Characteristics of Patients Who Report Confusion After Reading Their Primary Care Clinic Notes Online.

Patient access to online electronic medical records (EMRs) is increasing and may offer benefits to patients. However, the inherent complexity of medicine may cause confusion. We elucidate characteristics and health behaviors of patients who report confusion after reading their doctors' notes online. We analyzed data from 4,528 patients in Boston, MA, central Pennsylvania, and Seattle, WA, who were granted online access to their primary care doctors' clinic notes and who viewed at least one note during the 1-year intervention. Three percent of patients reported confusion after reading their visit notes. These patients were more likely to be at least 70 years of age (p < .0001), have fewer years of education (p < .0017), be unemployed (p < .0001), have lower levels of self-reported health (p < .0043), and worry more after reading visit notes (relative risk [RR] 4.83; confidence interval [CI] 3.17, 7.36) compared to patients who were not confused. In adjusted analyses, they were less likely to report feeling more in control of their health (RR 0.42; CI 0.25, 0.71), remembering their care plan (RR 0.26; CI 0.17, 0.42), and understanding their medical conditions (RR 0.32; CI 0.19, 0.54) as a result of reading their doctors' notes compared to patients who were not confused. Patients who were confused by reading their doctors' notes were less likely to report benefits in health behaviors. Understanding this small subset of patients is a critical step in reducing gaps in provider-patient communication and in efforts to tailor educational approaches for patients.

Performance of an underwater acoustic volume array using time-reversal focusing.

Time reversal permits acoustic focusing and beam forming in inhomogeneous and/or high-scattering environments. A volumetric array geometry can suppress back lobes and can fit a large, powerful array of elements into small spaces, like the free-water spaces on submarines. This research investigates applying the time-reversal method to an underwater acoustic volume array. The experiments evaluate the focusing performance of a 27-element volume array when different scattering structures are present within the volume of the array. The array is arranged in a 3x3x3 cubic matrix configuration with 18.75-cm vertical and horizontal element spacing. The system utilizes second-derivative Gaussian pulses to focus on a point 30 cm from the array. Results include a comparison between time-reversal focusing and standard focusing, an evaluation of the volume array's ability to suppress back lobes, and an analysis of how different scattering environments affect focal region size. Potential underwater applications for a volume array using time reversal include acoustic imaging, naval mine hunting, sonar, and underwater communications.