Search

Educators must provide controlled scenarios for health professional students to develop patient safety competencies related to telemedicine, including when and how to escalate care. We developed a telepsychiatry workshop to give students experience with a high-stakes mental health condition. The workshop included (1) pre-session readings; (2) didactics on mood disorders and telepsychiatry; (3) a motivational interviewing exercise; (4) a simulated telemedicine encounter; and (5) a faculty-led group debrief. We evaluated teaching effectiveness using a competency assessment with three scales: (1) medical knowledge; (2) interpersonal and communication skills; and (3) telemedicine competencies. Between 0 and 59% of students were entrustable for each telemedicine competency. Our workshop demonstrates how to teach students about the safe use of telehealth technology and provides practice triaging mental health conditions commonly encountered in primary care and mental health telemedicine clinics.

South Africa has taken an iterative approach to marine ecosystem mapping over 18 years that has provided a valuable foundation for ecosystem assessment, planning and decision-making, supporting improved ecosystem-based management and protection. Iterative progress has been made in overcoming challenges faced by developing countries, especially in the inaccessible marine realm. Our aim is to report on the approach to produce and improve a national marine ecosystem map to guide other countries facing similar challenges, and to illustrate the impact of even the simplest ecosystem map. South Africa has produced four map versions, from a rudimentary map of 34 biozones informed by bathymetry data, to the latest version comprising 163 ecosystem types informed by 83 environmental and biodiversity datasets that aligns with the IUCN Global Ecosystem Typology. Data were unlocked through academic and industry collaborations; multi-disciplinary, multi-realm and multi-generational networks of practitioners; and targeted research to address key gaps. To advance toward a more transparent, reproducible and data-driven approach, limitations, barriers and opportunities for improvement were identified. Challenges included limited human and data infrastructure capacity to collate, curate and assimilate many data sources, covering a variety of ecosystem components, methods and scales. Five key lessons that are of relevance for others working to advance ecosystem classification and mapping, were distilled. These include (1) the benefits of iterative improvement; (2) the value of fostering relationships among a co-ordinated network of practitioners including early-career researchers; (3) strategically prioritizing and leveraging resources to build and curate key foundational biodiversity datasets and understand drivers of biodiversity pattern; (4) the need for developing, transferring and applying capacity and tools that enhance data quality, analytical workflows and outputs; and (5) the application of new technology and emerging statistical tools to improve the classification and prediction of biodiversity pattern. South Africa’s map of marine ecosystem types has been successfully applied in spatial biodiversity assessment, prioritization to support protected area expansion and marine spatial planning. These successes demonstrate the value of a co-ordinated network of practitioners who continually build an evidence base and iteratively improve ecosystem mapping while simultaneously growing ecological knowledge and informing changing priorities and policy.

With increasing evidence of electroreception in terrestrial arthropods, understanding receptor level processes is vital to appreciating the capabilities and limits of this sense. Here, we examine the spatio-temporal sensitivity of mechanoreceptive filiform hairs in detecting electrical fields. We first present empirical data, highlighting the time-varying characteristics of biological electrical signals. We then explore how electrically sensitive hairs may respond to such stimuli. The main findings are: (i) oscillatory signals (elicited by wingbeats) influence the spatial sensitivity of hairs, unveiling an inextricable spatio-temporal link; (ii) wingbeat direction modulates spatial sensitivity; (iii) electrical wingbeats can be approximated by sinusoidally modulated DC signals; and (iv) for a moving point charge, maximum sensitivity occurs at a faster timescale than a hair’s frequency-based tuning. Our results show that electro-mechanical sensory hairs may capture different spatio-temporal information, depending on an object’s movement and wingbeat and in comparison, to aero-acoustic stimuli. Crucially, we suggest that electrostatic and aero-acoustic signals may provide distinguishable channels of information for arthropods. Given the pervasiveness of electric fields in nature, our results suggest further study to understand electrostatics in the ecology of arthropods and to reveal unknown ecological relationships and novel interactions between species.

Recent investigations highlight the possibility of electroreception within arthropods through charged mechanosensory hairs. This discovery raises questions about the influence of electrostatic interaction between hairs and surrounding electrical fields within this sensory modality. Here, we investigate these questions by studying electrostatic coupling in arrays of hairs. We establish the notion of sensitivity contours that indicate regions within which point charges deflect hairs beyond a given threshold. We then examine how the contour���s shape and size and the overall hair behaviour change in response to variations in the coupling between hairs. This investigation unveils synergistic behaviours whereby the sensitivity of hairs is enhanced or inhibited by neighbouring hairs. The hair spacing and ratio of a system���s electrical parameters to its mechanical parameters influence this behaviour. Our results indicate that electrostatic interaction between hairs leads to emergent sensory properties for biologically relevant parameter values. The analysis raises new questions around the impact of electrostatic interaction on the current understanding of sensory hair processes, such as acoustic sensing, unveiling new sensory capabilities within electroreception such as amplification of hair sensitivity and location-detection of charges in the environment.

Recent investigations highlight the possibility of electroreception within arthropods through charged mechanosensory hairs. This discovery raises questions about the influence of electrostatic interaction between hairs and surrounding electrical fields within this sensory modality. Here, we investigate these questions by studying electrostatic coupling in arrays of hairs. We establish the notion of sensitivity contours that indicate regions within which point charges deflect hairs beyond a given threshold. We then examine how the contour���s shape and size and the overall hair behaviour change in response to variations in the coupling between hairs. This investigation unveils synergistic behaviours whereby the sensitivity of hairs is enhanced or inhibited by neighbouring hairs. The hair spacing and ratio of a system���s electrical parameters to its mechanical parameters influence this behaviour. Our results indicate that electrostatic interaction between hairs leads to emergent sensory properties for biologically relevant parameter values. The analysis raises new questions around the impact of electrostatic interaction on the current understanding of sensory hair processes, such as acoustic sensing, unveiling new sensory capabilities within electroreception such as amplification of hair sensitivity and location-detection of charges in the environment.

Ioanna K Bolia, Aryan Haratian, Jennifer A Bell, Laith K Hasan, Nima Saboori, Ryan Palmer, Frank A Petrigliano, Alexander E Weber USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USACorrespondence: Alexander E WeberUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USAEmail weber.ae@gmail.comAbstract: Anterior cruciate ligament reconstructions (ACLR) are a relatively common procedure in orthopedic sports medicine with an estimated 130,000 arthroscopic operations performed annually. Most procedures are carried out on an outpatient basis, and though success rates of ACLR are as high as 95%, pain remains the most common postoperative complication delaying patient discharge, and thereby increasing the costs associated with patient care. Despite the success and relative frequency of ACLR surgery, optimal and widely accepted strategies and regimens for controlling perioperative pain are not well established. In recent years, the paradigm of pain control has shifted from exclusively utilizing opiates and opioid medications in the acute postoperative period to employing other agents and techniques including nerve blocks, intra-articular and periarticular injections of local anesthetic agents, NSAIDs, and less commonly, ketamine, tranexamic acid (TXA), sedatives, gabapentin, and corticosteroids. More often, these agents are now used in combination and in synergy with one another as part of a multimodal approach to pain management in ACLR, with the goal of reducing postoperative pain, opioid consumption, and the incidence of delayed hospital discharge. The purpose of this review is to consolidate current literature on various agents involved in the management of postoperative pain following ACLR, including the role of classically used opiate and opioid medications, as well as to describe other drugs currently utilized in practice either individually or in conjunction with other agents as part of a multimodal regimen in pain management in ACLR.Keywords: anterior cruciate ligament reconstruction, ACL, postoperative pain, patient outcomes, multimodal pain management

Service networks are common throughout the modern world, yet understanding how their individual services effect each other and contribute to overall system performance can be difficult. An important metric in these systems is the quality of service. This is an often overlooked measure when modelling and relates to how customers are affected by a service. Presented is a novel perspective for evaluating the performance of multi-class queueing networks through a combination of operational performance and service quality—denoted the “flow of outcomes”. Here, quality is quantified by customers moving between or remaining in classes as a result of receiving service or lacking service. Importantly, each class may have different flow parameters, hence the positive/negative impact of service quality on the system’s operational performance is captured. A fluid–diffusion approximation for networks of stochastic queues is used since it allows for several complex flow dynamics: the sequential use of multiple services; abandonment and possible rejoin; reuse of the same service; multiple customers classes; and, class and time dependent parameters. The scalability of the approach is a significant benefit since, the modelled systems may be relatively large, and the included flow dynamics may render the system analytically intractable or computationally burdensome. Under the right conditions, this method provides a framework for quickly modelling large time-dependent systems. This combination of computational speed and the “flow of outcomes” provides new avenues for the analysis of multi-class service networks where both service quality and operational efficiency interact.

This thesis investigates narratives of re-enchantment and disenchantment in three contemporary U.S. novels, Lydia Millet’s Mermaids in Paradise, Karen Tei Yamashita’s Tropic of Orange, and Thomas Pynchon’s Inherent Vice. Drawing on key concepts from ecocritcism and affect theory, I argue that these novels interrogate narratives and affects associated with questions central to the Anthropocene: climate-related dilemmas, questions of environmental justice, and animal ethics. Situating these texts in relation to environmental discourses, I show how affects of wonder and re-enchantment are produced within them through the insertion of anti-mimetic narrative objects into otherwise representationally realistic fictional worlds. These incursions, and the affective shifts they produce, challenge and interrupt in the novels narratives of ecological dread and disenchantment, which I link to the techniques and affects of noir. In each chapter of this study, I show how the dialogical interplay between disenchantment and re-enchantment disrupts preconceptions and assumptions about aspects of ecological crisis, and engenders or reinforces political commitments to environmentally related issues. Chapter One focuses on interspecies politics and animal rights in Mermaids in Paradise, environmental justice is central to the analysis of Tropic of Orange in Chapter Two, and the political dynamics of countercultural environmentalism inform my reading of Inherent Vice in Chapter Three. Throughout, I explore the potential of re-enchantment to suggest an alternative to disenchanted and apocalyptic narratives concerning the environment, and to articulate a productive politics for contemporary ecofiction.

Reseña del libro: Joni Adamson and Kimberly Ruffin (eds.), American studies, ecocriticism, and citizenship: thinking and acting in the local and global commons. New York: Routledge, 2013. xx, 269 p.

Chiral primary amines are important intermediates in the synthesis of pharmaceutical compounds. Fungal reductive aminases (RedAms) are NADPH-dependent dehydrogenases that catalyse reductive amination of a range of ketones with short-chain primary amines supplied in an equimolar ratio to give corresponding secondary amines. Herein we describe structural and biochemical characterisation as well as synthetic applications of two RedAms from Neosartorya spp. (NfRedAm and NfisRedAm) that display a distinctive activity amongst fungal RedAms, namely a superior ability to use ammonia as the amine partner. Using these enzymes, we demonstrate the synthesis of a broad range of primary amines, with conversions up to >97% and excellent enantiomeric excess. Temperature dependent studies showed that these homologues also possess greater thermal stability compared to other enzymes within this family. Their synthetic applicability is further demonstrated by the production of several primary and secondary amines with turnover numbers (TN) up to 14000 as well as continuous flow reactions, obtaining chiral amines such as (R)-2-aminohexane in space time yields up to 8.1 g L-1 h-1. The remarkable features of NfRedAm and NfisRedAm highlight their potential for wider synthetic application as well as expanding the biocatalytic toolbox available for chiral amine synthesis.