Assessment of Heart Failure Patients' Interest in Mobile Health Apps for Self-Care: Survey Study.

BackgroundHeart failure is a serious public health concern that afflicts millions of individuals in the United States. Development of behaviors that promote heart failure self-care may be imperative to reduce complications and avoid hospital re-admissions. Mobile health solutions, such as activity trackers and smartphone apps, could potentially help to promote self-care through remote tracking and issuing reminders.ObjectiveThe objective of this study was to ascertain heart failure patients' interest in a smartphone app to assist them in managing their treatment and symptoms and to determine factors that influence their interest in such an app.MethodsIn the clinic waiting room on the day of their outpatient clinic appointments, 50 heart failure patients participated in a self-administered survey. The survey comprised 139 questions from previously published, institutional review board-approved questionnaires. The survey measured patients' interest in and experience using technology as well as their function, heart failure symptoms, and heart failure self-care behaviors. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was among the 11 questionnaires and was used to measure the heart failure patients' health-related quality of life through patient-reported outcomes.ResultsParticipants were aged 64.5 years on average, 32% (16/50) of the participants were women, and 91% (41/45) of the participants were determined to be New York Heart Association Class II or higher. More than 60% (30/50) of the survey participants expressed interest in several potential features of a smartphone app designed for heart failure patients. Participant age correlated negatively with interest in tracking, tips, and reminders in multivariate regression analysis (P<.05). In contrast, MLHFQ scores (worse health status) produced positive correlations with these interests (P<.05).ConclusionsThe majority of heart failure patients showed interest in activity tracking, heart failure symptom management tips, and reminder features of a smartphone app. Desirable features and an understanding of factors that influence patient interest in a smartphone app for heart failure self-care may allow researchers to address common concerns and to develop apps that demonstrate the potential benefits of mobile technology

Bidirectional Representation Learning from Transformers using Multimodal Electronic Health Record Data to Predict Depression

Advancements in machine learning algorithms have had a beneficial impact on representation learning, classification, and prediction models built using electronic health record (EHR) data. Effort has been put both on increasing models' overall performance as well as improving their interpretability, particularly regarding the decision-making process. In this study, we present a temporal deep learning model to perform bidirectional representation learning on EHR sequences with a transformer architecture to predict future diagnosis of depression. This model is able to aggregate five heterogenous and high-dimensional data sources from the EHR and process them in a temporal manner for chronic disease prediction at various prediction windows. We applied the current trend of pretraining and fine-tuning on EHR data to outperform the current state-of-the-art in chronic disease prediction, and to demonstrate the underlying relation between EHR codes in the sequence. The model generated the highest increases of precision-recall area under the curve (PRAUC) from 0.70 to 0.76 in depression prediction compared to the best baseline model. Furthermore, the self-attention weights in each sequence quantitatively demonstrated the inner relationship between various codes, which improved the model's interpretability. These results demonstrate the model's ability to utilize heterogeneous EHR data to predict depression while achieving high accuracy and interpretability, which may facilitate constructing clinical decision support systems in the future for chronic disease screening and early detection.Comment: in IEEE Journal of Biomedical and Health Informatics (2021

The need for flexibility when negotiating professional boundaries in the context of homecare, dementia and end of life

Professional boundaries may help care staff to clarify their role, manage risk and safeguard vulnerable clients. Yet there is a scarcity of evidence on how professional boundaries are negotiated in a non-clinical environment (e.g. the home) by the home-care workforce in the context of complex care needs (e.g. dementia, end of-life care). Through analysis of semi-structured interviews, we investigated the experiences of home-care workers (N = 30) and their managers (N = 13) working for a range of home-care services in the South-East and London regions of England in 2016–17. Findings from this study indicate that home-care workers and their managers have clear perceptions of job role boundaries, yet these are modified in dementia care, particularly at end of life which routinely requires adaptability and flexibility. As a lone worker in a client’s home, there may be challenges relating to safeguarding and risk to both clients and workers. The working environment exacerbates this, particularly during end-of-life care where emotional attachments to both clients and their family may affect the maintenance of professional boundaries. There is a need to adopt context-specific, flexible and inclusive attitudes to professional boundaries, which reconceptualise these to include relational care and atypical workplace conventions. Pre-set boundaries which safeguard clients and workers through psychological contracts may help to alleviate to some extent the pressure of the emotional labour undertaken by home-care workers

Collapsible Pushdown Automata and Recursion Schemes

International audienceWe consider recursion schemes (not assumed to be homogeneously typed, and hence not necessarily safe) and use them as generators of (possibly infinite) ranked trees. A recursion scheme is essentially a finite typed {deterministic term} rewriting system that generates, when one applies the rewriting rules ad infinitum, an infinite tree, called its value tree. A fundamental question is to provide an equivalent description of the trees generated by recursion schemes by a class of machines. In this paper we answer this open question by introducing collapsible pushdown automata (CPDA), which are an extension of deterministic (higher-order) pushdown automata. A CPDA generates a tree as follows. One considers its transition graph, unfolds it and contracts its silent transitions, which leads to an infinite tree which is finally node labelled thanks to a map from the set of control states of the CPDA to a ranked alphabet. Our contribution is to prove that these two models, higher-order recursion schemes and collapsible pushdown automata, are equi-expressive for generating infinite ranked trees. This is achieved by giving an effective transformations in both directions

Chaos in Static Axisymmetric Spacetimes I : Vacuum Case

We study the motion of test particle in static axisymmetric vacuum spacetimes and discuss two criteria for strong chaos to occur: (1) a local instability measured by the Weyl curvature, and (2) a tangle of a homoclinic orbit, which is closely related to an unstable periodic orbit in general relativity. We analyze several static axisymmetric spacetimes and find that the first criterion is a sufficient condition for chaos, at least qualitatively. Although some test particles which do not satisfy the first criterion show chaotic behavior in some spacetimes, these can be accounted for the second criterion.Comment: More comments for the quantitative estimation of chaos are added, and some inappropriate terms are changed. This will appear on Class. Quant. Gra

Cosmic Ray Signatures of Multi-W Processes

We explore the discovery potential of cosmic ray physics experiments for Standard Model processes involving the nonperturbative production of O(30) weak gauge bosons. We demonstrate an experimental insensitivity to proton-induced processes and emphasize the importance of neutrino-induced processes. The Fly's Eye currently constrains the largest region of parameter space characterizing multi-W phenomena if a cosmic neutrino flux exists at levels suggested by recent models of active galactic nuclei. MACRO (DUMAND) can constrain or observe additional regions by searching for 1-100 (1-10) characteristic near-vertical (near-horizontal) spatially compact energetic muon bundles per year.Comment: 44 pages (LaTeX) + 19 PostScript figures in accompanying file (uuencoded), CERN-TH.6822/93,UCLA 93/TEP/2

Family Unification in Five and Six Dimensions

In family unification models, all three families of quarks and leptons are grouped together into an irreducible representation of a simple gauge group, thus unifying the Standard Model gauge symmetries and a gauged family symmetry. Large orthogonal groups, and the exceptional groups $E_7$ and $E_8$ have been much studied for family unification. The main theoretical difficulty of family unification is the existence of mirror families at the weak scale. It is shown here that family unification without mirror families can be realized in simple five-dimensional and six-dimensional orbifold models similar to those recently proposed for SU(5) and SO(10) grand unification. It is noted that a family unification group that survived to near the weak scale and whose coupling extrapolated to high scales unified with those of the Standard model would be evidence accessible in principle at low energy of the existence of small (Planckian or GUT-scale) extra dimensions.Comment: 13 pages, 2 figures, minor corrections, references adde

The role of undisclosed reserves in English open outcry auctions

This study considers the role that reserve prices may play in residential property auctions. In comparison to much of the previous empirical work, this study has access to undisclosed reserve prices from English auctions. Consistent with theoretical arguments in the auction literature, the results obtained illustrate that whilst higher reserve prices increase the revenue obtained for the seller, they also reduce the probability of sale. The findings also highlight the importance of auction participation, with the number of individual bidders and the number of bids significant in most specifications

Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth

We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10M scales significantly distinguished BPSD (N=160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p .05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0–5; PGBI-10M: 0–6) cut BPSD odds to 1/5 of those with high scores (CASI DLR− = 0.17; PGBI-10M DLR− = 0.18). High scores on either scale (CASI: 14+; PGBI-10M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs