Investigating the Impact of AI on Shared Decision-Making in Post-Kidney Transplant Care (PRIMA-AI): Protocol for a Randomized Controlled Trial.

BACKGROUND: Patients after kidney transplantation eventually face the risk of graft loss with the concomitant need for dialysis or retransplantation. Choosing the right kidney replacement therapy after graft loss is an important preference-sensitive decision for kidney transplant recipients. However, the rate of conversations about treatment options after kidney graft loss has been shown to be as low as 13% in previous studies. It is unknown whether the implementation of artificial intelligence (AI)-based risk prediction models can increase the number of conversations about treatment options after graft loss and how this might influence the associated shared decision-making (SDM). OBJECTIVE: This study aims to explore the impact of AI-based risk prediction for the risk of graft loss on the frequency of conversations about the treatment options after graft loss, as well as the associated SDM process. METHODS: This is a 2-year, prospective, randomized, 2-armed, parallel-group, single-center trial in a German kidney transplant center. All patients will receive the same routine post-kidney transplant care that usually includes follow-up visits every 3 months at the kidney transplant center. For patients in the intervention arm, physicians will be assisted by a validated and previously published AI-based risk prediction system that estimates the risk for graft loss in the next year, starting from 3 months after randomization until 24 months after randomization. The study population will consist of 122 kidney transplant recipients >12 months after transplantation, who are at least 18 years of age, are able to communicate in German, and have an estimated glomerular filtration rate <30 mL/min/1.73 m2. Patients with multi-organ transplantation, or who are not able to communicate in German, as well as underage patients, cannot participate. For the primary end point, the proportion of patients who have had a conversation about their treatment options after graft loss is compared at 12 months after randomization. Additionally, 2 different assessment tools for SDM, the CollaboRATE mean score and the Control Preference Scale, are compared between the 2 groups at 12 months and 24 months after randomization. Furthermore, recordings of patient-physician conversations, as well as semistructured interviews with patients, support persons, and physicians, are performed to support the quantitative results. RESULTS: The enrollment for the study is ongoing. The first results are expected to be submitted for publication in 2025. CONCLUSIONS: This is the first study to examine the influence of AI-based risk prediction on physician-patient interaction in the context of kidney transplantation. We use a mixed methods approach by combining a randomized design with a simple quantitative end point (frequency of conversations), different quantitative measurements for SDM, and several qualitative research methods (eg, records of physician-patient conversations and semistructured interviews) to examine the implementation of AI-based risk prediction in the clinic. TRIAL REGISTRATION: ClinicalTrials.gov NCT06056518; https://clinicaltrials.gov/study/NCT06056518. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54857.

Early ICD implantation following out-of-hospital cardiac arrest: a retrospective cohort study from the Swedish Registry for Cardiopulmonary Resuscitation.

BACKGROUND: It is unclear whether an implantable cardioverter-defibrillator (ICD) is generally beneficial in survivors of out-of-hospital cardiac arrest (OHCA). OBJECTIVE: We studied the association between ICD implantation prior to discharge and survival in patients with cardiac aetiology or initial shockable rhythm in OHCA. DESIGN: We conducted a retrospective cohort study in the Swedish Registry for Cardiopulmonary Resuscitation. Treatment associations were estimated using propensity scores. We used gradient boosting, Bayesian additive regression trees, neural networks, extreme gradient boosting and logistic regression to generate multiple propensity scores. We selected the model yielding maximum covariate balance to obtain weights, which were used in a Cox regression to calculate HRs for death or recurrent cardiac arrest. PARTICIPANTS: All cases discharged alive during 2010 to 2020 with a cardiac aetiology or initial shockable rhythm were included. A total of 959 individuals were discharged with an ICD, and 2046 were discharged without one. RESULTS: Among those experiencing events, 25% did so within 90 days in the ICD group, compared with 52% in the other group. All HRs favoured ICD implantation. The overall HR (95% CI) for ICD versus no ICD was 0.38 (0.26 to 0.56). The HR was 0.42 (0.28 to 0.63) in cases with initial shockable rhythm; 0.18 (0.06 to 0.58) in non-shockable rhythm; 0.32 (0.20 to 0.53) in cases with a history of coronary artery disease; 0.36 (0.22 to 0.61) in heart failure and 0.30 (0.13 to 0.69) in those with diabetes. Similar associations were noted in all subgroups. CONCLUSION: Among survivors of OHCA, those discharged with an ICD had approximately 60% lower risk of death or recurrent cardiac arrest. A randomised trial is warranted to study this further.

When performance is not enough-A multidisciplinary view on clinical decision support.

Scientific publications about the application of machine learning models in healthcare often focus on improving performance metrics. However, beyond often short-lived improvements, many additional aspects need to be taken into consideration to make sustainable progress. What does it take to implement a clinical decision support system, what makes it usable for the domain experts, and what brings it eventually into practical usage? So far, there has been little research to answer these questions. This work presents a multidisciplinary view of machine learning in medical decision support systems and covers information technology, medical, as well as ethical aspects. The target audience is computer scientists, who plan to do research in a clinical context. The paper starts from a relatively straightforward risk prediction system in the subspecialty nephrology that was evaluated on historic patient data both intrinsically and based on a reader study with medical doctors. Although the results were quite promising, the focus of this article is not on the model itself or potential performance improvements. Instead, we want to let other researchers participate in the lessons we have learned and the insights we have gained when implementing and evaluating our system in a clinical setting within a highly interdisciplinary pilot project in the cooperation of computer scientists, medical doctors, ethicists, and legal experts.

Deep Learning on Ultrasound Images Visualizes the Femoral Nerve with Good Precision.

The number of hip fractures per year worldwide is estimated to reach 6 million by the year 2050. Despite the many advantages of regional blockades when managing pain from such a fracture, these are used to a lesser extent than general analgesia. One reason is that the opportunities for training and obtaining clinical experience in applying nerve blocks can be a challenge in many clinical settings. Ultrasound image guidance based on artificial intelligence may be one way to increase nerve block success rate. We propose an approach using a deep learning semantic segmentation model with U-net architecture to identify the femoral nerve in ultrasound images. The dataset consisted of 1410 ultrasound images that were collected from 48 patients. The images were manually annotated by a clinical professional and a segmentation model was trained. After training the model for 350 epochs, the results were validated with a 10-fold cross-validation. This showed a mean Intersection over Union of 74%, with an interquartile range of 0.66-0.81.

Evaluation of a clinical decision support system for detection of patients at risk after kidney transplantation.

Patient care after kidney transplantation requires integration of complex information to make informed decisions on risk constellations. Many machine learning models have been developed for detecting patient outcomes in the past years. However, performance metrics alone do not determine practical utility. We present a newly developed clinical decision support system (CDSS) for detection of patients at risk for rejection and death-censored graft failure. The CDSS is based on clinical routine data including 1,516 kidney transplant recipients and more than 100,000 data points. In a reader study we compare the performance of physicians at a nephrology department with and without the CDSS. Internal validation shows AUC-ROC scores of 0.83 for rejection, and 0.95 for graft failure. The reader study shows that predictions by physicians converge toward the CDSS. However, performance does not improve (AUC-ROC; 0.6413 vs. 0.6314 for rejection; 0.8072 vs. 0.7778 for graft failure). Finally, the study shows that the CDSS detects partially different patients at risk compared to physicians. This indicates that the combination of both, medical professionals and a CDSS might help detect more patients at risk for graft failure. However, the question of how to integrate such a system efficiently into clinical practice remains open.

A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial.

OBJECTIVES: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. DESIGN: Cluster-randomized controlled trial. SETTING: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). PARTICIPANTS: N = 162 residents with dementia. INTERVENTION: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. MEASUREMENTS: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. RESULTS: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (ß = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. CONCLUSIONS: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

Working With Environmental Noise and Noise-Cancelation: A Workload Assessment With EEG and Subjective Measures.

As working and learning environments become open and flexible, people are also potentially surrounded by ambient noise, which causes an increase in mental workload. The present study uses electroencephalogram (EEG) and subjective measures to investigate if noise-canceling technologies can fade out external distractions and free up mental resources. Therefore, participants had to solve spoken arithmetic tasks that were read out via headphones in three sound environments: a quiet environment (no noise), a noisy environment (noise), and a noisy environment but with active noise-canceling headphones (noise-canceling). Our results of brain activity partially confirm an assumed lower mental load in no noise and noise-canceling compared to noise test condition. The mean P300 activation at Cz resulted in a significant differentiation between the no noise and the other two test conditions. Subjective data indicate an improved situation for the participants when using the noise-canceling technology compared to "normal" headphones but shows no significant discrimination. The present results provide a foundation for further investigations into the relationship between noise-canceling technology and mental workload. Additionally, we give recommendations for an adaptation of the test design for future studies.

Implementation and Effects of an Information Technology-Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial.

BACKGROUND: Mobile app-based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. OBJECTIVE: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. METHODS: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. RESULTS: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. CONCLUSIONS: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30621.

Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden.

INTRODUCTION: When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses' experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. METHOD: We conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses' experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed. RESULTS: A main category emerged from the results: " Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety ". The main category was based and formed on the following categories: " Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision ". "Interprofessional collaboration strengthens the medical assessment". "Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level". CONCLUSIONS: Ambulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient's current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.

Tolerability and Efficacy of Clindamycin/Tretinoin versus Adapalene/Benzoyl Peroxide in the Treatment of Acne Vulgaris.

Acne vulgaris is the most common dermatological disorder worldwide, causing significant physical and psychological morbidity. Topical combination therapy has shown superior efficacy compared to monotherapy, especially when combined with retinoids. Few studies have directly compared combined formulations. This evaluator-blinded pilot study compared the efficacy and tolerability of two marketed topical combination acne gels, clindamycin 1%-tretinoin 0.025% (CT) and benzoyl peroxide 2.5%-adapalene 0.1% (BA) in 20 patients with mild to moderate acne vulgaris. Gels were applied daily on opposite sides of the face for 21 days. The primary outcome was difference in transepidermal water loss (TEWL) at the end of treatment. Secondary endpoints were skin moisture content measurement, Investigators' Global Assessment, subject self-assessments (SSA) of burning/stinging, itching, erythema, and dryness/scaling, and Comparative Participant Satisfaction Questionnaire (CPSQ). Efficacy was assessed by inflammatory and non- inflammatory acne efflorescences counts. TEWL increased significantly for both CT and BA (+57.74%, P=0.002; +58.77%, P<0.001); skin moisture content significantly decreased only for BA (-16.47%, P=0.02). Only BA showed a significant increase in erythema and dryness/scaling (P=0.027 and P=0.014) and in SSA burning/stinging (P=0.04). Patient satisfaction evaluation also reflected the strong BA irritation. Although CT and BA both reduced acne lesions (P<0.001) and more patients preferred to continue with CT, subject perception of acne improvement was higher for BA. These findings suggest that CT and BA have similar efficacy in the treatment of mild to moderate papulopustular acne. However, CT was better tolerated than BA by both medical and subject evaluation. CT is an effective and tolerated treatment option.J Drugs Dermatol. 2021;20(3):295-301. doi:10.36849/JDD.2021.5641.

Effects of Spatial Speech Presentation on Listener Response Strategy for Talker-Identification.

This study investigates effects of spatial auditory cues on human listeners' response strategy for identifying two alternately active talkers ("turn-taking" listening scenario). Previous research has demonstrated subjective benefits of audio spatialization with regard to speech intelligibility and talker-identification effort. So far, the deliberate activation of specific perceptual and cognitive processes by listeners to optimize their task performance remained largely unexamined. Spoken sentences selected as stimuli were either clean or degraded due to background noise or bandpass filtering. Stimuli were presented via three horizontally positioned loudspeakers: In a non-spatial mode, both talkers were presented through a central loudspeaker; in a spatial mode, each talker was presented through the central or a talker-specific lateral loudspeaker. Participants identified talkers via speeded keypresses and afterwards provided subjective ratings (speech quality, speech intelligibility, voice similarity, talker-identification effort). In the spatial mode, presentations at lateral loudspeaker locations entailed quicker behavioral responses, which were significantly slower in comparison to a talker-localization task. Under clean speech, response times globally increased in the spatial vs. non-spatial mode (across all locations); these "response time switch costs," presumably being caused by repeated switching of spatial auditory attention between different locations, diminished under degraded speech. No significant effects of spatialization on subjective ratings were found. The results suggested that when listeners could utilize task-relevant auditory cues about talker location, they continued to rely on voice recognition instead of localization of talker sound sources as primary response strategy. Besides, the presence of speech degradations may have led to increased cognitive control, which in turn compensated for incurring response time switch costs.

LTOT Patients' Experience of a Portable Oxygen Unit and Health-Related Quality of Life-A Cross-Sectional Study.

Background: The purpose of the present study was to elucidate the experiences of long-term oxygen therapy (LTOT) patients with a portable oxygen unit and to describe the patients' self-assessed health-related quality of life (HRQoL). Methods: The study employed a prospective cross-sectional design. Data collection entailed two questionnaires, namely the MedTech20 (patients' experience of the medical device in four areas) and EQ-5D (HRQoL). The informants consisted of patients (n = 148) treated with such a medical device and that were registered in Skåne University Hospital's database, Medusa. Results: In the domain Sense of security the informant felt the equipment reliable and safe to use and expressed a sense of control for the user. Regarding Social participation, the responses did not indicate the device to facilitate leisure activities, movement outside the homes, traveling or everyday tasks to a larger extent. The respondents did express a reduced sense of compromised integrity, with a minor effect on Intimacy. With regards to Convenience, the responses indicated the product to provide Adaptability to personal needs. Overall, a strongly affected HRQoL (Your current health condition, EQ-VAS Md = 50 (IQR 36-70)) with strong correlation with EQ-5D was seen. Conclusions: Informants experienced the portable oxygen unit as reliable and safe to use while giving a sense of control over the disease itself. A minor impact on social participation was reported, except for a reduced sense of compromised integrity. The patients also reported a strongly reduced HRQoL.

The Experience of Using Video Support in Ambulance Care: An Interview Study with Physicians in the Role of Regional Medical Support.

Background: In order to facilitate more effective patient assessment and diagnostic support by improving the flow of information between ambulance nurses (AN) and physicians in the role of regional medical support (RMS), an application was developed for transmitting real-time video images. Objective: The objective of this study was to elucidate the physicians' experiences using a video application to support the assessment and triage procedure in ambulance care, when patients are deemed to not have an urgent need for emergency care. Design: The design for this research was a qualitative interview study. Ten physicians, working as RMS in ambulance care, were purposively selected to participate. The telemedicine concept studied consisted of a real-time video image application, in addition to the currently used mobile phone. When a patient was deemed eligible for inclusion in the study, the ambulance nurse (AN) contacted the RMS via telephone to initiate a video consultation. To elucidate the RMS experience of using the application, a conventional content analysis was performed. Results: The main theme "a feeling of being satisfied through a sense of increased patient safety" emerged from the following two categories: adds value in diagnosing situations (three subcategories, i.e., support in diagnosing, usability, and technical weakness) and increase communication opportunities (four subcategories, i.e., assessing the level of care, patient dialogue, professional communication, and team learning). Conclusions: Physicians in the role of RMS experienced a positive impact using video image transmission in addition to the currently used mobile phone. This evaluation was derived from a sense of increased patient safety in the assessment situation when patients were considered to be triaged to self-care.

Quality of life in people with dementia living in nursing homes: validation of an eight-item version of the QUALIDEM for intensive longitudinal assessment.

PURPOSE: Our aim was to examine whether quality of life which was repeatedly assessed over time is related with the comprehensive assessment of quality of life (QoL) and thereby to validate a brief QoL assessment. METHOD: This longitudinal study used a comprehensive assessment of quality of life at baseline (QUALIDEM; 37 items) to validate an eight-item version of QUALIDEM to assess momentary quality of life which was repeatedly administered using a tablet device after baseline. In all, 150 people with dementia from 10 long-term facilities participated. Momentary quality of life and comprehensive quality of life, age, gender, activities of daily living (Barthel Index), Functional assessment staging (FAST), and Geriatric Depression (GDS) have been assessed. RESULTS: Comprehensive and momentary quality of life showed good internal consistency with Cronbach's alpha of .86 and .88 to .93, respectively. For multiple associations of momentary quality of life with the comprehensive quality of life, momentary quality of life was significantly related to comprehensive quality of life (B = .14, CI .08/.20) and GDS (B = - .13, CI - .19/- .06). More specifically, the comprehensive QUALIDEM subscales 'positive affect', 'negative affect', 'restlessness', and 'social relationships' showed significant positive associations with momentary quality of life (p < .001). CONCLUSION: We found that momentary quality of life, reliably assessed by tablet, was associated with comprehensive measures of quality of life and depressive symptoms in people with dementia. Broader use of tablet-based assessments within frequent QoL measurements may enhance time management of nursing staff and may improve the care quality and communication between staff and people with dementia.

EffiCare: Better Prognostic Models via Resource-Efficient Health Embeddings.

Recent medical prognostic models adapted from high data-resource fields like language processing have quickly grown in complexity and size. However, since medical data typically constitute low data-resource settings, performances on tasks like clinical prediction did not improve expectedly. Instead of following this trend of using complex neural models in combination with small, pre-selected feature sets, we propose EffiCare, which focuses on minimizing hospital resource requirements for assistive clinical prediction models. First, by embedding medical events, we eliminate manual domain feature-engineering and increase the amount oflearning data. Second, we use small, but data-efficient models, that compute faster and are easier to interpret. We evaluate our approach on four clinical prediction tasks and achieve substantial performance improvements over highly resource-demanding state-of-the-art methods. Finally, to evaluate our model beyond score improvements, we apply explainability and interpretability methods to analyze the decisions of our model and whether it uses data sources and parameters efficiently.1.

Dataset on multichannel connectivity and video transmission carried on commercial 3G/4G networks in southern Sweden.

In this data article, we report real-world data on multichannel connectivity and videotransmission carried on commercial 3G/4G networks in the region of Skåne, southern Sweden. The data reported here complement the research article "Technical feasibility and ambulance nurses' view of a digital telemedicine system in pre-hospital stroke care - A pilot study" (1). The dataset was originally collected as part of a project aimed to test in a clinical setting the quality and usefulness of a linked image and sound transmission in the prehospital assessment of patients with suspected stroke. The project built on previous studies indicating that using high-quality telemedicine in stroke cases is feasible and has already impacted local stroke care Schwamm et al., 2009. In addition, studies support the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making Demaerschalk et al., 2012. Cellular networks for 3/4G networks have been greatly improved, a prerequisite for the use of these networks for e. g. medical applications. However, connectivity maps for planning purposes are usually based on theoretical values that do not consider smaller features of the terrain such as large trees, hills, rocks etc. and that may interfere with connectivity. To leverage several networks, multichannel devices have been developed that split the original transmission onto several independent channels and recombine the transmission on the receiver side. This setup allows to increase the available bandwidth and introduces at the same time an element of redundancy, provided that several providers with independent networks are used.

Technical feasibility and ambulance nurses' view of a digital telemedicine system in pre-hospital stroke care - A pilot study.

BACKGROUND: High-quality telemedicine in cases of suspected stroke has comparable precision with on-site medical examinations. A novel technical concept was developed in order to deliver a video/audio system to achieve more efficient patient assessment and diagnostic support. AIMS AND OBJECTIVES: The aim of the present pilot-study was to evaluate in a clinical setting the quality of a linked image and sound transmission in the prehospital assessment of patients with suspected stroke. In addition, we wanted to elucidate how ambulance nurses experienced the use of this innovative technology. DESIGN: The study used a quantitative method using questionnaires with fixed response options, combined with a qualitative approach to assess complementary statements of prehospital emergency care nurses (PEN) that had used the system. METHODS: The study was conducted in one ambulance care office and one hospital in southern Sweden. Six PEN and one neurological specialist (Dr) expressed their perceptions based on 11 cases with suspected stroke. Responses were assessed in the dimensions of the technology (Dr - image quality/sound quality; Dr and PEN), safety, sense of increased control and uniform assessment. A questionnaire technique was used, complemented with a qualitative part of the content analysis (PEN views). RESULTS: In the technology dimension, the Dr evaluated the image quality as Very good to Good (100%) while 75% of PEN answered that the digital stroke concept felt reliable to use and the digital stroke assessment is believed to increase uniform assessment. Asked if the present digital concept should be further developed and if further digital systems should be developed in general, the PEN were split in their responses (50 vs 50%), which could be related to a conception of unclear efficacy of the concept. Descriptions of the decisive comments emerged in three categories; Minor operating interference, Physician's competence crucial and Unclear efficacy. CONCLUSION: All respondents seem to have confidence in the assessed digital stroke concept. The image quality is perceived suitable in the assessment situation but the nurses expressed ambiguity about the efficiency of the entire concept. The ambulance nurses also highlighted the physician's skills and personality as important factors for further development of the concept.

P300 indicates context-dependent change in speech quality beyond phonological change.

OBJECTIVE: Non-invasive physiological methods like electroencephalography (EEG) are increasingly employed to assess human information processing during exposure to multimedia signals. In the quality engineering field, previous research has promoted the utility of the P300 event-related brain potential (ERP) component for indicating variation in quality perception. The present study provides a starting point to test whether the P300 and its two subcomponents, P3a and P3b, are truly reflective of changes in the perceived quality of transmitted speech signals given the presence of other, quality-unrelated changes in acoustic stimulation. APPROACH: High-quality and degraded variants of spoken words were presented in a two-feature oddball task, which required participants to actively respond to rarely occurring 'target' stimuli within a series of frequent 'standard' stimuli, thereby eliciting ERP waveforms. Target presentations involved either single quality changes or concurrent double changes in quality and the initial phoneme. MAIN RESULTS: In case additional phonological change was present, only varying quality of standard stimuli caused significant modulations in P3a and P3b characteristics (N = 32). Thus, the formation of different short-term quality references exerted a persisting influence on the auditory processing of transmitted speech. SIGNIFICANCE: The obtained results elucidate the importance of contextual and content-related influencing factors for proving the validity of the P300 as a psychophysiological indicator of speech quality change. Associated questions regarding the transfer of ERP-based quality assessment into more practically relevant measurement contexts are discussed.

Correction: Using imaging photoplethysmography for heart rate estimation in non-human primates.

[This corrects the article DOI: 10.1371/journal.pone.0202581.].