A Comparison of Afghanistan, Yuma, AZ, and Manufactured Sands Melted on EB-PVD Thermal Barrier Coatings

Sand ingestion into military aircraft turbine engines from desert environments have tested the performance and life of the engine. In particular, turbine section blades and nozzles are coated with a molten glass when the sand is heated to melting temperatures. This molten glass attacks protective coatings on the surface of these parts. Further research is needed to understand the sands behavior on thermal barrier coatings (TBC) when heated to melting temperatures. Also, further research is needed with manufactured sand used in current engine testing to understand the sand ingestion discrepancies between test engines and operational engines. In this study natural sands from Yuma, Arizona, and Afghanistan will be heated to melting temperatures side-by-side with the manufactured sands specifically created for engine testing. All sands will be heated on EB-PVD TBC buttons provided by two companies who produce TBC coated turbine blades for current military engines. The results of manufactured sand should theoretically behave like natural sand and CMAS melted on a thermal barrier coating in order to substantiate past, current, and future testing. Additionally, the two EB-PVD TBCs behavior with the molten and cooled sand will be compared in this study

Requirements for a Dashboard to Support Quality Improvement Teams in Pain Management

Pain management is often considered lower priority than many other aspects of health management in hospitals. However, there is potential for Quality Improvement (QI) teams to improve pain management by visualising and exploring pain data sets. Although dashboards are already used by QI teams in hospitals, there is limited evidence of teams accessing visualisations to support their decision making. This study aims to identify the needs of the QI team in a UK Critical Care Unit (CCU) and develop dashboards that visualise longitudinal data on the efficacy of patient pain management to assist the team in making informed decisions to improve pain management within the CCU. This research is based on an analysis of transcripts of interviews with healthcare professionals with a variety of roles in the CCU and their evaluation of probes. We identified two key uses of pain data: direct patient care (focusing on individual patient data) and QI (aggregating data across the CCU and over time); in this paper, we focus on the QI role. We have identified how CCU staff currently interpret information and determine what supplementary information can better inform their decision making and support sensemaking. From these, a set of data visualisations has been proposed, for integration with the hospital electronic health record. These visualisations are being iteratively refined in collaboration with CCU staff and technical staff responsible for maintaining the electronic health record. The paper presents user requirements for QI in pain management and a set of visualisations, including the design rationale behind the various methods proposed for visualising and exploring pain data using dashboards

Delta opioid receptor stimulation mimics ischemic preconditioning in human heart muscle

AbstractOBJECTIVESThe objective of this study was to examine whether the delta (δ) opioid receptor isoform is expressed in the human heart and whether this receptor improves contractile function after hypoxic/reoxygenation injury.BACKGROUNDDelta opioid receptor agonists mimic preconditioning (PC) in rat myocardium, corresponding to known cardiac δ opioid receptor expression in this species.METHODSThe messenger RNA transcript encoding the δ opioid receptor was identified in human atria and ventricles. To evaluate the cardioprotective role of the opioid receptor, human atrial trabeculae from patients undergoing coronary bypass grafting were isolated and superfused with Tyrode’s solution. A control group underwent 90 min of simulated ischemia and 120 min of reoxygenation. A second group was preconditioned with 3 min simulated ischemia and 7 min reoxygenation. Additional groups included: superfusion with the δ receptor agonist (DADLE) (10 nM), with the δ receptor antagonist naltrindole (10 nM) and with the mitochondrial KATP channel blocker 5-hydroxydecanoate (5HD) (100 μM) either with or without PC, respectively. A final group was superfused with 5HD before DADLE. The end point used was percentage of developed force after 120 min of reoxygenation.RESULTSResults, expressed as means ± SEM, were: control = 32.6 ± 3.8%; PC = 50.5% ± 1.8∗; DADLE = 46.0 ± 3.9%∗; PC + naltrindole = 25.5 ± 3.9%; naltrindole alone = 25.5 ± 4.3%; 5HD + PC = 28.9 ± 7.4%; 5HD alone = 24.1 ± 3.0%; 5HD + DADLE = 26.9 ± 4.4% (∗p < 0.001 vs. controls).CONCLUSIONSHuman myocardium expresses the δ opioid receptor transcript. Stimulation of this receptor appears to protects human muscle from simulated ischemia, similar to PC, and via opening of the mitochondrial KATP channel

Including the infant in family therapy and systemic practice: charting a new frontier

This position paper from a core group of infant mental health academics and clinicians addresses the conspicuous underrepresentation of the infant in mainstream family therapy. Despite infants' social capacities and clear contributions to family dynamics, they remain largely overlooked within this therapeutic context. We suggest that family therapists have moral and professional responsibilities to support the participation, protection, and well-being of all family members, including the infant. Here, we emphasise the importance of including the infant in the family therapy setting. By highlighting their frequent omission, we aim to amplify infants' often unheard ‘voice,’ role, and contributions to family development, especially recovery from distress. A shift towards infant inclusion as the rule rather than the exception represents a new frontier of integration. We first highlight the relational nature of infant development with a focus on the infants' psychosocial capacities and vulnerabilities. We then consider reasons why the infant may be overlooked in family and systemic therapies and offer a rationale for inviting the infant into these settings, illustrated through the use of a clinical case vignette. To facilitate infant inclusion, we propose a series of guidelines to meaningfully incorporate infants into family therapy practices. We conclude by encouraging shifts in family therapy research, training, and practice to better incorporate and understand the unique contributions of the infant to family life

Designing multiplayer games to facilitate emergent social behaviours online

This paper discusses an exploratory case study of the design of games that facilitate spontaneous social interaction and group behaviours among distributed individuals, based largely on symbolic presence 'state' changes. We present the principles guiding the design of our game environment: presence as a symbolic phenomenon, the importance of good visualization and the potential for spontaneous self-organization among groups of people. Our game environment, comprising a family of multiplayer 'bumper-car' style games, is described, followed by a discussion of lessons learned from observing users of the environment. Finally, we reconsider and extend our design principles in light of our observations

Practice patterns of radiation therapy technology in Australia: results of a national audit

Introduction: This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. Methods: The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. Results: Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. Conclusions: In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning

Clinical update: Heparin-induced thrombocytopenia: An update for the COVID-19 era

The increased use of heparin during the current COVID-19 pandemic has highlighted the risk of a rare but potentially serious complication of heparin therapy, viz. heparin-induced thrombocytopenia (HIT). This is a short review on the pharmacology of heparin and its derivatives, and the pathophysiology of HIT. Guidance on laboratory testing for and clinical management of HIT is presented in accordance with international guidelines. There are important similarities and differences between HIT and the new entity of vaccine-induced immune thrombotic thrombocytopenia, also known as thrombosis with thrombocytopenia syndrome, which clinicians need to be aware of

Successful nesting by 2 endangered Hawaiian waterbird species in a restored Indigenous wetland agroecosystem

The Hawaiian Stilt (Himantopus mexicanus knudseni) and Hawaiian Gallinule (Gallinula galeata sandvicensis) are federally endangered waterbirds endemic to the Hawaiian Islands. Both species are conservation-reliant; their population persistence is dependent on invasive predator control and removal of invasive plants that degrade habitat. We present observations of successful nesting by one Hawaiian Stilt pair and one Hawaiian Gallinule pair at a site managed within an adaptive Indigenous agroecological framework on the island of O‘ahu, Hawai‘i. The Hawaiian Stilt nest, found in February 2019, contained 4 eggs and produced 3 hatchlings, 2 of which were banded and monitored after hatching. The Hawaiian Gallinule nest, found in February 2020, contained 6 eggs and produced 5 hatchlings. Although no individuals were banded from this nest, 2 adults and 2 hatchlings were continuously observed in the nesting area after the eggs hatched. Lo‘i kalo Hawaiian wetland agroecosystems centered around the cultivation of kalo (taro; Colocasia esculenta), have the potential to expand Hawaiian waterbird habitat beyond state and federal protected areas. We are aware of unpublished accounts of Hawaiian waterbirds nesting in commercially farmed lo‘i kalo, but until now, there have been no previously published accounts of native waterbirds breeding in lo‘i kalo managed as Indigenous agroecosystems