Patent Publication Number: US-11647924-B2

Title: Wireless, disposable, extended use pulse oximeter apparatus and methods

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application is a continuation of U.S. application Ser. No. 16/805,052, filed Feb. 28, 2020, which application is a continuation of U.S. application Ser. No. 15/372,341 (now U.S. Pat. No. 10,646,144), filed Dec. 7, 2016, which claims the benefit of U.S. Provisional Application Ser. No. 62/264,233, filed Dec. 7, 2015, and which applications are incorporated herein by reference. To the extent appropriate, a claim of priority is made to each of the above disclosed applications. 
    
    
     FIELD OF THE INVENTION 
     The present inventions relate generally to the field of pulse oximetry, and more specifically to wireless, disposable, extended time period, continuous pulse oximeter sensor assemblies and related methods and apparatus. 
     BACKGROUND 
     Pulse oximetry is a technology that enables the noninvasive monitoring of a patient&#39;s arterial blood oxygen saturation and other parameters. The technology was first developed in the 1970s and has been successfully implemented in clinical settings as well as fitness and wellness applications. 
     In typical prior art pulse oximetry technology, oxygen saturation is measured by means of an optical probe (sensor). The sensor typically includes two light-emitting diodes (LEDs) in the visible (red) and near-infrared regions, and a silicon detector (photodiode) that detects the light emitted by those diodes after it has passed through some part of a patient&#39;s body. Typically, the sensor is attached to a blood perfused measurement site (the patient&#39;s digit, ear lobe, forehead, etc.), in a reflective or transmissive configuration, to create diffusive light paths through that measurement site. The diffusive light paths typically start at the LEDs and end at the photodiode. Because blood absorbs and scatters light at different rates depending on the applied light wavelength and the blood&#39;s oxygen saturation, the red and the near-infrared light wavelengths produced by the LEDs are attenuated at different rates by the site&#39;s optical paths (through the patient&#39;s body) before reaching the photodiode. 
     The pulsing of the patient&#39;s heart affects measurements with these sensors. For example, the heart&#39;s activity during its normal cardiac cycle produces a pulsatile arterial blood flow (plethysmograph) at the measurement site, and that pulsing modulates the light absorbed and scattered by the sensor throughout the site&#39;s optical paths. As a result, the red and near-infrared light signals reaching the photodiode also have a “pulsing” pattern, or a pulsatile component (photoplethysmograph), due to the heart/cardiac cycle. Measuring the red and the near-infrared photoplethysmographs over a series of cardiac cycles enables the sensor to noninvasively measure the patient&#39;s arterial blood oxygen saturation. This is because the oxygenated blood has higher optical absorption in the near-infrared wavelengths, while the deoxygenated blood has higher optical absorption at the red wavelengths. This property makes it easy to measure the ratio between oxygenated blood and deoxygenated blood (oxygen saturation). 
     As a consequence, the photoplethysmographs measured by the sensors also typically have fundamental periodicity identical to the heart rate and, therefore, can also be used to measure the patient&#39;s heart frequency (pulse rate). The photoplethysmograph intensities are a function of the measurement site&#39;s blood perfusion and, typically, the photoplethysmograph associated with the near-infrared wavelength is employed to estimate the site&#39;s blood perfusion. The near-infrared wavelength is chosen because it varies less with changes in oxygen saturation, given that the optical properties of oxygenated and deoxygenated blood are less discrepant at the near infrared region. Prior art pulse oximeters typically measure arterial oxygen saturation (SpO2), pulse rate (PR) and the site&#39;s blood perfusion (PI). 
     For clinical or otherwise “critical” applications, acceptable pulse oximeter measurement systems typically require complex electronics and signal processing, which typically requires relatively higher manufacturing costs and power consumption at some point in those systems. This economic and physical reality has a number of implications for the sensors used in such systems and technology. 
     Prior art pulse oximeters typically use optical sensors that are either reusable or disposable, either wired or wireless, and either “continuous” or “spot-check”, depending on the particular application for which and situation in which the sensor is to be used and other factors. Some prior publications purport to disclose various combinations of those features, but for economic and other reasons, those apparently are not economically feasible, for the market today commonly uses only either (a) wired disposable sensors or (b) wireless reusable sensors. Because of power consumption issues (such as those discussed herein), the wireless sensors typically are only used for “spot-check” applications. 
     In passing, as discussed herein, “continuous” measurement of a parameter describes a sequence of measurements by a sensor, with sampling that is frequent enough to reliably capture all important parameter trend information of interest. In other words, “continuous” does not mean “absolutely without interruption”. “Spot-check” describes when the oximeter measurements are for a generally short period of time, such as during a yearly physical or checkup at a doctor&#39;s office. 
     Each of the two main approaches mentioned above (wired disposable sensors or wireless reusable sensors) involves tradeoffs in costs, functionality, size, comfort, and other factors. For example, although prior art wireless sensors allow a user and/or doctor greater freedom of movement (because there are no wires to get tangled with other things, especially if the patient moves around while wearing the sensor), the power and functionality required to gather and transmit the sensor signals in prior art systems requires the wireless sensor to be relatively large and expensive. The power requirements for “continuous” sensing are also substantial in prior art systems, so typical prior art wireless sensors are only useful for “spot checking” oximeter measurements—the sensors must not only be cleaned between uses but also must be recharged or have their batteries replaced. In other words, the wireless reusable sensors have larger form factor and power consumption requirements, which make them not suitable for continuous use. 
     Disposable sensors have benefits such as helping reduce the need for cleaning the sensors between uses, but as noted above, because disposable sensors typically are thrown away after a single use, prior art disposable sensors typically are manufactured with relatively little onboard power or processing capability (so as to be less expensive). To achieve those goals, they typically are “wired” to some accompanying host device (because the sensor itself does not include the expensive power supply and complex electronics and required signal processing technology and power capabilities required for wireless sensors). Instead, the required complex electronics and signal processing are typically “offloaded” from the disposable sensors through the wires, to a nearby computer, monitor, or other host device, so that the “work” done by the sensor itself is relatively small. By using wired sensors, the electronics and signal processing can (to at least some degree) be accomplished on that “remote” machine rather than by the sensor assembly itself, and the “disposal” of the sensor does not involve throwing away something of greater cost. 
     These and other factors have prevented the implementation of a disposable wireless sensor product that can be used for an extended period of time and thus provide a “continuous” set of oximeter data for a patient with the convenience and other benefits of a wireless sensor, while still meeting the quality requirements for clinical and other critical data collection and monitoring. 
     Others have attempted hybrid systems such as the one in US 2014/0200420 A1, which uses a conventional disposable sensor (the lower cost component) wired to a sensor interface box (the higher cost component) wrapped around the subject&#39;s wrist that sends waveforms and or measurements wirelessly to a monitor so that measurements derived by the monitor are generally equivalent to measurements derived by the sensor. For the same reasons aforementioned, and because of the additional sensor wires and connectors required, such topologies have in general a relatively larger footprint, with excessive weight and required body area, making them not practical for continuous monitoring where the patient&#39;s comfort is a concern. In addition, the sensor interface box and cables are reusable and thus increase the risk of patient cross-contamination. 
     For applications that require continuous monitoring, the disposable sensor is preferred for a number of reasons, including:
         (i) Lighter and smaller size. The plastic enclosure and mechanical components in reusable sensors typically must be somewhat more rugged to withstand multiple uses. For disposable versions, those components typically are replaced with single-use adhesive tapes.   (ii) More consistent sensor placement and compliance over time, given that the disposable sensor typically is adhered to the patient&#39;s measurement site and is less likely to shift from that location.   (iii) Less risk of contamination, given that the sensor is used in a single patient before being disposed.   (iv) Performs better during the patient&#39;s physical activity (motion), given that sensor is relatively firmly attached to the patient and the relative motion between sensor and patient&#39;s measurement site is minimized.       

     As mentioned above, in prior art systems the disposable sensors typically are hard-wired to the monitor by means of a reusable patient cable, to reduce sensor costs and increase reliability. Reusable cables between the sensor and monitor provide other benefits, such as enabling the connection of several disposable sensor models into a single monitor model by simply interchanging connection cables. Prior art connection cables commonly offer and/or use different types of hardware connections and also can be used to configure the behavior of a monitor for a particular sensor application. 
     Prior art disposable sensor technologies continue to have some risks and limitations, including (by way of example and not by way of limitation):
         (i) The prior art connection cables used with the disposable sensors are relatively expensive, and therefore typically are reused. This typically requires that the cables be sterilized before they can be reused, especially in surgery rooms and areas where the risk of infections and contaminations are a concern.   (ii) In a hospital environment (and perhaps most environments), typically it is desirable to simplify the workflow. In that regard, management and sterilization of reusable patient cables adds complications and extra actions and measures to the workflow (rather than simplifying workflow). This in turn increases operating costs and can make the hospital staff and clinicians more prone to errors, including ones that may have a catastrophic effect on patients&#39; safety, recovery, and prognosis.   (iii) The patient&#39;s mobility is reduced by use of the cables (since the disposable sensor typically is attached to a monitor by means of a patient cable).   (iv) For applications (such as sleep monitoring) where the subject&#39;s comfort is a very important aspect of the procedure outcome, using a cable (typically attached to the disposable sensor) limits the patient&#39;s mobility (while at sleep), causing discomfort and potential changes in the subject&#39;s sleeping patterns, and thus interfering with the accuracy and/or the monitoring itself.   (v) In the monitoring of patients with highly contagious diseases (such as Ebola, SARS, etc.), the need for a patient cable and monitor nearby the patient increases the chances of cross contamination.       

     Other factors affect and/or result in the foregoing and other limitations of prior art disposable sensor technology. As indicated above, clinical grade pulse oximeter system typically requires advanced instrumentation electronics combined with powerful digital signal processors (DSPs) in order to measure SpO2, PR and PI (especially under extreme cases, such as where blood perfusion is low and/or motion and/or physical activity is present or accentuated). In addition, ambient light interferences (such as those caused by exposure of the sensor photodiode to natural light and/or light sources connected to the electric grid) must be filtered out before reliable measurements may be taken. These and/or other requirements can make it difficult to miniaturize the sensor and monitoring technologies, leading to solutions that are relatively more expensive and have higher power consumption, dimensions, and weight. 
     To minimize customers&#39; recurrent costs, medical device companies typically divide prior art clinical-grade pulse oximeter systems into three main components: (i) a low-cost disposable sensor, (ii) a reusable patient/connection cable, and (iii) a reusable monitor. In such systems, healthcare providers (hospital, clinics, etc.) typically will (a) purchase and reuse the expensive components (the patient cable and monitor) and (b) purchase and throw away after one use the less expensive components (the disposable sensors). The healthcare providers thus must make recurrent purchases of disposable sensors, to be used on new patients and even for subsequent/repeated tests on a single patient. However, this marketing approach has resulted in a relative low volume of sales of monitors and patient/connection cables (when compared to sales of devices in the consumer electronics market, for instance). Combined with the manufacturers&#39; sometimes high operating and development costs in the clinical-grade patient monitoring market segment, the sale prices of those patient cables and monitors can become unaffordable to many or even most healthcare providers. In order to reduce capital expenditure by the healthcare providers and increase sales, medical device companies typically have decided to offer binding contracts for these prior art systems, which enable healthcare providers to obtain monitors and patient cables at a reduced (perhaps loss-leading) price provided that the healthcare providers commit to purchasing the disposable sensors components for a certain period of time (for the entire organization and/or for individual departments (i.e., pediatrics, anesthesia, etc.)). As part of such contracts, the medical device companies also commonly provide training and technical support for the systems. This contractual arrangement typically is referred to in the industry as a full-house conversion. 
     Even though such disposable sensor supply contract arrangements may be attractive at first (given the relative low initial investment required), the contracts can become expensive over time. In addition to the typical exclusivity clauses in the supply contracts, and even after those periods of exclusivity have expired, the typical hard-wired connections between the sensors and the cable/monitor components allow medical device manufacturers to create physical mechanisms that prevent the healthcare providers from using any competitors&#39; disposable sensors on the manufacturer&#39;s proprietary monitors/cables. The proprietary physical cable/monitor/sensor connections can also increase the costs and efforts and risks to healthcare providers if they try to change to a competitors&#39; technology, because they (among other things) have to retrain personnel and change workflow to switch to a new monitoring solution. This puts healthcare providers in a position of very little control over, and relatively few good/flexible/economic options for their patient monitoring needs. It results in relatively higher costs to the healthcare providers and eventually to patients and our healthcare system generally. 
     Examples of wireless oximeters in the form of a wireless monitoring device which may be connected to a disposable adhesive sensor via a cable connection, are disclosed in U.S. Pat. No. 7,387,607. Other examples of wireless, disposable oximeters are disclosed in U.S. Pat. Nos. 7,486,977, 7,499,739, 8,457,704, and 8,903,467. In these prior art devices, a bandage comprising a single-use, disposable pulse oximeter is self-powered and transmits information wirelessly. In these prior art reflective oximeters, the light emitter and sensor are separated with a foam material. Such foam material may accentuate light piping between the emitter and sensor, and thereby artificially reduce the photoplethysmograph amplitude and accentuate measurement errors due to the position and pressure applied to the measurement site by the adhesive tape. Further, the required larger emitter-detector separation of these prior art oximeters would cause an exponential attenuation of light (not taught in the accompanying disclosures) due to the current and power levels required by both reflective or transmissive oximeters in order to create measurable signals at the sensor/detector with reasonable signal-to-noise ratios. In addition, the small emitter-detector separation necessitated by the required power consumption would create a very shallow penetration depth of the red and near-infrared wavelengths, thus preventing the probing of layers at the measurement site where the pulsatile capillary blood flow modulates the light signals in order to create the photoplethysmographs used to estimate oxygen saturation, pulse rate, perfusion, and their derivative measurements. 
     The above-mentioned power consumption required to perform both high quality demodulation of optical signals (in order to prevent ambient light interferences) and further estimation of interesting parameters is not accounted for in the disclosed architectures of these prior art wireless oximeters and their host devices. To be feasible, a distributed architecture is necessary where several complex high-latency tasks with floating-point operations are executed by the host device(s). The disclosed prior art oximeters do not include fixed-point low-power and/or low-cost processors that are required for pulse oximeter algorithms of medical grade instrumentation in sensor patches for extended use. 
     Other prior art oximeters are disclosed in U.S. Pat. No. 8,761,852, which discloses an adhesive, disposable device which transmits data wirelessly and includes a sensor module, a pliable membrane, and a communication module. In this prior art oximeter, optical sensors are connected to a patient by means of a pliable membrane attached to a wristband. U.S. Pat. No. 8,214,007 discloses a patient monitoring device with a plurality of electrical connections to the body of a patient for monitoring the body&#39;s electrical activity. This prior art monitoring device suffers from much of the same limitations as the above-mentioned disclosures. Among other things, the emitter-detector separation is not addressed relative to light piping and pressure, and the signal processing and power consumption requirements. 
     SUMMARY 
     In a preferred embodiment, the present inventions provide a wireless, disposable pulse oximeter sensor apparatus and methods capable of providing real-time, continuous, extended time period measurement readings of a user&#39;s SpO2, PR and PI. Preferably, the wireless, disposable pulse oximeter sensor provides several benefits over conventional, wired prior art pulse oximeters (whether disposable or not disposable), including, by way of example and not by way of limitation, having a small footprint, requiring low power consumption, having low manufacturing costs, and being monitor-agnostic. In preferred embodiments, these advantages are achieved in a low-power, compact pulse oximeter having compact instrumentation electronics, advanced signal processing and estimation algorithms, low-energy wireless communication protocols, and distributed computing. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present inventions will become apparent from the textual description considered in connection with the accompanying drawings. It should be understood, however, that the drawings are intended for the purpose of illustration and not as limits of the inventions. In other words, the present inventions are illustrated by way of example, and not by way of limitation, in the text and the figures of the accompanying drawings. In those drawings, like reference numerals generally refer to similar elements. Persons of ordinary skill in the art will understand, however, that at times, different numbers refer to elements that may have similar or even identical or interchangeable characteristics and functions (e.g., optical sensor  110  in  FIG.  1   , and optical sensor  403  in  FIG.  4   ). 
         FIG.  1    is a block diagram of a wireless, disposable, continuous pulse oximeter sensor, according to an embodiment of the inventions. 
         FIG.  2 A  shows two alternative embodiments of a wireless, disposable, continuous pulse oximeter sensor in accordance with the inventions, each of the embodiments attached to a digit, and each using a different adhesive tape layout (with those layouts depicted in greater detail in  FIGS.  2 G and  2 H , respectively). 
         FIGS.  2 B-F  show additional measurement sites on a patient&#39;s body where disposable, wireless pulse oximeter sensors can be applied/mounted. 
         FIG.  2 G  is a wireless, disposable, continuous pulse oximeter sensor with adhesive tape layout similar to a patch (with small adhesion area required), according to an embodiment of the inventions. 
         FIGS.  2 H-L  illustrate some of the many more alternative additional adhesive tape layouts with adhesion areas suitable for different applications and measurement sites for practicing the inventions. 
         FIG.  3    is a cross-section view of a wireless, disposable, continuous pulse oximeter sensor (with adhesive tape layout as depicted in  FIG.  2 G ), according to one of the many embodiments of the inventions. 
         FIG.  4    shows a frontend circuit schematic of a wireless, disposable, continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. 
         FIG.  5    shows a signal processing unit and antenna circuit schematic of a wireless, disposable, continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. 
         FIG.  6    shows a power management circuit schematic of a wireless, disposable, continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. 
         FIGS.  7 A-D  depict printed circuit board layers of a wireless, disposable, continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. 
         FIGS.  8 A-B ,  9 A-B, and  10 A-B show one of the many alternative ways in which the inventions can be packaged and delivered to a user, including a 3-part adhesive tape design, in accordance with an embodiment of the inventions. For the embodiment illustrated, the encapsulation tape design is shown in  FIG.  8 A  and the corresponding tape stack-up in  FIG.  8 B ; the tape design that enables the circuit board to be turned on by the clinician or user at the time of use is detailed in  FIG.  9 A  and its corresponding tape stack-up in  FIG.  9 B ; the tape design that enables skin-to-device adhesion is shown in  FIG.  10 A , and its stack up in  FIG.  10 B , respectively. Persons of ordinary skill in the art will understand that the dimensions and shapes shown in these and other drawings are not intended to be delimiting of the many different embodiments in which the inventions can be practiced. Instead, the dimensions and shapes are only intended to be illustrative of one of the many ways in which the inventions may be practiced. 
         FIG.  11    shows an exploded view of a wireless, disposable, continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. As illustrated,  FIG.  11    includes embodiments of the apparatus shown in  FIGS.  8    (element  1104 ),  9  (element  1105 ), and  10  (element  1106 ) above. 
         FIG.  12    shows a loop antenna (such as element  1103  from  FIG.  11   ) and battery soldered to a pulse oximeter printed circuit board (PCB), in accordance with an embodiment of the inventions. 
         FIGS.  13 A-B  are similar to  FIG.  12   , but show a battery and antenna being folded onto a PCB to give shape to the pulse oximeter-PCB assembly, in accordance with an embodiment of the inventions. 
         FIGS.  14 A-D  show the adhesive tape from  FIGS.  9 A-B  being attached to the adhesive tape depicted in  FIGS.  8 A-B , in accordance with an embodiment of the inventions. 
         FIGS.  15 A-J  depict one of the preferred embodiment of steps for attaching an adhesive tape assembly from  FIGS.  14 A-D  to a pulse oximeter assembly PCB assembly from  FIGS.  13 A-B , in accordance with an embodiment of the inventions. 
         FIGS.  16 A-B  illustrate one of the many embodiments of apparatus and methods of attachment of the adhesive tape (such as shown in  FIGS.  10 A-B ) to a wireless, disposable, continuous pulse oximeter assembly (such as shown in  FIGS.  15 A-J ), in accordance with an embodiment of the inventions. 
         FIGS.  17 A-B  are a front view and a back view of a preferred embodiment of a wireless, disposable, continuous pulse oximeter sensor fully assembled, in accordance with an embodiment of the inventions. 
         FIGS.  18 A-H  show one of the many embodiments of the inventions, including a series of steps to turn on and attach a wireless disposable pulse oximeter (such as shown in  FIGS.  17 A and  17 B ) to a body appendage (e.g., fingertip), in accordance with an embodiment of the inventions. 
         FIGS.  19 A-B  are a front view and a back view of a preferred embodiment of a wireless, disposable pulse oximeter sensor attached to a user&#39;s measurement site (e.g., fingertip), in accordance with an embodiment of the inventions. 
         FIG.  20    depicts a preferred embodiment of a wireless, disposable pulse oximeter of the inventions (lower left portion of the figure, affixed to a fingertip) connected to a laptop computer via Low-Energy Bluetooth wireless protocol. In a preferred embodiment, red and near-infrared waveforms are sent to the laptop for processing, visualization, and storage, in accordance with an embodiment of the inventions. 
         FIG.  21    illustrates a preferred monitor/display showing photoplethysmographs for the red and near-infrared wavelengths, in accordance with an embodiment of the inventions. 
         FIG.  22    illustrates a preferred monitor/display showing the red and near-infrared data waveforms sent from the disposable wireless pulse oximeter to a laptop computer, in accordance with an embodiment of the inventions. 
         FIG.  23    illustrates a preferred monitor/display showing two bars (one for the red and one for the near-infrared wavelength) depicting the light emitting diode (LED) currents and the internal gains of a pulse oximeter frontend being set to approximately 40% of its dynamic range, in accordance with an embodiment of the inventions. 
         FIG.  24    shows a snapshot of the SpO2, perfusion, and pulse rate measurements performed by preferred demodulation, decimation, led current calibration, sensor off patient, error handling, communication algorithms running on the disposable wireless pulse oximeter to produce high-quality red and near-infrared photoplethysmographs that are wirelessly and continuously sent to a laptop in order to have the oxygen saturation, pulse rate and perfusion index calculated and displayed on the laptop computer or other convenient monitor, in accordance with an embodiment of the inventions. 
         FIGS.  25 A-H  illustrates apparatus and a series of steps of one of the many embodiments of the inventions, by which a disposable, wireless, continuous pulse oximeter can be wrapped by a disposable adhesive bandage in order to protect the pulse oximeter from environmental conditions and avoid dislodgment of the device on applications that require long term use and/or are subjected to accentuated motion and physical activity, in accordance with an embodiment of the inventions. The disposable adhesive bandage also creates better coupling between the optical sensor and skin, thereby increasing the optical penetration depth for a given emitter-detector separation. 
         FIG.  26    shows a preferred oxygen saturation and pulse rate trend calculated every second in an 8-hour sleep study collected with a sensor attached to the patient as shown in  FIGS.  18  and  19   , using the system of  FIGS.  20  through  24   . 
         FIGS.  27 A-C  show a preferred signal processing unit and detuning resilient ceramic small-loop SMD antenna circuit schematic and printed circuit board layers (top and bottom) of a disposable, wireless continuous pulse oximeter sensor, in accordance with an embodiment of the inventions. 
         FIGS.  28 A-C  show one of the many alternative ways in which the wireless, disposable, continuous pulse oximeter sensor can be packaged, including a 3-part adhesive tape design, in accordance with an embodiment of the inventions. 
         FIG.  29    shows a preferred exploded view of a wireless, disposable, continuous pulse oximeter sensor with a detuning resilient ceramic small-loop SMD antenna, in accordance with an embodiment of the inventions. 
         FIGS.  30 A-H  depict preferred example steps for attaching the adhesive tape assembly from  FIGS.  28 A-B  to the pulse oximeter assembly-PCB assembly from  FIGS.  27 A-C , in accordance with an embodiment of the inventions. 
         FIG.  31    shows a preferred block diagram of the algorithms that may run on the sensor and the host, according to an embodiment of the inventions. 
         FIG.  32    highlights preferred design tradeoffs in the present inventions which enable the measurement of SpO2, PR, and PI using a small emitter-detector separation while still being able to produce acceptable signal-to-noise ratio figures. 
         FIG.  33    details a preferred design methodology used in the present inventions to quantify the tradeoffs and actions defined in  FIG.  32   . 
         FIGS.  34 A-C  show some of the many additional/alternative modulation schemes that can be used in the present inventions depending on the measurement conditions and blood parameters of interest. 
         FIGS.  35 A-D  show some of the many examples of multi-chip packages with different optical and geometric configurations that may be used in the present inventions. 
         FIGS.  36 A-C  show how distance affects measured perfusion and the process of converting it to a displayed perfusion with levels that are compatible with conventional transmissive oximeters placed on a patent&#39;s digit. 
         FIG.  37    shows the typical workflow, advantages, and technical specifications of a wireless, fully disposable, single-use continuous clinical-grade oximeter (OXXIOM™ ™) according to an embodiment of these inventions. 
         FIGS.  38 - 45    detail the features and workflow of the software that runs in the OXXIOM™ &#39;s host device (i.e, iPhone) so as to process, display, interact, and share the data received wirelessly from OXXIOM™. 
         FIG.  46    shows a sample of a Sleep Study Oximetry Report generated from the trend data for SpO 2 , PR, and PI measured by OXXIOM™. 
         FIG.  47    shows an embodiment of a release liner with XYZ-Axis Electrically Conductive Tape needed to assemble the one-time ON switch that activates OXXIOM™. 
         FIG.  48    depicts a detailed side view of OXXIOM™ with its main components as well as a top view of a few layout examples of electrical contact pads needed to create the one-time ON switch when combined (in the OXXIOM™ assembly) with the release liner shown in  FIG.  47   . 
         FIG.  49    shows several use cases for the OXXIOM™ oximeter aiming at delivering wireless, continuous, low-cost, clinical-grade monitoring solutions in home and hospital settings. 
         FIG.  50    depicts the drawings and technical specifications of OXXIOM™ &#39;s lithium manganese dioxide (Li—MnO2) custom primary (not rechargeable) battery. 
         FIG.  51    shows an embodiment where a fully disposable single-use continuous wireless oximeter is divided into three main parts, in order to enable low-cost and long-term monitoring on a single patient. 
         FIG.  52    shows a flowchart that describes the phases and main steps in OXXIOM™ &#39;s lifecycle when over-the-air firmware upgrade capability is available. 
     
    
    
     DETAILED DESCRIPTION 
     Various embodiments are now described with reference to the drawings, wherein like reference numerals are used to refer to like elements throughout. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of one or more embodiments. It may be evident, however, that certain embodiment(s) of the invention(s) may be practiced without these specific details. In other instances, well-known structures and devices are shown in representative block diagram form in order to facilitate describing one or more embodiments. 
     In the following paragraphs, the present invention will be described in detail by way of example with reference to the attached drawings. Throughout this description, the preferred embodiment and examples shown should be considered as exemplars, rather than as limitations on the present invention. As used herein, the “present invention” or “the invention” or “the inventions” refers to any one of the embodiments of the invention described herein, and any lawfully-covered equivalents. Furthermore, reference to various feature(s) of the “present invention” throughout this document does not mean that all claimed embodiments or methods must include the referenced feature(s). 
     In a preferred embodiment, the present invention provides a wireless, disposable, continuous pulse oximeter sensor having a small footprint, requiring low power consumption and low manufacturing costs, and being monitor-agnostic. Preferably, the wireless, disposable, continuous pulse oximeter provides low power and compact instrumentation electronics, advanced signal processing and estimation algorithms, low-energy wireless communication protocols, and distributed computing as shown in  FIG.  31   . These and other benefits will become readily apparent in the following detailed description of the present invention(s). 
     Persons of ordinary skill in the art will understand that the various elements of the apparatus described herein can be made from a wide variety of suitable materials and processes. Preferably, the sensor of the invention is lightweight and sufficiently durable for its intended purposes, and is compatible with contact with human skin and does not pose any significant health hazard to most or all persons on whom the sensor may by applied. Similarly, the various communication technologies and protocols described herein can be any of a wide variety of suitable systems, preferably providing secure, low-energy, reliable communication between the sensor and other components of the invention(s). 
     In a preferred embodiment of the invention, and as illustrated in  FIG.  1   , the wireless, disposable pulse oximeter sensor assembly  100  is attached to a patient&#39;s measurement site  111  such as a patient&#39;s digit ( FIG.  2 A ), forehead ( FIGS.  2 B and  2 C ), or other site (such as shown in  FIGS.  2 D- 2 F ) from which the sensor can readily access blood perfusion information. In a relatively simple embodiment, the pulse oximeter sensor assembly  100  is comprised of instrumentation electronics  107 , a processor  102 , a radio  103 , adhesive tape, and a disposable battery  109 . The sensor may be attached to a user&#39;s measurement site and turned on by means of a single-use, conductive tape-switch  112 . The sensor assembly  100  may be wirelessly connected to a device  105  such as a smart phone, tablet, desktop or laptop computer, bedside monitor, or similar device so that measurement data may be transmitted from the sensor assembly  100  to the device  105  to be processed and/or displayed and/or stored, for alarms, for electronic medical record data transfer, and/or for data sharing, to name a few uses of the data provided by the sensor assembly  100 . 
     Small Footprint 
     Preferably, the present invention provides a relatively small footprint (size) in its various components. Among other things, smaller size can require less material in manufacturing, improved ease of use, less room required for storage, less costs for transport, and a less intrusive device and instrument for patients&#39; increased comfort and mobility when using the apparatus and methods of the inventions. In a preferred embodiment, the pulse oximeter sensor assembly  100  may contain a small printed circuit board (PCB)  1101  ( FIG.  11   ) comprising a small footprint processor  102  with an integrated radio  103 , a compact integrated circuit  107  containing instrumentation electronics for signal conditioning and LED current driving, and a built-in disposable battery  109  combined with a single DC-DC switched converter  108  to provide the required higher voltage to drive the LEDs  113  and/or a silicon photodiode  114  of the actual optical sensor  110 . The processor  102  and instrumentation electronics  107  preferably are powered directly by the disposable battery  109 . The optical sensor  110  preferably is encapsulated with the PCB by any of a wide variety of suitable apparatus and methods, including (by way of example) by attaching flexible adhesive tapes of various types (optionally combined with PTFE) to the PCB. Persons of ordinary skill in the art will understand that the PCB may be rigid or flexible, or be in the form of a substrate where some or all the components are die attached and wire bonded to the substrate, and encapsulated for protection using epoxy or some other encapsulation material. Further, the sensor element  110  may be attached to the patient  111  using any of a wide variety of suitable apparatus and methods, including (by way of example) by using the adhesive tapes that are part of the sensor  110  encapsulation structure (as described herein). 
     Low Power Consumption 
     In a preferred embodiment of the present invention, low power consumption may be attained using a low-power ARM processor  102  with dual functionality for controlling a wireless low energy radio  103  and instrumentation electronics  107 . Preferably, the sensor element  110  comprises high efficiency LEDs  113  and at least one silicon photodiode (photodetector)  114 , and are arranged in a reflective configuration such that the LEDs  113  and at least one silicon photodiode  114  are physically separated from each other in order to minimize the required LED currents and frontend gains in the instrumentation electronics. Preferably, the instrumentation electronics  107  have very low bias currents and also operate at low voltages. In a preferred embodiment of the invention, ambient light interferences may be avoided or at least reduced by modulating and time-multiplexing the LEDs&#39; currents at a higher frequency in order to shift the spectral content of the generated and detected optical signals to a range in the spectrum where ambient light interferences are less likely to occur. A preferred modulation scheme  3101  as shown in  FIG.  31    may reduce the complexity of the demodulation, decimation, LED current calibration, sensor off patient, error handling and alarms, diagnostics, and communication algorithms shown in sensor algorithm block diagram  3002  running on the sensor processor  102 . In this type of preferred modulation, each LED is kept turned on for approximately 25% of the modulation time cycle (LED duty cycle) Smaller LED duty cycles can be used in order to reduce overall power consumption. The LEDs preferably are kept turned off for approximately 50% of the modulation time cycle. The intervals where the LEDs are turned off can also be increased if the LED duty cycles are to be reduced and if the modulation frequency is kept the same. The preferred two slots where the LEDs are turned off are used to probe and cancel the effects of ambient light. If sophisticated filtering and signal processing are employed in the demodulation scheme in order to recover the optical signals generated by the interplay of the LEDs optical signals and the attenuation caused by the measurement site&#39;s blood perfused tissue, then modulation frequencies as low as 1 KHz can be adopted with signal-to-noise ratio figures similar to medical-grade pulse oximeters. If the preferred low-cost low-power pulse oximeter frontend from Texas Instruments, AFE4403 is used as the instrumentation electronics  107 , then it can be programmed to generate and control directly the required LED modulation scheme without the need for additional resources from the sensor processor  102 . 
     Modulations as shown in  FIG.  34 A  can also be adopted in the case of measurement sites with low perfusion and/or subject to excessive motion.  FIGS.  34 B-C  show some of the possible scenarios where a particular type of modulation would be advantageous. A decision-making process algorithm is depicted in  FIG.  34 B , where the adopted modulation scheme depends on the factors aforementioned. For RED-GREEN-IR modulation shown, green and red LEDs are activated and modulated for a period of time according to the on-off pattern described, and then, the red LED (RED) is replaced with the near-infrared LED (IR) and also modulated for a period of time. This sequence of events repeats itself while the measurement site is subject to motion and/or low perfusion levels. When light in the wavelength range between violet and yellow (i.e., between 400 to 590 nm approximately) is applied to a blood-perfused measurement site, the higher light scattering and absorption seen in this region, create photoplethysmographs that are much larger in amplitude when compared to the ones in the red and near-infrared wavelength regions. Typically, the green wavelength is used because LEDs in this range offer good efficiency and reliability as well as lower cost when compared to other wavelengths in the violet-yellow range. Also, the optical properties of blood in the green region are desirable in terms of scattering and absorption levels. The photoplethysmograph associated with the green LED can be used to improve detection of the heart rate and/or the detection of the red and near-infrared true photoplethysmograph amplitudes and waveforms, which are required for an accurate measurement of the blood&#39;s oxygen saturation under low-perfusion and motion conditions. 
     The Multi-Wavelength Sequential Modulation can be used in case the parameters of interest require other wavelengths in addition to the red and near-infrared LEDs. Examples include the non-invasive measurement of other blood constituents (parameters), such as glucose, for diabetes disease management, water, for body hydration management, total hemoglobin, for anemia and/or blood transfusion management, etc. As shown in  FIG.  34 A , a number of light sources of various centroid wavelengths (i.e., λ1, λ2, . . . , λn LEDs) are turned on and off sequentially over time. In the case of the non-invasive measurement of glucose, multiple LEDs in the range of 900 nm to 1700 nm can be adopted. In the case of the non-invasive measurement of total hemoglobin and/or water, wavelengths in the range of 600 nm to 1350 nm should be sufficient. The spectral ranges defined are sufficient because blood and bloodless components at the measurement site have spectral features that are typically quite distinctive depending on the wavelength sub-range under consideration. For instance, water and glucose have higher absorption in the 1550 nm to 1700 nm range than the other components, the hemoglobin species have pronounced features in the 600 nm to 1350 nm, fat has in general pronounced scattering properties throughout the whole range when compared to other blood components, and so on and so forth. The modulation schemes shown in  FIG.  31    and  FIG.  34 A  can be switched over time depending on the particular application and/or measurement conditions. 
       FIG.  34 C  shows the case of a multi-parameter sensor that continuously measures SpO2, PR and PI, using modulation shown in  FIG.  31   , and/or the RED-GREEN-IR modulation, shown in  FIG.  34 A , and perform lower-frequency periodic spot-check measurements of other blood parameters, such as the ones previously mentioned (i.e., glucose, water, etc.) using the Multi-Wavelength Modulation. Such a topology is possible because typically water, glucose, hemoglobin, etc. concentrations in blood vary slower when compared to SpO2, PR and PI. Because typical measurement periodicity for the said parameters is in general much longer (i.e., once every 30 minutes, once an hour, etc.), the increase in the sensor power consumption is not significant. The additional LEDs and detector technologies (i.e., silicon and indium gallium arsenide photodiodes for the 600 nm to 1700 nm wavelength measurement range) required represent small incremental cost and negligible increase in sensor footprint. 
     The Multi-Wavelength Modulation shown in  FIG.  34 A  can also be used to measure SpO2, PR and PI. In this configuration, the red and near-infrared LEDs are combined with other wavelengths to create “n” photoplethysmographs that could be used to improve SpO2 accuracy or motion performance. Accuracy is improved because additional LEDs throughout the visible and near-infrared range enable estimation algorithms to counter the optical interference effects of other blood and bloodless components not needed in the measurement of oxygen saturation, pulse rate and/or perfusion. Operation under motion is improved because the effects of motion acceleration on the venous and capillary blood creates optical interferences in the measurement site that have distinct morphological features depending on the wavelength range, and hence are more likely to be eliminated from the photoplethysmographs through advanced signal processing. 
     Persons of ordinary skill in the art will understand that the wavelengths and other measurements and ranges discussed herein are generally intended to be representative of certain embodiments of the inventions, and not as delimiting as to the many ways in which the inventions can be practiced. 
     In certain embodiments of the invention, in order to compute SpO2, PR and PI, a distributed computing architecture may be used where SpO2, PR and PI are estimated on the host processor in order to increase the sensor&#39;s battery life as shown in block diagram  3003 . Preferably, the sensor processor  102  may execute the time critical, high frequency, low latency and low complexity tasks. Data processed by the sensor processor  102  may be reduced in bandwidth by decimation algorithms, and sent wirelessly to a host processor  105 . In a preferred embodiment, the host processor  105  may execute more complex, high latency tasks in order to calculate and continuously display the measurement values for SpO2, PR and PI. 
     Another issue related to power consumption has to do with the current levels the LEDs are required to operate. In order to obtain photoplethysmographs with acceptable signal-to-noise ratio, the LEDs must be driven by appropriate current levels that are functions of the optical path between emitter and detector for a given subject state and sensor frontend electronics and signal processing configurations. The larger the optical path, the higher the required LED currents and the deeper the optical penetration. In order to reduce the power consumption by the LEDs, it is desirable to use a very small emitter-detector separation. However, small emitter-detector separations create shallow optical probing and increase the chances of the light generated at the emitter to reach the detector without passing through the tissue&#39;s blood perfused inner layers (light piping). In some preferred embodiments of the inventions, the use of small emitter-detector separation is obtained by using a multi chip package  403 ,  711  such as the SFH7050 from OSRAM Opto Semiconductors as shown in  FIGS.  4  and  7 B  with picture showing it attached to a PCB in  FIG.  13 A , and a bandage that increases the optical coupling between sensor and skin as shown in  FIGS.  25 A-H . The multi chip package SFH7050 has an optically dark background in the emitter-detector gap region, and a small wall separating physically the emitter and detector regions. The tradeoffs involving emitter-detector separation, applied sensor pressure, light piping, photoplethysmograph amplitude, and LED power consumption are shown in  FIG.  32   . 
     An optically “dark” background as discussed herein preferably is a surface that absorbs most of the optical energy received in the wavelength of interest without reflecting it back. It is not only associated with the color of the background but also with the optical and mechanical properties of the chip or multi-chip package background and/or cavities that prevent light from being reflected back to the measurement site for a given wavelength range. This distinction can be important for certain embodiments, because materials that are regarded as opaque in the visible region might not be opaque in the near-infrared region, and vice-versa. Also, mechanical/geometric features of a surface will change the reflective properties of a material regardless of its color. 
       FIGS.  35 A-C  show some of the many configurations of a multi-chip package with optical emitter(s) and detector(s) inside optical cavities. Their components are defined in  FIG.  35 D . In various embodiments, the optical cavity can be filled with a material with optical refractive index closer to the skin in order to improve the sensor-skin optical coupling. In  FIG.  35 A , there are two optical cavities, one for the emitter and one for the detector, with walls that reflects light in order to improve sensor efficiency. Light piping is minimized by introducing an optically dark wall that minimizes the light transmitted directly from the recessed emitter to the recessed detector given their reception/emission cone. In  FIG.  35 B , the same functionality can be accomplished with a single cavity by making its walls optically dark. Another configuration is shown in  FIG.  35 C  where two cavities have their walls optically dark, which offer improved performance in terms of reduced light piping figures. A drawback in the configurations shown in  FIGS.  35 B-C  is the required relative higher LED power levels. However, they enable a reduced distance between emitter and detector for light-piping figures comparable to the configuration in  FIG.  35 A . This, in turn, reduces the required LED power levels given the exponential nature of light attenuation between emitter and detector as a function of the distance (emitter-detector separation). The configuration in  FIG.  35 C  is similar to the one found in the multi chip package SFH7050 OSRAM Opto Semiconductors previously described. 
     The optimal emitter-detector separation and applied pressure range by means of a bandage can be estimated by solving a Photon diffusion problem with boundaries conditions represented by 3D Boltzmann Transport Equations. Finite-element and finite-difference methods can be used to numerically solve the problem for various scenarios and conditions. In the case of the sensor shown in  FIGS.  17 A-B  with LEDs turned on shown in  FIG.  18 F , the optimal emitter-detector separation preferably is between 2.5 to 7 mm. The SFH7050 component preferably has a detector separation of approximately 3 mm and thus is suitable for preferred embodiments of the invention. Pressure ranges created by conventional adhesive bandages preferably are enough to prevent light piping from occurring as well as to substantially increase the photoplethysmograph amplitudes by improving significantly the optical compliance and coupling between the sensor and the patient&#39;s skin. 
       FIGS.  36 A-B  show the typical functional relations (mapping) between perfusion (perfusion index) measured by a conventional transmissive oximeter placed on a patient&#39;s finger or digit (X) and the measured perfusion of a reflective oximeter also placed on a digit (Y) as a function of the emitter-detector separation “d” depicted in  FIG.  36 B . Each curve (i.e., d=d0, d1, or d2) represents a different emitter-detector separation so that d2&gt;d1&gt;d0. In the case of the reduced emitter-detector separations adopted in these inventions, mappings (linear or nonlinear) such as the one shown in  FIG.  36 C  (d0 −1 ) can be used in order to convert the measured perfusion to a displayed perfusion so as to be compatible with the perfusion measured and displayed by a conventional transmissive oximeter placed on a digit. Depending on the measurement site where the reflective pulse oximeter sensor is placed (i.e., temple, arm, leg, digit, etc.), different curves can be used in order to refine conversion between measured and displayed perfusions. 
     Low Manufacturing/Overhead/Maintenance Costs 
     In certain embodiments, the present invention may provide relatively low manufacturing costs, such as by using an integrated sensor solution. Preferably, the sensor assembly  100  may include a reduced number of components and simple encapsulation, thus enabling the use of a simple manufacturing process with reduced number of stages and very high yields. In some embodiments, the inventions can eliminate the need for patient/connection cables/or and proprietary monitors, by use of wireless communication over standard technologies (such as Bluetooth) to a computer (such as a laptop or tablet or smart phone or other device) running an app or other software that can be readily distributed via the Internet or otherwise. The preferred wireless communication in combination with a host device that can be used for processing, storage and data visualization, reduces tremendously the complexity of wireless disposable continuous pulse oximeter sensors.  FIGS.  4 ,  6 , and  27 A -C through  30 A-H show a sensor embodiment with reduced number of components and assemblies. The PCB board  2901  preferably has only 3 small integrated circuits, a multi chip optical sensor package, a SMD antenna, two crystal oscillators, an inductor, and little over 20 passive components including resistors and capacitors. The integrated circuits preferably are a low-cost low-power fixed point ARM processor with Bluetooth Low Energy (BLE) radio from Nordic, NRF51422, a low-cost low-power pulse oximeter frontend from Texas Instruments, AFE4403, and a low-cost high-efficiency boost converter from Texas Instruments, TPS61220. The other components required to assemble the full sensor preferably are a lithium manganese dioxide battery  2902 , and a set of 3 adhesive tapes  2903 ,  2904 ,  2905  as shown in  FIG.  29   , totaling 5 component assemblies if we consider the assembled PCB board  2901  ( FIG.  29   ) as a single component assembly. Given its simplicity, it is expected that the total manufacturing cost of a wireless disposable continuous pulse oximeter sensor unit with the above description may be comparable to the total manufacturing cost of conventional wired disposable oximeter sensors, especially on scales of production for 1 million or more sensor units manufactured yearly. Given its preferred relatively small footprint, the inventions can be packaged and used in a wide variety of useful situations and applications. 
     Preferably, the inventions are practiced in embodiments that reduce their power consumption. For example, regarding “continuous” pulse oximeter monitoring, according to the Nyquist—Shannon sampling theorem, one can define the lowest sampling frequency for a parameter trend as a number strictly greater than twice the highest frequency component of the parameter trend. Thus, under that theorem, if a parameter trend has spectral content of interest with no frequencies higher than F Hertz, then the said trend can be completely recovered by a series of measurements that are spaced by no more than the 1/( 2 F) seconds. In this way, the same information conveyed by a “continuous” trend can be provided by its sampled trend counterpart provided that the sampling obeys the Nyquist-Shannon sampling theorem. Such approximation of continuous parameter trends by sampled ones allows the sensor to save power since its hardware can be partially or totally turned off between measurements. It also reduces the wireless bandwidth required to transmit the said trends, which in turn not only reduces consumed power, but also enables for the same radio power levels a longer sensor-to-host distance. 
     Monitor Agnostic 
     Preferably, and as indicated above, the present invention may be used with a wide variety of monitors. In a preferred embodiment, a wireless connection between the sensor and a host device (e.g., monitor), combined with portable algorithms for processing, displaying, etc. the measurements of SpO2, PR and PI, may enable the use of several types of monitors (e.g., smartphones, tablets, desktop and laptop computers, bedside monitors, etc.) with the sensor assembly  100 . This feature may give a healthcare provider the freedom and flexibility to choose the monitoring solution that best fits their needs in terms of cost and functionality and immediate circumstances of the patient, among other factors. 
     Referring further now to the drawings,  FIG.  1    shows a block diagram for a disposable, wireless pulse oximeter sensor  100 , according to a preferred embodiment of the invention. As shown in the figure, the sensor  100  includes a main processor  102 , such as the ARM Cortex M0 processor from Nordic Semiconductors. The processor may control a low energy radio  103 , through a Bluetooth connection, for example. The sensor  100  may be wirelessly connected  104  to a host device  105  such as, but not limited to, a laptop computer, desktop computer, smart tablet, smart phone, smart watch, wireless appliance, etc. In a preferred embodiment of the invention, a cloud connection  106  may connect to the host device  105  for storage, processing, and visualization of the data. In alternative embodiments (not shown), the sensor  100  itself may connect to the cloud, without the intermediate application software and/or hardware and/or steps of a host device  105 . The Internet Protocol Support Profile (IPSP) from the Bluetooth SIG and 6LoWPAN technology from the Internet Engineering Task Force (IETF), for instance, can be used to enable the sensor  100  with radio  103  to communicate with the Internet and cloud servers as well as other wireless sensors directly. 
     Referring back to the pulse oximeter sensor  100  components, the sensor  100  may include an integrated circuit  107 , such as Texas Instruments&#39; AFE4403, comprising a photodiode frontend, LED drivers, and control logic. Further, a DC-DC boost converter  108  may preferably power the LED driver circuit. Preferably, the sensor  100  may be powered by a disposable, long-lasting battery  109  such as a lithium manganese dioxide battery. An optical sensor  110  may include red and near-infrared LEDs and silicon photodiodes, such as the multi-chip package sensor SFH7050 available from OSRAM. Persons of ordinary skill in the art will understand that the number of chips for the optical sensor for any given embodiment of the inventions can be selected depending on costs and other factors. Red and near-infrared LEDs  113  and a silicon photodiode  114  may direct light onto a patient&#39;s measurement site such as a fingertip  111 . Preferably, a single-use ON switch  112  may be made from conductive adhesive copper foil tape. 
       FIG.  2 A  shows some of the many alternative embodiments of wireless, disposable, continuous pulse oximeter sensors attached to a patient&#39;s digit. In the figure, each pulse oximeter sensor uses a different adhesive tape layout, such as those depicted in  FIGS.  2 G and  2 H , respectively. Specifically, pulse oximeter  203  is attached to a patient&#39;s fingertip  202  using a flat adhesive bandage  205  encapsulated in a PTFE pocket  206 , as shown in  FIG.  2 G . A sensor  207  on the underside  208  of the pulse oximeter  203  may contact the patient&#39;s skin when the underside  208  is adhered to the patient&#39;s skin. In some of the many alternative embodiments of the inventions such as those shown in  FIGS.  2 H through  2 L , an adhesive bandage or tape  204  may be used to attach the pulse oximeter  203  to a patient&#39;s digit, or other measurement site. 
     The pulse oximeter of the present invention may be attached to any one or more of a range of suitable alternative measurement sites, including without limitation a patient&#39;s temple ( FIG.  2 B ), forehead ( FIG.  2 C ), neck ( FIG.  2 D ), and/or wrist ( FIGS.  2 E and  2 F ). 
     In  FIG.  3   , a pulse oximeter similar to the one shown in  FIG.  2 G  is shown in a cross-section view, depicting one of the many ways of fabricating a stack-up of the various components of a wireless, disposable, continuous pulse oximeter  300 . A PTFE encapsulation pocket  310  may house the components of the pulse oximeter  300 . From top-down, the pulse oximeter may include: an antenna  309 , a battery  308 , a printed circuit board (PCB)  301  and PCB components  302 , and an optical sensor  303 . For attachment to a patient&#39;s measurement site such as a fingertip, the pulse oximeter  300  may include PCB-to-skin adhesive layer and multiple biocompatible adhesive layers  305 ,  306 . A release liner  307  may be disposed between the adhesive layers  304 ,  305 ,  306  such that when the release liner is pulled, it exposes the optical sensor  303  and the adhesive layers  304 ,  305 ,  306  for attachment to a patient&#39;s measurement site. 
       FIG.  4    shows an example of one of the many suitable frontend circuit schematics of a wireless, disposable, continuous pulse oximeter sensor, according to an embodiment of the invention. The pulse oximeter sensor may include an integrated circuit  402  such as the AFE4403, or the AFE4490 circuits available by Texas Instruments, including a photodiode frontend, LED drivers, and control logic. An optical sensor  403  such as the SFH7050 sensor available by OSRAM, may include red and near-infrared LEDs and silicon photodiode. 
       FIG.  5    shows a signal processing unit and antenna circuit schematic of a wireless, disposable, continuous pulse oximeter sensor, according to an embodiment of the invention. The pulse oximeter may include a main processor  502  such as the ARM Cortex M0 processor available from Nordic Semiconductors. Further, the pulse oximeter may include a 16 MHz crystal oscillator  503 , a 32.768 kHz crystal oscillator  504 , a 2.45 GHz impedance balloon filter (single to differential)  505 , and antenna feed  506 . 
       FIG.  6    shows a power management circuit schematic of a wireless, disposable, continuous pulse oximeter sensor, according to an embodiment of the invention. Preferably, the power management circuit of the pulse oximeter may include: a boost convertor  602  such as TPS61220 from Texas Instruments, a ferrite inductor  603 , boost converter voltage setting resistors  604 ,  605 , debug pads  606  for the main processor, noise rejection pull down resistor  607 , battery voltage terminals  608 , ON switch pads (single use)  609 , and voltages for the main processor and integrated circuit  610 ,  611 ,  612 ,  613 ,  614 . 
       FIGS.  7 A-D  depict printed circuit board layers of a disposable, wireless pulse oximeter sensor, including: antenna feed  701 , main processor  702 , integrated circuit  703 , boost converter  704 , crystal oscillators  705 ,  706 , ferrite inductor  707 , battery voltage terminals  708 , ON switch pad  709 , debug pads  710  for main processor  702 , optical sensor  711 , and antenna “keep out” areas  712 ,  713 . 
       FIGS.  8 A-B ,  9 A-B, and  10 A-B show a 3-part adhesive tape design, according to some of the many various embodiments of the present invention. As mentioned above, persons of ordinary skill in the art will understand that the dimensions and shapes shown in these and other drawings are not intended to be delimiting of the many different embodiments in which the inventions can be practiced. Instead, the dimensions and shapes are only intended to be illustrative of one of the many ways in which the inventions may be practiced. 
       FIG.  8 A  shows an encapsulation tape design, and  FIG.  8 B  shows the corresponding tape stack-up. As shown in the figures, an encapsulated tape design may include a single coated foam medical tape  800  with a biocompatible foam backing  801 . A window  802  and through hole  803  may be cut out of the encapsulation tape  800 . The liner may include cuts  804  which do not extend through to the adhesive tape layers in order to facilitate the attachment of tab  900  to the encapsulation tape  800 . 
       FIG.  9 A  shows a tape design that enables the circuit board to be “turned on” or activated by the clinician or user at the time of use, and  FIG.  9 B  shows the corresponding tape stack-up. In a preferred embodiment, the present invention includes a tab  900  comprising a copper foil  901  and conductive adhesive which are used to activate an ON switch. A release liner  902  may be gripped by the clinician and/or user and peeled back via tab  900 , thereby exposing the conductive adhesive shown in  904  and completing and activating the circuit (and the battery power to the sensor  110  and other components of the sensor assembly  100 ). Thus, preferably the clinician or user at the time of use pulls tab  900  in order to activate the sensor assembly  100 . Persons of ordinary skill in the art will understand that any of a wide range of suitable switches can be fabricated and/or used to practice the inventions. 
     For the assembly  100  to work in its preferred manner, it must be positioned and held in contact on the patient&#39;s skin  111 . An example of one of the many ways in which this can be accomplished is illustrated in  FIG.  10 A , which shows a tape design that enables skin-to-device adhesion. A corresponding stack-up is shown in  FIG.  10 B . As shown in the figures, a double coated biocompatible tape  1000  may be provided and include: a first liner layer  1001 , a first adhesive layer, a carrier layer, a second adhesive layer, and a second releasable liner layer  1002 . 
       FIG.  11    shows an exploded view of a disposable, wireless pulse oximeter, according to an embodiment of the inventions. Persons of ordinary skill in the art will understand that certain components in  FIG.  11    correspond to those discussed above. Preferably, the present inventions include a printed circuit board (PCB)  1101 , a disposable, lithium manganese dioxide battery  1102 , a wired loop antenna  1103 , an encapsulated adhesive tape  1104 , a conductive adhesive tape assembly  1105 , and double-layer adhesive tape assembly  1106 . 
       FIG.  12    shows one of the many embodiments of the ways in which the inventions can be practiced, including a loop antenna and battery soldered to a pulse oximeter printed circuit board (PCB). 
     Related  FIGS.  13 A-B  show one of the many embodiments of the ways in which such a battery and antenna can be folded onto a PCB to give shape to the pulse oximeter-PCB assembly  100 . 
     Persons of ordinary skill in the art will understand that the inventions can be fabricated and assembled in a wide variety of suitable ways.  FIGS.  14 - 19    illustrate one of the many such ways, including by using some of the elements discussed above, to provide a compact and easy-to-use wireless, disposable, continuous pulse oximeter that preferably can be used for an extended period of monitoring physiological data from a patient. In the eventual assembly described and shown in the accompanying drawings, all that is required for end use of the sensor assembly  100  is to remove a tab “1” to activate the assembly, and then remove a tab “2” to expose an adhesive that then is pressed to the patient&#39;s skin (persons of ordinary skill in the art will understand, for example, that removing tab “1” in  FIGS.  18 A and  18 B  preferably establishes electrical contact across the copper foil and conductive adhesive  901  of  FIG.  9 A / 9 B and thereby between the corresponding terminals  1301  in the upper right of  FIG.  13 A , preferably activating the light on the sensor  110  as shown in  FIGS.  18 F and  18 G . 
     For example,  FIGS.  14 A-D  show the adhesive tape from  FIGS.  9 A-B  being attached to the adhesive tape depicted in  FIGS.  8 A-B .  FIGS.  15 A-J  depict the steps for attaching an adhesive tape assembly from  FIGS.  14 A-D  to a pulse oximeter assembly PCB assembly from  FIGS.  13 A-B .  FIGS.  16 A-B  show attachment of the adhesive tape from  FIGS.  10 A-B  to the assembly from  FIGS.  15 A-J .  FIGS.  17 A-B  show the wireless disposable pulse oximeter fully assembled.  FIGS.  18 A-H  show the steps necessary to turn on and attach the wireless disposable pulse oximeter to a body appendage (e.g., fingertip), according to an embodiment of the inventions.  FIGS.  19 A-B  show a wireless, disposable pulse oximeter sensor attached to a user&#39;s measurement site (e.g., fingertip). 
     Persons of ordinary skill in the art also will understand that the data monitored and transmitted from the assembly  100  can be used and displayed and/or stored in a wide variety of useful and beneficial ways. The example of  FIG.  20    depicts the wireless, disposable pulse oximeter connected to a laptop computer via Low-Energy Bluetooth wireless protocol. In a preferred embodiment, red and near-infrared waveforms are sent to the laptop for processing, visualization, and storage.  FIG.  21    shows the photoplethysmographs for the red and near-infrared wavelengths.  FIG.  22    shows the red and near-infrared data waveforms sent from the disposable wireless pulse oximeter to the laptop computer.  FIG.  23    shows two bars (one for the red and one for the near-infrared wavelength) depicting the light emitting diode (LED) currents and the internal gains of pulse oximeter frontend being set in order to maintain the frontend&#39;s dynamic range around 40% of its full range value.  FIG.  24    shows a snapshot of the SpO2, perfusion and pulse rate measurements performed by the algorithms running in the disposable wireless pulse oximeter and laptop computer. 
     Persons of ordinary skill in the art will understand that the details of the apparatus and methods for maintaining the relationship between the sensor assembly  100  and the digit  111  or other location on the patient can be any of a wide variety. One simple and very useful arrangement is depicted in  FIGS.  25 A-H , which show a preferred wireless, disposable, continuous oximeter sensor wrapped by a disposable adhesive bandage in order to further protect the pulse oximeter from environmental conditions and further avoid dislodgment of the device from the patient location/site, such as for applications that require relatively longer term use and/or are subjected to accentuated motion and/or physical activity by the patient or otherwise. The bandage preferably improves the optical compliance and coupling between sensor and skin thereby increasing the perfusion and measured photoplethysmograph amplitudes.  FIG.  32    shows the effects and tradeoffs of applying pressure to a wireless disposable continuous pulse oximeter sensor as shown in  FIGS.  25 A-H  by means of a bandage. 
       FIG.  26    shows a preferred oxygen saturation  2601  and pulse rate  2602  trend calculated every second during an 8-hour sleep study collected with the sensor attached to the patient as shown in  FIGS.  18  and  19    using the system of  FIGS.  20  through  24   . The sensor was wrapped using an adhesive bandage as shown in  FIGS.  25 A-H  in order to create additional pressure to improve optical coupling between optical sensor and the patient&#39;s skin and also to prevent the sensor from coming off from the patient&#39;s digit during sleep. The changes in pulse rate  2602  and oxygen saturation  2601  are due to the various sleep stages that the patient experienced during the night. 
       FIGS.  27 A-C  show a preferred signal processing unit and detuning resilient ceramic small-loop SMD antenna  2702  (such as the model 2450AT18D0100 from Johanson Technology) and circuit  2701  schematic and printed circuit board layers (top and bottom) of a disposable, wireless continuous pulse oximeter sensor. Preferred ceramic small-loop antennas  2702  offer robustness in performance near the human body and have a smaller footprint when compared to conventional loop antennas. 
       FIGS.  28 A-C  show one of the many alternative ways in which the wireless, disposable, continuous pulse oximeter sensor can be packaged, including a 3-part adhesive tape design. For the embodiment illustrated in  FIG.  28 A , the encapsulation tape design has two additional tabs when compared to the one in  FIG.  8 A  in order to increase encapsulation robustness. It is designed to be attached to the printed circuit board with small-loop antenna shown in  FIGS.  27 A-C . The tape design that enables the circuit board to be turned on by the clinician or user at the time of use is detailed in  FIG.  28 B  and the tape design that enables skin-to-device adhesion is shown in  FIG.  28 C , respectively. Persons of ordinary skill in the art will understand that the dimensions and shapes shown in these and other drawings are not intended to be delimiting of the many different embodiments in which the inventions can be practiced. Instead, the dimensions and shapes are only intended to be illustrative of one of the many ways in which the inventions may be practiced. 
       FIG.  29    shows an exploded view of a preferred wireless, disposable, continuous pulse oximeter sensor with a detuning resilient ceramic small-loop SMD antenna. As illustrated,  FIG.  29    includes embodiments of the apparatus shown in  FIGS.  28 A  (element  2903 ),  28 B (element  2904 ), and  28 C (element  2905 ),  27 A-C (element  2901 ) and lithium manganese dioxide battery (element  2902 ). 
       FIGS.  30 A-H  depict preferred example steps for attaching the adhesive tape assembly of  FIGS.  28 A-B  to the pulse oximeter-PCB assembly of  FIGS.  27 A-C .  FIGS.  30 A-H  highlight preferred additional steps required in the attachment of adhesive tape from  FIG.  28 A  given its additional tabs when compared to the one in  FIG.  8 A . 
       FIG.  31    shows a preferred block diagram of the algorithms that may run on the sensor and the host. The wireless, disposable, continuous pulse oximeter sensor may run the LED driver algorithms (i.e., LED modulation, LED current calibration), the frontend algorithms (i.e., demodulation, decimation) and the supervisory algorithms (i.e., sensor off patient, diagnostics, communication, error handling and alarms). The host device may run the backend algorithms (i.e., oxygen saturation and pulse rate, perfusion index) and supervisory algorithms (i.e., communication, storage, display and data sharing, error handling and alarms). The LED modulation algorithm may produce signals similar to the waveform shown in the upper right where the red and near-infrared LEDs would be turned on and off sequentially and periodically. 
       FIG.  32    highlights the preferred design tradeoffs in the present inventions which enable the measurement of SpO2, PR, and PI using a small emitter-detector separation while still being able to produce acceptable signal-to-noise ratio figures. Action  1  (decreasing emitter to detector separation) decreases required LED optical power but requires actions  2  (making emitter-detector gap region optically dark) and  3  (applying slight pressure to sensor by means of adhesive bandage) in order to counteract its undesirable effects (i.e., increase in the likelihood of light piping, reduction in the optical probing depth, reduction in the photoplethysmograph amplitude). 
       FIG.  33    details the preferred design methodology used in the present inventions to quantify the tradeoffs and actions defined in  FIG.  32   . A physiology model defines the target ranges and condition where the sensor must work within specifications. By solving 3D Boltzmann Transport equations with boundary conditions and applying the results to LED driver, frontend and backend models, it is possible to predict the sensor performance and make changes (if necessary) in the geometry and optical models in order to ensure all specifications are met by the sensor design. 
       FIG.  37    shows a typical workflow of a disposable, wireless single-use pulse oximeter (OXXIOM™), its advantages and technical specifications according to an embodiment of the inventions. The front  3701  and back  3702  views of the device are displayed highlighting its front identification label, and tabs 1 and 2. In order to apply the device to a patient, one needs to pull tab 1  3703  to turn on the device, and then pull tab 2  3704  to expose the adhesive tape. The device can be placed on the patient&#39;s digit  3705 , temple  3706 , or any other well-perfused site on the patient&#39;s body. OXXIOM™ connects wirelessly to the host device, which can be a laptop device  3707 , a mobile device  3708 , or any other device that has built-in Bluetooth Low Energy (BLE) radio, or similar technology. After use, OXXIOM™ can be disposed or recycled  3709 . A typical OXXIOM™ recycling workflow process would follow the following steps:
         1. Caregiver or user (buyer) buys OXXIOM™ device(s);   2. Caregiver/user collects used OXXIOM™ devices in batches and ships them to an OXXIOM™ recycling facility;   3. The recycling facility sterilizes the received OXXIOM™ product batches, typically using Chlorine Dioxide (CD) gas. Ethylene Oxide (ETO) sterilization is also suitable. However, in the case of ETO, it is recommended to remove the OXXIOM™ disposable battery soldered to the OXXIOM™ PCB prior to sterilization. The vacuum required by the ETO sterilization process may not be acceptable for embedded batteries such as the disposable lithium manganese dioxide battery preferably used in OXXIOM™.   4. A new battery is soldered to each reprocessed OXXIOM™ PCB and the electronics and built-in optical sensor are tested so as to ensure the same accuracy as a new OXXIOM™ device.   5. A new encapsulation is applied to the OXXIOM™ PCB-battery assembly and the assembled units are packaged and made ready for shipment. The caregiver/user receives a discount on the purchase of a new or reprocessed OXXIOM™ unit for each OXXIOM™ unit successfully recycled.       

       FIG.  37    describes the advantages that OXXIOM™ offers to patients, users, and healthcare providers. Preferably, the disposable, extended use, wireless pulse oximeter device according to an embodiment of the invention has several competitive advantages when compared to conventional, wired, extended use pulse oximeters. 
     Firstly, for patients and users, the present invention:
         1. Reduces risk of infection and cross contamination;   2. No risk of being exposed to the residue of chemical sterilants;   3. Ease of use, convenient, comfortable, allows freedom of movement;   4. Small, lightweight, water resistant.       

     Further, for healthcare providers, the present invention:
         1. Is single use, fully disposable, wireless;   2. No need to clean/sterilize;   3. No electricity required (under-developed countries, war zones, epidemic areas, etc.);   4. Eliminates failures due to equipment wear and tear;   5. Reduces Healthcare Associated Infections (HAI);   6. Minimal inventory footprint;   7. Easy to stock and transport;   8. Reduction in hospital and Ambulatory Surgical Center (ASC) operations and maintenance costs;   9. Simple workflow;   10. No risk of obsolete equipment.       

     In addition to the aforementioned advantages, the disposable, wireless pulse oximeter (OXXIOM™) technology, according to an embodiment of the inventions, provides significant capital and operating expenditure reductions for clinics and institutions that conduct sleep studies on patients in order to diagnose sleep-related disorders, such as obstructive, central, child, infant sleep apneas, snoring, sleep related groaning, etc. Typically, with reusable, wired technologies, the reusable device and disposable (reusable) sensor are shipped to the patient&#39;s house so as to collect data overnight. The collected data is later sent to the clinic for post-processing, analysis and diagnostics. Once the test is complete, the patient needs to ship the pulse oximeter back to the clinic so as to be sterilized and repacked for the next patient. The shipping and sterilization steps increase operating costs, and also increase workflow complexity. In addition, the clinic needs to have in stock enough reusable pulse oximeters to be able to supply test demands, which increase the capital investments required to operate. Currently, a typical continuous, clinical-grade, wired pulse oximeter costs, on average, approximately 50 times the price of an OXXIOM™ unit (as depicted in  FIG.  37   ) depending on the model and functionalities. A clinic performing 1000 tests a month, for instance, would need at least 125 reusable oximeters in order to keep up with test demand, if one assumes that it takes one day to ship the device to the patient&#39;s house, one day to conduct the test, one day to ship the device back to the clinic, and one day to have the device sterilized and sent to another patient&#39;s house, which would allow a device to be used twice a week, or eight times a month at most. This implies that the clinic would need capital investments in reusable oximeters of approximately 6250 times the price of an OXXIOM™ unit, in addition to costs incurred in shipping, processing, and sterilization. This would translate into approximately 6 months worth of testing, with operating expenses reduced by the savings with sterilization, processing, and at least half of the shipping costs. In addition, no new capital expenditures would be needed for expansion/upgrades. 
     According to the technical specs in  FIG.  37   , OXXIOM™ is small (30×17×7.5 mm) and lightweight (3.5 g), has clinical-grade performance as defined in ISO 80601-2-61, is fully disposable and wireless. As a result, it offers advantages in terms of comfort and convenience in applications where sterility, workflow, and sensor size/weight are a concern. Such is the case on the monitoring of infants and neonates. Infants and neonates should be constantly monitored during the first hours (days or weeks) of birth. A device like OXXIOM™ can be conveniently applied to the foot (neonate) or the right hand (normal infant), allowing the caregiver to have complete and free access to the baby without being concerned about the size and weight of the cables and sensor that conventional wired continuous oximetry requires. This allows the caregiver to move the infant around as needed without carrying a wired monitor or checking whether the pulse oximeter cable is of adequate length to reach onto infant. 
       FIGS.  38 - 45    show screen shots of an app that runs on a host device (iPhone) that pairs with OXXIOM™. The OXXIOM™ device (sensor) has been designed and manufactured according to an embodiment of the inventions.  FIG.  38 A-B  show app icon  3801  and startup screen  3802 .  FIG.  39 A  shows the measurement screen indicating that OXXIOM™ is not connected to the host device  3903 .  FIG.  39 B  shows the pop-up options  3901  that are made available to the user once the side drawer  3902  is selected. The “Start” option gives place to the screen shown in  FIG.  40 A , which allows the user to enter the OXXIOM™ barcode, patient ID barcode, gender and date of birth. By selecting “Scan it”  4001 , the barcode scanner screen is displayed (as shown in  FIG.  40 B ), which allows the user to scan the OXXIOM™ barcode to enable a secure Bluetooth pairing between the host device and OXXIOM™ or to scan the barcode that identifies the patient (as shown in  FIG.  41 A ). The barcode scanner support several types of barcode formats, including QR, UPCE, Code39, Code39Mod43, EAN13, EAN8, Code93, Code128, PDF417, Aztec, Interleaved2of5, ITF14 and DataMatrix. Other forms of secure pairing can also be used such as the Bluetooth pairing using the Near Field Communication (NFC) Protocol.  FIG.  41 B  shows the resulting screen after the barcodes are scanned and the patient&#39;s gender and date of birth are inputted. 
       FIGS.  42 A-B  depict the SpO2, PR and PI measurements and trend data, and waveforms  4203  being displayed by the host device after OXXIOM™ is placed on the patient and paired with the host device (iPhone). For each parameter displayed, a numerical display  4201  combined with a linear gauge indicator  4202  are provided. When the host screen is turned into landscape mode, data trends  4204  are also displayed. The parameter in boldface font (i.e., SpO2) on the left indicates the current trend data being displayed on the right. To change the trend data (i.e, PR) on the right, just select the corresponding numerical display on the left as shown in  FIG.  43 A . In the case of an alarm indicating that a parameter is outside of its normal range, the corresponding numerical display and linear gauge will turn into red color and an audible alarm will be triggered so as to alert the caregiver about a potential abnormal patient condition. In order to ensure the caregiver receives the alarm notification, if the remote notification option is enabled, the host device will send a text message and an email to the caregiver notifying him or her about the abnormal patient condition. In this case, the text or email message will contain the patient identification (ID, gender, date of birth) and location, as well as the current parameter readings and alarm settings. 
     The “Settings” option, when selected from the side drawer, gives place to the screen shown in  FIG.  43 B . In this screen, one can select the data trend duration (2, 5, 10, 30 or 60 minutes), how long the trend data will be saved (last 24 or 48 hours), and upper and lower SpO2 and PR alarms, which can have their values changed through sliding switches  4301   4302   4303   4304 . In this same screen, there is a field named Alarm Notifications  4305 , wherein one can enter the phone number(s) of caregiver(s). In case an alarm is trigged, a text message as described anteriorly is sent to the caregiver(s) via the phone number inputted on “Text #” field  4306 . 
       FIGS.  44 A-B  and  45  show an example of how trend data can be shared. The “Share Data” option, when selected from the side drawer, gives place to the screen shown in  FIG.  44 A . The user can then choose the file format  4401  (i.e, table or database), and once the user selects “Share”  4402 , the screen depicted in  FIG.  44 B  is made available to the user. In this screen the file with the selected format is attached to an email. In this case, the user selected the table format, and as a result, a Comma Separated Values (CSV) file was attached to the email message. The user then inputs the receiver&#39;s email and select “send” to have the email message delivered to the receiver. There are several possible sharing options, including cloud sharing, where a file is sent to a cloud storage service that can then be accessible by designed receiver(s). It is also possible to have short-range peer-to-peer sharing via WiFi or Bluetooth, such as the AirDrop® ad-hoc service from Apple, Inc. This service allows the transfer of trend data files without using email or mass storage devices. 
       FIG.  45    shows the content of a CSV file with trend data. Each row represents a single measurement record, with a time stamp (Date/Time), OXXIOM™ barcode, patient&#39;s ID #, Gender and DOB (Date Of Birth), and the SpO2, PR and PI measurements. The user has selected, in the “Settings” screen depicted in  FIG.  43 B , a 48-hour trend data storage, and thus, a measurement record is saved to the CSV file every 8 seconds. If the user had selected 24-hour trend data storage, then a measurement record every 4 seconds would be saved to the CSV file. These sampling rates ( 1  measurement every 4 or 8 seconds) are suitable to most clinical applications that perform trend data analysis for SpO2, PR and PI. There are other applications, however, where higher sampling frequencies might be required. OXXIOM™ can be configured to save measurements at a higher sampling frequency, such as one measurement record per second. The drawback is that the size of the trend data file to be shared increases proportionally with the sampling frequency. 
     In some applications, such as sleep studies, it is convenient to have also a oximetry report where statistical analysis is performed on the saved trend data.  FIG.  46    shows an example of a Sleep Study Oximetry Report that OXXIOM™ can share with recipient(s) (i.e., caregiver(s)). The report has a header with the basic patient identification, the OXXIOM™ barcode, date of the study and total recording time of the trend data. The three columns below the header show some statistical results related to each parameter measured during the study (i.e, SpO2, PR, and PI). As can be seen from the results shown in the report, the patient was subject to several desaturations ( 40 ) during sleep, and her saturation levels reached a minimum value of 70%. These results combined with the average, median, standard deviation, maximum, and minimum SpO2 and PR values, percentage of SpO2 values below 90%, 80%, and 70%, and maximum desaturation value and duration can help the physician diagnose potential patient&#39;s sleep-related disorders. The statistics about PI (Perfusion Index or Pulse Strength) in the report may also aid the physician to access the patient&#39;s level of comfort during the study. Very low PI values (when compared to the average or median PI values) may indicate, for instance, that the patient was feeling cold during the study, and this may have a negative effect on the observed results. 
       FIG.  47    is a detailed view of a liner tab with XYZ-axis electrically conductive tape used to implement an one-time ON switch (required to activate OXXIOM™) with dimensions and design identical to the one shown in  FIG.  28 B , with the exception that the electrically conductive tape changed from a copper foil layered with conductive adhesive to a XYZ-axis conductive adhesive without copper foil. In  FIG.  48   , this liner tab  4801  is attached to the OXXIOM™ Encapsulation  4810 . In order to activate OXXIOM™, the liner tap is pulled by the user so as to allow the electrically conductive tape  4802  to close the gap  4807  between the electrical contacts  4803 , and thus enabling the circulation of electrical current from the internal battery  4808  to the PCB  4809  electronic circuits. The use of highly conductive adhesive tapes such as the 3M  9713  eliminates the need for a conductive material (such as copper) to be layered together with the conductive tape as in one embodiment shown in  FIG.  28 B . This simplifies the one-time ON switch design. The two electrical contacts can be designed in several shapes and forms. In  FIG.  48   , three layout examples are shown for the contacts, a 2-pole configuration  4804 , a parallel-plate configuration  4805 , and a spiral configuration  4806 . The spiral and parallel configurations are advantageous compared to the 2-pole configuration in the sense that the gap boundaries (parallel lines between the two electrical contacts) are increased substantially for the same area of contact, which in turn reduce the overall contact resistance of a conductive adhesive tape applied on top of such surface layouts. This concept is illustrated with a 2-pole configuration with an extended gap boundary  4811  and its equivalent parallel-plate configuration  4812 . The 2-pole configuration  4811  requires a larger contact length in order to accommodate the same gap boundaries as the parallel-plate configuration  4812 . The reason why the contact resistance of the one-time ON switch (created when conductive adhesive tape is applied on top of such gap boundaries and contacts) is reduced as the gap boundary increases, while maintaining the same contact gap, has to do with the physical principle of electrical current circulation in parallel circuits. The conductive adhesive tape adhering the two contacts over the contact gap can be modeled as a resistor with value proportional to the gap size and inversely proportional to the contact size area and gap boundaries. By increasing the gap boundaries, one is effectively decreasing the contact resistance because this is electrically equivalent to adding more resistors in parallel throughout the gap boundaries, or adding more conductance per unit of gap boundary length, which in turn has the net effect of reducing the overall contact resistance of the one-time ON switch. The 2-pole configuration is a simpler and more robust design, even though it might offer a higher contact resistance. However, a careful selection of the appropriate separation between the two contacts (gap), combined with the use of a highly conductive tape may offer a simpler and also reliable solution. 
       FIG.  49    outlines some use-case scenarios for the OXXIOM™ device. For a hospital facility  4901 , OXXIOM™ units applied to patients are connected to the hospital network cloud services  4902 . The hospital, in this example, comprises of three different physical locations. The first location houses the computer servers running the cloud services  4902   4907 . The second houses the pediatrics unit, and the third, the surgery, recovery, and ICU units. These three locations are connected to the Internet via optical links in order to enable reliable connections and data throughputs. In the pediatrics unit, one OXXIOM™ unit  4903  is placed on a newborn. In this configuration, the OXXIOM™ communicates via Bluetooth Smart (BLE) protocol with a mobile/portable device  4904 . The host device sends information (i.e., measurements, waveforms, patient identification, alarms, etc.) to the hospital network via WiFi protocol through a router  4905 . The use of a mobile device  4904  provides great freedom to the caregiver as the newborn is moved around to be weighted, measured, and have its vital signs checked and physiology examined, since no wires are attached to the newborn and OXXIOM™ is very small and lightweight, while at the same time, provides real-time measurements of SpO2, PR, PI, waveforms and trend data. The other OXXIOM™ unit  4906  in the pediatrics unit is applied to a neonate. In this case, OXXIOM™ communicates wirelessly with a router  4905  using IPV6 (Internet Protocol Version 6) over Bluetooth Smart protocol. No host device is needed and the waveforms and OXXIOM™ diagnostics (battery current charge, connection status, patient identification, etc.) are sent to the OXXIOM™ Cloud Service  4907 . The waveforms and OXXIOM™ diagnostics are then processed in real-time by the OXXIOM™ Cloud service in order to calculate SpO2, PR, and PI measurements, trend data, and generate alarms if needed. This information is stored in the hospital network  4902  and conveyed to the caregivers through their mobile/portable devices. The surgery unit has an OXXIOM™  4909  (attached to a patient under surgery) that communicates wirelessly with a router  4911  using IPV6 over Bluetooth Smart protocol. The waveforms and OXXIOM™ diagnostics are sent to the OXXIOM™ Cloud Service  4907  via router  4911 . The waveforms and OXXIOM™ diagnostics are then processed in real-time by the OXXIOM™ Cloud service in order to calculate SpO2, PR, and PI measurements, trend data, and generate alarms if needed. This information is stored in the hospital network  4902  and sent (via router  4911 ) wirelessly to a multi-parameter monitor  4912  located in the same surgery unit and being used by the surgeon(s) and anesthesiologist(s) to monitor and display in real-time information about the patient under surgery (i.e., SpO2, PR, PI, waveforms, respiration rate, ECG, EEG, etc.). Similar wireless topology concepts are shown in the recovery  4913  and ICU  4914 . The selection of an OXXIOM™ configuration that requires or not a host device depends on a number of factors including safety levels, cost, and convenience. For hospital applications where the wireless network is not reliable, a mobile (or multi-parameter monitor) acting as the host device and wirelessly connected to OXXIOM™ via BLE would be preferable. When a reliable wireless network is available, or when short measurement interruptions are not of critical importance, then the operation of OXXIOM™ without a host device and connected directly to a router via IPV6 over Bluetooth Smart could be financially advantageous, and could simplify OXXIOM™ workflow (insomuch as it eliminates the need of a host device paired with OXXIOM™).  FIG.  49    also shows some use-case scenarios for the OXXIOM™ device in home settings. In home 1  4915 , the OXXIOM™ is paired with a mobile device that conveys measurement, alarm, and waveform information to the user (patient) as well as sends the same information wirelessly and in real-time through a router (Internet) to the hospital network. The mobile device could also send the same information via its mobile wireless network (if available), eliminating in this way the need for a router. Home 2  4916  has an OXXIOM™ connected to a mobile device that conveys measurement and waveform information to the user (patient) without sending it in real-time to the caregiver. The saved trend data could be sent afterwards to a recipient (doctor&#39;s office, sleep monitoring clinic, etc.) for further analysis and diagnosis. In the case of a home setting with reliable wireless network and internet connection, such as home 3  4917 , OXXIOM™ could be connected to a router (Internet) that would send the waveforms and diagnostic information directly to the OXXIOM™ Cloud Service  4907  so as to calculate SpO2, PR, and PI measurements, trend data, and generate alarms if needed, as well as share this information with the caregiver for appropriate action(s). 
       FIG.  50    depicts the drawings and technical specifications of OXXIOM™ &#39;s lithium manganese dioxide (Li—MnO2) custom primary (not rechargeable) battery. The Li—MnO2 battery is well suitable for low-cost application where relative safety levels and size/weight requirements are a concern. Such is the case of medical devices such as OXXIOM™. When compared to other battery technologies, it offers high energy density (about 250 Wh/kg), wide operating temperature range (−5 to 60 Celsius), long shelf life (due to very low rate of self-discharge), and can withstand high pulse current transients that typically occur in wireless radio circuitry such as the one present in OXXIOM™ (i.e., Bluetooth Low Energy). The battery&#39;s top view  5001  with width, length, and terminal dimensions and separation as well as the side view  5002  with thickness are shown in  FIG.  50   . The battery&#39;s discharge curves  5003  for a typical 5005 and worst-case  5004  scenarios are also depicted in  FIG.  50   . OXXIOM™. In both cases, for a 5-mA discharge current, the battery&#39;s terminal voltage drops slowly with time until it reaches 2.1V. At this value, the OXXIOM™ &#39;s circuitry no longer works reliably, and it is shut down with a notification sent to the user. The changes in battery nominal capacity observed in  FIG.  50    (from 120 to 150 mAh) are due to manufacturing process and lot-to-lot variations. However, in the worst-case scenario  5004 , the battery stores enough energy to power OXXIOM™ &#39;s circuitry continuously and uninterruptedly for 24 hours. The well-behaved and almost flat discharge curves  5004   5005  seen with the Li—MnO2 battery enable OXXIOM™ circuitry to be connected directly to the battery terminals without the need for voltage pre-regulation. This simplifies the required circuitry and also eliminates undesirable interferences and additional noise typically found in circuitries that require high-efficiency switching regulators for voltage pre-regulation. A complete set of specifications  5006  for the OXXIOM™ &#39;s custom battery is also depicted in  FIG.  50   . The physical separation (gap) between positive and negative terminals is chosen to be the smallest possible (from 2 to 5 mm) so as not to compromise safety levels. Given that the battery is soldered to OXXIOM™ &#39;s PCB, and should be perfectly aligned with OXXIOM™ &#39;s circuitry and SMD antenna to enable the soft encapsulation to take place, the small terminal separation provides less mechanical resistance to small adjustments required to compensate misalignments between PCB and battery that may occur during the soldering process. 
     There are applications where a single-use fully disposable device like OXXIOM™ might be required to operate for more than 24 hours continuously in a single patient. Short of replacing the device with a new one every 24 hours, one way of enabling longer uninterrupted monitoring intervals is to increase the OXXIOM™ &#39;s battery capacity. However, this implies increasing the size and weight of the device, which is not desirable in most clinical settings and monitoring applications. Another way is to divide the OXXIOM™ device  5121  into three parts as shown in  FIG.  51   . Part 1  5100  is a multi-layer biocompatible adhesive tape that is responsible for attaching the OXXIOM™ device to the patient skin (i.e., finger, temple, forehead, etc.). Part 2  5105  is the OXXIOM™ circuitry encapsulated (i.e., optical detector and emitter  5107 , PCB  5111  and components  5109 , antenna  5110 , electrical contacts  5108 , and encapsulation  5106 ). Part 3  5119  is the encapsulated assembly with non-rechargeable disposable battery  5118 , non-volatile memory  5117 , flex circuit  5116 , electrical contacts  5115  and adhesive tapes and release liners  5112   5113 , and electrically conductive adhesive tape contact pads  5114 . Part 1 and 3 are relative inexpensive when compared to Part 2. As a result, in order to reduce overall monitoring costs in applications that require extended interrupted continuous monitoring (for more than 24 hours for instance), one can ship to the user (caregiver) a package that could contain a single Part 2 unit, and several Part 2 and Part 3 units.  FIG.  51    shows an example of a shipping package  5120  containing ten units of part 1, five units of Part 3, and one unit of Part 2. This allows the caregiver to change the adhesive tape connecting the patient and device every 12 hours (for convenience), replace the battery every 24 hours for a continuous monitoring period of up to five days or 120 hours. At the end of the extended monitoring period (fifth day), the disposable oximeter circuitry (Part 2) and used Part 1 and Part 3 units are disposed/recycled. Part 1 has a release liner with biocompatible adhesive and film tape  5101  (attached to biocompatible foam tape  5102  for padding and optical compliance) that is used to attach the device to the patient. The release liner (tab) with adhesive tape and film at the opposite side  5104  is used to attach Part 1 to Part 2 Similarly, the release liner (tab) with adhesive tape and film  5112  in Part 3 is used to attach Part 3 to Part 2. Once the three parts are connected together, then the device can be attached to the patient for continuous monitoring (i.e., SpO2, PR, PI, waveforms, etc.). At the beginning of each monitoring shift (every 12 hours), for instance, the caregiver might want to replace Part 1 with a brand new one. This can be easily accomplished by pulling release liner (tab)  5103 , and then attaching a brand new Part 1 to the device (Part 2). In the same way, every 24 hours, the caregiver can easily replace Part 3 with a new one by just pulling release liner (tab)  5113 , and then attaching a brand new Part 3 to the device (Part 2). The battery and non-volatile memory are connected to the disposable oximeter circuitry (contacts  5108 ) via electrical contacts  5115  and electrically conductive adhesive tape  5114 . The non-volatile memory  5117  is used to prevent product counterfeiting and piracy, and also to record battery usage so as notify the user when it is time to replace Part 3 or prevent a worn (counterfeited) Part 3 from being (re)used, and thereby putting at risk the safety of the patient. The non-volatile memory comes with an array of functionalities that have been architected to provide flexible security mechanisms to enable a wide range of authentication models designed to prevent product counterfeiting and piracy. There is in the market today a number of non-volatile memory systems specially designed to prevent counterfeit and control device/sensor usage, such as the Atmel&#39;s CryptoMemory® EEPROM family, or the Maxim Integrated&#39;s Single-Contact 1-Wire Interface DeepCover Secure Authenticator. The authentication of Part 3  5119  is performed by the main processor in Part 2 and the non-volatile memory in Part 3 via an authentication algorithm. In some embodiments, a secure co-processor works together with the oximeter main processor in Part 1 to authenticate Part 3 via its non-volatile secure memory. For the DeepCover Secure Authenticator architecture from Maxim Integrated, for instance, the authentication can be accomplished by using in Part 1 a DS28E35 DeepCover Secure Authenticator with 1-Wire ECDSA, and in Part 2 (in addition to the main processor), the DS2475 DeepCover ECDSA Co-Processor with 1-Wire Master so as to enable asymmetric authentication. This scheme provides very strong security and offloads ECDSA (Elliptic Curve Digital Signature Algorithm) computations and key storage from main processor in Part 2. The basic workflow of the disposable oximeter described in  FIG.  51    (with package content example 5120 shown) can be summarized in the following steps:
         1. Remove release liner  5104  and attach Part 1 to Part 2 as shown in  FIG.  51   ;   2. Remove release liner  5112  and attach Part 3 to Part 2 as shown in  FIG.  51   ;   3. Remove release liner  5101  and attach fully assembled disposable oximeter to the patient&#39;s measurement site (i.e., finger, temple, forehead, foot, etc.);   4. Monitor patient continuously and uninterruptedly for 12 hours;   5. Pull release tab  5103  to remove Part 1 and replace it with a new one following step 1;   6. Monitor patient continuously and uninterruptedly for another 12 hours;   7. Remove disposable oximeter from patient, pull release tab  5113  to remove Part 3 and release tab  5103  to remove Part 1 and replace them with new ones following step 1 and 2;   8. Repeat steps 3 through 7 every 24 hours for 5 days or until patient is released, whichever comes first.       

     The same workflow can be applied to different disposable oximeter packages sizes (such as the one  5120  in  FIG.  51   ), depending on the battery capacity and the patient&#39;s adhesive tape replacement interval requirements. 
     A single-use, fully disposable, wireless, continuous pulse oximeter device like OXXIOM™ contains no outside connectors and its firmware programing typically happens during the manufacturing phase after its circuitry is assembled and tested. There are situations, however, where firmware upgrades are required for OXXIOM™ devices that have been already packaged and await to be shipped to customers, or that have been shipped to customers and await for activation. Firmware updates in medical devices take place often. The device manufacturer, by means of independent testing and/or customer complaints, determines the need for a firmware update that will lead to performance improvement and/or correction of undesired (and sometimes dangerous) behavior that may expose patients/users to unnecessary risks. When upgrades are necessary, the manufacturer conducts a correction/recall (for marketed devices that have left the direct control of the manufacturer), or a stock recovery (for devices that have not left the direct control of the manufacturer). Such procedures comprise of a series of steps and actions to be taken by a medical device manufacturer to correct the operation of its affected devices. In the case of OXXIOM™, in order to minimize the costs with corrections/recalls and/or stock recoveries associated with firmware updates, it is important to have an over-the-air upgrade capability implemented, so as to enable the programming of the latest firmware available at the moment the device (OXXIOM™) is activated by the user.  FIG.  52    shows a flowchart  5201  that describes the phases and main steps that occur in the OXXIOM™ &#39;s lifecycle when such over-the-air firmware upgrade capability is needed. During the “Manufacturing” phase, OXXIOM™ circuitry is assembled, and a secure over-the-air upgrade capability firmware is programmed into the OXXIOM™ &#39;s processor. The devices are then encapsulated, packaged, and shipped to customer(s). During the “Operation” phase, the customer activates OXXIOM™ and pairs it with the host device (or connects to the OXXIOM™ cloud service via IPV6 over Bluetooth Smart (BLE)). The host app or the OXXIOM™ cloud service communicates with OXXIOM™ &#39;s secure over-the-air upgrade capability firmware and programs (into the non-volatile memory of the OXXIOM™ &#39;s processor) the latest application firmware image. OXXIOM™ then begins normal operation. When a new application firmware image is available, then “Application Firmware Image Update” phase takes place. In this phase, either a new host application (app) is released, containing the new application firmware image (and the user updates host device with new app), or the host app downloads, from a cloud storage service, the new application firmware image. In addition, in order to enable OXXIOM™ operation through IPV6 via Bluetooth Smart, the new application firmware image is also uploaded to the OXXIOM™ cloud service. In this way, OXXIOM™ units activated by customers will always be running the latest application firmware during normal operation. Such an approach can save time and resources that would be otherwise required if such firmware updates would have to be performed manually, device-by-device, during corrections/recalls or stock recoveries. It is essential to understand that a disposable single-use low-cost device like OXXIOM™ would need to be disassembled, in order to perform a manual firmware update and then encapsulated again, which would be possible (but costly) in a stock recovery procedure. However, such process would be very difficult during a correction/recall procedure because the OXXIOM™ units would already be at the customers&#39; sites. This is not necessarily true for reusable medical devices since their higher cost and larger footprint allow for the inclusion of connectors/terminals, as part of their circuitry housing that enables firmware updates to be performed without the need for device disassembling. In an embodiment of the inventions, the OXXIOM™ device&#39;s processor is from Nordic Semiconductor, nRF51 (or nRF52) series, flash-based architecture that support over-the-air firmware updates. In this processor series, it is possible to conduct complete application and Bluetooth protocol stack over-the-air upgrades, which provide greater flexibility when compared to alternative static ROM/OTP-based processors. 
     Persons of ordinary skill in the art will understand that, among the many embodiments of the present inventions, a wide variety of combinations of elements and features can be beneficial and may be new and not obvious over prior art. Without being exhaustive, these may include:
         1. The workflow as shown in  FIG.  37   ;   2. App functionalities such as those shown in  FIGS.  39 - 45   . Some examples include:
           (i) Processing of data sent by an oximeter to a host device, to be processed to estimate SpO2, PR and PI, and then display measurements and waveforms in real-time;   (ii) Data stored for sharing and post-processing analysis such as the Sleep Study Oximetry report shown in  FIG.  46   ;   (iii) Barcode scanning for device pairing and patient identification;   
           3. A one-time switch with conductive tape and different contact layouts as described in  FIGS.  47  and  48   ;   4. An oximeter working in a network as described in  FIG.  49   , including:
           (i) an oximeter having app functionalities as described herein;   (ii) an oximeter with related cloud service via IPV6 through BLE, waveforms and measurements sent by a related cloud service to the hospital network to be processed in real-time for measurement and the display of waveforms in hospital monitors and mobile devices, network data storage for analysis and sharing with physicians and caregivers;   (iii) an oximeter used at home, both with a host device and without a host device;   
           5. Improved battery chemistry (having a very flat voltage profile with discharge, being low-cost, and safe) and having a short-contact gap (being easy to align PCB and battery after soldering) for applications such as with an oximeter, as described in  FIG.  50   ;   6. An oximeter having multiple disposable pieces, such as shown in  FIG.  51   ;   7. Over-the-air programming for oximeters, in order to simplify manufacturing, software updates, recalls, etc. for fully disposable solutions;   8. Recycling of oximeters, and/or the components thereof;   9. Low-cost ARM processor with radio functions and biosensing functions in combination with integrated low-cost frontend and LiMnO2 battery and boost-converter for the LEDs with larger band-gap voltage to enable a fully disposable, single-use, low cost, clinical-grade oximeter;   10. The combination of low-cost adhesive tapes with electronics to enable a low-cost, biocompatible encapsulation and one-time ON switch;   11. A distributed software architecture that (a) runs low-latency tasks such as those of oximeters of the invention, and (b) runs more complex/higher latency tasks in the host device or cloud service;   12. Alarm notifications sent to a caregiver(s) via text message or phone call when an alarm is triggered, such as shown in  FIG.  43   .       

     Various modifications and alterations of the inventions will become apparent to those skilled in the art without departing from the spirit and scope of the inventions, which is defined by the accompanying claims. It should be noted that steps recited in any method claims below do not necessarily need to be performed in the order that they are recited. Those of ordinary skill in the art will recognize variations in performing the steps from the order in which they are recited. In addition, the lack of mention or discussion of a feature, step, or component provides the basis for claims where the absent feature or component is excluded by way of a proviso or similar claim language. 
     While various embodiments of the present inventions have been described above, it should be understood that they have been presented by way of example only, and not of limitation. Likewise, the various diagrams may depict an example architectural or other configuration for the inventions, which is done to aid in understanding the features and functionality that may be included in the inventions. The inventions are not restricted to the illustrated example architectures or configurations, but the desired features may be implemented using a variety of alternative architectures and configurations. Indeed, it will be apparent to one of skill in the art how alternative functional, logical or physical partitioning and configurations may be implemented to implement the desired features of the present inventions. Also, a multitude of different constituent module names other than those depicted herein may be applied to the various partitions. Additionally, with regard to flow diagrams, operational descriptions and method claims, the order in which the steps are presented herein shall not mandate that various embodiments be implemented to perform the recited functionality in the same order unless the context dictates otherwise. 
     Terms and phrases used in this document, and variations thereof, unless otherwise expressly stated, should be construed as open ended as opposed to limiting. As examples of the foregoing: the term “including” should be read as meaning “including, without limitation” or the like; the term “example” is used to provide exemplary instances of the item in discussion, not an exhaustive or limiting list thereof; the terms “a” or “an” should be read as meaning “at least one,” “one or more” or the like; and adjectives such as “conventional,” “traditional,” “normal,” “standard,” “known” and terms of similar meaning should not be construed as limiting the item described to a given time period or to an item available as of a given time, but instead should be read to encompass conventional, traditional, normal, or standard technologies that may be available or known now or at any time in the future. Likewise, where this document refers to technologies that would be apparent or known to one of ordinary skill in the art, such technologies encompass those apparent or known to the skilled artisan now or at any time in the future. 
     A group of items linked with the conjunction “and” should not be read as requiring that each and every one of those items be present in the grouping, but rather should be read as “and/or” unless expressly stated otherwise. Similarly, a group of items linked with the conjunction “or” should not be read as requiring mutual exclusivity among that group, but rather should also be read as “and/or” unless expressly stated otherwise. Furthermore, although items, elements or components of the invention may be described or claimed in the singular, the plural is contemplated to be within the scope thereof unless limitation to the singular is explicitly stated. 
     The presence of broadening words and phrases such as “one or more,” “at least,” “but not limited to” or other like phrases in some instances shall not be read to mean that the narrower case is intended or required in instances where such broadening phrases may be absent. The use of the term “module” does not imply that the components or functionality described or claimed as part of the module are all configured in a common package. Indeed, any or all of the various components of a module, whether control logic or other components, may be combined in a single package or separately maintained and may further be distributed across multiple locations. 
     Additionally, the various embodiments set forth herein are described in terms of exemplary block diagrams, flow charts and other illustrations. As will become apparent to one of ordinary skill in the art after reading this document, the illustrated embodiments and their various alternatives may be implemented without confinement to the illustrated examples. For example, block diagrams and their accompanying description should not be construed as mandating a particular architecture or configuration. 
     The previous description of the disclosed embodiments is provided to enable any person skilled in the art to make or use the present inventions. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments without departing from the spirit or scope of the inventions. 
     Although the inventions are described above in terms of various exemplary embodiments and implementations, it should be understood that the various features, aspects and functionality described in one or more of the individual embodiments are not limited in their applicability to the particular embodiment with which they are described, but instead may be applied, alone or in various combinations, to one or more of the other embodiments of the inventions, whether or not such embodiments are described and whether or not such features are presented as being a part of a described embodiment. Thus the breadth and scope of the present inventions should not be limited by any of the above-described exemplary embodiments. Thus, the present inventions are not intended to be limited to the embodiments shown herein but are to be accorded the widest scope consistent with applicable law and the principles and novel features disclosed herein.