The Transformative Role of Telemedicine on Coordination: A Practice Approach

Delivering coordinated care at a distance challenges work practices and interprofessional collaboration. Using a case study methodology, we analyzed how three occupational groups, pathologists, technologists, and surgeons, coordinate work during the deployment of a major telepathology network in Eastern Canada. The aim of this study is to determine the extent to which and how telemedicine modifies coordination practices. \ \ Transformations emerged from our in-depth case analysis around three aspects of coordination: predictability, common understanding and accountability. First, predictability relied on routines in traditional settings, but shifted to a reliance on plans and rules in a telemedicine setting. Second, common understanding of the task shifted from relying on familiarity between stakeholders to an emphasis on standards. Third, accountability became less collective and more individual and contractual in a telemedicine setting, resulting in more marked boundaries between professional groups. Finally, proximity remained a determinant of accountability in telemedicine contexts, regardless of organizational arrangements. Implications for research and practice are discussed

IFC-based calculation of the Flemish Energy Performance Standard

This paper illustrates our findings concerning space based design methodologies and interoperability issues for today's Building Information Modeling (BIM) environments. A method is elaborated which enables building designers to perform an automated energy use analysis, based oil an Industry Foundation Classes (IFC) model derived from a commercial BIM environment, in this case Autodesk Revit 9.1. A prototype application was built, which evaluates the building model as well as vendor-neutral exchange mechanisms, in accordance with the Flemish Energy Performance Regulation (EPR) standard. Several issues regarding the need for space-based building models are identified and algorithms are developed to overcome possible shortcomings

A comparison of population viability measures

The viability of populations can be quantified with several measures, such as the probability of extinction, the mean time to extinction, or the population size. While conservation management decisions can be based on these measures, it has not yet been explored systematically if different viability measures rank species and scenarios similarly and if one viability measure can be converted into another to compare studies. To address this challenge, we conducted a quantitative comparison of eight viability measures based on the simulated population dynamics of more than 4500 virtual species. We compared (a) the ranking of scenarios based on different viability measures, (b) assessed direct correlations between the measures, and (c) explored if parameters in the simulation models can alter the relationship between pairs of viability measures. We found that viability measures ranked species similarly. Despite this, direct correlations between the different measures were often weak and could not be generalized. This can be explained by the loss of information due to the aggregation of raw data into a single number, the effect of model parameters on the relationship between viability measures, and because distributions, such as the probability of extinction over time, cannot be ranked objectively. Similar scenario rankings by different viability measures show that the choice of the viability metric does in many cases not alter which population is regarded more viable or which management option is the best. However, the more two scenarios or populations differ, the more likely it becomes that different measures produce different rankings. We thus recommend that PVA studies publish raw simulation data, which not only describes all risks and opportunities to the reader but also facilitates meta-analyses of PVA studies

Lethal and sublethal effects of azadirachtin on the bumblebee Bombus terrestris (Hymenoptera: Apidae)

Background: Lethal and sublethal effects of azadirachtin were studied on Bombus terrestris via oral exposure in the laboratory to bring out the potential risks of the compound to this important pollinator.Results: Microcolonies chronically exposed to azadirachtin via treated sugar water during 11 weeks in the laboratory exhibited a high mortality ranging from 32 to 100 % with a range of concentrations between 3.2 and 320 mg litre-1. No reproduction was scored at concentrations higher than 3.2 mg litre-1. At 3.2 mg litre-1, azadirachtin significantly inhibited the egg laying and, consequently, the production of drones during 6 weeks. When azadirachtin was tested under an experimental setup in the laboratory where bumblebees need to forage for food, the sublethal effects were stronger as the numbers of drones were reduced already with a concentration of 0.64 mg litre-1. Besides, a negative correlation was found between the body mass of male offspring and azadirachtin concentration.Conclusion: Azadirachtin can affect B. terrestris with a range of sublethal effects. This study confirms the need to test compounds on their safety, especially when they have to perform complex tasks such as foraging.Keywords: chronic oral exposure, insect growth regulator (IGR), neem, repellence effect, reproductio

Overexpression and characterization of medium-chain-length polyhydroxyalkanoate granule bound polymerases from Pseudomonas putida GPo1

<p>Abstract</p> <p>Background</p> <p>Polyhydroxyalkanoates (PHA) are synthesized by many bacteria in the cytoplasm as storage compounds for energy and carbon. The key enzymes for PHA biosynthesis are PHA polymerases, which catalyze the covalent linkage of 3-hydroxyacyl coenzymeA thioesters by transesterification with concomitant release of CoA. <it>Pseudomonas putida </it>GPo1 and many other <it>Pseudomonas </it>species contain two different class II polymerases, encoded by <it>phaC1 </it>and <it>phaC2</it>. Although numerous studies have been carried out on PHA polymerases and they are well characterized at the molecular level, the biochemical properties of the class II polymerases have not been studied in detail. Previously we and other groups purified the polymerases, however, the activities of the purified enzymes were several magnitude lower than the granule-bound enzymes. It is problematic to study the intrinsic properties of these enzymes with such low activities, although they are pure.</p> <p>Results</p> <p>PHA polymerase 1 (PhaC1) and PHA polymerase 2 (PhaC2) from <it>P. putida </it>GPo1 were overexpressed in the PHA-negative host <it>P. putida </it>GPp104 and purified from isolated PHA granules. Only minor activity (two to three orders of magnitude lower than that of the granule bound proteins) could be recovered when the enzymes were purified to homogeneity. Therefore, kinetic properties and substrate ranges were determined for the granule bound polymerases. The polymerases differed significantly with respect to their association with PHA granules, enzyme kinetics and substrate specificity. PhaC2 appeared to bind PHA granules more tightly than PhaC1. When <it>R</it>-3-hydroxyoctanoic acid was used as substrate, the granule-bound PhaC1 exhibited a <it>Km </it>of 125 (± 35) μM and a <it>V</it>max of 40.8 (± 6.2) U/mg PhaC1, while a <it>Km </it>of 37 (± 10) μM and a <it>V</it>max of 2.7 (± 0.7) U/mg PhaC2 could be derived for the granule-bound PhaC2. Granule-bound PhaC1 showed a strong preference for medium chain length (mcl-) 3-hydroxyacly-CoAs, with highest affinity towards 3-hydroxydecanoyl-CoA (40 U/mg PhaC1). Granule-bound PhaC2 demonstrated a far broader specificity ranging from short chain length up to long chain length substrates. Activity increased with increasing chain length with a maximum activity for 3-hydroxyacyl-CoAs containing 12 or more C-atoms.</p> <p>Conclusion</p> <p>The kinetic properties and substrate ranges were determined for both granule bound polymerases. Evidence was provided for the first time that two PHA polymerases exhibited significant differences in granule release and in vitro activity profiles, suggesting that there are substantial functional differences between granule bound PhaC1 and PhaC2.</p

Influence of growth stage on activities of polyhydroxyalkanoate (PHA) polymerase and PHA depolymerase in Pseudomonas putida U

<p>Abstract</p> <p>Background</p> <p>Medium chain length (mcl-) polyhydroxyalkanoates (PHA) are synthesized by many bacteria in the cytoplasm as storage compounds for energy and carbon. The key enzymes for PHA metabolism are PHA polymerase (PhaC) and depolymerase (PhaZ). Little is known of how mcl-PHA accumulation and degradation are controlled. It has been suggested that overall PHA metabolism is regulated by the β-oxidation pathway of which the flux is governed by intracellular ratios of [NADH]/[NAD] and [acetyl-CoA]/[CoA]. Another level of control could relate to modulation of the activities of PhaC and PhaZ. In order to investigate the latter, assays for <it>in vitro </it>activity measurements of PhaC and PhaZ in crude cell extracts are necessary.</p> <p>Results</p> <p>Two <it>in vitro </it>assays were developed which allow the measurement of PhaC and PhaZ activities in crude cell extracts of <it>Pseudomonas putida </it>U. Using the assays, it was demonstrated that the activity of PhaC decreased 5-fold upon exponential growth on nitrogen limited medium and octanoate. In contrast, the activity of PhaZ increased only 1.5-fold during growth. One reason for the changes in the enzymatic activity of PhaC and PhaZ could relate to a change in interaction with the phasin surface proteins on the PHA granule. SDS-PAGE analysis of isolated PHA granules demonstrated that during growth, the ratio of [phasins]/[PHA] decreased. In addition, it was found that after eliminating phasins (PhaF and PhaI) from the granules PhaC activity decreased further.</p> <p>Conclusion</p> <p>Using the assays developed in this study, we followed the enzymatic activities of PhaC and PhaZ during growth and correlated them to the amount of phasins on the PHA granules. It was found that in <it>P. putida </it>PhaC and PhaZ are concomitantly active, resulting in parallel synthesis and degradation of PHA. Moreover PhaC activity was found to be decreased, whereas PhaZ activity increased during growth. Availability of phasins on PHA granules affected the activity of PhaC.</p

Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis

Aim Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE. Methods and results We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36-0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35-1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95-4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25-8.11) were significantly more frequent among patients receiving thrombolysis. Conclusions Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhag

Evidence for feasibility of implementing online brief cognitive‐behavioral therapy for eating disorder pathology in the workplace

Objective: CBT-T is a brief (10-week) cognitive-behavioral therapy for non-underweight eating disorders. This report describes the findings from a single center, single group, feasibility trial of online CBT-T in the workplace as an alternative to health service settings. Method: This trial was approved by the Biomedical and Scientific Research Ethics committee, University of Warwick, UK (reference 125/20-21) and was registered with ISRCTN (reference number: ISRCTN45943700). Recruitment was based on self-reported eating and weight concerns rather than diagnosis, potentially enabling access to treatment for employees who have not previously sought help and for those with sub-threshold eating disorder symptoms. Assessments took place at baseline, mid-treatment (week 4), post-treatment (week 10), and follow-up (1 and 3 months post-treatment). Participant experiences following treatment were assessed using quantitative and qualitative approaches. Results: For the primary outcomes, pre-determined benchmarks of high feasibility and acceptability were met, based on recruiting >40 participants (N = 47), low attrition (38%), and a high attendance rate (98%) over the course of the therapy. Participant experiences revealed low previous help-seeking for eating disorder concerns (21%). Qualitative findings indicated a wide range of positive impacts of the therapy and the workplace as the therapeutic setting. Analysis of secondary outcomes for participants with clinical and sub-threshold eating disorder symptoms showed strong effect sizes for eating pathology, anxiety and depression, and moderate effect sizes for work outcomes. Discussion: These pilot findings provide a strong rationale for a fully powered randomized controlled trial to determine the effectiveness of CBT-T in the workplace. Public Significance: This study demonstrates the feasibility of implementing an eating disorders intervention (online CBT-T) in the workplace as an alternative to traditional healthcare settings. Recruitment was based on self-reported eating and weight concerns rather than diagnosis, potentially enabling access to treatment for employees who had not previously sought help. The data also provide insights into recruitment, acceptability, effectiveness, and future viability of CBT-T in the workplace

Local modulation of steroid action: rapid control of enzymatic activity.

peer reviewedEstrogens can induce rapid, short-lived physiological and behavioral responses, in addition to their slow, but long-term, effects at the transcriptional level. To be functionally relevant, these effects should be associated with rapid modulations of estrogens concentrations. 17beta-estradiol is synthesized by the enzyme aromatase, using testosterone as a substrate, but can also be degraded into catechol-estrogens via hydroxylation by the same enzyme, leading to an increase or decrease in estrogens concentration, respectively. The first evidence that aromatase activity (AA) can be rapidly modulated came from experiments performed in Japanese quail hypothalamus homogenates. This rapid modulation is triggered by calcium-dependent phosphorylations and was confirmed in other tissues and species. The mechanisms controlling the phosphorylation status, the targeted amino acid residues and the reversibility seem to vary depending of the tissues and is discussed in this review. We currently do not know whether the phosphorylation of the same amino acid affects both aromatase and/or hydroxylase activities or whether these residues are different. These processes provide a new general mechanism by which local estrogen concentration can be rapidly altered in the brain and other tissues

Femtosecond laser-induced sub-wavelength plasma inside dielectrics: I. Field enhancement

The creation of high energy density ($\gtrsim10^6$ joules per cm$^3$) over-critical plasmas in a large volume has essential applications in the study of warm dense matter, being present in the hot cores of stars and planets. It was recently shown that femtosecond Bessel beams enable creating over-critical plasmas inside sapphire with sub-wavelength radius and several tens of micrometers in length. Here, the dependence of field structure and absorption mechanism on the plasma density transverse profile are investigated by performing self-consistent Particle-In-Cell (PIC) simulations. Two { limiting} cases are considered: one is a homogeneous step-like profile, that can sustain plasmon formation, the second is an inhomogeneous Gaussian profile, where resonance absorption occurs. Comparing experimental absorption measures to analytical predictions allows determining the plasma parameters used in PIC simulations. The PIC simulation results are in good agreement with experimental diagnostics of total absorption, near-field fluence distribution, and far-field radiation pattern. We show that in each case an ambipolar field forms at the plasma surface due to the expansion of the hot electrons and that electron sound waves propagate into the over-critical region.Comment: 13 pages, 10 figures, published in Physics of Plasma