Determining Access of In-Person vs Virtual Clinic Visits in Orthopedic Medicine

INTRODUCTION: Virtual visits in orthopedics provide added benefits compared to in-person visits. We hypothesize that virtual visits will offer patients greater same-day and future access to orthopedic physicians. METHODS: Two previously established methodologies were used to measure orthopedic surgeons: same-day and third-next-available. Same-day access is analyzed using a ratio of unfilled to filled virtual return and in-person return appointments for every clinic day of each physician. Third-next-available is measured as the number of total non-clinic days and clinic days until each physician’s third next-available-virtual and in-person appointments. RESULTS: For same-day access, the ratio of unfilled virtual to filled virtual appointments was 1.04 on average, while the ratio of unfilled in-person to filled return in-person visits was 0.38 on average (p=0.00323). For third-next-available appointments, the in-person opening was 5.81 days out on average compared to the virtual visit being 8.31 days out on average (p=0.01525). Additionally, the in-person appointment was 2.5 clinic-days out on average and the virtual appointment was 3.95 clinic-days out on average (p\u3c0.001). As virtual visits are a fraction of total visits, we divided the third-next-available data by the rate at which each physician books virtual appointments. This resulted in a significantly increased standardized third-next-available measure of access for virtual appointments using both total days (p\u3c0.001) and clinic days (p\u3c0.001). DISCUSSION/CONCLUSION: Virtual return visits offer greater same-day access for patients compared to analogous in-person return visits. However, in-person appointment availability offers better access for patients in terms of scheduling a future visit, which may be due to the increased number of in-person visits offered compared to virtual visits provided at this time. When standardizing the third-next-available data for how often each visit modality is offered, virtual visits displayed greater levels of patient access. Thus, an increased volume of virtual visit appointments may offer patients greater access for scheduling purposes in the future

The Glycosylphosphatidylinositol-PLC in Trypanosoma brucei Forms a Linear Array on the Exterior of the Flagellar Membrane Before and After Activation

Bloodstream forms of Trypanosoma brucei contain a glycosylphosphatidylinositol-specific phospholipase C (GPI-PLC) that cleaves the GPI-anchor of the variable surface glycoprotein (VSG). Its location in trypanosomes has been controversial. Here, using confocal microscopy and surface labelling techniques, we show that the GPI-PLC is located exclusively in a linear array on the outside of the flagellar membrane, close to the flagellar attachment zone, but does not co-localize with the flagellar attachment zone protein, FAZ1. Consequently, the GPI-PLC and the VSG occupy the same plasma membrane leaflet, which resolves the topological problem associated with the cleavage reaction if the VSG and the GPI-PLC were on opposite sides of the membrane. The exterior location requires the enzyme to be tightly regulated to prevent VSG release under basal conditions. During stimulated VSG release in intact cells, the GPI-PLC did not change location, suggesting that the release mechanism involves lateral diffusion of the VSG in the plane of the membrane to the fixed position of the GPI-PLC

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

The Analysis of the H Lyman α Emission Line Profile from Jupiter's Aurora

International audienceWe present the analysis and modeling of the emission spectra of the jovian northern auroral region taken from May 28 to June 3, 1993, with the Goddard High Resolution Spectrograph on board the Hubble Space Telescope. They extend from 1204 to 1240 Â covering H Lyman α and part of the Werner and the Lyman bands of H 2. We used the 2×2 arcsec large science aperture combined with the G160M grating (spectral resolution of 570 mÂ) centred on Jupiter's central meridian. The auroral region studied extends from 50 to 60° north latitudes and from 130 to 220° System III longitudes. Within the 1 arcsec pointing uncertainty, most of the region delineated by the theoretical ovals at 5.9 and 30 jovian radii (R J) in the VIP4 model of J. E. C. Connerney, M. H. Acuna, N. F. Ness, and T. Satoh (1998, New models of Jupiter's magnetic field constrained by the Io flux tube footprint. J. Geophys. Res. 103, 11,929-11,939), including the auroral oval derived from the Wide Field Planetary Camera 2 images by J. T. Clarke, G. E. Ballester, J. T. Trauger, R. Evans, J. E. P. Connerney, K. Stapelfeld, D. Crisp, P. D. Feldman, C. J. Burrows, S. Casertano, J. S. Gallagher, R. E. Griffiths, J. J. Hester, J. G. Hoessel, J. A. Holtzman, J. E. Krist, V. Meadows, J. R. Mould, P. A. Scowen, A. M. Watson, and J. A. Westphal (1996, Far-ultraviolet imaging of Jupiter's aurora and the Io "footprint". Science274, 404-409), was sampled. We derive auroral brightnesses (averaged over the slit) ranging from 20 kR in the 190-220° longitude region to 30 kR in the 130-160° longitude range. We use the theoretical model developed by D. Rego, R. Prangé, and L. Ben Jaffel (1999, Auroral Lyman α and H 2 bands from the giant planets. 3. Lyman α intensity and spectral profile including radiative effects and H 2 color ratios. J. Geophys. Res. Planets.104, 5939-5954), which calculates self-consistently the auroral Lyman α line profile for electron and proton precipitations and a given frequency redistribution function. This model shows that Lyman α profiles are not dependent upon the identity of the particles for a given penetration depth. These profiles only constrain the atmospheric H column density above the emitting layer, H col. Best agreement with the data is found with the complete frequency redistribution (CR). We derive an auroral H col of 1.3×10 16 cm -2 for all spectra with an upper limit of 5×10 16 cm -2. Precipitating protons also produce fast H atoms by charge exchange which can also be excited, but the resulting Doppler-shifted profile was not detected. Present data thus rule out protons as being the only precipitating particles. In the auroral zones, theoretical models predict that chemical reactions induced by particle precipitations often result in the production of atomic hydrogen, and thus an enhancement of the H density is expected. However, the value of H col we derive, between ∼8 and 23 times less than the equatorial values of L. Ben Jaffel, J. T. Clarke, R. Prangé, R. Gladstone, and A. Vidal-Madjar (1993, The Lyman alpha bulge of Jupiter: Effects of a non-thermal velocity field. J. Geophys. Res. Lett.20(8), 747-750), is in good agreement with the auroral values of R. Prangé, D. Rego, L. Pallier, L. Ben Jaffel, C. Emerich, J. T. Clarke, G. E. Ballester, and J. Ajello (1997, Detection of self-reversed Lyman α lines from the jovian aurorae with the Hubble space Telescope, Astrophys. J.484, L169-L173). This suggests that the H abundance predicted with standard atmospheric model is unrealistically large in the auroral region

The Impact of Experience Versus Decision Aids on Patient Preference Toward Virtual Care

Introduction: Virtual care utilization has increased in recent years bringing questions of how to best inform patients regarding their use. Decision aids (DAs) are tools created to assist patients in making informed decisions about their health care. This study seeks to determine whether a DA or previous experience could better educate and influence patient's preference on virtual care. Methods: One hundred fifty participants from an orthopedic clinic of a multi-hospital system were divided into three groups. Group 1 (Virtual Care Cohort) had at least one previous virtual care visit and was surveyed with the Telemedicine Satisfaction Questionnaire (TSQ). Group 2 (In-person with Decision Aid) and Group 3 (In-person without Decision Aid) had no virtual care experience. Group 2 received a validated virtual care DA with a knowledge test. Both groups were also administered the TSQ. Results: After the DA, patients improved their score on 3 of 4 virtual care knowledge questions. Each cohort demonstrated a positive perception of virtual care; however, the specific reasons for their favorable views varied. The DA cohort did not show increased preference toward virtual care compared with the non-DA group and only responded significantly higher regarding encounter comfort. Patients with previous experience in virtual care responded most favorably to the majority of survey questions regarding their virtual care preferences when compared with both virtual care naive cohorts. Discussion and Conclusion: We found that patient experience was the most important factor in influencing patient preference toward virtual care. Although the DA increased their virtual care knowledge it did not increase their preference; therefore, efforts should be placed at encouraging patient to experience virtual care

Targeting Mosquitoes through Generation of an Insecticidal RNAi Yeast Strain Using Cas-CLOVER and Super PiggyBac Engineering in <i>Saccharomyces cerevisiae</i>

The global deployment of RNAi yeast insecticides involves transitioning from the use of laboratory yeast strains to more robust strains that are suitable for scaled fermentation. In this investigation, the RNA-guided Cas-CLOVER system was used in combination with Piggybac transposase to produce robust Saccharomyces cerevisiae strains with multiple integrated copies of the Sh.463 short hairpin RNA (shRNA) insecticide expression cassette. This enabled the constitutive high-level expression of an insecticidal shRNA corresponding to a target sequence that is conserved in mosquito Shaker genes, but which is not found in non-target organisms. Top-expressing Cas-CLOVER strains performed well in insecticide trials conducted on Aedes, Culex, and Anopheles larvae and adult mosquitoes, which died following consumption of the yeast. Scaled fermentation facilitated the kilogram-scale production of the yeast, which was subsequently heat-killed and dried. These studies indicate that RNAi yeast insecticide production can be scaled, an advancement that may one day facilitate the global distribution of this new mosquito control intervention