Cardiac Monitoring Research Articles

Twelve-lead ambulatory ECG recording using a seven-electrode recorder: An alternative method for electrophysiological evaluation

IntroductionConventional three-lead ambulatory electrocardiogram recording (3L-AECG) is used for the quantitative diagnosis of arrhythmias. However, the lack of crucial information, such as QRS morphology and orientation, renders the 3L-AECG incomplete for planning electrophysiological interventions. The 12-lead AECG (12L-AECG) merges the temporal resolution 3L-AECG with the spatial resolution of the standard electrocardiogram (S-ECG). Although it provides more detail, it is not widely used. This study aimed to verify whether the seven-electrode 12L-AECG and S-ECG have similar waveforms. MethodsA questionnaire consisting of 240 side-by-side comparisons (12 leads from 20 patients) was created. These consisted of a QRS registered using the 12L-AECG and a QRS from the same patient, registered using the S-ECG. The questionnaire was submitted to cardiologists trained in electrophysiology. For each comparison, the evaluator assigned “similar” or “different” depending on their own judgment. ResultsFive cardiologists completed the questionnaire, resulting in 1200 answers. The AECG-12 was similar to the ECG in 84.50 % of the instances (95 % confidence interval [CI] 83.20–86.50). The interobserver agreement was moderate (0.542, p < 0.001). The similarity between specific leads ranged up to 98 % (95 % CI 92.96–99.76). No significant differences were found among patients (p = 0.407). ConclusionThe seven-electrode 12L-AECG and S-ECG produced comparable waveforms. This similarity supports the use of 12L-AECG for accurate arrhythmia tracking and assists in planning electrophysiological procedures.

Arterial vascular complications predictive score in extrasystolic arrhythmia "EX-prognosis".

The aim of this study was the creation of an optimal model for predicting arterial vascular complications in patients with extrasystolic arrhythmia. A single-center prospective study was performed with involving 634 patients with supraventricular or ventricular extrasystoles (ES) of 700 or more per 24 hours. The control group consisted of 106 people with ES less than 700 per 24 hours. The main and control groups were initially equivalent in anthropometric criteria and concomitant pathology. The list of examinations included laboratory methods (including lipid profile, coagulograms), as well as instrumental studies (transthoracic and/or transesophageal echocardiography (EchoCG), Doppler ultrasound of the brachiocephalic arteries and arteries of the lower extremities, 24-hours ECG monitoring, according to the indications - computed tomography or magnetic resonance imaging of the brain, coronary angiography, stress echocardiography. Prospective observation of patients performed for 1 year after the initial examination. Combined end points: development of arterial vascular complications - stroke, myocardial infarction, distal arterial embolism of other locations. We studied the data on identified complications. Next, we built models for predicting complications in various ways: Decision Tree; Bootstrap Forest; Boosted Tree; Neural Boosted; Support Vector Machines; Fit Stepwise; Nominal Logistic; Generalized Regression Lasso; Generalized Regression Forward Selection; Generalized Regression Pruned Forward Selection; Generalized Regression Elastic Net; Generalized Regression Ridge. To assess the quality of the models and compare them we used cross-validation with 30 replications. The highest profit values with minimal values of false positive results were obtained for the Bootstrap Forest model. Basing on this model, we created arterial vascular complications predictive score in extrasystolic arrhythmia "EX-prognosis" that included the following parameters: atheroma type III in carotid arteries - 3 points; age 69+ years old - 2 points; ES appearing before transmitral blood flow peak in cardiac cycle 700 and more per 24 hours - 1 point; carotid arteries stenosis, non-significant - 1 point. If total number is 3 and more points, the risk of arterial vascular complications within 1 year is high. We recommend to use the scale "EX-prognosis" in the clinical practice. For a quick assessment of the total risk, it is optimal to implement the risk14.exe program - calculator - developed by us for a personal computer, based on this scale.

Impact of Paroxysmal Atrial Tachycardia on Thromboembolic Events and Major Adverse Cardiovascular Events: A Single-Center Retrospective Study.

Atrial fibrillation (AF) is known to increase the risk of thromboembolic events and major adverse cardiovascular events (MACE). The impact of paroxysmal atrial tachycardia (PAT) on these risks remains unclear. This retrospective cohort study was conducted involving 889 patients diagnosed with PAT and 1106 control patients without PAT, all of whom underwent their initial 24-hour ECG monitoring between 2015 to 2020. Kaplan-Meier survival analysis and Cox regression analysiswere used to evaluate the association between PAT and the study endpoints, including thromboembolic events and MACE. Over a mean follow-up period of 50.3 months, the incidence of thromboembolic events and MACE was significantly higher in the PAT group compared to the control group (6.5% vs 1.7% and 19.1% vs 9.9%, respectively). After adjusting for common risk factors and baseline imbalances, the PAT group exhibited a significantly elevated risk of thromboembolic events (hazard ratio [HR] 3.782, 95% confidence interval [CI] 2.212-6.467; P <0.001) and MACE (HR 1.795, 95% CI 1.398-2.305; P <0.001). However, the frequency of PAT episodes, heart rate, and maximum heart rate were not significantly associated with theseoutcomes. Within the PAT group, a history of stroke, transient ischemic attack, and chronic renal failure were identified as independent risk factors for thromboembolic events, while hypertension, coronaryheart disease, heart failure, and chronic renal failure were independently associated with MACE. PAT, as detected by 24-hour dynamic ECG, is associated with an increased risk of thromboembolic events and MACE.

Long-term noninvasive cardiac monitoring via Neutralized interfacial design for noise-suppressed near-infrared organic photodetectors

Organic photodetectors (OPDs) are the prime candidates for realizing commercial photoplethysmography (PPG) sensors in the future, although their performance and stability limitations remain as challenges. This study presents a strategy for fabricating high-precision, long-term, sustainable OPDs for non-invasive cardiac monitoring. In this work, the use of appropriate amounts of heterocyclic 1,3-diazoles (solid surfactants) enhances the morphology of PEDOT:PSS films and optimizes its energy level alignment, thus directly reducing the leakage current noise and improving the stability of the OPD. The OPDs with 0.5 wt% heterocyclic 1,3-diazole demonstrate enhanced dark current suppression and detectivity enhancement in the photoconductive and self-powered modes. Improved charge recombination dynamics and optimal resistance ratios lead to better performance of the champion device under low-intensity illumination. The champion device yields a more precise Photoplethysmography (PPG) signal under normal and exercise conditions when using a near-infrared light source, and it maintains a PPG signal intensity of more than 90 % after 315 days (7560 h) of storage in a nitrogen atmosphere. Optimized PPG sensors based on flexible substrates maintain signal intensity after seven days of air storage. The low hysteresis behavior also verifies that the optimized device has higher driving stability. High-reliability, high-validity accelerated photoplethysmography (APG) demonstrated that the champion PPG sensor would be used for accurate cardiovascular diagnostics, even over an extended period.

HIVAC (HIV-associated cardiomyopathy): An overlooked complication of HIV in developing countries.

Early initiation of anti-retroviral treatment and prompt management of heart failure in a AIDS patient is crucial. If resources available endomyocardial biopsy can guide the future management. HIV-associated cardiomyopathy (HIVAC) is a serious complication of HIV with poorly understood pathology. Systolic dysfunction was a common characteristic of HIVAC which is now replaced as diastolic dysfunction due to the availability of ART. There are various etiologies of HIVAC depending on the degree of viral replication, immune response, availability of ART, and also the disparity between high and low-income countries. We present the case report of a 65-year-old male with a past medical history of untreated HIV who came to the hospital with hemodynamic instability and was diagnosed with HIVAC with pulmonary TB, where the cause of HIVAC was poor immune response and opportunistic infection. Therefore, early cardiac monitoring is essential in HIV patients to prevent its advancement.

Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns (CABG-AF): Rationale and Design of an Investigator-Initiated Observational Study

New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased rates of adverse events (including mortality and stroke). Its incidence after coronary artery bypass grafting (CABG) is considered to be approximately 30 % and it is thought to be a transient condition. However, studies investigating POAF after CABG fail to provide appropriate data on incidence and arrhythmia patterns due to the use of intermittent rhythm detection strategies. These methods have a low sensitivity as compared to continuous monitoring. Subsequently, studies utilizing these techniques most likely do not identify all patients with arrhythmia and do not adequately demonstrate the long-term incidence of arrhythmia, which in turn may affect its association with adverse events. The CABG-AF study (German Clinical Trials Register Nr.: DRKS00018887) tests the hypothesis that the incidence of AF in the first 12 months after CABG is significantly underestimated. CABG-AF is an investigator-initiated multicenter, prospective, observational study in which 196 patients with no history of arrhythmia undergoing first-time CABG, receive an insertable cardiac monitor for continuous postoperative rhythm monitoring. The primary endpoint of the study is any episode of AF within the first 12 months after surgery. Secondary endpoints include AF burden, AF density and the ratio of silent to symptomatic AF episodes. Endpoints will be investigated by automatic and patient-initiated data transfers from the implanted device, by telephone interview of patients and by follow-up forms sent to patients by mail. The patients will be followed for a planned follow-up of 3 years. In conclusion, the CABG-AF study will provide information on the true incidence of AF after CABG as well as on the temporal patterns of the arrhythmia.

Proteasome inhibitors and risk of cardiovascular events in patients with multiple myeloma.

300 Background: Proteasome inhibitors (PI) represent a significant advancement in the treatment of multiple myeloma (MM). While recent studies have stressed the cardiovascular (CV) risk associated with carfilzomib (CARF) use, the risk with ixazomib (IXA) is underreported and no large comparative analysis is available. This study aims to compare CV and dose-limiting toxicities in MM patients treated with CARF and IXA. Methods: We conducted a retrospective cohort study analyzing TriNetX electronic medical records, including MM patients age 18 years and older who initiated CARF or IXA between January 1, 2016 to December 31, 2023. Patients with a prior history of heart failure (HF) or arrhythmias were excluded. We evaluated the incidence of new onset of HF and arrhythmia within three months of initiating PIs. Secondary outcomes included the incidence of diarrhea, nausea and vomiting during this period. Propensity score matching (PSM) was performed using 1:1 nearest neighbor matching to balance baseline characteristics. Matching covariates included patients’ demographics (age, sex, race/ethnicity), cardiovascular comorbidities and medications (cardiovascular and chemotherapy). Hazard ratios (HRs) for the outcomes were calculated using Cox proportional hazards models with a significance threshold of p&lt;0.05. Results: We identified 950 and 2,872 patients in the IXA- and CARF-treated cohorts, respectively. After PSM, each cohort included 753 patients, with a mean age of 65 years, 52% male and 65% white. Matched populations had no significant differences with respect to matching criteria. The new onset of HF within three months was 2.8% in the IXA group and 5.4% in the CARF group (HR: 0.50, 95% CI: 0.30–0.85, p=0.009). The new onset of arrhythmias was also significantly lower in the IXA group (4.3%) compared to the CARF group (6.6%) (HR:0.63, 95% CI:0.40–0.98, p=0.04). There was no significant difference in the incidence of diarrhea (HR: 0.92, 95% CI: 0.68–1.26, p=0.61), while nausea/vomiting was significantly lower in the IXA group (HR:0.71, 95% CI:0.54–0.93, p=0.013). Conclusions: Our study indicates that ixazomib is associated with a significantly lower risk of cardiac side effects compared to carfilzomib in the treatment of MM, with similar gastrointestinal side effects. Enhanced cardiac monitoring may be necessary for patients on carfilzomib. Further research is needed to validate these cardiovascular risk differences.

Use of continuous cardiac monitoring to assess the influence of atrial fibrillation burden and patterns on patient symptoms and healthcare utilization: the DEFINE AFib study

Use of continuous cardiac monitoring to assess the influence of atrial fibrillation burden and patterns on patient symptoms and healthcare utilization: the DEFINE AFib study

Long-Term Differences in AutonomicAlterations After Cryoballoonvs Radiofrequency AtrialFibrillation Ablation.

The long-term natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined. The authors sought to define the long-term impact of thermal catheter ablation on the cardiac autonomic system. The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using thermal ablation energy (radiofrequency or cryoballoon ablation). All patients underwent insertion of a Reveal LINQ implantable cardiac monitor prior to ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (HRV) (measured as the standard deviation of the average normal-to-normal), daytime heart rate, and nighttime heart rate (NHR). Longitudinal autonomic data in the 2-month period prior to the date of ablation were compared with the 3 years following ablation. Following ablation, there was a significant decrease in HRV (10-20ms; P< 0.0001) and significant increases in daytime heart rate and NHR (10 beats/min [P< 0.0001] and 7 beats/min [P< 0.0001], respectively). Changes in autonomic parameters were greatest in the first 3months following ablation but remained significantly different from baseline for 36months following ablation. Greater changes in NHR and HRV were associated with improved freedom from recurrent arrhythmia. The type of thermal ablation energy had no influence on the heart rate and autonomic parameters. Pulmonary vein isolation using thermal ablation energy results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are independent of the ablation technology employed and are associated with procedural success. (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration [CIRCA-DOSE]; NCT01913522).

Outpatient Laboratory Monitoring for Antibiotic-related Adverse Events in Children With Acute Hematogenous Osteomyelitis.

Monitoring for antibiotic-related lab abnormalities (ARLA), including hematologic, renal, and/or hepatic toxicity, in pediatric osteomyelitis is common. In 240 cases of osteomyelitis with outpatient laboratory monitoring, ARLA occurred in 13.3% with the most common finding being neutropenia. ARLA impacted antibiotic therapy in <1% of subjects, however, raising questions about the value of such monitoring being performed routinely.

Conductive Fabric Loop Sensor in Apparel Form for Cardiac Activity Monitoring

Conductive Fabric Loop Sensor in Apparel Form for Cardiac Activity Monitoring

Association of Angina, Myocardial Infarction and Atrial Fibrillation-A Bidirectional Mendelian Randomization Study.

Aims/Background Coronary heart disease (CHD) and atrial fibrillation (AF) exhibit a close relationship, yet the existing body of research predominantly relies on observational study methodologies, posing challenges in establishing causal relationships. The objective of our study is to investigate the causal linkages between coronary atherosclerosis (CAAs), angina pectoris, myocardial infarction (MI), and AF. Methods This study utilizes a two-sample Mendelian randomization (TSMR) methodology, leveraging genetic variation as a means of evaluating causality. Mendelian randomization is grounded in three primary assumptions: (1) the genetic variant is linked to the exposure, (2) the genetic variant is independent of confounding factors, and (3) the genetic variant influences the outcome solely through the exposure. Results The results of our study suggest a genetic predisposition in which CAAs, angina, and MI may enhance susceptibility to AF, while AF may reciprocally elevate the risk of CAAs. Conclusion In light of these findings, it is recommended that patients with CHD undergo regular cardiac rhythm monitoring, and that patients with AF receive anticoagulant and antiplatelet therapy whenever feasible. This study posits a practical implication for clinical practice.

Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A Cross-Sectional Study.

Prior analyses of the relationship between insurance status and receipt of tests and procedures have yielded conflicting findings and have focused on outpatient care. We sought to characterize the relationship between primary payer and diagnostic and procedural intensity, comparing rates of cardiac tests and procedures in matched hospitalized Medicaid and commercially insured patients. We created a propensity score-matched sample of Medicaid and commercially insured adults hospitalized at all acute care hospitals in Kentucky, Maryland, New Jersey, and North Carolina from 2016 to 2018. The main outcome was receipt of a cardiac test or procedure: echocardiogram, stress test, cardiac catheterization (elective, in acute coronary syndrome, in ST-segment-elevation myocardial infarction), and pacemaker and subcutaneous cardiac rhythm monitor implantation. Generalized linear models with a hospital-specific indicator variable were estimated to calculate the adjusted odds of a commercially insured patient receiving a given test or procedure relative to a Medicaid patient. Models controlled for race, ethnicity, and zip code income quartile. Commercially insured patients were more likely to receive each cardiac test or procedure, with adjusted odds ratios ranging from 1.16 (95% CI, 1.00-1.34) for cardiac catheterization in ST-segment-elevation myocardial infarction to 1.40 (95% CI, 1.27-1.54) for pacemaker implantation. Hospitalized commercially insured patients were more likely to undergo a range of cardiac tests and procedures, some of which may represent low-value care. This may be driven by a combination of physician and patient preference, financial incentives, and social determinants of health. Our findings support the need for hospital payment models focused on increasing value and reducing inequities.

A study on serum potassium and serum magnesium levels in acute myocardial infarction with special emphasis on rhythm disturbance

Background and objectives. Myocardial infarction (MI) is a severe cardiac event associated with plaque formation in arteries, leading to reduced blood flow to the heart. Arrhythmias, such as bradyarrhythmia or tachyarrhythmia, commonly accompany MI, contributing to its morbidity and mortality. Electrolyte disturbances, particularly potassium and magnesium imbalances, can exacerbate arrhythmic risks in MI patients. This study aimed to assess the incidence of alterations in serum potassium and magnesium levels during acute MI and their correlation with rhythm disturbances. Material and methods. A prospective analytical study was conducted with 150 patients diagnosed with acute MI based on ECG changes and elevated cardiac markers. Serum potassium and magnesium levels were measured, and rhythm disturbances were assessed using continuous cardiac monitoring and standard ECG. Spearman correlation analysis was performed to evaluate the association between serum potassium, serum magnesium, and rhythm changes. Results. The study investigated the demographic and clinical characteristics of participants and the potential relationship between serum electrolyte levels and arrhythmic changes. The mean age of the participants was 54.3 years, with a male predominance (76% male, 24% female). Among the participants, 50.67% had diabetes, 52% had hypertension, and 28% had both conditions. Serum electrolyte analysis showed elevated magnesium levels in 6.66% and elevated potassium levels in 12.66% of patients. Notably, arrhythmic changes in ECG were present in 62% of patients, with sinus tachycardia being the most prevalent (17%). However, statistical analysis revealed no significant correlation between serum magnesium, serum potassium, and rhythm changes (p &gt;0.05). These findings suggest that while arrhythmic changes are common, they are not directly associated with elevated levels of these electrolytes, indicating the need for further investigation into other potential factors influencing arrhythmias in this population. Conclusion. Despite the prevalence of electrolyte disturbances in acute MI patients, this study found no significant association between serum magnesium, serum potassium levels, and rhythm disturbances. Further research is warranted to elucidate the complex interplay between electrolyte imbalances and arrhythmias in MI.

Arduino-Based Real-Time ECG Monitoring System for Heart Signal Visualization

Electrocardiogram (ECG) monitoring is an essential tool in healthcare for diagnosing and tracking heart conditions. However, existing ECG devices are often expensive, limiting accessibility for personal or educational use. This project aims to develop a low-cost ECG monitoring system using an Arduino UNO, AD8232 sensor, and TFT SPI display. The system collects ECG signals via electrodes and displays the real-time PQRST waveform on the TFT screen and the Arduino IDE serial monitor. Resistors are utilized to ensure signal clarity by reducing electrical noise. The project successfully demonstrated the ability to visualize clear ECG signals in real time, offering a practical and cost-effective solution for continuous cardiac monitoring

CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments

Background and Purpose Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction. Methods We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke. In the Pre- period, consults were sent via EPIC electronic medical record (EMR), with additional direct communication when desired. In the CONNECT period, the pathway and module allowed for immediate communication between services. Outcomes included case rate, times, length of stay, and satisfaction. Hospital reports detailed Order to Activation (O-A) days. EM report review was used to obtain O-A time. Clinician satisfaction was assessed using Qualtrics survey. Patient satisfaction was assessed with Hospital Consumer Assessment of Health care Clinicians and Systems (HCAHPS) survey. Man-Whitney U test was used. Results 78 patients were included (30EM(38.5%), 48ILR(61.5%)). Age was 68 years ( P = 0.58). For ILRs, inpatient placements prior to discharge increased (3Pre vs 51 CONNECT; P &lt; 0.0001) as did outpatient placements (5 vs 16; P = 0.02). Order to Activation (O-A) time savings were significant for ILR overall (32 days vs 1 day; P = 0.03) and for Inpatient EM (13 days vs 3 days; P = 0.003). Time for consultant to view was 4 min and to respond was 6 min. Devices were placed at a median 6 hrs 32 min (EM: 4 hrs 19 min; ILR:7 hrs36 min). All (12/12) clinicians preferred the technique. Patient satisfaction improved on 13/19 (68%) questions. Conclusions There was a 1600% increase in ILR placements prior to discharge that was associated with the time period that the CONNECT process was in place. The robust improvement in ILR placements prior to discharge, high satisfaction, ease of use, closed loop communication, and respect for autonomy allowing more organic parallel discussions with patients improved clinician workflow which could potentially improve future risk reduction strategies.

An Evaluation of The Older Persons Presentation To The Emergency Department (ED) Following A Fall/Syncope/Presyncope

Abstract Background Falls events are a leading reason for presentations to the ED, particularly in older adults. Often these events are unwitnessed and unexplained. Therefore, there is strong consensus that the management of unexplained falls should be evaluated in a similar fashion to syncope as outlined by the World Falls and European Society of Cardiology guidelines. Methods The aim of this study was to evaluate adherence with current falls/syncope guidelines. Consecutive patients over the age of 75 who presented with a fall or syncope to a university teaching hospital in October 2023 were included. Data was collected on diagnostics completed (ECG, CT Brain, Carotid Doppler Ultrasound, EEG, pro BNP, Troponin, Echocardiogram, and External loop recorder), whether specialist falls review was performed, and readmission within 6 months. Completion of diagnostic tests were compared between those who were and were not reviewed by a specialist service using the Chi squared test. Results Falls/syncope/presyncope comprised 17.5% (160/913) of presentations of older people to the ED. Overall, 43% (n=68) had an ECG completed, 15% (n=23) had a pro BNP, and 24% (n=38) had a troponin level measured, 11% (n=17) had an Echo performed, and 10% (n=16) had prolonged cardiac monitoring (R test), 47% (n=74) had a CT Brain performed. Among those who were reviewed by a specialist falls service, (39% n= 62) completion of recommended investigations was significantly higher; ECG (69% v 26%, p&amp;lt;0.01), pro BNP (24% v 8.3%, p&amp;lt;0.01), echocardiogram (21% v 4.2%, p&amp;lt;0.01), cardiac monitoring (18% v 5.2%, p&amp;lt;0.01). Conclusion Falls and syncope are common presentations to the ED among older adults. Patients who were seen by a specialist falls team were more likely to have the appropriate diagnostics complete. Therefore, a specialist falls/syncope pathway led by a specialist falls service in the ED could result in better outcomes for patients.

Audit of Lithium Monitoring in a Mental Health for Older Persons (Dublin North City Central) Service

Abstract Background Lithium is a psychotropic medication used for the treatment of bipolar affective disorder and augmentation for treatment resistant depression. Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential for toxicity. Other medications with similar risk profiles, such as warfarin, have established monitoring programmes. Older adults receiving lithium therapy are at an increased risk of adverse events, given the prevalence of medical co-morbidities and changing pharmacokinetics. The authors of this audit identified the lack of formalized lithium monitoring programme in the Mental Health Service for Older Persons (MHSOP). The aim of this audit to compare monitoring practices in the MHSOP against the current gold standard Irish Medication Safety Network (IMSN) for Prescribing and Monitoring of Lithium Therapy. Methods A survey of all community medical charts identifying patients attending the service receiving lithium therapy was completed. Data collected pertained to diagnosis, treating consultant, lithium dose, if the patient received educational material, compliance with ECG and blood monitoring. Results The MHSOP active case load was 682 patients, 14 patients were prescribed lithium therapy. Cycle 1 of the audit demonstrated poor compliance of lithium monitoring against the gold standard. A lithium pack was inserted in patient files to prompt all clinicians to follow the recommended standardized monitoring of lithium therapy as per the IMSN guidelines. In cycle 2 of the audit there was an improvement in recording blood monitoring across the patient group. Conclusion The audit demonstrated improvement in compliance with international guidelines following the intervention. It was recommended that a formalized Lithium Clinic was a needed resource for the MHSOP. The lithium monitoring pack will continue to be added to clinical files, included in Non-Hospital Consultant (NCHD) induction and multi - disciplinary teaching sessions. It is proposed that the audit be repeated in one year to longitudinally assess compliance.

SemConvTree: Semantic Convolutional Quadtrees for Multi-Scale Event Detection in Smart City

The digital world is increasingly permeating our reality, creating a significant reflection of the processes and activities occurring in smart cities. Such activities include well-known urban events, celebrations, and those with a very local character. These widespread events have a significant influence on shaping the spirit and atmosphere of urban environments. This work presents SemConvTree, an enhanced semantic version of the ConvTree algorithm. It incorporates the semantic component of data through semi-supervised learning of a topic modeling ensemble, which consists of improved models: BERTopic, TSB-ARTM, and SBert-Zero-Shot. We also present an improved event search algorithm based on both statistical evaluations and semantic analysis of posts. This algorithm allows for fine-tuning the mechanism of discovering the required entities with the specified particularity (such as a particular topic). Experimental studies were conducted within the area of New York City. They showed an improvement in the detection of posts devoted to events (about 40% higher f1-score) due to the accurate handling of events of different scales. These results suggest the long-term potential for creating a semantic platform for the analysis and monitoring of urban events in the future.

Artifact removal from ECG signals using online recursive independent component analysis

The diagnosis of cardiac abnormalities and monitoring of heart health heavily rely on Electrocardiogram (ECG) signals. Unfortunately, these signals frequently encounter interference from diverse artifacts, impeding precise interpretation and analysis. To overcome this challenge, we suggest a novel method for real-time artifact removal from ECG signals through the utilization of Online Recursive Independent Component Analysis (ORICA). Our study outlines a systematic preprocessing pipeline, adaptively estimating the mixing matrix and demixing matrix of the ICA model while streaming data is processed. Additionally, we explore the selection of appropriate ICA components and the use of relevant feature extraction techniques to enhance the quality of extracted cardiac signals. This research presents a promising solution for removing artifacts from ECG signals in real-time, paving the way for improved cardiac diagnostics and monitoring systems. Comparative analyses demonstrate significant improvements in the accuracy of subsequent ECG analysis and interpretation following the application of our ORICA-based preprocessing.