‘GETTING HERE FROM THERE’: TRAUMA AND TRANSFORMATION IN CANADIAN MILITARY EDUCATION

In early 1997, the Canadian Minister of National Defence publicly issued an excoriating report that roundly condemned the poor state of leadership, ethics discipline, professional knowledge and education in the Canadian Armed Forces particularly among officers. His public exposure stemmed from a series of traumatic events that occurred in the four previous years. The most damning one had been the appalling revelation that some soldiers of the Canadian Airborne Regiment, then on a peacekeeping mission in Somalia, had beaten to death a young Somali teenager. The trail led right back to senior officers in Canada and there was evidence of a cover-up. The embarrassed government was forced into appointing a top level Somalia Commission of Inquiry1. Then, in the next several months, followed revelations recorded on camera of grotesque initiation rites and racism in airborne units and others. The usually complacent and unmilitary Canadian public was shocked and indignant.2 The government promptly disbanded the Canadian Airborne Regiment. How, many asked, did the Canadian Forces get here from its excellent performance in past decades? It had fought well in both World Wars, in Korea and had served with great distinction in the many United Nations missions since that time. Canadians, after all prided themselves believing that their forces were the humanitarian ‘honest northern brokers’ and perhaps the world’s best peacekeepers

Exercise capacity in children with isolated congenital complete atrioventricular block: does pacing make a difference?

Item does not contain fulltextThe management of patients with isolated congenital complete atrioventricular block (CCAVB) has changed during the last decades. The current policy is to pace the majority of patients based on a variety of criteria, among which is limited exercise capacity. Data regarding exercise capacity in this population stems from previous publications reporting small case series of unpaced patients. Therefore, we have investigated the exercise capacity of a group of contemporary children with CCAVB. Sixteen children (mean age 11.5 +/- 4; seven boys, nine girls) with CCAVB were tested. In 13 patients, a median number of three pacemakers were implanted, whereas in three patients no pacemaker was given. All patients had an echocardiogram and completed a cardiopulmonary cycle exercise test. Exercise parameters were determined and compared with reference values obtained from healthy Dutch peers. The peak oxygen uptake/body mass was reduced to 34.4 +/- 9.5 ml kg(-1) min(-1) (79 +/- 24% of predicted) and the ventilatory threshold was reduced to 52 +/- 17% of peak oxygen uptake (78 +/- 21% of predicted), whereas the peak work load/body mass was 2.8 +/- 0.6 W/kg (91 +/- 24% of predicted), which was similar to controls. Importantly, 25% of the paced patients showed upper rate restriction by the pacemaker. In conclusion, children with CCAVB show a reduced peak oxygen uptake and ventilatory threshold, whereas they show normal peak work rates. This indicates that they generate more energy during exercise from anaerobic energy sources. Paced children with CCAVB do not perform better than unpaced children.1 april 201