Automatic emotion recognition in clinical scenario: a systematic review of methods

none4Automatic emotion recognition has powerful opportunities in the clinical field, but several critical aspects are still open, such as heterogeneity of methodologies or technologies tested mainly on healthy people. This systematic review aims to survey automatic emotion recognition systems applied in real clinical contexts, to deeply analyse clinical and technical aspects, how they were addressed, and relationships among them. The literature review was conducted on: IEEEXplore, ScienceDirect, Scopus, PubMed, ACM. Inclusion criteria were the presence of an automatic emotion recognition algorithm and the enrollment of at least 2 patients in the experimental protocol. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Moreover, the works were analysed according to a reference model to deeply examine both clinical and technical topics. 52 scientific papers passed inclusion criteria. Most clinical scenarios involved neurodevelopmental, neurological and psychiatric disorders with the aims of diagnosing, monitoring, or treating emotional symptoms. The most adopted signals are video and audio, while supervised shallow learning is mostly used for emotion recognition. A poor study design, tiny samples, and the absence of a control group emerged as methodological weaknesses. Heterogeneity of performance metrics, datasets and algorithms challenges results comparability, robustness, reliability and reproducibility.openPepa, Lucia; Spalazzi, Luca; Capecci, Marianna; Ceravolo, Maria GabriellaPepa, Lucia; Spalazzi, Luca; Capecci, Marianna; Ceravolo, Maria Gabriell

Pain management for chronic musculoskeletal conditions : the development of an evidence-based and theory-informed pain self-management course

Objective: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. Design: We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. Setting: Primary care in the inner city of London, UK. Participants: Adults (18 years or older) with chronic musculoskeletal pain. Outcomes: Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. Results: The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. Conclusions: The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy. http://bit.ly/31SXeB

Experience of Robotic Exoskeleton Use at Four Spinal Cord Injury Model Systems Centers

Background and Purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians\u27 experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians\u27 perceptions of exoskeleton benefits and risks and developments that would enhance utility. Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. Discussion and Conclusions: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients\u27 expectations as more devices enter the market. Background and Purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians\u27 experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians\u27 perceptions of exoskeleton benefits and risks and developments that would enhance utility. Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. Discussion and Conclusions: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients\u27 expectations as more devices enter the market

Multidimensional integration through Markovian sampling under steered function morphing: a physical guise from statistical mechanics

We present a computational strategy for the evaluation of multidimensional integrals on hyper-rectangles based on Markovian stochastic exploration of the integration domain while the integrand is being morphed by starting from an initial appropriate profile. Thanks to an abstract reformulation of Jarzynski's equality applied in stochastic thermodynamics to evaluate the free-energy profiles along selected reaction coordinates via non-equilibrium transformations, it is possible to cast the original integral into the exponential average of the distribution of the pseudo-work (that we may term "computational work") involved in doing the function morphing, which is straightforwardly solved. Several tests illustrate the basic implementation of the idea, and show its performance in terms of computational time, accuracy and precision. The formulation for integrand functions with zeros and possible sign changes is also presented. It will be stressed that our usage of Jarzynski's equality shares similarities with a practice already known in statistics as Annealed Importance Sampling (AIS), when applied to computation of the normalizing constants of distributions. In a sense, here we dress the AIS with its "physical" counterpart borrowed from statistical mechanics.Comment: 3 figures Supplementary Material (pdf file named "JEMDI_SI.pdf"

Hypertensive Black Men\u27s Perceptions of a Nurse Administered Medication Protocol

Abstract Hypertension in the elderly population is a serious problem with approximately 65 million hypertensive adults in the United States. One important factor contributing to uncontrolled hypertension in the elderly population is medication non-adherence. The director of a cardiology clinic in Southern Georgia noted that older Black male patients were not taking their blood pressure medication as prescribed and as result had uncontrolled hypertension. It was proposed that a nurse protocol with tools to address non-adherence was an approach to address this problem. This qualitative key informant study identified a purposive sample of 10 Black men 65- 70 with a primary diagnosis of hypertension that was non-adherent in taking their hypertensive medication. The nurse conducted individual 45 minute teaching session with each participant that included tools to help them take their medication. A 15 minute follow-up phone call was done after one week. Participants were then interviewed about their perception of taking hypertensive medication. The interviews were recorded, transcribed, and coded for themes using constant comparative analysis. Six themes emerged: Medication Bottle Guides Medication Usage; Confusion about Side Effects; Reasons for Not Taking Medications; New Behavior; Unchanged Behavior, and Discovery of Other Problems. The overall result was that older Black men perceived that they were more adherent in taking their hypertensive medication following a nurse administered medication protocol. Key terms: Hypertensive, uncontrolled hypertensive, medication compliance, medication adherence, hypertensive in black men, and medication adherence protoco

An original framework for understanding human actions and body language by using deep neural networks

The evolution of both fields of Computer Vision (CV) and Artificial Neural Networks (ANNs) has allowed the development of efficient automatic systems for the analysis of people's behaviour. By studying hand movements it is possible to recognize gestures, often used by people to communicate information in a non-verbal way. These gestures can also be used to control or interact with devices without physically touching them. In particular, sign language and semaphoric hand gestures are the two foremost areas of interest due to their importance in Human-Human Communication (HHC) and Human-Computer Interaction (HCI), respectively. While the processing of body movements play a key role in the action recognition and affective computing fields. The former is essential to understand how people act in an environment, while the latter tries to interpret people's emotions based on their poses and movements; both are essential tasks in many computer vision applications, including event recognition, and video surveillance. In this Ph.D. thesis, an original framework for understanding Actions and body language is presented. The framework is composed of three main modules: in the first one, a Long Short Term Memory Recurrent Neural Networks (LSTM-RNNs) based method for the Recognition of Sign Language and Semaphoric Hand Gestures is proposed; the second module presents a solution based on 2D skeleton and two-branch stacked LSTM-RNNs for action recognition in video sequences; finally, in the last module, a solution for basic non-acted emotion recognition by using 3D skeleton and Deep Neural Networks (DNNs) is provided. The performances of RNN-LSTMs are explored in depth, due to their ability to model the long term contextual information of temporal sequences, making them suitable for analysing body movements. All the modules were tested by using challenging datasets, well known in the state of the art, showing remarkable results compared to the current literature methods

Palliative care for people with dementia living at home: a systematic review of interventions

Background: The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. Aims: To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. Design: A systematic review of home palliative care interventions in dementia. Data sources: The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. Results: We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. Conclusions: The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.Peer reviewedFinal Published versio

Contextual analysis of health care at discharge in leprosy: an integrative review

Objective: To analyze contextual relations of health care in the discharge of leprosy. Method: An analytical, reflexive study based on the theoretical framework of context analysis, elaborated through an integrative review of literature in the databases SCOPUS, PUBMED, LILACS, SCIELO and BDENF, with uncontrolled descriptors Leprosy and Patient Discharge, obtaining 14 publications. Results: The immediate context addresses health care at discharge in leprosy; the specific context treats leprosy as a public health problem; the symbolic conceptions and marks involving leprosy are encompassed by the general context; and in the metacontext are described the health programs and policies that subsidize the care of leprosy patients. Conclusion: The contextual elements emphasize the need to guarantee universal coverage of cases of leprosy, from diagnosis to the post-discharge, reinforcing leprosy as a public health problem. Despitehe limitations of the bibliographic studies, these have relevance for the health area