Neural indicators of fatigue in chronic diseases : A systematic review of MRI studies

The authors would like to thank the Sir Jules Thorn Charitable Trust for their financial support.Peer reviewedPublisher PD

Predicting non-response to multimodal day clinic treatment in severely impaired depressed patients: a machine learning approach

A considerable number of depressed patients do not respond to treatment. Accurate prediction of non-response to routine clinical care may help in treatment planning and improve results. A longitudinal sample of N = 239 depressed patients was assessed at admission to multi-modal day clinic treatment, after six weeks, and at discharge. First, patient’s treatment response was modelled by identifying longitudinal trajectories using the Hamilton Depression Rating Scale (HDRS-17). Then, individual items of the HDRS-17 at admission as well as individual patient characteristics were entered as predictors of response/non-response trajectories into the binary classification model (eXtremeGradient Boosting; XGBoost). The model was evaluated on a hold-out set and explained in human-interpretable form by SHapley Additive explanation (SHAP) values. The prediction model yielded a multi-class AUC = 0.80 in the hold-out set. The predictive power for the binary classification yielded an AUC = 0.83 (sensitivity = .80, specificity = .77). Most relevant predictors for non-response were insomnia symptoms, younger age, anxiety symptoms, depressed mood, being unemployed, suicidal ideation and somatic symptoms of depressive disorder. Non-responders to routine treatment for depression can be identified and screened for potential next-generation treatments. Such predictors may help personalize treatment and improve treatment response

Multimodal Mental Health Analysis in Social Media

Depression is a major public health concern in the U.S. and globally. While successful early identification and treatment can lead to many positive health and behavioral outcomes, depression, remains undiagnosed, untreated or undertreated due to several reasons, including denial of the illness as well as cultural and social stigma. With the ubiquity of social media platforms, millions of people are now sharing their online persona by expressing their thoughts, moods, emotions, and even their daily struggles with mental health on social media. Unlike traditional observational cohort studies conducted through questionnaires and self-reported surveys, we explore the reliable detection of depressive symptoms from tweets obtained, unobtrusively. Particularly, we examine and exploit multimodal big (social) data to discern depressive behaviors using a wide variety of features including individual-level demographics. By developing a multimodal framework and employing statistical techniques to fuse heterogeneous sets of features obtained through the processing of visual, textual, and user interaction data, we significantly enhance the current state-of-the-art approaches for identifying depressed individuals on Twitter (improving the average F1-Score by 5 percent) as well as facilitate demographic inferences from social media. Besides providing insights into the relationship between demographics and mental health, our research assists in the design of a new breed of demographic-aware health interventions

Few-Shot Learning for Chronic Disease Management: Leveraging Large Language Models and Multi-Prompt Engineering with Medical Knowledge Injection

This study harnesses state-of-the-art AI technology for chronic disease management, specifically in detecting various mental disorders through user-generated textual content. Existing studies typically rely on fully supervised machine learning, which presents challenges such as the labor-intensive manual process of annotating extensive training data for each disease and the need to design specialized deep learning architectures for each problem. To address such challenges, we propose a novel framework that leverages advanced AI techniques, including large language models and multi-prompt engineering. Specifically, we address two key technical challenges in data-driven chronic disease management: (1) developing personalized prompts to represent each user's uniqueness and (2) incorporating medical knowledge into prompts to provide context for chronic disease detection, instruct learning objectives, and operationalize prediction goals. We evaluate our method using four mental disorders, which are prevalent chronic diseases worldwide, as research cases. On the depression detection task, our method (F1 = 0.975~0.978) significantly outperforms traditional supervised learning paradigms, including feature engineering (F1 = 0.760) and architecture engineering (F1 = 0.756). Meanwhile, our approach demonstrates success in few-shot learning, i.e., requiring only a minimal number of training examples to detect chronic diseases based on user-generated textual content (i.e., only 2, 10, or 100 subjects). Moreover, our method can be generalized to other mental disorder detection tasks, including anorexia, pathological gambling, and self-harm (F1 = 0.919~0.978)

Sickness absence among patients with chronic pain in Swedish specialist healthcare

Background: Chronic pain beyond three months is a global public health problem. Every third adult suffers from a chronic pain condition, resulting in a socioeconomic burden that corresponds to 3-10% of gross domestic product in western economies. This burden can be largely attributed to absenteeism-related productivity loss where a few highly impaired individuals are the most resource-intensive. Simultaneously, a detailed overview of sickness absence (SA) associated with chronic pain is complicated by incongruent classification due to conflicting perspectives on the condition as either a symptom or a disease in its own right. Aim: Based on a well-defined chronic pain population in the Swedish specialist healthcare, this thesis primarily aims to provide a SA overview, to explore the possibility of SA prevention, and to evaluate interdisciplinary treatment (IDT) as a SA intervention. A secondary objective was to assess the psychometric properties of three questionnaires that measure the core domains of the chronic pain experience. Methods: The aims were addressed in three register-based studies using microdata from five Swedish national registers. Study I used sequence analysis to describe SA in 44,241 patients over a 7-year period and subsequently developed a machine learning-based model to predict chronic pain-related SA in the final two years. Study II emulated a target trial to compare the total SA duration over a 5-year period for 25,613 patients that were either included in an IDT program or in other/no interventions. Study III analyzed the properties of the Short Form-36 Health Survey (SF-36), the EuroQol 5-Dimensions instrument (EQ-5D), and the Hospital Anxiety and Depression Scale (HADS) within the item response theory-framework. Results: SA increased from 17% to 48% over the five years before specialist healthcare entry to then decrease to 38% over the final two years. With information on eight predictors, it was possible to discriminate between patients that would have low or high SA in the coming two years with 80% accuracy. SA trends were similar for patients in IDT programs and other/no interventions, albeit the IDT patients had 67 (95% CI: 48, 87) more SA days over the complete 5-year period. Finally, the psychometric evaluation revealed that SF-36 adequately captured physical and mental health, while HADS was suitable as a measure of overall emotional distress, and EQ-5D had insufficient precision for any meaningful application. Conclusion: Our findings are most useful to guide policy and research. SA in the studied patients remained high over the entire observation period. Decision support tools could prove valuable in identifying patients at risk of high SA earlier in the healthcare chain in order to direct preventative measures. We found no support for IDT decreasing SA more than other/no interventions, but it is possible that this was a consequence of our methodology. Further studies of the IDT effects are needed, but uncontrolled designs that attribute SA change over time to IDT are inappropriate for this purpose, as the SA peak observed around specialist healthcare entry is likely to be driven by the referral procedure. Finally, SF-36 and HADS are psychometrically sound measures of the chronic pain experience core domains

Understanding disease through remote monitoring technology:A mobile health perspective on disease and diagnosis in three conditions: stress, epilepsy, and COVID-19

Mobile systems and wearable technology have developed substantially over the last decade and provide a unique long-term and continuous insight and monitoring into medical condi- tions in health research. The opportunities afforded by mobile health in access, scale, and round-the-clock recording are counterbalanced by pronounced issues in areas like participant engagement, labelling, and dataset size. Throughout this thesis the different aspects of an mHealth study are addressed, from software development and study design to data collection and analysis. Three medically relevant fields are investigated: detection of stress from physiological signals, seizure detection in epilepsy and the characterisation and monitoring of COVID-19 through mobile health techniques.The first two analytical chapters of the thesis focus on models for acute stress and epileptic seizure detection, two conditions with autonomic and physiological manifestations. Firstly, a multi-modal machine learning pipeline is developed targetting focal and general motor seizures in patients with epilepsy. The heterogenity and inter-individual differences present in this study motivated the investigation of methods to personalise models with relatively little data. I subsequently consider meta-learning for few-shot model personalisation within acute stress classification, finding increased performance compared to standard methods.As the COVID-19 pandemic gripped the world the work of this thesis reoriented around using mHealth to understand the disease. Firstly, the study design and software development of Covid Collab, a crowdsourced, remote-enrollment COVID-19 study, are examined. Within these chapters, the patterns of participant enrolment and adherence in Covid Col- lab are also considered. Adherence could impact scientific interpretations if not properly accounted for. While basic drop-out and percent completion are often considered, a more dynamic view of a participant’s behaviour can also be important. A hidden Markov model approach is used to compare participant engagement over time.Secondly, the long-term effects of COVID are investigated through data collected in the Covid Collab study, giving insight into prevalence, risk factors, and symptom manifestation with respect to wearable-recorded physiological signals. Long-term and historical data accessed retrospectively facilitated the findings of significant correlations between development of long-COVID and mHealth-derived fitness and behaviour

Smart workplaces: a system proposal for stress management

Over the past last decades of contemporary society, workplaces have become the primary source of many health issues, leading to mental problems such as stress, depression, and anxiety. Among the others, environmental aspects have shown to be the causes of stress, illness, and lack of productivity. With the arrival of new technologies, especially in the smart workplaces field, most studies have focused on investigating the building energy efficiency models and human thermal comfort. However, little has been applied to occupants’ stress recognition and well-being overall. Due to this fact, this present study aims to propose a stress management solution for an interactive design system that allows the adapting of comfortable environmental conditions according to the user preferences by measuring in real-time the environmental and biological characteristics, thereby helping to prevent stress, as well as to enable users to cope stress when being stressed. The secondary objective will focus on evaluating one part of the system: the mobile application. The proposed system uses several usability methods to identify users’ needs, behavior, and expectations from the user-centered design approach. Applied methods, such as User Research, Card Sorting, and Expert Review, allowed us to evaluate the design system according to Heuristics Analysis, resulting in improved usability of interfaces and experience. The study presents the research results, the design interface, and usability tests. According to the User Research results, temperature and noise are the most common environmental stressors among the users causing stress and uncomfortable conditions to work in, and the preference for physical activities over the digital solutions for coping with stress. Additionally, the System Usability Scale (SUS) results identified that the system’s usability was measured as “excellent” and “acceptable” with a final score of 88 points out of the 100. It is expected that these conclusions can contribute to future investigations in the smart workplaces study field and their interaction with the people placed there.Nas últimas décadas da sociedade contemporânea, o local de trabalho tem se tornado principal fonte de muitos problemas de saúde mental, como o stress, depressão e ansiedade. Os aspetos ambientais têm se revelado como as causas de stress, doenças, falta de produtividade, entre outros. Atualmente, com a chegada de novas tecnologias, principalmente na área de locais de trabalho inteligentes, a maioria dos estudos tem se concentrado na investigação de modelos de eficiência energética de edifícios e conforto térmico humano. No entanto, pouco foi aplicado ao reconhecimento do stress dos ocupantes e ao bem-estar geral das pessoas. Diante disso, o objetivo principal é propor um sistema de design de gestão do stress para um sistema de design interativo que permita adaptar as condições ambientais de acordo com as preferências de utilizador, medindo em tempo real as características ambientais e biológicas, auxiliando assim na prevenção de stress, bem como ajuda os utilizadores a lidar com o stress quando estão sob o mesmo. O segundo objetivo é desenhar e avaliar uma parte do projeto — o protótipo da aplicação móvel através da realização de testes de usabilidade. O sistema proposto resulta da abordagem de design centrado no utilizador, utilizando diversos métodos de usabilidade para identificar as necessidades, comportamentos e as expectativas dos utilizadores. Métodos aplicados, como Pesquisa de Usuário, Card Sorting e Revisão de Especialistas, permitiram avaliar o sistema de design de acordo com a análise heurística, resultando numa melhoria na usabilidade das interfaces e experiência. O estudo apresenta os resultados da pesquisa, a interface do design e os testes de usabilidade. De acordo com os resultados de User Research, a temperatura e o ruído são os stressores ambientais mais comuns entre os utilizadores, causando stresse e condições menos favoráveis para trabalhar, igualmente existe uma preferência por atividades físicas sobre as soluções digitais na gestão do stresse. Adicionalmente, os resultados de System Usability Scale (SUS) identificaram a usabilidade do sistema de design como “excelente” e “aceitável” com pontuação final de 88 pontos em 100. É esperado que essas conclusões possam contribuir para futuras investigações no campo de estudo dos smart workplaces e sua interação com os utilizadores

Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review

Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data