Apple Vision Pro for Healthcare: "The Ultimate Display"? -- Entering the Wonderland of Precision Medicine

At the Worldwide Developers Conference (WWDC) in June 2023, Apple introduced the Vision Pro. The Vision Pro is a Mixed Reality (MR) headset, more specifically it is a Virtual Reality (VR) device with an additional Video See-Through (VST) capability. The VST capability turns the Vision Pro also into an Augmented Reality (AR) device. The AR feature is enabled by streaming the real world via cameras to the (VR) screens in front of the user's eyes. This is of course not unique and similar to other devices, like the Varjo XR-3. Nevertheless, the Vision Pro has some interesting features, like an inside-out screen that can show the headset wearers' eyes to "outsiders" or a button on the top, called "Digital Crown", that allows you to seamlessly blend digital content with your physical space by turning it. In addition, it is untethered, except for the cable to the battery, which makes the headset more agile, compared to the Varjo XR-3. This could actually come closer to the "Ultimate Display", which Ivan Sutherland had already sketched in 1965. Not available to the public yet, like the Ultimate Display, we want to take a look into the crystal ball in this perspective to see if it can overcome some clinical challenges that - especially - AR still faces in the medical domain, but also go beyond and discuss if the Vision Pro could support clinicians in essential tasks to spend more time with their patients.Comment: This is a Preprint under CC BY. This work was supported by NIH/NIAID R01AI172875, NIH/NCATS UL1 TR001427, the REACT-EU project KITE and enFaced 2.0 (FWF KLI 1044). B. Puladi was funded by the Medical Faculty of the RWTH Aachen University as part of the Clinician Scientist Program. C. Gsaxner was funded by the Advanced Research Opportunities Program from the RWTH Aachen Universit

The use of extended reality and machine learning to improve healthcare and promote greenhealth

Com a Quarta Revolução Industrial, a propagação da Internet das Coisas, o avanço nas áreas de Inteligência Artificial e de Machine Learning até à migração para a Computação em Nuvem, o termo "Ambientes Inteligentes" cada vez mais deixa de ser uma idealização para se tornar realidade. Da mesma forma as tecnologias de Realidade Extendida também elas têm aumentado a sua presença no mundo tecnológico após um "período de hibernação", desde a popularização do conceito de Metaverse assim como a entrada das grandes empresas informáticas como a Apple e a Google num mercado onde a Realidade Virtual, Realidade Aumentada e Realidade Mista eram dominadas por empresas com menos experiência no desenvolvimento de sistemas (e.g. Meta), reconhecimento a nível mundial (e.g. HTC Vive), ou suporte financeiro e confiança do mercado. Esta tese tem como foco o estudo do potencial uso das tecnologias de Realidade Estendida de forma a promover Saúde Verde assim como seu uso em Hospitais Inteligentes, uma das variantes de Ambientes Inteligentes, incorporando Machine Learning e Computer Vision, como ferramenta de suporte e de melhoria de cuidados de saúde, tanto do ponto de vista do profissional de saúde como do paciente, através duma revisão literarária e análise da atualidade. Resultando na elaboração de um modelo conceptual com a sugestão de tecnologias a poderem ser usadas para alcançar esse cenário selecionadas pelo seu potencial, sendo posteriormente descrito o desenvolvimento de protótipos de partes do modelo conceptual para Óculos de Realidade Extendida como validação de conceito.With the Fourth Industrial Revolution, the spread of the Internet of Things, the advance in the areas of Artificial Intelligence and Machine Learning until the migration to Cloud Computing, the term "Intelligent Environments" increasingly ceases to be an idealization to become reality. Likewise, Extended Reality technologies have also increased their presence in the technological world after a "hibernation period", since the popularization of the Metaverse concept, as well as the entry of large computer companies such as Apple and Google into a market where Virtual Reality, Augmented Reality and Mixed Reality were dominated by companies with less experience in system development (e.g. Meta), worldwide recognition (e.g. HTC Vive) or financial support and trust in the market. This thesis focuses on the study of the potential use of Extended Reality technologies in order to promote GreenHealth as well as their use in Smart Hospitals, one of the variants of Smart Environments, incorporating Machine Learning and Computer Vision, as a tool to support and improve healthcare, both from the point of view of the health professional and the patient, through a literature review and analysis of the current situation. Resulting in the elaboration of a conceptual model with the suggestion of technologies that can be used to achieve this scenario selected for their potential, and then the development of prototypes of parts of the conceptual model for Extended Reality Headsets as concept validation

Doctor of Philosophy

dissertationTreatment adherence remains a major challenge in tuberculosis (TB) control. Mobile phone text messaging is a promising tool to support TB treatment adherence. The purpose of this study was to develop a text messaging intervention to promote TB treatment adherence, assess feasibility and acceptability, and to explore initial efficacy. A collaborative team of clinicians, administrators and patients in treatment developed the intervention. Content analysis, based on the Information-Motivation-Behavioral Skills (IMB) model, guided educational message selection. To identify considerations for a larger trial a socio-technical evaluation model adapted from Conford, and Barber and associates was applied. The intervention was implemented as a mixed-method, randomized controlled pilot-study at a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were18 or older, without drug resistance or HIV, and had access to a mobile phone were recruited. Participants were randomized to usual care plus either medication calendar (n=19) or text messaging intervention (n=18) for the first 2 months of treatment. Data were obtained through interviews, field notes, self-reported adherence, sputum microscopy, and treatment outcomes. Most potential participants had access to mobile phones and knew how to send a text, supporting feasibility of the intervention. The majority of the participants (60%) indicated not being adequately informed about disease or treatment. Participants identified themes of feeling cared for, responsible for their treatment and valued the option to ask questions and receive quick answers. Texting group participants reported adherence 77% of the days (SD 23.5, range 22-100), whereas only 53% in the control group returned calendars. Sputum conversion and treatment outcomes were similar in both groups. Considerations for conducting a larger trial included reducing cost, improving the automated features, and strengthening capacity to return patients to treatment. A collaborative approach and application of the IMB model to guide development was supported. Overall the texting intervention was well accepted and feasible, daily reporting was superior, and adherence was monitored in real time. Although there was not clear evidence that the texting intervention was more efficacious, feasibility and acceptability results suggest that there is value in assessing this interactive intervention in a larger-scale study

An IoT based Virtual Coaching System (VSC) for Assisting Activities of Daily Life

Nowadays aging of the population is becoming one of the main concerns of theworld. It is estimated that the number of people aged over 65 will increase from 461million to 2 billion in 2050. This substantial increment in the elderly population willhave significant consequences in the social and health care system. Therefore, in thecontext of Ambient Intelligence (AmI), the Ambient Assisted Living (AAL) has beenemerging as a new research area to address problems related to the aging of the population. AAL technologies based on embedded devices have demonstrated to be effectivein alleviating the social- and health-care issues related to the continuous growing of theaverage age of the population. Many smart applications, devices and systems have beendeveloped to monitor the health status of elderly, substitute them in the accomplishment of activities of the daily life (especially in presence of some impairment or disability),alert their caregivers in case of necessity and help them in recognizing risky situations.Such assistive technologies basically rely on the communication and interaction be-tween body sensors, smart environments and smart devices. However, in such contextless effort has been spent in designing smart solutions for empowering and supportingthe self-efficacy of people with neurodegenerative diseases and elderly in general. Thisthesis fills in the gap by presenting a low-cost, non intrusive, and ubiquitous VirtualCoaching System (VCS) to support people in the acquisition of new behaviors (e.g.,taking pills, drinking water, finding the right key, avoiding motor blocks) necessary tocope with needs derived from a change in their health status and a degradation of theircognitive capabilities as they age. VCS is based on the concept of extended mind intro-duced by Clark and Chalmers in 1998. They proposed the idea that objects within theenvironment function as a part of the mind. In my revisiting of the concept of extendedmind, the VCS is composed of a set of smart objects that exploit the Internet of Things(IoT) technology and machine learning-based algorithms, in order to identify the needsof the users and react accordingly. In particular, the system exploits smart tags to trans-form objects commonly used by people (e.g., pillbox, bottle of water, keys) into smartobjects, it monitors their usage according to their needs, and it incrementally guidesthem in the acquisition of new behaviors related to their needs. To implement VCS, thisthesis explores different research directions and challenges. First of all, it addresses thedefinition of a ubiquitous, non-invasive and low-cost indoor monitoring architecture byexploiting the IoT paradigm. Secondly, it deals with the necessity of developing solu-tions for implementing coaching actions and consequently monitoring human activitiesby analyzing the interaction between people and smart objects. Finally, it focuses on the design of low-cost localization systems for indoor environment, since knowing theposition of a person provides VCS with essential information to acquire information onperformed activities and to prevent risky situations. In the end, the outcomes of theseresearch directions have been integrated into a healthcare application scenario to imple-ment a wearable system that prevents freezing of gait in people affected by Parkinson\u2019sDisease

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Smart Sensing Technologies for Personalised Coaching

People living in both developed and developing countries face serious health challenges related to sedentary lifestyles. It is therefore essential to find new ways to improve health so that people can live longer and can age well. With an ever-growing number of smart sensing systems developed and deployed across the globe, experts are primed to help coach people toward healthier behaviors. The increasing accountability associated with app- and device-based behavior tracking not only provides timely and personalized information and support but also gives us an incentive to set goals and to do more. This book presents some of the recent efforts made towards automatic and autonomous identification and coaching of troublesome behaviors to procure lasting, beneficial behavioral changes

Evaluation of direct-to-patient educational approaches for reducing inappropriate sedative-hypnotic use in community-dwelling older adults

Cette thèse teste l’hypothèse selon laquelle l’initiation du processus de déprescription des benzodiazépines peut être facilité chez les aînés via l’utilisation de documents éducatifs fondés sur des données probantes, soulignant les risques associés à ces médicaments ainsi que les alternatives non pharmacologiques plus sécuritaires. Cette thèse détaille comment nous avons développé, testé et adapté des outils éducatifs destinés aux consommateurs de benzodiazépines en nous basant sur des éléments de la théorie sociale cognitive et de la théorie constructiviste de l'apprentissage. Notre recherche a révélé l’importance du soutien offert par les professionnels de la santé chez les patients intéressés à déprescrire. Les étapes subséquentes de notre programme de recherche visaient à fournir aux aînés l'information nécessaire pour initier la conversation sur la déprescription, et, de façon simultanée, améliorer le niveau de confiance et outiller les professionnel de la santé, pour leur permettre d’assister les patients motivés à arrêter leurs sédatif-hypnotiques. Nous avons d'abord mené l'essai randomisé par grappes EMPOWER, où nous avons recruté 303 usagers chroniques de benzodiazépines âgés de 65 à 95 ans, dans 30 pharmacies communautaires (15 interventions, n = 148 participants, 15 témoins, n = 155). Une analyse préliminaire de l'effet de l'intervention sur la perception du risque associé aux benzodiazépines chez les participants a révélé que 45,1% de ceux ayant reçu l'intervention EMPOWER avaient signalé une augmentation du risque perçu, ce qui est associé à une meilleure acquisition des connaissances, à un changement des croyances, à une dissonance cognitive, à un sentiment d’auto-efficacité accru et à une plus grande intention d’entamer la conversation sur la cessation du médicament. Après 6 mois, 27% des patients du groupe d'intervention avaient cessé leur benzodiazépine contre 5% des témoins (différence de risque 23%, IC 95% 14-32%, ICC 0,008, NNT = 4). Aucun facteur de risque n’influençait l'effet de l'intervention. Subséquemment, nous avons cherché à mieux comprendre les raisons pour lesquelles l'intervention avait échoué ou réussi chez certains participants, afin de guider la recherche future. Nous avons vérifié si les patients avec un déficit cognitif léger avaient autant bénéficié de l'intervention que les patients avec une cognition normale. Une analyse post hoc de tous les participants ayant complété l'étude EMPOWER (n = i 261) n'a révélé aucune différence significative, l'arrêt des benzodiazépines ayant été noté chez 39 (32,0% [24.4,40.7]) participants avec déficit cognitif léger et chez 53 (38,1% [30.5,46.4]) participants avec une cognition normale (OR ajusté 0,79, IC 95% [0.45-1.38]). Nous avons ensuite mené une évaluation réaliste qui a révélé que l’intervention avait réussi à motiver 167 participants (n = 64%) à déprescrire, cela ayant été démontré par l'amélioration du niveau de connaissances et un sentiment d’inquiétude accru quant à la prise de benzodiazépines. La déprescription était plus souvent vouée à l’échec chez les participants s’il y avait un manque de support offert par un professionnel de la santé, si l’accent était mis sur la qualité de vie à court terme, ou en présence d’intolérance aux symptômes de sevrage ou de perception défavorable de son niveau de santé. En se basant sur les défis observés dans l'essai EMPOWER, nous avons cherché à éliminer certains des obstacles à la déprescription de sédatif-hypnotiques, ciblant spécifiquement la réticence des professionnels de la santé à soutenir les patients dans le processus de déprescription. L'intervention dans l'essai D-PRESCRIBE consistait en une approche éducative en deux volets dirigés par le pharmacien auprès des patients et des médecins, via la distribution de la brochure EMPOWER aux patients et d'une opinion pharmaceutique destinée aux prescripteurs. Nous avons développé un modèle standard d’opinion pharmaceutique fondé sur des données probantes, testé auprès d’un échantillon de 32 médecins et de 61 pharmaciens. Via révision du prototype, un modèle final a été obtenu par consensus. Dans le cadre de l'étude randomisée par grappes D-PRESCRIBE, nous avons recruté 299 utilisateurs chroniques de sédatif-hypnotiques âgés de 66 à 96 ans, provenant de 68 pharmacies communautaires (34 interventions, n = 145 participants, 34 témoins, n = 154). Après 6 mois, 44% des patients du groupe d'intervention avaient cessé leur sédatif-hypnotique, contre 6,5% chez les contrôles (différence de risque 38%, IC 95% 24-48%, ICC 0,012, NNT = 3). Les taux de cessation de D-PRESCRIBE étaient significativement plus élevés que ceux observés dans l'étude EMPOWER. Les résultats suggèrent que l’ajout d’une composante éducative chez les prescripteurs réduit leur réticence à soutenir un patient motivé par le processus de déprescription.This thesis tests the hypothesis that older adults can enable the initiation of benzodiazepine deprescribing when equipped with evidence-based educational material about drug harms and safer non-pharmacological alternatives. The work described in this thesis explains how we developed, tested, refined and adapted educational tools for benzodiazepine consumers, based on elements of social cognitive theory and constructivist learning theory. Our research revealed that health care provider support is required to assist patients in following through on their initial desire to deprescribe. Subsequent steps in my research program aimed to simultaneously equip older adults with the information they need to drive deprescribing conversations, while also boosting health care provider support and self-efficacy for enabling motivated patients to successfully discontinue sedative-hypnotics. We first conducted the EMPOWER cluster randomized trial, where we recruited 303 chronic users of benzodiazepine medication aged 65-95 years, recruited from 30 community pharmacies (15 intervention, n=148 participants; 15 control, n= 155). A preliminary analysis was conducted to evaluate the intervention’s effect on participants risk perception about benzodiazepines through knowledge acquisition and change in beliefs. We showed that 45.1% of participants receiving the EMPOWER intervention reported an increased perceived risk, which was associated with better knowledge acquisition, change in beliefs, occurrence of cognitive dissonance, increased self- efficacy and increased intent to discuss discontinuation. Six-months outcomes from the trial revealed that 27% of the intervention group had discontinued benzodiazepine use compared to 5% of controls (risk difference 23%, 95% CI 14-32%, ICC 0.008, NNT=4) with no risk factor characteristics interacting with the effect of the intervention. We then aimed to gain a better understanding as to why the intervention failed or succeeded for certain participants in order to guide future research. We tested whether patients with mild cognitive impairment (MCI) received the same benefits from the intervention as patients with normal cognition. A post-hoc analysis of all participants iii completing the EMPOWER study (n=261) revealed no significant differences, with benzodiazepine discontinuation occurring in 39 (32.0% [24.4,40.7]) participants with MCI and in 53 (38.1% [30.5,46.4]) with normal cognition (aOR 0.79, 95% CI [0.45– 1.38]). We then conducted a realist evaluation, which showed that the intervention triggered the motivation to deprescribe among 167 (n=64%) participants, demonstrated by improved knowledge and increased concern about taking benzodiazepines. Contexts where the deprescribing mechanisms failed included lack of support from healthcare providers, short-term quality of life focus, intolerance to withdrawal symptoms and perceived poor health. Based on the challenges observed in the EMPOWER trial, we aimed to address some of the observed barriers to sedative-hypnotic deprescribing, specifically targeting healthcare provider reluctance to support patients in the deprescribing process. The intervention in the subsequent D-PRESCRIBE trial consisted of a two-pronged educational approach brokered by the pharmacist to patients and physicians, through distribution of the EMPOWER brochure to patients and a pharmaceutical opinion to prescribers. We developed a standardized template for an evidence-based pharmaceutical opinion, which we tested in a convenience sample of 32 primary care physicians and 61 primary care pharmacists. The content and format of the prototype underwent revisions until a consensus was reached on a final recommended template. We then conducted the D-PRESCRIBE cluster randomized trial, where we recruited 299 chronic sedative-hypnotic medication users aged 66-96 years, from 68 community pharmacies (34 intervention, n=145 participants; 34 control, n= 154). Six-months outcomes yielded a 44% discontinuation rate in the intervention group compared to a 6.5% rate in the controls (risk difference 38%, 95% CI 24-48%, ICC 0.012, NNT=3) with risk profile characteristics interacting with the effect of the intervention. Discontinuation rates in D-PRESCRIBE were significantly higher than those observed in the EMPOWER trial. Process outcomes from the trial suggest that the added value of adding an educational component to prescribers is that it decreases reluctance to support motivated patients to attempt and succeed at deprescribing

mHealth in Practice

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. There has recently been an explosion of interest around the application of mobile communication technologies to support health initiatives in developing countries (mHealth). As a result, there is a need to promote and share rigorous research for better informed policy, programming, and investment. There are, however, few platforms for the exchange of information and proven practice between practitioners and researchers. The subtopic of prevention, well-being, and health promotion within mHealth is particularly ripe for deeper exploration. While many reports tout the potential of mobiles to influence behaviour change for health, there is limited knowledge about what works (and what does not work), and about how to evaluate current and future programs. This is a focused edited volume with contributions from leading researchers and practitioners to identify best practices in using mobile technologies to promote healthy behaviours (and reduce unhealthy ones) in resource-constrained settings with a special focus on developing countries. This topic is inherently interdisciplinary. Though the opportunities to leverage mobile phones for health are new, the challenges confronting researchers and practitioners are well-established and theoretically complex, with roots in decades of work on mediated behaviour change campaigns and theories