Patent Publication Number: US-2020281479-A1

Title: Wearable Vital Signs Monitor With Selective Signal Acquisition

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application claims the benefit of U.S. Provisional Application No. 62/815,914 filed Mar. 8, 2019. Said Application No. 62/815,914 is hereby incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     Wearable vital signs monitors (WVSMs) can provide benefits over non-wearable systems because such WVSMs can provide continuous 24/7 monitoring of key physiological signals. The accuracy of some physiologic signals, however, can be affected by the conditions under which they are sensed or collected. Furthermore, through study and analysis, it has been determined that acquisition of some physiological signals such as heart rate trend can be susceptible to noise or interference. Other signals such as resting heart rate can be difficult to measure unless the wearer has been sedentary for a certain period of time. Still other signals such as non-invasive blood pressure monitoring cannot be measured accurately unless the wearer is not moving to improve accuracy. Further still, some signals such as body weight cannot be measured with a WVSM and may involve using additional equipment such as a that is not a part of the core wearable system. 
    
    
     
       DESCRIPTION OF THE DRAWING FIGURES 
       Claimed subject matter is particularly pointed out and distinctly claimed in the concluding portion of the specification. However, such subject matter may be understood by reference to the following detailed description when read with the accompanying drawings in which: 
         FIG. 1  is a diagram of components of a sample wearable cardioverter defibrillator (WCD) system incorporating a wearable vital sign monitor (WVSM) in accordance with one or more embodiments. 
         FIG. 2  is a diagram showing sample components of an external defibrillator, such as the one belonging in the system of  FIG. 1 , including a WVSM in accordance with one or more embodiments. 
         FIG. 3  is a diagram of sample embodiments of components of a WCD system and an WVSM monitor in accordance with one or more embodiments. 
         FIG. 4  is a diagram illustrating WVSM monitoring categories and the respective example physiological signals in each category in accordance with one or more embodiments. 
         FIG. 5  is a diagram illustrating WVSM acquisition of a heart rate signal as an example in accordance with one or more embodiments. 
         FIG. 6  is a flow diagram of a method of acquiring a patient physiological parameter using two or more categories of monitoring in accordance with one or more embodiments. 
     
    
    
     It will be appreciated that for simplicity and/or clarity of illustration, elements illustrated in the figures have not necessarily been drawn to scale. For example, the dimensions of some of the elements may be exaggerated relative to other elements for clarity. Further, if considered appropriate, reference numerals have been repeated among the figures to indicate corresponding and/or analogous elements. 
     DETAILED DESCRIPTION 
     In the following detailed description, numerous specific details are set forth to provide a thorough understanding of claimed subject matter. It will, however, be understood by those skilled in the art that claimed subject matter may be practiced without these specific details. In other instances, well-known methods, procedures, components and/or circuits have not been described in detail. 
     In the following description and/or claims, the terms coupled and/or connected, along with their derivatives, may be used. In particular embodiments, connected may be used to indicate that two or more elements are in direct physical and/or electrical contact with each other. Coupled may mean that two or more elements are in direct physical and/or electrical contact. However, coupled may also mean that two or more elements may not be in direct contact with each other, but yet may still cooperate and/or interact with each other. For example, “coupled” may mean that two or more elements do not contact each other but are indirectly joined together via another element or intermediate elements. Finally, the terms “on,” “overlying,” and “over” may be used in the following description and claims. “On,” “overlying,” and “over” may be used to indicate that two or more elements are in direct physical contact with each other. It should be noted, however, that “over” may also mean that two or more elements are not in direct contact with each other. For example, “over” may mean that one element is above another element but not contact each other and may have another element or elements in between the two elements. Furthermore, the term “and/or” may mean “and”, it may mean “or”, it may mean “exclusive-or”, it may mean “one”, it may mean “some, but not all”, it may mean “neither”, and/or it may mean “both”, although the scope of claimed subject matter is not limited in this respect. In the following description and/or claims, the terms “comprise” and “include,” along with their derivatives, may be used and are intended as synonyms for each other. 
       FIG. 1  is a diagram of components of a sample wearable cardioverter defibrillator (WCD) system incorporating a wearable vital sign monitor (WVSM) in accordance with one or more embodiments. A wearable cardioverter defibrillator (WCD) system  10  according to some embodiments can protect an ambulatory patient by electrically restarting his or her heart if needed. Such a WCD system  10  may have a number of components. These components can be provided separately as modules that can be interconnected, or can be combined with other components, and so on. In one or more embodiments, WCD system  10  can include a wearable vital systems monitor (WVSM)  150  that is capable of monitoring one or more physiological parameters of the patient  82  for example as one or more of the patient parameters collected by WCD system  10 . WSVM  150  can come in a variety of form factors or support structures including, for example, a wrist band or watch, a chest band, an arm band, a head band, a leg band, or an ankle band. In other examples, WSVM  150  can be part of a support structure that comprises a cuff or similar device, or the support structure can comprise a vest, belt, or garment. In some embodiments, WSVM  150  can be part of WCD system  10 , and in other embodiments, WVSM  150  can be completely separate from WCD system  10 , and the scope of the disclosed subject matter is not limited in this respect. 
     In some embodiments, WSVM  150  can comprise a machine or computing platform comprising a processor and a memory coupled with the processor. The memory can include instructions thereon to configure the processor to perform any of the methods or operations described herein. In some examples, the methods or operations can be stored on a non-transitory machine readable or computer readable medium that, when the instructions are executed by the processor, configure the processor to perform any of the methods or operations described herein. 
       FIG. 1  depicts a patient  82 . Patient  82  may also be referred to as a person and/or wearer, since the patient is wearing components of the WCD system  10 . Patient  82  is ambulatory, which means that, while wearing the wearable portion of the WCD system  10 , patient  82  can walk around and is not necessarily bed-ridden. While patient  82  may be considered to be also a “user” of the WCD system  10 , this is not a requirement. For instance, a user of the wearable cardioverter defibrillator (WCD) may also be a clinician such as a doctor, nurse, emergency medical technician (EMT) or other similarly tasked individual or group of individuals. In some cases, a user may even be a bystander. The particular context of these and other related terms within this description should be interpreted accordingly. 
     A WCD system  10  according to embodiments can be configured to defibrillate the patient  82  who is wearing the designated parts the WCD system  10 . Defibrillating can be by the WCD system  10  delivering an electrical charge to the patient&#39;s body in the form of an electric shock. The electric shock can be delivered in one or more pulses. 
       FIG. 1  also depicts components of a WCD system  10  made according to embodiments. One such component is a support structure  170 , or garment, that is wearable by ambulatory patient  82 . Accordingly, support structure  170  can be configured to be worn by ambulatory patient  82  for at least several hours per day, and for at least several days, even a few months. It will be understood that support structure  170  is shown only generically in  FIG. 1 , and in fact partly conceptually.  FIG. 1  is provided merely to illustrate concepts about support structure  170  and is not to be construed as limiting how support structure  170  is implemented, or how it is worn. 
     Support structure  170  can be implemented in many different ways. For example, it can be implemented in a single component or a combination of multiple components. In embodiments, support structure  170  could include a vest, a half-vest, a garment, etc. In such embodiments such items can be worn similarly to analogous articles of clothing. In embodiments, support structure  170  could include a harness, one or more belts or straps, etc. In such embodiments, such items can be worn by the patient around the torso, hips, over the shoulder, etc. In embodiments, support structure  170  can include a container or housing, which can even be waterproof. In such embodiments, the support structure can be worn by being attached to the patient&#39;s body by adhesive material, for example as shown and described in U.S. Pat. No. 8,024,037 which is incorporated herein by reference in its entirety. Support structure  170  can even be implemented as described for the support structure of U.S. application Ser. No. 15/120,655, published as US 2017/0056682 A1, which is incorporated herein by reference in its entirety. In such embodiments, the person skilled in the art will recognize that additional components of the WCD system  10  can be in the housing of a support structure instead of being attached externally to the support structure, for example as described in the US 2017/0056682 A1 document. There can be other examples. 
       FIG. 1  shows a sample external defibrillator  100 . As described in more detail later in this document, some aspects of external defibrillator  100  include a housing and an energy storage module within the housing. As such, in the context of a WCD system  10 , defibrillator  100  is sometimes called a main electronics module or a monitor. The energy storage module can be configured to store an electrical charge. Other components can cause at least some of the stored electrical charge to be discharged via electrodes through the patient to deliver one or more defibrillation shocks through the patient  82 . 
       FIG. 1  also shows sample defibrillation electrodes  104  and/or  108 , which are coupled to external defibrillator  100  via electrode leads  105 . Defibrillation electrodes  104  and/or  108  can be configured to be worn by patient  82  in several ways. For instance, defibrillator  100  and defibrillation electrodes  104  and/or  108  can be coupled to support structure  170 , directly or indirectly. In other words, support structure  170  can be configured to be worn by ambulatory patient  82  to maintain at least one of electrodes  104  and/or  108  on the body of ambulatory patient  82 , while patient  82  is moving around, etc. The electrode can be thus maintained on the body by being attached to the skin of patient  82 , simply pressed against the skin directly or through garments, etc. In some embodiments the electrode is not necessarily pressed against the skin but becomes biased that way upon sensing a condition that could merit intervention by the WCD system  10 . In addition, many of the components of defibrillator  100  can be considered coupled to support structure  170  directly, or indirectly via at least one of defibrillation electrodes  104  and/or  108 . 
     When defibrillation electrodes  104  and/or  108  make good electrical contact with the body of patient  82 , defibrillator  100  can administer, via electrodes  104  and/or  108 , a brief, strong electric pulse  111  through the body. Pulse  111  is also known as shock, defibrillation shock, therapy, electrotherapy, therapy shock, etc. Pulse  111  is intended to go through and restart heart  85  to save the life of patient  82 . Pulse  111  can further include one or more pacing pulses of lesser magnitude to simply pace heart  85  if needed, and so on. 
     A typical defibrillator decides whether to defibrillate or not based on an electrocardiogram (ECG) signal of the patient. External defibrillator  100 , however, may initiate defibrillation, or hold-off defibrillation, based on a variety of inputs, with the ECG signal merely being one of these inputs. 
     A WCD system  10  according to embodiments can obtain data from patient  82 . For collecting such data, the WCD system  10  may optionally include at least an outside monitoring device  180 . Device  180  is called an “outside” device because it could be provided as a standalone device, for example not within the housing of defibrillator  100 . Device  180  can be configured to sense or monitor at least one local parameter. A local parameter can be a parameter of patient  82 , or a parameter of the WCD system  10 , or a parameter of the environment, as will be described later in this document. In some embodiments, outside monitoring device  180  can comprise a hub or similar device through which connections and/or leads may be made of the various components of the WCD system  100 . For example, at least some of the leads of external defibrillator  100  may be connected to and/or routed through the outside monitoring device  180  including, for example, one or more ECG leads, a right-leg drive (RLD) lead, leads connected to the defibrillation electrodes  104  and/or  108 , and so on. In some embodiments, outside monitoring device  180  can include a controller or processor that is used to implement at least a portion of the shock/no-shock algorithm to determine whether a shock should or should not be applied to the patient  82 , although the scope of the disclosed subject matter is not limited in this respect. 
     For some of these parameters, device  180  may include one or more sensors or transducers. Each one of such sensors can be configured to sense a parameter of patient  82 , and to render an input responsive to the sensed parameter. In some embodiments the input is quantitative, such as values of a sensed parameter. In other embodiments the input is qualitative, such as informing whether a threshold is crossed, and so on. Sometimes these inputs about patient  82  are also called physiological inputs and patient inputs. In embodiments, a sensor can be construed more broadly, as encompassing many individual sensors. 
     Optionally, device  180  can be physically coupled to support structure  170 . In addition, device  180  may be communicatively coupled with other components that are coupled to support structure  170 . Such communication can be implemented by a communication module, as will be deemed applicable by a person skilled in the art in view of this description. 
     In embodiments, one or more of the components of the shown WCD system  10  may be customized for patient  82 . This customization may include a number of aspects. For instance, support structure  170  can be fitted to the body of patient  82 . For another instance, baseline physiological parameters of patient  82  can be measured, such as the heart rate of patient  82  while resting, while walking, motion detector outputs while walking, etc. The measured values of such baseline physiological parameters can be used to customize the WCD system  10 , in order to make its diagnoses more accurate, since patients&#39; bodies differ from one another. Of course, such parameter values can be stored in a memory of the WCD system  10 , and so on. Moreover, a programming interface can be made according to embodiments, which receives such measured values of baseline physiological parameters. Such a programming interface may input automatically in the WCD system  10  these, along with other data. 
     In one or more embodiments, WCD system  10  may include a wearable vital systems monitor (WVSM)  150  that is capable of monitoring one or more physiological parameters of the patient  82  as one or more of the patient parameters collected by WCD system  10 . In some embodiments, WSVM  150  can be part of WCD system  10 , and in other embodiments, WVSM  150  can be completely separate from WCD system  10 , and the scope of the disclosed subject matter is not limited in this respect. In some examples, the WVSM  150  is capable of obtaining frequent physiological measurements while the patient  82  is wearing the WVSM  150  through the day and/or during the night when the patient  82  is sleeping. 
     The WVSM  150  can be provided in various types of form factors to be placed on the patient&#39;s body at various locations and/or to integrate with WCD system  10  in various ways. For example, in some embodiments, WVSM  150  can be worn on the wrist of the patient  82  or various other locations on the patient  82  such as on the arm, leg, ankle, chest, or back of the patient  82  depending on the provided form factor and/or technology utilized by the WVSM  150  to a physiological reading. 
     In some embodiments, WVSM  150  can be incorporated into an external device or accessory such as a smartphone. Such devices may come in various other form factors such as a patch, watch, earring, eyeglasses, ankle bracelet, and so on, wherein WVSM  150  can be unobtrusive. 
     In some embodiments, WVSM  150  can include a sensor built into the alert button or stop button of the WCD system  10  wherein the alert button or stop button is used by the patient  82  to stop an impending shock if the patient so desires. In such embodiments, the patient is already aware of the location of the alert button or stop button which would provide a simple and readily available device for the patient to use to take an appropriate measurement, for example a blood pressure or heart rate reading. For example, when WVSM  150  is in the alert button or stop button, the patient&#39;s blood pressure can be obtained whenever the patient  82  needs to abort a shock. 
     In one or more embodiments, WVSM  150  can include or otherwise comprise an optical pulse oximetry sensor and/or a methemoglobin sensor wherein optical NIBP sensor functionality can be implemented using a pulse oximetry or methemoglobin sensor. In other examples, WVSM  150  can comprise a cuff-less blood pressure monitor  150  can be incorporated in one or more of the ECG electrodes of the WCD system  10 . Such a WVSM  150  can be an optical sensor or an electro-mechanical sensor such as described in “A CMOS-based Tactile Sensor for Continuous Blood Pressure Monitoring”, Kirstein, Sedivy, et al., Proceedings of the Design, Automation and Test in Europe Conference and Exhibition, 1530-1591/05 (March 2005) which is incorporated herein by reference in its entirety. 
     In other embodiments, WVSM  150  can be adapted for use in proposed adhesive type defibrillators as disclosed in U.S. Pat. No. 8,024,037. For example, WVSM  150  can be disposed in one of the adhesive modules as shown in the &#39;037 patent, or in an “appendage” or “flap” that extends from the module so that WVSM  150  can be positioned on an appropriate location on the patient. Embodiments of a WVSM  150  can include a wireless communication interface such as BLUETOOTH, near-field communication (NFC), Wi-Fi DIRECT, ZIGBEE, and so on, to transmit the physiological data to a module of the WCD system  10 , to a personal communication device of the WCD system  10  for example as disclosed in U.S. Pat. No. 8,838,235, or to another remote device. Said U.S. Pat. No. 8,838,235 is incorporated herein by reference in its entirety. In some embodiments, a wired communication link can be used instead of a wireless communication link. For example, WVSM  150  can be implemented in an electrode that can be configured so that the blood pressure data is transmitted on a wire bundled with the wire or wires of the electrode sensors, or multiplexed on the same wire as the electrode data, and so on. 
       FIG. 2  is a diagram showing sample components of an external defibrillator, such as the one belonging in the system of  FIG. 1 , including a WVSM in accordance with one or more embodiments. Some components of WCD system  10  can be, for example, included in external defibrillator  100  of  FIG. 1 . The components shown in  FIG. 2  can be provided in a housing  201 , which may also be referred to as casing  201 . 
     External defibrillator  200  is intended for a patient who would be wearing it, such as ambulatory patient  82  of  FIG. 1 . Defibrillator  200  may further include a user interface  280  for a user  282 . User  282  can be patient  82 , also known as wearer  82 . Alternatively, user  282  can be a local rescuer at the scene, such as a bystander who might offer assistance, or a trained person. Alternatively, user  282  might be a remotely located trained caregiver in communication with the WCD system  10 . 
     User interface  280  can be made in a number of ways. User interface  280  may include output devices, which can be visual, audible or tactile, for communicating to a user  282  by outputting images, sounds or vibrations. Images, sounds, vibrations, and anything that can be perceived by user  282  can also be called human-perceptible indications (HPIs). There are many examples of output devices. For example, an output device can be a light, or a screen to display what is sensed, detected and/or measured, and provide visual feedback to user  282  acting as a rescuer for their resuscitation attempts, and so on. Another output device can be a speaker, which can be configured to issue voice prompts, beeps, loud alarm sounds and/or words to warn bystanders, etc. 
     User interface  280  further may include input devices for receiving inputs from users. Such input devices may include various controls, such as pushbuttons, keyboards, touchscreens, one or more microphones, and so on. An input device can be a cancel switch, which is sometimes called an “I am alive” switch or “live man” switch. In some embodiments, actuating the cancel switch can prevent the impending delivery of a shock and may be referred to as a stop button in such embodiments. 
     Defibrillator  200  may include an internal monitoring device  281 . Device  281  is called an “internal” device because it is incorporated within housing  201 . Monitoring device  281  can sense or monitor patient parameters such as patient physiological parameters, system parameters and/or environmental parameters, all of which can be called patient data. In other words, internal monitoring device  281  can be complementary or an alternative to outside monitoring device  180  of  FIG. 1 . Allocating which of the parameters are to be monitored by which of monitoring devices  180 ,  281  can be done according to design considerations. Device  281  may include one or more sensors as also described elsewhere in this document. 
     Patient parameters may include patient physiological parameters. Patient physiological parameters may include, for example and without limitation, those physiological parameters that can be of any help in detecting by the WCD system  10  whether or not the patient is in need of a shock or other intervention or assistance. Patient physiological parameters may also optionally include the patient&#39;s medical history, event history, and so on. Examples of such parameters include the patient&#39;s ECG, blood oxygen level, blood flow, blood pressure, blood perfusion, pulsatile change in light transmission or reflection properties of perfused tissue, heart sounds, heart wall motion, breathing sounds and pulse. Accordingly, monitoring device  180  and/or monitoring device  281  may include one or more sensors configured to acquire patient physiological signals. Examples of such sensors or transducers include one or more electrodes to detect ECG data, a perfusion sensor, a pulse oximeter, a device for detecting blood flow (e.g. a Doppler device), a sensor for detecting blood pressure (e.g. a cuff), an optical sensor, illumination detectors and sensors perhaps working together with light sources for detecting color change in tissue, a motion sensor, a device that can detect heart wall movement, a sound sensor, a device with a microphone, an SpO2 sensor, and so on. In accordance with one or more embodiments, monitoring device  180  and/or monitoring device  281  may include WVSM  150  and may tangibly embody one or more embodiments of WVSM  150  or may operate in conjunction with WVSM  150 , and the scope of the disclosed subject matter is not limited in this respect. In view of this disclosure, it will be appreciated that such sensors can help detect the patient&#39;s pulse, and can therefore also be called pulse detection sensors, pulse sensors, and pulse rate sensors. In addition, a person skilled in the art may implement other ways of performing pulse detection. 
     In some embodiments, the local parameter is a trend that can be detected in a monitored physiological parameter of patient  282 . A trend can be detected by comparing values of parameters at different times over short and long terms. Parameters whose detected trends can particularly help a cardiac rehabilitation program include: a) cardiac function (e.g. ejection fraction, stroke volume, cardiac output, etc.); b) heart rate variability at rest or during exercise; c) heart rate profile during exercise and measurement of activity vigor, such as from the profile of an accelerometer signal and informed from adaptive rate pacemaker technology; d) heart rate trending; e) perfusion, such as from SpO2, CO2, or other parameters such as those mentioned above; f) respiratory function, respiratory rate, etc.; g) motion, level of activity; and so on. Once a trend is detected, it can be stored and/or reported via a communication link, optionally along with a warning if warranted. From the report, a physician monitoring the progress of patient (user)  282  will know about a condition that is either not improving or deteriorating. 
     Patient state parameters include recorded aspects of patient (user)  282 , such as motion, posture, whether they have spoken recently plus maybe also what they said, and so on, plus optionally the history of these parameters. Alternatively, one of these monitoring devices could include a location sensor such as a Global Positioning System (GPS) location sensor. Such a sensor can detect the location, plus a speed can be detected as a rate of change of location over time. Many motion detectors output a motion signal that is indicative of the motion of the detector, and thus of the patient&#39;s body. Patient state parameters can be very helpful in narrowing down the determination of whether sudden cardiac arrest (SCA) is indeed taking place. 
     A WCD system  10  made according to embodiments may thus include a motion detector  287 . In embodiments, a motion detector can be implemented within monitoring device  180  or monitoring device  281 . Such a motion detector can be made in many ways as is known in the art, for example by using an accelerometer. In this example, a motion detector  287  is implemented within monitoring device  281 . A motion detector of a WCD system  10  according to embodiments can be configured to detect a motion event. A motion event can be defined as is convenient, for example a change in motion from a baseline motion or rest, etc. In such cases, a sensed patient parameter can include motion. 
     System parameters of a WCD system  10  can include system identification, battery status, system date and time, reports of self-testing, records of data entered, records of episodes and intervention, and so on. In response to the detected motion event, the motion detector may render or generate, from the detected motion event or motion, a motion detection input that can be received by a subsequent device or functionality. 
     Environmental parameters can include ambient temperature and pressure. Moreover, a humidity sensor may provide information as to whether or not it is likely raining. Presumed patient location could also be considered an environmental parameter. The patient location could be presumed or determined, if monitoring device  180  and/or monitoring device  281  includes a GPS location sensor as described above, and if it is presumed that the patient is wearing the WCD system  10 . 
     Defibrillator  200  typically includes a defibrillation port  210 , which can be a socket in housing  201 . Defibrillation port  210  includes electrical node  214  and/or electrical node  218 . Leads of defibrillation electrode  204  and/or defibrillation electrode  208 , such as leads  105  of  FIG. 1 , can be plugged into defibrillation port  210  so as to make electrical contact with node  214  and node  218 , respectively. It is also possible that defibrillation electrode  204  and/or defibrillation electrode  208  instead are connected continuously to defibrillation port  210 . Either way, defibrillation port  210  can be used for guiding, via electrodes, to the wearer at least some of the electrical charge that has been stored in an energy storage module  250  that is described more fully later in this document. The electric charge will be the shock for defibrillation, pacing, and so on. 
     Defibrillator  200  may optionally also have a sensor port  219  in housing  201 , which is also sometimes known as an ECG port. Sensor port  219  can be adapted for plugging in sensing electrodes  209 , which are also known as ECG electrodes and ECG leads. It is also possible that sensing electrodes  209  can be connected continuously to sensor port  219 , instead. Sensing electrodes  209  are types of transducers that can help sense an ECG signal, e.g. a 12-lead signal, or a signal from a different number of leads, especially if the leads make good electrical contact with the body of the patient and in particular with the skin of the patient. As with defibrillation electrodes  204  and/or  208 , the support structure  170  can be configured to be worn by patient  282  so as to maintain sensing electrodes  209  on a body of patient (user)  282 . For example, sensing electrodes  209  can be attached to the inside of support structure  170  for making good electrical contact with the patient, similarly with defibrillation electrodes  204  and/or  208 . 
     Optionally a WCD system  10  according to embodiments also includes a fluid that can be deployed automatically between the electrodes and the patient&#39;s skin. The fluid can be conductive, such as by including an electrolyte, for establishing a better electrical contact between the electrodes and the skin. Electrically speaking, when the fluid is deployed, the electrical impedance between each electrode and the skin is reduced. Mechanically speaking, the fluid may be in the form of a low-viscosity gel so that it does not flow away after being deployed from the location it is released near the electrode. The fluid can be used for both defibrillation electrodes  204  and/or  208 , and for sensing electrodes  209 . 
     The fluid may be initially stored in a fluid reservoir, not shown in  FIG. 2 . Such a fluid reservoir can be coupled to the support structure  170 . In addition, a WCD system  10  according to embodiments further includes a fluid deploying mechanism  274 . Fluid deploying mechanism  274  can be configured to cause at least some of the fluid to be released from the reservoir, and be deployed near one or both of the patient locations to which electrodes  204  and/or  208  are configured to be attached to the patient. In some embodiments, fluid deploying mechanism  274  is activated prior to the electrical discharge responsive to receiving activation signal (AS) from a processor  230 , which is described more fully later in this document. 
     In some embodiments, defibrillator  200  also includes a measurement circuit  220 , as one or more of its working together with its sensors or transducers. Measurement circuit  220  senses one or more electrical physiological signals of the patient from sensor port  219 , if provided. Even if defibrillator  200  lacks sensor port  219 , measurement circuit  220  optionally may obtain physiological signals through nodes  214  and/or  218  instead, when defibrillation electrodes  204  and/or  208  are attached to the patient. In these embodiments, the input reflects an ECG measurement. The patient parameter can be an ECG, which can be sensed as a voltage difference between electrodes  204  and  208 . In addition, the patient parameter can be an impedance, which can be sensed between electrodes  204  and  208  and/or between the connections of sensor port  219  considered pairwise. Sensing the impedance can be useful for detecting, among other things, whether these electrodes  204  and/or  208  and/or sensing electrodes  209  are not making good electrical contact with the patient&#39;s body. These patient physiological signals may be sensed when available. Measurement circuit  220  can then render or generate information about them as inputs, data, other signals, etc. As such, measurement circuit  220  can be configured to render a patient input responsive to a patient parameter sensed by a sensor. In some embodiments, measurement circuit  220  can be configured to render a patient input, such as values of an ECG signal, responsive to the ECG signal sensed by sensing electrodes  209 . More strictly speaking, the information rendered by measurement circuit  220  is output from it, but this information can be called an input because it is received as an input by a subsequent device or functionality. 
     Defibrillator  200  also includes a processor  230 . Processor  230  may be implemented in a number of ways. Such ways include, by way of example and not of limitation, digital and/or analog processors such as microprocessors and Digital Signal Processors (DSPs), controllers such as microcontrollers, software running in a machine, programmable circuits such as Field Programmable Gate Arrays (FPGAs), Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices (PLDs), Application Specific Integrated Circuits (ASICs), any combination of one or more of these, and so on. 
     Processor  230  may include, or have access to, a non-transitory storage medium, such as memory  238  that is described more fully later in this document. Such a memory  238  can have a non-volatile component for storage of machine-readable and machine-executable instructions. A set of such instructions can also be called a program. The instructions, which may also be referred to as “software,” generally provide functionality by performing acts, operations and/or methods as may be disclosed herein or understood by one skilled in the art in view of the disclosed embodiments. In some embodiments, and as a matter of convention used herein, instances of the software may be referred to as a “module” and by other similar terms. Generally, a module includes a set of the instructions to offer or fulfill a particular functionality. Embodiments of modules and the functionality delivered are not limited by the embodiments described in this document. 
     Processor  230  can be considered to have a number of modules. One such module can be a detection module  232 . Detection module  232  can include a Ventricular Fibrillation (VF) detector. The patient&#39;s sensed ECG from measurement circuit  220 , which can be available as inputs, data that reflect values, or values of other signals, may be used by the VF detector to determine whether the patient is experiencing VF. Detecting VF is useful because VF typically results in sudden cardiac arrest (SCA). Detection module  232  can also include a Ventricular Tachycardia (VT) detector, and so on. 
     Another such module in processor  230  can be an advice module  234 , which generates advice for what to do. The advice can be based on outputs of detection module  232 . There can be many types of advice according to embodiments. In some embodiments, the advice is a shock/no shock determination that processor  230  can make, for example via advice module  234 . The shock/no shock determination can be made by executing a stored Shock Advisory Algorithm (SAA). A Shock Advisory Algorithm can make a shock/no shock determination from one or more ECG signals that are captured according to embodiments, and determine whether or not a shock criterion is met. The determination can be made from a rhythm analysis of the captured ECG signal or otherwise. 
     In some embodiments, when the determination is to shock, an electrical charge is delivered to the patient. Delivering the electrical charge is also known as discharging and shocking the patient. As mentioned above, such can be for defibrillation, pacing, and so on. 
     In good or ideal conditions, a very reliable shock/no shock determination can be made from a segment of the sensed ECG signal of the patient. In practice, however, the ECG signal is often corrupted by electrical noise, which can make it difficult to analyze. Too much noise sometimes causes an incorrect detection of a heart arrhythmia, resulting in a false alarm to the patient. Noisy ECG signals may be handled as described in U.S. application Ser. No. 16/037,990, filed on Jul. 17, 2018 and since published as US 2019/0030351 A1, and in U.S. application Ser. No. 16/038,007, filed on Jul. 17, 2018 and since published as US 2019/0030352 A1, both by the same applicant and incorporated herein by reference in their entireties. 
     Processor  230  can include additional modules, such as other module  236 , for other functions. In addition, if internal monitoring device  281  is provided, processor  230  may receive its inputs, etc. 
     Defibrillator  200  optionally further includes a memory  238 , which can work together with processor  230 . Memory  238  may be implemented in a number of ways. Such ways include, by way of example and not of limitation, volatile memories, Nonvolatile Memories (NVM), Read-Only Memories (ROM), Random Access Memories (RAM), magnetic disk storage media, optical storage media, smart cards, flash memory devices, any combination of these, and so on. Memory  238  is thus a non-transitory storage medium. Memory  238 , if provided, can include programs and/or instructions for processor  230 , which processor  230  may be able to read and execute. More particularly, the programs can include sets of instructions in the form of code, which processor  230  may be able to execute upon reading. Executing is performed by physical manipulations of physical quantities, and may result in functions, operations, processes, acts, actions and/or methods to be performed, and/or the processor to cause other devices or components or blocks to perform such functions, operations, processes, acts, actions and/or methods. The programs can be operational for the inherent needs of processor  230  and can also include protocols and ways that decisions can be made by advice module  234 . In addition, memory  238  can store prompts for user  282 , if this user is a local rescuer. Moreover, memory  238  can store data. This data can include patient data, system data and environmental data, for example as learned by internal monitoring device  281  and outside monitoring device  180 . The data can be stored in memory  238  before it is transmitted out of defibrillator  200  or can be stored there after it is received by defibrillator  200 . 
     Defibrillator  200  can optionally include a communication module  290 , for establishing one or more wired and/or wireless communication links with other devices of other entities, such as a remote assistance center, Emergency Medical Services (EMS), and so on. The communication module  290  may include short range wireless communication circuitry for example in accordance with a BLUETOOTH or ZIGBEE standard, short or medium range wireless communication for example a W-Fi or wireless local area network (WLAN) in accordance with an Institute of Electrical and Electronics Engineers (IEEE) 802.11x standard, or a wireless wide area network (WWAN) in accordance with a Third Generation Partnership Project (3GPP) including a 3G, 4G, or 5G New Radio (NR) standard. The communication links can be used to transfer data and commands. The data may be patient data, event information, therapy attempted, cardiopulmonary resuscitation (CPR) performance, system data, environmental data, and so on. For example, communication module  290  may transmit wirelessly, e.g. on a daily basis, heart rate, respiratory rate, and other vital signs data to a server accessible over the internet, for instance as described in U.S. application Ser. No. 13/959,894 filed Aug. 6, 2012 and published as US 2014/0043149 A1 and which is incorporated herein by reference in its entirety. This data can be analyzed directly by the patient&#39;s physician and can also be analyzed automatically by algorithms designed to detect a developing illness and then notify medical personnel via text, email, phone, etc. Module  290  may also include such interconnected sub-components as may be deemed necessary by a person skilled in the art, for example an antenna, portions of a processor, supporting electronics, outlet for a telephone or a network cable, etc. Furthermore, in accordance with one or more embodiments, WVSM  150  can couple with communication module  290  of defibrillator  200  via a wired or wireless communication link. In some embodiments, WVSM  150  can couple with defibrillator  200  via outside monitoring device  180  of  FIG. 1  acting as an intermediate device, connector, bus, router, switch, or hub, and the scope of the disclosed subject matter is not limited in this respect. 
     Defibrillator  200  also may include a power source  240 . To enable portability of defibrillator  200 , power source  240  typically includes a battery. Such a battery typically can be implemented as a battery pack, which can be rechargeable or not. Sometimes a combination of rechargeable and non-rechargeable battery packs is provided. Other embodiments of power source  240  can include an alternating current (AC) power override, for where AC power will be available, an energy-storing capacitor or bank of capacitors, and so on. Appropriate components may be included to provide for charging or replacing power source  240 . In some embodiments, power source  240  is controlled and/or monitored by processor  230 . 
     Defibrillator  200  additionally may include an energy storage module  250 . Energy storage module  250  can be coupled to the support structure  170  of the WCD system  10 , for example either directly or via the electrodes and their leads. Module  250  is where some electrical energy can be stored temporarily in the form of an electrical charge when preparing it for discharge to administer a shock. In some embodiments, module  250  can be charged from power source  240  to the desired amount of energy as controlled by processor  230 . In typical implementations, module  250  includes a capacitor  252  which can be a single capacitor or a system or bank of capacitors, and so on. In some embodiments, energy storage module  250  includes a device that exhibits high power density such as an ultracapacitor. As described above, capacitor  252  can store the energy in the form of an electrical charge for delivering to the patient. 
     A decision to shock can be made responsive to the shock criterion being met, as per the above-mentioned determination. When the decision is to shock, processor  230  can be configured to cause at least some or all of the electrical charge stored in module  250  to be discharged through patient  82  while the support structure is worn by patient  82  so as to deliver a shock  111  to patient  82 . 
     For causing the discharge, defibrillator  200  can include a discharge circuit  255 . When the decision is to shock, processor  230  can be configured to control discharge circuit  255  to discharge through the patient  82  at least some or all of the electrical charge stored in energy storage module  250 . Discharging can be to nodes  214  and/or  218 , and from there to defibrillation electrodes  204  and/or  208 , so as to cause a shock to be delivered to the patient. Circuit  255  can include one or more switches  257 . Switches  257  can be made in a number of ways, such as by an H-bridge, and so on. Circuit  255  could also be thus controlled via processor  230 , and/or user interface  280 . 
     A time waveform of the discharge may be controlled by thus controlling discharge circuit  255 . The amount of energy of the discharge can be controlled by how much energy storage module has been charged, and by how long discharge circuit  255  is controlled to remain open. Defibrillator  200  optionally can include other components. 
       FIG. 3  is a diagram of sample embodiments of components of a WCD system and an WVSM monitor in accordance with one or more embodiments. A support structure  370  includes a vest-like wearable garment. Support structure  370  has a back side  371 , and a front side  372  that closes in front of the chest of the patient. In some examples, WVSM  150  can operate as part of WCD system  10  as discussed in further detail below. 
     The WCD system  10  of  FIG. 3  can include an external defibrillator  300 .  FIG. 3  does not show any support for external defibrillator  300 , which may be carried in a purse, on a belt, by a strap over the shoulder, and so on. Wires  305  connect external defibrillator  300  to electrodes  304 ,  308 , and/or  309 . Of those, electrodes  304  and  308  are defibrillation electrodes, and electrodes  309  are ECG sensing electrodes. 
     Support structure  370  is configured to be worn by the ambulatory patient to maintain electrodes  304 ,  308 , and/or  309  on a body of the patient. Back defibrillation electrodes  308  can be maintained in pockets  378 . The inside of pockets  378  can be made with loose netting, so that electrodes  308  can contact the back of the patient  82 , especially with the help of the conductive fluid that has been deployed in such embodiments. In addition, sensing electrodes  309  are maintained in positions that surround the patient&#39;s torso, for sensing ECG signals and/or the impedance of the patient  82 . 
     ECG signals in a WCD system  10  may include too much electrical noise to be useful. To ameliorate the problem, multiple ECG sensing electrodes  309  are provided, for presenting many options to processor  230 . These options are different vectors for sensing the ECG signal, as described in more detail below. 
     In accordance with one or more embodiments, WVSM  150  can communicate with external defibrillator  300 , for example via a wireless communication link  310  in some embodiments. In other embodiments, WVSM  150   150  also can communicate with external defibrillator  300  via a wired communication link, and the scope of the disclosed subject matter is not limited in this respect. 
       FIG. 4  is a diagram illustrating WVSM monitoring categories and the respective example physiological signals in each category in accordance with one or more embodiments. 
     A WVSM  150  as described herein can be configured to acquire specific physiologic signals at optimal times to maximize the accuracy of the recorded data and enable a WVSM  150  to accurately monitor any physiologic signal that can be acquired non-invasively. In embodiments, any physiologic signal can be categorized into at least one of several different acquisition frequency categories. In one example categorization arrangement  400  as shown in  FIG. 4 , physiological signals can be assigned to one of following three categories. A first monitoring category  410  can comprise Continuous 24/7 Monitoring. Physiological signals in this category  410  are monitored continuously while the WVSM  150  is being worn by the patient  82  or user. Some examples of physiological parameters that can fall under the Continuous 24/7 Monitoring category  410  can include arrythmia detection  416 , heart rate histograms  418 , atrial fibrillation (AF) burden  420 , peripheral capillary oxygen saturation (SpO2)  422 , activity and/or steps  424 , respiration rate  426 , core body temperature  428 , hemodynamic parameters  430 , or hydration  432 , among others. 
     A second monitoring category  412  can comprise Automatic Sedentary Monitoring. Physiological signals in this category can be automatically monitored when the WVSM  150  determines that the patient  82  or user is sedentary or otherwise meets the criteria for a “resting” measurement. Some examples of physiological parameters that can fall under the Automatic Sedentary Monitoring category  412  can include resting heart rate  434 , body position  436 , daily snapshot  438 , blood pressure  440 , resting respiration rate  442 , or heart rate trend  444 , among others. 
     An example procedure for determining that the physiological signals that can fall within the Automatic Sedentary Monitoring category  412  to be acquired can include be any combination of the following. (a) Time-based via a one-time user input of “active” hours and “sedentary” hours; (b) Time-based via time of day (e.g. nighttime); (c) Sensed low activity or sleeping period using an accelerometer in the WVSM  150 ; (d) Triggered using analysis of the signals acquired by various sensors for the continuous 24/7 monitoring, for example the signals acquired by the continuous ECG sensors could be characterized as “not noisy”, thereby triggering a sedentary recording of other physiologic signals; or (e) Triggered using sensed physiologic signals, for example a respiration rate below a certain threshold for a certain period of time could trigger a sedentary resting heart rate recording. 
     A third monitoring category  416  can comprise Manual Spot Measurements. Physiological signals in this category  416  can be monitored via manual intervention from the patient  82  or user, which can be triggered by user input to the WVSM  150 , by physical attachment of an accessory component to acquire the signal, or by wireless communication with a compatible device. Some examples of physiological parameters that can fall under the Manual Spot Measurements category  414  can include body weight  446 , blood glucose  448 , or blood alcohol concentration (BAC)  450 , among others. 
     In one example, as shown in  FIG. 3 , WVSM  150  can wirelessly communicate with WCD system  10  wherein WCD system  10  can obtain an ECG reading from the patient  82  and transmit the ECG reading to WSVM  150  for display, processing, or saving of the ECG reading. The ECG reading in can be obtained by the patient  82  initiating the WVSM  150  to obtain the ECG reading from the WCD system  10 . In another example, WVSM  150  can be wirelessly coupled to a scale (not shown) and the weight reading from the scale can be wireless transmitted to the WVSM  150  for display, processing, or saving of the weight reading. Many other examples of Manual Spot Readings  414  can be utilized, and the scope of the disclosed subject matter is not limited in this respect. 
     In some embodiments, in addition to the physiological signals being sorted into frequency categories, the same physiological signal could be recorded continuously, while sedentary, and also manually, and then aggregated together to form an optimal, combined, or representative view of the physiologic signal. In some embodiments, the effect of noise or other artifacts on a continuous signal can be offset or factored out by the influence of a more accurate sedentary recording. An example of aggregating the same physiological signal taken at different times and/or in different categories is shown in and described with respect to  FIG. 5 , below. 
       FIG. 5  is a diagram illustrating WVSM acquisition of a heart rate signal as an example in accordance with one or more embodiments. In  FIG. 5 , aggregation process  500  can comprise obtaining a heart rate trend  510  using a Continuous 24/7 Monitoring process  410 . In addition, a sedentary heart rate trend  512  can be obtained using an Automatic Sedentary Monitoring process  412 . Furthermore, a manual heart rate trend measurement  514  for X amount of time can be obtained using a Manual Spot Measurements process  414 . An aggregated optimal heart rate trend  516  can be obtained by combining the measurements from the categories, optionally applying weighting and/or rules to the measurements. 
     Table 1 below illustrates an example in which physiological signal aggregation and processing can be performed to generate optimal heart rate values that can be used to find a heart rate trend  516 . In one example, the continuous heart rate trend measurement  510  can be recorded once per minute regardless of the presence of noise in a simple implementation. In some embodiments, when the WVSM  150  determines that it is time to acquire a sedentary heart rate, for example per the three categories described above, the sedentary heart rate trend measurement  512  value can be aggregated with the continuous measurement  510  result for that particular minute and weighted with more importance than the continuous measurement  510 . For example, the sedentary heart rate trend measurement  512  can be weighted at 80 percent whereas the continuous heart rate trend measurement  510  can be weighted at 20 percent. Such an aggregation with weighting can result in a more accurate or representative aggregated heart rate trend, for example as shown in Table 1 below. Furthermore, a manual spot measurement  514  also can be aggregated into the overall trend, for example with no specific weighting to the measurement wherein the reading can stand alone. It is noted that these are merely examples of how measurements can be aggregated and/or weighted, and the scope of the disclosed subject matter is not limited in these respects. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Example heart rate signal aggregation 
               
            
           
           
               
               
               
               
            
               
                 Time 
                 Continuous Result 
                 Sedentary Result 
                 Aggregated Result 
               
               
                   
               
               
                 2:00:00 
                 65 bpm 
                 None 
                 2:00 - 65 bpm 
               
               
                 2:01:00 
                 150 bpm (noisy) 
                 None 
                 2:01 - 75 bpm 
               
               
                 2:01:15 
                 None 
                 56 bpm 
               
               
                 2:02:00 
                 70 bpm 
                 None 
                 2:02 - 70 bpm 
               
               
                 2:02:48 
                   
                   
                 +Manual - 82 bpm     
               
               
                   
               
            
           
         
       
     
     As shown in Table 1, at time 2:00:00 only a continuous heat rate measurement  510  was taken having a value of 65 beats per minute (bpm). The aggregated result for 2:00 is then 65 bpm. At time 2:01:00 a continuous result of 150 bpm was taken and flagged as noisy. For example, this higher reading is likely to be not entirely accurate. At time 2:01:15, a sedentary heart rate measurement  512  was obtained resulting in a value of 68 bpm. The sedentary result of 68 bpm can be weighted at 80% and combined with the continuous result weighted at 20% to result in an aggregated value at time 2:01 of (0.2) (150)+(0.8) (56)=75 bpm. At time 2:02:00 only a continuous heat rate measurement  510  was taken having a value of 70 bpm. The aggregated result for 2:02 is then 70 bpm. At time 2:02:48, only a single manual spot measurement was taken, with the resulting aggregated result of 82 bpm. It is noted that these are merely examples illustrating how measurements can be aggregated and/or weighted over multiple categories of measurement, and the scope of the disclosed subject matter is not limited in these respects. 
     In one or more example embodiments, aggregated measurements or a measurement trend, or both, can be presented to a user, patient  82 , or a professional such as a doctor, physician assistant, nurse, technician, patient advocate, or other healthcare provider, and so on, for example on a display of the WVSM  150 . In some examples, the aggregated measurements or measurement trend can be transmitted to a smartphone, tablet, computer, or similar computing device that is directly connected or wirelessly connected to the WVSM  150 , or that is remotely connected the WVSM  150  via a network. Such remotely located devices and/or personnel use the aggregated measurements or measurement trend to provide assistance, medical care, or well-being advice, and so on, to the user or patient  82  based at least in part on the aggregated measurements or measurement trend. It should be noted these are merely examples of other devices and/or personnel that the aggregated measurements or trends can be transmitted to and monitored, and the scope of the claimed subject matter is not limited in these respects. 
     Referring now to  FIG. 6 , a flow diagram of a method of acquiring a patient physiological parameter using two or more categories of monitoring in accordance with one or more embodiments will be discussed. Although  FIG. 6  shows one particular order and number of operations for method  600 , various other orders or numbers of operations may be provided in alternative embodiments, and the scope of the disclosed subject matter is not limited in these respects. Method  600  illustrates one example of how physiological parameters can be obtained using different monitoring categories and then aggregated. At operation  610 , a first measurement of a patient physiological parameter can be obtained based at a first frequency based on Continuous 24/7 Monitoring  410 . In some examples, the first frequency can be continuous or can occur sufficiently often per a unit time to be considered continuous. Optionally, at operation  612 , a first weighting can be applied to the first measurement. At operation  614 , a determination can be made whether the patient  82  is sedentary. If not, then the Continuous 24/7 Monitoring  410  can continue at operation  610 . If the patient  82  is stationary, then a second measurement of the patient physiological parameter can be obtained at a second frequency based on Automatic Sedentary Monitoring  412 . For example, the frequency of such measurements can be obtained whenever the WSVM  150  detects that the patient  82  is sedentary or inactive. Optionally, a second weighting can be applied at operation  618  to the second measurement. The first and the second measurements can then be aggregated to obtain a trend at operation  620 . 
     In some examples, a determination can be made at operation  620  whether a spot measurement should be made. If not, method  600  can continue at operation  610 . If a spot measurement should be made, for example as triggered by the user or patient  82 , or in response to some other device requesting the measurement such as a scale in response to the user or patient  82  stepping on the scale, then at operation  622  a third measurement can be obtained at a third frequency based on Manual Spot Measurement monitoring  414 . Then, the third measurement can be aggregated with the first measurement, the second measurement, or both, at operation  624 . In some examples, the third measurement can be obtained as a stand alone measurement in the aggregation to be compared with other aggregated measurements, although the scope of the disclosed subject matter is not limited in this respect. 
     Although the claimed subject matter has been described with a certain degree of particularity, it should be recognized that elements thereof may be altered by persons skilled in the art without departing from the spirit and/or scope of claimed subject matter. It is believed that the subject matter pertaining to a wearable vital signs monitor with selective signal acquisition and many of its attendant utilities will be understood by the forgoing description, and it will be apparent that various changes may be made in the form, construction and/or arrangement of the components thereof without departing from the scope and/or spirit of the claimed subject matter or without sacrificing all of its material advantages, the form herein before described being merely an explanatory embodiment thereof, and/or further without providing substantial change thereto. It is the intention of the claims to encompass and/or include such changes.