Prior conscious experience modulates the impact of audiovisual temporal correspondence on unconscious visual processing.

Conscious visual experiences are enriched by concurrent auditory information, implying audiovisual interactions. In the present study, we investigated how prior conscious experience of auditory and visual information influences the subsequent audiovisual temporal integration under the surface of awareness. We used continuous flash suppression (CFS) to render perceptually invisible a ball-shaped object constantly moving and bouncing inside a square frame window. To examine whether audiovisual temporal correspondence facilitates the ball stimulus to enter awareness, the visual motion was accompanied by click sounds temporally congruent or incongruent with the bounces of the ball. In Experiment 1, where no prior experience of the audiovisual events was given, we found no significant impact of audiovisual correspondence on visual detection time. However, when the temporally congruent or incongruent bounce-sound relations were consciously experienced prior to CFS in Experiment 2, congruent sounds yielded faster detection time compared to incongruent sounds during CFS. In addition, in Experiment 3, explicit processing of the incongruent bounce-sound relation prior to CFS slowed down detection time when the ball bounces became later congruent with sounds during CFS. These findings suggest that audiovisual temporal integration may take place outside of visual awareness though its potency is modulated by previous conscious experiences of the audiovisual events. The results are discussed in light of the framework of multisensory causal inference.

FREE: A randomized controlled feasibility trial of a cognitive behavioral therapy and technology-assisted intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes.

OBJECTIVE: The purpose of this study was to test the preliminary effectiveness of a cognitive behavioral therapy intervention (Fear Reduction Efficacy Evaluation [FREE]) designed to reduce fear of hypoglycemia in young adults with type 1 diabetes. The primary outcome was fear of hypoglycemia, secondary outcomes were A1C, and glycemic variability. METHODS: A randomized clinical trial was used to test an 8-week intervention (FREE) compared to an attention control (diabetes education) in 50 young adults with type 1 diabetes who experienced fear of hypoglycemia at baseline. All participants wore a continuous glucose monitor for the 8-week study period. Self-reported fear of hypoglycemia point-of-care A1C testing, continuous glucose monitor-derived glucose variability were measured at baseline, Week 8, and Week 12 (post-program). RESULTS: Compared to controls, those participating in the FREE intervention experienced a reduction in fear of hypoglycemia (SMD B = -8.52, p = 0.021), change in A1C (SMD B = 0.04, p = 0.841) and glycemic variability (glucose standard deviation SMD B = -2.5, p = 0.545) by the end of the intervention. This represented an 8.52% greater reduction in fear of hypoglycemia. CONCLUSION: A cognitive behavioral therapy intervention (FREE) resulted in improvements in fear of hypoglycemia. CLINICALTRIALS: govNCT03549104.

Audiovisual interactions outside of visual awareness during motion adaptation.

Motion aftereffects (MAEs), illusory motion experienced in a direction opposed to real motion experienced during prior adaptation, have been used to assess audiovisual interactions. In a previous study from our laboratory, we demonstrated that a congruent direction of auditory motion presented concurrently with visual motion during adaptation strengthened the consequent visual MAE, compared to when auditory motion was incongruent in direction. Those judgments of MAE strength, however, could have been influenced by expectations or response bias from mere knowledge of the state of audiovisual congruity during adaptation. To prevent such knowledge, we now employed continuous flash suppression to render visual motion perceptually invisible during adaptation, ensuring that observers were completely unaware of visual adapting motion and only aware of the motion direction of the sound they were hearing. We found a small but statistically significant congruence effect of sound on adaptation strength produced by invisible adaptation motion. After considering alternative explanations for this finding, we conclude that auditory motion can impact the strength of visual processing produced by translational visual motion even when that motion transpires outside of awareness.

Multivariable Automated Insulin Delivery System for Handling Planned and Spontaneous Physical Activities.

BACKGROUND: Hybrid closed-loop control of glucose levels in people with type 1 diabetes mellitus (T1D) is limited by the requirements on users to manually announce physical activity (PA) and meals to the artificial pancreas system. Multivariable automated insulin delivery (mvAID) systems that can handle unannounced PAs and meals without any manual announcements by the user can improve glycemic control by modulating insulin dosing in response to the occurrence and intensity of spontaneous physical activities. METHODS: An mvAID system is developed to supplement the glucose measurements with additional physiological signals from a wristband device, with the signals analyzed using artificial intelligence algorithms to automatically detect the occurrence of PA and estimate its intensity. This additional information gained from the physiological signals enables more proactive insulin dosing adjustments in response to both planned exercise and spontaneous unanticipated physical activities. RESULTS: In silico studies of the mvAID illustrate the safety and efficacy of the system. The mvAID is translated to pilot clinical studies to assess its performance, and the clinical experiments demonstrate an increased time in range and reduced risk of hypoglycemia following unannounced PA and meals. CONCLUSIONS: The mvAID systems can increase the safety and efficacy of insulin delivery in the presence of unannounced physical activities and meals, leading to improved lives and less burden on people with T1D.

Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study.

OBJECTIVE: Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. METHODS: Seventy-six non-shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. RESULTS: Median (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = -9.64, 95% confidence interval [-16.29, -2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = -0.18, 95% confidence interval [-0.32, -0.04]). CONCLUSION: Greater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. DATA AVAILABILITY STATEMENT: Data are available upon a reasonable request to the corresponding author.

Intact Recognition Memory and Altered Hippocampal Glucocorticoid Receptor Signaling in Fkbp5-deficient Mice Following Acute Uncontrollable Stress.

The FK506 binding protein 5 (FKBP5) is a co-chaperone that regulates the activity of the glucocorticoid receptor (GR) and has been reported to mediate stress resilience. This study aimed to determine the effects of Fkbp5 deletion on acute stress-induced recognition memory impairment and hippocampal GR signaling. Wild-type and Fkbp5-knockout mice were subjected to acute uncontrollable stress induced by restraint and electrical tail shock. First, we assessed the cognitive status of mice using a novel object recognition task. Next, we measured plasma corticosterone, GR levels, and the levels of GR phosphorylation at serine 211 in the hippocampus. Wild-type mice exhibited stress-induced memory impairments, whereas Fkbp5-knockout mice did not. Plasma corticosterone and GR levels did not differ between the non-stressed wild-type and Fkbp5-knockout mice, but the levels of phosphorylated GR were lower in Fkbp5-knockout mice than in wild-type mice. Wild-type and Fkbp5-knockout mice showed increased nuclear GR levels following stress, indicating GR translocation. However, cytosolic phosphorylated GR levels were lower in the hippocampi of Fkbp5-knockout mice following stress than in those of wild-type mice. These results suggest that FKBP5 deficiency increases resilience to acute stress by altering GR signaling.

Longitudinal analysis of annual national hemovigilance data to assess pathogen reduced platelet transfusion trends during conversion to routine universal clinical use and 7-day storage.

BACKGROUND: France converted to universal pathogen reduced (PR; amotosalen/UVA) platelets in 2017 and extended platelet component (PC) shelf-life from 5- to 7-days in 2018 and 2019. Annual national hemovigilance (HV) reports characterized longitudinal PC utilization and safety over 11 years, including several years prior to PR adoption as the national standard of care. METHODS: Data were extracted from published annual HV reports. Apheresis and pooled buffy coat [BC] PC use was compared. Transfusion reactions (TRs) were stratified by type, severity, and causality. Trends were assessed for three periods: Baseline (2010-14; ~7% PR), Period 1 ([P1] 2015-17; 8%-21% PR), and Period 2 ([P2] 2018-20; 100% PR). RESULTS: PC use increased by 19.1% between 2010 and 2020. Pooled BC PC production increased from 38.8% to 68.2% of total PCs. Annual changes in PCs issued averaged 2.4% per year at baseline, -0.02% (P1) and 2.8% (P2). The increase in P2 coincided with a reduction in the target platelet dose and extension to 7-day storage. Allergic reactions, alloimmunization, febrile non-hemolytic TRs, immunologic incompatibility, and ineffective transfusions accounted for >90% of TRs. Overall, TR incidence per 100,000 PCs issued declined from 527.9 (2010) to 345.7 (2020). Severe TR rates declined 34.8% between P1-P2. Forty-six transfusion-transmitted bacterial infections (TTBI) were associated with conventional PCs during baseline and P1. No TTBI were associated with amotosalen/UVA PCs. Infections with Hepatitis E (HEV) a non-enveloped virus resistant to PR, were reported in all periods. DISCUSSION: Longitudinal HV analysis demonstrated stable PC utilization trends with reduced patient risk during conversion to universal 7-day amotosalen/UVA PCs.

Bimetallic alloy Ag@Au nanorings with hollow dual-rims focus near-field on circular intra-nanogaps.

Here, we report a highly sensitive and reliable surface enhanced Raman scattering (SERS)-based immunoassay using bimetallic alloy Ag@Au hollow dual-rim nanorings (DRNs) where two hollow nanorings with different diameters are concentrically overlapped and connected by thin metal ligaments, forming circular hot-zones in the intra-nanogaps between the inner and outer rims. Pt DRNs were first prepared, and then Ag was deposited on the surface of the Pt skeleton, followed by Au coating, resulting in alloy Ag@Au hollow DRNs. The chemical stability of Au and the high optical properties of Ag are incorporated into a single entity, Ag@Au hollow DRNs, enabling strong single-particle SERS activity and biocompatibility through surface modification with thiol-containing functionalities. When Ag@Au hollow DRNs were utilized as nanoprobes for detecting human chorionic gonadotropin (HCG) hormone through a SERS-based immunoassay, a very low limit of detection of 10 pM with high reliability was achieved, strongly indicating their advantage as ultrasensitive SERS nanoprobes.

Plasmonic Cyclic Au Nanosphere Hexamers.

Rational design of plasmonic colloidal assemblies via bottom-up synthesis is challenging but would show unprecedented optical properties that strongly relate to the assembly's shape and spatial arrangement. Herein, the synthesis of plasmonic cyclic Au nanosphere hexamers (PCHs) is reported, wherein six Au nanospheres (Au NSs) are connected via thin metal ligaments. By tuning Au reduction, six dangling Au NSs are interconnected with a core hexagon nanoplate (NPL). Then, Pt atoms are selectively deposited on the edges of the spheres. After etching of the core, necklace-like nanostructures of Pt framework are obtained. Deposition of Au is followed, leading to PCHs in high yield (≈90%). Notably, PCHs exhibit the combinatorial plasmonic characteristics of individual Au NSs and the in-plane coupling of the six linked Au NSs. They yield highly uniform, reproducible, and polarization-independent single-particle surface-enhanced Raman scattering signals, which are attributed to the 2-dimensional isotropic alignment of the Au NSs. Those are applied to a SERS-based immunoassay as quantitative and qualitative single particle SERS nanoprobes. This assay shows a low limit-of-detection, down to 100 pm, which is orders of magnitude lower than those based on Au NSs, and one order of magnitude lower than an assay using analogous particles of smooth Au nanorings.

A physical activity-intensity driven glycemic model for type 1 diabetes.

BACKGROUND AND OBJECTIVE: The glucose response to physical activity for a person with type 1 diabetes (T1D) depends upon the intensity and duration of the physical activity, plasma insulin concentrations, and the individual physical fitness level. To accurately model the glycemic response to physical activity, these factors must be considered. METHODS: Several physiological models describing the glycemic response to physical activity are proposed by incorporating model terms proportional to the physical activity intensity and duration describing endogenous glucose production (EGP), glucose utilization, and glucose transfer from the plasma to tissues. Leveraging clinical data of T1D during physical activity, each model fit is assessed. RESULTS: The proposed model with terms accommodating EGP, glucose transfer, and insulin-independent glucose utilization allow for an improved simulation of physical activity glycemic responses with the greatest reduction in model error (mean absolute percentage error: 16.11 ± 4.82 vs. 19.49 ± 5.87, p = 0.002). CONCLUSIONS: The development of a physiologically plausible model with model terms representing each major contributor to glucose metabolism during physical activity can outperform traditional models with physical activity described through glucose utilization alone. This model accurately describes the relation of plasma insulin and physical activity intensity on glucose production and glucose utilization to generate the appropriately increasing, decreasing or stable glucose response for each physical activity condition. The proposed model will enable the in silico evaluation of automated insulin dosing algorithms designed to mitigate the effects of physical activity with the appropriate relationship between the reduction in basal insulin and the corresponding glycemic excursion.

Sleep optimization to improve glycemic control in adults with type 1 diabetes: study protocol for a randomized controlled parallel intervention trial.

BACKGROUND: Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets. Sleep is increasingly recognized as a potentially modifiable target for improving glycemic control. Diabetes distress, poor self-management behaviors, and reduced quality of life have also been linked to sleep variability and insufficient sleep duration. A significant gap of knowledge exists regarding interventions to improve sleep and the effects of sleep optimization on glycemic control in T1D. The purpose of this study is to determine the efficacy of a T1D-specific sleep optimization intervention (Sleep-Opt) on the primary outcomes of sleep variability, sleep duration, and glycemic control (A1C); other glycemic parameters (glycemic variability, time-in-range [TIR]); diabetes distress; self-management behaviors; quality of life; and other patient-reported outcomes in adults with T1D and habitual increased sleep variability or short sleep duration. METHODS: A randomized controlled parallel-arm study will be employed in 120 adults (aged 18 to 65 years) with T1D. Participants will be screened for habitual sleep variability (> 1 h/week) or insufficient sleep duration (< 6.5 h per night). Eligible subjects will be randomized to the Sleep-Opt intervention group or healthy living attention control group for 12 weeks. A 1-week run-in period is planned, with baseline measures of sleep by actigraphy (sleep variability and duration), glycemia (A1C and related glycemic measures: glycemic variability and TIR using continuous glucose monitoring), and other secondary outcomes: diabetes distress, self-management behaviors, quality of life, and additional patient-reported outcomes. Sleep-Opt is a technology-assisted behavioral sleep intervention that we recently developed that leverages the rapidly increasing public interest in sleep tracking. Our behavioral intervention employs four elements: a wearable sleep tracker, didactic content, an interactive smartphone application, and brief telephone counseling. The attention control group will participate in a healthy living information program. Baseline measures will be repeated at midpoint, program completion, and post-program (weeks 6, 12, and 24, respectively) to determine differences between the two groups and sustainability of the intervention. DISCUSSION: A better understanding of strategies to improve sleep in persons with T1D has the potential to be an important component of diabetes. TRIAL REGISTRATION: Clinical Trial Registration: NCT04506151 .

Heterogeneous Component Au (Outer)-Pt (Middle)-Au (Inner) Nanorings: Synthesis and Vibrational Characterization on Middle Pt Nanorings with Surface-Enhanced Raman Scattering.

We report a synthetic approach for heterometallic (Au-Pt-Au) nanorings with intertwined triple rings (NITs), wherein three differently sized metal circular nanorings concentrically overlap in a single entity. The synthetic method allows one to control the component of core nanorings (Au or Pt) with a tunable gap distance. The narrow circular nanogaps between inner and outer Au rings strongly enhance the electromagnetic near-field via intraparticle coupling of localized surface plasmon resonance, which realizes surface-enhanced Raman scattering (SERS) at the single-particle level. Importantly, when the component of the middle ring is Pt, in situ SERS measurement for electrochemical reactions on Pt domains could be monitored with electrochemical potential variations due to the near-field focusing that is assisted by plasmonically active inner and outer Au nanorings, which is not feasible with pure Pt nanoparticle systems. The resulting NIT systems are robust and may benefit the synthesis of complicated nanostructures, giving myriad applications.

Complex Shapes Are Bluish, Darker, and More Saturated; Shape-Color Correspondence in 3D Object Perception.

It has been shown that there is a non-random association between shape and color. However, the results of previous studies on the shape-color correspondence did not converge. To address the issue, we focused on shape complexity among a number of shape properties, particularly in terms of 3D shape, and parametrically manipulated the shape complexity and all three components of color. With two experiments, the current study aimed to closely examine the correspondence between shape complexity of 3D shape and color in terms of hue (Experiment 1), luminance, and saturation (Experiment 2). Participants were presented with the 3D shapes in either visual or visuo-haptic modes of exploration. Subsequently, they had to pick from a color palette the color best matching each shape of the object. In Experiment 1, we found that as shapes became more complex, the best associated hue changed from those with long wavelengths to ones with short wavelengths. Results of Experiment 2 demonstrated that as the shapes grew more complex, the associated luminance decreased, and saturation increased. Additionally, adding haptic exploration to visual exploration strengthened the association - for saturation in particular - with the pattern of shape-color correspondence maintained. Taken together, we demonstrated that complex shapes are associated with bluish, darker and more saturated colors, suggesting that shape complexity has a systematic relationship with color including hue, luminance, and saturation.

Ring-in-a-Triangle Nanoframes: Integrating with Intra- and Interhotspots for Highly Amplified Near-Field Focusing.

The development of a stepwise synthetic strategy for Au ring-in-a-triangle nanoframes with a high degree of structural solidity is essential to the advancement of highly amplified near-field focusing. This strategy leads to the formation of an inscribed nanoring in a triangular metal frame with stability to withstand elevated temperatures and an oxidizing environment, which is critical for successful single-particle surface-enhanced Raman scattering (SERS). The existence of inscribed nanorings plays an important role in enhancing the so-called "lightning rod effect," whereby the electromagnetic near-field enhancement occurs on the highly curved curvature of a metallic interface. We evaluated the corresponding single-particle SERS as a function of the thickness of the rims and then constructed two-dimensional (2D) bulk SERS substrates, wherein an ensemble of hotspots exists. The synergic contribution from both inter- and intrahotspots allowed the outstanding linearity of the calibration curve and the lowest limit of detection, ∼10-18 M for the analyte concentration.

Healthcare Professionals' Perceptions of Function-Focused Care Education for Nursing Home Practitioners.

A nursing home (NH) care environment necessitates a shared cognition-based education model that maintains effective function-focused care (FFC). This study's aim was to explore healthcare professionals' perceptions of function-focused care education for the development of an education model using a shared mental model (SMM) in NHs. Semi-structured interviews with 30 interdisciplinary practitioners from four different professions (nurses, physical therapists, occupational therapists, and social workers) and focus group interviews with 12 experts were conducted. Data were analyzed using content analysis, and the education model development was guided by the shared mental models for data interpretation and formation. Our FFC interdisciplinary educational model incorporates four key learning components: learning contents, educational activities, educational goals/outcome, and environment, and four types of SMMs: team, task, team interaction, and equipment. As for educational contents, a team's competencies with FFC were found to be team knowledge (physical and psychosocial functional care), team skills to perform FFC successfully (motivation, coaching and supporting, managing discomfort), and team attitude (possessing philosophy perceptions regarding FFC). As for learning outcomes, the shared cognition-based education model suggests not only the evaluation of practitioners, but also the assessment of residents' aspects.

Suppression of Osteoarthritis progression by post-natal Induction of Nkx3.2.

Osteoarthritis (OA) is an incurable joint disease affecting 240 million elderly population, and major unmet medical needs exist for better therapeutic options for OA. During skeletal development, Nkx3.2 has been shown to promote chondrocyte differentiation and survival, but to suppress cartilage hypertrophy and blood vessel invasion. Here we show that Nkx3.2 plays a key role in osteoarthritis (OA) pathogenesis. Marked reduction of Nkx3.2 expression was observed in three different murine OA models. Consistent with these findings, analyses of surgery-induced and age-driven OA models revealed that cartilage-specific post-natal induction of Nkx3.2 can suppress OA progression in mice. These results suggest that Nkx3.2 may serve as a promising target for OA drug development.

Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes.

AIMS/HYPOTHESIS: Suboptimal subjective sleep quality is very common in adults with type 1 diabetes. Reducing glycaemic variability is a key objective in this population. To date, no prior studies have examined the associations between objectively measured sleep quality and overnight glycaemic variability in adults with type 1 diabetes. We aimed to test the hypothesis that poor sleep quality would be associated with greater overnight glycaemic variability. METHODS: Data were collected in the home setting from 20 adults (ten male and ten female participants) with type 1 diabetes who were current insulin pump users. Simultaneous assessments of objective sleep quality (Zmachine Insight+) and continuous glucose monitoring (CGM) were performed over multiple nights (up to 15 nights) in each participant. Due to the real-life nature of this study, the participants kept their usual CGM alerts for out-of-range glucose values. Sleep quality was categorised as 'good' or 'poor' using a composite of objective sleep features (i.e. sleep efficiency, wake after sleep onset and number of awakenings) based on the National Sleep Foundation's consensus criteria. Glycaemic variability was quantified using SD and CV of overnight glucose values based on overnight CGM profiles. RESULTS: A total of 170 nights were analysed. Overall, 86 (51%) nights were categorised as good sleep quality, and 84 (49%) nights were categorised as poor sleep quality. Using linear mixed-effects models, poor sleep quality was significantly associated with greater glycaemic variability as quantified by SD (coefficient: 0.39 [95% CI 0.10, 0.67], p = 0.009) and CV (coefficient: 4.35 [95% CI 0.8, 7.9], p = 0.02) of overnight glucose values, after accounting for age, sex, BMI and overnight insulin dose. There was large inter- and intra-individual variability in sleep and glycaemic characteristics. Both pooled and individual-level data revealed that the nights with poor sleep quality had larger SDs and CVs, and, conversely, the nights with good sleep quality had smaller SDs and CVs. No associations were found between sleep quality and time spent in the target glucose range, or above or below the target glucose range, where CGM alarms are most likely to occur. CONCLUSIONS/INTERPRETATION: Objectively measured sleep quality is associated with overnight glycaemic variability in adults with type 1 diabetes. These findings highlight an important role of sleep quality in overnight glycaemic control in type 1 diabetes. They also provide a strong incentive to both patients and healthcare providers for considering sleep quality in personalised type 1 diabetes glycaemic management plans. Future studies should investigate the mechanisms linking sleep quality to glycaemic variability.

Physical Activity and Psychological Stress Detection and Assessment of Their Effects on Glucose Concentration Predictions in Diabetes Management.

OBJECTIVE: Continuous glucose monitoring (CGM) enables prediction of the future glucose concentration (GC) trajectory for making informed diabetes management decisions. The glucose concentration values are affected by various physiological and metabolic variations, such as physical activity (PA) and acute psychological stress (APS), in addition to meals and insulin. In this work, we extend our adaptive glucose modeling framework to incorporate the effects of PA and APS on the GC predictions. METHODS: A wristband conducive of use by free-living ambulatory people is used. The measured physiological variables are analyzed to generate new quantifiable input features for PA and APS. Machine learning techniques estimate the type and intensity of the PA and APS when they occur individually and concurrently. Variables quantifying the characteristics of both PA and APS are integrated as exogenous inputs in an adaptive system identification technique for enhancing the accuracy of GC predictions. Data from clinical experiments illustrate the improvement in GC prediction accuracy. RESULTS: The average mean absolute error (MAE) of one-hour-ahead GC predictions with testing data decreases from 35.1 to 31.9 mg/dL (p-value = 0.01) with the inclusion of PA information, and it decreases from 16.9 to 14.2 mg/dL (p-value = 0.006) with the inclusion of PA and APS information. CONCLUSION: The first-ever glucose prediction model is developed that incorporates measures of physical activity and acute psychological stress to improve GC prediction accuracy. SIGNIFICANCE: Modeling the effects of physical activity and acute psychological stress on glucose concentration values will improve diabetes management and enable informed meal, activity and insulin dosing decisions.

Discrimination of simultaneous psychological and physical stressors using wristband biosignals.

BACKGROUND AND OBJECTIVE: In this work, we address the problem of detecting and discriminating acute psychological stress (APS) in the presence of concurrent physical activity (PA) using wristband biosignals. We focused on signals available from wearable devices that can be worn in daily life because the ultimate objective of this work is to provide APS and PA information in real-time management of chronic conditions such as diabetes by automated personalized insulin delivery. Monitoring APS noninvasively throughout free-living conditions remains challenging because the responses to APS and PA of many physiological variables measured by wearable devices are similar. METHODS: Various classification algorithms are compared to simultaneously detect and discriminate the PA (sedentary state, treadmill running, and stationary bike) and the type of APS (non-stress state, mental stress, and emotional anxiety). The impact of APS inducements is verified with commonly used self-reported questionnaires (The State-Trait Anxiety Inventory (STAI)). To aid the classification algorithms, novel features are generated from the physiological variables reported by a wristband device during 117 hours of experiments involving simultaneous APS inducement and PA. We also translate the APS assessment into a quantitative metric for use in predicting the adverse outcomes. RESULTS: An accurate classification of the concurrent PA and APS states is achieved with an overall classification accuracy of 99% for PA and 92% for APS. The average accuracy of APS detection during sedentary state, treadmill running, and stationary bike is 97.3, 94.1, and 84.5%, respectively. CONCLUSIONS: The simultaneous assessment of APS and PA throughout free-living conditions from a convenient wristband device is useful for monitoring the factors contributing to an elevated risk of acute events in people with chronic diseases like cardiovascular complications and diabetes.