Medicine and Health Sciences Commons^™

The Shifting Landscape Of Adolescent Wellness In Boarding Schools: Can Time Spent Off Screens And Outdoors Improve Adolescent Wellbeing?, Kristen H. Peterson

Dartmouth College Master’s Theses

For nearly twenty years I have worked directly with adolescents as an independent school educator. Whether in the classroom, on the field, or in the dorm, I have observed and supported students through their middle and high school experiences. During this time, I have witnessed an alarming shift in adolescent physical, emotional, and social wellbeing. Concurrently, I have observed a dramatic increase in the amount of time students spend using screen-based devices, and a decrease in their time spent outdoors.

Using research to ground my anecdotal accounts in empirical understanding, my thesis examines whether or not screen use might help …

Connecting Linguistic Expressions And Pain Relief Through Transformer Model Construction And Analysis, Sarah M. Chacko

Computer Science Senior Theses

Chronic pain is a widespread problem that significantly impacts quality of life. Overprescription and abuse of pain medication continues to be a major public health issue and can further burden patients due to a fragmented health care system. Previous research has suggested a possible psychological basis to pain and the potential for safer, non-pharmacological alternatives for pain relief. This project leverages language models to study chronic pain development and relief through psychological treatments, which will be assessed through responses to post-treatment interviews. A transformer-based natural language processing model is employed to identify connections between language expressions and pain on a …

A Smartwatch Step-Counting App For Older Adults: Development And Evaluation Study, George Boateng, Curtis L. Petersen, David Kotz, Karen L. Fortuna, Rebecca Masutani, John A. Batsis

Dartmouth Scholarship

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have …

Leveraging Context Patterns For Medical Entity Classification, Garrett Johnston

Computer Science Senior Theses

The ability of patients to understand health-related text is important for optimal health outcomes. A system that can automatically annotate medical entities could help patients better understand health-related text. Such a system would also accelerate manual data annotation for this low-resource domain as well as assist in down- stream medical NLP tasks such as finding textual similarity, identifying conflicting medical advice, and aspect-based sentiment analysis. In this work, we investigate a state-of-the-art entity set expansion model, BootstrapNet, for the task of medical entity classification on a new dataset of medical advice text. We also propose EP SBERT, a simple model …

The Feasibility And Utility Of Harnessing Digital Health To Understand Clinical Trajectories In Medication Treatment For Opioid Use Disorder: D-Tect Study Design And Methodological Considerations, Lisa A. Marsch, Ching-Hua Chen, Sara R. Adams, Asma Asyyed, Monique B. Does, Saeed Hassanpour, Emily Hichborn, Melanie Jackson-Morris, Nicholas C. Jacobson, Heather K. Jones, David Kotz, Chantal A. Lambert-Harris, Zhiguo Li, Bethany Mcleman, Varun Mishra, Catherine Stanger, Geetha Subramaniam, Weiyi Wu, Cynthia I. Campbell

Dartmouth Scholarship

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid …

The Three-Way Interplay Among Early Life Exposures, The Gut Microbiome, And Outcomes In Infancy, Yuka Moroishi

Dartmouth College Ph.D Dissertations

The bidirectional relationship between the gut microbiome and immune system plays an important role in host immune status: the immune system provides the gut microbiome the optimal environment to thrive in, and the gut microbiome helps regulate the immune system. This relationship is especially important in infants, whose immune system is still premature and rely on innate immunity.

We investigated the three-way interplay among early-life exposures, the developing gut microbiome, and outcomes in infancy from the general population in New Hampshire, US. We used prospective cohort data from the New Hampshire Birth Cohort study to 1) determine whether timing of …

The Discrete-Event Modeling Of Administrative Claims (Demac) System: Dynamically Modeling The U.S. Healthcare Delivery System With Medicare Claims Data To Improve End-Of-Life Care, Rachael Chacko

Dartmouth College Undergraduate Theses

The shift of the U.S. healthcare delivery system from the treatment of acute conditions to chronic diseases requires a new method of healthcare system analysis to properly assess end- of-life (EOL) quality throughout the country. In this paper, we propose the Discrete-Event Modeling of Administrative Claims (DEMAC) system, which relies on a hetero-functional graph theory and discrete event-driven framework to dynamically model EOL care on multiple levels. The heat map visualizations produced by the DEMAC system enable the elucidation of not only patient-specific EOL care but also broader treatment patterns among providers and hospitals. As a whole, the DEMAC system …

Detecting Receptivity For Mhealth Interventions In The Natural Environment, Varun Mishra, Florian Künzler, Jan-Niklas Kramer, Elgar Fleisch, Tobias Kowatsch, David Kotz

Dartmouth Scholarship

Just-In-Time Adaptive Intervention (JITAI) is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user's receptivity. To this end, …

When Do Drivers Interact With In-Vehicle Well-Being Interventions? An Exploratory Analysis Of A Longitudinal Study On Public Roads, Kevin Koch, Varun Mishra, Shu Liu, Thomas Berger, Elgar Fleisch, David Kotz, Felix Wortmann

Dartmouth Scholarship

Recent developments of novel in-vehicle interventions show the potential to transform the otherwise routine and mundane task of commuting into opportunities to improve the drivers' health and well-being. Prior research has explored the effectiveness of various in-vehicle interventions and has identified moments in which drivers could be interruptible to interventions. All the previous studies, however, were conducted in either simulated or constrained real-world driving scenarios on a pre-determined route. In this paper, we take a step forward and evaluate when drivers interact with in-vehicle interventions in unconstrained free-living conditions.

To this end, we conducted a two-month longitudinal study with 10 …

Thaw Publications, Carl Landwehr, David Kotz

Computer Science Technical Reports

In 2013, the National Science Foundation's Secure and Trustworthy Cyberspace program awarded a Frontier grant to a consortium of four institutions, led by Dartmouth College, to enable trustworthy cybersystems for health and wellness. As of this writing, the Trustworthy Health and Wellness (THaW) project's bibliography includes more than 130 significant publications produced with support from the THaW grant; these publications document the progress made on many fronts by the THaW research team. The collection includes dissertations, theses, journal papers, conference papers, workshop contributions and more. The bibliography is organized as a Zotero library, which provides ready access to citation materials …

Evaluating The Reproducibility Of Physiological Stress Detection Models, Varun Mishra, Sougata Sen, Grace Chen, Tian Hao, Jeffrey Rogers, Ching-Hua Chen, David Kotz

Dartmouth Scholarship

Recent advances in wearable sensor technologies have led to a variety of approaches for detecting physiological stress. Even with over a decade of research in the domain, there still exist many significant challenges, including a near-total lack of reproducibility across studies. Researchers often use some physiological sensors (custom-made or off-the-shelf), conduct a study to collect data, and build machine-learning models to detect stress. There is little effort to test the applicability of the model with similar physiological data collected from different devices, or the efficacy of the model on data collected from different studies, populations, or demographics.

This paper takes …

Barriers And Facilitators In Implementing A Pilot, Pragmatic, Telemedicine-Delivered Healthy Lifestyle Program For Obesity Management In A Rural, Academic Obesity Clinic, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David Kotz, Stephen Bartels, Summer B. Cook, Richard I. Rothstein

Dartmouth Scholarship

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity.

Using Natural Language Processing And Sentiment Analysis To Augment Traditional User-Centered Design: Development And Usability Study, Curtis L. Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer B. Cook, Dawna M. Pidgeon, Brock Christensen, John A. Batsis

Dartmouth Scholarship

Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process.

Objective: This study aims …

Automatic Recognition, Segmentation, And Sex Assignment Of Nocturnal Asthmatic Coughs And Cough Epochs In Smartphone Audio Recordings: Observational Field Study, Filipe Barata, Peter Tinschert, Frank Rassouli, Claudia Steurer-Stey, Elgar Fleisch, Milo Puhan, Martin Brutsche, David Kotz, Tobias Kowatsch

Dartmouth Scholarship

Background: Asthma is one of the most prevalent chronic respiratory diseases. Despite increased investment in treatment, little progress has been made in the early recognition and treatment of asthma exacerbations over the last decade. Nocturnal cough monitoring may provide an opportunity to identify patients at risk for imminent exacerbations. Recently developed approaches enable smartphone-based cough monitoring. These approaches, however, have not undergone longitudinal overnight testing nor have they been specifically evaluated in the context of asthma. Also, the problem of distinguishing partner coughs from patient coughs when two or more people are sleeping in the same room using contact-free audio …

The Application Of Digital Health To The Assessment And Treatment Of Substance Use Disorders: The Past, Current, And Future Role Of The National Drug Abuse Treatment Clinical Trials Network, Lisa A. Marsch, Aimee Campbell, Cynthia Campbell, Ching-Hua Chen, Emre Ertin, Udi Ghitza, Chantal Lambert-Harris, Saeed Hassanpour, August F. Holtyn, Yih-Ing Hser, Petra Jacobs, Jeffrey D. Klausner, Shea Lemley, David Kotz, Andrea Meier, Bethany Mcleman, Jennifer Mcneely, Varun Mishra, Larissa Mooney, Edward Nunes, Chrysovalantis Stafylis, Catherine Stanger, Elizabeth Saunders, Geetha Subramaniam, Sean Young

Dartmouth Scholarship

The application of digital technologies to better assess, understand, and treat substance use disorders (SUDs) is a particularly promising and vibrant area of scientific research. The National Drug Abuse Treatment Clinical Trials Network (CTN), launched in 1999 by the U.S. National Institute on Drug Abuse, has supported a growing line of research that leverages digital technologies to glean new insights into SUDs and provide science-based therapeutic tools to a diverse array of persons with SUDs.

This manuscript provides an overview of the breadth and impact of research conducted in the realm of digital health within the CTN. This work has …

Workshop On The Development And Evaluation Of Digital Therapeutics For Health Behavior Change: Science, Methods, And Projects, Alan J. Budney, Lisa A. Marsch, Will M. Aklin, Jacob T. Borodovsky, Mary F. Brunette, Andrew T. Campbell, Jesse Dallery, David Kotz, Ashley A. Knapp, Sarah E. Lord, Edward V. Nunes, Emily A. Scherer, Catherine Stanger, William C. Torrey

Dartmouth Scholarship

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that …

Feasibility And Acceptability Of A Rural, Pragmatic, Telemedicine‐ Delivered Healthy Lifestyle Programme, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, Richard I. Rothstein

Dartmouth Scholarship

Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two‐way video‐conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth‐Hitchcock Weight and Wellness Center were recruited into a pragmatic, single‐arm, nonrandomized study of a remotely delivered 16‐week evidence‐based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on …

Exploring The State-Of-Receptivity For Mhealth Interventions, Florian Künzler, Varun Mishra, Jan-Niklas Kramer, David Kotz, Elgar Fleisch, Tobias Kowatsch

Dartmouth Scholarship

Recent advancements in sensing techniques for mHealth applications have led to successful development and deployments of several mHealth intervention designs, including Just-In-Time Adaptive Interventions (JITAI). JITAIs show great potential because they aim to provide the right type and amount of support, at the right time. Timing the delivery of a JITAI such as the user is receptive and available to engage with the intervention is crucial for a JITAI to succeed. Although previous research has extensively explored the role of context in users’ responsiveness towards generic phone notiications, it has not been thoroughly explored for actual mHealth interventions. In this …

Use Of Amulet In Behavioral Change For Geriatric Obesity Management, John A. Batsis, Alexandra B. Zagaria, Ryan J. Halter, George G. Boateng, Patrick Proctor, Stephen J. Bartels, David Kotz

Dartmouth Scholarship

Background: Obesity in older adults is a significant public health concern. Weight-loss interventions are known to improve physical function but risk the development of sarcopenia. Mobile health devices have the potential to augment existing interventions and, if designed accordingly, could improve one’s physical activity and strength in routine physical activity interventions.

Methods and results: We present Amulet, a mobile health device that has the capability of engaging patients in physical activity. The purpose of this article is to discuss the development of applications that are tailored to older adults with obesity, with the intention to engage and improve their health. …

Development And Usability Assessment Of A Connected Resistance Exercise Band Application For Strength-Monitoring, John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, David F. Kotz

Dartmouth Scholarship

Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting are fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time, and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults …

Technology For Behavioral Change In Rural Older Adults With Obesity, John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels, Elizabeth Carpenter-Song

Dartmouth Scholarship

Background: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population.

Methods: We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics.

Results: All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth …

Feeding The World With Die Rolls: Potential Applications Of Quantum Computing

Dartmouth Undergraduate Journal of Science

No abstract provided.

The Mouhefanggai And Cavalieri's Principle

Dartmouth Undergraduate Journal of Science

No abstract provided.

Ethical Regulation Of Medical Experiments On Humans, Nick Awertschenko

Dartmouth Undergraduate Journal of Science

No abstract provided.

The Science Behind Memory: Hippocampal Neural Cell Assemblies, Nishi Jain

Dartmouth Undergraduate Journal of Science

No abstract provided.

The Immunity Of The Many: Ethical Considerations Of Vaccinations In Light Of Herd Immunity, Sophia Koval

Dartmouth Undergraduate Journal of Science

No abstract provided.

Frontiers In Dna Synthesis: Click Chemistry

Dartmouth Undergraduate Journal of Science

No abstract provided.

Cilia And Flagella: From Discovery To Disease, Dylan J. Cahill

Dartmouth Undergraduate Journal of Science

No abstract provided.

Letter From The Editor

Dartmouth Undergraduate Journal of Science

No abstract provided.

Workshop On Emerging Technology And Data Analytics For Behavioral Health, David Kotz, Sarah E. Lord, A. James O'Malley, Luke Stark, Lisa Marsch

Dartmouth Scholarship

Wearable and portable digital devices can support self-monitoring for patients with chronic medical conditions, individuals seeking to reduce stress, and people seeking to modify health-related behaviors such as substance use or overeating. The resulting data may be used directly by a consumer, or shared with a clinician for treatment, a caregiver for assistance, or a health coach for support. The data can also be used by researchers to develop and evaluate just-in-time interventions that leverage mobile technology to help individuals manage their symptoms and behavior in real time and as needed. Such wearable systems have huge potential for promoting delivery …