In fighter pilot training, much of upgrade pilots’ (UPs’) learning takes place during mission debriefs. A debrief provides instructor pilots (IPs) the opportunity to correct situation awareness (SA) upon which the UPs base their tactical decisions. Unless the debrief is conducted with proper depth and breadth, the IPs’ feedback on UPs’ SA and tactical decision-making may be incomplete or false, resulting in poor, or even negative learning. In this study, a new debrief protocol based on the Critical Decision Method (CDM) is introduced. The protocol specifically addresses the SA of UPs. An evaluation was conducted to examine if a short CDM training programme to IPs would enhance their ability to provide performance feedback to UPs regarding their SA and tactical decision-making. The IPs were qualified flying instructors and the UPs were air force cadets completing their air combat training with BAe Hawk jet trainer aircraft. The impact of the training intervention was evaluated using Kirkpatrick’s four-level model. The first three levels of evaluation (Reactions, Learning and Behaviour) focused on the IPs, whereas the fourth level (Results) focused on the UPs. The training intervention had a positive impact on the Reactions, Learning and debrief Behaviour of the IPs. In air combat training missions, the UPs whose debriefs were based on the CDM protocol, had superior SA and overall performance compared to a control group.

The aim of this study was to assess whether adding Ca2+ to aggregate or native forms of β-lactoglobulin alters gut hormone secretion, gastric emptying rates and energy intake in healthy men and women. Fifteen healthy adults (mean ± sd: 9M/6F, age: 24 ± 5 years) completed four trials in a randomised, double-blind, crossover design. Participants consumed test drinks consisting of 30 g of β-lactoglobulin in a native form with (NATIVE + MINERALS) and without (NATIVE) a Ca2+-rich mineral supplement and in an aggregated form both with (AGGREG + MINERALS) and without the mineral supplement (AGGREG). Arterialised blood was sampled for 120 min postprandially to determine gut hormone concentrations. Gastric emptying was determined using 13C-acetate and 13C-octanoate, and energy intake was assessed with an ad libitum meal at 120 min. A protein × mineral interaction effect was observed for total glucagon-like peptide-1 (GLP-1TOTAL) incremental AUC (iAUC; P < 0·01), whereby MINERALS + AGGREG increased GLP-1TOTAL iAUC to a greater extent than AGGREG (1882 ± 603 v. 1550 ± 456 pmol·l−1·120 min, P < 0·01), but MINERALS + NATIVE did not meaningfully alter the GLP-1 iAUC compared with NATIVE (1669 ± 547 v. 1844 ± 550 pmol·l−1·120 min, P = 0·09). A protein × minerals interaction effect was also observed for gastric emptying half-life (P < 0·01) whereby MINERALS + NATIVE increased gastric emptying half-life compared with NATIVE (83 ± 14 v. 71 ± 8 min, P < 0·01), whereas no meaningful differences were observed between MINERALS + AGGREG v. AGGREG (P = 0·70). These did not result in any meaningful changes in energy intake (protein × minerals interaction, P = 0·06). These data suggest that the potential for Ca2+ to stimulate GLP-1 secretion at moderate protein doses may depend on protein form. This study was registered at clinicaltrials.gov (NCT04659902).

OBJECTIVES/GOALS: The goal of this presentation is to highlight the role of and challenges to the Biostatistics, Epidemiology and Research Design (BERD) Core as it transitions into (i) the resources and services module (ii) and also possibly a regional center of translational science. METHODS/STUDY POPULATION: BERD cores play key roles in translational research missions, often in the form of long-term collaborative relationships focusing on project conception and design, interim monitoring and review, analysis and dissemination. The resources and services module encourages consolidation of all resources and services under the single modular umbrella, which can pose challenges to BERD autonomy and function. CTSAs transitioning from local to regional centers can also threaten to overwhelm BERD workloads and resources. Our CTSA planned an outsource-insource model to make the BERD a central feature of the new module and transplant its functionality to partner institutions. RESULTS/ANTICIPATED RESULTS: The team has planned a centralized, web-based entry-point for both self-guided inquiry and electronic requests of all resources and services, which aides project database creation and provides notification for review. The review process adds two new approval types: guided assistance to help navigate connections to relevant resources, and triaged referrals to training modules for remediation and skills development. Our BERD has added a Consulting Laboratory for projects of sufficient but non-priority merit that would otherwise be waitlisted, and established connections with regional partner institutions to whom they can refer investigators. DISCUSSION/SIGNIFICANCE: We have consolidated all resources and services into a single, accessible location, emphasizing tailored guidance to maximize limited resources. We also planned a transportable regional model that accounts for local resources and capacity to keep from overstretching the BERD and other hubs.

Flight crews’ capacity to conduct take-off and landing in near zero visibility conditions has been partially addressed by advanced surveillance and cockpit display technology. This capability is yet to be realised within the context of manoeuvring aircraft within airport terminal areas. In this paper the performance and workload benefits of user-centre designed visual and haptic taxi navigational cues, presented via a head-up display (HUD) and active sidestick, respectively, were evaluated in simulated taxiing trials by 12 professional pilots. In addition, the trials sought to examine pilot acceptance of side stick nose wheel steering. The HUD navigational cues demonstrated a significant task-specific benefit by reducing centreline deviation during turns and the frequency of major taxiway deviations. In parallel, the visual cues reduced self-report workload. Pilot’s appraisal of nose wheel steering by sidestick was positive, and active sidestick cues increased confidence in the multimodal guidance construct. The study presents the first examination of how a multimodal display, combining visual and haptic cues, could support the safety and efficiency in which pilots are able to conduct a taxi navigation task in low-visibility conditions.

A high dose of whey protein hydrolysate fed with milk minerals rich in calcium (Capolac®) results in enhanced glucagon-like peptide-1 (GLP-1) concentrations in lean individuals; however, the effect of different calcium doses ingested alongside protein is unknown. The present study assessed the dose response of calcium fed alongside 25 g whey protein hydrolysate on GLP-1 concentrations in individuals with overweight/obesity. Eighteen adults (mean ± sd: 8M/10F, 34 ± 18 years, 28·2 ± 2·9 kgm−2) completed four trials in a randomised, double-blind, crossover design. Participants consumed test solutions consisting of 25 g whey protein hydrolysate (CON), supplemented with 3179 mg (LOW), 6363 mg (MED) or 9547 mg (HIGH) Capolac® on different occasions, separated by at least 48 h. The calcium content of test solutions equated to 65, 892, 1719 and 2547 mg, respectively. Arterialised-venous blood was sampled over 180 min to determine plasma concentrations of GLP-1TOTAL, GLP-17–36amide, insulin, glucose, NEFA, and serum concentrations of calcium and albumin. Ad libitum energy intake was measured at 180 min. Time–averaged incremental AUC (iAUC) for GLP-1TOTAL (pmol·l−1·min−1) did not differ between CON (23 ± 4), LOW (25 ± 6), MED (24 ± 5) and HIGH (24 ± 6). Energy intake (kcal) did not differ between CON (940 ± 387), LOW (884 ± 345), MED (920 ± 334) and HIGH (973 ± 390). Co-ingestion of whey protein hydrolysate with Capolac® does not potentiate GLP-1 release in comparison with whey protein hydrolysate alone. The study was registered at clinical trials (NCT03819972).

This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.

Impairment in reciprocal social behavior (RSB), an essential component of early social competence, clinically defines autism spectrum disorder (ASD). However, the behavioral and genetic architecture of RSB in toddlerhood, when ASD first emerges, has not been fully characterized. We analyzed data from a quantitative video-referenced rating of RSB (vrRSB) in two toddler samples: a community-based volunteer research registry (n = 1,563) and an ethnically diverse, longitudinal twin sample ascertained from two state birth registries (n = 714). Variation in RSB was continuously distributed, temporally stable, significantly associated with ASD risk at age 18 months, and only modestly explained by sociodemographic and medical factors (r2 = 9.4%). Five latent RSB factors were identified and corresponded to aspects of social communication or restricted repetitive behaviors, the two core ASD symptom domains. Quantitative genetic analyses indicated substantial heritability for all factors at age 24 months (h2 ≥ .61). Genetic influences strongly overlapped across all factors, with a social motivation factor showing evidence of newly-emerging genetic influences between the ages of 18 and 24 months. RSB constitutes a heritable, trait-like competency whose factorial and genetic structure is generalized across diverse populations, demonstrating its role as an early, enduring dimension of inherited variation in human social behavior. Substantially overlapping RSB domains, measurable when core ASD features arise and consolidate, may serve as markers of specific pathways to autism and anchors to inform determinants of autism's heterogeneity.

It is unclear if mild-to-moderate dehydration independently affects mood without confounders like heat exposure or exercise. This study examined the acute effect of cellular dehydration on mood. Forty-nine adults (55 % female, age 39 (sd 8) years) were assigned to counterbalanced, crossover trials. Intracellular dehydration was induced with 2-h (0·1 ml/kg per min) 3 % hypertonic saline (HYPER) infusion or 0·9 % isotonic saline (ISO) as a control. Plasma osmolality increased in HYPER (pre 285 (sd 3), post 305 (sd 4) mmol/kg; P < 0·05) but remained unchanged in ISO (pre 285 (sd 3), post 288 (sd 3) mmol/kg; P > 0·05). Mood was assessed with the short version of the Profile of Mood States Questionnaire (POMS). The POMS sub-scale (confusion-bewilderment, depression-dejection, fatigue-inertia) increased in HYPER compared with ISO (P < 0·05). Total mood disturbance score (TMD) assessed by POMS increased from 10·3 (sd 0·9) to 16·6 (sd 1·7) in HYPER (P < 0·01), but not in ISO (P > 0·05). When TMD was stratified by sex, the increase in the HYPER trial was significant in females (P < 0·01) but not in males (P > 0·05). Following infusion, thirst and copeptin (surrogate for vasopressin) were also higher in females than in males (21·3 (sd 2·0), 14·1 (sd 1·4) pmol/l; P < 0·01) during HYPER. In conclusion, cellular dehydration acutely degraded specific aspects of mood mainly in women. The mechanisms underlying sex differences may be related to elevated thirst and vasopressin.

Introduction: The ways in which Emergency Medicine (EM) physicians interact with the medical literature has been transformed with the rise of Free Open Access Medical Education (FOAM). Although nearly all residents use FOAM resources, some criticize the lack of universal quality assurance. This problem is a particular risk for trainees who have many time constraints and incompletely developed critical appraisal skills. One potential safeguard is journal club, which is used by virtually all EM residency programs in North America to review new literature. However, EM resident perspectives have not been studied. Our research objective was to describe how residents perceive journal club to influence how they translate the medical literature into their clinical practice. Our research question was whether FOAM has influenced residents’ goals and perceived value of journal club. Methods: We developed a semi-structured interview script in conjunction with a methods expert and refined it via pilot testing. Following constructivist grounded theory, and using both purposive and theoretical sampling, we conducted a focus group (n = 7) and 18 individual interviews with EM residents at the 4 training sites of the University of British Columbia. In total, we analyzed 920 minutes of recorded audio. Two authors independently coded each transcript, with discrepancies reconciled by discussion and consensus. Constant comparative analysis was performed. We conducted return of findings through public presentations. Results: We found evidence that journal club works as a community of practice with a progression of roles from junior to senior residents. Participants described journal club as a safe venue to compare practice patterns and to gain insight into the practical wisdom of their peers and mentors. The social and academic activities present at journal club interacted positively to foster this environment. In asking residents about ways that journal club accelerates knowledge translation, we actually found that residents cite journal club as a quality check to prevent premature adoption of new research findings. Residents are hesitant to adopt new literature into their practice without positive validation, which can occur during journal club. Conclusion: Journal club functions as a community of practice that is valued by residents. Journal club is a primary way that new evidence can be validated before being put into practice, and may act as quality assurance in the era of FOAM.

The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

Applied psychologists commonly use personality tests in employee selection systems because of their advantages regarding incremental criterion-related validity and less adverse impact relative to cognitive ability tests. Although personality tests have seen limited legal challenges in the past, we posit that the use of personality tests might see increased challenges under the Americans with Disabilities Act (ADA) and the ADA Amendments Act (ADAAA) due to emerging evidence that normative personality and personality disorders belong to common continua. This article aims to begin a discussion and offer initial insight regarding the possible implications of this research for personality testing under the ADA. We review past case law, scholarship in employment law, Equal Employment Opportunity Commission (EEOC) guidance regarding “medical examinations,” and recent literature from various psychology disciplines—including clinical, neuropsychology, and applied personality psychology—regarding the relationship between normative personality and personality disorders. More importantly, we review suggestions proposing the five-factor model (FFM) be used to diagnose personality disorders (PDs) and recent changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Our review suggests that as scientific understanding of personality progresses, practitioners will need to exercise evermore caution when choosing personality measures for use in selection systems. We conclude with six recommendations for applied psychologists when developing or choosing personality measures.

Hospital-onset bacteremia and fungemia (HOB), a potential measure of healthcare-associated infections, was evaluated in a pilot study among 60 patients across 3 hospitals. Two-thirds of all HOB events and half of nonskin commensal HOB events were judged as potentially preventable. Follow-up studies are needed to further develop this measure.