JMIR neurotechnology最新文献

As a novel technology frontier, neurotechnology is revolutionizing our perceptions of the brain and nervous system. With growing private and public investments, a thriving ecosystem of direct-to-consumer neurotechnologies has also emerged. These technologies are increasingly being introduced in many parts of the world, including Africa. However, as the use of this technology expands, neuroethics and ethics of emerging technology scholars are bringing attention to the critical concerns it raises. These concerns are largely not new but are uniquely amplified by the novelty of technology. They include ethical and legal issues such as privacy, human rights, human identity, bias, autonomy, and safety, which are part of the artificial intelligence ethics discourse. Most importantly, there is an obvious lack of regulatory oversight and a dearth of literature on the consideration of contextual ethical principles in the design and application of neurotechnology in Africa. This paper highlights lessons African stakeholders need to learn from the ethics and governance of artificial intelligence to ensure the design of ethically responsible and socially acceptable neurotechnology in and for Africa.

Background: Low sleep quality is a common symptom of multiple sclerosis (MS) and substantially decreases patients' quality of life. The autonomic nervous system (ANS) is crucial to healthy sleep, and the transition from wake to sleep produces the largest shift in autonomic activity we experience every day. For patients with MS, the ANS is often impaired. The relationship between the ANS and perceived sleep quality in patients with MS remains elusive.

Objective: In this study, we aim to quantify the impact of the ANS and MS on perceived sleep quality.

Methods: We monitored 77 participants over 2 weeks using an arm-worn wearable sensor and a custom smartphone app. Besides recording daily perceived sleep quality, we continuously recorded participants' heart rate (HR) and HR variability on a per-second basis, as well as stress, activity, and the weather (20,700 hours of sensor data).

Results: During sleep, we found that reduced HR variability and increased motion led to lower perceived sleep quality in patients with MS (n=53) as well as the age- and gender-matched control group (n=24). An activated stress response (high sympathetic activity and low parasympathetic activity) while asleep resulted in lower perceived sleep quality. For patients with MS, an activated stress response while asleep reduced perceived sleep quality more heavily than in the control group. Similarly, the effect of increased stress levels throughout the day is particularly severe for patients with MS. For patients with MS, we found that stress correlated negatively with minimal observed HR while asleep and might even affect their daily routine. We found that patients with MS with more severe impairments generally recorded lower perceived sleep quality than patients with MS with less severe disease progression.

Conclusions: For patients with MS, stress throughout the day and an activated stress response while asleep play a crucial role in determining sleep quality, whereas this is less important for healthy individuals. Besides ensuring an adequate sleep duration, patients with MS might thus work to reduce stressors, which seem to have a particularly negative effect on sleep quality. Generally, however, sleep quality decreases with MS disease progression.

Invasive brain-computer interfaces (BCIs) are gaining attention for their transformative potential in human-machine interaction. These devices, which connect directly to the brain, could revolutionize medical therapies and augmentative technologies. This viewpoint examines recent advancements, weighs benefits against risks, and explores ethical and regulatory considerations for the future of invasive BCIs.

Background: The COVID-19 pandemic transformed neurological care by both requiring digital health modalities to reach patients and profoundly lowering barriers to digital health adoption. This combination of factors has given rise to a distinctive, emerging care model in neurology characterized by new technologies, care arrangements, and uncertainties. As the pandemic transitions to an endemic, there is a need to characterize the current and future states of this unique period in neurology.

Objective: We sought to describe the current state of the pandemic- and postpandemic-related changes in neurological care and offer a view of the possible future directions of the field.

Methods: We reviewed several themes across the "new digital normal" in neurology, including trends in technology adoption, barriers to technology access, newly available telehealth services, unresolved questions, and an outlook on the future of digital neurology.

Results: In this new era of neurological care, we emphasize that synchronous audio-video telehealth remains the predominant form of digital interaction between neurologists and patients, mainly due to pandemic-related regulatory changes and the preexisting, steady adoption of video platforms in the prepandemic era. We also identify a persistent digital divide, with audio-only telehealth remaining a necessity for preserving care access. Asynchronous telehealth methods and services, including care coordination, interprofessional consultations, remote patient monitoring, and teletreatment are becoming increasingly important for neurological care. Finally, we identify several unanswered questions regarding the future of this "new normal," including the lasting effects of emergency regulatory changes, the value proposition of telehealth, the future of telehealth reimbursement in neurology, as well as privacy considerations and trade-offs in asynchronous neurological care models.

Conclusions: The COVID-19 pandemic has ushered in an era of digital adoption and innovation in neurological care, characterized by novel care models, services, and technologies, as well as numerous unresolved questions regarding the future.