A comprehensive survey of wearable and wireless ECG monitoring systems for older adults

Detecting and Predicting Pilot Mental Workload Using Heart Rate Variability: A Systematic Review

Measuring pilot mental workload (MWL) is crucial for enhancing aviation safety. However, MWL is a multi-dimensional construct that could be affected by multiple factors. Particularly, in the context of a more automated cockpit setting, the traditional methods of assessing pilot MWL may face challenges. Heart rate variability (HRV) has emerged as a potential tool for detecting pilot MWL during real-flight operations. This review aims to investigate the relationship between HRV and pilot MWL and to assess the performance of machine-learning-based MWL detection systems using HRV parameters. A total of 29 relevant papers were extracted from three databases for review based on rigorous eligibility criteria. We observed significant variability across the reviewed studies, including study designs and measurement methods, as well as machine-learning techniques. Inconsistent results were observed regarding the differences in HRV measures between pilots under varying levels of MWL. Furthermore, for studies that developed HRV-based MWL detection systems, we examined the diverse model settings and discovered that several advanced techniques could be used to address specific challenges. This review serves as a practical guide for researchers and practitioners who are interested in employing HRV indicators for evaluating MWL and wish to incorporate cutting-edge techniques into their MWL measurement approaches.

Successful revascularization of inferior ST-segment elevation myocardial infarction with positive "Dead Man Sign": A case report

This case report outlines the management of a 43-year-old male with no past medical history presenting with inferior ST-segment elevation myocardial infarction and a positive "Dead Man Sign." Prompt administration of antiplatelet therapy and emergent percutaneous coronary intervention led to successful revascularization of the occluded right coronary artery and left anterior descending artery. The patient remained asymptomatic throughout hospitalization and was discharged home with instructions for monthly follow-up for 1 year. Subsequent assessments demonstrated normal echocardiography and Electrocardiography (ECG) findings, indicating favorable cardiac recovery. This case emphasizes the critical importance of rapid recognition and intervention in ST-segment elevation myocardial infarction cases, as well as the significance of the Dead Man Sign as a predictor of the occluded culprit coronary vessels, demonstrating favorable outcomes achievable with timely revascularization strategies.

Cardiorespiratory Sensors and Their Implications for Out-of-Hospital Cardiac Arrest Detection: A Systematic Review

Out-of-hospital cardiac arrest (OHCA) is a major health problem, with a poor survival rate of 2-11%. For the roughly 75% of OHCAs that are unwitnessed, survival is approximately 2-4.4%, as there are no bystanders present to provide life-saving interventions and alert Emergency Medical Services. Sensor technologies may reduce the number of unwitnessed OHCAs through automated detection of OHCA-associated physiological changes. However, no technologies are widely available for OHCA detection. This review identifies research and commercial technologies developed for cardiopulmonary monitoring that may be best suited for use in the context of OHCA, and provides recommendations for technology development, testing, and implementation. We conducted a systematic review of published studies along with a search of grey literature to identify technologies that were able to provide cardiopulmonary monitoring, and could be used to detect OHCA. We searched MEDLINE, EMBASE, Web of Science, and Engineering Village using MeSH keywords. Following inclusion, we summarized trends and findings from included studies. Our searches retrieved 6945 unique publications between January, 1950 and May, 2023. 90 studies met the inclusion criteria. In addition, our grey literature search identified 26 commercial technologies. Among included technologies, 52% utilized electrocardiography (ECG) and 40% utilized photoplethysmography (PPG) sensors. Most wearable devices were multi-modal (59%), utilizing more than one sensor simultaneously. Most included devices were wearable technologies (84%), with chest patches (22%), wrist-worn devices (18%), and garments (14%) being the most prevalent. ECG and PPG sensors are heavily utilized in devices for cardiopulmonary monitoring that could be adapted to OHCA detection. Developers seeking to rapidly develop methods for OHCA detection should focus on using ECG- and/or PPG-based multimodal systems as these are most prevalent in existing devices. However, novel sensor technology development could overcome limitations in existing sensors and could serve as potential additions to or replacements for ECG- and PPG-based devices.

Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial

BACKGROUND

Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers.

OBJECTIVE

This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors.

METHODS

Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period.

RESULTS

A total of 120 participants were enrolled (mean age 65 years; 50/120, 41% female; 106/120, 88% White). The Pulsewatch system demonstrated 92.9% (95% CI 85.3%-97.4%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days.

CONCLUSIONS

Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1016/j.cvdhj.2021.07.002.

Few-shot transfer learning for personalized atrial fibrillation detection using patient-based siamese network with single-lead ECG records

The proliferation of wearable devices has allowed the collection of electrocardiogram (ECG) recordings daily to monitor heart rhythm and rate. For example, 24-hour Holter monitors, cardiac patches, and smartwatches are widely used for ECG gathering and application. An automatic atrial fibrillation (AF) detector is required for timely ECG interpretation. Deep learning models can accurately identify AFs if large amounts of annotated data are available for model training. However, it is impractical to request sufficient labels for ECG recordings for an individual patient to train a personalized model. We propose a Siamese-network-based approach for transfer learning to address this issue. A pre-trained Siamese convolutional neural network is created by comparing two labeled ECG segments from the same patient. We sampled 30-second ECG segments with a 50% overlapping window from the ECG recordings of patients in the MIT-BIH Atrial Fibrillation Database. Subsequently, we independently detected the occurrence of AF in each patient in the Long-Term AF Database. By fine-tuning the model with the 1, 3, 5, 7, 9, or 11 ECG segments ranging from 30 to 180 s, our method achieved macro-F1 scores of 96.84%, 96.91%, 96.97%, 97.02%, 97.05%, and 97.07%, respectively.

Flexible electronics for cardiovascular healthcare monitoring

Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.

Characterization and Validation of Flexible Dry Electrodes for Wearable Integration

When long-term biosignal monitoring is required via surface electrodes, the use of conventional silver/silver chloride (Ag/AgCl) gelled electrodes may not be the best solution, as the gel in the electrodes tends to dry out over time. In this work, the electrical behaviour and performance of dry electrodes for biopotential monitoring was assessed. Three materials were investigated and compared against the gold-standard Ag/AgCl gelled electrodes. To characterize their electrical behaviour, the impedance response over the frequency was evaluated, as well as its signal to noise ratio. The electrodes' performance was evaluated by integrating them in a proven electrocardiogram (ECG) acquisition setup where an ECG signal was acquired simultaneously with a set of dry electrodes and a set of standard Ag/AgCl gelled electrodes as reference. The obtained results were morphologically compared using the Normalised Root Mean Squared Error (nRMSE) and the Cosine Similarity (CS). The findings of this work suggest that the use of dry electrodes for biopotential monitoring is a suitable replacement for the conventional Ag/AgCl gelled electrodes. The signal obtained with dry electrodes is comparable to the one obtained with the gold standard, with the advantage that these do not require the use of gel and can be easily integrated into fabric to facilitate their use in long-term monitoring scenarios.

[Diagnostic predictive value of liver biopsy for clinical aspects]

Background

The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices.

Objective

We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches.

Methods

We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis.

Results

The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG.

Conclusions

Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.

Motion Artifact Reduction in Electrocardiogram Signals Through a Redundant Denoising Independent Component Analysis Method for Wearable Health Care Monitoring Systems: Algorithm Development and Validation

Background

The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices.

Objective

We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches.

Methods

We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis.

Results

The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG.

Conclusions

Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.

The Technology Acceptance Model and Older Adults' Exercise Intentions-A Systematic Literature Review

Aging is a global phenomenon, and the use of exercise technology by older adults can help them to prevent disease, achieve good health, and ultimately achieve successful aging. In the past, there literature compilation studies have been conducted on sports technology and young people or on the use of technology by the older adults; however, no studies have determined the attitudes of older adults toward sports technology. This review applied a systematic literature analysis to determine the factors that correlate the technology acceptance model with the older population's exercise attitudes. A total of 10 studies were identified as contributing to the use of exercise technology by older adults. The main findings of this review are that, of the 28 factors identified in the 10 studies, only 18 were identified as factors influencing older adults' use of sports technology in the technology acceptance model (TAM). Among these, fifteen factors affected intention, four factors affected perceived ease of use, three factors affected perceived usefulness, and two factors affected attitudes. Finally, discussing the related factors affecting TAM allows us to provide suggestions for future research directions.

DE-PNN: Differential Evolution-Based Feature Optimization with Probabilistic Neural Network for Imbalanced Arrhythmia Classification

In this research, a heartbeat classification method is presented based on evolutionary feature optimization using differential evolution (DE) and classification using a probabilistic neural network (PNN) to discriminate between normal and arrhythmic heartbeats. The proposed method follows four steps: (1) preprocessing, (2) heartbeat segmentation, (3) DE feature optimization, and (4) PNN classification. In this method, we have employed direct signal amplitude points constituting the heartbeat acquired from the ECG holter device with no secondary feature extraction step usually used in case of hand-crafted, frequency transformation or other features. The heartbeat types include normal, left bundle branch block, right bundle branch block, premature ventricular contraction, atrial premature, ventricular escape, ventricular flutter and paced beat. Using ECG records from the MIT-BIH, heartbeats are identified to start at 250 ms before and end at 450 ms after the respective R-peak positions. In the next step, the DE method is applied to reduce and optimize the direct heartbeat features. Although complex and highly computational ECG heartbeat classification algorithms have been proposed in the literature, they failed to achieve high performance in detecting some minority heartbeat categories, especially for imbalanced datasets. To overcome this challenge, we propose an optimization step for the deep CNN model using a novel classification metric called the Matthews correlation coefficient (MCC). This function focuses on arrhythmia (minority) heartbeat classes by increasing their importance. Maximum MCC is used as a fitness function to identify the optimum combination of features for the uncorrelated and non-uniformly distributed eight beat class samples. The proposed DE-PNN scheme can provide better classification accuracy considering 8 classes with only 36 features optimized from a 253 element feature set implying an 85.77% reduction in direct amplitude features. Our proposed method achieved overall 99.33% accuracy, 94.56% F1, 93.84% sensitivity, and 99.21% specificity.

An Overview of the Sensors for Heart Rate Monitoring Used in Extramural Applications

This work presents an overview of the main strategies that have been proposed for non-invasive monitoring of heart rate (HR) in extramural and home settings. We discuss three categories of sensing according to what physiological effect is used to measure the pulsatile activity of the heart, and we focus on an illustrative sensing modality for each of them. Therefore, electrocardiography, photoplethysmography, and mechanocardiography are presented as illustrative modalities to sense electrical activity, mechanical activity, and the peripheral effect of heart activity. In this paper, we describe the physical principles underlying the three categories and the characteristics of the different types of sensors that belong to each class, and we touch upon the most used software strategies that are currently adopted to effectively and reliably extract HR. In addition, we investigate the strengths and weaknesses of each category linked to the different applications in order to provide the reader with guidelines for selecting the most suitable solution according to the requirements and constraints of the application.

Deep Learning for Detecting and Locating Myocardial Infarction by Electrocardiogram: A Literature Review

Myocardial infarction is a common cardiovascular disorder caused by prolonged ischemia, and early diagnosis of myocardial infarction (MI) is critical for lifesaving. ECG is a simple and non-invasive approach in MI detection, localization, diagnosis, and prognosis. Population-based screening with ECG can detect MI early and help prevent it but this method is too labor-intensive and time-consuming to carry out in practice unless artificial intelligence (AI) would be able to reduce the workload. Recent advances in using deep learning (DL) for ECG screening might rekindle this hope. This review aims to take stock of 59 major DL studies applied to the ECG for MI detection and localization published in recent 5 years, covering convolutional neural network (CNN), long short-term memory (LSTM), convolutional recurrent neural network (CRNN), gated recurrent unit (GRU), residual neural network (ResNet), and autoencoder (AE). In this period, CNN obtained the best popularity in both MI detection and localization, and the highest performance has been obtained from CNN and ResNet model. The reported maximum accuracies of the six different methods are all beyond 97%. Considering the usage of different datasets and ECG leads, the network that trained on 12 leads ECG data of PTB database has obtained higher accuracy than that on smaller number leads data of other datasets. In addition, some limitations and challenges of the DL techniques are also discussed in this review.

Human-like tele-health robotics for older adults – A preliminary feasibility trial and vision

Introduction

The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults’ vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely.

Aim

This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care.

Method

Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians.

Results

The findings demonstrated the system’s capability to support remote examination of participants, and validated the system’s perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination.

Conclusion

This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

Electrocardiogram Quality Assessment with a Generalized Deep Learning Model Assisted by Conditional Generative Adversarial Networks

The electrocardiogram (ECG) is widely used for cardiovascular disease diagnosis and daily health monitoring. Before ECG analysis, ECG quality screening is an essential but time-consuming and experience-dependent work for technicians. An automatic ECG quality assessment method can reduce unnecessary time loss to help cardiologists perform diagnosis. This study aims to develop an automatic quality assessment system to search qualified ECGs for interpretation. The proposed system consists of data augmentation and quality assessment parts. For data augmentation, we train a conditional generative adversarial networks model to get an ECG segment generator, and thus to increase the number of training data. Then, we pre-train a deep quality assessment model based on a training dataset composed of real and generated ECG. Finally, we fine-tune the proposed model using real ECG and validate it on two different datasets composed of real ECG. The proposed system has a generalized performance on the two validation datasets. The model's accuracy is 97.1% and 96.4%, respectively for the two datasets. The proposed method outperforms a shallow neural network model, and also a deep neural network models without being pre-trained by generated ECG. The proposed system demonstrates improved performance in the ECG quality assessment, and it has the potential to be an initial ECG quality screening tool in clinical practice.

Anytime ECG Monitoring through the Use of a Low-Cost, User-Friendly, Wearable Device

Every year cardiovascular diseases kill the highest number of people worldwide. Among these, pathologies characterized by sporadic symptoms, such as atrial fibrillation, are difficult to be detected as state-of-the-art solutions, e.g., 12-leads electrocardiogram (ECG) or Holter devices, often fail to tackle these kinds of pathologies. Many portable devices have already been proposed, both in literature and in the market. Unfortunately, they all miss relevant features: they are either not wearable or wireless and their usage over a long-term period is often unsuitable. In addition, the quality of recordings is another key factor to perform reliable diagnosis. The ECG WATCH is a device designed for targeting all these issues. It is inexpensive, wearable (size of a watch), and can be used without the need for any medical expertise about positioning or usage. It is non-invasive, it records single-lead ECG in just 10 s, anytime, anywhere, without the need to physically travel to hospitals or cardiologists. It can acquire any of the three peripheral leads; results can be shared with physicians by simply tapping a smartphone app. The ECG WATCH quality has been tested on 30 people and has successfully compared with an electrocardiograph and an ECG simulator, both certified. The app embeds an algorithm for automatically detecting atrial fibrillation, which has been successfully tested with an official ECG simulator on different severity of atrial fibrillation. In this sense, the ECG WATCH is a promising device for anytime cardiac health monitoring.

The application and deployment of welfare technology in Swedish municipal care: a qualitative study of procurement practices among municipal actors

Background

Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology.

Methods

The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories.

Results

Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines ‘procurement competence’ as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model.

Conclusions

Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user’s needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users.

A Meta-Learning Approach for Fast Personalization of Modality Translation Models in Wearable Physiological Sensing

Modality translation grants diagnostic value to wearable devices by translating signals collected from low-power sensors to their highly-interpretable counterparts that are more familiar to healthcare providers. For instance, bio-impedance (Bio-Z) is a conveniently collected modality for measuring physiological parameters but is not highly interpretable. Thus, translating it to a well-known modality such as electrocardiogram (ECG) improves the usability of Bio-Z in wearables. Deep learning solutions are well-suited for this task given complex relationships between modalities generated by distinct processes. However, current algorithms usually train a single model for all users that results in ignoring cross-user variations. Retraining for new users usually requires collecting abundant labeled data, which is challenging in healthcare applications. In this paper, we build a modality translation framework to translate Bio-Z to ECG by learning personalized user information without training several independent architectures. Furthermore, our framework is able to adapt to new users in testing using very few samples. We design a meta-learning framework that contains shared and user-specific parameters to account for user differences while learning from the similarity amongst user signals. In this model, a meta-learner approximated by a neural network learns how to learn user-specific parameters and can efficiently update them in testing. Our experiments show that the proposed model reduces the normalized root mean square error (NRMSE) by 41% compared to training a single model for all users and by 36% compared to training independent models for each user. When adapting the model to new users, our model outperforms fine-tuning a pre-trained model through back-propagation by 40% using as few as two new samples in testing.

Sensitivity and Adjustment Model of Electrocardiographic Signal Distortion Based on the Electrodes' Location and Motion Artifacts Reduction for Wearable Monitoring Applications

Wearable vital signs monitoring and specially the electrocardiogram have taken important role due to the information that provide about high-risk diseases, it has been evidenced by the needed to increase the health service coverage in home care as has been encouraged by World Health Organization. Some wearables devices have been developed to monitor the Electrocardiographic in which the location of the measurement electrodes is modified respect to the Einthoven model. However, mislocation of the electrodes on the torso can lead to the modification of acquired signals, diagnostic mistakes and misinterpretation of the information in the signal. This work presents a volume conductor evaluation and an Electrocardiographic signal waveform comparison when the location of electrodes is changed, to find a electrodes’ location that reduces distortion of interest signals. In addition, effects of motion artifacts and electrodes’ location on the signal acquisition are evaluated. A group of volunteers was recorded to obtain Electrocardiographic signals, the result was compared with a computational model of the heart behavior through the Ensemble Average Electrocardiographic, Dynamic Time Warping and Signal-to-Noise Ratio methods to quantitatively determine the signal distortion. It was found that while the Einthoven method is followed, it is possible to acquire the Electrocardiographic signal from the patient’s torso or back without a significant difference, and the electrodes position can be moved 6 cm at most from the suggested location by the Einthoven triangle in Mason–Likar’s method.

A new approach for physical human activity recognition based on co-occurrence matrices

In recent years, it has been observed that many researchers have been working on different areas of detection, recognition and monitoring of human activities. The automatic determination of human physical activities is often referred to as human activity recognition (HAR). One of the most important technology that detects and tracks the activity of the human body is sensor-based HAR technology. In recent days, sensor-based HAR attracts attention in the field of computers due to its wide use in daily life and is a rapidly growing field of research. Activity recognition (AR) application is carried out by evaluating the signals obtained from various sensors placed in the human body. In this study, a new approach is proposed to extract features from sensor signals using HAR. The proposed approach is inspired by the Gray Level Co-Occurrence Matrix (GLCM) method, which is widely used in image processing, but it is applied to one-dimensional signals, unlike GLCM. Two datasets were used to test the proposed approach. The datasets were created from the signals obtained from the accelerometer, gyro and magnetometer sensors. Heralick features were obtained from co-occurrence matrix created after 1D-GLCM (One (1) Dimensional-Gray Level Co-Occurrence Matrix) was applied to the signals. HAR operation has been carried out for different scenarios using these features. Success rates of 96.66 and 93.88% were obtained for two datasets, respectively. It has been observed that the new approach proposed within the scope of the study provides high success rates for HAR applications. It is thought that the proposed approach can be used in the classification of different signals.

A novel method for noninvasive bioelectric measurement utilizing conductivity of seawater

A novel method of noninvasive bioelectric measurement that utilizes the conductivity of seawater covering a person’s whole body is proposed. Concretely, a conductor used as a common electrode is sunk into the seawater, and four special bioelectrodes isolated from the seawater are attached at measurement points on the body. Bioelectric signals generated between the common electrode and special bioelectrodes are then measured. To verify the effectiveness of the proposed method, bioelectric signals of six participants immersed in a bathtub filled with seawater were experimentally measured. The measurement results revealed that the proposed method enables multipoint bioelectric measurement using about half the number of bioelectrodes used by the conventional method on land, and a plurality of bioelectric phenomena can be observed at one measurement point. It was also revealed that compared with the conventional method, the proposed method significantly reduces external electrical noise included in the bioelectric signals by exploiting the shielding effect of seawater. If simple bioelectric measurements in seawater were possible in the manner described above, not only people such as scuba divers but also precious animals living in the sea could be noninvasively treated as measurement subjects.

Factors Affecting the Initial Engagement of Older Adults in the Use of Interactive Technology

Smart environments and the use of interactive technology has the potential to improve the quality of life for the senior community as well as to support the connections among the senior community and the world outside their community. In addition to the increasing number of studies in the field of aging and technologies, research is needed to understand the practical issues of user focus, adoption, and engagement for older adults to accept interactive technologies in their lives. In this study, we use two commercial technological interventions (uDraw and GrandPad) to understand technology-related perceptions and behaviors of older adults. We present five case studies that emerge from empirical observations of initial engagement with technology through research methods such as focus group discussions, in-depth interviews, observations, and diary studies. The contributions of this study are identification of the key factors that influence the initial engagement with interactive technology for older adults.

Development of Wearable Wireless Electrocardiogram Detection System using Bluetooth Low Energy

Wearable monitoring devices can provide patients and doctors with the capability to measure bio-signals on demand. These systems provide enormous benefits for people with acute symptoms of serious health conditions. In this paper, we propose a novel method for collecting ECG signals using two wireless wearable modules. The electric potential measured from a sub-module is transferred to the main module through Bluetooth Low Energy, and the collected values are simultaneously displayed in the form of a graph. This study describes the configuration and outcomes of the proposed system and discusses the important challenges associated with the functioning of the device. The proposed system had 84% signal similarity to that of other commercial products. As a band-type module was used on each wrist to check the signal, continuous observation of patients can be achieved without restricting their actions or causing discomfort.

Advances of ECG Sensors from Hardware, Software and Format Interoperability Perspectives

It is well-known that cardiovascular disease is one of the major causes of death worldwide nowadays. Electrocardiogram (ECG) sensor is one of the tools commonly used by cardiologists to diagnose and detect signs of heart disease with their patients. Since fast, prompt and accurate interpretation and decision is important in saving the life of patients from sudden heart attack or cardiac arrest, many innovations have been made to ECG sensors. However, the use of traditional ECG sensors is still prevalent in the clinical settings of many medical institutions. This article provides a comprehensive survey on ECG sensors from hardware, software and data format interoperability perspectives. The hardware perspective outlines a general hardware architecture of an ECG sensor along with the description of its hardware components. The software perspective describes various techniques (denoising, machine learning, deep learning, and privacy preservation) and other computer paradigms used in the software development and deployment for ECG sensors. Finally, the format interoperability perspective offers a detailed taxonomy of current ECG formats and the relationship among these formats. The intention is to help researchers towards the development of modern ECG sensors that are suitable and approved for adoption in real clinical settings.

Automatic Classification of Myocardial Infarction Using Spline Representation of Single-Lead Derived Vectorcardiography

Myocardial infarction (MI) is one of the most prevalent cardiovascular diseases worldwide and most patients suffer from MI without awareness. Therefore, early diagnosis and timely treatment are crucial to guarantee the life safety of MI patients. Most wearable monitoring devices only provide single-lead electrocardiography (ECG), which represents a major limitation for their applicability in diagnosis of MI. Incorporating the derived vectorcardiography (VCG) techniques can help monitor the three-dimensional electrical activities of human hearts. This study presents a patient-specific reconstruction method based on long short-term memory (LSTM) network to exploit both intra- and inter-lead correlations of ECG signals. MI-induced changes in the morphological and temporal wave features are extracted from the derived VCG using spline approximation. After the feature extraction, a classifier based on multilayer perceptron network is used for MI classification. Experiments on PTB diagnostic database demonstrate that the proposed system achieved satisfactory performance to differentiating MI patients from healthy subjects and to localizing the infarcted area.

Wearable Belt With Built-In Textile Electrodes for Cardio-Respiratory Monitoring

Unobtrusive and continuous monitoring of vital signs is becoming more and more important both for patient monitoring in the home environment and for sports activity tracking. Even though many gadgets and clinical systems exist, the need for simple, low-cost and easily applicable solutions still remains, especially in view of a more widespread use within everyone’s reach. The paper presents a fully wearable and wireless sensorized belt, suitable to simultaneously acquire respiratory and cardiac signals employing a single acquisition channel. The adopted method relies on a 50-kHz current injected in the subject thorax through a couple of textile electrodes and on envelope detection of the trans-thoracic voltage acquired from a couple of different embedded electrodes. The resulting signal contains both the baseband electrocardiogram (ECG) signal and the trans-thoracic impedance signal, which encodes respiratory acts. The two signals can be easily separated through suitable filtering and the cardio–respiratory rates extracted. The proposed solution yields performances comparable to those of a spirometer and a two-lead ECG. The whole system, with a realization cost below 100 €, a wireless interface, and several hours (or even days) of autonomy, is a suitable candidate for everyday use, especially if complemented by motion artifact removal techniques, currently under implementation.

A novel gateway-based solution for remote elderly monitoring

Internet of Things (IoT) technologies have been applied to various fields such as manufacturing, automobile industry and healthcare. IoT-based healthcare has a significant impact on real-time remote monitoring of patients' health and consequently improving treatments and reducing healthcare costs. In fact, IoT has made healthcare more reliable, efficient, and accessible. Two major drawbacks which IoT suffers from can be expressed as: first, thelimited battery capacityof thesensorsis quickly depleted due to the continuous stream of data; second, the dependence of the system on the cloud for computations and processing causes latency in data transmission which is not accepted in real-time monitoring applications. This research is conducted to develop a real-time, secure, and energy-efficient platform which provides a solution for reducing computation load on the cloud and diminishing data transmission delay. In the proposed platform, the sensors utilize a state-of-the-art power saving technique known as Compressive Sensing (CS). CS allows sensors to retrieve the sensed data using fewer measurements by sending a compressed signal. In this framework, the signal reconstruction and processing are computed locally on a Heterogeneous Multicore Platform (HMP) device to decrease the dependency on the cloud. In addition, a framework has been implemented to control the system, set different parameters, display the data as well as send live notifications to medical experts through the cloud in order to alert them of any eventual hazardous event or abnormality and allow quick interventions. Finally, a case study of the system is presented demonstrating the acquisition and monitoring of the data for a given subject in real-time. The obtained results reveal that the proposed solution reduces 15.4% of energy consumption in sensors, that makes this prototype a good candidate for IoT employment in healthcare.

El Kassabi H, Ismail H, Nujum Navaz A. ECG Monitoring Systems: Review, Architecture, Processes, and Key Challenges

Health monitoring and its related technologies is an attractive research area. The electrocardiogram (ECG) has always been a popular measurement scheme to assess and diagnose cardiovascular diseases (CVDs). The number of ECG monitoring systems in the literature is expanding exponentially. Hence, it is very hard for researchers and healthcare experts to choose, compare, and evaluate systems that serve their needs and fulfill the monitoring requirements. This accentuates the need for a verified reference guiding the design, classification, and analysis of ECG monitoring systems, serving both researchers and professionals in the field. In this paper, we propose a comprehensive, expert-verified taxonomy of ECG monitoring systems and conduct an extensive, systematic review of the literature. This provides evidence-based support for critically understanding ECG monitoring systems' components, contexts, features, and challenges. Hence, a generic architectural model for ECG monitoring systems is proposed, an extensive analysis of ECG monitoring systems' value chain is conducted, and a thorough review of the relevant literature, classified against the experts' taxonomy, is presented, highlighting challenges and current trends. Finally, we identify key challenges and emphasize the importance of smart monitoring systems that leverage new technologies, including deep learning, artificial intelligence (AI), Big Data and Internet of Things (IoT), to provide efficient, cost-aware, and fully connected monitoring systems.

Advanced Sensing and Human Activity Recognition in Early Intervention and Rehabilitation of Elderly People

Ageing is associated with a decline in physical activity and a decrease in the ability to perform activities of daily living, affecting physical and mental health. Elderly people or patients could be supported by a human activity recognition (HAR) system that monitors their activity patterns and intervenes in case of change in behavior or a critical event has occurred. A HAR system could enable these people to have a more independent life.

In our approach, we apply machine learning methods from the field of human activity recognition (HAR) to detect human activities. These algorithmic methods need a large database with structured datasets that contain human activities. Compared to existing data recording procedures for creating HAR datasets, we present a novel approach, since our target group comprises of elderly and diseased people, who do not possess the same physical condition as young and healthy persons.

Since our targeted HAR system aims at supporting elderly and diseased people, we focus on daily activities, especially those to which clinical relevance in attributed, like hygiene activities, nutritional activities or lying positions. Therefore, we propose a methodology for capturing data with elderly and diseased people within a hospital under realistic conditions using wearable and ambient sensors. We describe how this approach is first tested with healthy people in a laboratory environment and then transferred to elderly people and patients in a hospital environment.

We also describe the implementation of an activity recognition chain (ARC) that is commonly used to analyse human activity data by means of machine learning methods and aims to detect activity patterns. Finally, the results obtained so far are presented and discussed as well as remaining problems that should be addressed in future research.

Assessment of artifacts reduction and denoising techniques in Electrocardiographic signals using Ensemble Average-based method

BACKGROUND AND OBJECTIVE

Outpatient vital signs monitoring has a key role in medical diagnosis and treatment. However, ambulatory vital signs monitoring has great challenges to overcome, being the most important, the reduction of noise and Motion Artifacts, which hide essential information, particularly in Electrocardiographic signals. Despite efforts being made to reduce these artifacts, a comparative performance assessment of proposed techniques does not exist to the best of our knowledge and there are no enhancement level measurements obtained by the signals in the artifacts reduction. This article presents a new method based on Ensemble Average for the performance comparison of reported techniques for the processing and reduction of noise and artifacts in Electrocardiographic signals.

METHODS

The comparison was done using a dataset composed by six synthetic noised Electrocardiographic signals and six real one acquired from healthy volunteers that intentionally introduced Motion Artifacts. Several techniques that have reported positive results in the enhancement of Electrocardiographic signals were applied to this dataset to compare their performance in the reduction of Motion Artifacts. The Signal-to-Noise Ratio and the Ensemble Average as a distortion measurement were used to compare the performance of algorithms to produce an enhanced signal.

RESULTS

In agreement to previous reports, all studied methods show a significant improvement of the Signal-to-Noise Ratio. Concerning the distortion of the waveform, although all methods caused high distortion on the enhanced signal waveform, the Wavelet-ICA method showed the best performance. The percentage of signal distortion introduced by denoising techniques was evaluated through the proposed Ensemble Average Electrocardiographic method.

CONCLUSIONS

It was found that the proposed method based on Ensemble Average offers a complementary way to measure the performance of denoising techniques when considering the introduced distortion in the waveform segments once the artifact reduction process was applied and not only the change in the Signal-to-Noise Ratio.

Hernández A. Robust, real-time generic detector based on a multi-feature probabilistic method

Robust, real-time event detection from physiological signals acquired during long-term ambulatory monitoring still represents a major challenge for highly-artifacted signals. In this paper, we propose an original and generic multi-feature probabilistic detector (MFPD) and apply it to real-time QRS complex detection under noisy conditions. The MFPD method calculates a binary Bayesian probability for each derived feature and makes a centralized fusion, using the Kullback-Leibler divergence. The method is evaluated on two ECG databases: 1) the MIT-BIH arrhythmia database from Physionet containing clean ECG signals, 2) a benchmark noisy database created by adding noise recordings of the MIT-BIH noise stress test database, also from Physionet, to the MIT-BIH arrhythmia database. Results are compared with a well-known wavelet-based detector, and two recently published detectors: one based on spatiotemporal characteristic of the QRS complex and the second, as the MFDP, based on feature calculations from the University of New South Wales detector (UNSW). For both benchmark Physionet databases, the proposed MFPD method achieves the lowest standard deviation in sensitivity and positive predictivity (+P) despite its online algorithm architecture. While the statistics are comparable for low-to mildly artifactual ECG signals, the MFPD outperforms reference methods for artifacted ECG with low SNR levels reaching 87.48 ± 14.21% in sensitivity and 89.39 ± 14.67% in +P as compared to 88.30 ± 17.66% and 86.06 ± 19.67% respectively from UNSW, the best performing reference method. With demonstrations on the extensively studied QRS detection problem, we consider that the proposed generic structure of the multi-feature probabilistic detector should offer promising perspectives for long-term monitoring applications for highly-artifacted signals.

Performance of graphene ECG electrodes under varying conditions

Smart garments for invisible health sensing have been available for a number of years, with heart sensing typically performed using silver loaded conductive threads integrated into the fabric to pick up the electrocardiogram. Recent work has investigated printed graphene textiles as an alternative to this, which are potentially more environmentally friendly, cost-effective, and can be performed after garment manufacturing. This paper presents an exploration of second order factors on the performance of graphene textile electrodes for electrocardiogram measurements. We prepare graphenebased textile electrodes using a simple and highly scalable continuous padding method. We then analyze two metrics: the change in heart rate estimation error, and the changes in signal-to-noise ratio; under two separate conditions: an extended record length, and varying temperatures; to recreate the some of the conditions the material would experience when being worn in real-life. We report that neither the heart rate estimation error or the signal-to-noise ratio are significantly affected after a long record or with varying temperature. These tests indicate that graphene electrodes are suitable for electrocardiogram measurements in a wearable that will be subjected to these conditions.

A Chest-Laminated Ultrathin and Stretchable E-Tattoo for the Measurement of Electrocardiogram, Seismocardiogram, and Cardiac Time Intervals

Seismocardiography (SCG) is a measure of chest vibration associated with heartbeats. While skin soft electronic tattoos (e-tattoos) have been widely reported for electrocardiogram (ECG) sensing, wearable SCG sensors are still based on either rigid accelerometers or non-stretchable piezoelectric membranes. This work reports an ultrathin and stretchable SCG sensing e-tattoo based on the filamentary serpentine mesh of 28-µm-thick piezoelectric polymer, polyvinylidene fluoride (PVDF). 3D digital image correlation (DIC) is used to map chest vibration to identify the best location to mount the e-tattoo and to investigate the effects of substrate stiffness. As piezoelectric sensors easily suffer from motion artifacts, motion artifacts are effectively reduced by performing subtraction between a pair of identical SCG tattoos placed adjacent to each other. Integrating the soft SCG sensor with a pair of soft gold electrodes on a single e-tattoo platform forms a soft electro-mechano-acoustic cardiovascular (EMAC) sensing tattoo, which can perform synchronous ECG and SCG measurements and extract various cardiac time intervals including systolic time interval (STI). Using the EMAC tattoo, strong correlations between STI and the systolic/diastolic blood pressures, are found, which may provide a simple way to estimate blood pressure continuously and noninvasively using one chest-mounted e-tattoo.

Ambulatory cardiac bio-signals: From mirage to clinical reality through a decade of progress

BACKGROUND

Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly.

OBJECTIVES

The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis.

RESULTS

Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance.

CONCLUSIONS

Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.

A Systematic Review of Wearable Sensors and IoT-Based Monitoring Applications for Older Adults - a Focus on Ageing Population and Independent Living

This review aims to present current advancements in wearable technologies and IoT-based applications to support independent living. The secondary aim was to investigate the barriers and challenges of wearable sensors and Internet-of-Things (IoT) monitoring solutions for older adults. For this work, we considered falls and activity of daily life (ADLs) for the ageing population (older adults). A total of 327 articles were screened, and 14 articles were selected for this review. This review considered recent studies published between 2015 and 2019. The research articles were selected based on the inclusion and exclusion criteria, and studies that support or present a vision to provide advancement to the current space of ADLs, independent living and supporting the ageing population. Most studies focused on the system aspects of wearable sensors and IoT monitoring solutions including advanced sensors, wireless data collection, communication platform and usability. Moderate to low usability/ user-friendly approach is reported in most of the studies. Other issues found were inaccurate sensors, battery/ power issues, restricting the users within the monitoring area/ space and lack of interoperability. The advancement of wearable technology and the possibilities of using advanced IoT technology to assist older adults with their ADLs and independent living is the subject of many recent research and investigation.

Patient acceptability of wearable vital sign monitoring technologies in the acute care setting: A systematic review

AIMS AND OBJECTIVES

To examine patient acceptability of wearable vital sign monitoring devices in the acute setting.

BACKGROUND

Wearable vital sign monitoring devices may improve patient safety, yet hospital patients' acceptability of these devices is largely unreported.

DESIGN

A systematic review.

METHODS

Cumulative Index to Nursing and Allied Health Literature Complete, MEDLINE Complete and EMBASE were searched, supplemented by reference list hand searching. Studies were included if they involved adult hospital patients (≥18 years), a wearable monitoring device capable of assessing ≥1 vital sign, and measured patient acceptability, satisfaction or experience of wearing the device. No date restrictions were enforced. Quality assessments of quantitative and qualitative studies were undertaken using the Downs and Black Checklist for Measuring Study Quality and the Critical Appraisal Skills Programme Qualitative Research Checklist, respectively. Meta-analyses were not possible given data heterogeneity and low research quality. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was completed.

RESULTS

Of the 427 studies screened, seven observational studies met the inclusion criteria. Six studies were of low quality and one was of high quality. In two studies, patient satisfaction was investigated. In the remaining studies, patient experience, patient opinions and experience, patient perceptions and experience, device acceptability, and patient comfort and concerns were investigated. In four studies, patients were mostly accepting of the wearable devices, reporting positive experiences and satisfaction relating to their use. In three studies, findings were mixed.

CONCLUSION

There is limited high-quality research examining patient acceptability of wearable vital sign monitoring devices as an a priori focus in the acute setting. Further understanding of patient perspectives of these devices is required to inform their continued use and development.

RELEVANCE TO CLINICAL PRACTICE

The provision of patient-centred nursing care is contingent on understanding patients' preferences, including their acceptability of technology use.

Integrating an openEHR-based personalized virtual model for the ageing population within HBase

Background

Frailty is a common clinical syndrome in ageing population that carries an increased risk for adverse health outcomes including falls, hospitalization, disability, and mortality. As these outcomes affect the health and social care planning, during the last years there is a tendency of investing in monitoring and preventing strategies. Although a number of electronic health record (EHR) systems have been developed, including personalized virtual patient models, there are limited ageing population oriented systems.

Methods

We exploit the openEHR framework for the representation of frailty in ageing population in order to attain semantic interoperability, and we present the methodology for adoption or development of archetypes. We also propose a framework for a one-to-one mapping between openEHR archetypes and a column-family NoSQL database (HBase) aiming at the integration of existing and newly developed archetypes into it.

Results

The requirement analysis of our study resulted in the definition of 22 coherent and clinically meaningful parameters for the description of frailty in older adults. The implemented openEHR methodology led to the direct use of 22 archetypes, the modification and reuse of two archetypes, and the development of 28 new archetypes. Additionally, the mapping procedure led to two different HBase tables for the storage of the data.

Conclusions

In this work, an openEHR-based virtual patient model has been designed and integrated into an HBase storage system, exploiting the advantages of the underlying technologies. This framework can serve as a base for the development of a decision support system using the openEHR’s Guideline Definition Language in the future.

Integrated IoT intelligent system for the automatic detection of cardiac variability

Detection of abnormal cardiac events during clinical examination is a matter of chances, as such events may not happen at that precise moment. We therefore propose the implementation and evaluation of a mobile based system that allows a real-time detection of cardiovascular problems related to heart-rate variability. Our approach is to integrate an Internet of Things eHealth kit based on Arduino and validated algorithms for heart rate variability to build a low-cost, reliable and scalable solution. 12 healthy users have evaluated the system in different scenarios to assess the best performing algorithm and the best windowing interval. Finally, a mobile system based on an Android application which integrated the Pan and Tompkins algorithm with a 20 seconds windowing and a module to retrieve real-time electrocardiography through a Bluetooth interface was implemented and assessed.

A lightweight piecewise linear synthesis method for standard 12-lead ECG signals based on adaptive region segmentation

This paper presents a lightweight synthesis algorithm, named adaptive region segmentation based piecewise linear (ARSPL) algorithm, for reconstructing standard 12-lead electrocardiogram (ECG) signals from a 3-lead subset (I, II and V2). Such a lightweight algorithm is particularly suitable for healthcare mobile devices with limited resources for computing, communication and data storage. After detection of R-peaks, the ECGs are segmented by cardiac cycles. Each cycle is further divided into four regions according to different cardiac electrical activity stages. A personalized linear regression algorithm is then applied to these regions respectively for improved ECG synthesis. The proposed ARSPL method has been tested on 39 subjects randomly selected from the PTB diagnostic ECG database and achieved accurate synthesis of remaining leads with an average correlation coefficient of 0.947, an average root-mean-square error of 55.4μV, and an average runtime performance of 114ms. Overall, these results are significantly better than those of the common linear regression method, the back propagation (BP) neural network and the BP optimized using the genetic algorithm. We have also used the reconstructed ECG signals to evaluate the denivelation of ST segment, which is a potential symptom of intrinsic myocardial disease. After ARSPL, only 10.71% of the synthesized ECG cycles are with a ST-level synthesis error larger than 0.1mV, which is also better than those of the three above-mentioned methods.

Mobile Personal Health Monitoring for Automated Classification of Electrocardiogram Signals in Elderly

Mobile electrocardiogram (ECG) monitoring is an emerging area that has received increasing attention in recent years, but still real-life validation for elderly residing in low and middle-income countries is scarce. We developed a wearable ECG monitor that is integrated with a self-designed wireless sensor for ECG signal acquisition. It is used with a native purposely designed smartphone application, based on machine learning techniques, for automated classification of captured ECG beats from aged people. When tested on 100 older adults, the monitoring system discriminated normal and abnormal ECG signals with a high degree of accuracy (97%), sensitivity (100%), and specificity (96.6%). With further verification, the system could be useful for detecting cardiac abnormalities in the home environment and contribute to prevention, early diagnosis, and effective treatment of cardiovascular diseases, while keeping costs down and increasing access to healthcare services for older persons.

Nontraditional Electrocardiogram and Algorithms for Inconspicuous In-Home Monitoring: Comparative Study

BACKGROUND

Wearable and connected in-home medical devices are typically utilized in uncontrolled environments and often measure physiologic signals at suboptimal locations. Motion artifacts and reduced signal-to-noise ratio, compared with clinical grade equipment, results in a highly variable signal quality that can change significantly from moment to moment. The use of signal quality classification algorithms and robust feature delineation algorithms designed to achieve high accuracy on poor quality physiologic signals can prove beneficial in addressing concerns associated with measurement accuracy, confidence, and clinical validity.

OBJECTIVE

The objective of this study was to demonstrate the successful extraction of clinical grade measures using a custom signal quality classification algorithm for the rejection of poor-quality regions and a robust QRS delineation algorithm from a nonstandard electrocardiogram (ECG) integrated into a toilet seat; a device plagued by many of the same challenges as wearable technologies and other Internet of Things-based medical devices.

METHODS

The present algorithms were validated using a study of 25 normative subjects and 29 heart failure (HF) subjects. Measurements captured from a toilet seat-based buttocks electrocardiogram were compared with a simultaneously captured 12-lead clinical grade ECG. The ECG lead with the highest morphological correlation to buttocks electrocardiogram was used to determine the accuracy of the heart rate (HR), heart rate variability (HRV), which used the standard deviation of the normal-to-normal (SDNN) intervals between sinus beats, QRS duration, and the corrected QT interval (QT_c). These algorithms were benchmarked using the MIT-BIH Arrhythmia Database (MITDB) and European ST-T Database (EDB), which are standardized databases commonly used to test QRS detection algorithms.

RESULTS

Clinical grade accuracy was achieved for all buttocks electrocardiogram measures compared with standard Lead II. For the normative cohort, the mean was -0.0 (SD 0.3) bpm (N=141 recordings) for HR accuracy and -1.0 (SD 3.4) ms for HRV (N=135). The QRS duration and the QT_c interval had an accuracy of -0.5 (SD 6.6) ms (N=85) and 14.5 (SD 11.1) ms (N=85), respectively. In the HF cohort, the accuracy for HR, HRV, QRS duration, and QT_c interval was 0.0 (SD 0.3) bpm (N=109), -6.6 (SD 13.2) ms (N=99), 2.9 (SD 11.5) ms (N=59), and 11.2 (SD 19.1) ms (N=58), respectively. When tested on MITDB and EDB, the algorithms presented herein had an overall sensitivity and positive predictive value of over 99.82% (N=900,059 total beats), which is comparable to best in-class algorithms tuned specifically for use with these databases.

CONCLUSIONS

The present algorithmic approach to data analysis of noisy physiologic data was successfully demonstrated using a toilet seat-based ECG remote monitoring system. This approach to the analysis of physiologic data captured from wearable and connected devices has future potential to enable new types of monitoring devices, providing new insights through daily, inconspicuous in-home monitoring.

Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies

Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.