The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships.

INTRODUCTION: As telemedicine and telehealth services are experiencing increasing rates of adoption, industry leaders and healthcare service providers are becoming increasingly focused on human resource issues encountered in the delivery of a broad range of telehealth services. To create a forum for the discussion of many interrelated elements of telehealth service industry, a national conference entitled "Telemedicine & Telehealth Service Provider Showcase" (SPS) Conference was established in 2014, and repeated in 2016 and 2017, in Arizona. These SPS Conferences include thought leaders, telehealth service providers, government administrators, and academicians from leading programs addressing service provider workforce issues. METHODS: This report summarizes the content of SPS 2017 conference, held in Phoenix, AZ, October 2-3, 2017. The topics covered at SPS 2017 include using telehealth services as a strategic asset; development of appropriate effective partnerships; direct-to-consumer initiatives; important reimbursement, legislative, and regulatory issues (i.e., Centers for Medicare & Medicaid Services [CMS] approaches, financial models, and return on investment [ROI]); marketing; evaluation and applied metrics; remote monitoring and sensors; integration with electronic health records; and overall lessons learned. RESULTS: The content of SPS 2017 is summarized in the body of this report. The SPS 2017 program evaluators included attendees, speakers, and exhibitors. The knowledge attendees gained at SPS 2017 was characterized, by all three groups, as forward-looking and practical. CONCLUSION: SPS 2017 succeeded in identifying, and focusing on, solutions for issues, challenges, and barriers impacting the rapidly expanding telehealth service segment of the healthcare industry. The growing interest in this annual SPS Conference series apparently reflects, in part, the program committee's successes in identifying practical issues and their potential solutions.

A Pilot Study of Proinflammatory Cytokines and Fatigue in Women With Breast Cancer During Chemotherapy.

BACKGROUND: Fatigue remains a prevalent, persistent, and debilitating side effect of chemotherapy for stage I and II breast cancer patients. Severity of fatigue varies among patients. Evidence suggests that proinflammatory cytokines contribute to the development of fatigue. OBJECTIVE: The aim of this study is to investigate predictors of fatigue and cytokine levels in women undergoing chemotherapy for stage I or II breast cancer. METHODS: Piper Fatigue Scales and blood samples for interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were collected at baseline and days 7, 14, and 21 for each chemotherapy cycle. Descriptive statistics, general linear mixed models, and graphic analysis were used to analyze the data. RESULTS: The predominantly white convenience sample was composed of 11 women with stage I or II breast cancer who were 37 to 72 years old (mean, 52 years). Predictors of fatigue were type of chemotherapy drugs, time, and IL-6 levels. A predictor of IL-6 and TNF-α levels was whether chemotherapy was administered at the visit. Type of chemotherapy significantly predicted TNF-α levels. Fatigue patterns were characterized by chaotic pattern of peaks and troughs unique to each woman. CONCLUSIONS: Women with stage I and II breast cancer experienced variability in the severity of fatigue and levels of IL-6 and TNF-α throughout their treatment trajectories. The presence and role of genetic variants related to cancer-related fatigue may explain the individual variation and warrant further research. IMPLICATIONS FOR PRACTICE: These findings highlight the importance of symptom assessments including fatigue at each clinic visit and individualized interventions throughout the cancer trajectory.

FLAMEnGO 2.0: an enhanced fuzzy logic algorithm for structure-based assignment of methyl group resonances.

We present an enhanced version of the FLAMEnGO (Fuzzy Logic Assignment of Methyl Group) software, a structure-based method to assign methyl group resonances in large proteins. FLAMEnGO utilizes a fuzzy logic algorithm coupled with Monte Carlo sampling to obtain a probability-based assignment of the methyl group resonances. As an input, FLAMEnGO requires either the protein X-ray structure or an NMR structural ensemble including data such as methyl-methyl NOESY, paramagnetic relaxation enhancement (PRE), methine-methyl TOCSY data. Version 2.0 of this software (FLAMEnGO 2.0) has a user-friendly graphic interface and presents improved modules that enable the input of partial assignments and additional NMR restraints. We tested the performance of FLAMEnGO 2.0 on maltose binding protein (MBP) as well as the C-subunit of the cAMP-dependent protein kinase A (PKA-C). FLAMEnGO 2.0 can be used as a standalone method or to assist in the completion of partial resonance assignments and can be downloaded at www.chem.umn.edu/groups/veglia/forms/flamengo2-form.html.

Private payer telehealth reimbursement in the United States.

BACKGROUND: Significant information is available about government-reimbursed telehealth services such as Medicare and Medicaid across the United States. Although currently 20 states mandate reimbursement for telehealth services and some private insurers have voluntarily covered those services in other states, relatively little is known about telehealth provider experiences with reimbursement from private insurance payers. MATERIALS AND METHODS: To investigate this, the American Telemedicine Association's (ATA's) Telemental Health Special Interest Group (SIG), the Policy Group, and the Business and Finance SIG, with the help of ATA staff, conducted a national private payer reimbursement online survey in 2012 using Survey Monkey™ (Palo Alto, CA) ( www.surveymonkey.com/ ). RESULTS: Survey responses were received from respondents in 46 of the 50 states. The survey found that telehealth services are being reimbursed by private payers but that progress in reimbursement has been relatively slow compared with earlier surveys. CONCLUSIONS: Key findings from this study were that government payers as well as several major private payers are highly influential in payment policies for telehealth private payers, that private payers have administrative rules regarding telehealth reimbursement that are barriers to services and reimbursement, and that some providers would benefit from being better informed about billing and coding for telehealth services and how to advocate for telehealth services reimbursement.

Acute effects of walking environment and GSTM1 variants in children with asthma.

BACKGROUND: Exercise in air polluted by traffic emissions may aggravate airway inflammation in children with asthma, particularly those who produce decreased glutathione-S transferase (GST) as a result of GSTM1 gene deletion. OBJECTIVES: This pilot crossover study investigated whether children with asthma experience more airway changes when exercising outdoors near roadways than when exercising indoors. It also examined differences in risk between children with and without GSTM1 deletion. METHOD: Children between the ages of 5 and 12 years were assigned to groups and walked daily for 1 week in each exercise condition. Airway inflammation indicated by exhaled nitric oxide (eNO) and pulmonary functions measured as forced expiratory volume in 1 s (FEV1) and mid-expiratory flow rate were measured at baseline and at three intervals during the walking program. Independent variables of interest included walking condition (place), time of walking, genotype, and particulate matter (PM) exposure. RESULTS: A linear mixed models approach was used to investigate the contributions of targeted variables to respiratory outcomes. Results indicated that walking location and ambient level of ultrafine particulates during walking influenced function of small airways. Absence of one or both alleles for the GSTM1 gene did not influence airway function acutely. DISCUSSION: Mid-expiratory flow (FEF(25-75)) may be more informative than FEV1 in studies of acute lung function changes in children with asthma. Further study of the effects of varied environmental conditions on lower airway function of children is needed to optimize exercise experiences for urban children with asthma.

The flat-ribbon configuration of the periplasmic flagella of Borrelia burgdorferi and its relationship to motility and morphology.

Electron cryotomography was used to analyze the structure of the Lyme disease spirochete, Borrelia burgdorferi. This methodology offers a new means for studying the native architecture of bacteria by eliminating the chemical fixing, dehydration, and staining steps of conventional electron microscopy. Using electron cryotomography, we noted that membrane blebs formed at the ends of the cells. These blebs may be precursors to vesicles that are released from cells grown in vivo and in vitro. We found that the periplasmic space of B. burgdorferi was quite narrow (16.0 nm) compared to those of Escherichia coli and Pseudomonas aeruginosa. However, in the vicinity of the periplasmic flagella, this space was considerably wider (42.3 nm). In contrast to previous results, the periplasmic flagella did not form a bundle but rather formed a tight-fitting ribbon that wraps around the protoplasmic cell cylinder in a right-handed sense. We show how the ribbon configuration of the assembled periplasmic flagella is more advantageous than a bundle for both swimming and forming the flat-wave morphology. Previous results indicate that B. burgdorferi motility is dependent on the rotation of the periplasmic flagella in generating backward-moving waves along the length of the cell. This swimming requires that the rotation of the flagella exerts force on the cell cylinder. Accordingly, a ribbon is more beneficial than a bundle, as this configuration allows each periplasmic flagellum to have direct contact with the cell cylinder in order to exert that force, and it minimizes interference between the rotating filaments.

Ten-year experience of a private nonprofit telepsychiatry service.

This paper reports the results of a satisfaction survey of telepsychiatry patients at a rural community mental health clinic that had been providing psychiatric services solely via telemedicine for 10 years. The survey examined the perceived telepsychiatric session quality over a relatively long period of time with patients who had been utilizing the services for a number of years or over multiple sessions. One-page optional anonymous surveys were distributed from December 1, 2006, through March 30, 2007, covering 230 telepsychiatry patients, approximately 90% of current telepsychiatry patients at the agency. Of these, 76 patients responded, a 33.0% return rate. Among the respondents, satisfaction was generally very high, with telemedicine services provided over a period of up to 10 years perceived to be of similar (no worse) quality than in-person services. Results were further analyzed by gender, age, and number of telemedicine sessions experienced. Female patients appeared more accepting of the quality of medical care via telemedicine than male patients. Patients aged 20-49 had much higher acceptance rates than patients younger than 20 or older than 49. The least positive responses toward telemedicine were from patients in their 50s. Patients who had experienced 5 to 10 telemedicine sessions were more likely than patients who had experienced fewer than 5 to report that their sessions now run more smoothly than their initial sessions. Patients in their 20s and 30s reported the least need to have a clinician in the room with them to make them feel comfortable during their telemedicine sessions. Eight percent of respondents reacted negatively to the presence of a clinician in the room with them during their telemedicine sessions.

RLIP76 is a major determinant of radiation sensitivity.

RLIP76 (RALBP1) is a glutathione-conjugate transporter that is a critical component of clathrin-coated pit-mediated endocytosis, as well as in stress responses. In cultured cells, it provides protection from stressors including heat, oxidant chemicals, chemotherapeutic agents, UV irradiation, and X-irradiation. Here, we show marked reduction in glutathione conjugate transport capacity and stepwise increase in radiation sensitivity associated with heterozygous or homozygous loss of the RLIP76 gene in mice. Survival after radiation in homozygous knockout animals was significantly shorter than either the heterozygous knockouts or the wild type. Delivery of recombinant RLIP76 to mice lacking RLIP76 via a liposomal delivery system rescued radiation sensitivity. Furthermore, treatment of wild-type mice with RLIP76-containing liposomes conferred resistance to radiation. These findings suggest that inhibiting RLIP76 could be used for sensitization to radiation during cancer therapy and that RLIP76 liposomes could be radioprotective agents useful for treatment of iatrogenic or catastrophic radiation poisoning.

Self-defense and martial arts evaluation for college women: preliminary validation of perceptions of dangerous situations scale.

Martial arts and self-defense programs train fearful people, especially women, to be more competent and confident to defend themselves in dangerous situations. However, there are no validated instruments to evaluate the effectiveness of programs purporting to teach self-protection. The Perceptions of Dangerous Situations Scale (PDSS), composed of fear, likelihood and confidence subscales, was developed and validated for university women. Participants were 368 university women, ages 17 to 45 years (M age = 20.7 years). Content validity of the PDSS was established through an expert panel, and construct validity was established through principal components analysis and determination of instructional sensitivity. Reliability was established through alpha coefficients. The PDSS, when used with university women, offers promising measurement opportunities in self-defense and martial arts settings.