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Background and Aims: Wearable devices capture physiological signals non-invasively and passively. Many of these parameters have been linked to inflammatory bowel disease (IBD) activity. We evaluated the associative ability of several physiological metrics with IBD flares and how they change before the development of flare., Methods: Participants throughout the United States answered daily disease activity surveys and wore an Apple Watch, Fitbit or Oura Ring. These devices collected longitudinal heart rate (HR), resting heart rate (RHR), heart rate variability (HRV), steps, and oxygenation (SpO2). C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin were collected as standard of care. Linear mixed-effect models were implemented to analyze HR, RHR, steps, and SpO2, while cosinor mixed-effect models were applied to HRV circadian features. Mixed effect logistic regression was used to determine the predictive ability of physiological metrics., Results: 309 participants were enrolled across 36 states. Circadian patterns of HRV significantly differed between periods of inflammatory flare and remission, and symptomatic flare and remission. Marginal means for HR and RHR were higher during periods of inflammatory flare and symptomatic flare. There was lower daily steps during inflammatory flares. HRV, HR, and RHR differentiated whether participants with symptoms had inflammation. HRV, HR, RHR, steps, and SpO2 were significantly altered up to 7 weeks prior to inflammatory and symptomatic flares., Conclusions: Longitudinally collected physiological metrics from wearable devices can identify and change prior to IBD flares, suggesting their feasibility to monitor and predict IBD activity., (Copyright © 2025 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach., Objective: The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being., Methods: To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV., Results: In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant., Conclusions: In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions., (©Robert P Hirten, Matteo Danieletto, Kyle Landell, Micol Zweig, Eddye Golden, Renata Pyzik, Sparshdeep Kaur, Helena Chang, Drew Helmus, Bruce E Sands, Dennis Charney, Girish Nadkarni, Emilia Bagiella, Laurie Keefer, Zahi A Fayad. Originally published in JMIR Mental Health (https://mental.jmir.org), 25.04.2024.)

Background: The increasing use of smartphones, wearables, and connected devices has enabled the increasing application of digital technologies for research. Remote digital study platforms comprise a patient-interfacing digital application that enables multimodal data collection from a mobile app and connected sources. They offer an opportunity to recruit at scale, acquire data longitudinally at a high frequency, and engage study participants at any time of the day in any place. Few published descriptions of centralized digital research platforms provide a framework for their development., Objective: This study aims to serve as a road map for those seeking to develop a centralized digital research platform. We describe the technical and functional aspects of the ehive app, the centralized digital research platform of the Hasso Plattner Institute for Digital Health at Mount Sinai Hospital, New York, New York. We then provide information about ongoing studies hosted on ehive, including usership statistics and data infrastructure. Finally, we discuss our experience with ehive in the broader context of the current landscape of digital health research platforms., Methods: The ehive app is a multifaceted and patient-facing central digital research platform that permits the collection of e-consent for digital health studies. An overview of its development, its e-consent process, and the tools it uses for participant recruitment and retention are provided. Data integration with the platform and the infrastructure supporting its operations are discussed; furthermore, a description of its participant- and researcher-facing dashboard interfaces and the e-consent architecture is provided., Results: The ehive platform was launched in 2020 and has successfully hosted 8 studies, namely 6 observational studies and 2 clinical trials. Approximately 1484 participants downloaded the app across 36 states in the United States. The use of recruitment methods such as bulk messaging through the EPIC electronic health records and standard email portals enables broad recruitment. Light-touch engagement methods, used in an automated fashion through the platform, maintain high degrees of engagement and retention. The ehive platform demonstrates the successful deployment of a central digital research platform that can be modified across study designs., Conclusions: Centralized digital research platforms such as ehive provide a novel tool that allows investigators to expand their research beyond their institution, engage in large-scale longitudinal studies, and combine multimodal data streams. The ehive platform serves as a model for groups seeking to develop similar digital health research programs., International Registered Report Identifier (irrid): DERR1-10.2196/49204., (©Robert P Hirten, Matteo Danieletto, Kyle Landell, Micol Zweig, Eddye Golden, Georgy Orlov, Jovita Rodrigues, Eugenia Alleva, Ipek Ensari, Erwin Bottinger, Girish N Nadkarni, Thomas J Fuchs, Zahi A Fayad. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.11.2023.)

Objective: To assess whether an individual's degree of psychological resilience can be determined from physiological metrics passively collected from a wearable device., Materials and Methods: Data were analyzed in this secondary analysis of the Warrior Watch Study dataset, a prospective cohort of healthcare workers enrolled across 7 hospitals in New York City. Subjects wore an Apple Watch for the duration of their participation. Surveys were collected measuring resilience, optimism, and emotional support at baseline., Results: We evaluated data from 329 subjects (mean age 37.4 years, 37.1% male). Across all testing sets, gradient-boosting machines (GBM) and extreme gradient-boosting models performed best for high- versus low-resilience prediction, stratified on a median Connor-Davidson Resilience Scale-2 score of 6 (interquartile range = 5-7), with an AUC of 0.60. When predicting resilience as a continuous variable, multivariate linear models had a correlation of 0.24 ( P  = .029) and RMSE of 1.37 in the testing data. A positive psychological construct, comprised of resilience, optimism, and emotional support was also evaluated. The oblique random forest method performed best in estimating high- versus low-composite scores stratified on a median of 32.5, with an AUC of 0.65, a sensitivity of 0.60, and a specificity of 0.70., Discussion: In a post hoc analysis, machine learning models applied to physiological metrics collected from wearable devices had some predictive ability in identifying resilience states and a positive psychological construct., Conclusions: These findings support the further assessment of psychological characteristics from passively collected wearable data in dedicated studies., Competing Interests: DC is a coinventor on patents filed by the Icahn School of Medicine at Mount Sinai (ISMMS) relating to the treatment for treatment-resistant depression, suicidal ideation, and other disorders. ISMMS has entered into a licensing agreement with Janssen Pharmaceuticals, Inc, and it has received and will receive payments from Janssen under the license agreement related to these patents for the treatment of treatment-resistant depression and suicidal ideation. Consistent with the ISMMS Faculty Handbook (the medical school policy), DC is entitled to a portion of the payments received by the ISMMS. Because SPRAVATO has received regulatory approval for treatment-resistant depression, through the ISMMS, DC will be entitled to additional payments beyond those already received under the license agreement. DC is a named coinventor on several patents filed by ISMMS for a cognitive training intervention to treat depression and related psychiatric disorders. The ISMMS has entered into a licensing agreement with Click Therapeutics, Inc and has received and will receive payments related to the use of this cognitive training intervention for the treatment of psychiatric disorders. In accordance with the ISMMS Faculty Handbook, DC has received a portion of these payments and is entitled to a portion of any additional payments that the medical school may receive from this license with Click Therapeutics. DC is a named coinventor on a patent application filed by the ISMMS for the use of intranasally administered Neuropeptide Y for the treatment of mood and anxiety disorders. This intellectual property has not been licensed. DC is a named coinventor on a patent application in the United States and several issued patents outside the United States filed by the ISMMS related to the use of ketamine for the treatment of posttraumatic stress disorder. This intellectual property has not been licensed. EPB reports consultancy agreements with Deloitte and Roland Berger; ownership interest in Digital Medicine E. Böttinger GmbH, EBCW GmbH, and Ontomics, Inc; receiving honoraria from Bayer, Bosch Health Campus, Sanofi, and Siemens; and serving as a scientific advisor or member of Bosch Health Campus and Seer Biosciences Inc. LK declares research funding from Abbvie and Pfizer, consulting for Abbvie and Pfizer, and equity ownership/stock options in MetaMe Health and Trellus Health. MS-F declares research support from Novartis and Allergenis. GNN reports employment with, consultancy agreements with, and ownership interest in Pensieve Health and Renalytix AI; receiving consulting fees from AstraZeneca, BioVie, GLG Consulting, and Reata; and serving as a scientific advisor or member of Pensieve Health and Renalytix AI. ZAF discloses consulting fees from Alexion, GlaxoSmithKline, and Trained Therapeutix Discovery and research funding from Daiichi Sankyo, Amgen, Bristol Myers Squibb, and Siemens Healthineers. ZAF receives financial compensation as a board member and advisor to Trained Therapeutix Discovery and owns equity in Trained Therapeutix Discovery as a cofounder. The remaining authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States., Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission., Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center's aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app's primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content., Results: We launched our app over the course of two phases, the first phase being a "soft" launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person., Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly., (©Eddye A Golden, Micol Zweig, Matteo Danieletto, Kyle Landell, Girish Nadkarni, Erwin Bottinger, Lindsay Katz, Ricardo Somarriba, Vansh Sharma, Craig L Katz, Deborah B Marin, Jonathan DePierro, Dennis S Charney. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.05.2021.)