A Review of the Commercially Available ECG Detection and Transmission Systems-The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest

Sudden cardiac death (SCD) constitutes a major clinical and public health problem, whose death burden is comparable to the current worldwide pandemic. This comprehensive review encompasses the following topics: available rescue systems, wearable electrocardiograms (ECG), detection and transmission technology, and a newly developed fuzzy logic algorithm (FA) for heart rhythm classification which is state-of-the art in the field of SCD prevention. Project “PROTECTOR”, the Polish Rapid Transtelephonic ECG to Obtain Resuscitation for development of a rapid rescue system for patients at risk of sudden cardiac arrest (SCA), is presented. If a lethal arrhythmia is detected on the basis of FA, the system produces an alarm signal audible for bystanders and transmits the alarm message along with location to the emergency medical center. Phone guided resuscitation can be started immediately because an automated external defibrillator (AED) localization map is available. An automatic, very fast diagnosis is a unique feature of the PROTECTOR prototype. The rapid detection of SCA is based on a processor characterized by 100% sensitivity and 97.8% specificity (as measured in the pilot studies). An integrated circuit which implements FA has already been designed and a diagnosis is made within few seconds, which is extremely important in ischemic brain damage prophylaxis. This circuit could be implemented in smart implants (Sis).

Development of Nanosensors Based Intelligent Packaging Systems: Food Quality and Medicine

The issue of medication noncompliance has resulted in major risks to public safety and financial loss. The new omnipresent medicine enabled by the Internet of things offers fascinating new possibilities. Additionally, an in-home healthcare station (IHHS), it is necessary to meet the rapidly increasing need for routine nursing and on-site diagnosis and prognosis. This article proposes a universal and preventive strategy to drug management based on intelligent and interactive packaging (I2Pack) and IMedBox. The controlled delamination material (CDM) seals and regulates wireless technologies in novel medicine packaging. As such, wearable biomedical sensors may capture a variety of crucial parameters via wireless communication. On-site treatment and prediction of these critical factors are made possible by high-performance architecture. The user interface is also highlighted to make surgery easier for the elderly, disabled, and patients. Land testing incorporates and validates an approach for prototyping I2Pack and iMedBox. Additionally, sustainability, increased product safety, and quality standards are crucial throughout the life sciences. To achieve these standards, intelligent packaging is also used in the food and pharmaceutical industries. These technologies will continuously monitor the quality of a product and communicate with the user. Data carriers, indications, and sensors are the three most important groups. They are not widely used at the moment, although their potential is well understood. Intelligent packaging should be used in these sectors and the functionality of the systems and the values presented in this analysis.

Controlling the Structures, Flexibility, Conductivity Stability of Three-Dimensional Conductive Networks of Silver Nanoparticles/Carbon-Based Nanomaterials with Nanodispersion and their Application in Wearable Electronic Sensors

This research has successfully synthesized highly flexible and conductive nanohybrid electrode films. Nanodispersion and stabilization of silver nanoparticles (AgNPs) were achieved via non-covalent adsorption and with an organic polymeric dispersant and inorganic carbon-based nanomaterials-nano-carbon black (CB), carbon nanotubes (CNT), and graphene oxide (GO). The new polymeric dispersant-polyisobutylene-b-poly(oxyethylene)-b-polyisobutylene (PIB-POE-PIB) triblock copolymer-could stabilize AgNPs. Simultaneously, this stabilization was conducted through the addition of mixed organic/inorganic dispersants based on zero- (0D), one- (1D), and two-dimensional (2D) nanomaterials, namely CB, CNT, and GO. Furthermore, the dispersion solution was evenly coated/mixed onto polymeric substrates, and the products were heated. As a result, highly conductive thin-film materials (with a surface electrical resistance of approximately 10-2 Ω/sq) were eventually acquired. The results indicated that 2D carbon-based nanomaterials (GO) could stabilize AgNPs more effectively during their reductNion and, hence, generate particles with the smallest sizes, as the COO- functional groups of GO are evenly distributed. The optimal AgNPs/PIB-POE-PIB/GO ratio was 20:20:1. Furthermore, the flexible electrode layers were successfully manufactured and applied in wearable electronic sensors to generate electrocardiograms (ECGs). ECGs were, thereafter, successfully obtained.

Fabric Vest Socket with Embroidered Electrodes for Control of Myoelectric Prosthesis

Myoelectric prostheses assist users to live their daily lives. However, the majority of users are primarily confined to forearm amputees because the surface electromyography (sEMG) that understands the motion intents should be acquired from a residual limb for control of the myoelectric prosthesis. This study proposes a novel fabric vest socket that includes embroidered electrodes suitable for a high-level upper amputee, especially for shoulder disarticulation. The fabric vest socket consists of rigid support and a fabric vest with embroidered electrodes. Several experiments were conducted to verify the practicality of the developed vest socket with embroidered electrodes. The sEMG signals were measured using commercial Ag/AgCl electrodes for a comparison to verify the performance of the embroidered electrodes in terms of signal amplitudes, the skin-electrode impedance, and signal-to-noise ratio (SNR). These results showed that the embroidered electrodes were as effective as the commercial electrodes. Then, posture classification was carried out by able-bodied subjects for the usability of the developed vest socket. The average classification accuracy for each subject reached 97.92%, and for all the subjects it was 93.2%. In other words, the fabric vest socket with the embroidered electrodes could measure sEMG signals with high accuracy. Therefore, it is expected that it can be readily worn by high-level amputees to control their myoelectric prostheses, as well as it is cost effective for fabrication as compared with the traditional socket.

Application Challenges in Fiber and Textile Electronics

Modern electronic devices are moving toward miniaturization and integration with an emerging focus on wearable electronics. Due to their close contact with the human body, wearable electronics have new requirements including low weight, small size, and flexibility. Conventional 3D and 2D electronic devices fail to efficiently meet these requirements due to their rigidity and bulkiness. Hence, a new family of 1D fiber-shaped electronic devices including energy-harvesting devices, energy-storage devices, light-emitting devices, and sensing devices has risen to the challenge due to their small diameter, lightweight, flexibility, and weavability into soft textile electronics. The application challenges faced by fiber and textile electronics from single fiber-shaped devices to continuously scalable fabrication, to encapsulation and testing, and to application mode exploration, are discussed. The evolutionary trends of fiber and textile electronics are then summarized. Finally, future directions required to boost their commercialization are highlighted.

A Real-Time Vital-Sign Monitoring in the Physical Domain on a Mixed-Signal Reconfigurable Platform

This work presents a mixed-signal physical-compu-tation-electronics for monitoring three vital signs; namely heart rate, blood pressure, and blood oxygen saturation; from electrocardiography, arterial blood pressure, and photoplethysmography signals in real-time. The computational circuits are implemented on a reconfigurable and programmable signal-processing platform, namely field-programmable analog array (FPAA). The design leverages the core enabling technology of FPAA, namely floating-gate CMOS devices, and an on-chip low-power microcontroller to achieve energy-efficiency while not compromising accuracy. The custom physical-computation-electronics operating in CMOS subthreshold region, performs low-level (i.e., physiologically-relevant feature extraction) and high-level (i.e., detecting arrhythmia) signal processing in an energy-efficient manner. The on-chip microcontroller is used (1) in the programming mode for controlling the charge storage at the analog-memory elements to introduce patient-dependency into the system and (2) in the run mode to quantify the vital signs. The system has been validated against digital computation results from MATLAB using datasets collected from three healthy subjects and datasets from the MIT/BIH open source database. Based on all recordings in the MIT/BIH database, ECG R-peak detection sensitivity is 94.2%. The processor detects arrhythmia in three MIT/BIH recordings with an average sensitivity of 96.2%. The cardiac processor achieves an average percentage mean error bounded by 3.75%, 6.27%, and 7.3% for R-R duration, systolic blood pressure, and oxygen saturation level calculations; respectively. The power consumption of the ECG, blood-pressure and photo-plethysmography processing circuitry are 126 nW, 251 nW and 1.44 μW respectively in a 350 nm process. Overall, the cardiac processor consumes 1.82 μW.

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 new physiological signal acquisition patch designed with advanced respiration monitoring algorithm based on 3-axis accelerator and gyroscope

In a gradually aging society, families and hospitals have a growing demand for reliable and unobtrusive physiological signal monitoring for elderly people. However, the existing respiration rate monitoring methods and algorithms are still unsatisfactory. In this work, we introduce a physiological signal acquisition patch which integrates 3-axis accelerator and 3-axis gyroscope to estimate respiration rate, as well as ECG(electrocardiogram) sensor and surface temperature sensor. A complete set of respiration rate estimation algorithms is embedded in our patch, which can be used to identify whether the patch is worn or not, and to recognize, segment, de-noise and reconstruct the respiration signal. In-situ experiments have been conducted to prove the validity of the algorithms described in this paper and the possibilities of estimating respiration rate using a physiological signal acquisition patch. The mean absolute error (MAE) is 0.11(about ±0.7 times in a minute), which is the least among similar studies that acquire respiratory rate from 3-axis accelerators or electrocardiogram.

Design and evaluation of a ubiquitous chest-worn cardiopulmonary monitoring system for healthcare application: a pilot study

Ambulatory recording of physiological data will provide us deep insight into the physical condition of patients and athletes, and assessing treatment effects and training performances. This study presents a miniature wearable cardiopulmonary monitoring system called "Smart Chest Strap," which consists of an elastic band worn around the user's chest with integrated sensors, a physiological signals acquisition unit, and a mobile phone. The physiological signals including electrocardiogram, respiratory inductance plethysmograph, and accelerations (ACC) are sampled, digitalized, stored, and simultaneously transmitted to a mobile phone via Bluetooth. A medical validation test with participants performing discontinuous incremental treadmill (0-12 km/h) exercise was conducted. The results indicate nearly perfect correlations (0.999, 0.996, 0.994), small mean bias (0.60 BPM, 0.51 BPM, 0.05 g), and narrow limits of agreement (±2.90 BPM, ±1.81 BPM, ±0.09 g) for heart rate (HR), breathing rate (BR), and ACC represented as vector magnitude units (VMUs). There is a general trend of decrease in accuracy, precision, and correlation for HR, BR, and VMU as velocity increases, but these validity statistics are all within acceptable error limits and clinically accepted. The findings demonstrate that the Smart Chest Strap is valid and will have wider applications in healthcare, sports, and scientific research areas.

Direct patterning of organic conductors on knitted textiles for long-term electrocardiography

Wearable sensors are receiving a great deal of attention as they offer the potential to become a key technological tool for healthcare. In order for this potential to come to fruition, new electroactive materials endowing high performance need to be integrated with textiles. Here we present a simple and reliable technique that allows the patterning of conducting polymers on textiles. Electrodes fabricated using this technique showed a low impedance contact with human skin, were able to record high quality electrocardiograms at rest, and determine heart rate even when the wearer was in motion. This work paves the way towards imperceptible electrophysiology sensors for human health monitoring.

Body-monitoring and health supervision by means of optical fiber-based sensing systems in medical textiles

Long-term monitoring with optical fibers has moved into the focus of attention due to the applicability for medical measurements. Within this Review, setups of flexible, unobtrusive body-monitoring systems based on optical fibers and the respective measured vital parameters are in focus. Optical principles are discussed as well as the interaction of light with tissue. Optical fiber-based sensors that are already used in first trials are primarily selected for the section on possible applications. These medical textiles include the supervision of respiration, cardiac output, blood pressure, blood flow and its saturation with hemoglobin as well as oxygen, pressure, shear stress, mobility, gait, temperature, and electrolyte balance. The implementation of these sensor concepts prompts the development of wearable smart textiles. Thus, current sensing techniques and possibilities within photonic textiles are reviewed leading to multiparameter designs. Evaluation of these designs should show the great potential of optical fibers for the introduction into textiles especially due to the benefit of immunity to electromagnetic radiation. Still, further improvement of the signal-to-noise ratio is often necessary to develop a commercial monitoring system.

Unobtrusive sensing and wearable devices for health informatics

The aging population, prevalence of chronic diseases, and outbreaks of infectious diseases are some of the major challenges of our present-day society. To address these unmet healthcare needs, especially for the early prediction and treatment of major diseases, health informatics, which deals with the acquisition, transmission, processing, storage, retrieval, and use of health information, has emerged as an active area of interdisciplinary research. In particular, acquisition of health-related information by unobtrusive sensing and wearable technologies is considered as a cornerstone in health informatics. Sensors can be weaved or integrated into clothing, accessories, and the living environment, such that health information can be acquired seamlessly and pervasively in daily living. Sensors can even be designed as stick-on electronic tattoos or directly printed onto human skin to enable long-term health monitoring. This paper aims to provide an overview of four emerging unobtrusive and wearable technologies, which are essential to the realization of pervasive health information acquisition, including: 1) unobtrusive sensing methods, 2) smart textile technology, 3) flexible-stretchable-printable electronics, and 4) sensor fusion, and then to identify some future directions of research.

Adaptive motion artefact reduction in respiration and ECG signals for wearable healthcare monitoring systems

Wearable healthcare monitoring systems (WHMSs) have received significant interest from both academia and industry with the advantage of non-intrusive and ambulatory monitoring. The aim of this paper is to investigate the use of an adaptive filter to reduce motion artefact (MA) in physiological signals acquired by WHMSs. In our study, a WHMS is used to acquire ECG, respiration and triaxial accelerometer (ACC) signals during incremental treadmill and cycle ergometry exercises. With these signals, performances of adaptive MA cancellation are evaluated in both respiration and ECG signals. To achieve effective and robust MA cancellation, three axial outputs of the ACC are employed to estimate the MA by a bank of gradient adaptive Laguerre lattice (GALL) filter, and the outputs of the GALL filters are further combined with time-varying weights determined by a Kalman filter. The results show that for the respiratory signals, MA component can be reduced and signal quality can be improved effectively (the power ratio between the MA-corrupted respiratory signal and the adaptive filtered signal was 1.31 in running condition, and the corresponding signal quality was improved from 0.77 to 0.96). Combination of the GALL and Kalman filters can achieve robust MA cancellation without supervised selection of the reference axis from the ACC. For ECG, the MA component can also be reduced by adaptive filtering. The signal quality, however, could not be improved substantially just by the adaptive filter with the ACC outputs as the reference signals.

A WEARABLE BIOFEEDBACK SYSTEM SUPPORTING REAL-TIME PACED BREATHING TRAINING AND PHYSIOLOGICAL MONITORING

Slow and regular breathing can generate beneficial effects on cardiovascular system and reduce stress. Breathing pacer is usually helpful for a user to learn to control breathing and restore an optimal breathing pattern. In this paper, a wearable physiological monitoring system supporting real-time breathing biofeedback is presented. An elastic T-shirt with two inductive bands integrated in the positions of rib cage (RC) and abdomen (AB) is used as a motherboard both for physiological monitoring and respiratory biofeedback. Physiological signals such as RC and AB respiration, electrocardiography (ECG), photoplethysmograph (PPG) and artery pulse wave (APW) can be sampled, stored and transmitted wirelessly. When this system is used in biofeedback applications, respiratory signals are processed in real-time by a peak-detection algorithm to recognize the concurrent breathing pattern. By comparing the actual breathing rate with the guiding breathing rate, an audio biofeedback is generated by playing music audios stored in the Micro-SD card through an MP3 decoder chip VS1053. With this design, multiple functions of physiological monitoring, real-time signal processing and audio biofeedback were integrated in one wearable system. Experiment showed that through audio biofeedback this system can guide the user to practice a slow and regular breathing effectively. Physiological data recorded from a Yoga practitioner during meditation demonstrated the capability of the system to acquire cardiopulmonary physiological data during slow breathing. This system is a useful tool both for breathing biofeedback training and its related scientific researches.