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We describe a free-space optical communications system operating with an externally modulated infrared carrier signal at 1550 nm. The purpose of the system is to explore an alternative to radio-frequency wireless communications, which are subject to spectral congestion and bandwidth limitations. We provide details of the optical alignment procedure and a means for extrapolating the obtained results to larger transmission distances. To illustrate the versatility of the system, a relatively wideband signal was chosen for transmission: an NTSC analog video signal, whose instantaneous bandwidth was 6 MHz. We describe the performance of the system by examining its output image quality and signal-to-noise ratio.
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Objectives: Clinical notes are a veritable treasure trove of information on a patient's disease progression, medical history, and treatment plans, yet are locked in secured databases accessible for research only after extensive ethics review. Removing personally identifying and protected health information (PII/PHI) from the records can reduce the need for additional Institutional Review Boards (IRB) reviews. In this project, our goals were to: (1) develop a robust and scalable clinical text de-identification pipeline that is compliant with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule for de-identification standards and (2) share routinely updated de-identified clinical notes with researchers. Materials and Methods: Building on our open-source de-identification software called Philter, we added features to: (1) make the algorithm and the de-identified data HIPAA compliant, which also implies type 2 error-free redaction, as certified via external audit; (2) reduce over-redaction errors; and (3) normalize and shift date PHI. We also established a streamlined de-identification pipeline using MongoDB to automatically extract clinical notes and provide truly de-identified notes to researchers with periodic monthly refreshes at our institution. Results: To the best of our knowledge, the Philter V1.0 pipeline is currently the first and only certified, de-identified redaction pipeline that makes clinical notes available to researchers for nonhuman subjects' research, without further IRB approval needed. To date, we have made over 130 million certified de-identified clinical notes available to over 600 UCSF researchers. These notes were collected over the past 40 years, and represent data from 2757016 UCSF patients.
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BACKGROUND: The relationship between procedural volume and outcomes for percutaneous coronary interventions (PCI) is contentious, with previous reviews suggesting an inverse volume-outcome relationship. The aim of this study was to systematically review contemporary evidence to re-examine this relationship. METHODS: A systematic review and meta-analysis was undertaken to examine the relationship between PCI procedural volume (both at hospital- and operator-levels) and outcomes in adults. The primary outcome was mortality. The secondary outcomes were complications, healthcare utilisation and process outcomes. Searches were conducted from 1 January 2008 to 28 May 2019. Certainty of the evidence was assessed using 'Grading of Recommendations, Assessment, Development and Evaluations' (GRADE). Screening, data extraction, quality appraisal and GRADE assessments were conducted independently by two reviewers. RESULTS: Of 1,154 unique records retrieved, 22 observational studies with 6,432,265 patients were included. No significant association was found between total PCI hospital volume and mortality (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.69-1.03, I 2 = 86%). A temporal trend from significant to non-significant pooled effect estimates was observed. The pooled effect estimate for mortality was found to be significantly in favour of high-volume operators for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94, I 2 = 93%), and for high-volume hospitals for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94, I 2 = 78%). Overall, GRADE certainty of evidence was 'very low'. There were mixed findings for secondary outcomes. CONCLUSIONS: A volume-outcome relationship may exist in certain situations, although this relationship appears to be attenuating with time, and there is 'very low' certainty of evidence. While volume might be important, it should not be the only standard used to define an acceptable PCI service and a broader evaluation of quality metrics should be considered that encompass patient experience and clinical outcomes. Systematic review registration: PROSPERO, CRD42019125288.