This paper proposes a preliminary approach of such a system which can detect the simultaneous presence of several subjects in a common area using Kinect depth cameras. Most areas in home being dedicated to specific tasks, the localization enables the classification of tasks, whether collaborative or not. A scenario of a 24 hours day shrunk into 24 minutes was used to validate our approach. It pointed out the need of artifacts removal to reach high specificity and good sensitivity.

Characterization of a multi-user indoor positioning system based on low cost depth vision (Kinect) for monitoring human activity in a smart home.

An increasing number of systems use indoor positioning for many scenarios such as asset tracking, health care, games, manufacturing, logistics, shopping, and security. Many technologies are available and the use of depth cameras is becoming more and more attractive as this kind of device becomes affordable and easy to handle. This paper contributes to the effort of creating an indoor positioning system based on low cost depth cameras (Kinect). A method is proposed to optimize the calibration of the depth cameras, to describe the multi-camera data fusion and to specify a global positioning projection to maintain the compatibility with outdoor positioning systems. The monitoring of the people trajectories at home is intended for the early detection of a shift in daily activities which highlights disabilities and loss of autonomy. This system is meant to improve homecare health management at home for a better end of life at a sustainable cost for the community.

A support vector machine for predicting defibrillation outcomes from waveform metrics.

BACKGROUND: Algorithms to predict shock success based on VF waveform metrics could significantly enhance resuscitation by optimising the timing of defibrillation. OBJECTIVE: To investigate robust methods of predicting defibrillation success in VF cardiac arrest patients, by using a support vector machine (SVM) optimisation approach. METHODS: Frequency-domain (AMSA, dominant frequency and median frequency) and time-domain (slope and RMS amplitude) VF waveform metrics were calculated in a 4.1Y window prior to defibrillation. Conventional prediction test validity of each waveform parameter was conducted and used AUC>0.6 as the criterion for inclusion as a corroborative attribute processed by the SVM classification model. The latter used a Gaussian radial-basis-function (RBF) kernel and the error penalty factor C was fixed to 1. A two-fold cross-validation resampling technique was employed. RESULTS: A total of 41 patients had 115 defibrillation instances. AMSA, slope and RMS waveform metrics performed test validation with AUC>0.6 for predicting termination of VF and return-to-organised rhythm. Predictive accuracy of the optimised SVM design for termination of VF was 81.9% (± 1.24 SD); positive and negative predictivity were respectively 84.3% (± 1.98 SD) and 77.4% (± 1.24 SD); sensitivity and specificity were 87.6% (± 2.69 SD) and 71.6% (± 9.38 SD) respectively. CONCLUSIONS: AMSA, slope and RMS were the best VF waveform frequency-time parameters predictors of termination of VF according to test validity assessment. This a priori can be used for a simplified SVM optimised design that combines the predictive attributes of these VF waveform metrics for improved prediction accuracy and generalisation performance without requiring the definition of any threshold value on waveform metrics.

ActimedARM - design of a wearable system to monitor daily actimetry.

We developed a low power kinematic sensor, ActimedARM, incorporating three-axis accelerometer and magnetometer, a microcontroller ARM3, a ZigBee wireless communication and µSD memory storage. With embedded algorithms it can detect in real time the postures of the subject. A preliminary assessment conducted on 12 subjects reached a 97% correct classification rate. The device exhibits 32 days of autonomy on a 3600 mAh capacity battery, which makes it convenient for field experiments in true daily life.

The challenges facing wearable sensor systems.

It has been pointed out that, in spite of significant national and international funding programmes, there is a dearth of successfully commercialised wearable monitoring systems. Although problems such as financial reimbursement, device interoperability and the present lack of the required connected healthcare infrastructure are major hurdles to the provision of remote clinical monitoring of home-based patients, the "Mount Everest" of monitoring applications, why are wearable systems not already commercialised and used in less demanding applications? The numerous wearable systems which appear on the Web and even in the literature are, for the most part, basic prototypes unsuited to the demands of real-life applications. SMEs which do seek to commercialise clinically promising systems are unfortunately faced with many challenges and few as yet have survived long enough to successfully commercialise their innovations.

Objective evaluation of stress with the blind by the monitoring of autonomic nervous system activity.

Accessibility for the blind in an urban space must be studied under real conditions in their daily environment. A new approach for evaluating the impact of environmental conditions on blind pedestrians is the objective measure of stress by the monitoring of the autonomic nervous system (ANS) activity. Original techniques of data analysis and spatial representation are proposed for the detection of the ANS activity through the assessment of the electrodermal activity. Skin resistance was recorded with an EmoSense system on 10 blind subjects who followed a charted course independently. The course was 1065 meters long and consisted of various environmental conditions in an urban space. The spatial frequency of the non-specific skin resistance responses was used to provide a more relevant representation of geographic hotspots. Results of statistical analysis based on this new parameter are discussed to conclude on phenomena causing mental stress with the blind moving in an urban space.

A wearable, low-power, health-monitoring instrumentation based on a Programmable System-on-Chip.

Improvement in quality and efficiency of health and medicine, at home and in hospital, has become of paramount importance. The solution of this problem would require the continuous monitoring of several key patient parameters, including the assessment of autonomic nervous system (ANS) activity using non-invasive sensors, providing information for emotional, sensorial, cognitive and physiological analysis of the patient. Recent advances in embedded systems, microelectronics, sensors and wireless networking enable the design of wearable systems capable of such advanced health monitoring. The subject of this article is an ambulatory system comprising a small wrist device connected to several sensors for the detection of the autonomic nervous system activity. It affords monitoring of skin resistance, skin temperature and heart activity. It is also capable of recording the data on a removable media or sending it to computer via a wireless communication. The wrist device is based on a Programmable System-on-Chip (PSoC) from Cypress: PSoCs are mixed-signal arrays, with dynamic, configurable digital and analogical blocks and an 8-bit Microcontroller unit (MCU) core on a single chip. In this paper we present first of all the hardware and software architecture of the device, and then results obtained from initial experiments.