Expert, algorithm-assisted fetal heart rate interpretation has the potential to improve standard clinical performance by facilitating significantly earlier recognition of some tracings that are associated with metabolic acidemia without increasing the rate of operative intervention. However, this improvement is modest. Of infants who are born with metabolic acidemia, only approximately one-half potentially could be identified and have delivery expedited even under ideal circumstances, which are probably not realistic in current US practice. This represents the limits of electronic fetal heart rate monitoring performance. Additional technologies will be necessary if the goal of the prevention of neonatal metabolic acidemia is to be realized.

Recording of maternal uterine pressure (UP) and fetal heart rate (FHR) during labor and delivery is a procedure referred to as cardiotocography. We modeled this signal pair as an input-output system using a system identification approach to estimate their dynamic relation in terms of an impulse response function. We also modeled FHR baseline with a linear fit and FHR variability unrelated to UP using the power spectral density, computed from an auto-regressive model. Using a perinatal database of normal and pathological cases, we trained support-vector-machine classifiers with feature sets from these models. We used the classification in a detection process. We obtained the best results with a detector that combined the decisions of classifiers using both feature sets. It detected half of the pathological cases, with very few false positives (7.5%), 1 h and 40 min before delivery. This would leave sufficient time for an appropriate clinical response. These results clearly demonstrate the utility of our method for the early detection of cases needing clinical intervention.

Objectives: Atrial fibrillation (AF) is a common heart rhythm disorder associated with deadly and debilitating consequences including heart failure, stroke, poor mental health, reduced quality of life and death. Having an automatic system that diagnoses various types of cardiac arrhythmias would assist cardiologists to initiate appropriate preventive measures and to improve the analysis of cardiac disease. To this end, this paper introduces a new approach to detect and classify automatically cardiac arrhythmias in electrocardiograms (ECG) recordings.Methods: The proposed approach used a combination of Convolution Neural Networks (CNNs) and a sequence of Long Short-Term Memory (LSTM) units, with pooling, dropout and normalization techniques to improve their accuracy. The network predicted a classification at every 18th input sample and we selected the final prediction for classification. Results were cross-validated on the Physionet Challenge 2017 training dataset, which contains 8,528 single lead ECG recordings lasting from 9s to just over 60s.Results: Using the proposed structure and no explicit feature selection, 10-fold stratified cross-validation gave an overall F-measure of 0.83.10±0.015 on the held-out test data (mean ± standard deviation over all folds) and 0.80 on the hidden dataset of the Challenge entry server.

No abstract

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe. The clinical spectrum of SARS-CoV-2 pneumonia requires early detection and monitoring, within a clinical environment for critical cases and remotely for mild cases, with a large spectrum of symptoms. The fear of contamination in clinical environments has led to a dramatic reduction in on-site referrals for routine care. There has also been a perceived need to continuously monitor non-severe COVID-19 patients, either from their quarantine site at home, or dedicated quarantine locations (e.g. hotels). In particular, facilitating contact tracing with proximity and location tracing apps was adopted in many countries very rapidly. Thus, the pandemic has driven incentives to innovate and enhance or create new routes for providing healthcare services at distance. In particular, this has created a dramatic impetus to find innovative ways to remotely and effectively monitor patient health status. In this paper, we present a review of remote health monitoring initiatives taken in 20 states during the time of the pandemic. We emphasize in the discussion particular aspects that are common ground for the reviewed states, in particular the future impact of the pandemic on remote health monitoring and consideration on data privacy.