A smartphone application for reporting symptoms in adults with cystic fibrosis: Protocol of a randomised controlled trial

Introduction: In people with cystic fibrosis (CF), exacerbations have been shown to have profound and prolonged negative effects such as reducing physical activity and health-related quality of life, increasing the rate of decline of lung function and healthcare costs, and ultimately increasing the risk of mortality. Delayed initiation of treatment following the signs of an exacerbation has been shown to be associated with failure to recover to baseline. Therefore, the late identification and treatment of an exacerbation due to delayed presentation will potentially worsen short-term and long-term outcomes. We have developed a smartphone application, containing questions which require yes or no responses relating to symptoms suggestive of a respiratory exacerbation. Its use is intended to facilitate the early identification of symptoms suggestive of a respiratory exacerbation, and allow the CF team to initiate treatment sooner, thereby potentially reducing the risk of severe exacerbations which require intravenous antibiotics (IVAB) and often a hospital admission. Methods: We will undertake a randomised controlled trial. 60 adults with CF will be recruited and randomised to either the intervention or control group. The intervention group will use the smartphone application weekly for 12 months, or earlier than the next weekly reporting time if they feel their symptoms have worsened. The control group will continue to receive usual care, involving regular (approximately 3 monthly) CF outpatient clinic appointments. The primary outcome measure will be courses and days of IVAB. Ethics and dissemination: Approval was obtained from the Sir Charles Gairdner Group Human Research Ethics Committee for WA Health (2015-030) and Curtin University Human Research Ethics Committee (HR212/2015), and has been registered with the Australian and New Zealand Clinical Trials Registry. Results: of this study will be presented at international conferences and published in peer-reviewed journals in accordance with the Consolidated Standards of Reporting Trials statement. Trial registration number ACTRN12615000599572

Integrated cross-domain object storage in working memory: Evidence from a verbal-spatial memory task

Working-memory theories often include domain-specific verbal and visual stores (e.g., the phonological and visuospatial buffers of Baddeley, 1986), and some also posit more general stores thought to be capable of holding verbal or visuospatial materials (Baddeley, 2000; Cowan, 2005). However, it is currently unclear which type of store is primarily responsible for maintaining objects that include components from multiple domains. In these studies, a spatial array of letters was followed by a single probe identical to an item in the array or differing systematically in spatial location, letter identity, or their combination. Concurrent verbal rehearsal suppression impaired memory in each of these trial types in a task that required participants to remember verbal-spatial binding, but did not impair memory for spatial locations if the task did not require verbal-spatial binding for a correct response. Thus, spatial information might be stored differently when it must be bound to verbal information. This suggests that a cross-domain store such as the episodic buffer of Baddeley (2000) or the focus of attention of Cowan (2001) might be used for integrated object storage, rather than the maintenance of associations between features stored in separate domain-specific buffers

WoMMBAT: A user interface for hierarchical Bayesian estimation of working memory capacity

The change detection paradigm has become an important tool for researchers studying working memory. Change detection is especially useful for studying visual working memory, because recall paradigms are difficult to employ in the visual modality. Pashler (Perception & Psychophysics, 44, 369–378, 1988) and Cowan (Behavioral and Brain Sciences, 24, 87–114, 2001) suggested formulas for estimating working memory capacity from change detection data. Although these formulas have become widely used, Morey (Journal of Mathematical Psychology, 55, 8–24, 2011) showed that the formulas suffer from a number of issues, including inefficient use of information, bias, volatility, uninterpretable parameter estimates, and violation of ANOVA assumptions. Morey presented a hierarchical Bayesian extension of Pashler’s and Cowan’s basic models that mitigates these issues. Here, we present WoMMBAT (Working Memory Modeling using Bayesian Analysis Techniques) software for fitting Morey’s model to data. WoMMBAT has a graphical user interface, is freely available, and is cross-platform, running on Windows, Linux, and Mac operating systems

Clinical and molecular characterization of HER2 amplified-pancreatic cancer

<p>Background: Pancreatic cancer is one of the most lethal and molecularly diverse malignancies. Repurposing of therapeutics that target specific molecular mechanisms in different disease types offers potential for rapid improvements in outcome. Although HER2 amplification occurs in pancreatic cancer, it is inadequately characterized to exploit the potential of anti-HER2 therapies.</p> <p>Methods: HER2 amplification was detected and further analyzed using multiple genomic sequencing approaches. Standardized reference laboratory assays defined HER2 amplification in a large cohort of patients (n = 469) with pancreatic ductal adenocarcinoma (PDAC).</p> <p>Results: An amplified inversion event (1 MB) was identified at the HER2 locus in a patient with PDAC. Using standardized laboratory assays, we established diagnostic criteria for HER2 amplification in PDAC, and observed a prevalence of 2%. Clinically, HER2- amplified PDAC was characterized by a lack of liver metastases, and a preponderance of lung and brain metastases. Excluding breast and gastric cancer, the incidence of HER2-amplified cancers in the USA is >22,000 per annum.</p> <p>Conclusions: HER2 amplification occurs in 2% of PDAC, and has distinct features with implications for clinical practice. The molecular heterogeneity of PDAC implies that even an incidence of 2% represents an attractive target for anti-HER2 therapies, as options for PDAC are limited. Recruiting patients based on HER2 amplification, rather than organ of origin, could make trials of anti-HER2 therapies feasible in less common cancer types.</p&gt

Patient clinical documentation in telehealth environment: Are we collecting appropriate and sufficient information for best practice?

BACKGROUND: During the COVID-19 pandemic, the use of telehealth for patient visits grew rapidly and served an important role as a valuable and necessary resource. Although clinical documentation is critical for telehealth patient visits, there is limited information about how healthcare facilities manage telehealth patient visit documentation, technology used for telehealth visits, and challenges encountered with telehealth patient visit documentation. This study aimed to assess the use of telehealth during the pandemic, the quality of clinical documentation in telehealth practice and to identify challenges and issues encountered with telehealth patient visits in order to develop a strategy for best practices for telehealth documentation and data management. METHODS: Data were collected for this cross-sectional study in January-February 2021 via a self-designed survey of administrators/managers from physicians\u27 offices and mental health facilities. Survey questions included four categories: health organization demographic information; telehealth visits; clinical documentation for telehealth visit; and challenges and barriers related to telehealth documentation technology use. RESULTS: Of 76 respondents, more than half (62%) of the healthcare facilities started using telehealth for patient visits within one year of the onset of the COVID-19 pandemic, with 94% of respondents indicating an increased use of telehealth for patient visits since the pandemic. The most common types of telehealth patient care provided during the pandemic included pediatrics, primary care, cardiology, and women\u27s health. The most consistent data documentation of telehealth visits included: date of service, patient identification number, communication methods, patient informed consent, diagnosis and impression, evaluation results, and recommendations. The telehealth visit data was most commonly used for patient care and clinical practice, billing and reimbursement, quality improvement and patient satisfaction, and administrative planning. The top barriers to telehealth use by the healthcare professionals included patient challenges with telehealth services, such as inequities in quality of technology, lack of patient understanding, and lack of patient satisfaction; this was followed by frustration with constant updates of telehealth guidelines and procedures, understanding required telehealth documentation for reimbursement purposes, payer denial for telehealth visits, and legal and risk issues. CONCLUSIONS: Findings from this study can assist government entities, policymakers, and healthcare organizations in developing and advocating best practices in telehealth usage and clinical documentation improvement strategies

‘We achieve the impossible’: discourses of freedom and escape at music festivals and free parties

In this article, we explore the notion of freedom as a form of governance within contemporary consumer culture in a sphere where ‘freedom’ appears as a key component: outdoor music-based leisure events, notably music festivals and free parties. ‘Freedom’ is commodified as central to the marketing of many music festivals, which now form a highly commercialised sector of the UK leisure industry, subject to various regulatory restrictions. Free parties, in contrast, are unlicensed, mostly illegal and far less commercialised leisure spaces. We present data from two related studies to investigate how participants at three major British outdoor music festivals and a small rural free party scene draw on discourses of freedom, escape and regulation. We argue that major music festivals operate as temporary bounded spheres of ‘licensed transgression’, in which an apparent lack of regulation operates as a form of governance. In contrast, free parties appear to ‘achieve the impossible’ by creating alternative (and illegal) spaces in which both freedom and regulation are constituted in different ways compared to music festival settings

Regularity of Edge Ideals and Their Powers

We survey recent studies on the Castelnuovo-Mumford regularity of edge ideals of graphs and their powers. Our focus is on bounds and exact values of $\text{ reg } I(G)$ and the asymptotic linear function $\text{ reg } I(G)^q$, for $q \geq 1,$ in terms of combinatorial data of the given graph $G.$Comment: 31 pages, 15 figure

Nativity Differences in Stress among Asian and Pacific Islander American Women

According to the Stress Process Theory, people who are marginalized in society encounter more stress than those in more advantaged positions. Immigrants are one such marginalized group in the United States (US) who may experience greater psychological stress than their US-born counterparts due to (1) severing of social ties; (2) social disadvantage and marginalization; and (3) adaptation to a new environment. This study examines the disparity in stress by nativity, and how social factors contribute to this disparity for Asian and Pacific Islander (API) women. Data come from the Asian Community Health Initiative, which included a sample of 291 foreign-born and 155 US-born API women in the San Francisco Bay Area. Multivariable linear regression was used to estimate associations between nativity status and stress, measured using the Cohen Perceived Stress Scale, accounting for various social stressors. Foreign-born women had higher levels of stress compared to US-born. Stress was greater among women experiencing fewer socioeconomic resources, more discrimination, more acculturative stress, and low English proficiency. English proficiency accounted for much of the disparity in stress between foreign-born and US-born API women. This study contributes to our understanding of how stress among APIs is influenced by social disadvantage and marginalization in US society. Future research should further study how aspects of the immigrant experience are associated with stress among APIs over time