November 1st, 2016

Cuffless Photoplethysmography: Real or Not Real?

I was innocently reading my mail today when I ran across this:

http://www.medpagetoday.com/Blogs/IltifatHusain/61146

There are some problems with this article. I had trouble finding a link either in this, things linked to by this to the article which found problems in the previous app, "Instant Blood Pressure", to the Johns Hopkins article describing an attempt to validate the app by people not connected to the app. So, you know, google.

http://www.hopkinsmedicine.org/news/media/releases/popular_blood_pressure_app_misses_the_mark

App failed to detect most of the participants in the study who had high blood pressure, incorrectly saying they had normal blood pressure (using 140/90 as the cutoff, in case you were wondering).

The initial article I read had the perspective that, duh, of course this won't work, which honestly I initially did not have any problem with. But alas, as with a lot of bad rhetoric, the more the author went on, the more suspicious I became of that assumption. Helpfully, a word is supplied! photoplethysmography

Anyone who has ever been around a woman in labor, or any other poor unfortunate being continuously monitored by machines that go "beep" knows just how evil continuous blood pressure monitoring is. It disrupts focus, the ability to sleep and I still think it isn't good for the nerves distal to the cuff, I don't really care what anyone says. And can running a cuff that often be good for blood pressure walls? Can it? Really? (See what I mean about assumptions?) If you could take something along the lines of a pulse oximeter (which while obnoxious, is much more readily ignored than an automated cuff going off every fifteen minutes or whatever) and a microphone taped to your chest and use that instead, I am pretty sure we'd all just LOVE that, amirite?

But is it _real_? Sure, there are at least some scammy apps out there (surprise). And sure, there is going to come a day where we probably should actually do some enforcement on scammy apps that amount to some form of health care fraud.

But can cuffless photoplethysmography actually _work_?

It's not looking good, if people are resorting to things like this:

https://www.ncbi.nlm.nih.gov/pubmed/26736283

On the other hand, this:

https://www.ncbi.nlm.nih.gov/pubmed/26040284

I'm inclined to agree with the general thrust of this one: interesting possibilities, but not ready for clinical use yet.

https://www.researchgate.net/publication/237060099_Innovative_continuous_non-invasive_cuffless_blood_pressure_monitoring_based_on_photoplethysmography_technology

I hadn't realized that people had been working on this stuff for as long as they have, nor did I know there were commercial cuffless products out there already. Also, OMG the things they do to validate _non-invasive_ systems.

https://www.ncbi.nlm.nih.gov/pubmed/12131075

I can only hope that pigtail catheter was in the aortic arch for some other reason; the idea that they put one in to do this bicycle stress test is a little horrifying.

Oh, and while I focused exclusively on the BP aspects of photoplethysmography, one or more of the apps made other claims as well. If you are wondering about the ability to detect cholesterol non-invasively, well, I haven't found anything about using a camera, microphone and computing power that will do that, but I did find this:

http://www.prevu.com/English/pts/intro.html

ETA: I did find this, which seems sketchy at best:

http://www.inderscienceonline.com/doi/abs/10.1504/IJMEI.2012.048384

Also, there are people working on using impedance, which I'm pretty skeptical of. And a while back, people working trying to use IR as well. For the whole non-invasive cholesterol thing.

Organizing vs. Decluttering

I have a recliner. I used to have a Dutailier rocker, but then that whole vertigo thing happened and No More Rocking Chairs for Me. I got a really great recliner and ottoman to go with (Ekorne, which I never can manage to remember how to spell without looking it up because I know words in too many languages that sound roughly like that and it just confuses the hell out of me). Next to my recliner _should_ be some sort of small table for putting a book or device or tea and maybe a lamp on. But that's not how I roll. For a few years, I had a hutch with shelves on top of a 2 drawer lateral file (go big. Not go big or go home. Just, go big). The 2 drawer file now lives in my sort-of office and the hutch lives a separate life on the third floor. I downsized to a three shelf bookshelf that R. had (I don't own bookshelves this short, normally). This is where devices can be charged when they are not overnighting upstairs in their proper charging location. It is also where a bunch of books permanently live (the Dutch reference books, a copy of GTD, a book about Acton, the town trails guide, some blank books, a travel guide to Boston, another book with trails in a multi-town area, and all the Pfeffer holiday books and some similar things). There is also an ungodly stack of Random Crap: the last vestiges of magazine like reading material (Disney Files, Catalyst, some investor stuff, etc.). Library books live here so I don't lose track of them, etc.

Since I'm actually cleaning my own house, and because I am Lazy (<-- Aspirational Statement, so don't even try to argue with me. That is, I aspire to be clever enough to be successfully lazy), I have been trying to maximize the amount of vacuuming that can be done by Roomba (rather than me). I bet you can see where this is going.

So, I had to reorganize the 3 shelf bookshelf by my chair so I could get all the charging cords permanently up, up and away from where Roomba would eat them. Until I did this, every time Roomba ran, I had to blockade the shelf so Roomba wouldn't go nibble on those tasty, tasty cords.

Alas, I only managed to get rid of a couple of minor items. It doesn't really count as decluttering. I threw away a few receipts. I wound up some earbuds and put them into their container and put them in a new location. Really, it is barely worth mentioning. Virtually everything went back. I _did_ move some stuff off permanently to elsewhere -- there was a photo binder/scrapbook that moved to the shelf with the rest of like items. That meant the song books had to find a new home. Etc.

But it looks better, and more importantly it should work better. Of course, I'm probably still going to have to blockade the back of the couch, because I don't even want to think about Roomba repeatedly bashing itself against the somewhat tippy plant stands. Which have glass shelves on top.

ETA: Neat article at Unclutterer a few days ago:

https://unclutterer.com/2016/10/28/organizing-during-grief/

I read Alison Stewart's excellent book _Junk_ recently, and the spark for the author to write the book was emptying out her parents' basement after they passed. Several other stories in the book also involve people having to clear out a space after someone moves away abandoning things or dies. I don't have any reason to expect I'm going to die any time soon, or experience grief of some other sort, but reading the book definitely lit a fire under me. I don't want anyone else to have to sort through all this stuff, nor do I want to have to do it while any more impaired than I already am. Now is as good a time as I am ever going to get.