Antibiotic utilization for respiratory conditions (AXR) is a new Healthcare Effectiveness Data & Information Set ® (HEDIS®) measure designed to complement disease-specific metrics to improve outpatient antibiotic prescribing. Unique challenges include ensuring clinicians understand the metric and establishing appropriate goals within different health systems and service lines. Successful implementation requires awareness of the metric’s limitations and may be enhanced by co-reporting with condition-specific antibiotic use metrics to prioritize local interventions.

The Aerospace Integration Research Centre (AIRC) at Cranfield University offers industry and academia an open environment to explore the opportunities for efficient integration of aircraft systems. As a part of the centre, Cranfield University, Rolls-Royce, and DCA Design International jointly have developed the Future Systems Simulator (FSS) for the purpose of research and development in areas such as human factors in aviation, single-pilot operations, future cockpit design, aircraft electrification, and alternative control approaches. Utilising the state-of-the-art modularity principles in simulation technology, the FSS is built to simulate a diverse range of current and novel aircraft, enabling researchers and industry partners to conduct experiments rapidly and efficiently. Central to the requirement, a unique, user-experience-centred development and design process is implemented for the development of the FSS. This paper presents the development process of such a flight simulator with an innovative flight deck. Furthermore, the paper demonstrates the FSS’s capabilities through case studies. The cutting-edge versatility and flexibility of the FSS are demonstrated through the diverse example research case studies. In the final section, the authors provide guidance for the development of an engineering flight simulator based on lessons learned in this project.

Total, slightly, and highly swelling clay minerals can be separated and measured by the test procedure described. Separations of synthetic mixtures of essentially pure natural sediments indicate that the measurements are accurate within ± 1% of the true values for samples containing < 20% swelling clays, and that < 1% quantities can be detected. Test results using < 5 micron material show that small grain size is not a problem in effective separation.

The test procedure is primarily a centrifuge separation based on the hydrated grain densities of the swelling clay minerals. The sample grains are pretreated with silicone (Dow 1107). The swelling clays are separated from rock and soil samples by centrifuging the sample-water slurry over a non-water-miscible heavy liquid. The sample is stirred violently at and above the water-heavy liquid interface during this centrifuging. The desired swelling clay fraction is recovered in the water medium and the denser minerals are collected in the heavy liquid. Water-soluble minerals are removed by filtering. Quantitative measurements are based on dry weights.

Application of this method to petroleum engineering and geology is stressed, but other disciplines will have use for the described procedure.

Background: Currently there are no disease modifying treatment for Synucleinopathies including Parkinson’s disease Dementia (PDD). Carrying a mutation in the GBA gene (beta-glucocerebrosidase/ GCAse) is a leading risk factor for synucleinopathies. Raising activity GCAse lowers α-synuclein levels in cells and animal models. Ambroxol is a pharmacological chaperone for GCAse and can raise GCAse levels. Our goal is to test Ambroxol as a disease-modifying treatment in PDD. Methods: We randomized fifty-five individuals with PDD to Ambroxol 1050mg/day, 525mg/day, or placebo for 52 weeks. Primary outcome measures included safety, Alzheimer’s disease Assessment Scale-cognitive (ADAS-Cog) subscale and the Clinician’s Global Impression of Change (CGIC). Secondary outcomes included pharmacokinetics, cognitive and motor outcomes and and plasma and CSF biomarkers. Results: Ambroxol was well tolerated. There were 7 serious adverse events (SAEs) none deemed related to Ambroxol. GCase activity was increased in white blood cells by ~1.5 fold. There were no differences between groups on primary outcome measures. Patients receiving high dose Ambroxol appeared better on the Neuropsychiatric Inventory. GBA carriers appeared to improve on some cognitive tests. pTau 181 was reduced in CSF. Conclusions: Ambroxol was safe and well-tolerated in PDD. Ambroxol may improve biomarkers and cognitive outcomes in GBA1 mutation carrie.rs Ambroxol improved some biomarkerss. ClinicalTrials.gov NCT02914366

Hydrothermal synthesis experiments were conducted to study the transition from smectite to corrensite. A mixture of oxides with the bulk composition of corrensite—Na0.4(Si6.4Al1.6)(Mg7.8Al1.2)-O20(OH)10—was sealed in platinum capsules with 29–37 wt. % water. One set of samples was treated in cold-seal vessels at 500°C and 2 kbar for durations of 2, 3, 6, 12, and 24 h; the other set was treated at 350°C and 2 kbar for periods of 12 to 89 d. X-ray diffraction patterns (XRD) of oriented aggregates from treated products were obtained from ethylene glycol-solvated and air-dried preparations. Samples were also heated to 350°C either in a calibrated muffle furnace, removed and quickly placed in a nitrogen filled chamber on the diffractometer, or were heated at 350°C by using a calibrated heating stage mounted on the diffractometer.

Initial mineral assemblages at both temperatures contained only saponite and serpentine. In experiments at 500°C, saponite transformed to corrensite within 6 h; in experiments at 350°C, the transformation occurred as early as 22 d. Increased experiment times at both temperatures produced increasing amounts of well-crystallized corrensite, as indicated by several well-defined XRD peaks. No evidence of a randomly interstratified chlorite-smectite (C-S) precursor to corrensite was found. The identification of pure smectite, as opposed to highly-expanded randomly interstratified C-S, was possible only when clays were dehydrated on a heating stage on the diffractometer.

These results call for a new examination of hydrothermally-altered basalt that has been reported to contain randomly interstratified C-S as an intermediate step in the reaction of smectite to corrensite or chlorite. These results also strengthen the view held by increasing numbers of investigators that corrensite should be regarded as a single phase, not as a mixed-layered phyllosilicate.

Large research teams and consortia present challenges for authorship. The number of disciplines involved in the research can further complicate approaches to manuscript development and leadership. The CHARM team, representing a multi-disciplinary, multi-institutional genomics implementation study, participated in facilitated discussions inspired by team science methodologies. The discussions were centered on team members’ past experiences with authorship and perspectives on authorship in a large research team context. Team members identified challenges and opportunities that were used to create guidelines and administrative tools to support manuscript development. The guidelines were organized by the three values of equity, inclusion, and efficiency and included eight principles. A visual dashboard was created to allow all team members to see who was leading or involved in each paper. Additional tools to promote equity, inclusion, and efficiency included providing standardized project management for each manuscript and making “concept sheets” for each manuscript accessible to all team members. The process used in CHARM can be used by other large research teams and consortia to equitably distribute lead authorship opportunities, foster coauthor inclusion, and efficiently work with large authorship groups.

In recent years, there has been significant momentum in applying deep learning (DL) to machine health monitoring (MHM). It has been widely claimed that DL methodologies are superior to more traditional techniques in this area. This paper aims to investigate this claim by analysing a real-world dataset of helicopter sensor faults provided by Airbus. Specifically, we will address the problem of machine sensor health unsupervised classification. In a 2019 worldwide competition hosted by Airbus, Fujitsu Systems Europe (FSE) won first prize by achieving an F1-score of 93% using a DL model based on generative adversarial networks (GAN). In another comprehensive study, various modified and existing image encoding methods were compared for the convolutional auto-encoder (CAE) model. The best classification result was achieved using the scalogram as the image encoding method, with an F1-score of 91%. In this paper, we use these two studies as benchmarks to compare with basic statistical analysis methods and the one-class supporting vector machine (SVM). Our comparative study demonstrates that while DL-based techniques have great potential, they are not always superior to traditional methods. We therefore recommend that all future published studies of applying DL methods to MHM include appropriately selected traditional reference methods, wherever possible.

The Taita Falcon Falco fasciinucha is known to occur and breed at only a few locations in eastern and southern Africa and is currently listed as globally “Vulnerable” and “Critically Endangered” in South Africa. An accurate estimation of its conservation status is however hampered by a lack of data and understanding of the species’ habitat requirements and competitive interactions with congeners. Our aim was to address some of these knowledge gaps. We conducted cliff-nesting raptor surveys across a substantial area of the Mpumalanga/Limpopo escarpment in north-eastern South Africa and modelled habitat suitability for nesting Taita Falcons in relation to the proximity of conspecifics and a community of five other sympatric cliff-nesting raptor species, and in relation to a suite of biotic and abiotic environmental variables. Results suggested the location of Taita Falcon nest sites was negatively associated with distance to the nearest pair of conspecifics and the nearest pair of Lanner Falcons Falco biarmicus, and positively associated with tracts of intact, unfragmented forest and woodland around the base of the cliffs. Our results indicated that Taita Falcon and Lanner Falcon appeared to be responding in opposite ways to a directional change in environmental conditions. This response appeared to be detrimental to Taita Falcon and beneficial to Lanner Falcon. Furthermore, the degradation and destruction of Afrotropical woodland and forest is a documented and ongoing reality, both locally and across much of the Taita Falcon’s global distribution. We argue that our findings are sufficient to justify uplisting Taita Falcon to globally “Endangered”.

Consumption of probiotics and/or yogurt could be a solution for restoring the balance of the gut microbiota. This study examined associations of regular intake of probiotic supplements or yogurt with the gut microbiota among a diverse population of older adults (N=1,861; 60–72 years). Faecal microbial composition was obtained from 16S rRNA gene sequencing (V1–V3 region). General linear models were used to estimate the associations of probiotic supplement or yogurt intake with microbiome measures adjusting for covariates. Compared to non-yogurt consumers (N=1,023), regular yogurt consumers (≥once/week, N=818) had greater Streptococcus (β=0.29, P=0.0003) and lower Odoribacter (β=−0.33, P<0.0001) abundance. The directions of the above associations were consistent across the five ethnic groups but stronger among Japanese Americans (Streptococcus: β=0.56, P=0.0009; Odoribacter: β=−0.62, P=0.0005). Regular intake of probiotic supplements (N=175) was not associated with microbial characteristics (i.e., alpha diversity and the abundance of 152 bacteria genera). Streptococcus is one of the predominant bacteria genera in yogurt products, which may explain the positive association between yogurt consumption and Streptococcus abundance. Our analyses suggest that changes in Odoribacter were independent of changes in Streptococcus abundance. Future studies may investigate whether these microbial genera and their sub-level species mediate potential pathways between yogurt consumption and health.

Background: Canadian neurology residency programs recently transitioned to Competence Based Medical Education (CBME), designed to provide residents with stage-appropriate learning to develop and demonstrate competence. The successful implementation of CBME requires iterative evaluation as the adoption process may differ from the intended design due to systemic or program-specific factors. This study aims to (1) examine the variability in CBME implementation across Canadian neurology residency programs; (2) determine the barriers toward uptake of CBME; and (3) identify the benefits and pitfalls of CBME in neurology residency programs. Methods: A separate national survey was developed for residents and staff neurologists who participated in CBME for at least six months. Surveys were distributed through email, and responses were anonymized. Quantitative data were analyzed by response frequency and mean, where applicable. Free-form responses were analyzed qualitatively. Results: Staff neurologists felt prepared for CBME, but were divided on its fairness and impact on education quality. Residents experienced frequent but not necessarily timely or high-quality feedback. Barriers to implementation included increased paperwork, dissatisfaction with online platforms used to facilitate CBME, and bidirectional burden of initiating evaluations. Conclusions: Staff and residents have expressed unique perspectives on the first iteration of CBME. There remain opportunities for improvement in subsequent iterations.

Background: Neurology Residency training in Canada is transitioning to competence based medical education (CBME) in July 2020 and the Royal College Neurology Specialty Committee has identified “providing consultation for and managing patients at outlying centers,” to be an entrustable professional activity (EPA). At Western, neurology telephone consultations, from outlying centres, are attended by both the resident and the staff Neurologist. This scenario provides the ideal situation for direct observation and immediate formative feedback. The resident’s performance is assessed using the ’TeleTool’ which utilizes an entrustment scale and has a short narrative portion. Methods: This mixed methods study aims to determine the reliability and validity of the ’TeleTool’ in assessing the performance of the telephone consultation by senior neurology residents. Informed consent was obtained from residents (9) and staff (7) involved. Scores on the entrustment scale and narrative comments were analysed. Results: Information on 30 encounters (involving 9 residents) was collected. TeleTool results demonstrated higher entrustment scores in PGY4 and PGY5 levels. Overall, ratings were consistent across the 7 consultants assessors. Conclusions: The TeleTool was reliable and valid in assessing competence in the telephone consultation and will be a useful tool for assessment of this EPA.

Surveyed caregivers of children in Denver, Colorado, with acute otitis media (AOM) preferred immediate antibiotics over delayed antibiotics or observation. Overall, 77% stated that they would immediately fill a prescription written as delayed. In contrast, 86% of caregivers favored whichever duration was recommended by the provider or the shortest duration necessary.

Climate warming is occurring most rapidly in the Arctic, which is both a sentinel and a driver of further global change. Ecosystems and human societies are already affected by warming. Permafrost thaws and species are on the move, bringing pathogens and vectors to virgin areas. During a five-year project, the CLINF – a Nordic Center of Excellence, funded by the Nordic Council of Ministers, has worked with the One Health concept, integrating environmental data with human and animal disease data in predictive models and creating maps of dynamic processes affecting the spread of infectious diseases. It is shown that tularemia outbreaks can be predicted even at a regional level with a manageable level of uncertainty. To decrease uncertainty, rapid development of new and harmonised technologies and databases is needed from currently highly heterogeneous data sources. A major source of uncertainty for the future of contaminants and infectious diseases in the Arctic, however, is associated with which paths the majority of the globe chooses to follow in the future. Diplomacy is one of the most powerful tools Arctic nations have to influence these choices of other nations, supported by Arctic science and One Health approaches that recognise the interconnection between people, animals, plants and their shared environment at the local, regional, national and global levels as essential for achieving a sustainable development for both the Arctic and the globe.

As past usual diet quality may affect gut microbiome (GM) composition, we examined the association of the Healthy Eating Index (HEI)-2015 assessed 21 and 9 years before stool collection with measures of fecal microbial composition in a subset of the Multiethnic Cohort. A total of 5936 participants completed a validated quantitative FFQ (QFFQ) at cohort entry (Q1, 1993–1996), 5280 at follow-up (Q3, 2003–2008) and 1685 also at a second follow-up (Adiposity Phenotype Study (APS), 2013–2016). All participants provided a stool sample in 2013–2016. Fecal microbial composition was obtained from 16S rRNA gene sequencing (V1–V3 regions). HEI-2015 scores were computed based on each QFFQ. Using linear regression adjusted for relevant covariates, we calculated associations of HEI-2015 scores with gut microbial diversity and 152 individual genera. The mean HEI-2015 scores increased from Q1 (67 (sd 10)) to Q3 (71 (sd 11)) and APS (72 (sd 10)). Alpha diversity assessed by the Shannon Index was significantly higher with increasing tertiles of HEI-2015. Of the 152 bacterial genera tested, seven (Anaerostipes, Coprococcus_2, Eubacterium eligens, Lachnospira, Lachnospiraceae_ND3007, Ruminococcaceae_UCG-013 and Ruminococcus_1) were positively and five (Collinsella, Parabacteroides, Ruminiclostridium_5, Ruminococcus gnavus and Tyzzerella) were inversely associated with HEI-2015 assessed in Q1, Q3 and APS. The estimates of change per unit of the HEI-2015 score associated with the abundance of these twelve genera were consistent across the three questionnaires. The quality of past diet, assessed as far as ∼20 years before stool collection, is equally predictive of GM composition as concurrently assessed diet, indicative of the long-term consistency of this relation.

Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.