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Atrial fibrillation is a common heart arrhythmia which is characterized by a missing or irregular contraction of the atria. The disease is a risk factor for other more serious diseases and the total medical costs in society are extensive. Therefore it would be beneficial to improve and optimize the prevention and detection of the disease.   Pulse palpation and heart auscultation can facilitate the detection of atrial fibrillation clinically, but the diagnosis is generally confirmed by an ECG examination. Today there are several algorithms that detect atrial fibrillation by analysing an ECG. A common method is to study the heart rate variability (HRV) and by different types of statistical calculations find episodes of atrial fibrillation which deviates from normal sinus rhythm.   Two algorithms for detection of atrial fibrillation have been evaluated in Matlab. One is based on the coefficient of variation and the other uses a logistic regression model. Training and testing of the algorithms were done with data from the Physionet MIT database. Several steps of signal processing were used to remove different types of noise and artefacts before the data could be used.   When testing the algorithms, the CV algorithm performed with a sensitivity of 91,38%, a specificity of 93,93% and accuracy of 92,92%, and the results of the logistic regression algorithm was a sensitivity of 97,23%, specificity of 93,79% and accuracy of 95,39%. The logistic regression algorithm performed better and was chosen for implementation in Java, where it achieved a sensitivity of 97,31%, specificity of 93,47% and accuracy of 95,25%. / Förmaksflimmer är en vanlig hjärtrytmrubbning som kännetecknas av en avsaknad eller oregelbunden kontraktion av förmaken. Sjukdomen är en riskfaktor för andra allvarligare sjukdomar och de totala kostnaderna för samhället är betydande. Det skulle därför vara fördelaktigt att effektivisera och förbättra prevention samt diagnostisering av förmaksflimmer.   Kliniskt diagnostiseras förmaksflimmer med hjälp av till exempel pulspalpation och auskultation av hjärtat, men diagnosen brukar fastställas med en EKG-undersökning. Det finns idag flertalet algoritmer för att detektera arytmin genom att analysera ett EKG. En av de vanligaste metoderna är att undersöka variabiliteten av hjärtrytmen (HRV) och utföra olika sorters statistiska beräkningar som kan upptäcka episoder av förmaksflimmer som avviker från en normal sinusrytm.   I detta projekt har två metoder för att detektera förmaksflimmer utvärderats i Matlab, en baseras på beräkningar av variationskoefficienten och den andra använder sig av logistisk regression. EKG som kommer från databasen Physionet MIT används för att träna och testa modeller av algoritmerna. Innan EKG-signalen kan användas måste den behandlas för att ta bort olika typer av brus och artefakter.   Vid test av algoritmen med variationskoefficienten blev resultatet en sensitivitet på 91,38%, en specificitet på 93,93% och en noggrannhet på 92,92%. För logistisk regression blev sensitiviteten 97,23%, specificiteten 93,79% och noggrannheten 95,39%. Algoritmen med logistisk regression presterade bättre och valdes därför för att implementeras i Java, där uppnåddes en sensitivitet på 91,31%, en specificitet på 93,47% och en noggrannhet på 95,25%.

Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events. Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested. In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD. Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death. At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV. At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant. In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.

<p><strong>Background</strong>: Human rhinovirus/enterovirus (HRV/ENT) infections are commonly identified in children with acute respiratory infections (ARIs), but data on their clinical severity remains limited. We compared the clinical severity of HRV/ENT to respiratory syncytial virus (RSV), influenza A/B (FLU) and other common respiratory virus in children.</p> <p><strong>Methods</strong>: Retrospective study of children with ARIs and confirmed single positive viral infections on mid-turbinate swabs by molecular assays. Outcome measures included hospital admission and, for inpatients, a composite end-point consisting of intensive care admission, hospitalization greater than 5 days, oxygen requirements or death.</p> <p><strong>Results</strong>: A total of 116 HRV/ENT, 102 RSV, 99 FLU and 64 other common respiratory viruses were identified. Children with single HRV/ENT infections presented with significantly higher rates of underlying immunosuppressive conditions compared to those with RSV (37.9% vs 13.6%; p</p> <p><strong>Conclusions</strong>: Children with HRV/ENT had a more severe clinical course than those with RSV and FLUA/B infections and often had significant comorbidities. These findings emphasize the importance of considering HRV/ENT infection in children presenting with severe acute respiratory tract infections.</p> / Master of Science (MSc)

Le sepsis tardif, défini comme une infection systémique chez les nouveaux nés âgés de plus de 3 jours, survient chez environ 7% à 10% de tous les nouveau-nés et chez plus de 25% des nouveau-nés de très faible poids de naissance qui sont hospitalisés dans les unités de soins intensifs néonatals (USIN). Les apnées et bradycardies (AB) spontanées récurrentes et graves sont parmi les principaux indicateurs précoces cliniques de l'infection systémique chez les prématurés. L'objectif de cette thèse est de déterminer si la variabilité du rythme cardiaque (VRC), la respiration et l'analyse de leurs relations aident au diagnostic de l'infection chez les nouveaux nés prématurés par des moyens non invasifs en USIN. Par conséquent, on a effectué l'analyse Mono-Voie (MV) et Bi-Voies (BV) sur deux groupes sélectionnés de nouveau-nés prématurés: sepsis (S) vs. non-sepsis (NS). (1) Tout d'abord, on a étudié la série RR non seulement par des méthodes de distribution (moy, varn, skew, kurt, med, SpAs), par les méthodes linéaire: le domaine temporel (SD, RMSSD) et dans le domaine fréquentiel (p_VLF, p_LF, p_HF), mais aussi par les méthodes non–linéaires: la théorie du chaos (alphas, alphaF) et la théorie de l'information (AppEn, SamEn, PermEn, Regul). Pour chaque méthode, nous étudions trois tailles de fenêtre 1024/2048/4096, puis nous comparons ces méthodes afin de trouver les meilleures façons de distinguer S de NS. Les résultats montrent que les indices alphaS, alphaF et SamEn sont les paramètres optimaux pour séparer les deux populations. (2) Ensuite, la question du couplage fonctionnel entre la VRC et la respiration nasale est adressée. Des relations linéaires et non-linéaires ont été explorées. Les indices linéaires sont la corrélation (r²), l'indice de la fonction de cohérence (Cohere) et la corrélation temps-fréquence (r2t,f) , tandis que le coefficient de régression non-linéaire (h²) a été utilisé pour analyser des relations non-linéaires. Nous avons calculé les deux directions de couplage pendant l'évaluation de l'indice h2 de régression non-linéaire. Enfin, à partir de l'ensemble du processus d'analyse, il est évident que les trois indices (r2tf_rn_raw_0p2_0p4, h2_rn_raw et h2_nr_raw) sont des moyens complémentaires pour le diagnostic du sepsis de façon non-invasive chez ces patients fragiles. (3) Après, l'étude de faisabilité de la détection du sepsis en USIN est réalisée sur la base des paramètres retenus lors des études MV et BV. Nous avons montré que le test proposé, basé sur la fusion optimale des six indices ci-dessus, conduit à de bonnes performances statistiques. En conclusion, les mesures choisies lors de l'analyse des signaux en MV et BV ont une bonne répétabilité et permettent de mettre en place un test en vue du diagnostic non invasif et précoce du sepsis. Le test proposé peut être utilisé pour fournir une alarme fiable lors de la survenue d'un épisode d'AB tout en exploitant les systèmes de monitoring actuels en USIN. / Late-onset sepsis, defined as a systemic infection in neonates older than 3 days, occurs in approximately 10% of all neonates and in more than 25% of very low birth weight infants who are hospitalized in Neonatal Intensive Care Units (NICU). Recurrent and severe spontaneous apneas and bradycardias (AB) is one of the major clinical early indicators of systemic infection in the premature infant. Various hematological and biochemical markers have been evaluated for this indication but they are invasive procedures that cannot be repeated several times. The objective of this Ph.D dissertation was to determine if heart rate variability (HRV), respiration and the analysis of their relationships help to the diagnosis of infection in premature infants via non-invasive ways in NICU. Therefore, we carried out Mono-Channel (MC) and Bi-Channel (BC) Analysis in two selected groups of premature infants: sepsis (S) vs. non-sepsis (NS). (1) Firstly, we studied the RR series not only by distribution methods (moy, varn, skew, kurt, med, SpAs), by linear methods: time domain (SD, RMSSD) and frequency domain (p_VLF, p_LF, p_HF), but also by non-linear methods: chaos theory (alphaS, alphaF) and information theory (AppEn, SamEn, PermEn, Regul). For each method, we attempt three sizes of window 1024/2048/4096, and then compare these methods in order to find the optimal ways to distinguish S from NS. The results show that alphaS, alphaF and SamEn are optimal parameters to recognize sepsis from the diagnosis of late neonatal infection in premature infants with unusual and recurrent AB. (2) The question about the functional coupling of HRV and nasal respiration is addressed. Linear and non-linear relationships have been explored. Linear indexes were correlation (r²), coherence function (Cohere) and time-frequency index (r2t,f), while a non-linear regression coefficient (h²) was used to analyze non-linear relationships. We calculated two directions during evaluate the index h2 of non-linear regression. Finally, from the entire analysis process, it is obvious that the three indexes (r2tf_rn_raw_0p2_0p4, h2_rn_raw and h2_nr_raw) were complementary ways to diagnosticate sepsis in a non-invasive way, in such delicate patients.(3) Furthermore, feasibility study is carried out on the candidate parameters selected from MC and BC respectively. We discovered that the proposed test based on optimal fusion of 6 features shows good performance with the largest Area Under Curves (AUC) and the least Probability of False Alarm (PFA). As a conclusion, we believe that the selected measures from MC and BC signal analysis have a good repeatability and accuracy to test for the diagnosis of sepsis via non-invasive NICU monitoring system, which can reliably confirm or refute the diagnosis of infection at an early stage.

För småhusägare finns ekonomiska incitament till att sänka det årliga energibehovet för värme och tappvarmvattenberedning, då det utgör huvudparten av det totala årliga energibehovet för bostäder i Sverige. Valet av värmesystem är därför ett viktigt då det kan medföra mer eller mindre gynnsamma ekonomiska konsekvenser sett över längre tidsperioder,då den mängd köpt energi som systemet kräver kan medföra besparingar som viktas mot den ekonomiska investeringen av systemet.Syftet med denna studie har därför varit att skapa ett referensunderlag över fyra olika värmesystem med jämförelser mot småhus av olika storlek, geografisk placering samt olikaisoleringsstandard, där det eller de mest ekonomiskt gynnsamma värmesystemen, sett över en 50-årsperiod, kan utläsas utifrån dessa parametrar.De småhus som studien har jämfört har bestått av enplanshus med tre antagna areor, 89,7/120/150,3 m2. Dessa har jämförts för Malmö, Stockholm, Sundsvall samt Luleå, varpå varje area har innefattat tre olika antagna genomsnittliga värmegenomgångskoefficienter, Umedelvärden. Studien har genomförts med energiberäkningar enligt gradtimmemetoden, och den ekonomiska analysen genom beräknade livscykelkostnader, LCC, för de olika systemkonstellationerna. Fyra värmesystem har undersökts: Fjärrvärme, bergvärmepump, luft-vattenvärmepump samt frånluftsvärmepump. Frånluftsvärmepumpen har inkorporerats som ett FX-ventilationssystem, frånluftsventilation med värmeåtervinning. De övriga tre systemen har för studien kombinerats med ett FTX-ventilationssystem, från- och tilluftsventilation med värmeåtervinning.Resultaten har påvisat att FTX-system, i jämförelse med FX-system, sänker för samtliga studerade byggnader i Malmö det årliga värmeenergibehovet, den energi som måste tillsättas byggnaden, med 36–71%, medan det i Luleå sänks med 32–61%. Den årliga energianskaffningen, den energi som måste köpas för att värmesystemen skall generera erfordrad värmeenergi och tappvarmvattenberedning, är genomgående lägst för systemkonstellationen bergvärmepump i kombination med FTX. Den systemkonstellationenmed studiens genomgående högsta andel köpt energi, är fjärrvärme i kombination med FTX.Vid jämförelse av livscykelkostnader, LCC, har påvisats att fjärrvärme i kombination med FTX är mest ekonomiskt gynnsam endast då det årliga behovet av köpt energi är mycket litet, och att det vid högre behov istället blir det dyraste alternativet. Frånluftsvärmepump utgör ett ekonomiskt gynnsamt alternativ vid majoriteten av analyserade fall, tack vare lägre investeringskostnader som väger upp de högre värmeenergibehov som ventilationstypen medför. Bergvärme i kombination med FTX, utgör det dyraste alternativet i de flesta fall därdet årliga behovet av köpt energi är lågt, men påvisar ekonomisk gynnsamhet vid höga energibehov. Luft-vattenvärmepump i kombination med FTX, är relativt likvärdig bergvärmepump men har ej påvisats vara det billigaste alternativet i något studerat fall. Vid jämförelse mellan frånluftsvärmepump och bergvärmepump i kombination med FTX, har påvisats att för studiens samtliga analyserade objekt är den största prisskillnaden, utslaget på 50 år, mindre än 1.800 kr/år.Utifrån de parametrar som presenterats, har påvisats genomförbarhet i att skapa ett referensunderlag över optimal gynnsamhet för värme- och ventilationssystem hos småhus, vilket avläses utifrån husets storlek, U-medelvärde samt geografiska placering. / For homeowners, there are economic incentives to reduce the annual energy demand for heating and domestic hot water preparation, as these constitute the main part of the total annual energy demand for houses in Sweden. The choice of heating system is therefore important as it can have more or less favorable economic consequences over longer periods of time, as the amount of purchased energy required by the system can lead to savings that weigh against the economic investment in the system. The purpose of this study has therefore been to create a reference framework for four different heating systems, comparing them across houses of different sizes, geographical locations, and insulation standards, to identify the most economically beneficial heating systems over a 50-year period, that can be interpreted based on these parameters. The houses compared in the study were single-story houses with three assumed sizes: 89.7/120/150.3 m². They have been compared in Malmö, Stockholm, Sundsvall and Luleå, with each size having three different assumed average thermal transmittance values, average U-values. The study was conducted using energy calculations based on the degree-hour method, and the economic analysis was performed using calculated life cycle costs, LCC, for the different system configurations. Four heating systems were investigated: district heating, geothermal heat pump, air-to-water heat pump, and exhaust air heat pump. The exhaust air heat pump was incorporated as an MEVHR ventilation system, mechanical exhaust air ventilation with heat recovery, while the other three systems were combined with an HRVventilation system, mechanical exhaust and supply air ventilation with heat recovery. The results have shown that HRV systems, compared to MEVHR systems, reduce the annual heating energy demand, the amount of energy that must be supplied to the building, for all studied buildings in Malmö by 36-71%, while in Luleå it is reduced by 32-61%. The annual energy procurement, the amount of energy that must be purchased for the heating systems to generate the required heating energy and domestic hot water preparation, is consistently lowest for the geothermal heat pump system combined with the HRV. The system configuration with the highest proportion of purchased energy throughout the study is district heating combined with HRV. When comparing life cycle costs, LCC, it was found that district heating combined with HRVis the most economically beneficial system only when the annual demand for purchased energy is very low, and becomes the most expensive option at higher demands. The exhaust air heat pump is a cost-effective option in the majority of analyzed cases, thanks to lower investment costs that offset the higher heating energy demand induced by this type of ventilation. Geothermal heat pump combined with the HRV is the most expensive option in most cases when the annual demand for purchased energy is low but shows economic advantages at high energy demands. The air-to-water heat pump combined with the HRV is relatively similar to the geothermal heat pump but has not been shown to be the cheapest option in any of the studied cases. When comparing the exhaust air heat pump with the geothermal heat pump combined with the HRV, it is found that for all objects analyzed in the study, the largest price difference is, averaged over 50 years, less than 1,800 SEK/year. Based on the presented parameters, the feasibility of creating a reference framework for the cost-effectiveness of heating and ventilation systems in houses has been demonstrated, which can be assessed based on the house size, U-value, and geographical location.

Den tekniska utvecklingen har lett till att massiva mängder av information sänds, i högahastigheter. Detta flöde måste vi lära oss att hantera. För att maximera nyttan av de nyateknikerna och undkomma de problem som detta enorma informationsflöde bär med sig, börinteraktionskvalitet studeras. Vi måste anpassa gränssnitt efter användaren eftersom denneinte har möjlighet att anpassa sig till, och sortera i för stora informationsmängder. Vi måsteutveckla system som gör människan mer effektiv vid användande av gränssnitt.För att anpassa gränssnitten efter användarens behov och begränsningar krävs kunskaperom den mänskliga kognitionen. När kognitiv belastning studeras är det viktigt att en såflexibel, lättillgänglig och icke-påträngande teknik som möjligt används för att få objektivamätresultat, samtidigt som pålitligheten är av största vikt. För att kunna designa gränssnittmed hög interaktionskvalitet krävs en teknik att utvärdera dessa. Målet med uppsatsen är attfastställa en mätmetod väl lämpad för mätning av interaktionskvalitet.För mätning av interaktionskvalitet rekommenderas en kombinering av subjektiva ochfysiologiska mätmetoder, detta innefattar en kombination av Functional near-infraredspecroscopy; en fysiologisk mätmetod som mäter hjärnaktiviteten med hjälp av ljuskällor ochdetektorer som fästs på frontalloben, Electrodermal activity; en fysiologisk mätmetod sommäter hjärnaktiviteten med hjälp av elektroder som fästs över skalpen och NASA task loadindex; en subjektiv, multidimensionell mätmetod som bygger på kortsortering och mäteruppfattad kognitiv belastning i en sammanhängande skala. Mätning med hjälp av dessametoder kan resultera i en ökad interaktionskvalitet i interaktiva, fysiska och digitalagränssnitt. En uppskattning av interaktionskvalitet kan bidra till att fel vid interaktionminimeras, vilket innebär en förbättring av användares upplevelse vid interaktion. / Technical developments have led to the broadcasting of massive amounts of information, athigh velocities. We must learn to handle this flow. To maximize the benefits of newtechnologies and avoid the problems that this immense information flow brings, interactionquality should be studied. We must adjust interfaces to the user because the user does nothave the ability to adapt and sort overly large amounts of information. We must developsystems that make the human more efficient when using interfaces.To adjust the interfaces to the user needs and limitations, knowledge about humancognitive processes is required. When cognitive workload is studied it is important that aflexible, easily accessed and non assertive technique is used to get unbiased results. At thesame time reliability is of great importance. To design interfaces with high interaction quality,a technique to evaluate these is required. The aim of this paper is to establish a method that iswell suited for measurement of interaction quality.When measuring interaction quality, a combination of subjective and physiologicalmethods is recommended. This comprises a combination of Functional near-infraredspectroscopy; a physiological measurement which measures brain activity using light sourcesand detectors placed on the frontal lobe, Electrodermal activity; a physiological measurementwhich measures brain activity using electrodes placed over the scalp and NASA task loadindex; a subjective, multidimensional measurement based on card sorting and measures theindividual perceived cognitive workload on a continuum scale. Measuring with these methodscan result in an increase in interaction quality in interactive, physical and digital interfaces.An estimation of interaction quality can contribute to eliminate interaction errors, thusimproving the user’s interaction experience.