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Artificial intelligence for hemodynamic monitoring with a wearable electrocardiogram monitor

BackgroundThe ability to non-invasively measure left atrial pressure would facilitate the identification of patients at risk of pulmonary congestion and guide proactive heart failure care. Wearable cardiac monitors, which record single-lead electrocardiogram data, provide information that can be leveraged to infer left atrial pressures.MethodsWe developed a deep neural network using single-lead electrocardiogram data to determine when the left atrial pressure is elevated. The model was developed and internally evaluated using a cohort of 6739 samples from the Massachusetts General Hospital (MGH) and externally validated on a cohort of 4620 samples from a second institution. We then evaluated model on patch-monitor electrocardiographic data on a small prospective cohort.ResultsThe model achieves an area under the receiver operating characteristic curve of 0.80 for detecting elevated left atrial pressures on an internal holdout dataset from MGH and 0.76 on an external validation set from a second institution. A further prospective dataset was obtained using single-lead electrocardiogram data with a patch-monitor from patients who underwent right heart catheterization at MGH. Evaluation of the model on this dataset yielded an area under the receiver operating characteristic curve of 0.875 for identifying elevated left atrial pressures for electrocardiogram signals acquired close to the time of the right heart catheterization procedure.ConclusionsThese results demonstrate the utility and the potential of ambulatory cardiac hemodynamic monitoring with electrocardiogram patch-monitors.

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Synthetic Polymers

Abstract The global annual production of plastic is approaching a half‐billion tonnes and two families of synthetic polymers, polyethylene and polypropylene, account for approximately 45% of this production. The most common applications for synthetic polymers are in packaging and consumer/household goods and they are often referred to as single‐use plastics. However, other applications for synthetic polymers include medical/medical device, construction, agriculture, automotive, and industrial uses. Exposure to monomers, polymers, resins, and plastics can occur during the initial polymerization and manufacturing of the resins, the subsequent polymerization and manufacturing of the plastics and finished products, during use of the finished product, and during the product's end‐of‐life stage. This chapter focuses on understanding and mediating the toxicological issues with synthetic polymers in the workplace, including the production of the polymers, the resins, and the finished plastic products. In addition to the toxicology profiles, this chapter discusses production and uses, potential exposures, hazard classification, thermo‐decomposition products, sensitive applications such as food‐contact and medical applications, and exposure guidelines. The environmental impact of these synthetic polymers can be significant, so this chapter also touches on the life cycle of these polymers including recycled and bio‐based feedstocks, carbon emissions, macroplastic and microplastic pollution, degradation in the environment, additives, and end‐of‐life scenarios.

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