Digital phenotyping through multimodal, unobtrusive sensing

The growing adoption of multimodal wearable and mobile devices, such as smartphones and wrist-worn watches has generated an increase in the collection of physiological and behavioural data at scale. This digital phenotyping data enables researchers to make inferences regarding users’ physical and mental health at scale, for the first time. However, translating this data into actionable insights requires computational approaches that turn unlabelled, multimodal time-series sensor data into validated measures that can be interpreted at scale. This thesis describes the derivation of novel computational methods that leverage digital phenotyping data from wearable devices in large-scale populations to infer physical behaviours. These methods combine insights from signal processing, data mining and machine learning alongside domain knowledge in physical activity and sleep epidemiology. First, the inference of sleeping windows in free-living conditions through a heart rate sensing approach is explored. This algorithm is particularly valuable in the absence of ground truth or sleep diaries given its simplicity, adaptability and capacity for personalization. I then explore multistage sleep classification through combined movement and cardiac wearable sensing and machine learning. Further, I demonstrate that postural changes detected through wrist accelerometers can inform habitual behaviours and are valuable complements to traditional, intensity-based physical activity metrics. I then leverage the concomitant responses of heart rate to physical activity that can be captured through multimodal wearable sensors through a self-supervised training task. The resulting embeddings from this task are shown to be useful for the downstream classification of demographic factors, BMI, energy expenditure and cardiorespiratory fitness. Finally, I describe a deep learning model for the adaptive inference of cardiorespiratory fitness (VO2max) using wearable data in free living conditions. I demonstrate the robustness of the model in a large UK population and show the models’ adaptability by evaluating its performance in a subset of the population with repeated measures ~6 years after the original recordings. Together, this work increases the potential of multimodal wearable and mobile sensors for physical activity and behavioural inferences in population studies. In particular, this thesis showcases the potential of using wearable devices to make valuable physical activity, sleep and fitness inferences in large cohort studies. Given the nature of the data collected and the fact that most of this data is currently generated by commercial providers and not research institutes, laying the foundations for responsible data governance and ethical use of these technologies will be critical to building trust and enabling the development of the field of digital phenotyping.I was funded by GlaxoSmithKline and the Engineering and Physical Sciences Research Council. I was also supported by the Alan Turing Institute through their Enrichment Scheme

Logging Stress and Anxiety Using a Gamified Mobile-based EMA Application, and Emotion Recognition Using a Personalized Machine Learning Approach

According to American Psychological Association (APA) more than 9 in 10 (94 percent) adults believe that stress can contribute to the development of major health problems, such as heart disease, depression, and obesity. Due to the subjective nature of stress, and anxiety, it has been demanding to measure these psychological issues accurately by only relying on objective means. In recent years, researchers have increasingly utilized computer vision techniques and machine learning algorithms to develop scalable and accessible solutions for remote mental health monitoring via web and mobile applications. To further enhance accuracy in the field of digital health and precision diagnostics, there is a need for personalized machine-learning approaches that focus on recognizing mental states based on individual characteristics, rather than relying solely on general-purpose solutions. This thesis focuses on conducting experiments aimed at recognizing and assessing levels of stress and anxiety in participants. In the initial phase of the study, a mobile application with broad applicability (compatible with both Android and iPhone platforms) is introduced (we called it STAND). This application serves the purpose of Ecological Momentary Assessment (EMA). Participants receive daily notifications through this smartphone-based app, which redirects them to a screen consisting of three components. These components include a question that prompts participants to indicate their current levels of stress and anxiety, a rating scale ranging from 1 to 10 for quantifying their response, and the ability to capture a selfie. The responses to the stress and anxiety questions, along with the corresponding selfie photographs, are then analyzed on an individual basis. This analysis focuses on exploring the relationships between self-reported stress and anxiety levels and potential facial expressions indicative of stress and anxiety, eye features such as pupil size variation and eye closure, and specific action units (AUs) observed in the frames over time. In addition to its primary functions, the mobile app also gathers sensor data, including accelerometer and gyroscope readings, on a daily basis. This data holds potential for further analysis related to stress and anxiety. Furthermore, apart from capturing selfie photographs, participants have the option to upload video recordings of themselves while engaging in two neuropsychological games. These recorded videos are then subjected to analysis in order to extract pertinent features that can be utilized for binary classification of stress and anxiety (i.e., stress and anxiety recognition). The participants that will be selected for this phase are students aged between 18 and 38, who have received recent clinical diagnoses indicating specific stress and anxiety levels. In order to enhance user engagement in the intervention, gamified elements - an emerging trend to influence user behavior and lifestyle - has been utilized. Incorporating gamified elements into non-game contexts (e.g., health-related) has gained overwhelming popularity during the last few years which has made the interventions more delightful, engaging, and motivating. In the subsequent phase of this research, we conducted an AI experiment employing a personalized machine learning approach to perform emotion recognition on an established dataset called Emognition. This experiment served as a simulation of the future analysis that will be conducted as part of a more comprehensive study focusing on stress and anxiety recognition. The outcomes of the emotion recognition experiment in this study highlight the effectiveness of personalized machine learning techniques and bear significance for the development of future diagnostic endeavors. For training purposes, we selected three models, namely KNN, Random Forest, and MLP. The preliminary performance accuracy results for the experiment were 93%, 95%, and 87% respectively for these models

Low-Cost Indoor Localisation Based on Inertial Sensors, Wi-Fi and Sound

The average life expectancy has been increasing in the last decades, creating the need for new technologies to improve the quality of life of the elderly. In the Ambient Assisted Living scope, indoor location systems emerged as a promising technology capable of sup porting the elderly, providing them a safer environment to live in, and promoting their autonomy. Current indoor location technologies are divided into two categories, depend ing on their need for additional infrastructure. Infrastructure-based solutions require expensive deployment and maintenance. On the other hand, most infrastructure-free systems rely on a single source of information, being highly dependent on its availability. Such systems will hardly be deployed in real-life scenarios, as they cannot handle the absence of their source of information. An efficient solution must, thus, guarantee the continuous indoor positioning of the elderly. This work proposes a new room-level low-cost indoor location algorithm. It relies on three information sources: inertial sensors, to reconstruct users’ trajectories; environ mental sound, to exploit the unique characteristics of each home division; and Wi-Fi, to estimate the distance to the Access Point in the neighbourhood. Two data collection protocols were designed to resemble a real living scenario, and a data processing stage was applied to the collected data. Then, each source was used to train individual Ma chine Learning (including Deep Learning) algorithms to identify room-level positions. As each source provides different information to the classification, the data were merged to produce a more robust localization. Three data fusion approaches (input-level, early, and late fusion) were implemented for this goal, providing a final output containing complementary contributions from all data sources. Experimental results show that the performance improved when more than one source was used, attaining a weighted F1-score of 81.8% in the localization between seven home divisions. In conclusion, the evaluation of the developed algorithm shows that it can achieve accurate room-level indoor localization, being, thus, suitable to be applied in Ambient Assisted Living scenarios.O aumento da esperança média de vida nas últimas décadas, criou a necessidade de desenvolvimento de tecnologias que permitam melhorar a qualidade de vida dos idosos. No âmbito da Assistência à Autonomia no Domicílio, sistemas de localização indoor têm emergido como uma tecnologia promissora capaz de acompanhar os idosos e as suas atividades, proporcionando-lhes um ambiente seguro e promovendo a sua autonomia. As tecnologias de localização indoor atuais podem ser divididas em duas categorias, aquelas que necessitam de infrastruturas adicionais e aquelas que não. Sistemas dependentes de infrastrutura necessitam de implementação e manutenção que são muitas vezes dispendiosas. Por outro lado, a maioria das soluções que não requerem infrastrutura, dependem de apenas uma fonte de informação, sendo crucial a sua disponibilidade. Um sistema que não consegue lidar com a falta de informação de um sensor dificilmente será implementado em cenários reais. Uma solução eficiente deverá assim garantir o acompanhamento contínuo dos idosos. A solução proposta consiste no desenvolvimento de um algoritmo de localização indoor de baixo custo, baseando-se nas seguintes fontes de informação: sensores inerciais, capazes de reconstruir a trajetória do utilizador; som, explorando as características dis tintas de cada divisão da casa; e Wi-Fi, responsável pela estimativa da distância entre o ponto de acesso e o smartphone. Cada fonte sensorial, extraída dos sensores incorpora dos no dispositivo, foi, numa primeira abordagem, individualmente otimizada através de algoritmos de Machine Learning (incluindo Deep Learning). Como os dados das diversas fontes contêm informação diferente acerca das mesmas características do sistema, a sua fusão torna a classificação mais informada e robusta. Com este objetivo, foram implementadas três abordagens de fusão de dados (input data, early and late fusion), fornecendo um resultado final derivado de contribuições complementares de todas as fontes de dados. Os resultados experimentais mostram que o desempenho do algoritmo desenvolvido melhorou com a inclusão de informação multi-sensor, alcançando um valor para F1- score de 81.8% na distinção entre sete divisões domésticas. Concluindo, o algoritmo de localização indoor, combinando informações de três fontes diferentes através de métodos de fusão de dados, alcançou uma localização room-level e está apto para ser aplicado num cenário de Assistência à Autonomia no Domicílio

Wearable and Nearable Biosensors and Systems for Healthcare

Biosensors and systems in the form of wearables and “nearables” (i.e., everyday sensorized objects with transmitting capabilities such as smartphones) are rapidly evolving for use in healthcare. Unlike conventional approaches, these technologies can enable seamless or on-demand physiological monitoring, anytime and anywhere. Such monitoring can help transform healthcare from the current reactive, one-size-fits-all, hospital-centered approach into a future proactive, personalized, decentralized structure. Wearable and nearable biosensors and systems have been made possible through integrated innovations in sensor design, electronics, data transmission, power management, and signal processing. Although much progress has been made in this field, many open challenges for the scientific community remain, especially for those applications requiring high accuracy. This book contains the 12 papers that constituted a recent Special Issue of Sensors sharing the same title. The aim of the initiative was to provide a collection of state-of-the-art investigations on wearables and nearables, in order to stimulate technological advances and the use of the technology to benefit healthcare. The topics covered by the book offer both depth and breadth pertaining to wearable and nearable technology. They include new biosensors and data transmission techniques, studies on accelerometers, signal processing, and cardiovascular monitoring, clinical applications, and validation of commercial devices

The Application of Computer Techniques to ECG Interpretation

This book presents some of the latest available information on automated ECG analysis written by many of the leading researchers in the field. It contains a historical introduction, an outline of the latest international standards for signal processing and communications and then an exciting variety of studies on electrophysiological modelling, ECG Imaging, artificial intelligence applied to resting and ambulatory ECGs, body surface mapping, big data in ECG based prediction, enhanced reliability of patient monitoring, and atrial abnormalities on the ECG. It provides an extremely valuable contribution to the field

Machine learning to model health with multimodal mobile sensor data

The widespread adoption of smartphones and wearables has led to the accumulation of rich datasets, which could aid the understanding of behavior and health in unprecedented detail. At the same time, machine learning and specifically deep learning have reached impressive performance in a variety of prediction tasks, but their use on time-series data appears challenging. Existing models struggle to learn from this unique type of data due to noise, sparsity, long-tailed distributions of behaviors, lack of labels, and multimodality. This dissertation addresses these challenges by developing new models that leverage multi-task learning for accurate forecasting, multimodal fusion for improved population subtyping, and self-supervision for learning generalized representations. We apply our proposed methods to challenging real-world tasks of predicting mental health and cardio-respiratory fitness through sensor data. First, we study the relationship of passive data as collected from smartphones (movement and background audio) to momentary mood levels. Our new training pipeline, which combines different sensor data into a low-dimensional embedding and clusters longitudinal user trajectories as outcome, outperforms traditional approaches based solely on psychology questionnaires. Second, motivated by mood instability as a predictor of poor mental health, we propose encoder-decoder models for time-series forecasting which exploit the bi-modality of mood with multi-task learning. Next, motivated by the success of general-purpose models in vision and language tasks, we propose a self-supervised neural network ready-to-use as a feature extractor for wearable data. To this end, we set the heart rate responses as the supervisory signal for activity data, leveraging their underlying physiological relationship and show that the resulting task-agnostic embeddings can generalize in predicting structurally different downstream outcomes through transfer learning (e.g. BMI, age, energy expenditure), outperforming unsupervised autoencoders and biomarkers. Finally, acknowledging fitness as a strong predictor of overall health, which, however, can only be measured with expensive instruments (e.g., a VO2max test), we develop models that enable accurate prediction of fine-grained fitness levels with wearables in the present, and more importantly, its direction and magnitude almost a decade later. All proposed methods are evaluated on large longitudinal datasets with tens of thousands of participants in the wild. The models developed and the insights drawn in this dissertation provide evidence for a better understanding of high-dimensional behavioral and physiological data with implications for large-scale health and lifestyle monitoring.The Department of Computer Science and Technology at the University of Cambridge through the EPSRC through Grant DTP (EP/N509620/1), and the Embiricos Trust Scholarship of Jesus College Cambridg

Signal Processing Using Non-invasive Physiological Sensors

Non-invasive biomedical sensors for monitoring physiological parameters from the human body for potential future therapies and healthcare solutions. Today, a critical factor in providing a cost-effective healthcare system is improving patients' quality of life and mobility, which can be achieved by developing non-invasive sensor systems, which can then be deployed in point of care, used at home or integrated into wearable devices for long-term data collection. Another factor that plays an integral part in a cost-effective healthcare system is the signal processing of the data recorded with non-invasive biomedical sensors. In this book, we aimed to attract researchers who are interested in the application of signal processing methods to different biomedical signals, such as an electroencephalogram (EEG), electromyogram (EMG), functional near-infrared spectroscopy (fNIRS), electrocardiogram (ECG), galvanic skin response, pulse oximetry, photoplethysmogram (PPG), etc. We encouraged new signal processing methods or the use of existing signal processing methods for its novel application in physiological signals to help healthcare providers make better decisions