Increasing the Capacity of Primary Care Through Enabling Technology.

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow

Point-of-care testing for disasters: needs assessment, strategic planning, and future design.

Objective evidence-based national surveys serve as a first step in identifying suitable point-of-care device designs, effective test clusters, and environmental operating conditions. Preliminary survey results show the need for point-of-care testing (POCT) devices using test clusters that specifically detect pathogens found in disaster scenarios. Hurricane Katrina, the tsunami in southeast Asia, and the current influenza pandemic (H1N1, "swine flu") vividly illustrate lack of national and global preparedness. Gap analysis of current POCT devices versus survey results reveals how POCT needs can be fulfilled. Future thinking will help avoid the worst consequences of disasters on the horizon, such as extensively drug-resistant tuberculosis and pandemic influenzas. A global effort must be made to improve POC technologies to rapidly diagnose and treat patients to improve triaging, on-site decision making, and, ultimately, economic and medical outcomes

Preoperative Skin Conditioning: Extracellular Matrix Clearance and Skin Bed Preparation, A New Paradigm.

This paper introduces the concept of "skin bed preparation" prior to surgical procedures. Following the theory of chronic wound bed preparation and adapting the skin model to one of chronic wound changes related to extrinsic and intrinsic factors, a topical formulation aimed at recycling the extracellular matrix (ECM) from accumulated waste products is evaluated and discussed. The clearance of these products and stimulation of new replacements has the potential to change the regenerative milieu of the skin so that when procedures are carried out, cellular signaling and cross-talk at the dermal level are improved and healing is optimized. By introducing a combination of peptides and other synergistic active agents, a sequence of clearance, regeneration, and remodeling is initiated. This is confirmed and validated by a series of biopsies and clinical studies that demonstrate changes in the ECM as early as 2 to 3 weeks after application. Clinical studies related to resurfacing procedures show accelerated healing and improved symptomatic relief compared with standard of care by preconditioning the skin 2 weeks prior to the procedure. A similar approach is suggested as a potential advantage for invasive surgical procedures based on similar scientific principles elucidated on in the text

Submillimeter local oscillators for spaceborne heterodyne applications

Existing and prospective submillimeter local oscillator technologies are surveyed and compared with respect to criteria of suitability for application in spaceborne submillimeter heterodyne receivers as those proposed for the Large Deployable Reflector (LDR). Solid-state and plasma devices are considered in terms of fundamental limitations

Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities

CAS-CNN: A Deep Convolutional Neural Network for Image Compression Artifact Suppression

Lossy image compression algorithms are pervasively used to reduce the size of images transmitted over the web and recorded on data storage media. However, we pay for their high compression rate with visual artifacts degrading the user experience. Deep convolutional neural networks have become a widespread tool to address high-level computer vision tasks very successfully. Recently, they have found their way into the areas of low-level computer vision and image processing to solve regression problems mostly with relatively shallow networks. We present a novel 12-layer deep convolutional network for image compression artifact suppression with hierarchical skip connections and a multi-scale loss function. We achieve a boost of up to 1.79 dB in PSNR over ordinary JPEG and an improvement of up to 0.36 dB over the best previous ConvNet result. We show that a network trained for a specific quality factor (QF) is resilient to the QF used to compress the input image - a single network trained for QF 60 provides a PSNR gain of more than 1.5 dB over the wide QF range from 40 to 76.Comment: 8 page

Meeting Global Cooling Demand with Photovoltaics during the 21st Century

Space conditioning, and cooling in particular, is a key factor in human productivity and well-being across the globe. During the 21st century, global cooling demand is expected to grow significantly due to the increase in wealth and population in sunny nations across the globe and the advance of global warming. The same locations that see high demand for cooling are also ideal for electricity generation via photovoltaics (PV). Despite the apparent synergy between cooling demand and PV generation, the potential of the cooling sector to sustain PV generation has not been assessed on a global scale. Here, we perform a global assessment of increased PV electricity adoption enabled by the residential cooling sector during the 21st century. Already today, utilizing PV production for cooling could facilitate an additional installed PV capacity of approximately 540 GW, more than the global PV capacity of today. Using established scenarios of population and income growth, as well as accounting for future global warming, we further project that the global residential cooling sector could sustain an added PV capacity between 20-200 GW each year for most of the 21st century, on par with the current global manufacturing capacity of 100 GW. Furthermore, we find that without storage, PV could directly power approximately 50% of cooling demand, and that this fraction is set to increase from 49% to 56% during the 21st century, as cooling demand grows in locations where PV and cooling have a higher synergy. With this geographic shift in demand, the potential of distributed storage also grows. We simulate that with a 1 m$^3$ water-based latent thermal storage per household, the fraction of cooling demand met with PV would increase from 55% to 70% during the century. These results show that the synergy between cooling and PV is notable and could significantly accelerate the growth of the global PV industry

Meeting Global Cooling Demand with Photovoltaics during the 21st Century

Space conditioning, and cooling in particular, is a key factor in human productivity and well-being across the globe. During the 21st century, global cooling demand is expected to grow significantly due to the increase in wealth and population in sunny nations across the globe and the advance of global warming. The same locations that see high demand for cooling are also ideal for electricity generation via photovoltaics (PV). Despite the apparent synergy between cooling demand and PV generation, the potential of the cooling sector to sustain PV generation has not been assessed on a global scale. Here, we perform a global assessment of increased PV electricity adoption enabled by the residential cooling sector during the 21st century. Already today, utilizing PV production for cooling could facilitate an additional installed PV capacity of approximately 540 GW, more than the global PV capacity of today. Using established scenarios of population and income growth, as well as accounting for future global warming, we further project that the global residential cooling sector could sustain an added PV capacity between 20-200 GW each year for most of the 21st century, on par with the current global manufacturing capacity of 100 GW. Furthermore, we find that without storage, PV could directly power approximately 50% of cooling demand, and that this fraction is set to increase from 49% to 56% during the 21st century, as cooling demand grows in locations where PV and cooling have a higher synergy. With this geographic shift in demand, the potential of distributed storage also grows. We simulate that with a 1 m$^3$ water-based latent thermal storage per household, the fraction of cooling demand met with PV would increase from 55% to 70% during the century. These results show that the synergy between cooling and PV is notable and could significantly accelerate the growth of the global PV industry