In Vivo Raman Spectroscopy Reveals Biochemical Composition of the Esophageal Tissue in Pediatric Eosinophilic Esophagitis

INTRODUCTION

Biochemical alterations in the esophagus of patients with eosinophilic esophagitis (EoE) are poorly understood. We used Raman spectroscopy through a pediatric endoscope to identify key Raman features reflective of the esophageal biochemical composition to differentiate between children with EoE from non-EoE controls and between children with active (aEoE) and inactive EoE (iEoE).

METHODS

Spectral measurements were obtained using a customized pediatric endoscope-compatible fiber-optic Raman probe in real time during an esophagogastroduodenoscopy. Chemometric analysis was performed to identify key Raman features associated with EoE. Pearson correlation analysis was used to assess relationship between the key Raman features and EoE activity indices. Their diagnostic utility was ascertained using the receiver operator characteristic curve analysis.

RESULTS

Forty-three children were included in the study (EoE = 32 [74%] and non-EoE control = 11 [26%]; aEoE = 20 [63%] and iEoE = 12 [37%]). Raman intensities assigned to lipids, proteins, and glycogen:protein ratio accurately distinguished children with EoE from those without EoE and aEoE from iEoE. They significantly correlated with EoE activity indices. The Raman peak ratio for lipids had 90.6% sensitivity, 100% specificity, and an area under the curve of 0.95 to differentiate children with EoE from non-EoE controls. The glycogen:protein ratio had 70% sensitivity, 91.7% specificity, and an area under the curve of 0.75 to distinguish children with aEoE from iEoE.

DISCUSSION

Real-time intraendoscopy Raman spectroscopy is an effective method for identifying spectral markers reflective of the esophageal biochemical composition in children with EoE. This technique may aid in the diagnosis and monitoring of EoE and help to elucidate EoE pathogenesis.

Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study

BACKGROUND

Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men.

OBJECTIVE

This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men.

METHODS

We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion.

RESULTS

In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide.

CONCLUSIONS

Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31241.

Real-Time Real-World Digital Monitoring of Adolescent Suicide Risk During the Six Months Following Emergency Department Discharge: Protocol for an Intensive Longitudinal Study

BACKGROUND

Suicide is the second leading cause of death in adolescents, and self-harm is one of the strongest predictors of death by suicide. The rates of adolescents presenting to emergency departments (EDs) for suicidal thoughts and behaviors (STBs) have increased. Still, existing follow-up after ED discharge is inadequate, leaving a high-risk period for reattempts and suicide. There is a need for innovative evaluation of imminent suicide risk factors in these patients, focusing on continuous real-time evaluations with low assessment burden and minimal reliance on patient disclosure of suicidal intent.

OBJECTIVE

This study examines prospective longitudinal associations between observed real-time mobile passive sensing, including communication and activity patterns, and clinical and self-reported assessments of STB over 6 months.

METHODS

This study will include 90 adolescents recruited on their first outpatient clinic visit following their discharge from the ED due to a recent STB. Participants will complete brief weekly assessments and be monitored continuously for their mobile app usage, including mobility, activity, and communication patterns, over 6 months using the iFeel research app. Participants will complete 4 in-person visits for clinical assessment at baseline and at the 1-, 3-, and 6-month follow-ups. The digital data will be processed, involving feature extraction, scaling, selection, and dimensionality reduction. Passive monitoring data will be analyzed using both classical machine learning models and deep learning models to identify proximal associations between real-time observed communication, activity patterns, and STB. The data will be split into a training and validation data set, and predictions will be matched against the clinical evaluations and self-reported STB events (ie, labels). To use both labeled and unlabeled digital data (ie, passively collected), we will use semisupervised methods in conjunction with a novel method that is based on anomaly detection notions.

RESULTS

Participant recruitment and follow-up started in February 2021 and are expected to be completed by 2024. We expect to find prospective proximal associations between mobile sensor communication, activity data, and STB outcomes. We will test predictive models for suicidal behaviors among high-risk adolescents.

CONCLUSIONS

Developing digital markers of STB in a real-world sample of high-risk adolescents presenting to ED can inform different interventions and provide an objective means to assess the risk of suicidal behaviors. The results of this study will be the first step toward large-scale validation that may lead to suicide risk measures that aid psychiatric follow-up, decision-making, and targeted treatments. This novel assessment could facilitate timely identification and intervention to save young people's lives.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46464.

Quality of Sarcoma Care: Longitudinal Real-Time Assessment and Evidence Analytics of Quality Indicators

Sarcomas represent a large group of rare to very rare diseases, requiring complex management with a transdisciplinary approach. Overall progress has been hampered because of discipline, institution and network fragmentation, and there is no global data harmonization or quality standards. To report on and improve quality, a common definition of quality indicators (QIs) of sarcoma care as well as the capacity to assess longitudinal real-time data is required. An international advisory board of world-renowned sarcoma experts defined six categories of QIs, totaling more than 80 quality indicators. An interoperable (web-based) digital platform was then created combining the management of the weekly sarcoma board meeting with the sarcoma registry and incorporating patient-reported outcome measures (PROMs) into the routine follow-up care to assess the entire care cycle of the patient. The QIs were then programmed into the digital platform for real-time analysis and visualization. The definition of standardized QIs covering all physician- (diagnostics and therapeutics), patient- (PROMS/PREMS), and cost-based aspects in combination with their real-time assessment over the entire sarcoma care cycle can be realized. Standardized QIs as well as their real-time assessment and data visualization are critical to improving the quality of sarcoma care. By enabling predictive modelling and introducing VBHC, precision health care for a complex disease is on the horizon.

Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study

Background

Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited.

Objective

This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity.

Methods

After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal.

Results

Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance.

Conclusions

The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity.

Effects of stomach content on the breath alcohol concentration-transdermal alcohol concentration relationship

INTRODUCTION

Wearable devices that obtain transdermal alcohol concentration (TAC) could become valuable research tools for monitoring alcohol consumption levels in naturalistic environments if the TAC they produce could be converted into quantitatively-meaningful estimates of breath alcohol concentration (eBrAC). Our team has developed mathematical models to produce eBrAC from TAC, but it is not yet clear how a variety of factors affect the accuracy of the models. Stomach content is one factor that is known to affect breath alcohol concentration (BrAC), but its effect on the BrAC-TAC relationship has not yet been studied.

METHODS

We examine the BrAC-TAC relationship by having two investigators participate in four laboratory drinking sessions with varied stomach content conditions: (i) no meal, (ii) half and (iii) full meal before drinking, and (iv) full meal after drinking. BrAC and TAC were obtained every 10 min over the BrAC curve.

RESULTS

Eating before drinking lowered BrAC and TAC levels, with greater variability in TAC across person-device pairings, but the BrAC-TAC relationship was not consistently altered by stomach content. The mathematical model calibration parameters, fit indices, and eBrAC curves and summary score outputs did not consistently vary based on stomach content, indicating that our models were able to produce eBrAC from TAC with similar accuracy despite variations in the shape and magnitude of the BrAC curves under different conditions.

DISCUSSION AND CONCLUSIONS

This study represents the first examination of how stomach content affects our ability to model estimates of BrAC from TAC and indicates it is not a major factor.

Real-Time Quantitative Assessment of Accuracy and Precision of Blood Volume Derived from DCE-MRI in Individual Patients During a Clinical Trial

Accuracy and precision of quantitative imaging (QI) metrics should be assessed in real time in each patient during a clinical trial to support QI-based decision-making. We developed a framework for real-time quantitative assessment of QI metrics and evaluated accuracy and precision of dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI)–derived blood volume (BV) in a clinical trial for head and neck cancers. Patients underwent DCE-MRI before and after 2 weeks of radiation therapy (2wkRT). A mean as a reference value and a repeatability coefficient (RC) of BV values established from n patients in cerebellum volumes of interest (VOIs), which were normal and affected little by therapy, served as accuracy and precision measurements. The BV maps of a new patient were called accurate and precise if the values in cerebellum VOIs and the difference between the 2 scans agreed with the respective mean and RC with 95% confidence. The new data could be used to update reference values. Otherwise, the data were flagged for further evaluation before use in the trial. BV maps from 62 patients enrolled on the trial were evaluated. Mean BV values were 2.21 (±0.14) mL/100 g pre-RT and 2.22 (±0.17) mL/100 g at 2wkRT; relative RC was 15.9%. The BV maps from 3 patients were identified to be inaccurate and imprecise before use in the clinical trial. Our framework of real-time quantitative assessment of QI metrics during a clinical trial can be translated to different QI metrics and organ-sites for supporting QI-based decision-making that warrants success of a clinical trial.

Study Protocol on Ecological Momentary Assessment of Health-Related Quality of Life Using a Smartphone Application

Health-Related Quality of Life (HRQoL) is a construct of increasing importance in modern healthcare, and has typically been assessed using retrospective instruments. While such measures have been shown to have predictive utility for clinical outcomes, several cognitive biases associated with human recall and current mood state may undermine their validity and reliability. Retrospective tools can be further criticized for their lack of ecology, as individuals are usually assessed in less natural settings such as hospitals and health centers, and may be obliged to spend time and money traveling to receive assessment. Ecological momentary assessment (EMA) is an alternative, as mobile assessment using mobile health (mHealth) technology has the potential to minimize biases and overcome many of these limitations. Employing an EMA methodology, we will use a smartphone application to collect data on real-time HRQoL, with an adapted version of the widely used WHOQOL-BREF questionnaire. We aim to recruit a total of 450 healthy participants. Participants will be prompted by the application to report their real-time HRQoL over 2 weeks together with information on mood and current activities. At the end of 2 weeks, they will complete a retrospective assessment of their HRQoL and they will provide information about their sleep quality and perceived stress. The psychometric properties of real-time HRQoL will be assessed, including analysis of the factorial structure, reliability and validity of the measure, and compared with retrospective HRQoL responses for the same 2-week testing period. Further, we aim to identify factors associated with real-time HRQoL (e.g., mood, activities), the feasibility of the application, and within- and between-person variability in real-time HRQoL. We expect real-time HRQoL to have adequate validity and reliability, and positive responses on the feasibility of using a smartphone application for routine HRQoL assessment. The direct comparison of real-time and retrospective measures in this study will provide important novel insight into the efficacy of mHealth applications for HRQoL assessment. If shown to be valid, reliable and feasible for the collection of HRQoL data, mHealth applications may have future potential for facilitating clinical assessment, patient-physician communication, and monitoring individual HRQoL over course of treatment.

Real-time assessment of possible electromagnetic-field-induced changes in protein conformation and thermal stability

Previous studies on possible interactions of radiofrequency electromagnetic fields (RF EMFs) with proteins have suggested that RF EMFs might affect protein structure and folding kinetics. In this study, the isolated thermosensor protein GrpE of the Hsp70 chaperone system of Escherichia coli was exposed to EMFs of various frequencies and field strengths under strictly controlled conditions. Circular dichroism spectroscopy was used to monitor possible structural changes. Simultaneously, temperature was recorded at each point of observation. The coiled-coil part of GrpE has been reported to undergo a well-defined and fully reversible folding/unfolding transition, thus facilitating the differentiation between thermal and non-thermal effects of RF EMFs. Any direct effect of EMF on the conformation and/or stability would result in a shift of the conformational equilibrium of the protein at a given temperature. Possible immediate (t ≤ 0.1 s) and delayed (t ≥ 30 s) effects of RF EMFs were investigated with sinusoidal signals of 0.1, 1.0, and 1.9 GHz at various field strengths up to 5.0 kV/m and with GSM signals at 0.3 kV/m in the protein solution. Taking the overall uncertainty of the experimental system into account, possible RF EMF-induced shifts in the conformational equilibrium of less than 1% of its total range might have been detected. The results obtained with the different experimental protocols indicate, however, that the conformational equilibrium of GrpE is insensitive to electromagnetic fields in the tested range of frequency and field strength.

Background for Real-Time Monitoring and Intervention Related to Alcohol Use

Real-time assessment, known as ecological momentary assessment (EMA), and real-time intervention (ecological momentary intervention [EMI]) can significantly extend the reach and impact of interventions to help individuals reduce their drinking behavior. For EMA, the user provides information on the variable of interest (e.g., drinking or craving) via a mobile device.This data reporting can occur either at pre-specified times or in certain high-risk situations.The primary benefits of EMA include external validity, minimized recall bias, and the ability to capture dynamic patterns in human behavior. EMI refers to interventions that are delivered via mobile devices at the time when the user needs it (i.e., in a high-risk situation). Key constructs of EMI are what interventions are delivered and when they are delivered.The timing of the EMI often is determined by the user's EMA reports. Both EMA and EMI have been studied in people with alcohol use disorders. EMA and EMI often are used in conjunction with each other because EMA can help inform the optimal timing of EMI and help tailor its content. Further development of high-impact, algorithm-driven, technology-mediated real-time intervention may help reduce drinking and promote positive health behavior change.

Ecological Momentary Assessment and Alcohol Use Disorder Treatment

The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA).This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feed- back as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts.

Experimental system for real-time assessment of potential changes in protein conformation induced by electromagnetic fields

A novel experimental system to distinguish between potential thermal and non-thermal effects of electromagnetic fields (EMFs) on the conformational equilibrium and folding kinetics of proteins is presented. The system comprises an exposure chamber installed within the measurement compartment of a spectropolarimeter and allows real-time observation of the circular dichroism (CD) signal of the protein during EMF exposure. An optical temperature probe monitors the temperature of the protein solution at the site of irradiation. The electromagnetic, thermal, and fluid-dynamic behavior of the system is characterized by numerical and experimental means. The number of repeated EMF on/off cycles needed for achieving a certain detection limit is determined on the basis of the experimentally assessed precision of the CD measurements. The isolated thermosensor protein GrpE of the Hsp70 chaperone system of Eschericha coli serves as the test protein. Long-term experiments show high thermal reproducibility as well as thermal stability of the experimental setup.

BALANCE (Bioengineering Approaches for Lifestyle Activity and Nutrition Continuous Engagement): developing new technology for monitoring energy balance in real time

Methods that measure energy balance accurately in real time represent promising avenues to address the obesity epidemic. We developed an electronic food diary on a mobile phone that includes an energy balance visualization and computes and displays the difference between energy intake from food entries and energy expenditure from a multiple-sensor device that provides objective estimates of energy expenditure in real time. A geographic information system dataset containing locations associated with activity and eating episodes is integrated with an ArcPad mapping application on the phone to provide users with a visual display of food sources and locations associated with physical activity within their proximal environment. This innovative tool captures peoples' movement through space and time under free-living conditions and could potentially have many health-related applications in the future.

Wireless Handheld Computers in the Preclinical Undergraduate Curriculum

This report presents the results of a pilot project using wireless PDAs as teaching tools in an undergraduate medical curriculum. This technology was used to foster a transition from a passive to an interactive learning environment in the classroom and provided a solution for the implementation of computer-based exams for a large class. Wayne State Medical School recently provided model e570 Toshiba PocketPCs® (personal digital assistants or PDAs), network interface cards, and application software developed by CampusMobility® to 20 sophomore medical students. The pilot group of preclinical students used the PDAs to access web-based course content, for communication, scheduling, to participate in interactive teaching sessions, and to complete course evaluations. Another part of this pilot has been to utilize the PDAs for computer-based exams in a wireless environment. Server authentication that restricted access during the exams and a proctoring console to monitor and record the PDA screens will be described in this report. Results of a student satisfaction survey will be presented.