Medical waiver experience at U.S. Air Force Special Operations Command, 1992-2003

INTRODUCTION: Strict physical standards are applied to military applicants and service members, but these standards can be waived on a case-by-case basis when a member is felt to be capable of continued service in spite of their infirmity. Knowledge of the waiver experience at the unit or major command (MAJCOM) level could yield important operational risk management insight. The present study examined the waiver experience at Air Force Special Operations Command (AFSOC) from 1992 through 2003. METHODS: A dataset reflecting the accumulated waiver experience at AFSOC from 1992 to 2003 was reviewed. Diagnostic groups and occupations were tallied, and waiver rates determined for each. RESULTS: There were 1042 individuals considered for waivers of 1270 medical conditions. Combat controllers made up the largest occupational group, and were statistically more likely to seek waiver consideration than would be expected in the general AFSOC population. The five most commonly encountered diagnostic groups were: otorhinolaryngologic, 26.9%; musculoskeletal, 17.6%; ophthalmologic, 10.9%; cardiovascular, 7.2%; and gastrointestinal, 7.9%. Waivers were granted to 83.9% of the group. Pilots and navigators were more likely to receive a waiver, and aerial gunners were less likely to receive a waiver. DISCUSSION: The five most commonly encountered diagnostic groups accounted for 69% of waiver requests, and the overall waiver rate of 83.9% exceeded that reported in other studies. This MAJCOM-specific data could serve as a valuable resource for comparison to waiver data obtained from other MAJCOMs, and could aid in the development of targeted operational risk management activities.     

Health-related quality of life in patients with metastatic renal cell carcinoma treated with sunitinib vs interferon-�� in a phase III trial: final results and geographical analysis

Background:

In a randomised phase III trial, sunitinib significantly improved efficacy over interferon-α (IFN-α) as first-line therapy for metastatic renal cell carcinoma (mRCC). We report the final health-related quality of life (HRQoL) results.

Methods:

Patients (n=750) received oral sunitinib 50 mg per day in 6-week cycles (4 weeks on, 2 weeks off treatment) or subcutaneous IFN-α 9 million units three times weekly. Health-related quality of life was assessed with nine end points: the Functional Assessment of Cancer Therapy–General and its four subscales, FACT–Kidney Symptom Index (FKSI-15) and its Disease-Related Symptoms subscale (FKSI-DRS), and EQ-5D questionnaire''s EQ-5D Index and visual analogue scale. Data were analysed using mixed-effects model (MM), supplemented with pattern-mixture models (PMM), for the total sample and the US and European Union (EU) subgroups.

Results:

Patients receiving sunitinib reported better scores in the primary end point, FKSI-DRS, across all patient populations (P<0.05), and in nine, five, and six end points in the total sample, in the US and EU groups respectively (P<0.05). There were no significant differences between the US and EU groups for all end points with the exception of the FKSI item ‘I am bothered by side effects of treatment'' (P=0.02). In general, MM and PMM results were similar.

Conclusion:

Patients treated with sunitinib in this study had improved HRQoL, compared with patients treated with IFN-α. Treatment differences within the US cohort did not differ from those within the EU cohort.     

Evidence of mitochondrial dysfunction in obese adolescents

Aim: Although obesity and weight gain generally are anticipated to be caused by an imbalance between energy intake and energy expenditure, the significance of thyroid hormones (TH) remains unclear. Examination of mitochondrial function may reflect intracellular thyroid hormone effect and elucidate whether a lower metabolic rate is present. Methods: In a group of 34 obese adolescents (age <16 years and body mass index above the age‐related 95th percentile), and an age‐ and gender‐matched group of 32 lean adolescent, thyroid stimulating hormone (TSH) and basal oxygen consumption were measured and mitochondrial function in peripheral blood monocytes was determined by flow cytometry. Results: Significant increase in TSH (3.06 ± 1.56 mU/L vs. 2.33 ± 0.91 mU/L, p < 0.05) and a decrease in VO₂ (129 ± 16 mL O₂/m²*min vs. 146 ± 15 mL O₂/m²*min, p < 0.05) were observed in obese adolescents compared with lean adolescents. Flow cytometry analysis demonstrated a lower mitochondrial mass (6385 ± 1962 a.u. vs. 7608 ± 2328 a.u., p < 0.05) and mitochondrial membrane potential (11426 ± 3861 a.u. vs. 14017 ± 5536 a.u., p < 0.05) in obese adolescents compared with lean adolescents. These results are even more pronounced in adolescents with obese mothers. Conclusion: In obese adolescents, the increased TSH and lowered VO₂ propose a lowered basal metabolic rate and the impaired mitochondrial function suggests a decreased thyroid hormone stimulation of mitochondrial energy production. The maternal in‐heritage is suggestive of a basal metabolic defect or mitochondrial resistance for TH.     

“I’ll use it differently now”: using dual-systems theory to explore youth engagement with networked technologies

ObjectivesMany young Canadians experience high levels of networked connectivity, which some suggest may negatively impact their health. Adult monitoring has not been shown to be an effective long-term strategy for supporting young people in healthy engagement with tech. In this study, we explore the benefits of empowering young people to set healthy goals and monitor themselves. We engage with Shapka’s (2019) critique of dual-systems theory, and consider the relationship between the neurological and behavioural systems in relation to adolescent internet use.MethodsUsing a youth participatory action research approach, we co-designed a project with six adolescents to explore the ways that their use of networked technologies was affecting their lives by disconnecting and observing how the lack of networked connectivity changed their experiences. The youth used a media diary to track their use of devices both before and after disconnecting.ResultsThe main benefit of disconnecting appeared to be having the opportunity to reflect on one’s own use of networked devices. This enabled the participants to reconnect in a more intentional way. Findings support Shapka’s speculation that dual-systems theory, with a focus on regulation, may not be the most useful way of supporting adolescents in developing healthy habits around their wired tech.ConclusionAdolescent experiences of networked technologies are complex, yet they are able to navigate this landscape with intelligent strategies. Their self-directed exploration of disconnection helped them to become reflexive practitioners who were able to revisit their use of networked technologies with new insights and self-control.     

Morphological changes due to Lead exposure and the influence of DMSA on the gill tissues of the freshwater fish, Catla catla

Catla catla fingerlings were reared in freshwater and exposed to 15.5 ppm concentration of lead for 60 days. The morphological changes on the gill of the C. catla fingerlings due to lead intoxication and the effect of DMSA (meso 2,3-dimercaptosuccinic acid) on the affected tissues were observed using Scanning Electron Microscope. It has been found that the lead treated gill tissues showed certain marked changes, such as cell hypertrophy, alteration in the lamellar surfaces, epithelial hyperplasia and the fusion of adjacent lamellae. The antidote DMSA treatment reduces the toxic effects and helps the recovery of gill tissue and its return to the level of the control/normal.