State of Healthcare 2008

On 10 December, we published our fifth and final report to Parliament on the state of healthcare in England and Wales. We looked at the progress made in healthcare since 2004 and the challenges ahead. We also focused on how six key areas of care were provided to and experienced by patients in 2008.

Physiological Responses to Exercise-Heat Stress with Prototype Pulsed Microclimate Cooling System

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA487097&Location=U2&doc=GetTRDoc.pdf

Wearing nuclear, biological and chemical (NBC) clothing or body armor during hot weather operations increases heat strain, can compromise work capacity, and may lead to heat injury. The U.S. Army Natick Soldier Research, Development, and Engineering Center is working to develop a lightweight microclimate cooling system (MCCS) for dismounted Soldiers. This study evaluated a prototype, vapor compression MCCS with an integrated skin temperature sensor to trigger pulsed cooling (PC) cycles. Previous experiments showed PC to be as effective as continuous cooling (CC) while requiring less power, potentially reducing both weight and logistic requirements for MCCS. A 120 W prototype MCCS was tested on volunteers during continuous work wearing either NBC clothing or the Army Combat Uniform (ACU) with body armor. Trials were no cooling, CC, and PC from skin temperature feedback. Volunteers completed three trials at 30°C, 30% rh wearing NBC clothing, and three trials each at 45°C, 20% rh and 35°C, 70% rh wearing the ACU. Skin temperature, core temperature, heart rate, and sweating rate data were collected in all experiments to evaluate heat strain. We found that while the skin temperature feedback worked effectively, the prototype MCCS provided insufficient cooling for our scenarios.

A Review of Workplace Interventions that Promote Mental Wellbeing in the Workplace

http://www.nice.org.uk/nicemedia/pdf/MentalWellbeingWorkFinalReport.pdf

According to the most recently available Labour Force Survey for 2004-2005, 509,000 individuals in the UK believed they were suffering from stress, depression or anxiety and these conditions were caused or made worse by their current or past work. This resulted in an estimated 12.8 million working days lost with an average of 30.9 days off over a 12 month period. Those employed in the public sector had some of the highest rates of self-reported stress, anxiety and depression. In particular those with heavy workloads, tight deadlines, lack of support at work, in a threatening environment are recognised as being at an increased risk of stress, depression or anxiety. This review aims to determine which workplace interventions are effective and cost-effective in improving mental wellbeing.

Identification of Human Factors Concerns in Joint Strike Fighter and Training Recommendations

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488780&Location=U2&doc=GetTRDoc.pdf

Military aviation is the frontier of implementing leading edge technology. The major objectives of advanced technology aircraft are to increase pilot safety and mission efficiency; the Joint Strike Fighter, the most modern fighter aircraft under development, has many technological innovations for just this purpose. A common fact is that technology develops and is used faster than it can be researched thoroughly. This thesis seeks to identify and mitigate potential human factors concerns related to the Joint Strike Fighter, before it is used in the air forces of participating countries. The objective is neither to blame nor defend the design of the aircraft. Two surveys and an interview yielded the following findings: fighter pilots will use automation more in JSF than in their current types, the main LCD management will be key to mission efficiency and safety, the Distributed Aperture System should be addressed very carefully to avoid disorientati on issues, and tactical decision-making skills will be more important and demanding. New approaches for better automation training, more focus on data filtering, display management, prioritization skills, establishing robust standard operating procedures for DAS, and addressing the complex decision-making skills in more detail than the current training curriculums are concluded to be the major requirements of JSF pilot training.

Biomarkers of Risk for Post-Traumatic Stress Disorder (PTSD)

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488785&Location=U2&doc=GetTRDoc.pdf

The objective of this proposal is to study genetic and neuroendocrine biomarkers of risk in a carefully assessed population of military personnel who have recently returned from war zones. The target sample includes 300 men and women who have recently returned from hazardous deployment and are undergoing a comprehensive assessment of symptoms and stressors in a related 12-month longitudinal study. To date, we have enrolled 125 subjects. Samples of saliva have been obtained from all 125 enrolled subjects for analysis of DNA and candidate genes. Cortisol samples have been obtained from 96 of these subjects. Hormone and genetic data will be used to predict the development of PTSD and chronic PTSD. In addition, interactions of these biomarkers with trauma severity and other stressors as well as social supports will be examined.

A 21st Century National Public Health System

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488731&Location=U2&doc=GetTRDoc.pdf

The attention that SARS created in 2003 has influenced public and political perceptions about the risks associated with infectious diseases and the role the public health system should play in national security. This comparative case study was conducted to examine the Canadian public health's system response to SARS in order to formulate recommendations for the U.S. public health system. This analysis demonstrated that the governmental organizational structure of the U.S. public health system does not support its current mission or its new responsibilities for public health security. A national public health system is needed to support dual missions: the traditional mission of tailoring public health programs specific to the social and demographic needs of the citizens; and the new mission of public health security. In order to transform the current U.S. public health system into a national public health system two critical components must be addr essed at the federal, state, and local level: 1) organizational capacity and 2) service delivery. Recommendations are provided regarding the way forward at the federal level and work needing to be done at the state and local level towards building a national system capable of meeting the public health threats of the 21st century.

Short-Wavelength Countermeasures for Circadian Desynchrony

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488544&Location=U2&doc=GetTRDoc.pdf



Exposure to light at critical phases of the circadian cycle entrains circadian rhythms. Exposure of humans to bright light for an hour or more at the right phase of the circadian cycle produces significant phase shifts of circadian rhythms speeding recovery from jet-lag, and optimizing cognitive functionality and restorative sleep. Our work on mice produced the unexpected result that exposure to intermittent millisecond flashes of light distributed over an hour for a total of only 120 msec. of light can produce maximum phase shifts. Our specific aims were: 1) build a prototype, programmable photodiode based device to deliver light flashes of 1 to 3 msec duration to a person's eyes, 2) conceptualize a commercializable wearable device containing an algorithm that will provide an automatic flash delivery schedule, 3) test whether or not the human circadian system is susceptible to phase resetting by appropriately delivered millisecond flashes of ligh t, and 4) plan experiments to define optimal stimulation protocols. We built the prototype, we have also built prototypes of wearable commercializable devices with a flash delivery algorithm. Tests of flash effects on human circadian rhythms are underway. And, our plans for future experiments have been incorporated into our Phase II proposal

U.S. Airline Transport Pilot International Flight Language Experiences, Report 1: Background Information and General/Pre-Flight Preparation

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488606&Location=U2&doc=GetTRDoc.pdf

In 1998, the International Civil Aviation Organization (ICAO) took a heightened interest in the role of language in airline accidents. Its Air Navigation Commission was directed to complete the task of strengthening relevant ICAO provisions concerning language requirements. Member states agreed to take steps to ensure air traffic control (ATC) personnel and flight crews involved in flight operations in airspace where the use of the English language is required were proficient in conducting and comprehending radiotelephony communications in English. Since then, ICAO developed its English Language Proficiency (ELP) requirements and urged its Members to document their ELP test implementation plans by March 8, 2008. Until all ATC personnel and flight crews involved in flight operations obtain a passing level of ELP, the language-based problems international pilots face is not known. This report is a compilation of written responses and comments by a s mall focus group of 48 U.S. pilots of their difficulties in international operations. The focus group consisted of 12 international U.S. pilots from American, Continental, Delta, and United Airlines. Each focus group met with two interviewers to discuss their language experiences flying into countries where English may or may not be the local or national language among its radio operators, controllers, and pilots. In this report, the pilots responses to 23 of the 64 multi-part questions and their comments from discussions of those questions with interviewers are presented as a compiled narrative.

Prevention of Low Back Pain in the Military: A Randomized Clinical Trial

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488588&Location=U2&doc=GetTRDoc.pdf


The second year of the Prevention of Low Back Pain in the Military (POLM) clinical trial was extremely successful. The research team was able to complete all Year 2 tasks in a timely fashion, and continues to work ahead in several areas. Study recruitment was completed in Year 2, with immediate follow-ups continuing to Year 3. This year the first publication from the POLM study was reported in the peer review literature and the first presentation was completed at a national conference. Long term follows up were started in Year 2, using the study specific website as the platform for data collection and will continue in last 2 years of the study.SOURCE CODE: 139900

Workload and Stress of Crews Operating Future Manned Vehicles

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA488761&Location=U2&doc=GetTRDoc.pdf

Operators of future vehicles must perform many functions with a reduced crew size. Operator workload and stress will likely increase. This research examined the workload and stress of operators by: * Live versus virtual simulation * Two types of tasks * Autonomous versus standard driving * Driving speed * Two crew positions (driver and gunner). This is a powerpoint presentation