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BackgroundTelemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. ObjectiveThe aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. MethodsWe reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). ResultsWe included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). ConclusionsTelemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.

BackgroundTelemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied. ObjectiveThis study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF). MethodsWe conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis. ResultsA total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; P=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; P=.005). ConclusionsITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care. Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691

BackgroundAn ongoing challenge for smart homes research for aging-in-place is how to make sense of the large amounts of data from in-home sensors to facilitate real-time monitoring and develop reliable alerts. ObjectiveThe objective of our study was to explore the usefulness of a routine-based approach for making sense of smart home data for the elderly. MethodsMaximum variation sampling was used to select three cases for an in-depth mixed methods exploration of the daily routines of three elderly participants in a smart home trial using 180 days of power use and motion sensor data and longitudinal interview data. ResultsSensor data accurately matched self-reported routines. By comparing daily movement data with personal routines, it was possible to identify changes in routine that signaled illness, recovery from bereavement, and gradual deterioration of sleep quality and daily movement. Interview and sensor data also identified changes in routine with variations in temperature and daylight hours. ConclusionsThe findings demonstrated that a routine-based approach makes interpreting sensor data easy, intuitive, and transparent. They highlighted the importance of understanding and accounting for individual differences in preferences for routinization and the influence of the cyclical nature of daily routines, social or cultural rhythms, and seasonal changes in temperature and daylight hours when interpreting information based on sensor data. This research has demonstrated the usefulness of a routine-based approach for making sense of smart home data, which has furthered the understanding of the challenges that need to be addressed in order to make real-time monitoring and effective alerts a reality.

BackgroundThe high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices. ObjectiveThis study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. MethodsParticipants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. ResultsA total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(β)=1.45, 95% CI 1.09-1.95; exp(β)=1.61, 95% CI 1.17-2.22) and 9 months (exp(β)=1.55, 95% CI 1.14-2.10; exp(β)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(β)=1.07, 95% CI 1.03-1.11) and 9 months (exp(β)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(β)=2.25, 95% CI 1.29-3.92; exp(β)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(β)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(β)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. ConclusionsThe ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

BackgroundLifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson’s disease (PD). ObjectiveThe objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. MethodsThe dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. ResultsVisualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. ConclusionsLifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided.

The wheel hub is an important component of the wheel, and a good hub design can significantly improve vehicle handling, stability, and braking performance, ensuring safe driving. This article optimized the hub structure through morphological aspects, where reducing the hub weight contributed to enhanced fuel efficiency and overall vehicle performance. By referencing honeycombed structures, a bionic hub design is numerically simulated using finite element analysis and response surface optimization. The results showed that under the optimization of the response surface analytical model, the maximum stress of the optimized bionic hub was 109.34 MPa, compared to 119.77 MPa for the standard hub, representing an 8.7% reduction in maximum stress. The standard hub weighs 34.02 kg, while the optimized hub weight was reduced to 29.89 kg, a decrease of 12.13%. A fatigue analysis on the optimized hub indicated that at a stress of 109.34 MPa, the minimum load cycles were 4.217 × 105 at the connection point with the half-shaft, meeting the fatigue life requirements for commercial vehicle hubs outlined in the national standard GB/T 5334-2021. [ABSTRACT FROM AUTHOR]

Objectives Conversational agents (CAs) with emerging artificial intelligence present new opportunities to assist in health interventions but are difficult to evaluate, deterring their applications in the real world. We aimed to synthesize existing evidence and knowledge and outline an evaluation framework for CA interventions. Materials and Methods We conducted a systematic scoping review to investigate designs and outcome measures used in the studies that evaluated CAs for health interventions. We then nested the results into an overarching digital health framework proposed by the World Health Organization (WHO). Results The review included 81 studies evaluating CAs in experimental (n  = 59), observational (n  = 15) trials, and other research designs (n  = 7). Most studies (n  = 72, 89%) were published in the past 5 years. The proposed CA-evaluation framework includes 4 evaluation stages: (1) feasibility/usability, (2) efficacy, (3) effectiveness, and (4) implementation, aligning with WHO's stepwise evaluation strategy. Across these stages, this article presents the essential evidence of different study designs (n  = 8), sample sizes, and main evaluation categories (n  = 7) with subcategories (n  = 40). The main evaluation categories included (1) functionality, (2) safety and information quality, (3) user experience, (4) clinical and health outcomes, (5) costs and cost benefits, (6) usage, adherence, and uptake, and (7) user characteristics for implementation research. Furthermore, the framework highlighted the essential evaluation areas (potential primary outcomes) and gaps across the evaluation stages. Discussion and Conclusion This review presents a new framework with practical design details to support the evaluation of CA interventions in healthcare research. Protocol registration The Open Science Framework (https://osf.io/9hq2v) on March 22, 2021. [ABSTRACT FROM AUTHOR]

This paper investigates a coupled system of nonlinear hyperbolic equations with weak damping. It is shown that the global solution and finite time blow-up solution exist at subcritical or critical initial energy. Moreover, the finite time blow-up result at arbitrarily high initial energy is obtained. Also, we derive the exponential energy decay estimation of the global solution and estimate the upper and lower bounds of the blow-up time. [ABSTRACT FROM AUTHOR]

The target can deceive the flight vehicle by releasing an infrared decoy to make the line-of-sight (LOS) angle rate deflect greatly, thus causing the flight vehicle to miss the target. Therefore, in order to accurately strike the target in complex adversarial scenarios, this paper proposes a finite-time convergence guidance law (FTCG) combined with a finite-time disturbance observer (FTDO). The complex adversarial scenario is established by combining the relative motion model between the flight vehicle and the target and the motion model of the infrared decoy. Based on this, considering the dynamic characteristic of the flight vehicle's autopilot, a guidance model is obtained. Utilizing sliding mode control theory and finite-time control theory, an FTCG of the LOS angle rate is designed. Then, the finite-time convergence of the guidance law is proved and the total convergence time is derived. Finally, for the target maneuvering that is difficult to measure in the guidance law, an FTDO is used to estimate and compensate for the target maneuvering in the guidance law. Simulation results show that the FTCG can make the LOS angle rate quickly converge and accurately strike the target in different scenarios, with a good guidance accuracy and robustness. Compared with the sliding mode guidance law (SMGL) and the adaptive sliding mode guidance law (ASMGL) based on an extended state observer (ESO), the advantages of the designed guidance law are illustrated. Finally, FTCG is extended to be three dimensional and compared with the proportional navigation guidance law (PNG) to further illustrate its effectiveness in a three-dimensional coordinate system. [ABSTRACT FROM AUTHOR]

A conservative sharp interface method is proposed in this work to simulate two-dimensional/axisymmetric incompressible two-phase flows with phase change. In this method, we use the cut cell method to generate unstructured meshes near the interface, of which the cell edges overlap with the interface at each time step. On such mesh, the mass and heat transfer during phase change and all the jump conditions can be incorporated into the calculation of fluxes at the cell edges, to ensure that they are strictly satisfied at the interface in a sharp manner. The governing equations, including the incompressible Navier–Stokes equations, heat equation, and vapor mass fraction equation, are discretized by a second-order finite volume method in the arbitrary Lagrangian–Eulerian framework. To well couple the mass, heat, momentum, and interface evolution, the solution procedure is carefully designed and performed with several techniques. In such a way, the sharp discontinuity of the velocity, stress, temperature gradient, and vapor fraction, caused by the mass/heat transfer during phase change, can be simulated accurately and robustly. The performance of this method is systematically examined by cases of phase change at or below the saturated temperature, including vapor bubble in superheated liquid, film boiling, droplet evaporation at different relative humidity conditions, droplet evaporation under gravity, and droplet evaporation under forced convection. The applicability of the present method for incompressible two-phase flows with phase change is well demonstrated by comparing the numerical results with the benchmark, theoretical or experimental ones. [ABSTRACT FROM AUTHOR]