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Premature birth is the primary risk factor in neonatal deaths, with the majority of extremely premature babies cared for in neonatal intensive care units (NICUs). Mortality risk prediction in this setting can greatly improve patient outcomes and resource utilization. However, existing schemes often require laborious medical testing and calculation, and are typically only calculated once at admission. In this work, we propose a shallow hybrid neural network for the prediction of mortality risk in 3-day, 7-day, and 14-day risk windows using only birthweight, gestational age, sex, and heart rate (HR) and respiratory rate (RR) information from a 12-h window. As such, this scheme is capable of continuously updating mortality risk assessment, enabling analysis of health trends and responses to treatment. The highest performing scheme was the network that considered mortality risk within 3 days, with this scheme outperforming state-of-the-art works in the literature and achieving an area under the receiver-operator curve (AUROC) of 0.9336 with standard deviation of 0.0337 across 5 folds of cross-validation. As such, we conclude that our proposed scheme could readily be used for continuously-updating mortality risk prediction in NICU environments., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial-the telehealth technology remains as a "black box." Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation., Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research., Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth., Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients' experiences and emotions while using the device, patients' perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients' awareness, family involvement, and design implications for telehealth for T2D., Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients' UX and future design implications. Through HCI we can look into the "black box" phenomenon of clinical trials and create patient-centered telehealth solutions., (©Sakib Jalil, Trina Myers, Ian Atkinson, Muriel Soden. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 06.06.2019.)

Purpose: Spatial and temporal patterns of response of human glioblastoma to fractionated chemoradiation are described by changes in the bioscales of residual tumor volume (RTV), tumor cell volume fraction (CVF), and tumor cell kill (TCK), as derived from tissue sodium concentration (TSC) measured by quantitative sodium MRI at 3 Tesla. These near real-time patterns during treatment are compared with overall survival., Experimental Design: Bioscales were mapped during fractionated chemoradiation therapy in patients with glioblastomas ( n = 20) using TSC obtained from serial quantitative sodium MRI at 3 Tesla and a two-compartment model of tissue sodium distribution. The responses of these parameters in newly diagnosed human glioblastomas undergoing treatment were compared with time-to-disease progression and survival., Results: RTV following tumor resection showed decreased CVF due to disruption of normal cell packing by edema and infiltrating tumor cells. CVF showed either increases back toward normal as infiltrating tumor cells were killed, or decreases as cancer cells continued to infiltrate and extend tumor margins. These highly variable tumor responses showed no correlation with time-to-progression or overall survival., Conclusions: These bioscales indicate that fractionated chemoradiotherapy of glioblastomas produces variable responses with low cell killing efficiency. These parameters are sensitive to real-time changes within the treatment volume while remaining stable elsewhere, highlighting the potential to individualize therapy earlier in management, should alternative strategies be available., (©2018 American Association for Cancer Research.)

Background: Controlling bleeding early in the prehospital and military setting is an extremely important and life-saving skill. Wound clamping is a newly introduced technique that may augment both the effectiveness and logistics of wound packing with any gauze product. As these devices may be inadvertently removed, the potential consequences of such were examined in a simulated, extreme, inadvertent disengagement., Methods: The wound clamp used was an iTClamp (Innovative Trauma Care; Edmonton, Alberta, Canada) that was applied and forcefully removed (skin-pull) from the skin of both a human cadaver and swine. Sixty skin-pull tests were sequentially performed to measure the pull weight required to remove the device, any potential skin and device damage, how the device failed, and if the device could be re-applied., Results: Observations of the skin revealed that other than the expected eight small needle holes from device application, no other damage to the skin was sustained in 98.3% of cases. Conversely, of the 60 devices pulled, 93.3% of the devices sustained no damage and all could be re-applied. Four (6.7%) of the devices remained in place despite a maximum pull weight >22lb F (pound-force). The mean pull weights for pin bar pull were (lb F ): vertical 9.2 (SD=5.0); perpendicular 2.5 (SD=1.7); and parallel 5.3 (SD=3.1). For the encompassed pull position group, mean pull weights were (lb F ): vertical 5.7 (SD=2.3); perpendicular 3.0 (SD=2.5); and parallel 14.5 (SD=3.5). The overall mean for all groups was 6.7 (SD=5.2). The two main reasons that the iTClamp was pulled off were because the friction lock let go or the needles slipped out of one side of the skin due to the angle of the pull., Conclusion: Inadvertent, forcible removal of the iTClamp created essentially no skin damage seen when the wound clamp was forcibly removed from either cadaver or swine models in a variety of positions and directions. Thus, the risks of deployment in operational environments do not seem to be increased. Mckee JL , Lakshminarasimhan P , Atkinson I , LaPorta AJ , Kirkpatrick AW . Evaluation of skin damage from accidental removal of a hemostatic wound clamp (the iTClamp). Prehosp Disaster Med. 2017;32(6):651-656.

Treatment of high-grade primary brain tumors is based on experience from multicenter trials. However, the prognosis has changed little in 3 decades. This suggests that there is a fundamental oversight in treatment. This article provides an imaging perspective of how regional responses of primary brain tumors may be examined to guide a flexible treatment plan. Sodium imaging provides a measurement of cell density that can be used to measure regional cell kill. Such a bioscales of regionally and temporally sensitive biologic-based parameters may be helpful to guide tumor treatment. These suggestions are speculative and still being examined, but are presented to challenge the medical community to be receptive to changes in the standard of care when that standard continues to fail.

Purpose: To assess whether exposure to a 9.4 T static magnetic field during sodium imaging at 105.92 MHz affects human vital signs and cognitive function., Materials and Methods: Measurements of human vital signs and cognitive ability made before and after exposure to a 9.4 T MR scanner and a mock scanner with no magnetic field are compared using a protocol approved by the U.S. Food and Drug Administration (FDA)., Results: Exposure to a 9.4 T static magnetic field during sodium imaging did not result in a statistically significant change in the vital signs or cognitive ability of healthy normal volunteers., Conclusion: Vital sign and cognitive ability measurements made before and after sodium imaging at 9.4 T suggest that performing human MRI at 105.92 MHz in a 9.4 T static magnetic field does not pose a health risk.