Implications of telemedicine in care homes: considerations for the evolving risk landscape

This white paper explores the evolving risk portfolio of care homes, as well as the risk management and insurance implications of introducing telemedicine into the care environment. Telemedicine allows remote tracking and monitoring of patients’ health data, gathering and securely transferring patient data to a cloud-based platform that is accessed by the relevant health professionals, detecting any irregularities and sudden changes in real time, as well as administering medication. With proven benefits during times of crisis, we have recently seen a higher dependence on telemedicine and telehealth technologies, which have helped ensure continuous healthcare provision. Earlier this year, Lockton published a white paper on cyber threats within care homes due to the advances in the application of Internet of Things (IoT) and medical technologies, which includes telemedicine. However, the associated exposures span beyond the cyber landscape, including potential medical malpractice exposures, as well as weakened patient-healthcare provider relationships and lack of trust in the quality of services provided due to the limited face-to-face interactions

Assessing the waiting time for emergency orthopedic surgery for open fractures – A 6-month review of records at one of the largest referral public hospitals in Rwanda

INTRODUCTION: The delay in surgical intervention for open fractures can have severe negative consequences. However, the delay for patients with open fractures presenting at Centre Hospitalier Universitaire de Kigali (CHUK), one of the largest public hospitals in Kigali, Rwanda, had not been studied. This study assessed the waiting time for surgery and compared it against the 6-hour (ideal time) and 24-hours (acceptable time) standards.METHODS: A review of the postoperative register and patients’ records was conducted. All medical charts of open fracture cases between April and September 2018 were audited. A surgical case was considered significantly delayed if the time interval from patient arrival at the emergency room to the operation theater was longer than 24 hours. The demographics, acuity level, insurance status and work shifts, were assessed using bi- and multivariate analysis.RESULTS: A total of 115 open fracture case files were audited. From arrival at the emergency room to surgery, the median time was 41 hours (IQR 21, 93). Only 3 (2.6%) were operated within 6 hours and 38 (33%) within 6 to 24 hours. The main factor contributing to the delay was obtaining orthopedic consultation note and documenting the decision to operate (median 10 hours, IQR 4 to 17). Meanwhile, the designated emergency theater was not utilized for a total of 18 hours per day, especially during night shifts.CONCLUSION: There was a significant delay in obtaining emergency orthopedic consultation and, thus, the timing of the surgical treatment. Examining the patient flow system in orthopedic surgical care delivery is needed in order to maximize theater utilization at this urban university hospital

A Comparative Effectiveness Analysis of Three Continuous Glucose Monitors

OBJECTIVE To compare three continuous glucose monitoring (CGM) devices in subjects with type 1 diabetes under closed-loop blood glucose (BG) control. RESEARCH DESIGN AND METHODS Six subjects with type 1 diabetes (age 52 ± 14 years, diabetes duration 32 ± 14 years) each participated in two 51-h closed-loop BG control experiments in the hospital. Venous plasma glucose (PG) measurements (GlucoScout, International Biomedical) obtained every 15 min (2,360 values) were paired in time with corresponding CGM glucose (CGMG) measurements obtained from three CGM devices, the Navigator (Abbott Diabetes Care), the Seven Plus (DexCom), and the Guardian (Medtronic), worn simultaneously by each subject. Errors in paired PG–CGMG measurements and data reporting percentages were obtained for each CGM device. RESULTS The Navigator had the best overall accuracy, with an aggregate mean absolute relative difference (MARD) of all paired points of 11.8 ± 11.1% and an average MARD across all 12 experiments of 11.8 ± 3.8%. The Seven Plus and Guardian produced aggregate MARDs of all paired points of 16.5 ± 17.8% and 20.3 ± 18.0%, respectively, and average MARDs across all 12 experiments of 16.5 ± 6.7% and 20.2 ± 6.8%, respectively. Data reporting percentages, a measure of reliability, were 76% for the Seven Plus and nearly 100% for the Navigator and Guardian. CONCLUSIONS A comprehensive head-to-head-to-head comparison of three CGM devices for BG values from 36 to 563 mg/dL revealed marked differences in performance characteristics that include accuracy, precision, and reliability. The Navigator outperformed the other two in these areas

Structural, magnetic, electrical and supraconducting properties of the high temperature superconductor Nd(SrBa)Cu3O6+z Effect of argon annealing

We have studied the structural and superconducting properties of two samples superconductors Nd(SrBa)Cu3O6+z. One was a conventionally annealed sample at 450°C in oxygen (0) and the other was heated in argon at 850°C followed by oxygen annealing (A0). The Tc of the sample (O) was 68 K and that of (AO) sample was 78 K. This was confirmed by our AC susceptibility, resistivity and Seebeck effect measurements. Further, there was an enhancement in the shielding and the intergranular critical current. The X-ray and neutron data showed a tetragonal structure, and that the (O) sample had a higher impurity level arising from Nd entering the Sr/Ba sites that may result in a decrease in the carrier density (p) which also was confirmed by our thermopower measurements. A combination of several factors such as changes in the Cu (1) apical oxygen distance, chain oxygen ordering, increase in p and in-phase purity for the (AO) sample may qualitatively account for the observed data.We have studied the structural and superconducting properties of two samples superconductors Nd(SrBa)Cu3O6+z. One was a conventionally annealed sample at 450°C in oxygen (0) and the other was heated in argon at 850°C followed by oxygen annealing (A0). The Tc of the sample (O) was 68 K and that of (AO) sample was 78 K. This was confirmed by our AC susceptibility, resistivity and Seebeck effect measurements. Further, there was an enhancement in the shielding and the intergranular critical current. The X-ray and neutron data showed a tetragonal structure, and that the (O) sample had a higher impurity level arising from Nd entering the Sr/Ba sites that may result in a decrease in the carrier density (p) which also was confirmed by our thermopower measurements. A combination of several factors such as changes in the Cu (1) apical oxygen distance, chain oxygen ordering, increase in p and in-phase purity for the (AO) sample may qualitatively account for the observed data

The metaverse: Navigating the evolving risk landscape for retailers

The world is changing at an unprecedented pace. With every generation comes new needs and expectations, as well as innovative concepts that often trigger rapid shifts economies and sectors. To sustain their competitiveness in this everchanging market, as well as ensure relevance to the evolving consumer base, businesses are in a constant race to be ahead of the commercial curve. With technology acting as enabler for accelerated innovation, disruptors of tradition are constantly seeking methods for prompting change, whilst focusing on personalisation, creativity, and efficiency. The retail sector is a prime example for such change. From physical trading stalls, shopping centres, to e-commerce and online shopping, the sector is constantly evolving to increase efficiency and outreach, whilst elevating customer experience. So, what is the “next big thing” within the retail sector? Considering the lack of sensory immersion involved in the browse and click online model, retailers are now pursuing new operational realms to overcome the static nature of online shopping. New realms? The metaverse. In 2022, a study done by TLT, a UK law firm, revealed that out of 100 top UK retailers, 12% are already using the metaverse, and 39% plan on using it in the future. As the metaverse evolves, more retailers are expected to utilise the features and advantages offered. Hence, understanding the implications of this operational shift is crucial for mitigating any potential evolving or emerging exposures. This white paper delves into describing the building blocks of the metaverse, whilst examining the associated risk management and insurance implications for retail businesses

Tendon-like Electrospun PLGA Scaffolds with Optimized Physical Cues Induced Tenogenic Differentiation and Boosted Immunomodulatory Properties on Amniotic Epithelial Stem Cells.

Introduction: The advanced strategies in the field of Tissue Engineering might render possible overcoming the unsatisfactory results of conventional treatments to deal with tendinopathies. In this context, the design of tendon biomimetic electrospun scaffolds engineered with Amniotic Epithelial Stem Cells (AECs), which have shown a high teno-regenerative and immunomodulatory potential in tendon-defect models, can represent a promising solution for tendon regeneration. Methods: Poly(lactide-co-glycolic) acid (PLGA) scaffolds were fabricated using the electrospinning technique to mimic the native tendon biomechanics and extracellular matrix by optimizing: fiber alignment and diameter size (1.27 and 2.5 µm), and surface chemistry using the Cold Atmospheric Plasma (CAP) Technique. Moreover, the teno-inductive and immunomodulatory effects of these parameters on AECs have been also assessed. Results: The fabricated PLGA scaffolds with highly aligned fibers and small diameter size (1.27 µm) induced a stepwise tenogenic differentiation on AECs with an early epithelial-mesenchymal transition (EMT), followed by their tenogenic differentiation. Indeed, SCX, an early tendon marker, was significantly more efficiently translated into the downstream effector TNMD, a mature tendon marker. Moreover, 1.27 µm fiber diameter induced on AECs a higher expression of anti-inflammatory interleukin mRNAs (IL-4 and IL-10). The CAP treated PLGA scaffolds showed an improved cell adhesion and infiltration without altering their topological structure and teno-inductive properties. In fact, AECs engineered with CAP treated fibers, expressed in their cytoplasm TNMD. Moreover, CAP treatment did not alter the mechanical properties of PLGA scaffolds. Conclusions: The developed electrospun PLGA scaffolds with the optimized features represent an ideal tendon-like construct that could be applied in in-vivo models to evaluate their biosafety and teno-regenerative potential

A geospatial framework to support integrated biogeochemical modelling in the United Kingdom

Anthropogenic impacts on the aquatic environment, especially in the context of nutrients, provide a major challenge for water resource management. The heterogeneous nature of policy relevant management units (e.g. catchments), in terms of environmental controls on nutrient source and transport, leads to the need for holistic management. However, current strategies are limited by current understanding and knowledge that is transferable between spatial scales and landscape typologies. This study presents a spatially-explicit framework to support the modelling of nutrients from land to water, encompassing environmental and spatial complexities. The framework recognises nine homogeneous landscape units, distinct in terms of sensitivity of nutrient losses to waterbodies. The functionality of the framework is demonstrated by supporting an exemplar nutrient model, applied within the Environmental Virtual Observatory pilot (EVOp) cloud cyber-infrastructure. We demonstrate scope for the use of the framework as a management decision support tool and for further development of integrated biogeochemical modelling

Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa

Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART) in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI) recipients in South Africa.In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12-99 months; 1,510 person-years) were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml) and immunologic failure (as defined by WHO).After a median of 15 months on ART, 19% (n = 88) and 19% (n = 87) had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01). In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2-6.7), and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2-3.9), adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02).One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure