COVID-19: responding to a pandemic on Operation TORAL.

Operation TORAL was the UK's contribution to NATO's Operation RESOLUTE SUPPORT in Kabul, Afghanistan. Approximately 1000 British troops were deployed in Kabul when the arrival of the COVID-19 pandemic in Afghanistan was declared. This article will describe the challenges faced due to COVID-19 in Kabul.Medical planning considerations, occupational health issues, implementation of behaviour change and operating as part of a multinational organisation are all discussed, with challenges encountered detailed and potential solutions offered. The use of a suggested framework for ensuring the medical estimate process covered all areas relevant to an emerging viral pandemic -the 4Ds and 4Cs approach-proved particularly useful in the early stages of the pandemic in Afghanistan.

The History of the Post-Graduate Medical and Nursing Officers (PGMNO) course in the British Army.

Military medicine has been evolving for over 5000 years of recorded civilisation and conflict. The Army Medical Services performed poorly during the Crimean War and the British Army introduced a professional training course for medical officers in 1860. The Army Medical School and the predecessor of today's Post-Graduate Medical and Nursing Officers (PGMNO) course have had to adapt to changes in British foreign policy and military requirements. The Army Medical School instigated a rigorous scientific medical training which led to major advances in the study of tropical diseases and trauma medicine. These advances were quickly included in the training of future cohorts. Although the Army Medical School has now closed, the PGMNO course thrives at its new location at the Defence Medical Academy, Whittington. Modern general duties medical officers (GDMOs) must be able to provide medical care in a range of austere environments, including humanitarian relief and conflict zones. New clinicians complete their basic military training before completing the PGMNO course and the Diploma in the Medical Care of Catastrophes. This programme ensures that GDMOs and military nurse practitioners gain a wide knowledge of the latest military and humanitarian medicine. The current era will require clinicians who are competent generalists, who can perform in small teams in dispersed locations. This article summarises the development of the British Army's PGMNO course and the evolution of its syllabus as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Nerve agents: emergency preparedness.

Nerve agents (NAs) are a highly toxic group of chemical warfare agents. NAs are organophosphorus esters with varying physical and chemical properties depending on the individual agent. The most recently developed class of NA is ' Novichok ', the existence of which was first revealed in the early 1990s, just before Russia signed the Chemical Weapons Convention. In 1984, Iraq became the first nation to deploy NA on the battlefield when they used tabun against Iranian military forces in Majnoon Island near Basra. The first terrorist use of an NA is believed to be the attack in Matsumoto, Japan, on 27 June 1994 by the Aum Shinrikyo doomsday cult. Symptoms and ultimate toxicity from NA poisoning are related to the agent involved, the form and degree of exposure, and rapidity of medical treatment. The classic toxidrome of significant exposure to NA comprises bronchorrhoea, bronchospasm, bradycardia and convulsions, with an onset period of as early as a few seconds depending on the mode and extent of exposure. If medical management is not instituted rapidly, death may occur in minutes by asphyxiation and cardiac arrest. In the UK, emergency preparedness for NA poisoning includes an initial operational response programme across all blue light emergency services and key first responders. This paper describes the development, pathophysiology, clinical effects and current guidance for management of suspected NA poisoning. It also summarises the known events in which NA poisoning has been confirmed.

Can a weight management conditioning course help with armed forces recruitment?

British Armed Forces are facing the most significant recruitment crisis since 2010. An important contributing factor to the recruitment crisis is the rise in obesity of the UK population. At Army Training Centre Pirbright, a weight management programme (WMP) has been established for recruits who have failed their initial medical assessment (IMA). To determine the proportion of recruits who entered the WMP and passed basic and initial trade training, allowing entry into the British Army. Retrospective service evaluation of recruits entering WMP from inception in April 2015 to August 2018. Medical records were used to assess whether recruits completed initial training. 72.3% of recruits included in the WMP who would have previously failed their IMA because of a high body mass index (BMI) passed basic and initial trade training. This evaluation demonstrates potential for candidates otherwise excluded based on BMI. This WMP delivers structured nutritional support and encourages physical training. Once a BMI enters the accepted range, recruits could enter basic training. This WMP would deliver structured nutritional support and encourage physical training, with the aim of promoting healthy lifestyles. Neither the Royal Navy nor the Royal Air Force currently have a WMP. There is potential for WMPs to be introduced to all three services. UK Armed Forces face a recruitment crisis and need to be adaptable with a population where obesity is prevalent. At Pirbright 72.3% of candidates in the WMP passed basic and initial trade training.

A new class of hybrid super-supertetrahedral cluster and its assembly into a five-fold interpenetrating network.

We describe an entirely new type of tetrahedral cluster, representing a new level of structural hierarchy: a hybrid tetrahedron of supertetrahedra, formed by five T3 supertetrahedral clusters connected by bipyridyl linkers. Covalent assembly of these 37 Å super-supertetrahedra with smaller (10 Å) T3 clusters results in the formation of a two-dimensional covalent network which contains pores in the mesoporous range.

[Investigation of Inulinase Permolecular Organization from Producers of the Genus Aspergillus by Means of Some Computing and Experimental Methods].

The computer model for a dimer of inulinase from Aspergillus ficuum is designed. The permolecular organization of inulinase from Aspergillus niger is experimentally investigated. The question about the role of various inulinase forms in manifestation of their functional activity is discussed. It is shown, that in the process of inulinase dimerization when contacts between monomeric forms of the enzyme are formed, a key role belongs to the nonpolar amino acid residues.

Complex visual hallucinations and attentional performance in eye disease and dementia: a test of the Perception and Attention Deficit model.

OBJECTIVE: This study aimed to test the prediction from the Perception and Attention Deficit model of complex visual hallucinations (CVH) that impairments in visual attention and perception are key risk factors for complex hallucinations in eye disease and dementia. METHODS: Two studies ran concurrently to investigate the relationship between CVH and impairments in perception (picture naming using the Graded Naming Test) and attention (Stroop task plus a novel Imagery task). The studies were in two populations-older patients with dementia (n = 28) and older people with eye disease (n = 50) with a shared control group (n = 37). The same methodology was used in both studies, and the North East Visual Hallucinations Inventory was used to identify CVH. RESULTS: A reliable relationship was found for older patients with dementia between impaired perceptual and attentional performance and CVH. A reliable relationship was not found in the population of people with eye disease. CONCLUSIONS: The results add to previous research that object perception and attentional deficits are associated with CVH in dementia, but that risk factors for CVH in eye disease are inconsistent, suggesting that dynamic rather than static impairments in attentional processes may be key in this population.

[Some results of radiaton monitoring of the ISS Russian Segment in 2000-2005].

Dynamics of the ISS RS radiation environment was studied using the data of daily (operative) monitoring and personal dose measurements during 11 increments in the period between August 1, 2000 and October 28, 2005 overlapping the maximum phase of the 23rd solar cycle. It was shown that personal absorbed doses varied within the range of measurements of dual wavelength radiometer R-16, a component of the ISS radiation monitoring system. Power of the absorbed doses fell in the range of 0.017 to 0.02 cGy/day and was solar-dependent.

Iron sequestration on skin: a new route to improved deodorancy.

Axillary malodour is caused by the biotransformation of non-odorous precursors present in apocrine sweat and sebum by the axillary microflora. To counter this, underarm products typically contain high levels of bactericides. However, after an initial decrease in bacterial numbers, the surviving cells grow, producing a concomitant rise in axillary odour. A sustained deodorant effect might be achieved without recourse to bactericidal action if this bacterial growth could be inhibited for extended periods. The current study attempted to inhibit axillary bacterial growth by nutrient deprivation, primarily that of iron (Fe(III)). In vitro analyses identified iron (Fe(III)) as the trace metal whose deprivation had the most profound effect on bacterial growth. Further in vitro investigations with Fe-chelating agents demonstrated that a number of compounds with high binding constants for Fe(III) showed optimal activity. One candidate molecule, diethylenetriaminepentaacetic acid (DTPA), was capable of effectively inhibiting bacterial growth in vitro and on the skin of the lower back. Some bacterial species could additionally utilize iron bound to the iron carrier protein transferrin present in eccrine sweat. This was minimized by the use of an agent, butylated hydroxytoluene (BHT), capable of liberating iron from transferrin via reduction of transferrin-bound ferric ions, allowing subsequent sequestration of Fe(II). Deodorant efficacy evaluation of the combination of DTPA and BHT showed deodorancy benefits over and above that afforded by DTPA alone. This mixture of DTPA and BHT supplemented to a standard ethanolic deodorant, used on 50 people for 2 weeks, was highly effective in limiting bacterial growth in the axilla. Total aerobic bacteria in the axillae were reduced from a mean of log 5.75 (+/-0.73) to log 4.50 (+/-0.90) colony-forming units (cfu) cm(-2) (n = 27, P < 0.01) compared with a non-fortified standard ethanolic deodorant. This was reflected in significant decreases in axillary malodour production, as determined by malodour assessments (P < 0.01). The profile of the axillary microflora was maintained, and all populations were rapidly returned to preuse levels after cessation of product use. This new deodorant technology was benchmarked against leading antimicrobial-based deodorant systems. In three separate deodorant efficacy evaluations, the combination of DTPA and BHT was tested against Triethyl citrate, Triclosan and Farnesol in standard unfragranced ethanolic formulations. The combination of DTPA and BHT showed highly significant deodorancy benefits over and above all these antimicrobial-based deodorant technologies. The combination of an efficient iron chelator with an agent capable of liberating iron from transferrin offers significant benefits in terms of bacterial growth inhibition on the skin and provides a new route to axillary deodorancy.

Perceived barriers to physical activity among high school students.

BACKGROUND: Perceived barriers to physical activity, the factor structure of perceived barriers, and the relationship between perceived barriers and participation in vigorous physical activity were examined. METHODS: A two-stage cluster sample of high school students (N = 1,041) in a large Metropolitan Toronto school district was used. Students completed a questionnaire (response rate 81.4%) dealing with participation in physical activity in three settings. Factor analysis was used to examine the dimensionality of perceived barriers. Multiple regression analysis was then used to examine the relationship between perceived barriers and participation. RESULTS: Time constraints due to school work, other interests, and family activities were three of the four barriers considered most important. Females cited consistently higher levels of perceived barriers than males. Two empirically distinct and theoretically meaningful factors emerged from the analysis--perceived internal barriers and perceived external barriers. Perceived internal barriers were predictive of physical activity in overall activity and outside of school activity. Perceived external barriers were predictive of overall physical activity and other school activity, but in the direction opposite to that hypothesized. CONCLUSIONS: It was concluded that perceived barriers may be predictive of physical activity participation among high school students only under specific conditions.

Self-efficacy and participation in vigorous physical activity by high school students.

The relationship between physical activity self-efficacy and participation in vigorous physical activity by high school students is examined in this article. Self-efficacy is hypothesized to be positively related to participation in three settings (physical education class, other school-related activities, and outside of school). The effects of age, gender, perceived barriers, and actual barriers are also examined. The sample consists of 1,041 grade 9 and 11 students from a large Metropolitan Toronto school board. Factors derived from a previous (factor) analysis were used to examine the effects of self-efficacy, perceived barriers, and life strain (an actual barrier). The results of multiple regression analysis indicate that physical activity self-efficacy, despite external barriers (but not internal barriers), is predictive of physical activity participation in the hypothesized direction. Other results show consistent age and gender effects on physical activity participation and some support for the hypothesized relationship between perceived barriers and participation.

Internal structure of a measure of self-efficacy in physical activity among high school students.

The preliminary development of a measure of self-efficacy to participate in vigorous physical activity when confronted with specific perceived barriers to physical activity is described. Measures used in previous research ([Hofstetter, C.R., Hovell, M.F., Sallis, J.F., 1990a. Social learning correlates of exercise self-efficacy: Early experiences with physical activity, Social Science and Medicine, 31, 1169-1176.]; [Hofstetter, C.R., Sallis, J.F., Hovell, M.F., 1990b. Some health dimensions of self-efficacy: Analysis of theoretical specificity, Social Science and Medicine, 31, 1051-1056.]; [Reynolds, K.D., Killen, J.D., Bryson, M.S., Maron, D.J., Taylor, C.B., Maccoby, N., Farquhar, J.W., 1990. Psychosocial predictors of physical activity in adolescents, Preventive Medicine, 19, 541-551.]; [Sallis, J.F., Pinski, R.B., Grossman, R.M., Patterson, T.L., Nader, P.R., 1988. The development of self-efficacy scales for health-related diet and exercise behaviors, Health Education Research, 3, 283-292.]) were adapted and original items were developed. The 20-item measure has a 5-point Likert format ranging from not at all confident (1) to very confident (5). An earlier pilot study of 200 secondary school students showed that the measure was free of social desirability. The data were derived from a survey of 1041 secondary school students from a Metropolitan Toronto board of education. Principal component analysis (PCA) with oblique rotation of the data yielded two factors: self-efficacy to overcome external barriers and self-efficacy to overcome internal barriers. The 12-item external barriers subscale had a coefficient alpha of 0.88 and the 8-item internal barriers subscale had a coefficient alpha of 0.87. The subscales significantly correlated with the frequency of participation in vigorous physical activity. In summary, the results provide some support for the internal consistency reliability, construct validity, criterion validity, and discriminant validity of the measure. Though further psychometric research is warranted, the self-efficacy measure shows promise for physical activity research.

Interactions between biofilms and the environment.

The surfaces of bacteria are highly interactive with their environment. Whether the bacterium is Gram-negative or Gram-positive, most surfaces are charged at neutral pH because of the ionization of the reactive chemical groups which stud them. Since prokaryotes have a high surface area-to-volume ratio, this can have surprising ramifications. For example, many bacteria can concentrate dilute environmental metals on their surfaces and initiate the development of fine-grained minerals. In natural environments, it is not unusual to find such bacteria closely associated with the minerals which they have helped develop. Bacteria can be free-living (planktonic), but in most natural ecosystems they prefer to grow on interfaces as biofilms; supposedly to take advantage of the nutrient concentrative effect of the interface, although there must also be gained some protective value against predators and toxic agents. Using a Pseudomonas aeruginosa model system, we have determined that lipopolysaccharide is important in the initial attachment of this Gram-negative bacterium to interfaces and that this surface moiety subtly changes during biofilm formation. Using this same model system, we have also discovered that there is a natural tendency for Gram-negative bacteria to concentrate and package periplasmic components into membrane vesicles which bleb-off the surface. Since some of these components (e.g., peptidoglycan hydrolases) can degrade other surrounding cells, the vesicles could be predatory; i.e., a natural system by which neighboring bacteria are targeted and lysed, thereby liberating additional nutrients to the microbial community. This obviously would be of benefit to vesicle-producing bacteria living in biofilms containing mixed microbial populations.

Using a program logic model that focuses on performance measurement to develop a program.

A program logic model is used to make a program ready for an evaluation. It diagrammatically shows the relationships between the objectives of the program, program activities, indicators, and resources. This article describes an expanded logic model that has a greater focus on measurement of program performance. The expanded logic model specifies both outcome and process indicators, whereas other logic models only show service delivery indicators. Also, this article describes how the expanded logic model was used to develop a bicycle safety program. A workgroup established program boundaries and reviewed documents early in the process of developing the logic model. The workgroup developed the logic model which was subsequently reviewed by other stakeholders. The workgroup continually assessed the plausibility of the logic model. Challenges and advantages in using the logic model are discussed.

Pseudomonas aeruginosa PAO1 ceases to express serotype-specific lipopolysaccharide at 45 degrees C.

Most Pseudomonas aeruginosa strains are able to produce two distinct lipopolysaccharide (LPS) O-polysaccharide types, A-band (common-antigen) and B-band (serotype-specific) LPSs. The relative expression levels of these two LPS types in P. aeruginosa PAO1 (O5 serotype) at various growth temperatures were investigated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining or Western blotting (immunoblotting) with monoclonal antibodies specific for each O polysaccharide. A-band and B-band LPSs were expressed concurrently when the cells grew at 15, 25, and 35 degrees C; however, growth at 45 degrees C resulted in a surface deficiency in B-band LPS as determined by immunoblotting and agglutination with B-band-specific monoclonal antibody. Transfer of these cells (expressing A-band LPS but deficient in B-band LPS) [A+B-]) to a lower temperature (at which the division time was comparable) resulted in a rapid resumption of normal A-band and B-band expression. B-band LPS was detectable by immunoblotting before measurable growth of the culture had occurred.

Effects of spectral contrast on perceptual compensation for spectral-envelope distortion.

Features in a sound's spectral envelope are important for perceptual identification but they are likely to be accompanied by spurious features due to distortion by the transmission channel between source and listener. Previous experiments have demonstrated that there is perceptual compensation for this distortion, and the present experiments ask whether the compensation involves a separation of spurious and salient features. Listeners identified words containing a vowel test sound in an /aept/ to /ppt/ continuum, with a carrier phrase before each word. Effects of transmission channels were simulated by filtering the carrier and the /pt/ following the test sound. Filters were pairs with frequency responses that were the difference of the spectral envelopes from the end-point vowels. Contrasts were altered by multiplying decibel values of the carrier filter's frequency response or the test sound's spectral envelope by a positive number. This keeps features such as peaks at the same frequencies but changes the difference in level between peaks and valleys. When the contrasts of the carrier filters and test sound were the same, the continuum's phoneme boundary was shifted in a manner consistent with a perceptual compensation for the filters that affects the neighboring test sound. However, this shift decreased when the carrier-filter's contrast was less than that of the test sound, and increased slightly when the test-sound's contrast was less than the carrier-filter's contrast. Therefore, the amount of compensation increases with the amount of distortion, even when spectral features such as peaks are kept at the same frequencies. So compensation seems to occur before any perceptual extraction of these features.

Some effects of filtered contexts on the perception of vowels and fricatives.

When a phrase is filtered to simulate the effects of a transmission channel, a vowel played shortly afterward is heard as if there is perceptual compensation for the filter. However, a transmission channel would also have an effect on sounds that arrive after the vowel. The present experiments ask whether vowel test sounds are affected by the filtering of a subsequent affricate when there are no other sounds present. Effects on other types of test sounds from different subsequent sounds are measured as well. The experiments also ask whether these effects occur when there is information about the channel in a precursor phrase. Listeners identified words from continua between /It integral of/ and /epsilon t integral of/, /aept/ and /[symbol: see text]/, or /[symbol: see text]/ and /[symbol: see text]/. Filters' frequency responses were the difference of spectral envelopes from the end-point test sounds. The perceptual midpoints of all the continua were shifted in a manner consistent with compensation when the precursors were filtered, as well as when sounds subsequent to the test sound were filtered and there were no precursors. Also, when filtered precursors were present, the shifts increased when filtering was added to sounds subsequent to the test sound. These results indicate that mechanisms of perceptual compensation for filtering by transmission channels use information in preceding sounds in combination with information in following sounds and that these mechanisms operate between different types of speech sounds.

Perceptual compensation for speaker differences and for spectral-envelope distortion.

This study asks whether perceptual mechanisms that compensate for the spectral-envelope distortion of transmission channels also contribute to compensation for speaker differences. Subjects identified test words that were played after a carrier sentence. In some conditions the carriers were synthesized with F1 in low- and high-frequency ranges and in others they were distorted by filters whose frequency response is the spectral envelope of one vowel minus the spectral envelope of another. The filter /I/ minus /epsilon/ and its inverse were used. Test words were drawn from an /Itch/ to /epsilon tch/ continuum. Carriers filtered by /I/ minus /epsilon/ and its inverse give a phoneme boundary difference, indicating compensation for spectral envelope distortion. A phoneme boundary difference also occurs between carriers with F1 in low and high ranges, indicating compensation for speaker differences. Neither of these effects is reduced by playing the carrier backwards, even though a measurement of the perceived naturalness of carriers is sharply reduced by this manipulation. Analysis of carriers synthesized with low and high F1 showed that they have different long-term spectra, and subsequent experiments used time-stationary filters to alter this characteristic. The results showed that the long-term spectra of the carriers govern their influence on the identity of subsequent test sounds. However, measurements of perceptual confusions among the carriers and of perceived talker-differences between carriers revealed that other, time-varying factors are more important for voice identification.