Electronic Monitoring Devices Research Articles

Heart Rate Estimation using Hermite Transform Video Magnification and Deep Learning

Abstract: Monitoring of heart rate can be used in many medical and sports applications. Lack of portability and connection problems make traditional monitoring methods difficult to use outside of clinical environments. The computer vision techniques have shown that some physiological variables as heart rate can be measured without contact. Video magnification is one of these approaches used for the detection of the pulse signal. In this paper we propose a new strategy to magnify motion in a video sequence using the Hermite transform. In addition, a deep learning technique is implemented to estimate the beat-by-beat pulse signal. We trained the system and validated our results using an electronic pulse monitoring device. Our approach is compared with the classical video magnification using a Gaussian pyramid. The results show a better enhancement of spectral information from the color changes allowing an accurate estimation of the instantaneous beat by beat pulse than the Gaussian approach.

Comparing Non-Stress Test versus Umbilical Artery Doppler Velocimetry among Aample of High-risk Pregnant Women in Erbil City

Background: The mainstay of care for lowering maternal and perinatal mortality and morbidity is antepartum foetal surveillance. Numerous techniques are used, including fetal movements, Vibroacoustic stimulation tests, contraction stress tests, biophysical profiles of the fetus, modified biophysical profiles, non-stress testing and Doppler Umbilical artery of the fetus's. The fetal heart reaction to internal and extrinsic stimuli is seen on electronic fetal monitoring devices. The benefit of high resolution dynamic ultrasonography and Doppler imaging is that it allows for the visualization of the fetus and its surroundings as well as the monitoring of fetal health by measuring utero-placental circulation. Patients and techniques: The cross-sectional investigation including 120 pregnant women who visited the Maternity Teaching Hospital between 26 June and 31 August 2022 and complained of decreased uterine contractions have been included. The questionnaire included sociodemographic data, obstetrical data, information on the fetal outcome and method of delivery. In accordance with the American Academy of Obstetricians and Gynecologists, cardiotopography was utilized to conduct a non-stress test, and the outcomes were categorized as reactive and non-reactive. Cardiotopography was used to perform a non-stress test, and the results were classified as reactive or non-reactive in accordance with the American Academy of Obstetricians and Gynecologists. Also, during 32 weeks or more of gestation, the inferior vena cava was not compressed by the gravid uterus during ultrasonography of the umbilical arteries, which was performed in a semi-recumbent position with a slight lateral tilt. Result: Based on NST and Doppler velocimetry of the umbilical artery, all cases were classified into two groups. The outcomes of the two tests didn't significantly differ from one another. The rate of Cesarean section (CS) was 46.1% among women with non-reactive (abnormal) CTG, compared with 25% among women with normal CTG (p = 0.0316). Only one neonate (1.3%) died among women with normal CTG, while none of the neonates died among women with abnormal CTG. The rate of CS among women with abnormal ultrasonography was 80% compared to women (11%) with normal ultrasonography. Furthermore, one neonate (2.1%) in the group of abnormal doppler, compared with 0% in the normal group. Conclusion: NST and umbilical artery Doppler of are sensitive and specific tests with strong positive prognostic value to suggest a poor prognosis for the newborn. Doppler velocimetry of umbilical artery is more important than a non-stress test because it lowers the likelihood of a CS birth in non-reactive non-stress test situations without increasing the risk of perinatal morbidity and mortality. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.10-17

Anticipated barriers and facilitators for implementing smart inhalers in asthma medication adherence management

Smart inhalers are electronic monitoring devices which are promising in increasing medication adherence and maintaining asthma control. A multi-stakeholder capacity and needs assessment is recommended prior to implementation in healthcare systems. This study aimed to explore perceptions of stakeholders and to identify anticipated facilitators and barriers associated with the implementation of smart digital inhalers in the Dutch healthcare system. Data were collected through focus group discussions with female patients with asthma (n = 9) and healthcare professionals (n = 7) and through individual semi-structured interviews with policy makers (n = 4) and smart inhaler developers (n = 4). Data were analysed using the Framework method. Five themes were identified: (i) perceived benefits, (ii) usability, (iii) feasibility, (iv) payment and reimbursement, and (v) data safety and ownership. In total, 14 barriers and 32 facilitators were found among all stakeholders. The results of this study could contribute to the design of a tailored implementation strategy for smart inhalers in daily practice.

Flexible MWCNT/Silk fibroin film decorated with Pt NPs for electrochemical glucose sensors

Flexible glucose sensor has become a research focus of continuous blood glucose detection methods because it can easily and quickly detect the glucose content in human body fluids. We prepare a multi-walled carbon nanotube (MWCNT)/Silk Fibroin (SF) flexible film, decorated with platinum nanoparticles (Pt NPs) and loaded with glucose oxidase (GOx) to construct a Pt-MWCNT/SF glucose sensor. A flexible conductive film with an electrical conductivity of 8.5 × 10−5 S/m is prepared by controlling the content of MWCNT. The maximum breaking strength and elongation at the break of MWCNT/SF film are 19.12 MPa and 192%. The Pt-MWCNT/SF glucose sensor has excellent conductivity stability under mechanical deformation and accurately detects glucose in the presence of other biomolecules. The linear range of glucose response is 0.1 to 3.75 mM, and the sensitivity is 8.09 μA/mM·cm2. The biological electrode constructed based on MWCNT/SF film has excellent flexibility, which is expected to be integrated with other electronic devices for monitoring and managing human health.

Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa—a multiphase optimization strategy (MOST) approach using a fractional factorial design

BackgroundSouth Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town.MethodsWe will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package.DiscussionTo our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic.Trial registrationClinicalTrials.gov NCT05040841. Registered on 10 September 2021.

Zinc-ion engineered Plant-based multifunctional hydrogels for flexible wearable strain Sensors, Bio-electrodes and Zinc-ion hybrid capacitors

Multifunctional hydrogels, particularly with superior mechanical properties and using green/sustainable approaches, have attracted increasing attention because of their many applications and consistency with the green chemistry principle; unfortunately, their effective fabrication process is challenging. In this work, inspired by unique functions in plant-derived components, a multifunctional polyacrylic acid (PAA) hydrogel was innovatively developed using ZnCl2 and biomass-derived materials. Ingeniously, ZnCl2 has multiple functions, in combination with cellulose, lignin, and citric acid (CA), delivering intriguing properties to the hydrogel system. As a solvent system, the ZnCl2 solution has extraordinary H-bonding-donating ability, dissolving cellulose macromolecular chains; subsequently, solubilized cellulose as green reinforced-fillers are added to hydrogel, improving the strength properties, with compression strength of ∼ 4.1 MPa, tensile strength of ∼ 795.4 kPa, and elongation at break of ∼ 620 %. The lignin-ZnCl2 catalysis system imparts a fast PAA gelation process, and the resultant hydrogel has strong/long-lasting/repeatable adhesive strength of 25.5 kPa (on Zn-carbon cloth) in 28 days. Additionally, ZnCl2 can form reversible ionic/electrostatic interactions with both lignin and CA, further improving the adhesive and mechanical properties. As anti-freezing agents, water-retaining agents and conducting medium, ZnCl2 also endows the hydrogel with desirable environmental compatibility and good conductivity (14.2 mS·cm−1). Furthermore, the presence of plant-based components endows the hydrogel with ultraviolet (UV) blocking, biocompatibility and antibacterial attribute. Significantly, the as-prepared hydrogels are suited for such diverse applications as flexible wearable strain sensors, bio-electrodes and zinc-ion hybrid capacitors (ZHCs), even can efficiently work at −65 °C. This study provides a new strategy of engineering multifunctional hydrogels using plant-based functional components, and these hydrogels show promising applications in many emerging areas including electronic skin sensors, health monitoring and energy storage devices.

보호관찰관의 지지와 준수사항 위반과의 관계

This study aims at investigating the relationships between supportive attitude of probation officers toward criminals and the revocation of probation. In particular, the current study focuses on identifying crucial factors that are associated with the violations of probation conditions under electronic monitoring. It is significant to find out the key factors that might reduce the numbers of violation of EM conditions in order to prevent recidivism in South Korea. In 2022, Korean Ministry of Justice announced the additional implementation of electronic anklets device program on offenders who committed stalking with a partial revision of the Electronic Monitoring Device Attachment Act. There have been wide controversial criticism toward the expansion of the Electronic Monitoring Device Attachment Act from September 2008, which the law was uninitiated. In this regard, this study attempts to examine what factors can increase the effectiveness of the EM with the consideration of supportive attitude of officers in terms of reduction of violations of probation conditions under electronic monitoring. In addition, the present study highlights the association between the role of probation officers and the level of probation revocation. “Survey of the Operational Realities of Electronic Monitoring on Sex-offenders in 2013” was used as analyses data sets. Besides, this study relied on Sherman's Defiance theory(1993) to examine the relationships between the attitude of probation officers and violation of probationers under EM. After reviewing previous studies, related factors were analyzed by assigning key dependent variables such as violation of probation conditions and violation of electronic monitoring requirement. In addition, this study utilized independent variable as supportive attitude of probation officers. Furthermore, as control variables, age, educational background, criminal experience, and period of attachment to electronic devices were used in the model. Logistic regression analysis result demonstrated that EM attachment period and previous criminal history of offenders had a significant impact on increasing the violation of probation conditions. Regression analysis showed that probationer-officer relationship was not statistically significant factors that might decrease the number of violation of condition when other variables were controlled. These results showed that the compassionate attitude of the probation officer was not a significant factor for obtaining better compliance of offenders under EM. Further policy implications will be discussed.

Australian women’s experiences of wearing a non-invasive fetal electrocardiography (NIFECG) device during labour

BackgroundContinuous electronic fetal monitoring devices can restrict women’s freedom of movement and choice of positioning during labour and birth. Despite the use of continuous electronic fetal monitoring for the past 50 years, little attention has been paid to women’s experiences of wearing different fetal monitoring devices in labour. AimTo explore women’s views and experiences of wearing a beltless continuous electronic fetal monitoring device, the non-invasive fetal electrocardiogram during labour. MethodsA qualitative descriptive approach was taken. Recruitment was via a larger clinical feasibility study. Some women who consented to take part in the clinical feasibility study also consented to being interviewed during the postnatal period. Transcripts were thematically analysed. FindingsWomen reported improved comfort when wearing the non-invasive fetal electrocardiogram device. They appreciated how it enabled freedom of movement and an ability to actively participate in labour. They compared their experience with previous use of cardiotocography which they felt compromised their bodily autonomy. All forms of continuous electronic fetal monitoring experienced by women resulted in the unwelcome experience of ‘Poking and prodding’ by the midwife. DiscussionContinuous electronic fetal monitoring can negatively impact women’s labour and birth experience, particularly when the measurement of fetal wellbeing is prioritised. ConclusionThe way in which continuous electronic fetal monitoring technology is designed and used is an important component of optimising physiological processes and positive experiences for women during labour and birth for women with complex pregnancies. Non-invasive fetal electrocardiograpy is a promising additional option for women.

Clinical Impact of Electronic Monitoring Devices of Inhalers in Adults with Asthma or COPD: A Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to gain insight into the characteristics and clinical impact of electronic monitoring devices of inhalers (EMDs) and their clinical interventions in adult patients with asthma or COPD. The search included PubMed, Web of Science, Cochrane, Scopus and Embase databases, as well as official EMDs websites. We found eight observational studies and ten clinical trials, assessing a wide range of clinical outcomes. Results from the meta-analysis on adherence to inhalers in a period over three months were favourable in the EMD group (fixed effects model: SMD: 0.36 [0.25-0.48]; random effects model SMD: 0.41 [0.22-0.60]). An exploratory meta-analysis found an improvement in ACT score (fixed effect model SMD: 0.25 [0.11-0.39]; random effects model: SMD: 0.47 [-0.14-1.08]). Other clinical outcomes showed mixed results in the descriptive analyses. The findings of this review highlight the benefits of EMDs in the optimization of adherence to inhaled therapy as well as the potential interest in other clinical outcomes.

Amplifiers in Biomedical Engineering: A Review from Application Perspectives.

Continuous monitoring and treatment of various diseases with biomedical technologies and wearable electronics has become significantly important. The healthcare area is an important, evolving field that, among other things, requires electronic and micro-electromechanical technologies. Designed circuits and smart devices can lead to reduced hospitalization time and hospitals equipped with high-quality equipment. Some of these devices can also be implanted inside the body. Recently, various implanted electronic devices for monitoring and diagnosing diseases have been presented. These instruments require communication links through wireless technologies. In the transmitters of these devices, power amplifiers are the most important components and their performance plays important roles. This paper is devoted to collecting and providing a comprehensive review on the various designed implanted amplifiers for advanced biomedical applications. The reported amplifiers vary with respect to the class/type of amplifier, implemented CMOS technology, frequency band, output power, and the overall efficiency of the designs. The purpose of the authors is to provide a general view of the available solutions, and any researcher can obtain suitable circuit designs that can be selected for their problem by reading this survey.

Digital manufacturing of personalised footwear with embedded sensors

The strong clinical demand for more accurate and personalized health monitoring technologies has called for the development of additively manufactured wearable devices. While the materials palette for additive manufacturing continues to expand, the integration of materials, designs and digital fabrication methods in a unified workflow remains challenging. In this work, a 3D printing platform is proposed for the integrated fabrication of silicone-based soft wearables with embedded piezoresistive sensors. Silicone-based inks containing cellulose nanocrystals and/or carbon black fillers were thoroughly designed and used for the direct ink writing of a shoe insole demonstrator with encapsulated sensors capable of measuring both normal and shear forces. By fine-tuning the material properties to the expected plantar pressures, the patient-customized shoe insole was fully 3D printed at room temperature to measure in-situ gait forces during physical activity. Moreover, the digitized approach allows for rapid adaptation of the sensor layout to meet specific user needs and thereby fabricate improved insoles in multiple quick iterations. The developed materials and workflow enable a new generation of fully 3D printed soft electronic devices for health monitoring.

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Background: The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.Objective: We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.Methods: In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.Results: At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.Conclusion: Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.

A Study on the Relationship between Social Stigma and Willingness to Cut Off the Electronic Monitoring Device of Probationers

A Study on the Relationship between Social Stigma and Willingness to Cut Off the Electronic Monitoring Device of Probationers

Qualitative study of user perspectives and experiences of digital inhaler technology

Electronic monitoring devices (EMDs) have been trialled in interventions to improve inhaled corticosteroid adherence and clinical outcomes. This study sought to understand the perceptions and experiences of EMD end-users. Participants recruited into a six-month EMD study were invited to a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and analysed using the framework approach. Twenty-eight participants (68% female, median age 47) were interviewed. Individuals described feeling responsible for their asthma control. Recent attacks motivated a desire to maintain control. Study participation led to increased awareness of asthma status and medication use. Several individuals were open to integrating digital monitoring data with other mHealth inputs, perceiving the potential to enhance communication with clinicians and empower self-management. Openness to data sharing was tied to expectations of transparent data use. Data supported integrating beliefs and habit formation to achieve behaviour change. There was a willingness for an integrated, platform-based approach to digital self-management.

Effectiveness, usability and acceptability of a smart inhaler programme in patients with asthma: protocol of the multicentre, pragmatic, open-label, cluster randomised controlled ACCEPTANCE trial

IntroductionSuboptimal asthma control is associated with incorrect inhaler use and poor medication adherence, which could lead to unfavourable clinical and economic outcomes. Smart inhaler programmes using electronic monitoring devices (EMDs)...

Measurement of adherence to inhaled corticosteroids by self-report and electronic medication monitoring

Objective Poor adherence to daily inhaled corticosteroids (ICS) is an important factor contributing to asthma morbidity. Assessing adherence in clinical settings using self-reported adherence often overestimates actual adherence. Electronic monitoring devices (EMDs) are objective means of assessing adherence, but are not routinely used in practice. Here, we aimed to establish adherence rates to ICS using EMDs in an inner-city, minority population in the Bronx, NY, and to compare two methods of self-reported adherence with EMD-measured adherence. Methods Patients with physician-confirmed persistent asthma and daily ICS prescription were recruited. Self-reported adherence to ICS was measured by parental report for children and self-report for adults and the Medication Adherence Report Scale for Asthma (MARS-A). Two weeks after enrollment, EMD data were accessed for analysis. Daily adherence was calculated based on the number of puffs actuated per day as captured by EMD divided by the prescribed number of puffs. Results 41 children and 40 adults participated. Median EMD-measured ICS adherence was 41% (children) and 43% (adults). This was significantly lower than the median self-reported adherence (100% for children, p < 0.001; 100% for adults, p < 0.001). MARS-A score in children did not correlate with EMD adherence data (p = 0.18), while in adults, this correlation tended to be more consistent (p = 0.07). Conclusions Adherence to daily ICS as measured using EMD is low in this population. In both adults and children, self-reported adherence was a poor indicator of true adherence. Further efforts using objective measures of medication adherence for patients with high asthma morbidity may be warranted to guide therapeutic decisions.

Abstract 9445: Using Latent Class Analysis to Identify Antihypertensive Adherence Trajectories: The BETTER-BP Trial

Introduction: Adherence to antihypertensive medications remains low in many patients. In this context, the BETTER-BP randomized trial was designed to test whether providing small financial rewards for medication adherence with a text message-based lottery system improves adherence and lowers blood pressure. In this preliminary analysis we characterized adherence trends from baseline to 6 months in BETTER-BP through 12/2021. Methods: Participants were recruited from two safety-net clinics in New York City (Bellevue Hospital and NYU-Brooklyn FHC). There were 101 participants with six months of complete adherence data. Mean weekly adherence was recorded through an Adheretech electronic monitoring device. Latent class mixed methods analysis was used to determine categorizable adherence trajectory trends over six months. We then investigated factors (age, sex, insurance status, comorbidity burden, depression, self-efficacy) that predicted category membership. The analysis remained blinded to treatment arm given that full enrollment was not yet complete. Results: Three distinct adherence trajectories were determined: (1) High, persistent adherence (n=53), (2) Gradually declining adherence (n=33), and (3) Early declining non-adherence (n=15). In a multivariable analysis, only self-efficacy (based on the medication adherence self-efficacy scale [MASES]) had a significant (p=0.02) association with adherence, with mean MASES scores of 81.4, 76.3 and 72.1 for clusters (1), (2) and (3) respectively. Conclusions: In this preliminary analysis, we found that the majority of participants had high persistent adherence, and that those with high self-efficacy were more likely to be members of this category. These results will need to be confirmed at trial completion (target sample N = 435). Figure 1. Mean participant adherence trajectory clusters over six months.

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure

BackgroundNonadherence to antihypertensive medications remains a persistent problem that leads to preventable morbidity and mortality. Behavioral economic strategies represent a novel way to improve antihypertensive medication adherence, but remain largely untested especially in vulnerable populations which stand to benefit the most. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) was designed in this context, to test whether a digitally-enabled incentive lottery improves antihypertensive adherence and reduces systolic blood pressure (SBP). DesignBETTER-BP is a pragmatic randomized trial conducted within 3 safety-net clinics in New York City: Bellevue Hospital Center, Gouveneur Hospital Center, and NYU Family Health Centers – Park Slope. The trial will randomize 435 patients with poorly controlled hypertension and poor adherence (<80% days adherent) in a 2:1 ratio (intervention:control) to receive either an incentive lottery versus passive monitoring. The incentive lottery is delivered via short messaging service (SMS) text messages that are delivered based on (1) antihypertensive adherence tracked via a wireless electronic monitoring device, paired with (2) a probability of lottery winning with variable incentives and a regret component for nonadherence. The study intervention lasts for 6 months, and ambulatory systolic blood pressure (SBP) will be measured at both 6 and 12 months to evaluate immediate and durable lottery effects. ConclusionsBETTER-BP will generate knowledge about whether an incentive lottery is effective in vulnerable populations to improve antihypertensive medication adherence. If successful, this could lead to the implementation of this novel strategy on a larger scale to improve outcomes.

Effects of a Pharmacist-Led Educational Interventional Program on Electronic Monitoring–assessed Adherence to Direct Oral Anticoagulants: A Randomized, Controlled Trial in Patients with Nonvalvular Atrial Fibrillation

PurposeSeveral landmark trials have reported that direct oral anticoagulants (DOACs) are more effective in preventing stroke and systemic embolism than vitamin K antagonists. However, nonadherence to DOACs worsens prognosis in patients with nonvalvular atrial fibrillation (NVAF) despite the effectiveness of the drugs. The purpose of this study was to evaluate the effects of a pharmacist-led educational interventional program involving motivational interviewing on medication adherence, as assessed by electronic monitoring, in patients receiving DOACs for the treatment of NVAF. MethodsThis prospective, randomized, interventional study was conducted at outpatient cardiology clinics at general hospitals and pharmacies in Japan. Patients with NVAF who were treated with a once-daily DOAC (edoxaban) or a twice-daily DOAC (apixaban) were randomized to receive either: (1) an educational interventional program involving motivational interviewing regarding adherence to anticoagulants; or (2) standard medication counseling. The primary end point was the change in the medication adherence rate, calculated as the number of days that patients appropriately took the drug, as assessed by an electronic monitoring device, divided by the total number of days that the drug was prescribed, from a 12-week observation period to a 12-week intervention period. The secondary end points were tolerability outcomes. The effect of the educational interventional program on the primary end point was analyzed in subgroups stratified by gender and type of DOAC received. FindingsA total of 268 patients completed the observation period and were randomly assigned to one of the two study groups. The difference in the primary end point between the educational interventional program group and the standard medication counseling group was not significant (mean [SD], 2.9% [7.5%] vs 3.4% [8.3%]). On multiple linear regression analysis, the difference in DOAC adherence between the two groups was not significant, but that adherence to apixaban was significantly improved among men in the educational interventional program (β = 0.219; P = 0.012). Two patients died of causes considered unrelated to treatment; no stroke/systemic embolism or major bleeding events were observed. ImplicationsIn this randomized, controlled study of the effects of a pharmacist-led educational interventional program using motivational interviewing on adherence to DOACs among patients with NVAF, adherence to DOACs, as assessed using an electronic monitoring device, was not improved with the educational interventional program compared to standard medication counseling . However, adherence to twice-daily apixaban was improved among men, but not among women, in the educational interventional program group. In this study, the selection of DOACs was not randomized, and the lack of assessment of the association between adherence to DOACs and clinical outcomes was a limitation. Japan Registry of Clinical Trials (jRCT) indentifier: jRCTs031180142.

Study of flexible piezoresistive sensors based on the hierarchical porous structure CNT /PDMS composite materials

Flexible piezoresistive sensors (FPS) are important components of wearable electronics for human-machine interaction, human physiological signal monitoring and electronic skin. In this work, carbon nanotube (CNT)-polydimethylsiloxane (PDMS) (abbreviated as CP) composite materials with hierarchical porous structures were prepared by a facile solvothermal method. The electrical conductivity and mechanical elasticity of the porous structure CP composite materials can be separately tuned by varying the CNT mass fraction and PDMS composition ratio, respectively. A flexible piezoresistive sensor using porous structure CP composite materials as the sensing material was designed and fabricated. The optimized sensor exhibits a sensitivity of 0.59 kPa −1 in the pressure ranges of 0–260 kPa, a low detection limit of 12 Pa, a fast response time of 25 ms and outstanding cycling stability over 1,700 cycles. Such sensor design can be integrated into flexible wearable electronic devices for physiological signal monitoring in real-time. • The hierarchical porous structure CNT/PDMS composite materials were prepared by solvothermal method. • Mechanical and electrical properties of CNT/PDMS composite materials can be adjusted by changing the process parameters. • Sensing mechanism and sensor performance of FPS based on CNT/PDMS composite materials were studied. •Application of FPS for recording human respiratory volume and rate and human activity were examined.