Postprandial Glycemic Response to Whole Fruit versus Blended Fruit in Healthy, Young Adults.

While increased intake of dietary fiber is known to reduce postprandial glycemic response, it is less understood whether the disruption of dietary fiber, in a blender, alters the postprandial glycemic response. We compared the postprandial glycemic response in 20 young, healthy college students (12 female, 8 male) after consuming whole fruit vs. blended fruit. The fruit included gala apple, with the seeds removed, and blackberries. We used a repeated measures two-way ANOVA with fruit treatment as the within-subject variable, sex as the between-subjects factor, and glucose maximum, glucose incremental area under the curve (iAUC), and 60 min glucose as dependent variables. Glucose maximum and glucose iAUC were significantly lower (p < 0.05) in blended fruit compared to whole fruit and 60 min glucose was marginally significantly lower (p = 0.057) in blended fruit compared to whole fruit. Sex was not a significant main effect and sex*treatment was not a significant interaction for any of the dependent variables. We hypothesize that a reduced glycemic response in blended apple and blackberries compared to whole apple and blackberries might be associated with the release of dietary fiber and nutritive components from ground blackberry seeds.

A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19.

OBJECTIVES: Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS: We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals' real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS: Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS: Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients' comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.

Using Slack to Facilitate Virtual Small Groups for Individualized Interactive Instruction.

Individualized interactive instruction provides an opportunity for significant innovation and advances in curriculum design. We describe the development and implementation of virtual small group exercises into the curriculum of an emergency medicine residency training program using a free social media and communication platform (Slack). Two virtual small group exercises, one case-based and one open-ended, were trialed during the 2016 to 2017 academic year. We found that the exercises were feasible to implement in a learner group where 66% (41/62) had little or no prior experience with Slack. There was a trend toward a more favorable rating of the quality of the dialogue and of the task-technology fit for the case-based format as opposed to the open-ended educational activity.