Occupational health screening during Gurkha Central Selection: a retrospective cohort study.

OBJECTIVE: The selection process to the British Army's Brigade of Gurkhas is rigorous, demanding and competitive. The ethos of recruitment to the Gurkhas is grounded in an overarching tenant: that selection is free, fair and transparent. The aim of this study was to retrospectively review reasons for potential recruits (PRs) to be deemed medically unsuitable or deferred suitability on medical grounds for selection to the Brigade of Gurkhas. METHODS: A retrospective review was conducted by extracted data from published post-exercise reports for the past four years to ascertain numbers of PRs deemed medically fit, medically unsuitable or deferred suitability on medical grounds. The International Classification of Disease version 11 (ICD-11) codes were retrospectively assigned to code medical reasons for non-progression. Rates of medical non-progression were compared by year. RESULTS: A total of 3154 PRs were analysed between 2018 and 2021. There was no significant difference between PRs deemed medically fit and those deemed medically suitable or deferred on medical grounds over the study period (p=0.351). There was a significant difference in the ratio of PRs deferred on medical grounds and those deemed medically unsuitable over the study period (p<0.05). CONCLUSION: Selection to the Gurkhas is extremely competitive. These data demonstrate that, overall, reasons for medical deferral or unsuitability have remained constant despite the impact of a global pandemic. These data reinforce the central tenant of Gurkha selection; that it continues to be free, fair, and transparent.

Skill and experience impact neural activity during global and local biological motion processing.

During biological motion perception, individuals with perceptual experience learn to use more global processing, simultaneously extracting information from multiple body segments. Less experienced observers may use more local processing of individual body segments. The parietal lobe (e.g., alpha and beta power) has been shown to be critical to global and local static stimulus perception. Therefore, in this paper, we examined how skill impacts motion processing by assessing behavioral and neural responses to degrading global or local motion information for soccer penalty kicks. Skilled (N = 21) and less skilled (N = 19) soccer players anticipated temporally occluded videos of penalty kicks under normal, blurred (degraded local information), or spatially occluded (hips-only; degraded global information) viewing conditions. EEG was used to measure parietal alpha and beta power. Skilled players outperformed less skilled players, albeit both skill groups were less accurate in the blurred and hips-only conditions. Skilled performers showed significant decreases in bilateral parietal beta power in the hips-only condition, suggesting a greater reliance on global motion information under normal viewing conditions. Additionally, the hips-only condition elicited significantly greater beta relative to alpha power (beta - alpha), lower beta power, and lower alpha power than the control condition for both skill groups, suggesting spatial occlusion elicited a shift towards more local processing. Our novel findings demonstrate that skill and experience impact how motion is processed.

The role of peripheral vision during decision-making in dynamic viewing sequences.

Decision-making in team sports necessitates monitoring multiple performers located at different distances (i.e., viewing eccentricities) from a critical information source. The processing of peripheral information is generally impaired under anxiety and when responding to stimuli located at larger eccentricities. These hypotheses have not been sufficiently tested in dynamic performance environments. We examined how pressure and eccentricities affect decision-making and visual behaviour in 4v4 basketball defensive scenarios using a head mounted display. Experienced players monitored plays from the first-person perspective (centre position) and made defensive steps towards opponents threatening the basket from different eccentricities under low- and high-pressure. To tax working memory, participants simultaneously performed a backward counting task. Players responded slower and with lower accuracy to opponents at larger eccentricities. Players mostly fixated on the ball-carrier, but over 50% of fixations were located on peripheral players, indicating that information in the periphery must be frequently updated with foveal vision (i.e., pivot strategy). When pressured, participants increased mental effort and improved counting performance; however, gaze behaviour and decision-making were relatively unaffected. Findings suggest that basketball players respond more quickly to opponents positioned at lower compared to higher eccentricities at the cost of impaired responses to opponents in the periphery.

Anxiety does not always affect balance: the predominating role of cognitive engagement in a video gaming task.

Scientists have predominantly assessed anxiety's impact on postural control when anxiety is created by the need to maintain balance (e.g., standing at heights). In the present study, we investigate how postural control and its mechanisms (i.e., vestibular function) are impacted when anxiety is induced by an unrelated task (playing a video game). Additionally, we compare watching and playing a game to dissociate postural adaptations caused by increased engagement rather than anxiety. Participants [N = 25, female = 8, M (SD) age = 23.5 (3.9)] held a controller in four standing conditions of varying surface compliance (firm or foam) and with or without peripheral visual occlusion across four blocks: quiet standing (baseline), watching the game with a visual task (watching), playing the game (low anxiety), and playing under anxiety (high anxiety). We measured sway area, sway frequency, root mean square (RMS) sway, anxiety, and mental effort. Limited sway differences emerged between anxiety blocks (only sway area on firm surface). The watching block elicited more sway than baseline (greater sway area and RMS sway; lower sway frequency), and the low anxiety block elicited more sway than the watching block (greater sway area and RMS sway; higher sway frequency). Mental effort was associated with increased sway area and RMS sway. Our findings indicate that anxiety, when generated through competition, has minimal impact on postural control. Postural control primarily adapts according to mental effort and more cognitively engaging task constraints (i.e., playing versus watching). We speculate increased sway reflects the prioritization of attention to game performance over postural control.

The effect of anxiety on anticipation, allocation of attentional resources, and visual search behaviours.

Successful sports performance requires athletes to be able to mediate any detrimental effects of anxiety whilst being able to complete tasks simultaneously. In this study, we examine how skill level influences the ability to mediate the effects of anxiety on anticipation performance and the capacity to allocate attentional resources to concurrent tasks. We use a counterbalanced, repeated measures design that required expert and novice badminton players to complete a film-based anticipation test in which they predicted serve direction under high- and low-anxiety conditions. On selected trials, participants completed an auditory secondary task. Visual search data were recorded and the Mental Readiness Form v-3 was used to measure cognitive anxiety, somatic anxiety and self-confidence. The Rating Scale of Mental Effort was used to measure mental effort. The expert players outperformed their novice counterparts on the anticipation task across both anxiety conditions, with both groups anticipation performance deteriorating under high- compared to low-anxiety. This decrease across anxiety conditions was significantly greater in the novice compared to the expert group. High-anxiety resulted in a shorter final visual fixation duration for both groups when compared to low-anxiety. Anxiety had a negative impact on secondary task performance for the novice, but not the expert group. Our findings suggest that expert athletes more effectively allocated attentional resources during performance under high-anxiety conditions. In contrast, novice athletes used more attentional resources when completing the primary task and, therefore, were unable to maintain secondary task performance under high-anxiety.

Patient Evaluation of Emotional Comfort Experienced (PEECE): developing and testing a measurement instrument.

OBJECTIVES: The Patient Evaluation of Emotional Comfort Experienced (PEECE) is a 12-item questionnaire which measures the mental well-being state of emotional comfort in patients. The instrument was developed using previous qualitative work and published literature. DESIGN: Instrument development. SETTING: Acute Care Public Hospital, Western Australia. PARTICIPANTS: Sample of 374 patients. INTERVENTIONS: A multidisciplinary expert panel assessed the face and content validity of the instrument and following a pilot study, the psychometric properties of the instrument were explored. MAIN OUTCOME MEASURES: Exploratory and confirmatory factor analysis assessed the underlying dimensions of the PEECE instrument; Cronbach's α was used to determine the reliability; κ was used for test-retest reliability of the ordinal items. RESULTS: 2 factors were identified in the instrument and named 'positive emotions' and 'perceived meaning'. A greater proportion of male patients were found to report positive emotions compared with female patients. The instrument was found to be feasible, reliable and valid for use with inpatients and outpatients. CONCLUSIONS: PEECE was found to be a feasible instrument for use with inpatient and outpatients, being easily understood and completed. Further psychometric testing is recommended.

Identifying the causal mechanisms of the quiet eye.

Scientists who have examined the gaze strategies employed by athletes have determined that longer quiet eye (QE) durations (QED) are characteristic of skilled compared to less-skilled performers. However, the cognitive mechanisms of the QE and, specifically, how the QED affects performance are not yet fully understood. We review research that has examined the functional mechanism underlying QE and discuss the neural networks that may be involved. We also highlight the limitations surrounding QE measurement and its definition and propose future research directions to address these shortcomings. Investigations into the behavioural and neural mechanisms of QE will aid the understanding of the perceptual and cognitive processes underlying expert performance and the factors that change as expertise develops.

Osteochondritis dissecans of the knee: a practical guide for surgeons.

UNLABELLED: Osteochondritis Dissecans (OCD) is a condition for which the aetiology remains unknown. It affects subchondral bone and secondarily its overlying cartilage and is mostly found in the knee. It can occur in adults, but is generally identified when growth remains, when it is referred to as juvenile OCD. As the condition progresses, the affected subchondral bone separates from adjacent healthy bone, and can lead to demarcation and separation of its associated articular cartilage. Any symptoms which arise relate to the stage of the disease. Early disease without separation of the lesion results in pain. Separation of the lesion leads to mechanical symptoms and swelling and, in advanced cases, the formation of loose bodies. Early identification of OCD is essential as untreated OCD can lead to the premature degeneration of the joint, whereas appropriate treatment can halt the disease process and lead to healing. Establishing the stability of the lesion is a key part of providing the correct treatment. Stable lesions, particularly in juvenile patients, have greater propensity to heal with non-surgical treatment, whereas unstable or displaced lesions usually require surgical management. This article discusses the aetiology, clinical presentation and prognosis of OCD in the knee. It presents an algorithm for treatment, which aims to promote healing of native hyaline cartilage and to ensure joint congruity. TAKE HOME MESSAGE: Although there is no clear consensus as to the best treatment of OCD, every attempt should be made to retain the osteochondral fragment when possible as, with a careful surgical technique, there is potential for healing even in chronic lesions Cite this article: Bone Joint J 2016;98-B:723-9.

Cognitive function in cancer survivors: analysis of the 1999-2002 National Health and Nutrition Examination Survey.

PURPOSE: Cancer and its treatment may affect cognitive function through a number of direct and indirect pathways including inflammation, lipid metabolism, vascular damage, and changes in the blood-brain barrier. While short-term treatment-related cognitive changes are well recognized, only limited research is available in older, long-term survivors of cancer. METHODS: Using NHANES data from 1999 to 2002, 408 cancer survivors and 2639 non-cancer participants aged 60 years old and above were identified. Cognitive function of these groups were compared using the Digit Symbol Substitution Test (DSST) and self-reported problems with memory or confusion. RESULTS: After adjustment for covariates, cancer survivors scored, on average, 1.99 points lower on the DSST compared to non-cancer survivors (-1.99, 95 % CI -3.94, -0.05). Cancer survivors also had 17 % higher odds of self-reporting problems with memory or confusion (OR 1.17, 95 % CI 0.89, 1.53). CONCLUSION: In this nationally representative sample of older US adults, cancer survivors had lower DSST scores than non-survivors and had more self-reported problems with memory or confusion.

United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement.

OBJECTIVE: Summarize policies that support maternal and neonatal transport among states and territories. STUDY DESIGN: Systematic review of publicly available, web-based information on maternal and neonatal transport for each state and territory in 2014. Information was abstracted from published rules, statutes, regulations, planning documents and program descriptions. Abstracted information was summarized within two categories: transport and reimbursement. RESULTS: Sixty-eight percent of states and 25% of territories had a policy for neonatal transport; 60% of states and one territory had a policy for maternal transport. Sixty-two percent of states had a reimbursement policy for neonatal transport, whereas 20% reimbursed for maternal transport. Thirty-two percent of states had an infant back-transport policy while 16% included back-transport for both. No territories had reimbursement or back-transport policies. CONCLUSION: The lack of development of maternal transport reimbursement and neonatal back-transport policies negatively impacts the achievements of risk-appropriate care, a strategy focused on improving perinatal outcomes.

Understanding the distinct experience of rural interprofessional collaboration in developing palliative care programs.

INTRODUCTION: Palliative care is one component of rural generalist practice that requires interprofessional collaboration (IPC) amongst practitioners. Previous research on developing rural palliative care has created a four-phase capacity development model that included interprofessional rural palliative care teams; however, the details of rural team dynamics had not been previously explored and defined. A growing body of literature has produced models for interprofessional collaborative practice and identified core competencies required by professionals to work within these contexts. An Ontario College of Family Physicians discussion paper identifies seven essential elements for successful IPC: responsibility and accountability, coordination, communication, cooperation, assertiveness, autonomy, and mutual trust and respect. Despite the fact that IPC may be well conceptualized in the literature, evidence to support the transferability of these elements into rural health care practice or rural palliative care practice is lacking. The purpose of this research is to bridge the knowledge gap that exists with respect to rural IPC, particularly in the context of developing rural palliative care. It examines the working operations of these teams and highlights the elements that are important to rural collaborative processes. METHODS: For the purpose of this qualitative study, naturalistic and ethnographic research strategies were employed to understand the experience of rural IPC in the context of rural palliative care team development. Purposive sampling was used to recruit key informants as participants who were members of rural palliative care teams. The seven elements of interprofessional collaboration, as outline above, provided a preliminary analytic framework to begin exploring the data. Analysis progressed using a process of interpretive description to embrace new ideas and conceptualizations that emerged from the patterns and themes of the rural health providers' narratives. The questions of particular interest that guided this work were: What are the collaborative processes of a rural palliative care team? To what extent are the seven elements of IPC representative of rural teams' experiences? Are there any additional elements present when examining the experiences of rural teams? RESULTS: The analysis showed that the seven identified elements of IPC were very much integrated in rural teams' collaborative practice, and thus validated the applicability of these elements in a rural context. However, all seven elements were implemented with a rural twist: the distinctiveness of the rural environment was observed in each element. In addition, another element, specific to rural context, was observed, that being the 'automatic teams' of rural practitioners - the collaboration has been established informally and almost automatically between rural practitioners. CONCLUSIONS: This research contributes new knowledge about rural palliative care team work that can assist in implementing models for rural palliative care that apply accepted elements of collaborative practice in the rural context. Understanding the process of how rural teams form and continue to function will help further the current understanding of IPC in the context in which these professionals work.

Effects of a controlled heat stress during late gestation, lactation, and after weaning on thermoregulation, metabolism, and reproduction of primiparous sows.

Heat stress (HS) causes seasonal infertility in sows and decreases reproductive efficiency. The objective was to examine thermoregulation, metabolic responses, and reproduction in sows exposed to HS or thermoneutral (TN) conditions during different phases of a production cycle (gestation, lactation, and breeding). Fifty-eight first-parity Landrace (n = 26) or Landrace × Large White F1 (n = 32) sows were rotated through environmental chambers for 57 d beginning in late gestation. The ambient temperature sequences included either TN (18°C to 20°C) or HS (24°C to 30°C) for each production phase with the following treatment groups: TN-TN-TN (n = 15), TN-HS-TN (n = 14), HS-TN-HS (n = 14), and HS-HS-HS (n = 15) for gestation-farrowing-breeding (20, 24, and 13 d, respectively). Regardless of the temperature treatment, rectal temperatures were greater (P < 0.001) during lactation (39.36°C ± 0.01°C) than during the gestation (38.27°C ± 0.01°C) or the breeding period (38.77°C ± 0.01°C). The increase in rectal temperature (P < 0.001) and respiration rate (P < 0.001) in response to the HS was greatest during lactation. There was an effect of day (P < 0.001) on serum IGF-1 and insulin concentrations because both insulin and IGF-1 increased after farrowing. Compared with HS sows, the TN sows had greater feed intake (P < 0.001) and greater serum concentrations of insulin (early lactation; P < 0.05) and IGF-1 (late lactation; P < 0.05) when they were lactating. The effects of HS on sow BW, back fat, and loin eye area were generally not significant. Average BW of individual piglets at weaning was approximately 0.5 kg lighter for the sows in the HS farrowing room (P < 0.05). Weaning-to-estrus interval, percentage sows inseminated after weaning, subsequent farrowing rate, and subsequent total born were not affected by treatment. In summary, regardless of ambient temperature, sows undergo pronounced and sustained changes in rectal temperature when they transition through gestation, lactation, weaning, and rebreeding. The effects of HS on rectal temperature, respiration rate, feed intake, and metabolic hormones were greatest during lactation. The controlled HS that we imposed affected piglet weaning weight, but rebreeding and subsequent farrowing performance were not affected.

Multisensory perception and action in 3-ball cascade juggling.

Multisensory perception and action in 3-ball cascade juggling was investigated in intermediate-skilled performers by manipulating vision (full or lower field restricted) or ball weight (equal or different). There were main effects for both independent variables but no interactions. Manipulation of ball weight had a more pervasive effect on performance outcome, as well as central tendency and dispersion of kinematic measures of the juggling action. A common finding to both manipulations was that balls were tossed to higher zeniths, thus increasing parabola height and flight time. For intermediate-skilled jugglers, proprioception-haptics available when the balls were in the hands and vision of the balls and hands around the moment of ball toss and catch both make a contribution to the juggling action.

The effect of stimulus intensity on response time and accuracy in dynamic, temporally constrained environments.

The ability to make accurate judgments and execute effective skilled movements under severe temporal constraints are fundamental to elite performance in a number of domains including sport, military combat, law enforcement, and medicine. In two experiments, we examine the effect of stimulus strength on response time and accuracy in a temporally constrained, real-world, decision-making task. Specifically, we examine the effect of low stimulus intensity (black) and high stimulus intensity (sequin) uniform designs, worn by teammates, to determine the effect of stimulus strength on the ability of soccer players to make rapid and accurate responses. In both field- and laboratory-based scenarios, professional soccer players viewed developing patterns of play and were required to make a penetrative pass to an attacking player. Significant differences in response accuracy between uniform designs were reported in laboratory- and field-based experiments. Response accuracy was significantly higher in the sequin compared with the black uniform condition. Response times only differed between uniform designs in the laboratory-based experiment. These findings extend the literature into a real-world environment and have significant implications for the design of clothing wear in a number of domains.

The role of movement exaggeration in the anticipation of deceptive soccer penalty kicks.

Human movement containing deception about the true outcome is thought to be perceived differently compared to the non-deceptive version. Exaggeration in the movement is thought to change the perceiver's mode of functioning from an invariant to a cue-based mode. We tested these ideas by examining anticipation in skilled and less skilled soccer players while they viewed temporally occluded (-240 ms, -160 ms, -80 ms, 0 ms, +80 ms) deceptive, non-deceptive, and non-deceptive-exaggerated penalty kicks. Kinematic analyses were used to ascertain that the kicking actions differed across conditions. The accuracy of judging the direction of an opponent's kick as well as response confidence were recorded. Players were over confident when anticipating deceptive penalty kicks compared to non-deceptive kicks, suggesting a cue-based mode was used. Furthermore, there was a significant relationship between less skilled players' confidence ratings and their accuracy 80 ms before ball-foot contact in the deceptive and non-deceptive-exaggerated conditions, but not the non-deceptive condition. Because both deceptive and non-deceptive-exaggerated kicks contained exaggeration, results suggest exaggerated movements in the kickers' action at 80 ms before ball-foot contact explains why a cue-based mode prevails when anticipating deceptive kicks at this time point.

Short communication: glucose and fructose concentrations and expression of glucose transporters in 4- to 6-week pregnancies collected from Holstein cows that were either lactating or not lactating.

Glucose is an essential nutrient for the conceptus. The objective was to determine if lactation affected the amount of glucose crossing the placenta by measuring glucose and fructose in placental fluids in lactating and nonlactating cows. Holstein cows were assigned to one of 2 treatments immediately after parturition [lactating (n=23) or nonlactating (dried off immediately after calving; n=20)]. Pregnant cows were slaughtered at one of 3 d of pregnancy (d 28, 35, or 42) and tissues were collected. Plasma glucose and insulin were less in lactating cows. Pregnancies collected from lactating cows had less glucose and fructose in placental fluids compared with those from nonlactating cows. Relative to endometrium, the placenta expressed greater amounts of the glucose transporters SLC2A1 (Glut1), SLC2A3 (Glut3) and SLC2A4 (Glut4) mRNA. The mRNA for SLC2A1 decreased whereas the mRNA for SLC2A4 increased from d 28 to d 42 of pregnancy. Stepwise regression analyses for fetal and placental weight (dependent variable) retained day of pregnancy and maternal plasma insulin concentrations in the final model. The conclusion is that lower blood glucose and insulin in lactating cows may lead to less glucose crossing the placenta and slower fetal development during lactation. The slower fetal development may predispose lactating cows to fetal loss if developmental milestones are not reached.

Perceptual-cognitive expertise, practice history profiles and recall performance in soccer.

We examined whether high- or low-performing soccer players, classified based on established measures of perceptual-cognitive expertise, differed in regard to their practice history profiles and ability to recall elements of match performance. In Study 1, we measured perceptual-cognitive expertise in elite (n= 48) and non-elite (n= 12) youth soccer players using empirical tests of perceptual-cognitive skill. We then used a quartile split to stratify elite players into either high-performing (n= 12) or low-performing (n= 12) groups based on their test scores. A group of non-elite soccer players (n= 12) acted as controls. In Study 2, we used an established questionnaire to examine retrospectively the participation history profiles of the three groups. The high-performing group had accumulated more hours in soccer-specific play activity over the last 6 years of engagement in the sport compared to their low-performing counterparts and the non-elite controls. No differences were reported for hours accumulated in soccer-specific practice or competition between the high- and low-performing groups. In Study 3, a novel test was developed to examine episodic memory recall in soccer. Although this test successfully differentiated elite from non-elite players, no differences were evident between high- and low-performing groups, implying that episodic memory recall may not be a crucial component of perceptual-cognitive expertise in soccer.

Voices from the bush: remote area nurses prioritise hazards that contribute to violence in their workplace.

INTRODUCTION: Remote Area Nurses (RANs) in Australia frequently encounter hazards that contribute to violence in the work place. Resources to deal with this problem are limited. METHODS: Adopting a risk management approach and using the Delphi method, a panel of expert RANs (n=10) from geographically diverse communities across Australia, identified and prioritised hazards that increase the risk of violence to nurses. RESULTS: This descriptive study found that RANs encounter a wide variety of hazards from a variety of sources. Environmental hazards are complicated by living in remote areas and practicing in different locations. Relationships between the nurse and the community can be complex and lack of experience and organisational support may contribute to an increased risk of violence. Hazards prioritised as 'major' or 'extreme' risks included: clinic maintenance and security features, attending to patients at staff residences, RAN inexperience and lack of knowledge about the community, as well as intoxicated clients with mental health issues. A work culture that accepts verbal abuse as 'part of the job' was identified as a significant organisational risk to RANs. A lack of action from management when hazards are identified by clinic staff and insufficient recognition of the risk of violence by employers were also significant hazards. CONCLUSIONS: Further consideration of the hazards described in this study following the risk management process, may provide opportunities to reduce the risk of violence towards RANs. Proposed control measures should be developed in consultation with RANs and the remote communities they work in.