Fit for the frontline? Identification of mission-critical auditory tasks (MCATs) carried out by infantry and combat-support personnel

The ability to listen to commands in noisy environments and understand acoustic signals, while maintaining situational awareness, is an important skill for military personnel and can be critical for mission success. Seventeen auditory tasks carried out by British infantry and combat-support personnel were identified through a series of focus groups conducted by Bevis et al. For military personnel, these auditory tasks are termed mission-critical auditory tasks (MCATs) if they are carried in out in a military-specific environment and have a negative consequence when performed below a specified level. A questionnaire study was conducted to find out which of the auditory tasks identified by Bevis et al. satisfy the characteristics of an MCAT. Seventy-nine British infantry and combat-support personnel from four regiments across the South of England participated. For each auditory task participants indicated: 1) the consequences of poor performance on the task, 2) who performs the task, and 3) how frequently the task is carried out. The data were analysed to determine which tasks are carried out by which personnel, which have the most negative consequences when performed poorly, and which are performed the most frequently. This resulted in a list of 9 MCATs (7 speech communication tasks, 1 sound localization task, and 1 sound detection task) that should be prioritised for representation in a measure of auditory fitness for duty (AFFD) for these personnel. Incorporating MCATs in AFFD measures will help to ensure that personnel have the necessary auditory skills for safe and effective deployment on operational duties.     

HICOPS: Human Interface Computer Program in Space

BACKGROUND: During long experimental set ups, a protocol book usually guides cosmonauts. This is not very easy to work with in microgravity conditions and is not very efficient. For the cardiovascular physiology experiment CARDIOCOG during the Belgian Soyuz Mission (Odissea, November 2002) we developed a software program that guided the cosmonauts through the experiment. The software was developed in LabVIEW, thoroughly tested by CNES and the Russian space authorities and transported to the ISS as a stand-alone application. An adapted version was used during the Spanish Cervantes Mission in October 2003. RESULTS: This program provided several advantages: (1) error procedures could be easily dealt with in using the program's incorporated error structure; (2) the experimental sequences were easy to follow for the cosmonauts; (3) the experimental duration was exactly the same for all repetitions of the experiment, since the program imposed the timing; (4) after the flight, we were able to reconstruct all sequences of the experiment using a log-file that was automatically created during the different steps of the experiment; and (5) we were able to impose exact breathing frequencies to the cosmonauts using a visual aid. CONCLUSION: Less training was necessary for the cosmonauts to learn the experiment. Reconstruction of the experiment timing was easy. Exact breathing frequencies were obtained at each repetition. The program HICOPS worked to the overall satisfaction of the cosmonauts and they preferred working with HICOPS instead of with paper flow sheets. Data for the cardiovascular experiment during both missions were obtained in a standardised way.     

Imaging of myocarditis and inflammatory cardiomyopathies

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Maladie de Horton et pseudopolyarthrite rhizomélique : critères diagnostiques

Giant cell arteritis still results in high morbidity related to systemic complications involving the eyes, the central nervous system, the heart and the aorta. Therefore, reliable diagnostic criteria are required in giant cell arteritis and polymyalgia rheumatica (PMR), to detect and manage at early stages patients with giant cell arteritis and PMR. Indeed, diagnostic criteria of giant cell arteritis and PMR have been validated. Taken together, first we propose to review the diagnostic criteria of giant cell arteritis (ACR, GRACG) and PMR (Bird, Jones-Hazleman, Chuang-Hunder, Dasgupta). Second, more recent diagnostic criteria of GCA and PMR are further reviewed, including biochemical/immunological data (especially anti-ferritin antibodies), temporal artery biopsy and imaging findings (artery ultrasonography, angio-CT-scan, angio-MRI, PET-scan, joint echography, and MRI).     

Efficacy of escitalopram vs paroxetine on severe depression with associated anxiety: data from the "Boulenger" study

Several recent studies have underlined the importance of anxiety in major depressive disorders. It has been shown that anxiety was responsible for worsening of depression and reduction of the efficacy of the antidepressant treatment. While it is well known that SSRI are efficient in treating depression or anxiety disorders, the authors tried to determine the influence of baseline anxiety on the response to SSRI treatment in patients with severe depression receiving either escitalopram or paroxetine. In a 24-week double-blind clinical trial, 459 patients with a primary diagnosis of severe major depressive disorder were randomised to receive escitalopram (20mg) or paroxetine (40mg). Post hoc analyses of efficacy in patients with a baseline HAM-A total score less or equal to 20 (n=171) or greater than 20 (n=280) were based on analysis of covariance. (ANCOVA) (ITT, LOCF). At week 24, the mean change from baseline in MADRS total score was -24.2 for escitalopram-treated patients (n=141) and -21.5 for paroxetine treated patients (n=139) (p<0.05, between both groups) in high baseline anxiety patients (HAM-A>20) and the mean change from baseline in HAM-A total score was -17.4 (escitalopram) and -15.1 (paroxetine) (p<0.05, between both groups). As far as complete remitters (CGI-S=1) after 24-week treatment were concerned, their number was significantly higher with escitalopram in the case of marked baseline anxiety. No difference was shown in the low baseline anxiety group. Looking for the influence of baseline anxiety on SSRI treatment effects, the authors showed that antidepressant efficacy of 20mg escitalopram was better than 40mg paroxetine for patients highly depressed with comorbid anxiety symptoms and that, contrary to paroxetine, escitalopram maintained sustained antidepressant activity in patients featuring increased baseline anxiety levels.     

Actualités thérapeutiques dans le lymphome hodgkinien classique

Hodgkin lymphoma is a well-known clinico-pathological entity with a stable incidence among time accounting for 1200 new cases each year in France. The disease is one of the most curable cancer and occurs often in young patients with a median age at 33 years, the major clinical symptoms are lymph nodes mostly above the diaphragm (mediastinal and supra-clavicular). The diagnosis should be suggested with non-specific symptoms such as fever, night sweats, pruritus, weight-loss, lymph node, cough.. leading to prescribe routine exams like blood test with leucocyte count, erythrocyte sedimentation rate and chest Xray. Treatments always include chemotherapy and radiotherapy in localized disease and at a low dose only in involved fields. The usually good prognostic of Hodgkin lymphoma may not let us forget that there are still deaths in patients with refractory or early relapse of the disease. There is still an unmet need is these patients and the search for new drugs is essential.     

A shared mission? Changing relationships between government and church health services in Africa

This article reviews the relationships between government and church health providers within sub-Saharan Africa with a particular focus on East and Southern Africa. This is of particular interest at this time, given the changing configuration of the health sector in many countries as a result of health sector reform policies. The article provides a historical overview of the development and emerging role of the church health services within this changing environment. The factors affecting the relationship between the government and church sector are identified. These include differences in objectives, types of service provided, and the organizational culture and management styles. The paper then explores key issues seen to affect the future pattern of relationships including the changing scene, and identifies different models for relationships and implications for key actors including the Ministry of Health, church health agencies and coordinating bodies. The article concludes that church health services will continue to play a key role in health care in sub-Saharan Africa; however, there are challenges facing them and both parties need to develop a response to these.     

Breaking Away: Advocacy,Education, and the Relationship Between Maternal and Child Health Professionals and the American Public Health Association

Since its founding in 1921, the mission of the Maternal and Child Health (MCH) Section of the American Public Health Association (APHA) has been to develop innovative and creative approaches to addressing the health needs of mothers, children, and families. However, the growth and structure of APHA have impeded the capacity of MCH Section members to accomplish this mission. An independent organization would enhance the effectiveness of advocacy by MCH professionals and facilitate the dissemination of new strategies to address the needs of mothers and children. Consistent with the evolution of the profession of MCH, MCH professionals should withdraw from APHA and create a freestanding organization.