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Bacterial Contamination of Hospital Equipments in Two Tertiary Health Facilities in Central Nigeria and Their Corresponding Susceptibility to Antimicrobial Agents 尼日利亚中部两所三级医疗机构医院设备的细菌污染及其对抗菌药物的敏感性
Pub Date : 2019-09-25 DOI: 10.11648/J.IJBECS.20190502.13
Adamu Muktar Owuna, Owuna Jibril Egwu, Y. Hajara, Azamu Ibaku Gowon
Hospital is a major avenue for the spread of infectious diseases known as nosocomial infections. This study investigated the bacteria that colonize hospital equipments at the Federal Medical Centre and Nasarawa State University Clinic Keffi. Swab samples of different hospital equipments were collected and examined using standard microbiological techniques. Cultural features indicates the presence of the following bacteria; Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphylococcus aureus and Enterobacter spp. The mean bacterial load from NSUK clinic equipments (×104cfu/ml) were 0.32, 0.18, 0.19 and 0.1 for total viable, total coliform, total fecal coliform and staphylococcus aureus count respectively, while the mean bacterial load in FMC (×104cfu/ml) was 1.254, 0.347 and 0.283 for total viable count, coliform count and faecal coliform count accordingly. Frequency of occurrence of the bacteria isolates in FMC is in the order: Escherichia coli (50.0%)>Enterobacter spp. (30.0%)>Klebsiella spp. and Pseudomonas spp. (20.0%)>Staphylococcus aureus (0.0%); while that of NSUK clinic is in the order: Escherichia coli (50.0%)>Pseudomonas spp. (30.0%)>Staphylococcus aureus (10.0%), while Klebsiella spp. and Enterobacter spp. were not isolated at NSUK clinic. The antibiotic susceptibility pattern of the bacteria showed Pseudomonas spp. to be completely susceptible to Augmentin, Gentamicin, Chloramphenicol and Ciprofloxacin (100.0% each), while E. coli showed some degree of susceptibility to Streptomycin (44.4%), Ciprofloxacin and Perfloxacin (33.3%), Gentamicin and Sparfloxacin (22.2%), Augmentin, Ofloxacin, Septrin and Chloramphenicol (11.1%), but completely resistant to Amoxicillin. Klebsiella spp. and Enterobacter spp. were resistant to all the antibiotics tested, except for Streptomycin which they displayed high susceptibility of 100.0% and 66.7% for Klebsiella spp. and Enterobacter spp. respectively. Staphylococcus aureus was found to be resistant completely against all the antibiotics tested. Hence, it is pertinent to embrace hand hygiene so as to minimize the risk of acquiring nosocomial infections due to contaminated hospital equipments.
医院是传染病传播的主要途径,被称为院内感染。这项研究调查了联邦医疗中心和纳萨拉瓦州立大学诊所凯菲医院设备上的细菌。收集不同医院设备的拭子样本,并使用标准微生物学技术进行检测。培养特征表明存在以下细菌;大肠杆菌、克雷伯氏菌、假单胞菌、金黄色葡萄球菌和肠杆菌。NSUK临床设备的平均细菌负荷(×104cfu/ml)分别为0.32、0.18、0.19和0.1,而FMC的平均细菌负荷(×104cfu/ml)分别为1.254、0.347和0.283,分别为总活菌、总大肠菌群、总粪便大肠菌群。FMC中分离菌的出现频率依次为:大肠杆菌(50.0%)>肠杆菌(30.0%)>克雷伯氏菌和假单胞菌(20.0%)>金黄色葡萄球菌(0.0%);NSUK诊所的检出率为大肠杆菌(50.0%)>假单胞菌(30.0%)>金黄色葡萄球菌(10.0%),未检出克雷伯氏菌和肠杆菌。细菌的药敏模式显示,假单胞菌对奥格门汀、庆大霉素、氯霉素和环丙沙星均完全敏感(各为100.0%),大肠杆菌对链霉素(44.4%)、环丙沙星和环氟沙星(33.3%)、庆大霉素和斯帕沙星(22.2%)、奥格门汀、氧氟沙星、塞普林和氯霉素均有一定程度的敏感(11.1%),但对阿莫西林完全耐药。克雷伯氏菌和肠杆菌对除链霉素外的所有抗生素均耐药,对克雷伯氏菌和肠杆菌的敏感性分别为100.0%和66.7%。发现金黄色葡萄球菌对所有测试的抗生素都具有完全的耐药性。因此,应重视手卫生,以尽量减少因医院设备污染而导致医院感染的风险。
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引用次数: 0
In vitro Evaluation of the Anti-scavenging and Anthelmintic Activities of Artocarpus heterophyllus LAM Leaves (Moraceae) in the Democratic Republic of Congo 刚果(金)山菖蒲叶抗清除和驱虫活性的体外评价
Pub Date : 2019-09-24 DOI: 10.11648/J.IJBECS.20190502.11
Lengbiye Moke Emmanuel, K. Ngbolua, L. M. Messi, Mbembo-Wa-Mbembo Blaise, G. Bongo, Mutwale Kapepula Paulin, Ngombe Kabamba Nadège, J. N. Mbing, D. E. Pegnyemb, P. Mpiana
The extracts of Arthocarpus heterophyllus Lam. leaves were evaluated in vitro for their anthelmintic activity. Benhamia rosea and B. itoleisis were used as animal models and Albendazole as reference product (positive control). After calculating the yield, it appears that the ethanol extracts had given a better yield (0.70%) compared to the organic extracts. The result of the phytochemical screening by TLC (thin layer chromatography) showed the presence of phenolic compounds including anthocyanins, coumarins, anthraquinones, phenol acids and terpenoids. From this study, it appears that A. heterophyllus Lam. contains various secondary metabolites such as flavonoids (2.63±0.007mg EQ/100g MS), phenolic acids, coumarins, anthraquinones, terpenoids and anthocyanins (10.46±1.05 mg/100 MS) and total polyphenols (27.33±9.34 mg EAG/100 g MS). The organic/terpenic acids extract showed very high antioxidant activity against the ABTS radical (IC50: 0.97 ± 0.13 µg/ml). The ethanolic and organic acid extracts from the leaves of this plant species have an anthelminthic activity, but this activity is dose dependent. However, at the lowest concentration (0.625 mg/mL), ethanolic extract showed better activity with a paralysis time of 67.3±1.8 minutes compared to 76±2.1 minutes for the organic extract. But the mortality rate at the lowest concentration was higher for organic extracts, at 62.7% compared to 33.3% for ethanol extracts. It is therefore desirable to test bioactive extracts on gastrointestinal parasites of farm animals in order to confirm the results obtained. Ongoing in-depth phytochemical studies will identify the chemical compound (s) and active principle (s) for the formulation of anthelminthic phytomedicine for managing pathologies due to helminthes in farm animals.
土蹄草提取物。叶片的离体驱虫活性进行了评价。以玫瑰本蚤和伊氏双歧杆菌为动物模型,阿苯达唑为对照品(阳性对照)。在计算产率后,与有机提取物相比,乙醇提取物的产率(0.70%)更高。薄层色谱法筛选结果显示,其中含有花青素、香豆素、蒽醌、酚酸、萜类等酚类化合物。从本研究中可以看出,异叶草是一种天然植物。含有黄酮(2.63±0.007mg EQ/100g MS)、酚酸、香豆素、蒽醌、萜类和花青素(10.46±1.05 mg/ 100ms)和总多酚(27.33±9.34 mg EAG/ 100g MS)等多种次生代谢物。有机/萜烯酸提取物对ABTS自由基具有很强的抗氧化活性(IC50: 0.97±0.13µg/ml)。该植物叶片的乙醇和有机酸提取物具有驱虫活性,但这种活性是剂量依赖性的。然而,在最低浓度(0.625 mg/mL)下,乙醇提取物表现出更好的活性,麻痹时间为67.3±1.8分钟,而有机提取物为76±2.1分钟。但在最低浓度下,有机提取物的死亡率更高,为62.7%,而乙醇提取物为33.3%。因此,需要在农场动物的胃肠道寄生虫上测试生物活性提取物,以确认所获得的结果。正在进行的深入植物化学研究将确定化学化合物和有效原理,用于制定抗寄生虫植物药,以管理农场动物中由寄生虫引起的病理。
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引用次数: 3
Recordings of Impedance and Communication Between Defibrillator and Pacemaker Electrodes 除颤器和起搏器电极之间的阻抗和通信记录
Pub Date : 2019-07-01 DOI: 10.4018/IJBCE.2019070103
A. Jarløv, A. Jarløv, T. Jensen
External defibrillation involves short electric shocks of several thousand volts applied to the chest of patients suffering from heart stop. The shock coordinates disorganized muscle fibers of the heart which then can resume normal activity. Implanted pacemakers monitor the natural electrical activity of the heart via electrodes mounted permanently on the inside of the heart. If this activity is insufficient, the pacemaker stimulates the heart muscle by applying a short electrical impulse of a few volts. During the period of defibrillation, voltage differences arise simultaneously between various locations of the body preventing recordings of the heart's natural activity. In order to quantify parameters determining voltage and current in a conductive medium or in a myocardium when defibrillator and pacemaker electrodes are present simultaneously, impedances between electrodes positioned on conductive materials were recorded in laboratory set ups, and the methods were tested using a porcine heart in vitro.
体外除颤包括对心脏骤停患者的胸部施加数千伏特的短电击。电击会协调心脏紊乱的肌肉纤维,使其恢复正常活动。植入的起搏器通过永久安装在心脏内部的电极监测心脏的自然电活动。如果这种活动不足,起搏器通过施加几伏特的短电脉冲来刺激心肌。在除颤期间,身体不同部位之间同时产生电压差异,从而无法记录心脏的自然活动。为了量化在除颤器和起搏器电极同时存在时导电介质或心肌中确定电压和电流的参数,在实验室设置中记录了放置在导电材料上的电极之间的阻抗,并使用体外猪心脏测试了这些方法。
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引用次数: 0
A Primitive Survey on Ultrasonic Imaging-Oriented Segmentation Techniques for Detection of Fetal Cardiac Chambers 胎儿心腔超声成像分割技术的初步研究
Pub Date : 2019-07-01 DOI: 10.4018/IJBCE.2019070104
V. P. Prabha, N. Sriraam
Recognition of presence of fetal cardiac chambers through ultrasonic Doppler imaging poses a huge challenge for the clinical community. The four-chamber view and outflow tracts are found to be a potential identity marker for presence of all heart chambers as well as current states of fetal heart. Given the cine loop ultrasonic imaging sequences, computer-aided diagnostic tools have been developed to detect and measures the chambers through automated mode. Segmentation and region of interest identification process contribute significantly towards the presence of heart chamber and presence of abnormality. This study provides a primitive survey towards the ultrasonic imaging-oriented segmentation techniques for detection/recognition of all four fetal cardiac chambers. The challenges for the biomedical community were also reported.
通过超声多普勒成像识别胎儿心室的存在给临床带来了巨大的挑战。四室视图和流出道被发现是一个潜在的身份标记,所有的心脏室的存在,以及胎儿心脏的当前状态。鉴于电影循环超声成像序列,计算机辅助诊断工具已经开发出来,通过自动化模式检测和测量腔室。分割和兴趣区识别过程对心室的存在和异常的存在有重要作用。本研究为超声成像为导向的分割技术的检测/识别所有四个胎儿心室提供了初步的调查。还报告了生物医学界面临的挑战。
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引用次数: 3
Accessible Interface for Context Awareness in Mobile Devices for Users With Memory Impairment 为记忆障碍用户在移动设备中提供上下文感知的可访问接口
Pub Date : 2019-07-01 DOI: 10.4018/IJBCE.2019070101
Iyad Abu Doush, Sanaa Jarrah
Memory problems usually appear because of aging or may happen because of a brain injury. Such problems prevent the person from performing daily activities. In this paper, the authors propose a framework to develop a smartphone solution to detect and recognize the user context. In order to build the context detection framework, the authors compare three different machine learning techniques (C.4.5, random, and BFTree) in terms of context detection accuracy. Then, the authors use the classification technique with the highest accuracy in a mobile application to help users by detecting their context. The authors develop two interfaces based on the suggested accessibility features for users with memory impairment. Two scenarios are used to evaluate the user interface, and the results prove the applicability and the usability of the proposed context detection framework.
记忆问题通常是由于衰老或脑损伤而出现的。这些问题使患者无法进行日常活动。在本文中,作者提出了一个框架来开发智能手机解决方案,以检测和识别用户上下文。为了构建上下文检测框架,作者在上下文检测准确性方面比较了三种不同的机器学习技术(C.4.5, random和BFTree)。然后,作者在移动应用程序中使用最高准确率的分类技术来帮助用户检测他们的上下文。作者根据建议的可访问性特性为有记忆障碍的用户开发了两个界面。用两个场景对用户界面进行了评估,结果证明了所提出的上下文检测框架的适用性和可用性。
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引用次数: 4
A Study on Developing Cardiac Signals Recording Framework (CARDIF) Using a Reconfigurable Real-Time Embedded Processor 利用可重构实时嵌入式处理器开发心脏信号记录框架的研究
Pub Date : 2019-07-01 DOI: 10.4018/IJBCE.2019070102
Uma Arun, N. Sriraam
Due to recent developments in technology, there is a significant growth in healthcare monitoring systems. The most widely monitored human physiological parameters is electrocardiogram (ECG) which is useful for inferring the physiological state of humans. Most of the existing multi-channel ECG acquisition systems were not accessible in resource-constrained settings. This research study proposes a cardiac signal recording framework (CARDIF) using a reconfigurable input-output real-time embedded processor by employing a virtual instrumentation platform. The signal acquisition was configured using Lab VIEW virtual instrumentation block sets. A graphical user interface (GUI) was developed for real-time data acquisition and visualization. The time domain heart rate variability (HRV) statistics were calculated using CARDIF, and the same were compared with a clinical grade 12-channel ECG system. The quality of the acquired signals obtained from the proposed and standard systems was measured and compared by calculating signal-to-noise ratio (SNR). The proposed CARDIF was evaluated qualitatively by visual inspection by a clinician and quantitatively by fidelity measures and vital parameters estimation. The results are quite promising and can be extended for clinical validations.
由于最近技术的发展,医疗保健监测系统有了显著的增长。监测最广泛的人体生理参数是心电图(ECG),它有助于推断人的生理状态。大多数现有的多通道心电采集系统在资源受限的环境下无法使用。本研究提出了一种心脏信号记录框架(CARDIF),该框架采用可重构输入输出实时嵌入式处理器,采用虚拟仪器平台。信号采集使用Lab VIEW虚拟仪器模块集进行配置。开发了用于实时数据采集和可视化的图形用户界面(GUI)。使用CARDIF计算时域心率变异性(HRV)统计数据,并与临床级12通道心电图系统进行比较。通过计算信噪比(SNR),测量和比较了从提出的系统和标准系统获得的采集信号的质量。建议的CARDIF通过临床医生的目视检查进行定性评估,通过保真度测量和重要参数估计进行定量评估。结果很有希望,可以扩展到临床验证。
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引用次数: 1
High Education Level Protects European Americans but Not African Americans Against Chronic Obstructive Pulmonary Disease: National Health Interview Survey. 高教育水平可以保护欧洲裔美国人,但不能保护非裔美国人免受慢性阻塞性肺病的侵袭:全国健康访谈调查。
Pub Date : 2019-06-01 Epub Date: 2019-09-24 DOI: 10.11648/j.ijbecs.20190502.12
Shervin Assari, Hamid Chalian, Mohsen Bazargan

Background: Education level reduces the risk of chronic diseases (CDs), including Chronic Obstructive Pulmonary Disease (COPD). Minorities' Diminished Returns, however, refer to smaller health benefits of socioeconomic position (SEP) improvement for racial and ethnic minorities compared to majority groups. It is not known if MDRs exist for the effects of education level on COPD for African Americans (AAs), relative to European Americans (EAs).

Aims: Using a nationally representative sample, the current study explored racial and ethnic variation in the association between education level and COPD among American adults.

Methods: Data came from the National Health Interview Survey (NHIS 2015), a national survey. A total of 25,488 adults (18+ years old) were included in the study. From this number, 4,533 (17.8%) were AAs and 20,955 (82.2%) were EAs. Education level was the independent variable. Outcome was COPD. Age, gender, and income were the covariates. Race/ethnicity was the moderator.

Results: Overall, education level was inversely associated with the odds of COPD. A statistically significant interaction was found between race/ethnicity and education level on odds of COPD, indicating smaller effect of education for AAs compared to EAs.

Conclusions: In line with the Minorities' Diminished Returns (MDRs), highly educated AAs remained at high risk for COPD, a pattern which is not observed for EAs. Policies that exclusively address racial/ethnic inequalities in SEP may not be enough for eliminating racial/ethnic inequalities in COPD in the US. Public policies must go beyond equalizing SEP and address structural and environmental barriers that disproportionately increase risk of COPD in AAs across SEP levels. Future research should test if residential segregation and exposure to air pollutants contributes to high prevalence of COPD in highly educated AAs. Research is needed on multi-level interventions that may minimize MDR-related health disparities.

背景:教育水平可以降低患慢性疾病(CD)的风险,包括慢性阻塞性肺病(COPD)。然而,少数群体的递减回报是指与多数群体相比,少数种族和族裔的社会经济地位(SEP)改善对健康的益处较小。与欧洲裔美国人(EA)相比,非洲裔美国人(AA)受教育水平对COPD的影响是否存在MDR尚不清楚。目的:利用具有全国代表性的样本,目前的研究探讨了美国成年人受教育水平与COPD之间关系的种族和民族差异。方法:数据来自全国健康访谈调查(NHIS 2015),这是一项全国性调查。共有25488名成年人(18岁以上)参与了这项研究。从这个数字来看,4533个(17.8%)是AAs,20955个(82.2%)是EA。教育水平是自变量。结果为COPD。年龄、性别和收入是协变量。种族/民族是主持人。结果:总体而言,教育水平与COPD的发病率呈负相关。种族/民族和教育水平之间在COPD发病率方面存在统计学上显著的相互作用,表明与EAs相比,教育对AAs的影响较小。结论:与少数民族的递减回报率(MDR)一致,受过高等教育的AAs患COPD的风险仍然很高,这是EAs没有观察到的模式。仅解决SEP中种族/族裔不平等的政策可能不足以消除美国COPD中的种族/族裔差异。公共政策必须超越均衡SEP,并解决结构性和环境障碍,这些障碍会不成比例地增加不同SEP水平的AAs患COPD的风险。未来的研究应该测试居住隔离和暴露于空气污染物是否会导致受过高等教育的AAs中COPD的高患病率。需要对多层次干预措施进行研究,以最大限度地减少与耐多药相关的健康差异。
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引用次数: 0
ASSESSMENT OF NATURAL RADIOACTIVITY LEVEL IN SHORE SEDIMENT SAMPLES FROM NASSER LAKE AT ASWAN, EGYPT 埃及阿斯旺纳赛尔湖湖岸沉积物样本天然放射性水平的评估
Pub Date : 2019-01-31 DOI: 10.5121/IJBES.2019.6101
A. Taleb, A. Abbady, S. Harb
Thirty shore sediment samples taken from the side beach of Lake Nasser in south Arab Republic of Egypt to measuring the terrestrial radionuclides radium-226, thorium-232 and potassium-40 and its associated hazard indices. The activity concentration of natural radionuclides 226Ra,232Th and 40k in shore sediments samples under investigation are ranged from 1.92±0.077 to 17.55±0.676 Bqkg-1 with average value of 5.02±0.194 Bqkg-1, 5.62±0.281 to 28.77±1.441 Bqkg-1 with average value of 13.15±0.641 Bqkg-1 and 123.27±10.604 to 277.38±23.861 Bqkg-1 with average value of 200.26±17.054 Bqkg-1respectively .The radiation hazard indices which resulting from the presence of natural radionuclides in shore sediment samples were calculated and the obtained results indicate that the values of radium equivalent activity varies from 21.85 to 80.04 Bq/kg with average value of 39.25 Bq/kg, representative level index Iɣr varies from 0.16 to 0.58 with average value of 0.29.Absorbed dose rate varies from 10.63 to 37.541 nGy.h−1 with the average value of 18.83 nGy.h−1 . External hazard index Hix varies from 0.059 to 0.216 with average value of 0.105, internal hazard index Hin varies from 0.070 to 0.263 with average value of 0.119, annual outdoor effective dose varied from 0.013 to 0.046 mSvy-1 with average values 0.023 mSvy-1andThe indoor effective dose ranged from 0.052 to 0.184 mSvy-1, with average values 0.092 mSvy-1.
从阿拉伯埃及共和国南部纳赛尔湖侧滩采集的30个海岸沉积物样本用于测量陆地放射性核素镭-226、钍-232和钾-40及其相关危害指数。岸岸沉积物中天然放射性核素226Ra、232Th和40k的活度浓度范围为1.92±0.077 ~ 17.55±0.676 Bqkg-1,平均值为5.02±0.194 Bqkg-1;5.62±0.281 ~ 28.77±1.441 Bqkg-1,平均值为13.15±0.641 Bqkg-1, 123.27±10.604 ~ 277.38±23.861 Bqkg-1,平均值为200.26±17.054 Bqkg-1。计算了海岸沉积物样品中天然放射性核素存在的辐射危害指数,结果表明,镭当量活度值在21.85 ~ 80.04 Bq/kg之间,平均值为39.25 Bq/kg;代表性水平指数I * r变化范围为0.16 ~ 0.58,平均值为0.29。吸收剂量率变化范围为10.63 ~ 37.541 nGy.h−1,平均值为18.83 nGy.h−1。外部危害指数Hix范围为0.059 ~ 0.216,平均值为0.105;内部危害指数Hin范围为0.070 ~ 0.263,平均值为0.119;室外年有效剂量范围为0.013 ~ 0.046 mSvy-1,平均值为0.023 mSvy-1;室内有效剂量范围为0.052 ~ 0.184 mSvy-1,平均值为0.092 mSvy-1。
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引用次数: 2
Tools and Considerations to Develop the Blueprint for the Next Generation of Clinical Care Technology 制定下一代临床护理技术蓝图的工具和考虑
Pub Date : 2019-01-01 DOI: 10.4018/IJBCE.2019010101
C. Riha
This article provides a brief historical look at the genesis and evolution of clinical information systems. Based upon this historical background and the expertise of the authors, which encompasses, clinical, IT/cybersecurity, clinical engineering, as well as quality control expertise the article provides a roadmap for the next generation of clinical information systems. This next generation will not only provide consulting services to physicians via computer clinical decision support systems, but also the ability to perform autonomous and semi-autonomous care at the bedside via interfaces to medical devices (e.g. ventilators and infusion pumps), as well as auto ordering protocols.
本文简要介绍了临床信息系统的起源和发展历史。基于这一历史背景和作者的专业知识,包括临床、IT/网络安全、临床工程以及质量控制专业知识,本文为下一代临床信息系统提供了路线图。下一代机器人不仅可以通过计算机临床决策支持系统为医生提供咨询服务,还可以通过与医疗设备(如呼吸机和输液泵)的接口,以及自动订购协议,在床边执行自主和半自主护理。
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引用次数: 0
Elimination of Power Line Interference in ECG Signal Using Adaptive Filter, Notch Filter and Discrete Wavelet Transform Techniques 利用自适应滤波、陷波滤波和离散小波变换技术消除心电信号中的电力线干扰
Pub Date : 2019-01-01 DOI: 10.4018/ijbce.2019010103
Srinivasa M.G., Pandian P.S.
An ECG is a biomedical non-stationary signal, which contains valuable information about the electrical activity of the heart. The ECG is very sensitive and a weak signal, hence, it gets corrupted by various types of noise such as power line interference, baseline wander, motion artifacts, muscle contractions, electrode contact noise, etc., that may lead to a misdiagnosis. Among these noise parameters the power line interference is very crucial because noise falls in the ECG bandwidth, i.e. 0.05 Hz to 100 Hz. The article proposes the removal of power line interference (PLI) noise in an ECG signal based on discrete wavelet transform (DWT) and adaptive filtering techniques. The results are compared with the existing notch filter both in time and frequency domain by filter performance parameters like ESD, MSE %PSD and SNR.
心电图是一种生物医学上的非平稳信号,它包含有关心脏电活动的宝贵信息。心电图是一个非常敏感和微弱的信号,因此,它会被各种类型的噪声所破坏,如电源线干扰、基线漂移、运动伪影、肌肉收缩、电极接触噪声等,这可能导致误诊。在这些噪声参数中,电力线干扰是非常关键的,因为噪声落在心电带宽内,即0.05 Hz到100 Hz。提出了一种基于离散小波变换和自适应滤波技术的心电信号中电力线干扰噪声的去除方法。通过ESD、MSE %PSD和信噪比等滤波器性能参数与现有陷波滤波器在时域和频域进行了比较。
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引用次数: 6
期刊
International journal of biomedical engineering and clinical science
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