Device Worn Research Articles

Rationale and Evidence for Peripheral Nerve Stimulation for Treating Essential Tremor.

Background:There is growing recognition of peripheral stimulation techniques for controlling arm symptoms in essential tremor (ET). Recently, the FDA gave clearance to the Cala system, a device worn around the wrist to treat arm tremors. The Cala system stimulates the sensory afferents of the peripheral nerves with high-frequency pulses. These pulses are delivered to the median and radial nerves alternately at the tremor frequency of the individual patient.Methods:The PubMed database was searched using the terms (“Essential Tremor”[Mesh] OR “essential tremor” [Title/] OR “tremor” [Title/]) AND (“peripheral arm stimulation” [Title/] OR “Cala device” [Title/] OR “sensory afferent stimulation” [Title/] OR “afferent stimulation” [Title/] OR “arm stimulation” [Title/] OR “peripheral nerve stimulation” [Title/]).Results:The search yielded 54 articles. Many studies discussed the rationale and various strategies for peripheral modulation of tremor. While the Cala system was found to be safe and well-tolerated in ET, data on efficacy revealed mixed findings. In a large randomized, blinded trial (n = 77), the primary outcome evaluated with spiral drawing task did not improve but the secondary outcomes reflected by the arm tremor severity and the activities of the daily living score revealed 20–25% improvements. A subsequent trial (n = 323) found that the in-home use of the Cala device led to improvements of similar magnitude lasting for at least three months but the clinical assessments were open-labeled.Discussion:Peripheral stimulation techniques are promising therapeutic modalities for treating ET symptoms. Stimulation of sensory afferent nerve fibers at the wrist can potentially modulate the peripheral and central components of the tremor network. Although the Cala system is user-friendly, safe, and well-tolerated, the current clinical evidence on the efficacy is inconsistent and insufficient. Thus, more data is warranted for implementing peripheral nerve stimulation as a standard of care for ET.HighlightsThe current review discusses the rationale, background, and potential mechanisms for using peripheral arm stimulation devices for treating ET. The Cala system is a wrist-worn peripheral nerve stimulation device that received FDA clearance to treat arm tremors. The current review evaluates the evidence for the safety and efficacy of using the Cala system and similar devices in clinical practice.

95-OR: Impact of Flash Glucose Monitoring in People with Type 2 Diabetes Inadequately Controlled with Noninsulin Antihyperglycemic Therapy: IMMEDIATE study

Continuous glucose monitoring (CGM) has been shown to improve glycemic outcomes in people with diabetes using insulin therapies. In this multi-site, randomized trial, we studied adults with T2D inadequately controlled with non-insulin antihyperglycemic therapy to evaluate the impact of flash glucose monitoring (FGM) on glycemic and patient-reported outcomes. Participants received FGM + diabetes self-management education (DSME) or matched DSME alone for 16 weeks. Primary outcome was assessed by a blinded CGM device worn at baseline and at outcome. Among 116 participants enrolled (age 58.4 ± 10.1 years; T2D duration 10.1 ± 6.1 years; HbA1c 8.6 ± 1.1%) , the initial 82 completers (41 FGM + DSME, 41 DSME) showed time in range significantly greater in the FGM + DSME arm (76.1 ± 16.9%) compared to DSME arm (64.3 ± 23.2%) (p<0.01) . Time above range was similarly lower in the FGM + DSME arm (21.5 ± 17.8% vs. 31.3 ± 25.6%, p=0.03) . Hypoglycemia was rare in both arms. Glucose monitoring satisfaction scores improved in the FGM + DSME arm only (0.6 ± 0.5 vs. 0.0 ± 0.5, p<0.01) . Change in HbA1c was also greater in the FGM + DSME arm (-0.9 ± 0.9% vs. -0.5 ± 0.9%, p=0.03) . In this interim analysis, FGM users with T2D using non-insulin therapies had significantly greater time in range, satisfaction with glucose monitoring, and a greater reduction in HbA1c. Disclosure R.E.Brown: None. R.Aronson: Consultant; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Gilead Sciences, Inc., HTL Strefa, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; AstraZeneca, Bausch Health, Canada, Bayer AG, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Kowa Pharmaceuticals America, Inc., Medpace, Novo Nordisk, Sanofi, Tandem Diabetes Care, Inc., Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. Funding Abbott Diabetes Care, Inc.

Progressing to Objective Measures of Daily Mobility in Hospitalized Older Adults.

Accurate mobility assessment of hospitalized older adults is necessary to aid nurses in planning and providing appropriate mobility support; however, nurses cite lack of resources and time limitations as barriers. Accelerometry enables a detailed objective measurement of predominant hospital mobility activities in the older adult population, such as percent time sitting, and the sit-to-stand (STS) transition. The current exploratory study examined the use of a novel, unobtrusive accelerometry technique to obtain postural and STS metrics on 27 older adults during their hospital stay. Total device wear time in the hospital was 96.2%. Participants spent 60.3% time lying, 20.3% time sitting, 5.3% time standing, and 2% time stepping during hospitalization, and, on average, completed the STS transition 20 times (SD = 13) per 24-hour period. There were no participant complaints about wearing the device. Our exploratory study shows accelerometry provides automated, continuous data and may support accurate nursing assessment of patient mobility. [Journal of Gerontological Nursing, 48(5), 35-41.].

High-throughput screening of tribological properties of monolayer films using molecular dynamics and machine learning

Monolayer films have shown promise as a lubricating layer to reduce friction and wear of mechanical devices with separations on the nanoscale. These films have a vast design space with many tunable properties that can affect their tribological effectiveness. For example, terminal group chemistry, film composition, and backbone chemistry can all lead to films with significantly different tribological properties. This design space, however, is very difficult to explore without a combinatorial approach and an automatable, reproducible, and extensible workflow to screen for promising candidate films. Using the Molecular Simulation Design Framework (MoSDeF), a combinatorial screening study was performed to explore 9747 unique monolayer films (116964 total simulations) and a machine learning (ML) model using a random forest regressor, an ensemble learning technique, to explore the role of terminal group chemistry and its effect on tribological effectiveness. The most promising films were found to contain small terminal groups such as cyano and ethylene. The ML model was subsequently applied to screen terminal group candidates identified from the ChEMBL small molecule library. Approximately 193131 unique film candidates were screened with approximately a five order of magnitude speed-up in analysis compared to simulation alone. The ML model was thus able to be used as a predictive tool to greatly speed up the initial screening of promising candidate films for future simulation studies, suggesting that computational screening in combination with ML can greatly increase the throughput in combinatorial approaches to generate in silico data and then train ML models in a controlled, self-consistent fashion.

Efficacy and safety of tumor-treating fields in recurrent glioblastoma: a systematic review and meta-analysis.

Tumor-treating fields (TTF) is a novel cancer treatment that uses alternating electric fields to interfere with tumor cell mitosis. It has been approved by the U.S. food and drug administration for the treatment of recurrent glioblastoma (rGBM). We designed this meta-analysis to evaluate the efficacy and safety of TTF in the treatment of rGBM. The study was based on the PRISMA guideline. Systematic retrieval was performed in PubMed, Cochrane Library, and Embase databases. The outcomes were overall survival (OS) hazard ratio (HR), 1-year survival rate, and cutaneous toxicity. These studies included a total of 1048 rGBM patients who received TTF treatment. The overall survival time between the TTF group and the control group was HR 0.75 ([95%CI 0.63 to 0.89]; P = 0.001). Pooled 1-year overall survival rate and incidence of cutaneous toxicity were 0.47 and 0.48, respectively. Data were insufficient to evaluate the effect of MGMT methylation status and tumor recurrence times on heterogeneity. TTF therapy is effective for recurrent glioblastoma. However, most relevant trials should assess rGBM patient baseline characteristics such as age, KPS, MGMT methylation status, and number of tumor recurrence,. In addition, the risk of rashes caused by long-term wearing of devices should also be considered.

Reducing Friction in Orthodontic Brackets: A Matter of Material or Type of Ligation Selection? In-Vitro Comparative Study.

(1) Background: Orthodontic appliances have changed and improved with the increasing demand for orthodontic treatment of the general population. Patients desire for shorter orthodontic treatments and for the wearing of more aesthetic devices has led to the technological development of orthodontic brackets; these were manufactured from aesthetic materials (ceramics, composite polymers) and presented different designs regarding the way archwires are ligated to the bracket. The aim of this study was to determine whether there were any differences between the static frictional forces generated by stainless steel (metallic) and polycrystalline alumina (ceramics) conventional and self-ligating brackets. (2) Methods: Static friction assessment was carried out in vitro with a universal testing machine, HV-500N-S (Schmidt Control Instruments, Hans Schmidt & Co. GmbH), intended for measuring compression and traction forces. (3) Results: The study revealed significant differences in static frictional forces at the bracket-archwire interface between the tested brackets. Stainless steel brackets produced lower static friction forces than polycrystalline alumina and self-ligating brackets generally produced lower static frictional forces than conventional brackets. The reduction of frictional forces was noticeable in the first stages of treatment, when thin, flexible orthodontic archwires (0.016” NiTi) are used. Engaged with large rectangular stainless steel archwires, (0.019 × 0.025” SS), the frictional forces produced by conventional and self-ligating metal brackets were similar, no significant differences being observed between the two types of metallic design. However, in the case of tested ceramic brackets, the results showed that the self-ligating type allows a reduction in frictional forces even in advanced stages of treatment compared to conventionally ligation. (4) Conclusions: From the perspective of an orthodontic system with low frictional forces, metal brackets are preferable to aesthetic ones, and self-ligating ceramic brackets are preferable to conventional ceramic brackets.

Objective Measures of Physical Activity in Rural Communities: Factors Associated With a Valid Wear and Lessons Learned.

Compared with urban/suburban counterparts, rural communities experience lower rates of physical activity (PA) and higher rates of chronic disease. Promoting PA is important for disease prevention but requires reliable and valid measurement of PA. However, little is known about effectively collecting objective PA data in rural communities. Using data from a cluster randomized trial (Heartland Moves), which aims to increase PA in rural Missouri, this study explored factors associated with successful objective PA data collection and presents lessons learned. Baseline survey and accelerometry data were collected through Heartland Moves (n = 368) from August 2019 to February 2021, in southeast Missouri. Chi-square and logistic regression analyses were used to explore factors (demographics, subjective PA, and SMS reminders) associated with valid wear of PA devices. Overall, 77% had valid wears. Participants who were not married (odds ratio [OR] 0.48, 95% confidence interval [CI], 0.30-0.79) and those living alone (OR 0.49, 95% CI, 0.30-0.81) were less likely to have valid wears. Participants who met PA guidelines (OR 1.69, 95% CI, 1.03-2.75) or received SMS reminders (OR 3.25; 95% CI, 1.97-5.38) were more likely to have valid wears. Results are supported by lessons learned, including importance of communication (SMS reminders), accessing hard-to-reach groups (living alone), and need to adapt during data collection.

More or less? Improving monocular head mounted display assisted visual search by reducing guidance precision

ObjectiveTo test six different methods of directing a user's attention in a peripheral head mounted display assisted visual search task. BackgroundEach time a user needs to shift their attention between virtual information and their environment has a cost. The faster a user can process a guiding cue and the fewer times they need to return to it, the more efficient that cue will be at directing a user's attention. The most effective method, creating a visual effect at the location of the target, is not suitable for peripheral head mounted displays. This study tests alternative guiding cues better suited to these devices. MethodParticipants searched for a singleton target hidden among 299 distractors while directed with one of six device-delivered guiding cues. Search times were recorded. ResultsA static region map was the most efficient and most preferred cue. Static and dynamic directional cues were also effective in comparison to non-guided search. Cues designed to work solely within the participants’ peripheral vision were relatively ineffective ConclusionGuidance cues that direct a user's attention to targets within the real environment do not need to precisely lead to the target. It is instead more efficient to lead a user to the general vicinity of the target quickly and then have the user revert to their natural visual search behaviour. ApplicationThis finding is broadly useful when assisting visual search tasks with handheld or worn devices which do not cover the user's full field of view. PrécisThis study tested six different methods of guiding attention in a peripheral head-mounted display assisted visual search task. This study compared static, dynamic and peripheral-vision endogenous cues to targets and found a static simple map cue both fastest and most preferred by users.

A low-power HAR method for fall and high-intensity ADLs identification using wrist-worn accelerometer devices

Abstract There are many real-world applications like healthcare systems, job monitoring, well-being and personal fitness tracking, monitoring of elderly and frail people, assessment of rehabilitation and follow-up treatments, affording Fall Detection (FD) and ADL (Activity of Daily Living) identification, separately or even at a time. However, the two main drawbacks of these solutions are that most of the times, the devices deployed are obtrusive (devices worn on not quite common parts of the body like neck, waist and ankle) and the poor battery life. Thus, this work proposes a low-power classification algorithm based on an Ensemble of KNN and K-Means algorithms (EKMeans) to identify Falls and High-Intensity ADL events such as running, jogging and climbing up stairs. The input of EKMeans are triaxial accelerometer data gathered from wrist-wearable devices. The proposal will be validated on the Fall&ADL publicly available datasets UMAFall, UCIFall and FallAllD, considering two kinds of activity labelling: Two-Class and Multi-Class. An exhaustive comparative study between our proposal, and the baseline algorithms KNN and a feed-forward Neural Network (NN) is deployed, where EKMeans outperformed clearly the Specificity (ADL classification) of the KNN and NN for the three datasets. Finally, a comparative battery consumption study has been included deploying the analyzed algorithms in a WearOS smartwatch, where EKMeans drains the battery from 100% to 0% in 27.45 hours, saving 5% and 21% concerning KNN and NN, respectively. Keywords: Human Activity Recognition, ADL Identification, Fall Detection TS Clustering, TS Classification, Wearable Devices, Low-Power HAR.

Compressing 3D holographic information similar to data transmission via a single sideband

Subject of study. The possibility of real-time transmission of holographic information using standard radio channels by its compression through the removal of the carrier frequency and the use of a single sideband is investigated. Main results. We demonstrate that, according to Russian patent 2,707,582, information about a three-dimensional (3D) object can be stored in the form of two two-dimensional frames, one of which is the texture of the object surface, whereas the other is the depth map of its surface. After considering two principal methods for the formation of such a depth map, namely, the time-of-flight method and the method of structured light, we selected the latter owing to several advantages. This method was used to simulate the real-time recording process of a 3D portrait of a live person. Practical significance. We report the results of a numerical experiment demonstrating the possibility of transmission of 3D holographic images using standard communication channels intended for application in television and augmented reality without specialized glasses and other devices worn by the observer. This result is based on the proposed method for the separation of the carrier spatial frequency and frequencies containing the information about the holography object.

Associations Between Perceived Neighborhood Walkability and Device-Based Physical Activity and Sedentary Behavior Patterns in Older Adults.

Neighborhood walkability has been associated with self-reported sedentary behavior (SB) and self-reported and objective physical activity. However, self-reported measures of SB are inaccurate and can lead to biased estimates, and few studies have examined how associations differ by gender and age. The authors examined the relationships between perceived neighborhood walkability measured with the Physical Activity Neighborhood Environment Scale (scored 1.0-4.0) and device-based SB and physical activity in a cohort of community-dwelling older adults (N = 1,077). The authors fit linear regression models adjusting for device wear time, demographics, self-rated health, and accounting for probability of participation. The Higher Physical Activity Neighborhood Environment Scale was associated with higher steps (+676 steps/point on the Physical Activity Neighborhood Environment Scale, p = .001) and sit-to-stand transitions (+2.4 transitions/point, p = .018). Though not statistically significant, stratified analyses suggest an attenuation of effect for those aged 85 years and older and for women. Consistent with previous literature, neighborhood walkability was associated with more steps, though not with physical activity time. The neighborhood environment may also influence SB.

How Many Hours of Device Wear Time Are Required to Accurately Measure Physical Activity Post Stroke?

Background. Inadequate physical activity participation is a risk factor for secondary stroke. Before implementing appropriate management strategies, we need to accurately measure the physical activity of stroke survivors. We aimed to determine the duration of physical activity monitoring post-stroke that constitutes a valid day. Methods. We sampled stroke survivors’ physical activity for one week following discharge from inpatient rehabilitation using the Sensewear Armband (Bodymedia, Pittsburgh, PA, USA). To determine the impact of total daily wear time on activity estimate (sedentary, light, and moderate to vigorous physical activity) accuracy, we performed simulations, removing one, two, three, or four hours from a 14-h reference day, and analysed them with linear mixed models. Results. Sixty-nine participants (46 male, 65 ± 15 years) with 271 days of physical activity data were included. All physical activity variables were significantly underestimated for all data sets (10, 11, 12, or 13 h) compared to the 14-h reference data set. The number of days classified as not meeting physical activity recommendations increased as daily monitoring duration decreased: 13% misclassification with 10-h compared to 14-h dataset (p = 0.011). Conclusions. The accuracy of physical activity estimates increases with longer daily monitoring periods following stroke, and researchers should aim to monitor post-stroke physical activity for 14 daytime hours.

Study for Performance Increase of a Extractor Device by Steel Replacement of AISI 304 Steel for AISI 420 Steel.

The performance of an extractor device used in the food industry was studied from the development of structural analysis through computational modeling based on finite elements. These analyses considered the mechanical properties of AISI 304 and 420 stainless steels, in addition to the tribological aspects of the device in operation. Initially, uniaxial tensile tests were carried out according to the ABNT NBR 6892 standard and hardness tests were carried out according to ASTM E384, E92, and E18 standards. From the mechanical tests, structural analyses were carried out numerically on each of the components of the extractor device. After analyzing all the components, the device was assembled to be tested in operation. The wear and service life of devices made from these two materials were evaluated. From this study, it could be concluded that the extractor device made with AISI 420 stainless steel, in addition to having a lower manufacturing cost, suffered less wear and had an increase in service life of up to 650% compared to the extractor device made with steel stainless steel AISI 304.

Impact of Auditory–Oral Education on Device Use in Children With Hearing Loss

This study examined changes in datalogging for children attending an auditory-oral educational program with integrated audiology services versus children attending a mainstream or nonspecialized program. Eighty children participated in this study, half of which were enrolled in an auditory-oral educational program versus the nonspecialized or mainstream setting. Datalogging for cochlear implant and hearing aid users was obtained via retrospective medical and educational chart review from 2016 to 2019. Results demonstrated that at post-enrollment, children attending the auditory-oral educational program significantly increased device wear time (as measured by average hours/day) when compared to the control group. Children using hearing aids enrolled in the specialized educational program obtained the largest improvement in overall wear time, averaging an increase of 5 hr/day of device use from pre- to post-enrollment. This is the first study to document the association of specialized educational programs on device use. Clinical and educational programs should collaborate to provide integrated services to lessen family burden and increase a child's device use and retention.

How efficient are facial masks against COVID-19? Evaluating the mask use of various communities one year into the pandemic

Face masks are devices worn over the mouth and nose to protect against splashes, infectious respiratory droplets, or aerosols generated during breathing or coughing according to their filtering capacity. Medical masks, respirators, or cloth masks have been used for source control and for the protection of the exposed. After the first case on March 11, 2020, in Turkey, National COVID-19 Scientific Advisory Board published various contents for the correct use of masks. Medical face masks have been used in healthcare settings for both source control and potential personal protection before the COVID-19 pandemic. Adverse events associated with using masks are very sparse and mainly associated with tight-fitting respirators or dermatitis due to prolonged use and should not be a reason for refusal to use. Studies suggest the use of masks mainly in the healthcare facilities but also in the community for source control of people who have respiratory symptoms of communicable diseases other than COVID-19. They are likely to be acceptable if recommended, particularly in more severe epidemics and pandemics. Metaanalysis, case control, cross sectional, cohort, retrospective, retrospective cross sectional, research, randomized controlled, and controlled comparison studies were reviewed on the protective effect of masks on COVID-19 with laboratory evidence. Optimum use of face masks with additional precautions has been found to be useful controlling the spread of the respiratory viruses such as SARS-CoV-2 in most of the studies and metaanalyses. As a conclusion, the recent evidence in COVID-19 pandemic is consistent with the previous studies which have shown association between face mask use and decreased risk of viral infections, and medical face mask use should be encouraged both for the community and healthcare facilities along with other infection control measures such as hand hygiene, during outbreaks when there is widespread community transmission.

Factors influencing the use of hearing protection devices in Irish mine workers

Background: Workers who are exposed to high levels of noise should consider wearing HPDs when elimination of noise cannot be put in place. There are several factors including health and safety management systems, peers and policy that could influence workers to either use or not use HPDs. Objectives: To determine worker’s perception of noise risk in a mining setting and to determine if there is an association between organisational rules, knowledge, and the wearing of Hearing Protection Devices (HPDs). Methods: A cross- sectional study was conducted at a mining setting in Ireland in which 116 workers participated; a self-administered questionnaire survey was used. Data analysis was carried out using descriptive statistics and binary regression analysis. Results: The study had a response rate of 94% of the entire population. The mean exposure to noise levels that require HPDs is 5.32 hours. The results showed an association between using HPDs and organisation rules; and no association between preventing abnormal hearing, perceived influences in the workplace, knowledge and information. Conclusion: Factors that can influence workers likelihood to wear HPDs are organisation rules; this is unaffected by the influence of colleagues. Each company should have a clear policy to encourage workers to wear HPDs for preventing Noise Induced Hearing Loss (NIHL). Application: The findings highlighted that a company’s health and safety policy is important to encourage employees to wear HPDs. Mine settings or noisy workplaces should have transparent policies for employees to follow and benefit their hearing health, even if an employee is not aware of the full content of a policy, aspects are known.

CARL: a running recognition algorithm for free-living accelerometer data

Wearable accelerometers hold great promise for physical activity epidemiology and sports biomechanics. However, identifying and extracting data from specific physical activities, such as running, remains challenging. Objective. To develop and validate an algorithm to identify bouts of running in raw, free-living accelerometer data from devices worn at the wrist or torso (waist, hip, chest). Approach. The CARL (continuous amplitude running logistic) classifier identifies acceleration data with amplitude and frequency characteristics consistent with running. The CARL classifier was trained on data from 31 adults wearing accelerometers on the waist and wrist, then validated on free-living data from 30 new, unseen subjects plus 166 subjects from previously-published datasets using different devices, wear locations, and sample frequencies. Main results. On free-living data, the CARL classifier achieved mean accuracy (F 1 score) of 0.984 (95% confidence interval 0.962–0.996) for data from the waist and 0.994 (95% CI 0.991–0.996) for data from the wrist. In previously-published datasets, the CARL classifier identified running with mean accuracy (F 1 score) of 0.861 (95% CI 0.836–0.884) for data from the chest, 0.911 (95% CI 0.884–0.937) for data from the hip, 0.916 (95% CI 0.877–0.948) for data from the waist, and 0.870 (95% CI 0.834–0.903) for data from the wrist. Misclassification primarily occurred during activities with similar torso acceleration profiles to running, such as rope jumping and elliptical machine use. Significance. The CARL classifier can accurately identify bouts of running as short as three seconds in free-living accelerometry data. An open-source implementation of the CARL classifier is available at github.com/johnjdavisiv/carl.

Ecological momentary intervention to reduce suicide risk among adolescents (EMIRA)

Abstract Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one's natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group.

Continuous ECG monitoring versus mobile telemetry: A comparison of arrhythmia diagnostics in human- versus algorithmic-dependent systems.

BackgroundClinicians rarely scrutinize the full disclosure of a myriad of FDA-approved long-term rhythm monitors, and they rely on manufacturers to detect and report relevant rhythm abnormalities.ObjectiveThe objective of this study is to compare the diagnostic accuracy between mobile cardiac telemetry (MCT), which uses an algorithm-based detection strategy, and continuous long-term electrocardiography (LT-ECG) monitoring, which uses a human-based detection strategy.MethodsIn an outpatient arrhythmia clinic, we enrolled 50 sequential patients ordered to wear a 30-day MCT, to simultaneously wear a continuous LT-ECG monitor. Periods of concomitant wear of both devices were examined using the associated report, which was over-read by 2 electrophysiologists.ResultsForty-six of 50 patients wore both monitors simultaneously for an average of 10.3 ± 4.4 days (range: 1.2–14.8 days). During simultaneous recording, patients were more often diagnosed with arrhythmia by LT-ECG compared to MCT (23/46 vs 11/46), P = .018. Similarly, more arrhythmia episodes were detected during simultaneous recording with the LT-ECG compared to MCT (61 vs 19), P < .001. This trend remained consistent across arrhythmia subtypes, including ventricular tachycardia (13 patients by LT-ECG vs 7 by MCT), atrioventricular (AV) block (3 patients by LT-ECG vs 0 by MCT), and AV node reentrant tachycardia (2 patients by LT-ECG vs 0 by MCT). Atrial fibrillation (AF) was documented by both monitors in 2 patients; however, LT-ECG monitoring captured 4 additional AF episodes missed by MCT.ConclusionIn a time-controlled, paired analysis of 2 disparate rhythm monitors worn simultaneously, human-dependent LT-ECG arrhythmia detection significantly outperformed algorithm-based MCT arrhythmia detection.

Integrating monitor wearing to estimate household air pollution exposure parameters in the Ghana Randomized Air Pollution and Health Study (GRAPHS)

BACKGROUND AND AIM: Personal monitoring can enhance exposure-response studies. Prior studies employ a wearing compliance minimum threshold to reduce exposure misclassification. Leveraging the full range of device wearing data illuminates important exposure outcomes in the context of a large household air pollution cookstove intervention study with three arms (control, liquified petroleum gas (LPG), and improved biomass). METHODS: Evaluating the association between accelerometer-derived device wearing and mean 48-hr personal exposures in generalized estimating equations yields three parameters: (1) the y-intercept (0% device wearing) estimates community air pollution per study arm; (2) the difference between estimated concentrations per study arm at maximum device wearing is the effect of the cooking interventions on overall personal exposure; (3) estimated concentrations at maximum device wearing minus the y-intercept concentration estimates the average direct contribution of cooking events to personal exposure. RESULTS:Median device wearing during waking hours was 7- 8 hrs/day across study arms (range 0 - 15.9 hrs). Estimated community-level PM₂.₅ concentrations were similar across study arms (37-48 μg/m³). On average, the overall exposure was estimated at 108 ± 14 μg/m³ for the control arm and 53 ± 23 μg/m³ for LPG, suggesting a 50% reduction from this intervention. We estimate the direct contribution of individual cooking activities to exposure to be 60 ± 14 μg/m³ in the control arm and 6.2 ± 22.6 μg/m³ in the LPG arm (90% less). The improved biomass stove had negligible impact on reducing personal air pollution exposure. Using only data from cooking hours provided relatively similar % reductions for the LPG intervention (45% for overall; 85% for direct cooking impact). CONCLUSIONS:The association between device wearing and personal exposure allows quantification of important household air pollution exposure assessment outcomes, two of which previously could not be obtained without additional monitoring. KEYWORDS: Air pollution, Particulate matter, Modeling, Exposures