Simulation Training in U.K. General Aviation: An Undervalued Aid to Reducing Loss of Control Accidents

Analysis of data from 1,007 U.K. general aviation (GA) accidents demonstrates the predominant cause of accidents is loss of control, exacerbated by a lack of recent flying experience. These are long-standing problems that can be targeted effectively with simulation training. Discussion on training strategies in commercial aviation reinforces the logic of introducing simulation training for the GA pilot. Conclusions drawn affirm the notion that GA safety would benefit from implementation of regulated simulation training

Tracking changes in the occurrence and source of pharmaceuticals within the River Thames, UK: from source to sea

There is a growing interest in the occurrence and sources of pharmaceutical substances in the environment. This paper reports the first detailed transect of pharmaceutical occurrence along the River Thames, UK, from source to sea, undertaken during a period of high flow in 2016. In 37 samples a total of 41 pharmaceuticals and 2 lifestyle compounds (cocaine and sucralose) were detected. Total concentration of pharmaceuticals ranged from 0.0012 µg/l to 10.24 µg/l with a median of 2.6 µg/l. Sucralose concentrations varied from <0.01 to 5.9 µg/l with a median concentration of 1.93 µg/l and was detected in every sample except the groundwater-dominated sources of the Thames. Antimicrobials, including those on the surface water watch list (erythromycin, clarithromycin and azithromycin) were detected in every site downstream of the Thames source. Diclofenac, recently on the surface water watch list, was detected in 97% of Thames samples and above the proposed EQS of 0.1 g/L in 12 samples. Distinct increases in concentration and number of pharmaceuticals were found downstream of the Oxford, Mogdon and Hogsmill wastewater treatment works (WWTW) but were more subdued downstream of the Crossness and Beckton WWTW due to the tidal nature of the Thames and combined sewer outflows. Sucralose was found to be an excellent tracer of wastewaters (treated and untreated) and can be used as a proxy for many pharmaceuticals. Paracetamol and ibuprofen were tracers of untreated wastewater inputs to the Thames due to their high biodegradation within WWTWs

Burnout in the ICU : potential consequences for staff and patient well-being

Peer reviewedAuthor versio

P1NP and β-CTX-1 responses to a prolonged, continuous running bout in young healthy adult males: a systematic review with individual participant data meta-analysis.

Circulating biomarkers of bone formation and resorption are widely used in exercise metabolism research, but their responses to exercise are not clear. To quantify group responses and inter-individual variability of P1NP and β-CTX-1 after prolonged, continuous running (60-120 min at 65-75% VO2max) in young healthy adult males using individual participant data (IPD) meta-analysis. The protocol was designed following PRISMA-IPD guidelines. Changes in P1NP and β-CTX-1 relative to baseline were measured during, immediately after, and in the hours and days following exercise. Typical hourly and daily variations were estimated from P1NP and β-CTX-1 changes relative to baseline in non-exercise (control) conditions. Group responses and inter-individual variability were quantified with estimates of the mean and standard deviation of the difference, and the proportion of participants exhibiting an increased response. Models were conducted within a Bayesian framework with random intercepts to account for systematic variation across studies. P1NP levels increased during and immediately after running, where the proportion of response was close to 100% (75% CrI: 99 to 100%). P1NP levels returned to baseline levels within 1 hour and over the next 4 days, showing comparable mean and standard deviation of the difference with typical hourly (0.1 ± 7.6 ng·ml-1) and daily (-0.4 ± 5.7 ng·ml-1) variation values. β-CTX-1 levels decreased during and up to 4 hours after running with distributions comparable to typical hourly variation (-0.13 ± 0.11 ng·ml-1). There was no evidence of changes in β-CTX-1 levels during the 4 days after the running bout, where distributions were also similar between the running data and typical daily variation and (-0.03 ± 0.10 ng·ml-1). Transient increases in P1NP were likely biological artefacts (e.g., connective tissue leakage) and not reflective of bone formation. Comparable small decreases in β-CTX-1 identified in both control and running data, suggested that these changes were due to the markers' circadian rhythm and not the running intervention. Hence, prolonged continuous treadmill running did not elicit bone responses, as determined by P1NP and β-CTX-1, in this population. The protocol for this review was pre-registered on the Open Science Framework prior to implementation (https://osf.io/y69nd)