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Oklahoma City, OK, United States

Kratchounova D.,Civil Aerospace Medical Institute
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2016

Pilots’ awareness of the flight deck as a shared space is intrinsic and they interact with each other freely and naturally in it. However, these pilot-topilot interactions bear little resemblance to the pilot-aircraft interactions which are constrained within instrument panel areas where the majority of pilot interfaces currently reside. The inherent spatial characteristics of the flight deck afford the notion of an interspace. The interspace can be an environment where: (a) the pilots interact with technology in a multimodal fashion such that the actions in one modality complement, and collaborate the input from the others, producing a well-choreographed user experience; and (b) the spatial organization, temporal synchronization, and semantic collaboration of control input devices reflect the integration patterns characterizing people’s use of different modalities. Thus, the key to an effective design paradigm shift is contingent on successfully emulating these naturally occurring modality communication and cooperation patterns within the intended interspace. © Springer International Publishing Switzerland 2016.

Buriak S.E.,A.T. Still University | Potter J.,Harvard University | Potter J.,Beth Israel Deaconess Medical Center | Bleckley M.K.,Civil Aerospace Medical Institute
Journal of Continuing Education in the Health Professions | Year: 2015

Introduction: Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Methods: Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results: Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Discussion: Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Lewis R.J.,Civil Aerospace Medical Institute | Kemp P.M.,Civil Aerospace Medical Institute | Johnson R.D.,Forensic Chemistry And Toxicology Laboratory
Journal of Analytical Toxicology | Year: 2015

Paroxetine is a selective serotonin reuptake inhibitor commonly prescribed for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder. While the use of paroxetine is considered relatively safe, negative side effects, including nausea, drowsiness, insomnia and dizziness, can adversely affect a pilot's ability to safely operate an aircraft. The use of paroxetine may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for toxicological evaluation, a general understanding of drug distribution throughout postmortem specimens is important. This laboratory has determined the distribution of paroxetine in postmortem tissues and fluids from nine aviation accident fatalities. Specimens were processed using an n-butyl chloride liquid/liquid extraction followed by gas chromatographic/mass spectrometeric analysis. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 mg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was 1.67±1.16 urine (n = 4), 0.08±0.04 vitreous humor (n = 6), 5.77±1.37 liver (n = 8), 9.66±2.58 lung (n = 9), 1.44±0.57 kidney (n = 8), 3.80±0.69 spleen (n = 8), 0.15±0.04 muscle (n = 8), 4.27±2.64 brain (n = 7) and 1.05± 0.43 heart (n = 8). The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine can experience significant postmortem concentration changes. © The Author 2015.

Kupfer D.M.,Civil Aerospace Medical Institute | White V.L.,Civil Aerospace Medical Institute | Strayer D.L.,80 S. 1530 E. BEHS 502 | Crouch D.J.,Utah Toxicology Expert Services | Burian D.,Civil Aerospace Medical Institute
BMC Medical Genomics | Year: 2013

Background: As part of the civil aviation safety program to define the adverse effects of ethanol on flying performance, we performed a DNA microarray analysis of human whole blood samples from a five-time point study of subjects administered ethanol orally, followed by breathalyzer analysis, to monitor blood alcohol concentration (BAC) to discover significant gene expression changes in response to the ethanol exposure. Methods. Subjects were administered either orange juice or orange juice with ethanol. Blood samples were taken based on BAC and total RNA was isolated from PaxGene™ blood tubes. The amplified cDNA was used in microarray and quantitative real-time polymerase chain reaction (RT-qPCR) analyses to evaluate differential gene expression. Microarray data was analyzed in a pipeline fashion to summarize and normalize and the results evaluated for relative expression across time points with multiple methods. Candidate genes showing distinctive expression patterns in response to ethanol were clustered by pattern and further analyzed for related function, pathway membership and common transcription factor binding within and across clusters. RT-qPCR was used with representative genes to confirm relative transcript levels across time to those detected in microarrays. Results: Microarray analysis of samples representing 0%, 0.04%, 0.08%, return to 0.04%, and 0.02% wt/vol BAC showed that changes in gene expression could be detected across the time course. The expression changes were verified by qRT-PCR.The candidate genes of interest (GOI) identified from the microarray analysis and clustered by expression pattern across the five BAC points showed seven coordinately expressed groups. Analysis showed function-based networks, shared transcription factor binding sites and signaling pathways for members of the clusters. These include hematological functions, innate immunity and inflammation functions, metabolic functions expected of ethanol metabolism, and pancreatic and hepatic function. Five of the seven clusters showed links to the p38 MAPK pathway. Conclusions: The results of this study provide a first look at changing gene expression patterns in human blood during an acute rise in blood ethanol concentration and its depletion because of metabolism and excretion, and demonstrate that it is possible to detect changes in gene expression using total RNA isolated from whole blood. The analysis approach for this study serves as a workflow to investigate the biology linked to expression changes across a time course and from these changes, to identify target genes that could serve as biomarkers linked to pilot performance. © 2013 Kupfer et al.; licensee BioMed Central Ltd.

Lewis R.J.,Civil Aerospace Medical Institute | Angier M.K.,Civil Aerospace Medical Institute | Williamson K.S.,Civil Aerospace Medical Institute | Johnson R.D.,Forensic Chemistry And Toxicology Laboratory
Journal of Analytical Toxicology | Year: 2013

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder and post-traumatic stress disorder. Although the use of sertraline is relatively safe, certain side effects may negatively affect a pilot's performance and become a factor in an aviation accident. The authors' laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal aviation accident cases between 2001 and 2004. Eleven specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing gas chromatography-mass spectrometry. Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 mg/mL. The distribution coefficients of sertraline, expressed as specimen/blood ratio, were as follows: urine, 0.47±0.39 (n = 6); vitreous humor, 0.02±0.01 (n = 4); liver, 74±59 (n = 11); lung, 67±45 (n = 11); kidney, 7.4±5 (n = 11); spleen, 46±45 (n = 10); muscle, 2.1±1.3 (n = 8); brain, 22±14 (n = 10); heart, 9±7 (n = 11); and bile, 36±26 (n = 8). Postmortem distribution coefficients obtained for sertraline had coefficients of variation ranging from 47-99%. This study suggests that sertraline likely undergoes significant postmortem redistribution.

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