Tag: pubmed

JMIR Form Res. 2023 Feb 23;7:e42881. doi: 10.2196/42881.

ABSTRACT

BACKGROUND: The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child’s care team members (CTMs) in a timely manner.

OBJECTIVE: The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs’ and CTMs’ perceptions and experiences using secure messaging as a method of communication.

METHODS: This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child’s care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis.

RESULTS: A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child’s life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use.

CONCLUSIONS: Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child’s health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.

PMID:36821356 | DOI:10.2196/42881

JMIR Mhealth Uhealth. 2023 Feb 23;11:e40416. doi: 10.2196/40416.

ABSTRACT

BACKGROUND: In contrast to the large and increasing number of patients with stroke, clinical rehabilitation resources cannot meet their rehabilitation needs. Especially for those discharged, ways to carry out effective rehabilitation training without the supervision of physicians and receive guidance from physicians remain urgent problems to be solved in clinical rehabilitation and have become a research hot spot at home and abroad. At present, there are many studies on home rehabilitation training based on wearable devices, Kinect, among others, but these have disadvantages (eg, complex systems, high price, and unsatisfactory rehabilitation effects).

OBJECTIVE: This study aims to design a remote intelligent rehabilitation training system based on wearable devices and human-computer interaction training tasks, and to evaluate the effectiveness and safety of the remote rehabilitation training system for nonphysician-supervised motor rehabilitation training of patients with stroke through a clinical trial study.

METHODS: A total of 120 inpatients with stroke having limb motor dysfunction were enrolled via a randomized, parallel-controlled method in the rehabilitation institutions, and a 3-week clinical trial was conducted in the rehabilitation hall with 60 patients in the experimental group and 60 in the control group. The patients in the experimental group used the remote rehabilitation training system for rehabilitation training and routine clinical physical therapy (PT) training and received routine drug treatment every day. The patients in the control group received routine clinical occupational therapy (OT) training and routine clinical PT training and routine drug treatment every day. At the beginning of the training (baseline) and after 3 weeks, the Fugl-Meyer Motor Function Rating scale was scored by rehabilitation physicians, and the results were compared and analyzed.

RESULTS: Statistics were performed using SAS software (version 9.4). The total mean Fugl-Meyer score improved by 11.98 (SD 8.46; 95% CI 9.69-14.27) in the control group and 17.56 (SD 11.65; 95% CI 14.37-20.74) in the experimental group, and the difference between the 2 groups was statistically significant (P=.005). Among them, the mean Fugl-Meyer upper extremity score improved by 7.45 (SD 7.24; 95% CI 5.50-9.41) in the control group and 11.28 (SD 8.59; 95% CI 8.93-13.62) in the experimental group, and the difference between the 2 groups was statistically significant (P=.01). The mean Fugl-Meyer lower extremity score improved by 4.53 (SD 4.42; 95% CI 3.33-5.72) in the control group and 6.28 (SD 5.28; 95% CI 4.84-7.72) in the experimental group, and there was no significant difference between the 2 groups (P=.06). The test results showed that the experimental group was better than the control group, and that the patients’ motor ability was improved.

CONCLUSIONS: The remote rehabilitation training system designed based on wearable devices and human-computer interaction training tasks can replace routine clinical OT training. In the future, through medical device registration certification, the system will be used without the participation of physicians or therapists, such as in rehabilitation training halls, and in remote environments, such as communities and homes.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200061310; https://tinyurl.com/34ka2725.

PMID:36821348 | DOI:10.2196/40416

Appl Opt. 2023 Feb 20;62(6):A1-A11. doi: 10.1364/AO.473632.

ABSTRACT

Velocity measurement has a high application value in hydrological monitoring and flood disaster warning. The long-distance laser Doppler water flow velocimetry technology has the advantage of strong anti-interference ability and high spatial resolution, and it can realize the high-precision measurement of water flow velocity. Because water flow has low reflectance characteristics, how to extract Doppler frequency from weak non-stationary coherent signals is a crucial problem to be solved to realize long-distance water flow velocity measurement. However, the classical method requires the time domain signal to have high stationarity and is not suitable for processing the coherent signal in the water flow velocity measurement. Aiming at this problem, we proposed a water flow velocimetry method based on adaptive Gaussian weighted integral (AGWI). First, the spectral characteristics of the coherent signal are analyzed in detail, and a statistical model of weak non-stationary signals is established. A second-order Kaiser self-multiplication window (KSMW) is designed to suppress spectral leakage for the asynchronously sampled data. Then, an adaptive homogenization power spectral subtraction (AHPSS) is designed to reduce system noise. Finally, the Doppler spectrum reconstruction and Doppler frequency estimation are performed using the AGWI method to obtain the Doppler frequency, which is further processed to get the water flow velocity. The experimental results show that the method proposed in this paper can achieve accurate and stable measurement of river surface velocity under long-distance conditions.

PMID:36821294 | DOI:10.1364/AO.473632

Appl Opt. 2023 Feb 10;62(5):1253-1262. doi: 10.1364/AO.475825.

ABSTRACT

The fast-Fourier-transform-based filtering method for phase screen generation remains popular for numerical simulation of optical propagation through turbulence; however, these screens inherently underrepresent the spectral density at low wavenumbers. Here, the “Z-tilt” approach is explored to augment the spectral density at low wavenumbers by adding a random phase tilt, which is derived from the wavefront phase statistics of a Zernike polynomial basis. This approach is computationally efficient and can be applied to any statistically homogeneous and isotropic refractive index field. An analytic result is provided for the von Kármán spectrum with finite outer scale. In a quantitative comparison with phase screens compensated for using a common subharmonic approach, the Z-tilt method shows the best agreement with the analytical structure function when the outer scale is greater than about three times the screen dimension. For outer scales of the order of the screen dimension, the subharmonic and a modified Z-tilt method give the most accurate results. A propagation simulation demonstrates that the aperture-averaged angle-of-arrival variance is accurately predicted using the Z-tilt method.

PMID:36821225 | DOI:10.1364/AO.475825

J Opt Soc Am A Opt Image Sci Vis. 2023 Feb 1;40(2):285-293. doi: 10.1364/JOSAA.477639.

ABSTRACT

We show that quantum detector tomography can be applied to the human visual system to explore human perception of photon number states. In detector tomography, instead of using very hard-to-produce photon number states, the response of a detector to light pulses with known photon statistics of varying intensity is recorded, and a model is fitted to the experimental outcomes, thereby inferring the detector’s photon number state response. Generally, light pulses containing a Poisson-distributed number of photons are utilized, which are very easy to produce in the lab. This technique has not been explored to study the human visual system before because it usually requires a very large number of repetitions not suitable for experiments on humans. Yet, in the present study we show that detector tomography is feasible for human experiments. Assuming a simple model for this accuracy, the results of our simulations show that detector tomography is able to reconstruct the model using Bayesian inference with as few as 5000 trials. We then optimize the experimental parameters in order to maximize the probability of showing that the single-photon accuracy is above chance. As such, our study opens the road to study human perception on the quantum level.

PMID:36821198 | DOI:10.1364/JOSAA.477639

J Opt Soc Am A Opt Image Sci Vis. 2023 Feb 1;40(2):237-258. doi: 10.1364/JOSAA.472553.

ABSTRACT

Analysis of visual texture is important for many key steps in early vision. We study visual sensitivity to image statistics in three families of textures that include multiple gray levels and correlations in two spatial dimensions. Sensitivities to positive and negative correlations are approximately independent of correlation sign, and signals from different kinds of correlations combine quadratically. We build a computational model, fully constrained by prior studies of sensitivity to uncorrelated textures and black-and-white textures with spatial correlations. The model accounts for many features of the new data, including sign-independence, quadratic combination, and the dependence on gray-level distribution.

PMID:36821194 | DOI:10.1364/JOSAA.472553

Alzheimer Dis Assoc Disord. 2023 Jan-Mar 01;37(1):35-41. doi: 10.1097/WAD.0000000000000542. Epub 2023 Feb 23.

ABSTRACT

INTRODUCTION: Atherosclerosis has been shown to impact cognitive impairment, with most of the evidence originating from European, African, or East Asian populations that have employed carotid intima-media thickness (cIMT) as a biomarker for atherosclerosis. Vascular disease is related to dementia/cognitive decline. There is no community-based study from India that has looked at the association of cIMT with cognitive performance.

METHODS: In this cross-sectional study between December 2014 and 2019, we recruited 7505 persons [(mean age 64.6 (9.2) y) and 50.9% women] from a community-dwelling population in New Delhi. These persons underwent carotid ultrasound to quantify cIMT and a cognitive test battery that tapped into memory, processing speed, and executive function. We also computed the general cognitive factor (g-factor), which was identified as the first unrotated component of the principal component analysis and explained 37.4% of all variances in the cognitive tests. We constructed multivariate linear regression models adjusted for age, sex, education, and cardiovascular risk factors. Additional adjustment was made for depression, anxiety, and psychosocial support in the final model.

RESULTS: We found a significant association of higher cIMT with worse performance in general cognition (β=-0. 01(95% CI: -0.01; -0.01); P<0.001), processing speed (β=-0.20; 95% CI: -0.34; -0.07); P=0.003), memory (β=-0.29; 95% CI: -0.53; -0.05); P=0.016), and executive function (β=-0.54; 95% CI: -0.75; -0.33); P=<0.001). There was no statistically significant association of cIMT with Mini-Mental Status Examination score (β=0.02; 95% CI: -0.34; 0.40; 0.89).

CONCLUSION: The cross-sectional study found significant associations of increased cIMT with worse performance in global cognition, information processing, memory, and executive function.

PMID:36821176 | DOI:10.1097/WAD.0000000000000542

Appl Opt. 2023 Feb 1;62(4):844-860. doi: 10.1364/AO.478668.

ABSTRACT

This study proposes a color image encryption method combining Fresnel diffraction, multi-phase retrieval, and hyperchaotic mapping in two stages. First, the color image is converted into an amplitude-type computer-generated hologram (CGH) that overlaps in the frequency domain and separates in the spatial domain. The Gerchberg-Saxton (GS) multi-phase retrieval algorithm encrypts the CGH into a meaningless ciphertext in the second stage, scrambling/diffusing it further using four random sequences generated from the Lorenz hyperchaotic system. The experiment on public color images shows that the decrypted color images are highly consistent with plaintext images. This method’s key has a large space (approximately 10^∧301) and a small volume. Slight changes to the plaintext completely alter the ciphertext, and its pixel values are statistically independent, thus securing the proposed method against chosen-plaintext attacks and chosen-ciphertext attacks.

PMID:36821148 | DOI:10.1364/AO.478668

J Urol. 2023 Feb 23:101097JU0000000000003390. doi: 10.1097/JU.0000000000003390. Online ahead of print.

ABSTRACT

PURPOSE: Although Children’s Oncology Group renal tumor protocols mandate lymph node sampling (LNS) during extirpative surgery for pediatric renal tumors, LNS is often omitted or low yield. Concerns over morbidity associated with extended LNS have led to hesitancy in adopting a formal LNS template. We hypothesized that complications in children undergoing LNS for renal tumors would be rare, and not associated with the number of LNs sampled.

METHODS: A single-institution, retrospective review of patients aged 0-18yrs undergoing extirpative renal surgery with LNS for a suspected malignancy between 2005-2019 was performed. Patients with 0 or an unknown number of LNs sampled or <150 days of follow-up were excluded. A “clinically significant” (CS) complication was defined as any Clavien-Dindo complication ≥ III, small bowel obstruction (SBO), chylous ascites, organ injury, or wound infection. The number of LNs sampled and its influence on the odds of experiencing a CS complication was examined.

RESULTS: 144 patients met inclusion criteria. Median patient age was 38 months. Twenty-one patients (15%) had a CS complication, the most common of which was ileus/SBO (n = 16). In a multivariable analysis, increased LN yield was not found to influence the odds of experiencing a CS complication (P = .6).

CONCLUSIONS: In this cohort, there was no statistically significant difference in CS complications in patients who underwent more extensive LNS during surgery for a suspected malignant pediatric renal tumor. Future studies on protocol adherence, staging accuracy, and survival trends using a LNS template in these patients should be performed.

PMID:36821137 | DOI:10.1097/JU.0000000000003390

JAMA Otolaryngol Head Neck Surg. 2023 Feb 23. doi: 10.1001/jamaoto.2022.5186. Online ahead of print.

ABSTRACT

IMPORTANCE: Clear surgical margins reduce the risk of local recurrence, improve survival, and determine decision-making with regard to adjuvant treatment of squamous cell carcinoma of the head and neck (SCCHN). However, the definitions of clear, close, or positive surgical margins vary in both the literature and in practice.

OBJECTIVE: To examine whether the association between surgical margin distance and survival varies by primary tumor site.

DESIGN, SETTING, AND PARTICIPANTS: This was a secondary analysis of a multi-institutional, multinational randomized clinical trial. The trial enrolled patients from January 22, 2007, to March 29, 2013, with stage II to IVA resected SCCHN with extranodal extension (ENE) or positive margins (<5 mm from invasive tumor to the resected margin). The current analysis included those patients with known ENE and margin status and was conducted from April 29, 2022, to December 19, 2022.

INTERVENTIONS: Patients received adjuvant chemoradiotherapy plus either placebo or lapatinib.

MAIN OUTCOMES AND MEASURES: Overall survival (OS) was calculated to examine association with surgical margin distance, primary site, and survival, with stratification by ENE status.

RESULTS: Among 688 patients enrolled in the trial, 630 patients with known ENE and margin status were included. Exact patient ages were not made available; 523 (83%) patients were male, and 415 (66%) patients were White. Patients with 1 high-risk feature (positive margins or ENE) had significantly better OS vs 2 high-risk features (hazard ratio [HR], 0.65; 95% CI, 0.49-0.87), although most other results were not statistically significant. For example, in the cohort with ENE-negative disease, multivariable adjusted analysis showed nonsignificant improvements with shorter surgical margin distance (1- to 5-mm margins), and no association with OS was found in the cohort with ENE-positive status (either >5 mm margins or 1-5 mm margins). The association between survival and margin distance varied based on primary site, human papillomavirus (HPV) status, and ENE status. For example, HPV-positive status was associated with a significant and clinically meaningful increase in survival (adjusted HR, 0.33; 95% CI, 0.11-0.97). The improvement was greatest, although not significantly so, in patients with ENE- and HPV-negative oropharynx (OP), hypopharynx (HP), and larynx cancer (HR, 0.57; 95% CI, 0.30-1.10). No survival benefit was seen in ENE-negative oral cavity cancer (HR, 0.89; 95% CI, 0.45-1.77), nor was an association observed between margins and OS in HPV-positive OP cancer.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, the presence of high-risk features (extranodal extension, positive margins, or both) was associated with worse survival; longer survival was observed with greater surgical margin distance among patients with oral cavity tumors and human papillomavirus-negative tumors of the OP, larynx, or HP. No other significant differences were found. These findings support variable interpretation of surgical margin distance based on the primary site and HPV status.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00424255.

PMID:36821132 | DOI:10.1001/jamaoto.2022.5186