Objectives/Hypothesis
We present our experience with telemedicine visits in an otolaryngology outpatient setting within our institution's Center for Head and Neck Surgery.
Study Design
Retrospective ...chart review.
Methods
A review of telemedicine outpatient encounters examining patient demographics, visit type, and wait times was conducted. Internet‐based navigation applications were used to calculate travel distance and estimate commute time to our clinic. Patient survey responses were reviewed.
Results
Two hundred fifty telemedicine encounters were reviewed between December 2015 and June 2017. The average age of patients was 50 years (range, 4–87 years). Patients waited an average of 10 minutes for their telemedicine appointments and avoided an average estimated commute time of 78 minutes (64 miles). The majority of visits were postoperative encounters (70%). Clinical follow‐up of recent results or nonpostoperative complaints accounted for the remaining 30% of visits. All patients were offered a post‐telemedicine survey, and 78 (31%) completed the survey. Of the respondents, 95% of patients reported that they were satisfied with their visit. Among patients who were dissatisfied, wait time and technical issues were cited as reasons.
Conclusions
With appropriate patient selection, telemedicine is an effective way to safely conduct outpatient clinic visits while maintaining high patient satisfaction. It can be particularly useful for institutions with large catchment areas to minimize travel times and increase ease of communication.
Level of Evidence
4. Laryngoscope, 128:2072–2075, 2018
Many hydrological systems exhibit complex subsurface flow and storage behavior. Runoff observations often only provide insufficient information for unique process identification. Quantitative ...modeling of water and solute fluxes presents a potentially more powerful avenue to explore whether hypotheses about system functioning can be rejected or conditionally accepted. In this study we developed and tested four hydrological model structures, based on different hypotheses about subsurface flow and storage behavior, to identify the functioning of a large Mediterranean karst system. Using eight different system signatures, i.e., indicators of particular hydrodynamic and hydrochemical characteristics of the karst system, we applied a novel model evaluation strategy to identify the best conceptual model representation of the karst system within our set of possible system representations. Our approach to test model realism consists of three stages: (1) evaluation of model performance with respect to system signatures using automatic calibration, (2) evaluation of parameter identifiability using Sobol's sensitivity analysis, and (3) evaluation of model plausibility by combining the results of stages (1) and (2). These evaluation stages eliminated three out of four model structures and lead to a unique hypothesis about the functioning of the studied karst system. We used the estimated parameter values to further quantify subsurface processes. The chosen model is able to simultaneously provide high performances for eight system signatures with realistic parameter values. Our approach demonstrates the benefits of interpreting different tracers in a hydrologically meaningful way during model evaluation and identification.
Key Points
A new model evaluation approach to identify system processes
Combining calibration,sensitivity analysis and signatures reveals model behavior
Hydrochemical information is crucial for identification of hydrological systems
Aquaculture of groupers is carried out in tropical and subtropical areas throughout the world, but most production is from Asia, with three countries responsible for an estimated 92% of global ...production: China (65% of total production), Taiwan Province of China (17%) and Indonesia (11%). We calculate that there are at least 47 grouper species plus 15 grouper hybrids that have been trialled or are currently aquacultured. While grouper aquaculture has undoubtedly provided positive social and economic benefits to coastal communities in Asia, practices associated with grouper aquaculture have also led to widespread concerns regarding its environmental impacts. This paper reviews environmental, economic and social impacts of grouper aquaculture within a sustainability science framework. An update, building on early technical reviews of grouper aquaculture, was used to identify the main environmental, economic and social impacts. The main environmental impacts identified were as follows: seedstock sources, particularly the use of wild‐caught postlarval or juvenile fish as seedstock; the use of ‘trash’ fish as the major feed source; and water quality and substrate impacts of sea cage aquaculture. Significant economic and social impacts arising from grouper aquaculture include employment and income generation, but the economic impacts of disease outbreaks are significant, reducing fish survival to harvest size to around 50–70%. Current approaches to ameliorate negative impacts include the following: development and implementation of better management practices (BMPs) at national level, and the development of a global ecolabel certification scheme by the Aquaculture Stewardship Council. Both these approaches have significant constraints, particularly when applied to small‐scale farmers who produce the bulk of farmed grouper. We conclude that there is a need for improved higher level coordination between the major producer countries to address identified sustainability constraints to grouper aquaculture.
Megalocytiviruses cause high mortality diseases that have seriously impacted aquaculture, with the most frequent outbreaks occurring in East and South‐East Asia. The international trade of juvenile ...fish for food and ornamental aquaculture has aided the spread of these viruses, which have spread to Europe and Australia and other regions. Australian freshwater fishes were examined for susceptibility to infection with the exotic megalocytivirus, dwarf gourami iridovirus (DGIV), which belongs to a group with the type species, Infectious spleen and kidney necrosis virus (ISKNV). Fish were held at 23 ± 1 °C and challenged by intraperitoneal (IP) injection or by cohabitation with Murray cod, Maccullochella peelii (Mitchell) infected with DGIV. A species was deemed to be susceptible to DGIV based on evidence of viral replication, as determined by qPCR, and megalocytic inclusion bodies observed histologically. Horizontal transmission occurred between infected Murray cod and golden perch, Macquaria ambigua (Richardson), Macquarie perch, Macquaria australasica (Cuvier) and Murray cod. This indicated that DGIV shed from infected fish held at 23 °C can survive in fresh water and subsequently infect these naïve fish. Further, DGIV administered IP was highly pathogenic to golden perch, Macquarie perch and Murray cod. Compared to these species, the susceptibility of southern pygmy perch, Nannoperca australis (Gunther) was lower. Freshwater catfish (dewfish), Tandanus tandanus (Mitchell), were not susceptible under the experimental conditions based on the absence of clinical disease, mortality and virus replication. This study showed the potential risks associated with naïve and DGIV‐infected fish sharing a common water source.
Indonesia has a long history of aquaculture, dating from the 15th century. Subsequently, the country has become a significant contributor to global aquaculture production, destined for both ...international and domestic markets. In 2009 the Government of Indonesia announced its vision to see Indonesia become the highest (volume) producer of aquaculture products in the world by 2015, with production targets equivalent to an overall increase in production of 353% between 2009 and 2014. This paper comprises a PEEST (policy, economic, environmental, social, technical) review undertaken as a background study for a SWOT (strengths, weaknesses, opportunities, threats) analysis, the outcomes of the SWOT analysis and a discussion of possible approaches to support sustainable aquaculture development in Indonesia. To meet the vision of a dramatic expansion of aquaculture production, one or more of the following strategies is required: intensification and production segmentation, areal expansion, and/or production diversification. Most likely the continued development of aquaculture in Indonesia will be a combination of these three strategies, with the relative influence of each depending on production sector and market demands. A key issue identified in the PEEST review and SWOT analysis is the dominance (in terms of number) of Indonesian aquaculture by smallholder aquaculture farmers. We argue that a range of influences, including aquaculture production expansion and changing international market requirements, have the potential to negatively impact smallholder aquaculture farmers in Indonesia, and that further policy development should specifically address these issues.
Diet, especially seafood, is the main source of arsenic exposure for humans. The total arsenic content of a diet offers inadequate information for assessment of the toxicological consequences of ...arsenic intake, which has impeded progress in the establishment of regulatory limits for arsenic in food. Toxicity assessments are mainly based on inorganic arsenic, a well-characterized carcinogen, and arsenobetaine, the main organoarsenical in seafood. Scarcity of toxicity data for organoarsenicals, and the predominance of arsenobetaine as an organic arsenic species in seafood, has led to the assumption of their nontoxicity. Recent toxicokinetic studies show that some organoarsenicals are bioaccessible and cytotoxic with demonstrated toxicities like that of pernicious trivalent inorganic arsenic, underpinning the need for speciation analysis. The need to investigate and compare the bioavailability, metabolic transformation, and elimination from the body of organoarsenicals to the well-established physiological consequences of inorganic arsenic and arsenobetaine exposure is apparent. This review provides an overview of the occurrence and assessment of human exposure to arsenic toxicity associated with the consumption of seafood.
Brookhaven National Laboratory (BNL) and Thomas Jefferson National Accelerator Facility are collaborating on the design and construction of the next Electron Ion Collider (EIC) to be built at BNL. ...The EIC is a unique high-energy, high-luminosity, polarized electron-proton/ion collider. The EIC accelerator complex needs about 10 new rf and SRF systems with frequencies spanning 24 MHz to 1773 MHz, requiring more than 60 new high-power fundamental power couplers (FPCs). These couplers will operate in either pulsed mode or continuous wave mode with peak traveling wave power ranging from 10 s to 380 kW. Here we present our design for a 1-MW broadband rf window suitable for EIC rf and SRF systems with operating frequencies up to 591 MHz. This design takes advantage of the numerous synergies between the various rf and SRF systems to make it broadly applicable. The rf window design criteria are based on the requirement for the 591-MHz electron storage ring (ESR) SRF cavities, as it will operate at both the highest traveling wave power and the highest peak power over the EICrf/SRFcomplex. The results presented will detail the FPC power requirement, rf window choices, design criteria, and multiphysics performance in the most critical application, the ESR SRF cavity, and how the rf window design applies to other EICrf/SRFsystems.
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