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The US health care delivery system does not systematically engage or support family or friend care partners. Meanwhile, the uptake and familiarity of portals to personal health information are increasing among patients. Technology innovations, such as shared access to the portal, use separate identity credentials to differentiate between patients and care partners. Although not well-known, or commonly used, shared access allows patients to identify who they do and do not want to be involved in their care. However, the processes for patients to grant shared access to portals are often limited or so onerous that interested patients and care partners often circumvent the process entirely. As a result, the vast majority of care partners resort to accessing portals using a patient's identity credentials—a "do-it-yourself" solution in conflict with a health systems' legal responsibility to protect patient privacy and autonomy. The personal narratives in this viewpoint (shared by permission) elaborate on quantitative studies and provide first-person snapshots of challenges faced by patients and families as they attempt to gain or grant shared access during crucial moments in their lives. As digital modalities increase patient roles in health care interactions, so does the importance of making shared access work for all stakeholders involved—patients, clinicians, and care partners. Electronic health record vendors must recognize that both patients and care partners are important users of their products, and health care organizations must acknowledge and support the critical contributions of care partners as distinct from patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis. METHODS: We conducted an observational cohort study of date/time‐stamped patient portal use for a 5‐year period (October 3, 2017–October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients. RESULTS: Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%). DISCUSSION: The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights: Patient portal registration and use has been increasing among persons with diagnosed dementia.Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials.Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia.Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access. [ABSTRACT FROM AUTHOR]

We investigate the effect of bursty traffic in a long term evolution (LTE) and Wi-Fi aggregation (LWA)-enabled network. The LTE base station routes packets of the same IP flow through the LTE and Wi-Fi links independently. We motivate the use of superposition coding at the LWA-mode Wi-Fi access point (AP) so that it can serve LWA users and Wi-Fi users simultaneously. A random access protocol is applied in such system, which allows the native-mode AP to access the channel with probabilities that depend on the queue size of the LWA-mode AP to avoid impeding the performance of the LWA-enabled network. We analyze the throughput of the native Wi-Fi network and the delay experienced by the LWA users, accounting for the native-mode AP access probability, the traffic flow splitting between LTE and Wi-Fi, and the operating mode of the LWA user with both LTE and Wi-Fi interfaces. Our results show some fundamental tradeoffs in the throughput and delay behavior of LWA-enabled networks, which provide meaningful insight into the operation of such aggregated systems.

The persistent awareness of dynamic links quality is of critical importance to shared access systems, e.g., promoting sensing accuracy or even enabling seamless sharing, which remains yet as a challenging task. In this paper, we consider the shared access in heterogeneous small-cells, which are likely to be the main infrastructure components by utilizing the carrier aggregation (CA) scheme, potentially combining both licensed and unlicensed bands. We suggest a promising sensing scheme, which permits the simultaneous assessment of multiple links quality when detecting vacant spectrum, and hence is able to solve the long-standing hidden terminal problem. We incorporate an additional objective of acquiring dynamic link state information of multiple incumbent transmitters/receivers, and thereby, structure spectrum sensing as a mixed classification and estimation problem. The main challenge is that multiple channels may become similar with each other, and existing joint estimation schemes are unable to distinguish which incumbent is active and what its associated channel state is. To address this indistinguishable problem and alleviate the error propagation in recursive estimations, a novel alternating Bernoulli filtering algorithm is proposed. By fully exploiting the group transitional behavior of incumbents, a multiple-chains inference framework is developed. Numerical simulations validate our new scheme. Occupancy states of multiple incumbents can be identified accurately, by tracking their links quality and exploiting the underlying dynamics, which lays the foundation for more effective shared access. [ABSTRACT FROM AUTHOR]

Introduction: Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis., Methods: We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients., Results: Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%)., Discussion: The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

In this paper, we analyze a shared access network with a fixed primary node and randomly distributed secondary nodes whose spatial distribution follows a poisson point process. The secondary nodes use a random access protocol allowing them to access the channel with probabilities that depend on the queue size of the primary node. Assuming a system with multipacket reception receivers, having bursty packet arrivals at the primary and saturated traffic at the secondary nodes, our protocol can be tuned to alleviate congestion at the primary. We analyze the throughput of the secondary network and the primary average delay, as well as the impact of the secondary node access probability and transmit power. We formulate an optimization problem to maximize the throughput of the secondary network under delay constraints for the primary node; in the case of no congestion control, the optimal access probability can be provided in closed form. Our numerical results illustrate the effect of network operating parameters on the performance of the proposed priority-based shared access protocol. [ABSTRACT FROM AUTHOR]

This work focuses on the implementation of dynamic spectrum access in a scenario where the existing wireless infrastructure is shared by a secondary cellular system. We study the optimization of the physical antenna configuration of the secondary-system base stations, assuming that these antennas are deployed at the transmitter sites of a primary broadcast network. Specifically, we maximize the throughput of a secondary network (SN) operating within a primary network (PN) by finding the optimal antenna height and vertical tilt for the SN base stations. This optimization is constrained by the physical restrictions in the deployment site and by the maximum allowed interference to the PN. We show that this optimization provides significant gain in the cell throughput of the SN while reducing interference toward users of the primary system. As a case study, we design an optimized configuration for the SN antenna when the SN operates as a dedicated communication link for a regional transport system. To this end, field measurement data gathered in collaboration with a regional transport authority are used to calibrate the presented modeling method. [ABSTRACT FROM AUTHOR]

This article examines forms of shared access to technology where some privileges of ownership are retained. Sharing is defined as informal, non-remunerative resource distributing activities where multiple individuals have a relationship to a single device as purchaser, owner, possessor, operator and/or user. In the specific case of mobile phones in rural Uganda, dynamics of social policing and social obligation were mediated and concretized by these devices. Patterns of sharing mobile phones in rural Uganda led to preferential access for needy groups (such as those in ill health) while systematically and disproportionately excluding others (women in particular). The framework for sharing proposed in this article will be useful for structuring comparisons of technology adoption and access across cultural contexts. [ABSTRACT FROM AUTHOR]