Inter-rater and Intra-rater Reliability of the Videofluoroscopic Dysphagia Scale with the Standardized Protocol.

This study aimed to develop a standardized protocol for the assessment of videofluoroscopic dysphagia scale (VDS) and to demonstrate the inter-rater and intra-rater reliability of the VDS by applying the new standard protocol. A standardized protocol for the VDS was developed by dysphagia experts, including the original developer. To identify the reliability of the VDS using the protocol, 60 patients who underwent videofluoroscopic swallowing study (VFSS) for various etiologies were recruited retrospectively from three tertiary medical centers. Ten randomly selected cases were duplicated to evaluate the intra-rater reliability. Six physicians evaluated the VFSS data sets. Intraclass correlation coefficients were calculated for inter-rater and intra-rater reliability of the VDS score, and Gwet's kappa values for each VDS item were calculated. The inter-rater and intra-rater reliability of the total VDS score was 0.966 and 0.896, respectively. Notably, the evaluators' experience did not appear to have a significant impact on the reliability (physiatrists: 0.933/0.869, residents: 0.922/0.922). The reliability was consistent across different centers and dysphagia etiologies. The inter-rater and intra-rater reliability of the oral and pharyngeal sub-scores were 0.953/0.861 and 0.958/0.907, respectively. The inter-rater agreement of individual items ranged from 0.456 to 0.929, and nine items demonstrated good to very good level of agreement. Assessment of dysphagia using the VDS with the standard protocol showed excellent inter-rater and intra-rater reliabilities regardless of the evaluator's experience, VFSS equipment, and dysphagia etiologies. The VDS can be a useful assessment scale in the quantitative analysis of dysphagia based on VFSS findings.

Symptoms and daily experiences reported by children with cancer using a game-based app.

PURPOSE: Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app. DESIGN AND METHODS: Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis. RESULTS: Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms. CONCLUSIONS: Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population. PRACTICE IMPLICATIONS: Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.

Cortical thickness as predictor of response to exercise in people with Parkinson's disease.

We previously showed that dual-task cost (DTC) on gait speed in people with Parkinson's disease (PD) improved after 6 weeks of the Agility Boot Camp with Cognitive Challenge (ABC-C) exercise program. Since deficits in dual-task gait speed are associated with freezing of gait and gray matter atrophy, here we performed preplanned secondary analyses to answer two questions: (a) Do people with PD who are freezers present similar improvements compared to nonfreezers in DTC on gait speed with ABC-C? (b) Can cortical thickness at baseline predict responsiveness to the ABC-C? The DTC from 39 freezers and 43 nonfreezers who completed 6 weeks of ABC-C were analyzed. A subset of 51 participants (21 freezers and 30 nonfreezers) with high quality imaging data were used to characterize relationships between baseline cortical thickness and delta (Δ) DTC on gait speed following ABC-C. Freezers showed larger ΔDTC on gait speed than nonfreezers with ABC-C program (p < .05). Cortical thickness in visual and fronto-parietal areas predicted ΔDTC on gait speed in freezers, whereas sensorimotor-lateral thickness predicted ΔDTC on gait speed in nonfreezers (p < .05). When matched for motor severity, visual cortical thickness was a common predictor of response to exercise in all individuals, presenting the largest effect size. In conclusion, freezers improved gait automaticity even more than nonfreezers from cognitively challenging exercise. DTC on gait speed improvement was associated with larger baseline cortical thickness from different brain areas, depending on freezing status, but visual cortex thickness showed the most robust relationship with exercise-induced improvements in DTC.

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury: A Retrospective Cohort Study.

OBJECTIVE: To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI. METHODS: Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data. RESULTS: The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53-0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17-4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00-1.02; P = .009). CONCLUSIONS: Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.

Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors.

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.

Theoretical Investigation of the Radical-Radical Reaction of O((3)P) + C2H3 and Comparison with Gas-Phase Crossed-Beam Experiments.

Herein, we present an ab initio study of the prototypal radical-radical reactions of ground-state atomic oxygen [O((3)P)] with the vinyl (C2H3) radical using density functional theory and a complete basis set model. Two distinctive pathways on the lowest doublet potential energy surfaces (PESs) were predicted to be in competition: addition and abstraction. The barrierless addition of O((3)P) to the hydrocarbon radicals leads to energy-rich intermediate formation followed by subsequent isomerization and decomposition to yield various products: CH2CO (ketene) + H, CO + CH3, C2HOH (acetylenol) + H, (3,1)CCHOH + H, H2O + C2H, (3,1)CH2 + HCO, H2CO (formaldehyde) + CH, C2H2 (acetylene) + OH, and (3,1)CCH2 + OH. The competing but minor H-atom abstraction mechanisms produce C2H2 + OH and (1,3)CCH2 + OH. The optimized structures of the reactants, products, intermediates, and transition states and the reaction mechanisms were obtained on the lowest doublet PESs. The major pathway was predicted to be the formation of CH2CO + H through the low-barrier, single-step cleavages of the addition intermediates. The Levine-Bernstein prior method, statistical surprisal approach, and microcanonical Rice-Ramsperger-Kassel-Marcus theory were applied to deduce the energy distributions of H atoms and OH products and quantitative rate constants. On the basis of the statistical theory and the population analysis, the predicted energy distributions were compared to the kinetic energy release of H and the preferential population of the Π(A') component of OH products reported in recent gas-phase crossed-beam investigations (Park, M. J.; Jang, S. C.; Choi, J. H. J. Chem. Phys. 2012, 137, 204311), and their kinetic and dynamic characteristics were discussed.

Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) may appear on computerized tomography scans after mechanical thrombectomy for acute ischemic stroke. The incidence and prognosis of this observation remain unknown. We investigated the frequency and clinical consequences of SAH after treating acute ischemic stroke with a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent. METHODS: Seventy-four consecutive patients with acute ischemic stroke underwent mechanical thrombectomy with a Solitaire stent as a first-line treatment. Nonenhanced computerized tomography scans were performed before, immediately after, and 24 hours after treatment to detect SAH. Clinical outcome was assessed after treatment, on day 1, at discharge, and at 3 months. Clinical and radiological data were compared between patients with and without SAH. RESULTS: Twelve patients (16.2%) exhibited SAH associated with pure SAH (n=4) or mixed SAH and contrast extravasation (n=8). The SAH was located in the ipsilateral Sylvian fissure (n=11) or bilateral parietooccipital sulci (n=1). Patients with SAH had no periprocedural vessel perforations or arterial dissections and no postprocedural neurological deteriorations. Rescue angioplasty was performed more frequently in SAH group than in control group (33.3% vs 9.7%; P=0.05). Patients with SAH and those without had similar recanalization rates and clinical outcomes. CONCLUSIONS: SAH on post-therapeutic computerized tomography scans were not uncommon after primary mechanical thrombectomy with a Solitaire stent, but they seemed to be benign. Rescue angioplasty and unidentified, small vessel ruptures due to mechanical stretch during stent retrieval might give rise to these lesions.

Effect of electrical stimulation on botulinum toxin a therapy in patients with chronic myofascial pain syndrome: a 16-week randomized double-blinded study.

OBJECTIVE: To evaluate the effect of different intensities of electrical stimulation on botulinum toxin A (BTX-A) injection at trigger points (TrPs) in patients with chronic myofascial pain syndrome (MPS). DESIGN: Double-blind randomized trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Patients (N=76) with chronic MPS of the neck and shoulder regions. INTERVENTIONS: Patients were randomly assigned to 1 of 2 intervention groups: BTX-A injection followed by (1) electrical stimulation that induces visible muscle contraction (MOTOR group); or (2) electrical stimulation with an intensity just above the sensory threshold (SENSORY group). Electrical stimulation was administered for 30 minutes a day for 3 consecutive days after injection. MAIN OUTCOME MEASURES: The primary outcome was the visual analog scale (VAS) for pain. Secondary outcomes included the Neck Pain and Disability Scale (NPAD), Global Assessment of Improvement Scale (GAS), and pressure pain threshold (PPT). RESULTS: The VAS scores decreased significantly at 4, 8, 12, and 16 weeks from the baseline in both groups. Significant changes in the NPAD score over time were noted only in the SENSORY group at 8, 12, and 16 weeks. The SENSORY group showed lower VAS and NPAD scores at 16 weeks (P=.043 and P=.041, respectively), and higher treatment success rates at 12 and 16 weeks (P=.039 and P=.024, respectively) than the MOTOR group. There was no significant result in the GAS and PPT. CONCLUSIONS: Short-term electrical stimulation may affect the reduction in pain after BTX-A injection at TrPs in patients with chronic MPS of the neck and shoulder regions. Based on the results, it seems that sensory electrical stimulation was superior to motor electrical stimulation as an adjuvant therapy to BTX-A injection in patients with chronic MPS. Further studies are warranted to investigate the method facilitating the effect of BTX-A on MPS.

Immune profiles according to EGFR mutant subtypes and correlation with PD-1/PD-L1 inhibitor therapies in lung adenocarcinoma.

Background: We examined the distributions of 22 immune cell types and the responses to PD-1/PD-L1 inhibitors according to EGFR mutation profile, in three independent datasets of lung adenocarcinoma (LUAD). Methods: We used CIBERSORTx to analyze the distributions of immune cells, and tumor immune dysfunction and exclusion (TIDE) or tumor mutation burden (TMB) to analyze responses to anti-PD-1/PD-L1 therapy, in two public LUAD datasets. The results were verified with a validation set that included patients treated with PD-1/PD-L1 inhibitors. Results: Compared to EGFR mutants, EGFR wild-type carcinomas had higher numbers of CD8+ T cells, CD4 memory activated T cells and neutrophils, and lower numbers of resting dendritic cells and resting mast cells, in two of the datasets. In our subgroup analyses, CD8+ T cells and CD4 memory activated T cells were more numerous in EGFR rare variants than in wild-types, L858R mutants, and exon 19 deletion mutants. In our TIDE or TMB analyses, EGFR rare variants were predicted to respond better to PD-1/PD-L1 inhibitors than wild-types, L858R mutants, and exon 19 deletion mutants. In the validation set verified by immunohistochemical staining, levels of CD8+ T cells in the EGFR rare variant or wild-type groups were significantly higher than in the EGFR L858R and exon 19 deletion groups. In patients treated with PD-1/PD-L1 inhibitors, the survival rates of patients with EGFR wild-type and rare mutant carcinomas were higher than those with L858R and exon 19 deletion carcinomas. Conclusion: The EGFR rare mutation form of LUAD shows a higher immune activation state compared to wild-type, L858R, and exon 19 deletion variants, indicating it as a potential target for PD-1/PD-L1 inhibitor therapy.

Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 1: Rehabilitation for Motor Function (2022).

This clinical practice guideline (CPG) is the fourth edition of the Korean guideline for stroke rehabilitation, which was last updated in 2016. The development approach has been changed from a consensus-based approach to an evidence-based approach using the Grading of Recommendations Assessment Development and Evaluation (GRADE) method. This change ensures that the guidelines are based on the latest and strongest evidence available. The aim is to provide the most accurate and effective guidance to stroke rehabilitation teams, and to improve the outcomes for stroke patients in Korea. Fifty-five specialists in stroke rehabilitation and one CPG development methodology expert participated in this development. The scope of the previous clinical guidelines was very extensive, making it difficult to revise at once. Therefore, it was decided that the scope of this revised CPG would be limited to Part 1: Rehabilitation for Motor Function. The key questions were selected by considering the preferences of the target population and referring to foreign guidelines for stroke rehabilitation, and the recommendations were completed through systematic literature review and the GRADE method. The draft recommendations, which were agreed upon through an official consensus process, were refined after evaluation by a public hearing and external expert evaluation.

Predicting response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer: diffusion-weighted 3 Tesla MR imaging.

PURPOSE: To evaluate the efficacy of diffusion-weighted imaging (DWI) on 3 Tesla (T) MR imaging to predict the tumor response to neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. MATERIALS AND METHODS: Thirty-five patients who underwent neoadjuvant CRT and subsequent surgical resection were included. Tumor volume was measured on T2-weighted MR images before and after neoadjuvant CRT and the percentage of tumor volume reduction was calculated. The apparent diffusion coefficient (ADC) value was measured on the DWI before and after neoadjuvant CRT, and the change of ADC (Δ ADC) was calculated. The histopathologic response was categorized either as a responder to CRT or as a nonresponder. The relationship between the ADC parameters and the percentage of tumor volume reduction or histopathologic response was then evaluated. RESULTS: There was a significant correlation between tumor volume reduction and pre-CRT ADC and Δ ADC, respectively (r = -0.352, r = 0.615). Pre-CRT ADC of the histopathologic responders was significantly lower than that of the histopathologic nonresponders (P = 0.034). Δ ADC of the histopathologic responders was significantly higher than that of the histopathologic nonresponders (P < 0.005). CONCLUSION: DWI on 3T MR imaging may be a promising technique for helping to predict and monitor the treatment response to neoadjuvant CRT in patients with locally advanced rectal cancer.

Stroke Rehabilitation Fact Sheet in Korea.

With rapid aging, the number of stroke survivors with disabilities in Korea is increasing even if mortality is declining. Despite coordinated efforts for quality improvement of stroke rehabilitation in Korea, the statistics of stroke rehabilitation were not well reported. This review aimed to provide contemporary and comprehensive statistics and recent changes in stroke rehabilitation in Korea. The Clinical Practice Guideline for Stroke Rehabilitation in Korea was developed in 2009 and updated in 2012 and 2016. Additionally, the representative databases for stroke rehabilitation include the Korean Brain Rehabilitation Database and the Korean Stroke Cohort for functioning and rehabilitation. These nationwide databases provided current information on stroke rehabilitation. Among Korean stroke survivors, one in three had motor impairment, one in four had cognitive impairment, one in three had speech impairment, one in four was dependent in ambulation, one in six had swallowing difficulty, and one in four was dependent in activities in daily living at 5 years after stroke. Comprehensive inpatient rehabilitation following transfer to the department of rehabilitation medicine significantly decreased stroke-related mortality and long-term disability. This review provides an improved understanding of stroke rehabilitation and guidance to implement timely, coordinated, evidence-based stroke rehabilitation services to relieve the socioeconomic burden of stroke.

Identifying Patients Who Meet Criteria for Genetic Testing of Hereditary Cancers Based on Structured and Unstructured Family Health History Data in the Electronic Health Record: Natural Language Processing Approach.

BACKGROUND: Family health history has been recognized as an essential factor for cancer risk assessment and is an integral part of many cancer screening guidelines, including genetic testing for personalized clinical management strategies. However, manually identifying eligible candidates for genetic testing is labor intensive. OBJECTIVE: The aim of this study was to develop a natural language processing (NLP) pipeline and assess its contribution to identifying patients who meet genetic testing criteria for hereditary cancers based on family health history data in the electronic health record (EHR). We compared an algorithm that uses structured data alone with structured data augmented using NLP. METHODS: Algorithms were developed based on the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing for hereditary breast, ovarian, pancreatic, and colorectal cancers. The NLP-augmented algorithm uses both structured family health history data and the associated unstructured free-text comments. The algorithms were compared with a reference standard of 100 patients with a family health history in the EHR. RESULTS: Regarding identifying the reference standard patients meeting the NCCN criteria, the NLP-augmented algorithm compared with the structured data algorithm yielded a significantly higher recall of 0.95 (95% CI 0.9-0.99) versus 0.29 (95% CI 0.19-0.40) and a precision of 0.99 (95% CI 0.96-1.00) versus 0.81 (95% CI 0.65-0.95). On the whole data set, the NLP-augmented algorithm extracted 33.6% more entities, resulting in 53.8% more patients meeting the NCCN criteria. CONCLUSIONS: Compared with the structured data algorithm, the NLP-augmented algorithm based on both structured and unstructured family health history data in the EHR increased the number of patients identified as meeting the NCCN criteria for genetic testing for hereditary breast or ovarian and colorectal cancers.

Correction: Identifying Patients Who Meet Criteria for Genetic Testing of Hereditary Cancers Based on Structured and Unstructured Family Health History Data in the Electronic Health Record: Natural Language Processing Approach.

[This corrects the article DOI: 10.2196/37842.].

Bone Mineral Density in Adults With Cerebral Palsy.

Low bone mineral density (BMD) is an emerging health issue in adults with cerebral palsy (CP). This cross-sectional study aimed to describe the characteristics of BMD in adults with CP, and to elucidate the risk factors for low BMD in this population. People aged ≥20 years and diagnosed with CP were recruited from February 2014 to November 2014. We assessed BMD using dual-energy X-ray absorptiometry (DXA) for the lumbar spine, femoral neck, and total femur. Moreover, the body composition was assessed using DXA. We included a total of 87 adults with CP (mean age 42.01 years; 52 men). The prevalence of low BMD was 25.3%. Male sex and age were associated with lower BMD. BMD was significantly lower in the non-ambulatory group than that in the ambulatory group for both lumbar spine and femoral neck. The total fat mass demonstrated a positive correlation with the Z-score and BMD for the femur neck and total femur. Body mass index (BMI) and total fat mass were positively correlated with BMD in the lumbar spine, femoral neck, and total femur. However, the Gross Motor Function Classification Scale levels were negatively correlated with BMD at the aforementioned three sites. In conclusion, adults with CP revealed decreased BMD, which was associated with male sex, age, decreased gross motor function, loss of ambulatory function, low BMI, decreased total fat mass, and decreased total fat-free mass.

Body Fat Distribution and Associated Risk of Cardiovascular Disease in Adults With Cerebral Palsy.

Objective: Fat distribution has increasingly been acknowledged as a more significant health parameter than general obesity, in terms of the risk of cardiovascular disease (CVD). We aimed to investigate the regional fat distribution pattern and general body fat characteristics of adults with cerebral palsy (CP), and we explored the risk of CVD in this population. Methods: People aged ≥20 years who were diagnosed with CP were recruited between February 2014 and November 2014. The subjects underwent a structured interview, laboratory studies, and physical examination. The amount and distribution of fat were determined directly by dual-energy X-ray absorptiometry. Laboratory analysis was performed to measure total cholesterol and triglyceride, high-density lipoprotein (HDL), low-density lipoprotein, and fasting plasma glucose levels. The Framingham risk score (FRS) was used to present the 10-year risk for having CVD, and predictors such as sex, age, total cholesterol, HDL, systolic blood pressure, treatment for hypertension, and smoking status were used to calculate the FRS. Results: Ninety-nine adults (58 men, mean age 41.77 ± 8.95 years) with CP were included. The participants consisted of all five levels of the Gross Motor Function Classification System. The mean body mass index (BMI) was 22.52 ± 4.58 kg/m2. According to BMI criteria, 54.9% were overweight and 27.3% were obese. The fat mass index criteria revealed 10.1% excess fat and 7.6% obesity. In univariable regression analysis, age, the timing of physical function deterioration, and android fat percentage were associated with the FRS (p <0.001, p <0.001, and p = 0.007, respectively). In multiple regression analysis, the FRS was associated with age and android fat percentage, based on the following formula: " FRS= - 18 . 549 + 0 . 410  ∗  Age + 0 . 577  ∗  Android percent fat  ( % )   ( R 2 =0 . 528 ) ' '                                                                                                                                          ( p < 0.001 ) . Conclusions: Body fat distribution in the android area is significantly associated with future CVD risk in adults with CP.

Communication of pain by school-age children with cancer using a game-based symptom assessment app: A secondary analysis.

PURPOSE: To evaluate the self-reported pain experiences of school-age children with cancer participating in a feasibility trial of a game-based symptom assessment app. METHOD: Nineteen children (median: 8 years, range 6-12 years old) receiving cancer treatment were recruited to complete five days of symptom tracking between clinical visits using a symptom assessment app. Children could report pain as a general symptom with the ability to further localize pain on an avatar. Children could also describe symptoms in response to the app's free-text questions or the app's diary. Descriptive statistics characterized reports of pain frequency, severity, bother, and location. Free-text responses were examined for pain-related statements and analyzed using content analysis. RESULTS: All 19 children documented pain on at least one day of app reporting between clinical visits. Pain was most frequently recorded as of mild severity and mild bother. Participants localized pain most frequently to the head, followed by the stomach, chest, extremities, and mouth. Eleven children documented 32 qualitative statements which included rich descriptions of pain-related topics (i.e., "my port hurts a little") and location (i.e., "my vision aching"). CONCLUSIONS: These results demonstrate that school-age children with cancer are willing to describe their ambulatory pain experiences on a game-based mobile app through quantitative reports and by using narrative descriptions. Additionally, these findings can potentially guide clinicians in using multiple approaches to elicit a clinically meaningful evaluation of pain in this population.

"There's a problem, now what's the solution?": suggestions for technologies to support the menopausal transition from individuals experiencing menopause and healthcare practitioners.

OBJECTIVE: To elicit novel ideas for informatics solutions to support individuals through the menopausal transition. (Note: We use "individuals experiencing menopause" and "experiences" rather than "symptoms" when possible to counter typical framing of menopause as a cisgender women's medical problem.). METHODS: A participatory design study was conducted 2015-2017 in the Western US. Two sessions were held with individuals experiencing menopause recruited from the general public; and 3 sessions with healthcare practitioners (HCPs) including nurses, physicians, and complementary and integrative health (CIH) practitioners were held. Participants designed technologies addressing informational needs and burdensome experiences. HCPs reflected on designs from participants experiencing menopause. Directed content analysis was used to analyze transcripts. RESULTS: Eight individuals experiencing menopause (n = 4 each session) and 18 HCPs (n = 10 CIH, n = 3 nurses, n = 5 physicians) participated. All participants provided ideas for solution purpose, hardware, software, features and functions, and data types. Individuals experiencing menopause designed technologies to help understand and prevent burdensome menopause experiences. HCPs designed technologies for tracking and facilitating communication. Compared to nurses and physicians, CIH practitioners suggested designs reframing menopause as a positive experience and accounted for the complex lives of individuals experiencing menopause, including stigma; these ideas corresponded to comments made by participants experiencing menopause. Participants from both populations were concerned about data confidentiality and technology accessibility. CONCLUSIONS: Participant generated design ideas included novel ideas and incorporated existing technologies. This study can inform the development of new technologies or repurposing of existing technologies to support individuals through the menopausal transition.

A combined crossed-beam and ab initio study of the atom-radical reaction dynamics of O((3)P) + C(2)H(5)--> C(2)H(4) + OH: analysis of nascent internal state distributions of the OH product.

The oxidation reaction dynamics of ethyl radicals (C(2)H(5)) in the gas phase are investigated by applying a combination of high-resolution laser induced fluorescence spectroscopy in a crossed-beam configuration and ab initio theoretical calculations. The supersonic atomic oxygen (O((3)P)) and ethyl (C(2)H(5)) reactants are produced by photodissociation of NO(2) and supersonic flash pyrolysis of a synthesized precursor (azoethane), respectively. An exothermic channel leading to the C(2)H(5) + OH (X(2)Pi: upsilon'' = 0, 1) products is identified. The nascent rovibrational state distributions of the OH product show substantial bimodal internal excitations consisting of low- and high-N'' components with neither spin-orbit nor Lambda-doublet propensities in the ground and first excited vibrational states. The averaged vibrational population (P(upsilon'')), partitioning with respect to the low-N'' components of the upsilon'' = 0 level, shows a comparable population ratio of P(0)ratioP(1) = 1 ratio 1.06. On the basis of comparison between the population analyses using ab initio and prior statistical calculations, the title atom-radical reactive scattering processes are governed by dynamic characteristics. The reaction mechanism can be rationalized by two competing mechanisms: abstraction versus addition. The major low N''-components can be described in terms of the direct abstraction process responsible for the comparable vibrational populations, while the minor but hot rotational distribution of the high N''-components implies that some fraction of radical reactants is sampled to proceed through the short-lived addition-complex forming process.

Crossed-beam investigation of O(3P) + C2H5 --> C2H4 + OH.

The reaction dynamics of ground-state atomic oxygen [O((3)P)] with an ethyl radical (C(2)H(5)) in the gas phase was investigated using high-resolution laser spectroscopy in a crossed-beam configuration. An exothermic channel of O((3)P) + C(2)H(5) --> C(2)H(4) + OH was identified, and the nascent distributions of OH (X (2)Pi: upsilon'' = 0, 1) showed significant internal excitations with an unusual bimodal feature of low and high rotational N''-components with neither spin-orbit nor Lambda-doublet propensities. On the basis of the ab initio and statistical calculations, the reaction mechanism can be rationalized by two competing mechanisms: abstraction vs addition. The low N''-components with significant vibrational excitation can be described in terms of the direct abstraction process as a major channel. The extraordinarily hot rotational distribution of high N''-components implies that a portion of the fraction proceeds through the indirect short-lived addition-complex forming process. From the comparative analysis of the reactions of O((3)P) + several hydrocarbon molecules and radicals, the reactivity and mechanistic characteristics of the title reaction are discussed.