Background Video telehealth technology has the potential to enhance access for patients with clinical, social, and geographic barriers to care. We evaluated the implementation of a US Department of Veterans Affairs (VA) initiative to distribute tablets to high-need Veterans with access barriers. Methods In this mixed methods implementation study, we examined tablet adoption (ie, facility-level tablet distribution rates and patient-level tablet utilization rates) and reach (ie, sociodemographic and clinical characteristics of tablet recipients) between 5/1/16 and 9/30/17. Concurrently, we surveyed 68 facility telehealth coordinators to determine the most common implementation barriers and facilitators, and then conducted interviews with telehealth coordinators and regional leadership to identify strategies that facilitated tablet distribution and use. Results 86 VA facilities spanning all 18 geographic regions, distributed tablets to 6 745 patients. Recipients had an average age of 56 years, 53% lived in rural areas, 75% had a diagnosed mental illness, and they had a mean (SD) of 5 (3) chronic conditions. Approximately 4 in 5 tablet recipients used the tablet during the evaluation period. In multivariate logistic regression, tablet recipients were more likely to use their tablets if they were older and had fewer chronic conditions. Implementation barriers included insufficient training, staffing shortages, and provider disinterest (described as barriers by 59%, 55%, and 33% of respondents, respectively). Site readiness assessments, local champions, licensure modifications, and use of mandates and incentives were identified as strategies that may influence widespread implementation of home-based video telehealth. Conclusion VA’s initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached individuals with social and clinical access barriers. Implementation strategies that address staffing constraints and provider engagement may enhance the impact of such efforts.

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This four-year study, the first large-scale assessment of telemental health services, found that after initiation of such services, patients' hospitalization utilization decreased by an average of approximately 25%.

A variety of neurologic manifestations of COVID-19 infections have been reported. Here, we present a case of steroid-responsive MOG-antibody associated encephalitis, characterized by cognitive decline, headaches, fever, unilateral FLAIR-hyperintensities, and leptomeningeal enhancement, that occurred in the setting of recent COVID-19 infection.

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All observers (1 to 5) agree that the concentrations of lipid constituents in the serum of normal individuals vary greatly. In fact, the degree of variability is so great that no significance can be attached to a single observation unless it is extremely abnormal. On the other hand, there is evidence that the degree of variability of certain lipid components-for example, cholesterol-in a given normal person, is far more restricted (4 to 7). Furthermore, the relative proportions of certain of the constituents-for example, the ratio of free to total cholesterol-are quite constant, not only in a given individual, but also in the population at large (4,8). A large series of measurements of serum lipids from normal persons and patients has, therefore, been analyzed, in an effort to discover criteria which may permit more accurate evaluation of such measurements in pathologic or disturbed physiologic states. MATERIAL AND METHODSThe material consists of a large number of measurements of lipids in sera, collected during the last 10 years, from normal persons and patients with various diseases. The subjects were all in the postabsorptive state. The clinical material was derived chiefly from the medical and psychiatric services of the New Haven Hospital and Dispensary.The analytical methods of Man, Gildea, Peters, and Bogdanovitch (9 to 13) were employed. In a large proportion of the determinations, cholesterol, total fatty acid, and lipid phosphorus were measured; in a number, however, lipid phosphorus was omitted. In a few instances, both free and total cholesterol were determined; and in a still smaller fraction, iodine numbers were also included. For the last, the procedure of Yasuda (14) Sperry (8) found that the ratio of free to total cholesterol in a large series of normals varied only from 0.24 to 0.30. Brun (4) has reported variations from 0.24 to 0.32, which agrees with our own experience. The averages in all of the 3 series lay between 0.26 and 0.28. The maximum error in the calculation of cholesterol fatty acids, by the formula adopted, should not, therefore, exceed 6 per cent.The relative proportions of phospholipids are less certain. Only a few measurements of the concentration of sphingomyelin in serum have been published, and these differ greatly (15,16). Whether, however, this compound makes up 40 per cent of the phospholipid or is completely absent from serum, the apparent extreme possibilities, the error of estimating phospholipid fatty acids by the formula adopted will not exceed 10 per cent.Free fat is estimated, in terms of m.eq. of fatty acid per liter, by the formula, Fat fatty acid = total fatty acid-(Cholesterol ester fatty acid + phospholipid fatty acid). Being estimated by difference, it is subject to the summated errors of the other calculations. With the factors selected for the calculation of fatty acids of cholesterol esters and phospholipids, only one negative value,-4.3 707

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