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Connected health is a growing field and can be viewed from different perspectives, particularly in sleep apnea syndrome. The purpose of this review is to show how all these aspects of connected health are already used in the management of sleep apnea syndrome (SAS) and its comorbidities. First, it can give patients a better understanding and a better assessment of their health. It also facilitates their healthcare by allowing them a greater role in their care pathway. For healthcare providers, connected health tools make it possible to set up new procedures for diagnosing and monitoring ambulatory patients, and for the making of joint decisions by health professionals and patients. Finally, for researchers, e-health generates massive amounts of data, thus facilitating the acquisition of knowledge in real life situations and the development of new methodologies for clinical studies that are faster, less expensive and just as reliable. All these considerations are already applicable in the field of sleep apnea, both for proposed treatments and for comorbidities management and for the patient's involvement in his/her care pathway.

This prospective study provided an effective way of glucose monitoring for patients with diabetes complicated with coronavirus disease 2019. The use of an intermittently scanned continuous glucose monitoring system was significantly associated with better outcomes of coronavirus disease 2019 in patients with pre-existing diabetes.

Immediately before the pandemic, 300 enterprise Mayo Clinic physicians and advanced practice providers had performed a minimum of one video telemedicine consult in the preceding year. By July 15, 2020, the number of Mayo Clinic providers performing video telemedicine consults had risen to >6,500, reflecting a 2,000% increase. Through this pandemic, we have witnessed unprecedented growth in telemedicine utilization. The existing telemedicine system has proven to be scalable.

Ambulatory blood pressure (BP) monitoring provides a more precise measure of BP status than clinic BP and is currently recommended in the evaluation of high BP in children and adolescents. However, ambulatory BP monitoring may not always be available. Our aim was to determine the clinic BP percentile most likely to predict ambulatory hypertension. We evaluated clinic and ambulatory BP in 247 adolescents (median age, 15.7 years; 63% white; 54% male). Clinic BP percentile (based on the fourth report and the 2017 American Academy of Pediatrics clinical practice guidelines) and ambulatory BP status (normal versus hypertension) were determined by age-, sex-, and height-specific cut points. Sensitivity and specificity of different clinic BP percentiles and cutoffs to predict ambulatory hypertension were calculated. Forty (16%) and 67 (27%) patients had systolic hypertension based on the fourth report and the 2017 guidelines, respectively, whereas 38 (15%) had wake ambulatory systolic hypertension. The prevalence of ambulatory wake systolic hypertension increased across clinic systolic BP percentiles, from 3% when clinic systolic BP was

Purpose This study aimed to improve estimates of sitting time from hip-worn accelerometers used in large cohort studies by using machine learning methods developed on free-living activPAL data. Methods Thirty breast cancer survivors concurrently wore a hip-worn accelerometer and a thigh-worn activPAL for 7 d. A random forest classifier, trained on the activPAL data, was used to detect sitting, standing, and sit–stand transitions in 5-s windows in the hip-worn accelerometer. The classifier estimates were compared with the standard accelerometer cut point, and significant differences across different bout lengths were investigated using mixed-effect models. Results Overall, the algorithm predicted the postures with moderate accuracy (stepping, 77%; standing, 63%; sitting, 67%; sit-to-stand, 52%; and stand-to-sit, 51%). Daily level analyses indicated that errors in transition estimates were only occurring during sitting bouts of 2 min or less. The standard cut point was significantly different from the activPAL across all bout lengths, overestimating short bouts and underestimating long bouts. Conclusions This is among the first algorithms for sitting and standing for hip-worn accelerometer data to be trained from entirely free-living activPAL data. The new algorithm detected prolonged sitting, which has been shown to be the most detrimental to health. Further validation and training in larger cohorts is warranted.

To examine the accuracy of activity monitors in estimating energy expenditure (EE) during activities of varying mode and intensity and to evaluate the impact of including energy expended during recovery from activity (EPOC) on the EE estimate. EE estimates obtained from the Fitbit Surge (FBS), Garmin Vívofit (GV) and SenseWear Armband Mini (SWA) were compared to criterion EE with and without EPOC adjustments during moderate- and vigorous-intensity treadmill and cycling activities.Participants (N = 34; 23 males) completed counterbalanced treadmill or cycling conditions, comprised of a resting metabolic rate measurement, 10-min bouts of moderate- and vigorous-intensity activity and an EPOC measurement. Participants simultaneously wore the three activity monitors and a portable metabolic analyser.The FBS provided lowest percent error (PE) during treadmill walking (4.4%) and the GV during moderate (6.4%) and vigorous (-0.1%) cycling bouts. EPOC-adjusted PE was higher than non-EPOC PE across all monitors and activities. Mean absolute error rate (MAPE), indicating overall measurement error, was the smallest for the FBS (14.1%) during moderate treadmill walking and the largest for the SWA (53.5%) for vigorous intensity cycling. Only the FBS had comparable non-EPOC (14.6%) and EPOC-adjusted (17.6%) MAPE during treadmill walking.The activity monitors tended to underestimate EE during moderate and vigorous treadmill and cycling activities. The EE estimates from the activity monitors did not account for the energy cost met by anaerobic means during activity, as suggested by the higher EPOC-adjusted EE error rates.

Purpose of review IOP is the only treatable risk factor contributing to glaucoma and most management and treatment of glaucoma is based on IOP. However, current IOP measurements are limited to office hours and control of glaucoma in many patients would benefit from the ability to monitor IOP diurnally so as not to miss abnormal pressures, which occur outside of office hours Consequently, to improve patient care, the ability to enable accurate and minimally disruptive diurnal IOP monitoring would improve caring for these patients. Recent findings The studies we selected for this review can be divided into three categories: self-/home-tonometry, continuous invasive intraocular pressure measurements, and continuous noninvasive ocular measurements. Summary The desire to obtain better insight in our patients' true diurnal IOP has led to the development of home-tonometers, in addition to extraocular and intraocular continuous pressure measurement devices. All of the devices have respective advantages and disadvantages, but none to date completely fulfills the goal of providing a true diurnal IOP profile.Video abstracthttp://links.lww.com/COOP/A27.

Background/Aims: The FreeStyle® Libre Flash Glucose Monitoring System (FGM, Abbott) measures glucose concentrations in the interstitial fluid for up to 14 days. It has been approved for use in children aged > 4 years in January 2016. Experience in children is still limited. We evaluated the accuracy and usability of the FGM in children with type 1 diabetes mellitus (DM). Methods: 67 children with type 1 DM (35 girls), aged 4–18 years, were included. Subjects wore a sensor on the back of their upper arm. For the first 14 days, they regularly measured capillary blood glucose (BG) with their usual BG meter (Accu-Chek® Mobile [ACM], Roche [n = 24]; Contour® Next Link [CNL], Bayer [n = 26]; OneTouch® Verio® IQ [OTV], LifeScan [n = 17]) followed by a sensor glucose (SG) scanning. SG readings were compared to BG measurements by consensus error grid (CEG) analysis; the mean difference (MD), the mean relative difference (MRD), the mean absolute difference (MAD), and the mean absolute relative difference (MARD) were calculated. After 14 days, subjects were asked to fill in a questionnaire on the usability of the FGM. Results: 2,626 SG readings were paired with BG results. FGM readings were highly correlated with BG (r = 0.926, p < 0.001). 80.3% of the data pairs were in zone A (= no effect on clinical action) and 18.4% were in zone B (= altered clinical action with little or no effect on the clinical outcome) of the CEG. Overall MD was +7.5 mg/dL; MD varied with the BG meter: ACM +10.4 mg/dL, CNL +14.2 mg/dL, OTV –3.6 mg/dL (p < 0.001). Overall, MARD was 16.7%. We observed a large interindividual variability in the accuracy parameters. MD and MRD were inversely related to BMI (r = –0.261 [p < 0.05]; r = –0.266 [p < 0.05], respectively). MARD was inversely related to age (r = –0.266 [p < 0.05]). Twenty-nine patients (43.3%) reported sensor problems, mainly early detachment of the sensor. Nonetheless, the usability questionnaire indicated high levels of satisfaction. Conclusions: Our results showed a reasonable agreement between the FGM SG readings and capillary BG measurements in children. There was, however, a large interindividual variability. The wearing of the sensor requires special attention. Further studies in children are imperative in order to document the accuracy and safety of the FGM in the paediatric population.

This paper introduces a mathematical model that incorporates the pertinent optical and physiological properties of skin reflections with the objective to increase our understanding of the algorithmic principles behind remote photoplethysmography (rPPG). The model is used to explain the different choices that were made in existing rPPG methods for pulse extraction. The understanding that comes from the model can be used to design robust or application-specific rPPG solutions. We illustrate this by designing an alternative rPPG method, where a projection plane orthogonal to the skin tone is used for pulse extraction. A large benchmark on the various discussed rPPG methods shows that their relative merits can indeed be understood from the proposed model.

Clarke, AC, Anson, JM, and Pyne, DB. Proof of concept of automated collision detection technology in rugby sevens. J Strength Cond Res 31(4): 1116-1120, 2017-Developments in microsensor technology allow for automated detection of collisions in various codes of football, removing the need for time-consuming postprocessing of video footage. However, little research is available on the ability of microsensor technology to be used across various sports or genders. Game video footage was matched with microsensor-detected collisions (GPSports) in one men's (n = 12 players) and one women's (n = 12) rugby sevens match. True-positive, false-positive, and false-negative events between video and microsensor-detected collisions were used to calculate recall (ability to detect a collision) and precision (accurately identify a collision). The precision was similar between the men's and women's rugby sevens game (∼0.72; scale 0.00-1.00); however, the recall in the women's game (0.45) was less than that for the men's game (0.69). This resulted in 45% of collisions for men and 62% of collisions for women being incorrectly labeled. Currently, the automated collision detection system in GPSports microtechnology units has only modest utility in rugby sevens, and it seems that a rugby sevens-specific algorithm is needed. Differences in measures between the men's and women's game may be a result of physical size, and strength, and physicality, as well as technical and tactical factors.

Objective This work explored the potential use of a wearable sensor system for providing just-in-time (JIT) feedback on the progression of a meal and tested its ability to reduce the total food mass intake. Methods Eighteen participants consumed three meals each in a lab while monitored by a wearable sensor system capable of accurately tracking chew counts. The baseline visit was used to establish the self-determined ingested mass and the associated chew counts. Real-time feedback on chew counts was provided in the next two visits, during which the target chew count was either the same as that at baseline or the baseline chew count reduced by 25% (in randomized order). The target was concealed from the participant and from the experimenter. Nonparametric repeated-measures ANOVAs were performed to compare mass of intake, meal duration, and ratings of hunger, appetite, and thirst across three meals. Results JIT feedback targeting a 25% reduction in chew counts resulted in a reduction in mass and energy intake without affecting perceived hunger or fullness. Conclusions JIT feedback on chewing behavior may reduce intake within a meal. This system can be further used to help develop individualized strategies to provide JIT adaptive interventions for reducing energy intake.

La enfermedad cardiovascular causa, a nivel mundial, el 33 % de las muertes y en Costa Rica el 27 % de la mortalidad prematura. En el marco de una Seguridad Social en transformación y con recursos limitados, se desarrolla un nuevo perfil demográfico y epidemiológico. Con el advenimiento de la cultura de la Innovación Tecnológica, los programas de rehabilitación cardiaca son una estrategia de prevención secundaria efectiva pero su implementación es escasa y la población que se beneficia es limitada. Se ha descrito una disminución de 20% de la mortalidad general y de un 26% de la mortalidad por causa cardiaca para el paciente que completa un programa de rehabilitación cardiaca con estándares internacionales. Sin embargo, menos del 30 % de la población apta accede a uno. Los programas de rehabilitación cardiaca son una inversión costosa y compleja que debe de optimizarse en el marco de un buena Gestión en Salud. La Gestión para resultados en el Desarrollo plantea una gerencia pública fundada en una racionalidad económica que busca eficiencia, eficacia y la creación de valor público. La presente investigación buscó generar una propuesta de un sistema de monitoreo del programa de rehabilitación cardiaca de usuarios con cardiopatía isquémica, elaborado a partir del modelo de Gestión para Resultados en el Desarrollo. Se planteó una investigación observacional descriptiva de tipo retrospectiva con enfoque cuantitativo. La población en estudio correspondió a los pacientes con cardiopatía isquémica del programa de rehabilitación cardiaca del Hospital San Rafael de Alajuela en el periodo de enero 2016 a diciembre 2018. Se utilizó estadística descriptiva y los análisis fueron desarrollados por medio de Stata 15.1. La población de cardiópatas isquémicos que cumplieron los criterios de inclusión y exclusión (N: 50) fueron en su mayoría del sexo masculino 74%, con una edad promedio de 60.2 (DE 8.5) años, casados 76% y asalariados 62%. El 30 % con primaria completa y el 22% con secundaria incompleta. El diagnóstico de ingreso más frecuente fue Infarto Agudo de Miocardio revascularizado con stent coronario 76% y con un 62.0% de pacientes con riesgo Cardiovascular asociado al ejercicio de tipo moderado. Con respecto a las comorbilidades, estas fueron propias del Síndrome Metabólico. Se documentó dislipidemia 94%, hipertensión 82%, diabetes mellitus 40%, Hb1Ac promedio de 6.5% (DE:1.8%), sobrepeso con índice de masa corporal promedio de 27 Kg/m2 y un antecedente tabaquismo en los últimos cinco años de 14.0%. Los pacientes cardiópatas isquémicos fueron atendidos 3.4 (DE 3.0) meses posteriores al último evento Coronario y lograron una capacidad funcional basal de 9.2 (DE:2.5) METS en promedio. El 90 % obtuvieron al menos una valoración nutricional, 70% de valoración en salud mental y un 44% de valoración farmacológica. Se documentaron síntomas relacionados con un afecto depresivo en 50% de la población. Se determinó un 2% (DE:2.4) de consultas a urgencias y un 0.6% (DE:0.5) de hospitalizaciones por diversas causas. Con respecto a la fase de seguimiento, el 100 % de pacientes se mantuvieron en la consulta externa, el 98% (49/50) persistía realizando ejercicio y el 93.5% de los asalariados (29/31) logró regresar a la actividad laboral. Se documentó un abandono del 28% (14/50), el 71.4% por causa médica y el 28.6% por causa no médica. La revisión de las sesiones de rehabilitación cardiaca permitió determinar la distribución de los eventos menores y mayores asociados al ejercicio. Los principales eventos menores fueron hipertensión arterial 2.9 (DE:1.6), hipoglicemia 2.1 (DE:1.0), hiperglicemia 2.1 (DE: 1.4) y dolor torácico (DE:1.2). Los eventos mayores documentados fueron ángor inestable 12% (6/50), claudicación isquémica de miembros inferiores 8% (4/50) e insuficiencia cardiaca descompensada 2% (1/50). No se encontró una correlación significativa entre las características de la población de cardiópatas isquémicos y la aparición de eventos menores ni mayores. Se determinó una mejoría del 84% de la capacidad funcional al final del programa, así como de 40 % para el perfil lipídico y la Hb1Ac. Se realizó un taller de trabajo bajo la metodología de Metaplan, con personal de salud de programas de rehabilitación cardiaca con el fin de establecer los componentes del sistema de monitoreo. A través del análisis del aporte de los indicadores estructurales, de proceso, de resultado y de impacto, se propone la herramienta digital RehabiCor (https://rehabicorcr.com/ ), un panel de datos para el monitoreo de eventos asociados a la realización de ejercicio. El monitoreo de los eventos menores de un programa de rehabilitación cardiaca busca disminuir el ausentismo, facilita la incorporación temprana a la actividad laboral y detecta tempranamente eventos mayores, lo que permitirá darle seguimiento a la inversión que hace la institución en la atención de las complicaciones mayores, así como generar un sistema de retroalimentación con el fin de prevenirlas. RehabiCor busca incidir en un programa interdisciplinario para una población vulnerable y tiene como valor público, plantear la necesidad de un modelo de atención en salud moderno, centrado en el paciente, dinámico en su toma de decisiones e incorporando la innovación tecnológica. Después de una validación interna y externa, RehabiCor podría extenderse a otros programas de rehabilitación asociados a ejercicio supervisado e inclusive a programas de acondicionamiento físico en el marco de estrategias de Promoción de la Salud. UCR::Vicerrectoría de Investigación::Sistema de Estudios de Posgrado::Salud::Maestría Profesional en Salud Pública con énfasis en Gerencia de la Salud

Cardiac resynchronization therapy (CRT) is increasingly used in heart failure treatment and management of these patients imposes significant challenges. Remote monitoring is becoming essential for CRT follow-up and allows close surveillance of device function and patient condition. It is helpful to reduce clinic visits, increase device longevity and provide early detection of device failure. Clinical effects include prevention of appropriate and inappropriate shocks and early detection of arrhythmias, such as atrial fibrillation. For modification of heart failure the addition of monitoring to CRT by means of device-based multiparameters may help to modify disease progression and improve survival.

Background and objective. Increasing physical activity (PA) is safe and beneficial in lung cancer (LC) patients. Advanced-stage LC patients are under-studied and have worse symptoms and quality of life (QoL). We evaluated the feasibility of monitoring step count in advanced LC as well as potential correlations between PA and QoL. Methods. This is a prospective, observational study of 39 consecutive patients with advanced-stage LC. Daily step count over 1 week (via Fitbit Zip), QoL, dyspnea, and depression scores were collected. Spearman rank testing was used to assess correlations. Correlation coefficients (ρ) >0.3 or

Incidence and clinical significance of transient, daily fluctuations of biventricular pacing percentage (CRT%) remain unknown. We assessed the value of daily remote monitoring in identifying prognostically critical burden of low CRT%.Prospective, single-centre registry encompassed 304 consecutive heart failure patients with cardiac resynchronization therapy defibrillators (CRT-D). Patients with 24-h episodes of CRT% loss95% were assigned to quartiles depending on cumulative time spent in low CRT%: quartile 1 (1-8days), 2 (9-20days), 3 (21-60days) and quartile 4 (60days). During median follow-up of 35months 51,826 transmissions were analysed, including 15,029 in 208 (68.4%) patients with episodes of low CRT%. Overall, mean CRT%≥95% vs.95% resulted in a 4-fold lower mortality (17.3 vs. 68.2%; p0.001). Fifty-four percent of patients experienced episodes of CRT% loss, despite 85.6% having mean CRT%≥95%. Mortality was lowest in quartile 1 (7.7%), while longer periods of CRT% loss resulted in significantly higher death rates (25.0 vs. 34.6 vs. 57.7%; quartiles 2-4 respectively, p0.001), despite mean CRT% still being ≥95% in quartiles 1-3. Cumulative low CRT% burden was the independent risk factor for death (HR 1.013; 95% CI 1.006-1.021; p0.001). Mortality rose by 1.3 and 49% with every additional day and quartile of CRT% loss, respectively.Daily remote monitoring allows one to detect 24-h episodes of CRT% loss95% in over two-thirds of CRT-D recipients during median observation of 3years. Cumulative low CRT% burden (in days) independently predicts mortality before mean CRT% drop.

Purpose Self-reported measures have been widely used to indicate the presence of possible and probable sleep bruxism (SB) in both research and clinical situations. However, few studies have attempted to assess the diagnostic validity of this approach. The aim of this study was to estimate the diagnostic validity of self-reported measures of SB using an ambulatory single-channel electromyographic (EMG) device. Methods A total of 115 participants were enrolled and examined by standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) including two questions related to SB: self-reported SB and morning-jaw symptoms. An ambulatory single-channel EMG device (GrindCare3™, Medotech A/S) was used for measuring jaw–muscle EMG activity during sleep for seven consecutive nights. Cut-off values for different measures of EMG activity (average, maximum and minimum) and the coefficient of variation (CV) were selected to divide participants into two groups, with higher or lower EMG activity or CV values. The sensitivity and specificity for each question and combination of them were calculated. Results Self-reported SB had the highest sensitivity (compared with morning-jaw symptoms) for all measures of EMG activity and CV, although the values were low to modest (average: 76.0%, maximum: 76.9%, minimum: 77.3%, CV: 61.0%). The specificity was low for both the questions related to the different measures of EMG activity and CV (35.1–52.4%). Conclusions This study indicated that the diagnostic validity of self-reported measures of SB was low to modest using an ambulatory EMG device assessment as a reference. Using only self-reported measures for the assessment of SB may not have a high validity, which should be taken into consideration in the clinical evaluation of patients.

Quantitative gait analysis enables clinicians to evaluate patient mobility and to diagnose neuromuscular disorders. The clinical application of gait analysis is currently limited by the high operating costs of gait laboratories. The use of instrumented footwear that performs out of the lab measurements on subjects' walking patterns is a promising way to overcome this limitation. Besides serving as assessment tools, such devices can also act as retraining tools that help regulate a patient's gait with acoustic or vibrotactile stimuli.

Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behaviour in the home and predicting standard clinical assessment scores of the residents. To accomplish this goal, we propose a Clinical Assessment using Activity Behavior (CAAB) approach to model a smart home resident’s daily behavior and predict the corresponding standard clinical assessment scores. CAAB uses statistical features that describe characteristics of a resident’s daily activity performance to train machine learning algorithms that predict the clinical assessment scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years using prediction and classification-based experiments. In the prediction-based experiments, we obtain a statistically significant correlation (r = 0.72) between CAAB-predicted and clinician-provided cognitive assessment scores and a statistically significant correlation (r = 0.45) between CAAB-predicted and clinician-provided mobility scores. Similarly, for the classification-based experiments, we find CAAB has a classification accuracy of 72% while classifying cognitive assessment scores and 76% while classifying mobility scores. These prediction and classification results suggest that it is feasible to predict standard clinical scores using smart home sensor data and learning-based data analysis.

Introduction Clinic based uroflowmetry is commonly used in the diagnosis and management of lower urinary tract symptoms. AUA (American Urological Association) guidelines recommend 2 separate uroflowmetry tests with a voided volume greater than 150 ml for accurate interpretation. We characterized the interpretability of a series of uroflowmetry tests done at our institution and hypothesized that a significant number were noninterpretable because of inadequate urine volume. Methods Uroflowmetry results were collected from male patients at the UH (University of Utah Hospital) and VAMC (George Wahlen Veterans Affairs Medical Center) urology clinics between August 31, 2014 and September 30, 2014. Average time to perform uroflowmetry was determined. Tests with a volume of 150 ml or less were classified as noninterpretable. Data were characterized using descriptive statistics. Results During the study period 169 tests were collected, including 104 at UH and 65 at VAMC, of which 107 (63%) were noninterpretable. An estimated total of 1,452 tests were performed at UH and VAMC within a 12-month period. Average time to perform uroflowmetry by health care workers was 2 minutes 18 seconds. The estimated time loss per year for medical personnel due to noninterpretable uroflow studies was 35 hours. Conclusions More than 50% of clinic based uroflowmetry tests at our institution had a voided volume of 150 ml or less and were deemed noninterpretable per AUA guidelines. Current clinic based uroflowmetry testing strategies are inefficient and wasteful. Reliable, accurate alternatives to clinic based uroflowmetry for the diagnosis and management of lower urinary tract symptoms should be explored.

PURPOSE To evaluate the accuracy of intraocular pressure (IOP) measurements obtained with the newly available iCare HOME (RTHOME) rebound tonometer compared with the iCare ONE (RTONE) tonometer and Goldmann applanation tonometry (GAT), and possible correlation with central corneal thickness (CCT). MATERIALS AND METHODS IOP measurements were obtained from 154 patients by an ophthalmologist (doc) using each of the above-mentioned tonometers. In addition, patients (pat) measured their own IOP with the RTHOME and RTONE. The means and SD of results obtained with the different tonometers were compared. Agreement between the tonometers was calculated using the Bland-Altman method. RESULTS Mean IOPs for the right eyes only were 15.9±6.4 mm Hg (RTONEdoc), 15.8±6.4 mm Hg (RTONEpat), 15.0±5.9 mm Hg (RTHOMEdoc), 14.9±6.3 mm Hg (RTHOMEpat), and 15.8±4.4 mm Hg (GAT). Bland-Altman analysis revealed mean differences (bias) between RTONEdoc and RTHOMEdoc, between RTHOMEdoc and RTHOMEpat, and between RTHOMEdoc and GAT of 0.8, 0.1, and -0.8 mm Hg, respectively, with 95% limits of agreement of -3.5 to 5.2, -4.9 to 5.1, and -7.2 to 5.6 mm Hg, respectively. Linear regression of the comparisons revealed a proportional error over the range of pressures examined in the case of RTHOMEdoc versus GAT (slope=0.32, P

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.Determine the feasibility of using wearable technology (PAMSys™) to objectively monitor fall risk and gait in home and community settings in stroke survivors.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.Stroke survivors mean age was 70 ± 8 years old, were mainly Caucasian (60%) women (70%), and not significantly different than the age-matched controls (all P-values0.20). 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).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.

This study examines the accuracy of three popular, free Android-based pedometer applications (apps), namely, Runtastic (RT), Pacer Works (PW), and Tayutau (TY) in laboratory and free-living settings. Forty-eight adults (22.5 ± 1.4 years) completed 3-min bouts of treadmill walking at five incremental speeds while carrying a test smartphone installed with the three apps. Experiment was repeated thrice, with the smartphone placed either in the pants pockets, at waist level, or secured to the left arm by an armband. The actual step count was manually counted by a tally counter. In the free-living setting, each of the 44 participants (21.9 ± 1.6 years) carried a smartphone with installed apps and a reference pedometer (Yamax Digi-Walker CW700) for 7 consecutive days. Results showed that TY produced the lowest mean absolute percent error (APE 6.7%) and was the only app with acceptable accuracy in counting steps in a laboratory setting. RT consistently underestimated steps with APE of 16.8% in the laboratory. PW significantly underestimated steps when the smartphone was secured to the arm, but overestimated under other conditions (APE 19.7%). TY was the most accurate app in counting steps in a laboratory setting with the lowest APE of 6.7%. In the free-living setting, the APE relative to the reference pedometer was 16.6%, 18.0%, and 16.8% for RT, PW, and TY, respectively. None of the three apps counted steps accurately in the free-living setting.

Rafael Peinado*, Francisco Ruiz-Mateas, Maite Izquierdo, Eduardo Arana, Maria Robledo, Miguel Angel Arias, Juan Jimenez-Jaimez, Moises Rodriguez-Manero y Javier Chimeno Unidad de Arritmias y Electrofisiologia Cardiaca, Servicio de Cardiologia, Hospital Universitario La Paz, Madrid, Espana Unidad de Estimulacion Cardiaca, Area de Cardiologia, Hospital Costa del Sol, Marbella, Malaga, Espana Unidad de Arritmias, Servicio de Cardiologia, Hospital Clinico Universitario de Valencia, Valencia, Espana Unidad de Arritmias, Servicio de Cardiologia, Hospital Universitario Virgen del Rocio, Sevilla, Espana e Seccion de Arritmias, Servicio de Cardiologia, Hospital Universitario Araba, Vitoria, Alava, Espana Unidad de Arritmias y Electrofisiologia Cardiaca, Servicio de Cardiologia, Hospital Virgen de la Salud, Toledo, Espana Unidad de Arritmias, Servicio de Cardiologia, Hospital Universitario Virgen de las Nieves, Granada, Espana Unidad de Arritmias, Departamento de Cardiologia, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruna, Espana i Seccion de Cardiologia, Hospital Virgen de la Concha, Zamora, Espana

Intervening in response to ambulatory pulmonary artery pressure (PAP) measurements has been shown to improve outcomes in heart failure (HF) patients. A low cost non-invasive alternative to commercially available implantable devices for monitoring ambulatory PAP can improve HF management and reduce

Wearable technology is readily available for continuous assessment due to a growing number of commercial devices with increased data capture capabilities. However, many commercial devices fail to support suitable parameters (cut points) derived from the literature to help quantify physical activity (PA) due to differences in manufacturing. A simple metric to estimate cut points for new wearables is needed to aid data analysis.\ud \ud Objective: The purpose of this pilot study was to investigate a simple methodology to determine cut points based on ratios between sedentary behaviour (SB) and PA intensities for a new wrist worn device (PRO-Diary™) by comparing its output to a validated and well characterised ‘gold standard’ (ActiGraph™).\ud \ud Study design: Twelve participants completed a semi structured (four-phase) treadmill protocol encompassing SB and three PA intensity levels (light, moderate, vigorous). The outputs of the devices were compared accounting for relative intensity.\ud \ud Results: Count ratios (6.31, 7.68, 4.63, 3.96) were calculated to successfully determine cut-points for the new wrist worn wearable technology during SB (0 – 426) as well as light (427 – 803), moderate (804 – 2085) and vigorous (≥2086) activities, respectively.\ud \ud Conclusion: Our findings should be utilised as a primary reference for investigations seeking to use new (wrist worn) wearable technology similar to that used here (i.e. Pro-Diary™) for the purposes of quantifying SB and PA intensities. The utility of count ratios may be useful in comparing devices or SB/PA values estimated across different studies. However, a more robust examination is required for different devices, attachment locations and on larger/diverse cohorts.

Objective This study compared an objective measurement of physical activity (PA) in individuals with anorexia nervosa (AN) at low-weight, weight-restored, and post-treatment time points, and also compared PA in AN with that of healthy controls (HC). Method Sixty-one female inpatients with AN wore a novel accelerometer (the IDEEA) which measured PA at three time points: a) low-weight, b) weight-restored, and c) one month post-hospital discharge. Twenty-four HCs wore the IDEEA at one time point. Results Inpatients with AN became more physically active than they were at low-weight at weight restoration and following treatment discharge. Post-treatment patients with AN were more physically active than HCs during the day and less active at night, which was primarily accounted for by amount of time spent on feet, including standing and walking. Greater time spent on feet during the weight-restoration time point of inpatient treatment was associated with more rapid decrease in BMI over the 12 months following treatment discharge. Fidgeting did not differ between patients and controls, did not change with weight restoration, and did not predict post-treatment weight change. Discussion Use of a novel accelerometer demonstrated greater PA in AN than in HC. PA following weight restoration in AN, particularly time spent in standing postures, may contribute to weight loss in the year following hospitalization. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).

The extent of thermal strain while wearing personal protective equipment (PPE) during care activities for Ebola virus disease patients has not yet been characterized. From January to March 2015, 25 French healthcare workers (HCWs) in Conakry, Guinea, volunteered to be monitored while wearing PPE using an ingestible thermal sensor. The mean (standard deviation) working ambient temperature and relative humidity were 29.6 °C (2.0 °C) and 65.4% (10.3%), respectively; the mean time wearing PPE was 65.7 (13.5) minutes; and the mean core body temperature increased by 0.46 °C (0.20 °C). Four HCWs reached or exceeded a mean core body temperature of ≥ 38.5 °C. HCWs wearing PPE for approximately 1 hour exhibited moderate but safe thermal strain.

Freezing of gait (FoG) is a common gait impairment among patients with advanced Parkinson's disease. FoG is associated with falls and negatively impacts the patient's quality of life. Wearable systems that detect FoG in real time have been developed to help patients resume walking by means of rhythmic cueing. Current methods focus on detection, which require FoG events to happen first, while their prediction opens the road to preemptive cueing, which might help subjects to avoid freeze altogether. We analyzed electrocardiography (ECG) and skin-conductance (SC) data from 11 subjects who experience FoG in daily life, and found statistically significant changes in ECG and SC data just before the FoG episodes, compared to normal walking. Based on these findings, we developed an anomaly-based algorithm for predicting gait freeze from relevant SC features. We were able to predict 71.3% from 184 FoG with an average of 4.2 s before a freeze episode happened. Our findings enable the possibility of wearable systems, which predict with few seconds before an upcoming FoG from SC, and start external cues to help the user avoid the gait freeze.

Die Herzinsuffizienz ist in Landern westlicher Pragung eine der bedeutendsten Volkskrankheiten. Zu den Ursachen gehoren Bluthochdruck, koronare Herzkrankheit und Herzinfarkt, Diabetes mellitus sowie Nikotin- und Alkoholmissbrauch. Aber auch virale Infekte, Kardiomyopathien und Herzrhythmusstorungen konnen die Pumpfunktion des Herzens so schwachen, dass die Versorgung des Korpers mit sauerstoffreichem Blut nicht mehr gewahrleistet ist. Erfahren Sie hier, wie man die Herzinsuffizienz diagnostiziert und was man dagegen tun kann.

Electronic adherence monitors (EAMs) record and report an array of health behaviors, ranging from taking daily medications to wearing medical devices. EAMs are utilized in research worldwide and are being investigated for clinical use. However, there is also growing popular concern about the extent to which electronic devices may be used to monitor individuals, including allegations in the media that EAMs represent a move towards “Big Brother” in medicine. Here, we highlight the unique benefits as well as the potential ethical challenges that electronic adherence monitoring generates. These challenges surround autonomy, privacy and confidentiality, trust, and ancillary care obligations. We describe key questions within each of these domains that warrant further investigation, and present potential solutions to many of the concerns raised.

This study investigated the feasibility of the Infrared (IR) sensor-based walking aids for detecting the gait intention. To compensate for the defects of Force Sensing Resistors (FSRs) or force sensors, such as the velocity control problem on gait slopes, we used IR sensors to investigate knee joint anterior displacement in order to recognize the gait intention. We also measure leg muscle activities and foot pressure, in order to verify our investigation. We placed two IR sensors on the rollator center to sense left and right leg walking intentions. We took EMG signals of four leg muscles, and analyzed them. Foot pressure analysis parameters were the measured force and mean pressure. We conducted experiments on twenty young healthy adults. The results show that knee joint anterior displacement increases according to gait slope and velocity. We confirm similar results of knee joint anterior displacement through the IR sensors.

Diabetes devices are increasingly connected wirelessly to each other and to data-displaying reader devices. Threats to the accurate flow of information and commands may compromise the function of these devices and put their users at risk of health complications. Sound cybersecurity of connected diabetes devices is necessary to maintain confidentiality, integrity, and availability of the data and commands. Diabetes devices can be hacked by unauthorized agents and also by patients themselves to extract data that are not automatically provided by product software. Unauthorized access to connected diabetes devices has been simulated and could happen in reality. A cybersecurity standard designed specifically for connected diabetes devices will improve the safety of these products and increase confidence of users that the products will be secure.

In der Diskussion um den Nutzen der Heimmonitorversorgung insbesondere fur das Kollektiv fruhgeborener Kinder mit einem Apnoe-Bradykardie-Syndrom und/oder einer chronischen Lungenerkrankung spielt die Verkurzung des stationaren Aufenthaltes nicht nur unter soziookonomischen Gesichtspunkten sondern auch vor dem Hintergrund psychologischer und entwicklungsneurologischer Aspekte eine wichtige Rolle. Diesen Argumenten gegenuber stehen jedoch die Kosten dieser ambulanten Uberwachung sowie die fehlenden Standards fur die konsekutive Nachsorge dieser Kinder. Der folgende Artikel hat zum Ziel, die aktuelle Praxis der Heimmonitorverordnung und ihrer Nachbetreuung vor dem Hintergrund der Evidenzlage im Kontext der zu berucksichtigenden differenzialdiagnostischen Uberlegungen am Beispiel des etablierten Konzeptes der Neonatologie und des integrierten Sozialpadiatrischen Zentrums am Dr. von Haunerschen Kinderspital der Ludwig-Maximilians-Universitat in Munchen zu diskutieren.

Purpose The aim of this study is to explore whether urodynamics, with the addition of ambulatory urodynamic study (ambulatory-UDS), will be able to better predict and assess sacral neuromodulation (SNM) treatment outcome. Selection of patients is a critical element in achieving optimal outcome in SNM. Quantitative and qualitative results of urodynamic tests are used to justify surgical therapy and to evaluate treatment for lower urinary tract dysfunction. Therefore, these tests should be representative and subsequently offer a correct prognosis. Methods Between December 2002 until May 2013 selected patients with lower urinary tract symptoms (storage and/or voiding dysfunction) were included in an ambulatory urodynamic measurement database. From this database, the total subgroup of patients that underwent a sacral neuromodulation test evaluation was selected. Results A total of 98 patients were included. Success rate of SNM in patients with storage dysfunction was around 70 %, according to either conventional-UDS or ambulatory-UDS diagnosis. Based on conventional-UDS, success rate of SNM in patients with hypocontractility was 67 % and in acontractile patients 35 %. According to ambulatory-UDS diagnosis, success rates were 32 and 17 %, respectively. Conclusions This study shows that conventional-UDS overestimates the amount of patients diagnosed with hypocontractile or acontractile bladder. Patients with reduced contractility on ambulatory-UDS have a lower chance of SNM success. Hence, ambulatory-UDS allows us to select patients with a real acontractile bladder and predict SNM failure. In patients with storage dysfunction, additional ambulatory-UDS does not seem to contribute in predicting SNM outcome.

Continuous health status monitoring of infants is achieved with the development and fusion of wearable sensing technologies, wireless communication techniques and a low energy-consumption microprocessor with high performance data processing algorithms. As a clinical tool applied in the constant monitoring of physiological parameters of infants, wearable sensor systems for infants are able to transmit the information obtained inside an infant's body to clinicians or parents. Moreover, such systems with integrated sensors can perceive external threats such as falling or drowning and warn parents immediately. Firstly, the paper reviews some available wearable sensor systems for infants; secondly, we introduce the different modules of the framework in the sensor systems; lastly, the methods and techniques applied in the wearable sensor systems are summarized and discussed. The latest research and achievements have been highlighted in this paper and the meaningful applications in healthcare and behavior analysis are also presented. Moreover, we give a lucid perspective of the development of wearable sensor systems for infants in the future.

Background:Accurate assessments of physical activity and energy expenditure (EE) are needed to advance research on positive and negative graded walking.Purpose:To evaluate the validity of 2 SenseWear Armband monitors (Pro3 and the recently released Mini) during graded walking.Methods:Twenty healthy adults wore both monitors during randomized walking activities on a motorized treadmill at 7 grades (0%, ±5%, ±15%, and ±25%). Estimates of total EE from the monitors were computed using different algorithms and compared with values derived from indirect calorimetry methodology using a 2-way mixed model ANOVA (Device × Condition), correlation analyses and Bland-Altman plots.Results:There was no significant difference in EE between the 2 armbands in any of the conditions examined. Significant main effects for device and condition, as well as a consistent bias, were observed during positive and negative graded walking with a greater over- and under-estimation at higher slope.Conclusions:Both the armbands produced similar EE values and seem to be not accurate in estimation of EE during activities involving uphill and downhill walking. Additional work is needed to understand factors contributing to this discrepancy and to improve the ability of these monitors to accurately measure EE during graded walking.

Background Pacing can be a successful treatment for pallid breath-holding spells, primarily in individuals with severe bradycardia. Patient Description We describe an 18-month-old girl experiencing severe pallid breath-holding spells in whom repeated electrocardiographic, Holter, and electroencephalographic monitoring tests were all normal. Results Using a subcutaneous insertable cardiac monitor, severe bradycardia was detected during one of this girl's episodes. This finding led to a pacemaker implantation. Subsequently, her breath-holding spells completely resolved. Conclusion This child illustrates the ability of the insertable cardiac monitor to help and diagnose arrhythmias in children with unresolved clinical findings. The ability to implant it with a minimal scar makes it ideal for uncooperative individuals with relative few and unexpected episodes that are hard to diagnose.

Background:The purpose was to characterize energy expenditure (EE) during academic subjects and activities during an elementary school day.Methods:Children in 2nd to 4th grades (N = 33) wore the SenseWear Armband (SWA) for 5 school days to measure EE. Teachers’ logs were compared with SWA data to extract information about EE throughout the day. Energy expenditure was also compared among grades.Results:After controlling for body mass, grade level was not a significant predictor of average daily caloric expenditure, F (2, 17.58) = .29, P = .75, ω2 = .05. When comparing activities throughout the day, relative rates of EE differed significantly, Wilks’ F (7, 23) = 52.2, P = .00, ηp2 = .94, with PE and recess having higher EE. When academic subjects were compared (math, science, language arts), relative rate of EE was also significantly different, Wilks’ F (2, 30) = 4.31, P = .02, ηp2 = .22. For the full sample, relative rate EE was higher in science than in language arts.Conclusions:The school day provides opportunity for EE for children. These data support the potential benefit of active instruction in language arts as a method to increase school day EE.

Gait analysis continues to be an important technique for many clinical applications to diagnose and monitor certain diseases. Many mental and physical abnormalities cause measurable differences in a person's gait. Gait analysis has applications in sport, computer games, physical rehabilitation, clinical assessment, surveillance, human recognition, modelling, and many other fields. There are established methods using various sensors for gait analysis, of which, accelerometers are one of the most often employed. Accelerometer sensors are generally more user friendly and less invasive. In this paper, we review research regarding accelerometer sensors used for gait analysis with particular focus on clinical applications. We provide a brief introduction to accelerometer theory followed by other popular sensing technologies. The commonly used gait phases and parameters are enumerated. The details of extracting the papers for review are provided. We also review several gait analysis software. Then, we provide an extensive report of accelerometry based gait analysis systems and applications with additional emphasis on trunk accelerometry. We conclude this review with future research directions.

Objectives Older adults with cancer in developing countries face challenges accessing healthcare due to a lack of personnel and infrastructure. A decline in physical activity (defined as a decrease in the number of daily steps) may be a novel method for the timely detection of toxicity in older adults receiving chemotherapy in resource-constrained settings. Materials and Methods In this feasibility study, patients aged ≥ 65 years starting first-line chemotherapy for solid tumors were given a smartphone with a pedometer application. Daily steps were monitored daily for one cycle. If a ≥ 15% decrease from baseline was identified, the patient was called and the presence of toxicity assessed. The intervention would be feasible if ≥ 75% of the subjects recorded steps for ≥ 75% of the planned chemotherapy days. Results Forty patients (median age 73; 57% [N = 23] female) were included. Seventy percent (N = 28) had stage III-IV disease with 45% (N = 18) gastrointestinal, 23% (N = 9) breast, and 32% (N = 13) other malignancies. Mean pre-treatment daily steps was 3111 (Standard Deviation [SD] 1731), and median follow-up was 21 days (range 2–28). Despite having limited exposure to mobile technology, most (93%) patients used the smartphone appropriately, and 85% found it easy to use. Sixty percent of patients (N = 24) had toxicities managed over the phone, 27.5% (N = 10) were sent for urgent medical attention and 15% (N = 6) were hospitalized. Conclusion Using smartphones to monitor older adults with cancer receiving chemotherapy in a resource-constrained setting is feasible and acceptable. A decrease in the number of daily steps was common and helped to identify chemotherapy toxicity.

The aim of this study is to review the current tools for the assessment of stress response in humans, ranging from the use of psychological questionnaires to the latest tools involving portable digital devices. Practical implications in educational context are further discussed. XOTRIO1712 2.415 JCR (2018) Q2, 41/98 Health Care Sciences & Services, 12/26 Medical Informatics 0.565 SJR (2018) Q2, 28/163 Health Informatics, 11/57 Health Information Management, 104/941 Information Systems, 1184/2844 Medicine (miscellaneous) No data IDR 2018 UEM

We investigated the reliability of physical activity monitoring based on trunk accelerometry in older adults and assessed the number of measured days required to reliably assess physical activity. Seventy-nine older adults (mean age 79.1 ± 7.9) wore an accelerometer at the lower back during two nonconsecutive weeks. The duration of locomotion, lying, sitting, standing and shuffling, movement intensity, the number of locomotion bouts and transitions to standing, and the median and maximum duration of locomotion were determined per day. Using data of week 2 as reference, intraclass correlations and smallest detectable differences were calculated over an increasing number of consecutive days from week 1. Reliability was good to excellent when whole weeks were assessed. Our results indicate that a minimum of two days of observation are required to obtain an ICC ≥ 0.7 for most activities, except for lying and median duration of locomotion bouts, which required up to five days.