Evaluation of changes in the propagation of electrohysterographic signals of uterine records for predicting preterm birth

Letno se prezgodaj rodi veliko dojenčkov pred dopolnjenim 37. tednom nosečnosti. Analiza EHG signalov je že pokazala obetajoče rezultate pri napovedi prezgodnjega poroda dovolj zgodaj v nosečnosti, da bi lahko prezgodnji porod preprečili. V tem magistrskem delu smo razlike med prezgodnjimi in terminskimi materničnimi posnetki iskali v spremembah intenzitete in smeri propagacije (razširjanja) EHG signalov vzdolž maternice v horizontalni in vertikalni smeri, ki smo jih ocenili s pomočjo kratkočasovne križne korelacije. Na frekvenčnem območju 0,08⠒5,0 Hz smo hitrosti propagacije znotraj praznih intervalov prezgodnjih (terminskih) posnetkov ocenili na 10,56 cm/s (7,27 cm/s) in na 12,66 cm/s (10,84 cm/s) znotraj intervalov s popadki. Ocenjene hitrosti propagacije se nekoliko razlikujejo od tistih iz literature. Z našo metodo smo s klasifikatorjem QDA uspeli pravilno klasificirati (“Prezgodnji porod” ali “Terminski porod”) 83,96 % praznih intervalov. Pomembni rezultati magistrskega dela so ugotovitve, da so intervali izven popadkov (prazni intervali) zelo pomembni pri napovedovanju prezgodnjega poroda, da je količina merjene materine srčne frekvence pomemben dejavnik pri napovedovanju prezgodnjega poroda in da je možno učinkovito napovedati prezgodnji porod že okrog 23. tedna nosečnosti.Yearly there are a lot of preterm births, i.e. births before the 37th week of gestation is completed. Analysis of EHG signals has already shown promising results in predicting preterm birth in early pregnancy, so that preterm birth could be prevented. In this thesis we have searched for the differences between preterm and term uterine records in the changes in intensity and direction of EHG propagation along the uterus in horizontal and vertical direction, which has been estimated with short-time cross-correlation. On the frequency band 0,08⠒5,0 Hz we have estimated propagation velocity inside dummy intervals of preterm (term) records to be equal to 10,56 cm/s (7,27 cm/s) and equal to 12,66 cm/s (10,84 cm/s) inside intervals with contractions. Estimated propagation velocities differ slightly from the ones in the literature. With our method and QDA classifier we have correctly classified (“Preterm birth” or “Term birth”) 83,96 % dummy intervals. Important findings in this thesis are that the intervals outside of contractions (dummy intervals) are very important when predicting preterm birth, that the amount of measured frequency of maternal heart is shown to play an important role in the prediction of preterm birth and that it is possible to effectively predict preterm birth around the 23th week of gestation

Cycling Infrastructure

Biciklizam je kretanje kopnom korištenjem bicikla. To je prijevozno sredstvo na ljudski pogon. Prema današnjim vaţećim prometnim pravilima u većini drţava bicikl se smatra prometnim sredstvom. Zbog toga je biciklist ravnopravan sudionik u prometu. Postoji zakonska regulativa koja propisuje minimalnu potrebnu starosti vozača, pravila kretanja po javnim prometnicama, tehničke zahtjeve na biciklu itd. Biciklistički promet je, u usporedbi s drugim uobičajenim prijevoznim sredstvima (primjerice automobilima), daleko manje opasan po onečišćenje okoliša, a ujedno vrlo pozitivnog učinka na zdravlje ljudi koji voze bicikle. Brojni gradovi osiguravaju za bicikliste različitu infrastrukturu, koja biciklistima olakšava i osigurava voţnju. Postojeća prometna mreţa u Hrvatskoj projektirana je i izvoĎena tako da daje primarnu ulogu motornim vozilima, naročito osobnom automobilu, te javnom gradskom prijevozu. Udio biciklista u gradskom prometu nije zanemariv, pogotovo u ruralnim sredinama gdje biciklizam ima dugu tradiciju. Ulaganjem u izgradnju biciklističke infrastrukture sa povećanjem svijesti graĎana o mogućnostima korištenja energetski, ekološki i financijski prihvatljivijih oblika prijevoza, biciklizam kontinuirano biljeţi pozitivan razvojni trend.Cycling is a form of land transportation with the use of a bicycle which is a vehicle powered by human force. Most countries worldwide nowadays have traffic regulations which classify bicycles as transportation medium or a vehicle making a cyclist an equal traffic participant. There are legal regulations which provide the necessary age of the driver (cyclist), rules of driving on public roadways, the technical demands of the bicycle, etc. Trafficking of bicycles is, compared to other forms of transportation (e.g. automobiles), far less dangerous for the environment, with the bonus fact that it has a positive effect on the health of the people driving bicycles. Many cities ensure that cyclist have a special infrastructure, making the trafficking of bicycles safer and easier.The existing traffic network in Croatia is designed and performed in a way that motor vehicles have the primary role - especially automobiles and public transportation. The portion of cyclists in public city transportation is substantial, and especially in rural areas where it holds a long tradition. With investments in construction of cycling infrastructure and working on educating citizens about the possibilities of using more acceptable forms of transportation (considering energy, ecology and finances), cycling is continually showing a positive growth trend

Eicosapentaenoic acid in serum lipids could be inversely correlated with severity of clinical symptomatology in Croatian war veterans with posttraumatic stress disorder

Aim To explore the association between plasma fatty acids composition and the severity of clinical symptoms in Croatian war veterans with posttraumatic stress disorder (PTSD). Methods This cross-sectional study included 62 men diagnosed with PTSD caused by combat activities during the War in Croatia 1991-1995. Clinician-Administered PTSD Scale (CAPS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D-17) were used. Plasma fatty acids composition was determined by gas chromatography. Data about life-style habits were collected by a structured interview. To evaluate the association between plasma fatty acid levels and PTSD severity scales, multivariate general linear models (GLM) were applied while controlling for different confounders. Results Significant negative correlations were found between plasma eicosapentaenoic acid (EPA, 20:5n-3) level and the scores on psychological scales (τ = -0.326, P < 0.001 for CAPS; τ-0.304, P = 0.001 for HAM-A; and τ = -0.345, P < 0.001 for HAM-D-17). GLM confirmed that PTSD severity was affected by EPA (Wilks’Λ = 0.763-0.805, P = 0.006-0.018, ηp 0.195-0.237), arachidonic acid (AA)/EPA (Wilks’Λ = 0.699- 0.757, P = 0.004, ηp 0.243-0.301), and dairy products consumption (Wilks’Λ = 0.760-0.791, P = 0.045-0.088, ηp 0.128- 0.111). No other fatty acid or dietary/lifestyle variable was significant ( P = 0.362-0.633). Conclusion The study suggests that lower EPA levels are associated with the severity of clinical symptoms in PTSD

Ensemble Learning Using Individual Neonatal Data for Seizure Detection

Objective: Sharing medical data between institutions is difficult in practice due to data protection laws and official procedures within institutions. Therefore, most existing algorithms are trained on relatively small electroencephalogram (EEG) data sets which is likely to be detrimental to prediction accuracy. In this work, we simulate a case when the data can not be shared by splitting the publicly available data set into disjoint sets representing data in individual institutions. Methods and procedures: We propose to train a (local) detector in each institution and aggregate their individual predictions into one final prediction. Four aggregation schemes are compared, namely, the majority vote, the mean, the weighted mean and the Dawid-Skene method. The method was validated on an independent data set using only a subset of EEG channels. Results: The ensemble reaches accuracy comparable to a single detector trained on all the data when sufficient amount of data is available in each institution. Conclusion: The weighted mean aggregation scheme showed best performance, it was only marginally outperformed by the Dawid-Skene method when local detectors approach performance of a single detector trained on all available data. Clinical impact: Ensemble learning allows training of reliable algorithms for neonatal EEG analysis without a need to share the potentially sensitive EEG data between institutions.Peer reviewe

Nurses’ experiences and perspectives on aEEG monitoring in neonatal care: A qualitative study

Purpose: This study aimed to gather nurses’ experiences and perspectives regarding the amplitude-integrated electroencephalogram (aEEG) monitoring system in neonatal intensive care units (NICUs) and to explore potential avenues for future improvements. Design and Methods: This study employed a descriptive qualitative design. Semi-structured interviews were conducted with 20 nurses from the level-III NICU of a Dutch medical center. The collected interview data were analyzed using thematic analysis. Results: Seven main themes emerged: training in aEEG monitoring, proficiency in aEEG electrode placement and pattern interpretation, usual practices of using aEEG, neonatologist-nurse cooperation on aEEG, the performance of the automated seizure detection software, the usefulness of aEEG monitoring in the NICU, and feedback about the current aEEG monitoring system. Conclusions: Nurses confirmed that aEEG is a valuable tool for cerebral function monitoring in the NICU; however, improvements are necessary. For better utilization of aEEG in the NICU, it is recommended to enhance nurses’ aEEG knowledge and skills and apply state-of-art techniques to improve the monitoring system. Practice implications: To enhance the aEEG knowledge of NICU nurses, we suggest introducing structured training programs, conducting routine case-centered discussions, and creating readily available reference resources. To optimize the aEEG monitoring system, it is essential to incorporate innovative electrodes, provide remote accessibility, integrate advanced algorithms, and develop an intuitive graphical user interface

Zdravstvena njega bolesnika - ovisnika o psihoaktivnim tvarima

Izloženost psihoaktivnim tvarima predstavlja veliki javnozdravstveni problem. Psihoaktivne tvari stvaraju psihičku i fizičku ovisnost. Za psihičku ovisnost je karakterističan osjećaj zadovoljstva i želja za ponovnom konzumacijom droge kako bi se izazvala ugoda. Fizička ovisnost je stanje izazvano ponavljajućim uzimanjem droge koje zahtjeva njezino kontinuirano uzimanje kako bi se spriječilo nastajanje neugodnih simptoma apstinencije te kako bi se postiglo djelovanje kakvo je u početku izazivala manja količina psihoaktivne tvari. Postoji i kombinacija psihičke i fizičke ovisnosti. Ovisnost je kronična recidivirajuća bolest, koja zahtijeva specijaliziran tretman, dugotrajnu skrb i praćenje. Prema načinu djelovanja na svijest, razlikujemo: stimulanse, depresante, opioide, halucinogene, nikotin i marihuanu. Najčešće supstance odnosno psihoaktivne tvari koje ovisnik koristi su: opijum, sintetički opijati-amfetamin, heroin, kokain (crack i list koke) te kanabis. Zlouporaba droga prisutna je u svim dobnim skupinama, a najveći postotak prisutan je kod adolescenata. Neki od razloga posezanja mladih za drogom su nedostatak pravih životih vrijednosti, modernizacija društva, zanemarivanje od strane roditelja i bliskih osoba, nedovoljna posvećenost društva, nezrelost, psihička nestabilnost, znatiželja te velika raširenost psihoaktivnih tvari. Ovisnik se neprimjereno ponaša, zanemaruje svoje obaveze, mijenja mu se duštveni život i okruženje, gubi prijatelje, dolazi do napetosti i sukoba u obitelji te raskidanja ili narušavanja bliskih veza. Zadatak zdravstvenih djelatnika je predlaganje i provođenje specifičnih i konkretnih mjera kako bi se zlouporaba sredstava ovisnosti držala u granicama podnošljivosti za zajednicu. Psihoterapija je metoda koja se koristi za liječenje ovisnosti. Lijekovi se primjenjuju kao dodatna terapija. Vrlo su česti recidivi, naročito u drugoj fazi liječenja u kojoj se ovisnika uči i navikava na život bez droge. Za liječenje ovisnosti o psihoaktivnim tvarima važan je veliki trud i svakodnevno zalaganje zdravstvenog tima te podrška u grupnim terapijama i podrška obitelji. Programi prevencija ovisnosti trebali bi se provoditi od najranije dobi, počevši od vrtića i malih školi, a posebno bi trebali biti usmjereni na adolescente koji su najugroženija populacij

Zdravstvena njega bolesnika - ovisnika o psihoaktivnim tvarima

Izloženost psihoaktivnim tvarima predstavlja veliki javnozdravstveni problem. Psihoaktivne tvari stvaraju psihičku i fizičku ovisnost. Za psihičku ovisnost je karakterističan osjećaj zadovoljstva i želja za ponovnom konzumacijom droge kako bi se izazvala ugoda. Fizička ovisnost je stanje izazvano ponavljajućim uzimanjem droge koje zahtjeva njezino kontinuirano uzimanje kako bi se spriječilo nastajanje neugodnih simptoma apstinencije te kako bi se postiglo djelovanje kakvo je u početku izazivala manja količina psihoaktivne tvari. Postoji i kombinacija psihičke i fizičke ovisnosti. Ovisnost je kronična recidivirajuća bolest, koja zahtijeva specijaliziran tretman, dugotrajnu skrb i praćenje. Prema načinu djelovanja na svijest, razlikujemo: stimulanse, depresante, opioide, halucinogene, nikotin i marihuanu. Najčešće supstance odnosno psihoaktivne tvari koje ovisnik koristi su: opijum, sintetički opijati-amfetamin, heroin, kokain (crack i list koke) te kanabis. Zlouporaba droga prisutna je u svim dobnim skupinama, a najveći postotak prisutan je kod adolescenata. Neki od razloga posezanja mladih za drogom su nedostatak pravih životih vrijednosti, modernizacija društva, zanemarivanje od strane roditelja i bliskih osoba, nedovoljna posvećenost društva, nezrelost, psihička nestabilnost, znatiželja te velika raširenost psihoaktivnih tvari. Ovisnik se neprimjereno ponaša, zanemaruje svoje obaveze, mijenja mu se duštveni život i okruženje, gubi prijatelje, dolazi do napetosti i sukoba u obitelji te raskidanja ili narušavanja bliskih veza. Zadatak zdravstvenih djelatnika je predlaganje i provođenje specifičnih i konkretnih mjera kako bi se zlouporaba sredstava ovisnosti držala u granicama podnošljivosti za zajednicu. Psihoterapija je metoda koja se koristi za liječenje ovisnosti. Lijekovi se primjenjuju kao dodatna terapija. Vrlo su česti recidivi, naročito u drugoj fazi liječenja u kojoj se ovisnika uči i navikava na život bez droge. Za liječenje ovisnosti o psihoaktivnim tvarima važan je veliki trud i svakodnevno zalaganje zdravstvenog tima te podrška u grupnim terapijama i podrška obitelji. Programi prevencija ovisnosti trebali bi se provoditi od najranije dobi, počevši od vrtića i malih školi, a posebno bi trebali biti usmjereni na adolescente koji su najugroženija populacij