Spectral Analysis for Signal Detection and Classification : Reducing Variance and Extracting Features

Spectral analysis encompasses several powerful signal processing methods. The papers in this thesis present methods for finding good spectral representations, and methods both for stationary and non-stationary signals are considered. Stationary methods can be used for real-time evaluation, analysing shorter segments of an incoming signal, while non-stationary methods can be used to analyse the instantaneous frequencies of fully recorded signals. All the presented methods aim to produce spectral representations that have high resolution and are easy to interpret. Such representations allow for detection of individual signal components in multi-component signals, as well as separation of close signal components. This makes feature extraction in the spectral representation possible, relevant features include the frequency or instantaneous frequency of components, the number of components in the signal, and the time duration of the components. Two methods that extract some of these features automatically for two types of signals are presented in this thesis. One adapted to signals with two longer duration frequency modulated components that detects the instantaneous frequencies and cross-terms in the Wigner-Ville distribution, the other for signals with an unknown number of short duration oscillations that detects the instantaneous frequencies in a reassigned spectrogram. This thesis also presents two multitaper methods that reduce the influence of noise on the spectral representations. One is designed for stationary signals and the other for non-stationary signals with multiple short duration oscillations. Applications for the methods presented in this thesis include several within medicine, e.g. diagnosis from analysis of heart rate variability, improved ultrasound resolution, and interpretation of brain activity from the electroencephalogram

Evaluation and development of methods for time-frequency analysis of heart rate variability

Non-stationary signals are very common in nature, consider for example speech, music or heart rate. Using the concept of time-frequency analysis this thesis studies the performance of different time-frequency distributions of both simulated and real non-stationary signals. The signals studied are linear and non-linear frequency modulated (FM) signals. Two methods are studied to increase performance of the signals' time-frequency distributions. Since lag-independent kernels perform well with slow varying frequency modulated signals both methods use these. One method uses filtering with compact support lag-independent kernels and the other uses a penalty function with multitapers corresponding to lag-independent kernels. These methods are then evaluated using two performance measures and the results are used to improve the time-frequency distributions of heart rate variability signals. The thesis suggests that both of these methods improve the time-frequency distribution of such signals

Scaled reassigned spectrograms applied to linear transducer signals

This study evaluates the applicability of scaled reassigned spectrograms (ReSTS) on ultrasound radio frequency data obtained with a clinical linear array ultrasound transducer. The ReSTS's ability to resolve axially closely spaced objects in a phantom is compared to the classical cross-correlation method with respect to the ability to resolve closely spaced objects as individual reflectors using ultrasound pulses with different lengths. The results show that the axial resolution achieved with the ReSTS was superior to the cross-correlation method when the reflected pulses from two objects overlap. A novel B-mode imaging method, facilitating higher image resolution for distinct reflectors, is proposed

Mutations in INPP5K Cause a Form of Congenital Muscular Dystrophy Overlapping Marinesco-Sjögren Syndrome and Dystroglycanopathy.

Congenital muscular dystrophies display a wide phenotypic and genetic heterogeneity. The combination of clinical, biochemical, and molecular genetic findings must be considered to obtain the precise diagnosis and provide appropriate genetic counselling. Here we report five individuals from four families presenting with variable clinical features including muscular dystrophy with a reduction in dystroglycan glycosylation, short stature, intellectual disability, and cataracts, overlapping both the dystroglycanopathies and Marinesco-Sjögren syndrome. Whole-exome sequencing revealed homozygous missense and compound heterozygous mutations in INPP5K in the affected members of each family. INPP5K encodes the inositol polyphosphate-5-phosphatase K, also known as SKIP (skeletal muscle and kidney enriched inositol phosphatase), which is highly expressed in the brain and muscle. INPP5K localizes to both the endoplasmic reticulum and to actin ruffles in the cytoplasm. It has been shown to regulate myoblast differentiation and has also been implicated in protein processing through its interaction with the ER chaperone HSPA5/BiP. We show that morpholino-mediated inpp5k loss of function in the zebrafish results in shortened body axis, microphthalmia with disorganized lens, microcephaly, reduced touch-evoked motility, and highly disorganized myofibers. Altogether these data demonstrate that mutations in INPP5K cause a congenital muscular dystrophy syndrome with short stature, cataracts, and intellectual disability

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

High resolution time-frequency representations

Non-stationary signals are very common in nature, e.g. sound waves such as human speech, bird song and music. It is usually meaningful to describe a signal in terms of time and frequency. Methods for doing so exist and are well defined. From the time representation it is possible to see the oscillations or waves of the signal and if the signal changes over time. From the frequency representation, obtained from the Fourier transform, the frequency decomposition of the signal can be seen, i.e. which frequencies the signal contains.However the time and frequency representations are not unique for any given signal, i.e. the transformation from time to frequency is not injective. It is therefore, especially for non-stationary and multi-component signals, important to study a joint time-frequency (TF) representation, which shows how the frequency content of the signal varies with time. This is done in the field of time-frequency analysis, which is the topic of this thesis.There exist many different joint TF representations for any given signal and choosing an appropriate representation is most often not straight forward. Unfortunately there exist no optimal TF representation for all signals and finding good representations, especially for multi-component signals is a complex problem.In this thesis, methods for obtaining good TF representations, for two types of non-stationary and multi-component signals, and for extracting meaningful information from these representations, are developed. The two types of signals are long, frequency modulated signals and short, transient signals. Even though the types of signals are very different and require very different TF representations, the aim is to resolve components that are close in time, frequency or both. This requires TF representations with high resolution.For the long, frequency modulated signals, a signal adaptive method, which enables automatic comparison between different TF representations, is proposed. For the short, transient signals, a method which finds the TF centres of transient pulses and counts the number of pulses in a signal is presented. An approach for determining the (time) shape of transient pulses is also given

A novel Doppler penalty function for the multitaper Wigner-Ville distribution

This paper proposes a novel Doppler penalty kernel used in the computation of multitapers corresponding to the Wigner-Ville distribution. The resulting multitaper spectrogram will approximately fulfil the time-frequency concentration of the Wigner-Ville distribution but also suppress the cross-terms outside a signal dependent Doppler bandwidth, making the penalty kernel appropriate for linear frequency modulated signals. A limited number of tapers are used which results in computationally efficient calculations. A method for selecting a signal dependent Doppler bandwidth which balances the trade-off between auto-term resolution and cross-term suppression is also proposed. The time-frequency concentration of the proposed method is compared to other penalty kernel methods and a lag-independent kernel with compact support. The performance for white noise disturbances is also evaluated. Estimation of heart rate variability data exemplify the use of the penalty kernel