A Physiological Signal Processing System for Optimal Engagement and Attention Detection.

In today’s high paced, hi-tech and high stress environment, with extended work hours, long to-do lists and neglected personal health, sleep deprivation has become common in modern culture. Coupled with these factors is the inherent repetitious and tedious nature of certain occupations and daily routines, which all add up to an undesirable fluctuation in individuals’ cognitive attention and capacity. Given certain critical professions, a momentary or prolonged lapse in attention level can be catastrophic and sometimes deadly. This research proposes to develop a real-time monitoring system which uses fundamental physiological signals such as the Electrocardiograph (ECG), to analyze and predict the presence or lack of cognitive attention in individuals during task execution. The primary focus of this study is to identify the correlation between fluctuating level of attention and its implications on the physiological parameters of the body. The system is designed using only those physiological signals that can be collected easily with small, wearable, portable and non-invasive monitors and thereby being able to predict well in advance, an individual’s potential loss of attention and ingression of sleepiness. Several advanced signal processing techniques have been implemented and investigated to derive multiple clandestine and informative features. These features are then applied to machine learning algorithms to produce classification models that are capable of differentiating between the cases of a person being attentive and the person not being attentive. Furthermore, Electroencephalograph (EEG) signals are also analyzed and classified for use as a benchmark for comparison with ECG analysis. For the study, ECG signals and EEG signals of volunteer subjects are acquired in a controlled experiment. The experiment is designed to inculcate and sustain cognitive attention for a period of time following which an attempt is made to reduce cognitive attention of volunteer subjects. The data acquired during the experiment is decomposed and analyzed for feature extraction and classification. The presented results show that to a fairly reasonable accuracy it is possible to detect the presence or lack of attention in individuals with just their ECG signal, especially in comparison with analysis done on EEG signals. The continual work of this research includes other physiological signals such as Galvanic Skin Response, Heat Flux, Skin Temperature and video based facial feature analysis

WIRELESS INTELLIGENT STRUCTURAL HEALTH MONITORING SYSTEM

Metal structures are susceptible to various types of damages, including corrosion, stress damage, pillowing deformation, cracks etc. These kinds of damages in the metal structures occur mainly due to operational conditions and exposure to the environment. Our research involves a portable integrated wireless sensor system with video camera and ultrasound capabilities which is being developed to investigate corrosion damage on real structures in real time. This system uses images of the metal surfaces, which are captured from an integrated wireless sensor and then quantified and analyzed using computational intelligence. The quantification of the obtained images is done with specialized component analysis software which enhances and performs wavelet transforms on the received images. Through this quantized analysis of the images we can detect and isolate regions of degradation on the metal surface. We believe that the final developed system will allow us to detect damage in metallic structures in its early stages, thereby ensuring proper safety and maintenance of its structural health. This system will further be targeted towards medical applications with capabilities of remote health monitoring. The initial target areas being bone structure and cancer detection and analysis. Applying such a wireless data capture system in these areas will reveal a broad spectrum of the usage of such an application system

Biomedical informatics for computer-aided decision support systems: a survey

The volumes of current patient data as well as their complexity make clinical decision making more challenging than ever for physicians and other care givers. This situation calls for the use of biomedical informatics methods to process data and form recommendations and/or predictions to assist such decision makers. The design, implementation, and use of biomedical informatics systems in the form of computer-aided decision support have become essential and widely used over the last two decades. This paper provides a brief review of such systems, their application protocols and methodologies, and the future challenges and directions they suggest.First author draf

A Hierarchical Method for Removal of Baseline Drift from Biomedical Signals: Application in ECG Analysis

Noise can compromise the extraction of some fundamental and important features from biomedical signals and hence prohibit accurate analysis of these signals. Baseline wander in electrocardiogram (ECG) signals is one such example, which can be caused by factors such as respiration, variations in electrode impedance, and excessive body movements. Unless baseline wander is effectively removed, the accuracy of any feature extracted from the ECG, such as timing and duration of the ST-segment, is compromised. This paper approaches this filtering task from a novel standpoint by assuming that the ECG baseline wander comes from an independent and unknown source. The technique utilizes a hierarchical method including a blind source separation (BSS) step, in particular independent component analysis, to eliminate the effect of the baseline wander. We examine the specifics of the components causing the baseline wander and the factors that affect the separation process. Experimental results reveal the superiority of the proposed algorithm in removing the baseline wander

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

An Automated Optimal Engagement and Attention Detection System Using Electrocardiogram

This research proposes to develop a monitoring system which uses Electrocardiograph (ECG) as a fundamental physiological signal, to analyze and predict the presence or lack of cognitive attention in individuals during a task execution. The primary focus of this study is to identify the correlation between fluctuating level of attention and its implications on the cardiac rhythm recorded in the ECG. Furthermore, Electroencephalograph (EEG) signals are also analyzed and classified for use as a benchmark for comparison with ECG analysis. Several advanced signal processing techniques have been implemented and investigated to derive multiple clandestine and informative features from both these physiological signals. Decomposition and feature extraction are done using Stockwell-transform for the ECG signal, while Discrete Wavelet Transform (DWT) is used for EEG. These features are then applied to various machine-learning algorithms to produce classification models that are capable of differentiating between the cases of a person being attentive and a person not being attentive. The presented results show that detection and classification of cognitive attention using ECG are fairly comparable to EEG

An Entropy-Based Automated Cell Nuclei Segmentation and Quantification: Application in Analysis of Wound Healing Process

The segmentation and quantification of cell nuclei are two very significant tasks in the analysis of histological images. Accurate results of cell nuclei segmentation are often adapted to a variety of applications such as the detection of cancerous cell nuclei and the observation of overlapping cellular events occurring during wound healing process in the human body. In this paper, an automated entropy-based thresholding system for segmentation and quantification of cell nuclei from histologically stained images has been presented. The proposed translational computation system aims to integrate clinical insight and computational analysis by identifying and segmenting objects of interest within histological images. Objects of interest and background regions are automatically distinguished by dynamically determining 3 optimal threshold values for the 3 color components of an input image. The threshold values are determined by means of entropy computations that are based on probability distributions of the color intensities of pixels and the spatial similarity of pixel intensities within neighborhoods. The effectiveness of the proposed system was tested over 21 histologically stained images containing approximately 1800 cell nuclei, and the overall performance of the algorithm was found to be promising, with high accuracy and precision values

Prediction of episode of hemodynamic instability using an electrocardiogram based analytic: a retrospective cohort study

Abstract Background Predicting the onset of hemodynamic instability before it occurs remains a sought-after goal in acute and critical care medicine. Technologies that allow for this may assist clinicians in preventing episodes of hemodynamic instability (EHI). We tested a novel noninvasive technology, the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI), which analyzes a single lead of electrocardiogram (ECG) and extracts heart rate variability and morphologic waveform features to predict an EHI prior to its occurrence. Methods Retrospective cohort study at a quaternary care academic health system using data from hospitalized adult patients between August 2019 and April 2020 undergoing continuous ECG monitoring with intermittent noninvasive blood pressure (NIBP) or with continuous intraarterial pressure (IAP) monitoring. Results AHI-PI’s low and high-risk indications were compared with the presence of EHI in the future as indicated by vital signs (heart rate > 100 beats/min with a systolic blood pressure < 90 mmHg or a mean arterial blood pressure of < 70 mmHg). 4,633 patients were analyzed (3,961 undergoing NIBP monitoring, 672 with continuous IAP monitoring). 692 patients had an EHI (380 undergoing NIBP, 312 undergoing IAP). For IAP patients, the sensitivity and specificity of AHI-PI to predict EHI was 89.7% and 78.3% with a positive and negative predictive value of 33.7% and 98.4% respectively. For NIBP patients, AHI-PI had a sensitivity and specificity of 86.3% and 80.5% with a positive and negative predictive value of 11.7% and 99.5% respectively. Both groups performed with an AUC of 0.87. AHI-PI predicted EHI in both groups with a median lead time of 1.1 h (average lead time of 3.7 h for IAP group, 2.9 h for NIBP group). Conclusions AHI-PI predicted EHIs with high sensitivity and specificity and within clinically significant time windows that may allow for intervention. Performance was similar in patients undergoing NIBP and IAP monitoring