Scaling Up: Bringing the Transitional Care Model Into the Mainstream

Describes features of an innovative care management intervention to facilitate elderly, chronically ill patients' transitions among providers and settings; the adopting organization; and the external environment that affect its translation into practice

Blowin\u27 in the wind: Short-term weather and belief in anthropogenic climate change.

Abstract A series of polls provides new tests for how weather influences public beliefs about climate change. Statewide data from 5000 random-sample telephone interviews conducted on 99 days over 2.5 yr (2010-12) are merged with temperature and precipitation indicators derived from U.S. Historical Climatology Network (USHCN) station records. The surveys carry a question designed around scientific consensus statements that climate change is happening now, caused mainly by human activities. Alternatively, respondents can state that climate change is not happening, or that it is happening but mainly for natural reasons. Belief that humans are changing the climate is predicted by temperature anomalies on the interview day and the previous day, controlling for season, survey, and individual characteristics. Temperature effects concentrate among one subgroup, however: individuals who identify themselves as independent, rather than aligned with a political party. Interviewed on unseasonably warm days, independents tend to agree with the scientific consensus regarding anthropogenic climate change. On unseasonably cool days, they tend not to agree. Although temperature effects are sharpest for just a 2-day window, positive effects are seen for longer windows as well. As future climate change shifts the distribution of anomalies and extremes, this will first affect beliefs among unaligned voters

Arctic warming and your weather: Public belief in the connection

Will Arctic warming affect mid-latitude weather? Many researchers think so, and have addressed this question through scientific articles and news media. Much of the public accepts such a connection as well. Across three New Hampshire surveys with more than 1500 interviews, 60% of respondents say they think future Arctic warming would have major effects on their weather. Arctic/weather responses changed little after Superstorm Sandy brushed the region, but exhibit consistently strong partisan divisions that grow wider with education. Belief in an Arctic/weather connection also varies, in a nonlinear pattern, with the temperature anomaly around day of interview. Interviewed on unseasonably warm or cool days, respondents are more likely to think that Arctic warming would have major effects on their weather. This unscientific response seems to mirror the scientific discussion about extremes

Destination directed packet switch architecture for a 30/20 GHz FDMA/TDM geostationary communication satellite network

Emphasis is on a destination directed packet switching architecture for a 30/20 GHz frequency division multiplex access/time division multiplex (FDMA/TDM) geostationary satellite communication network. Critical subsystems and problem areas are identified and addressed. Efforts have concentrated heavily on the space segment; however, the ground segment was considered concurrently to ensure cost efficiency and realistic operational constraints

PHYLOGENY OF SOME MIDDLE AMERICAN PITVIPERS BASED ON A CLADISTIC ANALYSIS OF MITOCHONDRIAL 12S AND 16S DNA SEQUENCE INFORMATION

The cladistic relationships of several Middle American pitvipers representing the genera Bothrops (sensu stricto), Bothriechis, Cerrophidion, Lachesis and Porthidium were determined using mitochondrial 12S and 16S DNA sequence information. Maximum parsimony analyses were performed using PAUP on aligned sequences that included published information for related taxa. Two sets of analyses were conducted: one disregarding gaps in the aligned matrix, and another with gaps treated as a fifth base. When gaps were excluded resolution declined, although the general arrangement of the taxa changed little. A consistent relationship was the grouping of ((Porthidium, Bothriechis) Lachesis). The placement of Lachesis, as nested within other bothropoid genera, is only partially supported by results of other authors. The arrangement of Crotalus, Bothrops and Cerrophidion was ambiguous when gaps were discounted. In both trees, Agkistrodon was basal to the New World forms. The remaining genera, Trimeresurus (Protobothrops), Vipera, Azemiops, and Coluber, were uniformly distant to the former taxa. Also of interest is the lack of close relationship, based on the DNA data here and elsewhere, between Bothrops and Porthidium. This is in striking contrast to results based on morphologic and allozymic analyses of previous studies. It is concluded that additional DNA sequence information from a larger sample of taxa will be necessary to better assess the phylogenetic relationships among Middle American and related pitvipers

Application of Incident Command Structure to clinical trial management in the academic setting: principles and lessons learned

Background Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the ‘gold standard’ management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied ICS principles to organisation and management of the Prehospital Use of Plasma in Traumatic Haemorrhage (PUPTH) trial. This trial was a multidepartmental, multiagency, randomised clinical trial investigating prehospital administration of thawed plasma on mortality and coagulation response in severely injured trauma patients. We describe the ICS system as it would apply to large clinical trials in general, and the benefits, barriers, and lessons learned in utilising ICS principles to reorganise and coordinate the PUPTH trial. Results Without a formal trial management structure, early stages of the trial were characterised by inertia and organisational confusion. Implementing ICS improved organisation, coordination, and communication between multiple agencies and service groups, and greatly streamlined regulatory compliance administration. However, unfamiliarity of clinicians with ICS culture, conflicting resource allocation priorities, and communication bottlenecks were significant barriers. Conclusions ICS is a flexible and powerful organisational tool for managing large complex clinical trials. However, for successful implementation the cultural, psychological, and social environment of trial participants must be accounted for, and personnel need to be educated in the basics of ICS