On the real-time prevention and monitoring of exertional heat illness in military personnel.

The proliferation of user-friendly low-cost wearable sensors has brought the concept of real-time physiological monitoring for exertional heat illness to the cusp of reality. This paper reviews and discusses the current state of the art in real-time physiological status monitoring for exertional heat illness mitigation within the military context. The review examines how both advanced sensor systems, models and algorithms are being combined in an international and collaborative way and how this is providing real solutions to military units to reduce the risk held by the commander. This paper provides additional detail into the process of integrating physiological status monitoring into military training, it explores the development of on-body sensors, the algorithms that can provide actionable information, the process of planning and dynamic risk assessment and describes some of the physiological monitoring systems that are currently being developed by the representative nations. It then discusses the knowledge gaps of how the technology will be integrated into military training, the importance of meaningful, accurate information that is both sensitive and specific and further developing the accuracy of the algorithms and models that are being employed. Finally, it talks about future direction and how individualizing physiological status monitoring can lead to performance enhancement in the form of individualized heat acclimatization programs. In conclusion, physiological status monitoring is at a stage of transition and integration where it can be used effectively to manage and reduce exertional heat illness to enable military personnel to train hard-train safe.

Brain Metastases: Insights from Statistical Modeling of Size Distribution.

BACKGROUND AND PURPOSE: Brain metastases are a common finding on brain MRI. However, the factors that dictate their size and distribution are incompletely understood. Our aim was to discover a statistical model that can account for the size distribution of parenchymal metastases in the brain as measured on contrast-enhanced MR imaging. MATERIALS AND METHODS: Tumor volumes were calculated on the basis of measured tumor diameters from contrast-enhanced T1-weighted spoiled gradient-echo images in 68 patients with untreated parenchymal metastatic disease. Tumor volumes were then placed in rank-order distributions and compared with 11 different statistical curve types. The resultant R 2 values to assess goodness of fit were calculated. The top 2 distributions were then compared using the likelihood ratio test, with resultant R values demonstrating the relative likelihood of these distributions accounting for the observed data. RESULTS: Thirty-nine of 68 cases best fit a power distribution (mean R 2 = 0.938 ± 0.050), 20 cases best fit an exponential distribution (mean R 2 = 0.957 ± 0.050), and the remaining cases were scattered among the remaining distributions. Likelihood ratio analysis revealed that 66 of 68 cases had a positive mean R value (1.596 ± 1.316), skewing toward a power law distribution. CONCLUSIONS: The size distributions of untreated brain metastases favor a power law distribution. This finding suggests that metastases do not exist in isolation, but rather as part of a complex system. Furthermore, these results suggest that there may be a relatively small number of underlying variables that substantially influence the behavior of these systems. The identification of these variables could have a profound effect on our understanding of these lesions and our ability to treat them.

Improving health communication with photographic images that increase identification in three minority populations.

The homophily principle, that perceived similarities among people produce positive reactions, is a cross-cultural, global phenomenon. This study aimed to test the prediction that photographs that depict models similar to the target population improve health communication by increasing perceived identification in three racial/ethnic populations. Three separate nationally representative stratified samples (n = 1638) of African American, Hispanic and Native American adults were drawn from GfK's Knowledge Panel�. Participants read a message advocating increased physical activity and improved diets and completed measures on behavioral intentions, outcome and self-efficacy expectations and identification. The message contained photographs from a stock photograph service or photographs created for the research project to match the three minority populations, Real Health Photos (RHP). Structural equation modeling confirmed the theoretical hypothesis that RHP which matched the minority population increased behavioral intentions and was mediated by identification (P < 0.05) in all three racial/ethnic minority samples. Messages with only half of the matched RHP images had these same positive indirect effects among African Americans and Hispanics (P < 0.05). The impact of matching visual images in health messages to recipients derived from identification with the characters in images. Homophily and identification are hardwired, evolutionary, biological phenomena that should be capitalized on health educators with minority populations.

Introduction of a Dedicated Emergency Department MR Imaging Scanner at the Barrow Neurological Institute.

Use of advanced imaging in the emergency department has been increasing in the United States during the past 2 decades. This trend has been most notable in CT, which has increased concern over the effects of increasing levels of medical ionizing radiation. MR imaging offers a safe, nonionizing alternative to CT and is diagnostically superior in many neurologic conditions encountered in the emergency department. Herein, we describe the process of developing and installing a dedicated MR imaging scanner in the Neuroscience Emergency Department at the Barrow Neurological Institute and its effects on neuroradiology and the emergency department in general.

Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative.

OBJECTIVE: Bone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS). METHODS: KIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks). RESULTS: Scoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87-0.92 vs 0.32-0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM -0.69, p=0.015), but not MOAKS (SRM -0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05). CONCLUSIONS: KIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers.

[Glycogenosis type IV (Andersen disease). Clinical data, pathology, and genetics in a fatal perinatal case]. / Glykogenose Typ IV (Andersen). Klinik, Pathologie und Genetik eines letalen perinatalen Falles.

Here we report the case of a newborn with glycogenosis type IV (Andersen disease), who died shortly after birth. The diagnosis was established in the first instance by light microscopy and histochemistry, and subsequently ultrastructurally. DNA could be extracted from a fibroblast cell culture by sequencing the causative GBE1 gene (glycogen branching enzyme 1). Two compound heterozygous mutations in the gene were identified. The differential diagnosis should include Lafora disease as well as polyglucosan body disease. Since there is no effective therapy for glycogenosis type IV to date, prenatal diagnosis is mandatory.

Long-term effects of language intensity in preventive messages on planned family solar protection.

A series of sun safety messages containing highly intense language and deductive logical style achieved the most immediate compliance by parents, particularly when they intended to improve protection. Inductive messages were more successful when no intentions existed (D. B. Buller, Borland, & Burgoon, 1998; D. B. Buller et al., 2000). Interviewers recontacted 568 parents during the winter following message dissemination and assessed solar protection. A 2 (language intensity) x 2 (logical style) x 3 (behavioral intention) x 2 (person) mixed-model analysis of variance showed that parents receiving high-intensity, deductive messages reported the most improved solar protection and improvement was greatest when parents intended to improve protection. Over the long term, high language intensity may reinforce decisions to take preventive action and does not appear to provoke psychological reactance or resistance to these highly directive messages.

Implementing a 5-a-day peer health educator program for public sector labor and trades employees.

Peer education in the Arizona 5-a-Day project achieved lasting improvements in fruit and vegetable intake among multicultural employees. Measures monitored implementation of peer education from peer educators' logs, the program's reach from employee surveys, and employees' use in terms of employees' dietary change. Peer educators logged 9,182 coworker contacts. Contacts averaged 10.9 minutes, according to coworkers. Coworkers read an average of 4.7 booklets and 2.23 newsletters. Many employees talked with peer educators (59%) and read materials (54%) after the program finished. Employee reports of peer educator contact were positively associated with fruit and vegetable intake. Peereducation was implemented as intended and reached many coworkers. It continued after program completion, reached into coworkers' families, and was used by employees to improve intake. This method can be used with employees who rely on informal sources and whose work presents barriers to wellness activities.

Using language intensity to increase the success of a family intervention to protect children from ultraviolet radiation: predictions from language expectancy theory.

BACKGROUND: Even though people are informed about skin cancer prevention, they do not always comply with prevention advice. From Language Expectancy Theory, it was predicted that messages with high language intensity would improve compliance with sun safety recommendations and that this effect would be enhanced with deductive argument style. METHODS: Parents (N = 841) from a pediatric clinic and elementary schools received sun safety messages (newsletters, brochures, tip cards) by mail that varied in language intensity and logical style. Effects on attitudes and behavior were tested in a pretest-posttest factorial design. RESULTS: As hypothesized, parents receiving messages with high- as opposed to low-intensity language complied more with sun safety advice. Messages with highly intense language were more persuasive when the arguments were formatted in a deductive style; low language intensity was more persuasive in inductively styled messages. CONCLUSIONS: By carefully adjusting messages features, health professionals can obtain further compliance beyond that produced by educating people about health risks and creating favorable attitudes and self-efficacy expectations. Highly intense language may be a good general strategy in prevention messages and works better when conclusions and recommendations are offered explicitly to recipients, especially when advice is aimed at reducing their personal risk.

Communication strategies for dietary change in a worksite peer educator intervention.

At the heart of peer health education programs is the assumption that tapping social networks increases adoption of behavior change, yet the communication strategies used by peer educators have not been previously documented to assess the use of social networks in promotion of health messages. Our program in public worksites trained peer health educators to utilize their social networks along with individual persuasive strategies to promote the 5 a Day for Better Health message (i.e. eat five or more servings of fruits and vegetables every day). Communication strategies utilized by the peer health educators were tracked via monthly focus groups over a 9 month intervention in 40 social networks of labor and trades employees. Audiotapes were transcribed and content analyzed to identify 10 communication strategies used by peer educators. Strategies were rated as enacted in an individual or a group (collective) context. Peer health educators were more likely to implement 'creating context' and 'role modeling' as group context change strategies, and 'encouragement' and 'responding to employee needs' as individual change strategies. Strategies used most frequently by males were 'mock competition', 'giving materials' and 'encouragement', while females used 'creating context' and 'keeping 5 a Day visible' most frequently. Hispanic peer health educators were more likely to use individual change strategies than their non-Hispanic counterparts. Documentation of the creative approaches utilized by lay educators among their peers can inform public health professionals on (1) how to better train outreach workers within various cultural, gender and social contexts, and (2) how to maximize social network effects.

Randomized trial testing the effect of peer education at increasing fruit and vegetable intake.

BACKGROUND: The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. METHODS: Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. RESULTS: By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P<.0001) and the food-frequency (increase of 0.46 total daily servings; P =.002) questions at the outcome survey. The effect on the total number of servings persisted at the 6-month follow-up survey when measured by the intake recall (increase of 0.41 total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total daily servings; P =.743) questions. CONCLUSIONS: Peer education appears to be an effective means of achieving an increase in fruit and vegetable intake among lower socioeconomic, multicultural adult employees.

Evaluation of the "Sunny Days, Healthy Ways" sun safety CD-ROM program for children in grades 4 and 5.

Computer-based sun safety instruction has many advantages that may be attractive to health educators in schools. An educational multimedia computer program on sun safety was produced on CD-ROM for children in grades 4 and 5, which was based on the "Sunny Days, Healthy Ways" sun safety curriculum (SDHW). Its effects on children's sun safety knowledge, attitudes and behaviour were evaluated with 162 students in 8 fourth and fifth grade classes in a randomized pretest-posttest 2 x 2 factorial design. Children interacting with the CD-ROM program showed significant improvements in knowledge (p = 0.007). The effect on knowledge may have indirectly improved children's sun protection (r = 0.201, p = 0.013), even though the CD-ROM program did not directly increase sun protection (p > .05) or improve attitudes (p > .05). The CD-ROM program may be a cost-effective and administratively acceptable sun safety instructional strategy, however, like many short prevention strategies, it will be most successful at conveying information on sun safety to children.

Telemetry pill measurement of core temperature in humans during active heating and cooling.

PURPOSE: This study compared the agreement between core temperature measurements obtained using an ingestible temperature pill telemetry system (Tpill) with those obtained from rectal (Tre) and esophageal (Tes) thermocouples under conditions of increasing and decreasing body temperature. METHODS: Four men and five women (age 25+/-2 yr, BSA 1.81+/-0.05 m2, VO2 peak 3.1+/-0.4 L x min[-1]) participated in four 3-h trials: cold (18 degrees C) water rest (CWR), cold water exercise (CWE), warm (36 degrees C) water rest (WWR), and warm water exercise (WWE). Subjects were immersed to the neck for each trial. During resting trials, subjects sat quietly. During exercise trials, subjects completed three bouts of 15 min of rest, followed by 45 min of exercise on a cycle ergometer at 50% of peak oxygen uptake. The temperature pill was taken 10-12 h before testing, after which the subjects fasted. RESULTS: The trials created conditions of constantly decreasing (CWR) or increasing (WWR) core temperature, as well as periods of oscillating core temperature (CWE and WWE). Root mean squared deviation (RMSD) was calculated for each pair of measurements (Tpill vs Tre, Tpill vs Tes, Tre vs Tes) for each trial. An RMSD of "0" indicates perfect agreement; as RMSD increases, agreement worsens. On CWR, the RMSD for Tpill-Tes (0.23+/-0.04) was lower (P < 0.05) than for Tpill-Tre (0.43+/-0.10) or Tre-Tes (0.46+/-0.09). There were no significant differences in RMSD between measurement pairs on any other trial (average RMSD = 0.26 degrees C). Telemetry pill temperature and response time tended to be intermediate between Tre and Tes. CONCLUSION: These results suggest the telemetry pill system provides a valid measurement of core temperature during conditions of decreasing as well as increasing body temperature and during steady state.

Sun Smart Day: a pilot program for photoprotection education.

Excessive exposure to the sun's ultraviolet radiation (UVR) contributes to the etiology of melanoma and nonmelanoma skin cancers. Many behaviors that increase lifetime risk of skin cancer--sun exposure, sunburn, and lack of sun protection--occur early in childhood. A 1-day school-based skin cancer prevention effort--Sun Smart Day--was implemented and evaluated in three elementary schools to improve fourth-graders' knowledge, attitudes, and behaviors related to skin cancer prevention. A classroom-based skin cancer prevention lesson was compared to an interactive sun safety fair was vehicles for promoting comprehensive photoprotection. Sun Smart Day interventions had their greatest impact on fourth-graders' awareness and knowledge of skin cancer and children's increased knowledge persisted through the summer break. While both the classroom curriculum and the health fair boosted awareness and knowledge of sun safety among fourth graders, the classroom curriculum demonstrated a slight immediate advantage over the health fair on these outcomes. Also the curriculum was less difficult to implement, but the health fair was more engaging. A Sun Smart Day program may be an important first step in increasing public awareness and understanding of skin cancer and its prevention.

Comparison of bailout versus elective stenting: time to reassess our benchmarks of outcome.

The aim of this study was to compare the clinical outcome of elective and bailout stenting in an era of improved stent deployment techniques and antithrombotic therapy. We retrospectively analysed 136 consecutive patients undergoing stent implantation over a 15 mo period. There was no significant difference in the follow-up duration, length of hospital stay, or the total incidence of major complications between the two groups. Bailout stenting, as compared to elective stenting, was not associated with an increased incidence of in-hospital (no death vs. 1.4%, 4.6% non-Q myocardial infarction vs. 0%, 7.7% vascular complications vs. 7.0%) or late complications (no death vs. 1.4%, no non-Q myocardial infarction vs. 2.8%, 3.1% repeat angioplasty vs. 5.6%, 1.5% coronary artery bypass surgery vs. 1.4%). Stents can be implanted in cases of failed angioplasty with a success rate similar to that of elective stent implantation with a low incidence of complications and equivalent clinical outcome.

A novel family of viral death effector domain-containing molecules that inhibit both CD-95- and tumor necrosis factor receptor-1-induced apoptosis.

Molluscum contagiosum virus proteins MC159 and MC160 and the equine herpesvirus 2 protein E8 share substantial homology to the death effector domain present in the adaptor molecule Fas-associated death domain protein (FADD) and the initiating death protease FADD-like interleukin-1beta-converting enzyme (FLICE) (caspase-8). FADD and FLICE participate in generating the death signal from both tumor necrosis factor receptor-1 (TNFR-1) and the CD-95 receptor. The flow of death signals from TNFR-1 occurs through the adaptor molecule tumor necrosis factor receptor-associated death domain protein (TRADD) to FADD to FLICE, whereas for CD-95 the receptor directly communicates with FADD and then FLICE. MC159 and E8 inhibited both TNFR-1- and CD-95-induced apoptosis as well as killing mediated by overexpression of the downstream adaptors TRADD and FADD. Neither viral molecule, however, inhibited FLICE-induced killing, consistent with an inhibitory action upstream of the active death protease. These data suggest the existence of a novel strategy employed by viruses to attenuate host immune killing mechanisms. Given that bovine herpesvirus 4 protein E1.1 and Kaposi's sarcoma associated-herpesvirus protein K13 also possess significant homology to the viral inhibitory molecules MC159, MC160, and E8, it may be that this class of proteins is used ubiquitously by viruses to evade host defense.

Sunny days, healthy ways: evaluation of a skin cancer prevention curriculum for elementary school-aged children.

BACKGROUND: Primary prevention of skin cancer must start early in life to reduce total life-time sun exposure and severe overexposure in childhood. Childhood is an excellent time to form life-long prevention habits. A school-based curriculum can be an effective prevention strategy. OBJECTIVE: Our purpose was to determine the effectiveness of a skin cancer prevention curriculum at increasing knowledge and attitudes supporting prevention and decreasing sun exposure by children in grades four, five, and six. METHODS: Twenty-four classes (N = 447 students) from four public elementary schools in southern Arizona participated. Half received a pretest, half were tested at the conclusion of the 5-week curriculum in early spring, and half were tested 8 weeks later in late spring. Objective measures of suntanning were obtained. RESULTS: The curriculum increased knowledge about skin cancer prevention and attitudes supporting prevention and decreased suntanning. Self-reported preventive behavior was inconsistent and only weakly associated with measures of suntanning. CONCLUSION: The curriculum was effective at increasing skin cancer prevention. Resulting reduction in sun exposure was superior to that achieved with previous prevention curricula. Change in attitude needed time to emerge, appearing after 8 weeks. Self-reported preventive behavior by children in elementary school may lack validity. Pretesting did not alter effectiveness. Sixth-graders may be ready for more advanced content, but the curriculum is probably too advanced for kindergarten through third grade.

Randomized, double-blinded, placebo-controlled study of effect of wheat bran fiber and calcium on fecal bile acids in patients with resected adenomatous colon polyps.

BACKGROUND: Ongoing epidemiologic and nutritional studies suggest that colorectal carcinogenesis is consistent with complex interactions between genetic susceptibility and environmental and dietary factors. Among the dietary components found to reduce colon cancer risk are high intakes of dietary fiber and calcium. PURPOSE: We designed and conducted a randomized, double-blinded, placebo-controlled trial involving supplementation of the customary dietary intake with fiber and calcium and measurements of fecal bile acids to examine the potential mechanisms by which added dietary interventions might reduce colorectal cancer risk. METHODS: In a randomized, double-blinded, phase II study, we used a factorial design to measure the effects of dietary wheat bran fiber (2.0 or 13.5 g/day) in the form of cereal and supplemental calcium carbonate (250 or 1500 mg/day elemental calcium) taken as a tablet on fecal bile acid concentrations and excretion rates. Measurements were made at base-line randomization (i.e., after a 3-month placebo run-in period using 2.0 g wheat bran fiber plus 250 mg calcium carbonate) and after 3 and 9 months on treatment in a randomly selected 52-patient subsample of the 95 fully assessable study participants who had a history of colon adenoma resection. Concentrations of fecal bile acids, total, primary (i.e., chenodeoxycholic and cholic), and secondary (i.e., deoxycholic, lithocholic, and ursodeoxycholic), were measured in 72-hour stool samples by gas-liquid chromatography. All P values resulted from two-sided tests. RESULTS: All geometric mean fecal bile acid concentrations and excretion rates were lower at 9 months than at 0 months or 3 months on treatment in the high-dose fiber, high-dose calcium, and high-dose fiber/high-dose calcium treatment groups. The high-dose fiber effect at 9 months of supplementation was statistically significant with respect to virtually all geometric mean fecal bile acid concentrations and excretion rates. For example at 9 months versus 0 months, high-dose fiber supplementation caused a reduction in fecal concentrations of total bile acids (52% reduction; P = .001) and deoxycholic acid (48% reduction; P = .003). High-dose calcium supplementation also had a significant, but lower, effect at 9 months versus 0 months on the geometric mean total bile acid (35% reduction; P = .044) and deoxycholic fecal bile acid (36% reduction; P = .052) concentrations. CONCLUSIONS: High-dose wheat bran fiber and calcium carbonate supplements given for 9 months are associated with statistically significant reductions in both total and secondary fecal bile acid concentrations and excretion rates in patients with resected colon adenomas. This study supports the hypothesis that one of the important ways in which a high intake of wheat bran fiber and calcium may reduce the risk of colorectal neoplasia and cancer is by reduction of the concentrations of fecal bile acids. IMPLICATION: Phase III studies of these agents in the prevention of adenoma recurrence are necessary to confirm this hypothesis and have now been initiated at multiple institutions.

Post-categorical processing and attenuation of the auditory suffix: evidence from both immediate and delayed suffixes.

Recall of the final item in a spoken list is impaired by the presentation of a spoken to-be-ignored item following the list. The nature of the processes responsible for the stimulus suffix effect (as well as its magnitude) can be varied by manipulating the intrinsic characteristics of the relationship between the final list (target) item and suffix. A series of experiments show that systematic manipulation of both typicality of same-category membership of target-item and suffix (Experiment 1), and degree of synonymity between target-item and suffix (Experiment 2) result in differential attenuation in the magnitude of the suffix effect. The effect of the synonymity manipulation persists for up to twenty seconds after the presentation of the target-item (Experiment 3). That post-categorical processing of the suffix occurs provides direct support for semantic coding in short-term memory and contradicts models arguing that short-term memory is organised according to the principle of physical similarity (e.g., LeCompte and Watkins, 1993).