Experiences and career intentions of combat-deployed UK military personnel.

Background: Most studies of the psychological impact of military deployment focus on the negative and traumatic aspects. Less is known about the full range of deployment experiences nor how these may impact on career intentions. Aims: To examine subjective operational experiences and career intentions in deployed UK military personnel using data gathered toward the end of an operational deployment. Methods: Data were gathered during deployment in Iraq and Afghanistan. A self-report survey collected data on sociodemographic, operational and military factors. Respondents provided their strength of agreement or disagreement with six potentially positive deployment experiences and their endorsement or rejection of six possible career intentions. Two mental health measures assessed symptoms of common mental disorder and post-traumatic stress disorder. Results: Responses were 681 in Iran 2009 (100% response rate); 1421 in Afghanistan in 2010 (100%), 1362 in 2011 (96%) and 860 in 2015 (91%). Five of the potentially positive outcomes were endorsed by >50% of the sample: confidence about remaining healthy after returning home, pride in accomplishments, increased confidence in abilities, improved unit cohesion and experiencing a positive life effect. Ninety per cent of respondents planned to continue in service after returning home. Fewer positive deployment experiences, poorer mental health, lesser unit cohesion and more negative impressions of leadership were significantly associated with intention to leave service. Conclusions: Contrary to the popular belief that UK military personnel deployed to Iraq or Afghanistan experience negative outcomes, this paper shows that deployment can be a positive experience for a substantial majority of deployed personnel.

Psychological morbidity during the 2002 deployment to Afghanistan.

Questionnaires were completed by military personnel on arrival (n=1,696) in Kabul, Afghanistan and then again on departure (n=1,134). Analysis of the 113 personnel who completed both the arrivals and departures questionnaire revealed a lower alcohol use score after deployment (AUDIT mean difference (post-deployment - pre-deployment) = -0.39, 95% confidence interval (CI) = - 1.25 - +0.47) and no significant change to mental health (GHQ mean difference = 0.55, 95% CI = -0.07 - +1.17). An increase in psychosomatic symptoms (GHQ A mean difference = 0.22, 95% CI = -0.03 - +0.47) is considered to result from the adverse conditions, but it is not supported by other mental ill health markers. In conclusion, there appeared to be no negative effect on mental health from deployment to Afghanistan.

Evaluation of the effects of intravascular MR contrast media (gadolinium dendrimer) on 3D time of flight magnetic resonance angiography of the body.

The aims of this preliminary study were to establish the efficacy and minimum effective dose of TG(5)(FdDO3A)(52) gadolinium dendrimer for contrast-enhanced, three-dimensional (3D) time of flight (TOF) magnetic resonance angiography (MRA) of the body. In a dose ranging study in eight rabbits (Group A), each of two animals received 0.03; 0.02; 0.01; or 0.005 mmol/kg of the agent for 3D-TOF MRA of the pelvic circulation in the axial and coronal planes. An additional nine animals (Group B) received a dose of 0.02 mmol/kg for 3D-TOF MRA of the mediastinum, abdomen or of the lower limbs. Quantitative and qualitative analyses of the images from Group A demonstrated a dose-related reduction in saturation effects and improved visualization of vascular structures, with maximal augmentation of the contrast-to-noise ratio (CNR) at 0.03 mmol/kg. The dose of 0.02 mmol/kg was found to be the minimal effective dose at the three vascular regions.

Gynogenic lines of onion (Allium cepa L.): evidence of their homozygosity.

Haploid induction via gynogenesis offers the possibility of using doubled haploid (DH) inbred lines in onion breeding. A first DH line that originated from the open-pollinated (OP) cultivar 'Dorata di Parma' was obtained after overcoming difficulties associated with the haploidy of the regenerants. Spontaneous chromosome doubling occurs seldom in onion. The first DH line obtained was cloned and selfed to produce sufficient seeds for genetic studies. The homozygosity of the DH gynogenic line was revealed on the basis of the low standard deviations of the bulb traits polar diameter, shape index and weight with respect to those of the S1 line or the OP cultivar. In the DH line, moreover, segregation of RAPD and alpha esterase markers was not noted. Out of four primers revealing polymorphism at 16 ge-netic loci in the OP cultivar 'Dorata di Parma', none produced polymorphism in the DH gynogenic line. The Est-1 locus, homozygous in 22 plants (Est-1 (1/1) in 3 and Est-1 (2/2) in 19) and heterozygous (Est-1 (1/2)) in 11 plants of the OP cultivar, always carried the same alleles in the DH line. We also tested genetic stability during micropropagation of a second halpoid line obtained via gynogenesis from var. 'Senshyu Yellow'. Seventeen plants of this line were tested to detect changes occurring during the tissue culture process. Again no polymorphism was observed. The high genetic homogeneity observed in the two gynogenic lines of onion could be related to the absence of the callus phase during the gynogenic process.

Complication rates for the esophageal obturator airway and endotracheal tube in the prehospital setting.

PURPOSE: The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) and the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGTA) during the treatment of patients with prehospital cardiac arrest. METHODS: A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments. RESULTS: The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gastric tube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopharyngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively). CONCLUSIONS: The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use.(ABSTRACT TRUNCATED AT 250 WORDS)

The care management form.

The primary care physician and the continuing care unit administrator at Providence Center in Scarborough, ON collaborate with Bridget Campion, clinical ethicist at St. Joseph's Health Center in Toronto to describe a process and form that staff has developed to elicit and convey patient treatment preferences in long term care. Meant to be completed as soon after the patient's admission as possible, and subject to review and revision, the Care Management Form is one attempt to promote patient autonomy in long term care.

Change in survival from out-of-hospital cardiac arrest and its effect on coronary heart disease mortality, Minneapolis-St. Paul. The Minnesota Heart Survey.

Emergency medical services with advanced life support systems were implemented in the Minneapolis-St. Paul, Minnesota, area in the mid-1970s. To assess the impact of emergency medical services on coronary heart disease mortality, the authors reviewed ambulance records and hospital emergency room logs for possible out-of-hospital cardiac arrest cases in the period 1972-1982. Potential cases, and their survival to discharge, were validated by hospital record review and were checked against Minnesota death certificates for the year of cardiac arrest and the year following cardiac arrest. Age-adjusted rates of survival to 1 year after cardiac arrest (per 100,000 population) for survivors of out-of-hospital cardiac arrest aged 30-74 years increased significantly from 1972 to 1982 for men (1.8 vs. 11.7; p less than 0.00001) and for women (0.5 vs. 3.5; p less than 0.01). Coronary heart disease mortality rates declined in that period by 34.9% for men (from 527.5 per 100,000 to 343.3 per 100,000) and by 41.7% for women (from 168.6 per 100,000 to 98.3 per 100,000). The authors estimate that improved survival from out-of-hospital cardiac arrest contributed 5.4% (9.9 of 184.2) of the mortality decline for men and 4.3% (3.0 of 70.3) of the decline for women. This was a significant contribution to the decline in coronary heart disease mortality, but it explains only a small part of it.

Presence of fucosylated triantennary, tetraantennary and pentaantennary glycans in transferrin synthesized by the human hepatocarcinoma cell line Hep G2.

Transferrin synthesized by a human hepatocellular carcinoma cell line Hep G2 (called Hep G2 transferrin) was purified from culture media by immunoaffinity chromatography on a rabbit anti-(human serotransferrin) IgG column. The eluted transferrin was then resolved into five peaks on a cation-exchange column using the fast protein liquid chromatography system. The major fraction, named Hep G2 transferrin fraction C, having a molecular mass of 82.5 kDa was found to be homogeneous in polyacrylamide gel electrophoresis and in concanavalin-A-affinity crossed immunoelectrophoresis. A comparative analysis of the molar carbohydrate composition of normal human serotransferrin and of Hep G2 transferrin fraction C shows an increase in the latter in the number of galactose and N-acetylglucosamine residues and in the presence of fucose, which is absent in normal transferrin. By a combination of methylation analysis and NMR spectroscopy, the primary structure of the oligosaccharide alditols released from Hep G2 transferrin fraction C by reductive alkaline cleavage has been established as triantennary, tetraantennary and pentaantennary N-acetyllactosaminic structures with fucose residues (alpha 1-3)-linked to peripheral N-acetylglucosamine residues. These results indicate that the increase in the number of antennae in transferrin glycans synthesized by the hepatocarcinoma cell line is much more pronounced than in liver diseases such as alcoholic cirrhosis and that, in addition, the malignant transformation of human liver induces the presence of fucose.

Physiological significance of the marked increased branching of the glycans of human serotransferrin during pregnancy.

Human serotransferrin (Tf) presents a microheterogeneity based on the existence of biantennary and triantennary glycans of the N-acetyl-lactosaminic type. By affinity chromatography on a concanavalin A-Sepharose column in well-defined conditions, human serotransferrin isolated from healthy donors was resolved into three carbohydrate molecular variants: Tf-I (less than 1%), Tf-II (17 +/- 2%) and Tf-III (82 +/- 3%) containing two triantennary glycans, one triantennary and one biantennary glycans and two biantennary glycans respectively. In addition, two 'isomers' of the triantennary glycans containing the third antenna beta-1,4-linked to the alpha-1,3-mannose residue or beta-1,6-linked to the alpha-1,6-mannose residue were characterized by methylation analysis in the ratio 1:1 in both Tf-I and Tf-II variants. On concanavalin A crossed immuno-affinity electrophoresis, the patterns exhibited by each of the three purified variants or by a mixture of these variants were compared with the patterns given by transferrin present in sera from nonpregnant and pregnant women. The results suggest that the relative proportions of transferrin carbohydrate variants was unchanged when the concentration of transferrin was increased in serum from normal donors, whereas in the serum of pregnant women, especially in the last 3 months of pregnancy, when the serum concentration of transferrin reached 4.5-5 g/l, the relative proportions of the carbohydrate variants Tf-I and Tf-II increased from 1 to 6 +/- 1% and from 17 +/- 2 to 26 +/- 3% respectively while that of Tf-III decreased from 82 +/- 3 to 67 +/- 3%. The binding of the three transferrin carbohydrate variants to the receptor of the syncytiotrophoblast plasma membranes was determined by using Scatchard-plot analysis. The number of binding sites remained constant with an increase in the number of triantennary glycans whereas a decrease up to 6-fold in the affinity constant was observed. Detection of the transferrin-receptor complex by immunoblotting in the presence of non-dissociating detergents revealed the existence of only one type of receptor or of a receptor possessing similar properties involved in the binding of each of the three serotransferrin carbohydrate variants.

Hepatitis B vaccine and hepatitis B markers: cost effectiveness of screening prehospital personnel.

The purpose of this study was to evaluate the cost effectiveness of screening emergency medical technicians (EMTs) and paramedical personnel prior to administering hepatitis B vaccine. Hepatitis B screening and Heptavax vaccine were offered to 259 basic EMTs and paramedics. Of the 259 individuals, 62 refused screening, and six who had already received hepatitis B vaccine were excluded from the study. The screening was not continued after the results of the first 174 tests returned negative. All 191 participants were vaccinated. No hepatitis B surface antigen carriers and only three individuals positive for hepatitis B surface antibody were found among those screened. This study corroborates the Centers for Disease Control guidelines of cost effectiveness in screening prehospital health care workers.

Esophageal gastric tube airway vs endotracheal tube in prehospital cardiopulmonary arrest.

We evaluated the efficacy of the esophageal airway (EA) by prospectively randomizing 175 prehospital cardiopulmonary arrest patients to receive either an esophageal gastric tube airway (EGTA) or an endotracheal tube (ET). If attempts with the initial airway failed, the alternate airway was attempted. The cost of training paramedics in EA use was considerably less than the ET ($80 vs $1,000). Survival to the emergency room, to hospitalization and to discharge in ET and EGTA groups were 64.4 percent, 25.6 percent, 11.1 percent, and 54.1 percent, 27.1 percent, 12.9 percent, respectively--differences not statistically significant. The incidence of neurologic residual (ET 50 percent, EGTA 36.4 percent) and congestive heart failure (ET 40 percent, EGTA 45.5 percent) in surviving ET and EGTA patients did not differ (NS). An additional 125 consecutive patients with only the opportunity to receive an EA were also evaluated and did not differ in mortality, neurologic residual, or congestive heart failure from ET patients. We conclude that the EA is a satisfactory alternative to the ET for short-term prehospital use in cardiopulmonary arrest patients.

Alcohol-related acute atrial fibrillation. A case-control study and review of 40 patients.

Heavy alcohol use has been suspected to cause acute atrial fibrillation, but an association between these two common problems has never been demonstrated. We retrospectively reviewed 64 cases with idiopathic acute atrial fibrillation and 64 age- and sex-matched controls, randomly selected from among general medical admissions. Sixty-two percent of cases and 33% of controls had documentation as heavy users of alcohol. Furthermore, patients with alcohol-related atrial fibrillation were significantly more likely to manifest alcohol withdrawal syndrome than were other inpatients with heavy alcohol use. Patients with alcohol-related acute atrial fibrillation were not different from other patients with acute atrial fibrillation with respect to clinical evidence of congestive heart failure, electrocardiographic abnormalities, cardiomegaly, electrolyte disturbance, or response to therapy. Heavy alcohol use is an important potential etiology for acute atrial fibrillation; alcohol withdrawal may represent a particular risk for such alcohol-related atrial fibrillation.

Feasibility of simulating physicians' judgments of patient severity.

This article reports on adopting Gustafson's multiattribute utility method to develop a specific momentary severity index (vis-à-vis severity over time) for nontraumatic chest pain patients. A panel of physicians identified an appropriate set of indicators for the index. Three mathematic models were generated on the basis of these indicators with each model predicting no less than 81% of the variance in overall scores of 96 simulated patients with chest pain. High interrater reliability (0.94) was demonstrated. Congruent validity coefficients between the three model scores and the overall scores vary between 0.71 and 0.92 depending on how the panel physicians are grouped. Results indicate the feasibility of simulating physician judgments regarding patient severity in chest-pain-related cases.

Medical complications of cardiopulmonary arrest.

The clinical courses of 63 survivors of cardiopulmonary arrest were reviewed to determine the incidence and temporal occurrence of noncardiac complications and their relationships to mortality. Complications were grouped as occurring within 48 hours or less, within 48 to 96 hours, or more than 96 hours after cardiopulmonary arrest. Pneumonia, electrolyte level disturbances, and gastrointestinal tract hemorrhage each occurred in more than 28 (45%) of the 63 patients. Resuscitation-related injuries, seizures, and liver function test abnormalities each occurred in at least 18 (28%) of the 63 patients. Pneumonia and liver function test abnormalities were each significantly correlated with increased mortality. Septicemia, acute renal failure, and adult respiratory distress syndrome each occurred in three (5%) to four (7%) of the 63 patients and were always associated with mortality.