Clinicians’ Perceptions of Telemedicine for Conducting Family Conferences Prior to Transfer to a Tertiary Care Center Intensive Care Unit

Objectives: Critically ill patients are often transferred from rural to tertiary care medical centres for further higher levels of care. The transportation process may delay family conferences during which prognosis and goals of care are discussed. These conferences typically occur when family members meet the treating physicians for the first time in person after transport. Telemedicine is a tool that may be used to bridge this gap in communication by enabling these family conferences before transport. There are no data on perceptions of telemedicine used in this setting. We conducted a qualitative study assessing provider perceptions regarding the use of telemedicine for conducting family conferences prior to transport. Methods: Critical care physicians and nurses were invited to view an educational video demonstrating the process of conducting a family conference via telemedicine. Immediately following viewing of the video, physicians and nurses filled out an open-ended questionnaire regarding their thoughts and perceptions of the video and the telemedicine family conference approach. Results: There was a 68% response rate to the surveys. Responses were categorised into two major themes: benefits and barriers. Within the theme of benefits, three sub-themes were identified: satisfaction, knowledge and quality of care. We identified four domains within the theme of barriers: time, perception, technology and logistics. Conclusions: Respondents believe that there may be several benefits including increased satisfaction, improved communication and empowerment of families by dissemination of knowledge. Barriers to the use of this intervention identified include costs, time, technology and negative perceptions of the telemedicine conference

Demographic Responses of Least Terns and Piping Plovers to the 2011 Missouri River Flood—A Large-Scale Case Study

2011 led to substantial changes in abundance and distribution of unvegetated sand habitat. This river system is a major component of the breeding range for interior Least terns (Sternula antillarum; “terns”) and piping plovers (Charadrius melodus; “plovers”), both of which are Federally listed ground-nesting birds that prefer open, unvegetated sand and gravel nesting substrates on sandbars and shorelines. The 2011 flood inundated essentially all tern and plover nesting habitat during 2011, but it had potential to generate post-flood habitat conditions that favored use by terns and plovers in subsequent years. We compared several tern and plover demographic parameters during the pre-flood and post-flood periods on the Garrison Reach and Lake Sakakawea, North Dakota, to determine how this event influenced these species (both species on the Garrison Reach, and plovers only on Lake Sakakawea). The principal parameters we measured (nest survival, chick survival, and breeding population) showed spatial and temporal variation typical of opportunistic species occupying highly variable habitats. There was little evidence that nest survival of least terns differed between pre- and post-flood. During 2012 when habitat was most abundant on the Garrison Reach and Lake Sakakawea, piping plover nest survival was higher than in any other year in the study, but returned to rates comparable to pre-flood years in 2013. Chick survival for terns on the Garrison Reach and plovers on Lake Sakakawea showed a similar pattern to plover nest survival, with the 2012 rate exceeding all other years of the study, and the remaining pre-flood and post-flood years being generally similar but slightly higher in post-flood years. However, plover chick survival on the Garrison Reach in 2012 was similar to pre-flood years, and increased annually thereafter to its highest rate in 2014. Although wide confidence intervals precluded firm conclusions about flood effects on breeding populations, the general pattern suggested lower populations of plovers but higher populations of least terns immediately after the flood. Despite near total absence of breeding habitat on either study area during the flood of 2011, populations of both species persisted after the flood due to their propensity to disperse and/or forgo breeding for at least a year. Tern and plover populations have similarly persisted and recovered after the flood, but their mechanisms for persistence likely differ. Data on tern dispersal is generally lacking, but they are thought to show little fidelity to their natal grounds, have a propensity to disperse potentially long distances, and routinely forgo breeding until their second year, thus a lost opportunity to breed in a given area may be easily overcome. Plovers exhibit stronger demographic ties to the general area in which they previously nested, yet they occupy much broader nesting habitat features than terns and exploit three major landforms in the Dakotas (free-flowing rivers, reservoir shorelines, and wetland shorelines). Consequently, dispersal to and from non-Missouri River habitats and potential to exploit non-traditional habitats likely sustained the Northern Great Plains population through the flood event. Terns and plovers normally occupy similar habitats on the Missouri River and both species experienced similar loss of a breeding season due to the flood. Persistence of these populations after the flood underscores the importance of understanding their unique demographic characteristics and the context within which the Missouri River operates

A SIMULATION BASED SCHEDULING MODEL FOR CALL CENTERS WITH UNCERTAIN ARRIVAL RATES

In this paper we develop a two stage algorithm for scheduling call centers with strict SLAs and arrival rate uncertainty. The first cut schedule can be developed in less than a minute using a constructive heuristic. The schedule is then refined via a simulation based optimization approach. We find that when allowed to run for five minutes or less this two stage process can create a schedule with a total expected cost within a few percentage points of schedules generated using much more computationally intensive methods. This rapid scheduling process is designed to support front line managers who wish to evaluate multiple scheduling options in a what if analysis mode

Using Satellite Images of Environmental Changes to Predict Infectious Disease Outbreaks

A strong global satellite imaging system is essential for predicting outbreaks

The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in Europe

Background Ulcerative colitis (UC) is an inflammatory bowel disease with increasing prevalence worldwide. Current treatment strategies place considerable economic and humanistic burdens on patients. The aim of this study was to determine the socioeconomic burden of UC in adult patients in European countries in a real-world setting. Methods In this retrospective, cross-sectional and observational pan-European study, patients with moderate or severe UC were assigned to ARM 1 and patients who had moderate or severe UC but achieved mild or remission status 12 months before index date (or clinical consultation date), were assigned to ARM 2. Clinical and medical resource use data were collected via electronic case report forms, and data on non-medical and indirect costs, and health-related quality of life (HRQoL) were collected via patient and public involvement and engagement (PPIE) questionnaires. Per-patient annual total costs per ARM and per country were calculated using the collated resource use in the last 12 months (between the start of the documentation period and patient consultation or index date) and country specific unit costs. Quality of life was described by arm and by country. Results In the physician-reported eCRF population (n = 2966), the mean annual direct medical cost was €4065 in ARM 1 (n = 1835) and €2935 in ARM 2 (n = 1131). In the PPIE population (ARM 1, n = 1001; ARM 2, n = 647), mean annual direct cost was €4526 in ARM 1 and €3057 in ARM 2, mean annual direct non-medical cost was €1162 in ARM 1 and €1002 in ARM 2, mean annual indirect cost was €3098 in ARM 1 and €2309 ARM 2, and mean annual total cost was in €8787 in ARM 1 and €6368 in ARM 2. HRQoL scores showed moderate to high burden of UC in both groups. Conclusions The cost and HRQoL burden were high in patients in both ARM 1 and ARM 2 indicating unmet needs in the UC active population

Mitochondrial Reactive Oxygen Species in Lipotoxic Hearts Induces Post-Translational Modifications of AKAP121, DRP1 and OPA1 That Promote Mitochondrial Fission

Rationale: Cardiac lipotoxicity, characterized by increased uptake, oxidation and accumulation of lipid intermediates, contributes to cardiac dysfunction in obesity and diabetes. However, mechanisms linking lipid overload and mitochondrial dysfunction are incompletely understood. Objective: To elucidate the mechanisms for mitochondrial adaptations to lipid overload in postnatal hearts in vivo. Methods and Results: Using a transgenic mouse model of cardiac lipotoxicity overexpressing long-chain acyl-CoA synthetase 1 in cardiomyocytes, we show that modestly increased myocardial fatty acid uptake leads to mitochondrial structural remodeling with significant reduction in minimum diameter. This is associated with increased palmitoyl-carnitine oxidation and increased reactive oxygen species (ROS) generation in isolated mitochondria. Mitochondrial morphological changes and elevated ROS generation are also observed in palmitate- treated neonatal rat ventricular cardiomyocytes (NRVCs). Palmitate exposure to NRVCs initially activates mitochondrial respiration, coupled with increased mitochondrial membrane potential and adenosine triphosphate (ATP) synthesis. However, long-term exposure to palmitate (\u3e8h) enhances ROS generation, which is accompanied by loss of the mitochondrial reticulum and a pattern suggesting increased mitochondrial fission. Mechanistically, lipid-induced changes in mitochondrial redox status increased mitochondrial fission by increased ubiquitination of A-kinase anchor protein (AKAP121) leading to reduced phosphorylation of DRP1 at Ser637 and altered proteolytic processing of OPA1. Scavenging mitochondrial ROS restored mitochondrial morphology in vivo and in vitro. Conclusions: Our results reveal a molecular mechanism by which lipid overload-induced mitochondrial ROS generation causes mitochondrial dysfunction by inducing post-translational modifications of mitochondrial proteins that regulate mitochondrial dynamics. These findings provide a novel mechanism for mitochondrial dysfunction in lipotoxic cardiomyopathy. 38 pp; includes supplemental materials

Hugs and behaviour points: alternative education and the regulation of 'excluded' youth

In England, alternative education (AE) is offered to young people formally excluded from school, close to formal exclusion or who have been informally pushed to the educational edges of their local school. Their behaviour is seen as needing to change. In this paper, we examine the behavioural regimes at work in 11 AE programmes. Contrary to previous studies and the extensive ‘best practice’ literature, we found a return to highly behaviourist routines, with talking therapeutic approaches largely operating within this Skinnerian frame. We also saw young people offered a curriculum largely devoid of languages, humanities and social sciences. What was crucial to AE providers, we argue, was that they could demonstrate 'progress' in both learning and behaviour to inspectors and systems. Mobilising insights from Foucault, we note the congruence between the external regimes of reward and punishment used in AE and the kinds of insecure work and carceral futures that might be on offer to this group of young people

The \u3cem\u3eChlamydomonas\u3c/em\u3e Genome Reveals the Evolution of Key Animal and Plant Functions

Chlamydomonas reinhardtii is a unicellular green alga whose lineage diverged from land plants over 1 billion years ago. It is a model system for studying chloroplast-based photosynthesis, as well as the structure, assembly, and function of eukaryotic flagella (cilia), which were inherited from the common ancestor of plants and animals, but lost in land plants. We sequenced the ∼120-megabase nuclear genome of Chlamydomonas and performed comparative phylogenomic analyses, identifying genes encoding uncharacterized proteins that are likely associated with the function and biogenesis of chloroplasts or eukaryotic flagella. Analyses of the Chlamydomonas genome advance our understanding of the ancestral eukaryotic cell, reveal previously unknown genes associated with photosynthetic and flagellar functions, and establish links between ciliopathy and the composition and function of flagella