Prediction of Bradycardia using Decision Tree Algorithm and Comparing the Accuracy with Support Vector Machine

This study compares the Accuracy of Support Vector Machine (SVM) Classifier and Decision Tree (DT) Classifier in predicting Innovative Bradycardia disease diagnosis. Materials and Methods: There are 7,500 records in the dataset that was used for this investigation. 40 records are utilized in the test to get a 95% confidence level in Accuracy and a 1% margin of error. There are 12 qualities or features per record. Using Decision Tree and SVM, Innovative Bradycardia disease is detected. Results: According to the statistical analysis, the Accuracy of the Decision Tree Classifier was 92.62%, P<0.05, and the Accuracy of the SVM was 87.5%, P<0.05. The p value was calculated as 0.001 (p<0.05, independent sample t-test indicating a statistically significant difference in the accuracy rates between the two algorithms (SVM and DT). Conclusion: In the Innovative Bradycardia prediction task, the Decision Tree Classifier (92.5%) exhibited a significant improvement over the SVM (87.5%), as demonstrated by the findings of the present study

Advances in Electrocardiograms

Electrocardiograms have become one of the most important, and widely used medical tools for diagnosing diseases such as cardiac arrhythmias, conduction disorders, electrolyte imbalances, hypertension, coronary artery disease and myocardial infarction. This book reviews recent advancements in electrocardiography. The four sections of this volume, Cardiac Arrhythmias, Myocardial Infarction, Autonomic Dysregulation and Cardiotoxicology, provide comprehensive reviews of advancements in the clinical applications of electrocardiograms. This book is replete with diagrams, recordings, flow diagrams and algorithms which demonstrate the possible future direction for applying electrocardiography to evaluating the development and progression of cardiac diseases. The chapters in this book describe a number of unique features of electrocardiograms in adult and pediatric patient populations with predilections for cardiac arrhythmias and other electrical abnormalities associated with hypertension, coronary artery disease, myocardial infarction, sleep apnea syndromes, pericarditides, cardiomyopathies and cardiotoxicities, as well as innovative interpretations of electrocardiograms during exercise testing and electrical pacing

Master of Science

thesisRecent neonatal research suggests a causal pathway between premature birth, altered fat deposition, and metabolic disease later in life. Specifically, one study reported that preterm infants display altered adiposity with greater visceral adiposity at term-corrected age than term infants. In adults, increased visceral adiposity is associated with glucose intolerance independent of obesity. Therefore, identification of clinical measures of visceral adiposity may improve identification of at-risk infants. We measured anthropometrics, air displacement plethysmography, and visceral and subcutaneous tissue volumes using magnetic resonance imaging in preterm infants (n=12) born at <34 weeks gestational age at hospital discharge, and in term-born infants (n=12). Our data provide evidence of increased total and visceral adiposity by magnetic resonance imaging in preterm infants. Preterm infants had significantly greater percent body fat by air displacement plethysmography (p < 0.001) with higher total (p < 0.001) and visceral adiposity (p = 0.01) by magnetic resonance imaging at hospital discharge, as compared to term infants. Preterm infant visceral adiposity, when measured by magnetic resonance imaging, was correlated with weight (r = 0.70, p = 0.04), length (r = 0.77, p = 0.02), head circumference (r = 0.75, p = 0.02), mid-arm circumference (r = 0.72, p = 0.03), subscapular skinfold thickness (r = 0.86, p = 0.003), and suprailiac skinfold thickness (r = 0.73, p = 0.03). Overall, the study results indicate that low-cost anthropometric measures correlate with total, visceral, and subcutaneous adipose tissue by magnetic resonance imaging in preterm infants. Furthermore, these data provide preliminary findings to support the development of regression equations to identify preterm infants at risk of metabolic complications later in life

Seizures in Pre-term Infants Less than 29 Weeks: Incidence, Etiology, and Response to Treatment

Introduction. Seizures are neurological emergencies with short- and long-term adverse effects in pre-term infants. They may present with or without abnormal movements (clinical versus subclinical). Thus, the true incidence of seizures may be under-reported. Current research indicates that most seizures occur in the first few days of life, are associated with intraventricular hemorrhage (IVH), and show low response to anticonvulsant drugs. The purpose of this study was to evaluate incidence, etiology, clinical antecedents, mortality, and response to treatment of seizures in extremely pre-term infants. Methods. This is a retrospective cohort study of pre-term infants &lt; 29 weeks gestation from January 2011 to December 2013. Presence or absence of seizure was the outcome. Data extraction included demographics, medications, co-morbidities, mortality, and details of seizures. A multivariable prediction model was developed to evaluate risk for seizures. Results. Analysis included 269 pre-term infants. Incidence of EEG-confirmed seizures was 40% (108/269); 49% were clinical and 51% were subclinical. Seizures occurred in 72% of infants ≤ 24 weeks, 57% of those 25-26 weeks, and 23% of those 27-28 weeks. Most seizures (85%) occurred after day eight of life. Mortality was 14% in those with seizures versus 5% in those without (p = 0.019). The model showed seizures were associated significantly with gestational age and medications, while controlling for sex, APGAR score, and co-morbidities, including IVH. At discharge, anticonvulsants were continued in 66% (72/108) of infants with seizures. Conclusion. The incidence of seizures was highest in infants born most premature. Contrary to previous research, nearly two-thirds of pre-term infants with seizures did not have IVH or cystic periventricular leukomalacia; apnea of prematurity was a common presentation of subclinical seizures; and the majority of treated infants responded to Phenobarbital. These findings need be explored in future research

Evidence-based enteral feeding for preterm or low birth weight infants : systematic review of the use of protein hydrolysate formula

Infants born preterm, especially those born very preterm, are at elevated risk of mortality and morbidity secondary to organ immaturity and exposure to intensive and invasive care practices and procedures. Although care and outcomes for preterm infants have improved substantially over the past forty years, major challenges remain including the need for better strategies to prevent or treat complications such as necrotising enterocolitis and severe infection. These complications are the most common causes of death and disability after the early neonatal period for preterm infants and are associated with life-long health consequences and costs.This thesis first presents an overview of the epidemiology, causes, and risk factors for preterm birth, and a summary of the interventions for improving outcomes for preterm infants. I then describe the current understanding of the pathogenesis of necrotising enterocolitis, its impact on growth and development, and the evidence-base for interventions to prevent this condition. This discussion focusses on nutritional strategies, and particularly on how the timing and type of enteral feeding affects gut physiology and health, feed tolerance, and the risk of necrotising enterocolitis in preterm infants.The main body of the thesis consists of a Cochrane review of a specific enteral feeding option for preterm infants – the use of formula containing hydrolysed protein rather than standard formula. This costly strategy has become widely adopted in high-income countries based on perceptions that protein hydrolysate formulas are tolerated better by the immature gastro-intestinal tract, and are less likely to lead to complications including necrotising enterocolitis. Using Cochrane methods, we conducted the first systematic review of the evidence-base for this intervention. We found ten eligible randomised controlled trials (total participants 600). Meta-analyses did not show any significant differences in feed intolerance or necrotising enterocolitis, calling into question current policies and practice in neonatal units in high-income countries

Development and clinical impact assessment of a machine-learning model for early prediction of late-onset sepsis

Background and aim: Preterm infants are prone to neonatal infections such as late-onset sepsis (LOS). The consequences of LOS can be severe and potentially life-threatening. Unfortunately, LOS often presents with unspecific symptoms, and early screening laboratory tests have limited diagnostic value and are often late. This study aimed to build a predictive algorithm to aid doctors in the early detection of LOS in very preterm infants. Methods: In a retrospective cohort study, all consecutively admitted preterm infants (GA ≤ 32 weeks) from 2008 until 2019 were included. They were classified as LOS or control according to blood culture results, currently the gold standard. To generate features, routine and continuously measured oxygen saturation and heart rate data with a minute-by-minute sampling rate were extracted from electronic medical records. Care was taken not to include variables indicative of existing LOS suspicion. The timing of a positive blood culture served as a proxy for LOS-onset. An equivalent timestamp was generated in gestational-age-matched control patients without a positive blood culture. Three machine learning (ML) techniques (generalized additive models, logistic regression, and XGBoost) were used to build a classification algorithm. To simulate the performance of the algorithm in clinical practice, a simulation using multiple alarm thresholds was performed on hourly predictions for the total hospitalization period. Results: 292 infants with LOS were matched to 1497 controls. The median gestational age before matching was 28.1 and 30.3 weeks, respectively. Evaluation of the overall discriminative power of the LR algorithm yielded an AUC of 0.73 (p < 0.05) at the moment of clinical suspicion (t = 0). In the longitudinal simulation, our algorithm detects LOS in at least 47% of the patients before clinical suspicion without exceeding the alarm fatigue threshold of 3 alarms per day. Furthermore, medical experts evaluated the algorithm as clinically relevant regarding the feature contributions in the model explanations. Conclusions: An ML algorithm was trained for the early detection of LOS. Performance was evaluated on both prediction horizons and in a clinical impact simulation. To the best of our knowledge, our assessment of clinical impact with a retrospective simulation on longitudinal data is the most extensive in the literature on LOS prediction to date. The clinically relevant algorithm, based on routinely collected data, can potentially accelerate clinical decisions in the early detection of LOS, even with limited inputs

Informing the design of a trial of kangaroo mother care initiated before stabilisation amongst small and sick newborns in a sub-Saharan African context using mixed methods

An estimated 2.5 million neonates die every year, with preterm birth being the leading cause. Sub-Saharan Africa and southern Asia account for 78% of neonatal deaths. The WHO recommends kangaroo mother care (KMC) for stabilised newborns ≤2000g; however, most deaths occur before stabilisation. An evidence gap exists regarding KMC for this population. The overall aim of this PhD was to inform the design of a trial of KMC initiated before stabilisation in a sub-Saharan African context. The first part focused on assessing facility readiness and quantifying neonatal mortality risk. Cascade models were developed and used to assess 23 East African facilities. A logistic model was derived and validated using data from 187 UK hospitals and one Gambian hospital. The final model, including three parameters, demonstrated very good performance. The score requires further validation in low-resource contexts, but has potential to improve neonatal resource allocation. The second part of this PhD focused on evaluating the feasibility of initiating KMC before stabilisation and designing the trial. This study showed it was feasible to monitor and provide care in the KMC position, and found the intervention was acceptable to parents and providers. Launched in 2020, the OMWaNA trial will determine the mortality impact of this intervention within 7 days relative to standard care at four Ugandan hospitals. Process and economic evaluations will explore causal pathways for clinical effects, estimate incremental cost and costeffectiveness, and examine barriers and facilitators to inform uptake and sustainability. This PhD has developed a cascade model to assess facility readiness, validated a score to assess individual risk, and demonstrated the feasibility of initiating KMC before stabilisation. These studies have informed the design of a trial evaluating the mortality impact of this intervention in Uganda. The findings are expected to have broad applicability to low-resource hospitals and important policy implications

A Comprehensive Review of Hypertension in Pregnancy

Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals