Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA552009&Location=U2&doc=GetTRDoc.pdf


Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update

Hospenthal, Duane R ; Murray, Clinton K ; Andersen, Romney C ; Bell, R B ; Calhoun, Jason H ; Cancio, Leopoldo C ; Cho, John M ; Chung, Kevin K ; Clasper, Jon C ; Colyer, Marcus H

Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. 'This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of hlgh-dose cefazolin with or without metronidazole tor most postinjury indications, and recommendations tor redosing of antimicrobial agents, for use of negative pressure wound therapy, and tor oxygen supplementation in flight.
Descriptors : *INFECTIOUS DISEASES, *SURGERY, ANTIMICROBIAL AGENTS, CIVILIAN POPULATION, CLINICAL TRIALS, COMBAT AREAS, IN VITRO ANALYSIS, MILITARY PERSONNEL, OXYGEN, PRESSURE, PREVENTIVE MEDICINE, RESUSCITATION, THERAPY, TRAUMA, VETERANS(MILITARY PERSONNEL), WOUNDS AND INJURIES

Optical Filter Effects on Night Vision Goggle Acuity and Preservation of Dark Adaptation

http://www.dtic.mil/dtic/tr/fulltext/u2/a529412.pdf

Optical Filter Effects on Night Vision Goggle Acuity and Preservation of Dark Adaptation

Thomas, Roger S. ; Wright, Steve T. ; Clark, Patrick J. ; Thompson, William T. ; Gooch, John M.

The high output of night vision goggles (NVGs) can cause a loss of dark adaptation, resulting in suboptimal unaided vision. Optical filters have been designed to mitigate this problem by changing the overall output characteristics of the NVGs. Methods: Several aspects of visual performance related to NVG use were studied in a repeated measures design, filters versus no filters. NVG acuity was assessed using a 25% contrast chart, while preservation of dark adaptation after NVG use was measured with a scotopic sensitivity tester (SST) and a low luminance acuity chart. Testing was accomplished at two light levels, roughly corresponding to starlight and quarter moon conditions. Results: Use of the filters resulted in a statistically significant loss of acuity of about a 1/2 line (approximately 2.5 letters) at both light levels. The second part of the study identified a 47% improvement in preservation of dark adaptation under simulated starlight conditions and a 31% improvement under simulated quarter moon conditions with filter use; however, only the starlight finding was statistically significant. No significant differences in performance were seen with the low luminance chart. Discussion: Despite a small loss of visual acuity with filter use, the improvement in retention of dark adaptation may be beneficial in certain operational environments. Aviators, airmen, and commanders should evaluate how the potential for slightly poorer visual acuity and improved recovery of dark adapted vision relates to their mission specific requirements prior to implementing use of NVG filters.
Descriptors : *DARK ADAPTATION, *NIGHT VISION DEVICES, VISUAL ACUITY, OPTICAL FILTERS, EXPERIMENTAL DESIGN, REPRINTS, NIGHT VISION

Acceleration Tolerance After Ingestion of a Commercial Energy Drink

http://www.dtic.mil/docs/citations/ADA534177


Acceleration Tolerance After Ingestion of a Commercial Energy Drink


Walker, Thomas B. ; Balldin, Ulf ; Fischer, Joseph ; Storm, William ; Warren, Gordon L.


This study examined the ability of a commercial energy drink to enhance acceleration tolerance, strength under G-load, and cognitive performance immediately prior to and following acceleration exposure. Eight experienced centrifuge subjects completed three separate experimental acceleration exposures following ingestion of 11.5 ml/kg body weight of a)a commercial energy drink, providing 5.0 mg caffeine/kg body weight, b) a commercial energy drink without caffeine or c) placebo. The acceleration exposures consisted of a relaxed gradual onset run to peripheral light loss, a rapid onset run to 6.0 G for 15 s, and a simulated air combat maneuver (SACM) run of repeated alternations between 4.5 G for 15 seconds and 7G for 15 seconds until volitional exhaustion. Cognitive tests were performed prior to and after the acceleration profiles. Relaxed G-tolerance was significantly higher under the caffeine session, whereas SACM duration did not differ among the drink conditions. Hip adductor muscle strength was lower during the placebo session than during the other two sessions. Cognitive reaction time was faster post-acceleration than pre-acceleration, and faster under the caffeine condition than the placebo condition. We conclude that consumption of a caffeine-based energy drink enhances relaxed G-tolerance and may increase strength, but does not impact acceleration duration. We further conclude that cognitive reaction time is improved by the caffeinated drink, as well as by the physical exertion during the acceleration exposure.
Descriptors : *CAFFEINE, SIMULATION, REPRINTS, PERFORMANCE(HUMAN), COGNITION, STRENGTH(PHYSIOLOGY), ACCELERATION TOLERANCE, ENERGY, CENTRIFUGES, MUSCLES, EXPOSURE(PHYSIOLOGY), PLACEBOS, TEST AND EVALUATION, REACTION TIME

A Snack-based Ration Containing Caffeine Increases Caloric Intake and Improves Cognitive Performance

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA545299&Location=U2&doc=GetTRDoc.pdf

A Snack-based Ration Containing Caffeine Increases Caloric Intake and Improves Cognitive Performance
ARMY RESEARCH INST OF ENVIRONMENTAL MEDICINE NATICK MA
McClung, Holly L. ; Ely, Matthew R. ; Lieberman, Harris R. ; Smith, Julie E. ; McGraw, Susan M. ; Niro, Phil J. ; Davis, Betty A. ; Young, Andrew J. ; Montain, Scott J.


Warfighter cognitive performance degrades during sustained operations in part due to difficulty consuming adequate calories and limited access to stimulants such as caffeine. This investigation tested the effectiveness of a snack-based ration, containing caffeinated components, to increase energy and preserve cognitive performance during sustained operations. Eighty-nine Marines consumed either an entree-based (MRE) or a snack-based (FSR) ration during a four-day field exercise with limited sleep. Outcome measures included visual reaction time, logical reasoning, mood state (POMS), and energy intake. Total calories, CHO and caffeine intake was greater (P<0 .05) for FSR compared to MRE in part due to a significant increase in the number of daily eating episodes in those consuming the FSR (P<0.05). Reaction time was faster and fewer lapses in attention occurred in Marines consuming the FSR compared to MRE (P<0.05). There was no difference in logical reasoning between groups. Overall mood deteriorated over the course of the exercise with no difference between ration groups.
Descriptors : *CAFFEINE, *MILITARY RATIONS, REASONING, MEALS, COGNITION, PERFORMANCE(HUMAN), REACTION TIME

Beryllium

http://www.hse.gov.uk/research/rrpdf/rr873.pdf

RR873

Beryllium
A review of the health effects and the evidence for screening or surveillance in workers exposed to beryllium

Dr Anthony Darby & Dr David Fishwick

As exposure limits for beryllium have decreased, so has the incidence and severity of chronic beryllium disease.
There are however an emerging number of cases of subclinical disease and beryllium sensitization (BeS) that are being detected with new immunological tests, namely the beryllium lymphocyte proliferation test (BeLPT). Almost all the recent data on screening beryllium workers relates to the BeLPT, and more traditional screening programmes such as spirometry and chest x-rays that have been in use since the 1950s have only been evaluated as secondary endpoints.
Whilst the BeLPT has revolutionised the diagnosis of chronic beryllium disease (CBD), concerns have been raised about its inter- and intra-laboratory variability, possible reversibility in patients and uncertain sensitivity and specificity. There is also debate about the natural history of BeS and subclinical CBD and the ethical aspects of identifying disease early when there is no treatment, and subsequent employment implications. Another issue for the UK is the fact that only one laboratory offers BeLPT testing, although certain evidence supports double sampling of tests across laboratories to improve sensitivity and specificity. All these factors have led to certain US based groups advocating the use of BeLPT for screening and others not.
Therefore, in the US, a definitive stance on the content of a health surveillance programme has not been possible from the current evidence base. This is supported by the fact, for example, that the National Institute for Occupational Safety and Health (NIOSH), whilst citing many articles on beryllium on its website, does not offer any specific advice on health surveillance in beryllium workers, as it does for other industries.
This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Optimum test conditions and variability of otoacoustic emission testing in individuals with normal hearing

http://www.hse.gov.uk/research/rrpdf/rr840.pdf

RR840

Optimum test conditions and variability of otoacoustic emission testing in individuals with normal hearing


Kerry Poole

This study investigates issues important for the potential usefulness and practical application of OAE testing within an occupational health surveillance programme. Before this technique can be used within health surveillance, it is important to understand how reliable the measurements are and the level of change that could be detected over time within individuals. As any test of hearing function is potentially susceptible to background noise levels, it was also important to establish whether a soundproof room or audio booth would be required if this were to be used within health surveillance. We also wished to compare the reliability of OAE to that of standard puretone audiometry.
This report and the work it describes were funded by the Health and Safety Executive (HSE).

KEY MESSAGES
Otoacoustic emission testing (OAE) has good reliability and repeatability in individuals with normal hearing. It should be borne in mind that this study did not investigate the impact of noise exposure or hearing difficulties on OAE, both of which would be important factors in occupational health surveillance.
The smallest difference that can be detected using the technique appears to be small enough to be able to pickup changes that may be expected with noise-induced hearing loss over time, but this would need to be verified by future research work.
The room in which the measurements are performed (quiet room versus audio booth) has little influence on the reliability of the technique. Thus, a soundproof room may not be necessary to obtain good quality information.