Intensive Monitoring Program Research Articles

Determination of Cell Abundances and Paralytic Shellfish Toxins in Cultures of the Dinoflagellate Gymnodinium catenatum by Fourier Transform Near Infrared Spectroscopy

Harmful algal blooms are responsible worldwide for the contamination of fishery resources, with potential impacts on seafood safety and public health. Most coastal countries rely on an intense monitoring program for the surveillance of toxic algae occurrence and shellfish contamination. The present study investigates the use of near infrared (NIR) spectroscopy for the rapid in situ determination of cell concentrations of toxic algae in seawater. The paralytic shellfish poisoning (PSP) toxin-producing dinoflagellate Gymnodinium catenatum was selected for this study. The spectral modeling by partial least squares (PLS) regression based on the recorded NIR spectra enabled the building of highly accurate (R2 = 0.92) models for cell abundance. The models also provided a good correlation between toxins measured by the conventional methods (high-performance liquid chromatography with fluorescence detection (HPLC-FLD)) and the levels predicted by the PLS/NIR models. This study represents the first necessary step in investigating the potential of application of NIR spectroscopy for algae bloom detection and alerting.

Behavior Change Interventions to Reduce Illegal Fishing

Illegal fishing is a serious problem that threatens the sustainability of fisheries around the world. Historically, policy makers and fishery managers have relied on the “deterrence model” to alleviate it. This approach focuses on the imposition of strict sanctions and relatively intensive monitoring and enforcement programs in an attempt to increase the costs of illegal behavior. However, while this sort of command-and-control approach can sometimes be successful in large-scale fisheries, small-scale fisheries rarely have the associated resources or necessary governance structures required, and thus strong and reliable monitoring and enforcement has proven to be an elusive goal. Beyond these top-down approaches, non-monetary factors, whether they are cultural, social or psychological, can also influence illegal fishing behaviors, either positively or negatively, and failing to address these factors can undermine the efficacy of an otherwise effective and well-designed fishery management system. Here we explore the use of strategies to reduce illegal fishing behaviors based on insights from behavioral science, in order to augment and secure the effectiveness of conventional deterrence strategies as well as to provide support for alternative means of deterring illegal fishing often required for small-scale fisheries. We draw on theory and studies from the behavioral science literature to show how successful behavior change interventions have been implemented in other sectors, and describe a process for designing interventions for changing specific illegal fishing behaviors. The process begins with an in-depth stakeholder characterization to capture existing norms, beliefs, and modes of thinking about illegal fishing as well as descriptions of specific illegal fishing behaviors. Potential interventions that may disrupt the beliefs, norms, and thought modes that give rise to these behaviors, along with those that encourage desirable behaviors, are developed by applying principles gleaned from the behavioral science literature. These “hypothetical interventions” are then tested using artefactual experiments, piloted with small groups of actual stakeholders and, finally, scaled such that illegal fishing is significantly reduced.

Adapting metabarcoding-based benthic biomonitoring into routine marine ecological status assessment networks

The use of genomic approaches to assist with biodiversity estimations is an alternative to traditional biomonitoring, which is very time-consuming and costly. In response to the high demand for quick community descriptions, DNA metabarcoding can simultaneously assign taxonomy to hundreds of samples rapidly and at low cost. However, the technique has not routinely been incorporated into biomonitoring network programs yet. Here, we applied DNA metabarcoding methodologies at stations within the monitoring network of the Basque Water Agency, the competent authority for the application of the European Water Framework Directive in this region. We characterized the benthic macroinvertebrate communities from 18 estuarine and coastal sediment samples using morphology and metabarcoding-based taxonomic identification and evaluated the performance of several versions of the AZTI’s Marine Biotic Index (AMBI). Although metabarcoding detected 112 taxa against the 206 taxa identified through morphology, we showed that metabarcoding leads to similar biomonitoring conclusions compared with traditional techniques. Using the abundance and biomass of those taxa detected from morphological methodologies, we found a significant positive correlation with the number of reads obtained with metabarcoding approaches. The metabarcoding-based index derived from read counts, gAMBI, and the morphology-based index derived from individuals’ biomass, (B)AMBI, showed the best correlation and revealed excellent agreement at determining the ecological status of the stations analyzed. We calculated that, for the analysis of the 51 stations included in the Basque monitoring network, metabarcoding was 55% less costly and 72% less time consuming. The results of our study are relevant to policy makers and researchers in the field of ecological assessment and will contribute to the quick implementation of DNA metabarcoding to intensive monitoring programs.

In-Channel 3D Models of Riverine Environments for Hydromorphological Characterization

Recent legislative approaches to improve the quality of rivers have resulted in the design and implementation of extensive and intensive monitoring programmes that are costly and time consuming. An important component of assessing the ecological status of a water body as required by the Water Framework Directive is characterising the hydromorphology. Recent advances in autonomous operation and the spatial coverage of monitoring systems enables more rapid 3D models of the river environment to be produced. This study presents a Structure from Motion (SfM) semi-autonomous based framework for the estimation of key reach hydromorphological measures such as water surface area, wetted water width, bank height, bank slope and bank-full width, using in-channel stereo-imagery. The framework relies on a stereo-camera that could be positioned on an autonomous boat. The proposed approach is demonstrated along three 40 m long reaches with differing hydromorphological characteristics. Results indicated that optimal stereo-camera settings need to be selected based on the river appearance. Results also indicated that the characteristics of the reach have an impact on the estimation of the hydromorphological measures; densely vegetated banks, presence of debris and sinuosity along the reach increased the overall error in hydromorphological measure estimation. The results obtained highlight a potential way forward towards the autonomous monitoring of freshwater ecosystems.

Monitoring methods for the Golden Eagle Aquila chrysaetos in Norway

ABSTRACTCapsule: A description of the methods used for monitoring the Golden Eagle Aquila chrysaetos in NorwayAims: To provide a comprehensive description of monitoring methods.Methods: The intensive monitoring of the Golden Eagle in Norway started in 1991 as part of a national monitoring programme initiated by the Directorate for Nature Management (now the Norwegian Environment Agency). It has since become part of the Norwegian Large Predator Programme, and Golden Eagles are currently being monitored in 12 separate areas. Here we provide a comprehensive description of the current methods used in the intensive monitoring, with definitions, fieldwork and evaluation criteria for the final breeding status. In addition, a description of estimation of annual adult survival by genetic analysis is given. We describe the current methodology used in the intensive part of the Golden Eagle monitoring in Norway.Results: We present some results derived from the Norwegian monitoring system and discuss the potential for further analyses. In addition, we highlight aspects in the monitoring of the Golden Eagles where our methods deviate slightly from those applied in other countries and the potential effects of these.Conclusions: Intensive long-term monitoring programmes, such as this, will become increasingly valuable for monitoring the impact of environmental change, both from natural phenomena and from anthropogenic activities. To facilitate comparisons among the Golden Eagle monitoring programmes, detailed knowledge about the various methods applied is important.

Impact of shrimp aquaculture development on important ecosystems in India

Abstract The rapid growth of aquaculture has raised the environmental concern about the conversion of ecologically important areas such as mangroves and agricultural lands. The study explored the impact of shrimp aquaculture on land use change in India’s coastal wetlands using Landsat satellite data, geographical information system techniques and field verification. From 1988 to 2013, the area under aquaculture has grown by 879 %, which brought the tremendous changes in the coastal land use pattern. Mangrove and agriculture lands have been used for 5.04 % and 28.10 % of the aquaculture growth. Mudflats, scrublands, saltpan, and waterbodies have contributed to 51.65 %, 1.76 %, 1.73 % and 2.37 % of the aquaculture area expansion respectively. Mangrove areas have undergone severe changes due to gain and loss at different places. Environmental factors influenced the changes in mangroves, and the overall extent of mangrove has increased by 13.44 %. Construction activities and aquaculture have reduced the agricultural land by 3.52 % and 0.53 % respectively. The variation between the actual area under shrimp aquaculture and the Coastal Aquaculture Authority approved area indicate that the larger extent of shrimp farm operates without approval. Implementation of an intensive monitoring program for strict adherence to coastal aquaculture regulation laws will be helpful for the sustainability of coastal resources as well as aquaculture.

Significant Reduction in Full Metabolic Syndrome in Saudi Subjects with Elevated Fasting Glucose through an Intensive Lifestyle Monitoring Programme of 12 months

BackgroundThe present interventional study in adult Saudi subjects with elevated fasting glucose was aimed to determine the health benefits, in terms of reduction in full metabolic syndrome, of a 12‐month intensive lifestyle monitoring programme with emphasis on lowering dietary fat intake; exercise and increasing sunlight exposure.MethodsBetween April‐2012 and March‐2017, 300 Saudi subjects with baseline fasting glucose at 5.6 to 6.9mmol/l were screened and randomly divided into 3 groups: 1) General advice (GA) group who received a standard lifestyle change advice at recruitment and at 6‐months, 2) Intensive lifestyle monitoring programme (ILMP) group who was followed with a rigorous lifestyle modification support and 3) Metformin (GA+Met) group who was advised to take 3 tablets/day of 500 mg metformin hydrochloride. Basic anthropometric, glycemic, and lipid estimations were obtained at baseline and after 6‐months and 12‐months. The data for 85(GA), 73(ILMP) and 59(GA+Met) subjects was analyzed after removing those lost in follow‐up etc. The percentages of full metabolic syndrome and its five components were calculated for all three groups at different time points.ResultsThe mean fasting glucose at baseline, 6‐months and 12‐months respectively was 5.97±0.4, 6.07±0.7 and 5.92±0.9 (p=0.49) for GA group; 6.06±0.4, 5.66±0.8 and 5.67±0.8 (p<0.01) for ILMP group; and 6.57±0.5, 6.01±1.3 and 5.76±1.7 (p<0.01) for GA+Met group. 37.3 %( N=22) in GA+Met group were able to reduce their weight by atleast 5% from baseline while this number was 11 %( N=8) and 10.6 %( N=9) in ILMP and GA respectively. Full Metabolic syndrome at end of study compared to the baseline was 64.7%(N=55) vs 72.9%(62) (% change: Δ= −8.2%, p=not significant) for GA group; 35.6%(26) vs 61.6%(45) (Δ= −26%, p<0.01) for ILMP group and 64.4%(38) vs 83.1%(49) (Δ= −18.7%, p<0.01) for GA+Met group.ConclusionsThis study highlights the clinical potency of intensive lifestyle modification programme versus other anti‐diabetic management options in reducing full metabolic syndrome in Saudi adults with elevated fasting glucose.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Predator arrival elicits differential dispersal, change in age structure and reproductive performance in a prey population

Predators are an important ecological and evolutionary force shaping prey population dynamics. Ecologists have extensively assessed the lethal effects of invasive predators on prey populations. However, the role of non-lethal effects, such as physiological stress or behavioural responses like dispersal, has been comparatively overlooked and their potential population effects remain obscure. Over the last 23 years, we developed a mark-recapture program for the Audouin’s gull and an intensive carnivore monitoring program to assess how the appearance and invasion of the study site by carnivores affects population dynamics. We evaluate changes in turnover of discrete breeding patches within the colony, age structure and breeding performance. Once carnivores entered the colony, the number of occupied patches increased, indicating a higher patch turnover. Breeders responded by moving to areas less accessible to carnivores. More importantly, the presence of carnivores caused differential (and density-independent) breeding dispersal: experienced, better-performing breeders were more likely to leave the colony than younger breeders. This differential dispersal modified the age structure and reduced the reproductive performance of the population. Our results confirm the importance experience in the study of populations. The role of differential dispersal for animal population dynamics might be more important than previously thought, especially under scenarios of global change.

Experiences Gathered from the Construction of Napoli Underground

The design of a deep excavation must address a number of issues such as, for instance, the choice of an adequate support system, the definition of the sequence of construction phases, the computation of the stresses in the structural members, and the evaluation of the magnitude and distribution of ground displacements connected to the construction phases and to possible changes of groundwater pressures connected with the excavation. Under these premises, in the paper it is presented a summary of the main results obtained by an intense monitoring program carried out in the occasion of the construction of deep excavations in the densely urban environment of Napoli (Italia) for the completion of the existing Underground Line 1.

Destabilisation of Creeping Permafrost: The Plator Rock Glacier Case Study (Central Italian Alps)

The Plator rock glacier is the first such landform identified in the Italian Alps that shows destabilised behaviour. Analysis of six sets of sequential orthophotographs from 1981 to 2012 reveals an exceptional advance of the rock glacier front (92.1 m) and a horizontal velocity up to 4 m a-1 in different zones. The spatial variability of kinematics was evaluated by tracking sets of ‘tracer’ boulders on the rock glacier through time. Its velocity has progressively increased from the rooting zone to the tongue, with complex trends associated with distinct morphological features. Destabilisation likely occurred between 1954 and 1981, probably due to the relatively low elevation of the tongue, which resulted in warm permafrost conditions. Field observations reveal the presence of a large rock fall deposit, which occurred before 1981, and suggest that the debris overload could have triggered destabilisation. Since June 2015, an intensive monitoring programme has been implemented on the rock glacier, as the tongue is expected to travel over a steeper slope segment within the next 3 to 5 years, which could evolve in a catastrophic movement. Copyright © 2016 John Wiley & Sons, Ltd.

Stable isotopic signature of Australian monsoon controlled by regional convection

Abstract The aim of this study was to identify the main meteorological drivers of rainfall isotopic variation in north Australia in order to improve the interpretation of isotopic proxy records in this region. An intense monitoring program was conducted during two monsoonal events that showed significant and systematic isotopic change over time. The results showed a close link between isotopic variation in precipitation and variability in monsoon conditions, associated with the presence of large convective envelopes propagating through the study site. The largest negative amplitudes in the isotopic signal were observed when eastward and westward moving precipitation systems within the convective envelope merged over the measurement site. This suggests that the amplitude of the isotopic signal is related to the size and activity of the convective envelope. The strong correlation between rainfall isotopic variation, regional outgoing longwave radiation and regional rainfall amount supports this conclusion. This is further strengthened by the strong relationship between isotopic variation and the integrated rainfall history of air masses prior to arriving at the measurement locations. A local amount effect was not significant and these findings support the interpretation of δ 18 O as proxy for regional climatic conditions rather than local rainfall amount. Meteorological parameters that characterize intra-seasonal variability of monsoon conditions were also found to be strongly linked to inter-seasonal variability of the monthly based δ 18 O values in the Global Network of Isotopes in Precipitation (GNIP) database. This leads to the conclusion that information about the Australian monsoon variability can likely be inferred from the isotopic proxy record in North Australia on short (intra seasonal) and long (inter seasonal or longer) timescales.

Resolving spatiotemporal characteristics of the seasonal hypoxia cycle in shallow estuarine environments of the Severn River and South River, MD, Chesapeake Bay, USA.

The nature of emerging patterns concerning water quality stressors and the evolution of hypoxia within sub-estuaries of the Chesapeake Bay has been an important unresolved question among the Chesapeake Bay community. Elucidation of the nature of hypoxia in the tributaries of the Chesapeake Bay has important ramifications to the successful restoration of the Bay, since much of Bay states population lives within the watersheds of the tributaries. Very little to date, is known about the small sub-estuaries of the Chesapeake Bay due to limited resources and the difficulties in resolving both space and time dimensions on scales that are adequate to resolve this question. We resolve the spatio-temporal domain dilemma by setting up an intense monitoring program of water quality stressors in the Severn and South Rivers, MD. Volume rendered models were constructed to allow for a visual dissection of the water quality times series which illustrates the life cycle of hypoxia and anoxia at the mid to upper portions of the tidal tributaries. The model also shows that unlike their larger Virginian tributary counterparts, there is little to no evidence of severe hypoxic water intrusions from the main-stem of the Chesapeake Bay into these sub-estuaries.

Emergence of succinate dehydrogenase inhibitor resistance of Pyrenophora teres in Europe.

Net blotch caused by Pyrenophora teres is an important disease of barley worldwide. In addition to strobilurins (quinone ouside inhibitors) and azoles (demethylation inhibitors), succinate dehydrogenase inhibitors (SDHIs) are very effective fungicides for net blotch control. Recently, SDHI-resistant isolates have been found in the field. Intensive sensitivity monitoring programmes across Europe were carried out to investigate the situation concerning SDHI resistance in P. teres. The first isolates with a lower sensitivity to SDHIs registered in barley were found in Germany in 2012 and carried the B-H277Y substitution in the succinate dehydrogenase enzyme. In 2013 and 2014, a significant increase in isolates with lower SDHI sensitivity was detected mainly in France and Germany, and the range of target-site mutations increased. Most of the resistant isolates carried the C-G79R substitution, which exhibits a strong impact on all SDHIs in microtitre tests. All SDHIs tested were shown to be cross-resistant. Other substitutions are gaining in importance, e.g. C-N75S in France and D-D145G in Germany. So far, no double mutants in SDH genes have been detected. Glasshouse tests showed that SDHI-resistant isolates were still controlled by the SDHI fluxapyroxad when applied preventively. To date, most isolates with C-G79R substitution have not simultaneously carried the F129L change in cytochrome b, which causes resistance towards QoI fungicides at low to moderate levels. Several target-site mutations in the genes of subunits SDH-B, SDH-C and SDH-D with different impact on SDHI fungicides were detected. The pattern of mutations varied from year to year and between different regions. Strict resistance management strategies are recommended to maintain SDHIs as effective tools for net blotch control, especially in areas with low frequencies of resistant isolates. © 2016 Society of Chemical Industry.

Using telehealth to augment an intensive case monitoring program in veterans with schizophrenia and suicidal ideation: A pilot trial

Veterans with schizophrenia admitted for suicidal ideation were recruited into a post-discharge program consisting of Intensive Case Monitoring (ICM) with daily monitoring with the Health Buddy (HB; experimental group) or ICM alone (control group). This study tested the feasibility of the telehealth monitoring intervention in this population. Secondly, we determined whether augmentation of ICM with our intervention for 3 months would result in a reduction in suicidal ideation. Twenty of 25 telehealth participants could set up the device. Monthly adherence for telehealth participants was > 80%. A qualitative analysis of endpoint surveys revealed that the majority of participants had positive responses. In both groups, there were improvements in Beck Scale for Suicidal Ideation (BSS) scores at endpoint relative to baseline. No group differences were present with survival analysis when using remission (i.e., BSS score = 0) as the outcome; however, in a subgroup with a history of suicide attempt, there was a trend (p = .093) for a higher rate of remission for those in the HB condition. In conclusion, telehealth monitoring for this population appears to be feasible for those who are able to start using the system. The pilot data obtained should help investigators design better telehealth interventions for this population.

Effect of Different Psychoactive Substances on Serum Biochemical Parameters.

Background:Psychoactive substances affect mainly central nervous system and brain function causing changes in behavior.Objectives:The purpose of this study was to determine the effects of different psychoactive substances on serum biochemical parameters.Patients and Methods:The study included 324 drug dependents, and 69 controls. The patient group was determined according to DSM-IV (The diagnostic and statistical manual of mental disorders, fourth edition) criteria. All patients and control subjects were tested for routine biochemical parameters and urine toxicology parameters for psychoactive substance use. Cases and controls with accompanying diseases like diabetes, cancer, metabolic disorders etc. are excluded from the study. Moreover, an association between urine toxicology results and changes in biochemical parameters was evaluated for statistical significance.Results:There was a statistically significant difference in the Gamma-Glutamyl Transferase (GGT), uric acid, creatinine, urea, albumin, Aspartate Aminotransferase (AST) medians between the dependent and control groups (P < 0.05). We found a statistically significant difference in sodium and albumin levels between the opium-dependent and control groups (P < 0.05). In the benzodiazepin dependent group, we found a significant difference in GGT, urea, glucose, sodium, T protein, and AST levels (P < 0.05). Moreover, a statistically significant difference was observed in triglyceride and GGT levels between the ethyl glucuronide and control groups (P < 0.05).Conclusions:In psychoactive substance dependents, serum routine biochemistry parameters can be used to predict the need for intensive monitoring and treatment programs.

Stochastic uncertainty and sensitivities of nitrogen flows on dairy farms in The Netherlands

Nutrient management decisions and environmental policy making must be based on sound data and proper analysis. Annual data collection and monitoring of farm and nutrient performance are wrought with uncertainties. Such uncertainties need to be addressed as it may lead to ambiguities and wrong conclusions. We developed an input-output N balance model to describe and quantify N flows in dairy farming systems. Input for this model was based on monitored data for one year (2005) from one experimental (detailed monitoring) and 14 pilot commercial dairy farms (less detailed monitoring). A Monte Carlo approach was used to quantify effects of uncertainty of input data on annual farm N surplus, soil surface N surplus and N intake during grazing, followed by a sensitivity analysis to apportion the different sources of uncertainty. Uncertainties in data input were described with probability density functions. Farm N surplus of the 14 pilot farms ranged between 81 and 294 kg ha−1, soil surface N surplus between 35 and 256 kg ha−1, and N intake during grazing between 27 and 108 kg ha−1. The uncertainties of N flows – both relative and absolute – increased from farm N surplus (CV = 8%; SD = 15 kg N ha−1) to soil surface N surplus (CV = 12%; SD = 16 kg N ha−1) to N intake during grazing (CV = 49%; SD = 28 kg N ha−1). Variation in uncertainty among farms in farm and soil surface N surplus and N intake during grazing was substantial and was related to the farm structure and farm characteristics such as production intensity, N fixation by clover and annual changes in stocks of roughage and manure. We found that a monitoring program based on more measurements instead of estimates and/or fixed rate values from literature will not always result in a better quantification of farm and soil surface N surplus on clover-based dairy farms. However, on farms with no N fixation, an intensive monitoring program reduced the uncertainty in farm and soil surface N surplus by 23% and the uncertainty of N intake during grazing was reduced by more than 30%. Knowledge about uncertainties of N flows is necessary to correctly interpret the N performance on dairy farms and its evolution through time. A first step is to get insights into the most uncertain N flows on a dairy farm. The next step, where possible, is to improve the estimation of the most uncertain N flows. Based on the insights from this study, these steps will underpin the validation of trends in N performance and justify decisions in environmental policy making and/or decisions for making on-farm improvements.

Direct injection of tissue extracts in liquid chromatography/tandem mass spectrometry for the determination of pharmaceuticals and other contaminants of emerging concern in mollusks.

In the present study, a straightforward approach was validated for the analysis of pharmaceutically active compounds and endocrine-disrupting chemicals in the mollusk tissues, with a focus on two species commonly consumed in Southeast Asia (green mussels: Perna viridis; lokan clams: Polymesoda expansa). This approach relied on a simple solvent extraction (shaker table) followed by direct injection in liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). This "cleanup-free" approach was made possible by the use of isotopically labeled surrogates (to correct for matrix effects) and a post-column switch on the LC-MS/MS system (to remove potential interfering material). Altogether, relative recoveries were satisfactory for 36 out of 44 compounds (26-163% range) and excellent for 27 out of 44 compounds (79-107% range). Method detection limits (MDLs) were usually expressed in the nanogram per gram wet weight (ww) range and below. The method was successfully applied to 16 batches of green mussel samples collected in Singapore coastal waters. Trace levels of six compounds were detected in mussel tissues: caffeine (0.22-1.55 ng g(-1) ww), carbamazepine (<MDL-0.10 ng g(-1) ww), diltiazem (<MDL-0.13 ng g(-1) ww), diphenhydramine (<MDL-1.31 ng g(-1) ww), atrazine (<MDL-0.19 ng g(-1) ww), and bisphenol A (<MDL-7.6 ng g(-1) ww). The present method offers the perspective of high sample throughput, allowing for intensive monitoring programs and detailed exposure assessments.

Comparative efficacy of alemtuzumab and established treatment in the management of multiple sclerosis.

Alemtuzumab is the newest disease-modifying therapy approved for the treatment of relapsing multiple sclerosis. Alemtuzumab is an anti-CD52 targeted antibody that causes lysis of T and B lymphocytes, monocytes, natural killer cells, macrophages, and dendritic cells. Following its administration, a prolonged T-cell lymphopenia results with emergence of a reconstituted immune system that differs in its composition from that pretreatment. In clinical trials, alemtuzumab has shown impressive efficacy with regard to clinical and radiological outcomes in relapsing multiple sclerosis, along with sustained long-term beneficial effects, and it is attractive for its once-yearly administration. Despite this, the occurrence of serious secondary autoimmune disorders, infections, and a potential risk of malignancy necessitates a careful evaluation of risks versus benefits for an individual patient prior to its use. The requirement of patient commitment to the intense mandatory monitoring program is also a factor to be considered when incorporating alemtuzumab into the treatment regimen.

Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study.

BackgroundIntensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost.ObjectiveThe objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure.MethodsThis was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations.ResultsThere were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30).ConclusionsThis pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure.

Improving Medication Reconciliation compliance at admission: A single department's experience.

Background and objectivesThe objective of this research is to improve compliance of the medication reconciliation process at the time of patient admission in the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia using an innovative evidence-based approach.Materials and methodsMost of the recent efforts at our institution to revamp the medication reconciliation process have failed. Thus, we implemented an innovative evidence-based approach to improve the compliance of the reconciliation process at admission. This approach focused on the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre (KFSH&RC). We established specific educational and monitoring programs that were run over a two-month period, from June to July 2015. The educational program consisted of focused hands-on daily interactive training sessions presented to a small group of residents, i.e., 5–6 residents per session, for a period of one week. One resident was identified as a ”Super-User” to provide ongoing support for the other residents involved in the process. A close monitoring process was also implemented, which included daily follow up and encouragement from three assigned consultants. In addition, periodic independent audit report results prepared by Healthcare Information Technology Affairs (HITA) were communicated to the Department of Pediatrics regarding physician compliance in the medication reconciliation process.ResultsPhysician compliance for admission medication reconciliation documentation in ICIS ranged from (0–15%) between the first quarter of 2012 and the first quarter 2015, we designated the official hospital audit for the first quarter of 2015 as a baseline audit report. Between the first quarter of 2012 and 2015, the physician compliance for admission medication reconciliation was ranged between 0 to 15% according to the official hospital audit. We implemented our initiative during the months of June and July 2015. During that time, there was a gradual improvement in the number of admission medication reconciliations reported by the independent audits of our general Pediatrics Ward (B1), which represents the majority of pediatric admissions. The 57% of 26 patients had medication reconciliation completed by the first report dated 16 June 2015. This percentage improved to 92% out of a total of 13 patients at the last report on 12 July 2015. This consistent improvement also occurred in other areas where pediatric patients were admitted including the B3-1 (from 88% to 90%), the NICU 1 (from 83% to 100%) and the NICU 2 (from 90% to 100%).ConclusionsBy structuring and implementing intensive educational and monitoring programs, a marked improvement in the compliance of medication reconciliation at the time of admission for the pediatric patient population was achieved. We believe that our department-based results would be generalizable if a similar hospital-wide programme was to be rigorously implemented.