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Introduction The Covid-19 pandemic forced changes to care pathways. We have analysed the difference in provision of care to patients presenting with ureteric colic during the pandemic (PC) compared to a pre-pandemic cohort (PPC). Method A list was generated of all CT KUB scans requested in the emergency department. Imaging and notes were reviewed to identify acute ureteric colic presentations in September to December 2019 and 2020. Statistical significance was calculated using either the Student T-test or Chi-squared test. Results There were 92 patients in the PC, and 107 in the PPC. Primary treatment was provided for more patients during the pandemic (25% vs 10%, p The rate of conservative management (64% vs 76%, p>0.05), temporising stent (11% vs 14%, p>0.05), and nephrostomy insertion (1% vs 1%, p>0.05) was similar in PC and PPC. The PC had a shorter time to intervention (17 vs 39 days, p0.05), to ureteroscopy (35 vs 45 days, p>0.05), and to stone passage confirmation (44 vs 91 days, p There was no follow up for 15% and 30% respectively (p Conclusion During the pandemic, a reduction in electives created capacity for urgent interventions, (21% vs 7% ESWL, 4 vs 12 waiting days). Accordingly, the stone passage confirmation time was more than halved (44 vs 91 days). In accordance with recommendations from NICE, TISU and GIRFT, this demonstrates the importance of ringfencing ESWL, particularly as we emerge from the pandemic.

Sea cucumbers haven’t been utilized optimally, and have a high economic value, due to high protein content of meat. This research aims to know the proximate content and total amino acids of sea cucumber flour, and total amino acids of protein concentrate of sea cucumber. The result showed that different ratios of flour and solvent have a significant effect on protein concentrate. Proximate content and protein concentrate with the ratio of flour and solvents (1:3) are protein 74.25%, moisture 10.58%, ash 7.25%, carbohydrate 6.47%, crude fiber 2.66%, and fat 0.16%. Total amino acids protein concentrate (1:3) is 53.59%. The major amino acids protein concentrate are glutamic acid, glycine, alanine, and aspartic acid. Ratios of flour and solvent (1:4) are protein content 76.13%, moisture 10.35%, ash 7.17%, carbohydrate 6.03%, crude fiber 2.51% and fat 0.13%. Total amino acids protein concentrate (1:4) is 56.74%. The major amino acids in protein concentrate are glycine, glutamic acid, alanine, and arginine. Ratios of flour and solvent (1:5) are protein 77.35%, moisture 9.14%, ash 6.67%, carbohydrate 6.00%, crude fiber 2.45%, and fat 0.10% respectively. Total amino acids protein concentrate (1:5) is 61.63%. The major amino acids protein concentrate are glycine, glutamic acid, aspartic acid, and alanine.

Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

Introduction: Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe. Materials and methods: Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software. Results: A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4 ± 3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume < 1 portions of fruit/day and more than half (52%) eat < 1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6 hours/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30 min twice weekly was only performed by 33% of the respondents. Conclusions: Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.

This study aimed to determine the processing of gelatin of catfish skin using the papain enzyme in 3 different concentrations. The method used was an experiment with a factorial Completely Randomized Design (CRD). The experiment consisted of 2 factors, namely papain enzyme concentration and the immersion time of the enzyme with 3 replications. The first factor consisted of 3 levels, namely the use of papain enzymes P1 (2%), P2 (4%) and P3 (6%). The second factor, the immersion time consisted of 3 levels of 25 minutes (W1), 35 minutes (W2) and 45 minutes (W3). The data were analyzed by using CRD. The results showed that the combination of P2W1 showed the best viscosity and gel strength (6.77 CP and 115.17 g bloom).

Background Access to dermatologists is an ongoing concern for Medicaid enrollees. Understanding current use is a key step toward designing and implementing policies to improve access. Objective We sought to quantify how often Medicaid enrollees visit dermatologists and receive treatment for skin-related conditions compared with patients with other coverage or without health insurance. Methods We conducted a retrospective cross-sectional analysis of multiyear federal survey data (Medical Expenditure Panel Survey). The sample included Medical Expenditure Panel Survey respondents younger than 65 years from 2008 to 2012. Results In unadjusted comparisons, we found that 1.4% of Medicaid enrollees had an ambulatory visit to a dermatologist annually, compared with 1.2% of uninsured individuals and 5.5% of individuals with private coverage. In adjusted models, we found that health insurance source, age, sex, race/ethnicity, and geography are associated with the likelihood of having visits to a dermatologist. Compared with individuals with private coverage, Medicaid enrollees are less likely to receive a diagnosis for a skin condition by any provider and are less than half as likely to have skin-related diagnoses made by dermatologists. Limitations We have relatively few Medical Expenditure Panel Survey respondents for a subset of specific diagnoses. Conclusions Our findings emphasize the need for efforts to reduce disparities in access to dermatologists.

In May 2017, the American Academy of Dermatology convened a Dermatology Specialty Summit, with representatives from 15 dermatology specialty societies, the American Board of Dermatology, and the Coalition of Skin Diseases in attendance. The Summit's goal was to identify opportunities to address and enhance the perception of dermatology in the House of Medicine, the role of data in the changing health care environment, and access to dermatologic care. Summit participants collectively identified a list of 10 action items that address opportunities in these areas of concern. These include active participation in the House of Medicine, increased interaction with and education of our primary care colleagues, efforts to support DataDerm, and creative ways to improve access.

Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe.Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software.A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4±3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume1 portions of fruit/day and more than half (52%) eat1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6hours/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30min twice weekly was only performed by 33% of the respondents.Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.

Objectifs L’objectif de notre etude (IDENTIFY) etait de determiner le taux de cancer des voies urinaires de maniere contemporaine ainsi que les performances des tests diagnostiques chez des patients ayant une suspicion de cancer urothelial. Methodes Etude prospective, internationale et multicentrique aupres de patients adresses pour cystoscopie en consultation d’urologie. Les donnees demographiques, cliniques et des tests diagnostiques ont ete recoltees. Les taux de prevalence ont ete calcules pour chaque sous-type de cancer urologique de meme que la performance des tests diagnostiques. Resultats Plus de 11 060 patients consultant pour cystoscopie ont ete inclus dans 128 hopitaux de 30 pays (decembre 2017–decembre 2018). Au total, 65 % presentait une hematurie macroscopique (HMa), 29 % une hematurie microscopique (Hmi) et 6 % aucune hematurie (AH). La prevalence du cancer de la vessie (CV) etait de 17,7 % globalement ; de 18,1 %, 3,7 % et 26,6 % pour les groupes HMa, Hmi et AH respectivement. On retrouvait une HMa dans 81,5 % des cancers de vessie. La prevalence des tumeurs de la voie excretrice superieure (TVES) etait de 1 %, du carcinome a cellules renales de 0,9 % et le cancer de la prostate de 1,2 %. La prevalence du CV et des TVES culminait entre 70 et 79 ans et etait plus elevee chez les hommes. Les variables associees de maniere significative aux CV comprenaient le type d’hematurie, l’âge, les antecedents de tabagisme, l’anticoagulation, les signes fonctionnels urinaire de la phase de remplissage et plus d’un episode d’HMa (25,5 %) contre un seul episode (17,9 %). Les performances diagnostiques de l’echographie et de l’uroscanner sont presentees dans le Tableau 1 . Conclusion En cas d’hematurie macroscopique, une tumeur de vessie est identifiee dans pres d’une cystoscopie sur 5. L’echographie et l’uroscanner ont des performances similaires pour diagnostiquer un cancer de vessie. Ces nouvelles donnees permettront une approche personnalisee des bilans d’hematurie ainsi que le developpement de modeles predictifs afin optimiser la detection du cancer urothelial.

Research objectives were to explain smallholder oil palm production expenditure, to explain annual rate of their profit, to explain feasibility smallholder oil palm farming financially in Muaro Jambi District, Jambi. Study was conducted in in 2017. 86 samples were selected by sampling method purposively. Primary and secondary data was needed in this research. Research operated the calculation of TC = FC + VC to explain first objective. While I = TR − TC method was operated to explain second objective. In order to analyze last objective, some methods were operated. Research found that rate of its expenditure was in average level. Its cost included operation cost, labor cost and other cost. Rate of its profit each hectare was IDR 19.118.532.-while its rate per household was IDR 25.412.602.-Therefore, it can be said that smallholder oil palm farming was feasible.

Despite recent advances in breast cancer therapeutics, mortality of metastatic triple negative breast cancer (TNBC) subtype remains high; due to their lack of hormone receptors expression for targeted therapy. Aberrant activation of Wnt/β-catenin signaling has been associated with breast cancers; where 40% of total breast cancers have elevated β-catenin levels with increased Wnt activity. Recently, we identified DEAD-box RNA helicase DP103 as a novel prognostic biomarker and metastasis-driving oncogene; highly expressed in TNBC subtype. Interestingly, we found high DP103 expression to be positively correlated with high β-catenin expression in clinical specimens (n=400). This led us to hypothesize a possible role of DP103 in modulating the Wnt/β-catenin pathway in TNBCs. Depletion of DP103 in metastatic TNBC cells decreases Wnt/β-catenin activity and expression of downstream Wnt target genes, while overexpression of DP103 increases Wnt activity. Depletion of DP103 also decreases phosphorylation of LRP6 and several important Wnt modulators required for downstream Wnt activation. Moreover, induction of Wnt/β-catenin signaling in Wnt responsive TNBC cells also significantly increased DP103 expression, indicating a possible positive feedback loop. Both canonical and non-canonical Wnt signaling is known to independently promote stem cell growth in mammospheres. Herein, we will also provide evidence on the role of DP103 in promoting breast cancer stem cell-like properties. Collectively, our data show a novel regulatory role of DP103 in the Wnt/β-catenin signaling pathway and in promoting breast cancer stem cell-like behavior, presenting itself as a potential drug target in TNBC patients. Citation Format: Cai W, Cheong JK, Edison E, Banerjee A, Tan TZ, Gaboury L, Yousef EM, Thiery JP, Lobie PE, Virshup DM, Yap CT, Kumar AP. DEAD-box RNA helicase DP103 as a novel regulator of Wnt/β-catenin signaling pathway and promotes cancer stem cell-like behavior in triple negative breast cancers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-08-03.

Introduction The present maldistribution of dermatologists in the USA may make it difficult for patients to access timely and quality care. Access to specialty care may be even more challenging for rural and underserved patients due to geographical limitations and other socioeconomic hardships. With over one-third of primary care patients seeking care for at least one skin problem, it is important to follow the American Academy of Dermatology Special Positioning Workgroup\'s core areas of impact regarding treatment of conditions that affect millions of patients by using a team-based approach and telemedicine technologies. The objective of this study was to demonstrate the Dermatology Extension for Community Healthcare Outcomes (ECHO) project approach in multidisciplinary telementoring and education of primary care providers (PCPs) in treatment and management of complex, costly, and common skin diseases via live interactive video technologies. Methods Dermatology ECHO is a distance education telementoring platform that uses a multidisciplinary case-based approach in a non-judgemental environment. A team of specialists, including general dermatologists, pediatric dermatologists, a dermatopathologist, a clinical psychologist, and a nurse practitioner, meets via video with a number of PCPs from isolated, rural, or underserved areas to discuss de-identified patient cases and present dermatology-specific continuing medical education (CME)-approved didactic presentations. The University of Missouri, Department of Dermatology, leads the first Dermatology ECHO in the USA. They partner with various primary care clinics across Missouri to provide mentoring in the treatment of skin conditions. Missouri Telehealth Network provides operational support through the Show-Me ECHO project. The network also assists with provider recruitment activities. Results The authors describe a patient case to illustrate the effect of ECHO on provider distance learning and patient outcomes. A 69-year-old woman from rural Missouri was spurred by a rooster. She presented to her primary care clinic six times over a 2-month period. She was prescribed several different medications and underwent tests and one procedure, including vaccination. After the patient\'s case was presented during the Dermatology ECHO session, she was correctly diagnosed with a Mycobacterium skin infection, and new recommendations were made. The patient improved significantly within 2 weeks. Conclusions As specialty medical evidence-based recommendations continue to increase, providers practicing in isolated rural and underserved areas may find it challenging to keep up with the new knowledge. Dermatology ECHO creates a community of practice that allows participating providers to discuss complex cases, receive specific guidance and mentoring, and participate in CME presentations. The case presented here supports the authors\' observations that Dermatology ECHO is an appropriate platform for learning evidence-based medical knowledge via videoconferencing technology.

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.

We assessed the clinical course of patients after store and forward teledermatology in comparison with conventional consultations. Patients being referred from primary care to dermatology clinics were randomly assigned to teledermatology or a conventional consultation. A total of 392 patients were randomized; 261 patients completed the study and were included in the analysis. Their clinical course was rated on a five-point scale by a panel of three dermatologists, blinded to study assignment, who reviewed serial digital image sets. The clinical course was assessed by comparing images sets between baseline and first clinic visit (if one occurred) and between baseline and nine months. There was no evidence to suggest a difference between the two groups in either clinical course between baseline and nine months post-referral ( P = 0.88) or between baseline and the first dermatology clinic visit ( P = 0.65). Among teledermatology referrals, subsequent presentation for an in-person dermatology clinic visit was significantly correlated with clinical course ( P = 0.023). Store and forward teledermatology did not result in a significant difference in clinical course at either of two post-referral time periods.

The aim of this study was to retrospectively describe hybrid technology teledermatology encounters performed by a statewide telehealth network. Consult outcomes were reviewed to describe the number of encounters that resulted in a visit to the university-based dermatology clinics and the features of those visits.Teledermatology encounters were reviewed to determine encounter volume and the proportion of encounters that resulted in a university-based dermatology clinic visit. Additional information collected included demographics, the reason for the visit, management recommendations, and clinical diagnoses. After identifying those consults that resulted in a dermatology clinic visit, we reviewed a random sample of teledermatology encounters that did not result in a university-based dermatology clinic visit for a descriptive comparison.A total of 1,536 teledermatology encounters were completed by the network between 2001 and 2007. Of the 1,307 encounters reviewed, 56 patients were seen in the university-based dermatology clinic after the teledermatology encounter. The need for a procedure or clinic-based intervention was a reason for the visit in 79% of these encounters. When reviewing management recommendations, 46% of the patients who required a university-based clinic visit needed a procedural intervention compared with 8% of the group that did not need a clinic visit. Medical recommendations predominated in the telemedicine-only group (71%) compared with the clinic-based visit group (36%).Our study describes the features, such as demographics and case-mix, of users and nonusers of university-based dermatology clinics after teledermatology encounters that may be important considerations for future evaluations of teledermatology consult systems.

A rapid screening method for pesticides has been developed to promote more efficient processing of produce entering the United States. Foam swabs were used to recover a multiclass mixture of 132 pesticides from the surfaces of grapes, apples, and oranges. The swabs were analyzed using direct analysis in real time (DART) ionization coupled with a high-resolution Exactive Orbitrap™ mass spectrometer. By using a DART helium temperature gradient from 100-350°C over 3 min, a minimal separation of analytes based on volatility differences was achieved. This, combined with the Exactive's mass resolution of 100,00, allowed the chromatographic step, along with the typical compositing and extraction steps associated with gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/mass spectrometry (LC/MS) approaches, to be eliminated. Detection of 86% of the analytes present was consistently achieved at levels of 2 ng/g (per each apple or orange) and 10 ng/g (per grape). A resolution study was conducted with four pairs of isobaric compounds analyzed at a mass resolution of 100 000. Baseline separation was achieved with analyte ions differing in mass by 25 ppm and analyte ions with a mass difference of 10 ppm were partially resolved. In addition, field samples that had undergone traditional sample preparation using QuEChERS (quick, easy, cheap, rugged, and safe) were analyzed using both LC/MS and DART-MS and the results from the two techniques were found to be comparable in terms of identification of the pesticides present. The use of swabs greatly increased sample throughput by reducing sample preparation and analysis time.

Teledermatology refers to the use of technology to exchange dermatologic information. The demand for dermatologic care continues to grow rapidly, while the ability to deliver it is relatively static. In a world of scarce dermatologic resources and significant demand, teledermatology offers a relatively economical option for improving access to diagnostically reliable and accurate dermatologic care. Current teledermatologic research is focused on better understanding the quality of teledermatologic care as compared with standard methods of care delivery. This article examines teledermatology, from its origins, to its ‘present’, including recent studies examining the quality of teledermatologic care as well as the variety of ways in which this technology is being employed. Finally, it discusses the bright future of teledermatology and the directions it may take.

Research is yet to fully examine the utility and effectiveness of telehealth in primary care resident ambulatory training. This study examined the attitudes of preceptors, residents, and nurses on (1) the impact of telehealth on healthcare; (2) the impact of telehealth on the work activity of resident clinics; (3) the impact of telehealth on resident training in the outpatient setting; and (4) the impact of telehealth on relationships. There were three focus groups, one each of preceptors (N = 5), residents (N = 10), nurses (N = 7). Eight focus group themes evolved regarding the use of telehealth in the resident clinic: (1) impact on patient/provider relationships; (2) consistent with the values of those using telehealth; (3) logistics; (4) reduces patient transfers; (5) appropriate level of care; (6) reimbursement concerns; (7) psychological risk; and (8) impact on resident/attending relationships. Though as yet not generalizable, results of this pilot study suggest that there is general acceptability of telehealth in ambulatory resident training settings, but there is concern about the impact that telehealth may have on relationships, logistics, finances, and the need to see patients face-to-face when there is greater complexity.

Teledermatology studies have examined diagnostic concordance between live-interactive (LI) and in-person examinations (IP); and between store-and-forward (SF) and IP examinations. However, no studies have looked simultaneously across all three care delivery modalities, and few have measured management concordance and diagnostic confidence of the dermatologist. The purpose of this study was to compare LI and SF modalities with IP with respect to diagnostic and management concordance and to compare physician diagnostic confidence across the three modalities. Four dermatologists, in random rotation among all three care modalities, examined 110 new patients. Confidence was rated on a Likert scale from 1 to 5 (5 = total confidence; 1 = no confidence). Identical diagnoses were given to the patient by examiners from all three examination modalities in 70/110 patients (64%). More identical diagnoses were given for IP and LI examinations than for IP and SF examinations (80% vs. 73%); however, the difference was not statistically significant (p = 0.13). The highest self-reported confidence rating was given for 87% of IP examinations, 59% for LI, and 54% for SF. Diagnostic confidence ratings for SF and LI were not significantly different from each other (p = 0.50); however, diagnostic confidence ratings for LI and SF were both statistically lower than IP (p < 0.0001). Dermatologists were more confident with IP examination than either form of teledermatology. The percent of diagnostic and management agreement among IP, LI, and SF modalities was high.

The ATA assembled a group of experts to develop practice guidelines for teledermatology. This document represents the body of work that this distinguished group assembled. It was approved by the ATA Board of Directors and is presented here in its entirety.

In the aerobic oxidation of methanol catalyzed by a Ni(II)(TRISOX) complex [H3TRISOX = tris(1-propan-2-onyl oxime)amine], an intermediate is observed spectroscopically. The intensities of both the UV–Vis absorption and electron paramagnetic resonance (EPR) spectra associated with this intermediate maximize during the time period of maximum formaldehyde production, and decrease as the methanol oxidation activity decreases. The UV–Vis spectrum has prominent features at 350, 420, and 535 nm. The EPR spectrum is centered at g = 2.00 and shows splittings of 28 ± 5 G. Both of these spectra are consistent with characterization of the intermediate as including one or more iminoxyl radicals derived from the oximate groups of the TRISOX ligand. Spectroscopic features very similar to those in the air-oxidized intermediate are observed in electrochemically oxidized samples, suggesting that the electrochemically generated complex will be a useful model for the intermediate observed during catalytic turnover. The crystal structure of a Ni(II) complex with an intermediate protonation state of the ligand, [Ni(II)2(H2TRISOX)2(μ2:η1-ONO2)](NO3) · (CH3CN) · 5(H2O), 4, has been structurally characterized. Comparison to the previously reported [Ni(II)(H2TRISOX)(CH3CN)]2(ClO4)2, 3, shows that bis(μ-oximate) dimers can form either with or without an additional bridging ligand. Addition of the nitrato bridge decreases the Ni–Ni distance from 3.5752(13) A in 3 to 3.2014(4) A in 4. It is intriguing to note that the reactions catalyzed by the Ni(II)(TRISOX) complex, the net transfer of two hydrogen atoms from an alcohol or amine substrate to O2, are the same reactions catalyzed by several different metalloenzymes that also incorporate both a redox active metal and a redox active organic component in their active sites.

This article provides an introduction to the current state of research on the History of the Catholic Church, as reflected in studies and discussions published in books and journals in Brazil, in the years 1965-2015. The last five decades have witnessed the transformation of the field, from a discipline that concerned only Catholic ecclesiastics and laity, to a plural discipline with varied modes of approach, that attracts many specialists from the human sciences. Este artículo presenta al lector el panorama actual de los estudios y de los debates publicados en Brasil, en libros o revistas especializadas, en los años de 1965 a 2015, sobre temas e líneas de investigación en Historia de la Iglesia Católica. Queda demostrado en esas pocas líneas que en estas cinco décadas el tema pasó por grandes cambios: de ser una disciplina que interesaba casi que exclusivamente a eclesiásticos y fieles católicos, a una disciplina plural en sus metodologías de abordaje, atrayendo de este modo a muchos especialistas en ciencias humanas.

In addition to a well-recognized hyperhomocysteinemic state, folate deficiency also leads to profound hyperglycinemia. To further characterize the latter observation, two trials were conducted using a folate-deficient rat model to (1) determine the sensitivity of plasma glycine to folate repletion and (2) test the hypothesis that hyperglycinemia results from a reduced flux through the folate-dependent glycine cleavage system (GCS). Weanling male Sprague-Dawley rats were used, and they consumed an amino acid-defined diet with either 0 (FD) or 1 (FA) mg/kg of crystalline folic acid. In Trial 1, 30 rats consumed the FD diet for 28 days. Rats then consumed diets containing 0.1, 0.2, 0.3 or 0.4 mg/kg of folic acid for 14 days before termination. In Trial 2, 16 rats were allocated to receive either the FA (n=8) or FD (n=8) diet for 30 days before termination. Liver mitochondria were isolated and flux through the GCS (measured as 14CO2 production from 1-14C-glycine) was determined. Plasma from blood collected at termination was analyzed for folate, homocysteine and glycine. In Trial 1, both homocysteine and glycine responded linearly to increased dietary folic acid (milligrams per kilogram) levels (P.05). In Trial 2, plasma folate (FA=25.85 vs. FD=0.66; S.E.M.=1.4 microM), homocysteine (FA=11.1 vs. FD=55.3; S.E.M.=1.7 microM) and glycine (FA=564 vs. FD=1983; S.E.M.=114 microM) were significantly affected by folate deficiency (P.0001). However, glycine flux through hepatic GCS was not affected by folate deficiency (P.05). These results provide evidence that in a folate-deficient rat model, both homocysteine and glycine are sensitive to dietary folic acid levels; however, the observed hyperglycinemia does not appear to be related to a reduced flux through the hepatic GCS.

Summary Background: While there may be benefits that accrue to the use of telemedicine technology in patient care, such as decreased costs and improved access, it has yet to be determined how telemedicine impacts patients' ability to express themselves and accordingly, how it impacts health care providers' communication of instructions or expressions of empathy. Aim: The aim of this study was to examine the effect of telemedicine technology on communication by comparing the style and content of communication between actual (i.e., face to face) and virtual (i.e., non-face to face, telemedical) dermatology visits. The hypothesis was that there is no difference in the content and style of communication between actual and virtual visits in dermatology. Methods: Face-to-face and video-mediated dermatology sessions were observed and also audiotaped, timed and transcribed. A content analysis was performed. Results: Average duration of a face-to-face session was 11min (S.D. 0.08) and of a telemedical session 9min (S.D. 0.002). Small talk occurred in 20% of all face-to-face and 29.6% of all telemedical visits. Clinical assessment occurred in all sessions. Patient education occurred in 90% of face-to-face and 78% of telemedical visits. Other themes were also identified (e.g., discussion of treatment, promotion of compliance, psychosocial issues). In 14.8% of telemedical sessions technical issues were raised. Findings indicate that communication patterns in the two modes of care delivery are comparable.

A new pendant-arm derivative of diaza-18-crown-6, containing two oxime donor groups, has been synthesized and incorporated into a polyvinyl chloride (PVC) membrane ion-selective electrode. The electrode shows selectivity for Ag+ ion, with a near Nernstian response. Pb2+, Cu2+, Hg2+, and Tl+ are major interfering ions, with Cd2+ having minor interference. The electrode shows no potentiometric response for the ions Mg2+, Al3+, K+, Ca2+, Ni2+, Fe3+, and La3+, and is responsive to H+ at pH

The purpose of this study was to determine telehealth professionals' current experience with technology, expectations of future technical improvements, and how the technology might impact the delivery of care, including communication with patients and patient safety. We developed a semi-structured interview protocol with eight open-ended questions. A sample of telehealth professionals of the Missouri Telehealth Network (MTN) was selected to represent all major clinical specialties. Interviews were conducted during face-to-face encounters or over the phone. A content analysis was performed using the interview transcripts. A total of 32 telehealth professionals were interviewed (representing 80% of all professionals who were registered MTN users at the time of the study). Twenty-six of them are care providers (physicians, nurses, etc.), and the remaining six are administrators or educators. Self-reported experience with telemedicine ranged from 1 to 7 years (mean 3.72 years). Telehealth professionals find the technology acceptable and easy to integrate in the care delivery process. However, many professionals believe there is room for improvement and would like it to reach a more consistent, reliable, but yet flexible state. They recommended that emphasis be placed on improvement of the audio features, establishment of connections, and avoidance of interruptions. Thirty-two percent of the respondents did not know whether practicing telemedicine over the telehealth network would increase the risk of security and privacy violations. The study findings suggest that telehealth professionals need to be educated about the security features of a telehealth network. In addition, continuous quality improvement, including internal and external benchmarking, is applicable to telemedicine settings and can both improve the quality of teleconsultations and minimize errors.

A library of tripodal amine ligands with two oxime donor arms and a variable coordinating or noncoordinating third arm has been synthesized, including two chiral ligands based on l-phenylalanine. Their Ni(II) complexes have been synthesized and characterized by X-ray crystallography, UV-vis absorption, circular dichroism, and FTIR spectroscopy, mass spectrometry, and room-temperature magnetic susceptibility. At least one crystal structure is reported for all but one Ni/ligand combination. All show a six-coordinate pseudo-octahedral coordination geometry around the nickel center, with the bis(oxime)amine unit coordinating in a facial mode. Three distinct structure types are observed: (1) for tetradentate ligands, six-coordinate monomers are formed, with anions and/or solvent filling out the coordination sphere; (2) for tridentate ligands, six-coordinate monomers are formed with Ni(II)(NO(3))(2), with one monodentate and one bidentate nitrate filling the remaining coordination positions; (3) for tridentate ligands, six-coordinate, bis(mu-Cl) dimers are formed with Ni(II)Cl(2), with one terminal and two bridging chlorides filling the coordination sphere. The UV-vis absorption spectra of the complexes show that the value of 10 Dq varies according to the nature of the third arm of the ligand. The trend based on the third arm follows the order alkyl/arylamidecarboxylatealcoholpyridyloxime.

It is an interesting quirk of medical history that the legacy of Norman Barrett most ostensibly lies in the name of a disease the he was quite emphatically wrong about, at least when he first described it. Indeed, there are those who argue to remove the eponym in favour of the title ‘Columnar Lined Epithelium’, in part because of what little Barrett actually had to do with the correct initial characterisation of this disease. Yet the sum of Norman Barrett’s contributions to modern medicine is much more than a mistaken characterisation of a pathological process. Barrett was truly a pioneer of chest surgery in the UK – a speciality in its embryonic stages when he first qualified. He was also renowned as a teacher and academic of the highest calibre. In tracing the story of his life we can see how his natural attributes, life experiences and keen appreciation of the arts (especially history) facilitated personal success and such sharp insight into the vagaries of modern academic medicine.

Rapid advances in telehealth development and adoption are increasing the spectrum of information and communication technologies that can be applied not only to individual patient care but more broadly to population health as well. Participants in this breakout session were asked to address, from their diverse perspectives, a series of questions relating to the current and potential uses of telehealth applications and networks for public health and emergency/disaster preparedness and response systems. Participants identified several gaps in current understanding and research emphasis. There is a clear need for more and larger outcome studies to assess the impact and cost benefit of telehealth applications in terms of improving public health at the population and community levels. In addition, more research is needed to demonstrate the ability of telehealth tools and technologies to facilitate and extend the reach of major national clinical and public health research initiatives. Perhaps most importantly, the National Institutes of Health should develop and/or strengthen strategic partnerships with other funding agencies with overlapping or complementary interests to accelerate interdisciplinary research in this rapidly evolving but relatively understudied and complex field.

Over the past two decades, teledermatology has typically applied a hybrid model with both live-interactive and store-and-forward imaging technology during the diagnosis process. The primary challenges for teledermatology are integrations of diagnostic information and images captured by heterogeneous digital cameras used by the far sites, image sharing tools by the dermatologists and patients, and means for longitudinal diagnosis of skin diseases. These challenges not only cause disruptive clinic flow, but also limit the capability for the efficacy of diagnoses. The objectives of this study are to adapt mobile applications from in-person clinical to telehealth settings, and evaluate and compare its usability, effectiveness, and changes in clinic flow.