Longitudinal electrodermal recordings of mentally disabled individuals and their caretakers

BACKGROUND Almost no scientific observtions exist concerning the physiological changes and events that arise before nd during human agressive behavior. Yet, there are many instances where it might be of great benefit to have insight in these changes, for example when an individual has limited communicative capabilities to express their emotions and rising frustrations. In our project we focused on such a situation by measuring physiological changes of people with severe mental disabilities, who also consistently showed challenging behavior (CB) such as aggressive acts and self-injurious behavior. Caretakers often report being surprised by these outbursts and explicitly express a need for additional tools to gain insight in the arousal levels of their clients. The aim of our project was to investigate the potential value of ambulatory physiological measurements in bringing this insight to the caretakers. An additional goal was to also examine the relation between the physiological changes of the caretakers themselves and the CB of the clients. We did this because actions of direct care staff have been found to be antecedents of the aggressive behavior of clients, and therefore we wanted to investigate the possibility that heightened levels of arousal in caretakers might be associated with a higher likelihood of future aggressive behavior. METHOD We followed 9 individuals with severe mental disabilities and their regular caretakers during sessions of two to three hours on a fixed timeslot and day of the week over a period of months. During all those sessions (typically a total of 24 per client-caretaker couple), we measured electrodermal activity (EDA) with a wrist sensor, and we recorded the clients behavior on video. EDA, and the parameters that can be extracted from it, such as the number of skin conductance responses per minute, have been found to be a good estimate of the activity of the sympathetic part of the autonomic nervous systems. As such, it can be taken as a further operationalization of the arousal level of the client and caretaker, which was the dependent variable of interest for our project. The measurement device was the Q sensor "Curve" from Affectiva, which allows for wireless, non-intrusive measurements of EDA with a sample rate of 32 Hz (which is more than sufficient for state of the art analysis methods). A protocol was developed to realize these measurements, while minimizing distress for the clients (see Noordzij, Scholten, Laroy-Noordzij, 2012, Measuring Behavior). After each session caretakers noted whether any CB had occurred. Subsequently, trained professionals examined the videos and determined the nature, severity and onset of the CB. EDA parameters were extracted automatically both with computationally simple trough-to-peak analyses, and with more sophisticated decomposition analyses of the signal into its phasic and tonic components. RESULTS AND DISCUSSION As expected the participants displayed CB during many of the sessions. These events were typically associated with medium to highest amplitudes and frequencies of the electrodermal responses. Our data analysis also brought to light some of the complexities surrounding the determination of arousal levels of these clients. Even detailed viewing of the videos by trained professionals resulted in only moderate levels of inter-rater reliability concerning the severity CB and especially the precise onset of CB. This reflects the observation of experienced caretakers that the buildup phase towards CB is hard to detect. On the other hand, we also found low correlation between EDA fluctuations of caretakers and clients. This, and further video analysis, showed that caretakers did not continuously interact and track the arousal level of the clients on a behavioral level. This fact alone opens up a set of possibilities to create a monitoring system based on the EDA levels of client, which informs the caretaker when EDA levels are in a medium to high range (i.e. the only moments when CB occur). Currently, we are developing such a monitoring prototype, which, together with findings from our ongoing analysis of this rich data set will be further discussed during the presentation

Motivating and Counseling the Unemployed

During a ‘learning goal orientation’ training course for unemployed people, one of the participants, a woman in her forties, had a lot of resistance to participate in the course. I persuaded her to stay and assured her that all she had to do was sit down and watch. She persevered in her idea that this was a waste of time and even tried to convince me that I was also wasting my time. Two weeks after the training course, I called her for a follow-up interview to measure her job-search intentions and behavior. Her first response was: “I have to apologize for my behavior. After the training course I passed a temporary agency for elderly people and remembered what you had said about trying different strategies. And guess what, I now have a job and not just any job but exactly the job that I have wanted for so long”. This anecdote illustrates the potential impact that employment counseling and training courses can have on individuals who have lost their job. Losing one’s job is a life event with far reaching economic, psychological, and physical consequences (McKee-Ryan, Song, Wanberg, & Kinicki, 2005; Paul & Moser, 2009) and is considered to be one of the top 10 traumatic life experiences (Spera, Buhrfeind, & Pennebaker, 1994). Besides these consequences, unemployment also deprives a person of the additional gains from being employed, such as time structure, personal identity, interpersonal contact, and activity (Jahoda, 1982; Warr, 1987). Furthermore, the negative consequences of being unemployed tend to increase with increasing duration of unemployment (Rowley & Feather, 1987). Unemployment affects a substantial number of people in present day economies. For example, in the first three months of 2012, 11% of the labor force in Europe and 8.2% of the labor force in the United States were unemployed (Eurostat, 2012; U.S. Department of Labor, 2012). Approximately half of these individuals were long-term unemployed (i.e., more than six months) at that time. These numbers equal the numbers of the 1980s recession

Genotypic and phenotypic aspects of primary immunodeficiency diseases of the lymphoid system

This thesis focuses on the immunological phenotype, the mutation analysis, and the residual activity of mutated proteins in patients with PID of the lymphoid system. During this project, we have investigated possible genotype-(immuno)phenotype relationships in patients with antibody deficiencies and SCID. Consequently, mutation anal

Atlas.txt : Exploring Lingusitic Grounding Techniques for Communicating Spatial Information to Blind Users

Peer reviewedPostprin

Preoperative Screening at the Outpatient Clinic: Predicting cardiac risk in noncardiac surgery

The first chapter of this thesis analyzes perioperative cardiovascular mortality in noncardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands. The performance of Lee et al’s index in predicting perioperative cardiovascular mortality is validated in a 10-year surgical cohort of patients undergoing noncardiac surgery. Based on the results of chapter one, the analysis of perioperative mortality risk factors is continued in chapter two. In this chapter, over one million Dutch patients undergoing noncardiac surgery between 1991-2002 were studied. The influence of well known perioperative risk factors in high risk patients was analyzed in the general noncardiac surgical population, and the impact of surgery related risk on perioperative mortality was further clarified. The total cohort was used to derive and validate a newly constructed perioperative risk index to accurately predict all-cause mortality in noncardiac surgery

Evolving solitons in bubbly flows

At the end of the sixties, it was shown that pressure waves in a bubbly liquid obey the KdV equation, the nonlinear term coming from convective acceleration and the dispersive term from volume oscillations of the bubbles.\ud For a variableu, proportional to –p, wherep denotes pressure, the appropriate KdV equation can be casted in the formu t –6uu x +u xxx =0. The theory of this equation predicts that, under certain conditions, solitons evolve from an initial profileu(x,0). In particular, it can be shown that the numberN of those solitons can be found from solving the eigenvalue problem xx–u(x,0)=0, with(0)=1 and(0)=0.N is found from counting the zeros of the solution of this equation betweenx=0 andx=Q, say,Q being determined by the shape ofu(x,0). We took as an initial pressure profile a Shockwave, followed by an expansion wave. This can be realised in the laboratory and the problem, formulated above, can be solved exactly.\ud In this contribution the solution is outlined and it is shown from the experimental results that from the said initial disturbance, indeed solitons evolve in the predicated quantity.\u