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PURPOSE: The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS: The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS: All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohens d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS: To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.

BackgroundThe COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic.MethodsA literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services.ResultsSoon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints.ConclusionThe COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.

The Chinese writing system is different from English in that individual words both comprise one to four characters and are not separated by clear word boundaries (e.g., interword spaces). These differences raise the question of how readers of Chinese know where to move their eyes to support efficient lexical processing? The widely accepted "default-targeting hypothesis" suggests that Chinese readers direct their eyes to a small number of "preferred-viewing locations" (PVLs), such as the beginning or middle of upcoming words. In this article, we report two eye-movement experiments testing this hypothesis. In both experiments, participants read sentences comprising entirely two-character words, but either without (Experiment 1) or with (Experiment 2) explicit knowledge of this structure prior to their participation. The results of both experiments indicate the absence of PVLs. Simulations using implemented versions of a simple oculomotor-based hypothesis, two variants of the default-targeting hypothesis, and the hypothesis that saccade lengths are modulated as a function of estimated parafoveal-processing difficulty (i.e., dynamic-adjustment hypothesis) suggest that the latter provides the best account of saccadic-targeting during Chinese reading. These results are discussed in relation to broader issues of eye-movement control during reading and how models of such must be modified to provide more accurate accounts of the reading of Chinese and other languages.

【Objective】Aiming at the problem that BitString can not represent all Bit-Forwarding Routers (BFRs) in large-scale Software Defined Networking (SDN) multicast based on Bit Index Explicit Replication (BIER) due to the limited length, this study designs a Hierarchical Domain (HD)-BIER model and devises its construction algorithm.【Methods】The HD-BIER model is a multi-layer BIER network composed of multiple small-scale Sub Domains (SD), which enables BIER to support a number of devices exceeding the capacity of the BitString representation in large-scale networks. The proposed HD-BIER construction algorithm takes into account the BitString Length (BSL) limitation, link lengths between nodes, and network connectivity. It leverages the concept of community partition algorithms and introduces a modularity function based on node similarity as an evaluation metric for BIER SD partitioning. The construction follows a bottom-up approach to dynamically build the HD-BIER network.【Results】The simulation results show that the HD-BIER construction algorithm can effectively construct HD-BIER networks that exceed the BSL limit in either simple networks or the complex networks with a large number of nodes. Additionally, the resulting HD-BIER model not only ensures normal transmission of multicast service data flows through the gradual encapsulation and decapsulation of BitString layers but also maintains SDN multicast communication performance throughout this process.【Conclusion】The simulation results validate that the proposed HD-BIER model presents an effective multicast service support solution for even larger-scale networks.