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Region, Race, and Age Linked With Likelihood of Cancer Patients Using Telehealth Services

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Key takeaways

Cancer centers in the west were more than six times as likely to offer telehealth visits than other regions in the country.
Race, older age, and income level linked to use of telehealth services at cancer centers.
Each 10-year increase in patient age decreased the odds of a telehealth video visit by nearly 20 percent in cancer patients. Together, Black race and older age decreased the chances of a video visit by an additional 12 percent.

CHICAGO: Two studies improve understanding of how video and telephone telehealth services are used by patients and cancer centers across the country, identifying factors that could lead to more or less use of these services and guide efforts to improve access for patients who might otherwise be shut out. Research findings were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.

To improve access to care during the COVID-19 pandemic, many medical centers shifted to telehealth services. In fact, telehealth visits increased by 50 percent during the first quarter of 2020, compared with the same period in 2019, according to the CDC.*

Telehealth appointments are more efficient than traditional face-to-face encounters, eliminating the need for long travel and wait times, plus many patients prefer the convenience of remote visits. However, challenges for patients such as technical difficulties, internet connection issues, and limited access to smart devices can prevent patients from using this approach.

“Because of COVID, centers across the country had to ramp up telehealth services, and that begs the question, is it feasible for these centers to make this shift long-term?” said Harry Doernberg, a medical student at Yale School of Medicine, New Haven, Connecticut.

Telehealth use among Commission on Cancer-accredited centers

For the first study, Mr. Doernberg and colleagues addressed this question by conducting a secret shopper study on 371 ACS Commission on Cancer (CoC)-accredited centers across the U.S. The objective was to identify factors associated with the centers who offered telehealth services and those who did not. Between June and September 2020, researchers called the centers anonymously to find out if they had the capacity to offer telehealth appointments to breast cancer patients.

Among the study’s key findings:

The vast majority of CoC-accredited centers (316 of 371) offered telehealth visits for breast cancer patients.
After controlling for facility type (Comprehensive Community Cancer Program, Community Cancer Program, and more), teaching hospital status, and hospital size, geographic location was the only independent factor associated with telehealth access.
Centers located in the west were over six times (OR: 6.38) more likely to offer telehealth visits than other regions, including the northeast.

“Overall, this analysis highlights the fact that different regions of the country were more or less prepared to shift to telehealth during the pandemic,” said study coauthor Anees Chagpar, MD, MBA, MPH, FACS, FRCS (C), professor of surgery, Yale School of Medicine, and a member of Yale Cancer Center. “The next questions are: What happens going forward? How many of these centers will continue to offer telehealth? What percentage of patients will opt for telehealth visits? How these questions play out in the future remains to be seen.”

Telehealth use among a diverse population

For the second study, Connie Shao, MD, a general surgery resident at the University of Alabama Birmingham, and her colleagues looked at telehealth use between March and December 2020 among a diverse population of patients receiving care at a Commission on Cancer-accredited National Cancer Institute-designated cancer center in Birmingham.

Using billing data, researchers compared patient socioecological factors for outpatient clinic visits (in-person versus telehealth and within telehealth, telephone-only versus video). The analysis adjusted for factors such as zip code, household income, race, and sex to identify factors associated with telehealth use.

Among the key findings:

Of the 60,718 clinic visits, 84.4 percent (51,260) were in-person and 15.6 percent (9,458) were via telehealth, including video (41.7 percent) and telephone-only (58.3 percent) visits.
Telehealth visits were primarily used by patients who were white (70.3 percent), female (63.7 percent), and had private insurance (47.5 percent). Average age was 60.
Compared with video visits, telephone visits were used more by patients who are Black (25.8 percent vs. 18.4 percent), older (62 vs. 57), from lower income zip codes ($52,297 vs. $56,343), and publicly insured (52 percent vs. 41.4 percent).
For each decade of advancing patient age, the likelihood of having a video visit decreased by 18 percent. This was even more pronounced in Black patients where the likelihood of a video visit dropped by 40 percent for every decade. When Black race and older age were combined, the odds of having a video visit dropped by another 12 percent. This finding was despite increased video telehealth use over the study period.

“Telemedicine is here to stay,” Dr. Shao said. “The issue is how do we make sure patients are accessing it equitably? Unfortunately, some of our sickest patients are not able to access telemedicine that most benefits their health care needs. We want to offer patients, those who are far from the hospital and have a difficult time connecting with us, care with us, even as the COVID pandemic hopefully ends.”

Although telemedicine has been available for decades, COVID has accelerated its widespread use very quickly. Together, these two studies deepen understanding of how vulnerable patients are not reaping the benefits of its use, paving the way for additional research and improved access.

Currently, Dr. Shao and colleagues are implementing a process at their center where patient navigators screen patients to figure out who needs telehealth support. The patient navigators instruct patients on how to set up a video-based telemedicine visit. This gives patients the skill and confidence to use telehealth video visits now and for future appointments.

“We are currently collaborating with a group to roll out this program even more and to analyze the strength of the program and eliminate the barriers. We want to know what can be improved to achieve successful telemedicine visits,” Dr. Shao said. “As COVID wanes, the fear of coming into the hospital decreases. Moving forward, our concern is finding ways to help those patients better engage with us, often and remotely. A lot of these patients are rural and live hours away from a major hospital.”

Coauthors for the Yale University School of Medicine study are Walter Hsiang, BS, MBA; Victoria Marks, BS; Irene Pak; Dana Kim; Bayan Galal; Waez Umer; and Afash Haleem.

Authors have no disclosures to mention.

CITATION: Doernberg H, et al. Factors Affecting Telehealth Availability Amongst Breast Centers During the Pandemic. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.

Dr. Shao’s coauthors for the University of Alabama study are Marshall C. McLeod, PhD; Isabel C. dos Santos Marques, MD; Lauren Theiss, MD; Gregory D. Kennedy, MD, PhD, FACS; Mona N. Fouad, MD, MPH; Eric Wallace, MD; Daniel I. Chu, MD, FACS; and Sushanth Reddy, MD, FACS.

An American College of Surgeons resident research award and an AHRQ Grant for Health Services funded the study.

CITATION: Shao C, et al. Age Exacerbates Inequity in Telemedicine Use During the Covid-19 Pandemic for Cancer Patients in the Deep South. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.

“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

_______________________

* https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm.

# # #

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

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Original Source: bioengineer.org

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Gene Linked to Severe Learning Disabilities Governs Cell Stress Response

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DURHAM, N.C. – A gene that has been associated with severe learning disabilities in humans has been found to also play a vital role in cells’ response to environmental stress, according to a Duke University study appearing May 24 in the journal Cell Reports.

DURHAM, N.C. – A gene that has been associated with severe learning disabilities in humans has been found to also play a vital role in cells’ response to environmental stress, according to a Duke University study appearing May 24 in the journal Cell Reports.

Cells are stressed by factors  that may damage them, such as extreme temperatures, toxic substances, or mechanical shocks. When this happens, they undergo a range of molecular changes called the cellular stress response.

“Every cell, no matter from which organism, is always exposed to harmful substances in their environment that they have to deal with all the time,” said Gustavo Silva, assistant professor of biology at Duke and senior author on the paper. “Many human diseases are caused by cells not being able to cope with these aggressions.”

During the stress response, cells press pause the genes related to their normal housekeeping activities, and turn on genes related to crisis mode. Just like in a house being flooded, they put down the window cleaner, turn off the TV, and run to close the windows, then they patch holes, turn on the sump pump, and if needed, rip up carpet and throw away irreparably damaged furniture.

While studying mechanisms related to the cells’ health and their response to stress, the team saw that, under stress, a group of proteins was being modified inside the cells. They dug into it and found that the master regulator of this process is a gene called Rad6.

“When there is a stressor, cells need to change what proteins are produced,” said Vanessa Simões, associate in research in the Silva lab and lead author of the paper. “Rad6 goes in and gets the (protein-building) ribosomes to change their program and adapt what they are producing for the new stressful circumstances.”

Rad6 isn’t just any random gene. It can be found, sometimes under a different name, in almost all multicellular organisms. In humans, it is known for its association with a set of symptoms called “Nascimento Syndrome,” that include severe learning disabilities.

Nascimento Syndrome, also called X-linked intellectual disability type Nascimento, is still a poorly understood disease. It was officially described in 2006, and tends to run in families, giving scientists an early clue to its genetic causes. Affected individuals have severe learning disabilities, characteristic facial traits, with wide-set eyes and a depressed nose bridge, and a range of other debilitating symptoms.

Like many other genes, Rad6 doesn’t just do one thing. It’s a multiuse tool. By discovering an additional function, and one so tightly related to the cell’s health, Silva and his team get to add a new piece to the puzzle of Nascimento Syndrome.

“It’s still a big question or how exactly can a mutation to this gene lead to such a drastic syndrome in humans,” said Silva. “Our findings are exciting because Rad6 can be a model on which we can do genetic manipulations to try to understand how problems in coping with harmful conditions can be connected to how this disease progresses.”

“If we get a better understanding of how this gene works, we can actually try to interfere with it to help these patients have a better outcome.” he said.

But how does one actually “look” at what is happening with an infinitesimally small protein when a cell is stressed? With a fair amount of teamwork. Simões and Silva paired up with researchers from the Duke Biochemistry department and the Pratt School of engineering to gather all the help they needed.  

“We used biochemistry analyses, cellular assays, proteomics, molecular modeling, cryo-electron microscopy, a whole set of advanced techniques,” said Silva.

“It’s the cool thing about being in a place like Duke,” he said. “We found collaborators and resources easily, right here, and that really increases the impact of a study and our ability to do a more complete work.”

Funding for this study was provided by US National Institutes of Health R00 Award ES025835 and R35 Award GM137954 to Gustavo Silva. This work was also supported in part by R01 Award GM141223 to Alberto Bartesaghi and the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences Grant ZIC ES103326 to Mario J. Borgnia. Cryo- EM work was performed at the Duke University Shared Materials Instrumentation Facility (SMIF), a member of the North Carolina Research Triangle Nanotechnology Network (RTNN), which is supported by the National Science Foundation (grant ECCS- 1542015) as part of the National Nanotechnology Coordinated Infrastructure (NNCI). Funding was also provided from the UNC Lineberger Comprehensive Cancer Center through the University of California, Riverside Fund and the Cancer Center Support Grant P30CA016086. 

CITATION: “Redox-Sensitive E2 1 Rad6 Controls Cellular Response to Oxidative Stress Via K63-Linked Ubiquitination of Ribosomes,” Vanessa Simões, Blanche K. Cizubu, Lana Harley, Ye Zhou, Joshua Pajak, Nathan A Snyder, Jonathan Bouvette, Mario J. Borgnia, Gaurav Arya, Alberto Bartesaghi, and Gustavo M. Silva. Cell Reports, May 24 2022. DOI: 10.1016/j.celrep.2022.110860

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New Light-powered Catalysts Could Aid in Manufacturing

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CAMBRIDGE, MA — Chemical reactions that are driven by light offer a powerful tool for chemists who are designing new ways to manufacture pharmaceuticals and other useful compounds. Harnessing this light energy requires photoredox catalysts, which can absorb light and transfer the energy to a chemical reaction.

CAMBRIDGE, MA — Chemical reactions that are driven by light offer a powerful tool for chemists who are designing new ways to manufacture pharmaceuticals and other useful compounds. Harnessing this light energy requires photoredox catalysts, which can absorb light and transfer the energy to a chemical reaction.

MIT chemists have now designed a new type of photoredox catalyst that could make it easier to incorporate light-driven reactions into manufacturing processes. Unlike most existing photoredox catalysts, the new class of materials is insoluble, so it can be used over and over again. Such catalysts could be used to coat tubing and perform chemical transformations on reactants as they flow through the tube.

“Being able to recycle the catalyst is one of the biggest challenges to overcome in terms of being able to use photoredox catalysis in manufacturing. We hope that by being able to do flow chemistry with an immobilized catalyst, we can provide a new way to do photoredox catalysis on larger scales,” says Richard Liu, an MIT postdoc and the joint lead author of the new study.

The new catalysts, which can be tuned to perform many different types of reactions, could also be incorporated into other materials including textiles or particles.

Timothy Swager, the John D. MacArthur Professor of Chemistry at MIT, is the senior author of the paper, which appears today in Nature Communications. Sheng Guo, an MIT research scientist, and Shao-Xiong Lennon Luo, an MIT graduate student, are also authors of the paper.

Hybrid materials

Photoredox catalysts work by absorbing photons and then using that light energy to power a chemical reaction, analogous to how chlorophyll in plant cells absorbs energy from the sun and uses it to build sugar molecules.

Chemists have developed two main classes of photoredox catalysts, which are known as homogenous and heterogenous catalysts. Homogenous catalysts usually consist of organic dyes or light-absorbing metal complexes. These catalysts are easy to tune to perform a specific reaction, but the downside is that they dissolve in the solution where the reaction takes place. This means they can’t be easily removed and used again.

Heterogenous catalysts, on the other hand, are solid minerals or crystalline materials that form sheets or 3D structures. These materials do not dissolve, so they can be used more than once. However, these catalysts are more difficult to tune to achieve a desired reaction.

To combine the benefits of both of these types of catalysts, the researchers decided to embed the dyes that make up homogenous catalysts into a solid polymer. For this application, the researchers adapted a plastic-like polymer with tiny pores that they had previously developed for performing gas separations. In this study, the researchers demonstrated that they could incorporate about a dozen different homogenous catalysts into their new hybrid material, but they believe it could work more many more.

“These hybrid catalysts have the recyclability and durability of heterogeneous catalysts, but also the precise tunability of homogeneous catalysts,” Liu says. “You can incorporate the dye without losing its chemical activity, so, you can more or less pick from the tens of thousands of photoredox reactions that are already known and get an insoluble equivalent of the catalyst you need.”

The researchers found that incorporating the catalysts into polymers also helped them to become more efficient. One reason is that reactant molecules can be held in the polymer’s pores, ready to react. Additionally, light energy can easily travel along the polymer to find the waiting reactants.

“The new polymers bind molecules from solution and effectively preconcentrate them for reaction,” Swager says. “Also, the excited states can rapidly migrate throughout the polymer. The combined mobility of the excited state and partitioning of the reactants in the polymer make for faster and more efficient reactions than are possible in pure solution processes.”

Higher efficiency

The researchers also showed that they could tune the physical properties of the polymer backbone, including its thickness and porosity, based on what application they want to use the catalyst for.

As one example, they showed that they could make fluorinated polymers that would stick to fluorinated tubing, which is often used for continuous flow manufacturing. During this type of manufacturing, chemical reactants flow through a series of tubes while new ingredients are added, or other steps such as purification or separation are performed.

Currently, it is challenging to incorporate photoredox reactions into continuous flow processes because the catalysts are used up quickly, so they have to be continuously added to the solution. Incorporating the new MIT-designed catalysts into the tubing used for this kind of manufacturing could allow photoredox reactions to be performed during continuous flow. The tubing is clear, allowing light from an LED to reach the catalysts and activate them.

“The idea is to have the catalyst coating a tube, so you can flow your reaction through the tube while the catalyst stays put. In that way, you never get the catalyst ending up in the product, and you can also get a lot higher efficiency,” Liu says.

The catalysts could also be used to coat magnetic beads, making them easier to pull out of a solution once the reaction is finished, or to coat reaction vials or textiles. The researchers are now working on incorporating a wider variety of catalysts into their polymers, and on engineering the polymers to optimize them for different possible applications.

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The research was funded by the National Science Foundation and the KAUST Sensor Initiative.

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Watching Video Feed of Hospitalized Baby Improves Pumping Experience

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Parents who used videoconferencing technology to view their hospitalized baby reported an improved pumping experience while expressing milk for their premature infant. Videoconferencing also helped the whole family connect to their infant in the Neonatal Intensive Care Unit (NICU). These findings were published in Breastfeeding Medicinethis month.

Parents who used videoconferencing technology to view their hospitalized baby reported an improved pumping experience while expressing milk for their premature infant. Videoconferencing also helped the whole family connect to their infant in the Neonatal Intensive Care Unit (NICU). These findings were published in Breastfeeding Medicinethis month.

“Breast milk feeding is an essential component of care for the hospitalized premature infant, but it can be challenging due to factors including low milk supply, the need to express milk instead of feeding directly from the breast, as well as the stress and anxiety for new parents who are physically separated from their premature infants in the hospital environment,” said study lead author Adrienne Hoyt-Austin. “Our study explored the experience of pumping milk while watching one’s hospitalized baby with videoconferencing.”

The UC Davis Health study enrolled parents who used FamilyLink when they are not at the bedside in the UC Davis NICU. FamilyLink is a videoconferencing program which gives families the option to see their baby through a secure connection from a home computer, tablet or cellphone 24/7.

The team interviewed participants who pumped breastmilk while using FamilyLink to view their infant and those who pumped without videoconferencing.

Participants had given birth to an infant who was less than 34 weeks gestational age and was admitted to the UC Davis NICU.

In a one-on-one interview, participants were asked 14 open-ended questions regarding their breast milk pumping experience. The qualitative analysis identified four common themes. It showed that videoconferencing:

Provided bonding and connection. Participants felt “more of a connection” and “more of a bond” when seeing their hospitalized infant on video.
Provided motivation to pump. One participant said that seeing their baby is a “visual reminder that this is what I’m doing this for.”
Reminded participants that they were separated from their baby. One participant said, “I became just kind of guilty watching, feeling like I should be there instead of away.”
 Connected the whole family to their baby. Participants reported that videoconferencing helped introduce new family members to the baby and explain the complicated issue of neonatal hospitalization.

“In our interviews, we heard over and over again that that videoconferencing improved the pumping experience and gave motivation to continue to provide breast milk for their hospitalized infant. Participants also felt that seeing their baby while pumping strengthened the bond between the family with their newborn,” said Hoyt-Austin. “We hope that the use of videoconferencing for NICU parents will become a more widely available tool in NICUs that can help new parents in their breastfeeding journey.”       

The study co-authors are Iesha Miller, Kara Kuhn-Riordon, Jennifer Rosenthal, Caroline Chantry, James Marcin, Kristin Hoffman and Laura Kair, all of UC Davis Health.

The project was funded by the Children’s Miracle Network at UC Davis and the Clinical and Translational Science Center Highly-Innovative Award (UL1-TR001860). The researchers were supported by HRSA T32HP30037 grant, NIH’s Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) award (K12 HD051958) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) K23HD1015-50 grant.

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