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Objective: We compared a non-invasive fetal electrocardiogram (fECG) to Doppler cardiotocogram (CTG) during the 1st stage of labor. Study design: This was a prospective observational study of non-invasive fECG using five abdominal electrodes and one Doppler ultrasound probe in 27 patients. Data were analyzed for reliability, clinical and statistical equivalence. Results: The fECG was similar to the traditional Doppler method. The fECG characterizes a fetal heart rate (FHR) trace in a similar way with regards to acceleration count, decelerations count and coincidence, variability and baseline. The FHR was overall correlated (Pearson's r=0.91). Conclusion: This non-invasive fECG presents an alternative, reliable and accurate assessment for fetal well-being during the 1st stage of labor. [ABSTRACT FROM AUTHOR]

Background: To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO 2 ) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist., Methods: Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life., Results: From the datasets available (n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life (P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO 2 for fhPPG correlated with wrPO (r = 0.88), but there were significant differences in SpO 2 between the two devices between 3 and 8 min (P < 0.005), with less variance observed with fhPPG SpO 2 ., Conclusion: In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO 2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted., Impact: This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant's forehead in the delivery room immediately after birth. Significantly higher SpO 2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth., (© 2024. The Author(s).)

Introduction: Leakage of orogastric secretions past the cuff of a tracheal tube is a contributory factor in ventilator-associated pneumonia. Current bench test methods specified in the International Standard for Anaesthetic and Respiratory Equipment (EN ISO 5361:2023) to test cuff leakage involve using a glass or plastic rigid cylinder model of the trachea. There is a need for more realistic models to inform cuff leakage., Methods: We used human computerised tomography data and additive manufacturing (3D printing), combined with casting techniques to fabricate a bio-inspired synthetic tracheal model with analogous tissue characteristics. We conducted cuff leakage tests according to EN ISO 5361:2023 and compared results for high-volume low-pressure polyvinyl chloride and polyurethane cuffs between the rigid cylinder trachea with our bio-inspired model., Results: The tracheal model demonstrated close agreement with published tracheal tissue hardness for cartilaginous and membranous soft tissues. For high-volume low-pressure polyvinyl chloride cuffs the leakage rate was >50% lower in the bio-inspired tracheal model compared with the rigid cylinder model (151 [8] vs 261 [11] ml h -1 ). For high-volume low-pressure polyurethane cuffs, much lower leakage rates were observed than polyvinyl chloride cuffs in both models with leakage rates higher for the bio-inspired trachea model (0.1 [0.2] vs 0 [0] ml h -1 )., Conclusion: A reproducible tracheal model that incorporates the mechanical properties of the human trachea can be manufactured from segmented CT images and additive manufactured moulds, providing a useful tool to inform future cuff development, leakage testing for industrial applications, and clinical decision-making. There are differences between cuff leakage rates between the bio-inspired model and the rigid cylinder recommended in EN ISO 5361:2023. The bio-inspired model could lead to more accurate and realistic cuff leakage rate testing which would support manufacturers in refining their designs. Clinicians would then be able to choose better tracheal tubes based on the outcomes of this testing., (© 2024 The Authors.)

Significance: Our goal is to understand the root cause of reported oxygen saturation ( SpO 2 ) overestimation in heavily pigmented skin types to devise solutions toward enabling equity in pulse oximeter designs., Aim: We aim to gain theoretical insights into the effect of skin tone on SpO 2 - R curves using a three-dimensional, four-layer tissue model representing a finger., Approach: A finger tissue model, comprising the epidermis, dermis, two arteries, and a bone, was developed using a Monte Carlo-based approach in the MCmatlab software. Two skin tones-light and dark-were simulated by adjusting the absorption and scattering properties within the epidermal layer. Following this, SpO 2 - R curves were generated in various tissue configurations, including transmission and reflection modes using red and infrared wavelengths. In addition, the influence of source-detector (SD) separation distances on both light and dark skin tissue models was studied., Results: In transmission mode, SpO 2 - R curves did not deviate with changes in skin tones because both pulsatile and non-pulsatile terms experienced equal attenuation at red and infrared wavelengths. However, in reflection mode, measurable variations in SpO 2 - R curves were evident. This was due to differential attenuation of the red components, which resulted in a lower perfusion index at the red wavelength in darker skin. As the SD separation increased, the effect of skin tone on SpO 2 - R curves in reflection mode became less pronounced, with the largest SD separation exhibiting effects similar to those observed in transmission mode., Conclusions: Monte Carlo simulations have demonstrated that different light pathlengths within the tissue contribute to the overestimation of SpO 2 in people with darker skin in reflection mode pulse oximetry. Increasing the SD separation may mitigate the effect of skin tone on SpO 2 readings. These trends were not observed in transmission mode; however, further planned research using more complex models of the tissue is essential., (© 2024 The Authors.)

Pulse oximeters' (POs) varying performance based on skin tones has been highly publicised. Compared to arterial blood gas analysis, POs tend to overestimate oxygen saturation (SpO 2 ) values for people with darker skin (occult hypoxemia). The objective is to develop a test bench for assessing commercial home and hospital-based POs in controlled laboratory conditions. A laboratory simulator was used to mimic different SpO 2 values (~ 70 to 100%). Different neutral density and synthetic melanin filters were used to reproduce low signal and varying melanin attenuation levels. Six devices consisting of commercial home (Biolight, N = 13; ChoiceMMed, N = 18; MedLinket, N = 9) and hospital-based (Masimo Radical 7 with Neo L, N = 1; GE B450 Masimo SET with LNCS Neo L, N = 1; Nonin 9550 Onyx II™, N = 1) POs were reviewed and their response documented. Significant variations were observed in the recorded SpO 2 values among different POs when exposed to identical simulated signals. Differences were greatest for lower SpO 2 (< 80%) where empirical data is limited. All PO responses under low signal and melanin attenuation did not change across various simulated SpO 2 values. The bench tests do not provide conclusive evidence that melanin does not affect in vivo SpO 2 measurements. Research in the areas of instrument calibration, theory and design needs to be further developed., (© 2024. The Author(s).)

Heart rate is an extremely important physiological parameter to measure in critically unwell infants, as it is the main physiological marker that changes in response to a change in infant condition. Heart rate is routinely measured peripherally on a limb with a pulse oximeter. However, when infants are critically unwell, the blood supply to these peripheries is reduced in preference for central perfusion of vital organs such as the brain and heart. Measurement of heart rate with a reflection mode photoplethysmogram (PPG) sensor on the forehead could help minimise this problem and make it easier for other important medical equipment, such as cannulas, to be placed on the limbs. This study compares heart rates measured with a forehead-based PPG sensor against a wrist-based PPG sensor in 19 critically unwell infants in neonatal intensive care collecting 198 h of data. The two heart rates were compared using positive percentage agreement, Spearman's correlation coefficient and Bland-Altman analysis. The forehead PPG sensor showed good agreement with the wrist-based PPG sensor with limits of agreement of 8.44 bpm, bias of -0.22 bpm; positive percentage agreement of 98.87%; and Spearman's correlation coefficient of 0.9816. The analysis demonstrates that the forehead is a reliable alternative location for measuring vital signs using the PPG., Competing Interests: Simon John Stockwell is funded via the EPSRC and an associated CASE award from SurePulse Medical Ltd. T’ng Chang Kwok is funded by an MRC CiC grant with matched funding from SurePulse Medical Ltd. The following are University of Nottingham employees and shareholders in SurePulse Medical Ltd—Don Sharkey, Barrie Hayes-Gill, and Steve Morgan. Don Sharkey and Barrie Hayes-Gill are non-executive directors of SurePulse Medical Ltd., (Copyright © 2023 Stockwell, Kwok, Morgan, Sharkey and Hayes-Gill.)

Compression therapy is widely used as the gold standard for management of chronic venous insufficiency and venous leg ulcers, and the amount of pressure applied during the compression therapy is crucial in supporting healing. A fibre optic pressure sensor using Fibre Bragg Gratings (FBGs) is developed in this paper to measure sub-bandage pressure whilst removing cross-sensitivity due to strain in the fibre and temperature. The interface pressure is measured by an FBG encapsulated in a polymer and housed in a textile to minimise discomfort for the patient. The repeatability of a manual fabrication process is investigated by fabricating and calibrating ten sensors. A customized calibration setup consisting of a programmable translation stage and a weighing scale gives sensitivities in the range 0.4-1.5 pm/mmHg (2.6-11.3 pm/kPa). An alternative calibration method using a rigid plastic cylinder and a blood pressure cuff is also demonstrated. Investigations are performed with the sensor under a compression bandage on a phantom leg to test the response of the sensor to changing pressures in static situations. Measurements are taken on a human subject to demonstrate changes in interface pressure under a compression bandage during motion to mimic a clinical application. These results are compared to the current gold standard medical sensor using a Bland-Altman analysis, with a median bias ranging from -4.6 to -20.4 mmHg, upper limit of agreement (LOA) from -13.5 to 2.7 mmHg and lower LOA from -32.4 to -7.7 mmHg. The sensor has the potential to be used as a training tool for nurses and can be left in situ to monitor bandage pressure during compression therapy.

This work reports an optical fibre probe functionalised with 'cotton-shaped' gold-silica nanostructures for relative humidity (RH) monitoring. The sensor response utilises the localised surface plasmon resonance (LSPR) of self-assembled nanostructures: gold nanospheres (40 nm) surrounded by one layer of poly (allylamine hydrochloride) and hydrophilic silica nanoparticles (10-20 nm) on the end-facet of an optical fibre via a wavelength shift of the reflected light. Sensor optimisation is investigated by varying the density of gold nanoparticles on the end-facet of an optical fibre. It is demonstrated that the plasmonic hybridisation mode appearing when the average gold interparticle distance is small (Median: 7.5 nm) is more sensitive to RH after functionalisation than the singular plasmonic mode. The plasmonic hybridisation mode sensor demonstrates a high linear regression to RH with a sensitivity of 0.63 nm/%RH and excellent reversibility. The response time (T 10-90% ) and recovery time (T 90-10% ) are calculated as 1.2 ± 0.4 s and 0.95 ± 0.18 s. The sensor shows no measurable cross-talk to temperature in the tested range between 25 °C to 40 °C and the 95% limit of agreement is 3.1%RH when compared to a commercial reference sensor. Simulation with finite element analysis reveals a polarisation-dependent plasmonic hybridisation with a redshift of plasmonic wavelength as a decrease of the interparticle distance and a higher refractive index sensitivity, which results in a high sensitivity to RH as observed in the experiment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Incorrect endotracheal tube (ETT) cuff inflation pressure causes significant problems for intubated patients. The technical development and first in vivo use of a smart ETT for measurements at the cuff-trachea interface during mechanical ventilation are described. The intra-tracheal multiplexed sensing (iTraXS) ETT contains integrated optical fibre sensors to measure contact pressure and blood perfusion. The device is tested during mechanical ventilation in a porcine model (N=6). For contact pressure, signals were obtained in all 30 measurements. For perfusion, data could be obtained in all 33 measurements. In the 3 cases where the cuff was inflated to an artificially high-level, blood occlusion is observed., Competing Interests: The authors declare no conflicts of interest., (Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article’s title, journal citation, and DOI.)

Capillary refill time (CRT) refers to the time taken for body tissue to regain its colour after an applied blanching pressure is released. Usually, pressure is manually applied and not measured. Upon release of pressure, simple mental counting is typically used to estimate how long it takes for the skin to regain its colour. However, this method is subjective and can provide inaccurate readings due to human error. CRT is often used to assess shock and hydration but also has the potential to assess peripheral arterial disease which can result in tissue breakdown, foot ulcers and ultimately amputation, especially in people with diabetes. The aim of this study was to design an optical fibre sensor to simultaneously detect blood volume changes and the contact pressure applied to the foot. The CRT probe combines two sensors: a plastic optical fibre (POF) based on photoplethysmography (PPG) to measure blood volume changes and a fibre Bragg grating to measure skin contact pressure. The results from 10 healthy volunteers demonstrate that the blanching pressure on the subject's first metatarsal head of the foot was 100.8 ± 4.8 kPa (mean and standard deviation), the average CRT was 1.37 ± 0.46 s and the time to achieve a stable blood volume was 4.77 ± 1.57 s. For individual volunteers, the fastest CRT measured was 0.82 ± 0.11 and the slowest 1.94 ± 0.49 s. The combined sensor and curve fitting process has the potential to provide increased reliability and accuracy for CRT measurement of the foot in diabetic foot ulcer clinics and in the community.

The desire of many engineers is to see their work end up as a final product offering a real benefit to society-for a lecturer/professor at a university, this is a dream often out of reach of the majority. However, the university academic is a changed species from the early days of the binary line between Universities and Polytechnics and when a lecturer meant just that-teaching to future engineers. This article describes the process and experience gained by a university engineer to spin out their research from the university sector and achieve the goal of a product reaching a global audience., (© 2021 The Authors. Healthcare Technology Letters published by John Wiley & Sons Ltd on behalf of The Institution of Engineering and Technology.)

Textile-based systems are an attractive prospect for wearable technology as they can provide monitoring of key physiological parameters in a comfortable and unobtrusive form. A novel system based on multichannel optical fibre sensor probes integrated into a textile sleeve is described. The system measures the photoplethysmogram (PPG) at two wavelengths (660 and 830 nm), which is then used to calculate oxygen saturation (SpO 2 ). In order to achieve reliable measurement without adjusting the position of the garment, four plastic optical fibre (POF) probes are utilised to increase the likelihood that a high-quality PPG is obtained due to at least one of the probes being positioned over a blood vessel. Each probe transmits and receives light into the skin to measure the PPG and SpO 2 . All POFs are integrated in a stretchable textile sleeve with a circumference of 15 cm to keep the sensor in contact with the subject's wrist and to minimise motion artefacts. Tests on healthy volunteers show that the multichannel PPG sensor faithfully provides an SpO 2 reading in at least one of the four sensor channels in all cases with no need for adjusting the position of the sleeve. This could not be achieved using a single sensor alone. The multichannel sensor is used to monitor the SpO 2 of 10 participants with an average wrist circumference of 16.0 ± 0.6 cm. Comparing the developed sensor's SpO 2 readings to a reference commercial oximeter (reflectance Masimo Radical-7) illustrates that the mean difference between the two sensors' readings is -0.03%, the upper limit of agreement (LOA) is 0.52% and the lower LOA is -0.58%. This multichannel sensor has the potential to achieve reliable, unobtrusive and comfortable textile-based monitoring of both heart rate and SpO 2 during everyday life., Competing Interests: The authors declare no conflict of interest.

Advancements in availability and specificity of light-emitting diodes (LEDs) have facilitated trait modification of high-value edible herbs and vegetables through the fine manipulation of spectra. Coriander ( Coriandrum sativum L.) is a culinary herb, known for its fresh, citrusy aroma, and high economic value. Studies into the impact of light intensity and spectrum on C. sativum physiology, morphology, and aroma are limited. Using a nasal impact frequency panel, a selection of key compounds associated with the characteristic aroma of coriander was identified. Significant differences ( P < 0.05) were observed in the concentration of these aromatics between plants grown in a controlled environment chamber under the same photosynthetic photon flux density (PPFD) but custom spectra: red (100%), blue (100%), red + blue (RB, 50% equal contribution), or red + green + blue (RGB, 35.8% red: 26.4% green: 37.8% blue) wavelengths. In general, the concentration of aromatics increased with increasing numbers of wavelengths emitted alongside selective changes, e.g., the greatest increase in coriander-defining E-(2)-decenal occurred under the RGB spectrum. This change in aroma profile was accompanied by significant differences ( P < 0.05) in light saturated photosynthetic CO 2 assimilation, water-use efficiency (W i ), and morphology. While plants grown under red wavelengths achieved the greatest leaf area, RB spectrum plants were shortest and had the highest leaf:shoot ratio. Therefore, this work evidences a trade-off between sellable commercial morphologies with a weaker, less desirable aroma or a less desirable morphology with more intense coriander-like aromas. When supplemental trichromatic LEDs were used in a commercial glasshouse, the majority of compounds, with the exception of linalool, also increased showing that even as a supplement additional wavelength can modify the aromatic profile increasing its complexity. Lower levels of linalool suggest these plants may be more susceptible to biotic stress such as herbivory. Finally, the concentration of coriander-defining aromatics E-(2)-decenal and E-(2)-hexenal was significantly higher in supermarket pre-packaged coriander leaves implying that concentrations of aromatics increase after excision. In summary, spectra can be used to co-manipulate aroma profile and plant form with increasing spectral complexity leading to greater aromatic complexity and intensity. We suggest that increasing spectral complexity progressively stimulates signaling pathways giving rise to valuable economic traits., (Copyright © 2020 McAusland, Lim, Morris, Smith-Herman, Mohammed, Hayes-Gill, Crowe, Fisk and Murchie.)

An optical fibre sensor for monitoring relative humidity (RH) changes during exercise is demonstrated. The humidity sensor comprises a tip coating of poly (allylamine hydrochloride) (PAH)/silica nanoparticles (SiO 2 NPs) deposited using the layer-by-layer technique. An uncoated fibre is employed to compensate for bending losses that are likely to occur during movement. A linear fit to the response of the sensing system to RH demonstrates a sensitivity of 3.02 mV/% (R 2 = 0.96), hysteresis ± 1.17% RH when 11 bilayers of PAH/SiO 2 NPs are coated on the tip of the fibre. The performance of two different textiles (100% cotton and 100% polyester) were tested in real-time relative humidity measurement for 10 healthy volunteers. The results demonstrate the moisture wicking properties of polyester in that the relative humidity dropped more rapidly after cessation of exercise compared to cotton. The approach has the potential to be used to monitor sports performance and by clothing developers for characterising different garment designs.

Introduction: Noninvasive fetal heart rate monitoring using transabdominal fetal electrocardiographic detection is now commercially available and has been demonstrated to be an effective alternative to traditional Doppler ultrasonographic techniques. Our objective in this study was to compare the results of computerized identification of fetal heart rate patterns generated by ultrasound-based and transabdominal fetal electrocardiogram-based techniques with simultaneously obtained fetal scalp electrode-derived heart rate information., Material and Methods: We applied an objective computer-based analysis for recognition of fetal heart rate patterns (Monica Decision Support) to data obtained simultaneously from a direct fetal scalp electrode, Doppler ultrasound, and the abdominal-fetal electrocardiogram techniques. This allowed us to compare over 145 hours of fetal heart rate patterns generated by the external devices with those derived from the scalp electrode in 30 term singleton uncomplicated pregnancies during labor. The direct fetal scalp electrode is considered to be the most accurate and reliable technique used in current clinical practice, and was, therefore, used as the standard for comparison. The program quantified the baseline heart rate, long- and short-term variability. It indicated when an acceleration or deceleration was present and whether it was large or small., Results: Ultrasound was associated with significantly greater deviations from the fetal scalp electrode results than the abdominal fetal electrocardiogram technique in recognizing the correct baseline heart rate, its variability, and the presence of small and large accelerations and small decelerations. For large decelerations the two external methods were each not significantly different from the scalp electrode results., Conclusions: Noninvasive fetal heart rate monitoring using maternal abdominal wall electrodes to detect fetal cardiac activity more reliably reproduced the computerized analysis of heart rate patterns derived from a direct fetal scalp electrode than did traditional ultrasound-based monitoring. Abdominal-fetal electrocardiogram should, therefore, be considered a primary option for externally monitored patients., (© 2019 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Monitoring of key physiological and pharmacological parameters is an important part of a closed loop control system in critical care. Optical fiber sensors provide a versatile platform technology that can be easily incorporated into existing in-dwelling catheters or face masks. With appropriate functional coatings they can be used to monitor a range of relevant parameters and two different examples are presented: (i) respiration monitoring; (ii) drug level monitoring. Respiration monitoring involves monitoring of temperature and humidity in inhaled and exhaled breath. The optical fiber sensor consists of a fiber Bragg grating to measure temperature and a tip coating whose refractive index changes with humidity. The sensor is demonstrated to be able to track breath to breath changes when incorporated into a mask. Drug level monitoring is demonstrated in vitro using a long period grating coated with molecularly imprinted polymer nanoparticles that are sensitive to fentanyl. The sensor has a limit of detection of 50ng/ml.

A novel optical sensor probe combining monitoring of blood oxygen saturation (S p O₂) with contact pressure is presented. This is beneficial as contact pressure is known to affect S p O₂ measurement. The sensor consists of three plastic optical fibres (POF) used to deliver and collect light for pulse oximetry, and a fibre Bragg grating (FBG) sensor to measure contact pressure. All optical fibres are housed in a biocompatible epoxy patch which serves two purposes: (i) to reduce motion artefacts in the photoplethysmogram (PPG), and (ii) to transduce transverse loading into an axial strain in the FBG. Test results show that using a combination of pressure measuring FBG with a reference FBG, reliable results are possible with low hysteresis which are relatively immune to the effects of temperature. The sensor is used to measure the S p O₂ of ten volunteers under different contact pressures with perfusion and skewness indices applied to assess the quality of the PPG. The study revealed that the contact force ranging from 5 to 15 kPa provides errors of <2%. The combined probe has the potential to improve the reliability of reflectance oximeters. In particular, in wearable technology, the probe should find use in optimising the fitting of garments incorporating this technology.

Objective: To develop a compact probe that can be used to monitor humidity in ventilator care equipment. A mesoporous film of alternate layers of Poly(allylamine hydrochloride) (PAH) and silica (SiO2) nanoparticles (bilayers), deposited onto an optical fibre was used. The sensing film behaves as a Fabry-Perot cavity of low-finesse where the absorption of water vapour changes the optical thickness and produces a change in reflection proportional to humidity., Methods: The mesoporous film was deposited upon the cleaved tip of an optical fibre using the layer-by-layer method. The sensor was calibrated in a bench model against a commercially available capacitive sensor. The sensitivity and response time were assessed in the range from 5 % relative humidity (RH) to 95%RH for different numbers of bilayers up to a maximum of nine., Results: The sensitivity increases with the number of bilayers deposited; sensitivity of 2.28 mV/%RH was obtained for nine bilayers. The time constant of the response was 1.13 s ± 0.30 s which is faster than the commercial device (measured as 158 s). After calibration, the optical fibre humidity sensor was utilised in a bench top study employing a mechanical ventilator. The fast response time enabled changes in humidity in individual breaths to be resolved., Conclusion: Optical fibre sensors have the potential to be used to monitor breath to breath humidity during ventilator care., Significance: Control of humidity is an essential part of critical respiratory care and the developed sensor provides a sensitive, compact and fast method of humidity monitoring.

Non-contact photoplethysmography (PPG) provides multiple benefits over in-contact methods, but is not as tolerant to motion due to the lack of mechanical coupling between the subject and sensor. One limitation of non-contact photoplethysmography is discussed here, specifically looking at the topology and optical variations of the skin and how this impacts upon the ability to extract a photoplethysmogram when a subject moves horizontally across the field of view of the detector (a panning motion). When this occurs it is shown that whilst the general relationships between the speed of traversal, detection area and resultant signal quality can be found, the quality of signal in each individual case is determined by the properties of the area of skin chosen.

Capillary refill time (CRT) is a simple means of cardiovascular assessment which is widely used in clinical care. Currently, CRT is measured through manual assessment of the time taken for skin tone to return to normal colour following blanching of the skin surface. There is evidence to suggest that manually assessed CRT is subject to bias from ambient light conditions, a lack of standardisation of both blanching time and manually applied pressure, subjectiveness of return to normal colour, and variability in the manual assessment of time. We present a novel automated system for CRT measurement, incorporating three components: a non-invasive adhesive sensor incorporating a pneumatic actuator, a diffuse multi-wavelength reflectance measurement device, and a temperature sensor; a battery operated datalogger unit containing a self contained pneumatic supply; and PC based data analysis software for the extraction of refill time, patient skin surface temperature, and sensor signal quality. Through standardisation of the test, it is hoped that some of the shortcomings of manual CRT can be overcome. In addition, an automated system will facilitate easier integration of CRT into electronic record keeping and clinical monitoring or scoring systems, as well as reducing demands on clinicians. Summary analysis of volunteer (n  =  30) automated CRT datasets are presented, from 15 healthy adults and 15 healthy children (aged from 5 to 15 years), as their arms were cooled from ambient temperature to 5°C. A more detailed analysis of two typical datasets is also presented, demonstrating that the response of automated CRT to cooling matches that of previously published studies.

A system has been developed in which multi-exposure laser speckle contrast imaging (LSCI) is implemented using a high frame rate CMOS imaging sensor chip. Processing is performed using a field programmable gate array (FPGA). The system allows different exposure times to be simulated by accumulating a number of short exposures. This has the advantage that the image acquisition time is limited by the maximum exposure time and that regulation of the illuminating light level is not required. This high frame rate camera has also been deployed to implement laser Doppler blood flow processing, enabling a direct comparison of multi-exposure laser speckle imaging and laser Doppler imaging (LDI) to be carried out using the same experimental data. Results from a rotating diffuser indicate that both multi-exposure LSCI and LDI provide a linear response to changes in velocity. This cannot be obtained using single-exposure LSCI, unless an appropriate model is used for correcting the response.

Pulse oximetry is a noninvasive and continuous method for monitoring the blood oxygen saturation level. This paper presents the design and testing of a single-chip pulse oximeter fabricated in a 0.35 µm CMOS process. The chip includes photodiode, transimpedance amplifier, analogue band-pass filters, analogue-to-digital converters, digital signal processor and LED timing control. The experimentally measured AC and DC characteristics of individual circuits including the DC output voltage of the transimpedance amplifier, transimpedance gain of the transimpedance amplifier, and the central frequency and bandwidth of the analogue band-pass filters, show a good match (within 1%) with the circuit simulations. With modulated light source and integrated lock-in detection the sensor effectively suppresses the interference from ambient light and 1/f noise. In a breath hold and release experiment the single chip sensor demonstrates consistent and comparable performance to commercial pulse oximetry devices with a mean of 1.2% difference. The single-chip sensor enables a compact and robust design solution that offers a route towards wearable devices for health monitoring.

Around 5%-10% of newborn babies require some form of resuscitation at birth and heart rate (HR) is the best guide of efficacy. We report the development and first trial of a device that continuously monitors neonatal HR, with a view to deployment in the delivery room to guide newborn resuscitation. The device uses forehead reflectance photoplethysmography (PPG) with modulated light and lock-in detection. Forehead fixation has numerous advantages including ease of sensor placement, whilst perfusion at the forehead is better maintained in comparison to the extremities. Green light (525 nm) was used, in preference to the more usual red or infrared wavelengths, to optimize the amplitude of the pulsatile signal. Experimental results are presented showing simultaneous PPG and electrocardiogram (ECG) HRs from babies (n = 77), gestational age 26-42 weeks, on a neonatal intensive care unit. In babies ⩾32 weeks gestation, the median reliability was 97.7% at ±10 bpm and the limits of agreement (LOA) between PPG and ECG were +8.39 bpm and -8.39 bpm. In babies <32 weeks gestation, the median reliability was 94.8% at ±10 bpm and the LOA were +11.53 bpm and -12.01 bpm. Clinical evaluation during newborn deliveries is now underway.

The first fully integrated 2D CMOS imaging sensor with on-chip signal processing for applications in laser Doppler blood flow (LDBF) imaging has been designed and tested. To obtain a space efficient design over 64 × 64 pixels means that standard processing electronics used off-chip cannot be implemented. Therefore the analog signal processing at each pixel is a tailored design for LDBF signals with balanced optimization for signal-to-noise ratio and silicon area. This custom made sensor offers key advantages over conventional sensors, viz. the analog signal processing at the pixel level carries out signal normalization; the AC amplification in combination with an anti-aliasing filter allows analog-to-digital conversion with a low number of bits; low resource implementation of the digital processor enables on-chip processing and the data bottleneck that exists between the detector and processing electronics has been overcome. The sensor demonstrates good agreement with simulation at each design stage. The measured optical performance of the sensor is demonstrated using modulated light signals and in vivo blood flow experiments. Images showing blood flow changes with arterial occlusion and an inflammatory response to a histamine skin-prick demonstrate that the sensor array is capable of detecting blood flow signals from tissue.

Objective/aims: To investigate the presence of signal ambiguity of intrapartum fetal heart rate (FHR) monitoring during delivery by comparing simultaneous cardiotocogram (CTG), abdominal fetal electrocardiogram (ECG) with continuous maternal ECG., Methods: A total of 144 simultaneous CTG (Corometrics 250 series), abdominal fetal ECG (Monica -AN24™) and maternal ECG (Monica AN24™) recordings were evaluated., Main Outcome Measures: When the FHR is within 5 bpm of the maternal heart rate (MHR) acquired from the ECG, it is classified as 'MHR/FHR ambiguity'. Statistical analyses were performed with Fisher's exact test and the Wilcoxon signed-rank test., Results: Comparison of abdominal fetal ECG against CTG demonstrates significantly less 'MHR/FHR ambiguity' in both the first stage (mean 0.70 vs. 1.22%, p < 0.001) and second stage of labour (mean 3.30 vs. 6.20%, p < 0.001)., Conclusion: Intrapartum FHR monitoring in daily practice via the CTG modality provides significantly more 'MHR/FHR ambiguity' than abdominal fetal ECG, which also provides additional information on the MHR., (Copyright © 2013 S. Karger AG, Basel.)

Objective: The objective of this study was to assess the fetal heart rate (FHR) signal quality of non-invasive abdominal fetal electrocardiogram (fECG) in comparison to the Doppler ultrasound cardiotocogram (CTG) during the first and second stage of labour., Study Design: This was a prospective observational study of non-invasive fECG using five abdominally sited electrodes against the traditional Doppler ultrasound CTG probe on 144 patients. Data were analysed for signal quality before and after outlier removal., Results: Abdominal fECG signal quality was significantly better during the first stage of labour in comparison to Doppler CTG (median fECG reliability of 95.7 % vs. median 87.3 % for Doppler, p < 0.001), whereas during second stage of labour, equivalence was demonstrated (p > 0.05). For the first and second stage of labour, fECG showed 106/135 (78.5 %) and 46/98 (46.9 %) women having fetal signal loss below 20 %, respectively. Similarly, Doppler ultrasound demonstrated 104/135 (77.0 %) and 51/98 (52.0 %) women having fetal signal loss below 20 % during first and second stage of labour, respectively., Conclusion: The non-invasive abdominal fECG presents an improved FHR signal quality during the first stage of labour and an equivalent signal quality during the second stage.

Objective: Compare the accuracy and reliability of fetal heart rate identification from maternal abdominal fetal electrocardiogram signals (ECG) and Doppler ultrasound with a fetal scalp electrode., Design: Prospective open method equivalence study., Setting: Three urban teaching hospitals in the Northeast United States., Sample: 75 women with normal pregnancies in labor at >37 weeks of gestation., Methods: Three fetal heart rate detection methods were used simultaneously in 75 parturients. The fetal scalp electrode was the standard against which abdominal fetal ECG and ultrasound were judged., Main Outcome Measures: The positive percent agreement with the fetal scalp electrode indicated reliability. Bland-Altman analysis determined accuracy. The confusion rate indicated how frequently the devices tracked the maternal heart rate., Results: Positive percent agreement was 81.7 and 73% for the abdominal fetal ECG and ultrasound, respectively (p = 0.002). The abdominal fetal ECG had a lower root mean square error than ultrasound (5.2 vs. 10.6 bpm, p < 0.001). The confusion rate for ultrasound was 20-fold higher than for abdominal ECG (8.9 vs. 0.4%, respectively, p < 0.001)., Conclusion: Compared with the fetal scalp electrode, fetal heart rate detection using abdominal fetal ECG was more reliable and accurate than ultrasound, and abdominal fetal ECG was less likely than ultrasound to display the maternal heart rate in place of the fetal heart rate., (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)

What is believed to be the first fully integrated two-dimensional complementary metal oxide semiconductor (CMOS) imaging array for laser Doppler blood flow imaging is demonstrated. The sensor has 64×64 pixels and includes both analog and digital on-chip processing electronics. This offers several potential advantages over commercial sensors as the processing is tailored to the signals of interest and the data bottleneck that exists between the sensor and processing electronics is overcome. To obtain a space efficient design over 64×64 pixels means that standard processing electronics used off-chip cannot be implemented. Images of both simulated blood flow responses and a blood flow occlusion test demonstrate the capability.

Detection of ultrasound (US)-modulated fluorescence in turbid media is a challenge because of the low level of fluorescent light and the weak modulation of incoherent light. A very limited number of theoretical and experimental investigations have been performed, and this is, to our knowledge, the first demonstration of pulsed US-modulated fluorescence tomography. Experimental results show that the detected signal depends on the acoustic frequency and the fluorescent target's size along the ultrasonic propagation axis. The modulation depth of the detected signal is greatest when the length of the object along the acoustic axis is an odd number of half wavelengths and is weakest when the object is an integer multiple of an acoustic wavelength. Images of a fluorescent tube embedded within a 22- by 13- by 30 mm scattering gel phantom (μ(s)∼15  cm(-1), g=0.93) with 1-, 1.5-, and 2 MHz frequency US are presented. The modulation depth of the detected signal changes by a factor of 5 depending on the relative size of the object and the frequency. The approach is also verified by some simple experiments in a nonscattering gel and using a theoretical model.

Introduction: This study aimed to evaluate foetal signal quality obtained using an antenatal foetal ECG system (Monica 24™) and compare it with Doppler ultrasound CTG monitoring (Corometrics® 250 series). Material and Methods: Seventy pregnant women (gestational age: between 20 + 0 weeks and 40 + 0 weeks) were examined using the Monica AN24™ system and also underwent Doppler CTG. The signal quality of both methods was compared and correlated with gestational age and pre-pregnancy body mass index (BMI). Results: Overall, ECG had a signal quality of 77.4 % and CTG had a signal quality of 73.1 % (p > 0.05). In gestational weeks (GW) 20-26, the signal quality of ECG was significantly better compared to that obtained with CTG (75.5 vs. 45.3 %; p = 0.003), while in GW 27-36, the signal quality was better with CTG (72.3 vs. 83.0 %, p = 0.001). No difference in signal quality was found between the two methods after the 37th GW (87.7 vs. 86.1 %; p > 0.05). CTG showed a statistically significant correlation with BMI (rho 0.25, p < 0.05) while ECG showed no such correlation. Conclusion: The use of non-invasive ECG is particularly indicated in the early weeks of pregnancy, while CTG offers superior results during the vernix period. There was no difference in signal quality after the vernix period. The signal quality with ECG was found to be independent of BMI, while the signal quality of CTG deteriorated with increasing BMI.

Objective: To investigate the functional adaptive process of the fetal autonomic nervous system during hypnosis from the 20th week of gestation till term. Are there changes in the power spectrum analysis of fetal heart rate when the mother is having a clinical hypnosis or control period? Study Design: Fourty-nine FHR recordings were analysed. Included recordings were from singletons and abdominal fetal ECG-monitored pregnancies. All women were randomised to receive clinical hypnosis followed by a period with no intervention or vice versa. Statistical analyses were performed with the Wilcoxon signed ranks and Spearman rho correlation tests. Results: There was a significant difference found between fetal heart rate at baseline (144.3 ± 6.0) and hypnosis (142.1 ± 6.4). A difference was also detected between the standard deviation of the heart rate between baseline (6.7 ± 1.9) and hypnosis (6.8 ± 3.5). LFnu was smaller during baseline (80.2 ± 5.3) than during hypnosis (82.1 ± 5.7), whereas HFnu was significantly larger (19.8 ± 5.3 vs. 17.9 ± 5.7). There was no correlation between the gestation age and the change in LFnu, HFnu or ratio LF/HF due to the hypnosis intervention. Conclusion: The functional adaptive process of the fetal autonomic system during hypnosis is reflected by a sympathovagal shift towards increased sympathetic modulation.

In pulsed ultrasound modulated optical tomography (USMOT), an ultrasound (US) pulse performs as a scanning probe within the sample as it propagates, modulating the scattered light spatially distributed along its propagation axis. Detecting and processing the modulated signal can provide a 1-dimensional image along the US axis. A simple model is developed wherein the detected signal is modelled as a convolution of the US pulse and the properties (ultrasonic/optical) of the medium along the US axis. Based upon this model, a maximum likelihood (ML) method for image reconstruction is established. For the first time to our knowledge, the ML technique for an USMOT signal is investigated both theoretically and experimentally. The ML method inverts the data to retrieve the spatially varying properties of the sample along the US axis, and a signal proportional to the optical properties can be acquired. Simulated results show that the ML method can serve as a useful reconstruction tool for a pulsed USMOT signal even when the signal-to-noise ratio (SNR) is close to unity. Experimental data using 5 cm thick tissue phantoms (scattering coefficient μ(s) = 6.5 cm(-1), anisotropy factor g=0.93) demonstrate that the axial resolution is 160 μm and the lateral resolution is 600 μm using a 10 MHz transducer.

We apply virtual tissue engineering to the full term human uterus with a view to reconstruction of the spatiotemporal patterns of electrical activity of the myometrium that control mechanical activity via intracellular calcium. The three-dimensional geometry of the gravid uterus has been reconstructed from segmented in vivo magnetic resonance imaging as well as ex vivo diffusion tensor magnetic resonance imaging to resolve fine scale tissue architecture. A late-pregnancy uterine smooth muscle cell model is constructed and bursting analysed using continuation algorithms. These cell models are incorporated into partial differential equation models for tissue synchronisation and propagation. The ultimate objective is to develop a quantitative and predictive understanding of the mechanisms that initiate and regulate labour., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The emergence of full field laser Doppler blood flow imaging systems based on CMOS camera technology means that a large amount of data from each pixel in the image needs to be processed rapidly and system resources need to be used efficiently. Conventional processing algorithms that are utilized in single point or scanning systems are therefore not an ideal solution as they will consume too much system resource. Two processing algorithms that address this problem are described and efficiently implemented in a field programmable gate array. The algorithms are simple enough to use low system resource but effective enough to produce accurate flow measurements. This enables the processing unit to be integrated entirely in an embedded system, such as in an application-specific integrated circuit. The first algorithm uses a short Fourier transformation length (typically 8) but averages the output multiple times (typically 128). The second method utilizes an infinite impulse response filter with a low number of filter coefficients that operates in the time domain and has a frequency-weighted response. The algorithms compare favorably with the reference standard 1024 point fast Fourier transform in terms of both resource usage and accuracy. The number of data words per pixel that need to be stored for the algorithms is 1024 for the reference standard, 8 for the short length Fourier transform algorithm and 5 for the algorithm based on the infinite impulse response filter. Compared to the reference standard the error in the flow calculation is 1.3% for the short length Fourier transform algorithm and 0.7% for the algorithm based on the infinite impulse response filter., (Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.)

This paper presents a general embedded processing system implemented in a field-programmable gate array providing high frame rate and high accuracy for a laser Doppler blood flow imaging system. The proposed system can achieve a basic frame rate of flow images at 1 frame/second for 256 x 256 images with 1024 fast Fourier transform (FFT) points used in the processing algorithm. Mixed fixed-floating point calculations are utilized to achieve high accuracy but with a reasonable resource usage. The implementation has a root mean square deviation of the relative difference in flow values below 0.1% when compared with a double-precision floating point implementation. The system can contain from one or more processing units to obtain the required frame rate and accuracy. The performance of the system is significantly higher than other methods reported to date. Furthermore, a dedicated field-programmable gate array (FPGA) board has been designed to test the proposed processing system. The board is linked with a laser line scanning system, which uses a 64 x 1 photodetector array. Test results with various operating parameters show that the performance of the new system is better, in terms of noise and imaging speed, than has been previously achieved.

A 4 x 4 pixel array with analog on-chip processing has been fabricated within a 0.35 mum complementary metal oxide semiconductor process as a prototype sensor for laser Doppler blood flow imaging. At each pixel the bandpass and frequency weighted filters necessary for processing laser Doppler blood flow signals have been designed and fabricated. Because of the space constraints of implementing an accurate omega(0.5) filter at the pixel level, this has been approximated using the "roll off" of a high-pass filter with a cutoff frequency set at 10 kHz. The sensor has been characterized using a modulated laser source. Fixed pattern noise is present that is demonstrated to be repeatable across the array and can be calibrated. Preliminary blood flow results on a finger before and after occlusion demonstrate that the sensor array provides the potential for a system that can be scaled to a larger number of pixels for blood flow imaging.

This paper proposes a novel architecture for a data acquisition system intended to support the next generation of ultrasonic imaging instruments operating at or above 100 MHz. Existing systems have relatively poor signal-to-noise ratios and are limited in terms of their maximum data sampling rate, both of which are improved by a combination of embedded averaging and embedded interleaved sampling. "On-the-fly" pipelined operation minimizes control overheads for signal averaging. A two-clock sampling timing system provides for effective sampling rates that are a factor of 20 or more above the basic sampling rate of the analog-to-digital converter (ADC). The system uses commercial field-programmable gate array devices operated at clock frequencies commensurable with the ADC clock. Implementation is via the Xilinx Xtreme digital signal processing development kit, available at low cost. Sample rates of up to 2160 MHz have been achieved in combination with up to 16384 coherent averages using the above-mentioned off-the-shelf hardware.

Primary Objective: The prime rationale of this research is to investigate the possible occurrence of previously unrecognized episodes of desaturation apparent in preterm infants with chronic lung disease as they freely move around a non-artificial environment., Research Design: The study comprises 58 hours of telemetric recordings of SpO2, heart rate, body movement and temperature, along with full ECG and photoplethysmographic waveforms for eight preterm subjects in their home environment. MAIN OUTCOME/RESULTS: The data is analysed for remarkable events, more particularly periods of spontaneous desaturation. Statistical results for all case studies are collated into a table along with examples of graphical analysis., Conclusions: This study has shown that some patients are prone to episodes of hypoxemia during the course of normal daily activity or daytime sleep that would usually go unrecognized and that more effective management of supplemental oxygen treatment may be possible with continual unobtrusive monitoring.

In fetal heart monitoring using Doppler ultrasound signals the cardiac information is commonly extracted from non-directional signals. As a consequence often some of the cardiac events cannot be observed clearly which may lead to the incorrect detection of the valve and wall motions. Here, directional signals were simulated to investigate their enhancement of cardiac events, and hence provide clearer information regarding the cardiac activities. First, fetal Doppler ultrasound signals were simulated with signals encoding forward and reverse motion then obtained using a pilot frequency. The simulation results demonstrate that the model has the ability to produce realistic Doppler ultrasound signals and a pilot frequency can be used in the mixing process to produce directional signals that allow the simulated cardiac events to be distinguished clearly and correctly.