The INO80 chromatin remodeling complex prevents polyploidy and maintains normal chromatin structure at centromeres.

The INO80 chromatin remodeling complex functions in transcriptional regulation, DNA repair, and replication. Here we uncover a novel role for INO80 in regulating chromosome segregation. First, we show that the conserved Ies6 subunit is critical for INO80 function in vivo. Strikingly, we found that loss of either Ies6 or the Ino80 catalytic subunit results in rapid increase in ploidy. One route to polyploidy is through chromosome missegregation due to aberrant centromere structure, and we found that loss of either Ies6 or Ino80 leads to defective chromosome segregation. Importantly, we show that chromatin structure flanking centromeres is altered in cells lacking these subunits and that these alterations occur not in the Cse4-containing centromeric nucleosome, but in pericentric chromatin. We provide evidence that these effects are mediated through misincorporation of H2A.Z, and these findings indicate that H2A.Z-containing pericentric chromatin, as in higher eukaryotes with regional centromeres, is important for centromere function in budding yeast. These data reveal an important additional mechanism by which INO80 maintains genome stability.

Out-of-hours special patient notes.

In 2011, an out-of-hours service in central London reviewed its system for special patient notes (SPNs) - a main mechanism to communicate valuable information about patients to the clinicians who cover two-thirds of the week when day-time general practices are closed. This revealed that: half of frequent callers did not have an SPNabout half of existing SPNs were out of dateday-time general practitioners (GPs) respond well to requests by out-of-hours doctors to provide an SPNproviding SPNs was low on the list of priorities of day-time GPs who were too busy reacting to everyday problems.

Electronic palliative care co-ordination system: an electronic record that supports communication for end-of-life care - a pilot in Richmond, UK.

Most people prefer to die at home, however, the majority die in an acute hospital. Supporting a patient in their preferred place of care may be aided by exchange of information across sectors. Richmond piloted an electronic palliative care coordination system (EPaCCS) to enhance interprofessional communication for end-of-life care. One such EPaCCS is the Coordinate My Care (CMC) hosted by the Royal Marsden NHS Foundation Trust, now supported across London. It focused clinicians on having advance care planning conversations with patients and their carers and then documenting the outcome onto an electronic web-based record that can be shared with key healthcare professionals.

Out-of-hours special patient notes.

In 2011, an out-of-hours service in central London reviewed its system for special patient notes (SPNs) - a main mechanism to communicate valuable information about patients to the clinicians who cover two-thirds of the week when day-time general practices are closed. This revealed that: half of frequent callers did not have an SPNabout half of existing SPNs were out of dateday-time general practitioners (GPs) respond well to requests by out-of-hours doctors to provide an SPNproviding SPNs was low on the list of priorities of day-time GPs who were too busy reacting to everyday problems.

Electronic palliative care co-ordination system: an electronic record that supports communication for end-of-life care - a pilot in Richmond, UK.

Most people prefer to die at home, however, the majority die in an acute hospital. Supporting a patient in their preferred place of care may be aided by exchange of information across sectors. Richmond piloted an electronic palliative care coordination system (EPaCCS) to enhance interprofessional communication for end-of-life care. One such EPaCCS is the Coordinate My Care (CMC) hosted by the Royal Marsden NHS Foundation Trust, now supported across London. It focused clinicians on having advance care planning conversations with patients and their carers and then documenting the outcome onto an electronic web-based record that can be shared with key healthcare professionals.