Heart Rate Variability-Measured Stress and Academic Achievement in Medical Students

Wearable Biosensor Technology in Education: A Systematic Review

Wearable Biosensor Technology (WBT) has emerged as a transformative tool in the educational system over the past decade. This systematic review encompasses a comprehensive analysis of WBT utilization in educational settings over a 10-year span (2012-2022), highlighting the evolution of this field to address challenges in education by integrating technology to solve specific educational challenges, such as enhancing student engagement, monitoring stress and cognitive load, improving learning experiences, and providing real-time feedback for both students and educators. By exploring these aspects, this review sheds light on the potential implications of WBT on the future of learning. A rigorous and systematic search of major academic databases, including Google Scholar and Scopus, was conducted in accordance with the PRISMA guidelines. Relevant studies were selected based on predefined inclusion and exclusion criteria. The articles selected were assessed for methodological quality and bias using established tools. The process of data extraction and synthesis followed a structured framework. Key findings include the shift from theoretical exploration to practical implementation, with EEG being the predominant measurement, aiming to explore mental states, physiological constructs, and teaching effectiveness. Wearable biosensors are significantly impacting the educational field, serving as an important resource for educators and a tool for students. Their application has the potential to transform and optimize academic practices through sensors that capture biometric data, enabling the implementation of metrics and models to understand the development and performance of students and professors in an academic environment, as well as to gain insights into the learning process.

Nursing students' perceived anxiety and heart rate variability in mock skill competency assessment

BACKGROUND

Skill competency assessments induce stress and anxiety and may affect nursing student performance. Little is known about stress and perceived anxiety levels and their relationship in the mock skill competency assessment.

METHODS

A cross-sectional study was conducted to examine the stress levels (as assessed by heart rate variability, HRV) and perceived anxiety before, during and after the mock skill competency assessment, and to explore their relationships to performance in a total of ninety first-year undergraduate nursing students.

RESULTS

The HRV decreased significantly during the assessment and increased significantly 10 min after the assessment (p < 0.01). Higher performers showed significantly lower HRV during and after the assessment (p < 0.01). The assessment score was negatively correlated with HRV during and after the assessment (p < 0.05).

CONCLUSIONS

Considering assessment-related stress and anxiety through a mock assessment prior to the actual skill assessment provides implications for future nursing education.

Influence of COVID-19 on Stress at Work During the First Wave of the Pandemic Among Emergency Health Care Workers

OBJECTIVES

For more than 2 years, coronavirus disease (COVID-19) has forced worldwide health care systems to adapt their daily practice. These adaptations add to the already stressful demands of providing timely medical care in an overcrowded health care system. Specifically, the COVID-19 pandemic added stress to an already overwhelmed emergency and critical care health care workers (HCWs) on the front lines during the first wave of the pandemic.This study assessed comparative subjective and objective stress among frontline HCWs using a visual analog scale and biometric data, specifically heart rate variability (HRV).

METHODS

This is a prospective, observational study using surveys and heart rate monitoring among HCWs who work in 3 frontline health care units (emergency department, mobile intensive care unit, and intensive care unit) in the University Hospital of Clermont-Ferrand, France. Two sessions were performed: 1 during the first wave of the pandemic (April 10 to May 10, 2020) and 1 after the first wave of the pandemic (June 10 to July 15, 2020).The primary outcome is the difference in stress levels between the 2 time points. Secondary objectives were the impact of overcrowding, sociodemographics, and other variables on stress levels. We also assessed the correlation between subjective and objective stress levels.

RESULTS

Among 199 HCWs, 98 participated in biometric monitoring, 84 had biometric and survey data, and 12 with only biometric data. Subjective stress was higher during the second time point compared to the first (4.39 ± 2.11 vs 3.16 ± 2.34, P = 0.23). There were higher objective stress levels with a decrease in HRV between the first and the second time points. Furthermore, we found higher patient volumes as a source of stress during the second time point. We did not find any significant correlation between subjective and objective stress levels.

CONCLUSION

HCWs had higher stress levels between the 2 waves of the pandemic. Overcrowding in the emergency department is associated with higher stress levels. We did not find any correlation between subjective and objective stress among intensive care and emergency HCWs during the first wave of the pandemic.

Interactive teaching enhances students' physiological arousal during online learning

The pure transfer of face-to-face teaching to a digital learning environment can be accompanied by a significant reduction in the physiological arousal of students, which in turn can be associated with passivity during the learning process, often linked to insufficient levels of concentration and engagement in the course work. Therefore, the aim of this study was to investigate whether students' psychobiological stress responses can be enhanced in the context of anatomical online learning and how increased physiological parameters correlate with characteristics of learning experiences in a digital learning environment. Healthy first-year medical students (n = 104) experienced a regular practical course in Microscopic Anatomy either in face-to-face learning, in passive online learning or in an interaction-enhanced version of online learning. Compared to passive online learning, students engaged in the interaction-enhanced version of online learning displayed a significantly reduced Heart Rate Variability (P 0.001, partial η² = 0.381) along with a strong increase in salivary cortisol (P 0.001, partial η² = 0.179) and salivary alpha-amylase activity (P 0.001, partial η² = 0.195). These results demonstrated that the physiological arousal of students engaged in online learning can be enhanced via interactive teaching methods and pointed towards clear correlations between higher physiological responses and elementary criteria of learning experience such as engagement and attention.

Validity and Reliability of Short-Term Heart Rate Variability Parameters in Older People in Response to Physical Exercise

BACKGROUND

Currently, and to the best of our knowledge, there is no standardized protocol to measure the effect of low- to moderate-intensity physical exercise on autonomic modulation focused in older people.

AIM

Validate a test-retest short-term exercise protocol for measuring the autonomic response through HRV in older people.

METHODS

A test-retest study design was used. The participants were selected through intentional non-probabilistic sampling. A total of 105 older people (male: 21.9%; female: 78.1%) were recruited from a local community. The assessment protocol evaluated HRV before and immediately after the 2-min step test. It was performed twice on the same day, considering a time of three chronological hours between the two measurements.

RESULTS

The posterior distribution of estimated responses in the Bayesian framework suggests moderate to strong evidence favoring a null effect between measurements. In addition, there was moderate to robust agreement between heart rate variability (HRV) indices and assessments, except for low frequency and very low frequency, which showed weak agreement.

CONCLUSIONS

Our results provide moderate to strong evidence for using HRV to measure cardiac autonomic response to moderate exercise, suggesting that it is sufficiently reliable to show similar results to those shown in this test-retest protocol.

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Decreased sympathetic cardiovascular influences and hormone-physiological changes in response to Covid-19-related adaptations under different learning environments

To examine the implications of the transition from face-to-face to online learning from a psychobiological perspective, this study investigated potential differences in physiological stress parameters of students engaged in online or face-to-face learning and determined whether these can be identified as possible mediators between learning experience and achievement emotions. In a randomized experimental field study, medical students (n = 82) attended either regular face-to-face classes of the microscopic anatomy course or the same practical course online using Zoom videoconferencing platform. The present study investigated Heart Rate Variability (HRV) and salivary cortisol concentration as stress correlates, within the contexts of online and face-to-face learning and compared these parameters with a control group that was measured at rest. Additionally, participants completed a standardized questionnaire about their experienced emotions in relation to task achievement and subjective stress levels. A significant reduction in HRV was found in face-to-face learning, suggesting stronger stress responses in the face-to-face learning environment (η²  = 0.421, P < 0.001). Furthermore, participants engaged in face-to-face learning showed significantly higher cortisol concentrations (η²  = 0.115, P = 0.032). Additionally, increased sympathetic activation correlated with the discrete positive emotion of enjoyment exclusively within the face-to-face condition (r = 0.365, P = 0.043). These results indicate that the transfer of a face-to-face practical course in microscopic anatomy to an online learning environment is associated with decreased sympathetic and enhanced vagal cardiovascular influences, together with lower cortisol concentrations in healthy medical students.

Quantitative analysis of heart rate variability parameter and mental stress index

Background

Cardiovascular disease not only occurs in the elderly but also tends to become a common social health problem. Considering the fast pace of modern life, quantified heart rate variability (HRV) indicators combined with the convenience of wearable devices are of great significance for intelligent telemedicine. To quantify the changes in human mental state, this article proposes an improved differential threshold algorithm for R-wave detection and recognition of electrocardiogram (ECG) signals.

Methods

HRV is a specific quantitative indicator of autonomic nerve regulation of the heart. The recognition rate is increased by improving the starting position of R wave and the time-window function of the traditional differential threshold method. The experimental platform is a wearable sign monitoring system constructed based on body area networks (BAN) technology. Analytic hierarchy process (AHP) is used to construct the mental stress assessment model, the weight judgment matrix is constructed according to the influence degree of HRV analysis parameters on mental stress, and the consistency check is carried out to obtain the weight value of the corresponding HRV analysis parameters.

Results

Experimental results show that the recognition rate of R wave of real-time 5 min ECG data collected by this algorithm is >99%. The comprehensive index of HRV based on weight matrix can greatly reduce the deviation caused by the measurement error of each parameter. Compared with traditional characteristic wave recognition algorithms, the proposed algorithm simplifies the process, has high real-time performance, and is suitable for wearable analysis devices with low-configuration requirements.

Conclusion

Our algorithm can describe the mental stress of the body quantitatively and meet the requirements of application demonstration.

Nurse evaluation of stress levels during CPR training with heart rate variability using smartwatches according to their personality: A prospective, observational study

Background

Cardiopulmonary resuscitation (CPR) is a very critical phenomenon, and to prepare for it, most nurses undertake simulation training, during which learners’ stress levels should be managed. This study aims to evaluate nurses’ stress levels during CPR simulation training using heart rate variability (HRV) measured with a smartwatch and to determine the correlation between individual personality traits and stress levels.

Methods

This prospective observational study was conducted from July 2020 to December 2021. For nurses participating in advanced life support training with more than six months of clinical experience, their stress levels while performing as a CPR team leader were measured. Regarding stress levels, heart rate data measured with a smartwatch were processed using Kubios HRV Standard software to generate HRV parameters. The personality of participants was evaluated using the Big Five personality test. The degree of stress according to personality was determined using HRV parameters. Consequently, the correlation between personality and stress according to the clinical experience of cardiac arrest was analyzed.

Results

Of the 132 participants, 91.7% were female, and the median age of the sample was 27 years. Agreeable personality had the highest score (32.84±3.83). LF power (r = 0.18, p = 0.04) and HF power (r = 0.20, p = 0.02) showed a significant positive correlation with the agreeableness trait. In subgroup analysis according to the cardiac arrest experience, the agreeableness trait had a positive correlation with a standard deviation of NN intervals (r = 0.24, p = 0.01), root-mean-square of successive differences (r = 0.23, p = 0.02), LF Power (r = 0.26, p = 0.01), and HF power (r = 0.23, p = 0.02), but a negative correlation with mean HR (r = -0.22, p = 0.03).

Conclusion

The clinical experience in cardiac arrest and agreeableness were related to acute stress during training. In the future, it is necessary to apply a scenario of a level suitable for individual personality and experience, and evaluate the level and achievement of students.

A Virtual Reality and Online Learning Immersion Experience Evaluation Model Based on SVM and Wearable Recordings

The increasing development in the field of biosensing technologies makes it feasible to monitor students’ physiological signals in natural learning scenarios. With the rise of mobile learning, educators are attaching greater importance to the learning immersion experience of students, especially with the global background of COVID-19. However, traditional methods, such as questionnaires and scales, to evaluate the learning immersion experience are greatly influenced by individuals’ subjective factors. Herein, our research aims to explore the relationship and mechanism between human physiological recordings and learning immersion experiences to eliminate subjectivity as much as possible. We collected electroencephalogram and photoplethysmographic signals, as well as self-reports on the immersive experience of thirty-seven college students during virtual reality and online learning to form the fundamental feature set. Then, we proposed an evaluation model based on a support vector machine and got a precision accuracy of 89.72%. Our research results provide evidence supporting the possibility of predicting students’ learning immersion experience by their EEGs and PPGs.

Volatile Components of the Kuromoji Essential Oil (Lindera umbellata Thunb.) and the Utilization for Touch Care Treatment

The volatile components of kuromoji oil (Lindera umbellata Thunb.) obtained in Shizuoka Pref. were analyzed by GC/MS. Linalool, α-pinene, limonene, camphene, cis- and trans-dihydrocarvone, 1,8-cineol, 4-terpinenol, α-terpineol, piperitone, geranyl acetate, geraniol, and trans-nerolidol were identified as major components. Using enantio-MDGC-MS, the enantiomeric ratio ((R)-(-) vs (S)-(+)) of linalool in this oil was determined to be 67.8/32.2. Touch care treatment while sniffing this oil was done on cancer patients. We found that the relaxation effect persisted longer after the treatment compared to treatment without aroma.