Telemedicine as a Means to an End, Not an End in Itself

Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.

Influence of citrate and PEG coatings on the bioaccumulation of TiO2 and CeO2 nanoparticles following dietary exposure in rainbow trout

Background This study was conducted to provide much needed information on the potential of low solubility, highly biodurable nanoparticles (NPs) (TiO2 and CeO2 NPs), to bioaccumulate in fish and to investigate the relationship between an engineered nanomaterials surface coating, uptake and biokinetics in vivo. Rainbow trout (Oncorhynchus mykiss) were fed diets spiked with uncoated or surface coated (polyethylene glycol (PEG) or citrate (CIT)) TiO2 and CeO2 NPs (100 mg NPs/kg feed) for 10 days and thereafter fish were allowed to depurate for 42 days. Special care was taken to measure the real dispersed and actual administered concentrations, taking into consideration any potential losses from leaching, and to characterise the form (size, aggregation state, charge) of the NPs to which the fish were exposed. Results The coatings had an influence on levels of uptake and distributions. Most notably a higher uptake of PEG and CIT coated TiO2 and CeO2 NPs compared to fish exposed to uncoated materials was observed. The elimination of any Ti from tissues was rapid during the first day of depuration, whereas Ce levels remained in fish tissues (stomach, intestine and liver) with differences in depuration and redistribution of the three types of CeO2 NPs. However, no bioaccumulation potential for both tested metal oxide NPs in fish irrespective of coatings is expected according to BMF values < 1. Conclusions Distinct uptake, distribution and depuration kinetics in rainbow trout have been evidenced for different metal oxide NPs (TiO2 and CeO2 NPs). Coatings influenced uptake and in some cases led to slower depuration and distinct distributions, but do not make the uncoated NPs studied bioaccumulative (BMF > 1). Graphical Abstract

Provision of Library and Information Resources and Services on Suicide: Nigerian Libraries Perspective

This paper seeks to highlight the services and resources provided by Nigerian libraries on the prevalent incidents of suicide. The library is a hub of activities and its major purpose is to provide necessary and needed information to its teeming users. Library and information resources are those materials provided by the library both in printed and electronic formats which include the provision of information on suicide. These resources aid the provision of various information services such as current awareness service, selective dissemination of information, reader advisory service, and lots more. The diverse information services can be provided in collaboration with NGOs to create public awareness, provide signages on suicide and also train librarians on how to interact with users who are likely to possess such traits with the aid of the available resources that would help in suicide prevention, and also provide direction on how to get psychological help. From the literature review, very little is written on suicide by authors in Nigeria and it is a fact that Nigerian libraries do not give special attention to the provision of resources on suicide, especially the preventive aspect of it; therefore, a recommendation for a special corner in the library for such resources was proffered.

“Their Own Personal Unicorn”: The Workplace Experiences of Transgender Teachers

Multiple studies have shown that transgender individuals routinely face increased levels of hostility and discrimination in the workplace compared to their cisgender peers; this is also true for transgender educators, who are often marginalized or silenced for expressing their gender diversity. Exploring the experiences of transgender teachers can provide much-needed information for school and district leaders seeking to support and affirm transgender individuals as valued members of the school community. The workplace experiences of six transgender educators in various teaching roles were examined in this qualitative study. The researchers utilized semistructured interviews to explore participants’ professional lives, focusing on factors that affected decisions to reveal or conceal their gender identities, the climate of the schools in which they worked, and their support for LGBTQ students. Findings suggest that while support for LGBTQ teachers is growing, heteronormativity persists in troubling ways, particularly for transgender educators. Implications of these findings for school and district leaders are discussed.

Redwood National and State Parks: Geologic resources inventory report

Comprehensive park management to fulfill the NPS mission requires an accurate inventory of the geologic features of a park unit, but Comprehensive park management to fulfill the NPS mission requires an accurate inventory of the geologic features of a park unit, but park managers may not have the needed information, geologic expertise, or means to complete such an undertaking; therefore, the Geologic Resources Inventory (GRI) provides information and resources to help park managers make decisions for visitor safety, planning and protection of infrastructure, and preservation of natural and cultural resources. Information in the GRI report may also be useful for interpretation. park managers may not have the needed information, geologic expertise, or means to complete such an undertaking; therefore, the Geologic Resources Inventory (GRI) provides information and resources to help park managers make decisions for visitor safety, planning and protection of infrastructure, and preservation of natural and cultural resources. Information in the GRI report may also be useful for interpretation. This report synthesizes discussions from a scoping meeting for Redwood National and State Parks (referred to as the “parks” throughout this report) held in 2004 and a follow-up conference call in 2019. Two GRI–compiled GIS data sets of the geology and geohazards of the parks are the principal deliverables of the GRI. The GRI GIS data are available on the GRI publications website http://go.nps.gov/gripubs and through the NPS Integrated Resource Management Applications (IRMA) portal https://irma.nps.gov/App/Portal/Home. Enter “GRI” as the search text and select a park from the unit list. Writing of this report was based on those data and the interpretations of the source map authors (see “GRI Products” and “Acknowledgements”). A geologic map poster illustrates the geology GRI GIS data set and serves as a primary figure for this GRI report. No poster was prepared for the geohazards GRI GIS data set. Additionally, figure 7 of this report illustrates the locations of the major geologic features in the parks. Unlike the poster, which is divided into a northern and southern portion to show detail while accommodating the parks’ length, figure 7 is a single-page, simplified map. The features labeled on figure 7 are discussed in the “Geologic History, Features, and Processes” chapter. To provide a context of geologic time, this report includes a geologic time scale (see "Geologic History, Features, and Processes"). The parks’ geologic story encompasses 200 million years, starting in the Jurassic Period. Following geologic practice, the time scale is set up like a stratigraphic column, with the oldest units at the bottom and the youngest units at the top. Organized in this manner, the geologic time scale table shows the relative ages of the rock units that underlie the parks and the unconsolidated deposits that lie at the surface. Reading the “Geologic Event” column in the table, from bottom to top, will provide a chronologic order of the parks’ geologic history. The time scale includes only the map units within the parks that also appear on the geologic map poster; that is, map units of the geohazards data are not included. Geology is a complex science with many specialized terms. This report provides definitions of geologic terms at first mention, typically in parentheses following the term. Geologic units in the GRI GIS data are referenced in this report using map unit symbols; for example, map unit KJfrc stands for the Cretaceous (K) and Jurassic (J) Franciscan Complex (f), Redwood Creek schist (rc), which underlies a portion of the Redwood Creek watershed (see “GRI Products”).

ANALYZING IMPLICATURES IN TALIWANG DIALECT

This study aims to analyze the types of implicature and flouting maxims and the reasons for doing the flouting in Taliwang Dialect. It applied the descriptive method with a qualitative approach. Data was collected by recording natural conversations among the natives of Taliwang Dialect. It was found two types of implicature, namely, Generalized Conversational Implicature (GCI) and Particularized Conversational Implicatures (PCI). In GCI, the speaker and interlocutor could easily understand the conveyed utterances because they mostly used general statements which are commonly spoken in the Taliwang dialect. In PCI, both speaker and the interlocutor needed a particular knowledge to understand each other because of the flouting maxim. Some speakers or hearers in PCI often break the maxim in a conversation due to some reasons such as accepting untrue or lie information, receiving more information than the needed information, getting irrelevant information and having unclear or ambiguous information.

Epigenetics and DOHaD: how translation to predictive testing will require a better public understanding

Epigenetics is likely to play a role in the mediation of the effects of genes and environment in risk for many non-communicable diseases (NCDs). The Developmental Origins of Health and Disease (DOHaD) theory presents unique opportunities regarding the possibility of early life interventions to alter the epigenetic makeup of an individual, thereby modifying their risk for a variety of NCDs. While it is important to determine how we can lower the risk of these NCDs, it is equally important to understand how the public’s knowledge and opinion of DOHaD and epigenetic concepts may influence their willingness to undertake such interventions for themselves and their children. In this review, we provide an overview of epigenetics, DOHaD, NCDs, and the links between them. We explore the issues surrounding using epigenetics to identify those at increased risk of NCDs, including the concept of predictive testing of children. We also outline what is currently understood about the public’s understanding and opinion of epigenetics, DOHaD, and their relation to NCDs. In doing so, we demonstrate that it is essential that future research explores the public’s awareness and understanding of epigenetics and epigenetic concepts. This will provide much-needed information which will prepare health professionals for the introduction of epigenetic testing into future healthcare.

What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study

BackgroundUsing test, trace and isolate systems can help reduce the spread of COVID-19. Parents have the additional responsibility of using these systems for themselves and acting on behalf of their children to help control COVID-19. We explored factors associated with the use of England’s NHS Test and Trace service among parents of school-aged children. MethodsOne-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Data were explored using thematic analysis. ResultsThree themes and eight sub-themes emerged. In terms of recognising symptoms of COVID-19, parents needed prompting before recalling the main symptoms described by the NHS. Parents suggested several factors relating to the nature of the symptom(s) and contextual information that might lead to or prevent them from seeking a test. Although parents supported symptomatic testing, described trusting official sources of information (e.g., Government and NHS websites) and commonly reported no major concerns, minor concerns were raised regarding the accuracy of test results, safety at testing centres and logistics of testing. Parents perceived adherence to testing and self-isolation as pro-social behaviour, although family resources and circumstances impacted their ability to adhere fully. ConclusionsOur study identified several barriers to parents using NHS Test and Trace as needed. Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimised.

Pharmacogenomics: Ethical Issues in Data Management

"Pharmacogenomics uses a DNA sequence in order to create a “genetic map” that determines which drugs are the most efficient for a specific disease, in a particular patient. The needed information for developing personalized therapies needs, besides genetic data, various non-genetic factors might interfere with some mechanisms of drug action, and they should also be considered. The assumption that the genetic data is more important than any other type of non-genetic medical information may severely alter the reliability of pharmacogenomics. In order to decrease the risk for non-genetic factors to significantly alter the pharmacogenomics-related therapies, patients need to provide detailed information about them. This, however, is often not specifically sought upon by neither the patient (who sees this information as trivial when the physician interacts directly with her/his genes), nor the physician (who is often a genetics/ pharmacogenetics expert, who tends to see the genetic information as supreme). One of the main targets in data management is privacy. A lot of effort is needed to keep the data anonymous and creating a detailed informed consent to determine the patient to acknowledge the risks and the benefits of pharmacogenomics. However, proper management of data also includes obtaining all the relevant information to maximize beneficence, this being especially important in frontier techniques, such as pharmacogenomics. The purpose of this study is to analyze the main ethical issues in data management in pharmacogenomics, with an emphasis on the way the physician-patient relationship should be developed to maximize relevant data extraction and optimize its management. "