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Introduction: The novel Confirm Rx™ implantable cardiac monitor (ICM) with SharpSense™ technology incorporates a new P‐wave discriminator designed to improve AF detection. This study aimed to evaluate the diagnostic performance of the Confirm Rx™ ICM in detecting AF episodes of varying durations. Methods: We conducted a multicenter retrospective analysis of consecutive patients implanted with a Confirm Rx™ ICM (v1.2) across nine UK hospitals, all with documented AF lasting at least 6 min. Electrocardiograms (ECGs) were manually adjudicated by cardiologists. To account for intra‐ and inter‐reviewer variability, a random sample of 10% of ECGs underwent additional review. Disagreements were resolved by a third reviewer. Diagnostic performance was determined by calculating the gross and patient‐averaged positive predictive value (PPV) for AF episodes of different duration. The source of false positive (FP) detection was also categorized. Results: Overall, 16,230 individual ECGs from 232 patients were included. The median AF episode duration was 14 min. R‐wave amplitude remained stable during follow‐up (0.52 ± 0.27 mV [initial] vs. 0.54 ± 0.29 mV [end of follow‐up], p =.10). The gross and patient‐averaged PPV were 75.0% and 67.0%, respectively. Diagnostic performance (gross) increased with progressively longer AF episodes: 88.0% for ≥1 h, 97.3% for 6 h, and 100% for 24 h. The main source of FP during tachycardia was T‐wave oversensing (54.2%), while in non‐tachycardic episodes it was predominantly ectopy (71.2%). The AF burden precision was excellent (93.3%). Conclusion: The Confirm Rx™ ICM diagnostic performance was modest for all AF episodes (75%), with accuracy increasing for longer AF episodes. [ABSTRACT FROM AUTHOR]

Autonomic nerve activity is important in the mechanisms of paroxysmal atrial fibrillation (PAF). The purpose of this study was to test the hypothesis that a single burst of skin sympathetic nerve activity (SKNA) can toggle on and off PAF or premature atrial contraction (PAC) clusters. Simultaneous recording of SKNA and electrocardiogram (neuECG) recording was performed over 7 days in patients with PAF. In study 1, 8 patients (7 men and 1 woman; age 62 ± 8 years) had 124 episodes of PAF. An SKNA burst toggled both on and off PAF in 8 episodes (6.5%) (type 1), toggled on but not off in 12 episodes (9.7%) (type 2), and toggled on a PAC cluster followed by PAF in 4 episodes (3.2%) (type 3). The duration of these PAF episodes was <10 minutes. The remaining 100 episodes (80.6%) were associated with active SKNA bursts throughout PAF (type 4) and lasted longer than type 1 (P =.0185) and type 2 (P =.0027) PAF. There were 47 PAC clusters. Among them, 24 (51.1%) were toggled on and off, and 23 (48.9%) were toggled on but not off by an SKNA burst. In study 2, 17 patients (9 men and 8 women; age 58 ± 12 years) had <10 minutes of PAF (4, 8, 0, and 31 of types 1, 2, 3, and 4, respectively). There were significant circadian variations of all types of PAF. A single SKNA burst can toggle short-duration PAF and PAC cluster episodes on and off. The absence of continued SKNA after the onset might have affected the maintenance of these arrhythmias. [ABSTRACT FROM AUTHOR]

This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke. The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments. Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P =.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P =.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P =.02; SMD (MVPA)=0.56, P =.0004) and decreased SB with low-quality evidence (SMD=0.48, P =.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P =.002). In general, the risk of bias in the included studies was low. In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps. [ABSTRACT FROM AUTHOR]

Purpose: We performed an economic evaluation, from a societal perspective, to examine the cost-utility and cost-effectiveness of a wearable multimodal seizure detection device: NightWatch.Methods: We collected data between November 2018 and June 2020 from the PROMISE trial (NCT03909984), including children aged 4-16 years with refractory epilepsy living at home. Caregivers completed questionnaires on stress, quality of life, health care consumption and productivity costs after two-month baseline and two-month intervention with NightWatch. We used costs, stress levels and quality-adjusted life years (QALYs) to calculate incremental cost-effectiveness ratios (ICERs). Missing items were handled by mean imputation. Sensitivity analyses were performed to examine the robustness of the results including bootstrap sampling.Results: We included 41 children (44% female; mean age 9.8 years, standard deviation (SD) 3.7 years). Total societal costs of the baseline period (T1) were on average €3,238 per patient, whereas after intervention (T2) this reduced to 2,463 (saving €775). The QALYs were similar between both periods (mean QALY 0.90 per participant, SD at T1 0.10, SD at T2 0.13). At a ceiling ratio of €50.000, NightWatch showed a 72% cost-effective probability. Univariate sensitivity analyses, on the perspective and imputation method, demonstrated result robustness.Conclusion: Our study suggests that NightWatch might be a cost-effective addition to current standard care for children with refractory epilepsy living at home. Further research with an additional target group for a large timeframe may support the findings of this research. [ABSTRACT FROM AUTHOR]

Singers, college students, and females are groups known to be at an elevated risk of developing functional/hyperfunctional voice disorders; therefore, female college students majoring in vocal performance may be at an even higher risk. To mitigate this risk, it would be helpful to know the "safe limits" for voice use that would help maintain vocal health in this vulnerable group, but there is a paucity of high-quality objective information upon which to base such limits. This study employed weeklong ambulatory voice monitoring in a large group of vocally healthy female college student singers to begin providing the types of objective data that could be used to help develop improved vocal health guidelines. Participants included 64 vocally healthy females currently enrolled in a vocal performance or similar program at a college or university. An ambulatory voice monitor recorded neck-surface acceleration throughout a typical week. A singing classifier was applied to the data to separate singing from speech. Weeklong vocal dose measures and distributional characteristics for standard voice measures were computed separately for singing and speech, and for both types of phonation combined. Participants spent 6.2% of the total monitoring time speaking and 2.1% singing (with total phonation time being 8.4%). Singing had a higher f o mode, more pitch variability, higher average sound pressure level (SPL), negatively skewed SPL distributions, lower average CPP, and higher H 1 -H 2 values than speaking. These results provide a basis for beginning to establish vocal health guidelines for female students enrolled in college-level vocal performance programs and for future studies of the types of voice disorders that are common in this group. Results also demonstrate the potential value that ambulatory voice monitoring may have in helping to objectively identify vocal behaviors that could contribute to voice problems in this population. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the voice use of nurses working in intensive care units (ICUs) and their perception of acoustic environments. The research was conducted in four different hospitals in China during the COVID-19 pandemic. A total of 60 ICU nurses were recruited for their voice use monitoring and 100 nurses participated in the survey. Firstly, voice-related parameters such as voice level (SPL, dB), fundamental frequency (F0, Hz), and voicing time percentage (Dt, %) were measured using a vocal monitor. To collect data, a non-invasive accelerometer was attached to the participants' necks during their working hours. Secondly, the perception of the ICU acoustic environment was assessed using semantic differential. The results showed that nurses spoke approximately 0.9–4 dB louder to patients and colleagues in ICUs compared to quiet rooms, and their fundamental frequency (F0) significantly increased during work. The voice levels of nurses were influenced by background noise levels, with a significant correlation coefficient of 0.44 (p < 0.01). Furthermore, the background noise levels ranged from 58.1 to 73.9 dBA, exceeding the guideline values set by the World Health Organisation (WHO). The semantic differential analysis identified 'Stress' and 'Irritation' as the two main components, indicating the prevalence of negative experiences within ICUs. This study highlights the potential risk of voice disorders among ICU nurses. The findings also underscore the importance of implementing strategies to reduce noise levels in ICUs to reduce voice disorders among nurses. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, a protocol was designed for mail-out devices and educational materials created to teach patients how to install a device for 2 weeks of continuous ambulatory ECG monitoring. We compared data collection from two sequential patient populations; one who received standard device application in the same clinic in the months before the pandemic response, and another, who received their device by mail for self-installation. Patients received a single phone call when the device was mailed and were able to contact the manufacturer as needed for support. A total of 47 devices were assessed from each group. Each group was similar in age (70 vs 65 years), and clinical indication for monitoring. Noise signal magnitude (22.34 vs 26.28%), symptom based manual activation (10 vs 8 events) and APB/recorded hour burden measurements (37.05 vs 23.36%) were similar in both groups (all comparisons were statistically non-significant). Both groups had a similar mean of hours recorded (240.37 vs. 245.05 h). Zero patient kits were lost, and all reports were delivered. Overall, it was found that a mail-delivered home-based recording platform can be reliably used to acquire clinical data with similar data quality and patient compliance as a conventional in-clinic model for long term ambulatory ECG monitoring. [ABSTRACT FROM AUTHOR]

To assess the relationship between real-world walking activity in children and adolescents with myelomeningocele (MMC) and gross measures of lower extremity strength, range of motion, demographics, and medical history. Prospective study. Participants recruited in outpatient clinics; data collected in a hospital-based motion analysis laboratory and in the community. Children and adolescents (N=52) with daily step count data available from a larger study of ambulatory children and adolescents with MMC. Not applicable. Univariate and multivariate regression was used to assess which participant characteristics and clinical factors were related to average number of steps per day. Univariate analysis showed a lower number of steps per day correlated with older age, male sex, higher body mass index, higher lesion level, use of assistive devices for ambulation, history of shunt placement, more television (TV) watched per week, lower hip extension and abduction strength, knee flexion strength, and ankle dorsiflexion and plantarflexion strength, and decreased knee and hip range of motion. Only assistive device usage and hours of TV watched per week remained in the final multivariate model predicting number of steps per day. Walking activity in children and adolescents with MMC was best predicted by assistive device use and amount of sedentary activity. Other predictors of walking activity from univariate analysis were related to assistive device use. This information can help tailor rehabilitation efforts and educate patients and families. Interventions targeting early prevention of strength loss and contractures may be important to retain or increase walking activity in children and adolescents with MMC. • Steps per day in youth with spina bifida was best predicted by assistive device use. • Youth with spina bifida who use assistive devices walk less. • Older age, male sex, and higher body mass index correlated with fewer steps per day. • Reduced lower extremity strength also related to fewer steps per day. [ABSTRACT FROM AUTHOR]

Recent advances in Pulse Wave Analysis (PWA) technology enable Blood Pressure (BP) measuring devices to combine the non-invasive estimation of different vascular biomarkers in ambulatory conditions. This approach allows obtaining a dynamic assessment of vascular function during the 24-h in the conditions of daily life, including night sleep. In spite of the present limited proof of the prognostic significance of 24-h ambulatory PWA, data is accumulating indicating the ability of these techniques to facilitate the early screening of vascular alterations and to improve individual Cardiovascular (CV) risk stratification. The integration of 24-h PWA with e-health and telehealth may help boost the implementation of this approach in the routine clinical evaluation of patients at risk. Telehealth-based 24-h PWA may help standardize the evaluation of recordings by making available to doctors and researchers validated analytical algorithms through dedicated web services. It may facilitate the setup of a worldwide network between expert centres and peripheral hubs in order to improve the quality of the patient's assessment and to provide personalized care. It may establish communication between healthcare professionals and patients allowing remote monitoring and direct counselling, ultimately improving patients' health status. The use of telehealth may also allow creating registries and collecting big-data, useful to validate and improve the quality of the algorithms, including Artificial Intelligence (AI) and Machine Learning (ML) tools for predicting patients' risk and guide clinical care. Preliminary evidence from one of such registries (the Vascular health ASsessment Of The hypertENSive, VASOTENS Registry) seems to indicate that telehealth-based networks may be effective to collect definitive proof of the clinical utility of 24-h PWA. [ABSTRACT FROM AUTHOR]

Background:Stroke survivors often have persistent neural deficits related to motor function and sensation, which increase their risk of falling, most of which occurs at home or in community settings. The use of wearable technology to monitor fall risk and gait in stroke survivors may prove useful in enhancing recovery and/or preventing injuries. Objective:Determine the feasibility of using wearable technology (PAMSys™) to objectively monitor fall risk and gait in home and community settings in stroke survivors. Methods:In this feasibility study, we used the PAMSys to identify fall risk indicators (postural transitions: duration in seconds, and number of unsuccessful attempts), and gait (steps, speed, duration) for 48 hours during usual daily activities in stroke survivors (n = 10) compared to age-matched controls (n = 10). A questionnaire assessed device acceptability. Results:Stroke survivors mean age was 70 ± 8 years old, were mainly Caucasian (60%) women (70%), and not significantly different than the age-matched controls (allP-values >0.20). Stroke survivors (100%) reported that the device was comfortable to wear, didn't interfere with everyday activities, and were willing to wear it for another 48 hours. None reported any difficulty with the device while sleeping, removing/putting back on for showering or changing clothes. When compared to controls, stroke survivors had significantly worse fall risk indicators and walked less (P < 0.05). Conclusion:: Stroke survivors reported high acceptability of 48 hours of continuous PAMSys monitoring. The use of in-home wearable technology may prove useful in monitoring fall risk and gait in stroke survivors, potentially enhancing recovery. [ABSTRACT FROM AUTHOR]

Ambulatory monitoring represents an effective tool for the assessment of silent and transient myocardial ischemia during routine daily activities. Incidence of silent ischemia can provide important prognostic information about patients with coronary artery disease or acute coronary syndrome, as well as about post-myocardial infarction patients. The current technological progress enables development of powerful and miniaturized wearable devices for Holter monitoring. Higher sampling rates, dynamic range, and extended computational and storage capacity allow for considering of more complex methodological solutions such as high-frequency QRS analysis for diagnosing myocardial ischemia. Implementation of suitable methodologies for advanced detection of myocardial ischemia into modern ambulatory monitoring devices creates the potential of making the ambulatory myocardial ischemia monitoring a valuable diagnostic tool in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. Method Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0–10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). Results Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening ( p < .01) and increased levels of fatigue throughout the day were reported ( p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening ( p < .05). Objective and subjective measured physical activity showed low correlations. Conclusions This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue. [ABSTRACT FROM AUTHOR]

Introduction Epistaxis is the most common otorhinolaryngological emergency. Whether there is an association or cause and effect relationship between epistaxis and hypertension is a subject of longstanding controversy. Objective The aim of our study is to evaluate the relationship between epistaxis and hypertension. Materials and methods This study was conducted at Olaya Medical Center (Riyadh) during the period between May 2013 and June 2014. A total of 80 patients were divided into two groups: Group A consisted of 40 patients who presented with epistaxis, and Group B consisted of 40 patients who served as a control group. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed for all patients. Patients were followed up for a period of three months. Results Readings of blood pressure (BP) were similar between the two groups regarding BP at presentation, ABPM, and BP at three months. There was a higher number of attacks in patients with history of hypertension. There was highly significant positive correlation between number of attacks of epistaxis and BP readings. Systolic BP at presentation was higher in patients who needed more complex interventions such as pack, balloon or cautery than those managed by first aid. Conclusion We found no definite association between epistaxis and hypertension. Epistaxis was not initiated by high BP but was more difficult to control in hypertensive patients. [ABSTRACT FROM AUTHOR]

Objective To quantify longitudinal changes in sedentary behavior (ie, nonexercise seated or lying behavior) after stroke to ascertain whether reducing sedentary behavior might be a new therapeutic target. Design Longitudinal cohort study of patients with acute stroke who were followed over 1 year. Setting Acute teaching hospital or outpatient clinic, and the community after discharge. Participants A convenience sample of patients with acute stroke (N=96; median age, 72y, interquartile range [IQR]=64–80y; 67% men; median National Institute of Health Stroke Scale score=2, IQR=1–3) who were assessed at 1, 6, and 12 months after stroke. Interventions Not applicable. Main Outcome Measures Objective measures of amount and pattern of time spent in sedentary behavior: total sedentary time, weighted median sedentary bout length, and fragmentation index. Results Stroke survivors were highly sedentary, spending on average 81% of the time per day in sedentary behavior: median=19.9 hours (IQR=18.4–22.1h), 19.1 hours (17.8–20.8h), and 19.3 hours (17.3–20.9h) at 1, 6, and 12 months, respectively. Longitudinal changes in sedentary behavior were estimated using linear mixed effects models. Covariates were age, sex, stroke severity (National Institute of Health Stroke Scale score), physical capacity (6-minute walk distance), and functional independence (Nottingham Extended Activities of Daily Living Questionnaire score). Higher stroke severity and less functional independence were associated cross-sectionally with more sedentary behavior (β=.11, SE=.05, P =.020 and β=−.11, SE=.01, P <.001, respectively). Importantly, the pattern of sedentary behavior did not change over the first year after stroke and was independent of functional ability. Conclusions Stroke survivors were highly sedentary and remained so a year after stroke independently of their functional ability. Developing interventions to reduce sedentary behavior might be a potential new therapeutic target in stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose:The purpose of our study was to examine the monitoring capabilities of the Omron HJ-720ITC pedometer and determine the feasibility of using it in physical activity interventions.Methods:Using data from an 8-week lifestyle-intervention study, we tested the capabilities of the pedometer for recording physical activity data. Data from a total of 28 subjects were used in our analysis. The total number of patient steps per day was recorded over the duration of an intervention, as well as “aerobic steps per day” (ie, those taken at a cadence of > 60 steps per minute for ≥ 10 consecutive minutes). Daily wear time was computed in order to ascertain participant compliance in wearing the pedometer. In addition, aerobic steps per minute were computed, providing an assessment of activity intensity during continuous walking bouts.Results:Total steps per day and aerobic steps per day increased from baseline assessment to Week 8. Participants exceeded 100 steps/minute for 89% of their aerobic minutes, suggesting that they were in the moderate-intensity range (3–6 metabolic equivalent tasks) when performing continuous bouts of walking (> 10 minutes).Conclusion:The new pedometer is a reasonably priced, wearable activity monitor that is feasible for use in clinical and research settings. [ABSTRACT FROM PUBLISHER]

The article discusses the study that examines if personal-level environmental temperature (PET) or seasonality affects ambulatory monitoring of blood pressure (BP). At adjusted regression analysis, the study found the negative relationship of daytime systolic BP to PET, positive relationship of nighttime BP with daylight hours, and negative relationship between morning BP surge to daylight hours. The study provides evidence of PET and seasonality being predictors of ambulatory BP monitoring.

Abstract: Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Objective: To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls. Design: Cross-sectional observational study. Setting: Outpatient rehabilitation center. Participants: Patients with chronic stroke (n=38) and healthy controls (n=18). Intervention: Not applicable. Main Outcome Measures: Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Unimanual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity. Results: Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side. Conclusion: Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side. [Copyright &y& Elsevier]

The article discusses a study conducted to examine natural evolution of physical activity-related participation restrictions as seen in patients with Parkinson's Disease (PD). The study demonstrated significant improvement in the behavior due to rehabilitation and medical interventions. It concluded that continuous monitoring of ambulatory activity may be an important means of quantifying declining behavior resulting from rehabilitation. Limitations of the study are also discussed.

Abstract: Background: Compliance to long-term ambulatory electrocardiogram monitoring is important for diagnosis in patients with cardiac arrhythmia. This requires a system with a minimal impact on daily activities. Objective: The aim of this study was to investigate if a lightweight integrated adhesive monitor for long-term use without unacceptable adverse effects is feasible. Methods: The participants wore either a prototype lightweight monitor or a control system for a total of up to 30 days, changing patches once (investigational device) or twice (control) weekly. Comfort, skin irritation, and impact on quality of life were recorded. Results: The new monitor can be worn by most participants for periods of at least 6 days. Skin irritation and comfort rating were comparable, and impact on the quality of life was low compared with the control. Patients considered the device comfortable. Conclusion: An integrated adhesive monitor that can be worn on the skin up to 7 days with minimal side effects is feasible. [Copyright &y& Elsevier]

Abstract: Cheung VH, Gray L, Karunanithi M. Review of accelerometry for determining daily activity among elderly patients. Objectives: To review studies that used accelerometers to classify human movements and to appraise their potential to determine the activities of older patients in hospital settings. Data Sources: MEDLINE, CINAHL, and Web of Science electronic databases. A search constraint of articles published in English language between January 1980 and March 2010 was applied. Study Selection: All studies that validated the use of accelerometers to classify human postural movements and mobility were included. Studies included participants from any age group. All types of accelerometers were included. Outcome measures criteria explored within the studies were comparisons of derived classifications of postural movements and mobility against those made by using observations. Based on these criteria, 54 studies were selected for detailed review from 526 initially identified studies. Data Extraction: Data were extracted by the first author and included characteristics of study participants, accelerometers used, body positions of device attachment, study setting, duration, methods, results, and limitations of the validation studies. Data Synthesis: The accelerometer-based monitoring technique was investigated predominantly on a small sample of healthy adult participants in a laboratory setting. Most studies applied multiple accelerometers on the sternum, wrists, thighs, and shanks of participants. Most studies collected validation data while participants performed a predefined standardized activity protocol. Conclusions: Accelerometer devices have the potential to monitor human movements continuously to determine postural movements and mobility for the assessment of functional ability. Future studies should focus on long-term monitoring of free daily activity of a large sample of mobility-impaired or older hospitalized patients, who are at risk for functional decline. Use of a single waist-mounted triaxial accelerometer would be the most practical and useful option. [Copyright &y& Elsevier]

Question: What is the free-living physical activity of community-dwelling people with stroke compared with that of agematched healthy controls? Design: A cross-sectional observational study. Participants: 42 people with stroke and 21 agematched healthy controls aged 52 to 87 years living in Sydney, Australia. Outcome measures: Free-living physical activity was measured using the Intelligent Device for Energy Expenditure and Activity (IDEEA) and reported as duration (time on feet in min) and frequency (activity counts). Results: People with stroke spent 79 (95% CI 20 to 138) fewer min on their feet and performed 5308 (95% CI 3171 to 7445) fewer activity counts than healthy controls. The observation period of the free-living physical activity of stroke survivors was significantly less than that of the healthy controls. Data adjusted to a fixed observation period (12 hr) showed no relative difference in time on feet between the groups (mean difference 36 min, 95% CI -27 to 99) but that people after stroke still had relatively fewer activity counts than healthy controls (mean difference 4062 counts, 95% CI 1787 to 6337). Conclusions: The reduction in physical activity after stroke is not primarily because of a decrease in the time spent being active but rather a decrease in frequency of activity during that time. Future research into physical activity after stroke needs to consider energy expenditure because stroke survivors exhibit a reduced frequency of physical activity due to the nature of their impairments. [ABSTRACT FROM AUTHOR]

Rietberg MB, van Wegen EE, Uitdehaag BM, de Vet HC, Kwakkel G. How reproducible is home-based 24-hour ambulatory monitoring of motor activity in patients with multiple sclerosis? Objective: To determine the reproducibility of 24-hour monitoring of motor activity in patients with multiple sclerosis (MS). Design: Test-retest design; 6 research assistants visited the participants twice within 1 week in the home situation. Setting: General community. Participants: A convenience sample of ambulatory patients (N=43; mean age ± SD, 48.7±7.0y; 30 women; median Expanded Disability Status Scale scores, 3.5; interquartile range, 2.5) were recruited from the outpatient clinic of a university medical center. Interventions: Not applicable. Main Outcome Measures: Dynamic activity and static activity parameters were recorded by using a portable data logger and classified continuously for 24 hours. Reproducibility was determined by calculating intraclass correlation coefficients (ICCs) for test-retest reliability and by applying the Bland-Altman method for agreement between the 2 measurements. The smallest detectable change (SDC) was calculated based on the standard error of measurement. Results: Test-retest reliability expressed by the ICCagreement was .72 for dynamic activity, .74 for transitions, .77 for walking, .71 for static activity, .67 for sitting, .62 for standing, and .55 for lying. Bland and Altman analysis indicated no systematic differences between the first and second assessment for dynamic and static activity. Measurement error expressed by the SDC was 1.23 for dynamic activity, 66 for transitions, .99 for walking, 1.52 for static activity, 4.68 for lying, 3.95 for sitting, and 3.34 for standing. Conclusions: The current study shows that with 24-hour monitoring, a reproducible estimate of physical activity can be obtained in ambulatory patients with MS. [Copyright &y& Elsevier]

Abstract: The use of mobile sensor platforms to monitor an athlete’s performance is well reported. Using wireless technology its now possible to broadcast, store and analyse this data in near real time. The athletic environment is considered electrically harsh and for aquatic sports there are considerable challenges for the wireless transmission of athlete data. This paper outlines some of the recent developments in radio based technologies. Power consumption, antenna design, frequency selection, communications protocols, product selection and human comfort, together with some examples are reported. A range of licence free frequencies were investigated in the air/water interface and the antennas characterised. [Copyright &y& Elsevier]

Question: Which clinical measures of walking performance best predict free-living physical activity in community-dwelling people with stroke? Design: Cross-sectional observational study. Participants: 42 community-dwelling stroke survivors. Outcome measures: Predictors were four clinical measures of walking performance (speed, automaticity, capacity, and stairs ability). The outcome of interest was free-living physical activity, measured as frequency (activity counts) and duration (time on feet), collected using an activity monitor called the Intelligent Device for Energy Expenditure and Physical Activity. Results: Time on feet was predicted by stairs ability alone (B 166, 95% CI 55 to 278) which accounted for 48% of the variance. Activity counts were also predicted by stairs ability alone (B 6486, 95% CI 2922 to 10 050) which accounted for 58% of the variance. Conclusion: The best predictor of free-living physical activity in community-dwelling people with stroke was stairs ability. [ABSTRACT FROM AUTHOR]

Abstract: Mackey AH, Hewart P, Walt SE, Stott NS. The sensitivity and specificity of an activity monitor in detecting functional activities in young people with cerebral palsy. Objective: To evaluate the sensitivity and specificity of the Intelligent Device for Energy Expenditure and Activity (IDEEA) monitor in detecting functional activities in young people with cerebral palsy (CP). Design: Validation study. Setting: Two identical data collections completed 1 week apart at a gait laboratory. Participants: Twenty-five young people with CP and 30 able-bodied (AB) peers (age 8–25y; mean age CP 14.1y, Gross Motor Function Classification System Level I–III; mean age AB, 14.2y). Interventions: Not applicable. Main Outcome Measures: Each participant completed 5 functional activities (sitting, lying, standing, walking, and stairs), with the monitor attached. The sensitivity and specificity of the monitor in detecting each activity was calculated by comparison to a written timed report. Results: Sitting, lying, and standing were detected with median 100% sensitivity in both participant groups and across both testing sessions. Accuracy of walking detection was reduced compared with static activities (P<.05) across the 2 sessions and groups. The CP group had a significantly higher number of participants where the activity was not detected with 100% sensitivity (lie: 18% CP, 5% AB, P<.04; stand: 12% CP, 0% AB, P<.02; walk: 96% CP, 81% AB, P<.03). Stair climbing was detected in only half of the 12 participants with CP who could achieve the task. The IDEEA demonstrated high specificity (range, 97%–100%) for both participant groups. Conclusions: The IDEEA activity monitor had high levels of sensitivity and specificity in determining everyday static activities in participants with CP, with greater difficulties in detecting dynamic activities of walking and stair climbing. [Copyright &y& Elsevier]

Objective: There is considerable evidence that depressive mood is related to lower parasympathetic control of the heart, thus increasing cardiovascular risk. However, little is known about social factors (e.g., social affiliation) that might moderate this relationship. Design: The authors examined whether cardiac autonomic control in healthy individuals with depressive symptoms could be altered by social interaction. Therefore, the authors conducted a 22-hr ambulatory monitoring study with a sample of 63 adults. Main Outcome Measures: Depression was assessed by questionnaire. Heart rate, heart rate variability (HRV), physical activity, and negative affect were recorded throughout one day via portable monitoring devices. Results and Conclusion: Multilevel analyses revealed that depression was related to elevated negative affect and higher heart rate throughout the day. Moreover, there was a tendency toward lower HRV in individuals with higher depression scores. This association, however, was moderated by social context. When depressive participants were alone they evidenced lower HRV and higher negative affect, but not when they were engaged in social interactions with a partner, family members, or friends. These findings suggest that the relation between depression and cardiac autonomic control could be altered by social interaction, thus possibly buffering adverse health effects. [ABSTRACT FROM AUTHOR]

Abstract: The YAMAX Digiwalker pedometer has been previously confirmed as a valid and reliable monitor during level walking, however, little is known about its accuracy during non-level walking activities or between genders. Subsequently, this study examined the influence of non-level walking and gender on pedometer accuracy. Forty-six healthy adults completed 3-min bouts of treadmill walking at their normal walking pace during 11 inclines (0–10%) while another 123 healthy adults completed walking up and down 47 stairs. During walking, participants wore a YAMAX Digiwalker SW-700 pedometer with the number of steps taken and registered by the pedometer recorded. Pedometer difference (steps registered−steps taken), net error (% of steps taken), absolute error (absolute % of steps taken) and gender were examined by repeated measures two-way ANOVA and Tukey''s post hoc tests. During incline walking, pedometer accuracy indices were similar between inclines and gender except for a significantly greater step difference (−7±5steps vs. 1±4steps) and net error (−2.4±1.8% for 9% vs. 0.4±1.2% for 2%). Step difference and net error were significantly greater during stair descent compared to stair ascent while absolute error was significantly greater during stair ascent compared to stair descent. The current study demonstrated that the YAMAX Digiwalker SW-700 pedometer exhibited good accuracy during incline walking up to 10% while it overestimated steps taken during stair ascent/descent with greater overestimation during stair descent. Stair walking activity should be documented in field studies as the YAMAX Digiwalker SW-700 pedometer overestimates this activity type. [Copyright &y& Elsevier]

Abstract: White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L. Changes in walking activity and endurance following rehabilitation for people with Parkinson disease. Objective: To investigate changes in walking activity and endurance after interdisciplinary rehabilitation in people with Parkinson disease (PD). Design: Randomized controlled trial. Setting: Clinic, home, and community. Participants: Mild to moderate PD (Hoehn and Yahr stage 2–3). Interventions: Three experimental conditions lasting 6 weeks in duration: (1) no active rehabilitation; (2) 3.0 hours of interdisciplinary rehabilitation a week; or (3) 4.5 hours of interdisciplinary rehabilitation a week. Participants had stable medication regimes during the study. Main Outcome Measures: Walking activity was estimated with an activity monitor (AM) (time spent walking and number of 10-second walking periods) in the home and community settings over a 24-hour period. Walking endurance was measured in the clinic with the two-minute walk test (2MWT). Linear contrast analyses were applied to examine changes in walking activity and endurance after higher doses of rehabilitation, and 2-way analysis of variance models with interaction were applied to examine the effect of high and low baseline walking levels on changes. Results: The 2MWT was completed by 108 people with PD (mean age, 66.53y; with PD, 6.59y), and AM data were used from 74 of these people (mean age, 66.7y; with PD, 5.8y). Improvement in AM measures and the 2MWT did not significantly change across increasing dosages of interdisciplinary rehabilitation. Higher doses of rehabilitation resulted in significant improvements in the 2MWT for subjects with low baseline walking endurance (P=.001), and in AM measures for subjects with high baseline walking activity (P<.02). Conclusions: Interdisciplinary rehabilitation can improve walking activity and endurance depending on baseline walking levels. [Copyright &y& Elsevier]

Objective: To examine the psychobiological correlates of self-efficacy in teachers. Design: Study 1 examined associations between teacher self-efficacy and cardiac activation on a working day and Study 2 assessed the cortisol morning response in teachers with varying levels of teacher self-efficacy. Main outcome measures: Teacher self-efficacy was assessed by questionnaire. In Study 1 heart rate, heart rate variability, and locomotor activity were recorded by 22 hours ambulatory monitoring and subjective measures of stress and strain were obtained. Study 2 assessed the cortisol response to awakening to obtain a measure of HPA-axis activation and teachers filled in a questionnaire on physical complaints. Results and Conclusion: Study 1 found that self-efficacy proved protective for psychological well-being. Moreover, after controlling for locomotor activity, demographic, and lifestyle variables, self-efficacy was associated with elevated heart rate and attenuated heart rate variability during school and leisure time, respectively, but not during the night, thus questioning the health-implications of self-efficacy. Study 2 found that teachers high in self-efficacy exhibited an attenuated cortisol response to awakening and fewer cardiac complaints. The results of both studies are compatible with the view that teacher self-efficacy might act as a physiological toughening agent with possibly favorable health outcomes. [ABSTRACT FROM AUTHOR]

A small, community-based study to detect hypertension revealed one week of twice-daily home blood pressure (BP) measurements are more reliable and more accurately predict increased left ventricular mass than clinic or 24-hour ambulatory BP monitoring. [ABSTRACT FROM AUTHOR]

Objectives: The authors previously reported that individuals who rate their daily life as more demanding or less controllable by momentary electronic diary (ED) reports showed greater intima-medial thickness (IMT) by carotid ultrasonography. They now present prospective findings on this relation. Design. Three hundred thirty-five healthy individuals (ages 50-70 at study onset) completed ongoing ratings of activity and mood over a 6-day period, using ED assessments. Main Outcome Measures: Mean bilateral carotid artery IMT was measured at baseline and 36 months later. Results and Conclusion: Mean ratings of high demand and low control were significantly associated with IMT progression among men but not among women. These associations were not explained by traditional risk factors or by measures of occupational stress. Effects were partially accounted for by elevated ambulatory heart rates among those with low ratings of control. These data support the utility of ED-based measures for examining psychosocial risks in the prediction of cardiovascular disease progression. [ABSTRACT FROM AUTHOR]

Summary: Nocturnal panic (NP), waking from sleep in a state of panic, is a common occurrence among patients with panic disorder, with 44–71% reporting at least one such attack. NP is a non-REM event that is distinct from sleep terrors, sleep apnea, nightmares or dream-induced arousals. This review outlines recent advances in the characterization of NP, as well as current approaches to the assessment and treatment of NP. In contrast to earlier work, more recent studies suggest that patients with NP do not differ from patients without NP on sleep architecture, sleep physiology, self-reported sleep quality and severity of panic disorder. However, more precise measurement of physiological precipitants and features is warranted. Assessment of NP focuses on ruling out other explanations for NP, with differential diagnosis based on interviews, sleep polysomnography and ambulatory recording of sleep. Psychological treatment (cognitive-behavioral therapy) targets misappraisals of anxiety sensations, hyperventilatory response, and conditioned reactions to internal, physical cues. Recent evidence supports the efficacy of this approach, however, controlled studies on pharmacological agents in the treatment of NP are lacking. Research is needed to examine the effects of combined cognitive-behavioral therapy and medications, compared to medication alone in the treatment of NP. [Copyright &y& Elsevier]

With the increasing demand to assess cardiorespiratory fitness in leisure time sports and the fitness center setting, more practical tests than the exhaustive ergometric exercise test are desirable. Various submaximal exercise tests have been introduced that estimate VO2max based on the heart rate response to predetermined exercise intensities. However these tests do not estimate VO2max with satisfactory accuracy or reliability. In order to find a submaximal test with acceptable accuracy, we developed a method that measures the physical work at a predetermined heart rate. Seventy-one volunteers performed an incremental exercise test to measure VO2max, and two runs of 2.1 km each, substituting 1.5 km for subjects over 50. The running speeds were regulated by heart rate corresponding to 70% and 90%VO2max (V70 and V90). Simple regression analyses were made between V70 and V90 and VO2max and maximum Watts (Wmax), respectively (V70 vs. VO2max: r2=0.36; V70 vs. Wmax: r2=0.48; V90 vs. VO2max: r2=0.56; V90 vs. Wmax: r2=0.69; each: p<0.001). Using multiple regression analyses we added body mass, age, and resting heart rate as further independent variables which increased R² to 0.85 (p<0.001). In conclusion we suggest that this test is appropriate for general use and for documenting progress of cardiorespiratory training. [ABSTRACT FROM AUTHOR]

• People with MS fall frequently. • The gold standard for fall reporting is prospective self-report fall calendars. • There is increasing interest in automated fall detection. • We compare here three methods of fall counting, used concurrently. Background Falls occur across the population but are more common, and have more negative sequelae, in people with multiple sclerosis (MS). Given the prevalence and impact of falls, accurate measures of fall frequency are needed. This study compares the sensitivity and false discovery rates of three methods of fall detection: the current gold standard, prospective paper fall calendars, real-time self-reporting and automated detection, the latter two from a novel body-worn device. Methods Falls in twenty-five people with MS were recorded for eight weeks with prospective fall calendars, real-time body-worn self-report, and an automated body-worn detector concurrently. Eligible individuals were adults with MS enrolled in a randomized controlled trial of a fall prevention intervention. Entry criteria were at least two falls or near-falls in the previous two months, Expanded Disability Status Scale ≤ 6.0, community dwelling, and no MS relapse in the previous month. The sensitivity (proportion of true falls detected) and false discovery rates (proportion of false reports generated) of the fall detection methods were compared. A true fall was a fall reported by at least two methods. A false report was a fall reported by only one method. The trial is registered on ClinicalTrials.gov (NCT02583386) and is closed. Results In the 1,276 person-days of fall counting with all three methods in use simultaneously there were 1344 unique fall events. Of these, 8.5% (114) were true falls and 91.5% (1230) were false reports. Fall calendars had the lowest sensitivity (0.614) and the lowest false discovery rate (0.067). The automated detector had the highest sensitivity (0.921) and the highest false discovery rate (0.919). All methods generated under one false report per day. There were no fall detection-related adverse events. Conclusion Fall calendars likely underestimate fall frequency by around 40%. The automated detector evaluated here misses very few falls but likely overestimates the number of falls by around one fall per day. Additional research is needed to produce an ideal fall detection and counting method for use in clinical and research applications. Funding United States Department of Veterans Affairs, Rehabilitations Research and Development Service [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the impact on noninvasive ambulatory blood pressure monitoring on physical activity measured objectively by use of triaxial accelerometers.Methods: Twenty-four working men and women performed ambulatory blood pressure plus activity monitoring for 1 working day and evening and activity monitoring alone for a separate day and evening. Blood pressure measures were taken at 20-minute intervals during the day and 30-minute intervals in the evening and were accompanied by diary assessments of mood, location, and posture. Comparisons were made of energy expenditure on the 2 days and of activity levels during the minutes surrounding each blood pressure reading and diary completion.Results: Energy expenditure assessed in terms of activity calories per hour was significantly lower during blood pressure plus activity monitoring compared with activity monitoring alone (mean 37.3, SD = 16.3 vs. mean = 43.0, SD = 18.7 kcal, respectively: p = .02). Energy expenditure was lower during the 4 minutes surrounding each blood pressure reading than in the intervals between blood pressure readings. However, energy expenditure was also lower in the intervals between blood pressure readings than during comparable times on the activity only monitoring day. Blood pressure, heart rate, and physical activity were moderately correlated within individuals.Conclusions: Ambulatory blood pressure recording using automated sphygmomanometers is associated with reduced physical activity during the monitoring day. This is due partly to regular periods of immobility during cuff inflation and deflation and diary completion and partly to more general self-imposed restrictions on activity. This pattern has implications for the representativeness of ambulatory blood pressure monitoring, and the construction of ambulatory monitoring diaries. [ABSTRACT FROM AUTHOR]

Describes a study of the coupling interval of the initial beat of repetitive activity by 24-hour long-term electrocardiographic recordings in 76 patients with coronary artery disease at the time of angiography. Indication that coupling intervals were not significantly different between patients with certain ejection fractions and between patients who died suddenly and survivors; Worst prognosis observed in patients with both short coupling intervals for premature ventricular beats and couplets and a low ejection fraction; Conclusion that prolongation of coupling intervals by antiarrhythmic drug treatment or therapy with beta-blocking agents may have beneficial effects in the prevention of sudden death.

The article presents information on a study which analyzed incidence of sudden death and arrhythmia pattern in patients with resuscitation after myocardial infarction. Eighty patients with a mean age of 53 years were included consecutively in this retrospective study. Long-term ambulatory monitoring is widely accepted method in the diagnostic evaluation of ventricular arrhythmias. In the present study, significant differences in the incidence of isolated premature ventricular contractions and complex arrhythmias were observed between patients with late cardiac arrest and those without.

Propafenone is a new IC antiarrhythmic agent that is effective for suppression of spontaneously occurring ventricular arrhythmia as evaluated with monitoring and exercise testing. The incidence of nonserious, but disturbing side effects is low and the drug infrequently is discontinued because of adverse reactions. Serious side effects are primarily cardiac and include arrhythmia aggravation, CHF exacerbation, and conduction abnormalities. These complications occur primarily in those with severe underlying heart disease in whom this drug, like other antiarrhythmic agents, must be used cautiously. If the drug is effective and well tolerated, arrhythmia recurrence can be prevented. [ABSTRACT FROM AUTHOR]

Background: As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities.Objective: The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes.Methods: We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques.Results: A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations.Conclusions: There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers. [ABSTRACT FROM AUTHOR]

Background: Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions.Objective: This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care.Methods: We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature.Results: The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care.Conclusions: This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care. [ABSTRACT FROM AUTHOR]

Background: Smartphones contain sensors that measure movement-related data, making them promising tools for monitoring physical activity after a stroke. Activity recognition (AR) systems are typically trained on movement data from healthy individuals collected in a laboratory setting. However, movement patterns change after a stroke (eg, gait impairment), and activities may be performed differently at home than in a lab. Thus, it is important to validate AR for gait-impaired stroke patients in a home setting for accurate clinical predictions.Objective: In this study, we sought to evaluate AR performance in a home setting for individuals who had suffered a stroke, by using different sets of training activities. Specifically, we compared AR performance for persons with stroke while varying the origin of training data, based on either population (healthy persons or persons with stoke) or environment (laboratory or home setting).Methods: Thirty individuals with stroke and fifteen healthy subjects performed a series of mobility-related activities, either in a laboratory or at home, while wearing a smartphone. A custom-built app collected signals from the phone's accelerometer, gyroscope, and barometer sensors, and subjects self-labeled the mobility activities. We trained a random forest AR model using either healthy or stroke activity data. Primary measures of AR performance were (1) the mean recall of activities and (2) the misclassification of stationary and ambulatory activities.Results: A classifier trained on stroke activity data performed better than one trained on healthy activity data, improving average recall from 53% to 75%. The healthy-trained classifier performance declined with gait impairment severity, more often misclassifying ambulatory activities as stationary ones. The classifier trained on in-lab activities had a lower average recall for at-home activities (56%) than for in-lab activities collected on a different day (77%).Conclusions: Stroke-based training data is needed for high quality AR among gait-impaired individuals with stroke. Additionally, AR systems for home and community monitoring would likely benefit from including at-home activities in the training data. [ABSTRACT FROM AUTHOR]

Background: Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients' consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo.Objective: The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases.Methods: A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device's capacity to discriminate between asthma versus nonasthma cases.Results: ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=-.26, P=.05), forced vital capacity (FVC) (r=-.31, P=.02), and overall asthma control (r=-.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control (β=-.48, P=.003), quality of life (β=-.55, P=.001), and health care utilization (β=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95% CI 0.58-0.84), which was significantly different from chance (χ(2) 1=9.7, P=.002), indicating the device's discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3% and a specificity of 72.7%.Conclusions: This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients' awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma. [ABSTRACT FROM AUTHOR]

Background: Women's College Hospital, Toronto, Canada, offers specialized ambulatory surgical procedures. Patients often travel great distances to undergo surgery. Most patients receiving ambulatory surgery have a low rate of postoperative events necessitating clinic visits. However, regular follow-up is still considered important in the early postoperative phase. Increasingly, telemedicine is used to overcome the distance patients must travel to receive specialized care. Telemedicine data suggest that mobile monitoring and follow-up care is valued by patients and can reduce costs to society. Women's College Hospital has used a mobile app (QoC Health Inc) to complement in-person postoperative follow-up care for breast reconstruction patients. Preliminary studies suggest that mobile app follow-up care is feasible, can avert in-person follow-up care, and is cost-effective from a societal and health care system perspective. Objective: We hope to expand the use of mobile app follow-up care through its formal assessment in a randomized controlled trial. In postoperative ambulatory surgery patients at Women's College Hospital (WCH), can we avert in-person follow-up care through the use of mobile app follow-up care compared to conventional, in-person follow-up care in the first 30 days after surgery. Methods: This will be a pragmatic, single-center, open, controlled, 2-arm parallel-group superiority randomized trial comparing mobile app and in-person follow-up care over the first month following surgery. The patient population will comprise all postoperative ambulatory surgery patients at WCH undergoing breast reconstruction. The intervention consists of a postoperative mobile app follow-up care using the quality of recovery-9 (QoR9) and a pain visual analog scale (VAS), surgery-specific questions, and surgical site photos submitted daily for the first 2 weeks and weekly for the following 2 weeks. The primary outcome is the total number of physician visits related to the surgery over the first 30-days postoperative. The secondary outcomes include (1) the total number of phone calls and emails to a health care professional related to surgery, (2) complication rate, (3) societal and health care system costs, and (4) patient satisfaction over the first 30 days postoperative. Permutated-block randomization will be conducted by blocks of 4-6 using the program ralloc in Stata. This is an open study due to the nature of the intervention. Results: A sample of 72 (36 patients per group) will provide an E-test for count data with a power of 95% (/P/=.05) to detect a difference of 1 visit between groups, assuming a 10% drop out rate. Count variables will be analyzed using Poisson regression. Categorical variables will be tested using a chi-square test. Cost-effectiveness will be analyzed using net benefit regression. Outcomes will be assessed over the first 30 days following surgery. Conclusions: We hope to show that the use of a mobile app in follow-up care minimizes the need for in-person visits for postoperative patients. [ABSTRACT FROM AUTHOR]

Background: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. [ABSTRACT FROM AUTHOR]

Background: Women's College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications.Objective: The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients.Methods: This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks.Results: This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up.Conclusions: Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective. [ABSTRACT FROM AUTHOR]