Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.

Frostbite: pathogenesis and treatment.

Capsule habitats make it possible for human beings to survive and function in environments that would otherwise be lethal, such as space, the ocean depths, and the polar regions. The number of people entering capsules in the course of their work or for purposes of recreation is constantly increasing. However, long-term living in such habitats imposes physical and psychological risks as well as offering opportunities and benefits. This paper reviews what is known about the environmental, social, and personality aspects of adaptation to capsules, including sources of stress, selection criteria, obstacles to and facilitators of adequate coping, changes in group interaction, the role of temporal factors, and post-mission consequences.

The environmental psychology of capsule habitats.

Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient’s temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and removal of wet clothing in the prehospital phase followed by aggressive rewarming on arrival at the hospital if the patient’s injuries require damage control therapy. Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes. This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

/pdf/a-recommended-early-goal-directed-management-guideline-for-30cnah6ykj.pdf

A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients.

With million-volt x-rays on Kodak Industrial X-ray Film, Type M, the base of this dense casting shows fine structures that add up to a gross defect. The high contrast and low graininess of this film show clearly the character of the defect. At250 kv, aradiograph on Kodak Industrial X-ray Film, Type M, shows a threadlike structure extending from a cavity near the end of the vane. Here, too, high contrast and low graininess are essential,yetthefilmhasadequatespeed for reasonably short exposure.

Elmtown's youth—the impact of social classes on adolescents

Publisher Summary This chapter focuses on groups of people in polar camps, submarines, space capsules, and other exotic environments that are defined by the characteristics of isolation, confinement, and risk At the same time that exotic environments are becoming more salient, behavioral research on groups in exotic environments has almost ground to a halt The chapter considers certain barriers to further advancement in which people involved in such groups may view psychological research as useless or counterproductive The exotic environments of yesteryear have changed substantially, and many new exotic environments are available for study Social and organizational psychology has changed immensely, and many new developments can be taken into account The chapter illustrates those two theoretical models, the ecological and the behavioral, that have evolved around isolation and confinement research As group level phenomena are supplemented by organizational level phenomena, open systems theory may be put to good use

Groups in Exotic Environments

Previous research aimed at quantifying and reducing the decrements encountered in performing manual tasks in cold weather has not described the relationships between task characteristics and cold-induced impairments. The amount of decrement and, often times, the optimal means for reducing the decrement, appear to be task-specific. The research reported here is one in a series of studies formulated to explore those relationships. The strategy is to use tasks from the battery developed by Fleishman (1967) to measure the factorially 'pure' abilities needed to perform all manual tasks. 24 U.S. Marines performed this battery of nine tasks across a range of cold temperatures. To determine if the decrement due to wearing gloves might be less than the decrement due to cold hands as the air temperature decreased, performance on the battery of tasks was measured with and without gloves. Only three of the tasks (abilities) were affected by cold temperatures, and the amount of decrement increased as the air temperature decreased. Three tasks deteriorated due to wearing of gloves, two of those affected by cold and one other. Temperature affected performance independently of the glove effect. Half of the subjects did not complete bare-handed testing at -18 degrees C (approximately 20 min.), indicating this is the lower end of the temperature range in which bare-handed performance for more than a few minutes is practical.

Manual performance in the cold with gloves and bare hands.

Cold weather morbidity among United States Navy and Marine Corps Personnel.

W HiLE conceptual and methodological problems of defining mental health and its presumed opposite, mental illness, have been considerable, some areas of agreement are begin-' ning to appear among the many psychiatrists, psychologists, and social workers active in this field.' More and more, the most useful criterion of mental illness appears not only to be related to the incidence and severity of psychopathological symptoms but also, and perhaps more importantly, to the degree to which this symptomatology results in social dysfunctioning or, in extreme cases, social incapacitation. This \"social-dysfunctional\" criterion of mental health is particularly apropos the problem of adjustment of the 100 to 140 nuclear submarine crewmembers confined in close proximity to each other for extended submerged missions of 60 days or more. The introduction of the deterrence concept with the launching of the first Fleet Ballistic Missile submarine in the early 60s accented not only the importance of careful psychiatric screening of all incoming submarine personnel but also the requirement for a continuing assessment of the mental health status of the entire crew. A series of official instructions issued by the Secretary of the Navy at that time further emphasized the criticality of maintaining the optimal mental health of the submarine crews, in order to minimize the likelihood of an inadvertent launch of a nuclear-armed missile or some other casualty, with ultimate consequences conceivably affecting the viability of the planet Earth. Historically, the incidence of debilitative psychiatric illnesses in the Submarine Service has reportedly been incredibly small. For example, during World War II, the incidence of psychiatric casualties in the Submarine Service was reported to be 56 out of 126,160 manpatrols. A somewhat larger but still relatively low psychiatric incidence rate of 20 per 1,000 in this branch of the Service was reported about 10 years after Nautilus, the first nuclear submarine, was launched in 1954. This study indicated that about 24 per cent of the submariners referred for psychiatric evaluation were diagnosed as personality disorders, another 18 per cent neurotic, about seven per cent as psychotic, and the remainder undiagnosed. The trend toward an increase in the psychiatric incidence rate of active duty personnel across all of the US Armed Forces seems to have peaked in the mid-70s. While the diagnostic classifications of the psychiatric cases reported in the above studies were arrived at largely by interview and other direct observational techniques, the present study involved the use of a well-standardized, psychodiagnostic test, the Minnesota Multiphasic Personality

The mental health of nuclear submariners in the United States Navy.

: Enlisted submarine school graduates who failed to qualify were compared to graduates who had qualified with respect to basic test battery scores, grades in submarine school, scores on two paper-and-pencil tests of motivation and emotionality, and selected items of background information. Enlisted submarine school graduates who fail to qualify as compared to those who qualify are characterized as follows: (1) earn lower scores in an arithmetical aptitude test; (2) achieve lower grades in submarine school; (3) have higher probability not to have finished high school; (4) are slightly older at the time of entering submarine school; (5) are more likely to have been married; and (6) if an 'A' school graduate, the odds are in favor of his having one or more duty assignments intervening 'A' school and the onset of submarine school. Considering the population sample as a whole, neither the PIB (Personal Inventory Barometer) nor the SMQ (Self-reported Motivation Questionnaire) was related to disqualification. However, with education as a moderator variable, the PIB scores were significantly related to disqualification thus attesting to the complexity of the etiology of enlisted submarine disqualification.

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=AD0699599&Location=U2&doc=GetTRDoc.pdf

Factors Related To The Failure Of Enlisted Submarine School Graduates To Qualify.

: It has been well documented that manual performance deteriorates in the cold However, motor tasks require many independent abilities from fine, precise finger dexterity to gross arm-hand speed, and it is likely that each of these abilities is affected differentially by the cold To predict accurately the effects of cold on specific practical tasks, without direct test, the decrement to component skills must be known Two groups of US Marines practiced a battery of nine motor tasks in a climatic chamber during a five-day cold exposure in which the Marines lived in the chamber 24 hours a day Subjects practiced the tasks, each of which was known to load highly on a different psychomotor factor or manual ability, once a day for the first four days and were tested on the fifth day One group trained at 10 deg to 15 deg F, and the other group trained at 40 deg to 50 deg F Both groups were then tested at both temperatures on the fifth day to test the hypothesis that subjects practiced in the cold should perform better on subsequent tests in the cold relative to subjects practiced in the warmer temperatures, and those practiced in the warmer temperatures should perform better on subsequent tests in the warmer temperatures, and those practiced in the warmer temperatures relative to subjects practiced in the cold The hypothesis was not confirmed by the data, and methodological and theoretical problems in interpretation of that finding are discussed

/pdf/the-effect-of-the-thermal-conditions-of-training-and-testing-wtxp9plwr3.pdf

Ernest M. Noddin

Papers

Manual performance in the cold with gloves and bare hands.

Cold weather morbidity among United States Navy and Marine Corps Personnel.

The mental health of nuclear submariners in the United States Navy.

Factors Related To The Failure Of Enlisted Submarine School Graduates To Qualify.

The Effect of the Thermal Conditions of Training and Testing on the Performance of Motor Tasks Measuring Primary Manual Abilities