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Atrial fibrillation (AF) is a life threatening disease and can cause stroke, heart failure, and sometimes death. To reduce the rate of mortality and morbidity due to increased prevalence of AF, early detection of the same becomes a prior concern. Traditional machine learning (TML) algorithms and ensemble machine learning (EML) algorithms are proposed to detect AF in this article. The performances of both these methods are compared in this study. Methodology involves computation of RR interval features extracted from electrocardiogram and its classification into: normal, AF, and other rhythms. TML techniques such as Classification and Regression Tree, K Nearest Neighbor, C4.5, Iterative Dichotomiser 3, Support Vector Machine and EML classifier such as Random Forest (RF), and Rotation Forest are used for classification. The proposed method is evaluated using PhysioNet challenge 2017. During the tenfold cross validation, it is observed that RF classifier provided good classification accuracy of 99.10% with area under the curve of 0.998. Apart from contributing a new methodology, the proposed study also experimentally proves higher performance with ensemble learning method, RF. The methodology has many applications in health care management systems including defibrillators, cardiac pacemakers, etc.

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Recognition of human emotion states for affective computing based on Electroencephalogram (EEG) signal is an active yet challenging domain of research. In this study we propose an emotion recognition framework based on 2-dimensional valence-arousal model to classify High Arousal-Positive Valence (Happy) and Low Arousal-Negative Valence (Sad) emotions. In total 34 features from time, frequency, statistical and nonlinear domain are studied for their efficacy using Artificial Neural Network (ANN). The EEG signals from various electrodes in different scalp regions viz., frontal, parietal, temporal, occipital are studied for performance. It is found that ANN trained using features extracted from the frontal region has outperformed that of all other regions with an accuracy of 93.25%. The results indicate that the use of smaller set of electrodes for emotion recognition that can simplify the acquisition and processing of EEG data. The developed system can aid immensely to the physicians in their clinical practice involving emotional states, continuous monitoring, and development of wearable sensors for emotion recognition.

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Computer assisted automatic smart pattern analysis of cancer affected pixel structure takes critical role in pre-interventional decision making for oral cancer treatment. Internet of Things (IoT) in healthcare systems is now emerging solution for modern e-healthcare system to provide high quality medical care. In this research work, we proposed a novel method which utilizes a modified vesselness measurement and a Deep Convolutional Neural Network (DCNN) to identify the oral cancer region structure in IoT based smart healthcare system. The robust vesselness filtering scheme handles noise while reserving small structures, while the CNN framework considerably improves classification accuracy by deblurring focused region of interest (ROI) through integrating with multi-dimensional information from feature vector selection step. The marked feature vector points are extracted from each connected component in the region and used as input for training the CNN. During classification, each connected part is individually analysed using the trained DCNN by considering the feature vector values that belong to its region. For a training of 1500 image dataset, an accuracy of 96.8% and sensitivity of 92% is obtained. Hence, the results of this work validate that the proposed algorithm is effective and accurate in terms of classification of oral cancer region in accurate decision making. The developed system can be used in IoT based diagnosis in health care systems, where accuracy and real time diagnosis are essential.

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Diabetic macular edema (DME) is one of the most common causes of visual loss among diabetes mellitus patients. Early detection and successive treatment may improve the visual acuity. DME is mainly graded into non-clinically significant macular edema (NCSME) and clinically significant macular edema according to the location of hard exudates in the macula region. DME can be identified by manual examination of fundus images. It is laborious and resource intensive. Hence, in this work, automated grading of DME is proposed using higher-order spectra (HOS) of Radon transform projections of the fundus images. We have used third-order cumulants and bispectrum magnitude, in this work, as features, and compared their performance. They can capture subtle changes in the fundus image. Spectral regression discriminant analysis (SRDA) reduces feature dimension, and minimum redundancy maximum relevance method is used to rank the significant SRDA components. Ranked features are fed to various supervised classifiers, viz. Naive Bayes, AdaBoost and support vector machine, to discriminate No DME, NCSME and clinically significant macular edema classes. The performance of our system is evaluated using the publicly available MESSIDOR dataset (300 images) and also verified with a local dataset (300 images). Our results show that HOS cumulants and bispectrum magnitude obtained an average accuracy of 95.56 and 94.39% for MESSIDOR dataset and 95.93 and 93.33% for local dataset, respectively.

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Diabetic retinopathy (DR) is a leading cause of vision loss among diabetic patients in developed countries. Early detection of occurrence of DR can greatly help in effective treatment. Unfortunately, symptoms of DR do not show up till an advanced stage. To counter this, regular screening for DR is essential in diabetic patients. Due to lack of enough skilled medical professionals, this task can become tedious as the number of images to be screened becomes high with regular screening of diabetic patients. An automated DR screening system can help in early diagnosis without the need for a large number of medical professionals. To improve detection, several pattern recognition techniques are being developed. In our study, we used trace transforms to model a human visual system which would replicate the way a human observer views an image. To classify features extracted using this technique, we used support vector machine (SVM) with quadratic, polynomial, radial basis function kernels and probabilistic neural network (PNN). Genetic algorithm (GA) was used to fine tune classification parameters. We obtained an accuracy of 99.41 and 99.12% with PNN-GA and SVM quadratic kernels, respectively.

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The Electrocardiogram (ECG) is the P-QRS-T wave depicting the cardiac activity of the heart. The subtle changes in the electric potential patterns of repolarization and depolarization are indicative of the disease afflicting the patient. These clinical time domain features of the ECG waveform can be used in cardiac health diagnosis. Due to the presence of noise and minute morphological parameter values, it is very difficult to identify the ECG classes accurately by the naked eye. Various computer aided cardiac diagnosis (CACD) systems, analysis methods, challenges addressed and the future of cardiovascular disease screening are reviewed in this paper. Methods developed for time domain, frequency transform domain, and time-frequency domain analysis, such as the wavelet transform, cannot by themselves represent the inherent distinguishing features accurately. Hence, nonlinear methods which can capture the small variations in the ECG signal and provide improved accuracy in the presence of noise are discussed in greater detail in this review. A CACD system exploiting these nonlinear features can help clinicians to diagnose cardiovascular disease more accurately.

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Coronary artery disease (CAD) is one of the dangerous cardiac disease, often may lead to sudden cardiac death. It is difficult to diagnose CAD by manual inspection of electrocardiogram (ECG) signals. To automate this detection task, in this study, we extracted the heart rate (HR) from the ECG signals and used them as base signal for further analysis. We then analyzed the HR signals of both normal and CAD subjects using (i) time domain, (ii) frequency domain and (iii) nonlinear techniques. The following are the nonlinear methods that were used in this work: Poincare plots, Recurrence Quantification Analysis (RQA) parameters, Shannon entropy, Approximate Entropy (ApEn), Sample Entropy (SampEn), Higher Order Spectra (HOS) methods, Detrended Fluctuation Analysis (DFA), Empirical Mode Decomposition (EMD), Cumulants, and Correlation Dimension. As a result of the analysis, we present unique recurrence, Poincare and HOS plots for normal and CAD subjects. We have also observed significant variations in the range of these features with respect to normal and CAD classes, and have presented the same in this paper. We found that the RQA parameters were higher for CAD subjects indicating more rhythm. Since the activity of CAD subjects is less, similar signal patterns repeat more frequently compared to the normal subjects. The entropy based parameters, ApEn and SampEn, are lower for CAD subjects indicating lower entropy (less activity due to impairment) for CAD. Almost all HOS parameters showed higher values for the CAD group, indicating the presence of higher frequency content in the CAD signals. Thus, our study provides a deep insight into how such nonlinear features could be exploited to effectively and reliably detect the presence of CAD.

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The electrocardiogram (ECG) is being commonly used as a diagnostic tool to distinguish different types of atrial tachyarrhythmias. The inherent complexity and mechanistic and clinical inter-relationships often brings about diagnostic difficulties to treating physicians and primary health care professionals creating frequent misdiagnoses and cross classifications using visual criteria. The current paper presents a methodology for ECG based pattern analysis for detection of atrial flutter, atrial fibrillation and normal sinus rhythm beats. ECG is an inherently non-linear and non-stationary signal; its variation may contain indicators of current disease, or warnings about impending cardiac diseases. Routinely used time domain and frequency domain methods will not be able to capture the hidden information present in the ECG beats. In the present study, we have used non-linear features of higher order spectra (HOS) to differentiate the normal, atrial fibrillation and atrial flutter ECG beats. The bispectrum features were subjected to independent component analysis (ICA) for data reduction. The ICA coefficients were subsequently subjected to K-nearest-neighbor (KNN), classification and regression tree (CART) and neural network (NN) classifiers to evaluate the best automated classifier. We have obtained an average accuracy of 97.65%, sensitivity and specificity of 98.75% and 99.53% respectively using ten-fold cross validation. Overall, the results show that application of higher order spectra statistics is useful for the classification of atrial tachyarrhythmias with reasonably high accuracies. Further validation of the proposed technique will yield acceptable results for clinical implementation.

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Diabetes mellitus (DM) is a metabolic disorder that is widely rampant throughout the world population these days. The uncontrolled DM may lead to complications of eye, heart, kidney and nerves. The most common type of diabetes is the type 2 diabetes or insulin-resistant DM. Near-infrared spectroscopy (NIRS) technology is widely used in non-invasive monitoring of physiological signals. Three types of NIRS signals are used in this work: (i) variation in the oxygenated haemoglobin (O2Hb) concentration, (ii) deoxygenated haemoglobin (HHb), and (iii) ratio of oxygenated over the sum of the oxygenated and deoxygenated haemoglobin which is defined as: tissue oxygenation index (TOI) to analyze the effect of exercise on diabetes subjects. The NIRS signal has the characteristics of non-linearity and non-stationarity. Hence, the very small changes in this time series can be efficiently extracted using higher order statistics (HOS) method. Hence, in this work, we have used sample and HOS entropies to analyze these NIRS signals. These computer aided techniques will assist the clinicians to diagnose and monitor the health accurately and easily without any inter or intra observer variability. Results showed that after a one-year of physical exercise programme, all diabetic subjects increased the sample entropy of the NIRS signals, thus revealing a better muscle performance and an improved recruitment by the central nervous system. Moreover, after one year of physical therapy, diabetic subjects showed a NIRS muscular metabolic pattern that was not distinguished from that of controls. We believe that sample and bispectral entropy analysis is need when the aim is to compare the inner structure of the NIRS signals during muscle contraction, particularly when dealing with neuromuscular impairments.

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Intrinsic time-scale decomposition (ITD) is a new nonlinear method of time-frequency representation which can decipher the minute changes in the nonlinear EEG signals. In this work, we have automatically classified normal, interictal and ictal EEG signals using the features derived from the ITD representation. The energy, fractal dimension and sample entropy features computed on ITD representation coupled with decision tree classifier has yielded an average classification accuracy of 95.67%, sensitivity and specificity of 99% and 99.5%, respectively using 10-fold cross validation scheme. With application of the nonlinear ITD representation, along with conceptual advancement and improvement of the accuracy, the developed system is clinically ready for mass screening in resource constrained and emerging economy scenarios.

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Electrocardiogram (ECG) is the electrical activity of the heart indicated by P, Q-R-S and T wave. The minute changes in the amplitude and duration of ECG depicts a particular type of cardiac abnormality. It is very difficult to decipher the hidden information present in this nonlinear and nonstationary signal. An automatic diagnostic system that characterizes cardiac activities in ECG signals would provide more insight into these phenomena thereby revealing important clinical information. Various methods have been proposed to detect cardiac abnormalities in ECG recordings. Application of higher order spectra (HOS) features is a seemingly promising approach because it can capture the nonlinear and dynamic nature of the ECG signals. In this paper, we have automatically classified five types of beats using HOS features (higher order cumulants) using two different approaches. The five types of ECG beats are normal (N), right bundle branch block (RBBB), left bundle branch block (LBBB), atrial premature contraction (APC) and ventricular premature contraction (VPC). In the first approach, cumulant features of segmented ECG signal were used for classification; whereas in the second approach cumulants of discrete wavelet transform (DWT) coefficients were used as features for classifiers. In both approaches, the cumulant features were subjected to data reduction using principal component analysis (PCA) and classified using three layer feed-forward neural network (NN) and least square-support vector machine (LS-SVM) classifiers. In this study, we obtained the highest average accuracy of 94.52%, sensitivity of 98.61% and specificity of 98.41% using first approach with NN classifier. The developed system is ready clinically to run on large datasets.

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In this work, we have proposed an on-line computer-aided diagnostic system called "UroImage" that classifies a Transrectal Ultrasound (TRUS) image into cancerous or non-cancerous with the help of non-linear Higher Order Spectra (HOS) features and Discrete Wavelet Transform (DWT) coefficients. The UroImage system consists of an on-line system where five significant features (one DWT-based feature and four HOS-based features) are extracted from the test image. These on-line features are transformed by the classifier parameters obtained using the training dataset to determine the class. We trained and tested six classifiers. The dataset used for evaluation had 144 TRUS images which were split into training and testing sets. Three-fold and ten-fold cross-validation protocols were adopted for training and estimating the accuracy of the classifiers. The ground truth used for training was obtained using the biopsy results. Among the six classifiers, using 10-fold cross-validation technique, Support Vector Machine and Fuzzy Sugeno classifiers presented the best classification accuracy of 97.9% with equally high values for sensitivity, specificity and positive predictive value. Our proposed automated system, which achieved more than 95% values for all the performance measures, can be an adjunct tool to provide an initial diagnosis for the identification of patients with prostate cancer. The technique, however, is limited by the limitations of 2D ultrasound guided biopsy, and we intend to improve our technique by using 3D TRUS images in the future.

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Epilepsy is a chronic brain disorder which manifests as recurrent seizures. Electroencephalogram (EEG) signals are generally analyzed to study the characteristics of epileptic seizures. In this work, we propose a method for the automated classification of EEG signals into normal, interictal and ictal classes using Continuous Wavelet Transform (CWT), Higher Order Spectra (HOS) and textures. First the CWT plot was obtained for the EEG signals and then the HOS and texture features were extracted from these plots. Then the statistically significant features were fed to four classifiers namely Decision Tree (DT), K-Nearest Neighbor (KNN), Probabilistic Neural Network (PNN) and Support Vector Machine (SVM) to select the best classifier. We observed that the SVM classifier with Radial Basis Function (RBF) kernel function yielded the best results with an average accuracy of 96%, average sensitivity of 96.9% and average specificity of 97% for 23.6 s duration of EEG data. Our proposed technique can be used as an automatic seizure monitoring software. It can also assist the doctors to cross check the efficacy of their prescribed drugs.

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Epilepsy is a global disease with considerable incidence due to recurrent unprovoked seizures. These seizures can be noninvasively diagnosed using electroencephalogram (EEG), a measure of neuronal electrical activity in brain recorded along scalp. EEG is highly nonlinear, nonstationary and non-Gaussian in nature. Nonlinear adaptive models such as empirical mode decomposition (EMD) provide intuitive understanding of information present in these signals. In this study a novel methodology is proposed to automatically classify EEG of normal, inter-ictal and ictal subjects using EMD decomposition. EEG decomposition using EMD yields few intrinsic mode functions (IMF), which are amplitude and frequency modulated (AM and FM) waves. Hilbert transform of these IMF provides AM and FM frequencies. Features such as spectral peaks, spectral entropy and spectral energy in each IMF are extracted and fed to decision tree classifier for automated diagnosis. In this work, we have compared the performance of classification using two types of decision trees (i) classification and regression tree (CART) and (ii) C4.5. We have obtained the highest average accuracy of 95.33%, average sensitivity of 98%, and average specificity of 97% using C4.5 decision tree classifier. The developed methodology is ready for clinical validation on large databases and can be deployed for mass screening.

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Arrhythmia is one of the preventive cardiac problems frequently occurs all over the globe. In order to screen such disease at early stage, this work attempts to develop a system approach based on registration, feature extraction using discrete wavelet transform (DWT), feature validation and classification of electrocardiogram (ECG). This diagnostic issue is set as a two-class pattern classification problem (normal sinus rhythm versus arrhythmia) where MIT-BIH database is considered for training, testing and clinical validation. Here DWT is applied to extract multi-resolution coefficients followed by registration using Pan Tompkins algorithm based R point detection. Moreover, feature space is compressed using sub-band principal component analysis (PCA) and statistically validated using independent sample t-test. Thereafter, the machine learning algorithms viz., Gaussian mixture model (GMM), error back propagation neural network (EBPNN) and support vector machine (SVM) are employed for pattern classification. Results are studied and compared. It is observed that both supervised classifiers EBPNN and SVM lead to higher (93.41% and 95.60% respectively) accuracy in comparison with GMM (87.36%) for arrhythmia screening.

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