Paul Schmiedmayer

All Publications

• Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study. JMIR formative research Miranda, C., Matheson, B., Datta, N., Whyte, A., Yang, H. J., Schmiedmayer, P., Ravi, V., Aalami, O., Lock, J. 2025; 9: e70278

  Abstract

  Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)-based distress tolerance skills to support adolescents and families during mealtimes.Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT.BALANCE was developed collaboratively with Stanford University's Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app's usability, perceived effectiveness, and its impact on their distress tolerance.The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app's broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa.BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE's application to broader adolescent populations.

  View details for DOI 10.2196/70278

  View details for PubMedID 40019817

• Comprehensive real time remote monitoring for Parkinson's disease using Quantitative DigitoGraphy. NPJ Parkinson's disease Hoffman, S. L., Schmiedmayer, P., Gala, A. S., Wilkins, K. B., Parisi, L., Karjagi, S., Negi, A. S., Revlock, S., Coriz, C., Revlock, J., Ravi, V., Bronte-Stewart, H. 2024; 10 (1): 137

  Abstract

  People with Parkinson's disease (PWP) face critical challenges, including lack of access to neurological care, inadequate measurement and communication of motor symptoms, and suboptimal medication management and compliance. We have developed QDG-Care: a comprehensive connected care platform for Parkinson's disease (PD) that delivers validated, quantitative metrics of all motor signs in PD in real time, monitors the effects of adjusting therapy and medication adherence and is accessible in the electronic health record. In this article, we describe the design and engineering of all components of QDG-Care, including the development and utility of the QDG Mobility and Tremor Severity Scores. We present the preliminary results and insights from an at-home trial using QDG-Care. QDG technology has enormous potential to improve access to, equity of, and quality of care for PWP, and improve compliance with complex time-critical medication regimens. It will enable rapid "Go-NoGo" decisions for new therapeutics by providing high-resolution data that require fewer participants at lower cost and allow more diverse recruitment.

  View details for DOI 10.1038/s41531-024-00751-w

  View details for PubMedID 39068150

  View details for PubMedCentralID PMC11283542

• Quantitative DigitoGraphy: a Comprehensive Real-Time Remote Monitoring System for Parkinson's Disease. Research square Hoffman, S. L., Schmiedmayer, P., Gala, A. S., Wilkins, K. B., Parisi, L., Karjagi, S., Negi, A. S., Revlock, S., Coriz, C., Revlock, J., Ravi, V., Bronte-Stewart, H. 2024

  Abstract

  People with Parkinson's disease (PWP) face critical challenges, including lack of access to neurological care, inadequate measurement and communication of motor symptoms, and suboptimal medication management and compliance. We have developed QDG-Care: a comprehensive connected care platform for Parkinson's disease (PD) that delivers validated, quantitative metrics of all motor signs in PD in real time, monitors the effects of adjusting therapy and medication adherence and is accessible in the electronic health record. In this article, we describe the design and engineering of all components of QDG-Care, including the development and utility of the QDG Mobility and Tremor Severity Scores. We present the preliminary results and insights from the first at-home trial using QDG-Care. QDG technology has enormous potential to improve access to, equity of, and quality of care for PWP, and improve compliance with complex time-critical medication regimens. It will enable rapid "Go-NoGo" decisions for new therapeutics by providing high-resolution data that require fewer participants at lower cost and allow more diverse recruitment.

  View details for DOI 10.21203/rs.3.rs-3783294/v1

  View details for PubMedID 38343821

  View details for PubMedCentralID PMC10854288

• Utility of smart watches for identifying arrhythmias in children. Communications medicine Zahedivash, A., Chubb, H., Giacone, H., Boramanand, N. K., Dubin, A. M., Trela, A., Lencioni, E., Motonaga, K. S., Goodyer, W., Navarre, B., Ravi, V., Schmiedmayer, P., Bikia, V., Aalami, O., Ling, X. B., Perez, M., Ceresnak, S. R. 2023; 3 (1): 167

  Abstract

  Arrhythmia symptoms are frequent complaints in children and often require a pediatric cardiology evaluation. Data regarding the clinical utility of wearable technologies are limited in children. We hypothesize that an Apple Watch can capture arrhythmias in children.We present an analysis of patients ≤18 years-of-age who had signs of an arrhythmia documented by an Apple Watch. We include patients evaluated at our center over a 4-year-period and highlight those receiving a formal arrhythmia diagnosis. We evaluate the role of the Apple Watch in arrhythmia diagnosis, the results of other ambulatory cardiac monitoring studies, and findings of any EP studies.We identify 145 electronic-medical-record identifications of Apple Watch, and find arrhythmias confirmed in 41 patients (28%) [mean age 13.8 ± 3.2 years]. The arrythmias include: 36 SVT (88%), 3 VT (7%), 1 heart block (2.5%) and wide 1 complex tachycardia (2.5%). We show that invasive EP study confirmed diagnosis in 34 of the 36 patients (94%) with SVT (2 non-inducible). We find that the Apple Watch helped prompt a workup resulting in a new arrhythmia diagnosis for 29 patients (71%). We note traditional ambulatory cardiac monitors were worn by 35 patients (85%), which did not detect arrhythmias in 10 patients (29%). In 73 patients who used an Apple Watch for recreational or self-directed heart rate monitoring, 18 (25%) sought care due to device findings without any arrhythmias identified.We demonstrate that the Apple Watch can record arrhythmia events in children, including events not identified on traditionally used ambulatory monitors.

  View details for DOI 10.1038/s43856-023-00392-9

  View details for PubMedID 38092993

  View details for PubMedCentralID 4937287

• CardinalKit: open-source standards-based, interoperable mobile development platform to help translate the promise of digital health. JAMIA open Aalami, O., Hittle, M., Ravi, V., Griffin, A., Schmiedmayer, P., Shenoy, V., Gutierrez, S., Venook, R. 2023; 6 (3): ooad044

  Abstract

  Smartphone devices capable of monitoring users' health, physiology, activity, and environment revolutionize care delivery, medical research, and remote patient monitoring. Such devices, laden with clinical-grade sensors and cloud connectivity, allow clinicians, researchers, and patients to monitor health longitudinally, passively, and persistently, shifting the paradigm of care and research from low-resolution, intermittent, and discrete to one of persistent, continuous, and high resolution. The collection, transmission, and storage of sensitive health data using mobile devices presents unique challenges that serve as significant barriers to entry for care providers and researchers alike. Compliance with standards like HIPAA and GDPR requires unique skills and practices. These requirements make off-the-shelf technologies insufficient for use in the digital health space. As a result, budget, timeline, talent, and resource constraints are the largest barriers to new digital technologies. The CardinalKit platform is an open-source project addressing these challenges by focusing on reducing these barriers and accelerating the innovation, adoption, and use of digital health technologies. CardinalKit provides a mobile template application and web dashboard to enable an interoperable foundation for developing digital health applications. We demonstrate the applicability of CardinalKit to a wide variety of digital health applications across 18 innovative digital health prototypes.

  View details for DOI 10.1093/jamiaopen/ooad044

  View details for PubMedID 37485467

  View details for PubMedCentralID PMC10356573

• Reducing the Impact of Breaking Changes to Web Service Clients During Web API Evolution Schmiedmayer, P., Bauer, A., Bruegge, B., IEEE IEEE COMPUTER SOC. 2023: 1-11

  View details for DOI 10.1109/MOBILSoft59058.2023.00008

  View details for Web of Science ID 001031673900001

• Global Software Engineering in a Global Classroom Schmiedmayer, P., Chatley, R., Bernius, J., Krusche, S., Chaika, K., Krinkin, K., Bruegge, B., IEEE Comp Soc IEEE COMPUTER SOC. 2022: 113-121

  View details for DOI 10.1109/ICSE-SEET55299.2022.9794211

  View details for Web of Science ID 000850196300012