Information technologies for pain management

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. The importance of pain is attested by the fact that it is considered the fifth vital sign for indicating basic bodily functions, health and quality of life, together with the four other vital signs: blood pressure, body temperature, pulse rate and respiratory rate. However, while these four signals represent an objective physical parameter, the occurrence of pain expresses an emotional status that happens inside the mind of each individual and therefore, is highly subjective that makes difficult its management and evaluation. For this reason, the self-report of pain is considered the most accurate pain assessment method wherein patients should be asked to periodically rate their pain severity and related symptoms. Thus, in the last years computerised systems based on mobile and web technologies are becoming increasingly used to enable patients to report their pain which lead to the development of electronic pain diaries (ED). This approach may provide to health care professionals (HCP) and patients the ability to interact with the system anywhere and at anytime thoroughly changes the coordinates of time and place and offers invaluable opportunities to the healthcare delivery. However, most of these systems were designed to interact directly to patients without presence of a healthcare professional or without evidence of reliability and accuracy. In fact, the observation of the existing systems revealed lack of integration with mobile devices, limited use of web-based interfaces and reduced interaction with patients in terms of obtaining and viewing information. In addition, the reliability and accuracy of computerised systems for pain management are rarely proved or their effects on HCP and patients outcomes remain understudied. This thesis is focused on technology for pain management and aims to propose a monitoring system which includes ubiquitous interfaces specifically oriented to either patients or HCP using mobile devices and Internet so as to allow decisions based on the knowledge obtained from the analysis of the collected data. With the interoperability and cloud computing technologies in mind this system uses web services (WS) to manage data which are stored in a Personal Health Record (PHR). A Randomised Controlled Trial (RCT) was implemented so as to determine the effectiveness of the proposed computerised monitoring system. The six weeks RCT evidenced the advantages provided by the ubiquitous access to HCP and patients so as to they were able to interact with the system anywhere and at anytime using WS to send and receive data. In addition, the collected data were stored in a PHR which offers integrity and security as well as permanent on line accessibility to both patients and HCP. The study evidenced not only that the majority of participants recommend the system, but also that they recognize it suitability for pain management without the requirement of advanced skills or experienced users. Furthermore, the system enabled the definition and management of patient-oriented treatments with reduced therapist time. The study also revealed that the guidance of HCP at the beginning of the monitoring is crucial to patients' satisfaction and experience stemming from the usage of the system as evidenced by the high correlation between the recommendation of the application, and it suitability to improve pain management and to provide medical information. There were no significant differences regarding to improvements in the quality of pain treatment between intervention group and control group. Based on the data collected during the RCT a clinical decision support system (CDSS) was developed so as to offer capabilities of tailored alarms, reports, and clinical guidance. This CDSS, called Patient Oriented Method of Pain Evaluation System (POMPES), is based on the combination of several statistical models (one-way ANOVA, Kruskal-Wallis and Tukey-Kramer) with an imputation model based on linear regression. This system resulted in fully accuracy related to decisions suggested by the system compared with the medical diagnosis, and therefore, revealed it suitability to manage the pain. At last, based on the aerospace systems capability to deal with different complex data sources with varied complexities and accuracies, an innovative model was proposed. This model is characterized by a qualitative analysis stemming from the data fusion method combined with a quantitative model based on the comparison of the standard deviation together with the values of mathematical expectations. This model aimed to compare the effects of technological and pen-and-paper systems when applied to different dimension of pain, such as: pain intensity, anxiety, catastrophizing, depression, disability and interference. It was observed that pen-and-paper and technology produced equivalent effects in anxiety, depression, interference and pain intensity. On the contrary, technology evidenced favourable effects in terms of catastrophizing and disability. The proposed method revealed to be suitable, intelligible, easy to implement and low time and resources consuming. Further work is needed to evaluate the proposed system to follow up participants for longer periods of time which includes a complementary RCT encompassing patients with chronic pain symptoms. Finally, additional studies should be addressed to determine the economic effects not only to patients but also to the healthcare system

Olfaction-enhanced multimedia: Perspectives and challenges

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2011 Springer VerlagOlfaction—or smell—is one of the last challenges which multimedia and multimodal applications have to conquer. Enhancing such applications with olfactory stimuli has the potential to create a more complex—and richer—user multimedia experience, by heightening the sense of reality and diversifying user interaction modalities. Nonetheless, olfaction-enhanced multimedia still remains a challenging research area. More recently, however, there have been initial signs of olfactory-enhanced applications in multimedia, with olfaction being used towards a variety of goals, including notification alerts, enhancing the sense of reality in immersive applications, and branding, to name but a few. However, as the goal of a multimedia application is to inform and/or entertain users, achieving quality olfaction-enhanced multimedia applications from the users’ perspective is vital to the success and continuity of these applications. Accordingly, in this paper we have focused on investigating the user perceived experience of olfaction-enhanced multimedia applications, with the aim of discovering the quality evaluation factors that are important from a user’s perspective of these applications, and consequently ensure the continued advancement and success of olfaction-enhanced multimedia applications

The effect of context on the performance of children with ADHD on a series of computerised tasks and games

This thesis examines context effects in relation to the performance of children with ADHD in test and 'real world' situations. There is a wealth of empirical research that illustrates poor performance of these children on a range of cognitive measures, particularly tasks that claim to measure executive function and inhibitory control. However, anecdotal reports have suggested that while playing computer games these children display abilities that contrast sharply with empirical findings. This contrast was the basis for a series of studies using computer games and computerised tasks to investigate the performance of children with ADHD across contexts. The first investigation (Study 1), a questionnaire study, lent support to the anecdotal reports. Parents of children with ADHD confirmed that their children were able to sit still, concentrate, pay attention and achieve higher levels of success when playing computer games. In Study 2 parents of children with ADHD were asked to discuss the features of computer games they felt were most influential in contributing to their child's interest and performance. Observations made in the Study 3 provided further confirmation that performance improves when children with ADHD play computer games; performance in terms of error making and and on-task activity on a standardised test of inhibition and attention, the Conners' Continuous Performance Test II (CPT II), was significantly poorer than performance on a more 'game' like Pokemon version of the task and significantly different to the performance of typically developing children. Features of computer games that may have contributed to the observed improvements for children with ADHD were examined in four subsequent studies. These features included the addition of narrative, the addition of a points scoring system, the addition of character, auditory reinforcement and differing levels of response cost. Inhibitory performance on two commercially available games was also investigated (Study 8), and the performance of participants with ADHD was not significantly different to that of typically developing participants. The results raise questions about current understanding of the disorder and models of ADHD, stress the need for examining contextual sensitivity of children with apparently constitutional disorders such as ADHD, and have implications for methodological design and the contexts in which cognitive abilities are investigated

Traditional and new principles of perceptual grouping

Perceptual grouping refers to the process of determining which regions and parts of the visual scene belong together as parts of higher order perceptual units such as objects or patterns. In the early 20th century, Gestalt psychologists identified a set of classic grouping principles which specified how some image features lead to grouping between elements given that all other factors were held constant. Modern vision scientists have expanded this list to cover a wide range of image features but have also expanded the importance of learning and other non-image factors. Unlike early Gestalt accounts which were based largely on visual demonstrations, modern theories are often explicitly quantitative and involve detailed models of how various image features modulate grouping. Work has also been done to understand the rules by which different grouping principles integrate to form a final percept. This chapter gives an overview of the classic principles, modern developments in understanding them, and new principles and the evidence for them. There is also discussion of some of the larger theoretical issues about grouping such as at what stage of visual processing it occurs and what types of neural mechanisms may implement grouping principles

Investigation into the design of educational multimedia : video, interactivity and narrative

This study critically examines the design of multimedia in education. The study begins by reviewing existing media in education and then uses a series of empirical studies to uncover, and then examine the key issues for the design of educational multimedia.The research involves two studies. The first, a preliminary study, that identifies specific areas of interest for the research. This study looks at the existing use of an interactive video disc program for training in Price Waterhouse. The literature search, combined with the outcomes of the preliminary study, identified the areas for further research as: the use of video, forms of interaction, and the role of narrative. The main study examines these areas using two phases. The first phase analyses three treatments of the same educational text, on linear video, multimedia, and structured multimedia, each treatment maintaining the same content and narrative structure, but differing in presentation and control. The second phases builds on the results of the first with the creation and analysis of an interactive multimedia program that takes advantage of the identified strengths of multimedia, and specifically tackles problems found in the first phase. Qualitative data collection techniques are used in both phases, and form the basis of the findings.The findings are presented as implications for multimedia design, and discuss the use and development of narrative and grammar in multimedia, as well as the importance of carefully designed user interaction and goal definition