PEER-REVIEWED PAPER

A Novel Methodology
for the Experimental Evaluation of
Pulmonary Ventilator Performance Drift
F.P. Branca, P. Cappa, S.A. Sciuto*, S. Silvestri
Department of Mecbanics ami Aeronautics
UniuersiZJ' of Rome "La Sapienza"
Rome, /TAL}/
*Dept. of Meclwnicat ami industriai Engineeri11g,
/Il Uniuersity of Rome
An automa tic system (or the evaluation o( pulmonary ventila tar drift is proposcd. Some statistica/ indexes
commonly utilizcd in machine diagnostics, such as "Run test (or randomness", are briefly described and utilizcd
in drift tests in arder to comparatively evaluate their sensitivity. Three ventilators werc tested far 20 days hy
acquiring pressurc and flow analog signa fs by mcans of an analog-to-digital converter in arder to: (7) ca/eu/ate
main rcspiratory parameters; (2) save data onta magnetic support; and, finally, (3) postprocess the collected data
far drift evaluation. The results reported here va fidate the proposed experimental set-up far objective ventila tar
performance drift evaluation and show the differing levels of effectiveness of the examined indexes. Thcrcforc,
the system can be considered a valuable tool far Clinica/ Engineering Service (CES) technicians, during
maintenance procedures.
lndex Under: Ventila/or, pulmonary ventilator, drift
INTRODUCTION
P
ulmonarv ventilators, as i t is well known, are devices
that either contro! or asstst the mechantcal venttlatton
of a patient's lungs; they are commonly utilized in
cases of pulrnonary clisease or during anaesthesia', even for
long periods of time. With regard to the ventilator time
length utilization, it is important to outline that the major
portion of the workload of the rotai ventilator time (over
40%) is consumed by the weaning process'. which can last
more than 40 days'.
Since the ther.tpeutic goal of ventilation is to maintain
appropriate arteria! levels of oxygen, carbon dioxide and
pH, while minimizing patient risk, discomfort and time on
the ventilator, proper ventilator functioning, in common
use, is only verited by means of the analysis of the state of
the patient. The patient's state is determined by clinica!
ohservation ami hy the measurement of severa! parameters
performed by means of t1owmeters, capnometers, oxygen
analyzers, pulse oximeters ami multifunction analyzers.
Once the patient's state is determined, the clinician can
easily make small compensatory Chan).,>es in the levelo; of oxy-
gen, c;uhon diox.ide :md p H in the bl<xx.l on a daily basis.
However, in such a manner, it is not possihle to tgure
Branca et al.
out whether (l) paticnt condition change, (2) worsening
of metrological performances of thc previously cited
dcvices for patient state monitoring, or(:)) ventilator per-
formance drift is the main cause of ventilator parameter
correction. While performing periodica! pulmonary venti-
lator maintenance, CE..'i technicians should not only carry
out verification :md calihrJ.tion procedures in accordance
with ventilator manufacturer indications, hut also they
should conduct drift tests. With these tests, i t is possible to
evaluate the correct and consta n t functioning of these high
risk devices as a function of ti me. To t h e authors' knowl-
edge, drift tests are not currently prescribed by t h e ventila-
tor manufacturers.
!t is relevant to point out that the "Standard
Speciftcation for Yentilators Intendcd fr lise in Criticai
Care"' by the American Society for Testing and Materials
(ASTM), - the only reference found - describes rigorous
experimental methods to conduct endurance tests. From
an examination of this specification, which
seems mainly direc.:ted toward ventilator manufacturers in
order to estahlish the drift char.tcteristics of their products
Journal of Clinica! Engineering Vol. 22, No.3, May/June 1997
Copyright :9 1997, Lippincott-Raven Publishers
Journal of Clinical Engineering May/june 1997 163
TABLE 1 TEST EXPERIMENTAL
PROCEDURES
Ventilator Al A2
Maximum inspired flow
[liters per minute] 6.0 7.0
lnspiration time l e n ~ t h
breathing cycle tota
time length [percent] 25 25
Respiratory frequency
[breaths per minute] 20 Hl
B
7.5
33
20
adoption in current CES activity impracticable.Therefore. i t
seemed useful to huild a more usahle, suitable and suft-
ciently effective procedure for ventilator drift testing. In
particular. as a consequence of the needs of the CES of the
Childrens' Hospital "Bambino Ges", where ()R pulmonary
ventilators (for a St.<; million total value) are installed.
there appeared to be a gre;lt need for a PC-based automat-
ic procedure with a user friendly interface that can impk-
ment the ahove mentioned constraints. Furthermore,
depending on the high risks to patients who undergo
meehanical ventilation'-, this automatic computerized sys-
tem could easily he adapted for continuous monitoring in
long term ventilator utilization in the Intensive Care Unit
(ICU). Functions would include: (l) adding an extra alarm
t o prevent the possihility of sudden lililures, sue h as the dis-
connection of elements associated to the breathing system
(i.e .. the hose system); (2) maintaining detailed summary
reports l(>r archive purposes ""' "; and (3) acquiring and
recording respiratory parameters to allow better planning
ami controlling of weaning or other ther.1peutic interven-
tions".Therel(>re. we intenti:
l. to consider statistica! indexes generally utilized in
machine diagnostics that seem to be potentially useful to
test the relevance of ventilator drift phenomena, and deter-
mine the most suitable one;
2. to implement the chosen index in an automatic sys-
tem to quantify the ventilator parameter drift on-line and
then provide elements to CES technicians f()r maintenance
procedures and to physicians l(Jr extended clinica! utiliz:t-
tion, to evaluate reliability an d correct functioning of these
high-risk machines:
:). to record physiological pulmonary ventilation par.t-
meter trends on magnetic support during in vivo ventilator
use for arehive purposes, even fr sever.1l devices (for
example, ali the ventilators installed in an ICU).
164 Journal of Clinica! Engineering May/june 1997
STATISTICAL APPROACH
Drift phenomena are:: commonly itkntilkd with the
deviation over a specilc Lime period of a parameter value
from the set one. which represents the reference value.
From a technkal point of view. in ordc::r to rc::cognize drift
phenomena, it is defnitely more important to determine
and quanti!') the par.tmeter variation tendency as a func-
tion of time, rather than to compare any measured value
with a refcrence numbcr. which would be of no pr.tctical
effectiveness because ofthe r.mdom fluctuation which nat-
ur.lll)' affects the measure sequence. Therefore, statistica!
criteria are requircd in order to deduce the parametc::r
trend from the sequence of measured values. Because of
the lack of standards in statistica! methods for deetromed-
ical device drift evaluation and the unpredictahleness of
drift tendency (monotone an d/or periodica!)'""''". different
statistica! drift indexes capa bit: of managing scattered data
are briefly described bere.
The main hypothesis gener.llly accepted in drift statis-
tica! analysis is that the measured values are distrihuted on
a bell-shaped curve centered on the mean value. according
to the norma! distribution, while the measurand can be
considered constant and the dkct of ali environmental
condition variations can be discounted.
Firstly, the mean values (x) tor the trst amllast test days
and their relative standard tkviations (O') were evaluated.
Then. the angular coeftcient value" (AC) of the str.1ight
line that best lts the \'alue distribution of the chosen ven-
tilation par.tmeter as a function of time was considered
together with the corrdation coeftcient, (r), which indi-
cates how wdl data points support linear relation hetween
ti me ami x. Actually. only the AC sign can be usefully uti-
lized for drift analysis becausc:: it yidds information of the
data global tendency: in fact, its ahsolute value is not sig-
nifcant because it is a function of the utilized measuring
units.
The skewness" ""' " (S), i.e. the normalized third
moment of the observed distribution, calculated as:
1 N(x,-x)
3
S =(N -l)(N-2); <1
(l)
where N is the total sample number: and x
1
is the i-th read-
ing.
T11e S value allows the evaluation of the acquired data
distribution asymmetry (Fig. l): in fact. when thc distribu-
tion is perfectly symmt:tric with respect to the mean value,
S=O. Drift phenomenon determines a shift in data distrihu-
tion an d. consequently, S;tO, w h ere S>O implies a tendency
of data to values greater than distribution mean value and
vice-versa.
The Kurtosis' index" (K), i.e., the normalized f(mrth
moment of the observed distribution. is calculated as fol-
lows:
Branca et al.
N(N+I) I(x;-x)- 3(N-1)
2
(2)
K= (N-l)(N-2)(N-3) ,.
1
a (N-2)(N-3)
The K value estimates the observed distribution width
(Fig.l).As the index is normalized, K=O corresponds to the
norma! distribution. Tims. when K>O, the curve is sharper
th::m norma! an d the data spread is reduced, drift phenom-
enon ca n determine a K value decrease. However. data shift
can occur even though the distribution width does not sig-
nilcantly change: in t:tct. the mean value can shift as a
function of time, independent from distribution width.
The Run test for r.mdomness"' (R) is a specifc test w
Yerify the statistica! indepcndence of collectcd data as a
function of timc. i.e .. to determine whcther the samplc is
truly random.lt can also be effectively utilized to highlight
dependent data trends. such as drift. This test can be
schcmatized according t o the following steps: (l) ind the
median of thc values ami set up the hypothesis that the test
data are r.mdom: (2) differentiate between the values
above ami below thc median an d assign the sign "+"or .. _ .. ,
respectivcly: O) use the .. + an d -.. sequence rather than the
quantitative data: ( 4) count the run number in the new
series. where a run is detned as a succession of identica!
signs followed by different ones: :md, inally. (5) compare
the number of experirnental runs with the nurnber of runs
for actual r.mdom variable. for exarnple N=200: if the num-
ber of experimental runs. R.>'>";, lies between 84 ami 117.
x
FIGURE 1: Dstrbution normalized asymmetry.
the hypothesis of randomness of test data cannot be reject-
ed a t a \)\)'Y., contidence leve l''. This staternent means t ha t:
(l) the data collected as a function of t ime are randomly
distributed :md. subsequently. there is no shift if R.n,, is in
t h e r.mge of H4-l 17: (2) drift monotone tendcncy is present
if R.n ... <84: anJ. fnally, (3) Jata have a periodica! trend if
R,>r .. >117.
There are some ditkrences among the considered
indexes. In t:tct, to calculate Sand K. when they are already
implemented in a generai purpose spreadsheet (e.g. MS
Excel) for pnst-proeessing elaborations, we need to work
out statistica! par.tmeters, such as mean and standard devi-
Branca et al.
x
FIGURE 2: Distrbution normalzed width.
ation, hypothesizing that the samples were drawn from a
continuous distribution, such as the norma! one. For these
reasons. the above indexes are called "parJmetrics". On the
other hand, R, a "non-par.tmetric" index. implies experi-
ments conducted without neccssarily calculating any sta-
tistica! parJmeters and without any hypotheses on the lim-
iting data distribution. Furthermore x.AC and S seem to be
effective in evaluating drift phenomenon with a dominant
monotone trend, but less so, in the case of periodica! drift.
In the case of periodica! tendency shift. which is generally
related t o the worsening of working conditions, K seems to
be better ab le t o detect periodica! drift phenomena. Finally,
R seems to be the only index able to recognize both
monotone and periodica! drift tendency.
EXPERIMENTAL PROCEDURES AND RESULTS
In order to evaluate drift tendency, analog signals were
acquired directly from the venrilators by means of an ana-
log-to-digital 16-hit converter conrrolled by a personal
computer. Specifc software was developed for individual-
izing main respir.ltory parameters as a function of t ime an d
their shift.
Conventionally, to d<:terrnine the drift relevance, differ-
ent tests would be carried out under various working con-
ditions on severa! machines.Tims, the total nurnber of tests
needed for an exhaustive analysis would be too high and.
due to the test type, would take too long. In the present
research step, this shortcoming is overcome by restricting
the tests to only one functioning condition tor each venti-
lator. However, in the authors' opinion, the previously indi
cated restriction does not actually affect the evaluation of
the adopted critcria for drift analysis effectiveness.
To test and verify the proposed experimental method-
ology, three tlow-cycled ventilators from the same mamt-
facturer were investigated; the frst two ventilators were of
the same mode!, whereas the other one was different.
Journal of Clinica! Engineering May/june 1997 165
Tht:se ventilators, called for convenience A 1,A2 ancl H, dif-
kr (l) in t h<: contro l technology. in that the lrst two
machin<:s are analog and the last one is digitai; and (2) in
thc amount of performed workload (:::H,400,::: l 5,500 ami
:::2.300 hours for ventilators A I.A2 an d B, respectively).
The patient was simulated with the same test lungs
used by CES technicians at the Childrens' Hospital
"Bambino Ges" in periodica! calibrJtion procedures, as
suggested by the ventilator manufacturers. Although the
simulator's mechanical characteristics, i.e., resistance ancl
compliance, and their constancy as a function of time are
not specifed by the manufacturer, it is possible to hypoth-
esize t ha t small resistance and compliance variations, simi-
lar to casual patient condition changes during in vivo uti-
lization. do not affect the value of the set parJmeters con-
trollcd by thc vcntilator.
The chosen ventilator type provides three analog volt-
age output signals proportional to: (l) inspired flow, (2)
expired flow ami (3) pressure. From these signals (see
lnsplraled now
Expiralcd flow
cmRp
Pressun
~ ~
Drulhlne: cyde lime ltn&lh
FIGURE 3: Representation of main ventilation
paramelers.
1. Maximum inspired flow, IFmax;
2. lnspiration time length, IT;
3. Maximum expired flow;
4. Maximum pressure;
5. Base pressure;
6. Resistance pressure, RP;
7. Compliance pressure;
8. Pause time length;
9. Plateau pressure;
1 O. lnspired volume.
166 Journal of Clinica! Engineering May/)une 1997
Fig.3), severa! parJmeters usdul for characterizing thc
bn:athing pattern can be automatically dedun:d by means
of specitcally designed software. in order to compare
waveforms reconled at different times during the test.
When dealing with the type of ventilator that provides
aheolar ventilation by dispensing a precisely controlled
volume of air and oll.-ygen to a patient's lungs. main atten-
tion was focused on those parJmeters upon which per-
fused volume depends. The air volume perfused in a
breathing cycle is representcd by the area indicated by
no.JO in Fig.3. Wc dccided to take into account only those
ventilator parJmeters that can be set by the openltor and
t ha t directly affect mean inspired flow value (IF mean)
11/rnin l: (l) maxinmm inspired flow value during e a eh
inspiration, OFmax) [1/min]: (2) inspiration time length.
OD [s]: and (3) respir.ttory frequency. (Rf) [breaths/min].
The IFmean value can be calculated according to the rela-
tionship: IFmean=CIFmax160)x!TxRE Finally. to validate the
sensitivity of proposed methodology, (4) the value of the
resistance pressure exerted by the external circuit, RP
[cmH
2
0], which is generJlly aflected by unnoticeable drift,
was also measured.
Pressure and inspired and cxpired flow signals were
picked up by means of an automatic data acquisition sys-
tem schematized in Fig.4.The A/D converter has l(rbit res-
olution an d a l OOkHz maximum sampling rate when only
one cl1annel is utilizerJ. Because of the established rele-
vance of test area temper.tture variation cffects in system
performances, the ventilator temperature was also record-
ed; its value was always in the rJnge from 26 to ;,wc.
Each ventilator signa! was gathered a t 100kHz and post-
processed by means of the fast Fourier trJnsl(>rm per-
formed by MathcadTM modules. The signifcant signa!
power density values were always in the range of 0-5Hz.
Thus, a channel sampling rate of l kHz was judged ade-
quate to balance the tn1de-off between bendt of signa!
detail ;md data file dimension. In correspondence to peak
input values, an increase in noise signa! ratio, due t o trans-
ducer and conditioning circuir frequency response func-
tion. was also noticed: as a consequence, only signifcant
fgures were automatically recorded.The utilized A/D card
global metrological performances, provided by the
manufacturer, allow the error effects in long-term data
acquisition to be considered negligible. Furthermore,
before carrying out the in vitro drift tests, the examined
ventilators and the A/D card were calibrJted as suggested
by the manut;tcturers.
To evaluate drift phenomena, software was specitcally
devdoped using the LabVJEWTM signa! processing envi-
ronment, a graphic language designed to assure a friendly
anrJ interJctive user interf;tce to facilitate the system uti-
lization by CES technicians. The software: (l) triggers the
A/D converter by means of ventilator flow signa!; (2) col-
lects and stores rJw data every 15 minutes (the time win-
dow was set to ). 5s so t ha t an entire breathing cycle.
Branca et al.
J)eal
FIGURE 4: Scheme of the experimental set-up.
which lasts :h. cm be recorded); t es them in rea!
time to tletermine ventilation parameters and to evaluate
the considered statistica! indexes; an d. C 4) gives a grJphical
representation of data tentlencies.
Thrn: 20-day tests were conducted f(>r the examined
ventilators.The chosen experimental procedures are sum-
marized in "Etb.l. The results obtained for ventilator A l, A2
ami B. relative t o the three considered parameters (IT, IF"""
ami RF). an: summarized respectivdy in Tabs. 2, .">
ami 4. Included in these tables are: the frst and last day
me an values and their cr; the AC of the straight li ne that best
tts the data and its correlation coeftcient r. the frst and
last days S values: the K relative to ali of the collected data;
the R.N .... : antl tnally. the generateci automatic drift report
based on the results provided by R.rJ"vfrom an overJll
examination of the data trend (see, for example, Fig.';)
when: the variation of the maximum inspired flow as a
function of t ime for ventilator A2 is represented, a notice-
-

o m m m w
Time (hl
FIGURE 5: Maximum inspired flow vs. time for venti-
lator A2.
able variation of the parameter value set by the opnator
appears. as is also evidenced by the comparison of the
mean trst and last day values (see Tabs. 2, :\ and 4).
However, this comparison gives only rough indication,
which needs to be completed with inf(Jrmation provided
by cr values. The ohtained results indicate bot h a variation
of x ;md an increase of data spread; however. ventilators A l
ami A2 show more noticeable variations than ventilator B
does. The observed differences in behavior can be attrib
uted to the digitai data manipulation ami the rcduccd
amount of workload performed by vcntilator B.
AC, as already outlined in Table 2, gives a further indi-
cation of data tendency, but its numerica! value is strongly
dependant on the chosen measuring units.The computed
TABLE 2- VENTILATOR Al, EXPERIMENTAL RESULTS .
lnsp.
t ime
Ma x
insp.
fio w
Resp.
freq.
Branca et al.
First day
Xs
0.70
0.01 s
5.87
0.08
l/mi n
20.13
0.02
breaths/
last day
Xs
0.60
0.03 s
5.56
0.19
l/m in
20.50
0.16
breaths/
min min
AC r
-2 .OE-4 -0.78
l .7E-3 -0.82
l .4E-3 0.87
slsl day Slasl day
K
R99%
Drift
-2.5 0.62 0.24 58 Yes
-4.20 -0.06 0.57 52 Yes
3.01 0.70 -0.27 66 Yes
Journal of Clinica! Engineering Mayljune 1997 167
TABLE 3 - VENTILATOR A2, EXPERIMENTAL RESULTS
lnsp.
t ime
Ma x
insp.
fio w
Resp.
freq.
First day
XS
0.7<1
0.01 s
6.64
0.05
l/mi n
1 9.1.S
0.03
brc<1ths/
mi n
last day
xs
O.bY
0.01 s
6.24
0.07
l/mi n
19.38
0.12
bre<1ths/
mi n
AC r
-2.0E-4 -0.80
-7.9E-3 -0.78
4.6E-4 -0.52
ly signifcant: in bct, the prohahility that two uncorrelated
variables give an r value higher than or equal to the
ohtained one is less than O.OS%.
The comparison of Sh, ""' and S1"" ""'. does not seem
ab le to give univoca! indicatio.n. In fa et, for ventila t or A l, ali
the examined parameters are affected by relevant S
changes whosc absoltne values, ls l, lie in the range from
2.:) to 4.:).Ventilator A2, instead,shows values ranging from
0.2 t o l .H. Intermedia te values, 1:::; ls l:::; 2, are computed
f\>r ventila t or B. Thus, relative t o the tests carri ed out an d
reported hcre, it appears impossible to establisll gener.tl
criteria easily implementahlc in the tnal release of the
dcveloped software.
With regard to K efficiency. a shift phenomenon would
imply an increase in data spread ami negative K values.
However, negative values were determined only for RF for
..
~ 100 1so zoo :zso 100 no 400 .uo 100
Timelhl
FIGURE 6
Resistance pressure vs. time for entilator A2F
168 Journal of Clinica! Engineering May/june 1997
slst day slast day
K R'l<J" ..
Drift
-0.18 0.44 0.59 58 Yes
-0.4:3 -0.21 0.09 52 Yes
1.20 -0.60 -1.01 66 Yes
emerges also for K.
Finally, the ohtained results relative to R
99
.... confrm that
it is the only statistica! index ahle to recognize drift phe-
nomena; in fact, the ~ r .. values, normalized for N=200, are
always less t han H4 t<>r parameters that show drift. To du-
cidate the Rn ...'s ;tbility to also distinguish unnoticeahle
drift phenomena, the RP variation in Fig.6 is representcd as
a function of time. As expected, this pammeter does not
show noticeable drift, partly because resistancc pressure is
no t actually a ventilator char.tcteristi<:, but depends only on
the external air circuit, whose charJcteristic can be
assumed consta m in the set-up illustr.ued h ere. This unno-
ticeable drift is also contrmed hy R
9
,r .. values. which are
84, 84 and 92, respectively. for ventilators A l, A2 and H. In
conclusion, in Fig.6, it is possible to notice that a pressure
resolution of O.OHcmH
2
0 is caused by the ND converter
resolution, gain and rJnge selected and the small voltages
determined hy RP reduccd valucs .
CONCLUSIONS
The tests described here demonstr.tte the dfectiveness
of the experimentally validated procedures for objective
ventilator perfrmancc drift evaluation. In tact, the system
is able t o: (l) appraise ventilation parameter drift, (2) auto-
matically generJte a report based on the indication provid-
ed hy the Run test and (:)) give helpful in1lfl11ation about
the degener.ltion of ti me dependent performance to CES
technicians during maintenance proceures as well as to
medicai staff, who are required to make decisions on ven-
tilator management. In fact, during in l'i t'O application.
the seriousness of ventilation parameter drift has to be
ev;tluated by the ther.tpist, who is the only one able t o esti-
mate the actual patient ventilatory necds and their ranges
of variation.Finally, the adopted low-cost experimental set-
Branca et al.
TABLE 4- VENTILATOR B, EXPERIMENTAL RESULTS
lnsp.
t ime
Ma x
insp.
fio w
Resp.
freq.
First day
XS
0.97
0.06 s
7.1 H
0.02
limi n
19.6H
0.01
brcJths/
mi n
last day
xs
1.0.1
0.06 s
6.98
0.03
l/m in
19Sh
0.01
breJths/
mi n
AC
0.80
-4.7 E-4 -0.80
l.SE-4 -0.46
up ca n be casily adaptcd, hoth in harware ami in software,
to simultaneously monitor severa! vcntilators (for exampk,
all tbc vcntilators installe in an ICU).
NOMENCLATURE
IFmean
IT
K
N
RF
s
Slst dav
Slast ;;y
Standard deviation
Mean value
The i-th rcaing
Angular coefficient of the least square tt
str.tight line
Maximum inspired flow value
during each inspir.ttion
,'vlean inspircd flow value
Inspimtion time length
Kurtosis, i.e., normalized furth
moment of the observed distribution
111e total sample number
Correlation coeftcient
Run test for randomness
99% contdence leve! run
number
Rcspiratory frequency
Skcwness, i.e. normalized third moment
of thc obst:rved distrihution
Skcwness f()r trst day collecte data
Skewncss for last day collecte ata
ACKNOWLEDGMENTS
The authors wish to thank Rocco Conti and Francesco
Branca et al.
slsl day Slasl day
K
R99%
Drift
-0.43 1.58
-1.2S
60
Yes
-0.37 0.7H
-1.03
4ll
Yes
1.70 0.78
4.15
9
Yes
Rapanotti tr their helpful support, an cxpn:ss their
appreciation to the Departmcnt of Mechanics ami
Aeronautics of tl1e University of Rome "La Sapienza", ami
the Clinica! Engineering Service of the Children's Hospital
"Bambino Ges" of Rome for the experimental facilities.
coopcration and assistancc provided.
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BIOGRAPHIES
francesco Paolo llr.mct rtTcived a degree in Elcctrical
Engineering in 1960 from the \ lniversity of Rom t Sapienza".
He joincd thc lkpartmcnt of and Acronautics at the
Llni,ersity of Rome Sapienza" in 1961, wherc he is currently a
Full Proft:ssor of "Mechmical Measurements" ami in charge of
"Eicctromedical Devices". Sinn its establishmelll ( 19Rl), he has
heen the Director of the Clinica! Engineering Service at the
Children's Hospital "Bambino (jesit" (7:)0 betl medicai facility), a
pri\ate. IHH1-prolt hospital located in Vatican City. His main sci-
entilc interesls are in lhe arcas of instrumelllalion, bio-
medicai imlrurnemation. clinica! engineering md cxperimental
stress analysis.
Paolo Cappa r<:ceivetl. with honors, a degree in Mcchanical
Engint't'ring from \lniwrsity of Rome "La Sapienza" in l ')HO. H e
joinctl lhe Department of Mechanics and Aeronautics at the
170 journal of Clinica! Engineering May/june 1997
lJniversity of Rome "L'l Sapienza" in 19H l, w h ere h e is currently
an Associate Professor of"Sensors for Mechanical Measuremt:nts ...
Sin ce its establishment ( 19H l), h e has heen thc Director
of thc Clinica! Engineering Servicc at the Hospital
"ilamhino (jes". His main scientiic interests ;tre declrometlical
equipment management. metrological stutlics of gai t analysis
tem perlrmances antl biomedica! sensors.
Salvatore Andrea Scilllo reccived his degrn: in Mechanical
Engine<:ring in 1992 from the University of Rome "La Sapienza".
In 1992, h e joined the Departmenl of Mechanics and Acronautics
a t the Universily of Romt "La Sapienza" as a Hesearch Associate.
Since 1995. he has been Assislant Professor of "Mechanical
Measurements" at lht: Departm<:nt of Mechanical and Industriai
Engineering al III Universi[}' of Rome. H e has bee n acti\e in
Clinica! Engine<:ring Educalion an d Tmining. His current scientif
ic nt<:rcsts are: cxperimental hiomctlical measure-
mcnts ami clinica! engineering and electromcdical tle,ice man-
agement
Sergio Silwstri reccivctl his tlegree in Mcchanical Engineering in
199') from thc llniversity of Rome Sapienza".ln the same ycar
ht: joined the nepartm<:nt of Mechanics ami Aeronautics al the
l Jniversity as a lksearch Associate. His current scientilk interesls
are experimental mechanics, biomedica! measurements and hio-
physics.
Address ali correspondcncc and rt:print requests lo l".tolo Cappa.
lini v. of Rome Dept. of Mechanics ami Aeronautics.
Via Eutlossiana IH, OOIH4 Rome. ITALY
Branca et al.