Acceptability of a Novel Smartphone Application for Rhythm Evaluation in Patients with Atrial Fibrillation

Background: Investigators at UMass Medical School and WPI co-developed a novel smartphone application (app), PULSESMART, that detects atrial fibrillation (AF). AF is the world’s most common, serious heart rhythm problem. In its early stages, most cases of AF are paroxysmal (pAF), making them difficult to identify early in the course of disease. Long-term cardiac monitoring is frequently needed to diagnose and prevent complications from AF, such as stroke. Home monitoring for AF can be clinically impactful but existing technologies have cost or methodological limitations. Data are needed on the potential acceptability and usability of heart rhythm monitoring applications. Aim: Our aim was to examine patient acceptability of using a pAF detection app. Methods: 52 patients with pAF underwent rhythm assessment using the app and completed a standardized questionnaire. We looked specifically at responses to 3 questions: 1) how easy was it to use? 2) How important could it be for you? And 3) to what extent does it fit into your daily life? Results: The mean age was 68.5 years and 69% female. The majority of patients reported the app was easy to use (73%), could be important to them and their health (84%), and would fit into their daily lives (78%). Conclusions: After use of the pAF detection app, most patients reported positively. The results suggest that older persons with, or at risk for, pAF may benefit from smartphone-based arrhythmia detection platforms. Further work is needed to assess the feasibility of at-home or in-clinic app use

Monitoring Earth Pressure Balance Tunnels in Los Angeles

ABSTRACT: Tunneling using earth pressure balance (EPB) tunneling methods has been active in Los Angeles over the last seven years. Three recent large-diameter EPB tunnel projects have been completed to create approximately 32km (20 miles) of precast concrete lined tunnel excavated through alluvial soils and soft, sedimentary rock. This paper addresses monitoring of ground surface subsidence using data collected from geotechnical instrumentation and TBM performance parameters. TBM operating data are used in conjunction with surface-installed instrumentation to predict surface subsidence. TBM operations may then be adjusted to reduce potential settlementrelated damage to adjacent structures or utilities. Monitoring instruments using remote access is also addressed. The paper provides case histories of successful performance monitoring to support future urban tunneling projects

The Successful Aging After Elective Surgery Study: Cohort Description and Data Quality Procedures

Background/Objectives Delirium is the most common complication of major elective surgery in older patients. The Successful Aging after Elective Surgery (SAGES) study was designed to examine novel risk factors and long-term outcomes associated with delirium. This report describes the cohort, quality assurance procedures, and results. Design Long-term prospective cohort study. Setting Three academic medical centers. Participants A total of 566 patients age 70 and older without recognized dementia scheduled for elective major surgery. Measurements Participants were assessed preoperatively, daily during hospitalization, and at variable monthly intervals for up to 36 months post-discharge. Delirium was assessed in hospital by trained study staff. Study outcomes included cognitive and physical function. Novel risk factors for delirium were assessed including genetic and plasma biomarkers, neuroimaging markers, and cognitive reserve markers. Interrater reliability (kappa and weighted kappa) was assessed for key variables in 119 of the patient interviews. Results Participants were an average of 77 years old and 58% were female. The majority of patients (81%) were undergoing orthopedic surgery and 24% developed delirium post-operatively. Over 95% of eligible patients were followed for 18 months. There was >99% capture of key study outcomes (cognitive and functional status) at every study interview and interrater reliability was high (weighted kappas for delirium = 0.92 and for overall cognitive and functional outcomes = 0.94 -1.0). Completion rates for plasma biomarkers (4 timepoints) were 95%-99% and for neuroimaging (one year follow-up) was 86%. Conclusion The SAGES study will contribute to the understanding of novel risk factors, pathophysiology and long-term outcomes of delirium. This manuscript describes the cohort and data quality procedures, and will serve as a reference source for future studies based on SAGES

The Successful Aging After Elective Surgery Study: Cohort Description and Data Quality Procedures

Background/Objectives—Delirium is the most common complication of major elective surgery in older patients. The Successful Aging after Elective Surgery (SAGES) study was designed to examine novel risk factors and long-term outcomes associated with delirium. This report describes the cohort, quality assurance procedures, and results

Effect of preoperative pain and depressive symptoms on the risk of postoperative delirium: a prospective cohort study

Background Preoperative pain and depression predispose patients to delirium. We investigated whether pain and depressive symptoms interact to increase the risk of delirium.Methods We enrolled 459 people without dementia, who were aged 70 years or older and were scheduled for elective orthopaedic surgery between June, 2010, and August, 2013. At baseline, participants reported their current pain and the average and worst pain in the previous 7 days, on a scale of 0-10. Depressive symptoms before surgery were assessed with the 15-item geriatric depression scale and chart. Delirium after surgery was assessed with the confusion assessment method and chart. We used multivariable analysis to assess the relation between preoperative pain and postoperative delirium stratified by the presence of depressive symptoms.Findings Delirium was reported in 106 (23%) of patients, and was significantly more frequent in those with depressive symptoms at baseline than in those without (relative risk [RR] 1.6, 95% CI 1.2-2.3). Preoperative pain was associated with an increased adjusted risk of delirium across all pain measures (RR 1.07-1.08 per 1-point increase in pain). In stratified analyses, patients with depressive symptoms had a 21% increased risk of delirium for each 1-point increase in worst pain score, which indicated a significant interaction (p(interaction)=0.049). Similarly, a 13% increased risk of delirium was seen per 1-point increase in average pain score, but the interaction was not significant.Interpretation Preoperative pain and depressive symptoms are associated with increased risk of delirium, independently and with substantial interaction, which suggests a cumulative effect. These factors should be assessed before surgery