Paper towel shredding as a novel, affordable, noninvasive method for detecting arousals in hibernating rodents

Many research groups explore the regulation of hibernation or compare the physiology of heterothermic mammals between the torpid and aroused, euthermic states. Current methods for monitoring torpor (for example, infrared cameras, body temperature or heart-rate telemetry, and motion sensing) are costly, require specialized techniques, and can be invasive. Here we present an alternate method for determining torpor-bout duration that is cost-effective, noninvasive and accurate: paper towel shredding. In the winter, euthermic thirteen-lined ground squirrels will shred paper towels placed in the cage, but torpid animals will not. The presence of a shredded paper towel, indicating an arousal from torpor, is easily evaluated during routine daily monitoring. In 12 animals over 52 days, this simple technique detected 59 arousals with 100% accuracy when compared with the body temperature telemetry of the same animals. Moreover, this novel method avoids some of the drawbacks of other cheap monitoring systems such as the sawdust technique.

"But for the blind spot": Accuracy and diagnostic performance of smart watch cardiac features in pediatric patients

BACKGROUND

The Apple Watch™ (AW) offers heart rate (HR) tracking by photoplethysmography (PPG) and single-lead electrocardiographic (ECG) recordings. The accuracy of AW-HR and diagnostic performance of AW-ECGs among children during both sinus rhythm and arrhythmias have not been explored.

OBJECTIVE

The purposes of this study were to assess the accuracy of AW-HR measurements compared to gold standard modalities in children during sinus rhythm and arrhythmias and to identify non-sinus rhythms using AW-ECGs.

METHODS

Subjects ≤18 years wore an AW during (1) telemetry admission, (2) electrophysiological study (EPS), or (3) exercise stress test (EST). AW-HRs were compared to gold standard modality values. Recorded AW-ECGs were reviewed by 3 blinded pediatric electrophysiologists.

RESULTS

Eighty subjects (median age 13 years; interquartile range 1.0-16.0 years; 50% female) wore AW (telemetry 41% [n = 33]; EPS 34% [n = 27]; EST 25% [n = 20]). A total of 1090 AW-HR measurements were compared to time-synchronized gold standard modality HR values. Intraclass correlation coefficient (ICC) was high 0.99 (0.98-0.99) for AW-HR during sinus rhythm compared to gold standard modalities. ICC was poor comparing AW-HR to gold standard modality HR in tachyarrhythmias (ICC 0.24-0.27) due to systematic undercounting of AW-HR values. A total of 126 AW-ECGs were reviewed. Identification of non-sinus rhythm by AW-ECG showed sensitivity of 89%-96% and specificity of 78%-87%.

CONCLUSIONS

We found high levels of agreement for AW-HR values with gold standard modalities during sinus rhythm and poor agreement during tachyarrhythmias, likely due to hemodynamic effects of tachyarrhythmias on PPG-based measurements. AW-ECGs had good sensitivity and moderate specificity in identification of non-sinus rhythm in children.

The patient experience of in-hospital telemetry monitoring: a qualitative analysis

AIMS

In-hospital telemetry monitoring has been an integrated part of arrhythmia monitoring for decades. A substantial proportion of patients require arrhythmia monitoring during stays in non-intensive care units. However, studies exploring patients' experiences of telemetry monitoring are scarce. Therefore, the aim was to explore and describe patients' experiences of in-hospital telemetry monitoring in a non-intensive care setting.

METHODS AND RESULTS

Twenty face-to-face, semi-structured interviews were conducted. Interviews were conducted before discharge at two university hospitals in Norway. The patients were purposively sampled, resulting in a well-balanced population comprising 11 men and nine women, mean age 62 years (range 25-83). Average monitoring time was 9 days (range 3-14). Data were audiotaped, transcribed verbatim, and coded using NVivo software. Qualitative content analysis using an inductive approach was performed. Patients expressed a need for individualized information during telemetry monitoring. Their feelings of safety were related to responses from nurses from the central monitoring station when alarms from the telemetry were triggered. Despite perceived physical restrictions and psychological limitations associated with telemetry monitoring, they found monitoring to be beneficial because it facilitated the diagnosis of arrhythmia. Moreover, they expressed a need for improvements in wearable monitoring equipment. Patients expressed ambivalent feelings about discontinuing the telemetry and their readiness for discharge.

CONCLUSION

Patients need individualized information about the results of their telemetry monitoring in order to better understand the arrhythmia management and to increase their experience of safety after discharge. The limitations patients experienced should be taken into consideration in further upgrades of telemetry monitoring equipment.

Analysis of Electrocardiograms and Behavior in Mice from Pregnancy to Lactation Period

Changes in the mother-offspring relationship are presumably accompanied by dynamic changes in the autonomic nervous system. Although temporal measurements of autonomic activity have been performed in human mothers and infants, the analysis of long-term changes remains unexplored. Mouse mothers can form social bonds with their pups and have a short period of pregnancy and lactation, which makes them useful for the examination of physiological changes from pregnancy to pup-rearing. Therefore, a telemetry system was used for several weeks to measure the changes in the autonomic nervous system and the behavior of mouse mothers. The current results showed that an electrocardiogram (ECG) could be stably recorded regardless of the movements of mothers and parturition. ECG analysis showed that the heart rate gradually decreased from pregnancy to lactation, and sympathetic activity sharply increased as the pups developed. Furthermore, the simultaneous recording of behavior and ECG in the home cage enabled us to understand the behavior-dependent influences on the ECG, thereby revealing the characteristics of autonomic nervous activity during each behavior. Thus, the present experimental method helps to understand how the physiological characteristics of mothers change from pregnancy through pup rearing, supporting the healthy development of pups.

[Options for home telemonitoring in heart failure patients]

OBJECTIVE

To provide an overview of the effectiveness of various forms of home telemonitoring systems for heart failure and the potential role these systems may have in decreasing the burden on healthcare through reduction in heart failure hospitalizations.

DESIGN

Meta-analysis of randomized and observational studies.

METHODS

A meta-analysis of randomized and observational studies was carried out to assess the effect on mortality and heart failure-related hospitalizations, comparing standard heart failure care with the use of home monitoring systems.

RESULTS

The pooled results from 92 studies demonstrate a reduction in the risk of both mortality and heart failure admissions.

CONCLUSION

The results of this meta-analysis support the use of home telemonitoring systems. Determining which form of home telemonitoring is most suitable for which patient requires further research.

TrackdAT, an acoustic telemetry metadata dataset to support aquatic animal tracking research

Data on the movement and space use of aquatic animals are crucial to understand complex interactions among biotic and abiotic components of ecosystems and facilitate effective conservation and management. Acoustic telemetry (AT) is a leading method for studying the movement ecology of aquatic animals worldwide, yet the ability to efficiently access study information from AT research is currently lacking, limiting advancements in its application. Here, we describe TrackdAT, an open-source metadata dataset where AT research parameters are catalogued to provide scientists, managers, and other stakeholders with the ability to efficiently identify and evaluate existing peer-reviewed research. Extracted metadata encompasses key information about biological and technical aspects of research, providing a comprehensive summary of existing AT research. TrackdAT currently hosts information from 2,412 journal articles published from 1969 to 2022 spanning 614 species and 380,289 tagged animals. TrackdAT has the potential to enable regional and global mobilization of knowledge, increased opportunities for collaboration, greater stakeholder engagement, and optimization of future ecological research.

Troubleshooting Cochlear Implant Malfunction Using Neural Response Telemetry and Normal Saline

Cochlear implantation has become a standard of care for a child diagnosed with bilateral profound sensorineural hearing loss with a structured surgical standard operating procedure. A 3-year-old boy with bilateral profound prelingual sensorineural deafness underwent a Med-EL Sonata Ti100 implant. We faced a peculiar situation intraoperatively after inserting the electrodes and closing the wound. The impedance recording indicated high ground path impedance with short-circuiting of few electrodes. As a bionic implant, its electronic components may at times malfunction both intraoperatively and/or postoperatively; therefore, neural response telemetry (NRT) was invented to check it. By using NRT and a few milliliters of normal saline, we were able to diagnose as well as rectify the malfunctioning of the implant.

The unforeseen future: Impacts of the COVID-19 pandemic on home video-EEG telemetry

The coronavirus disease 2019 (COVID-19) pandemic had widespread impact on health care systems globally-particularly services arranged around elective admission and attendance such as epilepsy monitoring units and home video-EEG telemetry (HVET). Here, we review the ongoing impacts of the pandemic on HVET services among several different providers who used different initial models of HVET. We discuss the features of HVET that led to success in providing continued diagnostic services to patients with epilepsy and related disorders and through retrospective audit of our services demonstrate the high diagnostic yield of HVET. We reflect on this unforeseen future and its implications for other diagnostic techniques and approaches.

Fully implanted battery-free high power platform for chronic spinal and muscular functional electrical stimulation

Electrical stimulation of the neuromuscular system holds promise for both scientific and therapeutic biomedical applications. Supplying and maintaining the power necessary to drive stimulation chronically is a fundamental challenge in these applications, especially when high voltages or currents are required. Wireless systems, in which energy is supplied through near field power transfer, could eliminate complications caused by battery packs or external connections, but currently do not provide the harvested power and voltages required for applications such as muscle stimulation. Here, we introduce a passive resonator optimized power transfer design that overcomes these limitations, enabling voltage compliances of ± 20 V and power over 300 mW at device volumes of 0.2 cm2, thereby improving power transfer 500% over previous systems. We show that this improved performance enables multichannel, biphasic, current-controlled operation at clinically relevant voltage and current ranges with digital control and telemetry in freely behaving animals. Preliminary chronic results indicate that implanted devices remain operational over 6 weeks in both intact and spinal cord injured rats and are capable of producing fine control of spinal and muscle stimulation.

Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study

BACKGROUND

Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption.

OBJECTIVE

We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF.

METHODS

We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use.

RESULTS

Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring.

CONCLUSIONS

The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups.

A 60Mb/s -64dBm Body Channel Communication Transceiver Utilizing Manchester Code

Body channel communication (BCC) which uses the human body as the communication channel has shown better energy efficiency and security compared with air channel communication. This article presents a simple, stable, and high transfer rate BCC technique using Manchester encoding, capacitive termination, and digital signal transfer operation. Manchester encoding is used to realize the spectrum migration of the baseband signal, and digital signal transmission simplifies system design and improves signal stability. The chip is fabricated in 65-nm technology. The experimental results show that the proposed transceiver achieved the highest data rates of 60 Mbps and the measured RX sensitivity is -64dBm. And the chip is also used to set up a multi-sensor nodes communication system to realize the data interaction between one hub and eight slave sensors utilizing the human body as the communication medium.

What to consider for ECG in mice-with special emphasis on telemetry

Genetically or surgically altered mice are commonly used as models of human cardiovascular diseases. Electrocardiography (ECG) is the gold standard to assess cardiac electrophysiology as well as to identify cardiac phenotypes and responses to pharmacological and surgical interventions. A variety of methods are used for mouse ECG acquisition under diverse conditions, making it difficult to compare different results. Non-invasive techniques allow only short-term data acquisition and are prone to stress or anesthesia related changes in cardiac activity. Telemetry offers continuous long-term acquisition of ECG data in conscious freely moving mice in their home cage environment. Additionally, it allows acquiring data 24/7 during different activities, can be combined with different challenges and most telemetry systems collect additional physiological parameters simultaneously. However, telemetry transmitters require surgical implantation, the equipment for data acquisition is relatively expensive and analysis of the vast number of ECG data is challenging and time-consuming. This review highlights the limits of non-invasive methods with respect to telemetry. In particular, primary screening using non-invasive methods can give a first hint; however, subtle cardiac phenotypes might be masked or compensated due to anesthesia and stress during these procedures. In addition, we detail the key differences between the mouse and human ECG. It is crucial to consider these differences when analyzing ECG data in order to properly translate the insights gained from murine models to human conditions.

The impact of environmental and biological factors on the resting heart rate of dogs as assessed using 20 years of data from safety pharmacology studies

INTRODUCTION

A safety pharmacology study detects and evaluates potential side effects of a new drug on physiological function at therapeutic levels and above and, in most cases, prior to the initiation of clinical trials. The aim of this study was to investigate the effects of environmental and biological factors on resting heart rate (HR), a representative cardiac parameter in cardiovascular safety pharmacology.

METHODS

Over twenty years, 143 dogs (Beagles, Labradors and mongrels) received implanted telemetry transmitters to measure aortic pressure (AP), left ventricular pressure (LVP), Electrocardiogram (ECG) and body temperature. Throughout the 7-h period of data collection, data were continuously recorded without drug treatment and included the range of HRs resulting from spontaneous physiological changes. Statistics and visualizations were calculated using R and Spotfire.

RESULTS

Beagles had a higher HR than the mongrels, while Labradors had a lower HR than mongrels. Labradors were found to have a sex-based difference in HR, with females having a higher HR. A higher HR was observed in young animals of all breeds when they were in contact with humans. The cage system affected the HR of Labradors and mongrels more than Beagles. Larger dogs (e.g. Labrador) have a lower HR than smaller dogs (Beagles). Animals that are younger were found to have more HR variability and have a higher HR than older animals. In addition, older animals reacted less to the application period and human interaction than younger animals. The HR response of animals inside a cage system may depend on the cage system in which they were bred. A familiar cage system typically has less impact on HR.

DISCUSSION

This retrospective data base evaluation has demonstrated the impact of environmental and biological factors on cardiovascular parameters in the context of performing safety pharmacology studies. Breed, sex, age and the type of cage system used affected, at least in some cases, the HR and its variability. They should therefore be carefully considered when designing safety pharmacology studies to have the highest possible test sensitivity.

Tell-a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system

BACKGROUND

Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing.

METHODS

This quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA) that would fire after the recommended time period for reassessment had passed.

RESULTS

The average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-h reorder rate. There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner).

CONCLUSION

We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.

A comparison of activity data generated from cardiovascular telemetry studies - With quantitative open field locomotor studies in Wistar Han rats

Compound-mediated locomotion changes, conducted via open field infrared photobeam breaks, are an important common component of neurological assessments conducted in safety pharmacology studies. In addition to open field locomotor activity assessments, activity data (derived from changes in signal strength) from cardiovascular (CV) telemetry studies can also be an alternative method potentially used to assess locomotor effects. However, comparisons of these two methods have not been extensively characterized. The goal of this work was to compare these two methodologies to assess activity in rats using reference compounds known to have central nervous system (CNS)-stimulant (preladenant) or CNS-depressant (chlorpromazine) effects. Open field activity was conducted using the Kinder Scientific Motor Monitor system and data were collected for 30 min at each drug's expected time of maximum plasma exposure (Tmax). Telemetry-based CV assessment data were continuously acquired using DSI radiotelemetry instrumented animals for 24 h postdose (HPD). Drugs were administered during the lights-on period for both study types. Administration of preladenant caused increases in activity within 0.5-2 HPD for both methods. While administration of chlorpromazine caused decreases in activity in the infrared beam-based open field assessment (1.0-1.5 HPD), there was no effect on telemetry-derived activity during a similar time period. However, telemetry-derived decreases in activity were observed during the lights-off period (16-20 HPD), suggesting CNS-depressant compounds may be mischaracterized if the optimal dose administration time is not selected based on the light/dark cycle and pharmacokinetics. Overall, these results suggest that telemetry-based activity assessment is capable of detecting CNS-stimulant effects of compounds.

The contemporary ways of introduction ECG technology: ML, telemetry and bioauthentification

It has been exactly 180 years since the pioneering work of Dr. Carlo Matteucci, professor of physics at the University of Pisa (1842), laid the basis of the method for the registration of biopotentials generated by muscles. In particular, these studies have found practical application in the principal non-invasive method of functional diagnosis of the cardiac muscle - electrocardiography (ECG). Almost a century has passed since this method became recognized and widely used in the clinic. However, to date, it has not only retained its importance in practical medicine but also remains a valuable diagnostic tool. This method allows understanding and effectively prevents errors in the present and future repetition. There are observed favorable trends of ECG-based diagnostics systems implementation and improvement in functional assessment of myocardium electrophysiological characteristics, which reflect cardiovascular pathological vital markers. The essential aim of this article is to demonstrate modern approaches of implementing ECG technology to various fields of medicine and health informatics. This research demonstrated a large number of modern innovations devoted to the automation and modification of implementation of this electrophysiological method and the possible ways to implement it in matters of home and individual monitoring of patients. Furthermore, the review examines the socio-economic issues of deploying and administering tele-ECG technologies to follow up on the global principles of digitization of healthcare and on-site diagnostics by emergency medical services (Tab. 2, Fig. 4, Ref. 87). Keywords: electrocardiography, tele-ECG, user bioauthentification.

A Wireless Autonomous Real-Time Underwater Acoustic Positioning System

Recent acoustic telemetry positioning systems are able to reconstruct the positions and trajectories of organisms at a scale of a few centimeters to a few meters. However, they present several logistical constraints including receiver maintenance, calibration procedures and limited access to real-time data. We present here a novel, easy-to-deploy, energy self-sufficient underwater positioning system based on the time difference of arrival (TDOA) algorithm and the Global System for Mobile (GSM) communication technology, capable of locating tagged marine organisms in real time. We provide an illustration of the application of this system with empirical examples using continuous and coded tags in fish and benthic invertebrates. In situ experimental tests of the operational system demonstrated similar performances to currently available acoustic positioning systems, with a global positioning error of 7.13 ± 5.80 m (mean ± SD) and one-third of the pings can be localized within 278 m of the farthest buoy. Despite some required improvements, this prototype is designed to be autonomous and can be deployed from the surface in various environments (rivers, lakes, and oceans). It was proven to be useful to monitor a wide variety of species (benthic and pelagic) in real time. Its real-time property can be used to rapidly detect system failure, optimize deployment design, or for ecological or conservation applications.

[Remote electrocardiogram telemonitoring after endovascular interventions on the coronary arteries]

AIM

To evaluate the effectiveness of a new system for telemetric electrocardiogram (ECG) monitoring in patients after endovascular interventions (EI) on the coronary arteries (CA).

MATERIALS AND METHODS

168 patients with chronic ischemic heart disease who underwent EI on the CA on an outpatient basis, and during routine hospitalization, followed by telemetric ECG-monitoring after interventions were included. The monitoring was carried out using a three-channel telemetric recorder Astrocard HE3 (Russia), which provides continuous monitoring of 3-lead ECG for a long time.

RESULTS

The telemetry was successfully performed in all 168 (100%) patients. In 165 (98%) patients, the quality of the recording was regarded as good, in 3 (2%) as satisfactory. There were no cases of disconnection of the device, no interruptions in recording. During the observation period, no life-threatening arrhythmia revealed. When comparing the telemetry results in different groups of patients, there were no significant differences in the incidence of arrhythmia. Patients with a history of percutaneous coronary interventions were questioned; according to which 92% of respondents reported that they felt more comfortable after the intervention followed by telemetric ECG-monitoring.

CONCLUSION

Carrying out telemetric ECG-monitoring after EI on the CA improves the quality of observation after the procedure, promotes early discharge of patients, makes the intervention more comfortable and safe. The introduction of this technique into clinical practice will make it possible to more widely use the outpatient approach when carrying out EI, and to increase the turnover of specialized beds and the efficiency of the work of medical institutions.

Evaluation of six methods for external attachment of electronic tags to fish: assessment of tag retention, growth and fish welfare

External attachment of electronic tags has been increasingly used in fish studies. Many researchers have used ad hoc attachment methods and provided little or no validation for the assumption that tagging itself does not bias animal behaviour or survival. The authors compared six previously published methods for externally attaching acoustic transmitters to fish in a tank holding experiment with black sea bass Centropristis striata (L.). They tracked tag retention, fish growth and external trauma (as a measure of fish welfare) for 60 days. For each of these metrics, the results showed a wide range of responses among tagging treatments. A simple attachment method using a spaghetti tag passed through the dorsal musculature of the fish and tied to the end cap of the transmitter emerged as the preferred option based on high retention, no impact on growth and relatively low detriment to fish welfare. Future field studies using external electronic tagging should consider tag-related effects that could compromise results when selecting a method for tag attachment.

A Power-Harvesting CGM Chiplet Featuring Silicon-Based Enzymatic Glucose Sensor

Diabetes has become a leading cause of death and disability in the past decades. Continuous glucose monitoring (CGM) is a prevailing technique to determine the glucose level and provide in-time treatment. However, conventional CGM systems combine an electrochemical sensor with a CMOS chip, suffering from bulky size and interface issues. Integrating the CGM sensor on silicon is potential to miniaturize the CGM system and reduce the cost, while the recent silicon-based sensors show limited detection range and sensitivity. In this work, we present a silicon-based CGM chip let with wireless power transfer (WPT) and real-time wireless telemetry. Fabricated on a single silicon substrate, the chiplet consists of a silicon-based CGM sensor, a power-harvesting wireless-telemetry chip, and a silicon-based antenna. Measured results show that the chip let achieves a sensitivity of 4 μA.mM.cm-2 and a linear detection range of 0-10 mM. Based on WPT and backscattering communication, the chip let consumes 18.8 μ W power in glucose telemetry.

Hexagonal Stimulation Digital Controller Design and Verification for Wireless Subretinal Implant Device

Significant progress has been made in the field of micro/nano-retinal implant technologies. However, the high pixel range, power leakage, reliability, and lifespan of retinal implants are still questionable. Active implantable devices are safe, cost-effective, and reliable. Although a device that can meet basic safety requirements set by the Food and Drug Administration and the European Union is reliable for long-term use and provides control on current and voltage parameters, it will be expensive and cannot be commercially successful. This study proposes an economical, fully controllable, and configurable wireless communication system based on field-programmable gated arrays (FPGAs) that were designed with the ability to cope with the issues that arise in retinal implantation. This system incorporates hexagonal biphasic stimulation pulses generated by a digital controller that can be fully controlled using an external transmitter. The integration of two separate domain analog systems and a digital controller based on FPGAs is proposed in this study. The system was also implemented on a microchip and verified using in vitro results.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic

OBJECTIVE

The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase.

PATIENTS AND METHODS

From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines.

RESULTS

79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21).

CONCLUSIONS

Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care

BACKGROUND

Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4-10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks.

METHODS

Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates.

RESULTS

48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL).

CONCLUSIONS

Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting.

TRIAL REGISTRATION

Trial registration number: NCT02925312 (10/19/2016).

Time Window of Head Impact Kinematics Measurement for Calculation of Brain Strain and Strain Rate in American Football

Wearable devices have been shown to effectively measure the head's movement during impacts in sports like American football. When a head impact occurs, the device is triggered to collect and save the kinematic measurements during a predefined time window. Then, based on the collected kinematics, finite element (FE) head models can calculate brain strain and strain rate, which are used to evaluate the risk of mild traumatic brain injury. To find a time window that can provide a sufficient duration of kinematics for FE analysis, we investigated 118 on-field video-confirmed football head impacts collected by the Stanford Instrumented Mouthguard. The simulation results based on the kinematics truncated to a shorter time window were compared with the original to determine the minimum time window needed for football. Because the individual differences in brain geometry influence these calculations, we included six representative brain geometries and found that larger brains need a longer time window of kinematics for accurate calculation. Among the different sizes of brains, a pre-trigger time of 40 ms and a post-trigger time of 70 ms were found to yield calculations of brain strain and strain rate that were not significantly different from calculations using the original 200 ms time window recorded by the mouthguard. Therefore, approximately 110 ms is recommended for complete modeling of impacts for football.

Technical fishway passage structures provide high passage efficiency and effective passage for adult Pacific salmonids at eight large dams

Fishways have been widely used for upstream passage around human-built structures, but 'success' has varied dramatically. Evaluation of fishway success has typically been conducted at local scales using metrics such as fish passage efficiency and passage time, but evaluations are increasingly used in broader assessments of whether passage facilities meet population-specific conservation and management objectives. Over 15 years, we monitored passage effectiveness at eight dams on the Columbia and Snake rivers for 26,886 radio-tagged spring-summer and fall Chinook Salmon O. tshwaytscha, Sockeye Salmon O. nerka, and summer steelhead O. mykiss during their migrations to spawning sites. Almost all fish that entered dam tailraces eventually approached and entered fishways. Tailrace-to-forebay passage efficiency estimates at individual dams were consistently high, averaging 0.966 (SD = 0.035) across 245 run×year×dam combinations. These estimates are among the highest recorded for any migratory species, which we attribute to the scale of evaluation, salmonid life history traits (e.g., philopatry), and a sustained adaptive management approach to fishway design, maintenance, and improvement. Full-dam fish passage times were considerably more variable, with run×year×dam medians ranging from 5-65 h. Evaluation at larger scales provided evidence that fishways were biologically effective, e.g., we observed rapid migration rates (medians = 28-40 km/d) through river reaches with multiple dams and estimated fisheries-adjusted upstream migration survival of 67-69%. However, there were substantive uncertainties regarding effectiveness. Uncertainty about natal origins confounded estimation of population-specific survival and interpretation of apparent dam passage 'failure', while lack of post-migration reproductive data precluded analyses of delayed or cumulative effects of passing the impounded system on fish fitness. Although the technical fishways are effective for salmonids in the Columbia-Snake River system, other co-migrating species have lower passage rates, highlighting the need for species-specific design and evaluation wherever passage facilities impact fish management and conservation goals.

Mechanisms of disease-modifying effect of saracatinib (AZD0530), a Src/Fyn tyrosine kinase inhibitor, in the rat kainate model of temporal lobe epilepsy

We have recently demonstrated the role of the Fyn-PKCδ signaling pathway in status epilepticus (SE)-induced neuroinflammation and epileptogenesis in experimental models of temporal lobe epilepsy (TLE). In this study, we show a significant disease-modifying effect and the mechanisms of a Fyn/Src tyrosine kinase inhibitor, saracatinib (SAR, also known as AZD0530), in the rat kainate (KA) model of TLE. SAR treatment for a week, starting the first dose (25 mg/kg, oral) 4 h after the onset of SE, significantly reduced spontaneously recurring seizures and epileptiform spikes during the four months of continuous video-EEG monitoring. Immunohistochemistry of brain sections and Western blot analyses of hippocampal lysates at 8-day (8d) and 4-month post-SE revealed a significant reduction of SE-induced astrogliosis, microgliosis, neurodegeneration, phosphorylated Fyn/Src-419 and PKCδ-tyr311, in SAR-treated group when compared with the vehicle control. We also found the suppression of nitroxidative stress markers such as iNOS, 3-NT, 4-HNE, and gp91phox in the hippocampus, and nitrite and ROS levels in the serum of the SAR-treated group at 8d post-SE. The qRT-PCR (hippocampus) and ELISA (serum) revealed a significant reduction of key proinflammatory cytokines TNFα and IL-1β mRNA in the hippocampus and their protein levels in serum, in addition to IL-6 and IL-12, in the SAR-treated group at 8d in contrast to the vehicle-treated group. These findings suggest that SAR targets some of the key biomarkers of epileptogenesis and modulates neuroinflammatory and nitroxidative pathways that mediate the development of epilepsy. Therefore, SAR can be developed as a potential disease-modifying agent to prevent the development and progression of TLE.

Telemonitoring-Supported Exercise Training in Employees With Metabolic Syndrome Improves Liver Inflammation and Fibrosis

INTRODUCTION

Metabolic syndrome (MetS) is a major health problem worldwide and the main risk factor for metabolic-associated fatty liver disease (MAFLD). Established treatment options are lifestyle interventions facilitating dietary change and increased physical activity. Here, we tested the effect of a telemonitoring-supported intervention on liver parameter of inflammation and fibrosis in individuals with MetS.

METHODS

This was a prospective, randomized, parallel-group, and assessor-blind study performed in workers of the main Volkswagen factory (Wolfsburg, Germany). Volunteers with diagnosed MetS were randomly assigned (1:1) to a 6-month lifestyle intervention focusing on supervised, activity-tracker-guided exercise or to a waiting-list control group. This secondary analysis assessed the effect of the intervention on liver enzymes and MAFLD-related parameters.

RESULTS

We screened 543 individuals between October 10, 2017, and February 27, 2018, of whom 314 were randomly assigned to the intervention group (n = 160) or control group (n = 154). Liver transaminases, alkaline phosphatase, and gamma-glutamyl transferase significantly decreased after 6 months in the intervention group compared with the CG. Furthermore, an aspartate aminotransferase-to-platelet ratio index score as a marker for liver fibrosis significantly decreased in the intervention group. These improvements were associated with changes in obesity and exercise capacity.

DISCUSSION

A 6-month lifestyle intervention based on exercise training with individualized telemonitoring-based supervision led to improvements of liver inflammation and fibrosis in employees with MetS. Therefore, this intervention shows therapeutic potential for individuals at high risk of MAFLD (ClinicalTrials.gov Identifier: NCT03293264).

Implanted Microsensor Continuous IOP Telemetry Suggests Gaze and Eyelid Closure Effects on IOP-A Preliminary Study

Purpose

To explore the effect of gaze direction and eyelid closure on intraocular pressure (IOP).

Methods

Eleven patients with primary open-angle glaucoma previously implanted with a telemetric IOP sensor were instructed to view eight equally-spaced fixation targets each at three eccentricities (10°, 20°, and 25°). Nine patients also performed eyelid closure. IOP was recorded via an external antenna placed around the study eye. Differences of mean IOP between consecutive gaze positions were calculated. Furthermore, the effect of eyelid closure on gaze-dependent IOP was assessed.

Results

The maximum IOP increase was observed at 25° superior gaze (mean ± SD: 4.4 ± 4.9 mm Hg) and maximum decrease at 25° inferonasal gaze (-1.6 ± 0.8 mm Hg). There was a significant interaction between gaze direction and eccentricity (P = 0.003). Post-hoc tests confirmed significant decreases inferonasally for all eccentricities (mean ± SEM: 10°: -0.7 ± 0.2, P = 0.007; 20°: -1.1 ± 0.2, P = 0.006; and 25°: -1.6 ± 0.2, P = 0.006). Eight of 11 eyes showed significant IOP differences between superior and inferonasal gaze at 25°. IOP decreased during eyelid closure, which was significantly lower than downgaze at 25° (mean ± SEM: -2.1 ± 0.3 mm Hg vs. -0.7 ± 0.2 mm Hg, P = 0.014).

Conclusions

Our data suggest that IOP varies reproducibly with gaze direction, albeit with patient variability. IOP generally increased in upgaze but decreased in inferonasal gaze and on eyelid closure. Future studies should investigate the patient variability and IOP dynamics.

Noninvasive Neuroprosthesis Promotes Cardiovascular Recovery After Spinal Cord Injury

Spinal cord injury (SCI) leads to severe impairment in cardiovascular control, commonly manifested as a rapid, uncontrolled rise in blood pressure triggered by peripheral stimuli-a condition called autonomic dysreflexia. The objective was to demonstrate the translational potential of noninvasive transcutaneous stimulation (TCS) in mitigating autonomic dysreflexia following SCI, using pre-clinical evidence and a clinical case report. In rats with SCI, we show that TCS not only prevents the instigation of autonomic dysreflexia, but also mitigates its severity when delivered during an already-triggered episode. Furthermore, when TCS was delivered as a multisession therapy for 6 weeks post-SCI, the severity of autonomic dysreflexia was significantly reduced when tested in the absence of concurrent TCS. This treatment effect persisted for at least 1 week after the end of therapy. More importantly, we demonstrate the clinical applicability of TCS in treatment of autonomic dysreflexia in an individual with cervical, motor-complete, chronic SCI. We anticipate that TCS will offer significant therapeutic advantages, such as obviating the need for surgery resulting in reduced risk and medical expenses. Furthermore, this study provides a framework for testing the potential of TCS in improving recovery of other autonomic functions such lower urinary tract, bowel, and sexual dysfunction following SCI.

Long-term telemetric intracerebral pressure monitoring as a tool in intracranial hypotension

Intracranial hypotension (IH) remains a difficult neurosurgical diagnosis. Relying solely on the symptomatology may be misleading for both diagnosis and assessment of treatment effect as symptoms may resemble other conditions not related to IH. As such, paraclinical supplements in both diagnosis and treatment follow-up are warranted. We present a 42-year-old male with IH treated with computed tomography-guided epidural blood patch. The diagnosis and treatment assessment included continual intracerebral pressure (ICP) monitoring. We found ICP monitoring helpful in IH diagnosis and long-term assessment of treatment and propose this modality as a supplement in difficult IH cases.

Telemetric monitoring in idiopathic intracranial hypertension demonstrates intracranial pressure in a case with sight-threatening disease

The understanding of raised intracranial pressure (ICP) is increasing with the directed use of intracranial telemetric ICP monitors. This case uniquely observed ICP changes by telemetric monitoring in a patient with idiopathic intracranial hypertension (IIH), who developed rapid sight-threatening disease. A lumbar drain was inserted, as a temporising measure, and was clamped prior to surgery. This resulted in a rapid rise in ICP, which normalised after insertion of a ventriculoperitoneal shunt. This case highlighted the utility of the ICP monitor and the lumbar drain as a temporising measure to control ICP prior to a definitive procedure as recommended by the IIH consensus guidelines.

Ethical issues in using ambient intelligence in health-care settings

Ambient intelligence is increasingly finding applications in health-care settings, such as helping to ensure clinician and patient safety by monitoring staff compliance with clinical best practices or relieving staff of burdensome documentation tasks. Ambient intelligence involves using contactless sensors and contact-based wearable devices embedded in health-care settings to collect data (eg, imaging data of physical spaces, audio data, or body temperature), coupled with machine learning algorithms to efficiently and effectively interpret these data. Despite the promise of ambient intelligence to improve quality of care, the continuous collection of large amounts of sensor data in health-care settings presents ethical challenges, particularly in terms of privacy, data management, bias and fairness, and informed consent. Navigating these ethical issues is crucial not only for the success of individual uses, but for acceptance of the field as a whole.

Feasibility of using surgical implantation methods for acoustically tagging alewife (Alosa pseudoharengus) with V5 acoustic transmitters

Anadromous alewives (Alosa pseudoharengus) are abundant in the Canadian Maritimes, where they support lucrative commercial fisheries. Little is known about their coastal movement, and their potential to interact with anthropogenic structures. Acoustic telemetry can provide detailed information on the spatiotemporal distribution and survival of fishes in coastal areas, using information transmitted from tagged fishes and recorded by moored receivers. However, few acoustic telemetry studies have been performed on clupeids as they are extremely sensitive to handling, and are often compromised by surgical tag implantation. This research assesses the feasibility of a surgical tagging protocol using novel High Residency acoustic tags in alewives, and establishes a baseline of short-term tagging effects. Alewives from the Gaspereau River population were tagged between 2018 (n = 29) and 2019 (n = 96) with non-transmitting models of Vemco/Innovasea V5 HR tags. Tagging effects were evaluated based on recovery rate, reflex impairment, and necropsy-based health assessments. Alewives responded well to tagging, with low mortality (3%) and no observed instances of tag shedding 72 hours post-surgery. The use of sutures to close the incision site had no effect on recovery times. Water temperature and spawning condition had the greatest effect on the behavioural response of fish to tagging. Our findings suggest that, with proper handling and smaller acoustic tags, telemetry studies on alewives are feasible.

Comparison of extraocular and intraocular pressure transducers for measurement of transient intraocular pressure fluctuations using continuous wireless telemetry

The optimal approach for continuous measurement of intraocular pressure (IOP), including pressure transducer location and measurement frequency, is currently unknown. This study assessed the capability of extraocular (EO) and intraocular (IO) pressure transducers, using different IOP sampling rates and duty cycles, to characterize IOP dynamics. Transient IOP fluctuations were measured and quantified in 7 eyes of 4 male rhesus macaques (NHPs) using the Konigsberg EO system (continuous at 500 Hz), 12 eyes of 8 NHPs with the Stellar EO system and 16 eyes of 12 NHPs with the Stellar IO system (both measure at 200 Hz for 15 s of every 150 s period). IOP transducers were calibrated bi-weekly via anterior chamber manometry. Linear mixed effects models assessed the differences in the hourly transient IOP impulse, and transient IOP fluctuation frequency and magnitude between systems and transducer placements (EO versus IO). All systems measured 8000-12,000 and 5000-6500 transient IOP fluctuations per hour > 0.6 mmHg, representing 8-16% and 4-8% of the total IOP energy the eye must withstand during waking and sleeping hours, respectively. Differences between sampling frequency/duty cycle and transducer placement were statistically significant (p < 0.05) but the effect sizes were small and clinically insignificant. IOP dynamics can be accurately captured by sampling IOP at 200 Hz on a 10% duty cycle using either IO or EO transducers.

Real-time drone derived thermal imagery outperforms traditional survey methods for an arboreal forest mammal

Koalas (Phascolarctos cinereus) are cryptic and currently face regional extinction. The direct detection (physical sighting) of individuals is required to improve conservation management strategies. We provide a comparative assessment of three survey methods for the direct detection of koalas: systematic spotlighting (Spotlight), remotely piloted aircraft system thermal imaging (RPAS), and the refined diurnal radial search component of the spot assessment technique (SAT). Each survey method was repeated on the same morning with independent observers (03:00-12:00 hrs) for a total of 10 survey occasions at sites with fixed boundaries (28-76 ha) in Port Stephens (n = 6) and Gilead (n = 1) in New South Wales between May and July 2019. Koalas were directly detected on 22 occasions during 7 of 10 comparative surveys (Spotlight: n = 7; RPAS: n = 14; and SAT: n = 1), for a total of 12 unique individuals (Spotlight: n = 4; RPAS: n = 11; SAT: n = 1). In 3 of 10 comparative surveys no koalas were detected. Detection probability was 38.9 ± 20.03% for Spotlight, 83.3 ± 11.39% for RPAS and 4.2 ± 4.17% for SAT. Effective detectability per site was 1 ± 0.44 koalas per 6.75 ± 1.03 hrs for Spotlight (1 koala per 6.75 hrs), 2 ± 0.38 koalas per 4.35 ± 0.28 hrs for RPAS (1 koala per 2.18 hrs) and 0.14 ± 0.14 per 6.20 ± 0.93 hrs for SAT (1 koala per 43.39 hrs). RPAS thermal imaging technology appears to offer an efficient method to directly survey koalas comparative to Spotlight and SAT and has potential as a valuable conservation tool to inform on-ground management of declining koala populations.

Resource selection of a montane endemic: Sex-specific differences in white-bellied voles (Microtus longicaudus leucophaeus)

Resources that an individual selects contrasted against what is available can provide valuable information regarding species-specific behavior and ecological relationships. Small mammals represent excellent study organisms to assess such relationships. Isolated populations that exist on the edge of a species’ distribution often exhibit behavioral adaptations to the extremes experienced by a species and can provide meaningful insight into the resource requirements of the species. We deployed radio transmitters in a peripheral population of the long-tailed vole (Microtus longicaudus) during the mating season. We developed models of resource selection at multiple scales (within home range and patch). We found voles generally selected areas close to water and roads and consisting of high understory vegetation primarily composed of grasses. Resource selection varied between sexes suggesting different resource needs during the breeding season. The differential resource needs of voles might be a result of the energetic requirements for reproduction and are representative of a promiscuous or polygynous mating system.

Remotely monitored inactivity due to COVID-19 lockdowns. Potential hazard for heart failure patients

OBJECTIVES

To study the impact of curfews during the COVID-19 pandemic, on the physical activity in patients of heart failure implanted withcardiac implantable electronic devices (CIEDs).

METHODS

This was a retrospective single-center study of heart failure patients inserted with remote monitoring (RM)-capable CIED. We analyzed the transmitted data of physical activity and fluid volume status of all patients, before, and during the lockdown periods between February and April 2020. The clinical status of the patients was also evaluated.  Results: Device data from 429 patients implanted with CIED capable of RM were initially evaluated. Patients with an implantable loop recorder, Brugada or Long QT syndromes, and patients with incomplete transmissions were excluded. Eighty-two patients with heart failure were included. The median age was 65 years (58-72), and 53 (64.6%) subjects were men. There was a 27.1% decline in physical activity, and the median physical activity of patients significantly declined from 2.4 to 1.8 hours/day (p=0.000010).  Conclusion: Data obtained by remotely monitored CIED in heart failure patients suggests a significant decline in physical activity during the country lockdown due to the pandemic. Awareness of the future potential hazards in this group of patients is warranted.

Use of Neural Response Telemetry Measures to Objectively Set the Comfort Levels in the Nucleus 24 Cochlear Implant

Cochlear implant programming necessitates accurate setting of programming levels, including maximum stimulation levels, of all active electrodes. Frequently, clinical techniques are adequate for setting these levels; however, they are sometimes insufficient (e.g., very young children). In the Nucleus 24, several methods have been suggested for estimation of comfort levels (C levels) from neural response telemetry (NRT); however, many require co-application of clinical measurements. Data was obtained from 21 adult Nucleus 24 recipients to develop reliable predictions of C levels. Multiple regression analysis was performed on NRT threshold, slope of the NRT growth function, age, length of deafness, length of cochlear implant use and electrode impedance to examine predictive ability. Only the NRT threshold and slope of the growth function measures were significant predictors yielding R2 values from 0.391 to 0.769. Results demonstrated that these measures may provide an alternative means of estimating C levels when other clinical measures are unavailable.

Neural Response Telemetry and Auditory/Nonauditory Sensations in 15 Recipients of Auditory Brainstem Implants

Auditory brainstem implants (ABIs) provide a means of restoring some hearing sensations to individuals with neurofibromatosis type 2 (NF2) who are deaf after vestibular schwannoma removal. In this study, neural response telemetry (NRT) was used to record electrically evoked neuronal activity near the ABI electrode array in 15 such subjects. Our interest was to investigate whether NRT recordings from the brainstem might be useful in implanting or programming ABIs. We therefore sought relationships between postoperative NRT recordings and the sensations reported by the subjects in response to the test stimuli. However, no clear relationships among these variables were found, and it was not possible to differentiate recordings associated with auditory versus nonauditory sensations. The findings suggest that the categorization of NRT recordings used in this study is inappropriate for assisting with placement of an ABI electrode array intra-operatively or for programming the sound processor postoperatively.

[The advantages of remote patient monitoring in automated peritoneal dialysis]

The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can be transmitted remotely to an internet cloud. The introduction of remote patient monitoring (RPM) technologies also allows a better clinical control and tailoring of dialysis treatment through a web-based software (Claria-Sharesource Baxter). The aim of the present study is to determine the impact of RPM in a single center, both in clinical and organizational terms, compared to traditional technologies. We studied 26 prevalent APD patients aged 69±13 years, observing them for a period of six months while using the traditional technology and then further six months using the new technology. The patients had been on dialysis for 9 months before the start of the study and a relevant portion of them lived in mountainous or hilly areas. Our study shows an increase in the number of proactive calls from the center to the patients, a reduction of anxiety in patients and caregivers, an earlier detection of clinical problems, a reduction of unscheduled (urgent) visits and finally a reduction of hospitalizations after the adoption of RPM software. In our experience, the RPM system showed a good performance and a simple interface, allowing for the precise assessment of daily APD. Furthermore, RPM system improved the interaction between patients and healthcare providers, with a significant benefit in terms of safety and of care quality.

Satellite derived offshore migratory movements of southern right whales (Eubalaena australis) from Australian and New Zealand wintering grounds

Southern right whales (Eubalaena australis) migrate between Austral-winter calving and socialising grounds to offshore mid- to high latitude Austral-summer feeding grounds. In Australasia, winter calving grounds used by southern right whales extend from Western Australia across southern Australia to the New Zealand sub-Antarctic Islands. During the Austral-summer these whales are thought to migrate away from coastal waters to feed, but the location of these feeding grounds is only inferred from historical whaling data. We present new information on the satellite derived offshore migratory movements of six southern right whales from Australasian wintering grounds. Two whales were tagged at the Auckland Islands, New Zealand, and the remaining four at Australian wintering grounds, one at Pirates Bay, Tasmania, and three at Head of Bight, South Australia. The six whales were tracked for an average of 78.5 days (range: 29 to 150) with average individual distance of 38 km per day (range: 20 to 61 km). The length of individually derived tracks ranged from 645–6,381 km. Three likely foraging grounds were identified: south-west Western Australia, the Subtropical Front, and Antarctic waters, with the Subtropical Front appearing to be a feeding ground for both New Zealand and Australian southern right whales. In contrast, the individual tagged in Tasmania, from a sub-population that is not showing evidence of post-whaling recovery, displayed a distinct movement pattern to much higher latitude waters, potentially reflecting a different foraging strategy. Variable population growth rates between wintering grounds in Australasia could reflect fidelity to different quality feeding grounds. Unlike some species of baleen whale populations that show movement along migratory corridors, the new satellite tracking data presented here indicate variability in the migratory pathways taken by southern right whales from Australia and New Zealand, as well as differences in potential Austral summer foraging grounds.

Automated remote intraoperative cochlear implant device testing (CR220). Is it clinically efficient?

OBJECTIVES

To compare the clinical efficiency of the CR220 intraoperative remote assistant device used by the surgical team with that of the custom sound (CS) system used by an audiologist.

METHODS

This was a prospective clinical study in a quaternary care center (King Abdullah Ear Specialist Centre) in Riyadh, Saudi Arabia, between October 2018 and March 2019. We included adult and pediatric patients who underwent cochlear implant (CI) surgeries. For every participant, the intraoperative CI testing was performed via both the aforementioned methods. The time taken to complete the measurements with both approaches, including the time required by the audiologist to reach the operating room (OR) and to complete the test, was recorded.

RESULTS

There were no significant differences in the number of responding electrodes between the 2 approaches. For the 25 participants, the time taken for the measurements was 566 minutes with the CS and 173 with the CR220 systems. This significant difference indicates that considerable time can be saved.

CONCLUSION

The CR220 enables intraoperative CI electrode tests and auto-NRT measurements. Its ergonomics and ease-of-use help the surgical team conduct the tests without an audiologist in the OR, resulting in the efficient use of clinical resources. Further, the results generated were consistent with those of the CS system.

Progress on Range of Motion After Total Knee Replacement by Sensor-Based System

For total knee replacement (TKR) patients, rehabilitation after the surgery is key toregaining mobility. This study proposes a sensor-based system for effectively monitoringrehabilitation progress after TKR. The system comprises a hardware module consisting of thetriaxial accelerometer and gyroscope, a microcontroller, and a Bluetooth module, and a softwareapp for monitoring the motion of the knee joint. Three indices, namely the number of swings, themaximum knee flexion angle, and the duration of practice each time, were used as metrics tomeasure the knee rehabilitation progress. The proposed sensor device has advantages such asusability without spatiotemporal constraints and accuracy in monitoring the rehabilitation progress.The performance of the proposed system was compared with the measured range of motion of theCybex isokinetic dynamometer (or Cybex) professional rehabilitation equipment, and the resultsrevealed that the average absolute errors of the measured angles were between 1.65° and 3.27° forthe TKR subjects, depending on the swing speed. Experimental results verified that the proposedsystem is effective and comparable with the professional equipment.

Medical-Grade ECG Sensor for Long-Term Monitoring

The recent trend in electrocardiogram (ECG) device development is towards wireless body sensors applied for patient monitoring. The ultimate goal is to develop a multi-functional body sensor that will provide synchronized vital bio-signs of the monitored user. In this paper, we present an ECG sensor for long-term monitoring, which measures the surface potential difference between proximal electrodes near the heart, called differential ECG lead or differential lead, in short. The sensor has been certified as a class IIa medical device and is available on the market under the trademark Savvy ECG. An improvement from the user’s perspective—immediate access to the measured data—is also implemented into the design. With appropriate placement of the device on the chest, a very clear distinction of all electrocardiographic waves can be achieved, allowing for ECG recording of high quality, sufficient for medical analysis. Experimental results that elucidate the measurements from a differential lead regarding sensors’ position, the impact of artifacts, and potential diagnostic value, are shown. We demonstrate the sensors’ potential by presenting results from its various areas of application: medicine, sports, veterinary, and some new fields of investigation, like hearth rate variability biofeedback assessment and biometric authentication.

The place-cell representation of volumetric space in rats

Place cells are spatially modulated neurons found in the hippocampus that underlie spatial memory and navigation: how these neurons represent 3D space is crucial for a full understanding of spatial cognition. We wirelessly recorded place cells in rats as they explored a cubic lattice climbing frame which could be aligned or tilted with respect to gravity. Place cells represented the entire volume of the mazes: their activity tended to be aligned with the maze axes, and when it was more difficult for the animals to move vertically the cells represented space less accurately and less stably. These results demonstrate that even surface-dwelling animals represent 3D space and suggests there is a fundamental relationship between environment structure, gravity, movement and spatial memory.

Thermal habitat of adult Atlantic salmon Salmo salar in a warming ocean

The year-round thermal habitat at sea for adult Atlantic salmon Salmo salar (n = 49) from northern Norway was investigated using archival tags over a 10 year study period. During their ocean feeding migration, the fish spent 90% of the time in waters with temperatures from 1.6-8.4°C. Daily mean temperatures ranged from -0.5 to 12.9°C, with daily temperature variation up to 9.6°C. Fish experienced the coldest water during winter (November-March) and the greatest thermal range during the first summer at sea (July-August). Trends in sea-surface temperatures influenced the thermal habitat of salmon during late summer and autumn (August-October), with fish experiencing warmer temperatures in warmer years. This pattern was absent during winter (November-March), when daily mean temperatures ranged from 3.4-5.0°C, in both colder and warmer years. The observations of a constant thermal habitat during winter in both warmer and colder years, may suggest that the ocean distribution of salmon is flexible and that individual migration routes could shift as a response to spatiotemporal alterations of favourable prey fields and ocean temperatures.