"It seems like this past week has been quite challenging for you," a disembodied voice tells me, before proceeding to ask a series of increasingly personal questions. "Have you been feeling down or depressed?" "Can you describe what this feeling has been like for you?" "Does the feeling lift at all when something good happens?" When I respond to each one, my chatbot interviewer thanks me for my honesty and empathises with any issues. By the end of the conversation, I will have also spoken about my sleep patterns, sex drive and appetite for food.

Cardiotocography (CTG) is a low-cost, non-invasive fetal health assessment technique used globally, especially in underdeveloped countries. However, it is currently mainly used to identify the fetus's current status (e.g., fetal acidosis or hypoxia), and the potential of CTG in predicting future adverse pregnancy outcomes has not been fully explored. We aim to develop an AI-based model that predicts biological age from CTG time series (named CTGage), then calculate the age gap between CTGage and actual age (named CTGage-gap), and use this gap as a new digital biomarker for future adverse pregnancy outcomes. The CTGage model is developed using 61,140 records from 11,385 pregnant women, collected at Peking University People's Hospital between 2018 and 2022. For model training, a structurally designed 1D convolutional neural network is used, incorporating distribution-aligned augmented regression technology. The CTGage-gap is categorized into five groups: < -21 days (underestimation group), -21 to -7 days, -7 to 7 days (normal group), 7 to 21 days, and > 21 days (overestimation group). We further defined the underestimation group and overestimation group together as the high-risk group. We then compare the incidence of adverse outcomes and maternal diseases across these groups. The average absolute error of the CTGage model is 10.91 days. When comparing the overestimation group with the normal group, premature infants incidence is 5.33% vs. 1.42% (p < 0.05) and gestational diabetes mellitus (GDM) incidence is 31.93% vs. 20.86% (p < 0.05). When comparing the underestimation group with the normal group, low birth weight incidence is 0.17% vs. 0.15% (p < 0.05) and anaemia incidence is 37.51% vs. 34.74% (p < 0.05). Artificial intelligence-derived CTGage can predict the future risk of adverse pregnancy outcomes and hold potential as a novel, non-invasive, and easily accessible digital biomarker.

Dementia is a neurodegenerative condition that combines several diseases and impacts millions around the world and those around them. Although cognitive impairment is profoundly disabling, it is the noncognitive features of dementia, referred to as Neuropsychiatric Symptoms (NPS), that are most closely associated with a diminished quality of life. Agitation and aggression (AA) in people living with dementia (PwD) contribute to distress and increased healthcare demands. Current assessment methods rely on caregiver intervention and reporting of incidents, introducing subjectivity and bias. Artificial Intelligence (AI) and predictive algorithms offer a potential solution for detecting AA episodes in PwD when utilized in real-time. We present a 5-year study system that integrates a multimodal approach, utilizing the EmbracePlus wristband and a video detection system to predict AA in severe dementia patients. We conducted a pilot study with three participants at the Ontario Shores Mental Health Institute to validate the functionality of the system. The system collects and processes raw and digital biomarkers from the EmbracePlus wristband to accurately predict AA. The system also detected pre-agitation patterns at least six minutes before the AA event, which was not previously discovered from the EmbracePlus wristband. Furthermore, the privacy-preserving video system uses a masking tool to hide the features of the people in frames and employs a deep learning model for AA detection. The video system also helps identify the actual start and end time of the agitation events for labeling. The promising results of the preliminary data analysis underscore the ability of the system to predict AA events. The ability of the proposed system to run autonomously in real-time and identify AA and pre-agitation symptoms without external assistance represents a significant milestone in this research field.

Background: In the absence of prospective data on diabetic foot ulcers (DFU), cross-sectional associations with causal risk factors (peripheral neuropathy, and peripheral arterial disease (PAD)) could be used to establish the validity of plantar thermography for DFU risk stratification. Methods: First, we investigated the associations between the intrinsic clusters of plantar thermographic images with several DFU risk factors using an unsupervised deep-learning framework. We then studied associations between obtained thermography clusters and DFU risk factors. Second, to identify those associations with predictive power, we used supervised learning to train Convolutional Neural Network (CNN) regression/classification models that predicted the risk factor based on the thermograph (and visual) input. Findings: Our dataset comprised 282 thermographs from type 2 diabetes mellitus patients (aged 56.31 +- 9.18 years, 51.42 % males). On clustering, we found two overlapping clusters (silhouette score = 0.10, indicating weak separation). There was strong evidence for associations between assigned clusters and several factors related to diabetic foot ulceration such as peripheral neuropathy, PAD, number of diabetes complications, and composite DFU risk prediction scores such as Martins-Mendes, PODUS-2020, and SIGN. However, models predicting said risk factors had poor performances. Interpretation: The strong associations between intrinsic thermography clusters and several DFU risk factors support the validity of using thermography for characterising DFU risk. However, obtained associations did not prove to be predictive, likely due to, spectrum bias, or because thermography and classical risk factors characterise incompletely overlapping portions of the DFU risk construct. Our findings highlight the challenges in standardising ground truths when defining novel digital biomarkers.

The escalating prevalence of diabetes globally underscores the need for diabetes management. Recent research highlights the growing focus on digital biomarkers in diabetes management, with innovations in computational frameworks and noninvasive monitoring techniques using personalized glucose metrics. However, they predominantly focus on insulin dosing and specific glucose values, or with limited attention given to overall glycemic control. This leaves a gap in expanding the scope of digital biomarkers for overall glycemic control in diabetes management. To address such a research gap, we propose GluMarker -- an end-to-end framework for modeling digital biomarkers using broader factors sources to predict glycemic control. Through the assessment and refinement of various machine learning baselines, GluMarker achieves state-of-the-art on Anderson's dataset in predicting next-day glycemic control. Moreover, our research identifies key digital biomarkers for the next day's glycemic control prediction. These identified biomarkers are instrumental in illuminating the daily factors that influence glycemic management, offering vital insights for diabetes care.

Alzheimer's Disease (AD) and related dementia are a growing global health challenge due to the aging population. In this paper, we present ADMarker, the first end-to-end system that integrates multi-modal sensors and new federated learning algorithms for detecting multidimensional AD digital biomarkers in natural living environments. ADMarker features a novel three-stage multi-modal federated learning architecture that can accurately detect digital biomarkers in a privacy-preserving manner. Our approach collectively addresses several major real-world challenges, such as limited data labels, data heterogeneity, and limited computing resources. We built a compact multi-modality hardware system and deployed it in a four-week clinical trial involving 91 elderly participants. The results indicate that ADMarker can accurately detect a comprehensive set of digital biomarkers with up to 93.8% accuracy and identify early AD with an average of 88.9% accuracy. ADMarker offers a new platform that can allow AD clinicians to characterize and track the complex correlation between multidimensional interpretable digital biomarkers, demographic factors of patients, and AD diagnosis in a longitudinal manner.

With the development of wearable technologies, a new kind of healthcare data has become valuable as medical information. These data provide meaningful information regarding an individual's physiological and psychological states, such as activity level, mood, stress, and cognitive health. These biomarkers are named digital since they are collected from digital devices integrated with various sensors. In this study, we explore digital biomarkers related to stress modality by examining data collected from mobile phones and smartwatches. We utilize machine learning techniques on the Tesserae dataset, precisely Random Forest, to extract stress biomarkers. Using feature selection techniques, we utilize weather, activity, heart rate (HR), stress, sleep, and location (work-home) measurements from wearables to determine the most important stress-related biomarkers. We believe we contribute to interpreting stress biomarkers with a high range of features from different devices. In addition, we classify the $5$ different stress levels with the most important features, and our results show that we can achieve $85\%$ overall class accuracy by adjusting class imbalance and adding extra features related to personality characteristics. We perform similar and even better results in recognizing stress states with digital biomarkers in a daily-life scenario targeting a higher number of classes compared to the related studies.

Electrocardiography (ECG), an electrical measurement which captures cardiac activities, is the gold standard for diagnosing cardiovascular disease (CVD). However, ECG is infeasible for continuous cardiac monitoring due to its requirement for user participation. By contrast, photoplethysmography (PPG) provides easy-to-collect data, but its limited accuracy constrains its clinical usage. To combine the advantages of both signals, recent studies incorporate various deep learning techniques for the reconstruction of PPG signals to ECG; however, the lack of contextual information as well as the limited abilities to denoise biomedical signals ultimately constrain model performance. In this research, we propose Performer, a novel Transformer-based architecture that reconstructs ECG from PPG and combines the PPG and reconstructed ECG as multiple modalities for CVD detection. This method is the first time that Transformer sequence-to-sequence translation has been performed on biomedical waveform reconstruction, combining the advantages of both PPG and ECG. We also create Shifted Patch-based Attention (SPA), an effective method to encode/decode the biomedical waveforms. Through fetching the various sequence lengths and capturing cross-patch connections, SPA maximizes the signal processing for both local features and global contextual representations. The proposed architecture generates a state-of-the-art performance of 0.29 RMSE for the reconstruction of PPG to ECG on the BIDMC database, surpassing prior studies. We also evaluated this model on the MIMIC-III dataset, achieving a 95.9% accuracy in CVD detection, and on the PPG-BP dataset, achieving 75.9% accuracy in related CVD diabetes detection, indicating its generalizability. As a proof of concept, an earring wearable named PEARL (prototype), was designed to scale up the point-of-care (POC) healthcare system.

This Digital Health News industry roundup includes an IT award for the Department of Health and Social Care and Netcompany for the NHS Covid Pass, accreditation for an AI device and a virtual falls service keeping care home residents out of hospital. Digital health and AI company Empatica has received clearance of its Empatica Health Monitoring Platform by the US Food and Drug Administration (FDA). The platform has been cleared for continuous data collection to monitor blood oxygen saturation during rest, peripheral skin temperature, activity associated with movement during sleep and electrodermal activity. Each digital biomarker is based on trained algorithms that analyse sensor data in one-minute intervals. Dr. Marisa Cruz, chief medical officer of Empatica, said: "This clearance represents a significant step forward for our scientific community. Patients, healthcare providers, and researchers deserve digital health products that are accurate, validated in diverse populations, and intuitive to use. "We are proud to have built a solution that accomplishes these goals, offering a high-quality and reliable digital health tool to scientists working to improve patient outcomes through research and clinical care." The company has also announced the closing of its Series B financing. The investment was led by Sanofi Venture and RA Capital Management with participation by Black Opal Ventures. Empatica intends to use the financing to expand its suite of digital biomarkers for use in both patient care and in clinical trials as digital endpoints. Cris De Luca, partner at Sanofi Ventures and newly-appointed board member at Empatica, said: "By gaining higher resolution into disease symptomology through novel digital measures and digital biomarkers in clinical and real-world settings, Empatica is unlocking the possibilities of early disease detection, enhanced treatment decisions, and improving quality of life for patients around the world." International IT services company, Netcompany, alongside the Department for Health and Social Care (DHSC) have won the Emerging Technology of the Year award in the Technology Excellence category of the 2022 UK IT Industry Awards. The two companies were recognised for their work on the NHS Covid Pass, which also saw them receive a highly commended in the Best Healthcare IT Project of the Year 2022. The win reflects the vital role that the NHS Covid Pass has played in the safe reopening of the country. It allows users to shared their Covid-19 status or vaccination status when travelling internationally. Richard Davies, UK country managing partner at Netcompany, said: "This award recognises our talented teams, expertise, and dedication towards creating technology solutions that help to improve the everyday lives of citizens.

NeuraLight is on a mission to transform the lives of billions of people impacted by neurological disorders by digitizing neurological evaluation and care. Using their AI-driven platform to integrate multiple digital markers to accelerate and improve drug development, monitoring, and precision care for patients with neurological disorders, NeuraLight is revolutionizing patient care. NeuraLight's platform, which uses proprietary computer vision and deep learning algorithms to extract over 100 occulometic markers from facial videos captured with a standard webcam, will be used to evaluate ALS patients in a study parallel to NeuroSense's Phase IIb PARADIGM trial. PARADIGM is a double-blind, placebo-controlled study evaluating the efficacy of NeuroSense's lead combination drug candidate, PrimeC, in the treatment of ALS. The NeuroSense-NeuraLight collaboration entails sharing and tracking patient data to advance the identification and use of ALS digital biomarkers.