Aviation and the Microbiome

2020 ◽  
Vol 91 (8) ◽  
pp. 651-661
Author(s):  
Joshua T. Davis ◽  
Hilary A. Uyhelji
Keyword(s):  
Psychological Health ◽  
Aviation Safety ◽  
Autism Spectrum ◽  
Unintended Consequences ◽  
Microbial Colonization ◽  
Future Research ◽  
Aerospace Medicine ◽  
Medical Certification ◽  
Physical Disorders ◽  
The Impact

INTRODUCTION: Although the impact of microorganisms on their hosts has been investigated for decades, recent technological advances have permitted high-throughput studies of the collective microbial genomes colonizing a host or habitat, also known as the microbiome. This literature review presents an overview of microbiome research, with an emphasis on topics that have the potential for future applications to aviation safety. In humans, research is beginning to suggest relationships of the microbiome with physical disorders, including type 1 and type 2 diabetes mellitus, cardiovascular disease, and respiratory disease. The microbiome also has been associated with psychological health, including depression, anxiety, and the social complications that arise in autism spectrum disorders. Pharmaceuticals can alter microbiome diversity, and may lead to unintended consequences both short and long-term. As research strengthens understanding of the connections between the microbiota and human health, several potential applications for aerospace medicine and aviation safety emerge. For example, information derived from tests of the microbiota has potential future relevance for medical certification of pilots, accident investigation, and evaluation of fitness for duty in aerospace operations. Moreover, air travel may impact the microbiome of passengers and crew, including potential impacts on the spread of disease nationally and internationally. Construction, maintenance, and cleaning regimens that consider the potential for microbial colonization in airports and cabin environments may promote the health of travelers. Altogether, the mounting knowledge of microbiome effects on health presents several opportunities for future research into how and whether microbiome-based insights could be used to improve aviation safety.Davis JT, Uyhelji HA. Aviation and the microbiome. Aerosp Med Hum Perform. 2020; 91(8):651–661.

scholarly journals A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

2016 ◽  
Vol 25 (01) ◽  
pp. 13-29 ◽  
Author(s):  
J. Abraham ◽  
L. L. Novak ◽  
T. L. Reynolds ◽  
A. Gettinger ◽  
K. Zheng
Keyword(s):  
Information Technology ◽  
Time Series ◽  
Health Information Technology ◽  
Health Information ◽  
Unintended Consequences ◽  
Adverse Outcomes ◽  
Future Research ◽  
Health It ◽  
Recorded Data ◽  
The Impact

SummaryObjective: To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies.Method: Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development.Results: The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion: Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

Exploring the Effect of Disability, Race-Ethnicity, and Socioeconomic Status on Scores on the Self-Determination Inventory: Student Report

2018 ◽  
Vol 85 (1) ◽  
pp. 10-27 ◽  
Author(s):  
Karrie A. Shogren ◽  
Leslie A. Shaw ◽  
Sheida K. Raley ◽  
Michael L. Wehmeyer
Keyword(s):  
Socioeconomic Status ◽  
Best Practices ◽  
Interactive Effect ◽  
Autism Spectrum ◽  
The Self ◽  
Self Determination ◽  
Future Research ◽  
Assessment Development ◽  
Race Ethnicity ◽  
The Impact

The Self-Determination Inventory: Student Report (SDI:SR) was developed to address a need in the field for tools to assess self-determination that are aligned with current best practices in assessment development and administration, and emerging research and best practices in promoting self-determination. The present study explored patterns of differences in self-determination scores across students with and without disabilities (i.e., no disability, learning disabilities, intellectual disability, autism spectrum disorder, and other health impairments) of varying racial-ethnic backgrounds (i.e., White, African American or Black, Hispanic or Latino[a], and Other) as well as the impact of receiving free and reduced price lunch (as a proxy for socioeconomic status) on self-determination scores in these groups. Findings suggest an interactive effect of disability, race-ethnicity, and free and reduced price lunch status on self-determination scores. Implications for future research and practice are discussed.

Concept Analysis of Unintended Consequences

2018 ◽  
Vol 24 (2) ◽  
pp. 99-104
Author(s):  
Mykin Higbee
Keyword(s):  
Well Being ◽  
Concept Analysis ◽  
Unintended Consequences ◽  
Future Research ◽  
Model Case ◽  
Or Economics ◽  
Theoretical Application ◽  
Nursing Professionals ◽  
The Impact ◽  
Improve Health

The concept of unintended consequences is widely discussed in the realms of politics or economics, but not as frequently as related to health care. Nursing professionals act with the intent to improve health outcomes for patients; however, with every action, there are risks and consequences that may or may not be anticipated. This article utilizes a modified version of Walker and Avant’s framework for concept analysis (2011) to identify the characteristics, defining attributes, and antecedents of the concept of unintended consequences, present a model case and empirical referents, and provide a practical and theoretical application to nursing. Opportunities for future research related to the concept of unintended consequences include a closer study of nurses’ choices that may affect their well-being or productivity, as well as educational opportunities to better inform nurses of the impact unintended consequences may have on them and the care they provide.

scholarly journals The Immediate Effects of Deep Pressure on Young People with Autism and Severe Intellectual Difficulties: Demonstrating Individual Differences

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lana Bestbier ◽  
Tim I. Williams
Keyword(s):  
Young People ◽  
Psychological Health ◽  
Rating Scales ◽  
Evaluation Study ◽  
Autism Spectrum ◽  
Future Research ◽  
Open Label ◽  
Before And After ◽  
Response Measures ◽  
Deep Pressure

Background. Deep pressure is widely used by occupational therapists for people with autism spectrum disorders. There is limited research evaluating deep pressure. Objective. To evaluate the immediate effects of deep pressure on young people with autism and severe intellectual disabilities. Methods. Mood and behaviour were rated for 13 pupils with ASD and severe ID before and after deep pressure sessions. Results. Sufficient data was available from 8 participants to be analysed using Tau-U, a nonparametric technique that allows for serial dependence in data. Six showed benefits statistically. Five of these showed benefits across all domains, and one showed benefits on three out of five domains. Relevance to Clinical Practice. Deep pressure appears to be of immediate benefit to this population with autism and severe ID, but the heterogeneity of response suggests that careful monitoring of response should be used and deep pressure discontinued when it is no longer of benefit. Limitations. This is an open label evaluation study using rating scales. Recommendations for Future Research. Future studies of the use of deep pressure should use physiological response measures, in addition to blinded raters for aspects of behaviours such as attitude to learning psychological health not captured physiologically.

scholarly journals Employer costs of mental health claims and how psychologically healthy workplaces align with successful DM programs

2014 ◽  
Vol 9 ◽  
Author(s):  
Wendy Coduti
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Illness ◽  
Emotional Disorders ◽  
Psychological Health ◽  
Work Performance ◽  
The United States ◽  
Health Claims ◽  
Future Research ◽  
The Impact

Mental health (MH) and disability management (DM) businesses and DM professionals are proficient at addressing employee physical health, yet promoting employee MH is often ignored. Individuals claiming long-term disability (LTD), 85% identified MH conditions as their primary disability (Carls et al., 2012). Mental health LTD expenses are often higher due to longer recovery and challenges in return to work (Salkever, Goldman, Purushothaman, & Shinogle, 2000). Financial burdens of depression, anxiety, and emotional disorders are among the greatest of any disease condition in the workforce (Johnston et al., 2009). Globally, a fifth to a quarter of employees go to work everyday with a mental illness (Lorenzo-Romanella, 2011). Health care research has shown the impact of mental illness on work performance, however many employers and researchers are unaware of the value quality MH care has on employees and costs (Langlieb, & Kahn, 2005). The American Psychological Association (APA) identified five categories of workplace practices that promote psychological health in employees including: employee involvement; work-life balance; employee growth and development; health and safety; and employee recognition (APA, 2014). Organizational benefits of the five elements include: improved quality, performance and productivity; reduced absenteeism, presenteeism and turnover; fewer accidents and injuries; improved ability to attract and retain quality employees; improved customer service and satisfaction; and lower healthcare costs (APA, 2014). The presenters will discuss employer costs of MH claims and how psychologically healthy workplaces align with successful DM programs, decreasing MH claims and costs. Opportunities for future research include the United States Affordable Care Act (ACA) and its impact on MH (Mechanic, 2012) through provisions that encourage employers to adopt health promotion programs (Goetzel et al., 2012) and opportunities for research including comparisons of multinational employers regarding MH costs in countries with single payer systems, and in those without (United States), (Tanner, 2013).

scholarly journals Should we expect bilingualism to confer cognitive benefits in children with Autism Spectrum Disorders?

2020 ◽  
Author(s):  
Rachael Davis ◽  
Lewis Montgomery ◽  
Hugh Rabagliati ◽  
Antonella Sorace ◽  
Sue Fletcher-Watson
Keyword(s):  
Research Priorities ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Future Research ◽  
High Quality Research ◽  
Research Directions ◽  
Cognitive Benefits ◽  
Future Research Directions ◽  
The Impact

This article examines the ways in which bilingualism influences social and cognitive development and identifies intersections between corresponding aspects of autism, to inform future research directions. Three key domains are identified: social cognition; executive functions; and social-cultural factors. In each case we describe the evidence for the impact of bilingualism in typical development and map this onto what is known about the domain in autism. We examine the methodological quality of the existing literature to make recommendations for future approaches. Results suggest a dearth of high-quality research and lack of consensus. Research priorities include the need for innovative designs to explore potential impacts of bilingualism in order to increase the validity of the evidence base for caregivers and professionals.

scholarly journals The Role of Gut Microbiota and Gut–Brain Interplay in Selected Diseases of the Central Nervous System

2021 ◽  
Vol 22 (18) ◽  
pp. 10028
Author(s):  
Julia Doroszkiewicz ◽  
Magdalena Groblewska ◽  
Barbara Mroczko
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Gut Microbiota ◽  
Autism Spectrum ◽  
Future Research ◽  
Microbiota Composition ◽  
Parkinson’S Diseases ◽  
The Central Nervous System ◽  
The Impact ◽  
Gut Microbiota Composition

The gut microbiome has attracted increasing attention from researchers in recent years. The microbiota can have a specific and complex cross-talk with the host, particularly with the central nervous system (CNS), creating the so-called “gut–brain axis”. Communication between the gut, intestinal microbiota, and the brain involves the secretion of various metabolites such as short-chain fatty acids (SCFAs), structural components of bacteria, and signaling molecules. Moreover, an imbalance in the gut microbiota composition modulates the immune system and function of tissue barriers such as the blood–brain barrier (BBB). Therefore, the aim of this literature review is to describe how the gut–brain interplay may contribute to the development of various neurological disorders, combining the fields of gastroenterology and neuroscience. We present recent findings concerning the effect of the altered microbiota on neurodegeneration and neuroinflammation, including Alzheimer’s and Parkinson’s diseases, as well as multiple sclerosis. Moreover, the impact of the pathological shift in the microbiome on selected neuropsychological disorders, i.e., major depressive disorders (MDD) and autism spectrum disorder (ASD), is also discussed. Future research on the effect of balanced gut microbiota composition on the gut–brain axis would help to identify new potential opportunities for therapeutic interventions in the presented diseases.

scholarly journals Improving practice in safeguarding at the interface between hospital services and children’s social care: a mixed-methods case study

2015 ◽  
Vol 3 (4) ◽  
pp. 1-164 ◽  
Author(s):  
Susan White ◽  
David Wastell ◽  
Suzanne Smith ◽  
Christopher Hall ◽  
Emilie Whitaker ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Child Protection ◽  
Social Care ◽  
Research Programme ◽  
Unintended Consequences ◽  
Primary Site ◽  
Hospital Environment ◽  
Future Research ◽  
The Impact

BackgroundHospital settings have an important impact on children harmed by parents and carers. Concern arises from the capacity of these settings to respond effectively to individual needs despite increased NHS policy awareness and actions on safeguarding. Patient safety initiatives have rarely modelled in detail the social and cultural dynamics of child health settings and children’s safeguarding. This study is focused on supporting and evaluating clinician-led service design in an acute trust. A suite of initiatives and artefacts has been designed, based on sociotechnical principles, on the premise that only a thorough understanding of human, social and organisational challenges will afford effective solutions.ObjectivesThe study addresses the following primary question: ‘Can a safeguarding culture be designed within the hospital environment that will provide the conditions for the detection of children at risk of abuse and support protective actions before discharge, including collaboration with external agencies?’ Objectives include the development of a sociologically rich understanding of why diagnostic failures and communication breakdowns occur; the design of a suite of integrated interventions for promoting a positive safety culture, following a user-centred approach; and the evaluation of the effectiveness of this package, including its generalisability across sites.DesignThe study took place in two sites: the primary site where the initiatives were developed and a further site with the original intention of transferring developments. The investigation follows a broaddesign scienceapproach. The evaluation of a design intervention relies on a rigorous understanding of the realities of everyday practice, and the study thus draws on mixed methods to examine the impact of service redesign on cultures and practices.FindingsThe data suggest that safeguarding children can become mainstream patient safety business. Board support is vital. In our primary site, there has been a steady integration of learning from serious case reviews and other child protection-related processes with ‘patient safety’-related incidents, with growing recognition that similar systemic issues impact on both domains. Making use of a familiar vocabulary to redescribesafeguardingas asafetyissue, and thus as something fundamental to the functions of an acute hospital, has been part of the success. The data suggest that persistence, resilience and vigilance from the safeguarding leadership and executive teams are crucial. Current policy includes the development of the Child Protection Information Sharing project, which is intended to improve information flow between the NHS, particularly hospitals and children’s social care. The findings from this study suggest the importance of good design, piloting, incrementalism and a thorough empirical engagement with everyday practices during implementation of this and any future information systems based reform.ConclusionsSafeguarding takes place in a complex system and even minor changes within any part of that system can impact on the rest in unpredictable ways. It is important that managers adopt a ‘design attitude’ and seek to mitigate unintended consequences through careful experimentation. The findings suggest the need for the design of systems to enhance communication and not simply to ‘share information’. Technological solutions impact on everyday decision-making and can have unintended consequences. Attention to forces of change and stasis in health settings, the factors affecting technology transfer and the impact of the configuration of local authority services are suggested as a key priorities for future research.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Care Partners and Multiple Sclerosis

2015 ◽  
Vol 17 (6) ◽  
pp. 253-260 ◽  
Author(s):  
Tamara McKenzie ◽  
Mary Elizabeth Quig ◽  
Tuula Tyry ◽  
Ruth Ann Marrie ◽  
Gary Cutter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Caregiver Burden ◽  
Psychological Health ◽  
Well Being ◽  
Future Research ◽  
Online Questionnaire ◽  
Research Committee ◽  
Care Partners ◽  
Male Care ◽  
The Impact

Background: Caring for someone with multiple sclerosis (MS) can be a stressful experience that requires clinical attention. We investigated the impact of caregiver stress on the emotional well-being and physical health of the MS care partner using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods: Care partners of NARCOMS participants were invited to complete an online questionnaire that captured demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact of caregiving on employment. Results: Of 1446 care partners who agreed to participate, 1333 had complete data. Most were men (n = 825, 61.9%), with a mean (SD) age of 51.1 (11.2) years. The mean (SD) Zarit total score was 24.6 (15.1), placing the overall group in the mild caregiver burden range. Compared with male care partners, female care partners reported higher levels of burden and stress and more medication use for stress/anxiety and mood disorders. Male care partners were more likely to report physical concerns. Care partners of people with primary progressive MS reported greater perceived burden than did partners of people with secondary progressive MS and relapsing-remitting MS. More than 40% of care partners (559 of 1288) had missed work during the past year owing to caregiving responsibilities. Conclusions: Care partners of people with MS have substantial physical and psychological health concerns and experience an adverse impact on employment. Future research should evaluate how to mitigate the adverse effects of caregiving and evaluate positive aspects of the role.

scholarly journals Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029313 ◽  
Author(s):  
Dorothy McCaughan ◽  
Alison Booth ◽  
Cath Jackson ◽  
Simon Lalor ◽  
Gita Ramdharry ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Psychological Health ◽  
Neuromuscular Disorders ◽  
Well Being ◽  
Knee Instability ◽  
Future Research ◽  
Orthotic Devices ◽  
Patient Goals ◽  
Qualitative Interview Study ◽  
The Impact

ObjectivesAdults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes.DesignQualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using ‘Framework’.Setting and participantsA purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36–80 years).ResultsPatients’ medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively.ConclusionsOrthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects.Trial registration numberThis qualitative study was retrospectively registered as Current Controlled TrialsISRCTN65240228.

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