Search

IntroductionThe purpose of this pilot study was to assess for biomarkers indicative of passing intense physical training and establishing normative values within the tactical athlete population. Unfortunately, none of the biomarkers assessed were indicative of passing training, however, glucose, blood urea nitrogen, and creatine kinase (CK) levels stood out as abnormal. CK levels are commonly used in conjunction with muscle pain and/or myoglobinurea to diagnose exertional rhabdomyolysis (ER) in athletes and the military population. However, research shows that high CK levels may not correlate with acute kidney failure in ER.Materials and MethodsAfter IRB approval and informed consent, blood samples were obtained from 21 volunteers during two phases of the combat control training pipeline: the first phase (12 participants) was 2 hours of daily physical training followed by 8 hours of academics, and the second phase (nine volunteers) a grueling, 72 hour, intense training cycle (stress inoculation training, SIT) with a historic pass rate of only 50%. Biomarkers were also tracked 48 hours after cessation of SIT.ResultsNone of the biomarkers assessed showed a correlation with passing SIT, but high CK levels were well above the diagnostic threshold for ER—as high as 28,000 u/L. At a single point in time, a significant correlation did not exist between CK and others markers associated with rhabdomyolysis. Across time, partial correlations controlling for subject did exist between CK and other markers.ConclusionsIn our low-powered case control study (pilot study), a nonpathologic elevation of CK is prevalent in high-intensity military training, but not shown to correlate with values associated with acute kidney injury. We assume that real-time collection of these markers could be used once sensors are capable of real-time collection and have the potential for diagnostic affordance. When measured in a between subjects design, our study showed a lack of significance when correlating markers of acute renal injury and elevation of CK. However, when utilized for tracking purposes (within subjects design), the results do show a positive correlation between CK and renal failure biomarkers—specifically only at high physiological stress points.

Capturing age and sex of subjects from whole-body features has important applications in a wide variety of areas. However, current techniques for determining this information without subject interaction or high-resolution images are problematic. While computer vision techniques (e.g. poselets and histogram-oriented gradients) are functional at a stand-off, these methods often include areas influenced by characteristics such as clothing or hairstyle which vary by region and culture. Whole-body anthropometrics, especially those of children and youth experiencing rapid musculoskeletal changes, may help inform robust models of age estimation and sex classification. Models of anthropometric variables were developed from a pre-existing database for age estimation using linear regression techniques. Sex classification was performed both over the entire subject group as well as three individual age bins (2 ≤ subject age < 8, 8 ≤ subject age < 14, and 14 ≤ subject age). Age estimation models were highly dependent on head size and exhibited r-squared values as high as 0.91 and root mean square error values as low as 1.29 years. Sex classification was found to be highly linked to a combination of foot, hand, hip, and torso metrics for correct classification as high as 88%. The results presented herein may help develop and focus methods of determining age and sex.

Sample return missions to Phobos are the subject of future exploration plans. Given the proximity of Phobos to Mars, Mars’ potential to have supported life, and the possibility of material transfer from Mars to Phobos, careful consideration of planetary protection is required. If life exists, or ever existed, on Mars, there is a possibility that material carrying organisms could be present on Phobos and be collected by a sample return mission such as the Japanese Martian Moons eXplorer (MMX). Here we describe laboratory experiments, theoretical modelling and statistical analysis undertaken to quantify whether the likelihood of of a sample from Phobos material containing unsterilized material transferred from Mars is less than 10-6, the threshold to transition between restricted and unrestricted sample return classification for planetary protection. We have created heat, impact and radiation sterilisation models based on the Phobos environment, and through statistical analyses investigated the level of sterilisation expected for martian material transferred to Phobos. These analyses indicate that radiation is the major sterilisation factor, sterilising the Phobos surface over timescales of millions of years. The specific events of most relevance in the Phobos sample return context are the ‘young’ cratering events on Mars that result in Zunil-sized craters, which can emplace a large mass of martian material on Phobos, in a short period of time, thus inhibiting the effects of radiation sterilisation. Major unknowns that cannot yet be constrained accurately enough are found to drive the results – the most critical being the determination of exact crater ages to statistical certainty, and the initial biological loading on Mars prior to transfer. We find that, when taking a conservative perspective and assuming the best-case scenario for organism survival, for a 100 g sample of the Phobos regolith to be below the planetary protection requirement for unrestricted sample return, the initial biological loading on Mars must be 3cfu kg-1. For the planned MMX mission, a ∼10 g sample to be obtained from a 25-30 mm diameter core as planned would require an initial martian biological loading to be 4cfu kg-1, in order to remain compliant with the planetary protection threshold.

Studies on human perception have identified pelvis and torso motion as key discriminators between male and female gaits. However, while most observers would advocate that men and women walk differently, consistent findings and explanations of sex differences in gait kinematics across modern empirical studies are rare. In the present study we evaluated sex differences in whole body gait kinematics from a large sample of subjects (55 men, 36 women) walking at self selected speeds. We analyzed the data through comparisons of discrete metrics and whole curve analyses. Results showed that in the frontal plane, women walked with greater pelvic obliquity than men, but exhibited a more stable torso and head. Women had greater transverse plane pelvis and torso rotation as well as greater arm swing. Additional sex differences were noted at the hip and ankle. These kinematic results are in line with anectdotal observations and qualitative studies. In order to understand these observations and substantiate some of the explanations previously set forth in the biomechanics literature, we also explored possible reasons for dynamic sex effects, and suggested applications that may benefit from their consideration.

Introduction: It is estimated that up to 30% of medical services in Canada are potentially unnecessary, not supported by current evidence or may cause patient harm. This type of practice negatively impacts patients and the healthcare system. Evidence suggests that medical education strongly impacts resource utilization in future practice. Our objective was to integrate Choosing Wisely (CW) recommendations into the undergraduate medical education curriculum to improve students understanding of resource stewardship in their pre-clerkship training. Methods: Post-course survey data and written feedback were collected from the Cumming School of Medicines 2019 class. Qualitative analysis of written feedback was used to identify perceived strengths and areas of improvement to inform additional changes for the 2020 class through a Plan-Do-Study-Act (PDSA) cycle. Results: The post-course survey was completed by 143 students. 60% reported the inclusion of CW improved their ability to develop a clinical management plan. Using the information gathered from the qualitative analysis, we made the following changes for the 2020 class: create an introductory lecture on resource stewardship, incorporate relevant CW recommendations into case study learning objectives, and create standardized slides on CW recommendations for lecturers. Feedback from the 2020 class revealed that the changes were well received and students reported feeling more comfortable with resource stewardship concepts. Conclusion: This data reveals that our efforts have increased students confidence in creating a management plan that integrates resource stewardship and patient safety, and elicited strong faculty support. We will continue to integrate these changes and to obtain student and faculty feedback to help inform additional iterative changes for the subsequent cohort. Our findings are valuable for other medical schools across Canada seeking to incorporate CW material.

Public health spans several disciplines dedicated to the improvement of the health and well-being of popula tions across the globe. This mission broadly focuses on prevention of illness, disease, and injury; utilization of appropriate health-care services; and addressing of health-care disparities. The pursuit of social justice underlies this goal. Core disciplines include epidemi ology, environmental health sciences, health policy and management, social and behavioral sciences, and biostatistics. These disciplines draw on a fundamental knowledge of biology, a basic familiarity with social sciences, and an appreciation of socioeconomic and cultural variance among different people. An undergraduate Public Health Studies (PHS) major gives students a unique opportunity to enter into the world of public health. According to a survey by the Association of Schools of Public Health in 2005,113 schools of public health (SPHs) reported that their uni versities offered undergraduate majors. These schools included Johns Hopkins University (JHU), George Washington University (GWU), Loma Linda University (LLU), University of North Carolina at Chapel Hill (UNC-CH), University of California at Berkeley (UC Berkeley), University of Washington (UW), and Tulane University (TU). Three of these universities?GWU, UW, and TU?as well as four other schools?Bos ton University (BU), University of California at Los Angeles (UCLA), University of Southern California (USC), and University of South Florida (USF)?offer minors in undergraduate public health. Six of these schools and an additional 13 universities with SPHs

We assessed the advantages of a color-coded weapons symbology for a helmetmounted display over monochrome symbology by measuring military pilots' performance while they flew air-to-air combat in a simulator. The pilots fired missiles significantly sooner without sacrificing probability of kill when using the color coded symbology, demonstrating a substantial practical benefit of color. Actual or potential applications of this work include the design of color codes for helmetmounted and other displays that use complex symbology to assist performance on cognitively challenging tasks.

The nitrogen dynamics of storm runoff was studied using throughfall trenches on slopes with thin soils in a white pine forest catchment near Dorset, Ontario. Hydrologic data were combined with analysis of isotopic signatures and nitrogen chemistry in throughfall, soil water, and hillslope runoff. Two hypotheses were tested: (1) macropore preferential flow pathways are a source of nitrate flushing in storm runoff, and (2) the nitrogen chemistry of subsurface storm flow is controlled by the mixing of event water fluxes via macropores with preevent soil water. Most flow occurred at the soil-bedrock interface on the slopes, and the use of 18O indicated that a considerable fraction of event water moved vertically to bedrock via preferential flow paths. Despite high levels of inorganic N in throughfall, subsurface runoff N losses during autumn storms were dominated by dissolved organic nitrogen, and little nitrate flushing occurred via preferential flow paths. Comparisons of observed NO3- and NH4+ concentrations versus concentrations predicted from the mixture of event and preevent water in subsurface flow did not support hypothesis 2 and instead indicated depletion of inorganic N. Low rates of N mineralization and negligible nitrification in surface 0–0.1 m soil during June–October suggested high biological utilization of a limited soil N supply. Laboratory experiments in which soil cores were leached with solutions containing NO3- and bromide confirmed that the organic Ae horizon was a sink for NO3-. These data suggest that the biogeochemistry of the organic horizon can regulate patterns of inorganic N loss in subsurface runoff moving by preferential flow pathways in forest soils.

The largest study on post-allogeneic hematopoietic cell transplant lymphoproliferative disorder (PTLD) epidemiology showed a cumulative incidence of 1.7% in patients receiving antithymocyte globulin (ATG). We had noted an apparently higher incidence in our transplant recipients whose conditioning included ATG. Therefore, we formally determined the incidence of PTLD through chart review. We also evaluated whether counts of EBV-specific T lymphocytes measured by cytokine flow cytometry could identify patients at risk of developing PTLD. Among 307 allogeneic transplant recipients, 25 (8.1%) developed PTLD. This was biopsy proven in 11 patients, and was fatal in seven patients. Patient age, EBV serostatus, donor type/match or GVHD did not influence PTLD risk significantly. Median onset of PTLD was 55 (range, 28–770) days post transplant. Day 28 EBV-specific T lymphocyte counts were not significantly different in 11 patients who developed PTLD and 31 non-PTLD patients matched for published risk factors for PTLD. In summary, when using conditioning with thymoglobulin 4.5 mg/kg, the incidence of PTLD is relatively high and cannot be predicted by day 28 cytokine flow cytometry-determined EBV-specific T lymphocyte counts. Thus, in this scenario PTLD prevention may be warranted, for example, using EBV DNAemia monitoring with preemptive therapy.

A randomised trial has previously been repeated in which 437 women with node positive breast cancer received either a 12-week chemohormonal regimen consisting of cyclophosphamide, methotrexate, fluorouracil, vincristine, prednisone, adriamycin and tamoxifen or 36 weeks of CMFVP. The present analysis concerns the local recurrence rates for the 122 lumpectomy patients who did not receive breast irradiation. The cumulative rate of local breast recurrence was greater in the 12-week than the 36-week group, P = 0.02. Similarly, in the lumpectomy patients, the cumulative rate of distant recurrence was greater in the 12-week than the 36-week group, P = 0.04. In conclusion, our results suggest that adjuvant chemotherapy impacts on local breast recurrence in a similar manner to other sites in Stage II breast cancer patients treated by lumpectomy without radiation. Despite the use of a conventional 36-week adjuvant chemotherapy regimen, the local breast recurrence rate was substantial.

AB is a 73 year old Caucasian male who was diagnosed with mild Hemophilia A in 2001. He is part of a large kindred of patients with mild Hemophilia A enrolled in a cohort study. His family history was strongly positive. He was referred at the age of 69 years by a family member. His baseline Factor VIII level was 0.10. AB’s past medical history is characteristic of mild Hemophilia A. As a child he suffered frequently from epistaxis. He bled extensively after lacerations. He had had three significant accidents during his adult years, each of which resulted in massive bleeding and multiple blood transfusions. He had had three dental extractions which resulted in significant bleeding during two of three procedures. He had a hydrocele repair without complications. In 1999, he was extensively investigated for melena with no cause. He had an episode of atrial fibrillation and a possible transient ischemic attack treated with warfarin and aspirin. AB reported significant joint swelling and decreased range of motion. He also reported that he had “a leaky heart valve’. His initial physical examination revealed significant musculoskeletal problems. He had decreased range of motion bilaterally in his hips. He had extensive swelling of both knees and decreased range motion of both ankles. There was a limb length discrepancy of 1.5 cm. AB denied severe joint pain in his lower limbs or the usual symptoms associated with hemophiliac arthropathy. His aPTT was prolonged but he had not had a Factor VIII level previously measured and had never been told that he had Hemophilia A. He received a trial of prophylactic Recombinant Factor VIII three times a week for two months and was referred to an orthopedic surgeon. He received a “Factor First” Identification card recommending he receive 4000 units Recombinant Factor VIII for a major bleed. However, he had great difficulty in accepting the diagnosis and neither he nor his family initially volunteered that he had Hemophilia on his next admission. In April, 2002, AB was admitted to ICU in a community hospital, in Diabetic Ketoacidosis, three weeks after a snowmobile accident. Retrospectively, he reported back pain which he managed with NSAIDS. He was unable to walk prior to his hospitalization. In ICU, he required daily transfusions of PRBC & FFP. Abdominal CT on admission reported a resolving iliopsoas hematomas after an upper gastrointestinal bleed he was transferred to the provincial tertiary care centre. Follow-up CT showed bilateral ilopsoas hemtomas with abscess formation. A CT guided aspiration confirmed the presence of Staphyloccus aureus and a left paravertebral abscess. Follow-up CT showed no improvement. A second CT guided aspiration was performed which showed vertebral body destruction of L3, L4 and L5, discitis and multiple abscess formation. AB underwent L3-S1 fusion with laminectomy and decompression of L3–L4 and L4–L5 with no complications. In total AB received 316,040 units of RF VIII during a 122 day period of hospitalization. In contrast, the other 60 patients enrolled in our study only used 656,515 in a 4-year period. FACTOR VIII PRODUCT USAGE 2001–2004 FACTOR VIII PRODUCT USAGE 2001–2004

There has been much speculation about the ecology and behavior of whales, largely because effective techniques were not available for tracking them underwater, or for recording their dive depths. Thus, I developed a new tag and used it to mark free-swimming whales to monitor and record their geographical and vertical movements in real time. The tag contained 2 transmitters. The sonic transmitter (50 kHz) allowed submerged whales to be tracked from ≤2 km, and it produced a pulse rate or pulse intervalcoded signal from which dive depths were recorded. A VHF radio transmitter (148.00 MHz band) allowed individuals to be tracked at the sea surface from 10's of km

The pattern of sleep and wakefulness varies widely between individual people and is influenced by many factors. Several reports involving sub jective recording of sleep habits in young adults have been published, with particular emphasis on the duration of sleep (Bousfield, 1940; Lawrence and Shurley, 1970; Webb and Agnew, 1970). However, the variations within such a population and relation ships between the various aspects of behaviour re lating to sleep and wakefulness have not been described adequately. Much of the emphasis in the many sleep laboratories which have been established throughout the world has been on all-night electro encephalogram monitoring. Details of the usual pattern of dreaming and non-dreaming sleep stages have besn described for normal people of different ages and for patients with various physical and psychiatric illnesses (Kales, 1969). Important as such methods are in providing basic information on the nature of sleep and dreams, they do not tell us all we want to know about people's usual pattern of sleep and wakefulness and the factors which in fluence this pattern. For instance, electronic methods used in the laboratory do not tell us at what time our experimental subject usually goes to bed and to sleep at night when he is at home, nor do they tell us how often he dozes during the day, how often he takes sleeping tablets, how he feels about the quality of his sleep, and so on. This information can be obtained by means of detailed subjective reports in the form of either daily sleep charts kept for several weeks or a sleep questionnaire. Such methods of subjective reporting have been used among various occupational groups as well as hospital patients and healthy people of different ages (Lewis and Masterton, 1957; Masterton, 1965 a, b; McGhie and Russell, 1962; Johns, Egan, Gay, and Masterton, 1970). The importance of both subjective and objective methods for describing sleep habits in detail has recently been emphasized (Johns, 1971). The accuracy of subjective estimates of such para meters as the usual delay to sleep onset and the duration of sleep has been measured using objective techniques in the laboratory (Lewis, 1969; Baekeland and Hoy, 1970). There is a significant correlation between these subjective and objective measures, but the former tend to over-estimate the delay to sleep onset and to under-estimate the duration of sleep. This is a definite disadvantage in using sleep questionnaires but does not preclude their use, especi ally in determining the relationships between sleep habits in different groups of people. Monroe (1967) studied groups of'good' and 'poor' sleepers who were healthy young adults selected on the basis of their responses to a sleep questionnaire. The 'poor' sleepers reported usually having longer delays and more difficulty in falling asleep, and they woke up more often during the night than 'good' sleepers. The two groups did in fact have objective differences in the duration of their sleep, number of night awakenings, and the pattern of sleep stages when monitored electronically. Similar studies have demonstrated significant objective differences in the sleep patterns of subjects reporting to be 'long' as opposed to 'short' sleepers (Hartmann, Baekeland, Zwilling and Hoy, 1970; Webb and Friel, 1971). In the present study a sleep questionnaire was given to a relatively homogeneous population of fourth-year medical students at Monash University, Melbourne in 1969 and 1970. This involved 249 students, all of whom were of similar age and daily routine. In this report we shall describe the varia tions in, and the intercorrelations between, the answers given by these students to questions relating to the quality and quantity of their usual sleep. Some of these students took part also in two ad ditional studies of the relationship between levels of adrenocortical activity and sleep habits, and between personality and sleep habits, the results of which will be reported separately. This study forms part of a long-term investigation of normal variations in subjectively reported sleep and the nature of in somnia which is such a common symptom among hospital patients and in the general community (Johns et al, 1970).

The most fascinating aspect of the language and style of Tacitus is that they may be seen in evolution. If we set aside the Dialogus as a special case because of its subject matter, for which a Ciceronian style was virtually obligatory, we may follow Tacitus' style through a continuous process of development from the two monographs to the Histories and then to its culmination in his most mature work, the Annals—though to use this word ‘culmination’ may be to prejudge the issue. Of course stylistic change and development may be found in the works of many writers, Cicero and Propertius for instance, but in few writers if any is the development so clear to see, yet also so complicated, as in Tacitus.E. Wölfflin, who began the systematic investigation of Tacitus' language and style, maintained that there is in Tacitus' writings a persistent and continuous movement away from normal, hackneyed and colourless expressions towards novelty, colour and dignity, towards what the Greeks called σενότης—or, as some have chosen to put the matter, Tacitus in diverging more and more from the ‘normal’ became progressively more ‘Tacitean’.

The purpose of this paper is twofold: to comment on certain remarks of E. Koestermann, and to examine briefly some passages adduced by K. Wellesley as evidence for the alleged independence of the Leidensis (hereafter L).In a paper in CQ N.S. XV (1965), 299–322, I attempted to demonstrate by various arguments that the readings of L are not such as to support the claim that this manuscript has authority independent of M. Those arguments may be summarized as follows: that the majority of L's readings fall into a pattern of systematic normalization, that they give virtually no help in solving really deep corruptions, that L is particularly unreliable in transmitting proper names, that many readings of L show clear signs of being derived from M, that few (if any) of the good readings in L could not have been extracted from the corrupt text of M, and that other fifteenth-century manuscripts of Tacitus contain good corrections, not inferior to corrections found in L. No defender of L has yet, as far as I know, answered the arguments I put forward, and E. Koestermann has not even understood them, for he writes as follows (vol. iii of his commentary on the Annals [Heidelberg, 1967], p. 21): ‘[Goodyear] legt den Finger darauf, daß die abweichenden Lesarten in L in ihrer Diktion stärker ciceronischen Charakter tragen, demnach eher als Konjekturen zu verstehen seien. Aber dies Argument ist nicht durchschlagend, da die späteren Annalenbücher … eine gemässigtere Tendenz aufweisen und damit näher an Cicero heranrücken.’

Readings from a manuscript which once belonged to Rodolphus Agricola and later to Theodore Ryck were well known to and lightly esteemed by the editors of Tacitus from the late seventeenth to mid nineteenth centuries. Ryck cited over 1,200 of them in his edition of 1687. Later the whereabouts of the manuscript remained long unknown, until it was rediscovered by C. W. Mendell as Leidensis BPL 16. B in the University Library at Leiden.

‘Tiberium Neronem et Claudium Drusum priuignos imperatoriis nominibus auxit [sc. Augustus]’’, i.e. honoured them with salutations as ‘imperatores’’. So I took it in my commentary (Cambridge, 1972), supposing argument needless. I must now defend my view against R. Syme, Historia antiqua, Commentationes Louanienses in honorem W. Peremans (Louvain, 1977), p.239. Syme asserts ‘Avoiding a technical term, he [Tacitus] describes the stepsons of the Princeps as invested with imperatoriis nominibus (3.1). That is, a grant of imperium proconsular (after the campaigns of 11 B.C.).’’ He adds in a footnote ‘As emerges clearly from Dio 54.33.5 (Drusus), cf. 34.4 (Tiberius). The matter must be stated firmly, since both Koestermann and Goodyear are totally inadequate.’’ Let me make amends.