Impact of Therapeutic Inertia on Long-Term Blood Pressure Control: A Monte Carlo Simulation Study.

[Figure: see text].

Deep learning with wearable based heart rate variability for prediction of mental and general health.

The ubiquity and commoditisation of wearable biosensors (fitness bands) has led to a deluge of personal healthcare data, but with limited analytics typically fed back to the user. The feasibility of feeding back more complex, seemingly unrelated measures to users was investigated, by assessing whether increased levels of stress, anxiety and depression (factors known to affect cardiac function) and general health measures could be accurately predicted using heart rate variability (HRV) data from wrist wearables alone. Levels of stress, anxiety, depression and general health were evaluated from subjective questionnaires completed on a weekly or twice-weekly basis by 652 participants. These scores were then converted into binary levels (either above or below a set threshold) for each health measure and used as tags to train Deep Neural Networks (LSTMs) to classify each health measure using HRV data alone. Three data input types were investigated: time domain, frequency domain and typical HRV measures. For mental health measures, classification accuracies of up to 83% and 73% were achieved, with five and two minute HRV data streams respectively, showing improved predictive capability and potential future wearable use for tracking stress and well-being.

Future technology on the flight deck: assessing the use of touchscreens in vibration environments.

Use of touchscreens in the flight deck has been steadily increasing, however, their usability may be severely impacted when turbulent conditions arise. Most previous research focusses on using touchscreens in static conditions; therefore, this study assessed touchscreen use whilst undergoing turbulent representative motion, generated using a 6-axis motion simulator. Touchscreens were tested in centre, side and overhead positions, to investigate how turbulence affected: (1) error rate, movement times and accuracy, (2) arm fatigue and discomfort. Two touchscreen technologies were compared: a 15" infra-red and a 17.3" projected capacitive touchscreen with force sensing capability. The potential of the force sensing capability to minimise unintentional interactions was also investigated. Twenty-six participants undertook multi-direction tapping (ISO 9241; ISO 2010 ) and gesture tasks, under four vibration conditions (control, light chop, light turbulence and moderate turbulence). Error rate, movement time and workload increased and usability decreased significantly, with screen position and increasing turbulence level. Practitioner Summary: This study evaluated the use of infra-red and projected capacitive touchscreen technologies using multi-directional tapping and gesture tasks, whilst being subjected to different levels of turbulence representative motion. Performance degraded significantly with increasing turbulence level and touchscreen location. This has implications for future flight deck design.

Local Variation in Femoral Neck Cortical Bone: In Vitro Measured Bone Mineral Density, Geometry and Mechanical Properties.

Age- and disease (osteoporotic fractured and osteoarthritic tissue)-related changes in the distribution of cortical bone were examined, using a multimodality approach, including measurement of local density, geometry and mechanical properties, where changes in these properties can give rise to instability and increasing probability of fracture. In contrast to the majority of previously reported research, this study also focuses on the characteristic non-circular femoral neck cross-sectional geometry and variation in bone mineral density (BMD) around the femoral neck. Twenty-two osteoarthritic and 7 osteoporotic femoral neck slices, collected from elective and trauma-related arthroplasty, and 16 cadaveric donor tissue controls were tested mechanically using Reference Point Indentation (BioDent™, Active Life Technologies®, Santa Barbara, CA) and then scanned with in vitro-based radiography intended to replicate the dual-energy X-ray absorptiometry technique. All parameters were measured regionally around the circumference of the femoral neck, allowing examination of spatial variability within the cortical bone. Fractured tissue was less resistant to indentation in the thinner superolateral segment compared to other segments and other groups. BMD around the fractured femoral necks appeared more consistent than that of nonfractured tissue, where BMD was reduced in the superolateral segment for the other groups. Cortical bone was thin in the superolateral segment for all groups except for the osteoarthritic group, and was thicker in the inferomedial segment for both osteoarthritic and fractured groups, resulting in the largest variation in buckling ratio (ratio of cortical bone diameter to cortical bone thickness) around the femoral neck for the fractured group. With age, healthy controls appeared to have lower inferomedial cortical thickness, whereas no significant differences in Reference Point Indentation measurements and density were observed. The study has highlighted several (both quality- and quantity-related) parameters that may be used to improve prediction of fracture risk.

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck.

In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n = 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 [IQR 61-74] years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. © 2015 American Society for Bone and Mineral Research.

Feasibility of skin surface elastography by tracking skin surface topography.

Recent advances have led to a multitude of image modalities being used for visualization of tissue stiffness. High-resolution images of tissue stiffness are desirable, as they have the potential to provide useful diagnostic information. A noncontact optical imaging method has the attractions of low cost, simplicity, and utility when skin contact is undesirable. However, previous optical techniques have required the application of paint or ink to the surface of the skin and so have required contact. Therefore, the present study assessed the feasibility of tracking skin surface topography to produce elastograms. The study showed, by analyzing a variety of silicone skin surface replicas from various body sites of subjects of different ages, that skin surface elastography by tracking surface topography would be feasible. The study further showed that the quality of the strain images can be optimized by measuring skin line pattern frequency. Skin samples with high skin line frequency will achieve best spatial resolution, in the order of 1 mm, comparable to contact techniques reported previously. A mechanically inhomogeneous silicone replica was then imaged, illustrating the technique's ability to detect strain contrast. Finally, the feasibility of implementing the technique in vivo was illustrated using a single pigmented skin lesion.

Discomfort and the cortical haemodynamic response to coloured gratings.

In five experiments we measured the amplitude of the haemodynamic response to visual patterns using near infrared spectroscopy of the visual cortex. The patterns were gratings with bars that differed in chromaticity but not in luminance. In all experiments, with a wide range of chromaticities of the grating bars, the amplitude of the haemodynamic response increased with the separation of the chromaticities in the CIE 1976 UCS diagram. The amplitude did not vary consistently with the cone activation, or with the signal in colour difference channels. In four further experiments, again with a wide range of chromaticities, the gratings were rated for visual comfort. Discomfort increased consistently with the separation of the chromaticities. Given that a large haemodynamic response to patterns is generally associated with headache, we suggest that the discomfort may be a homeostatic signal to reduce sustained metabolic load on the visual cortex.

Multi-directional in vivo tensile skin stiffness measurement for the design of a reproducible tensile strain elastography protocol.

BACKGROUND/AIMS: Elastography is a promising new medical imaging modality, displaying spatial distribution of biomechanical properties such as local tissue strain response to an applied stress. To develop a reproducible test protocol for skin elastography, the effect of various parameters on skin stiffness measurements was investigated. METHODS: The parameters investigated were: history of skin loading before test loading (preconditioning), direction of test loading (anisotropy) and posture (pre-stress). If a sample of skin is loaded, its stiffness will temporarily change. Finally, the reproducibility of skin stiffness and anisotropy measurements, using the developed techniques, was investigated. RESULTS: By measuring how the stiffness changed with different time delays between loading cycles, the time required for healthy skin to return to its original pre-loaded state was in the region of 125 s. A second finding, which supports and extends previous work, was that skin stiffness varied with direction, by an approximate factor of 2, and that anisotropy was less apparent with preconditioned skin than non-preconditioned skin. Study of the effect of posture showed that care needs to be taken over which stiffness measure is used. For example, measurement of the load at a given displacement was found to be highly dependent on posture, whereas measurement of the phase III stiffness was independent of posture. CONCLUSION: It was shown that when the measurement variables and methods of analysis were standardised, skin stiffness could be measured reproducibly enough to distinguish between the stiffest and softest directions, and that these methods allowed formation of skin elastograms free from confounding influences.

Time course of the haemodynamic response to visual stimulation in migraine, measured using near-infrared spectroscopy.

BACKGROUND: In patients with migraine, an abnormally large haemodynamic response to epileptogenic visual stimulation has previously been observed, consistent with the hypothesis of a cortical hyperexcitability. Ophthalmic filters have been used in the treatment of migraine, and they reduce the haemodynamic response. METHODS: The present study used near-infrared spectroscopy (NIRS) to characterise the haemodynamic response to a range of visual stimuli in 20 patients with migraine (15 with aura and 5 without) and paired controls in order to assess the effect of ophthalmic treatment. In an initial study, the response to three stimuli (chequerboard, and two gratings of different spatial frequency) was measured. In a second study, using the mid-spatial frequency grating as stimulus, the response was compared when precision spectral filters (PSF), grey filters or filters of control colour were worn as ophthalmic lenses. RESULTS: In the first study the time course of the response differed between the groups. The difference was most distinct for the grating with mid-spatial frequency. In the second study the PSF broadened (normalised) the haemodynamic response in migraineurs relative to controls, consistent with fMRI BOLD findings and suggesting a physiological mechanism for their reported efficacy. In neither study were there differences in the amplitude of the response between migraine and control groups or indeed between filters. CONCLUSION: The time course of the functional response as measured by NIRS may be an effective tool to track therapy with PSF and explore the mechanisms of visual stress in migraine.

Reflectance of human skin using colour photometric stereo: with particular application to pigmented lesion analysis.

BACKGROUND/PURPOSE: The optical appearance of human skin is highly dependent on the interaction between the illumination (type and position), observer position and the skin surface structure. Different currently available photographic techniques record different aspects of this appearance, each providing its own incomplete description. This limits their usefulness, especially for pigmented skin lesion diagnosis. In this paper a new, easy to use, low-cost photographic method is described,which aims to generate an efficiently encoded yet reasonably complete representation of skin appearance. MATERIAL AND METHODS: A prototype hand-held camera was developed that rapidly acquires six colour images, each with the skin illuminated from a different direction. A novel photometric stereo processing was used to combine these into a colour image of the skin's diffuse reflectance, independent of the skin surface topography, as well as a separate representation of that topography in the form of a surface gradient image. Images of four clinical pigmented skin lesions were evaluated in comparison with conventional digital photographs by both visual judgement and automated lesion boundary detection. RESULTS: The new colour reflectance images were free from the effects of topographical shading, shadowing and specular reflections. Lesion boundaries obtained automatically from the reflectance images were always closer to the outline drawn by a dermatologist than those obtained from conventional photographs. Finally, recombining the colour reflectance and surface gradient data to form a virtual image of the skin surface that is highly realistic in appearance. CONCLUSIONS: The new colour photometric stereo camera produces images of skin and skin tumours in which the reflectance information that is related to subsurface pigment distribution is separated from the surface topographic information. The total information generated by the system, for use in visual or automated analysis, is potentially greater than that for either conventional photography or dermatoscopy alone. Its further development and broader clinical evaluation are warranted to determine its usefulness and role in a wide range of dermatological tasks, including tele-dermatology applications.