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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 9, NO. 3, SEPTEMBER 2005

A Multiparameter Wearable Physiologic Monitoring System for Space and Terrestrial Applications
Carsten W. Mundt, Kevin N. Montgomery, Usen E. Udoh, Valerie N. Barker, Guillaume C. Thonier, Arnaud M. Tellier, Robert D. Ricks, Robert B. Darling, Senior Member, IEEE, Yvonne D. Cagle, Nathalie A. Cabrol, Stephen J. Ruoss, Judith L. Swain, John W. Hines, and Gregory T. A. Kovacs, Member, IEEE

AbstractA novel, unobtrusive and wearable, multiparameter ambulatory physiologic monitoring system for space and terrestrial applications, termed LifeGuard, is presented. The core element is a wearable monitor, the crew physiologic observation device (CPOD), that provides the capability to continuously record two standard electrocardiogram leads, respiration rate via impedance plethysmography, heart rate, hemoglobin oxygen saturation, ambient or body temperature, three axes of acceleration, and blood pressure. These parameters can be digitally recorded with high delity over a 9-h period with precise time stamps and user-dened event markers. Data can be continuously streamed to a base station using a built-in Bluetooth RF link or stored in 32 MB of on-board ash memory and downloaded to a personal computer using a serial port. The device is powered by two AAA batteries. The design, laboratory, and eld testing of the wearable monitors are described. Index TermsAmbulatory physiologic monitoring, Bluetooth, crew physiologic observation device (CPOD), electrocardiogram (ECG), high altitude, LifeGuard, respiration, vital-signs, wearable.

I. INTRODUCTION

HERE ARE A number of situations in which noninvasive and continuous monitoring of physiologic and acceleration parameters is extremely useful in an ambulatory or stationary setting. For space applications, these include extravehicular activities (EVA, or spacewalks), launch and deorbit, exercise in microgravity, physiologic research, and unanticipated medical events [1]. There are also a number of terrestrial settings in which such capabilities are likely benecial, including monitoring of patients with cardiovascular disease to aid in diagnosis and to evaluate therapies, assessing gait stability, activity level, the quality/quantity of sleep, and monitoring of rst responders and accident victims [2][5].
Manuscript received October 11, 2004; revised April 13, 2005. This was supported in part by NASA Contracts NCC-1010 and NNA-04CC32A. Human subject testing was carried out under Stanford University Human Use Protocol numbers 78 527 (in-lab testing), 79 640 (Licancabur Expedition), and 79 825 (KC-135 ight). C. W. Mundt, K. N. Montgomery, U. E. Udoh, and G. T. A. Kovacs are with Stanford University, Stanford, CA 94304 USA and also with the NASA Ames Research Center, Moffett Field, CA 94035 USA (e-mail: cmundt@mail.arc.nasa.gov; kovacs@cis.stanford.edu). V. N. Barker, Y. D. Cagle, N. A. Cabrol, and J. W. Hines are with the NASA Ames Research Center, Moffett Field, CA 94035 USA. G. C. Thonier, A. M. Tellier, R. D. Ricks, S. J. Ruoss, and J. L. Swain are with Stanford University, Stanford, CA 94304 USA. R. B. Darling is with the University of Washington, Seattle, WA 98195-2500 USA. Digital Object Identier 10.1109/TITB.2005.854509

Current technology for ambulatory physiologic monitoring includes portable patient monitors for bedside and transport monitoring, and wearable devices for recording electrocardiographic data such as Holter monitors [6] and event monitors that are used for storing electrocardiographic data for subsequent analysis. Holter monitors record heart rate and/or electrocardiogram (ECG) continuously for several hours or days, while event monitors record these data for brief periods, and only upon activation by the user. Commercially available vital signs monitors include a number of portable and wearable devices. The Micropaq from Welch Allyn (Beaverton, OR), and the ApexPro from GE Medical Systems (Waukesha, WI) are two of the most advanced ambulatory patient monitors available today for wireless portable bedside monitoring and transport monitoring. Both devices measure and wirelessly transmit multiple physiologic parameters. The Micropaq acquires heart rate, SpO (an estimate of arterial oxygen saturation SaO measured by pulse oximetry), and several channels of ECG, and transmits these to a Welch Allyn FlexNet 802.11 wireless access point from where the data can be distributed for patient monitoring. The ApexPro has similar capabilities, but can also be interfaced to an external blood pressure device (Accutracker DX, Suntech Medical, Morrisville, NC). Both devices rely on access to a wireless infrastructure and do not record data internally. This limits their use to well-equipped, relatively benign environments, such as hospitals. Commercial Holter monitors, event recorders, and transtelephonic monitors do record data, but only heart rate and one or more channels of ECG. They do not stream these parameters wirelessly in real-time. Other commercial devices for monitoring vital signs include PCMCIA-Cards for measuring ECG, SpO , blood pressure, and carrying out spirometry (QRS Diagnostics, Plymouth, MN), sleep study devices [Nellcor Puritan Bennett (Melville) Ltd., Kanata, ON, and Itamar Medical Inc., Boston, MA] and shirt-type devices with attached or integrated physiologic sensors (Vivometrics, Ventura, CA, and Sensatex, New York). A exible vital signs monitoring system for sports and military applications was developed by FitSense Technologies (Southborough, MA), but it does not support the recording and transmission of electrocardiograms. However, FitSense does provide a good solution for low-bandwidth vital signs transmission with their proprietary BodyLAN system and an evaluation of their system during a Mount Everest expedition has been reported in [7] which also provides an excellent description of the evolution of wearable health data monitoring.

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A number of efforts to develop wearable monitors have been reported [8][21]. These include transtelephonic ECG monitors [8], personal computer memory card industry association (PCMCIA), and Compact Flashcard-based Holters [9], [10], Holters transmitting ECG wirelessly through a global system for mobile communications GSM() modem [11], [12], wearable ECG monitors with real-time user feedback [13], and monitors that transmit real-time ECG data over the Internet [10]. Rhee et al. developed a wearable photoplethymographic ring-sensor and integrated it with an ad-hoc self-organizing wireless network [14], and Paradiso is developing wireless, instrumented, smart-ber garments [15]. Most of these systems demonstrate new technologies and methods that advance the state of the art, but are generally prototypes that lack the integration and robustness to meet space ight requirements. Despite recent advances in medical technology, none of the currently available devices provides a combination of wearability, size, and functionality that satises demanding NASA requirements or allows the devices to be used in clinical studies where body motion and physiologic parameters are to be investigated simultaneously. The goal of this effort was to design a small, lightweight, wearable, ergonomic device that not only records and streams a comprehensive set of diagnostic-quality physiologic parameters, but can also record body position and orientation, acceleration in three axes, and can be used to mark events. This feature set, combined with wearability, alarm indicators, fault detections, and the ability to stream data to handheld Bluetooth-enabled devices, forms a compact and reliable system that not only improves medical care in space ight, but also enables a new range of physiologic studies to be performed in terrestrial applications, including medical care. II. METHODS AND MATERIALS The LifeGuard system consists of the CPOD device and a portable base station computer. The CPOD device, the core component of the system, is a small, lightweight, easy-to-use device that is worn on the body along with the physiologic sensors described below. It is capable of logging physiologic data as well as wirelessly transmitting data to a portable base station computer for display purposes and further processing [Fig. 1(a)]. A. Physiologic Sensors A matrix listing typical physiologic parameters for a number of application scenarios, including commercial and military scenarios, was generated since it was anticipated that such a system might prove very useful in terrestrial medical applications as well. This matrix was then used to choose a nal set of physiologic parameters representing a common denominator for all investigated applications. Most physiologic parameters supported by LifeGuard are measured with sensors that are external to the CPOD wearable device and can be congured as needed. The only sensors that are integrated into the CPOD are the accelerometers. Temperature can be measured in one of two ways: either with an ambient temperature plug, or with a probe (cable) for skin

or core temperature measurements. ECG and respiration signals are acquired using commercial button electrodes that are connected to the CPOD via snap-leads (such as Red Dot types 2249 and 2237 from 3M, St. Paul, MN). Pulse oximetry (SpO ) is measured with a Nonin pulse oximeter (Nonin Medical Inc., Plymouth, MN), which is typically attached to a nger (nger clip or exible wrap) or ear lobe (ear clip). For applications requiring subject mobility, the ex nger sensor from Nonin (model 8000J) was optimum. Nonin pulse oximeters are used with a mating signal conditioning and digitization unitthe Xpod. The Xpod used for LifeGuard (model 3011) streams serial data to the CPOD at a rate of about one sample per second. A cuff-based device is used to measure systolic and diastolic blood pressures. For applications involving signicant motion or vibration, an auscultatory motion-tolerant device can be used. The LifeGuard system supports the Accutracker II (Suntech Medical, Morrisville, NC), one of the most motion-tolerant devices available. Depending on the application, either all of the external sensors or any desired subset can be used. In many cases, ECG, respiration rate, activity (acceleration), skin temperature, and heart rate (derived from ECG through post-analysis) will sufce. This conguration only requires the ECG/respiration electrode set and provides the greatest degree of mobility. Fig. 1 (b) illustrates how the CPOD device is worn on the body. Amphipod sport packs (Amphipod, Inc., Seattle, WA) are used to secure the device around the waist. B. Prior Research Prototype System Initial development efforts by our group were focused on using commercial portable digital assistant (PDA) technology as the platform for physiologic data acquisition under the Microsoft Windows CE operating system. A prototype system using commercial off-the-shelf components was rst developed to rene requirements and to gain understanding about the real-world use of such a device. This Smart Healthcare Management System (SHMS) consisted of an easy-to-apply physiologic sensor pad (Nexan Ltd., Cambridge, UK), which provided a two-lead ECG and respiration signals. The electronics of the Nexan sensor was modied so that it transmitted its digitized data wirelessly using Bluetooth technology to a personal digital assistant (PDA, a Compaq/HP iPaq Pocket PC) running Windows CE (Microsoft, Redmond, WA). This PDA was worn on the body and could record data locally and/or transmit data in real-time via 802.11b (IEEE wireless local area network standard) over the Internet to a central server (a switchboard) where multiple devices (PCs, PDAs) could view the data live via the Internet. The SHMS system was used for in-lab and eld testing (including a high-altitude research study), and provided valuable real-world experience. A number of shortcomings were identied, including the lack of robustness of connectors, short battery lifetime, and external dependencies on commercial off-theshelf components (iPaqs, WindowsCE) that were not designed to meet the high reliability requirements of medical monitors. As a research prototype system the SHMS provided a mechanism for successfully demonstrating functionality and rening

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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 9, NO. 3, SEPTEMBER 2005

Panel A

Panel B Fig. 1. Panel A: LifeGuard System. 1) (a) CPOD vital signs monitor with physiologic sensors, including (b) electrodes for recording ECG and respiration waveforms, (c) pulse oximeter measuring SpO and heart rate, and (d) blood pressure monitor. 2) Diagram illustrating locations of CPOD monitor and sensors on body. 3) Communication options (RS-232 hardwired or Bluetooth wireless) for data transfer between CPOD and (e) base station computer. Panel B: Photograph of subject with cutaneous disposable electrodes in place on upper chest and left side, as well as a ngertip pulse-oximeter sensor. An Amphipod sport pack (Amphipod, Inc., Seattle, WA) is used to secure the device around the waist.

requirements for an eventual system, but was not capable of meeting the goal of a rugged physiologic monitoring system that was reliable and easy to use. A new, rened and optimized solution was required, and to be derived from careful examination of requirements across a broad range of applications. This effort resulted in the development of the LifeGuard system and the CPOD device. C. Technical Specications of CPOD Device Table I lists the technical specications of the CPOD. Many of these, such as battery lifetime, data storage capacity, and wireless range, are the result of trade-offs between the nal size and form factor of the device, its usability, and its feature set and functionality. For example, AAA batteries represented the best trade-off between battery size and capacity for this particular device. Primary cells were chosen over rechargeable battery packs due to their availability and ease of replacement.

A custom LCD panel displays information on the device status (logging, streaming, connection to base station) as well as cycles through the measured parameters (skin temperature, activity, heart rate, SpO , systolic and diastolic blood pressure, and remaining battery life). A button on the front of the device can be used to create and store event markers (the CPOD also incorporates an internal real time clock), and to enable the Bluetooth module. It can also stop the cycling display to continually show a single parameter. A piezo buzzer is used to alert the user of low battery life, low SpO , or high heart rate values. It also serves to signal an alarm when a sensor is disconnected or not functioning properly. The CPOD acquires and logs physiologic data and can download or stream this data on demand in real time to a base station device such as an IBM-compatible PC or Pocket PC. It also preprocesses the acquired signals, which currently includes scaling and averaging. The central element of the CPOD is a low-power

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TABLE I CPOD TECHNICAL SPECIFICATIONS

Fig. 2. Detailed photographs of CPOD device and illustration of its functional elements.

microcontroller that controls all peripheral devices, including an A/D converter, and 32 MB of on-board ash memory. The sampling rate for each parameter is programmable. At the default sampling rates (ECG at 256 S/sec, respiration at 64 S/sec, acceleration at 16 S/sec, temperature, SpO and heart rate at 1 S/sec) the CPOD can log data for up to 9 hours. The device has four ports for external sensors and one RS-232 port for hardwired transfer of logged physiologic data to a PC. The CPOD device is shown in Fig. 2, and a block diagram of the electronics of the device is shown in Fig. 3. One design challenge was to maintain a constant sampling rate across all channels while at the same time storing data in ash memory. This was accomplished by using ash memory chips with two built-in SRAM buffers (AT45DB642, Atmel, San Jose, CA). This allows continuous transfer of data to one of the two buffers of the memory chip, and periodic programming of the buffer contents to the nonvolatile ash memory.

The CPOD can stream data wirelessly via Bluetooth. Bluetooth was chosen as wireless technology due to its commercial availability and increasing industry support. Many laptops, Tablet PCs, PDAs, and cellular phones have Bluetooth built-in, thereby greatly simplifying the hardware of the base station or client device that is used to display the data from the CPOD. The CPOD was designed with a major consideration being ease of use. Device setup and data download are accomplished entirely from the base station computer. Once programmed, the device can be turned off until the time of use. Once turned on, the device will log the data from all physiologic sensors it was programmed to use. The only interaction the user has with the device is through the event button and status display. The user cannot change the basic operational mode of the device (logging or streaming), ensuring that the system meets the high reliability standards of medical monitoring devices.

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Fig. 3. Block diagram illustrating the main elements of the CPOD electronics. TABLE II CPOD TESTING SUMMARY. THESE TESTS WERE PERFORMED ON THE CPOD ONLY, NOT ON PERIPHERAL SENSORS

III. RESULTS A. Laboratory and Field Testing Laboratory testing focused on verication and validation of the data that the device records, as well as environmental and operational testing to ensure that the device is operational in extreme environments (see Table II). Verication and validation tests used data from signal generators and ECG simulator devices to verify that the device provided the correct output. Further tests comparing the output of the device with that of a commercial vital signs monitor (Propaq 106 EL, Welch Allyn, Beaverton, OR) were also performed. The analog front-end design was optimized to provide the highest signal delity possible. These changes were veried in laboratory and eld tests; details are described in the following paragraphs. A series of eld tests was undertaken to validate and rene the design of the device. To expose the system to a variety of environmental and physiologic conditions, tests were carried

out in medium- to high-altitude alpine environments. For each trial, subjects were instrumented and then engaged in high-exertion activities. The test series involved snowshoeing through Donner Pass and climbs on Mt. Adams, Mt. St. Helens, and Mt. Shasta. In each case, hardware and software issues were detected and then corrected. One change involved increasing the input impedance of the ECG input ampliers from 10 M to 100 M to improve common mode rejection. This modication, in combination with an increase in the high-pass cut-off frequency from 0.05 to 0.5 Hz, helped to reject motion artifacts and stabilize the ECG baseline. This greatly facilitated the real-time monitoring of ECG signals of moving subjects. To verify that this reduction in ECG bandwidth was acceptable for our purposes, a series of simulator-generated ECG arrhythmia waveforms was acquired and transmitted by the CPOD and then analyzed and correctly identied by cardiologists. Another design change targeted battery life. The main dc-dc converter of the device was redesigned to allow a more complete utilization of

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Fig. 4. CPOD Hardware Revisions. (a) Beta version of the device. (b) Final version.

Fig. 6. Subject preparing for a dive at the Licancabur summit. The white cable visible at the lower edge of the photograph (arrow) connects to the remote oxygen saturation sensor.

Fig. 5. Physiologic data recorded during high-altitude trial. SpO is indicated by the black line and heart rate data by the gray line. The recording covers approximately 4.5 h during an ascent of the Licancabur volcano. Time recorded and displayed is in Pacic Standard Time.

the capacity of the AAA batteries by choosing a more efcient step-up converter that can accept input voltages down to 0.7 V. The power management of the Bluetooth module was optimized as well by implementing a sleep mode that turns the module off if not used for a period of 60 s. One signicant issue was the identication of suitable disposable electrodes for the ECG and respiration sensors. After much testing, the electrodes with the best adhesion properties were determined to be 3M Red Dot types 2249 and 2237 (3M, St. Paul, MN). Many of these tests C as exposed the CPOD device to very low temperatures well as numerous shock conditions, and proved the superiority of ash memory for data storage over conventional hard-drives. Valuable user feedback resulted from these initial trials that led to an ergonomic redesign of the casing for the nal design (Fig. 4). This feedback focused on the robustness of connectors and comfort, and led to the use of LEMO (LEMO, Ecublens, Switzerland) connectors for all sensors to prevent accidental unplugging of leads, and the tapering of the sides of the device for improved comfort. Using a custom-designed Delrin casing in combination with a stacked board conguration helped signicantly to keep the size of the CPOD small without sacricing robustness. These initial tests used the device in a data logging rather than wireless transmission mode of operation, and because of the requirement for subsequent downloading and

Fig. 7. Physiologic data recorded during two dives in the summit lake [elevation 5900 m (19 400 ft) MSL]. SpO is indicated by the black line and heart rate data by the gray line. The dives started at 5:36 am and 5:44 am, respectively, and lasted about 2 min. The data illustrates a classic dive reex characterized by a lowering of heart rate with gradual decrease in SpO until surfacing and breathing.

browsing of data, a number of improvements in user interface design and functionality in the base station software were incorporated. As was found with the earlier PDA-based SHMS system, early use of the device in real-world scenarios prompted iterative renements in design and thus shortened the development process. B. Mission Oriented Testing in Extreme Environments 1) Space Station Analog: The rst evaluation of the system in a NASA test environment occurred in March of 2003 in the NASA Extreme Environment Mission Operations (NEEMO) facility, an underwater analog to the space station environment at a depth of 18 m (60 ft) located off Key Largo, FL. The main goal of this test was to evaluate ease of use and wearability. A further goal was to evaluate the feasibility and reliability of radio-frequency transmission within the metal-walled facility.

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Fig. 8. Data streaming setup at the Licancabur summit camp (left) and real-time data display at Stanford University (right). Physiologic data acquired by the CPOD was sent to a base station computer (tablet PC), and then transmitted by a satellite terminal to an INMARSAT communications satellite and from there to Stanford University.

In this eld test, astronauts used the device to monitor physiologic parameters during exercise and to monitor a crewmember during a simulated medical emergency. Positive feedback was received on wearability and usability of the system, and the feasibility of using Bluetooth in such an environment was demonstrated. 2) High Altitude: The rst signicant mission-oriented testing of the system occurred in October and November of 2003. During a connected pair of expeditions, a number of subjects were monitored when awake and asleep over an altitude range from sea level to approximately 6100 m (20 000 ft) mean sea level (MSL). The rst expedition took place in the Atacama Desert of Chile, and involved geologic and biological surveys of a Mars-like region. The second expedition started at the base of the Licancabur volcano on the Chile/Bolivia border, involved a survey of high-altitude lakes at approximately 4,300 m (14 000 ft) MSL. This was followed by a climb to approximately 6100 m (20 000 ft) MSL and then free-dives in a lake at that altitude. During these expeditions the CPOD instrument operated in three modes: freely moving subject/internal data recording, cabled but mobile underwater subject/internal data recording, and stationary subject with real-time satellite data streaming. Freely moving subjects were wired using the full cutaneous electrode set and oximeter sensor as shown in Fig. 1. This setup allows unobtrusive physiologic monitoring during exercise, hiking, and climbing. Several subjects were monitored during the ascent of the Licancabur volcano, and their ECG, respiration, SpO , heart rate, and activity were recorded. An example of the data is shown in Fig. 5. At two locations [Lake Helen, CA, N 40 deg. 29 49 , W 121 deg. 11 7 , altitude 2400 m (8000 ft) MSL] and the Licancabur summit lake [S 22 deg. 50 03 , W 67 deg. 53 00 , altitude 5900 m (19 400 ft) MSL], SpO and heart-rate data were acquired during shallow [ 3 m (10 ft)] dives in fresh

water, using custom-made 15-m (49-ft) cabled ngertip pulse oximeter units (Fig. 6). Data recorded during one of these dives is shown in Fig. 7. This data shows a classic dive reex lowering of heart rate, with gradual decrease in SpO until surfacing and breathing. To demonstrate real-time satellite data streaming, the CPOD was connected to the serial port of a Getac tablet PC (CA25, Getac, Inc., Lake Forest, CA). The custom LifeGuard BaseStation software was set up to stream data through a USB-connected ISDN modem (USB ISDN TA, Draytek, Hsin-Chu, Taiwan). The modem was connected to a Thrane & Thrane Capsat Messenger satellite terminal (Thrane & Thrane, Lyngby, Denmark), with data trafc directed to and from the EOR-W Inmarsat communications satellite from the Licancabur crater rim summit camp location [5900 m (19 400 ft) MSL]. The satellite transceiver was erected within an alpine tent at the summit camp. The net data throughput achieved was 64 kbits/sec, although the LifeGuard system can stream data over a much smaller bandwidth (9600 b/s) using its custom protocol. These data were transmitted through the satellite to downlink stations at France Telecom, then across the Internet in real-time to the switchboard server located at Stanford University, Stanford, CA. From there, clinicians and other observers were able to connect in to view the data stream live as it was received. Fig. 8 shows both the transmitting and receiving ends of the operation. IV. DISCUSSION LifeGuard was developed to provide a wireless vital signs monitor incorporating the ability to measure and record a comprehensive set of physiologic parameters, and housed within a small, compact, lightweight case that offers excellent wearability and ergonomics. This allows the device to be used for continuous unobtrusive monitoring during operations in remote

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and/or extreme environments where real time physiologic data would be useful such as in astronauts experiencing an emergency onboard the space station or shuttle, wounded soldiers on the battleeld, or re ghters and rst responders during search and rescue missions. Another unique aspect of the CPOD device is its capability of recording acceleration and body position information along with physiologic parameters. This feature enables activity and gait assessment, and if congured with only the pulse oximeter sensor even monitoring of high performance athletes. Furthermore, the ability of the CPOD to simultaneously log and stream data allows this device to be used for recording physiologic data during expeditions in remote areas and extreme environments, while at the same time providing the means to wirelessly check the health status of expedition members in real-time. Finally, the ability to congure the sensors connected to the CPOD as needed allows size, weight, and setup time of the system to be minimized. V. CONCLUSION In summary, a versatile, multiparameter wearable physiologic monitor capable of 9-h on-board digital data storage as well as real-time wireless data streaming has been developed. The system has broad applicability in space and terrestrial settings, including emergency and nonemergency medical monitoring of subjects in extreme environments. The system has been demonstrated to operate successfully in three different modes: freely moving subject; cabled subjects (for underwater studies); and remote subjects with real-time satellite telemetry. To date, more than 30 subjects have worn the LifeGuard system in various modes and environments, some of them for studies lasting several days. The general feedback has been very positive. The system is currently being evaluated in test deployments for space-related research (centrifuge experiments) within NASA. In addition, the system will be evaluated in clinical environments to obtain valuable input for further improvements of the CPOD device itself and the accompanying data analysis software package. ACKNOWLEDGMENT The authors would like to thank the National Geographic Society for their support of the Licancabur 2003 Expedition.They would also like to thank the Licancabur 2003 Expedition Science Team: E. A. Grin, A. Hock, A. Kiss, G. Borics, K. Kiss, E. Acs, G. Chong, C. Demergasso, R. Sivila, E. Ortega Casamayor, J. Zambrana, M. Liberman, M. Sunagua Coro, L. Escudero, C. Tambley, V. Gaete, R. L. Morris, B. Grigsby, R. Fitzpatrick, G. Hovde, their local guides, and the team of wonderful porters without whom this expedition would not have been possible. REFERENCES
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[4] M. L. Moy, S. J. Mentzer, and J. J. Reilly, Ambulatory monitoring of cumulative free-living activity, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 8995, MayJun. 2003. [5] N. L. W. Keijsers, M. W. I. M. Horstink, and S. C. A. M. Gielen, Online monitoring of dyskinesia in patients with Parkinsons disease, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 96103, MayJun. 2003. [6] N. J. Holter, New method for heart studies: continuous electrocardiography of active subjects over long periods is now practical, Science, vol. 134, p. 1214, 1961. [7] R. Satava, P. B. Angood, B. Harnett, C. Macedonia, and R. Merrell, The physiologic cipher at altitude: telemedicine and real-time monitoring of climbers on Mount Everest, Telemed. J. e-Health, vol. 6, no. 3, pp. 303313, 2000. [8] D. Franchi, A. Belardinelli, G. Palagi, A. Ripoli, and R. Bedini, New telemedicine approach to the dynamic ECG and other biological signals ambulatory monitoring, Comput. Cardiology, vol. 25, pp. 213216, 1998. [9] M. del Carmen Raola, D. Jimenez, I. Hernandez, A. Bas, R. Montero, and R. Gonzalez, Design and evaluation of a long-term ECG monitoring system, in Proc. 22nd Annu. Int. Conf. IEEE, vol. 2, Jul. 2000, pp. 934937. [10] K. Y. Kong, C. Y. Ng, and K. Ong, Web-based monitoring of real-time ECG data, Comput. Cardiology, vol. 27, pp. 189192, 2000. [11] J. M. Guillen, J. Millet, and A. Cebrian, Design of a prototype for dynamic electrocardiography monitoring using GSM technology: GSM-Holter, in Proc. 23rd Annu. EMBS Int. Conf., vol. 4, 2001, pp. 39563959. [12] S. L. Toral, J. M. Quero, M. E. Perez, and L. G. Franquelo, A microprocessor based system for ECG telemedicine and telecare, in Proc. IEEE Int. Symp. Circuits and Systems, May 2001, pp. IV-526IV-529. [13] T. Martin, E. Jovanov, and D. Raskovic, Issues in wearable computing for medical monitoring applications: a case study of a wearable ECG monitoring device, in Proc. 4th Int. Symp. Wearable Computers, Oct. 2000, pp. 4349. [14] S. Rhee and S. Liu, An ultra-low power, self-organizing wireless network and its applications to noninvasive biomedical instrumentation, in Proc. 2nd Joint EMBS/BMES Conf., vol. 3, Oct. 2002, pp. 18031804. [15] R. Paradiso, Wearable health care systems for vital signs monitoring, in Proc. 4th Annu. IEEE Conf. Information Technology Applications in Biomedicine, Apr. 2003, pp. 283286. [16] H. H. Asada, P. Shaltis, A. Reisner, S. Rhee, and R. C. Hutchinson, Mobile monitoring with wearable photoplethysmographic biosensors, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 2840, MayJun. 2003. [17] E. Jovanov, A. ODonnell Lords, D. Raskovic, P. G. Cox, R. Adhami, and F. Andrasik, Stress monitoring using a distributed wireless intelligent sensor system, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 4955, MayJun. 2003. [18] I. Korhonen, J. Prkk, and M. van Gils, Health monitoring in the home of the future, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 6673, MayJun. 2003. [19] E. Waterhouse, New horizons in ambulatory electroencephalography, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 7480, MayJun. 2003. [20] K. Kario, N. Yasui, and H. Yokoi, Ambulatory blood pressure monitoring for cardiovascular medicine, IEEE Eng. Med. Biol. Mag., vol. 22, no. 3, pp. 8188, MayJun. 2003. [21] A. Gandsas, K. Montgomery, R. Altrudi, and D. McKenas, In-ight continuous vital sign telemetry via the internet, J. Aviation, Space, Environ. Med., vol. 71, no. 1, Jan. 2000.

Carsten W. Mundt received the M.S. degree in electrical engineering from the Technical University of Dresden, Dresden, Germany, in 1994, and the Ph.D. degree in electrical engineering from North Carolina State University, Raleigh, in 1997. His experience includes embedded and wireless systems design, rmware development, data acquisition design, biotelemetry, and biomedical sensor development. He has been with NASA Ames, Moffett Field, CA, since 1997 and joined Stanford University, Stanford, CA, in 2001, where he continues to support NASA projects within the National Center for Space Biological Technologies. His current work is focused on wearable, wireless, physiologic monitors, and free-yer satellites for biological research in space and medicine.

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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 9, NO. 3, SEPTEMBER 2005

Kevin N. Montgomery received the Ph.D. degree in computer engineering from the University of California, Los Angeles. He is currently the Engineering Director of the National Center for Space Biological Technologies (NCSBT) at Stanford University, Stanford, CA. Earlier, as Technical Director of the National Biocomputation Center, his team developed technologies in computation, visualization, and simulation in medicine and surgery. Research projects included computer-based surgical planning, intraoperative assistance systems, surgical simulators, anatomical atlases, and wireless telemedicine/telemetry. He regularly serves on several study/review sections for DoD, NIH, NSF, and other granting agencies, as well as advises and consults with several small, high-tech companies in the Silicon Valley.

Arnaud M. Tellier received the M.S. degree in engineering from Ecole Centrale Paris, France, the M.S. degree in oceanography from Florida Atlantic University, Boca Raton, and the M.S. degree in computer science from Stanford University, Stanford, CA. He has eight years of technical experience in image processing, computer graphics, virtual reality, network programming, and software development. He is currently a senior research and development engineer for the National Biocomputation Center, a joint NASA-Stanford institute for applying advanced computational and visualization technologies for medicine and surgery.

Usen E. Udoh received the M.S. degree in electrical engineering from North Carolina State University, Raleigh, in 1999. His emphasis was in embedded systems and ASIC design. He has over six years of experience in industry in development of wearable systems and wireless platforms. He has previously represented the wireless community and has several patents related to Bluetooth technology. He joined NASA Ames Research Center, Moffett Field, CA, in 2001, where he was involved in the development of wearable devices for applications in space and medicine. He continues to support NASA projects on wearable monitors and autonomous biological analytical systems at the National Center for Space Biological Technologies (NCSBT), Stanford University, Stanford, CA.

Robert D. Ricks received the B.S. degree in electrical engineering from Purdue University, West Lafayette, IN, in 1958. He is currently a Senior Analog Design Engineer and Chief Engineer of the NASA Ames Astrobionics Program, Stanford University. Stanford, CA. He has 47 years of experience in diverse projects in medical, consumer, and NASA related programs. He has a 41year association with NASA, 25 years as a consultant, and the last 16 years as a full-time employee. He holds four U.S. patents, and one pending.

Valerie N. Barker received the B.S. degree in mechanical engineering from San Jose State University, San Jose, CA, and the M.S. degree in electromechanical engineering from Stanford University, Stanford, CA. She is currently a Mechanical Engineer at NASA Ames Research Center, Moffett Field, CA. She has applied her multidisciplinary skills on a variety of projects including wearable physiologic monitors and biosensors for the detection of chemical and biological warfare agents. Currently, she is the Lead Thermal Engineer for an autonomous genomics payload scheduled to launch at the end of 2005.

Robert B. Darling (S78M86SM94) was born in Johnson City, TN, on March 15, 1958. He received the B.S.E.E. (with highest honors), M.S.E.E., and Ph.D. degrees in electrical engineering from the Georgia Institute of Technology, Atlanta, in 1980, 1982, and 1985, respectively. He has been with the Department of Electrical Engineering, University of Washington, Seattle, since 1985, where he is presently a Professor of electrical engineering, an Adjunct Professor of bioengineering, and Director of the Electrical Engineering Microfabrication Laboratory. His research interests include electron device physics, device modeling, microfabrication, circuit design, optoelectronics, sensors, electrochemistry, and instrumentation electronics.

Guillaume C. Thonier received the M.S. degree in electrical engineering from the Ecole Polytechnique, Paris, France, and the M.S. degree in computer science from Stanford University, Stanford, CA. He has eight years of technical experience in computer graphics, virtual reality, articial intelligence, network programming, and software development. He is currently a Senior Research and Development Engineer for the National Biocomputation Center/ National Center for Space Biological Technologies (NCSBT), Stanford University. Current research includes the development of a software interface for a Smart HealthCare Monitoring System, designed to process, store and display real-time physiological data on a PC-based or embedded platform.

Yvonne D. Cagle received the B.S. degree in biochemistry from San Francisco State University, San Francisco, CA, in 1981, and the M.D. degree from the University of Washington, Seattle, in 1985. She is a NASA Astronaut currently assigned as the Astronaut Liaison to NASA Ames Research Center, Moffett Field, CA, and serves as the Astronaut Medical Advisor to the National Center for Space Biological Technologies. She is a Consulting Professor at the Department of Electrical Engineering, Stanford University, Stanford, CA. She is a USAF Colonel certied as a ight surgeon, board-certied in family practice, and certied as a FAA Senior Aviation Medical Examiner and ACLS Instructor. She is a Clinical Assistant Professor at The University of Texas Medical Branch (UTMB), Galveston, and The University of California at Davis. Her research interests include aerospace physiology, space adaptation syndrome, autonomic dysfunction, neuroplasticity, epilepsy, and brain injury.

MUNDT et al.: MULTIPARAMETER, WEARABLE PHYSIOLOGIC MONITORING SYSTEM

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Nathalie A. Cabrol is a Planetary Geologist at NASA ARC/SETI Institute, Moffett Field, CA, specialized in the evolution of water on Mars. She is a Co-I of the Mars Exploration Rover mission and PI of a NAI-funded project exploring the highest lakes on Earth as analogs to ancient Martian lakes. She develops exploration strategies for the robotic search of life in the Atacama Desert as a simulation for future astrobiological missions to Mars. She has over 250 publications and professional communications. She authored three books and several chapters of books. In 2005, Dr. Cabrol was elected Carey Fellow and Women of Discovery (Air and Space).

John W. Hines received the B.S. degree in electrical engineering from Tuskegee University, Tuskgee, AL, and the M.S. degree in biomedical and electrical engineering from Stanford University, Stanford, CA. He is currently a Senior Research Scientist at NASA-Ames Research Center, Moffett Feild, CA, and Manager of the Astrobionics Integrated Program/Project Team which develops advanced biomolecular and biomedical technologies for NASAs Human Exploration and Biological Research Missions and Programs. He has nearly 30 years of combined NASA and Air Force experience in biological and biomedical technology development, project management, engineering, and Life Sciences Spaceight hardware development.

Stephen J. Ruoss is an Associate Professor of Medicine in the Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, where he serves as Co-Chief. His research interests include high altitude physiology and human adaptation, as well as other lung injury and chronic pulmonary infection investigation. He has extensive experience at altitude, a consequence of his paired interests in high altitude physiology as well as climbing.

Judith L. Swain is Professor of Medicine, Dean for Translational Medicine, and the Founding Director of the College of Integrated Life Sciences (COILS), University of California, San Diego. She is widely known in the eld of molecular cardiology, and pioneered the use of transgenic animals to understand the genetic basis of cardiovascular development and disease. Her current research interests are centered on the assessing and enhancing human performance. She is currently Co-Director of the NASA National Center for Space Biological Technologies, Stanford University, Stanford, CA.

Gregory T. A. Kovacs (M83) received the BA.Sc. degree in electrical engineering from the University of British Columbia, Victoria, BC, Canada, in 1984, the M.S. degree in bioengineering from the University of California at Berkeley, in 1985, and the Ph.D. degree in electrical engineering and the MD degree from Stanford University, Stanford, CA, in 1992, respectively. He possesses extensive industry experience including co-founding several companies, most recently, Cepheid, Sunnyvale, CA. He is an Associate Professor of electrical engineering with Stanford University with a courtesy appointment in the Department of Medicine. In addition, he is the Director of Medical Device Technologies for the Astrobionics Program of the NASA Ames Research Center, and for the StanfordNASA National Biocomputation Center. He helps direct a variety of projects spanning wearable physiologic monitors, biosensor instruments for detection of chemical and biological warfare agents and space biology applications, and free-yer experiment payloads. He served as the Investigation Scientist for the debris team of the Columbia Accident Investigation Board, having worked for the rst four months after the accident at the Kennedy Space Center, FL. In this role, he carried out physical, photographic, X-ray, chemical, and other analyses on selected items from the nearly 90 000 lb of recovered debris and worked toward understanding the nature of the accident. His current research interests include biomedical instruments and sensors, miniaturized spaceight hardware, and biotechnology. Dr. Kovacs is a long-standing member of the Defense Sciences Research Council (DARPA) and has served as an associate chair and chairman. He is a Fellow of the American Institute for Medical and Biological Engineering. He held the Noyce Family Chair and was a Terman and then University Fellow at Stanford University. He was the recipient of a National Science Foundation (NSF) Young Investigator Award.

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