Continuous 24-h Photoplethysmogram Monitoring Enables Detection of Atrial Fibrillation

Aim: Atrial fibrillation (AF) detection is challenging because it is often asymptomatic and paroxysmal. We evaluated continuous photoplethysmogram (PPG) for signal quality and detection of AF.Methods: PPGs were recorded using a wrist-band device in 173 patients (76 AF, 97 sinus rhythm, SR) for 24 h. Simultaneously recorded 3-lead ambulatory ECG served as control. The recordings were split into 10-, 20-, 30-, and 60-min time-frames. The sensitivity, specificity, and F1-score of AF detection were evaluated for each time-frame. AF alarms were generated to simulate continuous AF monitoring. Sensitivities, specificities, and positive predictive values (PPVs) of the alarms were evaluated. User experiences of PPG and ECG recordings were assessed. The study was registered in the Clinical Trials database (NCT03507335).Results: The quality of PPG signal was better during night-time than in daytime (67.3 +/- 22.4% vs. 30.5 +/- 19.4%, p < 0.001). The 30-min time-frame yielded the highest F1-score (0.9536), identifying AF correctly in 72/76 AF patients (sensitivity 94.7%), only 3/97 SR patients receiving a false AF diagnosis (specificity 96.9%). The sensitivity and PPV of the simulated AF alarms were 78.2 and 97.2% at night, and 49.3 and 97.0% during the daytime. 82% of patients were willing to use the device at home.Conclusion: PPG wrist-band provided reliable AF identification both during daytime and night-time. The PPG data's quality was better at night. The positive user experience suggests that wearable PPG devices could be feasible for continuous rhythm monitoring.Peer reviewe

Expertise in using the Rorschach Comprehensive System in personality assessment

The aim of the present study has been to investigate how differently skilled clinical psychologists use the Rorschach Comprehensive System (RCS) when they assess personality. There are no earlier studies in this area, and therefore the nature of this study is exploratory, aiming at the discovery of new knowledge that can act as a basis for further investigations. The subjects comprised three skill groups (expert, intermediate, and novice groups), each of which included 10 participants. They were to assess the personality of two real patients, using the anamnesis, the WAIS-R profile, and the RCS-materials. The assessments were carried out thinking aloud and the transcribed verbal protocols (610 pages) were used as data. The relevant categories were found using a datadriven approach. They were as follows: items used from the RCS-materials, inferences made from items, integration of information, errors in using the RCS, and content and structure of personality characteristics. The first key result was that experts differed mostly from other groups by making more inferences from RCS-materials, integrating more, making fewer errors and constructing more complex personality characteristics, and skilled use of the RCS in personality assessment is thus primarily seen to be connected to these activities. The second main result was that there were no differences between the intermediate and novice groups, which raises discussion about the development of skills in this area