Burcu Ozek

Zhenyuan Lu, Burcu Ozek, Sagar Kamarthi

Pain is a serious worldwide health problem that affects a vast proportion of the population. For efficient pain management and treatment, accurate classification and evaluation of pain severity are necessary. However, this can be challenging as pain is a subjective sensation-driven experience. Traditional techniques for measuring pain intensity, e.g. self-report scales, are susceptible to bias and unreliable in some instances. Consequently, there is a need for more objective and automatic pain intensity assessment strategies. In this paper, we develop PainAttnNet (PAN), a novel transfomer-encoder deep-learning framework for classifying pain intensities with physiological signals as input. The proposed approach is comprised of three feature extraction architectures: multiscale convolutional networks (MSCN), a squeeze-and-excitation residual network (SEResNet), and a transformer encoder block. On the basis of pain stimuli, MSCN extracts short- and long-window information as well as sequential features. SEResNet highlights relevant extracted features by mapping the interdependencies among features. The third module employs a transformer encoder consisting of three temporal convolutional networks (TCN) with three multi-head attention (MHA) layers to extract temporal dependencies from the features. Using the publicly available BioVid pain dataset, we test the proposed PainAttnNet model and demonstrate that our outcomes outperform state-of-the-art models. These results confirm that our approach can be utilized for automated classification of pain intensity using physiological signals to improve pain management and treatment.

Burcu Ozek, Zhenyuan Lu, Srinivasan Radhakrishnan et al.

Improper pain management can lead to severe physical or mental consequences, including suffering, and an increased risk of opioid dependency. Assessing the presence and severity of pain is imperative to prevent such outcomes and determine the appropriate intervention. However, the evaluation of pain intensity is challenging because different individuals experience pain differently. To overcome this, researchers have employed machine learning models to evaluate pain intensity objectively. However, these efforts have primarily focused on point estimation of pain, disregarding the inherent uncertainty and variability present in the data and model. Consequently, the point estimates provide only partial information for clinical decision-making. This study presents a neural network-based method for objective pain interval estimation, incorporating uncertainty quantification. This work explores three algorithms: the bootstrap method, lower and upper bound estimation (LossL) optimized by genetic algorithm, and modified lower and upper bound estimation (LossS) optimized by gradient descent algorithm. Our empirical results reveal that LossS outperforms the other two by providing a narrower prediction interval. As LossS outperforms, we assessed its performance in three different scenarios for pain assessment: (1) a generalized approach (single model for the entire population), (2) a personalized approach (separate model for each individual), and (3) a hybrid approach (separate model for each cluster of individuals). Our findings demonstrate the hybrid approach's superior performance, with notable practicality in clinical contexts. It has the potential to be a valuable tool for clinicians, enabling objective pain intensity assessment while taking uncertainty into account. This capability is crucial in facilitating effective pain management and reducing the risks associated with improper treatment.

Xin Wang, Burcu Ozek, Aruna Mohan et al.

Electrocardiogram (ECG) analysis is crucial for diagnosing heart disease, but most self-supervised learning methods treat ECG as a generic time series, overlooking physiologic semantics and rhythm-level structure. Existing contrastive methods utilize augmentations that distort morphology, whereas generative approaches employ fixed-window segmentation, which misaligns cardiac cycles. To address these limitations, we propose RhythmBERT, a generative ECG language model that considers ECG as a language paradigm by encoding P, QRS, and T segments into symbolic tokens via autoencoder-based latent representations. These discrete tokens capture rhythm semantics, while complementary continuous embeddings retain fine-grained morphology, enabling a unified view of waveform structure and rhythm. RhythmBERT is pretrained on approximately 800,000 unlabeled ECG recordings with a masked prediction objective, allowing it to learn contextual representations in a label-efficient manner. Evaluations show that despite using only a single lead, RhythmBERT achieves comparable or superior performance to strong 12-lead baselines. This generalization extends from prevalent conditions such as atrial fibrillation to clinically challenging cases such as subtle ST-T abnormalities and myocardial infarction. Our results suggest that considering ECG as structured language offers a scalable and physiologically aligned pathway for advancing cardiac analysis.