The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

Master of Science / Department of Electrical and Computer Engineering / Steven Warren / A reference design for a wearable, wireless biomedical sensor set has been a long-term need for researchers at Kansas State University, driven by the idea that a basic set of sensor components could address the demands of multiple types of human and animal health monitoring scenarios if these components offered even basic reconfigurability. Such a reference design would also be a starting point to assess sensor performance and signal quality in the context of various biomedical research applications. This thesis describes the development of a set of wireless health monitoring sensors that can be used collectively as a data acquisition platform to provide biomedical research data and to serve as a baseline reference design for new sensor and system development. The host computer, an Intel Edison unit, offers plug-and-play usability and supports both Wi-Fi and Bluetooth wireless connectivity. The reference sensor set that accompanies the Intel Edison single-board computer includes an electrocardiograph, a pulse oximeter, and an accelerometer/gyrometer. All sensors are based on the same physical footprint and connector placement so that the sensors can be stacked to create a collection with a minimal volume and footprint. The latest hardware version is 3.1. Version 1.0 supported only a pulse oximeter, whereas version 2.0 included an electrocardiograph, pulse oximeter, and respiration belt. In version 3.0, the respiration belt was removed, and accelerometers and gyroscopes were added to the sensor set. Version 3.1 is a refined version of the latter design, where known hardware bugs were remedied. Future work includes the development of new sensors and casing designs that can hold these sensor stacks.

No description available.

Master of Science / Department of Electrical and Computer Engineering / Steven Warren / Pulse oximetry, a noninvasive circulatory system monitoring technique, has been widely adopted in clinical and homecare applications for the determination of heart rate and blood oxygen saturation, where measurement locations are typically limited to fingertips and earlobes. Prior research indicates a variety of additional clinical parameters that can be derived from a photoplethysmogram (PPG), the fundamental time-domain signal yielded by a pulse oximeter sensor. The gap between this research potential and practical device applications can be decreased by improvements in device design (e.g., sensor performance and geometry, sampling fidelity and reliability, etc.) and PPG signal processing. This thesis documents research focused on a novel pulse oximeter design and the accompanying PPG signal processing and interpretation. The filter-free reflectance design adopted in the module supplements new methods for signal sampling, control, and processing, with a goal to acquire high-fidelity raw data that can provide additional physiologic data for state-of-health analyses. Effective approaches are also employed to improve signal stability and quality, including shift-resistant baseline control, an anti-aliasing sampling frequency, light emitting diode intensity autoregulation, signal saturation inhibition, etc. MATLAB interfaces provide data visualization and processing for multiple applications. A feature detection algorithm (decision-making rule set) is presented as the latest application, which brings the element of intelligence into the pulse oximeter design by enabling onboard signal quality verification. Two versions of the reflectance sensor were designed, built, calibrated, and utilized in data acquisition work. Raw data, which are composed of four channels of signals at a 240 Hz sampling rate and a 12-bit precision, successfully stream to a personal computer via a serial connection or wireless link. Due to the optimized large-area sensor and the intensity autoregulation mechanism, PPG signal acquisition from measurement sites other than fingertips and earlobes, e.g., the wrist, become viable and retain signal quality, e.g., signal-to-noise ratio. With appropriate thresholds, the feature detection algorithm can successfully indicate motion occurrence, signal saturation, and signal quality level. Overall, the experimental results from a variety of subjects and body locations in multiple applications demonstrate high quality PPGs, prototype reliability, and prospects for further research value.

Noninvasive pulse oximetry represents an area of potential interest to the army, because it could provide cost-effective, safe, fast and real-time physiological assessment in a combat injured soldier. Consequently, there is a need to develop a reliable, battery-powered, wearable pulse oximeter to acquire and process photoplethysmographic (PPG) signals using an optimized sensor configuration. A key requirement in the optimal design of a wearable wireless pulse oximeter is low power management without compromising signal quality. This research investigated the advantage gained by increasing the area of the photodetector and decreasing the light emitting diode (LED) driving currents to reduce the overall power requirement of a reflectance mode pulse oximeter sensor. In vitro and preliminary in vivo experiments were conducted to evaluate a multiple photodetector reflectance sensor setup to simulate a varying detection area. It was concluded that a reflection pulse oximeter sensor employing a large area photodetector is preferred over a similar transmission type sensor for extending the battery life of a wireless pulse oximeter intended for future telemedicine applications.

A wireless, battery operated pulse oximeter system with a forehead mounted optical sensor was designed in our laboratory. This wireless pulse oximeter (WPO) would enable field medics to monitor arterial oxygen saturation (SpO2) and heart rate (HR) information accurately following injuries, thereby help to prioritize life saving medical interventions when resources are limited. Pulse oximeters developed for field-based applications must be resistant to motion artifacts since motion artifacts degrade the signal quality of the photoplethysmographic (PPG) signals from which measurements are derived. This study was undertaken to investigate if accelerometer-based adaptive noise cancellation (ANC) can be used to reduce SpO2 and HR errors induced by motion artifacts typically encountered during field applications. Preliminary studies conducted offline showed that ANC can minimize SpO2 and HR errors during jogging, running, and staircase climbing. An 8th order LMS filter with ì = 0.01 was successfully implemented in the WPO's embedded microcontroller. After real-time adaptive filtering of motion corrupted PPG signals, errors for HR values ranging between 60 - 180BPM were reduced from 12BPM to 6BPM. Similarly, ambient breathing SpO2 errors were reduced from 5% to 2%.

Στην διπλωματική εργασία αυτή παρουσιάζεται ένα μικρό σύστημα εντατικής παρακολούθησης. Παρουσιάζεται πλήρως η κατασκευή ενός οξύμετρου παλμού από πλευράς hardware και software αφού αυτό είναι συνδεδεμένο σε έναν κεντρικό υπολογιστή. Στο τέλος πήραμε μερικά δείγματα από άτομα εθελοντές για να δείξουμε πως λειτουργεί αυτό που έχει κατασκευαστεί. Επίσης παρουσιάζεται μια καινοτόμος ιδέα για την αντιμετώπιση του προβλήματος της υπνικής άπνοιας, που αφορά όχι τόσο πολύ στο θέμα πρόληψη, αλλά στην αντιμετώπιση δύσκολων, ακραίων καταστάσεων. / The current thesis presents a patient’s monitoring system for emergency rooms. It fully presents the construction of a pulse oximeter, including software and hardware development, which is connected to a server computer. Finally, some samples were taken from various volunteers to show how the pulse oximeter works. Also, the thesis presents an innovative idea for the problem of sleep apnea, for dealing critical situations.

Remote healthcare is a demanding as well as emergent research area. The rise of healthcare costs in the developed countries have made the policy makers for trying to find an alternate model of healthcare rather than relying on traditional healthcare system. Although advancement in the sensor technology, forthcomingness of devices like smart phones and improvement in artificial intelligence technology have made the remote healthcare close to reality but still there are plenty of issues to be solved before it becomes a commonly used healthcare model. In this thesis, studies of two vital physiological parameters pulse rate and oxygen saturation were done to unearth some patterns using Case-Based Reasoning technique. A three-tiered application is developed focusing remote healthcare. The results of the thesis could be used as a starting point of further research of two above mentioned physiological parameters in order to detect anomalous condition of health.