ABSTRACT
Data privacy in telemedicine has been extensively considered and reviewed in the literature, such as explorations of consent, who can access information, and the security of electronic systems. However, privacy breaches are also a potential concern in the physical setting and surroundings of the patient. Here we review clinical situations in which there is unanticipated loss of privacy, as well as potential physical and psychological safety concerns for the patient and others when privacy is limited. We identify ethical concerns and explore the challenges of supporting full true autonomous decision-making in this situation. We close with preliminary recommendations at the patient, clinician, and systems levels to help ensure privacy is maintained.
Subject(s)
Privacy , Telemedicine , Humans , ConfidentialityABSTRACT
BACKGROUND: Fatigue is commonly reported by ARDS survivors, but empirical data are scarce. RESEARCH QUESTION: This study evaluated fatigue prevalence and associated variables in a prospective study of ARDS survivors. STUDY DESIGN AND METHODS: This analysis is part of the ARDSNet Long-Term Outcomes Study (ALTOS) conducted at 38 US hospitals. Using age- and sex-adjusted, time-averaged random effects regression models, we evaluated associations between the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale with patient and critical illness variables, and with physical, cognitive, and mental health status at 6 and 12 months following ARDS. RESULTS: Among ARDS survivors, 501 of 711 (70%) and 436 of 659 (66%) reported clinically significant symptoms of fatigue at 6 and 12 months, respectively, with 41% and 28% reporting clinically important improvement and worsening (n = 638). At 6 months, the prevalence of fatigue (70%) was greater than that of impaired physical functioning (50%), anxiety (42%), and depression (36%); 46% reported both impaired physical function and fatigue, and 27% reported co-existing anxiety, depression, and fatigue. Fatigue was less severe in men and in those employed prior to ARDS. Critical illness variables (eg, illness severity, length of stay) had little association with fatigue symptoms. Worse physical, cognitive, and mental health symptoms were associated with greater fatigue at both the 6- and 12-month follow-up. INTERPRETATION: During the first year following ARDS, more than two-thirds of survivors reported clinically significant fatigue symptoms. Due to frequent co-occurrence, clinicians should evaluate and manage survivors' physical, cognitive, and mental health status when fatigue is endorsed.
Subject(s)
Fatigue/epidemiology , Fatigue/etiology , Health Status Indicators , Respiratory Distress Syndrome/complications , Activities of Daily Living , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Severity of Illness Index , Survivors , Time Factors , United States/epidemiologySubject(s)
Colorimetry/methods , Gold/chemistry , Metals/chemistry , Nanostructures/chemistry , Nanostructures/ultrastructure , Nanotechnology/methods , Peptides/chemistry , Crystallization/methods , Ions , Macromolecular Substances/chemistry , Materials Testing , Molecular Conformation , Particle Size , Protein Binding , Surface PropertiesABSTRACT
We used water as an environmental friendly medium for the synthesis of hexagonal WS2 nanoparticles by the pulsed laser method. The materials collected on substrates were oriented with the 2H-WS2 basal planes parallel to the surface. The use of water, UV lasers, and large WS2 targets prevented the nanoparticles from restructuring into inorganic fullerenes, which were observed in research using hydrocarbon solvents, longer wavelength lasers, and dispersed powder targets. Fairly good dispersion of nanoparticles suggests that large surface areas are available for chemical reactivity.
