Farhad Abtahi

Mean Expected Error in Prediction of Total Body Water: A True Accuracy Comparison between Bioimpedance Spectroscopy and Single Frequency Regression Equations

For several decades electrical bioimpedance (EBI) has been used to assess body fluid distribution and body composition. Despite the development of several different approaches for assessing total body water (TBW), it remains uncertain whether bioimpedance spectroscopic (BIS) approaches are more accurate than single frequency regression equations. The main objective of this study was to answer this question by calculating the expected accuracy of a single measurement for different EBI methods. The results of this study showed that all methods produced similarly high correlation and concordance coefficients, indicating good accuracy as a method. Even the limits of agreement produced from the Bland-Altman analysis indicated that the performance of single frequency, Suns prediction equations, at population level was close to the performance of both BIS methods; however, when comparing the Mean Absolute Percentage Error value between the single frequency prediction equations and the BIS methods, a significant difference was obtained, indicating slightly better accuracy for the BIS methods. Despite the higher accuracy of BIS methods over 50 kHz prediction equations at both population and individual level, the magnitude of the improvement was small. Such slight improvement in accuracy of BIS methods is suggested insufficient to warrant their clinical use where the most accurate predictions of TBW are required, for example, when assessing over-fluidic status on dialysis. To reach expected errors below 4-5%, novel and individualized approaches must be developed to improve the accuracy of bioimpedance-based methods for the advent of innovative personalized health monitoring applications.

Biosignal PI, an Affordable Open-Source ECG and Respiration Measurement System

Bioimedical pilot projects e.g., telemedicine, homecare, animal and human trials usually involve several physiological measurements. Technical development of these projects is time consuming and in particular costly. A versatile but affordable biosignal measurement platform can help to reduce time and risk while keeping the focus on the important goal and making an efficient use of resources. In this work, an affordable and open source platform for development of physiological signals is proposed. As a first step an 8–12 leads electrocardiogram (ECG) and respiration monitoring system is developed. Chips based on iCoupler technology have been used to achieve electrical isolation as required by IEC 60601 for patient safety. The result shows the potential of this platform as a base for prototyping compact, affordable, and medically safe measurement systems. Further work involves both hardware and software development to develop modules. These modules may require development of front-ends for other biosignals or just collect data wirelessly from different devices e.g., blood pressure, weight, bioimpedance spectrum, blood glucose, e.g., through Bluetooth. All design and development documents, files and source codes will be available for non-commercial use through project website, BiosignalPI.org.

An Affordable ECG and Respiration Monitoring System Based on Raspberry PI and ADAS1000 : First Step towards Homecare Applications

Homecare is a potential solution for problems associated with an aging population. This may involve several physiological measurements, and hence a flexible but affordable measurement device is needed. In this work, we have designed an ADAS1000-based four-lead electrocardiogram (ECG) and respiration monitoring system. It has been implemented using Raspberry PI as a platform for homecare applications. ADuM chips based on iCoupler technology have been used to achieve electrical isolation as required by IEC 60601 and IEC 60950 for patient safety. The result proved the potential of Raspberry PI for the design of a compact, affordable, and medically safe measurement device. Further work involves developing a more flexible software for collecting measurements from different devices (measuring, e.g., blood pressure, weight, impedance spectroscopy, blood glucose) through Bluetooth or user input and integrating them into a cloud-based homecare system.

A Knitted Garment using Intarsia Technique for Heart Rate Variability Biofeedback : Evaluation of Initial Prototype.

Heart rate variability (HRV) biofeedback is a method based on paced breathing at specific rate called resonance frequency by giving online feedbacks from user respiration and its effect on HRV. Since the HRV is also influence by different factors like stress and emotions, stress related to an unfamiliar measurement device, cables and skin electrodes may cover the underling effect of such kind of intervention. Wearable systems are usually considered as intuitive solutions which are more familiar to the end-user and can help to improve usability and hence reducing the stress. In this work, a prototype of a knitted garment using intarsia technique is developed and evaluated. Results show the satisfactory level of quality for Electrocardiogram and thoracic electrical bioimpedance i.e. for respiration monitoring as a part of HRV biofeedback system. Using intarsia technique and conductive yarn for making the connection instead of cables will reduce the complexity of fabrication in textile production and hence reduce the final costs in a final commercial product. Further development of garment and Android application is ongoing and usability and efficiency of final prototype will be evaluated in detail.

Development and preliminary evaluation of an Android based heart rate variability biofeedback system

The reduced Heart Rate Variability (HRV) is believed to be associated with several diseases such as congestive heart failure, diabetes and chronic kidney diseases (CKD). In these cases, HRV biofeedback may be a potential intervention method to increase HRV which in turn is beneficial to these patients. In this work, a real-time Android biofeedback application based on a Bluetooth enabled ECG and thoracic electrical bioimpedance (respiration) measurement device has been developed. The system performance and usability have been evaluated in a brief study with eight healthy volunteers. The result demonstrates real-time performance of system and positive effects of biofeedback training session by increased HRV and reduced heart rate. Further development of the application and training protocol is ongoing to investigate duration of training session to find an optimum length and interval of biofeedback sessions to use in potential interventions.

Cholinergic anti-inflammatory pathway activity in dialysis patients: a role for neuroimmunomodulation?

Background The cholinergic anti-inflammatory pathway (CAP) modulates inflammatory responses through the vagus nerve and the α-7-nicotinic acetylcholine receptor (α7nAChR) on macrophages and immune cells. Sympathetic/parasympathetic imbalance and chronic inflammation are both linked to poor outcome in dialysis patients. The aim of this study was to investigate CAP activity in these patients. Methods Twenty dialysis patients, 12 hemodialysis (HD) and 8 peritoneal dialysis (PD) patients (12 male, 8 female; age range 47–83 years) and 8 controls (5 male, 3 female; age range 31–52 years) were analyzed for C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-1b (IL-1b), IL-6 and IL-10 at baseline. The cytokines were then assessed after whole blood stimulation ex vivo with lipopolysaccharide (LPS) (10 and 100 ng/mL) and again in the presence of 45 and 90 μmol/L GTS-21, a cholinergic α7nAChR agonist. Results CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls. After LPS stimulation, TNF increased significantly more in patients than in controls but decreased to similar levels in both groups after addition of GTS-21. IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients. Interestingly, IL-10 increased after GTS-21 in a dose-dependent manner, but only in patients. Results in HD and PD patients did not differ. Conclusions The response of immune cells after LPS exposure and cholinergic stimulation suggests a functional CAP in dialysis patients. It may thus be possible to target the α7nAChR control of cytokine release as an anti-inflammatory strategy and thereby improve outcome in these patients.

Elimination of ECG Artefacts in Foetal EEG Using Ensemble Average Subtraction and Wavelet Denoising Methods : A Simulation

Biological signals recorded from surface electrodes contain interference from other signals which are not desired and should be considered as noise. Heart activity is especially present in EEG and ...

Removing respiratory artefacts from transthoracic bioimpedance spectroscopy measurements

Transthoracic impedance spectroscopy (TIS) measurements from wearable textile electrodes provide a tool to remotely and non-invasively monitor patient health. However, breathing and cardiac process ...

Software Tool for Analysis of Breathing Related Errors in Transthoracic Electrical Bioimpedance Spectroscopy Measurements

During the last decades, Electrical Bioimpedance Spectroscopy (EBIS) has been applied in a range of different applications and mainly using the frequency sweep-technique. Traditionally the tissue under study is considered to be timeinvariant and dynamic changes of tissue activity are ignored and instead treated as a noise source. This assumption has not been adequately tested and could have a negative impact and limit the accuracy for impedance monitoring systems. In order to successfully use frequency-sweeping EBIS for monitoring time-variant systems, it is paramount to study the effect of frequency-sweep delay on Cole Model-based analysis. In this work, we present a software tool that can be used to simulate the influence of respiration activity in frequency-sweep EBIS measurements of the human thorax and analyse the effects of the different error sources. Preliminary results indicate that the deviation on the EBIS measurement might be significant at any frequency, and especially in the impedance plane. Therefore the impact on Cole-model analysis might be different depending on method applied for Cole parameter estimation.

Elliptical broken line method for calculating capillary density in nailfold capillaroscopy: Proposal and evaluation

Nailfold capillaroscopy is a practical method for identifying and obtaining morphological changes in capillaries which might reveal relevant information about diseases and health. Capillaroscopy is harmless, and seems simple and repeatable. However, there is lack of established guidelines and instructions for acquisition as well as the interpretation of the obtained images; which might lead to various ambiguities. In addition, assessment and interpretation of the acquired images are very subjective. In an attempt to overcome some of these problems, in this study a new modified technique for assessment of nailfold capillary density is introduced. The new method is named elliptic broken line (EBL) which is an extension of the two previously known methods by defining clear criteria for finding the apex of capillaries in different scenarios by using a fitted elliptic. A graphical user interface (GUI) is developed for pre-processing, manual assessment of capillary apexes and automatic correction of selected apexes based on 90° rule. Intra- and inter-observer reliability of EBL and corrected EBL is evaluated in this study. Four independent observers familiar with capillaroscopy performed the assessment for 200 nailfold videocapillaroscopy images, form healthy subject and systemic lupus erythematosus patients, in two different sessions. The results show elevation from moderate (ICC=0.691) and good (ICC=0.753) agreements to good (ICC=0.750) and good (ICC=0.801) for intra- and inter-observer reliability after automatic correction of EBL. This clearly shows the potential of this method to improve the reliability and repeatability of assessment which motivates us for further development of automatic tool for EBL method.