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Objective. Perinatal asphyxia poses a significant risk to neonatal health, necessitating accurate fetal heart rate monitoring for effective detection and management. The current gold standard, cardiotocography, has inherent limitations, highlighting the need for alternative approaches. The emerging technology of non-invasive fetal electrocardiography shows promise as a new sensing technology for fetal cardiac activity, offering potential advancements in the detection and management of perinatal asphyxia. Although algorithms for fetal QRS detection have been developed in the past, only a few of them demonstrate accurate performance in the presence of noise and artifacts. Approach. In this work, we propose Power-MF , a new algorithm for fetal QRS detection combining power spectral density and matched filter techniques. We benchmark Power-MF against three open-source algorithms on two recently published datasets (Abdominal and Direct Fetal ECG Database: ADFECG, subsets B1 Pregnancy and B2 Labour; Non-invasive Multimodal Foetal ECG-Doppler Dataset for Antenatal Cardiology Research: NInFEA). Main results. Our results show that Power-MF outperforms state-of-the-art algorithms on ADFECG (B1 Pregnancy: 99.5% ± 0.5% F1-score, B2 Labour: 98.0% ± 3.0% F1-score) and on NInFEA in three of six electrode configurations by being more robust against noise. Significance. Through this work, we contribute to improving the accuracy and reliability of fetal cardiac monitoring, an essential step toward early detection of perinatal asphyxia with the long-term goal of reducing costs and making prenatal care more accessible., (Creative Commons Attribution license.)

Understanding dispersal potential, or the probability a species will move a given distance, under different environmental conditions is essential to predicting species' ability to move across the landscape and track shifting ecological niches. Two important drivers of dispersal ability are climatic differences and variations in local habitat type. Despite the likelihood these global drivers act simultaneously on plant populations, and thus dispersal potential is likely to change as a result, their combined effects on dispersal are rarely examined. To understand the effect of climate and varying habitat types on dispersal potential, we studied Geum triflorum -a perennial grassland species that spans a wide range of environments, including both prairie and alvar habitats. We explored how the climate of the growing season and habitat type (prairie vs. alvar) interact to alter dispersal potential. We found a consistent interactive effect of climate and habitat type on dispersal potential. Across prairie populations, an increased number of growing degree days favored traits that increase dispersal potential or the probability of dispersing farther distances. However, for alvar populations, dispersal potential tended to decrease as the number of growing degree days increased. Our findings suggest that under continued warming, populations in prairie habitats will benefit from increased gene flow, while alvar populations will become increasingly segregated, with reduced potential to track shifting fitness optima., (© 2024 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study., Objective: The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy., Methods: A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective., Results: A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated "above average" in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes., Conclusions: Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects., (© Michael Nissen, Carlos A Perez, Katharina M Jaeger, Hannah Bleher, Madeleine Flaucher, Hanna Huebner, Nina Danzberger, Adriana Titzmann, Constanza A Pontones, Peter A Fasching, Matthias W Beckmann, Bjoern M Eskofier, Heike Leutheuser. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)

During pregnancy, almost all women experience pregnancy-related symptoms. The relationship between symptoms and their association with pregnancy outcomes is not well understood. Many pregnancy apps allow pregnant women to track their symptoms. To date, the resulting data are primarily used from a commercial rather than a scientific perspective. In this work, we aim to examine symptom occurrence, course, and their correlation throughout pregnancy. Self-reported app data of a pregnancy symptom tracker is used. In this context, we present methods to handle noisy real-world app data from commercial applications to understand the trajectory of user and patient-reported data. We report real-world evidence from patient-reported outcomes that exceeds previous works: 1,549,186 tracked symptoms from 183,732 users of a smartphone pregnancy app symptom tracker are analyzed. The majority of users track symptoms on a single day. These data are generalizable to those users who use the tracker for at least 5 months. Week-by-week symptom report data are presented for each symptom. There are few or conflicting reports in the literature on the course of diarrhea, fatigue, headache, heartburn, and sleep problems. A peak in fatigue in the first trimester, a peak in headache reports around gestation week 15, and a steady increase in the reports of sleeping difficulty throughout pregnancy are found. Our work highlights the potential of secondary use of industry data. It reveals and clarifies several previously unknown or disputed symptom trajectories and relationships. Collaboration between academia and industry can help generate new scientific knowledge., (© 2023. Springer Nature Limited.)

Smartphones enable and facilitate biomedical studies as they allow the recording of various biomedical signals, including photoplethysmograms (PPG). However, user engagement rates in mobile health studies are reduced when an application (app) needs to be installed. This could be alleviated by using installation-free web apps. We evaluate the feasibility of browser-based PPG recording, conducting the first usability study on smartphone-based PPG. We present an at-home study using a web app and library for PPG recording using the rear camera and flash. The underlying library is freely made available to researchers. 25 Android users participated, using their own smartphones. The study consisted of a demographic and anamnestic questionnaire, the signal recording itself (60 s), and a consecutive usability questionnaire. After filtering, heart rate was extracted (14/17 successful), signal-to-noise ratios assessed (0.64 ± 0.50 dB, mean ± standard deviation), and quality was visually inspected (12/17 usable for diagnosis). Recording was not supported in 9 cases. This was due to the browser's insufficient support for the flash light API. The app received a System Usability Scale score of 82 ± 9, which is above the 90th percentile. Overall, browser flash light support is the main limiting factor for broad device support. Thus, browser-based PPG is not yet widely applicable, although most participants feel comfortable with the recording itself. The utilization of the user-facing camera might represent a more promising approach. This study contributes to the development of low-barrier, user-friendly, installation-free smartphone signal acquisition. This enables profound, comprehensive data collection for research and clinical practice.Clinical relevance- WebPPG offers low-barrier remote diagnostic capabilities without the need for app installation.

Objective: Clinical urine tests are a key component of prenatal care. As of now, urine test strips are evaluated through a time consuming, often error-prone and operator-dependent visual color comparison of test strips and reference cards by medical staff., Methods and Procedures: This work presents an automated pipeline for urinalysis with urine test strips using smartphone camera images in home environments, combining several image processing and color combination techniques. Our approach is applicable to off-the-shelf test strips in home conditions with no additional hardware required. For development and evaluation of our pipeline we collected image data from two sources: i) A user study (26 participants, 150 images) and ii) a lab study (135 images)., Results: We trained a region-based convolutional neural network that is able to detect the urine test strip location and orientation in images with a wide variety of light conditions, backgrounds and perspectives with an accuracy of 85.5%. The reference card can be robustly detected through a feature matching approach in 98.6% of the images. Color comparison by Hue channel (0.81 F1-Score), Matching factor (0.80 F1-Score) and Euclidean distance (0.70 F1-Score) were evaluated to determine the urinalysis results., Conclusion: We show that an automated smartphone-based colorimetric analysis of urine test strips in a home environment is feasible. It facilitates examinations and provides the possibility to shift care into an at-home environment., Clinical Impact: The findings demonstrate that routine urine examinations can be transferred into the home environment using a smartphone. Simultaneously, human error is avoided, accuracy is increased and medical staff is relieved.

The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7; four being part of a cluster), Clitocybe nebularis , Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.

Introduction: Panaeolina foenisecii is one of the most common and widely distributed lawn mushrooms in Europe and North America, and frequently involved in accidental mushroom ingestion, mainly in children. Nevertheless, there is contradictory information regarding the toxicity profile of P. foenisecii in the literature. Objective of the study was to assess clinical effects with particular attention on psychoactive properties of P. foenisecii in case of accidental oral exposure., Methods: This observational case series is based on prospectively collected data on mushroom poisoning using a structured data collection form, and it was performed in seven poisons centres in Germany and Switzerland. Inclusion criteria were accidental ingestion of at least one cap of P. foenisecii identified by a mycologist, and a follow up of at least 4 hours., Results: Nineteen cases met all inclusion criteria, and only children were involved with a mean age of 3 years. They ingested 1-2 mushrooms in 14 cases and 3-5 mushrooms in five cases. Three patients received a single dose of activated charcoal. Sixteen out of 19 cases did not develop any symptoms, 2/19 complained of minor abdominal discomfort. One child was temporarily mildly hyperactive, and this was the only patient observed in a hospital for 12 hours. None of the children showed signs of hallucinations., Conclusions: This multicentre study demonstrates that the typically small amounts of P. foenisecii ingested by children probably do not lead to clinically significant symptoms.

Introduction: Tolperisone is a centrally acting muscle relaxant that acts by blocking voltage-gated sodium and calcium channels. There is a lack of information on the clinical features of tolperisone poisoning in the literature. The aim of this study was to investigate the demographics, circumstances and clinical features of acute overdoses with tolperisone., Methods: An observational study of acute overdoses of tolperisone, either alone or in combination with one non-steroidal anti-inflammatory drug in a dose range not expected to cause central nervous system effects, in adults and children (< 16 years), reported to our poison centre between 1995 and 2013., Results: 75 cases were included: 51 females (68%) and 24 males (32%); 45 adults (60%) and 30 children (40%). Six adults (13%) and 17 children (57%) remained asymptomatic, and mild symptoms were seen in 25 adults (56%) and 10 children (33%). There were nine adults (20%) with moderate symptoms, and five adults (11%) and three children (10%) with severe symptoms. Signs and symptoms predominantly involved the central nervous system: somnolence, coma, seizures and agitation. Furthermore, some severe cardiovascular and respiratory signs and symptoms were reported. The minimal dose for seizures and severe symptoms in adults was 1500 mg. In 11 cases the latency between the ingestion and the onset of symptoms was known and was reported to be 0.5-1.5 h., Conclusions: The acute overdose of tolperisone may be life-threatening, with a rapid onset of severe neurological, respiratory and cardiovascular symptoms. With alternative muscle relaxants available, indications for tolperisone should be rigorously evaluated.

Background: Picking wild mushrooms is a popular pastime in Switzerland. Correct identification of the species is difficult for laypersons. Ingestion of toxic mushrooms may result in serious toxicity, including death. The aim of the study is to analyze and describe the circumstances of exposure to mushrooms, and to define the clinical relevance of mushroom poisoning for humans in Central Europe., Materials and Methods: We performed a retrospective case study and analyzed all inquiries concerning human exposures to mushrooms (n = 5638, 1.2% of all inquiries) which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009., Results: The most frequent reason for contacting the poison center in cases of adult exposure was toxicity resulting from edible species. Pediatric exposure predominantly occurred from mushrooms found around the home. Severe symptoms have not only been observed after ingestion of non-amatoxin-containing toxic mushrooms, i.e. Boletus sp. and Cortinarius sp., but also after meals of edible species. The mortality of confirmed amatoxin poisonings was high (5/32) compared to other reports., Conclusions: Inquiries regarding mushroom poisoning were a relatively infrequent reason for contacting the poison center. Nevertheless, accidental ingestion of toxic mushrooms can be responsible for severe or fatal poisonings. Although pediatric exposure to mushrooms found around the home has not led to serious toxicity in this study, prevention of exposure is warranted. Inspection of wild mushrooms by a certified mushroom expert or a mycologist seems to be a safe procedure which should be recommended., (Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

There have been significant improvements in the prognosis for patients suffering from hydrocephalus stemming from the introduction of the cerebrospinal fluid (CSF) shunt some 40 years ago. Currently, one of the major obstacles to effective shunt treatment is the mismatch between the physiology of the patient and the hydraulics of the shunt system. In order to maintain the proper relationship between CSF and cerebrovascular pressures, the implanted shunt needs to establish normal CSF outflow (absorption) and storage (compliance). Many of today's shunts establish a limited range of normal CSF outflow (absorption) and storage (compliance) once implanted, but a mismatch between CSF and cerebrovascular pressures may exist when the patient changes body position during daily activities. An uncoupling of these pressures creates mechanical strains within cerebral tissues, which are implicated in pathologies related to shunt malfunction. We suggest that re-establishment of normal CSF outflow resistance, which by definition is an indicator of both absorption and compliance, is a fundamental requirement for shunt treatment under most conditions.

This study characterizes the relationship between late-diastolic Doppler detected forward flow in the left ventricular outflow tract and diastolic transmitral flow. Pulsed-wave Doppler interrogation of the left ventricular outflow tract, in a prospective consecutive series (n = 137), revealed the presence of end-diastolic forward flow in 83% of the patients studied. Further quantification of both flow signals was performed in 67 patients. Pulsed-wave mapping demonstrated that peak velocity of the end-diastolic left ventricular outflow tract signal (J wave) was maximal, 2.6 +/- 0.7 cm from the aortic valve anulus, and occurred 48 +/- 34 milliseconds after the peak transmitral atrial velocity flow signal. Peak J velocity ranged from 25 to 118 cm per second and correlated with peak A velocity (r = 0.69, p less than 0.001). Peak J velocity was inversely related to left ventricular end-diastolic dimension (r = -0.53, p less than 0.0001) and left ventricular end-diastolic volume (r = -0.43, p less than 0.004). There was no relationship between J wave velocity and early diastolic filling. We concluded that a late-diastolic forward flow signal is commonly observed in the left ventricular outflow tract. It is a manifestation of transmitral atrial systolic flow in the left ventricular outflow tract and is determined predominantly by peak transmitral atrial velocity and left ventricular size.