Identifying organ donors attended by prehospital healthcare professionals - A scoping review.

INTRODUCTION: Organ donation is a life-saving intervention that provides hope for patients with end-stage organ failure, improving their longevity and quality of life. However, the demand for organs far exceeds the supply, leading to a significant disparity between patients on transplant waiting lists and the availability of suitable organs. To address this issue, innovative strategies, such as uncontrolled donation after circulatory death (uDCD) programs, have been proposed to expand the donor pool to the prehospital setting. AIM: This study aimed to systematically map the literature and comprehensively evaluate the involvement of prehospital healthcare professionals in identifying potential organ donors, as well as the barriers and systems impacting this process. METHODS: A scoping literature review was conducted guided by the PRISMA Extension for Scoping Reviews. Four electronic databases and grey literature were searched for articles examining the participation of prehospital healthcare professionals in the organ or tissue donation process. Relevant data were extracted, organised into narrative and tabular formats, and presented. RESULTS: A total of 33 articles were included for analysis, predominantly focusing on uDCD programs. The review identified a limited evidence-base regarding the role of prehospital healthcare professionals in organ donation. Four common themes emerged: discrepancies in criteria, decision-making processes, bridging strategies, and ethical considerations. CONCLUSION: This scoping literature review highlights the significant role of prehospital healthcare professionals in identifying and recruiting organ donors from non-traditional settings. Established uDCD systems show promise in alleviating the burden on transplant waitlists. However, there is a lack of consensus on enrolment criteria, transportation, and ethical considerations for uDCD. Further research is needed to address these gaps, establish evidence-based guidelines, and ensure the efficient and ethical utilisation of potential organ donors from unconventional settings.

Submarine medicine: An overview of the unique challenges, medical concerns, and gaps.

Submariners face many challenges. For example, they "live where they work" and can be called to duty anytime. They have limited access to open space, natural settings, fresh air, fresh food, sunlight, privacy, exercise, and outside communication. They support a wider range of missions than occur aboard most other Navy vessels. At sea or on shore, submariners work long hours under conditions with little margin for error. They may traverse remote or disputed areas of the ocean far from rescue assets, and must remain vigilant for potential encounters with hostile forces, onboard fires, anomalies in the breathing atmosphere, leaks, undersea collisions, or radiation exposures. If any of these factors cause casualties, the Independent Duty Corpsman (with intermittent advice from shore-based medical personnel), must be ready to provide aid as long as necessary. The challenges of submarine service led to the growth of the unique field of submarine medicine, which has maintained an excellent record of health and safety. This review introduces the field of submarine medicine as practiced in the U.S. Navy, describing its major concerns, giving an overview of the operation of a submarine medical department, and identifying several medical gaps that researchers are working to fill. Submarine medicine already has a stellar record in terms of radiation and atmospheric safety and has made strides in fatigue management. Ongoing work will deliver improved psychological screening and support tools. This report summarizes developments in these and other areas of submarine medicine.

Motion sickness diagnostic criteria: Consensus Document of the Classification Committee of the Bárány Society.

We present diagnostic criteria for motion sickness, visually induced motion sickness (VIMS), motion sickness disorder (MSD), and VIMS disorder (VIMSD) to be included in the International Classification of Vestibular Disorders. Motion sickness and VIMS are normal physiological responses that can be elicited in almost all people, but susceptibility and severity can be high enough for the response to be considered a disorder in some cases. This report provides guidelines for evaluating signs and symptoms caused by physical motion or visual motion and for diagnosing an individual as having a response that is severe enough to constitute a disorder.   The diagnostic criteria for motion sickness and VIMS include adverse reactions elicited during exposure to physical motion or visual motion leading to observable signs or symptoms of greater than minimal severity in the following domains: nausea and/or gastrointestinal disturbance, thermoregulatory disruption, alterations in arousal, dizziness and/or vertigo, headache and/or ocular strain. These signs and/or symptoms occur during the motion exposure, build as the exposure is prolonged, and eventually stop after the motion ends. Motion sickness disorder and VIMSD are diagnosed when recurrent episodes of motion sickness or VIMS are reliably triggered by the same or similar stimuli, severity does not significantly decrease after repeated exposure, and signs/symptoms lead to activity modification, avoidance behavior, or aversive emotional responses.   Motion sickness/MSD and VIMS/VIMSD can occur separately or together. Severity of symptoms in reaction to physical motion or visual motion stimuli varies widely and can change within an individual due to aging, adaptation, and comorbid disorders. We discuss the main methods for measuring motion sickness symptoms, the situations conducive to motion sickness and VIMS, and the individual traits associated with increased susceptibility. These additional considerations will improve diagnosis by fostering accurate measurement and understanding of the situational and personal factors associated with MSD and VIMSD.

Computerized Tests of Team Performance and Crew Coordination Suitable for Military/Aviation Settings.

INTRODUCTION: The coordination of team effort on shared tasks is an area of inquiry. A number of tests of team performance in challenging environments have been developed without comparison or standardization. This article provides a systematic review of the most accessible and usable low-to-medium fidelity computerized tests of team performance and determines which are most applicable to military- and aviation-relevant research, such as studies of group command, control, communication, and crew coordination. METHODS: A search was conducted to identify computerized measures of team performance. In addition to extensive literature searches (DTIC, Psychinfo, PubMed), the authors reached out to team performance researchers at conferences and through electronic communication. RESULTS: Identified were 57 potential tests according to 6 specific selection criteria (e.g., the requirement for automated collection of team performance and coordination processes, the use of military-relevant scenarios). The following seven tests (listed alphabetically) were considered most suitable for military needs: Agent Enabled Decision Group Environment (AEDGE), C3Conflict, the C3 (Command, Control, & Communications) Interactive Task for Identifying Emerging Situations (NeoCITIES), Distributed Dynamic Decision Making (DDD), Duo Wondrous Original Method Basic Awareness/Airmanship Test (DuoWOMBAT), the Leader Development Simulator (LDS), and the Planning Task for Teams (PLATT). Strengths and weaknesses of these tests are described and recommendations offered to help researchers identify the test most suitable for their particular needs. DISCUSSION: Adoption of a few standard computerized test batteries to study team performance would facilitate the evaluation of interventions intended to enhance group performance in multiple challenging military and aerospace operational environments.Lawson BD, Britt TW, Kelley AM, Athy JR, Legan SM. Computerized tests of team performance and crew coordination suitable for military/aviation settings. Aerosp Med Hum Perform. 2017; 88(8):722-729.

The Neurovestibular Challenges of Astronauts and Balance Patients: Some Past Countermeasures and Two Alternative Approaches to Elicitation, Assessment and Mitigation.

Astronauts and vestibular patients face analogous challenges to orientation function due to adaptive exogenous (weightlessness-induced) or endogenous (pathology-induced) alterations in the processing of acceleration stimuli. Given some neurovestibular similarities between these challenges, both affected groups may benefit from shared research approaches and adaptation measurement/improvement strategies. This article reviews various past strategies and introduces two plausible ground-based approaches, the first of which is a method for eliciting and assessing vestibular adaptation-induced imbalance. Second, we review a strategy for mitigating imbalance associated with vestibular pathology and fostering readaptation. In discussing the first strategy (for imbalance assessment), we review a pilot study wherein imbalance was elicited (among healthy subjects) via an adaptive challenge that caused a temporary/reversible disruption. The surrogate vestibular deficit was caused by a brief period of movement-induced adaptation to an altered (rotating) gravitoinertial frame of reference. This elicited adaptation and caused imbalance when head movements were made after reentry into the normal (non-rotating) frame of reference. We also review a strategy for fall mitigation, viz., a prototype tactile sway feedback device for aiding balance/recovery after disruptions caused by vestibular pathology. We introduce the device and review a preliminary exploration of its effectiveness in aiding clinical balance rehabilitation (discussing the implications for healthy astronauts). Both strategies reviewed in this article represent cross-disciplinary research spin-offs: the ground-based vestibular challenge and tactile cueing display were derived from aeromedical research to benefit military aviators suffering from flight simulator-relevant aftereffects or inflight spatial disorientation, respectively. These strategies merit further evaluation using clinical and astronaut populations.

Military Occupations Most Affected by Head/Sensory Injuries and the Potential Job Impact of Those Injuries.

OBJECTIVE: Identifying Department of Defense (DoD) occupations affected by injuries to the head and sensory systems. METHODS: We explored the Defense Medical Epidemiology Database to identify occupations with the highest incidence of injured personnel, then ranked how frequently they occurred in a top 10 list for each of four injury categories (head/brain, visual, auditory, vestibular) encompassing 25 injury codes. Across all four categories, the most affected occupations were identified, among which we chose three Army combat-related military occupational specialties (MOSs) for detailed study. We identified skills needed to perform these MOSs and explored whether MOS-critical deficits could be expected following the injuries. RESULTS: Some DoD occupations are more likely to suffer from these injuries, including Infantry, Combat Operations Control, Artillery/Gunnery, Motor Vehicle Operator, Combat Engineering, and Armor/Amphibious. Within these DoD occupations, we explored three Army combatant MOSs: Infantry (11B), Cavalry Scout (19D), and Artillery (13B), confirming that these jobs are likely to be disrupted by injuries within the four categories. CONCLUSIONS: Head and sensory injuries disproportionately affect certain military occupations. Relatively few injuries disrupt combat-related abilities that are job critical (e.g., firearms operation) and job specific (e.g., Artillery gunnery problems); these should be the focus of efforts to improve rehabilitation and RTD outcomes.

Motion sickness and sopite syndrome associated with parabolic flights: a case report.

OBJECTIVE: The purpose of this paper was to provide an extensive description of a case of sopite syndrome, a manifestation of motion sickness scarcely described in the literature. DESIGN: The following questionnaires were used to assess sopite syndrome symptoms pre, during and post parabolic flight; Misery Scale rate, Positive and Negative Affect Scale, the Motion Sickness Assessment Questionnaire and the Epworth Sleepiness Scale. STUDY SAMPLE: Case report of a 35-year old female compared to a control group (n = 26). RESULTS: We describe of sopite syndrome during parabolic flight. The subject reported drowsiness and she noted mood changes such as irritation and annoyance. Furthermore, she was not able to perform her assigned task. Her symptoms escalated into extreme fatigue and the inability to stay awake. Nauseogenic symptoms improved, but soporific symptoms persisted for several hours after the motion stimulus (i.e. parabolic flight). CONCLUSIONS: This case points towards the need for controlled studies to assess the prevalence of this syndrome among the general population and select groups. Future research should focus on developing tests for personnel screening and explore treatment options.

Functional screening for vestibular and balance problems soon after head injury: options in development for the field or aid station.

Vestibular balance dysfunction has been documented as a military problem after duty-related barotrauma and/ or traumatic head acceleration. We are fostering the development of rapid, portable, fieldable tests of balance function after such vestibular insults. We consulted on military-relevant tests with more than 50 vestibular researchers, scientific advisors, clinicians, and biomedical engineers working for government agencies, universities, clinics, hospitals, or businesses. Screening tests and devices appropriate for early (post-injury) military functional assessment were considered. Based on these consultations, we recommend that military field tests emphasize dynamic, functional, and duty-relevant aspects of standing balance, gait, visual acuity, perception of visual vertical, and vertigo. While many current tests are useful for the clinic, they often require modification before they are suitable for military field and aid station settings. This report summarizes likely future military testing needs, giving priority to testing approaches in development that promise to be rapid, portable, fieldready, semiautomated, usable by a nonspecialist, and suitable during testing and rehabilitation.

Quantum oscillations in the topological superconductor candidate Cu(0.25)Bi2Se3.

Quantum oscillations are generally studied to resolve the electronic structure of topological insulators. In Cu(0.25)Bi(2)Se(3), the prime candidate of topological superconductors, quantum oscillations are still not observed in magnetotransport measurement. However, using torque magnetometry, quantum oscillations (the de Haas-van Alphen effect) were observed in Cu(0.25)Bi(2)Se(3). The doping of Cu in Bi(2)Se(3) increases the carrier density and the effective mass without increasing the scattering rate or decreasing the mean free path. In addition, the Fermi velocity remains the same in Cu(0.25)Bi(2)Se(3) as that in Bi(2)Se(3). Our results imply that the insertion of Cu does not change the band structure and that conduction electrons in Cu doped Bi(2)Se(3) sit in the linear Dirac-like band.

Using flight simulators aboard ships: human side effects of an optimal scenario with smooth seas.

INTRODUCTION: The U.S. Navy is considering placing flight simulators aboard ships. It is known that certain types of flight simulators can elicit motion adaptation syndrome (MAS), and also that certain types of ship motion can cause MAS. The goal of this study was to determine if using a flight simulator during ship motion would cause MAS, even when the simulator stimulus and the ship motion were both very mild. METHODS: All participants in this study completed three conditions. Condition 1 (Sim) entailed "flying" a personal computer-based flight simulator situated on land. Condition 2 (Ship) involved riding aboard a U.S. Navy Yard Patrol boat. Condition 3 (ShipSim) entailed "flying" a personal computer-based flight simulator while riding aboard a Yard Patrol boat. Before and after each condition, participants' balance and dynamic visual acuity were assessed. After each condition, participants filled out the Nausea Profile and the Simulator Sickness Questionnaire. RESULTS: Following exposure to a flight simulator aboard a ship, participants reported negligible symptoms of nausea and simulator sickness. However, participants exhibited a decrease in dynamic visual acuity after exposure to the flight simulator aboard ship (T[25] = 3.61, p < 0.05). Balance results were confounded by significant learning and, therefore, not interpretable. DISCUSSION: This study suggests that flight simulators can be used aboard ship. As a minimal safety precaution, these simulators should be used according to current safety practices for land-based simulators. Optimally, these simulators should be designed to minimize MAS, located near the ship's center of rotation and used when ship motion is not provocative.