Telemedicine infectious diseases consultations and clinical outcomes: A systematic review

Background: Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods: We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results: From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions: Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration: PROSPERO CRD42018105225

Comparing the yield of Staphylococcus aureus recovery with static versus agitated broth incubation

Given the lack of standardization of methodologies for microbial recovery from built environments, we sought to compare the yield of Staphylococcus aureus with a broth enrichment method when incubated in agitated versus static conditions. Five unique strains of S. aureus at five different concentrations were cultured to compare direct plating, agitated broth enrichment, and static broth enrichment culture methods. All samples were incubated at 35° in ambient air. The lowest concentration recovered across three replicates and five strains did not differ between culture methods (Fisher’s exact test, p=0.50); notably, recovery of S. aureus was equivalent between static and agitated broth incubation. When broth enrichment was used (both static and agitated), the burden of S. aureus growth was higher (by semiquantitative assessment of 4-quadrant streaking) compared to the direct plating culture method. Optimizing strategies for microbial recovery is essential, particularly in areas of lower biomass, given the paucity of research concerning microbial communities of built environments. The results of this study, in conjunction with other experiments investigating microbiomes of built environments, can help inform protocols for standardizing culturing methods within built environments

Repression of glucocorticoid-stimulated angiopoietin-like 4 gene transcription by insulin.

Angiopoietin-like 4 (Angptl4) is a glucocorticoid receptor (GR) primary target gene in hepatocytes and adipocytes. It encodes a secreted protein that inhibits extracellular LPL and promotes adipocyte lipolysis. In Angptl4 null mice, glucocorticoid-induced adipocyte lipolysis and hepatic steatosis are compromised. Markedly, insulin suppressed glucocorticoid-induced Angptl4 transcription. To unravel the mechanism, we utilized small molecules to inhibit insulin signaling components and found that phosphatidylinositol 3-kinase and Akt were vital for the suppression in H4IIE cells. A forkhead box transcription factor response element (FRE) was found near the 15 bp Angptl4 glucocorticoid response element (GRE). Mutating the Angptl4 FRE significantly reduced glucocorticoid-induced reporter gene expression in cells. Moreover, chromatin immunoprecipitation revealed that GR and FoxO1 were recruited to Angptl4 GRE and FRE in a glucocorticoid-dependent manner, and cotreatment with insulin abolished both recruitments. Furthermore, in 24 h fasted mice, significant occupancy of GR and FoxO1 at the Angptl4 GRE and FRE was found in the liver. In contrast, both occupancies were diminished after 24 h refeeding. Finally, overexpression of dominant negative FoxO1 mutant abolished glucocorticoid-induced Angptl4 expression, mimicking the insulin suppression. Overall, we demonstrate that both GR and FoxO1 are required for Angptl4 transcription activation, and that FoxO1 negatively mediates the suppressive effect of insulin

Developing Leaders for a World Disrupted: A Case Study Evaluating Learning Transfer for an Executive Development Program

This qualitative case study sought to better understand the complexity of developing executives to lead in a landscape of disruption and uncertainty, and how to evaluate the effectiveness of the development intervention in a world that is constantly changing. The purpose of this study was to explore how executives make meaning from what they learned in a development program, how these executives transferred the learning to lead their teams in today’s dynamic world, and how their organization benefitted (if at all) from having leaders with increased capabilities in leading through change. The researcher chose a single-case study design to evaluate the long-term impact of an executive development program within a bounded organization by looking at three key areas for the research questions: individual development, facilitators and barriers to learning transfer, and organizational outcomes. The 13 study participants were a subset of a cohort from an Executive Development Program (EDP), designed to harness the power of disruption to prepare leaders to navigate their teams through a constantly changing landscape with care, curiosity, and courage. The EDP took place at Global Financial Analytics & Insights (GFAI,), a pseudonym, which is a firm providing essential information to the global financial markets to inform decision-making. The data collection methods leveraged to conduct this case study were semi-structured interviews with the 13 participants and program architect, and a review of archival program documentation. The data were coded and organized according to the research questions and conceptual framework. Analysis, interpretation and synthesis of the findings were organized into four analytic categories: (1) individual shifts in mindsets or behavior; (2) enabling factors of learning transfer; (3) barriers to learning transfer; and (4) tangible or intangible benefits for the organization. This study revealed that all 13 leaders in EDP experienced a shift in their leadership style in at least one of the three lenses of care, curiosity, or courage. It also revealed that all participants encountered facilitators and barriers to learning transfer, which were grouped into the themes of individual motivation, work environment, and program design. All leaders were able to describe at least one way that GFAI benefitted from the investment in the EDP, with the top benefit being an engaged and committed network of leaders who could rely on each other to solve problems across the firm. Recommendations are offered to practitioners who aspire to build highly capable leaders prepared to navigate a dynamic and disruptive world, including: (1) leverage measurement tools to understand a leader’s ability to adapt to complexity; (2) design learning experiences that provoke new perspectives to enable transformation; (3) evaluate programs over time to allow for participants to apply their learning and for others in the organization to recognize the shifts the leader is making; and (4) engage the Executive Team (the level of leadership that reports directly to the CEO) as program sponsors and champions early in the design process and clearly articulate what is expected of them as organizational leaders and role models. Recommendations for future research are also included

Implementation of telemedicine infectious diseases consultation in a rural hospital using the Active Implementation Framework

In this pilot study, guided by the Active Implementation Framework, telemedicine infectious diseases consultation was provided to hospitalized inpatients at a rural Missouri hospital. Measured outcomes included the implementation outcomes of feasibility, acceptability, appropriateness, and fidelity, as well as clinical outcomes of readmissions and death

Enhanced star formation in both disks and ram pressure stripped tails of GASP jellyfish galaxies

Exploiting the data from the GAs Stripping Phenomena in galaxies with MUSE (GASP) program, we compare the integrated Star Formation Rate- Mass relation (SFR-M_ast) relation of 42 cluster galaxies undergoing ram pressure stripping ("stripping galaxies") to that of 32 field and cluster undisturbed galaxies. Theoretical predictions have so far led to contradictory conclusions about whether ram pressure can enhance the star formation in the gas disks and tails or not and until now a statistically significant observed sample of stripping galaxies was lacking. We find that stripping galaxies occupy the upper envelope of the control sample SFR-M_ast relation, showing a systematic enhancement of the SFR at any given mass. The star formation enhancement occurs in the disk (0.2 dex), and additional star formation takes place in the tails. Our results suggest that strong ram pressure stripping events can moderately enhance the star formation also in the disk prior to gas removal.Comment: ApJL in pres

Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults

Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization–time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota

GASP. XII. The variety of physical processes occurring in a single galaxy group in formation

GAs Stripping Phenomena in galaxies with MUSE (GASP) is a program aimed at studying gas removal processes in nearby galaxies in different environments. We present the study of four galaxies that are part of the same group (z= 0.06359) and highlight the multitude of mechanisms affecting the spatially resolved properties of the group members. One galaxy is passive and shows a regular stellar kinematics. The analysis of its star formation history indicates that the quenching process lasted for a few Gyr and that the star formation declined throughout the disk in a similar way, consistent with strangulation. Another galaxy is characterised by a two-component stellar disk with an extended gas disk that formed a few 10^8 yr ago, most likely as a consequence of gas accretion. The third member is a spiral galaxy at the edges of the group, but embedded in a filament. We hypothesise that the compression exerted by the sparse intergalactic medium on the dense circumgalactic gas switches on star formation in a number of clouds surrounding the galaxy ("cosmic web enhancement"). Alternatively, also ram pressure stripping might be effective. Finally, the fourth galaxy is a spiral with a truncated ionised gas disk and an undisturbed stellar kinematics. An analytical model of the galaxy's restoring pressure, and its location and velocity within the cluster, suggest ram pressure is the most likely physical mechanism in action. This is the first optical evidence for stripping in groups.Comment: 19 page, 12 figure

CONSISTENCY AND VALIDITY OF ACUTE FOOT-STRIKE PATTERN ALTERATIONS DURING LABORATORY-BASED RUNNING

Due to the limited learning time allotted in most foot strike pattern modification studies, the reliability of pattern alterations may be jeopardized. The purpose of the current study was to investigate the reliability and validity of requested acute alteration of foot strike patterns performed by participants in a laboratory environment. Participants employed a high degree of consistency within foot strike pattern conditions and across the steps within a condition (average within subjects 95% confidence interval = 0.5° - 4°). On a group level, participants accurately performed all foot strike conditions with the exception of the midfoot strike pattern. Thus, even with the alteration of foot strike pattern, a generally reliable and valid foot strike angle performance is evidenced