A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment.

AbstractIntroduction:Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).Objective:What is appropriate SMR in RSEs?Methods:The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.Results:Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.Conclusions:Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs

Knowledge Gaps and Research Priorities on the Health Effects of Heatwaves: A Systematic Review of Reviews

Although extreme weather events have played a constant role in human history, heatwaves (HWs) have become more frequent and intense in the past decades, causing concern especially in light of the increasing evidence on climate change. Despite the increasing number of reviews suggesting a relationship between heat and health, these reviews focus primarily on mortality, neglecting other important aspects. This systematic review of reviews gathered the available evidence from research syntheses conducted on HWs and health. Following the PRISMA guidelines, 2232 records were retrieved, and 283 reviews were ultimately included. Information was extracted from the papers and categorized by topics. Quantitative data were extracted from meta-analyses and, when not available, evidence was collected from systematic reviews. Overall, 187 reviews were non-systematic, while 96 were systematic, of which 27 performed a meta-analysis. The majority evaluated mortality, morbidity, or vulnerability, while the other topics were scarcely addressed. The following main knowledge gaps were identified: lack of a universally accepted definition of HW; scarce evidence on the HW-mental health relationship; no meta-analyses assessing the risk perception of HWs; scarcity of studies evaluating the efficacy of adaptation strategies and interventions. Future efforts should meet these priorities to provide high-quality evidence to stakeholders

Numerical control matrix rotation for the LINC-NIRVANA Multi-Conjugate Adaptive Optics system

LINC-NIRVANA will realize the interferometric imaging focal station of the Large Binocular Telescope. A double Layer Oriented multi-conjugate adaptive optics system assists the two arms of the interferometer, supplying high order wave-front correction. In order to counterbalance the field rotation, mechanical derotation for the two ground wave-front sensors, and optical derotators for the mid-high layers sensors fix the positions of the focal planes with respect to the pyramids aboard the wave-front sensors. The derotation introduces pupil images rotation on the wavefront sensors: the projection of the deformable mirrors on the sensor consequently change. The proper adjustment of the control matrix will be applied in real-time through numerical computation of the new matrix. In this paper we investigate the temporal and computational aspects related to the pupils rotation, explicitly computing the wave-front errors that may be generated.Comment: 6 pages, 2 figures, presented at SPIE Symposium "Astronomical Telescopes and Instrumentation'' conference "Adaptive Optics Systems II'',Sunday 27 June 2010, San Diego, California, US

Hierarchichal-segmented AO in order to attain wide field compensation in the visible on an 8m class telescope

We describe the preliminary optimized layout for a partially optimized concept of an optical-8m class VLT-like 2x2 segmented camera where each channel is assisted by an equivalent of an MCAO system where the ground layer correction is commonly employed while the high altitude ones is performed in an open-loop fashion. While we derive the basic relationships among the Field of View and attainable correction with a pre-defined choice for the hardware, we discuss sky coverage and wavefront sensing issues employing natural and artificial references, involving the latest stateof-the-art in the development of wavefront sensing. We show that a flexible approach allow for a compensated Field of View that is variable and can be properly tuned matching the current turbulence situation and the requirement in term of quality of the compensation. A preliminary description of the overall optomechanical package is given as well along with a rough estimates of the efforts required to translates such a concept into reality.Comment: 6 pages, 4 figures, in AO4ELT5 Proceeding

Multiple Spatial Frequencies Pyramid WaveFront Sensing

A modification of the pyramid wavefront sensor is described. In this conceptually new class of devices, the perturbations are split at the level of the focal plane depending upon their spatial frequencies, and then measured separately. The aim of this approach is to increase the accuracy in the determination of some range of spatial frequency perturbations, or a certain classes of modes, disentangling them from the noise associated to the Poissonian fluctuations of the light coming from the perturbations outside of the range of interest or from the background in the pupil planes; the latter case specifically when the pyramid wavefront sensor is used with a large modulation. While the limits and the effectiveness of this approach should be further investigated, a number of variations on the concept are shown, including a generalization of the spatial filtering in the point-diffraction wavefront sensor. The simplest application, a generalization to the pyramid of the well-known spatially filtering in wavefront sensing, is showing promise as a significant limiting magnitude advance. Applications are further speculated in the area of extreme adaptive optics and when serving spectroscopic instrumentation where “light in the bucket” rather than Strehl performance is required

Ingot Laser Guide Stars Wavefront Sensing

We revisit one class of z-invariant WaveFront sensor where the LGS is fired aside of the telescope aperture. In this way there is a spatial dependence on the focal plane with respect to the height where the resonant scattering occurs. We revise the basic parameters involving the geometry and we propose various merit functions to define how much improvement can be attained by a z-invariant approach. We show that refractive approaches are not viable and we discuss several solutions involving reflective ones in what has been nicknamed "ingot wavefront sensor" discussing the degrees of freedom required to keep tracking and the basic recipe for the optical design.Comment: 6 pages, 4 figures, AO4ELT5 Conference Proceeding, 201

A Holographic Diffuser Generalised Optical Differentiation Wavefront Sensor

The wavefront sensors used today at the biggest World's telescopes have either a high dynamic range or a high sensitivity, and they are subject to a linear trade off between these two parameters. A new class of wavefront sensors, the Generalised Optical Differentiation Wavefront Sensors, has been devised, in a way not to undergo this linear trade off and to decouple the dynamic range from the sensitivity. This new class of WFSs is based on the light filtering in the focal plane from a dedicated amplitude filter, which is a hybrid between a linear filter, whose physical dimension is related to the dynamic range, and a step in the amplitude, whose size is related to the sensitivity. We propose here a possible technical implementation of this kind of WFS, making use of a simple holographic diffuser to diffract part of the light in a ring shape around the pin of a pyramid wavefront sensor. In this way, the undiffracted light reaches the pin of the pyramid, contributing to the high sensitivity regime of the WFS, while the diffused light is giving a sort of static modulation of the pyramid, allowing to have some signal even in high turbulence conditions. The holographic diffuser zeroth order efficiency is strictly related to the sensitivity of the WFS, while the diffusing angle of the diffracted light gives the amount of modulation and thus the dynamic range. By properly choosing these two parameters it is possible to build a WFS with high sensitivity and high dynamic range in a static fashion. Introducing dynamic parts in the setup allows to have a set of different diffuser that can be alternated in front of the pyramid, if the change in the seeing conditions requires it.Comment: 11 pages, 5 figure

Teaching extent and military service improve undergraduate self-assessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students

BackgroundThe purpose of this study was to identify the possible needs for undergraduate disaster medicine education in Sweden and to make informed recommendations for the implementation of disaster medicine content in medical and nursing schools in Sweden.MethodsAn online survey was distributed to undergraduate medical and nursing students through the directors of all medical and nursing programs at Swedish universities. The survey contained demographic questions, as well as questions about the amount of disaster medical education and previous experience with rescue, police, or military services. The final survey page contained self-assessments of disaster medical knowledge. Comparative statistics were applied between nursing and medical students, those with previous military service, and those without, as well as between universities.ResultsA total of 500 medical and 408 nursing students participated in this study. A median of 2 h of disaster medicine education was provided to senior medical students and 4 h was provided to senior nursing students. Senior medical students scored their disaster medical knowledge lower than nursing students (t-test, p < 0.001). A proportion of 1% had served in rescue services or police, and 7% of the participants had a history of military service, of which 67% served in a medical role. Those who had served in rescue services, police, or the armed forces had a higher self-assessed disaster medical knowledge base than those who had not (p < 0.007 and p < 0.001, respectively).ConclusionMost medical and nursing students in this study rated their disaster medical knowledge as insufficient. The correlation between the amount of disaster medical education and self-assessed disaster medical knowledge should influence and help direct Swedish educational policies

Pathfinder first light: alignment, calibration, and commissioning of the LINC-NIRVANA ground-layer adaptive optics subsystem

We present descriptions of the alignment and calibration tests of the Pathfinder, which achieved first light during our 2013 commissioning campaign at the LBT. The full LINC-NIRVANA instrument is a Fizeau interferometric imager with fringe tracking and 2-layer natural guide star multi-conjugate adaptive optics (MCAO) systems on each eye of the LBT. The MCAO correction for each side is achieved using a ground layer wavefront sensor that drives the LBT adaptive secondary mirror and a mid-high layer wavefront sensor that drives a Xinetics 349 actuator DM conjugated to an altitude of 7.1 km. When the LINC-NIRVANA MCAO system is commissioned, it will be one of only two such systems on an 8-meter telescope and the only such system in the northern hemisphere. In order to mitigate risk, we take a modular approach to commissioning by decoupling and testing the LINC-NIRVANA subsystems individually. The Pathfinder is the ground-layer wavefront sensor for the DX eye of the LBT. It uses 12 pyramid wavefront sensors to optically co-add light from natural guide stars in order to make four pupil images that sense ground layer turbulence. Pathfinder is now the first LINC-NIRVANA subsystem to be fully integrated with the telescope and commissioned on sky. Our 2013 commissioning campaign consisted of 7 runs at the LBT with the tasks of assembly, integration and communication with the LBT telescope control system, alignment to the telescope optical axis, off-sky closed loop AO calibration, and finally closed loop on-sky AO. We present the programmatics of this campaign, along with the novel designs of our alignment scheme and our off-sky calibration test, which lead to the Pathfinder's first on-sky closed loop images