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Butorac I, Carter A. The Coercive Potential of Digital Mental Health. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:28-30. [PMID: 34152911 DOI: 10.1080/15265161.2021.1926582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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102
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Lucivero F, Hallowell N. Digital/computational phenotyping: What are the differences in the science and the ethics? BIG DATA & SOCIETY 2021; 8:20539517211062885. [PMID: 37790725 PMCID: PMC10544038 DOI: 10.1177/20539517211062885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
The concept of 'digital phenotyping' was originally developed by researchers in the mental health field, but it has travelled to other disciplines and areas. This commentary draws upon our experiences of working in two scientific projects that are based at the University of Oxford's Big Data Institute - The RADAR-AD project and The Minerva Initiative - which are developing algorithmic phenotyping technologies. We describe and analyse the concepts of digital biomarkers and computational phenotyping that underlie these projects, explain how they are linked to other research in digital phenotyping and compare and contrast some of their epistemological and ethical implications. In particular, we argue that the phenotyping paradigm in both projects is grounded on an assumption of 'objectivity' that is articulated in different ways depending on the role that is given to the computational/digital tools. Using the concept of 'affordance', we show how specific functionalities relate to potential uses and social implications of these technologies and argue that it is important to distinguish among them as the concept of digital phenotyping is increasingly being used with a variety of meanings.
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Affiliation(s)
- Federica Lucivero
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, UK
| | - Nina Hallowell
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, UK
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Blom JMC, Colliva C, Benatti C, Tascedda F, Pani L. Digital Phenotyping and Dynamic Monitoring of Adolescents Treated for Cancer to Guide Intervention: Embracing a New Era. Front Oncol 2021; 11:673581. [PMID: 34262863 PMCID: PMC8273734 DOI: 10.3389/fonc.2021.673581] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johanna M. C. Blom
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Colliva
- Azienda Unità Sanitaria Locale di Modena, Distretto di Carpi, Carpi, Italy
| | - Cristina Benatti
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
- VeraSci., Durham, NC, United States
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Beck AK, Kelly PJ, Deane FP, Baker AL, Hides L, Manning V, Shakeshaft A, Neale J, Kelly JF, Gray RM, Argent A, McGlaughlin R, Chao R, Martini M. Developing a mHealth Routine Outcome Monitoring and Feedback App ("SMART Track") to Support Self-Management of Addictive Behaviours. Front Psychiatry 2021; 12:677637. [PMID: 34220583 PMCID: PMC8249767 DOI: 10.3389/fpsyt.2021.677637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Routine outcome monitoring (ROM) has been implemented across a range of addiction treatment services, settings and organisations. Mutual support groups are a notable exception. Innovative solutions are needed. SMART Track is a purpose built smartphone app designed to capture ROM data and provide tailored feedback to adults attending Australian SMART Recovery groups for addictive behaviour(s). Objective: Details regarding the formative stage of app development is essential, but often neglected. Improved consideration of the end-user is vital for curtailing app attrition and enhancing engagement. This paper provides a pragmatic example of how principles embedded in published frameworks can be operationalised to address these priorities during the design and development of the SMART Track app. Methods: Three published frameworks for creating digital health technologies ("Person-Based Approach," "BIT" Model and IDEAS framework) were integrated and applied across two stages of research to inform the development, design and content of SMART Track. These frameworks were chosen to ensure that SMART Track was informed by the needs and preferences of the end-user ("Person-Based"); best practise recommendations for mHealth development ("BIT" Model) and a collaborative, iterative development process between the multi-disciplinary research team, app developers and end-users (IDEAS framework). Results: Stage one of the research process generated in-depth knowledge to inform app development, including a comprehensive set of aims (clinical, research/organisation, and usage); clear articulation of the target behaviour (self-monitoring of recovery related behaviours and experiences); relevant theory (self-determination and social control); appropriate behavioural strategies (e.g., behaviour change taxonomy and process motivators) and key factors that may influence engagement (e.g., transparency, relevance and trust). These findings were synthesised into guiding principles that were applied during stage two in an iterative approach to app design, content and development. Conclusions: This paper contributes new knowledge on important person-centred and theoretical considerations that underpin a novel ROM and feedback app for people with addictive behaviour(s). Although person-centred design and best-practise recommendations were employed, further research is needed to determine whether this leads to improved usage outcomes. Clinical Trial Registration: Pilot Trial: http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336.
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Affiliation(s)
- Alison K. Beck
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Peter J. Kelly
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Frank P. Deane
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Joanne Neale
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - John F. Kelly
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Rebecca M. Gray
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Ryan Chao
- GHO, Customer Experience Agency, Sydney, NSW, Australia
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105
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Hartl D, de Luca V, Kostikova A, Laramie J, Kennedy S, Ferrero E, Siegel R, Fink M, Ahmed S, Millholland J, Schuhmacher A, Hinder M, Piali L, Roth A. Translational precision medicine: an industry perspective. J Transl Med 2021; 19:245. [PMID: 34090480 PMCID: PMC8179706 DOI: 10.1186/s12967-021-02910-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
In the era of precision medicine, digital technologies and artificial intelligence, drug discovery and development face unprecedented opportunities for product and business model innovation, fundamentally changing the traditional approach of how drugs are discovered, developed and marketed. Critical to this transformation is the adoption of new technologies in the drug development process, catalyzing the transition from serendipity-driven to data-driven medicine. This paradigm shift comes with a need for both translation and precision, leading to a modern Translational Precision Medicine approach to drug discovery and development. Key components of Translational Precision Medicine are multi-omics profiling, digital biomarkers, model-based data integration, artificial intelligence, biomarker-guided trial designs and patient-centric companion diagnostics. In this review, we summarize and critically discuss the potential and challenges of Translational Precision Medicine from a cross-industry perspective.
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Affiliation(s)
- Dominik Hartl
- Novartis Institutes for BioMedical Research, Basel, Switzerland.
- Department of Pediatrics I, University of Tübingen, Tübingen, Germany.
| | - Valeria de Luca
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Anna Kostikova
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jason Laramie
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Scott Kennedy
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Enrico Ferrero
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Richard Siegel
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Martin Fink
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | | | | | - Markus Hinder
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Luca Piali
- Roche Innovation Center Basel, Basel, Switzerland
| | - Adrian Roth
- Roche Innovation Center Basel, Basel, Switzerland
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Moldwin A, Demner-Fushman D, Goodwin TR. Empirical Findings on the Role of Structured Data, Unstructured Data, and their Combination for Automatic Clinical Phenotyping. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2021; 2021:445-454. [PMID: 34457160 PMCID: PMC8378600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The objective of this study is to explore the role of structured and unstructured data for clinical phenotyping by determining which types of clinical phenotypes are best identified using unstructured data (e.g., clinical notes), structured data (e.g., laboratory values, vital signs), or their combination across 172 clinical phenotypes. Specifically, we used laboratory and chart measurements as well as clinical notes from the MIMIC-III critical care database and trained an LSTM using features extracted from each type of data to determine which categories of phenotypes were best identified by structured data, unstructured data, or both. We observed that textual features on their own outperformed structured features for 145 (84%) of phenotypes, and that Doc2Vec was the most effective representation of unstructured data for all phenotypes. When evaluating the impact of adding textual features to systems previously relying only on structured features, we found a statistically significant (p < 0.05) increase in phenotyping performance for 51 phenotypes (primarily involving the circulatory system, injury, and poisoning), one phenotype for which textual features degraded performance (diabetes without complications), and no statistically significant change in performance with the remaining 120 phenotypes. We provide analysis on which phenotypes are best identified by each type of data and guidance on which data sources to consider for future research on phenotype identification.
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Affiliation(s)
- Asher Moldwin
- U.S. National Library of Medicine, Bethesda, MD, USA
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107
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DeLozier S, Bland HT, McPheeters M, Wells Q, Farber-Eger E, Bejan CA, Fabbri D, Rosenbloom T, Roden D, Johnson KB, Wei WQ, Peterson J, Bastarache L. Phenotyping coronavirus disease 2019 during a global health pandemic: Lessons learned from the characterization of an early cohort. J Biomed Inform 2021; 117:103777. [PMID: 33838341 PMCID: PMC8026248 DOI: 10.1016/j.jbi.2021.103777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/09/2021] [Accepted: 04/03/2021] [Indexed: 01/08/2023]
Abstract
From the start of the coronavirus disease 2019 (COVID-19) pandemic, researchers have looked to electronic health record (EHR) data as a way to study possible risk factors and outcomes. To ensure the validity and accuracy of research using these data, investigators need to be confident that the phenotypes they construct are reliable and accurate, reflecting the healthcare settings from which they are ascertained. We developed a COVID-19 registry at a single academic medical center and used data from March 1 to June 5, 2020 to assess differences in population-level characteristics in pandemic and non-pandemic years respectively. Median EHR length, previously shown to impact phenotype performance in type 2 diabetes, was significantly shorter in the SARS-CoV-2 positive group relative to a 2019 influenza tested group (median 3.1 years vs 8.7; Wilcoxon rank sum P = 1.3e-52). Using three phenotyping methods of increasing complexity (billing codes alone and domain-specific algorithms provided by an EHR vendor and clinical experts), common medical comorbidities were abstracted from COVID-19 EHRs, defined by the presence of a positive laboratory test (positive predictive value 100%, recall 93%). After combining performance data across phenotyping methods, we observed significantly lower false negative rates for those records billed for a comprehensive care visit (p = 4e-11) and those with complete demographics data recorded (p = 7e-5). In an early COVID-19 cohort, we found that phenotyping performance of nine common comorbidities was influenced by median EHR length, consistent with previous studies, as well as by data density, which can be measured using portable metrics including CPT codes. Here we present those challenges and potential solutions to creating deeply phenotyped, acute COVID-19 cohorts.
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Affiliation(s)
- Sarah DeLozier
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA.
| | - Harris T Bland
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Melissa McPheeters
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Quinn Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Eric Farber-Eger
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Cosmin A Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Dan Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Josh Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
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109
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Mobile device use among inpatients on a psychiatric unit: A preliminary study. Psychiatry Res 2021; 297:113720. [PMID: 33540205 DOI: 10.1016/j.psychres.2021.113720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Few studies have investigated barriers to mobile phone use for health purposes among patients with serious mental illness. In an inpatient psychiatric adult sample, we examined: (a) patterns and perceptions of mobile phone use and (b) the role of psychiatric diagnoses on mobile phone use for mental health purposes. Participants completed questionnaires after using a psychometrically validated scale to determine capacity for consent. Descriptive analyses revealed that most participants owned a smartphone (94%), data plan (94%), and frequently accessed the internet (75%). Only 27% used their mobile phones daily for health purposes and 47% had used their mobile phone to access their electronic medical record (EMR). Participants with psychotic disorders were significantly less likely to have mobile access to their EMR and expressed difficulty in using a mobile app for mental health purposes; whereas participants with depressive disorders expressed low interest in using their mobile devices to monitor their mental health. Adult psychiatric inpatients may have access to and be willing to use mobile phones for purposes related to mental health. However, key barriers may include frequency of mobile phone use for health purposes and lack of mobile access to the EMR, particularly among those with psychotic disorders.
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110
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Van Daele T, Best P, Bernaerts S, Van Assche E, De Witte NAJ. Dropping the E: The potential for integrating e-mental health in psychotherapy. Curr Opin Psychol 2021; 41:46-50. [PMID: 33743399 DOI: 10.1016/j.copsyc.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
E-mental health, or the use of technology in mental healthcare, has been the focus of research for over two decades. Over that period, the evidence base for the potential of technology to improve psychotherapeutic practice has grown steadily. This sharply contrasts with the actual use of e-mental health by psychotherapists, which has remained limited. In this article, we aim to illustrate how and when different technological tools and applications can play a role in psychotherapy. At the same time, we also highlight current limitations and discuss challenges for future research. A specific, yet hypothetical case, is used to guide this narrative review and make proposed applications tangible and concrete.
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Affiliation(s)
- Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium; School of Social Sciences, Education and Social Work, Queen's University Belfast, BT7 1NN Belfast, United Kingdom.
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, BT7 1NN Belfast, United Kingdom
| | - Sylvie Bernaerts
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
| | - Eva Van Assche
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
| | - Nele A J De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
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111
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Schultebraucks K, Chang BP. The opportunities and challenges of machine learning in the acute care setting for precision prevention of posttraumatic stress sequelae. Exp Neurol 2021; 336:113526. [PMID: 33157093 PMCID: PMC7856033 DOI: 10.1016/j.expneurol.2020.113526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
Personalized medicine is among the most exciting innovations in recent clinical research, offering the opportunity for tailored screening and management at the individual level. Biomarker-enriched clinical trials have shown increased efficiency and informativeness in cancer research due to the selective exclusion of patients unlikely to benefit. In acute stress situations, clinically significant decisions are often made in time-sensitive manners and providers may be pressed to make decisions based on abbreviated clinical assessments. Up to 30% of trauma survivors admitted to the Emergency Department (ED) will develop long-lasting posttraumatic stress psychopathologies. The long-term impact of those survivors with posttraumatic stress sequelae are significant, impacting both long-term psychological and physiological recovery. An accurate prognostic model of who will develop posttraumatic stress symptoms does not exist yet. Additionally, no scalable and cost-effective method that can be easily integrated into routine care exists, even though especially the acute care setting provides a critical window of opportunity for prevention in the so-called golden hours when preventive measures are most effective. In this review, we aim to discuss emerging machine learning (ML) applications that are promising for precisely risk stratification and targeted treatments in the acute care setting. The aim of this narrative review is to present examples of digital health innovations and to discuss the potential of these new approaches for treatment selection and prevention of posttraumatic sequelae in the acute care setting. The application of artificial intelligence-based solutions have already had great success in other areas and are rapidly approaching the field of psychological care as well. New ways of algorithm-based risk predicting, and the use of digital phenotypes provide a high potential for predicting future risk of PTSD in acute care settings and to go new steps in precision psychiatry.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, United States of America; Data Science Institute, Columbia University, New York, NY, United States of America.
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
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112
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Tomasik J, Han SYS, Barton-Owen G, Mirea DM, Martin-Key NA, Rustogi N, Lago SG, Olmert T, Cooper JD, Ozcan S, Eljasz P, Thomas G, Tuytten R, Metcalfe T, Schei TS, Farrag LP, Friend LV, Bell E, Cowell D, Bahn S. A machine learning algorithm to differentiate bipolar disorder from major depressive disorder using an online mental health questionnaire and blood biomarker data. Transl Psychiatry 2021; 11:41. [PMID: 33436544 PMCID: PMC7804187 DOI: 10.1038/s41398-020-01181-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
The vast personal and economic burden of mood disorders is largely caused by their under- and misdiagnosis, which is associated with ineffective treatment and worsening of outcomes. Here, we aimed to develop a diagnostic algorithm, based on an online questionnaire and blood biomarker data, to reduce the misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD). Individuals with depressive symptoms (Patient Health Questionnaire-9 score ≥5) aged 18-45 years were recruited online. After completing a purpose-built online mental health questionnaire, eligible participants provided dried blood spot samples for biomarker analysis and underwent the World Health Organization World Mental Health Composite International Diagnostic Interview via telephone, to establish their mental health diagnosis. Extreme Gradient Boosting and nested cross-validation were used to train and validate diagnostic models differentiating BD from MDD in participants who self-reported a current MDD diagnosis. Mean test area under the receiver operating characteristic curve (AUROC) for separating participants with BD diagnosed as MDD (N = 126) from those with correct MDD diagnosis (N = 187) was 0.92 (95% CI: 0.86-0.97). Core predictors included elevated mood, grandiosity, talkativeness, recklessness and risky behaviour. Additional validation in participants with no previous mood disorder diagnosis showed AUROCs of 0.89 (0.86-0.91) and 0.90 (0.87-0.91) for separating newly diagnosed BD (N = 98) from MDD (N = 112) and subclinical low mood (N = 120), respectively. Validation in participants with a previous diagnosis of BD (N = 45) demonstrated sensitivity of 0.86 (0.57-0.96). The diagnostic algorithm accurately identified patients with BD in various clinical scenarios, and could help expedite accurate clinical diagnosis and treatment of BD.
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Affiliation(s)
- Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK.
| | - Sung Yeon Sarah Han
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | - Dan-Mircea Mirea
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
| | - Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Nitin Rustogi
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Santiago G Lago
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Tony Olmert
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
- University of California San Diego School of Medicine, San Diego, California, USA
| | - Jason D Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
- Owlstone Medical Ltd, Cambridge, UK
| | - Sureyya Ozcan
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
- Department of Chemistry, Middle East Technical University, Ankara, Turkey
| | - Pawel Eljasz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | - Robin Tuytten
- Metabolomic Diagnostics, Little Island, Cork, Ireland
| | | | | | | | | | | | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK.
- Psyomics Ltd, Cambridge, UK.
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113
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Vlisides-Henry RD, Gao M, Thomas L, Kaliush PR, Conradt E, Crowell SE. Digital Phenotyping of Emotion Dysregulation Across Lifespan Transitions to Better Understand Psychopathology Risk. Front Psychiatry 2021; 12:618442. [PMID: 34108893 PMCID: PMC8183608 DOI: 10.3389/fpsyt.2021.618442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Ethical and consensual digital phenotyping through smartphone activity (i. e., passive behavior monitoring) permits measurement of temporal risk trajectories unlike ever before. This data collection modality may be particularly well-suited for capturing emotion dysregulation, a transdiagnostic risk factor for psychopathology, across lifespan transitions. Adolescence, emerging adulthood, and perinatal transitions are particularly sensitive developmental periods, often marked by increased distress. These participant groups are typically assessed with laboratory-based methods that can be costly and burdensome. Passive monitoring presents a relatively cost-effective and unobtrusive way to gather rich and objective information about emotion dysregulation and risk behaviors. We first discuss key theoretically-driven concepts pertaining to emotion dysregulation and passive monitoring. We then identify variables that can be measured passively and hold promise for better understanding emotion dysregulation. For example, two strong markers of emotion dysregulation are sleep disturbance and problematic use of Internet/social media (i.e., use that prompts negative emotions/outcomes). Variables related to mobility are also potentially useful markers, though these variables should be tailored to fit unique features of each developmental stage. Finally, we offer our perspective on candidate digital variables that may prove useful for each developmental transition. Smartphone-based passive monitoring is a rigorous method that can elucidate psychopathology risk across human development. Nonetheless, its use requires researchers to weigh unique ethical considerations, examine relevant theory, and consider developmentally-specific lifespan features that may affect implementation.
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Affiliation(s)
| | - Mengyu Gao
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Leah Thomas
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Parisa R Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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Perez-Pozuelo I, Spathis D, Clifton EA, Mascolo C. Wearables, smartphones, and artificial intelligence for digital phenotyping and health. Digit Health 2021. [DOI: 10.1016/b978-0-12-820077-3.00003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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115
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Moshe I, Terhorst Y, Opoku Asare K, Sander LB, Ferreira D, Baumeister H, Mohr DC, Pulkki-Råback L. Predicting Symptoms of Depression and Anxiety Using Smartphone and Wearable Data. Front Psychiatry 2021; 12:625247. [PMID: 33584388 PMCID: PMC7876288 DOI: 10.3389/fpsyt.2021.625247] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Depression and anxiety are leading causes of disability worldwide but often remain undetected and untreated. Smartphone and wearable devices may offer a unique source of data to detect moment by moment changes in risk factors associated with mental disorders that overcome many of the limitations of traditional screening methods. Objective: The current study aimed to explore the extent to which data from smartphone and wearable devices could predict symptoms of depression and anxiety. Methods: A total of N = 60 adults (ages 24-68) who owned an Apple iPhone and Oura Ring were recruited online over a 2-week period. At the beginning of the study, participants installed the Delphi data acquisition app on their smartphone. The app continuously monitored participants' location (using GPS) and smartphone usage behavior (total usage time and frequency of use). The Oura Ring provided measures related to activity (step count and metabolic equivalent for task), sleep (total sleep time, sleep onset latency, wake after sleep onset and time in bed) and heart rate variability (HRV). In addition, participants were prompted to report their daily mood (valence and arousal). Participants completed self-reported assessments of depression, anxiety and stress (DASS-21) at baseline, midpoint and the end of the study. Results: Multilevel models demonstrated a significant negative association between the variability of locations visited and symptoms of depression (beta = -0.21, p = 0.037) and significant positive associations between total sleep time and depression (beta = 0.24, p = 0.023), time in bed and depression (beta = 0.26, p = 0.020), wake after sleep onset and anxiety (beta = 0.23, p = 0.035) and HRV and anxiety (beta = 0.26, p = 0.035). A combined model of smartphone and wearable features and self-reported mood provided the strongest prediction of depression. Conclusion: The current findings demonstrate that wearable devices may provide valuable sources of data in predicting symptoms of depression and anxiety, most notably data related to common measures of sleep.
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Affiliation(s)
- Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yannik Terhorst
- Department of Research Methods, Ulm University, Ulm, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | | | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Denzil Ferreira
- Center for Ubiquitous Computing, University of Oulu, Oulu, Finland
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David C Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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116
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Smith E, Storch EA, Vahia I, Wong STC, Lavretsky H, Cummings JL, Eyre HA. Affective Computing for Late-Life Mood and Cognitive Disorders. Front Psychiatry 2021; 12:782183. [PMID: 35002802 PMCID: PMC8732874 DOI: 10.3389/fpsyt.2021.782183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/29/2021] [Indexed: 12/20/2022] Open
Abstract
Affective computing (also referred to as artificial emotion intelligence or emotion AI) is the study and development of systems and devices that can recognize, interpret, process, and simulate emotion or other affective phenomena. With the rapid growth in the aging population around the world, affective computing has immense potential to benefit the treatment and care of late-life mood and cognitive disorders. For late-life depression, affective computing ranging from vocal biomarkers to facial expressions to social media behavioral analysis can be used to address inadequacies of current screening and diagnostic approaches, mitigate loneliness and isolation, provide more personalized treatment approaches, and detect risk of suicide. Similarly, for Alzheimer's disease, eye movement analysis, vocal biomarkers, and driving and behavior can provide objective biomarkers for early identification and monitoring, allow more comprehensive understanding of daily life and disease fluctuations, and facilitate an understanding of behavioral and psychological symptoms such as agitation. To optimize the utility of affective computing while mitigating potential risks and ensure responsible development, ethical development of affective computing applications for late-life mood and cognitive disorders is needed.
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Affiliation(s)
- Erin Smith
- The PRODEO Institute, San Francisco, CA, United States.,Organisation for Economic Co-operation and Development (OECD), Paris, France.,Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, United States.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Ipsit Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Boston, MA, United States.,Division of Geriatric Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Stephen T C Wong
- Systems Medicine and Biomedical Engineering Houston Methodist, Houston, TX, United States
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, United States
| | - Harris A Eyre
- The PRODEO Institute, San Francisco, CA, United States.,Organisation for Economic Co-operation and Development (OECD), Paris, France.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
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117
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Sverdlov O, Curcic J, Hannesdottir K, Gou L, De Luca V, Ambrosetti F, Zhang B, Praestgaard J, Vallejo V, Dolman A, Gomez-Mancilla B, Biliouris K, Deurinck M, Cormack F, Anderson JJ, Bott NT, Peremen Z, Issachar G, Laufer O, Joachim D, Jagesar RR, Jongs N, Kas MJ, Zhuparris A, Zuiker R, Recourt K, Zuilhof Z, Cha JH, Jacobs GE. A Study of Novel Exploratory Tools, Digital Technologies, and Central Nervous System Biomarkers to Characterize Unipolar Depression. Front Psychiatry 2021; 12:640741. [PMID: 34025472 PMCID: PMC8136319 DOI: 10.3389/fpsyt.2021.640741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Digital technologies have the potential to provide objective and precise tools to detect depression-related symptoms. Deployment of digital technologies in clinical research can enable collection of large volumes of clinically relevant data that may not be captured using conventional psychometric questionnaires and patient-reported outcomes. Rigorous methodology studies to develop novel digital endpoints in depression are warranted. Objective: We conducted an exploratory, cross-sectional study to evaluate several digital technologies in subjects with major depressive disorder (MDD) and persistent depressive disorder (PDD), and healthy controls. The study aimed at assessing utility and accuracy of the digital technologies as potential diagnostic tools for unipolar depression, as well as correlating digital biomarkers to clinically validated psychometric questionnaires in depression. Methods: A cross-sectional, non-interventional study of 20 participants with unipolar depression (MDD and PDD/dysthymia) and 20 healthy controls was conducted at the Centre for Human Drug Research (CHDR), the Netherlands. Eligible participants attended three in-clinic visits (days 1, 7, and 14), at which they underwent a series of assessments, including conventional clinical psychometric questionnaires and digital technologies. Between the visits, there was at-home collection of data through mobile applications. In all, seven digital technologies were evaluated in this study. Three technologies were administered via mobile applications: an interactive tool for the self-assessment of mood, and a cognitive test; a passive behavioral monitor to assess social interactions and global mobility; and a platform to perform voice recordings and obtain vocal biomarkers. Four technologies were evaluated in the clinic: a neuropsychological test battery; an eye motor tracking system; a standard high-density electroencephalogram (EEG)-based technology to analyze the brain network activity during cognitive testing; and a task quantifying bias in emotion perception. Results: Our data analysis was organized by technology - to better understand individual features of various technologies. In many cases, we obtained simple, parsimonious models that have reasonably high diagnostic accuracy and potential to predict standard clinical outcome in depression. Conclusion: This study generated many useful insights for future methodology studies of digital technologies and proof-of-concept clinical trials in depression and possibly other indications.
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Affiliation(s)
| | - Jelena Curcic
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Liangke Gou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Valeria De Luca
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Bingsong Zhang
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, United States
| | - Jens Praestgaard
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
| | - Vanessa Vallejo
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Andrew Dolman
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
| | | | | | - Mark Deurinck
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - John J Anderson
- Neurotrack Technologies, Inc., Redwood City, CA, United States
| | - Nicholas T Bott
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | | | | | | | | | - Raj R Jagesar
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Niels Jongs
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | | | - Rob Zuiker
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Zoë Zuilhof
- Centre for Human Drug Research, Leiden, Netherlands
| | - Jang-Ho Cha
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States
| | - Gabriel E Jacobs
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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Lenze EJ, Nicol GE, Barbour DL, Kannampallil T, Wong AWK, Piccirillo J, Drysdale AT, Sylvester CM, Haddad R, Miller JP, Low CA, Lenze SN, Freedland KE, Rodebaugh TL. Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders. J Psychiatry Neurosci 2021; 46:E97-E110. [PMID: 33206039 PMCID: PMC7955843 DOI: 10.1503/jpn.200042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The goal of precision medicine (individually tailored treatments) is not being achieved for neurobehavioural conditions such as psychiatric disorders. Traditional randomized clinical trial methods are insufficient for advancing precision medicine because of the dynamic complexity of these conditions. We present a pragmatic solution: the precision clinical trial framework, encompassing methods for individually tailored treatments. This framework includes the following: (1) treatment-targeted enrichment, which involves measuring patients' response after a brief bout of an intervention, and then randomizing patients to a full course of treatment, using the acute response to predict long-term outcomes; (2) adaptive treatments, which involve adjusting treatment parameters during the trial to individually optimize the treatment; and (3) precise measurement, which involves measuring predictor and outcome variables with high accuracy and reliability using techniques such as ecological momentary assessment. This review summarizes precision clinical trials and provides a research agenda, including new biomarkers such as precision neuroimaging, transcranial magnetic stimulation-electroencephalogram digital phenotyping and advances in statistical and machine-learning models. Validation of these approaches - and then widespread incorporation of the precision clinical trial framework - could help achieve the vision of precision medicine for neurobehavioural conditions.
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Affiliation(s)
- Eric J Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Ginger E Nicol
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Dennis L Barbour
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas Kannampallil
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Alex W K Wong
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Jay Piccirillo
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Andrew T Drysdale
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Chad M Sylvester
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Rita Haddad
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - J Philip Miller
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Carissa A Low
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Shannon N Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Kenneth E Freedland
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas L Rodebaugh
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
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Digital Phenotyping and Patient-Generated Health Data for Outcome Measurement in Surgical Care: A Scoping Review. J Pers Med 2020; 10:jpm10040282. [PMID: 33333915 PMCID: PMC7765378 DOI: 10.3390/jpm10040282] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
Digital phenotyping-the moment-by-moment quantification of human phenotypes in situ using data related to activity, behavior, and communications, from personal digital devices, such as smart phones and wearables-has been gaining interest. Personalized health information captured within free-living settings using such technologies may better enable the application of patient-generated health data (PGHD) to provide patient-centered care. The primary objective of this scoping review is to characterize the application of digital phenotyping and digitally captured active and passive PGHD for outcome measurement in surgical care. Secondarily, we synthesize the body of evidence to define specific areas for further work. We performed a systematic search of four bibliographic databases using terms related to "digital phenotyping and PGHD," "outcome measurement," and "surgical care" with no date limits. We registered the study (Open Science Framework), followed strict inclusion/exclusion criteria, performed screening, extraction, and synthesis of results in line with the PRISMA Extension for Scoping Reviews. A total of 224 studies were included. Published studies have accelerated in the last 5 years, originating in 29 countries (mostly from the USA, n = 74, 33%), featuring original prospective work (n = 149, 66%). Studies spanned 14 specialties, most commonly orthopedic surgery (n = 129, 58%), and had a postoperative focus (n = 210, 94%). Most of the work involved research-grade wearables (n = 130, 58%), prioritizing the capture of activity (n = 165, 74%) and biometric data (n = 100, 45%), with a view to providing a tracking/monitoring function (n = 115, 51%) for the management of surgical patients. Opportunities exist for further work across surgical specialties involving smartphones, communications data, comparison with patient-reported outcome measures (PROMs), applications focusing on prediction of outcomes, monitoring, risk profiling, shared decision making, and surgical optimization. The rapidly evolving state of the art in digital phenotyping and capture of PGHD offers exciting prospects for outcome measurement in surgical care pending further work and consideration related to clinical care, technology, and implementation.
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120
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MacRae CA, Deo RC, Shaw SY. Ecosystem Barriers to Innovation Adoption in Clinical Practice. Trends Mol Med 2020; 27:5-7. [PMID: 33293198 DOI: 10.1016/j.molmed.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/28/2022]
Abstract
Despite increasing ability to understand and correct molecular derangements in disease, genomics and novel phenotypic assays are unevenly deployed in clinical practice. This has hampered translational research and our ability to identify clinically actionable subtypes of disease. Historic examples illustrate how the perspectives of stakeholders across the healthcare ecosystem can influence adoption of innovations in healthcare. Consideration of these factors, from discovery to implementation, can accelerate adoption of new molecular and digital phenotypes in a 'learning' healthcare ecosystem.
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Affiliation(s)
- Calum A MacRae
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Rahul C Deo
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Stanley Y Shaw
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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121
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Lagan S, Ramakrishnan A, Lamont E, Ramakrishnan A, Frye M, Torous J. Digital health developments and drawbacks: a review and analysis of top-returned apps for bipolar disorder. Int J Bipolar Disord 2020; 8:39. [PMID: 33259047 PMCID: PMC7704602 DOI: 10.1186/s40345-020-00202-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although a growing body of literature highlights the potential benefit of smartphone-based mobile apps to aid in self-management and treatment of bipolar disorder, it is unclear whether such evidence-based apps are readily available and accessible to a user of the app store. RESULTS Using our systematic framework for the evaluation of mental health apps, we analyzed the accessibility, privacy, clinical foundation, features, and interoperability of the top-returned 100 apps for bipolar disorder. Only 56% of the apps mentioned bipolar disorder specifically in their title, description, or content. Only one app's efficacy was supported in a peer-reviewed study, and 32 apps lacked privacy policies. The most common features provided were mood tracking, journaling, and psychoeducation. CONCLUSIONS Our analysis reveals substantial limitations in the current digital environment for individuals seeking an evidence-based, clinically usable app for bipolar disorder. Although there have been academic advances in development of digital interventions for bipolar disorder, this work has yet to be translated to the publicly available app marketplace. This unmet need of digital mood management underscores the need for a comprehensive evaluation system of mental health apps, which we have endeavored to provide through our framework and accompanying database (apps.digitalpsych.org).
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Affiliation(s)
- Sarah Lagan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
| | - Abinaya Ramakrishnan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
- Vanderbilt University, Nashville, TN, USA
| | - Evan Lamont
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
- Boston Graduate School of Psychoanalysis, Boston, MA, USA
| | - Aparna Ramakrishnan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
| | | | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA.
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122
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Rodrigues J, Studer E, Streuber S, Meyer N, Sandi C. Locomotion in virtual environments predicts cardiovascular responsiveness to subsequent stressful challenges. Nat Commun 2020; 11:5904. [PMID: 33214564 PMCID: PMC7677550 DOI: 10.1038/s41467-020-19736-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Individuals differ in their physiological responsiveness to stressful challenges, and stress potentiates the development of many diseases. Heart rate variability (HRV), a measure of cardiac vagal break, is emerging as a strong index of physiological stress vulnerability. Thus, it is important to develop tools that identify predictive markers of individual differences in HRV responsiveness without exposing subjects to high stress. Here, using machine learning approaches, we show the strong predictive power of high-dimensional locomotor responses during novelty exploration to predict HRV responsiveness during stress exposure. Locomotor responses are collected in two ecologically valid virtual reality scenarios inspired by the animal literature and stress is elicited and measured in a third threatening virtual scenario. Our model's predictions generalize to other stressful challenges and outperforms other stress prediction instruments, such as anxiety questionnaires. Our study paves the way for the development of behavioral digital phenotyping tools for early detection of stress-vulnerable individuals.
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Affiliation(s)
- João Rodrigues
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland.
| | - Erik Studer
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Stephan Streuber
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Nathalie Meyer
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Carmen Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland.
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A Spotlight on Patient- and Physician-Driven Digital Health and Mobile Innovation in Male Reproductive Medicine. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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124
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Smith SS, Kitterick PT, Scutt P, Baguley DM, Pierzycki RH. An exploration of psychological symptom-based phenotyping of adult cochlear implant users with and without tinnitus using a machine learning approach. PROGRESS IN BRAIN RESEARCH 2020; 260:283-300. [PMID: 33637224 DOI: 10.1016/bs.pbr.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The identification of phenotypes within populations with troublesome tinnitus is an important step towards individualizing tinnitus treatments to achieve optimal outcomes. However, previous application of clustering algorithms has called into question the existence of distinct tinnitus-related phenotypes. In this study, we attempted to characterize patients' symptom-based phenotypes as subpopulations in a Gaussian mixture model (GMM), and subsequently performed a comparison with tinnitus reporting. We were able to effectively evaluate the statistical models using cross-validation to establish the number of phenotypes in the cohort, or a lack thereof. We examined a cohort of adult cochlear implant (CI) users, a patient group for which a relation between psychological symptoms (anxiety, depression, or insomnia) and trouble tinnitus has previously been shown. Accordingly, individual item scores on the Hospital Anxiety and Depression Scale (HADS; 14 items) and the Insomnia Severity Index (ISI; 7 items) were selected as features for training the GMM. The resulting model indicated four symptom-based subpopulations, some primarily linked to one major symptom (e.g., anxiety), and others linked to varying severity across all three symptoms. The presence of tinnitus was self-reported and tinnitus-related handicap was characterized using the Tinnitus Handicap Inventory. Specific symptom profiles were found to be significantly associated with CI users' tinnitus characteristics. GMMs are a promising machine learning tool for identifying psychological symptom-based phenotypes, which may be relevant to determining appropriate tinnitus treatment.
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Affiliation(s)
- Samuel S Smith
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Pádraig T Kitterick
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom
| | - Polly Scutt
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom
| | - David M Baguley
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom
| | - Robert H Pierzycki
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom
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125
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H Birk R, Samuel G. Can digital data diagnose mental health problems? A sociological exploration of 'digital phenotyping'. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1873-1887. [PMID: 32914445 DOI: 10.1111/1467-9566.13175] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 05/11/2023]
Abstract
This paper critically explores the research and development of 'digital phenotyping', which broadly refers to the idea that digital data can measure and predict people's mental health as well as their potential risk for mental ill health. Despite increasing research and efforts to digitally track and predict ill mental health, there has been little sociological and critical engagement with this field. This paper aims to fill this gap by introducing digital phenotyping to the social sciences. We explore the origins of digital phenotyping, the concept of the digital phenotype and its potential for benefit, linking these to broader developments within the field of 'mental health sensing'. We then critically discuss the technology, offering three critiques. First, that there may be assumptions of normality and bias present in the use of algorithms; second, we critique the idea that digital data can act as a proxy for social life; and third that the often biological language employed in this field risks reifying mental health problems. Our aim is not to discredit the scientific work in this area, but rather to call for scientists to remain reflexive in their work, and for more social science engagement in this area.
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Affiliation(s)
- Rasmus H Birk
- Department of Communication & Psychology, Aalborg University, Aalborg, Denmark
| | - Gabrielle Samuel
- Department of Global Health & Social Medicine, King's College London, London, UK
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126
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Lunt H, Heenan HF. Diagnosing the Underlying Cause of Mild Hyperglycemia Using Interstitial Glucose Data. J Diabetes Sci Technol 2020; 14:1139-1140. [PMID: 32462915 PMCID: PMC7645131 DOI: 10.1177/1932296820929369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helen Lunt
- Diabetes Outpatients, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago Christchurch, New Zealand
- Helen Lunt, MD, Diabetes Outpatients, Canterbury District Health Board, 2 Oxford Terrace, Christchurch 8011, New Zealand.
| | - Helen F. Heenan
- Diabetes Outpatients, Canterbury District Health Board, Christchurch, New Zealand
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127
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Low CA. Harnessing consumer smartphone and wearable sensors for clinical cancer research. NPJ Digit Med 2020; 3:140. [PMID: 33134557 PMCID: PMC7591557 DOI: 10.1038/s41746-020-00351-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
As smartphones and consumer wearable devices become more ubiquitous, there is a growing opportunity to capture rich mobile sensor data continuously, passively, and in real-world settings with minimal burden. In the context of cancer, changes in these passively sensed digital biomarkers may reflect meaningful variation in functional status, symptom burden, quality of life, and risk for adverse clinical outcomes. These data could enable real-time remote monitoring of patients between clinical encounters and more proactive, comprehensive, and personalized care. Over the past few years, small studies across a variety of cancer populations support the feasibility and potential clinical value of mobile sensors in oncology. Barriers to implementing mobile sensing in clinical oncology care include the challenges of managing and making sense of continuous sensor data, patient engagement issues, difficulty integrating sensor data into existing electronic health systems and clinical workflows, and ethical and privacy concerns. Multidisciplinary collaboration is needed to develop mobile sensing frameworks that overcome these barriers and that can be implemented at large-scale for remote monitoring of deteriorating health during or after cancer treatment or for promotion and tailoring of lifestyle or symptom management interventions. Leveraging digital technology has the potential to enrich scientific understanding of how cancer and its treatment affect patient lives, to use this understanding to offer more timely and personalized support to patients, and to improve clinical oncology outcomes.
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Affiliation(s)
- Carissa A. Low
- Department of Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213 USA
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128
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Orsolini L, Fiorani M, Volpe U. Digital Phenotyping in Bipolar Disorder: Which Integration with Clinical Endophenotypes and Biomarkers? Int J Mol Sci 2020; 21:ijms21207684. [PMID: 33081393 PMCID: PMC7589576 DOI: 10.3390/ijms21207684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023] Open
Abstract
Bipolar disorder (BD) is a complex neurobiological disorder characterized by a pathologic mood swing. Digital phenotyping, defined as the 'moment-by-moment quantification of the individual-level human phenotype in its own environment', represents a new approach aimed at measuring the human behavior and may theoretically enhance clinicians' capability in early identification, diagnosis, and management of any mental health conditions, including BD. Moreover, a digital phenotyping approach may easily introduce and allow clinicians to perform a more personalized and patient-tailored diagnostic and therapeutic approach, in line with the framework of precision psychiatry. The aim of the present paper is to investigate the role of digital phenotyping in BD. Despite scarce literature published so far, extremely heterogeneous methodological strategies, and limitations, digital phenotyping may represent a grounding research and clinical field in BD, by owning the potentialities to quickly identify, diagnose, longitudinally monitor, and evaluating clinical response and remission to psychotropic drugs. Finally, digital phenotyping might potentially constitute a possible predictive marker for mood disorders.
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129
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Schwartz SM, Wildenhaus K, Bucher A, Byrd B. Digital Twins and the Emerging Science of Self: Implications for Digital Health Experience Design and “Small” Data. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.00031] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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130
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Towards a Personalized Multi-Domain Digital Neurophenotyping Model for the Detection and Treatment of Mood Trajectories. SENSORS 2020; 20:s20205781. [PMID: 33053889 PMCID: PMC7601670 DOI: 10.3390/s20205781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
The commercial availability of many real-life smart sensors, wearables, and mobile apps provides a valuable source of information about a wide range of human behavioral, physiological, and social markers that can be used to infer the user's mental state and mood. However, there are currently no commercial digital products that integrate these psychosocial metrics with the real-time measurement of neural activity. In particular, electroencephalography (EEG) is a well-validated and highly sensitive neuroimaging method that yields robust markers of mood and affective processing, and has been widely used in mental health research for decades. The integration of wearable neuro-sensors into existing multimodal sensor arrays could hold great promise for deep digital neurophenotyping in the detection and personalized treatment of mood disorders. In this paper, we propose a multi-domain digital neurophenotyping model based on the socioecological model of health. The proposed model presents a holistic approach to digital mental health, leveraging recent neuroscientific advances, and could deliver highly personalized diagnoses and treatments. The technological and ethical challenges of this model are discussed.
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131
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Potier R. The Digital Phenotyping Project: A Psychoanalytical and Network Theory Perspective. Front Psychol 2020; 11:1218. [PMID: 32760307 PMCID: PMC7374164 DOI: 10.3389/fpsyg.2020.01218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
A new method of observation is currently emerging in psychiatry, based on data collection and behavioral profiling of smartphone users. Numerical phenotyping is a paradigmatic example. This behavioral investigation method uses computerized measurement tools in order to collect characteristics of different psychiatric disorders. First, it is necessary to contextualize the emergence of these new methods and to question their promises and expectations. The international mental health research framework invites us to reflect on methodological issues and to draw conclusions from certain impasses related to the clinical complexity of this field. From this contextualization, the investigation method relating to digital phenotyping can be questioned in order to identify some of its potentials. These new methods are also an opportunity to test psychoanalysis. It is then necessary to identify the elements of fruitful analysis that clinical experience and research in psychoanalysis have been able to deploy regarding the challenges of digital technology. An analysis of this theme’s literature shows that psychoanalysis facilitates a reflection on the psychological effects related to digital methods. It also shows how it can profit from the research potential offered by new technical tools, considering the progress that has been made over the past 50 years. This cross-fertilization of the potentials and limitations of digital methods in mental health intervention in the context of theoretical issues at the international level invites us to take a resolutely non-reductionist position. In the field of research, psychoanalysis offers a specific perspective that can well be articulated to an epistemology of networks. Rather than aiming at a numerical phenotyping of patients according to the geneticists’ model, the case formulation method appears to be a serious prerequisite to give a limited and specific place to the integration of smartphones in clinical investigation.
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Affiliation(s)
- Rémy Potier
- Department of Psychoanalytic Studies, Institute of Humanities, Sciences and Societies, University of Paris, Paris, France
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132
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Abstract
An estimated 792 million people live with mental health disorders worldwide-more than one in ten people-and this number is expected to grow in the shadow of the Coronavirus disease 2019 (COVID-19) pandemic. Unfortunately, there aren't enough mental health professionals to treat all these people. Can artificial intelligence (AI) help? While many psychiatrists have different views on this question, recent developments suggest AI may change the practice of psychiatry for both clinicians and patients.
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133
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Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020. [PMID: 32304649 DOI: 10.1016/s2115-0366(20)30168-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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134
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Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020; 7:547-560. [PMID: 32304649 PMCID: PMC7159850 DOI: 10.1016/s2215-0366(20)30168-1] [Citation(s) in RCA: 3102] [Impact Index Per Article: 775.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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135
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Godfrey A, Goldsack JC, Tenaerts P, Coravos A, Aranda C, Hussain A, Barreto ME, Young F, Vitorio R. BioMeT and Algorithm Challenges: A Proposed Digital Standardized Evaluation Framework. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:0700108. [PMID: 32542118 PMCID: PMC7292480 DOI: 10.1109/jtehm.2020.2996761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 12/31/2022]
Abstract
Technology is advancing at an extraordinary rate. Continuous flows of novel data are being generated with the potential to revolutionize how we better identify, treat, manage, and prevent disease across therapeutic areas. However, lack of security of confidence in digital health technologies is hampering adoption, particularly for biometric monitoring technologies (BioMeTs) where frontline healthcare professionals are struggling to determine which BioMeTs are fit-for-purpose and in which context. Here, we discuss the challenges to adoption and offer pragmatic guidance regarding BioMeTs, cumulating in a proposed framework to advance their development and deployment in healthcare, health research, and health promotion. Furthermore, the framework proposes a process to establish an audit trail of BioMeTs (hardware and algorithms), to instill trust amongst multidisciplinary users.
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Affiliation(s)
- Alan Godfrey
- Computer and Information Sciences DepartmentNorthumbria UniversityNewcastle upon TyneNE1 8STU.K
| | | | - Pamela Tenaerts
- Clinical Trials Transformation Initiative (CTTI)DurhamNC27701USA
| | - Andrea Coravos
- Elektra LabsBostonMA02108USA
- Harvard-MIT Center for Regulatory ScienceBostonMA02115USA
| | - Clara Aranda
- Groupe Speciale Mobile Association (GSMA)LondonEC4N 8AFU.K
| | - Azid Hussain
- Institute of Translational Medicine (ITM), University of BirminghamBirminghamB15 2THU.K
| | - Marcos E Barreto
- Computer Science DepartmentFederal University of Bahia (UFBA)Salvador40170-110Brazil
| | - Fraser Young
- Computer and Information Sciences DepartmentNorthumbria UniversityNewcastle upon TyneNE1 8STU.K
| | - Rodrigo Vitorio
- School of MedicineOregon Health and Science UniversityPortlandOR97239USA
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136
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Huckvale K, Nicholas J, Torous J, Larsen ME. Smartphone apps for the treatment of mental health conditions: status and considerations. Curr Opin Psychol 2020; 36:65-70. [PMID: 32553848 DOI: 10.1016/j.copsyc.2020.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
Clinical and research interest in the potential of mobile health apps for the management of mental health conditions has recently been given added impetus by growing evidence of consumer adoption. In parallel, there is now a developing evidence base that includes meta-analyses demonstrating reductions in symptoms of depression and anxiety, and reduction in suicidal ideation. While these findings are encouraging, recent research continues to identify a number of potential barriers to the widespread adoption of mental health apps. These challenges include poor data governance and data sharing practices; questions of clinical safety relating to the management of adverse events and potentially harmful content; low levels of user engagement and the possibility of 'digital placebo' effects; and workforce barriers to integration with clinical practice. Current efforts to address these include the development of new models of care, such as 'digital clinics' that integrate health apps. Other contemporary innovations in the field such as digital sensing and just-in-time adaptive interventions are showing early promise for providing accessible and personalised care.
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Affiliation(s)
| | - Jennifer Nicholas
- Orygen, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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137
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Mercurio M, Larsen M, Wisniewski H, Henson P, Lagan S, Torous J. Longitudinal trends in the quality, effectiveness and attributes of highly rated smartphone health apps. EVIDENCE-BASED MENTAL HEALTH 2020; 23:107-111. [PMID: 32312794 PMCID: PMC7418607 DOI: 10.1136/ebmental-2019-300137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Background While there are numerous mental health apps on the market today, less is known about their safety and quality. This study aims to offer a longitudinal perspective on the nature of high visibility apps for common mental health and physical health conditions. Methods In July 2019, we selected the 10 top search-returned apps in the Apple App Store and Android Google Play Store using six keyword terms: depression, anxiety, schizophrenia, addiction, high blood pressure and diabetes. Each app was downloaded by two authors and reviewed by a clinician, and the app was coded for features, functionality, claims, app store properties, and other properties. Results Compared with 1 year prior, there were few statistically significant changes in app privacy policies, evidence and features. However, there was a high rate of turnover with only 34 (57%) of the apps from the Apple’s App Store and 28 (47%) from the Google Play Store remaining in the 2019 top 10 search compared with the 2018 search. Discussion Although there was a high turnover of top search-returned apps between 2018 and 2019, we found that there were few significant changes in features, privacy, medical claims and other properties. This suggests that, although the highly visible and available apps are changing, there were no significant improvements in app quality or safety.
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Affiliation(s)
- Mara Mercurio
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Larsen
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Hannah Wisniewski
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Philip Henson
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sarah Lagan
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - John Torous
- Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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138
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Fagherazzi G. Deep Digital Phenotyping and Digital Twins for Precision Health: Time to Dig Deeper. J Med Internet Res 2020; 22:e16770. [PMID: 32130138 PMCID: PMC7078624 DOI: 10.2196/16770] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/21/2019] [Accepted: 12/21/2019] [Indexed: 12/15/2022] Open
Abstract
This viewpoint describes the urgent need for more large-scale, deep digital phenotyping to advance toward precision health. It describes why and how to combine real-world digital data with clinical data and omics features to identify someone’s digital twin, and how to finally enter the era of patient-centered care and modify the way we view disease management and prevention.
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Affiliation(s)
- Guy Fagherazzi
- Luxembourg Institute of Health, Department of Population Health, Digital Epidemiology Hub, Strassen, Luxembourg
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139
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Spinazze P, Rykov Y, Bottle A, Car J. Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol. BMJ Open 2019; 9:e032255. [PMID: 31892655 PMCID: PMC6955549 DOI: 10.1136/bmjopen-2019-032255] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Rapid advancements in technology and the ubiquity of personal mobile digital devices have brought forth innovative methods of acquiring healthcare data. Smartphones can capture vast amounts of data both passively through inbuilt sensors or connected devices and actively via user engagement. This scoping review aims to evaluate evidence to date on the use of passive digital sensing/phenotyping in assessment and prediction of mental health. METHODS AND ANALYSIS The methodological framework proposed by Arksey and O'Malley will be used to conduct the review following the five-step process. A three-step search strategy will be used: (1) Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms; (2) Comprehensive literature search using all identified keywords, across all relevant electronic databases: IEEE Xplore, MEDLINE, the Cochrane Database of Systematic Reviews, PubMed, the ACM Digital Library and Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index), Scopus and (3) Snowballing approach using the reference and citing lists of all identified key conceptual papers and primary studies. Data will be charted and sorted using a thematic analysis approach. ETHICS AND DISSEMINATION The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal.
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Affiliation(s)
- Pier Spinazze
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
- Public Health & Primary Care, Imperial College London, London, UK
| | - Yuri Rykov
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Alex Bottle
- Primary Care and Social Medicine, Imperial College, London, UK
| | - Josip Car
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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140
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Abstract
PURPOSE OF REVIEW We critically evaluate the future potential of machine learning (ML), deep learning (DL), and artificial intelligence (AI) in precision medicine. The goal of this work is to show progress in ML in digital health, to exemplify future needs and trends, and to identify any essential prerequisites of AI and ML for precision health. RECENT FINDINGS High-throughput technologies are delivering growing volumes of biomedical data, such as large-scale genome-wide sequencing assays; libraries of medical images; or drug perturbation screens of healthy, developing, and diseased tissue. Multi-omics data in biomedicine is deep and complex, offering an opportunity for data-driven insights and automated disease classification. Learning from these data will open our understanding and definition of healthy baselines and disease signatures. State-of-the-art applications of deep neural networks include digital image recognition, single-cell clustering, and virtual drug screens, demonstrating breadths and power of ML in biomedicine. SUMMARY Significantly, AI and systems biology have embraced big data challenges and may enable novel biotechnology-derived therapies to facilitate the implementation of precision medicine approaches.
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Affiliation(s)
- Fabian V. Filipp
- Cancer Systems Biology, Institute of Computational Biology, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 München, Germany
- School of Life Sciences Weihenstephan, Technical University München, Maximus-von-Imhof-Forum 3, 85354 Freising, Germany
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141
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Barnett S, Huckvale K, Christensen H, Venkatesh S, Mouzakis K, Vasa R. Intelligent Sensing to Inform and Learn (InSTIL): A Scalable and Governance-Aware Platform for Universal, Smartphone-Based Digital Phenotyping for Research and Clinical Applications. J Med Internet Res 2019; 21:e16399. [PMID: 31692450 PMCID: PMC6868504 DOI: 10.2196/16399] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
In this viewpoint we describe the architecture of, and design rationale for, a new software platform designed to support the conduct of digital phenotyping research studies. These studies seek to collect passive and active sensor signals from participants' smartphones for the purposes of modelling and predicting health outcomes, with a specific focus on mental health. We also highlight features of the current research landscape that recommend the coordinated development of such platforms, including the significant technical and resource costs of development, and we identify specific considerations relevant to the design of platforms for digital phenotyping. In addition, we describe trade-offs relating to data quality and completeness versus the experience for patients and public users who consent to their devices being used to collect data. We summarize distinctive features of the resulting platform, InSTIL (Intelligent Sensing to Inform and Learn), which includes universal (ie, cross-platform) support for both iOS and Android devices and privacy-preserving mechanisms which, by default, collect only anonymized participant data. We conclude with a discussion of recommendations for future work arising from learning during the development of the platform. The development of the InSTIL platform is a key step towards our research vision of a population-scale, international, digital phenotyping bank. With suitable adoption, the platform will aggregate signals from large numbers of participants and large numbers of research studies to support modelling and machine learning analyses focused on the prediction of mental illness onset and disease trajectories.
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Affiliation(s)
- Scott Barnett
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, Australia
| | - Kit Huckvale
- Black Dog Institute, UNSW Sydney, Randwick, Australia
| | - Helen Christensen
- Black Dog Institute, UNSW Sydney, Randwick, Australia.,Mindgardens Neuroscience Network, Sydney, Australia
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, Australia
| | - Kon Mouzakis
- Black Dog Institute, UNSW Sydney, Randwick, Australia
| | - Rajesh Vasa
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, Australia
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Uhlhaas P, Torous J. Digital tools for youth mental health. NPJ Digit Med 2019; 2:104. [PMID: 31646184 PMCID: PMC6802195 DOI: 10.1038/s41746-019-0181-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Peter Uhlhaas
- 1Institute of Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, G12 8QB Scotland UK.,2Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446 USA
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