Alterations in Heart Rate (HR) and Heart Rate Variability (HRV) can reflect autonomic dysfunction associated with neurodegeneration. We investigate the influence of Mild Cognitive Impairment (MCI) on HR and its variability measures in the Indian population by designing a complete signal processing pipeline to detect the R-wave peaks and compute HR and HRV features from ECG recordings of 10 seconds, for point-of-care applications. The study cohort involves 297 urban participants, among which 48.48% are male and 51.51% are female. From the Addenbrooke's Cognitive Examination-III (ACE-III), MCI is detected in 19.19% of participants and the rest, 80.8% of them are cognitively healthy. Statistical features like central tendency (mean and root mean square (RMS) of the Normal-to-Normal (NN) intervals) and dispersion (standard deviation (SD) of all NN intervals (SDNN) and root mean square of successive differences of NN intervals (RMSSD)) of beat-to-beat intervals are computed. The Wilcoxon rank sum test reveals that mean of NN intervals (p = 0.0021), the RMS of NN intervals (p = 0.0014), the SDNN (p = 0.0192) and the RMSSD (p = 0.0206) values differ significantly between MCI and non-MCI classes, for a level of significance, 0.05. Machine learning classifiers like, Support Vector Machine (SVM), Discriminant Analysis (DA) and Naive Bayes (NB) driven by mean NN intervals, RMS, SDNN and RMSSD, show a high accuracy of 80.80% on each individual feature input. Individuals with MCI are observed to have comparatively higher HR than healthy subjects. HR and its variability can be considered as potential biomarkers for detecting MCI.
There has been growing interest in facial video-based remote photoplethysmography (rPPG) measurement recently, with a focus on assessing various vital signs such as heart rate and heart rate variability. Despite previous efforts on static datasets, their approaches have been hindered by inaccurate region of interest (ROI) localization and motion issues, and have shown limited generalization in real-world scenarios. To address these challenges, we propose a novel masked attention regularization (MAR-rPPG) framework that mitigates the impact of ROI localization and complex motion artifacts. Specifically, our approach first integrates a masked attention regularization mechanism into the rPPG field to capture the visual semantic consistency of facial clips, while it also employs a masking technique to prevent the model from overfitting on inaccurate ROIs and subsequently degrading its performance. Furthermore, we propose an enhanced rPPG expert aggregation (EREA) network as the backbone to obtain rPPG signals and attention maps simultaneously. Our EREA network is capable of discriminating divergent attentions from different facial areas and retaining the consistency of spatiotemporal attention maps. For motion robustness, a simple open source detector MediaPipe for data preprocessing is sufficient for our framework due to its superior capability of rPPG signal extraction and attention regularization. Exhaustive experiments on three benchmark datasets (UBFC-rPPG, PURE, and MMPD) substantiate the superiority of our proposed method, outperforming recent state-of-the-art works by a considerable margin.
This study employs cutting-edge wearable monitoring technology to conduct high-precision, high-temporal-resolution (1-second interval) cognitive load assessment on electroencephalogram (EEG) data from the FP1 channel and heart rate variability (HRV) data of secondary vocational students. By jointly analyzing these two critical physiological indicators, the research delves into their application value in assessing cognitive load among secondary vocational students and their utility across various tasks. The study designed two experiments to validate the efficacy of the proposed approach: Initially, a random forest classification model, developed using the N-BACK task, enabled the precise decoding of physiological signal characteristics in secondary vocational students under different levels of cognitive load, achieving a classification accuracy of 97%. Subsequently, this classification model was applied in a cross-task experiment involving the National Computer Rank Examination (Level-1), demonstrating the method's significant applicability and cross-task transferability in diverse learning contexts. Conducted with high portability, this research holds substantial theoretical and practical significance for optimizing teaching resource allocation in secondary vocational education, as well as for cognitive load assessment methods and monitoring. Currently, the research findings are undergoing trial implementation in the school.
A number of inhibitory and excitatory factors regulate the beating of the heart. Consequently, the inter-beat intervals (IBIs) are not constant but vary around a mean value, even in the absence of external factors like exercise or stress. Various statistics have been proposed to capture the heart rate variability (HRV) to provide a glimpse into this balance. These statistics usually require accurate estimation of IBIs as a first step. However, estimating IBIs accurately can be challenging in practice, especially for signals recorded in ambulatory conditions. We propose a lightweight state-space filter that models the IBIs as samples of an inverse Gaussian distribution with time-varying parameters. We make the filter robust against outliers by adapting the probabilistic data association filter to the setup. We demonstrate that the resulting filter can accurately identify outliers and the parameters of the tracked distribution can be used to compute a specific HRV statistic (standard deviation of normal-to-normal intervals) without further analysis.
Low-frequency oscillations in the human circulatory system is important for basic physiology and practical applications in clinical medicine. Our objective was to study which mechanism (central or local) is responsible for changes in blood flow fluctuations at around 0.1 Hz. We used the method of imaging photoplethysmography synchronized with electrocardiography to measure blood-flow response to local forearm heating of 18 healthy male volunteers. The dynamics of peripheral perfusion was revealed by a correlation processing of photoplethysmography data, and the central hemodynamics was assessed from the electrocardiogram. Wavelet analysis was used to estimate the dynamics of spectral components. Our results show that skin heating leads to multiple increase in local perfusion accompanied by drop in blood flow oscillations at 0.1 Hz, whereas no changes in heart rate variability was observed. After switching off the heating, perfusion remains at the high level, regardless decrease in skin temperature. The 0.1 Hz oscillations are smoothly recovered to the base level. In conclusion, we confirm the local nature of fluctuations in peripheral blood flow in the frequency band of about 0.1 Hz. A significant, but time-delayed, recovery of fluctuation energy in this frequency range after cessation of the skin warming was discovered. This study reveals a novel factor involved in the regulation microcirculatory vascular tone. A comprehensive study of hemodynamics using the new technique of imaging photoplethysmography synchronized with electrocardiography is a prerequisite for development of a valuable diagnostic tool.
Automatic stress detection using heart rate variability (HRV) features has gained significant traction as it utilizes unobtrusive wearable sensors measuring signals like electrocardiogram (ECG) or blood volume pulse (BVP). However, detecting stress through such physiological signals presents a considerable challenge owing to the variations in recorded signals influenced by factors, such as perceived stress intensity and measurement devices. Consequently, stress detection models developed on one dataset may perform poorly on unseen data collected under different conditions. To address this challenge, this study explores the generalizability of machine learning models trained on HRV features for binary stress detection. Our goal extends beyond evaluating generalization performance; we aim to identify the characteristics of datasets that have the most significant influence on generalizability. We leverage four publicly available stress datasets (WESAD, SWELL-KW, ForDigitStress, VerBIO) that vary in at least one of the characteristics such as stress elicitation techniques, stress intensity, and sensor devices. Employing a cross-dataset evaluation approach, we explore which of these characteristics strongly influence model generalizability. Our findings reveal a crucial factor affecting model generalizability: stressor type. Models achieved good performance across datasets when the type of stressor (e.g., social stress in our case) remains consistent. Factors like stress intensity or brand of the measurement device had minimal impact on cross-dataset performance. Based on our findings, we recommend matching the stressor type when deploying HRV-based stress models in new environments. To the best of our knowledge, this is the first study to systematically investigate factors influencing the cross-dataset applicability of HRV-based stress models.
Recent years have witnessed the great advance of bioradar system in smart sensing of vital signs (VS) for human healthcare monitoring. As an important part of VS sensing process, VS measurement aims to capture the chest wall micromotion induced by the human respiratory and cardiac activities. Unfortunately, the existing VS measurement methods using bioradar have encountered bottlenecks in making a trade-off between time cost and measurement accuracy. To break this bottleneck, this letter proposes an efficient recursive technique (BERT) heuristically, based on the observation that the features of bioradar VS meet the conditions of Markov model. Extensive experimental results validate that BERT measurement yields lower time costs, competitive estimates of heart rate, breathing rate, and heart rate variability. Our BERT method is promising us a new and superior option to measure VS for bioradar. This work seeks not only to solve the current issue of how to accelerate VS measurement with an acceptable accuracy, but also to inspire creative new ideas that spur further advances in this promising field in the future.
Heart rate variability (HRV) series reflects the dynamical variation of heartbeat-to-heartbeat intervals in time and is one of the outputs of the cardiovascular system. Over the years, this system has been recognized for generating nonlinear and complex heartbeat dynamics, with the latter referring to a high sensitivity to small -- theoretically infinitesimal -- input changes. While early research associated chaotic behavior with the cardiovascular system, evidence of stochastic inputs to the system, i.e., a physiological noise, invalidated those conclusions. To date, a comprehensive characterization of the cardiovascular system dynamics, accounting for dynamical noise input, has not been undertaken. In this study, we propose a novel methodological framework for evaluating the presence of regular or chaotic dynamics in noisy dynamical systems. The method relies on the estimation of asymptotic growth rate of noisy mean square displacement series in a two-dimensional phase space. We validated the proposed method using synthetic series comprising well-known regular and chaotic maps. We applied the method to real HRV series from healthy subjects, as well as patients with atrial fibrillation and congestive heart failure, during unstructured long-term activity. Results indicate that HRV series are consistently generated by a regular system driven by dynamical noise.
Virtual Reality (VR) has emerged as a promising tool for enhancing social skills and emotional well-being in individuals with Autism Spectrum Disorder (ASD). Through a technical exploration, this study employs a multiplayer serious gaming environment within VR, engaging 34 individuals diagnosed with ASD and employing high-precision biosensors for a comprehensive view of the participants' arousal and responses during the VR sessions. Participants were subjected to a series of 3 virtual scenarios designed in collaboration with stakeholders and clinical experts to promote socio-cognitive skills and emotional regulation in a controlled and structured virtual environment. We combined the framework with wearable non-invasive sensors for bio-signal acquisition, focusing on the collection of heart rate variability, and respiratory patterns to monitor participants behaviors. Further, behavioral assessments were conducted using observation and semi-structured interviews, with the data analyzed in conjunction with physiological measures to identify correlations and explore digital-intervention efficacy. Preliminary analysis revealed significant correlations between physiological responses and behavioral outcomes, indicating the potential of physiological feedback to enhance VR-based interventions for ASD. The study demonstrated the feasibility of using real-time data to adapt virtual scenarios, suggesting a promising avenue to support personalized therapy. The integration of quantitative physiological feedback into digital platforms represents a forward step in the personalized intervention for ASD. By leveraging real-time data to adjust therapeutic content, this approach promises to enhance the efficacy and engagement of digital-based therapies.
Engagement measurement finds application in healthcare, education, services. The use of physiological and behavioral features is viable, but the impracticality of traditional physiological measurement arises due to the need for contact sensors. We demonstrate the feasibility of unsupervised remote photoplethysmography (rPPG) as an alternative for contact sensors in deriving heart rate variability (HRV) features, then fusing these with behavioral features to measure engagement in online group meetings. Firstly, a unique Engagement Dataset of online interactions among social workers is collected with granular engagement labels, offering insight into virtual meeting dynamics. Secondly, a pre-trained rPPG model is customized to reconstruct rPPG signals from video meetings in an unsupervised manner, enabling the calculation of HRV features. Thirdly, the feasibility of estimating engagement from HRV features using short observation windows, with a notable enhancement when using longer observation windows of two to four minutes, is demonstrated. Fourthly, the effectiveness of behavioral cues is evaluated when fused with physiological data, which further enhances engagement estimation performance. An accuracy of 94% is achieved when only HRV features are used, eliminating the need for contact sensors or ground truth signals; use of behavioral cues raises the accuracy to 96%. Facial analysis offers precise engagement measurement, beneficial for future applications.
Cardiovascular diseases, including Heart Failure (HF), remain a leading global cause of mortality, often evading early detection. In this context, accessible and effective risk assessment is indispensable. Traditional approaches rely on resource-intensive diagnostic tests, typically administered after the onset of symptoms. The widespread availability of electrocardiogram (ECG) technology and the power of Machine Learning are emerging as viable alternatives within smart healthcare. In this paper, we propose several multi-modal approaches that combine 30-second ECG recordings and approximate long-term Heart Rate Variability (HRV) data to estimate the risk of HF hospitalization. We introduce two survival models: an XGBoost model with Accelerated Failure Time (AFT) incorporating comprehensive ECG features and a ResNet model that learns from the raw ECG. We extend these with our novel long-term HRVs extracted from the combination of ultra-short-term beat-to-beat measurements taken over the day. To capture their temporal dynamics, we propose a survival model comprising ResNet and Transformer architectures (TFM-ResNet). Our experiments demonstrate high model performance for HF risk assessment with a concordance index of 0.8537 compared to 14 survival models and competitive discrimination power on various external ECG datasets. After transferability tests with Apple Watch data, our approach implemented in the myHeartScore App offers cost-effective and highly accessible HF risk assessment, contributing to its prevention and management.
The effective detection and accurate clinical diagnosis of cardiac conditions strongly relies on the correct localization of R-peaks in the electrocardiogram (ECG). Recently, demand for sample-accurate R-peak detection, which is essential to precisely reveal vital features, such as heart rate variability and pulse transit time, has increased. Therefore, we propose two novel sample-accurate visibility-graph-based R-peak detectors, the FastNVG and the FastWHVG detector. The visibility graph (VG) transformation maps a discrete signal into a graph by representing sampling locations as nodes and establishing edges between mutually visible samples. However, processing large-scale clinical ECG data urgently demands further acceleration of VG-based algorithms. The proposed methods reduce the required computation time by one order of magnitude and simultaneously decrease the required memory compared to a recently proposed VG-based R-Peak detector. Instead of transforming the entire ECG, the proposed acceleration benefits largely from building the VG based on a subset containing only the samples relevant to R-peak detection. Further acceleration is obtained by adopting the computationally efficient horizontal visibility graph, which has not yet been used for R-peak detection. Numerical experiments and benchmarks on multiple ECG databases demonstrate a significantly superior performance of the proposed VG-based methods compared to popular R-peak detectors.
Fake news on social media has large, negative implications for society. However, little is known about what linguistic cues make people fall for fake news and, hence, how to design effective countermeasures for social media. In this study, we seek to understand which linguistic cues make people fall for fake news. Linguistic cues (e.g., adverbs, personal pronouns, positive emotion words, negative emotion words) are important characteristics of any text and also affect how people process real vs. fake news. Specifically, we compare the role of linguistic cues across both cognitive processing (related to careful thinking) and affective processing (related to unconscious automatic evaluations). To this end, we performed a within-subject experiment where we collected neurophysiological measurements of 42 subjects while these read a sample of 40 real and fake news articles. During our experiment, we measured cognitive processing through eye fixations, and affective processing in situ through heart rate variability. We find that users engage more in cognitive processing for longer fake news articles, while affective processing is more pronounced for fake news written in analytic words. To the best of our knowledge, this is the first work studying the role of linguistic cues in fake news processing. Altogether, our findings have important implications for designing online platforms that encourage users to engage in careful thinking and thus prevent them from falling for fake news.
This study introduces a novel, rich dataset obtained from home sleep apnea tests using the FDA-approved WatchPAT-300 device, collected from 7,077 participants over 21,412 nights. The dataset comprises three levels of sleep data: raw multi-channel time-series from sensors, annotated sleep events, and computed summary statistics, which include 447 features related to sleep architecture, sleep apnea, and heart rate variability (HRV). We present reference values for Apnea/Hypopnea Index (AHI), sleep efficiency, Wake After Sleep Onset (WASO), and HRV sample entropy, stratified by age and sex. Moreover, we demonstrate that the dataset improves the predictive capability for various health related traits, including body composition, bone density, blood sugar levels and cardiovascular health. These results illustrate the dataset's potential to advance sleep research, personalized healthcare, and machine learning applications in biomedicine.
Conversational Health Agents (CHAs) are interactive systems that provide healthcare services, such as assistance and diagnosis. Current CHAs, especially those utilizing Large Language Models (LLMs), primarily focus on conversation aspects. However, they offer limited agent capabilities, specifically lacking multi-step problem-solving, personalized conversations, and multimodal data analysis. Our aim is to overcome these limitations. We propose openCHA, an open-source LLM-powered framework, to empower conversational agents to generate a personalized response for users' healthcare queries. This framework enables developers to integrate external sources including data sources, knowledge bases, and analysis models, into their LLM-based solutions. openCHA includes an orchestrator to plan and execute actions for gathering information from external sources, essential for formulating responses to user inquiries. It facilitates knowledge acquisition, problem-solving capabilities, multilingual and multimodal conversations, and fosters interaction with various AI platforms. We illustrate the framework's proficiency in handling complex healthcare tasks via two demonstrations and four use cases. Moreover, we release openCHA as open source available to the community via GitHub.
PhysioZoo is a collaborative platform designed for the analysis of continuous physiological time series. The platform currently comprises four modules, each consisting of a library, a user interface, and a set of tutorials: (1) PhysioZoo HRV, dedicated to studying heart rate variability (HRV) in humans and other mammals; (2) PhysioZoo SPO2, which focuses on the analysis of digital oximetry biomarkers (OBM) using continuous oximetry (SpO2) measurements from humans; (3) PhysioZoo ECG, dedicated to the analysis of electrocardiogram (ECG) time series; (4) PhysioZoo PPG, designed to study photoplethysmography (PPG) time series. In this proceeding, we introduce the PhysioZoo platform as an open resource for digital physiological biomarkers engineering, facilitating streamlined analysis and data visualization of physiological time series while ensuring the reproducibility of published experiments. We welcome researchers to contribute new libraries for the analysis of various physiological time series, such as electroencephalography, blood pressure, and phonocardiography. You can access the resource at physiozoo.com. We encourage researchers to explore and utilize this platform to advance their studies in the field of continuous physiological time-series analysis.
Arrhythmia, an abnormal cardiac rhythm, is one of the most common types of cardiac disease. Automatic detection and classification of arrhythmia can be significant in reducing deaths due to cardiac diseases. This work proposes a multi-class arrhythmia detection algorithm using single channel electrocardiogram (ECG) signal. In this work, heart rate variability (HRV) along with morphological features and wavelet coefficient features are utilized for detection of 9 classes of arrhythmia. Statistical, entropy and energy-based features are extracted and applied to machine learning based random forest classifiers. Data used in both works is taken from 4 broad databases (CPSC and CPSC extra, PTB-XL, G12EC and Chapman-Shaoxing and Ningbo Database) made available by Physionet. With HRV and time domain morphological features, an average accuracy of 85.11%, sensitivity of 85.11%, precision of 85.07% and F1 score of 85.00% is obtained whereas with HRV and wavelet coefficient features, the performance obtained is 90.91% accuracy, 90.91% sensitivity, 90.96% precision and 90.87% F1 score. The detailed analysis of simulation results affirms that the presented scheme effectively detects broad categories of arrhythmia from single-channel ECG records. In the last part of the work, the proposed classification schemes are implemented on hardware using Raspberry Pi for real time ECG signal classification.
Electrocardiography (ECG) plays a significant role in diagnosing heart-related issues, it provides, accurate, fast, and dependable insights into crucial parameters like QRS complex duration, the R-R interval, and the occurrence, amplitude, and duration of P, R, and T waves. However, utilizing ECG for prolonged monitoring poses challenges as it necessitates connecting multiple electrodes to the patient's body. This can be discomforting and disruptive, hampering the attainment of uninterrupted recordings. Ballistocardiography (BCG) emerges as a promising substitute for ECG, presenting a non-invasive technique for recording the heart's mechanical activity. BCG signals can be captured using sensors positioned beneath the bed, thereby providing enhanced comfort and convenience for long-term monitoring of the subject. In a recent study, researchers compared the heart rate variability (HRV) indices derived from simultaneously acquired ECG and BCG signals. Encouragingly, the BCG signal yielded satisfactory results similar to those obtained from ECG, implying that BCG holds potential as a viable alternative for prolonged monitoring. The findings of this study carry substantial implications for the advancement of innovative, non-invasive methods in monitoring heart health. BCG showcases the ability to offer a more comfortable and convenient alternative to ECG while retaining its capacity to deliver accurate and reliable cardiac information concerning a patient's condition.
Smart watches and other wearable devices are equipped with photoplethysmography (PPG) sensors for monitoring heart rate and other aspects of cardiovascular health. However, PPG signals collected from such devices are susceptible to corruption from noise and motion artifacts, which cause errors in heart rate estimation. Typical denoising approaches filter or reconstruct the signal in ways that eliminate much of the morphological information, even from the clean parts of the signal that would be useful to preserve. In this work, we develop an algorithm for denoising PPG signals that reconstructs the corrupted parts of the signal, while preserving the clean parts of the PPG signal. Our novel framework relies on self-supervised training, where we leverage a large database of clean PPG signals to train a denoising autoencoder. As we show, our reconstructed signals provide better estimates of heart rate from PPG signals than the leading heart rate estimation methods. Further experiments show significant improvement in Heart Rate Variability (HRV) estimation from PPG signals using our algorithm. We conclude that our algorithm denoises PPG signals in a way that can improve downstream analysis of many different health metrics from wearable devices.
Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different individuals and at different times within the same individual to result in the minimum possible false-positive and false-negative rates. The application of standard cut-off points and risk scores across populations hinges upon the assumption of such generalizability. Such generalizability, in turn, hinges upon this condition that the phenomenon investigated by current statistical methods is ergodic, i.e., its statistical measures converge over individuals and time within the finite limit of observations. However, emerging evidence indicates that biological processes abound with non-ergodicity, threatening this generalizability. Here, we present a solution for how to make generalizable inferences by deriving ergodic descriptions of non-ergodic phenomena. For this aim, we proposed capturing the origin of ergodicity-breaking in many biological processes: cascade dynamics. To assess our hypotheses, we embraced the challenge of identifying reliable biomarkers for heart disease and stroke, which, despite being the leading cause of death worldwide and decades of research, lacks reliable biomarkers and risk stratification tools. We showed that raw R-R interval data and its common descriptors based on mean and variance are non-ergodic and non-specific. On the other hand, the cascade-dynamical descriptors, the Hurst exponent encoding linear temporal correlations, and multifractal nonlinearity encoding nonlinear interactions across scales described the non-ergodic heart rate variability ergodically and were specific. This study inaugurates applying the critical concept of ergodicity in discovering and applying digital biomarkers of health and disease.