Regular Duty Research Articles

Prevalence of Pain With Movement in Active Duty US Army Soldiers.

Soldiers must be able to perform a multitude of physically demanding tasks as part of their regular duty, but their physical readiness is often degraded due to pain and musculoskeletal injury (MSKI). The presence of pain with movement has been associated with increased MSKI risk in Soldiers. Improved awareness of the prevalence of painful movements in uninjured Soldiers could help inform Army injury mitigation efforts. The purpose of this study was to identify the prevalence of pain with movement in a population of healthy active duty Soldiers. The Selective Functional Movement Assessment-Top Tier Movements (SFMA-TTM), active range of motion (AROM) of the hips and shoulders, and the elicitation of pain with movement were measured in 268 healthy US Army Soldiers. Descriptive statistics were generated for the number of painful movements for each measure and inferential statistics; independent t-test and one-way independent analysis of variance (ANOVA) were used for analysis of the other measures. Greater than half (59%) of the participants reported pain with at least 1 movement and more than 41% reported pain with 2 or more movements. Soldiers reported a mean of 1.35 painful movements on the SFMA-TTM assessment and a mean of 1.54 painful AROM movements. Pain with functional movement patterns was common across a sample of uninjured Soldiers. The presence of pain with movement warrants further evaluation as it may impact a Soldier's physical performance, risk for future injury, and overall quality of life.

Assessment of PAH exposure and health risks among South Korean firefighters based on urinary PAH metabolites

Polycyclic aromatic hydrocarbons (PAHs) comprise a group of compounds resulting from the incomplete combustion of organic matter. Firefighters engaged in fire suppression are highly exposed to PAHs. This study centered on evaluating the exposure levels and health risks of PAHs in South Korean firefighters involved in firefighting activities. The concentrations of 10 PAH metabolites in the urine of firefighters were measured immediately after, and two weeks post their engagement in extinguishing a large tire factory fire. The levels of OH-PAHs in urine samples immediately after fire suppression were elevated by a factor of 1.01–1.84 compared to urine samples from non-exposed period. The median concentration of total PAH metabolites (OH-PAHs) was higher in urine samples immediately after fire suppression (5910 ng/g creatinine) than in urine samples from non-exposed periods (5020 ng/g creatinine). However, the ∑OH-PAH levels in firefighters’ urine were related to personal habits such as smoking. The concentrations of all individual OH-PAHs in the urine samples of nonsmokers exhibited a substantial increase, ranging from 1.37 to 2.3 times, clearly demonstrating that firefighting activities were a substantial source of PAH exposure. The calculated values associated with the health risks stemming from exposure to PAHs, including carcinogenic risk, total estimated daily intake (TEDI), and hazard quotients/index (HQs/HI), all fell within acceptable limits, indicating negligible risk. However, the HQ/HI values and TEDI for individual and total PAH exposures, except those for naphthalene, were 1.36–2.00 times higher in firefighters' samples taken after firefighting operations compared to those during regular duty. This underscores the need for more comprehensive investigations to comprehend the singular impact of firefighting activities due to the diverse sources of PAH emissions in the environment.

The measurement of mental fatigue following an overnight on-call duty among doctors using electroencephalogram.

This study aimed to measure the spectral power differences in the brain rhythms among a group of hospital doctors before and after an overnight on-call duty. Thirty-two healthy doctors who performed regular on-call duty in a tertiary hospital in Sarawak, Malaysia were voluntarily recruited into this study. All participants were interviewed to collect relevant background information, followed by a self-administered questionnaire using Chalder Fatigue Scale and electroencephalogram test before and after an overnight on-call duty. The average overnight sleep duration during the on-call period was 2.2 hours (p<0.001, significantly shorter than usual sleep duration) among the participants. The mean (SD) Chalder Fatigue Scale score of the participants were 10.8 (5.3) before on-call and 18.4 (6.6) after on-call (p-value < 0.001). The theta rhythm showed significant increase in spectral power globally after an overnight on-call duty, especially when measured at eye closure. In contrast, the alpha and beta rhythms showed reduction in spectral power, significantly at temporal region, at eye closure, following an overnight on-call duty. These effects are more statistically significant when we derived the respective relative theta, alpha, and beta values. The finding of this study could be useful for development of electroencephalogram screening tool to detect mental fatigue.

Suicide Risk, Alcohol Consumption and Attitudes towards Psychological Help-Seeking among Lithuanian General Population Men, Conscripts and Regular Active Duty Soldiers.

The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: 445 men from the general population, 490 conscripts, and 260 regular AD soldiers from the Lithuanian Armed Forces. The study's measures included: general suicide risk, alcohol consumption levels, frequency of using alcohol as a means to suppress difficult thoughts and feelings, and attitudes toward psychological help. Both military samples showed significantly lower suicide risk than men from the general population. Alcohol use as a means to suppress difficult thoughts and feelings was the most significant predictor of suicide risk and a significant mediator between alcohol consumption and suicide risk in all study groups. Another significant suicide risk predictor and mediator between alcohol consumption and suicide risk-i.e., the value of seeking psychological treatment-was found only in the conscript sample. Results of the current study suggest that there is an opportunity for intervention aimed at the attitudes toward seeking professional psychological help for conscripts. However, that might not be the case for regular AD soldiers, nor the general population of Lithuanian men.

Use of YEARS Algorithm in Military Health Care Beneficiaries to Evaluate Use of Computed Tomography Pulmonary Angiography.

Pulmonary embolism (PE) can be difficult to rule out without computed tomography pulmonary angiograms (CTPAs), as presentations vary. Multiple clinical decision rules (CDRs) exist to risk-stratify patients to avoid unnecessary CTPAs. However, the currently used CDRs are complex, and research has shown low compliance with their usage. The YEARS algorithm is less complex and excludes patients from CTPA if PE is not the most likely diagnosis, they do not have a history of hemoptysis, and no clinical signs of deep vein thrombosis, is less complex. However, no studies have evaluated YEARS in the U.S. Military health care beneficiary population. Therefore, this study sought to determine if implementing the YEARS algorithm could decrease the number of CTPAs ordered to rule out PE in low-risk patients. This retrospective, single-center cohort study applied the YEARS algorithm to low-risk military beneficiaries presenting to the emergency department in the calendar year 2020 at a single U.S. Army MTF. The primary outcome was the number of CTPAs indicated by the YEARS algorithm versus the number ordered via standard practice. We used chi-square testing to compare the number of subjects in whom YEARS indicated CTPA (meets criteria/does not meet criteria) versus the actual number of subjects who underwent CTPA (meets criteria/does not meet criteria). The secondary outcomes included applying YEARS similarly to the number of subjects >50 years of age (as opposed to age-adjusted d-dimer), determining the number of pregnant patients who could have avoided CTPA via application of YEARS, and assessing possible cost savings via reduction of CTPA. We included 353 subjects during the study period, 271 of whom underwent CTPA. YEARS would have only indicated 25 of them, P = .018. In patients >50 years of age, 164 underwent CTPA versus nine who met YEARS criteria, P = .014. Among pregnant patients, six underwent CTPA versus one who YEARS would have indicated, P = .130. Application of the YEARS algorithm would have led to a 90.8% reduction in CTPAs ordered with an overall known missed PE rate of 1.1%. Applying the YEARS algorithm in 2020 could have led to 246 fewer CTPAs at a minimum cost savings of $38,762.22 for the MTF based on the coded billing cost of $157.57 per CTPA when local staff radiologists performed image interpretation. This estimate does not consider the additional undisclosed cost of contracted radiologists interpreting after regular duty hours. For our military beneficiaries, our study indicates that the YEARS algorithm would have reduced CTPA utilization in all age ranges and potentially among pregnant patients with a known missed PE rate of 1.1%.

Economics of operating room use at auniversity eye hospital

In ophthalmologic surgery, there are usually short operation times and thus many changes between the individual operations, which are not subject to remuneration. As in maximum care hospitals consecutive different operations with different durations are often performed, emergency operations have to be inserted and further training of colleagues is practiced, it is particularly important to generate the shortest possible transfer times in order to have both sufficient operation time and to be able to treat as many cases as possible. The aim of this work is to evaluate the efficiency of the surgical performance of auniversity eye hospital. The surgeries performed in 2021 at the MHH Eye Clinic were evaluated with respect to the spectrum, number, surgery duration, transfer times and process times. In terms of personnel, each operating room was staffed with one assistant anesthesiologist, one nurse anesthetist, two operating room nurses, one surgeon, and 20% senior anesthesiologist supervision. Based on atheoretical concept, which provides an increased staffing ratio while maintaining the same infrastructure, it was calculated how many more surgeries could be performed if the transfer time was halved and whether the additional financial expense could be compensated. With atotal of n = 2712 surgeries performed during regular duty hours (244 working days) in 2 operating rooms (average daily n = 11.1; weekly n = 53.6 and monthly n = 237.1), the average surgery duration was 37 min and the transition time 43 min. This means that the operating rooms were used for surgery for 51% of the total operating time. Main procedures were vitrectomy with n = 1350 and cataract surgery with n = 1308. The new personnel concept provided one additional operating room nurse per operating room and one additional anesthesiologist for both operating rooms. The additional costs for this personnel expenditure were calculated at approx. 300,000 € per year. The halving of the transfer time from 43 min to about 21 min through possible overlapping induction and parallel work, which was not possible until now, results in an additional operation time of about 100 min per operating room, so that at least 4additional operations can be planned and performed. In this way, with stringent implementation and the same spatial structures with stable fixed costs, n = 976 more operations could be performed, which, minus the personnel costs, the additional material costs for surgery and anesthesia of 557,042 € and the inpatient hotel costs of 600,663 €, with an average length of stay of 2.8days, would result in an additional revenue of about 2.4times the additional personnel costs at the current flat rate of 3739.40 € and an average case mix index of the MHH Eye Hospital of 0.649 (total revenue: 2,155,449 €; profit marginII: 701,389 €) for the considered surgical patient collective in 2021. An increase of the personnel expenditure in the operating room for surgical subjects such as ophthalmology with shorter interventions and many changes is economically worthwhile also for alarge hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.

Staff Planning for Hospitals with Implicit Cost Estimation and Stochastic Optimization

We consider the anesthesiologist staff planning problem for operating services departments in large multi‐specialty hospitals without limit on anesthesiologist supply, where the planner makes monthly and daily decisions to minimize total costs. Each month the staff planner decides the number of anesthesiologists on regular duty and an on‐call consideration list for each day of the following month. In addition, each day, the staff planner decides how many on‐call anesthesiologists to call for the following day. Total costs consist of explicit and implicit costs. Explicit costs include the costs of calling an anesthesiologist and overtime costs. These costs are specified by the organization. Implicit costs encompass costs of not calling an on‐call anesthesiologist and under‐utilizing an anesthesiologist, and these have to be deduced from past decisions. We model the staff planning problem as a two‐stage integer stochastic dynamic program. We develop structural properties of this model and use them in a sample average approximation algorithm constructed to solve this problem. We also develop a procedure to estimate the implicit costs, which are included in this model. Using data from the operating services department at the UCLA Ronald Reagan Medical Center, our model shows the potential to reduce overall costs by 16%. We provide managerial insights related to the relative scale of these costs, hiring decisions by service, sensitivity to cost parameters, and improvements in the prediction of the booked time durations.

Design and Development of Pipe-inspection robot with vision 360°

A pipe is a most commonly used product in the daily operations of industrial plants. Boiler pipes and inner ribs reduce pollution, allowing industrial plants to be both environmentally friendly and economically efficient. However, if these pipes are damaged, it will cause a huge problem for humans and ecological imbalances. Therefore, an inside inspection of a pipe is most necessary, regular duty being conducted by a surveyor of the plant. Pipe inspection includes checking for cracks, defects, leaks, corrosion and blockages in a region. However, an individual cannot do this inspection due to life-risk impact, and there is a necessity for human intelligence. This proposed robot design helps inspect a portion of the building in less time than the entire vision. In addition, the view can be recorded and easily the damaged or blocked portions of the pipe.

Treatment outcomes of peri-articular steroid injection for patients with work-related sacroiliac joint pain and lumbar para-spinal muscle strain.

Evaluating treatment outcomes of local corticosteroid injections for work-related lower back pain (LBP) as the current evidence for the American College of Occupational and Environmental Medicine guidelines is considered insufficient to recommend this practice. The authors conducted a retrospective study involving the patients who were treated with peri-articular and lower lumbar corticosteroid injections for work-related LBP at their occupational medicine clinic. Sixty-four patients met the inclusion criteria. The average pain level was reduced from M±SD 5.1±2.0 to M±SD 3.1±2.3 after the corticosteroid injection (p < 0.0001). Thirty-five patients (55%) were discharged to regular duty; 23 (36%) were transferred to orthopedics due to persistent pain; and 6 (9%) were lost to follow-up. Corticosteroid injections for work-related LBP are effective in reducing pain and enhancing discharge to regular duty. Nonetheless, larger prospective trials are needed to validate these findings. Int J Occup Med Environ Health. 2021;34(1):111-20.

Life on Call: Perspectives of Junior and Senior Internal Medicine Residents.

Models of daytime and nighttime on-call responsibilities for residents vary across internal medicine training programs, but there are few data regarding residents' perceptions of their on-call experiences. The authors sought to understand what residents perceive as the benefits and detriments of 24-hour, in-house call, a perspective instrumental to informing change. The authors conducted in-depth individual interviews and focus groups between December 2018 and March 2019 with 17 internal medicine residents from postgraduate years 1, 2, and 3 at the University of Toronto about their on-call experiences. Using constructivist grounded theory, the authors developed a framework to understand the residents' perceived benefits and drawbacks of 24-hour in-house call. Residents' experiences on call were grouped into 7 themes regarding negative and positive aspects of call. Participants reported multidimensional fatigue related to call, including decision fatigue, emotional fragility and lability, and loss of empathy, and also reported that call adversely affected their personal lives. Residents expressed conflicting opinions as to whether prolonged duty hours affected patient outcomes. In contrast, residents also expressed benefits to call, including that overnight call led to increased autonomy and decision-making skills and provided preparation for future careers as independent internists. They described developing camaraderie and a sense of belonging to a team with coresidents overnight. Lastly, residents described occupying different roles during regular duty hours and while on call-daytime roles revolved around follow-up of previously admitted patients and administrative tasks, while overnight duties centered on initial workup and medical stabilization of referred patients. Understanding the nuanced phenomenon of being on call from the perspective of those who live through it is a critical step in creating evidence-based educational policies. New call models should emphasize resident autonomy and decision making and should include a consideration of residents' perceived differences between daytime and on-call roles.

Response to AAR Articles

Response to AAR Articles

The Efficacy and Safety of Rapid Cycling Vagus Nerve Stimulation in Children With Intractable Epilepsy

PurposeVagus nerve stimulation (VNS) is an effective adjunctive therapy for drug-resistant epilepsy. Nevertheless, information is lacking regarding optimization of stimulation parameters to improve efficacy. Our study examines the safety and efficacy of rapid duty cycle VNS (OFF time ≤1.1 minute keeping duty cycle less than 50%) in pediatric cohort with intractable epilepsy. MethodsRetrospective chart review of 50 patients (one to 17 years) with drug-resistant epilepsy treated with VNS between 2010 and 2015 at a single pediatric epilepsy center. Safety and tolerability data were aggregated across all patient visits to determine frequency of adverse events between differing duty cycles. We also compared seizure reduction rates for each patient at (1) last regular duty cycle visit, (2) first rapid duty cycle visit, and (3) last recorded rapid duty cycle visit. ResultsRapid duty cycle was well tolerated, with no adverse events reported in 96.6% patient encounters. At the last visit before switching to rapid duty cycle 45.5% patients were showing response to VNS (seizure reduction rates ≥50%). This rate increased to 77.3% after switching to rapid duty cycle and remained at 77.4% at the last rapid duty cycle visit. Fifteen patients (34.1%) became responders to VNS after switching to rapid cycling; another 19 (43.2%) maintained their response with mostly improved seizure reduction rates. In only a few instances, responders became nonresponders after switching to rapid duty cycle. ConclusionsRapid duty cycle VNS is probably safe and well tolerated; it may also be more efficacious than regular cycling VNS in some patients. This study highlights the necessity of prospective, long-term, double-blinded studies for understanding the advantages of this VNS modality.

Exploring burnout and the association with the educational climate in pediatric residents in Thailand

BackgroundThis study, undertaken in Bangkok, Thailand, explored the extent to which paediatric residents in a non-Western setting experienced burnout and the potential association with factors in the medical educational climate and work-related quality of life.MethodsAn exploratory sequential mixed methods design was employed in a cross-sectional study. The initial, quantitative phase used the validated Maslach Burnout Inventory, the Postgraduate Hospital Educational Environmental Measure (PHEEM) and Work-Related Quality of Life scale (WRQoL). Regression analysis was used to identify the correlation between burnout and educational climate. Thereafter, residents in all years with high levels of burnout on subscales were interviewed individually.ResultsForty-one paediatric residents completed the three questionnaires. None had high levels related to burnout in all three domains (emotional exhaustion, high level of depersonalization and perceived low personal accomplishment), seven (17%) showed high levels in two out of three domains. Emotional exhaustion and educational climate (perceptions of role autonomy, perceptions of teaching, perceptions of social support) were correlated with work-related quality of life. In the interviews, the main themes related to burnout were inappropriate tasks, teachers and teaching styles, the perception of knowledge insecurity relating to task performance, time dimensions, life crisis during training, role expectations and work allocation clarity, and facilities such as accommodation.ConclusionsThe study, in a non-Western setting, demonstrated a positive relation between educational climate and work-related quality of life. To help reduce the risk of burnout, the following factors were identified: minimize unnecessary or duplicated workload, schedule time arrangements to avoid extension of regular duty hours, and clearly define role expectations. The impact of inappropriate tasks, teachers and teaching styles (including unsafe environment) on the incidence of burnout was also highlighted. Additional studies focusing on teaching styles, safe learning climate and mistreatment in a non-Western context are needed.

Intelligent Computing Based Formulas to Predict the Settlement of Shallow Foundations on Cohesionless Soils

Introduction:Although it is a regular duty of geotechnical engineers to evaluate how much shallow foundation settles in the granular soil, there is no well-approved formula for this task. The intent of this research is to develop a formula that is adequately simple to be used in routine geotechnical engineering work but complete enough to address the behavior of granular soil associated with the settlement issue.Methods:Cone penetration test and foundation load test data were used to generate a formula that can predict the settlement. Genetic Programming (GP) based Symbolic Regression (GP-SR) and artificial neural networks were used to develop an optimized formula. Settlements were also calculated using the finite method and compared to the results of the developed formula.Results and Conclusion:Two formulas were developed using SR, and several models were developed using ANN. ANN model 1 has the highest R2value (0.93) and the lowest MSE (0.16) among all developed ANN and GP-SR models. FEM settlements were almost double the measured ones in some instances.

ЗАХІДНОЄВРОПЕЙСЬКІ ВІЙСЬКОВІ ПРАКТИКИ І ТЕХНОЛОГІЇ В УКРАЇНІ XVIII СТОЛІТТЯ

The “Military Revolution”, which became a concentrated manifestation of Europe’s political leadership during the XVIIth – XVIIIth centuries, produced new realities in the military sphere: regular armies, subordinated and held by centralized states, unified arms and clothing, division into types of military forces, special drill and education for soldiers and officers. Leadership in military technology consisted of fortifications and artillery that developed in the direction of increasing technical capacity, unification and standardization of new weapons. New approaches to the organization of the armed forces changed the character of wars. If in the XVIIth century East and West of Europe had a kind of parity in their military achievements and technologies, then in the XVIIIth century it finally moved to the West. In this context, an important issue is how Western European achievements were spread in Ukraine, in particular the Cossack Hetmanate, whose military-political model was clearly structured for military purposes. The analysis of these influences and borrowings shows that they were heterogeneous in nature. In the Cossack army, elements of the regular troop duty and sentry service and even drill instructions were gradually being appeared. The Cossack starshyna (officials) faced with the practice of the regular army during the Russian imperial wars. However, all these influences were episodic and spontaneous, without changing the essence of the military institutions of the Hetmanate. In artillery, technical innovations were implemented more actively, but were hampered by lack of funding. In the fortification area, the control of which was completely transferred to imperial power, Western technologies and specialists, were used by metropolitan power in their own defensive projects. It is significant that the acquaintance and borrowing of any military innovations in the XVIIIth century occurred almost exclusively through Russian mediation. This tendency was fully in line with the gradual loss of the Hetmanate’s sovereignty, the destruction of its army.

Staff Planning for Hospitals with Cost Estimation and Optimization

We consider the anesthesiologist staff planning problem for operating services departments in large multi-specialty hospitals. In this problem, the planner makes monthly and daily decisions to minimize total costs. The monthly decisions include deciding how many anesthesiologists should be on regular duty and how many should be on-call for each day of the month and for each specialty. The daily decisions involve determining how many on-call anesthesiologists to actually use in the surgical schedule for the next day. Total costs comprise of explicit and implicit costs. Explicit costs include the costs of calling an anesthesiologist from call and overtime costs, and are decided by the organization. Implicit costs are the costs of keeping but not calling an anesthesiologist on-call and under-utilizing an anesthesiologist, and these have to be deduced from past decisions. The staff planning problem is important in operating services departments. This paper solves this problem by incorporating implicit costs, demand uncertainty and service specialties. This is unique both in practice and the academic literature. We model the staff planning problem as a two-stage integer stochastic dynamic program. We develop structural properties of this model and use them in a sample average approximation algorithm constructed to solve this problem. We develop a procedure to estimate the implicit costs, which are included in this model. Using data from the operating services department at the UCLA Ronald Reagan Medical Center, we and that the cost of not calling an anesthesiologist on the on-call list is 56% more than the cost of actually calling the anesthesiologists. Also, the cost of idle time for anesthesiologists was 94% more than the cost of overtime. Our model shows the potential to reduce overall costs by 13%. We provide managerial insights related to hiring decisions by specialty, sensitivity to cost parameters, and improvements in prediction of booked time durations.

Hidden Markov Model Based Signal Characterization for Weak Light Communication

Weak illumination by light emitting diode (LED) can be realized by either peak-power transmission at a low duty cycle or low-power transmission at a regular duty cycle. In this paper, we address the signal characterization and transmission rate of visible light communication for the latter case. We first characterize the LED nonlinear effect via a state transition model based on the experimental measurements. Then, we adopt hidden Markov model (HMM) to characterize the LED transmission under weak illumination. Based on the HMM, we propose a Monte Carlo method to compute the achievable transmission rate and apply Viterbi algorithm to detect the signals. The achievable transmission rates and detection performance of the HMM-based model are evaluated by simulation results. Moreover, both numerical and experimental results show lower bit error rate of the Viterbi algorithm compared with the per symbol detection.

“You’ve Done Very Well” (“Das haben Sie sehr schön gemacht”): On Courage and Presence of Mind in Spiritual Issues

Although it is not unusual to be called ad hoc onto a ward where one is not on regular duty, there are special challenges for the pastoral caregiver. For example, one might not be familiar with the staff or with the medical focus of the unit. This study (on multiple visits over the course of a long day) demonstrates vividly that the reason a chaplain is called may not always match the real need of the patient and/or of the persons who are close to that patient. Questions that seem to have nothing to do with pastoral care may have a spiritual core or may imply suffering from feelings of futility, of spiritual pain and unresolved religious issues that often remain largely ignored in practice, despite the “total pain” concept in palliative care. The courage to address spiritual issues explicitly, for example, by offering a ritual in pastoral care, can be crucial inmaking positive changes possible.

Real life turnaround time of blood cultures in the clinical microbiology laboratory: results of the first Italian survey, May 2015

&lt;em&gt;Background and aims&lt;/em&gt;: Blood culture (BC) results are essential to guide antimicrobial chemotherapy for patients with sepsis. However, BC is a time-consuming exam, which can take several days. Reducing BCs turn around time (TAT) could impact on multiple outcome parameters and TAT monitoring is an important tool for measurement of microbiology laboratory performance. The aim of this study was to provide an overview of BC TATs among Italian microbiology laboratories. &lt;br /&gt;&lt;em&gt;Materials and methods&lt;/em&gt;: Five laboratories collected and recorded, for a month period, date and time of the BC processing events. Cumulative TATs were analysed using the GraphPad software. &lt;br /&gt;&lt;em&gt;Results&lt;/em&gt;: Participating laboratories reported data from 302 sepsis episodes. The median time from when the BC system produced a positive signal until Gram-stain results were reported was 7.6 hours. A rapid molecular identification and antimicrobial susceptibility testing (AST) was performed in 26.5% of BCs. Mean TAT for identification report was significantly lower when a molecular approach was adopted (12 vs. 28.7 hours, P&amp;lt;0.001). Similarly, results of the molecular AST were obtained more than 24 hours in advance compared with phenotypic AST (mean 13.2 vs. 47.6, P&amp;lt;0.001). TATs from BC positivity of laboratories opened 7 days/week were not significantly lower than those of laboratories opened 6 days/week. &lt;br /&gt;&lt;em&gt;Conclusions&lt;/em&gt;: BC is a time-consuming exam, however, molecular identification and AST methods can drastically reduce time to results. The lack of difference between TATs observed for laboratories working 7 days/week and 6 days/week, coupled with a high rate of BCs turning positive during the night enable to conclude that the most urgent measure to reduce TATs is the expansion of laboratory regular duty hours.

Colonic Ischemia in a High-Performance Aircraft Pilot

Introduction: Those undergoing accelerated g-forces experience tissue ischemia due to pooling of blood within the extremities. While the most common side effect of accelerated g-forces is loss of consciousness, any part of the body at risk of decreased perfusion may be affected. Case Description: A 23 year old Japanese male with no significant past medical history was sent to the United States for flight training at a local Air Force base. During a mission he reportedly experienced a gravitational force of 4.5 which was the highest yet in his training. Following the flight he immediately developed abdominal cramping with hematochezia that gradually improved over the following three days. Colonoscopy was performed and was significant for patchy, erythematous and edematous mucosa within the recto-sigmoid junction concerning for colonic ischemia and was otherwise normal. Biopsies of the affected areas were obtained and revealed non-specific lamina propria congestion which may be seen in healing colonic ischemia. The patient denied a personal or family history of thromboembolic disorders, tobacco use, recent travel, prescription or over the counter medication use. The patient was treated conservatively and was able to return to regular flight duty without any further incidents. Discussion: Colonic ischemia (CI) is not uncommon but is rarely reported in those who are healthy and younger than 50. The cause of CI is thought to be related to hypoperfusion followed by a reperfusion injury. Often times a specific cause for ischemia is not identified and the incident is attributed to non-occlusive ischemia. Risk factors for CI include hypoperfusion states such as heart failure, sepsis and physical activity, mechanical colonic obstruction, medications, and perioperative. A review of the literature reveals two case reports of adults who developed CI after transatlantic flights with no other risk factors identified. To our knowledge this is the first case report of CI following exposure to increased g-force.