Sickle cell disease: Wheeze or asthma?

Sickle cell disease (SCD) is the most common life-limiting genetic disease among African Americans, affecting more than 100,000 people in the United States. Respiratory disorders in patients with sickle cell disease have been associated with increased morbidity and mortality. Associations between asthma and pain, acute chest syndrome (ACS), and even death have long been reported. More recently wheezing, even in the absence of an asthma diagnosis, has gained attention as a possible marker of SCD severity. Several challenges exist with regards to making the diagnosis of asthma in patients with SCD, including the high prevalence of wheezing, evidence of airway obstruction on pulmonary function testing, and/or airway hyperresponsiveness among patients with SCD. These features often occur in isolation, in the absence of other clinical criteria necessary for an asthma diagnosis. In this review we will summarize: 1) Our current understanding of the epidemiology of asthma, wheezing, airway obstruction, and airway responsiveness among patients with SCD; 2) The evidence supporting associations with SCD morbidity; 3) Our understanding of the pathophysiology of airway inflammation in SCD; 4) Current approaches to diagnosis and management of asthma in SCD; and 5) Future directions

A mixed methods study of the factors that influence whether intervention research has policy and practice impacts: perceptions of Australian researchers

Objectives: To investigate researchers’ perceptions about the factors that influenced the policy and practice impacts (or lack of impact) of one of their own funded intervention research studies. Design: Mixed method, cross-sectional study. Setting: Intervention research conducted in Australia and funded by Australia’s National Health and Medical Research Council between 2003 and 2007. Participants: The chief investigators from 50 funded intervention research studies were interviewed to determine if their study had achieved policy and practice impacts, how and why these impacts had (or had not) occurred and the approach to dissemination they had employed. Results: We found that statistically significant intervention effects and publication of results influenced whether there were policy and practice impacts, along with factors related to the nature of the intervention itself, the researchers’ experience and connections, their dissemination and translation efforts, and the postresearch context. Conclusions: This study indicates that sophisticated approaches to intervention development, dissemination actions and translational efforts are actually widespread among experienced researches, and can achieve policy and practice impacts. However, it was the links between the intervention results, further dissemination actions by researchers and a variety of postresearch contextual factors that ultimately determined whether a study had policy and practice impacts. Given the complicated interplay between the various factors, there appears to be no simple formula for determining which intervention studies should be funded in order to achieve optimal policy and practice impacts

Tracking funded health intervention research

Objective: To describe the research publication outputs from intervention research funded by Australia’s National Health and Medical Research Council (NHMRC). Design and setting: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007. Main outcome measures: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables. Results: Most of the identified studies tested intervention efficacy or effectiveness in clinical or community settings, with few testing the later stages of intervention development, such as replication, adaptation or dissemination. Studies focused largely on chronic disease treatment and management, and encompassed various medical and allied health disciplines. Equal numbers of studies had interventions that produced statistically significant results on primary outcomes, (27) and those that did not (27). The mean number of total published articles per grant was 3.3, with 2.0 articles per grant focusing on results, and the remainder covering descriptive, exploratory or methodological aspects of intervention research. Conclusions: Our study provides a benchmark for the publication outputs of NHMRC-funded health intervention research in Australia. Research productivity is particularly important for intervention research, where findings are likely to have more immediate and direct applicability to health policy and practice. Tracking research outputs in this way provides information on whether current research investment patterns match the need for evidence about health care interventions

Evidence for a Vast Prograde Stellar Stream in the Solar Vicinity

Massive dwarf galaxies that merge with the Milky Way on prograde orbits can be dragged into the disk plane before being completely disrupted. Such mergers can contribute to an accreted stellar disk and a dark matter disk. Here we present Nyx, a vast stellar stream in the vicinity of the Sun, which provides the first indication that such an event occurred in the Milky Way. We identify about 200 stars that have coherent radial and prograde motion in this stream using a catalogue of accreted stars built by applying deep learning methods to the Gaia data. Taken together with chemical abundance and orbital information, these results strongly favour the interpretation that Nyx is the remnant of a disrupted dwarf galaxy. Further justified by FIRE hydrodynamic simulations, we demonstrate that prograde streams like Nyx can be found in the disk plane of galaxies and identified using our methods

Inclusive School Community: Why is it so Complex?

This paper addresses the question: why is it so hard for school communities to respond to diversity in learners, staff and parents in inclusive ways? The authors draw on theory and recent professional experience in Queensland, Australia, to offer four guiding principles that address traditional assumptions about learning that result in inequality of opportunity and outcomes for students. The authors suggest these principles to support the development of a more inclusive school community: (1) develop a learning community incorporating a critical friend; (2) value and collaborate with parents and the broader community; (3) engage students as citizens in school review and develop¬ment; and (4) support teachers’ critical engagement with inclusive ideals and practices. The authors describe how the principles can work in concert in a school community

A Theory of Challenge and Threat States in Athletes: a revised conceptualization

The Theory of Challenge and Threat States in Athletes (TCTSA) provides a psychophysiological framework for how athletes anticipate motivated performance situations. The purpose of this review is to discuss how research has addressed the 15 predictions made by the TCTSA, to evaluate the mechanisms underpinning the TCTSA in light of the research that has emerged in the last ten years, and to inform a revised TCTSA (TCTSA-R). There was support for many of the 15 predictions in the TCTSA, with two main areas for reflection identified; to understand the physiology of challenge and to re-evaluate the concept of resource appraisals. This re-evaluation informs the TCTSA-R which elucidates the physiological changes, predispositions, and cognitive appraisals that mark challenge and threat states. First, the relative strength of the sympathetic nervous system response is outlined as a determinant of challenge and threat patterns of reactivity and we suggest that oxytocin and neuropeptide Y are also key indicators of an adaptive approach to motivated performance situations and can facilitate a challenge state. Second, although predispositions were acknowledged within the TCTSA, how these may influence challenge and threat states was not specified. In the TCTSA-R it is proposed that one’s propensity to appraise stressors as a challenge that most strongly dictates acute cognitive appraisals. Third, in the TCTSA-R a more parsimonious integration of Lazarusian ideas of cognitive appraisal and challenge and threat is proposed. Given that an athlete can make both challenge and threat primary appraisals and can have both high or low resources compared to perceived demands, a 2x2 bifurcation theory of challenge and threat is proposed. This reflects polychotomy of four parts; high challenge, low challenge, low threat, and high threat. For example, in low threat, an athlete can evince a threat state but still perform well so long as they perceive high resources. Consequently, we propose suggestions for research concerning measurement tools and a reconsideration of resources to include social support. Finally, applied recommendations are made based on adjusting demands and enhancing resources.N/

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Towards Engineering Fair and Equitable Software Systems for Managing Low-Altitude Airspace Authorizations

Small Unmanned Aircraft Systems (sUAS) have gained widespread adoption across a diverse range of applications. This has introduced operational complexities within shared airspaces and an increase in reported incidents, raising safety concerns. In response, the U.S. Federal Aviation Administration (FAA) is developing a UAS Traffic Management (UTM) system to control access to airspace based on an sUAS's predicted ability to safely complete its mission. However, a fully automated system capable of swiftly approving or denying flight requests can be prone to bias and must consider safety, transparency, and fairness to diverse stakeholders. In this paper, we present an initial study that explores stakeholders' perspectives on factors that should be considered in an automated system. Results indicate flight characteristics and environmental conditions were perceived as most important but pilot and drone capabilities should also be considered. Further, several respondents indicated an aversion to any AI-supported automation, highlighting the need for full transparency in automated decision-making. Results provide a societal perspective on the challenges of automating UTM flight authorization decisions and help frame the ongoing design of a solution acceptable to the broader sUAS community