Effects of halogenated contaminants on reproductive development in wild mink (Neovison vison) from locations in Canada.

The concept of the Anthropocene, that humans are now re-engineering global ecosystems, is in part evidenced by the pervasive pollution by persistent organic pollutants (POPs). Certain POPs are hormone mimics and can disrupt endocrine and hence reproductive processes, shown mainly by laboratory studies with model species. There are, in contrast, fewer confirmations of such disruption from eco-epidemiological studies of wild mammals. Here we used the American mink (Neovison vison) as a sentinel species for such a study. Over the period 1998-2006, 161 mink carcasses were obtained from commercial trappers in the Canadian provinces of British Columbia and Ontario. Mink were aged, sexed, measured, and body condition assessed. Livers were analyzed either individually or pooled for organochlorine (OC) pesticides, polychlorinated biphenyls (PCBs), and subsets for polybrominated diphenyl ethers (PBDEs). We primarily addressed whether contaminants affected male reproductive development by measuring baculum size and assessing the influences of age and body condition. We also considered the influence of spatial variation on relative exposure and size of baculum. Statistical models separated by age class revealed that significant relationships between baculum length or mass and juvenile mink were mostly positive, whereas for adults and first year mink they were mostly negative. A significant negative relationship for adult mink was determined between DDE and both baculum length and mass. For juvenile mink we found significant positive relationships between ∑PCBs, DDE and ∑PBDEs with baculum length. Our results provide some indication of negative effects of halogenated contaminants on male reproductive development in wild mink, and the most likely candidate chemical is the confirmed anti-androgenic compound, DDE, rather than PCBs or other compounds.

Perceived efficacy and utility of postgraduate physician assistant training programs.

OBJECTIVE: The purpose of this study was to explore graduates' perceptions of the efficacy and perceived utility of postgraduate physician assistant (PA) programs. METHODS: Using an online tool, a survey was sent to postgraduate PA program graduates that contained demographic questions and descriptive questions examining the perceived utility of completing a postgraduate PA program. RESULTS: Surveys were e-mailed to 149 graduates of postgraduate PA programs; 113 responded (75% response rate). After completing postgraduate training, 97% of graduates felt their training made them more competitive in the job market; 74% believed time from orientation to full productivity was reduced; and 95% would recommend completion of a postgraduate training program. CONCLUSIONS: Completion of a postgraduate PA program is an alternative to on-the-job training. Graduates perceived that the benefits from these programs include increased competitiveness in the job market, decreased onboarding time, and overall enhancement of their professional careers.

Avian influenza viruses in wild birds in Canada following incursions of highly pathogenic H5N1 virus from Eurasia in 2021-2022.

Following the detection of novel highly pathogenic avian influenza virus (HPAIV) H5N1 clade 2.3.4.4b in Newfoundland, Canada, in late 2021, avian influenza virus (AIV) surveillance in wild birds was scaled up across Canada. Herein, we present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds during the first year (November 2021-November 2022) following the incursions of HPAIV from Eurasia. The key objectives of the surveillance program were to (i) identify the presence, distribution, and spread of HPAIV and other AIVs; (ii) identify wild bird morbidity and mortality associated with HPAIV; (iii) identify the range of wild bird species infected by HPAIV; and (iv) genetically characterize detected AIV. A total of 6,246 sick and dead wild birds were tested, of which 27.4% were HPAIV positive across 12 taxonomic orders and 80 species. Geographically, HPAIV detections occurred in all Canadian provinces and territories, with the highest numbers in the Atlantic and Central Flyways. Temporally, peak detections differed across flyways, though the national peak occurred in April 2022. In an additional 11,295 asymptomatic harvested or live-captured wild birds, 5.2% were HPAIV positive across 3 taxonomic orders and 19 species. Whole-genome sequencing identified HPAIV of Eurasian origin as most prevalent in the Atlantic Flyway, along with multiple reassortants of mixed Eurasian and North American origins distributed across Canada, with moderate structuring at the flyway scale. Wild birds were victims and reservoirs of HPAIV H5N1 2.3.4.4b, underscoring the importance of surveillance encompassing samples from sick and dead, as well as live and harvested birds, to provide insights into the dynamics and potential impacts of the HPAIV H5N1 outbreak. This dramatic shift in the presence and distribution of HPAIV in wild birds in Canada highlights a need for sustained investment in wild bird surveillance and collaboration across interagency partners. IMPORTANCE: We present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds in the year following the first detection of highly pathogenic avian influenza virus (HPAIV) H5N1 on the continent. The surveillance program tested over 17,000 wild birds, both sick and apparently healthy, which revealed spatiotemporal and taxonomic patterns in HPAIV prevalence and mortality across Canada. The significant shift in the presence and distribution of HPAIV in Canada's wild birds underscores the need for sustained investment in wild bird surveillance and collaboration across One Health partners.

Assessing the academic and professional needs of trauma nurse practitioners and physician assistants.

Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States. A 14-question electronic survey, using SurveyMonkey, was distributed to PAs/NPs at trauma centers identified through the American College of Surgeons Web site and other online resources. Demographic questions included trauma center level, provider type, level of education, and professional affiliations. Likert scale questions were incorporated to assess level of mentorship, comfort level with training, and individual perceived needs for academic and professional development. There were 120 survey respondents: 60 NPs and 60 PAs. Sixty-two respondents (52%) worked at level I trauma centers and 95 (79%) were hospital-employed. Nearly half (49%) reported working in trauma centers for 3 years or less. One hundred nineteen respondents (99%) acknowledged the importance of trauma-specific education; 98 (82%) were required by their institution to obtain such training. Thirty-five respondents (32%) reported receiving $1000 per year or less as a continuing medical education benefit. Insufficient mentorship, professional development, and academic development were identified by 22 (18%), 16 (13%), and 30 (25%) respondents, respectively. Opportunities to network with trauma PAs/NPs outside their home institution were identified as insufficient by 79 (66%). While PAs/NPs in trauma centers recognize the importance of continued contemporary trauma care and evidence-based practices, attending trauma-related education is not universally required by their employers. Financial restrictions may pose an additional impediment to academic development. Therefore, resource-efficient opportunities should be a prime consideration for advanced practitioners education, especially since half of the reported workforce has 3 years or less experience. The Eastern Association of Trauma and other organizations can provide an ideal venue for mentorship, academic development, and networking that is vital to PA/NP professional development and, ultimately, quality patient care.

Assessing plastic ingestion in birds of prey from British Columbia, Canada.

Since first being introduced for public use in the 1960s, plastic has become one of the most pervasive and ubiquitous forms of pollution globally. The potential fate and effects of plastic pollution on birds is a rapidly growing area of research, but knowledge of terrestrial and freshwater species is limited. Birds of prey have been particularly understudied, with no published data on plastic ingestion in raptors in Canada to date, and very few studies globally. To assess the ingestion of plastic in raptors, we analysed the contents of the upper gastrointestinal tracts from a total of 234 individuals across 15 raptor species, collected between 2013 and 2021. Upper gastrointestinal tracts were assessed for plastics and anthropogenic particles > 2 mm in size. Of the 234 specimens examined, only five individuals across two species had evidence of retained anthropogenic particles in the upper gastrointestinal tract. Two of 33 bald eagles (Haliaeetus leucocephalus, 6.1%) had retained plastics in the gizzard, while three of 108 barred owls (Strix varia, 2.8%) had retained plastic and non-plastic anthropogenic litter. The remaining 13 species were negative for particles > 2 mm in size (N = 1-25). These results suggest that most hunting raptor species do not appear to ingest and retain larger anthropogenic particles, though foraging guild and habitat may influence risk. We recommend that future research investigate microplastic accumulation in raptors, in order to gain a more holistic understanding of plastic ingestion in these species. Future work should also focus on increasing sample sizes across all species to improve the ability to assess landscape- and species-level factors that influence vulnerability and susceptibility of plastic pollution ingestion.

A novel calicivirus discovered in trumpeter swans (Cygnus buccinator) expands the richness of known avian caliciviruses.

Caliciviruses are ssRNA viruses that can infect a wide range of hosts, including birds. While several avian caliciviruses have been discovered, their taxonomy and host distribution are largely unknown. We molecularly characterized a novel calicivirus (trumpeter swan calicivirus: TruSCV) in trumpeter swans over-wintering in south-west British Columbia, Canada. The positivity rate was 20.3% (14/69) and there were no significant differences in infection rates between males (5/34, 14.7%) and females (9/35, 25.7%) or among considered age groups (juveniles: 4/14, 28.6%; sub-adults: 1/9, 11.1%; adults: 9/46, 19.6%). Twelve infected swans died of lead poisoning, one because of starvation, and one from physical injuries. TruSCV complete genome possessed the typical organization and protein motifs of caliciviruses and a type 2 IRES and its closest relative was a virus circulating in Australian ducks. Phylogenetic analyses showed the existence of 34 different but monophyletic avian caliciviruses. These viruses, while having conserved genomic organization and protein motifs, possess different IRES types and group in several divergent clades, with only two of them corresponding to currently defined genera, highlighting the need for epidemiological investigations and systematic analyses to better define their taxonomy. Follow-up studies are needed to elucidate the diversity, distribution, and pathogenic potential of TruSCV.

Chemical identification of microplastics ingested by Red Phalaropes (Phalaropus fulicarius) using Fourier Transform Infrared spectroscopy.

Chemical characterization of plastics ingested by wildlife helps identify sources of plastic pollution in nature and informs assessments of exposure risk to contaminants. In 2016, Red Phalaropes (Phalaropus fulicarius) were found dead on the north coast of British Columbia, Canada, during their southward migration. Previously, ingested particles suspected to be plastics were reported upon gut examination in all carcasses collected, which likely contributed to mortality. Here, we provide chemical identification of the ingested particles using Fourier Transform Infrared (FTIR) spectroscopy. Polymer identification was successful for 41 of the 52 analysed particles (79%): 41 (79%) were confirmed as plastics, 6 (11%) were not plastics, and 5 (10%) could not be identified. The most commonly ingested plastics were polyethylene (42%) and polypropylene (23%), both of which are known to float in the marine environment. Our study highlights the vulnerability of surface foraging seabirds to plastic pollution in the marine environment.

Modelling entanglement rates to estimate mortality of marine birds in British Columbia commercial salmon gillnet fisheries.

Incidental mortality of marine birds in fisheries is an international conservation concern, including in Canada where globally significant populations of vulnerable diving species overlap with coastal gillnet fisheries. In British Columbia (BC), commercial salmon gillnet fishing effort was historically very high (>200,000 days fished annually in the early 1950's), and although this fishery has declined, over 6,400 days were fished annually in the 2006-2016 decade. Observations of seabird bycatch within the commercial fishery, however, are limited in both scope (comprising <2% of cumulative effort 2001-2016) and in time (being available only from 1995 onwards and only for a small number of areas). Using onboard fishery observer data from commercial, test and experimental fisheries (1995-2016), we developed two models to estimate the number of marine birds captured per set in sockeye (Oncorhynchus nerka) and chum (O. keta) salmon gillnet fisheries employing a Generalized Linear Mixed Modeling (GLMM) approach in a hierarchical Bayesian framework, with observer data post-stratified by fisheries management area and year. Using estimates of total commercial fishing effort (estimated number of sets, 2001-2016) we applied the models to extrapolate annual take for the main bird species (or groups) of interest. Multinomial probability estimates of species composition were calculated based upon a sample of 852 birds identified to species that were associated with sockeye or chum fisheries, enabling estimates (with CIs) of potential numbers of the mostly commonly observed species (common murres (Uria aalge), rhinoceros auklets (Cerorhinca monocerata), and marbled murrelets (Brachyramphus marmoratus)) entangled annually in commercial sockeye and chum salmon gillnet fisheries throughout BC. Conservative estimates of annual losses to entanglement were greatest for common murres (2,846, 95% CI: 2,628-3,047), followed by rhinoceros auklets (641, CI: 549-770) and marbled murrelets (228 CI: 156-346). Populations of all three of these alcids species are currently in decline in BC and entanglement mortality is a conservation concern. Gillnet mortality has been identified as a longstanding threat to marbled murrelet populations, which are recognized as Threatened in the Canada and the United States of America (USA). In addition, 622 (CI: 458-827) birds from 12 other species were estimated to be entangled annually. We conclude that cumulative mortality from incidental take in salmon gillnet fisheries is one of the largest sources of human-induced mortality for marine birds in BC waters, a conservation concern impacting both breeders and visiting migrants.

Anticoagulant rodenticides in three owl species from Western Canada, 1988-2003.

Anticoagulant rodenticides are widely used to control rodent infestations. Previous studies have shown that nontarget organisms, such as birds, are at risk for both primary and secondary poisoning. This paper presents rodenticide residue information on the livers from 164 strigiformes which included barn owls (Tyto alba), barred owls (Strix varia), and great horned owls (Bubo virginianus), collected from 1988 to 2003 in the province of British Columbia and the Yukon Territory, Canada. Livers were analyzed for brodifacoum, bromadiolone, chlorophacinone, diphacinone, difethialone, and warfarin. Our results show that, of the 164 owl livers analyzed, 70% had residues of at least one rodenticide, and of these 41% had more than one rodenticide detected. Of the three species of owls examined, barred owls were most frequently exposed (92%, n = 23); brodifacoum and bromadiolone were most often detected, with liver concentrations ranging from 0.001 to 0.927 mg/kg brodifacoum, and 0.002 to 1.012 mg/kg bromadiolone. Six of the owls (three barred owls, two barn owls, and one great horned owl) were diagnosed as having died from anticoagulant poisoning; all six owls had brodifacoum residues in the liver.

The American Association of Colleges of Nursing's Geriatric Nursing Education Consortium.

The American Association of Colleges of Nursing (AACN) administers several complementary programs to improve nursing care for older adults, including the Geriatric Nursing Education Consortium (GNEC). GNEC, a national initiative with generous funding from the John A. Hartford Foundation and operated in collaboration with the Hartford Institute for Geriatric Nursing at New York University, is designed to enhance geriatric content in senior-level undergraduate nursing courses. As a result of the GNEC initiative, faculty at a majority of baccalaureate programs at schools of nursing across the country have been educated in the fundamentals of teaching geriatric nursing and the use of geriatric curriculum resources. Using a train-the-trainer approach, GNEC's primary goal has been to support and empower baccalaureate nursing faculty as they champion geriatric education, train other faculty, and oversee revision of the senior-level undergraduate curriculum at their home institutions.

Using mobile phones for rapid reporting of zoonotic diseases in rural South Africa.

Human health is inextricably linked to animal health and production, particularly in developing regions of the world where animals play an important role in communities by providing transportation and food. Many deaths occur each year from a number of well-known and preventable animal diseases that are transmitted to humans, especially in developing countries, due to a lack of early detection and preventative measures. Despite the link between human health and animal health, veterinary telehealth has not attracted much attention from researchers in the medical health community. This paper describes a case study exploring the use of mobile phones for rapid reporting of zoonotic diseases in South Africa. It outlines an SMS-based mobile service to enable community members to report suspected cases of diseases. This service aims to increase the number and density of traditional reporting sources to facilitate near real-time reporting and consequently more rapid response to zoonoses outbreaks. The initial phases of this system design are described in addition to future directions.

Influence of overwinter distribution on exposure to persistent organic pollutants (POPs) in seabirds, ancient murrelets (Synthliboramphus antiquus), breeding on the Pacific coast of Canada.

Assessing the fate of both legacy and newer persistent organic pollutants (POPs) is an ongoing challenge. Top predators, including seabirds, are effective monitors of POPs because they forage over a range of marine habitats, integrating signals over space and time. However, migration patterns can make unravelling contaminant sources, and potentially assessments of the effectiveness of regulations, challenging if chemicals are acquired at distant sites. In 2014, we fitted geolocators on ancient murrelets (Synthliboramphus antiqueus) at four colonies on the Pacific Coast of Canada to obtain movement data throughout an annual cycle. All birds underwent a post-breeding moult in the Bering Sea. Around one-third then returned to overwinter on the British Columbia (BC) coast while the rest migrated to overwinter in waters along the north Asian coast. Such a stark difference in migration destination provided an opportunity to examine the influence of wintering location on contaminant signals. In summer 2015, we collected blood samples from returned geo-tagged birds and analyzed them for a suite of contaminants, including polybrominated diphenyl ethers (PBDEs), non-PBDE halogenated flame retardants, perfluoroalkyl substances (PFASs), organochlorines, and mercury. Feathers were also collected and analyzed for stable isotopes (δ13C, δ15N, and δ34S). We found no significant differences in blood concentrations of any contaminant between murrelets from the two different overwinter areas, a result that indicates relatively rapid clearance of POPs accumulated during winter. Spatial variation in diet (i.e., δ13C) was associated with both BDE-47 and -99 concentrations. However, individual variation in trophic level had little influence on concentrations of any other examined contaminants. Thus, blood from these murrelets is a good indicator of recent, local contaminants, as most signals appear independent of overwintering location.

Seasonal variability in vulnerability for Cassin's auklets (Ptychoramphus aleuticus) exposed to microplastic pollution in the Canadian Pacific region.

Marine plastic pollution is an emerging global conservation challenge, potentially impacting organisms at all trophic levels. However, currently it is unclear to what extent plastic pollution is impacting marine organisms at the population, species or multispecies level. In this study, we explore seasonal exposure (i.e., vulnerability) of Cassin's Auklet (Ptychoramphus aleuticus) to plastic pollution with exposure models during boreal summer and winter seasons. Based on these models, we infer exposure at the population level for this species, in the Canadian Pacific region where approximately 75% of the global population of this species breeds. The models quantify plastic exposure by determining seasonal core foraging areas and plastic concentrations found in those same areas. Core foraging areas were determined using a Generalized Additive Model based on at-sea observation data (collected year round: 1990-2010) and 50% Home Range Kernels based on aerial telemetry data (May and June 1999-2001). Plastic concentrations within these core areas were interpolated based on seawater microplastic concentrations from the summer of 2012. We found that during the boreal summer, Cassin's Auklets were exposed to relatively low concentrations of plastics. During the winter, auklet distribution shifted towards the coast where plastic concentrations are considerably higher. Model derived seasonal variability in exposure was consistent with necropsy results from bird carcasses recovered during the winter of 2014, and from a multiyear study on chick provisioning during the summer. Local oceanography likely plays a role in determining seasonal shifts in both marine bird as well microplastic concentrations, and hence exposure. As well, individual sensitivity (i.e., dose-dependent effect) may vary with annual cycles. Currently, research is focusing on determining how sensitive individual birds are to microplastic concentrations, and our models will help translate sensitivity found at the individual level to potential impacts at population or species level.

Fonofos poisons raptors and waterfowl several months after granular application.

From 1994 to 1999 in the Lower Fraser Valley region of southwest Canada, fonofos (Dyfonate G) was recommended for control of introduced wireworm (Agriotes spp.) pests on potato and other root crops. As part of a wildlife-monitoring program, we collected 15 raptors, including 12 bald eagles (Haliaeetus leucocephalus), found dead or debilitated on or near agricultural lands with severely inhibited brain and/or plasma cholinesterase activity and fonofos residues in ingesta. Bird remains, in nine cases waterfowl, were identified in the ingesta samples. Another seven bald eagles had severe cholinesterase inhibition, but without evidence of fonofos residues. During two winters from 1996 to 1998, 420 ha of potato fields, half of which had been treated the previous spring with fonofos and the remainder untreated, were searched weekly for evidence of wildlife mortality. Search efficiency was assessed with placed duck carcasses. Waterfowl outnumbered other species in field-use counts and comprised the greatest proportion of birds found dead. We found 211 wildlife remains, most scavenged; 35 intact carcasses were suitable for postmortem examination and/or toxicology analyses. Cholinesterase activity was assayed in brains of 18 waterfowl, five of which had severely depressed activity (average inhibition 74%; range, 69-78%). The gastrointestinal tract of a mallard found in a field treated with granular product contained 49 microg/g fonofos residues, linking waterfowl mortality with labelled use of the product. These findings demonstrate the risk of both primary and secondary poisoning by anticholinesterase insecticides where wildlife make intensive use of farmed fields.

The power of visual memory: the earliest remembered drawing of Alberto Giacometti, Snow White in Her Coffin.

Since the time of Freud, many psychoanalysts have seen screen memories and earliest memories as reflecting underlying dynamics. I propose that an earliest remembered artwork is a highly condensed construction similar to a screen memory. Alberto Giacometti's earliest remembered drawing, of Snow White in Her Coffin, contains clues to the artist's personality and references to childhood experience. Giacometti's memory of the drawing done in childhood is a striking condensation of significant biographical events and psychodynamic conflicts, as well as a marker of important unconscious fantasies. The artist's postwar sculptural style, utilizing gaunt figures, epitomizes the final transformation of the psychological meaning of his earliest remembered drawing.

Are ocean conditions and plastic debris resulting in a 'double whammy' for marine birds?

We report a mortality event of Red Phalaropes (Phalaropus fulicarius) that occurred from October to November 2016 on the north coast of British Columbia, Canada. All individuals were severely underweight and showing signs of physiological stress. The guts of all carcasses contained ingested plastics (100%, n = 9). Distribution modelling from pelagic bird surveys (1990-2010) indicated that Red Phalaropes are not typically found in the study area during fall months. Ocean conditions during fall 2016 were unusually warm, coinciding with reduced upwelling in the study area. eBird records since 1980 indicated Red Phalaropes are observed closer to shore during periods associated with reduced upwelling. These results suggest that distribution shifts of Red Phalaropes closer to shore, where plastic debris occurs in higher concentrations, may lead phalaropes to feed on plastic debris while in a weakened state, resulting in a combination of two adverse circumstances.

Post-breeding movements of Ancient Murrelet Synthliboramphus antiquus family groups, subsequent migration of adults and implications for management.

Increased shipping in British Columbia (BC) waters poses risks for marine birds from marine oil spills. Ancient Murrelets (Synthliboramphus antiquus), small marine diving birds of which half of the world's population breeds in BC, are especially susceptible to oiling immediately after departing from their breeding colonies, as their offspring are flightless, constraining their parents to remain with them. In 2014 we deployed geolocator loggers on Ancient Murrelets at four breeding colonies, two on the east and two on the west coast of Haida Gwaii to investigate patterns of post-breeding dispersal and subsequent migratory movements. Birds from east coast colonies moved south and east after leaving their colonies, remaining in Queen Charlotte Sound and adjacent waters for 4-6 weeks, whereas those from west coast colonies moved steadily north and west, so that they left BC waters earlier than those from east coast colonies. These movements were consistent with being driven by surface currents. In June, all birds moved rapidly to the eastern Aleutians, SE Bering Sea, and waters off Kamchatka, where they probably moulted. In August, most moved north, some passing through Bering Straits into the Chukchi Sea. In October-November some birds returned to waters off western N America (33%) and the remainder carried on westwards to waters off Japan, Korea and NE China. For the former group the movement to the Bering Sea in June constituted a moult migration and, as such, is the first described for an auk. Those birds wintering in Asia began moving east in February and arrived off BC in March, when observations at colonies show that burrow visits begin in Haida Gwaii. Our data suggest that, immediately after colony departure, birds from the east coast colonies (about half the population of Haida Gwaii) are at higher risk from potential oil spills in northern British Columbia waters than those breeding on the west coast.

The effects of environmental exposure to DDT on the brain of a songbird: changes in structures associated with mating and song.

Dichlorodiphenyltrichloroethane (DDT) is a persistent organochlorine compound found worldwide that causes significant anatomical, physiological and behavioural abnormalities in humans and wildlife. However, little is known about whether environmental exposure to DDT affects the brain. Here, we show that environmental exposure to DDT alters the brains of American Robins (Turdus migratorius) in several ways. Increasing levels of DDT resulted in: (i) smaller brain and relative forebrain volumes; (ii) a reduction in the size of two song nuclei, nucleus robustus arcopallialis (RA) and HVC; and (iii) a drastic reduction in neuronal size and overall volume of nucleus intercollicularis (ICo), a structure that is critical for normal sexual behaviour. These changes likely result from stress, direct neurotoxicity and androgen receptor antagonism by the primary metabolite of DDT, p,p'-DDE and this is corroborated by analyses of brain region volumes and p,p'-DDE levels. Our results therefore demonstrate that environmental exposure to DDT is correlated with significant changes in the brain and specifically those structures related to mating and song. Given the magnitude of these changes in the brain and the fact that environmental DDT exposure was restricted to early development, we conclude that both humans and wildlife that live in DDT contaminated environments may be at risk of neurological damage.

The ViCCU Project -- achieving virtual presence using Ultrabroadband internet in a Critical Clinical application -- initial results.

The ViCCU (Virtual Critical Care Unit) Project sought to address the problems of shortages of Critical Care staff by developing a system that could use the capabilities of Ultrabroadband networks so as to have a Critical Care Specialist virtually present at a distant location. This is not possible in a clinically useful way with current systems. A new system (ViCCU) was developed and deployed. Critically ill or injured patients are now routinely assessed and managed remotely using this system. It has led to a more appropriate level of transfers of patients and the delivery of a quality of clinical service not previously available. This paper describes the history of the project, its novelty, the clinically significant technical aspects of the system and its deployment. The initial results to the end of September 2004 are described.