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1. The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study

   https://doi.org/10.2196/25018  

   Sobolev, Michael ; Vitale, Rachel ; Wen, Hongyi ; Kizer, James ; Leeman, Robert ; Pollak, J P ; Baumel, Amit ; Vadhan, Nehal P ; Estrin, Deborah ; Muench, Frederick ( January 2021 , JMIR mHealth and uHealth)

   Background The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life. Objective The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the generalmore »public. Methods The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app. Results We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research. Conclusions This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions. Trial Registration ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653« less
2. A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

   https://doi.org/10.2196/30991  

   Jimah, Tamara ; Borg, Holly ; Kehoe, Priscilla ; Pimentel, Pamela ; Turner, Arlene ; Labbaf, Sina ; Asgari Mehrabadi, Milad ; Rahmani, Amir M. ; Dutt, Nikil ; Guo, Yuqing ( January 2021 , JMIR Formative Research)

   Background The 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. Objective The 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. Methods A 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 emotionalmore »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 correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.« less
3. Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors

   https://doi.org/10.2196/24014  

   Akbar, Fatema ; Mark, Gloria ; Prausnitz, Stephanie ; Warton, E Margaret ; East, Jeffrey A ; Moeller, Mark F ; Reed, Mary E ; Lieu, Tracy A ( January 2021 , JMIR Medical Informatics)

   Background Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results Physicians spentmore »an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98%). Conclusions This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours.« less
4. Continuous Authentication based on Hand Micro-movement during Smartphone Form Filling by Seated Human Subjects [Continuous Authentication based on Hand Micro-movement during Smartphone Form Filling by Seated Human Subjects]

   https://doi.org/10.5220/0010225804240431  

   Ray, Aratrika ; Hou, Daqing ; Schuckers, Stephanie ; Barbir, Abbie ( January 2021 , 7th International Conference on Information Systems Security and Privacy)

   Mobile devices typically rely on entry-point and other one-time authentication mechanisms such as a password, PIN, fingerprint, iris, or face. But these authentication types are prone to a wide attack vector and worse 1 INTRODUCTION Currently smartphones are predominantly protected a patterned password is prone to smudge attacks, and fingerprint scanning is prone to spoof attacks. Other forms of attacks include video capture and shoulder surfing. Given the increasingly important roles smartphones play in e-commerce and other operations where security is crucial, there lies a strong need of continuous authentication mechanisms to complement and enhance one-time authentication such that even if the authentication at the point of login gets compromised, the device is still unobtrusively protected by additional security measures in a continuous fashion. The research community has investigated several continuous authentication mechanisms based on unique human behavioral traits, including typing, swiping, and gait. To this end, we focus on investigating physiological traits. While interacting with hand-held devices, individuals strive to achieve stability and precision. This is because a certain degree of stability is required in order to manipulate and interact successfully with smartphones, while precision is needed for tasks such as touching or tapping a small target on themore »touch screen (Sitov´a et al., 2015). As a result, to achieve stability and precision, individuals tend to develop their own postural preferences, such as holding a phone with one or both hands, supporting hands on the sides of upper torso and interacting, keeping the phone on the table and typing with the preferred finger, setting the phone on knees while sitting crosslegged and typing, supporting both elbows on chair handles and typing. On the other hand, physiological traits, such as hand-size, grip strength, muscles, age, 424 Ray, A., Hou, D., Schuckers, S. and Barbir, A. Continuous Authentication based on Hand Micro-movement during Smartphone Form Filling by Seated Human Subjects. DOI: 10.5220/0010225804240431 In Proceedings of the 7th International Conference on Information Systems Security and Privacy (ICISSP 2021), pages 424-431 ISBN: 978-989-758-491-6 Copyrightc 2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved still, once compromised, fail to protect the user’s account and data. In contrast, continuous authentication, based on traits of human behavior, can offer additional security measures in the device to authenticate against unauthorized users, even after the entry-point and one-time authentication has been compromised. To this end, we have collected a new data-set of multiple behavioral biometric modalities (49 users) when a user fills out an account recovery form in sitting using an Android app. These include motion events (acceleration and angular velocity), touch and swipe events, keystrokes, and pattern tracing. In this paper, we focus on authentication based on motion events by evaluating a set of score level fusion techniques to authenticate users based on the acceleration and angular velocity data. The best EERs of 2.4% and 6.9% for intra- and inter-session respectively, are achieved by fusing acceleration and angular velocity using Nandakumar et al.’s likelihood ratio (LR) based score fusion.« less
5. Edge-Assisted Sensor Control in Healthcare IoT

   https://doi.org/10.1109/GLOCOM.2018.8647457  

   Amiri, Delaram ; Anzanpour, Arman ; Azimi, Iman ; Levorato, Marco ; Rahmani, Amir M. ; Liljeberg, Pasi ; Dutt, Nikil ( December 2018 , 2018 IEEE Global Communications Conference (GLOBECOM))

   The Internet of Things is a key enabler of mobile health-care applications. However, the inherent constraints of mobile devices, such as limited availability of energy, can impair their ability to produce accurate data and, in turn, degrade the output of algorithms processing them in real-time to evaluate the patient’s state. This paper presents an edge-assisted framework, where models and control generated by an edge server inform the sensing parameters of mobile sensors. The objective is to maximize the probability that anomalies in the collected signals are detected over extensive periods of time under battery-imposed constraints. Although the proposed concept is general, the control framework is made specific to a use-case where vital signs – heart rate, respiration rate and oxygen saturation – are extracted from a Photoplethysmogram (PPG) signal to detect anomalies in real-time. Experimental results show a 16.9% reduction in sensing energy consumption in comparison to a constant energy consumption with the maximum misdetection probability of 0.17 in a 24-hour health monitoring system.