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So um my idea was to start with a quick reminder of the last session. But I'm not, I know that as at what's here last week, I don't know, Mohamed if you, I was able to attend the last session. So I don't know if I need to do the summary. Well, in case, I'm not sure if Mohammed was there. So I'm Theresa, I'm a doctor from Spain. I'm doing a clinical research fellowship at Imperial College, London. And last week, we were talking about a D H D and general considerations about a D H D. And today we're going to focus on the use of digital tools in mental health and more particularly in a D H D. So as I say, I wanted to start with this reminder and then to ask to, to let people ask questions if you had, I know that as I have some, some questions last week and to discuss then and then I wanted to um uh sorry to talk about the reasons for using new technologies in medicine and more specifically in psychiatry, the mode of delivery of these um interventions through digital tools, the mode of use these interventions in medicine. So I want to give you some examples and to explain some papers, focus on A D H D and then to speak about the limitations and challenges of these new technologies, the importance of the engagement and the clinical implications. So again, I don't know if you need me to do the the summary, I can, I can go quickly through this and then we can discuss the questions if it's OK. So um we have three core symptoms in A D H D that are in attentional productivity, impulsivity. And then um these symptoms can be categorized into, to behavioral patterns that can be impulsive, impulsiveness and in productivity or inattentiveness. And most of our patient's are going to have symptoms that fall into both categories. But we can also have a diagnosis of A D H D with symptoms from only one of the two categories. And this is the case of A D D or attention deficit disorder where patient's only have symptoms from the inattentiveness component here in the table. Um I have summarised the symptoms from the two different behavioral patterns. So, in productivity and impulsivity aspects, we're going to see people unable to respect terms, talking a lot with this physical movements and impulsivity. And then in the inattention pattern, we will see patient's forget, fel losing things, unable to concentrate, doing these premature changes between activities. Then in terms of theology, we, we talked last week that there is no, a specific cause of uh phd or we haven't find, find it. But um, we know that there is a genetic component and first degree relatives of patient's with H D tends uh to be likely to develop a D H D themselves. Then, um, we also have prenatal factors and the most studied that with most evidence are the low weight at birth and also the prematurity, we have these neurobiological deficits. So we know that the brain in these kids are going to match er slowly, slowly and more specifically in the prefrontal cortex that plays a part in regulating emotions and motor symptoms. So we expect this area to be impaired in Children with A D H D. There is also an implication of the catecholaminergic system with this no dopamine and not adrenaline. And um just the general brand sets of uh these kids uh is smaller than in the general population. And then we are going to read things about environmental factors, family factors, but there is no evidence. Um that's uh and the results are controversial about these factors. So we are not going in general to ask parents to avoid certain food or um we know that family factors have an important role in the course and the outcomes. But there is no reason to think that this heart parenting or poor parenting can lead to develop A D H D. Um We also know that H D is associated with comorbidities. So the most frequent are oppositional and conduct problems. But we also find association with other neuro developmental disorders, mood disorder, anxiety, depression, the use of substances, communication problems and problems with the sleep. And then just to finish the quick summary for the diagnosis, we are going to conduct a specialist assessment. It's worth doing observation at school, asking for reports from other professionals, asking parents about the symptoms and um supporting our clinical thinking with questioners and then for treatment, we have these psychological interventions. So last week, we talk a lot about these behavioral strategies that we can advise parents and teachers to try and the importance of psychotic eight uh teachers carers and then medication. So the perfect thing is if we need medication to combine medication with these psychological interventions, uh there are more evidence for medication that for these psychological interventions. So we can leave these interventions for milder cases or young people that are for kids under five years old when we cannot start medication. And then in terms of medication, we have two categories, the stimulants and the non stimulants. Um We're going to start with the stimulants. Again. There is more evidence for stimulants and better effects, uh best effects and less side effects than non stimulant medication. And the first choice is going to be methylphenidate depending on the brand that we are going to use. If we are going to use um immediate release tablets or modified release tablets, the dosage is different but more or less. Um in with methylphenidate, we will start with 5 mg once or twice a day and we can increase until 60 mg. Mm. What else then? Um the most important side effects of the stimulants. And we need to explain these two parents and two patient's are the decreasing the appetite and problems with the sleep. So we have to, to see to keep this in mind and uh to think about these side effects, um sometimes we need to change, to switch to other treatments to reduce these side effects. So the key points here are that it is not naughtiness is common across all cultures. It can be serious and can persist into adulthood. So uh let's remind that HD in adulthood leads to negative consequences. So more substance abuse, more suicide, more divorce accidents, other psychiatrist problems, unemployment, it can be also stigmatizing and can lead to social exclusion and blaming families for these behaviors. Yeah, and it's treatable. So with and spatial. So we need to fight it and to, to short this meal. It so yes, it was the quick reminder. I don't know if you want to ask something or if we start with the use of digital tools and then we leave the questions for the end. Shall I continue? Yes. Yes. Okay, perfect. So um the use of the, so I, I wanted to speak to you about the digital tools in mental health because it's um my research field, I'm working on developing an app to support mental health and young people. And I think it's uh has these tools, has a promising future and can be interesting for the new generations. So the reasons for using these digital tools in psychiatry is that uh first nowadays, uh mental disorders in Children and young people around the world reach 30% more or less. And this means an increasing demand on child and adolescent mental health services. So um currently here in the UK, Children and young people who do not receive any treatment at all and have mental health problems reach 75%. So we can see that it's very common and this is due to some barriers to attend these mental health services. So barriers such as stigma, uh feelings of shame, nous and embarrassment when we need to share our feelings or our problems with uh clinician or a stranger uh concerns with confidentiality. The cost, of course, people sometimes cannot afford certain services and the access. So um people who lives in remote places or when we have natural disasters worse. So that's why I think it's important to keep in mind these new technologies as they can overcome many of these barriers. So uh they have an enormous potential to, to sort out these problems. And this is the reason why they are increasing so rapidly in the last years. So um um they increase the uptake, there are efficient. Um They can allow us to personalize interventions and they have advantages such as anonymity from feedback, cost effectiveness, the applicability in real life and treatment fidelity and they help us to ease the pressures on face to face services and they help us to avoid a stigma. And some studies that have had compared the results from interventions face to face and interventions using these digital tools, a state that the results are comparable. So that's a good point. Um I wanted to show you this in case you are interested in this topic. It's a glossary of the common terms of the field of digital healthcare. And well, I think it's interesting to know some of the terms as now we can usually read this these terms. So for example, and the definitions are pretty similar to each other with a few differences. So for example, uh for each use, um it helps, it's anything health related that use information and communications technology. And then m health, it's a branch of the health. But when we deliver these interventions using portable electronic mobile devices, technologies such as the smartphone tablets, wearable devices. So yeah, maybe it's worth looking at this table to better understand the topics. Then in terms of the mode of delivery, um digital health interventions vary widely in terms of the contact content to design the levels of interactivity with the user, the hardware through which we can access the intervention or the mode of delivery. So we have many different options. For example, websites, we can deliver interventions through games, apps, robots feel to a reality mobile messages. We're going to see this in more detail. And now I'm working on apps, I think there are good and cost effective solution to address some mental health gaps and how we can use these digital tools in in mental health. So we can use it for both for, for for two things, for observation and for delivering interventions or for both of them. So in terms of observation, they are, they are perfect for a research setting as they allow us to capture data and they are also very good for a clinical settings as we can monitor symptoms. I'm going to explain how to use these digital tools for observation. Uh explaining what is ecological momentary assessment and explaining what is passive sensing technologies. And we will see some papers more focused on how to use these tools in a D H D population. And then we can use them for delivering interventions. So we will speak about ecological momentary interventions just in time adaptive interventions and other interventions that I found very interesting uh to know. So let's start about how to use this tool for doing observation. Um We can do this through two different methods using E M A that is ecological Monetary assessment and also known as experienced sampling or ambulatory assessment. So to explain this I like to use the example of emotion regulation. So, emotion regulation is our ability to change our emotions that to modify our emotions depending on the context and the environment. So it's something that is not going to be a static, but it's going to be um dynamic and we are going to change our emotions through the day and uh it's essential for a healthy development. So when we use rating scales, we are not able to capture these dynamic fluctuations in the motion regulation as we are asking something in a specific point of time. So um E M A ecological momentary assessment is designed to record rating in real time and uh to deliver a representation of the patient in a naturalistic setting. So this means that um we are going to ask people to complete surveys or questions many times in a day, during days, during weeks, during months and then we can capture each stage of these regulation pro project process ary and we can increase the ecological validity of the data. We can reduce the recall bias is because we are asking a person to report how they are feeling in this exact moment. Not to remember how they were feeling like a week ago, we're going to reduce the emotion impact in the responses. So the current mood has been shown to impact retrospectively self report. So this means that if I'm feeling low now and they asked me to rate my mood, uh how I have been feeling for the last month. Um I'm going to tend to be more pessimistic about my mood and to rate it lower than it really was or uh lower than it will rate it if I was feeling okay now. So my current mood has an impact on my responses. Uh This is a cognitive pious and using this technique, we reduce this bias as we are answering the question in the exact moment. And this is going to allow us to have uh important longitudinal data. It's something feasible acceptable and then it's a promising tool. But of course, there are some limitations of doing this. Uh We are still asking people to self report their own emotions. So we know that when we do this, our insight can be limit limited. And also there are some practical limitations. So asking a person to answer questions many times in a day, give us a lot of data but can be border cem uh and also people cannot access their mobile phone to respond these kind of questions anywhere. So for example, if they are attending a class at school or if they are working, they cannot be with their mobile phone completing these surveys. So to overcome these limitations, we can use the passive sensing technologies. So the perfect thing to do is to combine E M A with passive sensing technology to um observe and to assess all of these symptoms. Passive sensing technology. So I like to use the example of the mobile phone because I think it's the most convenient one as people usually uh bring their mobile phone in their daily life in real settings. And we can get very good and valuable information from the mobile phone. For example, using the GPS, we can know the location without asking the user to actively record or engage in anything. So we can get continuous objective and limited effort information. If something is not clear, please put it in the chat and I will re explain it. I hope. Yeah, sorry Yemi, full phone its ecological momentary assessment. It's also you can also um find it as experienced sampling method or ambulatory assessment. But they mainly use this uh E M A. So I wanted to show you some papers focus on A D H D. Um Here we have a systematic review that wanted to examine if we have used E M A for assessing A D H D populations and if it's feasible. So in this systematic review, they analyzed 23 studies and they concluded that yes, we have already used these methods for uh observation in a D H D population. And so far it has been successfully implemented with high completion rates of the questions reaching 87.7%. Um But they highlight that of course, we need more research with longer monitoring periods and more focused on teenagers in this systematic review. They mentioned this paper here. Uh that is that, that try to examine uh to which extent child's negative emotional lability measure using M A. And also to which extent A D H D diagnosis predict uh the frequency of daily parenting hassles and the intensity of parenting stress resulting from these daily hassles. So, in this paper here, they mentioned uh meta analysis about parenting stress and 80 HD. And researchers found that both in proactive and impulsive but also inattentive symptoms of A D H D are associated with greater global parenting stress. So we know that Children with A D H T has challenging behaviors and an import functioning. And these increase the demands on parents that have to interfere on behalf of their children's in many different situations, not only at home, but also at school or outside, you know, where these Children have these difficulties. So uh in general, parents of Children with A D H D encounter, uh more frequent parenting task and more challenging behaviors. There are some studies saying and suggesting that parents of Children with A D H D also a struggle and find difficult to um appropriately managing this parenting stress. So here we have uh the combination of greater demands with this greater difficulty in meeting the these specific needs in Children with A D H D has a negative impact on the family functioning and predicts parenting stress. So that's one of the reasons why uh last week And today I say it's very important to support these parents um to help them to, to support and to help their Children and to avoid all of these negative consequences and negative outcomes. And course, so um when we tried to measure children's emotional lability, we use retrospective um tools. So questionnaires, etcetera, that can give us valuable information but not real time data. So here we can use E M A and it can be very convenient to get this real time data. So in this study here, what they did is they took a sample of um 80 for Children aged 8 to 12 years old and then parents have to record three times a day, their children's mood using E M A. So before they go to school, after coming back to school and in the evening and they also complete uh positive and negative affect the scale. So doing doing different analysis, they conclude that parents of Children with A D H D reported significantly greater frequency of the parenting hustles and intensity on uh of parenting stress. And also they conclude that this study suggests that children's negative emotional lability is a sick mythic to based uh don't be and with H D children's without any ghd and defined findings are consistent with previous studies. So here we can conclude that we need to support uh of Children with these emotional disregulation, emotional ability, but more specifically, if they also have th okay, I want to explain passive sensing technology or this thing, emptying a smartwatch, mobile phones, etcetera. I have created these two tables to to go through this quickly because there is a lot of examples, a lot of different devices we can use um if you're interested, I instruct all of this data from a systematic review that I can send it to you. But for example, we can use wearable devices and smartphones to get a lot of information from our patient's. We can have uh data about their heart rate variability and BP using smartwatches, mobility GS um skin patches, we can have information about their physical activity using feet picked apple watches, smartphones again using the accelerometer embedded in smartphones. And for example, um I they read um in the systematic review, they were mentioning a study made in people suffering from Parkinson. And then they were, they were using these accelerometers in the smartphone to study and to observe the movement pattern. We can also know uh through these devices. If a person is engaging in a physical activity as a strategy to regulate their emotions. We can, as I say before, use the GPS in the smartphone to identify context that are associated with specific emotional responses. So for example, um if we combine this GPS think with an E M A, we can know if a person is going uh to allocation that it's very stressful for this person as they are feeling in the question in the EMA that they are getting stressed and in the GPS, we can that they are going to this specific location. And then the idea is to provide an intervention to reduce these negative emotions, we can get acoustical language data using again a smartphone, accessing the micro of the microphone. Uh There is a study uh accessing the microphone of a mobile phone trying to identify if people were doing the a frag Matic breathing patterns. Um Sorry. So uh they identified if a person we're doing deep breathing and then they conclude that they were engaging in these diaphragmatic breathing patterns as a method to control their emotions. We can also access the microphone and then uh conclusive a person is socializing uh depending on what we hear in the background or if a person is in a very stressful situation, we are going also to talk about uh the limitations that these things can have. Um There are studies trying to detect emotions through um the camera of the mobile phone, identifying some images, videos, body postures, uh faces and then there is a study trying to relate certain emotions with the popularity response. Again, accessing the camera in the mobile phone, we can use social media to get a lot of information. So social media, it's we know that most of the teenagers now use social media so it can allow us to have very big samples of data. And there are studies trying to identify patch ear's and changes in the patterns of people, posting photos, posting text, etcetera and then trying to identify changes in there in these patterns with certain emotions, emotions. There is a study doing this in Facebook and trying the idea is to prevent um suicide. So identifying people who are getting the press and the goal is to the Christian side, we can use a small home technology. So this is very convenient because we are not only assessing a person but the family as a whole. We can know again, if there are in a stressful situation, we can have information about the temporary at home delighting virtual reality. So I went to an event where they present a program using virtual reality to help people who were suffering from uh psychosis. And then they were also suffering from agoraphobia. They were funding very stressful to live their home and to socialize with people outside their home. Then in this virtual reality program, these people can uh they were recreating different scenarios. For example, the GPS consultation, the street, the shop, and then this patient's could practice how to behave, how to regulate their emotions, how to fill in these different scenario before doing it in real life and the feedback was very positive. So the participants in these uh by the study uh find it very useful and they said that it was easy to live their home and to do a normal life after having practice it in virtual reality. So again, this is a promising tool. This is more an intervention that an observation, but sometimes the limit between intervention observation is a bit blurred in these technologies. And then we have other devices that I found very interesting to know. I think there are like very original and photoreceptors. For example, it takes deals smart generally as my smart, I were eat tattoos. So I did a quick research about the tattoos because I was very curious. And then I found these two examples. Well, there are tattoos or patches, skin patches. So this first picture here is from the Brown Motorola and with this E tattoo or patches, we can get passive information about E Z E G E M G Temperate, er E G. And then this second example here it's from the brand Loreal and then you can know about your uh UV exposure and you can check your data in asthma phone app. I think it was very curious to know. So now let's focus a bit on how to use these passive technologies in A D H D. So I wanted to show you today these different technologies. But to be honest, I only found papers using a smartwatch and the accelerometer embedded in a smartwatch. So and also most of the results were most of the research we're pilot studies. So without research yet, so I can conclude here that there is a scars research on this field. So on the use of technologies for A D H D. So if you're interested in, in research, I think there is room for doing research and yes, researching about all of these tools. So in this first study here, um it's a pilot study on the efficacy of a stop watch that these are smart to watch up, created to track movements in people with A D H D and to provide these participants with feedback. So, uh of course, they were specifically focusing on the proactive proactivity aspect of A D H D. It's a pilot study. So there are no results uh in the second paper here, also a pilot study. But with some results, they were again using the smart watch. So the accelerometer uh in the smart watch to um uh the idea was to find an objective tool to evaluate the efficacy of treatment. So here, 10 Children with a D H D were this smart watch one month before starting medication, one month after starting medication. So the medication was methylphenidate 10 mg. And they conclude two things here. They conclude that results from the snap for questioners and results from these uh smartwatch and accelerometers were strongly correlated. So that's a good point. And they also conclude that the level of movement significantly decrease after being on medications for a month. So this is a result that we could expect we know that these medications are effective uh with a D H D but they give us a promising tool as so far. What we have been using is questionnaires. And when we use questionnaires, some what we are gathering uh subjective data's, we are asking teachers, parents to give their, their opinion and their view on the child behavior. And sometimes there are some discrepancies between the results from the school, the research from parents. So if you, if we can, if you are able to use this smart watch, we uh the results are going to be completely objective. So uh there are a promising tool and this third question are here again, they were using a smart watch and the accelerometer and gyroscope embedded in the smart watch to analyze the movements in Children with A D H D compared with Children without A D H D. So in this case, um this population were the smart watch um and they record the data during two hours for during three days when they were in the classroom. So in a naturalistic setting, and again, they conclude that people with a D H D in in this um study had more frequent and vary able movements than people without a tht. So again, this is something that we can expect, but they present here uh objective tool to better understand these movement patterns and um to have objective data just to say, to explain accelerometer measures acceleration, acceleration, motions of acceleration, um I'm uh sorry, linear accelerations. And then the gyroscopes um measure angular velocity. So this is the time rate at which an object rotates about an axis. In this paper, they get, they present many details about different tax is different accelerations. But it was difficult to understand and I don't think it's, it's very specific, so I don't think it's interesting. So now now that we have seen how to use these tools for inter for observation, we are going to see how to use them to deliver interventions. So uh I'm aware of the time, I think, I don't know if I'm going to have time to, to finish. So I'm going to go through this quickly. Um We can use E M I. So uh um this is similar to ecological momentary assessment but instead of asking users to complete questions or yes to respond questions, we are delivering interventions through pre program test messages or through an app and then we can ask people uh to engage in a specific skill, we can deliver psychoeducation, we can deliver support therapy. So it's like delivering interventions during the day, then we have to just in time adaptive intervention. So this means to deliver the intervention just in the moment when the person needed in response to contextual cues that indicate us that this person needs to support or needs the regulation uh intervention. So, uh for example, I'm going to uh make this up. But let's imagine that we know that a person is going to a very stressful situation location because we are getting this data from the GPS of the their mobile phone. And this the heart rate variability is also increasing, the BP is increasing. We get all of these data from this passive technologies in the mobile phone. Uh and the person using E M A is recording that it's getting very nervous. So we know that this this is the optimal window when to the divert intervention and to help this person to regulate their emotions, we have other kind of technology so we can use a smart environment. Um So this means for example, using the smart home technology that I said before too, assess the family as a whole to when we are detecting that this family is getting a stress. For example, due to the noise in the background, we can deliver interventions by playing coming music, changing the light's changing the temperature at home to create a more relaxing environment for this family or a smart toy intervention. So there is a paper using a toy uh with I think it was eight Children. Uh And this though it was like a four be uh delivering emotional regulation interventions in the moment and when uh difficult was very positive. Uh Of course, all of these researches are in earlier stages and we need more research with more monitoring. And yeah. So in terms of um A D H T, this is um narrative review explaining how to use just in time of that adaptive interventions in A D H D. It was very difficult for me to find ate beef but not at all. But Israel, they say that let us know about the relationship between uh these incomes trigger and context and environment. So combining mobile real time analysis with automated real time feedback on parameters of interest may to pay change be in page. And this this mythological approach is just time adaptive intervention. Doesn't I just explain in this review here dimension this study, this is the product study that is part of an European project, aiming to increase comorbidities in people with a D H D. So uh the goal is to decrease depression and obesity in a GHD population and they wanted to do it through non pharmacological treatments. So they randomize a sample in people that are going to do exercise, people that are going to get bright light therapy. And another part of the sample is the control the control group. So the idea of this project is to see if doing this non formal psychological uh therapies, discom morbidity of depression and obesity decrease. This is a local. So there are not research yet. But uh the idea is uh let's take the population that is going to engage in exercise. So um the idea is to um they are going to be given instructions to perform exercise through and a smart phone app and then they are going to be guided through this training by exercise, video, motivational reminders and also overview of uh they're weekly goals. Um or the idea is to get to deliver to this participants daily feedback about their steps about the movement, acceleration and also about the duration of the aerobic exercise, their strengthening exercise. And they think that giving this daily feedback and in real time feedback, this is going to increase the motivation and the compliance. So, uh let's see when they post, when they uh published the results, if it's uh successful or not. So, um in terms of summary, we have seen that we can use these technologies for in psychiatry, for emotional disregulation, agoraphobia. Uh There are a bit from psychosis, social anxiety, depression, then we can also uh use it for obesity, Parkinson PTSD and some papers have also uh state that they have also used these technologies, osteoarthritis, terrible part policy strokes. Uh I'm sure that there are many other uses, but I'm not aware of them. If you are interested, you can, I'm sure that there are papers about it. So now let's talk quickly, talk about the limitations and challenges. So uh the main limitation is the low patient engagement and the high to dropout rates. So, um on average, when we don't load an app, for example, we are going to use it for four weeks and then we're going to stop using it sometimes without any reason So we need to think about how to increase this engagement and to reduce these rates. Mm um The reason can be that the failure to address important aspect of the disease through these digital tools or the challenge of managing comorbidities or helping people in acute crisis. Uh People from from studies also highlight that concerns about the data security, the private policies where we are going to a store, all of this data problems with the accessibility. And uh in my opinion, some of the technologies that I have explained can be somewhat intrusive. This is my opinion. I don't know. What do you think? For example, the think of changing lights at home, pay, playing music, etcetera to to come down the environment. I think it's a bit intrusive in my opinion, or accessing the GPS, accessing the microphone, these kind of things. So in terms of uh I think it's important to quickly view how, how we can increase this engagement. So uh this active involvement of participant with the intervention uh to increase engagement, we are going to have factors that depends on the intervention itself and factors that depends on the person itself. So in terms of the intervention, um people state that the excessive the acceptability is very important. So this means the willingness to use the app. And John people say that it's going to depend on the features. Sorry, I'm speaking about apps because it's my research field. But this uh relates to all the digital to in general. So uh it's going to depend on certain features, for example, they lack apps that present videos, not a lot of text or long text, simple information that they can understand the ability to personalize the app to create a profile, to communicate with others. Then the second factor is to use ability. So the degree to which this digital health intervention was able to be used. Uh So is it what it has to be easy to understand is easy to use, straightforward user friendly self space it and then we have the suite ability. So the degree to which the digital health tool is in line with daily activities. So for example, if they can access it at home, if they can do the interventions or the exercise that the app ask them to do into and to integrate these into their everyday life. And then we have factors that depend on the person. For example, the opportunity they, people say that they need to trust uh the information that we are delivering through the digital health uh tool. It's useful if we put the logo, if they know the brand or the name of the organization, uh if they understand the privacy policy, uh it's they are more likely to use the app. If they can do it in an anonymous way, then the motivation, of course, they are going to use the app. If they are curious about it and they find it helpful and useful. And then there are other factors uh that depending on the person that are going to impact on their capability to use the apps. So stress force in the environment, in the mental health, physical health, social uh social factors, etcetera. So uh I'm finishing now, um these digital tools are a helpful way to support and to treat mental health problems. But so on now nowadays, for the time being, it can be a very important complement to other psychological support. So I mean, we are not going to do to do an interventions with a patient only with these digital tools. So now we are going to combine these digital tools with face to face intervention and the normal interventions we have so far. Then digital health interventions should be sweet table for child and young people lifestyle, focusing on these of access, the design to ensure that is not to complicate and it's appealing for these uh population and then the level of trust and the ability to connect with others uh should be carefully considered because in many focus group with patient that have been using these apps, they always highlight this, they need to connect with others and to trust the information. Um Again, I wanted to recommend so resources. So we talk a bit about them last week. This last resources here, the British National formulary for Children is very useful if, if you want to check the dosage of medication for, for a D H D or for other mental health problems and that's all. Thank you very much for listening. Mhm. Okay. I'm reading. Can you remotely detect and send emergency help by picking up on cardiac arrhythmias precipitated by possible intoxication or some harmful activities. So I haven't read papers um saying this specifically but what you are asking here, I think it's related with adjusting time adapt active intervention. So the goal of these interventions is to deliver this in the moment interventions. So that's a very good idea. I'm not, I don't know if they are using this or if they are pilot study or protocols to to do this. But I think maybe in a few in a future it can be. Yes, a good, a good intervention. So thank you buddy. Uh Do you have any other questions? Does it make sense? What I explain? Because sometimes I feel like gives a lot of information. Yes, Assad. Yes, because regarding is one of the instruments means that the passive sensing technology uh you showed us to photos regarding these silicon ships. Sorry, I cannot hear you correctly. Uh Sure to see MS silicon chips method that which is used for the detecting the A D H D triggers or activities. Uh The silicon chest. Can you grate it in the chat because I'm not, I cannot hear you correctly. Sorry you OK. Sorry. Yeah, you said about this silicon chip, which could be used in the further detecting of the A D H D. And, uh, um, for a moment, I thought that this silicon chip which is used, it would be similar to that we used in diabetes. When we monitor and regulate the, regulate the, uh, insulin level, it could be same, we could use the medication as well in this, these silicon chips or a device which would be attached to the skin. Yeah, that's in the same manner. Yeah, that's it. Yes, just yesterday, I was speaking with a nurse about this and they explain me this uh that you, your skin and then you can detect the sugar levels if they need more insulin. So, yeah, that's the idea. Something similar to, to this. Yeah. Thank you for someone. How expensive because uh it's not uh like for someone who is in UK, the NHS is a very good uh organization for life insurance that it's a medical but for where the people who don't have these technologies to help them, it would be quite difficult because if you go in America where it's expensive, but still it's uh they do recognize a D H D if you go to countries such as, uh, I don't know, North Korea or India where A D H D has not taken something as seriously or their mental issues where in India mental issues are not taking that seriously, the parents might be very difficult to find a food, these kind of treatments and therapies or the methods of like diagnosing and treating the the Children or the patient's. Actually the last time I, last time the questions was regarding A D H D was the same. How much the uh this is this question I asked uh the teachers as well, how much of a government rule plays in this for the helping the A D H D or mental health issue? Because uh I may, I gave an example which was given by some other G P professor in UK. It was in some Arabic country, there was a leader who, who means in that country. There's no protocol for any mental health issue. But since when the leader of that country had a child born in his family who had an A D H D issue after that interview. After that incident, there is an A D H D uh clinic and like the protocols are right now in the medical system. Yeah. Oh, the country doesn't have, that could be very expensive for the countries who do have, it could be very keep or affordable. Yes. Yes, I agree. So it's going to depend on the country, the circumstances if they are going to take this more seriously or not. Of course. Yes. Thank you very much as bad for, for sharing this. Uh I don't have experience in working in other parts. So I have been working in Spain and in the UK where uh yes, we are, we have this uh public National Health so we can support patient's with this. But well, uh maybe it's our role to, to do the psychoeducation to, to other people too. Yes, teachers, parents about this and to take this into account and about the the price and the if these tools are expensive or not. I think for example, apps, as I said, it's a very good cost effective solutions. So the app, one of the main things uh that increase engagement and that people highlight in this focus group is that the app has to be free if not, they are not going to pay for it. Uh So yes, it's also something to, to keep in mind if we want to, to use these tools and to increase engagement.