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BACKGROUND: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. OBJECTIVE: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. METHODS: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. RESULTS: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. CONCLUSIONS: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force.

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The 'Guinea Pig Club' has been described as the most exclusive club in the world, but the entrance fee is something most men would care not to pay, and the conditions of membership are arduous in the extreme. The Guinea Pig Club was formed in July 1941 to support aircrew who were undergoing reconstructive plastic surgery after receiving burn injuries in the Second World War. This paper will explore the novel surgical techniques employed to treat the Guinea Pig Club members, their experiences at the hospital and their lives after the war and how Sir Archibald McIndoe and the Guinea Pig club members revolutionised burns plastic surgery as we know it today.

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In highly stressful environments, individuals with diverging stress-reactivity can perform differently. Identification of blood markers of stress-reactivity is of major significance to help human performance during stress. Candidate transcripts were identified between stressed and non-stressed strains of rats' blood and brain, and overlapping significant differentially expressed genes were selected. Serum levels of human orthologues of these proteins, in lieu of blood RNA, in addition to classic stress and general clinical markers, were measured in 33 Battlefield Airmen undergoing a 52 day long preparatory training course before their course of initial entry (COIE). Blood samples and factors of affective state, negative valence "Threat" and positive valence "Challenge", were obtained five times across different days of training which included either routine physical exercise or prolonged and intense physical and mental training. During training, levels of chloride (Cl), dehydroepiandrosterone-sulfate (DHEA-S), creatinine kinase (CK), and total carbon dioxide (TCO2) differed between airmen who subsequently graduated from their COIE and those who did not. Time dependent changes of serum TCO2 and neuropeptide Y (NPY), as well as the affective factor Challenge differed by future graduation status throughout the training. Serum levels of parvin beta (PARVB) correlated with the affective factor Threat, while those of NPY, testosterone, coactosin like F-actin binding protein 1 (COTL1) and C-reactive protein (CRP) correlated with factor Challenge during the extended, intensive periods of training, consistently. These pilot data suggest that the identified panel of blood markers can measure stress responsiveness, which has the potential to advance individualized stress-management strategies.

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The main purpose of this study was to examine factors related to exercise behavior of civil airmen. The subjects for the study were 200 civil airman including pilots, flight officers and flight engineers working for "A" airline in South Korea. The data was collected from April, 1 to 30, 1996 using a questionnaire that was developed for this study, and analyzed using SPSS(Statistical Package for Social Science). The subjects consisted of 200 males. The average age was 42 years old and the majority(82.5%) were married. The large proportion of subjects had received four years of college education or more(86%), and reported having a religion(71%). The average height and weight were 171.7cm and 69.4kg respectively. The average working period and total flight time were 8 years and 6002 hours respectively. Ninety-five percent of sample exercised regularly. As for the frequency of the exercise, 4% of the sample never exercised and 26% of the sample exercised less than once per week, while 44.5% and 24.5% of the sample exercised once or two times, and more than three times per week respectively. The type of exercise was strengthening (30.0%) and aerobic exercise such as jogging(54%), mountain climbing(37.5%) and golf(33.0%). Nearly three fourths of the sample were involved in more than the "light heavy" level of intensity(72.5%) and the average duration was 74.9 minutes. The following factors are related to the exercise behavior. 1) Age and marriage were positively related to exercise behavior(p<.05). 2) The cognitive/perceptual factor is related to exercise behavior. Those who perceived that their health was poor, that health was out of their control exercised less frequently. Also those who showed low self efficacy, and those who valued their health less exercised less frequently. 3) Among environmental factors, social support such as peers, spouse and media influenced exercise behavior. Also the use of a health center was related to a higher level of exercise behavior compared to self-regulated home exercise. Irregular duty was the higher barrier to exercise. 4) The type and intensity of exercise were related to exercise behavior, but not duration. Those who have been jogging or mountain climbing regularly, and those who exercised rather intensely showed a higher frequency of exercise. However, there was no difference in duration 5) The results of stepwise multiple regression analysis showed that the variables which were related to exercise behavior were exercise intensity, exercise place and whether the subject was married. These three factors accounted for 37% of the variance.

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OBJECTIVE: To assess whether cardiopulmonary resuscitation performed by in-house physicians is effective for long-term-care residents. DESIGN: Retrospective chart review. SETTING: Long-term-care facility with an intermediate care unit, skilled care unit, and a convalescent and assessment unit at a retirement community for veterans. PARTICIPANTS: All residents resuscitated from April 1987 to August 1990. All participants were male. The mean age was 75 years +/- 7.3 (range 42-93 years). MAIN OUTCOME MEASUREMENTS: Charts were abstracted for demographics, advanced directives information, information about the arrest, and post-resuscitation course. RESULTS: Forty-five elderly residents underwent resuscitation during this period. Nine residents (20%) were successfully resuscitated, with seven dying within 24 hours of hospitalization. No residents survived to return to long-term care (95% CI, 0-7%). The diagnoses were consistent with age-related chronic disease. Seventeen (38%) arrests were witnessed. The predominant rhythm at onset of resuscitation was asystole. CONCLUSION: We conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long-term-care populations.

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