Exertional sickling: Questions and controversy

Sickle cell trait (SCT) occurs in about 8% of African-Americans and is often described to be of little clinical consequence. Over time, a number of risks have emerged, and among these are rare but catastrophic episodes of sudden death in athletes and other individuals associated with physical activities which is often described as exercise collapse associated with sickle trait (ECAST). Despite an epidemiologic link between SCT and sudden death as well as numerous case reports in both medical literature and lay press, no clear understanding of the key pathophysiologic events has been identified. Strategies for identification of individuals at risk and prevention of ECAST have been both elusive and controversial. Stakeholders have advocated for different approaches to this issue particularly with regard to screening for hemoglobin S. Furthermore, the recommendations and guidelines that are in place for the early recognition of ECAST and the prevention and treatment of the illness are not well defined and remain fragmented. Among the cases identified, those in collegiate football players in the United States are often highlighted. This manuscript examines these case studies and the current recommendations to identify areas of consensus and controversy regarding recommendations for prevention, recognition and treatment of ECAST

Dynamic Resource Allocation in Conservation Planning

Consider the problem of protecting endangered species by selecting patches of land to be used for conservation purposes. Typically, the availability of patches changes over time, and recommendations must be made dynamically. This is a challenging prototypical example of a sequential optimization problem under uncertainty in computational sustainability. Existing techniques do not scale to problems of realistic size. In this paper, we develop an efficient algorithm for adaptively making recommendations for dynamic conservation planning, and prove that it obtains near-optimal performance. We further evaluate our approach on a detailed reserve design case study of conservation planning for three rare species in the Pacific Northwest of the United States

Co constructing A Complex Narrative Using Constructivist Grounded Theory

This study explores patients’ perceptions of the health-care assistant within U.K. secondary care. Employing constructivist grounded theory, 20 patient interviews were coded and analyzed using constant comparison to ensure findings were grounded within the data. Data were collected in a large teaching hospital in England between 2014 and 2015. Charmaz’s (2014) grounded theory methodology is underpinned by a constructivist paradigm in which there is recognition of multiple social realities. This was a suitable methodology for capturing the complexities of patienthood and the associated social world and it also supported co construction between researcher and participant. Charmaz’s (2014) guiding principles of intensive interviewing within a semistructured interview schedule helped to ensure that data collected were congruent with a constructivist perspective on co construction. Researcher positionality has the potential to impact upon the co construction of realities, influencing the data collection and subsequent analysis from what is known or not known by them as researcher. Reflection and reflexivity are necessary elements in constructivist grounded theory to understand more deeply how this co construction is made and to ensure transparency of decisions. In addition to traditional methods of journaling and memoing the researcher used a mind-map software package to ensure complexities within the narrative were not lost and to map researcher influences and perceptions as the data analysis took shape. This approach enabled the researcher to present an auditable trail of influences, decisions, and complexities within the findings. This article will address the reflexive journey undertaken by the researcher

SB28-10/11: Student Health

SB28-10/11: Student Health. This resolution failed during the March 16, 2011 meeting of the Associated Students of the University of Montana (ASUM)

Socio-spatial authenticity at co-created music festivals

From the early days of hippie counter-culture, music festivals have been an important part of the British summer. Today they are commercialised offerings without the counter-cultural discourse of earlier times. Drawing on participant observation, interviews and focus groups conducted at a rock festival and a smaller boutique festival, the paper examines how their design, organisation and management are co-created with participants to produce authentic experiences. The paper contributes to research on authenticity in tourism by examining how authenticity emerges and is experienced in such co-created commercial settings. It presents the importance that the socio-spatial plays in authenticity experiences and how socio-spatial experience and engagement can also be recognised as a form of aura

Exploration of the student nurses' experiences in practice of patient safety events, reporting and patient involvement

Background/introduction Qualified and student nurses remain at the forefront of dealing with, and reporting, patient safety events or incidents. There has been limited exploration of whether and how the patient's perspective is represented by staff or student nurses using formal reporting systems. Objectives The overall aim of the study was to explore the student nurses' experiences in practice of patient safety events they were themselves directly or indirectly involved in. This specifically explored the subsequent reporting and inclusion of the patient perspectives that may or may not have taken place. Design A qualitative approach to this research was selected using the principles of thematic analysis to analyse data gathered from focus groups of student nurses across all year groups. Setting Three universities participated in the study located in the north east, south east and east of England. Participants Student nurses from across the year groups attended focus groups. Methods Following ethical approval and informed consent, participants took part in focus groups within each university setting. Data were transcribed verbatim and analysed using thematic analysis. Results Three themes were identified: the benefit of reporting and patient involvement, the barriers experienced by the students in reporting and the support needed to ensure they do the right thing in practice. Conclusion Learning for students from patient safety incidents is important and seeking patients' views and perceptions adds to the learning experience. There are however challenges for the student in practice in both reporting and patient involvement. Resources are needed that follow and feed into the student learning alongside a workforce that see the benefit of learning from those we care for

Coding in the cot? Factors influencing 0-17s’ experiences with technology and coding in the United Kingdom

In the modern world, digital technology is all around us and our ability to engage with it efficiently and productively has implications for our success as individuals and as a society. The idea that children should hone their digital literacy skills through formal schooling has been recognized by educators and policy makers alike. Before children enter schooling, however, there are now an increasing number of ways for children to begin to learn about computers, robots, and coding. In this research, we present a survey of 729 UK parents (approximately 56% Welsh) of children between 0 and 17 years and asked them to report on whether they and their child had experience with different kinds of digital technology, with a particular emphasis on computer coding. We found that children are outpacing their parents in terms of coding experience before they even turn eight-years-old. Children are generally engaged with digital technology and coding earlier than their parents were as children (e.g., over 70% of two-year-olds use smart devices; nearly 40% of 7-year-olds have experience coding). Logistic regression analyses indicate that boys are significantly more likely to have experience coding than girls and children with parents who have experience coding are significantly more likely to have experience coding themselves. Parents who placed a relatively higher value on STEM education were also more likely to report that their children had experience coding. These findings align with literature on science capital suggesting that there are societal discrepancies in children’s exposure to and experiences in STEM subjects. We also found that children with reported experience coding are also reported to show more interest in coding and robotics. This makes the fact that we find differences in exposure to coding prior to formal schooling even more problematic, as the discrepancies seen in early childhood may build up in later years in terms of motivation, engagement, and interest. Taken together, the current research shines light on the positive finding that young children are engaging with coding at early ages, but it also identifies potential problem areas regarding the breadth of exposure and experience. It highlights the need to ensure that the divide between those with and without science capital does not widen, allowing all children the freedom to obtain digital literacy that will help foster a more advanced future

The Impact of Trajectory Prediction Uncertainty on Air Traffic Controller Performance and Acceptability

A Human-In-The-Loop air traffic control simulation investigated the impact of uncertainties in trajectory predictions on NextGen Trajectory-Based Operations concepts, seeking to understand when the automation would become unacceptable to controllers or when performance targets could no longer be met. Retired air traffic controllers staffed two en route transition sectors, delivering arrival traffic to the northwest corner-post of Atlanta approach control under time-based metering operations. Using trajectory-based decision-support tools, the participants worked the traffic under varying levels of wind forecast error and aircraft performance model error, impacting the ground automations ability to make accurate predictions. Results suggest that the controllers were able to maintain high levels of performance, despite even the highest levels of trajectory prediction errors

Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England

Background: A large proportion of the 200 000 HCV-infected individuals in the UK are undiagnosed or lost to follow-up. Engaging knowninfected individuals in treatment is essential for elimination. Methods: Using PHE surveillance data and HCV treatment registers from North East of England (NE) treatment centres for 1997–2016, we estimated the number of HCV cases not linked to treatment and the proportion with active infection. We compared distances of treated and untreated cases to treatment services, and assessed the effect of expanding HCV treatment into existing drug and alcohol treatment centres in the NEE on treatment accessibility. Results The odds of being treated was associated with distance to treatment services. Confirmatory results for ~50% were not reported to PHE NE. Overall, 3385 patients reported to PHE NE had no record of treatment; we estimated 1621 of these may have been lost to follow-up after confirmation of active infection. Conclusions: Poor access to healthcare services may contribute to under-diagnosis or loss to follow-up. Expanding HCV treatment delivery into NEE drug and alcohol treatment centres would improve the accessibility of treatment services to people infected with/at risk of HCV. This may increase the proportion receiving treatment and support progress towards elimination