Reverse triggering neural network and rules-based automated detection in acute respiratory distress syndrome.

PURPOSE: Dyssynchrony may cause lung injury and is associated with worse outcomes in mechanically ventilated patients. Reverse triggering (RT) is a common type of dyssynchrony presenting with several phenotypes which may directly cause lung injury and be difficult to identify. Due to these challenges, automated software to assist in identification is needed. MATERIALS AND METHODS: This was a prospective observational study using a training set of 15 patients and a validation dataset of 13 patients. RT events were manually identified and compared with "rules-based" programs (with and without esophageal manometry and reverse triggering with breath stacking), and were used to train a neural network artificial intelligence (AI) program. RT phenotypes were identified using previously defined rules. Performance of the programs was compared via sensitivity, specificity, positive predictive value (PPV) and F1 score. RESULTS: 33,244 breaths were manually analyzed, with 8718 manually identified as reverse-triggers. The rules-based and AI programs yielded excellent specificity (>95% in all programs) and F1 score (>75% in all programs). RT with breath stacking (24.4%) and mid-cycle RT (37.8%) were the most common phenotypes. CONCLUSIONS: Automated detection of RT demonstrated good performance, with the potential application of these programs for research and clinical care.

Adaptive Maximal Blood Flow Velocity Estimation From Transcranial Doppler Echos.

OBJECTIVE: Novel applications of transcranial Doppler (TCD) ultrasonography, such as the assessment of cerebral vessel narrowing/occlusion or the non-invasive estimation of intracranial pressure (ICP), require high-quality maximal flow velocity waveforms. However, due to the low signal-to-noise ratio of TCD spectrograms, measuring the maximal flow velocity is challenging. In this work, we propose a calibration-free algorithm for estimating maximal flow velocities from TCD spectrograms and present a pertaining beat-by-beat signal quality index. METHODS: Our algorithm performs multiple binary segmentations of the TCD spectrogram and then extracts the pertaining envelopes (maximal flow velocity waveforms) via an edge-following step that incorporates physiological constraints. The candidate maximal flow velocity waveform with the highest signal quality index is finally selected. RESULTS: We evaluated the algorithm on 32 TCD recordings from the middle cerebral and internal carotid arteries in 6 healthy and 12 neurocritical care patients. Compared to manual spectrogram tracings, we obtained a relative error of -1.5%, when considering the whole waveform, and a relative error of -3.3% for the peak systolic velocity. CONCLUSION: The feedback loop between the signal quality assessment and the binary segmentation yields a robust algorithm for maximal flow velocity estimation. Clinical Impact: The algorithm has already been used in our ICP estimation pipeline. By making the code and the data publicly available, we hope that the algorithm will be a useful building block for the development of novel TCD applications that require high-quality flow velocity waveforms.

Model-Based Separation, Detection, and Classification of Eye Movements.

OBJECTIVE: We present a physiologically motivated eye movement analysis framework for model-based separation, detection, and classification (MBSDC) of eye movements. By estimating kinematic and neural controller signals for saccades, smooth pursuit, and fixational eye movements in a mechanistic model of the oculomotor system we are able to separate and analyze these eye movements independently. METHODS: We extended an established oculomotor model for horizontal eye movements by neural controller signals and by a blink artifact model. To estimate kinematic (position, velocity, acceleration, forces) and neural controller signals from eye position data, we employ Kalman smoothing and sparse input estimation techniques. The estimated signals are used for detecting saccade start and end points, and for classifying the recording into saccades, smooth pursuit, fixations, post-saccadic oscillations, and blinks. RESULTS: On simulated data, the reconstruction error of the velocity profiles is about half the error value obtained by the commonly employed approach of filtering and numerical differentiation. In experiments with smooth pursuit data from human subjects, we observe an accurate signal separation. In addition, in neural recordings from non-human primates, the estimated neural controller signals match the real recordings strikingly well. SIGNIFICANCE: The MBSDC framework enables the analysis of multi-type eye movement recordings and provides a physiologically motivated approach to study motor commands and might aid the discovery of new digital biomarkers. CONCLUSION: The proposed framework provides a model-based approach for a wide variety of eye movement analysis tasks.

Estimation of Neural Inputs and Detection of Saccades and Smooth Pursuit Eye Movements by Sparse Bayesian Learning.

Eye movements reveal a great wealth of information about the visual system and the brain. Therefore, eye movements can serve as diagnostic markers for various neurological disorders. For an objective analysis, it is crucial to have an automatic and robust procedure to extract relevant eye movement parameters. An essential step towards this goal is to detect and separate different types of eye movements such as fixations, saccades and smooth pursuit. We have developed a model-based approach to perform signal detection and separation on eye movement recordings, using source separation techniques from sparse Bayesian learning. The key idea is to model the oculomotor system with a state space model and to perform signal separation in the neural domain by estimating sparse inputs which trigger saccades. The algorithm was evaluated on synthetic data, neural recordings from rhesus monkeys and on manually annotated human eye movement recordings with different smooth pursuit paradigms. The developed approach shows a high noise-robustness, provides saccade and smooth pursuit parameters, as well as estimates of the position, velocity and acceleration profiles. In addition, by estimating the input to the oculomotor system, we obtain an estimate of the neural inputs to the oculomotor muscles.

A multiscale, model-based analysis of the multi-tissue interplay underlying blood glucose regulation in type I diabetes.

A multiscale model for blood glucose regulation in diabetes type I patients is constructed by integrating detailed metabolic network models for fat, liver and muscle cells into a whole body physiologically-based pharmacokinetic/pharmacodynamic (pBPK/PD) model. The blood glucose regulation PBPK/PD model simulates the distribution and metabolization of glucose, insulin and glucagon on an organ and whole body level. The genome-scale metabolic networks in contrast describe intracellular reactions. The developed multiscale model is fitted to insulin, glucagon and glucose measurements of a 48h clinical trial featuring 6 subjects and is subsequently used to simulate (in silico) the influence of geneknockouts and drug-induced enzyme inhibitions on whole body blood glucose levels. Simulations of diabetes associated gene knockouts and impaired cellular glucose metabolism, resulted in elevated whole body blood-glucose levels, but also in a metabolic shift within the cell's reaction network. Such multiscale models have the potential to be employed in the exploration of novel drug-targets or to be integrated into control algorithms for artificial pancreas systems.

Motion sensitivity analysis of retinal ganglion cells in mouse retina using natural visual stimuli.

One of the major objectives in functional studies of the retina is the understanding of neural circuits and identification of the function of involved nerve cells. Instead of stimulating the retina with light patterns of simple geometrical shapes, we analyze the response of retinal ganglion cells of mouse retina to a black and white movie containing a natural scenery. By correlating measured spike trains with a metric for the velocity of a visual scene, PV0 cells were found to be direction selective, whereas PV5 cells did not show any sensitivity to motion.

Estimation of heart rate and heart rate variability from pulse oximeter recordings using localized model fitting.

Heart rate variability is one of the key parameters for assessing the health status of a subject's cardiovascular system. This paper presents a local model fitting algorithm used for finding single heart beats in photoplethysmogram recordings. The local fit of exponentially decaying cosines of frequencies within the physiological range is used to detect the presence of a heart beat. Using 42 subjects from the CapnoBase database, the average heart rate error was 0.16 BPM and the standard deviation of the absolute estimation error was 0.24 BPM.