Recent publications
Objectives
Identify existing research on impacts of transitions between electronic health record (EHR) systems on patients' healthcare experiences.
Methods
Scoping review. We searched MedLine, OVID, Embase, CINAHL, and PsycInfo databases for articles on patient experiences with EHR-to-EHR transitions.
Results
Three studies met inclusion criteria. All three used validated surveys to compare patient satisfaction with care pre- and post-transition. The surveys did not include specific questions about the EHR transition; one study focused on patient perceptions of provider computer use. Satisfaction levels initially decreased following EHR implementation, then returned to baseline between six and 15 months later in two of three studies. Factors associated with changes in observed satisfaction are unknown.
Conclusions
Patient experience has been given limited attention in studies of EHR-to-EHR transitions. Future research should look beyond satisfaction, and examine how an EHR-to-EHR transition can impact the quality of patients' care, including safety, effectiveness, timeliness, efficiency, and equity.
Innovation
To our knowledge, this is the first literature review on EHR transitions that specifically focused on patient experiences. In preparation for a transition from one EHR to another, healthcare system leaders should consider the multiple ways patients' experiences with care may be impacted and develop strategies to minimize disruptions in care.
Single flux quantum (SFQ) technology has garnered significant attention due to its low switching power and high operational speed. Researchers have been actively pursuing more advanced devices and technologies to further reduce the reliance on inductors, bias, and dynamic power. Recently, innovative magnetic Josephson junction devices have emerged, enhancing the field of superconductor electronics (SCE) logic. This paper introduces a novel cell library design that relies entirely on Josephson junctions (JJs), showing promising potential for eliminating the need for inductors in conventional SFQ cells. This results in a 55% reduction in cell size and an 80% decrease in both static and dynamic power consumption. The proposed library implements a half flux quantum (HFQ) logic, where each pulse duration is half that of a single flux quantum pulse. The paper presents the schematics of the basic cells, emphasizing critical circuit parameters and their margins. Additionally, it examines layout blueprints, showcasing the advantageous areasaving characteristics of the proposed design.
The emergence of diverse machine learning (ML) models has led to groundbreaking revolutions in computer vision (CV). These ML models include convolutional neural networks (CNNs), graph neural networks (GNNs), and vision transformers (ViTs). However, existing hardware accelerators designed for CV lack the versatility to support various ML models, potentially limiting their applicability to real-world scenarios. To address this limitation, we introduce VisionAGILE, a domain-specific accelerator designed to be versatile and capable of accommodating a range of ML models, including CNNs, GNNs, and ViTs. VisionAGILE comprises a compiler, a runtime system, and a hardware accelerator. For the hardware accelerator, we develop a novel unified architecture with a flexible data path and memory organization to support the computation primitives in various ML models. Regarding the compiler design, we develop a unified compilation workflow that maps various ML models to the proposed hardware accelerator. The runtime system executes dynamic sparsity exploitation to reduce inference latency and dynamic task scheduling for workload balance. The compiler, the runtime system, and the hardware accelerator work synergistically to support a variety of ML models in CV, enabling low-latency inference. We deploy the hardware accelerator on a state-of-the-art data center FPGA (Xilinx Alveo U250). We evaluate VisionAGILE on diverse ML models for CV, including CNNs, GNNs, hybrid models (comprising both CNN and GNN), and ViTs. The experimental results indicate that, compared with state-of-the-art CPU (GPU) implementations, VisionAGILE achieves a speedup of 81.7× (4.8×) in terms of latency. Evaluated on standalone CNNs, GNNs, and ViTs, VisionAGILE demonstrates comparable or higher performance with state-of-the-art CNN accelerators, GNN accelerators, and ViT accelerators, respectively
Introduction
Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (¹1 Ferguson EL, Ramos-Carpinteyro R, Soputro N, Chavali JS, Geskin A, Kaouk JH. Single-Port Robotic Radical Prostatectomy Using Transvesical and Transperineal Access in Patients with a Hostile Abdomen. J Endourol. 2024;38:150-8. doi: 10.1089/end.2023.0128.
https://doi.org/10.1089/end.2023.0128... , ²2 Pettenuzzo G, Ditonno F, Cannoletta D, Morgantini L, Sauer RC, Torres-Anguiano JR, et al. Single Port Radical Prostatectomy as a Viable Option for Highly Complex Patients: A Single Center Experience. Urology. 2024;189:55-63. doi: 10.1016/j.urology.2024.04.051.
https://doi.org/10.1016/j.urology.2024.0... ).
Materials and Methods
Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (³3 Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, et al. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am. 2004;31:701-17. doi: 10.1016/j.ucl.2004.06.011.
https://doi.org/10.1016/j.ucl.2004.06.01... , ⁴4 Soputro NA, Kaouk J. Single-port robot-assisted radical prostatectomy. World J Urol. 2024;42:245. doi: 10.1007/s00345-024-04914-5.
https://doi.org/10.1007/s00345-024-04914... ).
Results
Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months.
Conclusion
Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen.
Objective
To further evaluate a genomic classifier (GC) in a cohort of patients undergoing radical cystectomy (RC), as long non‐coding RNA (lncRNA)‐based genomic profiling has suggested utility in identifying a distinct tumour subgroup corresponding to a favourable prognosis in patients with bladder cancer.
Patients and Methods
Transcriptome‐wide expression profiling using Decipher Bladder was performed on transurethral resection of bladder tumour samples from a cohort of patients with high‐grade, clinically organ‐confined (cTa–T2N0M0) urothelial carcinoma (UC) who subsequently underwent RC without any neoadjuvant therapy (n = 226). The lncRNA‐based luminal favourable status was determined using a previously developed GC. The primary endpoint was overall survival (OS) after RC. Secondary endpoints included cancer‐specific mortality and upstaging at RC.
Results
In the study, 134 patients were clinical non‐muscle‐invasive bladder cancer (cTa/Tis/T1) and 92 patients were cT2. We identified 60 patients with luminal favourable subtype, all of which showed robust gene expression patterns associated with less aggressive bladder cancer biology. On multivariate analysis, patients with the luminal favourable subtype (vs without) were significantly associated with lower odds of upstaging to pathological (p)T3+ disease (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.12–0.82; P = 0.02), any upstaging (OR 0.41, 95% CI 0.20–0.83; P = 0.01), and any upstaging and/or pN+ (OR 0.50, 95% CI 0.25–1.00; P = 0.05). Luminal favourable bladder cancer was significantly associated with better OS (hazard ratio 0.33, 95% CI 0.15–0.74; P = 0.007).
Conclusions
This study validates the performance of the GC for identifying UCs with a luminal favourable subtype, harbouring less aggressive tumour biology.
A striking feature of Oxygen Deficient Zones (ODZs) on the eastern boundary of the Pacific Ocean are large subsurface plumes of iodide. Throughout the oceans, iodate is the predominant and thermodynamically favored species of dissolved iodine, but iodate is depleted within these plumes. The origin of iodide plumes and mechanism of reduction of iodate to iodide remains unclear but is thought to arise from a combination of in situ reduction and inputs from reducing shelf sediments. To distinguish between these sources, we investigated iodine redox speciation along the Oregon continental shelf. This upwelling system resembles ODZs but exhibits episodic hypoxia, rather than a persistently denitrifying water column. We observed elevated iodide in the benthic boundary layer overlying shelf sediments, but to a much smaller extent than within ODZs. There was no evidence of offshore plumes of iodide or increases in total dissolved iodine. Results suggest that an anaerobic water column dominated by denitrification, such as in ODZs, is required for iodate reduction. However, re‐analysis of iodine redox data from previous ODZ work suggests that most iodate reduction occurs in sediments, not the water column, and is also decoupled from denitrification. The underlying differences between these regimes have yet to be resolved, but could indicate a role for reduced sulfur in iodate reduction if the sulfate reduction zone is closer to the sediment‐water interface in ODZ shelf sediments than in Oregon sediments. Iodate reduction is not a simple function of oxygen depletion, which has important implications for its application as a paleoredox tracer.
OBJECTIVES
To quantify the occupational radiation exposure with a 3-dimensional (3D) fluoroscopic machine during routine use in pelvic and acetabular surgery and to determine whether the additional radiation exposure encountered with the 3D fluoroscopic spin is within previously accepted limits.
METHODS
Design
Prospective cohort study.
Setting
Level I trauma center.
Patient Selection Criteria
All patients undergoing 3D fluoroscopy intraoperatively during pelvis (OTA/AO 61B,C) or acetabular (OTA/AO 62A-C) surgery between April 2021 and July 2021.
Outcome Measures and Comparisons
Radiation dose at standardized locations around the operating room during the spin portion of the 3D fluoroscopy.
RESULTS
Seventy-six 3D spins were performed on 69 patients during the study period. The average emitted radiation dose from the machine for the routine fluoroscopy portion of the case was 74.5 mGy. The average displayed radiation dose in the air for the spin portion of the case was 39.9 mGy, an average of 53.6% less radiation than the routine fluoroscopy portion. For the spin portion, the average radiation exposure seen by the patient was 3.42 mGy (centered on the patient) and the average maximal exposure in the room was 0.062 mGy. Minimal radiation was detected outside the operating room doors.
CONCLUSIONS
The radiation exposure encountered by operating room personnel with 3D fluoroscopy appears to be within safe occupational limits. The marginal increase in radiation exposure during pelvic and acetabular surgery should not discourage the use of 3D imaging intraoperatively.
LEVEL OF EVIDENCE
Level IV, Case Series.
Importance
Since 2018, a movement has emerged to define Alzheimer disease (AD) as a purely biological entity based on biomarker findings. The recent revision of the Alzheimer Association (AA) criteria for AD furthers this direction. However, concerns about a purely biological definition of AD being applied clinically, the understanding of AD by society at large, and the translation of blood-based biomarkers into clinical practice prompt these International Working Group (IWG) updated recommendations.
Objective
To consider the revised AA criteria and to offer an alternative definitional view of AD as a clinical-biological construct for clinical use. The recommendations of the 2021 IWG diagnostic criteria are updated for further elaborating at-risk and presymptomatic states.
Evidence Review
PubMed was searched for articles published between July 1, 2020, and March 1, 2024, using the terms “biomarker” OR “amyloid” OR “tau” OR “neurodegeneration” OR “preclinical” OR “CSF” OR “PET” OR “plasma” AND “Alzheimer’s disease.” The references of relevant articles were also searched.
Findings
In the new AA diagnostic criteria, AD can be defined clinically as encompassing cognitively normal people having a core 1 AD biomarker. However, recent literature shows that the majority of biomarker-positive cognitively normal individuals will not become symptomatic along a proximate timeline. In the clinical setting, disclosing a diagnosis of AD to cognitively normal people with only core 1 AD biomarkers represents the most problematic implication of a purely biological definition of the disease.
Conclusions and Relevance
The ultimate aim of the field was to foster effective AD treatments, including preventing symptoms and dementia. The approach of diagnosing AD without a clinical and biological construct would be unwarranted and potentially concerning without a clear knowledge of when or whether symptoms will ever develop. It is recommended that those who are amyloid-positive only and, more generally, most biomarker-positive cognitively normal individuals, should not be labeled as having AD. Rather, they should be considered as being at risk for AD. The expansion of presymptomatic AD is viewed as a better diagnostic construct for those with a specific pattern of biomarkers, indicating that they are proximate to the expression of symptoms in the near future.
This is my 21st “Games” column and it is time to review my motivations for writing each past column and provide any responses that I have received.
Developing countries have increasingly decentralized power to local governments. This paper studies the implications of a central element of decentralization (polity size) using population-based discontinuities that determine local government boundaries for over 100,000 Indian villages. Over the short and long run, individuals allocated into local governments with smaller populations have better access to public goods. We provide suggestive evidence that these results are related to heightened civic engagement and stronger political incentives, but not to other mechanisms such as elite capture. (JEL D72, H41, H75, H76, O17, O18, R50)
We conducted a field experiment that randomized advertisements, advertisement content, and prices across 2,204 counties in the United States to study the impacts on online purchases of naloxone, an opioid overdose reversal drug. Advertising increased web-site users but only impacted purchases when combined with a price reduction. Messages emphasizing the discreet nature of online sales had no additional impact on purchases. Comparing counties with advertisements featuring a highly discounted price to those featuring the full price, we estimate a price elasticity of demand for online naloxone of −1.3. Price is a significant barrier to online purchases of this lifesaving medication. (JEL C93, H75, I12, I18, L65, M37)
Several semi-active control laws were proposed to reduce the maximum response of the benchmark test model of the base-isolation system, and their effectiveness was verified through E-Defense experiments.
1. Control performance and response reduction effects of testing control laws could be appropriately evaluated considering the equivalent damping factor for each semi-active controlled response.
2. Proposed semi-active control laws could be classified as two typical types depending on their force-velocity characteristics.
3. Proposed semi-active control laws could reduce the maximum displacement responses without increasing the absolute acceleration of the superstructure, while the control performance depended on the seismic motion characteristics.
Young adulthood is a critical development period when mental health problems such as anxiety and depression become more prevalent. Likewise, there is evidence to suggest that depression and anxiety may lead to increased pornography usage. We examined the association of depression and anxiety symptoms with pornography viewing frequency among a prospective cohort of young adults (n = 1864) from California. Multinomial logistic regression models estimated the association of depression symptoms only, anxiety symptoms only, and comorbid depression and anxiety with pornography viewing frequency (never, < 3 times/month, one to several times/week, one to several times/day) at a 6-month follow-up. Models adjusted for gender, sexual orientation, sexual satisfaction, and adverse childhood experiences. Participants with comorbid depression and anxiety (vs. no depression or anxiety symptoms) had 2.72 (95% CI: 1.66–4.46) times the odds of frequent pornography viewing (one to several times/day) compared to never watching pornography. There was an association of depression symptoms only with frequent pornography viewing but it did not reach statistical significance (OR: 1.95, 95% CI: 0.78–4.89). Anxiety symptoms alone (vs. no depression and anxiety symptoms) were not associated with pornography viewing at any frequency in the full sample. However, in gender-stratified models, anxiety symptoms alone were associated with pornography viewing among women (OR: 1.44. 95% CI: 1.00–2.07), but not men (1.12, 95% CI: 0.65–1.96). Findings suggest comorbid depression and anxiety symptoms are associated with frequent pornography viewing among young adults, and anxiety symptoms alone are associated with pornography viewing among women, but not men.
Childhood and adolescence are pivotal developmental stages for psychological health. An understanding of psychological mechanisms related to well-being is important for promoting positive life outcomes for youth. Research generally shows that the basic psychological need for autonomy is significantly associated with well-being. To examine the magnitude and sources of variation in this relationship, we conducted a meta-analysis of 90 reports to analyze the average effect of autonomy need satisfaction (ANS) and frustration (ANF) on indicators of psychological well- and ill-being for K-12 (Kindergarten to 12th grade) youth. Results indicated that ANS was positively associated with psychological well-being and negatively associated with psychological ill-being among youth. Further, ANF was negatively associated with psychological well-being and positively associated with psychological ill-being. Moderator analyses indicated that the association between ANS and well-being was stronger for studies conducted with children and adolescents in East Asian countries compared to studies conducted in the USA, Canada, or Northern Europe when controlling for publication status and measurement reliability. Results also showed that the average correlation between ANS and well-being was stronger for studies located in more collectivistic countries compared to individualistic countries when controlling for publication status and measurement reliability. The relationship between ANS and ill-being was stronger for studies conducted in the USA and Canada compared to East Asian and European contexts. Together, results suggest that autonomy satisfaction is related to the well- and ill-being of youth across cultural contexts, but that there is cultural variation in the association between experiences of autonomy and well-being.
Sensitive and reliable characterization of chirality in nanostructures and molecules is of great importance in multidisciplinary research combining physics, chemistry and nanotechnology, with potential applications in pharmaceutical and agrochemical industry. Chirality is connected to circular dichroism (CD) - the absorption difference when the chiral medium is excited with circular polarizations of opposite handedness. Hence, measuring chirality by direct absorption measurements is of great interest in nanophotonics and plasmonics community, where the nanostructured media can enhance chiro-optical effects. Here we present a recently constructed photo-acoustic spectroscopy (PAS) set-up, which offers many degrees of freedom in characterization. We use a laser which is widely tuneable in the near-infrared (680-1080 nm) and visible (340-540 nm) ranges. The laser output is modulated with a mechanical chopper, where its frequency defines the penetration depth of the thermal signal. The input polarization is controlled by a linear polarizer and a quarter-wave plate, and the laser can be focused before impinging on the sample in the tightly closed photo-acoustic cell. The cell is placed on translational and rotational stages, which allows for the spatial mapping and extrinsic chirality measurements. Finally, a sensitive microphone measures the pressure changes in the cell, enabling scattering-free measurement of absorption and CD.
The rising burden of dementia calls for high‐quality data on cognitive decline and dementia onset. The second wave of the Harmonized Diagnostic Assessment for the Longitudinal Aging Study in India (LASI‐DAD) was designed to provide longitudinal assessments of cognition and dementia in India. All Wave 1 participants were recruited for a follow‐up interview, and a refresher sample was drawn from the Longitudinal Aging Study in India, a nationally representative cohort of Indians aged 45 and older. Respondents underwent a battery of cognitive tests, geriatric assessments, and venous blood collection. Their health and cognitive status were also assessed through an interview with a close family member or friend. Clinical consensus diagnosis was made based on the Clinical Dementia Rating®, and comprehensive data on risk factors of dementia were collected, including neurodegenerative biomarkers, sensory function, and environmental exposures. A total of 4635 participants were recruited between 2022 and 2024 from 22 states and union territories of India, accounting for 97.9% of the population in India. The response rate was 84.0%, and 71.5% of the participants provided venous blood specimen. LASI‐DAD provides rich new data to study cognition, dementia, and their risk factors longitudinally in a nationally representative sample of older adults in India. Longitudinal cognitive data, together with longitudinally assessed biomarker data and novel data on sensory function and environmental exposures, provide a unique opportunity to establish associations between risk factors and biologically defined cognitive aging phenotypes.
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