An Ontology for Telemedicine Systems Resiliency to Technological Context Variations in Pervasive Healthcare.

Clinical data are crucial for any medical case to study and understand a patient's condition and to give the patient the best possible treatment. Pervasive healthcare systems apply information and communication technology to enable the usage of ubiquitous clinical data by authorized medical persons. However, quality of clinical data in these applications is, to a large extent, determined by the technological context of the patient. A technological context is characterized by potential technological disruptions that affect optimal functioning of technological resources. The clinical data based on input from these technological resources can therefore have quality degradations. If these degradations are not noticed, the use of this clinical data can lead to wrong treatment decisions, which potentially puts the patient's safety at risk. This paper presents an ontology that specifies the relation among technological context, quality of clinical data, and patient treatment. The presented ontology provides a formal way to represent the knowledge to specify the effect of technological context variations in the clinical data quality and the impact of the clinical data quality on a patient's treatment. Accordingly, this ontology is the foundation for a quality of data framework that enables the development of telemedicine systems that are capable of adapting the treatment when the quality of the clinical data degrades, and thus guaranteeing patients' safety even when technological context varies.

Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery.

Expression of emotional state is considered to be a core facet of an individual's emotional competence. Emotional processing in BN has not been often studied and has not been considered from a broad perspective. This study aimed at examining the implicit and explicit emotional expression in BN patients, in the acute state and after recovery. Sixty-three female participants were included: 22 BN, 22 recovered BN (R-BN), and 19 healthy controls (HC). The clinical cases were drawn from consecutive admissions and diagnosed according to DSM-IV-TR diagnostic criteria. Self reported (explicit) emotional expression was measured with State-Trait Anger Expression Inventory-2, State-Trait Anxiety Inventory, and Symptom Check List-90 items-Revised. Emotional facial expression (implicit) was recorded by means of an integrated camera (by detecting Facial Feature Tracking), during a 20 minutes therapeutic video game. In the acute illness explicit emotional expression [anxiety (p<0.001) and anger (p<0.05)] was increased. In the recovered group this was decreased to an intermediate level between the acute illness and healthy controls [anxiety (p<0.001) and anger (p<0.05)]. In the implicit measurement of emotional expression patients with acute BN expressed more joy (p<0.001) and less anger (p<0.001) than both healthy controls and those in the recovered group. These findings suggest that there are differences in the implicit and explicit emotional processing in BN, which is significantly reduced after recovery, suggesting an improvement in emotional regulation.

Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED.

The facial and subjective emotional reaction in response to a video game designed to train emotional regulation (Playmancer).

Several aspects of social and emotional functioning are abnormal in people with eating disorders. The aim of the present study was to measure facial emotional expression in patients with eating disorders and healthy controls whilst playing a therapeutic video game (Playmancer) designed to train individuals in emotional regulation. Participants were 23 ED patients (11 AN, 12 BN) and 11 HCs. ED patients self reported more anger at baseline but expressed less facial expression of anger during the Playmancer game. The discrepancy between self-report and non-verbal expression may lead to problems in social communication.

Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study.

BACKGROUND: Previous review studies have suggested that computer games can serve as an alternative or additional form of treatment in several areas (schizophrenia, asthma or motor rehabilitation). Although several naturalistic studies have been conducted showing the usefulness of serious video games in the treatment of some abnormal behaviours, there is a lack of serious games specially designed for treating mental disorders. AIM: The purpose of our project was to develop and evaluate a serious video game designed to remediate attitudinal, behavioural and emotional processes of patients with impulse-related disorders. METHOD AND RESULTS: The video game was created and developed within the European research project PlayMancer. It aims to prove potential capacity to change underlying attitudinal, behavioural and emotional processes of patients with impulse-related disorders. New interaction modes were provided by newly developed components, such as emotion recognition from speech, face and physiological reactions, while specific impulsive reactions were elicited. The video game uses biofeedback for helping patients to learn relaxation skills, acquire better self-control strategies and develop new emotional regulation strategies. In this article, we present a description of the video game used, rationale, user requirements, usability and preliminary data, in several mental disorders.

Experience with Using the Sensewear BMS Sensor System in the Context of a Health and Wellbeing Application.

An assessment of a sensor designed for monitoring energy expenditure, activity, and sleep was conducted in the context of a research project which develops a weight management application. The overall goal of this project is to affect sustainable behavioural change with respect to diet and exercise in order to improve health and wellbeing. This paper reports results of a pretrial in which three volunteers wore the sensor for a total of 11 days. The aim was to gain experience with the sensor and determine if it would be suitable for incorporation into the ICT system developed by the project to be trialled later on a larger population. In this paper we focus mainly on activity monitoring and user experience. Data and results including visualizations and reports are presented and discussed. User experience proved positive in most respects. Exercise levels and sleep patterns correspond to user logs relating to exercise sessions and sleep patterns. Issues raised relate to accuracy, one source of possible interference, the desirability of enhancing the system with real-time data transmission, and analysis to enable real-time feedback. It is argued that automatic activity classification is needed to properly analyse and interpret physical activity data captured by accelerometry.

A scenario guideline for designing new teletreatments: a multidisciplinary approach.

Lack of user acceptance of telemedicine services is an important barrier to deployment and stresses the need for involving users, i.e. medical professionals. However, the involvement of users in the service development process of telemedicine services is difficult because of (a) the knowledge gap between the expertise of medical and technical experts; (b) the language gap, i.e. the use of different terminologies between the medical and the technical professions; and (c) the methodological gap in applying requirement methods to multidisciplinary scientific matters. We have developed a guideline in which the medical and technical domains meet. The guideline can be used to develop a scenario from which requirements can be elicited. In a retrospective analysis of a myofeedback-based teletreatment service, the technically-oriented People-Activities-Context-Technology (PACT) framework and medically-oriented principles of evidence-based medicine were incorporated into a guideline. The guideline was developed to construct the content of a scenario which describes the new teletreatment service. This allows the different stakeholders to come together and develop the service. Our approach provides an arena for different stakeholders to take part in the early stages of the design process. This should increase the chance of user acceptance and thus adoption of the service being developed.

The myofeedback-based teletreatment system and its evaluation.

The myofeedback-based teletreatment system allows patients to receive tactile and/or visual feedback on muscle activity and muscle relaxation times. Health-care professionals can analyse muscle activity and muscle relaxation times and provide guidance to the patient on the course of treatment. The system was evaluated in a small clinical trial. Qualitative data were obtained by interviews and visual inspection of graphical patient data during the trial. Quantitative data were based on post-trial data analysis. We used a revised version of the information systems success model to evaluate the teletreatment system, and focused on the success categories of system use and user satisfaction. The evaluation found good input data quality, system quality and information quality. Both system use and user satisfaction were good. Thus the teletreatment system appears suitable for small scale clinical deployment. However, the sensory components suffered from heavy use and embedded software problems which made them unreliable. Large scale deployment requires improvement in terms of durability and reliability of the system's sensors.

Induction of sexual arousal in women under conditions of institutional and ambulatory laboratory circumstances: a comparative study.

INTRODUCTION: Measuring under naturally occurring circumstances increases ecological validity. We developed an ambulatory psychophysiological laboratory that allows experiments to be performed at home. AIMS: To compare institutional laboratory task measures with ambulatory laboratory task measures. MAIN OUTCOME MEASURES: Vaginal pulse amplitude (VPA), clitoral blood volume (CBV), subjective report of sexual arousal, preconscious attentional bias for erotic stimuli, subjective reports about feeling at ease, tense, anxious or inhibited. METHODS: VPA and CBV were measured in eight women with hypoactive sexual desire disorder (HSDD) and eight healthy controls while exposed to neutral and erotic film clips both in the institute's laboratory and at home. Before and after film clip presentations, subjects performed an emotional Stroop task and completed two questionnaires. RESULTS: In healthy controls, genital measures of sexual arousal were significantly increased at home compared with the institutional laboratory, whereas no differences were observed between the institutional laboratory and the at home measurements in women with HSDD. The responses at home were significantly higher in healthy controls compared with women with HSDD. Subjective experience of genital responding increased at home for both groups of women. Concordance between subjective experience and genital sexual arousal was more pronounced in the institutional laboratory setting. Preconscious attentional bias was stronger in the institutional laboratory for both groups of women. Healthy controls felt more at ease and less inhibited at home while subjects with HSDD did not. CONCLUSIONS: The use of an ambulatory laboratory is a valuable tool allowing psychophysiological (sex) research under more natural circumstances (e.g., a participant's home). In this study, the increase in ecological validity resulted in a qualitative differentiation between the healthy controls and the women with HSDD in the home setting, which is not apparent in the artificial setting of the institutional laboratory.

Mobile patient monitoring: the MobiHealth system.

The forthcoming wide availability of high bandwidth public wireless networks will give rise to new mobile health care services. Towards this direction the MobiHealth project has developed and trialed a highly customisable vital signals' monitoring system based on a Body Area Network (BAN) and an m-health service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signals over public wireless networks to healthcare providers. Nine trials with different health care cases and patient groups in four different European countries have been conducted to test and verify the system, the service and the network infrastructure for its suitability and the restrictions it imposes to mobile health care applications.

MobiHealth: ambulant patient monitoring over next generation public wireless networks.

The wide availability of high bandwidth public wireless networks as well as the miniaturisation of medical sensors and network access hardware allows the development of advanced ambulant patient monitoring systems. The MobiHealth project developed a complete system and service that allows the continuous monitoring of vital signals and their transmission to the health care institutes in real time using GPRS and UMTS networks. The MobiHealth system is based on the concept of a Body Area Network (BAN) allowing high personalization of the monitored signals and thus adaptation to different classes of patients. The system and service has been trialed in four European countries and for different patient cases. First results confirm the usefulness of the system and the advantages it offers to patients and medical personnel.

Wireless body area networks for healthcare: the MobiHealth project.

The forthcoming wide availability of high bandwidth public wireless networks will give rise to new mobile health care services. Towards this direction the MobiHealth project has developed and trialed a highly customisable vital signals' monitoring system based on a Body Area Network (BAN) and an m-health service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signals over public wireless networks to healthcare providers. Nine trials with different health care cases and patient groups in four different European countries have been conducted to test and verify the system, the service and the network infrastructure for its suitability and the restrictions it imposes to mobile health care applications.