The costs and potential savings of a novel telepaediatric service in Queensland

BACKGROUND: There are few cost-minimisation studies in telemedicine. We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person. METHODS: In November 2000, we established a novel telepaediatric service for selected regional hospitals in Queensland. Instead of transferring patients to Brisbane, the majority of referrals to specialists in Brisbane were dealt with via videoconference. Since the service began, 1499 consultations have been conducted for a broad range of paediatric sub-specialities including burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry. RESULTS: During a five year period, the total cost of providing 1499 consultations through the telepaediatric service was A$955,996. The estimated potential cost of providing an outpatient service to the same number of patients at the Royal Children's Hospital in Brisbane was A$1,553,264; thus, telepaediatric services resulted in a net saving of approximately A$600,000 to the health service provider. CONCLUSION: Telepaediatrics was a cheaper method for the delivery of outpatient services when the workload exceeded 774 consultations. A sensitivity analysis showed that the threshold point was most sensitive to changes related to patient travel costs, coordinator salaries and videoconference equipment costs. The study showed substantial savings for the health department, mainly due to reduced costs associated with patient travel

DotMapper: an open source tool for creating interactive disease point maps

BACKGROUND: Molecular strain typing of tuberculosis isolates has led to increased understanding of the epidemiological characteristics of the disease and improvements in its control, diagnosis and treatment. However, molecular cluster investigations, which aim to detect previously unidentified cases, remain challenging. Interactive dot mapping is a simple approach which could aid investigations by highlighting cases likely to share epidemiological links. Current tools generally require technical expertise or lack interactivity. RESULTS: We designed a flexible application for producing disease dot maps using Shiny, a web application framework for the statistical software, R. The application displays locations of cases on an interactive map colour coded according to levels of categorical variables such as demographics and risk factors. Cases can be filtered by selecting combinations of these characteristics and by notification date. It can be used to rapidly identify geographic patterns amongst cases in molecular clusters of tuberculosis in space and time; generate hypotheses about disease transmission; identify outliers, and guide targeted control measures. CONCLUSIONS: DotMapper is a user-friendly application which enables rapid production of maps displaying locations of cases and their epidemiological characteristics without the need for specialist training in geographic information systems. Enhanced understanding of tuberculosis transmission using this application could facilitate improved detection of cases with epidemiological links and therefore lessen the public health impacts of the disease. It is a flexible system and also has broad international potential application to other investigations using geo-coded health information

Subglacial swamps

peer-reviewedThe existence of both water and sediment at the bed of ice streams is well documented, but there is a lack of fundamental understanding about the mechanisms of ice, water and sediment interaction. We pose a model to describe subglacial water flow below ice sheets, in the presence of a deformable sediment layer. Water flows in a rough-bedded film; the ice is supported by larger clasts, but there is a millimetric water layer submerging the smaller particles. Partial differential equations describing the water film are derived from a description of the dynamics of ice, water and mobile sediment. We assume that sediment transport is possible, either as fluvial bedload, but more significantly by ice-driven shearing and by internal squeezing. This provides an instability mechanism for rivulet formation; in the model, downstream sediment transport is compensated by lateral squeezing of till towards the incipient streams. We show that the model predicts the formation of shallow, swamp-like streams, with a typical depth of the order of centimetres. The swamps are stable features, typically with a width of the order of tens to hundreds of metres.PUBLISHEDpeer-reviewe

Müller glia activation in response to inherited retinal degeneration is highly varied and disease-specific

Despite different aetiologies, most inherited retinal disorders culminate in photoreceptor loss, which induces concomitant changes in the neural retina, one of the most striking being reactive gliosis by Müller cells. It is typically assumed that photoreceptor loss leads to an upregulation of glial fibrilliary acidic protein (Gfap) and other intermediate filament proteins, together with other gliosis-related changes, including loss of integrity of the outer limiting membrane (OLM) and deposition of proteoglycans. However, this is based on a mix of both injury-induced and genetic causes of photoreceptor loss. There are very few longitudinal studies of gliosis in the retina and none comparing these changes across models over time. Here, we present a comprehensive spatiotemporal assessment of features of gliosis in the degenerating murine retina that involves Müller glia. Specifically, we assessed Gfap, vimentin and chondroitin sulphate proteoglycan (CSPG) levels and outer limiting membrane (OLM) integrity over time in four murine models of inherited photoreceptor degeneration that encompass a range of disease severities (Crb1rd8/rd8, Prph2+/Δ307, Rho-/-, Pde6brd1/rd1). These features underwent very different changes, depending upon the disease-causing mutation, and that these changes are not correlated with disease severity. Intermediate filament expression did indeed increase with disease progression in Crb1rd8/rd8 and Prph2+/Δ307, but decreased in the Prph2+/Δ307 and Pde6brd1/rd1 models. CSPG deposition usually, but not always, followed the trends in intermediate filament expression. The OLM adherens junctions underwent significant remodelling in all models, but with differences in the composition of the resulting junctions; in Rho-/- mice, the adherens junctions maintained the typical rod-Müller glia interactions, while in the Pde6brd1/rd1 model they formed predominantly between Müller cells in late stage of degeneration. Together, these results show that gliosis and its associated processes are variable and disease-dependent

SIRT1 Activity Is Linked to Its Brain Region-Specific Phosphorylation and Is Impaired in Huntington’s Disease Mice

Huntingtons disease (HD) is a neurodegenerative disorder for which there are no disease-modifying treatments. SIRT1 is a NAD+-dependent protein deacetylase that is implicated in maintaining neuronal health during development, differentiation and ageing. Previous studies suggested that the modulation of SIRT1 activity is neuroprotective in HD mouse models, however, the mechanisms controlling SIRT1 activity are unknown. We have identified a striatum-specific phosphorylation-dependent regulatory mechanism of SIRT1 induction under normal physiological conditions, which is impaired in HD. We demonstrate that SIRT1 activity is down-regulated in the brains of two complementary HD mouse models, which correlated with altered SIRT1 phosphorylation levels. This SIRT1 impairment could not be rescued by the ablation of DBC1, a negative regulator of SIRT1, but was linked to changes in the sub-cellular distribution of AMPK-α1, a positive regulator of SIRT1 function. This work provides insights into the regulation of SIRT1 activity with the potential for the development of novel therapeutic strategies

Sensitivity of stratospheric water vapour to variability in tropical tropopause temperatures and large-scale transport

Abstract. Concentrations of water vapour entering the tropical lower stratosphere are primarily determined by conditions that air parcels encounter as they are transported through the tropical tropopause layer (TTL). Here we quantify the relative roles of variations in TTL temperatures and transport in determining seasonal and interannual variations of stratospheric water vapour. Following previous studies, we use trajectory calculations with the water vapour concentration set by the Lagrangian dry point (LDP) along trajectories. To assess the separate roles of transport and temperatures, the LDP calculations are modified by replacing either the winds or the temperatures with those from different years to investigate the wind or temperature sensitivity of water vapour to interannual variations and, correspondingly, with those from different months to investigate the wind or temperature sensitivity to seasonal variations. Both ERA-Interim reanalysis data for the 1999–2009 period and data generated by a chemistry–climate model (UM-UKCA) are investigated. Variations in temperatures, rather than transport, dominate interannual variability, typically explaining more than 70 % of variability, including individual events such as the 2000 stratospheric water vapour drop. Similarly seasonal variation of temperatures, rather than transport, is shown to be the dominant driver of the annual cycle in lower stratospheric water vapour concentrations in both the model and reanalysis, but it is also shown that seasonal variation of transport plays an important role in reducing the seasonal cycle maximum (reducing the annual range by about 30 %). The quantitative role in dehydration of sub-seasonal and sub-monthly Eulerian temperature variability is also examined by using time-filtered temperature fields in the trajectory calculations. Sub-monthly temperature variability reduces annual mean water vapour concentrations by 40 % in the reanalysis calculation and 30 % in the model calculation. As with other aspects of dehydration, simple Eulerian measures of variability are not sufficient to quantify the implications for dehydration, and the Lagrangian sampling of the variability must be taken into account. These results indicate that, whilst capturing seasonal and interannual variation of temperature is a major factor in modelling realistic stratospheric water vapour concentrations, simulation of seasonal variation of transport and of sub-seasonal and sub-monthly temperature variability are also important and cannot be ignored. </jats:p

Drawing Boundaries

In “On Drawing Lines on a Map” (1995), I suggested that the different ways we have of drawing lines on maps open up a new perspective on ontology, resting on a distinction between two sorts of boundaries: fiat and bona fide. “Fiat” means, roughly: human-demarcation-induced. “Bona fide” means, again roughly: a boundary constituted by some real physical discontinuity. I presented a general typology of boundaries based on this opposition and showed how it generates a corresponding typology of the different sorts of objects which boundaries determine or demarcate. In this paper, I describe how the theory of fiat boundaries has evolved since 1995, how it has been applied in areas such as property law and political geography, and how it is being used in contemporary work in formal and applied ontology, especially within the framework of Basic Formal Ontology

Geography teacher educators’ identity, roles and professional learning in a volatile, uncertain, complex and ambiguous world

Globally, teacher educators work in contexts which are shaped and informed by persistent policy reform and global environmental crises which we argue, combine to create a professional life that is volatile, uncertain, complex and ambiguous (VUCA). Through a case study of geography teacher educators (GTEs) based in England, we explore the experiences, knowledge and professional growth of teacher educators. Our findings draw on data from responses to an online questionnaire (n = 51), a practitioner workshop and 11 semi-structured interviews. We find that GTEs have multi-faceted identities which are shaped by professional, social and personal realms through engagement with a diverse community of practice. The VUCA context of teacher education is visible in the professional identities of GTEs in both affirming and deleterious ways which we argue, are linked to perceptions of professional autonomy. We argue that the professional role of teacher educators is to bravely engage with policy making as part of their contribution to a socially and environmentally just future for all

A cost minimisation analysis of a telepaediatric otolaryngology service

Background: Paediatric ENT services in regional areas can be provided through telemedicine (tele-ENT) using videoconferencing or with a conventional outpatient department ENT service (OPD-ENT) in which patients travel to see the specialist. The objective of this study was to identify the least-cost approach to providing ENT services for paediatric outpatients