Electrode-Skin Impedance Model Parameter Estimation in the Frequency-Domain.

This paper presents a method for identifying parameter values for a double parallel resistor/constant-phase-element model of the electrode-skin interface for individual silver and silver/silver chloride electrodes. The impedance of each electrode was measured in five from 1 Hz-10 kHz. Phase features of these data were used to guide initial estimates for parameter values which were refined using a least squares algorithm.

Investigation of Narrow-band NIR LED Spectral Response Towards a Non-invasive Glucose Sensor.

Spectroscopy is utilised extensively in medical sensing technology. Typically, hand-held spectroscopy equipment uses miniature narrow-band light emitting diodes (LEDs) and photodiodes to emit and detect light, respectively. Photodiodes typically absorb light across a wide spectra so measurements can be corrupted by surrounding light.

Physical Artificial Arterial Pulse System for Development and Testing of PPG-Based Sensors.

A physical system to generate a PPG-mimicking signal was designed and validated using everyday low-cost components to aid in medical sensor design. The pulse waveform was created by driving a working fluid into a silicone tube and changing the pressure within it. The corresponding waveform mimics a PPG signal through an artery, is adaptable, and repeatable.

Low cost circulatory pressure acquisition and fluid infusion rate measurement system for clinical research.

Acquiring patient physiological waveforms is useful for studying hemodynamic management and developing medical monitoring systems. A low cost, Arduino controlled data acquisition system acquires arterial pressure waveforms (Edwards Lifesciences TruWave compatible) and measures fluid infusion rate using hanging scales. This system can be used at the same time as a clinical monitor, enabling recording of patient arterial pressure and fluid delivery for clinical research.

Predicting fluid-response, the heart of hemodynamic management: A model-based solution.

Background: Intravenous fluid infusions are an important therapy for patients with circulatory shock. However, it is challenging to predict how patients' cardiac stroke volume (SV) will respond, and thus identify how much fluids should be delivered, if any. Model-predicted SV time-profiles of response to fluid infusions could potentially be used to guide fluid therapy.

Preload & Frank-Starling curves, from textbook to bedside: Clinically applicable non-additionally invasive model-based estimation in pigs.

Background: Determining physiological mechanisms leading to circulatory failure can be challenging, contributing to the difficulties in delivering effective hemodynamic management in critical care. Continuous, non-additionally invasive monitoring of preload changes, and assessment of contractility from Frank-Starling curves could potentially make it much easier to diagnose and manage circulatory failure.

Method: This study combines non-additionally invasive model-based methods to estimate left ventricle end-diastolic volume (LEDV) and stroke volume (SV) during hemodynamic interventions in a pig trial (N = 6).

Tube-load model: A clinically applicable pulse contour analysis method for estimation of cardiac stroke volume.

Background And Objectives: Accurate, reproducible, and reliable real-time clinical measurement of stroke volume (SV) is challenging. To accurately estimate arterial mechanics and SV by pulse contour analysis, accounting for wave reflection, such as by a tube-load model, is potentially important. This study tests for the first time whether a dynamically identified tube-load model, given a single peripheral arterial input signal and pulse transit time (PTT), provides accurate SV estimates during hemodynamic instability.

Low-cost stimulation resistant electromyography.

Surface Electromyography (sEMG) is the non-invasive measurement of skeletal muscle contraction bio-potentials. Measuring sEMG of a stimulated muscle can prove particularly difficult due to large scale and long lasting stimulation-induced artefacts: if an sEMG device does not account for such artefacts, its measurements can be swamped and components damaged. sEMG has been used in a wide range of clinical and biomedical fields, providing measures such as muscular fatigue and subject intent.

Incorporating pulse wave velocity into model-based pulse contour analysis method for estimation of cardiac stroke volume.

Background And Objectives: Stroke volume (SV) and cardiac output (CO) are important metrics for hemodynamic management of critically ill patients. Clinically available devices to continuously monitor these metrics are invasive, and less invasive methods perform poorly during hemodynamic instability. Pulse wave velocity (PWV) could potentially improve estimation of SV and CO by providing information on changing vascular tone.

Data captured using low-cost active electromyography.

Surface electromyography (sEMG) data was captured for three able-body subjects, from their right biceps brachii using the POLE sensor outlined in "Low-cost active electromyography" [1]. Data was captured for 45 seconds per subject, resulting in 12-21 contractions per subject. The raw data files, along with a sinusoidal waveform have been provided.

Accurate end systole detection in dicrotic notch-less arterial pressure waveforms.

Identification of end systole is often necessary when studying events specific to systole or diastole, for example, models that estimate cardiac function and systolic time intervals like left ventricular ejection duration. In proximal arterial pressure waveforms, such as from the aorta, the dicrotic notch marks this transition from systole to diastole. However, distal arterial pressure measures are more common in a clinical setting, typically containing no dicrotic notch.

Attributes, Performance, and Gaps in Current & Emerging Breast Cancer Screening Technologies.

Background: Early detection of breast cancer, combined with effective treatment, can reduce mortality. Millions of women are diagnosed with breast cancer and many die every year globally. Numerous early detection screening tests have been employed.

Clinically applicable model-based method, for physiologically accurate flow waveform and stroke volume estimation.

Background And Objectives: Cardiovascular dysfunction can be more effectively monitored and treated, with accurate, continuous, stroke volume (SV) and/or cardiac output (CO) measurements. Since direct measurements of SV/CO are highly invasive, clinical measures are often discrete, or if continuous, can require recalibration with a discrete SV measurement after hemodynamic instability. This study presents a clinically applicable, non-additionally invasive, physiological model-based, SV and CO measurement method, which does not require recalibration during or after hemodynamic instability.

Model-based glycemic control in a Malaysian intensive care unit: performance and safety study.

Stress-induced hyperglycemia is common in critically ill patients. A few forms of model-based glycemic control have been introduced to reduce this phenomena and among them is the automated STAR protocol which has been used in the Christchurch and Gyulá hospitals' intensive care units (ICUs) since 2010. This article presents the pilot trial assessment of STAR protocol which has been implemented in the International Islamic University Malaysia Medical Centre (IIUMMC) Hospital ICU since December 2017.

Nutrition delivery, workload and performance in a model-based ICU glycaemic control system.

Background And Objective: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), and has been associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a model-based GC protocol that uniquely maintains normoglycaemia by changing both insulin and nutrition interventions, and has been proven effective in controlling blood glucose (BG) in the ICU.

Interpretation of Retrospective BG Measurements.

Background: This study investigates blood glucose (BG) measurement interpolation techniques to represent intermediate BG dynamics, and the effect resampling of retrospective BG data has on key glycemic control (GC) performance results. GC protocols in the ICU have varying BG measurement intervals ranging from 0.5 to 4 hours.

Performance of Stochastic Targeted Blood Glucose Control Protocol by virtual trials in the Malaysian intensive care unit.

Background And Objective: Blood glucose variability is common in healthcare and it is not related or influenced by diabetes mellitus. To minimise the risk of high blood glucose in critically ill patients, Stochastic Targeted Blood Glucose Control Protocol is used in intensive care unit at hospitals worldwide. Thus, this study focuses on the performance of stochastic modelling protocol in comparison to the current blood glucose management protocols in the Malaysian intensive care unit.

Next-generation, personalised, model-based critical care medicine: a state-of-the art review of in silico virtual patient models, methods, and cohorts, and how to validation them.

Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining.

Nutrition delivery of a model-based ICU glycaemic control system.

Background: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a proven, effective model-based ICU GC protocol that uniquely maintains normo-glycaemia by changing both insulin and nutrition interventions to maximise nutrition in the context of GC in the 4.

Generalisability of a Virtual Trials Method for Glycaemic Control in Intensive Care.

Background: Elevated blood glucose (BG) concentrations (Hyperglycaemia) are a common complication in critically ill patients. Insulin therapy is commonly used to treat hyperglycaemia, but metabolic variability often results in poor BG control and low BG (hypoglycaemia).

Objective: This paper presents a model-based virtual trial method for glycaemic control protocol design, and evaluates its generalisability across different populations.

Assessing respiratory mechanics using pressure reconstruction method in mechanically ventilated spontaneous breathing patient.

Background: Respiratory system modelling can aid clinical decision making during mechanical ventilation (MV) in intensive care. However, spontaneous breathing (SB) efforts can produce entrained "M-wave" airway pressure waveforms that inhibit identification of accurate values for respiratory system elastance and airway resistance. A pressure wave reconstruction method is proposed to accurately identify respiratory mechanics, assess the level of SB effort, and quantify the incidence of SB effort without uncommon measuring devices or interruption to care.

Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis.

Background: The changes in metabolic pathways and metabolites due to critical illness result in a highly complex and dynamic metabolic state, making safe, effective management of hyperglycemia and hypoglycemia difficult. In addition, clinical practices can vary significantly, thus making GC protocols difficult to generalize across units.The aim of this study was to provide a retrospective analysis of the safety, performance and workload of the stochastic targeted (STAR) glycemic control (GC) protocol to demonstrate that patient-specific, safe, effective GC is possible with the STAR protocol and that it is also generalizable across/over different units and clinical practices.

Peripheral venous blood oxygen saturation can be non-invasively estimated using photoplethysmography.

Measurement of peripheral venous oxygen saturation (SvO2) is currently performed using invasive catheters or direct blood draw. The purpose of this study was to non-invasively determine SvO2 using a variation of pulse oximetry techniques. Artificial respiration-like modulations applied to the peripheral vascular system were used to infer regional SvO2 using photoplethysmography (PPG) sensors.

Automated logging of inspiratory and expiratory non-synchronized breathing (ALIEN) for mechanical ventilation.

Asynchronous Events (AEs) during mechanical ventilation (MV) result in increased work of breathing and potential poor patient outcomes. Thus, it is important to automate AE detection. In this study, an AE detection method, Automated Logging of Inspiratory and Expiratory Non-synchronized breathing (ALIEN) was developed and compared between standard manual detection in 11 MV patients.

An Assessment of the relationship between dicrotic notch timing and cardiac preload.

Cardiovascular disease (CVD) patient outcomes can be improved by extracting and synthesizing as much useful information as possible from a limited number of available measurements. An important metric in assessing the pathological state of CVD patients is cardiac preload. Left ventricular preload can be estimated through the surrogate measurement of left ventricular end diastolic volume (LVEDV).