Detection of myocardial scar from the VCG using a supervised learning approach

This paper addresses the possibility of detecting presence of scar tissue in the myocardium through the in- vestigation of vectorcardiogram (VCG) characteristics. Scarred myocardium is the result of myocardial infarction (MI) due to ischemia and creates a substrate for the manifestation of fatal arrhythmias. Our efforts are focused on the development of a classification scheme for the early screening of patients for the presence of scar. More specifically, a supervised learning model based on the extracted VCG features is proposed and validated through comprehensive testing analysis. The achieved accuracy of 82.36% (sensitivity 84.31%, specificity 77.36%) indicates the potential of the proposed screening mechanism for detecting the presence/absence of scar tissue

On the detection of myocardial scar based on ECG/VCG analysis

In this paper, we address the problem of detecting the presence of myocardial scar from standard ECG/VCG recordings, giving effort to develop a screening system for the early detection of scar in the point-of-care. Based on the pathophysiological implications of scarred myocardium, which results in disordered electrical conduction, we have implemented four distinct ECG signal processing methodologies in order to obtain a set of features that can capture the presence of myocardial scar. Two of these methodologies: a.) the use of a template ECG heartbeat, from records with scar absence coupled with Wavelet coherence analysis and b.) the utilization of the VCG are novel approaches for detecting scar presence. Following, the pool of extracted features is utilized to formulate an SVM classification model through supervised learning. Feature selection is also employed to remove redundant features and maximize the classifier's performance. Classification experiments using 260 records from three different databases reveal that the proposed system achieves 89.22% accuracy when applying 10- fold cross validation, and 82.07% success rate when testing it on databases with different inherent characteristics with similar levels of sensitivity (76%) and specificity (87.5%)

Age-related changes in global motion coherence: conflicting haemodynamic and perceptual responses

Our aim was to use both behavioural and neuroimaging data to identify indicators of perceptual decline in motion processing. We employed a global motion coherence task and functional Near Infrared Spectroscopy (fNIRS). Healthy adults (n = 72, 18-85) were recruited into the following groups: young (n = 28, mean age = 28), middle-aged (n = 22, mean age = 50), and older adults (n = 23, mean age = 70). Participants were assessed on their motion coherence thresholds at 3 different speeds using a psychophysical design. As expected, we report age group differences in motion processing as demonstrated by higher motion coherence thresholds in older adults. Crucially, we add correlational data showing that global motion perception declines linearly as a function of age. The associated fNIRS recordings provide a clear physiological correlate of global motion perception. The crux of this study lies in the robust linear correlation between age and haemodynamic response for both measures of oxygenation. We hypothesise that there is an increase in neural recruitment, necessitating an increase in metabolic need and blood flow, which presents as a higher oxygenated haemoglobin response. We report age-related changes in motion perception with poorer behavioural performance (high motion coherence thresholds) associated with an increased haemodynamic response

Flexible Buffer Materials to Reduce Contact Resistance in Thermal Insulation Measurements

Thermal insulation test methods approach their lower limits as thermal resistance falls below 0.1 m2⋅K/W. This is the minimum value specified in ASTM C 518 (ASTM International, 2010b) while ASTM C 177 (ASTM International, 2010a) proposes about 0.06 m2⋅K/W. Nevertheless these are the test methods, along with their ISO equivalents, required by Australasian building codes and directed at many products and materials with thermal resistance on the low side of 0.1 m2⋅K/W. Alternatives, such as ASTM E 1530 (ASTM International, 2011), cover much lower resistances but require carefully prepared small specimens and very-high contact pressures and are therefore largely unsuitable for both technical and compliance reasons. For these low resistances, the insulation test methods face large errors because of interface resistance between specimen and the apparatus hot and cold plates. Staying with C 518, the problem can be avoided by using direct measurement of the test specimen surface temperatures, but this is difficult, has its own accuracy issues, and is often impractical for commercial laboratories. This technique is generally used in conjunction with interface materials such as flexible foam between the specimen and the hot and cold plates, to enhance contact and also provide an access path for temperature sensors. The alternative prospect of using these interface materials to ensure good specimen contact has been studied, in conjunction with a simple two-step thermal resistance determination based on the difference between presence and absence of the test specimen. This article presents results of a study using this difference approach for the measurement of 12 highly conducting materials, including sheets of aluminum, phenolic, HDPE, MgO, bonded rubber and cork granules, PMMA, and compressed wood fiber. For each material, repeated measurements have been performed with four different interface or “buffer” materials: PVC, silicone, EVA, and nitrile. Silicone sponge provides the most uniform results, consistent with a measurably lower hysteresis. The difference technique yielded a lower indicated thermal resistance than direct measurement by between 0.003 and 0.01 m2⋅K/W, with some variation depending on the specimen surface characteristics and to a lesser extent on the choice of buffer. Larger differences were associated with bowed, uneven or roughly surfaced specimens. The difference-technique results have greater variability, but they may be seen as better estimates of the actual specimen resistance, as contact resistance is much lower for soft-surface interfaces. An interface resistance of up to 0.01 m2⋅K/W is large enough to be of significance in many thermal measurements

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

Poor reproducibility of compression elastography in the Achilles tendon: same day and consecutive day measurements.

OBJECTIVE To determine the reproducibility of compression elastography (CE) when measuring strain data, a measure of stiffness of the human Achilles tendon in vivo, over consecutive measures, consecutive days and when using different foot positions. MATERIALS AND METHODS Eight participants (4 males, 4 females; mean age 25.5 ± 2.51 years, range 21-30 years; height 173.6 ± 11.7 cm, range 156-189 cm) had five consecutive CE measurements taken on one day and a further five CE measures taken, one per day, at the same time of day, every day for a consecutive 5-day period. These 80 measurements were used to assess both the repeatability and reproducibility of the technique. Means, standard deviations, coefficient of variation (CV), Pearson correlation analysis (R) and intra-class correlation coefficients (ICC) were calculated. RESULTS For CE data, all CVs were above 53%, R values indicated no-to-weak correlations between measures at best (range 0.01-0.25), and ICC values were all classified in the poor category (range 0.00-0.11). CVs for length and diameter measures were acceptably low indicating a high level of reliability. CONCLUSIONS Given the wide variation obtained in the CE results, it was concluded that CE using this specific system has a low level of reproducibility for measuring the stiffness of the human Achilles tendon in vivo over consecutive days, consecutive measures and in different foot positions

Reproducibility of shear wave elastography measuresof the Achilles tendon.

OBJECTIVE To assess the reproducibility of shear wave elastography (SWE) measures in the Achilles tendon (AT) in vivo. MATERIALS AND METHODS Shear wave velocity (SWV) of 14 healthy volunteers [7 males, 7 females; mean age 26.5 ± 3.8 years, mean height 171.6 ± 10.9 cm, mean Victorian Institute of Sports Assessment Achilles questionnaire (VISA-A) score 99.4 ± 1.2] was measured with the foot relaxed and fixed at 90°. Data were collected over five consecutive measures and 5 consecutive days. RESULTS Mean SWV values ranged from 7.91 m/s-9.56 m/s ± 0.27-0.50 m/s. Coefficient of variation (CV), correlations and intra-class correlation coefficient (ICC) scores ranged from 2.9%-6.3%, 0.4-0.7 and 0.54-0.85 respectively. No significant differences were noted for longitudinal or transverse data with respect to protocol or time and no significant differences were noted for foot position in transverse data. Significant differences in SWV values were noted between foot positions for longitudinal scanning (p = <0.05), with a relaxed foot position providing SWV values on average 0.47 m/s faster than a fixed position. Increased reproducibility was obtained with the foot relaxed. ICC between operators was 0.70 for transverse and 0.80 for longitudinal scanning. CONCLUSIONS Reproducible SWE measures were obtained over a 1-h period as well as a period of 5 consecutive days with more reliable measures obtained from a longitudinal plane using a relaxed foot position. SWE also has a high level of agreement between operators making SWE a reproducible technique for quantitatively assessing the mechanical properties of the human AT in vivo

Design and development of the Australian and New Zealand (ANZ) myeloma and related diseases registry

© 2016 The Author(s). Background: Plasma cell dyscrasias (PCD) are a spectrum of disorders resulting from the clonal expansion of plasma cells, ranging from the pre-malignant condition monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). MM generates a significant burden of disease on the community and it is predicted that it will increase in both incidence and prevalence owing to an ageing population and longer survival secondary to new therapeutic options. Robust and comprehensive clinical data are currently lacking but are required to define current diagnostic, investigational and management patterns in Australia and New Zealand (ANZ) for comparison to both local and international guidelines for standards of care. A clinical registry can provide this information and subsequently support development of strategies to address any differences, including providing a platform for clinical trials. The Myeloma and Related Diseases Registry (MRDR) was developed to monitor and explore variations in practices, processes and outcomes in ANZ and provide benchmark outcomes nationally and internationally for PCD. This paper describes the MRDR aims, development and implementation and discusses challenges encountered in the process. Methods: The MRDR was established in 2012 as an online database for a multi-centre collaboration across ANZ, collecting prospective data on patients with a diagnosis of MGUS, MM, solitary plasmacytoma or plasma cell leukaemia. Development of the MRDR required multi-disciplinary team participation, IT and biostatistical support as well as financial resources. Results: More than 1250 patients have been enrolled at 23 sites to date. Here we describe how database development, data entry and securing ethics approval have been major challenges for participating sites and the coordinating centre, and our approaches to resolving them. Now established, the MRDR will provide clinically relevant and credible monitoring, therapy and 'real world' outcome data, to support the conduction of high quality studies. In addition, the Myeloma 1000 sub-study is establishing a repository of paired peripheral blood specimens from registry patients to study mechanisms underlying disease progression. Conclusion: Establishment of the MRDR has been challenging, but it is a valuable investment that will provide a platform for coordinated national and international collaboration for clinical research in PCD in ANZ

Long Term Efficacy and Safety of Bronchoscopic Thermal Vapor Ablation in Patients with COPD: A Retrospective Study of 50 Patients

Barak Pertzov,1– 4 Merav Ben Avraham,1,2 Eldar Priel,3– 5 Lev Freidkin,1,2 Dror Rosengarten,1,2 Mordechai Reuven Kramer1,2 1Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, ON, Canada; 4Department of Medicine, McMaster University, Hamilton, ON, Canada; 5Division of Thoracic Surgery, St. Joseph’s Healthcare, Hamilton, ON, CanadaCorrespondence: Barak Pertzov, Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach Tikva, 4941492, Israel, Tel +972-3-9377221/3, Fax +972-3-9242091, Email [email protected]: Bronchoscopic Thermal Vapor Ablation (BTVA) has demonstrated improvements in FEV1 and quality of life in clinical trials. However, the long-term benefits and overall efficacy of this procedure remain uncertain and are not yet fully established.Methods: We conducted a retrospective observational study of all patients who underwent BTVA at Rabin Medical Center, Israel. The primary outcome was the change in FEV₁ from baseline. Secondary outcomes included other pulmonary function parameters and procedural adverse events.Results: A total of 50 patients were included in the study. The mean FEV1 values at baseline, 6 months, and 12 months post-procedure (n=31) were 0.74± 0.21 L, 0.93± 0.32 L, and 0.85± 0.25 L, respectively (overall P&lt; 0.001; pairwise comparisons: baseline to 6 months, P&lt; 0.001; baseline to 12 months, P=0.016). The mean FVC values at baseline, 6 months, and 12 months post-procedure (n=31) were 1.97± 0.56 L, 2.27± 0.71 L, and 2.14± 0.68 L, respectively (overall P=0.003; pairwise comparisons: baseline to 6 months, P=0.002; baseline to 12 months, P=0.125). Post-procedural complications included pneumonia in 5 patients (11%), of whom 3 developed necrotizing pneumonia and subsequently died, resulting in a 6% post-procedural mortality rate in the entire cohort. Hemoptysis was reported in 1 patient (2%).Conclusion: Bronchoscopic thermal vapor ablation is a minimally invasive bronchoscopic intervention for lung volume reduction. The procedure was associated with significant improvements in FEV₁ at 6 to 12 months and in FVC at 6 months, followed by a gradual decline over 12 to 24 months. Further research is warranted to optimize patient selection, enhance procedural safety, and assess long-term efficacy.Plain Language Summary: COPD is a disease that damages lung tissue. The damaged areas become hyperinflated, compressing healthier parts of the lung and reducing their function. Bronchoscopic Thermal Vapor Ablation (BTVA) is a minimally invasive treatment that uses heated water vapor to target and shrink these damaged areas. During the procedure, a thin tube with a camera (bronchoscope) is inserted into the lungs to deliver vapor directly to diseased regions. The vapor causes controlled injury, leading to shrinkage of the targeted tissue and allowing healthier lung areas to expand and function more effectively. BTVA can be repeated by treating different regions over time, potentially maintaining its benefits.In this study, we evaluated the effectiveness and safety of BTVA in patients with advanced COPD. Lung function improved significantly at 6 and 12 months compared to baseline. Between 12 and 24 months, the benefits gradually declined but remained above baseline.Side effects were primarily pneumonia and temporary coughing up of blood, which resolved in most cases. However, three patients developed severe pneumonia and died, highlighting the need for further research.In conclusion, BTVA improved lung function, but careful selection of treatment areas and energy levels is important to reduce complications and enhance safety.Keywords: COPD, emphysema, BLVR, BTVA, vapor, FEV1, safet

Rethinking the Poverty-disease Nexus: the Case of HIV/AIDS in South Africa

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa