Recent changes in hypoxia training at the Royal Air Force Centre of Aviation Medicine.

Hypoxia training at the Royal Air Force Centre of Aviation Medicine (RAF CAM) has traditionally involved the use of a hypobaric chamber to induce hypoxia. While giving the student experience of both hypoxia and decompression, hypobaric chamber training is not without risks such as decompression sickness and barotrauma. This article describes the new system for hypoxia training known as Scenario-Based Hypoxia Training (SBHT), which involves the subject sitting in an aircraft simulator and wearing a mask linked by hose to a Reduced Oxygen Breathing Device (ROBD). The occupational requirements to be declared fit for this new training method are also discussed.

Proxy consent: moral authority misconceived.

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person's best interests and that the new legislation introduces only an advisor, not a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people's desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people's thought processes indicates that we are unlikely ever to achieve accurate simulations of others' wishes in making a proxy decision. Third, even if we could accurately simulate other people's beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements.

The effect of camera viewing angle on posture assessment repeatability and cumulative spinal loading.

Video-based task analysis in the workplace is often limited by equipment location and production line arrangement, therefore making it difficult to capture the motion in a single plane. The purpose of this study was to investigate the effects of camera placement on an observer's ability to accurately assess working postures in three dimensions and the resultant influence on the reliability and repeatability of calculated cumulative loading variables. Four video cameras were placed at viewing angles of 0 degrees, 45 degrees, 60 degrees and 90 degrees to the frontal plane, enabling the simultaneous collection of views of four lifting tasks (two symmetric and two asymmetric). A total of 11 participants were trained in the use of the 3DMatch 3-D posture matching software package (developed at the University of Waterloo) and were required to analyse 16 lifting trials. Four of the participants were randomly selected to return within 72 h and repeat the analysis protocol to test intra-observer repeatability. Posture matching agreement between camera views was higher when the body segments had a minimal range of motion during the task. There was no significant participant main effect; however, there was a significant (p < 0.05) task main effect. Intraclass correlation coefficients (ICC) were calculated to assess the between day reliability. Compression, reaction anterior shear and extension moment were all found to have excellent reliability (ICC > 0.75). Joint anterior shear and joint posterior shear both provided fair to good reliability (0.4 > ICC < 0.75). Overall, the impact of the camera viewing angle on an observer's ability to match working postural exposure was found to be small.

Sex differences in the rate of fatigue development and recovery.

BACKGROUND: Many musculoskeletal injuries in the workplace have been attributed to the repetitive loading of muscle and soft tissues. It is not disputed that muscular fatigue is a risk factor for musculoskeletal injury, however the disparity between gender with respect to muscular fatigability and rate of recovery is not well understood. Current health and safety guidelines do not account for sex differences in fatiguability and may be predisposing one gender to greater risk. The purpose of this study was to quantify the sex differences in fatigue development and recovery rate of lower and upper body musculature after repeated bouts of sustained isometric contractions. METHODS: Twenty-seven healthy males (n = 12) and females (n = 15) underwent bilateral localized fatigue of either the knee extensors (male: n = 8; female: n = 8), elbow flexors (male: n = 8; female: n = 10), or both muscle groups. The fatigue protocol consisted of ten 30-second sub-maximal isometric contractions. The changes in maximum voluntary contraction (MVC), electrically evoked twitches, and motor unit activation (MUA) were assessed along with the ability to control the sustained contractions (SLP) during the fatigue protocol using a mixed four-factor repeated measures ANOVA (gender x side x muscle x time) design with significance set at p < 0.05. RESULTS: There was a significant loss of MVC, MUA, and evoked twitch amplitude from pre- to post-fatigue in both the arms and legs. Males had greater relative loss of isometric force, a higher rate of fatigue development, and were less capable of maintaining the fatiguing contractions in the legs when compared to the females. CONCLUSION: The nature of the induced fatigue was a combination of central and peripheral fatigue that did not fully recover over a 45-minute period. The results appear to reflect sex differences that are peripheral, and partially support the muscle mass hypothesis for explaining differences in muscular fatigue.

Differential regulation of survival and growth in adult sympathetic neurons: an in vitro study of neurotrophin responsiveness.

The survival and growth of embryonic and postnatal sympathetic neurons is dependent on both NGF and NT3. While it has been established that adult sensory neurons survive independently of neurotrophins, the case is less clear for adult sympathetic neurons, where the studies of survival responses to neurotrophins have relied upon using long-term cultures of embryonic neurons. We have previously established a method to culture purified young (7 day) and adult (12 week) sympathetic neurons isolated from adult rat superior cervical ganglia (SCG) in order to examine their survival and growth responses to neurotrophins. We now show that by 12 weeks after birth virtually all neurons (90%) survive for 24 h in the absence of neurotrophins. Neuron survival is unaffected by treatment with anti-NGF antibodies (anti-NGF) or with the tyrosine kinase inhibitor, K252a, confirming the lack of dependence on extrinsic neurotrophins. Duration of neuron survival in culture increases significantly between E19 and day 7 and week 12 posnatally, and is similarly unaffected by the presence of anti-NGF or K252a. Saturating concentrations of NGF and NT3 are equipotent in promoting neurite extension and branching. However, we find that NGF is more potent than NT3 in promoting neurite growth, irrespective of postnatal age. The growth-promoting effects of NGF and NT3 are almost entirely blocked by K252a, demonstrating that these effects are mediated via activation of Trk receptors, which therefore appear to remain crucial to plasticity of adult neurons. Our results indicate that maturing neurons acquire protection against cell death, induced in the absence of neurotrophin, while retaining their growth responsiveness to these factors.