Use of telemedicine to improve cpap non-adherence in patients with obstructive sleep apnea, a pilot study

Abstract The aim of this project is to improve continuous positive airway pressure (CPAP) non-adherence in patients newly diagnosed with obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by recurrent collapse of the upper airway during sleep. Untreated, OSA is associated with co-morbidity and decreased quality of life. The standard for OSA treatment is CPAP. Adherence to CPAP is not optimal. Applying telemedicine technology to monitor adherence of CPAP treatment, allows for early intervention. Prior research has shown mixed results with use of telemedicine on non-adherence rates. This is a pilot study using telemedicine to monitor adherence data to trigger patient support throughout the first 3 months of CPAP therapy. In total, 56 newly diagnosed OSA patients were randomized to standard care (SC, n=23) or telemedicine (TM, n=33). SC received follow-up appointment at 6-weeks; those in TM had weekly data monitoring for the first 3 months, in addition to standard care. If CPAP use did not meet adherence criteria, a support phone call was conducted. Study results were compared to baseline non-adherence rates. Study results did not show significant improvement in CPAP non-adherence rates with telemedicine intervention compared to standard care (p=0.43). There was improvement in non-adherence rates in both TM (8.0%) and SC (15.8%) arms at 3-months, from baseline non-adherence rate (22.8%). Although the improvement seen in CPAP non-adherence rates was not significant, future studies with larger sample sizes may note more robust significance. Clinical significance related to increased adherence rates should not be undervalued

What qualitative systems mapping is and what it could be: integrating and visualizing diverse knowledge of complex problems

Researchers in sustainability science deal with increasingly complex problems that cross administrative, geographical, disciplinary, and sectoral boundaries, and are characterized by high stakes and deep uncertainties. This in turn creates methodological challenges to frame, structure, and solve complex problems in science and practice. There is a long tradition in visualizing systems as diagrams, and concept and cognitive maps, but there is insufficient differentiation and comparison between these methods and no clear umbrella term has yet been established. Against this background, we systematically review three foundational methods from different academic disciplines—causal diagrams, concept mapping, and cognitive mapping. Comparing and contrasting them, we facilitate a coherent understanding of qualitative systems mapping (QSM) as an umbrella term. We then proceed to explore the evident intersections between these methods to showcase some of the inter- and transdisciplinary opportunities and challenges crystallizing in integrated QSM approaches. Finally, we share case study insights from the food–water–biodiversity nexus in Austria and elaborate on some of the methodological nuances to data integration in QSM. Overall, with this overview paper, we lay the groundwork for a systematic, transparent, and yet flexible development and application of QSM methods to support mixed-methods research design and clear case study documentation, as well as fostering effective inter- and transdisciplinary communication in sustainability science. Further research needs to explore these QSM applications in depth across alternative sustainability science contexts, particularly with respect to efficient and rigorous protocols for knowledge and data integration vis-a-vis complex problems and transdisciplinary research processes

Deep Emissions Reductions and Mainstreaming of Mitigation and Adaptation: Key Findings

Climate policy "mainstreaming", "proofing" and "integration" are concepts that are increasingly appearing in a range of EU policy discussions, including those concerning the 2014-2020 Multi-Annual Financial Framework (MFF). They reflect the view that all policy sectors need to play a part in both reducing emissions and increasing resilience to unavoidable climate impacts. Broadly defined, mainstreaming involves including climate considerations in policy processes, improving the consistency among policy objectives, and where necessary, giving priority to climate-related goals above others. Although often couched in technical language, profound political challenges, at multiple levels of governance, lie at the heart of the mainstreaming agenda. The RESPONSES project analysed how far adaptation and mitigation was being mainstreamed in EU policies, and assessed the potential opportunities and limits for the future

Integrative Qualitative Systems Mapping (IQSM) approach for knowledge integration in transdisciplinary research

Systems approaches provide tools to address the increasing complexity of societal challenges. However, current qualitative system map (QSM) approaches lack the ability to visualize findings early on in a research process and systematically document and integrate qualitative data in an efficient, low-resources manner. Therefore, we propose a novel application for QSM – Integrative Qualitative System Map (IQSM) – which was developed in the WaterStressAT project

Insects for breakfast and whales for dinner: the diet and body condition of dingoes on Fraser Island (K’gari)

Top-predators play stabilising roles in island food webs, including Fraser Island, Australia. Subsidising generalist predators with human-sourced food could disrupt this balance, but has been proposed to improve the overall health of the island’s dingo (Canis lupus dingo) population, which is allegedly ‘starving’ or in ‘poor condition’. We assess this hypothesis by describing the diet and health of dingoes on Fraser Island from datasets collected between 2001 and 2015. Medium-sized mammals (such as bandicoots) and fish were the most common food items detected in dingo scat records. Stomach contents records revealed additional information on diet, such as the occurrence of human-sourced foods. Trail camera records highlighted dingo utilisation of stranded marine fauna, particularly turtles and whales. Mean adult body weights were higher than the national average, body condition scores and abundant-excessive fat reserves indicated a generally ideal-heavy physical condition, and parasite loads were low and comparable to other dingo populations. These data do not support hypotheses that Fraser Island dingoes have restricted diets or are in poor physical condition. Rather, they indicate that dingoes on Fraser Island are capable of exploiting a diverse array of food sources which contributes to the vast majority of dingoes being of good-excellent physical condition

Pulmonary Arterial Morphometry from Microfocal X-Ray Computed Tomography

The objective of this study was to develop an X-ray computed tomographic method for pulmonary arterial morphometry. The lungs were removed from a rat, and the pulmonary arterial tree was filled with perfluorooctyl bromide to enhance X-ray absorbance. At each of four pulmonary arterial pressures (30, 21, 12, and 5.4 mmHg), the lungs were rotated within the cone of the X-ray beam that was projected from a microfocal X-ray source onto an image intensifier, and 360 images were obtained at 1° increments. The three-dimensional image volumes were reconstructed with isotropic resolution with the use of a cone beam reconstruction algorithm. The luminal diameter and distance from the inlet artery were measured for the main trunk, its immediate branches, and several minor trunks. These data revealed a self-consistent tree structure wherein the portion of the tree downstream from any vessel of a given diameter has a similar structure. Self-consistency allows the entire tree structure to be characterized by measuring the dimensions of only the vessels comprising the main trunk of the tree and its immediate branches. An approach for taking advantage of this property to parameterize the morphometry and distensibility of the pulmonary arterial tree is developed

Operationalizing Resilience Against Natural Disaster Risk: Opportunities, Barriers, and a Way Forward

The risks from floods have been rising globally due to increasing population, urbanization and economic development in hazard prone areas. The number of flood disasters throughout the world nearly doubled in the decade from 2000-2009 compared to the previous decade. There have been more flood disasters in the last four years (2010-2013) than in the whole decade of the 1980's. Evidence indicates that climate change-induced sea level rise, storm surge and more intense flooding will reinforce this trend unless risk management measures are undertaken immediately to well manage future losses and make communities more resilient to flooding. It is widely recognized that there is a mutually reinforcing relationship between disaster risk and development: disasters impact development and development impacts disasters. Evidence shows that repeated disasters undermine long-term socio-economic objectives. This is particularly evident in low income countries where disasters can impede the development process. The extensive time required to recover from damage, loss of capacity with which to rebuild and systemic risk negatively affect livelihoods in these countries, in the extreme case trapping people in poverty. In developed countries, recent floods triggered massive economic losses and undermined long-term competitiveness. The impact of disasters is felt most acutely by households and communities. In both developing and developed countries alike, local level studies strongly indicate that the poor suffer disproportionately due to the lack of financial and social safety nets, and institutional representation. Development can affect disaster risk via three main channels: by (1) increasing the physical assets and people exposed to the risk, (2) increasing the capacity to reduce the risk, respond to the risk and recover from the risk and (3) increasing or decreasing the vulnerability based on specific development strategies chosen. We identify this interaction as a key research gap; taking account of and balancing development opportunities with disaster risk will require a paradigm shift in the way we think about and do both development and disaster risk management

Porcine endogenous retroviruses PERV A and A/C recombinant are insensitive to a range of divergent mammalian TRIM5 proteins including human TRIM5

The potential risk of cross-species transmission of porcine endogenous retroviruses (PERV) to humans has slowed the development of xenotransplantation, using pigs as organ donors. Here, we show that PERVs are insensitive to restriction by divergent TRIM5{alpha} molecules despite the fact that they strongly restrict a variety of divergent lentiviruses. We also show that the human PERV A/C recombinant clone 14/220 reverse transcribes with increased efficiency in human cells, leading to significantly higher infectivity. We conclude that xenotransplantation studies should consider the danger of highly infectious TRIM5{alpha}-insensitive human-tropic PERV recombinants

Management of multiple threats achieves meaningful koala conservation outcomes

Management actions designed to mitigate development or anthropogenic impacts on species of conservation concern are often implemented without quantifying the benefit to the species. It is often unclear what combinations and intensities of management actions are required to achieve meaningful conservation outcomes. We investigate whether disease and predator control can reverse population declines of koalas (Phascolarctos cinereus). Based on longitudinal monitoring of the epidemiological and demographic status of over 500 animals over 4 years, coupled with an intensive disease and predator management programme, we use survival analyses to estimate annual age-specific survival rates and population growth, and simulations to quantify the benefit of these actions. Predation and disease accounted for 63% and 29% of mortality, respectively, across all years, with wild dog (dingoes or dingo-hybrids: Canis dingo, C. dingo × Canis familiaris), carpet pythons (Morelia spilota) and domestic dogs (C. familiaris) accounting for 82%, 14% and 4% of confirmed predation mortalities, respectively. In the first 2 years, before disease and dog control had major impact, the population was declining rapidly with annual growth rates of 0.66 and 0.90. In the third and fourth years, after interventions had been fully implemented, the population growth rate had increased to 1.08 and 1.20. The intrinsic survival rate of joeys was 71.2% (excluding deaths resulting from the death of the mother). Adult survival rates varied as a function of sex, age and year. Even in a declining koala population, management actions can achieve meaningful conservation outcomes (population growth rates greater than one). However, benefits may be short-lived in the absence of longer term strategies to manage threats. This work also identifies wild dogs as a major threat to koalas, highlighting the need to better understand how wild dog impacts vary in space and time. Policy implications. Offsetting policy that addresses habitat loss alone may achieve little or no meaningful benefit to declining koalas populations. Management must address suites of threats affecting these populations and ensure that the cumulative effects of these actions achieve positive population growth rates