Real-World Disparities in Remote Follow-Up of Cardiac Implantable Electronic Devices and Impact of the COVID-19 Pandemic: A Single-Center Experience.

Background Remote monitoring (RM) of cardiac implantable electronic devices has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in use and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in cardiac implantable electronic device RM. Methods and Results This was a retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted cardiac implantable electronic device or device upgrade between January 2017 and December 2020 were included. Patients were classified as RM positive (RM+) when they underwent at least ≥2 remote interrogations per year during follow-up. Of all eligible patients, 2520 patients were included, and 34% were women. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, whereas 26% were implantable cardioverter-defibrillators, and 8% were cardiac resynchronization therapy with implantable cardioverter-defibrillators. Most patients (83%) were of European American ancestry. During follow-up, 66% of patients were classified as RM+. Patients who were younger, European American, college-educated, lived in a county with higher median household income, and were active on the hospital's patient portals were more frequently RM+. In an adjusted regression model, RM+ remained associated with the use of the online patient portal (odds ratio [OR], 2.889 [95% CI, 2.387-3.497]), presence of an implantable cardioverter-defibrillator (OR, 1.489 [95% CI, 1.207-1.835]), advanced college degree (OR, 1.244 [95% CI, 1.014-1.527]), and lastly with European American ancestry (P<0.05). During the years of the COVID-19 pandemic, the number of RM+ patients increased, whereas the association with ancestry and ethnicity decreased. Conclusions Despite being offered to all patients at implantation, significant disparities were present in cardiovascular implantable electronic device RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center- and patient-specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.

Perspectives from remote sensing to investigate the COVID-19 pandemic: A future-oriented approach.

As scientific technology and space science progress, remote sensing has emerged as an innovative solution to ease the challenges of the COVID-19 pandemic. To examine the research characteristics and growth trends in using remote sensing for monitoring and managing the COVID-19 research, a bibliometric analysis was conducted on the scientific documents appearing in the Scopus database. A total of 1,509 documents on this study topic were indexed between 2020 and 2022, covering 165 countries, 577 journals, 5239 institutions, and 8,616 authors. The studies related to remote sensing and COVID-19 have a significant increase of 30% with 464 articles. The United States (429 articles, 28.42% of the global output), China (295 articles, 19.54% of the global output), and the United Kingdom (174 articles, 11.53%) appeared as the top three most contributions to the literature related to remote sensing and COVID-19 research. Sustainability, Science of the Total Environment, and International Journal of Environmental Research and Public Health were the three most productive journals in this research field. The utmost predominant themes were COVID-19, remote sensing, spatial analysis, coronavirus, lockdown, and air pollution. The expansion of these topics appears to be associated with cross-sectional research on remote sensing, evidence-based tools, satellite mapping, and geographic information systems (GIS). Global pandemic risks will be monitored and managed much more effectively in the coming years with the use of remote sensing technology.

Evaluation of urban green space per capita with new remote sensing and geographic information system techniques and the importance of urban green space during the COVID-19 pandemic.

A recently conducted study by the Centers for Disease Control and Prevention encouraged access to urban green space for the public over the prevalence of COVID-19 in that exposure to urban green space can positively affect the physical and mental health, including the reduction rate of heart disease, obesity, stress, stroke, and depression. COVID-19 has foregrounded the inadequacy of green space in populated cities. It has also highlighted the extant inequities so as to unequal access to urban green space both quantitatively and qualitatively. In this regard, it seems that one of the problems related to Malatya is the uncoordinated distribution of green space in different parts of the city. Therefore, knowing the quantity and quality of these spaces in each region can play an effective role in urban planning. The aim of the present study has been to evaluate urban green space per capita and to investigate its distribution based on the population of the districts of Battalgazi county in Malatya city through developing an integrated methodology (remote sensing and geographic information system). Accordingly, in Google Earth Engine by images of Sentinel-1 and PlanetScope satellites, it was calculated different indexes (NDVI, EVI, PSSR, GNDVI, and NDWI). The data set was prepared and then by combining different data, classification was performed according to support vector machine algorithm. From the landscaping maps obtained, the map was selected with the highest accuracy (overall accuracy: 94.43; and kappa coefficient: 90.5). Finally, by the obtained last map, the distribution of urban green space per capita and their functions in Battalgazi county and its districts were evaluated. The results of the study showed that the existing urban green spaces in the Battalgazi/Malatya were not distributed evenly on the basis of the districts. The per capita of urban green space is twenty-four regions which is more than 9m2 and in twenty-three ones is less than 9m2. The recommendation of this study was that Türkiye city planners and landscape designers should replan and redesign the quality and equal distribution of urban green spaces, especially during and following COVID-19 pandemic. Additionally, drawing on the Google Earth Engine cloud system, which has revolutionized GIS and remote sensing, is recommended to be used in land use land cover modeling. It is straightforward to access information and analyze them quickly in Google Earth Engine. The published codes in this study makes it possible to conduct further relevant studies.

Identifying spatiotemporal patterns of COVID-19 transmissions and the drivers of the patterns in Toronto: a Bayesian hierarchical spatiotemporal modelling.

Spatiotemporal patterns and trends of COVID-19 at a local spatial scale using Bayesian approaches are hardly observed in literature. Also, studies rarely use satellite-derived long time-series data on the environment to predict COVID-19 risk at a spatial scale. In this study, we modelled the COVID-19 pandemic risk using a Bayesian hierarchical spatiotemporal model that incorporates satellite-derived remote sensing data on land surface temperature (LST) from January 2020 to October 2021 (89 weeks) and several socioeconomic covariates of the 140 neighbourhoods in Toronto. The spatial patterns of risk were heterogeneous in space with multiple high-risk neighbourhoods in Western and Southern Toronto. Higher risk was observed during Spring 2021. The spatiotemporal risk patterns identified 60% of neighbourhoods had a stable, 37% had an increasing, and 2% had a decreasing trend over the study period. LST was positively, and higher education was negatively associated with the COVID-19 incidence. We believe the use of Bayesian spatial modelling and the remote sensing technologies in this study provided a strong versatility and strengthened our analysis in identifying the spatial risk of COVID-19. The findings would help in prevention planning, and the framework of this study may be replicated in other highly transmissible infectious diseases.

Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept.

OBJECTIVE: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment and reduce potential exposures during coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 intensive care unit. RESULTS: All nine patients required mechanical ventilation and corticosteroids. During the protocol, 75.7% of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients. CONCLUSIONS: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.

A survey on the attitudes of parents with young children on in-home monitoring technologies and study designs for infant research.

Remote in-home infant monitoring technologies hold great promise for increasing the scalability and safety of infant research (including in regard to the current Covid-19 pandemic), but remain rarely employed. These technologies hold a number of fundamental challenges and ethical concerns that need addressing to aid the success of this fast-growing field. In particular, the responsible development of such technologies requires caregiver input. We conducted a survey of the opinions of 410 caregivers on the viability, privacy and data access of remote in-home monitoring technologies and study designs. Infant-friendly wearable devices (such as sensing body suits) were viewed favourably. Caregivers were marginally more likely to accept video and audio recording in the home if data was anonymised (through automated processing) at point of collection, particularly when observations were lengthy. Caregivers were more open to international data sharing for anonymous data. Caregivers were interested in viewing all types of data, but were particularly keen to access video and audio recordings for censoring purposes (i.e., to delete data segments). Taken together, our results indicate generally positive attitudes to remote in-home monitoring technologies and studies for infant research but highlight specific considerations such as safety, privacy and family practicalities (e.g. multiple caregivers, visitors and varying schedules) that must be taken into account when developing future studies.

Telemedicine in the Coronavirus Disease 2019 Pandemic: A Pediatric Rehabilitation Perspective.

ABSTRACT: In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.

Diagnostic Modalities for the Detection of SARS-CoV-2: Principles, Advantages, and Pitfalls.

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a significant worldwide health concern in recent months. The world has not dealt with such adversities since World War II. The spread has had a devastating and massive impact on global health, the economy, and people's everyday lives. With the crisis looming around the world, there is not yet any report of a clinically approved drug effective against this virus or or vaccine that can prevent people from getting infected. In this article, we describe different types of diagnostic tests currently used to detect SARS-CoV-2 infection. We also present an overview of the basic principles involved, advantages, and the pitfalls associated with each technique. This article also provides an insight into various supplementary diagnostic modalities, including recent advancements in sensing technologies and further clinical improvement and novelties to fight this pandemic.

Outcomes and Healthcare Provider Perceptions of Real-Time Continuous Glucose Monitoring (rtCGM) in Patients With Diabetes and COVID-19 Admitted to the ICU.

OBJECTIVE: We assessed the clinical utility and accuracy of real-time continuous glucose monitoring (rtCGM) (Dexcom G6) in managing diabetes patients with severe COVID-19 infection following admission to the intensive care unit (ICU). METHODS: We present retrospective analysis of masked rtCGM in 30 patients with severe COVID-19. rtCGM was used during the first 24 hours for comparison with arterial-line point of care (POC) values, where clinicians utilized rtCGM data to adjust insulin therapy in patients if rtCGM values were within 20% of point-of-care (POC) values during the masked period. An investigator-developed survey was administered to assess nursing staff (n = 66) perceptions regarding the use of rtCGM in the ICU. RESULTS: rtCGM data were used to adjust insulin therapy in 30 patients. Discordance between rtCGM and POC glucose values were observed in 11 patients but the differences were not considered clinically significant. Mean sensor glucose decreased from 235.7 ± 42.1 mg/dL (13.1 ± 2.1 mmol/L) to 202.7 ± 37.6 mg/dL (11.1 ± 2.1 mmol/L) with rtCGM management. Improvements in mean sensor glucose were observed in 77% of patients (n = 23) with concomitant reductions in daily POC measurements in 50% of patients (n = 15) with rtCGM management. The majority (63%) of nurses reported that rtCGM was helpful for improving care for patients with diabetes patients during the COVID-19 pandemic, and 49% indicated that rtCGM reduced their use of personal protective equipment (PPE). CONCLUSIONS: Our findings provide a strong rationale to increase clinician awareness for the adoption and implementation of rtCGM systems in the ICU. Additional studies are needed to further understand the utility of rtCGM in critically ill patients and other clinical care settings.

Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic.

The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.

Physical distancing and risk of COVID-19 in small-scale fisheries: a remote sensing assessment in coastal Ghana.

The novel coronavirus is predicted to have dire implications on global food systems including fisheries value chains due to restrictions imposed on human movements in many countries. In Ghana, food production, both agriculture and fisheries, is exempted from restrictions as an essential service. The enforcement of COVID-19 prevention protocols, particularly social distancing, has been widely reported in Ghana's agricultural markets whereas casual observations and media reports on fish landing sites suggest no such enforcements are in place. This study aimed to provide sound scientific evidence as a basis for informed policy direction and intervention for the artisanal fishing sector in these challenging times. We employed an unmanned aerial vehicle in assessing the risk of artisanal fishers to the pandemic using physical distancing as a proxy. From analysis of cumulative distribution function (G-function) of the nearest-neighbour distances, this study underscored crowding at all surveyed fish landing beaches, and identified potential "hotspots" for disease transmission. Aerial measurements taken at times of peak landing beach activity indicated that the highest proportion of people, representing 56%, 48%, 39% and 78% in Elmina, Winneba, Apam and Mumford respectively, were located at distances of less than one metre from their nearest neighbour. Risk of crowding was independent of the population at the landing beaches, suggesting that all categories of fish landing sites along the coast would require equal urgency and measured attention towards preventing and mitigating the spread of the disease.

Remote Fingerstick Blood Collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Testing.

The rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has propelled the rapid development of serologic tests that can detect anti-SARS-CoV-2 antibodies. These have been used for studying the prevalence and spread of infection in different populations, and helping establish a recent diagnosis of coronavirus disease 2019 (COVID-19), and will likely be used to confirm humoral immunity after infection or vaccination. However, nearly all lab-based high-throughput SARS-CoV-2 serologic assays require a serum sample from venous blood draw, limiting their applications and scalability. Here, we present a method that enables large-scale SARS-CoV-2 serologic studies by combining self or office collection of fingerprick blood with a volumetric absorptive microsampling device (Mitra, Neoteryx LLC) with a high-throughput electrochemiluminescence-based SARS-CoV-2 total antibody assay (Roche Elecsys, Roche Diagnostics Inc) that is emergency use authorization approved for use on serum samples and widely used by clinical laboratories around the world. We found that the Roche Elecsys assay has a high dynamic range that allows for accurate detection of SARS-CoV-2 antibodies in serum samples diluted 1:20 as well as contrived dried blood extracts. Extracts of dried blood from Mitra devices acquired in a community seroprevalence study showed near identical sensitivity and specificity in detection of SARS-CoV-2 antibodies compared with neat sera using predefined thresholds for each specimen type. Overall, this study affirms the use of Mitra dried blood collection device with the Roche Elecsys SARS-CoV-2 total antibody assay for remote or at-home testing as well as large-scale community seroprevalence studies.

Perspective on the increasing role of optical wearables and remote patient monitoring in the COVID-19 era and beyond.

SIGNIFICANCE: The COVID-19 pandemic is changing the landscape of healthcare delivery in many countries, with a new shift toward remote patient monitoring (RPM). AIM: The goal of this perspective is to highlight the existing and future role of wearable and RPM optical technologies in an increasingly at-home healthcare and research environment. APPROACH: First, the specific changes occurring during the COVID-19 pandemic in healthcare delivery, regulations, and technological innovations related to RPM technologies are reviewed. Then, a review of the current state and potential future impact of optical physiological monitoring in portable and wearable formats is outlined. RESULTS: New efforts from academia, industry, and regulatory agencies are advancing and encouraging at-home, portable, and wearable physiological monitors as a growing part of healthcare delivery. It is hoped that these shifts will assist with disease diagnosis, treatment, management, recovery, and rehabilitation with minimal in-person contact. Some of these trends are likely to persist for years to come. Optical technologies already account for a large portion of RPM platforms, with a good potential for future growth. CONCLUSIONS: The biomedical optics community has a potentially large role to play in developing, testing, and commercializing new wearable and RPM technologies to meet the changing healthcare and research landscape in the COVID-19 era and beyond.

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England.

AIMS: People with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D. METHODS: Data were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2). RESULTS: Two hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9-10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods). CONCLUSION: Sensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

IoMT (Internet of Medical Things): Reducing Cost While Improving Patient Care.

Citizens' dissatisfaction with the scope of the United States health care system has been a hot topic for many years. In a country where patient to nurse ratios remain 6:1, even universal health care coverage cannot guarantee adequate patient care. These issues were further highlighted by the COVID-19 pandemic, where inadequate hospital funding and lack of attention to patients led to challenging situations in hotspot areas. Although this pandemic will shape us for many years to come with far reaching impacts, social distancing norms have accelerated technologies that enable services to be delivered remotely, a capability even more necessary in our health care system. By providing care that can be delivered remotely, we can focus in-person care in our hospitals to only the ones who really need it. This allows us to scale our systems, protect lives, and safeguard economic activity.

A Wearable Stethoscope for Long-Term Ambulatory Respiratory Health Monitoring.

Lung sounds acquired by stethoscopes are extensively used in diagnosing and differentiating respiratory diseases. Although an extensive know-how has been built to interpret these sounds and identify diseases associated with certain patterns, its effective use is limited to individual experience of practitioners. This user-dependency manifests itself as a factor impeding the digital transformation of this valuable diagnostic tool, which can improve patient outcomes by continuous long-term respiratory monitoring under real-life conditions. Particularly patients suffering from respiratory diseases with progressive nature, such as chronic obstructive pulmonary diseases, are expected to benefit from long-term monitoring. Recently, the COVID-19 pandemic has also shown the lack of respiratory monitoring systems which are ready to deploy in operational conditions while requiring minimal patient education. To address particularly the latter subject, in this article, we present a sound acquisition module which can be integrated into a dedicated garment; thus, minimizing the role of the patient for positioning the stethoscope and applying the appropriate pressure. We have implemented a diaphragm-less acousto-electric transducer by stacking a silicone rubber and a piezoelectric film to capture thoracic sounds with minimum attenuation. Furthermore, we benchmarked our device with an electronic stethoscope widely used in clinical practice to quantify its performance.