Migraine History and Recurrence in Military Pilot Applicants

BACKGROUND: Migraine is a common condition with features that can adversely impact aviation activities. The diagnosis of migraine is often compatible with civil aviation training, but is much more concerning for military pilot applicants. A history of migraine headache traditionally medically excluded potential military pilot applicants due to unpredictability of occurrence and potential for operational distraction or incapacitation. Medical standards and policy applications have been quite variable, ranging from total exclusion for even one headache occurrence to as low as a 1-yr migraine-free period before consideration. In many instances, policy application has been subjective and not based on objective evidence. This presents a challenge to waiver authorities and also potentially sends a mixed message to command authorities. There is essentially no current literature evidence applicable to the aviation population on migraine occurrence risk.METHODS: This study reviewed 71 U.S. Air Force pilot applicants who were diagnosed with migraine and had been granted waivers to assess any predictive factors for migraine recurrence and its aeromedical impact.RESULTS: Only three applicants had recurrence after waiver was granted, with two of these occurring within 2 yr of their last reported migraine event, and all recurrences noted within 3 yr.DISCUSSION: Data indicated favorable risk with suitable migraine-free observation before military pilot training, which could be incorporated into aeromedical standards and policies.Hesselbrock RR, Haynes JT. Migraine history and recurrence in military pilot applicants. Aerosp Med Hum Perform. 2020; 91(1):37–40.

Ethics of organ procurement from the unrepresented patient population

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act (RUAGA) of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion.

Conditions for Contingent Instructors Engaged in the Scholarship of Teaching and Learning

An increasingly large number of courses in Canadian postsecondary institutions are taught by contingent instructors who hold full- or part-time positions for contractually limited time periods. Despite strong commitments to advancing teaching and learning, the labour and employment conditions for contingent instructors affect the incentives and possibilities for them to engage in the scholarship of teaching and learning (SoTL). Through a collaborative writing inquiry, the 9 authors examine the influences of three key conditions of contingency: institutional knowledge, status, and role; invisibility and isolation; and precarity. Four composite stories demonstrate the ways varied conditions of contingency may play out in contingent instructors’ lives and typically undermine the possibilities for them to pursue SoTL. Institutions present contingent instructors with a mixed message: research and SoTL are desirable and frequently encouraged, yet contingent instructors are often ineligible or hindered from engagement. Dans les établissements d’enseignement post-secondaires canadiens, un nombre de plus en plus élevé de cours sont enseignés par des instructeurs occasionnels ayant des contrats à temps plein ou à temps partiel pour des périodes contractuelles limitées. Malgré les solides engagements pour l’avancement de l’enseignement et de l’apprentissage, les conditions de travail et d’emploi des instructeurs occasionnels affectent les motivations et les possibilités qui pourraient leur permettre de s’engager dans l’avancement des connaissances en enseignement et en apprentissage (ACEA). Grâce à une enquête menée en collaboration, les 9 auteurs examinent les influences de trois conditions clés de ces emplois occasionnels : connaissance institutionnelle, statut et rôle; invisibilité et isolement; et précarité. Quatre témoignages composés montrent les manières dont les conditions variées de ces emplois occasionnels peuvent jouer un rôle dans la vie des instructeurs occasionnels et comment cela affaiblit les possibilités auxquelles ils ont accès afin de poursuivre des activités en ACEA. Les établissements présentent la situation des instructeurs occasionnels avec un message mixte : la recherche et l’ACEA sont des activités désirables et fréquemment encouragées, toutefois les instructeurs occasionnels sont souvent empêchés de s’y engager ou inéligibles.

Addressing perceptions of opiate-using prisoners to take-home naloxone: findings from one English region

Purpose – The purpose of this paper is to understand prisoner perceptions on being trained and having received take-home naloxone (THN) kits once released from prison back into the community, in order to prevent an opiate-related overdose. Design/methodology/approach – A survey was run of all prisoners receiving THN training across ten prisons in one English region. In total, 142 prisoners were surveyed out of 206 (69 per cent) being trained in THN across the ten prisons. Five focus groups (n=26) with prisoners were conducted across four remand and one open prison that included discussions on THN within a range of topics. Discussions were recorded using short-hand and the data were subsequently thematically interpreted using visual mapping techniques. Findings – The survey highlighted a high degree of exposure amongst prisoners to overdose either directly (54 per cent) or having witnessed another person’s overdose (73 per cent). For prisoners who had overdosed, only a minority (38 per cent) were taken to hospital by an ambulance. In total, 81 per cent of prisoners surveyed also expressed little or no knowledge about THN prior to training. Prisoners were resistant to THN as an intervention resulting from this lack of prior knowledge. Focus group interviews suggested that there was a confused and mixed message in providing a harm reduction initiative within the context of recovery-orientated treatment. Prisoners also exhibited name confusion with other drugs (naltrexone) and there was some degree of resistance to being trained based on perceived side-effects brought on by its administration. Prisoners were also acutely aware of official agency perceptions (e.g. police) if seen to be in possession of THN kits. Practical implications – The distribution of THN within a custodial setting requires consideration of wider marketing approaches to address levels of confusion and misapprehension amongst prisoners. Originality/value – The study is one of the few focused on THN based on a UK prison environment.