Ophthalmology outpatient attendances have significantly increased recently with rising pressure from backlogs arising from the pandemic. Medical retina digital surveillance clinics for stable ...follow-up appointments are well established. We present a model for assessing new referrals and evaluating clinical outcomes and long-term sustainability in a complex high-volume medical retina service.
Suitable routine new patient referrals were identified from electronic referrals and referred to this new pathway. Structured history, visual acuities, and intraocular pressures were recorded, and widefield colour fundus and optical coherence tomography imaging were performed at a imaging hub for asynchronous consultant-led review.
1458 patients were invited to attend over four months, with a 13.2% did-not-attend (DNA) rate. Common diagnoses included stable diabetic retinopathy (19.9%), early age-related macular degeneration (6.7%), central serous retinopathy (8.8%), and retinal vein occlusion (6.3%). 7 patients (0.05%) required urgent same-day review. 61 (5.0%) required urgent face-to-face (F2F) assessment within two weeks. A total of 727 (59.0%) were either discharged or remained in the virtual pathway following their first visit.
This study encourages the use of a digital model that efficiently assesses suitable newly referred medical retina patients in both complex and local eye unit settings. This decreased the need for F2F clinics and resources. Further patient satisfaction surveys for digital services are currently being evaluated to guide long-term sustainability of this model.
Objective
Similarities in the clinical and laboratory features of primary Sjögren’s syndrome (SS) and systemic lupus erythematosus (SLE) have led to attempts to treat patients with primary SS or SLE ...with similar biologic therapeutics. However, the results of many clinical trials are disappointing, and no biologic treatments are licensed for use in primary SS, while only a few biologic agents are available to treat SLE patients whose disease has remained refractory to other treatments. With the aim of improving treatment selections, this study was undertaken to identify distinct immunologic signatures in patients with primary SS and patients with SLE, using a stratification approach based on immune cell endotypes.
Methods
Immunophentyping of 29 immune cell subsets was performed using flow cytometry in peripheral blood from patients with primary SS (n = 45), patients with SLE (n = 29), and patients with secondary SS associated with SLE (SLE/SS) (n = 14), all of whom were considered to have low disease activity or be in clinical remission, and sex‐matched healthy controls (n = 31). Data were analyzed using supervised machine learning (balanced random forest, sparse partial least squares discriminant analysis), logistic regression, and multiple t‐tests. Patients were stratified by K‐means clustering and clinical trajectory analysis.
Results
Patients with primary SS and patients with SLE had a similar immunologic architecture despite having different clinical presentations and prognoses. Stratification of the combined primary SS, SLE, and SLE/SS patient cohorts by K‐means cluster analysis revealed 2 endotypes, characterized by distinct immune cell profiles spanning the diagnoses. A signature of 8 T cell subsets that distinctly differentiated the 2 endotypes with high accuracy (area under the curve 0.9979) was identified in logistic regression and machine learning models. In clinical trajectory analyses, the change in damage scores and disease activity levels from baseline to 5 years differed between the 2 endotypes.
Conclusion
These findings identify an immune cell toolkit that may be useful for differentiating, with high accuracy, the immunologic profiles of patients with primary SS and patients with SLE as a way to achieve targeted therapeutic approaches.
Virtual Technologies Trends in Education Martín-Gutiérrez, Jorge; Mora, Carlos Efrén; Añorbe-Díaz, Beatriz ...
Eurasia Journal of Mathematics, Science and Technology Education,
02/2017, Letnik:
13, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Virtual reality captures people’s attention. This technology has been applied in many sectors such as medicine, industry, education, video games, or tourism. Perhaps its biggest area of interest has ...been leisure and entertainment. Regardless the sector, the introduction of virtual or augmented reality had several constraints: it was expensive, it had poor ergonomics, or implied too much work to create contents. Recent technological innovations, including the rapid adoption of smartphones by society, have facilitated the access to virtual reality and augmented reality of anyone. In addition, several large companies like Apple, Facebook, Samsung, and Magic Leap, among others, have increased their investment to make these technologies to improve their accessibility within the next few years. Educational institutions will benefit from better accessibility to virtual technologies; this will make it possible to teach in virtual environments that are impossible to visualize in physical classrooms, like accessing into virtual laboratories, visualizing machines, industrial plants, or even medical scenarios. The huge possibilities of accessible virtual technologies will make it possible to break the boundaries of formal education.
Abstract Background National guidelines advocate broad molecular profiling as part of the standard diagnostic evaluation for advanced non-small cell lung cancer (NSCLC), with the goal of identifying ...driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines may present challenges to community oncologists. Methods Retrospective review of genomic testing patterns in patients with non-squamous NSCLC treated by 89 oncologists at 15 sites throughout New Jersey and Maryland between January 2013 and December 2015. Results 814 patients (89% stage IV; 11% stage IIIB) were identified in the COTA database. 479 (59%) met guideline recommendations for EGFR and ALK biomarker testing; 63 (8%) underwent comprehensive genomic profiling (CGP) for all four major types of alterations (point mutations, indels, fusions and copy number amplifications). Gender, age, race, site of care (referral vs. community center), and practice size did not influence CGP frequency. Active smokers and patients who died within 30 days were tested less frequently (p<0.05). Among those not tested for EGFR and ALK , 52% received chemotherapy without documented reasons for non-testing, 32% did not receive anti-neoplastic therapy and 13% had insufficient tissue for genotyping. Conclusions Genomic testing presents multiple logistical challenges for the community based oncologist, including coordination of sample handling, long turnaround times, test reimbursement, access to targeted therapies, insufficient tissue, and the patient harm from repeat biopsies necessary if tissue is insufficient. Opportunities exist for improvement in guideline adherence, possibly through new technologies such as “liquid biopsies,” which obviate tissue biopsy in select settings.
Power to Synthetic-Natural-Gas (SNG) technology consists of two main steps: water electrolysis and methanation; the primary energy input is usually surplus power from renewable energy sources, while ...the electrolytic hydrogen and carbon oxides from different COx sources are converted into methane that can be fed in the natural gas grid. We focus on methanation technology, where the main criteria are the complexity of process setup and reactor sizes to achieve production and SNG quality for gas-grid injection. The processes are simulated using a plug-flow model for the reactors and a pseudo-homogeneous kinetic law describing the reaction of CO2 (that is rate limiting). The results show that feeding biogas or syngas (instead of CO2) for methanation has remarkable effects regarding the operation and design of the processes; it is concluded that Power-to-SNG technologies that use methane rich streams are favorable in terms of biogas upgrading, H2 requirements, reactor volumes and process simplicity, as far as these resources are available: e.g., using a typical composition (60% CH4) the required inputs are 0.96 kmol of biogas, 1.54 kmol of H2 and 0.26 m3 of reactors (two adiabatic beds with recirculation, R/F = 0.695) per kmol/min of pipeline quality dry gas product (95% CH4), which means 60% hydrogen saving, less than 26% reaction volumes and near 62% reduction of process throughput, when compared to the methanation process that uses pure CO2; conversion of syngas can be also favorable, but it requires high recirculation due to the large proportions of COx; e.g. for syngas (47.3%H2-25.9%CO-17.2%CO2-9.6%CH4), the required values mean a 53% hydrogen saving and less than 25% reaction volumes, but only 11% reduction of process throughput.
•Comprehensive analysis of Power-to-SNG technologies using different COx sources.•Methane rich feedstocks are favorable in terms of biogas or syngas upgrading.•Process is optimized in two adiabatic beds with recirculation and water condensation.•The product fits with requirements for injection into the natural gas grid (95% CH4).
•Water conservation and non-conventional resources are triggered by basin closure.•Water conservation systems increased energy consumption by irrigation since 2005.•Monitoring of water abstraction, ...water consumption, and energy use by irrigation should be implemented at basin level.•Mature water economies such as Spain may exhibit reduced water abstractions and increased energy consumption.
This study describes the evolution of the Spanish irrigated sector and focuses on water abstraction, water consumption, and energy use in the period 1950–2017. The analysis shows evidence of the basins reaching closure state and the impact on energy use from irrigation supply. The response in the context of an increasing water demand with a limited supply has been investment in water-saving and conservation technologies (WSCT) with the transformation of furrow-irrigated areas into those of drip and sprinkler, resulting in an increase in irrigation efficiency. The effect of this policy implies an increase in energy use by a factor of six in the period while the irrigated area triples and its water use doubles in the same period. Water abstraction reaches its peak in the year 2004 and decreases slightly as a consequence of subsidies to WSCT. The impact on energy consumption in pumping and treatment illustrates the water-energy nexus in Spain’s agriculture and the change in the water policy paradigm from supply augmentation towards demand management.
Regions and basins suffering from water scarcity have promoted the modernization of irrigation systems, defined as irrigation efficiency enhancement as a measure for the adaptation to a growing ...demand and a limited supply of water resources. In the period 2002–2015, Spain carried out an intense irrigation modernization process with the aim of achieving significant water savings and higher flexibility and to guarantee supply, among other favourable outcomes (e.g. environmental and socio-economic). Nevertheless, certain unfavourable effects of irrigation modernization also need to be discussed. This study analyses these effects in Spain based upon a DPSIR (Driving forces, Pressures, States, Impacts, and Responses) framework and a wide-ranging review of the existing empirical literature. Our findings are highly relevant to inform decision-makers in the planning of future irrigation modernization programmes worldwide.
•Augmented reality (AR) technology facilitates collaborative work in education.•Apps based on AR environments provide satisfaction during the learning process.•Students declare an improvement in ...learning when augmented reality tools were used.•Our tools allow learning of theoretical contents in an autonomous way.•Our tools facilitate collaboration among students.
The learning scenarios described in this work reach further than any previous approach. The connections between augmented reality (AR) and traditional learning based on textbooks through the well-known augmented books also known as “magic books,” are already there. However, they are restricted to just a few isolated uses that commonly take place on a PC showing 3D information with few actions in higher education. In a collaborative and autonomous way, this work combines every learning process from the electrical machines course in the electrical engineering degree. It allows interactive and autonomous studying as well as collaborative performance of laboratory practices with other students and without a teacher’s assistance. Tools presented in this work achieve a connection between the theoretical explanations and the laboratory practices using augmented reality as a nexus. Students feel comfortable about it and consider that tools are nice, easy, and useful, according to the goal of learning contents, training on performance, and design of installations and machines.
Meteorological drought is defined as the event that arises when precipitation is lower than average and initially affects rainfed crops; this is transformed into hydrological drought when persistent ...drought affects water storage. We have studied the economic impact of multiyear droughts by applying the economic surplus to the last severe drought (2005–2008) in Andalusia. The method is applied to both rainfed and irrigated agriculture. The results show negative effects on regional social welfare, with an estimated global loss of EUR 1512 million, although this negative impact is unequally distributed. There is a quantity effect (lower yields) and higher prices due to shorter supply. Overall, rainfed farms experience a negative impact on their income since higher prices only partially compensate for yield reduction, although, paradoxically, certain irrigation farms increase their income when higher prices overcorrect lower yields. Consumers are always negatively affected by drought. This result may aid in the design of agricultural policy models and drought-recovery policies.
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•Effects of hydrological drought on farmers differ according to crop category and whether the system is rainfed or irrigated.•Consumers lose, due to the quantity effect and the price effect, while not all farmers incur losses due to the price effect.•Irrigated crops take advantage of the price effect due to quantity effect losses in rainfed crops.
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