N o i s e

C

The book offers noise technologies for monitoring of the beginning of o n

cardiovascular and respiratory diseases, considering the possibility of t r listening to the sounds of heart and lungs by means of mobile phones. o l

Such estimates of the sounds of heart and lungs as noise variance, value of o f noise correlation, cross-correlation function between the useful signal and H the noise and coefficient of correlation are used as informative attributes e a for identification of the beginning of the latent period of diseases. For this r t purpose, obtained noise estimates are taken as symptoms and, by training, their combinations are used to form the set of reference symptoms and the bank of set of symptoms of both disease state and healthy state of the phone user, who after a certain training period can use the phone as a device for noise control of his heart and lungs health. Duplication of monitoring with application of informative attributes obtained by means of technologies for robust correlation, spectral and position-binary analysis provides validity of results.

Telman Aliev Tahir Alizada Narmin Rzayeva Telman Aliev Telman Aliev was born in 1935 in . 1977 – Noise Control of Heart by Doctor of Computing Sciences, 1985 – Professor, 1991 – Keldysh Medal, 2001 – full member of the Azerbaijan National Academy of Sciences, 2004 – Means of a Mobile Phone Order of Glory AR. Director of Cybernetics Institute () since 1988. Telman Aliev is author of over 400 Noise analysis of the sound of heart and published papers, 60 patents and 10 monographs. lungs for monitoring of the beginning of the latent period of their diseases A l i e v ,

A l i z a d a ,

R z a y e

978-3-659-31130-7 v a Contents

Preface ...... 9 Introduction ...... 19

Chapter 1. Applicability of mobile phones for noise control of heart performance ...... 27 1.1 Mission of computer diagnostics of cardiovascular and respiratory systems...... 27 1.2 Purposes of noise monitoring in noise control of the heart on a mobile phone...... 29

1.3 Complications of use of mobile phones in noise control of the heart with application of conventional technologies ...... 31 1.4 Factors influencing the adequacy of process of control of the heart by correlation analysis methods...... 32 1.5 Factors influencing the adequacy of computer diagnostics by spectral analysis methods...... 36 1.6 Influence of filtration on the adequacy of computer diagnostics ...... 38 1.7 Influence of conventional methods of choice of sampling interval on the adequacy of computer diagnostics...... 40

Chapter 2. Robust technology for correlation noise analysis of heart sound and sound of human respiratory organs...... 43

2.1 Specifics of analysis of heart sound and sound of respiratory organs with application of correlation analysis technology ...... 43 2.2 Technology for calculation of the value providing robustness of estimates of auto- and cross-correlation functions of heart sound and sound of respiratory organs...... 44

5 Contents

2.3 Robust algorithms for improving estimates of correlation functions of the sound of heart and respiratory organs...... 49 2.4 Digital technology for analysis of noise and useful signal of heart sound and sound of respiratory organs in the absence of correlation between them...... 52 2.5 Digital technology for calculation of noise variance of heart sound and sound of respiratory organs in the presence of correlation between the useful signal and the noise...... 55 2.6 Correlation technologies for noise indication of the beginning of origin of cardiovascular diseases...... 61 2.7 Robust noise technology of monitoring of the beginning of origin of cardiovascular diseases...... 64 2.8 Technology of determination of estimates of cross-correlation function and coefficient of correlation between the useful signal and the noise of heart sound and sound of respiratory organs ...... 67 2.9 Robust correlation indicators of the beginning of origin of cardiovascular diseases ...... 70

Chapter 3. Robust technology for spectral noise analysis of heart sound and sound of human respiratory organs ...... 73

3.1 Spectral robust technology for analysis of heart and lungs sound ...... 73

3.2 Origin of difference of positive and negative errors from noise in spectral analysis of heart and lungs sound received at the output of a mobile phone microphone ...... 76

3.3 Algorithms for determination of robust estimates of Fourier series coefficients in spectral monitoring of the condition of heart and lungs...... 81

3.4 Robust spectral indicators of origin of cardiovascular diseases...... 87

Chapter 4. Position-binary technology for noise analysis of periodic sound of human heart and respiratory organs ...... 93

4.1 Specific character of heart and lungs sound received at the output of microphones of mobile phones...... 93 6 Contents

4.2 Position-binary technology for analysis of heart and lungs sound received from microphones of mobile phones ...... 94

4.3 Possibility of application of position-binary technology for monitoring of the condition of cardiovascular and respiratory systems...... 98

4.4 Excessive frequency sampling of signals of heart and respiratory organs...... 99

4.5 Position-binary noise analysis of the sound of heart and respiratory organs ... 104

4.6 Position-binary indicators of the beginning of origin of cardiovascular and respiratory diseases...... 108

Chapter 5. Forms of noise monitoring of the latent period of deviation of condition of heart and respiratory organs from the norm by mobile phones ...... 111

5.1 Correlation robust technology for monitoring of the beginning of the latent period of vascular pathology of human body ...... 111

5.2 Forms of noise monitoring and control of the latent period of deviation of cardiovascular and respiratory systems from the norm by mobile phones ...... 116

References ...... 131

Appendix A: Multichannel voltage-to-digital converter (Author's certificate) ...... 141 Appendix B: Multichannel correlation meter (Author's certificate) ...... 142 Appendix C: Multichannel correlator (Author's certificate)...... 143 Appendix D: Multichannel adaptive device for transmission of information with delta modulation (Author's certificate)...... 144 Appendix E: Device for illness diagnostics (Author's certificate)...... 145 Appendix F: Multifunctional analog-to-digital converter (Author's certificate) ...... 146 Appendix G: Stationary stochastic objects diagnostics device (Author's certificate)...... 147 Appendix H: Device for information registration (Author's certificate) ...... 148 Appendix I: Signals receiving and transmission device (Author's certificate)...... 149 7 Contents

Appendix J: Analyzer of rheovasosignals for indication of existence of permeability-breach vessels (Author's certificate) ...... 150 Appendix K: Expert system (Eurasian patent)...... 151 Appendix L: Method of monitoring of the beginning of vessel illness of limbs (Eurasian patent) ...... 152

8 Preface

A lot of time has passed since people got cars, streamships and stream engines. God saw that people's life was still hard and boring. And He decided to help them one more time and gave them signals. The Devil saw that and creates noise and mixed them with signals. That is why for a long time people could not use signals and asked scientists to deliver them from that misfortune. Scientists created methods and technologies of filtration and suppression but then signals were distorted and many precious and concealed secrets were lost with noise.

It was a concurrence of circumstances that we became involved in developing of technologies and tools of medical diagnostics. In 1972, physiologists of the Academy of Sciences (AS) of the Azerbaijan SSR asked their president to order a system for automating physiological experiments for them. The reasoning behind their request was that such a system had been developed by the USSR AS and allowed Moscow scientists to raise the level of physiological experiments considerably. Then, with the approval of the directing officials of the Azerbaijan AS, manufacture of a similar system was ordered for our Academy. This order was accepted. However, after a while, when the order had to be paid, it turned out that we could not afford it. But our esteemed physiologists were very persistent. So the President of the Academy put his foot down and said, “Let our cyberneticists do it!” Development of special-purpose devices and tools at the Cybernetics Institute of the Azerbaijan AS at that period was entrusted to a separate laboratory, which had good resources. At the same time, we all realized that it was quite a complex system and it was manufactured by some restricted access facility in Moscow. Naturally, we did not have their resources, not to mention that it was a completely new field for our institute. Of course, everyone refused to do this work but I turned out to be the softest

9 P reface of all. My superiors convinced me that it was a very distinguished task and practically forced me to get involved with it. It was made quite clear that if I failed I could say good-bye to our institute. I began studying the prototype design of the system and the issues that physiologists were dealing with. For some reason, I became very interested in this work. This system appeared to be designated first of all for experimental research of information processes in the brain. For this purpose, data was taken from 12-, 24- and 48-channel electroencephalographs in the process of experiments and analyzed by correlation and spectral methods. Obtained data were used to form the idea of information processes in the object under experiment. The amount of obtained results of automated effect on test animals for different variations was enormous. Afterwards, the results were analyzed by physiologists. First of all, we needed a synchronous converter for conversion of multi-channel electroencephalographs to digital code with subsequent correlation and spectral analysis. We did not find a suitable multi-channel synchronous converter in literature. Thus, we had to design several modifications of multi-channel synchronous analog- to-digital converters, which would allow us to digitize a 48-channel electroencephalogram without hardware-related time shifts between channels. All the modifications of the system developed by us were patented (see the author’s certificates among the appendices). In the process, we solved the problem of commissioning of this system and training of physiologists on its use. A state commission was organized in 1975, where we handed the system over to physiologists, who used it successfully for a long time. Thus, the first successful step in this direction was taken.

10 Preface

Multi-channel synchronous converter of electroencephalograms to digital code (1975)

Testing of equipment for automating physiological experiments at the Cybernetics Institute of AS of the Azerbaijan SSR (1975)

11 P reface

On the eve of commissioning of the systems for automating physiological experiments at the Cybernetics Institute of AS of the Azerbaijan SSR (1975)

President of AS of the Azerbaijan SSR, Professor Hasan Abdullayev demonstrates the equipment for automating physiological experiments to the leader of the Republic Heydar Aliyev visiting the exhibition of the Academy (1975)

12 Preface

After some time, the then Minister of Health of our republic saw somewhere (probably abroad) equipment controlling health condition of critical care patients. He decided that it would be appropriate to use such equipment in our country, too. However, there was no such equipment in the at that time, and Minister ordered that equipment at our institute. We agreed with the design office of the Leningrad Polytechnical Institute (now St. Petersburg State Polytechnical University) to join our efforts to fulfill this order. Financing of this system from the Ministry was quite generous. Together, we made an equipment complex that allowed uninterrupted measuring of basic parameters of vital activity of critical care patients, such as temperature, pulse, breath etc. Use of this complex in critical care wards of the Republican Hospital showed that Minister has been right, since the equipment allowed controlling condition of several serious critical care patients.

Equipment controlling health condition of critical care unit patients (1981)

13 P reface

If even minutest changes occurred in the preset range of measured parameters for any of the patients, a corresponding alarm was sent to the indicator board of the nurse (medical staff) on duty. The system proved to be more observant than nurses. The equipment was also usable in operating rooms. After that we began developing the idea in this direction. It was at that time that the Institute of Cardiology in Baku brought up the issue of on-line diagnosing of cardiovascular diseases in rural, especially in mountainous regions of Azerbaijan. In collaboration with them, we offered a technology for compression and unpacking of electrocardiograms without significant data loss. This technology allowed sending ECG by telegraph and then recovering it by unpacking at the Institute of Cardiology.

Device for transmitting of electrocardiograms by telegraph (1985)

14 Preface

That made it possible to diagnose serious cardiac patients at the Institute of Cardiology without transporting them from mountainous regions. Operational test was successful. We received a patent (author’s certificate) for this device, too. After this work has been done, we were completely fascinated by this field and I put forward the idea of monitoring of the initial stage of cardiovascular diseases. The gist of the idea was to calculate correlation function between rheovasosignals picked up from a patient’s limbs. If extremes of functions coincided with the zero point, i.e. if there was no time shift between leads, it meant that the patient was healthy. If cross-correlation function adopts an extreme value in some time, it was obviously a result of dilation in the vascular system in the patient’s limb.

Correlation system for monitoring of pathophysiological processes in the cardiovascular system (1982)

15 P reface

Eurasian patent № 010086, 30.06.2008 Patent № 1602454, 01.07.1990

Rxx(τ)

t

Блок Преоб- Робастно- диагностики и разова- корреляцион- прогнозирова- тель ная ния экстремальная кардиолог

система

Correlation extreme system for monitoring of impaired vascular patency (1990)

Then, with one of my graduate students, I made a device and it was tested on more than 200 patients at the Baku Semashko Clinical Hospital (now Clinical Medical Center). That graduate student of mine defended a PhD thesis on this work at the Institute of Medical Instrument Engineering in Moscow in 1990. We dealt with some other problems after that, but monitoring of cardiovascular diseases with application of the offered technology still attracted us. Afterwards, we developed a technology for analysis of noise of noisy signals. And then we had the idea of possible presence of noise in rheovasosignals during the origin of pathophysiological processes in the cardiovascular system. We used it to develop technologies and means of monitoring of the condition of cardiovascular system both by analyzing time shift between rheovasosignals in a patient’s limbs and by determining such informative attributes as noise variance, value of noise correlation, cross-correlation function between the useful signal and the noise, etc. Besides, for this purpose, we also developed correlation and spectral indicators that responded instantly to any changes in the cardiovascular system reflected in rheovasosignals. We received a Eurasian patent for this work. The picture shows the experimental version of this device. 16 Preface

Portable device for noise monitoring of microchanges in the cardiovascular system (2010)

As you can see, the device is quite small size. I asked my fellow researchers to make it even smaller. It was possible again. Then I asked myself why we needed that device at all, if we could use a mobile phone, which had much more resources than our device. All members of my team agreed and we began working on realization of this project. To conclude the aforementioned, we believe that the following should be noted. It is indisputable that many people suffering from cardiovascular and respiratory diseases these days consult a physician only when their diseases have already taken an express form. This complicates their treatment significantly and requires heavy material costs and takes much time and in most cases treatment does not recover their health completely. To eliminate this problem, a convenient and accessible tool has to be created, which could be used by potential patients to get information at home on whether they should see a physician in the beginning of the latent period of diseases. Accordingly, the main goal of creating a technology for computer diagnostics of cardiovascular and respiratory systems is to provide tools facilitating physicians’

17 P reface work and allowing one to increase adequacy of diagnostics [1, 47-51, 54-57, 60-62, 66-69, 72, 73,76]. The main objective of creating a technology for monitoring of cardiovascular and respiratory systems by mobile phones is to equip mobile phones with the software that allows informing the owner about the need to see a physician in the beginning of the latent period of diseases. The book present our way of solving the problem of application of mobile phones in monitoring (not diagnostics!) of both the beginning of origin and the dynamic of change in the cardiovascular diseases with use of noise technologies. In the working process, we found that practical application of mobile phones in solving of this problem was quite real. It was also obvious that solving of this problem required carrying out of research and natural experiments on a much larger scale than we did it. Taking this into account, I decided to publish a monograph based on the obtained results with the purpose of drawing attention of mobile phone manufacturers, medical community and information technology and systems specialists to this problem. In this, I received active assistance from my students: Dr. Tahir Alizada and graduate student Narmin Rzayeva.

Professor Telman Aliev Director of the Cybernetics Institute of ANAS Baku, Azerbaijan December 2012

18 Introduction

Reduction in price and size of computer equipment paved new ways to monitor state of health, an example of which is Holter monitor offered by the American biophysicist Norman Holter in 1949 [87]. Holter monitor continuously records ECG in the course of 24 hours for its subsequent analysis by a cardiologist. The shortcoming of Holter monitor is its inability to process ECG signals for continuous monitoring of condition of the cardiovascular system. Condition of the cardiovascular system is not therefore determined on-line but only after a certain amount of time, with a cardiologist being involved. To eliminate the above-mentioned shortcoming, researchers in the field of cardiologic equipment are developing devices that process cardiosignals on-line [58], which makes it possible to alert a patient to significant deviations from normal parameters of his ECG [43-45, 59, 63, 65, 70, 77-79]. However, such alert is frequently late. For this reason, researchers work on possibility of performing monitoring of the cardiovascular system based on ECG parameters that correlate with the latent period of origin of pathology, which will allow informing patients of serious malfunction of the cardiovascular system before it starts. Solving of this problem is covered in the present book.

State-of-the-art

The Japanese company Nihon Kohden [94] presents a wireless system of monitoring by means of Nihon Kohden transmitter and the central station that receives data of a large number of patients, or by means of Nihon Kohden telemetry system. The condition of a patient and measuring of vital signs are monitored every single second. Belgian company IMEC [90] developed a mobile ECG system that works paired with Android OS based smartphones. The device is linked to the apparatus via wireless connection with low power consumption. Standard Bluetooth connection consumes too much energy, so scientists had to develop a replacement. ECG

19 I ntroduction interface is based on the standard Secure Digital Input Output (SDIO) applied in Google phones. The essence is in receiving a lasting picture of the patient’s cardiac rhythm; all you need to do is to attach several sensors to the body and enable monitoring. The system will allow sending medical statistics by SMS or e-mail. There is also an option of tracking down the location of the patient via GPS, which is very useful for rapid response if cardiogram leaves much to be desired. The basic part of the interface has been ‘borrowed’ from the Linux nucleus, which makes the appearance of versions ported to devices working with this OS possible. The system is not mass produced, so it is not present in the market yet. [96] Italian company Ates Medica Device [82] developed "Easy ECG Mobile", a mobile telemedical ECG system. Easy ECG Mobile system consists of mobile ECG recorders and the central stations. Mobile recorder (MR) allows registering, visualizing, saving ECG records and sending ECG records to the central station. MR is a compact and easy-to-control device consisting of two units: "Easy ECG Pocket" digital ECG amplifier and the control unit. Easy ECG Pocket records ECG and sends it in the digital form to the control unit via wireless connection. The control unit is a communicator (a PDA with mobile phone) equipped with "Mobile ECG" application. Devices are interconnected via Bluetooth. The control unit receives ECG signals registered by means of Easy ECG Pocket, visualizing and saving it in memory. After that the record can be sent to the central station by pressing one single button. The record is transmitted via the Internet in several seconds and via wireless local area network practically instantly. The system is mass produced at the present time [86]. The German company Custo Med GmbH [84] developed "Custo Tera" system that allows performing continuous monitoring of the cardiovascular system by means of ECG. The electric activity of the heart is recorded on a holter ECG over a period of usually 24 hours, at least 18 hours. During the recording process data are registered in a recorder and are then evaluated by analyzing software in the PC. Holter ECG systems have been successfully developed and sold worldwide by custo med for 20 years already. The new custo tera holter ECG concept has been implemented in close cooperation with the users in hospitals and physicians' offices. Even the basic version offers all functions that make it possible to create a validated holter ECG report within the shortest time [85]. The Swedish company Ericsson [88] developed "Ericsson Mobile Health" (EMH) system. EMH is a system for remote monitoring of the condition of the 20 Introduction cardiovascular system and designated for measuring of medical parameters of both adults and children. The system provides comfortable access to measuring of a number of parameters, including ECG, blood pressure, pulse rate. EMH consists of the patient’s set, the server unit and the application. The patient’s set includes one or more medical sensors, an individual communications device and additional accessories (battery charger, batteries and sensor accessories). The communications device is the center of the patient’s set, which receives measurement data from the sensors via Bluetooth technology and sending them to the server unit of the system via mobile network. Physicians view patients’ data by means of web applications developed for various purposes and ensuring connection with the server unit. EMH 3.0 is mass produced by Ericsson at the present time [89]. The Israeli company Aerotel Medical Systems [80] is one of the world leaders in the production of modular mobile units designed for transmission of important medical data by means of phone, mobile phone and other electronic communication devices. The company offers Aerotel Heartline system for ECG monitoring. The products include the full range of personal devices with 1 to 12 channels for data transmission via phone, which are used for remote diagnostics or first aid. Registered ECG signals are sent via phone to the medical center, where they are received by the special "Heartline" computer station and the results are displayed on the screens. [81] Transnational company LifeWatch [92] created a smartphone that can be used for measuring vital signs and tracking state of health. This smartphone has the name of LifeWatch V and is running on Android 2.3. Placing fingers on the special sensors, the user will be able to measure his temperature, pulse, degree of oxygen in blood, body fat, blood sugar, stress level, and also take a cardiogram. All collected data is automatically saved to a remote server and can be retrieved by the patient or his physician. The device is equipped with special software allowing users to choose appropriate diet, plan their day, physical activities and even administration of medications [93]. The Russian company Cardiocode Ltd [83] developed and presented "Cardiocode" monitoring system in 2005. Apart from cardiosignals, the equipment measures and analyzes rheosignals. That distinctive feature allows one to determine the condition of the cardiovascular system of patients and detect a wide range of pathological processes in advance. According to the manufacturer, the system is unique. In 2009, the company presented the mobile version of the system. Mobil 21 I ntroduction

Cardiocode is easy to use. Putting on the light device that looks like an ordinary wristlet, a patient can read the information on the condition of his heart at home with pressing of a button. The data are sent to from the device to the Call Center, where they are instantly deciphered and studied by experts. If the situation is critical, an operator contacts the patient and takes further qualified action. One of the new methods of ECG analysis, which is widely applied these days in scientific research and everyday clinical practice for evaluation of malfunction in electrical characteristics of myocardium, is analysis of T-wave alteration. Recurrent processes of myocardial depolarization and repolarization even in a healthy heart have insignificant fluctuations that are reflected in low-amplitude oscillations of ECG signal (low-amplitude ECG alternation). Research demonstrated that ECG waves alternations are effective markers of hidden myocardial processes that precede pathological changes [45, 74, 75, 95, 97]. The aforementioned method and its particular case, “ECG dispersion mapping”, was used to build alternation analyzer devices called “Cardiovisor” [91]. It follows from the above-mentioned that mobile systems for monitoring of the condition of the cardiovascular system available on the market are not actually mobile in the proper sense of the word, as they require additional data processing in stationary conditions. Besides, monitoring in the existing mobile systems is based on the parameters that do not fully reflect hidden pathological processes in the cardiovascular system. Thus, existing mobile means of monitoring of cardiovascular system do not allow assessing the condition of cardiovascular system on the spot without sending data to the server via communication channels for further processing [80-96]. The book offers technologies of robust noise identification of the sound of heart and lungs for monitoring of the beginning of the latent period of their diseases by means of mobile phones. This will make it possible for owners of mobile phones to get the information on their health state at home or at work in real time.

What this book offers

It is commonly known that diagnosing of a disease first of all requires making combinations of symptoms (CS). Some symptoms can be detected by physician while talking to and examining the patient, whereas some are revealed by corresponding

22 Introduction laboratory tests and some by means of such devices as X-ray unit, electrocardiograph, ultrasound scanner, etc. A set of symptoms (SS) is formed from them after that, which is used for identification of the patient’s condition. Naturally, SS for various diseases can be incorporated in a bank of sets of symptoms (BSS), which, with application of computer science, can be used to create a system of computer diagnostics [115]. One important and specific peculiarity and difficulty of diagnostics is due to the fact that SS of many diseases overlap. Diagnostic errors, which are, unfortunately, rather frequent, are explained by fatigue, forgetfulness, bad mood, lack of attention or competence or experience, etc. Computers have no such characteristic, and if no error was made in the process of SS formation, adequacy of disease identification is ensured. So, after SS have been formed and with BSS being available, problem of disease identification will clearly be easy to solve. We can therefore assume that computer diagnostics has good prospects. However, considering that SS formation requires a lot of different laboratory tests, as well as different, expensive and difficult-to-operate medical equipment, home use of computer diagnostics is practically unrealistic at the present time. Accordingly, major computer diagnostics can be arranged in hospitals, clinics and special laboratories. In that case, it is reasonable to perform computer diagnostics with assistance of a physician or other qualified medical staff, which will raise the efficiency of their labor [1, 47-51, 54-57, 60-62, 66-69, 72, 73, 76]. Unfortunately, besides numerous advantages, such kind of diagnostics has two significant shortcomings. First, it is quite expensive and since inaccessible for the majority of population. Second, its capacity is limited and takes patients too much time. Thereby, alongside with the aforementioned type of computer diagnostics, “self- adjusting” complexes are also very promising. Most users of such complexes are patients with cardiovascular, respiratory, endocrine diseases. To relieve diagnostic complexes, to make them generally assessable and to minimize time spent on diagnostic procedure, it is also reasonable to develop and create the following versions of computer diagnostics. • SS, BSS and computer diagnostic systems for several most popular diseases.

23 I ntroduction

• Easy-to-use and inexpensive tools for monitoring of several most popular diseases. Monitoring results define whether the patient should be referred to a risk group to take an expensive diagnostic procedure [46, 52, 71, 99-103, 111, 112]. State-of-the-art of information technology allows one to solve both these problems. This book is devoted to solving of the second one. In the following paragraphs, we will consider the possibility of creating and prospects of mass application of tools for monitoring of such widely spread diseases as cardiovascular and respiratory diseases in more detail. The analysis of literature has demonstrated that to solve the problem of monitoring of cardiovascular diseases, MS can be formed based on such characteristics as rheovasosignals, cardiograms, pulse per time unit, blood pressure, body temperature and heart sound. Monitoring of respiratory diseases in the respiratory system can be performed based on lung sound, voice spectrum, pulse per time unit, temperature, electrocardiogram. Theoretically, one of options of computer monitoring for such patients at home can be as follows. The above-mentioned parameters are measured in normal health condition for a certain period of time (a week, a months, etc.). They are taken as informative attributes and SS are formed from them, and corresponding estimates are determined for such parameters as heart and lung sound, voice spectrum, electrocardiogram and rheovasosignals of the heart, using the known technologies. Therefore, in that period, the system undergoes some kind of training and BSS for the patient’s healthy condition forms. If the patient is interested in the condition of his cardiovascular and respiratory systems after a certain amount of time, he “measures” (“determines”) his current SS and enters it in the computer, after which the condition of the patient’s parameters is identified. If at least one informative attribute turns out to be different from the reference one by a value exceeding the threshold value, the decision is made to refer the patient to the risk group to take clinical computer diagnostics. However, this option has one significant shortcoming, since it requires analyzing rheovasosignals and cardiosignals. It complicated the structure of the equipment and such complex is uncomfortable, expensive and difficult to use at home. It is therefore obvious that creations of a system for computer monitoring of cardiovascular and respiratory diseases requires developing of such technologies, which would allow one to carry out reliable adequate monitoring of those diseases. It can be achieved by extracting maximum diagnostic information contained in heart sound, lung sound and 24 Introduction voice spectrum. Experience of well-known and indispensable physicians of the past, as well as the carried out research showed that noise of heart sound, lung sound and voice spectrum of patients contains quite large amount of diagnostic information required for quality monitoring of the state of such diseases. Thus, in the option under consideration, equipment should have the feature of auscultation of heart sound, lung sound and voice spectrum of patients and reading of such parameters as temperature, pulse and blood pressure. Obviously, modern mobile phones (smartphones) are capable of receiving these source data and their resources are quite sufficient for formation of SS and BSS, as well for solving of monitoring problem. The following is an example of how a mobile phone can serve its owner for this purpose. The mobile phone during analysis of the user’s voice spectrum informs that “there is a suspicion of origin of flu” and recommends listening to his lungs. The user listened to his lungs by the phone, just in case. After that, if the suspicion is confirmed in the process of identification with duplication, then a message appears about the risk of the beginning of cold-related diseases. If necessary, the mobile phone can be equipped with the software for providing the user with recommendation about consulting a medical specialist and administration of a preventive medicine. Thus, long before an express manifestation of flu, the disease can be cured well in advance as a result of “mobile monitoring”. It is obviously expedient to apply mobile phones for this purpose, almost every third human on the planet being a user of mobile networks. In the long term, to create the auscultation mode for heart and lung sound, mobile phone manufacturers will only have to make provision for higher sensitivity of microphone (sufficient for quality recording of heart and lung sound). Technical resources of modern mobile phones are enough to realize noise technologies for noise analysis and BSS formation. To conclude the aforementioned, we believe that the following should be noted. It is indisputable that many people suffering from cardiovascular and respiratory diseases these days consult a physician only when their diseases have already taken an express form. This complicates their treatment significantly and requires heavy material costs and takes much time and in most cases treatment does not recover their health completely. To eliminate this problem, a convenient and accessible tool has to

25 I ntroduction be created, which could be used by potential patients to get information at home on whether they should see a physician in the beginning of the latent period of diseases. Accordingly, the main goal of creating a technology for computer diagnostics of cardiovascular and respiratory systems is to provide tools facilitating physicians’ work and allowing one to increase adequacy of diagnostics [1, 47-51, 54-57, 60-62, 66-69, 72, 73, 76]. The main objective of creating a technology for monitoring of cardiovascular and respiratory systems by mobile phones is to equip mobile phones with the software that allows informing the owner about the need to see a physician in the beginning of the latent period of diseases. Authors of the book would like to thank the Science Development Foundation under President of the Azerbaijan Republic for the financial support of the project “Designing the mobile hardware-software complex for rheosignal processing of cardiovascular system using the robust technology and noise monitoring theory”1. The received grant was used to carry out numerous computing experiments and full- scale study of the technologies offered in this book.

1 This work was supported by the Science Development Foundation under the President of the Republic of Azerbaijan – Grant No. EIF-2011-1(3)-82/09/1

26