Beyond mobile apps: a survey of technologies for mental well-being

Mental health problems are on the rise globally and strain national health systems worldwide. Mental disorders are closely associated with fear of stigma, structural barriers such as financial burden, and lack of available services and resources which often prohibit the delivery of frequent clinical advice and monitoring. Technologies for mental well-being exhibit a range of attractive properties, which facilitate the delivery of state-of-the-art clinical monitoring. This review article provides an overview of traditional techniques followed by their technological alternatives, sensing devices, behaviour changing tools, and feedback interfaces. The challenges presented by these technologies are then discussed with data collection, privacy, and battery life being some of the key issues which need to be carefully considered for the successful deployment of mental health toolkits. Finally, the opportunities this growing research area presents are discussed including the use of portable tangible interfaces combining sensing and feedback technologies. Capitalising on the data these ubiquitous devices can record, state of the art machine learning algorithms can lead to the development of robust clinical decision support tools towards diagnosis and improvement of mental well-being delivery in real-time

Impact of obstructive sleep apnoea/hypopnoea and its treatment with continuous positive airway pressure on the outcome of stroke

BACKGROUND: The prevalence of sleep-disordered breathing (SDB) in stroke is high. One study showed SDB had a negative impact on the functional capacity of stroke patients on discharge and another that SDB was associated with a higher mortality rate. However, these findings are disputed. The impact of SDB in stroke patients on cognition and health-related quality of life is also not clear. The one randomized controlled trial of nasal continuous positive airway pressure (CPAP) in stroke patients with SDB showed CPAP improved wellbeing but not other outcomes. I hypothesised that: (1) SDB is related to stroke outcome and (2) treatment of SDB in stroke patients with CPAP would improve functional outcome.METHODS: There are three parts of the thesis: (1) a study of the prevalence of SDB after stroke; (2) a randomized controlled trial (RCT) of CPAP after stroke and (3) a longitudinal cohort study to investigate the impact of SDB on outcome after stroke. On day 14-19 after stroke, recruited patients underwent a limited sleep study using a validated system (Embletta PDS, Medcare Flaga, Iceland). Baseline assessments were performed on the morning following the sleep study. On day 21-25 following stroke, patients who had (A+H)-h⁻¹ ≥ 30 with < 30% of central events were randomized to 8 weeks of CPAP treatment with Autoset T (ResMed, SanDiego USA) or conservative treatment for SDB. All outcomes were recorded in the 8th week after randomization or 3 months after stroke for non-randomized patients. All recruited patients received follow-up at six months after stroke. If available, patients also received 12 months and 18 months follow-up until the last recruited patient had had his 6 months follow-up. The Nottingham Extended ADL Index (EADL) was chosen as the primary outcome measure. Secondary outcome measures included: Subscales of EADL, NIH Stroke Scale (NIHSS), Barthel Index (BI), Stanford Sleepiness Scale (SSS), Addenbrooke's Cognitive Examination (ACE) and Mini- Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), MOS Short Form 36 Health Survey (SF-36) and ambulatory blood pressure - measured with Spacelabs 90207 (Spacelabs, Redmond, USA).RESULTS: We screened 658 patients with recent strokes and excluded those with dementia, confusion, severe dysphasia or insufficient hand function to use CPAP. Only 96 of 658 patients remained eligible of whom 25 declined to give informed consent. 71 patients were thus successfully recruited for overnight limited sleep study 14-19 days following stroke. Sixty-six patients with adequate recording were included in the study: 45 men and 21 women, median age 74yrs. The sleep study showed 50% of patients had more than 30 apnoeas + hypopnoeas per hour in bed [expressed as (A+H)-h⁻¹]. Pulse oximetry alone had lower sensitivity (70%) but high specificity (90%) to predict (A+H)-h⁻¹ ≥ 30. A combination of age, body mass index, snoring and excessive daytime sleepiness based on logistic regression model is useful as a screening tool at the bedside (sensitivity = 85%, specificity = 70%) to predict (A+H)-h⁻¹ ≥ 30 in stroke before referring patients for overnight sleep study. Interaction of lowest oxygen saturation and lowest heart rate is independently associated with stroke during sleep in patients with (A+H)-h⁻¹ < 30 (p = 0.023). Patients with (A+H)-h⁻¹ ≥ 30 more often had their stroke during daytime than patients with (A+H)-h⁻¹ < 30 (p = 0.006). Thirty patients who had (A+H)-h⁻¹ ≥ 30, with < 30% central apnoea or Cheyne-Stokes respiration, proceeded to a randomized controlled trial starting from the 4th week after stroke with 15 patients randomized to CPAP and 15 to conservative treatment for SDB. Conventional stroke treatment was maintained in all patients. Duration of treatment was 8 weeks and blind outcome assessment was performed at 3 months and 6 month after stroke. The result showed compliance with CPAP was poor with mean 1.40 hours and median 0.16 hours per night. There was no statistically significant difference in the outcomes, sleepiness and ambulatory blood pressure with CPAP therapy. Increased length of keeping CPAP was correlated with higher score of language subscale in the Addenbrooke's Cognitive Examination (Spearman's rho = 0.544, p = 0.036) and lower score in the depression subscale of the Hospital Anxiety and Depression Scale (HADS, Spearman's rho = -0.538, p = 0.039). All 66 patients with adequate sleep studies received longitudinal follow-up at 3, 6 12 and 18 months following stroke. The patients with (A+H)-h⁻¹ ≥ 30 had a trend to worse functional capacity in both Barthel Index and Nottingham Extended ADL Index (EADL) than patients with (A+H)-h⁻¹ < 30 but there was only a statistically significant difference in the mobility subscale of EADL. The negative influence of (A+H)-h⁻¹ ≥ 30 on functional capacity and health-related quality of life following stroke was only statistically significant in patients with mild stroke (NIH Stroke Scale, NIHSS < 7) at both 3 and 6 months, lesser emotional distress (HADS < 8) at both 3 and 6 months and lesser cognitive impairment (Mini Mental State Examination ≥ 28) at 6 months after stroke in subgroup analysis. The difference of Modified Rankin Scale between groups was significant at 6 months after stroke (p = 0.026). There was no difference in cognitive or emotional outcome. No significant difference of mortality rate was noted.CONCLUSIONS: We focused on a group of patients with mild to moderate stroke (median NIHSS = 6) within a narrow time span (14-19 days) and confirmed a high prevalence of SDB in stroke. CPAP compliance was a major problem but might be enhanced by selecting patients with higher functional capacity, higher cognitive function especially language and less depression in the acute or subacute phase of stroke. We also found that sleep-disordered breathing had little or no effect on cognitive and emotional outcomes, health-related quality of life and mortality in stroke patients. Many other factors resulting from brain damage or complications of stroke have stronger influences on stroke outcome than SDB

Enhancing the Diagnosis and Management of Obstructive Sleep Apnoea in Atrial Fibrillation Patients

Background: Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia, and significantly increases the risk of stroke and cardiovascular mortality. It is strongly associated with obstructive sleep apnoea (OSA). Aims: 1. Examine the epidemiology of OSA in a hospital cohort with AF. 2. Compare the diagnostic accuracy of clinical screening tools for OSA in patients with AF. 3. Compare cardiac autonomic function in AF patients with and without OSA. 4. Conduct a pilot study of mandibular advancement splint (MAS) therapy for OSA in AF patients. Methods: 107 AF patients were recruited. The diagnostic accuracy of screening tools including a level 3 (portable) sleep study device as compared to polysomnography in AF patients was assessed. Cardiac autonomic function as a potential mechanistic link between OSA and AF was assessed using Heart Rate Variability (HRV). A pilot study of OSA treatment in AF patients using MAS therapy was conducted. Results: 62.6% of patients were newly diagnosed with OSA. Patients with moderate to severe OSA showed an increased BMI, neck circumference and Mallampati score, but were not significantly different in terms of daytime somnolence. Oxygen desaturation index (ODI) derived from a Level 3 portable sleep study device performed best for the diagnosis of moderate to severe and severe OSA, with excellent diagnostic accuracy (AUC 0.899, 95% CI 0.838 – 0.960 and AUC 0.925, 95% CI 0.859 – 0.991 respectively). We found a chronic increase in parasympathetic nervous activity in paroxysmal AF patients with OSA. MAS therapy showed high rates of acceptance, compliance and efficacy in AF patients. Conclusions: This thesis contributes to our understanding of the association between AF and OSA across a spectrum o

Quantification of vascular function changes under different emotion states: A pilot study

Recent studies have indicated that physiological parameters change with different emotion states. This study aimed to quantify the changes of vascular function at different emotion and sub-emotion states. Twenty young subjects were studied with their finger photoplethysmographic (PPG) pulses recorded at three distinct emotion states: natural (1 minute), happiness and sadness (10 minutes for each). Within the period of happiness and sadness emotion states, two sub-emotion states (calmness and outburst) were identified with the synchronously recorded videos. Reflection index (RI) and stiffness index (SI), two widely used indices of vascular function, were derived from the PPG pulses to quantify their differences between three emotion states, as well as between two sub-emotion states. The results showed that, when compared with the natural emotion, RI and SI decreased in both happiness and sadness emotions. The decreases in RI were significant for both happiness and sadness emotions (both P< 0.01), but the decreases in SI was only significant for sadness emotion (P< 0.01). Moreover, for comparing happiness and sadness emotions, there was significant difference in RI (P< 0.01), but not in SI (P= 0.9). In addition, significant larger RI values were observed with the outburst sub-emotion in comparison with the calmness one for both happiness and sadness emotions (both P< 0.01) whereas significant larger SI values were observed with the outburst sub-emotion only in sadness emotion (P< 0.05). Moreover, gender factor hardly influence the RI and SI results for all three emotion measurements. This pilot study confirmed that vascular function changes with diffenrt emotion states could be quantified by the simple PPG measurement

Aerospace Medicine and Biology: A continuing bibliography with indexes, supplement 171

This bibliography lists 186 reports, articles, and other documents introduced into the NASA scientific and technical information system in August 1977

Shallow Neural Network for Biometrics from the ECG-WATCH

Applications such as surveillance, banking and healthcare deal with sensitive data whose confidentiality and integrity depends on accurate human recognition. In this sense, the crucial mechanism for performing an effective access control is authentication, which unequivocally yields user identity. In 2018, just in North America, around 445K identity thefts have been denounced. The most adopted strategy for automatic identity recognition uses a secret for encrypting and decrypting the authentication information. This approach works very well until the secret is kept safe. Electrocardiograms (ECGs) can be exploited for biometric purposes because both the physiological and geometrical differences in each human heart correspond to uniqueness in the ECG morphology. Compared with classical biometric techniques, e.g. fingerprints, ECG-based methods can definitely be considered a more reliable and safer way for user authentication due to ECG inherent robustness to circumvention, obfuscation and replay attacks. In this paper, the ECG WATCH, a non-expensive wristwatch for recording ECGs anytime, anywhere, in just 10 s, is proposed for user authentication. The ECG WATCH acquisitions have been used to train a shallow neural network, which has reached a 99% classification accuracy and 100% intruder recognition rate

Aerospace Medicine and Biology: A continuing bibliography with indexes (supplement 133)

This special bibliography lists 276 reports, articles, and other documents introduced into the NASA Scientific and Technical Information System in September 1974

The neuroscience of body memory: Recent findings and conceptual advances

The body is a very special object, as it corresponds to the physical component of the self and it is the medium through which we interact with the world. Our body awareness includes the mental representation of the body that happens to be our own, and traditionally has been defined in terms of body schema and body image. Starting from the distinction between these two types of representations, the present paper tries to reconcile the literature around body representations under the common framework of body memory. The body memory develops ontogenetically from birth and across all the life span and is directly linked to the development of the self. Therefore, our sense of self and identity is fundamentally based on multisensory knowledge accumulated in body memory, so that the sensations collected by our body, stored as implicit memory, can unfold in the future, under suitable circumstances. Indeed, these sets of bodily information had been proposed as possible key factors underpinning several mental health illnesses. Following this perspective, the Embodied Medicine approach put forward the use of advanced technologies to alter the dysfunctional body memory to enhance people’s well-being. In the last sections, recent experimental pieces of evidence will be illustrated that targeted specifically bodily information for increasing health and wellbeing, by means of two strategies: interoceptive feedback and bodily illusions

Using EEG data to predict engagement in face-to-face conversations

To date engagement in face-to-face conversation has been studied almost exclusively through the post event measurement of self-reporting surveys or questionnaires. Electroencephalography (EEG) has been used for decades to examine brain activity for both research and diagnostic purposes. Medical grade EEG equipment is both costly and confined to being used within laboratory settings. With the recent advent of off-the-shelf consumer grade portable EEG-devices, novel psychological research on cognitive computations that have traditionally been confined to self-report, is now a reality. Although it is well documented that people use their cognitive abilities during conversations, an extensive literature search found no studies on the use of EEG data to obtain a neurological engagement score during conversation. Consequently, the present study sought to remedy a gap in the literature, and capitalised on the readily available consumer-grade portable EEG equipment. A within-participants quantitative study with 42 participants examined whether EEG predicted engagement during face-to-face getting acquainted conversations. Participants’ alpha and beta brain activity were examined from EEG data collected during two separate conversations, and participants also completed a post-hoc self-report on their engagement and attention. The results of the study found a significant difference for participants’ alpha brain activity and engagement, but not for the beta activity and engagement. There was also no significant difference found for participants attention and their alpha or beta activity. A surprising additional finding in the present study was a within-participant consistency for both alpha and beta activity across the two conversations, which is consistent with individual differences stability found in other psychophysiological studies. Overall, the present study has found that alpha activity is necessary for neurological engagement during face-to-face getting acquainted conversations. Therefore, future research is warranted on the use of EEG as an additional tool in face-to-face communication to compliment self-report and measure engagement