Smartphone Photoplethysmography Pulse Rate Covaries With Stress and Anxiety During a Digital Acute Social Stressor.

OBJECTIVE: Heart rate is a transdiagnostic correlate of affective states and the stress diathesis model of health. Although most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index pulse rate dynamics in real-world environments with commercially available mobile health and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices is unevenly distributed across important demographic characteristics, including socioeconomic status, education, and age, making it difficult to collect pulse rate dynamics in diverse populations. Therefore, there is a need to democratize mobile health PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states. METHODS: In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test, as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 102 university students. RESULTS: Smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG pulse rate was significantly associated with concurrent self-reported stress and anxiety ( b = 0.44, p = .018) as well as prospective stress and anxiety at the subsequent time points, although the strength of this association diminished the farther away pulse rate got from self-reported stress and anxiety (lag 1 model: b = 0.42, p = .024; lag 2 model: b = 0.38, p = .044). CONCLUSIONS: These findings indicate that PPG provides a proximal measure of the physiological correlates of stress and anxiety. Smartphone-based PPG can be used as an inclusive method for diverse populations to index pulse rate in remote digital study designs.

Induction of acute stress through an internet-delivered Trier Social Stress Test as assessed by photoplethysmography on a smartphone.

Recent studies have demonstrated the feasibility of administering the Trier Social Stress Test (TSST) through the internet, with major implications for promoting inclusivity in research participation. However, online TSST studies to date are limited by a lack of control groups and the need for biological measures of stress reactivity that can be fully implemented online. Here, we test smartphone-based photoplethysmography as a measure of heart rate reactivity to an online variant of the TSST. Results demonstrate significant acceleration in heart rate and heightened self-reported stress and anxiety in the TSST condition relative to a placebo version of the TSST. The placebo condition led to a significant increase in self-reported stress and anxiety relative to baseline levels, but this increase was smaller in magnitude than that observed in the TSST condition. These findings highlight the potential for smartphone-based photoplethysmography in internet-delivered studies of cardiac reactivity and demonstrate that it is critical to utilize random assignment to a control or stressor condition when administering acute stress online.

Does stress run through the leash? An examination of stress transmission between owners and dogs during a walk.

Humans and dogs have co-evolved for over 10,000 years. Recent research suggests that, through the domestication process, dogs have become proficient at responding to human commands, attention and emotional states. However, the extent to which a companion dog responds to human emotions, such as stress, remains to be understood. This study examines whether a companion dog's stress, as measured by cortisol levels and heart rate, increases during a familiar outdoor walk in response to its owner's experience of stress. Sixty-eight owner/dog dyads participated in this study. The dyads were randomly assigned to an Experimental or Control group. Owners in the Experimental group were informed the walk would be digitally recorded for subsequent evaluation of their handling skills, whereas those in the Control group were informed the walk would be digitally recorded for archival purposes (no evaluation). This manipulation was implemented to induce a mild stress response in the owners. Salivary cortisol samples were collected from the owner and their dog before and after the walk. The dyad was also fitted with monitoring devices to record heart rate throughout the walk. Finally, personality information regarding the owner and their dog was collected. We found that cortisol production within the dyad showed a marginal inverse correlation. We also found that owners' Openness to Experience and dogs' Fearfulness influenced the heart rate of the other during the first minute of a walk. These results support that although stress may be detected within a dyad, this does not result in an associated significant change in cortisol or heart rate.

A nurse-led implantable loop recorder service is safe and cost effective.

INTRODUCTION: Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures. METHODS: Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. RESULTS: A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. CONCLUSION: ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.