Tissue-informative mechanism for wearable non-invasive continuous blood pressure monitoring

Microfluidic Wearable Devices for Sports Applications

This study aimed to systematically review the application and research progress of flexible microfluidic wearable devices in the field of sports. The research team thoroughly investigated the use of life signal-monitoring technology for flexible wearable devices in the domain of sports. In addition, the classification of applications, the current status, and the developmental trends of similar products and equipment were evaluated. Scholars expect the provision of valuable references and guidance for related research and the development of the sports industry. The use of microfluidic detection for collecting biomarkers can mitigate the impact of sweat on movements that are common in sports and can also address the issue of discomfort after prolonged use. Flexible wearable gadgets are normally utilized to monitor athletic performance, rehabilitation, and training. Nevertheless, the research and development of such devices is limited, mostly catering to professional athletes. Devices for those who are inexperienced in sports and disabled populations are lacking. Conclusions: Upgrading microfluidic chip technology can lead to accurate and safe sports monitoring. Moreover, the development of multi-functional and multi-site devices can provide technical support to athletes during their training and competitions while also fostering technological innovation in the field of sports science.

On the development of low power wearable devices for assessment of physiological vital parameters: a systematic review

Aim

Smart wearable devices for continuous monitoring of health conditions have bbecome very important in the healthcare sector to acquire and assess the different physiological parameters. This paper reviews the nature of physiological signals, desired vital parameters, role of smart wearable devices, choices of wearable devices and design considerations for wearable devices for early detection of health conditions.

Subject and methods

This article provides designers with information to identify and develop smart wearable devices based on the data extracted from a literature survey on previously published research articles in the field of wearable devices for monitoring vital parameters.

Results

The key information available in this article indicates that quality signal acquisition, processing and longtime monitoring of vital parameters requires smart wearable devices. The development of smart wearable devices with the listed design criteria supports the developer to design a low power wearable device for continuous monitoring of patient health conditions.

Conclusion

The wide range of information gathered from the review indicates that there is a huge demand for smart wearable devices for monitoring health conditions at home. It further supports tracking heath status in the long term via monitoring the vital parameters with the support of wireless communication principles.

A Computational Modeling and Simulation Workflow to Investigate the Impact of Patient-Specific and Device Factors on Hemodynamic Measurements from Non-Invasive Photoplethysmography

Cardiovascular disease is the leading cause of death globally. To provide continuous monitoring of blood pressure (BP), a parameter which has shown to improve health outcomes when monitored closely, many groups are trying to measure blood pressure via noninvasive photoplethysmography (PPG). However, the PPG waveform is subject to variation as a function of patient-specific and device factors and thus a platform to enable the evaluation of these factors on the PPG waveform and subsequent hemodynamic parameter prediction would enable device development. Here, we present a computational workflow that combines Monte Carlo modeling (MC), gaussian combination, and additive noise to create synthetic dataset of volar fingertip PPG waveforms representative of a diverse cohort. First, MC is used to determine PPG amplitude across age, skin tone, and device wavelength. Then, gaussian combination generates accurate PPG waveforms, and signal processing enables data filtration and feature extraction. We improve the limitations of current synthetic PPG frameworks by enabling inclusion of physiological and anatomical effects from body site, skin tone, and age. We then show how the datasets can be used to examine effects of device characteristics such as wavelength, analog to digital converter specifications, filtering method, and feature extraction. Lastly, we demonstrate the use of this framework to show the insensitivity of a support vector machine predictive algorithm compared to a neural network and bagged trees algorithm.

An Alignment-Free Sensing Module for Noninvasive Radial Artery Blood Pressure Measurement

Sensor–artery alignment has always been a significant problem in arterial tonometry devices and prevents their application to wearable continuous blood pressure (BP) monitoring. Traditional solutions are to use a complex servo system to search for the best measurement position or to use an inefficient pressure sensor array. In this study, a novel solid–liquid mixture pressure sensing module is proposed. A flexible film with unique liquid-filled structures greatly reduces the pulse measurement error caused by sensor misplacement. The ideal measuring location was defined as −2.5 to 2.5 mm from the center of the module and the pressure variation was within 5.4%, which is available in the real application. Even at a distance of ±4 mm from the module center, the pressure decays by 23.7%, and its dynamic waveform is maintained. In addition, the sensing module is also endowed with the capability of measuring the pulse wave transmit time as a complementary method for BP measuring. The capability of the developed alignment-free sensing module in BP measurement was been validated. Twenty subjects were selected for the BP measurement experiment, which followed IEEE standards. The experimental results showed that the mean error of SBP is −4.26 mmHg with a standard deviation of 7.0 mmHg, and the mean error of DBP is 2.98 mmHg with a standard deviation of 5.07 mmHg. The device is expected to provide a new solution for wearable continuous BP monitoring.

A Transfer Function Model Development for Reconstructing Radial Pulse Pressure Waveforms Using Non-Invasively Measured Pulses by a Robotic Tonometry System

The primary goal of this study is to develop a mathematical model that can establish a transfer function relationship between the “external” pulse pressures measured by a tonometer and the “internal” pulse pressure in the artery. The purpose of the model is to accurately estimate and rebuild the internal pulse pressure waveforms using arterial tonometry measurements. To develop and validate a model without human subjects and operators for consistency, this study employs a radial pulse generation system, a robotic tonometry system, and a write model with an artificial skin and vessel. A transfer function model is developed using the results of the pulse testing and the mechanical characterization testing of the skin and vessel. To evaluate the model, the pulse waveforms are first reconstructed for various reference pulses using the model with tonometry data. They are then compared with pulse waveforms acquired by internal measurement (by the built-in pressure sensor in the vessel) the external measurement (the on-skin measurement by the robotic tonometry system). The results show that the model-produced pulse waveforms coinciding well with the internal pulse waveforms with small relative errors, indicating the effectiveness of the model in reproducing the actual pulse pressures inside the vessel.

The underlying mechanism of intersite discrepancies in ejection time measurements from arterial waveforms and its validation in the Framingham Heart Study

Radial applanation tonometry is a well-established method for clinical hemodynamic assessment and is also becoming popular in wrist-worn fitness trackers. The time difference between the foot and the dicrotic notch of the arterial pressure waveform is a well-accepted approximation for the left ventricular ejection time (ET). However, several clinical studies have shown that ET measured from the radial pressure waveform deviates from that measured centrally. In this work, we consider the systolic wave and the dicrotic wave as two independent traveling waves and hypothesize that their wave speed difference leads to the intersite differences of measured ET (ΔET). Accordingly, we derived a mathematical dicrotic wave decomposition model and identified the most influential factors on ΔET via global sensitivity analysis. In our clinical validation on a heterogeneous cohort (N = 5,742) from the Framingham Heart Study (FHS), the local sensitivity analysis results resembled the sensitivity variation patterns of ΔET from model simulations. A regression analysis on FHS data, using morphological features of radial pressure waveforms to estimate the carotid ET, produced a root mean square error of 3.76 ms and R² of 0.91. The proposed dicrotic wave decomposition model can explain the intersite ET measurement discrepancies observed in the clinical data of FHS and can facilitate the precise identification of ET with radial pressure waveforms. Therefore, the proposed model will improve various physics-based pulse wave analysis methods as well as prospective artificial intelligence methods for tackling the subsequent big data produced from widespread wearable radial pressure monitoring.NEW & NOTEWORTHY Based on a new understanding of pressure wave propagation, we propose a novel dicrotic wave decomposition model considering the dicrotic wave as an independent traveling component. The proposed model can explain the mechanism underlying the intersite discrepancies in ejection time measurement from arterial waveforms and then, in principle, enhance the accuracy of both classical physics-based as well as more contemporary artificial intelligence-based pulse wave analysis methods in clinical and wearable radial blood pressure monitoring applications.

A Multi-Functional Physiological Hybrid-Sensing E-Skin Integrated Interface for Wearable IoT Applications

This paper presents a flexible multi-functional physiological sensing system that provides multiple noise-immune readout architectures and hybrid-sensing capability with an analog pre-processing scheme. The proposed multi-functional system is designed to support five physiological detection methodologies of piezo-resistive, pyro-resistive, electro-metric, opto-metric and their hybrid, utilizing an in-house multi-functional e-skin device, in-house flexible electrodes and a LED-photodiode pair. For their functional verification, eight representative physiological detection capabilities were demonstrated using wearable device prototypes. Especially, the hybrid detection method includes an innovative continuous measurement of blood pressure (BP) while most previous wearable devices are not ready for it. Moreover, for effective implementation in the form of the wearable device, post-processing burden of the hybrid method was much reduced by integrating a proposed analog pre-processing scheme, where only simple counting process and calibration remain to estimate the BP. This multi-functional sensor readout circuits and their hybrid-sensing interface are fully integrated into a single readout integrated circuit (ROIC), which is designed to implement three readout paths: two electrometric readout paths and one impedometric readout path. For noise-immune detection of the e-skin sensor, a pseudo-differential front-end with a ripple reduction loop is proposed in the impedometric readout path, and also state-of-the-art body-oriented noise reduction techniques are adopted for the electrometric readout path. The ROIC is fabricated in a CMOS process and in-house e-skin devices and flexible electrodes are also fabricated.

Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association

The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.

A compact pulsatile simulator based on cam-follower mechanism for generating radial pulse waveforms

Background

There exists a growing need for a cost-effective, reliable, and portable pulsation simulator that can generate a wide variety of pulses depending on age and cardiovascular disease. For constructing compact pulsation simulator, this study proposes to use a pneumatic actuator based on cam-follower mechanism controlled by a DC motor. The simulator is intended to generate pulse waveforms for a range of pulse pressures and heart beats that are realistic to human blood pulsations.

Methods

This study first performed in vivo testing of a healthy young man to collect his pulse waveforms using a robotic tonometry system (RTS). Based on the collected data a representative human radial pulse waveform is obtained by conducting a mathematical analysis. This standard pulse waveform is then used to design the cam profile. Upon fabrication of the cam, the pulsatile simulator, consisting of the pulse pressure generating component, pressure and heart rate adjusting units, and the real-time pulse display, is constructed. Using the RTS, a series of testing was performed on the prototype to collect its pulse waveforms by varying the pressure levels and heart rates. Followed by the testing, the pulse waveforms generated by the prototype are compared with the representative, in vivo, pulse waveform.

Results

The radial Augmentation Index analysis results show that the percent error between the simulator data and human pulse profiles is sufficiently small, indicating that the first two peak pressures agree well. Moreover, the phase analysis results show that the phase delay errors between the pulse waveforms of the prototype and the representative waveform are adequately small, confirming that the prototype simulator is capable of simulating realistic human pulse waveforms.

Conclusions

This study demonstrated that a very accurate radial pressure waveform can be reproduced using the cam-based simulator. It can be concluded that the same testing and design methods can be used to generate pulse waveforms for other age groups or any target pulse waveforms. Such a simulator can make a contribution to the research efforts, such as development of wearable pressure sensors, standardization of pulse diagnosis in oriental medicine, and training medical professionals for pulse diagnosis techniques.

Wearable Health Devices-Vital Sign Monitoring, Systems and Technologies

Wearable Health Devices (WHDs) are increasingly helping people to better monitor their health status both at an activity/fitness level for self-health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnostic and guidance of treatment. The technology revolution in the miniaturization of electronic devices is enabling to design more reliable and adaptable wearables, contributing for a world-wide change in the health monitoring approach. In this paper we review important aspects in the WHDs area, listing the state-of-the-art of wearable vital signs sensing technologies plus their system architectures and specifications. A focus on vital signs acquired by WHDs is made: first a discussion about the most important vital signs for health assessment using WHDs is presented and then for each vital sign a description is made concerning its origin and effect on heath, monitoring needs, acquisition methods and WHDs and recent scientific developments on the area (electrocardiogram, heart rate, blood pressure, respiration rate, blood oxygen saturation, blood glucose, skin perspiration, capnography, body temperature, motion evaluation, cardiac implantable devices and ambient parameters). A general WHDs system architecture is presented based on the state-of-the-art. After a global review of WHDs, we zoom in into cardiovascular WHDs, analysing commercial devices and their applicability versus quality, extending this subject to smart t-shirts for medical purposes. Furthermore we present a resumed evolution of these devices based on the prototypes developed along the years. Finally we discuss likely market trends and future challenges for the emerging WHDs area.

A Three-Step Resolution-Reconfigurable Hazardous Multi-Gas Sensor Interface for Wireless Air-Quality Monitoring Applications

This paper presents a resolution-reconfigurable wide-range resistive sensor readout interface for wireless multi-gas monitoring applications that displays results on a smartphone. Three types of sensing resolutions were selected to minimize processing power consumption, and a dual-mode front-end structure was proposed to support the detection of a variety of hazardous gases with wide range of characteristic resistance. The readout integrated circuit (ROIC) was fabricated in a 0.18 μm CMOS process to provide three reconfigurable data conversions that correspond to a low-power resistance-to-digital converter (RDC), a 12-bit successive approximation register (SAR) analog-to-digital converter (ADC), and a 16-bit delta-sigma modulator. For functional feasibility, a wireless sensor system prototype that included in-house microelectromechanical (MEMS) sensing devices and commercial device products was manufactured and experimentally verified to detect a variety of hazardous gases.

A Triple-Mode Flexible E-Skin Sensor Interface for Multi-Purpose Wearable Applications

This study presents a flexible wireless electronic skin (e-skin) sensor system that includes a multi-functional sensor device, a triple-mode reconfigurable readout integrated circuit (ROIC), and a mobile monitoring interface. The e-skin device's multi-functionality is achieved by an interlocked micro-dome array structure that uses a polyvinylidene fluoride and reduced graphene oxide (PVDF/RGO) composite material that is inspired by the structure and functions of the human fingertip. For multi-functional implementation, the proposed triple-mode ROIC is reconfigured to support piezoelectric, piezoresistance, and pyroelectric interfaces through single-type e-skin sensor devices. A flexible system prototype was developed and experimentally verified to provide various wireless wearable sensing functions-including pulse wave, voice, chewing/swallowing, breathing, knee movements, and temperature-while their real-time sensed data are displayed on a smartphone.

ECG Monitoring Garment Using Conductive Carbon Paste for Reduced Motion Artifacts

The heart is a fundamental organ of the human circulatory system and the continuous measurement of electrocardiogram (ECG) signals is of great importance for pre-detection of heart diseases. Dry electrodes that do not require electrolyte gel have been developed for wearable ECG monitoring applications. However, this kind of electrode often introduces motion artifacts because of the high contact impedance between the electrode and skin. We propose a wearable ECG monitoring garment that employs electrodes made of conductive carbon-based paste. This paste is directly applied to the skin and after drying for 5 min, it forms a patch electrode that is detachable and flexible. The contact impedance between the patch electrode and the skin is very low because the paste covers the skin in a conformal manner. The experimental results show that the contact area of the carbon-based paste on the skin replica is almost 100%. At frequencies under 10 Hz, the contact impedance of the patch electrode is of 70.0 kΩ, much lower than the typical 118.7 kΩ impedance of a Ag/AgCl electrode. We also demonstrate that the ECG signals measured using the custom-designed garment and the patch electrodes are very stable even during actions such as walking and running.

Cerebral blood volume and oxygen supply uniformly increase following various intrathoracic pressure strains

Intrathoracic pressure (ITP) swings challenge many physiological systems. The responses of cerebral hemodynamics to different ITP swings are still less well-known due to the complexity of cerebral circulation and methodological limitation. Using frequency-domain near-infrared spectroscopy and echocardiography, we measured changes in cerebral, muscular and cardiac hemodynamics in five graded respiratory maneuvers (RM), breath holding, moderate and strong Valsalva maneuvers (mVM/sVM) with 20 and 40 cmH2O increments in ITP, moderate and strong Mueller maneuvers (mMM/sMM) with 20 and 40 cmH2O decrements in ITP controlled by esophageal manometry. We found cerebral blood volume (CBV) maintains relative constant during the strains while it increases during the recoveries together with increased oxygen supply. By contrast changes in muscular blood volume (MBV) are mainly controlled by systemic changes. The graded changes of ITP during the maneuvers predict the changes of MBV but not CBV. Changes in left ventricular stroke volume and heart rate correlate to MBV but not to CBV. These results suggest the increased CBV after the ITP strains is brain specific, suggesting cerebral vasodilatation. Within the strains, cerebral oxygen saturation only decreases in sVM, indicating strong increment rather than decrement in ITP may be more challenging for the brain.

A Wireless ExG Interface for Patch-Type ECG Holter and EMG-Controlled Robot Hand

This paper presents a wearable electrophysiological interface with enhanced immunity to motion artifacts. Anti-artifact schemes, including a patch-type modular structure and real-time automatic level adjustment, are proposed and verified in two wireless system prototypes of a patch-type electrocardiogram (ECG) module and an electromyogram (EMG)-based robot-hand controller. Their common ExG readout integrated circuit (ROIC), which is reconfigurable for multiple physiological interfaces, is designed and fabricated in a 0.18 μm CMOS process. Moreover, analog pre-processing structures based on envelope detection are integrated with one another to mitigate signal processing burdens in the digital domain effectively.