Making a case for telehealth: measuring the carbon cost of health-related travel

Background: Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions.Methods: A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e).Results: Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time.Conclusions: Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas

Calcium transients in single adrenal chromaffin cells detected with aequorin

AbstractThe effect of 55 mM K+ and nicotine on intracellular free calcium was monitored in bovine adrenal chromaffin cells microinjected with aequorin. In contrast to results with quin 2, which suggested that stimulation of chromaffin cells resulted in sustained rises in free calcium, aequorin measurements showed that 55 mM K+ and nicotine resulted in a transient (60–90 s) elevation of free calcium. The peak free calcium and duration of the transient elicited by nicotine were dose-dependent. The concentration of nicotine (10 μM) giving a maximal secretory response gave a peak rise in free calcium of up to 1 μM. 55 mM K+ which only releases 30% of the catecholamine released by 10 μM nicotine generated a calcium transient indistinguishable from that due to 10 μM nicotine. These results support the idea that nicotinic agonists generate an alternative second messenger in addition to the rise in free calcium

A Simple Device for Measuring the Minimum Current Velocity to Maintain Semi-Buoyant Fish Eggs in Suspension

Pelagic broadcast spawning cyprinids are common to Great Plains rivers and streams. This reproductive guild produces non-adhesive semi-buoyant eggs that require sufficient current velocity to remain in suspension during development. Although studies have shown that there may be a minimum velocity needed to keep the eggs in suspension, this velocity has not been estimated directly nor has the influence of physicochemical factors on egg buoyancy been determined. We developed a simple, inexpensive flow chamber that allowed for evaluation of minimum current velocity needed to keep semi-buoyant eggs in suspension at any time frame during egg development. The device described here has the capability of testing the minimum current velocity needed to keep semi-buoyant eggs in suspension at a wide range of physicochemical conditions. We used gellan beads soaked in freshwater for 0, 24, and 48 hrs as egg surrogates and evaluated minimum current velocities necessary to keep them in suspension at different combinations of temperature (20.0 ± 1.0 °C, 25.0 ± 1.0 °C, and 28.0 ± 1.0 °C) and total dissolved solids (TDS; 1,000 mg L-1, 3,000 mg L-1, and 6,000 mg L-1). We found that our methodology generated consistent, repeatable results within treatment groups. Current velocities ranging from 0.001–0.026 needed to keep the gellan beads in suspension were negatively correlated to soak times and TDS and positively correlated with temperature. The flow chamber is a viable approach for evaluating minimum current velocities needed to keep the eggs of pelagic broadcast spawning cyprinids in suspension during development

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Missing Footage at the AAS

The Roundtable session at this year’s annual meeting of the Association for Asian Studies (AAS) in Philadelphia was titled “Against Amnesia: History, Memory and the Role of Public Intellectuals in 21st Century China.” A mix of scholars from China and North America were scheduled to report and discuss, but at the last minute our featured speaker, Ms. Cui Weiping (崔卫平) of the Beijing Film Academy, could not attend. She was prevented from leaving China for the roundtable even though she had been specially invited by the AAS and had her passport, US visa, and air tickets in hand. She was given the news verbally by Chinese “authorities” just a few days before the meeting. (A New York Times story on the subject can be found here.) The irony is obvious. While we gathered to speak about amnesia in the past (I was a late addition to the panel), here was a new kind of amnesia in the making. Cui Weiping is a talented documentary film-maker dedicated to giving voice to sectors of China’s society that have been forgotten in the cheerful story of reform and development. Her contribution to the roundtable was central to our topic of historical forgetting, and we were looking forward to Professor Cui’s presentation of clips from her various documentary films and comments on her work as a public intellectual. But those film clips and her presence became the most important missing footage of the AAS meetings this year. In the strange world of government control in the 21st century, while the Chinese authorities successfully prevented Professor Cui from coming to Philadelphia, we were able to show a few PowerPoint images that she could e-mail to us! Indeed, you can also follow her Twitter exchanges on these developments. Still, at least for older scholars amongst us, the limited benefits of the Internet are overshadowed by this denial of the freedom to travel without reason. It is a sad and sorry return to earlier days when China was closed off from the world. It left us wondering: what is the message the Chinese government wants to send

Guiding the People: Chinese Statecraft from Confucian Literati to Communist Cadres

Video of full lecture with presentation slides edited into the video.Timothy Cheek, History, University of British Columbia kicks off this semester's CCCI lecture series with the theme of "China, the Central State and All Under Heaven." How is China governed? It is a question on our minds today as the rule of Xi Jinping in China challenges American hopes and stokes our fears. Is it Communist? Capitalist? Confucian? Making sense of Chinese statecraft, or of how any state is governed, requires not only political analysis but also some sense of the context, inherited problems, sense of self, that is, of its history. This is a fundamental historiographical challenge: how and in what ways can knowledge of past practice inform our understanding of later or current practice? How can specific knowledge of history inform, deepen, challenge, and open up new questions about what we think we know of our present rather than simply reinforcing our current assumptions and prejudices? This lecture explores that challenge to the practice of history through the example of one sort of governance—state-sponsored, village-based local public education in civic virtues. This state attempt to create ideal subjects began with the Confucians of the early 11th century, continued in rural education programs in Republican China in the 1930s, re-emerged in Communist ideological remolding campaigns under Mao, and appeared once again in political study sessions in Xi Jinping’s China today.Cornell East Asia Program, The Levinson China and Asia-Pacific Studies Program, Cornell Society for the Humanities, and the Department of History.1_6hkgsbn

Remaking area studies : Teaching and Learning Across Asia and the Pacific : [book review]

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