Left ventricular hypertrophy detection using electrocardiographic signal.

Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.

Protective preparation: a process central to family caregivers of persons with mild cognitive impairment.

ABSTRACTBackground:To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan. METHODS: A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI. RESULTS: One core theme emerged: "protective preparation." This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management. CONCLUSIONS: Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.

Progressive compensatory symbiosis: spouse caregiver experiences of caring for persons with dementia in Taiwan.

OBJECTIVES: Spouse caregivers have been the predominant family members who care for persons with dementia in Taiwan. Although studies in western countries have described the caregiving experiences and changes in the marital relationship for these spouse caregivers, this information is lacking in Taiwan. This study explored the experiences of spouse caregivers caring for persons with dementia in Taiwan. METHODS: A grounded theory approach was used for this qualitative descriptive study. Data were collected through recorded in-depth interviews and observations with 15 spouse caregivers of persons with dementia. Constant comparative analysis was used to analyse the transcripts and field notes. RESULTS: Analysis of interview transcripts revealed that the experiences of caregiving for spouse caregivers who lived with persons with dementia could be described as 'progressive compensatory symbiosis.' This core category included three components: awareness of unbalanced intimacy, making a commitment and implementing a compensatory scheme. These experiences could be either mutually beneficial or unbalanced and fluctuated as the disease progressed through the phases of 'subtle,' 'revealed' and 'confirmed,' which also influence the pace, transition and evolution of the compensatory symbiosis. CONCLUSION: This exploratory study describes the family caregiving experiences for 15 spouse caregivers of persons with dementia in Taiwan. These results can provide guidance for developing interventions to prepare, facilitate and promote a mutually beneficial adjustment for spousal caregivers and their spouses as dementia progresses. The findings are worthy of further investigation with a larger sample and a prospective design.

Image-quality figure evaluator based on contrast-detail phantom in radiography.

BACKGROUND: In radiology, it is significantly important to produce adequate diagnostic information while minimally affecting the patient with the lowest amount of dose. A contrast-detail phantom is generally used to study the quality of image and the amount of radiation dose for digital X-ray imaging systems. To evaluate the quality of a phantom image, radiologists are traditionally required to manually indicate the location of the holes in each square in the phantom image. Then, the image quality figure (IQF) of the image can be evaluated. However, evaluation by the human eye is subjective as well as time-consuming, and it differs from person to person. METHODS: In this paper, an image processing-based IQF evaluator is proposed to automatically measure the quality of a phantom image. Nine phantom images, each consisting of 2382 × 2212 pixels, were used as test images and were provided by Taichung Hospital, Department of Health, Executive Yuan, Taiwan, Republic of China. The IP-IQF evaluator separates the phantom image into squares and then stretches the contrast of each square to the range 0-255. After that, it splits each square into 3 × 3 equal-sized regions, and recognizes the pattern of the square based on the features computed by mean-difference gradient operation and run length enhancer. Furthermore, a genetic algorithm-based parameter values-detecting algorithm is presented to compute the optimal values of the parameters used in the IP-IQF evaluator. RESULTS: The experimental results demonstrate that CoCIQ and the IP-IQF evaluator can efficiently measure the IQF of a phantom image. The IP-IQF evaluator is more effective than a radiologist and CoCIQ in evaluating the IQF of a phantom image. CONCLUSIONS: The proposed IQF evaluator is more sensitive than not only the observation of radiologists but also the computer program CoCIQ. Moreover, a genetic algorithm is provided to compute the most suitable values of the parameters used in the IQF evaluator.

Tamper detection and recovery for medical images using near-lossless information hiding technique.

Digital medical images are very easy to be modified for illegal purposes. For example, microcalcification in mammography is an important diagnostic clue, and it can be wiped off intentionally for insurance purposes or added intentionally into a normal mammography. In this paper, we proposed two methods to tamper detection and recovery for a medical image. A 1024 x 1024 x-ray mammogram was chosen to test the ability of tamper detection and recovery. At first, a medical image is divided into several blocks. For each block, an adaptive robust digital watermarking method combined with the modulo operation is used to hide both the authentication message and the recovery information. In the first method, each block is embedded with the authentication message and the recovery information of other blocks. Because the recovered block is too small and excessively compressed, the concept of region of interest (ROI) is introduced into the second method. If there are no tampered blocks, the original image can be obtained with only the stego image. When the ROI, such as microcalcification in mammography, is tampered with, an approximate image will be obtained from other blocks. From the experimental results, the proposed near-lossless method is proven to effectively detect a tampered medical image and recover the original ROI image. In this study, an adaptive robust digital watermarking method combined with the operation of modulo 256 was chosen to achieve information hiding and image authentication. With the proposal method, any random changes on the stego image will be detected in high probability.

[A conceptual analysis of professional commitment].

Professional Commitment is an attitude, and it is the core and spirit of professionalism. In addition to increasing personal stability in the profession, it also enables individuals to reach their professional goals in general. Because nurses usually have more opportunities than other health care professionals to be in contact with patients, patients receive most of their information about health care from nurses. If nurses accept professional commitment as early as possible, the quality of patient-care will be improved. That is the reason why professional commitment is regarded as the hallmark of quality in professional care. This paper will use the conceptual analysis framework developed by Walker and Avant (1995) to examine and analyze professional commitment and establish its relationship with nursing. The authors hope that it can provide nurses with the opportunity to understand this concept more fully, to support their own profession, to raise the position of the nursing profession and to guarantee the health of the general public.