Does the technique employed for skin temperature assessment alter outcomes? A systematic review

The hysteresis damage of cold exposure on tissue and transcript levels in mice

OBJECTIVES

Although cold stress-induced damage to the heart and thyroid has been reported, specific organ associations between the heart and thyroid with delayed injury mechanisms have not been investigated. In this study, we determined the damage time and transcript levels of a large number of genes in the heart and thyroid after cold exposure. Meanwhile, we analysed the relationship between heart and thyroid injury in human medical records to determine the association of delayed injury from cold exposure.

METHODS

Mice were exposed to cold stress and hysteresis injury. Gene changes at the transcriptional level were detected using high throughput sequencing technology. The most variable genes were verified at the protein level using Western Blotting and medical records were collected and analysed.

RESULTS

The damage was the most severe when the animals were allowed to recover to room temperature for 4 h after exposure to cold stress. During this process, STAT1 and ATF3 genes were acutely up-regulated. Analysis of human medical records showed the highest correlation between AST and T4 under cold stress (p = 0.0011).

CONCLUSIONS

Exposure to cold increases blood level of free thyroid hormone and biomarkers of myocardial injury, as well as related mRNA levels. These changes were more pronounced after return to room temperature.

Toward an Accurate IR Remote Sensing of Body Temperature Radiometer Based on a Novel IR Sensing System Dubbed Digital TMOS

A novel uncooled thermal sensor based on a suspended transistor, fabricated in standard CMOS-SOI process, and released by dry etching, dubbed Digital TMOS, has been developed. Using the transistor as the sensing element has advantages in terms of internal gain, low power, low-cost technology, and high temperature sensitivity. A two channel radiometer, based on the new nano-metric CMOS-SOI-NEMS Technology, enables remote temperature sensing as well as emissivity sensing of the forehead and body temperatures of people, with high accuracy and high resolution. Body temperature is an indicator of human physiological activity and health, especially in pediatrics, surgery, and general emergency departments. This was already recognized in past pandemics such as SARS, EBOLA, and Chicken Flu. Nowadays, with the spread of COVID-19, forehead temperature measurements are used widely to screen people for the illness. Measuring the temperature of the forehead using remote sensing is safe and convenient and there are a large number of available commercial instruments, but studies show that the measurements are not accurate. The surface emissivity of an object has the most significant effect on the measured temperature by IR remote sensing. This work describes the achievements towards high–performance, low-cost, low power, mobile radiometry, to rapidly screen for fever to identify victims of the coronavirus (COVID-19). The main two aspects of the innovation of this study are the use of the new thermal sensor for measurements and the extensive modeling of this sensor.

Tissue heating in different short wave diathermy methods: A systematic review and narrative synthesis

OBJECTIVE

To assess the change in temperature caused by different short wave diathermy (SWD) methods of application in different healthy tissues.

DATA SOURCES

The Cochrane Central Register of Controlled Trials, MEDLINE, Science Direct, CINAHL, SciELO, PEDro, ClinicalTrials.gov, Brazilian Registry of Clinical Trials and the World Health Organization ICTRP were searched (1990-April 2020).

METHODS

Randomized, quasi-randomized, and single-arm controlled trials assessing temperature change after SWD application in healthy adults were included. Group analysis was done according to SWD mode and where temperature was collected, risk of bias was assessed using the Cochrane tool and the quality of evidence using GRADE. A narrative synthesis was conducted since methodological homogeneity was not sufficient to undertake a meta-analysis.

RESULTS

Eleven studies were included, reporting data of 240 subjects. Regarding skin temperature change, the application that increased temperature the most was under the electrode using continuous SWD on coplanar arrangement of capacitive technique (7.9 [1.76] °C), coplanar arrangement also had the slowest temperature decay, and the lowest temperature found was through a low dose application of pulsed SWD (0.34 [0.69] °C). Regarding muscle temperature change, the application that increased temperature the most was using the inductive technique of pulsed SWD (4.58 [0.87] °C), this technique also had the slowest temperature decay, and the lowest temperature found was through ReBound shortwave diathermy (2.31 [0.87] °C).

CONCLUSION

SWD efficacy depends on setting choices. This review provides a detailed description of SWD methods of application and a quantitative data set of resulting temperature change.

The use of infrared thermography for the dynamic measurement of skin temperature of moving athletes during competition; methodological issues

Objective. To investigate the use of infrared thermography (IRT) for skin temperature measurement of moving athletes during competition and its sensitivity to factors that are traditionally standardised.Approach. Thermograms were collected for 18 female athletes during the 20 km racewalk at the 2019 World Athletics Championships, with a medium-wave, cooled indium antimonide medium wave infrared band (MWIR) and a long-wave, uncooled microbolometer longwave infrared band (LWIR) infrared camera.Main results. The MWIR provided greater clarity images of motion due to a shorter exposure and response time and produced a higher percentage of acceptable images. Analysing acceptable images only, the LWIR and WMIR produced good levels of agreement, with a bias of -0.1 ± 0.6 °C in mean skin temperature for the LWIR. As the surface area of an ROI was reduced, the measured temperature became less representative of the whole ROI. Compared to measuring the whole area ROI, a single central pixel produced a bias of 0.3 ± 0.3 °C (MWIR) and 0.1 ± 0.4 °C (LWIR) whilst using the maximum and minimum temperature pixels resulted in deviations of 1.3 ± 0.4 °C and -1.1 ± 0.3 °C (MWIR) and 1.2 ± 0.3 °C and -1.3 ± 0.4 °C (LWIR). The sensitivity to air and reflected temperatures was lower for the LWIR camera, due to the higher emissivity of skin in its wavelength.Significance. IRT provides an appropriate tool for the measurement of skin temperature during real-world competition and critically during athlete motion. The cheaper LWIR camera provides a feasible alternative to the MWIR in low rate of motion scenarios, with comparable precision and sensitivity to analysis. However, the LWIR is limited when higher speeds prevent the accurate measurement and ability to capture motion.

A Thermal Skin Model for Comparing Contact Skin Temperature Sensors and Assessing Measurement Errors

To improve the measurement and subsequent use of human skin temperature (Tsk) data, there is a need for practical methods to compare Tsk sensors and to quantify and better understand measurement error. We sought to develop, evaluate, and utilize a skin model with skin-like thermal properties as a tool for benchtop Tsk sensor comparisons and assessments of local temperature disturbance and sensor bias over a range of surface temperatures. Inter-sensor comparisons performed on the model were compared to measurements performed in vivo, where 14 adult males completed an experimental session involving rest and cycling exercise. Three types of Tsk sensors (two of them commercially available and one custom made) were investigated. Skin-model-derived inter-sensor differences were similar (within ±0.4 °C) to the human trial when comparing the two commercial Tsk sensors, but not for the custom Tsk sensor. Using the skin model, all surface Tsk sensors caused a local temperature disturbance with the magnitude and direction dependent upon the sensor and attachment and linearly related to the surface-to-environment temperature gradient. Likewise, surface Tsk sensors also showed bias from both the underlying disturbed surface temperature and that same surface in its otherwise undisturbed state. This work supports the development and use of increasingly realistic benchtop skin models for practical Tsk sensor comparisons and for identifying potential measurement errors, both of which are important for future Tsk sensor design, characterization, correction, and end use.

Flexible Hybrid Electrodes for Continuous Measurement of the Local Temperature in Long-Term Wounds

Long-term wounds need a continuous assessment of different biophysical parameters for their treatment, and there is a lack of affordable biocompatible devices capable of obtaining that uninterrupted flow of data. A portable prototype that allows caregivers to know the local temperature behavior of a long-term wound over time and compare it with different reference zones has been developed. Alternative flexible substrates, screen-printing techniques, polymeric inks, and an embedded system have been tested to achieve potential indicators of the status and evolution of chronic wounds. The final system is formed by temperature sensors attached to a flexible and stretchable medical-grade substrate, where silver conductive tracks have been printed as interconnections with the data-acquisition unit. In addition, a specific datalogger has been developed for this system. The whole set will enable health personnel to acquire the temperature of the wound and its surroundings in order to make decisions regarding the state and evolution of the wound.

Perceptual Quality Assessment of Compressed Vibrotactile Signals Through Comparative Judgment

In this article, we present a comprehensive scheme for the quality assessment of compressed vibrotactile signals with human assessors. Inspired by the multiple stimulus test with hidden reference and anchors (MUSHRA) from the audio domain, we designed a method in which each compressed signal is compared to its original signal and rated on a numerical scale. For each signal tested, the hidden reference and two anchor signals are used to validate the results and provide assessor screening criteria. Differing from previous approaches, our method is hierarchically structured and strictly timed in a sequential manner to avoid experimental confounds and provide precise psychophysical assessments. We validated our method in an experiment with 20 human participants in which we compared two state-of-the-art lossy codecs. The results show that, with our approach, the performance of different codecs can be compared effectively. Furthermore, the method also provides a measure of subjective quality at different data compression rates. The proposed procedure can be easily adapted to evaluate other vibrotactile codecs.

Comparing Explicit and Implicit Measures for Assessing Cross-Cultural Food Experience

The present study investigated the potential of implicit physiological measures to provide objective measures of affective food experience in contrast to explicit self-report ratings in a cross-cultural context. Dutch and Thai participants viewed 120 food images portraying universal food image categories (regular and molded food) and cultural food image categories (typically Dutch and Thai food). The universal food images were taken as ground truth high and low valence stimuli, where we assumed no genuine difference in affective experience between nationalities. In contrast, for the cultural food images, we did expect a genuine difference between nationalities. Participants were asked to rate valence, arousal and liking of each food image. In addition, heart rate (HR) and phasic electrodermal activity (EDA) responses to the images were recorded. Typically Asian and Western response biases were found for explicit ratings of regular and molded food with an extreme response style for Dutch, and a middle response style for Thai participants. However, such bias was not observed in HR. For cultural food image categories, HR showed the hypothesized interaction between participant nationality and food image category, reflecting the expected genuine difference between nationalities in affective food experience. Besides presenting participants with images, we also asked participants to taste typically Thai and Dutch drinks. Similar to images, a significant interaction between participant nationality and cultural food category was found for HR. An interaction was also found for sip size, while this was not seen in explicit measures. We attribute this to differences in the moment that these measures were taken. In this study, phasic EDA did not appear to be a sensitive measure of affective food experience, possibly since stimuli mostly differed in valence rather than arousal. To conclude, our study constitutes an example where cultural bias negatively affected the accuracy of self-reports, and only the implicit physiological measures followed the prior expectations of genuine food experience, indicating the potential of these measures to study cross-cultural food experience.

Skin temperature as a clinical parameter for nursing care: a descriptive correlational study

Objective:

To identify the skin temperature in different body areas of hospitalised individuals in the surgical unit, without risk of developing a pressure ulcer (PU).

Methods:

A descriptive, correlational and cross-sectional study, carried out May–October 2017, in a surgical unit of a university hospital in southern Brazil. Temperature was measured at the bony prominences including scapula, elbow, trochanters and heels, on both sides of the body, as well as occipital and sacral regions.

Results:

A total of 230 patients took part in the study. All regions of the body measured presented differences in temperatures. The sacral region presented the highest mean temperature (34.2±0.1°C). Patients (aged 18–59 years) had higher skin temperatures in the sacral region than older patients (aged 60–88 years). There was a symmetry in temperatures on both sides of the body. There was a low degree of correlation between age, room temperature, room humidity and skin temperature in some body regions.

Conclusion:

The study established mean values for skin temperature in specific body regions in patients without risk of developing a PU, hospitalised in a surgical unit. It also demonstrates how skin temperature can be used as a clinical parameter in practice to support the prevention of PUs.

"Beet" the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud's phenomenon

Raynaud's phenomenon (RP) is characterized by recurrent transient peripheral vasospasm and lower nitric oxide (NO) bioavailability in the cold. We investigated the effect of nitrate-rich beetroot juice (BJ) supplementation on 1) NO-mediated vasodilation, 2) cutaneous vascular conductance (CVC) and skin temperature (T_sk) following local cooling, and 3) systemic anti-inflammatory status. Following baseline testing, 23 individuals with RP attended four times, in a double-blind, randomized crossover design, following acute and chronic (14 days) BJ and nitrate-depleted beetroot juice (NDBJ) supplementation. Peripheral T_sk and CVC were measured during and after mild hand and foot cooling, and during transdermal delivery of acetylcholine and sodium nitroprusside. Markers of anti-inflammatory status were also measured. Plasma nitrite concentration ([nitrite]) was increased in the BJ conditions (P < 0.001). Compared with the baseline visit, thumb CVC was greater following chronic-BJ (Δ2.0 flux/mmHg, P = 0.02) and chronic-NDBJ (Δ1.45 flux/mmHg, P = 0.01) supplementation; however, no changes in T_sk were observed (P > 0.05). Plasma [interleukin-10] was greater, pan endothelin and systolic and diastolic blood pressure (BP) were reduced, and forearm endothelial function was improved, by both BJ and NDBJ supplementation (P < 0.05). Acute and chronic BJ and NDBJ supplementation improved anti-inflammatory status, endothelial function and blood pressure (BP). CVC following cooling increased post chronic-BJ and chronic-NDBJ supplementation, but no effect on T_sk was observed. The key findings are that beetroot supplementation improves thumb blood flow, improves endothelial function and anti-inflammatory status, and reduces BP in people with Raynaud's.NEW & NOTEWORTHY This is the first study to examine the effect of dietary nitrate supplementation in individuals with Raynaud's phenomenon. The principal novel findings from this study were that both beetroot juice and nitrate-depleted beetroot juice 1) increased blood flow in the thumb following a cold challenge; 2) enhanced endothelium-dependent and -independent vasodilation in the forearm; 3) reduced systolic and diastolic blood pressure, and pan-endothelin concentration; and 4) improved inflammatory status in comparison to baseline.

Skin Temperature Measurement Using Contact Thermometry: A Systematic Review of Setup Variables and Their Effects on Measured Values

Background: Skin temperature (T_skin) is commonly measured using T_skin sensors affixed directly to the skin surface, although the influence of setup variables on the measured outcome requires clarification. Objectives: The two distinct objectives of this systematic review were (1) to examine measurements from contact T_skin sensors considering equilibrium temperature and temperature disturbance, sensor attachments, pressure, environmental temperature, and sensor type, and (2) to characterise the contact T_skin sensors used, conditions of use, and subsequent reporting in studies investigating sports, exercise, and other physical activity. Data sources and study selection: For the measurement comparison objective, Ovid Medline and Scopus were used (1960 to July 2016) and studies comparing contact T_skin sensor measurements in vivo or using appropriate physical models were included. For the survey of use, Ovid Medline was used (2011 to July 2016) and studies using contact temperature sensors for the measurement of human T_skinin vivo during sport, exercise, and other physical activity were included. Study appraisal and synthesis methods: For measurement comparisons, assessments of risk of bias were made according to an adapted version of the Cochrane Collaboration's risk of bias tool. Comparisons of temperature measurements were expressed, where possible, as mean difference and 95% limits of agreement (LoA). Meta-analyses were not performed due to the lack of a common reference condition. For the survey of use, extracted information was summarised in text and tabular form. Results: For measurement comparisons, 21 studies were included. Results from these studies indicated minor (<0.5°C) to practically meaningful (>0.5°C) measurement bias within the subgroups of attachment type, applied pressure, environmental conditions, and sensor type. The 95% LoA were often within 1.0°C for in vivo studies and 0.5°C for physical models. For the survey of use, 172 studies were included. Details about T_skin sensor setup were often poorly reported and, from those reporting setup information, it was evident that setups widely varied in terms of type of sensors, attachments, and locations used. Conclusions: Setup variables and conditions of use can influence the measured temperature from contact T_skin sensors and thus key setup variables need to be appropriately considered and consistently reported.

Skin Temperature Measurement Using Contact Thermometry: A Systematic Review of Setup Variables and Their Effects on Measured Values

Background: Skin temperature (Tskin) is commonly measured using Tskin sensors affixed directly to the skin surface, although the influence of setup variables on the measured outcome requires clarification. Objectives: The two distinct objectives of this systematic review were (1) to examine measurements from contact Tskin sensors considering equilibrium temperature and temperature disturbance, sensor attachments, pressure, environmental temperature, and sensor type, and (2) to characterise the contact Tskin sensors used, conditions of use, and subsequent reporting in studies investigating sports, exercise, and other physical activity. Data sources and study selection: For the measurement comparison objective, Ovid Medline and Scopus were used (1960 to July 2016) and studies comparing contact Tskin sensor measurements in vivo or using appropriate physical models were included. For the survey of use, Ovid Medline was used (2011 to July 2016) and studies using contact temperature sensors for the measurement of human Tskinin vivo during sport, exercise, and other physical activity were included. Study appraisal and synthesis methods: For measurement comparisons, assessments of risk of bias were made according to an adapted version of the Cochrane Collaboration's risk of bias tool. Comparisons of temperature measurements were expressed, where possible, as mean difference and 95% limits of agreement (LoA). Meta-analyses were not performed due to the lack of a common reference condition. For the survey of use, extracted information was summarised in text and tabular form. Results: For measurement comparisons, 21 studies were included. Results from these studies indicated minor (<0.5°C) to practically meaningful (>0.5°C) measurement bias within the subgroups of attachment type, applied pressure, environmental conditions, and sensor type. The 95% LoA were often within 1.0°C for in vivo studies and 0.5°C for physical models. For the survey of use, 172 studies were included. Details about Tskin sensor setup were often poorly reported and, from those reporting setup information, it was evident that setups widely varied in terms of type of sensors, attachments, and locations used. Conclusions: Setup variables and conditions of use can influence the measured temperature from contact Tskin sensors and thus key setup variables need to be appropriately considered and consistently reported.

Efficacy and safety of a new coverlet device on skin microclimate management: a pilot study in critical care patients

OBJECTIVE

To test the effect of a new coverlet device, allowing air circulation at the body/underlying surface interface, on skin microclimate management.

METHOD

This prospective observational pilot study took place in a 15-bed university-affiliated intensive care unit. Overall, 34 mechanically ventilated patients were included. Skin humidity and temperature were monitored before and after the implementation of the tested device at the occiput, scapulas, buttocks and sacrum. Humidity and temperature were evaluated through surface skin impedance and an infra-red thermometer, respectively. Health professionals were asked to evaluate the device.

RESULTS

After implementation of the coverlet device, there was a rapid, sustained and significant decrease in skin humidity at all sites ranging from 6 % to 15 %, excluding the occiput. Skin temperature also significantly decreased from 1 % at both scapulas, but not at the other studied body sites. No side effects were observed. Health professionals reported that the device was easy and quick to install. Although they did not report a subjective improvement in skin moisture or temperature, they considered the device to be efficient.

CONCLUSION

Although limited by its design, this pilot study suggests a good efficacy of the studied device on skin microclimate management. Further data are warranted to test the clinical implications of our findings.

Skin Protectants Made of Curable Polymers: Effect of Application on Local Skin Temperature

Objective: To measure the skin temperature after application of a new skin protectant intended for incontinence-associated dermatitis (IAD), compared with a commercial product with an analogous cyanoacrylate-based chemistry.

Approach: Twelve healthy human volunteers received an application of the new product on one thigh and of the comparator on the other thigh. An infrared camera using ThermaCAM™ software imaged the skin and measured the temperature at the skin surface over time to characterize the thermal cure profile induced by the products on the skin.

Results: The new product led to a drop in skin surface temperature (endothermic reaction), whereas the commercial product displayed an exotherm and a slight rise in skin surface temperature.

Innovation: Cyanoacrylate-based chemistries come in various formulations, differing in the side chains and additives used. They are liquid monomers that polymerize after application, and this polymerization is accompanied by an exothermic reaction that can be perceived as an unpleasant warming sensation, especially on compromised skin. A new formulation was designed to mitigate this rise in temperature.

Conclusion: The new skin protectant may potentially be more comfortable for IAD patients, since it causes a drop in skin surface temperature instead of a rise during the curing process that follows application.

Perceived exertion is as effective as the perceptual strain index in predicting physiological strain when wearing personal protective clothing

OBJECTIVE

The perceptual strain index (PeSI) has been shown to overcome the limitations associated with the assessment of the physiological strain index (PSI), primarily the need to obtain a core body temperature measurement. The PeSI uses the subjective scales of thermal sensation and perceived exertion (RPE) to provide surrogate measures of core temperature and heart rate, respectively. Unfortunately, thermal sensation has shown large variability in providing an estimation of core body temperature. Therefore, the primary aim of this study was to determine if thermal comfort improved the ability of the PeSI to predict the PSI during exertional-heat stress.

METHODS

Eighteen healthy males (age: 23.5years; body mass: 79.4kg; maximal aerobic capacity: 57.2ml·kg^-1·min^-1) wore four different chemical/biological protective garments while walking on treadmill at a low (<325W) or moderate (326-499W) metabolic workload in environmental conditions equivalent to wet bulb globe temperatures 21, 30 or 37°C. Trials were terminated when heart rate exceeded 90% of maximum, when core body temperature reached 39°C, at 120min or due to volitional fatigue. Core body temperature, heart rate, thermal sensation, thermal comfort and RPE were recorded at 15min intervals and at termination. Multiple statistical methods were used to determine the most accurate perceptual predictor.

RESULTS

Significant moderate relationships were observed between the PeSI (r=0.74; p<0.001), the modified PeSI (r=0.73; p<0.001) and unexpectedly RPE (r=0.71; p<0.001) with the PSI, respectively. The PeSI (mean bias: -0.8±1.5 based on a 0-10 scale; area under the curve: 0.887), modified PeSI (mean bias: -0.5±1.4 based on 0-10 scale; area under the curve: 0.886) and RPE (mean bias: -0.7±1.4 based on a 0-10 scale; area under the curve: 0.883) displayed similar predictive performance when participants experienced high-to-very high levels of physiological strain.

CONCLUSIONS

Modifying the PeSI did not improve the subjective prediction of physiological strain. However, RPE provided an equally accurate prediction of physiological strain, particularly when high-to-very high levels of strain were observed. Therefore, given its predictive performance and user-friendliness, the evidence suggests that RPE in isolation is a practical and cost-effective tool able to estimate physiological strain during exertional-heat stress under these work conditions.

Innovative algorithm to evaluate the capabilities of visual, near infrared, and infrared technologies for the detection of veins for intravenous cannulation

Intravenous cannulation is the process of inserting a cannula into a vein to administrate medication, fluids, or to take blood samples. The process of identification and of locating veins plays an important role during the intravenous cannulation procedure to reduce health care costs and the suffering of patients. This paper compares the three technologies used to assess their suitability and capability for the detection of veins to support the cannulation process. Three types of cameras are used in this study; a visual, an infrared, and a near infrared. The collected images, 103 in total, from the three technologies have been analyzed using a wide range of image processing techniques and compared with identification templates to evaluate the performance of each technology. The results show that the near infrared technology supported by suitable LED illumination is the most effective for the visualization of veins. However, infrared thermography is found to be successful when followed by a cold stimulation.