JMIR Biomedical Engineering

Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the “atmosome.” The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health.

Software as a medical device (SaMD) has gained the attention of medical device regulatory bodies as the prospects of standalone software for use in diagnositic and therapeutic settings have increased. However, to date, figures related to SaMD have not been made available by regulators, which limits the understanding of how prevalent these devices are and what actions should be taken to regulate them.

The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications.

The COVID-19 pandemic has demonstrated the possibility of severe ventilator shortages in the near future.

Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)–guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation.

Transcranial magnetic stimulation (TMS), when applied over the primary motor cortex, elicits a motor-evoked potential (MEP) in electromyograms measured from peripheral muscles. MEP amplitude has often been observed to fluctuate trial to trial, even with a constant stimulus. Many factors cause MEP fluctuations in TMS. One of the primary factors is the weak stationarity and instability of cortical activity in the brain, from which we assumed MEP fluctuations originate. We hypothesized that MEP fluctuations are suppressed when TMS is delivered to the primary motor cortex at a time when several electroencephalogram (EEG) channels measured on the scalp are highly similar in the frequency domain.

Numerous virtual reality (VR) systems have received regulatory clearance as therapeutic medical devices for in-clinic and at-home use. These systems enable remote patient monitoring of clinician-prescribed rehabilitation exercises, although most of these systems are nonimmersive. With the expanding availability of affordable and easy-to-use head-mounted display (HMD)-based VR, there is growing interest in immersive VR therapies. However, HMD-based VR presents unique risks. Following standards for medical device development, the objective of this paper is to demonstrate a risk management process for a generic immersive VR system for remote patient monitoring of at-home therapy. Regulations, standards, and guidance documents applicable to therapeutic VR design are reviewed to provide necessary background. Generic requirements for an immersive VR system for home use and remote patient monitoring are identified using predicate analysis and specified for both patients and clinicians using user stories. To analyze risk, failure modes and effects analysis, adapted for medical device risk management, is performed on the generic user stories and a set of risk control measures is proposed. Many therapeutic applications of VR would be regulated as a medical device if they were to be commercially marketed. Understanding relevant standards for design and risk management early in the development process can help expedite the availability of innovative VR therapies that are safe and effective.

Ultrasound-based radiomic features to differentiate between benign and malignant breast lesions with the help of machine learning is currently being researched. The mean echogenicity ratio has been used for the diagnosis of malignant breast lesions. However, gray scale intensity histogram values as a single radiomic feature for the detection of malignant breast lesions using machine learning algorithms have not been explored yet.

Clinical decision support systems (CDSS) have the potential to lower the patient mortality and morbidity rates. However, signal artifacts present in physiological data affect the reliability and accuracy of the CDSS. Moreover, patient monitors and other medical devices generate false alarms while processing physiological data, further leading to alarm fatigue because of increased noise levels, staff disruption, and staff desensitization in busy critical care environments. This adversely affects the quality of care at the patient bedside. Hence, artifact detection (AD) algorithms play a crucial role in assessing the quality of physiological data and mitigating the impact of these artifacts.

Smartphone use is widely spreading in society. Their embedded functions and sensors may play an important role in therapy monitoring and planning. However, the use of smartphones for intrapersonal behavioral and physical monitoring is not yet fully supported by adequate studies addressing technical reliability and acceptance.

Currently, nearly 6 in 10 US adults are suffering from at least one chronic condition. Wearable technology could help in controlling the health care costs by remote monitoring and early detection of disease worsening. However, in recent years, there have been disappointments in wearable technology with respect to reliability, lack of feedback, or lack of user comfort. One of the promising sensor techniques for wearable monitoring of chronic disease is bioimpedance, which is a noninvasive, versatile sensing method that can be applied in different ways to extract a wide range of health care parameters. Due to the changes in impedance caused by either breathing or blood flow, time-varying signals such as respiration and cardiac output can be obtained with bioimpedance. A second application area is related to body composition and fluid status (eg, pulmonary congestion monitoring in patients with heart failure). Finally, bioimpedance can be used for continuous and real-time imaging (eg, during mechanical ventilation). In this viewpoint, we evaluate the use of wearable bioimpedance monitoring for application in chronic conditions, focusing on the current status, recent improvements, and challenges that still need to be tackled.

The term “plasmonic” describes the relationship between electromagnetic fields and metallic nanostructures. Plasmon-based sensors have been used innovatively to accomplish different biomedical tasks, including detection of cancer. Plasmonic sensors also have been used in biochip applications and biosensors and have the potential to be implemented as implantable point-of-care devices. Many devices and methods discussed in the literature are based on surface plasmon resonance (SPR) and localized SPR (LSPR). However, the mathematical background can be overwhelming for researchers at times.