Telemedicine: An Augmentation Strategy to Mitigate the Primary Care Shortage

According to the Association of American Medical Colleges, the primary care workforce shortage in 2025 will exceed 46,000 primary care physicians. Healthcare business leaders in Gwinnett County, Georgia have not evaluated the advantages and disadvantages of telemedicine (TM) to mitigate the workforce shortage. The purpose of this qualitative descriptive study was to determine factors primary care physician administrators consider when deciding to implement TM as a potential solution for the growing physician shortage. A purposive sample of 20 primary care physician administrators located in Gwinnett County, Georgia was drawn. The theory of disruptive technology was the conceptual framework. Data collected stemmed from semistructured interviews with each participant and review of organizational plans and workflow documents. Data were recorded, transcribed, and coded to develop themes. Three themes morphed from the study: TM awareness and education, TM cost and reimbursement, and TM implementation and utilization. Results indicated that awareness and education of leaders toward TM requires improvement, costs, and reimbursement were variables for deciding to implement or not implement TM, and TM implementation requires knowing the appropriate use of TM. The implications for positive social change include the potential for primary care physician administrators to positively influence the healthcare workforce shortage by adding flexibility to manage patient workflow with TM. Additionally, the potential for physician administrators to utilize TM for healthcare access, creating savings in transportation, energy consumption, and resource optimization, may provide better access to hard-to-reach populations

Variation in female aggression in 2 three-spined stickleback populations with female throat and spine coloration

Despite growing interest in female ornament evolution, we still have a rudimentary understanding of female display traits relative to similar traits in males. Under one popular adaptive scenario, fe- male ornaments are hypothesized to function in female–female competition and serve as badges of status, such that their expression is linked with elevated aggression in some cases. In this study, we investigated the relationship between 2 female ornaments—male-like red throat color and red spine coloration—and female aggression in 2 independently derived stream-resident populations of three-spined stickleback Gasterosteus aculeatus. Using simulated intrusions, we tested whether females with redder ornaments were generally more aggressive, and for variation in aggressive and social behaviors between the 2 populations. We found that the red intensity of the throat and spine did not predict aggression levels in either population, suggesting a limited role for both fe- male ornaments during female–female interaction. The 2 populations exhibited different levels of aggressive behaviors, unrelated to the color patches. Our results suggest that variation in selective pressures between populations may promote interpopulation variance in aggressive behavior but not the correlation between female ornamentation and aggression, and raise the possibility that red coloration may have evolved through different mechanisms or processes in the 2 populations

In the Eye of the Beholder? Motivated Reasoning in Disputed Elections

This study uses an experimental design to simulate the ballot counting process during a hand-recount after a disputed election. Applying psychological theories of motivated reasoning to the political process, we find that ballot counters’ party identification conditionally influences their ballot counting decisions. Party identification’s effect on motivated reasoning is greater when ballot counters are given ambiguous, versus specific, instructions for determining voter intent. This study’s findings have major implications for ballot counting procedures throughout the United States and for the use of motivated reasoning in the political science literature

Differences in soft-sediment macrobenthic assemblages invaded by Caulerpa taxifolia compared to uninvaded habitats

Caulerpa taxifolia is a habitat-forming green alga that has invaded several temperate regions worldwide. Although C. taxifolia covers large areas of soft-sediment habitat, little is known about its effects on soft-sediment invertebrate assemblages. We compared soft-sediment macroinvertebrate assemblages in 2 estuaries in southeastern Australia invaded by C. taxifolia to examine 2 main predictions: (1) areas covered with C. taxifolia will have different assemblages compared to unvegetated sediment because infauna are inhibited but epifauna are facilitated, and (2) areas with C. taxifolia will have different assemblages compared to those with native seagrasses (Halophila ovalis and Zostera capricorni) because infauna are inhibited but epifauna are not. Multidimensional scaling and ANOSIM showed differences in invertebrate assemblages between all habitats. In C. taxifolia, infauna were less abundant and epifauna were more abundant compared to unvegetated sediment. However, when compared to native seagrasses, epifauna in C. taxifolia were more abundant than in H. ovalis in one estuary but less abundant than in Z. capricorni in another estuary, while infauna in C. taxifolia were less abundant than in both seagrass species. The consistently low infaunal abundance in C. taxifolia, irrespective of infaunal feeding mode, suggests C. taxifolia impacts infauna generally. Examination of environmental factors potentially responsible for the low abundance of infauna indicated that differences in redox potential (and associated chemical changes) may explain patterns in abundance of infauna among habitats. Our findings indicate that invasion by C. taxifolia causes important changes to soft-sediment macroinvertebrate assemblages and suggest that infauna may be particularly vulnerable to invasion because of changes to sediment chemistry

Gene Expression in Male and Female Stickleback from Populations with Convergent and Divergent Throat Coloration

Understanding of genetic mechanisms underlying variation in sexual dichromatism remains limited, especially for carotenoid‐based colors. We addressed this knowledge gap in a gene expression study with threespine stickleback. We compared male and female throat tissues across five populations, including two in which female red coloration has evolved convergently. We found that the expression of individual genes, gene ontologies, and coexpression networks associated with red female color within a population differed between California and British Columbia populations, suggesting differences in underlying mechanisms. Comparing females from each of these populations to females from populations dominated by dull females, we again found extensive expression differences. For each population, genes and networks associated with female red color showed the same patterns for males only inconsistently. The functional roles of genes showing correlated expression with female color are unclear within populations, whereas genes highlighted through inter‐population comparisons include some previously suggested to function in carotenoid pathways. Among these, the most consistent patterns involved TTC39B (Tetratricopeptide Repeat Domain 39B), which is within a known red coloration QTL in stickleback and implicated in red coloration in other taxa

Male red throat coloration, pelvic spine coloration, and courtship behaviours in threespine stickleback

Background: In addition to exhibiting red nuptial throat coloration, male threespine sticklebacks (Gasterosteus aculeatus) often possess red coloration on their pelvic spines. Although variation in throat colour has been shown to be associated with male reproductive behaviour, limited research has been devoted to the behavioural correlates of red spine colour. Like the red throat, spine colour might correlate with components of male reproductive behaviour and may also be androgen dependent, with important implications for a potential signalling function. Hypothesis: Spine coloration, like throat coloration, is correlated with components of courtship behaviour, and also with the fish androgen 11-ketotestosterone (11KT). Methods: To examine the role of male throat and spine colour expression in a mating context, we measured the behavioural response of nesting males to conspecific females. We analysed the relationships between throat and spine colours with reproductive behaviours as well as with 11KT. Results: Males with more intensely red throats courted females more vigorously, whereas males with redder spines displayed relatively more aggressive behaviour during courtship. An initial analysis of a subsample of males showed that 11KT was positively associated with spine colour intensity, but not with red throats or any behaviours. Hence throat and spine colour may reflect different components of male reproductive behaviour, and 11KT is a potential mediator of spine coloration in males

Optimizing viable leukocyte sampling from the female genital tract for clinical trials: an international multi-site study

BACKGROUND: Functional analysis of mononuclear leukocytes in the female genital mucosa is essential for understanding the immunologic effects of HIV vaccines and microbicides at the site of HIV exposure. However, the best female genital tract sampling technique is unclear. Methods and FINDINGS: We enrolled women from four sites in Africa and the US to compare three genital leukocyte sampling methods: cervicovaginal lavages (CVL), endocervical cytobrushes, and ectocervical biopsies. Absolute yields of mononuclear leukocyte subpopulations were determined by flow cytometric bead-based cell counting. Of the non-invasive sampling types, two combined sequential cytobrushes yielded significantly more viable mononuclear leukocytes than a CVL (p<0.0001). In a subsequent comparison, two cytobrushes yielded as many leukocytes (∼10,000) as one biopsy, with macrophages/monocytes being more prominent in cytobrushes and T lymphocytes in biopsies. Sample yields were consistent between sites. In a subgroup analysis, we observed significant reproducibility between replicate same-day biopsies (r = 0.89, p = 0.0123). Visible red blood cells in cytobrushes increased leukocyte yields more than three-fold (p = 0.0078), but did not change their subpopulation profile, indicating that these leukocytes were still largely derived from the mucosa and not peripheral blood. We also confirmed that many CD4 + T cells in the female genital tract express the α4β7 integrin, an HIV envelope-binding mucosal homing receptor. CONCLUSIONS: CVL sampling recovered the lowest number of viable mononuclear leukocytes. Two cervical cytobrushes yielded comparable total numbers of viable leukocytes to one biopsy, but cytobrushes and biopsies were biased toward macrophages and T lymphocytes, respectively. Our study also established the feasibility of obtaining consistent flow cytometric analyses of isolated genital cells from four study sites in the US and Africa. These data represent an important step towards implementing mucosal cell sampling in international clinical trials of HIV prevention

International Capital Markets and Informal Dollar Standards in the CIS and East Asia

Although most CIS and East Asian countries are de jure classified as free floaters, they de facto pursue (tight) dollar pegs. This paper emphasizes dollar denomination of shortterm and long-term payment flows as reasons for exchange rate stabilization. Based on the analysis of ‚competitive depreciations' and ‚competitive appreciations‘ among the CIS and East Asian currencies it is argued that the adherence to a common external anchor currency enhances macroeconomic stability. Finally, the potential of euro and ruble (CIS) as well as yen and yuan (East Asia) to challenge the dollar as anchor currencies in the respective regions is explored

Male Choice in the Stream-Anadromous Stickleback Complex

Studies of mating preferences and pre-mating reproductive isolation have often focused on females, but the potential importance of male preferences is increasingly appreciated. We investigated male behavior in the context of reproductive isolation between divergent anadromous and stream-resident populations of threespine stickleback, Gasterosteus aculeatus, using size-manipulated females of both ecotypes. Specifically, we asked if male courtship preferences are present, and if they are based on relative body size, non-size aspects of ecotype, or other traits. Because male behaviors were correlated with each other, we conducted a principal components analysis on the correlations and ran subsequent analyses on the principal components. The two male ecotypes differed in overall behavioral frequencies, with stream-resident males exhibiting consistently more vigorous and positive courtship than anadromous males, and an otherwise aggressive behavior playing a more positive role in anadromous than stream-resident courtship. We observed more vigorous courtship toward smaller females by (relatively small) stream-resident males and the reverse pattern for (relatively large) anadromous males. Thus size-assortative male courtship preferences may contribute to reproductive isolation in this system, although preferences are far from absolute. We found little indication of males responding preferentially to females of their own ecotype independent of body size