A medical approach to language delay

No Abstract

Design and performance of a multicentre, randomized controlled trial of teleconsulting.

We have designed and performed a multicentre, randomized controlled trial of teleconsulting. The trial investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing as an alternative to general practitioner referral to a hospital specialist. The participating general practitioners referred a total of 3170 patients who satisfied the entry criteria. Of these, 1040 (33%) failed to provide consent or otherwise refused to participate in the trial. Of the patients recruited to the trial, a total of 1902 (91%) completed and returned the baseline questionnaire. Although the trial was successful in recruiting sufficient patients and in obtaining high questionnaire response rates, the findings will require careful interpretation to take account of the limits which the protocol placed on the ability of general practitioners to select patients for referral

1 Pengaruh Penyuluhan Bencana Banjir Terhadap Kesiapsiagaan Siswa SMP Katolik Soegiyo Pranoto Manado Menghadapi Banjir

Banjir merupakan salah satu bencana yang sering terjadi di Indonesia. Bencana banjir dapat menyebabkan kerugian dan korban jiwa. Kota Manado setiap tahunnya mengalami bencana banjir sehingga memerlukan kesiapsiagaan bencana yang terkoordinasi. SMP Katolik Soegiyo Pranoto salah satu yang selalu terkena dampak ketika DAS Sawangan dan Tondano tidak mampu menampung debit air sungai. Tujuan penelitian ini untuk Menganalisis Penyuluhan Bencana Banjir Terhadap Kesiapsiagaan Siswa SMP Katolik Soegiyo Pranoto Menghadapi Banjir. Sampel dalam penelitian ini berjumlah 52 responden dengan menggunakan teknik total sampling. Desain penelitian yang digunakan yaitu desain one group pre test-post test dan data yang dikumpulkan dari responden dengan menggunakan lembar kuesioner. Hasil Penelitian diperoleh nilai P-value sebesar 0,00 (<0,05) dengan nilai t hitung sebesar 34,69 dan t tabel sebesar 2,009. Kesimpulan menunjukkan adanya pengaruh penyuluhan bencana banjir terhadap kesiapsiagaan siswa SMP Katolik Soegiyo Pranoto Manado menghadapi banjir. Saran dapat digunakan sebagai bahan informasi dan pengembangan ilmu pengetahuan dalam penanggulangan bencana lebih khusus pada kesiapsiagaan

Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial.

BACKGROUND: The current model of general practitioner referral of patients to hospital specialists in the UK is sometimes associated with unnecessary duplication of investigations and treatments. We aimed to compare joint teleconsultations between general practitioners, specialists, and patients (virtual outreach) with standard outpatient referral. METHODS: Virtual outreach services were established in London and Shrewsbury. The general practitioners referred 3170 patients, of whom 2094 consented to participate in the study and were eligible for inclusion. 1051 patients were randomly assigned virtual outreach, and 1043 standard outpatient appointments. We followed up the patients for 6 months after their index consultation. The primary outcome measure was the offer of a follow-up outpatient appointment. Analysis was by intention to treat. FINDINGS: More patients in the virtual outreach group than the standard group were offered a follow-up appointment (502 [52%] vs 400 [41%], odds ratio 1.52 [95% CI 1.27-1.82], p<0.0001). Significant differences in effects were observed between the two sites (p=0.009) and across different specialties (p<0.0001). Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ear, nose, and throat surgery and orthopaedics than in the other specialties. Fewer tests and investigations were ordered in the virtual outreach group by an average of 0.79 per patient (0.37-1.21, p=0.0002). Patients' satisfaction (analysed per protocol) was greater after a virtual outreach consultation than after a standard outpatient consultation (mean difference 0.33 scale points [95% CI 0.23-0.43], p<0.0001), with no heterogeneity between specialties or sites. INTERPRETATION: The trial showed that allocation of patients to virtual outreach consultations is variably associated with increased offers of follow-up appointments according to site and specialty, but leads to significant increases in patients' satisfaction and substantial reductions in tests and investigations. Efficient operation of such services will require appropriate selection of patients, significant service reorganisation, and provision of logistical support

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.Design Cost consequences study alongside randomised controlled trial.Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments.Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction.Results Overall six month costs were greater for the virtual outreach consultations (pound724 per patient) than for conventional outpatient appointments (pound625): difference in means pound99 ($162; is not an element of138) (95% confidence interval pound10 to pound187, P=0.03). if the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound108 (pound73 to pound142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost 8 pound (5 pound to 10 pound, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound11 (pound10 to pound12, P < 0.0001).Condusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported

Baseline Assessment and Prioritization Framework for IVHM Integrity Assurance Enabling Capabilities

Fundamental to vehicle health management is the deployment of systems incorporating advanced technologies for predicting and detecting anomalous conditions in highly complex and integrated environments. Integrated structural integrity health monitoring, statistical algorithms for detection, estimation, prediction, and fusion, and diagnosis supporting adaptive control are examples of advanced technologies that present considerable verification and validation challenges. These systems necessitate interactions between physical and software-based systems that are highly networked with sensing and actuation subsystems, and incorporate technologies that are, in many respects, different from those employed in civil aviation today. A formidable barrier to deploying these advanced technologies in civil aviation is the lack of enabling verification and validation tools, methods, and technologies. The development of new verification and validation capabilities will not only enable the fielding of advanced vehicle health management systems, but will also provide new assurance capabilities for verification and validation of current generation aviation software which has been implicated in anomalous in-flight behavior. This paper describes the research focused on enabling capabilities for verification and validation underway within NASA s Integrated Vehicle Health Management project, discusses the state of the art of these capabilities, and includes a framework for prioritizing activities

Diagnosis, monitoring and treatment of tuberous sclerosis complex: A South African consensus response to international guidelines

Tuberous sclerosis complex (TSC) is a genetic disorder with multi-system manifestations and a high burden of disease. In 2013, an international panel of TSC experts revised the guidelines for the diagnosis, surveillance and treatment of the disorder. In South Africa (SA), a local multidisciplinary group of healthcare professionals and TSC researchers reviewed the international guidelines to generate an SA consensus clinical update on the identification, diagnosis, treatment and lifelong monitoring of individuals who live with TSC. We strongly endorse dissemination and use of the international guidelines for the assessment, monitoring and treatment of TSC. In addition, we strongly support access to genetic testing and to mTOR (mammalian target of rapamycin) inhibitors to treat subependymal giant cell astrocytomas not amenable to surgery and renal angiomyolipomas larger than 3 cm, and as adjunctive treatment for refractory focal seizures. We await with interest results from mTOR inhibitor trials of skin and TSC-associated neuropsychiatric disorders (TAND). With regard to training, we recommend the inclusion of TSC in undergraduate and postgraduate medical and health sciences curricula, and the promotion of other continuing professional development events to raise awareness about TSC. We also support the development of a TSC user/carer/parent organisation to provide an informal support network for families across SA. We acknowledge that some progress has been made in recent years in SA, but much remains to be done. We hope that this SA consensus clinical update based on the international guidelines will make a positive contribution to increase knowledge and improve clinical care for all patients who live with TSC in SA, and their families

OGLE-2016-BLG-0613LABb: A Microlensing Planet in a Binary System

We present the analysis of OGLE-2016-BLG-0613, for which the lensing light curve appears to be that of a typical binary-lens event with two caustic spikes but with a discontinuous feature on the trough between the spikes. We find that the discontinuous feature was produced by a planetary companion to the binary lens. We find 4 degenerate triple-lens solution classes, each composed of a pair of solutions according to the well-known wide/close planetary degeneracy. One of these solution classes is excluded due to its relatively poor fit. For the remaining three pairs of solutions, the most-likely primary mass is about $M_1\sim 0.7\,M_\odot$ while the planet is a super-Jupiter. In all cases the system lies in the Galactic disk, about half-way toward the Galactic bulge. However, in one of these three solution classes, the secondary of the binary system is a low-mass brown dwarf, with relative mass ratios (1 : 0.03 : 0.003), while in the two others the masses of the binary components are comparable. These two possibilities can be distinguished in about 2024 when the measured lens-source relative proper motion will permit separate resolution of the lens and source.Comment: 14 pages, 9 figure