Transcript Chronobiologically-interpreted blood pressure (BP) and

It is our privilege to introduce Larry A. BEATY, the
computer scientist and honorary member of our
laboratory, of the Phoenix Study Group of the
Institute of Electrical and Electronics Engineers, who
translates chronobiology and chronomics into a
practical, affordable, personally safe, informatically
secure system, demonstrating that the major hurdle
of affordability can eventually be overcome. You see
him (arrow) and his team on the next 2 slides.
Franz Halberg & Germaine Cornélissen
For the Halberg Chronobiology Center
University of Minnesota
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Minnesota team, L-R: Bing Wu, Jinyi Wu, Larry Beaty (arrow), Ellis Nolley, Othild Schwartzkopff,
Franz Halberg, Patricia Grambsch, Bob Schlentz, Lyazzat Gumarova, Germaine Cornélissen, Jole
Shackelford, Dewayne Hillman, Mary Sampson (photo: Jacob Madenford)
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L-R: Jinyi Wu, MD; from the Phoenix Study Group, Larry Beaty (arrow), Ellis Nolley, Bob
Schlentz; Lyazzat Gumarova, PhD; Germaine Cornélissen, PhD (photo: Jacob
Madenford)
Still a long way to go !
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Chronobiologically-interpreted
blood pressure (BP) and heart rate
(HR) Monitoring for less than $100
Larry Beaty, Germaine Cornelissen,
Ellis Nolley, Franz Halberg
http://www.phoenix.tc-ieee.org/
http://www.msi.umn.edu/~halberg/
Presentation Copyright 2012 Larry A. Beaty
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Larry Beaty
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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Phoenix Project
• A Study Group of IEEE Twin Cities section
– Volunteer Engineers and University Students from
Twin Cities (Minneapolis) and around the world
• Develop Ambulatory Blood Pressure Monitor
– Inexpensive, unobtrusive, easy to use
–½
x 24 x 7
– Suitable for Chronobiological Interpretation
– To be used by Halberg Chronobiology Center
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Phoenix Project
• Open Source development model
– Intellectual Property to be Public Domain
– Not a “for-profit” organization
• Two avenues of Investigation in the lab
– “Cuffless” BP measurement
• e.g., pulse wave velocity, pulse wave analysis
– Improvements to cuff-based monitors
• Comfortable arm cuffs and accurate wrist cuffs
Presentation Copyright 2012 Larry A. Beaty
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Halberg Chronobiology Center
• University of Minnesota (USA)
• Discovery of associations between space
weather and physiology
– Some variations in blood pressure appear to be
caused by earth and space weather
• Discovery and definition of VVDs
– Some anomalies in the normal variations of BP are
indicators of health problems; these are Vascular
Variability Disorders (VVDs)
Presentation Copyright 2012 Larry A. Beaty
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Halberg Chronobiology Center
• Dr. Franz Halberg: “We all try to leave the world a
better place than we found it. My colleagues and I
were trying to find a way for self surveillance that
would be cost effective and continuous and replace the
intervals of blindness (lack of information) between
yearly or other visits to care provider. The finding in
Minnesota with Prof. Otsuka’s data that Vascular
Variability Disorders (VVDs), when they coexist, can
change the risk of stroke from within 6 years from less
than 5% to near 100% became a good first reason for
us to do so. That the same endeavor can have
dividends with respect to space weather and it’s effects
on the good and bad in us. And crime challenged me.”
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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VVDs
• Vascular Variability Disorders (VVDs)
– Definition: Persistent anomalies in periodic
characteristics of blood pressure or heart rate, often
representing independent, additive risks of stroke
–
–
–
–
–
–
MESOR Hypertension (MH)
Circadian Hyper-Amplitude Tension (CHAT)
Excessive Pulse Pressure (EPP)
Ecphasia
Ecfrequentia
Deficient Heart Rate Variability (DHRV)
Presentation Copyright 2012 Larry A. Beaty
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VVDs
Illustrated
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VVDs
Illustrated
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VVDs
Independent
Additive
Raise Risk
Of Stroke
5% - 100%
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Hyperbaric Index
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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Sphygmochron
• Report on chronobiologic characteristics of a
patient’s blood pressure and heart rate
profile, typically measured half-hourly for
seven days
– Patient data section
– Cosinor parameter section
– Non-parametric section
– Diagnosis section
– Visualization charts
Presentation Copyright 2012 Larry A. Beaty
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Presentation Copyright 2012 Larry A. Beaty
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Patient Data section
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Cosinor Parameter section
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Non-parametric section
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Diagnosis section
Presentation Copyright 2012 Larry A. Beaty
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Visualization Charts section
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Visualization Charts section
Chronodesms
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CUSUM tool
MONITORING THE MEAN SEEMS SUCCESSFUL
BUT WHAT HAPPENS TO THE AMPLITUDE?
(J Appl Biomed 2006; 4: 73-86)
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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Website and Databases
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Website and Databases
• The research website would contain:
– Data access mechanisms (meeting appropriate
privacy and security requirements)
– Data analysis tools
• This is where we:
– Learn of Aeolian nature of periodicities in the data
– Learn new periodicities over time
– Analyze on populations
Presentation Copyright 2012 Larry A. Beaty
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Website and Databases
• Criteria for kinds of data to save on website
– Streams & ad-hoc collections
– Search & relational query capability
• Sources of data could include: Police, local
health officials, NOAA, NASA
– Space weather (e.g., Solar Wind Speed)
– Local weather (e.g, Aa, Kp, temperature)
Presentation Copyright 2012 Larry A. Beaty
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Website and Databases
• The healthcare website would contain:
– The analysis tools
– Libraries of reference materials for different
audiences (physician, general public, student)
– List of ABPMs usable for C-ABPM
– Social networking mechanisms
Presentation Copyright 2012 Larry A. Beaty
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Social Networking
• Builds relationships on shared interests,
activities
• Recommendation system linked to trust
• Provides for Communication, Valuable
Content
• Subtle form of advertising, useful for teaching
• Best integrated into existing systems (e.g.,
Facebook)
Presentation Copyright 2012 Larry A. Beaty
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Social Networking Example 1
– Person uses CUSUM tool finds helpful intervention
– Publishes to trusted friends
– Friends vote on it and other published items
– Voting results are published to their friends
– Some of those friends of friends develop an
interest in the improved treatment, educate
themselves on it, and apply it to themselves, then
publish their own CUSUM results and the cycle
begins again
Presentation Copyright 2012 Larry A. Beaty
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Social Networking Example 2
– 6 people independently find helpful intervention
via CUSUM
– Website discovers similarities later, forms group of
6 new friends
– New group discusses their helpful intervention
and the validation of their discovery
– Group decides whether to publish the information
to ever-widening groups of friends
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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Wrist Monitor Hardware
• Purpose of modifying off-the-shelf homemarket wrist monitors: an interim solution to
the problem of making continual, comfortable
BP measurement affordable for everybody
– Secondarily, it is an early mechanism for getting
significant amounts of BP data to the website
– We would like to have involvement from existing
BP monitor manufacturers: modifying, testing,
and manufacturing products for the marketplace
Presentation Copyright 2012 Larry A. Beaty
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Costs
ABPMs
• Professional
• A&D ABPMs through BIOCOS
Typical Costs
• $2000 - $5000
• $400 - $500
ABPMs?
• Home quality monitors
• Timer (added in our lab)
• Timer (added by manufacturer)
• $50 - $150
• $30
• “Free”
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Modifying a wrist monitor
Presentation Copyright 2012 Larry A. Beaty
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Timer control circuit
•
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Buzzer control circuit
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Modified Monitor Hardware
• Arm cuff monitors
– Microlife BP 3AC1-PC
– A&D UA-767PC
• Wrist cuff monitors
– OMRON HEM670-IT
– A&D UB-511USB
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
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Wrist Monitor Test Results
• Results on 5 subjects wearing modified
OMRON and A&D wrist monitors are
encouraging enough to motivate continued
work in the lab.
• The results should motivate wrist monitor
manufacturers to add automation to their
monitors
Presentation Copyright 2012 Larry A. Beaty
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Wrist Monitor Test Results
OMRON
SBP
M
phi
M
A
phi
82.5
87.1
*
13.3
13.8
-220.0
-220.0
72.2
71.7
10.4
9.3
-248.0
-249.0
-248
-242
71.7
68.0
*
13.4
13.5
-243.0
-239.0
73.2
72.1
9.4
6.7
-252.0
-250.0
0.9
3.1
-117
-271
67.6
67.6
3.7
4.7
-250
-199
65.6
72.0
*
1.9
3.2
-280
-182
5.2
6.8
-95
-94
76.3
74.9
3.8
1.2
-86
-108
64.9
63.6
12.6
10.9
-236
-247
115.8
1.4
-259
69.2
7.9
-261
110.3
12.1
-239
71.0
11.2
-241
110.6
12.8
-139
71.1
12.0
-240
114.2
13.6
-245
68.3
8.2
-240
113.5
13.0
-250
67.1
7.2
-248
no difference between wrist #1 and #2
no difference between arm cuff before or after wrist monitoring
wrist #1 vs. arm (After)
*
*
wrist #1 vs. arm (After, ed.)
*
*
73.4
75.2
74.7
72.7
72.5
9.3
13.6
13.7
10.8
10.9
-240
-240
-241
-245
-244
VSto (F, 45y)
arm
wrist
OSch (F, 87y)
arm
wrist
DHil (M, 70y)
arm
wrist
phi
130.6
137.0
*
14.4
15.2
-238
-230
118.6
112.0
*
17.9
16.3
112.6
115.2
116.7
126.3
*
HR
A
LB (M, 48y)
arm
wrist
A
DBP
M
GCor (F, 59)
arm (Before)
wrist #1 $
wrist #2 $
arm (After)
" (edited)
$ (4-min apart)
Presentation Copyright 2012 Larry A. Beaty
*
*
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Wrist Monitor Test Results
OMRON
SBP
M
phi
M
A
phi
82.5
87.1
*
13.3
13.8
-220.0
-220.0
72.2
71.7
10.4
9.3
-248.0
-249.0
-248
-242
71.7
68.0
*
13.4
13.5
-243.0
-239.0
73.2
72.1
9.4
6.7
-252.0
-250.0
0.9
3.1
-117
-271
67.6
67.6
3.7
4.7
-250
-199
65.6
72.0
*
1.9
3.2
-280
-182
5.2
6.8
-95
-94
76.3
74.9
3.8
1.2
-86
-108
64.9
63.6
12.6
10.9
-236
-247
115.8
1.4
-259
69.2
7.9
-261
110.3
12.1
-239
71.0
11.2
-241
110.6
12.8
-139
71.1
12.0
-240
114.2
13.6
-245
68.3
8.2
-240
113.5
13.0
-250
67.1
7.2
-248
no difference between wrist #1 and #2
no difference between arm cuff before or after wrist monitoring
wrist #1 vs. arm (After)
*
*
wrist #1 vs. arm (After, ed.)
*
*
73.4
75.2
74.7
72.7
72.5
9.3
13.6
13.7
10.8
10.9
-240
-240
-241
-245
-244
VSto (F, 45y)
arm
wrist
OSch (F, 87y)
arm
wrist
DHil (M, 70y)
arm
wrist
phi
130.6
137.0
*
14.4
15.2
-238
-230
118.6
112.0
*
17.9
16.3
112.6
115.2
116.7
126.3
*
HR
A
LB (M, 48y)
arm
wrist
A
DBP
M
GCor (F, 59)
arm (Before)
wrist #1 $
wrist #2 $
arm (After)
" (edited)
$ (4-min apart)
Presentation Copyright 2012 Larry A. Beaty
*
*
45
Wrist monitors: inaccurate readings
• The wrist is lower than the heart during the day
• We look at blood pressure differently, so accuracy
of individual readings isn’t so important
– Characteristics of circadian rhythms compared to
other rhythms measured the same way – patterns of
health or lack of health still emerge
– Readings from same time of day averaged with each
other, so the occasional bad reading is averaged out
– We can develop correction and cleaning algorithms
• Irregular Heart Beat detection often indicates bad reading
Presentation Copyright 2012 Larry A. Beaty
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What is missing from commercial
home blood pressure monitors?
• Changes to commercial off-the-shelf wrist
monitors that would be “necessary”:
– Automatic, timed reading capability
– Audible and Tactile warning
– Retry failed readings after 1 minute
• Notice that it’s a short list
• It is likely that these features can be
implemented using microprocessor capability
already in the wrist monitors
Presentation Copyright 2012 Larry A. Beaty
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What is missing from commercial
home blood pressure monitors?
• Changes to commercial off-the-shelf wrist
monitors that would be “nice to have”:
–
–
–
–
–
–
–
–
Programmable time intervals other than 30 minutes
More memory – store 350 readings or more (1 week)
Motion or position of monitor during readings
Audible notifications of low battery
Allow use of rechargable batteries
Light, small, mount of top of wrist
Blank display for privacy
Breatheable, washable, replaceable cuffs
Presentation Copyright 2012 Larry A. Beaty
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What is missing from commercial
home blood pressure monitors?
• Changes to commercial off-the-shelf wrist
monitors that would be “lower priority”:
– Reinforced cloth liner
– Wireless interface to computer or cell phone
– Usability improvements to the software that is
used of offload the data
• Eliminate the concepts of sessions and needing to erase
the data
Presentation Copyright 2012 Larry A. Beaty
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Outline
•
•
•
•
•
•
•
Introductions
Vascular Variability Disorders (VVDs)
Tools: Sphygmochron, CUSUM
Website and Database
Wrist Monitor description
Wrist Monitor test results
Summary
Presentation Copyright 2012 Larry A. Beaty
50
Summary
• In the all-volunteer, open-source IEEE Phoenix
Project lab, we have been looking at
modifying commercial off-the-shelf (COTS)
wrist-cuff blood pressure monitors for use as a
chronobiologically-interpreted ambulatory
blood pressure monitor (C-ABPM) device.
• With some minor improvements, wrist
monitors can be a practical, affordable CABPM for large numbers of people.
Presentation Copyright 2012 Larry A. Beaty
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Summary
• These monitors are already accurate enough
to detect CHAT, Ecphasia, Ecfrequentia, DHRV.
• Work continues to determine if they can also
detect MESOR-hypertension and Excessive
Pulse Pressure accurately.
• Monitor manufacturers have changes to make
for comfort and convenience, and to meet
safety regulations.
Presentation Copyright 2012 Larry A. Beaty
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Summary
• Wrist C-ABPMs would be one of several valuable
tools for self-monitoring, implemented by
sending the data to the website and getting
Sphygmochron and CUSUM tests in return.
• The website implements continuous
improvement in the analyses via ever-improving
reference values and accounting for earth
weather and space weather effects on
physiological and psychological variables.
Presentation Copyright 2012 Larry A. Beaty
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