Disparities in Offering Enrollment in Remote Patient Monitoring for COVID-19.

Introduction: Remote patient monitoring (RPM) programs are increasingly common. There is a risk that inequitable use of RPM will perpetuate existing health care disparities. We conducted a study to determine if enrollment in a COVID-19 RPM program was offered differentially across demographic groups. Methods: From March through September 2020, patients with COVID-19 were evaluated within a large academic health system with a standardized care pathway that directed providers to refer the patients for RPM. We conducted a retrospective cohort study to evaluate the effects of social vulnerability and urbanicity of residence on the odds of referral. We estimated vulnerability using the CDC social vulnerability index (SVI) and used logistic regression to determine odds ratios (ORs) for referral based on SVI and urbanicity. Results: Of 16,739 patients who had a qualifying health care encounter, 2,946 (17.6%) were referred for RPM. Patients in census tracts with higher social vulnerability were less likely to be referred than those in tracts with lower vulnerability (OR 0.73, 95% confidence interval 0.63-0.84). Patients living in Micropolitan/Large Rural Cities or Small Towns/Small Rural Towns were more likely to be referred than those in Metropolitan/Urban areas. In the full regression model, including both SVI and urbanicity, urbanicity was the strongest predictor of referral, and patients living in Metropolitan/Urban areas were the most likely to be referred. Conclusions: We found disparities in who is offered access to remote monitoring despite the use of standardized care pathways. Health systems need to evaluate how they implement RPM programs and care pathways to ensure equitable care delivery.

Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review.

OBJECTIVE: Cervical lymphadenopathy is a frequent finding in children that poses diagnostic challenges. We sought to compare the utility of fine needle aspiration (FNA) with ultrasound (US) for evaluating pediatric cervical lymphadenopathy based on published literature. STUDY DESIGN: In October 2019, we performed a comprehensive electronic search of PubMed, OVID (MEDLINE), EMBASE, and Scopus databases. Two authors independently screened and assessed full-text reports of potentially eligible studies. We compared sensitivity, specificity, positive predictive value estimates, and balanced accuracy for determining the underlying etiology of lymphadenopathy. RESULTS: The initial search returned 7736 possible studies, of which 31 met the criteria for inclusion. A total of 25 studies were included in the final analysis, with a total of 4721 patients, of which 52.8% were male. Of these, 9 (36.0%) examined US, and 16 (64%) examined fine needle aspiration. The pooled balanced accuracy for determining etiology was 87.7% for US and 92.9% for FNA. Reactive lymphadenopathy was identified in 47.9%, 9.2% were malignant, 12.6% were granulomatous, and 6.6% were non-diagnostic. CONCLUSIONS: In this systematic review, US was identified as an accurate initial diagnostic imaging modality in children. Fine needle aspiration was found to play a significant role in ruling out malignant lesions and potentially avoiding excisional biopsy.

Remote Patient Monitoring for COVID-19: A Retrospective Study on Health Care Utilization.

Introduction: Data are limited on the effectiveness of remote patient monitoring (RPM) for acute illnesses, including COVID-19. We conducted a study to determine if enrollment in a COVID-19 RPM program was associated with better outcomes. Methods: From March through September 2020, patients with respiratory symptoms and presumptive COVID-19 were referred to the health system's COVID-19 RPM program. We conducted a retrospective cohort study comparing outcomes for patients enrolled in the RPM (n = 4,435) with those who declined enrollment (n = 2,742). Primary outcomes were emergency room, hospital, and intensive care unit admissions, and death. We used logistic regression to adjust for demographic differences and known risk factors for severe COVID-19. Results: Patients enrolled in the RPM were less likely to have risk factors for severe COVID-19. There was a significant decrease in the odds of death for the group enrolled in the RPM (adjusted odds ratio [OR] = 0.50; 95% confidence interval [CI], 0.30-0.83) and a nonsignificant decrease in the odds of the other primary outcomes. Increased number of interactions with the RPM significantly decreased the odds of hospital admission (OR = 0.92; 95% CI, 0.88-0.95). Conclusions: COVID-19 RPM enrollment was associated with decreased odds of death, and the more patients interacted with the RPM, the less likely they were to require hospital admission. RPM is a promising tool that has the potential to improve patient outcomes for acute illness, but controlled trials are necessary to confirm these findings.

A cooperative adsorbent for the switch-like capture of carbon dioxide from crude natural gas.

Natural gas constitutes a growing share of global primary energy due to its abundant supply and lower CO2 emission intensity compared to coal. For many natural gas reserves, CO2 contamination must be removed at the wellhead to meet pipeline specifications. Here, we demonstrate the potential of the diamine-appended metal-organic framework ee-2-Mg2(dobpdc) (ee-2 = N,N-diethylethylenediamine; dobpdc4- = 4,4'-dioxidobiphenyl-3,3'-dicarboxylate) as a next-generation CO2 capture material for high-pressure natural gas purification. Owing to a cooperative adsorption mechanism involving formation of ammonium carbamate chains, ee-2-Mg2(dobpdc) can be readily regenerated with a minimal change in temperature or pressure and maintains its CO2 capacity in the presence of water. Moreover, breakthrough experiments reveal that water enhances the CO2 capture performance of ee-2-Mg2(dobpdc) by eliminating "slip" of CO2 before full breakthrough. Spectroscopic characterization and multicomponent adsorption isobars suggest that the enhanced performance under humid conditions arises from preferential stabilization of the CO2-inserted phase in the presence of water. The favorable performance of ee-2-Mg2(dobpdc) is further demonstrated through comparison with a benchmark material for this separation, zeolite 13X, as well as extended pressure cycling. Overall, these results support continued development of ee-2-Mg2(dobpdc) as a promising adsorbent for natural gas purification.

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes.

PURPOSE OF REVIEW: Glossectomy remains a common treatment of oral tongue malignancies, which has a range of functional impacts depending on the extent of resection. This review aims to categorize and provide context for the approach to reconstructing these defects using recent evidence. RECENT FINDINGS: The reconstruction method of choice should be tailored to the size and location of the glossectomy defect with special consideration to replace tongue volume and preserve mobility. There has been an increasing focus on patient-reported outcomes in oral tongue reconstruction. For defects beyond one-third of the tongue, free tissue reconstruction, and more recently, the submental artery island flap yield excellent results. Advances in reconstruction of larger defects have included preoperative soft tissue planning and assessment of outcomes in total glossectomy patients with laryngeal preservation. SUMMARY: Depending on the defect, the appropriate reconstruction may range from healing by secondary intention to large volume free tissue transfer. In general, functional outcomes diminish with increasing size and complexity of the defect regardless of the reconstructive technique.

Semi-automated Clinical Content Curation of COVID-19 Chatbot Remote Patient Monitoring Solution.

Remote patient monitoring (RPM) programs are being increasingly utilized in the care of patients to manage acute and chronic disease including with acute COVID-19. The goal of this study is to explore the topics and patterns of patients' messages to the care team in an RPM program in patients with presumed COVID-19. We conducted a topic analysis to 6,262 comments from 3,248 patients enrolled in the COVID-19 RMP at M Health Fairview. Evaluation of comments was performed using LDA and CorEx topic modeling. Subject matter experts evaluated topic models, including identification of and defining topics and categories. Topics plotted over time to identify trends in topic weights over the enrollment period. The overall accuracy of comments assignment to topics by LDA and CorEx models were 72.8% and 88.2%. Most identified topics focused on signs and symptoms of COVID-19. Topics related to COVID-19 diagnosis demonstrated a correlation with announcements of availability of viral and antibody testing in national and local media.

Rapid implementation of a COVID-19 remote patient monitoring program.

OBJECTIVE: The study sought to evaluate early lessons from a remote patient monitoring engagement and education technology solution for patients with coronavirus disease 2019 (COVID-19) symptoms. MATERIALS AND METHODS: A COVID-19-specific remote patient monitoring solution (GetWell Loop) was offered to patients with COVID-19 symptoms. The program engaged patients and provided educational materials and the opportunity to share concerns. Alerts were resolved through a virtual care workforce of providers and medical students. RESULTS: Between March 18 and April 20, 2020, 2255 of 3701 (60.93%) patients with COVID-19 symptoms enrolled, resulting in over 2303 alerts, 4613 messages, 13 hospital admissions, and 91 emergency room visits. A satisfaction survey was given to 300 patient respondents, 74% of whom would be extremely likely to recommend their doctor. DISCUSSION: This program provided a safe and satisfying experience for patients while minimizing COVID-19 exposure and in-person healthcare utilization. CONCLUSIONS: Remote patient monitoring appears to be an effective approach for managing COVID-19 symptoms at home.

Hydroxyapatite-doped alginate beads as scaffolds for the osteoblastic differentiation of mesenchymal stem cells.

This work investigates the role of an osteoblastic matrix component, hydroxyapatite (HA), in modular alginate scaffolds to support osteoblastic differentiation of human mesenchymal stem cells for the purpose of tissue engineered bone constructs. This system is first evaluated in a tubular perfusion bioreactor, which has been shown to improve osteoblastic differentiation over static culture conditions. HMSCs in alginate scaffolds that contain HA show increased osteoblastic gene expression compared to cells in pure alginate scaffolds, as well as significantly more matrix production and mineralization. The differentiated hMSCs and cell-laid matrix are ultimately evaluated in an in vivo site specific model. Implantation of these scaffolds with preformed matrix into the rat femoral condyle defects results in abundant bone growth and significant incorporation of the scaffold into the surrounding tissue. The developed mineralized matrix, induced in part by the HA component in the scaffold, could lead to increased tissue development in critically sized defects, and should be included in future implant strategies. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2325-2333, 2016.

Gay and Bisexual Men's Willingness to Use a Self-Collected Anal Cancer Screening Test.

OBJECTIVE: We investigated gay and bisexual men's willingness to self-administer an anal cancer screening test at home. METHODS: We conducted 2 national, online cross-sectional surveys of self-identified gay and bisexual men: Study I in 2009 with men ages 20 to 59 (n = 306) and Study II in 2013 with men ages 18 to 26 (n = 428). We used multivariate logistic regression analyses to determine variables associated with willingness to self-administer the screening test. RESULTS: Most men were willing to self-administer an anal cancer screening test (78% Study I; 67% Study II). In Study I, willingness was higher among men who trusted anal Paps to find treatable cancer (adjusted odds ratio [aOR] = 1.47; 95% CI, 1.04-2.09) and who believed that men who have sex with men should be screened for anal cancer between 1 and 3 years vs. other intervals (aOR = 2.19; 95% CI, 1.17-4.10). In Study II, willingness was higher among men who perceived greater likelihood of anal cancer (aOR = 1.57; 95% CI, 1.12-2.20). Their most common concerns were not performing the test correctly and inaccuracy of results. CONCLUSIONS: Many gay and bisexual men were willing to self-administer anal cancer screening tests at home. If routine screening is warranted, self-collected home testing could improve participation.

Evaluation of the in vitro cytotoxicity of cross-linked biomaterials.

This study evaluated the in vitro cytotoxicity of poly(propylene fumarate) (PPF). PPF is an aliphatic biodegradable polymer that has been well characterized for use in bone tissue engineering scaffolds. Four different cell types, human mesenchymal stem cells (hMSC), fibroblasts (L929), preosteoblasts (MC3T3), and canine mesenchymal stem cells (cMSC), were used to evaluate the cytotoxicity of PPF. These cell types represent the tissues that PPF would interact with in vivo as a bone tissue scaffold. The sol fraction of the PPF films was measured and then utilized to estimate cross-linking density. Cytotoxicity was evaluated using XTT assay and fluorescence imaging. Results showed that PPF supported similar cell metabolic activities of hMSC, L929, MC3T3, and cMSC compared to the noncytotoxic control, high-density polyethylene (HDPE) and were statistically different than those cultured with the cytotoxic control, a polyurethane film containing 0.1% zinc diethyldithiocarbamate (ZCF). Results showed differing cellular responses to ZCF, the cytotoxic control. The L929 cells had the lowest cell metabolic activity levels after exposure to ZCF compared to the cell metabolic activity levels of the MC3T3, hMSC, or cMSC cells. Qualitative verification of the results using fluorescence imaging demonstrated no change in cell morphology, vacuolization, or detachment when cultured with PPF compared to HDPE or blank media cultures. Overall, the cytotoxicity response of the cells to PPF was demonstrated to be similar to the cytotoxic response of cells to known noncytotoxic materials (HDPE).

Ethanol and water adsorption in methanol-derived ZIF-71.

A room temperature method for synthesizing zeolitic imidizolate framework 71 (ZIF-71) is described. The methanol-based synthesis results in >95% yields (based on Zn) and produces crystals with 70% greater surface area than reported earlier. Ethanol uptake into the ZIF compares favorably with a recent modeling-based study. Water uptake was significantly higher than model predictions.

Porous EH and EH-PEG scaffolds as gene delivery vehicles to skeletal muscle.

PURPOSE: Synthetic biomaterials are widely used in an attempt to control the cellular behavior of regenerative tissues. This can be done by altering the chemical and physical properties of the polymeric scaffold to guide tissue repair. This paper addresses the use of a polymeric scaffold (EH network) made from the cyclic acetal monomer, 5-ethyl-5-(hydroxymethyl)-ß,ß-dimethyl-1,3-dioxane-2-ethanol diacrylate (EHD), as a release device for a therapeutic plasmid encoding for an insulin-like growth factor-1 green fluorescent protein fusion protein (IGF-1 GFP). METHODS: Scaffolds were designed to have different porous architectures, and the impact of these architectures on plasmid release was determined. We hypothesized that IGF-1 could be delivered more effectively using a porous scaffold to allow for the release of IGF-1. RESULTS: We showed that by altering the number of pores exposed to the surface of the network, faster plasmid loading and release were achieved. In addition, the IGF-1 GFP plasmids were found to be effective in producing IGF-1 and GFP within human skeletal muscle myoblast cell cultures. CONCLUSIONS: This work aims to show the utility of EH biomaterials for plasmid delivery for potentially localized skeletal muscle regeneration.