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"Phillips, Christopher"
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Rhetoric Versus Reality - Embedding a New Relationship Within Integrated Care Systems for Third Sector Organisations
Introduction: Within the UK, NHS England has outlined the integral role of third sector organisations as a strategic partner in integrated care systems. This study sought to explore the embedding of a ‘new relationship’ in the co-design and delivery of ‘local’ services. Methods: Thirteen semi-structured interviews were conducted within a local authority area in England, with leaders from both the statutory and third sector. Interviews were analysed using framework analysis. Findings and Discussion: Findings suggest there is a need to go beyond the rhetoric in embedding a ‘new relationship’ with the third sector. More needs to be done to change the narrative as to how the third sector is perceived, for sectoral stereotypes to be dispelled, to move beyond tokenistic engagement and focus on how improving health can be tackled together. Whilst place-based forms of governance will differ, a greater understanding by the statutory sector of ‘local’ organisational and individual dynamics, capabilities and perspectives is paramount. Conclusion: The study concludes that policy narratives are not underpinned with institutional structures and mechanisms. Without a concerted effort and commitment to meaningful engagement, there is a risk that third sector goodwill dissipates in the face of the latest iteration of policy rhetoric.
Journal Article
Ophidiomycosis, an emerging fungal disease of snakes: Targeted surveillance on military lands and detection in the western US and Puerto Rico
Wildlife disease surveillance and pathogen detection are fundamental for conservation, population sustainability, and public health. Detection of pathogens in snakes is often overlooked despite their essential roles as both predators and prey within their communities. Ophidiomycosis (formerly referred to as Snake Fungal Disease, SFD), an emergent disease on the North American landscape caused by the fungus Ophidiomyces ophiodiicola, poses a threat to snake population health and stability. We tested 657 individual snakes representing 58 species in 31 states from 56 military bases in the continental US and Puerto Rico for O. ophiodiicola. Ophidiomyces ophiodiicola DNA was detected in samples from 113 snakes for a prevalence of 17.2% (95% CI: 14.4-20.3%), representing 25 species from 19 states/territories, including the first reports of the pathogen in snakes in Idaho, Oklahoma, and Puerto Rico. Most animals were ophidiomycosis negative (n = 462), with Ophidiomyces detected by qPCR (n = 64), possible ophidiomycosis (n = 82), and apparent ophidiomycosis (n = 49) occurring less frequently. Adults had 2.38 times greater odds than juveniles of being diagnosed with ophidiomycosis. Snakes from Georgia, Massachusetts, Pennsylvania, and Virginia all had greater odds of ophidiomycosis diagnosis, while snakes from Idaho were less likely to be diagnosed with ophidiomycosis. The results of this survey indicate that this pathogen is endemic in the eastern US and identified new sites that could represent emergence or improved detection of endemic sites. The direct mortality of snakes with ophidiomycosis is unknown from this study, but the presence of numerous individuals with clinical disease warrants further investigation and possible conservation action.
Journal Article
Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises
Abstract
Background
It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for.
Methods
To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period.
Results
In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization.
Conclusions
The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.
Journal Article
High-sensitivity dual-comb and cross-comb spectroscopy across the infrared using a widely tunable and free-running optical parametric oscillator
Dual-comb spectroscopy (DCS) enables high-resolution measurements at high speeds without the trade-off between resolution and update rate inherent to mechanical delay scanning. However, high complexity and limited sensitivity remain significant challenges for DCS systems. We address these via a wavelength-tunable dual-comb optical parametric oscillator (OPO) combined with an up-conversion detection method. The OPO is tunable from 1300-1670 nm (signal) and 2700-5000 nm (idler). Spatial multiplexing in both the laser and OPO cavities creates a near-common path arrangement, enabling comb-line-resolved measurements in free-running operation. The narrow instantaneous bandwidth results in high power per comb-line up to 160
μ
W in the mid-infrared. Through intra-cavity up-conversion based on cross-comb spectroscopy, we leverage these power levels while overcoming the sensitivity limitations of direct mid-infrared detection. This approach yields a high signal-to-noise ratio (50.2 dB Hz
1/2
) and high dual-comb figure of merit (3.5 × 10
8
Hz
1/2
). This scheme enabled detecting ambient methane over a 3-meter path length in millisecond time scale.
The authors demonstrate a widely tunable dual-comb optical parametric oscillator in the mid-infrared, and combine it with an intra-cavity up-conversion detection scheme to obtain high-sensitivity and high-resolution spectroscopy measurements.
Journal Article
Development of Snake Fungal Disease after Experimental Challenge with Ophidiomyces ophiodiicola in Cottonmouths (Agkistrodon piscivorous)
Snake fungal disease (SFD) is a clinical syndrome associated with dermatitis, myositis, osteomyelitis, and pneumonia in several species of free-ranging snakes in the US. The causative agent has been suggested as Ophidiomyces ophiodiicola, but other agents may contribute to the syndrome and the pathogenesis is not understood. To understand the role of O. ophiodiicola in SFD, a cottonmouth snake model of SFD was designed. Five cottonmouths (Agkistrodon piscivorous) were experimentally challenged by nasolabial pit inoculation with a pure culture of O. ophiodiicola. Development of skin lesions or facial swelling at the site of inoculation was observed in all snakes. Twice weekly swabs of the inoculation site revealed variable presence of O. ophiodiicola DNA by qPCR in all five inoculated snakes for 3 to 58 days post-inoculation; nasolabial flushes were not a useful sampling method for detection. Inoculated snakes had a 40% mortality rate. All inoculated snakes had microscopic lesions unilaterally on the side of the swabbed nasolabial pit, including erosions to ulcerations and heterophilic dermatitis. All signs were consistent with SFD; however, the severity of lesions varied in individual snakes, and fungal hyphae were only observed in 3 of 5 inoculated snakes. These three snakes correlated with post-mortem tissue qPCR evidence of O. ophiodiicola. The findings of this study conclude that O. ophiodiicola inoculation in a cottonmouth snake model leads to disease similar to SFD, although lesion severity and the fungal load are quite variable within the model. Future studies may utilize this model to further understand the pathogenesis of this disease and develop management strategies that mitigate disease effects, but investigation of other models with less variability may be warranted.
Journal Article