Marine Benthic Habitat Mapping of Muir Inlet, Glacier Bay National Park and Preserve, Alaska With an Evaluation of the Coastal and Marine Ecological Classification Standard III

Seafloor geology and potential benthic habitats were mapped in Muir Inlet, Glacier Bay National Park and Preserve, Alaska, using multibeam sonar, ground-truth information, and geological interpretations. Muir Inlet is a recently deglaciated fjord that is under the influence of glacial and paraglacial marine processes. High glacially derived sediment and meltwater fluxes, slope instabilities, and variable bathymetry result in a highly dynamic estuarine environment and benthic ecosystem. We characterize the fjord seafloor and potential benthic habitats using the Coastal and Marine Ecological Classification Standard (CMECS) recently developed by the National Oceanic and Atmospheric Administration (NOAA) and NatureServe. Substrates within Muir Inlet are dominated by mud, derived from the high glacial debris flux. Water-column characteristics are derived from a combination of conductivity temperature depth (CTD) measurements and circulation-model results. We also present modern glaciomarine sediment accumulation data from quantitative differential bathymetry. These data show Muir Inlet is divided into two contrasting environments: a dynamic upper fjord and a relatively static lower fjord. The accompanying maps represent the first publicly available high-resolution bathymetric surveys of Muir Inlet. The results of these analyses serve as a test of the CMECS and as a baseline for continued mapping and correlations among seafloor substrate, benthic habitats, and glaciomarine processes

Evaluation of Technology Concepts for Traffic Data Management and Relevant Audio for Datalink in Commercial Airline Flight Decks

Datalink is currently operational for departure clearances and in oceanic environments and is currently being tested in high altitude domestic enroute airspace. Interaction with even simple datalink clearances may create more workload for flight crews than the voice system they replace if not carefully designed. Datalink may also introduce additional complexity for flight crews with hundreds of uplink messages now defined for use. Finally, flight crews may lose airspace awareness and operationally relevant information that they normally pickup from Air Traffic Control (ATC) voice communications with other aircraft (i.e., party-line transmissions). Once again, automation may be poised to increase workload on the flight deck for incremental benefit. Datalink implementation to support future air traffic management concepts needs to be carefully considered, understanding human communication norms and especially, the change from voice- to text-based communications modality and its effect on pilot workload and situation awareness. Increasingly autonomous systems, where autonomy is designed to support human-autonomy teaming, may be suited to solve these issues. NASA is conducting research and development of increasingly autonomous systems, utilizing machine-learning algorithms seamlessly integrated with humans whereby task performance of the combined system is significantly greater than the individual components. Increasingly autonomous systems offer the potential for significantly improved levels of performance and safety that are superior to either human or automation alone. Two increasingly autonomous systems concepts - a traffic data manager and a conversational co-pilot - were developed to intelligently address the datalink issues in a complex, future state environment with significant levels of traffic. The system was tested for suitability of datalink usage for terminal airspace. The traffic data manager allowed for automated declutter of the Automatic Dependent Surveillance-Broadcast (ADS-B) display. The system determined relevant traffic for display based on machine learning algorithms trained by experienced human pilot behaviors. The conversational co-pilot provided relevant audio air traffic control messages based on context and proximity to ownship. Both systems made use of the connected aircraft concepts to provide intelligent context to determine relevancy above and beyond proximity to ownship. A human-in-the-loop test was conducted in NASA Langley Research Centers Integration Flight Deck B-737-800 simulator to evaluate the traffic data manager and the conversational co-pilot. Twelve airline crews flew various normal and non-normal procedures and their actions and performance were recorded in response to the procedural events. This paper details the flight crew performance and evaluation during the events

Impact of Advanced Synoptics and Simplified Checklists During Aircraft Systems Failures

AbstractNatural human capacities are becoming increasingly mismatched to the enormous data volumes, processing capabilities, and decision speeds demanded in todays aviation environment. Increasingly Autonomous Systems (IAS) are uniquely suited to solve this problem. NASA is conducting research and development of IAS - hardware and software systems, utilizing machine learning algorithms, seamlessly integrated with humans whereby task performance of the combined system is significantly greater than the individual components. IAS offer the potential for significantly improved levels of performance and safety that are superior to either human or automation alone. A human-in-the-loop test was conducted in NASA Langleys Integration Flight Deck B-737-800 simulator to evaluate advanced synoptic pages with simplified interactive electronic checklists as an IAS for routine air carrier flight operations and in response to aircraft system failures. Twelve U.S. airline crews flew various normal and non-normal procedures and their actions and performance were recorded in response to failures. These data are fundamental to and critical for the design and development of future increasingly autonomous systems that can better support the human in the cockpit. Synoptic pages and electronic checklists significantly improved pilot responses to non-normal scenarios, but implementation of these aids and other intelligent assistants have barriers to implementation (e.g., certification cost) that must overcome

An introduction to Elinor Glyn : her life and legacy

This special issue of Women: A Cultural Review re-evaluates an author who was once a household name, beloved by readers of romance, and whose films were distributed widely in Europe and the Americas. Elinor Glyn (1864–1943) was a British author of romantic fiction who went to Hollywood and became famous for her movies. She was a celebrity figure of the 1920s, and wrote constantly in Hearst's press. She wrote racy stories which were turned into films—most famously, Three Weeks (1924) and It (1927). These were viewed by the judiciary as scandalous, but by others—Hollywood and the Spanish Catholic Church—as acceptably conservative. Glyn has become a peripheral figure in histories of this period, marginalized in accounts of the youth-centred ‘flapper era’. Decades on, the idea of the ‘It Girl’ continues to have great pertinence in the post-feminist discourses of the twenty-first century. The 1910s and 1920s saw the development of intermodal networks between print, sound and screen cultures. This introduction to Glyn's life and legacy reviews the cross-disciplinary debate sparked by renewed interest in Glyn by film scholars and literary and feminist historians, and offers a range of views of Glyn's cultural and historical significance and areas for future research

European Cystic Fibrosis Society Standards of Care: Framework for the Cystic Fibrosis Centre

A significant increase in life expectancy in successive birth cohorts of people with cystic fibrosis (CF) is a result of more effective treatment for the disease. It is also now widely recognized that outcomes for patients cared for in specialist CF Centres are better than for those who are not. Key to the effectiveness of the specialist CF Centre is the multidisciplinary team (MDT), which should include consultants, clinical nurse specialist, microbiologist, physiotherapist, dietitian, pharmacist, clinical psychologist, social worker, clinical geneticist and allied healthcare professionals, all of whom should be experienced in CF care. Members of the MDT are also expected to keep up to date with developments in CF through continued professional development, attendance at conferences, auditing and involvement in research. Specialists CF Centres should also network with other Centres both nationally and internationally, and feed Centre data to registries in order to further the understanding of the disease. This paper provides a framework for the specialist CF Centre, including the organisation of the Centre and the individual roles of MDT members, as well as highlighting the value of CF organisations and disease registries

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

A blood atlas of COVID-19 defines hallmarks of disease severity and specificity.

Treatment of severe COVID-19 is currently limited by clinical heterogeneity and incomplete description of specific immune biomarkers. We present here a comprehensive multi-omic blood atlas for patients with varying COVID-19 severity in an integrated comparison with influenza and sepsis patients versus healthy volunteers. We identify immune signatures and correlates of host response. Hallmarks of disease severity involved cells, their inflammatory mediators and networks, including progenitor cells and specific myeloid and lymphocyte subsets, features of the immune repertoire, acute phase response, metabolism, and coagulation. Persisting immune activation involving AP-1/p38MAPK was a specific feature of COVID-19. The plasma proteome enabled sub-phenotyping into patient clusters, predictive of severity and outcome. Systems-based integrative analyses including tensor and matrix decomposition of all modalities revealed feature groupings linked with severity and specificity compared to influenza and sepsis. Our approach and blood atlas will support future drug development, clinical trial design, and personalized medicine approaches for COVID-19

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Levels of empathy in undergraduate emergency health, nursing, and midwifery students: a longitudinal study

Purpose: This research examines the extent and nature of empathy among emergency health (paramedic), nursing, and midwifery students at one Australian university and investigates the longitudinal changes in empathy levels across the course of study.Methods: First-, second-, and third-year students at Monash University completed the Jefferson Scale of Empathy-Health Professional (JSE-HP) in 2008, 2009, and 2010, and the resulting mean empathy scores were analyzed by course, year of course, year of study, age, and sex.Results: Midwifery students were found to have higher empathy levels than nursing and emergency health students. Second- and third-year students scored higher than their counterparts in the first year. Empathy levels dipped in 2009 and rose in 2010. Students aged 26-30 years and 31-35 years recorded higher scores than their younger colleagues, and female students were found to be more empathic than their male counterparts.Conclusion: The finding that empathy levels are relatively stable over the term of study contributes to the understanding of how empathy evolves over the course of study and offers insights into the importance of incorporating and promoting empathy in health care curricula