Estimating the proportion of overweight soldiers in the Australian Army by combat uniform waist size.

INTRODUCTION: Recent studies have shown an increasing number of overweight and obese members serving in many armies. Overweight and obesity can be estimated using either body mass index or waist circumference measures. The aim of this research was to estimate the proportion of the Australian Army considered to be overweight and obese by waist circumference using the proxy measure of issued combat uniform waist size. METHOD: The Australian Army has been progressively replacing combat uniforms with a new uniform design and camouflage pattern since 2016. The total number of issued combat uniforms by size was obtained from the points of issue for the three Australian Army combat brigades from the first issue of the new uniform in January 2016 through to November 2019. The waist size of issued combat pants was collated from each of the three points of issue, adjusted for measured waist size accuracy and sex, and analysed to estimate the proportion of overweight and obese soldiers in the Australian Army. RESULTS: There were a total of 155 735 combat pants issued across the three points of issue. The mean waist size based on combat uniform pant size was found to be 90.4 cm, with an SD of 7.5 cm. Based on these data, approximately 23.3% of the Australian Army population can be estimated to be overweight and an additional 4.5% to be obese. CONCLUSIONS: The Australian Army, like many western armies, has a significant proportion of overweight personnel. This can negatively affect operational capability, health and future healthcare costs both within the military and to society after military service has concluded. This is the first study to use a uniform waist size as a proxy to estimate overweight and obesity. This technique has application for the military, emergency services or any other organisation in which uniforms are provided.

Chronic Urticaria: An Overview of Treatment and Recent Patents.

BACKGROUND: Up to 1% of the general population in the USA and Europe suffer from chronic urticaria (CU) at some point in their lifetime. CU has an adverse effect on the quality of life. OBJECTIVE: This study aims to provide an update on the epidemiology, pathogenesis, clinical manifestations, diagnosis, aggravating factors, complications, treatment and prognosis of CU. METHODS: The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term "chronic urticaria" at the following links: www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. RESULTS: CU is a clinical diagnosis, based on the episodic appearance of characteristic urticarial lesions that wax and wane rapidly, with or without angioedema, on most days of the week, for a period of six weeks or longer. Triggers such as medications, physical stimuli, and stress can be identified in 10 to 20% of cases. C-reactive protein/erythrocyte sedimentation rate, and complete blood cell count with differential are the screening tests that may be used to rule out an underlying disorder. The mainstay of therapy is reassurance, patient education, avoidance of known triggers, and pharmacotherapy. Secondgeneration H1 antihistamines are the drugs of choice for initial therapy because of their safety and efficacy profile. If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable, the dose of second-generation H1 antihistamines can be increased up to fourfold the manufacturer's recommended dose (all be it off license). If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable after the fourfold increase in the dosage of second-generation H1 antihistamines, omalizumab should be added. If satisfactory improvement does not occur after 6 months or earlier if the symptoms are intolerable after omalizumab has been added, treatment with cyclosporine and second-generation H1 antihistamines is recommended. Short-term use of systemic corticosteroids may be considered for acute exacerbation of CU and in refractory cases. Recent patents for the management of chronic urticaria are also discussed. Complications of CU may include skin excoriations, adverse effect on quality of life, anxiety, depression, and considerable humanistic and economic impacts. On average, the duration of CU is around two to five years. Disease severity has an association with disease duration. CONCLUSION: CU is idiopathic in the majority of cases. On average, the duration of CU is around two to five years. Treatment is primarily symptomatic with second generation antihistamines being the first line. Omalizumab has been a remarkable advancement in the management of CU and improves the quality of life beyond symptom control.

Determination of iron status in women attending genitourinary clinics with pruritus vulvae.

OBJECTIVE: To compare iron status in women with pruritus vulvae and in asymptomatic controls. METHODS: 42 women with pruritus vulvae and 42 asymptomatic broadly age-matched controls were enrolled in this prospective study. The outcome measures assessed were serum iron, serum ferritin, total iron-binding capacity, haemoglobin and transferrin saturation. RESULTS: 12 (29%) participants and 10 (24%) controls were iron deficient; 1 (2%) participant and 1 (2%) control had laboratory-defined iron deficiency anaemia. Participants generally had lower levels of iron markers than controls, with differences (95% confidence interval (CI)) of -3.5 microg/l (-9.89 to 6.99) for serum ferritin (p = 0.73), -4.9 mmol/l (-8.12 to 0.12) for serum iron (p = 0.06) and -5.5 mmol/l (-5.75 to 1.46) for total iron-binding capacity (p = 0.24). No significant difference in haemoglobin or mean cell volume was shown between the two groups (haemoglobin: p = 0.17, 95% CI -0.83 to 0.15; mean cell volume: p = 0.15, 95% CI -4.59 to 0.73). CONCLUSION: This study does not provide evidence to support the routine determination of iron status in patients presenting to genitourinary medicine clinics with pruritus vulvae from all causes.

Scanning laser reflectometry of retinal and subretinal tissues.

Measurements of the human ocular fundus that make use of the light returning through the pupil are called reflectometry. Early reflectometry studies were limited by poor light return from the retina and strong reflections from the anterior surface of the eye. Artifacts produced misleading results in diseases like age-related macular degeneration. Novel laser sources, scanning, confocal optics, and digital imaging provide improved sampling of the signal from the tissues of interest: photoreceptors and retinal pigment epithelial cells. A wider range of wavelengths is now compared, including the near infrared. Reflectometry now provides functional mapping, even in severe pathology.

Multiply scattered light tomography and confocal imaging: detecting neovascularization in age-related macular degeneration.

A novel technique, Multiply Scattered Light Tomography (MSLT), and confocal Infrared Imaging are used to provide diagnostic information using a comfortable, rapid, and noninvasive method. We investigated these techniques in detecting neovascularization in age-related macular degeneration. The MSLT used a Vertical Cavity Surface Emitting Laser (VCSEL) at 850 nm, while the confocal imaging technique used either the VCSEL or a 790 nm laser diode. Both were implemented into the topographical scanning system (TopSS, Laser Diagnostic Technologies, Inc.) Confocal imaging with both lasers provided different information about neovascularization as a function of focal plane, and different also from MSLT.

Small incision cataract surgery and placement of posterior chamber intraocular lenses in patients with diabetic retinopathy.

BACKGROUND AND OBJECTIVE: Diabetic patients undergoing cataract surgery have been demonstrated to have a guarded prognosis. Small incision cataract surgery has been postulated to cause fewer complications than other techniques of cataract extraction. We looked at small incision cataract surgery to see how diabetics fared. PATIENTS AND METHODS: One hundred fifty-four eyes of diabetic patients were evaluated preoperatively through dilated fundus examination and Snellen visual acuity. The eyes then underwent small incision cataract surgery and were followed, undergoing periodic ophthalmoscopy, Snellen visual acuity measurement and additional postoperative therapeutic and surgical intervention. RESULTS: Final visual acuity improved by two Snellen lines or more in 61 out of 154 (40%) eyes. Final visual acuity worsened in 38 out of 154 (25%) eyes. CONCLUSIONS: Our results are similar to those reported for extracapsular surgery and phacoemulsification, suggesting that the prognosis is guarded for diabetics, even when undergoing small incision cataract surgery.

Management of sexually transmitted disease by surgeons.

The management of 63 patients diagnosed by surgeons as having sexually transmitted disease (STD) was audited. A diagnosis of STD was made in 51 (81%) of patients without taking a sexual history. Only 2 (3%) patients were referred to genitourinary medicine (GUM). Appropriate microbiological specimens were obtained from only two of 52 (4%) patients diagnosed with either pelvic inflammatory disease (PID) or epididymo-orchitis. Reliance was placed on inappropriate specimens in 22 (42%). There was widespread use of inappropriate antibiotics. The management of sexually transmitted disease by surgeons was very poor. These patients should all be referred to genito-urinary medicine.

Ultrasound-guided cryotherapy for retinal tears in patients with vitreous hemorrhage.

BACKGROUND AND OBJECTIVE: The goal was to utilize ultrasound-guided cryotherapy as an immediate, low-risk, noninvasive, precise method of treating retinal tears obscured by vitreous hemorrhage. PATIENTS AND METHODS: Eleven patients with sudden onset of vitreous hemorrhage were referred for diagnosis and management. Ophthalmoscopy with scleral depression was unsuccessful at localizing peripheral retinal tears, and all of the patients were examined with ultrasound using the techniques of standardized echography. The cryoprobe was positioned for cryotherapy using both transverse and longitudinal B-scan approaches following the indentation of the globe as it appeared on the oscilloscope. RESULTS: On follow-up examination after the vitreous hemorrhage cleared, 10 of the 11 tears were examined by ophthalmoscopy and were thought to have been adequately treated. One patient had a retinal detachment after remaining stable for 3 months. Two patients were treated with laser to enhance the cryotherapy seal. One patient was observed by another physician and underwent vitrectomy due to vitreous hemorrhage that persisted 2 months following cryotherapy. After vitrectomy, the physician reported a successful cryotherapy reaction at the treated tear. One final patient in the series required vitrectomy and scleral buckle before the hemorrhage had cleared, and the treatment did not appear to be complete. CONCLUSION: Ultrasound-guided cryotherapy provides a noninvasive, inexpensive treatment alternative for retinal tears obscured by vitreous hemorrhage.

The Sigma Project.

The Sigma Project, underway in a number of health care settings across Trent Regional Health Authority, is making dramatic productivity gains and improvements in the quality of care. The Project is being spearheaded by a number of Trust chief executives and unit general managers.

Comparison of amalgam behaviour under static and cyclic sub-modulus of rupture loading.

The behaviour of amalgam beam specimens subjected to a sub-modulus of rupture load at 37 degrees C was compared in static and cyclic modes. Testing was performed using identical equipment, with cyclic testing conducted by intermittent load application for both tests. The specimens tested exhibited varying degrees of deformation and times to fracture in both tests. The mode of load application, either cyclic or static, did not appear to have a significant effect on the degree of amalgam deformation or time to fracture. The most important factors relating to deformation are time of total load application, creep of the specific amalgam and temperature of testing.

Dental amalgams subjected to sub-fracture stresses at 37 degrees C.

Amalgam beam specimens were subjected to sub-modulus of rupture loads at 37 degrees C. The specimens tested underwent varying degrees of deformation and ultimate fracture determined by the degree of specimen bend and time to fracture. The property most closely related to the sub-fracture loading behaviour was creep, particularly the 72-h determination of this property. Time and temperature of testing are also significant factors. The present study indicates the importance of the use of 37 degrees C testing in low-load stressing of dental amalgam. The study has confirmed the nature of failure of amalgam in relation to its rheological properties at the temperature at which amalgam functions clinically.

Adaptation of eight modern dental amalgams to walls of Class I cavity preparations.

An in vitro study was conducted in which a range of amalgam alloys was condensed into Class I cavity preparations. The force of condensation and increment size were varied to determine the effect of these operator variables on the adaptation, of the alloys investigated, to the prepared cavity walls. Specimens were sectioned, metallographically polished and examined using light and scanning electron microscopes. For each specimen ten random points on the pulpal and both vertical walls were selected to measure the adaptation of the amalgam to the tooth structure. For the Class I cavity preparation the adaptation of all alloys to the vertical walls was better than the adaptation to the pulpal walls. The overall adaptability of the alloy did not appear to be determined by the particle size, shape or composition. Condensation force was the most important factor in influencing adaptation of amalgam to the cavity walls. Heavy condensation forces produced better adaptation for all alloys particularly when condensing small increments.

Adaptation of dental amalgam to the cavosurface margin of Class I cavity preparations.

The adaptation of a range of amalgam alloys to the cavosurface margin of Class I cavity preparations was examined for two condensation techniques. The marginal contour of amalgam condensed into the cavity preparation and packed approximately 1 mm past the cavosurface margin was compared with amalgam margins of restorations which were packed to final contour with minimal carving. The effect of burnishing and/or polishing the cavosurface margin was compared with carving the amalgam to the cavosurface margin. Specimens were sectioned, metallographically polished and examined using a light microscope. The technique of overpacking amalgam produced a greater number of acceptable amalgam margins at the cavosurface margin than the condensation technique of packing to final contour, the best cavosurface margin was produced when specimens were burnished and polished, the carved margin being the least desirable. The cuspal incline also influenced the quality of the marginal finish with the difficulty of marginal finishing increasing with the steepness in cuspal incline.

Blindness from retrobulbar injection into the optic nerve.

We report two patients with marked visual loss due to injection within the optic nerve sheath. Findings included severe visual loss, optic disc edema, retinal edema, and intraretinal, preretinal, and vitreous hemorrhage. A review of similar cases in the literature reveals a common but ill-advised use of sharp retrobulbar needles with the technique of retrobulbar injection described by Atkinson. A modified technique which limits the risk of optic nerve trauma is described.

Retinal pigment epithelial lipofuscin and melanin and choroidal melanin in human eyes.

Optical measurements of the pigments of the retinal pigment epithelium (RPE) and choroid were made on 38 human autopsy eyes of both blacks and whites, varying in age between 2 wk and 90 yr old. Lipofuscin in melanin-bleached RPE was measured as fluorescence at 470 mm following excitation at 365 nm and was found to be proportional to fluorescence measured at 560 nm in unbleached tissue. Transmission measurements of RPE and choroidal melanin were converted and expressed as optical density units. The choroidal melanin content increased from the periphery to the posterior pole. RPE melanin concentration decreased from the periphery to the posterior pole with an increase in the macula. Conversely, the amount of RPE lipofuscin increased from the periphery to the posterior pole with a consistent dip at the fovea. There was an inverse relationship between RPE lipofuscin concentration and RPE melanin concentration. The RPE melanin content was similar between whites and blacks. Lipofuscin concentration was significantly greater (P = 0.002) in the RPE of whites compared to blacks; whereas blacks had a significantly greater (P = 0.005) choroidal melanin content than whites. The amounts of both choroidal and RPE melanin showed a trend of decreasing content with aging, whereas the amount RPE lipofuscin tended to increase (whites greater than blacks). Per fundus area, the amount of choroidal melanin was always greater than that in the RPE. There was a statistically significant (P = 0.001) increase in RPE height with age, most marked in eyes of whites after age 50 and correlated with the increase in lipofuscin concentration.

Relationship of senile macular degeneration to ocular pigmentation.

We prospectively evaluated 650 consecutive white patients with senile macular degeneration and compared them to a control group of 363 patients. Ocular pigmentation (iris color and fundus pigmentation) was recorded for each patient, as was hair color (as a child and young adult) and age at evaluation. Patients were from the New England states and Florida. Our most significant finding was that 494 patients with senile macular degeneration (76%) had light-colored irides compared with 145 of the controls (40%). Fundus pigmentation closely corresponded to iris pigmentation (P less than 0.01). Hair color was blond or light brown in 370 of the patients with senile macular degeneration (57%) and in 105 of the controls (29%). Further, there was a tendency for individuals with lightly pigmented irides to have senile macular degeneration at an earlier age than those with dark irides (P less than .01). Thus, increased ocular pigmentation tends to decrease the risk of developing senile macular degeneration.