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The COVID-19 pandemic accelerated adoption of telemedicine visits into American medicine. It is commonly believed that, within a matter of weeks, telemedicine was widely and successfully implemented and that medicine is forever changed. The experience on the ground, however, is more nuanced, with both positive and negative experiences for patients and clinicians. Advanced models of team-based care with in-room support (aTBC) have developed over the past decade, with strategic delegation of tasks to uptrained support staff, allowing physicians to provide undivided attention to their patients and greater access to care for their populations. Herein, we describe our initial experiences with telemedicine in the context of many years practicing in aTBC models. Our experience demonstrates that when implementing telemedicine visits, it is important to avoid a reflex reversion to the outmoded model of the physician alone in the room with the patient and instead bring forth the safety, quality, and satisfaction advantages associated with aTBC. We provide a practical “how-to” guide for implementing telemedicine visits; outline logistical details of representative video and audio visits from our own practices; describe new opportunities for family engagement, care coordination, and comanagement across specialties; and outline a research agenda going forward to further knowledge of the risks and benefits and optimal application of health care on a telemedicine platform.

Agile methods, when applied to the implementation of large enterprise resource planning (ERP) system projects, present several benefits over traditional non-agile approaches. This study presents several established models for applying Agile to large projects, and then it shows in details how to apply Scaled Agile Framework (SAFe) to a large ERP implementation. This study also discusses the critical success factors required for maximizing success in ERP implementation. The study utilizes a multi-vocal literature review to develop a scholar-practitioner view of an ERP system, and then it combines that perspective with our own experience in implementing large ERP projects using SAFe. To the best of our knowledge, this study is a first in establishing SAFe for the implementation of large ERP projects.

Feed is one of the largest costs in most aquaculture operations, and as such, aquaculturists are continually striving to improve on ingredient sourcing and formulations to increase growth and performance while reducing costs. Analysis of the energy expended in digestion of different feeds can be a valuable early indicator of the suitability of a new ingredient or formulation. We use respirometry, an activity level analysis, and proximate analysis of fecal samples to compare the metabolic cost of digestion in California yellowtail (Seriola dorsalis) fed two different diets – a meal of whole sardine fillets representing a whole fish diet and a commercial pelleted feed designed specifically for Seriola aquaculture. Respiration trials reveal that the specific dynamic action coefficient (SDACoefficient), SDA coefficient (SDACoefficient), or percent of energy expended on digestion in relation to the total energy available in a meal, was more than double for a whole-fish type meal (20.8 ± 0.1%) than for the pelleted meal (10.2 ± 0.8%). Analysis of fish activities indicated 12.3% greater activity during the whole-fish type meal, as compared with the pelleted meal. After 24 h, the total amount of protein and lipid remaining in the feces from the whole-fish type meal (4.2 ± 0.7 kJ, 2.2 ± 0.4 kJ respectively) was significantly higher than the pelleted meal (1.8 ± 0.2 kJ, 0.9 ± 0.2 kJ respectively). Digestibility of the whole-fish type meal was slightly lower than the pelleted meal at 95.3 ± 0.5% and 97.7 ± 0.2%, respectively. The reduction in the energetic cost of digestion observed in fish fed the commercial pellet diet is likely attributed to the additional processing during manufacture, which liberates a significant portion of the energy normally allotted towards digestion. The results of this work reveal and quantify the benefits of switching from whole-fish feed to a commercial compound feed, as the reduced energetic costs of digestion allow for greater amounts of energy to be available for somatic growth.

SUMMARYThroughout the tropics, developing countries and territories are highly dependent on nearshore marine resources for food and income, however information on the sustainability and proper management of these fisheries is lacking. In Pohnpei, Micronesia, the sustainability of a coral reef finfishery was assessed by comparing coral reef fish demand to coral reef biocapacity using a marine ecological footprint (MEF) analysis. Based on geo-referenced satellite and aerial imagery, Pohnpei and surrounding atolls have 184.2 km2 of coral reef habitat with a sustainable finfish yield of 573–1118 t yr−1, however total harvest was estimated at 4068 t yr−1, exceeding biocapacity by 360–710%. The MEF was supported by observed impacts to coral reef resources, including (1) long-term declines in fish spawning aggregation density, (2) reductions in mean size, age and fecundity of key commercial species, (3) reliance on undersized fish, and (4) decadal declines in mean size and abundance of fishes of iconic value and critical to ecosystem maintenance. The commercial fishery was responsible for 68% of finfish catch volume, while reef fish consumption, at 93 kg person−1 yr−1, was among the highest in the region. To sustainably meet current demand, up to 833 km2 of additional reef area would be required. The study illustrates the MEF, at least rudimentarily, reflects biological reality on local reefs and represents a valuable analytical tool in a marine policymaker's toolbox.

This study investigated endocrine control of branchial ionoregulatory function in Nile tilapia (Oreochromis niloticus) by prolactin (Prl188 and Prl177), growth hormone (Gh) and cortisol. Branchial expression of Na(+)/Cl(-) cotransporter (ncc) and Na(+)/K(+)/2Cl(-) cotransporter (nkcc) genes were employed as specific markers for freshwater- and seawater-type ionocytes, respectively. We further investigated whether Prl, Gh and cortisol direct expression of two Na(+), K(+)-ATPase (nka)-α1 subunit genes, denoted nka-α1a and nka-α1b. Tilapia transferred to fresh water following hypophysectomy failed to adequately activate gill ncc expression; ncc expression was subsequently restored by Prl replacement. Prl188 and Prl177 stimulated ncc expression in cultured gill filaments in a concentration-related manner, suggesting that ncc is regulated by Prl in a gill-autonomous fashion. Tilapia transferred to brackish water (23 ‰) following hypophysectomy exhibited a reduced capacity to up-regulate nka-α1b expression. However, Gh and cortisol failed to affect nka-α1b expression in vivo. Similarly, we found no clear effects of Gh or cortisol on nkcc expression both in vivo and in vitro. When considered with patterns previously described in euryhaline Mozambique tilapia (O. mossambicus), the current study suggests that ncc is a conserved target of Prl in tilapiine cichlids. In addition, we revealed contrasting dependencies upon the pituitary to direct nka-α1b expression in hyperosmotic environments between Nile and Mozambique tilapia.

This paper compares three different strategies/treatments for determining fertilization rates for producing natural foods in semi-intensive aquaculture ponds. The first strategy used a predetermined, fixed-input rate of nitrogen (N) and phosphorus (P) based on results from previous yield trials. The second strategy was based on algal nutrient concentrations, and used biweekly water quality measurements in combination with a microcomputer-based expert system, PONDCLASS©, to determine fertilization rates. The third approach, the algal bioassay fertilization strategy (ABFS), was based on algal growth responses to nutrient [i.e., N, P, and carbon (C)] enrichment, and used weekly, pond-specific algal bioassays to determine both nutrient requirements and associated rates of nutrient inputs. The three fertilization strategies were applied to Nile tilapia (Oreochromis niloticus) growout ponds over a 120-day period, with five ponds per treatment. All ponds were fertilized weekly with urea, triple superphosphate, agricultural lime, and/or chicken manure in amounts determined by each strategy. Results indicated that net fish yields (NFYs) were not significantly different (P=0.094) between treatments, with the fixed-input treatment giving the highest but most variable yields. Average NFYs±S.E. (standard error) for the 120-day growout period were 2124±276, 1476±151, and 1651±133 kg ha−1 for the fixed-input strategy, PONDCLASS©, and ABFS treatments, respectively. The relatively lower NFYs for PONDCLASS© and ABFS indicate that neither approach maximized fish production. Nitrogen utilization efficiencies of fertilizer inputs were similar for all three strategies. Although the fixed-input approach used approximately 20% more N than the other two approaches, mean algal productivities and NFYs were also proportionally higher with this treatment. This result is consistent with the observation that algal productivities in PONDCLASS© and ABFS ponds were nearly always limited by N availability. However, both P utilization and fertilization cost efficiencies were significantly better with PONDCLASS© and ABFS than with the fixed-input treatment. The fixed-input approach not only used a higher P input rate than necessary, it did not account for ecological differences between ponds within the same treatment (e.g., nutrient and light limitation of algal productivity, inorganic turbidity, etc.), which can affect a pond's response to fertilization. In particular, the fixed-input treatment did not add carbon to compensate for nonuniform losses in alkalinity, which resulted in relatively high soluble P concentrations in treatment ponds where C availability apparently limited algal productivity. Including C fertilization in the fixed-input treatment would have likely reduced NFY variability and improved P utilization efficiency in those ponds. Because both PONDCLASS© and the ABFS adjusted pond-specific fertilization requirements throughout the study, they provided increased fertilization efficiencies and profitability over the fixed-input strategy. However, the ABFS is more practical than PONDCLASS© for rural application because it is far simpler and does not require water chemistry, computers, laboratory equipment, technical expertise, or electricity to implement. Based on this study, the recommended fertilization strategy designed to achieve cost-efficient, consistently high yields is a modified ABFS approach that uses a fixed-input fertilization rate for N, and algal bioassays to determine time-specific and pond-specific fertilization requirements for P and C.

Aquaculturists typically report growth using absolute (g/d), relative (Vo increase in body weight), and specific growth rates (Told). Less frequently, von Bertalanffy Growth Functions (VBGF) are used. Each of these rates is a numerical representation of growth which assumes a specific relationship between size and time (linear, exponential, or asymptotic). Aquaculturists typically determine size at time throughout their experiments. Unfortunately, the intermediate data points are usually ignored when computing growth rates (except for VBGF) and the appropriateness of the method for calculating growth for a particular data set is not tested. This paper reviews the basis and computation of each of the growth rates in an effort to encourage aquaculturists to use the appropriate growth rates.

A simple tank system, using artificial aeration to supply oxygen and incoming water to dilute metabolic by-products and other wastes, was tested. Blue tilapia, Oreochromis aureus , were grown under a wide range of loads, 7–31 kg liter −1 min −1 , and densities, 19–77 kg fish m −3 culture unit. Average yield ranged from 6–10 kg m −3 culture unit per month. Approximately 14–20 m 3 of water was used for each kilogram of fish produced.