Validation of Smartphone Based Heart Rate Tracking for Remote Treatment of Panic Attacks.

Panic attacks are an impairing mental health problem that affects 11% of adults every year [1]. Those who suffer from panic attacks often do not seek psychological treatment, citing the inability to receive care during their attacks as a contributing factor. A digital medicine solution which provides an accessible, real-time mobile health (mHealth) biofeedback intervention for panic attacks may address this problem. Critical to this approach are methods for capturing physiological arousal during an attack. Herein, we validate an algorithm for capturing physiological arousal using smartphone video of the fingertip. Results demonstrate that the algorithm is able to estimate heart rates that are highly correlated with ECG-derived values (r > 0.99), effectively reject low-quality data often captured outside of controlled laboratory environments (AUC > 0.90), and resolve the physiological arousal experienced during a panic attack. Moreover, patient reported measures indicate that this measurement modality is feasible during panic attacks, and the act of taking the measurement may stop the attack. These results point toward the need for future development and clinical evaluation of this mHealth intervention for preventing panic attacks.

Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.

Head-tilt maneuver assists with achieving airway patency during resuscitation. However, the relationship between angle of head-tilt and airway patency has not been defined. Our objective was to define an optimal head-tilt position for airway patency in neonates (age: 0-28 days) and young infants (age: 29 days-4 months). We performed a retrospective study of head and neck magnetic resonance imaging (MRI) of neonates and infants to define the angle of head-tilt for airway patency. We excluded those with an artificial airway or an airway malformation. We defined head-tilt angle a priori as the angle between occipito-ophisthion line and ophisthion-C7 spinous process line on the sagittal MR images. We evaluated medical records for Hypoxic Ischemic Encephalopathy (HIE) and exposure to sedation during MRI. We analyzed MRI of head and neck regions of 63 children (53 neonates and 10 young infants). Of these 63 children, 17 had evidence of airway obstruction and 46 had a patent airway on MRI. Also, 16/63 had underlying HIE and 47/63 newborn infants had exposure to sedative medications during MRI. In spontaneously breathing and neurologically depressed newborn infants, the head-tilt angle (median ± SD) associated with patent airway (125.3° ± 11.9°) was significantly different from that of blocked airway (108.2° ± 17.1°) (Mann Whitney U-test, p = 0.0045). The logistic regression analysis showed that the proportion of patent airways progressively increased with an increasing head-tilt angle, with > 95% probability of a patent airway at head-tilt angle 144-150°.