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During the coronavirus disease of 2019 (COVID-19) pandemic, overseas military bases faced unique challenges to preserve force health protection while simultaneously caring for military beneficiaries. The response to the rapidly evolving challenges surrounding transmission of the severe acute respiratory syndrome coronavirus 2 in Okinawa, Japan, required innovative solutions. One innovative solution was the COVID-19 Operational Response Cell established at Camp Courtney, Marine Corps Base Camp Smedley D. Butler. This interview describes the COVID-19 Response Cell operations and essential lessons learned by a Navy Nurse Corps officer working with III Marine Expeditionary Force, a forward-deployed force in the U.S. Indo-Pacific Command.

The human spleen can contract and transiently boost the blood with stored erythrocytes. We measured spleen volume and contraction during apneas in two groups, each containing 12 Caucasian participants (each 3 women): one group planning to summit Mt. Everest (8848 m; "Climbers") and another trekking to Everest Base Camp (5300 m; "Trekkers"). Tests were done in Kathmandu (1370 m) 1-3 days after arrival, before the Climb/Trek. Age, height, weight, vital capacity, resting heart rate, and arterial oxygen saturation were similar between groups (not significant). After 15 minutes of sitting rest, all participants performed a 1-minute apnea and, after 2 minutes of rest, 1 maximal duration apnea was performed. Six of the climbers did a third apnea and hemoglobin concentration (Hb) was measured. Three axial spleen diameters were measured by ultrasonic imaging before and after the apneas for spleen volume calculation. Mean (standard deviation) baseline spleen volume was larger in Climbers [367 (181) mL] than in Trekkers [228 (70) mL

Moore, G.W.K., Paolo Cristofanelli, Paolo Bonasoni, Gian Pietro Verza, and J.L. Semple. Was an avalanche swarm responsible for the devastation at Mount Everest Base Camp during the April 2015 Nepal earthquake?

Photo credit: UX Solutions Prague David Anton, the Royal National Lifeboat Institution’s first consultant occupational physician, who investigated multiple high profile aeroplane crashes and was a consultant to the US navy and air force, has died at his home at the age of 75. David Anton was born in London to Tony Anton, a solicitor, and Vera (nee Dobson). He was educated at Strode’s School, Egham, and Solihull School, along with his three younger brothers. His lifelong interest in mountains and the outdoors was sparked by an inspirational teacher who had the class follow the progress of John Hunt’s successful Everest expedition, building a model of the mountain and studying the climbers and their equipment. During Anton’s life, he travelled to many of the world’s great mountain ranges, including Everest base camp, and studied the physiology of survival. He adored his formidable but affable grandfather, Harry Dobson, a retired Grenadier Guard who had fought and been wounded at Ypres. A Yeoman of the Guard, Dobson lived for the rest of his life in a flat at St James’s Palace. As a child, Anton’s parents took him to the Farnborough Air Show, which made a great impression and influenced his career path. Anton summed this up on his blog in 2019: “I have always been interested in why things go wrong and the physical and mental consequences that follow. I suppose it started when I was a boy. My parents took me to the Farnborough Air Show from a very young age, but we missed the day when John Derry crashed into the crowd, killing 31 people. The aircraft fell where we used to sit. Had we been there we would have …

The process of becoming a physician-scientist is a long and often harrowing one. The author reflects on her own experience deciding to commit to a career as a physician-scientist and setting out on that career path. She identifies the largest challenges as the lack of clear direction to becoming a physician-scientist; the long lag time between the end of graduate medical education and becoming faculty, resulting in lower wages, less job security, and conflicts with personal goals; and a tension between traditional definitions of success and her own areas of interest. The author also reviews the advantages that led to her first faculty position as a physician-scientist: innovative educational programs that integrate medical and research training, financial support for physician investigators, a supportive educational milieu, and appropriately tailored promotion tracks. Advances on these three fronts could support increasing numbers of trainees pursuing careers as physician-scientists.

As is known to all, science and technology is the first productive force. As the "base camp" for cultivating talents, colleges and universities should pay more attention to innovation. Grassroots party organizations in colleges and universities invest a lot of manpower and material resources in organizing innovative thematic party day activity, the purpose of which is to guarantee the thematic party day activity can realize dual innovation on form and content, to motivate party members in colleges and universities to actively take part in. As they are talents and newly-emerging force cultivated by colleges and universities, they are capable of accomplishing works of universities. Therefore, the theme of the party day activities should be feasible, so as to fully mobilize the enthusiasm of college party members and broaden their thinking. Such innovative activities are truly valuable activities. Therefore, activity design is particularly important. This paper conducts research and analysis on the design and innovation of themed party day activity of grassroots part organizations in colleges and universities.

Every spring, Everest Base Camp (5345 m) morphs from a remote, undulating glacier to a miniature city over 2 km2 in size and housing over a thousand people in nearly 50 separate camp sites. During a 2–3 month-period, several hundred climbers will make an attempt on the summit of Mount Everest (8848 m) with the support of hundreds of dedicated Sherpas as high-altitude porters, base camp staff, mountain guides and pathfinders (the ‘Icefall Doctors’). During weeks of preparation, trains of yaks can be seen in the distance, ferrying up loads from the nearest seasonal settlement Gorak Shep—a desolate, dusty village a few hours away. Each team will then spend weeks acclimatising to the altitude, where there is less than half the oxygen available compared with at sea level. To support these teams, the Himalayan Rescue Association (HRA) staffs a temporary clinic at Base Camp known as ‘Everest ER’ (figure 1). It is the highest emergency room in the world, and for the last 12 years has treated climbers and expedition staff alike. It is a non-profit organisation whose volunteers have, on many occasions, been involved in providing life-saving treatment. The clinic runs 24/7 and will see over 500 patients in a season, with anything from difficulty sleeping to life-threatening cerebral oedema or severe frostbite. Challenges include the subzero temperatures, limited equipment, low ambient oxygen levels and geographical isolation. Figure 1 Everest ER close to the Khumbu Icefall. The 2014 season started no differently from any of the previous years. On 18 April—Good Friday—our team at the clinic had already been in place for 2 weeks and seen more than 100 patients when, at 06:45, a loud roar woke many of us at Base Camp from sleep. The sound of an avalanche is not uncommon in that area, but this was unusual in its protracted rumble and echoing …

We hypothesized that ascent to altitude would result in reduced sublingual microcirculatory flow index (MFI) and increased vessel density. Twenty-four subjects were studied using sidestream dark-field imaging, as they ascended to 5300 m; one cohort remained at this altitude (n = 10), while another ascended higher (maximum 8848 m; n = 14). The MFI, vessel density and grid crossings (GX; an alternative density measure) were calculated. Total study length was 71 days; images were recorded at sea level (SL), Namche Bazaar (3500 m), Everest base camp (5300 m), the Western Cwm (6400 m), South Col (7950 m) and departure from Everest base camp (5300 m; 5300 m-b). Peripheral oxygen saturation (SpO2), heart rate and blood pressure were also recorded. Compared with SL, altitude resulted in reduced sublingual MFI in small ( 25 microm rose from 1.68 (+/- 0.43) mm mm(-2) at SL to 2.27 (+/- 0.57) mm mm(-2) at 5300 m-b (P = 0.005); GX increased at all altitudes (P < 0.001). The reduction in MFI was greater in climbers than in those who remained at 5300 m in small and medium-sized vessels (P = 0.017 and P = 0.002, respectively). At 7950 m, administration of supplemental oxygen resulted in a further reduction of MFI and increase in vessel density. Thus, MFI was reduced whilst GX increased in the sublingual mucosa with prolonged exposure to hypoxia and was exaggerated in those exposed to extreme altitude.

What you need to know A 25 year old man plans to trek to Everest Base Camp (5545 m) in Nepal for charity. He asks you for a prescription of acetazolamide to prevent mountain sickness. For most people, mountain sickness is a self limiting illness, but it can become life threatening. It is estimated that more than 100 million people per year travel to the hypoxic environments found at altitudes above 2500 m,1 and at least 10% to 20% of unacclimatised individuals develop acute mountain sickness at this height.2 Acclimatisation to altitude involves multiple physiological changes, occurring over days to weeks, which enable individuals to function better in these hypoxic environments. If this natural adaptation is surpassed by the rate of exposure to altitude, acute mountain sickness can occur. Acetazolamide can help to prevent acute mountain sickness developing and has fewer side effects than alternative drugs such as dexamethasone, which can mask symptoms and therefore carries greater risks.2345 Acetazolamide causes mild diuresis and increases renal excretion of bicarbonate, causing a mild metabolic acidosis which in turn increases respiratory rate (improving oxygenation). In the UK, prescribing acetazolamide for travel is an optional service, not included in the general practitioner’s contract. Some GPs may decide not to prescribe acetazolamide on this basis, or because they feel it is outside the scope of their practice. This article is an approach to discussing travel and activity at high altitude, prevention of sickness, and acetazolamide prescription for non-specialists. ### History #### What does the person know about acute mountain sickness? Symptoms of acute mountain sickness …

The primary objective of the American Medical Research Expedition to Everest was to obtain information on human physiology at the highest possible altitude, including the Everest summit. An important data point was the barometric pressure on the summit, because this determines the inspired P(O(2)). The first measurement ever taken was 253.0 mmHg. Because modeling studies had shown that extreme hyperventilation was essential to reach these great altitudes, 34 alveolar gas samples were collected above an altitude of 8000 m, including 4 on the summit. These showed that hyperventilation reduced the alveolar P(CO(2)) to between 7 and 8 mmHg in one climber. An important finding was that alveolar P(O(2)) was defended at a value of about 35 mmHg by the increasing hyperventilation as the climbers ascended higher. Venous blood samples collected on two summiters gave a mean base excess of -7.2 meq.L(-1). Using the alveolar P(CO(2)) value, this gave an arterial pH of over 7.7, indicating an extreme degree of respiratory alkalosis. While climbing at an altitude of 8300 m, one summiter showed a respiratory frequency of 86 breaths.min(-1) and tidal volume of 1.26 L, indicating very rapid shallow breathing. Maximal oxygen consumption for the summit was derived by having well-acclimatized subjects exercise maximally at an altitude of 6300 m while breathing 14% oxygen. The V(O(2)) was just over 1 L.min(-1), which is sufficient to explain how exceptional humans can reach the summit without supplementary oxygen. In addition to the measurements at altitudes over 8000 m, data were obtained at two camps at 5400- and 6300-m altitude. These gave information on the control of ventilation, periodic breathing, blood physiology, cerebral function, and metabolism.

BACKGROUND The change of anaerobic exercise abilities during and after a high-altitude expedition or hypoxic exposure is not well studied. To evaluate the effects of an extreme-altitude expedition on anaerobic performance, the 10-second supramaximal test and endocrine hormones were evaluated before and after an expedition to Peak Lenin. METHODS Four subjects (3 male and 1 female, age (30.5 +/- 16.5) years) were recruited into the study. Three sets of tests were performed, including a basic test at sea level and 20 days before first arrival at the base camp (3600 m), a middle test done at day after returning from the summit to the base camp and the post test at the 10th day after return to the sea level. Both the supramaximal test, performed by a cycle ergometer, and body composition, performed by bioelectrical impedance analysis, were completed before the basic test and post test. The endocrine hormones including cortisol, growth hormone, testosterone, noradrenaline, adrenaline, dopamine, glucagon and beta-endorphin were measured at all tests. RESULTS Comparing the conditions before and after the expedition, the body measurement parameters were decreased after the expedition, i.e., body weight (-4.22%, P < 0.05), fat-free mass (-2.09%, P < 0.01) and body fat (-8.95%, P = 0.172). The peak power relative/body weight ratio (PP/BW) was similar ((9.70 +/- 1.97) vs (9.11 +/- 1.80) W/kg, P = 0.093), while mean power/body weight ratio (MP/BW) was reduced significantly after the expedition ((9.14 +/- 1.77) vs (8.33 +/- 1.74) W/kg, P < 0.05). Peak power/fat-free mass (PP/FFM), mean power/fat-free mass (MP/FFM) and fatigue index (FI) were significantly lower after the expedition (PP/FFM: (11.95 +/- 1.71) vs (10.99 +/- 1.59) W/kg, P < 0.05; MP/FFM: (11.26 +/- 1.50) vs (10.04 +/- 1.55) W/kg, P < 0.005; FI (85.55 +/- 4.17)% vs (77.25 +/- 4.40)%, P < 0.05). Hormone assays showed a significant increase of noradrenaline (basic vs middle, P < 0.05) as well as decrease of adrenaline (P < 0.05). Meanwhile, a trend towards an increase in dopamine (basic vs middle) and a decrease of beta-endorphin (basic vs post) were also noted. CONCLUSIONS These results suggested that an expedition to an extreme altitude may have negative effects on anaerobic performance. It showed that a significant increase of noradrenaline (basic vs middle) as well as decrease of adrenaline after the expedition to Peak Lenin had occurred. The real physiological significance needs to be further investigated.

People taking part in commercial treks are exposed to high altitude (HA) while eating ad libitum, a situation that has been related to under eating and body weight loss. We investigated this phenomenon in westerners taking part in a typical Himalayan trek. Body weight, energy intake (EI), macronutrient composition of the diet, and acute mountain sickness symptoms (AMS) were measured in seven healthy individuals (aged 45 +/- 12 yr and BMI 24.6 +/- 4.4 kg/m(2)) during a 19-day trek to Makalu Base Camp. Comparisons were made between three periods of the trek: a 5-day climb below 2500 m (low altitude 1: LA1), an 8-day period between 3500 m and 5200 m (high altitude: HA), and a 4-day descent below 2500 m (low altitude 2: LA2). Body weight was significantly reduced at the end of the trek (p0.01). A decrease in total EI was observed at HA (p0.05). This was followed by an increase in EI upon return to LA2 (p0.001). Neither EI nor macronutrient composition of the diet was associated with the presence of AMS. In conclusion, a decrease in EI was observed in HA, which does not seem to be macronutrient specific.

At extreme altitude, air has an almost identical composition compared to air at sea level, while its pressure is altitude-dependently lower. When supplementary oxygen is used to achieve an acceptable inspiratory pressure of oxygen (PI(O2)) during climbing, the barometric pressure difference to lower altitudes is not compensated for. In this report, we tried theoretically to apply pressure support ventilation (PSV) to partially compensate for low barometric pressures. PSV is widely used for respiratory home care and is applicable via a nasal mask. Since there are light-weight units with long battery lives on the market, we speculated that these units may to some extent replace bottled oxygen. PSV was in theory applied at barometric pressures of 400 torr (Everest Base Camp), 284 torr (South Col), and 253 torr (summit of Mt. Everest). We found that during PSV at a mean airway pressure of 16.5 torr on the summit of Mt. Everest, a fraction of inspired oxygen (FI(O2)) of 0.34 sufficed to achieve an alveolar partial pressure (PA(O2)) of 67 torr. PSV increases PI(O2) by 3.5 torr, which in theory elevates the maximum oxygen consumption (V(O2max)) by 218 mL.min(-1) in an acclimatized climber in this setting. An additional benefit of PSV at extreme altitude may come from the unloading of the respiratory muscles.

Take home message Sporting events in the most extreme of places and conditions can safely take place provided adequate medical facilities and resources are available, along with adequate education of the participants. The Everest marathon is a biannual race run from 5184 m near Everest base camp and finishing in the Sherpa capital of Namche Bazaar at 3446 m. It is recognised as the highest and possibly the toughest marathon race in the world. The runners start at a height at which the atmospheric pressure and inspired oxygen pressure are 50% of the value at sea level.1 It began in 1987 to an outcry from many altitude experts who felt the risks of running at that altitude were unjustifiable.2 However, it has proven to be a safe if tough race. There have been no fatalities. On average over the seven marathons, 5–10% of contestants have been unable to complete the whole race, some completing part of the course.3 In 1995 the course was unsafe because of a heavy snowfall, and only a half marathon was run. The previous races have been held in late November after the monsoon season. This year for the first time it was held in April, a warmer time of year. Daytime temperatures were typically around freezing, falling at night to −10°C. The main medical problems facing previous medical teams have been altitude sickness, diarrhoea and vomiting, chest infections, and musculoskeletal disorders, especially anterior knee pains, contusions, and blistering of the feet.4 Knowledge of previous problems and the use of drug formularies from previous marathons helped to ensure that the expedition was adequately equipped. This isolated route is away from medical access for long parts of the trek, requiring the medical team to be completely self sufficient. The race has potential for …

Present study is based on Naxal movement in Chhattisgarh state and its impact on Tribal life. Study is focus on comparative study of social life of tribal people before coming to base camps and changes after boarding to base camps. Researcher has been try to find out that what are the change in tribal culture due to naxal incidents and what is impact of health program in the region after naxal activity. Findings of the study shows that in some context the naxal incidents are benificial of tribal people because in the base camp they having sufficient heath facility, especially in the context of women and children health facility which is provided by the govt.

Canadian cardiac anaesthetist who died hours after climbing Mount Everest Canadian cardiac anaesthetist Charles MacAdams was a skilled physician, highly respected for his exemplary care and outstanding compassion. He taught, researched, and provided clinical care at the Foothills Medical Centre, Libin Cardiovascular Institute of Alberta, and University of Calgary in Calgary, Alberta, Canada. MacAdams also spent many months developing, teaching, and supervising critical care and cardiac anaesthesia at the Tribhuvan University Institute of Medicine in Kathmandu in Nepal. Charlie, as he was known to friends and family, was popular with his colleagues, students, and patients. He was passionate about his family, science, medicine, mentoring, research, adventure, his desire to make the world a better place, mountaineering, hiking, sailing, running, great conversations, boxer dogs, the Rockies, and Nepal. In May this year, Charlie MacAdams happily combined many of his passions during a trip that combined medical education and mountaineering in Nepal. He achieved a very special goal when he successfully completed the ascent and descent of the North Col of Mount Everest (7020 m). After the descent, he apparently went to sleep on the night of 10 May at Mount Everest’s base camp in Tibet, exhausted but exhilarated. He died in his tent during that night. He was 61 years old. MacAdams’s son, …

Aconcagua (6962 m) is one of the seven summits and the highest mountain outside of Asia. Climbers of varying experience are drawn to its nontechnical route. Our objective was to detail the prior altitude experience of climbers attempting to summit Aconcagua. We asked all climbers on the normal route of Aconcagua to complete questionnaires with demographics and prior high altitude experience while acclimatizing at Plaza de Mulas base camp during 9 nonconsecutive days in January 2009. 127 volunteers from 22 countries were enrolled. Mean age was 39.8 years and 88.2% were male. Median altitude at place of residence was 200 m (IQR: 30, 700). Median previous maximum altitude reached was 5895 m (IQR: 5365, 6150). 7.1% of climbers had never been above 4000 m. Median previous maximum sleeping altitude was 4800 m (IQR: 4300, 5486). 12.6% of climbers had never slept above 4000 m. Climbers who performed acclimatization treks spent a mean of 3.6 (2.5, 4.7) days at3000 m in the previous 2 months. However, 50.4% of climbers performed no acclimatization treks. Although the majority of mountaineers who attempt Aconcagua have prior high altitude experience, a substantial minority has never been above 4000 m.

‘Exped 2010’, a climbing and trekking expedition to the Everest region of Nepal, marked the 150th anniversary of the Army Cadet Force, during October 2010. A team of 20 cadets aged 14-18 years together with a combination of adults, mountain leaders and the expedition doctor, completed the trek to Everest Base Camp with a small number summiting Island Peak. The junior team, consisting of younger members aged 14-16 years, were limited to sleeping at a maximum altitude of 4240m but nevertheless, achieved a trekking altitude of 5000m. Over the three week period, there were a number of challenges for the expedition doctor - integrating into the team, finding time to rest and acclimatise along with the others whilst dealing with over 35 consultations, numerous cases of traveller’s diarrhoea, several helicopter evacuations and also managing cases of altitude illness both within the group and for several foreign trekkers along the way.

The Caudwell Xtreme Everest (CXE) expedition involved the detailed study of 222 subjects ascending to 5300 m or higher during the first half of 2007. Following baseline measurements at sea level, 198 trekker-subjects trekked to Everest Base Camp (EBC) following an identical ascent profile. An additional group of 24 investigator-subjects followed a similar ascent to EBC and remained there for the duration of the expedition, with a subgroup of 14 collecting data higher on Everest. This article focuses on published data obtained by the investigator-subjects at extreme altitude (>5500 m). Unique measurements of peak oxygen consumption, middle cerebral artery diameter and blood velocity, and microcirculatory blood flow were made on the South Col (7950 m). Unique arterial blood gas values were obtained from 4 subjects at 8400 m during descent from the summit of Everest. Arterial blood gas and microcirculatory blood flow data are discussed in detail.

In October 2006 a British echocardiographer, a senior house officer from Kathmandu, and myself were in Lobuje (4900 m above sea level), eight hours' walk below the Everest base camp in the foothills of the Himalayas. We were there to help with the “high altitude pulmonary edema prevention trial 2006.” One evening, when it was snowing outside and the dining hall of the teahouse was full of the trekkers on their way to or from Everest base camp and Kalapathar, we were busy tabulating our research data. The owner of …

In September 2010, a 37-year-old male was brought to our infectious disease clinic a week after a medical expedition in the Maranhao region of the Amazon rainforest, Brazil. He reported an insect bite on his right forearm 2 months earlier while he was in the forest, and noticed a furuncle enlarging overtime, becoming swollen and erythematous. Drainage was performed at the base camp and a short course of oral antibiotics was administered for presumed cellulitis. The lesion recurred (Figure 1) and continued to expand with sporadic whitish sero-sanguinous discharge, the patient referring a sense that …

The effects of inspiratory muscle training (IMT) were evaluated at rest and during exercise in normobaric hypoxia (NH) and then an 11-day trek to 5300m. A 7-week IMT program was completed by 6 females and 3 males (age 34.8 ± 10.0 years) randomized to IMT (n = 4) or placebo [P (n = 5)]. A Powerbreathe was initially set at a resistance of 50% (IMT) or used at 15% of maximal inspiratory pressure (MIP) throughout (P). A self-paced walking test was completed before and after training at PIO2 = 104.1mmHg, 3440m (NH1); PIO2 = 85.9 mmHg, 4930m (NH2); and at 3440m during the trek (HH). Exercise data were interpolated to 4.8 km/hour to evaluate training effects. Patterns of change suggest possible benefits of IMT, but due to small group sizes and variability, these trends are not significant. MIP increased by 6% and 4% following IMT and P. Pulse oxygen saturation (SaO2) during exercise in NH2 increased by*4% following IMT, with no change in P. Decreases in resting SaO2 during the expedition (4930m) were attenuated in IMT (85.0 ± 3.61%) compared to P (80.0 ± 5.87%). Comparisons between NH1 exercise post-training and HH showed a decrease in perceived dyspnoea and effort in IMT ( - 0.3 and - 0.7) but an increase in P ( + 0.7 and + 2.6). Nonsignificant trends within the data suggest that the altitude-induced decrease in resting and exercise SaO2 and intensified perceived effort and dyspnoea during exercise were attenuated following IMT. However, further research is required to establish any beneficial effect of IMT.

Edmund Hilary and Tenzing Norgay were first in 1953. Since then, over 2,500 people have followed in their footsteps and on 21 May 2006, Andrew Sutherland became the first British surgeon to reach the summit of Mount Everest. Travelling as the team doctor, Mr Sutherland was part of the EVERESTMAX expedition who recently completed the highest climb on earth, commencing at the Dead Sea in Jordan and ending at the summit of Mount Everest. Mr Sutherland joined the expedition at Everest base camp as the team prepared for their ascent of the challenging north-east ridge.

Summary points Acute altitude illnesses are potentially serious conditions that can affect otherwise fit individuals who ascend too rapidly to altitude. They include high altitude headache, acute mountain sickness, high altitude cerebral oedema, and high altitude pulmonary oedema. The number of people travelling to altitude for work (soldiers, miners, construction workers, and astronomers) or for recreation (skiing, trekking, mountain biking, and climbing) is rising, and increased media attention towards these activities has also raised the profile of altitude related illness. Typical scenarios in which such illness might occur are a family trek to Everest base camp in Nepal (5360 m), a fund raising climb of Mount Kilimanjaro (5895 m), or a tourist visit to Machu Picchu (2430 m). Awareness of potential altitude related problems is important even for healthcare practitioners working at lower altitude, because patients may ask for advice about the safety of a proposed journey and how to prevent illness at altitude. #### Sources and selection criteria We searched Medline and Google Scholar with no …

Rajeev Mathew, Sveta Alladi, Alexandra Rogers, and Naginder Singh made the trip to Everest base camp

In September 2000 my dad and I set off to cycle across the main spine of the Himalayas—a 1000 km trip from Lhasa, the capital of Chinese occupied Tibet, via Everest Base Camp, to Kathmandu in Nepal. Landing in Lhasa, at 3650 m above sea level, was the first shock. I was breathless after climbing a single flight of stairs. We spent three days there acclimatising. With the Chinese occupation great care was needed. Mentioning the Dalai Lama, the exiled Buddhist leader, could land you in prison. Every publicly accessible room in The Potala—the palace of the Dalai Lama— has walls that both see and hear. The Tibetans leave money on the shrines in every room they enter in the belief that they will be rewarded in the afterlife, seemingly indifferent that the money actually goes to the Chinese government. After three days of the bustling city it was a …

The occurrence of mesolithic artefacts around Malham Tarn and Great Close Mire has been noted from the 1920s onwards. Pollen analysis at Tarn Moss to the west of Malham Tarn in the 1950s indicated that forest clearance had begun during Zone VI (c. 7000–5500 bc). Between 1972 and 1982, five prolific flint sites and a sixth, minor site were located in this area. The sites are of ‘Narrow Blade’ affinities and may have formed a summer base camp for hunter/gatherer groups operating in the Craven Pennines. Some artefacts of neolithic date have been found on the sites and this may indicate continuity. There is evidence for forest clearance and settlement in the later neolithic and this was well established by the Early Bronze Age.

Twenty-one climbers who were members of the American Ultima Thule Everest Expedition participated in a double-blind, randomized clinical trial of phenytoin prophylaxis for acute mountain sickness during the approach to the northeast ridge of Mount Everest. The study was carried out between Beijing and base camp at 16,800 feet. Time spent ascending from Beijing to base camp averaged 13 days. High-altitude symptom questionnaires were filled out beginning in Lhasa at 11,800 feet and in Xigatse at 12,000 feet, in Xegar at 14,000 feet, and at base camp. Computer analysis of the questionnaire answers performed by an impartial analyst revealed that climbers who took phenytoin were less likely to have headaches at base camp. No other statistically significant differences were observed, but the power of the sample size was low.

SummaryThis article describes a nine day trek covering in excess of 100 miles in the Himalayas, reaching Mount Annapurna Base Camp (15,000 ft), undertaken by members of the ship’s company of HMS Swift and myself during an Adventurous Training period. The expedition title, “Chhito Ra Pakka”, derived from the ship’s motto “Swift and Sure”, proved to be an apt choice.

It is probably well known that the Japanese compelled Allied prisoners of war to work on the Bangkok-Moulmein railway, which was constructed during the war through the jungles of Siam and Burma. The author, who was captured in Java, arrived at the base camp of Nom-Pladuk on the 9th of February, 1943, and was sent at once to Taroewa, a village situated some 8 miles up-country. Being a member of the so-called ‘nail-shift,’ I started from this camp whenever opportunities presented themselves to study the entire region of the railway and the immediate surroundings as far north as the ‘Three Pagodas Pass’ on the Siam-Burma frontier, where the connection with the Burma section of the railway was accomplished. The total distance involved is somewhat over 140 miles, and the course of the river, the Mei Fingnoi, or Meklong, was always followed. Since all my discoveries were made along the first 75 miles of the railway, the remaining part need hardly be mentioned.From the outset, I was constantly on the alert for prehistoric remains, this being possible since much ground was removed during the construction of the railway, but methodical investigations were naturally out of the question, while much of the material collected was subsequently lost again. All my scientific notes were taken from me by the Japanese.

Objective: Oxygen availability falls with ascent to altitude and also as a consequence of critical illness. Because cellular sequelae and adaptive processes may be shared in both circumstances, high altitude exposure (‘physiological hypoxia’) assists in the exploration of the response to pathological hypoxia. We therefore studied the response of healthy participants to progressive hypobaric hypoxia at altitude. The primary objective of the study was to identify differences between high altitude inhabitants (Sherpas) and lowland comparators.Methods: We performed an observational cohort study of human responses to progressive hypobaric hypoxia (during ascent) and subsequent normoxia (following descent) comparing Sherpas with lowlanders. Studies were conducted in London (35m), Kathmandu (1300m), Namche Bazaar (3500m) and Everest Base Camp (5300m). Of 180 healthy volunteers departing from Kathmandu, 64 were Sherpas and 116 were lowlanders. Physiological, biochemical, genetic and epigenetic data were collected. Core studies focused on nitric oxide metabolism, microcirculatory blood flow and exercise performance. Additional studies performed in nested subgroups examined mitochondrial and metabolic function, and ventilatory and cardiac variables. Of the 180 healthy participants who left Kathmandu, 178 (99%) completed the planned trek. Overall, more than 90% of planned testing was completed. Forty-four study protocols were successfully completed at altitudes up to and including 5300m. A subgroup of identical twins (all lowlanders) was also studied in detail.Conclusion: This programme of study (Xtreme Everest 2) will provide a rich dataset relating to human adaptation to hypoxia, and the responses seen on re-exposure to normoxia. It is the largest comprehensive high altitude study of Sherpas yet performed. Translational data generated from this study will be of relevance to diseases in which oxygenation is a major factor.

In June 1980 I had the opportunity of visiting Anchorage, the largest city in Alaska with a population of 202,000. A city that started as a Base Camp for workers building the Alaskan Railroad in 1914, was devastated by one of the largest earthquakes on record in 1964 and emerged a year later rebuilt as the ‘All American’ city that it is today.

Everest, the Testing Place by John B. West, MD, is a chronicle of the 1981 American research expedition to Mount Everest organized and led by Dr West, who is a professor of medicine and physiology at the University of California, San Diego. Dr West is recognized and respected for his pioneering work in ventilation perfusion relationships and high-altitude physiology. This expedition combined scientific objectives with the adventure of climbing at extreme altitudes and, in some ways, was a continuation of the 1960-1961 Himalayan scientific mountaineering expedition, of which Dr West was a member. Dr West begins his book by detailing the history of mountaineering with emphasis on scientific investigations at high altitudes. He then describes the challenging problems encountered in obtaining funding, selecting team members, developing new equipment for high-altitude cardiopulmonary research, and assembling and transporting the equipment. The trek to the base camp is detailed, as are the problems

To the Editor.— On the recent American Expedition to Dhaulagiri, Nepal, (8,167 meters [26,795 feet]), the sixth highest mountain in the world, I developed numerous splinter hemorrhages in my fingernails. They appeared spontaneously during a restful evening when I was at base camp (5,880 meters [19,300 feet]), and the next morning I counted 46, of which 11 were beneath each thumbnail. The hemorrhages were thin, red, longitudinal streaks between 0.5 and 4 mm long, arranged near the distal part of the nail bed in a corona (Fig 1). As they grew out, they could be seen to lie in the soft, thin layer peeling off the undersurface of the nail. I had spent the previous five weeks in good health, transporting loads of 18 to 27 kg (40 to 60 lbs) from 760 meters (2,500 feet) to base camp, where I had been living for six days. The previous day

To the Editor.— One of the crucial factors in the pathogenesis of high-altitude pulmonary edema (HAPE) is hypoxic pulmonary hypertension. 1 In the rat, this pressor response to hypoxia can be prevented and reversed by calcium antagonists. 2 I would like to report a personal experience of amelioration of HAPE symptoms by nifedipine. Report of a Case.— On Sept 10,1986,I flew from Katmandu, Nepal (an altitude of 1200 m), to an altitude of 2800 m. I subsequently climbed in three days to a base camp at an altitude of 5400 m on Mount Makalu (8485 m). On Sept 16, two well-acclimatized friends and I ascended to 6000 m. On the following day, we climbed via the Kukuczka Ridge to an altitude of 6900 m, where we established a camp. The climb was steep and demanding. I used 500 mg of acetazolamide daily as prophylaxis against acute mountain sickness. Nevertheless, having