Factors Affecting Performance on an Army Urban Operation Casualty Evacuation for Male and Female Soldiers

Introduction: This study was conducted to determine what physical and physiological characteristics contribute to the performance of an urban operation casualty evacuation (UO) and its predictive test, FORCE combat (FC) and describe the metabolic demand of the UO in female soldiers. Methods: Seventeen military members (9 M and 8 F) completed a loaded walking maximal aerobic test, the UO and FC. Heart rate reserve (HRR) and completion time were used as efficiency/performance measures. Oxygen consumption (VO2) was directly measured for UO on five female participants with a portable indirect calorimetry system, and analysed using descriptive statistics. Stepwise multiple regression analysis were used to determine the contribution of the non-modifiable (age, sex, height) and modifiable characteristics (lean body mass to dead mass ratio (LBM:DM), VO2max corrected for load (L.VO2max), peak force (PF) measured on an isometric mid-thigh pull (IMTP) and medicine ball chest throw distance (Dist) on to the performance of each exercise. Results: LBM:DM and PF were the only factors included in the stepwise regression model for UO, predicting 70% of UO performance (p<0.01). For FC, L.VO2max only was included in the stepwise regression model predicting 54% of FC performance (p<0.01). Sex, age and height were not included in the regression model. The average metabolic cost of UO was 21.4 mL of O2*kg-1*min-1 in female soldiers while wearing PPE Conclusion: This study showed that modifiable factors such as body composition, PF on IMTP and L.VO2max are key contributors to performance on UO and FC performance

Telemedicine coverage for post-operative ICU patients.

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p \u3c 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation

Integrated methodologies of economics and socio-economics assessments in ocean renewable energy : private and public perspectives

This paper offers a holistic approach to the evaluation of an ocean renewable energy (ORE) technology type or specific project in order to provide a comprehensive assessment of both narrow economic and broader socio-economic performance. This assessment incorporates methods from three pillars areas: Economic - financial returns and efficient use of resources, Social - employment, social and community cohesion and identity, and Environmental - including the physical environment and pollution. These three pillars are then considered in the broader context of governance. In order to structure this evaluation, a novel parameter space model was created, defined by the three pillars and by the scale of the system under assessment. The scale of the system ranged from individual components of an ORE project; to projects comprising of a number of devices; through to a geographic regions in which multiple farms may be deployed. The parameter space consists of an inner circle representing the boundary of interest for a private investor, or a firm, developing an ORE project. The outer circle is characterised by assessment tools typically employed at the broader stakeholder level including economic, social, and environmental methods that can be employed at local, regional or national scale and which are typically employed to inform policy and decision making regarding ORE. Governance sets the stage within which management occurs. Wider impacts to the firm undertaking the project will take into account “externalities” of the project across the three fields. In this model, key methods identified are mapped onto this parameter space and the connectivity explored. The paper demonstrates that the three pillars are inter-connected and each must be considered in any meaningful assessment of ORE sustainability. An integrated assessment approach has the ability to address both the private and the public aspects of an ORE development,. This analysis provides insights on existing best practice, but also reveals the potential for disconnect between an ORE project’s commercial viability and its contribution to environmental and social goals

The role of structured inpatient lipid protocols in optimizing non-statin lipid lowering therapy: a review and single-center experience

Dyslipidemia is a leading contributor to atherosclerotic cardiovascular disease (ASCVD). There has been a significant improvement in the treatment of dyslipidemia in the past 10 years with the development of new pharmacotherapies. The intent of this review is help enhance clinicians understanding of non-statin lipid lowering therapies in accordance with the 2022 American College of Cardiology Expert Consensus Clinical Decision Pathway on the Role of Non-statin Therapies for LDL-Cholesterol Lowering. We also present a single-center experience implementing a systematic inpatient protocol for lipid lowering therapy for secondary prevention of ASCVD

Do successor effects in reading reflect lexical parafoveal processing? Evidence from corpus-based and experimental eye movement data

Abstract In the past, most research on eye movements during reading involved a limited number of subjects reading sentences with specific experimental manipulations on target words. Such experiments usually only analyzed eye-movements measures on and around the target word. Recently, some researchers have started collecting larger data sets involving large and diverse groups of subjects reading large numbers of sentences, enabling them to consider a larger number of influences and study larger and more representative subject groups. In such corpus studies, most of the words in a sentence are analyzed. The complexity of the design of corpus studies and the many potentially uncontrolled influences in such studies pose new issues concerning the analysis methods and interpretability of the data. In particular, several corpus studies of reading have found an effect of successor word (n&#xa0;+&#xa0;1) frequency on current word (n) fixation times, while studies employing experimental manipulations tend not to. The general interpretation of corpus studies suggests that readers obtain parafoveal lexical information from the upcoming word before they have finished identifying the current word, while the experimental manipulations shed doubt on this claim. In the present study, we combined a corpus analysis approach with an experimental manipulation (i.e., a parafoveal modification of the moving mask technique, Rayner & Bertera, 1979), so that, either (a) word n+1, (b) word n+;2, (c) both words, or (d) neither word was masked. We found that denying preview for either or both parafoveal words increased average fixation times. Furthermore, we found successor effects similar to those reported in the corpus studies. Importantly, these successor effects were found even when the parafoveal word was masked, suggesting that apparent successor frequency effects may be due to causes that are unrelated to lexical parafoveal preprocessing. We discuss the implications of this finding both for parallel and serial accounts of word identification and for the interpretability of large correlational studies of word identification in reading in general

Selenium in reproduction

Selenium is an essential trace element of importance to human biology and health. Increasing evidence suggests that this mineral plays an important role in normal growth and reproduction in animals and humans, and selenium supplementation is now recommended as part of public health policy in geographical areas with severe selenium deficiency in soil. This review addresses the biological functions of selenium followed by a detailed review of associations between selenium status and reproductive health. In many countries, selenium dietary intake falls below the recommended nutrient intakes and is inadequate to support maximal expression of the selenoenzymes. Numerous reports implicate selenium deficiency in several reproductive and obstetric complications including male and female infertility, miscarriage, preeclampsia, fetal growth restriction, preterm labor, gestational diabetes, and obstetric cholestasis. Currently, there is inadequate information from the available small intervention studies to inform public health strategies. Larger intervention trials are required to reinforce or refute a beneficial role of selenium supplementation in disorders of reproductive health

Studying synapses in human brain with array tomography and electron microscopy

Postmortem studies of synapses in human brain are problematic due to the axial resolution limit of light microscopy and the difficulty preserving and analyzing ultrastructure with electron microscopy. Array tomography overcomes these problems by embedding autopsy tissue in resin and cutting ribbons of ultrathin serial sections. Ribbons are imaged with immunofluorescence, allowing high-throughput imaging of tens of thousands of synapses to assess synapse density and protein composition. The protocol takes approximately 3 days per case, excluding image analysis, which is done at the end of the study. Parallel processing for transmission electron microscopy (TEM) using a protocol modified to preserve structure in human samples allows complimentary ultrastructural studies. Incorporation of array tomography and TEM into brain banking is a potent way of phenotyping synapses in well-characterized clinical cohorts to develop clinico-pathological correlations at the synapse level. This will be important for research in neurodegenerative disease, developmental diseases, and psychiatric illness

The Nutrition and Enjoyable Activity for Teen Girls (NEAT girls) randomized controlled trial for adolescent girls from disadvantaged secondary schools: rationale, study protocol, and baseline results

Background: Child and adolescent obesity predisposes individuals to an increased risk of morbidity and mortality from a range of lifestyle diseases. Although there is some evidence to suggest that rates of pediatric obesity have leveled off in recent years, this has not been the case among youth from low socioeconomic backgrounds. The purpose of this paper is to report the rationale, study design and baseline findings of a school-based obesity prevention program for low-active adolescent girls from disadvantaged secondary schools. Methods/Design: The Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention will be evaluated using a group randomized controlled trial. NEAT Girls is a 12-month multi-component school-based intervention developed in reference to Social Cognitive Theory and includes enhanced school sport sessions, interactive seminars, nutrition workshops, lunch-time physical activity (PA) sessions, PA and nutrition handbooks, parent newsletters, pedometers for self-monitoring and text messaging for social support. The following variables were assessed at baseline and will be completed again at 12- and 24-months: adiposity, objectively measured PA, muscular fitness, time spent in sedentary behaviors, dietary intake, PA and nutrition social-cognitive mediators, physical self-perception and global self-esteem. Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA and nutrition behavior change will be explored. Discussion: NEAT Girls is an innovative intervention targeting low-active girls using evidence-based behavior change strategies and nutrition and PA messages and has the potential to prevent unhealthy weight gain and reduce the decline in physical activity and poor dietary habits associated with low socio-economic status. Few studies have reported the long-term effects of school-based obesity prevention programs and the current study has the potential to make an important contribution to the field

Comprehensive and Integrated Genomic Characterization of Adult Soft Tissue Sarcomas

Sarcomas are a broad family of mesenchymal malignancies exhibiting remarkable histologic diversity. We describe the multi-platform molecular landscape of 206 adult soft tissue sarcomas representing 6 major types. Along with novel insights into the biology of individual sarcoma types, we report three overarching findings: (1) unlike most epithelial malignancies, these sarcomas (excepting synovial sarcoma) are characterized predominantly by copy-number changes, with low mutational loads and only a few genes (, , ) highly recurrently mutated across sarcoma types; (2) within sarcoma types, genomic and regulomic diversity of driver pathways defines molecular subtypes associated with patient outcome; and (3) the immune microenvironment, inferred from DNA methylation and mRNA profiles, associates with outcome and may inform clinical trials of immune checkpoint inhibitors. Overall, this large-scale analysis reveals previously unappreciated sarcoma-type-specific changes in copy number, methylation, RNA, and protein, providing insights into refining sarcoma therapy and relationships to other cancer types

Integrated genomic characterization of oesophageal carcinoma

Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies