Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service.

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.

The test-retest reliability of the Military Physical Loading Questionnaire (MPLQ).

INTRODUCTION: Despite the high prevalence of musculoskeletal injuries, there is a shortage of data quantifying the risk factors attributable to cumulative occupational demands among UK Military personnel. We developed a new comprehensive questionnaire that examines occupational and operational physical loading during military service. The aim of this study was to examine the test-retest reliability of the Military Physical Loading Questionnaire (MPLQ). METHODS: Intraclass correlation coefficients (ICC) were used to evaluate the test-retest reliability (4-week interval) of the MPLQ on 18 occupational and 18 operational items in 50 male (mean age: 36 years; SD ±7.9) UK military personnel. A stratified analysis based on duration of Service (0-10 years, 11-20 years and ≥21 years) was conducted to assess whether stability of task items was dependent on participant length of recall. Internal consistency was assessed by Cronbach's alpha (α) coefficients. RESULTS: Reliability of individual operational items ranged from fair to almost perfect agreement (ICC range: 0.37-0.89; α range: 0.53-0.94) with most items demonstrating moderate to substantial reliability. Overall scores related to occupational items showed substantial to almost perfect agreement between administrations (ICC range: 0.73-0.94; α range: 0.84-0.96). Stratifying by duration of Service showed similar within group reliability to the entire sample and no pattern of decreasing or increasing reliability with length of recall period was observed. CONCLUSIONS: It is essential that data used in planning UK military policy and health services are as accurate as possible. This study provides preliminary support for the MPLQ as a reliable self-report instrument for assessing the cumulative lifelong effects of occupational loading in UK military personnel. Further validation studies using larger and more demographically diverse military populations will support its interpretation in future epidemiological research.

The effect of dietary water soluble carbohydrate to nitrogen ratio on nitrogen partitioning and isotopic fractionation of lactating goats offered a high-nitrogen diet.

The objective of this study was to investigate the relationship between nitrogen (N) partitioning and isotopic fractionation in lactating goats consuming diets with a constant high concentration of N and increasing levels of water soluble carbohydrate (WSC). Eight lactating goats were offered four different ratios of WSC : N in the diet. A two-period incomplete cross-over design was used, with two goats assigned to each treatment in each period. N balance measurements were conducted, with measurement of feed N intake and total output of N in milk, faeces and urine. Treatment, period and infusion effects were tested using general ANOVA; the relationships between variables were analysed by linear regression. Dietary treatment and period had significant effects on dry matter (DM) intake (g/day). DM digestibility (g/kg DM) and N digestibility (g/kg N) increased as the ratio of WSC : N increased in the diet. No treatment effect was observed on milk urea N concentration (g/l) or urinary excretion of purine derivatives (mM/day). Although dietary treatment and period had significant effects on N intake, the change of N intake was small; no effect was observed for N partitioning among faeces, milk and urine. Milk, plasma and faeces were enriched in 15N compared with feed, whilst urine was depleted in 15N relative to feed. No significant relationship was established between N partitioning and isotopic fractionation. This study failed to confirm the potential to use N isotopic fractionation as an indicator of N partitioning in dairy goats when diets provided N in excess to requirements, most likely because the range of milk N output/N intake and urinary N output/N intake were narrow.

The effects of dietary nitrogen to water-soluble carbohydrate ratio on isotopic fractionation and partitioning of nitrogen in non-lactating sheep.

The main objective of this study was to investigate the relationship between partitioning and isotopic fractionation of nitrogen (N) in sheep consuming diets with varying ratios of N to water-soluble carbohydrate (WSC). Six non-lactating sheep were offered a constant dry matter (DM) allowance with one of three ratios of dietary N/WSC, achieved by adding sucrose and urea to lucerne pellets. A replicated 3 dietary treatments (Low, Medium and High N/WSC) × 3 (collection periods) and a Latin square design was used, with two sheep assigned to each treatment in each period. Feed, faeces, urine, plasma, wool, muscle and liver samples were collected and analysed for ¹5N concentration. Nitrogen intake and outputs in faeces and urine were measured for each sheep using 6-day total collections. Blood urea N (BUN) and urinary excretion of purine derivative were also measured. Treatment effects were tested using general ANOVA; the relationships between measured variables were analysed by linear regression. BUN and N intake increased by 46% and 35%, respectively, when N/WSC increased 2.5-fold. However, no indication of change in microbial protein synthesis was detected. Results indicated effects of dietary treatments on urinary N/faecal N, faecal N/N intake and retained N/N intake. In addition, the linear relationships between plasma δ¹5N and urinary N/N intake and muscle δ¹5N and retained N/N intake based on individual measurements showed the potential of using N isotopic fractionation as an easy-to-use indicator of N partitioning when N supply exceeds that required to match energy supply in the diet.

Delay in diagnosis of neck of femur stress fracture in a female military recruit.

We report the delay in diagnosis of a Neck of Femur (NOF) stress fracture in mixed sex basic military training. Stress fractures are common in military training with the incidence reported as ranging between 3.2-31%. NOF stress fractures, whilst only representing around 8% of stress fractures are associated with a high morbidity. It is imperative that medical officers looking after military recruits have a sound knowledge of the potential signs, symptoms and presentation of these injuries. Medical officers should always remains vigilant for stress fractures especially in mixed military training.

Assessment of the production of analgesia induced by application of a rubber ring or local anaesthetic to the antler pedicle of yearling stags.

AIMS: To compare two methods of applying rubber rings to the pedicles of yearling stags to induce analgesia in the antler prior to removal. To compare the application of a rubber ring with that of a lignocaine ring block of the antler pedicle on the efficacy and time course of the analgesia produced in yearling stags. METHODS: Rubber rings were applied to the pedicles of 36 yearling stags that required velvet antler removal. The standard method, a doubled-over ring expanded and lowered down from the distal end of the antler and released midway down the pedicle, was compared with a cable-tie method on the other pedicle, where a ring was pulled around the pedicle by an electrical cable tie threaded through the ring. Brief electrical stimulation (train-of-four mode) was applied proximal and distal to the ring before, and at regular intervals for 1 hour after, application of the ring to a level that produced an auriculopalpebral reflex response. In a second experiment, each pair of antlers per yearling stag (n=36) was allocated to one of three pairs of treatments, viz no treatment (control) and the cable-tie method as described above, control and local anaesthesia (a ring block of 2 ml 2% lignocaine per cm pedicle circumference), or the cable-tie method and local anaesthesia. Electrical stimulation (tetanic mode) was applied to each antler approximately 25 mm distal to the pedicle/antler junction before, and at intervals up to 1 hour after, application of treatments at a level required to produce a head/neck avoidance behavioural response. In a third experiment, the two electrical stimulation protocols used above were directly compared by measuring the response of stags (n=8) to one protocol on each pedicle/antler prior to, and at intervals for 1 hour after, application of a rubber ring. At the end of each treatment in all three experiments, analgesia of the antler was established as a nil behavioural response of the stag to a saw cut to the antler (the 'nick test'). RESULTS: For both methods of application of a ring the minimum electrical stimulation required distal to the ring to elicit a reflex response increased from around 16 to 55 mA by 60 minutes. In contrast, the electrical stimulation required proximal to the ring remained low (approximately 17.0 mA) throughout. No stag subjected to either of the methods of application responded to the nick test 60 minutes after application of the ring. The electrical stimulation required to produce a behavioural response increased very rapidly in stags treated with local anaesthetic and at a slower rate in those treated with the cable-tie method but showed no significant increase in control stags. After 4 and 30 minutes, for local anaesthesia and the cable-tie method, respectively, 95% of stags were not responding to 80 mA. A significantly greater proportion of stags with antlers treated with local anaesthetic and the cable-tie method did not respond to the nick test than controls, and there was no significant difference in the frequency of the response between stags with treated antlers. The minimum current required to produce a response proximal to a rubber ring was slightly higher on average for train-of-four electrical stimulus (mean 18.1 (SD 2.6) mA) than for the tetanic mode (mean 11.9 (SD 2.5) mA). The increase in minimum current required to produce the respective response to stimulation distal to the ring was similar for both methods, although the maximum predicted value (67.4 mA) was lower for train-of-four than for the tetanic mode (84.5 mA). No stag responded to the nick test > or = 60 minutes after application of the ring. CONCLUSIONS: The cable-tie method was no different from the standard method as a procedure for producing analgesia in the antlers of yearling stags and should be accepted as an appropriate procedure for applying analgesic rings to yearling stags. The analgesia produced in the antlers of yearling stags by rubber rings applied by the cable-tie method to the pedicle was similar to that of a lignocaine ring block, but the time course for the development of analgesia was markedly different. Given that a lignocaine ring block is accepted as an adequate method of pain relief for antler removal, the application of rubber rings followed by a period of > or = 30 minutes after application can be advocated as a viable alternative for pain relief.

Use of ultrasound to identify chronic Achilles tendinosis in an active asymptomatic population.

OBJECTIVES: The aim of the study was to identify the prevalence of degenerative change in the Achilles tendons of currently asymptomatic individuals and correlate it with their degree of physical activity. METHODS: We recruited 126 healthy subjects, mean age 33.1, range 20 - 50 (78 males and 48 females). Their levels of physical activity were assessed by a questionnaire and scored using the Allied Dunbar Fitness Survey criteria, modified to exclude non-weight bearing activity. One investigator, who was blinded to the activity levels, ultrasound scanned all 252 tendons. Tendons were examined for evidence of hypoechoic regions, localised fusiform thickening, and the cross-sectional diameter of each was measured. RESULTS: Overall 59% (149) of tendons had ultrasound evidence of hypoechoic regions. In 50 tendons (in 31 patients) there was a history of previous Achilles pain and 84% of these had hypoechoic regions. Thirty three percent of subjects in the lowest quartile of activity had evidence of hypoechoic regions compared to 72.6% in the most active quartile (Pearson Chi2 p < 0.01). Only 5.6% of all Achilles tendons had ultrasound evidence of localised fusiform thickening, with none in the inactive group compared to 6.4% in the very active group (Pearson Chi2 p = 0.03). CONCLUSIONS: Degenerative changes, identified by ultrasound, are common in the Achilles tendon and are often asymptomatic. There is a direct relationship between these changes and levels of current and lifetime activity. The natural history of asymptomatic chronic Achilles tendinosis and their relationship to future pain or tendon pathology is unknown.

Liveweight gain and copper status of young deer treated or untreated with copper oxide wire particles on ten deer farms in Canterbury.

AIMS: To measure the liveweight response of young deer to copper supplementation on a range of deer farms in the Canterbury region of the South Island, New Zealand, and relate any response to plasma copper concentration. METHODS: On each of 10 farms throughout north and mid-Canterbury, young deer (4-7 months old) were allocated by liveweight to two groups of 45-50. The deer in one group each received 5 g copper oxide wire particles (COWP) at the start of the project (March-June 2000) and a further 10 g COWP 3 months later (+Cu group), while the other group received no copper supplementation (-Cu group). Liveweight (+/-1 kg) of all deer was recorded monthly. A 10 ml blood sample was taken from a sub-sample of 10 animals in each group at the beginning of the trial and from the same animals 3 and 6 months later for measurement of plasma copper concentration. RESULTS: There was no significant effect (p=0.96) of treatment with COWP on liveweight gain (overall mean liveweight gain = 169 g/day). This result was consistent for all farms and for both periods. Mean plasma copper concentration declined from 12.5 (SD 3.4) to 10.3 (SD 3.0) micromol/l in +Cu groups, and to a significantly lower level (p<0.001) of 8.6 (SD 3.2) in -Cu groups after 3 months, at which time 38% of -Cu animals were considered hypocupraemic (<8 micromol/l). At the end of the second 3-month period there was no significant treatment effect on plasma copper concentration, which averaged 9.4 (SD 2.3) micromol/l. Of the feed samples submitted (n=46), only 17% had a copper concentration <5.0 mg/kg dry matter (DM), 13% had a molybdenum concentration >1.0 mg/kg, and 21% had a sulphur content >3.5 g/kg. CONCLUSIONS: Under the conditions of these trials, no response in liveweight gain to copper supplementation was observed despite evidence of hypocupraemia in 38% of -Cu animals, which gained weight at similar rates to those that had adequate plasma copper levels. The extent of the hypocupraemia was either not sufficiently severe, or not maintained for a long enough period to cause copper deficiency resulting in reduced liveweight gain. No other signs of copper deficiency were evident. There is scope for deer farmers to reassess the need for copper supplementation in young deer.