Health risk behaviors and quality of life among recent veterans and implications for VA health care

Context: The US Armed Forces are experiencing a greatly increased operational tempo due to ongoing military actions around the world. The effects of service members' service component (active or reserve) on post-deployment health risk behaviors and quality of life have not been well characterized. Objective: To compare post-deployment health risk behaviors and health-related quality of life (QOL) among active and reserve component veterans of ongoing military actions. Design: Cross-sectional study based on secondary analysis of data from VA's outpatient Survey of Healthcare Experiences of Patients (SHEP). Setting: Survey mailed monthly to a stratified random sample of veterans who received outpatient care at VA facilities in FY2005. Participants: Outpatients with confirmed deployment in support of Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) (n=7,156). Measures: Demographic patient characteristics, AUDIT -C (alcohol use), smoking status, estimated BMI, SF-12 MCS (mental) and PCS (physical) QOL scales. Results: In unadjusted analyses, active component members were more likely to report binge drinking (p=0.008), healthy BMI (p 100 cigarettes (p=0.02). Adjusted mean BMI (p=0.03) and SF-12 MCS (p=0.007) were slightly higher for active component members. Conclusions: Service category was not associated with post-deployment health risk behaviors after controlling for demographic covariates. Statistically significant differences in BMI and mental well-being were small and not clinically meaningful. Health risk behaviors are highly prevalent in this post-deployment population, and mental and physical well-being scores are below national means.Master of Public Healt

Effect of fatigue and hypohydration on gait characteristics during treadmill exercise in the heat while wearing firefighter thermal protective clothing.

This study compared the gait characteristics of individuals walking in heat while wearing firefighting equipment in fatigued and non-fatigued states. Nineteen subjects performed a 50-min treadmill protocol in a heated room while gait patterns were recorded using a digital video camcorder. Forty gait cycles were analyzed near the beginning (9 min) and at the end (39-49 min) of exercise. Spatio-temporal gait variables including step frequency, step length, swing time, stance time, cycle time and double-support time were determined. Gait variability was quantified by the standard deviation (SD) and coefficient of variation (CV) of each variable. Left-right symmetry was calculated using the symmetry index (SI) and symmetry angle (SA). Paired t-tests (alpha = 0.05) were performed to identify difference between the beginning and the end of the protocol for each measured variable. Spatio-temporal gait characteristics did not differ between the beginning and the end of exercise. Gait variability of the double-support time increased at the end as measured by both SD (P = 0.037) and CV (P = 0.030) but no change was observed for other variables. Left-right symmetry measured using either SI or SA did not differ between sessions. In summary, spatio-temporal gait characteristics and symmetry while wearing firefighting equipment are insensitive to physiological fatigue. Prolonged walking in heat while wearing firefighting equipment may increase gait variability and therefore the likelihood of a fall. Future studies are needed to confirm the potential relationship between fatigue and gait variability and to investigate the possible influence of individual variation

Mirror Neutron Stars

The fundamental nature of dark matter is entirely unknown. A compelling candidate is Twin Higgs mirror matter, invisible hidden-sector cousins of the Standard Model particles and forces. This generically predicts mirror neutron stars, degenerate objects made entirely of mirror nuclear matter. We find their structure using realistic equations of state, robustly modified based on first-principle quantum chromodynamic calculations. We predict their detectability with gravitational waves and binary pulsars, suggesting an impressive discovery potential and ability to probe the dark sector.Comment: 5p, 2 figures + references + supplemental material (17p, 5 figures

Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest

Background In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of −0.2 percentage points (95% confidence interval, −1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.

STRENGTH AND CONDITIONING PROGRAMMES FOR IMPROVING BACK MUSCLE FATIGABILITY IN FIREFIGHTERS

Back pain and back-related injuries are common in firefighters. The purpose of this study was to compare the effectiveness of two different types of strength and conditioning programmes in improving back muscle fatigability in firefighters. A total of 12 male firefighters completed 16 weeks on supervised exercise intervention programme. The Functional Group was prescribed unilateral movements that mimicked the asymmetrical nature of firefighting tasks. The Conventional Group performed more bilaterally loaded, symmetrical exercise training. The lumbar extensor muscles’ resistance to fatigue was assessed using the Modified Sorensen test with electromyography (EMG). The EMG median frequency slope was less steep (p = 0.023, η²p =0.420) after training, indicating improvement in fatigability. There was no difference between the groups (p = .605, η²p = 0.028) and no interaction effect (p = 0.245, η²p =0.132). In conclusion, a well-rounded strength and conditioning programme is promising in improving back muscle fatigability in firefighters

Rate of change in longitudinal EMG indicates time course of an individual's neuromuscular adaptation in resistance-based muscle training

An individual's long-term neuromuscular adaptation can be measured through time-domain analyses of surface electromyograms (EMG) in regular resistance-based training. The perceived changes in recruitment, such as those measured during muscle fatigue, can subsequently prolong the recovery time in rehabilitation applications. Thus, by developing quantifiable methods for measuring neuromuscular adaptation, adjuvant treatments applied during neurorehabilitation can be improved to reduce recovery times and to increase patient quality of care. This study demonstrates a novel time-domain analysis of long-term changes in EMG captured neuromuscular activity that we aim to use to develop a quantified performance metric for muscle-based intervention training and optimization of an individual. We measure EMG of endurance and hypertrophy-based resistance exercises of healthy participants over 100 days to identify trends in long-term neuromuscular adaptation. Particularly, we show that the rate of EMG amplitude increase (motor recruitment) is dependent on the training modality of an individual. Particularly, EMG decreases over time with repetitive training – but the rate of decrease is different in hypertrophy, endurance, and control exercises. We found that the EMG peak contraction decreases across all subjects, on average, by 8.23 dB during hypertrophy exercise and 10.09 dB for endurance exercises over 100 days of training, while control participants showed negligible change. This represents approximately 2 dB difference EMG activity when comparing endurance and hypertrophy exercises, and >8 dB change when comparing to our control cases. As such, we show that the slope of the long-term EMG activity is related to the resistance-based exercise. We believe this can be used to identify person-specific performance metrics, and to create optimized interventions using a measured performance baseline of an individual

Postdischarge antibiotic use for prophylaxis following spinal fusion

OBJECTIVE: Despite recommendations to discontinue prophylactic antibiotics after incision closure or \u3c24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion. DESIGN: Multicenter retrospective cohort study. PATIENTS: This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded. METHODS: Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models. RESULTS: In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00-1.70), lymphoma (OR, 2.57; 95% CI, 1.11-5.98), solid tumor (OR, 3.63; 95% CI, 1.62-8.14), morbid obesity (OR, 1.64; 95% CI, 1.09-2.47), paralysis (OR, 2.38; 95% CI, 1.30-4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17-7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01-1.93), longer length of stay, and intraoperative antibiotics. CONCLUSIONS: Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge

Surgeon choice in the use of postdischarge antibiotics for prophylaxis following mastectomy with and without breast reconstruction

Multiple guidelines recommend discontinuation of prophylactic antibiotics \u3c24 hours after surgery. In a multicenter, retrospective cohort of 2,954 mastectomy patients ± immediate breast reconstruction, we found that utilization of prophylactic postdischarge antibiotics varied dramatically at the surgeon level among general surgeons and was virtually universal among plastic surgeons

Heat Safety in the Workplace:Modified Delphi Consensus to Establish Strategies and Resources to Protect U.S Workers

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity

Long Range Plan: Dense matter theory for heavy-ion collisions and neutron stars

Since the release of the 2015 Long Range Plan in Nuclear Physics, major events have occurred that reshaped our understanding of quantum chromodynamics (QCD) and nuclear matter at large densities, in and out of equilibrium. The US nuclear community has an opportunity to capitalize on advances in astrophysical observations and nuclear experiments and engage in an interdisciplinary effort in the theory of dense baryonic matter that connects low- and high-energy nuclear physics, astrophysics, gravitational waves physics, and data scienceComment: 70 pages, 3 figures, White Paper for the Long Range Plan for Nuclear Scienc