ParaVR: a virtual reality training simulator for paramedic skills maintenance

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the link in this recordBackground Virtual Reality (VR) technology is emerging as a powerful educational tool which is used in medical training and has potential benefits for paramedic practice education. Aim The aim of this paper is to report development of ParaVR, which utilises VR to address skills maintenance for paramedics. Methods University of Chester VR developers and the Welsh Ambulance Services NHS Trust (WAST) developed ParaVR in four stages: 1. Identifying requirements and specifications 2. Alpha version development, 3. Beta version development 4. Management: Development of software, further funding and commercialisation. Results Needle Cricothyrotomy and Needle Thoracostomy emerged as candidates for the prototype ParaVR. The Oculus Rift head mounted display (HMD) combined with Novint Falcon haptic device was used, and a virtual environment crafted using 3D modelling software, ported (a computing term meaning transfer (software) from one system or machine to another) onto Oculus Go and Google cardboard VR platform. Accepted Author Preprint, cite as: Rees N, John N, Vaughan N, Dorrington K, Day T, (2020) ParaVR: A Virtual Reality Training Simulator for Paramedic Skills maintenance, JPAR Journal of Paramedic Practice, November 2020 issue. Conclusion VR is an emerging educational tool with the potential to enhance paramedic skills development and maintenance. The ParaVR program is the first step in our development, testing, and scaling up of this technologyBevan CommissionRoyal Academy of Engineerin

Modelling the mortality of members of group schemes in South Africa

In this paper, the methodology underlying the graduation of the mortality of members of group schemes in South Africa underwritten by life insurance companies under group life-insurance arrangements is described and the results are presented. A multivariate parametric curve was fitted to the data for the working ages 25 to 65 and comparisons are made with the mortality rates from the SA85–90 ultimate rates for insured lives and the ASSA2008 AIDS and demographic model. The results show that the mortality of members of group schemes is lower than that of the general population, mortality decreasing with increasing salary, as would be expected. For males it was found that there were differences in mortality rates by industry for a given salary band, whereas for females these differences only occurred in the lower salary bands. Furthermore, there is evidence of the healthy-worker effect at ages 60 and above, where the mortality rates appear to level off or even decrease as age increases. This contrasts with the mortality rates from the SA85–90 ultimate rates for insured lives and the ASSA2008 AIDS and demographic model, which increase exponentially

Health and economic impact of HIV/AIDS on South African households: a cohort study

BACKGROUND: South African households are severely affected by human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS) but health and economic impacts have not been quantified in controlled cohort studies. METHODS: We compared households with an HIV-infected member, and unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa. Interviews were conducted with one key informant in each household, at baseline and six months later. We studied 1913 members of 404 households, with 94% and 96% follow up, respectively. Household and individual level analyses were done. RESULTS: Members of affected households, compared to members of unaffected households, were independently more likely to be continuously ill (adjusted odds ratio (OR) 2.1, 95% CI 1.3–3.4 at follow up), and to die (adjusted OR 3.4, 95% CI 1.0–11), mainly due to infectious diseases. Government clinics and hospitals were the main sources of health care. Affected households were poorer than unaffected households at baseline (relative income per person 0.61, 95% CI 0.49–0.76). Over six months expenditure and income decreased more rapidly in affected than in unaffected households (baseline-adjusted relative expenditure 0.86, 95% CI 0.75–0.99 and income 0.89, 95% CI 0.75–1.05). Baseline morbidity was independently associated with lower income and expenditure at baseline but not with changes over six months. CONCLUSIONS: HIV/AIDS affects the health and wealth of households as well as infected individuals, aggravating pre-existing poverty

Bioavailability and effects of microplastics on marine zooplankton: A review

Microplastics are abundant and widespread in the marine environment. They are a contaminant of global environmental and economic concern. Due to their small size a wide range of marine species, including zooplankton can ingest them. Research has shown that microplastics are readily ingested by several zooplankton taxa, with associated negative impacts on biological processes. Zooplankton is a crucial food source for many secondary consumers, consequently this represents a route whereby microplastic could enter the food web and transfer up the trophic levels. In this review we aim to: 1) evaluate the current knowledge base regarding microplastic ingestion by zooplankton in both the laboratory and the field; and 2) summarise the factors which contribute to the bioavailability of microplastics to zooplankton. Current literature shows that microplastic ingestion has been recorded in 39 zooplankton species from 28 taxonomic orders including holo- and meroplanktonic species. The majority of studies occurred under laboratory conditions and negative effects were reported in ten studies (45%) demonstrating effects on feeding behaviour, growth, development, reproduction and lifespan. In contrast, three studies (14%) reported no negative effects from microplastic ingestion. Several physical and biological factors can influence the bioavailability of microplastics to zooplankton, such as size, shape, age and abundance. We identified that microplastics used in experiments are often different to those quantified in the marine environment, particularly in terms of concentration, shape, type and age. We therefore suggest that future research should include microplastics that are more representative of those found in the marine environment at relevant concentrations. Additionally, investigating the effects of microplastic ingestion on a broader range of zooplankton species and life stages, will help to answer key knowledge gaps regarding the effect of microplastic on recruitment, species populations and ultimately broader economic consequences such as impacts on shell- and finfish stocks

HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review.

Published versio

Determinants of ventilation and pulmonary artery pressure during early acclimatization to hypoxia in humans.

Pulmonary ventilation and pulmonary arterial pressure both rise progressively during the first few hours of human acclimatization to hypoxia. These responses are highly variable between individuals, but the origin of this variability is unknown. Here, we sought to determine whether the variabilities between different measures of response to sustained hypoxiawere related, which would suggest a common source of variability. Eighty volunteers individually underwent an 8-h isocapnic exposure to hypoxia (end-tidal PO2=55 Torr) in a purpose-built chamber. Measurements of ventilation and pulmonary artery systolic pressure (PASP) assessed by Doppler echocardiography were made during the exposure. Before and after the exposure, measurements were made of the ventilatory sensitivities to acute isocapnic hypoxia (GpO2 ) and hyperoxic hypercapnia, the latter divided into peripheral (GpCO2 ) and central (GcCO2 ) components. Substantial acclimatization was observed in both ventilation and PASP, the latter being 40% greater in women than men. No correlation was found between the magnitudes of pulmonary ventilatory and pulmonary vascular responses. For GpO2 , GpCO2 and GcCO2 , but not the sensitivity of PASP to acute hypoxia, the magnitude of the increase during acclimatization was proportional to the pre-acclimatization value. Additionally, the change in GpO2 during acclimatization to hypoxia correlated well with most other measures of ventilatory acclimatization. Of the initial measurements prior to sustained hypoxia, only GpCO2 predicted the subsequent rise in ventilation and change in GpO2 during acclimatization. We conclude that the magnitudes of the ventilatory and pulmonary vascular responses to sustained hypoxia are predominantly determined by different factors and that the initial GpCO2 is a modest predictor of ventilatory acclimatization

Elevation of iron storage in humans attenuates the pulmonary vascular response to hypoxia

Sustained hypoxia over several hours induces a progressive rise in pulmonary artery systolic pressure (PASP). Administration of intravenous iron immediately prior to the hypoxia exposure abrogates this effect, suggesting that manipulation of iron stores may modify hypoxia-induced pulmonary hypertension. Iron (ferric carboxymaltose) administered intravenously has a plasma half-life of 7-12 hours. Thus, any therapeutic use of intravenous iron would require its effect on PASP to persist long after the iron-sugar complex has been cleared from the blood. To examine this, we studied PASP during sustained (6-h) hypoxia on four separate days (days 0, 1, 8 and 43) in 22 participants. On day 0, the rise in PASP with hypoxia was well matched between the iron and saline groups. On day 1, each participant received either 1 g of ferric carboxymaltose or saline in a double-blind manner. After administration of intravenous iron, the rise in PASP with hypoxia was attenuated by ~50%, and this response remained suppressed on both days 8 and 43 (p<0.001). Following administration of intravenous iron, values for ferritin concentration, transferrin saturation and hepcidin concentration rose significantly (p<0.001, p <0.005 and p<0.001, respectively) and values for transferrin concentration fell significantly (p<0.001). These changes remained significant at day 43. We conclude that the attenuation of the pulmonary vascular response to hypoxia by elevation of iron stores persists long after the artificial iron-sugar complex has been eliminated from the blood. The persistence of this effect suggests that intravenous iron may be of benefit in some forms of pulmonary hypertension

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far