Digital Commons Network^™

Cultural Traits May Replace Human Mobility Data In Forecasting Covid-19 Mortality: A Deep Learning Approach, Saif Abbas, Tamer Oraby, Michael G. Tyshenko, Samit Bhattacharyya

School of Mathematical & Statistical Sciences Faculty Publications

The COVID-19 pandemic highlighted the need for accurate epidemic forecasting to support public health decision-making. Most existing approaches depend heavily on human mobility data, while largely neglecting population behavior shaped by socio-cultural norms. In this study, we analyze daily COVID-19 mortality and Google mobility data from 72 countries during the first 130 d of the pandemic, a period characterized by high uncertainty and behavioral heterogeneity. In particular, we examine whether Hofstede’s country-level cultural dimensions can serve as latent behavioral forecasters of mortality in lieu of dynamic mobility indicators. Using 100 d for training and 30 d for forecasting, we employ …

Wellness Literature Review – 2025, Martin Huecker, Brian A. Ferguson

Journal of Wellness

Introduction: Clinician well-being remains a persistent challenge, with ongoing burnout and psychological distress despite efforts by systems and individuals. This Journal of Wellness annual review covers studies published in 2025.

Methods: The Editors searched PubMed and Google Scholar for prospective and interventional studies / clinical trials in humans, with focus on well-being. Authors utilized artificial intelligence (AI)–based large language model (LLM) (ChatGPT, OpenAI^TM) to assist with preliminary identification of relevant studies, however authors noted significant AI-associated errors and outright misrepresentations requiring hand curated product generation and manual PubMed searches.

Literature in Review: We continue to appreciate a shift …

Loss Of Atp-Dependent Citrate Lyase Drives Left Ventricular Dysfunction By Metabolic Remodeling, Shijie Liu, Seth T Gammon, Lin Tan, Yaqi Gao, Kyoungmin Kim, Mahmoud H Elbatreek, Adrian Arrieta, Ian K Williamson, Rebecca L Salazar, Janet Pham, Angela Davidian, Radhika Khanna Neicheril, Benjamin D Gould, Heidi Vitrac, Alia Sadiq, An Q Dinh, Evan C Lien, Francisca N De Luna Vitorino, Joanna M Gongora, Sara A Martinez, Melanie T Odenkirk, Anna K Boatman, Jessie R Chappel, Lawrence S C Czer, Evan P Kransdorf, David J Lefer, Blake M Hanson, Benjamin A Garcia, Erin M Baker, Matthew G Vander Heiden, Philip L Lorenzi, Heinrich Taegtmeyer, David Piwnica-Worms, James F Martin, Anja Karlstaedt

Faculty, Staff and Student Publications

Background: Metabolic adaptation and maladaptation are hallmarks of the failing heart and may be a target for therapeutic interventions. For example, sustained glucose oxidation during cardiac stress is associated with increased activity and abundance of ACL (ATP-dependent citrate lyase, Acly), which produces acetyl-coenzyme A (CoA) from citrate and CoA and supports de novo lipid synthesis. However, our understanding of how ACL supports cardiac metabolic adaptation and its potential to modulate disease pathophysiology has not yet been investigated.

Methods: We used human heart tissue samples from healthy donors and patients with nonischemic cardiomyopathy. Next, we used CRISPR (clustered, regularly interspaced …

Molecular Mechanism Leading To Human Coronary Atherosclerosis Assessed By Proteomic Analysis And Rna Sequences, Sarah J Parker, Chunhong Mao, David L Caudell, Austin Lyle Seals, Yizhi Wang, Thomas D Green, Joseph M Mcclung, Joshua T Maxwell, Jacolby T Roddey, Kiarash Shakeriastani, Chiung-Ting Wu, Yingzhou Lu, Do-Kyun Kim, Justyna Fert-Bober, Dongping Du, Archana Bhat, Niveda Sundararaman, Matthew Ayres, Rakhi Pandey, Saurabh Bhardwaj, Genesio M Karere, Dana Troxclair, Fannie Jackson, Gordon L Love, Richard Vander Heide, James Hixson, Jennifer E Van Eyk, Yue Wang, David Herrington

Faculty, Staff and Student Publications

Background and aims: Atherosclerosis results from cellular and extracellular changes in the arterial wall, preceded by molecular shifts that initiate disease and drive tissue conversion, yet these changes are not yet fully described. More data are needed concerning these early changes in the coronary artery molecular landscape that signify the initiation of atherosclerosis and the subsequent tissue pheno-conversion to atherosclerotic plaque. This report summarizes results from a large biorepository of human coronary artery tissue, applying state-of-the-art omics technology, advanced data analytic methods, and an arterial organoid model system to predict molecular dynamics and identify potential regulatory mechanisms that could interrupt …

Association Between Opioids And Leukemia/Lymphoma In Adults Living In The United States, Brenda Sue Newberry-Colasanti

Walden Dissertations and Doctoral Studies

Opioid prescribing rates and opioid misuse remain high throughout the United States. Exposure to opioids has been positively associated with various cancers; however, research evaluating associations between opioid exposure and hematologic cancers like leukemia and lymphoma is limited. Using the Socio- Ecological Model as a foundation, this quantitative cross-sectional study aimed to analyze the association between medicinal opioid use, opioid misuse, and leukemia/lymphoma while exploring how selected social determinants of health (SDOH) may modify that relationship. Secondary data were pooled from the 2015–20-year United States National Survey on Drug Use and Health (NSDUH). One thousand three hundred and twenty binary …

Internalized Colorism As A Gendered Barrier To Skin Cancer Information Avoidance Among Hispanic College Students, Soo Yun Kim, Wan-Lin Chang

Communication Faculty Publications

Skin cancer disparities persist among racial and ethnic minority populations, yet sociocultural factors shaping engagement with preventive health information remain understudied. This study examines whether internalized colorism functions as a barrier to skin cancer information avoidance among Hispanic college students and whether these associations differ by sex. Using survey data from 300 undergraduates at a Hispanic-serving institution, hierarchical regression analyses examined how three dimensions of colorism, including self-concept, attractiveness, and upward mobility, were associated with skin cancer information avoidance. Results indicated that only the attractiveness dimension predicted information avoidance. This association was moderated by sex, such that attractiveness-based colorism was …

Experiences Of Cholesterol Management Among Obese Individuals: A Qualitative Exploration Of Statin Use, Diet, And Physical Activity, Ke'andra S. Foggie

Doctoral Dissertations and Projects

The prevalence of hypercholesterolemia has increased over the past decade, with obesity identified as a major contributing factor. This study examined how individuals with obesity and hypercholesterolemia managed cholesterol and experienced related challenges within their daily lives. Guided by the Chronic Care Model, the research explored participant-reported experiences of statin therapy and lifestyle practices, including dietary behaviors and physical activity, as components of cholesterol management. Qualitative data were collected through semi-structured interviews, observations, and document analysis to analyze participant-reported barriers, supports, and contextual factors that shape how these practices are incorporated into daily routines. Although extensive research has examined statin …

Uncovering The Path To Diagnosis Among Adults With Attention-Deficit/Hyperactivity Disorder: A Constructivist Grounded Theory Mini-Study, Jeffrey D. Whitaker, Rick Zoucha, Melissa Kalarchian

Graduate Student Research Symposium

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, yet many adults are first diagnosed only after years of functional strain, compensation, and alternative explanations for their difficulties. Purpose: This study explored how adults first diagnosed with ADHD in adulthood described navigating the process of obtaining a formal diagnosis. Methods: A constructivist grounded theory mini-study was conducted with seven adults, ages 27 to 43, who reported receiving their first formal ADHD diagnosis at age 18 or later. Participants completed semi-structured Zoom interviews focused on early experiences, symptom interpretation, help-seeking, and formal assessment. Data were analyzed using initial, focused, and theoretical …

Association Between Occupational Stress, Sleep Quality, And Premature Ejaculation Among Indonesian Information Technology Workers, Muhammad Faisal Ratman, Suryo Wibowo, Muhammad Ilyas, Retno Asti Werdhani, Dewi Yunia Fitriani

Occupational and Environmental Medicine Journal of Indonesia

Introduction Premature ejaculation (PE) is a common sexual dysfunction that significantly impacts quality of life. Occupational stress and poor sleep quality are hypothesized as risk factors, particularly among Information and Technology (IT) workers who experience unique occupational stressors. This study aimed to evaluate the proportion of PE, examine the influence of occupational stress and sleep quality on PE, and determine whether sleep quality mediates the relationship between occupational stress and PE among Indonesian IT workers.

Methods This cross-sectional study involved 89 married male IT workers who completed online questionnaires, including the Premature Ejaculation Diagnostic Tool (PEDT), Perceived Occupational Stress (POS) …

Food And Drug Administration Audit Outcomes And Their Association With Class I And Class Ii Food Recalls, Mark Baker

Walden Dissertations and Doctoral Studies

Foodborne illness and food recalls remain major public health concerns in the United States. Guided by the Theory of Planned Behavior, the purpose of this quantitative secondary analysis was to examine whether Food and Drug Administration (FDA) inspection classifications, warning letters, and prior 24-month inspection frequency were associated with facility involvement in a subsequent Class I or Class II food recall. Question-specific analytic files were created from publicly available FDA administrative records. Eligible records included FDA-regulated food facilities with qualifying inspection or warning letter events and sufficient data to assess recall involvement within a 12-month follow-up period. The final analytic …

Depressive Symptoms And Functional Disability Among Older Adults In Nakhon Ratchasima Province, Thailand: A Cross-Sectional Population-Based Study, Jiranya Bureemas, Atthawit Singsalasang

Journal of Health Research

Background: Depressive symptoms have been associated with activities of daily living (ADL) disability; however, evidence among Thai older adults remains limited and inconsistent. This study investigates the association between depressive symptoms and ADL disability in older Thai adults.

Methods: A cross-sectional analytic study was conducted among 312 older adults in Nakhon Ratchasima, Thailand, who were selected using a multistage sampling method. Data were collected between April and July 2023 using structured questionnaires covering demographic and environmental variables. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. ADL disability was measured using the Barthel and Chula ADL Indices. Multiple logistic …

Healthcare Access And The Persistent Racial Disparities In Low Birth Weight, Zaheda A. Hussain, Yadanar Moe

DePaul Discoveries

Low birth weight (LBW), defined as less than 2,500 grams, is an influential factor contributing to infant mortality in the United States, with significant racial disparities between Black and White mothers. This study analyzed data from 3,054 Black and White mothers collected from the 2018 National Health Interview Survey to explore the association between access to medical care and LBW within different racial groups. The prevalence of LBW was 8.0%. Overall, mothers without a usual place of medical care had, on average, an 18% higher risk of LBW than those with a usual place (OR = 1.18, 95% CI: 0.80–1.74). …

Clearing The Air: Tracking Spatial And Temporal Pm2.5 Variability Along A Biking Transect In Chicago, Beau R. Rass

DePaul Discoveries

Fine particulate matter (PM₂.₅) poses significant risks to human health and disproportionately affects marginalized communities in urban environments (World Health Organization [WHO], 2021; Tessum et al., 2021). Using low-cost mobile sensors, this study explored spatiotemporal PM₂.₅ concentration patterns along a north–south transect of Halsted Street in Chicago. A 2B Technologies Portable Aerosol Monitor (PAM) mounted on a bicycle was used to continuously record PM₂.₅ concentrations with associated GPS coordinates at approximately two-second intervals during 16 sampling events between 08-12-2025 and 10-05-2025. PM₂.₅ concentrations did not differ significantly among the South Side, West Loop, and North Side regions, contrary to the …

Llm-As-A-Judge For Infection Prevention And Control And Antimicrobial Resistance Impact: Comparing Three Main Llms Vs. Human Experts' Assessment, Marcello Di Pumpo, Leonardo Villani, Maria Rosaria Gualano, Danilo Buonsenso, Francesca Raffaelli, Daniele Donà, Patrizia Laurenti, Vittorio Maio, Stefania Boccia, Walter Ricciardi

College of Population Health Faculty Papers

BACKGROUND: Large language models (LLMs) are increasingly used to generate health information, yet their reliability as evaluators remains unclear. This study investigated the feasibility of an LLM-as-a-judge methodology in the context of infection prevention and antimicrobial resistance (AMR), comparing automated ratings with human expert benchmarks.

METHODS: We performed a secondary analysis of an expert-annotated dataset of health messages. Three leading LLMs (ChatGPT, Claude, Gemini) independently evaluated the same messages using an adapted DISCERN tool across five domains: information reliability, quality, AMR impact, persuasiveness, and overall score. We utilized descriptive statistics, intra-rater reliability tests, and mixed-effects ordinal regression to analyze divergence …

Comments Re: Regulation For Federal Financial Assistance, Fred D. Ledley, Edward Zhou, Brian C. Fox

CISI Publication

This comment focuses on the proposed modifications to §200.205 “Federal Agency Merit Review of Proposals” and §200.340 “Termination and suspension” of Title 2 of the Code of Federal Regulations. We argue that the pre-issuance review, discretionary termination provisions, and other constraints of federal research support that would be established under this proposal create impediments to the scientifically-driven process of discovery and innovation that has long provided the foundation for advances in American prosperity, influence, health, and wellbeing. Our comments focus specifically on federal support for biomedical research by the National Institutes of Health (NIH) for the purpose of advancing healthcare …

Metabolic Syndrome Is Associated With Increased Mortality In Patients With Breast Or Prostate Cancer, Jessica P Hwang, Ning Zhang, Mercy W Misoi, Sabhi Gull, Zayd A Razouki, Justin R Gregg, Natalia I Heredia, Sharon H Giordano

Faculty, Staff and Student Publications

We investigated the association of metabolic syndrome (MetS) with mortality in patients with breast and prostate cancer. Breast and prostate cancer cohorts were created retrospectively using the SEER-Medicare database. Patients with first primary breast or prostate cancer diagnosed in 2008-2019 were identified using ICD-O-3 site and histology codes. Among those, patients with MetS were identified using ICD-9/10-CM codes, CPT/HCPCS codes, and prescription drug use from Medicare claims files. We defined continuous enrollment from 12 months before through 12 months after diagnosis, exposure during the first 12 months after diagnosis, and survival follow-up starting 12 months after diagnosis. We used multivariable …

Leveraging Health Information Exchange (Hie) Data To Demonstrate The Impact On Health Outcomes Of Community Based Organization Interventions: Case Studies Of Housing Placement And Medically Tailored Meal Program, Kevin Kramer, Harm Scherpbier, William Marella

College of Population Health Faculty Papers

Objective

Methods

Exploring Lifestyle Transitions And Perceptions Of Weight And Health Among College Students In Huntsville, Texas, Keyonna Nicole Thomas

Walden Dissertations and Doctoral Studies

College students aged 18–25 transitioning to independent living often experience changes in diet, physical activity, stress, and time management that increase health risks. These challenges may be amplified in semi-urban communities by limited access to healthy food, transportation barriers, and scheduling constraints. This qualitative phenomenological study explored how college students in Huntsville, Texas, perceived and interpreted these lifestyle changes and their influence on perceptions of health and weight. Guided by the social ecological model, the study included 12 participants who were 18–25 years old, enrolled in college, living independently in Huntsville, Texas, and able to describe their experiences with lifestyle …

Antropometri Tangan Penduduk Kota Ambon Sebagai Dasar Perancangan Ergonomis, Puan Maryam Leaongso, Wilma Latuny, Aminah Soleman

National Journal of Occupational Health and Safety

The limited availability of hand anthropometric data for the Indonesian population, particularly for the residents of Ambon City, may affect the accuracy of designing ergonomic products, work equipment, and public facilities. This study aimed to measure and analyze 25 hand dimensions of the Ambon City population based on gender and age, and to compare the measurement results with national anthropometric data. This research employed a quantitative method with a descriptive design through an anthropometric approach. Data were collected directly from 200 respondents, consisting of 100 females (aged 18–40 years) and 100 males (aged 20–40 years). Data analysis was performed using …

Promoting Equity For Children And Adolescents Through Implementation Processes In Health And Social Care: A Scoping Review, Michelle Gooey, Heather Morris, Rebecca Madill, Callie Walsh-Bailey, Ahlia Griffiths, Melissa Savaglio, Claire Blewitt, Amanda O'Connor, Sara Holton, Helia Khalesi, Sofia Grage-Moore, Maria Fernandez, Echezona E Ezeanolue, Allison Metz, Ana Baumann, Helen Skouteris

Faculty, Staff and Student Publications

Background: Despite the many existing implementation methods, theories, and frameworks, implementation science is insufficiently closing the research-to-practice gap. Bridging this gap is critical to achieving healthy and thriving communities globally, and requires implementation processes that promote equity and reach diverse populations, especially those most in need. The aim of this scoping review was to identify, thematically analyse, categorise, and provide examples of implementation processes described in equity-focused literature, with a focus on health and social care interventions for children and adolescents from birth to 18 years of age.

Methods: A comprehensive search of literature was undertaken across six electronic databases …

Penilaian Safety Climate Di Area Quarry Pada Pabrik Semen Di Indonesia, Andrizqa Andrizqa, Mufti Wirawan, Raden Ismail Haq, Asep Zaenal Muttaqien, Muhammad Arifin Ramzy Lubis

National Journal of Occupational Health and Safety

Work in the quarry area of the cement industry has a high risk of occupational accidents. Workers' understanding of the safety climate is important to prevent workplace accidents and injuries. This study aimed to assess the safety climate in the quarry area of a cement plant in Indonesia while identifying aspects that still require improvement. This study employed a descriptive quantitative approach using a questionnaire adapted from the Loughborough Safety Climate Assessment Toolkit (LSCAT). The sample consisted of all workers in the quarry area, including 49 permanent workers and 90 contract workers. The results showed that the average safety climate …

Sleep Disturbances Affect Sleep Quality Of Hospitalized Adults, Tonjia Hardesty

Dissertations

Abstract

Background: Sleep disturbances affect the quality of sleep hospitalized adults experience, possibly extending patient recovery time. Treatment of insomnia frequently includes pharmacological interventions exposing patients to potential side effects, leading to negative patient outcomes.  The purpose of this project was to determine if a sleep hygiene toolkit including eye masks, earplugs, advocacy cards, and removal of nicotine patches at bedtime would improve patient sleep quality without use of pharmacological interventions.

Methods: A descriptive observational design was used in this quality improvement (QI) project. A convenience sample of 37 (N =37) participants over the age of 18 years and …

Fecal Fatty Acids And Other Risk Factors Associated With Multiple Sclerosis Score, Progression And Diagnosis Among Hispanic Adults, Juliana Ayala-Viqueira

Walden Dissertations and Doctoral Studies

Multiple sclerosis (MS) is a chronic neurological condition with insufficient research regarding risk factors influencing MS severity score (MSSS), progression and diagnosis among Hispanic adults living in the United States. This cross-sectional study assessed factors associated with MS score, progression and diagnosis using secondary data from the International Multiple Sclerosis Microbiome Study (iMSMS). Guided by the ecological model, the study included N = 576 participants with MS. Manuscript 1 explored the association between body mass index (BMI), sodium consumption, and the MS severity score in a Hispanic adult population. A multiple linear regression was conducted to examine whether age and …

Identification Of Prognostic Factors For Disease Recurrence-Free Survival (Drfs) In Breast Cancer Patients Using The Cox Proportional Hazards Model, Dwi Cahyaning Putri, Veny Prabaningrum, Samsul Arifin

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Breast cancer remains one of the most common malignancies among women worldwide, with recurrence remaining a major clinical challenge. Despite various treatment efforts, the mortality rate from breast cancer remains high, particularly among patients with worse clinical and molecular conditions. This study aims to identify factors influencing the survival of breast cancer patients using the Cox proportional hazards model. The study analyzes clinical and molecular data of breast cancer patients to identify key risk factors affecting Disease Recurrence-Free Survival (DRFS). Analysis was conducted using Kaplan-Meier, the Log Rank test, and the Cox proportional hazards model. The results showed that nodal …

Global Trends In School Disaster Preparedness Research: Bibliometric Analysis Impacts On Public Health And Safety, Muhammad Farid, Muhammad Agita Hutomo, Oktomi Wijaya, Dian Ika Puspitasari

Chulalongkorn Medical Journal

Background: Disasters disrupt daily human activities, arising from natural or artificial triggers, with varying impacts based on community vulnerability and resource capacity. Effective disaster management involves a cycle of mitigation, preparedness, response, and recovery. One of the mitigation measures is to establish school disaster preparedness that integrate education and capacity building.

Objective: The aim of this research is to conduct a bibliometric analysis based on Scopus publications regarding school disaster preparedness.

Methods: A bibliometric analysis was performed on publications indexed in Scopus from 1965 to 2024. Data were processed and visualized using VOSviewer to explore trends in annual outputs, contributing …

Applying The Ottawa Charter To Evaluate Health Literacy Outcomes Of The Little Aussie Bugs Course For Australian Early Childhood Educators, Amelia Ruscoe, Elizabeth J. Cook, Eleanor K. O'Brien, Leesa N. Costello, Gillian Kirk, Ros Sambell, Theresa Rayfield, Amanda Devine, Ruth M. Wallace

Research outputs 2022 to 2026

Early childhood offers an important opportunity to lay the foundations for lifelong health literacy. The Little Aussie Bugs (LAB) dialogic book series and online professional development (PD) course were designed to support Early Childhood Education and Care (ECEC) educators to embed health literacy concepts, including hygiene, healthy eating, and oral health, into everyday learning routines. This mixed methods study evaluated the course pilot and examined its contribution through the lens of the Ottawa Charter for Health Promotion—a framework comprising five interrelated action areas: building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and reorienting health services. …

Adapting And Delivering An Extension Diabetes Self-Management Support Program To Serve The Hispanic Community, Camden Bryan, Samantha Kanny, Christina Dietz, Danielle Mcfall, Michelle Parisi, Michelle Stancil, Johanna Bruen, Rhonda Matthews, Windsor W Sherrill

Journal of Extension

Expanding Extension education programs to serve the Hispanic community will be important as this population continues to grow. The rate of diabetes is higher among the Hispanic population than the non-Hispanic population; however, the barriers to implementing a health education program and recruiting participants are plentiful. This paper highlights the work conducted by the Clemson Cooperative Extension Service, in partnership with organizations across South Carolina, to adapt and deliver the Health Extension for Diabetes program to the Hispanic community. It offers insights into effective strategies for program adaptation, recruitment, and delivery that agents can use to overcome barriers and increase …

Building Academic-Community Partnerships To Reduce Rural Health Disparities, Latoya J. O'Neal, Marcia Brown, Biswadeep Dhar, Noemi Reyes, Brittany Blake, John Diaz, Karla Shelnutt

Journal of Extension

Rural health disparities are increasing in the United States. Academic–community partnerships between Extension and faith-based organizations present a unique opportunity to improve health outcomes in rural areas. The main objective of this study was to identify the perceived barriers, needs, and strategies for implementing effective and sustainable health promotion programs through Extension and faith community partnerships. We conducted semi-structured interviews with Extension professionals and faith community leaders (N = 15). Our results suggest that academic–community partnerships could leverage shared needs, resources, and strategies to serve as a model for reducing health disparities among low-income, minoritized adults residing in rural …

Collaboration Is Key: Improving And Increasing Inclusive Programming Through Partnership, Brandy D James, Elizabeth Sparks, Fiona S Davey, Burris Duncan, Nadine Chau

Journal of Extension

Collaborative partnerships between Cooperative Extension offices and the University Centers for Excellence in Developmental Disabilities are a key opportunity to assess and improve accessible, inclusive programming for the communities they serve. This article outlines such a partnership between local Extension, the local UCEDD, and the local Network for Down Syndrome. It reviews their collaborative process and the resulting pilot program—-an inclusive cooking class. Evaluations of the program and collaborative process demonstrate that the partners' collaboration enabled organizational capacity building and improved service provision for persons with Down Syndrome.

Rapid Recovery Of Peripheral Oxygen Saturation In Hypoxic Covid-19 Patients With Ivermectin/Doxycycline/Zinc Multidrug Therapy, Sabine Hazan, Adriana C. Vidal, Eleftherios Gkioulekas, Anoja W. Gunaratne, Sibaish Dolai, Robert L. Clancy, Peter A. Mccullough, Thomas J. Borody

School of Mathematical & Statistical Sciences Faculty Publications

Several combination therapies for the early outpatient treatment of COVID-19 were proposed by independent research groups at the onset of the pandemic during 2020 and 2021. In this observational study, we report on the outcomes of an off-label triple combination therapy, consisting of ivermectin, doxycycline, and zinc, with adjunct vitamin C and D3 supplementation, which was used on high-risk COVID-19 patients. These patients refused an initial recommendation to seek inpatient care, despite a high-risk presentation compounded with one or more comorbidities and/or severe hypoxia. Telemedicine was used to administer personalized treatment to patients at home, who did not have access …