bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic dilemmas of mechanical restriction of the medial rectus: A case report
Authors: Gallogly James A. , Faraji Farhoud , Jumaily Mejd H. , Schneider John S. , Brunworth Joseph D.
Published: June 2018

Background

Due to the proximity of the maxillary sinus and ethmoid sinuses to the orbit, inflammatory processes that originate in the sinonasal region have the potential to extend into the orbit.

Objective

We presented a case of ptosis and restrictive strabismus of the medial rectus muscle.

Methods

A case report with a literature review of possible diagnoses.

Results

Biopsy, imaging, and laboratory evaluation by otolaryngology, ophthalmology, and rheumatology services were unable to identify the cause of the fibrosis after 22 months of follow-up. A response to oral steroids indicated an inflammatory process.

Conclusion

Unilateral mechanical restriction of the medial rectus muscle is a rare complication of nasal disease. Inflammatory processes and iatrogenic injury are known to cause fibrosis of surrounding tissue. We presented a unique case of medial rectus fibrosis that did not meet the diagnostic criteria of recognized etiologies.
Relationship Between Rhinitis, Asthma, and Eczema and the Presence of Sensitization in Young Swiss Adults
Authors: Steiner Urs C. , Bachmann Lucas M. , Soyka Micheal B. , Regenass Stephan , Steinegger Lukas , Probst Elsbeth
Published: June 2018

Background

Rhinitis is a very common disease with allergies being the most frequent causative factor. It can co-occur together with asthma and eczema in atopic as well as in nonatopic patients.

Objectives

To assess the prevalence of allergic sensitization within patient groups with rhinitis in consideration of the co-occurring disorders of asthma and eczema.

Methods

Students of the third year of medical school completed an anonymous questionnaire on age, gender, and clinical symptoms, such as seasonal rhinitis, perennial rhinitis, asthma, and eczema, and underwent an ImmunoCAP Rapid test. We calculated the prevalence of sensitization within subgroups of patients reporting allergic disorders, such as rhinitis, asthma, and eczema.

Results

Questionnaires and ImmunoCAP Rapid tests of 1513 medical students were analyzed. The participants’ self-reported presence of seasonal/perennial rhinitis, asthma, and eczema was compared to the presence of sensitization. Data of 1467 subjects could be analyzed. Seasonal rhinitis was the most common symptom, followed by eczema, asthma, and perennial rhinitis. The participants were differentiated into 16 subgroups according to the combined clinical manifestations of the different symptoms and association to sensitization within subgroups. The prevalence of sensitization ranged from 18% in subjects reporting only eczema without any other symptom to 100% in those reporting to have asthma, seasonal/perennial rhinitis, and eczema together. In subjects reporting no sign or symptom at all, the prevalence of sensitization was 19%. Seasonal rhinitis was the strongest single predictor for sensitization with the highest proportion of sensitized participants in all symptom combinations (67%–100%), followed by perennial rhinitis (31%–100%), asthma (30%–100%), and eczema (18%–100%).

Conclusion

Rhinitis most often is associated with allergen sensitization, and the probability of sensitization is substantially enhanced by co-occurrence of asthma. A careful assessment of clinical signs and symptoms is important and enables the selection of patients in whom targeted diagnostic analysis and therapy is appropriate. Trial registration: retrospectively registered by the Cantonal Ethics Committee Zurich on 22.01.2016; Nr: 08-2016.
Effect of a Novel Photoelectrochemical Oxidation Air Purifier on Nasal and Ocular Allergy Symptoms
Authors: Rao Nikhil G. , Kumar Ambuj , Wong Jenny S. , Shridhar Ravi , Goswami Dharendra Y.
Published: June 2018

Background

Photoelectrochemical oxidation (PECO) is a new air purification technology developed to reduce circulating indoor allergens. PECO removes particles as small as 0.1 nm with the destruction of organic matter otherwise not trapped by a traditional filter and removes volatile organic compounds.

Objective

We hypothesized that with daily use, the device would reduce user nasal and ocular allergy total symptom scores (TSS) within 4 weeks.

Methods

The study was performed among 46 individuals with self-reported allergies using a portable PECO air purifier. Self-reported TSS were calculated at baseline and weekly for 4 weeks following initiation of continuous use of the system. TSS was the sum of total nasal symptom scores (TNSS) and total ocular symptom scores (TOSS) for the week.

Results

There was a statistically significant change in overall TSS from baseline to 4 weeks (10.1 at baseline and 4.35 postintervention) resulting in a mean difference of 5.75 (95% confidence interval [CI] 4.32–7.18; P < .0001). There was a statistically significant change in TNSS from baseline to 4 weeks (6.3 at baseline and 3.04 postintervention) resulting in a mean difference of 3.26 (95% CI 2.33–3.19; P < .0001). There was a statistically significant change in TOSS from baseline to 4 weeks (3.82 at baseline and 1.3 postintervention) resulting in a mean difference of 2.52 (95% CI 1.74–3.3; P < .0001).

Conclusion

With the use of PECO air purification technology, TSS, TNSS, and TOSS decreased significantly. These improvements were consistent over the 4-week course of device use.
Bereavement Outcomes as Causal Systems: A Network Analysis of the Co-Occurrence of Complicated Grief and Posttraumatic Growth
Authors: Bellet Benjamin W. , Jones Payton J. , Neimeyer Robert A. , McNally Richard J.
Published: June 2018

Bereavement can lead to negative outcomes such as complicated grief (CG), but some mourners with symptoms of CG often experience positive sequelae of loss such as posttraumatic growth (PTG) as well. We propose that grief and growth co-occur and change one another because they alternately reinforce and weaken each other at the level of their respective constituent elements. We investigated the structure of a network of CG and PTG elements to elucidate how grief and growth can co-occur within a potentially causal system in bereaved young adults. Challenges to control and identity disturbance ranked as the most highly central symptoms in the CG network; the discovery of a new life path and greater personal strength were similarly central elements of PTG. Finally, the degree of disruption and change in mourners’ worldviews emerged as the element that most strongly bridged the two domains, suggesting a pivotal connection between grief and growth.
Review of 16 cases of aneurysmal bone cyst in the proximal femur treated by extended curettage and cryosurgery with reconstruction using autogenous nonvascularized fibula graft
Authors: Rahman Mohamed Abdel , El Masry Ayman Mohammad , Azmy Sherif Ishak
Published: June 2018

Background:

Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity.

Methods:

We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures.

Results:

The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection.

Conclusions:

Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.
Updating an International Medical Device Standard: A Process for Audible Alarms
Authors: Edworthy Judy Reed , McNeer Richard , Bennett Christopher , Dudaryk Roman
Published: June 2018

Many human factors and ergonomics problems are associated with clinical alarms, usaually referred to as ‘alarm fatigue’. Among these problems is the nature of auditory signals used to attract attention, as these signals are often difficult to learn, easily confusable, and sometimes prone to masking. Symptomatic of this problem is the poor quality of the audible alarms associated with a global medical device safety standard, IEC 60601-1-8. A project aimed at improving and updating these sounds according to best practice is being carried out. This paper charts the progress of this venture and summarizes the results and the published papers which present those results.
Triage Nurses Decision-Support Application Design
Authors: Levis Tamari , Schwartz Dagan , Bitan Yuval
Published: June 2018

In this paper, we will present the planning and design process of a triage decision-support application, aimed to be used for both research data gathering and real-time triage decision-making. Triage is an initial classification of emergency department (ED) patients, according to the severity level of their medical condition. The need of fast and accurate triage decision-making, lead to the development of widely used triage algorithms, such as ESI (Emergency Severity Index).

Observations and interviews with triage personnel exposed difficulties of triage process and helped us create an ESI-based decision making model. Next, we built a multiple-choice questioner to characterize the application and required features. 40 triage nurses completed the questioner. Results indicated that the most highly requested feature was an automated severity grade calculator, which became the core of the proposed design.

While current design focuses on the analytical decision model, statistical analysis of the questioner results indicated that it is often insufficient when facing medical reality complexities, dictating nurse’s frequent use of intuition. Using triage systems data analysis and modern machine-learning methodologies, we inspire to develop a second version of the application that will integrate intuitive insights into triage scale algorithmic decision process.
Minimizing the Impact of Interoperability Errors on Clinicians
Authors: Dobre Jolie , Carter Tippy , Herout Jennifer , Cournoyer Amanda
Published: June 2018

There is little guidance in the literature on how health information technology (HIT) interfaces should be designed to inform clinicians of data availability. As the industry focuses on interoperability between systems and devices, and as more HIT products aggregate data from external sources, it becomes increasingly critical to identify methods to alert clinicians of the availability of data without negatively impacting clinician workflow or contributing to alert fatigue. This paper reports on a case study of a usability study done on the U.S. Department of Veteran’s Affairs (VA) Joint Legacy Viewer (JLV) to provide guidance to developers on communication of connection errors and interface status. The issue, process to explore the issue, and findings are discussed. As publicly developed software, the efforts behind VA’s JLV design choices and images of design solutions can be shared to further the field’s understanding.
A Systematic Method for Using Critical Decision Method Interviews to Generate a Garden Path Scenario for Human-in-the-Loop Simulations for Training and Evaluation of New Technologies
Authors: Militello Laura G. , Sushereba Christen , Fernandez Simon , Bahner David , Patterson Emily S.
Published: June 2018

Strategies for assessing macrocognitive skill must be tailored to work domains and specific tasks. This paper describes one approach for leveraging the critical decision method, a structured interview technique, to develop an assessment method for new technologies. The approach uses garden path scenarios, where initial cues suggest a different (false prime) diagnosis than later cues and thus requires changing the leading diagnosis over time, to assess sensemaking and re-planning skills in the context of tactical combat casualty care. Critical decision method interviews with emergency medicine physicians revealed critical cues specific to particular injuries and common across different injuries, and also provided cases that were used as the foundation for garden path scenarios. Evaluations using this approach with garden path scenarios enables having an objective measure to compare performance with and without a new technology on a continuous variable of the time until landmark events, such as recognition of a critical cue, committing to a likely diagnosis, or ruling out an inaccurate diagnosis. Additional measures include whether or not particular cues are noticed based upon gaze tracking data and think aloud statements, and exams that assess knowledge of anatomy and treatment priorities. Re-planning measures will focus on comparing performance to an expert model such as for tourniquet application, whether or not tasks on a checklist are conducted in the expected order including for prioritizing where to look for patient assessment, action priorities, and the trainee’s ability to link diagnosis to appropriate treatment.
A Linguistic Approach for Facilitating the Interpretation of the Human Factors and Ergonomics Society Symposium Proceedings: An Efficient Method for Real-Time Literature Review
Authors: Arnold Tim , Fuller Helen J. A.
Published: June 2018

The Human Factors and Ergonomics Society (HFES) has for some time been a leader in facilitating the discussion of human factors in health care. We hoped to capture essences of these discussions through reviewing and analyzing the last ten years of health care-related HFES Annual Meetings Proceedings and the last six years of the HFES Health-Care Symposium Proceedings. Because of the large number of papers, we utilized semi-automated means to process the Proceedings abstracts. These semi-automated means included methods in natural language processing (NLP), computational linguistics (CL), and corpus linguistics. We provide example approaches for visualizing linguistic themes within this body of text that may contribute to efforts in prospective risk awareness within health care. We also suggest an initial framework that is amenable for longitudinal, living, and interactive visualizations into this important and growing body of work.
Assessing Interaction Strategies for Health IT: An Entropy Based Approach
Authors: Wang Xiaomei , Berg Rebecca , McGeorge Nicolette , LaVergne David , Benda Natalie , Bisantz Ann
Published: June 2018

We proposed new metrics based on information entropy to capture characteristics of screen use and switching among information display screens. These metrics reflect differences in the regularity of the time spent on each screen/display or the number of visits to each screen/display. We also provided simulation and case study to demonstrate the sensitivity and usefulness of the metrics.
Human Computer Interaction Trends in Healthcare: An Update
Authors: Stowers Kimberly , Mouloua Mustapha
Published: June 2018

As the medical community evolves, so does its reliance on technology. With the rise of robotic surgery systems, the use of computers in tracking patient in-processing, and now mandates surrounding Electronic Health Records (EHR), it has become prudent to examine these systems as part of their larger sociotechnical systems. As such, an increase in Human Computer Interaction (HCI) research in healthcare setting has been seen. A prior trend analysis examined this phenomenon by analyzing specific areas of HCI-healthcare published as HFES proceedings from 1999 until 2009. This paper updates that analysis to explore trends in healthcare proceedings published by HFES from 2009 until 2017, during which time the Affordable Healthcare Act was passed and the HFES healthcare symposia were introduced and hosted separately from the primary annual HFES meetings. Changes in trends and their impact are discussed.
A Strategic Approach to Determining the Relative Impact of Team Behavior on Guideline Violations
Authors: Ashby Aaron B. , Smith Marshall L. , Gaines Regina J. , Kaufman David R.
Published: June 2018

Excellence in teamwork is an essential part of achieving high levels of performance in the delivery of healthcare and in the promotion of patient safety across a range of disciplines. There have been numerous efforts to promote adherence to guidelines and evidence-best practice. Advanced cardiac life support (ACLS) refers to a set of clinical interventions for several life-threatening conditions. Adherence to ACLS guidelines maximizes the probability of successful resuscitation and minimizes the long-term consequences for the patient. However, adherences rates to guidelines are known to be low despite quality guidelines and significant investment in training. Part of the problem has to do with the fact that most ACLS teams spontaneously assemble based on the availability of personnel at a given time on a hospitable floor, thus presenting formidable challenges for training as a team. The objective of this study was to produce a taxonomy of resuscitation team behaviors that impact adherence to the ACLS guidelines. Towards that end, the guidelines were translated into sets of rules to develop a means for measuring adherence and to investigate the role of team behaviors in guideline violations. The mean adherence to rules was highly variable, but comparatively low. We describe problems associated with adherence to CPR rules, ventilation and medication administration. Specifically, rule violations could be explained by behaviors such as misplaced attention, lack of sensitivity to temporal constraints, lapses in communication and failed execution of a subtask. Some of these behaviors are arguably the product of individual skills and others reflect a lack of cohesiveness, leadership and situation awareness in the spontaneously assembled teams. The specific implications for training are explored.
Cardiac Arrhythmia Simulations for Comparing Remote Telemetry Monitoring Systems
Authors: Segall Noa , Franklin Ron’Nisha , Wright Melanie C.
Published: June 2018

To increase the potential for timely detection of cardiac events, hospitalized patients who are at risk for critical arrhythmias are put on telemetry to continuously monitor their heart rhythm. However, telemetry monitoring systems vary widely between hospitals, there are few guidelines for decisions regarding optimal practices, and few studies have compared the efficiency of different monitoring systems. Our goal was to determine the impact of different monitoring systems on the time to detect and respond to critical cardiac events. To this end, we compared the process of communicating a critical alarm to the patient’s nurse in 2 hospitals with different monitoring systems, to determine the most efficient system. We conducted in situ unannounced simulations of cardiac arrest in the 2 hospitals to measure the response times of monitor watchers and patient care unit staff. As expected, we found response times to be shorter in the hospital that had a more direct method for monitor watchers to contact patients’ nurses. In addition to the method for communicating arrhythmias, there are many other differences between the monitoring systems in the 2 hospitals that could also have affected response times. We are using discrete event simulation to develop computer simulation models of the hospitals that will allow us to take multiple factors into account when comparing them.
Order effect when comparing usability of two telehealth remote monitoring technology solutions
Authors: Leinonen Juuso , Sparnon Erin , Tremoulet Patrice
Published: June 2018

An experienced healthcare device evaluator collaborated with a human factors scientist to develop and conduct a usability test of two different telehealth remote monitoring solutions as part of a larger technology evaluation. Twenty-one participants used each of the telehealth platforms to capture and transmit data. Typically users of telehealth platforms capture and send their own data, however, we asked our participants to place a bag of sand on wirelessly connected scales to capture weight information and to place the wireless pulse oximeters on the healthcare device evaluator’s index finger to get blood oxygen saturation measurements. This protocol enabled participants to go through the processes required to capture and share representative data without providing any of their own personal health data. After using each solution to complete the same series of three tasks, participants filled out the System Usability Scale (SUS) questionnaire. We intended to compare SUS scores within-subjects, but discovered that the SUS scores for the second solution were not independent. In particular, the participants who used the system that was harder to use second produced SUS scores for that system that were significantly lower than the participants who rated that system first. We conclude that it may not be appropriate to use a within-subjects design if experimenters plan to compare the SUS scores for different systems.
Investigating the HbA1c Assessment Methods for a Smart and Connected Diabetes System
Authors: Gutierrez Alexa , Sasangohar Farzan , Lawley Mark , Nobari Elnaz Salehzadeh , Qaraqe Khalid , Petrovski Goran , Abdul-Ghani
Published: June 2018

Texas A&M University at Qatar has partnered with two local Qatari hospitals, Hamad Hospital and Sidra Hospital, to design an insulin pump that will transfer patients’ data to an online server in real time. HbA1c is one of the most common forms of measurement for diagnosing diabetes. The fact that there are variations of the formula to be found was considered unusual. This poster is intended to evaluate different methods of calculating A1c and propose improvements. Using a mixed method including literature review and stakeholder interviews we document the challenges involved in utilizing the new assessment in an innovative testbed.
Home Use Devices and SaMDs in Patient Self-Care: Concept to Develop Excellenct Products in Digital Health
Authors: Rasche Peter , Barton Laura , Schäfer Katharina , Theis Sabine , Bröhl Christina , Wille Matthias , Mertens Alexander
Published: June 2018

The German healthcare system is characterized by digital change. In recent years, a trend towards the entry of start-ups and medium-sized enterprises into this sector has developed. These types of companies in particular are facing enormous challenges due to the industry and the ongoing digital change. This article presents the fundamental developments and challenges of these companies. Further solutions developed by the Tech4Age research group are presented briefly. Finally, this article describes how these solutions can be integrated into a formal concept for the promotion and further development of SMEs and start-ups in the German health industry in order to enable them quickly and comprehensively for the development of excellent digital health products.
The Patient in Patient Safety: Starting the Conversation
Authors: Papautsky Elizabeth Lerner , Holden Richard J. , Valdez Rupa S. , Belden Jeffery , Karavite Dean , Marquard Jenna , Mickelson Robin , Muthu Naveen
Published: June 2018

Through a variety of activities, patients take active roles in their health, which may directly or indirectly influence safety and quality. We provide brief overviews of perspectives from researchers and practitioners conducting work on patient-centered topics to highlight the need for awareness and research on the role of the patient and informal caregiver in patient safety.
A Mixed Methods Approach to Tailoring Evidence-Based Guidance for Antibiotic Stewardship to One Medical System
Authors: Patterson Emily S. , Dewart Courtney M. , Stevenson Kurt , Mbodj Awa , Lustberg Mark , Hade Erinn M. , Hebert Courtney
Published: June 2018

Our objective is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. Clinical decision support tools are a promising technology for providing evidence-based guidance that incorporates data about patients from electronic health records. Nevertheless, congruence with policies and procedures and local experts’ opinions, as well as taking into account local resistance data for the medical center’s patient population, is needed when selecting and ordering the antibiotic medication options provided by pWISCA. This paper presents findings from applying a mixed methods approach to identify and prioritize antibiotic medications and associated contextual data to display in a CDS tailored to the local hospital. We discuss implications of these findings.
Objective Pain Measurement based on Physiological Signals
Authors: Lin Yingzi , Wang Li , Xiao Yan , Urman Richard D. , Dutton Richard , Ramsay Michael
Published: June 2018

In an attempt to understand human physiological signals when an individual is subjected to pain, we set up a tonic pain experiment in a laboratory setting. The subjects’ physiological signals were recorded, timestamped, and compared to an initial 30 second baseline measurement. Subjects were also asked to verbally state their level of pain based on a visual analog scale in order to compare reported pain levels with physiological signals. The physiological signals measured were: Electroencephalography (EEG), Pupillary Unrest Under Ambient Light (PUAL), Skin Conductance (SC), Electromyography (EMG), Respiration Rate (RR), Blood Volume Pulse (BVP), Skin Temperature (ST), Blood Pressure (BP), and Facial Expression (FE). ANOVA and frequency domain analyses were conducted on the data in order to determine whether there was a significant difference between the ‘pain’ and ‘no pain’ (baseline) states of an individual. Based on our results, skin conductance, PUAL, facial expression, and EEG signals were theorized to be good signals for the classification of tonic pain, or any pain applied directly to an individual.
Increasing the Use of Evidence Based Practices in Stroke Rehabilitation
Authors: Laffoon Joseph M. , Nathan-Roberts Dan
Published: June 2018

This paper examines stroke rehabilitation as performed by healthcare professionals and the possibility for an improved rate of patient recovery through an “instructional document” that would be attached to research findings. Current practices as well as reported barriers are examined and presented. There is a disconnect between current practices and the most effective treatments or evidence based practices. After exploration and noting that research papers have limitations when used as instructions, this paper points towards solutions. The possibility of adding an instructional document, in line with current Human Factors principles, to stroke rehabilitation research is ultimately explored as way of increasing the use of evidence based practices and thus improve patient outcome.
Coherent Coding of Enhanced Interaural Cues Improves Sound Localization in Noise With Bilateral Cochlear Implants
Authors: Williges Ben , Jürgens Tim , Hu Hongmei , Dietz Mathias
Published: June 2018

Bilateral cochlear implant (BCI) users only have very limited spatial hearing abilities. Speech coding strategies transmit interaural level differences (ILDs) but in a distorted manner. Interaural time difference (ITD) information transmission is even more limited. With these cues, most BCI users can coarsely localize a single source in quiet, but performance quickly declines in the presence of other sound. This proof-of-concept study presents a novel signal processing algorithm specific for BCIs, with the aim to improve sound localization in noise. The core part of the BCI algorithm duplicates a monophonic electrode pulse pattern and applies quasistationary natural or artificial ITDs or ILDs based on the estimated direction of the dominant source. Three experiments were conducted to evaluate different algorithm variants: Experiment 1 tested if ITD transmission alone enables BCI subjects to lateralize speech. Results showed that six out of nine BCI subjects were able to lateralize intelligible speech in quiet solely based on ITDs. Experiments 2 and 3 assessed azimuthal angle discrimination in noise with natural or modified ILDs and ITDs. Angle discrimination for frontal locations was possible with all variants, including the pure ITD case, but for lateral reference angles, it was only possible with a linearized ILD mapping. Speech intelligibility in noise, limitations, and challenges of this interaural cue transmission approach are discussed alongside suggestions for modifying and further improving the BCI algorithm.
Decision-making under Risk: Evidence from the Hindi Movie Industry
Authors: Ghosh Soham , Paul Abhishek , Sharma Megha , Basu Sumanta
Published: June 2018

Despite being the largest producer of movies in the world, Bollywood—the Hindi movie industry—is underresearched. In this article, we first identify the factors that make this industry unique in such a way that research conducted in the context of any other film industry may not be applicable in Bollywood. Using a mix of primary and secondary data, we provide insights into the relationship between various input and output variables. We also identify the major determinants of the satellite right price of a movie and statistically show why the current determinants are far from optimal. We also propose better factors for determining the satellite right price.
A multi-site mechanism model for studying Pb and Cu retention from aqueous solutions by Fe-Mg-rich clays
Authors: Kypritidou Z. , Argyraki A.
Published: June 2018

The retention mechanisms of metal ions during interaction of clay with metal-rich aqueous solutions is usually investigated by sorption isotherms. Although classical isotherm models may provide sufficient information about the characteristics of the solid–liquid system, they do not distinguish among the various retention mechanisms. This study presents a methodological approach of combining batch experiment data and geochemical modelling for the characterization of the interaction of Mg-Fe-rich clay materials with monometallic solutions of Pb and Cu. For this purpose, a palygorskite clay (PCM), an Fe-smectite clay (SCM) and a natural palygorskite-Fe-smectite mixed clay (MCM) were assessed for their effectiveness as metal ion sorbents. The sorption capacity of the materials follows the order MCM > SCM > PCM and ranges between 27.6–52.1 mg g–1for Pb and 7.7–17.6 mg g–1for Cu. Based on the experimental results that allowed the speciation calculations, fitting of sorption isotherms and the investigation of relationships between protons, Mg and the metals studied we suggest that a combination of sorption mechanisms occurs during the interaction of clay materials with metal solutions. These involve surface complexation, ion exchange and precipitation of solid compounds onto the solid surface. A three-term isotherm model was employed to quantify the role of each of the above mechanisms in the overall retention process. The superior performance of mixed clay among the materials tested is attributed to the synergetic effect of exchange in the interlayer and specific sorption on the clay edges.
The occurrence of a titanium dioxide/silica white pigment on wooden Andean qeros: a cultural and chronological marker
Authors: Howe Ellen , Kaplan Emily , Newman Richard , Frantz James H. , Pearlstein Ellen , Levinson Judith , Madden Odile
Published: June 2018

A white pigment found on a sub-set of polychromed wooden Andean ritual drinking cups called qeros has been characterized by X-ray diffraction, X-ray fluorescence spectroscopy and Raman spectroscopy as consisting principally of cristobalite (SiO2), anatase (TiO2), and α-quartz (SiO2). This unexpected assemblage of minerals is like that reportedly found in an exposed titanium ore body in southern Peru, an area once part of the Inka Empire. The ore is a close match in color and composition to the white pigment found on the qeros and offers a possible candidate for the geological source of this material. The temporal horizon for the use of this pigment appears to be ca. 1532–1570, correlating with what we refer to here as the Transitional Inka/Early Colonial period, although production of polychromed qeros may have begun before this time and certainly continued well into the eighteenth century or later. Not long after the arrival of the Spanish, this titanium dioxide/silica pigment was replaced by lead white, a result of Spanish influence. We suggest that white pigments on qeros offer material evidence for establishing a chronology for these ritual vessels and that the titanium dioxide/silica pigment on this group of qeros constitutes a previously unidentified, naturally occurring white pigment indigenous to the southern Andes, the first use of which probably dates to the Pre-Columbian period.
Variance-based model interpolation for improved full-waveform inversion in the presence of salt bodies
Authors: Ovcharenko Oleg , Kazei Vladimir , Peter Daniel , Alkhalifah Tariq
Published: June 2018

When present in the subsurface, salt bodies impact the complexity of wave-equation-based seismic imaging techniques, such as least-squares reverse time migration and full-waveform inversion (FWI). Typically, the Born approximation used in every iteration of least-squares-based inversions is incapable of handling the sharp, high-contrast boundaries of salt bodies. We have developed a variance-based method for reconstruction of velocity models to resolve the imaging and inversion issues caused by salt bodies. Our main idea lies in retrieving useful information from independent updates corresponding to FWI at different frequencies. After several FWI iterations, we compare the model updates by considering the variance distribution between them to identify locations most prone to cycle skipping. We interpolate velocities from the surrounding environment into these high-variance areas. This approach allows the model to gradually improve from identifying easily resolvable areas and extrapolating the model updates from those to the areas that are difficult to resolve at early FWI iterations. In numerical tests, our method demonstrates the ability to obtain convergent FWI results at higher frequencies.
Embedded boundary methods for modeling 3D finite-difference Laplace-Fourier domain acoustic-wave equation with free-surface topography
Authors: AlSalem Hussain , Petrov Petr , Newman Gregory , Rector James
Published: June 2018

We have developed embedded boundary methods to handle arbitrarily shaped topography to accurately simulate acoustic seismic wave propagation in the Laplace-Fourier domain. The purpose is to use this method to enhance accurate wave simulation near the surface. Unlike most existing methods such as the ones using curvilinear grids to fit irregular surface topography, we use a regular Cartesian grid system without suffering from the staircasing error that occurs in conventional implementations. In this improved embedded-boundary method, we use the method of images, by imposing ghost nodes above the surface and approximating their acoustic pressures using linear extrapolation, quadratic interpolation, or cubic interpolation, to account for an arbitrarily curved surface. Implementing this method instead of using curvilinear grids near the boundaries greatly reduces the complexity of preprocessing procedures and the computational cost. Furthermore, using numerical examples, we found the accuracy gain and performance of our embedded-boundary methods in comparison with conventional finite-difference implementation of the problem.
Fluid saturation evolution with imbibition in unconventional natural gas reservoirs
Authors: Meng Mianmo , Ge Hongkui , Shen Yinghao , Ji Wenming , Ren Fei
Published: June 2018

Hydraulic fracturing plays an important role in developing unconventional natural gas. The large amount of fracturing fluid retention becomes a significant phenomenon in gas fields. Much research has been carried out to explain this mechanism. Imbibition is regarded as one of the important factors and has been investigated extensively. However, the saturation evolution of different types of fluids (liquid, free gas, and trapped gas) has been less researched during imbibition. A porosity experiment combined with an imbibition experiment was conducted to research the fluids-saturation evolution. There are three types of experimental rocks: tight sand, volcanic rock, and shale. The free-gas saturation decreases with the increasing liquid saturation in all samples. However, the sum of these two types of saturation is approximately 100% during imbibition in tight sand. This indicates that the pore space is almost totally filled by liquid and free gas. The sum of these two types of saturation is less than 100% during imbibition in volcanic rock. This indicates that there is trapped gas by liquid. Trapped-gas saturation increases at the early period and decreases at the late period. The sum of these two types of saturation greatly exceeds 100% during imbibition and increases with the imbibition time in shale rocks. This means that there is large amount of extra imbibition liquid. At the same time, the free-gas saturation fluctuates with the increasing liquid saturation. Based on the above results, it can be concluded that tight sand reservoirs have nearly no trapped gas and extra imbibition liquid, volcanic reservoirs have trapped gas and a little extra imbibition liquid, and shale reservoirs have some trapped gas and a large amount of extra imbibition liquid. This research contributes to understanding the fluid saturation evolution during hydraulic fracturing in unconventional natural gas reservoirs.
Digital Health for Geriatric Oncology
Authors: Fallahzadeh Ramin , Rokni Seyed Ali , Ghasemzadeh Hassan , Soto-Perez-de-Celis Enrique , Shahrokni Armin
Published: June 2018

In this review, we describe state-of-the-art digital health solutions for geriatric oncology and explore the potential application of emerging remote health-monitoring technologies in the context of cancer care. We also discuss the benefits and motivations behind adopting technology for symptom monitoring of older adults with cancer. We provide an overview of common symptoms and of the digital solutions–designed remote symptom assessment. We describe state-of-the-art systems for this purpose and highlight the limitations and challenges for the full-scale adoption of such solutions in geriatric oncology. With rapid advances in Internet-of-things technologies, many remote assessment systems have been developed in recent years. Despite showing potential in several health care domains and reliable functionality, few of these solutions have been designed for or tested in older patients with cancer. As a result, the geriatric oncology community lacks a consensus understanding of a possible correlation between remote digital assessments and health-related outcomes. Although the recent development of digital health solutions has been shown to be reliable and effective in many health-related applications, there exists an unmet need for development of systems and clinical trials specifically designed for remote cancer management of older adults with cancer, including developing advanced remote technologies for cancer-related symptom assessment and psychological behavior monitoring at home and developing outcome-oriented study protocols for accurate evaluation of existing or emerging systems. We conclude that perhaps the clearest path to future large-scale use of remote digital health technologies in cancer research is designing and conducting collaborative studies involving computer scientists, oncologists, and patient advocates.
Technology Applications: Use of Digital Health Technology to Enable Drug Development
Authors: Liu Joyce F. , Lee Jung-min , Strock Ellie , Phillips Ruth , Mari Karine , Killiam Bill , Bonam Matthew , Milenkova Tsveta , Kohn Elise C. , Ivy S. Percy
Published: June 2018

Purpose

This pilot study developed and evaluated the feasibility, usability, and perceived satisfaction with an end-user mobile medical application and provider web portal. The two interfaces allowed for remote monitoring, provided daily guidance in the management of hypertension and diarrhea, and allowed for rapid management of adverse events during a clinical trial of olaparib and cediranib.

Patients and Methods

eCO (eCediranib/Olaparib) was designed for patient self-reported, real-time management of hypertension and diarrhea using remote monitoring. eCO links to a Bluetooth-enabled blood pressure (BP) monitor and transmits data to a secure provider web portal. eCO use was assessed for suitability, usability, and satisfaction after 4 weeks using a 17-item questionnaire. Metrics regarding patient-reported BP and diarrhea events were analyzed.

Results

Sixteen patients enrolled in the pilot. A total of 98.2% of expected BP values were reported: 94.2% via Bluetooth and 5.8% entered manually. Twelve patients experienced 21 BP events (systolic BP > 140 and/or diastolic BP > 90 mmHg on two consecutive readings); data from cycle 1 were comparable to the study database. Thirteen patients reported diarrhea (more than one stool per 24 hours over baseline) categorized as grade 1 or 2, which was comparable to the study database. Survey analysis showed that patients had statistically significant, positive responses to the use of the eCO application. Patients indicated eCO use made them feel more involved in their care and better connected to their health care team. The only aspect of the application that did not show a statistically significant positive response was the process of reporting diarrhea.

Conclusion

The eCO application was designed to assist in managing acute treatment-related events most often associated with treatment discontinuation, need for drug holidays, or dose interruption. Hypertension and diarrhea events reported via eCO allowed rapid provider response and a positive overall patient experience.
Clinical Integration of Digital Solutions in Health Care: An Overview of the Current Landscape of Digital Technologies in Cancer Care
Authors: Garg Shivank , Williams Noelle L. , Ip Andrew , Dicker Adam P.
Published: June 2018

Digital health constitutes a merger of both software and hardware technology with health care delivery and management, and encompasses a number of domains, from wearable devices to artificial intelligence, each associated with widely disparate interaction and data collection models. In this review, we focus on the landscape of the current integration of digital health technology in cancer care by subdividing digital health technologies into the following sections: connected devices, digital patient information collection, telehealth, and digital assistants. In these sections, we give an overview of the potential clinical impact of such technologies as they pertain to key domains, including patient education, patient outcomes, quality of life, and health care value. We performed a search of PubMed ( www.ncbi.nlm.nih.gov/pubmed ) and www.ClinicalTrials.gov for numerous terms related to digital health technologies, including digital health, connected devices, smart devices, wearables, activity trackers, connected sensors, remote monitoring, electronic surveys, electronic patient-reported outcomes, telehealth, telemedicine, artificial intelligence, chatbot, and digital assistants. The terms health care and cancer were appended to the previously mentioned terms to filter results for cancer-specific applications. From these results, studies were included that exemplified use of the various domains of digital health technologies in oncologic care. Digital health encompasses the integration of a vast array of technologies with health care, each associated with varied methods of data collection and information flow. Integration of these technologies into clinical practice has seen applications throughout the spectrum of care, including cancer screening, on-treatment patient management, acute post-treatment follow-up, and survivorship. Implementation of these systems may serve to reduce costs and workflow inefficiencies, as well as to improve overall health care value, patient outcomes, and quality of life.
Minimally Invasive Real-Time Detection of Actionable Mutations in Patients With Metastatic Solid Tumors Using Fine-Needle and Liquid Biopsies
Authors: Aung Kyaw L. , Bedard Philippe L. , Yu Celeste , Boerner Scott L. , Zuzarte Philip C. , Ghai Sangeet , Berman Hal K. , Serra Stefano , Giesler Amanda , Ahmed Lailah , Joshua Anthony M. , Moore Malcolm J. , Oza Amit M. , Amir Eitan , McPherson John D. , Zhang Tong , Sukhai Mahadeo A. , Stockley Tracy L. , Kamel-Reid Suzanne , Siu Lillian L. , Hansen Aaron R.
Published: June 2018

Purpose

Fine-needle biopsy (FNB) and liquid biopsy are minimally invasive methods of tumor sampling that provide feasible means to assess tumor genotypes in real time. However, more data are needed to establish the strength of these methods by benchmarking against the current gold standard methods, core-needle biopsy (CNB) or surgical excision of the tumor.

Patients and Methods

Eligible patients with advanced solid tumors were prospectively recruited. We performed mutation profiling using matched tumor DNA obtained by CNB, FNB and liquid biopsy, and matrix-assisted laser desorption/ionization time-of-flight custom mass-spectrometry or targeted next-generation DNA sequencing. The actionability of detected mutations was determined using the OncoKB Web tool. Agreement between mutations detected in CNBs, FNBs, and circulating tumor DNA (ctDNA) was examined.

Results

Forty-one patients underwent tumor biopsy. Thirty CNBs (73%) and 34 FNBs (83%) had sufficient tumor and DNA for mutation profiling. Median DNA yield from CNB and FNB were 775 ng (interquartile range, 240 to 347 4ng) and 649 ng (interquartile range, 180 to1350 ng), respectively. Of 29 CNB/FNB pairs available for comparison, actionable mutation results were concordant in 28 (96%). Six of nine actionable mutations (67%) that were found by CNB, FNB, or both were detectable in ctDNA. Two additional actionable mutations were found exclusively in ctDNA.

Conclusion

Optimally processed FNB and liquid biopsy can be used routinely for tumor mutation profiling to identify actionable mutations.
Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient—When Blood Is Not an Option
Authors: Tan Gee Mei , Guinn Nicole R. , Frank Steven M. , Shander Aryeh
Published: June 2018

Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients’ beliefs and ensuring their safety.