Knowledge and Attitudes of Lifestyle Medicine-Based Care in a Military Community.

INTRODUCTION: The Department of Defense spends more than $3 billion annually on medical costs of lifestyle-related morbidity. Military service members and veterans engage in unhealthy behaviors at a higher rate than the civilian population. Lifestyle medicine may mitigate lifestyle-related chronic diseases and increase medical readiness in the U.S. Military. However, patients' perspectives in a military community regarding a lifestyle medicine-based approach to health care have not been studied. The purpose of this study was to assess the knowledge and attitudes of and interest in lifestyle medicine-based care within a military community. MATERIALS AND METHODS: Following exempt study determination from the Madigan Army Medical Center Human Protections Office (Reference No. 220092), a prospective, cross-sectional, mixed-methods survey study was conducted from September 2020 to January 2021. Volunteer subjects, including active duty service members, National Guard/Reserves service members, and military dependents, were recruited to complete the anonymous survey while seeking care at five military clinics on Joint Base Lewis-McChord, Washington. The study's outcome measures were the overall level of awareness of lifestyle medicine, ranked level of importance of seven core lifestyle domains, the level of interest in seeking care from a lifestyle medicine practitioner, and the preferred lifestyle medicine care delivery setting. Kruskal-Wallis analyses of variance were conducted for categorical outcome variables. Mean composite scores were calculated for lifestyle domain rankings. RESULTS: A total of 623 respondents completed the survey with a 62.3% response rate. The majority of respondents (89.7%) lacked definitive knowledge of the field of lifestyle medicine. Food/nutrition and sleep were ranked the highest of all lifestyle domains to include in a healthcare approach in the overall sample and across all subgroups. Quitting smoking and alcohol use were ranked the lowest of importance overall and across all subgroups. The majority of respondents (65.7%) reported it was extremely or very important that lifestyle is part of the healthcare discussion with their provider. Of 614 responses, 77.6% of respondents expressed interest in a lifestyle medicine-based approach to health care, with 40.1% indicating they were extremely or very interested in this approach. A direct correlation was noted between education levels and level of interest in lifestyle medicine. Many respondents selected their primary care provider (34.6%) or a lifestyle medicine practitioner embedded in their primary care clinic (26.1%) as their preferred method of lifestyle medicine provision. A higher smoking rate was demonstrated in service members in combat arms occupational specialties. CONCLUSIONS: Despite an overall low level of awareness of lifestyle medicine, most respondents expressed interest in a lifestyle medicine approach to health care, with food/nutrition and sleep ranked as the most important domains. Lower levels of education may be a potential barrier to patient willingness to engage in lifestyle medicine care. Service members in combat arms occupational specialties may represent a potential target population for smoking cessation interventions. Further research with a larger sample more proportionately inclusive of all military service branches is needed.

Harnessing imaging biomarkers to refine individualized cardiovascular disease risk: a case-based discussion.

Traditional models of cardiovascular risk assessment rely on population-level risk factors and may not accurately capture individualized risk. Imaging biomarkers such as plaque characterization and pericoronary fat inflammation may offer refined risk prediction and allow physicians to personalize care-plans for cardiovascular disease prevention. The integration of plaque morphology and pericoronary inflammation into clinical care is highlighted using a case-based discussion. This article reviews the existing body of evidence supporting the use of novel biomarkers in an individualized comprehensive risk assessment algorithm.

Pre-Endoscopy Use of Proton Pump Inhibitor Intravenous Bolus Dosing in Hemodynamically Stable Patients With Suspected Upper Gastrointestinal Bleeding: Results of a Pharmacist-Managed Hospital Protocol to Reduce Continuous Infusion Pantoprazole Use.

Background: Guidelines for acute upper gastrointestinal bleeding (UGIB) recommend use of proton pump inhibitors (PPI) administered by continuous IV infusion (CI). Although data suggest comparable outcomes with CI and IV push (IVP) dosing post-endoscopy, there are limited data to support IVP PPI as the pre-endoscopy regimen. Objective: To evaluate the impact of a pharmacist-managed protocol for reducing PPI CIs and substitution of PPI IVP dosing in hemodynamically stable patients with suspected acute upper gastrointestinal bleeding (UGIB) prior to endoscopic intervention. Design, Setting, and Participants: Retrospective study; Tertiary-care community teaching hospital; Hemodynamically stable adults with confirmed or suspected UGIB. Hemodynamic stability was defined as a systolic blood pressure >90 mmHg, heart rate <100 beats, mean arterial pressure >65 mmHg, and no requirement for vasopressors. Intervention: All iterations of treatment recommendations encouraged an initial pantoprazole 80 mg IVP dose. In the pre-intervention group, patients were then treated at the at the provider's discretion with the majority receiving CI pantoprazole. After implementation of the original protocol (Phase I), all hemodynamically stable patients were allowed 1 bag of CI pantoprazole (80 mg infused over 10 hours) before being transitioned by the pharmacist to pantoprazole 40 mg IVP every 12 hours. After internal analysis, the protocol was revised to allow patients to be immediately transitioned to IVP dosing without an initial CI (Phase II). Main Outcome: Incidence of continued bleeding or re-bleeding within 7 days of initial PPI dose. Results: A total of 325 patients were included across all 3 study phases. The median number of CI bags per patient was reduced from 4 pre-intervention, to 1.5 in phase I, and to 0 in phase II (P < .001). The primary endpoint of continued bleeding or re-bleeding within 7 days was similar across all 3 groups (5.0% vs 6.5% vs 5.2%, P = .92). Mean intravenous pantoprazole costs were reduced by $21.73/patient. Conclusions: Movement toward preferential use of IVP PPI prior to endoscopy for hemodynamically stable patients with confirmed or suspected UGIBs resulted in similar rates of continued bleeding or re-bleeding and generated modest cost savings. These findings warrant further investigation.

False-Positive Rates and Associated Risk Factors on the Vestibular-Ocular Motor Screening and Modified Balance Error Scoring System in US Military Personnel.

CONTEXT: In 2018, the US military developed the Military Acute Concussion Evaluation-2 (MACE-2) to inform the acute evaluation of mild traumatic brain injury (mTBI). However, researchers have yet to investigate false-positive rates for components of the MACE-2, including the Vestibular-Ocular Motor Screening (VOMS) and modified Balance Error Scoring System (mBESS), in military personnel. OBJECTIVE: To examine factors associated with false-positive results on the VOMS and mBESS in US Army Special Operations Command (USASOC) personnel. DESIGN: Cross-sectional study. SETTING: Military medical clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 416 healthy USASOC personnel completed the medical history, VOMS, and mBESS evaluations. MAIN OUTCOME MEASURE(S): False-positive rates for the VOMS (≥2 on VOMS symptom items, >5 cm for near point of convergence [NPC] distance) and mBESS (total score >4) were determined using χ2 analyses and independent-samples t tests. Multivariable logistic regressions (LRs) with adjusted odds ratios (aORs) were performed to identify risk factors for false-positive results on the VOMS and mBESS. The VOMS item false-positive rates ranged from 10.6% (smooth pursuits) to 17.5% (NPC). The mBESS total score false-positive rate was 36.5%. RESULTS: The multivariable LR model supported 3 significant predictors of VOMS false-positives, age (aOR = 1.07; 95% CI = 1.02, 1.12; P = .007), migraine history (aOR = 2.49; 95% CI = 1.29, 4.81; P = .007), and motion sickness history (aOR = 2.46; 95% CI = 1.34, 4.50; P = .004). Only a history of motion sickness was a significant predictor of mBESS false-positive findings (aOR = 2.34; 95% CI = 1.34, 4.05; P = .002). CONCLUSIONS: False-positive rates across VOMS items were low and associated with age and a history of mTBI, migraine, or motion sickness. False-positive results for the mBESS total score were higher (36.5%) and associated only with a history of motion sickness. These risk factors for false-positive findings should be considered when administering and interpreting VOMS and mBESS components of the MACE-2 in this population.

Assessing the Clinical Utility of a Wearable Device for Physiological Monitoring of Heart Rate Variability in Military Service Members with Traumatic Brain Injury.

Introduction: Autonomic dysfunction has been implicated as a consequence of traumatic brain injury (TBI). Heart rate variability (HRV) may be a viable measure of autonomic dysfunction that could enhance rehabilitative interventions for individuals with TBI. This pilot study sought to assess the feasibility and validity of using the Zeriscope™ platform system in a real-world clinical setting to measure HRV in active-duty service members with TBI who were participating in an intensive outpatient program. Methods: Twenty-five service members with a history of mild, moderate, or severe TBI were recruited from a military treatment facility. A baseline assessment was conducted in the cardiology clinic where point validity data were obtained by comparing a 5-min recording of a standard 12-lead electrocardiogram (ECG) output against the Zeriscope platform data. Results: Compared with the ECG device, the Zeriscope device had a concordance coefficient (rc) of 0.16, falling below the standard deemed to represent acceptable accuracy in HR measurement (i.e., 0.80). Follow-up analyses excluding outliers did not significantly improve the concordance coefficient to an acceptable standard for the total participant sample. System Usability Survey responses showed that participants rated the Zeriscope system as easy to use and something that most people would learn to use quickly. Conclusions: This study demonstrated promise in ambulatory HRV measurement in a representative military TBI sample. Future research should include further refinement of such ambulatory devices to meet the specifications required for use in a military active-duty TBI population.

Test-retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel.

The Military Acute Concussion Evaluation 2 (MACE 2), which includes the Vestibular-Ocular Motor Screening (VOMS) tool and the single-leg stance component of the modified Balance Error Scoring System (mBESS), was introduced in 2018 as an assessment of acute mTBI in US military personnel. However, the reliability of the VOMS and mBESS in this population has not been established. OBJECTIVES: The primary purpose of this study was to examine the reliability of the VOMS across a 6-month period in healthy, uninjured US Army Special Operations Command (USASOC) personnel. DESIGN: Active duty/heathy military personnel (n=108) completed the VOMS and mBESS at baseline and follow-up 6 months later (±1 month). METHOD: Cronbach's alpha was used to examine the internal consistency of the VOMS and mBESS at both time points. Two-way mixed intra-class correlation coefficients (ICC) with consistency agreement were used to evaluate test-retest reliability. RESULTS: VOMS demonstrated excellent internal consistency (α=0.99), whereas, the mBESS demonstrated poor internal consistency (α=0.29). Test-retest reliability of VOMS items was moderate-to-good with ICCs ranging from 0.60 to 0.81. Test-retest reliability was moderate for mBESS total score (ICC=0.59) and double-leg stance (ICC=0.73), while single-leg (ICC=0.49) and tandem (ICC=0.02) stances were poor. CONCLUSIONS: The findings suggest that VOMS has high internal consistency and moderate-to-good test-retest reliability. mBESS has poor internal consistency and poor-to-moderate test-retest reliability. The results suggest that VOMS is a reliable addition to the MACE-2, whereas, mBESS single-leg stance is less reliable. As such, mBESS double-leg stance may be a more reliable measure of balance in this population.

Instructional and Assessment Redesign of a Sterile Compounding Course Using Immersive Simulation.

Objective. To revise a traditional sterile compounding course to include content, competencies, and immersive simulations relevant to the current practice of sterile compounding pharmacy. Methods. Faculty and staff at the University of North Texas System College of Pharmacy made significant revisions to an existing sterile compounding course. Instruction was provided in didactic and laboratory sessions and delivered in three modules: fundamental skills, integration of skills and knowledge, and exceptions and specialty topics. Integration laboratory sessions consisted primarily of repetitive but increasingly difficult simulations that included both technician and pharmacist activities. Assessment methods included checkpoint assessments, a mock objective structured clinical examination (OSCE), a written examination, and a final comprehensive OSCE. Effectiveness of the course redesign was assessed by comparing student performance on assessments, overall course performance, and student perceptions extracted from the student course evaluation. Results. Of the 364 students enrolled in the sterile compounding course across four terms, 156 were in the pre-implementation cohort (cohort 1) and 208 were in the post-implementation cohort (cohort 2). Two hundred twenty-eight students completed the course evaluation. Course evaluations significantly demonstrated students' improved perceptions related to seven of 11 survey elements, most notably, critical thinking, integration of concepts, and students feeling challenged. Student performance on laboratory summative assessments also improved. However, written examination scores did not change. Conclusion. This novel sterile compounding course provided a practice-oriented blueprint for instruction and assessment of sterile compounding.

Beating Obesity: Factors Associated with Interest in Workplace Weight Management Assistance in the Mining Industry.

BACKGROUND: Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. METHODS: A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. RESULTS: A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. CONCLUSION: Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.

Racial IQ Differences among Transracial Adoptees: Fact or Artifact?

Some academic publications infer from studies of transracial adoptees' IQs that East Asian adoptees raised in the West by Whites have higher IQs than Western Whites, and that White adoptees raised by Whites have higher IQs than Black adoptees raised by Whites. Those publications suggest that this is because genetic differences give East Asians a higher mean IQ than Whites, and Whites a higher mean IQ than Blacks. This paper proposes a parsimonious alternative explanation: the apparent IQ advantage of East Asian adoptees is an artifact caused by ignoring the Flynn effect and adoption's beneficial effect on IQ, and most of the IQ disadvantage of Black adoptees disappears when one allows for attrition in the Minnesota Transracial Adoption Study, and acknowledges the results of other studies. Diagnosing these artifacts suggests a nil hypothesis: East Asian, White, and Black adoptees raised in the same environment would have similar IQs, hinting at a minimal role for genes in racial IQ differences.

Employee factors associated with interest in improving sun protection in an Australian mining workforce.

BACKGROUND: As Australia experiences moderate to extreme levels of ultraviolet radiation from the sun, high participation in sun protection behaviour is required to minimise the risk of developing skin cancer. Understanding factors associated with interest in improving sun protection will enable employers to increase enrolment in sun protection programs. METHOD: A cross-sectional survey was conducted at mining sites in rural Australia. The survey assessed employee demographics, stages of change and health-belief model variables, sun protection behaviour, and preferences for improving sun protection. RESULTS: Overall, 897 employees participated: 73% were male and 47% were classed as being at high risk of ultraviolet-related illnesses. Although 24% of high-risk participants wanted to increase their sun protection practices, only 6% wanted employer-provided sun protection assistance. Marital status and recent experience of sunburn were associated with desire to improve sun protection. Over 50% of the high-risk participants who did not want to increase their sun protection and did not want assistance were in the pre-contemplative stage of change. Self-efficacy was associated with desire to improve sun protection while susceptibility was associated with desire for assistance. CONCLUSION: The use of sun protection behaviours among this sample was low. Many employees at high risk of ultraviolet radiation exposure do not believe their approach to sun protection needs changing. SO WHAT?: Workplace health promotion programs need to educate employees about susceptibility to ultraviolet radiation exposure and develop employees' self-efficacy for sun protection behaviours. These findings can inform the content development of sun protection communication strategies targeting employees.

Intraoperative and Postoperative Blood Glucose Concentrations in Diabetic Surgical Patients Receiving Lactated Ringer's Versus Normal Saline: A Retrospective Review of Medical Records.

BACKGROUND: Hyperglycemia is associated with poor postoperative outcomes after carotid endarterectomy. This retrospective study examined the effect of lactated Ringer's and normal saline solutions on intraoperative blood glucose control in diabetic patients undergoing carotid endarterectomy. METHODS: The anesthetic and surgical records of type 2 diabetic patients who underwent carotid endarterectomy and received either lactated Ringer's solution or normal saline exclusively during the case were reviewed, and 20 patients were randomly selected from each group for further analysis. The outcome of interest was preoperative to postoperative change in blood glucose. RESULTS: The preoperative to postoperative mean changes in glucose for the normal saline and lactated Ringer's groups were 34.4 ± 70.32 mg/dL and 64.5 ± 61.38 mg/dL, respectively. This slight difference in the mean change in glucose between the 2 groups was not statistically significant (P=0.157). CONCLUSION: Lactated Ringer's solution does not appear to cause a significant change in the mean blood glucose levels in diabetic patients undergoing carotid endarterectomy compared to patients receiving normal saline. Randomized controlled trials are needed to further determine whether lactated Ringer's solution adversely affects glucose control in diabetic surgical patients.

Equilibrium probability distribution of a conductive sphere's floating charge in a collisionless, drifting Maxwellian plasma.

A dust grain in a plasma has a fluctuating electric charge, and past work concludes that spherical grains in a stationary, collisionless plasma have an essentially Gaussian charge probability distribution. This paper extends that work to flowing plasmas and arbitrarily large spheres, deriving analytic charge probability distributions up to normalizing constants. We find that these distributions also have good Gaussian approximations, with analytic expressions for their mean and variance.

A critical review of Richard Lynn's reports on reaction time and race.

In the early 1990s, psychologist Richard Lynn published papers documenting average reaction times and decision times in samples of nine-year-olds taken from across the world. After summarizing these data, Lynn interpreted his results as evidence of national and racial differences in decision time and general intelligence. Others have also interpreted Lynn's data as evidence of racial differences in decision time and intelligence. However, comparing Lynn's summaries with his original reports shows that Lynn misreported and omitted some of his own data. Once these errors are fixed the rankings of nations in Lynn's datasets are unstable across different decision time measures. This instability, as well as within-race heterogeneity and between-race overlap in decision times, implies that Lynn's reaction time data do not permit generalizations about the decision times and intelligence of people of different races.