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RationaleIdentifying patients who could be safely managed at home versus those needing hospitalisation was a particular concern during early COVID-19. Respiratory viruses remain a concern, including new COVID-19 variants, influenza and respiratory syncytial virus. We developed COVIDFree@Home, a mobile application and clinician dashboard for remote monitoring, to determine if remotely collected measures could predict low oxygen saturation in home-isolating patients with COVID-19.MethodsWe conducted a prospective cohort study of patients newly diagnosed with COVID-19 from three Toronto hospitals between 2020 and 2022. Participants used the COVIDFree@Home app daily to enter symptoms, temperature, heart rate and oxygen saturation at home, which clinicians monitored via an online dashboard. We analysed baseline characteristics and remote monitoring variables to identify predictors of oxygen saturation ≤92%. A random forest classifier was trained to predict low oxygen saturation in the following 2 days. A secondary objective was to identify factors predicting hospitalisation.ResultsOf 431 participants, 376 (87.2%) entered at least one measure. Of the 376, 49 (13%) experienced low oxygen saturation, and 19 (5.1%) were hospitalised. Baseline factors associated with low oxygen saturation included older age, obesity, pre-existing pulmonary disease and Alpha/Beta variant. The classifier predicted future low oxygen saturation with an area under the curve of 0.68 (sensitivity 57%, specificity 72%, positive predictive value 3%, negative predictive value 99%). Key predictive factors included cough, lower baseline oxygen saturation, severe fatigue, higher temperature and higher heart rate. Factors associated with hospitalisation included dyspnoea, fever, Alpha/Beta variant and comorbidities of hypertension, mental illness and diabetes. Patients with a runny nose or sore throat were less likely to be hospitalised.ConclusionsDuring the COVID-19 pandemic, remote monitoring along with knowledge of baseline characteristics could predict low oxygen saturation in the next 2 days in people with COVID-19. This approach may help identify individuals needing medical attention during future pandemics, though further model improvement is necessary.Trial registration numberNCT04453774.

During the COVID-19 pandemic, many with acute infection isolated at home, with a small but significant number requiring hospitalization. At the time, since the pathogen was fairly unknown, clinicians were uncertain about which patients would rapidly deteriorate and need hospitalization. We developed the COVIDFree@Home smartphone app and clinician dashboard to monitor and support people managing at home with acute COVID-19 infection. It was uncertain whether such an app would be used by patients and whether it would support patient care. This knowledge would inform telemedicine and digital health tools being used to deliver care to patients remotely at that time. This study aimed to determine the feasibility of using a smartphone app and clinician dashboard for remote clinical monitoring of people with COVID-19 at home. A feasibility study set at 3 hospital sites (University Health Network, Sunnybrook Health Sciences Centre, and Trillium Health Partners) between 2020 and 2022 was conducted. Participants newly diagnosed with COVID-19 were asked to enter data into a smartphone app called COVIDFree@Home twice daily for 10 days while isolating at home. Their data, including symptoms, temperature, and oxygen saturation, were monitored on a clinician-facing dashboard. The primary outcome of feasibility was the number of patients who used the app. We also examined patient satisfaction through a survey questionnaire. A total of 431 patients were recruited, out of which 229 (56.5%) were females and the average age was 38.9 (SD 12.8) years. There were 376 (87.2%) participants who used the app to report symptoms or oxygen saturation at least once. Among these participants, 373 (99.2%) reported symptoms and 363 (96.5%) reported oxygen saturation. Participants reported symptoms an average of 1.7 (SD 1.1) times per day for a median of 5 (IQR 3-8) days. Oxygen saturation levels were reported 1.5 times per day for a median of 6 (IQR 4-9) days. There were 19 hospitalizations (4.4%) among study participants. Most patients felt comfortable using the app, felt reassured their data was being monitored and did not have privacy concerns. Patients with acute COVID-19 infection engaged with a remote home monitoring platform, however, not at the recommended frequency or duration. Remote patient monitoring of acute respiratory infection appears viable and can offer patients reassurance. It has the potential to reduce strain on the health care system during future pandemics, but further evidence is required to demonstrate improved health outcomes.

Study Objectives: This study examines the impact of cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) therapy for comorbid insomnia and sleep apnea on nocturnal sleep and daytime functioning. Methods: A partial factorial design was used to examine treatment pathways with CBT-I and PAP and the relative benefits of each treatment. One hundred eighteen individuals with comorbid insomnia and sleep apnea were randomized to receive CBT-I followed by PAP, self-monitoring followed by CBT-I concurrent with PAP, or self-monitoring followed by PAP only. Participants were assessed at baseline, PAP titration, and 30 and 90 days after PAP initiation. Outcome measures included sleep diary- and actigraphy-measured sleep, Flinders Fatigue Scale, Epworth Sleepiness Scale, Functional Outcome of Sleep Questionnaire, and cognitive emotional measures. Results: A main effect of time was found on diary-measured sleep parameters (decreased sleep onset latency and wake after sleep onset; increased total sleep time and sleep efficiency) and actigraphy-measured sleep parameters (decreased wake after sleep onset; increased sleep efficiency) and daytime functioning (reduced Epworth Sleepiness Scale, Flinders Fatigue Scale; increased Functional Outcome of Sleep Questionnaire) across all arms (all P < .05). Significant interactions and planned contrast comparisons revealed that CBT-I was superior to PAP and self-monitoring on reducing diary-measured sleep onset latency and wake after sleep onset and increasing sleep efficiency, as well as improving Functional Outcome of Sleep Questionnaire and Flinders Fatigue Scale compared to self-monitoring. Conclusions: Improvements in sleep and daytime functioning were found with PAP alone or concomitant with CBT-I. However, more rapid effects were observed on self-reported sleep and daytime performance when receiving CBT-I regardless of when it was initiated. Therefore, concomitant treatment appears to be a favorable approach to accelerate treatment outcomes. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea (MATRICS); URL: https://clinicaltrials.gov/ct2/show/NCT01785303 ; Identifier: NCT01785303. Citation: Tu AY, Crawford MR, Dawson SC, et al. A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: effects on nocturnal sleep and daytime performance. J Clin Sleep Med . 2022;18(3):789–800.

Tobe et al cite that the Canadian Cardiovascular Harmonized National Guideline Endeavor (C-CHANGE) is a nationally endorsed guideline process, targeting primary care health care practitioners. C-CHANGE promotes patient care by bringing nine guideline groups together, to provide a composite set of recommendations to help clinicians formulate a comprehensive treatment plan directed toward patient priorities. The 2018 update to the C-CHANGE guideline includes a total of 77 recommendations and 52 recommendations that are newly added or updated. A new category for hypertension for high-risk individuals has been developed with a new lower threshold for treatment (130 mm Hg systolic) and target blood pressure (< 120 mm Hg systolic). Multifaceted care for patients with cardiovascular risks includes the cornerstones of health behavior change, such as healthy eating and regular physical activity.

A bstract Evidence for Higgs boson decay to a pair of muons is presented. This result combines searches in four exclusive categories targeting the production of the Higgs boson via gluon fusion, via vector boson fusion, in association with a vector boson, and in association with a top quark-antiquark pair. The analysis is performed using proton-proton collision data at s = 13 TeV, corresponding to an integrated luminosity of 137 fb − 1 , recorded by the CMS experiment at the CERN LHC. An excess of events over the back- ground expectation is observed in data with a significance of 3.0 standard deviations, where the expectation for the standard model (SM) Higgs boson with mass of 125.38 GeV is 2.5. The combination of this result with that from data recorded at s = 7 and 8 TeV, corresponding to integrated luminosities of 5.1 and 19.7 fb − 1 , respectively, increases both the expected and observed significances by 1%. The measured signal strength, relative to the SM prediction, is 1.19 − 0.39 + 0.40 stat − 0.14 + 0.15 syst . This result constitutes the first evidence for the decay of the Higgs boson to second generation fermions and is the most precise measurement of the Higgs boson coupling to muons reported to date.

New sets of CMS underlying-event parameters (“tunes”) are presented for the pythia 8 event generator. These tunes use the NNPDF3.1 parton distribution functions (PDFs) at leading (LO), next-to-leading (NLO), or next-to-next-to-leading (NNLO) orders in perturbative quantum chromodynamics, and the strong coupling evolution at LO or NLO. Measurements of charged-particle multiplicity and transverse momentum densities at various hadron collision energies are fit simultaneously to determine the parameters of the tunes. Comparisons of the predictions of the new tunes are provided for observables sensitive to the event shapes at LEP, global underlying event, soft multiparton interactions, and double-parton scattering contributions. In addition, comparisons are made for observables measured in various specific processes, such as multijet, Drell–Yan, and top quark-antiquark pair production including jet substructure observables. The simulation of the underlying event provided by the new tunes is interfaced to a higher-order matrix-element calculation. For the first time, predictions from pythia 8 obtained with tunes based on NLO or NNLO PDFs are shown to reliably describe minimum-bias and underlying-event data with a similar level of agreement to predictions from tunes using LO PDF sets.

A bstract A search for a heavy Higgs boson in the H → WW and H → ZZ decay channels is reported. The search is based upon proton-proton collision data samples corresponding to an integrated luminosity of up to 5.1 fb −1 at s = 7 TeV and up to 19.7fb −1 at s = 8 TeV, recorded by the CMS experiment at the CERN LHC. Several final states of the H → WW and H → ZZ decays are analyzed. The combined upper limit at the 95% confidence level on the product of the cross section and branching fraction exclude a Higgs boson with standard model-like couplings and decays in the range 145 < m H < 1000 GeV. We also interpret the results in the context of an electroweak singlet extension of the standard model.

Properties of the Higgs boson with mass near 125 GeV are measured in proton-proton collisions with the CMS experiment at the LHC. Comprehensive sets of production and decay measurements are combined. The decay channels include [gamma][gamma], ZZ, WW, [tau][tau], bb, and [mu][mu] pairs. The data samples were collected in 2011 and 2012 and correspond to integrated luminosities of up to 5.1fb^-1 at 7 TeV and up to 19.7 fb^-1 at 8 TeV. From the high-resolution [gamma][gamma] and ZZ channels, the mass of the Higgs boson is determined to be 125.02^+0.26_-0.27(stat)^+0.14_-0.15(syst)GeV. For this mass value, the event yields obtained in the different analyses tagging specific decay channels and production mechanisms are consistent with those expected for the standard model Higgs boson. The combined best-fit signal relative to the standard model expectation is 1.00 +/- 0.09(stat)^+0.08_-0.07(theo) +/- 0.07(syst) at the measured mass. The couplings of the Higgs boson are probed for deviations in magnitude from the standard model predictions in multiple ways, including searches for invisible and undetected decays. No significant deviations are found.

A bstract A search for narrow and broad resonances with masses greater than 1.8 TeV decaying to a pair of jets is presented. The search uses proton-proton collision data at s = 13 TeV collected at the LHC, corresponding to an integrated luminosity of 137 fb − 1 . The background arising from standard model processes is predicted with the fit method used in previous publications and with a new method. The dijet invariant mass spectrum is well described by both data-driven methods, and no significant evidence for the production of new particles is observed. Model independent upper limits are reported on the production cross sections of narrow resonances, and broad resonances with widths up to 55% of the resonance mass. Limits are presented on the masses of narrow resonances from various models: string resonances, scalar diquarks, axigluons, colorons, excited quarks, color-octet scalars, W′ and Z′ bosons, Randall-Sundrum gravitons, and dark matter mediators. The limits on narrow resonances are improved by 200 to 800 GeV relative to those reported in previous CMS dijet resonance searches. The limits on dark matter mediators are presented as a function of the resonance mass and width, and on the associated coupling strength as a function of the mediator mass. These limits exclude at 95% confidence level a dark matter mediator with a mass of 1.8 TeV and width 1% of its mass or higher, up to one with a mass of 4.8 TeV and a width 45% of its mass or higher.

A bstract A search for phenomena beyond the standard model in final states with two oppositely charged same-flavor leptons and missing transverse momentum is presented. The search uses a data sample of proton-proton collisions at s = 13 TeV, corresponding to an integrated luminosity of 137 fb − 1 , collected by the CMS experiment at the LHC. Three potential signatures of physics beyond the standard model are explored: an excess of events with a lepton pair, whose invariant mass is consistent with the Z boson mass; a kinematic edge in the invariant mass distribution of the lepton pair; and the nonresonant production of two leptons. The observed event yields are consistent with those expected from standard model backgrounds. The results of the first search allow the exclusion of gluino masses up to 1870 GeV, as well as chargino (neutralino) masses up to 750 (800) GeV, while those of the searches for the other two signatures allow the exclusion of light-flavor (bottom) squark masses up to 1800 (1600) GeV and slepton masses up to 700 GeV, respectively, at 95% confidence level within certain supersymmetry scenarios.