The modern age of Physiological Measurement.

Clinical doctors (I am one) feel confident that apparently sudden and catastrophic illness sometimes has subtle beginnings, ones that could be detected by experienced doctors at times where interventions would be miraculously useful. Since doctors cannot be at every bedside all the time, continuous physiological measurement in the form of electronic cardiorespiratory monitoring has been in heavy use for the past half century and maybe more. The big idea is that small aberrations in physiology, if recognized in time, could lead to early detection and treatment, and improved outcomes. Readers and contributors to Physiological Measurement are, of course, familiar with this line of thinking. Is it any good? Frankly, it has been hard to tell. In 1958, Hon published a paper in an obstetrical journal that changed forever how babies are born (Hon 1958). He discovered an unmistakable signature of distress in the physiological monitoring of the fetus, such as might be brought about by strangling on the umbilical cord when the uterus contracted during labor. The signature lay in the pattern of heartbeats?instead of the normal variability we all know about, the heartbeats became monotonously regular with ominous punctuations of slowing down. Today, nearly every mother in labor has a belt around her tumultuous gravid abdomen that records the contraction of the uterus and the heart beat pattern of the fetus. The output is a long strip of paper that collects on the floor and is periodically swept up, held out like a banner, and pronounced as 'non-reassuring' or 'not non-reassuring' based on the degree to which reduced variability and transient decelerations were present. A non-reassuring tracing?as judged solely by the emotional response of the beholder?very often prompts Caesarean section, despite repeated demonstrations that this practice does not improve the outcome of the babies. Clearly, all this has brought us is a lot more Caesarean sections. This is not the fault of Dr Hon, and does not mean that the fetus is not trying to tell us something when the heart shows us reduced variability and transient decelerations. But the evidence that such monitoring saves babies does not exist. What went wrong? In my view, this was the right idea but at the wrong time, a time of paper chart recordings of the original data, and paper medical records that had insufficient clinical detail. Cloistered groups unable to share methods or data sets published small studies of selected patients, in journals that existed only in hard copy in medical school libraries. The times are rapidly changing, and with them our capabilities and our imperatives. We are simultaneously watching unfold the revolutions of open access in the academic publishing world, big data in the scientific world, and quality and patient safety initiatives in the clinical world. So, one would think, we should all expect to have freely available studies of very large data sets reporting on ways to save lives using existing monitors. It is appealing to think there will soon be a time when all the data that we collect in patient care are used in real time to monitor clinical changes, both for the better and for the worse. What is the role of Physiological Measurement in these times? My vision is that it should be the world's most respected and useful source on quantitative analysis of human physiology in clinical settings. And its mission, in my view, is to publish repeatable, rigorous, accessible, clinically relevant papers that help the medical and engineering community take care of patients. There is something specific we will work towards. The Editorial Board and I are committed to the prospect of what the Royal Society in its 'Science as an Open Enterprise ' document of summer 2012 called the 'executable paper' (The Royal Society 2012). The essence of such a paper is that the data and the programs for analysis are made available through hyperlinks. In concept, the interested reader might download them, and reproduce the results. One aspect of the mission is to make Physiological Measurement the preferred venue for such works?paper, data and code. While all of us should applaud and support this concept, it is a serious matter to produce such a work. We are exploring mechanisms, mindful of the complex issues of data storage and access, privacy of personal health information, cross-platform availability and compatibility, not to mention the costs involved at each step. There are advantages, though, to investigators in producing these research works. Government funding is increasingly scrutinized for its direct benefits to human health. Focusing your work in this direction is thus doubly appealing?change the world, and get grant funding, too. We invite accounts of quantitative description and representation of human physiology and pathophysiology. I hope to increase the clinical applicability of our papers while maintaining the historically very high standard of mathematical explication. It is fun to think about how the unexpected may change these views. Three years time (the duration of my contract) may have us agog at something completely new and different, as CT and MRI imaging left us disoriented by their clarity at first. Finally, I am honored to occupy the role of Editor-in-Chief, so ably performed by my predecessors, Professor Richard Bayford, Professor Michael Neuman and many others before them. Giants indeed, and the view from their shoulders is very appealing. References Hon E H 1958 The electronic evaluation of the fetal heart rate Am. J. Obstet. Gynecol. 75 1215?30 The Royal Society 2012 Science as an open enterprise Science Policy Centre Report 02/12 (London: The Royal Society)