Resilience Engineering’s Potential For Advanced Air Mobility (AAM)

The national airspace (NAS) will rapidly evolve in the next ten to twenty years. Plans for Advanced Air Mobility (AAM) during that period envision highly automated airspace management systems and electrically powered vehicles. AAM concepts also anticipate limited human roles. The goal of limiting the human role is to minimize the potential for misadventures, yet how the human role is limited needs to be carefully considered in order to also preserve the potential for human successes. The field of resilience engineering (RE) focuses on how systems can change in order to seize an opportunity or withstand an unforeseen challenge. RE methods rely on the use of empirical data to optimize the ability of any system to adapt. RE studies have shown how individual and team initiatives ensure resilient system performance by creating safety through flexibility. Benefits of the RE approach include improved awareness of operational circumstances and how system elements depend on each other, and the ability to allocate limited resources and prepare for surprise. RE offers the ability to account for and incorporate the human role as an essential element in order to ensure NAS systems’ resilient performance. Data on the human contribution to safe and resilient system performance, which is termed “work as done,” are available but are not being considered as the NAS evolves. We present an approach that describes how use of RE can enable the evolving NAS to adapt, and perform, in a resilient manner

Retinal Detachment with Vitreous Hemorrhage Causing Acute Angle Closure Glaucoma

A 90-year-old female with past medical history of trigeminal neuralgia presented with a four-day history of a left-sided headache, nausea, vomiting, and vision loss in her left eye and one month of intermittent flashes of light in her left eye. Her left eye was diffusely injected with a cloudy cornea and fixed, mid-dilated, and non-reactive pupil. The vision in her, right eye was 20/200 with an intraocular pressure (IOP) of 16 mm Hg; her left eye was no light perception (NLP) with an IOP of 56 mm Hg. She was started on dorzolamide, brimonidine, and latanoprost eye drops. A bedside ultrasound performed by an emergency medicine physician demonstrated evidence of vitreous hemorrhage and concern for retinal detachment. Slit lamp examination performed by ophthalmologist demonstrated the left anterior chamber to be flat with a bulging iris and detached retina. Consequently, the patient was diagnosed with acute angle closure glaucoma secondary to increasing posterior chamber pressures. Given concern for altered mental status, the patient received a CT head in association with an inpatient MRI for headache refractory to home carbamazepine dosing regimen. Both imaging modalities corroborated the ultrasound\u27s findings. In addition to the IOP-lowering medications, atropine, traditionally contraindicated in primary acute angle closure glaucoma, was added. Given her age, length of symptoms, and lack of light perception at presentation, her vision was deemed unsalvageable. Her pain was controlled with oral opioids and she was discharged with outpatient ophthalmology follow-up. At time of discharge, the IOP in her left eye was 49 mm Hg.https://scholarlycommons.henryford.com/merf2020caserpt/1007/thumbnail.jp

Evaluation of acoustic telemetry grids for determining aquatic animal movement and survival

1. Acoustic telemetry studies have frequently prioritized linear configurations of hydrophone receivers, such as perpendicular from shorelines or across rivers, to detect the presence of tagged aquatic animals. This approach introduces unknown bias when receivers are stationed for convenience at geographic bottlenecks (e.g. at the mouth of an embayment or between islands) as opposed to deployments following a statistical sampling design. 2. We evaluated two-dimensional acoustic receiver arrays (grids: receivers spread uniformly across space) as an alternative approach to provide estimates of survival, movement and habitat use. Performance of variably spaced receiver grids (5–25 km spacing) was evaluated by simulating (1) animal tracks as correlated random walks (speed: 0.1–0.9 m/s; turning angle SD: 5–30°); (2) variable tag transmission intervals along each track (nominal delay: 15–300 s); and (3) probability of detection of each transmission based on logistic detection range curves (midpoint: 200–1,500 m). From simulations, we quantified (i) time between successive detections on any receiver (detection time), (ii) time between successive detections on different receivers (transit time), and (iii) distance between successive detections on different receivers (transit distance). 3. In the most restrictive detection range scenario (200 m), the 95th percentile of transit time was 3.2 days at 5 km, 5.7 days at 7 km and 15.2 days at 25 km grid spacing; for the 1,500 m detection range scenario, it was 0.1 days at 5 km, 0.5 days at 7 km and 10.8 days at 25 km. These values represented upper bounds on the expected maximum time that an animal could go undetected. Comparison of the simulations with pilot studies on three fishes (walleye Sander vitreus, common carp Cyprinus carpio and channel catfish Ictalurus punctatus) from two independent large lake ecosystems (lakes Erie and Winnipeg) revealed shorter detection and transit times than what simulations predicted. 4. By spreading effort uniformly across space, grids can improve understanding of fish migration over the commonly employed receiver line approach, but at increased time cost for maintaining grids

Evaluation of acoustic telemetry grids for determining aquatic animal movement and survival

1. Acoustic telemetry studies have frequently prioritized linear configurations of hydrophone receivers, such as perpendicular from shorelines or across rivers, to detect the presence of tagged aquatic animals. This approach introduces unknown bias when receivers are stationed for convenience at geographic bottlenecks (e.g. at the mouth of an embayment or between islands) as opposed to deployments following a statistical sampling design. 2. We evaluated two-dimensional acoustic receiver arrays (grids: receivers spread uniformly across space) as an alternative approach to provide estimates of survival, movement and habitat use. Performance of variably spaced receiver grids (5–25 km spacing) was evaluated by simulating (1) animal tracks as correlated random walks (speed: 0.1–0.9 m/s; turning angle SD: 5–30°); (2) variable tag transmission intervals along each track (nominal delay: 15–300 s); and (3) probability of detection of each transmission based on logistic detection range curves (midpoint: 200–1,500 m). From simulations, we quantified (i) time between successive detections on any receiver (detection time), (ii) time between successive detections on different receivers (transit time), and (iii) distance between successive detections on different receivers (transit distance). 3. In the most restrictive detection range scenario (200 m), the 95th percentile of transit time was 3.2 days at 5 km, 5.7 days at 7 km and 15.2 days at 25 km grid spacing; for the 1,500 m detection range scenario, it was 0.1 days at 5 km, 0.5 days at 7 km and 10.8 days at 25 km. These values represented upper bounds on the expected maximum time that an animal could go undetected. Comparison of the simulations with pilot studies on three fishes (walleye Sander vitreus, common carp Cyprinus carpio and channel catfish Ictalurus punctatus) from two independent large lake ecosystems (lakes Erie and Winnipeg) revealed shorter detection and transit times than what simulations predicted. 4. By spreading effort uniformly across space, grids can improve understanding of fish migration over the commonly employed receiver line approach, but at increased time cost for maintaining grids

Current erosion indices—flawed or valid? Summary

The problem of erosive tooth wear appears increasingly to be encountered by clinicians and researchers. An adequate way of defining and recording erosive tooth wear is essential in order to assess the extent of this clinical phenomenon, both on an individual level and in the population, and for the adequate provision of preventive and therapeutic measures. Well-established erosion indices have been used in most of these studies, although in many cases modifications have been made to suit the different research aims. This use of different indices is one reason why it still cannot be claimed that there is enough current knowledge on this clinical phenomenon. This article summarises the proceedings of a workshop to discuss the topic of dental erosion indices. The result of the workshop is the proposal for a new scoring system (Basic Erosive Wear Examination, BEWE) designed for use both within the research field and for dental clinicians, with the aims of standardising assessment of erosion for international comparisons, raising awareness and providing guidelines for treatment of erosive tooth wear in dental practice

Structure–Function Aspects of PstS in Multi-Drug–Resistant Pseudomonas aeruginosa

The increasing prevalence of multi-drug–resistant (MDR) strains of Pseudomonas aeruginosa among critically ill humans is of significant concern. In the current study, we show that MDR clinical isolates of P. aeruginosa representing three distinct genotypes that display high virulence against intestinal epithelial cells, form novel appendage-like structures on their cell surfaces. These appendages contain PstS, an extracellular phosphate binding protein. Using anti-PstS antibodies, we determined that the PstS-rich appendages in MDR strains are involved in adherence to and disruption of the integrity of cultured intestinal epithelial cell monolayers. The outer surface–expressed PstS protein was also identified to be present in P. aeruginosa MPAO1, although to a lesser degree, and its role in conferring an adhesive and barrier disruptive phenotype against intestinal epithelial cells was confirmed using an isogenic ΔPstS mutant. Formation of the PstS rich appendages was induced during phosphate limitation and completely suppressed in phosphate-rich media. Injection of MDR strains directly into the intestinal tract of surgically injured mice, a known model of phosphate limitation, caused high mortality rates (60%–100%). Repletion of intestinal phosphate in this model completely prevented mortality. Finally, significantly less outer surface PstS was observed in the MPAO1 mutant ΔHxcR thus establishing a role for the alternative type II secretion system Hxc in outer surface PstS expression. Gene expression analysis performed by RT-PCR confirmed this finding and further demonstrated abundant expression of pstS analogous to pa5369, pstS analogous to pa0688/pa14–55410, and hxcX in MDR strains. Taken together, these studies provide evidence that outer surface PstS expression confers a highly virulent phenotype of MDR isolates against the intestinal epithelium that alters their adhesive and barrier disrupting properties against the intestinal epithelium

Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients

<p>Abstract</p> <p>Background</p> <p>Whole brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery (SRS), and combinations of the three modalities are used in the management of patients with metastatic brain tumors. We present the previously unreported survival outcomes of 275 patients treated for newly diagnosed brain metastases at Cancer Care Northwest and Gamma Knife of Spokane between 1998 and 2008.</p> <p>Methods</p> <p>The effects treatment regimen, age, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), primary tumor histology, number of brain metastases, and total volume of brain metastases have on patient overall survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival curves, Andersen 95% confidence intervals, approximate confidence intervals for log hazard-ratios, and multivariate Cox proportional hazard models.</p> <p>Results</p> <p>The median clinical follow up time was 7.2 months. On multivariate analysis, survival statistically favored patients treated with SRS alone when compared to patients treated with WBRT alone (p < 0.001), patients treated with resection with SRS when compared to patients treated with SRS alone (p = 0.020), patients in ECOG-PS class 0 when compared to patients in ECOG-PS classes 2 (p = 0.04), 3 (p < 0.001), and 4 (p < 0.001), patients in the non-small-cell lung cancer group when compared to patients in the combined melanoma and renal-cell carcinoma group (p < 0.001), and patients with breast cancer when compared to patients with non-small-cell lung cancer (p < 0.001).</p> <p>Conclusions</p> <p>In our analysis, patients benefited from a combined modality treatment approach and physicians must consider patient age, performance status, and primary tumor histology when recommending specific treatments regimens.</p