PORTABLE HEART ATTACK WARNING SYSTEM BY MONITORING THE ST SEGMENT VIA SMARTPHONE ELECTROCARDIOGRAM PROCESSING

Cardiovascular disease (CVD) is the single leading cause of death in both developed and developing countries. The most deadly CVD is heart attack, which 7,900,000 Americans suffer each year, and 16% of cases are fatal. The Electrocardiogram (ECG) is the most widely adopted clinical tool to diagnose and assess the risk of CVD. Early diagnosis of heart attacks, by detecting abnormal ST segments within one hour of the onset of symptoms, is necessary for successful treatment. In clinical settings, resting ECGs are used to monitor patients automatically. However, given the sporadic nature of heart attacks, it is unlikely that the patient will be in a clinical setting at the onset of a heart attack. While Holter-based portable monitoring solutions offer 24 to 48-hour ECG recording, they lack the capability of providing any real-time feedback for the thousands of heart beats they record, which must be tediously analyzed offline.Processing ECG signals on a smartphone-based platform would unite the portability of Holter monitors and the real-time processing capability of state-of-the-art resting ECG machines to provide an assistive diagnosis for early heart attack warning. Furthermore, smartphones serve as an ideal platform for telemedicine and alert systems and have a portable form factor. To detect heart attacks via ECG processing, a real-time, accurate, context aware ST segment monitoring algorithm, based on principal component analysis and a support vector machine classifier is proposed and evaluated. Real-time feedback is provided by implementing a state-of-the-art, multilevel warning system ranging from audible notifications to text messages to points of contacts with the GPS location of the user. The smartphone test bed makes use of a novel, real-time verification system using a streaming database to analyze the strain of heart attack detection system under normal phone operation. Furthermore, the entire system is prototyped and fully functional, running on a smartphone to demonstrate the real-time, portable functionality of the platform. Experimental results show that a classification accuracy of 96% for ST segment elevation of individual beats can be achieved and all ST episodes were correctly detected during testing with the European ST database

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

Bastards as Clients: the House of Savoy and its illegitimate children

Writing of the problems facing Philippe d'Orléans in 1715 at the beginning of his regency for Louis XV, the duc de Saint-Simon grew heated in his discussion of one of the aspects of early-modern court society which he most detested: "Dans quelque servitude que tout fut réduit en France, il restoit des points sur lesquels la terreur pouvoit retenir les discours, mais n'avoit pas atteint à corrompre les esprits. Un de ces points étoit celui des bâtards, de leurs établissements, surtout de leur ..