For those with attention deficit hyperactivity disorder (ADHD), social interactions involving high levels of face-to-face interaction can raise stress levels and emotional dysregulation. Using animated avatar video models may mitigate potential emotional dysregulation while learning social skills in these populations. This study examined autonomic data of adolescents aged 7-13 diagnosed with attention deficit hyperactivity disorder (ADHD), n=5 during avatar animated video modeling (AAVM) of social and emotional skills. This was a replication study with the addition of biofeedback data collection and a change of population. Participants were given three Nearpod training modules with AAVM and multiple-choice quizzes on self-awareness, social awareness, and relationship skills. Using a multiple baseline design, we collected Social Emotional Learning (SEL) scores at baseline, and during each phase of intervention. During all phases, we collected heart rate and analyzed heart rate variability (HRV) metrics: standard deviation of N-N intervals (SDNN), high frequency (HF), low frequency (LF), and HF/LF ratio). We also collected real-time somatic data: muscle tension (EMG), skin conductance (SC), and skin temperature (temp). The somatic autonomic data were not analyzed as part of this thesis. Results suggest that persons with ADHD may benefit from avatar animated video modeling delivered instruction based on patterns in autonomic data, increases in scores on the targeted skills taught during instruction, and participant's expressions about this method of learning. In future research and practice the population for this content could be narrowed to age 8-12. Reliable but smaller and less obtrusive biofeedback devices are currently available, and having several accessible options is recommended.

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The last advancements in technology leads to an easy acquisition and spreading of multi-dimensional multimedia content, e.g. videos, which in many cases depict human faces. From such videos, valuable information describing the intrinsic characteristic of the recorded user can be retrieved: the features extracted from the facial patch are relevant descriptors that allow for the measurement of subject's emotional status or the identification of synthetic characters. One of the emerging challenges is the development of contactless approaches based on face analysis aiming at measuring the emotional status of the subject without placing sensors that limit or bias his experience. This raises even more interest in the context of Quality of Experience (QoE) measurement, or the measurement of user emotional status when subjected to a multimedia content, since it allows for retrieving the overall acceptability of the content as perceived by the end user. Measuring the impact of a given content to the user can have many implications from both the content producer and the end-user perspectives. For this reason, we pursue the QoE assessment of a user watching multimedia stimuli, i.e. 3D-movies, through the analysis of his facial features acquired by means of contactless approaches. More specifically, the user's Heart Rate (HR) was retrieved by using computer vision techniques applied to the facial recording of the subject and then analysed in order to compute the level of engagement. We show that the proposed framework is effective for long video sequences, being robust to facial movements and illumination changes. We validate it on a dataset of 64 sequences where users observe 3D movies selected to induce variations in users' emotional status. From one hand understanding the interaction between the user's perception of the content and his cognitive-emotional aspects leads to many opportunities to content producers, which may influence people's emotional statuses according to needs that can be driven by political, social, or business interests. On the other hand, the end-user must be aware of the authenticity of the content being watched: advancements in computer renderings allowed for the spreading of fake subjects in videos. Because of this, as a second challenge we target the identification of CG characters in videos by applying two different approaches. We firstly exploit the idea that fake characters do not present any pulse rate signal, while humans' pulse rate is expressed by a sinusoidal signal. The application of computer vision techniques on a facial video allows for the contactless estimation of the subject's HR, thus leading to the identification of signals that lack of a strong sinusoidality, which represent virtual humans. The proposed pipeline allows for a fully automated discrimination, validated on a dataset consisting of 104 videos. Secondly, we make use of facial spatio-temporal texture dynamics that reveal the artefacts introduced by computer renderings techniques when creating a manipulation, e.g. face swapping, on videos depicting human faces. To do so, we consider multiple temporal video segments on which we estimated multi-dimensional (spatial and temporal) texture features. A binary decision of the joint analysis of such features is applied to strengthen the classification accuracy. This is achieved through the use of Local Derivative Patterns on Three Orthogonal Planes (LDP-TOP). Experimental analyses on state-of-the-art datasets of manipulated videos show the discriminative power of such descriptors in separating real and manipulated sequences and identifying the creation method used. The main finding of this thesis is the relevance of facial features in describing intrinsic characteristics of humans. These can be used to retrieve significant information like the physiological response to multimedia stimuli or the authenticity of the human being itself. The application of the proposed approaches also on benchmark dataset returned good results, thus demonstrating real advancements in this research field. In addition to that, these methods can be extended to different practical application, from the autonomous driving safety checks to the identification of spoofing attacks, from the medical check-ups when doing sports to the users' engagement measurement when watching advertising. Because of this, we encourage further investigations in such direction, in order to improve the robustness of the methods, thus allowing for the application to increasingly challenging scenarios.

Intra-dialytic hypotension (IDH) is the most common complication in haemodialysis (HD) treatment and has been linked with increased mortality in HD patients. Despite various approaches towards understanding the underlying physiological mechanisms giving rise to IDH, the causes of IDH are poorly understood. Heart Rate Variability (HRV) has previously been suggested as a predictive measure of IDH. In contrast to conventional spectral HRV measures in which the frequency bands are defined by fixed limits, a new spectral measure of HRV is introduced in which the breathing rate is used to identify and measure the physiologically-relevant peaks of the frequency spectrum. The ratio of peaks leading up to the IDH event was assessed as a possible measure for IDH prediction. Changes in the proposed measure correlate well with the magnitude of abrupt changes in blood pressure in patients with autonomic dysfunction, but there is no such correlation in patients without autonomic dysfunction. At present, routine clinical vital sign monitoring beyond simple weight and blood pressure measurements at the start and end of each session has not established itself in clinical practice. To investigate the benefits of continuous vital sign monitoring in HD patients with regard to detecting and predicting IDH, different population-based and patient-specific models of normality were devised and tested on data from an observational study at the Oxford Renal Unit in which vital signs were recorded during HD sessions. Patient-specific models of normality performed better in distinguishing between IDH and non-IDH data, primarily due to the wide range of vital sign data included as part of the training data in the population-based models. Further, a patient-specific data fusion model was constructed using Parzen windows to estimate a probability density function from the training data consisting of vital signs from IDH-free sessions. Although the model was constructed using four vital sign inputs, novelty detection was found to be primarily driven by blood pressure decreases.

Deep brain stimulation (DBS) is a neurosurgical intervention now established for the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, several prospective case series have been reported, but few centres worldwide have published findings from patients treated during the last decade using current standards of technology. This thesis seeks to survey the current clinical status of DBS for pain, investigate its mechanisms and their interactions with autonomic function, its clinical limitations and ablative alternatives. Presented first is a review of the current status of analgesic DBS including contemporary clinical studies. The historical background, scientific rationale, patient selection and assessment methods, surgical techniques and results are described. The clinical outcomes of DBS of the sensory thalamus and periventricular / periaqueductal grey (PAVG) matter in two centres are presented including results from several pain and quality of life measures. A series of translational investigations in human subjects receiving DBS for pain elucidating mechanisms of analgesic DBS and its effects upon autonomic function are then presented. Single photon emission tomography comparing PAVG, VP thalamus and dual target stimulation is described. Somatosensory and local field potential (LFP) recordings suggesting PAVG somatotopy are shown. ABPM results demonstrating changes with PAVG DBS are given and Portapres studies into heart rate variability changes with ventral PAVG DBS are detailed. Investigations using naloxone are then shown to hypothesise separate dorsal opioidergic and ventral parasympathetic analgesic streams in the PAVG. Finally, cingulotomy in lung cancer to relieve pain and dyspnoea results are discussed in the context of altering pain and autonomic function by functional neurosurgery. Pain and autonomic interactions and mechanisms in deep brain surgery for pain are then discussed alongside its limitations with proposals made for optimising treatment and improving outcomes.

The electro-optic technique of measuring the cardiovascular pulse wave known as photoplethysmography (PPG) is clinically utilised for noninvasive characterisation of physiological components by dynamic monitoring of tissue optical absorption. There has been a resurgence of interest in this technique in recent years, driven by the demand for a low cost, compact, simple and portable technology for primary care and community-based clinical settings, and the advancement of computer-based pulse wave analysis techniques. PPG signal provides a means of determining cardiovascular properties during the cardiac cycle and changes with ageing and disease. This thesis focuses on the photoplethysmographic signal for cardiovascular assessment. The contour of the PPG pulse wave is influenced by vascular ageing. Contour analysis of the PPG pulse wave provides a rapid means of assessing vascular tone and arterial stiffness. In this thesis, the parameters extracted from the PPG pulse wave are examined in young adults. The results indicate that the contour parameters of the PPG pulse wave could provide a simple and noninvasive means to study the characteristic change relating to arterial stiffness. The pulsatile component of the PPG signal is due to the pumping action of the heart, and thus could reveal the circulation changes of a specific vascular bed. Heart rate variability (HRV) represents one of the most promising quantitative markers of cardiovascular control. Calculation of HRV from the peripheral pulse wave using PPG, called pulse rate variability (PRV), is investigated. The current work has confirmed that the PPG signal could provide basic information about heart rate (HR) and its variability, and highly suggests a good alternative to understanding dynamics pertaining to the autonomic nervous system (ANS) without the use of an electrocardiogram (ECG) device. Hence, PPG measurement has the potential to be readily accepted in ambulatory cardiac monitoring due to its simplicity and comfort. Noncontact PPG (NPPG) is introduced to overcome the current limitations of contact PPG. As a contactless device, NPPG is especially attractive for physiological monitoring in ambulatory units, NICUs, or trauma centres, where attaching electrodes is either inconvenient or unfeasible. In this research, a prototype for noncontact reflection PPG (NRPPG) with a vertical cavity surface emitting laser (VCSEL) as a light source and a high-speed PiN photodiode as a photodetector is developed. The results from physiological experiments suggest that NRPPG is reliable to extract clinically useful information about cardiac condition and function. In summary, recent evidence demonstrates that PPG as a simple noninvasive measurement offers a fruitful avenue for noninvasive cardiovascular monitoring. Key words: Photoplethysmography (PPG), Cardiovascular assessment, Pulse wave contour analysis, Arterial stiffness, Heart rate (HR), Heart rate variability (HRV), Pulse rate variability (PRV), Autonomic nervous system (ANS), Electrocardiogram (ECG).