Validation of a test for the physical performance evaluation of elderly and diseased subjects

In questo lavoro di tesi è stato validato un test sottomassimale per la valutazione funzionale di soggetti con prestazioni fisiche limitate (anziani e pazienti con malattie cardiovascolari), anche inseriti in programmi riabilitativi. Il "test of performance" (TOP) è di facile esecuzione, rappresenta un'alternativa al "test cardiopolmonare", molto più complesso, e prevede lo sviluppo di strumentazione e algoritmi di valutazione specifici. Nella modalità più semplice viene registrato il solo segnale elettrocardiografico (ECG) durante una prova da sforzo a basso carico, eseguita secondo un protocollo che prevede la suddivisione del test in due fasi. Nella prima fase si svolge il "tilt test" in cui il paziente passa dal clinostatismo all'ortostatismo, per valutare la funzionalità del sistema nervoso autonomo. Nella seconda fase il paziente esegue il test da sforzo sul cicloergometro a due carichi di lavoro diversi, inizialmente un carico lieve e poi uno moderato. Il test è basato sull'analisi delle modalità di adeguamento elettrocardiografico ai diversi livelli di sforzo e nella fase di recupero. Il segnale acquisito durante il tilt test è analizzato utilizzando metodi che quantificano la variabilità della frequenza cardiaca (HRV), che permette di valutare il bilanciamento tra l'attività del sistema vagale e del sistema simpatico. L'analisi HRV viene eseguita nel dominio del tempo, e nel dominio della frequenza. Il segnale elettrocardiografico rilevato durante la successiva fase a carico crescente, viene analizzato valutando le modalità di adeguamento della frequenza cardiaca sia per i cambiamenti sia per le stabilizzazioni. Particolare attenzione viene data all'analisi della fase adattativa al diverso carico e alla fase di recupero dopo lo sforzo. Da queste analisi, mediate confronto tra diverse classi di pazienti, si ritiene di potere ottenere parametri quantitativi di efficienza funzionale

The Application of the Extended Poincaré Plot in the Analysis of Physiological Variabilities

The Poincaré plot is a geometrical technique used to visualize and quantify the correlation between two consecutive data points in a time-series. Since the dynamics of fluctuations in physiological rhythms exhibit long-term correlation and memory, this study aimed to extend the Poincaré plot by calculating the correlation between sequential data points in a time-series, rather than between two consecutive points. By incorporating this so-called lag, we hope to integrate a temporal aspect into quantifying the correlation, to depict whether a physiological system holds prolonged association between events separated by time. In doing so, it attempts to instantaneously characterize the intrinsic behavior of a complex system. We tested this hypothesis on three different physiological time-series: heart rate variability in patients with liver cirrhosis, respiratory rhythm in asthma and body temperature fluctuation in patients with cirrhosis, to evaluate the potential application of the extended Poincaré method in clinical practice. When studying the cardiac inter-beat intervals, the extended Poincaré plot revealed a stronger autocorrelation for patients with decompensated liver cirrhosis compared to less severe cases using Pearson’s correlation coefficient. In addition, long-term variability (known as SD2 in the extended Poincaré plot) appeared as an independent prognostic variable. This holds significance by acting as a non-invasive tool to evaluate patients with chronic liver disease and potentially facilitate transplant selection as an adjuvant to traditional criteria. For asthmatics, employing the extended Poincaré plot allowed for a non-invasive tool to differentially diagnose various classifications of respiratory disease. In the respiratory inter-breath interval analysis, the receiver operating characteristic (ROC) curve provided evidence that the extension of the Poincaré plot holds a greater advantage in the classification of asthmatic patients, over the traditional Poincaré plot. Lastly, the analysis of body temperature from patients using the extended Poincaré plot helped identify inpatients from outpatients with cirrhosis. Through these analyses, the extended Poincaré plot provided unique and additional information which could potentially make a difference in clinical practice. Conclusively, the potential use of our work lies in its possible application of predicting mortality for the organ allocation procedure in patients with cirrhosis and non-invasively distinguish between atopic and non-atopic asthma

The Application of the Extended Poincaré Plot in the Analysis of Physiological Variabilities

The Poincaré plot is a geometrical technique used to visualize and quantify the correlation between two consecutive data points in a time-series. Since the dynamics of fluctuations in physiological rhythms exhibit long-term correlation and memory, this study aimed to extend the Poincaré plot by calculating the correlation between sequential data points in a time-series, rather than between two consecutive points. By incorporating this so-called lag, we hope to integrate a temporal aspect into quantifying the correlation, to depict whether a physiological system holds prolonged association between events separated by time. In doing so, it attempts to instantaneously characterize the intrinsic behavior of a complex system. We tested this hypothesis on three different physiological time-series: heart rate variability in patients with liver cirrhosis, respiratory rhythm in asthma and body temperature fluctuation in patients with cirrhosis, to evaluate the potential application of the extended Poincaré method in clinical practice. When studying the cardiac inter-beat intervals, the extended Poincaré plot revealed a stronger autocorrelation for patients with decompensated liver cirrhosis compared to less severe cases using Pearson’s correlation coefficient. In addition, long-term variability (known as SD2 in the extended Poincaré plot) appeared as an independent prognostic variable. This holds significance by acting as a non-invasive tool to evaluate patients with chronic liver disease and potentially facilitate transplant selection as an adjuvant to traditional criteria. For asthmatics, employing the extended Poincaré plot allowed for a non-invasive tool to differentially diagnose various classifications of respiratory disease. In the respiratory inter-breath interval analysis, the receiver operating characteristic (ROC) curve provided evidence that the extension of the Poincaré plot holds a greater advantage in the classification of asthmatic patients, over the traditional Poincaré plot. Lastly, the analysis of body temperature from patients using the extended Poincaré plot helped identify inpatients from outpatients with cirrhosis. Through these analyses, the extended Poincaré plot provided unique and additional information which could potentially make a difference in clinical practice. Conclusively, the potential use of our work lies in its possible application of predicting mortality for the organ allocation procedure in patients with cirrhosis and non-invasively distinguish between atopic and non-atopic asthma

Heart Rate Variability (HRV) analysis : a methodology for organizational neuroscience

Recently, the application of neuroscience methods and findings to the study of organizational phenomena has gained significant interest and converged in the emerging field of organizational neuroscience. Yet, this body of research has principally focused on the brain, often overlooking fuller analysis of the activities of the human nervous system and associated methods available to assess them. In this paper, we aim to narrow this gap by reviewing heart rate variability (HRV) analysis, which is that set of methods assessing beat-to-beat changes in the heart rhythm over time, used to draw inference on the outflow of the autonomic nervous system (ANS). In addition to anatomo- physiological and detailed methodological considerations, we discuss related theoretical, ethical, and practical implications. Overall, we argue that this methodology offers the opportunity not only to inform on a wealth of constructs relevant for management inquiries, but also to advance the organizational neuroscience research agenda and its ecological validity

Estimating spectral HRV features with missing data

Abstract. Physiological signals, ECG signal, have been widely used for diagnosis, disease identification and nowadays for self-monitoring. Missing data represents the problem in spectral analysis. This study focuses on the HRV power spectral analysis in frequency-domain using three methods with simulated missing data in real RR interval tachograms. Actual missing ECG data are collected from the unconstrained measurement. Parametric, Non-parametric and uneven sampling approach were used for calculating the power spectral density (PSD), and cubic spline interpolation method was used for the non-parametric method. Based on this studies outcome, the effect of missing R-R interval data and optimal method was observed through the simulated real R-R interval tachograms for missing data. About 0 to 6 percentage data were removed according to the exponential Poisson distribution from the real R-R interval data for normal sinus rhythm, atrial fibrillation, tachycardia and bradycardia patient which data obtained from MIT-BIH Arrhythmia database to simulate real-world packet loss. For this analysis, 5 min duration data were used in all and 1000 Monte Carlo runs is performed for certain percentage missing data. Power spectral density (PSD) corresponding each frequency component was estimated as the frequency-domain parameters in each run and error power percentage based on each element difference between with and without the missing data duration were calculated. In addition, this study revealed that power spectral entropy measurement from power spectral density which differentiates between different arrhythmias

Design, Evaluation, and Application of Heart Rate Variability Analysis Software (HRVAS)

The analysis of heart rate variability (HRV) has become an increasingly popular and important tool for studying many disease pathologies in the past twenty years. HRV analyses are methods used to non-invasively quantify variability within heart rate. Purposes of this study were to design, evaluate, and apply an easy to use and open-source HRV analysis software package (HRVAS). HRVAS implements four major categories of HRV techniques: statistical and time-domain analysis, frequency-domain analysis, nonlinear analysis, and time-frequency analysis. Software evaluations were accomplished by performing HRV analysis on simulated and public congestive heart failure (CHF) data. Application of HRVAS included studying the effects of hyperaldosteronism on HRV in rats. Simulation and CHF results demonstrated that HRVAS was a dependable HRV analysis tool. Results from the rat hyperaldosteronism model showed that 5 of 26 HRV measures were statistically significant (p\u3c0.05). HRVAS provides a useful tool for HRV analysis to researchers

Multimodal Signal Processing for Diagnosis of Cardiorespiratory Disorders

This thesis addresses the use of multimodal signal processing to develop algorithms for the automated processing of two cardiorespiratory disorders. The aim of the first application of this thesis was to reduce false alarm rate in an intensive care unit. The goal was to detect five critical arrhythmias using processing of multimodal signals including photoplethysmography, arterial blood pressure, Lead II and augmented right arm electrocardiogram (ECG). A hierarchical approach was used to process the signals as well as a custom signal processing technique for each arrhythmia type. Sleep disorders are a prevalent health issue, currently costly and inconvenient to diagnose, as they normally require an overnight hospital stay by the patient. In the second application of this project, we designed automated signal processing algorithms for the diagnosis of sleep apnoea with a main focus on the ECG signal processing. We estimated the ECG-derived respiratory (EDR) signal using different methods: QRS-complex area, principal component analysis (PCA) and kernel PCA. We proposed two algorithms (segmented PCA and approximated PCA) for EDR estimation to enable applying the PCA method to overnight recordings and rectify the computational issues and memory requirement. We compared the EDR information against the chest respiratory effort signals. The performance was evaluated using three automated machine learning algorithms of linear discriminant analysis (LDA), extreme learning machine (ELM) and support vector machine (SVM) on two databases: the MIT PhysioNet database and the St. Vincent’s database. The results showed that the QRS area method for EDR estimation combined with the LDA classifier was the highest performing method and the EDR signals contain respiratory information useful for discriminating sleep apnoea. As a final step, heart rate variability (HRV) and cardiopulmonary coupling (CPC) features were extracted and combined with the EDR features and temporal optimisation techniques were applied. The cross-validation results of the minute-by-minute apnoea classification achieved an accuracy of 89%, a sensitivity of 90%, a specificity of 88%, and an AUC of 0.95 which is comparable to the best results reported in the literature

ARFIMA-GARCH modeling of HRV: Clinical application in acute brain injury

In the last decade, several HRV based novel methodologies for describing and assessing heart rate dynamics have been proposed in the literature with the aim of risk assessment. Such methodologies attempt to describe the non-linear and complex characteristics of HRV, and hereby the focus is in two of these characteristics, namely long memory and heteroscedasticity with variance clustering. The ARFIMA-GARCH modeling considered here allows the quantification of long range correlations and time-varying volatility. ARFIMA-GARCH HRV analysis is integrated with multimodal brain monitoring in several acute cerebral phenomena such as intracranial hypertension, decompressive craniectomy and brain death. The results indicate that ARFIMA-GARCH modeling appears to reflect changes in Heart Rate Variability (HRV) dynamics related both with the Acute Brain Injury (ABI) and the medical treatments effects. (c) 2017, Springer International Publishing AG

Heart Diseases Diagnosis Using Artificial Neural Networks

Information technology has virtually altered every aspect of human life in the present era. The application of informatics in the health sector is rapidly gaining prominence and the benefits of this innovative paradigm are being realized across the globe. This evolution produced large number of patients’ data that can be employed by computer technologies and machine learning techniques, and turned into useful information and knowledge. This data can be used to develop expert systems to help in diagnosing some life-threating diseases such as heart diseases, with less cost, processing time and improved diagnosis accuracy. Even though, modern medicine is generating huge amount of data every day, little has been done to use this available data to solve challenges faced in the successful diagnosis of heart diseases. Highlighting the need for more research into the usage of robust data mining techniques to help health care professionals in the diagnosis of heart diseases and other debilitating disease conditions. Based on the foregoing, this thesis aims to develop a health informatics system for the classification of heart diseases using data mining techniques focusing on Radial Basis functions and emerging Neural Networks approach. The presented research involves three development stages; firstly, the development of a preliminary classification system for Coronary Artery Disease (CAD) using Radial Basis Function (RBF) neural networks. The research then deploys the deep learning approach to detect three different types of heart diseases i.e. Sleep Apnea, Arrhythmias and CAD by designing two novel classification systems; the first adopt a novel deep neural network method (with Rectified Linear unit activation) design as the second approach in this thesis and the other implements a novel multilayer kernel machine to mimic the behaviour of deep learning as the third approach. Additionally, this thesis uses a dataset obtained from patients, and employs normalization and feature extraction means to explore it in a unique way that facilitates its usage for training and validating different classification methods. This unique dataset is useful to researchers and practitioners working in heart disease treatment and diagnosis. The findings from the study reveal that the proposed models have high classification performance that is comparable, or perhaps exceed in some cases, the existing automated and manual methods of heart disease diagnosis. Besides, the proposed deep-learning models provide better performance when applied on large data sets (e.g., in the case of Sleep Apnea), with reasonable performance with smaller data sets. The proposed system for clinical diagnoses of heart diseases, contributes to the accurate detection of such disease, and could serve as an important tool in the area of clinic support system. The outcome of this study in form of implementation tool can be used by cardiologists to help them make more consistent diagnosis of heart diseases

Advanced Signal Processing in Wearable Sensors for Health Monitoring

Smart, wearables devices on a miniature scale are becoming increasingly widely available, typically in the form of smart watches and other connected devices. Consequently, devices to assist in measurements such as electroencephalography (EEG), electrocardiogram (ECG), electromyography (EMG), blood pressure (BP), photoplethysmography (PPG), heart rhythm, respiration rate, apnoea, and motion detection are becoming more available, and play a significant role in healthcare monitoring. The industry is placing great emphasis on making these devices and technologies available on smart devices such as phones and watches. Such measurements are clinically and scientifically useful for real-time monitoring, long-term care, and diagnosis and therapeutic techniques. However, a pertaining issue is that recorded data are usually noisy, contain many artefacts, and are affected by external factors such as movements and physical conditions. In order to obtain accurate and meaningful indicators, the signal has to be processed and conditioned such that the measurements are accurate and free from noise and disturbances. In this context, many researchers have utilized recent technological advances in wearable sensors and signal processing to develop smart and accurate wearable devices for clinical applications. The processing and analysis of physiological signals is a key issue for these smart wearable devices. Consequently, ongoing work in this field of study includes research on filtration, quality checking, signal transformation and decomposition, feature extraction and, most recently, machine learning-based methods