Search results for: working heart rate
11579 When Conducting an Analysis of Workplace Incidents, It Is Imperative to Meticulously Calculate Both the Frequency and Severity of Injuries Sustain
Authors: Arash Yousefi
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Experts suggest that relying exclusively on parameters to convey a situation or establish a condition may not be adequate. Assessing and appraising incidents in a system based on accident parameters, such as accident frequency, lost workdays, or fatalities, may not always be precise and occasionally erroneous. The frequency rate of accidents is a metric that assesses the correlation between the number of accidents causing work-time loss due to injuries and the total working hours of personnel over a year. Traditionally, this has been calculated based on one million working hours, but the American Occupational Safety and Health Organization has updated its standards. The new coefficient of 200/000 working hours is now used to compute the frequency rate of accidents. It's crucial to ensure that the total working hours of employees are equally represented when calculating individual event and incident numbers. The accident severity rate is a metric used to determine the amount of time lost or wasted during a given period, often a year, in relation to the total number of working hours. It measures the percentage of work hours lost or wasted compared to the total number of useful working hours, which provides valuable insight into the number of days lost or wasted due to work-related incidents for each working hour. Calculating the severity of an incident can be difficult if a worker suffers permanent disability or death. To determine lost days, coefficients specified in the "tables of days equivalent to OSHA or ANSI standards" for disabling injuries are used. The accident frequency coefficient denotes the rate at which accidents occur, while the accident severity coefficient specifies the extent of damage and injury caused by these accidents. These coefficients are crucial in accurately assessing the magnitude and impact of accidents.Keywords: incidents, safety, analysis, frequency, severity, injuries, determine
Procedia PDF Downloads 9011578 Identifying Physiological Markers That Are Sensitive to Cognitive Load in Preschoolers
Authors: Priyashri Kamlesh Sridhar, Suranga Nanayakkara
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Current frameworks in assessment follow lesson delivery and rely heavily on test performance or teacher’s observations. This, however, neglects the underlying cognitive load during the learning process. Identifying the pivotal points when the load occurs helps design effective pedagogies and tools that respond to learners’ cognitive state. There has been limited research on quantifying cognitive load in preschoolers, real-time. In this study, we recorded electrodermal activity and heart rate variability (HRV) from 10 kindergarteners performing executive function tasks and Johnson Woodcock test of cognitive abilities. Preliminary findings suggest that there are indeed sensitive task-dependent markers in skin conductance (number of SCRs and average amplitude of SCRs) and HRV (mean heart rate and low frequency component) captured during the learning process.Keywords: early childhood, learning, methodologies, pedagogies
Procedia PDF Downloads 32011577 Characteristics of Children Heart Rhythm Regulation with Acute Respiratory Diseases
Authors: D. F. Zeynalov, T. V. Kartseva, O. V. Sorokin
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Currently, approaches to assess cardiointervalography are based on the calculation of data variance intervals RR. However, they do not allow the evaluation of features related to a period of the cardiac cycle, so how electromechanical phenomena during cardiac subphase are characterized by differently directed changes. Therefore, we have proposed a method of subphase analysis of the cardiac cycle, developed in the department of hominal physiology Novosibirsk State Medical University to identify the features of the dispersion subphase of the cardiac cycle. In the present paper we have examined the 5-minute intervals cardiointervalography (CIG) to isolate RR-, QT-, ST-ranges in healthy children and children with acute respiratory diseases (ARD) in comparison. It is known that primary school-aged children suffer at ARD 5-7 times per year. Consequently, it is one of the most relevant problems in pediatrics. It is known that the spectral indices and indices of temporal analysis of heart rate variability are highly sensitive to the degree of intoxication during immunological process. We believe that the use of subphase analysis of heart rate will allow more thoroughly evaluate responsiveness of the child organism during the course of ARD. The study involved 60 primary school-aged children (30 boys and 30 girls). In order to assess heart rhythm regulation, the record CIG was used on the "VNS-Micro" device of Neurosoft Company (Ivanovo) for 5 minutes in the supine position and 5 minutes during active orthostatic test. Subphase analysis of variance QT-interval and ST-segment was performed on the "KardioBOS" software Biokvant Company (Novosibirsk). In assessing the CIG in the supine position and in during orthostasis of children with acute respiratory diseases only RR-intervals are observed typical trend of general biological reactions through pressosensitive compensation mechanisms to lower blood pressure, but compared with healthy children the severity of the changes is different, of sick children are more pronounced indicators of heart rate regulation. But analysis CIG RR-intervals and analysis subphase ST-segment have yielded conflicting trends, which may be explained by the different nature of the intra- and extracardiac influences on regulatory mechanisms that implement the various phases of the cardiac cycle.Keywords: acute respiratory diseases, cardiointervalography, subphase analysis, cardiac cycle
Procedia PDF Downloads 27511576 Vagal Nerve Stimulator as a Treatment Approach in CHARGE Syndrome: A Case Report
Authors: Roya Vakili, Lekaa Elhajjmoussa, Barzin Omidi-Shal, Kim Blake
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Objective: The purpose of this case report is to highlight the successful treatment of a patient with Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness, (CHARGE syndrome) using a vagal nerve stimulator (VNS). Background: This is the first documented case report, to the authors' best knowledge, for a patient with CHARGE syndrome, epilepsy, autism, and postural orthostatic tachycardia syndrome (POTS) that was successfully treated with an implanted VNS therapeutic device. Methodology: The study is a case report. Results: This is the case of a 24-year-old female patient with CHARGE syndrome (non-random association of anomalies Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness) and several other comorbidities including refractory epilepsy, Patent Ductus Arteriosus (PDA) and POTS who had significant improvement of her symptoms after VNS implantation. She was a VNS candidate given her longstanding history of drug-resistant epilepsy and current disposition secondary to CHARGE syndrome. Prior to VNS implantation, she experienced three generalized seizures a year and daily POTS-related symptoms. She was having frequent lightheadedness and syncope spells due to a rapid heart rate and low blood pressure. The VNS device was set to detect a rapid heart rate and send appropriate stimulation anytime the heart rate exceeded 20% of the patient’s normal baseline. The VNS device demonstrated frequent elevated heart rates and concurrent VNS release every 8 minutes in addition to the programmed events. Following VNS installation, the patient became more active, alert, and communicative and was able to verbally communicate with words she was unable to say prior. Her GI symptoms also improved, as she was able to tolerate food better orally in addition to her G and J tube, likely another result of the vagal nerve stimulation. Additionally, the patient’s seizures and POTS-related cardiac events appeared to be well controlled. She had prolonged electroencephalogram (EEG) testing, showing no significant change in epileptiform activity. Improvements in the patient’s disposition are believed to be secondary to parasympathetic stimulation, adequate heart rate control, and GI stimulation, in addition to behavioral changes and other benefits via her implanted VNS. Conclusion: VNS showed promising results in improving the patient's quality of life and managing her diverse symptoms, including dysautonomia, POTs, gastrointestinal mobility, cognitive functioning as well seizure control.Keywords: autism, POTs, CHARGE, VNS
Procedia PDF Downloads 8511575 Heart Failure Identification and Progression by Classifying Cardiac Patients
Authors: Muhammad Saqlain, Nazar Abbas Saqib, Muazzam A. Khan
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Heart Failure (HF) has become the major health problem in our society. The prevalence of HF has increased as the patient’s ages and it is the major cause of the high mortality rate in adults. A successful identification and progression of HF can be helpful to reduce the individual and social burden from this syndrome. In this study, we use a real data set of cardiac patients to propose a classification model for the identification and progression of HF. The data set has divided into three age groups, namely young, adult, and old and then each age group have further classified into four classes according to patient’s current physical condition. Contemporary Data Mining classification algorithms have been applied to each individual class of every age group to identify the HF. Decision Tree (DT) gives the highest accuracy of 90% and outperform all other algorithms. Our model accurately diagnoses different stages of HF for each age group and it can be very useful for the early prediction of HF.Keywords: decision tree, heart failure, data mining, classification model
Procedia PDF Downloads 40211574 An Exploratory Research of Human Character Analysis Based on Smart Watch Data: Distinguish the Drinking State from Normal State
Authors: Lu Zhao, Yanrong Kang, Lili Guo, Yuan Long, Guidong Xing
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Smart watches, as a handy device with rich functionality, has become one of the most popular wearable devices all over the world. Among the various function, the most basic is health monitoring. The monitoring data can be provided as an effective evidence or a clue for the detection of crime cases. For instance, the step counting data can help to determine whether the watch wearer was quiet or moving during the given time period. There is, however, still quite few research on the analysis of human character based on these data. The purpose of this research is to analyze the health monitoring data to distinguish the drinking state from normal state. The analysis result may play a role in cases involving drinking, such as drunk driving. The experiment mainly focused on finding the figures of smart watch health monitoring data that change with drinking and figuring up the change scope. The chosen subjects are mostly in their 20s, each of whom had been wearing the same smart watch for a week. Each subject drank for several times during the week, and noted down the begin and end time point of the drinking. The researcher, then, extracted and analyzed the health monitoring data from the watch. According to the descriptive statistics analysis, it can be found that the heart rate change when drinking. The average heart rate is about 10% higher than normal, the coefficient of variation is less than about 30% of the normal state. Though more research is needed to be carried out, this experiment and analysis provide a thought of the application of the data from smart watches.Keywords: character analysis, descriptive statistics analysis, drink state, heart rate, smart watch
Procedia PDF Downloads 16711573 An Auxiliary Technique for Coronary Heart Disease Prediction by Analyzing Electrocardiogram Based on ResNet and Bi-Long Short-Term Memory
Authors: Yang Zhang, Jian He
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Heart disease is one of the leading causes of death in the world, and coronary heart disease (CHD) is one of the major heart diseases. Electrocardiogram (ECG) is widely used in the detection of heart diseases, but the traditional manual method for CHD prediction by analyzing ECG requires lots of professional knowledge for doctors. This paper introduces sliding window and continuous wavelet transform (CWT) to transform ECG signals into images, and then ResNet and Bi-LSTM are introduced to build the ECG feature extraction network (namely ECGNet). At last, an auxiliary system for coronary heart disease prediction was developed based on modified ResNet18 and Bi-LSTM, and the public ECG dataset of CHD from MIMIC-3 was used to train and test the system. The experimental results show that the accuracy of the method is 83%, and the F1-score is 83%. Compared with the available methods for CHD prediction based on ECG, such as kNN, decision tree, VGGNet, etc., this method not only improves the prediction accuracy but also could avoid the degradation phenomenon of the deep learning network.Keywords: Bi-LSTM, CHD, ECG, ResNet, sliding window
Procedia PDF Downloads 8911572 Wavelet-Based Classification of Myocardial Ischemia, Arrhythmia, Congestive Heart Failure and Sleep Apnea
Authors: Santanu Chattopadhyay, Gautam Sarkar, Arabinda Das
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This paper presents wavelet based classification of various heart diseases. Electrocardiogram signals of different heart patients have been studied. Statistical natures of electrocardiogram signals for different heart diseases have been compared with the statistical nature of electrocardiograms for normal persons. Under this study four different heart diseases have been considered as follows: Myocardial Ischemia (MI), Congestive Heart Failure (CHF), Arrhythmia and Sleep Apnea. Statistical nature of electrocardiograms for each case has been considered in terms of kurtosis values of two types of wavelet coefficients: approximate and detail. Nine wavelet decomposition levels have been considered in each case. Kurtosis corresponding to both approximate and detail coefficients has been considered for decomposition level one to decomposition level nine. Based on significant difference, few decomposition levels have been chosen and then used for classification.Keywords: arrhythmia, congestive heart failure, discrete wavelet transform, electrocardiogram, myocardial ischemia, sleep apnea
Procedia PDF Downloads 13411571 Comparison of the Effect of Heart Rate Variability Biofeedback and Slow Breathing Training on Promoting Autonomic Nervous Function Related Performance
Authors: Yi Jen Wang, Yu Ju Chen
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Background: Heart rate variability (HRV) biofeedback can promote autonomic nervous function, sleep quality and reduce psychological stress. In HRV biofeedback training, it is hoped that through the guidance of machine video or audio, the patient can breathe slowly according to his own heart rate changes so that the heart and lungs can achieve resonance, thereby promoting the related effects of autonomic nerve function; while, it is also pointed out that if slow breathing of 6 times per minute can also guide the case to achieve the effect of cardiopulmonary resonance. However, there is no relevant research to explore the comparison of the effectiveness of cardiopulmonary resonance by using video or audio HRV biofeedback training and metronome-guided slow breathing. Purpose: To compare the promotion of autonomic nervous function performance between using HRV biofeedback and slow breathing guided by a metronome. Method: This research is a kind of experimental design with convenient sampling; the cases are randomly divided into the heart rate variability biofeedback training group and the slow breathing training group. The HRV biofeedback training group will conduct HRV biofeedback training in a four-week laboratory and use the home training device for autonomous training; while the slow breathing training group will conduct slow breathing training in the four-week laboratory using the mobile phone APP breathing metronome to guide the slow breathing training, and use the mobile phone APP for autonomous training at home. After two groups were enrolled and four weeks after the intervention, the autonomic nervous function-related performance was repeatedly measured. Using the chi-square test, student’s t-test and other statistical methods to analyze the results, and use p <0.05 as the basis for statistical significance. Results: A total of 27 subjects were included in the analysis. After four weeks of training, the HRV biofeedback training group showed significant improvement in the HRV indexes (SDNN, RMSSD, HF, TP) and sleep quality. Although the stress index also decreased, it did not reach statistical significance; the slow breathing training group was not statistically significant after four weeks of training, only sleep quality improved significantly, while the HRV indexes (SDNN, RMSSD, TP) all increased. Although HF and stress indexes decreased, they were not statistically significant. Comparing the difference between the two groups after training, it was found that the HF index improved significantly and reached statistical significance in the HRV biofeedback training group. Although the sleep quality of the two groups improved, it did not reach that level in a statistically significant difference. Conclusion: HRV biofeedback training is more effective in promoting autonomic nervous function than slow breathing training, but the effects of reducing stress and promoting sleep quality need to be explored after increasing the number of samples. The results of this study can provide a reference for clinical or community health promotion. In the future, it can also be further designed to integrate heart rate variability biological feedback training into the development of AI artificial intelligence wearable devices, which can make it more convenient for people to train independently and get effective feedback in time.Keywords: autonomic nervous function, HRV biofeedback, heart rate variability, slow breathing
Procedia PDF Downloads 17511570 Computational Fluid Dynamics Simulation and Comparison of Flow through Mechanical Heart Valve Using Newtonian and Non-Newtonian Fluid
Authors: D. Šedivý, S. Fialová
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The main purpose of this study is to show differences between the numerical solution of the flow through the artificial heart valve using Newtonian or non-Newtonian fluid. The simulation was carried out by a commercial computational fluid dynamics (CFD) package based on finite-volume method. An aortic bileaflet heart valve (Sorin Bicarbon) was used as a pattern for model of real heart valve replacement. Computed tomography (CT) was used to gain the accurate parameters of the valve. Data from CT were transferred in the commercial 3D designer, where the model for CFD was made. Carreau rheology model was applied as non-Newtonian fluid. Physiological data of cardiac cycle were used as boundary conditions. Outputs were taken the leaflets excursion from opening to closure and the fluid dynamics through the valve. This study also includes experimental measurement of pressure fields in ambience of valve for verification numerical outputs. Results put in evidence a favorable comparison between the computational solutions of flow through the mechanical heart valve using Newtonian and non-Newtonian fluid.Keywords: computational modeling, dynamic mesh, mechanical heart valve, non-Newtonian fluid
Procedia PDF Downloads 38611569 Cardiovascular Disease Prediction Using Machine Learning Approaches
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It is estimated that heart disease accounts for one in ten deaths worldwide. United States deaths due to heart disease are among the leading causes of death according to the World Health Organization. Cardiovascular diseases (CVDs) account for one in four U.S. deaths, according to the Centers for Disease Control and Prevention (CDC). According to statistics, women are more likely than men to die from heart disease as a result of strokes. A 50% increase in men's mortality was reported by the World Health Organization in 2009. The consequences of cardiovascular disease are severe. The causes of heart disease include diabetes, high blood pressure, high cholesterol, abnormal pulse rates, etc. Machine learning (ML) can be used to make predictions and decisions in the healthcare industry. Thus, scientists have turned to modern technologies like Machine Learning and Data Mining to predict diseases. The disease prediction is based on four algorithms. Compared to other boosts, the Ada boost is much more accurate.Keywords: heart disease, cardiovascular disease, coronary artery disease, feature selection, random forest, AdaBoost, SVM, decision tree
Procedia PDF Downloads 15311568 Effects of Handgrip Isometric Training in Blood Pressure of Patients with Peripheral Artery Disease
Authors: Raphael M. Ritti-Dias, Marilia A. Correia, Wagner J. R. Domingues, Aline C. Palmeira, Paulo Longano, Nelson Wolosker, Lauro C. Vianna, Gabriel G. Cucato
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Patients with peripheral arterial disease (PAD) have a high prevalence of hypertension, which contributes to a high risk of acute cardiovascular events and cardiovascular mortality. Strategies to reduce cardiovascular risk of these patients are needed. Meta-analysis studies have shown that isometric handgrip training promotes reductions in clinical blood pressure in normotensive, pre-hypertensive and hypertensive individuals. However, the effect of this exercise training on other cardiovascular function indicators in PAD patients remains unknown. Thus, the aim of this study was to analyze the effects of isometric handgrip training on blood pressure in patients with PAD. In this clinical trial, 28 patients were randomly allocated into two groups: isometric handgrip training (HG) and control (CG). The HG conducted the unilateral handgrip training three days per week (four sets of two minutes, with 30% of maximum voluntary contraction with an interval of four minutes between sets). CG was encouraged to increase their physical activity levels. At baseline and after eight weeks blood pressure and heart rate were obtained. ANOVA two-way for repeated measures with the group (GH and GC) and time (pre- and post-intervention) as factors was performed. After 8 weeks of training there were no significant changes in systolic blood pressure (HG pre 141 ± 24.0 mmHg vs. HG post 142 ± 22.0 mmHg; CG pre 140 ± 22.1 mmHg vs. CG post 146 ± 16.2 mmHg; P=0.18), diastolic blood pressure (HG pre 74 ± 10.4 mmHg vs. HG post 74 ± 11.9 mmHg; CG pre 72 ± 6.9 mmHg vs. CG post 74 ± 8.0 mmHg; P=0.22) and heart rate (HG pre 61 ± 10.5 bpm vs. HG post 62 ± 8.0 bpm; CG pre 64 ± 11.8 bpm vs. CG post 65 ± 13.6 bpm; P=0.81). In conclusion, our preliminary data indicate that isometric handgrip training did not modify blood pressure and heart rate in patients with PAD.Keywords: blood pressure, exercise, isometric, peripheral artery disease
Procedia PDF Downloads 32911567 The Ratio of Second to Fourth Digit Length Correlates with Cardiorespiratory Fitness in Male College Students Men but Not in Female
Authors: Cheng-Chen Hsu
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Background: The ratio of the length of the second finger (index finger, 2D) to the fourth finger (ring finger, 4D) (2D:4D) is a putative marker of prenatal hormones. A low 2D:4D ratio is related to high prenatal testosterone (PT) levels. Physiological research has suggested that a low 2D:4D ratio is correlated with high sports ability. Aim: To examine the association between cardiorespiratory fitness and 2D:4D. Methods: Assessment of 2D:4D; Images of hands were collected from participants using a computer scanner. Hands were placed lightly on the surface of the plate. Image analysis was performed using Image-Pro Plus 5.0 software. Feature points were marked at the tip of the finger and at the center of the proximal crease on the second and fourth digits. Actual measurement was carried out automatically, 2D:4D was calculated by dividing 2nd by 4th digit length. YMCA 3-min Step Test; The test involves stepping up and down at a rate of 24 steps/min for 3 min; a tape recording of the correct cadence (96 beats/min) is played to assist the participant in keeping the correct pace. Following the step test, the participant immediately sits down and, within 5 s, the tester starts counting the pulse for 1 min. The score for the test, the total 1-min postexercise heart rate, reflects the heart’s ability to recover quickly. Statistical Analysis ; Pearson’s correlation (r) was used for assessing the relationship between age, physical measurements, one-minute heart rate after YMCA 3-minute step test (HR) and 2D:4D. An independent-sample t-test was used for determining possible differences in HR between subjects with low and high values of 2D:4D. All statistical analyses were carried out with SPSS 18 for Window. All P-values were two-tailed at P = 0.05, if not reported otherwise. Results: A median split by 2D:4D was applied, resulting in a high and a low group. One-minute heart rate after YMCA 3-minute step test was significantly difference between groups of male right-hand 2D:4D (p = 0.024). However, no difference in left-hand 2D:4D values between groups in male, and no digit ratio difference between groups in female. Conclusion: The results showed that cardiopulmonary fitness is related to right 2D:4D, only in men. We argue that prenatal testosterone may have an effect on cardiorespiratory fitness in male but not in female.Keywords: college students, digit ratio, finger, step test, fitness
Procedia PDF Downloads 27511566 Gender Features of Left Ventricular Myocardial Remodeling and the Development of Chronic Heart Failure in Patients with Postinfarction Cardiosclerosis
Authors: G. Dadashova, A. Bakhshaliyev
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Aim: Determine gender differences in the etiology and clinical outcomes, as well as in the remodeling of the left ventricle (LV) in patients with chronic heart failure (CHF), suffering from arterial hypertension (AH) and coronary heart disease (CHD). Material and methods: The study included 112 patients of both sexes; aged 45 to 60 years with postinfarction cardiosclerosis had functional class (FC) heart failure II-IV of NYHA which were examined on the basis of Azerbaijan Scientific Research Institute of Cardiology. The patients were divided into 2 groups: 1st c. 60 males, mean age 54,8 ± 3,3 years, and 2nd gr 52 women, mean age 55,8 ± 3,1 years. To assess cardiac hemodynamic all patients underwent echocardiography (B-M-modes) using ‘Vivid 3’. Thus on the basis of indicators such as the index of the relative thickness of the left ventricle wall and the index of left ventricular mass (LVMI) was identified the architectonic model of the left ventricle. Results: According to our research leading cause of heart failure in women is 50.5% of cases of hypertension, ischemic heart disease 23.7% (with 79.5% of the cases developed in patients with chronic heart failure who did not have a history of myocardial infarction). While in men is the undisputed leader of CHD, forming 78.3% of CHF (80.3% in men with CHF occurred after myocardial infarction). According to our research in women more often than men CHF develops a type of diastolic dysfunction (DD, and left ventricular ejection fraction remained unchanged. Since DD occurs in men at 65,8% vs. 76,4% of women when p < 0,05. In the group of women was more common prognostic neblagopryatnye remodeling - eccentric hypertrophy of the left ventricle: 68% vs. 54.5% among men (p < 0,05), concentric left ventricular hypertrophy: 21% in women vs 19,1% (p > 0,05 ). Conclusions: Patients with heart failure are a number of gender-specific: the prevalence of hypertension in women, and coronary heart disease in men. While in women with heart failure often recorded diastolic dysfunction and characterized by the development of prognostically unfavorable remodeling types: eccentric and concentric LV hypertrophy.Keywords: chronic heart failure, arterial hypertension, remodeling, diastolic dysfunction, men, women, ischemic heart disease
Procedia PDF Downloads 34811565 Impact of Neuron with Two Dendrites in Heart Behavior
Authors: Kaouther Selmi, Alaeddine Sridi, Mohamed Bouallegue, Kais Bouallegue
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Neurons are the fundamental units of the brain and the nervous system. The variable structure model of neurons consists of a system of differential equations with various parameters. By optimizing these parameters, we can create a unique model that describes the dynamic behavior of a single neuron. We introduce a neural network based on neurons with multiple dendrites employing an activation function with a variable structure. In this paper, we present a model for heart behavior. Finally, we showcase our successful simulation of the heart's ECG diagram using our Variable Structure Neuron Model (VSMN). This result could provide valuable insights into cardiology.Keywords: neural networks, neuron, dendrites, heart behavior, ECG
Procedia PDF Downloads 8511564 The Effect of Eight Weeks of Aerobic Training on Indices of Cardio-Respiratory and Exercise Tolerance in Overweight Women with Chronic Asthma
Authors: Somayeh Negahdari, Mohsen Ghanbarzadeh, Masoud Nikbakht, Heshmatolah Tavakol
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Asthma, obesity and overweight are the main factors causing change within the heart and respiratory airways. Asthma symptoms are normally observed during exercising. Epidemiological studies have indicated asthma symptoms occurring due to certain lifestyle habits; for example, a sedentary lifestyle. In this study, eight weeks of aerobic exercises resulted in a positive effect overall in overweight women experiencing mild chronic asthma. The quasi-experimental applied research has been done based on experimental and control groups. The experimental group (seven patients) and control group (n = 7) were graded before and after the test. According to the Borg dyspnea and fatigue Perception Index, the training intensity has determined. Participants in the study performed a sub-maximal aerobic activity schedule (45% to 80% of maximum heart rate) for two months, while the control group (n = 7) stayed away from aerobic exercise. Data evaluation and analysis of covariance compared both the pre-test and post-test with paired t-test at significance level of P≤ 0.05. After eight weeks of exercise, the results of the experimental group show a significant decrease in resting heart rate, systolic blood pressure, minute ventilation, while a significant increase in maximal oxygen uptake and tolerance activity (P ≤ 0.05). In the control group, there was no significant difference in these parameters ((P ≤ 0.05). The results indicate the aerobic activity can strengthen the respiratory muscles, while other physiological factors could result in breathing and heart recovery. Aerobic activity also resulted in favorable changes in cardiovascular parameters, and exercise tolerance of overweight women with chronic asthma.Keywords: asthma, respiratory cardiac index, exercise tolerance, aerobic, overweight
Procedia PDF Downloads 23411563 Prediction of Coronary Heart Disease Using Fuzzy Logic
Authors: Elda Maraj, Shkelqim Kuka
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Coronary heart disease causes many deaths in the world. Unfortunately, this problem will continue to increase in the future. In this paper, a fuzzy logic model to predict coronary heart disease is presented. This model has been developed with seven input variables and one output variable that was implemented for 30 patients in Albania. Here fuzzy logic toolbox of MATLAB is used. Fuzzy model inputs are considered as cholesterol, blood pressure, physical activity, age, BMI, smoking, and diabetes, whereas the output is the disease classification. The fuzzy sets and membership functions are chosen in an appropriate manner. Centroid method is used for defuzzification. The database is taken from University Hospital Center "Mother Teresa" in Tirana, Albania.Keywords: coronary heart disease, fuzzy logic toolbox, membership function, prediction model
Procedia PDF Downloads 16111562 Working Hours of Nurses in Public Hospitals: An Analyse Based on Working Schedules
Authors: Feride Eskin Bacaksiz, Arzu K. Harmanci Seren
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The problems about the working hours of nursing personnel, such as overworking, numbers of night or daytime shifts, is stated one of the most complained issues by nurses. Otherwise, besides of nursing shortage, absenteeism of nurses because of sickness, some other health problems, or other reasons enforces nurse managers to make working schedules. In this study, it was aimed to analyse and evaluate the working schedules of nurses working in public hospitals. Working schedule lists of nursing personnel for the months of October and November in two public hospitals were analysed and evaluated. Approvals were acquired from the head nurse managers. Descriptive and comparative analyses were used. Totally 36 lists were analysed from two hospitals. There were totally 416 nurses (manager nurse: 25, nurse: 391) and 6-28 (12.6, SD=5.34) nurses in each list. It was found that nurses were working 8 (42.5%), 12 (27.9%) and 16 (20%) hours, in inpatient clinics (74.8%). Totally 20.2% of the nurses were absent during analysing time due to the annual, paid or unpaid leaves. Nurses were generally working 20-112 hours (80.27, SD=11.92). Most of the nurses over worked 1.5-443 hours (47.436, SD=60.78) the year before that year. It was determined that 11.8% of the nurses (n: 49) were working only night shifts and 42.1% (n: 175) of the nurses were working only daytime shifts. It was found that there were inequities in the working hours of nurses.Keywords: nurse, public hospitals, working conditions, working schedules
Procedia PDF Downloads 28311561 Automated Heart Sound Classification from Unsegmented Phonocardiogram Signals Using Time Frequency Features
Authors: Nadia Masood Khan, Muhammad Salman Khan, Gul Muhammad Khan
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Cardiologists perform cardiac auscultation to detect abnormalities in heart sounds. Since accurate auscultation is a crucial first step in screening patients with heart diseases, there is a need to develop computer-aided detection/diagnosis (CAD) systems to assist cardiologists in interpreting heart sounds and provide second opinions. In this paper different algorithms are implemented for automated heart sound classification using unsegmented phonocardiogram (PCG) signals. Support vector machine (SVM), artificial neural network (ANN) and cartesian genetic programming evolved artificial neural network (CGPANN) without the application of any segmentation algorithm has been explored in this study. The signals are first pre-processed to remove any unwanted frequencies. Both time and frequency domain features are then extracted for training the different models. The different algorithms are tested in multiple scenarios and their strengths and weaknesses are discussed. Results indicate that SVM outperforms the rest with an accuracy of 73.64%.Keywords: pattern recognition, machine learning, computer aided diagnosis, heart sound classification, and feature extraction
Procedia PDF Downloads 26211560 Physical Fitness in Omani Children with Sickle Cell Disease and Sickle Cell Trait
Authors: Mahfoodha Al-Kitani, Dylan Thompson, Keith Stokes
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Sickle cell disease (SCD) and sickle cell trait (SCT) are the most common hematological diseases in Oman according to the national survey of genetic blood disorders. The aim of this study was to determine markers of physical fitness and anthropometrics indices in children with sickle cell disease and children with sickle cell trait and compare them with normal healthy children of the same age. One hundred and twenty male children participated in the present study divided to three groups: 40 with sickle disease (SCD; age, 13.3(.80), height, 131.9(3.5), mass, 29.2(3.1)); 40 with sickle cell trait (SCT; age, 12.2(.80), height, 141.0(9.9), mass, 38.0(4.4)); and 40 controls with normal hemoglobin (Con; age, 12.8(.80), height, 139.4(8.7), mass, 37.2(4.3)). All children completed a 5-min running exercise test on a treadmill at speed corresponding to 5 km/hr. Heart rate and was recorded during exercise and during 10-min of recovery. Blood lactate was measured before and 5 min after the completion of exercise. Children with SCD exhibited a higher mean value (P < 0.05) for percent body fat and fat mass than the normal healthy subjects and SCT subjects. Resting values of hemoglobin were similar in SCT (11.04(.78)) and control (10.8(94)) groups, and lower in SCD (8.89(.54); P < 0.05). There was a strong correlation between peak heart rate and resting hemoglobin levels for the three groups (r= -.472. n= 120, p < .0005).The SCD group (175.2(10.3)) exhibited higher mean heart rate during exercise than those observed in the SCT (143.7(9.5)) and normal control children (144.5(22.4); P < 0.05). Additionally, SCD children showed higher serum lactate values before and after treadmill exercise compared to the other groups (P < 0.05). Children with sickle cell trait demonstrate similar physical fitness level and similar exercise responses to treadmill stress test to normal children. In contrast, SCD children have lower body mass, higher fat mass and lower physical fitness than children with SCT and healthy controls.Keywords: sickle cell disease, sickle cell trait, children, exercise
Procedia PDF Downloads 42911559 Improving Access to Palliative Care for Heart Failure Patients in England Using a Health Systems Approach
Authors: Alex Hughes
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Patients with advanced heart failure develop specific palliative care needs due to the progressive symptom burden and unpredictable disease trajectory. NICE guidance advises that palliative care should be provided to patients with both cancer and non-cancer conditions as and when required. However, there is some way to go before this guidance is consistently and effectively implemented nationwide in conditions such as heart failure. The Ambitions for Palliative and End of Life Care: A national framework for local action in England provides a set of foundations and ambitions which outline a vision for what high-quality palliative and end-of-life care look like in England. This poster aims to critically consider how to improve access to palliative care for heart failure patients in England by analysing the foundations taken from this framework to generate specific recommendations using Soft Systems Methodology (SSM). The eight foundations analysed are: ‘Personalised care planning’, ‘Shared records’, ‘Evidence and information’, ‘Involving, supporting and caring for those important to the dying Person’, ‘Education and training’, ‘24/7 access’, ‘Co-design’ and ‘Leadership.’ A number of specific recommendations have been generated which highlight a need to close the evidence-policy gap and implement policy with sufficient evidence. These recommendations, alongside the creation of an evidence-based national strategy for palliative care and heart failure, should improve access to palliative care for heart failure patients in England. Once implemented, it will be necessary to evaluate the effect of these proposals to understand if access to palliative care for heart failure patients actually improves.Keywords: access, health systems, heart failure, palliative care
Procedia PDF Downloads 12811558 Intelligent Wireless Patient Monitoring and Tracking System
Authors: Ch. Sandeep Kumar Subudhi, S. Sivanandam
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Our system is to monitor the human body temperature, blood pressure (BP), Pulse Rate and ECG and tracking the patient location. In our system the body temperature is detected by using LM35 temperature sensor, blood pressure is detected by the BP sensor, pulse rate is detected by the ear plug pulse sensor and the ECG is detected by the three lead ECG sensor in the working environment of the patient. The sensed information is sent to the PIC16F877 microcontroller through signal conditioning circuit. A desired amount of sensor value is set and if it is exceeded preliminary steps should be taken by indication by buzzer. The sensor information will be transmitted from the patient unit to the main controller unit with the help of Zigbee communication medium which is connected with the microcontrollers in the both units. The main controller unit will send those sensor data as well as the location of that patient by the help of GPS module to the observer/doctor. The observer/doctor can receive the SMS sent by GSM module and further decision can be taken. The message is sent to a cell phone using global system mobile (GSM) Modem. MAX232 acts as a driver between microcontroller and modem.Keywords: LM35, heart beat sensor, ECG Sensor, BP Sensor, Zigbee module, GSM module, GPS module, PIC16F877A microcontroller
Procedia PDF Downloads 38211557 Assessment of Five Photoplethysmographic Methods for Estimating Heart Rate Variability
Authors: Akshay B. Pawar, Rohit Y. Parasnis
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Heart Rate Variability (HRV) is a widely used indicator of the regulation between the autonomic nervous system (ANS) and the cardiovascular system. Besides being non-invasive, it also has the potential to predict mortality in cases involving critical injuries. The gold standard method for determining HRV is based on the analysis of RR interval time series extracted from ECG signals. However, because it is much more convenient to obtain photoplethysmogramic (PPG) signals as compared to ECG signals (which require the attachment of several electrodes to the body), many researchers have used pulse cycle intervals instead of RR intervals to estimate HRV. They have also compared this method with the gold standard technique. Though most of their observations indicate a strong correlation between the two methods, recent studies show that in healthy subjects, except for a few parameters, the pulse-based method cannot be a surrogate for the standard RR interval- based method. Moreover, the former tends to overestimate short-term variability in heart rate. This calls for improvements in or alternatives to the pulse-cycle interval method. In this study, besides the systolic peak-peak interval method (PP method) that has been studied several times, four recent PPG-based techniques, namely the first derivative peak-peak interval method (P1D method), the second derivative peak-peak interval method (P2D method), the valley-valley interval method (VV method) and the tangent-intersection interval method (TI method) were compared with the gold standard technique. ECG and PPG signals were obtained from 10 young and healthy adults (consisting of both males and females) seated in the armchair position. In order to de-noise these signals and eliminate baseline drift, they were passed through certain digital filters. After filtering, the following HRV parameters were computed from PPG using each of the five methods and also from ECG using the gold standard method: time domain parameters (SDNN, pNN50 and RMSSD), frequency domain parameters (Very low-frequency power (VLF), Low-frequency power (LF), High-frequency power (HF) and Total power or “TP”). Besides, Poincaré plots were also plotted and their SD1/SD2 ratios determined. The resulting sets of parameters were compared with those yielded by the standard method using measures of statistical correlation (correlation coefficient) as well as statistical agreement (Bland-Altman plots). From the viewpoint of correlation, our results show that the best PPG-based methods for the determination of most parameters and Poincaré plots are the P2D method (shows more than 93% correlation with the standard method) and the PP method (mean correlation: 88%) whereas the TI, VV and P1D methods perform poorly (<70% correlation in most cases). However, our evaluation of statistical agreement using Bland-Altman plots shows that none of the five techniques agrees satisfactorily well with the gold standard method as far as time-domain parameters are concerned. In conclusion, excellent statistical correlation implies that certain PPG-based methods provide a good amount of information on the pattern of heart rate variation, whereas poor statistical agreement implies that PPG cannot completely replace ECG in the determination of HRV.Keywords: photoplethysmography, heart rate variability, correlation coefficient, Bland-Altman plot
Procedia PDF Downloads 32311556 Sportband: An Idea for Workout Monitoring in Amateur and Recreational Sports
Authors: Kamila Mazur-Oleszczuk, Rafal Banasiuk, Dawid Krasnowski, Maciej Pek, Marcin Podgorski, Krzysztof Rykaczewski, Sabina Zoledowska, Dawid Nidzworski
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Workout safety is one of the most significant challenges of recreational sports. Loss of water and electrolytes is a consequence of thermoregulatory sweating during exercise. The rate of sweat loss and its chemical composition can fluctuate within and among individuals. That is why we propose our sportband 'Flow' as a device for monitoring these parameters. 'Flow' consists of two parts: an intelligent module and a mobile application. The application allows verifying the training progress and data archiving. The sportband intelligent module includes temperature, heart rate and pulse measurement (non-invasive, continuous methods of workout monitoring). Apart from the standard components, the device will consist of a sweat composition analyzer situated in sportband intelligent module. Sweat is a water solution of numerous compounds such as ions (sodium up to 1609 µg/ml, potassium up to 274 µg/ml), lactic acid (skin pH is between 4.5 - 6) and a small amount of glucose. Awareness of sweat composition allows personalizing electrolyte intake after training. A comprehensive workout monitoring (sweat composition, heart rate, blood oxygen level) will provide improvement in the training routine and time management, which is our goal for the development of the sweat composition analyzer.Keywords: flow, sportband, sweat, workout monitoring
Procedia PDF Downloads 15111555 The Amount of Organic Phosphates (Like DPG) Existing in Blood is Determining Factor of Mammal’s Bulk
Authors: Ramin Amirmardfar
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Throughout Necessary oxygen should be supplied for all cells of a mammal at any moment through blood to make it possible remain alive all cells the mammal’s body. In case a mammal’s bulk is large, there is a farther distance between cells in different tissues and mammals’ heart. Therefore red blood cells in bulky mammal’s body should be capable of conveying oxygen to farther distances. To make it practical, oxygen should be glued red blood cells tenaciously. In other words, cohesion strength of oxygen to red blood cell of bulky mammal’s blood should be much more than the same of small mammal’s blood. In mammal’s bodies, the controlling factor of amount of cohesion of oxygen to red blood cell, are organic phosphates (like DPG). The less DPG in red blood cells of a mammal, the more cohesion of oxygen to red blood cell (at the same rate). As much as oxygen is glued more tenacious to red blood cells, oxygen could been carried to farther distance and as much as oxygen could be conveyed to farther points of heart, bulk of mammal could be larger at the same rate.Keywords: mammals size, animals size, organic phosphates, DPG, red blood cell, metabolism
Procedia PDF Downloads 35511554 Effects of a Simulated Power Cut in Automatic Milking Systems on Dairy Cows Heart Activity
Authors: Anja Gräff, Stefan Holzer, Manfred Höld, Jörn Stumpenhausen, Heinz Bernhardt
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In view of the increasing quantity of 'green energy' from renewable raw materials and photovoltaic facilities, it is quite conceivable that power supply variations may occur, so that constantly working machines like automatic milking systems (AMS) may break down temporarily. The usage of farm-made energy is steadily increasing in order to keep energy costs as low as possible. As a result, power cuts are likely to happen more frequently. Current work in the framework of the project 'stable 4.0' focuses on possible stress reactions by simulating power cuts up to four hours in dairy farms. Based on heart activity it should be found out whether stress on dairy cows increases under these circumstances. In order to simulate a power cut, 12 random cows out of 2 herds were not admitted to the AMS for at least two hours on three consecutive days. The heart rates of the cows were measured and the collected data evaluated with HRV Program Kubios Version 2.1 on the basis of eight parameters (HR, RMSSD, pNN50, SD1, SD2, LF, HF and LF/HF). Furthermore, stress reactions were examined closely via video analysis, milk yield, ruminant activity, pedometer and measurements of cortisol metabolites. Concluding it turned out, that during the test only some animals were suffering from minor stress symptoms, when they tried to get into the AMS at their regular milking time, but couldn´t be milked because the system was manipulated. However, the stress level during a regular “time-dependent milking rejection” was just as high. So the study comes to the conclusion, that the low psychological stress level in the case of a 2-4 hours failure of an AMS does not have any impact on animal welfare and health.Keywords: dairy cow, heart activity, power cut, stable 4.0
Procedia PDF Downloads 31111553 A Crossover Study of Therapeutic Equivalence of Generic Product Versus Reference Product of Ivabradine in Patients with Chronic Heart Failure
Authors: Hadeer E. Eliwa, Naglaa S. Bazan, Ebtissam A. Darweesh, Nagwa A. Sabri
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Background: Generic substitution of brand ivabradine prescriptions can reduce drug expenditures and improve adherence. However, the distrust of generic medicines by practitioners and patients due to doubts regarding their quality and fear of counterfeiting compromise the acceptance of this practice. Aim: The goal of this study is to compare the therapeutic equivalence of brand product versus the generic product of ivabradine in adult patients with chronic heart failure with reduced ejection fraction (≤ 40%) (HFrEF). Methodology: Thirty-two Egyptian patients with chronic heart failure with reduced ejection fraction (HFrEF) were treated with branded ivabradine (Procrolan ©) and generic (Bradipect ©) during 24 (2x12) weeks. Primary outcomes were resting heart rate (HR), NYHA FC, Quality of life (QoL) using Minnesota Living with Heart Failure (MLWHF) and EF. Secondary outcomes were the number of hospitalizations for worsening HFrEF and adverse effects. The washout period was not allowed. Findings: At the 12th week, the reduction in HR was comparable in the two groups (90.13±7.11 to 69±11.41 vs 96.13±17.58 to 67.31±8.68 bpm in brand and generic groups, respectively). Also, the increase in EF was comparable in the two groups (27.44 ±4.59 to 33.38±5.62 vs 32±5.96 to 39.31±8.95 in brand and generic groups, respectively). The improvement in NYHA FC was comparable in both groups (87.5% in brand group vs 93.8% in the generic group). The mean value of the QOL improved from 31.63±15.8 to 19.6±14.7 vs 35.68±17.63 to 22.9±15.1 for the brand and generic groups, respectively. Similarly, at end of 24 weeks, no significant changes were observed from data observed at 12th week regarding HR, EF, QoL and NYHA FC. Only minor side effects, mainly phosphenes, and a comparable number of hospitalizations were observed in both groups. Conclusion: The study revealed no statistically significant differences in the therapeutic effect and safety between generic and branded ivabradine. We assume that practitioners can safely interchange between them for economic reasons.Keywords: bradipect©, heart failure, ivabradine, Procrolan ©, therapeutic equivalence
Procedia PDF Downloads 45811552 Considerations for the Use of High Intensity Interval Training in Secondary Physical Education
Authors: Amy Stringer, Resa Chandler
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High Intensity Interval Training (HIIT) involves a 3-10-minute circuit of various exercises which is a viable alternative to a traditional cardiovascular and strength training regimen. Research suggests that measures of health-related fitness can either be maintained or actually improve with the use of this training method. After conducting a 6-week HIIT research study with 10-14 year old children, considerations for using a daily HIIT workout are presented. Is the use of HIIT with children a reasonable consideration for physical education programs? The benefits and challenges of this type of an intervention are identified. This study is significant in that achieving fitness gains in a small amount of daily class time is an attractive concept – especially for physical education teachers who often do not have the time necessary to accomplish all of their curricular goals in the amount of class time assigned. Basic methodologies include students participating in a circuit of exercises for 7-10 minutes at 80-95% of max heart rate as measured by heart rate monitors. Student pre and post fitness test data were collected for cardio-vascular endurance, muscular endurance, and body composition. Research notes as well as commentary by the teachers and researchers who participated in the HIIT study contributed to the understanding of the cost-benefit analysis. Major findings of the study are that HIIT has limited effectiveness but is a good choice for limited class times. Student efficacy of their ability to complete the exercises and visible heart rate data were considered to be significant factors in success of the HIIT study. The effective use of technology promoting positive audience effect during the display of heart rate data was more important at the beginning of the study than at the end. Student ‘buy-in’ and motivation, teacher motivation and ‘buy-in’, the variety of activities in the circuit and the fitness level of the student at the beginning of the study were also findings influencing the fitness outcomes of the study. Concluding Statement: High intensity interval training can be used effectively in a secondary physical education program. It is not a ‘magic bullet’ to produce health-related fitness outcomes in every student but it is an effective tool to enhance student fitness in a limited time and contribute to the goals of the program.Keywords: cardio vascular fitness, children, high intensity interval training, physical education
Procedia PDF Downloads 11411551 Effect of Tai-Chi and Cyclic Meditation on Hemodynamic Responses of the Prefrontal Cortex: A Functional near Infrared Spectroscopy
Authors: Singh Deepeshwar, N. K. Manjunath, M. Avinash
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Meditation is a self-regulated conscious process associated with improved awareness, perception, attention and overall performance. Different traditional origin of meditation technique may have different effects on autonomic activity and brain functions. Based on this quest, the present study evaluated the effect of Tai-Chi Chuan (TCC, a Chines movement based meditation technique) and Cyclic Meditation (CM, an Indian traditional based stimulation and relaxation meditation technique) on the hemodynamic responses of the prefrontal cortex (PFC) and autonomic functions (such as R-R interval of heart rate variability and respiration). These two meditation practices were compared with simple walking. Employing 64 channel near infrared spectroscopy (NIRS), we measured hemoglobin concentration change (i.e., Oxyhemoglobin [ΔHbO], Deoxyhemoglobin [ΔHbR] and Total hemoglobin change [ΔTHC]) in the bilateral PFC before and after TCC, CM and Walking in young college students (n=25; average mean age ± SD; 23.4 ± 3.1 years). We observed the left PFC activity predominantly modulates sympathetic activity effects during the Tai-Chi whereas CM showed changes on right PFC with vagal dominance. However, the changes in oxyhemoglobin and total blood volume change after Tai-Chi was significant higher (p < 0.05, spam t-maps) on the left hemisphere, whereas after CM, there was a significant increase in oxyhemoglobin (p < 0.01) with a decrease in deoxyhemoglobin (p < 0.05) on right PFC. The normal walking showed decrease in Oxyhemoglobin with an increase in deoxyhemoglobin on left PFC. The autonomic functions result showed a significant increase in RR- interval (p < 0.05) along with significant reductions in HR (p < 0.05) in CM, whereas Tai-chi session showed significant increase in HR (p < 0.05) when compared to walking session. Within a group analysis showed a significant reduction in RR-I and significant increase in HR both in Tai-chi and walking sessions. The CM showed there were a significant improvement in the RR - interval of HRV (p < 0.01) with the reduction of heart rate and breath rate (p < 0.05). The result suggested that Tai-Chi and CM both have a positive effect on left and right prefrontal cortex and increase sympathovagal balance (alertful rest) in autonomic nervous system activity.Keywords: brain, hemodynamic responses, yoga, meditation, Tai-Chi Chuan (TCC), walking, heart rate variability (HRV)
Procedia PDF Downloads 30611550 Gene Expressions in Left Ventricle Heart Tissue of Rat after 150 Mev Proton Irradiation
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Introduction: In mediastinal radiotherapy and to a lesser extend also in total-body irradiation (TBI) radiation exposure may lead to development of cardiac diseases. Radiation-induced heart disease is dose-dependent and it is characterized by a loss of cardiac function, associated with progressive heart cells degeneration. We aimed to determine the in-vivo radiation effects on fibronectin, ColaA1, ColaA2, galectin and TGFb1 gene expression levels in left ventricle heart tissues of rats after irradiation. Material and method: Four non-treatment adult Wistar rats as control group (group A) were selected. In group B, 4 adult Wistar rats irradiated to 20 Gy single dose of 150 Mev proton beam locally in heart only. In heart plus lung irradiate group (group C) 4 adult rats was irradiated by 50% of lung laterally plus heart radiation that mentioned in before group. At 8 weeks after radiation animals sacrificed and left ventricle heart dropped in liquid nitrogen for RNA extraction by Absolutely RNA® Miniprep Kit (Stratagen, Cat no. 400800). cDNA was synthesized using M-MLV reverse transcriptase (Life Technologies, Cat no. 28025-013). We used Bio-Rad machine (Bio Rad iQ5 Real Time PCR) for QPCR testing by relative standard curve method. Results: We found that gene expression of fibronectin in group C significantly increased compared to control group, but it was not showed significant change in group B compared to group A. The levels of gene expressions of Cola1 and Cola2 in mRNA did not show any significant changes between normal and radiation groups. Changes of expression of galectin target significantly increased only in group C compared to group A. TGFb1 expressions in group C more than group B showed significant enhancement compared to group A. Conclusion: In summary we can say that 20 Gy of proton exposure of heart tissue may lead to detectable damages in heart cells and may distribute function of them as a component of heart tissue structure in molecular level.Keywords: gene expression, heart damage, proton irradiation, radiotherapy
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