Early Biomarkers and Intervention Programs for the Infant Exposed to Prenatal Stress

Functional development of affective and reward circuits, cognition and response inhibition later in life exhibits vulnerability periods during gestation and early childhood. Extensive evidence supports the model that exposure to stressors in the gestational period and early postnatal life increases an individual's susceptibility to future impairments of functional development. Recent versions of this model integrate epigenetic mechanisms of the developmental response. Their understanding will guide the future treatment of the associated neuropsychiatric disorders. A combination of non-invasively obtainable physiological signals and epigenetic biomarkers related to the principal systems of the stress response, the Hypothalamic-Pituitary axis (HPA) and the Autonomic Nervous System (ANS), are emerging as the key predictors of neurodevelopmental outcomes. Such electrophysiological and epigenetic biomarkers can prove to timely identify children benefiting most from early intervention programs. Such programs should ameliorate future disorders in otherwise apparently healthy children. The recently developed Early Family-Centered Intervention Programs aim to influence the care and stimuli provided daily by the family and improving parent/child attachment, a key element for healthy socio-emotional adult life. Although frequently underestimated, such biomarker-guided early intervention strategy represents a crucial first step in the prevention of future neuropsychiatric problems and in reducing their personal and societal impact.Comment: 18 pages-Revie

Cardiopulmonary coupling indices to assess weaning readiness from mechanical ventilation

The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients’ readiness, there is still around 15–20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation –being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness

‘What would happen if I said “Yes”?’ : Measuring the immediate and long-term impact of improvisation training on student teachers’ subjective, neuroendocrine and psychophysiological responses

Improvisation is commonly understood as a performance or creating something without preparation. As an art form, improvised theatrical plays are created spontaneously on stage without a script. As an applied form of theatre, improvisation has been utilised in fields requiring collaboration and a tolerance for uncertainty, such as in the business and education sectors. This dissertation contributes to the literature in educational research by investigating applied improvisation as a tool to promote student teachers’ interpersonal competence. Applied improvisation enables individuals to explore and practise teaching-related encounters in a fictional and psychologically safe context. Psychological safety is particularly important when practising challenging interactions. Despite the fictionality of the context, bodily experiences during improvisations may promote experiential learning. The research summarised in this dissertation was guided by two primary research questions. First, I asked whether improvisation training influenced student teachers’ interpersonal competence and social stress. Student teachers (n = 19) participated in a 7-week (17.5-h) improvisation intervention, comprising the fundamentals of theatre improvisation and status expression (verbal and nonverbal behaviours indicating the social dominance of a person). The impact of the intervention was measured using subjective self-reports (interpersonal confidence, i.e., belief regarding one’s capability related to effective social interactions, self-esteem and experienced stress) and a large array of physiological measurements (heart rate, heart rate variability, skin conductance, facial muscle activity, frontal electroencephalogram (EEG) alpha asymmetry and stress hormone cortisol). Self-reports, physiological measurements and Trier Social Stress Tests (TSST; including public speaking) were performed before and after the improvisation intervention. An improvisation course was arranged for the control group (n = 20) following the intervention study. One year later, the long-term effects of improvisation training on self-reported interpersonal confidence were measured in a follow-up study. Second, I asked how real versus fictional social rejections impact experienced stress and psychophysiological responses. Student teachers (n = 39) participated in an experiment including both real (interview) and fictional (improvisation exercises) dyadic interactions. In the real condition, student teachers were unaware that the interviewer was an actor trained to include subtle social rejections during the interview by using three types of social rejections: devaluing, interrupting and nonverbal rejections. In the fictional condition, student teachers were informed in advance which social rejection type would be used during a later improvisation exercise. Experienced stress and psychophysiological reactivity during social rejections were measured under both experimental conditions. Following an improvisation intervention, interpersonal confidence and its components of performance confidence and a tolerance for failure increased relative to controls, whilst one year later the improved performance confidence persisted. Furthermore, a heterogeneous treatment effect was found. Those with the lowest pretest interpersonal confidence score benefited most from the improvisation intervention. No between-group differences in self-esteem were observed. Psychological and physiological indications of relief from performance-related stress were also observed following improvisation training. In addition, interpersonal confidence moderated self-reported and cardiovascular stress responses. Thus, interpersonal confidence may be worth controlling for in future research which examines the effects of interventions aimed at relieving social stress. The results also support the notion that repetition may also diminish performance-related stress, since the control group exhibited decreases in cardiovascular stress during some of the test conditions. The primary finding regarding the second research question emerged through the absence of any systematic attenuation of the psychophysiological reactivity to fictional versus real-world social rejections. In other words, although student teachers knew that improvised social rejections were fictional, their psychophysiological responses during improvisation remained relatively similar and associated with those of real-world rejections. It appears as though personal relevance and engagement during improvisation explain the relatively similar bodily responses. This result suggests that interpersonal encounters can be realistically modelled through applied improvisation. In this dissertation research, I also produced a validated self-report measure, the Interpersonal Confidence Questionnaire (ICQ), to evaluate the impact of social interaction training relying on applied improvisation. Using an additional dataset (n = 208), I validated the questionnaire and examined the impact of improvisation training on a larger sample. A confirmatory factor analysis identified six factors—performance confidence, flexibility, listening skills, a tolerance for failure, collaboration motivation and presence—that contribute to interpersonal confidence. Thus, the ICQ appeared valid and reliable as a self-report measure of interpersonal confidence. In summary, the findings from this research indicate that a relatively brief improvisation intervention promotes interpersonal confidence, specifically amongst those with low interpersonal confidence. Furthermore, improvisation training serves as an intervention against performance anxiety and generates long-term improvements to performance confidence. This dissertation provides a theoretical framework and empirical support for the application of improvisation as a tool to develop interpersonal competence skills, particularly within professions requiring face-to-face interactions. Regardless of the fictionality of the improvisational context, genuine emotions and experiences may emerge, serving as experiential learning experiences. The significance of these findings may extend to theatre-based practices and drama education in general, which rely on holistic action and personal engagement in fictional contexts. The findings agree with previous research, suggesting that including the improvisation method in teacher education curricula can enhance student teachers’ interpersonal competence as well as their skills related to sensitive and responsive teaching. Finally, this dissertation contributes to social neuroscience by recommending an ecologically valid experimental design wherein naturally unfolding social interactions can be achieved using improvisation techniques. Keywords: experiential learning, fictionality, improvisation, interpersonal confidence, intervention, psychophysiology, social interaction, social rejection, social stress, teacher education, theatre-based practicesImprovisaatiolla tarkoitetaan yleisesti esiintymistä tai toimintaa, jota ei suunnitella etukäteen. Teatterissa improvisoidut näytelmät syntyvät näyttämöllä spontaanisti ilman käsikirjoitusta. Soveltava teatteri hyödyntää improvisaatiota aloilla, joissa tarvitaan yhteistyötä ja epävarmuuden sietokykyä, kuten liike-elämässä ja koulutuksessa. Tämä väitöstyö tarkastelee teatterilähtöistä improvisaatiomenetelmää opettajakoulutuksen kontekstissa. Käyttämällä improvisaatiota soveltavan teatterin muotona on mahdollista tutkia ja harjoitella vuorovaikutukseen liittyviä kohtaamisia kuvitteellisessa ja psykologisesti turvallisessa ympäristössä. Psykologinen turvallisuus on erityisen tärkeää, kun harjoitellaan haastavissa vuorovaikutustilanteissa toimimista. Ympäristön fiktiivisyydestä, eli kuvitteellisuudesta, huolimatta improvisaatioharjoittelu tarjoaa kehollisia kokemuksia, jotka voivat edistää kokemuksellista oppimista. Väitöstutkimuksen ensimmäisenä tavoitteena oli selvittää improvisaatioharjoittelun vaikutuksia opettajaopiskelijoiden vuorovaikutusosaamiseen ja sosiaaliseen stressiin. Opettajaopiskelijoille (N = 19) järjestettiin 7 viikon (17,5 h) interventio, jossa harjoiteltiin improvisaation perusteita ja statusilmaisua, eli sanallista ja sanatonta ilmaisua liittyen valta-asemaan vuorovaikutuksessa. Intervention vaikutuksia kartoitettiin itsearviointien (vuorovaikutusvarmuus, itsetunto ja koettu stressi) kautta ja kehollisia vaikutuksia mittaamalla opettajaopiskelijoiden kehollisia vasteita (syke, sykevälivaihtelu, ihon sähkönjohtavuus, kasvolihasten aktivaatio, aivosähkökäyrä ja stressihormoni kortisoli). Fysiologiset mittaukset, Trierin sosiaalisen stressin testit (mm. julkinen puhe) sekä itsearvioinnit suoritettiin ennen improvisaatiointerventiota ja sen jälkeen. Kontrolliryhmälle (N = 20) järjestettiin improvisaatiokurssi loppumittausten jälkeen. Vuorovaikutusvarmuutta mitattiin viivästetyllä kyselyllä vielä vuoden kuluttua interventiosta. Väitöstutkimuksen toinen tavoite oli syventää ymmärrystä siitä, miten tietoisuus tilanteen fiktiivisyydestä vaikuttaa kokemukseen vertaamalla aidon ja fiktiivisen vuorovaikutustilanteen kehollisia vasteita. Opettajaopiskelijat (N = 39) osallistuivat kokeeseen, joka sisälsi sekä aidon (haastattelu) että fiktiivisen (improvisaatioharjoittelu) vuorovaikutustilanteen. Aidossa tilanteessa opettajaopiskelijat eivät tienneet, että haastattelijan tehtävänä oli epäsuorasti torjua opiskelijoiden vastauksia vähättelemällä, keskeyttämällä ja sanattomalla torjunnalla. Fiktiivisessä tilanteessa opettajaopiskelijoille kerrottiin etukäteen mitä em. torjuntatapaa improvisaatioharjoituksessa käytetään. Molemmissa koetilanteissa mitattiin koettua stressiä ja kehollisia vasteita epäsuorien sosiaalisten torjuntojen aikana. Improvisaatioharjoittelu lisäsi osallistujien vuorovaikutusvarmuutta sekä sen osatekijöitä esiintymisvarmuutta ja epäonnistumisen sietokykyä, kun tuloksia verrattiin kontrolliryhmään. Vuoden kuluttua interventiosta esiintymisvarmuus säilyi korkeammalla tasolla kontrolliryhmään verrattuna. Tulosten mukaan improvisaatioharjoittelusta oli hyötyä erityisesti epävarmimmille opettajaopiskelijoille, joilla vuorovaikutus- ja esiintymisvarmuus kasvoi eniten. Itsetunnossa ei havaittu eroa interventio- ja kontrolliryhmien välillä. Sykevälivaihtelu ja kasvolihasten aktivaatio osoittivat, että improvisaatiokurssilaiset olivat rentoutuneempia esiintymisvuoroa odottaessa kuin kontrolliryhmä. Sykevälivaihtelun ja koetun stressin mukaan epävarmimpien kurssilaisten stressitaso laski enemmän kuin varmempien. Tulokset tukevat myös käsitystä, että toistoharjoittelu voi lieventää esiintymiseen liittyvää stressiä, koska myös kontrolliryhmässä stressivasteet laskivat osassa esiintymistilanteita. Väitöstutkimuksen keskeinen löydös vertailtaessa aitoja ja fiktiivisiä vuorovaikutustilanteita oli se, että improvisoitujen ja aitojen sosiaalisten torjuntojen keholliset vasteet eivät systemaattisesti eronneet toisistaan. Toisin sanoen, vaikka opettajaopiskelijat tiesivät, että improvisoidut sosiaaliset torjunnat olivat fiktiivisiä, keholliset vasteet olivat samankaltaisia kuin vastaavassa aidossa tilanteessa. Tulokset viittaavat siihen, että sosiaalisia vuorovaikutustilanteita voidaan mallintaa realistisesti teatterilähtöisen improvisaation keinoin. Väitöstyö tuotti myös validoidun vuorovaikutusvarmuuden itsearviointimittarin improvisaatiopohjaisten vuorovaikutuskoulutusten vaikutusten arviointiin. Itsearviointimittarin validoinnissa käytettiin konfirmatorista faktorianalyysia ja laajempaa kyselyaineistoa (N = 208). Faktorianalyysi osoitti, että vuorovaikutusvarmuuteen sisältyy kuusi osa-aluetta: esiintymisvarmuus, joustavuus, kuunteleminen, epäonnistumisen sietokyky, yhteistyömotivaatio ja läsnäolo. Tulosten mukaan mittari on myös luotettava vuorovaikutusvarmuuden itsearvioinnin väline. Tutkimustulosten mukaan jo suhteellisen lyhyt improvisaatioharjoittelu voi lisätä erityisesti epävarmojen henkilöiden vuorovaikutusvarmuutta sekä lieventää esiintymisjännitystä. Esiintymisvarmuuden osalta positiiviset vaikutukset olivat pitkäaikaisia. Väitöstyö tuottaa myös uutta, empiiristä tietoa improvisaatioharjoittelun kehollisista vaikutuksista. Tulosten merkitystä voidaan ulottaa myös muille soveltavan teatterin alueille, joissa teatterilähtöisillä menetelmillä pyritään tuottamaan elämyksellisiä oppimiskokemuksia ja kokemuksellista oppimista. Väitöstutkimus luo teoreettista pohjaa sovelletun improvisaation käyttämiselle laajemminkin työelämän ja arkipäivän vuorovaikutustilanteiden mallintamiseen. Löydökset vahvistavat aikaisempia kansainvälisiä tutkimustuloksia, joiden mukaan improvisaatio opettajankoulutuksen osana lisäisi opettajan vuorovaikutuskompetenssia sekä opetuksen sensitiivisyyttä ja vuorovaikutteisuutta. Poikkitieteellinen väitöstyö osoitti myös käytännön suuntaviivoja improvisaation ja neurotieteen yhdistämiselle vuorovaikutuksen kokeellisessa tutkimuksessa. Avainsanat: fiktiivisyys, improvisaatio, interventio, kokemuksellinen oppiminen, opettajakoulutus, psykofysiologia, sosiaalinen stressi, sosiaalinen torjunta, teatterilähtöiset menetelmät, vuorovaikutus, vuorovaikutusvarmuu

Data fusion of relative movement in fast, repetitive-action sports using body wireless area networks

Rowing is an intensive, all-body sport, where bad technique can lead to injury. Crew cohesion, particularly timing, is vital to the performance of the boat. The coaching process, and injury prevention, could be enhanced if data relating to the movement of the oarsmen could be collected, without hindrance to the oarsmen, during on-water training. Literature until recently has concentrated upon boat-centric measurement. Advances in wireless technology have made feasible the collection of data from multiple physically separate sites, including on-body. After analysis of candidate radio standards, a Zigbee wireless Body Sensor Network (BSN) was designed and developed to synchronously collect data from several sensors across the wireless BSN. By synchronising sensor nodes via scheduled synchronising messages from the central coordinating node, synchronisation within 0.79msec ±0.39ms was achieved. Minimisation of the on-time of the sensor node radios currently extends the battery life by a factor of 5. Acceleration and muscle activity data collected using the wireless BSN was compared to data synchronously collected using proven motion analysis techniques to validate the system. Synchronous muscle activity data was collected via the wireless BSN from several muscles during both land-based and on-water rowing and the results compared. The system was proven to facilitate the identification of bad rowing technique, as well as differences in muscle recruitment between land- and water-based rowing. Data collection from a rowing crew was also demonstrated, and their muscle activity and inter-crew timing analysed. With an additional sensor node upon the boat, it is possible to correlate acceleration and muscle activity from the oarsman with acceleration of the boat itself. A novel, power-optimised wireless sensor network has been designed and demonstrated to facilitate on-water rowing monitoring that can be extended beyond single oarsman measurements to analyse the interaction and cohesion of a crew and their impact upon boat performance

Multimodal Signal Processing for Diagnosis of Cardiorespiratory Disorders

This thesis addresses the use of multimodal signal processing to develop algorithms for the automated processing of two cardiorespiratory disorders. The aim of the first application of this thesis was to reduce false alarm rate in an intensive care unit. The goal was to detect five critical arrhythmias using processing of multimodal signals including photoplethysmography, arterial blood pressure, Lead II and augmented right arm electrocardiogram (ECG). A hierarchical approach was used to process the signals as well as a custom signal processing technique for each arrhythmia type. Sleep disorders are a prevalent health issue, currently costly and inconvenient to diagnose, as they normally require an overnight hospital stay by the patient. In the second application of this project, we designed automated signal processing algorithms for the diagnosis of sleep apnoea with a main focus on the ECG signal processing. We estimated the ECG-derived respiratory (EDR) signal using different methods: QRS-complex area, principal component analysis (PCA) and kernel PCA. We proposed two algorithms (segmented PCA and approximated PCA) for EDR estimation to enable applying the PCA method to overnight recordings and rectify the computational issues and memory requirement. We compared the EDR information against the chest respiratory effort signals. The performance was evaluated using three automated machine learning algorithms of linear discriminant analysis (LDA), extreme learning machine (ELM) and support vector machine (SVM) on two databases: the MIT PhysioNet database and the St. Vincent’s database. The results showed that the QRS area method for EDR estimation combined with the LDA classifier was the highest performing method and the EDR signals contain respiratory information useful for discriminating sleep apnoea. As a final step, heart rate variability (HRV) and cardiopulmonary coupling (CPC) features were extracted and combined with the EDR features and temporal optimisation techniques were applied. The cross-validation results of the minute-by-minute apnoea classification achieved an accuracy of 89%, a sensitivity of 90%, a specificity of 88%, and an AUC of 0.95 which is comparable to the best results reported in the literature