This investigation evaluated the electrocardiographic responses at rest and in the stress test of adults and elderly of both genres in normoxia and hypoxia situations. For this, were tested. 67 voluntaries from the ages of 50 to 79, divided in 45 sedentary persons, men and women (Group 1); 15 soccer players that play the city championship at the senior category (55 or plus) (Group 2) and seven high performance canoeists (Group 3). The participants were submitted, following the order, to rest and stress test EKG, in both normoxia and hypoxia situations. The EKG tracing results were compared qualitatively, between the described situations, and the clinical observations revealed in the tests analyzed. Results: 52 subjects presented EKG results of normal effort and without difference between the two test situations (normoxia and hypoxia). In 12 subjects were found tracing alterations that occur in hypoxia that didn t appeared in normoxia. Referring specifically to the hypoxia alteration, were shown, at total, a five-case occurrence of extrasystoles, eleven ST segment depression and 1 T wave flatness. The number of cases of apparently healthy persons, that didn t showed alteration of TEN and TEH, which allows to claim that the hypoxia exam is safe to these people. The cases of TEH alteration, without TEN correspondence, suggest that TEH can be more sensible to detect alterations with a possible pathological indicative; mainly referring to myocardial ischemia signals and rhythm disturbs. / Esta investigação avalia as respostas eletrocardiográficas em repouso e no teste ergométrico de adultos e idosos de ambos os sexos nas situações de normoxia e em hipoxia. Para isso, foram testadas 67 pessoas voluntárias na faixa etária entre 50 a 79 anos, divididos em 45 pessoas sedentárias, homens e mulheres (Grupo 1); 15 jogadores de futebol que disputam o campeonato da cidade na categoria sênior (igual ou maior que 55 anos) (Grupo 2) e sete canoístas de alto rendimento (Grupo 3). Os participantes foram submetidos, seguindo a ordem, a ECG de repouso e teste ergométrico, ambos nas situações de normoxia e hipoxia. Os resultados de traçado eletrocardiográfico foram comparados qualitativamente entre as situações descritas, e as observações clínicas manifestas nos testes analisados. Resultados: 52 sujeitos apresentaram resultados de ECG de esforço normais e sem diferenciação entre as duas situações de testes (normoxia e hipoxia). Já em 12 sujeitos constatou-se que as alterações de traçado que ocorreram em hipóxia não tinham aparecido em normoxia. Referindo-se especificamente às alterações em hipoxia, foram evidenciadas, no total, a ocorrência de cinco casos de extrassístoles, onze de infradesnivelamento do segmento ST e 1 de achatamento da onda T. O número de casos de pessoas aparentemente sadias, que não apresentaram alterações do TEN e TEH, permite afirmar que o exame em hipoxia é seguro para essas pessoas. Os casos de alteração no TEH, sem correspondência em TEN, sugerem que o TEH pode ser mais sensível para detectar alterações com possível indicativo patológico, principalmente no que se refere a sinais de isquemia miocárdica e distúrbio de ritmo.

Abstract The main objective of this thesis project is to implement a wireless vital signs monitoring system for measuring the ECG of a patient in the home environment. The research focuses on two specific research objectives: 1) the development of a distributed healthcare system for vital signs monitoring using wireless sensor network devices and 2) a practical test and performance evaluation for the reliability for such low-rate wireless technology in ubiquitous health monitoring applications. The first section of the thesis describes the design and implementation of a ubiquitous healthcare system constructed from tiny components for the home healthcare of elderly persons. The system comprises a smart shirt with ECG electrodes and acceleration sensors, a wireless sensor network node, a base station and a server computer for the continuous monitoring of ECG signals. ECG data is a commonly used vital sign in clinical and trauma care. The ECG data is displayed on a graphical user interface (GUI) by transferring it to a PDA or a terminal PC. The smart shirt is a wearable T-shirt designed to collect ECG and acceleration signals from the human body in the course of daily life. In the second section, a performance evaluation of the reliability of IEEE 802.15.4 low-rate wireless ubiquitous health monitoring is presented. Three scenarios of performance studies are applied through practical tests: 1) the effects of the distance between sensor nodes and base-station, 2) the deployment of the number of sensor nodes in a network and 3) data transmission using different time intervals. These factors were measured to analyse the reliability of the developed technology in low-rate wireless ubiquitous health monitoring applications. The results showed how the relationship between the bit-error-rate (BER) and signal-to-noise ratio (SNR) was affected when varying the distance between sensor node and base-station, through the deployment of the number of sensor nodes in a network and through data transmission using different time intervals.

Familial amyloidosis with polyneuropathy (FAP) was first reported from Portugal in 1952, but since then this syndrome has been recognized in many countries including Sweden. In this investigation cardiac and pulmonary functions in the Swedish variety of FAP were studied. A retrospective survey of the ECG findings in 71 patients showed a high prevalence of atrioventricular (38%) and intraventricular (41%) conduction defects, and also a high prevalence of atrial fibrillation (14%). In several patients a progression in the conduction defects to advanced disturbances could be observed and 10 out of 71 patients (14%) in the present series required pacemaker treatment. A histopathological study of the atrioventricular part of the conduction system showed marked amyloid infiltration in each case, which may explain the high prevalence of conduction defects. In an échocardiographie study which emcompassed 22 consecutive patients, all but those two patients with the shortest duration of symptomatic disease showed abnormal features. The most frequent and characteristic findings were hypertrophy of the interventricular septum (86%) and a hyperrefractile appearance of the iryocardium (68%). This unusual association of échocardiographie features is considered almost diagnostic of cardiac amyloidosis. A hemodynamic study showed an essentially normal systolic heart function, but in several patients there were signs of impaired diastolic function with increased myocardial rigidity. Several patients showed signs of obstruction of the ventricular outflow tracts. This finding, as well as the échocardiographie features, is in accordance with altered anatomical and functional properties of the interventricular septum. The major pulmonary function abnormalities were decreased maximum respiratory pressure which indicate that the neuropathy in FAP involves the respiratory musculature, and impaired diffusing capacity consistent with an alveo-capillary block caused by amyloid deposits. / digitalisering@umu

Abstract This dissertation aimed at developing a multi-modal sensing u-healthcare system (MSUS), which reflects the unique properties of a healthcare application in a wireless sensor network. Together with health parameters, such as ECG, SpO2 and blood pressure, the system also transfers context-aware data, including activity, position and tracking data, in a wireless sensor network environment at home or in a hospital. Since packet loss may have fatal consequences for patients, health-related data are more critical than most other types of monitoring data. Thus, compared to environmental, agricultural or industrial monitoring, healthcare monitoring in a wireless environment imposes different requirements and priorities. These include heavy data traffic with wavelike parameters in wireless sensor network and fatal data loss due to the traffic. To ensure reliable data transfer in a wireless sensor network, this research placed special emphasis on the optimization of sampling rate, packet length and transmission rate, and on the traffic reduction method. To improve the reliability and accuracy of diagnosis, the u-healthcare system also collects context-aware information on the user’s activity and location and provides real-time tracking. Waveform health parameters, such as ECG, are normally sampled in the 100 to 400 Hz range according to the monitoring purpose. This type of waveform data may incur a heavy burden in wireless communication. To reduce wireless traffic between the sensor nodes and the gateway node, the system utilizes on-site ECG analysis implemented on the sensor nodes as well as query architecture. A 3D VRML viewer was also developed for the realistic monitoring of the user’s moving path and location. Two communication methods, an 802.15.4-based wireless sensor network and a CDMA cellular network are used by sensors placed on the users’ bodies to gather medical data, which is then transmitted to a server PC at home or in the hospital, depending on whether the sensor is within or outside the range of the wireless sensor network.

Background Chronic Obstructive Pulmonary disease (COPD) is an under-diagnosed disease with a prevalence of approximately 10%, highly dependent on age and smoking habits. Comorbidities are common in COPD and of these, cardiovascular diseases (CVD) are the most common. COPD is the fourth leading cause of death globally, and CVD probably contribute to the high mortality. Within CVD, Ischemic Heart Disease (IHD) is the most common. It is highly clinically relevant to identify signs of ischemic heart disease, other cardiac conditions, and risk factors for CVD in COPD. Electrocardiogram (ECG) is a simple but still major diagnostic tool in clinical cardiology, including disturbances in the electric conduction system and ischemia. Due to the under-diagnosis of COPD, there is limited knowledge regarding the prevalence and prognostic impact of ECG abnormalities in COPD. Arterial stiffness is a risk factor for CVD, which has raised an increased interest, however not evaluated in population based studies of COPD. Aim The overall aim was to describe cardiovascular aspects on COPD, with a specific focus on arterial stiffness, prevalence and prognostic impact of ischemic ECG abnormalities and prolonged QT interval, by comparing subjects with and without obstructive lung function impairment in a population-based cohort. Methods The thesis is based on the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study; a population-based longitudinal cohort study. During the years 2002-2004, all participants in clinical examinations from previously recruited large population-based cohorts were invited to re-examination including spirometry and a structured interview. All subjects with obstructive lung function impairment (n=993) were identified, together with 993 age and sex-matched referents without airway obstruction. The study population (n=1986) has been invited to annual examinations since 2005 including spirometry and structured interview. Papers I-III are based on data from 2005 when electrocardiogram (ECG) was recorded in addition to the basic program. All ECGs were Minnesota coded and QT-time was measured. Paper IV is based data from 2010 when non-invasive measurements of arterial stiffness, assessed as pulse wave velocity (PWV), was added to the program. Spirometric data were classified as normal lung function (NLF), restrictive spirometric pattern (RSP) and airway obstruction (COPD). The following spirometric criteria for COPD were used: post-bronchodilator FEV1/VC<0.70 (papers I-IV, in paper III labelled GOLD-COPD) and lower limit of normal, LLN (LLN-COPD) (paper III). Spirometric classification of COPD severity was based on FEV1 % predicted as a continuous variable or according to the Global Initiative for Obstructive Lung Disease (GOLD), divided into GOLD 1-4. Results The prevalence of ischemic heart disease (IHD), both self-reported and assessed as probable and possible ischemic ECG abnormalities (I-ECG) according to the Whitehall criteria, was similar among subjects with NLF and COPD. The prevalence of both self-reported and probable (I-ECG) according to Whitehall increased by GOLD grade.  Among those with COPD, self-reported IHD was associated with disease severity, assessed as FEV1 % predicted also after adjustment for age and sex (paper I). In both COPD and NLF, those with I-ECG had a higher cumulative mortality over 5 years than those without I-ECG (29.6 vs. 10.6%, p<0.001 and 17.1 vs. 6.3 %, p=0.001). When analysed in a multivariate model, the Mortality Risk Ratio (MRR, 95%CI) was increased for subjects with COPD and I-ECG (2.4, 1.5-3.9), and non-significantly so for NLF with I-ECG (1.65, 0.94-2.90), when compared to NLF without I-ECG.  When analyzed separately among subjects with COPD, the increased risk for death associated with I-ECG persisted independent of age, sex, BMI-class, smoking habits and disease severity assessed as FEV1 % predicted (1.89, 1.20-2.99). The proportion without reported IHD was high among those with I-ECG; 72.4% in NLF and 67.3% in COPD. The pattern was similar also among them; I-ECG was associated with an increased risk for death in COPD and non-significantly so in NLF (paper II). Mean corrected QT-time (QTc) and prevalence of QTc prolongation was higher in RSP than NLF but similar in NLF and GOLD-COPD. The prevalence of borderline as well as prolonged QTc increased by GOLD grade (test for trend p=0.012 for both groups). Of those with GOLD-COPD, 52% fulfilled the LLN-criterion (LLN-COPD). When comparing LLN-COPD and NLF, the pattern was similar as when comparing NLF and GOLD-COPD. The cumulative mortality over 5 years was higher among subjects with borderline and prolonged QTc than those with normal QTc in subjects with GOLD-COPD and LLN-COPD but not in NLF and RSP (paper III). Arterial stiffness, assessed as PWV, was higher in GOLD 3-4 compared to non-COPD (10.52 vs. 9.13 m/s, p=0.042). Reported CVD and age >60 were both associated with significantly higher PWV in COPD as well as in non-COPD. In a multivariate model, GOLD 3-4 remained associated with higher PWV when compared with non-COPD, also when adjusted for sex, age group, smoking habits, blood pressure, reported CVD and pulse rate (paper IV). Conclusion In this population-based study, the prevalence of ischemic ECG abnormalities was similar among subjects with normal lung function and COPD, but increased by disease severity among subjects with COPD. Ischemic ECG abnormalities were associated with an increased mortality among subjects with COPD, independent of common confounders and disease severity, also among those without known heart disease. Whilst the prevalence of QTc prolongation was similar in NLF, COPD and LLN-COPD, it was associated with an increased mortality only in the COPD-groups. ECG is a simple non-invasive method and seems to identify findings of prognostic importance among subjects with COPD. Central arterial stiffness, a known risk factor for cardiovascular disease, was increased among subjects with severe and very severe COPD when compared to subjects without COPD independent of common confounders.

Heterologous expression systems such as COS-7 cells have demonstrated the profound effects of KCNAB1-3 or Kvβ1-3 proteins on voltage gated potassium channels (Kv) channels. Indeed, in the presence of these β-subunits transiently expressed Kv channels are often modulated in multiple ways. Kv channel membrane expression is often increased in the presence of β-subunits. In addition, non-inactivating Kv currents suddenly become fast-inactivating and fast-inactivating channels become even faster. While much research has demonstrated the profound effects the β-subunits in particular the Kvβ1 subunit have on transiently expressed Kv currents little to date is known of the physiological role it may play. One study demonstrated that by “knocking out” Kvβ1 cardiomyocyte current changes were noted including a decrease in the Ito,f current. While this novel finding demonstrated a key cardiac physiological role of the Kvβ1 subunit it left many unanswered questions as to determine the cardiovascular regulation the Kvβ1 subunit provides. Indeed, cardiac arrhythmias and other electrical abnormalities within the heart such as long QT present patients with many unfortunate unknowns. Many of these incidences occur often abruptly with cardiac electrical abnormalities. Genetic research has begun to shine light on key cardiovascular genes in particular those coding for ion channels and auxiliary subunits or β-subunits. Kv channels and their β-subunits have gained particular notoriety in their key responsibility in restoring the resting membrane potential known as the repolarization phase. Indeed genetic manipulation and physiological examination of Kv channels and recently their β-subunits has demonstrated profound physiological results including prolonged QT durations within mice altered functional activity during physiological cycles such as estrus. While initial findings of Kvβ1 have demonstrated profound cellular and cardiomyocyte current alterations much still remains unknown. Therefore, this work hypothesizes that the Kvβ1 subunit provides a profound cardiovascular role in regulation and redox sensing at the physiological and pathophysiological level in both males and females. This work identifies a sex-based difference in cardiovascular regulation by Kvβ1 as well as demonstrated a profound redox sensing ability during altered metabolic states seen in pathophysiological conditions.

abstract: In the era of artificial intelligent (AI), deep neural networks (DNN) have achieved accuracy on par with humans on a variety of recognition tasks. However, the high computation and storage requirement of DNN training and inference have posed challenges to deploying or locally training the DNNs on mobile and wearable devices. Energy-efficient hardware innovation from circuit to architecture level is required.In this dissertation, a smart electrocardiogram (ECG) processor is first presented for ECG-based authentication as well as cardiac monitoring. The 65nm testchip consumes 1.06 μW at 0.55 V for real-time ECG authentication achieving equal error rate of 1.7% for authentication on an in-house 645-subject database. Next, a couple of SRAM-based in-memory computing (IMC) accelerators for deep learning algorithms are presented. Two single-array macros titled XNOR-SRAM and C3SRAM are based on resistive and capacitive networks for XNOR-ACcumulation (XAC) operations, respectively. XNOR-SRAM and C3SRAM macros in 65nm CMOS achieve energy efficiency of 403 TOPS/W and 672 TOPS/W, respectively. Built on top of these two single-array macro designs, two multi-array architectures are presented. The XNOR-SRAM based architecture titled “Vesti” is designed to support configurable multibit activations and large-scale DNNs seamlessly. Vesti employs double-buffering with two groups of in-memory computing SRAMs, effectively hiding the write latency of IMC SRAMs. The Vesti accelerator in 65nm CMOS achieves energy consumption of <20 nJ for MNIST classification and <40μJ for CIFAR-10 classification at 1.0 V supply. More recently, a programmable IMC accelerator (PIMCA) integrating 108 C3SRAM macros of a total size of 3.4 Mb is proposed. The28nm prototype chip achieves system-level energy efficiency of 437/62 TOPS/W at 40 MHz, 1 V supply for DNNs with 1b/2b precision. In addition to the IMC works, this dissertation also presents a convolutional neural network (CNN) learning processor, which accelerates the stochastic gradient descent (SGD) with momentum based training algorithm in 16-bit fixed-point precision. The65nm CNN learning processor achieves peak energy efficiency of 2.6 TOPS/W for16-bit fixed-point operations, consuming 10.45 mW at 0.55 V. In summary, in this dissertation, several hardware innovations from circuit to architecture level are presented, exploiting the reduced algorithm complexity with pruning and low-precision quantization techniques. In particular, macro-level and system-level SRAM based IMC works presented in this dissertation show that SRAM based IMC is one of the promising solutions for energy-efficient intelligent systems. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2020

Convolutional Neural Networks (CNNs) are a widely accepted means of solving complex classification and detection problems in imaging and speech. However, problem complexity often leads to considerable increases in computation and parameter storage costs. Many successful attempts have been made in effectively reducing these overheads by pruning and compressing large CNNs with only a slight decline in model accuracy. In this study, two pruning methods are implemented and compared on the CIFAR-10 database and an ECG arrhythmia classification task. Each pruning method employs a pruning phase interleaved with a finetuning phase. It is shown that when performing the scale-factor pruning algorithm on ECG, finetuning time can be expedited by 1.4 times over the traditional approach with only 10% of expensive floating-point operations retained, while experiencing no significant impact on accuracy.

Tato práce se zabývá možností využití vlnkové transformace v aplikacích, které se zabývají potlačením šumu. Především se jedná o oblast filtrace signálu EKG. Úkolem je zhodnotit vliv různých parametrů nastavení samotné filtrace a zjistit jaký vliv má různé nastavení prahování wavelet koeficientů. Výsledkem práce je také stanovení hodnot prahů, stanovení nejlepšího způsobu rozkladu signálu a volba rekonstrukčních bank filtrů. Text obsahuje výsledky Wienerovy filtrace, při které byly testovány různé banky rozkladových a rekonstrukčních filtrů.Všechny popsané filtrační metody byly testovány na reálných záznamech EKG s aditivním myopotenciálním šumem. Algoritmy byly realizovány v prostředí MATLAB.

This thesis focuses on the development of a GNU Health Module for electrocardiogram monitoring and the development of an application providing a fundamental electrocardiogram analysis. The theoretical part contains a brief introduction to hospital information systems including electronic patient record and healthcare data standards information, followed by a description of the GNU Health application and the implementation of the electrocardiogram analysis, written in the Python programming language. The practical part deals with the development of the GNU Health Monitoring module and the external application for signal analysis. The results, disscussion and the conclusion follow.