High-angular-sensitivity X-ray phase-contrast microtomography of soft tissue through a two-directional beam-tracking synchrotron set-up.

Two-directional beam-tracking (2DBT) is a method for phase-contrast imaging and tomography that uses an intensity modulator to structure the X-ray beam into an array of independent circular beamlets that are resolved by a high-resolution detector. It features isotropic spatial resolution, provides two-dimensional phase sensitivity, and enables the three-dimensional reconstructions of the refractive index decrement, δ, and the attenuation coefficient, µ. In this work, the angular sensitivity and the spatial resolution of 2DBT images in a synchrotron-based implementation is reported. In its best configuration, angular sensitivities of ∼20 nrad and spatial resolution of at least 6.25 µm in phase-contrast images were obtained. Exemplar application to the three-dimensional imaging of soft tissue samples, including a mouse liver and a decellularized porcine dermis, is also demonstrated.

Relationship Maintenance Scale in Young Couples: Validity Evidence and Reliability of a Short Scale in Peru.

Relationship maintenance has shifted from understudied to extensively researched in the past two decades due to its close association with satisfaction. This study aimed to validate the Relationship Maintenance Scale (EMP) in a sample of young adults in Lima. The sample included 899 participants aged 18-25 (Mean = 20.67, SD = 2.54); 690 females (76.80%) and 209 males (23.20%), all in relationships of at least three months (Mean = 22.05, SD = 19.95). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to determine the EMP's structure, with Omega coefficient (ω) estimating reliability. Results indicated a four-factor structure for EMP, removing items 8, 9, 12, and 14, demonstrating good fit (SRMR = .043; CFI = .977; TLI = .971; RMSEA = .058). EMP showed acceptable reliability across factors: Companionship (ω = .78), Affectivity (ω = .83), Complementarity (ω = .77), and Shared interaction (ω = .70), with the latter being less stable. EMP correlated as expected with relationship satisfaction (r ≥ .50). In conclusion, EMP is a valid and reliable instrument for future Spanish studies, with further research on psychometric properties recommended.

Identification of Olives Using In-Field Hyperspectral Imaging with Lightweight Models.

During the growing season, olives progress through nine different phenological stages, starting with bud development and ending with senescence. During their lifespan, olives undergo changes in their external color and chemical properties. To tackle these properties, we used hyperspectral imaging during the growing season of the olives. The objective of this study was to develop a lightweight model capable of identifying olives in the hyperspectral images using their spectral information. To achieve this goal, we utilized the hyperspectral imaging of olives while they were still on the tree and conducted this process throughout the entire growing season directly in the field without artificial light sources. The images were taken on-site every week from 9:00 to 11:00 a.m. UTC to avoid light saturation and glitters. The data were analyzed using training and testing classifiers, including Decision Tree, Logistic Regression, Random Forest, and Support Vector Machine on labeled datasets. The Logistic Regression model showed the best balance between classification success rate, size, and inference time, achieving a 98% F1-score with less than 1 KB in parameters. A reduction in size was achieved by analyzing the wavelengths that were critical in the decision making, reducing the dimensionality of the hypercube. So, with this novel model, olives in a hyperspectral image can be identified during the season, providing data to enhance a farmer's decision-making process through further automatic applications.

New Psychometric Evidence of the Grief Impairment Scale (GIS) in People Who Have Experienced the Death of a Loved One From a Network Psychometric Approach in Two Latin American Countries.

This study aimed to evaluate the psychometric properties of the Grief Impairment Scale (GIS) using a network psychometric model. A total of 1048 individuals from Peru and El Salvador participated. A network psychometric model was used to determine internal structure, reliability, and cross-country invariance. The results indicate that the GIS items were grouped into a single network structure through Exploratory Graph Analysis. Reliability was estimated by structural consistency, and it was found that when replicating the network structure within an empirical dimension, a single network structure was consistently obtained, and all items remained stable. Furthermore, the network structure was invariant, thus functioning similarly across the different country groups. In conclusion, the GIS presented solid psychometric evidence of validity based on its internal structure, reliability, and cross-country invariance. Therefore, the GIS is a psychometrically sound measure of functional impairment symptoms due to grief for Peruvian and Salvadoran individuals.

Race and Apolipoprotein E-e4 Allele Status Differences in the Association Between Loneliness and Cognitive Decline.

OBJECTIVE: This study aimed to examine race and apolipoprotein E-e4 allele (APOE-e4) status differences in the longitudinal associations between loneliness and cognitive decline. METHODS: The study sample is composed of participants ( N = 7696, 64% Black participants and 36% White participants) from the Chicago Health and Aging Project, a population-based cohort study. Mixed-effects regression models were conducted to examine the longitudinal associations between loneliness on global cognitive function and individual tests of cognitive function. Models were also stratified by race and APOE-e4. RESULTS: A greater percentage of Black participants (17%) reported loneliness at baseline visit compared with White participants (12%). Black and White participants who were lonely individuals had a similar rate of decline in global cognitive function at 0.075 (95% confidence interval [CI] = -0.082 to -0.068) standard deviation unit (SDU) per year for Black participants and at 0.075 (95% CI = -0.086 to -0.063) SDU per year for White participants. Lonely participants with APOE-e4 had a higher rate of global cognitive decline at -0.102 (95% CI = -0.115 to -0.088) SDU per year than for lonely participants without APOE-e4 at -0.052 (95% CI = -0.059 to -0.045) SDU per year. CONCLUSIONS: The burden of loneliness and its relation to cognitive decline is higher among participants with APOE-e4 compared with those without APOE-e4. Loneliness is associated with cognitive decline in both Black and White participants.

Data Acquisition for Condition Monitoring in Tactical Vehicles: On-Board Computer Development.

This paper outlines the development of an onboard computer prototype for data registration, storage, transformation, and analysis. The system is intended for health and use monitoring systems in military tactical vehicles according to the North Atlantic Treaty Organization Standard Agreement for designing vehicle systems using an open architecture. The processor includes a data processing pipeline with three main modules. The first module captures the data received from sensor sources and vehicle network buses, performs a data fusion, and saves the data in a local database or sends them to a remote system for further analysis and fleet management. The second module provides filtering, translation, and interpretation for fault detection; this module will be completed in the future with a condition analysis module. The third module is a communication module for web serving data and data distribution systems according to the standards for interoperability. This development will allow us to analyze the driving performance for efficiency, which helps us to know the vehicle's condition; the development will also help us deliver information for better tactical decisions in mission systems. This development has been implemented using open software, allowing us to measure the amount of data registered and filter only the relevant data for mission systems, which avoids communication bottlenecks. The on-board pre-analysis will help to conduct condition-based maintenance approaches and fault forecasting using the on-board uploaded fault models, which are trained off-board using the collected data.

A General-Purpose Distributed Analytic Platform Based on Edge Computing and Computational Intelligence Applied on Smart Grids.

Currently, in many data landscapes, the information is distributed across various sources and presented in diverse formats. This fragmentation can pose a significant challenge to the efficient application of analytical methods. In this sense, distributed data mining is mainly based on clustering or classification techniques, which are easier to implement in distributed environments. However, the solution to some problems is based on the usage of mathematical equations or stochastic models, which are more difficult to implement in distributed environments. Usually, these types of problems need to centralize the required information, and then a modelling technique is applied. In some environments, this centralization may cause an overloading of the communication channels due to massive data transmission and may also cause privacy issues when sending sensitive data. To mitigate this problem, this paper describes a general-purpose distributed analytic platform based on edge computing for distributed networks. Through the distributed analytical engine (DAE), the calculation process of the expressions (that requires data from diverse sources) is decomposed and distributed between the existing nodes, and this allows sending partial results without exchanging the original information. In this way, the master node ultimately obtains the result of the expressions. The proposed solution is examined using three different computational intelligence algorithms, i.e., genetic algorithm, genetic algorithm with evolution control, and particle swarm optimization, to decompose the expression to be calculated and to distribute the calculation tasks between the existing nodes. This engine has been successfully applied in a case study focused on the calculation of key performance indicators of a smart grid, achieving a reduction in the number of communication messages by more than 91% compared to the traditional approach.

Combining Freestanding Ferroelectric Perovskite Oxides with Two-Dimensional Semiconductors for High Performance Transistors.

We demonstrate the fabrication of field-effect transistors based on single-layer MoS2 and a thin layer of BaTiO3 (BTO) dielectric, isolated from its parent epitaxial template substrate. Thin BTO provides an ultrahigh-κ gate dielectric effectively screening Coulomb scattering centers. These devices show mobilities substantially larger than those obtained with standard SiO2 dielectrics and comparable with values obtained with hexagonal boron nitride, a dielectric employed for fabrication of high-performance two-dimensional (2D) based devices. Moreover, the ferroelectric character of BTO induces a robust hysteresis of the current vs gate voltage characteristics, attributed to its polarization switching. This hysteresis is strongly suppressed when the device is warmed up above the tetragonal-to-cubic transition temperature of BTO that leads to a ferroelectric-to-paraelectric transition. This hysteretic behavior is attractive for applications in memory storage devices. Our results open the door to the integration of a large family of complex oxides exhibiting strongly correlated physics in 2D-based devices.

A Psychometric Analysis of the Spanish Version of the Grief Impairment Scale: A Screening Tool of Biopsychosocial Grief-Related Functional Impairment in a Salvadoran Sample.

The objective of this study was to translate and psychometrically evaluate a Spanish version of the Grief Impairment Scale (GIS) using a sample of bereaved adults from El Salvador (N = 579). The results confirm the unidimensional structure of the GIS, and solid reliability, item characteristics, and criterion-related validity, where the GIS scale significantly and positively predicts depression. However, this instrument only showed evidence of configural and metric invariance between different sex groups. Overall, these results support the Spanish version of the GIS as a psychometrically sound screening tool for health professionals and researchers to use in their clinical work.

COVID-19 Bereavement in Ten Latin American Countries: Measurement Invariance of the Pandemic Grief Scale and Its Relation to Suicidal Ideation.

The present study aimed to evaluate the cross-cultural measurement invariance of the Pandemic Grief Scale (PGS) in ten Latin American countries. A total of 2,321 people who had lost a family member or other loved one due to COVID-19 participated, with a mean age of 34.22 years old (SD = 11.99). In addition to the PGS, a single item of suicidal ideation was applied. The unidimensional model of the PGS had adequate fit in most countries and good reliability estimates. There was evidence of measurement invariance by country and gender. Also, a one-point increase in the PGS was associated with an almost twofold increase in the odds of suicidal ideation. Scores greater than or equal to 4 on the PGS are proposed as a cut off to identify individuals with suicidal ideation. Strong evidence of the cross-cultural validity of the PGS is provided.

Assessment of Obsessive Thoughts About COVID-19 in 7 Latin American Countries: Structure and Measurement Invariance of the Obsession With COVID-19 Scale.

The present study aimed to evaluate the measurement invariance of the Obsession with COVID-19 Scale (OCS) among seven Latin American countries: Bolivia, Brazil, Cuba, El Salvador, Guatemala, Paraguay, and Uruguay. Although the OCS has been used in several countries and languages, there is a need for approaches that better integrate the cross-cultural equivalence of the scale. A total of 3185 people participated in the study. The results indicated the presence of a unidimensional structure and good reliability indices for the OCS in each country. The alignment method indicated that the OCS is an invariant measure of COVID-19 obsession among the populations of seven Latin American countries. The findings based on IRT analysis indicated that all OCS items had adequate discrimination and difficulty parameters. The findings contribute to the understanding of the internal structure of the scale in different countries at the same time, something that has been pending evaluation.

Molecular basis of Toxoplasma gondii oryzalin resistance from a novel α-tubulin binding site model.

Oryzalin (ORY) is a dinitroaniline derivative that inhibits the microtubule polymerization in plants and parasitic protozoa by selectively binding to the α-tubulin subunit. This herbicidal agent exhibits good antiprotozoal activity against major human parasites, such as Toxoplasma gondii (toxoplasmosis), Leishmania mexicana (leishmaniasis), and Plasmodium falciparum (malaria). Previous chemical mutagenesis assays on T. gondii α-tubulin (TgAT) have identified key mutations that lead to ORY resistance. Herein, we employed alchemical free energy methods and molecular dynamics simulations to determine if the ORY resistance mutations either decrease the TgAT's affinity of the compound or increase the protein stability. Our results here suggest that L136F and V202F mutations significantly decrease the affinity of ORY to TgAT, while T239I and V252L mutations diminish TgAT's flexibility. On the other hand, protein stability predictors determined that R243S mutation reduces TgAT stability due to the loss of its salt bridge interaction with E27. Interestingly, molecular dynamics simulations confirm that the loss of this key interaction leads to ORY binding site closure. Our study provides a better insight into the TgAT-ORY interaction, further supporting our recently proposed ORY-binding site.

Synthesis, in vitro, in silico and in vivo hypoglycemic and lipid-lowering effects of 4-benzyloxy-5-benzylidene-1,3-thiazolidine-2,4-diones mediated by dual PPAR α/γ modulation.

In current work, we prepared a series of nine 4-benzyloxy-5-benzylidene-1,3-thiazolidine-2,4-diones using a two-step pathway. Compounds 1-9 were tested in vitro using a set of three proteins recognized as important targets in diabetes and related diseases: PPARα, PPARγ, and GLUT-4. Compounds 1-3, 5, and 7 showed significant increases in the mRNA expression of PPARγ and GLUT-4, whereas compounds 1-3 did it over PPARα. Compounds 1-3 were identified as a dual PPAR α/γ modulators and were selected for evaluating the in vivo antidiabetic action at 100 mg/kg dose, being orally actives and decreasing blood glucose concentration in a hyperglycemic mice model, as well as reducing the triacylglycerides levels in normolipidemic rats. Docking and molecular dynamics studies were conducted to clarify the dual effect and binding mode of compounds 1-3 on both PPARs. Compounds 2 and 3 exhibited robust in vitro and in vivo efficacy and could be considered dual PPAR modulators with antidiabetic and antidyslipidemic effects.

Spinal exposure for anterior lumbar interbody fusion (ALIF) in the lateral decubitus position: anatomical and technical considerations.

PURPOSE: Single position surgery has demonstrated to reduce hospital length of stay, operative times, blood loss, postoperative pain, ileus, and complications. ALIF and LLIF surgeries offer advantages of placing large interbody devices under direct compression and can be performed by a minimally invasive approach in the lateral position. Furthermore, simultaneous access to the anterior and posterior column is possible in the lateral position without the need for patient repositioning. The purpose of this study is to outline the anatomical and technical considerations for performing anterior lumbar interbody fusion (ALIF) in the lateral decubitus position. METHODS: Surgical technique and technical considerations for reconstruction of the anterior column in the lateral position by ALIF at the L4-5 and L5-S1 levels. RESULTS: Topics outlined in this review include: Operating room layout and patient positioning; surgical anatomy and approach; vessel mobilization and retractor placement for L4-5 and L5-S1 lateral ALIF exposure, in addition to comparative technique of disc space preparation, trialing and implant placement compared to the supine ALIF procedure. CONCLUSIONS: Anterior exposure performed in the lateral decubitus position allows safe-, minimally invasive access and implant placement in ALIF. The approach requires less peritoneal and vessel retraction than in a supine position, in addition to allowing simultaneous access to the anterior and posterior columns when performing 360° Anterior-Posterior fusion.

Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches.

PURPOSE: Circumferential (AP) lumbar fusion surgery is an effective treatment for degenerative and deformity conditions of the spine. The lateral decubitus position allows for simultaneous access to the anterior and posterior aspects of the spine, enabling instrumentation of both columns without the need for patient repositioning. This paper seeks to outline the anatomical and patient-related considerations in anterior column reconstruction of the lumbar spine from L1-S1 in the lateral decubitus position. METHODS: We detail the anatomic considerations of the lateral ALIF, transpsoas, and anterior-to-psoas surgical approaches from surgeon experience and comprehensive literature review. RESULTS: Single-position AP surgery allows simultaneous access to the anterior and posterior column and may combine ALIF, LLIF, and minimally invasive posterior instrumentation techniques from L1-S1 without patient repositioning. Careful history, physical examination, and imaging review optimize safety and efficacy of lateral ALIF or LLIF surgery. An excellent understanding of patient spinal and abdominal anatomy is necessary. Each approach has relative advantages and disadvantages according to the disc level, skeletal, vascular, and psoas anatomy. CONCLUSIONS: A development of a framework to analyze these factors will result in improved patient outcomes and a reduction in complications for lateral ALIF, transpsoas, and anterior-to-psoas surgeries.

Lateral decubitus single position anterior-posterior (AP) fusion shows equivalent results to minimally invasive transforaminal lumbar interbody fusion at one-year follow-up.

PURPOSE: This study compares perioperative and 1-year outcomes of lateral decubitus single position circumferential fusion (L-SPS) versus minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for degenerative pathologies. METHODS: Multicenter retrospective chart review of patients undergoing AP fusion with L-SPS or MIS TLIF. Demographics and clinical and radiographic outcomes were compared using independent samples t tests and chi-squared analyses with significance set at p < 0.05. RESULTS: A total of 445 patients were included: 353 L-SPS, 92 MIS TLIF. The L-SPS cohort was significantly older with fewer diabetics and more levels fused. The L-SPS cohort had significantly shorter operative time, blood loss, radiation dosage, and length of stay compared to MIS TLIF. 1-year follow-up showed that the L-SPS cohort had higher rates of fusion (97.87% vs. 81.11%; p = 0.006) and lower rates of subsidence (6.38% vs. 38.46%; p < 0.001) compared with MIS TLIF. There were significantly fewer returns to the OR within 1 year for early mechanical failures with L-SPS (0.0% vs. 5.4%; p < 0.001). 1-year radiographic outcomes revealed that the L-SPS cohort had a greater LL (56.6 ± 12.5 vs. 51.1 ± 15.9; p = 0.004), smaller PI-LL mismatch (0.2 ± 13.0 vs. 5.5 ± 10.5; p = 0.004). There were no significant differences in amount of change in VAS scores between cohorts. Similar results were seen after propensity-matched analysis and sub-analysis of cases including L5-S1. CONCLUSIONS: L-SPS improves perioperative outcomes and does not compromise clinical or radiographic results at 1-year follow-up compared with MIS TLIF. There may be decreased rates of early mechanical failure with L-SPS.

[The Pan American Health Organization's Virtual Campus for Public Health as a technical cooperation strategyO Campus Virtual de Saúde Pública da Organização Pan-Americana de Saúde como estratégia de cooperação técnica]. / El Campus Virtual de Salud Pública de la Organización Panamericana de la Salud como estrategia de cooperación técnica.

The Virtual Campus for Public Health (VCPH) is the educational platform of the Pan American Health Organization, conceived as a tool for technical cooperation.The objectives of this article are to: characterize the training offered at the VCPH, identifying its virtual courses; characterize course participants; describe technological updating processes and the advances made in terms of accessibility; and identify the VCPH's relationship with the main lines of cooperation of the Pan American Health Organization.The VCPH has developed 210 tutored courses and 226 self-learning courses since 2007, related to the Organization's policies. Heterogeneous use of the campus was observed in the different areas of cooperation. The number of self-learning courses conducted during the pandemic surpassed the total figure accumulated in previous years.Participants are mainly from Latin America; 67.5% are women between 26 and 45 years of age; 57.1% have a university education, mainly in nursing or medicine; half of them work in hospitals and 35.8% at the first level of care.More than 90% of the participants had a favorable opinion of the topics addressed, the learning resources offered, and the characteristics of the virtual classroom. Among difficulties, they indicated little available time and poor internet access; among advantages, they emphasized independent schedules and access to various sources of information. The available assessment tools are not sufficient to determine the impact of VCPH educational programs.The challenges are to deepen the accessibility and quality of education offered, strengthen links with areas of cooperation, and improve course evaluations and knowledge about VCPH users.

O Campus Virtual de Saúde Pública é a plataforma educacional da Organização Pan-Americana da Saúde, concebida como uma ferramenta de cooperação técnica.Os objetivos deste artigo são caracterizar os treinamentos oferecidos pelo Campus Virtual de Saúde Pública, identificando as propostas de cursos virtuais; caracterizar os participantes desses cursos; descrever os processos de atualização tecnológica e seu progresso em termos de acessibilidade; e identificar sua relação com as principais linhas de cooperação da Organização Pan-Americana da Saúde.Desde 2007, o Campus Virtual de Saúde Pública desenvolveu 210 cursos com orientação e 226 cursos de autoaprendizagem relacionados às políticas da Organização. Houve um uso heterogêneo do campus em relação aos diferentes temas de cooperação. O número de cursos de autoaprendizagem realizados durante a pandemia excedeu o número total acumulado nos anos anteriores.Os participantes são oriundos principalmente da América Latina. No total, 67,5% são mulheres, com idade entre 26 e 45 anos, e 57,1% têm formação universitária, principalmente em enfermagem ou medicina. Metade trabalha em hospitais e 35,8% na atenção primária.Mais de 90% dos participantes fizeram uma avaliação favorável dos tópicos abordados, recursos de conhecimento e características da sala de aula virtual. Como dificuldades, destacam-se a pouca disponibilidade de tempo e o acesso limitado à Internet. As vantagens incluem a autonomia de horários e o acesso a várias fontes de informação. As ferramentas de avaliação disponíveis não são suficientes para reconhecer o impacto dos programas educacionais.Os desafios são aprofundar a acessibilidade e a qualidade das propostas educacionais, fortalecer sua relação com os temas de cooperação e melhorar a avaliação dos cursos e o conhecimento dos usuários.

Decision Support System to Classify and Optimize the Energy Efficiency in Smart Buildings: A Data Analytics Approach.

In this paper, an intelligent data analysis method for modeling and optimizing energy efficiency in smart buildings through Data Analytics (DA) is proposed. The objective of this proposal is to provide a Decision Support System (DSS) able to support experts in quantifying and optimizing energy efficiency in smart buildings, as well as reveal insights that support the detection of anomalous behaviors in early stages. Firstly, historical data and Energy Efficiency Indicators (EEIs) of the building are analyzed to extract the knowledge from behavioral patterns of historical data of the building. Then, using this knowledge, a classification method to compare days with different features, seasons and other characteristics is proposed. The resulting clusters are further analyzed, inferring key features to predict and quantify energy efficiency on days with similar features but with potentially different behaviors. Finally, the results reveal some insights able to highlight inefficiencies and correlate anomalous behaviors with EE in the smart building. The approach proposed in this work was tested on the BlueNet building and also integrated with Eugene, a commercial EE tool for optimizing energy consumption in smart buildings.

Design and Evaluation of a Heterogeneous Lightweight Blockchain-Based Marketplace.

The proposal of this paper is to introduce a low-level blockchain marketplace, which is a blockchain where participants could share its power generation and demand. To achieve this implementation in a secure way for each actor in the network, we proposed to deploy it over efficient and generic low-performance devices. Thus, they are installed as IoT devices, registering measurements each fifteen minutes, and also acting as blockchain nodes for the marketplace. Nevertheless, it is necessary that blockchain is lightweight, so it is implemented as a specific consensus protocol that allows each node to have enough time and computer requirements to act both as an IoT device and a blockchain node. This marketplace will be ruled by Smart Contracts deployed inside the blockchain. With them, it is possible to make registers for power generation and demand. This low-level marketplace could be connected to other services to execute matching algorithms from the data stored in the blockchain. Finally, a real test-bed implementation of the marketplace was tested, to confirm that it is technically feasible.

Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19.

Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion: The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphone-specific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.