Stressful experiences affect biological stress systems, such as the hypothalamic–pituitary–adrenal (HPA) axis. Life stress can potentially alter regulation of the HPA axis and has been associated with poorer physical and mental health. Little, however, is known about the relative influence of stressors that are encountered at different developmental periods on acute stress reactions in adulthood. In this study, we explored three models of the influence of stress exposure on cortisol reactivity to a modified version of the Trier Social Stress Test (TSST) by leveraging 37 years of longitudinal data in a high-risk birth cohort (N = 112). The cumulative stress model suggests that accumulated stress across the lifespan leads to dysregulated reactivity, whereas the biological embedding model implicates early childhood as a critical period. The sensitization model assumes that dysregulation should only occur when stress is high in both early childhood and concurrently. All of the models predicted altered reactivity, but do not anticipate its exact form. We found support for both cumulative and biological embedding effects. However, when pitted against each other, early life stress predicted more blunted cortisol responses at age 37 over and above cumulative life stress. Additional analyses revealed that stress exposure in middle childhood also predicted more blunted cortisol reactivity.

The aim of this research was to look at the emergence of wearable technology and the internet of things (IoT) and their current and potential use in the health and care area. There is a wide and ever-expanding range of wearables, devices, apps, data aggregators and platforms allowing the measurement, tracking and aggregation of a multitude of health and lifestyle measures, information and behaviours. The use and application of such technology and the corresponding richness of data that it can provide bring the health and care insurance market both potential opportunities and challenges. Insurers across a range of fields are already engaging with this type of technology in their proposition designs in areas such as customer engagement, marketing and underwriting. However, it seems like we are just at the start of the journey, on a learning curve to find the optimal practical applications of such technology with many aspects as yet untried, tested or indeed backed up with quantifiable evidence. It is clear though that technology is only part of the solution, on its own it will not engage or change behaviours and insurers will need to consider this in terms of implementation and goals. In the first weeks of forming this working party, it became evident that the potential scope of this technology, the information already out there and the pace of development of it, is almost overwhelming. With many yet-unanswered questions the paper focuses on pulling together in one place relevant information for the consideration of the health and care actuary, and also to open the reader’s eyes to potential future innovations by drawing on use of the technology in other markets and spheres, and the “science fiction–like” new technology that is just around the corner. The paper explores:

• an overview of wearables and IoT and available measures,

• examples of how this technology is currently being used,

• data considerations,

• risks and challenges,

• future technology developments and

• what this may mean for the future of insurance.

Pressure ridges impact the mass, energy and momentum budgets of the sea-ice cover and present an obstacle to transportation through ice-infested waters. Quantifying ridge characteristics is important for understanding total sea-ice mass and for improving the representation of sea-ice dynamics in high-resolution models. Multi-sensor measurements collected during annual Operation IceBridge (OIB) airborne surveys of the Arctic provide new opportunities to assess the sea ice at the end of winter. We present a new methodology to derive ridge sail height from high-resolution OIB Digital Mapping System (DMS) visible imagery. We assess the efficacy of the methodology by mapping the full sail height distribution along 12 pressure ridges in the western and central Arctic. Comparisons against coincident Airborne Topographic Mapper (ATM) elevation anomalies are used to demonstrate the methodology and evaluate DMS-derived sail heights. Sail heights and elevation anomalies were correlated at 0.81 or above. On average mean and maximum sail height agreed with ATM elevation to within 0.11 and 0.49 m, respectively. Of the ridges mapped, mean sail height ranged from 0.99 to 2.16 m, while maximum sail height ranged from 2.1 to 4.8 m. DMS also delivered higher sampling along ridge crests than coincident ATM data.

The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.

Introduction: Canadian stroke best practice guidelines recommend patients suspected of Acute Cerebrovascular Syndrome (ACVS) receive urgent brain imaging, preferably CTA. Yet, high requisition rates for non-ACVS patients overburdens limited radiological resources. We hypothesize that our clinical prediction rule (CPR) previously developed for diagnosis of ACVS in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. Methods: Our data consists of records for 1978 ED-referred patients to our TIA clinic in Victoria, BC from 2015-2016. Clinic referral forms captured all data needed for the CPR. For patients who received CTA, orders were placed in the ED or at the TIA clinic upon arrival. We use McNemar’s test to compare the sensitivity (sens) and specificity (spec) of our CPR vs. the baseline CTA orders for identifying ACVS. Results: Our sample (49.5% male, 60.6% ACVS) has a mean age of 70.9±13.6 yrs. Clinicians ordered 1190 CTAs (baseline) for these patients (60%). Where CTA was ordered, 65% of patients (n=768) were diagnosed as ACVS. To evaluate our CPR, predicted probabilities of ACVS were computed using the ED referral data. Those patients with probabilities greater than the decision threshold and presenting with at least one focal neurological deficit clinically symptomatic of ACVS were flagged as would have received a CTA. Our CPR would have ordered 1208 CTAs (vs. 1190 baseline). Where CTA would have been ordered, 74% of patients (n=893) had an ACVS diagnosis. This is a significantly improved performance over baseline (sens 74.5% vs. 64.1%, p<0.001; spec 59.6% vs. 45.9%, p<0.001). Specifically, the CPR would have ordered an additional 18 CTAs over the 2-yr period, while simultaneously increasing the number of imaged-ACVS patients by 125 with imaging 107 fewer non-ACVS patients. Conclusion: Using ED physician referral data, our CPR demonstrates significantly higher sensitivity and specificity for CTA imaging of ACVS patients than baseline CTA utilization. Moreover, our CPR would assist ED physicians to apply and practice the Canadian stroke best practice guidelines. ED physician use of our CPR would increase the number of ACVS patients receiving CTA imaging before ED discharge (rather than later at TIA clinics), and ultimately reduce the burden of false-positives on radiological departments.

Introduction/Innovation Concept: In 2014, Eastern Ontario paramedic services, their medical director staff and area community colleges developed an EMS Boot Camp experience to orient Queen’s University and the University of Ottawa emergency medicine residents to the role of paramedics and the challenges they face in the field. Current EMS ride-alongs and didactic classroom sessions were deemed ineffective at adequately preparing residents to provide online medical control. From those early discussions came the creation of a real-world, real-time (RWRT) educational experience. Methods: Specific challenges unique to paramedicine are difficult to communicate to a medical control physician at the other end of a telephone. The goal of this one-day educational experience is for residents to gain insight into the complexity and time sensitive nature of delivering medical care in the field. Residents are immersed as responding paramedics in a day of intense RWRT simulation exercises reflecting the common paramedic logistical challenges to delivering patient care in an uncontrolled and dynamic environment. Curriculum, Tool, or Material: Scenarios, run by paramedic students, are overseen by working paramedics from participating paramedic services. Residents learn proper use of key equipment found on an Ontario ambulance while familiarize themselves with patient care standards and medical directives. Scenarios focus on prehospital-specific clinical care issues; performing dynamic CPR in a moving vehicle, extricating a bariatric patient with limited personnel, large scale multi-casualty triage as well as other time sensitive, high risk procedures requiring online medical control approval (i.e. chest needle thoracostomy). Conclusion: EMS Boot Camp dispels preconceived biases regarding “what it’s really like” to deliver high quality prehospital clinical care. When providing online medical control in the future, the residents will be primed to understand and expect certain challenges that may arise. The educational experience fosters collaboration between prehospital and hospital-based providers. The sessions provide a reproducible, standardized experience for all participants; something that cannot be guaranteed with traditional EMS ride-alongs. Future sessions will evaluate participant satisfaction and self-efficacy with the use of a standard evaluation form including pre/post self-evaluations.