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Barretstown Castle Holiday Camp for seriously ill children may have long-term beneficial effects on children with life-threatening illnesses. The presented evidence suggests that the experience is a contemporary rite of passage. The different stages of separation, transition and reaggregation can be identified. The separation from family and civil society is remarkably complete. Established norms no longer prevail in the transitional phase of liminality. Communitas and I-thou relationships become the mode of interaction. Barretstown added the dimension of Therapeutic Recreation to an American camp experience. The structured sequences of Therapeutic Recreation mediated by caras (councillors) encourage personal change. The Barretstown experience may be a life-enhancing ritual process and an important social experience in chronic severe childhood illnesses.

The European Union project of Single European Sky initiated a reorganization of European airspace and proposed additional measures for air traffic management to achieve the key objectives of improving efficiency and capacity while at the same time enhancing safety. The concept of multiple remote tower operation is that air traffic controllers (ATCOs) can control several airfields from a distant virtual control centre. The control of multiple airfields can be centralised to a virtual centre permitting the more efficient use of ATCO resources. This research was sponsored by the Single European Sky ATM Research Program and the ATM Operations Division of the Irish Aviation Authority. A safety case was developed for migration of multiple remote tower services to live operations. This research conducted 50 large scale demonstration trials of remote tower operations from single tower operations to multiple tower operations for safety assessment by air navigation safety regulators in 2016. A dedicated team of air traffic controllers and technology experts successfully completed the safety assessment of multiple remote tower operations in real time. The implementation of this innovative technology requires a careful balance between cost-efficiency and the safety of the air traffic control in terms of capacity and human performance. The live trial exercises demonstrated that the air traffic services provided by the remote tower for a single airport and two medium airports by a single ATCO with 'in sequence' and 'simultaneous' aircraft operation was at least as safe as provided by the local towers at Cork and Shannon aerodromes. No safety occurrence was reported nor did any operational safety issue arise during the conduct of the fifty live trial exercises.

AbstractThe nature of the current rotating roster, providing 24‐h air traffic services over five irregular shifts, leads to accumulated fatigue which impairs air traffic controllers' cognitive function and task performance. It is imperative to develop an effective fatigue risk management system to improve aviation safety based upon scientific approaches.Two empirical studies were conducted to address this issue. Study 1 investigated the mixed effect of circadian rhythm disorders and resource depletion on controllers' accumulated fatigue. Then, study 2 proposed a potential biofeedback solution of quick coherence technique which can mitigate air traffic controllers' (ATCOs') fatigue while on controller working position and improve ATCOs' mental/physical health.The current two‐studies demonstrated a scientific approach to fatigue analysis and fatigue risk mitigation in the air traffic services domain. This research offers insights into the fluctuation of ATCO fatigue levels and the influence of a numbers of factors related to circadian rhythm and resource depletion impact on fatigue levels on study 1; and provides psychophysiological coherence training to increase ATCOs' fatigue resilience to mitigate negative impacts of fatigue on study 2.Based on these two studies, the authors recommended that an extra short break for air traffic controllers to permit practicing the quick coherence breathing technique for 5 min at the sixth working hour could substantially recharge cognitive resources and increase fatigue resilience. Application: Present studies highlight an effective fatigue intervention based on objective biofeedback to moderate controllers' accumulated fatigue as a result of rotating shift work. Accordingly, air navigation services providers and regulators can develop fatigue risk management systems based on scientific approaches to improve aviation safety and air traffic controller's wellbeing.

AbstractFatigue is an inevitable hazard in the provision of air traffic services and it has the potential to degrade human performance leading to occurrences. The International Civil Aviation Organization (ICAO) requires air navigation services which providers establish fatigue risk management systems (FRMS) based on scientific principles for the purpose of managing fatigue. To develop effective FRMSs, it is important to investigate the relationship between traffic volume, air traffic management occurrences, and fatigue. Fifty‐seven qualified ATCOs from a European Air Navigation Services provider participated in this research by providing data indicating their alertness levels over the course of a 24‐hour period. ATCOs' fatigue data were compared against the total of 153 occurrences and 962,328 air traffic volumes from the Eurocontrol TOKAI incident database in 2019. The result demonstrated that ATCO fatigue levels are not the main contributory factor associated with air traffic management occurrences, although fatigue did impact ATCOs' performance. High traffic volume increases ATCO cognitive task load that can surpass available attention resources leading to occurrences. Furthermore, human resilience drives ATCOs to maintain operational safety though they suffer from circadian fatigue. Consequently, FRMS appropriately implemented can be used to mitigate the effects of fatigue. First‐line countermeasure strategies should focus on enough rest breaks and roster schedule optimization; secondary strategies should focus on monitoring ATCOs' task loads that may induce fatigue. It is vital to consider traffic volume and ATCOs' alertness levels when implementing effective fatigue risk management protocols.

To use medical devices rationally, health-care professionals must base their choices of which devices to recommend for individual patients on an objective appraisal of their safety and clinical efficacy. The evidence submitted by manufacturers when seeking approval of their high-risk devices must be publicly available, including technical performance and premarket clinical studies. Giving physicians access to this information supplements the peer-reviewed scientific literature and might be essential for comparing alternative devices within any class. Interested patients should be encouraged to review the evidence for any device that has been recommended for them. The new EU law on medical devices states that the manufacturer is to prepare a summary of the evidence for any implantable or high-risk device. Defining its content, however, has been delegated to implementing legislation, which is now being considered. From a clinical perspective, it is imperative that all evidence reviewed by notified bodies and regulatory authorities is disclosed—with the exception, if justified, only of technical specifications that are considered confidential or manufacturing details that are protected as intellectual property—and public access to this evidence must be guaranteed by EU law. From ethical and other perspectives, there are no grounds for less clinical evidence being available to health-care professionals about the medical devices that they use than is already available for new pharmaceutical products. Full transparency is needed; without it, informed decisions relating to the use of new medical devices will remain impossible.

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies' Task forces on CVD prevention in clinical practice.2 - 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat. ; Peer reviewed