Ironic processes of concentration and suppression under pressure: A study on rifle shooting in Norwegian elite biathletes.

In rifle shooting, suppressing unwanted thoughts can backfire in one's performance, causing athletes to behave contrary to their desired intention and further deteriorate their performance. PURPOSE: This study examined how priming attentional and negative cues affected participants' shooting performances toward ironic error targets under cognitive load conditions in Stroop task across two experiments. METHODS: Semi-elite biathletes (Experiment 1, n = 10; Experiment 2, n = 9) participated in the study. The study used a within-subject quasi-experimental design, particularly a one-way repeated measures multivariate analysis of variance and a 2 × 2 fully repeated measures analysis of variance, to determine the participants' hit rates and shooting response times (RTs). In both experiments, the participants completed the reverse-Stroop-based target shooting performance under low- and high-cognitive load conditions while receiving frequent priming attentional and negative cues. RESULTS: The findings from Experiment 1 suggest that regulating repetitive priming attentional thoughts is efficacious in mitigating the likelihood of ironic performance errors and interference effects. The results of Experiment 2 show that repetitive priming negative cues resulted in negligible ironic error hit rates and slower RTs in target hits under high-cognitive load conditions. The Bayesian analyses provided evidence supporting the null hypotheses. CONCLUSION: Trying to control repetitive priming attentional and negative thoughts reduces ironic performance errors to a similar degree under cognitive load conditions among biathletes, regardless of interference effects. Further research is needed to determine the effectiveness of suppressing task-relevant negative instructions in reducing the likelihood of ironic performance errors under pressure.

The significance of shooting angle in seal shooting.

The present study aimed to investigate the relationship between shooting angle to the head and animal welfare outcomes in the hunt of young harp seals (Pagophilus groenlandicus). The study population consisted of young harp seals belonging to the Greenland Sea harp seal population. A sample of 171, 2-7 weeks old, weaned harp seals of both sexes were included. The study was conducted as an open, randomised parallel group designed trial during the regular hunt. The animals were allocated into four groups, A-D, according to the observed shooting angle to the head, defined as the angle between the direction of the shot and the longitudinal axis of the animal's head: (A) directly from the front; (B) obliquely from the front; (C) directly from the side; and (D) obliquely or directly from behind. Instantaneous death rate (IDR) and time to death (TTD) were the main variables. The mean IDR differed significantly between groups and was highest in group B (96.8%) and lowest in group C (66.7%). For all groups combined it was 84.2%. The mean TTD for seals not rendered instantaneously unconscious or dead (n = 27) differed significantly between groups and was shortest in group A (16 s) and longest in group C (85 s). However, the number of animals included in the TTD analysis was limited. In conclusion, based on the significantly higher IDR, the shooting angle obliquely from the front is recommended to help achieve the best animal welfare outcomes during the hunt of young harp seals.

Late Kidney Injury After Admission to Intensive Care Unit for Acute Heart Failure.

Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, n = 509), Class R (risk; ≥ 1.5, n = 214), Class I (injury; ≥ 2.0, n = 78), and Class F (failure; ≥ 3.0, n = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, P = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, P < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, P < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, P = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (P = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (P = 0.017).The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.

Timing and Degree of Acute Kidney Injury in Patients Requiring Non-Surgical Intensive Care.

BACKGROUND: The degree and timing of acute kidney injury (AKI) on admission and during hospitalization in patients requiring non-surgical intensive care remain unclear.Methods and Results: In this study, 3,758 patients requiring intensive care were analyzed retrospectively. AKI was defined based on the ratio of serum creatinine concentrations recorded at each time point (i.e., on admission and during the first 5 days in the intensive care unit and during hospitalization) to those measured at baseline. Patients were grouped by combining AKI severity (RIFLE class) and timing (i.e., from admission to 5 days [A-5D]; from 5 days to hospital discharge [5D-HD]) as follows: No-AKI; New-AKI (no AKI to Class R [risk; ≥1.5-fold increase in serum creatinine], I [injury; ≥2.0-fold increase in serum creatinine], and F [failure; ≥3.0-fold increase in serum creatinine or receiving dialysis during hospitalization]); Stable-AKI (Class R to R; Class I to I); and Worsening-AKI (Class R to I or F; Class I to F). Multivariate logistic regression analysis indicated that 730-day mortality was independently associated with Class R, I, and F on admission; Class I and F during the 5D-H period; and New-AKI and Worsening-AKI during A-5D and 5D-HD. CONCLUSIONS: AKI on admission, even Class R, was associated with a poor prognosis. An increase in RIFLE class during hospitalization was identified as an important factor for poor prognosis in patients requiring intensive care.

Evaluation of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) as an early diagnostic marker of acute kidney injury (AKI) in critically ill trauma patients.

Background and Aims: Acute kidney injury (AKI) is a frequent complication of severe trauma associated with high mortality. The aim of this study was to evaluate the diagnostic ability of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of AKI assessed by RIFLE criteria as reference in trauma patients in intensive care unit (ICU). Material and Methods: This was a prospective observational study. Four hundred and eighteen patients admitted in the trauma ICU with age ≥18 years without known renal diseases were followed-up (serum creatinine, urine output, and estimated glomerular filtration rate) for 5 consecutive days. As per RIFLE criteria, 70 patients were broadly classified as AKI and rest of the patients (n = 348) as non-AKI. Plasma and urine samples of AKI (n = 70) and non-AKI (n = 70) patients were further assessed for 3 consecutive days following admission. Results: Mean plasma NGAL (pNGAL) was significantly elevated in AKI patients as compared with non-AKI patients; on admission: 204.08 versus 93.74 ng/mL (P = 0.01); at 24 h: 216.73 versus 94.63 ng/mL (P = 0.01); and 48 h: 212.77 versus 86.32 ng/mL (P = 0.01). Mean urine NGAL (uNGAL) at 48 h was also significantly elevated: 15.45 ng/mL in AKI patients as compared with 13.48 ng/mL in non-AKI patients (P = 0.01). Plasma and urine NGAL levels were significantly associated with increased mortality. Conclusion: pNGAL had good predictive value on admission (area under the receiver operative characteristic [AUROC] 0.84), at 24 h (AUROC 0.88) and 48 h (AUROC 0.87), while uNGAL had moderate performance at 24 h (AUROC 0.61) and 48 h (AUROC 0.71). pNGAL can be used as an early and potent diagnostic and predictive marker of AKI and mortality in critically ill trauma patients.

Insights into early postoperative acute kidney injury following lung transplantation.

BACKGROUND: Acute kidney injury (AKI) is a common complication after lung transplantation (LT) and is associated with higher cost and mortality. We sought to evaluate the incidence of postoperative AKI, defined as AKI within 14 days of transplant, and identify associated perioperative factors. METHODS: We conducted a single-center, retrospective review of 153 lung transplant recipients. Postoperative AKI was determined using the RIFLE (Risk, Injury, Failure, Loss, End Stage) criteria. Perioperative covariates and their association with postoperative AKI were analyzed using Cox proportional hazards. Kaplan-Meier survival curves were constructed to evaluate patient survival at 1 year and data finalization. A sub-analysis was performed evaluating factors associated with early AKI (within 48 h of transplant) and late AKI. RESULTS: Postoperative AKI occurred in 36.6% of patients with 51.8% of cases occurring within 48 h of LT. Recipient race, transplant type, cardiopulmonary support, and red blood cell administration were associated with postoperative AKI. Survival was significantly lower in patients with postoperative AKI following LT. CONCLUSIONS: Postoperative AKI within 2 weeks of lung transplant is associated with lower short- and long-term survival. Perioperative factors associated with postoperative AKI may be potential points of intervention to minimize AKI development in the future.

Performance-determining factors in biathlon prone shooting without physical stress.

This study investigated the most important factors determining biathlon prone shooting performance. Ten female and 16 male biathletes (age 19.9 ± 2.9 years) from the national teams of Finland and Vuokatti-Ruka Sports Academy performed 6 × 5 biathlon prone shooting shots without physical stress under laboratory conditions. Shooting performance and multiple aiming point trajectory variables were measured together with an analysis of triggering force. Based on the aiming point trajectory data principal component analysis, we identified four technical components in biathlon prone shooting: stability of hold, aiming accuracy, cleanness of triggering, and timing of triggering. Multiple regression analysis (MRA) further determined that cleanness of triggering, aiming accuracy, and timing of triggering accounted for 80% of mean shooting performance (p < 0.001). Better stability of hold, aiming accuracy and cleanness of triggering were directly associated with better shooting performance (0.62 ≤ |r| ≥0.79, all p < 0.001). Better stability of hold measures were also associated with better cleanness of triggering, and higher pre-shot trigger force levels were associated with better stability of hold and cleanness of triggering. These results indicate that with both direct and indirect effects on performance, stability of hold seems to be a general prerequisite for successful biathlon shooting. The results also highlight the importance of aiming accuracy, cleanness and timing of triggering, along with a high pre-shot trigger force level. The variables identified in this study could be used to assess biathletes' performance in the most relevant shooting technical aspects to guide the emphasis of their shooting training.

Comprehensive characterization of firing byproducts generated from small arms firing of lead-free frangible ammunition.

Following the introduction of lead-free frangible ammunition in United States Air Force small arms firing ranges, Combat Arms instructors have routinely reported experiencing adverse health symptoms during live fire training exercises, including sore throat, cough, and headache. Previous studies have found that these symptoms occur despite occupational exposure limits not being exceeded. To better characterize the potential source and mechanisms for health symptoms, a comprehensive characterization of the physicochemical properties of gases and aerosols emitted during the firing of the M9 pistol and M4 rifle using lead-free frangible ammunition was completed. Weapons were fired within a sealed chamber using a remote firing mechanism. A suite of direct-reading instruments and collection-based analytical methods were used to determine the composition of the emissions. Emissions were dominated by carbon monoxide and ultrafine particles. Other prevalent gases included carbon dioxide, ammonia, formaldehyde, hydrogen cyanide, and nitric oxide when measured using Fourier-transform infrared spectroscopy. An electrical, low-pressure impactor showed that, on average, the count median diameter immediately after firing was 36 ± 4 nm (n = 10 rounds) and 32 ± 3 nm (n = 14 rounds) for the M9 pistol and M4 rifle, respectively. Analytical methods were used to determine that emitted particles were primarily composed of soot, copper, and potassium, with trace amounts of calcium, silicon, sodium, sulfur, and zinc. Results from this research confirm prior work and expand upon the characterization of emissions generated from firing lead-free frangible ammunition. By employing multiple methods to measure and analyze data we were able to quantify both total and respirable particle fractions and determine particle morphology and composition. Characterization of the emissions provides insight into potential exposure risks that may lead to the development of adverse health symptoms allowing for the development of strategies for risk mitigation.

Polymyxin-induced nephrotoxicity and its predictors: a systematic review and meta-analysis of studies conducted using RIFLE criteria of acute kidney injury.

Polymyxins are last-resort antibiotics re-emerged to treat infections caused by multidrug resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacterial infections. However, polymyxin-associated nephrotoxicity has become the main safety concern. Therefore, we conducted this systematic review and meta-analysis on polymyxin-induced nephrotoxicity and its predictors using studies conducted based on the validated RIFLE (Risk, Injury, Failure, Loss of Function and End-stage renal disease) criteria of acute kidney damage. Literature search was carried out through visiting legitimate databases and indexing services including PubMed, MEDLINE (Ovid®), EMBASE (Ovid®), and Scopus to retrieve relevant studies. Following screening and eligibility evaluation, relevant data were extracted from included studies and analyzed using STATA 15.0 and Rev-Man 5.3. Inverse variance method with random effects pooling model was used for the analysis of outcome measures at 95% confidence interval. Besides, meta-regression, meta-influence, and publication bias analyses were conducted. A total of 48 studies involving 6,199 adult patients aged ≥ 18 years were included for systematic review and meta-analysis. The pooled incidence of polymyxin-induced nephrotoxicity was found to be 45% (95% CI: 41- 49%; I2 = 92.52%). Stratifying with RIFLE severity scales, pooled estimates of polymyxin-treated patients identified as 'risk', 'injury' and 'failure' were 17% (95% CI: 14-20%), 13% (95% CI: 11-15%), and 10% (95% CI: 9-11%), respectively. Besides, the pooled incidence of colistin-induced nephrotoxicity was about 48% (95% CI: 42-54%), whereas that of polymyxin B was 38% (95% CI: 32-44%). Likewise, colistin had 37% increased risk of developing nephrotoxicity compared to the polymyxin B treated cohorts (RR = 1.37, 95% CI: 1.13-1.67; I2 = 57%). Older age (AOR = 1.03, 95% CI: 1.01-1.05), daily dose (AOR = 1.46, 95% CI: 1.09-1.96), underlying diabetes mellitus (AOR = 1.81, 95% CI: 1.25-2.63), and concomitant nephrotoxic drugs (AOR = 2.31, 95% CI: 1.79-3.00) were independent risk factors for polymyxin-induced nephrotoxicity. Patients with high serum albumin level were less likely (AOR = 0.69, 95% CI: 0.56-0.85] to experience nephrotoxicity compared to those with low albumin level. Despite the resurgence of these antibiotics for the chemotherapy of MDR/XDR-Gram-negative superbugs, the high incidence of nephrotoxicity has become a contemporary clinical concern. Being elderly, high daily dose, having underlying diseases such as diabetes, and use of concomitant nephrotoxic drugs were independent predictors of nephrotoxicity. Therefore, therapeutic drug monitoring should be done to these patients to outweigh the potential benefits of polymyxin therapy from its risk.

Acute renal disease in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and HIPEC: the influence of surgery and the cytostatic agent used.

BACKGROUND: The main objective of this study was to evaluate the differences between cisplatin and paclitaxel in the development of postoperative renal toxicity, using as a reference the RIFLE (Risk, Injury, Insufficiency, Loss, and End-stage renal function) and AKIN (Acute Kidney Injury Network) criteria in patients with primary or recurrent ovarian cancer with peritoneal dissemination treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: One hundred fifty-two patients who were treated between December 2007 and June 2017 were analyzed. RESULTS: Patients who received previous platinum-based chemotherapy had higher baseline creatinine levels than those who had not (p = 0.05). A total of 11 (7.2%) and 4 (2.6%) patients developed an acute renal dysfunction (ARD) during the postoperative period of cytoreduction and HIPEC according to the RIFLE and AKI criteria respectively. RIFLE detects a higher rate of ARD due to different parameters such as GFR (7.2% versus 2.6%, p = 0.016). Performing ostomy (p = 0.007; OR: 39.320; 95% CI = 2.74-56.13) and using of cisplatin during HIPEC treatment (p = 0.017; OR = 13.619; 95% IC = 1.600-25.95) were factors independently related to a higher rate of ARD. CONCLUSION: ARD has a multifactorial origin. Cisplatin was associated with the development of a higher rate of ARD than paclitaxel. Diagnosis of ARD did not correlate with worse survival figures.

Aiming strategy affects performance-related factors in biathlon standing shooting.

This study focused on investigating differences in shooting performance and performance-related factors between two different aiming strategies (HOLD, low radial velocity during the approach 0.4-0.2 seconds before triggering, and TIMING, high radial velocity) in biathlon standing shooting. A total of 23 biathletes fired 8 × 5 standing shots at rest (REST) and 2 × 5 shots during a race simulation (RACE). Shooting performance (hit point distance from the center of the target), aiming point trajectory and postural balance were measured from each shot. Shooting performance was similar both at REST (HOLD 33 ± 5 mm vs TIMING 38 ± 8 mm, P = .111) and in RACE (40 ± 11 mm vs 47 ± 12 mm, P = .194). Better shooting performance was related to smaller distance of the aiming point mean location (REST r = 0.93, P < .001, RACE r = 0.72, P = .018) and higher time spent within ⅔ of the distance of the hit area edge from the center 0.6-0.0 seconds before triggering (REST r=-0.88, P = .001, RACE r=-0.73, P = .016) in HOLD, and to lower aiming point total velocity 0.6-0.0 seconds before triggering (REST r = 0.77, P = .009, RACE r = 0.88, P = .001) and less aiming point movement 0.2-0.0 seconds before triggering (REST r = 0.82, P = .003, RACE r = 0.72, P = .012) in TIMING. Postural balance was related to shooting performance at REST in both groups and in RACE in TIMING. Biathletes using the hold strategy should focus on stabilizing the aiming point before triggering and aiming at the center, whereas biathletes using the timing strategy benefit of decreasing the total velocity during the final approach as well as minimizing the aiming point movement right before triggering.

Safety analysis regarding acute kidney injuries for chloride-restrictive intravenous fluid administration against that of chloride-liberal for patients admitted in the medical intensive care unit: A non-randomised retrospective (chrachl-mic) study.

BACKGROUND: Acute kidney injuries are common in the medical intensive care unit. Generally, intravenous normal saline is administered in critically ill patients but it is associated with acute kidney injury. Current knowledge of chloride and its effect on the physiological functions of the kidney is limited. The objectives of the study were to compare the safety of chloride-restrictive intravenous fluid administration against that of chloride-liberal regarding acute kidney injuries. METHODS: Data regarding RIFLE (risk, injury, failure, loss, and end-stage renal failure) categories, Kidney Disease: Improved Global Outcomes (KDIGO) stage, Δ creatinine, and requirements of renal replacement therapy of 285 patients admitted to medical intensive care unit for critical illness during 4-months from the hospitalisation were retrospectively collected and analysed. Patients received chloride-liberal intravenous fluid (CL cohort, n = 163) or that of chloride-restrictive (CR cohort, n = 122) during bundle-of-care. RESULTS: Patients with risk (P = .039) and injury (P = .041) categories of RIFLE, high Δ creatinine (0.22 ± 0.02 mg/dL/patient vs 0.18 ± 0.02 mg/dL/patient, P < .0001), and patients with KDIGO stage 1 (P = .023) and stage 2 (P = .048) were reported significantly higher in the CL cohort than the CR cohort. The higher numbers of patients were put on renal replacement therapy in the CL cohort than those of the CR cohort (16 vs 3, P = .014). CONCLUSION: The chloride-restrictive intravenous fluid administration has reduced the chances of acute kidney injuries in the intensive medical care unit.

Association of the HPA axis response to upcoming competition and shooting outcomes in elite junior shooting players.

Successful shooting performance in competition is reliant on several factors such as shooting techniques and competition-associated psychological stresses. This study examined the hypothalamus-pituitary-adrenal (HPA) axis response to upcoming competition and its association with shooting outcomes in elite junior shooting players. The cortisol awakening response (CAR) and dehydroepiandrosterone (DHEA) secretion after awakening were measured for two consecutive days (the day before and on the day of competition for the selection of national shooting team members) in 19 junior men and 21 junior women players, and the shooting scores of the individual players were obtained. The total cortisol secretion during the CAR period (CARauc) increased, but total DHEA secretion during the post-awakening period (Daucawk) decreased on the day of competition, compared with one day before competition. The CARauc was higher in women than in men players, whereas Daucawk was higher in men than in women players across the two consecutive days. Cortisol and DHEA levels were comparable between low-scored (below the mean scores for air pistol or air rifle players) and high-scored players one day before competition. However, the CARauc on the day of competition was higher and the variations in the CARauc and molar CARauc/Daucawk ratios across the two consecutive days were greater in low-scored than in high-scored men and women players. These results indicated that upcoming competition involves alterations of the CAR and DHEA secretion after the awakening period, and greater HPA response to the upcoming competition was adversely associated with shooting scores in junior shooting athletes.Lay summaryAn important upcoming competition was perceived as a strong stressor on awakening that induced alteration in CAR and DHEA secretion after the awakening period in elite shooting players. This study observed that, irrespective of their age and period of shooting practice, the HPA axis function on the day of competition was associated with shooting outcomes in elite shooting players.

Effects of police body armour on overmatching ballistic injury.

Overmatching occurs when body armour that has been designed to resist perforation by a specified projectile is perforated by a greater threat. This may result in wounding to the body armour wearer. In this work, overmatching of two types of police body armour was studied using two types of ammunition. The use of a 250-mm-long gelatine block to represent the depth of the human torso combined with armour panels mounted on the anterior and posterior of the block allowed for a more realistic simulation to be completed. There was some evidence to suggest that overmatching events could lead to increased levels of damage during a survivable incident compared with no body armour being present. This information is of interest to armour designers and medical personnel that might treat such wounds.

Hemolytic Uremic syndrome associated with pregnancy: Outcome from acute Kidney Injury.

OBJECTIVE: To report here, case series of women developing acute kidney injury (AKI) in association with hemolytic uremic syndrome (HUS) during pregnancy or within days postpartum. METHODS: Subjects for the study reported here comprised of a cohort of 49 women referred from OBGYN and diagnosed having AKI and HUS. AKI was defined according to RIFLE criteria and HUS on basis of hematological, biochemical and histological features. All patients had normal size kidneys on ultrasonography and no previous co- morbidity. RESULTS: From January 2000 - January 2020, 49 such women were admitted/ referred to this facility. The mean age of these patients was 29.02±5.258 years. Two had HUS during pregnancy while rest during postpartum. Majority of women had more than one insults these include hemorrhages, intrauterine deaths, operative measure (lower segment caesarean section). Renal replacement was required in all women. Complete renal recovery was observed in 14 patients, while one died during acute phase of illness. CKD-V developed in 17 patients, 16 patients lost long term follow up, but were dialysis free till last follow up and one left against medical advice during acute phase of illness. Treatment with plasmapheresis revealed significantly better renal recovery (p value 0.03) in this group of patients. CONCLUSION: AKI with background of Hemolytic Uremic Syndrome (HUS) may remain irreversible in many of these young women. Plasmapheresis should be offered to patients with established diagnosis of HUS.

[Morphological specific damage of clothing by shots from a smooth-bore hunting rifle with cartridges of multi shells from various distances]. / Morfologicheskie osobennosti povrezhdenii odezhdy, prichinennykh vystrelami s razlichnykh rasstoyanii iz gladkostvol'nogo okhotnich'ego ruzh'ya patronami s polisnaryadami.

The aim of the work is to study the design features of cartridges with multi shells for a smooth-bore hunting rifle of 12 mm caliber and results of firing these cartridges from various distances. Were revealed the morphological signs and features of injuries to tissue targets hit from a distance of 5-40 m. Was argued a necessity to continue a comprehensive study of the issue with the subsequent development of criteria for differential diagnosis of this type of shot injuries.

Sleep restriction and cognitive load affect performance on a simulated marksmanship task.

Sleep restriction degrades cognitive and motor performance, which can adversely impact job performance and increase the risk of accidents. Military personnel are prone to operating under sleep restriction, and previous work suggests that military marksmanship may be negatively affected under such conditions. Results of these studies, however, are mixed and have often incorporated additional stressors (e.g. energy restriction) beyond sleep restriction. Moreover, few studies have investigated how the degree of difficulty of a marksmanship task impacts performance following sleep restriction. The purpose of the current experiment was to study the effects of sleep restriction on marksmanship while minimizing the potential influence of other forms of stress. A friend-foe discrimination challenge with greater or lesser degrees of complexity (high versus low load) was used as the primary marksmanship task. Active duty Soldiers were recruited, and allowed 2 h of sleep every 24 h over a 72-h testing period. Marksmanship tasks, cognitive assessment metrics and the NASA-Task Load Index were administered daily. Results indicated that reaction times to shoot foe targets and signal friendly targets slowed over time. In addition, the ability to correctly discriminate between friend and foe targets significantly decreased in the high-cognitive-load condition over time despite shot accuracy remaining stable. The NASA-Task Load Index revealed that, although marksmanship performance degraded, participants believed their performance did not change over time. These results further characterize the consequences of sleep restriction on marksmanship performance and the perception of performance, and reinforce the importance of adequate sleep among service members when feasible.

Predictive risk factors of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy for ovarian peritoneal carcinomatosis.

OBJECTIVE: The aim of our study was to assess the incidence and identify the predictive risk factors of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy. METHODS: This is a retrospective study from two centers evaluating patients with advanced or recurrent ovarian cancer who underwent cytoreductive surgery followed by cisplatin-based hyperthermic intra-peritoneal chemotherapy from January 2007 to December 2013. Patients were classified into two groups according to the occurrence of acute kidney injury, defined as a glomerular filtration rate at post-operative day 7 25% lower than at day 0. We also evaluated acute kidney injury following Risk, Injury, Failure, Lost and End-stage kidney function criteria. Univariate and multivariate analyses were conducted in order to assess the association between different variables and the occurrence of acute kidney injury. RESULTS: Sixty-six patients were included: 29 (44%) underwent first-line treatment and 37 (56%) were treated for recurrent disease. The incidence of post-operative acute kidney injury was 48%. After multivariate analysis, hypertension (OR 18.6; 95% CI 1.9 to 182.3; p=0.012) and low intra-operative diuresis (OR 0.5; 95% CI 0.4 to 0.8; p=0.001) were associated with acute kidney injury. CONCLUSION: The incidence of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy was high. Hypertension and low intra-operative diuresis were independent risk factors for this complication. Adequate peri-operative hydration, in order to maintain correct diuresis, could decrease the occurrence of acute kidney injury in patients undergoing cytoreductive surgery plus hyperthermic intra-peritoneal chemotherapy.

Postural balance and rifle stability in a standing shooting position after specific physical effort in biathletes.

The aim of the study was to evaluate the effect of maximal specific physical effort on postural balance and rifle stability in biathletes in a standing shooting position. The study included 10 junior elite biathletes. The measurements were taken with the Vicon system and AMTI force platform. Postural balance and rifle stability characteristics were determined at rest as well as 1 and 5 min post maximal specific physical effort which was performed on a ski ergometer and continued until exhaustion. Maximal physical effort exerted a significant effect on all examined postural sway and rifle sway characteristics. The duration of the post-exercise changes was longer than 5 minutes. Higher post-effort rifle sway was observed in the vertical direction than in the across the shooting line direction. Post-effort postural balance impairment in the shooting line was much greater than in the across the shooting line direction. Moreover, a strong correlation was found between postural balance and rifle stability. Maximal physical effort influenced postural balance and rifle stability during aiming. Rifle sway during aiming in a standing shooting position seems to be coordinated with the postural sway of the biathlete's body. Thus, an increase in postural sway contributes to greater sway and lesser stability of the rifle.

Validation of Renal Risk Score Models for Coronary Artery Bypass Surgery in Diabetic Patients.

BACKGROUND: Coronary artery bypass grafting is applicable with very low mortality and morbidity rates around the world. However, exposure to even one of the risk factors increases mortality and morbidity significantly. There are three acute kidney injury definitions, and classification methods are applicable (Kidney Disease: Improving Global Outcomes (KDIGO); Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE);" (for accuracy) and Acute Kidney Injury Network (AKIN)), for understanding and grading of renal impairment. With these definitions, it became possible to take measures at an early stage and start the management process. Methods for assessing renal impairment after coronary artery bypass grafting (CABG) specifically in patients with diabetes mellitus require further investigation. We compared these three acute kidney injury definitions for prediction of outcomes in diabetic patients undergoing coronary artery bypass grafting procedure. METHODS: Between January 2010 and December 2013, a total of 617 consecutive patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass in our institution were included in the study. RESULTS: We considered 617 CABG operations on diabetes mellitus patients for this study from January 2010 to December 2013. The three scores provided good discriminative capacity in the global patient sample, with the area under the ROC curve (AUC) being higher, RIFLE (0.803, 95% CI: 0.724-0.882). The goodness of fit was good for all scales. CONCLUSIONS: Especially in on-pump CABG patients with diabetes mellitus, we can use AKIN, RIFLE, and KDIGO scoring systems to predict early diagnosis for acute kidney injury (AKI). In our analysis, the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.