Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia:A Randomized Waitlist Controlled Trial

Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia. Objective: The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial. Methods: We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant’s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition. Results: The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=–0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up. Conclusions: This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens. Trial Registration: Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4

Взаимосвязь ожирения и нарушений углеводного обмена с синдромом обструктивного апноэ во сне

Представлены литературные данные клинических исследований, в которых синдром обструктивного апноэ во сне (СОАС) рассматривается как фактор риска развития нарушений углеводного обмена, в том числе сахарного диабета 2−го типа. Анализируется взаимосвязь наиболее значимых факторов, влияющих на прогрессирование нарушений углеводного обмена у пациентов с СОАС. Приведен анализ данных о связи СОАС с диабетической автономной нейропатией и инсулинорезистентностью. Рассматривается возможность применения СРАР−терапии для коррекции метаболических нарушений у пациентов с сахарным диабетом.Представлено літературні дані клінічних досліджень, у яких синдром обструктивного апное під час сну (СОАС) розглянуто як фактор ризику розвитку порушень вуглеводного обміну, у тому числі цукрового діабету 2−го типу. Аналізується взаємозв'язок найбільш значущих факторів, що впливають на прогресування порушень вуглеводного обміну у пацієнтів із СОАС. Наведено аналіз даних про зв'язок СОАС із діабетичною автономною нейропатією та інсулінорезистентністю. Розглянуто можливість використання СРАР−терапії для корекції метаболічних порушень у пацієнтів із цукровим діабетом.Literature data about clinical trials, in which sleep apnea syndrome (SAS) is featured as a risk factor of carbohydrate metabolism disorders, including type 2 diabetes mellitus, are presented. Association of the most significant factors influencing the progress carbohydrate metabolism disorders in patients with SAS is analyzed. The data about the association of SAS and diabetic autonomous neuropathy and insulin resistance are featured. Possibility to use CPAP therapy for correction of metabolic disorders in patients with diabetes mellitus is discussed

Human Handheld-Device Interaction: An Adaptive User Interface

The move to smaller, lighter and more powerful (mobile) handheld devices, whe-ther PDAs or smart-phones, looks like a trend that is building up speed. With numerous embedded technologies and wireless connectivity, the drift opens up unlimited opportunities in daily activities that are both more efficient and more exciting. Despite all these advancing possibilities, the shrinking size and the mobile use impose challenges for both technical and usability aspects of the devices and their applications. An adaptive user interface, that is able to autonomously adjust its display and available actions to current goals, contexts and emotions of its user, represents solutions for limited input options, various constraints of the output presentation, and user requirements due to mobility and attention shifting in human handheld-device interaction. The present work made preliminary steps in proposing a framework for a rapid construction of adaptive user interfaces that are multimodal, context-aware and affective, on handheld devices. The framework consists of predefined modules that are able to work in isolation but can also be connected in an ad hoc way as part of the framework. The modules deal with human handheld-device interaction, the interpretation of the user's actions, knowledge structure and management, the selection of appropriate responses and the presentation of feedback. Human language and visual perception models have been studied in formulating concepts or ideas as both text and visual language-based messages. An adaptive circular on-screen keyboard and visual language-based interfaces have been proposed as alternative input options for fast interaction. In particular, sentences in the visual language can be constructed using spatial arrangements of visual symbols, such as icons, lines, arrows and ellipses. As icons offer a potential across language barriers, any interaction using the visual language is suitable for language-independent contexts. Personalized predictive and language-based features have also been added to accelerate both input methods. An ontology has been chosen to represent knowledge of the user, the task and the world. The modeling and structure of the knowledge representation has been designed for sharing common semantics, integrating the communication inter-modules, and fulfilling the context aware requirement. It enables the framework to be developed into a widespread application for different domains. The context awareness is approached by interpreting both verbal and non-verbal aspects of user inputs to update the system's belief about the user, the task and the world. Methods and techniques to fuse multiple input modalities for multiple messages from multiple users into a coherence and context dependent interpretation have been developed. A simple approach to emotion analysis has been proposed to interpret the nonverbal aspect of the inputs. It is based on a keyword spotting approach by categorizing the emotional state into a certain valence orientation with intensity. The approach is suitable for a high uncertainties input recognition. Template-based interaction management and output generation methods have been developed. The templates have a direct link to concepts in the ontology-based knowledge representation. This approach supports a common semantic with other modules within the framework. It allows the development of a bigger scale system with consistent and easy to verify knowledge repositories. A multimodal, multi-user, and multi-device communication system in the field of crisis management built based on the framework has been developed as a proof of the proposed concepts. This system consists of comprehensive selected modules for reporting and collaborating observations using handheld devices in mobile ad-hoc network-based communication. It supports communication using the combination of text, visual language and graphics. The system is able to interpret user messages, construct knowledge of the user, the task and the world, and develop a crisis scenario. User tests were aimed at an assessment of whether or not users are capable of expressing their messages using the provided modalities. The tests also addressed usability issues on interacting with an adaptive user interface on handheld devices. The experimental results indicated that the adaptive user interface is able to support communication between users and between users and their handheld devices. Moreover, an explorative study within this research has also generated knowledge regarding (technical, social and usability aspects of) user requirements in adaptive user interfaces and (generally) human handheld-device interaction. The rationale behind our approaches, designs, empirical evaluations and implications for research on the framework for an adaptive user interface on handheld devices are also described in this thesis.Man Machine Interaction, MediamaticsElectrical Engineering, Mathematics and Computer Scienc

Bayesian Classification of Disaster Events on the Basis of Icon Messages of Observers.

During major disaster events, human operators in a crisis center will be overloaded with a flood of phone calls. As an increasing number of people in and around big cities do not master the native language, the need for automated systems that automatically process the context and content of information about disaster situations from the communicated messages becomes apparent. To support language-independent communication and to reduce the ambiguity and multitude semantics, we developed an icon-based reporting observation system. Contrast to previous approaches of such a system, we link icon messages to disaster events without using Natural Language Processing. We developed a dedicated set of icons related to the context and characteristic features of disaster events. The developed system is able to compute the probability of the appearance of possible disaster events using Bayesian reasoning. In this paper, we present the reporting system, the developed icons, the Bayesian model, and the results of a user test.Intelligent InteractionElectrical Engineering, Mathematics and Computer Scienc

An automated text-based synthetic face with emotions for web lectures

Web lectures have many positive aspects, e.g. they enable learners to easily control the learning experiences). To develop high-quality online learning materials takes a lot of time and human efforts [2]. An alternative is to develop a digital teacher. We have developed a prototype of a synthetic 3D face that shows emotion associated to text-based speech in an automated way. As a first step, we studied how humans express emotions in face-to-face communication. Based on this study, we have developed a 2D affective lexicon and a set of rules that describes dependencies between linguistic contents and emotions.Intelligent SystemsElectrical Engineering, Mathematics and Computer Scienc

Computed Ontology-based Situation Awareness of Multi-User Observations

In recent years, we have developed a framework of human-computer interaction that offers recognition of various communication modalities including speech, lip movement, facial expression, handwriting/drawing, gesture, text and visual symbols. The framework allows the rapid construction of a multimodal, multi-device, and multi-user communication system within crisis management. This paper reports the approaches used in multi-user information integration (input fusion) and multimodal presentation (output fission) modules, which can be used in isolation, but also as part of the framework. The latter is able to specify and produce contextsensitive and user-tailored output combining language, speech, visual-language and graphics. These modules provide a communication channel between the system and users with different communication devices. By the employment of ontology, the system’s view about the world is constructed from multi-user observations and appropriate multimodal responses are generated.Intelligent SystemsElectrical Engineering, Mathematics and Computer Scienc

Dynamic Routing during Disaster Events

Innovations in mobile technology allow people to request route information on their smartphone to reach safe areas during emergency and disaster evacuations. In return, the affected people in the field can send their observation reports, e.g. using a dedicated icon-based disaster language. However, given the turbulent nature of disaster situations, the people and systems at crisis center are subjected to information overload, which can obstruct timely and accurate information sharing. A dynamic and automated evacuation plan that is able to predict future disaster outcome can be used to coordinate the affected people to safety in times of crisis. In this paper, we present a dynamic version of the shortest path algorithm of Dijkstra. The algorithm is able to compute the shortest path from the GPS-based location of the user (sent by the smartphone) to the safety area by taking into account possible affected areas in future. In the case of a toxic cloud, the “plume” model has been used to predict the path of the “plume” and to compute affected areas in the future. The algorithm has been tested in a simulation study and used in an experiment during a simulated crisis event in the city of Rotterdam.Intelligent InteractionElectrical Engineering, Mathematics and Computer Scienc

Utilizing the Potential of the Affected Population and Prevalent Mobile Technology during Disaster Response: Propositions for a Literature Survey

Despite the growing awareness of the untapped potential of the affected population in a disaster situation, their inclusion in a disaster management is extremely limited. This study aims to survey the literature to see whether utilizing the affected people and prevalent mobile technology can be used during disaster response. The idea is to provide the affected with a way to lead themselves to safety and empower them to serve as distributed active sources of information. This way, those people will reach safety by themselves, while at the same time helping to construct a clear image of the disaster situation without burdening the already overwhelmed emergency services. This study examines knowledge derived from disaster sociology, draws on experience from recent disasters, and extrapolates current technological solutions. By establishing that such a solution is feasible, it offers a basis for empirical studies on a mobile technology that can be used during disaster response.Intelligent SystemsElectrical Engineering, Mathematics and Computer Scienc