Abstract: A device, called expandable spacer, for improving the efficacy of drug delivery in metered dose inhalers is described. The device has a body made of flexible (might be expandable) material. It can shrink in size when it is not in use and can go back to its normal shape and size when it is used. The device further comprises a valve (can be one way valve) that helps the drug to be maintained inside the spacer's cavity and opens during inhalation and closes during exhalation.

Abstract: An arrangement for an inhaler comprises at least one electric evaporator for evaporating liquid supplied from the evaporator, and for adding the evaporated liquid to an air flow flowing through the inhaler to form an aerosol, and a flow rate measuring arrangement for measuring the volume and/or mass flow of the air flow flowing through the inhaler. The flow rate measuring arrangement comprises a heating device, a downstream temperature sensor arranged downstream of the heating device for measuring an air outlet temperature and an electronic control device, wherein the electronic control device is adapted to determine the volume and/or mass flow of the air flow flowing through the inhaler on the basis of a temperature difference between the air outlet temperature and an air inlet temperature of the air flow upstream of the heating device.

Abstract: A nasal powder dispenser device having a reservoir containing at least one dose of powder; a nasal dispenser head for inserting into a user's nostril, the nasal dispenser head including a dispenser orifice; and an air expeller that, during actuation of the nasal powder dispenser device, generates a flow of compressed air so as to dispense a dose of powder into the nostril through the dispenser orifice. The air expeller has an air chamber and a piston that slides in airtight manner in the air chamber so as to compress the air contained in the air chamber. In the nasal powder dispenser device, a pressure of the flow of compressed air generated by the air expeller is higher than 0.7 bar; and a volume of the air chamber is greater than 1700 mm3.

Abstract: A system for controlling patient sedation and spontaneous breathing intensity includes a ventilator system that delivers ventilation to the patient. The system further includes a spontaneous breathing control module configured to determine a first spontaneous breathing intensity at a first sedative status of the patient, and a second spontaneous breathing intensity at a second sedative status of the patient. A sedation/breathing relationship is then defined between spontaneous breathing intensity and sedative status for the patient based on the first and second sedative statuses and the first and second spontaneous breathing intensities. The spontaneous breathing control module then receives a desired spontaneous breathing intensity for the patient and determines a desired sedative status that achieves that desired spontaneous breathing intensity based on the sedation/breathing relationship.

Abstract: Described is a system including a sensor and a processing arrangement. The sensor measures data corresponding to a patient's breathing patterns. The processing arrangement analyzes the breathing patterns to determine whether the breathing patterns are indicative of a REM sleep state. In another embodiment, the processing arrangement analyzes the breathing patterns to determine whether the breathing patterns are indicative of one of the following states: (i) a wake state and (ii) a sleep state. In another embodiment, a neural network analyzes the data to determine whether the breathing patterns are indicative of one of the following states: (i) a REM sleep state, (ii) a wake state and (iii) a sleep state. In another embodiment, the processing arrangement analyzes the data to determine whether the breathing pattern is indicative of an arousal.

Abstract: A droplet delivery device and related methods for delivering precise and repeatable dosages to a subject for pulmonary use is disclosed. The droplet delivery device includes a housing, a reservoir, and ejector mechanism, and at least one differential pressure sensor. The droplet delivery device is automatically breath actuated by the user when the differential pressure sensor senses a predetermined pressure change within housing. The droplet delivery device is then actuated to generate a stream of droplets having an average ejected droplet diameter within the respirable size range, e.g, less than about 5 ?m, so as to target the pulmonary system of the user.

Abstract: ET securement devices and methods are provided wherein the ET securement devices generally include two portions: a first portion for securing an ET tube and a second portion for attaching to the patient. The first portion is configured to releasably attach to the second portion to secure the ET tube relative to the patient.

Abstract: A mask assembly for delivering pressurized gas to a patient comprising a mask having an inspiratory port and an expiratory port located on generally opposite sides, wherein said ports are sized, oriented, positioned, and/or spaced apart a sufficient distance to allow a cross-flow of pressurized gas to flow through the mask assembly; an outlet limb connected to the expiratory port and having an aperture in pneumatic communication with the breathing chamber; the aperture size being variable between a first, open configuration and at least one second configuration that is different from the first. A ventilation system for delivering pressurized gas to a patient comprising a seal formed with the patient's airways and in pneumatic communication with a plenum chamber; an exchanger positioned at least partially within the plenum chamber, and in pneumatic communication with inspiratory and expiratory flow paths, to recover heat and/or moisture from gas exhaled by the patient.

Abstract: The present invention relates to a method for controlling a thermoregulated ventilation circuit (100) equipped with a control unit (40) and comprising an active humidifier (10). The active humidifier (10) further comprises, in turn, a cartridge (20) equipped with a humidification chamber (21) adapted to contain water to be heated for the humidification of the air through a heating element (30), and the thermoregulated circuit (100) further comprising at least one intake tube (120) for conveying the air exiting said cartridge and provided with heating means (123) for heating the air exiting said cartridge (20).

Abstract: A system for tracking anesthetic agent in a vaporizer reservoir includes a mass flow sensor configured to measure a flow rate entering or exiting a vaporizer chamber, a gas pressure sensor configured to measure a pressure of a mixed gas provided from the vaporizer chamber, a gas temperature sensor configured to measure a temperature of the mixed gas provided from the vaporizer chamber, and an agent time module executable on a processor. The agent time module is configured to calculate a remaining agent time based on at least the gas flow rate, the pressure of the mixed gas, the temperature of the mixed gas, and an anesthetic concentration in the mixed gas. The remaining agent time is then provided for display on a display device.

Abstract: Provided are a brain stimulation system, method, apparatus and storage medium based on artificial intelligence. The system includes: a plurality of brain stimulation terminals and a cloud platform. The cloud platform is configured to, with artificial intelligence algorithm especially machine learning and deep learning, generate multi-dimensional psychological big data using physiological data and psychological state evaluation parameters gotten from the plurality of brain stimulation terminals and established models of algorithm for disease diagnosis.

Abstract: The present disclosure provides a therapeutic method and related system applicable to learning, attention, cognitive, and developmental disorders. This method combines auditory, visual, and vestibular stimuli into a systematic method which can be customized to address individual learning, attention, and processing disorders. This therapeutic method may be wirelessly implemented in a group setting.

Abstract: A system and method of monitoring the health of a person. The system comprises at least one sensor capable of measuring at least one physiological signal generated by the autonomic nervous system of the person for providing measurement data, and a data processing system which is configured to store a reference indicator, to receive measurement data from the sensor during a plurality of consecutive health-maintenance sessions in order to collect a plurality of measurement data sets corresponding to said health-maintenance sessions, to determine at last one health indicator based on the measurement data sets, said at least one health indicator being sensitive to physiological state of or changes in the autonomic nervous system, and to compare the at least one health indicator with said reference indicator. Objective information on autonomic nervous system related dysfunctions is retrieved which allows for systematic treatment to the person.

Abstract: A robot-connected IoT-based sleep-caring system includes a sleep-caring robot and an IoT system. The sleep-caring robot includes environment monitoring, physiology monitoring, sleep monitoring, sound, lighting and electricity control, a smart storage compartment, central data processing, and machine arms. The IoT system senses and executes instructions from the sleep-caring robot, thereby catering to bedroom activities of the user.

Abstract: Embodiments include methods, systems, and computer program products for detection and remediation of anxiety. Aspects include receiving an anxiety indicator. Aspects also include analyzing the anxiety indicator to determine whether an anxiety level exceeds an anxiety threshold. Aspects also include, based upon a determination that the anxiety level exceeds the anxiety threshold, selecting a first sound. Aspects also include outputting the first sound. Aspects also include receiving an anxiety feedback. Aspects also include determining, based upon the anxiety feedback, whether the anxiety level is decreasing.

Abstract: A catheter sheath device may include an elongate member and a moveable member. The elongate member may include a first lumen, and the moveable member may include a second lumen. The moveable member may be physically coupled to a portion of the elongate member to permit relative movement therebetween. A first relative movement between the moveable member and a portion of the elongate member may cause the second lumen to be positioned at a first location that permits delivery of at least a portion of a catheter into the second lumen but not into the first lumen from the second lumen. A second relative movement between the moveable member and the portion of the elongate member may cause the second lumen to be positioned at a second location that permits delivery of the at least the portion of the catheter through both the second lumen and the first lumen.

Abstract: A catheter tube has a single-lumen distal-side tube and a single-lumen proximal-side tube, the distal-side tube and the proximal-side tube are connected in such a way that a lumen of the distal-side tube and a lumen of the proximal-side tube communicate with each other, a guide wire port that opens to the outside is provided in the distal-side tube, and the inner diameter of the lumen of the proximal-side tube is smaller than the inner diameter of the lumen of the distal-side tube,

Abstract: A medical device may be a loading tool including a tubular member having a lumen extending therethrough. The tubular member may include a distal portion and a proximal portion. The proximal portion of the tubular member may include a flexible member. The flexible member may be axially and radially adjustable between a first configuration and a second configuration. The distal portion of the tubular member may be configured to engage a valve, and the valve may be in communication with a lumen of an elongated medical device.

Abstract: A catheter is provided that includes a catheter body, a catheter hub, and a securing member disposed in the catheter hub to clamp the catheter between the securing member and the catheter hub. The securing member has an outer peripheral surface making contact with and stretching an inner peripheral surface of the catheter body. The catheter includes a recessed relief portion into which a thickness of the catheter body is inserted, the relief portion being partially provided circumferentially in an inner peripheral surface of the catheter hub.

Abstract: A guide extension catheter may include a proximal shaft and a tubular distal sheath including an exchange channel allowing for access (e.g. side access) into the lumen. Guide extension catheters may be used in conjunction with a guide catheter and a medical device having a distal region disposed within the guide catheter and a proximal region disposed outside of the guide catheter. A portion of the proximal region of the medical device can be passed through the exchange channel and into the lumen, and the guide extension catheter can be advanced into the guide catheter over the medical device without removing the medical device from the guide catheter. The exchange channel can extend in a straight line path along the sheath, or may extend in an indirect path along the sheath.

Abstract: A urinary catheter assembly comprises: a urinary catheter, a tubular case and a sleeve fixedly arranged over at least a part of a non-insertable section of the urinary catheter. The sleeve includes two oppositely arranged openings and a body extending between the opening. In a first position, a storage position, the tubular case is arranged to enclose the insertable section of the urinary catheter and is removably connected to the sleeve and/or to the non-insertable section of the urinary catheter. The body portion of the sleeve is provided with a first engagement member, and the tubular case is provided with a second engagement member, thereby enabling the tubular case, when removed from the non-insertable part of the urinary catheter, to be releasably connected to the sleeve in a second disposition, the second disposition being different from the first disposition. A method for producing a urinary catheter assembly is also disclosed.

Abstract: Some embodiments of a medical device anchor system include an anchor device that secures a medical instrument (such as a catheter or the like) in place relative to a skin penetration point using subcutaneous anchors. In some implementations, the medical instrument can be coupled to the anchor device using a snap-lock cap mechanism.

Abstract: MVO is treated by introducing injectate into blood vessels affected by MVO at precise flow rates, while blocking retrograde flow, such that the natural pumping of the heart aids in forcing the injectate into the affected microvessels. Monitoring pressure distal of an occlusion balloon is used to determine treatment effectiveness and heart health.

Abstract: A fluid removal device is provided for removing fluid from pleural space that includes a flexible, open tube with a slight resting curve. A first channel along a greater curvature of the tube contains a plurality of cannulas that can be extended into the pleural space to infuse medications. A second channel along a lesser curvature of the tube contains a line attached to the outer portion of the tube and tension placed on the line will increase the curve of the tube to assist in the placement of the tip of the tube in a desired location in the pleural space. The tube may be connected to a portable suction/fusion device via a click connect device. The tube may also include an improved tip and a tab for extending the cannulas maintains the corridor of stability.

Abstract: In another example, a bioresorbable implant for use in a nasal region includes one or more bioresorbable polymers, and a pharmaceutical composition coupled to the one or more bioresorbable polymers. A release rate of the pharmaceutical composition is related to a degradation rate of the one or more bioresorbable polymers.

Abstract: An assembly for the thermal treatment and moisture treatment of physical conditions, the assembly including, a first thermal pack having a body, the body having a first face and a second face, the first face having a first protrusion. The assembly further includes a sleeve operatively arranged to receive the first thermal pack, the sleeve having a first surface. The assembly also includes a medicament pad arranged to be removably secured to the first surface of the sleeve.

Abstract: The disclosure belongs to medical devices and particularly to soluble microneedle patches and small dose medical injection devices for transdermal injections of medical and cosmetic materials to patients. It also belongs to micro-electro-mechanical systems technology (MEMS). The materials can include vitamins, proteins, glycerides, vaccines, mono-, oligo- or polysaccharides, organic acids and its salts, as well as combinations of the said materials and their derivatives. The disclosed micro-needle patch can be used for medical purposes in hospitals, outpatient and home conditions.

Abstract: The present invention teaches a cylindrical tattoo tube which includes an ink reservoir located on one side of the cylinder. A plunger may be included in the ink reservoir to control the amount of ink being dispensed. A user may manually actuate the plunger while tattooing, thereby eliminating the need constantly dip during the tattooing procedure.

Abstract: A medical connector for use in a fluid pathway includes a substantially transparent housing having a proximal end with a proximal opening and a distal end with a distal opening, and a cavity extending therebetween. The connector provides a substantially visible fluid flow path extending through a substantial portion of the connector.

Abstract: A method for treating pain or discomfort in a patient is disclosed. The method comprises stimulating a cranial nerve with an electrical signal. The pain or discomfort may be a withdrawal symptom. The cranial nerve may be in an auricular area of the patient. The cranial nerve may be cranial nerve V, cranial nerve VII, cranial nerve IX, cranial nerve X, or branches of greater and lesser occipital nerves thereof and their associated neurovascular bundles. The withdrawal symptom may result from cessation of an opioid. The method may further comprise administering a secondary drug treats one or more of the withdrawal symptoms and addiction. The secondary drug may be administered about one day to about one week after initiating the stimulating step.

Abstract: Devices, methods and systems for transmitting signals through a device located in a blood vessel of an animal, for stimulating and/or sensing activity of media proximal to the device, wherein the media includes tissue and/or fluid.

Abstract: Tips for use on a tunneling tool provide the ability to pull an implantable medical lead extension or catheter body through a subcutaneous tunnel. The tips may include a pin with a barb, where the barb is inserted within a compliant portion of a connector body of the lead extension or a catheter body to create an interference fit that allows the connector body or catheter body to be pulled through the tunnel. The tips may include a carrier that has a cavity for the connector body, where the tunneling is performed with the carrier present on the tunneling tool. A body is positioned within the cavity of the carrier to prevent tissue from snagging on and collecting within the carrier. The body may include a tip portion that performs the tunneling function. The carrier may also provide tunneling and/or may be attached to the tunneling tool during tunneling.

Abstract: A medical electrical lead having a conductor assembly covered by an insulating layer, and a shield covering positioned adjacent or proximate to at least a portion of the insulating layer in order to shield the conductor assembly from one or more electromagnetic fields. The shield covering is formed of a polymer-matrix composite. The polymer-matrix composite includes a polymeric resin having discontinuous conductive fillers provided therein. The discontinuous conductive fillers include one or more of nano-sized metal structures and nano-sized non-metallic conductive structures. The nano-sized non-metallic conductive structures can have a coating formed of one or more metals. The nano-sized non-metallic conductive structures can be formed of carbon. In turn, the nano-sized non-metallic conductive structures can include one or more of carbon nanofibers, carbon filaments, carbon nanotubes, and carbon nanoflakes.

Abstract: A power supply apparatus includes a power supply configured to apply an alternating current to a magnetic field generation apparatus; and a controller configured to control the alternating current applied by the power supply. The controller controls the power supply to apply the alternating current having a waveform pattern including a plurality of current waveforms having different frequency spectrums from each other.

Abstract: An oral appliance is disclosed that provides electrical stimulation to a patient's tongue in a manner that prevents collapse of the tongue and/or soft palate during sleep. More specifically, the appliance may induce a reversible current or currents in a lateral direction across the tongue in a manner that shortens the patient's Palatoglossus muscle, which in turn pulls the patient's soft palate downward towards a base of the tongue and/or decreases a volume of the tongue.

Abstract: Systems and methods for implementation of a disposable miniaturized implant for treatment of Post-Operative Ileums (POI),a miniaturized implant for treating chronic GI dysmotility (e.g., dysphagia, gastroesophageal reflux disease (GERD), nausea, functional dyspepsia, blockage of transit, and gastroparesis, inflammatory bowel disease) and obesity, by providing electrical stimulation to the part of bowel going through surgery to expedite the healing process while recording the smooth muscle activities simultaneously, or providing stimulation on a treatment location of the GI tract or the branch of the vagus nerve. Systems and methods are also provided for non-invasive, transcutaneous stimulation of anatomy within the abdomen of the patient.

Abstract: Devices and methods are disclosed that allow a patient to self-treat a medical condition, such as migraine headache and trigeminal neuralgia and the like, by noninvasive electrical stimulation of nerves of the head, particularly supraorbital, supratrochlear, infraorbital, and mental nerves in the vicinity of their foramen or notch. The system comprises a handheld mobile device, such as a smartphone, that is applied to the surface of the patient's head. One or more electrodes on the mobile device apply electrical impulses transcutaneously through the patient's skin to the targeted nerve to treat the medical condition. The system is designed to address problems that arise particularly during self-treatment, when a medical professional is not present.

Abstract: Devices, systems and methods are disclosed that allow a patient to self-treat a medical condition, such as migraine headache, by electrical noninvasive stimulation of a vagus nerve. The system comprises a stimulator that is applied to the surface of the patient's neck. The device housing transmits data to a patient interface device such as a mobile phone or computer relating to the status of a stimulation session. The interface device in turn may communicate with a database contained within other computers, via a network or the internet. The system is designed to address problems that arise particularly during self-treatment, when a medical professional is not present.

Abstract: Disclosed is a process whereby galvanic skin response is measured after the stimulation of the cranium by micro direct current. The body is stimulated through the cranium by micro direct current by creating a cybernetic loop of a loop of current-carrying material, after which the body's responses are measured. The process uses a galvanic skin response and voltage measuring and frequency counting unit; this galvanic skin response data is then used in the same process cycle to generate secondary stimulation. The cybernetic loop is attached to the upper part of the cranium with three connection points to the upper forehead. All parts are connected with the electrode coil, consisting of five clockwise and five counter-clockwise loops, the silver necklace around the neck used as grounding, and the appropriate jack outputs. The method uses the input signals processed by the control software and the emitted micro direct current.

Abstract: Systems and techniques are disclosed to establish programming of an implantable electrical neurostimulation device for treating chronic pain of a human subject, through the use of a dynamic model adapted to determine pain treatment parameters for a human patient and identify a new device operational program to implement the pain treatment parameters to address the chronic pain condition.

Abstract: Systems and techniques are disclosed to adjust programming of an implantable electrical neurostimulation device for treating chronic pain of a human subject, through the use of a dynamic model adapted to identify pain treatment parameters for a human patient and determine a best device operational program to implement the pain treatment parameters to address the chronic pain condition. In an example, the system to adjust programming of the neurostimulation device performs operations that: obtain data related to a state of pain of the human subject; identify pain treatment parameters using a dynamic model adapted to evaluate the pain treatment parameters in the human subject over a time period, based on the data related to the state of pain; and select a neurostimulation program for the neurostimulation device, corresponding to at least a portion of the identified pain treatment parameters.

Abstract: An implantable vagus nerve stimulation (VNS) system includes a sensor configured to measure ECG data for a patient, a stimulation subsystem configured to deliver VNS to the patient, and a control system configured to perform a heart rate variability analysis with the ECG data. In some aspects, performing the heart rate variability analysis includes measuring R-R intervals between successive R-waves for the ECG data measured during a stimulation period and a baseline period, plotting each R-R interval against an immediately preceding R-R interval for each of the stimulation period and the baseline period, and determining at least one of a standard deviation from an axis of a line perpendicular to an identity line for each of the stimulation period plot and the baseline period plot or a centroid of each of the stimulation period plot and the baseline period plot.

Abstract: Systems and techniques are disclosed to establish programming of an implantable electrical neurostimulation device for treating pain of a human subject, through the use and adjustment of analgesic stimulation parameters based on trust dynamics and trust measurements. In an example, the system to establish programming of the neurostimulation device performs operations that: determine a trust measurement value that is derived from results of at least one commitment made with a human subject, via observable interactions; determine a modification of at least one neurostimulation programming parameter, based on the trust measurement value; and to cause the implantable neurostimulation device to implement the modification of the at least one neurostimulation programming parameter. Further examples are provided to produce and track the trust measurement value, as well as identify a pain susceptibility value and determine a receptiveness to analgesic effects based on these and other trust dynamics.

Abstract: A system or method for identifying sets of stimulation parameters can include receiving at least one image of a region of a patient; registering the at least one image with an anatomical or physiological atlas that identifies different anatomical or physiological structures; identifying a desired stimulation region using the at least one image; comparing the desired stimulation region with each of a plurality of predetermined estimated stimulation regions, where each of the estimated stimulation regions is a calculated estimate of a stimulation volume for a corresponding set of electrical stimulation parameters; selecting one of the predetermined estimated stimulation regions based on the comparing; and providing the corresponding set of electrical stimulation parameters for the selected one of the predetermined estimated stimulation regions to a user or an electrical stimulation device.

Abstract: Implantable medical devices include an enclosure that is constructed by machining of a material rather than by forming or stamping. The machining produces one or more internal features within the enclosure. These internal features may include shelves that may act as a stiffener and create separate compartments within the enclosure. These internal features may include contoured edges along the shelves to accommodate conductors and other structures that extend from one compartment to another. These features may include slots that are present in one or more locations, such as on a surface of one of the shelves. These internal features may also include standoffs that establish a gap between an internal component and the external wall of the enclosure. These internal features may also include different thicknesses in different areas of the enclosure, such as one wall thickness in one compartment and a different wall thickness in another compartment.

Abstract: An example method includes receiving, by an implantable device and from an external device, an energy signal; transducing, by the implantable device, the energy signal into electrical power; outputting, by the implantable device and to the external device, a feedback signal that represents an absolute level of the electrical power transduced from the energy signal, wherein the feedback signal includes a first portion that represents a relative level of the electrical power transduced from the energy signal and a second portion that represents a reference voltage level; and delivering, by the implantable device, a level of electrical stimulation therapy proportional to the absolute level of the electrical power transduced from the energy signal.

Abstract: Methods and systems for selecting stimulation parameters using targeting and steering techniques are presented. For example, a method or system (via actions performed by a processor) can include receiving a name of an anatomical or physiological target or a name of a disease or disorder; receiving a clinical goal; and using at least 1) the anatomical or physiological target or disease or disorder and 2) the clinical goal, selecting a set of stimulation parameters. Another method or system (via actions performed by its processor) can include receiving a first set of stimulation parameters; receiving a command to alter the first set of stimulation parameters that does not include, or is not composed exclusively of, a numerical value for any of the stimulation parameters; and modifying the first set of stimulation parameters to create a second set of stimulation parameters based on the command.

Abstract: A fixing device for fixing a longitudinally extended element, having a fixing sleeve that surrounds a lumen extended in an axial direction for receiving the longitudinally extended element, the fixing sleeve having an inner side defining the lumen and an outer side facing away from the inner side, the fixing sleeve being embodied for fixing the fixing sleeve on the longitudinally extended element to be subjected to compression in the radial direction of the fixing sleeve by means of the at least one fixing element. The fixing device has an indicator device that is embodied to visually indicate when a force applied to the fixing sleeve by means of the at least one fixing element for compressing the fixing sleeve attains or exceeds a threshold.

Abstract: Methods and apparatus for a three-stage ventricular cardioversion and defibrillation therapy that treats ventricular tachycardia and fibrillation at low energy levels. An implantable therapy generator adapted to generate and selectively deliver a three-stage ventricular therapy and at least two leads operably each having at least one electrode adapted to be positioned proximate the ventricle of the patient. The device is programmed to deliver a three-stage therapy via both a far-field configuration and a near-field configuration of the electrodes upon detection of a ventricular arrhythmia. The three-stage therapy includes a first stage for unpinning of one or more singularities associated with the ventricular arrhythmia, a second stage for anti-repinning of the one or more singularities, both of which are delivered via the far-field configuration of the electrodes, and a third stage for extinguishing of the one or more singularities associated delivered via the near-field configuration of the electrodes.

Abstract: A patient-worn ambulatory cardiac monitoring device for monitoring a patient during a patient activity includes at least one physiological sensor configured to detect signals indicative of cardiac activity, an activity sensor and associated circuitry configured to monitor patient movements, and a vibrational sensor configured to monitor a cardio-vibrational signal of the patient. The at least one physiological sensor can include one of an ECG sensor and a heart rate sensor. At least one processor in communication with the at least one physiological sensor, the activity sensor, and the vibrational sensor, is configured to measure, during the patient activity, at least one time interval between an ECG fiducial point in an ECG signal and a cardio-vibrational fiducial point in the cardio-vibrational signal during a cardiac cycle of the patient's heart.