5 years of teleoncology in North Queensland: a sustainable model

Background: The Townsville Cancer Centre (TCC) has been delivering its medical oncology services closer to home for patients from 19 rural centres via teleoncology since 2007. Patients are satisfied with this model of care. The aim is to describe the services extended to rural patients and the resource improvements enjoyed by rural hospitals as a result of teleoncology over this period. Methods: Data for patients treated via teleoncology from 1st April 2007 to 31st March 2012 was extracted from the oncology information system of TCC. Demographic details and type of services provided are presented descriptively. Results: A total of 170 patients were seen in 800 consultations over 60 months. Median age was 58 years (20–89), males 46% and females 54%. 25 patients were from remote indigenous communities. Most common cancer types were breast (37%), colorectal (21%) and lung (22%). A total of 87 patients received chemotherapy in Mount Isa, supervised remotely from Townsville via video conference with curative intent in 30% and palliative intent in the rest. Examples of chemotherapy regimens included docetaxel, doxorubicin and cyclophosphamide (TAC), bleomycin, etoposide and cisplatin (BEP), methotreaxte and ifosfamide infusion. 15 patients were seen urgently and appropriate treatment initiated within 24 hours in Mount Isa, thus avoiding inter hospital transfer. Six admitted patients were seen on regular ward rounds. Severe toxicities included one death from pneumonia, one stroke and one resuscitated cardiac arrest. By improving the resources in Mount Isa hospital to accommodate these services, numbers of oncology specific medical and allied health practitioners and service capability have improved. Conclusion: Teleoncology model can enhance rural service capabilities and health resources so that comprehensive medical oncology services can be sustainably provided to rural areas by remote supervision

STUDIES ON GENETIC CORRELATION AND PATH COEFFICIENT ANALYSIS OF BLACKGRAM (Vigna mungo [L.] Hepper) GENOTYPES UNDER SALINITY

A study was carried out with twenty-one blackgram genotypes in coastal saline low land in three seasons to study the genetic correlation and path coefficient analysis. Eleven seed yield and yield contributing traits were recorded on the genotypes raised in RBD design with two replications. Based on the pooled analysis, plant height, pods per plant and yield per plant recorded high PCV and GCV value. High heritability along with genetic advance as percent of mean observed for days to first flowering, plant height, primary branches, clusters per plant, pods per plant and yield per plant. Genotypic correlation studies revealed that yield per plant had positive significant correlation with plant height, clusters per plant, pods per plant, pod length and seeds per pod. Path coefficient analysis indicated high positive direct effect of pods per plant and pod length on yield per plant in saline condition. The genotype VBG-10010 performed well under saline environment over seasons. &nbsp

Large-scale electrophysiology and deep learning reveal distorted neural signal dynamics after hearing loss

Listeners with hearing loss often struggle to understand speech in noise, even with a hearing aid. To better understand the auditory processing deficits that underlie this problem, we made large-scale brain recordings from gerbils, a common animal model for human hearing, while presenting a large database of speech and noise sounds. We first used manifold learning to identify the neural subspace in which speech is encoded and found that it is low-dimensional and that the dynamics within it are profoundly distorted by hearing loss. We then trained a deep neural network (DNN) to replicate the neural coding of speech with and without hearing loss and analyzed the underlying network dynamics. We found that hearing loss primarily impacts spectral processing, creating nonlinear distortions in cross-frequency interactions that result in a hypersensitivity to background noise that persists even after amplification with a hearing aid. Our results identify a new focus for efforts to design improved hearing aids and demonstrate the power of DNNs as a tool for the study of central brain structures

Use of telehealth in the management of non/critical emergencies in rural or remote emergency departments: a systematic review

Background: Telehealth has been used extensively in Emergency Departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote ED settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods: Articles were identified through database searches of CINAHL, Cochrane, MEDLINE(OVID), Informit and SCOPUS, as well as screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies. Information was extracted relating to telehealth program model, the scope of service and participating health professionals. The outcomes of telehealth programs were determined by analysing the uptake and usage of telehealth, the impact on altering diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results: Of the 2532 identified records, fifteen were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programs predominantly utilised by nursing staff with limited local medical support. Tele-consultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and less patients were discharged home. Discharge against medical advice rates were low at 0.92-1.1%. Conclusion: The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programs may assist in reducing unnecessary patient transfer and secondary overtriage, while increasing the capacity of ED staff to diagnose and manage patients locally, which may translate into increased local hospital admission and reduced discharge rates following teleconsultation

Delimitation of lymphatic filariasis transmission risk areas: a geo-environmental approach

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) depends upon Mass Drug Administration (MDA) to interrupt transmission. Therefore, delimitation of transmission risk areas is an important step, and hence we attempted to define a geo-environmental risk model (GERM) for determining the areas of potential transmission of lymphatic filariasis. METHODS: A range of geo-environmental variables has been selected, and customized on GIS platform to develop GERM for identifying the areas of filariasis transmission in terms of "risk" and "non-risk". The model was validated through a 'ground truth study' following standard procedure using GIS tools for sampling and Immuno-chromotographic Test (ICT) for screening the individuals. RESULTS: A map for filariasis transmission was created and stratified into different spatial entities, "risk' and "non-risk", depending on Filariasis Transmission Risk Index (FTRI). The model estimation corroborated well with the ground (observed) data. CONCLUSION: The geo-environmental risk model developed on GIS platform is useful for spatial delimitation purpose on a macro scale

Mathematical modelling of lymphatic filariasis elimination programmes in India: Required duration of mass drug administration and post-treatment level of infection indicators

Background: India has made great progress towards the elimination of lymphatic filariasis. By 2015, most endemic districts had completed at least five annual rounds of mass drug administration (MDA). The next challenge is to determine when MDA can be stopped. We performed a simulation study with the individual-based model LYMFASIM to help clarify this. Methods: We used a model-variant for Indian settings. We considered different hypotheses on detectability of antigenaemia (Ag) in relation to underlying adult worm burden, choosing the most likely hypothesis by comparing the model predicted association between community-level microfilaraemia (Mf) and antigenaemia (Ag) prevalence levels to observed data (collated from literature). Next, we estimated how long MDA must be continued in order to achieve elimination in different transmission settings and what Mf and Ag prevalence may still remain 1 year after the last required MDA round. The robustness of key-outcomes was assessed in a sensitivity analysis. Results: Our model matched observed data qualitatively well when we assumed an Ag detection rate of 50 % for single worm infections, which increases with the number of adult worms (modelled by relating detection to the presence of female worms). The required duration of annual MDA increased with higher baseline endemicity and lower coverage (varying between 2 and 12 rounds), while the remaining residual infection 1 year after the last required treatment declined with transmission intensity. For low and high transmission settings, the median residual infection levels were 1.0 % and 0.4 % (Mf prevalence in the 5+ population), and 3.5 % and 2.0 % (Ag prevalence in 6-7 year-old children). Conclusion: To achieve elimination in high transmission settings, MDA must be continued longer and infection levels must be reduced to lower levels than in low-endemic communities. Although our simulations were for Indian settings, qualitatively similar patterns are also expected in other areas. This should be taken into account in decision algorithms to define whether MDA can be interrupted. Transmission assessment surveys should ideally be targeted to communities with the highest pre-control transmission levels, to minimize the risk of programme failure