Observational study of travel distance between participants in U.S. telemedicine sessions with estimates of emissions savings.

BACKGROUND: Digital health and telemedicine are potentially important strategies to decrease healthcare's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. OBJECTIVE: This study aimed to (1) determine the travel distance between participants in U.S. telemedicine sessions, and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national, observational data describing the geographical characteristics of telemedicine session participants. METHODS: We conducted a retrospective observational study of telemedicine sessions in the United States between Jan. 1. 2022 and Feb. 21, 2023, on the Doxy.me platform. Using google distance matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the U.S. RESULTS: The median round-trip travel distance between patients and providers was 49 miles. The median CO2 emissions savings per telemedicine session was 19.81 kg CO2. Accounting for the energy costs of telemedicine and U.S. transportation patterns, among other factors, we estimate that the use of telemedicine in the U.S. during the years 2021- 2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. CONCLUSIONS: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based upon national data, indicate that telemedicine may be an important strategy in reducing the healthcare sector's carbon footprint.

Designed Ankyrin Repeat Proteins as Actin Labels of Distinct Cytoskeletal Structures in Living Cells.

The orchestrated assembly of actin and actin-binding proteins into cytoskeletal structures coordinates cell morphology changes during migration, cytokinesis, and adaptation to external stimuli. The accurate and unbiased visualization of the diverse actin assemblies within cells is an ongoing challenge. We describe here the identification and use of designed ankyrin repeat proteins (DARPins) as synthetic actin binders. Actin-binding DARPins were identified through ribosome display and validated biochemically. When introduced or expressed inside living cells, fluorescently labeled DARPins accumulated at actin filaments, validated through phalloidin colocalization on fixed cells. Nevertheless, different DARPins displayed different actin labeling patterns: some DARPins labeled efficiently dynamic structures, such as filopodia, lamellipodia, and blebs, while others accumulated primarily in stress fibers. This differential intracellular distribution correlated with DARPin-actin binding kinetics, as measured by fluorescence recovery after photobleaching experiments. Moreover, the rapid arrest of actin dynamics induced by pharmacological treatment led to the fast relocalization of DARPins. Our data support the hypothesis that the localization of actin probes depends on the inherent dynamic movement of the actin cytoskeleton. Compared to the widely used LifeAct probe, one DARPin exhibited enhanced signal-to-background ratio while retaining a similar ability to label stress fibers. In summary, we propose DARPins as promising actin-binding proteins for labeling or manipulation in living cells.

Will the United States pass on telemedicine progress?

Background: During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Methods: Here, we argue that we must continue the flexibilities to better understand telemedicine's quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. Conclusion: We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine's quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.

Narrative review of telemedicine applications in decentralized research.

Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.

HyPer as a tool to determine the reductive activity in cellular compartments.

A multitude of cellular metabolic and regulatory processes rely on controlled thiol reduction and oxidation mechanisms. Due to our aerobic environment, research preferentially focuses on oxidation processes, leading to limited tools tailored for investigating cellular reduction. Here, we advocate for repurposing HyPer1, initially designed as a fluorescent probe for H2O2 levels, as a tool to measure the reductive power in various cellular compartments. The response of HyPer1 depends on kinetics between thiol oxidation and reduction in its OxyR sensing domain. Here, we focused on the reduction half-reaction of HyPer1. We showed that HyPer1 primarily relies on Trx/TrxR-mediated reduction in the cytosol and nucleus, characterized by a second order rate constant of 5.8 × 102 M-1s-1. On the other hand, within the mitochondria, HyPer1 is predominantly reduced by glutathione (GSH). The GSH-mediated reduction rate constant is 1.8 M-1s-1. Using human leukemia K-562 cells after a brief oxidative exposure, we quantified the compartmentalized Trx/TrxR and GSH-dependent reductive activity using HyPer1. Notably, the recovery period for mitochondrial HyPer1 was twice as long compared to cytosolic and nuclear HyPer1. After exploring various human cells, we revealed a potent cytosolic Trx/TrxR pathway, particularly pronounced in cancer cell lines such as K-562 and HeLa. In conclusion, our study demonstrates that HyPer1 can be harnessed as a robust tool for assessing compartmentalized reduction activity in cells following oxidative stress.

Telemedicine from Home or the Office: Perceptions of Mental Health Providers.

Introduction: The COVID-19 pandemic led to a rapid transition to telemedicine for mental health care and redefined many providers' work environments and practices. The purpose of the study was to investigate the impact of work location on telemental health (TMH) benefits, disruptions, and concerns to further understand the rapid implementation of telemedicine for mental health treatment. Methods: A sample of 175 practicing TMH providers completed an online survey between July and August 2020. Providers answered questions about personal demographics and practice characteristics. Next, they answered questions about benefits, disruptions, and concerns regarding the use of telemedicine in their practice. Chi-square and independent samples t-test were conducted to identify work location differences for personal demographics and clinical practice characteristics. Three multivariate analyses of covariance were conducted to examine overall differences in perceptions of telemedicine benefits, concerns, and disruptions based on work location while covarying for provider race, ethnicity, percentage of caseload seen through telemedicine, practice type, specialty, and primary method of reimbursement. Results: TMH providers who primarily work from an office reported more benefit of reduced costs/overhead (ηp2 = 0.039), less benefit of limiting the spread of the virus (ηp2 = 0.028), and more concern about reimbursement (ηp2 = 0.046) than those who primarily work from home. We observed no difference in disruptions, patient access to care, quality of care, and work-life balance. Discussion: Exploration into work location of TMH providers aids in understanding of clinical workflows and provider wellbeing. Our findings suggest that telemedicine may be easily integrated into different types of clinical workflows and work locations.

Consensus Guidelines for Teledermatology: Scoping Review.

BACKGROUND: Consensus guidelines and recommendations play an important role in fostering quality, safety, and best practices, as they represent an expert interpretation of the biomedical literature and its application to practice. However, it is unclear whether the recent collective experience of implementing telemedicine and the concurrent growth in the evidence base for teledermatology have resulted in more robust guidance. OBJECTIVE: The objective of this review was to describe the extent and nature of currently available guidance, defined as consensus guidelines and recommendations available for telemedicine in dermatology, with guidance defined as consensus or evidence-based guidelines, protocols, or recommendations. METHODS: We conducted a single-reviewer scoping review of the literature to assess the extent and nature of available guidance, consensus guidelines, or recommendations related to teledermatology. We limited the review to published material in English since 2013, reflecting approximately the past 10 years. We conducted the review in November and December of the year 2022. RESULTS: We identified 839 potentially eligible publications, with 9 additional records identified through organizational websites. A total of 15 publications met the inclusion and exclusion criteria. The guidelines focused on varied topics and populations about dermatology and skin diseases. However, the most frequent focus was general dermatology (8/15, 53%). Approximately half of the telemedicine guidance described in the publications was specific to dermatology practice in the context of the COVID-19 pandemic. The publications were largely published in or after the year 2020 (13/15, 87%). Geographical origin spanned several different nations, including Australia, the United States, European countries, and India. CONCLUSIONS: We found an increase in COVID-19-specific teledermatology guidance during 2020, in addition to general teledermatology guidance during the period of the study. Primary sources of general teledermatology guidance reported in the biomedical literature are the University of Queensland's Centre for Online Health and Australasian College of Dermatologists E-Health Committee, and the American Telemedicine Association. There is strong evidence of international engagement and interest. Despite the recent increase in research reports related to telemedicine, there is a relative lack of new guidance based on COVID-19 lessons and innovations. There is a need to review recent evidence and update existing recommendations. Additionally, there is a need for guidance that addresses emerging technologies.

Therapist perspectives on telehealth-based virtual reality exposure therapy.

Virtual reality (VR) can enhance mental health care. In particular, the effectiveness of VR-based exposure therapy (VRET) has been well-demonstrated for treatment of anxiety disorders. However, most applications of VRET remain localized to clinic spaces. We aimed to explore mental health therapists' perceptions of telehealth-based VRET (tele-VRET) by conducting semi-structured, qualitative interviews with 18 telemental health therapists between October and December 2022. Interview topics included telehealth experiences, exposure therapy over telehealth, perceptions of VR in therapy, and perspectives on tele-VRET. Therapists described how telehealth reduced barriers (88.9%, 16/18), enhanced therapy (61.1%, 11/18), and improved access to clients (38.9%, 7/18), but entailed problems with technology (61.1%, 11/18), uncontrolled settings (55.6%, 10/18), and communication di culties (50%, 9/18). Therapists adapted exposure therapy to telehealth by using online resources (66.7%, 12/18), preparing client expectations (55.6%, 10/18), and adjusting workflows (27.8%, 5/18). Most therapists had used VR before (72.2%, 13/18) and had positive impressions (55.6%, 10/18), but none had used VR clinically. In response to tele-VRET, therapists requested interactive session activities (77.8%, 14/18) and customizable interventions components (55.6%, 10/18). Concerns about tele-VRET included risks with certain clients (77.8%, 14/18), costs (50%, 9/18), side effects and privacy (22.2%, 4/18), and inappropriateness for specific forms of exposure therapy (16.7%, 3/18). These results show how designing for telehealth may extend VRET and can help inform collaborative development of health technologies.

Older adults' experience with virtual conversational agents for health data collection.

Introduction: Virtual conversational agents (i.e., chatbots) are an intuitive form of data collection. Understanding older adults' experiences with chatbots could help identify their usability needs. This quality improvement study evaluated older adults' experiences with a chatbot for health data collection. A secondary goal was to understand how perceptions differed based on length of chatbot forms. Methods: After a demographic survey, participants (≥60 years) completed either a short (21 questions), moderate (30 questions), or long (66 questions) chatbot form. Perceived ease-of-use, usefulness, usability, likelihood to recommend, and cognitive load were measured post-test. Qualitative and quantitative analyses were used. Results: A total of 260 participants reported on usability and satisfaction metrics including perceived ease-of-use (5.8/7), usefulness (4.7/7), usability (5.4/7), and likelihood to recommend (Net Promoter Score = 0). Cognitive load (12.3/100) was low. There was a statistically significant difference in perceived usefulness between groups, with a significantly higher mean perceived usefulness for Group 1 than Group 3. No other group differences were observed. The chatbot was perceived as quick, easy, and pleasant with concerns about technical issues, privacy, and security. Participants provided suggestions to enhance progress tracking, edit responses, improve readability, and have options to ask questions. Discussion: Older adults found the chatbot to be easy, useful, and usable. The chatbot required low cognitive load demonstrating it could be an enjoyable health data collection tool for older adults. These results will inform the development of a health data collection chatbot technology.

Inhibition of thioredoxin reductase activity reduces the antioxidant defense capacity of human pluripotent stem cells under conditions of mild but not severe oxidative stress.

Pro-oxidative shift in redox balance, usually termed as "oxidative stress", can lead to different cell responses depending on its intensity. Excessive accumulation of reactive oxygen species ("oxidative distress") can cause DNA, lipid and protein damage. Physiological oxidative stimulus ("oxidative eustress"), in turn, can favor cell proliferation and differentiation - the processes of paramount importance primarily for stem cells. Functions of antioxidant enzymes in cells is currently a focus of intense research, however the role of different antioxidant pathways in pluripotent cell responses to oxidative distress/eustress is still under investigation. In this study, we assessed the contribution of the thioredoxin reductase (TrxR)-dependent pathways to maintaining the redox homeostasis in human induced pluripotent stem cells and their differentiated progeny cells under basal conditions and under conditions of oxidative stress of varying intensity. Employing the genetically encoded H2O2 biosensor cyto-HyPer and two inhibitors of thioredoxin reductase (auranofin and Tri-1), we show that the reduced activity of TrxR-dependent enzymatic systems leads to the non-cytotoxic disruption of thiol-disulfide metabolism in the cytoplasm of both pluripotent and differentiated cells under basal conditions. Quantifying the cytoplasmic concentrations of peroxide establishing in H2O2-stressed cells, we demonstrate that TrxR-dependent pathways contribute to the antioxidant activity in the cell cytoplasm under conditions of mild but not severe oxidative stress in both cell lines tested. The observed effects may testify about a conservative role of the TrxR-controlled enzymatic systems manifested as a response to physiological redox stimuli rather than a protection against the severe oxidative stress.

My data choices: Pilot evaluation of patient-controlled medical record sharing technology.

Patients desire greater control over sharing their digital health data. Consent2Share (C2S) is an open-source consent tool offered by SAMHA and the VA to support granular data sharing (GDS) options that align with patient preferences and data privacy regulations. The need to validate this tool exists. We pilot tested C2S with 199 English and Spanish-speaking patients with behavioral health conditions (BHCs) and patient guardians. Data were analyzed using mixed methodology. All participants desired granular control over the sharing of their health data. Most participants (87%) were highly interested in using a tool that offered granular options for executing data sharing decisions, with over half (55%) indicated that being able to specify the data type, data recipient, and data use purpose made them more willing to share their medical records. Majority (83%) indicated that the supported data type sharing categories satisfied their data-sharing privacy preferences. Majority (87%) also reported that knowing the purpose of data use made them more comfortable in sharing. Some participants (28%) accessed the education materials provided on data type sharing options. Patients want granular choices when sharing medical records. Consent2Share and its supported data type sharing categories are adequate to capture patients' data sharing preferences. Further development is needed before deployment in clinical environments.

Virtual conversational agents versus online forms: Patient experience and preferences for health data collection.

Objective: Virtual conversational agents, or chatbots, have emerged as a novel approach to health data collection. However, research on patient perceptions of chatbots in comparison to traditional online forms is sparse. This study aimed to compare and assess the experience of completing a health assessment using a chatbot vs. an online form. Methods: A counterbalanced, within-subject experimental design was used with participants recruited via Amazon Mechanical Turk (mTurk). Participants completed a standardized health assessment using a chatbot (i.e., Dokbot) and an online form (i.e., REDCap), each followed by usability and experience questionnaires. To address poor data quality and preserve integrity of mTurk responses, we employed a thorough data cleaning process informed by previous literature. Quantitative (descriptive and inferential statistics) and qualitative (thematic analysis and complex coding query) approaches were used for analysis. Results: A total of 391 participants were recruited, 185 of whom were excluded, resulting in a final sample size of 206 individuals. Most participants (69.9%) preferred the chatbot over the online form. Average Net Promoter Score was higher for the chatbot (NPS = 24) than the online form (NPS = 13) at a statistically significant level. System Usability Scale scores were also higher for the chatbot (i.e. 69.7 vs. 67.7), but this difference was not statistically significant. The chatbot took longer to complete but was perceived as conversational, interactive, and intuitive. The online form received favorable comments for its familiar survey-like interface. Conclusion: Our findings demonstrate that a chatbot provided superior engagement, intuitiveness, and interactivity despite increased completion time compared to online forms. Knowledge of patient preferences and barriers will inform future design and development of recommendations and best practice for chatbots for healthcare data collection.

FORECASTING THE DEVELOPMENT OF PURULENT-INFLAMMATORY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE BOWEL OBSTRUCTION.

OBJECTIVE: The aim: The purpose of the study is to improve the results of treatment of patients with acute intestinal obstruction of tumor origin by developing individualized surgical tactics considering the level of cryoglobulins. PATIENTS AND METHODS: Materials and methods: 96 patients with ileus of tumor origin were studied. The mean age of patients was 54.7 ± 5.9 years. 30 patients were diagnosed with colorectal cancer, 35 patients - with sigmoid cancer, 13 patients - with cecum and ascending colon, 11 patients - with transverse colon cancer, and 7 patients with descending colon cancer. Isolation of cryoglobulins from blood serum was performed by the method of A. E. Kalovidoris with modifications. The content of Ig A, Ig M, Ig G, total Ig E in the serum was investigated using enzyme-linked immunosorbent assay systems "Granum-Ukraine", the content of allergen-specific Ig E was investigated using enzyme-linked immunosorbent assay systems produced by "Microgen". RESULTS: Results: As a result of treatment of 96 patients, it was found that the level of development of postoperative purulent complications was significantly influenced by the level of cryoglobulinemia and the volume of surgery (CMU, p <0.05). It was found that in patients with decompensated intestinal obstruction, the initial concentration of cryoglobulins was 16.4% higher than in the group with compensated intestinal obstruction (CMU, p <0,05). CONCLUSION: Conclusions: Determination of cryoglobulinemia on admission of patients with acute obstructive ileus of tumor origin is a simple and effective method for predicting the development of purulent-inflammatory complications in the postoperative period and can influence the choice of treatment tactics.

Changes to transcatheter aortic valve replacement (TAVR) services during the first wave of the COVID-19 pandemic: A single centre experience from United Kingdom tertiary hospital.

AIMS: COVID-19 had a devastating impact on patients with severe aortic stenosis (AS). Like many cardiac procedures, transcatheter aortic valve replacement (TAVR) services were suspended during the first wave of COVID-19. We took the opportunity to evaluate the clinical outcomes and identify any delays at different stages of the TAVR pathway during the COVID-19 pandemic. METHODS: Prospectively collected data on 210 consecutive TAVR patients between March 2019 and March 2021 were analysed. We compared the clinical outcomes and 30-day mortality rates of TAVR cases pre-pandemic and during the pandemic. We also looked to identify any time lags from the initial referral to respective stages of the TAVR workup. RESULTS: A total of 134 patients underwent TAVR prior to the national lockdown (March 2019-March 2020), compared to 76 patients during COVID-19 (April 2020-April 2021). Success rates of TAVR were similar (99% prior to the pandemic and 97.4% during COVID-19). The 30-day survival rates were 98.6% and 94.7%, respectively. Median length of stay post TAVR was 2 days during COVID-19 and 2.5 days prior to the pandemic (p = 0.064). Patients were seen quicker in clinic (median of 33 days) during COVID-19, compared to 51 days before COVID-19 (p = 0.044). No significant difference in times from referral to discussion at TAVR multidisciplinary team (MDT) meetings, CT Aortogram and TAVR implantation, in both groups. CONCLUSIONS: Reconfiguring the patient pathway during COVID-19 allowed TAVR to be performed safely, with a similar success rate and no excess complications or increased 30-day mortality. There proved to be no delay in the respective stages of patient TAVR workup, during the pandemic.

Perceptions and Concerns of SUD Treatment Organizations Regarding the CARES Act's Alterations to Patient Confidentiality Regulations.

Objectives: Learn how substance use disorder (SUD) treatment organizations view and respond to changes in confidentiality and disclosure law following adoption of CARES Act Sec. 3221 and prior to promulgation of revised implementing regulations. Methods: Online survey followed by informal interviews. Representatives of SUD organizations reported their degree of awareness of Sec. 3221 provisions and their organizations' views on amendments to disclosure practices; current and future changes of organizational policies; difficulties anticipated in implementing new rules; and preferences for resources. Results: Forty informant surveys on 30 organizations completed. Participants (62.5 percent) indicated being somewhat knowledgeable about Sec. 3221. Evenly divided positive and concerned views on Sec. 3221 reflect tension between preserving confidentiality of patient records and improving coordination of care. Most (76.7 percent) reported organizational discussions on Sec. 3221. Some (30 percent) identified changes to make in near future. Over a third expected few or no barriers to implementing changes to privacy and disclosure practices, while most (64.7 percent) expected hindrances including complexity and tensions in the law, staff education, cost, technological adjustments, and changes in the ways SUD organizations interact with external organizations and individuals. To overcome barriers noted, participants expressed desire (66.7 percent) for teaching tools such as webinars and templates to follow. Conclusions: SUD treatment organizations began thinking of and planning for proposed changes well before expected implementation of Sec. 3221. Their concerns reflected practicalities of implementation, determining content of law, and wondering about the extent to which it solves problems (improving coordination of care among various providers) or endangered other goals (protecting confidentiality of SUD patient records).

Behavioral Health Professionals' Perceptions on Patient-Controlled Granular Information Sharing (Part 1): Focus Group Study.

BACKGROUND: Patient-controlled granular information sharing (PC-GIS) allows a patient to select specific health information "granules," such as diagnoses and medications; choose with whom the information is shared; and decide how the information can be used. Previous studies suggest that health professionals have mixed or concerned opinions about the process and impact of PC-GIS for care and research. Further understanding of behavioral health professionals' views on PC-GIS are needed for successful implementation and use of this technology. OBJECTIVE: The aim of this study was to evaluate changes in health professionals' opinions on PC-GIS before and after a demonstrative case study. METHODS: Four focus groups were conducted at two integrated health care facilities: one serious mental illness facility and one general behavioral health facility. A total of 28 participants were given access to outcomes of a previous study where patients had control over medical record sharing. Participants were surveyed before and after focus groups on their views about PC-GIS. Thematic analysis of focus group output was paired with descriptive statistics and exploratory factor analysis of surveys. RESULTS: Behavioral health professionals showed a significant opinion shift toward concern after the focus group intervention, specifically on the topics of patient understanding (P=.001), authorized electronic health record access (P=.03), patient-professional relationship (P=.006), patient control acceptance (P<.001), and patient rights (P=.02). Qualitative methodology supported these results. The themes of professional considerations (2234/4025, 55.5% of codes) and necessity of health information (260/766, 33.9%) identified key aspects of PC-GIS concerns. CONCLUSIONS: Behavioral health professionals agreed that a trusting patient-professional relationship is integral to the optimal implementation of PC-GIS, but were concerned about the potential negative impacts of PC-GIS on patient safety and quality of care.

Behavioral Health Professionals' Perceptions on Patient-Controlled Granular Information Sharing (Part 2): Focus Group Study.

BACKGROUND: Patient-directed selection and sharing of health information "granules" is known as granular information sharing. In a previous study, patients with behavioral health conditions categorized their own health information into sensitive categories (eg, mental health) and chose the health professionals (eg, pharmacists) who should have access to those records. Little is known about behavioral health professionals' perspectives of patient-controlled granular information sharing (PC-GIS). OBJECTIVE: This study aimed to assess behavioral health professionals' (1) understanding of and opinions about PC-GIS; (2) accuracy in assessing redacted medical information; (3) reactions to patient rationale for health data categorization, assignment of sensitivity, and sharing choices; and (4) recommendations to improve PC-GIS. METHODS: Four 2-hour focus groups and pre- and postsurveys were conducted at 2 facilities. During the focus groups, outcomes from a previous study on patients' choices for medical record sharing were discussed. Thematic analysis was applied to focus group transcripts to address study objectives. RESULTS: A total of 28 health professionals were recruited. Over half (14/25, 56%) were unaware or provided incorrect definitions of granular information sharing. After PC-GIS was explained, all professionals demonstrated understanding of the terminology and process. Most (26/32 codes, 81%) recognized that key medical data had been redacted from the study case. A majority (41/62 codes, 66%) found the patient rationale for categorization and data sharing choices to be unclear. Finally, education and other approaches to inform and engage patients in granular information sharing were recommended. CONCLUSIONS: This study provides detailed insights from behavioral health professionals on granular information sharing. Outcomes will inform the development, deployment, and evaluation of an electronic consent tool for granular health data sharing.

Resistance to H2O2-induced oxidative stress in human cells of different phenotypes.

Application of genetically encoded biosensors of redox-active compounds promotes the elaboration of new methods for investigation of intracellular redox activities. Previously, we have developed a method to measure quantitatively the intracellular concentration of hydrogen peroxide (H2O2) in living cells using genetically encoded biosensor HyPer. In the present study, we refined the method and applied it for comparing the antioxidant system potency in human cells of different phenotypes by measuring the gradient between the extracellular and cytoplasmic H2O2 concentrations under conditions of H2O2-induced external oxidative stress. The measurements were performed using cancer cell lines (K-562 and HeLa), as well as normal human cells - all expressing HyPer in the cell cytoplasm. As normal cells, we used three isogenic lines of different phenotypes - mesenchymal stem/stromal cells (MSCs), induced pluripotent stem cells (iPSCs) derived from MSCs by reprogramming, and differentiated iPSC progenies with the phenotype resembling precursory MSCs. When exposing cells to exogenous H2O2, we showed that at low oxidative loads (<50 µM of H2O2) the gradient depended on extracellular H2O2 concentration. At high loads (>50 µM of H2O2), which caused the exhaustion of thioredoxin activity in the cell cytoplasm, the gradient stabilized, pointing out that it is the functional status of the thioredoxin-depended enzymatic system that drives the dependence of the H2O2 gradient on the oxidative load in human cells. At high H2O2 concentrations, the cytoplasmic H2O2 level in cancer cells was found to be several hundred times lower than the extracellular one. At the same time, in normal cells, extracellular-to-intracellular gradient amounted to thousands of times. Upon reprogramming, the potency of cellular antioxidant defense increased. In contrast, differentiation of iPSCs did not result in the changes in antioxidant system activity in the cell cytoplasm, assuming that intensification of the H2O2-detoxification processes is inherent to a period of early human development.

Isolation of megakaryocytes using magnetic cell separation and adverse effects induced by diclofenac toxicity in an experiment.

This study investigates the response of bone marrow (particularly megakaryocytes) in mice under the influence of diclofenac sodium for 10 days using intraperitoneal injection at various doses. A fundamentally new immunomagnetic separation method was applied during the experiment, which helped obtain pure lines of bone marrow cells, particularly megakaryocytes (MC), without admixtures of other cells or their particles. The resulting cells completely retain their structure and can be used in further research. The study determined that different doses of diclofenac sodium have different effects on different groups of diabetes mellitus cells CD34-megakaryocytes. The use of 1.0 mg/ml sharply negatively affects the state of early populations of megakaryocytes (decrease by 80%, p=0.05), a dose of 0.025 mg/ml had the least effect on this population of cells (22.8%, p=0.05). The greatest number of average forms of diabetes mellitus 34 was observed when using a dose of 0.95 mg/ml (22.8%, p=0.05), with a gradual decrease in the dose, the indicator of this group of cells decreased. A dose of 0.03 mg/ml did not affect the quantitative state of megakaryocytes, and a dose of 0.025 mg/ml caused a slight decrease (16.6%, p=0.05). Indicators of mature cells of megakaryocytes CD 34- decreased in all studied groups, however, their maximum value reached a maximum decrease by 0.25 mg/ml (55.2%, p=0.05), the dose of diclofenac sodium 0.03 mg/ml, lower (18.4%, p=0.05). Diclofenac sodium in different doses has different effects on the degree of differentiation of CD 34-. Its introduction positively affects the state of intermediate forms of megakaryocytes, except for minimal doses, while the effect on early and mature forms in all cases turned out to be negative.

Recommendations to Inform Substance Use Disorder Data Sharing Research: Scoping Review and Thematic Analysis.

OBJECTIVES: Title 42 Code of Federal Regulations Part 2 (42 CFR Part 2 or Part 2) was enacted in 1975 to protect patients receiving treatment for substance use disorders. A scoping review on Part 2 characterized published work. METHODS: Seven databases were searched. Studies were categorized based on date of publication, primary objectives, methods, and findings. A thematic analysis was conducted using article titles and abstracts. RESULTS: Of the 36 studies identified, the majority (78%) were opinions or legal reviews, (22%) employed quantitative and/or qualitative methods to study the impact of Part 2, and over half (58%) were published in the past 5 years. Only 8% of studies reported stakeholder involvement in Part 2 studies and no study included patients or patient advocates. No study discussed the efforts to align Part 2 with Health Insurance Portability and Accountability Act or provided evidence of the benefit of this alignment. Three main themes emerged from the review: care delivery (46.6%), law and ethics (27.6%), and technology (25.9%). There were no studies focusing on stigma and its effect on substance use treatment and Part 2. CONCLUSIONS: Despite the significance of Part 2, the literature is sparse. It is time to initiate a new era of scholarly research that focuses on the impact of statutes and policies that govern substance use disorder data sharing. Specifically, we recommend research on Part 2 and Health Insurance Portability and Accountability Act alignment, the effects of Part 2 on patients, as well as providers and other stakeholder perceptions on the regulation.