International concurrent course delivery: Bringing pragmatic research to the classroom

Tele-health, or health care at a distance, is increasingly becoming a common form of health service delivery yet few academics are researching this field, and fewer are teaching about it. This presentation discusses the development and delivery of a highly innovative online course delivered internationally and concurrently. Through a review of early applications of the technology in the UK and Canada, the course highlights societal, economic and technological drivers and the benefits, opportunities, challenges and barriers to this type of service delivery. It allows students from Western University, Canada to engage with academics and students from the University of Sheffield, UK as the content is provided by academic leaders in the field from both Universities allowing students to gain an international, comparative perspective. Students on the course are exposed not only to the new technology, but to the best academics undertaking cutting-edge research to develop and mainstream them

Leveraging scarce resources

Professors Marita Kloseck and Deborah Fitzsimmons, from Western University, Canada, use a technology-enabled capacity building approach to enhance community palliative services and suppor

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention. Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home

UpLIFTIng PFI: does LIFT improve public-private procurement?

The Private Finance Initiative (PFI) and Local Improvement Finance Trust (LIFT) were both introduced by the UK government as part of a drive to improve public service provision. Both PFI and LIFT focus on leveraging the key strengths of the public and private sectors when developing new facilities. This paper does not seek to question the need for new infrastructure, but rather discusses the difficulties encountered when trying to analyse LIFT as a system and when evaluating whether it can address earlier concerns about the PFI procurement process. Our analysis suggests that it is difficult to predict whether LIFT will be capable of delivering on its promise of providing cost-effective, bespoke Primary Care facilities

Evaluating the design and reporting of pragmatic trials in osteoarthritis research

Objectives. Among the challenges in health research is translating interventions from controlled experimental settings to clinical and community settings where chronic disease is managed daily. Pragmatic trials offer a method for testing interventions in real-world settings but are seldom used in OA research. The aim of this study was to evaluate the literature on pragmatic trials in OA research up to August 2016 in order to identify strengths and weaknesses in the design and reporting of these trials. Methods. We used established guidelines to assess the degree to which 61 OA studies complied with pragmatic trial design and reporting. We assessed design according to the pragmatic–explanatory continuum indicator summary and reporting according to the pragmatic trials extension of the CONsolidated Standards of Reporting Trials guidelines. Results. None of the pragmatic trials met all 11 criteria evaluated and most of the trials met between 5 and 8 of the criteria. Criteria most often unmet pertained to practitioner expertise (by requiring specialists) and criteria most often met pertained to primary outcome analysis (by using intention-to-treat analysis). Conclusion. Our results suggest a lack of highly pragmatic trials in OA research. We identify this as a point of opportunity to improve research translation, since optimizing the design and reporting of pragmatic trials can facilitate implementation of evidence-based interventions for OA care

Clinical Focus on Lung Cancer: A snapshot of lung cancer for Ontario health care providers and managers

This monograph on lung cancer has been prepared to provide information on patterns of practice to those directly involved in the provision of care to lung cancer patients. As well, it should be helpful to those who are responsible for managing aspects of the cancer system that impact on the care that lung cancer patients receive across the province of Ontario. The practice patterns are shown against the backdrop of the evidence-based guidelines developed by the Lung Disease Site Group of Cancer Care Ontario’s Program in Evidence based Care. In addition to information on patterns of practice, this monograph provides information on the timeliness of access to care, as well as a brief overview of the incidence and mortality of lung cancer, and the trends in the main risk factor for developing lung cancer, namely smoking. In brief, it provides a snapshot of the quality of care for lung cancer patients in the province of Ontario. It is hoped that this monograph will assist those responsible for care delivery to achieve the best possible results for patients with a diagnosis of lung cancer

Regularity of the Solutions to SPDEs in Metric Measure Spaces

In this paper we study the regularity of non-linear parabolic PDEs and stochastic PDEs on metric measure spaces admitting heat kernel estimates. In particular we consider mild function solutions to abstract Cauchy problems and show that the unique solution is Hölder continuous in time with values in a suitable fractional Sobolev space. As this analysis is done via a-priori estimates, we can apply this result to stochastic PDEs on metric measure spaces and solve the equation in a pathwise sense for almost all paths. The main example of noise term is of fractional Brownian type and the metric measure spaces can be classical as well as given by various fractal structures. The whole approach is low dimensional and works for spectral dimensions less than 4

Use of humanised rat basophilic leukaemia cell line RS-ATL8 for the assessment of allergenicity of Schistosoma mansoni proteins.

BACKGROUND Parasite-specific IgE is thought to correlate with protection against Schistosoma mansoni infection or re-infection. Only a few molecular targets of the IgE response in S. mansoni infection have been characterised. A better insight into the basic mechanisms of anti-parasite immunity could be gained from a genome-wide characterisation of such S. mansoni allergens. This would have repercussions on our understanding of allergy and the development of safe and efficacious vaccinations against helminthic parasites. METHODOLOGY/PRINCIPAL FINDINGS A complete medium- to high-throughput amenable workflow, including important quality controls, is described, which enables the rapid translation of S. mansoni proteins using wheat germ lysate and subsequent assessment of potential allergenicity with a humanised Rat Basophilic Leukemia (RBL) reporter cell line. Cell-free translation is completed within 90 minutes, generating sufficient amounts of parasitic protein for rapid screening of allergenicity without any need for purification. Antigenic integrity is demonstrated using Western Blotting. After overnight incubation with infected individuals' serum, the RS-ATL8 reporter cell line is challenged with the complete wheat germ translation mixture and Luciferase activity measured, reporting cellular activation by the suspected allergen. The suitability of this system for characterization of novel S. mansoni allergens is demonstrated using well characterised plant and parasitic allergens such as Par j 2, SmTAL-1 and the IgE binding factor IPSE/alpha-1, expressed in wheat germ lysates and/or E. coli. SmTAL-1, but not SmTAL2 (used as a negative control), was able to activate the basophil reporter cell line. CONCLUSION/SIGNIFICANCE This method offers an accessible way for assessment of potential allergenicity of anti-helminthic vaccine candidates and is suitable for medium- to high-throughput studies using infected individual sera. It is also suitable for the study of the basis of allergenicity of helminthic proteins

The dust environment of comet 67P/Churyumov-Gerasimenko from Rosetta OSIRIS and VLT observations in the 4.5 to 2.9 au heliocentric distance range inbound

Context. The ESA Rosetta spacecraft, currently orbiting around cornet 67P/Churyumov-Gerasimenko, has already provided in situ measurements of the dust grain properties from several instruments, particularly OSIRIS and GIADA. We propose adding value to those measurements by combining them with ground-based observations of the dust tail to monitor the overall, time-dependent dust-production rate and size distribution. Aims. To constrain the dust grain properties, we take Rosetta OSIRIS and GIADA results into account, and combine OSIRIS data during the approach phase (from late April to early June 2014) with a large data set of ground-based images that were acquired with the ESO Very Large Telescope (VLT) from February to November 2014. Methods. A Monte Carlo dust tail code, which has already been used to characterise the dust environments of several comets and active asteroids, has been applied to retrieve the dust parameters. Key properties of the grains (density, velocity, and size distribution) were obtained from. Rosetta observations: these parameters were used as input of the code to considerably reduce the number of free parameters. In this way, the overall dust mass-loss rate and its dependence on the heliocentric distance could be obtained accurately. Results. The dust parameters derived from the inner coma measurements by OSIRIS and GIADA and from distant imaging using VLT data are consistent, except for the power index of the size-distribution function, which is alpha = -3, instead of alpha = -2, for grains smaller than 1 mm. This is possibly linked to the presence of fluffy aggregates in the coma. The onset of cometary activity occurs at approximately 4.3 AU, with a dust production rate of 0.5 kg/s, increasing up to 15 kg/s at 2.9 AU. This implies a dust-to-gas mass ratio varying between 3.8 and 6.5 for the best-fit model when combined with water-production rates from the MIRO experiment