Sepsis remains a leading cause of morbidity and mortality among intensive care unit (ICU) patients. For each hour treatment initiation is delayed after diagnosis, sepsis-related mortality increases by approximately eight percent. Therefore, maximizing effective care requires early recognition and initiation of treatment protocols. Antecedent signs and symptoms of sepsis can be subtle and unrecognizable (e.g., loss of autonomic regulation of vital signs), causing treatment delays and harm to the patient. In this work we investigated the utility of high-resolution blood pressure (BP) and heart rate (HR) times series dynamics for the early prediction of sepsis in patients from an urban, academic hospital, meeting the third international consensus definition of sepsis (sepsis-III) during their ICU admission. Using a multivariate modeling approach we found that HR and BP dynamics at multiple time-scales are independent predictors of sepsis, even after adjusting for commonly measured clinical values and patient demographics and comorbidities. Earlier recognition and diagnosis of sepsis has the potential to decrease sepsis-related morbidity and mortality through earlier initiation of treatment protocols.

An electrocardiogram (ECG) signal may be affected by different types of disturbances/noises e.g. Power Line Interference (PLI), baseline wander, motion artifacts etc. Removing such disturbing signals from an ECG signal is the key to its accurate analysis leading to diagnosis of potential disease(s). In this paper, we present State Space Recursive Least Squares (SSRLS) filter based method for removal of 50Hz PLI noise from an ECG signal. The results are encouraging when compared with notch filter of varying attenuation levels. Under varying PLI noise levels, the SSRLS filter is seen to show superior performance as compared to notch filter. This work is part of National Information & Communication Technologies Research and Development (ICT R&D) fund project done in collaboration with National Institute of Heart Diseases (NIHD), Pakistan.

Background: Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods, infants with coarctation may present with life-threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and results: Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children's Healthcare of Atlanta. Patients with coarctation were receiving prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual's upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions: We were able to identify specific features in pulse oximetry waveforms that were able to accurately identify patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further largescale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

No abstract

No abstract

No abstract

The paper deals with the analy variability in three domains, the time domain, and the statistical domain. Different parameters the domains and they are given different weig accuracy of detecting arrhythmias. The series the ECG is used for each of the analysis tech domain parameters were the standard deviation deviation of defined segments of the RR interv consecutive beats that differ by more than a pre RMS value of the standard deviation. The analysis included four power spectrums includin Periodogram, Burg spectrum and the Yule spectr domain parameters included calculating the Information Based Similarity Index, Modified Transform Coefficients and viewing Poincare p methods are better analyzing tools as compared they are given more weight-age in determining RR-interval series. Based on the different weigh different methods, depending on their credi calculated for each of the series of RR-intervals get high scores around a pre defined value are according to the Fuzzification laws.

Objective. High morphological variability magnitude (MVM) and microvolt T wave alternans (TWA) within an electrocardiogram (ECG) signifies increased electrical instability and risk of sudden cardiac death. However, the influence of breathing rate (BR), heart rate (HR), and signal-to-noise ratio (SNR) is unknown and may inflate measured values. Approach. We synthesize ECGs with morphologies derived from the Physikalisch-Technische Bundesanstalt Database. We calculate MVM and TWA at varying BRs, HRs and SNRs. We compare the MVM and TWA of signal with versus without breathing at varying HRs and SNRs. We then quantify the percentage of MVM and TWA estimates affected by BR and HR in a healthy population and assess the effect of removing these affected estimates on a method for classifying individuals with and without post-traumatic stress disorder (PTSD). Main results. For signals with high SNR (>15 dB), MVM is significantly increased when BRs are > 9 respirations/minute (rpm) and HRs are < 100 beats/minute (bpm). Increased TWAs are detected for HR/BR pairs of 60/15, 60/30 and 120/30 bpm/rpm. For 18 healthy participants, 8.33% of TWA windows and 66.76% of MVM windows are affected by BR and HR. On average, the number of windows with TWA elevations > 47 μV decreases by 23% after excluding regions with significant BR and HR effect. Adding HR and BR to a morphological variability feature increases the classification performance by 6% for individuals with and without PTSD. Significance. Physiological BR and HR significantly increase MVM and TWA , indicating that BR and HR should be considered separately as confounders. The code for this work has been released as part of an open-source toolbox.