Blood and Breath Alcohol Concentration from Transdermal Alcohol Biosensor Data: Estimation and Uncertainty...

Transdermal alcohol biosensors that do not require active participation of the subject and yield near continuous measurements have the potential to significantly enhance the data collection abilities of alcohol researchers and clinicians who currently rely exclusively on breathalyzers and drinking diaries. Making these devices accessible and practical requires that transdermal alcohol concentration (TAC) be accurately and consistently transformable into the well-accepted measures of intoxication, blood/breath alcohol concentration (BAC/BrAC). A novel approach to estimating BrAC from TAC based on covariate-dependent physics-informed hidden Markov models with two emissions is developed. The hidden Markov chain serves as a forward full-body alcohol model with BrAC and TAC, the two emissions, assumed to be described by a bivariate normal which depends on the hidden Markovian states and person-level and session-level covariates via built-in regression models. An innovative extension of hidden Markov modeling is developed wherein the hidden Markov model framework is regularized by a first-principles PDE model to yield a hybrid that combines prior knowledge of the physics of transdermal ethanol transport with data-based learning. Training, or inverse filtering, is effected via the Baum-Welch algorithm and 256 sets of BrAC and TAC signals and covariate measurements collected in the laboratory. Forward filtering of TAC to obtain estimated BrAC is achieved via a new physics-informed regularized Viterbi algorithm which determines the most likely path through the hidden Markov chain using TAC alone. The Markovian states are decoded and used to yield estimates of BrAC and to quantify the uncertainty in the estimates. Numerical studies are presented and discussed. Overall good agreement between BrAC data and estimates was observed with a median relative peak error of 22% and a median relative area under the curve error of 25% on the test set. We also demonstrate that the physics-informed Viterbi algorithm eliminates non-physical artifacts in the BrAC estimates.