Towards Personalized Healthcare in Cardiac Population: The Development of a Wearable ECG Monitoring System, an ECG Lossy Compression Schema, and a ResNet-Based AF Detector

Cardiovascular diseases (CVDs) are the number one cause of death worldwide. While there is growing evidence that the atrial fibrillation (AF) has strong associations with various CVDs, this heart arrhythmia is usually diagnosed using electrocardiography (ECG) which is a risk-free, non-intrusive, and cost-efficient tool. Continuously and remotely monitoring the subjects' ECG information unlocks the potentials of prompt pre-diagnosis and timely pre-treatment of AF before the development of any life-threatening conditions/diseases. Ultimately, the CVDs associated mortality could be reduced. In this manuscript, the design and implementation of a personalized healthcare system embodying a wearable ECG device, a mobile application, and a back-end server are presented. This system continuously monitors the users' ECG information to provide personalized health warnings/feedbacks. The users are able to communicate with their paired health advisors through this system for remote diagnoses, interventions, etc. The implemented wearable ECG devices have been evaluated and showed excellent intra-consistency (CVRMS=5.5%), acceptable inter-consistency (CVRMS=12.1%), and negligible RR-interval errors (ARE<1.4%). To boost the battery life of the wearable devices, a lossy compression schema utilizing the quasi-periodic feature of ECG signals to achieve compression was proposed. Compared to the recognized schemata, it outperformed the others in terms of compression efficiency and distortion, and achieved at least 2x of CR at a certain PRD or RMSE for ECG signals from the MIT-BIH database. To enable automated AF diagnosis/screening in the proposed system, a ResNet-based AF detector was developed. For the ECG records from the 2017 PhysioNet CinC challenge, this AF detector obtained an average testing F1=85.10% and a best testing F1=87.31%, outperforming the state-of-the-art

Diversidade e Estrutura Genéticas de Bryconamericus aff. Iheringii (Characiformes: Characidae) na Área de Influência do Reservatório da Itaipu

Trabalho de Conclusão de Curso apresentado ao Instituto Latino-Americano de Ciências da Vida e Natureza da Universidade Federal da Integração Latino-Americana, como requisito parcial à obtenção do título de Bacharel em Ciências Biológicas – Ecologia e Biodiversidade.A diversidade genética é necessária para que as populações evoluam e se adaptem às mudanças ambientais, e comumente, está distribuída em um padrão dentro e entre populações que é referido como estrutura genética. O isolamento e a existência de poucos caminhos migratórios entre águas doces implicam na estruturação genética, principalmente, para peixes que possuem baixa mobilidade. Peixes de pequeno porte (≤ 15 cm de comprimento), que habitam riachos, representam, no mínimo 50% de toda a ictiofauna sul-americana e apresentam um alto grau de endemismo, devido, em parte, à sua baixa capacidade de deslocamento. Neste contexto, o presente trabalho objetivou avaliar a diversidade e a estrutura genéticas do caracídeo Bryconamericus aff. iheringii na área de influência do reservatório da Itaipu Binacional. Para isto, foram analisados 47 espécimes, 23 coletados em riachos da margem direita (Paraguai) e 24 coletados em riachos da margem esquerda (Brasil) do reservatório da Itaipu. Para acessar sua diversidade genética, foi empregado o marcador molecular D-loop, sendo estimado o número de haplótipos, os índices de diversidade haplotípica e nucleotídica e o nível de estruturação entre as diferentes amostras. B. aff. iheringii apresentou níveis de diversidade genética dentro do padrão relatado para a espécie, com moderados (amostras do Paraguai) a altos (amostras do Brasil) níveis de diversidade, o que se deve, sobretudo, ao fato de que quase todos os riachos paraguaios analisados são de uma única microbacia, enquanto os riachos brasileiros são de quatro microbacias diferentes. As populações não parecem ter respondido a eventos drásticos recentes, pois mesmo as presentes em regiões sob a pressão de atividades agrícolas, mostram variações no DNA mitocondrial. Foram encontrados altos níveis de estruturação genética entre o conjunto de amostras paraguaio e brasileiro e entre as microbacias dentro de cada país, o que se deve, principalmente, aos processos de colonização destas drenagens, os quais possivelmente envolvem fundadores com diferentes linhagens haplotípicas. Além disso, parece plausível que o rio Paraná (reservatório da Itaipu) funciona como uma barreira ao fluxo gênico entre as diferentes margens e entre suas microbacias. Deste modo, a identificação de linhagens é de grande importância, pois a manutenção da diversidade genética de uma espécie depende de sua preservação. Considerando a importância de estudos genético-populacionais para a conservação de espécies, espera-se que este trabalho possa servir como base para futuros estudos mais amplos com peixes de riachos

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Feasibility and Accuracy of Automated Three-Dimensional Echocardiographic Analysis of Left Atrial Appendage for Transcatheter Closure

Background: Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional transesophageal echocardiography (3DTEE) is more accurate than the two-dimensional (2D) modality for evaluation of the complex anatomy of LAA. However, 3D-TEE analysis of LAA is challenging and highly expertise dependent. In this study, we sought to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D-TEE data. Methods: The intra-procedural 3D TEE data of 158 patients who underwent LAAC were retrospectively analyzed with a novel automated LAA analysis software tool. Based on the 3D TEE data, the software semi-automatically segmented the 3D LAA structure, determined the device landing zone (LZ), and generated measurements of the LZ dimensions and the LAA length, allowing manual editing if necessary. The accuracy of LAA pre-implantation anatomic measurement reproducibility, and time for analysis of the automated software were compared against expert manual 3D analysis. The software feasibility to predict the optimal device size was directly compared to implanted models. Results: Automated 3D analysis of the LAA on 3D-TEE was feasible in all patients. There were excellent agreements between automated and manual measurements of LZ maximal diameter (bias:-0.32, LOA:-3.56; 2.92), area-derived mean diameter (bias:-0.24, LOA:-3.12, 2.64), and LAA depth (bias:0.02, LOA:-3.14; 3.18). Automated 3D analysis, with manual editing if necessary, accurately identified the implanted device size in 90.5% of patients, outperforming 2DTEE (68.9%, p<0.01). The automated software showed results competitive against the manual analysis of 3D-TEE with higher intra- and inter-observer reproducibility and allowed quicker analysis (101.9±9.3s vs. 183.5±42.7s, p<0.001) compared to manual analysis.This work was funded by the projects “NORTE-01-0145-FEDER-000045” and “NORTE-01-0145-FEDER-000059”, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). It was also funded by national funds, through the FCT – Fundação para a Ciência e Tecnologia and FCT/MCTES in the scope of the project UIDB/05549/2020 and UIDP/05549/2020 and the grant CEECIND/03064/2018. This work was also funded by the Hong Kong Special Administrative Region Government Health and Medical Research Fund (05160976

Feasibility and accuracy of automated three-dimensional echocardiographic analysis of left atrial appendage for transcatheter closure

Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than the two-dimensional modality for evaluation of the complex anatomy of the left atrial appendage (LAA). However, 3D transesophageal echocardiographic analysis of the LAA is challenging and highly expertise dependent. The aim of this study was to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D transesophageal echocardiographic data.This work was funded by the projects “NORTE-01-0145-FEDER-000045” and “NORTE-01-0145-FEDER-000059”, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). It was also funded by national funds, through the FCT – Fundação para a Ciência e Tecnologia and FCT/MCTES in the scope of the project UIDB/05549/2020 and UIDP/05549/2020 and the grant CEECIND/03064/2018. This work was also funded by the Hong Kong Special Administrative Region Government Health and Medical Research Fund (05160976)

Automated left heart chamber volumetric assessment using three-dimensional echocardiography in Chinese adolescents

Background: Several studies have reported the accuracy and reproducibility of HeartModel for automated determination of three-dimensional echocardiography (3DE)-derived left heart volumes and left ventricular (LV) ejection fraction (LVEF) in adult patients. However, it remains unclear whether this automated adaptive analytics algorithm, derived from a ‘training’ population, can encompass adequate echo images in Chinese adolescents. Objectives: The aim of our study was to explore the accuracy of HeartModel in adolescents compared with expert manual three-dimensional (3D) echocardiography. Methods: Fifty-three Chinese adolescent subjects with or without heart disease underwent 3D echocardiographic imaging with an EPIQ system (Philips). 3D cardiac volumes and LVEF obtained with the automated HeartModel program were compared with manual 3D echocardiographic measurements by an experienced echocardiographer. Results: There was strong correlation between HeartModel and expert manual 3DE measurements (r = 0.875–0.965, all P < 0.001). Automated LV and left atrial (LA) volumes were slightly overestimated when compared to expert manual measurements, while LVEF showed no significant differences from the manual method. Importantly, the intra- and inter-observer variability of automated 3D echocardiographic model was relatively low (<1%), surpassing the manual approach (3.5–17.4%), yet requiring significantly less analyzing time (20 ± 7 vs 177 ± 30 s, P < 0.001). Conclusion: Simultaneous quantification of left heart volumes and LVEF with the automated HeartModel program is rapid, accurate and reproducible in Chinese adolescent cohort. Therefore, it has a potential to bring 3D echocardiographic assessment of left heart chamber volumes and function into busy pediatric practice