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Friday, May 13, 2022

Neural oscillation

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Neural_oscillation

Neural oscillations, or brainwaves, are rhythmic or repetitive patterns of neural activity in the central nervous system. Neural tissue can generate oscillatory activity in many ways, driven either by mechanisms within individual neurons or by interactions between neurons. In individual neurons, oscillations can appear either as oscillations in membrane potential or as rhythmic patterns of action potentials, which then produce oscillatory activation of post-synaptic neurons. At the level of neural ensembles, synchronized activity of large numbers of neurons can give rise to macroscopic oscillations, which can be observed in an electroencephalogram. Oscillatory activity in groups of neurons generally arises from feedback connections between the neurons that result in the synchronization of their firing patterns. The interaction between neurons can give rise to oscillations at a different frequency than the firing frequency of individual neurons. A well-known example of macroscopic neural oscillations is alpha activity.

Neural oscillations in humans were observed by researchers as early as 1924 (by Hans Berger). More than 50 years later, intrinsic oscillatory behavior was encountered in vertebrate neurons, but its functional role is still not fully understood. The possible roles of neural oscillations include feature binding, information transfer mechanisms and the generation of rhythmic motor output. Over the last decades more insight has been gained, especially with advances in brain imaging. A major area of research in neuroscience involves determining how oscillations are generated and what their roles are. Oscillatory activity in the brain is widely observed at different levels of organization and is thought to play a key role in processing neural information. Numerous experimental studies support a functional role of neural oscillations; a unified interpretation, however, is still lacking.

Simulation of neural oscillations at 10 Hz. Upper panel shows spiking of individual neurons (with each dot representing an individual action potential within the population of neurons), and the lower panel the local field potential reflecting their summed activity. Figure illustrates how synchronized patterns of action potentials may result in macroscopic oscillations that can be measured outside the scalp.

History

Richard Caton discovered electrical activity in the cerebral hemispheres of rabbits and monkeys and presented his findings in 1875. Adolf Beck published in 1890 his observations of spontaneous electrical activity of the brain of rabbits and dogs that included rhythmic oscillations altered by light detected with electrodes directly placed on the surface of the brain. Before Hans Berger, Vladimir Vladimirovich Pravdich-Neminsky published the first animal EEG and the evoked potential of a dog.

Overview

Neural oscillations are observed throughout the central nervous system at all levels, and include spike trains, local field potentials and large-scale oscillations which can be measured by electroencephalography (EEG). In general, oscillations can be characterized by their frequency, amplitude and phase. These signal properties can be extracted from neural recordings using time-frequency analysis. In large-scale oscillations, amplitude changes are considered to result from changes in synchronization within a neural ensemble, also referred to as local synchronization. In addition to local synchronization, oscillatory activity of distant neural structures (single neurons or neural ensembles) can synchronize. Neural oscillations and synchronization have been linked to many cognitive functions such as information transfer, perception, motor control and memory.

Five frequency bands of neural oscillation, as seen in ten seconds of EEG.

Neural oscillations have been most widely studied in neural activity generated by large groups of neurons. Large-scale activity can be measured by techniques such as EEG. In general, EEG signals have a broad spectral content similar to pink noise, but also reveal oscillatory activity in specific frequency bands. The first discovered and best-known frequency band is alpha activity (8–12 Hz) that can be detected from the occipital lobe during relaxed wakefulness and which increases when the eyes are closed. Other frequency bands are: delta (1–4 Hz), theta (4–8 Hz), beta (13–30 Hz), low gamma (30–70 Hz), and high gamma (70–150 Hz) frequency bands, where faster rhythms such as gamma activity have been linked to cognitive processing. Indeed, EEG signals change dramatically during sleep and show a transition from faster frequencies to increasingly slower frequencies such as alpha waves. In fact, different sleep stages are commonly characterized by their spectral content. Consequently, neural oscillations have been linked to cognitive states, such as awareness and consciousness.

Although neural oscillations in human brain activity are mostly investigated using EEG recordings, they are also observed using more invasive recording techniques such as single-unit recordings. Neurons can generate rhythmic patterns of action potentials or spikes. Some types of neurons have the tendency to fire at particular frequencies, so-called resonators. Bursting is another form of rhythmic spiking. Spiking patterns are considered fundamental for information coding in the brain. Oscillatory activity can also be observed in the form of subthreshold membrane potential oscillations (i.e. in the absence of action potentials). If numerous neurons spike in synchrony, they can give rise to oscillations in local field potentials. Quantitative models can estimate the strength of neural oscillations in recorded data.

Neural oscillations are commonly studied from a mathematical framework and belong to the field of "neurodynamics", an area of research in the cognitive sciences that places a strong focus upon the dynamic character of neural activity in describing brain function. It considers the brain a dynamical system and uses differential equations to describe how neural activity evolves over time. In particular, it aims to relate dynamic patterns of brain activity to cognitive functions such as perception and memory. In very abstract form, neural oscillations can be analyzed analytically. When studied in a more physiologically realistic setting, oscillatory activity is generally studied using computer simulations of a computational model.

The functions of neural oscillations are wide-ranging and vary for different types of oscillatory activity. Examples are the generation of rhythmic activity such as a heartbeat and the neural binding of sensory features in perception, such as the shape and color of an object. Neural oscillations also play an important role in many neurological disorders, such as excessive synchronization during seizure activity in epilepsy or tremor in patients with Parkinson's disease. Oscillatory activity can also be used to control external devices such as a brain–computer interface.

Physiology

Oscillatory activity is observed throughout the central nervous system at all levels of organization. Three different levels have been widely recognized: the micro-scale (activity of a single neuron), the meso-scale (activity of a local group of neurons) and the macro-scale (activity of different brain regions).

Tonic firing pattern of single neuron showing rhythmic spiking activity

Microscopic

Neurons generate action potentials resulting from changes in the electric membrane potential. Neurons can generate multiple action potentials in sequence forming so-called spike trains. These spike trains are the basis for neural coding and information transfer in the brain. Spike trains can form all kinds of patterns, such as rhythmic spiking and bursting, and often display oscillatory activity. Oscillatory activity in single neurons can also be observed in sub-threshold fluctuations in membrane potential. These rhythmic changes in membrane potential do not reach the critical threshold and therefore do not result in an action potential. They can result from postsynaptic potentials from synchronous inputs or from intrinsic properties of neurons.

Neuronal spiking can be classified by their activity patterns. The excitability of neurons can be subdivided in Class I and II. Class I neurons can generate action potentials with arbitrarily low frequency depending on the input strength, whereas Class II neurons generate action potentials in a certain frequency band, which is relatively insensitive to changes in input strength. Class II neurons are also more prone to display sub-threshold oscillations in membrane potential.

Mesoscopic

A group of neurons can also generate oscillatory activity. Through synaptic interactions, the firing patterns of different neurons may become synchronized and the rhythmic changes in electric potential caused by their action potentials will add up (constructive interference). That is, synchronized firing patterns result in synchronized input into other cortical areas, which gives rise to large-amplitude oscillations of the local field potential. These large-scale oscillations can also be measured outside the scalp using electroencephalography (EEG) and magnetoencephalography (MEG). The electric potentials generated by single neurons are far too small to be picked up outside the scalp, and EEG or MEG activity always reflects the summation of the synchronous activity of thousands or millions of neurons that have similar spatial orientation. Neurons in a neural ensemble rarely all fire at exactly the same moment, i.e. fully synchronized. Instead, the probability of firing is rhythmically modulated such that neurons are more likely to fire at the same time, which gives rise to oscillations in their mean activity (see figure at top of page). As such, the frequency of large-scale oscillations does not need to match the firing pattern of individual neurons. Isolated cortical neurons fire regularly under certain conditions, but in the intact brain cortical cells are bombarded by highly fluctuating synaptic inputs and typically fire seemingly at random. However, if the probability of a large group of neurons is rhythmically modulated at a common frequency, they will generate oscillations in the mean field (see also figure at top of page). Neural ensembles can generate oscillatory activity endogenously through local interactions between excitatory and inhibitory neurons. In particular, inhibitory interneurons play an important role in producing neural ensemble synchrony by generating a narrow window for effective excitation and rhythmically modulating the firing rate of excitatory neurons.

Macroscopic

Neural oscillation can also arise from interactions between different brain areas coupled through the structural connectome. Time delays play an important role here. Because all brain areas are bidirectionally coupled, these connections between brain areas form feedback loops. Positive feedback loops tend to cause oscillatory activity where frequency is inversely related to the delay time. An example of such a feedback loop is the connections between the thalamus and cortex – the thalamocortical radiations. This thalamocortical network is able to generate oscillatory activity known as recurrent thalamo-cortical resonance. The thalamocortical network plays an important role in the generation of alpha activity. In a whole-brain network model with realistic anatomical connectivity and propagation delays between brain areas, oscillations in the beta frequency range emerge from the partial synchronisation of subsets of brain areas oscillating in the gamma-band (generated at the mesoscopic level).

Mechanisms

Neuronal properties

Scientists have identified some intrinsic neuronal properties that play an important role in generating membrane potential oscillations. In particular, voltage-gated ion channels are critical in the generation of action potentials. The dynamics of these ion channels have been captured in the well-established Hodgkin–Huxley model that describes how action potentials are initiated and propagated by means of a set of differential equations. Using bifurcation analysis, different oscillatory varieties of these neuronal models can be determined, allowing for the classification of types of neuronal responses. The oscillatory dynamics of neuronal spiking as identified in the Hodgkin–Huxley model closely agree with empirical findings. In addition to periodic spiking, subthreshold membrane potential oscillations, i.e. resonance behavior that does not result in action potentials, may also contribute to oscillatory activity by facilitating synchronous activity of neighboring neurons. Like pacemaker neurons in central pattern generators, subtypes of cortical cells fire bursts of spikes (brief clusters of spikes) rhythmically at preferred frequencies. Bursting neurons have the potential to serve as pacemakers for synchronous network oscillations, and bursts of spikes may underlie or enhance neuronal resonance.

Network properties

Apart from intrinsic properties of neurons, biological neural network properties are also an important source of oscillatory activity. Neurons communicate with one another via synapses and affect the timing of spike trains in the post-synaptic neurons. Depending on the properties of the connection, such as the coupling strength, time delay and whether coupling is excitatory or inhibitory, the spike trains of the interacting neurons may become synchronized.[32] Neurons are locally connected, forming small clusters that are called neural ensembles. Certain network structures promote oscillatory activity at specific frequencies. For example, neuronal activity generated by two populations of interconnected inhibitory and excitatory cells can show spontaneous oscillations that are described by the Wilson-Cowan model.

If a group of neurons engages in synchronized oscillatory activity, the neural ensemble can be mathematically represented as a single oscillator. Different neural ensembles are coupled through long-range connections and form a network of weakly coupled oscillators at the next spatial scale. Weakly coupled oscillators can generate a range of dynamics including oscillatory activity. Long-range connections between different brain structures, such as the thalamus and the cortex (see thalamocortical oscillation), involve time-delays due to the finite conduction velocity of axons. Because most connections are reciprocal, they form feed-back loops that support oscillatory activity. Oscillations recorded from multiple cortical areas can become synchronized to form large scale brain networks, whose dynamics and functional connectivity can be studied by means of spectral analysis and Granger causality measures. Coherent activity of large-scale brain activity may form dynamic links between brain areas required for the integration of distributed information.

Neuromodulation

In addition to fast direct synaptic interactions between neurons forming a network, oscillatory activity is regulated by neuromodulators on a much slower time scale. That is, the concentration levels of certain neurotransmitters are known to regulate the amount of oscillatory activity. For instance, GABA concentration has been shown to be positively correlated with frequency of oscillations in induced stimuli. A number of nuclei in the brainstem have diffuse projections throughout the brain influencing concentration levels of neurotransmitters such as norepinephrine, acetylcholine and serotonin. These neurotransmitter systems affect the physiological state, e.g., wakefulness or arousal, and have a pronounced effect on amplitude of different brain waves, such as alpha activity.

Mathematical description

Oscillations can often be described and analyzed using mathematics. Mathematicians have identified several dynamical mechanisms that generate rhythmicity. Among the most important are harmonic (linear) oscillators, limit cycle oscillators, and delayed-feedback oscillators. Harmonic oscillations appear very frequently in nature—examples are sound waves, the motion of a pendulum, and vibrations of every sort. They generally arise when a physical system is perturbed by a small degree from a minimum-energy state, and are well understood mathematically. Noise-driven harmonic oscillators realistically simulate alpha rhythm in the waking EEG as well as slow waves and spindles in the sleep EEG. Successful EEG analysis algorithms were based on such models. Several other EEG components are better described by limit-cycle or delayed-feedback oscillations. Limit-cycle oscillations arise from physical systems that show large deviations from equilibrium, whereas delayed-feedback oscillations arise when components of a system affect each other after significant time delays. Limit-cycle oscillations can be complex but there are powerful mathematical tools for analyzing them; the mathematics of delayed-feedback oscillations is primitive in comparison. Linear oscillators and limit-cycle oscillators qualitatively differ in terms of how they respond to fluctuations in input. In a linear oscillator, the frequency is more or less constant but the amplitude can vary greatly. In a limit-cycle oscillator, the amplitude tends to be more or less constant but the frequency can vary greatly. A heartbeat is an example of a limit-cycle oscillation in that the frequency of beats varies widely, while each individual beat continues to pump about the same amount of blood.

Computational models adopt a variety of abstractions in order to describe complex oscillatory dynamics observed in brain activity. Many models are used in the field, each defined at a different level of abstraction and trying to model different aspects of neural systems. They range from models of the short-term behaviour of individual neurons, through models of how the dynamics of neural circuitry arise from interactions between individual neurons, to models of how behaviour can arise from abstract neural modules that represent complete subsystems.

Single neuron model

Simulation of a Hindmarsh–Rose neuron showing typical bursting behavior: a fast rhythm generated by individual spikes and a slower rhythm generated by the bursts.
 

A model of a biological neuron is a mathematical description of the properties of nerve cells, or neurons, that is designed to accurately describe and predict its biological processes. The most successful and widely used model of neurons, the Hodgkin–Huxley model, is based on data from the squid giant axon. It is a set of nonlinear ordinary differential equations that approximates the electrical characteristics of a neuron, in particular the generation and propagation of action potentials. The model is very accurate and detailed and Hodgkin and Huxley received the 1963 Nobel Prize in physiology or medicine for this work.

The mathematics of the Hodgkin–Huxley model are quite complicated and several simplifications have been proposed, such as the FitzHugh–Nagumo model, the Hindmarsh–Rose model or the capacitor-switch model as an extension of the integrate-and-fire model. Such models only capture the basic neuronal dynamics, such as rhythmic spiking and bursting, but are more computationally efficient. This allows the simulation of a large number of interconnected neurons that form a neural network.

Spiking model

A neural network model describes a population of physically interconnected neurons or a group of disparate neurons whose inputs or signalling targets define a recognizable circuit. These models aim to describe how the dynamics of neural circuitry arise from interactions between individual neurons. Local interactions between neurons can result in the synchronization of spiking activity and form the basis of oscillatory activity. In particular, models of interacting pyramidal cells and inhibitory interneurons have been shown to generate brain rhythms such as gamma activity. Similarly, it was shown that simulations of neural networks with a phenomenological model for neuronal response failures can predict spontaneous broadband neural oscillations.eural mass model

Simulation of a neural mass model showing network spiking during the onset of a seizure. As the gain A is increased the network starts to oscillate at 3Hz.
 

Neural field models are another important tool in studying neural oscillations and are a mathematical framework describing evolution of variables such as mean firing rate in space and time. In modeling the activity of large numbers of neurons, the central idea is to take the density of neurons to the continuum limit, resulting in spatially continuous neural networks. Instead of modelling individual neurons, this approach approximates a group of neurons by its average properties and interactions. It is based on the mean field approach, an area of statistical physics that deals with large-scale systems. Models based on these principles have been used to provide mathematical descriptions of neural oscillations and EEG rhythms. They have for instance been used to investigate visual hallucinations.

Kuramoto model

Simulation of Kuramoto model showing neural synchronization and oscillations in the mean field
 

The Kuramoto model of coupled phase oscillators is one of the most abstract and fundamental models used to investigate neural oscillations and synchronization. It captures the activity of a local system (e.g., a single neuron or neural ensemble) by its circular phase alone and hence ignores the amplitude of oscillations (amplitude is constant). Interactions amongst these oscillators are introduced by a simple algebraic form (such as a sine function) and collectively generate a dynamical pattern at the global scale. The Kuramoto model is widely used to study oscillatory brain activity and several extensions have been proposed that increase its neurobiological plausibility, for instance by incorporating topological properties of local cortical connectivity. In particular, it describes how the activity of a group of interacting neurons can become synchronized and generate large-scale oscillations. Simulations using the Kuramoto model with realistic long-range cortical connectivity and time-delayed interactions reveal the emergence of slow patterned fluctuations that reproduce resting-state BOLD functional maps, which can be measured using fMRI.

Activity patterns

Both single neurons and groups of neurons can generate oscillatory activity spontaneously. In addition, they may show oscillatory responses to perceptual input or motor output. Some types of neurons will fire rhythmically in the absence of any synaptic input. Likewise, brain-wide activity reveals oscillatory activity while subjects do not engage in any activity, so-called resting-state activity. These ongoing rhythms can change in different ways in response to perceptual input or motor output. Oscillatory activity may respond by increases or decreases in frequency and amplitude or show a temporary interruption, which is referred to as phase resetting. In addition, external activity may not interact with ongoing activity at all, resulting in an additive response.

Ongoing activity

Spontaneous activity is brain activity in the absence of an explicit task, such as sensory input or motor output, and hence also referred to as resting-state activity. It is opposed to induced activity, i.e. brain activity that is induced by sensory stimuli or motor responses. The term ongoing brain activity is used in electroencephalography and magnetoencephalography for those signal components that are not associated with the processing of a stimulus or the occurrence of specific other events, such as moving a body part, i.e. events that do not form evoked potentials/evoked fields, or induced activity. Spontaneous activity is usually considered to be noise if one is interested in stimulus processing; however, spontaneous activity is considered to play a crucial role during brain development, such as in network formation and synaptogenesis. Spontaneous activity may be informative regarding the current mental state of the person (e.g. wakefulness, alertness) and is often used in sleep research. Certain types of oscillatory activity, such as alpha waves, are part of spontaneous activity. Statistical analysis of power fluctuations of alpha activity reveals a bimodal distribution, i.e. a high- and low-amplitude mode, and hence shows that resting-state activity does not just reflect a noise process. In case of fMRI, spontaneous fluctuations in the blood-oxygen-level dependent (BOLD) signal reveal correlation patterns that are linked to resting states networks, such as the default network. The temporal evolution of resting state networks is correlated with fluctuations of oscillatory EEG activity in different frequency bands.

Ongoing brain activity may also have an important role in perception, as it may interact with activity related to incoming stimuli. Indeed, EEG studies suggest that visual perception is dependent on both the phase and amplitude of cortical oscillations. For instance, the amplitude and phase of alpha activity at the moment of visual stimulation predicts whether a weak stimulus will be perceived by the subject.

Frequency response

In response to input, a neuron or neuronal ensemble may change the frequency at which it oscillates, thus changing the rate at which it spikes. Often, a neuron's firing rate depends on the summed activity it receives. Frequency changes are also commonly observed in central pattern generators and directly relate to the speed of motor activities, such as step frequency in walking. However, changes in relative oscillation frequency between different brain areas is not so common because the frequency of oscillatory activity is often related to the time delays between brain areas.

Amplitude response

Next to evoked activity, neural activity related to stimulus processing may result in induced activity. Induced activity refers to modulation in ongoing brain activity induced by processing of stimuli or movement preparation. Hence, they reflect an indirect response in contrast to evoked responses. A well-studied type of induced activity is amplitude change in oscillatory activity. For instance, gamma activity often increases during increased mental activity such as during object representation. Because induced responses may have different phases across measurements and therefore would cancel out during averaging, they can only be obtained using time-frequency analysis. Induced activity generally reflects the activity of numerous neurons: amplitude changes in oscillatory activity are thought to arise from the synchronization of neural activity, for instance by synchronization of spike timing or membrane potential fluctuations of individual neurons. Increases in oscillatory activity are therefore often referred to as event-related synchronization, while decreases are referred to as event-related desynchronization.

Phase resetting

Phase resetting occurs when input to a neuron or neuronal ensemble resets the phase of ongoing oscillations. It is very common in single neurons where spike timing is adjusted to neuronal input (a neuron may spike at a fixed delay in response to periodic input, which is referred to as phase locking) and may also occur in neuronal ensembles when the phases of their neurons are adjusted simultaneously. Phase resetting is fundamental for the synchronization of different neurons or different brain regions because the timing of spikes can become phase locked to the activity of other neurons.

Phase resetting also permits the study of evoked activity, a term used in electroencephalography and magnetoencephalography for responses in brain activity that are directly related to stimulus-related activity. Evoked potentials and event-related potentials are obtained from an electroencephalogram by stimulus-locked averaging, i.e. averaging different trials at fixed latencies around the presentation of a stimulus. As a consequence, those signal components that are the same in each single measurement are conserved and all others, i.e. ongoing or spontaneous activity, are averaged out. That is, event-related potentials only reflect oscillations in brain activity that are phase-locked to the stimulus or event. Evoked activity is often considered to be independent from ongoing brain activity, although this is an ongoing debate.

Asymmetric amplitude modulation

It has recently been proposed that even if phases are not aligned across trials, induced activity may still cause event-related potentials because ongoing brain oscillations may not be symmetric and thus amplitude modulations may result in a baseline shift that does not average out. This model implies that slow event-related responses, such as asymmetric alpha activity, could result from asymmetric brain oscillation amplitude modulations, such as an asymmetry of the intracellular currents that propagate forward and backward down the dendrites. Under this assumption, asymmetries in the dendritic current would cause asymmetries in oscillatory activity measured by EEG and MEG, since dendritic currents in pyramidal cells are generally thought to generate EEG and MEG signals that can be measured at the scalp.

Function

Neural synchronization can be modulated by task constraints, such as attention, and is thought to play a role in feature binding, neuronal communication, and motor coordination. Neuronal oscillations became a hot topic in neuroscience in the 1990s when the studies of the visual system of the brain by Gray, Singer and others appeared to support the neural binding hypothesis. According to this idea, synchronous oscillations in neuronal ensembles bind neurons representing different features of an object. For example, when a person looks at a tree, visual cortex neurons representing the tree trunk and those representing the branches of the same tree would oscillate in synchrony to form a single representation of the tree. This phenomenon is best seen in local field potentials which reflect the synchronous activity of local groups of neurons, but has also been shown in EEG and MEG recordings providing increasing evidence for a close relation between synchronous oscillatory activity and a variety of cognitive functions such as perceptual grouping and attentional top-down control.

Pacemaker

Cells in the sinoatrial node, located in the right atrium of the heart, spontaneously depolarize approximately 100 times per minute. Although all of the heart's cells have the ability to generate action potentials that trigger cardiac contraction, the sinoatrial node normally initiates it, simply because it generates impulses slightly faster than the other areas. Hence, these cells generate the normal sinus rhythm and are called pacemaker cells as they directly control the heart rate. In the absence of extrinsic neural and hormonal control, cells in the SA node will rhythmically discharge. The sinoatrial node is richly innervated by the autonomic nervous system, which up or down regulates the spontaneous firing frequency of the pacemaker cells.

Central pattern generator

Synchronized firing of neurons also forms the basis of periodic motor commands for rhythmic movements. These rhythmic outputs are produced by a group of interacting neurons that form a network, called a central pattern generator. Central pattern generators are neuronal circuits that—when activated—can produce rhythmic motor patterns in the absence of sensory or descending inputs that carry specific timing information. Examples are walking, breathing, and swimming, Most evidence for central pattern generators comes from lower animals, such as the lamprey, but there is also evidence for spinal central pattern generators in humans.

Information processing

Neuronal spiking is generally considered the basis for information transfer in the brain. For such a transfer, information needs to be coded in a spiking pattern. Different types of coding schemes have been proposed, such as rate coding and temporal coding. Neural oscillations could create periodic time windows in which input spikes have larger effect on neurons, thereby providing a mechanism for decoding temporal codes.

Perception

Synchronization of neuronal firing may serve as a means to group spatially segregated neurons that respond to the same stimulus in order to bind these responses for further joint processing, i.e. to exploit temporal synchrony to encode relations. Purely theoretical formulations of the binding-by-synchrony hypothesis were proposed first, but subsequently extensive experimental evidence has been reported supporting the potential role of synchrony as a relational code.

The functional role of synchronized oscillatory activity in the brain was mainly established in experiments performed on awake kittens with multiple electrodes implanted in the visual cortex. These experiments showed that groups of spatially segregated neurons engage in synchronous oscillatory activity when activated by visual stimuli. The frequency of these oscillations was in the range of 40 Hz and differed from the periodic activation induced by the grating, suggesting that the oscillations and their synchronization were due to internal neuronal interactions. Similar findings were shown in parallel by the group of Eckhorn, providing further evidence for the functional role of neural synchronization in feature binding. Since then, numerous studies have replicated these findings and extended them to different modalities such as EEG, providing extensive evidence of the functional role of gamma oscillations in visual perception.

Gilles Laurent and colleagues showed that oscillatory synchronization has an important functional role in odor perception. Perceiving different odors leads to different subsets of neurons firing on different sets of oscillatory cycles. These oscillations can be disrupted by GABA blocker picrotoxin, and the disruption of the oscillatory synchronization leads to impairment of behavioral discrimination of chemically similar odorants in bees and to more similar responses across odors in downstream β-lobe neurons. Recent follow-up of this work has shown that oscillations create periodic integration windows for Kenyon cells in the insect mushroom body, such that incoming spikes from the antennal lobe are more effective in activating Kenyon cells only at specific phases of the oscillatory cycle.

Neural oscillations are also thought be involved in the sense of time and in somatosensory perception. However, recent findings argue against a clock-like function of cortical gamma oscillations.

Motor coordination

Oscillations have been commonly reported in the motor system. Pfurtscheller and colleagues found a reduction in alpha (8–12 Hz) and beta (13–30 Hz) oscillations in EEG activity when subjects made a movement. Using intra-cortical recordings, similar changes in oscillatory activity were found in the motor cortex when the monkeys performed motor acts that required significant attention. In addition, oscillations at spinal level become synchronised to beta oscillations in the motor cortex during constant muscle activation, as determined by cortico-muscular coherence. Likewise, muscle activity of different muscles reveals inter-muscular coherence at multiple distinct frequencies reflecting the underlying neural circuitry involved in motor coordination.

Recently it was found that cortical oscillations propagate as travelling waves across the surface of the motor cortex along dominant spatial axes characteristic of the local circuitry of the motor cortex. It has been proposed that motor commands in the form of travelling waves can be spatially filtered by the descending fibres to selectively control muscle force. Simulations have shown that ongoing wave activity in cortex can elicit steady muscle force with physiological levels of EEG-EMG coherence.

Oscillatory rhythms at 10 Hz have been recorded in a brain area called the inferior olive, which is associated with the cerebellum. These oscillations are also observed in motor output of physiological tremor and when performing slow finger movements. These findings may indicate that the human brain controls continuous movements intermittently. In support, it was shown that these movement discontinuities are directly correlated to oscillatory activity in a cerebello-thalamo-cortical loop, which may represent a neural mechanism for the intermittent motor control.

Memory

Neural oscillations, in particular theta activity, are extensively linked to memory function. Theta rhythms are very strong in rodent hippocampi and entorhinal cortex during learning and memory retrieval, and they are believed to be vital to the induction of long-term potentiation, a potential cellular mechanism for learning and memory. Coupling between theta and gamma activity is thought to be vital for memory functions, including episodic memory. Tight coordination of single-neuron spikes with local theta oscillations is linked to successful memory formation in humans, as more stereotyped spiking predicts better memory.

Sleep and consciousness

Sleep is a naturally recurring state characterized by reduced or absent consciousness and proceeds in cycles of rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. Sleep stages are characterized by spectral content of EEG: for instance, stage N1 refers to the transition of the brain from alpha waves (common in the awake state) to theta waves, whereas stage N3 (deep or slow-wave sleep) is characterized by the presence of delta waves. The normal order of sleep stages is N1 → N2 → N3 → N2 → REM.

Development

Neural oscillations may play a role in neural development. For example, retinal waves are thought to have properties that define early connectivity of circuits and synapses between cells in the retina.

Pathology

Handwriting of a person affected by Parkinson's disease showing rhythmic tremor activity in the strokes
 
Generalized 3 Hz spike and wave discharges reflecting seizure activity

Specific types of neural oscillations may also appear in pathological situations, such as Parkinson's disease or epilepsy. These pathological oscillations often consist of an aberrant version of a normal oscillation. For example, one of the best known types is the spike and wave oscillation, which is typical of generalized or absence epileptic seizures, and which resembles normal sleep spindle oscillations.

Tremor

A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal cords, trunk, and legs. Most tremors occur in the hands. In some people, tremor is a symptom of another neurological disorder. Many different forms of tremor have been identified, such as essential tremor or Parkinsonian tremor. It is argued that tremors are likely to be multifactorial in origin, with contributions from neural oscillations in the central nervous systems, but also from peripheral mechanisms such as reflex loop resonances.

Epilepsy

Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.

Thalamocortical dysrhythmia

In thalamocortical dysrhythmia (TCD), normal thalamocortical resonance is disrupted. The thalamic loss of input allows the frequency of the thalamo-cortical column to slow into the theta or delta band as identified by MEG and EEG by machine learning. TCD can be treated with neurosurgical methods like thalamotomy.

Applications

Clinical endpoints

Neural oscillations are sensitive to several drugs influencing brain activity; accordingly, biomarkers based on neural oscillations are emerging as secondary endpoints in clinical trials and in quantifying effects in pre-clinical studies. These biomarkers are often named "EEG biomarkers" or "Neurophysiological Biomarkers" and are quantified using quantitative electroencephalography (qEEG). EEG biomarkers can be extracted from the EEG using the open-source Neurophysiological Biomarker Toolbox.

Brain–computer interface

Neural oscillation has been applied as a control signal in various brain–computer interfaces (BCIs). For example, a non-invasive BCI can be created by placing electrodes on the scalp and then measuring the weak electric signals. Although individual neuron activities cannot be recorded through non-invasive BCI because the skull damps and blurs the electromagnetic signals, oscillatory activity can still be reliably detected. The BCI was introduced by Vidal in 1973 as challenge of using EEG signals to control objects outside human body.

After the BCI challenge, in 1988, alpha rhythm was used in a brain rhythm based BCI for control of a physical object, a robot. Alpha rhythm based BCI was the first BCI for control of a robot. In particular, some forms of BCI allow users to control a device by measuring the amplitude of oscillatory activity in specific frequency bands, including mu and beta rhythms.

mHealth

From Wikipedia, the free encyclopedia
 
Nurse using a mobile phone in Accra, Ghana

mHealth (also written as m-health or mhealth) is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and personal digital assistants (PDAs), and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery/sharing of healthcare information for practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care (via mobile telemedicine) as well as training and collaboration of health workers.

While mHealth has application for industrialized nations, the field has emerged in recent years as largely an application for developing countries, stemming from the rapid rise of mobile phone penetration in low-income nations. The field, then, largely emerges as a means of providing greater access to larger segments of a population in developing countries, as well as improving the capacity of health systems in such countries to provide quality healthcare. Within the mHealth space, projects operate with a variety of objectives, including increased access to healthcare and health-related information (particularly for hard-to-reach populations); improved ability to diagnose and track diseases; timelier, more actionable public health information; and expanded access to ongoing medical education and training for health workers.

Definitions

Malaria Clinic in Tanzania helped by SMS for Life program that uses cell phones to efficiently deliver malaria vaccine

mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery. The term mHealth was coined by Robert Istepanian as use of "emerging mobile communications and network technologies for healthcare". A definition used at the 2010 mHealth Summit of the Foundation for the National Institutes of Health (FNIH) was "the delivery of healthcare services via mobile communication devices". The GSM Association representing the worldwide mobile communications industry published a report on mHealth in 2010 describing a new vision for healthcare and identified ways in which mobile technology might play a role in innovating healthcare delivery systems and healthcare system cost management.

While there are some projects that are considered solely within the field of mHealth, the linkage between mHealth and eHealth is unquestionable. For example, an mHealth project that uses mobile phones to access data on HIV/AIDS rates would require an eHealth system in order to manage, store, and assess the data. Thus, eHealth projects many times operate as the backbone of mHealth projects.

In a similar vein, while not clearly bifurcated by such a definition, eHealth can largely be viewed as technology that supports the functions and delivery of healthcare, while mHealth rests largely on providing healthcare access. Because mHealth is by definition based on mobile technology such as smartphones, healthcare, through information and delivery, can better reach areas, people, and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare.

Medical uses

mHealth apps are designed to support diagnostic procedures, to aid physician decision-making for treatments, and to advance disease-related education for physicians and people under treatment. Mobile health has much potential in medicine and, if used in conjunction with human factors may improve access to care, the scope, and quality of health care services that can be provided. Some applications of mobile health may also improve the ability to improve accountability in healthcare and improve continuum of care by connecting interdisciplinary team members.

mHealth is one aspect of eHealth that is pushing the limits of how to acquire, transport, store, process, and secure the raw and processed data to deliver meaningful results. mHealth offers the ability of remote individuals to participate in the health care value matrix, which may not have been possible in the past. Participation does not imply just consumption of health care services. In many cases remote users are valuable contributors to gather data regarding disease and public health concerns such as outdoor pollution, drugs and violence.

While others exist, the 2009 UN Foundation and Vodafone Foundation report presents seven application categories within the mHealth field:

  • Education and awareness
  • Helpline
  • Diagnostic and treatment support
  • Communication and training for healthcare workers
  • Disease and epidemic outbreak tracking
  • Remote monitoring
  • Remote data collection

Education and awareness

Education and awareness programs within the mHealth field are largely about the spreading of mass information from source to recipient through short message services (SMS). In education and awareness applications, SMS messages are sent directly to users' phones to offer information about various subjects, including testing and treatment methods, availability of health services, and disease management. SMSs provide an advantage of being relatively unobtrusive, offering patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo. Additionally, SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education, health clinics, and a deficit of healthcare workers.

Helpline

Helpline typically consists of a specific phone number that any individual is able to call to gain access to a range of medical services. These include phone consultations, counseling, service complaints, and information on facilities, drugs, equipment, and/or available mobile health clinics.

Diagnostic support, treatment support, communication and training for healthcare workers

Diagnostic and treatment support systems are typically designed to provide healthcare workers in remote areas advice about diagnosis and treatment of patients. While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnose, other projects provide direct diagnosis to patients themselves. In such cases, known as telemedicine, patients might take a photograph of a wound or illness and allow a remote physician to diagnose to help treat the medical problem. Both diagnosis and treatment support projects attempt to mitigate the cost and time of travel for patients located in remote areas.

mHealth projects within the communication and training for healthcare workers subset involve connecting healthcare workers to sources of information through their mobile phone. This involves connecting healthcare workers to other healthcare workers, medical institutions, ministries of health, or other houses of medical information. Such projects additionally involve using mobile phones to better organize and target in-person training. Improved communication projects attempt to increase knowledge transfer amongst healthcare workers and improve patient outcomes through such programs as patient referral processes. For example, the systematic use of mobile instant messaging for the training and empowerment of health professionals has resulted in higher levels of clinical knowledge and fewer feelings of professional isolation.

Disease surveillance, remote data collection, and epidemic outbreak tracking

Projects within this area operate to utilize mobile phones' ability to collect and transmit data quickly, cheaply, and relatively efficiently. Data concerning the location and levels of specific diseases (such as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or ministries of health or other organizations identify outbreaks and better target medical resources to areas of greatest need. Such projects can be particularly useful during emergencies, in order to identify where the greatest medical needs are within a country.

Policymakers and health providers at the national, district, and community level need accurate data in order to gauge the effectiveness of existing policies and programs and shape new ones. In the developing world, collecting field information is particularly difficult since many segments of the population are rarely able to visit a hospital, even in the case of severe illness. A lack of patient data creates an arduous environment in which policy makers can decide where and how to spend their (sometimes limited) resources. While some software within this area is specific to a particular content or area, other software can be adapted to any data collection purpose.

Treatment support and medication compliance for patients, including chronic disease management

Remote monitoring and treatment support allows for greater involvement in the continued care of patients. Recent studies seem to show also the efficacy of inducing positive and negative affective states, using smart phones. Within environments of limited resources and beds—and subsequently a 'outpatient' culture—remote monitoring allows healthcare workers to better track patient conditions, medication regimen adherence, and follow-up scheduling. Such projects can operate through either one- or two-way communications systems. Remote monitoring has been used particularly in the area of medication adherence for AIDS, cardiovascular disease, chronic lung disease, diabetes, antenatal mental health, mild anxiety, and tuberculosis. Technical process evaluations have confirmed the feasibility of deploying dynamically tailored, SMS-based interventions designed to provide ongoing behavioral reinforcement for persons living with HIV among others.

In conclusion, the use of mobile phone technology (in combination with a web-based interface) in health care results in an increase in convenience and efficiency of data collection, transfer, storage and analysis management of data as compared with paper-based systems. Formal studies and preliminary project assessments demonstrate this improvement of efficiency of healthcare delivery by mobile technology. Nevertheless, mHealth should not be considered as a panacea for healthcare. Possible organizational issues include the ensuring of appropriate use and proper care of the handset, lost or stolen phones, and the important consideration of costs related to the purchase of equipment. There is therefore a difficulty in comparison in weighing up mHealth interventions against other priority and evidence-based interventions.

Criticism and concerns

The extensive practice of mhealth research has sparked criticism, for example on the proliferation of fragmented pilot studies in low- and middle-income countries, which is also referred to as "pilotitis." The extent of un-coordinated pilot studies prompted for instance the Ugandan Director General Health Services Dr Jane Ruth Aceng in 2012 to issue a notice that, "in order to jointly ensure that all eHealth efforts are harmonized and coordinated, I am directing that ALL eHealth projects/Initiatives be put to halt." The assumptions that justify mhealth initiatives have also been challenged in recent sociological research. For example, mobile phones have been argued to be less widely accessible and usable than is often portrayed in mhealth-related publications; people integrate mobile phones into their health behavior without external intervention; and the spread of mobile phones in low- and middle-income countries itself can create new forms of digital and healthcare exclusion, which mhealth interventions (using mobile phones as a platform) cannot overcome and potentially accentuate. Mhealth has also been argued to alter the practice of healthcare and patient-physician relationships as well as how bodies and health are being represented. Another widespread concern relates to privacy and data protection, for example in the context of electronic health records.

Studies looking into the perceptions and experiences of primary healthcare professionals using mheath have found that most health care professionals appreciated being connected to their colleagues, however some prefer face to face communication. Some healthcare workers also felt that while reporting was improved and team members who require help or training could be more easily identified, some healthcare professionals did not feel comfortable being monitored continuously. A proportion of healthcare professionals prefer paper reporting. The use of mobile apps may sometimes lead to healthcare professionals spending more time performing additional tasks such as filling out electronic forms and may generate more workload in some cases. Some healthcare professionals also do not feel comfortable with work-related contact from patients/clients outside of business hours (however some professionals did find this useful for emergencies).

Communicating with clients/patients while using a mobile device may need to be considered. A decrease in eye contact and the potential to miss non-verbal cues due to concentrating on a screen while speaking with patients is a potential consideration.

Society and Culture

Healthcare in low- and middle-income countries

Disability-adjusted life year for all causes per 100,000 inhabitants in 2004.
  no data
  less than 9,250
  9,250–16,000
  16,000–22,750
  22,750–29,500
  29,500–36,250
  36,250–43,000
  43,000–49,750
  49,750–56,500
  56,500–63,250
  63,250–70,000
  70,000–80,000
  more than 80,000

Middle income and especially low-income countries face a plethora of constraints in their healthcare systems. These countries face a severe lack of human and physical resources, as well as some of the largest burdens of disease, extreme poverty, and large population growth rates. Additionally, healthcare access to all reaches of society is generally low in these countries.

According to a World Health Organization (WHO) report from June 2011, higher-income countries show more mHealth activity than do lower-income countries (as consistent with eHealth trends in general). Countries in the European Region are currently the most active and those in the African Region the least active. The WHO report findings also included that mHealth is most easily incorporated into processes and services that historically use voice communication through conventional telephone networks. The report was the result of a mHealth survey module designed by researchers at the Earth Institute's Center for Global Health and Economic Development, Columbia University.

The WHO notes an extreme deficit within the global healthcare workforce. The WHO notes critical healthcare workforce shortages in 57 countries—most of which are characterized as developing countries—and a global deficit of 2.4 million doctors, nurses, and midwives. The WHO, in a study of the healthcare workforce in 12 countries of Africa, finds an average density of physicians, nurses and midwives per 1000 population of 0.64. The density of the same metric is four times as high in the United States, at 2.6.

The burden of disease is additionally much higher in low- and middle-income countries than high-income countries. The burden of disease, measured in disability-adjusted life year (DALY), which can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability, is about five times higher in Africa than in high-income countries. In addition, low- and middle-income countries are forced to face the burdens of both extreme poverty and the growing incidence of chronic diseases, such as diabetes and heart disease, an effect of new-found (relative) affluence.

Considering poor infrastructure and low human resources, the WHO notes that the healthcare workforce in sub-Saharan Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration.

The WHO, in reference to the healthcare condition in sub-Saharan Africa, states:

The problem is so serious that in many instances there is simply not enough human capacity even to absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.

Mobile technology has made a recent and rapid appearance into low- and middle-income nations. While, in the mHealth field, mobile technology usually refers to mobile phone technology, the entrance of other technologies into these nations to facilitate healthcare are also discussed here.

Health and development

The link between health and development can be found in three of the Millennium Development Goals (MDGs), as set forth by the United Nations Millennium Declaration in 2000. The MDGs that specifically address health include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water. A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis.

Healthcare in developed countries

In developed countries, healthcare systems have different policies and goals in relation to the personal and population health care goals.

In the US and EU many patients and consumers use their cell phones and tablets to access health information and look for healthcare services. In parallel the number of mHealth applications grew significantly in the last years.

Doctors, nurses and clinicians use mobile devices to access patient information and other databases and resources.

Technology and market

Basic SMS functions and real-time voice communication serve as the backbone and the current most common use of mobile phone technology. The broad range of potential benefits to the health sector that the simple functions of mobile phones can provide should not be understated.

The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people, faster. As a result of such technological advances, the capacity for improved access to information and two-way communication becomes more available at the point of need.

Mobile phones

Mobile phone subscribers per 100 inhabitants 1997–2007

With the global mobile phone penetration rate drastically increasing over the last decade, mobile phones have made a recent and rapid entrance into many parts of the low- and middle-income world. Improvements in telecommunications technology infrastructure, reduced costs of mobile handsets, and a general increase in non-food expenditure have influenced this trend. Low- and middle-income countries are utilizing mobile phones as "leapfrog technology" (see leapfrogging). That is, mobile phones have allowed many developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump to modern mobile technology.

The number of global mobile phone subscribers in 2007 was estimated at 3.1 billion of an estimated global population of 6.6 billion (47%). These figures are expected to grow to 4.5 billion by 2012, or a 64.7% mobile penetration rate. The greatest growth is expected in Asia, the Middle East, and Africa. In many countries, the number of mobile phone subscribers has bypassed the number of fixed-line telephones; this is particularly true in developing countries. Globally, there were 4.1 billion mobile phones in use in December 2008. See List of countries by number of mobile phones in use.

While mobile phone penetration rates are on the rise, globally, the growth within countries is not generally evenly distributed. In India, for example, while mobile penetration rates have increased markedly, by far the greatest growth rates are found in urban areas. Mobile penetration, in September 2008, was 66% in urban areas, while only 9.4% in rural areas. The all India average was 28.2% at the same time. So, while mobile phones may have the potential to provide greater healthcare access to a larger portion of a population, there are certainly within-country equity issues to consider.

Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are, on average, getting wealthier in low- and middle-income nations. Vendors, such as Nokia, are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100, such as Sun's Java phone). Non-food consumption expenditure is increasing in many parts of the developing world, as disposable income rises, causing a rapid increase in spending on new technology, such as mobile phones. In India, for example, consumers have become and continue to become wealthier. Consumers are shifting their expenditure from necessity to discretionary. For example, on average, 56% of Indian consumers' consumption went towards food in 1995, compared to 42% in 2005. The number is expected to drop to 34% by 2015. That being said, although total share of consumption has declined, total consumption of food and beverages increased 82% from 1985 to 2005, while per-capita consumption of food and beverages increased 24%. Indian consumers are getting wealthier and they are spending more and more, with a greater ability to spend on new technologies.

Smartphones

More advanced mobile phone technologies are enabling the potential for further healthcare delivery. Smartphone technologies are now in the hands of a large number of physicians and other healthcare workers in low- and middle-income countries. Although far from ubiquitous, the spread of smartphone technologies opens up doors for mHealth projects such as technology-based diagnosis support, remote diagnostics and telemedicine, preprogrammed daily self-assessment prompts, video or audio clips,[56] web browsing, GPS navigation, access to web-based patient information, post-visit patient surveillance, and decentralized health management information systems (HMIS).

While uptake of smartphone technology by the medical field has grown in low- and middle-income countries, it is worth noting that the capabilities of mobile phones in low- and middle-income countries has not reached the sophistication of those in high-income countries. The infrastructure that enables web browsing, GPS navigation, and email through smartphones is not as well developed in much of the low- and middle-income countries. Increased availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world.

Other technologies

Beyond mobile phones, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed for use in the mHealth field. Many of these technologies, while having some application to low- and middle-income nations, are developing primarily in high-income countries. However, with broad advocacy campaigns for free and open source software (FOSS), applications are beginning to be tailored for and make inroads in low- and middle-income countries.

Some other mHealth technologies include:

  • Patient monitoring devices
  • Mobile telemedicine/telecare devices
  • Microcomputers
  • Data collection software
  • Mobile Operating System Technology
  • Mobile applications (e.g., gamified/social wellness solutions)
  • Chatterbots

Mobile device operating system technology

Technologies relate to the operating systems that orchestrate mobile device hardware while maintaining confidentiality, integrity and availability are required to build trust. This may foster greater adoption of mHealth technologies and services, by exploiting lower cost multi purpose mobile devices such as tablets, PCs, and smartphones. Operating systems that control these emerging classes of devices include Google's Android, Apple's iPhone OS, Microsoft's Windows Mobile, and RIM's BlackBerry OS.

Operating systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user, while managing display real estate, power consumption and security posture. With advances in capabilities such as integrating voice, video and Web 2.0 collaboration tools into mobile devices, significant benefits can be achieved in the delivery of health care services. New sensor technologies such as HD video and audio capabilities, accelerometers, GPS, ambient light detectors, barometers and gyroscopes can enhance the methods of describing and studying cases, close to the patient or consumer of the health care service. This could include diagnosis, education, treatment and monitoring.

Air quality sensing technologies

Environmental conditions have a significant impact on public health. Per the World Health Organization, outdoor air pollution accounts for about 1.4% of total mortality. Utilizing Participatory sensing technologies in mobile telephone, public health research can exploit the wide penetration of mobile devices to collect air measurements, which can be utilized to assess the impact of pollution. Projects such as the Urban Atmospheres are utilizing embedded technologies in mobile phones to acquire real time conditions from millions of users mobile phones. By aggregating this data, public health policy shall be able to craft initiatives to mitigate the risk associated with outdoor air pollution.

Data

Data has become an especially important aspect of mHealth. Data collection requires both the collection device (mobile phones, computer, or portable device) and the software that houses the information. Data is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to "tag" voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.

History

The motivation behind the development of the mHealth field arises from two factors. The first factor concerns the myriad constraints felt by healthcare systems of developing nations. These constraints include high population growth, a high burden of disease prevalence, low health care workforce, large numbers of rural inhabitants, and limited financial resources to support healthcare infrastructure and health information systems. The second factor is the recent rapid rise in mobile phone penetration in developing countries to large segments of the healthcare workforce, as well as the population of a country as a whole. With greater access to mobile phones to all segments of a country, including rural areas, the potential of lowering information and transaction costs in order to deliver healthcare improves.

The combination of these two factors has motivated much discussion of how greater access to mobile phone technology can be leveraged to mitigate the numerous pressures faced by developing countries' healthcare systems.

Research

Emerging trends and areas of interest:

  • Emergency response systems (e.g., road traffic accidents, emergency obstetric care).
  • Human resources coordination, management, and supervision.
  • Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians.
  • Clinician-focused, evidence-based formulary, database and decision support information available at the point of care.
  • Pharmaceutical supply chain integrity and patient safety systems (e.g. Sproxil and mPedigree).
  • Clinical care and remote patient monitoring (e.g. Clear Arch Health).
  • Health extension services.
  • Inpatient monitoring.
  • Health services monitoring and reporting.
  • Health-related mLearning for the general public.
  • Public health services, for example, tobacco cessation
  • Mental health promotion and illness prevention 
  • Training and continuing professional development for health care workers.
  • Health promotion and community mobilization.
  • Support of long-term conditions, for example medication reminders and diabetes self-management.
  • Peer-to-peer personal health management for telemedicine.
  • Social mobilization for infectious disease prevention.
  • Surgical follow-up, such as for major joint arthroplasty patients.
  • Mobile social media for global health personnel; for example, the capacity to facilitate professional connectedness, and to empower health workforce.

According to the Vodafone Group Foundation on February 13, 2008, a partnership for emergency communications was created between the group and United Nations Foundation. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world.

Quantum Zeno effect

From Wikipedia, the free encyclopedia
 
With the increasing number of measurements the wave function tends to stay in its initial form. In the animation, a free time evolution of a wave function, depicted on the left, is in the central part interrupted by occasional position measurements that localize the wave function in one of nine sectors. On the right, a series of very frequent measurements leads to the quantum Zeno effect.

The quantum Zeno effect (also known as the Turing paradox) is a feature of quantum-mechanical systems allowing a particle's time evolution to be slowed down by measuring it frequently enough with respect to some chosen measurement setting.

Sometimes this effect is interpreted as "a system cannot change while you are watching it". One can "freeze" the evolution of the system by measuring it frequently enough in its known initial state. The meaning of the term has since expanded, leading to a more technical definition, in which time evolution can be suppressed not only by measurement: the quantum Zeno effect is the suppression of unitary time evolution in quantum systems provided by a variety of sources: measurement, interactions with the environment, stochastic fields, among other factors. As an outgrowth of study of the quantum Zeno effect, it has become clear that applying a series of sufficiently strong and fast pulses with appropriate symmetry can also decouple a system from its decohering environment.

The name comes from Zeno's arrow paradox, which states that because an arrow in flight is not seen to move during any single instant, it cannot possibly be moving at all. The first rigorous and general derivation of the quantum Zeno effect was presented in 1974 by Degasperis, Fonda, and Ghirardi, although it had previously been described by Alan Turing. The comparison with Zeno's paradox is due to a 1977 article by George Sudarshan and Baidyanath Misra.

According to the reduction postulate, each measurement causes the wavefunction to collapse to an eigenstate of the measurement basis. In the context of this effect, an observation can simply be the absorption of a particle, without the need of an observer in any conventional sense. However, there is controversy over the interpretation of the effect, sometimes referred to as the "measurement problem" in traversing the interface between microscopic and macroscopic objects.

Another crucial problem related to the effect is strictly connected to the time–energy indeterminacy relation (part of the indeterminacy principle). If one wants to make the measurement process more and more frequent, one has to correspondingly decrease the time duration of the measurement itself. But the request that the measurement last only a very short time implies that the energy spread of the state in which reduction occurs becomes increasingly large. However, the deviations from the exponential decay law for small times is crucially related to the inverse of the energy spread, so that the region in which the deviations are appreciable shrinks when one makes the measurement process duration shorter and shorter. An explicit evaluation of these two competing requests shows that it is inappropriate, without taking into account this basic fact, to deal with the actual occurrence and emergence of Zeno's effect.[9]

Closely related (and sometimes not distinguished from the quantum Zeno effect) is the watchdog effect, in which the time evolution of a system is affected by its continuous coupling to the environment.

Description

Unstable quantum systems are predicted to exhibit a short-time deviation from the exponential decay law. This universal phenomenon has led to the prediction that frequent measurements during this nonexponential period could inhibit decay of the system, one form of the quantum Zeno effect. Subsequently, it was predicted that measurements applied more slowly could also enhance decay rates, a phenomenon known as the quantum anti-Zeno effect.

In quantum mechanics, the interaction mentioned is called "measurement" because its result can be interpreted in terms of classical mechanics. Frequent measurement prohibits the transition. It can be a transition of a particle from one half-space to another (which could be used for an atomic mirror in an atomic nanoscope) as in the time-of-arrival problem, a transition of a photon in a waveguide from one mode to another, and it can be a transition of an atom from one quantum state to another. It can be a transition from the subspace without decoherent loss of a qubit to a state with a qubit lost in a quantum computer. In this sense, for the qubit correction, it is sufficient to determine whether the decoherence has already occurred or not. All these can be considered as applications of the Zeno effect. By its nature, the effect appears only in systems with distinguishable quantum states, and hence is inapplicable to classical phenomena and macroscopic bodies.

The mathematician Robin Gandy recalled Turing's formulation of the quantum Zeno effect in a letter to fellow mathematician Max Newman, shortly after Turing's death:

[I]t is easy to show using standard theory that if a system starts in an eigenstate of some observable, and measurements are made of that observable N times a second, then, even if the state is not a stationary one, the probability that the system will be in the same state after, say, one second, tends to one as N tends to infinity; that is, that continual observations will prevent motion. Alan and I tackled one or two theoretical physicists with this, and they rather pooh-poohed it by saying that continual observation is not possible. But there is nothing in the standard books (e.g., Dirac's) to this effect, so that at least the paradox shows up an inadequacy of Quantum Theory as usually presented.

— Quoted by Andrew Hodges in Mathematical Logic, R. O. Gandy and C. E. M. Yates, eds. (Elsevier, 2001), p. 267.

As a result of Turing's suggestion, the quantum Zeno effect is also sometimes known as the Turing paradox. The idea is implicit in the early work of John von Neumann on the mathematical foundations of quantum mechanics, and in particular the rule sometimes called the reduction postulate. It was later shown that the quantum Zeno effect of a single system is equivalent to the indetermination of the quantum state of a single system.

Various realizations and general definition

The treatment of the Zeno effect as a paradox is not limited to the processes of quantum decay. In general, the term Zeno effect is applied to various transitions, and sometimes these transitions may be very different from a mere "decay" (whether exponential or non-exponential).

One realization refers to the observation of an object (Zeno's arrow, or any quantum particle) as it leaves some region of space. In the 20th century, the trapping (confinement) of a particle in some region by its observation outside the region was considered as nonsensical, indicating some non-completeness of quantum mechanics. Even as late as 2001, confinement by absorption was considered as a paradox. Later, similar effects of the suppression of Raman scattering was considered an expected effect, not a paradox at all. The absorption of a photon at some wavelength, the release of a photon (for example one that has escaped from some mode of a fiber), or even the relaxation of a particle as it enters some region, are all processes that can be interpreted as measurement. Such a measurement suppresses the transition, and is called the Zeno effect in the scientific literature.

In order to cover all of these phenomena (including the original effect of suppression of quantum decay), the Zeno effect can be defined as a class of phenomena in which some transition is suppressed by an interaction – one that allows the interpretation of the resulting state in the terms 'transition did not yet happen' and 'transition has already occurred', or 'The proposition that the evolution of a quantum system is halted' if the state of the system is continuously measured by a macroscopic device to check whether the system is still in its initial state.

Periodic measurement of a quantum system

Consider a system in a state , which is the eigenstate of some measurement operator. Say the system under free time evolution will decay with a certain probability into state . If measurements are made periodically, with some finite interval between each one, at each measurement, the wave function collapses to an eigenstate of the measurement operator. Between the measurements, the system evolves away from this eigenstate into a superposition state of the states and . When the superposition state is measured, it will again collapse, either back into state as in the first measurement, or away into state . However, its probability of collapsing into state after a very short amount of time is proportional to , since probabilities are proportional to squared amplitudes, and amplitudes behave linearly. Thus, in the limit of a large number of short intervals, with a measurement at the end of every interval, the probability of making the transition to goes to zero.

According to decoherence theory, the collapse of the wave function is not a discrete, instantaneous event. A "measurement" is equivalent to strongly coupling the quantum system to the noisy thermal environment for a brief period of time, and continuous strong coupling is equivalent to frequent "measurement". The time it takes for the wave function to "collapse" is related to the decoherence time of the system when coupled to the environment. The stronger the coupling is, and the shorter the decoherence time, the faster it will collapse. So in the decoherence picture, a perfect implementation of the quantum Zeno effect corresponds to the limit where a quantum system is continuously coupled to the environment, and where that coupling is infinitely strong, and where the "environment" is an infinitely large source of thermal randomness.

Experiments and discussion

Experimentally, strong suppression of the evolution of a quantum system due to environmental coupling has been observed in a number of microscopic systems.

In 1989, David J. Wineland and his group at NIST observed the quantum Zeno effect for a two-level atomic system that was interrogated during its evolution. Approximately 5,000 9Be+ ions were stored in a cylindrical Penning trap and laser-cooled to below 250 mK. A resonant RF pulse was applied, which, if applied alone, would cause the entire ground-state population to migrate into an excited state. After the pulse was applied, the ions were monitored for photons emitted due to relaxation. The ion trap was then regularly "measured" by applying a sequence of ultraviolet pulses during the RF pulse. As expected, the ultraviolet pulses suppressed the evolution of the system into the excited state. The results were in good agreement with theoretical models. A recent review describes subsequent work in this area.

In 2001, Mark G. Raizen and his group at the University of Texas at Austin observed the quantum Zeno effect for an unstable quantum system, as originally proposed by Sudarshan and Misra. They also observed an anti-Zeno effect. Ultracold sodium atoms were trapped in an accelerating optical lattice, and the loss due to tunneling was measured. The evolution was interrupted by reducing the acceleration, thereby stopping quantum tunneling. The group observed suppression or enhancement of the decay rate, depending on the regime of measurement.

In 2015, Mukund Vengalattore and his group at Cornell University demonstrated a quantum Zeno effect as the modulation of the rate of quantum tunnelling in an ultracold lattice gas by the intensity of light used to image the atoms.

The quantum Zeno effect is used in commercial atomic magnetometers and proposed to be part of birds' magnetic compass sensory mechanism (magnetoreception).

It is still an open question how closely one can approach the limit of an infinite number of interrogations due to the Heisenberg uncertainty involved in shorter measurement times. It has been shown, however, that measurements performed at a finite frequency can yield arbitrarily strong Zeno effects. In 2006, Streed et al. at MIT observed the dependence of the Zeno effect on measurement pulse characteristics.

The interpretation of experiments in terms of the "Zeno effect" helps describe the origin of a phenomenon. Nevertheless, such an interpretation does not bring any principally new features not described with the Schrödinger equation of the quantum system.

Even more, the detailed description of experiments with the "Zeno effect", especially at the limit of high frequency of measurements (high efficiency of suppression of transition, or high reflectivity of a ridged mirror) usually do not behave as expected for an idealized measurement.

It was shown that the quantum Zeno effect persists in the many-worlds and relative-states interpretations of quantum mechanics.

Classical radicalism

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