Clouds Proportionate Medical Data Stream Analytics for Internet of Things-Based Healthcare Systems.

Internet of Things (IoT) assisted healthcare systems are designed for providing ubiquitous access and recommendations for personal and distributed electronic health services. The heterogeneous IoT platform assists healthcare services with reliable data management through dedicated computing devices. Healthcare services' reliability depends upon the efficient handling of heterogeneous data streams due to variations and errors. A Proportionate Data Analytics (PDA) for heterogeneous healthcare data stream processing is introduced in this manuscript. This analytics method differentiates the data streams based on variations and errors for satisfying the service responses. The classification is streamlined using linear regression for segregating errors from the variations in different time intervals. The time intervals are differentiated recurrently after detecting errors in the stream's variation. This process of differentiation and classification retains a high response ratio for healthcare services through spontaneous regressions. The proposed method's performance is analyzed using the metrics accuracy, identification ratio, delivery, variation factor, and processing time.

ECG Language processing (ELP): A new technique to analyze ECG signals.

BACKGROUND: A language is constructed of a finite/infinite set of sentences composing of words. Similar to natural languages, the Electrocardiogram (ECG) signal, the most common noninvasive tool to study the functionality of the heart and diagnose several abnormal arrhythmias, is made up of sequences of three or four distinct waves, including the P-wave, QRS complex, T-wave, and U-wave. An ECG signal may contain several different varieties of each wave (e.g., the QRS complex can have various appearances). For this reason, the ECG signal is a sequence of heartbeats similar to sentences in natural languages) and each heartbeat is composed of a set of waves (similar to words in a sentence) of different morphologies. METHODS: Analogous to natural language processing (NLP), which is used to help computers understand and interpret the human's natural language, it is possible to develop methods inspired by NLP to aid computers to gain a deeper understanding of Electrocardiogram signals. In this work, our goal is to propose a novel ECG analysis technique, ECG language processing (ELP), focusing on empowering computers to understand ECG signals in a way physicians do. RESULTS: We evaluated the proposed approach on two tasks, including the classification of heartbeats and the detection of atrial fibrillation in the ECG signals. Overall, our technique resulted in better performance or comparable performance with smaller neural networks compared to other deep neural networks and existing algorithms. CONCLUSION: Experimental results on three databases (i.e., PhysioNet's MIT-BIH, MIT-BIH AFIB, and PhysioNet Challenge 2017 AFIB Dataset databases) reveal that the proposed approach as a general idea can be applied to a variety of biomedical applications and can achieve remarkable performance.

A greedy graph search algorithm based on changepoint analysis for automatic QRS complex detection.

The electrocardiogram (ECG) signal is the most widely used non-invasive tool for the investigation of cardiovascular diseases. Automatic delineation of ECG fiducial points, in particular the R-peak, serves as the basis for ECG processing and analysis. This study proposes a new method of ECG signal analysis by introducing a new class of graphical models based on optimal changepoint detection models, named the graph-constrained changepoint detection (GCCD) model. The GCCD model treats fiducial points delineation in the non-stationary ECG signal as a changepoint detection problem. The proposed model exploits the sparsity of changepoints to detect abrupt changes within the ECG signal; thereby, the R-peak detection task can be relaxed from any preprocessing step. In this novel approach, prior biological knowledge about the expected sequence of changes is incorporated into the model using the constraint graph, which can be defined manually or automatically. First, we define the constraint graph manually; then, we present a graph learning algorithm that can search for an optimal graph in a greedy scheme. Finally, we compare the manually defined graphs and learned graphs in terms of graph structure and detection accuracy. We evaluate the performance of the algorithm using the MIT-BIH Arrhythmia Database. The proposed model achieves an overall sensitivity of 99.64%, positive predictivity of 99.71%, and detection error rate of 0.19 for the manually defined constraint graph and overall sensitivity of 99.76%, positive predictivity of 99.68%, and detection error rate of 0.55 for the automatic learning constraint graph.

A Graph-constrained Changepoint Detection Approach for ECG Segmentation.

Electrocardiogram (ECG) signal is the most commonly used non-invasive tool in the assessment of cardiovascular diseases. Segmentation of the ECG signal to locate its constitutive waves, in particular the R-peaks, is a key step in ECG processing and analysis. Over the years, several segmentation and QRS complex detection algorithms have been proposed with different features; however, their performance highly depends on applying preprocessing steps which makes them unreliable in realtime data analysis of ambulatory care settings and remote monitoring systems, where the collected data is highly noisy. Moreover, some issues still remain with the current algorithms in regard to the diverse morphological categories for the ECG signal and their high computation cost. In this paper, we introduce a novel graph-based optimal changepoint detection (GCCD) method for reliable detection of Rpeak positions without employing any preprocessing step. The proposed model guarantees to compute the globally optimal changepoint detection solution. It is also generic in nature and can be applied to other time-series biomedical signals. Based on the MIT-BIH arrhythmia (MIT-BIH-AR) database, the proposed method achieves overall sensitivity Sen = 99.76, positive predictivity PPR = 99.68, and detection error rate DER = 0.55 which are comparable to other state-of-the-art approaches.1 2.

HAN-ECG: An interpretable atrial fibrillation detection model using hierarchical attention networks.

Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias that affects the lives of many people around the world and is associated with a five-fold increased risk of stroke and mortality. Like other problems in the healthcare domain, artificial intelligence (AI)-based models have been used to detect AF from patients' ECG signals. The cardiologist level performance in detecting this arrhythmia is often achieved by deep learning-based methods, however, they suffer from the lack of interpretability. In other words, these approaches are unable to explain the reasons behind their decisions. The lack of interpretability is a common challenge toward a wide application of machine learning (ML)-based approaches in the healthcare which limits the trust of clinicians in such methods. To address this challenge, we propose HAN-ECG, an interpretable bidirectional-recurrent-neural-network-based approach for the AF detection task. The HAN-ECG employs three attention mechanism levels to provide a multi-resolution analysis of the patterns in ECG leading to AF. The detected patterns by this hierarchical attention model facilitate the interpretation of the neural network decision process in identifying the patterns in the signal which contributed the most to the final detection. Experimental results on two AF databases demonstrate that our proposed model performs better than the existing algorithms. Visualization of these attention layers illustrates that our proposed model decides upon the important waves and heartbeats which are clinically meaningful in the detection task (e.g., absence of P-waves, and irregular R-R intervals for the AF detection task).

Single-modal and multi-modal false arrhythmia alarm reduction using attention-based convolutional and recurrent neural networks.

This study proposes a deep learning model that effectively suppresses the false alarms in the intensive care units (ICUs) without ignoring the true alarms using single- and multi- modal biosignals. Most of the current work in the literature are either rule-based methods, requiring prior knowledge of arrhythmia analysis to build rules, or classical machine learning approaches, depending on hand-engineered features. In this work, we apply convolutional neural networks to automatically extract time-invariant features, an attention mechanism to put more emphasis on the important regions of the segmented input signal(s) that are more likely to contribute to an alarm, and long short-term memory units to capture the temporal information presented in the signal segments. We trained our method efficiently using a two-step training algorithm (i.e., pre-training and fine-tuning the proposed network) on the dataset provided by the PhysioNet computing in cardiology challenge 2015. The evaluation results demonstrate that the proposed method obtains better results compared to other existing algorithms for the false alarm reduction task in ICUs. The proposed method achieves a sensitivity of 93.88% and a specificity of 92.05% for the alarm classification, considering three different signals. In addition, our experiments for 5 separate alarm types leads significant results, where we just consider a single-lead ECG (e.g., a sensitivity of 90.71%, a specificity of 88.30%, an AUC of 89.51 for alarm type of Ventricular Tachycardia arrhythmia).

Inverse Feature Learning: Feature Learning Based on Representation Learning of Error.

This paper proposes inverse feature learning (IFL) as a novel supervised feature learning technique that learns a set of high-level features for classification based on an error representation approach. The key contribution of this method is to learn the representation of error as high-level features, while current representation learning methods interpret error by loss functions which are obtained as a function of differences between the true labels and the predicted ones. One advantage of this error representation is that the learned features for each class can be obtained independently of learned features for other classes; therefore, IFL can learn simultaneously meaning that it can learn new classes' features without retraining. Error representation learning can also help with generalization and reduce the chance of over-fitting by adding a set of impactful features to the original data set which capture the relationships between each instance and different classes through an error generation and analysis process. This method can be particularly effective in data sets, where the instances of each class have diverse feature representations or the ones with imbalanced classes. The experimental results show that the proposed IFL results in better performance compared to the state-of-the-art classification techniques for several popular data sets. We hope this paper can open a new path to utilize the proposed perspective of error representation learning in different feature learning domains.

SleepEEGNet: Automated sleep stage scoring with sequence to sequence deep learning approach.

Electroencephalogram (EEG) is a common base signal used to monitor brain activities and diagnose sleep disorders. Manual sleep stage scoring is a time-consuming task for sleep experts and is limited by inter-rater reliability. In this paper, we propose an automatic sleep stage annotation method called SleepEEGNet using a single-channel EEG signal. The SleepEEGNet is composed of deep convolutional neural networks (CNNs) to extract time-invariant features, frequency information, and a sequence to sequence model to capture the complex and long short-term context dependencies between sleep epochs and scores. In addition, to reduce the effect of the class imbalance problem presented in the available sleep datasets, we applied novel loss functions to have an equal misclassified error for each sleep stage while training the network. We evaluated the performance of the proposed method on different single-EEG channels (i.e., Fpz-Cz and Pz-Oz EEG channels) from the Physionet Sleep-EDF datasets published in 2013 and 2018. The evaluation results demonstrate that the proposed method achieved the best annotation performance compared to current literature, with an overall accuracy of 84.26%, a macro F1-score of 79.66% and κ = 0.79. Our developed model can be applied to other sleep EEG signals and aid the sleep specialists to arrive at an accurate diagnosis. The source code is available at https://github.com/SajadMo/SleepEEGNet.

An Unsupervised Feature Learning Approach to Reduce False Alarm Rate in ICUs.

The high rate of false alarms in intensive care units (ICUs) is one of the top challenges of using medical technology in hospitals. These false alarms are often caused by patients' movements, detachment of monitoring sensors, or different sources of noise and interference that impact the collected signals from different monitoring devices. In this paper, we propose a novel set of high-level features based on unsupervised feature learning technique in order to effectively capture the characteristics of different arrhythmia in electrocardiogram (ECG) signal and differentiate them from irregularity in signals due to different sources of signal disturbances. This unsupervised feature learning technique, first extracts a set of low-level features from all existing heart cycles of a patient, and then clusters these segments for each individual patient to provide a set of prominent high-level features. The objective of the clustering phase is to enable the classification method to differentiate between the high-level features extracted from normal and abnormal cycles (i.e., either due to arrhythmia or different sources of distortions in signal) in order to put more attention to the features extracted from abnormal portion of the signal that contribute to the alarm.

Simultaneous multiple features tracking of beats: A representation learning approach to reduce false alarm rates in ICUs.

The high rate of false alarms is a key challenge related to patient care in intensive care units (ICUs) that can result in delayed responses of the medical staff. Several rule-based and machine learning-based techniques have been developed to address this problem. However, the majority of these methods rely on the availability of different physiological signals such as different electrocardiogram (ECG) leads, arterial blood pressure (ABP), and photoplethysmogram (PPG), where each signal is analyzed by an independent processing unit and the results are fed to an algorithm to determine an alarm. That calls for novel methods that can accurately detect the cardiac events by only accessing one signal (e.g., ECG) with a low level of computation and sensors requirement. We propose a novel and robust representation learning framework for ECG analysis that only rely on a single lead ECG signal and yet achieves considerably better performance compared to the state-of-the-art works in this domain, without relying on an expert knowledge. We evaluate the performance of this method using the "2015 Physionet computing in cardiology challenge" dataset. To the best of our knowledge, the best previously reported performance is based on both expert knowledge and machine learning where all available signals of ECG, ABP and PPG are utilized. Our proposed method reaches the performance of 97.3%, 95.5 %, and 90.8 % in terms of sensitivity, specificity, and the challenge's score, respectively for the detection of five arrhythmias when only one single ECG lead signals is used without any expert knowledge.

A Deviation Analysis Framework for ECG Signals Using Controlled Spatial Transformation.

Current automated heart monitoring tools use supervised learning methods to recognize heart disorders based on ECG signal morphology. We develop a new ECG processing algorithm that enables early prediction of disorders through a novel deviation analysis. The idea is developing a patient-specific ECG baseline and characterizing the deviation of signal morphology towards any of the abnormality classes with specific morphological features. To enable this feature, a novel controlled non-linear transformation is designed to achieve maximal symme- try in the feature space. Our results using benchmark MIT-BIH database show that the proposed method achieves a classification accuracy of 96% and can be used to trigger yellow alarms to warn patients from increased risk of upcoming heart abnormalities (5% to 10% increase with respect to normal conditions). This feature can be used in health monitoring devices to advise patients to take preventive and precaution actions before critical situations.

Inter- and intra-patient ECG heartbeat classification for arrhythmia detection: A sequence to sequence deep learning approach.

Electrocardiogram (ECG) signal is a common and powerful tool to study heart function and diagnose several abnormal arrhythmias. While there have been remarkable improvements in cardiac arrhythmia classification methods, they still cannot offer acceptable performance in detecting different heart conditions, especially when dealing with imbalanced datasets. In this paper, we propose a solution to address this limitation of current classification approaches by developing an automatic heartbeat classification method using deep convolutional neural networks and sequence to sequence models. We evaluated the proposed method on the MIT-BIH arrhythmia database, considering the intra-patient and inter-patient paradigms, and the AAMI EC57 standard. The evaluation results for both paradigms show that our method achieves the best performance in the literature (a positive predictive value of 96.46% and sensitivity of 100% for the category S, and a positive predictive value of 98.68% and sensitivity of 97.40% for the category F for the intra-patient scheme; a positive predictive value of 92.57% and sensitivity of 88.94% for the category S, and a positive predictive value of 99.50% and sensitivity of 99.94% for the category V for the inter-patient scheme.).

A Feature Selection Method Based on Shapley Value to False Alarm Reduction in ICUs A Genetic-Algorithm Approach.

High false alarm rate in intensive care units (ICUs) has been identified as one of the most critical medical challenges in recent years. This often results in overwhelming the clinical staff by numerous false or unurgent alarms and decreasing the quality of care through enhancing the probability of missing true alarms as well as causing delirium, stress, sleep deprivation and depressed immune systems for patients. One major cause of false alarms in clinical practice is that the collected signals from different devices are processed individually to trigger an alarm, while there exists a considerable chance that the signal collected from one device is corrupted by noise or motion artifacts. In this paper, we propose a low-computational complexity yet accurate game-theoretic feature selection method which is based on a genetic algorithm that identifies the most informative biomarkers across the signals collected from various monitoring devices and can considerably reduce the rate of false alarms 1.

Game Theoretic Approach for Systematic Feature Selection; Application in False Alarm Detection in Intensive Care Units.

Intensive Care Units (ICUs) are equipped with many sophisticated sensors and monitoring devices to provide the highest quality of care for critically ill patients. However, these devices might generate false alarms that reduce standard of care and result in desensitization of caregivers to alarms. Therefore, reducing the number of false alarms is of great importance. Many approaches such as signal processing and machine learning, and designing more accurate sensors have been developed for this purpose. However, the significant intrinsic correlation among the extracted features from different sensors has been mostly overlooked. A majority of current data mining techniques fail to capture such correlation among the collected signals from different sensors that limits their alarm recognition capabilities. Here, we propose a novel information-theoretic predictive modeling technique based on the idea of coalition game theory to enhance the accuracy of false alarm detection in ICUs by accounting for the synergistic power of signal attributes in the feature selection stage. This approach brings together techniques from information theory and game theory to account for inter-features mutual information in determining the most correlated predictors with respect to false alarm by calculating Banzhaf power of each feature. The numerical results show that the proposed method can enhance classification accuracy and improve the area under the ROC (receiver operating characteristic) curve compared to other feature selection techniques, when integrated in classifiers such as Bayes-Net that consider inter-features dependencies.

Network-Based Enriched Gene Subnetwork Identification: A Game-Theoretic Approach.

Identifying subsets of genes that jointly mediate cancer etiology, progression, or therapy response remains a challenging problem due to the complexity and heterogeneity in cancer biology, a problem further exacerbated by the relatively small number of cancer samples profiled as compared with the sheer number of potential molecular factors involved. Pure data-driven methods that merely rely on multiomics data have been successful in discovering potentially functional genes but suffer from high false-positive rates and tend to report subsets of genes whose biological interrelationships are unclear. Recently, integrative data-driven models have been developed to integrate multiomics data with signaling pathway networks in order to identify pathways associated with clinical or biological phenotypes. However, these approaches suffer from an important drawback of being restricted to previously discovered pathway structures and miss novel genomic interactions as well as potential crosstalk among the pathways. In this article, we propose a novel coalition-based game-theoretic approach to overcome the challenge of identifying biologically relevant gene subnetworks associated with disease phenotypes. The algorithm starts from a set of seed genes and traverses a protein-protein interaction network to identify modulated subnetworks. The optimal set of modulated subnetworks is identified using Shapley value that accounts for both individual and collective utility of the subnetwork of genes. The algorithm is applied to two illustrative applications, including the identification of subnetworks associated with (i) disease progression risk in response to platinum-based therapy in ovarian cancer and (ii) immune infiltration in triple-negative breast cancer. The results demonstrate an improved predictive power of the proposed method when compared with state-of-the-art feature selection methods, with the added advantage of identifying novel potentially functional gene subnetworks that may provide insights into the mechanisms underlying cancer progression.

Identifying gene subnetworks associated with clinical outcome in ovarian cancer using Network Based Coalition Game.

The problem of identifying interacting genes that jointly are associated with a phenotype is considered. When the number of features are extremely large compared to the number of samples, there may be several subsets of features that provide acceptable levels of predictability. This is particularly true in cancer genomics, where we are interested in finding functionally related gene sets likely to jointly drive cancer phenotypes. In this paper, a novel game theoretic solution is proposed by modeling genes as players of a Coalition Game. This method discovers and develops informative gene subnetworks by integrating gene expression profiling of cancer tissues with protein-protein interaction (PPI) networks. These subnetworks are gradually developed by selective addition of candidate genes that present maximal Shapely values in coalition with subnetworks of genes. We applied the proposed algorithm to an ovarian cancer dataset (N = 201), in order to identify optimal subnetworks that can predict cancer progression risk in response to platinum-based therapy. We show improved predictive power of the proposed method when compared to state-of-the-art feature selection methods, with the added advantage of identifying potentially functional gene subnetworks that may provide insights into the mechanisms underlying cancer progression.