Xiao Hu

Zhicheng Guo, Cheng Ding, Duc H. Do et al.

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. It is associated with an increased risk of stroke, heart failure, and other cardiovascular complications, but can be clinically silent. Passive AF monitoring with wearables may help reduce adverse clinical outcomes related to AF. Detecting AF in noisy wearable data poses a significant challenge, leading to the emergence of various deep learning techniques. Previous deep learning models learn from a single modality, either electrocardiogram (ECG) or photoplethysmography (PPG) signals. However, deep learning models often struggle to learn generalizable features and rely on features that are more susceptible to corruption from noise, leading to sub-optimal performances in certain scenarios, especially with low-quality signals. Given the increasing availability of ECG and PPG signal pairs from wearables and bedside monitors, we propose a new approach, SiamAF, leveraging a novel Siamese network architecture and joint learning loss function to learn shared information from both ECG and PPG signals. At inference time, the proposed model is able to predict AF from either PPG or ECG and outperforms baseline methods on three external test sets. It learns medically relevant features as a result of our novel architecture design. The proposed model also achieves comparable performance to traditional learning regimes while requiring much fewer training labels, providing a potential approach to reduce future reliance on manual labeling.

Sully F. Chen, Zhicheng Guo, Cheng Ding et al.

Rapid, reliable, and accurate interpretation of medical time-series signals is crucial for high-stakes clinical decision-making. Deep learning methods offered unprecedented performance in medical signal processing but at a cost: they were compute-intensive and lacked interpretability. We propose Sparse Mixture of Learned Kernels (SMoLK), an interpretable architecture for medical time series processing. SMoLK learns a set of lightweight flexible kernels that form a single-layer sparse neural network, providing not only interpretability, but also efficiency, robustness, and generalization to unseen data distributions. We introduce a parameter reduction techniques to reduce the size of SMoLK's networks while maintaining performance. We test SMoLK on two important tasks common to many consumer wearables: photoplethysmography (PPG) artifact detection and atrial fibrillation detection from single-lead electrocardiograms (ECGs). We find that SMoLK matches the performance of models orders of magnitude larger. It is particularly suited for real-time applications using low-power devices, and its interpretability benefits high-stakes situations.

Pranay Jain, Cheng Ding, Cynthia Rudin et al.

Smart watches and other wearable devices are equipped with photoplethysmography (PPG) sensors for monitoring heart rate and other aspects of cardiovascular health. However, PPG signals collected from such devices are susceptible to corruption from noise and motion artifacts, which cause errors in heart rate estimation. Typical denoising approaches filter or reconstruct the signal in ways that eliminate much of the morphological information, even from the clean parts of the signal that would be useful to preserve. In this work, we develop an algorithm for denoising PPG signals that reconstructs the corrupted parts of the signal, while preserving the clean parts of the PPG signal. Our novel framework relies on self-supervised training, where we leverage a large database of clean PPG signals to train a denoising autoencoder. As we show, our reconstructed signals provide better estimates of heart rate from PPG signals than the leading heart rate estimation methods. Further experiments show significant improvement in Heart Rate Variability (HRV) estimation from PPG signals using our algorithm. We conclude that our algorithm denoises PPG signals in a way that can improve downstream analysis of many different health metrics from wearable devices.

Yuzhang Xie, Jiaying Lu, Joyce Ho et al.

Linking (aligning) biomedical concepts across diverse data sources enables various integrative analyses, but it is challenging due to the discrepancies in concept naming conventions. Various strategies have been developed to overcome this challenge, such as those based on string-matching rules, manually crafted thesauri, and machine learning models. However, these methods are constrained by limited prior biomedical knowledge and can hardly generalize beyond the limited amounts of rules, thesauri, or training samples. Recently, large language models (LLMs) have exhibited impressive results in diverse biomedical NLP tasks due to their unprecedentedly rich prior knowledge and strong zero-shot prediction abilities. However, LLMs suffer from issues including high costs, limited context length, and unreliable predictions. In this research, we propose PromptLink, a novel biomedical concept linking framework that leverages LLMs. It first employs a biomedical-specialized pre-trained language model to generate candidate concepts that can fit in the LLM context windows. Then it utilizes an LLM to link concepts through two-stage prompts, where the first-stage prompt aims to elicit the biomedical prior knowledge from the LLM for the concept linking task and the second-stage prompt enforces the LLM to reflect on its own predictions to further enhance their reliability. Empirical results on the concept linking task between two EHR datasets and an external biomedical KG demonstrate the effectiveness of PromptLink. Furthermore, PromptLink is a generic framework without reliance on additional prior knowledge, context, or training data, making it well-suited for concept linking across various types of data sources. The source code is available at https://github.com/constantjxyz/PromptLink.

Zhaoliang Chen, Cheng Ding, Saurabh Kataria et al.

This study introduces a novel application of a Generative Pre-trained Transformer (GPT) model tailored for photoplethysmography (PPG) signals, serving as a foundation model for various downstream tasks. Adapting the standard GPT architecture to suit the continuous characteristics of PPG signals, our approach demonstrates promising results. Our models are pre-trained on our extensive dataset that contains more than 200 million 30s PPG samples. We explored different supervised fine-tuning techniques to adapt our model to downstream tasks, resulting in performance comparable to or surpassing current state-of-the-art (SOTA) methods in tasks like atrial fibrillation detection. A standout feature of our GPT model is its inherent capability to perform generative tasks such as signal denoising effectively, without the need for further fine-tuning. This success is attributed to the generative nature of the GPT framework.

Runze Yan, Cheng Ding, Ran Xiao et al.

Atrial fibrillation (AF), a common cardiac arrhythmia, significantly increases the risk of stroke, heart disease, and mortality. Photoplethysmography (PPG) offers a promising solution for continuous AF monitoring, due to its cost efficiency and integration into wearable devices. Nonetheless, PPG signals are susceptible to corruption from motion artifacts and other factors often encountered in ambulatory settings. Conventional approaches typically discard corrupted segments or attempt to reconstruct original signals, allowing for the use of standard machine learning techniques. However, this reduces dataset size and introduces biases, compromising prediction accuracy and the effectiveness of continuous monitoring. We propose a novel deep learning model, Signal Quality Weighted Fusion of Attentional Convolution and Recurrent Neural Network (SQUWA), designed to learn how to retain accurate predictions from partially corrupted PPG. Specifically, SQUWA innovatively integrates an attention mechanism that directly considers signal quality during the learning process, dynamically adjusting the weights of time series segments based on their quality. This approach enhances the influence of higher-quality segments while reducing that of lower-quality ones, effectively utilizing partially corrupted segments. This approach represents a departure from the conventional methods that exclude such segments, enabling the utilization of a broader range of data, which has great implications for less disruption when monitoring of AF risks and more accurate estimation of AF burdens. Our extensive experiments show that SQUWA outperform existing PPG-based models, achieving the highest AUCPR of 0.89 with label noise mitigation. This also exceeds the 0.86 AUCPR of models trained with using both electrocardiogram (ECG) and PPG data.

Juntong Ni, Saurabh Kataria, Shengpu Tang et al.

Photoplethysmography (PPG) is widely used in wearable health monitoring, yet large PPG foundation models remain difficult to deploy on resource-limited devices. We present PPG-Distill, a knowledge distillation framework that transfers both global and local knowledge through prediction-, feature-, and patch-level distillation. PPG-Distill incorporates morphology distillation to preserve local waveform patterns and rhythm distillation to capture inter-patch temporal structures. On heart rate estimation and atrial fibrillation detection, PPG-Distill improves student performance by up to 21.8% while achieving 7X faster inference and reducing memory usage by 19X, enabling efficient PPG analysis on wearables.

Yuzhang Xie, Xu Han, Ran Xu et al.

Knowledge graphs (KGs) are important products of the semantic web, which are widely used in various application domains. Healthcare is one of such domains where KGs are intensively used, due to the high requirement for knowledge accuracy and interconnected nature of healthcare data. However, KGs storing general factual information often lack the ability to account for important contexts of the knowledge such as the status of specific patients, which are crucial in precision healthcare. Meanwhile, electronic health records (EHRs) provide rich personal data, including various diagnoses and medications, which provide natural contexts for general KGs. In this paper, we propose HypKG, a framework that integrates patient information from EHRs into KGs to generate contextualized knowledge representations for accurate healthcare predictions. Using advanced entity-linking techniques, we connect relevant knowledge from general KGs with patient information from EHRs, and then utilize a hypergraph model to "contextualize" the knowledge with the patient information. Finally, we employ hypergraph transformers guided by downstream prediction tasks to jointly learn proper contextualized representations for both KGs and patients, fully leveraging existing knowledge in KGs and patient contexts in EHRs. In experiments using a large biomedical KG and two real-world EHR datasets, HypKG demonstrates significant improvements in healthcare prediction tasks across multiple evaluation metrics. Additionally, by integrating external contexts, HypKG can learn to adjust the representations of entities and relations in KG, potentially improving the quality and real-world utility of knowledge.

Cheng Ding, Zhicheng Guo, Zhaoliang Chen et al.

Foundation models, especially those using transformers as backbones, have gained significant popularity, particularly in language and language-vision tasks. However, large foundation models are typically trained on high-quality data, which poses a significant challenge, given the prevalence of poor-quality real-world data. This challenge is more pronounced for developing foundation models for physiological data; such data are often noisy, incomplete, or inconsistent. The present work aims to provide a toolset for developing foundation models on physiological data. We leverage a large dataset of photoplethysmography (PPG) signals from hospitalized intensive care patients. For this data, we propose SimQuality, a novel self-supervised learning task based on convolutional neural networks (CNNs) as the backbone to enforce representations to be similar for good and poor quality signals that are from similar physiological states. We pre-trained the SimQuality on over 36 million 30-second PPG pairs and then fine-tuned and tested on six downstream tasks using external datasets. The results demonstrate the superiority of the proposed approach on all the downstream tasks, which are extremely important for heart monitoring on wearable devices. Our method indicates that CNNs can be an effective backbone for foundation models that are robust to training data quality.

Yulin Sun, Xiaopeng Si, Runnan He et al.

Timely identification of harmful brain activities via electroencephalography (EEG) is critical for brain disease diagnosis and treatment, which remains limited application due to inter-rater variability, resource constraints, and poor generalizability of existing artificial intelligence (AI) models. In this study, a convolutional neural network model, VIPEEGNet, was developed and validated using EEGs recorded from Massachusetts General Hospital/Harvard Medical School. The VIPEEGNet was developed and validated using two independent datasets, collected between 2006 and 2020. The development cohort included EEG recordings from 1950 patients, with 106,800 EEG segments annotated by at least one experts (ranging from 1 to 28). The online testing cohort consisted of EEG segments from a subset of an additional 1,532 patients, each annotated by at least 10 experts. For the development cohort (n=1950), the VIPEEGNet achieved high accuracy, with an AUROC for binary classification of seizure, LPD, GPD, LRDA, GRDA, and "other" categories at 0.972 (95% CI, 0.957-0.988), 0.962 (95% CI, 0.954-0.970), 0.972 (95% CI, 0.960-0.984), 0.938 (95% CI, 0.917-0.959), 0.949 (95% CI, 0.941-0.957), and 0.930 (95% CI, 0.926-0.935). For multi classification, the sensitivity of VIPEEGNET for the six categories ranges from 36.8% to 88.2% and the precision ranges from 55.6% to 80.4%, and performance similar to human experts. Notably, the external validation showed Kullback-Leibler Divergence (KLD)of 0.223 and 0.273, ranking top 2 among the existing 2,767 competing algorithms, while we only used 2.8% of the parameters of the first-ranked algorithm.

Cheng Ding, Zhicheng Guo, Cynthia Rudin et al.

This paper explores the challenges in evaluating machine learning (ML) models for continuous health monitoring using wearable devices beyond conventional metrics. We state the complexities posed by real-world variability, disease dynamics, user-specific characteristics, and the prevalence of false notifications, necessitating novel evaluation strategies. Drawing insights from large-scale heart studies, the paper offers a comprehensive guideline for robust ML model evaluation on continuous health monitoring.