Telepathology Networking in VISN-12 of the Veterans Health Administration

The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from telepathology. The enthusiasm and technical skill of providers are essential for success. As well, frequent communication and rapid technical support are necessary. Finally, in a supportive environment, telepathology is a tool that can help bring together clinical laboratories with shared missions and goals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63151/1/153056200750040200.pd

Willingness to Pay for Potting Mix Containing Eastern Redcedar Biochar under Alternative Information Sets

Biochar is considered an environmentally friendly potting mix ingredient because it sequesters carbon, and its biomass can be obtained from renewable resources. If the biomass is obtained from the undesirable eastern redcedar (Juniperus virginiana), then it has the additional benefit of helping to curtail its spread and protect natural habitats. If consumers recognize this benefit, then they may be willing to pay a premium for potting mix made from eastern redcedar biochar. This study used an internet survey of potting mix customers to measure the size of this potential premium. The results showed that consumers were willing to pay $2.42/ft3 more for potting mix containing 20% eastern redcedar biochar (by weight). This premium was even larger for respondents who were aware of the weedy nature of eastern redcedar

Colored Shade Nets Affect Growth but Not Flowering of Four Greenhouse-grown Potted Ornamental Species

The color of horticultural shade nets is known to influence crop growth and quality because of variations in the amount and quality of light. Four ornamental plant species (celosia, begonia, gerbera, and fountain grass) were grown under aluminet, pearl, and red shade nets plus black as the control at 50% shade intensity for 8 weeks. Black had the least transmittance (∼10% to 30% of ambient) within the red spectrum (620–750 nm), whereas red had the greatest at ∼70% to 80%. Aluminet and pearl resulted in a similar reduction in photosynthetic photon flux at ∼50% to 55% and ∼55% to 65% of ambient, respectively. Aluminet increased the shoot dry weight for begonia and celosia, whereas no differences among shade nets were seen for gerbera or fountain grass. The chlorophyll concentration was greatest under aluminet for each species except begonia. Shade net color did not affect flower number

Height Control of Greenhouse-grown Pansy Using Colored Shade Nets

Pansy (Viola ×wittrockiana) is a greenhouse crop commonly grown under black shade net; it often requires the use of chemical plant growth regulators to maintain a compact growth habit. Nonchemical efforts to alter plant morphology, such as height, would provide a more sustainable solution than chemical application. The objective of these studies was to evaluate the effects of different colors of shade nets on controlling growth and flowering of pansy. In Expt. 1, ‘Clear Yellow’, ‘Buttered Popcorn’, and ‘Deep Orange’ pansy plugs were placed under 30% blue or black shade net or, as a control group, where grown with no shade net. In Expt. 2, the same three cultivars of pansy were grown under 50% black, red, pearl, or aluminized shade net. Data were collected on plant height, plant width, flower number, plant survival, soil plant analysis development chlorophyll meter (SPAD) readings, and light quality. In Expt. 1, the blue shade net reduced height to flower and height to leaves, but also decreased flower number and plant survival as compared with black shade net. All plants under no shade died. In Expt. 2, SPAD, an indicator of plant quality by estimating leaf greenness, was found to be lower under black shade net, whereas pearl shade net led to a decrease in plant height and no effect on the number of flowers. Light quality, including red-to-far-red ratio, varied among shade treatments, whereas light intensity was reduced under aluminized, black (50%), and red shade nets compared with other shade treatments. Blue and pearl shade nets both reduced plant height, but blue shade net also reduced plant survival and flowering

Functional studies of the kidney of living animals using multicolor 2-photon microscopy

Optical microscopy, when applied to living animals, provides a powerful means of studying cell biology in the most physiologically relevant setting. The ability of two-photon microscopy to collect optical sections deep into biological tissues has opened up the field of intravital microscopy to high-resolution studies of the brain, lens, skin, and tumors. Here we present examples of the way in which two-photon microscopy can be applied to intravital studies of kidney physiology. Because the kidney is easily externalized without compromising its function, microscopy can be used to evaluate various aspects of renal function in vivo. These include cell vitality and apoptosis, fluid transport, receptor-mediated endocytosis, blood flow, and leukocyte trafficking. Efficient two-photon excitation of multiple fluorophores permits comparison of multiple probes and simultaneous characterization of multiple parameters and yields spectral information that is crucial to the interpretation of images containing uncharacterized autofluorescence. The studies described here demonstrate the way in which two-photon microscopy can provide a level of resolution previously unattainable in intravital microscopy, enabling kinetic analyses and physiological studies of the organs of living animals with subcellular resolution

Seasonal Controls on the Exchange of Carbon and Water in an Amazonian Rain Forest

The long-term resilience of Amazonian forests to climate changes and the fate of their large stores of organic carbon depend on the ecosystem response to climate and weather. This study presents 4 years of eddy covariance data for CO2 and water fluxes in an evergreen, old-growth tropical rain forest examining the forest's response to seasonal variations and to short-term weather anomalies. Photosynthetic efficiency declined late in the wet season, before appreciable leaf litter fall, and increased after new leaf production midway through the dry season. Rates of evapotranspiration were inelastic and did not depend on dry season precipitation. However, ecosystem respiration was inhibited by moisture limitations on heterotrophic respiration during the dry season. The annual carbon balance for this ecosystem was very close to neutral, with mean net loss of 890 ± 220 kg C ha−1 yr−1, and a range of −221 ± 453 (C uptake) to +2677 ± 488 (C loss) kg C ha−1 yr−1 over 4 years. The trend from large net carbon release in 2002 towards net carbon uptake in 2005 implies recovery from prior disturbance. The annual carbon balance was sensitive to weather anomalies, particularly the timing of the dry-to-wet season transition, reflecting modulation of light inputs and respiration processes. Canopy carbon uptake rates were largely controlled by phenology and light with virtually no indication of seasonal water limitation during the 5-month dry season, indicating ample supplies of plant-available-water and ecosystem adaptation for maximum light utilization.Earth and Planetary SciencesEngineering and Applied SciencesOrganismic and Evolutionary Biolog

Patient-reported Outcomes and Quality of Life After Treatment of Choroidal Melanoma: A Comparison of Enucleation Versus Radiotherapy in 1596 Patients

Purpose: To test the hypothesis that patients treated with radiotherapy for choroidal melanoma enjoy better quality of life (QoL) than patients who have undergone enucleation. Methods: In this nonrandomized study, patients with choroidal melanoma treated at the Royal Liverpool University Hospital, Liverpool, UK, were invited to complete QoL questionnaires approximately 6 months postoperatively and then on each anniversary of their primary treatment. These instruments consisted of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-OPT30 questionnaire, Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Treatment questionnaire. Patient-reported outcomes were correlated with demographics, ocular treatment, social factors, presenting tumor and ocular status, self-reported general health, marital status, and employment status. Results: The 1596 patients were treated with radiotherapy (72.3%) or enucleation (27.7%). Enucleation was associated with male sex (χ2, P = .004), older age (t test, P Conclusions: Patient-reported outcomes and QoL were worse in patients who had undergone primary enucleation for choroidal melanoma. These outcomes may partly have been caused by factors predisposing to enucleation rather than enucleation itself, because enucleated patients tended to be older, with more advanced disease at presentation, and a worse prognosis for survival. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.</p

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

Characterization of the Basal and mTOR-Dependent Acute Pulmonary and Systemic Immune Response in a Murine Model of Combined Burn and Inhalation Injury

Severe burn injury leads to a cascade of local and systemic immune responses that trigger an extreme state of immune dysfunction, leaving the patient highly susceptible to acute and chronic infection. When combined with inhalation injury, burn patients have higher mortality and a greater chance of developing secondary respiratory complications including infection. No animal model of combined burn and inhalation injury (B+I) exists that accurately mirrors the human clinical picture, nor are there any effective immunotherapies or predictive models of the risk of immune dysfunction. Our earlier work showed that the mechanistic/mammalian target of rapamycin (mTOR) pathway is activated early after burn injury, and its chemical blockade at injury reduced subsequent chronic bacterial susceptibility. It is unclear if mTOR plays a role in the exacerbated immune dysfunction seen after B+I injury. We aimed to: (1) characterize a novel murine model of B+I injury, and (2) investigate the role of mTOR in the immune response after B+I injury. Pulmonary and systemic immune responses to B+I were characterized in the absence or presence of mTOR inhibition at the time of injury. Data describe a murine model of B+I with inhalation-specific immune phenotypes and implicate mTOR in the acute immune dysfunction observed

Retaining young people in a longitudinal sexual health survey: a trial of strategies to maintain participation

&lt;p&gt;BACKGROUND:There is an increasing trend towards lower participation in questionnaire surveys. This reduces representativeness, increases costs and introduces particular challenges to longitudinal surveys, as researchers have to use complex statistical techniques which attempt to address attrition. This paper describes a trial of incentives to retain longitudinal survey cohorts from ages 16 to 20, to question them on the sensitive topic of sexual health.&lt;/p&gt; &lt;p&gt;METHODS: A longitudinal survey was conducted with 8,430 eligible pupils from two sequential year groups from 25 Scottish schools. Wave 1 (14 years) and Wave 2 (16 years) were conducted largely within schools. For Wave 3 (18 years), when everyone had left school, the sample was split into 4 groups that were balanced across predictors of survey participation: 1) no incentive; 2) chance of winning one of twenty-five vouchers worth 20 pounds; 3) chance of winning one 500 pounds voucher; 4) a definite reward of a 10 pounds voucher sent on receipt of their completed questionnaire. Outcomes were participation at Wave 3 and two years later at Wave 4. Analysis used logistic regression and adjusted for clustering at school level.&lt;/p&gt; &lt;p&gt;RESULTS: The only condition that had a significant and beneficial impact for pupils was to offer a definite reward for participation (Group 4). Forty-one percent of Group 4 participated in Wave 3 versus 27% or less for Groups 1 to 3. At Wave 4, 35% of Group 4 took part versus 25% or less for the other groups. Similarly, 22% of Group 4 participated in all four Waves of the longitudinal study, whereas for the other three groups it was 16% or less that participated in full.&lt;/p&gt; &lt;p&gt;CONCLUSIONS: The best strategy for retaining all groups of pupils and one that improved retention at both age 18 and age 20 was to offer a definite reward for participation. This is expensive, however, given the many benefits of retaining a longitudinal sample, we recommend inclusion of this as a research cost for cohort and other repeat-contact studies.&lt;/p&gt