Neoplasia in an assurance population of Puerto Rican crested toads (Peltophryne lemur).

Disease monitoring of amphibian assurance populations is an important buffer against ongoing global extinctions. This study documents a high incidence of neoplasia in a zoo-managed assurance population of Puerto Rican crested toads (Peltophryne lemur; PRCTs). Over 5 years, neoplasia was diagnosed in 17/49 (35%) submitted adult PRCTs and was the cause of death or euthanasia in 13/17 (72%). Most toads were male (16/17; 94%) and 6 to 11-years-old (average 8.1 years). Notably, seven toads (41%) had multiple neoplasms. Of the 29 neoplasms identified, 17 (59%) were cutaneous or subcutaneous. The most common neoplasms included mast cell tumors (MCTs; 8/29; 28%), histiocytic sarcomas (6/29; 21%), lymphoma/leukemia (4/29; 14%), and squamous cell carcinomas (3/29; 10%). Distant metastases were documented in 6/8 (75%) toads with MCTs. Causes for neoplasia in this population were not determined though may include genetic or environmental factors. Continued investigations of managed endangered amphibians will help elucidate mechanisms of carcinogenesis.

SARS-CoV-2 B.1.1.7 Variant Infection in Malayan Tigers, Virginia, USA.

We report infection of 3 Malayan tigers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.7 (Alpha) variant at a zoologic park in Virginia, USA. All tigers exhibited respiratory signs consistent with SARS-CoV-2 infection. These findings show that tigers are susceptible to infection with the SARS-CoV-2 B.1.1.7 variant.

Emerging Despite the Indelible Wound: A Grounded Theory of Family Transformation Following Adolescent Suicide.

Family members of a person who has died by suicide are at an increased risk of experiencing depression, post-traumatic stress disorder, suicide ideation, and suicide. However, despite the experience of losing a family member to suicide, most families continue to function and even live well following this difficult experience. This study sought to understand and describe the transformation process that occurs in family member survivors using a grounded theory approach. Seven families, who experienced the loss of an adolescent in their family by suicide, participated in this qualitative study that used a grounded theory methodology. The results describe the transformation process experienced by the family, one of growth and learning, even though the wound from their tragic loss was still present. According to the grounded theory developed in this study, the suicide is a cataclysm, followed by a sinking period that is tempered by the presence of lifebuoys, which are supports that can be found within the families or from people around them. It is necessary for family nurses to understand this transformation process to better support surviving family members and improve suicide postvention care.

The FORCE Fitness Profile--Adding a Measure of Health-Related Fitness to the Canadian Armed Forces Operational Fitness Evaluation.

In 2013, the Canadian Armed Forces (CAF) implemented the Fitness for Operational Requirements of Canadian Armed Forces Employment (FORCE), a field expedient fitness test designed to predict the physical requirements of completing common military tasks. Given that attaining this minimal physical fitness standard may not represent a challenge to some personnel, a fitness incentive program was requested by the chain of command to recognize and reward fitness over and above the minimal standard. At the same time, it was determined that the CAF would benefit from a measure of general health-related fitness, in addition to this measure of operational fitness. The resulting incentive program structure is based on gender and 8 age categories. The results on the 4 elements of the FORCE evaluation were converted to a point scale from which normative scores were derived, where the median score corresponds to the bronze level, and silver, gold, and platinum correspond to a score which is 1, 2, and 3 SDs above this median, respectively. A suite of rewards including merit board point toward promotions and recognition on the uniform and material rewards was developed. A separate group rewards program was also tabled, to recognize achievements in fitness at the unit level. For general fitness, oxygen capacity was derived from FORCE evaluation results and combined with a measure of abdominal circumference. Fitness categories were determined based on relative risks of mortality and morbidity for each age and gender group. Pilot testing of this entire program was performed with 624 participants to assess participants' reactions to the enhanced test, and also to verify logistical aspects of the electronic data capture, calculation, and transfer system. The newly dubbed fitness profile program was subsequently approved by the senior leadership of the CAF and is scheduled to begin a phased implementation in June 2015.

Development and Implementation of Evidence-Based Physical Employment Standards: Key Challenges in the Military Context.

The use of evidence-based physical employment standards is critical in selecting individuals who can meet the requirements of arduous military occupations. The methods used to generate the physical assessments and standards are critical to the process and must withstand legal scrutiny. This article addresses the challenges encountered when developing, validating, and implementing physical standards and assessments. The challenges covered by the study include: (a) identification of critical job tasks and minimum requirements for performance of the tasks, (b) involvement of military personnel as subject-matter experts,

The Value of Strength as a Predictor of Musculoskeletal Injury in Canadian Armed Forces Basic Infantry Candidates.

INTRODUCTION: Musculoskeletal injuries (MSKI) impact military organizations by threatening their operational readiness, warranting investigation into relevant factors to inform risk reduction strategies. While several self-reported and physical performance measures have been associated with MSKI among military personnel, few have been validated and none have been reported in Canadian basic infantry candidates. The purpose of this study was to investigate associations between self-reported and physical performance measures and MSKI, and determine their validity as predictors of MSKI, in Canadian basic infantry candidates. METHODS: This was a planned secondary analysis of a study tracking MSKI at a basic infantry training facility in Ontario, Canada approved by Defence Research & Development Canada. Before the basic infantry training, consenting candidates completed a baseline testing session including self-reported questionnaires, measures of anthropometry, and physical performance previously associated with MSKI (ankle dorsiflexion test, Y-Balance Test, Isometric Mid-Thigh Pull, and the Fitness for Operational Requirements of CAF Employment (FORCE) evaluation). All MSKI reported by candidates were diagnosed by licensed healthcare providers. From a total sample of 129 candidates, 76% (n = 98) were used to determine any associations between baseline testing variables and MSKI and to develop a predictive model (Development Sample), while 24% (n = 33) were used to offer preliminary validation of the same predictive model (Validation Sample). The binary logistic regression and independent sample t-testing determined independent associations with MSKI in the Development Sample. All continuous variables and dichotomous variables previously associated with MSKI risk (Smoker Yes/No, previous history of MSKI, and physical inactivity) were entered into a backward stepwise logistic regression analysis to assess the predictive association with MSKI incidence in the Development Sample. The regression model was then applied to the Validation Sample. RESULTS: A total of 35 MSKI were diagnosed by Health Services Centre staff. The majority of the MSKI were acute (63%), sustained to the hip, knee, and ankle (74%). The most common diagnoses were strains and sprains (71%). Uninjured participants performed significantly better on the Relative Isometric Mid-Thigh Pull, FORCE 20 mR, FORCE ILS, and FORCE Estimated VO2peak compared to injured participants. Logistic regression analysis showed that the only variable with significant independent association with diagnosed MSKI incidence was self-reported previous history of MSKI. However, the backward stepwise logistic regression analysis retained self-reported previous history of MSKI, FORCE SBD, FORCE Estimated VO2peak, and Isometric Mid-Thigh Pull Peak Force as predictors of MKSI. The logistic regression model including these variables could predict MSKI with an accuracy of 79% in the Development Sample and 67% in the Validation Sample. CONCLUSION: This study provides preliminary support for the value of measures of absolute muscular strength and cardiorespiratory fitness as predictors of MSKI in Canadian basic infantry candidates. Given the associations between physical performance measures and MSKI, and their necessity during occupational tasks, it is recommended that Canadian basic infantry training facilities integrate resistance training with external loads to best prepare their candidates to meet their occupational demands and potentially minimize MSKI. Further investigations to confirm the predictive capacity of these variables in a larger sample across additional facilities are warranted.

The feasibility of implementing an evidence-based physical training program during a Canadian Armed Forces basic infantry course.

OBJECTIVES: Determine the feasibility of implementing an evidence-based training program compared to a control during a basic infantry training course, and compare their effectiveness on measures of injuries and associated burdens. DESIGN: Prospective, cohort, feasibility study. METHODS: Infantry candidates awaiting course between 01-April-2019 and 31-March-2020 were invited to participate while those releasing from the military, awaiting occupational transfer or having >5 medical employment limitation days were excluded. Consenting participants were allocated to an infantry course prospectively scheduled to host either the evidence-based program or a control. The evidence-based program adapted modified physical training strategies from previous studies reporting reduced injuries in recruits and was supervised by certified fitness professionals, while the control was at the discretion of infantry instructors. RESULTS: With the exception of intervention duration which was limited due to operational factors, all feasibility outcomes were met including a recruitment rate of 171/203=84.2% and an intervention adherence of 126/144=87.5%. Stakeholders reported that the evidence-based program implementation was feasible, posing a manageable demand on resources without compromising operations. Evidence-based program participants reported 68% fewer overuse musculoskeletal injuries, 296 fewer medical employment limitation days and 11 fewer attritions than control participants. CONCLUSIONS: An evidence-based training program is feasible to implement on a basic infantry training course, and results in fewer musculoskeletal injuries, medical employment limitation days and attrition. Given these results, this program should be generalizable for a full experimental trial, and may be scaled for intermediate/advanced infantry and/or other combat occupation courses to promote an evolution towards evidence-based training.

ECG during helicopter underwater escape training.

INTRODUCTION: Coincidental stimulation of the sympathetic and parasympathetic nervous system can cause "autonomic conflict" and consequent cardiac arrhythmias. The present study tested the hypotheses that: 1) cardiac arrhythmias would be seen in those undertaking helicopter underwater escape training (HUET); 2) the occurrence of arrhythmias in individuals could be predicted; and 3) the heart rate response to HUET would habituate with repeated runs. METHODS: There were 26 male volunteers who each undertook 5 HUET submersions into water at 29.5 degrees C, with each run separated by 10 min. Each submersion included a 3-min, 40-s pre-submersion period, a 10-s submersion, and 40-s post-submersion period. Participants wore a three-lead telemetric ECG system beneath an immersion suit and underclothing. Skin temperature was measured in one participant. Each participant undertook tests to establish their autonomic function, including heart rate variability, face immersion, cold pressor test, and aerobic capacity assessment. RESULTS: The heart rate response to HUET was reduced by the fourth run when compared to the first run. Across all runs, 32 cardiac arrhythmias were identified (25%) in 22 different participants; all but 6 of the arrhythmias occurred just after submersion. Only aerobic fitness appeared inversely associated with the occurrence of arrhythmias. CONCLUSIONS: The heart rate response to HUET habituates. HUET produces cardiac arrhythmias; these are asymptomatic and probably of little clinical significance in young, fit individuals. It remains to be seen if this is the case with either an older, less fit cohort of people or in those undertaking longer breath holds in colder water.

Effects of ankle-foot orthoses for children with hemiplegia on weight-bearing and functional ability.

PURPOSE: To compare the effects of a leaf spring ankle-foot orthosis (LAFO) and a hinged AFO with plantar flexion stop with that of shoe only on weight-bearing and function in children with hemiplegia. METHODS: The study used an experimental single-subject alternating treatment design with replication. Outcomes measured were weight-bearing symmetry, weight-bearing on the hemiplegic rear foot compared with that of the forefoot, functional ability, and child and parent preference. RESULTS: Both AFOs increased relative contact area of the hemiplegic foot. The LAFO increased relative force through the hemiplegic foot. There was increased pressure through the rear foot, time spent on the rear foot, and force through the forefoot. Rear foot contact area increased in the LAFO. Neither AFO affected function. Patient preference for AFO condition was inconsistent. CONCLUSION: Both AFOs increased weight-bearing through the hemiplegic foot and rear foot, indicative of potential benefit to growth. Neither the LAFO nor the hinged AFO with plantar flexion stop improved function of the children.

Reliability of FORCE COMBAT™: A Canadian army fitness objective.

OBJECTIVES: The Canadian Army fitness objective is FORCE COMBAT™. This consists of a 5km march (35kg) between 50-60min, and the annual FORCE physical employment standard as a circuit without the usual 5min rest intervals (FORCE circuit) in full fighting order (25kg). The objective of this research was to determine the number of practice attempts required to establish reliability of FORCE COMBAT™. Additionally, this study aims to identify the minimal detectable change once reliability is established. DESIGN: The study used a within participant design. METHODS: 33 Canadian Army members were divided into two groups. Group 1 performed four maximum effort attempts of FORCE COMBAT™ completely. Group 2 performed only the FORCE circuit component, not the loaded march. On the fifth trial, the tasks of the groups were switched. Variability within and between trials of the FORCE circuit of FORCE COMBAT™ were analysed based on six statistical factors of reliability. RESULTS: Four statistical factors indicated that one maximal effort practice attempt of FORCE COMBAT™ is required, as reflected in the variability of performance between trials 1 and 2. The minimum detectable change, highlighting inherent measurement error of the test was 89.18s with 95% confidence. CONCLUSIONS: Results suggest that Canadian Army members should complete one FORCE COMBAT™ in completion at maximal effort, before formal assessment. Further, members performing within 89s of the recommended completion time, on FORCE COMBAT™ should be offered a re-attempt (in its entirety).

Physical employment standards, physical training and musculoskeletal injury in physically demanding occupations.

BACKGROUND: Physically demanding occupations such as the military, firefighting and law enforcement have adopted physical employment standards (PES). The intent of PES is to match the physical capacity of personnel with the physical demands of job tasks. Inadequate physical capacity can affect occupational task performance as well musculoskeletal injury (MSKI) risk. OBJECTIVE: To present contemporary evidence on the relationship(s) between PES, physical training, physical capacity and MSKI in physically demanding occupations, and provide recommendations regarding physical training for improved occupational performance and reduced MSKI risk. METHODS: This narrative review draws on evidence from 104 published sources. RESULTS: Physical training is central to the development and maintenance of occupationally-relevant physical capacity, as well as mitigating MSKI risk associated with job performance. In addition, given the prevalence of manual handling tasks, strength training needs to be emphasised in physical training regimen. CONCLUSIONS: PES development can inform both physical training and injury prevention strategies in physically demanding occupations. Furthermore, a physical performance continuum is essential to through-career maintenance of occupational performance and health, and the preservation of organisational capability. Finally, organisations should consider the potential to implement PES as maximal performance tests to better understand the relationship between occupational task performance and MSKI risk.

Factors Affecting Performance on an Army Urban Operation Casualty Evacuation for Male and Female Soldiers.

INTRODUCTION: This study was conducted to determine what physical and physiological characteristics contribute to the performance of an urban operation casualty evacuation (UO) and its predictive test, FORCE combat (FC) and describe the metabolic demand of the UO in female soldiers. METHODS: Seventeen military members (9 M and 8 F) completed a loaded walking maximal aerobic test, the UO and FC. Heart rate reserve (HRR) and completion time were used as efficiency/performance measures. Oxygen consumption (VO2) was directly measured for UO on five female participants with a portable indirect calorimetry system, and analyzed using descriptive statistics. Stepwise multiple regression analysis was used to determine the contribution of the non-modifiable (age, sex, height) and modifiable characteristics (lean body mass to dead mass ratio (LBM:DM), VO2max corrected for load (L.VO2max), peak force (PF) measured on an isometric mid-thigh pull (IMTP) and medicine ball chest throw distance (Dist) on to the performance of each exercise. RESULTS: LBM:DM and PF were the only factors included in the stepwise regression model for UO, predicting 70% of UO performance (p < 0.01). For FC, L.VO2max only was included in the stepwise regression model predicting 54% of FC performance (p < 0.01). Sex, age and height were not included in the regression model. The average metabolic cost of UO was 21.4 mL of O2*kg-1*min-1 in female soldiers while wearing PPE. CONCLUSION: This study showed that modifiable factors such as body composition, PF on IMTP and L.VO2max are key contributors to performance on UO and FC performance.

A database of predictor test sex bias for development of military physical employment standards.

BACKGROUND: Hesitation to employ females for physically demanding jobs is often due to sex related physical abilities. A physical employment standard (PES) identifies individuals who are physically capable for work. OBJECTIVE: A database containing 300 + sources of physical performance tests (PFTs) will inform potential sex bias for PES development. METHODS: Weighted means and probability density curves illustrate the percentage overlap between male and female performance on PFT data from the armed forces of 11 countries and the open literature. Where female training data were available, the change in percentage overlap illustrates the potential for reduction in sex-related differences. RESULTS: PFTs demonstrating the extremes of sex disparity were bench press (11 sources) and sit-ups (14 sources) with 9% and 93% overlap in performance, respectively. Training for bench press; pull ups; VO2max; and upright pull improved female performance by 12%, 22%, 35%, and 23% respectively. This translated into narrowing the gap between male and female mean performance by 1%, 4%, 5%, and 10% respectively. CONCLUSIONS: The ability of PFT to predict performance is essential; however, PFTs with more overlap will facilitate development of PES with reduced sex bias. PFTs with the greatest potential for improvement in females are identified here.

Reliability of the individual components of the Canadian Armed Forces Physical Employment Standard.

This investigation recruited 24 participants from both the Canadian Armed Forces (CAF) and civilian populations to complete 4 separate trials at "best effort" of each of the 4 components in the CAF Physical Employment Standard named the FORCE Evaluation: Fitness for Operational Requirements of CAF Employment. Analyses were performed to examine the level of variability and reliability within each component. The results demonstrate that candidates should be provided with at least 1 retest if they have recently completed at least 2 previous best effort attempts as per the protocol. In addition, the minimal detectable difference is given for each of the 4 components in seconds which identifies the threshold for subsequent action, either retest or remedial training, for those unable to meet the minimum standard. These results will educate the delivery of this employment standard, function as a method of accommodation, in addition to providing direction for physical training programs.

Perspectives on resilience for military readiness and preparedness: Report of an international military physiology roundtable.

Modern warfare operations often occur in volatile, uncertain, complex, and ambiguous (VUCA) environments accompanied by physical exertion, cognitive overload, sleep restriction and caloric deprivation. The increasingly fast-paced nature of these operations requires military personnel to demonstrate readiness and resiliency in the face of stressful environments to maintain optimal cognitive and physical performance necessary for success. Resiliency, the capacity to overcome the negative effects of setbacks and associated stress on performance, is a complex process involving not only an individual's physiology and psychology, but the influence of factors such as sex, environment, and training. The purpose of this moderated roundtable was to address five key domains of resiliency in a point/counterpoint format: physiological versus psychological resiliency, sex differences, contributions of aerobic and strength training, thermal tolerance, and the role of nature versus nurture. Each speaker was given three minutes to present and the moderator facilitated questions and discussion following the panel's presentation. The interconnectedness of the five domains highlights the need for an interdisciplinary approach to understand and build resilience to enhance military performance.

Validity and reliability of physical employment standards.

In this paper the role of validity and reliability in the development of physical employment standards (PESs) and the consideration of these factors in determining the final pass/fail criteria for a PES and ultimately the legal defensibility of a PES is examined. Particular attention is paid to the use of subject-matter experts, the levels of evidence used in the establishment of the minimum acceptable pace/intensity for the completion of critical tasks, and the considerations needed in physical test selection.

A sub-maximal occupational aerobic fitness test alternative, when the use of heart rate is not appropriate.

UNLABELLED: Several emergency response organisations have introduced a minimum aerobic fitness test to predict performance on critical tasks, as well as to help ensure some protection against the cardiovascular stress associated with emergency situations. A popular indirect sub-maximal test of aerobic fitness is the step test; this test relies on the relationship between exercise intensity, heart rate and aerobic capacity. This relationship, and the tests that rely on it, are not valid for individuals who are on prescribed medication (often for high blood pressure) that alter the heart rate response to exercise. OBJECTIVE: The purpose of the work described in this paper was to develop a sub-maximal test of aerobic fitness that did not rely on heart rate. PARTICIPANTS AND METHODS: Eighty-four subjects undertook the Tecumseh step test and a six-minute maximal walk test. RESULTS: A Pearson Product correlation of r=- 0.81, P< 0.01 was identified between the distance that an individual could walk in six minutes and their heart rate response to the step test. CONCLUSIONS: It is concluded that the walk test offers a valid alternative to the step test for the indirect sub-maximal assessment of aerobic fitness.