The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology

Data-driven methods for analyzing ballistocardiograms in longitudinal cardiovascular monitoring

Cardiovascular disease (CVD) is the leading cause of death in the US; about 48% of American adults have one or more types of CVD. The importance of continuous monitoring of the older population, for early detection of changes in health conditions, has been shown in the literature, as the key to a successful clinical intervention. We have been investigating environmentally-embedded in-home networks of non-invasive sensing modalities. This dissertation concentrates on the signal processing techniques required for the robust extraction of morphological features from the ballistocardiographs (BCG), and machine learning approaches to utilize these features in non-invasive monitoring of cardiovascular conditions. At first, enhancements in the time domain detection of the cardiac cycle are addressed due to its importance in the estimation of heart rate variability (HRV) and sleep stages. The proposed enhancements in the energy-based algorithm for BCG beat detection have shown at least 50% improvement in the root mean square error (RMSE) of the beat to beat heart rate estimations compared to the reference estimations from the electrocardiogram (ECG) R to R intervals. These results are still subject to some errors, primarily due to the contamination of noise and motion artifacts caused by floor vibration, unconstrained subject movements, or even the respiratory activities. Aging, diseases, breathing, and sleep disorders can also affect the quality of estimation as they slightly modify the morphology of the BCG waveform.Includes bibliographical reference

Automated deep phenotyping of the cardiovascular system using magnetic resonance imaging

Across a lifetime, the cardiovascular system must adapt to a great range of demands from the body. The individual changes in the cardiovascular system that occur in response to loading conditions are influenced by genetic susceptibility, and the pattern and extent of these changes have prognostic value. Brachial blood pressure (BP) and left ventricular ejection fraction (LVEF) are important biomarkers that capture this response, and their measurements are made at high resolution. Relatively, clinical analysis is crude, and may result in lost information and the introduction of noise. Digital information storage enables efficient extraction of information from a dataset, and this strategy may provide more precise and deeper measures to breakdown current phenotypes into their component parts. The aim of this thesis was to develop automated analysis of cardiovascular magnetic resonance (CMR) imaging for more detailed phenotyping, and apply these techniques for new biological insights into the cardiovascular response to different loading conditions. I therefore tested the feasibility and clinical utility of computational approaches for image and waveform analysis, recruiting and acquiring additional patient cohorts where necessary, and then applied these approaches prospectively to participants before and after six-months of exercise training for a first-time marathon. First, a multi-centre, multi-vendor, multi-field strength, multi-disease CMR resource of 110 patients undergoing repeat imaging in a short time-frame was assembled. The resource was used to assess whether automated analysis of LV structure and function is feasible on real-world data, and if it can improve upon human precision. This showed that clinicians can be confident in detecting a 9% change in EF or a 20g change in LV mass. This will be difficult to improve by clinicians because the greatest source of human error was attributable to the observer rather than modifiable factors. Having understood these errors, a convolutional neural network was trained on separate multi-centre data for automated analysis and was successfully generalizable to the real-world CMR data. Precision was similar to human analysis, and performance was 186 times faster. This real-world benchmarking resource has been made freely available (thevolumesresource.com). Precise automated segmentations were then used as a platform to delve further into the LV phenotype. Global LVEFs measured from CMR imaging in 116 patients with severe aortic stenosis were broken down into ~10 million regional measurements of structure and function, represented by computational three-dimensional LV models for each individual. A cardiac atlas approach was used to compile, label, segment and represent these data. Models were compared with healthy matched controls, and co-registered with follow-up one year after aortic valve replacement (AVR). This showed that there is a tendency to asymmetric septal hypertrophy in all patients with severe aortic stenosis (AS), rather than a characteristic specific to predisposed patients. This response to AS was more unfavourable in males than females (associated with higher NT-proBNP, and lower blood pressure), but was more modifiable with AVR. This was not detected using conventional analysis. Because cardiac function is coupled with the vasculature, a novel integrated assessment of the cardiovascular system was developed. Wave intensity theory was used to combine central blood pressure and CMR aortic blood flow-velocity waveforms to represent the interaction of the heart with the vessels in terms of traveling energy waves. This was performed and then validated in 206 individuals (the largest cohort to date), demonstrating inefficient ventriculo-arterial coupling in female sex and healthy ageing. CMR imaging was performed in 236 individuals before training for a first-time marathon and 138 individuals were followed-up after marathon completion. After training, systolic/diastolic blood pressure reduced by 4/3mmHg, descending aortic stiffness decreased by 16%, and ventriculo-arterial coupling improved by 14%. LV mass increased slightly, with a tendency to more symmetrical hypertrophy. The reduction in aortic stiffness was equivalent to a 4-year reduction in estimated biological aortic age, and the benefit was greater in older, male, and slower individuals. In conclusion, this thesis demonstrates that automating analysis of clinical cardiovascular phenotypes is precise with significant time-saving. Complex data that is usually discarded can be used efficiently to identify new biology. Deeper phenotypes developed in this work inform risk reduction behaviour in healthy individuals, and demonstrably deliver a more sensitive marker of LV remodelling, potentially enhancing risk prediction in severe aortic stenosis

딥러닝 기반 혈압 예측 기법

학위논문 (박사) -- 서울대학교 대학원 : 공과대학 전기·정보공학부, 2020. 8. 윤성로.While COVID-19 is changing the world's social profile, it is expected that the telemedicine sector, which has not been activated due to low regulation and reliability, will also undergo a major change. As COVID-19 spreads in the United States, the US Department of Health \& Human Services temporarily loosens the standards for telemedicine, while enabling telemedicine using Facebook, Facebook Messenger-based video chat, Hangouts, and Skype. The expansion of the telemedicine market is expected to quickly transform the existing treatment-oriented hospital-led medical market into a digital healthcare service market focused on prevention and management through wearables, big data, and health records analysis. In this prevention and management-oriented digital healthcare service, it is very important to develop a technology that can easily monitor a person's health status. One of the vital signs that can be used for personal health monitoring is blood pressure. High BP is a common and dangerous condition. About 1 out of 3 adults in the U.S. (about 75 million people) have high BP. This common condition increases the risk of heart disease and stroke, two of the leading causes of death for Americans. High BP is called the silent killer because it often has no warning signs or symptoms, and many people are not aware they have it. For these reasons, it is important to develop a technology that can easily and conveniently check BP regularly. In biomedical data analysis, various studies are being attempted to effectively analyze by applying machine learning to biomedical big data accumulated in large quantities. However, collecting blood pressure-related data at the level of big data is very difficult and very expensive because it takes a lot of manpower and time. So in this dissertation, we proposed a three-step strategy to overcome these issues. First, we describe a BP prediction model with extraction and concentration CNN architecture, to process publicly disclosed sequential ECG and PPG dataset. Second, we evaluate the performance of the developed model by applying the developed model to privately measured data. To address the third issue, we propose the knowledge distillation method and input pre-processing method to improve the accuracy of the blood pressure prediction model. All the methods proposed in this dissertation are based on a deep convolutional neural network (CNN). Unlike other studies based on manual recognition of the features, by utilizing the advantage of deep learning which automatically extracts features, raw biomedical signals are used intact to reflect the inherent characteristics of the signals themselves.코로나 19에 의한 전 세계의 사회적 프로필 변화로, 규제와 신뢰성이 낮기 때문에 활성화 되지 않은 원격 의료 분야도 큰 변화를 겪을 것으로 예상됩니다. 코로나 19가 미국에 퍼짐에 따라 미국 보건복지부는 원격 진료의 표준을 일시적으로 완화하면서 페이스북, 페이스북 메신저 기반 화상 채팅, 행아웃, 스카이프를 사용한 원격 진료를 가능하게 했습니다. 원격의료 시장의 확장은 기존의 치료중심 병원주도의 의료시장을 웨어러블, 빅 데이터 및 건강기록 분석을 통한 예방 및 관리에 중점을 둔 디지털 의료 서비스 시장으로 빠르게 변화시킬 것으로 예상됩니다. 이러한 예방 및 관리 중심의 디지털 헬스케어 서비스에서는 사람의 건강 상태를 쉽게 모니터링 할 수 있는 기술 개발이 매우 중요한데 혈압은 개인 건강 모니터링에 사용될 수 있는 필수 징후 중 하나 입니다. 고혈압은 아주 흔하고 위험한 질환입니다. 미국 성인 3명중 1명(약 7,500만명)이 고혈압을 가지고 있습니다. 이는 미국인의 주요 사망 원인 중 두가지인 심장질환과 뇌졸중의 위험을 증가 시킵니다. 고혈압은 신체에 경고 신호나 자각 증상이 없어 많은 사람들이 자신이 고혈압인 것을 인지하지 못하기 때문에 "사일런트 킬러"라 불리웁니다. 이러한 이유로 정기적으로 쉽고 편리하게 혈압을 확인할 수 있는 기술의 개발이 매우 중요합니다. 생체의학 데이터 분석 분야에서는 머신 러닝을 대량으로 수집된 생체의학 빅 데이터에 적용하는 다양한 연구가 효과적으로 이루어지고 있습니다. 그러나 빅 데이터 수준으로 다량의 혈압 관련 데이터를 수집하는 것은 많은 전문적인 인력들이 오랜시간을 필요로 하기 때문에 매우 어렵고 비용 또한 많이 필요합니다. 따라서 본 학위논문에서는 이러한 문제를 극복하기 위한 3단계 전략을 제안했습니다. 먼저 누구나 시용할 수 있도록 공개되어 있는 심전도, 광용적맥파 데이터셋을 이용, 순차적인 심전도, 광용적맥파 신호에서 혈압을 잘 예측하도록 고안된 추출 및 농축 작업을 반복하는 함성곱 신경망 구조를 제안했습니다. 두번째로 제안된 합성곱 신경망 모델을 개인에게서 측정한 광용적맥파 신호를 이용해 제안된 함성곱 신경망 모델의 성능을 평가했습니다. 세번째로 혈압예측 모델의 정확성을 높이기 위해 지식 증류법과 입력신호 전처리 방법을 제안했습니다. 이 논문에서 제안된 모든 혈압예측 방법은 합성곱 신경망을 기반으로 합니다. 혈압 예측에 필요한 특징들을 수동으로 추출해야 하는 다른 연구들과 다르게 특징을 자동으로 추출하는 딥러닝의 장점을 활용, 아무런 처리도 하지 않은 원래 그대로의 생체 신호에서 신호 자체의 고유한 특징을 반영할 수 있습니다.1 Introduction 1 2 Background 5 2.1 Cuff-based BP measurement methods 9 2.1.1 Auscultatory method 9 2.1.2 Oscillometric method 10 2.1.3 Tonometric method 11 2.2 Biomedical signals used in cuffless BP prediction methods 13 2.2.1 Electrocardiography (ECG) 13 2.2.2 Photoplethysmography (PPG) 20 2.3 Cuffless BP measurement methods 21 2.3.1 PWV based BP prediction methods 25 2.3.2 Machine learning based pulse wave analysis methods 26 2.4 Deep learning for sequential biomedical data 30 2.4.1 Convolutional neural networks 31 2.4.2 Recurrent neural networks 32 3 End-to-end blood pressure prediction via fully convolutional networks 33 3.1 Introduction 35 3.2 Method 38 3.2.1 Data preparation 38 3.2.2 CNN based prediction model 41 3.2.3 Detailed architecture 45 3.3 Experimental results 47 3.3.1 Setup 47 3.3.2 Model evaluation & selection 48 3.3.3 Calibration-based method 51 3.3.4 Performance comparison 52 3.3.5 Verification using international standards for BP measurement grading criteria 54 3.3.6 Performance comparison by the input signal combinations 56 3.3.7 An ablation study of each architectural component of extraction-concentration blocks 58 3.3.8 Preprocessing of input signal to improve blood pressure prediction performance 59 3.4 Discussion 61 3.5 Summary 63 4 Blood pressure prediction by a smartphone sensor using fully convolutional networks 64 4.1 Introduction 66 4.2 Method 69 4.2.1 Data acquisition 71 4.2.2 Preprocessing of the PPG signals 71 4.2.3 PPG signal selection 71 4.2.4 Data preparation for CNN model training 72 4.2.5 Network architectures 72 4.3 Experimental results 75 4.3.1 Implementation details 75 4.3.2 Effect of PPG combination on BP prediction 75 4.3.3 Performance comparison with other related works 76 4.3.4 Verification using international standards for BP measurement grading criteria 77 4.3.5 Preprocessing of input signal to improve blood pressure prediction performance 79 4.4 Discussion 81 4.5 Summary 83 5 Improving accuracy of blood pressure prediction by distilling the knowledge of neural networks 84 5.1 Introduction 85 5.2 Methods 87 5.3 Experimental results 88 5.4 Discussion & Summary 89 6 Conclusion 90 6.1 Future work 92 Bibliography 93 Abstract (In Korean) 106Docto

Personalized data analytics for internet-of-things-based health monitoring

The Internet-of-Things (IoT) has great potential to fundamentally alter the delivery of modern healthcare, enabling healthcare solutions outside the limits of conventional clinical settings. It can offer ubiquitous monitoring to at-risk population groups and allow diagnostic care, preventive care, and early intervention in everyday life. These services can have profound impacts on many aspects of health and well-being. However, this field is still at an infancy stage, and the use of IoT-based systems in real-world healthcare applications introduces new challenges. Healthcare applications necessitate satisfactory quality attributes such as reliability and accuracy due to their mission-critical nature, while at the same time, IoT-based systems mostly operate over constrained shared sensing, communication, and computing resources. There is a need to investigate this synergy between the IoT technologies and healthcare applications from a user-centered perspective. Such a study should examine the role and requirements of IoT-based systems in real-world health monitoring applications. Moreover, conventional computing architecture and data analytic approaches introduced for IoT systems are insufficient when used to target health and well-being purposes, as they are unable to overcome the limitations of IoT systems while fulfilling the needs of healthcare applications. This thesis aims to address these issues by proposing an intelligent use of data and computing resources in IoT-based systems, which can lead to a high-level performance and satisfy the stringent requirements. For this purpose, this thesis first delves into the state-of-the-art IoT-enabled healthcare systems proposed for in-home and in-hospital monitoring. The findings are analyzed and categorized into different domains from a user-centered perspective. The selection of home-based applications is focused on the monitoring of the elderly who require more remote care and support compared to other groups of people. In contrast, the hospital-based applications include the role of existing IoT in patient monitoring and hospital management systems. Then, the objectives and requirements of each domain are investigated and discussed. This thesis proposes personalized data analytic approaches to fulfill the requirements and meet the objectives of IoT-based healthcare systems. In this regard, a new computing architecture is introduced, using computing resources in different layers of IoT to provide a high level of availability and accuracy for healthcare services. This architecture allows the hierarchical partitioning of machine learning algorithms in these systems and enables an adaptive system behavior with respect to the user's condition. In addition, personalized data fusion and modeling techniques are presented, exploiting multivariate and longitudinal data in IoT systems to improve the quality attributes of healthcare applications. First, a real-time missing data resilient decision-making technique is proposed for health monitoring systems. The technique tailors various data resources in IoT systems to accurately estimate health decisions despite missing data in the monitoring. Second, a personalized model is presented, enabling variations and event detection in long-term monitoring systems. The model evaluates the sleep quality of users according to their own historical data. Finally, the performance of the computing architecture and the techniques are evaluated in this thesis using two case studies. The first case study consists of real-time arrhythmia detection in electrocardiography signals collected from patients suffering from cardiovascular diseases. The second case study is continuous maternal health monitoring during pregnancy and postpartum. It includes a real human subject trial carried out with twenty pregnant women for seven months