Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review.

BACKGROUND: The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis. METHODS: A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures. RESULTS: Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25 to 63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability.Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation. CONCLUSION: This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.

Assessing the Incidence of Head Trauma in Australian Mixed Martial Arts: A Retrospective Analysis of Fight Outcomes.

BACKGROUND: Mixed martial arts (MMA) is experiencing a surge in popularity in Australia. Previous research has suggested knockout (KO) and technical knockout (TKO) are frequent outcomes during competition, raising concern about the brain health of athletes. This study aims to describe fight outcomes in Australian MMA and to explore differences in fight-ending outcomes between male and female athletes, amateur and professional competition, and different weight classes. HYPOTHESIS: There is no difference in the incidence of KO/TKO between level of competition, sex, and weight class. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: Retrospective analysis of 143 Australian MMA events from 2020 to 2023 was conducted using video replay to assess fight outcomes between sex and level of competition. Binary logistic regression analysis was used to determine relationships between weight class and KO/TKO fight outcomes. RESULTS: Male competition (34%) had a significantly greater number of KO/TKO secondary to head strikes fight outcomes compared with female competition (23%) (P = 0.01). The KO/TKO rate secondary to head strikes for amateur and professional male competition was 16.6 and 18.7 per 100 athlete-exposures (AEs), respectively. The amateur and professional female rate was 12.6 and 7.4 per 100 AEs, respectively. Amateur male light heavyweight and heavyweight, and professional male heavyweight were at greater odds of a KO or TKO compared with other weight classes in their equivalent level of competition. CONCLUSION: There is a sex and professional level disparity in the incidence of fight-ending head trauma in Australian MMA. The study findings highlight the urgent need for targeted safety protocols and medical oversight, particularly for men in heavier weight classes. CLINICAL RELEVANCE: This study highlights the need for enhanced safety protocols and medical oversight in Australian MMA, particularly for male athletes in heavier weight divisions.

Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article.

BACKGROUND: For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE: This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS: The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS: Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION: SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress.

Combinatorial therapeutic enzymes to combat multidrug resistance in bacteria.

AIMS: Antibiotic resistance including multidrug resistance (MDR) is a negative symbol to the human health system because it loses the capability to treat infections. Unfortunately, the available antibiotics do not show an effective therapeutic response against bacterial infections. In the situation of global antibiotic unresponsiveness, enzymatic therapy especially in combinatorial form seems an effective approach to control bacterial infection and combat resistance. The article is important because it focuses on combinatorial enzymatic therapy that has multiple properties (effective antibacterial performances, antibiofilm capacity, immunomodulators, targeted actions, synergistic actions, multiple targeting, and resistance-proof properties) and can address antibiotic resistance effectively. MATERIALS AND METHODS: We searched the related topics with Pubmed, Scopus, and Google Scholar databases and finally 73 relevant papers were reviewed in detail and cited in this article. KEY FINDINGS: Discusses properties of combinatorial therapeutic enzymes made it an accomplished means over antibiotic therapy. This article discusses the need for combinatorial enzymatic therapy against bacterial infection, its distinguished features, and properties with multi-mechanistic antibacterial action. It discussed the European Medicine Agency and Food and Drug Administration-approved therapeutic enzymes (antibacterial and antibiofilm). SIGNIFICANCE: This article provided the possible combination of the enzyme that may be used as an antibacterial agent along with limitations and future scope of combinatorial antibacterial enzymatic agents. This article could draw the attention of researchers to combinatorial therapeutic enzymatic molecules as effective and futuristic therapy to overcome the problem of multiple antibiotic resistance in bacteria.

Sexually selected weapons can wear out, decreasing their effectiveness in combat.

Sexual selection has resulted in some of the most elaborate traits seen in animals, many of which are used as weapons. These weapons can be incredibly diverse, even within species. Such morphological variation has largely been attributed to the environment in which individuals are reared and their genetics. However, variation in weapon form could also be the result of a weapon wearing out from usage. This mechanism has received relatively little attention. In this study, we demonstrate that sexually selected weapons can wear out from repeated use, providing experimental evidence that weapon usage can contribute to the diversity of weapon shapes observed within species. In a second experiment, we demonstrate that having a worn-out weapon decreases an individual's fighting ability. This finding illustrates that the shape of a weapon can have an important role in determining contest outcomes. Overall, these results suggest that individuals are limited in the number of times they can effectively use their weapons, which may be one factor (among others) influencing how frequently an animal engages in a fight.

Evaluation of ComBat harmonization for reducing across-tracer biases in regional amyloid PET analyses.

Background: Differences in amyloid positron emission tomography (PET) radiotracer pharmacokinetics and binding properties lead to discrepancies in amyloid-ß uptake estimates. Harmonization of tracer-specific biases is crucial for optimal performance of downstream tasks. Here, we investigated the efficacy of ComBat, a data-driven harmonization model, for reducing tracer-specific biases in regional amyloid PET measurements from [18F]-florbetapir (FBP) and [11C]-Pittsburgh Compound-B (PiB). Methods: One-hundred-thirteen head-to-head FBP-PiB scan pairs, scanned from the same subject within ninety days, were selected from the Open Access Series of Imaging Studies 3 (OASIS-3) dataset. The Centiloid scale, ComBat with no covariates, ComBat with biological covariates, and GAM-ComBat with biological covariates were used to harmonize both global and regional amyloid standardized uptake value ratios (SUVR). Intraclass correlation coefficient (ICC) and mean standardized absolute error (MsAE) were computed to measure the absolute agreement between tracers. Additionally, longitudinal amyloid SUVRs from an anti-amyloid drug trial were simulated using linear mixed effects modeling. Differences in rates-of-change between simulated treatment and placebo groups were tested, and change in statistical power/Type-I error after harmonization was quantified. Results: In the head-to-head tracer comparison, the best ICC and MsAE were achieved after harmonizing with ComBat with no covariates for the global summary SUVR. ComBat with no covariates also performed the best in harmonizing regional SUVRs. In the clinical trial simulation, harmonization with both Centiloid and ComBat increased statistical power of detecting true rate-of-change differences between groups and decreased false discovery rate in the absence of a treatment effect. The greatest benefit of harmonization was observed when groups exhibited differing FPB-to-PiB proportions. Conclusions: ComBat outperformed the Centiloid scale in harmonizing both global and regional amyloid estimates. Additionally, ComBat improved the detection of rate-of-change differences between clinical trial groups. Our findings suggest that ComBat is a viable alternative to Centiloid for harmonizing regional amyloid PET analyses.

Effects of Ischemic Preconditioning on Sport-Specific Performance in Highly Trained Taekwondo Athletes.

Ischemic preconditioning (IPC), which involves episodes of blood flow restriction followed by reperfusion, has uncertain effects on athletes. Additionally, employing sports-specific tests that are highly familiar to athletes can enhance methodological rigor in determining IPC's effects on taekwondo performance. This study aimed to investigate IPC's influence on taekwondo athletes' performance through two studies. To induce occlusion in both studies, the cuff was inflated to an individualized occlusion pressure established for each athlete's lower limb, with four cycles of occlusion lasting five minutes each, alternated with five-minute reperfusion intervals. Both traditional frequentist statistics and Bayesian analysis were employed. In the first study, eleven high-level athletes were subjected to either IPC or a placebo (SHAM) procedure on both legs, followed by performing countermovement jumps (CMJs) and a specific taekwondo endurance test. However, no significant differences were observed in taekwondo endurance performance or CMJ between the IPC and SHAM conditions. The second study involved fourteen elite athletes who underwent the same IPC or SHAM conditions, performing CMJ and three bouts of the Multiple Frequency Speed of Kick test (FSKTmult) in three blocks, each separated by approximately thirty minutes. Again, the results indicated no significant differences in FSKTmult measures or CMJ performance between the two conditions. In conclusion, IPC did not significantly affect neuromuscular (in both studies), endurance (in the first study), or anaerobic (in the second study) performance in these taekwondo athletes.

Intergenerational Judo: Synthesising Evidence- and Eminence-Based Knowledge on Judo across Ages.

In alignment with European policies regarding intergenerational sports, this study seeks to integrate existing evidence- (i.e., umbrella review) and eminence- (i.e., international validated educational courses for coaches) based knowledge on judo training across the lifespan. For evidence knowledge, searches of the Google Scholar, ISI-WoS, PubMed, and Scopus databases (PROSPERO ID: CRD42024535420) for studies focused on training youth and older judo practitioners, with no time restriction up to April 2024, were conducted. This resulted in 16 systematic reviews meeting the inclusion criteria, with an "excellent" (n = 6), "good" (n = 7), and "fair" (n = 3) quality according to the NIH tool. With a large sample size (n = 372,655), the reviews focused on wellbeing (n = 9; bone status, injuries, and psychophysical effects) and performance (n = 7; athlete success, combat time, rapid weight loss, and the Special Judo Fitness Test), examining athletic levels (novices to Olympics), sex, and age (children to older adults). For eminence knowledge, the International Judo Federation Academy courses encompassed the "Undergraduate Certificate as Judo Instructor" (UCJI), which provides a comprehensive structure for teaching judo, including techniques, moral code, roles, responsibilities, refereeing, safety, and age-specific belt examination requirements and progression, and the "Educating Judo Coaches for Older Practitioners" (EdJCO) curricula, which provide theoretical and applied modules (e.g., ageing, health, and organisation) to train older judo practitioners. The findings were summarised in a framework, highlighting the most relevant aspects of intergenerational judo programmes (i.e., aims, key characteristics, coaches' roles, barriers, and facilitators). To develop a comprehensive educational intergenerational judo methodology, future research should examine coaches' and practitioners' opinions on intergenerational judo activities carried out in different national contexts.

Benefits of Judo Practice for Individuals with Neurodevelopmental Disorders: A Systematic Literature Review.

This systematic literature review evaluates the benefits of judo practice designed for individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), Intellectual Developmental Disorders (IDDs), and attention-deficit/hyperactivity disorder (ADHD). This review adheres to the PRISMA 2020 guidelines, focusing on the physical, social, emotional, and cognitive benefits of judo. A comprehensive search across databases, such as PubMed, Google Scholar, ResearchGate, B-On, and Scopus, was conducted, and relevant studies were selected based on explicit inclusion and exclusion criteria. Sixteen intervention studies were included, which contributed to a detailed understanding of the impact of judo. The results indicated significant benefits in terms of physical activity, social interactions, emotional well-being, and cognitive functions among participants. A synthesis of results is presented, showing the overall positive effect of judo practice. This review highlights the potential of judo as supportive therapy for individuals with NDDs, advocating its inclusion in therapeutic and educational settings. Limitations due to study heterogeneity and the need for more randomized controlled trials are also discussed.

Harmonization of Longitudinal Diffusion Tensor Imaging Data of the Pediatric Cervical and Thoracic Spinal Cord at 3T Using Longitudinal ComBat.

Diffusion tensor imaging (DTI) of the spinal cord has been extensively used to identify biomarkers for spinal cord pathology. Previously, the longitudinal ComBat (longComBat) technique was examined to reduce scanner effects in multi-site, multi-scanner spinal cord DTI data. This study aimed to assess its effectiveness on longitudinal scans using a single-scanner pediatric dataset, including healthy and spinal cord injury (SCI) subjects. Two identical datasets were collected from 42 healthy and 27 SCI subjects with a 2-hour interval between scans on a 3T Siemens MRI scanner. Axial DTI images of the entire cervical and thoracic spinal cord were obtained, and various average diffusion tensor metrics (FA, MD, RD, & AD) were measured at each vertebral level. Pearson correlation and intraclass correlation coefficients were used to evaluate inter- and intra-subject agreement pre- and post-harmonization. Minimal improvement in agreement was observed with the mean square residual (MSR) model, while the restricted maximum likelihood estimator (REML) model showed reduced intra-subject agreement in all the tensor metrics. The significant variability between longitudinal DTI scans within a single scanner was likely due to physiological motion rather than scanner effects. Post-harmonization using the longComBat MSR model showed limited improvement in agreement.

Headbutting through time: A review of this hypothesized behavior in "dome-headed" fossil taxa.

Headbutting is a combative behavior most popularly portrayed and exemplified in the extant bighorn sheep (Ovis canadensis). When behaviorally proposed in extinct taxa, these organisms are oft depicted Ovis-like as having used modified cranial structures to combatively slam into one another. The combative behavioral hypothesis of headbutting has a long and rich history in the vertebrate fossil literature (not just within Dinosauria), but the core of this behavioral hypothesis in fossil terrestrial vertebrates is associated with an enlarged osseous cranial dome-an osteological structure with essentially no current counterpart. One confounding issue found in the literature is that while the term "headbutting" sounds simplistic enough, little terminology has been used to describe this hypothesized behavior. And pertinent to this special issue, potential brain trauma and the merits of such proposed pugilism have been assessed largely from the potential deformation of the overlying osseous structure; despite the fact that extant taxa readily show that brain damage can and does occur without osteological compromise. Additionally, the extant taxa serving as the behavioral counterpart for comparison are critical, not only because of the combative behaviors and morphologies they display, but also the way they engage in such behavior. Sheep (Ovis), warthogs (Phacochoerus), and bison (Bison) all engage in various forms of "headbutting", but the cranial morphologies and the way each engages in combat is markedly different. To hypothesize that an extinct organism engaged in headbutting like an extant counterpart in theory implies specific striking:contacting surfaces, speed, velocity, and overall how that action was executed. This review examines the history and usage of the headbutting behavioral hypothesis in these dome-headed fossil taxa, their respective extant behavioral counterparts, and proposes a protocol for specific behavioral terms relating to headbutting to stem future confusion. We also discuss the disparate morphology of combative cranial structures in the fossil record, and the implications of headbutting-induced brain injury in extinct taxa. Finally, we conclude with some potential implications for artistic reconstructions of fossil taxa regarding this behavioral repertoire.

Relationship between visual ability assessment and punch performance in competition in male amateur boxers.

Sport visual ability plays an important role in the performance of elite athletes in competition. However, its relationship with boxers' performance has not been fully understood. This study investigated the relationship between sports visual abilities and in-competition punching performance in 26 highly trained male amateur boxers. Ten visual abilities of the boxers were tested using the Senaptec Sensory Station (Senaptec, Beaverton, OR, United States), including Visual Clarity (VC), Contrast Sensitivity (CS), Depth Perception (DP), Near Far Quickness (NFQ), Target Capture (TC), Perception Span (PS), Multiple Object Tracking (MOT), Eye-Hand Coordination (EHC), Go/No Go (GNG), and Reaction Time (RT). Performance analyses were conducted on national boxing championships conducted by the boxers to analyze their punching accuracy. Correlation and regression analyses showed that punch performance %Hit was very strong correlated with DP, EHC, GNG, and RT, and showed a strong correlation with VC, CS, and PS. %Hit was moderate correlated with MOT, while there was no correlation with NFQ and TC. In addition, RT, EHC, and DP are important visual ability variables for boxers. The results of this study indicate that there is an overall relationship between sports visual ability and boxing performance, but there is also a specific relationship between variables in visual ability and boxing performance, especially faster reaction times, better processing of visual information, and decision-making abilities, and the ability to accurately recognize the distance and position of an opponent and their punches are essential for enhancing boxing performance. Further studies are needed to investigate the relationship between sport visual ability and more comprehensive performance in boxers, and the possibility of enhancing performance through specific visual training.

The Brazilian National Plan to Combat Marine Litter: A critical assessment.

The Brazilian National Plan to Combat Marine Litter was launched in March 2019 and in its context, 577 campaigns were carried out to clean up beaches, rivers, estuaries and mangroves, until January 2023, at an estimated cost of US$ 16,733,000.00. The volume collected in four years represented only 0.0041 % of the total solid waste discharged annually in the maritime waters under the country's jurisdiction. The direct benefit to society was only US$ 173,751.41 at market value for the litter collected. Litter lesser than 2.5 cm was left out, not been characterized. The results achieved deserve reflection and critical evaluation, in order to allow improvements, serving as reference. The participation of around 43,000 people in cleanup campaigns is an indication of environmental citizenship and an asset that cannot be overlooked by managers, demanding focus, tangible results and benefits in terms of environmental quality, well-being and savings on public cleaning services costs.

Relationship of selected conditioning parameters and sport performance indicators in karate.

Introduction: The variables of aerobic performance and aerobic capacity are of significant importance in maintaining intensity during a fight and also contribute to faster recovery between rounds in sports fighting in karate. Anaerobic performance is crucial for the execution of the techniques during high-intensity offensive or defensive actions that determine the outcome of a fight. The objective of this study was to assess the relationship between selected performance indicators of aerobic and anaerobic capacity to sports performance in karate. Methods: The study included six male karate athletes (age 28 ± 3 years, body mass 85.10 kg; height 185.5 cm), medalists from European and World championship, events in senior categories. The selection criteria included training experience and sports level. The Karate specific aerobic test (KSAT) was use in conjunction with heart rate monitoring and changes in blood lactate levels to diagnose special aerobic endurance parameters. To determine the level of anaerobic performance the Wingate test were choosed. Technical and tactical indicators (efficiency, effectiveness and activeness of the attack) were used to assess the sports skill level during competition. Results: Based on the Spearman correlation coefficient results demonstrated statistically significant differences (rs = -0.81) with large effect size index between efficiency of the attack and average heart rate achieved in the test KSAT. Additionally statistically significant differences (rs = 0.81) with large effect size were demonstrated between the fatigue index and efficiency of the attack Furthermore, the selected indicators of special aerobic endurance parameters and anaerobic performance demonstrated a high degree of predictive validity in relation to the efficiency (rp = 0.960) and activity (rp = 0.927) of attacks. Conclusion: The high level of predictive validity confirmed the importance of a high level of anaerobic conditions for performance in karate. The low values of the average heart rate in relation to the efficiency of the attack confirm the high performance level of karate athletes in relation to special aerobic performance parameters. It was found that the effectiveness of the attack had no relation to the monitored parameters.

Striking a balance: Exploring attention, attack accuracy and speed in fencing performance.

In fencing, it remains unclear whether practice enhances visual-spatial attention allocation. We explored whether this ability is improved in fencers and if it is related to attack speed and accuracy. Twelve novices (<1 year of experience) and 12 trained epee fencers (18 ± 10 years of experience) visited the laboratory twice (familiarization and testing session). They performed a covert orienting of visuospatial attention test (COVAT) on a computer and an epee test, involving 30 trials of 3 shuttles followed by fast attack phases where the fencers quickly hit a target (randomly proposed out of 8). We measured COVAT reaction time, number of successful target hits, and execution time to hit in the fencing test. We found shorter COVAT reaction time for trained fencers (332 ± 24 ms) versus novices (367 ± 32 ms; p < 0.001). The number of hits was greater for trained fencers (22 ± 3) versus novices (16 ± 3; p < 0.001). ANCOVA showed a difference in execution time at the test (823 ± 73 ms vs. 913 ± 141 ms, p = 0.035). A relationship was found between hits and execution time and between execution time and COVAT reaction time for the trained group (r = 0.62, p = 0.03 and r = 0.70, p = 0.01, respectively) but not in the novice group (r = 0.11, p = 0.72 and r = 0.45, p = 0.14, respectively). Mediation analysis showed that the relationship between execution time and number of hits (ADE: p = 0.008) was not mediated by COVAT reaction time (ACME: p = 0.17). These results evidence the importance of visual-spatial attention allocation in fencing and evidence differences between novices and trained fencers with important implications for talent development in the early career stage.

Emotional processing is not enough: relations among resilience, emotional approach coping, and posttraumatic stress symptoms among combat veterans.

Combat soldiers are exposed to various potentially traumatic events and face high risk of developing military-related psychopathology, such as depression, posttraumatic stress and grief (PTSS). However, a strong body of research shows that resilience is the default in the aftermath of trauma and indeed, many veterans do not develop high symptomatic levels. To explicate this inconsistency, the current study examined the associations among PTSS, resilience, and patterns of emotional-approach coping. A sample of 595 male combat veterans filled out questionnaires on trauma exposure, PTSS, depressive symptoms, resilience, and emotional-approach coping. Their data were analyzed using structural equation modeling path analysis. Participants reported high exposure to potentially traumatic events during service. Mean scores were high for resilience and relatively low for PTSS and depressive symptoms; 13% had a clinical level of posttraumatic stress disorder. Structural equation modeling revealed that emotional-approach coping strategies mediated the relationship between resilience and PTSS. However, emotional expression was associated with lower PTSS levels, whereas emotional processing was associated with higher PTSS levels. These results suggest that although emotional-approach coping was related to higher resilience, emotional expression (an intrapersonal coping strategy) might have a more positive effect than self-oriented emotional coping strategies. Providing veterans with supportive opportunities and a wider repertoire of emotional coping skills might enhance their well-being, reduce postservice emotional distress while not harming veterans' resilience levels.

Acute and Chronic Weight-Making Practice in Professional Mixed Martial Arts Athletes: An Analysis of 33 Athletes Across 80 Fights.

Mixed martial arts' popularity has increased in recent years, alongside descriptive research and evidence-based performance recommendations. Guidelines for (both chronic and acute) weight making exist; however, how these translate in real-life scenarios and detailed investigations on practices in larger groups deserve attention. The present study examined the body mass (BM) and composition of 33 professional mixed martial arts athletes preparing for 80 fights. Athletes were supported by on-site dietitians, who encouraged evidence-based practices. Fasted BM was measured throughout the last ∼10 days before all bouts (acute weight management phase). A subset of athletes had body composition assessed before and after the chronic weight loss phase for 40 fights. Most athletes engaged in chronic BM loss, and all engaged in acute weight loss. Many lost fat-free mass (FFM) during the chronic phase, with rates of BM loss <0.5% best preserving FFM. Regardless of losses, the present athletes possessed greater FFM than other combat sport athletes and engaged in greater acute weight loss. Dehydration in the 24-48 hr before the weigh-in was not reflective of weight regain after the weigh-in, rather BM 7-10 days before the weigh-in was most reflective. These findings suggest that many mixed martial arts athletes could increase FFM at the time of competition by maintaining leaner physiques outside of competition and/or allowing increased time to reduce BM chronically. Acutely, athletes can utilize evidence-based protocols, eliminating carbohydrates, fiber, sodium, and finally fluid in a staged approach, before the weigh-in, reducing the amount of sweating required, thus theoretically better protecting health and preserving performance.

Evaluation of the critical warzone experiences scale among Gulf War I-era veterans: Associations with PTSD symptoms, depressive symptoms, and suicidal thoughts and behaviors.

Prior research has established the psychometric properties of the Critical Warzone Experiences (CWE) scale among post-9/11 Iraq/Afghanistan-era veterans; however, the psychometric properties of the CWE among Gulf War I-era veterans have not yet been established. The first objective of the present study was to examine the psychometric properties of the CWE among Gulf War I-era veterans. The second objective was to test the hypothesis that the CWE would have a significant indirect effect on suicidal thoughts and behaviors via posttraumatic stress disorder (PTSD) and depressive symptoms. To test these hypotheses, a survey packet that included the CWE and measures of PTSD symptoms, depressive symptoms, and suicidal thoughts and behaviors was administered to 1,153 Gulf War I-era veterans. Consistent with prior research in post-9/11 Iraq/Afghanistan-era veterans, the CWE exhibited good internal consistency (α = .85), a unidimensional factor structure (RMSEA = .056, CFI = .959, SRMR = .033; average factor loading = .69), and good concurrent validity with PTSD (r = .47, p < .001) and depressive (r = .31, p < .001) symptoms among Gulf War I-era veterans. Additionally, as hypothesized, a significant indirect effect from the CWE to suicidal thoughts and behaviors via PTSD and depressive symptoms (ß = .35, p < .001) was also observed. Taken together, our findings provide strong support for using the CWE with Gulf War I-era veterans.

Improving Trauma and Critical Care Proficiency and Readiness for Air Force Personnel in Critical Medical Specialties: A Pacific Air Forces Perspective.

Most U.S. Air Force medical personnel spend their time at military treatment facilities (MTFs) caring for patients whose ailments are far less complex or urgent than the severe trauma-related injuries they would see in war. This mismatch between peacetime and wartime medical care necessitates a deliberate effort on the part of the Air Force Medical Service (AFMS) as a whole and the Pacific Air Forces (PACAF) to ensure that personnel in critical medical specialties receive the training and hands-on clinical experience they need to save lives in a high-casualty environment. The goal of this research project was to investigate approaches for increasing readiness and proficiency. To develop a portfolio of readiness building activities, the authors analyzed manpower and personnel data, reviewed Comprehensive Medical Readiness Program (CMRP) checklists and relevant literature, engaged in discussions with the stakeholder community, and developed models of the assignment system and of skill acquisition and decay. They present their findings and recommendations for the future and have developed a prototype framework to demonstrate a possible method for deciding which readiness building activities and assignment policies to employ.