Paediatric palliative care by video consultation at home: a cost minimisation analysis

Background: In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland

A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities

Background: The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services

Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us?

Background: Advances in technology have made the use of telehealth in the home setting a feasible option for palliative care clinicians to provide clinical care and support. However, despite being widely available and accessible, telehealth has still not been widely adopted either in Australia or internationally. The study aim was to investigate the barriers, enablers and perceived usefulness for an established home telehealth program in paediatric palliative care from the perspective of clinicians

Speech-language Pathology Services Delivered by Telehealth in a Rural Educational Setting: the School’s Perspective

Introduction: Access to speech-language pathology services for children in rural and remote communities is often limited. Telehealth is increasingly used to provide these services to schools, demonstrating high satisfaction with both service providers and recipients, but the requirements for successful program implementation are as yet unclear. We aimed to explore the implementation requirements for a telehealth speech-language pathology service for children from the perspective of a rural school. Methods: A qualitative approach, supplemented by program activity data, was used to understand the experiences and perceptions of the benefits, limitations, enablers and barriers of a telehealth speech-language pathology program delivered to a school servicing approximately 400 children in a small rural town in the state of Queensland, Australia. Thematic analysis was conducted of transcripts of individual semi-structured interviews with nine school teaching staff and field notes of informal discussions regarding 85 speech-language pathology telehealth sessions (n = 9 children) during program establishment and implementation. Results: The speech-language pathology telehealth service was acceptable to teaching staff at the rural school, who cited improved access, the suitability of the technology for child engagement, and perceived effectiveness. Implementation issues were highlighted as critical to program success and scalability, particularly staff workload, technological issues, communication processes, and sustainability. Conclusion: School-based speech-language pathology services delivered via telehealth were perceived as a suitable way of increasing access for children by rural school staff. Future implementations of telehealth speech-language pathology programs should prospectively consider workload implications and develop strategies to communicate with and involve school staff.     &nbsp

Formation of the oxygen torus in the inner magnetosphere: Van Allen Probes observations

We study the formation process of an oxygen torus during the 12–15 November 2012 magnetic storm, using the magnetic field and plasma wave data obtained by Van Allen Probes. We estimate the local plasma mass density (ρL) and the local electron number density (neL) from the resonant frequencies of standing Alfvén waves and the upper hybrid resonance band. The average ion mass (M) can be calculated by M ∼ ρL/neL under the assumption of quasi-neutrality of plasma. During the storm recovery phase, both Probe A and Probe B observe the oxygen torus at L = 3.0–4.0 and L = 3.7–4.5, respectively, on the morning side. The oxygen torus has M = 4.5–8 amu and extends around the plasmapause that is identified at L∼3.2–3.9. We find that during the initial phase, M is 4–7 amu throughout the plasma trough and remains at ∼1 amu in the plasmasphere, implying that ionospheric O+ ions are supplied into the inner magnetosphere already in the initial phase of the magnetic storm. Numerical calculation under a decrease of the convection electric field reveals that some of thermal O+ ions distributed throughout the plasma trough are trapped within the expanded plasmasphere, whereas some of them drift around the plasmapause on the dawnside. This creates the oxygen torus spreading near the plasmapause, which is consistent with the Van Allen Probes observations. We conclude that the oxygen torus identified in this study favors the formation scenario of supplying O+ in the inner magnetosphere during the initial phase and subsequent drift during the recovery phase

Misplaced Cervical Screws Requiring Reoperation.

STUDY DESIGN: A multicenter, retrospective case series. OBJECTIVE: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. METHODS: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. RESULTS: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%). CONCLUSIONS: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication

Parents, children and the porous boundaries of the sexual family in law and popular culture

This article focuses on a perceived ideological overlap between popular cultural and judicial treatments of sex and conjugality that contributes to a discursive construction of parenthood and parenting. The author perceives that in both legal and popular cultural texts, there is a sense in which notions of ‘natural’ childhood are discursively constituted as being put at risk by those who reproduce outside of dominant sexual norms, and that signs of normative sexuality (typically in the form of heterosexual coupling) may be treated as a sign of safety. These ideas are rooted in ancient associations between fertility, sexuality and femininity that can also be traced in the historical development of the English language. With the help of commentators such as Martha Fineman, the article situates parents and children within a discourse of family which prioritises conjugality, with consequences for the ways in which the internal and external boundaries of families are delineated

Excitation of EMIC waves detected by the Van Allen Probes on 28 April 2013

Abstract We report the wave observations, associated plasma measurements, and linear theory testing of electromagnetic ion cyclotron (EMIC) wave events observed by the Van Allen Probes on 28 April 2013. The wave events are detected in their generation regions as three individual events in two consecutive orbits of Van Allen Probe-A, while the other spacecraft, B, does not detect any significant EMIC wave activity during this period. Three overlapping H+ populations are observed around the plasmapause when the waves are excited. The difference between the observational EMIC wave growth parameter (Eh) and the theoretical EMIC instability parameter (Sh) is significantly raised, on average, to 0.10 ± 0.01, 0.15 ± 0.02, and 0.07 ± 0.02 during the three wave events, respectively. On Van Allen Probe-B, this difference never exceeds 0. Compared to linear theory (Eh\u3eSh), the waves are only excited for elevated thresholds

Reducing the impacts of leg hold trapping on critically endangered foxes by modified traps and conditioned trap aversion on San Nicolas Island, California, USA

Padded leg-hold live traps were used as the primary removal technique in the successful eradication of feral cats Felis silvestris catus from San Nicolas Island, California, USA. Risk of injury to endemic San Nicolas Island foxes Urocyon littoralis dickeyi, a similarly sized and more abundant non-target species, was mitigated by using a smaller trap size, modifying the trap and trap set to reduce injuries, and utilising a trap monitoring system to reduce time animals spent in traps. Impacts to foxes during the eradication campaign were further reduced by having a mobile veterinary hospital on island to treat injured foxes. Compared to other reported fox trapping efforts, serious injuries were reduced 2-7 times. Trapping efforts exceeded animal welfare standards, with 95% of fox captures resulting in minor or no injuries. Older foxes were more likely to receive serious injury. Fox captures were also reduced through aversive conditioning, with initial capture events providing a negative stimulus to prevent recaptures. Fox capture rates decreased up to six times during seven months of trapping, increasing trap availability for cats, and improving the efficacy of the cat eradication program. No aspect of the first capture event was significantly linked to the chance of recapture