Digital twins for health: a scoping review.

The use of digital twins (DTs) has proliferated across various fields and industries, with a recent surge in the healthcare sector. The concept of digital twin for health (DT4H) holds great promise to revolutionize the entire healthcare system, including management and delivery, disease treatment and prevention, and health well-being maintenance, ultimately improving human life. The rapid growth of big data and continuous advancement in data science (DS) and artificial intelligence (AI) have the potential to significantly expedite DT research and development by providing scientific expertise, essential data, and robust cybertechnology infrastructure. Although various DT initiatives have been underway in the industry, government, and military, DT4H is still in its early stages. This paper presents an overview of the current applications of DTs in healthcare, examines consortium research centers and their limitations, and surveys the current landscape of emerging research and development opportunities in healthcare. We envision the emergence of a collaborative global effort among stakeholders to enhance healthcare and improve the quality of life for millions of individuals worldwide through pioneering research and development in the realm of DT technology.

Developing text-messaging support for fathers after perinatal loss.

BACKGROUND: Perinatal loss is a devastating occurrence for expecting parents. Although both parents are affected, research on fathers' grief has not resulted in effective support services for fathers. AIM: To describe a multi-stage co-design process for developing text messaging support for fathers experiencing perinatal loss. METHODS: Co-designed text messages were developed in collaboration with a perinatal bereavement organisation, mothers and fathers with lived experience of perinatal loss, and clinicians working with bereaved parents. Bereaved parents responded to a survey about bereaved fathers' information needs (stage 1). A qualitative descriptive data analysis created topics for the generation of text messages (stage 2). Parents with lived experience and clinicians evaluated the messages on importance and clinical fit (stage 3). Messages were revised (stage 4), followed by parent and clinician evaluation and final message revision (stage 5). FINDINGS: There were 959 survey respondents; the majority agreed that support for fathers would have been useful; 539 provided comments. Qualitative analysis created twelve topics within three themes, leading to the generation of 64 text messages. Messages were evaluated by 27 lived experience parents and 19 clinicians as important (91.6%) and understandable (91.3%), and 92.5% of clinicians agreed the messages fitted clinical guidelines. Message revision resulted in 59 messages across three themes. The final evaluation by 12 parents and 14 clinicians led to a final revised set of 52 messages. CONCLUSION: Text-based support for bereaved fathers can be developed in a co-design process to accord with clinical practice, from topics suggested parents with lived experience.

Examining the structure validity of the Pittsburgh Sleep Quality Index among female workers during New Zealand's initial COVID-19 lockdown.

Sleep is important for good physical and mental health. The COVID-19 pandemic lockdown created a unique context that impacted psychological and social drivers for sleeping well. The Pittsburgh Sleep Quality Index (PSQI) is a widely used measurement tool assessing subjective sleep quality. The traditional model of the PSQI (a one-factor model), whilst validated and used across different populations, has also been questioned with regards to data fit and representativeness of its global score in different social and work-related circumstances. Examination of the structure validity of the PSQI in the unique context of the pandemic has been scarce. This study determined the PSQI structure validity amongst employed women considered to experience increased stressors during the pandemic lockdown. The subjectively reported PSQI data from 498 female workers (mean age 44.6 years) collected during New Zealand's first national COVID-19 lockdown (April, 2020) was used. Confirmatory factor analyses compared the original one-factor model of the PSQI with the two- and three-factor models used by Jia et al. (2019) within this pandemic context. Results showed that the two-factor model provided a superior fit of the PSQI data compared to the original one-factor or a three-factor model. These findings suggest that a sub-score of the PSQI with two factors appears to be better at describing the sleep quality of healthy working women during the constrained situation of the pandemic lockdown compared to a single global sleep quality score. This indicates the importance of considering the validity of subjective sleep measures when used within unique social contexts and stressors.

Thermography of the superfluid transition in a strongly interacting Fermi gas.

Heat transport can serve as a fingerprint identifying different states of matter. In a normal liquid, a hotspot diffuses, whereas in a superfluid, heat propagates as a wave called "second sound." Direct imaging of heat transport is challenging, and one usually resorts to detecting secondary effects. In this study, we establish thermography of a strongly interacting atomic Fermi gas, whose radio-frequency spectrum provides spatially resolved thermometry with subnanokelvin resolution. The superfluid phase transition was directly observed as the sudden change from thermal diffusion to second-sound propagation and is accompanied by a peak in the second-sound diffusivity. This method yields the full heat and density response of the strongly interacting Fermi gas and therefore all defining properties of Landau's two-fluid hydrodynamics.

Providing clinicians with 'how to' knowledge for technology-based innovation: Introducing the SMS4dads texts.

ISSUE ADDRESSED: Male partners are key supports for women in birth preparation and postnatally. Text-messaging can deliver timely information to expectant and new fathers to increase their support of the mother. However, technological innovations in healthcare often fail to be adopted. This study aims to assess the impact of disseminating a 'taster' set of SMS messages to increase clinicians' engagement with the intervention. METHODS: Example messages from SMS4dads were delivered to clinicians over a 3-week period and a link provided to an evaluation survey. Agreement to two closed questions was rated on a five-point Likert scale; the frequency of specific recalled messages was calculated for the first open-ended question. Responses to the remaining open-ended questions were analysed with a descriptive thematic approach. RESULTS: A total of 418 participants (female 61.5%) working in health organisations (80.4%), mostly in nursing (33.9%) or midwifery (19.6%) enrolled. Of the 77 (18.4%) participants who provided an evaluation, 96% agreed or strongly agreed that the Professional Taster gave them a better understanding of how to explain the program, and 88% agreed or strongly agreed that they are now more likely to tell parents about the program. Analysis of the remaining two open-ended questions revealed clinicians' concerns for fathers alongside their primary focus on maternal wellbeing. CONCLUSION: Providing 'how to' knowledge through receiving a sample of the intervention may increase clinicians' acceptance of technological innovation. SO WHAT?: Health-promoting digital interventions using text are increasing. Novel tested strategies for gaining buy-in from healthcare staff will be needed.

Developing a text message intervention for fathers with partners experiencing perinatal depression or anxiety.

BACKGROUND: Support from fathers to their partners is important to reduce distress in mothers during the perinatal period when conditions such as depression and anxiety can be common. The SMS4dads digital platform delivers text messages to fathers but has not previously addressed specific messages to fathers with partners who are experiencing perinatal depression and/or anxiety (PNDA). AIM: To develop messages, in collaboration with experienced parents and clinicians, that are suitable for fathers whose partner is experiencing PNDA. METHODS: Messages designed to enhance the quality of partner support for mothers experiencing PNDA were drafted by the SMS4dads team based on suggestions from mothers with lived experience of PNDA. Mothers and fathers with lived experience and expert clinicians rated the messages for importance and understanding. Clinicians additionally rated clinical relevance. Open response comments from parents and clinicians were collated for each message. Re-drafted messages were screened again and checked for literacy level. RESULTS: Forty-one draft messages received a total of 170 ratings from 24 parents and 164 ratings from 32 clinicians. Over three quarters of parents and clinicians agreed or strongly agreed that messages were understandable (parents 85.6%; clinicians 77.4%), important (parents 86.3%; clinicians 86.6%), and 85.5% of clinicians rated the messages as clinically relevant. Comments from clinicians (n = 99) and parents (n = 46) were reviewed and guided message development. Thirty re-drafted messages were screened and 16 edited based on a second round of ratings and comments from parents and clinicians. CONCLUSION: Messages for fathers whose partners are experiencing depression and anxiety can be developed and evaluated in collaboration with lived experience of parents and clinicians.

Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis.

BACKGROUND: Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back "STOP" to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions. OBJECTIVE: This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers. METHODS: Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021. RESULTS: Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included "other reasons" (83/202, 41.1%), followed by "not helpful" (47/202, 23.3%) and "too busy" (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked. CONCLUSIONS: Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers' role may be an important consideration in reducing fathers' disengagement.

Equipping fathers to support distressed mothers: What do mothers want fathers to know and do?

ISSUE ADDRESSED: Up to one in five new mothers experience depression or anxiety, and their partners are often the first line of social and practical support. However, many fathers are unprepared for their role as support person. The SMS4dads program (www.sms4dads.com) provides text-based support to new fathers but lacks specific messages addressing maternal mental distress. METHODS: A mixed methods process engaged mothers with lived experience of perinatal mental distress to identify message content for co-designing texts in SMS4dads. Participants completed surveys derived from research literature and parenting websites using the theoretical framework of support domains: emotional or affectionate support, informational support, tangible support and positive social interaction. Mothers also indicated the most appropriate timing of support: at the point of identifying the distress (emerging), with ongoing symptoms (persistent) or during recovery (easing). Free text comments from mothers were linked to survey topics to provide examples of wording suitable for text messages to fathers. RESULTS: Fifty-five mothers with lived experience completed the surveys. All support items were more often endorsed as helpful rather than not helpful by mothers. Emotional support was thought helpful in the early stages, tangible support was valued with ongoing symptoms and social interaction appreciated as symptoms eased. CONCLUSIONS: Mothers experiencing perinatal depression and anxiety require a range of supportive actions by their partners, including household tasks and baby-care, encouragement, listening and managing relationships with family and friends. SO WHAT?: Information provided by distressed mothers can provide guidance to professionals when designing information for fathers/partners. Digital delivery of this co-designed information to fathers across urban and rural areas may enhance the competence of fathers working to support mothers experiencing mental distress in the perinatal period.

Exploring the Darkverse: A Multi-Perspective Analysis of the Negative Societal Impacts of the Metaverse.

The Metaverse has the potential to form the next pervasive computing archetype that can transform many aspects of work and life at a societal level. Despite the many forecasted benefits from the metaverse, its negative outcomes have remained relatively unexplored with the majority of views grounded on logical thoughts derived from prior data points linked with similar technologies, somewhat lacking academic and expert perspective. This study responds to the dark side perspectives through informed and multifaceted narratives provided by invited leading academics and experts from diverse disciplinary backgrounds. The metaverse dark side perspectives covered include: technological and consumer vulnerability, privacy, and diminished reality, human-computer interface, identity theft, invasive advertising, misinformation, propaganda, phishing, financial crimes, terrorist activities, abuse, pornography, social inclusion, mental health, sexual harassment and metaverse-triggered unintended consequences. The paper concludes with a synthesis of common themes, formulating propositions, and presenting implications for practice and policy.

Online mental health screening for rural fathers over the perinatal period.

OBJECTIVE: To determine the feasibility of identifying distressed fathers in rural areas of NSW via a 'light touch' support program (SMS4dads). DESIGN: A retrospective observational study using self-reported distress and routinely captured help-seeking behaviour over a 14-month period (September 2020-December 2021) comparing rural and urban fathers. SETTING: Rural and urban Local Health Districts in NSW. PARTICIPANTS: A total of 3261 expectant and new fathers enrolled in a text-based information and support service (SMS4dads). MAIN OUTCOME MEASURES: Registrations, K10 score, program engagement, attrition, escalation and referral to online mental health services. RESULTS: Rural (13.3%) and urban (13.2%) enrolments were equivalent. Rural fathers had higher rates of distress than urban fathers (rural 19%; urban 16%) and were more likely to be smokers, consume alcohol at risky levels and report lower education levels. Rural fathers were more likely to exit the program early (HR = 1.32; 95% CI 1.08-1.62; p = 0.008); however, once adjusted for demographic factors aside from rurality, this increased likelihood was nonsignificant (HR = 1.10; 95% CI 0.88-1.38; p = 0.401). Although engagement with psychological support during the program was equivalent, a greater proportion of rural participants were escalated to online mental health support (7.7%) than urban participants (6.1%); however, this was nonsignificant (p = 0.222). CONCLUSION: Digital platforms offering text-based parenting information in a 'light touch' format may be an effective way to screen rural fathers for mental distress and connect them to online support.

The use of deep learning for smartphone-based human activity recognition.

The emerging field of digital phenotyping leverages the numerous sensors embedded in a smartphone to better understand its user's current psychological state and behavior, enabling improved health support systems for patients. As part of this work, a common task is to use the smartphone accelerometer to automatically recognize or classify the behavior of the user, known as human activity recognition (HAR). In this article, we present a deep learning method using the Resnet architecture to implement HAR using the popular UniMiB-SHAR public dataset, containing 11,771 measurement segments from 30 users ranging in age between 18 and 60 years. We present a unified deep learning approach based on a Resnet architecture that consistently exceeds the state-of-the-art accuracy and F1-score across all classification tasks and evaluation methods mentioned in the literature. The most notable increase we disclose regards the leave-one-subject-out evaluation, known as the most rigorous evaluation method, where we push the state-of-the-art accuracy from 78.24 to 80.09% and the F1-score from 78.40 to 79.36%. For such results, we resorted to deep learning techniques, such as hyper-parameter tuning, label smoothing, and dropout, which helped regularize the Resnet training and reduced overfitting. We discuss how our approach could easily be adapted to perform HAR in real-time and discuss future research directions.

Testing the acceptability of stillbirth awareness messages in an SMS program for fathers.

ISSUE ADDRESSED: To raise expectant fathers' awareness of risk factors for stillbirth. METHODS: A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three-point Likert scale and provided comments. RESULTS: Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important-good information," "not appropriate/anxiety provoking" and "not relevant-obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." CONCLUSIONS: Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers-to-be. SO WHAT?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father-focused text messaging service.

Detection of heart rate using smartphone gyroscope data: a scoping review.

Heart rate (HR) is closely related to heart rhythm patterns, and its irregularity can imply serious health problems. Therefore, HR is used in the diagnosis of many health conditions. Traditionally, HR has been measured through an electrocardiograph (ECG), which is subject to several practical limitations when applied in everyday settings. In recent years, the emergence of smartphones and microelectromechanical systems has allowed innovative solutions for conveniently measuring HR, such as smartphone ECG, smartphone photoplethysmography (PPG), and seismocardiography (SCG). However, these measurements generally rely on external sensor hardware or are highly susceptible to inaccuracies due to the presence of significant levels of motion artifact. Data from gyrocardiography (GCG), however, while largely overlooked for this application, has the potential to overcome the limitations of other forms of measurements. For this scoping review, we performed a literature search on HR measurement using smartphone gyroscope data. In this review, from among the 114 articles that we identified, we include seven relevant articles from the last decade (December 2012 to January 2023) for further analysis of their respective methods for data collection, signal pre-processing, and HR estimation. The seven selected articles' sample sizes varied from 11 to 435 participants. Two articles used a sample size of less than 40, and three articles used a sample size of 300 or more. We provide elaborations about the algorithms used in the studies and discuss the advantages and disadvantages of these methods. Across the articles, we noticed an inconsistency in the algorithms used and a lack of established standardization for performance evaluation for HR estimation using smartphone GCG data. Among the seven articles included, five did not perform any performance evaluation, while the other two used different reference signals (HR and PPG respectively) and metrics for accuracy evaluation. We conclude the review with a discussion of challenges and future directions for the application of GCG technology.

Fall detection using accelerometer-based smartphones: Where do we go from here?

According to World Health Organization statistics, falls are the second leading cause of unintentional injury deaths worldwide. With older people being particularly vulnerable, detecting, and reporting falls have been the focus of numerous health technology studies. We screened 267 studies and selected 15 that detailed pervasive fall detection and alerting apps that used smartphone accelerometers. The fall datasets used for the analyses included between 4 and 38 participants and contained data from young and old subjects, with the recorded falls performed exclusively by young subjects. Threshold-based detection was implemented in six cases, while machine learning approaches were implemented in the other nine, including decision trees, k-nearest neighbors, boosting, and neural networks. All methods could ultimately achieve real-time detection, with reported sensitivities ranging from 60.4 to 99.3% and specificities from 74.6 to 100.0%. However, the studies had limitations in their experimental set-ups or considered a restricted scope of daily activities-not always representative of daily life-with which to define falls during the development of their algorithms. Finally, the studies omitted some aspects of data science methodology, such as proper test sets for results evaluation, putting into question whether reported results would correspond to real-world performance. The two primary outcomes of our review are: a ranking of selected articles based on bias risk and a set of 12 impactful and actionable recommendations for future work in fall detection.

Ethnic disparities in publicly-available pulse oximetry databases.

Inaccuracies have been reported in pulse oximetry measurements taken from people who identified as Black. Here, we identify substantial ethnic disparities in the population numbers within 12 pulse oximetry databases, which may affect the testing of new oximetry devices and impact patient outcomes.

Photons think inside the box.

Light confined to a sheet offers a glimpse into low-dimensional quantum gases.

Crystallization of bosonic quantum Hall states in a rotating quantum gas.

The dominance of interactions over kinetic energy lies at the heart of strongly correlated quantum matter, from fractional quantum Hall liquids1, to atoms in optical lattices2 and twisted bilayer graphene3. Crystalline phases often compete with correlated quantum liquids, and transitions between them occur when the energy cost of forming a density wave approaches zero. A prime example occurs for electrons in high-strength magnetic fields, where the instability of quantum Hall liquids towards a Wigner crystal4-9 is heralded by a roton-like softening of density modulations at the magnetic length7,10-12. Remarkably, interacting bosons in a gauge field are also expected to form analogous liquid and crystalline states13-21. However, combining interactions with strong synthetic magnetic fields has been a challenge for experiments on bosonic quantum gases18,21. Here we study the purely interaction-driven dynamics of a Landau gauge Bose-Einstein condensate22 in and near the lowest Landau level. We observe a spontaneous crystallization driven by condensation of magneto-rotons7,10, excitations visible as density modulations at the magnetic length. Increasing the cloud density smoothly connects this behaviour to a quantum version of the Kelvin-Helmholtz hydrodynamic instability, driven by the sheared internal flow profile of the rapidly rotating condensate. At long times the condensate self-organizes into a persistent array of droplets separated by vortex streets, which are stabilized by a balance of interactions and effective magnetic forces.