2D-WinSpatt-Net: A Dual Spatial Self-Attention Vision Transformer Boosts Classification of Tetanus Severity for Patients Wearing ECG Sensors in Low- and Middle-Income Countries.

Tetanus is a life-threatening bacterial infection that is often prevalent in low- and middle-income countries (LMIC), Vietnam included. Tetanus affects the nervous system, leading to muscle stiffness and spasms. Moreover, severe tetanus is associated with autonomic nervous system (ANS) dysfunction. To ensure early detection and effective management of ANS dysfunction, patients require continuous monitoring of vital signs using bedside monitors. Wearable electrocardiogram (ECG) sensors offer a more cost-effective and user-friendly alternative to bedside monitors. Machine learning-based ECG analysis can be a valuable resource for classifying tetanus severity; however, using existing ECG signal analysis is excessively time-consuming. Due to the fixed-sized kernel filters used in traditional convolutional neural networks (CNNs), they are limited in their ability to capture global context information. In this work, we propose a 2D-WinSpatt-Net, which is a novel Vision Transformer that contains both local spatial window self-attention and global spatial self-attention mechanisms. The 2D-WinSpatt-Net boosts the classification of tetanus severity in intensive-care settings for LMIC using wearable ECG sensors. The time series imaging-continuous wavelet transforms-is transformed from a one-dimensional ECG signal and input to the proposed 2D-WinSpatt-Net. In the classification of tetanus severity levels, 2D-WinSpatt-Net surpasses state-of-the-art methods in terms of performance and accuracy. It achieves remarkable results with an F1 score of 0.88 ± 0.00, precision of 0.92 ± 0.02, recall of 0.85 ± 0.01, specificity of 0.96 ± 0.01, accuracy of 0.93 ± 0.02 and AUC of 0.90 ± 0.00.

Self-supervised learning for human activity recognition using 700,000 person-days of wearable data.

Accurate physical activity monitoring is essential to understand the impact of physical activity on one's physical health and overall well-being. However, advances in human activity recognition algorithms have been constrained by the limited availability of large labelled datasets. This study aims to leverage recent advances in self-supervised learning to exploit the large-scale UK Biobank accelerometer dataset-a 700,000 person-days unlabelled dataset-in order to build models with vastly improved generalisability and accuracy. Our resulting models consistently outperform strong baselines across eight benchmark datasets, with an F1 relative improvement of 2.5-130.9% (median 24.4%). More importantly, in contrast to previous reports, our results generalise across external datasets, cohorts, living environments, and sensor devices. Our open-sourced pre-trained models will be valuable in domains with limited labelled data or where good sampling coverage (across devices, populations, and activities) is hard to achieve.

Digital health technologies to strengthen patient-centred outcome assessment in clinical trials in inflammatory arthritis.

Common to all inflammatory arthritides, namely rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, is a potential for reduced mobility that manifests through joint pain, swelling, stiffness, and ultimately joint damage. Across these conditions, consensus has been reached on the need to capture outcomes related to mobility, such as functional capacity and physical activity, as core domains in randomised controlled trials. Existing endpoints within these core domains rely wholly on self-reported questionnaires that capture patients' perceptions of their symptoms and activities. These questionnaires are subjective, inherently vulnerable to recall bias, and do not capture the granularity of fluctuations over time. Several early adopters have integrated sensor-based digital health technology (DHT)-derived endpoints to measure physical function and activity in randomised controlled trials for conditions including Parkinson's disease, Duchenne's muscular dystrophy, chronic obstructive pulmonary disease, and heart failure. Despite these applications, there have been no sensor-based DHT-derived endpoints in clinical trials recruiting patients with inflammatory arthritis. Borrowing from case studies across medicine, we outline the opportunities and challenges in developing novel sensor-based DHT-derived endpoints that capture the symptoms and disease manifestations most relevant to patients with inflammatory arthritis.

Digital health technologies and machine learning augment patient reported outcomes to remotely characterise rheumatoid arthritis.

Digital measures of health status captured during daily life could greatly augment current in-clinic assessments for rheumatoid arthritis (RA), to enable better assessment of disease progression and impact. This work presents results from weaRAble-PRO, a 14-day observational study, which aimed to investigate how digital health technologies (DHT), such as smartphones and wearables, could augment patient reported outcomes (PRO) to determine RA status and severity in a study of 30 moderate-to-severe RA patients, compared to 30 matched healthy controls (HC). Sensor-based measures of health status, mobility, dexterity, fatigue, and other RA specific symptoms were extracted from daily iPhone guided tests (GT), as well as actigraphy and heart rate sensor data, which was passively recorded from patients' Apple smartwatch continuously over the study duration. We subsequently developed a machine learning (ML) framework to distinguish RA status and to estimate RA severity. It was found that daily wearable sensor-outcomes robustly distinguished RA from HC participants (F1, 0.807). Furthermore, by day 7 of the study (half-way), a sufficient volume of data had been collected to reliably capture the characteristics of RA participants. In addition, we observed that the detection of RA severity levels could be improved by augmenting standard patient reported outcomes with sensor-based features (F1, 0.833) in comparison to using PRO assessments alone (F1, 0.759), and that the combination of modalities could reliability measure continuous RA severity, as determined by the clinician-assessed RAPID-3 score at baseline (r2, 0.692; RMSE, 1.33). The ability to measure the impact of the disease during daily life-through objective and remote digital outcomes-paves the way forward to enable the development of more patient-centric and personalised measurements for use in RA clinical trials.

Longitudinal Trend Monitoring of Multiple Sclerosis Ambulation Using Smartphones.

Goal: Smartphone and wearable devices may act as powerful tools to remotely monitor physical function in people with neurodegenerative and autoimmune diseases from out-of-clinic environments. Detection of progression onset or worsening of symptoms is especially important in people living with multiple sclerosis (PwMS) in order to enable optimally adapted therapeutic strategies. MS symptoms typically follow subtle and fluctuating disease courses, patient-to-patient, and over time. Current in-clinic assessments are often too infrequently administered to reflect longitudinal changes in MS impairment that impact daily life. This work, therefore, explores how smartphones can administer daily two-minute walking assessments to monitor PwMS physical function at home. Methods: Remotely collected smartphone inertial sensor data was transformed through state-of-the-art Deep Convolutional Neural Networks, to estimate a participant's daily ambulatory-related disease severity, longitudinally over a 24-week study. Results: This study demonstrated that smartphone-based ambulatory severity outcomes could accurately estimate MS level of disability, as measured by the EDSS score ([Formula: see text]: 0.56,[Formula: see text]0.001). Furthermore, longitudinal severity outcomes were shown to accurately reflect individual participants' level of disability over the study duration. Conclusion: Smartphone-based assessments, that can be performed by patients from their home environments, could greatly augment standard in-clinic outcomes for neurodegenerative diseases. The ability to understand the impact of disease on daily-life between clinical visits, through objective digital outcomes, paves the way forward to better measure and identify signs of disease progression that may be occurring out-of-clinic, to monitor how different patients respond to various treatments, and to ultimately enable the development of better, and more personalised care.

Interpretable deep learning for the remote characterisation of ambulation in multiple sclerosis using smartphones.

The emergence of digital technologies such as smartphones in healthcare applications have demonstrated the possibility of developing rich, continuous, and objective measures of multiple sclerosis (MS) disability that can be administered remotely and out-of-clinic. Deep Convolutional Neural Networks (DCNN) may capture a richer representation of healthy and MS-related ambulatory characteristics from the raw smartphone-based inertial sensor data than standard feature-based methodologies. To overcome the typical limitations associated with remotely generated health data, such as low subject numbers, sparsity, and heterogeneous data, a transfer learning (TL) model from similar large open-source datasets was proposed. Our TL framework leveraged the ambulatory information learned on human activity recognition (HAR) tasks collected from wearable smartphone sensor data. It was demonstrated that fine-tuning TL DCNN HAR models towards MS disease recognition tasks outperformed previous Support Vector Machine (SVM) feature-based methods, as well as DCNN models trained end-to-end, by upwards of 8-15%. A lack of transparency of "black-box" deep networks remains one of the largest stumbling blocks to the wider acceptance of deep learning for clinical applications. Ensuing work therefore aimed to visualise DCNN decisions attributed by relevance heatmaps using Layer-Wise Relevance Propagation (LRP). Through the LRP framework, the patterns captured from smartphone-based inertial sensor data that were reflective of those who are healthy versus people with MS (PwMS) could begin to be established and understood. Interpretations suggested that cadence-based measures, gait speed, and ambulation-related signal perturbations were distinct characteristics that distinguished MS disability from healthy participants. Robust and interpretable outcomes, generated from high-frequency out-of-clinic assessments, could greatly augment the current in-clinic assessment picture for PwMS, to inform better disease management techniques, and enable the development of better therapeutic interventions.

Smartphone- and Smartwatch-Based Remote Characterisation of Ambulation in Multiple Sclerosis During the Two-Minute Walk Test.

Leveraging consumer technology such as smartphone and smartwatch devices to objectively assess people with multiple sclerosis (PwMS) remotely could capture unique aspects of disease progression. This study explores the feasibility of assessing PwMS and Healthy Control's (HC) physical function by characterising gait-related features, which can be modelled using machine learning (ML) techniques to correctly distinguish subgroups of PwMS from healthy controls. A total of 97 subjects (24 HC subjects, 52 mildly disabled (PwMSmild, EDSS [0-3]) and 21 moderately disabled (PwMSmod, EDSS [3.5-5.5]) contributed data which was recorded from a Two-Minute Walk Test (2MWT) performed out-of-clinic and daily over a 24-week period. Signal-based features relating to movement were extracted from sensors in smartphone and smartwatch devices. A large number of features (n = 156) showed fair-to-strong (R 0.3) correlations with clinical outcomes. LASSO feature selection was applied to select and rank subsets of features used for dichotomous classification between subject groups, which were compared using Logistic Regression (LR), Support Vector Machines (SVM) and Random Forest (RF) models. Classifications of subject types were compared using data obtained from smartphone, smartwatch and the fusion of features from both devices. Models built on smartphone features alone achieved the highest classification performance, indicating that accurate and remote measurement of the ambulatory characteristics of HC and PwMS can be achieved with only one device. It was observed however that smartphone-based performance was affected by inconsistent placement location (running belt versus pocket). Results show that PwMSmod could be distinguished from HC subjects (Acc. 82.2 ± 2.9%, Sen. 80.1 ± 3.9%, Spec. 87.2 ± 4.2%, F 1 84.3 ± 3.8), and PwMSmild (Acc. 82.3 ± 1.9%, Sen. 71.6 ± 4.2%, Spec. 87.0 ± 3.2%, F 1 75.1 ± 2.2) using an SVM classifier with a Radial Basis Function (RBF). PwMSmild were shown to exhibit HC-like behaviour and were thus less distinguishable from HC (Acc. 66.4 ± 4.5%, Sen. 67.5 ± 5.7%, Spec. 60.3 ± 6.7%, F 1 58.6 ± 5.8). Finally, it was observed that subjects in this study demonstrated low intra- and high inter-subject variability which was representative of subject-specific gait characteristics.

Baseline Association of Motoric Cognitive Risk Syndrome With Sustained Attention, Memory, and Global Cognition.

OBJECTIVES: Slow gait has been shown to be a good predictor of declining cognitive function in healthy older adults. Motoric cognitive risk (MCR) syndrome is a new construct incorporating slow gait and subjective cognitive complaints in individuals without dementia who have preserved activities of daily living. This analysis investigated the prevalence of MCR and factors associated with MCR in a nationally representative population. In addition, cross-sectional associations between MCR and cognitive domains, an relationship yet to be fully elucidated in literature, was investigated. MEASUREMENTS: Participants completed a comprehensive neuropsychological assessment and gait analysis at a health assessment center. Logistic regression was employed to examine associated health factors. Composite scores reflecting global cognition, memory, sustained attention, executive function, and processing speed were constructed using neuropsychological test scores. Associations between MCR and these composites were quantified using multivariate generalized linear modelling. All analyses were weighted to be nationally representative. SETTING: Community-dwelling adults in The Irish Longitudinal Study on Aging (TILDA) completed an interview and a center-based health assessment. PARTICIPANTS: Participants aged 60 years and over (n = 2151, age; mean: 67.84 years, range: 60-93) were included. Participants with a Mini-Mental State Examination score of below 24, a diagnosis of serious memory impairment, Parkinson disease, dementia, or Alzheimer disease were excluded. RESULTS: MCR prevalence was estimated at 2.56% (95% confidence interval 1.97, 3.31). Significant risk factors for MCR were antidepressant use [odds ratio (OR) 4.46, P < .001], self-reported poor vision (OR 4.92, P < .05), and obesity (OR 2.29, P < .01). Individuals with MCR performed worse on tests that assess memory (B: -0.58, P < .001), global cognition (B: -0.42, P < .001), and sustained attention (B: -0.34, P < .05) with robust adjustment made for confounding demographic and health variables. CONCLUSIONS: MCR is characterized by strong negative associations with global cognition, attention, and memory. This may be indicative of the underlying pathology of MCR. The effect of antidepressant use on MCR is novel and may represent an important consideration in future studies.