Designing digital patient experiences: The digital health design framework.

BACKGROUND: Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices. OBJECTIVES: We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx). METHODS: A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach. RESULTS: We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges. CONCLUSIONS: We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.

Risk Factors for Negative Emotions in Patients Undergoing Radical Resection of Hilar Cholangiocarcinoma and Their Influence on Prognosis.

Background: Hilar cholangiocarcinoma (HCCA) is a common malignant tumor of the biliary system. Factors such as limited physical function, intractability, and high mortality caused by the tumor lead to negative emotions, such as anxiety and depression in patients. In this study, we investigated the risk factors for negative emotions in patients undergoing radical resection of HCCA during the perioperative period and its effect on prognosis to provide strategies for alleviating the negative emotional disorders of patients and improving prognosis. Methods: From September 2016 to August 2021, we retrospectively examined 205 patients with HCCA who underwent radical resection in our hospital. The incidence of negative emotions and the clinical parameters of patients were compared using Chi-square tests and t-tests. The independent risk factors for unfavorable feelings in patients during the perioperative period were determined using binary logistic regression. The key variables influencing the postoperative survival status of HCCA patients were identified using the log-rank univariate analysis and Cox proportional risk regression analysis. Results: The results of the binary logistic regression analysis showed that perioperative negative emotions were independently influenced by family monthly income (OR = 0.069), medical insurance (OR = 0.089), family care (OR = 0.013), sleep quality (OR = 0.071), TNF-α (OR = 5.851), and bile leakage (OR = 29.412) (P < 0.05). The age of the patient (OR = 2.003), preoperative CA19-9 (OR = 2.038), lymph node metastases (OR = 2.327), and negative mood (OR = 3.054) were independent risk variables that affected the survival status of patients, as determined by the results of Cox regression analysis (P < 0.05). Conclusion: In this study, we found that anxiety and depression in patients undergoing radical operation of HCCA are related to family monthly income, medical insurance, sleep quality, family care, TNF-α, and bile leakage; also, negative emotions have adverse effects on prognosis.

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study.

Background: Nowadays, the incidence of perihilar cholangiocarcinoma (PHCC) is increasing yearly, and biliary fistula is a common complication. However, there are few reports on the factors affecting the occurrence of biliary fistula. This study aimed to analyze the risk factors for the occurrence of biliary fistula after radical surgery for PHCC in elderly patients to provide a reference basis for improving the prognosis. Methods: From April 2016 to April 2021, we randomly included 250 elderly patients with pathologically diagnosed PHCC. Based on our established inclusion and exclusion criteria, we included 211 patients finally Bile drainage for 3 consecutive days after abdominal drainage or single bile drainage ≥100 mL/d was used as the diagnostic criteria for biliary fistula. Multiple logistic regression was used to analyze the independent risk factors for biliary fistula after radical surgery for PHCC. Besides, the Prognostic Score (PS), the Karnofsky performance score (KPS), and the quality of life (QOL) score were used to assess the patients' postoperative recovery, and survival curves were drawn to reflect their 1-year survival rate, using overall survival. Results: The statistical results showed a 36.5% incidence of biliary fistula. Our study showed that preoperative cholangitis, number of biliary anastomoses, etc. were independent risk factors for grade B and grade C biliary fistula. Besides, the presence of intraoperative hemorrhage (OR =0.223, P=0.006) and γ-glutamyl transpeptidase (γ-GT) on the first postoperative day (OR =1.011, P=0.013) were still independent risk factors for grade B biliary fistula, while C-reactive protein (CRP) (OR =1.026, P=0.011) and total bilirubin (TBil) (OR =0.003, P=1.066) on the first postoperative day and bile duct diameter (OR =0.299, P=0.020) were independent risk factors for grade C biliary fistula. Analysis of variance (ANOVA) showed statistically significant differences (P<0.05) between the three groups in terms of PS (P=0.000), KPS (P=0.001), and QOL scores (P=0.000). Conclusions: The incidence of postoperative biliary fistula remains high in elderly patients treated with radical surgery for PHCC and seriously affects their prognosis. Therefore, focusing on the clinical characteristics and risk factors of patients, improving surgical precision and enhancing postoperative patient care to reduce the likelihood of postoperative biliary fistula, thereby prolonging patient life.

In Situ Visualization of Membrane Fouling Evolution during Ultrafiltration Using Label-Free Hyperspectral Light Sheet Fluorescence Imaging.

Profound understanding of fouling behaviors and underlying mechanisms is fundamentally important for fouling control in membrane-based environmental applications. Therefore, it entails novel noninvasive analytical approaches for in situ characterizing the formation and development of membrane fouling processes. This work presents a characterization approach based on hyperspectral light sheet fluorescence microscopy (HSPEC-LSFM), which is capable of discriminating various foulants and providing their 2-dimensional/3-dimensional spatial distributions on/in membranes in a label-free manner. A fast, highly sensitive and noninvasive imaging platform was established by developing a HSPEC-LSFM system and further extending it to incorporate a laboratory-scale pressure-driven membrane filtration system. Hyperspectral data sets with a spectral resolution of ∼1.1 nm and spatial resolution of ∼3 µm as well as the temporal resolution of ∼8 s/plane were obtained, and the fouling formation and development process of foulants onto membrane surfaces, within the pores and on the pore walls were clearly observed during the ultrafiltration of protein and humic substances solutions. Pore blocking/constriction at short times while cake growth/concentration polarization at longer times was found to have coupled effects for the flux decline in these filtration tests, and yet the contribution of each effect as well as the transition of the governing mechanisms was found distinct. These results demonstrate in situ label-free characterization of membrane fouling evolution with the recognition of foulant species during filtration and provide new insights into membrane fouling. This work offers a powerful tool to investigate dynamic processes for a wide range of membrane-based explorations.

SnS Nanoflakes/Graphene Hybrid: Towards Broadband Spectral Response and Fast Photoresponse.

High responsivity has been recently achieved in a graphene-based hybrid photogating mechanism photodetector using two-dimensional (2D) semiconductor nanosheets or quantum dots (QDs) sensitizers. However, there is a major challenge of obtaining photodetectors of fast photoresponse time and broad spectral photoresponse at room temperature due to the high trap density generated at the interface of nanostructure/graphene or the large band gap of QDs. The van der Waals interfacial coupling in small bandgap 2D/graphene heterostructures has enabled broadband photodetection. However, most of the photocarriers in the hybrid structure originate from the photoconductive effect, and it is still a challenge to achieve fast photodetection. Here, we directly grow SnS nanoflakes on graphene by the physical vapor deposition (PVD) method, which can avoid contamination between SnS absorbing layer and graphene and also ensures the high quality and low trap density of SnS. The results demonstrate the extended broad-spectrum photoresponse of the photodetector over a wide spectral range from 375 nm to 1550 nm. The broadband photodetecting mechanisms based on a photogating effect induced by the transferring of photo-induced carrier and photo-hot carrier are discussed in detail. More interestingly, the device also exhibits a large photoresponsivity of 41.3 AW-1 and a fast response time of around 19 ms at 1550 nm. This study reveals strategies for broadband response and sensitive photodetectors with SnS nanoflakes/graphene.

Ultrasensitive Detection of Biomarkers in a Color-Switchable Microcavity-Reactor Laser.

Early detection and diagnosis are vitally important in reducing the mortality rate of fatal diseases but require highly sensitive detection of biomarkers. Presently, detection methods with the highest sensitivity require in vitro processing, while in vivo compatible fluorescence detections require a much higher concentration of biomarkers or limit of detection (LOD). In this paper, a fundamentally new strategy for ultrasensitive detection based on color-switchable lasing with a cavity-enhanced reduction of LOD is demonstrated, down to 1.4 × 10-16  mg ml-1 for a quantitative detection, lower than both the fluorescence method and plasmonic enhanced method. For a qualitative or a yes/no type of detection, the LOD is as low as 10-17  mg ml-1 . The approach in this work is based on a dye-embedded, in vivo compatible, polystyrene-sphere cavity, penetrable by biomarkers. A polystyrene sphere serves the dual roles of a laser cavity and an in vivo bio-reactor, in which dye molecules react with a biomarker, reporting biomarker information through lasing signals. The cavity-enhanced emission and lasing with only a single biomarker molecule per cavity allow improved visual distinguishability via color changes. Furthermore, when combined with a narrow-band filter, the color-switchable lasers act as an "on-off" logic signal and can be integrated into multiplexing detection assay biochips.

Hot carrier dynamics in MoS2/WS2heterostructure.

TMDs based heterostructure have drawn much attention for its potential application in photoelectric devices benefiting from the rapid and effective carrier separation and ultra-long interlayer exciton lifetime. Recent studies on carrier dynamics of TMDs based heterostructures are mainly focused on the transfer process of photo-generated carriers across the interface and lifetime of interlayer exciton but little attention is paid on the dynamics of hot carriers. Here, the carrier dynamics of hot carriers in MoS2/WS2heterostructure is investigated by transient absorption spectra. Rapid separation of electron and hole is observed. More importantly, hot carriers of C exciton, which contribute to the absorption of most of the visible light, could compensate for the carrier loss in the band edge exciton energy band through the intervalley transfer process. This re-injection process of hot carriers of C exciton could compensate for carrier depletion in photoelectric devices, thus may greatly improve the light utilization in optoelectronic devices.

SnSe Nanosheets: From Facile Synthesis to Applications in Broadband Photodetections.

In recent years, using two-dimensional (2D) materials to realize broadband photodetection has become a promising area in optoelectronic devices. Here, we successfully synthesized SnSe nanosheets (NSs) by a facile tip ultra-sonication method in water-ethanol solvent which was eco-friendly. The carrier dynamics of SnSe NSs was systematically investigated via a femtosecond transient absorption spectroscopy in the visible wavelength regime and three decay components were clarified with delay time of τ1 = 0.77 ps, τ2 = 8.3 ps, and τ3 = 316.5 ps, respectively, indicating their potential applications in ultrafast optics and optoelectronics. As a proof-of-concept, the photodetectors, which integrated SnSe NSs with monolayer graphene, show high photoresponsivities and excellent response speeds for different incident lasers. The maximum photo-responsivities for 405, 532, and 785 nm were 1.75 × 104 A/W, 4.63 × 103 A/W, and 1.52 × 103 A/W, respectively. The photoresponse times were ~22.6 ms, 11.6 ms, and 9.7 ms. This behavior was due to the broadband light response of SnSe NSs and fast transportation of photocarriers between the monolayer graphene and SnSe NSs.

UbasM: An effective balanced optical clearing method for intact biomedical imaging.

Optical clearing methods can facilitate deep optical imaging in biological tissue by reducing light scattering and this has enabled accurate three-dimensional signal visualization and quantification of complex biological structures. Unfortunately, existing optical clearing approaches present a compromise between maximizing clearing capability, the preservation of fluorescent protein emission and membrane integrity and the speed of sample processing - with the latter typically requiring weeks for cm scale tissue samples. To address this challenge, we present a new, convenient, aqueous optical clearing agent, termed UbasM: Urea-Based Amino-Sugar Mixture, that rapidly renders fixed tissue samples highly transparent and reliably preserves emission from fluorescent proteins and lipophilic dyes in membrane integrity preserved tissues. UbasM is simple, inexpensive, reproducible and compatible with all labeling methods that we have encountered. It can enable convenient, volumetric imaging of tissue up to the scale of whole adult mouse organs and should be useful for a wide range of light microscopy and tomography techniques applied to biomedical research, especially the study on organism-level systems biology at multiple levels.

A Thresholdless Tunable Raman Nanolaser using a ZnO-Graphene Superlattice.

A ZnO-graphene superlattice is synthesised via a spatially confined reaction. When illuminated by a pump laser, the Stokes' photons of the superlattice are greatly amplified by the surface plasmon at the interface of the graphene and the ZnO. Benefitting from the special geometry, the ZnO-graphene superlattice allows the generation of a tunable nanolaser that operates from the visible to near-infrared range at room temperature.

Magnetocaloric effects in a freestanding and flexible graphene-based superlattice synthesized with a spatially confined reaction.

Superlattices have attracted great interest because of their tailorable electronic properties at the interface. However, the lack of an efficient and low-cost synthetic method represents a huge challenge to implement superlattices into practical applications. Herein, we report a space-confined nanoreactor strategy to synthesize flexible freestanding graphene-based superlattice nanosheets, which consist of alternately intercalated monolayered metal-oxide frameworks and graphene. Taking vanadium oxide as an example, clear-cut evidences in extended X-ray absorption fine structure, high-resolution transmission electron microscopy and infrared spectra have confirmed that the vanadium oxide frameworks in the superlattice nanosheets show high symmetry derived from the space-confinement and electron-donor effect of graphene layers, which enable the superlattice nanosheets to show emerging magnetocaloric effect. Undoubtedly, this freestanding and flexible superlattice synthesized from a low-cost and scalable method avoids complex transferring processes from growth substrates for final applications and thus should be beneficial to a wide variety of functionalized devices.

Rocking-chair configuration in ultrathin lithium vanadate-graphene hybrid nanosheets for electrical modulation.

The ability to control electronic property of a material by externally applied voltage is greatly anticipated in modern electronics, and graphene provide potential application foreground for this issue on account of its exotic ambipolar transport property. In this study, we proposed that inorganic-graphene intercalated nanosheet is an effective solution to optimize the transport property of graphene. As an example, lithium vanadate-graphene (LiVO-graphene) alternately intercalated nanosheets were designed and successfully synthesized. Theoretical calculation implied that its rocking chair configuration may provide a new pathway to switch the carrier in graphene layer between p-type and n-type while the position of embedded Li ions is controlled by an external field. Thus, a demo transistor was fabricated with layer-by-layer overlapping of LiVO-graphene nanosheets which proved that this inorganic-graphene structure could be used for electrical modulation in electronic devices.