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All sourcesNASA NTRSDOE OSTI
NASA NTRS2002

Left ventricular outflow tract mean systolic acceleration as a surrogate for the slope of the left ventricular end-systolic pressure-volume relationship

OBJECTIVE: The goal of this study was to analyze left ventricular outflow tract systolic acceleration (LVOT(Acc)) during alterations in left ventricular (LV) contractility and LV filling. BACKGROUND: Most indexes described to quantify LV systolic function, such as LV ejection fraction and cardiac output, are dependent on loading conditions. METHODS: In 18 sheep (4 normal, 6 with aortic regurgitation, and 8 with old myocardial infarction), blood flow velocities through the LVOT were recorded using conventional pulsed Doppler. The LVOT(Acc) was calculated as the aortic peak velocity divided by the time to peak flow; LVOT(Acc) was compared with LV maximal elastance (E(m)) acquired by conductance catheter under different loading conditions, including volume and pressure overload during an acute coronary occlusion (n = 10). In addition, a clinically validated lumped-parameter numerical model of the cardiovascular system was used to support our findings. RESULTS: Left ventricular E(m) and LVOT(Acc) decreased during ischemia (1.67 +/- 0.67 mm Hg.ml(-1) before vs. 0.93 +/- 0.41 mm Hg.ml(-1) during acute coronary occlusion [p < 0.05] and 7.9 +/- 3.1 m.s(-2) before vs. 4.4 +/- 1.0 m.s(-2) during coronary occlusion [p < 0.05], respectively). Left ventricular outflow tract systolic acceleration showed a strong linear correlation with LV E(m) (y = 3.84x + 1.87, r = 0.85, p < 0.001). Similar findings were obtained with the numerical modeling, which demonstrated a strong correlation between predicted and actual LV E(m) (predicted = 0.98 [actual] -0.01, r = 0.86). By analysis of variance, there was no statistically significant difference in LVOT(Acc) under different loading conditions. CONCLUSIONS: For a variety of hemodynamic conditions, LVOT(Acc) was linearly related to the LV contractility index LV E(m) and was independent of loading conditions. These findings were consistent with numerical modeling. Thus, this Doppler index may serve as a good noninvasive index of LV contractility.

Non-NASA Center↗
NASA NTRS2010

Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and Braslet-M Occlusion Cuffs

The objective of this joint U.S. - Russian project was the development and validation of an in-flight methodology to assess a number of cardiac and vascular parameters associated with circulating volume and its manipulation in long-duration space flight. Responses to modified Valsalva and Mueller maneuvers were measured by cardiac and vascular ultrasound (US) before, during, and after temporary volume reduction by means of Braslet-M thigh occlusion cuffs (Russia). Materials and Methods: The study protocol was conducted in 14 sessions on 9 ISS crewmembers, with an average exposure to microgravity of 122 days. Baseline cardiovascular measurements were taken by echocardiography in multiple modes (including tissue Doppler of both ventricles) and femoral and jugular vein imaging on the International Space Station (ISS). The Braslet devices were then applied and measurements were repeated after >10 minutes. The cuffs were then released and the hemodynamic recovery process was monitored. Modified Valsalva and Mueller maneuvers were used throughout the protocol. All US data were acquired by the HDI-5000 ultrasound system aboard the ISS (ATL/Philips, USA) during remotely guided sessions. The study protocol, including the use of Braslet-M for this purpose, was approved by the ISS Human Research Multilateral Review Board (HRMRB). Results: The effects of fluid sequestration on a number of echocardiographic and vascular parameters were readily detectable by in-flight US, as were responses to respiratory maneuvers. The overall volume status assessment methodology appears to be valid and practical, with a decrease in left heart lateral E (tissue Doppler) as one of the most reliable measures. Increase in the femoral vein cross-sectional areas was consistently observed with Braslet application. Other significant differences and trends within the extensive cardiovascular data were also observed. (Decreased - RV and LV preload indices, Cardiac Output, LV E all maneuvers, LV Stroke Volume). Conclusions: This Study: 1) Addressed specific aspects of operational space medicine and space physiology, including assessment of circulating volume disturbances 2) Expanded the applications of diagnostic ultrasound imaging and Doppler techniques in microgravity. 3) Used respiratory maneuvers against the background of acute circulating volume manipulations which appear to enhance our ability to noninvasively detect volume-dependency in a number of cardiac and vascular parameters. 4) Determined that Tei index is not clinically changed therefore contractility not altered in the face of reduced preload. 5) Determined that increased Femoral Vein Area indicating blood being sequestered in lower extremities correlates with reduced preload and cardiac output. 6) That Braslet may be the only feasible means of acutely treating high pressure pulmonary edema in reduced gravity environments.

Hamilton, Douglas↗
NASA NTRS1993

Medical evaluations on the KC-135 1991 flight report summary

The medical investigations completed on the KC-135 during FY 1991 in support of the development of the Health Maintenance Facility and Medical Operations are presented. The experiments consisted of medical and engineering evaluations of medical hardware and procedures and were conducted by medical and engineering personnel. The hardware evaluated included prototypes of a crew medical restraint system and advanced life support pack, a shuttle orbiter medical system, an airway medical accessory kit, a supplementary extended duration orbiter medical kit, and a surgical overhead canopy. The evaluations will be used to design flight hardware and identify hardware-specific training requirements. The following procedures were evaluated: transport of an ill or injured crewmember at man-tended capability, surgical technique in microgravity, transfer of liquids in microgravity, advanced cardiac life support using man-tended capability Health Maintenance Facility hardware, medical transport using a model of the assured crew return vehicle, and evaluation of delivery mechanisms for aerosolized medications in microgravity. The results of these evaluation flights allow for a better understanding of the types of procedures that can be performed in a microgravity environment.

Lloyd, Charles W.↗
NASA NTRS2005

Keeping a Beat on the Heart

Feel the relief of a patient suffering from heart arrhythmia, who is able to return home while having her heart monitored by health professionals 24 hours a day, without the fear that she will miss an important indicator and suffer a fatal heart attack - using technology originally developed to conduct experiments on the Space Shuttle. Approximately 400,000 Americans die every year from sudden heart attacks . Medical research revealed that patterns of electrical activity in the heart can act as predictors of these lethal cardiac events known as arrhythmias. Fortunately, certain arrhythmias such as ventricular fibrillation (loss of regular heartbeat and subsequent loss of function) and ventricular tachycardia (rapid heartbeats), can be detected and appropriately treated. Today, patients at moderate risk of arrhythmias can benefit from technology that would permit long- term continuous monitoring of electrical cardiac rhythms outside the hospital environment in the comfort of their own homes. Medical telemetry systems, also known as telemedicine, are evolving rapidly as wireless communication technology advances, evidenced by the commercial products and research prototypes for remote health monitoring that have appeared in recent years. Wireless systems allow patients to move freely in their home and work environment while being monitored remotely by health care professionals.

Liszka, Kathy J.↗
NASA NTRS2006

User Interactive Software for Analysis of Human Physiological Data

Ambulatory physiological monitoring has been used to study human health and performance in space and in a variety of Earth-based environments (e.g., military aircraft, armored vehicles, small groups in isolation, and patients). Large, multi-channel data files are typically recorded in these environments, and these files often require the removal of contaminated data prior to processing and analyses. Physiological data processing can now be performed with user-friendly, interactive software developed by the Ames Psychophysiology Research Laboratory. This software, which runs on a Windows platform, contains various signal-processing routines for both time- and frequency- domain data analyses (e.g., peak detection, differentiation and integration, digital filtering, adaptive thresholds, Fast Fourier Transform power spectrum, auto-correlation, etc.). Data acquired with any ambulatory monitoring system that provides text or binary file format are easily imported to the processing software. The application provides a graphical user interface where one can manually select and correct data artifacts utilizing linear and zero interpolation and adding trigger points for missed peaks. Block and moving average routines are also provided for data reduction. Processed data in numeric and graphic format can be exported to Excel. This software, PostProc (for post-processing) requires the Dadisp engineering spreadsheet (DSP Development Corp), or equivalent, for implementation. Specific processing routines were written for electrocardiography, electroencephalography, electromyography, blood pressure, skin conductance level, impedance cardiography (cardiac output, stroke volume, thoracic fluid volume), temperature, and respiration

Cowings, Patricia S.↗
NASA NTRS1996

Evaluation of transit-time and electromagnetic flow measurement in a chronically instrumented nonhuman primate model

The Physiology Research Branch at Brooks AFB conducts both human and nonhuman primate experiments to determine the effects of microgravity and hypergravity on the cardiovascular system and to identify the particular mechanisms that invoke these responses. Primary investigative efforts in our nonhuman primate model require the determination of total peripheral resistance, systemic arterial compliance, and pressure-volume loop characteristics. These calculations require beat-to-beat measurement of aortic flow. This study evaluated accuracy, linearity, biocompatability, and anatomical features of commercially available electromagnetic (EMF) and transit-time flow measurement techniques. Five rhesus monkeys were instrumented with either EMF (3 subjects) or transit-time (2 subjects) flow sensors encircling the proximal ascending aorta. Cardiac outputs computed from these transducers taken over ranges of 0.5 to 2.0 L/min were compared to values obtained using thermodilution. In vivo experiments demonstrated that the EMF probe produced an average error of 15% (r = .896) and 8.6% average linearity per reading, and the transit-time flow probe produced an average error of 6% (r = .955) and 5.3% average linearity per reading. Postoperative performance and biocompatability of the probes were maintained throughout the study. The transit-time sensors provided the advantages of greater accuracy, smaller size, and lighter weight than the EMF probes. In conclusion, the characteristic features and performance of the transit-time sensors were superior to those of the EMF sensors in this study.

Non-NASA Center↗
NASA NTRS1995

A universal steady state I-V relationship for membrane current

A purely electrical mechanism for the gating of membrane ionic channel gives rise to a simple I-V relationship for membrane current. Our approach is based on the known presence of gating charge, which is an established property of the membrane channel gating. The gating charge is systematically treated as a polarization of the channel protein which varies with the external electric field and modifies the effective potential through which the ions migrate in the channel. Two polarization effects have been considered: 1) the up or down shift of the whole potential function, and 2) the change in the effective electric field inside the channel which is due to familiar effect of the effective reduction of the electric field inside a dielectric body because of the presence of surface charges on its surface. Both effects are linear in the channel polarization. The ionic current is described by a steady state solution of the Nernst-Planck equation with the potential directly controlled by the gating charge system. The solution describes reasonably well the steady state and peak-current I-V relationships for different channels, and when applied adiabatically, explains the time lag between the gating charge current and the rise of the ionic current. The approach developed can be useful as an effective way to model the ionic currents in axons, cardiac cells and other excitable tissues.

NASA Discipline Regulatory Physiology↗
NASA NTRS1987

Application of non-linear dynamics to the characterization of cardiac electrical instability

Beat-to-beat alternation in the morphology of the ECG has been previously observed in hearts susceptible to fibrillation. In addition, fibrillation has been characterized by some as a chaotic state. Period doubling phenomena, such as alternation, and the onset of chaos have been connected by non-linear dynamical systems theory. In this paper, we describe the use of a technique from nonlinear dynamics theory, the construction of a first return nap, to assess the susceptibility to fibrillation threshhold in canine experiments.

NASA Discipline Cardiopulmonary↗
NASA NTRS1991

Is the normal heartbeat chaotic or homeostatic?

Limits to the usefulness of homeostasis as a guiding physiological principle are revealed by new mechanisms derived from study of nonlinear systems that generate a type of variability called chaos. Loss of complex physiological variability may occur in certain pathological conditions including heart rate dynamics before sudden death and with aging.

NASA Program Space Physiology and Countermeasures↗
NASA NTRS1992

Vasopressin responses to unloading arterial baroreceptors during cardiac nerve blockade in conscious dogs

We examined the relative contributions of afferent input from the heart and from arterial baroreceptors in the stimulation of arginine vasopressin (AVP) secretion in response to hypotension caused by thoracic inferior vena caval constriction (TIVCC). Afferent input from cardiac receptors was reversibly blocked by infusing 2% procaine into the pericardial space to anesthetize the cardiac nerves. Acute cardiac nerve blockade (CNB) alone caused a rise in mean arterial pressure (MAP) of 24 +/- 3 mmHg but no change in plasma AVP. If the rise in MAP was prevented by TIVCC, plasma AVP increased by 39 +/- 15 pg/ml, and if MAP was allowed to increase and then was forced back to control by TIVCC, plasma AVP increased by 34 +/- 15 pg/ml. Thus the rise in MAP during CNB stimulated arterial baroreceptors, which in turn compensated for the loss of inhibitory input from cardiac receptors on AVP secretion. These results indicate that the maximum secretory response resulting from complete unloading of cardiac receptors at a normal MAP results in a mean increase in plasma AVP of 39 pg/ml in this group of dogs. When MAP was reduced 25% below control levels (from 95 +/- 5 to 69 +/- 3 mmHg) by TIVCC during pericardial saline infusion, plasma AVP increased by 79 +/- 42 pg/ml. However, the same degree of hypotension during CNB (MAP was reduced from 120 +/- 5 to 71 +/- 3 mmHg) led to a greater (P less than 0.05) increase in plasma AVP of 130 +/- 33 pg/ml. Because completely unloading cardiac receptors can account for an increase of only 39 pg/ml on average in this group of dogs, the remainder of the increase in plasma AVP must be due to other sources of stimulation. We suggest that the principal stimulus to AVP secretion after acute CNB in these studies arises from unloading the arterial baroreceptors.

NASA Center ARC↗
NASA NTRS2001

Influence of respiratory motor neurone activity on human autonomic and haemodynamic rhythms

Although humans hold great advantages over other species as subjects for biomedical research, they also bring major disadvantages. One is that among the many rhythmic physiological signals that can be recorded, there is no sure way to know which individual change precedes another, or which change represents cause and which represents effect. In an attempt to deal with the inherent complexity of research conducted in intact human subjects, we developed and used a structural equation model to analyse responses of healthy young men to pharmacological changes of arterial pressure and graded inspiratory resistance, before and after vagomimetic atropine. Our model yielded a good fit of the experimental data, with a system weighted R2 of 0.77, and suggested that our treatments exerted both direct and indirect influences on the variables we measured. Thus, infusions of nitroprusside and phenylephrine exerted all of their direct effects by lowering and raising arterial pressure; the changes of R-R intervals, respiratory sinus arrhythmia and arterial pressure fluctuations that these drugs provoked, were indirect consequences of arterial pressure changes. The only direct effect of increased inspiratory resistance was augmentation of arterial pressure fluctuations. These results may provide a new way to disentangle and understand responses of intact human subjects to experimental forcings. The principal new insight we derived from our modelling is that respiratory gating of vagal-cardiac motor neurone firing is nearly maximal at usual levels of arterial pressure and inspiratory motor neurone activity.

Non-NASA Center↗
NASA NTRS2006

High-frequency ECG

The standard ECG is by convention limited to 0.05-150 Hz, but higher frequencies are also present in the ECG signal. With high-resolution technology, it is possible to record and analyze these higher frequencies. The highest amplitudes of the high-frequency components are found within the QRS complex. In past years, the term "high frequency", "high fidelity", and "wideband electrocardiography" have been used by several investigators to refer to the process of recording ECGs with an extended bandwidth of up to 1000 Hz. Several investigators have tried to analyze HF-QRS with the hope that additional features seen in the QRS complex would provide information enhancing the diagnostic value of the ECG. The development of computerized ECG-recording devices that made it possible to record ECG signals with high resolution in both time and amplitude, as well as better possibilities to store and process the signals digitally, offered new methods for analysis. Different techniques to extract the HF-QRS have been described. Several bandwidths and filter types have been applied for the extraction as well as different signal-averaging techniques for noise reduction. There is no standard method for acquiring and quantifying HF-QRS. The physiological mechanisms underlying HF-QRS are still not fully understood. One theory is that HF-QRS are related to the conduction velocity and the fragmentation of the depolarization wave in the myocardium. In a three-dimensional model of the ventricles with a fractal conduction system it was shown that high numbers of splitting branches are associated with HF-QRS. In this experiment, it was also shown that the changes seen in HF-QRS in patients with myocardial ischemia might be due to the slowing of the conduction velocity in the region of ischemia. This mechanism has been tested by Watanabe et al by infusing sodium channel blockers into the left anterior descending artery in dogs. In their study, 60 unipolar ECGs were recorded from the entire ventricular surface and were signal-averaged and filtered in the 30-250 Hz frequency range. The results showed that the decrease noted in the HF-QRS correlated linearly with the local conduction delay. The results suggest that HF-QRS is a potent indicator of disturbed local conduction. An alternative theory is that HF-QRS reflect the shape of the original electrocardiographic signal. Bennhagen et al showed that root mean square (RMS) voltage values of the depolarization signal correlate poorly with the signal amplitude but highly with the first and second derivatives, i.e. the velocity and the acceleration of the signal. It has also been suggested that the autonomic nervous system affects HF-QRS. For example, sitting up causes significant changes in HF-QRS in some leads compared to the supine position [Douglas et al., 2006]. Unpublished results indicate that familial dysautonomic patients (both vagal and sympathetic degeneration) have very little Reduced Amplitude Zones (RAZ) formation . Athletic individuals, especially elite athletes, who have vagally-mediated changes on the conventional ECG (i.e. early repolarization, bradycardia) have increased RAZ formation. Further electrophysiological studies are needed, however, to better understand the underlying mechanisms of HF-QRS. Several investigators have studied HF-QRS in different cardiac conditions, including acute myocardial ischemia and myocardial infarction (MI). However, in order for clinicians to confidently use HF-QRS as an adjunct to standard ECG, more knowledge about the characteristics of HF-QRS is needed.

Tragardh, Elin↗
NASA NTRS1996

Cardiovascular Deconditioning and Venous Air Embolism in Simulated Microgravity in the Rat

Astronauts conducting extravehicular activities undergo decompression to a lower ambient pressure, potentially resulting in gas bubble formation within the tissues and venous circulation. Additionally, exposure to microgravity produces fluid shifts within the body leading to cardiovascular deconditioning. A lower incidence of decompression illness in actual spaceflight compared with that in ground-based altitude chamber flights suggests that there is a possible interaction between microgravity exposure and decompression illness. The purpose of this study was to evaluate the cardiovascular and pulmonary effects of simulated hypobaric decompression stress using a tail suspension (head-down tilt) model of microgravity to produce the fluid shifts associated with weightlessness in conscious, chronically instrumented rats. Venous bubble formation resulting from altitude decompression illness was simulated by a 3-h intravenous air infusion. Cardiovascular deconditioning was simulated by 96 h of head-down tilt. Heart rate, mean arterial blood pressure, central venous pressure, left ventricular wall thickening and cardiac output were continuously recorded. Lung studies were performed to evaluate edema formation and compliance measurement. Blood and pleural fluid were examined for changes in white cell counts and protein concentration. Our data demonstrated that in tail-suspended rats subjected to venous air infusions, there was a reduction in pulmonary edema formation and less of a decrease in cardiac output than occurred following venous air infusion alone. Mean arterial blood pressure and myocardial wall thickening fractions were unchanged with either tail-suspension or venous air infusion. Heart rate decreased in both conditions while systemic vascular resistance increased. These differences may be due in part to a change or redistribution of pulmonary blood flow or to a diminished cellular response to the microvascular insult of the venous air embolization.

Robinson, R. R.↗
NASA NTRS2015

Free-Energy Calculations. A Mathematical Perspective

Ion channels are pore-forming assemblies of transmembrane proteins that mediate and regulate ion transport through cell walls. They are ubiquitous to all life forms. In humans and other higher organisms they play the central role in conducting nerve impulses. They are also essential to cardiac processes, muscle contraction and epithelial transport. Ion channels from lower organisms can act as toxins or antimicrobial agents, and in a number of cases are involved in infectious diseases. Because of their important and diverse biological functions they are frequent targets of drug action. Also, simple natural or synthetic channels find numerous applications in biotechnology. For these reasons, studies of ion channels are at the forefront of biophysics, structural biology and cellular biology. In the last decade, the increased availability of X-ray structures has greatly advanced our understanding of ion channels. However, their mechanism of action remains elusive. This is because, in order to assist controlled ion transport, ion channels are dynamic by nature, but X-ray crystallography captures the channel in a single, sometimes non-native state. To explain how ion channels work, X-ray structures have to be supplemented with dynamic information. In principle, molecular dynamics (MD) simulations can aid in providing this information, as this is precisely what MD has been designed to do. However, MD simulations suffer from their own problems, such as inability to access sufficiently long time scales or limited accuracy of force fields. To assess the reliability of MD simulations it is only natural to turn to the main function of channels - conducting ions - and compare calculated ionic conductance with electrophysiological data, mainly single channel recordings, obtained under similar conditions. If this comparison is satisfactory it would greatly increase our confidence that both the structures and our computational methodologies are sufficiently accurate. Channel conductance, defined as the ratio of ionic current through the channel to applied voltage, can be calculated in MD simulations by way of applying an external electric field to the system and counting the number of ions that traverse the channel per unit time. If the current is small, a voltage significantly higher than the experimental one needs to be applied to collect sufficient statistics of ion crossing events. Then, the calculated conductance has to be extrapolated to the experimental voltage using procedures of unknown accuracy. Instead, we propose an alternative approach that applies if ion transport through channels can be described with sufficient accuracy by the one-dimensional diffusion equation in the potential given by the free energy profile and applied voltage. Then, it is possible to test the assumptions of the equation, recover the full voltage/current dependence, determine the reliability of the calculated conductance and reconstruct the underlying (equilibrium) free energy profile, all from MD simulations at a single voltage. We will present the underlying theory, model calculations that test this theory and simulations on ion conductance through a channel that has been extensively studied experimentally. To our knowledge this is the first case in which the complete, experimentally measured dependence of the current on applied voltage has been reconstructed from MD simulations.

free energy↗
NASA NTRSDate not supplied

Exploration Atmosphere Demonstration of A Multi-Functional Integrated Medical Device (Tempus Pro)

INTRODUCTION The Exploration Medical Capability (ExMC) element within the Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) within the Mars Campaign Office seek to advance medical system design and risk-informed decision-making for exploration missions. This includes assessment of candidate devices and their compatibility within a variety of increasingly Earth-independent medical scenarios. The Tempus Pro (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf (COTS), multi-functional integrated medical device capable of vital signs monitoring, with built-in procedure support (iAssist), patient record and telemedicine communication features, and medical imaging (e.g., camera, laryngoscope, ultrasound) that meets multiple exploration medical capability needs. One of several hypobaric atmospheres being considered for exploration vehicles is 8.2 psi with 34% oxygen. To assess the useability of the Tempus Pro in such environments by individuals without formal medical training, the unit was tested in May and June of 2023 at the Johnson Space Center 20-Foot Exploration Atmosphere Chamber in conjunction with the Exploration Atmospheres-2 (EA-2) study. TECHNOLOGY DEMONSTRATION Eight subjects in the EA-2 study were assigned roles as the caregiver or patient – or both in the case of a self-exam – and caregivers were asked to place sensors for 3-Lead ECG, non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and temperature using Tempus Pro’s iAssist. Depending on the procedure, additional tasks included an oropharyngeal exam of the throat with the laryngoscope and capturing ultrasound images of a cardiac subxiphoid view or of the user’s choice from a pre-specified list. Scenarios ranged from remote-guided to fully autonomous operations and surveyed the effectiveness of support, amount of support desired, and importance of support by type (e.g., written crew procedures, iAssist and device guidance, remote console guidance, etc.). Feedback from the subjects and the support personnel was also gathered to inform future designs for training and support and to determine what operations are plausible given different levels of each. An unweighted NASA task load index (TLX) was used to profile the demands of using the device, however the sample size does not support statistics. The research was exploratory in nature and qualitative information was the main goal. Calibration checks on the Tempus Pro were conducted before and after chamber testing to ensure the device was in useable condition. RESULTS All subjects performed their tasks successfully and found the Tempus Pro easy to use with the support provided. The calibration checks outside the chamber showed that the Tempus Pro remained unchanged and measurements inside the chamber were within normal values. Caregivers taking the NASA TLX reported mean scores ≤ 41/100 showing the tasks to be undemanding and less demanding with repeated use (~20/100). Novice users were able to easily connect sensors and take vital signs with the guidance from Tempus Pro’s iAssist feature. For more complex tasks, such as the oropharyngeal exam and ultrasound image acquisition, guidance beyond iAssist was needed, primarily from a supporting physician. Feedback on the importance of support types varied by person and scenario but greater than 50% of the support used by each was non-native to the device. Overall opinions were positive, but the ultrasound users expressed a lack of confidence in their results and 3 out of 4 desired more time, training, or support. Subjects found the sensors to be comfortable and comparable to prior experiences with such devices, except for the blood pressure cuff, which squeezed too tightly for uncomfortably long periods. Many observations provoked discussion, especially regarding ultrasound, that will aide decisions about future demonstrations.

R. S. Miller↗