Speech Analysis

Contains reports on two research projects

Community pharmacist clinical portal enabled access to aspects of patients' primary and secondary care EHR: exploring the general public's views in NHS Tayside.

Background and Objective: Community pharmacist access to aspects of patients' primary and secondary care electronic healthcare records (EHR) was piloted in NHS Tayside, Scotland. While policy makers and pharmacists are largely in favour of community pharmacist access, and there is an unmet service need based on GP workforce-workload evidence, the general public's perspectives of pharmacist EHR access had yet to be explored in Scotland. Objective: to determine the general public's perspectives of community pharmacist EHR access in NHS Tayside. Design: A survey methodology using paper-based questionnaires posted to a random sample of the general public in NHS Tayside (March-May 2017). Quantitative data were analysed using descriptive statistics (IBM SPSS version_21_). The study was approved by university Ethical Review Committee. Results: Of 1000 surveys distributed, 205 returned, (27 undeliverable), providing a response rate of 21%. Although some were unsure (23%; n = 47/203), most indicated their community pharmacist would be better able to recognise problems with medicines/healthcare given access to patients' EHR (63%; n = 127/203), knew why each medicine was prescribed (74%; n = 150/203), and thought that a long-term condition would make access to patient records essential (73%; n = 148/203). Few respondents were against/were non-committal on community pharmacists having read or read-and-write access to EHR. For example, the Emergency Care Summary (ECS) (13%; n = 27/201) where, if access were permitted, respondents preferred that consent should not be required on each and every occasion: ECS (73%; n = 148/203). Many felt access to patients' EHR would mean the pharmacist was better informed so could provide better care (68%; n = 136/200) and that mistakes were less likely to happen (71%; n = 142/200). Conclusion: Findings from this survey recognised community pharmacists could contribute more to improving patient care and safety, as part of the wider healthcare team, if they were better informed through access to patients' EHR. Enabling treatment of common clinical conditions in community pharmacy brings benefits to patients while reducing pressure on GP appointments. While there remain areas of uncertainty, and this is a small albeit representative sample from one area in Scotland, this study demonstrates support for community pharmacist access to patients' EHR with a preference for a simplified consent process

Heat-Related Mortality in a Warming Climate: Projections for 12 U.S. Cities

Heat is among the deadliest weather-related phenomena in the United States, and the number of heat-related deaths may increase under a changing climate, particularly in urban areas. Regional adaptation planning is unfortunately often limited by the lack of quantitative information on potential future health responses. This study presents an assessment of the future impacts of climate change on heat-related mortality in 12 cities using 16 global climate models, driven by two scenarios of greenhouse gas emissions. Although the magnitude of the projected heat effects was found to differ across time, cities, climate models and greenhouse pollution emissions scenarios, climate change was projected to result in increases in heat-related fatalities over time throughout the 21st century in all of the 12 cities included in this study. The increase was more substantial under the high emission pathway, highlighting the potential benefits to public health of reducing greenhouse gas emissions. Nearly 200,000 heat-related deaths are projected to occur in the 12 cities by the end of the century due to climate warming, over 22,000 of which could be avoided if we follow a low GHG emission pathway. The presented estimates can be of value to local decision makers and stakeholders interested in developing strategies to reduce these impacts and building climate change resilience

Evaluating Coastal Landscape Response to Sea-Level Rise in the Northeastern United States - Approach and Methods

The U.S. Geological Survey is examining effects of future sea-level rise on the coastal landscape from Maine to Virginia by producing spatially explicit, probabilistic predictions using sea-level projections, vertical land movement rates (due to isostacy), elevation data, and land-cover data. Sea-level-rise scenarios used as model inputs are generated by using multiple sources of information, including Coupled Model Intercomparison Project Phase 5 models following representative concentration pathways 4.5 and 8.5 in the Intergovernmental Panel on Climate Change Fifth Assessment Report. A Bayesian network is used to develop a predictive coastal response model that integrates the sea-level, elevation, and land-cover data with assigned probabilities that account for interactions with coastal geomorphology as well as the corresponding ecological and societal systems it supports. The effects of sea-level rise are presented as (1) level of landscape submergence and (2) coastal response type characterized as either static (that is, inundation) or dynamic (that is, landform or landscape change). Results are produced at a spatial scale of 30 meters for four decades (the 2020s, 2030s, 2050s, and 2080s). The probabilistic predictions can be applied to landscape management decisions based on sea-level-rise effects as well as on assessments of the prediction uncertainty and need for improved data or fundamental understanding. This report describes the methods used to produce predictions, including information on input datasets; the modeling approach; model outputs; data-quality-control procedures; and information on how to access the data and metadata online

Time to look for evidence : Results-based approach to biodiversity conservation on farmland in Europe

Increased use of annual payments to land managers for ecological outcomes indicates a growing interest in exploring the potential of this approach. In this viewpoint, we drew on the experiences of all schemes paying for biodiversity outcomes/results on agricultural land operating in the EU and EFTA countries with the aim of reviewing the decisive elements of the schemes' design and implementation as well as the challenges and opportunities of adopting a results-based approach. We analysed the characteristics of results-based schemes using evidence from peer-reviewed literature, technical reports, scheme practitioners and experts in agri-environment-climate policy. We developed a typology of the schemes and explored critical issues influencing the feasibility and performance of results-based schemes. The evidence to date shows that there are at least 11 advantages to the results-based approach not found in management-based schemes with similar objectives, dealing with environmental efficiency, farmers' participation and development of local biodiversity-based projects. Although results-based approaches have specific challenges at every stage of design and implementation, for many of these the existing schemes provide potential solutions. There is also some apprehension about trying a results-based approach in Mediterranean, central and eastern EU Member States. We conclude that there is clear potential to expand the approach in the European Union for the Rural Development programming period for 2021-2028. Nevertheless, evidence is needed about the approach's efficiency in delivering conservation outcomes in the long term, its additionality, impact on the knowledge and attitudes of land managers and society at large, development of ways of rewarding the achievement of actual results, as well as its potential for stimulating innovative grassroots solutions.Peer reviewe

Thrombocytogenesis by megakaryocyte; Interpretation by protoplatelet hypothesis

Serial transmission electron microscopy of human megakaryocytes (MKs) revealed their polyploidization and gradual maturation through consecutive transition in characteristics of various organelles and others. At the beginning of differentiation, MK with ploidy 32N, e.g., has 16 centrosomes in the cell center surrounded by 32N nucleus. Each bundle of microtubules (MTs) emanated from the respective centrosome supports and organizes 16 equally volumed cytoplasmic compartments which together compose one single 32N MK. During the differentiation, single centriole separated from the centriole pair, i.e., centrosome, migrates to the most periphery of the cell through MT bundle, corresponding to a half of the interphase array originated from one centrosome, supporting one “putative cytoplasmic compartment” (PCC). Platelet demarcation membrane (DM) is constructed on the boundary surface between neighbouring PCCs. Matured PCC, composing of a tandem array of platelet territories covered by a sheet of DM is designated as protoplatelet. Eventually, the rupture of MK results in release of platelets from protoplatelets

Observation of a biaxial nematic phase in potassium laurate-1-decanol-water mixtures

[[abstract]]The phase diagram of the ternary system potassium laurate-1-decanol-D2O was studied over concentration ranges where nematic phases are likely to occur. Two uniaxial nematic phases which are separated by a biaxial nematic phase are found. In limited concentration range the following phase sequence may be observed reversibly on heating and on cooling: isotropic-uniaxial nematic (positive optical anisotropy)-biaxial nematic-uniaxial nematic (negative optical anisotropy)-biaxial nematic-uniaxial nematic (positive optical anisotropy)-isotropic.[[incitationindex]]SCI[[booktype]]紙本[[booktype]]電子

Evaluating the Impact of a ‘Virtual Clinic’ on Patient Experience, Personal and Provider Costs of Care in Urinary Incontinence: A Randomised Controlled Trial.

Objective: To evaluate the impact of using a ‘virtual clinic’ on patient experience and cost in the care of women with urinary incontinence. Materials and Methods: Women, aged > 18 years referred to a urogynaecology unit were randomised to either (1) A Standard Clinic or (2) A Virtual Clinic. Both groups completed a validated, web-based interactive, patient-reported outome measure (ePAQ-Pelvic Floor), in advance of their appointment followed by either a telephone consultation (Virtual Clinic) or face-to-face consultation (Standard Care). The primary outcome was the mean ‘short-term outcome scale’ score on the Patient Experience Questionnaire (PEQ). Secondary Outcome Measures included the other domains of the PEQ (Communications, Emotions and Barriers), Client Satisfaction Questionnaire (CSQ), Short-Form 12 (SF-12), personal, societal and NHS costs. Results: 195 women were randomised: 98 received the intervention and 97 received standard care. The primary outcome showed a non-significant difference between the two study arms. No significant differences were also observed on the CSQ and SF-12. However, the intervention group showed significantly higher PEQ domain scores for Communications, Emotions and Barriers (including following adjustment for age and parity). Whilst standard care was overall more cost-effective, this was minimal (£38.04). The virtual clinic also significantly reduced consultation time (10.94 minutes, compared with a mean duration of 25.9 minutes respectively) and consultation costs compared to usual care (£31.75 versus £72.17 respectively), thus presenting potential cost-savings in out-patient management. Conclusions: The virtual clinical had no impact on the short-term dimension of the PEQ and overall was not as cost-effective as standard care, due to greater clinic re-attendances in this group. In the virtual clinic group, consultation times were briefer, communication experience was enhanced and personal costs lower. For medical conditions of a sensitive or intimate nature, a virtual clinic has potential to support patients to communicate with health professionals about their condition

Prenatal stress and subsequent exposure to chronic mild stress influence dendritic spine density and morphology in the rat medial prefrontal cortex

<p>Abstract</p> <p>Background</p> <p>Both prenatal stress (PS) and postnatal chronic mild stress (CMS) are associated with behavioral and mood disturbances in humans and rodents. The aim of this study was to reveal putative PS- and/or CMS-related changes in basal spine morphology and density of pyramidal neurons in the rat medial prefrontal cortex (mPFC).</p> <p>Results</p> <p>We show that rats exposed to PS and/or CMS display changes in the morphology and number of basal spines on pyramidal neurons in the mPFC. CMS had a negative effect on spine densities, particularly on spines of the mushroom type, which are considered to form stronger and more stable synapses than other spine types. PS alone did not affect spine densities, but had a negative effect on the ratio of mushroom spines. In addition, PS seemed to make rats less responsive to some of the negative effects of CMS, which supports the notion that PS represents a predictive adaptive response.</p> <p>Conclusion</p> <p>The observed changes may represent a morphological basis of PS- and CMS-related disturbances, and future studies in the field should not only consider total spine densities, but also separate between different spine types.</p