Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

Self-Similar Dynamical Relaxation of Dark Matter Halos in an Expanding Universe

We investigate the structure of cold dark matter halos using advanced models of spherical collapse and accretion in an expanding Universe. These base on solving time-dependent equations for the moments of the phase-space distribution function in the fluid approximation; our approach includes non-radial random motions, and most importantly, an advanced treatment of both dynamical relaxation effects that takes place in the infalling matter: phase-mixing associated to shell crossing, and collective collisions related to physical clumpiness. We find self-similar solutions for the spherically-averaged profiles of mass density rho(r), pseudo phase-space density Q(r) and anisotropy parameter beta(r). These profiles agree with the outcomes of state-of-the-art N-body simulations in the radial range currently probed by the latter; at smaller radii, we provide specific predictions. In the perspective provided by our self-similar solutions we link the halo structure to its two-stage growth history, and propose the following picture. During the early fast collapse of the inner region dominated by a few merging clumps, efficient dynamical relaxation plays a key role in producing a closely universal mass density and pseudo phase-space density profiles; in particular, these are found to depend only weakly on the detailed shape of the initial perturbation and the related collapse times. The subsequent inside-out growth of the outer regions feeds on the slow accretion of many small clumps and diffuse matter; thus the outskirts are only mildly affected by dynamical relaxation but are more sensitive to asymmetries and cosmological variance.Comment: 31 pages, 16 figures. Typos corrected. Accepted by Ap

Modeling deltaic lobe‐building cycles and channel avulsions for the Yellow River delta, China

River deltas grow by repeating cycles of lobe development punctuated by channel avulsions, so that over time, lobes amalgamate to produce a composite landform. Existing models have shown that backwater hydrodynamics are important in avulsion dynamics, but the effect of lobe progradation on avulsion frequency and location has yet to be explored. Herein, a quasi‐2‐D numerical model incorporating channel avulsion and lobe development cycles is developed. The model is validated by the well‐constrained case of a prograding lobe on the Yellow River delta, China. It is determined that with lobe progradation, avulsion frequency decreases, and avulsion length increases, relative to conditions where a delta lobe does not prograde. Lobe progradation lowers the channel bed gradient, which results in channel aggradation over the delta topset that is focused farther upstream, shifting the avulsion location upstream. Furthermore, the frequency and location of channel avulsions are sensitive to the threshold in channel bed superelevation that triggers an avulsion. For example, avulsions occur less frequently with a larger superelevation threshold, resulting in greater lobe progradation and avulsions that occur farther upstream. When the delta lobe length prior to avulsion is a moderate fraction of the backwater length (0.3–0.5L_b), the interplay between variable water discharge and lobe progradation together set the avulsion location, and a model capturing both processes is necessary to predict avulsion timing and location. While this study is validated by data from the Yellow River delta, the numerical framework is rooted in physical relationships and can therefore be extended to other deltaic systems

Regulatory control and the costs and benefits of biochemical noise

Experiments in recent years have vividly demonstrated that gene expression can be highly stochastic. How protein concentration fluctuations affect the growth rate of a population of cells, is, however, a wide open question. We present a mathematical model that makes it possible to quantify the effect of protein concentration fluctuations on the growth rate of a population of genetically identical cells. The model predicts that the population's growth rate depends on how the growth rate of a single cell varies with protein concentration, the variance of the protein concentration fluctuations, and the correlation time of these fluctuations. The model also predicts that when the average concentration of a protein is close to the value that maximizes the growth rate, fluctuations in its concentration always reduce the growth rate. However, when the average protein concentration deviates sufficiently from the optimal level, fluctuations can enhance the growth rate of the population, even when the growth rate of a cell depends linearly on the protein concentration. The model also shows that the ensemble or population average of a quantity, such as the average protein expression level or its variance, is in general not equal to its time average as obtained from tracing a single cell and its descendants. We apply our model to perform a cost-benefit analysis of gene regulatory control. Our analysis predicts that the optimal expression level of a gene regulatory protein is determined by the trade-off between the cost of synthesizing the regulatory protein and the benefit of minimizing the fluctuations in the expression of its target gene. We discuss possible experiments that could test our predictions.Comment: Revised manuscript;35 pages, 4 figures, REVTeX4; to appear in PLoS Computational Biolog

Essential role of CFTR in PKA-dependent phosphorylation, alkalinization, and hyperpolarization during human dperm capacitation

Mammalian sperm require to spend a limited period of time in the female reproductive tract to become competent to fertilize in a process called capacitation. It is well established that HCO3 − is essential for capacitation because it activates the atypical soluble adenylate cyclase ADCY10 leading to cAMP production, and promotes alkalinization of cytoplasm, and membrane hyperpolarization. However, how HCO3 − is transported into the sperm is not well understood. There is evidence that CFTR activity is involved in the human sperm capacitation but how this channel is integrated in the complex signaling cascades associated with this process remains largely unknown. In the present work, we have analyzed the extent to which CFTR regulates different events in human sperm capacitation. We observed that inhibition of CFTR affects HCO3 −-entrance dependent events resulting in lower PKA activity. CFTR inhibition also affected cAMP/PKA-downstream events such as the increase in tyrosine phosphorylation, hyperactivated motility, and acrosome reaction. In addition, we demonstrated for the first time, that CFTR and PKA activity are essential for the regulation of intracellular pH, and membrane potential in human sperm. Addition of permeable cAMP partially recovered all the PKA-dependent events altered in the presence of inh-172 which is consistent with a role of CFTR upstream of PKA activation.Fil: Puga Molina, Lis del Carmen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Pinto, Nicolás Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Torres Rodríguez, Paulina. Universidad Nacional Autónoma de México; MéxicoFil: Romarowski, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Vicens Sanchez, Alberto. Universidad Nacional Autónoma de México; MéxicoFil: Visconti, Pablo E.. University of Massachussets; Estados UnidosFil: Darszon, Alberto. Universidad Nacional Autónoma de México; MéxicoFil: Treviño, Claudia L.. Universidad Nacional Autónoma de México; MéxicoFil: Buffone, Mariano Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentin

On the gravitational, dilatonic and axionic radiative damping of cosmic strings

We study the radiation reaction on cosmic strings due to the emission of dilatonic, gravitational and axionic waves. After verifying the (on average) conservative nature of the time-symmetric self-interactions, we concentrate on the finite radiation damping force associated with the half-retarded minus half-advanced ``reactive'' fields. We revisit a recent proposal of using a ``local back reaction approximation'' for the reactive fields. Using dimensional continuation as convenient technical tool, we find, contrary to previous claims, that this proposal leads to antidamping in the case of the axionic field, and to zero (integrated) damping in the case of the gravitational field. One gets normal positive damping only in the case of the dilatonic field. We propose to use a suitably modified version of the local dilatonic radiation reaction as a substitute for the exact (non-local) gravitational radiation reaction. The incorporation of such a local approximation to gravitational radiation reaction should allow one to complete, in a computationally non-intensive way, string network simulations and to give better estimates of the amount and spectrum of gravitational radiation emitted by a cosmologically evolving network of massive strings.Comment: 48 pages, RevTex, epsfig, 1 figure; clarification of the domain of validity of the perturbative derivation of the string equations of motion, and of their renormalizabilit

The application of predictive modelling for determining bio-environmental factors affecting the distribution of blackflies (Diptera: Simuliidae) in the Gilgel Gibe watershed in Southwest Ethiopia

Blackflies are important macroinvertebrate groups from a public health as well as ecological point of view. Determining the biological and environmental factors favouring or inhibiting the existence of blackflies could facilitate biomonitoring of rivers as well as control of disease vectors. The combined use of different predictive modelling techniques is known to improve identification of presence/absence and abundance of taxa in a given habitat. This approach enables better identification of the suitable habitat conditions or environmental constraints of a given taxon. Simuliidae larvae are important biological indicators as they are abundant in tropical aquatic ecosystems. Some of the blackfly groups are also important disease vectors in poor tropical countries. Our investigations aim to establish a combination of models able to identify the environmental factors and macroinvertebrate organisms that are favourable or inhibiting blackfly larvae existence in aquatic ecosystems. The models developed using macroinvertebrate predictors showed better performance than those based on environmental predictors. The identified environmental and macroinvertebrate parameters can be used to determine the distribution of blackflies, which in turn can help control river blindness in endemic tropical places. Through a combination of modelling techniques, a reliable method has been developed that explains environmental and biological relationships with the target organism, and, thus, can serve as a decision support tool for ecological management strategies

Pharmacists in Pharmacovigilance: Can Increased Diagnostic Opportunity in Community Settings Translate to Better Vigilance?

The pharmacy profession has undergone substantial change over the last two to three decades. Whilst medicine supply still remains a central function, pharmacist’s roles and responsibilities have become more clinic and patient focused. In the community (primary care), pharmacists have become important providers of healthcare as Western healthcare policy advocates patient self-care. This has resulted in pharmacists taking on greater responsibility in managing minor illness and the delivery of public health interventions. These roles require pharmacists to more fully use their clinical skills, and often involve diagnosis and therapeutic management. Community pharmacists are now, more than ever before, in a position to identify, record and report medication safety incidents. However, current research suggests that diagnostic ability of community pharmacists is questionable and they infrequently report to local or national schemes. The aim of this paper is to highlight current practice and suggest ways in which community pharmacy can more fully contribute to patient safety

Absentee Fathers\u27 Intergenerational Impact on Developing Children

This paper examines the crisis of single parent homes, specifically absentee fathers in America. It examines and attempts to explore how father-figure inclusion can mitigate the consequences experienced by the majority of children in absent father homes. Scholarly research to date indicates children of absentee fathers are susceptible to detrimental conditions including an increased likelihood of delinquent behavior, higher risk for teenage pregnancy, emotional instability and an increased propensity for substance abuse. Longitudinal effects can manifest as intergenerational absenteeism, arrested development, low wage employment, stunted education, recidivist incarceration and higher rates of suicide. The objective of this research is to extrapolate new knowledge about the phenomenon of absent fathers by reviewing, critiquing, and synthesizing existing literature as an offering to the body of scholarly work in hopes of reconceptualizing methods for intervention. This is accomplished through qualitative research design, utilizing integrative literature review methodology. Findings strongly suggest high rates of intergenerational father absenteeism through divorce, out of wedlock child bearing, incarceration and other issues leave children at a disadvantage in many areas, and if the rate of father absenteeism can be reduced it will also decrease rates of domestic violence, juvenile detention, unplanned pregnancies, teenaged substance abuse, and behavioral issues in school among other various social problems