Cerebrospinal fever was rare in the British Army prior to World War I. An outbreak of the disease on Salisbury Plain in late 1914 posed new challenges. The War Office established the Central Cerebrospinal Fever Laboratory at the Royal Army Medical (RAM) College early in 1915 to conduct research, develop diagnostic tests and coordinate the military response. The Royal Army Medical Corps (RAMC) set up dedicated cerebrospinal wards for the hospitalisation and treatment of patients. The new Medical Research Committee (MRC) supported bacteriological studies of epidemic strains of the meningococcus responsible for the outbreak. The Lister Institute of Preventive Medicine, an independent research institution, acted as a key supplier of antimeningococcus serum. The mortality of military patients during 1915 was poor because the testing infrastructure was still developing, the RAMC had limited experience of treating cases, and the therapeutic serums available at the time seemed ineffective. The survival rate of home troops improved during the war-through the concerted efforts of the RAMC, MRC and Lister Institute-due to timely diagnosis, and early, intensive and prolonged treatment with improved serums. The Official History of the War highlights subsequent trials undertaken with strain-specific MRC serums in late 1918 and 1919 but fails to acknowledge that in late 1917/early 1918 the Lister Institute supplied the RAM College with large quantities of an efficacious multivalent serum and corresponding monovalent serums that were not included in a formal trial.
INTRODUCTION:On military operations, ballistic impact damage is possible to lithium ion (Li-ion) batteries worn on the body by military personnel and the potential for exothermic reactions may result in injury. This paper investigated the effect of impact on batteries that might be worn in front or behind body armour.METHODS:Li-ion batteries were subjected to ballistic impact both without and in combination with body armour using 7.62×39 mm ammunition (mean velocity=769 m/s) at charge levels up to 40%. The effect of penetrating impacts on charged batteries was also investigated using an outdoor range.RESULTS:The backface signature due to ballistic impact was reduced by including a battery pack between fabric body armour and an armour plate, however the batteries were crushed and mechanically disrupted. Ballistic impacts on batteries mounted in front of an armour plate resulted in perforation of the batteries. Increases in temperature, fire and toxic gas emission were noted when batteries were penetrated by an impact.CONCLUSIONS:Batteries provided limited ballistic protection disproving the hypothesis that batteries could replace or enhance existing body armour solutions. Ballistic impact of charged batteries could lead to injury due to heat/flame and toxic discharge. It is recommended that batteries need to be carried in a position from which they can be rapidly removed from contact with the body.
BACKGROUND AND OBJECTIVE Few studies have examined the relationship between dietary patterns and antioxidant status. We aimed to explore the association between major dietary patterns and oxidative stress biomarkers including serum protein carbonyl (PC), ceruloplasmin and total antioxidant capacity (TAC). METHOD In this cross-sectional study, we randomly selected 320 female nurses aged 20-45 years. General information of participants was collected by trained interviewers. Their weight and height were measured and dietary intakes were determined by the 147-food-item semiquantitative food frequency questionnaire. Dietary patterns were derived by principal component analysis of yielding 25 food groups. In this study, 90 subjects were randomly selected from all participants with serum levels of PC, ceruloplasmin and TAC measured further. To determine the association between dietary patterns' score and oxidative stress biomarkers, multiple linear regression analysis was conducted. RESULTS Three dietary patterns were derived: healthy, unhealthy and traditional. After adjusting for several confounding factors, the unhealthy dietary pattern was inversely related to the serum concentration of ceruloplasmin and PC (p<0.05). The relationship between other dietary patterns and antioxidant biomarkers was not significant. CONCLUSIONS According to the results of this study, unhealthy dietary patterns may have an adverse effect on serum ceruloplasmin.
Introduction In April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability. Method The Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading. Results A total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%). Several factors that slowed an individual's recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management. Conclusions MSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units. The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.
INTRODUCTION Parametric survival models are used to develop injury risk curves (IRCs) from impact tests using postmortem human surrogates (PMHS). Through the consideration of different output variables, input parameters and censoring, different IRCs could be created. The purpose of this study was to demonstrate the feasibility of the Brier Score Metric (BSM) to determine the optimal IRCs and derive them from lower leg impact tests. METHODS Two series of tests of axial impacts to PMHS foot-ankle complex were used in the study. The first series used the metrics of force, time and rate, and covariates of age, posture, stature, device and presence of a boot. Also demonstrated were different censoring schemes: right and exact/uncensored (RC-UC) or right and uncensored/left (RC-UC-LC). The second series involved only one metric, force, and covariates age, sex and weight. It contained interval censored (IC) data demonstrating different censoring schemes: RC-IC-UC, RC-IC-LC and RC-IC-UC-LC. RESULTS For each test set combination, optimal IRCs were chosen based on metric-covariate combination that had the lowest BSM value. These optimal IRCs are shown along with 95% CIs and other measures of interval quality. Forces were greater for UC than LC data sets, at the same risk levels (10% used in North Atlantic Treaty Organisation (NATO)). All data and IRCs are presented. CONCLUSIONS This study demonstrates a novel approach to examining which metrics and covariates create the best parametric survival analysis-based IRCs to describe human tolerance, the first step in describing lower leg injury criteria under axial loading to the plantar surface of the foot.
