Application of Dynamic Mode Decomposition to Characterize Temporal Evolution of Plantar Pressures from Walkway Sensor Data in Women with Cancer.

Pressure sensor-impregnated walkways transform a person's footfalls into spatiotemporal signals that may be sufficiently complex to inform emerging artificial intelligence (AI) applications in healthcare. Key consistencies within these plantar signals show potential to uniquely identify a person, and to distinguish groups with and without neuromotor pathology. Evidence shows that plantar pressure distributions are altered in aging and diabetic peripheral neuropathy, but less is known about pressure dynamics in chemotherapy-induced peripheral neuropathy (CIPN), a condition leading to falls in cancer survivors. Studying pressure dynamics longitudinally as people develop CIPN will require a composite model that can accurately characterize a survivor's gait consistencies before chemotherapy, even in the presence of normal step-to-step variation. In this paper, we present a state-of-the-art data-driven learning technique to identify consistencies in an individual's plantar pressure dynamics. We apply this technique to a database of steps taken by each of 16 women before they begin a new course of neurotoxic chemotherapy for breast or gynecologic cancer. After extracting gait features by decomposing spatiotemporal plantar pressure data into low-rank dynamic modes characterized by three features: frequency, a decay rate, and an initial condition, we employ a machine-learning model to identify consistencies in each survivor's walking pattern using the centroids for each feature. In this sample, our approach is at least 86% accurate for identifying the correct individual using their pressure dynamics, whether using the right or left foot, or data from trials walked at usual or fast speeds. In future work, we suggest that persistent deviation from a survivor's pre-chemotherapy step consistencies could be used to automate the identification of peripheral neuropathy and other chemotherapy side effects that impact mobility.

Exploring the acute cardiovascular effects of Floatation-REST.

The central nervous system (CNS) exerts a strong regulatory influence over the cardiovascular system in response to environmental demands. Floatation-REST (Reduced Environmental Stimulation Therapy) is an intervention that minimizes stimulation from the environment, yet little is known about the autonomic consequences of reducing external sensory input to the CNS. We recently found that Floatation-REST induces a strong anxiolytic effect in anxious patients while paradoxically enhancing their interoceptive awareness for cardiorespiratory sensations. To further investigate the physiologic nature of this anxiolytic effect, the present study measured acute cardiovascular changes during Floatation-REST using wireless and waterproof equipment that allowed for concurrent measurement of heart rate, heart rate variability (HRV), breathing rate, and blood pressure. Using a within-subjects crossover design, 37 clinically anxious participants with high levels of anxiety sensitivity and 20 non-anxious comparison participants were randomly assigned to undergo a 90-min session of either Floatation-REST or an exteroceptive comparison condition that entailed watching a relaxing nature film. Measures of state anxiety and serenity were collected before and after each session, while indices of autonomic activity were measured throughout each session. HRV was calculated using both time-series and frequency domain analyses. Linear mixed-effects modeling revealed a significant main effect of condition such that relative to the film condition, Floatation-REST elicited significant decreases (p < 0.001) in diastolic blood pressure, systolic blood pressure, breathing rate, and certain metrics of HRV including the standard deviation of the interbeat interval (SDNN), low-frequency HRV, and very low-frequency HRV. Heart rate showed a non-significant trend (p = 0.073) toward being lower in the float condition, especially toward the beginning of the session. The only metric that showed a significant increase during Floatation-REST was normalized high-frequency HRV (p < 0.001). The observed physiological changes were consistent across both anxious and non-anxious participants, and there were no significant group by condition interactions. Blood pressure was the only cardiac metric significantly associated with float-related reductions in state anxiety and increases in serenity. These findings suggest that Floatation-REST lowers sympathetic arousal and alters the balance of the autonomic nervous system toward a more parasympathetic state. Clinical trial registration: [https://clinicaltrials.gov/show/NCT03051074], identifier [NCT03051074].

Cortical Reorganization of Early Somatosensory Processing in Hemiparetic Stroke.

The cortical motor system can be reorganized following a stroke, with increased recruitment of the contralesional hemisphere. However, it is unknown whether a similar hemispheric shift occurs in the somatosensory system to adapt to this motor change, and whether this is related to movement impairments. This proof-of-concept study assessed somatosensory evoked potentials (SEPs), P50 and N100, in hemiparetic stroke participants and age-matched controls using high-density electroencephalograph (EEG) recordings during tactile finger stimulation. The laterality index was calculated to determine the hemispheric dominance of the SEP and re-confirmed with source localization. The study found that latencies of P50 and N100 were significantly delayed in stroke brains when stimulating the paretic hand. The amplitude of P50 in the contralateral (to stimulated hand) hemisphere was negatively correlated with the Fügl-Meyer upper extremity motor score in stroke. Bilateral cortical responses were detected in stroke, while only contralateral cortical responses were shown in controls, resulting in a significant difference in the laterality index. These results suggested that somatosensory reorganization after stroke involves increased recruitment of ipsilateral cortical regions, especially for the N100 SEP component. This reorganization delays the latency of somatosensory processing after a stroke. This research provided new insights related to the somatosensory reorganization after stroke, which could enrich future hypothesis-driven therapeutic rehabilitation strategies from a sensory or sensory-motor perspective.

Multi-Phase Locking Value: A Generalized Method for Determining Instantaneous Multi-Frequency Phase Coupling.

BACKGROUND: Many physical, biological and neural systems behave as coupled oscillators, with characteristic phase coupling across different frequencies. Methods such as n : m phase locking value (where two coupling frequencies are linked as: mf 1 = nf 2) and bi-phase locking value have previously been proposed to quantify phase coupling between two resonant frequencies (e.g. f, 2f/3) and across three frequencies (e.g. f 1, f 2, f 1 + f 2), respectively. However, the existing phase coupling metrics have their limitations and limited applications. They cannot be used to detect or quantify phase coupling across multiple frequencies (e.g. f 1, f 2, f 3, f 4, f 1 + f 2 + f 3 - f 4), or coupling that involves non-integer multiples of the frequencies (e.g. f 1, f 2, 2f 1/3 + f 2/3). NEW METHODS: To address the gap, this paper proposes a generalized approach, named multi-phase locking value (M-PLV), for the quantification of various types of instantaneous multi-frequency phase coupling. Different from most instantaneous phase coupling metrics that measure the simultaneous phase coupling, the proposed M-PLV method also allows the detection of delayed phase coupling and the associated time lag between coupled oscillators. RESULTS: The M-PLV has been tested on cases where synthetic coupled signals are generated using white Gaussian signals, and a system comprised of multiple coupled Rössler oscillators, as well as a human subject dataset. Results indicate that the M-PLV can provide a reliable estimation of the time window and frequency combination where the phase coupling is significant, as well as a precise determination of time lag in the case of delayed coupling. This method has the potential to become a powerful new tool for exploring phase coupling in complex nonlinear dynamic systems.

Taking the body off the mind: Decreased functional connectivity between somatomotor and default-mode networks following Floatation-REST.

Floatation-Reduced Environmental Stimulation Therapy (REST) is a procedure that reduces stimulation of the human nervous system by minimizing sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational, and proprioceptive channels, in addition to minimizing musculoskeletal movement and speech. Initial research has found that Floatation-REST can elicit short-term reductions in anxiety, depression, and pain, yet little is known about the brain networks impacted by the intervention. This study represents the first functional neuroimaging investigation of Floatation-REST, and we utilized a data-driven exploratory analysis to determine whether the intervention leads to altered patterns of resting-state functional connectivity (rsFC). Healthy participants underwent functional magnetic resonance imaging (fMRI) before and after 90 min of Floatation-REST or a control condition that entailed resting supine in a zero-gravity chair for an equivalent amount of time. Multivariate Distance Matrix Regression (MDMR), a statistically-stringent whole-brain searchlight approach, guided subsequent seed-based connectivity analyses of the resting-state fMRI data. MDMR identified peak clusters of rsFC change between the pre- and post-float fMRI, revealing significant decreases in rsFC both within and between posterior hubs of the default-mode network (DMN) and a large swath of cortical tissue encompassing the primary and secondary somatomotor cortices extending into the posterior insula. The control condition, an active form of REST, showed a similar pattern of reduced rsFC. Thus, reduced stimulation of the nervous system appears to be reflected by reduced rsFC within the brain networks most responsible for creating and mapping our sense of self.

Wireless Coexistence of Cellular LBT Systems and BLE 5.

The 2.4 GHz spectrum is home to several Radio Access Technologies (RATs), including ZigBee, Bluetooth Low Energy (BLE), and Wi-Fi. Accordingly, the technologies' spectrum-sharing qualities have been extensively studied in literature. License-Assisted Access (LAA) Listen-Before-Talk (LBT) has been identified in technical reports as the foundation for the channel access mechanism for 5G New Radio-Unlicensed (NR-U) operating in the 2.4 GHz Industrial, Scientific, and Medical (ISM) band. The introduction of NR-U into this band raises new concerns regarding coexistence of the newcomer with traditional incumbents. This article reports an investigation of BLE 5 and cellular LBT coexisting systems by means of empirical evaluation. The importance of this study stems from that the studied LBT mechanism is indicative of how 5G NR-U would perform in the 2.4 GHz band. Tests were performed in conformity with the American National Standards Institute (ANSI) C63.27 standard for evaluation of wireless coexistence, and results were reported in terms of throughput and interframe delays. In accordance with the standard and under different BLE physical layers (PHYs) and LBT priority classes, three setups were investigated. These pertain to the three tiers of evaluation, which correspond to the criticality of the device under test. Results demonstrated how BLE throughput dropped as the intended-to-unintended signal ratio decreased, and LBT classes exhibited a diminishing effect as the class priority descended. Long Range BLE PHY was found to sustain longer gap times (i.e., delay) than the other two PHYs; however, it showed less susceptibility to interference. Results also demonstrated that low data rate BLE PHYs hindered the LBT throughput performance since they correspond to longer airtime durations.

5G NR-U: Homogeneous Coexistence Analysis.

Current technical reports indicate License-Assisted Access (LAA) Listen-Before-Talk (LBT) as the preferred channel access scheme for the upcoming 5G New Radio-Unlicensed. Various studies have examined heterogeneous coexistence of WiFi/LTE-LAA systems. This paper investigates the homogeneous coexistence of intra-network LAA-LBT devices operating in dense deployment scenarios. Results relevant to ETSI-specified priority classes are reported in terms of channel utilization, collision probability, and channel access delay. The framework presented in this paper is then employed to investigate wireless coexistence in a 5G-enabled intensive care unit employing remote patient monitoring over 5G NR-U.

PESA: Probabilistic Efficient Storage Algorithm for Time-Domain Spectrum Measurements.

Wireless communication is an essential part of daily life for users globally with applications in medical devices, cellular phones, Internet of Things nodes, and others. Accordingly, there is a need to understand the patterns and properties of radio frequency spectrum use by acquiring accurate spectrum utilization measurements. However, the massive storage volume needed to execute spectrum surveys-especially when a fast sampling rate is used-is an impeding factor in terms of cost and ease-of-access. In this article, a probabilistic efficient storage algorithm (PESA) is proposed to facilitate high-accuracy, time-domain spectrum surveys conducted at a fast sample acquisition rate to detect sporadic spectrum occupancy patterns that could be on the order of microseconds. PESA divides the dynamic range of a monitoring equipment into bins-each represented by one component of a Gaussian mixture model (GMM). Windows of activity and inactivity in the measurements are established by comparing with a threshold and then indicators to the GMM component that best describes a window are recorded. Hence, reducing required storage volume. Results demonstrate that ≈ 99% reduction in storage volume is achievable while maintaining an accurate estimation of channel utilization and activity/inactivity periods. Furthermore, a Lab-VIEW implementation of PESA on a hardware platform was executed and used to survey Wi-Fi channel 1 in a healthcare environment for seven consecutive hours. Although more than 25 billion samples were observed, resulting data only occupied 96.28 megabytes.

On the Coexistence of LTE-LAA in the Unlicensed Band: Modeling and Performance Analysis.

Long term evolution (LTE) technology leveraging the unlicensed band is anticipated to provide a solution for the challenges stemming from the rapid growth of mobile wireless services, the scarcity of available licensed spectrum, and the expected significant increase in mobile data traffic. Ensuring fair operation in terms of spectrum sharing with current unlicensed spectrum incumbents is a key concern relative to the success and viability of Unlicensed LTE (U-LTE). This paper addresses the problem of modeling and evaluating the coexistence of LTE license-assisted-access in the unlicensed band. The paper presents a novel analytical model using Markov chain to accurately model the LAA listen-before-talk scheme, as specified in the final technical specification 36.213 of 3GPP release 13 and 14. Furthermore, model validation is demonstrated through numerical and simulation results comparison. Model performance evaluation is examined and contrasted with IEEE 802.11 distributed coordination function. Finally, a comprehensive coexistence performance analysis is conducted for both homogeneous and heterogeneous network scenarios and coexistence results are presented and discussed herein.

Estimating the Likelihood of Wireless Coexistence Using Logistic Regression: Emphasis on Medical Devices.

Medical device manufacturers incorporate wireless technology in their designs to offer convenience and agility to both patients and caregivers. However, the use of unlicensed radio spectrum bands by both medical devices and other equipment raises concerns about wireless coexistence. Work by the accredited standards committee C63 of the American National Standards Institute (ANSI) to provide the community with a consensus standard for coexistence evaluation resulted in the publication of the ANSI C63.27 standard, which was later recognized by the U.S. Food and Drug Administration. Estimating the likelihood of wireless coexistence of a system under test (SUT) in a given environment is central to the evaluation and reporting of wireless coexistence, as made clear in the C63.27 standard. However, no method to perform this estimation is provided. In this paper, we propose the use of logistic regression (LR) to estimate the likelihood of wireless coexistence of a medical device in its intended environment. Radiated open environment coexistence testing was used to realize a test scenario in which the interfering network was IEEE 802.11n Wi-Fi and the SUT was ZigBee; exemplary wireless technologies for interfering network and medical device, respectively. LR model fitting was then performed to derive a model that describes the performance of SUT under a range of wireless coexistence phenomena. Finally, results were incorporated with the outcome of a spectrum survey using Monte Carlo simulation to estimate the SUT likelihood of wireless coexistence in a hospital environment.

Practical aspects of wireless medical device coexistence testing.

Integrating wireless technology in medical devices has proved beneficial for both patients and caregivers. However, the use of shared, unlicensed spectrum bands by both medical and non-medical wireless devices has raised concerns about wireless coexistence. The challenge of incorporating wireless communication into a medical device is to ensure reasonable medical device effectiveness and patient safety. Consequently, work to develop a standardized process to assess wireless coexistence, primarily for wireless medical devices, was carried by Subcommittee 7 of American National Standards Institute (ANSI)-accredited standards committee (ASC) C63 and the Wireless Working Group (SM-WG06) of the Association for the Advancement of Medical Instrumentation (AAMI). Both groups have recently released their respective documents. In this article, we discuss practical aspects of wireless coexistence testing-in the realm of ANSI C63.27 and AAMI TIR69-to help answer basic, yet important, questions such as what to test, how to test, and how to present results.

Characterizing the 2.4 GHz Spectrum in a Hospital Environment: Modeling and Applicability to Coexistence Testing of Medical Devices.

The increasing use of shared, unlicensed spectrum bands by medical devices and nonmedical products highlights the need to address wireless coexistence to ensure medical device safety and effectiveness. This paper provides the first step to approximate the probability of a device coexisting in its intended environment by providing a generalized framework for modeling the environment. The application of this framework is shown through an 84-day spectrum survey of the 2.4-2.48 GHz industrial, scientific, and medical band in a hospital environment in the United States. A custom platform was used to monitor power flux spectral density and record received power. Channel utilization of three nonoverlapping channels of 20 MHz bandwidth-relative to IEEE 802.11 channels 1, 6, and 11-were calculated and fitted to a generalized extreme value distribution. Low channel utilization was observed (<10%) in the surveyed environment with sporadic occurrences of higher channel utilization (>50%). Reported findings can be complementary to wireless coexistence testing. This paper can provide input to the development of a consensus standard for wireless device coexistence test methods and a consensus document focused on wireless medical device coexistence risk management.

Design analysis of a fiber-bundle-based mobile free-space optical link with wavelength diversity.

This paper reports on a simulation-based investigation of a wavelength diverse free-space optical link with an emphasis on identifying design choices that optimize the performance of the system under different operating scenarios. The simulation incorporates experimental data into the theoretical calculations for optical propagation to better describe the performance of the physical designs. The performance is evaluated in terms of the coverage area at the receiver, which is a measure of misalignment tolerance and is dependent not only on wavelength but on other key parameters, such as link length, transmitted power, the pattern of transmitters, beam divergence, and the receiver construction. The investigation finds that the coverage area of the receiver can be optimized for a given wavelength by proper choices of these parameters, and that parameter choices exist that minimize the change in performance when switching between wavelengths or for variations in link parameters. The interrelationships among key parameters and their impact on the potential system performance are investigated. The results provide guidance on the further development of the overall system.

Developing a reproducible non-line-of-sight experimental setup for testing wireless medical device coexistence utilizing ZigBee.

The integration of heterogeneous wireless technologies is believed to aid revolutionary healthcare delivery in hospitals and residential care. Wireless medical device coexistence is a growing concern given the ubiquity of wireless technology. In spite of this, a consensus standard that addresses risks associated with wireless heterogeneous networks has not been adopted. This paper serves as a starting point by recommending a practice for assessing the coexistence of a wireless medical device in a non-line-of-sight environment utilizing 802.15.4 in a practical, versatile, and reproducible test setup. This paper provides an extensive survey of other coexistence studies concerning 802.15.4 and 802.11 and reports on the authors' coexistence testing inside and outside an anechoic chamber. Results are compared against a non-line-of-sight test setup. Findings relative to co-channel and adjacent channel interference were consistent with results reported in the literature.

Switched diversity approach for multireceiving optical wireless systems.

A number of existing spatial diversity schemes have been shown to improve the performance of optical wireless communication systems in diversity-rich environments. Among all, switched diversity has low complexity and is simple to implement. In this paper, an innovative spatial diversity scheme based on switched diversity is proposed. The scheme, namely switch-to-dominant combining, contributes to a higher bit error rate (BER) performance when compared to conventional switched diversity schemes, including switch-and-stay and switch-and-examine diversity. The optical multireceiver wireless system operates in a spatially correlated and lognormally distributed fading channel. Analytical analyses are conducted to demonstrate BER and processing load performance offered by the new scheme and compare them to available schemes, i.e., conventional switched combining and selection combining.