Cardiovascular monitoring systems for aging in place: current perspectives and a novel toilet seat-based system

Cardiovascular disease (CVD) is a leading cause of death. Questions remain as to how older adults, providers and researchers can harness remote patient monitoring (RPM) to maintain/improve cardiovascular health--especially in light of COVID-19 and increased reliance on telehealth. The objective of this study was to understand the perceptions of older adults with cardiovascular challenges and providers surrounding a novel RPM device. The Heart Seat (THS) developed by Casana, is a toilet-seat-based cardiac monitoring device. Focus groups, stratified by gender, were conducted in 2021 by the UF Health Precision Health Research Center (UFIRB202100290) with older (55+) adults (n=36) in The Villages, Florida. Adoption, benefits/concerns, usability, utility and gender differences were explored. One-on-one provider interviews (n=6) explored future utility of THS. The primary benefit of THS noted by providers and older adults was ease-of-use and passive data collection, promoting adherence. Providers considered THS ‘easy-to-use’ and a positive alternative to current RPM devices. While genders' sentiments towards cardiac monitoring devices were similar, males reported having more experience with RPM. Despite this, females reported using cardiac monitoring devices more consistently than males. Therefore, passive RPM may be beneficial for increasing adherence in males. Participants' largest concern surrounding RPM was information sharing, including data monitoring, and security. Providers were also concerned about information sharing, specifically who would receive/monitor and interpret data from RPM. RPM devices should focus on enhancing ease-of-use, catering to user and provider information sharing and data monitoring/interpretation preferences and privacy.

Numerical Investigation of Bioaerosol Transport in a Compact Lavatory

The lavatory is a fertile area for the transmission of infectious disease through bioaerosols between its users. In this study, we built a generic compact lavatory model with a vacuum toilet, and computational fluid dynamics (CFD) is used to evaluate the effects of ventilation and user behaviors on the airflow patterns, and the resulting fates of bioaerosols. Fecal aerosols are readily released into the lavatory during toilet flush. Their concentration rapidly decays in the first 20 s after flushing by deposition or dilution. It takes about 315 s to 348 s for fine bioaerosols (<10 µm in diameter) to decrease to 5% of the initial concentration, while it takes 50 and 100 µm bioaerosols approximately 11 and <1 s, respectively, to completely deposit. The most contaminated surfaces by aerosol deposition include the toilet seat, the bowl, and the nearby walls. The 10 µm aerosols tend to deposit on horizontal surfaces, while the 50 and 100 µm bioaerosols almost always deposit on the bowl. In the presence of a standing thermal manikin, the rising thermal plume alters the flow field and more bioaerosols are carried out from the toilet; a large fraction of aerosols deposit on the manikin’s legs. The respiratory droplets generated by a seated coughing manikin tend to deposit on the floor, legs, and feet of the manikin. In summary, this study reveals the bioaerosol dilution time and the easily contaminated surfaces in a compact lavatory, which will aid the development of control measures against infectious diseases.

Revision Of A Standard For The Test Of A Toilet-Incorporated Medical Electric Bed

We developed a toilet-incorporated electric medical bed for bedridden patients, in which a toilet basin, or a commode, is incorporated in the pelvic plate of an electric medical bed. A replaceable toilet seat is located in the mattress of the bed, and toilet basin was tightly attached on the pelvic plate the bed. The excretion slides through a storage tube that angles toward the side of the bed and is automatically collected in a disposable plastic bag. We, however, encountered a problem with testing this newly developed medical bed with the relevant international standard IEC 60601-2-52:2009, or with the corresponding Korean standard KS P 0388:2012--Electrically operated adjustable bed for home care. There was no clear indication in the scopes of the above standards as to whether this standard testing method is applicable to an electric medical bed embedded with a commode. We revised the Korean standard KS P 0388:2012 to accommodate the toilet-incorporated medical bed in the scope of the standard and successfully performed the mechanical tests including the durability, impact, and deformation test of the bed, proving that the newly developed toilet-incorporated medical bed is mechanically strong and durable enough to pass the standard tests.

Design and evaluation of a novel approach to invisible electrocardiography (ECG) in sanitary facilities using polymeric electrodes

Multiple wearable devices for cardiovascular self-monitoring have been proposed over the years, with growing evidence showing their effectiveness in the detection of pathologies that would otherwise be unnoticed through standard routine exams. In particular, Electrocardiography (ECG) has been an important tool for such purpose. However, wearables have known limitations, chief among which are the need for a voluntary action so that the ECG trace can be taken, battery lifetime, and abandonment. To effectively address these, novel solutions are needed, which has recently paved the way for “invisible” (aka “off-the-person”) sensing approaches. In this article we describe the design and experimental evaluation of a system for invisible ECG monitoring at home. For this purpose, a new sensor design was proposed, novel materials have been explored, and a proof-of-concept data collection system was created in the form of a toilet seat, enabling ECG measurements as an extension of the regular use of sanitary facilities, without requiring body-worn devices. In order to evaluate the proposed approach, measurements were performed using our system and a gold standard equipment, involving 10 healthy subjects. For the acquisition of the ECG signals on the toilet seat, polymeric electrodes with different textures were produced and tested. According to the results obtained, some of the textures did not allow the acquisition of signals in all users. However, a pyramidal texture showed the best results in relation to heart rate and ECG waveform morphology. For a texture that has shown 0% signal loss, the mean heart rate difference between the reference and experimental device was − 1.778 ± 4.654 Beats per minute (BPM); in terms of ECG waveform, the best cases present a Pearson correlation coefficient above 0.99.

Evaluation of Standing-Up Motion from a Forward-Sloping Toilet Seat for Older People

(1) Background: In-home assistive systems to help people with physical disabilities stand up from toilets are necessary, and the ease of the standing-up motion should be evaluated. (2) Methods: This study investigated the ease of the standing-up motion using objective and subjective data from healthy participants to facilitate the development of a toilet-seat-tilting system. Participants were divided into younger and older age groups. Objective data concerning muscle activity (EMG), three-dimensional (3D) body motion, and center of pressure distribution (COP) were collected. The participants also provided subjective data related to standing up from a toilet tilted at three different angles. (3) Results: All participants repeated the motion 25 times for each angle and provided feedback regarding their standing-up experience under each condition. Objective EMG, COP, and 3D body motion analysis results varied across individuals and age groups. The older group exhibited a consistent pattern of head motion while standing up. Thus, older individuals prefer a forward trunk-inclination motion. (4) Conclusions: According to the collected subjective data, all participants found it easier to stand when the seat angle was 5° or 10°; objective data on the ankle dorsiflexion angle, muscle activity, and head motion may be related to the subjective ease of the standing-up motion.