Abstract: Embodiments herein relate to ear-wearable stress and anxiety monitoring systems, devices and methods. Embodiments herein further relate to ear-wearable systems and devices that can detect and take actions to alleviate device wearer's stress and anxiety. In an embodiment an ear-wearable stress and/or anxiety monitoring system is included having a control circuit, a microphone, and a sensor package that can include a motion sensor. The ear-wearable system is configured to evaluate data from at least one of the microphone and the sensor package and classify a stress level of a device wearer using a machine learning classification model and periodically update the machine learning classification model based on indicators of stress experienced by the device wearer.

Abstract: Provided herein are systems and methods of associating stimuli with conditions of users. A computing system may identify, in response to presenting a first stimulus to a user, a relevance value of the first stimulus indicative of a relevance of the first stimulus with a condition of the user. The computing system may classify, responsive to the relevance value satisfying a threshold, the first stimulus as having a non-neutral reaction type associated with the condition to the user. The computing system may store, in one or more data structures, an association between the user and the first stimulus classified as having the non-neutral reaction type for presenting in a therapy session to address the condition of the user. The computing system may provide instructions for presenting the first stimulus in the therapy session to address the condition of the user.

Abstract: A neurofeedback system includes an EEG apparatus, a presentation apparatus and a controller. The controller is configured to: (i) cause the presentation apparatus to display an overlaid image to the user that comprises a first image flickering at a first frequency and a second image flickering at a second frequency different than the first frequency, the first image being an affective distractor stimulus image and the second image being a task-relevant stimulus image, (ii) receive from the EEG apparatus a number of first steady-state visual evoked potential (SSVEP) signals generated in response the first image of the overlaid image and a number of second SSVEP signals generated in response the second image of the overlaid image, and (iii) calculate feedback indicative of how much attention of the was user allocated to the task-relevant stimulus image versus how much attention of the user was allocated to the affective distractor stimulus image.

Abstract: A flexible sensor configured for use in a bladder is flexible and moveable from a first position in which it is configured to not be discharged from the bladder to a second position in which it is configured to be inserted into the bladder. A sensor insertion tool includes an over sheath, a push rod configured to be inserted into a first lumen of the over sheath. The flexible sensor is positioned in the first lumen of the over sheath, the push rod is then inserted partially into the over sheath behind the flexible sensor. The sensor insertion tool is then positioned at a location, such as the opening to the bladder, in which the sensor is to be deployed.

Abstract: A biological signal detection electrode stable in performance over a long period of time includes an insulating base material having electrical insulation, an electrode terminal buried in the insulating base material such that a signal detection surface is included in a part of a lower surface of the insulating base material, a conductive gel film provided on the lower surface of the insulating base material to cover the signal detection surface, an extraction electrode which is connected to the electrode terminal and has a terminal unit exposed on an upper surface of the insulating base material, and a magnetic body to be a counterpart of the conductive magnet disposed below the terminal unit in the insulating base material. The magnetic body is given only the function of mechanical connection, and the electrode terminal is formed of a corrosion-resistant material, for example Ag—AgCl, not corroded by the conductive gel film.

Abstract: Disclosed are various embodiments for a butterfly hinge electrode and uses thereof. A butterfly hinge electrode may have a first and second wing positioned adjacent to one another and connected through a coupling mechanism. The butterfly hinge electrode may have a first and second electrode assembly, the first electrode assembly positioned on the first wing and the second electrode assembly positioned on the second wing. The butterfly hinge electrode may further comprise a compression assembly. Further, the butterfly hinge electrode may be inserted into a subdermal layer of a patient for neurological monitoring through the use of the first and second electrode assemblies on the first and second wings.

Abstract: Provided are are conformable conductors and electrode arrays and related methods of their manufacture and use. The disclosed structures can be implanted into or placed outside of the body of a subject to record biosignals and/or to deliver electrical stimulation, in addition to other, non-biological applications for electrical and/or chemical sensing and stimulation. One can form a pattern an absorbent material (e.g., with a laser cutter), which is later infused with a conductive ink that can include, e.g., MXene materials, reduced graphene oxide (rGO), graphene/graphite, gold, platinum, or other metallic nanoparticles, carbon nanotubes, conductive polymers, or other conductive ink materials. The resulting electrode arrays can be compatible with magnetic resonance imaging (MRI or fMRI) and transcranial magnetic stimulation (TMS) modalities, and the disclosed process can rapidly produce electrodes at high yield.

Abstract: A method comprises identifying P-waves within a cardiac signal stored by a medical device for a cardiac episode detected by the medical device, and calculating a gain factor for display of the cardiac signal based on the identified P-waves.

Abstract: An illustrative multimodal measurement system includes a wearable assembly configured to be worn by a user; and a module configured to be removably inserted into the wearable assembly and comprising: a housing, a printed circuit board (PCB) and a light guide assembly configured to emit light directed at a target within the user. The light guide assembly comprises: a lower light guide portion housed within the housing and having a proximal end attached to the PCB, a conductive spring member housed within the housing and comprising a coil positioned around an external surface of the lower light guide portion, and a conductive upper light guide portion connected to the lower light guide portion and configured to protrude from an upper surface of the housing and be in contact with a surface of a body of the user.

Abstract: A device and a signal processing method that can monitor human memory performance by recognizing and characterizing high-gamma (65-250 Hz) and beta (14-30 Hz) band oscillations in the left Brodmann Area 40 (BA40) of the brain that correspond with the strength of memory encoding or correct recall. The signal processing method detects high-gamma and beta band oscillations in the electrical signals recorded from left BA40, and quantifies the spectral content, power, duration, onset, and offset of the oscillations. The oscillation's properties are used to classify the subject's memory performance on the basis of a comparison with the subject's prior human memory performance and the properties of the corresponding oscillations. A report of the subject's current memory performance can be utilized in a closed loop brain stimulation device that serves the purpose of enhancing human memory performance.

Abstract: A head-mountable device including a housing, a display positioned in the housing, a processor positioned in the housing, and a retention band connected to the housing, the retention band comprising a sensor configured to monitor a brain activity of a user.

Abstract: Disclosed herein are methods, systems, apparatuses, and media for sensing neuromuscular signals. In one example, a device for sensing neuromuscular signals comprises a wearable structure. The device includes a plurality of signal electrodes aligned along an interior portion of the wearable structure, each signal electrode configured to detect neuromuscular signals. The device further includes a plurality of amplifiers corresponding to the plurality of signal electrodes, wherein an amplifier has: a first input operatively coupled to a corresponding signal electrode; a second input; and an output corresponding to a neuromuscular signal channel. The device further includes circuitry configured to generate a common mode reference signal directly or indirectly based on signals from one or more electrodes, wherein the second input of each amplifier of the plurality of amplifiers is configured to receive the common mode reference signal or a signal based on the common mode reference signal.

Abstract: A system for modulating bladder function is disclosed. A system for evaluating the electrophysiological function of a bladder is disclosed. Methods for performing a controlled surgical procedure on a bladder are disclosed. A system for performing controlled surgical procedures in a minimally invasive manner is disclosed. An implantable device for monitoring and/or performing a neuromodulation procedure on a bladder is disclosed.

Abstract: Systems and methods for remote therapy and patient monitoring are provided. A method comprises contacting an outer skin surface of a patient with a contact surface of a stimulator and transmitting an electrical impulse from the stimulator transcutaneously through the outer skin surface to a nerve within the patient. Data related to parameters of the electrical impulse applied to the nerve is stored and transmitted to a remote source. The data may include duration of treatment, amplitude of the electrical impulse, compliance with a prescribed therapy regimen or other relevant data related to the therapy. The method may further include collecting patient status data, such as symptoms of a medical condition (e.g., severity of a headache) before, during and/or after stimulation. The patient status data is correlated with the treatment data to monitor compliance and/or the effectiveness of the therapy.

Abstract: A method of diagnosing a neurodegenerative disorder (ND) in a patient comprising: (a) obtaining MRI image(s) of the patient's brain, (b) using the MRI image(s) of the patient's brain to segment sub-cortical structures associated with the ND into sub-regions, based on structural connectivity to cortical sub-regions, (c) extracting one or more MRI features from each of the sub-regions generated by the segmentation, and (d) using one or more machine learning techniques to classify the patient as being ND positive or ND negative based on comparisons of the one or more MRI features to at least one training data set that includes MRI features of each of the sub-regions generated by the segmentation of known ND positive controls and MRI features of each of the sub-regions generated by the segmentation of ND negative controls, thereby diagnosing ND. Also computer-based or cloud-based systems to diagnose a ND in a subject.

Abstract: A method and system (100) for augmented interpretation of shear wave elastography between first and second imaging modalities comprises performing an elastography measurement via a second imaging modality (20), different from a first imaging modality (10), to obtain at least one second imaging modality elastography value (32, 60) of a region of interest (33). At least one corresponding first imaging modality elastography value (36, 38, 62) is predicted based on the obtained second imaging modality elastography value. A graphical user interface or smart report dashboard (50) is generated that shows (i) a fibrosis level (521) of the region of interest, wherein the fibrosis level is determined as a function of (i)(a) the at least one second imaging modality elastography value (32) and/or (i)(b) the predicted at least one corresponding first imaging modality elastography value (36, 38).

Abstract: Disclosed is a device including a skin microscope for acquiring images at different wavelengths of one or more areas of a person's skin. The device includes one or more pH sensors, one or more temperature sensors, a bioimpedance sensor and a pulse oximeter included in the device so that, together with the acquisition of a skin image, it is possible to co-register the temperature, the bioimpedance and saturation of hemoglobin in the field of view of the microscope, and the pH in the immediate vicinity of that field of view. The device can be connected to an electronic device, such as a “smartphone”, for the transmission of the acquired data to the latter, possibly after they have undergone initial processing using specific algorithms.

Abstract: A method of imaging and analyzing the joint of a patient, such as a knee, involves acquiring a three-dimensional data of the joint of the patient, reconstructing an articular contact geometry of the joint based on the 3D data, determining a tissue quality on articular contact geometry based on the 3D data, determining movement capacity of the joint based on the reconstructed articular contact geometry; and determining a motion signature of the joint based on the reconstructed articular contact geometry and the tissue quality.

Abstract: The present invention relates to a sensor arrangement comprising a support substrate and at least two microwave antennas fixedly arranged in or on said support substrate, each microwave antenna being separated from all other microwave antennas by a band-stop structure configured to cancel direct coupling between the microwave antennas, said sensor arrangement further comprising microwave signal transmission paths configured to transmit microwave signals to or from said microwave antennas. The invention also relates to a system comprising such a sensor arrangement and a method for non-invasive assessment of a property of subdermal tissue in a subject.

Abstract: The present disclosure is directed towards systems and methods for improving analysis of sleep data by classifying users based on sleeper type. In particular, a wearable computing system can obtain a first set of motion sensor data from the motion sensor for a user during a first period. The wearable computing system can determine a sleeper type from a plurality of sleeper types for the user based on the first set of motion sensor data received from the motion sensor. The wearable computing system can select a sleep analysis model from a plurality of sleep analysis models based on the sleeper type determined for the user. The wearable computing system can use the selected sleep analysis model to analyze a second set of motion sensor data from a second period to determine one or more sleep characteristics for the user during the second period.

Abstract: Presented herein are techniques to managing tinnitus by delivering tinnitus therapy signals to a recipient during time periods in which tinnitus may be most noticeable. The techniques presented herein optimize the tinnitus therapy signals for the recipient by taking into account the recipients state or level of “wakefulness” or “arousal” (e.g., the recipients arousal state). That is, the techniques presented herein manage a recipients tinnitus by adjusting one or more attributes/parameters of the tinnitus therapy signals (e.g., amplitude, frequency, rate, modulation, type, etc.) based on, or in a manner that is dependent upon, the person's wakefulness/arousal state.

Abstract: The present technology relates to systems and methods for evaluating a user's sleep data. More particularly, the present technology contemplates a computer-implemented system or method of evaluating a quality of sleep for a user based on sleep data, such as by determining a set of quality metrics for the user's sleep based on the sleep data using a set of probabilistic models.

Abstract: One or more algorithms are used to, in respect of each of a plurality of EEG snippets from a subject, allocate to each snippet a class selected from one or more classes, each class being associated with drug impairment level. The one or more algorithms are each defined by a model and a set of parameters and have been previously trained with a plurality of labelled EEG snippets, the labelled snippets including, for each of the classes, at least one snippet associated with a test subject experiencing the level of drug impairment associated with said each class. A statistical model is created which provides desired levels of sensitivity and accuracy based upon the proportion of snippets from test subjects having the known level of drug effect that falls within the associated class. Drug effect is defined by applying the statistical model to the classes allocated to the snippets.

Abstract: Device and method for determining an efficacy of chronic pain treatment including providing a first set of at least one stimulus to a subject, obtaining first measurements of at least two physiological parameters in response to the first set of at least one stimulus, providing chronic pain treatment to the subject, providing a second set of at least one stimulus to the subject, obtaining second measurements of the at least two physiological parameters in response to the second set of at least one stimulus; and determining an efficacy of the chronic pain treatment by applying a classification algorithm on the first and second measurements of the at least two physiological parameters.

Abstract: A portable vein viewer apparatus may be battery powered and hand-held to reveal patient vasculature information to aid in venipuncture processes. The apparatus comprises a first laser diode emitting infrared light, and a second laser diode emitting only visible wavelengths, wherein vasculature absorbs a portion of the infrared light causing reflection of a contrasted infrared image. A pair of silicon PIN photodiodes, responsive to the contrasted infrared image, causes transmission of a corresponding signal. The signal is processed through circuitry to amplify, sum, and filter the outputted signals, and with the use of an image processing algorithm, the contrasted image is projected onto the patient's skin surface using the second laser diode. Revealed information may comprise vein location, depth, diameter, and degree of certainty of vein locations. Projection of vein images may be a positive or a negative image. Venipuncture needles may be coated to provide visibility in projected images.

Abstract: Systems and methods include a cellular, WiFi, and Bluetooth transceiver coupled to a processor; an accelerometer or a motion sensor coupled to the processor; and a sensor coupled to the processor to sense mood or body vital sign.

Abstract: A wearable computing device is provided. The wearable computing device includes a, conductive housing and a printed circuit board at least partially disposed within the conductive housing. The wearable computing device further includes a slot antenna defined by a gap between the conductive housing and the printed circuit board. The wearable computing device includes a display screen electrically coupled to the printed circuit board. The wearable computing device includes a cover positioned on the display screen. The cover includes a top surface and a bottom surface. The wearable computing device includes a biometric sensor electrode positioned partially on the top surface of the cover. The biometric sensor at least partially wraps around a periphery of the cover.

Abstract: A wearable device to accurately detect biometric information of the user. The wearable device includes a ring body; a light emitting element which is disposed in the ring body, and is configured to emit light toward a center side of a ring; and a first optical element which is disposed in the ring body to be closer to the center side of the ring than the light emitting element, and is configured to change a direction of travel of the light to a direction narrowing a directional angle of the light. The ring body includes a protrusion on an inner peripheral surface of the ring body where the first optical element is disposed, and the protrusion is formed to protrude closer to the center side of the ring than another part of the inner peripheral surface where the first optical element is not disposed.

Abstract: A wearable physiological measurement apparatus comprises a base, a bridge member, and a first and second support members movably coupled to the base and the bridge member to surround size-variable an opening for accommodating a care giver's finger therein. A measurement device is coupled to the base and with a probe projecting toward the opening for contacting the finger for vital sign measurement and monitoring. Resilient members are coupled between the base, the bridge member and the first and second support members to bias the base, the bridge member and the first and second support members moving toward each other to grip the finger to maintain proper contact of the probe to the finger.

Abstract: A wearable patch system comprises a sensor (14) for measuring at least one sweat parameter, and a controller (16) for indicating the need to replace the patch. The controller is configured to receive the at least one sweat parameter and compare the at least one sweat parameter to a first threshold. The controller is also configured to determine the replacement information based on the total amount of time during which the at least one sweat parameter exceeds the first threshold; and/or a value indicative of the at least one sweat parameter in respect of the total amount of time during which the at least one sweat parameter exceeds the first threshold. The controller is further configured to output an indication that the wearable patch needs (12) replacing based on the replacement information.

Abstract: A physiological signal monitoring device includes a base, a sensor, a transmitter, an adhesive layer and a pad. The sensor is carried by the base. The transmitter is coupled to the sensor. The adhesive layer is arranged on a bottom surface of the base. The pad includes an adhesive backing and a coupling backing. The adhesive backing is fabricated by weaving first threads and includes first holes. The coupling backing provides a coupling surface, and is fabricated by weaving second threads and includes second holes and piques. The piques are arranged on the coupling surface to form convex and concave three-dimensional textures on the coupling surface. The adhesive layer soaks the pad through the second holes and wraps at least one of the second threads and the first threads, so as to make the pad be connected to the base through the adhesive layer.

Abstract: A method for monitoring intoxication of a user, the method including: receiving a set of samples from a body region of a user; generating an intoxication metric based on the set of samples; and providing a notification to the user based on the intoxication metric. The method can additionally or alternatively include: modifying operation of the transdermal alcohol sensing device based on the intoxication metric; determining contextual data; maintaining a hydration level of the transdermal alcohol sensing device; and any other suitable processes. A system for monitoring intoxication of a user including a sensor and a housing. The system can additionally or alternatively include any or all of: an inlet, a fastener, an electronics subsystem, a user device, and/or any other suitable component.

Abstract: Provided is a bio-adhesive device including an adhesive material layer, an electronic device layer, and a protective film layer to have advantages of being harmless to the human body, being naturally degraded in the body without a separate removal process, and capable of observing the movement of internal organs more closely in real time from outside the body.

Abstract: A method comprises delivering a first implant to an orifice of a chamber of a heart, anchoring the first implant at the orifice, delivering a sensor device to the orifice, and coupling the sensor device to the first implant.

Abstract: A sensor implant system comprises a shunt implant comprising a central flow portion configured to maintain an opening through a tissue wall and a sensor implant device. The sensor implant device comprises a shunt body configured to fit at least partially within the central flow portion of the shunt implant and a sensor device coupled to the shunt body.

Abstract: A physiological information processing method executed by a computer. The physiological information processing method includes obtaining a plurality of electroencephalogram signals indicating an electroencephalogram of a subject, using a plurality of electrodes attached to a head of the subject, each of the plurality of electroencephalogram signals being associated with a respective one of the plurality of electrodes, obtaining, from each of the plurality of electroencephalogram signals, a plurality of artifact component signals indicating different types of artifacts, calculating effective values of the plurality of artifact component signals of each of the electroencephalogram signals, determining whether the effective value of each of the artifact component signals of the electroencephalogram signal satisfies a predetermined condition, and visually presenting information related to the artifact associated with the artifact component signal of which the effective value satisfies the predetermined condition.

Abstract: The present disclosure provides computer-implemented methods, systems, and devices for mitigating noise in a signal. A user computing device comprises physiological signal sensor configured to generate a first signal relating one or more characteristics associated with a user. The user computing device further comprises a transducer configured to generate a noise signature signal based on detection of one or more noise sources. The user computing device further comprises one or more control circuits configured to modify the first signal based on the noise signature signal to generate a modified first signal. The control circuits are further configured to determine one or more characteristics associated with a user based on the modified first signal.

Abstract: A method, application program, smart device, and computer system may capture images of a body part of a patient, determine one or more vital signs of the patient by image processing optionally assisted by a machine learning model, determine a physiological state for one or more of the vital signs with a computational model generated by another machine learning model, and initiate a communication with a medical professional's communication device based on the physiological state being outside a threshold range.

Abstract: Systems, methods, and other embodiments relate to autonomous clinical screening and assessment of a patient using a reinforcement learning framework. In at least one approach, a method includes determining, using a control model, a focus point for acquiring imaging data about the patient. The method includes controlling an imaging device according to the focus point to acquire the imaging data. The method includes analyzing the imaging data using a recognition model that outputs a result about a condition of the patient. The method includes providing the result.

Abstract: A method and an apparatus for determining a coronary heart disease probability are provided. The method includes: obtaining ECG signals of one or more leads of a user; determining, based on the ECG signals of the one or more leads, reconstructed signals respectively corresponding to the ECG signals of the one or more leads; and determining a coronary heart disease probability of the user based on the ECG signals of the one or more leads and the reconstructed signals respectively corresponding to the ECG signals of the one or more leads.

Abstract: Various embodiments of the present disclosure provide signal interpretation and data aggregation techniques for generating predictive insights for a user. The techniques may include receiving initial physiological features for a user that are based on recorded sensor values for the user. The techniques include generating activity encodings for the user based on interaction data objects for the user and generating a combined input feature vector by aggregating the initial physiological features and the activity encodings. The techniques include generating, using a machine learning model, a physiological prediction for the user based on the combined input feature vector.

Abstract: The present invention relates to multispectral imaging. In order to improve an identification of relevant multispectral material transitions (in particular caused by injected contrast agent), an apparatus is proposed to use the local maxima of the variances and/or covariances of the intensities of the multi-channel images to locate material transitions. In comparison to gradient vectors, the local variance is not directed and not prone to noise. An alternative apparatus is proposed to use the local covariance deficits of the intensities of the multi-channel images to locate material transitions. The proposed alternative approach is independent of spatial drifts across the image volume.

Abstract: An image display method executed by a processor comprises displaying a screen including a two-dimensional fundus image of an examined eye and a three-dimensional eyeball image of the examined eye, finding a second region in the three-dimensional eyeball image that corresponds to a first region specified in the two-dimensional fundus image, and displaying a mark indicating the second region in the three-dimensional eyeball image.

Abstract: Various methods and systems are provided for monitoring and displaying a patient status. In one example, the patient monitoring system includes a display device configured to display a patient status view include on or more multidimensional plots overlaying more than one of real time values, historical values, and upper and lower threshold values for a plurality of patient parameters, and additionally being configured to display an abbreviated representation of the one or more multidimensional plots that can be reached directly from the patient status view. The abbreviated representation is displayed in an unlaunched state, and displays a limited version of the respective multidimensional plot and is selectable to launch and enable the respective multidimensional plot to be seen.

Abstract: Improved graphical user interfaces for analyte monitoring systems are provided. For example, disclosed herein are various embodiments of GUIs, each of which include a graph portion comprising a trend line indicative of a user's analyte levels over a predetermined time period, and a plurality of summary metrics comprising a plurality of minimum analyte levels and maximum analyte levels associated with a plurality of time increments within the predetermined time period. In many embodiments, the plurality of minimum analyte levels and maximum analyte levels are aligned with an x-axis of the graph portion.

Abstract: A portable device for projecting medical data of a patient, including a housing, wireless technology that allows the exchange of data between different electronic devices, a projector that can project a light beam image of the data received from the wireless technology onto a desired surface away from the housing, and a coupler that couples the projector to the housing and enables the projector to tilt and/or swivel and/or rotate so that the location of the projected light beam image can be changed, e.g., to display on a ceiling or desired wall. The medical data projected can be glucose level data. The apparatus enables a person to easily obtain information on their glucose levels when they wake at night without having to access an electronic device to obtain the information.

Abstract: A wearable medical device caregiver notification system includes a patient communication device. The patient communication device is configured to receive patient data from the wearable medical device. Using a criteria app, the patient communication device can determine if preset goal criteria, such as wear time compliance or number of steps taken, have been met. Upon determining that a goal criterion has not been met, the patient communication device can transmit a notification to a designated caregiver communication device indicating that the goal was not achieved.

Abstract: Apparatus, methods, and systems, of conducting virtual healthcare examinations of patients are provided by using a mobile workstation to collect video and/or audio from patients and other patient information using an integrated system of a plurality of cameras, an ultrasound machine, a 12 lead EKG unit, an otoscope, a thermometer, a blood glucose machine, a pulse oximeter, a blood pressure cuff, and a stethoscope and providing it to healthcare professionals and other interested persons who are not on site.

Abstract: A patient monitoring system includes at least one sensor configured to measure patient data including physiologic waveform data, a defibrillator configured to couple to the at least one sensor and including a touchscreen user interface, at least one processor communicatively coupled to the touchscreen user interface and configured to cause the touchscreen user interface to display the patient data including at least one physiologic waveform based on the physiologic waveform data, detect user input including a first user touchscreen input and a second user touchscreen input, define endpoints of a caliper based on the first user touchscreen input and the second user touchscreen input, wherein the endpoints of the caliper identify a particular portion of the at least one physiologic waveform, and cause the touchscreen to display a measurement of the particular portion of the at least one physiologic waveform based on the endpoints of the caliper.

Abstract: An automated method and kiosk for obtaining diagnostic images of a patient are provided. The method is performed by receiving personal information about the patient at the automated kiosk, obtaining, with a diagnostic imaging system at the automated kiosk, a first diagnostic image of the patient from a first projection angle relative to at least one body part of the patient, and obtaining, with the diagnostic imaging system, a second diagnostic image of the patient from a second projection angle relative to the at least one body part. The method steps are performed without real-time control of the automated kiosk by another human.