Innovation and safety in critical care: should we collaborate with the industry? Yes

As clinicians we all want to improve care for our patients. We can do that in two ways. We can do what we currently do better, or we can do new things (better). The development of large clinical academic trials groups and networks has enabled clinicians to understand what particular clinical care leads to better patient-centred outcomes. Ironically, we have learnt that many of our “usual” interventions either provided no benefit or were even harmful. Thus, clinicians, can improve the safety and effectiveness of critical care practice. But when it comes to innovation - new therapeutics and novel diagnostics - then it is hard to imagine that we could achieve this without input from or partnership with industry. Furthermore, a brief walk around an ICU illustrates cogently the vast number of devices used and drugs being infused, all of which originated in industry, some with much and some with little clinician scientist input. We argue herein that such collaboration is not only acceptable, it is necessary and can be done ethically, using established guidelines and conflict of interest disclosure

Clinical Legal Education: Quality & Supervision

Practice report containing artefacts from one day international conference on supervision and quality in clinical legal education. The report contains the material shared by the participants before the event and videos of the clinicians describing their work and answering questions

Hydrostatic Chandra X-ray analysis of SPT-selected galaxy clusters - I. Evolution of profiles and core properties

We analyse Chandra X-ray Observatory observations of a set of galaxy clusters selected by the South Pole Telescope using a new publicly available forward-modelling projection code, MBPROJ2, assuming hydrostatic equilibrium. By fitting a power law plus constant entropy model we find no evidence for a central entropy floor in the lowest entropy systems. A model of the underlying central entropy distribution shows a narrow peak close to zero entropy which accounts for 60 per cent of the systems, and a second broader peak around 130keVcm2 . We look for evolution over the 0.28–1.2 redshift range of the sample in density, pressure, entropy and cooling time at 0.015R500 and at 10 kpc radius. By modelling the evolution of the central quantities with a simple model, we find no evidence for a non-zero slope with redshift. In addition, a non-parametric sliding median shows no significant change. The fraction of cool-core clusters with central cooling times below 2 Gyr is consistent above and below z = 0.6 (~30–40 per cent). Both by comparing the median thermodynamic profiles, centrally biased towards cool cores, in two redshift bins, and by modelling the evolution of the unbiased average profile as a function of redshift, we find no significant evolution beyond self-similar scaling in any of our examined quantities. Our average modelled radial density, entropy and cooling-time profiles appear as power laws with breaks around 0.2R500. The dispersion in these quantities rises inwards of this radius to around 0.4 dex, although some of this scatter can be fitted by a bimodal model

Experimentally induced increases in fecundity lead to greater nestling care in blue tits

This is the final version. Available on open access from the Royal Society via the DOI in this recordModels on the evolution of bi-parental care typically assume that maternal investment in offspring production is fixed and predict subsequent contributions to offspring care by the pair are stabilized by partial compensation. While experimental tests of this prediction are supportive, exceptions are commonplace. Using wild blue tits (Cyanistes caeruleus), we provide, to our knowledge, the first investigation into the effects of increasing maternal investment in offspring production for subsequent contributions to nestling provisioning by mothers and male partners. Females that were induced to lay two extra eggs provisioned nestlings 43% more frequently than controls, despite clutch size being made comparable between treatment groups at the onset of incubation. Further, experimental males did not significantly reduce provisioning rates as expected by partial compensation, and if anything contributed slightly (9%) more than controls. Finally, nestlings were significantly heavier in experimental nests compared with controls, suggesting that the 22% average increase in provisioning rates by experimental pairs was beneficial. Our results have potential implications for our understanding of provisioning rules, the maintenance of bi-parental care and the timescale over which current-future life-history trade-offs operate. We recommend greater consideration of female investment at the egg stage to more fully understand the evolutionary dynamics of bi-parental care.NERCRegion Midi-Pyrenee

Adipokines and the Right Ventricle: The MESA-RV Study.

ObjectiveObesity is associated with changes in both right (RV) and left (LV) ventricular morphology, but the biological basis of this finding is not well established. We examined whether adipokine levels were associated with RV morphology and function in a population-based multiethnic sample free of clinical cardiovascular disease.MethodsWe examined relationships of leptin, resistin, TNF-α, and adiponectin with RV morphology and function (from cardiac MRI) in participants (n = 1,267) free of clinical cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA)-RV study. Multivariable regressions (linear, quantile [25th and 75th] and generalized additive models [GAM]) were used to examine the independent association of each adipokine with RV mass, RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume (RVSV) and RV ejection fraction (RVEF).ResultsHigher leptin levels were associated with significantly lower levels of RV mass, RVEDV, RVESV and stroke volume, but not RVEF, after adjustment for age, gender, race, height and weight. These associations were somewhat attenuated but still significant after adjustment for traditional risk factors and covariates, and were completely attenuated when correcting for the respective LV measures. There were no significant interactions of age, gender, or race/ethnicity on the relationship between the four adipokines and RV structure or function.ConclusionsLeptin levels are associated with favorable RV morphology in a multi-ethnic population free of cardiovascular disease, however these associations may be explained by a yet to be understood bi-ventricular process as this association was no longer present after adjustment for LV values. These findings complement the associations previously shown between adipokines and LV structure and function in both healthy and diseased patients. The mechanisms linking adipokines to healthy cardiovascular function require further investigation

Impact of Mobile Text Reminders on Medication Compliance

Purpose/Background Patient noncompliance with medication leads to longer and more frequent infections and health issues. Using mobile reminders, patients can be prompted to take their medication, schedule their followup appointments, or fill their prescription to encourage compliance and better overall health. Methods A search of PubMed, LibKey, and EBSCO was conducted. Articles reviewed included meta-analysis, randomized controlled trials, and systematic reviews in the use of mobile reminders on patient compliance, specifically in medication adherence. Then, we reviewed the article methods and outcomes across various health issues addressed. The articles were then reviewed for criteria such as population size, length of study, and health issues addressed before being recorded to a spreadsheet for further analysis. Results The articles included 4 randomized controlled trials, 2 clinical trials, and 1 systematic review. Per the articles, the most effective methods to increase the rate of compliance are behavior change techniques, improving general T2DM care, providing evidence-based informational leaflets about direct reminders to patients, incorporating direct reminder systems into primary care appointments, and adding a point-of-care reminder to the electronic medical record. Interventions that did not improve adherence were financial incentives and printed reminders to the PCPs. Implications for Nursing Practice Further studies are needed, especially with longer length of study, the results tend to be beneficial. Selected studies showed that there was at least some degree of improvement in patient compliance though not all were able to say there was a positive effect on long term health. These results are promising and promote continued research on implementing technology to improve health outcomes

Influence of expressive speech on ASR performances: application to elderly assistance in smart home

International audienceSmart homes are discussed as a win-win solution for maintaining the Elderly at home as a better alternative to care homes for dependent elderly people. Such Smart homes are characterized by rich domestic commands devoted to elderly safety and comfort. The vocal command has been identified as an efficient , well accepted, interaction way, it can be directly addressed to the "habitat", or through a robotic interface. In daily use, the challenges of vocal commands recognition are the noisy environment but moreover the reformulation and the expressive change of the strictly authorized commands. This paper focuses (1) to show, on the base of elicited corpus, that expressive speech, in particular distress speech, strongly affects generic state of the art ASR systems (20 to 30%) (2) how interesting improvement thanks to ASR adaptation can regulate (15%) this degradation. We conclude on the necessary adaptation of ASR system to expressive speech when they are designed for person's assistance

Do sound waves transport the AGN energy in the Perseus cluster?

The level of random motions in the intracluster gas lying between 20 and 60 kpc radius in the core of the Perseus cluster has been measured by the Hitomi Soft X-ray Spectrometer (SXS) at 164 ± 10 km s$^{−1}$ . The maximum energy density in turbulent motions on that scale is therefore low. If dissipated as heat, the turbulent energy will be radiated away in less than 80 Myr and cannot spread across the core. A higher velocity is needed to prevent a cooling collapse. Gravity waves are shown to travel too slowly in a radial direction. Here we investigate propagation of energy by sound waves. The energy travels at ~1000 km s$^{−1}$ and can cross the core in a cooling time. We show that the displacement velocity amplitude of the gas required to carry the power is consistent with the Hitomi result and that the inferred density and temperature variations are consistent with $\textit{Chandra}$ observations.ACF, CP, CSR and HRR thank the Hitomi collaboration for the opportunity to participate in the analysis of the SXS data. ACF, CP, HRR and SAW acknowledge support from ERC Advanced Grant FEEDBACK, 340442

Assessment of resource availability and sustainability for subsistence fishers in South Africa, with a review of resource management procedures

The availability of resources and their suitability for subsistence and small-scale commercial fishers in South Africa were assessed and appropriate options for the management of resources recommended. Assessment of current resource utilization and recommendations for future subsistence and/or small-scale commercial use were based on information gathered during a nationwide survey of 144 subsistence fishing communities in South Africa and a review of relevant published and unpublished literature. Current patterns of resource use in three regions of the coast (West, South and East coasts) revealed that most true subsistence fisheries occur in the eastern half of the country. These fisheries are primarily focused on invertebrate species found on intertidal rocky shores and sandy beaches, or in estuaries. Fish are harvested by rod or handline, netting or traditional fishing methods (fishtraps, spearing, baited baskets). No “new” or previously underutilized resources were identified as suitable for subsistence fishing in any of the three regions. The potential for several new small-scale commercial fisheries was identified, but the need to retain certain resources for subsistence fisheries (rather than converting them to small-scale commercial fisheries) was evident in certain areas. Resources with high commercial value were not considered suitable for subsistence fishing, but rather for the introduction of small-scale commercial fisheries. The overall management strategy for the subsistence sector, which is currently in the process of being developed, must ensure sufficient flexibility to be able to take into account regional and site-specific requirements. It will also need to develop co-management structures, protect traditional fishing practices, avoid user conflict and provide for no-take areas, all within the framework of sustainable resource utilization.Keywords: estuarine resources, fisheries management, intertidal resources, subsistence fisheries, subtidal resourcesAfrican Journal of Marine Science 2002, 24: 489–50