Can smartphone technology improve patient care?

Introduction The emergence of evidenced-based medicine (EBM) has led to an ever-increasing plethora of guidelines to follow in order to best deliver this high standard of care. Compliance with such guidelines remains sub-optimal and novel methods of guideline dissemination have become popular. Two patient safety areas of major morbidity and, potentially, mortality for patients are venous thromboembolism (VTE) and sepsis. Prophylaxis is available to minimise risk of VTE and early resuscitation bundles for sepsis, such as Sepsis Six have become widely promoted. Both of these areas have local guidelines that should be followed but compliance is poor. At the start of this period of research Sepsis Six had not yet been rolled-out in the surgical department at the RAH, Paisley. This provided a golden opportunity to look at guideline dissemination for one area, using a variety of modalities. Smartphone technology has become ubiquitous in the past few years. The reasons for this are examined and the role for smartphones, and their applications (apps) in delivering assistance to doctors involved in front-line care is discussed. Potential regulatory issues are reviewed. Aims The aims of this thesis are: To assess prevalence of smartphones in the doctor population in a three-site hospital board area and these doctors’ attitudes to smartphone technology for clinical uses. To design and implement novel apps for thromboprophylaxis and Sepsis Six as a supplemental modality for guideline dissemination. To assess the impact of the introduction of these apps on guideline compliance, including assessing for fatiguing of interest. Materials and Methods A SurveyMonkey questionnaire was emailed to all 456 doctors across the three hospitals in the GGC Clyde sector asking about smartphone ownership and usage and their views on the roles of apps for clinical care. Native smartphone apps were designed and developed for both iPhone and android platforms for both VTE prophylaxis and Sepsis Six. Once these had been field-tested, and pre-app audit of current guideline compliance undertaken they were manually deployed to the surgical junior doctors at the Royal Alexandra Hospital, Paisley. Concurrently, while the Sepsis Six app was being developed the concept of Sepsis Six was rolled out using standard posters, presentations and tutorials. After each modality introduction for both VTE prophylaxis and Sepsis Six audit was undertaken both early, and some time later, to try and assess possible fatiguing of interest and compliance. Results There was a good response to the survey, revealing very high smartphone ownership levels at virtually 90%, with 100% ownership in doctors in the early years of training. Further analysis revealed that doctors in the middle of their training, rather than at either extreme, were the most likely to use a smartphone for clinical care. Doctors preferentially own iPhones rather than Android based smartphones which is out-of-keeping with worldwide, and indeed UK statistics, strongly favouring Android. VTE prophylaxis at baseline audit was better than expected. This meant it was difficult to show any improvement on addition of the smartphone app. There were transient improvements in the correct prescribing of anti-embolic stockings however but generally results suggested that the app simply wasn’t being used. Sepsis bundle compliance at baseline was poor but slowly improved over the seven audit points. There were no sharp improvements in Sepsis Six bundle compliance to suggest that either the traditional methods or the app were particularly good at improving guideline compliance. Conclusions Electronic patient care is fast becoming universal and smartphone/ tablet technology will be at the forefront of this. Despite disappointing results here,the use of an app for more complex patient-specific guidelines is likely to become increasingly popular, as long as accuracy of the information provided by the app can be guaranteed

A Tie Dye Onion: STORIES

Contains the following stories: 1. By the River; 2. Secrets the People in this Room Know; 3. The Grave Keepers of the Mattaponi; 4-6. The Graham’s Stories: What Will We Do When We Are Old?, Things I Wanted as a Child, The Pros and Cons of Being an Alcoholic; 7. Rind; 8. Under the Cranberry Bog; 9. Switzerland; 10. Malcolm; 11. Glass in a Silver Coat; 12. VertebraBachelor of Art

NDM-504: MULTI-PLATFORM TORNADO DAMAGE SCENE PRESERVATION

A severe tornado system produced damage to engineered metal buildings at an industrial facility outside Pampa, TX and toppled several nearby center-pivot irrigation structures. Rapid remote-sensing preservation of this overall damage scene was of particular necessity: access to the industrial facility was prohibited, and the overall size of the center-pivot irrigation system disallowed rapid direct measurement of member displacements. Engineers and architects from West Texas A&M University, University of Nebraska-Lincoln, and Texas Tech University collaborated to acquire and preserve the damage scene for future study, using a suite of existing and emerging platforms: including 3D point clouds derived from aerial FoDAR, aerial drone imaging, terrestrial laser scanning, and terrestrial digital photogrammetry as well as two-dimensional, four-band satellite imaging. Data collection using these various platforms offers guidance for the future remote-sensing preservation of damage scenes, the validation of estimated wind speeds currently employed in the Enhanced Fujita Scale of tornado intensity, and the further development of techniques for automated remote-sensing-based wind damage assessments

The effect of polyploidy and hybridization on the evolution of floral colour in Nicotiana (Solanaceae)

Background and Aims: We investigate whether changes in floral colour accompany polyploid and homoploid hybridisation, important processes in angiosperm evolution. Potentially, changes in floral colour can facilitate speciation through pollinator shifts. Methods: We examined spectral reflectance of corolla tissue from 60 Nicotiana (Solanaceae) accessions (41 taxa) based on spectral shape (corresponding to pigmentation) as well as bee and hummingbird colour perception to assess patterns of floral colour evolution. We compared polyploid and homoploid hybrid spectra to those of their progenitors to evaluate whether hybridisation has resulted in floral colour shifts. Key Results: Floral colour categories in Nicotiana seem to have arisen multiple times independently during the evolution of the genus. Polyploid and homoploid hybrids can display a floral colour: 1) intermediate between progenitors, 2) like one or other progenitor, or 3) a transgressive or divergent colour not present in either progenitor. Conclusions: Floral colour evolution in Nicotiana is weakly constrained by phylogeny, but colour shifts occur and are sometimes associated with allopolyploid or homoploid speciation. Transgressive floral colour in N. tabacum has arisen by inheritance of anthocyanin pigmentation from its paternal progenitor while having a plastid phenotype like its maternal progenitor. Potentially, floral colour evolution has been driven by, or resulted in, pollinator shifts

AMI observations of Lynds Dark Nebulae: further evidence for anomalous cm-wave emission

Observations at 14.2 to 17.9 GHz made with the AMI Small Array towards fourteen Lynds Dark Nebulae with a resolution of 2' are reported. These sources are selected from the SCUBA observations of Visser et al. (2001) as small angular diameter clouds well matched to the synthesized beam of the AMI Small Array. Comparison of the AMI observations with radio observations at lower frequencies with matched uv-plane coverage is made, in order to search for any anomalous excess emission which can be attributed to spinning dust. Possible emission from spinning dust is identified as a source within a 2' radius of the Scuba position of the Lynds dark nebula, exhibiting an excess with respect to lower frequency radio emission. We find five sources which show a possible spinning dust component in their spectra. These sources have rising spectral indices in the frequency range 14.2--17.9 GHz. Of these five one has already been reported, L1111, we report one new definite detection, L675, and three new probable detections (L944, L1103 and L1246). The relative certainty of these detections is assessed on the basis of three criteria: the extent of the emission, the coincidence of the emission with the Scuba position and the likelihood of alternative explanations for the excess. Extended microwave emission makes the likelihood of the anomalous emission arising as a consequence of a radio counterpart to a protostar or a proto-planetary disk unlikely. We use a 2' radius in order to be consistent with the IRAS identifications of dark nebulae (Parker 1988), and our third criterion is used in the case of L1103 where a high flux density at 850 microns relative to the FIR data suggests a more complicated emission spectrum.Comment: submitted MNRA

High sensitivity measurements of the CMB power spectrum with the extended Very Small Array

We present deep Ka-band ($\nu \approx 33$ GHz) observations of the CMB made with the extended Very Small Array (VSA). This configuration produces a naturally weighted synthesized FWHM beamwidth of $\sim 11$ arcmin which covers an $\ell$-range of 300 to 1500. On these scales, foreground extragalactic sources can be a major source of contamination to the CMB anisotropy. This problem has been alleviated by identifying sources at 15 GHz with the Ryle Telescope and then monitoring these sources at 33 GHz using a single baseline interferometer co-located with the VSA. Sources with flux densities \gtsim 20 mJy at 33 GHz are subtracted from the data. In addition, we calculate a statistical correction for the small residual contribution from weaker sources that are below the detection limit of the survey. The CMB power spectrum corrected for Galactic foregrounds and extragalactic point sources is presented. A total $\ell$-range of 150-1500 is achieved by combining the complete extended array data with earlier VSA data in a compact configuration. Our resolution of $\Delta \ell \approx 60$ allows the first 3 acoustic peaks to be clearly delineated. The is achieved by using mosaiced observations in 7 regions covering a total area of 82 sq. degrees. There is good agreement with WMAP data up to $\ell=700$ where WMAP data run out of resolution. For higher $\ell$-values out to $\ell = 1500$, the agreement in power spectrum amplitudes with other experiments is also very good despite differences in frequency and observing technique.Comment: 16 pages. Accepted in MNRAS (minor revisions

Accelerating functional gene discovery in osteoarthritis.

Osteoarthritis causes debilitating pain and disability, resulting in a considerable socioeconomic burden, yet no drugs are available that prevent disease onset or progression. Here, we develop, validate and use rapid-throughput imaging techniques to identify abnormal joint phenotypes in randomly selected mutant mice generated by the International Knockout Mouse Consortium. We identify 14 genes with functional involvement in osteoarthritis pathogenesis, including the homeobox gene Pitx1, and functionally characterize 6 candidate human osteoarthritis genes in mouse models. We demonstrate sensitivity of the methods by identifying age-related degenerative joint damage in wild-type mice. Finally, we phenotype previously generated mutant mice with an osteoarthritis-associated polymorphism in the Dio2 gene by CRISPR/Cas9 genome editing and demonstrate a protective role in disease onset with public health implications. We hope this expanding resource of mutant mice will accelerate functional gene discovery in osteoarthritis and offer drug discovery opportunities for this common, incapacitating chronic disease

Accelerating functional gene discovery in osteoarthritis.

Osteoarthritis causes debilitating pain and disability, resulting in a considerable socioeconomic burden, yet no drugs are available that prevent disease onset or progression. Here, we develop, validate and use rapid-throughput imaging techniques to identify abnormal joint phenotypes in randomly selected mutant mice generated by the International Knockout Mouse Consortium. We identify 14 genes with functional involvement in osteoarthritis pathogenesis, including the homeobox gene Pitx1, and functionally characterize 6 candidate human osteoarthritis genes in mouse models. We demonstrate sensitivity of the methods by identifying age-related degenerative joint damage in wild-type mice. Finally, we phenotype previously generated mutant mice with an osteoarthritis-associated polymorphism in the Dio2 gene by CRISPR/Cas9 genome editing and demonstrate a protective role in disease onset with public health implications. We hope this expanding resource of mutant mice will accelerate functional gene discovery in osteoarthritis and offer drug discovery opportunities for this common, incapacitating chronic disease

ZRANB3 is an African-specific type 2 diabetes locus associated with beta-cell mass and insulin response

Abstract: Genome analysis of diverse human populations has contributed to the identification of novel genomic loci for diseases of major clinical and public health impact. Here, we report a genome-wide analysis of type 2 diabetes (T2D) in sub-Saharan Africans, an understudied ancestral group. We analyze ~18 million autosomal SNPs in 5,231 individuals from Nigeria, Ghana and Kenya. We identify a previously-unreported genome-wide significant locus: ZRANB3 (Zinc Finger RANBP2-Type Containing 3, lead SNP p = 2.831 × 10−9). Knockdown or genomic knockout of the zebrafish ortholog results in reduction in pancreatic β-cell number which we demonstrate to be due to increased apoptosis in islets. siRNA transfection of murine Zranb3 in MIN6 β-cells results in impaired insulin secretion in response to high glucose, implicating Zranb3 in β-cell functional response to high glucose conditions. We also show transferability in our study of 32 established T2D loci. Our findings advance understanding of the genetics of T2D in non-European ancestry populations