Validation of an Accelerometer Based BCG Method for Sleep Analysis

Sleep problems are one of the most common medical complaints today. Polysomnography (PSG) as the current standard for sleep analysis is expensive, intrusive and complex. Thus, finding a reliable and unobtrusive method for longer-term home use is important. Ballistocardiography (BCG) based methods have shown potential in sleep analysis recently. The usability and performance of a BCG based method in qualitative and quantitative analysis of sleep was evaluated. The method was validated in a clinical test on 20 subjects using PSG as a reference. Heart rate (HR), heart rate variability (HRV), respiratory rate (RR), respiratory rate variability (RRV), respiratory depth (Rdepth) and movement were utilized for sleep stage detection. The BCG parameter accuracy was presented as the mean error from PSG with 95% confidence interval. The errors were -0.1 ± 4.4 beats per minute for HR, -0.9 ± 14.7 ms for high frequency (HF) HRV, -3.0 ± 29.9 ms for low frequency (LF) HRV, 0.3 ± 4.5 breaths per minute for RR and -40 ± 424 ms for RRV respectively. Correlation coefficient was 0.97 for HR, 0.67 for HF HRV, 0.71 for LF HRV, 0.54 for RR and 0.49 for RRV. HR, RRV and Rdepth were typically at an increased level in REM sleep and wakefulness and decreased in deep sleep. RRV was at its highest during wakefulness. HRV was at a decreased level in REM and wakefulness and increased in deep sleep. Movement was higher during wakefulness than in sleep

Pharmacological and optical activation of TrkB in Parvalbumin interneurons regulate intrinsic states to orchestrate cortical plasticity

Elevated states of brain plasticity typical for critical periods of early postnatal life can be reinstated in the adult brain through interventions, such as antidepressant treatment and environmental enrichment, and induced plasticity may be critical for the antidepressant action. Parvalbumin-positive (PV) interneurons regulate the closure of developmental critical periods and can alternate between high and low plasticity states in response to experience in adulthood. We now show that PV plasticity states and cortical networks are regulated through the activation of TrkB neurotrophin receptors. Visual cortical plasticity induced by fluoxetine, a widely prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant, was lost in mice with reduced expression of TrkB in PV interneurons. Conversely, optogenetic gain-of-function studies revealed that activation of an optically activatable TrkB (optoTrkB) specifically in PV interneurons switches adult cortical networks into a state of elevated plasticity within minutes by decreasing the intrinsic excitability of PV interneurons, recapitulating the effects of fluoxetine. TrkB activation shifted cortical networks towards a low PV configuration, promoting oscillatory synchrony, increased excitatory-inhibitory balance, and ocular dominance plasticity. OptoTrkB activation promotes the phosphorylation of Kv3.1 channels and reduces the expression of Kv3.2 mRNA providing a mechanism for the lower excitability. In addition, decreased expression and puncta of Synaptotagmin2 (Syt2), a presynaptic marker of PV interneurons involved in Ca2+-dependent neurotransmitter release, suggests lower inputs onto pyramidal neurons suppressing feed-forward inhibition. Together, the results provide mechanistic insights into how TrkB activation in PV interneurons orchestrates the activity of cortical networks and mediating antidepressant responses in the adult brain.Peer reviewe

The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment

Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game–based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions

Scaling the Magnetic Resonance Imaging Through Design Research

The superior soft-tissue contrast and sensitivity for pathologies have made magnetic resonance imaging (MRI) a primary modality in medical imaging. At present, the high initial and running costs, and demanding requirements for siting and operating personnel limit its availability to large hospitals and imaging clinics. Improved accessibility of MRI technology can lead into new healthcare services. To study this, we set up the Accessible Magnetic Resonance Imaging (AMRI) research platform, including a multidisciplinary research team and a very low field MRI device for evaluation of new service solutions. We explored the expected value of accessibility in point-of-care contexts, achieving validation and improved focus for initial need-descriptions for the solution. Our design research points towards the potential of a more accessible MRI in improving healthcare provision, and that ever-prevalent medical imaging healthcare services could cause systemic changes to the healthcare processes, technologies, and operating environments.Peer reviewe

Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals : Interview Study

Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation.Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools.Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed.Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability-it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools.Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them.Peer reviewe

The qualities of patients interested in using a game-based digital mental health intervention for depression: a sequential mixed methods study

Abstract Background Digital interventions are typically evaluated by their effectiveness and engagement, while the characteristics of patients who perceive them to be attractive have remained poorly understood. This challenges user-centered intervention development but also presents an avenue to improve intervention efficacy and engagement. Our objective was to characterize people to whom game-based interventions appeal to with a focus on their mental health backgrounds and prior digital game experiences. Methods We performed a sequential mixed methods study with adults suffering from major depressive disorder (MDD) who participated in a randomized controlled clinical trial studying the effectiveness of a game-based digital intervention for depression. First, randomly chosen participants were interviewed (N = 22), and the transcribed data were analyzed inductively. Then, focusing on the themes established through the interview data, we triangulated the findings using complementary questionnaire data (N = 445). Results The interview data yielded four themes that we illuminated with quantified questionnaire data. (T1) The participants had enduring and diverse psychiatric symptomology: 73% had been diagnosed with a comorbid disorder in addition to depression. (T2) Participants had received at least some treatments that had not led to full remission of depression. 92% currently received therapeutic support, psychiatric medication, or both. (T3) Many participants had close relationships with digital gaming and played actively: on average, for 13 h a week on various gaming platforms and in various genres. (T4) Some participants used gaming to manage their psychiatric symptoms, and 76% found that playing helped them feel better. Conclusions Identifying and characterizing people attracted to game-based therapeutic interventions can catalyze intervention development and improve their efficacy. We found that game-based interventions have appealing potential across diverse psychiatric symptoms and for people with prior or existing treatments. Game-based interventions may appeal particularly to active players and offer a promising alternative to the self-treatment usage of entertainment games

Motion Artifact Reduction in Ambulatory Electrocardiography Using Inertial Measurement Units and Kalman Filtering

Electrocardiography (ECG) using lightweight and inexpensive ambulatory ECG devices makes it possible to monitor patients during their daily activities and can give important insight in arrhythmias and other cardiac diseases. However, everyday activities cause several kinds of motion artifacts which deteriorate the ECG quality and thus complicate both automated and manual ECG analysis. In this paper, we discuss some of the challenges associated with long-term ambulatory ECG and propose a baseline wander compensation algorithm based on inertial measurement units (IMUs) attached to each ECG electrode. The IMUs are used for estimating the local electrode motion which in turn is used as the reference signal for baseline wander reduction. We evaluate the proposed algorithm on data gathered in clinical trials and show that the baseline wander is successfully removed, without compromising the ECG's morphology.Peer reviewe