Rozprawy doktorskie na temat „Biomedical and Physiological Monitoring”

Accurate assessment of a child’s health is critical for appropriate allocation of medical resources and timely delivery of healthcare in both primary care (GP consultations) and secondary care (ED consultations). Serious illnesses such as meningitis and pneumonia account for 20% of deaths in childhood and require early recognition and treatment in order to maximize the chances of survival of affected children. Due to time constraints, poorly defined normal ranges, difficulty in achieving accurate readings and the difficulties faced by clinicians in interpreting combinations of vital signs, vital signs are rarely measured in primary care and their utility is limited in emergency departments. This thesis aims to develop a monitoring and data fusion system, to be used in both primary care and emergency department settings during the initial assessment of children suspected of having a serious infection. The proposed system relies on the photoplethysmogram (PPG) which is routinely recorded in different clinical settings with a pulse oximeter using a small finger probe. The most difficult vital sign to measure accurately is respiratory rate which has been found to be predictive of serious infection. An automated method is developed to estimate the respiratory rate from the PPG waveform using both the amplitude modulation caused by changes in thoracic pressure during the respiratory cycle and the phenomenon of respiratory sinus arrhythmia, the heart rate variability associated with respiration. The performance of such automated methods deteriorates when monitoring children as a result of frequent motion artefact. A method is developed that automatically identifies high-quality PPG segments mitigating the effects of motion on the estimation of respiratory rate. In the final part of the thesis, the four vital signs (heart rate, temperature, oxygen saturation and respiratory rate) are combined using a probabilistic framework to provide a novelty score for ranking various diagnostic groups, and predicting the severity of infection in two independent data sets from two different clinical settings.

Modern intelligent monitoring systems use digital computer technology to analyze and evaluate physiological vital signs. This analytical and evaluative process is performed by algorithms developed for this purpose. The degree of 'intelligence' of the monitoring system is dependent on the 'sensitivity' and 'specificity' of these algorithms. In order to develop robust and clinically valid algorithms, a database of representative waveforms is required. The aim of this thesis was to create a neonatal vital signs database to be used for this purpose, by means of a computer-based central station. The computer was interfaced to a number of neonatal monitors (Neonatal ICU, Groote Schuur Hospital). The monitors were interrogated to obtain patient condition, ECG waveforms and respiration waveforms using the impedance technique. When possible, percentage oxygen saturation was also captured. The database contains 509 documented clinical records obtained from 35 patients and 20 records containing examples of technical alarm conditions and high frequency noise. Additional patient record data is included. Clinical events recorded include apnoea, bradycardia, periodic breathing tachycardia, tachypnoea and normal traces. These events were recorded against a variety of signal quality conditions that have been characterized in Appendix C. A prototype rate detection algorithm was checked using samples from the database.

This thesis presents a new system of monitoring human motion and muscle activity concurrently, in pervasive and uncontrolled environments, for prolonged periods of time. Current technologies such as optical based motion tracking and electromyography (EMG) are considered the gold standard, but have limited use outside of a controlled laboratory environment. Restraints on collection durations, due to temporary sensors, as well as a limited collection space in which monitoring is capable, results in a constrained system which is not suitable for prolonged observation. Using a custom made inertial measurement unit (IMU) and mechanomyography (MMG) sensor, information from both motion and muscle activity was combined, in order to better understand human activity by allowing prolonged collection in unrestricted environments. IMU and MMG measurements have been compared to standard optical tracking and EMG measurements, demonstrating the viability of this technology in a clinical setting and particularly in the natural environment. This novel sensor is lightweight, inexpensive, low power, wireless, easy to use, gives results comparable to standard laboratory techniques, and is able to monitor motion and muscle activity over long periods of time. This work shows a strong agreement with the current literature on MMG response to increments of force, and a greater sensitivity to muscular fatigue detection when compared against EMG, all through pervasive studies. Using machine learning and pattern recognition methods, gait analysis and detection of progressive change over time was achieved in typical and atypical conditions, over prolonged periods. Finally, this work has shown applicable use in prosthesis control and gesture switching. Outside of muscle monitoring, alternative uses have been established, with preliminary results showing a suitable use in foetal monitoring. This work establishes a novel method of human motion and muscle monitoring which produces a suitably high accuracy when compared against the gold standard, however, without the limitations which confine the wearer to a finite space or limited duration time. The studies presented here introduce a number of areas in which prolonged and pervasive collection can expand this field, while producing complementary results against laboratory based technology.

Globally, population numbers are growing, and the lifespan of the elderly is increasing. Therefore, this phenomenon requires that society commit more money, facilities, and staff for health care. The Internet of Things (IoT) can be employed to cover the financial shortfall in healthcare resources by using sensors for remote health monitoring such as the Shimmer device. The Shimmer physiological sensor is a Bluetooth-enabled radio device designed and used for monitoring various human health conditions. Using a sufficient number of the Shimmer devices with proper sampling rate can affect the provision of health and related information in realtime. Moreover, this type of sensor can sometimes be attached to the human body, which can create an inference between the sensors and the human body. The high-noise environment may also impact the sensor. This thesis reviews and analyses several scenarios in which Shimmer devices can be used by medical practitioners to offer reliable physiological measurements, such as ECG and movement. This study found that the Shimmers device can provide reliable data by using a specific configuration when the maximum number of sensors participate in a piconet network.

Thesis (MScEng (Mechanical and Mechatronic Engineering))--Stellenbosch University, 2008.
This thesis is concerned with the development and testing of a non-invasive device that is unassailable, and can be placed on an aggressive psychiatric patient to monitor the vital signs of this patient. Two devices, a glove measuring oxygen saturation and another on the dorsal part (back) of the patient measuring heart rate via electrocardiography (ECG), skin temperature and respiratory rate were designed and implemented. The data is transmitted using wireless technology. Both devices connect to one central monitoring station using two separate Bluetooth connections ensuring a total wireless setup. All the hardware and software to measure these variables have been designed and implemented. A Matlab graphical user interface (GUI) was developed for signal processing and monitoring of the vital signs of the psychiatric patient. Detection algorithms were implemented to detect ECG arrhythmias such as premature ventricular contraction and atrial fibrillation. The prototype was manufactured and tested in a laboratory setting on five volunteers. Satisfactory test results were obtained and the primary objectives of the thesis were fulfilled

Mestrado em Engenharia de Computadores e Telemática
The daily life in modern societies has a high impact in individuals. Long-term stress, changes, traumas and life experiences are some of environmental factors that lead to the development of anxiety disorders. Anxiety disorders affects many people in their daily lives, since they may lead to social isolation, clinical depression, and can impair a person’s ability to work, study and routine activities. Nevertheless, there are many effective therapies available for such disease, sufferers do not seek for treatment, because they underestimate the problem, the treatments duration, cost or difficult in access. In result, it is of the utmost importance that researchers can recreate, as accurately as possible, real life conditions in psychological studies. However, that is not always possible. Recent improvements in sensors technology make then a straightforward solution to gather physiological data. However, their standalone use is quite limited. Nevertheless, combining those sensors with a Smartphone creates an independent solution that without any more requirements has an enormous potential, due to the advanced computing power and connectivity features available. In this dissertation it is proposed the BeMonitored, a Smartphone based solution to support more ecological valid monitoring of psychological experiments. BeMonitored delivers customizable specific context dependent audio-visual stimuli and using external resources connected via Bluetooth or Smartphone own resources (camera, gps), is able to capture the subject’s behavior, physiology and environment. As a proof of concept, BeMonitored was tested in a spider phobia population, where it was found that spider phobic was separated from control subjects using solely the face motion captured with the Smartphone camera. Also, heart rate differences were found between spider and neutral stimuli. Although current study focused only on spider phobia, the results support the validity and the potential of using BeMonitored in other phobias related, especially in cognitive behavioral therapy (CBT) scenarios, either for assessment of the phobia “stage” or to deliver a stepwise sequence of video stimuli according to accepted psychology guidelines.
O dia a dia nas sociedades modernas, tem um grande impacto nos indivíduos. O stress continuado, mudanças, traumas e as experiências de vida, são alguns dos fatores ambientais que potenciam o desenvolvimento de doenças de ansiedade. Este tipo de doenças podem conduzir ao isolamento social, a depressões, à diminuição da capacidade de trabalhar, estudar ou executar tarefas do quotidiano. Apesar de existirem inúmeras terapias eficazes no tratamento deste tipo de doenças, os sofredores, não procuram tratamento, ou por desvalorizarem o problema, ou devido à duração e custo associado ou pelo difícil acesso. Deste modo, é da extrema importância que os investigadores consigam recriar as condições da vida real no estudo de doenças do foro psicológico.Contudo, tal nem sempre é possível. As recentes evoluções ao nível dos sensores biomédicos fazem deles uma solução simples para adquirir sinais biológicos. Contudo, o seu uso isolado é de certa forma limitado. Por outro lado, combinando estes sensores com um Smartphone, criamos uma solução independente, com enorme potencial, devido ao avançado poder computacional e conectividade destes dispositivos. Nesta dissertação propomos o sistema BeMonitored: uma solução baseada em Smartphone para suportar um estudo ecologicamente válido a nível da monitorização de doenças do foro psicológico. BeMonitored é uma solução que permite expor os sujeitos a um estímulo audiovisual configurável, que usando sensores biomédicos ligados por Bluetooth ao Smartphone, juntamente com os seus recursos de hardware (ex: câmera, GPS), é capaz de adquirir o comportamento e a fisiologia dos sujeitos, bem como o contexto envolvente. Como prova de conceito, o BeMonitored foi testado num estudo de fobia a aranhas, onde foi possível obter resultados que nos permitem separar os sujeitos fóbicos dos sujeitos de controlo usando apenas o movimento facial capturado com a camara do smartphone. Encontraram-se também diferenças na frequência cardiaca entre os segmentos de vídeo com aranhas e neutros. Apesar do estudo ser focado nas fobias a aranhas, os resultados obtidos confirmam a validade e o potencial de utilização do BeMonitored em outras fobias, bem como em cenários de terapia cognitivo-comportamental(CBT), quer para a avaliação do nível de fobia quer na exposição gradual de estímulos de video de acordo com as directizes aceites na área da psicologia.

Nowadays, Point-of-Care (PoC) are making a shifting of the classical medical procedures and treatment protocols, enhancing the performance of medical surveillance in all the world. It is a reliable and very cost-effective solution, specially in mid to low income countries and areas where access to specialized clinical laboratories is very restricted. However, there are several operational challenges and technical issues that must be addressed when aiming for a clinical system based on PoC devices health surveillance, decentralized patient self-testing and centralized data management for devices, pathologies treatment and patient monitoring improvement. The aim of this research is to design, fabricate and test a novel device / technology for PoC instantaneous screening and monitoring of cellular species, to address these issues and add new functionalities to existing devices to create Lab-on-a-Chip devices. The technique used to cellular monitoring is based on direct measurement from samples by means of its inherent electrical impedance, in order to overcome the operational challenges present on the actual PoC devices on the market. The state of the art of PoC devices have been analysed to study their strengths and weakness, and determine the necessary improvements. This is, the development of instrumentation electronics, sensing systems as well as design protocols for truly PoC devices, relying on straight forward standards for economic, low power consumption, versatile, safe and reliable devices. The development of such technologies and devices is entailed to the evolution of these systems as implantable LOC devices for in vivo continuous monitoring of the patients. In this case, the development of simplified low-power electronics and sensing systems, leads to its miniaturization and integration in a single microchip with multiple functionalities. A discrete bench-top system for IA have been designed, fabricated and tested. The design and validation of different instrumentation electronics and sensing systems is presented, as well as design protocols for truly PoC devices. The device has been designed to perform an Impedance Spectrometry (IS) experiment in order to validate the whole device electronics as well as to characterize the sensing system and its interface accurately. A first approach to a portable and compact device for PoC early instantaneous detection of anaemia, relying on hematocrit (HCT) screening, is described. This device has been designed to work directly with fresh whole blood samples. An experimental set-up and protocol of operation have been defined for instant impedance detection to determine the system detection accuracy, sensitivity and coefficient of variation. As you will notice, the device has been developed using prototyping tools from National Instruments for fast development and validation, as well as application functionalities. Moreover, the possibilities of the integration of this technology within other devices, for increased functionalities, have been validated. The experiments were carried out with different instrumentations front-end as well as different sensing systems typologies, and the same back-end electronics for signal processing and system control. The analysed samples and its environment were dramatically different: laboratory sample formed by E. coli 5K strains working as a monitoring functionality of a DEP-enhanced concentrator for automated detection and concentration of bacteriological species. Finally, it has been developed a specific PoC device for HCT detection and validated through a clinical assessment with whole blood samples. The design is based in the previously presented device’s electronic instrumentation and sensing system with the addition of an economic and low power back-end solution. A clinical study has been performed and the results obtained during the experimental procedures are shown, analysed and discussed. We summarize the conclusions obtained after this research and recommend future developments that could be done to develop truly last generation PoC devices and integrated LOC single-chip devices.
L’objectiu de la tesi és la realització d’equipaments electrònics per aplicacions biomèdiques de caràcter Poin-of-Care en entorns d’investigació, control i tractament clínic. Aquest projecte es troba en el marc de les activitats de recerca del grup, on el desenvolupament d’electròniques d’interface amb el mon biomèdic i la recerca de noves tecnologies i aplicacions d’instrumentació són unes de les principals tasques que porten a terme. Donades aquestes consideracions, a l’últim any s’ha definit un camí dintre dels sistemes d’instrumentació PoC orientats al control d’agents biològics cel·lulars amb tècniques d’anàlisi d’impedància. Aquests dispositius estan basats en dos conceptes claus: el disseny d’instrumentació electrònica senzilla, econòmica i de baix consum, així com sistemes de sensat versàtils i d’un sol us. D’aquesta manera, és possible desenvolupar equipaments versàtils, portables i de baix cost que poden aportar gran rendiment en diferents camps de la biomedicina. Amb aquestes premisses, s’ha desenvolupat un equipament d’anàlisi d’impedància independent del sistema de sensat, el que comporta la possibilitat d’utilitzar multitud de tipus de sistemes de sensat. Aquest equipament, consta d’una senzilla instrumentació electrònica basada en un sistema de sensat preparat per diferents tipus de sensors, tot controlat per un microprocessador encarregat del control automatitzat del hardware, post-processat de dades i comunicació amb un ordinador remot. El sistema és capaç de treballar en un rang de freqüències molt ampli, amb diferent tipus de potència de senyal i diferent tipus d’anàlisi i representació, com ara Electrochemical Impedance Spectroscopy (EIS) amb representació amb diagrames de Bode i Nyquist, o la selecció de punts de freqüencials concrets per un tipus d’anàlisi més específic per a un experiment biomèdic més concret, senzill i ràpid. Es tracta d’un equipament econòmic, fiable i senzill per l’anàlisi d’hematòcrit, que aporta avenços com la gran capacitat d’integració en ambients clínics, la possibilitat de fer un control medico sanitari instantani i reportar telemàticament els resultats o la possibilitat d’implementar un sistema de control mèdic integrat i automatitzat.

We have assessed the introduction of a commercially available computerised physiological trend monitoring network into a neonatal intensive care area. The attitudes of staff and parents were on the whole favourable, with the majority feeling that infant care benefited from the introduction of computers. A detailed study of the effects of computerised physiological monitoring on patient outcome in both short and medium term, showed no significant benefits. The computers improved both the quality and accuracy of the stored infant physiological data. Artefact was predominantly predictable; it could be ignored in real time trends and removed from recorded data prior to statistical analysis. Neonatalogy is a relatively new science, and a continuously expanding physiological data source could help to improve patient care through research. Three areas were explored: (a) Reference blood pressures ranges were established for very low birth weight infants, using more detailed information on a larger group of infants than previously possible. (b) Infants with retinopathy of prematurity compared to those without the disease, did not differ significantly in the amount of time they spent with a continuously monitored transcutaneous oxygen greater than 12 kPa. (c) Previously undescribed blood pressure waves were identified. Associated with hypoxia, they may help improve understanding of fetal autonomic development. Although unable to demonstrate an improvement in patient outcome resulting from the introduction of a computerised physiological network (possibly due to poor outcome measurements), we have demonstrated improved staff confidence, better physiological record and the opportunity for improvement in care through research.

This thesis examined the benefits of physiological and performance testing of elite swimmers. The study considered the following research questions: the degree to which physiological and performance measures in training contribute to swimming performance; sources and magnitude of variability in testing, training and competition performance; the magnitudes of changes in test measures during routine training; and the reliability, validity and utility of miniaturised and automated smart sensor technology to monitor the stroke and performance times of swimmers in training. The experimental approach involved the retrospective analysis of five years of physiological and performance testing of elite level swimmers, the development of a new accelerometry-based smart sensor device to monitor swimmers in the pool, a cross-sectional study comparing the physiological and performance responses of swimmers of different levels, and the effects of an intensive 14-day training program on submaximal physiological and performance measures. Collectively, the outcomes of these studies provide a strong justification for the physiological and performance testing of elite swimmers, a quantitative framework for interpreting the magnitude of changes and differences in test scores and sources of variation, and highlight the potential utility of new smart sensor technology to automate the monitoring of a swimmer�s training performance. The first study (Chapter 2) characterises the changes and variability in test performance, physiological and anthropometric measures, and stroke mechanics of swimmers within and between seasons over their elite competitive career. Forty elite swimmers (24 male, 16 female) performed a 7 x 200-m incremental swimming step test several times each 6-month season (10 � 5 tests, spanning 0.5 to 6.0 y). Mixed linear modeling provided estimates of change in the mean and individual responses for measures based on submaximal performance (fixed 4-mM lactate), maximal performance (the seventh step), and lean mass (from skinfolds and body mass). Submaximal and maximal swim speed increased within each season from the pre to taper phase by ~2.2% for females and ~1.5% for males (95% confidence limits �1.0%), with variable contributions from stroke rate and stroke length. Most of the gains in speed were lost in the off-season, leaving a net average annual improvement of ~1.0% for females and ~0.6% for males (�1.0%). For submaximal and maximal speed, individual variation between phases was �2.2% and the typical measurement error was �0.8%. In conclusion, step test and anthropometric measures can be used to confidently monitor progressions in swimmers in an elite training program within and between seasons. The second study (Chapter 3) quantified the relationship between changes in test measures and changes in competition performance for individual elite swimmers. The primary question addressed was whether test measures could predict a swimmers performance at the major end-of-season competition. The same sample group as in Study 1 was examined. A 7 x 200-m incremental swimming step-test and anthropometry were conducted in up to four training phases each season. Correlations of changes in step-test and anthropometric measures between training phases between and within seasons, with changes in competition performance between seasons, were derived by repeated-measures mixed modeling and linear regression. Changes in competition performance were best tracked by changes in test measures between taper phases. The best single predictor of competition performance was skinfolds for females (r = -0.53). The best predictor from the step-test was stroke rate at 4-mM lactate (females, r = 0.46; males, r = 0.41); inclusion of the second-best step-test predictor in a multiple linear regression improved the correlations marginally (females, r =0.52 with speed in the seventh step included; males, r = 0.58 with peak lactate concentration included). Changes in test measures involving phases other than the taper provided weak and inconclusive correlations with changes in performance, possibly because the coaches and swimmers took corrective action when tests produced poor results. In conclusion, a combination of fitness and techniques factors are important for competitive performance. The step test is apparently a useful adjunct in a swimmer�s training preparation for tracking large changes in performance. These initial studies identified stroke mechanics as a major determinant of a swimmer�s performance. Chapter 4 details the development of a small tri-axial accelerometry-based smart sensor device (the Traqua) that enables continual monitoring of various performance/stroke characteristics in swimming. The initial focus was to develop a device that automated the detection of a swimmer�s movements, specifically lap times, stroke rate and stroke count. The Traqua consists of a tri-axial accelerometer packaged with a microprocessor, which attaches to the swimmer at the pelvis to monitor their whole body movements while swimming. This study established the failure/error rate in the first generation algorithms developed to detect the swimming-specific movements of stroke identification, laps (start, turn and finish), and strokes (stroke count and stroke rate) in a cohort of 21 elite and sub-elite swimmers. Movements were analysed across a range of swimming speeds for both freestyle and breaststroke. These initial algorithms were reasonably successful in correctly identifying the markers representing specific segments of a swimming lap in a range of swimmers across a spectrum of swimming speeds. The first iteration of the freestyle algorithm produced error-rates of 13% in detection of lap times, 5% for stroke rate, and 11% for stroke count. Subsequent improvements of the software reduced the error rate in lap and stroke detection. This improved software was used in the following two studies. The next study (Chapter 5) evaluated the reliability and validity of the Traqua against contemporary methods used for timing, stroke rate and stroke count determination. The subjects were 14 elite and 10 sub-elite club-level swimmers. Each swimmer was required to swim seven evenly paced 200-m efforts on a 5-min cycle, graded from easy to maximal. Swimmers completed the test using their main competitive stroke (21 freestyle, 3 breaststroke). Timing was compared for each 50-m lap and total 200-m time by electronic touch pads, video coding, a hand-held manual stopwatch, and the Traqua. Stroke count was compared for video coding, self-reported counting, and the Traqua, while the stroke rate was compared via video coding, hand-held stopwatch, and the Traqua. Retest trials were conducted under the same conditions 7 d following the first test. All data from the Traqua presented in this and the subsequent studies were visually inspected for errors in the automated algorithms, where the algorithms had either failed to correctly identify the start, turn, finish or individual strokes and corrected prior to analysis. The standard error of the estimate for each of the timing methods for total 200 m was compared with the criterion electronic timing. These standard errors were as follows: Traqua (0.64 s; 90% confidence limits 0.60 � 0.69 s), Video (0.52 s; 0.49 � 0.55 s); Manual (0.63 s; 0.59 � 0.67 s). Broken down by 50-m laps, the standard error of the estimate for the Traqua compared with the electronic timing for freestyle only was: 1st 50-m 0.35 s; 2nd and 3rd 50-m 0.13 s; 4th 50-m 0.65 s. When compared with the criterion video-coding determination, the error for the stroke count was substantially lower for the Traqua (0.6 strokes.50 m-1; 0.5 � 0.6 strokes.50 m-1) compared to the self-reported measure (2.3 strokes.50 m-1; 2.5 � 2.9 strokes.50 m-1). However, the error for stroke rate was similar between the Traqua (1.5 strokes.min-1; 1.4 � 1.6 strokes.min-1) and the manual stopwatch (1.8 strokes.min-1; 1.7 � 1.9 strokes.min-1). The typical error of measurement of the Traqua was 1.99 s for 200-m time, 1.1 strokes.min-1 for stroke rate, and 1.1 strokes.50 m-1 for stroke count. In conclusion, the Traqua is comparable in accuracy to current methods for determining time and stroke rate, and better than current methods for stroke count. A substantial source of error in the Traqua timing was additional noise in the detection of the start and finish. The Traqua is probably useful for monitoring of routine training but electronic timing and video are preferred for racing and time trials. Having established the reliability and validity of the Traqua, Chapter 6 addressed the ability to discriminate the pattern of pacing between different levels of swimmers in the 7 x 200-m incremental step test. This study also sought to quantify the differences in pacing between senior and junior swimmers. Eleven senior elite swimmers (5 female, 6 male) and 10 competitive junior swimmers (3 female, 7 male) participated in this study. Each swimmer was required to swim seven evenly paced 200-m freestyle efforts on a 5-min cycle, graded from easy to maximal. The Traqua was used to measure time, stroke rate and stroke count. The senior swimmers were better able to descend in each of the 200-m efforts. Overall the senior swimmers were ~2-3 s per 50 m faster than the junior swimmers. Both groups were fastest in the first 50-m lap with the push start. The senior swimmers then descended the 50- m time for each of the subsequent laps, getting ~0.5 s faster per lap, with the final lap the fastest. In contrast, the junior swimmers swam a similar time for each of the subsequent laps. The junior swimmers were marginally more variable in their times (coefficient of variation: ~2%) compared with the senior swimmers (~1.8%). In comparison to junior swimmers, the senior swimmers in this study were faster, adopted a more uniform negative split strategy to pacing within a 200-m effort, and were more consistent in reproducing submaximal and maximal swimming speeds. The final study (Chapter 7) analysed the effect of 14-d of intensive training on the reproducibility of submaximal swimming performance in elite swimmers. Submaximal physiological and performance testing is widely used in swimming and other individual sports but the variability in test measures, and the effects of fatigue, during intensive training have surprisingly not been quantified systematically. Seven elite swimmers (3 male and 4 female) participated in an intensive 14-d training camp one month prior to the National championships. The aim of the study was to characterise the intra-session, daily and training block variability of submaximal swimming time, physiological and stroke characteristics in elite swimmers. The swimmers performed a specified submaximal 200-m effort in most sessions, after the warm-up and at the end of the session for both morning and afternoon sessions. During the efforts, swimming time and stroke mechanics were measured and physiological measures were recorded immediately on completion. The Traqua was worn by all swimmers in every training session. Mixed linear modeling was used to provide estimates of changes in the mean and individual responses (within-athlete variation as a coefficient of variation) for all measures. The swimmers were moderately slower (1.4%; �1.4%) over the 14-d training camp. The mean submaximal 200-m effort was very likely to be faster (0.7%; confidence limits �0.7%) in the afternoon compared with the morning session. The females were more variable in their submaximal performance times (CV=2.6%) than the male swimmers (1.7%). Blood lactate concentration was almost certainly lower (-23%; �10%) following higher volume in the previous session; however a higher intensity workout the previous session almost certainly leads to higher lactate (21%; �15%) in the current session. Considered together, these results indicate that the 200-m submaximal test is useful in monitoring submaximal physiological and performance measures and the negative effects of cumulative fatigue. In conclusion, changes in the physiological and performance measures derived from the poolbased progressive incremental step test are moderately correlated with changes in end-ofviii. season competition performance. The magnitudes of changes and differences in test measures between phases within a season, from season to season, and between males and females, established in this study can be applied to similar elite level swimmers preparing for major competition. The quantification of typical error of the same measures demonstrates that coaches and scientists can distinguish real and worthwhile improvements using the 7 x 200-m step test. Continual pool-based monitoring with the automated smart sensor Traqua device may provide more accurate and detailed information about a swimmer�s training adaptation than current fitness tests and monitoring methods. Finally, submaximal testing in trained swimmers is useful in monitoring progress in physiological and performance measures, and the impact of cumulative fatigue during an intensive period of training. Collectively, the outcomes of these studies indicate that routine physiological and performance testing can provide measurable benefits for elite swimmers and their coaches.

The use of optical methods for performing non-invasive physiological and biochemical monitoring has been investigated, with particular emphasis on the application of near-infrared spectrophotocetry for following changes in the redox state of cytochrome oxidase. Initial studies of the gross optical properties of in vivo tissue were made using an image intensifier. These demonstrated that some light is transmitted through biological tissues and that such material is very highly scattering. In order to investigate the feasibiity of non-invasively monitoring changes in the redox state of cytochrome oxidase in vivo. spectrophotometric and oxygen measurements were made on solutions containing the pure enzyme and yeast cell suspensions. These demonstrated the high affinity that the enzyme has for oxygen in such preparations, in contrast to the much lower apparent affinities in vivo that have been reported. These results were then modelled mathematically, and a possible-explanation for this anomaly suggested. Potential problems with applying this method are also presented. The interest in cytochrome oxidase is due to its importance in oxidative metabolism. However in performing this role it also assists in the prevention of oxidative damage, whose contribution to various disease states in paediatrics is briefly considered. Two instruments were also constructed, and used, firstly to measure the spectral characteristics of transmitted and reflected light in vivo. ana secondly to study the cardiac synchronous pulsatile component of this light (commonly referred to as the photoplethysmogram).

Tissue oxygen tension (tPO2) reflects the balance between local oxygen supply and demand and could thus be a useful monitoring modality. However, both the consistency and amplitude of the tPO2 response in different organs during varied cardiorespiratory insults is unknown. Using an anaesthetised rat model I investigated the effects of endotoxaemia, progressive haemorrhage and acute hypoxaemia on tPO2 measured in deep (liver and renal cortex) and peripheral (skeletal muscle and bladder) organ beds. Different patterns were seen in each of the shock states with conditionspecific variations in the degree of acidaemia, lactataemia, and tissue oxygen responses between organs. Endotoxaemia resulted in a rise in bladder tPO2, an early fall in muscle and liver tPO2 but no significant change in renal cortical tPO2. In a more severe model of endotoxaemic sepsis, different patterns were seen between cortical and outer medullary oxygenation, and the intra/extravascular compartments of the kidney. Progressive haemorrhage however produced proportional falls in liver, muscle and bladder tPO2 but renal cortical tPO2 was maintained until profound blood loss had occurred. Administration of high inspired oxygen concentrations initially increased tissue PO2 although this fell with continued blood loss. By contrast, acute hypoxaemia and hyperoxaemia induced proportional changes in tPO2 in all organ beds. Tissue PO2 monitoring in a long-term sepsis model revealed a fall in global oxygen delivery during early sepsis (6h) with concurrent decreases in muscle, liver and renal cortical tissue PO2. Myocardial function was severely compromised at this timepoint, due largely to hypovolaemia despite concurrent background fluid resuscitation. Furthermore, fluid loading and an oxygen challenge test revealed discordance between the macro- and microcirculation, likely contributing to the oxygen supply-demand imbalance. By contrast, during established sepsis (24h), tissue oxygen tensions normalised with an improvement in myocardial and circulatory function. However, at this timepoint there was evidence of ill health, continued hyperlactataemia and organ failure, thus highlighting the complexity of this particular disease state. Taken together, these studies highlight the heterogeneity of responses in different organ beds during varied shock states. This likely relates to local changes in oxygen supply and utilisation. They also challenge the traditional paradigm that a fall in global oxygen delivery by whatever means has a similar response at the organ level. Furthermore, it highlights the particular sensitivity and/or adaptation of some organs to specific insults. Consequently, the baseline tissue oxygen tension in peripheral organ beds does not necessarily mimic that observed in deeper, vital organs. However, if combined with a dynamic challenge (e.g. an oxygen challenge test), these differences can be unmasked, thus highlighting the potential utility of this monitoring device in clinical practice.

Measuring physiological parameters or vital sign using camera has become popular in recent years. Contact-less monitoring and extraction of vital signs can be important source of information in situations like medical care system and safety control system. This paper presents the implementation of real-time, non-contact method for extraction of vital signs, heart rate in this case. A better face tracking method is used for efficient face detection. This study extends some of the previous works done and have a comparison study with several methods. The developed system used filtering with window over the green channel of the signal and then Converted to frequency domain to analyze the signal to detect heart rate. The developed system achieved high correlation and showed small error while referencing with actual heart signal from ECG. This method delivers better result in better light condition but gives fairly good result on lower light as well.

Monitoring mobility at home and in the community, and understanding the environment and context in which mobility occurred, is essential for rehabilitation medicine. This thesis introduces a Wearable Mobility Monitoring System (WMMS) for objective measurement of community mobility. This prototype WMMS was created using a smartphone-based approach that allowed for an all-in-one WMMS. The wearable system is worn freely on a person's belt, like a normal phone. The WMMS was designed to monitor a user's mobility state and to take a photograph when a change-of-state was detected. These photographs are used to identify the context of mobility events (i.e., using an elevator, walking up/down stairs, type of walking surface). Mobility evaluation using the proposed WMMS was performed on five able-bodied subjects. System performance for detecting changes-of-state and the ability to identify context from the photographs was analyzed. The WMMS demonstrated good potential for community mobility monitoring.

The high incidence of pulmonary disease in critically ill patients necessitates new and improved techniques for pulmonary monitoring and thoracic imaging. To investigate pulmonary monitoring techniques using pressure and flow signals, I developed a comprehensive computational model of subjects breathing spontaneously or with the support of an assist-ventilator. The model was used to quantitatively assess measurement techniques for dynamic intrinsic positive end-expiratory pressure (PEEP$ rm sb{i})$ and inspiratory work of breathing. The results demonstrate that some means of correction for both expiratory muscle activity and cardiogenic oscillations on esophageal pressure is necessary if dynamic PEEP$ rm sb{i}$ and work of breathing are to be measured accurately on-line. I also conclude that the discrepancies between static and dynamic PEEP$ rm sb{i}$ are caused by heterogeneity of the expiratory flow limitation. An adaptive filter to reduce the cardiogenic oscillations on esophageal pressure was developed and validated in a computer simulation. In four intensive care patients, the adaptive filter markedly attenuated the apparent cardiogenic oscillations and reduced the standard deviation of the measured PEEP$ rm sb{i}$ by 57%. Investigation of the interactions between patients and a pressure support ventilator using the computer model confirmed our present understanding of patient-ventilator asynchrony and indicated that patient and ventilator form a highly nonlinear dynamic system, so that the optimal ventilator settings most likely vary between patients and with time. In the second part of this thesis, I investigated the importance of inaccuracies in conventional Finite Elements for thoracic Electrical Impedance Tomography (EIT) imaging. Augmenting the number of first-order Finite Elements did not efficiently reduce these inaccuracies. A computer simulation suggested that the accuracy of the forward solution needs to be improved by at least 30 dB before useful

This mixed-method study investigated the effects of self-directed physiological monitoring on therapists anxiety. Ten therapists participated in a10-week physiological monitoring training sessions while monitoring respiratory sinus arrhythmia (RSA) and heart rate variability (HRV). The participants completed the state-trait anxiety inventory questionnaire after having a first, sixth, or tenth therapy session with a client. This was designed to monitor their state anxiety while working with clients. A series of paired sampled t-tests was conducted to assess changes in HRV, RSA, trait anxiety, and state anxiety. One significant result was found: the RSA of the therapist increased significantly. Correlations existed between the HRV of the therapist increasing and the trait anxiety of the therapist decreasing through RSA training sessions although they were not significant at the .05 level.

Intensive Care Units (ICUs) host patients in critical condition who are being monitored by sensors which measure their vital signs. These vital signs carry information about a patient’s physiology and can have a very rich structure at fine resolution levels. The task of analysing these biosignals for the purposes of monitoring a patient’s physiology is referred to as physiological condition monitoring. Physiological condition monitoring of patients in ICUs is of critical importance as their health is subject to a number of events of interest. For the purposes of this thesis, the overall task of physiological condition monitoring is decomposed into the sub-tasks of modelling a patient’s physiology a) under the effect of physiological or artifactual events and b) under the effect of drug administration. The first sub-task is concerned with modelling artifact (such as the taking of blood samples, suction events etc.), and physiological episodes (such as bradycardia), while the second sub-task is focussed on modelling the effect of drug administration on a patient’s physiology. The first contribution of this thesis is the formulation, development and validation of the Discriminative Switching Linear Dynamical System (DSLDS) for the first sub-task. The DSLDS is a discriminative model which identifies the state-of-health of a patient given their observed vital signs using a discriminative probabilistic classifier, and then infers their underlying physiological values conditioned on this status. It is demonstrated on two real-world datasets that the DSLDS is able to outperform an alternative, generative approach in most cases of interest, and that an a-mixture of the two models achieves higher performance than either of the two models separately. The second contribution of this thesis is the formulation, development and validation of the Input-Output Non-Linear Dynamical System (IO-NLDS) for the second sub-task. The IO-NLDS is a non-linear dynamical system for modelling the effect of drug infusions on the vital signs of patients. More specifically, in this thesis the focus is on modelling the effect of the widely used anaesthetic drug Propofol on a patient’s monitored depth of anaesthesia and haemodynamics. A comparison of the IO-NLDS with a model derived from the Pharmacokinetics/Pharmacodynamics (PK/PD) literature on a real-world dataset shows that significant improvements in predictive performance can be provided without requiring the incorporation of expert physiological knowledge.

Master of Science
Department of Electrical and Computer Engineering
Steven Warren
The continuous and autonomous real-time monitoring of cattle state of health can provide major benefits for the U.S. livestock industry and lead to a higher quality beef product. Complete real-time monitoring could not only lead to earlier detection of disease in individual animals and reduce the spread of disease to a larger herd, but it could ultimately reduce the cost and frequency of on-site veterinary consultations. This thesis details a wearable device that is mounted on cattle to collect data from a network of internal and external sensors. In addition to the basic data collection, this thesis will describe the infrastructure to communicate these data sets to a central database for permanent storage and future analysis. Physiological, ambient environment, and physical activity data are acquired by the various sensors to give a good indication of the state of health of an animal wearing the device. The communication of data from internal sensors to an external wearable receiver is of particular interest since tissue is not an ideal medium for radio-frequency data transmission. Past research has attempted to use such links with little success due to large signal attenuation at high frequencies and a package that becomes much too large to be usable at low frequencies. As a result, a wireless communications method employing magnetic inductance at relatively low frequencies over short distances is described here.

Long-term clinical success of total hip replacement surgery is dependent on initial implant stability. For noncemented, porous coated implants in particular, initial stability is essential for fixation by bone ingrowth to occur. A method for evaluating initial stability by quantifying relative implant-bone micromotion has been developed. Based on the assumption that transverse sections of the implant are rigid bodies, the technique measured motion at proximal and distal sites, two clinically relevant regions of an implant. Mathematical transformations derived from measurements obtained by a series of linear displacement transducers were used to determine the three-dimensional displacement vector of any point on the plane. This method was successful in assessing stability of two different implants under physiological loading using either synthetic or cadaveric femora and different surgical protocols for the preparation of the intramedullary canal. The displacements of points at the implant-bone interface for both permanent and recoverable micromotion were obtained. This method may be of use in evaluating new implants and the effect on stability of alternative surgical protocols.

Anterior cruciate ligament (ACL) injuries are one of most common musculoskeletal injuries and negatively affect mobility and quality of life. ACL rupture requires reconstruction to repair ligament at an estimated cost of $1.5 billion/year. Current surgical solutions invariably involve either donor site morbidity with the use of autografts or the risk of disease transmission and immune rejection with the use of allografts. Successful reconstruction requires the presence of an intact interface between ligament and bone, a transitional tissue called the enthesis. The enthesis is critical for the safe and effective transfer of force from the stiff bone to the more compliant ligament by providing a gradual transition of mechanical and biochemical properties to prevent the formation of stress concentrations. A tissue engineered ligament containing mature entheses is a promising alternative to autografts and allografts, especially since this interface does not normally regenerate. Toward this end, this dissertation sought to improve engineered fibrin-based bone-to-bone ligaments previously developed by our lab and to demonstrate their utility in understanding physiological processes through three specific aims: 1) optimize the environment for in vitro ligament function, 2) induce the formation of a fibrocartilaginous interface, and 3) demonstrate the utility of engineered ligaments as a physiological model.

In Aim 1, the in vitro culture environment was investigated for engineered ligaments formed using human ACL fibroblasts. Using a DOE approach, we identified significant effects and interactions of soluble factors on the maximal tensile load (MTL) and collagen content of engineered human ACL. The DOE model was used to predict a maximal growth media which significantly improved the MTL and collagen content of engineered ligaments and can be combined with increases in the initial construct volume for 77% further improvement in MTL. In addition to the improvements in tissue function, these data suggest that a DOE approach can more efficiently optimize in vitro parameters including the dosage and timing of chemical and mechanical stimuli as well as any interactions.

Aim 2 presented two strategies to improve of the engineered enthesis. First, the local release of bone morphogenetic protein (BMP)-4 at the enthesis of engineered ligaments demonstrated improved interface strength as well as the transition of cells at the enthesis towards an unmineralized fibrocartilage phenotype. Second, engineered ligaments formed in a modular fashion improved the mechanical function and the morphology of the engineered enthesis including the development of cell and soft tissue integration into the mineral phase, a tidemark between mineralized and unmineralized tissue, and the presence of a dense band of extracellular matrix (ECM) at the soft tissue-mineral interface. Importantly, this is the first demonstration of the in vitro formation of a functional interface between engineered ligament and mineral in a complete bone-to-bone ligament unit.

Aim 3 demonstrated the use of our engineered ligament model as a physiological tool. During the estrogen surge in the menstrual cycle, there is an associated increase in the incidence of ACL ruptures as well as knee laxity. Using physiological levels of estrogen mimicking the estrogen surge in vitro, we determined that estrogen decreases the activity of the collagen crosslinker lysyl oxidase (LOX) with a subsequent decrease in tissue stiffness providing insight into why women have greater incidences of ACL rupture. We also examined the role of the exercise-induced biochemical environment on connective tissue using our in vitro model. Engineered ligaments cultured with serum obtained from human donors after exercise had significantly better mechanical strength and collagen content than those treated with serum obtained at rest. In 2D culture, we determined that this effect was likely a result of greater mTOR and ERK signaling.

In summary, the work in this dissertation has made great strides in developing a more mature engineered bone-to-bone ligament. We have optimized a growth factor environment for their in vitro culture and created the most advanced engineered enthesis to date. We have also used these engineered tissues as a platform to mechanistically study the influence of hormones on connective tissue. With further advances in our understanding of the in vivo development of ligaments and their entheses, our bone-to-bone engineered ligaments can be improved making them more suited for clinical applications and for probing physiologically processes in a more controlled environment.

An extensive review of the literature revealed that there are still significant weakness in the available technology for blood flow measurement. This dissertation describes two techniques for blood velocity measurement. The first is an invasive method which uses multimodal optical fibres for light transmission to and from a sensing tip, which attenuates the light depending upon the blood velocity. The design and construction of this flowmeter is presented and bench results shown. The modulated light is transmitted to the detection and processing circuit and provision is made for the transducer to be insensitive to pressure fluctuations and ambient light. The second technique, which is noninvasive, uses a continuous wave Doppler ultrasonic technique; the instrument designed is a portable directional Doppler velocimeter with purpose-built probes intended for monitoring blood flow in femorodistal bypass grafts in ambulatory patients. This portable unit differs from conventional Doppler units in many respect which are described. This unit has been developed in order to understand the behaviour of blood flow in grafts while the patients are persuing everyday tasks. A postoperative study of successful in situ vein grafts from 8 patients has been undertaken to determine the feasibility of the technique. This pilot study shows that posture can have an effect on blood flow in grafts, and also shows that it is possible to monitor blood velocity with Doppler techniques for a long period of time, without intervention of an operator.

The potential of selected culture parameters for characterization, quantification and elucidation of the culture physiological state in batch, fed batch and continuous cultivations of C. acetobutylicum was examined in this investigation.
The application of theoretical stoichiometric pathway models and on-line NADH fluorescence measurements proved a useful tool in an attempt to assess the intracellular redox state of the solventogenic culture under different growth conditions.
Correlations of key process parameters confirmed the importance of NADH as a regulatory substance in the cell metabolism. A solventogenic culture accumulates more NADH than that in the acidogenic phase. It features an inverse relationship between the specific butanol accumulation rate $(q sb{B})$ and the specific fluorescence (F/X). Fluorescence was also demonstrated to be a suitable control parameter for the regulation of the medium feed rate resulting in constant butanol levels in the fed batch culture.
An improved unstructured mathematical model of the culture system represented the batch acidogenic and continuous culture solventogenic metabolism. However, the culture growth lag occurring in solventogenic transient cultures could only be represented by a structured mathematical culture model which included the markers of "culture growth" (RNA) and "reductive capabilities" (NADH fluorescence) of C. acetobutylicum.

A knowledge-based expert system was developed to automatically assess the level of EEG abnormality of pediatric patients monitored in the ICU. The system receives six hours of 8-channel EEGs and classifies the background EEG as one of seven abnormality levels.
A total of 188, six-hour EEGs were visually interpreted by a neurologist and used as training examples. Spectral band activity was computed; artifacts were rejected using a median filter with a hard-limiter. Quantitative variables reflecting amplitude, symmetry, Front/Back differentiation and time variability were then extracted based on the study of Pasupathy (1994). Relationships between quantitative measures and the neurologist's assessment of amplitude, symmetry and Front/Back differentiation were established. A two-layer neural network having the measures of EEG variability as input was created for variability evaluation. A single-layer network was constructed to give the integrative interpretation of EEG abnormality based on the neurologist's assessment of the four features. Suitable knowledge base and inference engine were also constructed.
Performance was tested using the rotation method of error estimation. 45% of testing instances were classified the same as the neurologist's interpretation. 46% were classified with an error of one abnormality level. Possible improvement and the clinical future of the system are discussed.

During long-term EEG monitoring of epileptic patients, seizure detection assists in selecting information important for diagnosis. We present a new generation of detection methods with self-adapting, more specifically patient-adapting, algorithms for two functions: (1) Reduction of false seizure detections (FSDs), thus increasing the sensitivity of detection. (2) Detection of seizure onset, thus providing a warning which is useful to patient and observers, allowing appropriate precautions and observations.
The self-adapting algorithm for reducing FSDs utilizes FSDs from one baseline monitoring session as template patterns. In subsequent sessions, events having a pattern similar to any template pattern are eliminated from the detection. A unique "similarity" measure was used to reflect the relation between two muitichannel EEG patterns. An extensive test was done on twenty patients with 2600 hours of monitoring. Results show an average reduction in FSDs by 61% with a risk of missing seizures of 2.7%, comparing to the most commonly used method.
The self-adapting algorithm for seizure onset detection assumes one seizure has been recorded and uses that seizure and one set of non-seizure EEG to train a patient-specific classifier. By using special features and a modified nearest-neighbor classifier, this algorithm reached an onset detection rate of 100% with an average delay of 9.6 seconds after onset. The average false alarm rate was only 0.21/hour, making it an acceptable warning device. This test was done on 17 patients with 77 seizures.
In conclusion, our self-adapting algorithms make seizure detection more accurate and effective than was possible before. They are also efficient, practical and capable to work in real time.

Driving a vehicle involves a series of events, which are related to and evolve with the mental state (such as sleepiness, mental load, and stress) of the driv- er. These states are also identified as causal factors of critical situations that can lead to road accidents and vehicle crashes. These driver impairments need to be detected and predicted in order to reduce critical situations and road accidents. In the past years, physiological signals have become conven- tional measures in driver impairment research. Physiological signals have been applied in various studies to identify different levels of mental load, sleepiness, and stress during driving. This licentiate thesis work has investigated several artificial intelligence algorithms for developing an intelligent system to monitor driver mental state using physiological signals. The research aims to measure sleepiness and mental load using Electroencephalography (EEG). EEG signals, if pro- cessed correctly and efficiently, have potential to facilitate advanced moni- toring of sleepiness, mental load, fatigue, stress etc. However, EEG signals can be contaminated with unwanted signals, i.e., artifacts. These artifacts can lead to serious misinterpretation. Therefore, this work investigates EEG arti- fact handling methods and propose an automated approach for EEG artifact handling. Furthermore, this research has also investigated how several other physiological parameters (Heart Rate (HR) and Heart Rate Variability (HRV) from the Electrocardiogram (ECG), Respiration Rate, Finger Tem- perature (FT), and Skin Conductance (SC)) to quantify drivers’ stress. Dif- ferent signal processing methods have been investigated to extract features from these physiological signals. These features have been extracted in the time domain, in the frequency domain as well as in the joint time-frequency domain using wavelet analysis. Furthermore, data level signal fusion has been proposed using Multivariate Multiscale Entropy (MMSE) analysis by combining five physiological sensor signals. Primarily Case-Based Reason- ing (CBR) has been applied for drivers’ mental state classification, but other Artificial intelligence (AI) techniques such as Fuzzy Logic, Support Vector Machine (SVM) and Artificial Neural Network (ANN) have been investigat- ed as well. For drivers’ stress classification, using the CBR and MMSE approach, the system has achieved 83.33% classification accuracy compared to a human expert. Moreover, three classification algorithms i.e., CBR, an ANN, and a SVM were compared to classify drivers’ stress. The results show that CBR has achieved 80% and 86% accuracy to classify stress using finger tempera- ture and heart rate variability respectively, while ANN and SVM reached an accuracy of less than 80%.
Vehicle Driver Monitoring

Advances in monitoring technology have resulted in the collection of a vast amount of data that exceeds the simultaneous surveillance capabilities of expert clinicians in the clinical environment. To facilitate the clinical decision-making process, this thesis solves two fundamental problems in physiological monitoring: signal estimation and trend-pattern recognition. The general approach is to transform changes in different trend features to nonzero level-shifts by calculating the model-based forecast residuals and then to apply a statistical test or Bayesian approach on the residuals to detect changes. The EWMA-Cusum method describes a signal as the exponentially moving weighted average (EWMA) of historical data. This method is simple, robust, and applicable to most variables. The method based on the Dynamic Linear Model (refereed to as Adaptive-DLM method) describes a signal using the linear growth model combined with an EWMA model. An adaptive Kalman filter is used to estimate the second-order characteristics and adjust the change-detection process online. The Adaptive-DLM method is designed for monitoring variables measured at a high sampling rate. To address the intraoperative variability in variables measured at a low sampling rate, a generalized hidden Markov model is used to classify trend changes into different patterns and to describe the transition between these patterns as a first-order Markov-chain process. Trend patterns are recognized online with a quantitative evaluation of the occurrence probability. In addition to the univariate methods, a test statistic based on Factor Analysis is also proposed to investigate the inver-variable relationship and to reveal subtle clinical events. A novel hybrid median filter is also proposed to fuse heart-rate measurements from the ECG monitor, pulse oximeter, and arterial BP monitor to obtain accurate estimates of HR in the presence of artifacts. These methods have been tested using simulated and clinical data. The EWMA-Cusum and Adaptive-DLM methods have been implemented in a software system iAssist and evaluated by clinicians in the operating room. The results demonstrate that the proposed methods can effectively detect trend changes and assist clinicians in tracking the physiological state of a patient during surgery.

Coaches are constantly seeking more ecologically valid and reliable data to improve professional sporting performance. Using unobtrusive, valid and reliable mobile physiological monitoring devices may assist in achieving this aim. For example, there is limited information regarding professional fast bowlers in cricket and understanding this role during competitive in-match scenarios rather than in simulated bowling events could enhance coaching and physical conditioning practices. The BioharnessTM is a mobile monitoring device and assesses 5 variables (Heart rate [HR], Breathing frequency [BF], Accelerometry [ACC], Skin temperature [ST] and Posture [P]) simultaneously. Therefore, the aims of this research were to assess the effectiveness of the BioharnessTM mobile monitoring device during professional sporting performance using fast bowlers in cricket and this was to be achieved in five research studies. Study 1 presented the physiological profile of professional cricketers reporting fitness data with other comparable professional athletes, with a specific interest in fast bowlers who were to be the focus of this work. The 2nd and 3rd study assessed the reliability and validity of the BioharnessTM through controlled laboratory based assessment. For validity, strong relationships (r = .89 to .99, P < .01) were reported for HR, BF, ACC and P. Limits of Agreement reported HR (-3 ± 32 beat.min-1), BF (-3.5 ± 43.7 br.min-1) and P (0.2 ± 2.6o). ST established moderate relationships (-0.61 ± 1.98 oC; r =.76, P <.01). Reliability between subject data reported low Coefficient of Variation (CV) and strong correlations for ACC and P (CV < 7.6%; r = .99, P <.01). HR and BF (CV ~ 19.4%; r ~.70, P <.01) and ST (CV 3.7%; r = .61, P < .01), present more variable data. Intra and inter device data presented strong relationships (r > .89, P < .01, CV < 10.1%) for HR, ACC, P and ST. BF produced weaker data (r < .72, CV < 17.4%). Study 4 assessed reliability and validity of the BioharnessTM in a field based environment using an intermittent protocol. Precision of measurement reported good relationships (r = .61 to .67, P < .01) and large Limits of Agreement for HR (> 79.2 beat.min-1) and BF (> 54.7 br.min-1). ACC presented excellent precision (r = .94, P < .01). Results for HR (r = ~ .91, P < .01: CV <7.6%) and ACC (r > .97, P < .01; CV < 14.7%) suggested these variables are reliable in the field environment. BF presented more variable data (r = .46 - .61, P < .01; CV < 23.7%). In all studies, as velocity of movement increased (> 10 km.h-1) variables became more erroneous. HR and ACC were deemed as valid and reliable to be assessed during in-match sporting performance in study 5. This final study sought to utilise and assess the BioharnessTM device within professional cricket, assessing physiological responses of fast-medium bowlers within a competitive sporting environment, collected over three summer seasons. The BioharnessTM presented different physiological profiles for One Day (OD) and Multi Day (MD) cricket with higher mean HR (142 vs 137 beats.min-1, P < .05) and ACC (Peak acceleration (PkA) 227.6 vs 214.9 ct.episode-1, P < .01) values in the shorter match format. Differences in data for the varying match states of bowling (HR, 142 vs 137 beats.min-1, PkA 234.1 vs 226.6 ct.episode-1), between over (HR, 129 vs 120beats.min-1, PkA 136.4 vs 126.5 ct.episode-1) and fielding (115 vs 106 beats.min-1, PkA 1349.9 vs 356.1 ct.episode-1) were reported across OD and MD cricket. Therefore, this information suggests to the coach that the training regimes for fast bowlers should be specific for the different demands specific to the format of the game employed. Relationships between in-match BioharnessTM data and bowling performance were not clearly established due to the complexities of uncontrollable variables within competitive cricket. In conclusion, the BioharnessTM has demonstrated acceptable validity and reliability in the laboratory and the field setting for all variables (Heart rate, Breathing frequency, Accelerometry, Skin temperature and Posture) but with limitations for heart rate and breathing frequency at the more extreme levels of performance. Furthermore, taking these limitations into account it has successfully been utilised to assess performance and provide further insight into the physiological demands in the professional sport setting. Therefore, this work suggests that coaches and exercise scientists working together should seek to utilise new mobile monitoring technology to access unique insights in to sporting performance which may be unobtainable in the laboratory or a simulated field based event.

The purpose of this research was to develop a new diffuse reflectance model to facilitate rapid and accurate extraction of tissue physiological characteristics from diffuse reflectance spectra. The model used hybrid statistic formulas to describe the probability of a photon reemerging at the tissue surface and its weight attenuation during migration. Validations by Monte Carlo simulations indicate that the model is accurate for a wide range of optical parameters and short source-detector separations with an error less than 10%. Furthermore, the model was incorporated in the process of interpreting diffuse reflectance spectra from a set of tissue simulating phantoms; the dynamic changes in hemoglobin oxygenation of the phantoms were obtained accurately. Findings of this research demonstrate the utility of the new diffuse reflectance model for extracting physiological information from tissue diffuse reflectance spectra, and due to speed and accuracy advantages over existing models, applicability for use in the clinical setting.

Osteoarthritis, which affects over 21 million people and costs the US $61 billion/yr, is devastating the US population and taxing the health care system. These numbers will increase exponentially as the population ages. It is reported that previous trauma to cartilage resulting in focal chondral defects progresses to osteoarthritis if treatment is delayed or unsuccessful. Current treatment modalities for focal chondral defects have had variable success rates. As such scaffold based therapies in combination with tissue engineering are being developed as an alternative therapy for focal chondral defects. One important area of research to be addressed for these therapies to be successful is rapid integration of native tissue with the implant. An advantage of using scaffold based therapies is that scaffolds provide a stable surface for tissue to grow on and integrate with the existing tissue. In addition, there is the opportunity to use scaffolds for measuring joint loading. These measurements are crucial for a better understanding of the loading environment leading to osteoarthritis as well as for development of rehabilitation regimens when tissue engineering is used to treat defects. It is the goal of this research to determine if mimicking the native trabecular bone structure can be utilized to promote rapid bone ingrowth into implants and to determine whether these implants can be used to directly measure in vivo joint loads. To address the goals of this study, polybutylene terephthalate scaffolds were designed and then built using a fused deposition modeling system. Two different scaffold designs were utilized to determine if mimicking bone structure results in improved bone ingrowth. One scaffold was a biomimetic scaffold that replicated the trabecular bone structure and the other utilized a simple porous structure. These scaffolds were also equipped with strain gauges so that they could be used to monitor joint loading within the knee joint. The strain gauges were used in combination with implantable miniature radio transmitters to allow a fully internal measurement system to be used to determine joint loads during gait as well as other weight bearing activities. Using histology and μCT it was observed that the biomimetic scaffolds increased bone ingrowth into the scaffold over 500% compared to the simple porous scaffolds. These biomimetic scaffolds also increased bone growth in the areas adjacent to the scaffold. Additionally, it was demonstrated that these scaffolds when outfitted with strain gauges could measure axial joint loads occurring within the knee joint during various activities. It was noted that the temporal measurements were highly correlated with video analysis and that peak loads increased as a function of time post implantation. The ability of biomimetic scaffolds to increase bone ingrowth is important for anchoring the scaffold in place and allowing successful integration of tissue engineered cartilage with the native tissue. This will improve success rates of scaffold based tissue engineering therapies. The ability of implants to measure joint loads is crucial to developing a better understanding of osteoarthritis as well as improving rehabilitation protocols. Additionally, by monitoring the change in peak loads with time it will be possible to monitor the healing response at the implant site. Overall, this research demonstrates that polybutylene terephthalate scaffolds have the ability to be used in combination with tissue engineering constructs to treat focal chondral defects and are capable or providing direct in vivo loading measurements.

Current noninvasive blood pressure (BP) measurement methods estimate the systolic and diastolic blood pressure (SBP and DBP) at two random instants in time. The BP variability and its serious consequences on the measurement are not recognized by most physicians. The standard for automated BP devices sets a maximum allowable system error of +/- 5 mmHg, even though natural BP variability often exceeds these limits. This thesis characterizes the variability of SBP and DBP and proposes a new approach to augment the conventional noninvasive measurement using simultaneous recordings of the oscillometric and continuous arterial pulse waveforms by providing: 1) The mean SBP (or DBP) over the measurement interval, 2) Their respective standard deviations, and 3) An indicator as to whether or not the oscillometric reading is an outlier. Recordings with healthy subjects showed that the approach has prominent potential and does not suffer from bias relative to the conventional method.

By the analysis of the literature, it looks like the strive for new piglets’ models of disease have prevaricated the necessity for a deeper knowledge of the physiology of the animal. It is well known how difficult it is to interpret obtained data when poor to none reference standards are provided and how hard it is to apply techniques borrowed from other models, no matter how similar they can look. The aim of the present work was to collect knowledge and information regarding the piglets by studying its physiology and to validating new techniques. The experiments can be divided into two categories: physiological investigations and new techniques and future applications. Blood and Cerebrospinal fluid were analyzed in a quali-quantitative manner in piglets. The studies, thanks to the extensive statistical analyses and the high number of sampled population, provide with important reference intervals that will allow for better understanding of several metabolic processes. For the second category, technical experiments aimed to find easier and relatively pain free procedures for the collection of Cerebrospinal fluid and intrathecal administration in piglets, were performed. Operators’ skills often are a limiting factor for the feasibility of experimental protocols, and easier techniques are the best way to break down these walls. Moreover, when leading to lower mortality and higher welfare, those techniques allow for better results and higher ethical standards. The last experiment aimed to create a comprehensive map of CNS transduction upon intrathecal administration of Adeno-Associated Viral vector in piglets, and to evaluate their potential toxicity. The obtained result will help choosing the right serotype depending on the targeted cell population, thus avoiding preliminary studies reducing the number of enrolled animals. In conclusion, this thesis represents an additional step toward the standardization of the physiological piglet model and its refinement and reduction in experimental protocols.

The endangered Arabian oryx, Oryx leucoryx faces a wide range of issues that potentially have adverse effects on their welfare while they are free-ranging in their natural habitat, housed in captivity for conservation breeding or when they are translocated from the wild to captivity or vice versa. Furthermore, the global increase in the number of captive Arabian oryx (currently more than 95 % of the world population of about 8000 individuals), gives rise to particular concern for their welfare and health within captive conditions. Thorough assessment of the welfare of animals involves physiological and behavioural measures. Methods for assessment of welfare in Arabian oryx have not been established and the present studies aim at establishing physiological tools for assessment of welfare. Therefore, the present studies developed and applied new methods for non-invasive assessment of welfare in the Arabian oryx (using faecal samples), and established reference values for a range of haematological, biochemical and clinical parameters. The potential disturbances in these parameters were investigated after immobilisation and tranquillisation and post- transportation. Two enzyme immuno-assays (EIA I and II) for faecal glucocorticoid metabolites (FGM) were validated by stimulation and suppression of the hypothalamic-pituitary-adrenal axis through injection of synthetic adrenocorticotropic hormone (ACTH) and dexamethasone, respectively. These studies established a lag-time of 14 ± 1 h between secretion of glucocorticoids into the blood stream and excretion of the measured FGM. Faecal incubation at 30°C for 3 days showed that EIA I measured more stable faecal glucocorticoid metabolites than EIA II, and has greater potential for application in field conditions. This method was found to be invaluable for measuring stress and hence assessment of welfare status, and its use is recommended in planning welfare improvements. Measurement of FGM successfully detected the stress of road transportation (630 km for 8-10 h), showing an increase 2 days after transport, followed by recovery to basal FGM levels after re-housing for up to 11 days. Releasing oryx to the wild, in Oman, and tracking for 11 days, after transportation 50-70 km from the captive site (Arabian Oryx Sanctuary, Jaaluni), caused an increase in FGM to the highest levels seen in these studies, and suggests a high level of stress was experienced after release of oryx. Published reference values for haematological, biochemical, hormonal and clinical parameters for Arabian oryx are limited, with little information for non-immobilised and non-tranquillised oryx or consideration of possible age and sex differences. Therefore, reference values and inter-percentile ranges (2.5 and 97.5 percentiles) were established for 32 parameters, in separate groups of male and female adult oryx, without using immobilising or tranquillising chemicals during capture. The haematological parameters investigated were white blood cell count and differentiation (%) of cell types (neutrophils, lymphocytes, monocytes, eosinophils, basophils), number of platelets, red blood cell count, haemoglobin concentration and haematocrit, erythrocyte cell volume, erythrocyte haemoglobin content and concentration, serum osmolality and ions (sodium, potassium, chloride, calcium, magnesium and phosphorus). Biochemical parameters investigated were serum urea, glucose, total protein, albumin and plasma lactate concentrations. Clinical parameters investigated were body temperature, heart and respiratory rates. Hormonal parameters measured were cortisol, free-thyroxine, free-triiodothyronine and insulin concentrations. Near basal values for serum cortisol were measured in Arabian oryx sampled within 2 min, while values were significantly higher in oryx sampled within 5-10 min. The reference values established in these studies are considered valuable tools for diagnosis of disease and physiological alterations in male and female Arabian oryx. To investigate the possible effects of the common practice of immobilisation and tranquillisation on physiological and biochemical status, two restraint chemicals (xylazine and perphenazine enanthate) were evaluated. Xylazine (an immobilising agent) caused changes in many clinical, hormonal, haematological and biochemical parameters; respiratory rate decreased by 74 %, heart rate decreased by 58 %, causing a decrease in red blood cell count, haemoglobin concentration and haematocrit, serum albumin and total protein concentration. Xylazine also induced a decrease in serum insulin, which probably caused the observed increase in serum glucose. Perphenazine enanthate (a long-acting tranquilliser) was found to have no adverse effects on most parameters, which generally remained in the reference ranges. However, a reduction in blood haematocrit and related parameters (red blood cell count and plasma haemoglobin concentration) occurred, 1-3 days after injection. The tranquilliser also plays a role in reducing stress and significantly reduced serum cortisol 2-3 days after injection in oryx held in captivity compared to oryx that received a saline (control) injection. FGM increased significantly one day after injection of perphenazine enanthate and saline, suggesting the animals were initially stressed by the handling and venipuncture, taking into consideration the lag-time from cortisol secretion to appearance of FGM. The baseline concentration of serum cortisol was used in assessing the stress caused by handling before and after transporting Arabian oryx for 630 km (8-10 h) and the acute effects of handling and injections. Increased serum cortisol was always associated with leukocytosis, neutrophilia and lymphopenia. Serum cortisol of non-transported oryx was reduced by the tranquilliser perphenazine enanthate, but transportation of tranquillised Arabian oryx during hot ambient temperature (maximum 42 °C) resulted in fatigue and prevented reaching a clear conclusion of the role of the tranquilliser in reducing transport stress. Non-tranquillised oryx transported at a maximum of 26-30 °C showed a similar level of stress as implied by the level of faecal glucocorticoid metabolites, but without fatigue. However, the tranquilliser induced calmness in Arabian oryx for up to 7 days, which facilitated capture and handling. Therefore, perphenazine enanthate has a potential to be used in the management practices, such as movement and transport of Arabian oryx. This thesis discusses the current and future welfare issues that face Arabian oryx in captivity, upon release and in the wild. Additional methods are proposed for thorough assessment and improvement of welfare to complement the methods established by the present studies.

Neurologically related injuries cause a similar number of deaths ascancer, and brain damage is the second commonest cause of death in theworld and probably the leading cause of permanent disability. Thedevastating effects of most cases of brain damage could be avoided if itwere detected and medical treatment initiated in time. The passiveelectrical properties of biological tissue have been investigated for almost acentury and electrical bioimpedance studies in neurology have beenperformed for more than 50 years. Even considering the extensive effortsdedicated to investigating potential applications of electrical bioimpedancefor brain monitoring, especially in the last 20 years, and the specificallyacute need for such non-invasive and efficient diagnosis support tools,Electrical Bioimpedance technology has not made the expectedbreakthrough into clinical application yet. In order to reach this stage inthe age of evidence-based medicine, the first essential step is todemonstrate the biophysical basis of the method under study. The presentresearch work confirms that the cell swelling accompanying thehypoxic/ischemic injury mechanism modifies the electrical properties ofbrain tissue, and shows that by measuring the complex electricalbioimpedance it is possible to detect the changes resulting from braindamage. For the development of a successful monitoring method, after thevital biophysical validation it is critical to have available the properelectrical bioimpedance technology and to implement an efficient protocolof use. Electronic instrumentation is needed for broadband spectroscopymeasurements of complex electrical bioimpedance; the selection of theelectrode setup is crucial to obtain clinically relevant measurements, andthe proper biosignal analysis and processing is the core of the diagnosissupport system. This work has focused on all these aspects since they arefundamental for providing the solid medico-technological backgroundnecessary to enable the clinical usage of Electrical Bioimpedance forcerebral monitoring.

abstract: Monitoring vital physiological signals, such as heart rate, blood pressure and breathing pattern, are basic requirements in the diagnosis and management of various diseases. Traditionally, these signals are measured only in hospital and clinical settings. An important recent trend is the development of portable devices for tracking these physiological signals non-invasively by using optical methods. These portable devices, when combined with cell phones, tablets or other mobile devices, provide a new opportunity for everyone to monitor one’s vital signs out of clinic. This thesis work develops camera-based systems and algorithms to monitor several physiological waveforms and parameters, without having to bring the sensors in contact with a subject. Based on skin color change, photoplethysmogram (PPG) waveform is recorded, from which heart rate and pulse transit time are obtained. Using a dual-wavelength illumination and triggered camera control system, blood oxygen saturation level is captured. By monitoring shoulder movement using differential imaging processing method, respiratory information is acquired, including breathing rate and breathing volume. Ballistocardiogram (BCG) is obtained based on facial feature detection and motion tracking. Blood pressure is further calculated from simultaneously recorded PPG and BCG, based on the time difference between these two waveforms. The developed methods have been validated by comparisons against reference devices and through pilot studies. All of the aforementioned measurements are conducted without any physical contact between sensors and subjects. The work presented herein provides alternative solutions to track one’s health and wellness under normal living condition.
Dissertation/Thesis
Doctoral Dissertation Electrical Engineering 2016

Nanomaterials have emerged as a remarkable class of materials in recent years owing to their excellent electrical, chemical, and physical properties. The first two-dimensional (2D) material to be discovered, graphene, has been the torchbearer in this regard with its superlative properties and a strong impact on numerous technologies. Sensor technology is one such space where nanomaterials have brought an impressive facelift. A new genre of sensors was imperative in the biomedical field where the existing brittle and rigid wafer-based electronics have their limitations. The present talk describes my work accomplished in the synthesis of graphene and innovative device fabrication techniques, which has led to sensors that are highly sensitive, flexible, stretchable, and skin-conformal, notably preferred in biomedical sensing technology. These flexible wearable sensors see potential service in monitoring human physiological parameters, like heart rate, breathing rate, body temperature, body de-hydration, limb movement, tactile sensing, and so on. These sensors have a direct impact on the well-being of the masses, especially considering the current crisis in healthcare systems. Another area identified for possible improvement using nanomaterials is the vacuum sensing technology in industrial applications, which has not seen significant improvement over a long period of time. Vacuum technology has far-reaching utilization in areas like medical equipment, water treatment and petrochemical plants, food and beverages industry, space technology, semiconductor industry, thin-film technology, nuclear and defense requirements, and so forth. The limitations of available vacuum measurement devices such as narrow operating range, large form factor, expensive and need for cascaded gauges can be addressed using the developed vacuum sensor based on graphene nanocomposite. This talk summarizes the research carried out towards the design and development of graphene-based sensors targeting the above-described domains. The work includes a graphene supercapacitor model-based strain sensor with high noise immunity for biomedical applications. A multifunctional piezoresistive sensor with graphene nanosheets with a focus on commercially viable wearable devices has been developed for vital biomonitoring requirements. Further, graphene nanocomposite with gas chemisorption property has been explored for vacuum pressure measurement for a broader scope of applications. The developed sensor prototypes based on graphene nanomaterial have given a fresh perspective in the field of sensor technology.

碩士
明新科技大學
電機工程系碩士班
103
With the fast progress of medical technology, the average age of Taiwanese is sharply increased; it makes Taiwan marches toward aging population society. Nowadays people usually eating out, their tastes of food are getting heavier. In the long term, it will lead to some chronic diseases. It often threats people's health. Also the 2nd Generation National Health Insurance (NHI 2) spends more and more medical resources. Therefore, developing the Home Nursing Care System to improve convenience and the quality of care, and reduce the social cost has become particularly important. This article designs two devices Apps - Monitor Physiological Information and Wheelchair Control. The fuzzy logic control is applied to the Monitor Information Physiological system to notify people when patients blood oxygen level and heart rate getting lower due to non-artificial factors can be used. The oxygen requirement of patients will show on the phone by the Apps. And caregivers or medical staffs can understand their needs of supply oxygen content, let the heartbeat and oxygen of patient should return to normal conditions. On the other hand, the Wheelchair Control device App, can adjust the best body posture of caregivers by the phone sensor. It also can be controlled through the manual mode. Under this Apps’ help, caregivers can have a good care environment.

碩士
國立彰化師範大學
電子工程學系
101
This article consists of the usage of GPRS to serve as long range transmission platform in transmitting heart rate, temperature values, GPS positioning coordinates and other relevant data to remote monitoring system (host). Real-time heart rate value is measured by heartbeat sensor which widely available in on the market, analysis of real-time temperature is calculated base on the differences in voltage value observed within negative temperature coefficient thermistor resistor,and, inclusive GPS positioning function which exploit GOOGLE MAP, combining all of them into a monitoring system. This particular remote monitoring system will be able to provide warning and raise alert if there is any physiological abnormalities happen on the subject. Under these circumstances, distress signal will be sent to rescue unit for immediate relief during any possible motors-related accidents or reduce any other potential death which resulted from physiological failures. Finally, empirical result shows the monitoring system is capable in recording changes in the physiological state, and, successfully delivers distress signal when a subject is suffering from physiological abnormalities and provide his marked coordinate via GOOGLE MAP which facilitates the rescue.