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Emotional states, as indicators of affect, are pivotal to overall health, making their accurate prediction before onset crucial. Current studies are primarily centered on immediate short-term affect detection using data from wearable and mobile devices. These studies typically focus on objective sensory measures, often neglecting other forms of self-reported information like diaries and notes. In this paper, we propose a multimodal deep learning model for affect status forecasting. This model combines a transformer encoder with a pre-trained language model, facilitating the integrated analysis of objective metrics and self-reported diaries. To validate our model, we conduct a longitudinal study, enrolling college students and monitoring them over a year, to collect an extensive dataset including physiological, environmental, sleep, metabolic, and physical activity parameters, alongside open-ended textual diaries provided by the participants. Our results demonstrate that the proposed model achieves predictive accuracy of 82.50% for positive affect and 82.76% for negative affect, a full week in advance. The effectiveness of our model is further elevated by its explainability., Comment: Accepted by Connected Health: Applications, Systems and Engineering Technologies (CHASE) 2024

The profound impact of food on health necessitates advanced nutrition-oriented food recommendation services. Conventional methods often lack the crucial elements of personalization, explainability, and interactivity. While Large Language Models (LLMs) bring interpretability and explainability, their standalone use falls short of achieving true personalization. In this paper, we introduce ChatDiet, a novel LLM-powered framework designed specifically for personalized nutrition-oriented food recommendation chatbots. ChatDiet integrates personal and population models, complemented by an orchestrator, to seamlessly retrieve and process pertinent information. The personal model leverages causal discovery and inference techniques to assess personalized nutritional effects for a specific user, whereas the population model provides generalized information on food nutritional content. The orchestrator retrieves, synergizes and delivers the output of both models to the LLM, providing tailored food recommendations designed to support targeted health outcomes. The result is a dynamic delivery of personalized and explainable food recommendations, tailored to individual user preferences. Our evaluation of ChatDiet includes a compelling case study, where we establish a causal personal model to estimate individual nutrition effects. Our assessments, including a food recommendation test showcasing a 92\% effectiveness rate, coupled with illustrative dialogue examples, underscore ChatDiet's strengths in explainability, personalization, and interactivity., Comment: Accepted by The IEEE/ACM international conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE) 2024

The concept of Quality of Life (QoL) refers to a holistic measurement of an individual's well-being, incorporating psychological and social aspects. Pregnant women, especially those with obesity and stress, often experience lower QoL. Physical activity (PA) has shown the potential to enhance the QoL. However, pregnant women who are overweight and obese rarely meet the recommended level of PA. Studies have investigated the relationship between PA and QoL during pregnancy using correlation-based approaches. These methods aim to discover spurious correlations between variables rather than causal relationships. Besides, the existing methods mainly rely on physical activity parameters and neglect the use of different factors such as maternal (medical) history and context data, leading to biased estimates. Furthermore, the estimations lack an understanding of mediators and counterfactual scenarios that might affect them. In this paper, we investigate the causal relationship between being physically active (treatment variable) and the QoL (outcome) during pregnancy and postpartum. To estimate the causal effect, we develop a Causal Machine Learning method, integrating causal discovery and causal inference components. The data for our investigation is derived from a long-term wearable-based health monitoring study focusing on overweight and obese pregnant women. The machine learning (meta-learner) estimation technique is used to estimate the causal effect. Our result shows that performing adequate physical activity during pregnancy and postpartum improves the QoL by units of 7.3 and 3.4 on average in physical health and psychological domains, respectively. In the final step, four refutation analysis techniques are employed to validate our estimation.

Mental health conditions, prevalent across various demographics, necessitate efficient monitoring to mitigate their adverse impacts on life quality. The surge in data-driven methodologies for mental health monitoring has underscored the importance of privacy-preserving techniques in handling sensitive health data. Despite strides in federated learning for mental health monitoring, existing approaches struggle with vulnerabilities to certain cyber-attacks and data insufficiency in real-world applications. In this paper, we introduce a differential private federated transfer learning framework for mental health monitoring to enhance data privacy and enrich data sufficiency. To accomplish this, we integrate federated learning with two pivotal elements: (1) differential privacy, achieved by introducing noise into the updates, and (2) transfer learning, employing a pre-trained universal model to adeptly address issues of data imbalance and insufficiency. We evaluate the framework by a case study on stress detection, employing a dataset of physiological and contextual data from a longitudinal study. Our finding show that the proposed approach can attain a 10% boost in accuracy and a 21% enhancement in recall, while ensuring privacy protection., Comment: 5 pages, 2 figures

Warfarin, an anticoagulant medication, is formulated to prevent and address conditions associated with abnormal blood clotting, making it one of the most prescribed drugs globally. However, determining the suitable dosage remains challenging due to individual response variations, and prescribing an incorrect dosage may lead to severe consequences. Contextual bandit and reinforcement learning have shown promise in addressing this issue. Given the wide availability of observational data and safety concerns of decision-making in healthcare, we focused on using exclusively observational data from historical policies as demonstrations to derive new policies; we utilized offline policy learning and evaluation in a contextual bandit setting to establish the optimal personalized dosage strategy. Our learned policies surpassed these baseline approaches without genotype inputs, even when given a suboptimal demonstration, showcasing promising application potential.

Effective diabetes management is crucial for maintaining health in diabetic patients. Large Language Models (LLMs) have opened new avenues for diabetes management, facilitating their efficacy. However, current LLM-based approaches are limited by their dependence on general sources and lack of integration with domain-specific knowledge, leading to inaccurate responses. In this paper, we propose a knowledge-infused LLM-powered conversational health agent (CHA) for diabetic patients. We customize and leverage the open-source openCHA framework, enhancing our CHA with external knowledge and analytical capabilities. This integration involves two key components: 1) incorporating the American Diabetes Association dietary guidelines and the Nutritionix information and 2) deploying analytical tools that enable nutritional intake calculation and comparison with the guidelines. We compare the proposed CHA with GPT4. Our evaluation includes 100 diabetes-related questions on daily meal choices and assessing the potential risks associated with the suggested diet. Our findings show that the proposed agent demonstrates superior performance in generating responses to manage essential nutrients., Comment: 4 pages, 3 figures, and 2 tables, conference paper

State-of-the-art rule-based and classification-based food recommendation systems face significant challenges in becoming practical and useful. This difficulty arises primarily because most machine learning models struggle with problems characterized by an almost infinite number of classes and a limited number of samples within an unbalanced dataset. Conversely, the emergence of Large Language Models (LLMs) as recommendation engines offers a promising avenue. However, a general-purpose Recommendation as Language Processing (RLP) approach lacks the critical components necessary for effective food recommendations. To address this gap, we introduce Food Recommendation as Language Processing (F-RLP), a novel framework that offers a food-specific, tailored infrastructure. F-RLP leverages the capabilities of LLMs to maximize their potential, thereby paving the way for more accurate, personalized food recommendations.

Respiratory rate (RR) serves as an indicator of various medical conditions, such as cardiovascular diseases and sleep disorders. These RR estimation methods were mostly designed for finger-based PPG collected from subjects in stationary situations (e.g., in hospitals). In contrast to finger-based PPG signals, wrist-based PPG are more susceptible to noise, particularly in their low frequency range, which includes respiratory information. Therefore, the existing methods struggle to accurately extract RR when PPG data are collected from wrist area under free-living conditions. The increasing popularity of smartwatches, equipped with various sensors including PPG, has prompted the need for a robust RR estimation method. In this paper, we propose a convolutional neural network-based approach to extract RR from PPG, accelerometer, and gyroscope signals captured via smartwatches. Our method, including a dilated residual inception module and 1D convolutions, extract the temporal information from the signals, enabling RR estimation. Our method is trained and tested using data collected from 36 subjects under free-living conditions for one day using Samsung Gear Sport watches. For evaluation, we compare the proposed method with four state-of-the-art RR estimation methods. The RR estimates are compared with RR references obtained from a chest-band device. The results show that our method outperforms the existing methods with the Mean-Absolute-Error and Root-Mean-Square-Error of 1.85 and 2.34, while the best results obtained by the other methods are 2.41 and 3.29, respectively. Moreover, compared to the other methods, the absolute error distribution of our method was narrow (with the lowest median), indicating a higher level of agreement between the estimated and reference RR values.

Agents represent one of the most emerging applications of Large Language Models (LLMs) and Generative AI, with their effectiveness hinging on multimodal capabilities to navigate complex user environments. Conversational Health Agents (CHAs), a prime example of this, are redefining healthcare by offering nuanced support that transcends textual analysis to incorporate emotional intelligence. This paper introduces an LLM-based CHA engineered for rich, multimodal dialogue-especially in the realm of mental health support. It adeptly interprets and responds to users' emotional states by analyzing multimodal cues, thus delivering contextually aware and empathetically resonant verbal responses. Our implementation leverages the versatile openCHA framework, and our comprehensive evaluation involves neutral prompts expressed in diverse emotional tones: sadness, anger, and joy. We evaluate the consistency and repeatability of the planning capability of the proposed CHA. Furthermore, human evaluators critique the CHA's empathic delivery, with findings revealing a striking concordance between the CHA's outputs and evaluators' assessments. These results affirm the indispensable role of vocal (soon multimodal) emotion recognition in strengthening the empathetic connection built by CHAs, cementing their place at the forefront of interactive, compassionate digital health solutions., Comment: 7 pages, 2 figures, 2 tables, conference paper

To perform effective causal inference in high-dimensional datasets, initiating the process with causal discovery is imperative, wherein a causal graph is generated based on observational data. However, obtaining a complete and accurate causal graph poses a formidable challenge, recognized as an NP-hard problem. Recently, the advent of Large Language Models (LLMs) has ushered in a new era, indicating their emergent capabilities and widespread applicability in facilitating causal reasoning across diverse domains, such as medicine, finance, and science. The expansive knowledge base of LLMs holds the potential to elevate the field of causal reasoning by offering interpretability, making inferences, generalizability, and uncovering novel causal structures. In this paper, we introduce a new framework, named Autonomous LLM-Augmented Causal Discovery Framework (ALCM), to synergize data-driven causal discovery algorithms and LLMs, automating the generation of a more resilient, accurate, and explicable causal graph. The ALCM consists of three integral components: causal structure learning, causal wrapper, and LLM-driven causal refiner. These components autonomously collaborate within a dynamic environment to address causal discovery questions and deliver plausible causal graphs. We evaluate the ALCM framework by implementing two demonstrations on seven well-known datasets. Experimental results demonstrate that ALCM outperforms existing LLM methods and conventional data-driven causal reasoning mechanisms. This study not only shows the effectiveness of the ALCM but also underscores new research directions in leveraging the causal reasoning capabilities of LLMs.

Current digital mental healthcare solutions conventionally take on a reactive approach, requiring individuals to self-monitor and document existing symptoms. These solutions are unable to provide comprehensive, wrap-around, customized treatments that capture an individual's holistic mental health model as it unfolds over time. Recognizing that each individual requires personally tailored mental health treatment, we introduce the notion of Personalized Mental Health Navigation (MHN): a cybernetic goal-based system that deploys a continuous loop of monitoring, estimation, and guidance to steer the individual towards mental flourishing. We present the core components of MHN that are premised on the importance of addressing an individual's personal mental health state. Moreover, we provide an overview of the existing physical health navigation systems and highlight the requirements and challenges of deploying the navigational approach to the mental health domain.

ObjectivesTo assess, in terms of self-efficacy in weight management, the effectiveness of the SLIM lifestyle intervention among overweight or obese women during pregnancy and after delivery, and further to exploit machine learning and event mining approaches to build personalized models. Additionally, the aim is to evaluate the implementation of the SLIM intervention.MethodsThis prospective trial, which is a non-randomized, quasi-experimental, pre-post intervention, includes an embedded mixed-method process evaluation. The SLIM Intervention is delivered by public health nurses (n = 9) working in maternity clinics. The public health nurses recruited overweight women (n = 54) at their first antenatal visit using convenience sampling. The core components of the intervention i.e. health technology, motivational interviewing, feedback, and goal setting, are utilized in antenatal visits in maternity clinics starting from gestational week 15 or less and continuing to 12 weeks after delivery. Mixed effect models are used to evaluate change over time in self-efficacy, weight management and weight change. Simple mediation models are used to assess calories consumed and moderate to vigorous physical activity (MVPA) as mediators between self-efficacy and weight change. Signal processing and machine learning techniques are exploited to extract events from the data collected via the Oura ring and smartphone-based questionnaires.DiscussionThe SLIM intervention was developed in collaboration with overweight women and public health nurses working in maternity clinics. This study evaluates the effectiveness of the intervention among overweight women in increasing self-efficacy and achieving a healthy weight; thus, impacting the healthy lifestyle and long-term health of the whole family. The long-term objective is to contribute to women's health by supporting weight-management through behavior change via interventions conducted in maternity clinics.Trial registrationThe trial was regi

BackgroundThe development and quality assurance of perinatal eHealth self-monitoring systems is an upcoming area of inquiry in health science. Building patient engagement into eHealth development as a core component has potential to guide process evaluation. Access, 1 attribute of patient engagement, is the focus of study here. Access to eHealth self-monitoring programs has the potential to influence pregnancy health and wellness outcomes. Little is known about how pregnant users' ability to obtain resources is influenced by their own adaptive activities and the mediating activities of eHealth systems during the process of real-world testing of these systems.ObjectiveHere, we examine the patient engagement process of access occurring during the adaptation of eHealth self-monitoring use from a sociomaterial perspective.MethodsIn this mixed methods convergent evaluation design, we interviewed women about perceptions of the adaptation process of using an eHealth self-monitoring system. Deductive analysis was conducted guided by the definition of access as an attribute of patient engagement. After initial qualitative and quantitative data collection and analysis, participants were spilt based on their level of use of the eHealth system (physical wear time of self-monitoring device). Content analysis was then conducted according to user group, using a conceptual matrix developed from ontological perspectives of sociomateriality.ResultsPregnant users' adaptive activities and the mediation activities of the eHealth system represent a cocreation process that resulted in user group-specific characteristics of accessing and using the system. The high- and low-use groups experienced different personal adaptation and eHealth mediation during this process of cocreation. Differences were noted between high- and low-use groups, with the high-use group giving attention to developing skills in recording and interpreting data and the low-use group discussing the manual adding of acti

SARS-CoV-2 (COVID-19) has caused over 80 million infections 973,000 deaths in the United States, and mutations are linked to increased transmissibility. This study aimed to determine the effect of SARS-CoV-2 variants on respiratory features, mortality, and to determine the effect of vaccination status. A retrospective review of medical records (n = 55,406 unique patients) using the University of California Health COvid Research Data Set (UC CORDS) was performed to identify respiratory features, vaccination status, and mortality from 01/01/2020 to 04/26/2022. Variants were identified using the CDC data tracker. Increased odds of death were observed amongst unvaccinated individuals and fully vaccinated, partially vaccinated, or individuals who received any vaccination during multiple waves of the pandemic. Vaccination status was associated with survival and a decreased frequency of many respiratory features. More recent SARS-CoV-2 variants show a reduction in lower respiratory tract features with an increase in upper respiratory tract features. Being fully vaccinated results in fewer respiratory features and higher odds of survival, supporting vaccination in preventing morbidity and mortality from COVID-19.

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.

The adverse effects of loneliness on both physical and mental well-being are profound. Although previous research has utilized mobile sensing techniques to detect mental health issues, few studies have utilized state-of-the-art wearable devices to forecast loneliness and comprehend the physiological manifestations of loneliness and its predictive nature. The primary objective of this study is to examine the feasibility of forecasting loneliness by employing wearable devices, such as smart rings and watches, to monitor early physiological indicators of loneliness. Furthermore, smartphones are employed to capture initial behavioral signs of loneliness. To accomplish this, we employed personalized machine learning techniques, leveraging a comprehensive dataset comprising physiological and behavioral information obtained during our study involving the monitoring of college students. Through the development of personalized models, we achieved a notable accuracy of 0.82 and an F-1 score of 0.82 in forecasting loneliness levels seven days in advance. Additionally, the application of Shapley values facilitated model explainability. The wealth of data provided by this study, coupled with the forecasting methodology employed, possesses the potential to augment interventions and facilitate the early identification of loneliness within populations at risk.

Sleep quality is crucial to both mental and physical well-being. The COVID-19 pandemic, which has notably affected the population's health worldwide, has been shown to deteriorate people's sleep quality. Numerous studies have been conducted to evaluate the impact of the COVID-19 pandemic on sleep efficiency, investigating their relationships using correlation-based methods. These methods merely rely on learning spurious correlation rather than the causal relations among variables. Furthermore, they fail to pinpoint potential sources of bias and mediators and envision counterfactual scenarios, leading to a poor estimation. In this paper, we develop a Causal Machine Learning method, which encompasses causal discovery and causal inference components, to extract the causal relations between the COVID-19 pandemic (treatment variable) and sleep quality (outcome) and estimate the causal treatment effect, respectively. We conducted a wearable-based health monitoring study to collect data, including sleep quality, physical activity, and Heart Rate Variability (HRV) from college students before and after the COVID-19 lockdown in March 2020. Our causal discovery component generates a causal graph and pinpoints mediators in the causal model. We incorporate the strongly contributing mediators (i.e., HRV and physical activity) into our causal inference component to estimate the robust, accurate, and explainable causal effect of the pandemic on sleep quality. Finally, we validate our estimation via three refutation analysis techniques. Our experimental results indicate that the pandemic exacerbates college students' sleep scores by 8%. Our validation results show significant p-values confirming our estimation.

Daily monitoring of stress is a critical component of maintaining optimal physical and mental health. Physiological signals and contextual information have recently emerged as promising indicators for detecting instances of heightened stress. Nonetheless, developing a real-time monitoring system that utilizes both physiological and contextual data to anticipate stress levels in everyday settings while also gathering stress labels from participants represents a significant challenge. We present a monitoring system that objectively tracks daily stress levels by utilizing both physiological and contextual data in a daily-life environment. Additionally, we have integrated a smart labeling approach to optimize the ecological momentary assessment (EMA) collection, which is required for building machine learning models for stress detection. We propose a three-tier Internet-of-Things-based system architecture to address the challenges. We utilized a cross-validation technique to accurately estimate the performance of our stress models. We achieved the F1-score of 70\% with a Random Forest classifier using both PPG and contextual data, which is considered an acceptable score in models built for everyday settings. Whereas using PPG data alone, the highest F1-score achieved is approximately 56\%, emphasizing the significance of incorporating both PPG and contextual data in stress detection tasks.

Conversational Health Agents (CHAs) are interactive systems that provide healthcare services, such as assistance and diagnosis. Current CHAs, especially those utilizing Large Language Models (LLMs), primarily focus on conversation aspects. However, they offer limited agent capabilities, specifically lacking multi-step problem-solving, personalized conversations, and multimodal data analysis. Our aim is to overcome these limitations. We propose openCHA, an open-source LLM-powered framework, to empower conversational agents to generate a personalized response for users' healthcare queries. This framework enables developers to integrate external sources including data sources, knowledge bases, and analysis models, into their LLM-based solutions. openCHA includes an orchestrator to plan and execute actions for gathering information from external sources, essential for formulating responses to user inquiries. It facilitates knowledge acquisition, problem-solving capabilities, multilingual and multimodal conversations, and fosters interaction with various AI platforms. We illustrate the framework's proficiency in handling complex healthcare tasks via three demonstrations. Moreover, we release openCHA as open source available to the community via GitHub., Comment: 23 pages, 6 figures, 3 tables, journal paper

While analytics of sleep electroencephalography (EEG) holds certain advantages over other methods in clinical applications, high variability across subjects poses a significant challenge when it comes to deploying machine learning models for classification tasks in the real world. In such instances, machine learning models that exhibit exceptional performance on a specific dataset may not necessarily demonstrate similar proficiency when applied to a distinct dataset for the same task. The scarcity of high-quality biomedical data further compounds this challenge, making it difficult to evaluate the model's generality comprehensively. In this paper, we introduce Transfer Euclidean Alignment - a transfer learning technique to tackle the problem of the dearth of human biomedical data for training deep learning models. We tested the robustness of this transfer learning technique on various rule-based classical machine learning models as well as the EEGNet-based deep learning model by evaluating on different datasets, including human and mouse data in a binary classification task of detecting individuals with versus without traumatic brain injury (TBI). By demonstrating notable improvements with an average increase of 14.42% for intraspecies datasets and 5.53% for interspecies datasets, our findings underscore the importance of the use of transfer learning to improve the performance of machine learning and deep learning models when using diverse datasets for training.

Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients' well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present an comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process., Comment: 14 pages, 4 figures, 2 tables, journal paper

The proliferation of Internet-connected health devices and the widespread availability of mobile connectivity have resulted in a wealth of reliable digital health data and the potential for delivering just-in-time interventions. However, leveraging these opportunities for health research requires the development and deployment of mobile health (mHealth) applications, which present significant technical challenges for researchers. While existing mHealth solutions have made progress in addressing some of these challenges, they often fall short in terms of time-to-use, affordability, and flexibility for personalization and adaptation. ZotCare aims to address these limitations by offering ready-to-use and flexible services, providing researchers with an accessible, cost-effective, and adaptable solution for their mHealth studies. This article focuses on ZotCare's service orchestration and highlights its capabilities in creating a programmable environment for mHealth research. Additionally, we showcase several successful research use cases that have utilized ZotCare, both in the past and in ongoing projects. Furthermore, we provide resources and information for researchers who are considering ZotCare as their mHealth research solution., Comment: 23 pages, 5 figures, 6 tables, journal paper

Traditionally, the regime of mental healthcare has followed an episodic psychotherapy model wherein patients seek care from a provider through a prescribed treatment plan developed over multiple provider visits. Recent advances in wearable and mobile technology have generated increased interest in digital mental healthcare that enables individuals to address episodic mental health symptoms. However, these efforts are typically reactive and symptom-focused and do not provide comprehensive, wrap-around, customized treatments that capture an individual's holistic mental health model as it unfolds over time. Recognizing that each individual is unique, we present the notion of Personalized Mental Health Navigation (MHN): a therapist-in-the-loop, cybernetic goal-based system that deploys a continuous cyclic loop of measurement, estimation, guidance, to steer the individual's mental health state towards a healthy zone. We outline the major components of MHN that is premised on the development of an individual's personal mental health state, holistically represented by a high-dimensional cover of multiple knowledge layers such as emotion, biological patterns, sociology, behavior, and cognition. We demonstrate the feasibility of the personalized MHN approach via a 12-month pilot case study for holistic stress management in college students and highlight an instance of a therapist-in-the-loop intervention using MHN for monitoring, estimating, and proactively addressing moderately severe depression over a sustained period of time. We believe MHN paves the way to transform mental healthcare from the current passive, episodic, reactive process (where individuals seek help to address symptoms that have already manifested) to a continuous and navigational paradigm that leverages a personalized model of the individual, promising to deliver timely interventions to individuals in a holistic manner.

Traditionally, the regime of mental healthcare has followed an episodic psychotherapy model wherein patients seek care from a provider through a prescribed treatment plan developed over multiple provider visits. Recent advances in wearable and mobile technology have generated increased interest in digital mental healthcare that enables individuals to address episodic mental health symptoms. However, these efforts are typically reactive and symptom-focused and do not provide comprehensive, wrap-around, customized treatments that capture an individual's holistic mental health model as it unfolds over time. Recognizing that each individual is unique, we present the notion of Personalized Mental Health Navigation (MHN): a therapist-in-the-loop, cybernetic goal-based system that deploys a continuous cyclic loop of measurement, estimation, guidance, to steer the individual's mental health state towards a healthy zone. We outline the major components of MHN that is premised on the development of an individual's personal mental health state, holistically represented by a high-dimensional cover of multiple knowledge layers such as emotion, biological patterns, sociology, behavior, and cognition. We demonstrate the feasibility of the personalized MHN approach via a 12-month pilot case study for holistic stress management in college students and highlight an instance of a therapist-in-the-loop intervention using MHN for monitoring, estimating, and proactively addressing moderately severe depression over a sustained period of time. We believe MHN paves the way to transform mental healthcare from the current passive, episodic, reactive process (where individuals seek help to address symptoms that have already manifested) to a continuous and navigational paradigm that leverages a personalized model of the individual, promising to deliver timely interventions to individuals in a holistic manner.

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

Digital health-enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker-delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.

BackgroundSleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant.ObjectiveIn an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic.MethodsCollege student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day.ResultsParticipants with a higher sleep onset latency (b=-1.09, SE 0.36; P=.006) and TST (b=-0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=-0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04).ConclusionsFluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability m

Digital health-enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker-delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.

Accurate peak determination from noise-corrupted photoplethysmogram (PPG) signal is the basis for further analysis of physiological quantities such as heart rate. Conventional methods are designed for noise-free PPG signals and are insufficient for PPG signals with low signal-to-noise ratio (SNR). This paper focuses on enhancing PPG noise-resiliency and proposes a robust peak detection algorithm for PPG signals distorted due to noise and motion artifact. Our algorithm is based on convolutional neural networks (CNNs) with dilated convolutions. We train and evaluate the proposed method using a dataset collected via smartwatches under free-living conditions in a home-based health monitoring application. A data generator is also developed to produce noisy PPG data used for model training and evaluation. The method performance is compared against other state-of-the-art methods and is tested with SNRs ranging from 0 to 45 dB. Our method outperforms the existing adaptive threshold, transform-based, and machine learning methods. The proposed method shows overall precision, recall, and F1-score of 82%, 80%, and 81% in all the SNR ranges. In contrast, the best results obtained by the existing methods are 78%, 80%, and 79%. The proposed method proves to be accurate for detecting PPG peaks even in the presence of noise.

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

Post-acute sequelae of SARS-CoV-2 (PASC) is defined as persistent symptoms after apparent recovery from acute COVID-19 infection, also known as COVID-19 long-haul. We performed a retrospective review of electronic health records (EHR) from the University of California COvid Research Data Set (UC CORDS), a de-identified EHR of PCR-confirmed SARS-CoV-2-positive patients in California. The purposes were to (1) describe the prevalence of PASC, (2) describe COVID-19 symptoms and symptom clusters, and (3) identify risk factors for PASC. Data were subjected to non-negative matrix factorization to identify symptom clusters, and a predictive model of PASC was developed. PASC prevalence was 11% (277/2,153), and of these patients, 66% (183/277) were considered asymptomatic at days 0-30. Five PASC symptom clusters emerged and specific symptoms at days 0-30 were associated with PASC. Women were more likely than men to develop PASC, with all age groups and ethnicities represented. PASC is a public health priority.

BackgroundSleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant.ObjectiveIn an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic.MethodsCollege student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day.ResultsParticipants with a higher sleep onset latency (b=-1.09, SE 0.36; P=.006) and TST (b=-0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=-0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04).ConclusionsFluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability m

Aims and objectivesTo determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function.BackgroundPost-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised.DesignDescriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection.MethodsParticipants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data.ResultsParticipants reported experiencing a mean of 21 symptoms (range 1-93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and "brain pressure" among the most distressing and impacting daily life.ConclusionsPost-acute sequelae of SARS-CoV-2 infection can be characterised by a wide range of symptoms, many of which cause moderate-to-severe distress and can hinder survivors' overall well-being.Relevance to clinical practiceThis study advances our understanding

ObjectiveTo develop a machine learning algorithm utilizing heart rate variability (HRV) and salivary cortisol to detect the presence of acute stress among pregnant women that may be applied to future clinical research.MethodsECG signals and salivary cortisol were analyzed from 29 pregnant women as part of a crossover study involving a standardized acute psychological stress exposure and a control non-stress condition. A filter-based features selection method was used to identify the importance of different features [heart rate (HR), time- and frequency-domain HRV parameters and salivary cortisol] for stress assessment and reduce the computational complexity. Five machine learning algorithms were implemented to assess the presence of stress with and without salivary cortisol values.ResultsOn graphical visualization, an obvious difference in heart rate (HR), HRV parameters and cortisol were evident among 17 participants between the two visits, which helped the stress assessment model to distinguish between stress and non-stress exposures with greater accuracy. Eight participants did not display a clear difference in HR and HRV parameters but displayed a large increase in cortisol following stress compared to the non-stress conditions. The remaining four participants did not demonstrate an obvious difference in any feature. Six out of nine features emerged from the feature selection method: cortisol, three time-domain HRV parameters, and two frequency-domain parameters. Cortisol was the strongest contributing feature, increasing the assessment accuracy by 10.3% on average across all five classifiers. The highest assessment accuracy achieved was 92.3%, and the highest average assessment accuracy was 76.5%.ConclusionSalivary cortisol contributed a significant increase in accuracy of the assessment model compared to using a range of HRV parameters alone. Our machine learning model demonstrates acceptable accuracy in detection of acute stress among pregnant women when comb

BackgroundPhotoplethysmography (PPG) is a low-cost and easy-to-implement method to measure vital signs, including heart rate (HR) and pulse rate variability (PRV) which widely used as a substitute of heart rate variability (HRV). The method is used in various wearable devices. For example, Samsung smartwatches are PPG-based open-source wristbands used in remote well-being monitoring and fitness applications. However, PPG is highly susceptible to motion artifacts and environmental noise. A validation study is required to investigate the accuracy of PPG-based wearable devices in free-living conditions.ObjectiveWe evaluate the accuracy of PPG signals-collected by the Samsung Gear Sport smartwatch in free-living conditions-in terms of HR and time-domain and frequency-domain HRV parameters against a medical-grade chest electrocardiogram (ECG) monitor.MethodsWe conducted 24-hours monitoring using a Samsung Gear Sport smartwatch and a Shimmer3 ECG device. The monitoring included 28 participants (14 male and 14 female), where they engaged in their daily routines. We evaluated HR and HRV parameters during the sleep and awake time. The parameters extracted from the smartwatch were compared against the ECG reference. For the comparison, we employed the Pearson correlation coefficient, Bland-Altman plot, and linear regression methods.ResultsWe found a significantly high positive correlation between the smartwatch's and Shimmer ECG's HR, time-domain HRV, LF, and HF and a significant moderate positive correlation between the smartwatch's and shimmer ECG's LF/HF during sleep time. The mean biases of HR, time-domain HRV, and LF/HF were low, while the biases of LF and HF were moderate during sleep. The regression analysis showed low error variances of HR, AVNN, and pNN50, moderate error variances of SDNN, RMSSD, LF, and HF, and high error variances of LF/HF during sleep. During the awake time, there was a significantly high positive correlation of AVNN and a moderate positive correl

Smart eHealth applications deliver personalized and preventive digital healthcare services to clients through remote sensing, continuous monitoring, and data analytics. Smart eHealth applications sense input data from multiple modalities, transmit the data to edge and/or cloud nodes, and process the data with compute intensive machine learning (ML) algorithms. Run-time variations with continuous stream of noisy input data, unreliable network connection, computational requirements of ML algorithms, and choice of compute placement among sensor-edge-cloud layers affect the efficiency of ML-driven eHealth applications. In this chapter, we present edge-centric techniques for optimized compute placement, exploration of accuracy-performance trade-offs, and cross-layered sense-compute co-optimization for ML-driven eHealth applications. We demonstrate the practical use cases of smart eHealth applications in everyday settings, through a sensor-edge-cloud framework for an objective pain assessment case study.

Health monitoring applications increasingly rely on machine learning techniques to learn end-user physiological and behavioral patterns in everyday settings. Considering the significant role of wearable devices in monitoring human body parameters, on-device learning can be utilized to build personalized models for behavioral and physiological patterns, and provide data privacy for users at the same time. However, resource constraints on most of these wearable devices prevent the ability to perform online learning on them. To address this issue, it is required to rethink the machine learning models from the algorithmic perspective to be suitable to run on wearable devices. Hyperdimensional computing (HDC) offers a well-suited on-device learning solution for resource-constrained devices and provides support for privacy-preserving personalization. Our HDC-based method offers flexibility, high efficiency, resilience, and performance while enabling on-device personalization and privacy protection. We evaluate the efficacy of our approach using three case studies and show that our system improves the energy efficiency of training by up to $45.8\times$ compared with the state-of-the-art Deep Neural Network (DNN) algorithms while offering a comparable accuracy.

Deep-learning-based intelligent services have become prevalent in cyber-physical applications including smart cities and health-care. Collaborative end-edge-cloud computing for deep learning provides a range of performance and efficiency that can address application requirements through computation offloading. The decision to offload computation is a communication-computation co-optimization problem that varies with both system parameters (e.g., network condition) and workload characteristics (e.g., inputs). Identifying optimal orchestration considering the cross-layer opportunities and requirements in the face of varying system dynamics is a challenging multi-dimensional problem. While Reinforcement Learning (RL) approaches have been proposed earlier, they suffer from a large number of trial-and-errors during the learning process resulting in excessive time and resource consumption. We present a Hybrid Learning orchestration framework that reduces the number of interactions with the system environment by combining model-based and model-free reinforcement learning. Our Deep Learning inference orchestration strategy employs reinforcement learning to find the optimal orchestration policy. Furthermore, we deploy Hybrid Learning (HL) to accelerate the RL learning process and reduce the number of direct samplings. We demonstrate efficacy of our HL strategy through experimental comparison with state-of-the-art RL-based inference orchestration, demonstrating that our HL strategy accelerates the learning process by up to 166.6x., Comment: arXiv admin note: text overlap with arXiv:2202.10541

Deep-learning-based intelligent services have become prevalent in cyber-physical applications including smart cities and health-care. Deploying deep-learning-based intelligence near the end-user enhances privacy protection, responsiveness, and reliability. Resource-constrained end-devices must be carefully managed in order to meet the latency and energy requirements of computationally-intensive deep learning services. Collaborative end-edge-cloud computing for deep learning provides a range of performance and efficiency that can address application requirements through computation offloading. The decision to offload computation is a communication-computation co-optimization problem that varies with both system parameters (e.g., network condition) and workload characteristics (e.g., inputs). On the other hand, deep learning model optimization provides another source of tradeoff between latency and model accuracy. An end-to-end decision-making solution that considers such computation-communication problem is required to synergistically find the optimal offloading policy and model for deep learning services. To this end, we propose a reinforcement-learning-based computation offloading solution that learns optimal offloading policy considering deep learning model selection techniques to minimize response time while providing sufficient accuracy. We demonstrate the effectiveness of our solution for edge devices in an end-edge-cloud system and evaluate with a real-setup implementation using multiple AWS and ARM core configurations. Our solution provides 35% speedup in the average response time compared to the state-of-the-art with less than 0.9% accuracy reduction, demonstrating the promise of our online learning framework for orchestrating DL inference in end-edge-cloud systems.

Continuous monitoring of blood pressure (BP)can help individuals manage their chronic diseases such as hypertension, requiring non-invasive measurement methods in free-living conditions. Recent approaches fuse Photoplethysmograph (PPG) and electrocardiographic (ECG) signals using different machine and deep learning approaches to non-invasively estimate BP; however, they fail to reconstruct the complete signal, leading to less accurate models. In this paper, we propose a cycle generative adversarial network (CycleGAN) based approach to extract a BP signal known as ambulatory blood pressure (ABP) from a clean PPG signal. Our approach uses a cycle generative adversarial network that extends theGAN architecture for domain translation, and outperforms state-of-the-art approaches by up to 2x in BP estimation.

BackgroundTechnology enables the continuous monitoring of personal health parameter data during pregnancy regardless of the disruption of normal daily life patterns. Our research group has established a project investigating the usefulness of an Internet of Things-based system and smartwatch technology for monitoring women during pregnancy to explore variations in stress, physical activity and sleep. The aim of this study was to examine daily patterns of well-being in pregnant women before and during the national stay-at-home restrictions related to the COVID-19 pandemic in Finland.MethodsA longitudinal cohort study design was used to monitor pregnant women in their everyday settings. Two cohorts of pregnant women were recruited. In the first wave in January-December 2019, pregnant women with histories of preterm births (gestational weeks 22-36) or late miscarriages (gestational weeks 12-21); and in the second wave between October 2019 and March 2020, pregnant women with histories of full-term births (gestational weeks 37-42) and no pregnancy losses were recruited. The final sample size for this study was 38 pregnant women. The participants continuously used the Samsung Gear Sport smartwatch and their heart rate variability, and physical activity and sleep data were collected. Subjective stress, activity and sleep reports were collected using a smartphone application developed for this study. Data between February 12 to April 8, 2020 were included to cover four-week periods before and during the national stay-at-home restrictions. Hierarchical linear mixed models were exploited to analyze the trends in the outcome variables.ResultsThe pandemic-related restrictions were associated with changes in heart rate variability: the standard deviation of all normal inter-beat intervals (p = 0.034), low-frequency power (p = 0.040) and the low-frequency/high-frequency ratio (p = 0.013) increased compared with the weeks before the restrictions. Women's subjectively evaluated str

BackgroundMaternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women's health positively after pregnancy. The study's aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals.MethodsThis qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model.ResultsIn the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women's identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women's lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling.ConclusionsOur findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions

Pregnancy is a unique time when many mothers gain awareness of their lifestyle and its impacts on the fetus. High-quality care during pregnancy is needed to identify possible complications early and ensure the mother's and her unborn baby's health and well-being. Different studies have thus far proposed maternal health monitoring systems. However, they are designed for a specific health problem or are limited to questionnaires and short-term data collection methods. Moreover, the requirements and challenges have not been evaluated in long-term studies. Maternal health necessitates a comprehensive framework enabling continuous monitoring of pregnant women. In this paper, we present an Internet-of-Things (IoT)-based system to provide ubiquitous maternal health monitoring during pregnancy and postpartum. The system consists of various data collectors to track the mother's condition, including stress, sleep, and physical activity. We carried out the full system implementation and conducted a real human subject study on pregnant women in Southwestern Finland. We then evaluated the system's feasibility, energy efficiency, and data reliability. Our results show that the implemented system is feasible in terms of system usage during nine months. We also indicate the smartwatch, used in our study, has acceptable energy efficiency in long-term monitoring and is able to collect reliable photoplethysmography data. Finally, we discuss the integration of the presented system with the current healthcare system.

BackgroundThe physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.ObjectiveThe aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.MethodsA case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson cor

BackgroundThe physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.ObjectiveThe aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.MethodsA case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson cor

Pregnancy is a unique time when many mothers gain awareness of their lifestyle and its impacts on the fetus. High-quality care during pregnancy is needed to identify possible complications early and ensure the mother's and her unborn baby's health and well-being. Different studies have thus far proposed maternal health monitoring systems. However, they are designed for a specific health problem or are limited to questionnaires and short-term data collection methods. Moreover, the requirements and challenges have not been evaluated in long-term studies. Maternal health necessitates a comprehensive framework enabling continuous monitoring of pregnant women. In this paper, we present an Internet-of-Things (IoT)-based system to provide ubiquitous maternal health monitoring during pregnancy and postpartum. The system consists of various data collectors to track the mother's condition, including stress, sleep, and physical activity. We carried out the full system implementation and conducted a real human subject study on pregnant women in Southwestern Finland. We then evaluated the system's feasibility, energy efficiency, and data reliability. Our results show that the implemented system is feasible in terms of system usage during nine months. We also indicate the smartwatch, used in our study, has acceptable energy efficiency in long-term monitoring and is able to collect reliable photoplethysmography data. Finally, we discuss the integration of the presented system with the current healthcare system.

BackgroundTechnology enables the continuous monitoring of personal health parameter data during pregnancy regardless of the disruption of normal daily life patterns. Our research group has established a project investigating the usefulness of an Internet of Things-based system and smartwatch technology for monitoring women during pregnancy to explore variations in stress, physical activity and sleep. The aim of this study was to examine daily patterns of well-being in pregnant women before and during the national stay-at-home restrictions related to the COVID-19 pandemic in Finland.MethodsA longitudinal cohort study design was used to monitor pregnant women in their everyday settings. Two cohorts of pregnant women were recruited. In the first wave in January-December 2019, pregnant women with histories of preterm births (gestational weeks 22-36) or late miscarriages (gestational weeks 12-21); and in the second wave between October 2019 and March 2020, pregnant women with histories of full-term births (gestational weeks 37-42) and no pregnancy losses were recruited. The final sample size for this study was 38 pregnant women. The participants continuously used the Samsung Gear Sport smartwatch and their heart rate variability, and physical activity and sleep data were collected. Subjective stress, activity and sleep reports were collected using a smartphone application developed for this study. Data between February 12 to April 8, 2020 were included to cover four-week periods before and during the national stay-at-home restrictions. Hierarchical linear mixed models were exploited to analyze the trends in the outcome variables.ResultsThe pandemic-related restrictions were associated with changes in heart rate variability: the standard deviation of all normal inter-beat intervals (p = 0.034), low-frequency power (p = 0.040) and the low-frequency/high-frequency ratio (p = 0.013) increased compared with the weeks before the restrictions. Women's subjectively evaluated str

BackgroundMaternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women's health positively after pregnancy. The study's aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals.MethodsThis qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model.ResultsIn the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women's identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women's lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling.ConclusionsOur findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions

The world has been affected by COVID-19 coronavirus. At the time of this study, the number of infected people in the United States is the highest globally (31.2 million infections). Within the infected population, patients diagnosed with acute respiratory distress syndrome (ARDS) are in more life-threatening circumstances, resulting in severe respiratory system failure. Various studies have investigated the infections to COVID-19 and ARDS by monitoring laboratory metrics and symptoms. Unfortunately, these methods are merely limited to clinical settings, and symptom-based methods are shown to be ineffective. In contrast, vital signs (e.g., heart rate) have been utilized to early-detect different respiratory diseases in ubiquitous health monitoring. We posit that such biomarkers are informative in identifying ARDS patients infected with COVID-19. In this study, we investigate the behavior of COVID-19 on ARDS patients by utilizing simple vital signs. We analyze the long-term daily logs of blood pressure (BP) and heart rate (HR) associated with 150 ARDS patients admitted to five University of California academic health centers (containing 77,972 samples for each vital sign) to distinguish subjects with COVID-19 positive and negative test results. In addition to the statistical analysis, we develop a deep neural network model to extract features from the longitudinal data. Our deep learning model is able to achieve 0.81 area under the curve (AUC) to classify the vital signs of ARDS patients infected with COVID-19 versus other ARDS diagnosed patients. Since our proposed model uses only the BP and HR, it would be possible to review data prior to the first reported cases in the U.S. to validate the presence or absence of COVID-19 in our communities prior to January 2020. In addition, by utilizing wearable devices, and monitoring vital signs of subjects in everyday settings it is possible to early-detect COVID-19 without visiting a hospital or a care site.

eHealth systems deliver critical digital healthcare and wellness services for users by continuously monitoring physiological and contextual data. eHealth applications use multi-modal machine learning kernels to analyze data from different sensor modalities and automate decision-making. Noisy inputs and motion artifacts during sensory data acquisition affect the i) prediction accuracy and resilience of eHealth services and ii) energy efficiency in processing garbage data. Monitoring raw sensory inputs to identify and drop data and features from noisy modalities can improve prediction accuracy and energy efficiency. We propose a closed-loop monitoring and control framework for multi-modal eHealth applications, AMSER, that can mitigate garbage-in garbage-out by i) monitoring input modalities, ii) analyzing raw input to selectively drop noisy data and features, and iii) choosing appropriate machine learning models that fit the configured data and feature vector - to improve prediction accuracy and energy efficiency. We evaluate our AMSER approach using multi-modal eHealth applications of pain assessment and stress monitoring over different levels and types of noisy components incurred via different sensor modalities. Our approach achieves up to 22\% improvement in prediction accuracy and 5.6$\times$ energy consumption reduction in the sensing phase against the state-of-the-art multi-modal monitoring application.