Longitudinal Changes in the Body Mass Index of British Army Pilots.

INTRODUCTION: Aircraft are manufactured according to design parameters that must account for the size and physical characteristics of the pilot. While cockpit dimensions, seats, restraints, and related components do not change substantially over the airframe lifecycle, it is conceivable that the occupant may, even if initially well-suited. This investigation focused on longitudinal body mass index (BMI) changes within a cohort of British Army Air Corps pilots.METHODS: The study was a retrospective examination of electronic medical record data to assess longitudinal change within a representative cohort of Army pilots. Voluntary subjects were assigned unique subject numbers matched with individual electronic medical record data. Subject's age, service length, height, weight, and BMI were extracted from routine historical aviation medical exams.RESULTS: Among 106 British Army Air Corps pilots, the mean age was 35.3 yr (SD = 7.4) with average length of service as a pilot of 9.0 yr (SD = 5.2). Within the observed cohort, the mean change in individual weight over time was an increase of 4.6 kg (SD = 7.3). Height remained relatively stable with a mean increase of 0.6 cm (SD = 1.9). Given the increase in weight, BMI was noted to increase longitudinally with a mean of 1.3 kg · m-2 (SD = 2.4).DISCUSSION: British Army pilots experience increases in BMI over time much like the general population. Results of this study serve to inform future policy related to the body composition of aviation applicants, the retention of previously qualified pilots, and the safety concerns of crashworthiness design specifications.Porter WD, Wilde GD, Jeffery NP, Walters PL, Eke AJ, Bushby AJR, Adams MS, Gaydos SJ. Longitudinal changes in the body mass index of British Army pilots. Aerosp Med Hum Perform. 2024; 95(2):118-122.

Comparison of the effects of ketamine and morphine on performance of representative military tasks.

BACKGROUND: When providing care under combat or hostile conditions, it may be necessary for a casualty to remain engaged in military tasks after being wounded. Prehospital care under other remote, austere conditions may be similar, whereby an individual may be forced to continue purposeful actions despite traumatic injury. Given the adverse side-effect profile of intramuscular (i.m.) morphine, alternative analgesics and routes of administration are of interest. Ketamine may be of value in this capacity. OBJECTIVES: To delineate performance decrements in basic soldier tasks comparing the effects of the standard battlefield analgesic (10 mg i.m. morphine) with 25 mg i.m. ketamine. METHODS: Representative military skills and risk propensity were tested in 48 healthy volunteers without pain stimuli in a double-blind, placebo-controlled, crossover design. RESULTS: Overall, participants reported more symptoms associated with ketamine vs. morphine and placebo, chiefly dizziness, poor concentration, and feelings of happiness. Performance decrements on ketamine, when present, manifested as slower performance times rather than procedural errors. CONCLUSIONS: Participants were more symptomatic with ketamine, yet the soldier skills were largely resistant to performance decrements, suggesting that a trained task skill (autonomous phase) remains somewhat resilient to the drugged state at this dosage. The performance decrements with ketamine may represent the subjects' adoption of a cautious posture, as suggested by risk propensity testing whereby the subject is aware of impairment, trading speed for preservation of task accuracy. These results will help to inform the casualty care community regarding appropriate use of ketamine as an alternative or opioid-sparing battlefield analgesic.

Hypoxic hypoxia at moderate altitudes: review of the state of the science.

Unpressurized aircraft routinely operate at altitudes where hypoxia may be of concern. A systematic literature review was conducted regarding hypoxic impairment, including mental functions, sensory deficits, and other pertinent research findings that may affect aviation-related duties at moderate altitude (8000 to 15,000 ft/2438 to 4572 m). The results of this review suggest that cognitive and psychomotor deficits may include learning, reaction time, decision-making, and certain types of memory. However, results are difficult to quantify and reliably reproduce. Inconsistency of results may be related to the subtlety of deficits compared to high altitude, differences among individual compensatory mechanisms, variation in methodology or sensitivity of metrics, presence or absence of exercise, heterogeneous neuronal central nervous system (CNS) response, and interindividual variation. Literature regarding hypoxic visual decrements is more consistent. Rod photoreceptors are more susceptible to hypoxia; visual degradation has been demonstrated at 4000 to 5000 ft (1219 to 1524 m) under scotopic and 10,000 ft (3048 m) under photopic conditions. Augmented night vision goggle resolution demonstrates more resilience to mild hypoxic effects than the unaided eye under starlight conditions. Hypocapnia enhances visual sensitivity and contrast discrimination. Hyperventilation with resulting respiratory alkalosis and cerebral vasoconstriction may confound both cognitive/ psychomotor and visual experimental results. Future research should include augmentation of validated neuropsychological metrics (surrogate investigational end points) with actual flight metrics, investigation of mixed gas formulations, contribution of hypocapnic vasoconstrictive effects on hypoxic performance, and further investigation into cellular- and systems-level approaches for heterogeneous CNS response. Research is also required into the contribution of mild-moderate hypoxia in human factors- and spatial disorientation-related mishaps.

Clinicians' attitudes to depression in Europe: a pooled analysis of Depression Attitude Questionnaire findings.

BACKGROUND: Depression in primary care is common but under-recognized and suboptimally managed. Health professionals' attitudes are likely to play an important part in their recognition and management of depression. OBJECTIVES: To pool findings from studies using the Depression Attitude Questionnaire (DAQ) to provide greater detail of clinicians' attitudes and the measure's psychometric properties. METHODS: Electronic databases and grey literature were searched for relevant studies. Data from eligible studies were requested and pooled analysis conducted. RESULTS: Twenty studies were eligible and data were obtained from 12 of these involving GPs (n = 1543) and nurses (n = 984). Responses showed strong disagreement that depression is due to ageing or weakness. European GPs were more positive about depression treatments than UK GPs; nurses were more favourable about psychotherapy than GPs. UK GPs especially strongly opposed notions that depression is best managed by psychiatrists. Trends over time indicated increasing acknowledgement of psychological therapies and the nurse's role in depression management. Factor analysis indicated that many DAQ items fitted weakly within an overall model. The most parsimonious solution involved two factors: a positive view of depression and its treatment response and professional confidence in depression management. CONCLUSIONS: Individual DAQ items appear to measure key aspects of clinicians' attitudes to depression, and item responses indicate important differences between professions and geographical settings as well as changes over time. There are problems with the DAQ as a scale: its internal consistency is weak, and several items appear specific to particular professions or service structures, indicating that this questionnaire should be revised.

A clinical evaluation of the plaque removal efficacy of five manual toothbrushes.

OBJECTIVE: To assess and compare the plaque removal efficacy of five different Oral-B manual toothbrushes: CrossAction Pro-Health (CAPH), CrossAction (CA), Exceed (EX), Advantage 123 (ADV 123), and Indicator (IND). METHODS: This was a single-use, five-treatment, examiner-blind, randomized, five-period (visit) crossover study, with 10 different treatment sequences (groups) that determined the order in which the five toothbrushes were assigned at study visits. Three toothbrushes had an advanced CrissCross bristle design (CAPH, CA, EX), while two had more standard designs with straight bristles (ADV 123 and IND). At the first visit, subjects disclosed their plaque with disclosing solution, and an examiner performed a baseline plaque examination using the Rustogi, et al. Modification of the Navy Plaque Index (RMNPI). Subjects brushed for one minute with their assigned toothbrush under supervision, after which they again disclosed their plaque and were given a second plaque examination. The same procedure was followed for each of the visits in turn. RESULTS: All five manual toothbrushes showed a statistically significant (p < 0.0001) reduction in plaque from baseline for the whole mouth (84% to 93%), gingival margin (74% to 88%), and approximal surfaces (95% to 99%). For pair-wise treatment comparisons for all three plaque measures, CAPH, CA, and EX demonstrated statistically significantly better plaque removal than ADV 123 and IND (all p < 0.018). No other treatment comparisons were statistically significant. CONCLUSION: All five manual toothbrushes showed highly effective plaque reduction for whole mouth, gingival margin, and approximal surfaces. Comparisons between brushes showed consistent advantages for CAPH, CA, and EX compared to ADV 123 and IND for all three plaque measures, indicating that advances in toothbrush design can further enhance plaque removal.

Clinical evaluation of brushing time and plaque removal potential of two manual toothbrushes.

AIM: To compare plaque removal efficacy of Oral-B CrossAction (CA) used for 1 min with an American Dental Association (ADA) manual toothbrush used for 2 or 5 min in an examiner-blind, three-treatment, six-period crossover study. MATERIALS AND METHODS: After refraining from all oral hygiene procedures for 23-25 h, subjects were randomly assigned to one of nine possible six-period (visit) treatment sequences. Plaque was assessed at baseline (Rustogi Modified Navy Plaque Index). Post-brushing scores were recorded after brushing with a marketed dentifrice and the assigned toothbrush for the specified duration. The same procedure was followed at each of six subsequent visits. Clinical measurements were carried out by the same examiner. RESULTS: Forty subjects completed the study. All three treatments effectively removed plaque from the whole mouth, along the gingival margin and from approximal surfaces. Whole mouth and gingival margin plaque removal scores with CA for 1 min did not differ significantly from scores with the ADA toothbrush used for 2 min. The ADA brush used for 5 min showed significantly greater whole mouth (P < 0.001) and gingival margin (P < 0.001) plaque reduction than the two other treatments. Approximal plaque removal scores did not differ between the three treatments. CONCLUSIONS: Efficient plaque removal can be achieved after 1 min of brushing with CA. The amount of plaque removed did not differ significantly from that achieved with the ADA brush after 2 min of brushing. Greater whole mouth and gingival margin plaque removal scores were seen with the ADA brush after 5 min.

Digestive proteinases of the larger black flour beetle, Cynaeus angustus (Coleoptera: Tenebrionidae).

Digestion in the larger black flour beetle, Cynaeus angustus (LeConte), was studied to identify new control methods for this pest of stored grains and grain products. The physiological pH of the larval gut, as measured with extracts in water, was approximately 6.1, and the pH for optimal hydrolysis of casein by gut extracts was 6.2 when buffers were reducing. However, under non-reducing conditions, hydrolysis of casein and synthetic serine proteinase substrates was optimal in alkaline buffer. Three major proteinase activities were observed in zymograms using casein or gelatin. Caseinolytic activity of C. angustus gut extracts was inhibited by inhibitors that target aspartic and serine proteinase classes, with minor inhibition by a cysteine proteinase inhibitor. In particular, soybean trypsin and trypsin/chymotrypsin inhibitors were most effective in reducing the in vitro caseinolytic activity of gut extracts. Based on these data, further studies are suggested on the effects of dietary soybean inhibitors of serine proteinases, singly and in combination with aspartic and cysteine proteinase inhibitors, on C. angustus larvae. Results from these studies can be used to develop new control strategies to prevent damage to grains and stored products by C. angustus and similar coleopteran pests.

Maintenance of tooth color after prophylaxis: comparison of three dentifrices.

Pellicle rapidly accumulates on tooth surfaces after prophylaxis and may acquire cosmetically unacceptable levels of stain. A three-month clinical trial was conducted to evaluate stain prevention by a new silica-based tartar control whitening dentifrice (Crest Extra Whitening) compared to marketed tartar control baking soda peroxide whitening and regular dentifrice controls. Prior to the trial, a one-month screening exercise was conducted to identify adult subjects who accumulated extrinsic tooth stain after dental prophylaxis. A total of 672 subjects were stratified based on tooth whiteness, gender and tobacco usage, then given a dental prophylaxis and randomized into one of three dentifrice treatment groups. All product use was unsupervised. Change in tooth whiteness (delta L*) was determined by comparing colorimeter measurements collected on the facial surfaces of the four central incisors at months 1 and 3 to baseline. Ninety-six percent of subjects completed the three-month study. At both one and three months, the two whitening dentifrices did not differ from baseline in terms of delta L*. In contrast, the regular control had delta L* values of -0.26 and -0.39 at one and three months, respectively, differing significantly from baseline at both time points. Each of the whitening dentifrices differed statistically from the regular control in stain accumulation (p < or = 0.001) at one and three months, but were not different from each other. In general, all three test dentifrices were well tolerated. These data demonstrate the effectiveness of the new tartar control whitening dentifrice in preventing stain accumulation after dental prophylaxis compared to the marketed regular dentifrice control.

Behavioral and histological outcomes following graded spinal cord contusion injury in the C57Bl/6 mouse.

A computer-controlled electromagnetic spinal cord injury device (ESCID) has been adapted to develop a mouse model of spinal cord contusion injury. In the present study, we have extended this model in C57Bl/6 mice with behavioral and histopathological outcome assessment. Three groups of mice received a laminectomy at the T(9) vertebral level followed by a contusion injury from a predetermined starting load of 1500 dynes. Contusion was produced by rapid displacement of the spinal cord to a peak distance of 0.3, 0.5, or 0.8 mm, with the entire injury and retraction procedure completed over a 23-ms epoch. Control groups received laminectomy alone or complete transection. Functional recovery was examined for 9 weeks after injury using the BBB locomotor rating scale, grid walking, and footprint analysis. Distinct patterns of locomotor recovery were evident across the five groups. Measurements of spared white matter at the epicenter, lesion length, and cross-sectional area of fibronectin-immunopositive scar tissue were also significantly different between injury groups. The severity of injury corresponded with the biomechanical measures recorded at the time of impact as well as with behavioral and histological parameters. The results demonstrate that graded contusion injuries can be produced reliably in mice using the ESCID. The data provide a thorough and quantitative analysis of the effects of contusion injury on long-term behavioral and histological outcome measures in this strain and species.

Approach to the acute abdomen.

Acute abdominal pain is a clinical sign associated with several underlying disease processes, many of which can be life threatening. Abdominal pain requires efficient diagnostic evaluation to determine the appropriate course of treatment. Definitive treatment involves medical and/or surgical management. The emergency clinician must be well versed in the diagnostic approach to these patients to facilitate appropriate therapy.

Serotonin reuptake is less efficient in taste aversion resistant than in taste aversion-prone rats.

We have previously reported the development of rat lines bred selectively for differences in taste aversion conditionability. Earlier studies demonstrated that the taste aversion resistant (TAR) animals exhibited lower concentrations of brain serotonin and consumed greater amounts of ethanol than their taste aversion prone (TAP) counterparts. In the present study, TAR rats demonstrated significantly less efficient brain serotonin transport compared to TAP rats, but the rat lines demonstrated similar levels of serotonin transporter or V(max) and similar whole brain paroxetine (a specific serotonin reuptake inhibitor) binding (B(max)). These results suggest that the rat lines differ in the mechanisms that transport serotonin into nerve endings, but do not differ in the binding of serotonin to the transporter or in the number of serotonin transport sites. The data support the hypothesis that genetically determined differences in the serotonin system contribute to individual differences in taste aversion conditionability. The findings further suggest that differences in serotonin transport may influence the propensity to self-administer ethanol.

Autologous skin banking.

Small amounts of excess autograft are commonly harvested during burn procedures, and typically these are discarded. However, the resources of a local skin bank may be used to preserve this tissue for a later autologous use. This has been a routine practice in our institution and we feel that it has impacted favorably on patient care. In this paper we report 42 consecutive applications of autologous frozen skin and illustrate the technique with a case report.

Differences in free-choice ethanol acceptance between taste aversion-prone and taste aversion-resistant rats.

Taste aversion (TA)-prone (TAP) and TA-resistant (TAR) rats were tested for naive, nonforced acceptance of ethanol. Ethanol acceptance had played no role in line development. Rather, the lines had been developed via bidirectional, nonsibling matings based on susceptibility to develop cyclophosphamide-induced conditioned TAs to a 0.1% saccharin solution (at cyclophosphamide doses of 12.5 mg/kg for males and 15.0 mg/kg for females, i.p.). Rats from the 23rd selectively bred generations, with no prior exposure to ethanol, were given 24-hr access to a two-bottle choice between plain tap water and a solution of ethanol in water. Rats were initially given access to 1% ethanol in water, and the ethanol concentration was increased by 1% every 3 days to a maximum of 10%. Ethanol consumption (g ethanol consumed/kg body weight) and preference scores (volume ethanol solution consumed/total fluid intake) were determined by daily bottle weighings. At 1% ethanol concentration, there were no differences between the rat lines in terms of ethanol consumption or preference. At concentrations of 2 to 10%, TAP rats consumed less ethanol and showed a decreased preference for the ethanol solutions than TAR rats. Maximum ethanol consumption was reached at the 6% concentration for both lines. The mean (+/- SE) values of consumption at 6% ethanol were 1.8 (+/- 0.8) and 5.6 (+/- 0.5) g of ethanol/kg body weight for TAP and TAR rats, respectively. Mean (+/- SE) preference scores at 6% ethanol were 26 (+/- 12) and 76 (+/- 6) for TAP and TAR rats, respectively. These findings indicate that differences in TA conditionability may be associated with the propensity of rats to be high or low consumers of ethanol. Based on these data, it is hypothesized that high susceptibility for TA conditionability may deter many individuals from consuming the high levels of ethanol that usually precede alcohol tolerance and dependence.

Do you know what a dietetic technician can do? A focus on clinical technicians and their expanded roles and responsibilities.

Dietetic technicians, registered, play a key role in providing quality, cost-effective client care and foodservice management and are guided by the mission statement of the American Dietetic Association to promote optimal nutrition, health, and well-being. Many organizations use dietetic technicians to complete the screening and/or basic level assessments. The dietetic technician also can assist with patient monitoring and complete such tasks as calculating and documenting calorie counts, providing basic diet instruction, monitoring diet consumption and compliance, and determining tolerance of nutritional supplements. Since the last role delineation study was conducted, dietetic technicians have expanded into many different work settings, and practice roles have changed accordingly.

Validation of the MCMI-III PTSD scale among combat veterans.

The new MCMI-III Posttraumatic Stress Disorder (PTSD) scale was validated on 104 combat veterans who were divided into two groups, PTSD Treatment Group and Non-PTSD Treatment Group. PTSD status was carefully determined by clinical interview and therapists' reports. The Combat Exposure Scale, the Mississippi Scale for Combat-related PTSD, and the Impact of Events Scale were also given. Analysis showed that the MCMI-III PTSD scale had a low internal consistency, but that it significantly differentiated the two groups and significantly correlated to those on other PTSD self-report scales. This scale appeared to be influenced by an acquiescent response style. Further validation studies are needed.

Full proceedings from the National Conference to Develop a National Skin Cancer Agenda. American Academy of Dermatology and Centers for Disease Control and Prevention, Washington, D.C., April 8-10, 1995.

National efforts to reduce skin cancer incidence and mortality require scientifically coordinated efforts. This report summarizes the first American Academy of Dermatology/Centers for Disease Control and Prevention national conference to develop a skin cancer agenda. Leading experts in dermatology, public health, medicine, health education, nursing, behavioral sciences, environmental health and epidemiology identified and prioritized skin cancer control issues in five key areas. Discussion centered around strategies for reducing UV exposure and increasing public and professional awareness of skin cancer. Panelists in five sessions developed consensus on several public and professional recommendations and a series of research strategies.

A comparison of aural and rectal temperature measurements in children with moderate and severe injuries.

OBJECTIVE: The purpose of this study was to compare initial rectal and aural (i.e., ear-based) temperature measurements in children with moderate and severe injuries during their trauma care in the emergency department. DESIGN: A cross-sectional, prospective design was used to compare aural temperature and rectal temperatures in injured children. SAMPLE/SETTING: A convenience sample of 40 children who met the study inclusion criteria were enrolled at the level I pediatric regional resource trauma center in western Pennsylvania. METHODS: Aural temperature was measured by infrared technology (IVAC Corporation, San Diego, Calif.), and rectal temperatures were measured with a thermistor (IVAC Corporation). RESULTS: The subjects (N = 40) ranged in age from 1 to 14 years (mean 6.9 years; SD = 4.4 years). The mean difference between rectal and aural temperature measurements (mean = -0.3 degree C; SD = 0.76 degree C) was statistically significant when compared with a paired t test (p < 0.05). The Pearson product-moment correlation coefficient between aural and rectal temperature measurements was moderate to high (r = 0.85). CONCLUSION: The moderate to high correlation between the two methods shows promise for use of aural infrared temperature measurements as a screening measure for children with moderate and severe injuries.

Lung volume reduction surgery. Case selection, operative technique, and clinical results.

OBJECTIVE: A clinical study was undertaken to define optimal preoperative strategies and intraoperative techniques that would result in the least morbidity and maximum physiologic improvements in patients with end-stage emphysema selected for lung volume reduction surgery. BACKGROUND: Lung volume reduction surgery recently has been advocated as an alternative or a bridge to lung transplantation for patients with end-stage chronic obstructive pulmonary disease. The risks, benefits, and long-term results have not been clarified. METHODS: Twenty-six patients underwent lung volume reduction surgery with a 3-month follow-up on 17 patients. Preoperative and postoperative changes in pulmonary function parameters, quality of life, and oxygen requirement were analyzed. The value of preoperative localization of diseased lung segments and how this affects intraoperative resection is addressed. RESULTS: Forty-nine percent improvement in FEV1 (forced expiratory volume in 1 second) and 23% improvement in FVC (forced vital capacity) were seen after lung volume reduction surgery. Supplemental oxygen requirement was decreased and 79% of patients reported a much better quality of life. Mortality was 3.8% and air leak morbidity was 18%. CONCLUSIONS: Lung volume reduction surgery can predictably improve objective and subjective pulmonary function in selected patients with end-stage emphysema with low morbidity and mortality. Careful patient selection, accurate preoperative localization of diseased target areas, skilled anesthetic technique, meticulous operative approach, and intense postoperative support are essential to achieve favorable results.