Table of contents

Accelerometry shows promise in providing an inexpensive but effective means of long-term ambulatory monitoring of elderly patients. The accurate classification of everyday movements should allow such a monitoring system to exhibit greater 'intelligence', improving its ability to detect and predict falls by forming a more specific picture of the activities of a person and thereby allowing more accurate tracking of the health parameters associated with those activities. With this in mind, this study aims to develop more robust and effective methods for the classification of postures and motions from data obtained using a single, waist-mounted, triaxial accelerometer; in particular, aiming to improve the flexibility and generality of the monitoring system, making it better able to detect and identify short-duration movements and more adaptable to a specific person or device. Two movement classification methods were investigated: a rule-based Heuristic system and a Gaussian mixture model (GMM)-based system. A novel time-domain feature extraction method is proposed for the GMM system to allow better detection of short-duration movements. A method for adapting the GMMs to compensate for the problem of limited user-specific training data is also proposed and investigated. Classification performance was considered in relation to data gathered in an unsupervised, directed routine conducted in a three-month field trial involving six elderly subjects. The GMM system was found to achieve a mean accuracy of 91.3%, distinguishing between three postures (sitting, standing and lying) and five movements (sit-to-stand, stand-to-sit, lie-to-stand, stand-to-lie and walking), compared to 71.1% achieved by the Heuristic system. The adaptation method was found to offer a mean accuracy of 92.2%; a relative improvement of 20.2% over tests without subject-specific data and 4.5% over tests using only a limited amount of subject-specific data. While limited to a restricted subset of possible motions and postures, these results provide a significant step in the search for a more robust and accurate ambulatory classification system.

Electrical impedance myography (EIM) is a painless and non-invasive technique for the assessment of muscle which we apply here to the effects of normal aging. The paper presents a cross-sectional analysis of EIM data from the quadriceps and tibialis anterior of 100 healthy subjects (44 men, 56 women, ages 18–90 years). The principal EIM parameter, the spatially averaged phase θ_avg, shows a roughly quadratic reduction with increasing age, declining more steeply beyond 60 years. The correlation was stronger in men (quadriceps: r² = 0.68 for men, 0.52 for women; tibialis anterior: r² = 0.74 for men, 0.38 for women; p < 0.001 throughout). Additionally, four subjects (age greater than 75 years) were asked to return for repeat testing several years after their initial assessment. These longitudinal results qualitatively confirm the cross-sectional data, though with greater reductions in θ_avg at high age. The findings of this study support the potential use of EIM as a simple and effort-independent test of muscle health in the elderly.

The whole body bioimpedance technique is a highly promising non-invasive, reproducible, fast and inexpensive bed-side method for monitoring hydration status. Using segmental bioimpedance measurements, it is possible to obtain information about the fluid change in each body segment (Song, Lee, Kim and Kim 1999 Perit. Dial. Int.19 386–90). In this pilot study we have measured 25 male patients (30–65 yr, BMI 20–32 kg m⁻²) undergoing continuous ambulatory peritoneal dialysis (CAPD). Tetrapolar impedance measurements were obtained using the right-side technique (whole body), and a segmental impedance method focused in the thorax region. Blood pressure (BP) measurements were taken manually with a sphygmomanometer. Patients were classified as either stable (group 0) or unstable (group 1) using clinical parameters of overall cardiovascular risk. The Mahalanobis distance (dM²) was calculated for the mean blood pressure (BP_mean), and the impedance parameter R normalized by body height H for the right-side (R_RS/H) and the thorax segment (R_TH/H). Differences between groups were significant (p < 0.0001) for R_TH/H and for BP_mean, and less significant (p = 0.016) for R_RS/H. Group 1 patients showed a small dM² as compared with a reference patient (a critical patient with acute lung edema) with high BP_mean and low values of R_TH/H and R_RS/H. Moreover, Group 0 patients showed a larger dM² with respect to the reference patient, with lower BP_mean and higher values of R_TH/H and R_RS/H. All patients classified as unstable by clinical assessment were correctly classified using R_TH/H in conjunction with BP_meanusing dM². Segmental-monofrequency non-invasive bioimpedance of the thoracic region could provide a simple, objective non-invasive method of support for facilitating the clinical assessment of CAPD patients.

The role of respiration in the genesis of heart rate variability (HRV) has been the subject matter of many experimental and modeling studies. It is widely accepted that the high frequency (HF) peak of a HRV power spectrum, which is centered at the average respiratory frequency, is caused by mechanisms activated by respiration. On the other hand, there is a debate on the possible role of respiration in the genesis of the low frequency (LF) peak which is usually centered around 0.1 Hz. In this study, a comprehensive cardiorespiratory interaction model is used to test various hypotheses regarding the role of respiration in the LF peak of HRV. In this model, chest and abdomen circumference signals and lung volume signal are used as respiratory inputs. Simulations are made for periodic, spontaneous and slightly irregular respiratory patterns, and it is observed that the more low frequency (LF) power there in the respiratory signals, the more LF power there in the model-predicted HRV. Experiments on nine volunteers are also performed for the same respiratory patterns and similar results are observed. Furthermore, the actual measured respiratory signals are input to the model and the model predicted and the actual HRVs are compared both in time domain and also with respect to their power spectra. It is concluded in general that respiration not only is the major contributor to the genesis of the HF peak in the HRV power spectrum, but also plays an important role in the genesis of its LF peak. Thus, the LF/HF ratio, which is used to assess sympathovagal balance, cannot be correctly utilized in the absence of simultaneous monitoring of respiration during an HRV test.

The aim of this study was to compare the dependence of heart rate variability (HRV) on heart period (RR interval length) under different physiological and pathological states in order to detect changes in HR modulation. The dependence of HRV on the RR interval length in healthy elderly subjects, congestive heart failure (CHF) patients and one patient with a transplanted heart (T) was compared with healthy young subjects. Spectral powers, sample entropy (SampEn) and short-term fractal scaling exponent (α₁) were determined from 24 h free-running recordings. For the same HR, HRV measures were different in different groups. In healthy subjects HRV measures depended on RR interval length and all spectral powers were highly correlated, although reduced in elderly subjects. SampEn at high HR was the most sensitive quantity to changes induced by aging. In disease, CHF and T, an achievable HR range was decreased, all spectral powers were reduced, but correlated, and the dependence of HRV measures on RR was lost. There was an evident difference in the dependence of nonlinear on linear measures between young subjects and all the other studied groups. In disease the reduction in autonomic control was associated with the decrease in short-range correlation and regularity in RR series. We have concluded that the analysis of HRV measures as functions of RR interval length can reveal important aspects of HR control that might be lost in averaging.

Micro electro-mechanical and NANO technologies are sensibly reducing circuit and geometrical errors in accelerometer sensors. These sensors are often used as portable inclinometer sensors for trunk flexion monitoring in clinical applications. In this case, the rotating trunk generates centripetal acceleration, an error source that technological efforts cannot eliminate. This study analysed the effect of this source for typical human monitoring conditions by simulations and clinical validation using a wearable device with rate gyroscopes and accelerometers (Giansanti and Maccioni 2005 Physiol. Meas.26 689–705). Results showed that this error source did not affect long-term monitoring applications (Mathie et al 2004 Physiol. Meas.25 R1–R20) but in the short-term monitoring caused a mean angular error equal to 0.96° for the most critical single-task application represented by the sit-to-stand.

External defibrillation requires the application of high voltage electrical impulses via large external electrodes, placed on selected locations on the thorax surface. The position of the electrodes is one of the major determinants of the transthoracic impedance (TTI) which influences the intracardiac current flow during electric shock and defibrillation success. The variety of factors which influence TTI measurements raised our interest to investigate the range of TTI values and the temporal TTI variance during long-term application of defibrillation self-adhesive electrodes in two conventional positions on the patient's chest—position 1 (sub-clavicular/sub-axillar position) and position 2 (antero-posterior position). The prospective study included 86 randomly selected volunteers (39 male and 49 female, 67 patients with normal skin, 13 patients with dry skin and 6 patients with greasy skin, 16 patients with chest pilosity and 70 patients without chest pilosity). The TTI was measured according to the interelectrode voltage drop obtained by passage of a low-amplitude high-frequency current (32 kHz) between the two self-adhesive electrodes (active area about 92 cm²). For each patient, the TTI values were measured within 10 s, 1 min and 5 min after sticking the electrodes to the skin surface, independently for the two tested electrode positions. We found that the expected TTI range is between 58 Ω and 152 Ω for position 1 and between 55 Ω and 149 Ω for position 2. Although the two TTI ranges are comparable, we measured significantly higher TTI mean of about (107.2 ± 22.3) Ω for position 1 compared to (96.6 ± 19.2) Ω for position 2 (p = 0.001). This fact suggested that the antero-posterior position of the electrodes is favourable for defibrillation. Within the investigated time interval of 5 min, we observed a significant TTI reduction with about 6.9% (7.4 Ω/107.2 Ω) for position 1 and about 5.3% (5.1 Ω/96.6 Ω) for position 2. We suppose that the long-term application of self-adhesive electrodes would lead to improvement of the physical conditions for conduction of the defibrillation current and to diminution of energy loss in the electrode–skin contact impedance. We found that gender is important when position 1 is used because women have significantly higher TTI (111 ± 20.3) Ω compared to the TTI of men (102.6 ± 24) Ω (p = 0.0442). Although we found some specifics of the electrode–skin contact layer, we can conclude that because of the insignificant differences in TTI, the operator of the defibrillator paddles does not need to take into consideration the skin type and pilosity of the patients. Analysis of the correlations between TTI and the individual patient characteristics (chest size, weight, height, age) showed that these patient characteristics are unreliable factors for prediction of the TTI values and optimal defibrillation pulse parameters and energy.

The ability to assess cardiac output noninvasively has been the focus of interest for many researchers. While the open-circuit acetylene (C₂H₂) method seems promising, it is prone to error due to ventilation–perfusion inequality. Measurements during exercise, at high altitude or in patients with chronic obstructive pulmonary disease (COPD) could be unreliable and further validation studies under these circumstances may be needed. We used a computer model based on formulae derived from the multiple inert gas elimination technique to quantify error in measurements resulting from inequality at rest, during exercise or at high altitude. Moreover, potential errors encountered in patients with COPD were quantified. In healthy subjects, inequality related measurement error seems negligible, under both normoxic and hypoxic conditions and especially during exercise. In COPD, errors up to 20% at rest and up to 15% during exercise are expected. It is therefore concluded from our model that the open-circuit C₂H₂ uptake method is expected to be accurate in normal subjects. Its validity in COPD needs further study.

Photoplethysmography and pulse oximetry are techniques based on optical principles, which are widely used in medical practice for non-invasive monitoring. There are some processes which may affect specific organs or parts without a significant repercussion on the information provided non-invasively. Here, we report on the preliminary results obtained by transmittance photoplethysmography in pig intra-peritoneal organs along a surgical intervention, using a measurement system based on two near-infrared laser diodes. Analysis of the signals recorded at 750 nm and 850 nm in the mesentery root, mesocolon, gastric wall and aorta artery has shown the affordability of performing in situ photoplethysmography for visceral perfusion evaluation.

Snoring is a prevalent condition with a variety of negative social effects and associated health problems. Treatments, both surgical and therapeutic, have been developed, but the objective non-invasive monitoring of their success remains problematic. We present a method which allows the automatic monitoring of snoring characteristics, such as intensity and frequency, from audio data captured via a freestanding microphone. This represents a simple and portable diagnostic alternative to polysomnography. Our system is based on methods that have proved effective in the field of speech recognition. Hidden Markov models (HMMs) were employed as basic elements with which to model different types of sound by means of spectrally based features. This allows periods of snoring to be identified, while rejecting silence, breathing and other sounds. Training and test data were gathered from six subjects, and annotated appropriately. The system was tested by requiring it to automatically classify snoring sounds in new audio recordings and then comparing the result with manually obtained annotations. We found that our system was able to correctly identify snores with 82–89% accuracy, despite the small size of the training set. We could further demonstrate how this segmentation can be used to measure the snoring intensity, snoring frequency and snoring index. We conclude that a system based on hidden Markov models and spectrally based features is effective in the automatic detection and monitoring of snoring from audio data.

Phantoms are often used to simulate tissue during the development, testing and calibration of medical devices. In order to infer the specific absorption rate (SAR) and resistive heating in phantoms from temperature measurements, the specific heat capacity and density of the phantom are needed. Stauffer et al (2003 Int. J. Hyperth.19 89–101) developed several phantoms that mimic dielectric properties of liver tissue at 915 MHz. However, thermal properties of the phantoms were not presented. We have measured specific heat capacities and densities for these phantoms. We also present dielectric properties for these phantoms measured from 0.7 to 20 GHz, including 2.45 GHz—a commonly used frequency for microwave hyperthermia and ablation.

This study describes new applications for the method of calibrated multiple accelerometry, which detects posture and distinct motion patterns, and limb movements continuously. The aim of our study was to evaluate this assessment technique in terms of its suitability for exploring the relationships between pathological limb movement activity (e.g., periodic leg movements) and posture. The new method proved to be appropriate for the simultaneous assessment of pathological leg jerks and posture and provided a means to revealing possible relations. Generally, our study demonstrates the application of this (ambulatory) assessment technique in the field of sleep and neurological disorders.

Current systems for radiofrequency ablation of liver tumors are unable to consistently treat tumors larger than 3 cm in diameter with a single electrode in a single application. One of the strategies for enlarging coagulation zone dimensions is to infuse saline solutions into the tissue through the active electrodes. Nevertheless, the uncontrolled and undirected diffusion of boiling saline into the tissue has been associated with irregular coagulation zones and severe complications, mainly due to reflux of saline along the electrode path. In order to improve the perfusion bipolar ablation method, we hypothesized that the creation of small monopolar coagulation zones adjacent to the bipolar electrodes and previous to the saline infusion would create preferential paths for the saline to concentrate on the targeted coagulation zone. Firstly, we conducted ex vivo experiments in order to characterize the monopolar coagulation zones. We observed that they are practically impermeable to the infused saline. On the basis of this finding, we built theoretical models and conducted computer simulations to assess the feasibility of our hypothesis. Temperature distributions during bipolar ablations with and without previous monopolar coagulation zones were obtained. The results showed that in the case of monopolar coagulation zones the temperature of the tissue took longer to reach 100 °C. Since this temperature value is related to rise of impedance, and the time necessary for this process is directly related to the volume of the coagulation zone, our results suggest that monopolar sealing would allow larger coagulation zones to be created. Future experimental studies should confirm this benefit.

We comment on the paper by Juniewicz et al (2005 Physiol. Meas.26 1039–48) which addresses problems in application of the Marmarou model for analyzing intracranial pressure changes during and after the infusion test, as well as the clinical relevance of the additional parameters obtained during prolonged infusion.

Not all dynamic phenomena which may influence a course of intracranial pressure during the CSF infusion test are described by the classical Marmarou model. Exact mathematical considerations, although formally interesting, may practically prove to be of limited value. Performing infusion through one needle or attempts to shorten the time of recording may prevent an accurate interpretation of the test.