Characterization of EEG patterns in brain-injured subjects and controls after a Snoezelen® intervention

Producción CientíficaBackground and objective. The aim of this study was to assess the changes induced in electroencephalographic (EEG) activity by a Snoezelen® intervention on individuals with brain-injury and control subjects. Methods: EEG activity was recorded preceding and following a Snoezelen® session in 18 people with cerebral palsy (CP), 18 subjects who have sustained traumatic brain-injury (TBI) and 18 controls. EEG data were analyzed by means of spectral and nonlinear measures: median frequency (MF), individual alpha frequency (IAF), sample entropy (SampEn) and Lempel-Ziv complexity (LZC). Results: Our results showed decreased values for MF, IAF, SampEn and LZC as a consequence of the therapy. The main changes between pre-stimulation and post-stimulation conditions were found in occipital and parietal brain areas. Additionally, these changes are more widespread in controls than in brain-injured subjects, which can be due to cognitive deficits in TBI and CP groups. Conclusions: Our findings support the notion that Snoezelen® therapy affects central nervous system, inducing a slowing of oscillatory activity, as well as a decrease of EEG complexity and irregularity. These alterations seem to be related with higher levels of relaxation of the participants.Ministerio de Economía y Competitividad (TEC2014-53196-R)Junta de Castilla y León (VA059U13 y BIO/VA08/15

Acceptance of ambient assisted living (AAL) technologies among older Australians : a review of barriers in user experience

One of the great challenges facing Australian society is that of an ageing population. Amongst the issues involved in this drastic demographic change, the most significant aspect is the demand for older Australians to live independently at home. The development of Ambient Assisted Living (AAL) technologies aims to address this issue. The advancement of AAL applications have been done to support the users with their daily-life activities and health concerns by providing increased mobility, security, safety in emergencies, health-monitoring, improved lifestyle, and fall-detection through the use of sensors. However, the optimum uptake of these technologies among the end-users (the elderly Australians) still remains a big concern. Thus, there is an elevated need to understand the needs and preferences of the seniors in order to improve the acceptance of AAL applications. The aim of this study is to investigate the barriers and perceptions in the use of AAL applications amongst older Australians. Focus groups and quantitative surveys have been conducted to provide a detailed analysis of these impediments. The results show that there are different factors that restrict the use of these technologies along with the fact that elderly people have certain preferences when using them. An understanding of these factors has been gained and suggestions have been made to increase the acceptance of AAL devices. This work gives useful insights towards the design of AAL solutions according to user needs

Understanding the temporal dynamics of visual hallucinations in Parkinson's Disease with dementia

PhD ThesisBackground Integrative models of visual hallucinations (VH) posit that the symptom requires disruptions to both bottom-up and top-down visual processing. Although many lines of evidence point to a mixture of aberrant processing and disconnection between key nodes in the visual system, in particular the dorsal and ventral attention networks, there have been no attempts to understand the dynamic behaviour of these systems in Parkinson’s disease with dementia (PDD) with VH. Aims The primary aim of this thesis was to explore the correlates of synaptic communication in the visual system and how spatio-temporal dynamics of the early visual system are altered in relation to the severity of VH. The secondary aim was to help understand the balance between the contributions of bottom-up and top-down processing for the experience of VH in PDD. Methods An assortment of investigative approaches, including resting state electroencephalography (EEG), visual evoked potentials (VEPs), and concurrent EEG and transcranial magnetic stimulation (TMS) were applied in a group of PDD patients with a range of VH severities (n = 26) and contrasted with a group of age matched healthy controls (n = 17). Results Latency of the N1 component was similar between groups, suggesting intact transfer between the retina and the cortex. However, PDD patients had an inherent reduction in the amplitude of the VEP components and displayed a pattern of declining P1 latencies in association with more frequent and severe VH. Evoked potentials arising from TMS of the striate cortex were similar in amplitude and latency for each of the components between PDD and controls. However, inter-component activity at several stages was altered in the PDD group, whilst the frequency and severity of VH was positively associated with the amplitudes of several components in the occipital and parietal regions. Finally, attentional modulation as measured by the alpha-band reactivity was also compromised in PDD patients. iv Conclusions These data provide neurophysiological evidence that both early bottom-up and top-down dysfunctions of the visual system occur in PDD patients who hallucinate, thus supporting integrative models of VH.National Institute for Health Research (NIHR) Biomedical Research Unit (BRU)

Interdisciplinary perspectives on privacy awareness in lifelogging technology development

Population aging resulting from demographic changes requires some challenging decisions and necessary steps to be taken by different stakeholders to manage current and future demand for assistance and support. The consequences of population aging can be mitigated to some extent by assisting technologies that can support the autonomous living of older individuals and persons in need of care in their private environments as long as possible. A variety of technical solutions are already available on the market, but privacy protection is a serious, often neglected, issue when using such (assisting) technology. Thus, privacy needs to be thoroughly taken under consideration in this context. In a three-year project PAAL (‘Privacy-Aware and Acceptable Lifelogging Services for Older and Frail People’), researchers from different disciplines, such as law, rehabilitation, human-computer interaction, and computer science, investigated the phenomenon of privacy when using assistive lifelogging technologies. In concrete terms, the concept of Privacy by Design was realized using two exemplary lifelogging applications in private and professional environments. A user-centered empirical approach was applied to the lifelogging technologies, investigating the perceptions and attitudes of (older) users with different health-related and biographical profiles. The knowledge gained through the interdisciplinary collaboration can improve the implementation and optimization of assistive applications. In this paper, partners of the PAAL project present insights gained from their cross-national, interdisciplinary work regarding privacy-aware and acceptable lifelogging technologies.Open Access funding enabled and organized by Projekt DEAL. This work is part of the PAAL-project (“Privacy-Aware and Acceptable Lifelogging services for older and frail people”). The support of the Joint Programme Initiative “More Years, Better Lives” (award number: PAAL_JTC2017), the German Federal Ministry of Education and Research (grant no: 16SV7955), the Swedish Research Council for Health, Working Life, and Welfare (grant no: 2017–02302), the Spanish Agencia Estatal de Investigacion (PCIN-2017-114), the Italian Ministero dell’Istruzione dell’Universitá e della Ricerca, (CUP: I36G17000380001), and the Canadian Institutes of Health Research is gratefully acknowledged

Fusion, 2023

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1015/thumbnail.jp

Challenges to Patient-Provider Relationships and Managing Chronic Pain of African Americans with HIV and a History of Drug Use in Baltimore

Chronic pain in people with HIV (PWH) is common and often undertreated, and likely compounds pain-related distress, stress of discrimination in healthcare, and substance use for self-medicating, which negatively impact PWH’s interactions with healthcare providers and vice versa. Substance use- and race-associated stigma and bias in pain care also contribute to disparities in pain and its treatment. Challenges in managing chronic pain in the context of the current opioid epidemic present further threats to PWH’s patient-provider relationships. This mixed-methods dissertation explored the role of social discrimination and patient-provider engagement in PWH’s quality-of-life in the context of chronic pain. The objective was to identify individual-level, interpersonal (patient-provider) and structural factors predictive of pain self-medicating and quality-of-life among African Americans with HIV and a history of drug use. Structural equation modeling using longitudinal survey data from 331 PWH in Baltimore, Maryland, USA found that patient-centered patient-provider engagement with primary-care providers (PCE-PCP) mediated the effects of healthcare discrimination and pain treatment denial on later substance use for pain; and the effects of depression and healthcare discrimination on later mental health-related quality-of-life. In-depth interview and focus group discussions revealed PWH’s experiences of tension, conflict, and distress in discussing pain and pain treatment with PCPs. Some reported feeling unfairly judged and prejudicially treated based on their history of drug use. Prior experiences of discrimination in healthcare settings also contributed to participants’ mistrust in the healthcare system. Participants expressed the need for providers interacting with them respectfully and empathically, and considering their opinions and preferences in treatment decision making. Our findings suggest that interpersonal skills for PCE are important for addressing discriminatory treatment in healthcare, substance use, and mental health challenges of this marginalized population. Interventions should target people with intersecting vulnerabilities to discrimination and healthcare professionals interacting with them to foster mutual, collaborative patient-provider relationships. An integrated approach to treating pain and substance use concurrently with HIV and other comorbidities is much needed. A framework of compassion and joint patient-provider decision making with a goal of reducing social harms, pain and distress should be adopted for quality care and well-being of African American PWH

Apport de l'intelligence artificielle au domaine des villes intelligentes : application à l'assistance des déplacements des personnes à mobilité réduite

La transformation des villes en « villes intelligentes » est un des objectifs que les gouvernements visent depuis une dizaine d’années. Cette transformation touche à plusieurs aspects de la ville, dont l’éco-citoyenneté, la gouvernance durable ou encore la mobilité intelligente. C’est sur cet aspect que nos travaux se focalisent. En effet, malgré une certaine progression depuis quelques années, les personnes à mobilité réduite sont souvent oubliées dans la question de l’amélioration des déplacements urbains grâce aux technologies de l’information et de la communication. Parmi ces technologies, l’intelligence artificielle englobe plusieurs domaines et est en plein essor. Un de ces derniers, l’intelligence ambiante vise à la conception de services interconnectés interagissant avec l’environnement physique réel pour offrir des services visant à supporter les activités humaines. C’est dans ce contexte que se placent nos travaux : l’étude et la construction d’un système ambiant dédié à l’assistance des personnes à mobilité réduite en milieu urbain. Or, plusieurs verrous contraignent la conception d’un tel système. Tout d’abord, dans ces domaines, nous avons remarqué que le vocabulaire des termes issus de ces domaines était inconstant, et que toute la communauté scientifique n’est pas unanime sur la définition de certains concepts. Notre première contribution consiste en une ontologie, décrite en OWL, qui recouvre l’ensemble des éléments et concepts nécessaires à la conception de ce type de systèmes. Ensuite, plusieurs études scientifiques actuelles soulignent le manque de modèle d’architecture générique pour de tels systèmes. Ce faisant, la myriade de solutions proposées dans ce domaine souffre de limites fortes sur le plan de l’interopérabilité et de la réutilisabilité des travaux. C’est pourquoi notre deuxième contribution se traduit en un modèle générique facilitant la conception de tout type de système ambiant dédié à l’assistance. Ce modèle s’appuie sur l’ontologie proposée, tout en gardant les utilisateurs au centre du modèle. Enfin, il a été remarqué que les systèmes ambiants dédiés à l'assistance sont déployés de manière ad-hoc. Soit en simulation, en évaluant statistiquement les sorties du système. Soit en milieu réel, où l'évaluation du système se fait par la même observation statistique des sorties, ou par un questionnaire d'évaluation soumis aux utilisateurs. Nous proposons une approche originale de mise en œuvre de tels systèmes. D'une part, cette dernière se base sur une mise en opération du système par simulation hybride, sur laquelle les éléments réels sont ajoutés progressivement, jusqu'à un déploiement en milieu réel complet. D'autre part, dans le but d'évaluer l'impact direct du système, nous proposons l'analyse de son impact par les outils issus du domaine de l'analyse du réseau social des utilisateurs.Abstract: The transformation of cities into "smart cities" is one of the goals that governments have been aiming at for the last ten years. This transformation affects several aspects of the city, including eco-citizenship, sustainable governance, and smart mobility. It is on this aspect that our work focuses. Indeed, despite a certain progress in the last few years, people with reduced mobility are often forgotten when it comes to improving urban travel thanks to information and communication technologies. Among these technologies, artificial intelligence is booming and encompasses several fields. Among them, ambient intelligence aims at the design of interconnected services interacting with the real physical environment to provide services to support human activities. It is in this context that our work is placed: the study and construction of an ambient system dedicated to the assistance of people with reduced mobility in an urban environment. However, the design of such a system is constrained by several obstacles. First, we noticed that the vocabulary of the terms coming from these domains was inconstant, and that the whole scientific community is not unanimous on the definition of certain concepts. Our first contribution consists in an ontology, described in OWL, which covers all the elements and concepts necessary for the design of this type of system. Secondly, several current scientific studies underline the lack of a generic architecture model for such systems. As a result, the myriad of solutions proposed in this field suffer from strong limitations in terms of interoperability and reusability of the works. Therefore, our second contribution translates into a generic model facilitating the design of any type of ambient system dedicated to assistance. This model is based on the proposed ontology, while keeping the users at the center of the model. Finally, it has been noticed that ambient systems dedicated to assistance are deployed in an ad-hoc way, either in simulation or in real environment, with an evaluation limited to a statistical analysis of the outputs, or by an evaluation questionnaire submitted to users. We propose an original approach to the implementation of such systems. On the one hand, this approach is based on a simulation-based implementation of the system, on which real elements are progressively added, until a complete deployment in real environment. On the other hand, to evaluate the direct impact of the system, we introduce the analysis of its impact by tools coming from the field of user social network analysis

The use of new technology to improve genetic testing

Molecular confirmation of a clinical diagnosis of an inherited disease or of congenital malformations is of paramount importance for patients and their families. It is the conclusion of the differential diagnostic process, and provides information on the prognosis, in some cases on the therapeutic options, and on the recurrence risk. Currently, targeted sequencing of gene (s) of interest is the preferred approach for searching for small pathogenic mutations. The work presented in this thesis describes the application of new techniques for detecting small variations (mutations) in genomic DNA that underlie various disorders. These techniques include High Resolution Melting Curve Analysis (HR-MCA) followed by Sanger sequencing, targeted, X-exome and whole exome capture followed by Next Generation Sequencing (NGS). We have optimized, tested and applied the different new molecular techniques mentioned above to 1) faci litate the detection of disease causing mutations in several disorders with suspected Mendelian inheritance, 2) to speed up the identification of disease genes, 3) to provide a systematic tool for classifying previously intractable genetic diseasesUBL - phd migration 201