Tag: pubmed

JMIR Res Protoc. 2025 Jun 27;14:e69539. doi: 10.2196/69539.

ABSTRACT

BACKGROUND: Needs assessments in patients with juvenile idiopathic arthritis (JIA) have revealed a need for disease information, self-management skills, and peer support. We previously developed and tested the acceptability of an in-person and videoconference-based self-management program (SMP) to address these needs.

OBJECTIVE: The aim of this pilot randomized controlled trial (RCT; the VISTA-JIA trial) is to evaluate the feasibility and preliminary effectiveness of a virtual group-based SMP for adolescents with JIA in comparison to a waitlist control group.

METHODS: A total of 100 participants with confirmed JIA (aged 12-17 years) will be recruited from 5 Canadian pediatric rheumatology centers and randomized 1:1 to the intervention or waitlist control groups. Adolescents in the intervention group will receive the virtual SMP. Those randomized to the control group will receive standard of care alone and will later be eligible for the SMP. The SMP includes JIA disease education, self-management strategies, and peer support. Four 60- to 90-minute sessions will be conducted over 8 weeks with a group size of 4-6 participants. The primary feasibility outcome will be adherence to the SMP (defined as completion of all 4 sessions by at least 80% of participants). Other secondary feasibility outcomes will include recruitment and withdrawal rates, the proportion of completed questionnaires, engagement and satisfaction with the SMP measured through a semistructured virtual interview, and intervention fidelity (consistent content and technology delivery). Secondary preliminary effectiveness outcomes will be assessed by completing 5 validated questionnaires at pre- and postprogram time points: (1) the Medical Issues, Exercise, Pain, and Social Support Questionnaire to assess perceived ability to manage JIA (self-management); (2) the Children’s Arthritis Self-Efficacy Scale to assess self-efficacy; (3) the Pediatric Quality of Life Inventory 3.0 Rheumatology-Teen Module to assess health-related quality of life; (4) the PROMIS (Patient-Reported Outcomes Measurement Information System) Pediatric Pain Interference Scale to assess pain interference; and (5) Readiness for Adult Care in Rheumatology to assess transition readiness. Descriptive statistics and nonparametric tests will be used to analyze the data.

RESULTS: The study setup is complete at all centers, including training of the facilitators, revising and finalizing education sessions, participant’s handout guide, and fidelity checklist. Recruitment began in January 2024 and is expected to conclude by December 2025. Feasibility outcomes, including adherence and engagement, as well as preliminary effectiveness, will be analyzed post intervention.

CONCLUSIONS: This is the first evidence-based, virtual, interactive, group-structured JIA SMP in Canada. This SMP will address needs for disease information, self-management skills, and peer support in adolescents with JIA. The results of this pilot study will inform a full-scale RCT focused on the efficacy and cost-effectiveness of the program with the goal of integration in routine clinical practice across Canada.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06184100; https://clinicaltrials.gov/study/NCT06184100.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/69539.

PMID:40577780 | DOI:10.2196/69539

Phys Rev Lett. 2025 Jun 13;134(23):230402. doi: 10.1103/xxlq-d1sw.

ABSTRACT

Our current understanding of quantum chaos in many-body quantum systems hinges on the random matrix theory (RMT) behavior of eigenstates and their energy level statistics. Although RMT has been remarkably successful in describing “coarse” features of many-body quantum Hamiltonians in chaotic regimes, such as the Wigner-Dyson level spacing statistics or the volume-law behavior of eigenstate entanglement entropy, it remains a challenge to describe their “finer” features, particularly those arising from spatial locality. Here, we show that we can accurately describe the statistical behavior of eigenstate ensembles in many-body Hamiltonians by using pure random states with physical constraints that capture the essential features of the Hamiltonian, specifically spatial locality and symmetries. We demonstrate our approach on local spin Hamiltonians with a scalar U(1) charge. By constructing ensembles of constrained random states that account for two commuting scalar charges playing the role of energy and magnetization, we describe the patterns of entanglement of midspectrum eigenstates beyond their average volume-law behavior, including O(1) corrections and fluctuations, analytically and numerically. When defining the correspondence between quantum chaotic eigenstates in many-body Hamiltonians and RMT ensembles, our work highlights the important role played by spatial locality in describing universal features beyond the volume-law behavior.

PMID:40577753 | DOI:10.1103/xxlq-d1sw

Phys Rev Lett. 2025 Jun 13;134(23):237402. doi: 10.1103/g1cz-wk1l.

ABSTRACT

Traditional studies of memory for meaningful narratives focus on specific stories and their semantic structures but do not address common quantitative features of recall across different narratives. We introduce a statistical ensemble of random trees to represent narratives as hierarchies of key points, where each node is a compressed representation of its descendant leaves, which are the original narrative segments. Recall from this hierarchical representation is constrained by working memory capacity. Our analytical solution aligns with observations from large-scale narrative recall experiments. Specifically, our model explains that (1) average recall length increases sublinearly with narrative length and (2) individuals summarize increasingly longer narrative segments in each recall sentence. Additionally, the theory predicts that for sufficiently long narratives, a universal, scale-invariant limit emerges, where the fraction of a narrative summarized by a single recall sentence follows a distribution independent of narrative length.

PMID:40577734 | DOI:10.1103/g1cz-wk1l

Phys Rev Lett. 2025 Jun 13;134(23):230404. doi: 10.1103/fk9d-k8dc.

ABSTRACT

We investigate the dynamics of multimode optical systems driven by two-photon processes and subject to nonlocal losses, incorporating quantum noise at the Gaussian level. Our findings show that the statistics retrieved from a single Gaussian quantum trajectory exhibits emergent thermal equilibrium governed by an Ising Hamiltonian, encoded in the dissipative coupling between modes. The system’s effective temperature is set by the driving strength relative to the oscillation threshold. Given the ultrashort timescales typical of all-optical devices, our Letter demonstrates that such multimode optical systems can operate as ultrafast Boltzmann samplers, paving the way toward the realization of efficient hardware for combinatorial optimization, with promising applications in machine learning and beyond.

PMID:40577733 | DOI:10.1103/fk9d-k8dc

Phys Rev Lett. 2025 Jun 13;134(23):237102. doi: 10.1103/xlmq-g6m5.

ABSTRACT

The principle of covariance, a cornerstone of modern physics, asserts the equivalence of all inertial frames of reference. Fluctuation theorems, as extensions of the second law of thermodynamics, establish universal connections between irreversibility and fluctuation in terms of stochastic thermodynamic quantities. However, these relations typically assume that both the thermodynamic system and the heat bath are at rest with respect to the observer, thereby failing to satisfy the principle of covariance. In this Letter, by introducing covariant work and heat that incorporate both energy-related and momentum-related components, we promote fluctuation theorems into covariant forms applicable to moving thermodynamic systems and moving heat baths. We illustrate this framework with two examples: the work statistics of a relativistic stochastic field and the heat statistics of a relativistic Brownian motion. Although our Letter is carried out in the context of special relativity, the results can be extended to the nonrelativistic limit. Our Letter combines the principle of covariance and fluctuation theorems into a coherent framework and may have applications in the study of thermodynamics relevant to cosmic microwave background as well as the radiative heat transfer and noncontact friction between relatively moving bodies.

PMID:40577730 | DOI:10.1103/xlmq-g6m5

Phys Rev Lett. 2025 Jun 13;134(23):236601. doi: 10.1103/ggls-zhl8.

ABSTRACT

We develop a theory of edge excitations of fractonic systems in two dimensions, and elucidate their connections to bulk transport properties and quantum statistics of bulk excitations. The system we consider has immobile point charges, dipoles constrained to move only along lines perpendicular to their moment, and freely mobile quadrupoles and higher multipoles, realizing a bulk fractonic analog of fractional quantum Hall phases. We demonstrate that a quantized braiding phase between two bulk excitations is obtained only in two cases: when a point quadrupole braids around an immobile point charge, or when two non-orthogonal point dipoles braid with one another. The presence of a boundary edge in the system entails two types of gapless edge excitation modes, one that is fractonic with immobile charges and longitudinal dipoles, and a second non-fractonic mode consisting of transverse dipoles. We derive a novel current algebra of the fractonic edge modes. Further, investigating the effect of local edge-to-edge tunneling on these modes, we find that such a process is a relevant perturbation suggesting the possibility of edge deformation.

PMID:40577726 | DOI:10.1103/ggls-zhl8

JMIR Res Protoc. 2025 Jun 27;14:e65351. doi: 10.2196/65351.

ABSTRACT

BACKGROUND: Regular testing is recognized as a key strategy for HIV control. The 2023 Integrated Biological and Behavioral Survey (IBBS) in Cambodia revealed that nearly one-third of men who have sex with men (MSM) and one-fourth of transgender women (TGW) were never tested for HIV or not for more than 12 months. The majority of MSM and TGW were tested at community-based organizations (CBOs) facilities and by CBO outreach workers, while private facilities are poorly used for HIV testing (6% for MSM and 9% for TGW). Private pharmacies could be able to deliver HIV self-testing kits giving the advantage of confidentiality, anonymity, and time savings, in particular for those reluctant to visit CBOs. The recruitment of participants using a respondent-driven sampling method could provide the opportunity to reach MSM and TGW outside the network of CBOs.

OBJECTIVE: This pilot study aims to evaluate the feasibility of free HIV self-testing delivery by a private pharmacy combined with a respondent-driven sampling method to improve HIV testing among MSM and TGW in Phnom Penh, Cambodia.

METHODS: Both qualitative and quantitative approaches are used in this prospective feasibility study. The protocol was approved by the National Ethics Committee for Health Research in Cambodia (N0 351 NECHR). MSM and TGW aged more than 18 years old will be recruited via a respondent-driven sampling method with seeds recruited at hot spots and on social networks. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging, and calling applications. Each recruited peer will bring the coupon to receive direct and free access to one HIV self-testing kit at partner pharmacies as well as 10 additional coupons to recruit members of their networks. As for quantitative analysis, data from the study website will be imported, appended into a single matrix using Stata version 18SE (StataCorp), and analyzed using descriptive statistics, with a statistical significance level of .05. After 6 months, a qualitative assessment will be conducted among users, providers, and policymakers or key stakeholders to evaluate the acceptability and appropriateness of the strategy and to identify the barriers, facilitators, and recommendations. All transcripts will be analyzed according to the 6-phase reflexive thematic approach by Braun and Clarke. The results will be reported by participant-based and provider-based issues. QSR NVivo V.14 for Windows will be used to manage the data.

RESULTS: The study was funded by Agence nationale de recherches sur le sida, les hépatites, et les maladies infectieuses émergentes (ANRS) in September 2023. Approval of the study protocol was successfully obtained from the NECHR in Cambodia and the Commission Nationale de l’Informatique et des Libertés (CNIL) in France (Autorisation Tacite) in February 2025. Data collection will be conducted between September 2024 and December 2025. The initial results are expected to be published in February 2026.

CONCLUSIONS: This public-private partnership intervention could allow the hidden population of MSM and TGW in Phnom Penh to be reached and tested.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05745168; https://clinicaltrials.gov/study/NCT05745168.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/65351.

PMID:40577719 | DOI:10.2196/65351

JMIR Form Res. 2025 Jun 27;9:e63713. doi: 10.2196/63713.

ABSTRACT

BACKGROUND: Patients’ web-based access to their medical records and secure messaging (SM) via patient portals is becoming increasingly prevalent worldwide. SM offers several potential benefits, including improved health outcomes and increased patient engagement. However, SM also raises concerns about effects on the therapeutic relationship and may be constrained by factors such as limited digital literacy and access to digital devices. Evidence on the use of SM in mental health is limited, and results are inconclusive.

OBJECTIVE: This study aimed to examine (1) the purposes for which health care professionals (HCPs) and patients with psychiatric disorders use SM to communicate and (2) the specific use patterns associated with both patients and HCPs.

METHODS: The secure messages (n=274) of 38 patients with psychiatric disorders and 4 HCPs (psychiatrists) from 3 psychiatric outpatient clinics in Brandenburg, Germany, was analyzed using thematic analysis. The data selected for this study represent a subsample from a larger study comprising a total of 116 patients. The subsample consists of the patients and HCPs who used SM.

RESULTS: A total of 274 messages were analyzed: 22.3% (61/274) were initial notes from HCPs, 44.5% (122/274) were patient responses, and 33.2% (91/274) were HCP replies. Patients sent between 1 and 15 messages (mean 4.16, SD 3.42) and logged in 1 to 42 times (mean 10.78, SD 9.38). Most messages were sent during the day, although some were also sent at night and in the early morning. Regarding the purposes of SM, 4 core functions of SM were identified: reporting and feedback, interpersonal uses, intrapersonal uses, and organizational uses. Both patients and HCPs used SM to share treatment-relevant information and elicited feedback on treatment and medication. Furthermore, secure messages included expressions of gratitude by the patients, in addition to well-wishes and emotional support from the HCPs. SM allowed patients to reflect on their treatment and provide self-encouragement. Finally, secure messages were used to address organizational aspects such as scheduling, appointments, and administrative tasks.

CONCLUSIONS: SM in outpatient mental health care is multifaceted and holds the potential to enhance therapeutic contact and improve access to care by enabling quick, low-threshold communication between patients and HCPs, allowing treatment-related concerns to be addressed promptly and effectively. However, the asynchronous nature of SM also poses new challenges, particularly in managing acute mental health crises and in setting boundaries to prevent HCPs from being perceived as constantly available. Therefore, specific training for HCPs-both during medical education and in clinical practice-is essential, along with clear guidelines on handling crises and managing sensitive information.

PMID:40577718 | DOI:10.2196/63713

JMIR Form Res. 2025 Jun 27;9:e69075. doi: 10.2196/69075.

ABSTRACT

BACKGROUND: Large language model (LLM)-assisted content analysis (LACA) is a modification of traditional content analysis, leveraging the LLM to codevelop codebooks and automatically assign thematic codes to a web-based reviews dataset.

OBJECTIVE: This study aims to develop and validate the use of LACA for analyzing hospital web-based reviews and to identify themes of issues from web-based reviews using this method.

METHODS: Web-based reviews for 53 private hospitals in Selangor, Malaysia, were acquired. Fake reviews were filtered out using natural language processing and machine learning algorithms trained on yelp.com validated datasets. GPT-4o mini model application programming interface (API) was then applied to filter out reviews without any quality issues. In total, 200 of the remaining reviews were randomly extracted and fed into the GPT-4o mini model API to produce a codebook validated through parallel human-LLM coding to establish interrater reliability. The codebook was then used to code (label) all reviews in the dataset. The thematic codes were then summarized into themes using factor analysis to increase interpretability.

RESULTS: A total of 14,938 web-based reviews were acquired, of which 1121 (9.3%) were fake, 1279 (12%) contained negative sentiments, and 9635 (88%) did not contain any negative sentiment. GPT-4o mini model subsequently inducted 41 thematic codes together with their definitions. Average human-GPT interrater reliability is perfect (κ=0.81). Factor analysis identified 6 interpretable latent factors: “Service and Communication Effectiveness,” “Clinical Care and Patient Experience,” “Facilities and Amenities Quality,” “Appointment and Patient Flow,” “Financial and Insurance Management,” and “Patient Rights and Accessibility.” The cumulative explained variance for the six factors is 0.74, and Cronbach α is between 0.88 and 0.97 (good and excellent) for all factors except factor 6 (0.61: questionable). The factors identified follow a global pattern of issues identified from the literature.

CONCLUSIONS: A data collection and processing pipeline consisting of Python Selenium, the GPT-4o mini model API, and a factor analysis module can support valid and reliable thematic analysis. Despite the potential for collection and information bias in web-based reviews, LACA of web-based reviews is cost-effective, time-efficient, and can be performed in real time, helping hospital managers develop hypotheses for further investigations promptly.

PMID:40577714 | DOI:10.2196/69075

West J Emerg Med. 2025 May 20;26(3):425-430. doi: 10.5811/westjem.21279.

ABSTRACT

INTRODUCTION: Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients.

METHODS: This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs with a chief complaint of abdominal pain across four states (MN, WI, AZ, FL) between July 1, 2018-November 15, 2022. Patients ≥12 years of age were included. Patients’ sex assigned at birth and gender identity was extracted from the EHR via patient-provided registration fields. Two independent investigators independently reviewed each medical record of the identified TGD patient to validate the accuracy of pulled gender identity. Discrepancies were resolved by a third reviewer. Each transgender patient was matched to cisgender GBQ males (gay, bisexual, queer), cisgender LBQ (lesbian, bisexual, queer) females, cisgender heterosexual males, and cisgender heterosexual females using propensity score (PS) matching. We calculated the PS values using a multivariable logistic regression model where being transgender was the outcome, and covariates in the model included age, site, mental health history, and gastrointestinal history.

RESULTS: We initially identified 300 patients as TGD based on electronic data pull. An additional 1,000 patients were also included in the cohort for matching purposes. The agreement between electronic and manual review was 99.9%, and the kappa was 0.998 (95% confidence interval 0.994-1.000). We were able to match patients except for GBQ males due to low numbers. There is a significant difference in age between groups (P <0.001) with GBQ males being older than other groups.

CONCLUSION: The methodology for identifying transgender and gender diverse patients in the EHR was accurate compared to manual review of gender identity. The TGD patients were able to be well matched, except to GBQ males. This provides a validated method to identify TGD patients in the EHR and further study disparities they may receive in care.

PMID:40577712 | DOI:10.5811/westjem.21279