Optimization and Technical Validation of the AIDE-MOI Fall Detection Algorithm in a Real-Life Setting with Older Adults.

Falls are the primary contributors of accidents in elderly people. An important factor of fall severity is the amount of time that people lie on the ground. To minimize consequences through a short reaction time, the motion sensor "AIDE-MOI" was developed. "AIDE-MOI" senses acceleration data and analyzes if an event is a fall. The threshold-based fall detection algorithm was developed using motion data of young subjects collected in a lab setup. The aim of this study was to improve and validate the existing fall detection algorithm. In the two-phase study, twenty subjects (age 86.25 ± 6.66 years) with a high risk of fall (Morse > 65 points) were recruited to record motion data in real-time using the AIDE-MOI sensor. The data collected in the first phase (59 days) was used to optimize the existing algorithm. The optimized second-generation algorithm was evaluated in a second phase (66 days). The data collected in the two phases, which recorded 31 real falls, was split-up into one-minute chunks for labelling as "fall" or "non-fall". The sensitivity and specificity of the threshold-based algorithm improved significantly from 27.3% to 80.0% and 99.9957% (0.43) to 99.9978% (0.17 false alarms per week and subject), respectively.

Leadless cardiac resynchronization therapy: An in vivo proof-of-concept study of wireless pacemaker synchronization.

BACKGROUND: Contemporary leadless pacemakers (PMs) only feature single-chamber ventricular pacing. However, the majority of patients require dual-chamber pacing or cardiac resynchronization therapy (CRT). Several leadless PMs implanted in the same heart would make that possible if they were able to synchronize their activity in an efficient, safe, and reliable way. Thus, a dedicated ultra-low-power wireless communication method for PM synchronization is required. OBJECTIVE: The purpose of this study was to develop a leadless CRT system and to evaluate its function in vivo. METHODS: Device synchronization was implemented using conductive intracardiac communication (CIC). Communication frequencies were optimized for intracardiac device-device communication. Energy consumption, safety, and reliability of the leadless PM system were tested in animal experiments. RESULTS: We successfully performed CRT pacing with 3 independent devices synchronizing their action using CIC. No arrhythmias were induced by the novel communication technique. Ninety-eight percent of all communication impulses were transmitted successfully. The optimal communication frequency was around 1 MHz, with a corresponding transmitted power of only 0.3 µW at a heart rate of 60 bpm. CONCLUSION: Leadless PMs are able to synchronize their action using CIC and may overcome the key limitation of contemporary leadless PMs.

Fundamental Characterization of Conductive Intracardiac Communication for Leadless Multisite Pacemaker Systems.

OBJECTIVE: A new generation of leadless cardiac pacemakers effectively overcomes the main limitations of conventional devices, but only offer single-chamber pacing, although dual-chamber or multisite pacing is highly desirable for most patients. The combination of several leadless pacemakers could facilitate a leadless multisite pacemaker but requires an energy-efficient wireless communication for device synchronization. This study investigates the characteristics of conductive intracardiac communication between leadless pacemakers to provide a basis for future designs of leadless multisite pacemaker systems. METHODS: Signal propagation and impedance behavior of blood and heart tissue were examined by in vitro and in vivo measurements on domestic pig hearts and by finite-element simulations in the frequency range of 1 kHz to 1 MHz. RESULTS: A better signal transmission was obtained for frequencies higher than 10 kHz. The influence of a variety of practical parameters on signal transmission could be identified. A larger distance between pacemakers increases signal attenuation. A better signal transmission is obtained through larger inter-electrode distances and a larger electrode surface area. Furthermore, the influence of pacemaker encapsulation and relative device orientation was assessed. CONCLUSION: This study suggests that conductive intracardiac communication is well suited to be incorporated in leadless pacemakers. It potentially offers very low power consumption using low communication frequencies. SIGNIFICANCE: The presented technique enables highly desired leadless multisite pacing in near future.

Transthoracic Coronary Flow Data at Rest Predict High-Risk Stress Tests.

Background Several recent studies have reported the opportunity to diagnose significant narrowing of the coronary arteries without stress testing using local flow acceleration. Purpose To define how often patients with increased coronary flow velocities at rest (≥ 0.70 m/s) have a positive exercise echocardiography test. Material and Methods A total of 150 patients scheduled for exercise echocardiography were studied using transthoracic Doppler echocardiography in order to assess coronary artery flow velocity before exercise. Pulsed wave Doppler registered blood flow velocity placed on the color signal. The maximal diastolic velocity of coronary flow was measured. Results Of participants, 16% had a velocity of more than 0.70 m/s in the left main/proximal left anterior/proximal left circumflex arteries (LM/pLAD). A significant correlation was observed between the value of the maximal velocity in LM/pLAD and the ejection fraction at the peak of exercise ( r ≈ -0.39, P < 0.0001); between the value of the maximal velocity in LM/pLAD and index of wall motion abnormalities (IWMA) at the peak of exercise ( r ≈ 0.44, P < 0.0001); and between the value of the maximal velocity in LM/pLAD and dIWMA ( r ≈ 0.41, P < 0.0001). Afterwards, severe ischemia in stress echocardiography tests was observed in this group. The average IWMA of these tests was found to be 2.3. Sixty-two angiograms were available for comparison with Doppler data. Conclusion There is a significant correlation between the value of the maximal velocity in LM/pLAD/pLCx at rest and the severity of wall motion abnormalities during exercise tests.

Leadless Dual-Chamber Pacing: A Novel Communication Method for Wireless Pacemaker Synchronization.

Contemporary leadless pacemakers only feature single-chamber pacing capability. This study presents a prototype of a leadless dual-chamber pacemaker. Highly energy-efficient intrabody communication was implemented for wireless pacemaker synchronization. Optimal communication parameters were obtained by in vivo and ex vivo measurements in the heart and blood. The prototype successfully performed dual-chamber pacing in vivo. The presented wireless communication method may in the future also enable leadless cardiac resynchronization therapy.

Potential of Piezoelectric MEMS Resonators for Grape Must Fermentation Monitoring.

In this study grape must fermentation is monitored using a self-actuating/self-sensing piezoelectric micro-electromechanical system (MEMS) resonator. The sensor element is excited in an advanced roof tile-shaped vibration mode, which ensures high Q-factors in liquids (i.e., Q ~100 in isopropanol), precise resonance frequency analysis, and a fast measurement procedure. Two sets of artificial model solutions are prepared, representing an ordinary and a stuck/sluggish wine fermentation process. The precision and reusability of the sensor are shown using repetitive measurements (10 times), resulting in standard deviations of the measured resonance frequencies of ~0.1%, Q-factor of ~11%, and an electrical conductance peak height of ~12%, respectively. With the applied evaluation procedure, moderate standard deviations of ~1.1% with respect to density values are achieved. Based on these results, the presented sensor concept is capable to distinguish between ordinary and stuck wine fermentation, where the evolution of the wine density associated with the decrease in sugar and the increase in ethanol concentrations during fermentation processes causes a steady increase in the resonance frequency for an ordinary fermentation. Finally, the first test measurements in real grape must are presented, showing a similar trend in the resonance frequency compared to the results of an artificial solutions, thus proving that the presented sensor concept is a reliable and reusable platform for grape must fermentation monitoring.

In vivo tear film thickness measurement and tear film dynamics visualization using spectral domain optical coherence tomography.

Dry eye syndrome is a highly prevalent disease of the ocular surface characterized by an instability of the tear film. Traditional methods used for the evaluation of tear film stability are invasive or show limited repeatability. Here we propose a new non-invasive fully automated approach to measure tear film thickness based on spectral domain optical coherence tomography and on an efficient delay estimator. Silicon wafer phantom were used to validate the thickness measurement. The technique was applied in vivo in healthy subjects. Series of tear film thickness maps were generated, allowing for the visualization of tear film dynamics. Our results show that the in vivo central tear film thickness measurements are precise and repeatable with a coefficient of variation of about 0.65% and that repeatable tear film dynamics can be observed. The presented approach could be used in clinical setting to study patients with dry eye disease and monitor their treatments.

Cytology of the nasal mucosa after total laryngectomy.

CONCLUSION: This study demonstrates morphological changes in the nasal mucosa as a consequence of functional changes of the nasal cavity after total laryngectomy (TLE). OBJECTIVE: Observation of the changes of the nasal mucosa in patients after TLE. PATIENTS AND METHODS: A cohort observational study contained 30 patients after TLE. These patients underwent nasal endoscopy and cytological and microbiological examination of the nasal mucosa. The control group comprised 30 patients. RESULTS: In patients who underwent TLE, morphological changes occurred in the nasal mucosa. The hyperplasia of the cells in the basal zone was the most remarkable change after TLE. The difference was statistically significant (p=0.0002) in comparison with the control group. No statistically significant difference was shown in the incidence of squamous cell metaplasia. The inflammatory changes in the nasal mucosa were found in only 10% of patients after TLE; in comparison with the control group the statistically significant decrease was proven (p=0.003). The presence of bacteria in the nasal mucosa without any signs of inflammation was demonstrated in 27% of the patients who underwent TLE. That finding was not seen in the control group. The statistically significant difference was demonstrated (p=0.0046).