Human thermophysiological models: Quantification of uncertainty in the output quantities of the passive system due to uncertainties in the control equations of the active system via the Monte Carlo method.

Uncertainty propagation analysis in the Fiala thermophysiological model is performed by the Monte Carlo Method. The uncertainties of the output quantities of the passive system, due to imported uncertainties in the coefficients of the control equations of the active system, caused by the variation of the experimental data, are computed. The developed and implemented in-house code is accordingly validated. The effect of the input uncertainties, in each of the four main responses (shivering, vasodilatation, vasoconstriction, sweating) of the active system, is separately examined by simulating the human exposure from neutral conditions to cold and hot environments. It is predicted that the maximum output uncertainties of the response mechanisms may be of the same order of magnitude as the imported ones, while the corresponding maximum uncertainties in core and skin temperatures always remain less than 2%. The maximum absolute deviations of the rectal (core) temperatures from their estimated mean values may be up to 0.72 °C and 0.22 °C, due to input uncertainties in shivering and sweating respectively, while the corresponding deviations due to uncertainties in vasomotion processes are negligible. The deviations, particularly the ones due to shivering, are significant, since differences of a few tenths of a degree may have large impact in human health. The maximum absolute deviations of the skin temperatures are 0.42 °C in the hands due to uncertainties in shivering and 0.69 °C in the feet due to uncertainties in vasodilatation. These deviations are less significant than the core ones, but they may still affect human thermal sensation and comfort. The present analysis provides a better insight in the dynamic response of the model and indicates which response mechanism needs to be further investigated by more accurate estimates in order to improve model reliability. It can be also applied in other human thermophysiological models.

Infrared thermography for assessment of thoracic paravertebral block: a prospective observational study.

BACKGROUND: There was no "gold standard" to assess the success or failure of thoracic paravertebral block (TPVB). Measurement of skin temperature with infrared thermography (IT) would be a reliable method to evaluate the effectiveness of regional blocks. This study aimed to explore the feasibility of using skin temperature difference (Td) determined by IT between the blocked and unblocked side to predict the spread of TPVB. METHODS: Sixty-one patients undergoing elective unilateral breast or thoracoscopic surgery were enrolled in this prospective observational study. TPVB was performed at T4 and T5 under real-time ultrasound guidance with 10 mL of 0.4% ropivacaine for each patient, respectively. Td between the blocked and unblocked side were measured with IT from T2 to T10 at the anterior chest wall before TPVB and 5 min, 10 min, 15 min and 20 min after TPVB. Pinprick test was performed at 20 min after TPVB. Successful TPVB was defined as no sensation to pinprick in 3 or more adjacent dermatomes corresponding to the site of injection at 20 min after TPVB. Td was compared to pinprick test for evaluating its effectiveness in predicting the success of TPVB. The sensitivity, specificity, and cut-off value of Td for predicting successful TPVB were determined by receiver operator characteristic (ROC) curve analysis. RESULTS: Compared with the baseline value before block, Td from T2 to T10 were significantly increased at each time point in successful blocks. In failed blocks, Td was not increased in any dermatome. The increase of Td at T4-T7 was more than 1 °C 20 min after successful TPVB. Fifteen minutes after block, Td increase at T4 had the greatest potential to predict block success. The area under the ROC curve was 0.960 at a cut-off value of 0.63 °C with a sensitivity of 83.3% and a specificity of 100.0%. CONCLUSIONS: This study suggested that the increase of Td at T4 dermatome determined by IT between the blocked and unblocked side is an early, quantitative, and reliable predictor of successful TPVB. TRIAL REGISTRATION: Clinical trial registration: NCT04078347 .

Is Physiological Equivalent Temperature (PET) a superior screening tool for heat stress risk than Wet-Bulb Globe Temperature (WBGT) index? Eight years of data from the Gothenburg half marathon.

BACKGROUND: The Wet-Bulb Globe Temperature (WBGT) index is a common tool to screen for heat stress for sporting events. However, the index has a number of limitations. Rational indices, such as the physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI), are potential alternatives. AIM: To identify the thermal index that best predicts ambulance-required assistances and collapses during a city half marathon. METHODS: Eight years (2010-2017) of meteorological and ambulance transport data, including medical records, from Gothenburg's half-marathon were used to analyse associations between WBGT, PET and UTCI and the rates of ambulance-required assistances and collapses. All associations were evaluated by Monte-Carlo simulations and leave-one-out-cross-validation. RESULTS: The PET index showed the strongest correlation with both the rate of ambulance-required assistances (R2=0.72, p=0.008) and collapses (R2=0.71, p=0.008), followed by the UTCI (R2=0.64, p=0.017; R2=0.64, p=0.017) whereas the WBGT index showed substantially poorer correlations (R2=0.56, p=0.031; R2=0.56, p=0.033). PET stages of stress, match the rates of collapses better that the WBGT flag colour warning. Compared with the PET, the WBGT underestimates heat stress, especially at high radiant heat load. The rate of collapses increases with increasing heat stress; large increase from the day before the race seems to have an impact of the rate of collapses. CONCLUSION: We contend that the PET is a better predictor of collapses during a half marathon than the WBGT. We call for further investigation of PET as a screening tool alongside WBGT.

Infrared dermal thermometry is highly reliable in the assessment of patients with Charcot neuroarthropathy.

BACKGROUND: Charcot neuroarthropathy (Charcot foot) is a serious limb-threatening complication most commonly seen in individuals with diabetic peripheral neuropathy. Although dermal thermometry is widely used by clinicians to assist in the diagnosis, monitoring, and management of the disease, there is limited high-quality evidence to support its reliability. Therefore, this study investigated the intra-rater and inter-rater reliability of infrared dermal thermometry in patients with Charcot neuroarthropathy. METHODS: We collected clinical, demographic, health status, and foot examination information on 32 adults with Charcot neuroarthropathy from a metropolitan high-risk foot service in Melbourne, Australia. Infrared dermal thermometry assessments were conducted by two independent raters at 10 anatomical sites of the Charcot foot using both a (i) touch and (ii) non-touch technique. Intra-rater and inter-rater reliability of the two assessment techniques were evaluated using intra-class correlation coefficients (ICCs), limits of agreement, standard error of measurement, and minimal detectable change statistics. RESULTS: Mean age was 59.9 (standard deviation [SD], 10.5) years, 68.8% were male, average duration of diabetes was 20.6 (SD, 15.1) years, 71.9% had type 2 diabetes, 93.8% had peripheral neuropathy, 43.8% had peripheral arterial disease, and 50% had previous foot ulceration. Charcot foot most commonly affected the tarsometatarsal joints (38.9%), had a median duration of 2.8 (interquartile range [IQR], 1.3 to 5.9) months, and a large proportion were being treated with total contact casting (69.4%). Overall, there was good to excellent intra-rater and inter-rater relative reliability for the 'touch' technique (ICC, 0.87 to 0.99; ICC, 0.83 to 0.98, respectively), and excellent intra-rater and inter-rater relative reliability for the 'non-touch' technique (ICC, 0.93 to 0.99; ICC, 0.91 to 0.99, respectively). In addition, measurement error was found to be relatively low across the 10 anatomical sites. CONCLUSIONS: Infrared dermal thermometry can now be used with confidence in clinical and research settings to provide a reliable assessment of skin temperature in patients with Charcot neuroarthropathy, using either a touch or non-touch technique at 10 commonly used testing sites. A non-touch technique, however, was observed to have slightly higher reliability indicating it may be associated with less measurement error than the touch technique.

Temperature-compensated infrared-based low-cost mobile platform module for mass human temperature screening.

As fast human temperature screening is needed in large public areas, this paper proposes a low-cost mobile platform module that combines the advantages of analyzing visible and thermal images. In particular, the key idea relies on face detection in the visible image. Then the coordinates of all faces detected are mapped on to the thermal image to determine their corresponding temperatures. Internal temperature compensation and external reference temperature also are employed to reduce the unwanted temperature fluctuation inside the module and in the surrounding environment. Our mobile platform module, called $\unicode{x00B5} {\rm Therm}$, uses a FLIR ONE camera as our visible and thermal imaging cameras. It can simultaneously determine the temperatures of nine people at a speed of 8 frames/second. A field test operation was performed for four days with 1,170 people, with very promising results of 100% sensitivity, 92.6% specificity, and 92.7% accuracy.

Heat stress assessment during intermittent work under different environmental conditions and clothing combinations of effective wet bulb globe temperature (WBGT).

This study examined whether different combinations of ambient temperature and relative humidity for the effective wet bulb globe temperature, in conjunction with two different levels of clothing adjustment factors, elicit a similar level of heat strain consistent with the current threshold limit value guidelines. Twelve healthy, physically active men performed four 15-min sessions of cycling at a fixed rate of metabolic heat production of 350 watts. Each trial was separated by a 15-min recovery period under four conditions: (1) Cotton coveralls + dry condition (WD: 45.5 °C dry-bulb, 15% relative humidity); (2) Cotton coveralls + humid condition (WH: 31 °C dry-bulb, 84% relative humidity); (3) Protective clothing + dry condition (PD: 30 °C dry-bulb, 15% relative humidity); and (4) Protective clothing + humid condition (PH: 20 °C dry-bulb, 80% relative humidity). Gloves (mining or chemical) and headgear (helmet or powered air-purifying respirator) were removed during recovery with hydration ad libitum. Rectal temperature (Tre), skin temperature (Tsk), physiological heat strain (PSI), perceptual heat strain (PeSI), and body heat content were calculated. At the end of the 2-hr trials, Tre remained below 38 °C and the magnitude of Tre elevation was not greater than 1 °C in all conditions (WD: 0.9, WH: 0.8, WH: 0.7, and PD: 0.6 °C). However, Tsk was significantly increased by approximately 2.1 ± 0.8 °C across all conditions (all p ≤ 0.001). The increase in Tsk was the highest in WD followed by PD, WH, and PH conditions (all p ≤ 0.001). Although PSI and PeSI did not indicate severe heat strain during the 2-hr intermittent work period, PSI and PeSI were significantly increased over time (p ≤ 0.001). This study showed that core temperature and heat strain indices (PSI and PeSI) increased similarly across the four conditions. However, given that core temperature increased continuously during the work session, it is likely that the American Conference of Governmental Industrial Hygienist's TLV® upper limit core temperature of 38.0 °C may be surpassed during extended work periods under all conditions.

ThermoLabAnimal - A high-throughput analysis software for non-invasive thermal assessment of laboratory mice.

Body temperature changes in laboratory mice are often assessed by invasive and stressful methods, which may confound the measurement. Infrared thermography is a possible non-invasive alternative, but the cost of standard thermal cameras, lack of dedicated software for biomedical purposes, and labour-intensiveness of thermal image analysis have limited their use. An additional limitation lies on the scarcity of research on the causing factors of differences between body surface and core body temperature. We propose a method for automatic assessment of mean body surface temperature in freely-moving mice, using dedicated software for thermal image analysis. While skin surface temperature may not necessarily be linearly correlated with core body temperature (in itself an imprecise concept), under standardized environmental conditions, such as those in which laboratory animals are kept, mean body surface temperature can provide useful information on their thermal status (i.e. deviations from normothermia, namely hypo- and hyperthermia). We developed a publicly available software that includes an imaging analysis workflow/algorithm for automatic segmentation of the pixels associated with the animal from the pixels associated with the background, removing the need for manually defining the area of analysis. A batch analysis mode is also available, for automatic and high-throughput analysis of all image files located in a folder. The software is compatible with the most widespread thermal camera manufacturer, 'FLIR Systems', as well as with the low-cost 'Thermal Expert TE-Q1' miniaturized high-resolution thermal camera used for this study. Furthermore, the software has been validated in a mouse model expressing non-transient hypothermia, where the thermal analysis results were compared with readings from implanted thermo-sensitive passive integrated transponders tags. Thermography allows for thermal assessment of laboratory animals without the effect of handling stress on their physiology or behaviour. Our automatic image analysis software also removes observer errors and bias, while speeding up the data processing.

Model of Steady-state Temperature Rise in Multilayer Tissues Due to Narrow-beam Millimeter-wave Radiofrequency Field Exposure.

The assessment of health effects due to localized exposures from radiofrequency fields is facilitated by characterizing the steady-state, surface temperature rise in tissue. A closed-form analytical model was developed that relates the steady-state, surface temperature rise in multilayer planar tissues as a function of the spatial-peak power density and beam dimensions of an incident millimeter wave. Model data was derived from finite-difference solutions of the Pennes bioheat transfer equation for both normal-incidence plane waves and for narrow, circularly symmetric beams with Gaussian intensity distribution on the surface. Monte Carlo techniques were employed by representing tissue layer thicknesses at different body sites as statistical distributions compiled from human data found in the literature. The finite-difference solutions were validated against analytical solutions of the bioheat equation for the plane wave case and against a narrow-beam solution performed using a commercial multiphysics simulation package. In both cases, agreement was within 1-2%. For a given frequency, the resulting analytical model has four input parameters, two of which are deterministic, describing the level of exposure (i.e., the spatial-peak power density and beam width). The remaining two are stochastic quantities, extracted from the Monte Carlo analyses. The analytical model is composed of relatively simple functions that can be programmed in a spreadsheet. Demonstration of the analytical model is provided in two examples: the calculation of spatial-peak power density vs. beam width that produces a predefined maximum steady-state surface temperature, and the performance evaluation of various proposed spatial-averaging areas for the incident power density.

Development of a Wireless Health Monitoring System for Measuring Core Body Temperature from the Back of the Body.

In this paper, a user-friendly and low-cost wireless health monitoring system that measures skin temperature from the back of the body for monitoring the core body temperature is proposed. To measure skin temperature accurately, a semiconductor-based microtemperature sensor with a maximum accuracy of ±0.3°C was chosen and controlled by a high-performance/low-power consumption Acorn-Reduced Instruction Set Computing Machine (ARM) architecture microcontroller to build the temperature measuring device. Relying on a 2.4 GHz multichannel Gaussian frequency shift keying (GFSK) RF communication technology, up to 100 proposed temperature measuring devices can transmit the data to one receiver at the same time. The shell of the proposed wireless temperature-measuring device was manufactured via a 3D printer, and the device was assembled to conduct the performance tests and in vivo experiments. The performance test was conducted with a K-type temperature sensor in a temperature chamber to observe temperature measurement performance. The results showed an error value between two devices was less than 0.1°C from 25 to 40°C. For the in vivo experiments, the device was attached on the back of 10 younger male subjects to measure skin temperature to investigate the relationship with ear temperature. According to the experimental results, an algorithm based on the curve-fitting method was implemented in the proposed device to estimate the core body temperature by the measured skin temperature value. The algorithm was established as a linear model and set as a quadratic formula with an interpolant and with each coefficient for the equation set with 95% confidence bounds. For evaluating the goodness of fit, the sum of squares due to error (SSE), R-square, adjusted R-square, and root mean square error (RMSE) values were 33.0874, 0.0212, 0.0117, and 0.3998, respectively. As the experimental results have shown, the mean value for an error between ear temperature and estimated core body temperature is about ±0.19°C, and the mean bias is 0.05 ± 0.14°C when the subjects are in steady status.

Clinical assessment of arthritic knee pain by infrared thermography.

Background Infrared thermography (IRT) provides accurate measurements of surface temperatures. In inflammatory conditions such as arthritis, tissue temperature is elevated, which can be measured on the periarticular skin surface by IRT. The aim of this review is to evaluate the evidence for the relationship between skin temperature (measured by IRT) and arthritic knee pain and discuss the limitations of IRT in clinical settings of arthritis. Method To reach this goal, a mini-review of all the relevant papers indexed in PubMed was conducted. Results Several studies suggest a significant correlation between skin temperature assessed by IRT and the severity of arthritic knee pain (especially in osteoarthritis and rheumatoid arthritis). Conclusion IRT is a reliable technique to assess inflammatory arthritis pain.

Reliability of a novel thermal imaging system for temperature assessment of healthy feet.

BACKGROUND: Thermal imaging is a useful modality for identifying preulcerative lesions ("hot spots") in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet. METHODS: Plantar skin foot temperatures were measured with the novel thermal imaging device (Diabetic Foot Ulcer Prevention System (DFUPS), constructed by Photometrix Imaging Ltd) and also with a hand-held infrared spot thermometer (Thermofocus® 01500A3, Tecnimed, Italy) after 20 min of barefoot resting with legs supported and extended in 105 subjects (52 males and 53 females; age range 18 to 69 years) as part of a multicentre clinical trial. The temperature differences between the right and left foot at five regions of interest (ROIs), including 1st and 4th toes, 1st, 3rd and 5th metatarsal heads were calculated. The intra-instrument agreement (three repeated measures) and the inter-instrument agreement (hand-held thermometer and thermal imaging device) were quantified using intra-class correlation coefficients (ICCs) and the 95% confidence intervals (CI). RESULTS: Both devices showed almost perfect agreement in replication by instrument. The intra-instrument ICCs for the thermal imaging device at all five ROIs ranged from 0.95 to 0.97 and the intra-instrument ICCs for the hand-held-thermometer ranged from 0.94 to 0.97. There was substantial to perfect inter-instrument agreement between the hand-held thermometer and the thermal imaging device and the ICCs at all five ROIs ranged between 0.94 and 0.97. CONCLUSIONS: This study reports the performance of a novel thermal imaging device in the assessment of foot temperatures in healthy volunteers in comparison with a hand-held infrared thermometer. The newly developed thermal imaging device showed very good agreement in repeated temperature assessments at defined ROIs as well as substantial to perfect agreement in temperature assessment with the hand-held infrared thermometer. In addition to the reported non-inferior performance in temperature assessment, the thermal imaging device holds the potential to provide an instantaneous thermal image of all sites of the feet (plantar, dorsal, lateral and medial views). TRIAL REGISTRATION: Diabetic Foot Ulcer Prevention System NCT02317835, registered December 10, 2014.

Content validation of the Patient-Reported Hamilton Inventory for Complex Regional Pain Syndrome: Validité de contenu du Hamilton Inventory for Complex Regional Pain Syndrome, une mesure des résultats déclarés par le patient.

BACKGROUND: Complex regional pain syndrome (CRPS) is a perplexing neurological condition, and persons with CRPS experience substantial loss of daily roles and activities. A condition-specific measure is being developed to evaluate CRPS. PURPOSE: We describe the use of cognitive interviews to examine content validity of this patient-reported outcome measure for CRPS. METHOD: Interviews with 44 persons with CRPS were analyzed to identify problems with wording and support content validation. Item-total correlations were calculated for proposed subscales, and scores were plotted to consider floor/ceiling effects. FINDINGS: Interviews identified questions where respondents considered factors unrelated to the construct of interest or were underaddressed by the questionnaire, including depression and skin temperature. The symptoms, daily function, and coping/social impact scales demonstrated satisfactory correlations (Cronbach's alpha 0.76-0.86). Despite a sampling bias of severity, no frank floor/ceiling effects were noted. IMPLICATIONS: This study builds a foundation for continuing development and evaluation of the measurement properties of the Patient-Reported Hamilton Inventory for CRPS. It makes explicit the iterative decisions involved in rigorous instrument development.

Towards a wearable sensor system for continuous occupational cold stress assessment.

This study investigated the usefulness of continuous sensor data for improving occupational cold stress assessment. Eleven volunteer male subjects completed a 90-120-min protocol in cold environments, consisting of rest, moderate and hard work. Biomedical data were measured using a smart jacket with integrated temperature, humidity and activity sensors, in addition to a custom-made sensor belt worn around the chest. Other relevant sensor data were measured using commercially available sensors. The study aimed to improve decision support for workers in cold climates, by taking advantage of the information provided by data from the rapidly growing market of wearable sensors. Important findings were that the subjective thermal sensation did not correspond to the measured absolute skin temperature and that large differences were observed in both metabolic energy production and skin temperatures under identical exposure conditions. Temperature, humidity, activity and heart rate were found to be relevant parameters for cold stress assessment, and the locations of the sensors in the prototype jacket were adequate. The study reveals the need for cold stress assessment and indicates that a generalised approached is not sufficient to assess the stress on an individual level.

Using wearable physiological sensors to predict energy expenditure.

Lower-limb assistive robotic devices are often evaluated by measuring a reduction in the user's energy cost. Using indirect calorimetry to estimate energy cost is poorly suited for real-time estimation and long-term collection. The goal of this study was to use data from wearable sensors to predict energy cost with better temporal resolution and less variability than breath measurements. We collected physiological data (heart rate, electrodermal activity, skin temperature) and mechanical data (EMG, accelerometry) from three healthy subjects walking on a treadmill at various speeds on level ground, inclined, and backwards. Ground truth energy cost was established by averaging steady-state breath measurements. Raw physiological signals correlated well with ground truth energy cost, but raw mechanical signals did not. Correlation of mechanical signals was improved by calculating accelerometer magnitudes and linear envelope EMG signals, and further improved by averaging the signals over several seconds. A multiple linear regression including physiological and mechanical data accurately predicted ground truth energy cost across all subjects and activities tested, with less variability and better temporal resolution than breath measurements. The sensors used in this study were fully portable, and such algorithms could be used to estimate energy cost of users in the real world. This could greatly improve the design, control, and evaluation of lower-limb assistive robotic devices.

Development of a Protocol for Simultaneous Assessment of Cognitive Functioning Under Psychosocial Stress.

This study presents a protocol for induction of moderate psychosocial stress and investigates its impact on psychological and physiological responses. The proposed procedure was designed to enable researchers to assess cognitive performance under effect of various classes of stressors. The protocol's structure contains three main periods: baseline, assessment, and recovery. The assessment stage starts with task anticipation, during which audience (three-member commission) is introduced and apparatus (cameras, microphones, lights, and physiological measuring devices) stationed. Subsequently, cognitive performance was tested. The protocol was evaluated on 56 university students that were randomly assigned to control or stress (protocol) treatment and administered three cognitive tests (working memory operation span, remote associates test, and semantic fluency). Compared to control sessions, protocol induced state anxiety, interfering worry thoughts, and disturbance during recovery period. In addition, the stress group also showed elevated levels of skin conductance, higher average heart rates, and larger drops in peripheral temperature. Even though more research is needed, these results suggest that the protocol effectively induces both psychological and physiological stress responses and therefore encourages utilization in cognitive-affective and cognitive-biological fields of research.

Towards an automatic early stress recognition system for office environments based on multimodal measurements: A review.

Stress is a major problem of our society, as it is the cause of many health problems and huge economic losses in companies. Continuous high mental workloads and non-stop technological development, which leads to constant change and need for adaptation, makes the problem increasingly serious for office workers. To prevent stress from becoming chronic and provoking irreversible damages, it is necessary to detect it in its early stages. Unfortunately, an automatic, continuous and unobtrusive early stress detection method does not exist yet. The multimodal nature of stress and the research conducted in this area suggest that the developed method will depend on several modalities. Thus, this work reviews and brings together the recent works carried out in the automatic stress detection looking over the measurements executed along the three main modalities, namely, psychological, physiological and behavioural modalities, along with contextual measurements, in order to give hints about the most appropriate techniques to be used and thereby, to facilitate the development of such a holistic system.

Distinct temporal filtering mechanisms are engaged during dynamic increases and decreases of noxious stimulus intensity.

Physical stimuli are subject to pronounced temporal filtering during afferent processing such that changes occurring at certain rates are amplified and others are diminished. Temporal filtering of nociceptive information remains poorly understood. However, the phenomenon of offset analgesia, where a disproportional drop in perceived pain intensity is caused by a slight drop in noxious heat stimulation, indicates potent temporal filtering in the pain pathways. To develop a better understanding of how dynamic changes in a physical stimulus are constructed into an experience of pain, a transfer function between the skin temperature and the perceived pain intensity was modeled. Ten seconds of temperature-controlled near-infrared (970 nm) laser stimulations above the pain threshold with a 1°C increment, decrement, or constant temperature were applied to the dorsum of the hand of healthy human volunteers. The skin temperature was assessed by an infrared camera. Offset analgesia was evoked by laser heat stimulation. The estimated transfer functions showed shorter latencies when the temperature was increased by 1°C (0.53 seconds [0.52-0.54 seconds]) than when decreased by 1°C (1.15 seconds [1.12-1.18 seconds]) and smaller gains (increase: 0.89 [0.82-0.97]; decrease: 2.61 [1.91-3.31]). The maximal gain was observed at rates around 0.06 Hz. These results show that temperature changes occurring around 0.06 Hz are best perceived and that a temperature decrease is associated with a larger but slower change in pain perception than a comparable temperature increase. These psychophysical findings confirm the existence of differential mechanisms involved in temporal filtering of dynamic increases and decreases in noxious stimulus intensity.

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes.

AIMS/HYPOTHESIS: Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness. METHODS: Twenty-four patients with type 1 diabetes (ten aware, 14 unaware) were studied during normoglycaemia (5.0-6.0 mmol/l), hypoglycaemia (2.0-2.5 mmol/l) and during recovery from hypoglycaemia (5.0-6.0 mmol/l) using hyperinsulinaemic glucose clamping. During each 1 h phase, Ts was measured twice by infrared thermography imaging in pre-defined areas (nose, glabella and the five left fingertips), symptoms of hypoglycaemia were scored and blood was sampled. RESULTS: Ts decreased during hypoglycaemia on the nose and glabella. The highest decrements were recorded on the nose (aware: -2.6 °C, unaware: -1.1 °C). In aware patients, the differences in temperature were statistically significant on both nose and glabella, whereas there was only a trend in the unaware group. There was a significant difference in hypoglycaemia-induced temperature changes between the groups. Patients in the aware group had higher hypoglycaemia symptom scores and higher adrenaline (epinephrine) levels during hypoglycaemia. CONCLUSIONS/INTERPRETATION: The hypoglycaemia-associated decrement in Ts can be assessed by infrared thermography and is larger in patients with normal hypoglycaemia awareness compared with unaware patients.

Validation of an innovative method, based on tilt sensing, for the assessment of activity and body position.

Since there is less movement during sleep than during wake, the recording of body movements by actigraphy has been used to indirectly evaluate the sleep-wake cycle. In general, most actigraphic devices are placed on the wrist and their measures are based on acceleration detection. Here, we propose an alternative way of measuring actigraphy at the level of the arm for joint evaluation of activity and body position. This method analyzes the tilt of three axes, scoring activity as the cumulative change of degrees per minute with respect to the previous sampling, and measuring arm tilt for the body position inference. In this study, subjects (N = 13) went about their daily routine for 7 days, kept daily sleep logs, wore three ambulatory monitoring devices and collected sequential saliva samples during evenings for the measurement of dim light melatonin onset (DLMO). These devices measured motor activity (arm activity, AA) and body position (P) using the tilt sensing of the arm, with acceleration (wrist acceleration, WA) and skin temperature at wrist level (WT). Cosinor, Fourier and non-parametric rhythmic analyses were performed for the different variables, and the results were compared by the ANOVA test. Linear correlations were also performed between actimetry methods (AA and WA) and WT. The AA and WA suitability for circadian phase prediction and for evaluating the sleep-wake cycle was assessed by comparison with the DLMO and sleep logs, respectively. All correlations between rhythmic parameters obtained from AA and WA were highly significant. Only parameters related to activity levels, such as mesor, RA (relative amplitude), VL5 and VM10 (value for the 5 and 10 consecutive hours of minimum and maximum activity, respectively) showed significant differences between AA and WA records. However, when a correlation analysis was performed on the phase markers acrophase, mid-time for the 10 consecutive hours of highest (M10) and mid-time for the five consecutive hours of lowest activity (L5) with DLMO, all of them showed a significant correlation for AA (R = 0.607, p = 0.028; R = 0.582, p = 0.037; R = 0.620, p = 0.031, respectively), while for WA, only acrophase did (R = 0.621, p = 0.031). Regarding sleep detection, WA showed higher specificity than AA (0.95 ± 0.01 versus 0.86 ± 0.02), while the agreement rate and sensitivity were higher for AA (0.76 ± 0.02 versus 0.66 ± 0.02 and 0.71 ± 0.03 versus 0.53 ± 0.03, respectively). Cohen's kappa coefficient also presented the highest values for AA (0.49 ± 0.04) and AP (0.64 ± 0.04), followed by WT (0.45 ± 0.06) and WA (0.37 ± 0.04). The findings demonstrate that this alternative actigraphy method (AA), based on tilt sensing of the arm, can be used to reliably evaluate the activity and sleep-wake rhythm, since it presents a higher agreement rate and sensitivity for detecting sleep, at the same time allows the detection of body position and improves circadian phase assessment compared to the classical actigraphic method based on wrist acceleration.