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PubMed2004

Research requirements for operational decision-making using models of fatigue and performance.

Sustained human performance is critical to job and mission success in many federal agencies including national defense, aerospace exploration, and transportation. For the responsible agencies, applications of the basic biomedical and applied human factors science provide the best available solutions to help individuals perform more effectively and with increased safety. Key products of this research are biomathematical models that predict periods of impaired performance, with applications in planning tools, real time monitoring, and intervention decision aids. Since it is difficult to quantify the number of judgment errors or accidents averted, metrics of success for fatigue management systems must be largely based on the accuracy of performance predictions derived from laboratory-based research studies and the extent to which such results can be generalized to the field environment. Performance metrics must, at a minimum, be correlated with occupational task performance to demonstrate relevance to real-world applications. This paper outlines broad goals for human effectiveness research related to fatigue, alertness, and performance. To advance from the present state of knowledge to useful predictive models requires a well-coordinated commitment from federal agencies. Users should be made aware that current models and tests are not likely to encompass all of the aspects of human performance that are relevant to field environments and occupations.

Decision Support Techniques↗
PubMed2006

A new approach to determine method detection limits for compound-specific isotope analysis of volatile organic compounds.

Compound-specific isotope analysis (CSIA) has been established as a useful tool in the field of environmental science, in particular in the assessment of contaminated sites. What limits the use of gas chromatography/isotope ratio mass spectrometry (GC/IRMS) is the low sensitivity of the method compared with GC/MS analysis; however, the development of suitable extraction and enrichment techniques for important groundwater contaminants will extend the fields of application for GC/IRMS. So far, purge and trap (P&T) is the most effective, known preconcentration technique for on-line CSIA with the lowest reported method detection limits (MDLs in the low microg/L range). With the goal of improving the sensitivity of a fully automated GC/IRMS analysis method, a commercially available P&T system was modified. The method was evaluated for ten monoaromatic compounds (benzene, toluene, para-xylene, ethylbenzene, propylbenzene, isopropylbenzene, 1,2,3-trimethylbenzene, 1,2,4-trimethylbenzene, 1,3,5-trimethylbenzene, fluorobenzene) and ten halogenated volatile organic compounds (VOCs) (dichloromethane, cis-1,2-dichloroethene, trans-1,2-dichloroethene, carbon tetrachloride, chloroform, 1,2-dichloroethane, trichloroethene, tetrachlorethene, 1,2-dibromoethane, bromoform). The influence of method parameters, including purge gas flow rates and purge times, on delta13C values of target compounds was evaluated. The P&T method showed good reproducibility, high linearity and small isotopic fractionation. MDLs were determined by consecutive calculation of the delta13C mean values. The last concentration for which the delta13C value was within this iterative interval and for which the standard deviation was lower than +/-0.5 per thousand for triplicate measurements was defined as the MDL. MDLs for monoaromatic compounds between 0.07 and 0.35 microg/L are the lowest values reported so far for continuous-flow isotope ratio measurements using an automated system. MDLs for halogenated hydrocarbons were between 0.76 and 27 microg/L. The environmental applicability of the P&T-GC/IRMS method in the low-microg/L range was demonstrated in a case study on groundwater samples from a former military air field contaminated with VOCs.

Journal Article↗
PubMed1984

Pharmacy technician training in the United States Army.

Pharmacy technician training in the U.S. Army is described. The training program, officially titled the pharmacy specialist course, is conducted at the U.S. Army Academy of Health Sciences on Fort Sam Houston in San Antonio, Texas. The 17-week program is conducted six times a year, accommodating up to 75 students per class. Before entering the course, the soldiers must complete basic combat infantry training and a general medical orientation course. Standardized examinations are given to ensure the students have the basic prerequisite knowledge. The curriculum emphasizes psychomotor skills with laboratory requirements supported by didactic instruction. During the first seven weeks of the course, the students receive instruction in pharmacy administration, pharmaceutical chemistry, pharmaceutical calculations, and pharmaceutical preparations. The last nine weeks of instruction focus on pharmacology, physiology and pathology, and hospital pharmacy practice. The laboratory simulates a hospital pharmacy and is used exclusively for the training program. The students are continually evaluated and provided with individualized supportive counseling by the faculty. Overall attrition has remained at approximately 22% for fiscal years 1981, 1982, and 1983. Following graduation and assignment to a medical-treatment facility, the technicians have several opportunities for advanced training and continuing education. The proficiency and competency of the graduates are continually monitored by an annual skill qualification test. The pharmacy specialist course conducted by the U.S. Army, accredited by ASHP, can serve as a standard for the comprehensive vocational and technical training of pharmacy technicians.

Accreditation↗
PubMed1983

Psychiatric assessment of female fliers at the U.S. Air Force School of Aerospace Medicine (USAFSAM).

There were 17 female fliers referred for evaluation to the Neuropsychiatry Branch, Clinical Sciences Division, of the USAF School of Aerospace Medicine, Brooks AFB, TX, between October 1976 and September 1982: five primarily for emotional reasons; seven primarily for somatic disorders and only secondarily for emotional symptoms; two for entry to the Airsickness Rehabilitation/Treatment protocol; and three for routine evaluation in preparation for possible future space flight. This number is too small for any sort of statistical analysis, but one emerging theme has clinical importance. A significant number of male fliers tend to see these female fliers in stereotyped roles--mother, potential sexual partner, little sister, daughter--and then respond to the assigned role rather than to a real person. Whether a woman accepts this projected role as egosyntonic or rejects it as egosyntonic, its existence may affect her real-life role. For example, one woman pilot reported that her instructors seemed to make allowances for her sex by expecting less of her than they did of her male colleagues, "carrying" her along as if she were a little sister. While such role-casting may be carried on subconsciously, its behavioral manifestations are real and may have the potential for affecting flight safety. This study represents an initial approach to the data in this area, and is intended to alert flight surgeons to the implications of such role-casting in the flight environment.

Aerospace Medicine↗
PubMed2005

Origins of the Interdepartmental Committee on Nutrition for National Defense, and a brief note concerning its demise.

The Interdepartmental Committee on Nutrition for National Defense was established in 1955 after malnutrition was found common among troops of the Republic of Korea and of the Republic of China (Taiwan). The initial purpose was identification of nutrition problems among military personnel (later, and among civilians) of countries of "special interest." Surveys measured status, assisted with the establishment of nutrition resources, and facilitated investigator learning and research. A major initial accomplishment was the preparation of a manual of procedures, which evolved into the 1963 Manual for Nutrition Surveys. The first 3 surveys, conducted in 1956, were of the armies of Iran, Pakistan, and Korea. They identified poor nutrition status in some troops, provided a basis for improving rations, and confirmed the effectiveness of the methodology. These surveys were followed by surveys of 30 additional countries that in nearly all instances included civilians and provided a basis for programs and the institutions for improvement of nutrition. On August 1, 1967, the program was reorganized and the Nutrition Program, CDC, based at NIH, was created. This occurred in response to the 1967 Partnership for Health Amendments "to make a comprehensive survey of the incidence and location of serious hunger and malnutrition, and health problems incident thereto, in the United States and to report these conditions to the Congress." The Ten State Nutrition Survey was done in response. Findings of malnutrition, especially in populations of low-income states were politically unwelcome in some quarters. Consequently the program was redirected, and, according to 2 observers, the survey findings were suppressed.

Diet↗
PubMed2002

The educational experiments of school health promotion for the youth in Japan: analysis of the 'sport test' over the past 34 years.

The objective of this study was to analyze independently the results of a 'sport test' that had been conducted in Japanese schools for 34 years without interruption, and to examine how physical education in Japanese schools affects health promotion in youths and what problems remain to be solved. The source of materials for the present study were the Annual Reports on the Survey of Physical Fitness and Athletic Ability for the period 1965-1998, published by the Ministry of Education, Science, Sports and Culture. Means and standard deviations of total scores from physical fitness and athletic ability tests in 11-year-olds (6th graders in elementary school), 14-year-olds (3rd graders in junior high school) and 17-year-olds (3rd graders in senior high school) were analyzed. The results of this study suggest that the trends of changes in mean score and coefficient of variation (CV) for physical fitness and athletic ability in Japanese youths are associated with the outcome of physical training through physical education in school, as well as the effect of the media--mainly television and television games. (1) The increase in mean scores and the decrease in CV observed from 1964 to the first half of the 1970s were probably due to the positive influence of the Guideline for Teaching. This guideline emphasized a systematic approach to athletic techniques, together with active practice of physical fitness training in schools, under the directives of the Boards of Education in response to the social 'Physical Fitness Campaign' policy at that time. (2) The leveling off of mean scores and CVs observed from the early half of the 1970s to the later half of the 1980s might be a result of the invasion of television into Japanese family life. (3) The decrease in mean scores and increase in CV observed since the later half of the 1980s were assumed to be caused by the negative influence of a Guideline for Teaching characterized by the key words 'Physical Education for More Pleasure' and a steep increase in the number of television games. (4) In terms of methodology, analyzing not only the mean scores but also the CV probably provided a more accurate evaluation of the outcome of health promotion in youths. In conclusion, strategies for health promotion in youths, especially for proper nurturing of physical fitness and athletic ability, should include not only delivery of physical fitness training in schools, but also continuous monitoring of multiple indicators, and ensuring proper 'Learning of the Body'. The latter should include providing learning opportunities centering on the 'body' (not the 'body' for the sake of labour or military manpower, but one's own 'body' per se); guiding young people to recognize the states of their own body and physical fitness, and to understand how they can be improved. To be effective in implementation, the need to increase the number of professional teachers in physical education should be examined. All possible opportunities should also be taken to inform youths of the negative effects of television and television games, and to encourage them to spend less time on these and more time being physically active from the moment they arise.

Adolescent↗
PubMed1994

Clustering of hypertension, diabetes, and obesity in adult male twins: same genes or same environments?

We investigated the mediating role of genetic factors in the clustering of hypertension, diabetes, and obesity, using the twin registry maintained by the National Academy of Sciences--National Research Council. The study sample included 2,508 male twin pairs born between 1917 and 1927 who responded to a mailed questionnaire that covered demographic variables, cardiovascular risk factors, and health behaviors. The incidence of hypertension and diabetes in this cohort was ascertained from subjects' self-report of a physician diagnosis and/or the use of prescription medications. The body-mass index calculated from self-reports of height and weight was used as a measure of obesity. Descriptive analyses indicated probandwise concordance rates of 34.0%, 31.2%, and 32.7%, respectively, for the joint occurrences of hypertension and diabetes, hypertension and obesity, and diabetes and obesity in MZ twin pairs. Corresponding concordance rates in DZ twin pairs were 8.1%, 14.9%, and 2.8%. The probandwise concordance for the clustering of all three conditions in the same individuals was 31.6% in MZ pairs and 6.3% in DZ pairs (relative risk 5.0; X2(1) = 2.6; P < .15). Multivariate genetic modeling of the correlation in liabilities to develop these conditions suggested the presence of a common latent factor mediating the clustering of hypertension, diabetes, and obesity in this twin sample. This common factor was influenced by both genetic and environmental effects (59% 8 genetic, 41% environmental). The genetic influences on the common latent factor were due to dominant rather than additive sources; the environmental influences appeared to be specific rather than shared by co-twins.

Aged↗
PubMed2003

Surgery of the head and 70-day brain surgeons.

In 1917, the Sugeon General of the United States Army, William Gorgas, learned that almost 15% of the casualties on the Western Front sustained intracranial injuries. Soon after the United States declared war in April 1917, the Council of National Defense established a General Medical Board and attached a brain surgery subsection to its Committee of Ophthalmology. Postcards were sent to experts around the country, asking for the names of individuals who had specialty training or practice in brain surgery. In August, Gorgas assumed control of this subsection and created a Division of Surgery of the Head in the American Army Medical Department, with additional sections for plastic surgery, ophthalmology, and otolaryngology. He needed almost 300 brain surgeons; he received 50 names. As Harvey Cushing, Gilbert Horrax, and others went to France, neurosurgeons at home trained student officers. Schools were established in Philadelphia (Charles Frazier), Chicago (Dean Lewis), New York City (Charles Elsberg), St. Louis (Ernest Sachs), and Camp Greenleaf in Georgia (Claude Coleman), with 10-week intensive courses for selected candidates. Basic science and x-ray classes and operative clinics addressed most aspects of neurosurgical care. An army manual outlined clinical diagnoses and surgical techniques. Lewis H. Weed established a laboratory at Johns Hopkins Hospital, staffed by volunteers such as K.D. Blackfan and W.E. Dandy, to investigate infections of the central nervous system. By the time of the armistice, Gorgas had his complement of brain surgeons. The newly trained brain surgeons and their mentors gradually made their way to the Western Front during the summer of 1918. Plans for a neurosurgical school in France were quickly discarded as the American Army Medical Department changed the specialized assignments to front-line general surgical care. Some of the 190 brain surgeons in the American Expeditionary Forces, notably Gilbert Horrax, Charles E. Dowman, and Charles Neuhoff, treated head injuries exclusively, whereas others, such as Eustace Semmes and Howard Naffziger, treated all battle casualties depending on the tactical circumstances. The rational but naive recommendations for coordinated care made by Cushing, as senior consultant in neurosurgery, were hindered by the confusion of the St. Mihiel and Meuse-Argonne offensives and the chaos of war. Only three 70-day brain surgeons participated in the postwar development of the specialty. However, 9 of 10 original members of the Neurosurgical Club, which was established 18 months after the armistice, taught in American Army Medical Department courses or served on the Western Front. The schools and their teachers emphasized a growing recognition of neurosurgical expertise in the early 20th century.

Brain Injuries↗
PubMed1993

The arts of war and medicine: a study in symbiosis.

Practitioners of warfare and medicine have both considered their respective disciplines part art and part science. Each has seen dramatic advances over the past several centuries, and the histories of progress in warfare and medical practice are inextricably intertwined. For example, the congregation of large armies inspired the development of epidemiologic analysis and preventive medicine, which forestalled the disastrous loss of life that typified all wars through the U.S. Civil War. Warfare also helped to clarify the critical distinction between medicine and health in several ways. Battles generate tremendous demands on the trauma surgeon, which triggers advances in understanding of trauma, surgery, fluid and electrolyte management, first aid, and triage. Similarly, the health of soldiers before and after combat is a result of public health measures that physicians have been ill-suited to manage. The dramatic severity of epidemics in armies progressively forced health professionals and politicians to seek solutions to illnesses that had plagued the general population to lesser degrees for millennia. The exigencies of war inspired creation of the nursing profession, with the burden and opportunity falling on women. Women were not allowed to hold positions of responsibility in caring for the sick until the enormity of the Civil War prevented men from occupying all such positions. Because each generation tends to view itself as "modern," its inherent weaknesses often go uncorrected and even unobserved. The interconnected histories of war and medicine provide a warning to remain open to discovering those practices that need radical reform to prevent the current generation of physicians from appearing utterly ridiculous to physicians 100 years hence. This treatise focuses, therefore, on the symbiotic advances in warfare on health before this century because death in war due to trauma was statistically far less important than death due to disease.

Dysentery↗
PubMed1997

Design & rationale of the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).

The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is a randomized, double-blind, placebo-controlled primary prevention trial. It is designed to test the hypothesis that in addition to a lipid-lowering diet, treatment with lovastatin is more effective than placebo in reducing acute major coronary events (i.e., sudden cardiac death, fatal and nonfatal myocardial infarction, and unstable angina) in a cohort with normal to mildly elevated total (180 to 264 mg/dl) and low-density lipoprotein (LDL) cholesterol (130 to 190 mg/dl) and low high-density lipoprotein (HDL) cholesterol (< or =45 mg/dl for men and < or =47 mg/dl for women). Two sites in Texas, Lackland Air Force Base in San Antonio and the University of North Texas Health Science Center in Fort Worth, will conduct the study. After at least 12 weeks of an American Heart Association Step 1 diet and 2 weeks placebo run-in, 6,605 men and women, ages 45 to 73 and 55 to 73 years, respectively, without clinical evidence of coronary heart disease, are randomized in equal numbers to either lovastatin (20 mg/day) or placebo. Study procedures maintain the blind, allowing titration of lovastatin from 20 to 40 mg/day to achieve an LDL cholesterol goal of < or = 110 mg/dl. All participants are followed until study completion, when 320 participants have had a primary end point or a minimum of 5 years after the last participant is randomized, whichever occurs last. All end points are adjudicated by an independent committee using prespecified criteria. Unique features of this trial are (1) the inclusion of unstable angina in the primary end point to reflect the increasing trend to treat coronary heart disease aggressively before a myocardial infarction has occurred, (2) aggressive pharmacologic intervention, with titration, to attain an LDL cholesterol goal less than the current National Cholesterol Education Panel guidelines for primary prevention, and (3) a cohort that includes women, the elderly, and those with mild to moderate hyperlipidemia and low HDL cholesterol. Compared with earlier studies, results will be applicable to a broader population and may help clarify the role of aggressive LDL cholesterol reduction measures in primary prevention. Treatment of this population is likely to realize the greatest cumulative long-term benefit in the prevention of acute major coronary events.

Aged↗
PubMed2006

The effect of Nazism on medical progress in gastroenterology: the inefficiency of evil.

While Nazism is almost universally recognized as a great evil, control of science and medicine by the totalitarian Nazi state might be viewed as increasing efficiency. Scientific methods are applied to semiquantitatively analyze the effects of Nazism on medical progress in gastroenterology to document its pernicious effects, and to honor outstanding gastroenterologists persecuted or murdered by the Nazis. This is a retrospective, quasi-case-controlled study. To disprove the null hypothesis that Nazism was efficient, retarded progress in gastroenterology is demonstrated by (1) enumerating the loss to Nazi Germany from 1933 to 1944 due to violent death, incarceration, or forced exile of key researchers in gastroenterology, defined by authorship of at least one book or 10 articles in peer-reviewed journals or other outstanding scholarship; (2) demonstrating a statistically significantly greater loss in Nazi Germany than in non-Nazi (Weimar German Republic from 1921 to 1932) or anti-Nazi (democratic America from 1933 to 1944) control groups; and (3) demonstrating that each loss was directly due to Nazism (murder, incarceration, or exile due to documented threat of violence/death or revocation of medical license). Sources of error in analyzing events from 70 years ago are described. Nazi Germany and Nazi-occupied Europe gained 0 and lost 53 key gastroenterology researchers, including 32 lost due to forced exile, 11 murdered by the Nazis, 5 lost due to suicide under threat of violence, 3 in hiding from the Gestapo, and 2 for other reasons. Fifty-two of the gastroenterologists were persecuted solely because they were Jewish or of Jewish descent and one because he was a Christian anti-Nazi Polish patriot. Particularly severe losses occurred in endoscopy. The loss in Nazi Germany from 1933 to 1944 was significantly greater than that in non-Nazi Germany and Austria from 1921 to 1932 (53 versus 4; odds ratio = 25.27; 95% CI: 9.01-70.48; P < 0.0001) and was significantly greater than that in anti-Nazi America from 1933 to 1944 (53 versus 0; odds ratio > 104.0; 95% CI: 17.62-608.95; P < 0.0001). Lost physicians in Nazi Germany (with reasons for loss) included Ismar Boas, the father of modern gastroenterology (suicide after medical license revoked); Hans Popper, the father of hepatopathology (fled impending arrest); Rudolph Nissen, the father of antireflux surgery (fled after job dismissal); Rudolph Schindler, the father of semiflexible endoscopy (fled after incarceration); Heinrich Lamm, the first to experimentally demonstrate fiberoptic transmission and the first to suggest its applicability for gastroscopy (fled after medical license revoked); Hermann Strauss, a pioneer in rigid sigmoidoscopy (suicide in a concentration camp); A.A.H. van den Bergh, who discovered the van den Bergh reaction to differentiate indirect from direct bilirubin (died in hiding in Nazi-occupied Holland); and Kurt Isselbacher, subsequently the Chief of Gastroenterology at Harvard Medical School (fled in childhood after a grandfather murdered by Nazis). All four refugee physicians who were reexposed to Nazi domination, after a regime change in their country of refuge, fled again or committed suicide. The Nazi damage to German and Austrian gastroenterology was immense, e.g., 13 of 14 major international discoveries in diagnostic gastroscopy were made by Germans or Austrians before the Third Reich, versus only 1 of 8 subsequently (odds ratio = 91; 95% CI: 3.58-13,887.61; P < 0.001). Eighteen (34%) of the persecuted physicians immigrated to America, thereby contributing to the postwar flourishing of American gastroenterology, particularly gastrointestinal endoscopy. In conclusion, the Third Reich severely retarded and reversed medical progress in gastroenterology in Germany. The inefficiency of Nazism, as herein documented, is attributable to the Nazi commitment of so much human, economic, and social resources to the military to wage wars of aggression, to the secret police (Gestapo) to pursue and exterminate perceived internal enemies, and to the Party to control and regiment civil society. Most inefficient is the incarceration, exile, or murder of Germany's most trained physicians and talented researchers because of religion or race, sociological parameters that are irrelevant to productivity. Intimidation and repression stifle scientific scholarship and creativity. This work disproves the myth of the efficiency of Nazism, and like tyrannies, by the novel application of semiquantitative scientific methodology to assess causality in medical history.

Austria↗