Brain vital signs as a quantitative measure of cognition: Methodological implementation in a care home environment.

Introduction: Managing cognitive function in care homes is a significant challenge. Individuals in care have a variety of scores across standard clinical assessments, such as the Mini-Mental Status Exam (MMSE), and many of them have scores that fall within the range associated with dementia. A recent methodological advance, brain vital sign monitoring through auditory event-related potentials, provides an objective and sensitive physiological measurement to track abnormalities, differences, or changes in cognitive function. Taking advantage of point-of-care accessibility, the current study evaluated the methodological feasibility, the assessment of whether a particular research method can be successfully implemented, of quantitatively measuring cognition of care home residents using brain vital signs. Secondarily, the current study examined the relationship between brain vital signs, specifically the cognitive processing associated N400 component, and MMSE scores in care home residents. Materials and methods: Brain vital signs used the established N100 (auditory sensation), P300 (basic attention), and N400 (cognitive processing) event-related potential (ERP) components. A total of 52 residents were enrolled, with all participants evaluated using the MMSE. Participants were assigned into homogeneous groups based on their MMSE scores, and were categorized into low (n = 14), medium (n = 17), and high (n = 13) MMSE groups. Both brain vital sign measures and underlying ERP waveforms were examined. Statistical analyses used partial least squares correlation (PLS) analyses in which both MMSE and age were included as factors, as well as jackknife approaches, to test for significant brain vital sign changes. Results: The current study successfully measured and analyzed standardized, quantifiable brain vital signs in a care home setting. ERP waveform data showed specific N400 changes between MMSE groups as a function of MMSE score. PLS analyses confirmed significant MMSE-related and age-related differences in the N400 amplitude (p < 0.05, corrected). Similarly, the jackknife approach emphasized the N400 latency difference between the low and high MMSE groups. Discussion and conclusion: It was possible to acquire brain vital signs measures in care home residents. Additionally, the current study evaluated brain vital signs relative to MMSE in this group. The comparison revealed significant decreasing in N400 response amplitude (cognitive processing) as a function of both MMSE score and age, as well as a slowing of N400 latency. The findings indicate that objective neurophysiological measures of impairment are detectable in care home residents across the span of MMSE scores. Direct comparison to MMSE- and age-related variables represents a critical initial step ahead of future studies that will investigate relative improvements in sensitivity, validity, reliability and related advantages of brain vital sign monitoring.

Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review.

BACKGROUND: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. OBJECTIVE: This study aims to synthesize qualitative insights into opioid users' acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. METHODS: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. RESULTS: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. CONCLUSIONS: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users.

Distributed sensing along fibers for smart clothing.

Textile sensors transform our everyday clothing into a means to track movement and biosignals in a completely unobtrusive way. One major hindrance to the adoption of "smart" clothing is the difficulty encountered with connections and space when scaling up the number of sensors. There is a lack of research addressing a key limitation in wearable electronics: Connections between rigid and textile elements are often unreliable, and they require interfacing sensors in a way incompatible with textile mass production methods. We introduce a prototype garment, compact readout circuit, and algorithm to measure localized strain along multiple regions of a fiber. We use a helical auxetic yarn sensor with tunable sensitivity along its length to selectively respond to strain signals. We demonstrate distributed sensing in clothing, monitoring arm joint angles from a single continuous fiber. Compared to optical motion capture, we achieve around five degrees error in reconstructing shoulder, elbow, and wrist joint angles.

Evaluating reliability in wearable devices for sleep staging.

Sleep is crucial for physical and mental health, but traditional sleep quality assessment methods have limitations. This scoping review analyzes 35 articles from the past decade, evaluating 62 wearable setups with varying sensors, algorithms, and features. Our analysis indicates a trend towards combining accelerometer and photoplethysmography (PPG) data for out-of-lab sleep staging. Devices using only accelerometer data are effective for sleep/wake detection but fall short in identifying multiple sleep stages, unlike those incorporating PPG signals. To enhance the reliability of sleep staging wearables, we propose five recommendations: (1) Algorithm validation with equity, diversity, and inclusion considerations, (2) Comparative performance analysis of commercial algorithms across multiple sleep stages, (3) Exploration of feature impacts on algorithm accuracy, (4) Consistent reporting of performance metrics for objective reliability assessment, and (5) Encouragement of open-source classifier and data availability. Implementing these recommendations can improve the accuracy and reliability of sleep staging algorithms in wearables, solidifying their value in research and clinical settings.

Innovative Approaches to Menstruation and Fertility Tracking Using Wearable Reproductive Health Technology: Systematic Review.

BACKGROUND: Emerging digital health technology has moved into the reproductive health market for female individuals. In the past, mobile health apps have been used to monitor the menstrual cycle using manual entry. New technological trends involve the use of wearable devices to track fertility by assessing physiological changes such as temperature, heart rate, and respiratory rate. OBJECTIVE: The primary aims of this study are to review the types of wearables that have been developed and evaluated for menstrual cycle tracking and to examine whether they may detect changes in the menstrual cycle in female individuals. Another aim is to review whether these devices are effective for tracking various stages in the menstrual cycle including ovulation and menstruation. Finally, the secondary aim is to assess whether the studies have validated their findings by reporting accuracy and sensitivity. METHODS: A review of PubMed or MEDLINE was undertaken to evaluate wearable devices for their effectiveness in predicting fertility and differentiating between the different stages of the menstrual cycle. RESULTS: Fertility cycle-tracking wearables include devices that can be worn on the wrists, on the fingers, intravaginally, and inside the ear. Wearable devices hold promise for predicting different stages of the menstrual cycle including the fertile window and may be used by female individuals as part of their reproductive health. Most devices had high accuracy for detecting fertility and were able to differentiate between the luteal phase (early and late), fertile window, and menstruation by assessing changes in heart rate, heart rate variability, temperature, and respiratory rate. CONCLUSIONS: More research is needed to evaluate consumer perspectives on reproductive technology for monitoring fertility, and ethical issues around the privacy of digital data need to be addressed. Additionally, there is also a need for more studies to validate and confirm this research, given its scarcity, especially in relation to changes in respiratory rate as a proxy for reproductive cycle staging.

Identifying unique spectral fingerprints in cough sounds for diagnosing respiratory ailments.

Coughing, a prevalent symptom of many illnesses, including COVID-19, has led researchers to explore the potential of cough sound signals for cost-effective disease diagnosis. Traditional diagnostic methods, which can be expensive and require specialized personnel, contrast with the more accessible smartphone analysis of coughs. Typically, coughs are classified as wet or dry based on their phase duration. However, the utilization of acoustic analysis for diagnostic purposes is not widespread. Our study examined cough sounds from 1183 COVID-19-positive patients and compared them with 341 non-COVID-19 cough samples, as well as analyzing distinctions between pneumonia and asthma-related coughs. After rigorous optimization across frequency ranges, specific frequency bands were found to correlate with each respiratory ailment. Statistical separability tests validated these findings, and machine learning algorithms, including linear discriminant analysis and k-nearest neighbors classifiers, were employed to confirm the presence of distinct frequency bands in the cough signal power spectrum associated with particular diseases. The identification of these acoustic signatures in cough sounds holds the potential to transform the classification and diagnosis of respiratory diseases, offering an affordable and widely accessible healthcare tool.

Textile-Based Body Capacitive Sensing for Knee Angle Monitoring.

Monitoring human movement is highly relevant in mobile health applications. Textile-based wearable solutions have the potential for continuous and unobtrusive monitoring. The precise estimation of joint angles is important in applications such as the prevention of osteoarthritis or in the assessment of the progress of physical rehabilitation. We propose a textile-based wearable device for knee angle estimation through capacitive sensors placed in different locations above the knee and in contact with the skin. We exploited this modality to enhance the baseline value of the capacitive sensors, hence facilitating readout. Moreover, the sensors are fabricated with only one layer of conductive fabric, which facilitates the design and realization of the wearable device. We observed the capability of our system to predict knee sagittal angle in comparison to gold-standard optical motion capture during knee flexion from a seated position and squats: the results showed an R2 coefficient between 0.77 and 0.99, root mean squared errors between 4.15 and 12.19 degrees, and mean absolute errors between 3.28 and 10.34 degrees. Squat movements generally yielded more accurate predictions than knee flexion from a seated position. The combination of the data from multiple sensors resulted in R2 coefficient values of 0.88 or higher. This preliminary work demonstrates the feasibility of the presented system. Future work should include more participants to further assess the accuracy and repeatability in the presence of larger interpersonal variability.

An Open-Source Graphical User Interface-Embedded Automated Electrocardiogram Quality Assessment: A Balanced Class Representation Approach.

The rise in cardiovascular diseases necessitates accurate electrocardiogram (ECG) diagnostics, making high-quality ECG recordings essential. Our CNN-LSTM model, embedded in an open-access GUI and trained on balanced datasets collected in clinical settings, excels in automating ECG quality assessment. When tested across three datasets featuring varying ratios of acceptable to unacceptable ECG signals, it achieved an F1 score ranging from 95.87% to 98.40%. Training the model on real noise sources significantly enhances its applicability in real-life scenarios, compared to simulations. Integrated into a user-friendly toolbox, the model offers practical utility in clinical environments. Furthermore, our study underscores the importance of balanced class representation during training and testing phases. We observed a notable F1 score change from 98.09% to 95.87% when the class ratio shifted from 85:15 to 50:50 in the same testing dataset with equal representation. This finding is crucial for future ECG quality assessment research, highlighting the impact of class distribution on the reliability of model training outcomes.

Revolutionizing smartphone gyrocardiography for heart rate monitoring: overcoming clinical validation hurdles.

Accurate heart rate (HR) measurement is crucial for optimal cardiac health, and while conventional methods such as electrocardiography and photoplethysmography are widely used for continuous daily monitoring, they may face practical limitations due to their dependence on external sensors and susceptibility to motion artifacts. In recent years, mechanocardiography (MCG)-based technologies, such as gyrocardiography (GCG) and seismocardiography (SCG), have emerged as promising alternatives to address these limitations. GCG has shown enhanced sensitivity and accuracy for HR detection compared to SCG, although its benefits are often overlooked in the context of the widespread use of accelerometers in HR monitoring applications. In this perspective, we aim to explore the potential and challenges of GCG, while recognizing that other technologies, including photoplethysmography and remote photoplethysmography, also have promising applications for HR monitoring. We propose a roadmap for future research to unlock the transformative capabilities of GCG for everyday heart rate monitoring.

Feasibility of force myography for the direct control of an assistive robotic hand orthosis in non-impaired individuals.

BACKGROUND: Assistive robotic hand orthoses can support people with sensorimotor hand impairment in many activities of daily living and therefore help to regain independence. However, in order for the users to fully benefit from the functionalities of such devices, a safe and reliable way to detect their movement intention for device control is crucial. Gesture recognition based on force myography measuring volumetric changes in the muscles during contraction has been previously shown to be a viable and easy to implement strategy to control hand prostheses. Whether this approach could be efficiently applied to intuitively control an assistive robotic hand orthosis remains to be investigated. METHODS: In this work, we assessed the feasibility of using force myography measured from the forearm to control a robotic hand orthosis worn on the hand ipsilateral to the measurement site. In ten neurologically-intact participants wearing a robotic hand orthosis, we collected data for four gestures trained in nine arm configurations, i.e., seven static positions and two dynamic movements, corresponding to typical activities of daily living conditions. In an offline analysis, we determined classification accuracies for two binary classifiers (one for opening and one for closing) and further assessed the impact of individual training arm configurations on the overall performance. RESULTS: We achieved an overall classification accuracy of 92.9% (averaged over two binary classifiers, individual accuracies 95.5% and 90.3%, respectively) but found a large variation in performance between participants, ranging from 75.4 up to 100%. Averaged inference times per sample were measured below 0.15 ms. Further, we found that the number of training arm configurations could be reduced from nine to six without notably decreasing classification performance. CONCLUSION: The results of this work support the general feasibility of using force myography as an intuitive intention detection strategy for a robotic hand orthosis. Further, the findings also generated valuable insights into challenges and potential ways to overcome them in view of applying such technologies for assisting people with sensorimotor hand impairment during activities of daily living.

PPG2ECGps: An End-to-End Subject-Specific Deep Neural Network Model for Electrocardiogram Reconstruction from Photoplethysmography Signals without Pulse Arrival Time Adjustments.

Electrocardiograms (ECGs) provide crucial information for evaluating a patient's cardiovascular health; however, they are not always easily accessible. Photoplethysmography (PPG), a technology commonly used in wearable devices such as smartwatches, has shown promise for constructing ECGs. Several methods have been proposed for ECG reconstruction using PPG signals, but some require signal alignment during the training phase, which is not feasible in real-life settings where ECG signals are not collected at the same time as PPG signals. To address this challenge, we introduce PPG2ECGps, an end-to-end, patient-specific deep-learning neural network utilizing the W-Net architecture. This novel approach enables direct ECG signal reconstruction from PPG signals, eliminating the need for signal alignment. Our experiments show that the proposed model achieves mean values of 0.977 mV for Pearson's correlation coefficient, 0.037 mV for the root mean square error, and 0.010 mV for the normalized dynamic time-warped distance when comparing reconstructed ECGs to reference ECGs from a dataset of 500 records. As PPG signals are more accessible than ECG signals, our proposed model has significant potential to improve patient monitoring and diagnosis in healthcare settings via wearable devices.

Conversational Agents and Avatars for Cardiometabolic Risk Factors and Lifestyle-Related Behaviors: Scoping Review.

BACKGROUND: In recent years, there has been a rise in the use of conversational agents for lifestyle medicine, in particular for weight-related behaviors and cardiometabolic risk factors. Little is known about the effectiveness and acceptability of and engagement with conversational and virtual agents as well as the applicability of these agents for metabolic syndrome risk factors such as an unhealthy dietary intake, physical inactivity, diabetes, and hypertension. OBJECTIVE: This review aimed to get a greater understanding of the virtual agents that have been developed for cardiometabolic risk factors and to review their effectiveness. METHODS: A systematic review of PubMed and MEDLINE was conducted to review conversational agents for cardiometabolic risk factors, including chatbots and embodied avatars. RESULTS: A total of 50 studies were identified. Overall, chatbots and avatars appear to have the potential to improve weight-related behaviors such as dietary intake and physical activity. There were limited studies on hypertension and diabetes. Patients seemed interested in using chatbots and avatars for modifying cardiometabolic risk factors, and adherence was acceptable across the studies, except for studies of virtual agents for diabetes. However, there is a need for randomized controlled trials to confirm this finding. As there were only a few clinical trials, more research is needed to confirm whether conversational coaches may assist with cardiovascular disease and diabetes, and physical activity. CONCLUSIONS: Conversational coaches may regulate cardiometabolic risk factors; however, quality trials are needed to expand the evidence base. A future chatbot could be tailored to metabolic syndrome specifically, targeting all the areas covered in the literature, which would be novel.

The Use of Photoplethysmography in the Assessment of Mental Health: Scoping Review.

BACKGROUND: With the rise in mental health problems globally, mobile health provides opportunities for timely medical care and accessibility. One emerging area of mobile health involves the use of photoplethysmography (PPG) to assess and monitor mental health. OBJECTIVE: In recent years, there has been an increase in the use of PPG-based technology for mental health. Therefore, we conducted a review to understand how PPG has been evaluated to assess a range of mental health and psychological problems, including stress, depression, and anxiety. METHODS: A scoping review was performed using PubMed and Google Scholar databases. RESULTS: A total of 24 papers met the inclusion criteria and were included in this review. We identified studies that assessed mental health via PPG using finger- and face-based methods as well as smartphone-based methods. There was variation in study quality. PPG holds promise as a potential complementary technology for detecting changes in mental health, including depression and anxiety. However, rigorous validation is needed in diverse clinical populations to advance PPG technology in tackling mental health problems. CONCLUSIONS: PPG holds promise for assessing mental health problems; however, more research is required before it can be widely recommended for clinical use.

Passive and Wireless All-Textile Wearable Sensor System.

Mobile health technology and activity tracking with wearable sensors enable continuous unobtrusive monitoring of movement and biophysical parameters. Advancements in clothing-based wearable devices have employed textiles as transmission lines, communication hubs, and various sensing modalities; this area of research is moving towards complete integration of circuitry into textile components. A current limitation for motion tracking is the need for communication protocols demanding physical connection of textile with rigid devices, or vector network analyzers (VNA) with limited portability and lower sampling rates. Inductor-capacitor (LC) circuits are ideal candidates as textile sensors can be easily implemented with textile components and allow wireless communication. In this paper, the authors report a smart garment that can sense movement and wirelessly transmit data in real time. The garment features a passive LC sensor circuit constructed of electrified textile elements that sense strain and communicate through inductive coupling. A portable, lightweight reader (fReader) is developed for achieving a faster sampling rate than a downsized VNA to track body movement, and for wirelessly reading sensor information suitable for deployment with a smartphone. The smart garment-fReader system monitors human movement in real-time and exemplifies the potential of textile-based electronics moving forward.

The use of deep learning for smartphone-based human activity recognition.

The emerging field of digital phenotyping leverages the numerous sensors embedded in a smartphone to better understand its user's current psychological state and behavior, enabling improved health support systems for patients. As part of this work, a common task is to use the smartphone accelerometer to automatically recognize or classify the behavior of the user, known as human activity recognition (HAR). In this article, we present a deep learning method using the Resnet architecture to implement HAR using the popular UniMiB-SHAR public dataset, containing 11,771 measurement segments from 30 users ranging in age between 18 and 60 years. We present a unified deep learning approach based on a Resnet architecture that consistently exceeds the state-of-the-art accuracy and F1-score across all classification tasks and evaluation methods mentioned in the literature. The most notable increase we disclose regards the leave-one-subject-out evaluation, known as the most rigorous evaluation method, where we push the state-of-the-art accuracy from 78.24 to 80.09% and the F1-score from 78.40 to 79.36%. For such results, we resorted to deep learning techniques, such as hyper-parameter tuning, label smoothing, and dropout, which helped regularize the Resnet training and reduced overfitting. We discuss how our approach could easily be adapted to perform HAR in real-time and discuss future research directions.

Cross-Link-Dependent Ionogel-Based Triboelectric Nanogenerators with Slippery and Antireflective Properties.

Given the ability to convert various ambient unused mechanical energies into useful electricity, triboelectric nanogenerators (TENGs) are gaining interest since their inception. Recently, ionogel-based TENGs (I-TENGs) have attracted increasing attention because of their excellent thermal stability and adjustable ionic conductivity. However, previous studies on ionogels mainly pursued the device performance or applications under harsh conditions, whereas few have investigated the structure-property relationships of components to performance. The results indicate that the ionogel formulation-composed of a crosslinking monomer with an ionic liquid-affects the conductivity of the ionogel by modulating the cross-link density. In addition, the ratio of cross-linker to ionic liquid is important to ensure the formation of efficient charge channels, yet increasing ionic liquid content delivers diminishing returns. The ionogels are then used in I-TENGs to harvest water droplet energy and the performance is correlated to the ionogels structure-property relationships. Improvement of the energy harvesting is further explored by the introduction of surface polymer brushes on I-TENGs via a facile and universal method, which enhances droplet sliding by means of ideal surface contact angle hysteresis and improves its anti-reflective properties by employing the I-TENG as a surface covering for solar cells.

Detecting Safety Anomalies in pHRI Activities via Force Myography.

The potential application of using a wearable force myography (FMG) band for monitoring the occupational safety of a human participant working in collaboration with an industrial robot was studied. Regular physical human-robot interactions were considered as activities of daily life in pHRI (pHRI-ADL) to recognize human-intended motions during such interactions. The force myography technique was used to read volumetric changes in muscle movements while a human participant interacted with a robot. Data-driven models were used to observe human activities for useful insights. Using three unsupervised learning algorithms, isolation forest, one-class SVM, and Mahalanobis distance, models were trained to determine pHRI-ADL/regular, preset activities by learning the latent features' distributions. The trained models were evaluated separately to recognize any unwanted interactions that differed from the normal activities, i.e., anomalies that were novel, inliers, or outliers to the normal distributions. The models were able to detect unusual, novel movements during a certain scenario that was considered an unsafe interaction. Once a safety hazard was detected, the control system generated a warning signal within seconds of the event. Hence, this study showed the viability of using FMG biofeedback to indicate risky interactions to prevent injuries, improve occupational health, and monitor safety in workplaces that require human participation.

Blood pressure stratification using photoplethysmography and light gradient boosting machine.

Introduction: Globally, hypertension (HT) is a substantial risk factor for cardiovascular disease and mortality; hence, rapid identification and treatment of HT is crucial. In this study, we tested the light gradient boosting machine (LightGBM) machine learning method for blood pressure stratification based on photoplethysmography (PPG), which is used in most wearable devices. Methods: We used 121 records of PPG and arterial blood pressure (ABP) signals from the Medical Information Mart for Intensive Care III public database. PPG, velocity plethysmography, and acceleration plethysmography were used to estimate blood pressure; the ABP signals were used to determine the blood pressure stratification categories. Seven feature sets were established and used to train the Optuna-tuned LightGBM model. Three trials compared normotension (NT) vs. prehypertension (PHT), NT vs. HT, and NT + PHT vs. HT. Results: The F1 scores for these three classification trials were 90.18%, 97.51%, and 92.77%, respectively. The results showed that combining multiple features from PPG and its derivative led to a more accurate classification of HT classes than using features from only the PPG signal. Discussion: The proposed method showed high accuracy in stratifying HT risks, providing a noninvasive, rapid, and robust method for the early detection of HT, with promising applications in the field of wearable cuffless blood pressure measurement.

GRGB rPPG: An Efficient Low-Complexity Remote Photoplethysmography-Based Algorithm for Heart Rate Estimation.

Remote photoplethysmography (rPPG) is a promising contactless technology that uses videos of faces to extract health parameters, such as heart rate. Several methods for transforming red, green, and blue (RGB) video signals into rPPG signals have been introduced in the existing literature. The RGB signals represent variations in the reflected luminance from the skin surface of an individual over a given period of time. These methods attempt to find the best combination of color channels to reconstruct an rPPG signal. Usually, rPPG methods use a combination of prepossessed color channels to convert the three RGB signals to one rPPG signal that is most influenced by blood volume changes. This study examined simple yet effective methods to convert the RGB to rPPG, relying only on RGB signals without applying complex mathematical models or machine learning algorithms. A new method, GRGB rPPG, was proposed that outperformed most machine-learning-based rPPG methods and was robust to indoor lighting and participant motion. Moreover, the proposed method estimated the heart rate better than well-established rPPG methods. This paper also discusses the results and provides recommendations for further research.