The Effect of Fetal Heart Rate Segment Selection on Deep Learning Models for Fetal Compromise Detection.

Monitoring the fetal heart rate (FHR) is common practice in obstetric care to assess the risk of fetal compromise. Unfortunately, human interpretation of FHR recordings is subject to inter-observer variability with high false positive rates. To improve the performance of fetal compromise detection, deep learning methods have been proposed to automatically interpret FHR recordings. However, existing deep learning methods typically analyse a fixed-length segment of the FHR recording after removing signal gaps, where the influence of this segment selection process has not been comprehensively assessed. In this work, we develop a novel input length invariant deep learning model to determine the effect of FHR segment selection for detecting fetal compromise. Using this model, we perform five times repeated five-fold cross-validation on an open-access database of 552 FHR recordings and assess model performance for FHR segment lengths between 15 and 60 minutes. We show that the performance after removing signal gaps improves with increasing segment length from 15 minutes (AUC = 0.50) to 60 minutes (AUC = 0.74). Additionally, we demonstrate that using FHR segments without removing signal gaps achieves superior performance across signal lengths from 15 minutes (AUC = 0.68) to 60 minutes (AUC = 0.76). These results show that future works should carefully consider FHR segment selection and that removing signal gaps might contribute to the loss of valuable information.

Computerised Cardiotocography Analysis for the Automated Detection of Fetal Compromise during Labour: A Review.

The measurement and analysis of fetal heart rate (FHR) and uterine contraction (UC) patterns, known as cardiotocography (CTG), is a key technology for detecting fetal compromise during labour. This technology is commonly used by clinicians to make decisions on the mode of delivery to minimise adverse outcomes. A range of computerised CTG analysis techniques have been proposed to overcome the limitations of manual clinician interpretation. While these automated techniques can potentially improve patient outcomes, their adoption into clinical practice remains limited. This review provides an overview of current FHR and UC monitoring technologies, public and private CTG datasets, pre-processing steps, and classification algorithms used in automated approaches for fetal compromise detection. It aims to highlight challenges inhibiting the translation of automated CTG analysis methods from research to clinical application and provide recommendations to overcome them.

Multi-stage sleep classification using photoplethysmographic sensor.

The conventional approach to monitoring sleep stages requires placing multiple sensors on patients, which is inconvenient for long-term monitoring and requires expert support. We propose a single-sensor photoplethysmographic (PPG)-based automated multi-stage sleep classification. This experimental study recorded the PPG during the entire night's sleep of 10 patients. Data analysis was performed to obtain 79 features from the recordings, which were then classified according to sleep stages. The classification results using support vector machine (SVM) with the polynomial kernel yielded an overall accuracy of 84.66%, 79.62% and 72.23% for two-, three- and four-stage sleep classification. These results show that it is possible to conduct sleep stage monitoring using only PPG. These findings open the opportunities for PPG-based wearable solutions for home-based automated sleep monitoring.

Automated measurement of inter-arytenoid distance on 4D laryngeal CT: A validation study.

Changes to the voice are prevalent and occur early in Parkinson's disease. Correlates of these voice changes on four-dimensional laryngeal computed-tomography imaging, such as the inter-arytenoid distance, are promising biomarkers of the disease's presence and severity. However, manual measurement of the inter-arytenoid distance is a laborious process, limiting its feasibility in large-scale research and clinical settings. Automated methods of measurement provide a solution. Here, we present a machine-learning module which determines the inter-arytenoid distance in an automated manner. We obtained automated inter-arytenoid distance readings on imaging from participants with Parkinson's disease as well as healthy controls, and then validated these against manually derived estimates. On a modified Bland-Altman analysis, we found a mean bias of 1.52 mm (95% limits of agreement -1.7 to 4.7 mm) between the automated and manual techniques, which improves to a mean bias of 0.52 mm (95% limits of agreement -1.9 to 2.9 mm) when variability due to differences in slice selection between the automated and manual methods are removed. Our results demonstrate that estimates of the inter-arytenoid distance with our automated machine-learning module are accurate, and represents a promising tool to be utilized in future work studying the laryngeal changes in Parkinson's disease.

Performance of a Convolutional Neural Network Derived From PPG Signal in Classifying Sleep Stages.

Automatic sleep stage classification is vital for evaluating the quality of sleep. Conventionally, sleep is monitored using multiple physiological sensors that are uncomfortable for long-term monitoring and require expert intervention. In this study, we propose an automatic technique for multi-stage sleep classification using photoplethysmographic (PPG) signal. We have proposed a convolutional neural network (CNN) that learns directly from the PPG signal and classifies multiple sleep stages. We developed models for two- (Wake-Sleep), three- (Wake-NREM-REM) and four- (Wake-Light sleep-Deep sleep-REM) stages of sleep classification. Our proposed approach shows an average classification accuracy of 94.4%, 94.2%, and 92.9% for two, three, and four stages, respectively. Experimental results show that the proposed CNN model outperforms existing state-of-the-art models (classical and deep learning) in the literature.

Scalable Cluster Tendency Assessment for Streaming Activity Data using Recurring Shapelets.

Automatic interpretation of cluster structure in rapidly arriving data streams is essential for timely detection of interesting events. Human activities often contain bursts of repeating patterns. In this paper, we propose a new relative of the Visual Assessment of Cluster Tendency (VAT) model, to interpret cluster evolution in streaming activity data where shapes of recurring patterns are important. Existing VAT algorithms are either suitable only for small batch data and unscalable to rapidly evolving streams, or cannot capture shape patterns. Our proposed incremental algorithm processes streaming data in chunks and identifies repeating patterns or shapelets from each chunk, creating a Dictionary-of-Shapes (DoS) that is updated on the fly. Each chunk is transformed into a lower dimensional representation based on it's distance from the shapelets in the current DoS. Then a small set of transformed chunks are sampled using an intelligent Maximin Random Sampling (MMRS) scheme, to create a scalable VAT image that is incrementally updated as the data stream progresses. Experiments on two upper limb activity datasets demonstrate that the proposed method can successfully and efficiently visualize clusters in long streams of data and can also identify anomalous movements.

Detection of Epileptic Seizure Using Accelerometer Time Series Data and Hidden Markov Model.

Epilepsy is one of the most prevalent neurological diseases globally, which causes seizures in the patient. As per a survey done worldwide, it is found that approximately 70 million people are living with epilepsy (~1% of the total population of the world). Effective detection of these seizures requires specialized approaches such as video and electroencephalography monitoring, which are expensive and are mainly available at specialized hospitals and institutes. Hence, there is a need to develop simpler and affordable systems that can be made available to health care centers and patients for accurate detection of epileptic seizures. A wireless remote monitoring system based on a wrist-worn accelerometer is an optimum choice for the same. Sophisticated algorithms need to be developed for effectively detecting seizure events from this accelerometer data with minimal false alarms. This paper presents a Hidden Markov Model (HMM) based probabilistic approach applied to the reduced-dimension feature vector representation of time-series accelerometer data to detect epileptic seizures. The results obtained from the HMM were compared with three commonly used machine learning models viz. support vector machine (SVM), logistic regression, and random forest. The proposed approach was able to detect 95.7% of seizures with a low false alarm rate of 14.8% with a run time of just under 24 seconds.

Effect of Pd-Sensitization on Poisonous Chlorine Gas Detection Ability of TiO2: Green Synthesis and Low-Temperature Operation.

Ganoderma lucidum mushroom-mediated green synthesis of nanocrystalline titanium dioxide (TiO2) is explored via a low-temperature (≤70 °C) wet chemical method. The role of Ganoderma lucidum mushroom extract in the reaction is to release the ganoderic acid molecules that tend to bind to the Ti4+ metal ions to form a titanium-ganoderic acid intermediate complex for obtaining TiO2 nanocrystallites (NCs), which is quite novel, considering the recent advances in fabricated gas sensing materials. The X-ray powder diffraction, field emission scanning electron microscopy, Raman spectroscopy, and Brunauer-Emmett-Teller measurements etc., are used to characterize the crystal structure, surface morphology, and surface area of as-synthesized TiO2 and Pd-TiO2 sensors, respectively. The chlorine (Cl2) gas sensing properties are investigated from a lower range of 5 ppm to a higher range of 400 ppm. In addition to excellent response-recovery time, good selectivity, constant repeatability, as well as chemical stability, the gas sensor efficiency of the as-synthesized Pd-TiO2 NC sensor is better (136% response at 150 °C operating temperature) than the TiO2 NC sensor (57% at 250 °C operating temperature) measured at 100 ppm (Cl2) gas concentration, suggesting that the green synthesized Pd-TiO2 sensor demonstrates efficient Cl2 gas sensing properties at low operating temperatures over pristine ones.

Multifunctional Cu2SnS3 Nanoparticles with Enhanced Photocatalytic Dye Degradation and Antibacterial Activity.

We present a simplistic, ultrafast, and facile hydrothermal deposition of ternary Cu2SnS3 nanoparticles (CTS NPs). The fabricated CTS NPs show superior antimicrobial and photocatalytic activities. In the presence of UV-Visible illumination, methylene blue (MB) dye was studied for photocatalytic dye degradation activity of CTS NPs. Excellent efficiency is shown by incorporating CTS NPs to degrade MB dye. There is a ~95% decrease in the absorbance peak of the dye solution within 120 min. Similarly, CTS NPs tested against three bacterial strains, i.e., B. subtilis, S. aureus, P. vulgaris, and one fungal strain C. albicans, defining the lowest inhibitory concentration and zone of inhibition, revealed greater antimicrobial activity. Hence, it is concluded that the CTS NPs are photocatalytically and antimicrobially active and have potential in biomedicine.

Robustness of electrocardiogram signal quality indices.

Electrocardiogram (ECG) signal quality indices (SQIs) are essential for improving diagnostic accuracy and reliability of ECG analysis systems. In various practical applications, the ECG signals are corrupted by different types of noise. These corrupted ECG signals often provide insufficient and incorrect information regarding a patient's health. To solve this problem, signal quality measurements should be made before an ECG signal is used for decision-making. This paper investigates the robustness of existing popular statistical signal quality indices (SSQIs): relative power of QRS complex (SQIp), skewness (SQIskew), signal-to-noise ratio (SQIsnr), higher order statistics SQI (SQIhos) and peakedness of kurtosis (SQIkur). We analysed the robustness of these SSQIs against different window sizes across diverse datasets. Results showed that the performance of SSQIs considerably fluctuates against varying datasets, whereas the impact of varying window sizes was minimal. This fluctuation occurred due to the use of a static threshold value for classifying noise-free ECG signals from the raw ECG signals. Another drawback of these SSQIs is the bias towards noise-free ECG signals, that limits their usefulness in clinical settings. In summary, the fixed threshold-based SSQIs cannot be used as a robust noise detection system. In order to solve this fixed threshold problem, other techniques can be developed using adaptive thresholds and machine-learning mechanisms.

Detection of fetal arrhythmias in non-invasive fetal ECG recordings using data-driven entropy profiling.

Objective.Fetal arrhythmias are a life-threatening disorder occurring in up to 2% of pregnancies. If identified, many fetal arrhythmias can be effectively treated using anti-arrhythmic therapies. In this paper, we present a novel method of detecting fetal arrhythmias in short length non-invasive fetal electrocardiography (NI-FECG) recordings.Approach.Our method consists of extracting a fetal heart rate time series from each NI-FECG recording and computing an entropy profile using a data-driven range of the entropy tolerance parameterr. To validate our approach, we apply our entropy profiling method to a large clinical data set of 318 NI-FECG recordings.Main Results.We demonstrate that our method (TotalSampEn) provides strong performance for classifying arrhythmic fetuses (AUC of 0.83) and outperforms entropy measures such asSampEn(AUC of 0.68) andFuzzyEn(AUC of 0.72). We also find that NI-FECG recordings incorrectly classified using the investigated entropy measures have significantly lower signal quality, and that excluding recordings of low signal quality (13.5% of recordings) increases the classification performance ofTotalSampEn(AUC of 0.90).Significance.The superior performance of our approach enables automated detection of fetal arrhythmias and warrants further investigation in a prospective clinical trial.

Evaluation of Mesh and Sensor Resolution for Finite Element Modeling of Non-Invasive Fetal ECG Signals.

Non-invasive fetal electrocardiography (NI-FECG) is an emerging tool with novel diagnostic potential for monitoring fetal wellbeing using electrical signals acquired from the maternal abdomen. However, variations in the geometric structure and conductivity of maternal-fetal tissues have been shown to affect the reliability of NI-FECG signals. Previous studies have utilized detailed finite element models to simulate these impacts, however this approach is computationally expensive. In this study, we investigate a range of mesh and sensor resolutions to determine an optimal trade-off between computational cost and modeling accuracy for simulating NI-FECG signals. Our results demonstrate that an optimal refinement of mesh resolution provides comparable accuracy to a detailed reference solution while requiring approximately 12 times less computation time and one-third of the memory usage. Furthermore, positioning simulated sensors at a 20 mm grid spacing provides a sufficient representation of abdominal surface potentials. These findings represent default parameters to be used in future simulations of NI-FECG signals. Code for the model utilized in this work is available under an open-source GPL license as part of the fecgsyn toolbox.Clinical Relevance- Simulating NI-FECG signals provides the opportunity to study the effects of sensor placement and maternal-fetal anatomic variations in a controlled setting. This work has relevance in determining default parameters for efficiently performing these simulations.

Measures of Bipedal Toe-Ground Clearance Asymmetry to Characterize Gait in Stroke Survivors.

Post-stroke hemiparesis often impairs gait and increases the risks of falls. Low and variable Minimum Toe Clearance (MTC) from the ground during the swing phase of the gait cycle has been identified as a major cause of such falls. In this paper, we study MTC characteristics in 30 chronic stroke patients, extracted from gait patterns during treadmill walking, using infrared sensors and motion analysis camera units. We propose objective measures to quantify MTC asymmetry between the paretic and non-paretic limbs using Poincaré analysis. We show that these subject independent Gait Asymmetry Indices (GAIs) represent temporal variations of relative MTC differences between the two limbs and can distinguish between healthy and stroke participants. Compared to traditional measures of cross-correlation between the MTC of the two limbs, these measures are better suited to automate gait monitoring during stroke rehabilitation. Further, we explore possible clusters within the stroke data by analysing temporal dispersion of MTC features, which reveals that the proposed GAIs can also be potentially used to quantify the severity of lower limb hemiparesis in chronic stroke.

Upper limb movement profiles during spontaneous motion in acute stroke.

Objective.The clinical assessment of upper limb hemiparesis in acute stroke involves repeated manual examination of hand movements during instructed tasks. This process is labour-intensive and prone to human error as well as being strenuous for the patient. Wearable motion sensors can automate the process by measuring characteristics of hand activity. Existing work in this direction either uses multiple sensors or complex instructed movements, or analyzes only thequantityof upper limb motion. These methods are obtrusive and strenuous for acute stroke patients and are also sensitive to noise. In this work, we propose to use only two wrist-worn accelerometer sensors to study thequalityof completely spontaneous upper limb motion and investigate correlation with clinical scores for acute stroke care.Approach.The velocity time series estimated from acquired acceleration data during spontaneous motion is decomposed into smaller movement elements. Measures of density, duration and smoothness of these component elements are extracted and their disparity is studied across the two hands.Main results.Spontaneous upper limb motion in acute stroke can be decomposed into movement elements that resemble point-to-point reaching tasks. These elements are smoother and sparser in the normal hand than in the hemiparetic hand, and the amount of smoothness correlates with hemiparetic severity. Features characterizing the disparity of these movement elements between the two hands show statistical significance in differentiating mild-to-moderate and severe hemiparesis. Using data from 67 acute stroke patients, the proposed method can classify the two levels of hemiparetic severity with 85% accuracy. Additionally, compared to activity-based features, the proposed method is robust to the presence of noise in acquired data.Significance.This work demonstrates that the quality of upper limb motion can characterize and identify hemiparesis in stroke survivors. This is clinically significant towards the continuous automated assessment of hemiparesis in acute stroke using minimally intrusive wearable sensors.

Visual Structural Assessment and Anomaly Detection for High-Velocity Data Streams.

The widespread use of Internet-of-Things (IoT) technologies, smartphones, and social media services generates huge amounts of data streaming at high velocity. Automatic interpretation of these rapidly arriving data streams is required for the timely detection of interesting events that usually emerge in the form of clusters. This article proposes a new relative of the visual assessment of the cluster tendency (VAT) model, which produces a record of structural evolution in the data stream by building a cluster heat map of the entire processing history in the stream. The existing VAT-based algorithms for streaming data, called inc-VAT/inc-iVAT and dec-VAT/dec-iVAT, are not suitable for high-velocity and high-volume streaming data because of high memory requirements and slower processing speed as the accumulated data increases. The scalable iVAT (siVAT) algorithm can handle big batch data, but for streaming data, it needs to be (re)applied everytime a new datapoint arrives, which is not feasible due to the associated computation complexities. To address this problem, we propose an incremental siVAT algorithm, called inc-siVAT, which deals with the streaming data in chunks. It first extracts a small size smart sample using an intelligent sampling scheme, called maximin random sampling (MMRS), then incrementally updates the smart sample points on the fly, using our novel incremental MMRS (inc-MMRS) algorithm, to reflect changes in the data stream after each chunk is processed, and finally, produces an incrementally built iVAT image of the updated smart sample, using the inc-VAT/inc-iVAT and dec-VAT/dec-iVAT algorithms. These images can be used to visualize the evolving cluster structure and for anomaly detection in streaming data. Our method is illustrated with one synthetic and four real datasets, two of which evolve significantly over time. Our numerical experiments demonstrate the algorithm's ability to successfully identify anomalies and visualize changing cluster structure in streaming data.

Novel Measures of Similarity and Asymmetry in Upper Limb Activities for Identifying Hemiparetic Severity in Stroke Survivors.

Stroke survivors are often characterized by hemiparesis, i.e., paralysis in one half of the body, severely affecting upper limb movements. Monitoring the progression of hemiparesis requires manual observation of limb movements at regular intervals, and hence is a labour intensive process. In this work, we use wrist-worn accelerometers for automated assessment of hemiparesis in acute stroke. We propose novel measures of similarity and asymmetry in hand activities through bivariate Poincaré analysis between two-hand accelerometer data for quantifying hemiparetic severity. The proposed descriptors characterize the distribution of activity surrogates derived from acceleration of the two hands, on a 2D bivariate Poincaré Plot. Experiments show that while the descriptors CSD1 and CSD2 can identify hemiparetic patients from control subjects, their normalized difference CSDR and the descriptors Complex Cross-Correlation Measure ( C3M) and Activity Asymmetry Index ( AAI) can distinguish between mild, moderate and severe hemiparesis. These measures are compared with traditional measures of cross-correlation and evaluated against the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard for hemiparetic severity estimation. This study, undertaken on 40 acute stroke patients with varying levels of hemiparesis and 15 healthy controls, validates the use of short length ( 5 minutes) wearable accelerometry data for identifying hemiparesis with greater clinical sensitivity. Results show that the proposed descriptors with a hierarchical classification model outperform state-of-the-art methods with overall accuracy of 0.78 and 0.85 for 4-class and 3-class hemiparesis identification respectively.

Modified Distribution Entropy as a Complexity Measure of Heart Rate Variability (HRV) Signal.

The complexity of a heart rate variability (HRV) signal is considered an important nonlinear feature to detect cardiac abnormalities. This work aims at explaining the physiological meaning of a recently developed complexity measurement method, namely, distribution entropy (DistEn), in the context of HRV signal analysis. We thereby propose modified distribution entropy (mDistEn) to remove the physiological discrepancy involved in the computation of DistEn. The proposed method generates a distance matrix that is devoid of over-exerted multi-lag signal changes. Restricted element selection in the distance matrix makes "mDistEn" a computationally inexpensive and physiologically more relevant complexity measure in comparison to DistEn.

Entropy Profiling: A Reduced-Parametric Measure of Kolmogorov-Sinai Entropy from Short-Term HRV Signal.

Entropy profiling is a recently introduced approach that reduces parametric dependence in traditional Kolmogorov-Sinai (KS) entropy measurement algorithms. The choice of the threshold parameter r of vector distances in traditional entropy computations is crucial in deciding the accuracy of signal irregularity information retrieved by these methods. In addition to making parametric choices completely data-driven, entropy profiling generates a complete profile of entropy information as against a single entropy estimate (seen in traditional algorithms). The benefits of using "profiling" instead of "estimation" are: (a) precursory methods such as approximate and sample entropy that have had the limitation of handling short-term signals (less than 1000 samples) are now made capable of the same; (b) the entropy measure can capture complexity information from short and long-term signals without multi-scaling; and (c) this new approach facilitates enhanced information retrieval from short-term HRV signals. The novel concept of entropy profiling has greatly equipped traditional algorithms to overcome existing limitations and broaden applicability in the field of short-term signal analysis. In this work, we present a review of KS-entropy methods and their limitations in the context of short-term heart rate variability analysis and elucidate the benefits of using entropy profiling as an alternative for the same.

Poincaré Descriptors for Identifying Hemiparesis in Acute Stroke using Wearable Accelerometry.

Stroke survivors are often characterized by hemiparesis, i.e., paralysis in one half of the body, that severely affects upper limb movements. Continuous monitoring of the progression of hemiparesis requires manual observation of the limb movements at regular intervals and hence is a labour intensive process. In this work, we use wrist-worn accelerometers for automated assessment of hemiparetic severity in acute stroke patients through bivariate Poincaré analysis between accelerometer data from the two hands during spontaneous and instructed movements. Experiments show that while the bivariate Poincaré descriptors CSD1 and CSD2 can identify hemiparetic patients from control subjects, a novel descriptor called Complex Cross-Correlation Measure (C3M) can distinguish between moderate and severe hemiparesis. Further, we justify the use of C3M by showing that it is described by multiple-lag cross-correlations, representing the co-ordination of activity between two hands. The descriptors are compared against the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard for evaluation of hemiparetic severity, and studied using statistical tests for developing supervised models for hemiparesis classification.Clinical relevance-This study establishes the suitability of wrist-worn accelerometers in identifying hemiparetic severity in stroke patients through novel descriptors of hand co-ordination.

Entropy Profiling for Detection of Fetal Arrhythmias in Short Length Fetal Heart Rate Recordings.

The use of fetal heart rate (FHR) recordings for assessing fetal wellbeing is an integral component of obstetric care. Recently, non-invasive fetal electrocardiography (NI-FECG) has demonstrated utility for accurately diagnosing fetal arrhythmias via clinician interpretation. In this work, we introduce the use of data-driven entropy profiling to automatically detect fetal arrhythmias in short length FHR recordings obtained via NI-FECG. Using an open access dataset of 11 normal and 11 arrhythmic fetuses, our method (TotalSampEn) achieves excellent classification performance (AUC = 0.98) for detecting fetal arrhythmias in a short time window (i.e. under 10 minutes). We demonstrate that our method outperforms SampEn (AUC = 0.72) and FuzzyEn (AUC = 0.74) based estimates, proving its effectiveness for this task. The rapid detection provided by our approach may enable efficient triage of concerning FHR recordings for clinician review.