Interactive 3-D Software in Aircraft Rescue and Fire Fighting Training

As the nexus between aviation, fire science, and emergency management becomes increasingly more complex, technology can be used to augment training and avoid risk while maintaining authenticity with situational reality. In Aircraft Rescue & Fire Fighting (ARFF), the manner in which the learning content is effectively imparted to the student-professional can make all the difference in a successful emergency response. The interactive 3-D software developed exclusively for Dallas/Fort Worth Fire Training Research Center (DFW FTRC) is part of a curriculum designed to educated and train ARFF professionals in life-saving strategies and tactics. Through a 2013 Memorandum of Understanding, the world’s leading aviation and aerospace university, Embry-Riddle Aeronautical University (ERAU), and DFW FTRC have created a unique partnership for the conduct of research to explore emerging issues in the discipline. Researchers from ERAU designed this collaborative study to examine how effectively the DFW FTRC virtual technology software in the classroom translated knowledge and accelerated haptic skill transfer to the hands-on portion of ARFF training at the facility. The qualitative approach integrated classroom observations with key informant interviews to create a single-case study exploratory research strategy. Emergent themes led to a richer understanding of experiential learning, particularly key differences among individual student characteristics and instructional culture that influence student proficiency and attitudes. Most noteworthy were: a larger interest among international over domestic students, age/generational difficulties with new technology, and an apprehension among ARFF professionals to transition from traditional tabletop exercises to virtual reality. Variability also existed within the instructional culture, including inconsistencies of software integration in the classroom, instructor proficiency with the software, and adult and group teaching theories. The study also found that knowledge and accelerated haptic skill transfer were positively associated with the virtual reality software, and that interactive participation and memory reinforcement were supported by the findings. Time required for curriculum development advancing further integration of the software into the training program was a significant administrative and operational challenge. Software recommendations included options that allow scenario-specific applications and variable incident conditions, thus enriching each classroom learning experience. Marketing of this software remains the final task for DFW FTRC, as cost-effective distribution could revolutionize training across public safety. Future research should also evaluate pedagogy to categorize learning constructivism using simulator-based and software-supported education and training. How this may be applied to public safety professions where risk is an inherent part of training is a crucial need in the industry

Learning from Asiana 214--Minimizing Strike/Rollover for Aircraft Rescue and Firefighting

Following the crash of Asiana flight 214 on July 6, 2013, the National Transportation Safety Board (NTSB) provided a recommendation to the Aircraft Rescue & Fire Fighting Working Group (ARFFWG) to develop best practices to avoid strike/rollover of seriously injured or deceased persons in mass casualty situations. This paper summarizes the research process and the technical committee’s conclusions. The qualitative inquiry used participatory research and evaluation from medico-legal professionals and the expert committee comprised of 21 aircraft rescue and firefighting experts. Key informants were complemented by documentary analysis, including FAA Advisory Circulars, regulations, standards, medical and aircraft rescue industry publications. The research provides specific committee recommendations for establishing control zones in the mass casualty environment, using START for triage, surveillance, transportation, training and certification of both ARFF personnel and incident command, and airport emergency planning strategies. A best practice for ARFF personnel, which is a tactical procedure for task prioritization at aircraft crash incidents, is also proposed. The authors suggest future pilot testing for evaluation of these best practices following NTSB’s consent with the committee’s recommendations

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Abstract—Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46–9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70–13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22–79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke

Live-Cell Microscopy Reveals Small Molecule Inhibitor Effects on MAPK Pathway Dynamics

Oncogenic mutations in the mitogen activated protein kinase (MAPK) pathway are prevalent in human tumors, making this pathway a target of drug development efforts. Recently, ATP-competitive Raf inhibitors were shown to cause MAPK pathway activation via Raf kinase priming in wild-type BRaf cells and tumors, highlighting the need for a thorough understanding of signaling in the context of small molecule kinase inhibitors. Here, we present critical improvements in cell-line engineering and image analysis coupled with automated image acquisition that allow for the simultaneous identification of cellular localization of multiple MAPK pathway components (KRas, CRaf, Mek1 and Erk2). We use these assays in a systematic study of the effect of small molecule inhibitors across the MAPK cascade either as single agents or in combination. Both Raf inhibitor priming as well as the release from negative feedback induced by Mek and Erk inhibitors cause translocation of CRaf to the plasma membrane via mechanisms that are additive in pathway activation. Analysis of Erk activation and sub-cellular localization upon inhibitor treatments reveals differential inhibition and activation with the Raf inhibitors AZD628 and GDC0879 respectively. Since both single agent and combination studies of Raf and Mek inhibitors are currently in the clinic, our assays provide valuable insight into their effects on MAPK signaling in live cells

The Rural Household Multiple Indicator Survey, data from 13,310 farm households in 21 countries

The Rural Household Multiple Indicator Survey (RHoMIS) is a standardized farm household survey approach which collects information on 758 variables covering household demographics, farm area, crops grown and their production, livestock holdings and their production, agricultural product use and variables underlying standard socio-economic and food security indicators such as the Probability of Poverty Index, the Household Food Insecurity Access Scale, and household dietary diversity. These variables are used to quantify more than 40 different indicators on farm and household characteristics, welfare, productivity, and economic performance. Between 2015 and the beginning of 2018, the survey instrument was applied in 21 countries in Central America, sub-Saharan Africa and Asia. The data presented here include the raw survey response data, the indicator calculation code, and the resulting indicator values. These data can be used to quantify on- and off-farm pathways to food security, diverse diets, and changes in poverty for rural smallholder farm households

Neurodevelopmental and Epilepsy Phenotypes in Individuals With Missense Variants in the Voltage-Sensing and Pore Domains of KCNH5

Background and Objectives KCNH5 encodes the voltage-gated potassium channel EAG2/Kv10.2. We aimed to delineate the neurodevelopmental and epilepsy phenotypic spectrum associated with de novo KCNH5 variants.Methods We screened 893 individuals with developmental and epileptic encephalopathies for KCNH5 variants using targeted or exome sequencing. Additional individuals with KCNH5 variants were identified through an international collaboration. Clinical history, EEG, and imaging data were analyzed; seizure types and epilepsy syndromes were classified. We included 3 previously published individuals including additional phenotypic details.Results We report a cohort of 17 patients, including 9 with a recurrent de novo missense variant p.Arg327His, 4 with a recurrent missense variant p.Arg333His, and 4 additional novel missense variants. All variants were located in or near the functionally critical voltage-sensing or pore domains, absent in the general population, and classified as pathogenic or likely pathogenic using the American College of Medical Genetics and Genomics criteria. All individuals presented with epilepsy with a median seizure onset at 6 months. They had a wide range of seizure types, including focal and generalized seizures. Cognitive outcomes ranged from normal intellect to profound impairment. Individuals with the recurrent p.Arg333His variant had a self-limited drug-responsive focal or generalized epilepsy and normal intellect, whereas the recurrent p.Arg327His variant was associated with infantile-onset DEE. Two individuals with variants in the pore domain were more severely affected, with a neonatal-onset movement disorder, early-infantile DEE, profound disability, and childhood death.Discussion We describe a cohort of 17 individuals with pathogenic or likely pathogenic missense variants in the voltage-sensing and pore domains of Kv10.2, including 14 previously unreported individuals. We present evidence for a putative emerging genotype-phenotype correlation with a spectrum of epilepsy and cognitive outcomes. Overall, we expand the role of EAG proteins in human disease and establish KCNH5 as implicated in a spectrum of neurodevelopmental disorders and epilepsy.</p

How Can We Improve Oncofertility Care for Patients? A Systematic Scoping Review of Current International Practice and Models of Care

© The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. BACKGROUND: Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE: The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS: A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES: A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices. WIDER IMPLICATIONS: This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations

Introduction: Toward an Engaged Feminist Heritage Praxis

We advocate a feminist approach to archaeological heritage work in order to transform heritage practice and the production of archaeological knowledge. We use an engaged feminist standpoint and situate intersubjectivity and intersectionality as critical components of this practice. An engaged feminist approach to heritage work allows the discipline to consider women’s, men’s, and gender non-conforming persons’ positions in the field, to reveal their contributions, to develop critical pedagogical approaches, and to rethink forms of representation. Throughout, we emphasize the intellectual labor of women of color, queer and gender non-conforming persons, and early white feminists in archaeology