Telecardiology and its settings of application: An update

2017 ◽  
Vol 24 (5) ◽  
pp. 373-381 ◽  
Author(s):  
Giuseppe Molinari ◽  
Martina Molinari ◽  
Matteo Di Biase ◽  
Natale D Brunetti
Keyword(s):  
Real Time ◽  
Tertiary Care ◽  
Implantable Devices ◽  
Decision Making Process ◽  
Clinical Settings ◽  
Medical Specialties ◽  
Coronary Syndrome ◽  
Wide Range ◽  
Patients With Heart Failure ◽  
The Impact

Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.

scholarly journals An Adaptive Bitrate Switching Algorithm for Speech Applications in Context of WebRTC

2021 ◽  
Vol 17 (4) ◽  
pp. 1-21
Author(s):  
Mohannad Alahmadi ◽  
Peter Pocta ◽  
Hugh Melvin
Keyword(s):  
Real Time ◽  
Data Exchange ◽  
Quality Of Experience ◽  
End User ◽  
High Quality ◽  
Content Type ◽  
Switching Algorithm ◽  
Wide Range ◽  
The Impact

Web Real-Time Communication (WebRTC) combines a set of standards and technologies to enable high-quality audio, video, and auxiliary data exchange in web browsers and mobile applications. It enables peer-to-peer multimedia sessions over IP networks without the need for additional plugins. The Opus codec, which is deployed as the default audio codec for speech and music streaming in WebRTC, supports a wide range of bitrates. This range of bitrates covers narrowband, wideband, and super-wideband up to fullband bandwidths. Users of IP-based telephony always demand high-quality audio. In addition to users’ expectation, their emotional state, content type, and many other psychological factors; network quality of service; and distortions introduced at the end terminals could determine their quality of experience. To measure the quality experienced by the end user for voice transmission service, the E-model standardized in the ITU-T Rec. G.107 (a narrowband version), ITU-T Rec. G.107.1 (a wideband version), and the most recent ITU-T Rec. G.107.2 extension for the super-wideband E-model can be used. In this work, we present a quality of experience model built on the E-model to measure the impact of coding and packet loss to assess the quality perceived by the end user in WebRTC speech applications. Based on the computed Mean Opinion Score, a real-time adaptive codec parameter switching mechanism is used to switch to the most optimum codec bitrate under the present network conditions. We present the evaluation results to show the effectiveness of the proposed approach when compared with the default codec configuration in WebRTC.

scholarly journals Impact of smoking habit on platelet reactivity in a cohort of patients admitted due to an acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.C Gomez Polo ◽  
D Vivas Balcones ◽  
A.L Marcano Fernandez ◽  
J Playan Escribano ◽  
L.M Lugo Gavidia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Smoking Habit ◽  
Tertiary Care ◽  
Funding Source ◽  
P2y12 Inhibitors ◽  
Lower Response ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background Several pharmacodynamic studies have shown the impact of smoking habit on platelet reactivity; with a reduction on platelet aggregation. Wether this inhibition in platelet reactivity is due to tobacco effects in platelet signaling pathways or due to a pharmacodynamic interaction with antiplatelet therapies is not well stablished. Purpose Our aim was to study the influence of smoking habit in platelet reactivity and in the response to P2Y12 inhibitors. Methods Patients admitted in four tertiary care hospitals due to an acute coronary syndrome that undergone percutaneous coronary intervention (PCI) were consecutively and prospectively recruited. All the patients received dual antiplatelet therapy with aspirin and a P2Y12 inhibitor following current European Guidelines. Platelet function was assessed at day 1 and day 30 post-PCI by VerifyNow P2Y12, VASP (Vasodilator-stimulated phosphoprotein) y MEA (Multiple electrode aggregometry). Results A total of 1000 patients were enrolled, of whom 12 had to be excluded due to inaccurate processing of blood samples. 372 patients (37,6%) had smoking habit. Non-smoking patients showed higher prevalence of high blood pressure [423 (68.7%) vs 196 (52.7%)] and diabetes mellitus [213 (34.6%) vs 81 (21.8%)]. Smoking patients were younger [57.3 (9,6) years old vs 68.4 (11.1)], with higher incidence of acute coronary syndrome with ST segment elevation [184 patients (49,5%) vs 241 (39.1%), p<0,001]. There were no differences in platelet function at day 1. When analysing platelet function 30 days post-PCI, a lower inhibition of platelet reactivity in non-smoking patients as compared with smoking patients was observed in those treated with clopidogrel, with higher prevalence of clopidogrel-resistance in non-smoking patients (VerifyNow, 51,2% prevalence of high platelet reactivity in non-smoking patients vs 34,9% 30 days after PCI, p=0,023). On the other hand, smoking patients that received ticagrelor did not show any differences. Patients with smoking habit treated with prasugrel showed a lower response of borderline statistical significance. Conclusion Smoking habit was associated with a lower response to prasugrel of borderline significance, and with higher response to clopidogrel, according with previous studies suggesting a pharmacodynamics interaction between tobacco use and P2Y12 inhibitors. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fondo de Investigaciones Sanitarias (FIS)

scholarly journals Audit and Feedback in emergency: a systematic review and an Italian project to investigate and improve quality of care

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Sabrina Licata ◽  
Annarita Tullio ◽  
Francesca Valent
Keyword(s):  
Systematic Review ◽  
Audit And Feedback ◽  
Clinical Settings ◽  
Improve Quality ◽  
Multimodal Approach ◽  
Review Of Literature ◽  
Feedback Process ◽  
Wide Range ◽  
The Impact

The Audit and Feedback process (A&F) is commonly accepted as a good way to improve quality in health care, also in Emergency Departments (ED), where health aspects and pathologies are very different, usually acute and highly complex. Within an Italian Ministry of Health research project called EASY-NET, we conducted a systematic review of literature on A&F in EDs from 2014 to December 2019 to evaluate the impact of this approach in a particular setting where time-dependent indicators are fundamental. We selected 24 articles: 9 about infective pathologies (i.e. antibiotic stewardship), 6 about cardiovascular acute emergencies (i.e. cardiac arrest), 2 about stroke, 3 about laboratory tests, and 4 about other fields (i.e. diabetic ketoacidosis or use of prothrombin complex). Most of articles proposed a multimodal approach: only 7 concerned A&F alone. Despite the wide range on interventions modality and the poor comparability of the considered studies, the results are encouraging and confirm the importance to implement A&F both in emergency and in other clinical settings.

scholarly journals A real-time test of food hazard awareness

2015 ◽  
Vol 117 (8) ◽  
pp. 2112-2128 ◽  
Author(s):  
Caroline Millman ◽  
Dan Rigby ◽  
Davey Jones ◽  
Gareth Edwards-Jones
Keyword(s):  
Food Safety ◽  
Real Time ◽  
Hazard Identification ◽  
Training Experience ◽  
Content Type ◽  
Survey Tool ◽  
Safety Awareness ◽  
Wide Range ◽  
The Impact ◽  
Hazard Awareness

Purpose – Food poisoning attributable to the home generates a large disease burden, yet is an unregulated and largely unobserved domain. Investigating food safety awareness and routine practices is fraught with difficulties. The purpose of this paper is to develop and apply a new survey tool to elicit awareness of food hazards. Data generated by the approach are analysed to investigate the impact of oberservable heterogeneity on food safety awareness. Design/methodology/approach – The authors develop a novel Watch-and-Click survey tool to assess the level of awareness of a set of hazardous food safety behaviours in the domestic kitchen. Participants respond to video footage stimulus, in which food hazards occur, via mouse clicks/screen taps. This real-time response data is analysed via estimation of count and logit models to investigate how hazard identification patterns vary over observable characteristics. Findings – User feedback regarding the Watch-and-Click tool approach is extremely positive. Substantive results include significantly higher hazard awareness among the under 60s. People who thought they knew more than the average person did indeed score higher but people with food safety training/experience did not. Vegetarians were less likely to identify four of the five cross-contamination hazards they observed. Originality/value – A new and engaging survey tool to elicit hazard awareness with real-time scores and feedback is developed, with high levels of user engagement and stakeholder interest. The approach may be applied to elicit hazard awareness in a wide range of contexts including education, training and research.

scholarly journals The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal

2021 ◽  
Author(s):  
João Calvão ◽  
Ana Filipa Amador ◽  
Catarina Martins da Costa ◽  
Paulo Maia Araújo ◽  
Teresa Pinho ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
The Impact

Long Term Experience of the Real Time Fouling Deposits Thickness Measurements for On-Line Sootblowing Optimization

2015 ◽  
Author(s):  
B. Chudnovsky ◽  
N. Menn
Keyword(s):  
Renewable Energy ◽  
Power Plant ◽  
Real Time ◽  
Operation Conditions ◽  
Wide Range ◽  
On Line ◽  
Cycle Efficiency ◽  
The Impact ◽  
Long Term Experience

Over the past years there has been a dramatic increase in the regulatory requirements for low emissions. Renewable energy targets and CO2 emissions markets drive the transition to a cleaner and renewable energy production system. In addition to increasing the overall plant cycle efficiency, there two principal means of the reduction of the CO2 from coal fired power plants: by coal and biomass co-firing and by the capture and long term storage of the CO2 emitted from power plant. Carbon dioxide capture and storage will involve substantial capital investment, accompanied by a significant power plant cycle efficiency penalty, and is not currently available on a fully commercial basis. Co-firing biomass, in comparison with other renewable sources, is the main contributor to technologies meeting the world’s renewable energy target. However, the impact of biomass co-firing on boilers performance and integrity has been modest. Operational problems associated with the deposition and retention of ash materials can and do occur on all the major gas-side components of combustion and boilers. The process occurs over a wide range of flue gas and surface temperatures, and dependent both on the characteristics of the ash and on the design and operation conditions of the furnace and boiler. Development and validation of the predictive models have been hindered significantly by the practical difficulties in the obtaining reliable data from the boilers operated with coal and biomass. Although specialized on–line deposition monitoring and sootblowing control systems are commercially available, but they are based on a very simple estimates of the fouling factors, which results in crude and not reliable approach to optimization of sootblowers operation. In the present paper an alternative approach and a new technique based on electro-optical sensor are demonstrated. The long term experience with the system attached to the furnace wall and capable to move the compact sensor in and out of the furnace, allowing to measure simultaneously deposits thickness and reflectivity, is described in details. Results of our study show that dynamics of both parameters on the operated power unit can be registered simultaneously in real time and then interpreted separately. Experiments have been carried out with different coal types at 575MW unit equipped with CE tangential boiler and 550 Mw equipped with B&W boiler with opposite fired burners. The measurements were performed in different locations of the furnace. It was shown that dynamics of thickness and reflectivity variation just after the wall cleaning activation are quite different. Situations have been registered where changes of reflectivity have a significant impact on heat transfer, comparable and sometimes even greater than that of growing fouling thickness. Technique and device exploited in this study appears to be a very useful tool for sootblowing optimization and, as a result, for improvement of boiler efficiency and reduction of water wall erosion and corrosion in both pulverized coal and co-firing boilers.

The impact of hybridization, engine combustion method, and energy management system connectivity on heavy-duty vehicle operation

2021 ◽  
pp. 095440702098304
Author(s):  
Carrie M Hall
Keyword(s):  
Real Time ◽  
Energy Management ◽  
High Efficiency ◽  
Fuel Efficiency ◽  
Vehicle Speed ◽  
Heavy Duty ◽  
Wide Range ◽  
Engine Combustion ◽  
The Impact ◽  
Heavy Duty Vehicles

A wide range of strategies for reducing energy consumption from heavy-duty vehicles have been explored from vehicle electrification to real-time vehicle energy management based on vehicle-to-vehicle and vehicle-to-infrastructure communication. Full electrification of heavy-duty vehicles can be challenging due to current limitations on battery energy density. However, hybridization and the implementation of high efficiency engines present other potential near-term solutions. In contrast to many prior studies that have explored the use of one or two of these techniques, this work discusses the combined influence of hybridization level, engine combustion mode, and connected energy management on fuel efficiency in heavy-duty applications. The impact of hybridization in different driving conditions is quantified and the effectiveness of hybrid powertrain structures with different engine combustion strategies is also explored. Utilizing an alternative combustion strategy can improve fuel efficiency by 5% in conventional and mild hybrids but was found to have a more minimal impact in full hybrids. An additional layer of complexity is also introduced when vehicles have some degree of connectivity and this influence on the energy management method is investigated by comparing control approaches which leverage current and future vehicle speed information. Connectivity and the ability to optimize energy production in real-time was found to be essential in uncertain cases and enable improvements in fuel consumption of up to 12% over baseline cases.

scholarly journals Clinical Profile and One Year Outcome of Atrial Fibrillation- A Prospective Cohort Study

2020 ◽  
Author(s):  
Praveen Satheesan ◽  
Veena Felix ◽  
Alummoottil George Koshy
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Good Control ◽  
Coronary Syndrome ◽  
One Year ◽  
The Impact

Introduction: Atrial Fibrillation (AF) is the most common arrhythmia in clinical practice and imposes a great burden on health care resources. There is limited data regarding the impact of AF in our population. Aim: To estimate the mortality and Major adverse Cardiovascular events {(MACE)- Acute Coronary Syndrome (ACS), Stroke, Cardiac death} in AF patients in a tertiary care centre in South India. Materials and Methods: This prospective cohort study included all patients >18 years with newly diagnosed or previously documented evidence of AF in Electrocardiography (ECG). Transient reversible causes and critically ill patients were excluded. Total of 346 patients were recruited and prospectively, followed-up at 1, 3, 6 and 12 months for development of MACE, anticoagulation status, Prothrombin Time (PT), International Normalised Ratio (INR) and major bleeding events. Baseline data including clinical parameters, comorbidities and appropriate investigations such as ECG and Echocardiogram (ECHO) parameters were collected with a structured questionnaire and analysed at one year using appropriate statistical tests. Results: Average age was 60.5 years (SD 11.5 years) and majority (74.6%) were between 50-75 years. Females were more (59.5% vs 40.5%). Most common AF risk factor was Hypertension (44.5%) followed by Rheumatic Heart Disease (RHD) in 27.2% of AF patients. AF was classified as permanent in 42.2%, persistent in 23.1% and paroxysmal in 34.7%. Valvular AF was present in 26.6% and non-valvular AF in 73.4%. At one year, 17 patients were lost to follow-up. CHA2DS2VASc score of ≥2 was present in 65.1%. During one year follow-up the MACE rate was 26.7% (ischemic stroke in 9.4%, ACS in 2.7% and cardiac mortality in 14.6 %). Mean time in Therapeutic Range (TTR) was 28.12%. TTR >60% (good control) was present in only 9.2%. Conclusion: AF continues to be a significant arrhythmia causing substantial morbidity and mortality. Non-valvular AF was thrice as common as valvular AF. Though 3/4th of the patients were on oral anticoagulants, <10% had their INR under good control which contributed to the higher events. To improve the outcomes in AF patients, treatment of risk factors and optimal anticoagulation plays a crucial role.

scholarly journals A Multi-sensor Evaluation of Precipitation Uncertainty for Landslide-triggering Storm Events

2020 ◽  
Author(s):  
Elsa Culler ◽  
Andrew Badger ◽  
J. Minear ◽  
Kristy Tiampo ◽  
Spencer Zeigler ◽  
...  
Keyword(s):  
Real Time ◽  
Data Availability ◽  
Average Intensity ◽  
Large Set ◽  
Storm Events ◽  
Peak Intensity ◽  
Intense Storm ◽  
Wide Range ◽  
The Impact ◽  
Landslide Triggering

Extreme precipitation can have profound consequences for communities, resulting in natural hazards such as rainfall-triggered landslides that cause casualties and extensive property damage. A key challenge to understanding and predicting rainfall-triggered landslides comes from observational uncertainties in the depth and intensity of precipitation preceding the event. Practitioners and researchers must select among a wide range of precipitation products, often with little guidance. Here we evaluate the degree of precipitation uncertainty across multiple precipitation products for a large set of landslide-triggering storm events and investigate the impact of these uncertainties on predicted landslide probability using published intensity-duration thresholds. The average intensity, peak intensity, duration, and NOAA-Atlas return periods are compared ahead of 228 reported landslides across the continental US and Canada. Precipitation data are taken from four products that cover disparate measurement methods: near real-time and post-processed satellite (IMERG), radar (MRMS), and gauge-based (NLDAS-2). Landslide-triggering precipitation was found to vary widely across precipitation products with the depth of individual storm events diverging by as much as 296 mm with an average range of 51 mm. Peak intensity measurements, which are typically influential in triggering landslides, were also highly variable with an average range of 7.8 mm/hr and as much as 57 mm/hr. The two products more reliant upon ground-based observations (MRMS and NLDAS-2) performed better at identifying landslides according to published intensity-duration storm thresholds, but all products exhibited hit-ratios of greater than 0.56. A greater proportion of landslides were predicted when including only manually-verified landslide locations. We recommend practitioners consider low-latency products like MRMS for investigating landslides, given their near-real time data availability and good performance in detecting landslides. Practitioners would be well-served considering more than one product as a way to confirm intense storm signals and minimize the influence of noise and false alarms.

scholarly journals MATLAB/Simulink modelling and simulation of 9-level cascaded h-bridge multilevel inverter with mismatched DC sources

2019 ◽  
Vol 10 (2) ◽  
pp. 617
Author(s):  
W. V. Yong ◽  
M. S. Chye ◽  
Y. C. Tan ◽  
S. L. Ong ◽  
J. H. Leong
Keyword(s):  
Real Time ◽  
Multilevel Inverter ◽  
Matlab Simulink ◽  
Dc Voltage ◽  
Iterative Computation ◽  
Simulink Model ◽  
Calculation Technique ◽  
Wide Range ◽  
The Impact ◽  
Angle Calculation

<span lang="EN-US">This paper presents a MATLAB/Simulink model for a 9-level cascaded H-bridge multilevel inverter with mismatched DC voltage sources. The impact of mismatched DC voltage sources on the performance of the 9-level CHBMI is investigated. Due to the mismatched voltages among DC voltage sources, the output fundamental voltage is different from the input reference voltage. To address this problem, a switching-angle calculation technique that accounts for mismatched as well as varying DC voltage sources is demonstrated. The switching angles obtained using this technique is able to produce the desired output fundamental voltage for a wide range of input reference voltages. Since this switching-angle calculation technique does not require complex iterative computation, it has the potential for real-time implementation.</span>

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