Effect of crew resource management training in a multidisciplinary obstetrical setting

Objective To assess the effect of a Crew Resource Management (CRM) intervention specifically designed to improve teamwork and communication skills in a multidisciplinary obstetrical setting. Method Design-A before-and-after cross-sectional study designed to assess participants' satisfaction, learning and change in behaviour, according to Kirkpatrick's evaluation framework for training programmes. Setting-Labour and delivery units of a large university-affiliated hospital. Participants-Two hundred and thirty nine midwives, nurses, physicians and technicians from the department of anaesthesia, obstetrics and paediatrics. Intervention-All participants took part in a CRM-based training programme specifically designed to improve teamwork and communication skills. Principal measures of outcome-We assessed participants' satisfaction by means of a 10-item standardized questionnaire. A 36-item survey was administered before and after the course to assess participants' learning. Behavioural change was assessed by a 57-item safety attitude questionnaire measuring staff's change in attitude to safety over 1 year of programme implementation. Results Most participants valued the experience highly and 63-90% rated their level of satisfaction as being very high. Except for seven items, the 36-item survey testing participants' learning demonstrated a significant change (P < 0.05) towards better knowledge of teamwork and shared decision making after the training programme. Over the year of observation, there was a positive change in the team and safety climate in the hospital [odds ratio (OR) 2.9, 95% confidence interval (CI) (1.3-6.3) to OR 4.7, 95% CI (1.2-17.2)]. **There was also improved stress recognition [OR 2.4, 95% CI (1.2-4.8) to OR 3.0, 95% CI (1.0-8.8)]. Conclusion The implementation of a training programme based on CRM in a multidisciplinary obstetrical setting is well accepted and contributes to a significant improvement in interprofessional teamwor

Command and Control Systems for Search and Rescue Robots

The novel application of unmanned systems in the domain of humanitarian Search and Rescue (SAR) operations has created a need to develop specific multi-Robot Command and Control (RC2) systems. This societal application of robotics requires human-robot interfaces for controlling a large fleet of heterogeneous robots deployed in multiple domains of operation (ground, aerial and marine). This chapter provides an overview of the Command, Control and Intelligence (C2I) system developed within the scope of Integrated Components for Assisted Rescue and Unmanned Search operations (ICARUS). The life cycle of the system begins with a description of use cases and the deployment scenarios in collaboration with SAR teams as end-users. This is followed by an illustration of the system design and architecture, core technologies used in implementing the C2I, iterative integration phases with field deployments for evaluating and improving the system. The main subcomponents consist of a central Mission Planning and Coordination System (MPCS), field Robot Command and Control (RC2) subsystems with a portable force-feedback exoskeleton interface for robot arm tele-manipulation and field mobile devices. The distribution of these C2I subsystems with their communication links for unmanned SAR operations is described in detail. Field demonstrations of the C2I system with SAR personnel assisted by unmanned systems provide an outlook for implementing such systems into mainstream SAR operations in the future

German evidence and consensus‐based (S3) guideline: Vaccination recommendations for the prevention of HPV‐associated lesions

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view

Building consensus on water use assessment of livestock production systems and supply chains: outcome and recommendations from the FAO LEAP Partnership

The FAO Livestock Environmental Assessment and Performance (LEAP) Partnership organised a Technical Advisory Group (TAG) to develop reference guidelines on water footprinting for livestock production systems and supply chains. The mandate of the TAG was to i) provide recommendations to monitor the environmental performance of feed and livestock supply chains over time so that progress towards improvement targets can be measured, ii) be applicable for feed and water demand of small ruminants, poultry, large ruminants and pig supply chains, iii) build on, and go beyond, the existing FAO LEAP guidelines and iv) pursue alignment with relevant international standards, specifically ISO 14040 (2006)/ISO 14044 (2006), and ISO 14046 (2014). The recommended guidelines on livestock water use address both impact assessment (water scarcity footprint as defined by ISO 14046, 2014) and water productivity (water use efficiency). While most aspects of livestock water use assessment have been proposed or discussed independently elsewhere, the TAG reviewed and connected these concepts and information in relation with each other and made recommendations towards comprehensive assessment of water use in livestock production systems and supply chains. The approaches to assess the quantity of water used for livestock systems are addressed and the specific assessment methods for water productivity and water scarcity are recommended. Water productivity assessment is further advanced by its quantification and reporting with fractions of green and blue water consumed. This allows the assessment of the environmental performance related to water use of a livestock-related system by assessing potential environmental impacts of anthropogenic water consumption (only “blue water”); as well as the assessment of overall water productivity of the system (including “green” and “blue water” consumption). A consistent combination of water productivity and water scarcity footprint metrics provides a complete picture both in terms of potential productivity improvements of the water consumption as well as minimizing potential environmental impacts related to water scarcity. This process resulted for the first time in an international consensus on water use assessment, including both the life-cycle assessment community with the water scarcity footprint and the water management community with water productivity metrics. Despite the main focus on feed and livestock production systems, the outcomes of this LEAP TAG are also applicable to many other agriculture sector

Expedição ao Sítio Histórico e Patrimônio Cultural Kalunga: um Relato de Experiência

The Kalunga Historical and Cultural Heritage Site (SHPCK) is located in the northeast of Goiás and is considered one of the best-preserved areas of native Cerrado in all of Brazil. This is due to local geographic characteristics and mainly to the sustainable character of agricultural production by the traditional peoples who inhabit the region. In addition to having a vast preserved territory, the Kalungas have unique traditional knowledge about local plants. Due to biodiversity, they have access to herbal plants that can be used in human and animal food. However, the number of species of toxic plants may also considered high. With this report we aim to describe the unique experience that was the Expedition to the Kalunga Historical and Cultural Site and Heritage, as well as to emphasize the importance of the toxic plants of the Cerrado and the appreciation of traditional knowledge.A Comunidade Quilombola Kalunga fixou-se no Sítio Patrimônio Histórico e Cultural Kalunga (SHPCK), localizado no nordeste do estado de Goiás, e é considerada uma das áreas mais bem preservadas de Cerrado nativo em todo o Brasil. Isso se deve à dificuldade de acesso, às características geográficas locais e também ao caráter sustentável da produção agropecuária do povo quilombola que habita a região. Além de possuírem vasto território preservado, os Kalungas detêm conhecimento tradicional singular sobre as plantas locais e, graças à biodiversidade do Cerrado, eles têm acesso a plantas fitoterápicas e que podem ser utilizadas na alimentação humana e animal. No entanto, o número de espécies de plantas tóxicas também pode ser considerado elevado. Com este relato, objetivamos descrever a experiência única que foi a Expedição ao Sítio e Patrimônio Histórico e Cultural Kalunga, assim como ressaltar a importância das plantas tóxicas do Cerrado e da valorização do conhecimento tradicional.A Comunidade Quilombola Kalunga fixou-se no Sítio Patrimônio Histórico e Cultural Kalunga (SHPCK), localizado no nordeste do estado de Goiás, e é considerada uma das áreas mais bem preservadas de Cerrado nativo em todo o Brasil. Isso se deve à dificuldade de acesso, às características geográficas locais e também ao caráter sustentável da produção agropecuária do povo quilombola que habita a região. Além de possuírem vasto território preservado, os Kalungas detêm conhecimento tradicional singular sobre as plantas locais e, graças à biodiversidade do Cerrado, eles têm acesso a plantas fitoterápicas e que podem ser utilizadas na alimentação humana e animal. No entanto, o número de espécies de plantas tóxicas também pode ser considerado elevado. Com este relato, objetivamos descrever a experiência única que foi a Expedição ao Sítio e Patrimônio Histórico e Cultural Kalunga, assim como ressaltar a importância das plantas tóxicas do Cerrado e da valorização do conhecimento tradicional

Unlocking pre-1850 instrumental meteorological records

A global inventory of early instrumental meteorological measurements is compiled that comprises thousands of mostly nondigitized series, pointing to the potential or weather data rescu

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Geminate Recombination versus Cage Escape in the Reductive Quenching of a Re(I) Carbonyl Complex on Mesoporous ZrO2

In the wider context of artificial photosynthesis, this work aims to explore the functionality and characteristics of rhenium tricarbonyl complexes as photosensitizers in heterogeneous water reduction systems. To that end, the reductive quenching of an excited ReICl(2,2′‐bipyridine‐4,4′‐bisphosphonic acid)(CO)3 adsorbed on a redox-neutral scaffold by phenothiazine was observed by transient IR spectroscopy. From the spectroscopic and time response, the full reaction cycle could be elucidated, and the intrinsic lifetime of the excited Re complex, together with rates for reductive quenching, cage escape, as well as geminate recombination and secondary back electron transfer could be determined. Three different scenarios have been explored, which decrease the mobility of the reactants in the system in a stepwise manner: Starting from a reference system with all compounds in solution, first the Re complex was immobilized on the surface, and in a second step also the quencher. The overall reaction cycle for all reactants in solution is preserved as long as the quencher is in solution, with relatively minor changes of the rates of the individual reaction steps. The overall cage escape yield was found to be larger on the surface. As soon as the quencher is co-adsorbed alongside the Re-complex, however, the reaction cycle changes completely. Electron transfer occurred only from quencher molecules that sit next to an excited Re complex, and there is no possibility of cage escape. Varying the ratio of quencher molecules and Re-complexes, it is concluded that molecules do not cluster on the surface, and that excitation energy migration is not a very efficient process