The effects of acute yoga on anxiety symptoms in response to a carbon dioxide inhalation task in women

Background: Acute exercise is becoming an increasingly popular approach for treating anxiety symptoms in individuals with clinical and/or subclinical levels of anxiety. However, there has been limited empirical effort in studying such anxiolytic effects in individuals of this specific target population (i.e., those with elevated anxiety). This has consequently led to floor effects in the literature. There further has been inadequate focus on women, who are significantly more affected by these symptoms. Finally, yoga has not been adequately studied for such effects, although it has become a mainstream alternative health practice approach by many individuals. Objectives: The purpose of this study was to examine the efficacy of a single bout of vinyasa-style yoga versus a stretching control condition for improving immediate and delayed cognitive and physical anxiety symptoms induced by a 5-minute, 7.5.% CO2-inhalation protocol in women with self-reported high anxiety sensitivity. Methods: In a within-subjects design, 18 women with elevated anxiety sensitivity completed 1 baseline session, and 2 experimental conditions in a randomized, counterbalanced order. Yoga and control conditions consisted of 40 minutes of guided vinyasa-style yoga and light stretching, respectively. Participants completed the 7.5% CO2-inhalation task before, immediately after and 1 hour after the experimental conditions and filled out questionnaires on state anxiety, panic and anger before and after the inhalation. Respiratory measures (i.e., respiration rate, ventilation, tidal volume, CO2 production) and self-reported overall anxiety data were collected via a metabolic cart attached to the mouthpiece during the inhalation task. Repeated measures ANOVAs were conducted for all outcome measures. Results: Based on the results of the 3-way ANOVA, there was no evidence for a differential pattern of change in self-reported or respiratory outcomes in response to the inhalation task between the 2 conditions (p>.05). There was a significant main effect of inhalation (i.e., from pre- to post-inhalation) on the self-reported panic and anxiety symptoms in both conditions (p<.05). Finally, collapsed over exposure and condition, there was a slight reduction in cognitive anxiety over time (i.e., from baseline to immediately post and 1-hour post-inhalation task). Conclusion: A light-to-moderate intensity vinyasa-style yoga does not appear to be more efficacious than a light stretching session for improving symptoms of anxiety and panic in response to the anxiogenic 5-minute, 7.5% CO2-air mixture inhalation task. However, there appears to be an overall effect of general physical activity for attenuating cognitions of anxiety, irrespective of the physiological responses. Furthermore, the inhalation task administered in the present study appears to be a reliable method for mimicking both acute panic and more generalized anxiety state symptoms under laboratory conditions

Designing and evaluating an online reinforcement learning agent for physical exercise recommendations in N-of-1 trials

Personalized adaptive interventions offer the opportunity to increase patient benefits, however, there are challenges in their planning and implementation. Once implemented, it is an important question whether personalized adaptive interventions are indeed clinically more effective compared to a fixed gold standard intervention. In this paper, we present an innovative N-of-1 trial study design testing whether implementing a personalized intervention by an online reinforcement learning agent is feasible and effective. Throughout, we use a new study on physical exercise recommendations to reduce pain in endometriosis for illustration. We describe the design of a contextual bandit recommendation agent and evaluate the agent in simulation studies. The results show that adaptive interventions add complexity to the design and implementation process, but have the potential to improve patients' benefits even if only few observations are available. In order to quantify the expected benefit, data from previous interventional studies is required. We expect our approach to be transferable to other interventions and clinical interventions

Screen time use in children under 3 years old: a systematic review of correlates

Background: A large percentage (68%) of children under age 3 use screen media, such as television, DVDs and video games, on a daily basis. Research suggests that increased screen time in young children is linked to negative health outcomes, including increased BMI, decreased cognitive and language development and reduced academic success. Reviews on correlates of screen time for young children have included preschool age children and children up to age 7; however, none have focused specifically on correlates among infants and toddlers. As research suggests that screen media use increases with age, examining correlates of early media exposure is essential to reducing exposure later in life. Thus, this paper systemically reviews literature published between January 1999 and January 2013 on correlates of screen time among children between 0 and 36 months of age. Methods: Two methods were used to conduct this review: (1) Computerized searches of databases (PubMed, PsycINFO, ERIC, Medline); and (2) Reference sections of existing reviews and primary studies. Inclusion criteria were: (1) The article included separate data for children 36 months and younger, (2) English language, (3) peer reviewed article, (4) analysis reported for screen viewing as a dependent variable, (5) original research article and, (6) examined correlates or associations between screen time and other demographic, contextual or behavioral variables. Articles were compiled between 2011 and 2013 and evaluation occurred in 2012 and 2013. Results: The literature search identified 29 studies that met inclusion criteria. These studies investigated a total of 33 potential correlates, which were examined in this review. Findings suggest demographic variables most commonly correlated with high screen time among infants and toddlers are child’s age (older) and race/ethnicity (minority). Child BMI, maternal distress/depression, television viewing time of the mother and cognitive stimulation in the home environment were also associated with screen media use. Studies reported that child sex, first born status, paternal education, non-English speaking family, two-parent household, number of children in the home and non-parental childcare were not associated with screen time among children aged 0–36 months. Associations were unclear (fewer than 60% of studies report an association) for maternal age, maternal education and household income. The remaining correlates were investigated in fewer than three studies and thus not coded for an association. Conclusions: The correlates identified in this study point to avenues for intervention to reduce screen time use in young children. However, further research is necessary to explore a number of environmental, socio-cultural and behavioral correlates that are under-examined in this population and may further inform prevention and intervention strategies

Keyword-optimized Template Insertion for Clinical Information Extraction via Prompt-based Learning

Clinical note classification is a common clinical NLP task. However, annotated data-sets are scarse. Prompt-based learning has recently emerged as an effective method to adapt pre-trained models for text classification using only few training examples. A critical component of prompt design is the definition of the template (i.e. prompt text). The effect of template position, however, has been insufficiently investigated. This seems particularly important in the clinical setting, where task-relevant information is usually sparse in clinical notes. In this study we develop a keyword-optimized template insertion method (KOTI) and show how optimizing position can improve performance on several clinical tasks in a zero-shot and few-shot training setting

A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

BACKGROUND: Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). PURPOSE: To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. METHOD: A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). RESULTS: The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. CONCLUSION: Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement

Physiological response to firefighting activities of various work cycles using extended duration and prototype SCBA

Firefighters’ self-contained breathing apparatus (SCBA) protects the respiratory system during firefighting but increases the physiological burden. Extended duration SCBA (>30 min) have increased air supply, potentially increasing the duration of firefighting work cycles. To examine the effects of SCBA configuration and work cycle (length and rest), 30 firefighters completed seven trials using different SCBA and one or two bouts of simulated firefighting following work cycles common in the United States. Heart rate, core temperature, oxygen consumption, work output and self-reported perceptions were recorded during all activities. Varying SCBA resulted in few differences in these parameters. However, during a second bout, work output significantly declined while heart rates and core temperatures were elevated relative to a single bout. Thirty seven per cent of the subjects were unable to complete the second bout in at least one of the two-bout conditions. These firefighters had lower fitness and higher body mass than those who completed all assigned tasks. Practitioner Summary: The effects of extended duration SCBA and work/rest cycles on physiological parameters and work output have not been examined. Cylinder size had minimal effects, but extended work cycles with no rest resulted in increased physiological strain and decreased work output. This effect was more pronounced in firefighters with lower fitness.This work was supported by the Department of Homeland Security Fire Prevention and Safety, Federal Emergency Management Agency [grant number EMW-2010-FP-01606].Ope

Associations between physical exercise patterns and pain symptoms in individuals with endometriosis: a cross-sectional mHealth-based investigation

Objectives This study investigates the association of daily physical exercise with pain symptoms in endometriosis. We also examined whether an individual’s typical weekly (ie, habitual) exercise frequency influences (ie, moderates) the relationship between their pain symptoms on a given day (day t) and previous-day (day t-1) exercise.Participants The sample included 90 382 days of data from 1009 participants (~85% non-Hispanic white) living with endometriosis across 38 countries.Study design This was an observational, retrospective study conducted using data from a research mobile app (Phendo) designed for collecting self-reported data on symptoms and self-management of endometriosis.Primary outcome measures The two primary outcomes were the composite day-level pain score that includes pain intensity and location, and the change in this score from previous day (Δ-score). We applied generalised linear mixed-level models to examine the effect of previous-day exercise and habitual exercise frequency on these outcomes. We included an interaction term between the two predictors to assess the moderation effect, and adjusted for previous-day pain, menstrual status, education level and body mass index.Results The association of previous-day (day t-1) exercise with pain symptoms on day t was moderated by habitual exercise frequency, independent of covariates (rate ratio=0.96, 95% CI=0.95 to 0.98, p=0.0007 for day-level pain score, B=−0.14, 95% CI=−0.26 to −0.016, p=0.026 for Δ-score). Those who regularly engaged in exercise at least three times per week were more likely to experience favourable pain outcomes after having a bout of exercise on the previous day.Conclusions Regular exercise might influence the day-level (ie, short-term) association of pain symptoms with exercise. These findings can inform exercise recommendations for endometriosis pain management, especially for those who are at greater risk of lack of regular exercise due to acute exacerbation in their pain after exercise

A modified SCBA facepiece for accurate metabolic data collection from firefighters

<div><p>To better assess the energy expenditure and exertion of firefighters during simulated firefighting activities, a commercial firefighter self-contained breathing apparatus (SCBA) facepiece was modified to interface with a portable metabolic monitoring device (Cosmed K4b²) while still functioning as a positive pressure SCBA air supply. To validate the device, standard National Fire Protection Association 1981 SCBA function tests were conducted and 14 subjects performed variable-workload assessments using all combinations of two test devices (Cosmed K4b² and metabolic cart) and two masks (modified SCBA facepiece and stock manufacturer-supplied breath collection). Metabolic data collected with the Cosmed K4b² via the modified facepiece were found to be accurate when compared to a ParvoMedics Truemax 2400 metabolic cart (average per cent difference: 4.6%). This modified facepiece design is suitable for use in metabolic studies requiring the utilisation of an SCBA system. Furthermore, the well-established overestimation of oxygen consumption from the Cosmed K4b² system was replicated.</p></div

Development of the ehive Digital Health App: Protocol for a Centralized Research Platform

BackgroundThe increasing use of smartphones, wearables, and connected devices has enabled the increasing application of digital technologies for research. Remote digital study platforms comprise a patient-interfacing digital application that enables multimodal data collection from a mobile app and connected sources. They offer an opportunity to recruit at scale, acquire data longitudinally at a high frequency, and engage study participants at any time of the day in any place. Few published descriptions of centralized digital research platforms provide a framework for their development. ObjectiveThis study aims to serve as a road map for those seeking to develop a centralized digital research platform. We describe the technical and functional aspects of the ehive app, the centralized digital research platform of the Hasso Plattner Institute for Digital Health at Mount Sinai Hospital, New York, New York. We then provide information about ongoing studies hosted on ehive, including usership statistics and data infrastructure. Finally, we discuss our experience with ehive in the broader context of the current landscape of digital health research platforms. MethodsThe ehive app is a multifaceted and patient-facing central digital research platform that permits the collection of e-consent for digital health studies. An overview of its development, its e-consent process, and the tools it uses for participant recruitment and retention are provided. Data integration with the platform and the infrastructure supporting its operations are discussed; furthermore, a description of its participant- and researcher-facing dashboard interfaces and the e-consent architecture is provided. ResultsThe ehive platform was launched in 2020 and has successfully hosted 8 studies, namely 6 observational studies and 2 clinical trials. Approximately 1484 participants downloaded the app across 36 states in the United States. The use of recruitment methods such as bulk messaging through the EPIC electronic health records and standard email portals enables broad recruitment. Light-touch engagement methods, used in an automated fashion through the platform, maintain high degrees of engagement and retention. The ehive platform demonstrates the successful deployment of a central digital research platform that can be modified across study designs. ConclusionsCentralized digital research platforms such as ehive provide a novel tool that allows investigators to expand their research beyond their institution, engage in large-scale longitudinal studies, and combine multimodal data streams. The ehive platform serves as a model for groups seeking to develop similar digital health research programs. International Registered Report Identifier (IRRID)DERR1-10.2196/4920