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Nocturnal monitoring of continuous, cuffless blood pressure (BP) can unleash a whole new world for the prognostication of cardiovascular and other diseases due to its strong predictive capability. Nevertheless, the lack of an accurate and reliable method, primarily due to confounding variables, has prevented its widespread clinical adoption. Herein, we demonstrate how optimized machine learning using the Catch-22 features, when applied to the photoplethysmogram waveform and personalized with direct BP data through transfer learning, can accurately estimate systolic and diastolic BP. After training with a hemodynamically compromised VitalDB “calibration-free” dataset (n = 1293), the systolic and diastolic BP tested on a distinct VitalDB dataset that met AAMI criteria (n = 116) had acceptable error biases of −1.85 mm Hg and 0.11 mm Hg, respectively [within the 5 mm Hg IEC/ANSI/AAMI 80601-2-30, 2018 standard], but standard deviation (SD) errors of 19.55 mm Hg and 11.55 mm Hg, respectively [exceeding the stipulated 8 mm Hg limit]. However, personalization using an initial calibration data segment and subsequent use of transfer learning to fine-tune the pretrained model produced acceptable mean (−1.31 mm Hg and 0.10 mm Hg) and SD (7.91 mm Hg and 4.59 mm Hg) errors for systolic and diastolic BP, respectively. Levene’s test for variance found that the personalization method significantly outperformed (p < 0.05) the calibration-free method, but there was no difference between three machine learning methods. Optimized multimodal Catch-22 features, coupled with personalization, demonstrate great promise in the clinical adoption of continuous, cuffless blood pressure estimation in applications such as nocturnal BP monitoring.

Hand foot and mouth disease (HFMD) and tetanus are serious infectious diseases in low- and middle-income countries. Tetanus, in particular, has a high mortality rate and its treatment is resource-demanding. Furthermore, HFMD often affects a large number of infants and young children. As a result, its treatment consumes enormous healthcare resources, especially when outbreaks occur. Autonomic nervous system dysfunction (ANSD) is the main cause of death for both HFMD and tetanus patients. However, early detection of ANSD is a difficult and challenging problem. The authors aim to provide a proof-of-principle to detect the ANSD level automatically by applying machine learning techniques to physiological patient data, such as electrocardiogram waveforms, which can be collected using low-cost wearable sensors. Efficient features are extracted that encode variations in the waveforms in the time and frequency domains. The proposed approach is validated on multiple datasets of HFMD and tetanus patients in Vietnam. Results show that encouraging performance is achieved. Moreover, the proposed features are simple, more generalisable and outperformed the standard heart rate variability analysis. The proposed approach would facilitate both the diagnosis and treatment of infectious diseases in low- and middle-income countries, and thereby improve patient care.

Cardiovascular diseases are one of the most severe causes of mortality, annually taking a heavy toll on lives worldwide. Continuous monitoring of blood pressure seems to be the most viable option, but this demands an invasive process, introducing several layers of complexities and reliability concerns due to non-invasive techniques not being accurate. This motivates us to develop a method to estimate the continuous arterial blood pressure (ABP) waveform through a non-invasive approach using Photoplethysmogram (PPG) signals. We explore the advantage of deep learning, as it would free us from sticking to ideally shaped PPG signals only by making handcrafted feature computation irrelevant, which is a shortcoming of the existing approaches. Thus, we present PPG2ABP, a two-stage cascaded deep learning-based method that manages to estimate the continuous ABP waveform from the input PPG signal with a mean absolute error of 4.604 mmHg, preserving the shape, magnitude, and phase in unison. However, the more astounding success of PPG2ABP turns out to be that the computed values of Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Systolic Blood Pressure (SBP) from the estimated ABP waveform outperform the existing works under several metrics (mean absolute error of 3.449 ± 6.147 mmHg, 2.310 ± 4.437 mmHg, and 5.727 ± 9.162 mmHg, respectively), despite that PPG2ABP is not explicitly trained to do so. Notably, both for DBP and MAP, we achieve Grade A in the BHS (British Hypertension Society) Standard and satisfy the AAMI (Association for the Advancement of Medical Instrumentation) standard.

Compared with diastolic blood pressure (DBP) and systolic blood pressure (SBP), the blood pressure (BP) waveform contains richer physiological information that can be used for disease diagnosis. However, most models based on photoplethysmogram (PPG) signals can only estimate SBP and DBP and are susceptible to noise signals. We focus on estimating the BP waveform rather than discrete BP values. We propose a model based on a generalized regression neural network to estimate the BP waveform, SBP and DBP. This model takes the raw PPG signal as input and BP waveform as output. The SBP and DBP are extracted from the estimated BP waveform. In addition, the model contains encoders and decoders, and their role is to be responsible for the conversion between the time domain and frequency domain of the waveform. The prediction results of our model show that the mean absolute error is 3.96 ± 5.36 mmHg for SBP and 2.39 ± 3.28 mmHg for DBP, the root mean square error is 5.54 for SBP and 3.45 for DBP. These results fulfill the Association for the Advancement of Medical Instrumentation (AAMI) standard and obtain grade A according to the British Hypertension Society (BHS) standard. The results show that the proposed model can effectively estimate the BP waveform only using the raw PPG signal.

Hemorrhage is the leading cause of preventable death from trauma. Accurate monitoring of hemorrhage and resuscitation can significantly reduce mortality and morbidity but remains a challenge due to the low sensitivity of traditional vital signs in detecting blood loss and possible hemorrhagic shock. Vital signs are not reliable early indicators because of physiological mechanisms that compensate for blood loss and thus do not provide an accurate assessment of volume status. As an alternative, machine learning (ML) algorithms that operate on an arterial blood pressure (ABP) waveform have been shown to provide an effective early indicator. However, these ML approaches lack physiological interpretability. In this paper, we evaluate and compare the performance of ML models trained on nine ABP-derived features that provide physiological insight, using a database of 13 human subjects from a lower-body negative pressure (LBNP) model of progressive central hypovolemia and subsequent progressive restoration to normovolemia (i.e., simulated hemorrhage and whole blood resuscitation). Data were acquired at multiple repressurization rates for each subject to simulate varying resuscitation rates, resulting in 52 total LBNP collections. This work is the first to use a single ABP-based algorithm to monitor both simulated hemorrhage and resuscitation. A gradient-boosted regression tree model trained on only the half-rise to dicrotic notch (HRDN) feature achieved a root-mean-square error (RMSE) of 13%, an R2 of 0.82, and area under the receiver operating characteristic curve of 0.97 for detecting decompensation. This single-feature model’s performance compares favorably to previously reported results from more-complex black box machine learning models. This model further provides physiological insight because HRDN represents an approximate measure of the delay between the ABP ejected and reflected wave and therefore is an indication of cardiac and peripheral vascular mechanisms that contribute to the compensatory response to blood loss and replacement.

An important means for preventing and managing cardiovascular disease is the non-invasive estimation of blood pressure. There is particular interest in developing approaches that provide accurate cuffless and continuous estimation of this important vital sign. This paper proposes a method that uses dynamic changes of the pulse waveform over short time intervals and calibrates the system based on a mathematical model that relates reflective PTT (R-PTT) to blood pressure. An advantage of the method is that it only requires collecting the photoplethysmogram (PPG) using one optical sensor, in addition to initial non-invasive measurements of blood pressure that are used for calibration. This method was applied to data from 30 patients, resulting in a mean error (ME) of 0.59 mmHg, a standard deviation of error (SDE) of 7.07 mmHg, and a mean absolute error (MAE) of 4.92 mmHg for diastolic blood pressure (DBP) and an ME of 2.52 mmHg, an SDE of 12.15 mmHg, and an MAE of 8.89 mmHg for systolic blood pressure (SBP). These results demonstrate the possibility of using the PPG signal for the cuffless continuous estimation of blood pressure based on the analysis of calibrated changes in cardiovascular dynamics, possibly in conjunction with other methods that are currently being researched.

The extraction of relevant features from the photoplethysmography signal for estimating certain physiological parameters is a challenging task. Various feature extraction methods have been proposed in the literature. In this study, we present a novel fiducial point extraction algorithm to detect c and d points from the acceleration photoplethysmogram (APG), namely “CnD”. The algorithm allows for the application of various pre-processing techniques, such as filtering, smoothing, and removing baseline drift; the possibility of calculating first, second, and third photoplethysmography derivatives; and the implementation of algorithms for detecting and highlighting APG fiducial points. An evaluation of the CnD indicated a high level of accuracy in the algorithm’s ability to identify fiducial points. Out of 438 APG fiducial c and d points, the algorithm accurately identified 434 points, resulting in an accuracy rate of 99%. This level of accuracy was consistent across all the test cases, with low error rates. These findings indicate that the algorithm has a high potential for use in practical applications as a reliable method for detecting fiducial points. Thereby, it provides a valuable new resource for researchers and healthcare professionals working in the analysis of photoplethysmography signals.

Measuring continuous blood pressure (BP) in real time by using a mobile health (mHealth) application would open a new door in the advancement of the healthcare system. This study aimed to propose a real-time method and system for measuring BP without using a cuff from a digital artery. An energy-efficient real-time smartphone-application-friendly one-dimensional (1D) Squeeze U-net model is proposed to estimate systolic and diastolic BP values, using only raw photoplethysmogram (PPG) signal. The proposed real-time cuffless BP prediction method was assessed for accuracy, reliability, and potential usefulness in the hypertensive assessment of 100 individuals in two publicly available datasets: Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-I) and Medical Information Mart for Intensive Care (MIMIC-III) waveform database. The proposed model was used to build an android application to measure BP at home. This proposed deep-learning model performs best in terms of systolic BP, diastolic BP, and mean arterial pressure, with a mean absolute error of 4.42, 2.25, and 2.56 mmHg and standard deviation of 4.78, 2.98, and 3.21 mmHg, respectively. The results meet the grade A performance requirements of the British Hypertension Society and satisfy the AAMI error range. The result suggests that only using a short-time PPG signal is sufficient to obtain accurate BP measurements in real time. It is a novel approach for real-time cuffless BP estimation by implementing an mHealth application and can measure BP at home and assess hypertension.

This paper compares the structural design of two organic biosensors that minimize power consumption in wireless photoplethysmogram (PPG) waveform monitoring. Both devices were fabricated on the same substrate with a red organic light-emitting diode (OLED) and an organic photodiode (OPD). Both were designed with a circular OLED at the center of the device surrounded by OPD. One device had an OLED area of 0.06 cm2, while the other device had half the area. The gap distance between the OLED and OPD was 1.65 mm for the first device and 2 mm for the second. Both devices had an OPD area of 0.16 cm2. We compared the power consumption and signal-to-noise ratio (SNR) of both devices and evaluated the PPG signal, which was successfully collected from a fingertip. The reflectance-based organic pulse meter operated successfully and at a low power consumption of 8 µW at 18 dB SNR. The device sent the PPG waveforms, via Bluetooth low energy (BLE), to a PC host at a maximum rate of 256 kbps data throughput. In the end, the proposed reflectance-based organic pulse meter reduced power consumption and improved long-term PPG wireless monitoring.

This work aims to predict and classify patients into diabetic and nondiabetic subjects based on age and four independent variables extracted from the analysis of photoplethysmogram (PPG) morphology in time domain. The study has two main stages, the first one was the analysis of PPG waveform to extract b/a, RI, DiP, and SPt indices. These parameters contribute by some means to the prediction of diabetes. They were statistically significant and correlated with the HbA1C test. The second stage was building a neural network based classifier to predict diabetes. The model showed an accuracy of 90.2% in training phase and an accuracy of 85.5% in testing phase. The findings of this research work may contribute towards the prediction of diabetes in early stages. Also, the proposed classifier showed a high accuracy in predicting the existence of diabetes in Saudi people population.