Search results for: sudden cardiac death.

Authors: Mustafa M. Donma, Orkide Donma

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Zinc (Zn) is a vital element required for growth and development particularly in children. It exhibits some protective effects against cardiovascular diseases (CVDs). Zn may be a potential biomarker of cardiovascular health. High sensitive cardiac troponin T (hs-cTnT) and cardiac myosin binding protein C (cMyBP-C) are new generation markers used for prediagnosis, diagnosis and prognosis of CVDs. The aim of this study is to determine Zn as well as new generation cardiac markers’ profiles in children with normal body mass index (N-BMI), obese (OB), morbid obese (MO) children and children with metabolic syndrome (MetS) findings. The association among them will also be investigated. Four study groups were constituted. The study protocol was approved by the institutional Ethics Committee of Tekirdag Namik Kemal University. Parents of the participants filled informed consent forms to participate in the study. Group 1 is composed of 44 children with N-BMI. Group 2 and Group 3 comprised 43 OB and 45 MO children, respectively. 45 MO children with MetS findings were included in Group 4. World Health Organization age- and sex-adjusted BMI percentile tables were used to constitute groups. These values were 15-85, 95-99 and above 99 for N-BMI, OB and MO, respectively. Criteria for MetS findings were determined. Routine biochemical analyses including Zn were performed. hs-cTnT and cMyBP-C concentrations were measured by enzyme-linked immunosorbent assay. Data were analyzed by using SPSS software. p < 0.05 was accepted as significant. Four groups were matched for age and gender. Decreased Zn concentrations were measured in Groups 2, 3 and 4 compared to Group 1. Groups did not differ from one another in terms of hs-cTnT. There were statistically significant differences between cMyBP-C levels of MetS group and N-BMI as well as OB groups. There was an increasing trend going from N-BMI group to MetS group. There were statistically significant negative correlations between Zn and hs-cTnT as well as cMyBP-C concentrations in MetS group. In conclusion, inverse correlations detected between Zn and new generation cardiac markers (hs-TnT and cMyBP-C) have pointed out that decreased levels of Zn accompany increased levels of hs-cTnT as well as cMyBP-C in children with MetS. This finding emphasizes that both Zn and these new generation cardiac markers may be evaluated as biomarkers of cardiovascular health during severe childhood obesity precipitated with MetS findings and also suggested as the messengers of the future risk in the adulthood periods of children with MetS.

Keywords: Cardiac myosin binding protein-C, cardiovascular diseases, children, high sensitive cardiac troponin T, obesity.

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Authors: Miho Tsukamoto

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This paper examines Japanese life expectancy, and the declining birth rate to investigate the Japanese people’s view of death, and their consciousness of death. To support their perspectives toward death, “Eitai Kuyobo,” and tombs with Japanese animation will be focused as Japanese citizens have created unique tombs designs of their own tombs. With the methodological aspects, Japan’s birth and mortality rates, Japan’s average life expectancy, history of tombs, creation of one’s own tombs and types of marriage will be significant. By examining the Japanese history of tombs, social change and unique tombs, and the increase of mortality rate in Japanese super-aging society, this study contributes the change of people’s view toward tombs, and a view toward life and death. Accordingly, focusing on the change of people’s view toward tombs it is concluded that the change is caused by the increase of mortality rate in Japanese super-aging society.

Keywords: Tombs, History, Change, New Designed Tombs, Family Relationship.

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Authors: F. Pourhasanzade, S. H. Sabzpoushan

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The heart tissue is an excitable media. A Cellular Automata is a type of model that can be used to model cardiac action potential propagation. One of the advantages of this approach against the methods based on differential equations is its high speed in large scale simulations. Recent cellular automata models are not able to avoid flat edges in the result patterns or have large neighborhoods. In this paper, we present a new model to eliminate flat edges by minimum number of neighbors.

Keywords: Cellular Automata, Action Potential Simulation, Isotropic Pattern.

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Authors: M. Hakami, A. Jammaly, I. Attafi, M. Oraiby, M. Jeraiby

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We reviewed an unusual case of a 65-year-old male taking an herbal mixture containing compounds with anticholinesterase activity for a long period of time, presented with acute my myocardial infarction and multiple organ dysfunction syndrome followed by death. Clinically, there are findings correlated with anticholinesterase activity, such as bilateral miosis, diaphoresis, vomiting and fasciculation without a history of any toxic ingestion or exposure. Gas chromatography–mass spectrometry screening studies identified the presence of thymol, anethole in the herbal extract and butylated hydroxytoluene in the blood sample. Hence, with this case report, we intend to highlight the necessity of evaluating the long-term use of the herbal mixture.

Keywords: Cholinesterase inhibitors, thymol, anethole, butylated hydroxytoluene, cardiac toxicity and myocardial infarction.

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Authors: Weronika Kurowska-Nouyrigat, Jacek Szumbarski

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Nowadays, cardiac disease is one of the most common cause of death. Each year almost one million of angioplasty interventions and stents implantations are made all over the world. Unfortunately, in 20-30% of cases neointimal proliferations leads to restenosis occurring within the following period of 3-6 months. Three major factors are believed to contribute mostly to the edge restenosis: (a) mechanical damage of the artery-s wall caused by the stent implantation, (b) interaction between the stent and the blood constituents and (c) endothelial growth stimulation by small (lower that 1.5 Pa) and oscillating wall shear stress. Assuming that this last actor is particularly important, a numerical model of restenosis basing on wall shear stress distribution in the stented artery was elaborated. A numerical simulations of the development of in-stent restenosis have been performed and realistic geometric patterns of a progressing lumen reduction have been obtained

Keywords: Coronary artery disease, coronary blood flow, instent restenosis.

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Authors: C. C. D. Kulathilake, M. Jayatilake, T. Takahashi

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The myocardium is composed of specialized muscle which relies mainly on fatty acid and sugar metabolism and it is widely contribute to the heart functioning. The changes of the cardiac energy-producing system during heart failure have been proved using autoradiography techniques. This study focused on evaluating sugar and fatty acid metabolism in myocardium as cardiac energy getting system using heart-accumulated radiopharmaceuticals. Two sets of autoradiographs of heart cross sections of Lewis male rats were analyzed and the time- accumulation curve obtained with use of the MATLAB image processing software to evaluate fatty acid and sugar metabolic functions.

Keywords: Autoradiographs, fatty acid, radiopharmaceuticals and sugar.

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Authors: Tesnim Charrad, Kaouther Nouira, Ahmed Ferchichi

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In order to reduce the number of deaths due to heart problems, we propose the use of Hierarchical Temporal Memory Algorithm (HTM) which is a real time anomaly detection algorithm. HTM is a cortical learning algorithm based on neocortex used for anomaly detection. In other words, it is based on a conceptual theory of how the human brain can work. It is powerful in predicting unusual patterns, anomaly detection and classification. In this paper, HTM have been implemented and tested on ECG datasets in order to detect cardiac anomalies. Experiments showed good performance in terms of specificity, sensitivity and execution time.

Keywords: HTM, Real time anomaly detection, ECG, Cardiac Anomalies.

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Authors: Mary Gloria C. Njoku, Leonard A. Jason, Nicole Porter, Molly Brown

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The objective of this study was to examine the interaction between mode of illness onset and psychiatric comorbidity on the health outcomes of persons with ME/CFS. A total of 114 individuals with ME/CFS participated in this study. Individuals completed a battery of baseline measures including the fatigue severity scale and measures of disability. Findings indicated that those with sudden illness onset had more impaired physical health functioning. In addition, among individuals with sudden onset, those without psychiatric comorbidity had greater fatigue severity and lower overall physical health than those with psychiatric comordibity. In contrast, among individuals with gradual illness onset, those with psychiatric comorbity had higher fatigue severity than those without comorbid psychiatric disorders. The health outcomes of individuals who have ME/CFS with or without psychiatric comorbidity are impacted by the mode of illness onset and this suggest that it is important to examine these factors in future research.

Keywords: Health Outcomes, ME/CFS, Mode of Illness Onset, Psychiatric Comorbidity.

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Authors: Katarzyna Czubak

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The aim of this paper is description of the notion of the death for prisoners and the ways of deal with. They express indifference, coldness, inability to accept the blame, they have no shame and no empathy. Is it enough to perform acts verging on the death. In this paper we described mechanisms and regularities of selfdestructive behaviour in the view of the relevant literature? The explanation of the phenomenon is of a biological and sociopsychological nature. It must be clearly stated that all forms of selfdestructive behaviour result from various impulses, conflicts and deficits. That is why they should be treated differently in terms of motivation and functions which they perform in a given group of people. Behind self-destruction there seems to be a motivational mechanism which forces prisoners to rebel and fight against the hated law and penitentiary systems. The imprisoned believe that pain and suffering inflicted on them by themselves are better than passive acceptance of repression. The variety of self-destruction acts is wide, and some of them take strange forms. We assume that a life-death barrier is a kind of game for them. If they cannot change the degrading situation, their life loses sense.

Keywords: Self- destruction, Simulation, Negative emotions, Consequences of conviction.

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Authors: Ramesh K. Sunkaria

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The linear methods of heart rate variability analysis such as non-parametric (e.g. fast Fourier transform analysis) and parametric methods (e.g. autoregressive modeling) has become an established non-invasive tool for marking the cardiac health, but their sensitivity and specificity were found to be lower than expected with positive predictive value <30%. This may be due to considering the RR-interval series as stationary and re-sampling them prior to their use for analysis, whereas actually it is not. This paper reviews the non-linear methods of HRV analysis such as correlation dimension, largest Lyupnov exponent, power law slope, fractal analysis, detrended fluctuation analysis, complexity measure etc. which are currently becoming popular as these uses the actual RR-interval series. These methods are expected to highly accurate cardiac health prognosis.

Keywords: chaos, nonlinear dynamics, sample entropy, approximate entropy, detrended fluctuation analysis.

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Authors: Young-Seok Choi

Abstract:

This work proposes a data-driven multiscale based quantitative measures to reveal the underlying complexity of electroencephalogram (EEG), applying to a rodent model of hypoxic-ischemic brain injury and recovery. Motivated by that real EEG recording is nonlinear and non-stationary over different frequencies or scales, there is a need of more suitable approach over the conventional single scale based tools for analyzing the EEG data. Here, we present a new framework of complexity measures considering changing dynamics over multiple oscillatory scales. The proposed multiscale complexity is obtained by calculating entropies of the probability distributions of the intrinsic mode functions extracted by the empirical mode decomposition (EMD) of EEG. To quantify EEG recording of a rat model of hypoxic-ischemic brain injury following cardiac arrest, the multiscale version of Tsallis entropy is examined. To validate the proposed complexity measure, actual EEG recordings from rats (n=9) experiencing 7 min cardiac arrest followed by resuscitation were analyzed. Experimental results demonstrate that the use of the multiscale Tsallis entropy leads to better discrimination of the injury levels and improved correlations with the neurological deficit evaluation after 72 hours after cardiac arrest, thus suggesting an effective metric as a prognostic tool.

Keywords: Electroencephalogram (EEG), multiscale complexity, empirical mode decomposition, Tsallis entropy.

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Authors: Young-Seok Choi

Abstract:

It has been known that a characteristic Burst-Suppression (BS) pattern appears in EEG during the early recovery period following Cardiac Arrest (CA). Here, to explore the relationship between cortical and subcortical neural activities underlying BS, extracellular activity in the parietal cortex and the centromedian nucleus of the thalamus and extradural EEG were recorded in a rodent CA model. During the BS, the cortical firing rate is extraordinarily high, and that bursts in EEG correlate to dense spikes in cortical neurons. Newly observed phenomena are that 1) thalamic activity reemerges earlier than cortical activity following CA, and 2) the correlation coefficient of cortical and thalamic activities rises during BS period. These results would help elucidate the underlying mechanism of brain recovery after CA injury.

Keywords: Cortex, thalamus, cardiac arrest, burst-suppression.

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Authors: Travis J. Meyer, Jasodra Ramlall, Phyo Thu, Nidhi Gadura

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For centuries humans have used the antimicrobial properties of copper to their advantage. Yet, after all these years the underlying mechanisms of copper mediated cell death in various microbes remain unclear. We had explored the hypothesis that copper mediated increased levels of lipid peroxidation in the membrane fatty acids is responsible for increased killing in Escherichia coli. In this study we show that in both gram positive (Staphylococcus aureus) and gram negative (Pseudomonas aeruginosa) bacteria there is a strong correlation between copper mediated cell death and increased levels of lipid peroxidation. Interestingly, the non-spore forming gram positive bacteria as well as gram negative bacteria show similar patterns of cell death, increased levels of lipid peroxidation, as well as genomic DNA degradation, however there is some difference in loss in membrane integrity upon exposure to copper alloy surface.

Keywords: Antimicrobial, copper, gram positive, gram negative.

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Authors: Meenakshi Mahajan, Arun Sharma, Navendu Sharma

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Increasing use of cell phone as a medium of human interaction is playing a vital role in solving riddles of crime as well. A young girl went missing from her home late in the evening in the month of August, 2008 when her enraged relatives and villagers physically assaulted and chased her fiancée who often frequented her home. Two years later, her mother lodged a complaint against the relatives and the villagers alleging that after abduction her daughter was either sold or killed as she had failed to trace her. On investigation, a rusted cell phone with partial visible IMEI number, clothes, bangles, human skeleton etc. recovered from abandoned well in the month of May, 2011 were examined in the lab. All hopes pinned on identity of cell phone, for only linking evidence to fix the scene of occurrence supported by call detail record (CDR) and to dispel doubts about mode of sudden disappearance or death as DNA technology did not help in establishing identity of the deceased. The conventional scientific methods were used without success and international mobile equipment identification number of the cell phone could be generated by using statistical analysis followed by online verification. 

Keywords: Call detail record, Luhn algorithm, stereomicroscope.

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Authors: Josip Visković, Josip Arnerić, Ante Rozga

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Based on the fact that volatility is time varying in high frequency data and that periods of high volatility tend to cluster, the most successful and popular models in modeling time varying volatility are GARCH type models. When financial returns exhibit sudden jumps that are due to structural breaks, standard GARCH models show high volatility persistence, i.e. integrated behavior of the conditional variance. In such situations models in which the parameters are allowed to change over time are more appropriate. This paper compares different GARCH models in terms of their ability to describe structural changes in returns caused by financial crisis at stock markets of six selected central and east European countries. The empirical analysis demonstrates that Markov regime switching GARCH model resolves the problem of excessive persistence and outperforms uni-regime GARCH models in forecasting volatility when sudden switching occurs in response to financial crisis.

Keywords: Central and east European countries, financial crisis, Markov switching GARCH model, transition probabilities.

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Authors: Farhan Ismaeel Dakheel, Raoof Smko, K. Negrat, Abdelsalam Almarimi

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In this paper we used data mining techniques to identify outlier patients who are using large amount of drugs over a long period of time. Any healthcare or health insurance system should deal with the quantities of drugs utilized by chronic diseases patients. In Kingdom of Bahrain, about 20% of health budget is spent on medications. For the managers of healthcare systems, there is no enough information about the ways of drug utilization by chronic diseases patients, is there any misuse or is there outliers patients. In this work, which has been done in cooperation with information department in the Bahrain Defence Force hospital; we select the data for Cardiac patients in the period starting from 1/1/2008 to December 31/12/2008 to be the data for the model in this paper. We used three techniques for finding the drug utilization for cardiac patients. First we applied a clustering technique, followed by measuring of clustering validity, and finally we applied a decision tree as classification algorithm. The clustering results is divided into three clusters according to the drug utilization, for 1603 patients, who received 15,806 prescriptions during this period can be partitioned into three groups, where 23 patients (2.59%) who received 1316 prescriptions (8.32%) are classified to be outliers. The classification algorithm shows that the use of average drug utilization and the age, and the gender of the patient can be considered to be the main predictive factors in the induced model.

Keywords: Data Mining, Clustering, Classification, Drug Utilization..

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Authors: Ahmed M. Farag, Wael F. Mohamed, Atef A. Ata, Burhamy M. Burhamy

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The main objective of the present paper is to derive an easy numerical technique for the analysis of the free vibration through the stepped regions of plates. Based on the utilities of the step by step integration initial values IV and Finite differences FD methods, the present improved Initial Value Finite Differences (IVFD) technique is achieved. The first initial conditions are formulated in convenient forms for the step by step integrations while the upper and lower edge conditions are expressed in finite difference modes. Also compatibility conditions are created due to the sudden variation of plate thickness. The present method (IVFD) is applied to solve the fourth order partial differential equation of motion for stepped plate across two different panels under the sudden step compatibility in addition to different types of end conditions. The obtained results are examined and the validity of the present method is proved showing excellent efficiency and rapid convergence.

Keywords: Vibrations, Step by Step Integration, Stepped plate, Boundary.

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Authors: Marcos A. Dullius, Ramon C. Fernandes, Divanízia N. Souza

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The aim of this study was to develop a dynamic cardiac phantom for quality control in myocardial scintigraphy. The dynamic heart phantom constructed only contained the left ventricle, made of elastic material (latex), comprising two cavities: one internal and one external. The data showed a non-significant variation in the values of left ventricular ejection fraction (LVEF) obtained by varying the heart rate. It was also possible to evaluate the ejection fraction (LVEF) through different arrays of image acquisition and to perform an intercomparison of LVEF by two different scintillation cameras. The results of the quality control tests were satisfactory, showing that they can be used as parameters in future assessments. The new dynamic heart phantom was demonstrated to be effective for use in LVEF measurements. Therefore, the new heart simulator is useful for the quality control of scintigraphic cameras.

Keywords: sheart, nuclear medicine, phantom

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Authors: Renato Dedic, Madjid Allili, Roger Lecomte, Adbelhamid Benchakroun

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The class of geometric deformable models, so-called level sets, has brought tremendous impact to medical imagery. In this paper we present yet another application of level sets to medical imaging. The method we give here will in a way modify the speed term in the standard level sets equation of motion. To do so we build a potential based on the distance and the gradient of the image we study. In turn the potential gives rise to the force field: F~F(x, y) = P ∀(p,q)∈I ((x, y) - (p, q)) |ÔêçI(p,q)| |(x,y)-(p,q)| 2 . The direction and intensity of the force field at each point will determine the direction of the contour-s evolution. The images we used to test our method were produced by the Univesit'e de Sherbrooke-s PET scanners.

Keywords: PET, Cardiac, Heart, Mouse, Geodesic, Geometric, Level Sets, Deformable Models, Edge Detection, Segmentation.

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Authors: R.K.Tuli

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In the present communication, we have studied different variations in the entropy measures in the different states of queueing processes. In case of steady state queuing process, it has been shown that as the arrival rate increases, the uncertainty increases whereas in the case of non-steady birth-death process, it is shown that the uncertainty varies differently. In this pattern, it first increases and attains its maximum value and then with the passage of time, it decreases and attains its minimum value.

Keywords: Entropy, Birth-death process, M/G/1 system, G/M/1system, Steady state, Non-steady state

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Authors: Paria Soleimani, Arezoo Neshati

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Myocardial infarction is one of the leading causes of death in the world. Some of these deaths occur even before the patient reaches the hospital. Myocardial infarction occurs as a result of impaired blood supply. Because the most of these deaths are due to coronary artery disease, hence the awareness of the warning signs of a heart attack is essential. Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort, then early detection and successful treatment of these symptoms is vital to save them. Therefore, importance and usefulness of a system designing to assist physicians in early diagnosis of the acute heart attacks is obvious. The main purpose of this study would be to enable patients to become better informed about their condition and to encourage them to seek professional care at an earlier stage in the appropriate situations. For this purpose, the data were collected on 711 heart patients in Iran hospitals. 28 attributes of clinical factors can be reported by patients; were studied. Three logistic regression models were made on the basis of the 28 features to predict the risk of heart attacks. The best logistic regression model in terms of performance had a C-index of 0.955 and with an accuracy of 94.9%. The variables, severe chest pain, back pain, cold sweats, shortness of breath, nausea and vomiting, were selected as the main features.

Keywords: Coronary heart disease, acute heart attacks, prediction, logistic regression.

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Authors: Asit K Sikary, O. P. Murty

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In this study, we have collected cases with adipocere formation, which were from the South Delhi region (average room temperature 27-390C) and autopsied at our centre. Details of the circumstances of the death, cause and time of death, surrounding environment and demographic profile of the deceased were taken into account. Total 16 cases were included in this study. Adipocere formation was predominantly present over cheeks, shoulder, breast, flanks, buttocks, and thighs. Out of 16, 11 cases were found in a dry atmosphere, 5 cases were brought from the water. There were 5 cases in which adipocere formation was seen in less than 2 days, and among them, in 1 case, as early as one day. This study showed that adipocere formation can be seen as early as 1 day in a hot and humid environment.

Keywords: Adipocere, drowning, hanging, humid environment, strangulation, subtropical climate.

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Authors: Angelica I. Aviles, Pilar Sobrevilla, Alicia Casals

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Compensating physiological motion in the context of minimally invasive cardiac surgery has become an attractive issue since it outperforms traditional cardiac procedures offering remarkable benefits. Owing to space restrictions, computer vision techniques have proven to be the most practical and suitable solution. However, the lack of robustness and efficiency of existing methods make physiological motion compensation an open and challenging problem. This work focusses on increasing robustness and efficiency via exploration of the classes of 1−and 2−regularized optimization, emphasizing the use of explicit regularization. Both approaches are based on natural features of the heart using intensity information. Results pointed out the 1−regularized optimization class as the best since it offered the shortest computational cost, the smallest average error and it proved to work even under complex deformations.

Keywords: Motion Compensation, Optimization, Regularization, Beating Heart Surgery, Ill-posed problem.

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Authors: Samuel P. Prahlow, Anthony Sciuva, Katherine Bombly, Emily Wilson, Shiv Dhiman, Savita Arya

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A prevalence cohort study of atherosclerotic lesions within cadavers was performed to better understand and characterize the prevalence of atherosclerosis among Georgia residents within body donors in the Philadelphia College of Osteopathic Medicine (PCOM) - Georgia body donor program. We procured specimens from cadavers used for medical student, physical therapy student, and biomedical science student cadaveric anatomical dissection at PCOM - South Georgia and PCOM - Georgia. Tissues were prepared using hematoxylin and eosin (H&E) stain as histological slides by Colquitt Regional Medical Center Laboratory Services. One section from each of the following arteries was taken after cadaveric dissection at the site of most calcification palpated grossly (if present): left anterior descending coronary artery, left internal carotid artery, abdominal aorta, splenic artery, and hepatic artery. All specimens were graded and categorized according to the American Heart Association’s Modified and Conventional Standards for Atherosclerotic Lesions using x4, x10, x40 microscopic magnification. Our study cohort included 22 cadavers, with 16 females and 6 males. The average age was 72.54 and median age was 72, with a range of 52 to 90 years old. The cause of death determination listing vascular and/or cardiovascular causes were present on 6 of the 22 death certificates. 19 of 22 (86%) cadavers had at least a single artery grading > 5. Of the cadavers with at least a single artery graded at greater than 5, only 5 of 19 (26%) cadavers had a vascular or cardiovascular cause of death reported. Malignancy was listed as a cause of death on 7 (32%) of death certificates. The average atherosclerosis grading of the common hepatic, splenic and left internal carotid arteries (2.15, 3.05, and 3.36 respectively) were lower than the left anterior descending artery and the abdominal aorta (5.16 and 5.86 respectively). This prevalence study characterizes atherosclerosis found in five medium and large systemic arteries within cadavers from the state of Georgia.

Keywords: Atherosclerosis, cardiovascular, histology, pathology.

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Authors: Khalid Kaddoura, Tarek Zayed

Abstract:

Infrastructure assets are essential in urban cities; their purpose is to facilitate the public needs. As a result, their conditions and states shall always be monitored to avoid any sudden malfunction. Sewer systems, one of the assets, are an essential part of the underground infrastructure as they transfer sewer medium to designated areas. However, their conditions are subject to deterioration due to ageing. Therefore, it is of great significance to assess the conditions of pipelines to avoid sudden collapses. Current practices of sewer pipeline assessment rely on industrial protocols that consider distinct defects and grades to conclude the limited average or peak score of the assessed assets. This research aims to enhance the evaluation by integrating the Quality Function Deployment (QFD) and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) methods in assessing the condition of sewer pipelines. The methodology shall study the cause and effect relationship of the systems’ defects to deduce the relative influence weights of each defect. Subsequently, the overall grade is calculated by aggregating the WHAT’s and HOW’s of the House of Quality (HOQ) using the computed relative weights. Thus, this study shall enhance the evaluation of the assets to conclude informative rehabilitation and maintenance plans for decision makers.

Keywords: Condition assessment, DEMATEL, QFD, sewer pipelines.

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Authors: F. Kovács, K. Kádár, G. Hosszú, Á. T. Balogh, T. Zsedrovits, N. Kersner, A. Nagy, Gy. Jeney

Abstract:

The paper presents a novel screening method to indicate congenital heart diseases (CHD), which otherwise could remain undetected because of their low level. Therefore, not belonging to the high-risk population, the pregnancies are not subject to the regular fetal monitoring with ultrasound echocardiography. Based on the fact that CHD is a morphological defect of the heart causing turbulent blood flow, the turbulence appears as a murmur, which can be detected by fetal phonocardiography (fPCG). The proposed method applies measurements on the maternal abdomen and from the recorded sound signal a sophisticated processing determines the fetal heart murmur. The paper describes the problems and the additional advantages of the fPCG method including the possibility of measurements at home and its combination with the prescribed regular cardiotocographic (CTG) monitoring. The proposed screening process implemented on a telemedicine system provides an enhanced safety against hidden cardiac diseases.

Keywords: Cardiac murmurs, fetal phonocardiography, screening of CHDs, telemedicine system.

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Authors: Insung Jung, Gi-Nam Wang

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In this paper, we present user pattern learning algorithm based MDSS (Medical Decision support system) under ubiquitous. Most of researches are focus on hardware system, hospital management and whole concept of ubiquitous environment even though it is hard to implement. Our objective of this paper is to design a MDSS framework. It helps to patient for medical treatment and prevention of the high risk patient (COPD, heart disease, Diabetes). This framework consist database, CAD (Computer Aided diagnosis support system) and CAP (computer aided user vital sign prediction system). It can be applied to develop user pattern learning algorithm based MDSS for homecare and silver town service. Especially this CAD has wise decision making competency. It compares current vital sign with user-s normal condition pattern data. In addition, the CAP computes user vital sign prediction using past data of the patient. The novel approach is using neural network method, wireless vital sign acquisition devices and personal computer DB system. An intelligent agent based MDSS will help elder people and high risk patients to prevent sudden death and disease, the physician to get the online access to patients- data, the plan of medication service priority (e.g. emergency case).

Keywords: Neural network, U-healthcare, MDSS, CAP, DSS.

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Authors: B. Lefranc, C. Aufauvre-Poupon, C. Martin-Krumm, M. Trousselard

Abstract:

Isolated and confined environments (ICE) present several challenges which may adversely affect human’s psychology and physiology. Submariners in Sub-Surface Ballistic Nuclear (SSBN) mission exposed to these environmental constraints must be able to perform complex tasks as part of their normal duties, as well as during crisis periods when emergency actions are required or imminent. The operational and environmental constraints they face contribute to challenge human adaptability. The impact of such a constrained environment has yet to be explored. Establishing a knowledge framework is a determining factor, particularly in view of the next long space travels. Ensuring that the crews are maintained in optimal operational conditions is a real challenge because the success of the mission depends on them. This study focused on the evaluation of the impact of stress on mental health and sensory degradation of submariners during a mission on SSBN using cardiac biosignal (heart rate variability, HRV) clustering. This is a pragmatic exploratory study of a prospective cohort included 19 submariner volunteers. HRV was recorded at baseline to classify by clustering the submariners according to their stress level based on parasympathetic (Pa) activity. Impacts of high Pa (HPa) versus low Pa (LPa) level at baseline were assessed on emotional state and sensory perception (interoception and exteroception) as a cardiac biosignal during the patrol and at a recovery time one month after. Whatever the time, no significant difference was found in mental health between groups. There are significant differences in the interoceptive, exteroceptive and physiological functioning during the patrol and at recovery time. To sum up, compared to the LPa group, the HPa maintains a higher level in psychosensory functioning during the patrol and at recovery but exhibits a decrease in Pa level. The HPa group has less adaptable HRV characteristics, less unpredictability and flexibility of cardiac biosignals while the LPa group increases them during the patrol and at recovery time. This dissociation between psychosensory and physiological adaptation suggests two treatment modalities for ICE environments. To our best knowledge, our results are the first to highlight the impact of physiological differences in the HRV profile on the adaptability of submariners. Further studies are needed to evaluate the negative emotional and cognitive effects of ICEs based on the cardiac profile. Artificial intelligence offers a promising future for maintaining high level of operational conditions. These future perspectives will not only allow submariners to be better prepared, but also to design feasible countermeasures that will help support analog environments that bring us closer to a trip to Mars.

Keywords: Adaptation, exteroception, HRV, ICE, interoception, SSBN.

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Authors: Bill D. Geis, Frederick Newman

Abstract:

Suicide and wrongful death forensic cases are the fastest rising tort in mental health law. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from US state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. But suicide ideation, in the matter of suicide risk determination, may be a necessary but insufficient target of lethal suicide risk assessment. Assessment of near-term suicide risk—assessment that goes beyond verbalized suicide ideation and relates to acute crisis variables—is likely needed. Specifically, such other or additional suicide risk variable assessment may be required in the context of lethal suicide risk situations, as opposed to the discernment of general, nonlethal suicide behavior as a standard of practice (whether a patient is having suicidal thoughts or exhibiting an ambivalent suicide attempt potential). In the current study, verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The Lethal Suicide Risk Assessment, Acute Model, and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training and become the legal standard of care for expected clinical behavior. Without this expanded clinical assessment perspective, the standard of care for suicide assessment is out of sync with current knowledge—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: Forensic evaluation, standard of care, suicide, suicide assessment, wrongful death.

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Authors: Mustafa M. Donma, Sule G. Kacmaz, Ahsen Yilmaz, Savas Guzel, Orkide Donma

Abstract:

Obesity, as excessive fat accumulation in the body, is a global health problem. The prevalence of obesity and its complications increase due to easy access to high-energy food and decreased physical activity. Cardiovascular diseases (CVDs) constitute a significant part of obesity-related morbidity and mortality. Since the effects of obesity on cardiovascular system may start during childhood without clinical findings, elucidating the mechanisms of cardiovascular changes associated with childhood obesity became more important. In this study, we aimed to investigate some biochemical parameters which may be involved in obesity-related pathologic processes of CVDs. One hundred and seventy-seven children were included in the study, and they were divided into four groups based upon WHO criteria and presence of the metabolic syndrome (MetS): children with normal-BMI, obesity, morbid obesity, and MetS. High-sensitive cardiac troponin T (hs-cTnT), cardiac myosin binding protein C (cMyBP-C), trimethylamine N-oxide (TMAO), soluble tumor necrosis factor-like weak inducer (sTWEAK), chromogranin A (CgA), multimerin-2 levels, and other biochemical parameters were measured in serum samples. Anthropometric measurements and clinical findings of the children were recorded. Statistical analyses were performed. Children with normal-BMI had significantly higher CgA levels than children with obesity, morbid obesity, and MetS (p < 0.05). Cardiac MyBP-C levels of children with MetS were significantly higher than of children with normal-BMI and OB children (p < 0.05). There was no significant difference in hs-cTnT, sTWEAK, TMAO and multimerin-2 between the groups (p>0.05). These results suggested that cMyBP-C and CgA molecules may be involved in the pathogenesis of obesity-related CVDs.

Keywords: biomarker, cardiovascular diseases, children, obesity

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