Utilizing Digital Health to Collect Electronic Patient-Reported Outcomes in Prostate Cancer: Single-Arm Pilot Trial

Background: Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment. Objective: This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer. Methods: Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index. In a single-arm pilot study with patients receiving prostate cancer treatment at Thomas Jefferson University Hospital and affiliates, participants were recruited, and instructed to download Strength Through Insight and complete ePROs once a week over 12 weeks. A mixed methods approach, including qualitative pre- and poststudy interviews, was used to evaluate the feasibility and acceptability of Strength Through Insight for the collection and care management of cancer treatment. Results: Thirty patients consented to the study; 1 patient failed to complete any of the questionnaires and was left out of the analysis of the intervention. Moreover, 86% (25/29) reached satisfactory questionnaire completion (defined as completion of 60% of weekly questions over 12 weeks). The lower bound of the exact one-sided 95% CI was 71%, exceeding the 70% feasibility threshold. Most participants self-identified with having a high digital literacy level (defined as the ability to use, understand, evaluate, and analyze information from multiple formats from a variety of digital sources), and only a few participants identified with having a low digital literacy level (defined as only having the ability to gather information on the Web). Interviews were thematically analyzed to reveal the following: (1) value of emotional support and wellness in cancer treatment, (2) rise of social patient advocacy in online patient communities and networks, (3) patient concerns over privacy, and (4) desire for personalized engagement tools. Conclusions: Strength Through Insight was demonstrated as a feasible and acceptable method of data collection for ePROs. A high compliance rate confirmed the app as a reliable tool for patients with localized and advanced prostate cancer. Nearly all participants reported that using the smartphone app is easier than or equivalent to the traditional paper-and-pen approach, providing evidence of acceptability and support for the use of remote PRO monitoring. This study expands on current research involving the value of digital health, as a social and behavioral science, augmented with technology, can begin to contribute to population health management, as it shapes psychographic segmentation by demographic, socioeconomic, health condition, or behavioral factors to group patients by their distinct personalities and motivations, which influence their choices

Cerebral sympatholysis: experiments on in vivo cerebrovascular regulation and ex vivo cerebral vasomotor control

Whether cerebral sympathetic-mediated vasomotor control can be modulated by local brain metabolism remains unknown. This study tested the hypothesis that application or removal of a cognitive task during a cold pressor test (CPT) would attenuate and restore rises in cerebrovascular resistance (CVR), respectively. Middle cerebral artery blood velocity (transcranial Doppler) and mean arterial pressure (finger photoplethysmography) were examined in healthy adults (n=16; 8 F and 8 M) who completed a control CPT, followed by a CPT coupled with a cognitive task administered either A) at the onset of the CPT and terminated 30 s prior to the end of the CPT or B) 30 s after the onset of the CPT and for the duration of the CPT (condition order was counterbalanced). The major finding was that the CPT increased the index of CVR, and such increases were abolished when a cognitive task was completed concurrently and restored when the cognitive task was removed. As a secondary experiment, vasomotor interactions between sympathetic transduction pathways (α1 adrenergic and Y1 peptidergic) and compounds implicated in functional sympatholysis (adenosine (ADO), and adenosine triphosphate (ATP)) were explored in isolated porcine cerebral arteries (wire myography). The data reveal α1 receptor agonism potentiated vasorelaxation modestly in response to ADO but not ATP. Pre-exposure to ATP attenuated contractile responses to α1 agonism. Overall, the data suggest a cognitive task attenuates increases in CVR during sympatho-excitation, possibly related to an interaction between purinergic and α1-adrenergic signaling pathways

The Relationship Between Resilience, Stress & PTSD

Post-traumatic stress disorder (PTSD) is characterized by intrusive thoughts or memories of the traumatic event that hinder daily life activities of individuals with a PTSD diagnosis. Stress exposure has further been shown to exacerbate PTSD symptoms. Given that resilience has been shown to buffer levels of stress, the current study investigated whether resilience may moderate the relationship between stress and PTSD symptoms. Eighty-one participants over the age of 18 were recruited from the University of Missouri-Saint Louis and St. Louis community. Participants completed 3 self-report measures of resilience, exposure to stressful life events (e.g., Have you ever been in a car accident before?), and PTSD symptoms. In support our first hypothesis, we found that stress exposure was associated with greater PTSD symptoms (b = 2.08, t(77) = 5.02, p \u3c .001). However, resilience did not moderate the relationship between stress exposure and PTSD symptoms (B = -0.01, p = .68). Future studies may examine the influence of medications on PTSD, chronic stress, and resilience

Changes in hospital utilization by individuals experiencing homelessness after engaging with interdisciplinary, low-barrier healthcare services in Portland, Maine

Introduction: The Maine Medical Center Preble Street Learning Collaborative (PSLC) aims to couple medical education with addressing the unmet healthcare needs of those experiencing homelessness in Portland, Maine. The PSLC provides low-barrier medical, psychiatric, dental, and case management services to all-comers and is co-located near many of the city’s social services. The purpose of this study was to evaluate the impact of the PSLC in its first 19 months by describing demographic characteristics and patterns in hospital utilization of patients served by the PSLC. Methods: We performed a retrospective chart review of 888 patients with one or more PSLC encounters between January 2017 and July 2018. We collected data from electronic health records and included one full year before and after each patient’s first PSLC encounter. We stratified patients based upon number of ED visits in the year prior to first PSLC encounter. Non-utilizers (N=392) made zero visits, low-utilizers (N=356) made 1-3 visits, high-utilizers (N=116) made 4-9 visits, and very-high-utilizers (N=made 10 or more visits. Results: Pre- to post-PSLC engagement, we demonstrate significant increases in yearly mean number of ED visits (0 to 0.96, PPPP=.005) and very-high-utilizers (15.0 to 5.92, P\u3c.001). Conclusions: These results illustrate that engagement with the PSLC was associated with decreased ED visits by high- and very-high-utilizers and increased visits by previous non-utilizers. For high-utilizers experiencing homelessness, health systems may reduce rates of ED utilization by providing low-barrier access to complex care coordination in clinics specifically focused on serving this population

Adult Pulmonary Langerhans Cell Histiocytosis with Osseous Involvement: understanding this rare mimic of malignancy

Langerhans cells are dendritic cells that form the antigenic barrier of the human body. They occur in nearly any tissue but are most prevalent in the skin, submucosa of the bronchial tree, and other mucosae. Langerhans Cell Histiocytosis (LCH) develops when these cells damage the tissues in which they reside through a combination of inflammatory and monoclonal stimulation. The pulmonary variant of LCH involves the lung parenchyma and creates a wide variety of disturbances: pulmonary hypertension and both obstructive and restrictive lung disease. Osseous involvement, in addition to the pulmonary variant, presents with pulmonary masses and lytic bone lesions, which sparks suspicion for malignancy. Early recognition of this rare pathology is important as early treatment is clinically beneficial. The following explores a case of adult Pulmonary Langerhans Cell Histiocytosis with osseous involvement

Irradiation of N95 Masks for their Sterilization and Reuse During the COVID19 Pandemic

Research Objective We sought to investigate the feasibility of irradiation for N95 mask sterilization

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: a diagnosis obscured by concomitant recreational drug use

Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in the case of atypical presentations or those with past or current substance use disorder. Early identification and treatment are essential to good outcomes and minimal sequalae at two years. Therefore, it is essential to consider aNMDAre with the symptom profile regardless of patient age, sex, race, or clinical disorder. Below is detailed the difficulty in diagnosing aNMDAre in a 32-year-old white male with a history of methamphetamine, opioid, benzodiazepine, and marijuana use

Enumeration of distinct mechanically stable disk packings in small systems

We create mechanically stable (MS) packings of bidisperse disks using an algorithm in which we successively grow or shrink soft repulsive disks followed by energy minimization until the overlaps are vanishingly small. We focus on small systems because this enables us to enumerate nearly all distinct MS packings. We measure the probability to obtain a MS packing at packing fraction $\phi$ and find several notable results. First, the probability is highly nonuniform. When averaged over narrow packing fraction intervals, the most probable MS packing occurs at the highest $\phi$ and the probability decays exponentially with decreasing $\phi$. Even more striking, within each packing-fraction interval, the probability can vary by many orders of magnitude. By using two different packing-generation protocols, we show that these results are robust and the packing frequencies do not change qualitatively with different protocols.Comment: 4 pages, 3 figures, Conference Proceedings for X International Workshop on Disordered System

Fasting Insulin, Adiponectin, hs-CRP Levels, and The Components of Metabolic Syndrome

ABSTRACT 3, 5, 7, 7, 4

Opportunistic Screening for The Detection of Newly Diagnosed Diabetes Melitus

Background. It is estimated that 50% of the diabetic patients are undiagnosed. Opportunistic screening is one of the screening method, to detect newly diagnosed diabetes mellitus. The aim of this study is to detect the undiagnosed diabetes mellitus by screening in the clinical setting. Subjects and Methods. Subjects were form the EIDEG screening for diabetes mellitus. The procedure is a two step screening, first using the reflectance meter for capillary blood sugar, followed by confirmation test in the laboratory. Capillary blood sugar was divided into 3 groups, < 100 mg/dL as normal, 100-199 mg/dl possible diabetes, and ? 200 mg/dL suspected diabetes. For group two, an OGTT was performed, and for group three, only FPG. Diabetes mellitus was diagnosed if FPG ? 126 mg/dl and or 2 hour OGTT ?200 mg/dl. Results. During the screening, 4737 subjects can be screened, only 1654 completed the screening. Diabetes mellitus was diagnosed in 240 subjects or 14.5%. There were more females compared to males, 52,9% and 47,1% subsequently, most were at the age ?50 years. More diabetic patients were diagnosed by OGTT compared to FPG only. Conclusions. This study showed that opportunistic screening may detect more diabetic patients. It is suggested that this screening procedure can be used by every clinicians in their daily practice