Economic Environment and Applications of Telemedicine

Telemedicine is broadly defined as the transmission of electronic medical data across a distance among hospitals, clinicians, and/or patients. This definition is deliberately unlimited to what kind of information is transmitted, how the information is transmitted, or how the information is used once received (HCAB, 2003). Telemedicine has the potential of making a greater positive effect on the future of healthcare and medicine than any other modality. Fueled by advances in multiple technologies such as digital communications, full-motion/compressed video, and telecommunications, providers see an unprecedented opportunity to provide access to high-quality care, independent of distance or location

Phase 2 Outreach Plan- Buffalo, NY ITS4US Deployment Project

693JJ321C000005The Buffalo NY ITS4US Deployment Project seeks to improve mobility to, from, and within the Buffalo Niagara Medical Campus by deploying new and advanced technologies with a focus on addressing existing mobility and accessibility challenges. Examples of the technologies to be deployed are electric and self-driving shuttles, a trip planning app that is customized for accessible travel, intersections that use tactile and mobile technologies to enable travelers with disabilities to navigate intersections, and Smart Infrastructure to support outdoor and indoor wayfinding. The deployment geography includes the 120-acre Medical Campus and surrounding neighborhoods with a focus on three nearby neighborhoods (Fruit Belt, Masten Park, and Allentown) with underserved populations (low income, vision loss, deaf or hard of hearing, physical disabilities (including wheeled mobility device users) and older adults). This document is the Outreach Plan for Phase 2 of the project, which identifies the outreach efforts this project will perform to promote and ensure stakeholder engagement

Phase 1 Outreach Plan- Buffalo, NY ITS4US Deployment Project

693JJ321C000005The Buffalo NY ITS4US Deployment Project seeks to improve mobility to, from, and within the Buffalo Niagara Medical Campus by deploying new and advanced technologies with a focus on addressing existing mobility and accessibility challenges. Examples of the technologies to be deployed are electric and self-driving shuttles, a trip planning app that is customized for accessible travel, intersections that use tactile and mobile technologies to enable travelers with disabilities to navigate intersections, and Smart Infrastructure to support outdoor and indoor wayfinding. The deployment geography includes the 120-acre Medical Campus and surrounding neighborhoods with a focus on three nearby neighborhoods (Fruit Belt, Masten Park, and Allentown) with underserved populations (low income, vision loss, deaf or hard of hearing, physical disabilities (including wheeled mobility device users) and older adults). This document is the Outreach Plan, which identifies the outreach efforts this pilot will perform to promote and ensure stakeholder engagement

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation.

Regulatory T cells (Tregs) have been shown to be critical in the balance between autoimmunity and tolerance and have been implicated in several human autoimmune diseases. However, the small number of Tregs in peripheral blood limits their therapeutic potential. Therefore, we developed a protocol that would allow for the expansion of Tregs while retaining their suppressive activity. We isolated CD4+CD25 hi cells from human peripheral blood and expanded them in vitro in the presence of anti-CD3 and anti-CD28 magnetic Xcyte Dynabeads and high concentrations of exogenous Interleukin (IL)-2. Tregs were effectively expanded up to 200-fold while maintaining surface expression of CD25 and other markers of Tregs: CD62L, HLA-DR, CCR6, and FOXP3. The expanded Tregs suppressed proliferation and cytokine secretion of responder PBMCs in co-cultures stimulated with anti-CD3 or alloantigen. Treg expansion is a critical first step before consideration of Tregs as a therapeutic intervention in patients with autoimmune or graft-versus-host disease

Federal Register

Daily publication of the U.S. Office of the Federal Register contains rules and regulations, proposed legislation and rule changes, and other notices, including "Presidential proclamations and Executive Orders, Federal agency documents having general applicability and legal effect, documents required to be published by act of Congress, and other Federal agency documents of public interest" (p. ii). Table of Contents starts on page iii